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Biomedical subjects

K Main

Publications and source records attributed to K Main.

16 recordsLinked to original sources
PubMed2001

The Kentucky Homeplace Project: family health care advisers in underserved rural communities.

The Kentucky Homeplace Project (KHP) is a state-legislated program designed to address well-documented deficits in the health status of and health resources available to many of Kentucky's rural residents. Since its inception in 1994, the KHP has served approximately 80,000 clients, primarily through home visits by trained, locally residing paraprofessionals known as family health care advisers. These family health care advisers employ culturally appropriate strategies to meet immediate needs as well as to foster long-term client empowerment and the adoption of health prevention strategies. This descriptive examination of KHP provides information regarding (a) the advantages of the program, with specific attention to its orientation toward provision of culturally appropriate health services; (b) the disadvantages of KHP, including competing budgetary priorities and its vulnerability to local economic and political trends; and (c) the potential application of similar programs for other rural, difficult-to-reach populations.

Family Health↗
PubMed1996

Growth hormone, insulin-like growth factor I and its binding proteins 1 and 3 in last trimester intrauterine growth retardation with increased pulsatility index in the umbilical artery.

OBJECTIVE: The interrelationships between maternal hormone levels and placental dysfunction in mothers bearing children with intrauterine growth retardation remain unclear. We have examined some endocrinological aspects of intrauterine growth retardation and, in particular, tested whether low levels of GH and IGF-I in maternal serum are associated with direct evidence of placental dysfunction. DESIGN: Prospective, descriptive and comparative. PATIENTS: Women with singleton pregnancies: 48 with a small for gestation fetus (SGA) (estimated fetal weight less than -1.5 standard deviation scores) and 28 with an appropriate for gestation fetus (AGA). MEASUREMENTS: Maternal serum GH, IGF-I, IGFBP-1 and 3 were determined, and fetal weight and umbilical artery pulsatility index (PI) was estimated by ultrasonography and Doppler ultrasound at 33 weeks gestational age. RESULTS: Serum IGF-I was lower in the SGA group (246 vs 297 micrograms/l, P = 0.03) but GH and IGFBP-1 and -3 did not differ between the groups. In the 16 SGA pregnancies with increased PI, IGF-I concentration was low (218 micrograms/l, quartiles 149-265), whereas in the 32 with normal PI, IGF-I was 269 micrograms/l, quartiles 219-382. Serum IGFBP-1 was increased in the high PI group compared to the normal PI group (161 micrograms/l vs 113, P = 0.05). CONCLUSION: Maternal serum IGF-I concentration was lower in small for gestational age pregnancies with increased pulsatility of the umbilical artery blood flow, compared to small for gestational age pregnancies with normal umbilical blood flow, which in turn was close to the IGF-I concentration in appropriate for gestational age pregnancies. Growth hormone concentrations did not differ among the groups.

Female↗
PubMed1995

A controlled study on serum insulin-like growth factor-I and urinary excretion of growth hormone in fibromyalgia.

OBJECTIVE: It has been hypothesized that secretory deficiencies of growth hormone may play a pathophysiological role in fibromyalgia (FM). Our objective was thus to evaluate the secretion of growth hormone in FM. METHODS: The 24-h urinary growth hormone excretion and serum levels of insulin-like growth factor-I (IGF-I) was measured in 17 middle aged women with FM and 19 healthy women. The degree of subjective sleep disturbance was also determined. RESULTS: Sleep was significantly more disturbed in the patients than the controls. We found no significant differences in the urinary excretion of growth hormone and serum levels of IGF-I between patients with FM and healthy controls. CONCLUSION: Major secretory deficiencies were not documented. However, the power of our study does not allow us to discard the role of minor secretory deficiencies of human growth hormone in FM.

Adult↗
PubMed1994

The ratio between serum levels of insulin-like growth factor (IGF)-I and the IGF binding proteins (IGFBP-1, 2 and 3) decreases with age in healthy adults and is increased in acromegalic patients.

