Heidi Splete

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

SAN ANTONIO – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

Photo credit: CDC/Dr. Gilda Jones

"Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications," she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

"Indiscriminate use of PPIs without proper indication should be discouraged," she said. "There is a real-time need for guidelines on the use of PPIs, especially in hospitals."

Dr. Janarthanan reported having no financial conflicts of interest.

Many factors contribute to a child's perception of pain, including their age, past experiences, and cognitive development, according to Dr. Brandie J. Metz.

Dr. Metz shared tips and techniques to improve the pediatric dermatologic surgery experience for the doctor, patient, and parent at the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

Create a calm environment. When talking with a pediatric patient, get down on their level – sit at or below the child's height, and talk directly to him or her. Explain the procedure in a nonthreatening way, but do not leave anything out, and be honest about what is going to happen, noted Dr. Metz, the director of pediatric dermatology at the University of California, Irvine. "There should be no surprises."

Allow the child to have some control over the situation by allowing him or her to choose a radio station to play in the background or a DVD to watch if possible. Engage children in conversation, and let them choose the color for a surgical dressing, said Dr. Metz.

During the procedure, position the parent at the head of the table and strategically drape the surgical field so the parent and child cannot see the actual procedure. Take extra time to cover surgical trays or blood-soaked gauze that could increase the anxiety of the parent or child, she said.

When performing injections, slow infiltration is best; also, consider using a topical anesthetic and 30-gauge needles, she recommended. Dr. Metz prefers buffered, warmed lidocaine, with 1 cc 8.4% sodium bicarbonate/10 cc of 1% lidocaine.

The issue of anesthesia is an important one for pediatric surgery patients. There are no set rules or guidelines about the age at which surgical procedures can be performed with local vs. general anesthesia, Dr. Metz said. She recommended local anesthesia as an option for girls aged 8-9 years and older, and boys aged 9-10 years and older, but it ultimately depends on the maturity of the child. "Consider general anesthesia for larger procedures and in younger children," she said.

Remember that some elective dermatologic surgeries can be postponed until the preadolescent or adolescent years, she noted. Few data exist on the risks of general anesthesia for young children, but the risk appears highest during the first month of life, and complications are more common in emergency procedures, compared with elective procedures, she said. According to the American Society of Anesthesiologists, the risk of a complication from anesthesia in a healthy child ranges from 1:20,000 to 1:80,000 or less.

When performing excisions in children, 2-octyl cyanoacrylate (Dermabond) is an option, Dr. Metz reported. Several studies have shown the advantage of this skin glue over sutures or staples. However, studies of Dermabond have not controlled for confounding factors including excision location, patient ethnicity, and previous keloids.

Advantages of 2-octyl cyanoacrylate include speed of use, avoidance of a follow-up visit to remove sutures, and ability to withstand getting wet. Also, the antibacterial properties of the product might reduce the risk of post-surgery infections, Dr. Metz noted.

Disadvantages of 2-octyl cyanoacrylate include cost ($30/vial), the inability to place the product in the wound, and the lack of strength for use in high-tension areas, she reported.

Dr. Metz also shared tips for the staged excision of congenital nevi in children, which is an option when tissue expansion is not advisable and primary closure is not possible. Her recommendations for a successful excision include:

• Take as much of the lesion as possible during the first stage.

• Don't wait too long between stages. The timing should be about 6 to 8 weeks; long enough for the tension on the skin to relax, but not long enough for the scar to spread.

• Consider absorbable sutures to avoid the need for a suture removal visit.

Dr. Metz disclosed having no conflicts of interest. SDEF and this news organization are owned by Elsevier.

Many factors contribute to a child's perception of pain, including their age, past experiences, and cognitive development, according to Dr. Brandie J. Metz.

Dr. Metz shared tips and techniques to improve the pediatric dermatologic surgery experience for the doctor, patient, and parent at the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

Create a calm environment. When talking with a pediatric patient, get down on their level – sit at or below the child's height, and talk directly to him or her. Explain the procedure in a nonthreatening way, but do not leave anything out, and be honest about what is going to happen, noted Dr. Metz, the director of pediatric dermatology at the University of California, Irvine. "There should be no surprises."

Allow the child to have some control over the situation by allowing him or her to choose a radio station to play in the background or a DVD to watch if possible. Engage children in conversation, and let them choose the color for a surgical dressing, said Dr. Metz.

During the procedure, position the parent at the head of the table and strategically drape the surgical field so the parent and child cannot see the actual procedure. Take extra time to cover surgical trays or blood-soaked gauze that could increase the anxiety of the parent or child, she said.

