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1.
Violence Vict ; 35(2): 160-175, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-32273375

RESUMEN

Recent research has pointed to the need for systematic law enforcement training on domestic violence when nonfatal strangulation is involved to improve evidence-based prosecution of these potentially deadly assaults; however, virtually no research has examined the legal response to nonfatal strangulation since many states have made it a separate criminal felony. The current exploratory study examines filing, charging, and adjudication decisions of nonfatal strangulation cases over a 3-year period based on evidence documentation in law enforcement reports to explore how these cases are handled by the criminal justice system in Brevard County, Florida. Results support previous research showing the importance of training police officers and other personnel as insufficient evidence may be one possible factor limiting the prosecutors' ability to successfully prosecute domestic violence strangulation offenders to the highest extent available under the law. Implications spread across multiple disciplines.


Asunto(s)
Asfixia , Violencia Doméstica , Aplicación de la Ley , Víctimas de Crimen , Violencia Doméstica/legislación & jurisprudencia , Florida , Humanos , Policia
2.
J Pediatr ; 212: 172-179.e1, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31227282

RESUMEN

OBJECTIVE: To understand whether spontaneous vs induced puberty and the type and route of estrogen influence the height of girls with Turner syndrome on growth hormone (GH). STUDY DESIGN: Search of an international database of children treated with GH revealed 772 girls with Turner syndrome followed from GH initiation to near adult height. Data from girls with sustained spontaneous puberty (n = 145) were compared with those requiring estrogens for induction or maintenance of puberty (n = 627). RESULTS: At GH start, mean age (7.5 vs 7.9 years), weight (-1.7 vs -1.7 SDS), and body mass index (0.2 SDS vs 0.1 SDS) were similar for girls with spontaneous puberty and with induced puberty. Although those girls with spontaneous puberty were shorter than those with induced puberty, when midparental height was taken into consideration, starting heights in both groups averaged -2.8 SDS. Both groups received approximately 0.3 mg/kg/week of GH. Girls with spontaneous puberty initiated puberty and reached near adult height earlier than girls with induced puberty (12.6 ± 1.8 years vs 13.4 ± 1.4 years and 16.0 ± 1.3 years vs 16.9 ± 1.4 years, respectively). Although girls with spontaneous puberty grew more in the first year of GH therapy and between the onset of puberty and near adult height (11.0 cm vs 9.3 cm), height SDS at near adult height and the length of time in puberty before reaching near adult height were comparable. A 45,X karyotype was detected in 22.1% of girls with spontaneous puberty and in 58.4% of girls with induced puberty. Patients receiving transdermal estrogens did not grow better than those on oral estrogens. Adverse event reporting was comparable between groups. CONCLUSIONS: Girls with Turner syndrome with spontaneous puberty tended to grow better in response to GH than girls with induced puberty, but not enough to produce a difference in height SDS at near adult height.


Asunto(s)
Estatura , Hormona de Crecimiento Humana/uso terapéutico , Pubertad , Síndrome de Turner/tratamiento farmacológico , Adolescente , Adulto , Niño , Femenino , Humanos , Pubertad/efectos de los fármacos , Pubertad/fisiología , Síndrome de Turner/fisiopatología
3.
Endocr Pract ; 24(6): 517-526, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29624099

