Supplemental fitness activities and fitness in urban elementary school classrooms.

BACKGROUND: The physical activity levels of US children are declining. Opportunities for physical activity within city schools are constrained by time and space limits. This study determined whether a supplemental program of physical activity would significantly alter the fitness levels of low-income, minority, urban elementary schoolchildren. METHODS: Ninety-nine students from two Cleveland Public Schools served as subjects. One school received a 15-week intervention program where teams of two medical students met with urban elementary schoolchildren three times a week for physical activity sessions. The other school served as a control and received no supplemental activity other than a regularly scheduled physical education class held once a week. We obtained field measurements of skinfold thickness, heart rate response to submaximal exercise, and sit and reach flexibility. RESULTS: The supplemental activity group showed significant improvements in flexibility, body composition, and heart rate response to submaximal exercise. CONCLUSIONS: This investigation indicates that a program of fitness activities conducted within the classroom can significantly improve levels of fitness in urban elementary schoolchildren.

Obstetric analgesia.

Several analgesic options are available for patients during labor. Selection of the appropriate technique must be individualized. Education and preparation begins during prenatal care. If medications are to be used, the risks and benefits to the mother and infant must be considered. Continued patient-doctor communication throughout labor is essential. Patient preferences, tempered by sound medical judgement, should guide the selection of the optimal modality for pain control during labor.

Gas gangrene: potential for hyperbaric oxygen therapy.

Clostridial myonecrosis (gas gangrene) is an uncommon sequela of traumatic injury. Infection with Clostridium perfringens in devitalized tissue is the most common cause. Wide surgical debridement and appropriate antibiotic therapy remain the standard of care. However, the addition of hyperbaric oxygen therapy to standard management has been shown to have a synergistic effect in reducing morbidity and mortality in both canine and murine models. Although no prospective human data are available, retrospective data indicate that concomitant hyperbaric oxygen therapy has resulted in a twofold reduction in mortality. Where feasible, hyperbaric oxygen therapy should routinely be incorporated into the treatment plan for gas gangrene. Primary care physicians are in a unique position not only to make an early diagnosis but also to have a central role in coordinating multidisciplinary care often needed for this potentially fatal infection.

Streptokinase therapy. Recognizing and treating allergic reactions.

Streptokinase is an important component in the treatment strategy for acute myocardial infarction. However, physicians need to be aware that some patients may experience allergic reactions to this drug. Prompt recognition and appropriate management of symptoms usually result in recovery from the allergic event without further complication.

Ergogenic supplements and health risk behaviors.

OBJECTIVE: Our goals were to determine the prevalence of ergogenic supplement use in a young healthy population and to examine the extent to which supplement use is associated with specific health risk behaviors. STUDY DESIGN: We performed a cross-sectional survey. POPULATION: Individuals entering military service for enlisted training were included. OUTCOMES MEASURED: We recorded previous use of any nutritional ergogenic supplements and self-reported health risk behaviors. RESULTS: Of 550 eligible participants, 499 completed the survey (91% response rate). Individuals who used ergogenic supplements were more likely to drink alcohol (adjusted odds ratio [AOR]=1.8; 95% confidence interval [CI], 1.1-3.1), more likely to drink heavily (AOR=2.4; 95% CI, 1.5-3.9), more likely to ride in a vehicle with someone who had been drinking (AOR=2.2; 95% CI, 1.3-3.6), more likely to drive after drinking (AOR=2.4; 95% CI, 1.3-4.4), and more likely to have been in a physical fight (AOR=1.9; 95% CI, 1.0-3.5), compared with those who had not used supplements. Men were more likely to use supplements than women (P <.001). There were no differences in patterns of supplement use according to age or body mass index. CONCLUSIONS: Our study indicates an association between individuals who use ergogenic nutritional supplements and specific health risk behaviors. This represents an important opportunity for preventive counseling.

The maternal perspective on prenatal ultrasound.

BACKGROUND: Most women in the United States will have a routine sonogram during pregnancy. The medical necessity of this is debatable. The goal of our study was to examine maternal beliefs about prenatal sonography. METHODS: We surveyed 150 prenatal patients at their point of entry to maternity care at a large military medical center. The main outcome measures were the patient's desire for a prenatal sonogram, the reasons for wanting a sonogram, the number of sonograms wanted, and the patient's willingness to pay for the examination. RESULTS: Of the 150 eligible subjects, 137 (91%) participated and 135 (98%) wanted a prenatal sonogram. Fifty-one (37%) of the respondents were willing to pay for the sonogram if it was not ordered by their provider. The reasons for wanting a sonogram (to determine the sex of the fetus, to ensure that the fetus was healthy, general maternal reassurance, and to ensure adequate fetal growth) were similar across age, race, and income (military rank). CONCLUSIONS: Our study indicates that most women want a sonogram during pregnancy, and many are willing to pay for the examination. Women appear to want sonograms for reasons that may not assist their provider with immediate clinical decision making. This is a potentially important disagreement between cost-saving and patient satisfaction that maternity care providers must consider when deciding whether to perform prenatal sonography for women with low-risk pregnancies.

Deep venous thrombosis of the upper extremity.

Deep venous thrombosis (DVT) of the upper extremity is a relatively uncommon but important cause of morbidity, especially in young active persons. The causes of upper extremity DVT may be categorized as catheter-related, spontaneous (effort-related) and miscellaneous (e.g., trauma, intravenous drug use). Diagnosis is based on clinical history and confirmed by either duplex ultrasonography or contrast venography. Significant controversy surrounds the optimal management of upper extremity DVT. Treatment options include conservative therapy, anticoagulation, catheter-directed thrombolysis and surgical intervention to remove intravascular clot or revise the anatomy of the costoclavicular space. Early aggressive treatment of active young patients may decrease long-term morbidity.

Intrathecal narcotics for labor analgesia.

Intrathecal narcotics are a relatively recent addition to the list of analgesic options that are available for the management of labor pain. Pain during the first stage of labor is related to repetitive uterine contractions and resultant cervical dilatation, while pain during the second stage is due to stretching of the perineum. Traditionally, continuous epidural analgesia has been used as the reference standard for providing comfort during labor. Intrathecal narcotics represent a safe and effective alternative that provides significant, rapid relief of labor pain during the first stage of labor. The drugs most often used for intrathecal administration include sufentanil, fentanyl, meperidine and morphine. Use of intrathecal narcotics does not significantly affect the natural progression of labor, and no adverse fetal outcomes have been reported.

Case description of ascariasis.

Ascaris lumbricoides are among the medically important worms belonging to the phylum Nematoda (roundworms) that are parasites of the human gastrointestinal tract. Despite current sanitation and hygiene standards in the United States, infection due to intestinal roundworms is not uncommon in children and adults. A high index of suspicion is warranted as patients may present anywhere along a spectrum of illness from asymptomatic to acutely ill. The following is a case presentation and discussion of Ascaris lumbricoides, the common roundworm or intestinal longworm. Arch Fam Med. 2000;9:1193-1194