OBJECTIVE: Several in-vitro studies have suggested that the biological actions of IGF-I can be modified by the presence of specific IGF binding proteins. In man, the 24-hour serum levels of IGF-I and IGFBP-3 remain constant, but short-term changes in the IGF-I/IGFBP-3 ratio have been described following GH administration. Serum levels of IGF-I and IGFBP-3 decrease with age in normal adults and are elevated in active acromegaly due to excessive GH secretion. However, the individual ratios between serum levels of IGF-I and IGFBP-3 in acromegalic and healthy adults have not been described previously. METHODS AND MATERIALS: We studied this ratio in 198 healthy adults and in 56 acromegalic patients, grouped according to their serum GH levels (group I GH < 2mIU/l II GH 2-10 mIU/l; III GH > 10 mIU/l). In all subjects a single blood sample was drawn for IGF-I, IGF-II, IGFBP-1, IGFBP-2, IGFBP-3 and GH measurements by specific RIAs. In 38 of the patients a 24-hour urinary collection was performed for GH determination. RESULTS: In healthy adults serum levels of IGF-I and IGFBP-3 decreased with increasing age (r = -0.52 and r = -0.34, respectively, P < 0.0001). In addition, the molar IGF-I/IGFBP-3 ratio declined with increasing age (r = -0.44, P = 0.0001). In patients with acromegaly and high serum GH levels (group III), circulating IGF-I was increased 7.97 standard deviations (SDS) and IGFBP-3 was increased 4.20 SDS (P < 0.0001). Serum levels of IGF-II were normal in all three groups (588 +/- 240 micrograms/l) whereas IGFBP-1 and IGFBP-2 levels were low and IGFBP-2 levels decreased significantly with increasing serum GH levels (P < 0.0001). The molar IGF-I/IGFBP-3 ratio in the acromegalic patients was significantly higher than in the controls (P < 0.0001) and correlated significantly with urinary GH excretion (r = 0.67, P < 0.0001) as well as with serum GH levels (r = 0.73, P < 0.0001). CONCLUSION: We demonstrated a decreasing molar IGF-I/IGFBP-3 ratio with increasing age in healthy adults and an increased ratio between serum IGF-I and IGFBP-3 levels in acromegalic patients. As IGF-II is normal and IGFBP-1 and IGFBP-2 are inversely correlated to the serum GH levels in the acromegalic patients, we speculate that the molar ratio between IGF-I and IGFBP-3 reflects free (biologically active) IGF-I and is dependent on GH levels.

Acromegaly↗
PubMed1994

Serum insulin-like growth factor-I in 1030 healthy children, adolescents, and adults: relation to age, sex, stage of puberty, testicular size, and body mass index.

Serum levels of insulin-like growth factor-I (IGF-I) increase with age and pubertal development. The large variation in circulating IGF-I levels in adolescence makes it difficult to use the IGF-I value of a single child in the assessment of his growth status. In addition, the interference of IGF-binding proteins in many IGF-I assays contributes to this problem. We measured IGF-I in acid-ethanol-extracted serum from 1030 healthy children, adolescents, and adults, employing a RIA that reduces interference of IGF-binding proteins by using monoiodinated Tyr31-[125I]des-(1-3)IGF-I as radioligand. Mean serum IGF-I concentrations increased slowly in prepubertal children from 80-200 micrograms/L with a further steep increase during puberty to approximately 500 micrograms/L. After puberty, a subsequent continuous fall in circulating IGF-I levels was apparent throughout adulthood to a mean of 100 micrograms/L at the age of 80 yr (P < 0.0001). Girls had maximal IGF-I levels at 14.5 yr of age, whereas boys had peak IGF-I levels 1 yr later. This is almost 2 yr later than average peak height velocity. The large variation in serum IGF-I levels during puberty was diminished when data were separated according to sex and Tanner stage of puberty. Interestingly, we found a significant variation with age within the Tanner stages; there was an increase in serum IGF-I concentrations with age in the early pubertal stages and a decrease in the late stages (P < 0.05). Serum IGF-I increased concomitantly with increasing testicular volume. Multiple regression analysis revealed that serum IGF-I levels predicted height velocity in the following year (r = 0.33; P < 0.0001). Body mass index did not correlate significantly with serum IGF-I in prepubertal children in a multiple regression analysis. In conclusion, there was a significant variation in serum IGF-I levels with age within a given Tanner stage of puberty in addition to the well known increase with increasing age or pubertal stage. Accordingly, the effects of sex, age, and puberty on serum IGF-I cannot be separated into simple additive components when studying 1030 children in a cross-sectional design. Thus, the age-, sex-, and puberty-corrected IGF-I values may, in fact, improve the use of serum IGF-I as a diagnostic tool to distinguish between a child with retarded puberty and a GH-deficient individual.