When performing injections, slow infiltration is best; also, consider using a topical anesthetic and 30-gauge needles, she recommended. Dr. Metz prefers buffered, warmed lidocaine, with 1 cc 8.4% sodium bicarbonate/10 cc of 1% lidocaine.

The issue of anesthesia is an important one for pediatric surgery patients. There are no set rules or guidelines about the age at which surgical procedures can be performed with local vs. general anesthesia, Dr. Metz said. She recommended local anesthesia as an option for girls aged 8-9 years and older, and boys aged 9-10 years and older, but it ultimately depends on the maturity of the child. "Consider general anesthesia for larger procedures and in younger children," she said.

Remember that some elective dermatologic surgeries can be postponed until the preadolescent or adolescent years, she noted. Few data exist on the risks of general anesthesia for young children, but the risk appears highest during the first month of life, and complications are more common in emergency procedures, compared with elective procedures, she said. According to the American Society of Anesthesiologists, the risk of a complication from anesthesia in a healthy child ranges from 1:20,000 to 1:80,000 or less.

When performing excisions in children, 2-octyl cyanoacrylate (Dermabond) is an option, Dr. Metz reported. Several studies have shown the advantage of this skin glue over sutures or staples. However, studies of Dermabond have not controlled for confounding factors including excision location, patient ethnicity, and previous keloids.

Advantages of 2-octyl cyanoacrylate include speed of use, avoidance of a follow-up visit to remove sutures, and ability to withstand getting wet. Also, the antibacterial properties of the product might reduce the risk of post-surgery infections, Dr. Metz noted.

Disadvantages of 2-octyl cyanoacrylate include cost ($30/vial), the inability to place the product in the wound, and the lack of strength for use in high-tension areas, she reported.

Dr. Metz also shared tips for the staged excision of congenital nevi in children, which is an option when tissue expansion is not advisable and primary closure is not possible. Her recommendations for a successful excision include:

• Take as much of the lesion as possible during the first stage.

• Don't wait too long between stages. The timing should be about 6 to 8 weeks; long enough for the tension on the skin to relax, but not long enough for the scar to spread.

• Consider absorbable sutures to avoid the need for a suture removal visit.

Dr. Metz disclosed having no conflicts of interest. SDEF and this news organization are owned by Elsevier.

Many factors contribute to a child's perception of pain, including their age, past experiences, and cognitive development, according to Dr. Brandie J. Metz.

Dr. Metz shared tips and techniques to improve the pediatric dermatologic surgery experience for the doctor, patient, and parent at the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

Create a calm environment. When talking with a pediatric patient, get down on their level – sit at or below the child's height, and talk directly to him or her. Explain the procedure in a nonthreatening way, but do not leave anything out, and be honest about what is going to happen, noted Dr. Metz, the director of pediatric dermatology at the University of California, Irvine. "There should be no surprises."

Allow the child to have some control over the situation by allowing him or her to choose a radio station to play in the background or a DVD to watch if possible. Engage children in conversation, and let them choose the color for a surgical dressing, said Dr. Metz.

During the procedure, position the parent at the head of the table and strategically drape the surgical field so the parent and child cannot see the actual procedure. Take extra time to cover surgical trays or blood-soaked gauze that could increase the anxiety of the parent or child, she said.

When performing injections, slow infiltration is best; also, consider using a topical anesthetic and 30-gauge needles, she recommended. Dr. Metz prefers buffered, warmed lidocaine, with 1 cc 8.4% sodium bicarbonate/10 cc of 1% lidocaine.

The issue of anesthesia is an important one for pediatric surgery patients. There are no set rules or guidelines about the age at which surgical procedures can be performed with local vs. general anesthesia, Dr. Metz said. She recommended local anesthesia as an option for girls aged 8-9 years and older, and boys aged 9-10 years and older, but it ultimately depends on the maturity of the child. "Consider general anesthesia for larger procedures and in younger children," she said.

Remember that some elective dermatologic surgeries can be postponed until the preadolescent or adolescent years, she noted. Few data exist on the risks of general anesthesia for young children, but the risk appears highest during the first month of life, and complications are more common in emergency procedures, compared with elective procedures, she said. According to the American Society of Anesthesiologists, the risk of a complication from anesthesia in a healthy child ranges from 1:20,000 to 1:80,000 or less.

When performing excisions in children, 2-octyl cyanoacrylate (Dermabond) is an option, Dr. Metz reported. Several studies have shown the advantage of this skin glue over sutures or staples. However, studies of Dermabond have not controlled for confounding factors including excision location, patient ethnicity, and previous keloids.

