Is timing of haemorrhage by spectrophotometry similar for haemorrhages in the subdural and subarachnoid space?
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Biomedical subjects
Publications and source records attributed to N R Belton.
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Among babies born at term, low birthweight predicts cardiovascular risk factors and disease in adulthood. This study shows that babies born prematurely, whether or not they have intrauterine growth retardation, are predisposed to similar risks as adults.
Energy and nutrient intakes were assessed in 136 children, aged 7-8 years and living in and around Edinburgh, using the 7 d weighed inventory technique. The results were compared with UK dietary reference values (DRV) for energy, macronutrients and micronutrients. NSP intakes were compared with a calculated reference value (CRV). Mean energy intakes were close to the estimated average requirement for both boys and girls. Mean percentages of food energy derived from fat and saturated fat were high in relation to DRV (37 and 14 compared with 35 and 11 respectively). Mean percentage of food energy derived from total carbohydrate was close to the DRV of 50 but intakes of starch appeared to be low and intakes of total sugars high (23 and 26% food energy respectively). Superficially, this suggests that there is a need to alter the balance of carbohydrate in favour of increasing starch and lowering total sugar. There was, however, a clear 'fat-sugar seesaw', i.e. children with a high percentage energy from total sugars had a low percentage energy from fat, and vice versa. In view of this finding, it is possible that efforts to reduce total sugar intake in children may result in a further increase in percentage energy from fat. Mean intakes of NSP were only 50% of the CRV, but this guideline may be set too high. Mean intakes of most micronutrients were above reference nutrient intakes. Reported low intakes of Zn and Se were treated with caution due to the perceived incompleteness of the data for these in the nutrient database. The authors concluded that targeting high intakes of total fat and saturated fat should be the health priorities in this age-group.
The contribution of breakfast to mean daily energy and nutrient intakes was investigated in a sample of 7-8-year-old children recruited by letter from five Scottish schools. After eighteen families dropped out of the study and three dietary records were discarded, the final sample numbered 136 (51%). Dietary data were collected using the 7 d weighed inventory, while a questionnaire was used to classify children into manual or non-manual social class groups. Mean daily energy intakes were close to estimated average requirements (Department of Health, 1991), while intakes of most micronutrients were in excess of reference nutrient intakes (RNI; Department of Health, 1991). The most popular breakfast consumed by the children was one including a ready-to-eat breakfast cereal (RTEBC). Differences in macronutrient content were seen between breakfasts of boys and girls, while manual-social-class children ate breakfasts which were lower in energy, NSP and certain micronutrients than those of non-manual-class children. Breakfast contributed 14% of energy and 9-36% of micronutrient intakes to the overall diets. Breakfasts including RTEBC contributed significantly more energy and nutrients than other types of breakfast. Children who ate RTEBC nearly every day had overall diets which had a higher nutrient density and were lower in fat than those of children who ate RTEBC less frequently or not at all. Intakes of most micronutrients were above the RNI in both these groups, with the exception of folate, Fe and vitamin A, which were below the RNI for those consuming RTEBC infrequently. However, the type of breakfast eaten did not appear to influence energy and nutrient intakes at other meals during the day. Nevertheless, it was concluded that breakfast, particularly one containing RTEBC, had a strong influence on the daily energy and nutrient intakes of 7-8-year-old children, particularly by reducing the proportion of energy from fat.
Social class may have an important influence on dietary intakes and health. Information on specific nutrient differences between children of high and low social classes may help explain health inequalities and identify target areas for nutrition education. In this study, energy and nutrient intakes were estimated in 136 7-8-year-olds, from a range of social backgrounds, using 7-day weighed inventories. A structured questionnaire was used to establish social class. Lower social class children had significantly lower daily intakes of many micronutrients, which nevertheless met dietary reference values, and a higher percentage energy from fat. In addition, lower social class children consumed less breakfast cereal, more full fat milk, were more likely to take school meals and received a greater proportion of energy and nutrients from snacks than higher social class children. Lower social class children were significantly shorter, but this association was independent of diet. The results suggest that lower social class children are a vulnerable group nutritionally. Nutrition education should focus on influencing the dietary patterns of lower social class children to favour a decrease in percentage energy from fat.
This paper reports whether diets relatively high in non-starch polysaccharide (NSP) or those which meet Dietary Reference Values for percentage energy from fat are associated with poor growth and anthropometric status. Children aged seven to eight years (n = 136) were recruited from five schools in and around Edinburgh, selected randomly by Lothian Region's Education Department. Dietary intakes were estimated by their parents, using the seven day weighed inventory method. Height and weight were measured twice, with an interval of approximately 12 months, and expressed as standard deviation scores of 1990 UK population standards. There were no significant differences in mean height, weight, body mass index and height velocity between those children whose diets were relatively high in NSP or low in percentage energy from fat compared to the remainder of the sample. In addition, using multiple regression analysis, no associations were seen between growth and low fat diets or between growth and higher fibre diets. These results suggest that the low fat, higher fibre message can be applied to young children. However, further research is required to ensure that the results found in this sample apply to other groups of children.
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The effects on mineral metabolism of therapeutic doses of corticosteroids were investigated in infantile cortical hyperostosis; in four untreated cases the calcium, phosphorus, and magnesium balances were strongly positive. In one severe case, treatment with prednisolone was associated with an alteration to negative calcium and magnesium balance, and faecal losses of calcium were particularly high. This effect persisted for at least three months after the steroids had been discontinued, and during this period there was pronounced retardation of linear growth. Six months after the treatment had been stopped mineral balance was again positive and there was rapid 'catch up' in growth. In infancy, the negative effect of corticosteroids on calcium, phosphorus, and magnesium metabolism may contribute to inhibition of bone growth and steroid stunting.