Adolescent↗
PubMed1993

Urinary growth hormone (U-GH) excretion and serum insulin-like growth factor 1 (IGF-1) in patients with alcoholic cirrhosis.

Basal serum growth hormone (GH) levels are elevated and insulin-like growth factor 1 (IGF-1) concentrations in serum are suppressed in patients with chronic liver disease. The aim of this study was to measure the urinary GH (U-GH) excretion and IGF-1 concentrations in patients with cirrhosis and to correlate these both to clinical and biochemical characteristics and survival rate. Urinary GH excretion, IGF-1, and other biochemical parameters were measured in 36 patients with alcoholic cirrhosis, while in the control group of 34 healthy individuals only U-GH excretion was measured. U-GH excretion was significantly higher in patients than in the healthy controls (p < 0.00001), and increased with deteriorating liver function assessed by modified Child-Turcotte score (p < 0.01). The highest U-GH excretions were found in patients with hepatic encephalopathy (p < 0.003). IGF-1 levels were reduced in cirrhosis and correlated with liver function (p < 0.001). Serum IGF-1 concentrations below 3.1 nmol/l were associated with a poor prognosis (p < 0.004). The elevated U-GH in patients with alcoholic cirrhosis may reflect high serum levels of GH due to increased pituitary secretion or decreased hepatic degradation of GH. In addition, the IGF-1 levels reflect the degree of hepatic insufficiency and, thus, seem to provide new prognostic information.

Adult↗
PubMed1991

Predicting and monitoring of growth in children with short stature during the first year of growth hormone treatment.

Fifteen prepubertal short stature children (10 girls, 5 boys), mean age 9.6 years (range 5.2-12.7 years), with normal response to growth hormone stimulation tests (group A) or partial growth hormone deficiency (GHD) of idiopathic nature (group B) were included in a controlled longitudinal study for evaluation of predictive parameters for the long-term growth response after administration of biosynthetic human growth hormone (B-hGH). The average knee-heel length velocity for the first 3 months was significantly correlated to total body height velocity during the following 9 months (p less than 0.0008). By contrast, this association could not be found for height velocity during the same period. The increase in serum values of alkaline phosphatase and insulin-like growth factor I (IGF-1) during the first month of treatment was not significantly correlated to height velocity during the first year. During one year of treatment with B-hGH the mean height velocity for groups A and B increased from 4.4 cm/year (range 2.5-6.5) to 7.6 cm/year (range 4.7-10.6). Bone age advanced by 1.08 +/- 0.60 per chronological year. The ratio between total height and knee-heel length prior to treatment was 3.34 +/- 0.10 and after one year 3.33 +/- 0.10, suggesting a proportional linear growth. An inverse relationship was observed between the ratio and chronological age. In conclusion, early knee-heel measurement may be a useful non-invasive predictor of long-term linear growth in children during treatment with growth hormone, and the ratio of total height to lower leg length may be of importance in detecting dysproportional growth.

Age Determination by Skeleton↗
PubMed1991

Urinary growth hormone excretion in 657 healthy children and adults: normal values, inter- and intraindividual variations.