Advantages of 2-octyl cyanoacrylate include speed of use, avoidance of a follow-up visit to remove sutures, and ability to withstand getting wet. Also, the antibacterial properties of the product might reduce the risk of post-surgery infections, Dr. Metz noted.

Disadvantages of 2-octyl cyanoacrylate include cost ($30/vial), the inability to place the product in the wound, and the lack of strength for use in high-tension areas, she reported.

Dr. Metz also shared tips for the staged excision of congenital nevi in children, which is an option when tissue expansion is not advisable and primary closure is not possible. Her recommendations for a successful excision include:

• Take as much of the lesion as possible during the first stage.

• Don't wait too long between stages. The timing should be about 6 to 8 weeks; long enough for the tension on the skin to relax, but not long enough for the scar to spread.

• Consider absorbable sutures to avoid the need for a suture removal visit.

Dr. Metz disclosed having no conflicts of interest. SDEF and this news organization are owned by Elsevier.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Statin use was associated with a moderate but significant 10% reduction in risk of colorectal cancer, based on a meta-analysis of 24 studies, investigators reported at the annual scientific meeting of the American College of Gastroenterology.

Data from some previous studies have suggested that statin use helps protect against colon cancer, but epidemiologic studies have shown mixed results, said Dr. Ivo Ditah of Wayne State University in Detroit and his colleagues in their poster.

The researchers reviewed data from 24 studies published from 1996 to 2009. The results included a total of 1.7 million adults who participated in 12 case-control studies, 6 randomized controlled trials, and 6 cohort studies.

Overall, the pooled risk estimate was 0.90, for a significant 10% reduction in colorectal cancer risk among statin users. The average duration of statin use was 2.8 years.

When the types of studies were analyzed separately, statin use was associated with a significant 10% reduction in colorectal cancer risk in the case-control studies and a significant 11% reduction in the cohort studies. In the randomized controlled trials, statin use was linked to a 10% reduction in risk of colorectal cancer, but this decrease was not significant.

Although the data show a modest overall reduction in colorectal cancer risk associated with statin use, the results appear to be driven by less robust study designs, rather than by randomized, controlled trials, the investigators noted.

In addition, the study was limited by the lack of long-term trials, which are important given the latency period between the initial stages of cancer development and its detection, the researchers said.

The researchers had no financial conflicts to disclose.

SAN ANTONIO – Colorectal adenomas were significantly more common in adults with type 2 diabetes, compared with the general adult population, based on a study of 860 patients who underwent screening colonoscopy.

“Colonic adenomas and advanced adenomas were independently predicted by diabetes,” wrote Dr. Nisheet Waghray of MetroHealth Medical Center in Cleveland, and colleagues. They presented their findings in a poster at theameeting.

Previous studies have shown a 30%-40% increase in colorectal cancer risk in adults with type 2 diabetes, but the association between type 2 diabetes and the risk of colorectal adenomas has not been well studied, the investigators explained.

The researchers reviewed colonoscopy data from 269 adults with type 2 diabetes and 591 adults without diabetes who were screened at a single medical center between January 2007 and January 2010.

All of the following findings – three or more adenomas, adenomas larger than 1 cm, a proximal location of advanced adenomas, and a higher mean number of polyps – were significantly more common in the diabetes patients than in the nondiabetics.

The percentage of patients with three or more adenomas was 14% in those with diabetes vs. 10% in the general population, and the rate of adenomas larger than 1 cm was 9.7% and 4.7%, respectively.

The average number of polyps in patients with diabetes vs. those without diabetes was 4.9 vs. 2.5. In addition, 68% of advanced adenomas in the diabetes patients were proximal, compared with 31% of those in the general population.

The average age of the patients with diabetes was 57 years, vs. 61 years in the general population, but this difference was not significant. There were no significant differences between the two groups in terms of body mass index, family history of colorectal cancer, or patient use of alcohol, tobacco, or nonsteroidal anti-inflammatory drugs. Approximately 60% of the patients in both groups were black.

The findings suggest that type 2 diabetes influences not only the number of adenomatous polyps, but also their location within the colon. More research is needed to confirm the results, but this study “adds plausibility that diabetes may play a role in the adenoma-carcinoma sequence,” Dr. Waghray and colleagues noted.

The researchers said that they had no financial conflicts to disclose.

SAN ANTONIO – Colorectal adenomas were significantly more common in adults with type 2 diabetes, compared with the general adult population, based on a study of 860 patients who underwent screening colonoscopy.

