Position statement: the 'pros' of cholesterol screening of children.
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Biomedical subjects
Publications and source records attributed to W B Strong.
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The relationship between hostility and coronary artery disease may be partially mediated by unhealthy lifestyle behaviors. This study examined the relationship between hostility, lifestyle behaviors, and physical risk factors in 138 adult men and women. Subjects completed the Cook and Medley Hostility Scale (Ho scale) and self-reports of their dietary habits, consumption of alcohol and cigarettes, and physical activity. Recent findings indicated that a composite hostility score from three rationally derived subscales of the Ho scale tapping the dimensions of cynicism, hostile affect, and aggressiveness was a better predictor of mortality than the total Ho score. Thus, this composite measure of hostility and the total Ho score were used in data analyses. Measures of resting blood pressure, height, weight, and adiposity were also obtained. In men and women, both measures of hostility were positively associated with cholesterol intake and vigorous physical activity. Among women, both hostility measures were positively related to animal fat intake and negatively related to fiber intake. The composite measure was positively related to their resting systolic pressures. Among men, both hostility measures were positively related to cigarette smoking and sugar intake and negatively associated with systolic blood pressure and calcium intake. Findings are discussed in terms of previous research linking hostility to lifestyle behaviors and CAD.
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A 13-mo-old child is brought to his pediatrician following sudden onset of left-sided hemiplegia. The pediatrician accompanies the child and family to the emergency room. The pediatrician has been following the child, who has a diagnosis of possible cyanotic congenital heart disease. The child has never been known to have had a hypercyanotic episode. Oxygen saturation determinations by pulsed oximeter had been in the range of 84% to 88%. On one occasion, when the child was very upset, a reading of 78% was observed. At his 1-year visit, his hemoglobin level was 13 g/dL. On admission to the emergency department, a computed tomographic scan of the head was ordered. It demonstrated a right-sided nonhemorrhagic cerebrovascular lesion.
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The influence of family history of coronary artery disease on children's hemodynamic responses to exercise was examined with 25 black boys aged 7 to 10 years. Blood pressure, heart rate, cardiac output, stroke volume, and total peripheral resistance were evaluated during preexercise, peak exercise, and recovery stages. Children with a family history of CAD exhibited greater systolic blood pressure and total peripheral resistance during preexercise and peak exercise stages than did those without a family history of coronary artery disease. After controlling for preexercise differences, the group with a family history of coronary artery disease exhibited greater increases in systolic blood pressure and less attenuation of total peripheral resistance to peak exercise than the group without a family history of coronary artery disease. Cardiac output indexed by body surface area and stroke volumes were higher at all times in the group without a family history compared with the group with a family history of coronary artery disease. Findings are compared with those of adult studies in terms of influence of family history of coronary artery disease on cardiovascular reactivity to stress.
BACKGROUND: Physical inactivity is an independent risk factor for cardiovascular disease, yet little is known concerning factors which influence participation in physical activity or exercise. Two studies assessed the relationships between self-reported physical activity and social support for exercise. METHOD: One study involved a biracial sample of middle-class male and female teachers (mean age = 38.5 +/- 8.9 years) and one involved a biracial sample of lower- to middle-class males and females (mean age = 35.8 +/- 5.1 years). RESULTS: In both studies the social support scales had high internal consistencies and a two-component solution identical to the original validation study. In both studies, social support for exercise positively correlated with physical activity, but the relationships were mediated by race, gender, specific types of support (i.e., family, friend), and dimensions of physical activity (i.e., global, work, sports, and leisure). In both studies, regardless of work status and race, women's overall activity, particularly during leisure time, was positively related to family support for exercise. In both studies white women's overall activity levels, especially sports and leisure activities, were positively related to friend support. In both studies, black women's sports activity was positively associated with family support. Among white men in both studies, sports activities and total energy expenditure were positively related to family and friend support. Black men's sports-related activity was positively related to family support among the teachers and to friend support among subjects in the second study. CONCLUSION: Findings are discussed in terms of future research directed toward identification of other familial and sociocultural variables which might influence individuals' involvement in physical activity.
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This study evaluated the effect of intracardiac shunting on the accuracy of thoracic bioimpedance-derived cardiac output determinations. Twenty-six patients, ranging in age from 3 months to 17 years, underwent cardiac catheterization during which simultaneous Fick and impedance measurements of cardiac output were obtained. The subjects were divided into three groups: 10 children with no intracardiac shunts, nine children with predominant left-to-right intracardiac shunts, and seven children with predominant right-to-left intracardiac shunts. Positive correlations between impedance and Fick-derived cardiac output determinations were obtained in the non-shunt group (r = 0.84), with lower correlations in the left-to-right shunt group (r = 0.70). In the right-to-left shunt group, the impedance derived cardiac output correlated with Fick pulmonary flow (r = 0.82), but the variability was unacceptably large. Although further study is needed, impedance cardiography appears to have validity as a methodology in pediatric critical care and cardiovascular health research.
Primary prevention of coronary artery disease in children and young adults is important and can be instituted through a family-oriented cardiac risk factor clinic. Such a clinic was initiated at the Medical College of Georgia in March 1988. Children whose total cholesterol level (TC) exceeded 200 mg/dL when screened by their primary care physician were referred with their siblings and parents for fasting lipid profile and further evaluation. Data are available for the initial 21 families, including 30 children and 36 adults. The mean TC level was 258 mg/dL for index cases, 195 mg/dL for siblings, and 233 mg/dL for parents. Follow-up data obtained after therapy at a mean of 6 months are available for 12 families, including 14 children and 14 adults. The mean change in TC was from 265 to 246 mg/dL; 82% of the patients had a decrease in TC. Only one index case was documented as having neither a sibling nor a parent with an elevated cholesterol level. Family-oriented cardiac risk factor clinics are important for the identification and treatment of hypercholesterolemia in asymptomatic young people when primary prevention is possible.
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The case history of an infant with tetralogy of Fallot who had a Waterston anastomosis performed at the age of 1 year is presented. Subsequent chest roentgenograms revealed a ringlike calcification which was shown at angiography and operation to be due to a false aneurysm of the right pulmonary artery at the site of the Waterston anastomosis. The aneurysm also produced unidirectional obstruction of the right pulmonary artery. A review of the literature suggested that a false aneurysm of the right pulmonary artery after a Waterson anatomosis had not been reported previously.
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