Total bone mineral content and body composition by x-ray densitometry in newborns.

Measurement of total body bone mineral content and body composition has not previously been convenient in the newborn. X-ray densitometry, otherwise known as dual-energy x-ray absorptiometry (DEXA), has been used in adults to assess with accuracy and precision the total body mineral content, lean mass, and fat. Body composition measurements were determined in vivo by DEXA in term newborns, and they were compared with values reported by chemical analysis of the cadaver, with skin-fold thickness measurements, and with bone mineral content measured by single photon absorptiometry. The intermeasurement coefficient of variation was < or = 2.5% for bone mineral content, and < or = 1% for fat and lean mass. The values for bone mineral content, fat, and lean mass fall within the ranges expected based on the reported values measured by chemical analysis of the infant cadaver. Triceps and quadriceps skin-fold measurements were best correlated with total body fat as measured by DEXA. The bone mineral content of the distal third radius site as measured by single photon absorptiometry in newborns showed significant correlation with total body bone mineral content. DEXA provides a reproducible and convenient method for the determination of body composition in newborns.     

An experience with measles vaccine

A study was conducted in Simla town to know the effectiveness and reactions of measles vaccine. One hundred and eight children in the age group of 9–23 months were immunized with measles vaccine and followed over a period of 2 years. Eighty nine children were also followed up as controls. The difference in the attack rate of measles in these two groups was highly significant. Mild fever was found to be a significant side effect. No other reaction like rash or convulsions was observed.     

Pulmonary arterio-venous fistulae in hepatic cirrhosis

Cyanosis, clubbing, and arterial oxygen desaturation may occur in patients with liver disease, and are attributed to the presence of pulmonary or peripheral arterio-venous shunting. Cardiac catheterisation and angiocardiography in a patient with a normal heart did not demonstrate the presence of abnormal arterio-venous anastomoses. Pulmonary shunting was proved when intravenous technetium-labelled macroaggregated albumin, normally held up in capillary networks, was passed quickly through the lungs and immediately detected in high systemic blood flow organs. The opening of peripheral and pulmonary anastomoses in patients with liver disease may be owing to the presence of a vasodilatory substance such as ferritin, which was found to be abnormally increased in the patient's blood.     

Ferritin concentrations in dried serum spots from capillary and venous blood in children in Sri Lanka: a validation study

BACKGROUND: Assessing iron status continues to be challenging in field situations. Spot methods developed for analyzing ferritin from serum or plasma samples that are spotted and dried on filter paper have been shown to provide reliable and accurate iron-status assessments. However, the spot methods are based on samples from venous serum or plasma and have not been evaluated in field settings. OBJECTIVE: We evaluated the validity of analyzing ferritin to assess iron status by using venous and capillary dried-serum-spot (DSS) samples by the spot method compared with using serum ferritin by the traditional method in a field setting. DESIGN: Venous and capillary blood was obtained from healthy schoolchildren (n = 100; +/- SD age: 8.9 +/- 0.3 y) in Colombo, Sri Lanka. To prepare DSS samples, we aliquoted precisely 20 microL serum per spot on filter paper, air-dried the spots, and placed them in airtight plastic bags until analysis by the spot ferritin method with the use of cellulase from Trichoderma reesei at 2 wk after collection. Venous serum (100 microL) was frozen until ferritin determination by traditional radioimmunoassay. RESULTS: Venous and capillary DSS ferritin values correlated strongly with traditional serum ferritin values (r = 0.88 and 0.86, respectively; P = 0.0001). The geometric means (+/- 1 SD) for venous and capillary DSS ferritin and traditional ferritin were 26.9 (15.3-47.4), 33.9 (20.9-54.8), and 33.1 (18.6-58.8) microg/L, respectively, and were not significantly different. Venous and capillary DSS methods on average (+/- SD) yielded ferritin values that were 5.8 +/- 10.1 microg/L lower and 0.1 +/- 9.4 microg/L higher, respectively, than serum ferritin values obtained with the traditional method. CONCLUSIONS: Capillary and venous DSS methods for analyzing ferritin provide accurate tools for assessing iron status. Furthermore, capillary DSS ferritin is a practical means of detecting iron deficiency in field settings.     

