Quantitative vitreous fluorophotometry. A sensitive technique for measuring early breakdown of the blood-retinal barrier in young diabetic patients.

Vitreous and aqueous humor fluorescein concentrations were measured one hour after graded intravenous fluorescein was given to 20 juvenile diabetics, ages 20 to 40, with and without retinopathy, and to 12 controls of similar age. Vitreous fluorescein concentrations were significantly higher in diabetics, indicating breakdown of the blood-retinal barrier. Mean vitreous fluorescein values were 10.66 +/- 0.65 for the diabetics and 4.28 +/- 0.37 ng./ml. for the controls. Breakdown of the blood-retinal barrier was also confirmed in diabetics under the age of 20 without retinopathy. The blood-aqueous barrier was similarly altered in diabetics. Vitreous fluorophotometry quantitatively measures breakdown of the blood-retinal barrier, possibly the earliest detectable ocular vascular abnormality in juvenile diabetic patients.

Renal-resistant hormonoplethoric hypoparathyroidism with evidence for a defective response to cAMP.

A 15.5-yr-old black male is reported with hypocalcemia, hyperphosphatemia, and severe osteitis fibrosa cystica. While hypocalcemic and hyperphosphatemic, the circulating parathyroid hormone (PTH) level and urinary cAMP excretion were increased. An infusion of exogenous PTH produced a normal maximal excretion of urinary cAMP but failed to increase phosphate excretion. Correction of the hypocalcemia by administration of 200,000 U vitamin D daily lowered the endogenous PTH level and basal excretion of cAMP to normal; at that time, infusion of PTH produced both a normal rise in urinary cAMP and a normal phosphaturic response. This pattern of response suggests pseudohypoparathyroidism with a calcium-sensitive defect in renal phosphate transport distal to the PTH receptor adenyl cyclase mechanism, producing hyperphosphatemia, hypocalcemia, and secondary hyperparathyroidism. The osteitis fibrosa cystica was presumably due to the increased PTH, suggesting that resistance to PTH was present in kidney but not bone.

Decreased cortical thickness & osteopenia in children with diabetes mellitus.

A recent study using the photon absorption technique has revealed a high frequency of significant bone loss in diabetic adults regardless of age or duration of diabetes. In this study 107 diabetic children age 4-18 were studied using cortical bone thickness and skeletal maturation as indicators of bone development. Overall, 25% of all diabetic children had cortical thickness values below the five percent limit for normal children. This was more common in boys than girls and was unrelated to duration of diabetes. A modest increase in delayed skeletal maturation did not account for the cortical thinning and osteopenia observed. The cause of the osteopenia of diabetic children remains an enigma.

Vitreous fluorophotometry in juvenile-onset diabetes mellitus.

Vitreous fluorophotometry was carried out in 99 juvenile-onset, insulin-dependent diabetics and 31 control subjects. The mean vitreous fluorescein concentration one hour after intravenous administration of fluorescein, 7 mg/kg, was 5.4 +/- 0.3 ng/ml (mean +/- SEM) for controls and 9.5 +/- 0.4 ng/ml for diabetics (P less than .005). Diabetic patients with or without background retinopathy, when randomly matched for age or duration of their disease, had similar vitreous fluorophotometry measurements. The break-down of the blood-retinal barrier to fluorescein appears to be the earliest detectable ocular abnormality of diabetes.

Spine fusion for atlanto-axial instability.

A follow-up study was done on fifty-seven spine fusions for atlanto-axial instability, classified as Type I - deficient odontoid (twenty-eight patients), Type II - deficient ligaments (twenty-three patients), and Type III - rotatory fixation (six patients). The average age of the patients at the time of the fusion was thirty years, and half had had significant trauma. Symptoms had been present for an average of 12.3 months before fusion. Preoperatively pain was the predominant complaint in twenty-nine; neurological complaints, in twenty-four; and instability in the rest. Of the forty-six Gallie fusions, there was one non-union and of the eleven occipitocervical fusions, two non-unions. Follow-up averaging 4.2 years revealed resolution of symptoms in almost all patients.

Ethical decision making in managing trauma.

