Decreased bone mass in adolescents with bone fragility fracture but not in young children: a case-control study.

Background: The incidence of distal forearm fracture due to minimal/moderate trauma shows a bimodal distribution for age at event, with one peak occurring during early adolescence, in both boys and girls and the other one in postmenopausal females. The aim of this study was, therefore, to document whether the relationship between bone mineral density and fracture is different in young children compared with adolescents. Methods: A matched-pair, case-control study has been conducted to evaluate bone mineral density in 469 young children and 387 adolescents of both sexes, with/without fracture due to minimal/moderate trauma with assurance that the compared groups were equally susceptible to the outcome event. All fractures were radiographically confirmed. The study utilized bone mineral areal density of the total body, spine, hips, and forearm; volumetric bone mineral density of the forearm; and metacarpal radiogrammetry measurements. The study controlled for skeletal development, bone geometry, body composition, hand grip strength, calcium intake, and vitamin D status. Results: Adolescents with distal forearm fracture have reduced bone mineral density at multiple skeletal regions of interest. This was documented by the bone mineral areal density measurements at multiple skeletal sites (p < 0.001), volumetric bone mineral density measurements of the forearm (p < 0.0001), and metacarpal radiogrammetry (p < 0.001). Adolescent females with fracture had reduced cross-sectional areas of the radius and metacarpals. The bone status of young female and male children with fracture was no different to its controls. Increased body fatness was more prevalent among fracture cases than in controls. Around 72% of young female and male children with fracture had serum 25-hydroxyvitamin D levels below the threshold of 31 ng/ml, compared with only 42% of female controls and to 51% of male controls. Conclusions: Adolescents with bone fragility fracture had reduced bone mineral density at multiple skeletal regions of interest, whereas this was not the case with younger children. The results of the study may have implications for the prevention of bone fragility in this segment of the pediatric population.

Effectiveness and Safety of Electroconvulsive Therapy in Clinical Practice / 신경정신의학

OBJECTIVES: There is little research on the practice and effectiveness of electroconvulsive therapy (ECT) in Korea. This study investigated the practice pattern, effectiveness, and safety of ECT. METHODS: This chart review study included electronic medical records of 180 patients treated with ECT between January 2007 and December 2013 at the Asan Medical Center. Symptomatic improvement was assessed using Clinical Global Impression (CGI) scale. Treatment response was defined as CGI improvement scale score of 2 or less. Re-hospitalization was used as an indicator of recurrence. Safety was assessed by spontaneous reports from patients. RESULTS: One hundred and eighty patients underwent 1539 sessions of modified ECT. Their most frequent diagnosis was major depressive disorder (n=74, 41.1%). The most common indication for ECT was poor response to medication (n=177, 75.3%). Treatment response rate was 66.9% in acute phase group and 63.8% in the patients with poor response to medication. The recurrence rate at six months after the end of the course was 29.6%. Memory impairment or amnesia was the most common adverse effect. CONCLUSION: There was a remarkable improvement following ECT in patients who responded poorly to medications, and most adverse effects were tolerable and temporary. The present study suggests that ECT could be a useful treatment option.

A Psychiatric Approach to Prince Sado: A Bipolar Disorder Sufferer or a Victim of Party Strife / 신경정신의학

OBJECTIVES: Prince Sado was the tragic royal heir who was sealed in a rice chest and starved to death by his father, King Yeongjo. The question of whether he was a victim of party strife or his death was the result of his psychiatric disorder is still controversial. In this paper, we investigated the question of whether he had suffered from bipolar disorder by reviewing his psychiatric symptoms and family history. METHODS: We examined the available literature on Prince Sado and his family, particularly focusing on Hanjungnok (Memoirs of Lady Hyegyeong), written by Prince Sado's wife. RESULTS: Review of the literature showed that Prince Sado suffered from psychiatric symptoms, including depressed mood, anxiety, suicidal behavior, aggressive behavior, and persecutory delusion from the age of 13 to 27. Many of his symptoms match the Diagnostic and Statistical Manual of Mental Disorders' criteria for depressive and manic episodes and it is highly suspected that he had bipolar disorder. He also showed clothing phobia, which can be regarded as an obsessive compulsive symptom. Some of his relatives, King Gyeongjong and Sanggyegun, might have suffered from depressive disorder. CONCLUSION: The characteristics of his symptoms suggest that Prince Sado might have had bipolar disorder. His mental disorder might explain in part the cause of his death.