RESUMEN

OBJECTIVE: Understanding of acromegaly disease management is hampered in the U.S. by the lack of a national registry. We describe medical management in a population with confirmed acromegaly. METHODS: Inpatient and outpatient electronic health records (EHRs) were used to create a database of de-identified patients assigned the Acromegaly and Gigantism International Classification of Diseases, 9th revision (ICD-9) code and/or an appropriate pituitary procedure code at 1 of 4 regional hospital systems over a 6- to 11-year period. Information regarding demographics, medical history, labs, procedures, and medications was collected and supplemented with a chart review to validate the diagnosis of acromegaly. RESULTS: Of 367 patients with validated acromegaly, available records showed that during the years studied, pituitary surgery was performed on 31%, 4% received radiosurgery, and 22% were prescribed a drug indicated for acromegaly. Insulin-like growth factor-1 (IGF-1) levels were measured in 62% of patients, 83% of whom had at least 1 normal value. Coded comorbidities reflect those reported previously in patients with acromegaly, with the exception of esophageal reflux in 20% of patient records. Fewer data regarding acromegaly-specific medications and testing were available for patients aged 65 and older. CONCLUSION: AcroMEDIC is a U.S. multisite retrospective study of acromegaly that captured medical management in the majority of patients included in the cohort. Chart review highlighted the importance of verification of coded diagnoses. Most of the acromegaly-related comorbidities identified here are known to increase with age and obesity. Patients ≥65 appeared to have less active management/monitoring of their disease. Medical attention should be directed to this population to address evolving needs over time. ABBREVIATIONS: AcroMEDIC = Acromegaly Multisite Electronic Data Innovative Consortium; BMI = body mass index; CCI = Charlson Comorbidity Index; EHR = electronic health record; GH = growth hormone; GHRA = growth hormone receptor antagonist; ICD-9 = International Classification of Diseases, 9th revision; IGF-1 = insulin-like growth factor-1; SSA = somatostatin analogue.


Asunto(s)
Acromegalia/terapia , Registros Electrónicos de Salud , Enfermedades Raras/terapia , Acromegalia/sangre , Acromegalia/diagnóstico , Adulto , Factores de Edad , Anciano , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Factor I del Crecimiento Similar a la Insulina/análisis , Masculino , Persona de Mediana Edad , Enfermedades Raras/diagnóstico
4.
Aust Occup Ther J ; 61(6): 446-57, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25308316

RESUMEN

BACKGROUND/AIM: Occupational therapists working in brain injury rehabilitation are required to use the skill of advocacy to ensure that people with a brain injury have the right to engage in their chosen occupations. However, no studies were found exploring the use of advocacy by occupational therapists working in brain injury rehabilitation. To investigate how occupational therapists working in brain injury rehabilitation defined and implemented the skill of advocacy when working with clients. METHOD: Interpretative phenomenological analysis was used to guide planning, data collection and analysis. Thirteen occupational therapists from six NSW metropolitan, regional and rural brain injury rehabilitation units participated in semi-structured interviews. All interviews were transcribed and member-checked prior to in-depth idiographic, inductive and interrogative analysis of each transcript. FINDINGS: Participants identified the key elements of advocacy as the representation and education of clients and significant others. They indicated that all brain injury rehabilitation workers used advocacy when working with their clients, but were unable to identify unique ways that occupational therapists used advocacy when compared with other brain injury rehabilitation staff. However, they all felt that occupational therapists were well suited to advocate for clients in brain injury rehabilitation settings. CONCLUSION: Although participants had difficulty identifying unique ways in which occupational therapists used advocacy in brain injury rehabilitation settings, they all agreed that advocacy was an important skill for occupational therapists to develop and implement.


Asunto(s)
Actitud del Personal de Salud , Lesiones Encefálicas/rehabilitación , Terapia Ocupacional/métodos , Defensa del Paciente/normas , Humanos , Entrevistas como Asunto , Nueva Gales del Sur , Terapia Ocupacional/normas , Relaciones Profesional-Familia , Relaciones Profesional-Paciente , Investigación Cualitativa
5.
Clin Endocrinol (Oxf) ; 79(2): 178-84, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23278636

RESUMEN

OBJECTIVE: Growth hormone (GH) replacement may increase bone mineral density (BMD) in GH-deficient (GHD) adults. The goal of this study was to identify predictors of BMD response to GH replacement in GH naïve adults. DESIGN AND MEASUREMENTS: This was a retrospective analysis of data extracted from KIMS (Pfizer International Metabolic Database), an international pharmacoepidemiological survey of adult GHD patients from 31 countries. PATIENTS: A total of 231 GH naive adults were identified (115 women and 116 men) who had BMD measured on the same densitometer in the lumbar spine (LS) and/or femoral neck (FN) both at baseline and after 4 years of GH replacement. RESULTS: After 4 years, there was a median (10th, 90th percentile) 4·6% (-5·2%, 12·2%) increase in LS BMD over baseline (P = 0·0001). There was a positive correlation between per cent change in LS BMD and age at the onset of pituitary disease (r = 0·25, P = 0·001). There was no change in FN BMD over baseline [0·0% (-7·3%, 8·5%)]. On multivariate analysis, older age at the onset of pituitary disease predicted a greater increase in LS BMD on GH replacement (r = 0·55, P < 0·0001). CONCLUSIONS: In a population of GH naïve adults, GH replacement led to a significant increase in LS BMD over baseline, but no change in FN BMD. The potential for greater BMD improvement on GH replacement therapy in adults with disease of later onset should be considered when making treatment decisions in this patient population.