The major changes in health care delivery today further cloud the perspectives of patient autonomy, participation, and justice and the ideals of the virtuous practice of medicine. A Workable Integrative Negotiation approach with COAST permeating the medical setting and health agenda, however, can help promote effective and ethical participatory communication in medicine. Clearly, instituting such change in a non-surgical decision-making procedure requires a new culture among all participants. The case of traumatic injury provides an excellent back-drop for employing ethical decision making which in the long term can help usher in the most efficacious, ethical treatment for the individual, physician, and society. Additionally, today's omnipresent changes in medicine can help advance ethical directions in health-care decision making. For example adding ethical decision making and negotiation education in curricula for those in medicine, along with allied health professionals, and those who might become patient advocates or serve on ethics committees, can initiate a change in medical decision making. Full-fledged tort reform that allows all alternatives protects physicians and patients when the appropriate decision "to not treat or intervene" is rendered can be an important step toward a healthier society. Instituting an outcome-based reimbursement system among government and providers can serve as a quasi-selection process based on the superseding objectives of the community at large. Finally, a participatory citizenry (from physicians to patients to society-at-large) that balances violence prevention, communication, innovation, community involvement, and appropriate treatment could advance optimal civic health. The challenge is to initiate such change with the communication principles outlined herein.

Attaining global health: challenges and opportunities.

PIP: This issue of the Population Bulletin examines health trends in both developed and developing regions using health measures such as mortality and morbidity and the disability-adjusted life year. It also assesses the challenge of improving health worldwide. The authors proposed the following common denominators in the global challenge to improve health: 1) an individual's health status reflects the interplay of many factors such as the physical environment, political stability, and community structure; 2) direct correlation between the population's level of health and educational levels within that population; 3) prudent use of existing resources may contribute to a healthier public; 4) both public sector and private sector resources are vital for obtaining the best health possible; 5) effective infrastructure for health delivery requires fundamental changes in how governments and health system operate; and 6) policies to promote health are key components of community health efforts.^ieng

Effective Decision-making: A Negotiation Perspective for Health Psychology and Health Communication.

This article examines the critical role of communication and interpersonal negotiation in provider/consumer relations. Only through the use of strategic and competent communication can providers and consumers work cooperatively to make effective health-care decisions. A conflict resolution/shared negotiation model is presented to illustrate how communication can facilitate cooperative decision- making in health care. The model emphasizes cooperation, trust and mutual adaptation between providers and consumers. A case study is then presented to illustrate further the model and cooperative health-care decision-making processes.

Yogurt. Contributory factor in development of nutritional rickets.

Vitamin D deficient rickets occurred in a 15-month-old black girl for whom yogurt had been substituted for milk products. Investigation determined that commercially available yogurt contains no vitamin D, and that this fact is not generally recognized by lay persons and health professionals. Use of yogurt as a major source of nutritional intake in infants and young children may be a contributory factor in development of vitamin D deficiency rickets.

Health literacy: communication for the public good.

This article builds upon a presentation at the Fifth Global Health Conference on Health Promotion (Mexico City, 9 June 2000), seeking to advance the development of health literacy through effective communication. First, it offers a timely reflection for health promotion epistemology in particular, and the potential approach to framing health promotion activities in general, with health literacy as a bridging concept. The concept of health literacy is briefly explained and defined, followed by identification of some promising communication interventions to diffuse health literacy. Four predominant areas within the communication field are described that shed light on approaches for developing health literacy: integrated marketing communication, education, negotiation and social capital. Each component can contribute to strategic science-based communication. Finally, the article elucidates that communication and developing health literacy are not simple solutions. Communication is not simply message repetition, but includes the development of an environment for community involvement to espouse common values of humankind. With effective communication, worldwide health literacy can become a reality in the 21st century, embodying health as a central tenet of human life.

Misled and confused? Telling the public about MMR vaccine safety. Measles, mumps, and rubella.

The extraordinary events surrounding the measles, mumps, and rubella (MMR) vaccine in the United Kingdom have not only placed in jeopardy the use of this triple vaccine but have also spread concern to other parts of the world. Examination of the public's worry about MMR vaccine reveals they have been exposed to a range of conflicting views resulting in the feeling of having been misled about the safety of the vaccine. There are various groups and individuals who have legitimate roles in informing the public about such subjects. But is each one behaving in an ethically responsible way? And if confidence falters, vaccine coverage dips, and an outbreak of measles, mumps, or rubella ensues, who, if anyone, will stand and say "I misled them, I confused them, this is my responsibility"? We examine the ethical issues of each group with a voice in the debate about vaccine safety.

The status and scope of health communication.

We examine the field of health communication with a multimethodological analysis, presenting a brief historical synopsis of the academic literature as well as the results of a survey administered to academicians who identified communication and health to be major fields of interest. After this descriptive backdrop of health communication, we offer a prescription for an ideal health communicator--that is, one with an interdisciplinary background--to use ethical, persuasive means to craft, deliver, and evaluate campaigns that promote good health and disease prevention; to plan, influence, and implement health policy; and to employ ethical decision making that will enhance the quality of life for individuals and communities throughout the globe.

