Percentile distributions of bone measurements in Iowa children: the Iowa Bone Development Study.

Four hundred twenty-eight white children (200 boys and 228 girls) ages 4.5-6.5 yr had spine, hip, and whole-body bone mineral density (BMD) and bone mineral content (BMC) measured by dual-energy X-ray absorptiometry(DXA) as part of the Iowa Bone Development Study. Anthropometric measurements, including height, weight, and body mass index (BMI) were determined for each child at the time the bone measurements were made. The age- and gender-specific height percentile based on the 2000 CDC Growth Charts (www.cdc.gov/growthcharts/) was determined for each child. These percentiles were used to classify children into four groups as defined by the 25th, 50th,and 75th percentile cutpoints. Percentile distributions were determined within each height quartile group to delineate percentiles (5th, 25th, 50th, 75th, 95th) for BMD and BMC. Gender differences in BMD and BMC were investigated before and after stratification into height groups. Boys had higher age-height-weight-adjusted means for most BMD and BMC measures except spine BMD. Bone measurements increased with height quartile, indicating that taller children have greater BMD and BMC compared to shorter children of the same age and gender. Within any given quartile,mean BMD and BMC measurements were similar for boys and girls, with the exception of hip BMD, for which values were consistently higher for boys (p < 0.05). In addition, whole-body BMC values were higher for boys in quartiles 1 and 3 (p < 0.05). These bone measures provide norms for young white children and serve as a reference for comparison with other racial and ethnic groups, as well as with childhood populations that are at risk for osteopenia because of chronic disease. Gender, age, and height are useful clinical predictors of BMD and BMC in young children.     

The epidemiology of myasthenia gravis in central and western Virginia.

We conducted a study of the epidemiology of myasthenia gravis (MG) in four locations in central and western Virginia from 1970 through 1984. The population surveyed was 555,851 in 1984. A total of 73 new cases of MG occurred during the survey period, producing an overall average annual incidence rate of 9.1 per million. The point prevalence rate in 1980 was 13.4 per 100,000, and in 1984 it was 14.2. Approximately 15% of the population was black, and we found that incidence and prevalence rates for the black population were higher than the corresponding white population. When the population was subdivided into <50 and 50+ age groups, the incidence and prevalence were significantly higher in the older group. The rates we report here are higher than rates reported from any other locality. The reasons for the higher rates include optimal case identification, survey of a population with a higher incidence, and increasing aging of the population.     

Head injury mortality in two centers with different emergency medical services and intensive care

The authors report data collected prospectively on 551 cases of head injury in New Delhi, India, and 822 cases in Charlottesville, Virginia. The mortality rate, adjusted for initial severity of injury, was 11.0% in New Delhi versus 7.2% in Charlottesville (p less than 0.02). There was a striking similarity in mortality rates at both centers when comparing patients with the least severe head injuries and those with the most severe injuries according to the motor score of the Glasgow Coma Scale (GCS M). However, in the group with an abnormal but purposeful motor response (GCS M = 5), the mortality rate was 12.5% in New Delhi versus 4.8% in Charlottesville (p less than 0.01). The relative absence of prehospital emergency care and the delay in admission after head injury in New Delhi are cited as two possible causes for the differences in mortality rates in this subgroup of patients with "moderate" head injuries.     

Inhibition of rat corneal angiogenesis by 16-kDa prolactin and by endogenous prolactin-like molecules.

PURPOSE: The cornea is an avascular organ, where induction of new blood vessels involves the turn-on of proangiogenic factors and/or the turn-off of antiangiogenic regulators. Prolactin (PRL) fragments of 14 kDa and 16 kDa bind to endothelial cell receptors and inhibit angiogenesis. This study was designed to determine whether antiangiogenic PRL-like molecules are involved in cornea avascularity. METHODS: Sixteen-kDa PRL and basic fibroblast growth factor (bFGF) or anti-PRL antibodies were placed into rat cornea micropockets and neovascularization evaluated by the optical density associated with capillaries stained by the peroxidase reaction and by the number of vessels growing into the implants. Prolactin receptors in corneal epithelium were investigated by immunocytochemistry. RESULTS: bFGF induced a dose-dependent stimulation of corneal neovascularization. This effect was inhibited by coadministration of 16-kDa PRL, as indicated by a 65% reduction in vessel density and a 50% decrement in the incidence of angiogenic responses. Corneal angiogenic reactions of different intensities were induced by implantation of polyclonal and monoclonal anti-PRL antibodies. Corneal epithelial cells were labeled by several anti-PRL receptor monoclonal antibodies. CONCLUSIONS: These findings show that exogenous 16-kDa PRL inhibits bFGF-induced corneal neovascularization and suggest that PRL-like molecules with antiangiogenic actions function in the cornea. PRL receptors in the corneal epithelium may imply that PRL in the cornea derives from lacrimal PRL internalized through an intracellular pathway. These observations are consistent with the notion that members of the PRL family are potential regulators of corneal angiogenesis.     

