RESUMO
STUDY OBJECTIVE: Oral contraceptive pills (OCs) are a commonly prescribed method of birth control for sexually experienced adolescents. The purpose of the current study was to describe anticipated parental involvement and adolescent compliance with pill taking, and to describe experiences with a 20-mcg OC regarding satisfaction and side effects after six cycles. DESIGN: Anticipated parental involvement and anticipated compliance, and experiences with an OC, were assessed at baseline, and after the first and sixth cycles during a clinical trial of oral contraceptives, which required parental consent. SETTING: Three adolescent medicine clinics in New York, NY; Cincinnati, OH; and San Juan, Puerto Rico. PARTICIPANTS: The sample consisted of 43 female adolescents with a mean age of 17 years. RESULTS: The majority of adolescents living with a parent anticipated parental involvement, and few adolescents anticipated difficulties with consistent pill taking. For two side effects (weight and mood changes), more than 30% of the adolescents anticipated the occurrence or worsening of side effects. However, few adolescents actually experienced increases in any of the nine side effects assessed. Ninety-seven percent of adolescents in this trial reported being satisfied with a 20-mcg OC. CONCLUSIONS: Health care providers can assess adolescents' anticipated difficulties with compliance with daily pill taking, and desire for help from their parents. This information can be incorporated into counseling to promote consistent and correct use.
Assuntos
Anticoncepcionais Orais Combinados , Etinilestradiol/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Levanogestrel/administração & dosagem , Cooperação do Paciente , Adolescente , Comportamento do Adolescente , Serviços de Saúde do Adolescente , Adulto , Feminino , Humanos , Cidade de Nova Iorque , Ohio , Relações Pais-Filho , Porto RicoRESUMO
To determine whether unstimulated urine samples could be used to identify children needing chelation therapy for lead poisoning, we compared urinary lead excretion with and without chelation. A convenience sample of 39 children was admitted to a pediatric clinical research center for therapeutic chelation. Urine was collected for 24 hours on 2 consecutive days. Edetate disodium calcium, 1000 mg/m2, was given intramuscularly in two divided doses on the second day. Significant correlations existed between urinary lead excretion (PbU) on the control day at 12- and 24-hour collection intervals and on the first day of chelation (p less than 0.0001). Published criteria for positive edetate disodium calcium provocative tests were used to calculate corresponding cutoff points for unstimulated 24-hour PbU. Resultant PbU values ranged from 10.4 to 35.6 micrograms (0.05 to 0.17 mumol). When PbU was expressed in terms of creatinine excretion, cutoff points of 0.06 and 0.19 microgram PbU/mg creatinine were determined, making possible the use of random unstimulated samples to assist in the identification of children in need of chelation.
Assuntos
Terapia por Quelação , Ácido Edético , Intoxicação por Chumbo/terapia , Chumbo/urina , Criança , Pré-Escolar , Creatinina/urina , Humanos , Lactente , Intoxicação por Chumbo/sangue , Intoxicação por Chumbo/urina , Monitorização Fisiológica , Valor Preditivo dos Testes , Protoporfirinas/sangueRESUMO
Seventy-one very low birth weight (less than or equal to 1500 gm) infants were studied to determine the sequential changes in serum vitamin D metabolite concentrations between infants with and without radiographically documented rickets, fractures, or both (R/F). Usual intake of vitamin D included 20 IU/kg/day from parenteral nutrition or 400 IU/day supplementation with enteral feeding. Radiographs of both forearms and serum samples were obtained at 3, 6, 9, and 12 months. Twenty-two infants had R/F. At 3 months, significantly lower mean (+/- SEM) serum phosphorus levels (4.5 +/- 0.4 vs 6.1 +/- 0.2 mg/dl), higher 1,25-dihydroxyvitamin D (1,25-[OH]2D) concentrations (96 +/- 5 vs 77 +/- 4 pg/ml), and higher free 1,25-(OH)2D index (1,25-[OH]2D:vitamin D binding protein ratio; 5.2 +/- 0.3 x 10(5) vs 4.0 +/- 0.2 x 10(5] were found in the R/F group. These values returned to normal and were similar between groups on subsequent measurements. Serum calcium, magnesium, and 25-hydroxyvitamin D (25-OHD) concentrations were normal and similar between groups. In both groups, serum vitamin D binding concentrations increased initially but remained stable and normal beyond 6 months. We conclude that in very low birth weight infants with R/F, the vitamin D status (as indicated by serum 25-OHD concentrations) is normal, and that lowered serum phosphorus levels, higher serum 1,25-(OH)2D levels, and a higher free 1,25-(OH)2D index support the thesis that mineral deficiency (especially of phosphorus) may be important in the pathogenesis of R/F in small preterm infants.
Assuntos
Calcifediol/sangue , Calcitriol/sangue , Fraturas Ósseas/sangue , Recém-Nascido de Baixo Peso/sangue , Raquitismo/sangue , Proteína de Ligação a Vitamina D/sangue , Nutrição Enteral , Fraturas Ósseas/complicações , Humanos , Recém-Nascido , Nutrição Parenteral , Estudos Prospectivos , Raquitismo/complicações , Vitamina D/administração & dosagemRESUMO
The response to aluminum loading from parenteral nutrition (PN) solutions was determined in 20 infants with gestational ages 29 to 41 weeks and birth weights 880 to 3630 gm. Mean duration of PN was 43 days (range 5 to 175 days). Ten infants received a high Al load (from an experimental high calcium- and phosphorus-containing PN solution, with a measured Al content of 306 +/- 26 micrograms/L (mean +/- SE), n = 11), for up to 6 weeks. Ten infants received a lower Al load (from standard Ca-P solutions, measured Al content 144 +/- 16 micrograms/L, n = 11). Five infants received PN with a low Al load for longer than 6 weeks. The mean urine Al/creatinine (Cr) ratio (micrograms/mg) increased threefold, from 0.3 +/- 0.09 to 0.97 +/- 0.17 during PN in the entire group (P less than 0.001), and was significantly higher in infants who received greater Al loading (P less than 0.001). There was no significant difference between preterm and term infants in the rate of change in urine Al/Cr during the study. Urine Al was calculated to account for less than 50% of Al load. During the study, serum Al concentrations ranged from 6 to 318 micrograms/L (median 37 micrograms/L, compared with the median 18 micrograms/L for normal infants and children). Serum Al concentrations were not significantly changed during the study, or between infants in high or lower Al loading groups. Vertebrae from autopsy of two infants who received the lower Al containing PN for 71 and 152 days, respectively, stained positive for Al at the bone mineralization front. Thus, currently used PN solutions are contaminated with Al, urine Al concentration is higher with higher Al loading, and is not different in term and preterm infants. We suggest that renal elimination of Al in infants is incomplete, as assessed by lower urine Al excretion versus load, elevated serum Al concentration, and bone deposition of Al.