Analysis of lead and cadmium in cereal products and duplicate diets of a small group of selected Brisbane children for estimation of daily metal exposure.

Exposure to toxic metals such as lead (Pb) and cadmium (Cd) from foods is a concern for young children. The aims of the study were to analyse the levels of Pb and Cd in breakfast cereals, rice products and diets of selected children, and to estimate the daily intakes of Pb and Cd in these children. The samples (n = 82) of ready-to-eat breakfast cereals and rice products (n = 36) were collected and obtained from various markets in Brisbane, Australia. The samples for a duplicate diet study were collected for 3 consecutive days from normal healthy children (n = 15). The analysis was performed using ICP-MS after microwave digestion. The levels of Pb and Cd found in breakfast cereals and rice products ranged from <0.01 to 0.25 mg/kg for Pb and <0.01 to 0.11 mg/kg for Cd. The estimated daily intakes of Pb and Cd in children varied widely and ranged from 0.90 to 11.7 (5.6 ±â€¯3.5 µg/day) for Pb and 0.98 to 9.5 (4.0 ±â€¯2.2 µg/day) for Cd. The study shows low intakes of Pb and Cd in children.

Urox containing concentrated extracts of Crataeva nurvala stem bark, Equisetum arvense stem and Lindera aggregata root, in the treatment of symptoms of overactive bladder and urinary incontinence: a phase 2, randomised, double-blind placebo controlled trial.

BACKGROUND: Storage lower urinary tract symptoms (LUTS) including overactive bladder (OAB) and urinary incontinence (UI) affect millions of people worldwide, significantly impacting quality of life. Plant based medicines have been documented both empirically and in emerging scientific research to have varying benefits in reducing bladder symptoms. We assessed the efficacy of Urox®, a proprietary combination of phytomedicine extracts including, Cratevox™ (Crataeva nurvala) stem bark, Equisetem arvense stem and Lindera aggregata root, in reducing symptoms of OAB and UI. METHODS: Efficacy of the herbal combination on a variety of bladder symptoms compared to an identical placebo, were documented in a randomised, double-blind, placebo controlled trial conducted at two primary care centres. Data were collected at baseline, 2, 4 and 8 weeks, with the primary outcome being self-reported urinary frequency. Statistical analysis included mixed effects ordered logistic regression with post hoc Holm's test to account for repeated measures, and included an intention-to-treat analysis. RESULTS: One hundred and fifty participants (59% female, aged; mean ± SD; 63.5 ± 13.1 years) took part in the study. At week 8, urinary day frequency was significantly lower (OR 0.01; 95%CI 0.01 to 0.02; p < 0.001) in response to treatment (mean ± SD; 7.69 ± 2.15/day) compared to placebo (10.95 ± 2.47/day). Similarly, episodes of nocturia were significantly fewer (OR 0.03; 95%CI 0.02 to 0.05) after 8 weeks of treatment (2.16 ± 1.49/night) versus placebo (3.14 ± 1.36/night). Symptoms of urgency (OR 0.02; 95%CI 0.01 to 0.03), and total incontinence (OR 0.03; 95% CI 0.01 to 0.06) were also lower (all p < 0.01) in the treatment group. Significant improvements in quality of life were reported after treatment in comparison to placebo. No significant side effects were observed resulting in withdrawal from treatment. CONCLUSIONS: The outcome of this study demonstrated both statistical significance and clinical relevance in reducing symptoms of OAB, urinary frequency and/or urgency and incontinence. The demonstrated viability of the herbal combination to serve as an effective treatment, with minimal side-effects, warrants further longer term research and consideration by clinicians. TRIAL REGISTRATION: NCT02396160 (registered on 17 March 2015 - before any statistical analyses commenced).

Future Doctors' Perceptions about Incorporating Nutrition into Standard Care Practice.

OBJECTIVE: The increasing prevalence of chronic disease has been largely attributed to long-term poor nutrition and lifestyle choices. This study investigates the attitudes of our future physicians toward nutrition and the likelihood of incorporating nutrition principles into current treatment protocols. METHODS: Setting: The setting of this study was an Australian university medical school. SUBJECTS: Subjects including year 1-4 students (n = 928) in a 4-year medical bachelor, bachelor of surgery (MBBS) degree program. Students were invited to participate in a questionnaire based on an existing instrument, the Nutrition in Patient Care Attitude (NIPC) Questionnaire, to investigate their attitudes toward nutrition in health care practices. RESULTS: Respondents indicated that "high risk patients should be routinely counseled on nutrition" (87%), "nutrition counseling should be routine practice" (70%), and "routine nutritional assessment and counseling should occur in general practice" (57%). However, despite overall student support of nutritional counseling (70%) and assessment (86%), students were reluctant to perform actual dietary assessments, with only 38% indicating that asking for a food diary or other measure of dietary intake was important. CONCLUSION: These findings demonstrate that future physicians are aware of the importance of considering nutrition counseling and assessment. However, students are unlikely to adequately integrate relevant nutritional information into their treatment protocols, evidenced by their limited use of a basic nutritional assessment. This is potentially the result of a lack of formal nutrition education within their basic training.