A Psychiatric Approach to Prince Sado: A Bipolar Disorder Sufferer or a Victim of Party Strife / 신경정신의학

OBJECTIVES: Prince Sado was the tragic royal heir who was sealed in a rice chest and starved to death by his father, King Yeongjo. The question of whether he was a victim of party strife or his death was the result of his psychiatric disorder is still controversial. In this paper, we investigated the question of whether he had suffered from bipolar disorder by reviewing his psychiatric symptoms and family history. METHODS: We examined the available literature on Prince Sado and his family, particularly focusing on Hanjungnok (Memoirs of Lady Hyegyeong), written by Prince Sado's wife. RESULTS: Review of the literature showed that Prince Sado suffered from psychiatric symptoms, including depressed mood, anxiety, suicidal behavior, aggressive behavior, and persecutory delusion from the age of 13 to 27. Many of his symptoms match the Diagnostic and Statistical Manual of Mental Disorders' criteria for depressive and manic episodes and it is highly suspected that he had bipolar disorder. He also showed clothing phobia, which can be regarded as an obsessive compulsive symptom. Some of his relatives, King Gyeongjong and Sanggyegun, might have suffered from depressive disorder. CONCLUSION: The characteristics of his symptoms suggest that Prince Sado might have had bipolar disorder. His mental disorder might explain in part the cause of his death.

Interactive introductory nutrition course focusing on disease prevention increased whole-grain consumption by college students.

OBJECTIVE: To estimate current consumption of whole grains in college students and determine whether there would be an increase in whole-grain consumption after the students completed an interactive introductory nutrition course focusing on disease prevention. METHODS: Eighty college students, 18-24 years old, participated in the study. Grain and whole-grain consumption, whole-grain food sources, and energy intake were measured before and after the nutrition course. Repeated-measures analysis of variance was performed. RESULTS: After the study, whole-grain intake significantly increased from 0.37 ounces (oz) to 1.16 oz (P < .001), whereas total grain intake remained the same (3.07 oz). The number of whole-grain food sources increased from 7 to 11 food items after the intervention. CONCLUSIONS AND IMPLICATIONS: A general nutrition course can be used as an avenue to increase whole-grain intake by college students.

Evaluation of effectiveness of class-based nutrition intervention on changes in soft drink and milk consumption among young adults.

BACKGROUND: During last few decades, soft drink consumption has steadily increased while milk intake has decreased. Excess consumption of soft drinks and low milk intake may pose risks of several diseases such as dental caries, obesity, and osteoporosis. Although beverage consumption habits form during young adulthood, which has a strong impact on beverage choices in later life, nutrition education programs on beverages are scarce in this population. The purpose of this investigation was 1) to assess soft drink and milk consumption and 2) to evaluate the effectiveness of 15-week class-based nutrition intervention in changing beverage choices among college students. METHODS: A total of 80 college students aged 18 to 24 years who were enrolled in basic nutrition class participated in the study. Three-day dietary records were collected, verified, and analyzed before and after the intervention. Class lectures focused on healthful dietary choices related to prevention of chronic diseases and were combined with interactive hands on activities and dietary feedback. RESULTS: Class-based nutrition intervention combining traditional lecture and interactive activities was successful in decreasing soft drink consumption. Total milk consumption, specifically fat free milk, increased in females and male students changed milk choice favoring skim milk over low fat milk. (1% and 2%). CONCLUSION: Class-based nutrition education focusing on prevention of chronic diseases can be an effective strategy in improving both male and female college students' beverage choices. Using this type of intervention in a general nutrition course may be an effective approach to motivate changes in eating behaviors in a college setting.

Effect of nutrition intervention using a general nutrition course for promoting fruit and vegetable consumption among college students.

OBJECTIVE: To evaluate the effectiveness of implementing nutrition intervention using a general nutrition class to promote consumption of fruits and vegetables in college students. DESIGN: 3-day food records were collected, verified, and analyzed before and after the intervention. SETTING: A midwestern university. PARTICIPANTS: 80 college students, ages 18 to 24, participated in the study. INTERVENTION: The intervention focused on nutrition knowledge related to prevention of chronic diseases, healthful dietary choices increasing fruit and vegetable consumption, dietary feedback, and interactive hands-on activities. MAIN OUTCOME MEASURES: Consumption of: total vegetable, fresh vegetable, starchy vegetable, french fries, vegetable juice, total fruit, fresh fruit, canned fruit, and fruit juice. ANALYSIS: Dependent t test was used to analyze the differences in pre- and posttest. Analysis of variance was used to determine differences in dietary changes between groups. RESULTS: Participants significantly increased consumption of not only total fruits and vegetables (P < .005), but also fresh fruits and vegetables (P < .005). Intake of french fries decreased significantly (P < .05). Females responded better to the intervention than males in increasing vegetable consumption (P < .05). CONCLUSIONS AND IMPLICATIONS: Class-based nutrition intervention focusing on prevention of chronic diseases is a cost-effective approach to increasing fruit and vegetable consumption among college students.

