Night waking in 1-year-old children in England

A national sample of 1500 mothers of 1-year-old children received a postal questionnaire concerned with the sleeping patterns of their children. The response rate was 69%. Seventeen per cent of mothers reported that their 1-year-old presented a moderate or severe sleep problem and 26% said their child woke at night on at least five nights a week. While these two measures correlated, 10% of those who reported their infant woke on at least five nights a week did not consider this to be a problem. Neither sex of infant, social class, method of infant feeding or numbers of house moves were associated with sleep problems. The pattern of results strongly suggest an association between night waking and other sleeping difficulties and stress for mothers. This was indicated by the association we found with complaints about housing, overcrowding, more negative attitudes toward motherhood, lower assessments of maternal well-being, lack of practical support from partners, the use of more negative adjectives to describe their baby and more frequent feelings of being dominated by their baby. While these associations may be explained by the stresses of living with a night-waking baby, it is also likely that a mother who is feeling somewhat depressed and negative toward her baby is more likely to see night waking as significant and as a problem. There were class differences in how parents coped with a shortage of space. Middle-class parents were more likely to put a baby in with a sibling while working class parents more often had the baby in their own room. Middle-class parents were more likely to leave a night-waking baby to cry.     

Accuracy of Equations to Predict Basal Metabolic Rate in Older Women

Objective To assess the accuracy of several published equations for predicting basal metabolic rate (BMR) in older women.

Design BMR was assessed in 116 healthy, older white women, aged 60 to 82 years, on three successive mornings by indirect calorimetry. Body composition was determined by dual energy X-ray absorptiometry or hydrostatic weighing. The measured BMRs were compared with values obtained from eight published prediction equations that used solely, or in various combinations, measures of height, weight, fat-free mass, age, and menopausal status.

Statistical analyses performed The root mean squared prediction error (RMSPE) was used to determine how accurately predicted BMR matched actual BMR for each subject. In addition, regression analysis was used to evaluate accuracy of predicted BMR vs directly measured BMR.

Results Predicted mean BMR determined using all eight equations was significantly correlated to measured BMR (P=.0001), accounting for 30% to 52% of the variance of measured BMR. When analyzed by RMSPE, however, the equations of Owen et al (1986), Fredrix et al (1990), and Harris-Benedict (1919) predicted actual BMR for each subject within an average of 116 kcal/day, and the equation of Cunningham (1980) resulted in the largest prediction error at 208 kcal/day.

Applications/conclusions The regression equations of Owen et al (1986), which used body weight, Fredrix et al (1990), which used body weight and age, and Harris-Benedict (1919), which used age, weight, and height as variables, were most accurate in predicting BMR in our sample of healthy older women. J Am Diet Assoc. 1995; 95:1387-1392.     

House officers in general medicine: their perception of educational value of rotation components

Summary: As curriculum planners in general medicine residency training programmes we were concerned about house officers' anecdotal reports that hospital work requirements often overshadow individual learning goals. After each of five rotations, we asked residents to identify the educational 'usefulness' of certain rotation components which can be included in three categories; team members, work-related activities and educational events. Of 165 surveys distributed, 127 (77%) were returned. Data were analysed by residency year and by all years combined. The mean overall perception of learning was 3.9 out of a possible 5 points suggesting that residents do find some learning value. Results suggest that different residency years vary as to the significance of specific educational components. The importance of faculty/resident relationships to residents' perceptions of learning value was highlighted in particular.     

Lipids and lipoproteins as risk factors for coronary heart disease in men with abnormal glucose tolerance: the Honolulu Heart Program