“Colonic adenomas and advanced adenomas were independently predicted by diabetes,” wrote Dr. Nisheet Waghray of MetroHealth Medical Center in Cleveland, and colleagues. They presented their findings in a poster at theameeting.

Previous studies have shown a 30%-40% increase in colorectal cancer risk in adults with type 2 diabetes, but the association between type 2 diabetes and the risk of colorectal adenomas has not been well studied, the investigators explained.

The researchers reviewed colonoscopy data from 269 adults with type 2 diabetes and 591 adults without diabetes who were screened at a single medical center between January 2007 and January 2010.

All of the following findings – three or more adenomas, adenomas larger than 1 cm, a proximal location of advanced adenomas, and a higher mean number of polyps – were significantly more common in the diabetes patients than in the nondiabetics.

The percentage of patients with three or more adenomas was 14% in those with diabetes vs. 10% in the general population, and the rate of adenomas larger than 1 cm was 9.7% and 4.7%, respectively.

The average number of polyps in patients with diabetes vs. those without diabetes was 4.9 vs. 2.5. In addition, 68% of advanced adenomas in the diabetes patients were proximal, compared with 31% of those in the general population.

The average age of the patients with diabetes was 57 years, vs. 61 years in the general population, but this difference was not significant. There were no significant differences between the two groups in terms of body mass index, family history of colorectal cancer, or patient use of alcohol, tobacco, or nonsteroidal anti-inflammatory drugs. Approximately 60% of the patients in both groups were black.

The findings suggest that type 2 diabetes influences not only the number of adenomatous polyps, but also their location within the colon. More research is needed to confirm the results, but this study “adds plausibility that diabetes may play a role in the adenoma-carcinoma sequence,” Dr. Waghray and colleagues noted.

The researchers said that they had no financial conflicts to disclose.

SAN ANTONIO – Colorectal adenomas were significantly more common in adults with type 2 diabetes, compared with the general adult population, based on a study of 860 patients who underwent screening colonoscopy.

“Colonic adenomas and advanced adenomas were independently predicted by diabetes,” wrote Dr. Nisheet Waghray of MetroHealth Medical Center in Cleveland, and colleagues. They presented their findings in a poster at theameeting.

Previous studies have shown a 30%-40% increase in colorectal cancer risk in adults with type 2 diabetes, but the association between type 2 diabetes and the risk of colorectal adenomas has not been well studied, the investigators explained.

The researchers reviewed colonoscopy data from 269 adults with type 2 diabetes and 591 adults without diabetes who were screened at a single medical center between January 2007 and January 2010.

All of the following findings – three or more adenomas, adenomas larger than 1 cm, a proximal location of advanced adenomas, and a higher mean number of polyps – were significantly more common in the diabetes patients than in the nondiabetics.

The percentage of patients with three or more adenomas was 14% in those with diabetes vs. 10% in the general population, and the rate of adenomas larger than 1 cm was 9.7% and 4.7%, respectively.

The average number of polyps in patients with diabetes vs. those without diabetes was 4.9 vs. 2.5. In addition, 68% of advanced adenomas in the diabetes patients were proximal, compared with 31% of those in the general population.

The average age of the patients with diabetes was 57 years, vs. 61 years in the general population, but this difference was not significant. There were no significant differences between the two groups in terms of body mass index, family history of colorectal cancer, or patient use of alcohol, tobacco, or nonsteroidal anti-inflammatory drugs. Approximately 60% of the patients in both groups were black.

The findings suggest that type 2 diabetes influences not only the number of adenomatous polyps, but also their location within the colon. More research is needed to confirm the results, but this study “adds plausibility that diabetes may play a role in the adenoma-carcinoma sequence,” Dr. Waghray and colleagues noted.

The researchers said that they had no financial conflicts to disclose.

Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8-13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005.

There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead author Dr. Lisa L. Bakhos said in an interview. She had conducted the study while she was a teaching fellow at Brown University in Providence, R.I. (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009-3101]).

First, many adults feel that because these athletes are so young, they could not possibly get seriously hurt. “This is, of course, not the case,” said Dr. Bakhos, an emergency physician at the Jersey Shore University Medical Center in Neptune, N.J.

“Also, a few good studies have shown that head injury in younger children can have more long-term effects, as you are essentially damaging a developing brain,” she explained. More data have surfaced about cognitive deficits in older children after concussion, she said, “which leads to conjecture that younger children would suffer the same — if not more — deficits long term.” However, this link needs further study. The American Academy of Pediatrics has just released “Sport-Related Concussion in Children and Adolescents” (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2010-2005]).

