Clinical Briefs



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Am Fam Physician. 2000 Dec 1;62(11):2541-2542.

HIV Testing for Children in Foster Care

The Committee on Pediatric AIDS of the American Academy of Pediatrics (AAP) has issued a statement on the identification and care of infants, children and adolescents in foster care who have been exposed to or infected with human immunodeficiency virus (HIV). The AAP statement appears in the July 2000 issue of Pediatrics.

The AAP committee makes the following recommendations for HIV testing of infants, children and adolescents in foster care:

Infants. Physicians and foster care agencies should work together to determine HIV exposure and infection status for all infants in foster care. If maternal serologic status is unknown and the state has guardianship and authority to consent to medical care, the infant should be tested for HIV antibody.

Children. Testing for HIV should be performed for all children in foster care who have symptoms or physical findings suggestive of HIV infection; been sexually abused; a sibling who is HIV-infected; or a parent who is HIV-infected or is at increased risk of HIV infection. Testing for HIV should also be considered for all children in foster care whose maternal serologic status is unknown.

Adolescents. Testing for HIV is recommended for all adolescents in foster care who have symptoms or physical findings suggestive of HIV infection; a sibling who is HIV-infected; a parent who is HIV-infected or at increased risk of HIV infection; a current or past sexual partner who is HIV-infected or at increased risk of HIV infection; received a transfusion before 1985; a history of sexual abuse or a diagnosis of sexual abuse or a diagnosis of sexually transmitted disease; or a history of illicit substance use or abuse. Testing should also be considered for all adolescents in foster care who are sexually active or have a history of sexual activity and for those whose medical history and family history are unavailable or inadequate for assessment of the above risk factors.

The AAP statement also recommends that all foster parents should be educated regularly about HIV infection and be informed of the HIV exposure or infection status of children in their care.

Nutrition Guidelines for Patients on Dialysis

To improve the nutritional status of patients on dialysis in the United States, the National Kidney Foundation (NKF) has published a set of recommendations for the nutritional care of persons receiving chronic dialysis treatment. The recommendations, titled “Clinical Practice Guidelines for Nutrition in Chronic Renal Failure,” were created through the Kidney Disease Outcomes Quality Initiative, the NKF's patient outcomes program.

The NKF guidelines provide recommendations for evaluating protein-energy nutritional status and for prescribing the appropriate levels of dietary energy and protein intake for children and adults with chronic renal failure. Based on a structured review of the medical literature and expert opinion, the guidelines provide recommendations for adults and children. The guidelines for children address dietary needs for vitamins, zinc and copper, as well as treatment with recombinant human growth hormone. They also provide recommendations regarding the nutritional intake of L-carnitine for adult patients, the nutritional management of nondialyzed adults with advanced chronic renal insufficiency and the management of acutely ill adult and pediatric patients.

Specific guidelines for protein and energy intake include:

  • Optimal protein intake for adults is 1.2 g per kg of body weight per day. The initial dietary protein intake for children being treated with maintenance hemodialysis should be based on the recommended dietary allowance for their chronologic age plus an additional 0.4 g per kg per day.

  • Optimal protein for adult patients on chronic peritoneal dialysis is 1.2 to 1.3 g per kg of body weight per day. The initial dietary protein intake for children being treated with maintenance peritoneal dialysis should be based on the recommended dietary allowance for their chronologic age plus an additional increment based on anticipated peritoneal losses.

  • The recommended daily energy intake for adult patients on maintenance hemodialysis or chronic peritoneal dialysis is 35 kcal per kg of body weight per day for those younger than 60 years, and 30 to 35 kcal per kg of body weight per day for persons 60 years and older.

For more information on kidney disease and nutrition, contact the NKF Materials Department at 800-622-9010, ext. 175, or write to the NKF, 30 E. 33rd St., New York, NY 10016.

Exercise and Health in the Older Adult

The American College of Sports Medicine (ACSM) has released an official statement on the effects of exercise in the older adult. According to current evidence, adults who participate in a regular exercise program can effectively reduce and/or prevent many of the functional declines associated with aging. The statement appears in the ACSM's Current Comments, July 2000.

Cardiovascular exercise is important in older adults because it can help maintain and improve heart and lung function and cardiac output, and can enhance endurance. According to the ACSM statement, older adults can adapt to regular aerobic training as well as younger adults. To improve cardiovascular fitness, the ACSM recommends that older adults exercise at an intensity of 55/65 to 90 percent of maximum heart rate (or 40/50 to 80 percent of heart rate reserve) for 20 to 60 minutes three to five days per week. The lower ranges are for unfit or frail persons who are just beginning an exercise program.

Loss of muscle mass and strength with aging can lead to a higher risk of falls and fractures, impaired ability to regulate body temperature, slower metabolism, deficient glucose regulation and overall loss of ability to perform everyday tasks. By adding resistance training to their exercise regimen, older adults can make significant gains in strength. In just three to four months of training, older adults can increase their strength two- to threefold. With prolonged resistance training, a modest increase in muscle size is possible.

Other health benefits associated with exercise in the older adult include favorable changes in lipid profile, blood pressure and body composition; an increase in insulin sensitivity; improved bone health and lower risk of osteoporosis; improved postural stability; and increased flexibility and range of motion.

Current Comments are official statements by the ACSM concerning topics of interest to the public at large. More information may be obtained by calling 317-637-9200 or by writing the ACSM at P.O. Box 1440, Indianapolis, IN 46206-1440.

Intervention Strategies and Treatment of Substance Abuse Problems

The Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA) has released Treatment Improvement Protocols (TIPs) that identify brief strategies to address substance abuse problems and help physicians motivate behavior change in their patients. The guidelines were developed by consensus panels of recognized experts.

TIP no. 34, “Brief Interventions and Brief Therapies for Substance Abuse,” provides physicians with current scientifically validated information on the usefulness of these innovative and shorter forms of substance abuse treatment. According to TIP no. 34, brief interventions are techniques that focus on shorter-term goals such as entering treatment or changing behavior. This type of intervention is particularly valuable when more extensive treatments are unavailable.

TIP no. 35, “Enhancing Motivation for Change in Substance Abuse Treatment,” outlines the latest approaches to help physicians motivate even the most difficult patients to comply with treatment. The TIP also provides information on current research, methods and assessment instruments related to enhancing patient motivation. TIP no. 35 describes the “stages of change” model, which includes precontemplation, contemplation, preparation, action and maintenance. These stages are thought of as a cycle rather than a linear progression as patients move back and forth through the cycle. The TIP also highlights motivational interviewing as a means of interacting with patients.

To order a copy of the publications, contact SAMHSA's National Clearinghouse for Alcohol and Drug Information at 800-729-6686.



Copyright © 2000 by the American Academy of Family Physicians.
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