Abstract. Objectives. To evaluate lipids and lipoproteins as risk factors for coronary heart disease (CHD) in older men with non-insulin-dependent diabetes (NIDDM) or abnormal glucose tolerance compared with normoglycaemic men. Design. A prospective, population-based cohort study based on the lipoprotein examination (1970–72) of the Honolulu Heart Program. Follow-up was through to December 1988. Setting. Honolulu, Hawaii. Subjects. Japanese-American men, ages 51–72 at baseline: 2042 with 1 h glucose < 12.5 mmol l^?1 (normal group); 376 on oral hypoglycaemic agents or with 1 h glucose ≥ 12.5 mmol l^?1 after 50 g oral glucose challenge (abnormal glucose tolerance group). None had prevalent coronary heart disease (CHD) or stroke at baseline. Main outcome measures. Incident CHD: definite nonfatal myocardial infarction (MI) or fatal CHD. Results. There were 221 incident cases in the normal group, and 65 in the abnormal glucose tolerance group. Total and high-density lipoprotein (HDL) cholesterol were significant predictors of incident CHD in men with NIDDM or abnormal glucose tolerance after controlling for age, body-mass index, systolic blood pressure, pack-years of cigarettes and alcohol consumption (P < 0.05). Total, low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) cholesterol were significant predictors in normal men, and HDL cholesterol was of borderline significance. Conclusions. Abnormal lipids and lipoproteins are significant, independent predictors of CHD in subjects with NIDDM or abnormal glucose tolerance. Attention to lipid and lipoproteins as CHD risk factors should be part of clinical management of these patients.     

Dynamic mutation loci: allele distributions in different populations

To assess the relative contributions of trans -acting factors (replication and repair functions) and cis -acting elements (repeat and flanking DNA composition) to the mechanism of trinucleotide repeat sequence mutation we have analysed the distribution of copy number polymorphisms at 12 loci associated with dynamic mutations in 15 populations of different ethnic origins. Genome wide instability of repeats in a particular population would be evidence of trans -acting factor instigation of the mutation process, whereas instability at a particular locus (perhaps even in several populations) would be evidence that the composition of the particular locus was the most significant factor contributing to mutation. The FRA16A locus is highly polymorphic in only the European population. Some other loci exhibit distinct distributions of alleles between different populations. Therefore sequences in the vicinity of the repeat - the cis component of a particular locus - appear(s) to be more important in the mutation mechanism than sporadic genome-wide instability induced by trans -acting factors such as the DNA mismatch repair enzymes.     

Retinoid-Induced Hypertriglyceridemia in Rats Is Mediated by Retinoic Acid Receptors

Retinoids in clinical use today are known to induce hypertriglyceridemiaas one of their major side effects. The purpose of the presentstudy was to determine, in an appropriate animal model, if retinoid-inducedhypertriglyceridemia is mediated by retinoic acid receptors(RARs) and/or by retinoid X receptors (RXRs). Oral gavage ofmale Fischer rats with 13-cis-retinoic acid for 6 days causeda rapid and sustained increase in serum triglycerides that wasreversible within 4 days posttreatment In subsequent experiments,rats were treated by gavage once daily for 3 days with variousretinoids, and serum triglyceride levels were determined 24hr after the last treatment without fasting. All-trans-and 13-cis-retinoicacid, which can be converted to both RAR and RXR agonists, and9-cis-retinoic acid, an RAR/RXR pan-agonist, caused dose-dependentincreases in serum triglycerides at doses that did not causeweight loss or mucocutaneous toxicity. Ro 13–6298 andAGN 190121, two RAR-specific agonists, caused dose-dependentincreases in serum triglycerides, although Ro 13–6298only induced hypertriglyceridemia at weight-suppressive doses.Two RXR-selective agonists, LG100268 and AGN 191701, failedto induce hypertriglyceridemia or weight loss up to the highestdoses tested. A structural isomer of AGN 190121 that does notactivate RARs or RXRs, AGN 190727, did not induce hypertriglyceridemia.Hypertriglyceridemia induced by AGN 190121 was significantlyinhibited by co-treatment with an RAR-selective antagonist,AGN 193109. Taken together, these data provide strong evidencethat retinoid-induced hypertriglyceridemia is mediated, at leastin part, by RARs. These data also suggest that RXR-specificagonists may have reduced potential to induce hypertriglyceridemiarelative to RAR-active retinoids.     

THE "ON CALL" SERVICE OFFERED BY THE DEPARTMENT OF ANAESTHESIA, MANCHESTER ROYAL INFIRMARY

The "on-call" service offered by the Department of Anaesthesia,Manchester Royal Infirmary was studied in December 1981. Thereasons for any delay in service were analysed and suggestionsfor improvement discussed. ^*Present address: Main Theatre, Hope Hospital, Eccles Old Road,Salford