Arsenic in rice and diets of children.

Levels of arsenic in Australian and imported rice (n = 36) were evaluated using inductively coupled plasma mass spectrometry (ICP-MS) for total arsenic and a hyphenated high-performance liquid chromatography ICP-MS system for arsenic species. The study also assessed the daily intake of total As from diets of healthy children (n = 15), collected over three consecutive days. A wide variation of total As levels (range: <0.05-0.42 mg/kg) in Australian and imported rice was found. The mean level of total As (0.24 ± 0.09 mg/kg, n = 10) in the Australian rice was relatively higher than imported rice from other countries (0.09 ± 0.04 mg/kg, n = 26). The mean level (0.25 ± 0.08 mg/kg, n = 7) of dimethylarsenic acid was considerably higher than that of inorganic As (III) (0.07 ± 0.03 mg/kg, n = 7) in the Australian rice. Children's daily intakes of total As varied widely, ranging from 1.7 to 31.2 (11.5 ± 8.9 µg/day), which was comparable to other countries.

Micronutrient, antioxidant, and oxidative stress status in children with severe cerebral palsy.

BACKGROUND: Markers indicative of micronutrient and antioxidant status in children with cerebral palsy (CP) were explored due to these children's well-documented issues with food intake and the limited biochemical literature. MATERIALS AND METHODS: Children aged 4 to 12 years with marked CP (n = 24) and controls (n = 24) were recruited. The CP group represented orally (O) or enterally fed (E) children. Concentrations of red cell folate (RCF), magnesium, superoxide dismutase (SOD), glutathione reductase, and peroxidase were measured, as well as serum methylmalonic acid and vitamin C. Plasma hemoglobin, C-reactive protein, α-tocopherol, cholesterol, zinc, protein carbonyls, and total antioxidant capacity were also quantified. RESULTS: Data are reported as mean (SD) and z scores where values differ with age. Many similarities existed, but zinc z scores were reduced in O (-1.10 [0.83]) vs controls (-0.54 [0.54]) (P < .05), as well as for glutathione reductase in O (10.15 [1.69]) vs E (12.22 [2.41]) and controls (11.51 [1.67]) (P < .05). RCF was greatly increased in E (1422 [70]) vs O (843 [80]) and controls (820 [43]) (P < .001). SOD was decreased in E (24.3 [1.4]) vs controls (27.0 [2.8]) (P < .05). CONCLUSION: Considering their vast impact on physiology, micronutrients should be routinely monitored in orally fed children with swallowing disorders and dietary limitations. Excessive intakes, particularly long term in enterally fed children, should also be monitored in view of their potential for competitive inhibition, particularly at high levels.

Methylation capacity in children with severe cerebral palsy.

BACKGROUND: Methylation cycle and folate-mediated one-carbon metabolism maintenance is important for many physiological processes including neurotransmitter regulation, nerve myelination and DNA synthesis. These processes play an indispensible role in growth and development, as well as in cognitive function and neuromuscular stability, which are key issues in children with severe cerebral palsy (CP). METHODS: Blood samples were collected from children with severe CP (n = 24) and age-matched typically developing healthy controls (n = 24), as an exploratory study. The CP group was divided into orally (O) or enterally fed via percutaneous endoscopic gastrostomy (E). Concentrations of red cell folate (RCF), methylmalonic acid (MMA), mean cell volume (MCV), homocysteine (Hcy), cystathionine, choline, betaine and urate were assayed. RESULTS: Homocysteine was increased in both O mean (±SD) = 6·28 (±1·81 µM) and E = 6·03 (±1·28), vs. controls = 5·07 (±0·98) P = 0·02. Higher MMA was found in controls = 157 (±54) and O = 141 (±101), vs. E = 88(±21) P = 0·05. RCF was higher in E = 1422 (±70 nM) vs. O = 843 (±80) and controls = 820 (±43) P < 0·001. MCV z-scores were elevated in E = 3·1 (±1·8) and O = 1·1 (±1·1) compared with controls = -0·2 (±1·1) P < 0·001. Urate was significantly reduced in O = -0·64 (±1·38) and E = -0·87 (±0·71), vs. controls = 0·18 (±0·62) P = 0·006. CONCLUSIONS: Raised MCV in the presence of elevated red cell folate, adequate B12 status and low plasma urate suggest potential methyltetrahydrofolate trapping and impaired purine synthesis. Well-documented malnutrition issues in O may explain differences between CP groups. These data support the hypothesis of possible dysregulation in methylation capacity and/or folate one-carbon metabolism, although more research is needed to elucidate a precise mechanism.

Use of certainty-based marking in a second-year medical student cohort: a pilot study.