Urinary growth hormone (u-GH) excretion was measured in 547 healthy children and 110 adults by ELISA with a detection limit of 1.1 ng/l u-GH after prior concentration of the urine samples (20- to 30-fold). u-GH excretion values were significantly dependent on the pubertal stage (p less than 0.0001) with maximum values in Tanner stage 3 for girls and 4 for boys. This corresponded to a peak in u-GH excretion between 11.5-14.5 years in girls and 12.5-16 years in boys. Additionally, u-GH excretion in adults was significantly higher than in prepubertal children (p less than 0.001). The day/night ratio of u-GH excretion (pg/h) was significantly higher in females than in males (p less than 0.01). In Tanner stages 1-4, u-GH excretion during the day was lower than that at night, whereas the opposite was true in late puberty and in adult women. The interindividual variation of u-GH excretion within the same Tanner stage was considerable and approximately double the intraindividual variation. The day-to-day variation could be further reduced by collection of three consecutive urine samples. The variations were larger if night samples instead of 24-hour samples were considered. The expression of u-GH excretion in nanograms per gram creatinine did not diminish the observed variation and blunted the pubertal increase in u-GH excretion. In conclusion, (1) u-GH excretion depends significantly on age, sex and pubertal maturation as does the day/night ratio of u-GH excretion. (2) The interindividual variation in u-GH excretion is considerable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Influence of sex and growth hormone deficiency on sweating.

Sweat secretion rate (SSR) was measured by the pilocarpine iontophoresis test in (a) 254 healthy children and adolescents (aged 6.0 to 19.2 years, mean age 11.2 years); in (b) 58 healthy adults (aged 20.4 to 75.2 years, mean age 37.6 years); and in (c) eight prepubertal patients with growth hormone (GH) deficiency (aged 4.2 to 13.5 years, mean age 8.9 years). Boys had higher median values for SSR than girls (pre-pubertal children: 92.7 vs 64.5 mg 30 min-1 pubertal children: 110.3 vs 73.1 mg 30 min-1), and men showed higher values than women (135.5 vs 49.2 mg 30 min-1). In addition, the change in sweat excretion rate from childhood to adulthood showed a difference between the sexes. Both pre-pubertal and pubertal boys had a lower secretion value than adult men (p less than 0.001 and 0.01, respectively), whereas girls showed higher secretion values than adult women (p less than 0.01 and p less than 0.001, respectively). There was a significant increase in SSR from prepuberty to puberty (p less than 0.001) for both sexes. The children with GH deficiency, all pre-pubertal, showed significantly reduced SSR (p less than 0.001) compared with the healthy children (median values: 32.8 vs 80.0 mg 30 min-1). We conclude that (a) sweat secretion pattern in children shows a significant sex difference and (b) sweating in children is dependent on growth hormone.

Adolescent↗
PubMed1991

A behaviorally effective model for training of general health professionals by a rheumatology team.

This project evaluated a model for inservice arthritis education based in part on principles of applied behavior analysis. Thirty-seven public health nurses (PHN) from 10 rural midwestern counties received instruction about screening and management of patients with arthritis; a random half of counties also received public and physician information interventions designed to increase arthritis referrals to community physicians under specific circumstances. In clinic interviews with patients of PHN showed modest, but significant, increases in 14 of 16 target behaviors attributable to inservice education. Because measured arthritis impact was low in this older adult population, physician referral rates were not affected by either intervention. This model illustrates generalizable behavior modification guidelines that are useful adjuncts to traditional procedures for development of professional arthritis education.

Aged↗
PubMed1990

A nation-wide cross-sectional study of urinary albumin excretion rate, arterial blood pressure and blood glucose control in Danish children with type 1 diabetes mellitus. Danish Study Group of Diabetes in Childhood.

