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This study determines the relationship between psychosocial adjustment in school-aged children and one aspect of exposure to violence, the proximity of exposure, in terms of (1) "physical" proximity and (2) "emotional" proximity to the victims of violence. A convenience sample of 175 children aged 9 to 12 years from a primary care clinic of a large urban hospital were interviewed about their exposure to violence using the Children's Report of Exposure to Violence. Psychosocial adjustment was measured through maternal reports using the Child Behavior Checklist (CBCL) and the Personal Adjustment and Role Skills Scale (PARS III). Children were categorized into three groups according to their closest proximity to exposure to violence ("victim" > "witness" > exposure through other people's "report") and two groups according to emotional proximity (victim was a "familiar person" or "stranger"). All children (23/175) who scored above the CBCL clinical cutoff (T score > 63) were witnesses or victims of violence. The CBCL total T scores (higher score = more maladjustment) showed that the "victims" group (mean 52.4) scored significantly higher than the "witness" group (mean 50.0) and "report" group (mean 47.4). The PARS III total scores (lower scores = more maladjustment) showed that the "victims" group (mean 87.5) scored significantly lower than the "witness" group (mean 93.1) and "report" group (mean 98.2). The relationship of the child to the victim was not associated with significantly different CBCL and PARS III scores. Children exposed to more proximal forms of violence as victims or witnesses exhibited more psychosocial maladjustment.

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PIP: Nicaragua's previously moderate population growth accelerated after 1940 because of better health care and sanitary practices. Today the death rate is 6/1000, and birth rates remain high at 33/1000; natural increase equals 2.7% per year. Life expectancy for men and women is 62 and 68, respectively. 45% of the population is younger than 15 years. The total fertility rate is 4.6. It is higher among women with no formal education (6.9), and among rural women (6.4). 53% of women are pregnant or have at least 1 child by age 19. 35% of births occur within 2 years of an earlier birth. Although 97% of women aged 15-49 know about at least 1 form of modern contraception, only 49% who were in a union during 1992-1993 used a contraceptive. Rural women, especially those with lower educational status, have the least experience with contraceptives; 63% of urban women report contraceptive use, in comparison to 33% of rural women. Mortality rates for infants (49/1000) and children (72/1000) have decreased. The main causes of infant death are trauma or asphyxia at birth, and complications associated with premature or low-weight babies; those for children are dehydration (from diarrhea), acute respiratory infections, meningitis, and illnesses preventable with vaccines. About 75% of children are immunized, usually at a later age than recommended. The geography, climate, and ethnic composition of Nicaragua, and recent events affecting its economy are briefly described.^ieng

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AIM: To investigate the effect of dexfenfluramine (dF) on Energy Expenditure (EE). DESIGN: 20 obese females were studied in a double-blind design. Pre-diet and at 14 and 28 days of VLCD and dF treatment (30 mg/d) or placebo, Resting Metabolic Rate (RMR), 3 h-Thermic Effect of Food (3 h-TEF) and body composition were determined. EE and body composition were measured by indirect calorimetry and bioelectrical impedance, respectively. RESULTS: No differences between groups were observed in relation to weight loss, body composition changes or RMR. At 3 h postprandial, the EE was still elevated in both groups. No changes on TEF were observed in the placebo group during VLCD. In contrast, TEF decreased in dF group during VLCD (P < 0.05). No significant differences in TEF at the end of the study were observed between groups. CONCLUSION: These results suggest that dF modifies 3 h-TEF but not RMR in obese patients during VLCD administration.

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The aim of this study was to assess changes in resting energy expenditure (REE) related to changes in fat free mass (FFM) in nine morbid obese (BMI 43 +/- 5.1 kg/m2) hospitalised females on VLCD. REE was measured by 30 min indirect calorimetry before and after 28 days of hospitalisation. Changes in FFM were assessed by bioelectrical impedance analysis (BIA), hydrostatic weighing (HW) and nitrogen balance (N). REE decreased 11.5% from 7.8 +/- 1.0 to 6.9 +/- 0.8 MJ/d. Total weight loss was 8.4 +/- 1.9 kg or 7.4% with an estimated FFM loss of 3.4 +/- 1.8 (BIA), 2.9 +/- 1.9 (HW) and 1.8 +/- 1.0 (N). As the fall in REE was larger than the loss of FFM, it is concluded that morbid obese patients develop an energy saving adaptation during rapid weight loss.