Asunto(s)
Densidad Ósea , Hormona de Crecimiento Humana/deficiencia , Hormona de Crecimiento Humana/uso terapéutico , Vértebras Lumbares/metabolismo , Adulto , Edad de Inicio , Bases de Datos Factuales , Femenino , Cuello Femoral/diagnóstico por imagen , Cuello Femoral/metabolismo , Terapia de Reemplazo de Hormonas , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos
6.
Proc Natl Acad Sci U S A ; 105(49): 19348-53, 2008 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-19047632

RESUMEN

Allen's Rule documents a century-old biological observation that strong positive correlations exist among latitude, ambient temperature, and limb length in mammals. Although genetic selection for thermoregulatory adaptation is frequently presumed to be the primary basis of this phenomenon, important but frequently overlooked research has shown that appendage outgrowth is also markedly influenced by environmental temperature. Alteration of limb blood flow via vasoconstriction/vasodilation is the current default hypothesis for this growth plasticity, but here we show that tissue perfusion does not fully account for differences in extremity elongation in mice. We show that peripheral tissue temperature closely reflects housing temperature in vivo, and we demonstrate that chondrocyte proliferation and extracellular matrix volume strongly correlate with tissue temperature in metatarsals cultured without vasculature in vitro. Taken together, these data suggest that vasomotor changes likely modulate extremity growth indirectly, via their effects on appendage temperature, rather than vascular nutrient delivery. When combined with classic evolutionary theory, especially genetic assimilation, these results provide a potentially comprehensive explanation of Allen's Rule, and may substantially impact our understanding of phenotypic variation in living and extinct mammals, including humans.


Asunto(s)
Regulación de la Temperatura Corporal/fisiología , Temperatura Corporal/fisiología , Cartílago/fisiología , Huesos Metatarsianos/fisiología , Adaptación Fisiológica/fisiología , Animales , Animales no Consanguíneos , Cartílago/irrigación sanguínea , Cartílago/crecimiento & desarrollo , Masculino , Huesos Metatarsianos/irrigación sanguínea , Huesos Metatarsianos/crecimiento & desarrollo , Ratones , Ratones Endogámicos C57BL , Técnicas de Cultivo de Órganos , Flujo Sanguíneo Regional/fisiología , Temperatura
7.
J Natl Med Assoc ; 101(7): 690-7, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19634590

RESUMEN

PURPOSE: The purpose of this study was to develop and test the efficacy of a prostate health curriculum designed to train African American and Afro Caribbean barbers to deliver prostate cancer control messages to their customers. PROCEDURES: The curriculum was drafted from information obtained from needs assessment surveys administered to barbers and customers from various barbershops in Brooklyn, New York. Focus groups were conducted to further inform the curriculum, which was pilot tested in training sessions. FINDINGS: The high incidence of late-stage diagnosis prostate cancer in African Americans has often been attributed to lack of screening. In surveys administered to 92 customers and 19 barbers, only 26% of customers and 42% of barbers reported having some knowledge of the prostate-specific antigen (PSA) screening test. More than 90% of the barbers expressed a willingness to obtain prostate cancer information to specifically share with their customers, and 83% of customers expressed an interest in obtaining prostate cancer information and willingness to receive that information from their barbers. Following the pilot training, barber knowledge of prostate cancer increased significantly (p < .0001). CONCLUSIONS: This pilot study suggests that there is a need for intervention programs that will raise awareness and increase prostate health knowledge and behavior in communities with elevated incidence of prostate cancer. The study further suggests that barbers are willing to use their leadership skills to educate and encourage their customers to engage in informed decision making.


