RESUMO
OBJECTIVE: To evaluate pulmonary function and exercise capacity in children with myelomeningocele. STUDY DESIGN: Prospective evaluation in a randomly selected cohort of 12 subjects (10 to 17 years of age) with myelomeningocele and 12 control subjects matched for age, sex, and arm span. METHODS: Spirometry, lung volumes, maximum respiratory pressures, maximum oxygen expenditure during arm ergometry, and anaerobic threshold were measured. RESULTS: Mean total lung capacity and fractional lung volumes were significantly lower in case subjects than control subjects. Eleven subjects (92%) had a reduced forced vital capacity; seven (58%) had restrictive disease as evidenced by reductions in total lung capacity with normal or increased forced expiratory volume in 1 second/forced vital capacity ratio. Nine subjects (75%) had respiratory muscle weakness as evidenced by reduced maximum respiratory pressures or a low maximum voluntary ventilation. Exercise capacity was reduced as evidenced by a lower maximum oxygen consumption at peak exercise (13.8 +/- 4.8 vs 21.3 +/- 7.5 ml/min per kilogram of body weight; p < 0.02) and a lower anaerobic threshold (12.4 +/- 5.1 vs 17.3 +/- 4.2 ml/min per kilogram; p < 0.01) than the control group. Though the majority of subjects with myelomeningocele had a significant degree of restrictive disease, respiratory muscle weakness, or both, only one subject had pulmonary symptoms during exercise. CONCLUSIONS: Though most subjects with myelomeningocele had a significant degree of restrictive lung disease, respiratory muscle weakness, or both, exercise capacity was mostly limited by arm weakness. Skeletal muscle weakness may mask the symptoms of an underlying pulmonary abnormality, which may not be evident unless a pathologic cause of increased ventilation is present. Pulmonary function testing is suggested to screen for these abnormalities.
Assuntos
Tolerância ao Exercício , Pneumopatias Obstrutivas/etiologia , Meningomielocele/complicações , Meningomielocele/fisiopatologia , Insuficiência Respiratória/etiologia , Adolescente , Limiar Anaeróbio , Peso Corporal , Estudos de Casos e Controles , Criança , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Consumo de Oxigênio , Estudos Prospectivos , Capacidade VitalRESUMO
The purpose of this study was to determine the stated willingness of parents/caretakers to allow the administration of multiple, injected immunizations to their children at a single visit. Two hundred eighty-one parents/caretakers accompanying their children to an inner-city pediatric clinic were presented with hypothetical situations in which their children would be due for two, three, or four injections to complete their series of age-appropriate immunizations. Given a scenario of two needed injections, 24 (8.5%) of the 281 parents/caretakers preferred to divide the injections between two visits; for three injections, 119 (42.3%) preferred two visits; and for four injections, 164 (58.4%) preferred two visits. The commonly stated preference of our predominantly minority parent/caretaker population to divide more than two injections between two visits seriously conflicts with the US Public Health Service's National Vaccine Advisory Committee's recommendations and potentially exacerbates immunization delays. Therefore, physicians must be prepared to strongly urge simultaneous administration of all needed vaccine doses at any opportunity.
Assuntos
Atitude Frente a Saúde , Imunização/normas , Injeções/psicologia , Adulto , Distribuição de Qui-Quadrado , Feminino , Política de Saúde , Humanos , Imunização/psicologia , Lactente , Masculino , Grupos Minoritários , Pais/psicologia , Papel do Médico , Estados Unidos , População UrbanaRESUMO
OBJECTIVE: To compare the reading level required to understand childhood immunization information forms with the reading grade level of an inner-city parent/caretaker population. DESIGN: Descriptive study (parents/caretakers). SETTING: Inner-city pediatric clinic. PARTICIPANTS: One hundred fifty English-speaking, low-income parent/caretakers. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: The reading level of our parent population ranged from grades 2.9 to 13.3, with a median grade level of 6.90. The reading levels required for the three vaccine information pamphlets issued in 1992 by the Centers for Disease Control and Prevention (Atlanta, Ga) averaged 11.1 (approximately at the level of a high school junior). Eighty-six percent of our parents/caretakers did not have a reading level sufficient to cope with the easiest of the forms. CONCLUSIONS: The vaccine information pamphlets require a reading level beyond the capability of the vast majority of our parent population. Therefore, the goal of informed consent clearly is not being met.
Assuntos
Compreensão , Termos de Consentimento , Imunização , Consentimento Livre e Esclarecido , Folhetos , Consentimento dos Pais , Leitura , Populações Vulneráveis , Adolescente , Adulto , Cuidadores , Escolaridade , Feminino , Promoção da Saúde , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Pais , PediatriaRESUMO
Human immunodeficiency virus (HIV) is the cause of acquired immunodeficiency syndrome (AIDS). Encoded by the HIV genome are several precursor proteins that undergo proteolytic cleavage to yield functional proteins. The env precursor protein is cleaved by a cellular protease. The gag precursor protein of HIV (p55), however, is cleaved by a virally encoded aspartate protease (HIV Protease). Cleavage of p55 is required for viral maturation and infectivity. There are also several host cell aspartate proteases that serve important homeostatic functions. Cathepsins D and E are lysosomal aspartate proteases which are believed to play an important role in macrophage function, and it has been suggested that inhibition of these enzymes by an HIV protease inhibitor may exacerbate immunosuppression in AIDS patients. We have studied the effect of SK&F 107461 (a hydroxyethylene dipeptide isostere inhibitor of HIV protease), on various host defense functions of human monocytes. Pepstatin A (an inhibitor of most aspartate proteases) and leupeptin (an inhibitor of serine and cysteine proteases) were included as controls. Although less potent than the prototypic aspartate protease inhibitor pepstatin, SK&F 107461 inhibited partially purified cathepsin D in vitro. However, in cell-based assays, SK&F 107461 had no effect on the degradation of hemoglobin, antigen processing of the protein antigen streptokinase, or secretion of 17-kD IL-1 beta by monocytes at concentrations which inhibit maturation of intracellular virus in HIV infected monocytes. Furthermore, SK&F 107461 had no effect on constitutive candidacidal activity. In contrast, leupeptin and pepstatin A partially inhibited accessory cell function of monocytes in the proliferative response to the recall antigen streptokinase. In addition, leupeptin partially inhibited degradation of hemoglobin.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Inibidores da Protease de HIV/farmacologia , Monócitos/efeitos dos fármacos , Oligopeptídeos/farmacologia , Células Apresentadoras de Antígenos/efeitos dos fármacos , Candida albicans/imunologia , Catepsina D/antagonistas & inibidores , HIV-1/efeitos dos fármacos , HIV-1/crescimento & desenvolvimento , HIV-1/ultraestrutura , Humanos , Técnicas In Vitro , Interleucina-1/metabolismo , Macrófagos/efeitos dos fármacos , Macrófagos/microbiologia , Monócitos/imunologia , Monócitos/fisiologia , Fagocitose/efeitos dos fármacos , Proteínas/metabolismoRESUMO
Although children are being more frequently called as witnesses in court proceedings, they often do not tell the truth. If lying is defined as giving a false statement for personal gain, then lying is only one of several causes for children not giving an accurate account of events. Other reasons include an immature brain, a congenitally acquired defect in the central nervous system, or the presence of an emotional disturbance such as psychosis or hysteria. The desire of a child to please others--that is, parents, therapists, or lawyers--may also result in an invalid statement. These factors and motivations should be considered in trying to interpret a youngster's statement.