Metabolic effects of growth hormone treatment: an early predictor of growth response?

Fourteen children receiving one year of recombinant human growth hormone (rhGH) treatment underwent measurement of serial changes in body composition (measured by skinfold thickness, bioelectrical impedance, and H2(18)O dilution), resting energy expenditure (REE, estimated by ventilated hood indirect calorimetry), and total free living daily energy expenditure (TEE, measured by the doubly labelled water technique). Mean height velocity increased from 4.9 to 8.6 cm/year after six months of treatment. Fat free mass (FFM) increased more during the first six weeks (24.4 g/day) than from six to 26 weeks of treatment (6.8 g/day); fat mass decreased by 7.2 g/day and 1.1 g/day respectively. The six week increase in REE (kJ/day) was maintained after six months of treatment, though expressed per kilogram FFM (kJ/kgFFM/day), returned to pretreatment values by three months. Height velocity increases at six months correlated with six week changes in fat mass measured by skinfold thickness and REE, though use of this relationship to predict growth response in individuals is limited by the wide 95% prediction intervals. No significant changes in growth, body composition, or energy expenditure were observed between six and 12 months of treatment, in either patients who had initially responded well to treatment or those who were poor initial responders to treatment and who had their dose of rhGH doubled after six months.     

HIV-1tat induced apoptosis of T-cells is not mediated by TGF-β

Recent reports have demonstrated that the HIV-1 transactivator protein,tat, induces apoptosis in T-lymphocyte cell lines, as well as in peripheral blood mononuclear cells, and stimulates a cascade of events resulting in up-regulation of the potent immunosuppressive cytokine, transforming growth factor-β (TGF-β). In this study we evaluated the ability of TGF-β to mediatetat induced apoptosis in T-lymphocyte cell lines. T-cells treated exogenously with either TGF-β1 or a combination of tat and pan-specific TGF-β neutralizing antibodies showed little change in the amount of apoptosis. When treated with pan-specific TGF-β neutralizing antibodies, Jurkat cells that stably expresstat protein (Jurkat-tat) showed only a modest decrease in apoptosis, while CEM-TART cells (CEM T-cells expressing both HIV-1tat andrev) demonstrated little change in the amount of apoptosis. In conclusion, we have demonstrated that TGF-β does not play a significant role in mediatingtat induced T-cell apoptosis.     

Proton MRS imaging in the follow-up of patients with suspected low-grade gliomas

We compared the value of changes in proton magnetic resonance spectroscopic imaging (¹H-MRSI) with changes in clinical status and/or contrast-enhanced magnetic resonance imaging (MRI) in the monitoring of patients with suspected low-grade glioma (LGG). From June 1, 1999 till May 31, 2002, we included consecutive, neurologically intact adult patients suspected of having an LGG, demonstrating non-enhancing supratentorial lesions without edema or mass effect on MRI, and in whom all treatment (including a diagnostic biopsy) was deferred. Till January 1, 2003, patients were surveyed clinically and radiologically (contrast-enhanced MRI and ¹H-MRSI). Patients who showed progression on clinical examination and/or MRI were denoted as progressive disease. Other patients were denoted as stable disease. A decrease in NAA/CHO ratio of 20% compared to the baseline value was considered as indicative for progression on ¹H-MRSI. We included 14 patients with suspected LGG. Seven patients demonstrated progressive disease during the follow-up period, preceded or accompanied by concomitant ¹H-MRSI changes in five patients. Four of these five patients were operated on within the follow-up interval. The histological diagnosis demonstrated high-grade glioma in three and LGG in one patient. In the other two patients with progressive disease, no progression was found on ¹H-MRSI. The other seven patients demonstrated stable disease, but four of them showed progression on ¹H-MRSI. Our data do not show convincing evidence that ¹H-MRSI contributes to adequate monitoring and follow-up of patients with suspected LGG. Future research should preferably include pathological data at the time of ¹H-MRSI changes.     

Youth health care: much prevention for little money

As part of government policy, the 'Youth healthcare' prevention programme is offered free of charge to all children aged 0 to 19 years who are resident in the Netherlands. It consists of a programme of primary prevention (including vaccinations, information and advice) and secondary prevention (screening, surveillance, early diagnosis) and individual prevention and care. Many elements from the programme package have been shown to have a favourable cost-effectiveness relationship, in terms of health benefits and financially. Other elements have a social priority. The present government expenditure for the total youth healthcare package is about 380 million euros per year, that is 1900 euros per child. In terms of conditions prevented or years of life gained, this is cheaper than accepted prevention programmes for adults. The present approach can only be maintained and strengthened, if the expenditure is increased so that new programme elements can be investigated and--if found effective--implemented.     

Early detection of psychosocial problems in adolescents: how useful is the Dutch short indicative questionnaire (KIVPA)?

BACKGROUND: Psychosocial problems, such as behavioural, emotional, and educational problems, are highly prevalent among children and adolescents. Early treatment may reduce these problems, if accurately identified. Validated questionnaires may support identification. The aim of this study is to assess the psychometric qualities of such a questionnaire, the Short Indicative Questionnaire for Psychosocial problems among Adolescents (KIVPA,) and to determine whether it is suitable for and adds to the early detection of psychosocial problems among adolescents. METHODS: Data came from a national sample of 1,440 Dutch adolescents, using the KIVPA, the Child Behavior Checklist (CBCL), and the Youth Self-Report (YSR). Of these, 1,248 provided data on all questionnaires (77.8%). The scale structure of the KIVPA was assessed; its sensitivity and specificity using CBCL, YSR and referral for psychosocial problems as criteria; and its contribution to detecting CBCL and YSR problems. RESULTS: The KIVPA is mostly uni-dimensional but the variance explained by its main factor is relatively low. The total KIVPA score discriminates between adolescents with and without problems on the three criteria. Using a clinical YSR total problem score as criterion, sensitivity and specificity are 0.82 and 0.85, respectively, at the proposed cut-off (area under the ROC curve: 0.92; 95% confidence interval (CI) 0.90-0.95). The odds ratio of a clinical YSR score for an elevated KIVPA score is 29.1 (95% CI: 14.4-59.1), although the KIVPA mainly covers internalizing problems. CONCLUSION: The KIVPA has added value in the early detection of internalizing psychosocial problems, but is not sufficiently efficient.     

GP income in relation to workload in deprived urban areas in The Netherlands. Before and after the 1996 pay review

BACKGROUND: General practitioner workload is higher in deprived urban areas and for the elderly. This led to the introduction of additional GP payments regarding these patients, in the UK and in the Netherlands. This study examines whether this has resulted in more equal payment for work done in the Netherlands. METHODS: GP workload and income have been assessed on the basis of a survey among 1154 GPs (response: 62%). RESULTS: Suggest that total GP income is still lower in deprived areas, but per hour and per patient contact the additional payments gave equity. CONCLUSION: It is thus concluded that Dutch deprivation payments effectively compensate GPs in deprived areas for their higher workload.