Asunto(s)
Peluquería , Negro o Afroamericano , Educación en Salud , Neoplasias de la Próstata/prevención & control , Región del Caribe/etnología , Curriculum , Humanos , Masculino , Ciudad de Nueva York , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Recursos Humanos
8.
J Health Care Poor Underserved ; 19(1): 216-26, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18263997

RESUMEN

OBJECTIVES: To assess the effectiveness of breast health promoting messages administered by salon stylists to clients in the salon setting. METHODS: Forty salons in an urban, minority area were randomly assigned to provide messages to clients or to serve as controls. Pre-intervention surveys were completed by 1,185 salon clients. Following program initiation, assessments of 1,210 clients were conducted. RESULTS: Among women completing surveys at control salons, 10% reported exposure to breast health messages, as opposed to 37% at experimental salons (OR 5.4, 95% CI 3.7-7.9). Self-reported exposure to stylist-delivered messages was associated with improved breast self-examination rates (OR 1.6, 95% CI 1.2-2.1) and with greater intentions to have a clinical breast examination (OR 1.9, 95% CI 1.1-3.3). CONCLUSION: Hair salons are a potentially important venue for promotion of health behaviors related to breast cancer detection.


Asunto(s)
Industria de la Belleza , Negro o Afroamericano , Neoplasias de la Mama/prevención & control , Cabello , Promoción de la Salud/organización & administración , Adulto , Neoplasias de la Mama/etnología , Región del Caribe , Investigación Participativa Basada en la Comunidad , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad
9.
Eur J Endocrinol ; 176(2): 213-220, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27932529

RESUMEN

OBJECTIVE: To examine the effectiveness and safety of primary pegvisomant monotherapy. DESIGN: Retrospective analysis of data extracted from ACROSTUDY (global observational outcomes study of patients with acromegaly treated with pegvisomant). METHODS: The earliest time to insulin-like growth factor 1 (IGF-1) normalization on pegvisomant monotherapy was determined. Both the proportion of patients who achieved IGF-1 normalization and the time to IGF-1 normalization on pegvisomant monotherapy were assessed. RESULTS: Eligible patients included 28 subjects on primary medical therapy (PT) and 176 controls on adjunctive pegvisomant therapy treated postoperatively, including 43 who were naïve to medical therapy (NMT) and 133 who were previously treated medically and were washed out (WASH). IGF-1 normalization occurred in 76.9% (PT), 85.2% (NMT) and 78.3% (WASH) patients (P = NS). Median times to IGF-1 normalization were 0.5 year (PT), 0.7 year (NMT) and 0.6 year (WASH), P = NS. On survival analysis, the fraction of patients controlled on pegvisomant monotherapy was not different between groups. Higher baseline IGF-1 levels, obtained at study entry, predicted a lower likelihood of IGF-1 normalization on monotherapy (P = 0.012). Safety data include low prevalence of skin rashes, injection site reactions and reversible transaminase elevations. There was one patient (NMT) with a verified increase in tumor size. CONCLUSIONS: Pegvisomant monotherapy, administered either as primary medical therapy or as adjunctive therapy according to local practice, led to IGF-1 normalization in >75% of patients. Pegvisomant monotherapy had a favorable safety profile, consistent with previous observations. Prospective data are needed to further evaluate the role of primary pegvisomant monotherapy in acromegaly.


Asunto(s)
Acromegalia/tratamiento farmacológico , Hormona de Crecimiento Humana/análogos & derivados , Acromegalia/metabolismo , Adulto , Anciano , Femenino , Hormona de Crecimiento Humana/uso terapéutico , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Adulto Joven
10.
J Sch Health ; 76(6): 208-14, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16918840

RESUMEN

Preadolescence involves cognitive, social, and physiological changes along with changes in the child's environment. During this developmental stage, young adolescents are transitioning into middle school, forming a larger social network, and managing parental expectations for assuming more responsibility for self-care. The impact of these developmental changes on asthma management is not well understood. The purpose of this study was to better understand asthma and asthma management from the perspective of middle school students. A partnership was formed between the university researcher, several school nurses, and a representative of the health department, through the Orange County Asthma Coalition. Funds were secured from the American Lung Association. School nurses helped to identify and recruit 50 middle school students with asthma to participate in focus groups. The focus-group discussions centered on asthma management with implications for intervention development. Analyses sought to identify developmental issues that affect management. Results indicated that the transition to middle school represents a challenge to managing asthma. As compared with the elementary school environment, support structures are broader and more diffuse, physical education is more demanding, and peer pressure is greater. Nevertheless, the desire for greater autonomy and independence in self-care was strong, particularly among eighth graders. Most interventions are designed for either children or adults, without recognizing the important developmental changes that are occurring in preadolescents with implications for asthma management. A school-based intervention in middle school may help students with asthma transition to greater autonomy of care, while easing transition in other domains of life.