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BACKGROUND: The equations available for the prediction of basal energy expenditure (BEE) may not be applicable in morbid obese individuals since the contribution of the fat free mass (FFM) over the BEE is not constant. The aim of this study was to obtain new equations for the prediction of BEE which are specific for patients with morbid obesity. METHODS: In 26 women with morbid obesity age, weight, body composition by bioelectric impedance and BEE by open circuit indirect calorimetry were determined. The BEE observed was compared with that estimated from the previously described equations. The multiple regression method was used to obtain the BEE prediction equations. RESULTS: Upon comparison of the BEE observed with the BEE estimated by the described equations a significant relation was found between both parameters. The differences were also significant except when the Harris-Benedict equation was used. Multiple regression analysis demonstrated that when the variables of body composition were included, the FFM explained 75% of the variation in BEE and on forcing the entrance of fatty mass, the explanation increased to 79%. When only the anthropometric variables were included, weight explained 69% of the variation. CONCLUSIONS: In morbid obesity, most of the equations described for estimating basal energy expenditure are not applicable. New equations are reported for the prediction of energy expenditure.

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Several fibrinolytic variables, including plasminogen activator inhibitor activity, were studied before and after exercise in 67 normolipidaemic patients with coronary artery disease and in 25 hyperlipidaemic patients with coronary artery disease. Before exercise plasminogen activator inhibitor activity was higher in the patient groups than in a group of 10 healthy volunteers. For those who were normolipidaemic plasminogen activator inhibitor activity was greater in patients with angina pectoris who had had a myocardial infarction. The concentration of antigenic tissue-type plasminogen activator was similar in all the patients with coronary artery disease and higher than in the control group. After the exercise test fibrinolytic capacity was lower in the patients with angina pectoris and a previous history of myocardial infarction. After exercise both the released immunological tissue-type plasminogen activator and fibrinolytic capacity were lower in the hyperlipidaemic patients than in the normolipidaemic patients. The concentration of plasminogen activator inhibitor was also higher in the hyperlipidaemic patients. Patients with hyperlipidaemia IV had the highest plasminogen activator inhibitor activity. The increase in plasminogen activator inhibitor activity found in the patients was partially inhibited by antiserum against plasminogen activator inhibitor-1 in vitro. The formation of a complex of about 115,000 daltons between plasminogen activator inhibitor and purified tissue-type plasminogen activator was detected by a zymographic fibrin technique. These findings show that in patients with coronary artery disease fibrinolytic activity is impaired by an increase in plasminogen activator inhibitor. Impaired fibrinolysis may be related to the clinical evolution of coronary artery disease in these patients.

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65 pregnant women distributed in two groups, by a double-blind method received a placebo or a sunscreen cream (Pabafil SPF 10, with absorption range from 290 to 360 nm) for daily use on face during the second quarter of their pregnancy in summer time. In 30 patients "with optimum fulfillment" in the products application (16 with placebo and 14 with sunscreen cream) the melasma appearances were significantly lower in those with sunscreen application. In subgroups of the total number of pregnant women, with similar proportion of patients with placebo and sunscreen, the melasma appearances were significantly lower in skin types I-II, and in those that used cosmetics (versus those that did not). No differences were observed in subgroups by age, parity, and with or without history of previous melasma.

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The prognostic value of early load-limited and symptom-limited exercise testing has been compared in 200 men younger than 65 years of age, after myocardial infarction. 164 patients performed both tests and in 79 of the 200 cases who performed the early test the result was positive (40%); the percentage of positive tests was higher with the symptom-limited test (53.6%). The prognostic value of both tests was high. During the follow-up the mortality rate was higher in patients with positive results, but the early test enables the identification of patients in a higher risk group before hospital discharge.

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