A diet high in wheat fiber decreases the bioavailability of soybean isoflavones in a single meal fed to women.

The absorption of some dietary components may be inhibited by dietary fiber. To study the effect of dietary fiber on the bioavailability of Isoflavones, seven healthy women were randomly assigned in a crossover design to a control diet containing 15 g dietary fiber or a wheat fiber-supplemented diet containing 40 g dietary fiber, both fed with a single dose of 0.9 mg isoflavones/kg body weight from tofu or texturized vegetable protein (TVP). The fiber-rich diet produced 55% lower plasma genistein at 24 h after soy dosing (P < 0.05) and reduced total urinary genistein by 20% (P < 0.03). Urinary daidzein was not significantly related to fiber intake. Highly insoluble, dietary wheat fiber reduced the absorption of genistein probably by its bulking effect and hydrophobic binding to this compound. Urinary genistein was greater by 23% after tofu than after TVP consumption (P < 0.02), but the percentage of ingested genistein recovered in urine was not affected by soy product intake. The higher urinary genistein after tofu consumption compared with TVP was apparently due to differences in amount of genistein between these soy foods, not the different forms of genistein present in these two soy food products.

Factors affecting employability among young adults with spina bifida and hydrocephalus.

A sample of 98 young adults with spina bifida were interviewed. None had severe learning difficulties. All were resident in S. Wales or the West of England. Only a third were in open competitive employment, mainly of a clerical nature. Their incomes fell well below average British earnings. Comparing those in work with the unemployed showed they differed significantly according to intelligence, academic qualifications, continence, behaviour, overall disability score and place of residence. The non-discriminating factors are listed and the implications of the findings discussed.

Maternal response to anomalies detected by antenatal ultrasonography.

OBJECTIVE: To determine the effect of an atypical antenatal scan on the expectant mother. DESIGN: Postnatal postal questionnaire. SETTING: Questionnaires completed at home after the infants had been investigated at a regional paediatric surgical unit. SUBJECTS: Twenty-nine mothers. RESULTS: The mothers had a very positive attitude to antenatal ultrasonography. The information that the scan was atypical resulted in a high level of parental anxiety which sometimes persisted into the postnatal period. CONCLUSION: A multidisciplinary approach is required for the management of the expectant mother who has an atypical scan.

Spina bifida children in ordinary schools: handicap, attainment and behaviour.

Virtually all survivors of a selective surgical treatment policy were reassessed. This paper describes the status of 43 of the 74 in ordinary schools. The small number placed in special units often had very low or deviant scores on all measures. Those fully integrated had scores insignificantly different from the controls on reading, spelling and mathematics, but had weaknesses of tests of hand function. The majority of fully integrated pupils were free from behaviour problems. The extent of physical handicap encountered among pupils in the ordinary school is described.

Medical and social service provision for families of children with NTD.

The supply of services to the families of children with spina bifida participating in the South Wales longitudinal study was reviewed. Initially general information and contact with other mothers were the commonest needs; as the children grew older the need for practical, material and financial help took priority. Parents were, generally, very satisfied with support provided by hospital staff with whom they had frequent, regular contact. Contact with health visitors and social workers was considered insufficient and unsatisfactory. Mothers of more severely disabled children were most likely to receive visits, but some saw none and contact with the social services decreased as the children got older. The locally organised parents association (SWASBAH) was able to provide information, financial assistance, holiday accommodation, and contact with others in a similar position; all of which were common, but otherwise inadequately met, needs. Despite improvements, particularly in financial benefits, over the course of the study, at 18 years parents appeared largely unsupported as they faced major changes in their children's lives. Throughout the study support from SWASBAH and the interviewer appeared to far outweight the statutory, non-medical, support.

The fathers of children with spina bifida.

Health, employment, marital outcome and involvement with the child, of fathers with spina bifida (IF) and with "normal" controls (CF), were analysed at intervals from birth to 18 years. By 10 years IF had poorer reported health than did CF. By 18 years IF had more specific health problems, many being psychosomatic in nature, than CF or index and control mothers. This pattern was also reflected in the GHQ scores; IF had a significantly higher incidence of symptoms than CF. Practical involvement of IF and CF was generally little different but at 18 years 30% of IF were still involved in their child's "personal care". Employment and income amongst IF and CF did not differ in the early years. By 18 years, significantly more IF were claiming invalidity benefit, while they were also more likely to be the family's only wage-earner. Our evidence suggests that IF suffered surprisingly severely as a result of emotional strain. Both the psychological and practical problems could be alleviated to the benefit of all family members.

Possible personality problems among 10-year-old spina bifida children.

Forty-four 10-year-old spina bifida children and 52 non-disabled controls completed the Rogers Personal Adjustment Inventory and their teachers assessed their school behaviour on the Bristol Social Adjustment Guide. Spina bifida children and the controls had similar school adjustment scores but the former appeared to have significantly more emotional problems on the Rogers Inventory suggesting that they have private worries not revealed by characteristic behaviour in school. Factors associated with apparent emotional upset are considered and implications for support discussed.

The results of a selective surgical policy on the cognitive abilities of children with spina bifida.

A cohort of spina-bifida children born between 1973 and 1978 and subjected to selection for surgery was divided into those who met specific physical criteria at birth and were offered immediate treatment, and those who had delayed treatment because of adverse criteria. There was a significantly higher level of intelligence among children treated immediately but a fifth of those given delayed treatment had normal levels of intelligence. There were negligible differences in intelligence between the children given delayed treatment and an unselectively treated series of children born between 1964 and 1966, suggesting that postponing surgery for a period does not necessarily have a disastrous effect upon ability.