Asunto(s)
Desarrollo del Adolescente , Asma/terapia , Cooperación del Paciente/psicología , Autocuidado/métodos , Adolescente , Asma/psicología , Niño , Femenino , Grupos Focales , Humanos , Masculino , Autonomía Personal , Calidad de Vida , Instituciones Académicas , Estudiantes
11.
J Bone Miner Res ; 20(6): 987-93, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15883639

RESUMEN

UNLABELLED: Systemic growth hormone injections increased spine and femur length in a mouse model of OI. Femur BMC, cross-sectional area, and BMD were increased. Smaller gains were produced in vertebral BMC and cross-sectional area. Biomechanical testing showed improvements to structural and material properties in the femur midshaft, supporting expanded testing of growth hormone therapy in children with OI. INTRODUCTION: Osteoblasts in heterozygous Cola2oim mutant mice produce one-half the normal amounts of the alpha2 strand of type I procollagen. The mice experience a mild osteogenesis imperfecta (OI) phenotype, with femurs and vertebrae that require less force than normal to break in a biomechanical test. MATERIALS AND METHODS: Subcutaneous injections of recombinant human growth hormone (rhGH) or saline were given 6 days per week to oim/+ mice between 3 and 12 weeks of age, in a protocol designed to simulate a trial on OI children. RESULTS: rhGH injections promoted significant weight gain and skeletal growth compared with saline-treated control animals. Femur and spine lengths were increased significantly. Significant increases at the femur midshaft in cortical BMD (2.2%), BMC (15.5%), and cross-sectional area (13%) were produced by rhGH treatment. Increases in the same cortical bone parameters were measured in the metaphyseal region of the femur and in tail vertebrae, but lumbar vertebrae showed significant increases in BMC (9.6%) and cross-sectional area (10.1%) of trabecular bone. Three-point bending testing documented functional improvements to the femur mid-shafts. GH treatment produced significant increases in bone stiffness (23.7%), maximum load (30.8%), the energy absorbed by the femurs to the point of maximum load (44.5%), and the energy to actual fracture (40.4%). The ultimate stress endured by the bone material was increased by 14.1%. CONCLUSIONS: Gains in bone length, cross-sectional area, BMD, BMC, structural biomechanical properties, and strength were achieved without directly addressing the genetic collagen defect in the mice. Results support expanded clinical testing of GH injections in children with OI.


Asunto(s)
Hormona del Crecimiento/uso terapéutico , Osteoblastos/efectos de los fármacos , Osteogénesis Imperfecta/tratamiento farmacológico , Animales , Fenómenos Biomecánicos , Peso Corporal/efectos de los fármacos , Huesos/efectos de los fármacos , Colágeno/genética , Colágeno Tipo I , Densitometría , Modelos Animales de Enfermedad , Fémur/efectos de los fármacos , Fémur/patología , Fracturas Óseas/prevención & control , Heterocigoto , Humanos , Vértebras Lumbares/efectos de los fármacos , Ratones , Ratones Endogámicos C57BL , Ratones Transgénicos , Mutación , Osteoblastos/metabolismo , Fenotipo , Factores de Tiempo
12.
J Clin Endocrinol Metab ; 99(6): 2018-29, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24694339