Nation-wide screening for microalbuminuria in Denmark was performed in 22 paediatric departments treating children with Type 1 diabetes. Over a period of 6 months 1020 children (less than or equal to 12 years) and adolescents (greater than 12 to 19 years) were screened (81% of total). Of these, 957 (94%) performed at least two timed overnight urine collections. In 209 non-diabetic subjects the upper 95% limit for normal albumin excretion rate (AER) was 20 micrograms min-1. Mean overnight AER was significantly (p less than 0.001) elevated in diabetic (3.0 x/divided by 2.3 (SD tolerance factor) micrograms min-1) and in non-diabetic (2.5 x/divided by 2.2 micrograms min-1) adolescents compared with diabetic (1.7 x/divided by 2.1 micrograms min-1) and non-diabetic (1.3 x/divided by 2.2 micrograms min-1) children. In the diabetic patients AER was positively correlated with the body surface area and age. Among the patients with Type 1 diabetes, 4.3% (18 males and 23 females) had AER greater than 20 to 150 micrograms min-1 (persistent microalbuminuria). A further 7 adolescents (0.7%) had overt proteinuria (greater than 150 micrograms min-1). Clinical data for the 41 diabetic patients with AER greater than 20 to 150 micrograms min-1 were compared with those for 569 diabetic adolescents with AER less than or equal to 20 micrograms min-1 and duration of diabetes more than 2 years. The group with AER greater than 20 to 150 micrograms min-1 had significantly higher mean age (16.5 years) than the group with AER less than or equal to 20 micrograms min-1 (15.0 years; p less than 0.001). Females with AER greater than 20 to 150 micrograms min-1 had significantly higher mean HbA1c level (10.8 +/- 1.9%) than those with AER less than or equal to 20 micrograms min-1 (9.8 +/- 1.9%, p less than 0.003); they also had impaired linear growth (standard deviation score -0.25 vs + 0.16; p = 0.003). These associations were not found in males. Mean body mass index (BMI) was significantly increased in both females (22.2 +/- 2.9 kg m-2) and males (20.8 +/- 2.7 kg m-2) with AER greater than 20 to 150 micrograms min-1, compared with diabetic patients with AER less than or equal to 20 micrograms min-1 (females 20.8 +/- 3.0 kg m-2, p = 0.02; males 19.7 +/- 2.4 kg m-2, p less than 0.006).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1990

Peripheral nerve injuries of the shoulder in the athlete.

Athletic injuries about the shoulder resulting in lesions of the suprascapular, axillary, long thoracic, musculocutaneous, and spinal accessory nerves are uncommon. Yet these lesions are well described in the literature, and they may occur as isolated injuries. Rarely do they occur following surgical procedures about the shoulder of the athlete. Furthermore, these injuries may mimic other more commonly occurring athletic injuries thus giving rise to diagnostic confusion. The clinical syndromes that result from these isolated lesions have been discussed, along with their mechanisms of injury. Increased awareness, careful physical examination, and EMGs may greatly simplify the diagnosis. The treatment and prognosis for these injuries has been outlined.

Athletic Injuries↗
PubMed1978

The impact of the public hearing process on the HSP and AIP of an HSA: an evaluative case study.

This paper evaluates the public hearing process and discusses some implications and ramifications of a public hearing process within one health systems agency (HSA). Standards for a public hearing are outlined. The standards include the utilization of logic and simple language in the preparation of the proposal, the delineation of public consent and public opinion, clarification of the intent of the public hearing, the preparation of the public for the hearing, and the post-hearing work program. This evaluative study indicates that the public hearing process had minimal direct effect on the HSP and AIP but substantial indirect effects. Indirect effects included influencing the content and issues, defining linkages, delineation of public consent and public opinion, and heightening a sense of political feasibility and public credibility. Equally important was the staff awareness of the political-social climate of the region, the governing board and the DHEW Guidelines. Recommendations for HSAs are also developed. These include the development of a responsive mechanism, the "stimulation" of proponents, education on the nature of the public hearing process, and clarification of the nature of the public interest.

Communication↗