Biomechanical studies of a dynamized anterior thoracolumbar implant

STUDY DESIGN: An in vitro investigation into the biomechanical properties of a dynamized anterolateral compression implant that allows controlled subsidence. OBJECTIVES: To determine the extent to which both modes of the anterolateral compression implant (controlled collapsing and rigid) are able to reestablish the stability of the lumbar spine after L4 corpectomy. SUMMARY OF BACKGROUND DATA: Over time, anterior and posterior spinal implants have been associated with progressive angulation, and occasionally implant failure and breakage. To circumvent this occurrence and provide better graft loading, dynamized or collapsing devices for clinical use have been developed. METHODS: Eight fresh calf spines (L1-L6) were placed in a biomechanical testing frame. Pure moments of 6 Nm were loaded onto the intact spine in six directions: flexion, extension, right and left lateral bending, and right and left axial rotation. A total L4 corpectomy then was performed, and the defect grafted with a wooden dowel. Loading was repeated after the specimens were stabilized using the two modes of the anterolateral compression implant in succession. RESULTS: The results showed that both modes of the implant (the rigid mode in particular) restore the stiffness of the unstable spine to normal levels of flexion, extension, and right and left lateral bending, even to levels exceeding normal. These devices, however, fall short of achieving normal stability in right and left axial rotation. CONCLUSION: In the cadaveric calf spine after L4 corpectomy, restoration of stability with a dynamized anterior spinal implant is possible in flexion, extension, and right and left lateral bending, but not in axial rotation.     

Programa de atención farmacéutica integrada en pacientes con enfermedades crónicas

ObjectivesTo assess whether an integrated pharmaceutical care programme (IPCP) improves clinical evolution, patient quality of life, and reduces health costs in chronic patients.Material and methodsA parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up.ResultsWe had the participation of 8 different hospitals, 8 primary care centres, and 109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems (MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study.ConclusionsIntegrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network.     

Risk factors for domestic sporadic campylobacteriosis among young children in Sweden

A case-control study was conducted in Sweden to study risk factors for domestically acquired Campylobacter jejuni/coli infections among children aged less than 6 y. A total of 126 cases, reported to the national surveillance system were recruited over 1 y. Controls, selected from the population register, were matched to the cases by age, gender, place of residence and time of infection of the case. Information was gathered by posted questionnaires. Two separate conditional regression models were developed including and excluding 'protective' factors. Two of the factors significantly associated with Campylobacter infection were water-related: having a well in the household (OR=2.6) and drinking water from a lake/river (OR=7.4; 6.0). Other exposures associated with increased risk were: having a dog (OR=8.4; 3.8) and eating grilled meat (OR=5.5; 2.1). Drinking unpasteurized milk was borderline significant in 1 model (OR=3.7). Eating sausage was protective (OR=0.05). Eating chicken was not a significant risk. Exposures such as eating grilled meat and drinking water from a lake or a river were more common in the warm months, a factor that may partly explain the observed seasonality. The authors suggest that differences between risk factors across studies may reflect geographical and age-specific differences in the sources of infection.     

Confirmed interruption of indigenous measles transmission in Catalonia

From November 1998 to December 2000, 84 suspected measles cases were reported in Catalonia (6 090 040 inhabitants). Of the 73 laboratory tested cases (87%), 20 showed IgM antibodies specific to measles and 3 were epidemiologically linked to a confirmed case. Among these 23 confirmed cases, 13 were indigenous, the last two cases reported dating back from June 1999 and July 2000. These results confirm the success of the measles elimination programme implemented in 1998 in Catalonia.