RESUMEN

CONTEXT: GH deficiency (GHD) may occur in adults with cured acromegaly (acroGHD). OBJECTIVE: Our objective was to examine the effectiveness and safety of GH replacement in acroGHD. DESIGN: This study was a retrospective analysis of data from KIMS (Pfizer International Metabolic Database). SETTING: Data were extracted from a pharmaco-epidemiological survey of >16 000 GHD adults from 31 countries. PATIENTS: The effectiveness population included 115 adults with acroGHD and 142 age-, gender-, and body mass index-matched GHD adults with nonfunctioning pituitary adenoma (NFPA) followed up to 5 years on GH. The safety population included 164 adults with acroGHD and 2469 with NFPA, all GH-replaced. Both acroGHD and NFPA were compared with several cohorts from the general population (including the World Health Organization Global Burden of Disease). OUTCOME MEASURES: Outcome measures included quality of life (QoL-AGHDA), lipids, serious adverse events, and additional safety endpoints. RESULTS: Median GH dose was 0.3 mg/d in acroGHD and NFPA at 5 years. There were comparable improvements in QoL-AGHDA and total and low-density lipoprotein cholesterol in acroGHD and NFPA. High-density lipoprotein cholesterol increased only in acroGHD. Cardiovascular mortality was increased in acroGHD vs NFPA (standardized mortality ratio = 3.03, P = .02). All-cause mortality was similar in acroGHD (ratio between observed/expected cases [95% confidence interval] = 1.32 [0.70-2.25]) and lower in NFPA [observed/expected = 0.58 [0.48-0.70]) in comparison with the general population. There was no difference in incidence of all cancers, benign or malignant brain tumors, or diabetes mellitus between acroGHD and NFPA. CONCLUSIONS: GH replacement has comparable effects on quality of life and lipids in acroGHD and NFPA. Further investigation is needed to examine whether the increased cardiovascular mortality may be attributed to the history of previous GH excess in acroGHD.


Asunto(s)
Acromegalia/terapia , Terapia de Reemplazo de Hormonas , Hormona de Crecimiento Humana/uso terapéutico , Hipopituitarismo/tratamiento farmacológico , Acromegalia/epidemiología , Adulto , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Terapia de Reemplazo de Hormonas/efectos adversos , Terapia de Reemplazo de Hormonas/estadística & datos numéricos , Hormona de Crecimiento Humana/deficiencia , Humanos , Hipopituitarismo/epidemiología , Hipopituitarismo/etiología , Masculino , Persona de Mediana Edad , Inducción de Remisión , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
14.
Eur J Endocrinol ; 167(3): 343-51, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22711759

RESUMEN

OBJECTIVE: Childhood-onset GH deficiency (COGHD) is associated with low bone mineral density (BMD). Adults with persistent COGHD may be at risk for insufficient bone accrual or bone loss during adulthood. The purpose of this study was to identify BMD predictors and to characterize the effects of GH replacement on BMD in COGHD adults with persistent GHD. DESIGN: Retrospective analysis of the KIMS database. METHODS: Variables predicting standardized BMD (sBMD) were identified. The effect of GH replacement (3 years) on BMD was examined. RESULTS: Three hundred and fourteen COGHD adults (148 women, 166 men; 62 non-naïve, 178 semi-naïve, and 74 true naïve, depending on length and timing of previous GH replacement), who had BMD measured in lumbar spine (LS) and femoral neck (FN) at study entry. In semi-naïve subjects, a longer gap in GH replacement between childhood and adulthood was predictive of lower sBMD in the FN (r=-0.18, P=0.038). TSH deficiency predicted lower sBMD in the LS (r=-0.16, P=0.052). In true naïve patients, a longer gap between onset of pituitary disease and study entry (r=-0.35, P=0.012), and female gender (r=-0.27, P=0.043) independently predicted lower sBMD in the FN. There were no differences in BMD increases between non-naïve, semi-naïve, and true naïve subjects on GH replacement. CONCLUSIONS: In semi-naïve subjects a longer interval off GH replacement was associated with lower sBMD in the FN. Among true naïve patients, a longer gap between the onset of pituitary disease and GH replacement, and female gender predicted lower sBMD in the FN.