Selective surgical management of neural tube malformations.

The physical characteristics of 49 children with spina bifida cystica, survivors of a group subjected to selection for early surgery are compared with 39 children alive from an earlier unselected series, born in the 1960s, and reviewed retrospectively. Sixteen children were also studied in whom the initial decision not to operate had been followed by survival and subsequent treatment. Children selected for initial surgery have a significantly lower mortality than those not selected and their mobility at 5 to 7 years of age is better, although only marginally so compared with the unselected group. Selection does not decrease the need for shunt treatment of the associated hydrocephalus. None of those not initially selected for surgery have normal faecal or urinary continence, whereas 35% of the selected in group have normal continence and urinary tracts. Children treated immediately have significantly higher degrees of intelligence than both the unselectively treated and those whose treatment was delayed but a fifth of the latter group were intellectually normal. There were only small differences in intelligence between children given delayed treatment and those unselectively treated, suggesting that postponing surgery does not necessarily have a deleterious effect on ability.

The relationship between intelligence and academic achievements in spina bifida adolescents.

I.Q. scores taken at sixteen years were significantly related to external examination results in both spina bifida and control groups. An I.Q. of 110 or more was associated with a high probability of GCE passes and an I.Q. under 90 with no passes. Three interrelated factors were responsible for poor academic achievement. These were: special school attendance shunt insertion, and severe physical handicap Only 6% of the aggressively treated children in this study are likely to enter higher education; those leaving school without qualifications and a physical handicap are much more likely to be unemployed.

Long-term reactions following a stillbirth with a congenital abnormality: a preliminary report.

Just over half of the sixty women who were interviewed ten and twenty years after they were delivered of a stillborn malformed baby, seem to have resolved their grief completely and have accepted the stillbirth. The remainder have become clinically depressed or have shown physical symptoms typical of anxiety states. Factors contributing to their unresolved mourning were: 1) failure on the doctor's part to explain, comprehensively, the reason for the stillbirth; 2) lack of emotional support during and after the stillbirth.

Family reactions to surgical correction for kyphoscoliosis in spina bifida children: a preliminary report.

The families of 11 children who had been operated for the correction of kyphosis and scoliosis not less than 12 months previously were visited. The anxieties and expectations of patients and parents were investigated and the results compared with a similar investigation in the schools of the children.

The energy expenditure of spina bifida children during walking and wheelchair ambulation.

Energy expenditure was measured during walking and wheelchair ambulation among a group of 22 spina bifida children. Walking energy expenditure was generally higher than during wheelchair ambulation and significantly higher again than that expected for normals matched for weight. The energy expended during both types of locomotion related to the weight of the subjects and not the site of lesion. Physical apathy, excessive weight and increased energy expenditure tended to be connected. Data are presented which will be of use in assessing the physical effort involved in the two types of locomotion, and in calculating dietary energy requirements.

The clinical and psychological characteristics of children with the "cocktail party" syndrome.

40% of a group of children with spina bifida were identified as having the "cocktail party" syndrome at the age of 5. In comparison to spina bifida cases with meaningful speech, children with this syndrome tended to have more severe multiple physical handicaps and to be of significantly lower intelligence. At the age of 7 there were significant differences between the two groups in school performance. Reassessment at 10 showed that almost half of the children no longer showed this syndrome, but those who retained this behaviour were grossly retarded. The aetiology of the condition is discussed.

Differences between Welsh and Canadian children on parts of the test of motor impairment.

Four subtests, which measured hand function, were taken from the Test of Motor Impairment and given to 53 10-year-old children of normal intelligence. The results showed a wide variation in achievement with one test at a very inappropriate level of difficulty. Girls were consistently faster than boys, achieving a result which was statistically significant in one instance. It is suggested that this test requires restandardization for use among British populations. The provision of separate norms for the sexes would improve the disciminatory value of this instrument.

Differences in reading achievement between spina bifida children attending normal schools and those attending special schools.

This paper reports the reading scores measured on Neale's Analysis of Reading Ability of a series of 55 spina bifida children, some of whom attended normal schools and the remainder attended special schools and matched controls. A multiple regression equation was used to compare observed scores with the expected scores. The children receiving a normal school education were reading up to the level expected from their intelligence test scores, but the children in special schools had significant differences between observed and expected scores. The discrepancies may be accounted for by more profound physical handicap among the special school children but teachers' expectations may also be important in influencing reading achievement.

Marital stability following the birth of a child with spina bifida.

The matrimonial stability of 142 families where a child with neural tube malformation (mostly spina bifida) was born between 1964 and 1966, including 56 families with a surviving spina bifida child, was examined in January 1976. The divorce rate for families with a surviving child was found to be nine times higher than that for the local population and three times higher than for families experiencing bereavement of their spina bifida child. Marriages which followed a pre-nuptial conception resulting in a spina bifida child were particularly vulnerable and had a divorce or separation risk of 50 per cent. All the divorced fathers had remarried, but only one of the mothers. It is concluded that a handicapped child adds greatly to the strain on a marriage, especially when this has not been cemented before the arrival of a child. This strain is diminished by the child's early death.

Spina bifida children's scores on the Wechsler Intelligence Scale for Children.

An analysis of the scores of 58 cases assessed on the WISC suggested there was differential intellectual prognosis according to type of lesion, the presence of hydrocephalus, degree of physical disability and sex, with girls having the poorer outcome.