BACKGROUND: Assessments which consider both competence and confidence attempt to provide insight into actual performance in order to optimize physician capabilities, providing motivation and direction for future learning. The aim of this project was to assess medical students' thoughts and opinions of the utility of a certainty-based marking (CBM) protocol with respect to improving their learning experiences. METHODS: Second-year medical students at the University of Queensland were provided with a series of optional online formative assessment tools, in the form of 10 sample questions, to support their current module learning outcomes. During four consecutive weeks, CBM was offered on weeks 1, 2, and 4, with week 3 being provided in the usual question-answer format. A mixed-method survey was distributed at the conclusion of the trial period to obtain feedback on the students' impressions of learning via this technique. RESULTS: Of the 400 students, 15%, 11%, 9%, and 8% used the resource over the four-week period, respectively. During the four-week module directly prior to the test module, 46%, 44%, 44%, and 40% of the students accessed the sample questions which were delivered in the usual multiple choice format. A majority of the students either agreed or strongly agreed that CBM was easy to understand (52%) and useful (57%), but took more time (67%) because they needed to consider their certainty level for every question (76%). A number of students (43%) also stated that CBM affected their attitudes toward decision-making, while 86% thought it would be most useful for revision as opposed to an examination format. DISCUSSION: Despite the inherent benefits of gaining experience in higher order thinking processes, students were less likely to participate in the CBM tasks than standard multiple choice, even though these did not count toward their final grades. CONCLUSION: Utilizing such practices at the beginning of an educational program may minimize apparent resistance and alter learning practices to become conducive to deeper levels of learning. This has been corroborated in other studies aiming to encourage similar higher order cognitive processes.

Protein levels in enteral feeds: do these meet requirements in children with severe cerebral palsy?

Children with cerebral palsy (CP) have been documented to have feeding difficulties, which increase in line with condition severity and result in lowered growth potential. Much nutrition literature surrounds energy intake and expenditure in these children, with less information available on other parameters such as protein and micronutrients, which are also important for growth and development. We examined differences in protein intake and a variety of protein metabolism indices in children with CP compared with controls. A total of twenty-four children aged 4-12 years with marked CP fed orally (O, n 15) or enterally (E, n 9) were recruited, including age-matched typically developing children (C, n 24). Fasting blood samples were analysed for levels of albumin, creatinine, urea and urate. Parents collected an exact food replica for three consecutive days of their child's actual intake, which were directly analysed for protein content. Significant differences were found in protein intakes between the groups (mean percentage minimum requirements: E = 178 (sd 47); O = 208 (sd 95); C = 311 (sd 119), P = 0·005). Despite all children consuming over recommended levels, children with CP had significantly reduced levels of the protein metabolic indices compared with controls. These include as z-scores: albumin mean C = 0·71 (sd 1·04) and CP = - 0·17 (sd 1·60), P = 0·03; creatinine C = - 2·06 (sd 0·46) and CP = - 3·11 (sd 0·98), P < 0·001; urate C = 0·18 (sd 0·62) and CP = - 0·58 (sd 0·93), P = 0·002. Post hoc analysis, the present data show potentially greater protein metabolism issues in enterally fed children, compared with the other groups. This may also support recent literature that suggests shortfalls in current recommendations.

Micronutrient adequacy and morbidity: paucity of information in children with cerebral palsy.

A literature review was conducted to investigate the status of vitamins and minerals in children with cerebral palsy and the implications of various deficiencies on health outcomes. Children with cerebral palsy commonly have feeding difficulties, which significantly impact their growth, general health, and life expectancy. Current nutritional literature focuses on energy expenditure, with little information available on other parameters, such as micronutrient status. Due to the paucity of micronutrient research in these children, the impacts of deficiencies and benefits in other populations have been considered. The role of micronutrients in maintaining cellular homeostasis throughout all body systems highlights a need for future research and monitoring of their levels, particularly in vulnerable populations with well-documented incidence of undernutrition.

Major depressive disorder and nutritional medicine: a review of monotherapies and adjuvant treatments.

A literature review was conducted to examine the evidence for nutritional interventions in depression. It revealed a number of significant conclusions. Interestingly, more positive clinical trials were found to support adjuvant, rather than monotherapeutic, use of nutrients to treat depression. Much evidence exists in the area of adjuvant application of folic acid, S-adenosyl-methionine, omega-3, and L-tryptophan with antidepressants. Current evidence does not support omega-3 as an effective monotherapy to treat depression. However, this may be due, at least in part, to olive oil being used as the control intervention, some studies using docosahexaenoic acid alone or a higher docosahexaenoic acid to eicosapentaenoic acid ratio, and significant heterogeneity regarding depressive populations. Nevertheless, adjunctive prescription of omega-3 with antidepressants, or in people with dietary deficiency, may be beneficial. Inositol lacks evidence as an effective antidepressant and cannot be currently recommended. Evidence on the use of L-tryptophan for depression is inconclusive, and additional studies utilizing a more robust methodology are required.