Asunto(s)
Densidad Ósea/efectos de los fármacos , Bases de Datos Factuales , Enanismo Hipofisario/tratamiento farmacológico , Enanismo Hipofisario/epidemiología , Hormona de Crecimiento Humana/administración & dosificación , Adolescente , Adulto , Factores de Edad , Densidad Ósea/fisiología , Niño , Preescolar , Enanismo Hipofisario/metabolismo , Femenino , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores de Tiempo , Adulto Joven
15.
J Clin Endocrinol Metab ; 96(5): 1516-23, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21367928

RESUMEN

CONTEXT: GH deficiency (GHD) is associated with low bone mineral density (BMD). Risk factors for lower BMD in this GHD population have not been fully elucidated. In particular, there are limited published data in GH-naïve subjects. OBJECTIVE: The objective of the study was to identify endocrine correlates of low BMD in treatment-naïve adult GHD subjects. DESIGN: This was a retrospective analysis of data extracted from the (Pfizer International Metabolic Study) KIMS database. SETTING: The study was an international epidemiological survey of more than 15,000 adult GHD patients from 31 countries. PATIENTS: A total of 1218 subjects with stringently defined GHD of adult onset (641 women and 577 men) who were GH naïve and had BMD measured in the posterior anterior lumbar spine and femoral neck by dual-energy X-ray absorptiometry. MAIN OUTCOME MEASURES: Variables associated with standardized BMD (sBMD) in adult-onset GHD were examined. RESULTS: In the LS, body mass index (r = 0.13, P < 0.01), unreplaced sex steroid deficiency (r = -0.17, P < 0.0001), and corticotropin deficiency (r = -0.11, P < 0.01) were independently associated with sBMD. In the FN, age (r = -0.19, P < 0.0001), female gender (r = -0.18, P < 0.0001), body mass index (r = 0.21, P < 0.0001), and decreased IGF-I SD scores (r = 0.10, P < 0.001) were independently associated with sBMD. CONCLUSIONS: Hormone variables associated with lower sBMD in patients with adult-onset GHD include unreplaced sex steroid deficiency and corticotropin deficiency in the LS and lower IGF-I SDS in the FN.


Asunto(s)
Hormona Adrenocorticotrópica/deficiencia , Densidad Ósea/fisiología , Hormonas Esteroides Gonadales/deficiencia , Hormona de Crecimiento Humana/deficiencia , Factor I del Crecimiento Similar a la Insulina/deficiencia , Absorciometría de Fotón , Adulto , Edad de Inicio , Arginina/farmacología , Índice de Masa Corporal , Bases de Datos Factuales , Femenino , Fracturas Óseas/epidemiología , Prueba de Tolerancia a la Glucosa , Hormona del Crecimiento/uso terapéutico , Terapia de Reemplazo de Hormonas , Hormona de Crecimiento Humana/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Hipófisis/metabolismo , Estudios Retrospectivos , Caracteres Sexuales , Columna Vertebral/anatomía & histología , Estimulación Química , Adulto Joven
16.
Connect Tissue Res ; 48(1): 19-26, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17364663

RESUMEN

Growth hormone is known to stimulate connective tissue, but the degree to which it influences skin biomechanical properties is unclear. This study tested the hypothesis that human growth hormone transgene expression changes the material properties and structural composition of adult mouse skin. Fracture toughness and elastic modulus were measured on freshly dissected dorsal skin and fixed samples were analyzed histologically. Transgenics had higher elastic moduli than their sex-matched non transgenic littermates, and male transgenics demonstrated increased fracture toughness. Male transgenics also had thicker skin than controls with a selectively increased dermis. In contrast, female transgenics had thinner skin than controls due to a reduced hypodermis. Biomechanical and histological variables were strongly correlated. Significant sex differences were present in nearly all comparisons indicating a dimorphic response to growth hormone in the skin. These data demonstrate that constant low-level growth hormone expression in marrow differentially affects skin layer thickness and concomitantly alters its biomechanical properties.


Asunto(s)
Fenómenos Biomecánicos , Hormona de Crecimiento Humana/genética , Fenómenos Fisiológicos de la Piel , Piel/química , Animales , Elasticidad , Femenino , Humanos , Masculino , Ratones , Ratones Transgénicos , Caracteres Sexuales , Piel/anatomía & histología , Estrés Mecánico
17.
Anat Rec (Hoboken) ; 290(4): 375-81, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17514762

