Clinical Briefs



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Am Fam Physician. 1998 Oct 1;58(5):1219-1222.

Youth Strength Training

The American College of Sports Medicine (ACSM) has issued a statement emphasizing that children can participate in strength training programs if they have the emotional maturity to accept and follow directions. The ACSM defines strength training as a systematic program of exercises designed to increase a person's ability to exert or resist force.

The ACSM believes that the goal of strength training should be to improve the musculoskeletal strength of children and adolescents while exposing them to safe and effective training methods. Programs must be well supervised and properly designed with program variation. A medical examination is recommended for children with known or suspected health problems who want to participate in a strength-training program. Although a medical examination is not mandatory for apparently healthy children, the ACSM believes that it is desirable.

Additional information can be obtained from the ACSM, P.O. Box 1440, Indianapolis, IN 46206; telephone: 317-637-9200; fax: 317-634-7817.

New Treatment for Venous Leg Ulcers

The U.S. Food and Drug Administration has approved a new bioengineered skin (Apligraf) that can significantly improve healing in skin ulcers caused by venous insufficiency. Apligraf is indicated for use with standard therapy for the treatment of noninfected partial- and full-thickness venous skin ulcers of more than one month's duration that have not adequately responded to conventional therapy.

Apligraf is a two-layer living skin substitute with both an epidermis and a dermis, composed of living human keratinocytes and fibroblasts. Its special composition provides wound protection and enhances the growth of healthy new skin.

Apligraf is manufactured by Organogenisis Inc., Canton, Mass.

Changes in Mortality from Heart Failure

A report in the August 7, 1998, issue of Morbidity and Mortality Weekly Report shows that between 1988 and 1995, the number of deaths from congestive heart failure in the United States declined in persons over 65 years of age. Declines were noted in each racial and sex group. Age-adjusted rates for persons aged 65 years and older declined from 116.9 deaths per 100,000 standard population in 1988 to 107.6 deaths per 100,000 population in 1995. This represents an average annual decline of 1.1 percent compared with the 1988 rates. The decrease was greatest for black adults—3 percent per year for black men and 2.2 percent per year for black women.

According to the report, the decline suggests improved survival among older adults with heart failure or mis-diagnosis of the underlying cause of death among adults with heart failure. Declines in death rates among black adults and white men may reflect improved early detection of and changes in the management of patients with hypertension, myocardial infarction and heart failure.

A statement from the American Heart Association (AHA) regarding the report in MMWR says that the decline in death rates can be attributed to better medical treatments, such as broader use of angiotensin converting enzyme (ACE) inhibitors. The AHA states that ACE inhibitors are particularly helpful in the period right after myocardial infarction to prevent development of congestive heart failure and, for those who already have congestive heart failure, these medicines can improve exercise capacity.

AAP Statement on Female Genital Mutilation

The Committee on Bioethics of the American Academy of Pediatrics (AAP) has issued a statement opposing all forms of female genital mutilation. This practice, also known as female circumcision, is the ritual cutting and alteration of the genitalia of female infants, girls and female adolescents. According to the AAP, this practice still persists in Africa and in certain communities in the Middle East and Asia. Physicians with patients from these areas may see patients who have undergone female genital mutilation, or they may be asked to perform this procedure. The performance of female genital mutilation is illegal in the United States and constitutes child abuse.

The statement, published in the July 1998 issue of Pediatrics, discusses the various types of female genital mutilation, cultural and ethical issues of the procedure, and culturally sensitive education of patients and parents of patients. The AAP states that physicians should be aware that this practice has serious, life-threatening health risks for children and women, including hemorrhage, pelvic infection and infertility. The AAP recommends that patients and their parents receive culturally sensitive education about the physical harms and psychologic risks that are associated with female genital mutilation, and that families be dissuaded from carrying out this practice.

Alcohol and Its Effect on Sleep

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has published a report on alcohol and its effect on sleep (Alcohol Alert No. 41). The report discusses the effects of alcohol consumption on sleep patterns, the potential health consequences of alcohol consumption combined with disturbed sleep, and the risk for relapse in patients with alcoholism who fail to recover normal sleep patterns.

According to the report, alcohol consumption affects the function of brain chemicals that influence sleep. Sleep disorders may be induced by alcohol consumption due to disruption of the sequence and duration of sleep states and by changing the amount of time it takes to fall asleep and the total sleep time. The adverse effects of sleep deprivation are increased following alcohol consumption. Reduced alertness may impair driving performance and cause problems in certain work situations.

Older persons are particularly at risk, because alcohol levels in the blood and brain are higher in older persons than in younger persons after consumption of an equivalent dose of alcohol. Consumed at bedtime, alcohol increases older persons' susceptibility to sleep disturbances.

NIAAA Director Enoch Gordis, M.D., notes that “many nursing mothers are still regularly advised by their physicians to have a drink to promote lactation (so called let-down reflex). Babies who receive alcohol in breast milk are known to have disrupted sleeping patterns. Because researchers do not yet know what effect this disruption has on nursing infants, physicians should reconsider this advice.”

The complete report on alcohol and sleep can be found on the NIAAA Web site at http://www.niaaa.nih.gov. Copies of Alcohol Alert are available free of charge from the NIAAA, Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849-0686.

