The increasing impact of arthritis on public health.

Age is the most powerful risk factor for osteoarthritis (OA) in the United States. It is estimated that 68% of individuals older than 55 years have radiographic evidence of OA. The US is growing older--the over-65 age group represented only 4% of the population in 1900, but accounted for 12.4% in 1988, and is projected to account for 22% by the year 2030. As the age of our population has increased, so has the prevalence of arthritis. About 43 million individuals (1 in 6) have arthritis, and most are older than 45 years. By the year 2020, 59.4 million persons in the US will be affected by arthritis, thus increasing chronic disability and costs by more than 25%. The annual cost to society in medical care and lost wages is currently estimated to be $65 billion, and is projected to escalate to $95 billion by the year 2000. Physicians who provide care for the increased number of patients with arthritis in the 21st century must be aware of improved therapeutic modalities to reduce arthritis related disabilities, hospitalizations, and complications related to therapy, to minimize the risk of adverse drug reactions, and to preserve function.

The report of the Surgeon General: preventing tobacco use among young people.

This year's surgeon general's report on smoking and health is the first such report to focus on young people. From extensive data that indicate that tobacco use is a pediatric epidemic, the report reached six major conclusions: (1) Nearly all first use of tobacco occurs by age 18. (2) Most adolescent smokers are addicted to nicotine. (3) Tobacco is often the first drug used by young people who subsequently use illegal drugs. (4) There are identified psychosocial risk factors for the onset of tobacco use. (5) Cigarette advertising also appears to increase young people's risk of smoking. (6) Communitywide efforts have successfully reduced adolescent use of tobacco. This commentary restates each of the six conclusions, summarizes the data that support each, and then considers the implications of the conclusions for public health action.

School-based clinics and the pediatric nurse: an interview with Surgeon General designee M. Joycelyn Elders. Interview by Judith E. Vessey and Margo N. Swanson.

Among Dr. Joycelyn Elders' goals as Surgeon General is to work toward a national school-based clinic program. In this interview, she speaks with Pediatric Nursing regarding the implementation of school-based clinics in Arkansas, arguments for and against school-based clinics, the financial responsibility for these clinics, and the role of pediatric nurses in this segment of health care reform.

Portrait of inequality.

America's children are stalked by race- and income-based inequities that demand our attention. Health care reform efforts that respect the needs of the entire child can diminish these inequities. Six prescriptions will help: universal early childhood education; comprehensive health and family life education; parental support; reinforcement of male responsibility; comprehensive school-based clinics; and opportunities for higher education.

Glomerulopathy in patient with Donohue syndrome (leprechaunism).

OBJECTIVE: To evaluate renal structure in a child with Donohue syndrome (leprechaunism), who at 10 yr of age was noted to have hypertension, microalbuminuria, and enlarged kidneys, a renal biopsy was performed. RESEARCH DESIGN AND METHODS: The renal biopsy tissue was evaluated by light and electron microscopy with standard stereological techniques to measure glomerular volume, glomerular basement membrane width, fractional mesangial volume, and peripheral capillary filtering surface density. RESULTS: On renal biopsy, there was a marked increase in glomerular volume, glomerular basement width, and mesangial volume, findings similar to those seen in patients with diabetic nephropathy. CONCLUSIONS: This patient with marked insulin resistance associated with Donohue syndrome demonstrates renal and glomerular enlargement and morphometric glomerular changes similar to those seen in patients with diabetic nephropathy. In unusual syndromes with hyperglycemia and hyperinsulinemia, renal structural and functional changes typical of traditional diabetes mellitus may be seen.

Adolescent health issues: what is our role?

PIP: The state of US children's health and recommendations for improvement are reported. The 1st table identifies youth as risk, i.e., at the current rate, 1 in 10 women will give birth by the time they turn 18. Among black children, white children 1-4 years, and blacks 15-24 years, death rates actually increased from 1985 to 1987. Injuries, particularly due to violence, have replaced communicable diseases as the primary cause of death among adolescents. Since 1976, immunization has deteriorated. There is a refusal to recognize sexually active adolescents, in spite of 2.5 million cases of sexually transmitted disease. The 6 strategies discussed intervention begin with providing high quality preschool education programs for all children. The 2nd urges educational programs from kindergarten through 12th grade that help children make healthy choices, improve their self-esteem, and accept as much responsibility for their own lives as possible. Parenting education, as the 3rd strategy, promotes the education and support of parents, especially for young and poor parents. The 4th strategy involves male responsibility and instruction on obligations in pregnancy and parenthood, including a requirement of financial commitment from fathers and identification of the father by Social Security number on an infant's birth certificate. The 5th strategy is the provision for school-based health services, including family life counseling and contraceptive services for adolescents. The 6th strategy is to provide free college tuition and books at a state supported school for students with at least a B average, good citizenship record, and a family income of $20,000. It is cheaper to offer children opportunity than to pay the costs of the consequences of poverty.^ieng

Hypertrophy of clitoral hood: presenting sign of neurofibromatosis in female child.

Although clitoral involvement with neurofibromatosis is rare, all cases previously reported have described clitoral hypertrophy due to neurofibromas of the clitoral corpora. We report on a patient who had localized enlargement of the prepuce only, with no evidence of neurofibromatous infiltration. In all cases, diagnosis of clitoromegaly requires basic chromosomal and endocrinologic evaluation. However, recognition of its association with neurofibromatosis due to either neurofibromas of the genitalia or localized genital hypertrophy may spare the patient an unnecessary or invasive evaluation. Because of an association with urinary tract neurofibromas, the patient with genital involvement should have cystoscopy. Clitoroplasty with sparing of the neurovascular bundle and glans is the preferred method of management of the enlarged clitoris.

Effects of dideoxyforskolin on proteoglycan synthesis and structure in embryonic chick chondrocyte cultures.

1,9-Dideoxyforskolin inhibits proteoglycan synthesis and xyloside-initiated glycosaminoglycan (GAG) synthesis in chick embryo chondrocytes. Dideoxyforskolin does not affect the length of xyloside-initiated GAG chains secreted into the medium but chains from the dense proteoglycan secreted into the medium appear slightly longer. Incorporation of labeled serine into the dense proteoglycan and subsequent digestion with Pronase revealed a dramatic decrease in percent of total radioactivity associated with GAG chains in the proteoglycan from cultures treated with forskolin or dideoxyforskolin. These observations suggest that these diterpenes have a specific inhibitory effect on chain initiation reactions and thus may be useful tools in the study of proteoglycan synthesis and processing.