RESUMEN

The proximal and distal growth plates of the principal long bones do not contribute equally to longitudinal growth. Most forelimb elongation occurs at the shoulder and wrist, while most hindlimb growth occurs at the knee. This study examined whether insulin-like growth factor-I (IGF-I), a potent growth regulator, could underlie this variation via differential receptor expression. The spatiotemporal distribution of the IGF-I receptor (IGF-IR) was mapped in hindlimb growth plates (overall and within regional zones) from immature mice using immunohistochemistry. Growth activity was assessed by size/morphology of the growth plate and proliferating cell nuclear antigen (PCNA) expression. Both IGF-IR and PCNA staining declined considerably with age in the proximal femur and distal tibia (hip and ankle), but expression remained high in the more active distal femur and proximal tibia (knee) throughout growth. Growth plate size decreased with age in all sites, but the absolute and relative decline in IGF-IR in the hips and ankles of older mice indicated a site-specific loss of IGF-I sensitivity in these less active regions. These results suggest that regulation of the IGF-IR may at least partially mediate differential long bone growth, thereby providing a local mechanism for altering skeletal proportions absent modification of systemic hormone levels.


Asunto(s)
Placa de Crecimiento/metabolismo , Miembro Posterior/crecimiento & desarrollo , Receptor IGF Tipo 1/metabolismo , Factores de Edad , Animales , Evolución Biológica , Placa de Crecimiento/fisiología , Miembro Posterior/metabolismo , Ratones , Ratones Endogámicos C57BL , Antígeno Nuclear de Célula en Proliferación/metabolismo
18.
Body Image ; 2(2): 137-49, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18089182

RESUMEN

We conducted a set of four studies with a total of 1288 adult and undergraduate women and men to develop the Acceptance of Cosmetic Surgery Scale. These studies provide evidence of this scale's reliability, as well as convergent and discriminant validity. Initial explorations using this 15-item scale indicate that acceptance of cosmetic surgery is negatively related to satisfaction with physical appearance and positively related to attitudes about make-up use. The acceptance of cosmetic surgery may be more related to fears about becoming unattractive than to hopes of becoming more attractive. Cosmetic surgery attitudes were positively related to age for women but not for men. The study's limitations and implications are discussed.

19.
Spine (Phila Pa 1976) ; 30(13): 1491-5, 2005 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-15990661

RESUMEN

STUDY DESIGN: A human growth hormone transgene was bred into mice of the Cola2oim (oim) lineage. Caudal (tail) vertebrae from male and female mice at early skeletal maturity and at midlife were evaluated for physical and biomechanical properties. OBJECTIVE: To test whether constant low-level growth hormone expression within the marrow could improve structural or material properties of caudal vertebrae in oim mice. SUMMARY OF BACKGROUND DATA: A spontaneous genetic defect in a type I procollagen gene created the oim mouse model for osteogenesis imperfecta. Bones of heterozygous oim mice are biomechanically inferior to wild-type controls. Bone marrow expression of human growth hormone was demonstrated previously to enhance bone deposition and structural biomechanical properties in caudal vertebrae of transgenic mice. METHODS: Compression tests were performed individually on three caudal vertebrae (Ca4, 5, and 6) from each mouse to determine their structural biomechanical properties. Volumetric and mineral content measurements were also made. In a subset of vertebrae, the ashing measurements were confirmed and extended by peripheral quantitative tomographic scanning, which also allowed calculation of the failure stress. RESULTS: Heterozygous oim mouse vertebrae had structural and material properties inferior to the wild-type controls. Growth hormone transgene expression increased the size and mineral content of the vertebrae from mutant mice, and increased biomechanical structural values for maximum load and energy to failure. Failure stress was not improved. CONCLUSIONS: Growth hormone stimulation of size and bone mineral content of osteogenesis imperfecta mutant mouse caudal vertebrae contributed to their improved performance in axial compression. There was no evidence for improved material properties, however.


Asunto(s)
Terapia Genética/métodos , Hormona de Crecimiento Humana/genética , Osteogénesis Imperfecta/terapia , Columna Vertebral/fisiología , Animales , Fenómenos Biomecánicos , Densidad Ósea , Modelos Animales de Enfermedad , Femenino , Expresión Génica , Heterocigoto , Humanos , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Transgénicos , Osteogénesis Imperfecta/patología , Osteogénesis Imperfecta/fisiopatología , Columna Vertebral/patología , Cola (estructura animal)
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