Concerns of children with a chronic illness: a cognitive-developmental study of juvenile diabetes.

Chronically ill children become increasingly able to understand their illnesses as they develop intellectually. But cognitive development also brings the ability to grasp the meaning of a poor prognosis or functional limitations, which may take an emotional toll on the youngster. We studied this problem in a sample of children with insulin-dependent diabetes. Those who had more advanced disease concepts were more worried about their diabetes. Children saw their parents as worried primarily about current management of the disease, suggesting that youngsters' concerns about the future were difficult to discuss at home. There is a need for clinicians and parents to integrate emotional support into the education and management of chronically ill children.

Radioimmunoassay for type I procollagen in growth hormone-deficient children before and during treatment with growth hormone.

Type I procollagen concentrations were measured by radioimmunoassay in sera from 14 growth hormone-deficient children before and during 12 months of treatment with human growth hormone. Basal procollagen levels were lower than those of control children and comparable to those of normal adults. With treatment, the mean procollagen level increased into the range of the control children and was significantly greater than the baseline level at 1, 2, 3, and 12 months (p less than 0.01; p less than 0.05). Although there was no significant statistical correlation between the growth velocity during treatment and the serum procollagen level, there was a suggestion that a high basal procollagen may be predictive of a less than optimal response to human growth hormone.

Russell-Silver syndrome and hypopituitarism. Patient report and literature review.

Russell-Silver syndrome (RSS) is a sporadic form of prenatal onset dwarfism with typical facial features, variable asymmetry, and linear growth 3 to 4 SDs below the mean. Endocrinologic studies are usually normal; however, six cases of RSS with growth hormone deficiency have been reported, three of which had additional pituitary abnormalities. We describe another case, a 7-year-old girl with RSS and deficiencies of growth hormone, corticotropin, and thyroid-stimulating hormone. Replacement therapy including growth hormone resulted in an improved growth velocity, though twice the usual dose of growth hormone was required and short stature persisted. Since growth hormone secretion is usually normal in RSS, the existence of individuals with RSS phenotype and hypopituitarism including growth hormone deficiency suggests etiologic heterogeneity. We recommend that those individuals with RSS phenotype and a continuous significant decline in height velocity be investigated for pituitary abnormalities. Unusually high replacement doses of growth hormone may be required to overcome deficiency.

An assessment of the health communication job market across multiple types of organizations.

This study seeks to answer three questions: (1) What is the employment outlook for health communication practitioners? (2) What specialized knowledge and skills should a competent health communication practitioner possess? and (3) How much academic training or professional experience is necessary to become a competent health communication practitioner? To this end, 104 employers of health communication practitioners, representing different types of large, medium, and small companies and organizations from various regions of the United States, were interviewed by telephone. The interview protocol was based on nine core health communication responsibilities identified by a working group of health communication academicians and practitioners. The study suggests a positive employment outlook, where those seeking jobs in health communication before the year 2000 could enjoy varied job opportunities in the wake of an anticipated moderate expansion in the field. Those with 1 to 10 years of experience are most in demand. While an undergraduate degree provides an academic background to perform most responsibilities, for six of the nine core responsibilities an advanced degree was preferred by at least one-third of respondents.

Relationship of somatomedin-C concentration to bone age in boys with constitutional delay of growth.

Serum somatomedin-C (Sm-C) levels increase sharply during puberty, leading to difficulty in the interpretation of Sm-C values obtained from children who exhibit a discrepancy between chronological age (CA) and pubertal development. To evaluate the utility of assessing Sm-C levels on the basis of bone age (BA), we measured serum Sm-C levels in 44 boys with constitutional delay of growth (CDG). Levels of Sm-C were compared with the normative data of the Nichols Institute Reference Laboratories (NIRL), Los Angeles, by age category, substituting BA for CA. We found the mean Sm-C level in boys with CDG to be lower than that for NIRL normal subjects in each age category for both CA and BA, but the regression curve for Sm-C levels based on BA more closely approximated the NIRL regression curve than did the curve based on CA. The rise in Sm-C levels observed in NIRL normal subjects between CA 13 to 14 years is delayed in boys with CDG until CA 15 to 17 years only when a correction for BA is not made. We conclude that in boys with CDG, Sm-C levels should be interpreted on the basis of BA rather than CA, especially during the peripubertal period. The observation of blunted Sm-C levels in all age categories, even when BA was used, suggests that short children with presumed CDG may be at high risk for a "nonclassic" form of growth hormone deficiency.