Selenium-dependent glutathione peroxidase activity is increased in healthy post-menopausal women.

Selenium helps protect against peroxidation during aging as part of the glutathione peroxidase (GPx) antioxidant system. Selenium status, however, is often low in elderly persons who have low selenium intake, live in institutions, and have certain chronic diseases. In addition, a relationship has been observed between the female reproductive hormone, estrogen, and selenium status, with blood selenium and GPx activity coinciding with fluctuations in estrogen during the menstrual cycle. These findings suggest that the decrease in estrogen following menopause may cause a decrease in selenium status, and thus accelerate the process of aging and increase the risk of certain diseases. The current study compared selenium status in healthy premenopausal (n = 13, 21 to 43 years) and postmenopausal (n = 10, 57 to 86 years) women. Selenium intakes of both groups were similar and greater than the recommended dietary allowance (RDA) of 55 microg/day for adult women. Although neither plasma nor RBC selenium concentrations were significantly different between groups, postmenopausal women had significantly greater plasma (p < 0.02), and RBC (p < 0.05) GPx activities compared to premenopausal women possibly in response to oxidative processes associated with aging. These results indicate that the selenium status of healthy postmenopausal women did not decline with menopause and that their antioxidant capability, as measured by GPx activity, was preserved with dietary intake of selenium greater than the RDA.

Calcium supplementation and bone mineral density in females from childhood to young adulthood: a randomized controlled trial.

BACKGROUND: Short-term studies established that calcium influences bone accretion during growth. Whether long-term supplementation influences bone accretion in young adults is not known. OBJECTIVE: This study evaluated the long-term effects of calcium supplementation on bone accretion among females from childhood to young adulthood. DESIGN: A 4-y randomized clinical trial recruited 354 females in pubertal stage 2 and optionally was extended for an additional 3 y. The mean dietary calcium intake of the participants over 7 y was approximately 830 mg/d; calcium-supplemented persons received an additional approximately 670 mg/d. Primary outcome variables were distal and proximal radius bone mineral density (BMD), total-body BMD (TBBMD), and metacarpal cortical indexes. RESULTS: Multivariate analyses of the primary outcomes indicated that calcium-supplementation effects vary over time. Follow-up univariate analyses indicated that all primary outcomes were significantly larger in the supplemented group than in the placebo group at the year 4 endpoint. However, at the year 7 endpoint, this effect vanished for TBBMD and distal radius BMD. Longitudinal models for TBBMD and proximal radius BMD, according to the time since menarche, showed a highly significant effect of supplementation during the pubertal growth spurt and a diminishing effect thereafter. Post hoc stratifications by compliance-adjusted total calcium intake and by final stature or metacarpal total cross-sectional area showed that calcium effects depend on compliance and body frame. CONCLUSIONS: Calcium supplementation significantly influenced bone accretion in young females during the pubertal growth spurt. By young adulthood, significant effects remained at metacarpals and at the forearm of tall persons, which indicated that the calcium requirement for growth is associated with skeletal size. These results may be important for both primary prevention of osteoporosis and prevention of bone fragility fractures during growth.

Plasma selenium and plasma and erythrocyte glutathione peroxidase activity increase with estrogen during the menstrual cycle.

OBJECTIVE: This study was designed to determine the timing and magnitude of changes in selenium status in relation to the fluctuation of 17-beta-estradiol during the menstrual cycle and the effect of different phases of the menstrual cycle on dietary selenium intake. METHODS: Plasma 17-beta-estradiol and plasma and erythrocyte selenium and glutathione peroxidase (GPx) activity were measured in fasting blood samples collected in the morning at four times over three phases of the menstrual cycle: early follicular (EF: days 1-3 menstruation), periovulatory (PO; E-1: 1 day before estrogen peak and E: during estrogen peak) and mid-luteal (ML: 7-9 days after ovulation) in healthy women (n = 14) aged 21 to 39 years and with regular menstrual cycles (26 to 30 days). The estrogen peak was confirmed by measurement of the luteinizing hormone surge. Dietary records (three-day) coincided with blood collection for each phase. RESULTS: Plasma selenium and plasma and erythrocyte GPx activity were greatest during the periovulatory phase, coinciding with the estrogen peak. No differences were observed for erythrocyte selenium or dietary selenium throughout the cycle. A linear relationship existed between estradiol and plasma selenium (p < 0.0027), plasma GPx activity (p < 0.0001), and erythrocyte GPx activity (p < 0.0001). CONCLUSIONS: These results indicate that blood selenium parameters fluctuate during the menstrual cycle such that the phase of the cycle should be considered when assessing selenium status.