Warnings About Heartburn Drug

New warnings of cardiac problems associated with the use of the drug cisapride (Propulsid), a treatment for nighttime heartburn, have been issued by the U.S. Food and Drug Administration (FDA). The drug's labeling has been revised to include information about the cardiac risks associated with the drug. Physicians are encouraged to prescribe every reasonable alternative before using cisapride in patients with heartburn. The FDA has had reports of serious adverse reactions, including heart rhythm abnormalities and deaths, in patients receiving cisapride since the drug became available in 1993. The FDA notes that the deaths cannot be proved to be directly related to the drug. The revised labeling also includes the following warnings:

  • Cisapride should not be used in patients taking certain antibiotics, anti-depressants, antifungal agents, protease inhibitors or various other drugs.

  • Cisapride is contraindicated in patients with certain disorders, such as multiple organ failure, congestive heart failure, chronic obstructive pulmonary disease and advanced cancer.

  • Cisapride is contraindicated in patients with electrolyte disorders. These patients include persons with severe dehydration, vomiting, diarrhea or malnutrition, or those needing acute-care diuretic or insulin treatment.

The drug should be used, according to the FDA, in patients who have not responded adequately to lifestyle modifications or other drugs for treating nighttime heartburn caused by gastroesophageal reflux disease. If the patient does not receive relief from nighttime heartburn, the drug should be discontinued.

Sale of Non–Health-Related Goods by Physicians

The Council on Ethical and Judicial Affairs of the American Medical Association has published a statement on the sale of non–health-related goods from physicians' offices. Published in the August 12, 1998, issue of JAMA, the statement discusses the ethical problems with for-profit sales of such goods. The following information was excerpted from the conclusion of the report:

The recommendations of the council are as follows:

  • Physicians should not sell non–health-related goods from their offices or other treatment settings, with the exception noted in the following recommendation.

  • Physicians may sell non–health-related goods from their offices for the profit of community organizations (e.g., Girl Scout cookies), provided that (a) the product is low cost, (b) the physician does not make a profit, (c) such sales are not a regular part of business, (d) sales are conducted in a dignified way, and (e) patients do not feel pressured to buy.

ACSM Statement on Aging and Exercise

The American College of Sports Medicine (ACSM) has issued a position paper that contains advice on aging and exercise. Published in the June 1998 issue of Medicine & Science in Sports & Exercise, the paper discusses cardiovascular function, strength training, the role of exercise in postural stability and flexibility, psychologic function, and exercise for the frail and very old.

“Most people are living longer, and the quality of life is increasingly important to them,” said Robert S. Mazzeo, Ph.D., who chaired the writing group. “Aging is a very complex process; it involves a great many variables that interact with one another, but regular physical activity seems to cut across all of them and contribute to the physical and psychologic well-being that defines healthy aging. This position paper discusses some of the more important factors.”

Skin Cancer Fact Sheet

The National Youth Sports Safety Foundation, Inc. (NYSSF) has published a new fact sheet titled, “Skin Cancer,” which provides current information on the statistics of skin cancer, risk factors, suggestions for prevention of skin cancer, use of sunscreen and skin cancer resources. The fact sheet was written in collaboration with the American Cancer Society and is especially designed for parents, health professionals, program administrators and coaches to serve as a guideline on current recommendations. Copies of the fact sheet can be obtained from the NYSSF for $2 each by writing NYSSF, Dept. SK, 333 Longwood Ave., Suite 202, Boston, MA 02115-5711.

According to the ACSM, participation in a regular exercise program can reduce the risk involved in both cardiovascular and age-associated diseases, greatly improving the functional capacity and quality of life for members of the older population. Endurance training can help maintain and improve various aspects of cardiovascular function, cardiac output and arteriovenous oxygen difference. Strength training is important to offset the loss of muscle mass and strength typically associated with aging. Both endurance and strength training programs greatly improve the functional capacity of older men and women. Benefits also include improved bone health, improved ability to stand erect and avoid falls, maintaining an independent lifestyle, and increased flexibility and range of motion.

Urine-Based Test to Detect HIV Antibodies

The U.S. Food and Drug Administration has approved the urine-based HIV-1 Western Blot test that confirms the presence of antibodies to human immunodeficiency virus (HIV) in urine samples.

Clinical trials of persons who were at low-risk for HIV infection were conducted to determine the specificity of the test. Blood serum and urine samples were tested, and results were compared. The results showed that the specificity was 100 percent (515 out of 515). To determine the sensitivity of the test, another study was conducted with persons known to be HIV positive by blood tests. Results showed that the sensitivity of the test was 99.7 percent (746 out of 748). The two urine samples that had negative results on the Western Blot test were from seropositive individuals who had acquired immunodeficiency syndrome and were receiving anti-retroviral therapy.

According to the manufacturer, the urine HIV test system reduces costs because urine requires no specialized collection devices, means of handling or disposal system, or trained medical personnel for sample collection. Samples require no preservation and are stable for 55 days at room temperature. More information about the test can be obtained by calling 800-428-4007 (ext. 2957) or 510-526-2541.


Copyright © 1998 by the American Academy of Family Physicians.
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