Addressing tobacco in managed care: a survey of dentists' knowledge,attitudes, and behaviors

OBJECTIVES: This study assessed the tobacco cessation knowledge, attitudes, and behaviors of dentists participating in a large managed care dental plan. METHODS: Participating dentists in 4 states were surveyed via mail. RESULTS: Dentists' perceived success in helping patients quit using tobacco was highly correlated with discussion of specific strategies for quitting, advice about the use of nicotine gum, and time spent counseling patients. Dentists who were confident about their smoking cessation knowledge frequently advised patients to quit and spent more time counseling patients about tobacco cessation. CONCLUSIONS: Tobacco cessation is not a routine part of dental practice. Knowledge, time spent counseling patients, and specific strategies for quitting were associated with dentists' perceptions of success.     

Smoking behaviors and regular source of health care among African Americans

OBJECTIVES: The purpose of the study was to determine associations between having a regular source of health care, advice from a physician to quit smoking, and smoking-related behaviors among African American smokers. METHODS: A secondary analysis was conducted on data obtained from an intervention study with a posttest assessment of the effectiveness of smoking status as a vital sign. The setting was an adult walk-in clinic at a large inner-city hospital and 879 African American adult current smokers were examined. RESULTS: Among African American smokers, there was an association between having a regular source of health care and planning to quit smoking within the next 30 days (OR = 1.46; 95% CI: 1.04-2.05), receiving physician advice to quit (OR = 1.46; 95% CI: 1.02-2.10), and smoking < or =10 cigarettes a day (OR = 1.42; 95% CI: 1.00-2.03). CONCLUSIONS: African American current smokers with a regular source of health care were further along the quitting process than those without a regular source of health care. Our findings indicate a potential benefit of complementing programs that increase physician cessation advice rates with policies that increase rates of health insurance and the likelihood that individuals have a regular source of health care.     

Pitfalls of radiation survey after brachytherapy implant removal preceding Tl-201 study

An unexpected elevated postimplant radiation survey is described in an elderly patient with an interstitial low-dose-rate iridium-192 (Ir-192) needle implant for endometrial cancer. The elevated activity was related to prolonged clearance of Tl-201 from a cardiac study that had been performed 7 days earlier. The Tl-201 accumulated in the soft tissue, particularly the colon, resulting in increased survey readings over the abdomen and raising concern that an Ir-192 source remained within the patient. This case shows that delayed excretion of a diagnostic radionuclide agent can cause elevated activity high enough to confound postradiotherapy implant survey readings. The estimated surface exposure from a single iridium source left in the pelvis was determined using a phantom study. Possible factors causing decreased excretion of Tl-201 in a patient with heart disease, arteriosclerotic vascular disease, previous pelvic radiation therapy, and a brachytherapy procedure are discussed. A preloading radiation survey is recommended in patients who have had previous nuclear medicine studies involving radionuclides with long half-lives.     

Concordance of Patient-Physician Obesity Diagnosis and Treatment Beliefs in Rural Practice Settings

CONTEXT: Although clinical guidelines recommend routine screening and treatment for obesity in primary care, lack of agreement between physicians and patients about the need for obesity treatment in the primary care setting may be an unexplored factor contributing to the obesity epidemic. PURPOSE AND METHODS: To better understand this dynamic, we surveyed 439 obese patients (body mass index >or=30) at the time of clinic visits in 2003 at diverse primary care settings in rural Kansas and conducted same-day interviews with their physicians (N = 28). We used Spearman's correlation to describe and compare patient and physician responses. FINDINGS: Most patients were women (66%). Their mean age was 55.8 years, and mean body mass index was 37.7. Half (51%) reported discussing their weight on that visit date. Overall, 51% of patients wanted to discuss weight more often with their physician and 54% wanted to discuss weight sooner. Patients and physicians gave similar assessments of the patient's preference for discussing weight loss, how often weight was discussed at visits, and the patient's motivation for weight loss. Spearman's correlations on these variables were .33, .54, and .25, respectively (all P < .001). CONCLUSIONS: These patients and their physicians demonstrated a weak to moderate agreement on several variables crucial to initiating and continuing obesity care. Understanding patient and provider beliefs and preferences regarding obesity diagnosis and treatment is essential in designing obesity interventions for primary care.