Of 357 children with acute diarrhoea admitted to the City Hospital, Edinburgh, over a 12-month period, only 5 (1.4%) required IV infusions. Three hundred and nineteen were treated with oral rehydration (OR). Of these 269 were studied in detail and 43% had signs of dehydration, but in none of them was it severe. There were no fatalities. Patients were randomly allocated to treatment with one of three OR solutions in a double blind trial. The solutions had sodium concentrations of 35, 50 and 90 mmol (mEq)/l, and dextrose of 200 (36 g/l), 111 (20 g/l) and 110 (19.8 g/l) mmol/l, respectively. Hypernatraemia was not a clinical problem and only 5 children (2%) were biochemically hypernatraemic on admission. Treatment did not cause clinical hypernatraemia. At the second assessment only 3 children were biochemically hypernatraemic, one from each treatment group, and no one had clinical signs. All three solutions were safe and effective in the relatively mildly dehydrated patients currently seen in the UK.
One hundred and forty five Asian children born at Sorrento Maternity Hospital, Birmingham, were reviewed at the age of 22 months. A significant association of iron deficiency and poor vitamin D state was found. Two fifths of the children were anaemic, two fifths had a low plasma concentration of vitamin D, and one fifth had both features. This was more than simple overlap of the two deficiencies; the children with low plasma vitamin D concentrations had significantly lower concentrations of haemoglobin and serum iron. On the other hand, the deficiencies were not merely individual features of generally poor nutrition; growth and other measures of protein energy nutrition were slightly better in these children, and their plasma zinc concentration was no lower than in the children without deficiencies. It seems, therefore, that child health surveillance as currently practised--for example, growth monitoring, clinical signs, etc--will not detect these problems unless a haemoglobin determination is included. In view of the association of poor iron and vitamin D state combined prophylaxis is desirable. At present, strategies for preventing rickets in this country are not combined with attempts to detect or prevent iron deficiency. In our opinion they should be and the options are discussed.
Nutritional rickets in infancy and childhood due to vitamin D deficiency continues to be a world-wide problem. Its occurrence is probably higher in many tropical and sub-tropical countries, despite abundant sunlight than in many more northerly latitudes, where its incidence is mainly limited to children of Asian origin and those with dark skins. Social and cultural customs including the adherence to a special, often vegetarian diet, the avoidance of sunlight together with increasing urbanisation, extended breast feeding and severe malnutrition are recognisable factors in the pathogenesis of rickets. Recent research has suggested that the regulation of vitamin D metabolism may be different in black children compared with those who have a fair skin. Supplementation of mothers in pregnancy and of children in infancy with vitamin D together with health education to promote a diet containing foods rich in vitamin D can ameliorate this preventable disease.
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A study of 221 children admitted to hospital in the course of a year allowed establishment of a reference range for plasma 25-hydroxyvitamin D. None of these children had evidence of biochemical rickets. Most Asian children, however, were vitamin D deficient in comparison, and this deficiency was most noticeable in girls aged 13 to 15 years: biochemical rickets occurred in six per cent of these adolescent Asians. If vitamin D requirements are not met during the physiological growth spurt, permanent pelvic deformity may result. Vitamin D deficiency persisting into pregnancy will adversely affect the infant, producing an increased risk of hypocalcaemic fits, dental enamel hypoplasia, infantile rickets, and reduced postnatal growth. Our data support the need for vitamin D supplementation, and we suggest that annual oral vitamin D supplements in the autumn would alleviate the problem.
Pregnant women receiving daily supplements of 400 IU (10 microgram) of vitamin D2 from the 12th week of pregnancy had plasma calcium concentrations higher at 24 weeks but similar at delivery to those in control pregnant women who did not receive the supplements. Infants of the women receiving the supplements had higher calcium, lower phosphorus, and similar magnesium concentrations on the sixth day of life and a lower incidence of hypocalcaemia than infants of the control women. Plasma concentrations of 25-hydroxycholecalciferol, which showed a seasonal variation, were higher in mothers and infants in the treated group. Cord-blood calcium, magnesium, phosphorus, and 25-hydroxycholecalciferol concentrations correlated with maternal values at delivery. Breast-fed infants had higher calcium and magnesium and lower phosphorus and 25-hydroxycholecalciferol concentrations than artificially fed infants. A defect of dental enamel was found in a high proportion of infants (many of whom had suffered from hypocalcaemia) born to the control women. These results suggest that vitamin D supplementation during pregnancy would be beneficial for mothers, whose intake from diet and skin synthesis is appreciably less than 500 IU of vitamin D daily.
A clinical and biochemical evaluation has been made of a new milk formula, Modified Carnation milk (MCM), based on cows' milk but with the mineral content and concentration of caloric nutrients altered to make it correspond more closely to human milk. MCM produced higher plasma calcium and magnesium concentrations in 6-day-old infants than those produced by unmodified evaporated and dried milks, achieving concentrations closer to those of breast milk. Plasma free amino acid concentrations in MCM-fed infants are nearer breast-fed values than those in unmodified milk-fed infants where higher individual plasma amino acid concentrations persist during the first 3 months. MCM-fed infants had low plasma urea concentrations and lower urine osmolalities at 6 days, 3 weeks, 6 weeks, 3 months, and 6 months than infants fed on the evaporated and dried milks, and similar plasma urea and urine osmolalities to those of breast-fed infants. MCM is likely to be superior to unmodified evaporated and dried milks in preventing convulsions of the hypocalcaemic/hypomagnesaemic/hyperphosphataemic type, and seems less likely to cause hypertonic dehydration. MCM is easily prepared, readily accepted by babies, and appears to be nutritionally adequate for the feeding of term infants.