Dr. Bakhos and her colleagues reviewed 1997-2007 data from the NEISS (National Electronic Injury Surveillance System), and 2001-2005 data from the NEISS-AIP (All-Injury Program). The NEISS system allows researchers to investigate injury- and product-related ED visits.

In 2001-2005, about half of all ED visits for concussion across older and younger age groups were related to sports, including 58% of visits in children aged 8-13 years and 46% of visits in those aged 14-19 years. About 4 in 1,000 children aged 8-13 years and 6 in 1,000 of those aged 14-19 years went to the ED for a sports-related concussion.

During the 1997-2007 period, ED visits for the most popular organized team sports (football, ice hockey, soccer, basketball, and baseball) doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.

“The take-home message for pediatricians is, take concussion seriously even in the very young athlete,” said Dr. Bakhos. “Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents.”

“We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly [by] the use of helmets at all times,” she noted.

The study was limited by the exclusion of sports-related concussions that were treated in non-ED settings, and by underreporting of sports-related concussions, the researchers noted. The AAP has published a new clinical report that “outlines the current state of knowledge on pediatric and adolescent sport-related concussions,” wrote lead authors Dr. Mark E. Halstead and Dr. Kevin D. Walter, on behalf of the AAP's Council on Sports Medicine and Fitness. It includes the SCAT 2 (Sport Concussion Assessment Tool 2), a standardized method of evaluating concussion in athletes aged 10 and older.

The report includes the following recommendations:

▸ Stay off the field. Even if symptoms subside, young athletes should never return to play on the same day they have a concussion. They need more recovery time than do older athletes.

▸ See a doctor. Any children or adolescents who suffer concussions during sports should be medically cleared by a physician before they return to activity.

▸ Rest mind and body. All young athletes should refrain from physical and mental activity until they are asymptomatic at rest and when active. Evidence suggests that cognitive exertion — including doing homework, watching TV, and playing video games — can exacerbate symptoms post concussion.

In the last few years, several states have passed laws requiring educational materials about sports-related concussion for school-aged athletes, coaches, and parents. The AAP began working on the report before the first law was passed, said Dr. Halstead, director of the sports concussion program at Washington University in St. Louis. “We felt there was a need to address specifically the [pediatric] athlete and address all the recent research that has been published on this topic,” he said in an interview.

“The recommendations presented aren't significantly different from other recent documents published, but these were primarily published in sports medicine journals, which many pediatricians do not review. We wanted to bring these recommendations to the forefront to the pediatric community, and expand upon the details provided in previous documents published. We have highlighted some of the new research on neuroimaging, balance assessments, long-term complications, education, and neuropsychological testing,” Dr. Halstead said.

Dr. Walter added, “I think it is also important to recognize that because we have learned more about concussion diagnosis, treatment, and complications, the treatment that coaches and parents received when they had a concussion themselves at a young age is likely different [from treatment] today.” Many parents and coaches don't think concussion is a big deal because they had one when they were younger and they “toughed it out” and “are fine now,” said Dr. Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin in Milwaukee.

The authors acknowledged the lack of published baseline neuropsychological data on children younger than 12 years, and noted that assessment by a neuropsychologist might be helpful for children who have had more than one concussion, or whose postconcussive symptoms persist for several months.

Dr. Halstead emphasized the following take-home tips for clinicians:

▸ Never should young athletes return to play on the day of their concussion, nor should they return to play until they are symptom free both at rest and at exertion.

▸ A concussion is an injury to the brain, and rest is paramount. “If an athlete injures an ankle or knee and cannot run on it, we wouldn't think twice about resting that injury until it healed. Why should we treat the brain any differently?”

▸ Doctors are interested in getting an athlete back to play and activity as soon as possible. “But we need to be smart about it and make sure it is safe for that young athlete first.”

▸ Continue to educate everyone involved — coaches, parents, teachers, and athletes — in preventing and managing sports-related concussions.

None of the researchers mentioned in this story had any financial conflicts to disclose.

View on the News

Awareness Drives Rise in Reports

I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the ED, there are even more injuries occurring that are not being reported.

I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis. (My 2003 paper shows that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.

As we continue to peel the onion on concussion, we realize that it is an extremely complex injury. We now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.

Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.

One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.

Vitals

MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians. He disclosed that he is a cofounder of ImPACT, a computerized neurocognitive testing tool.

Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8-13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005.

There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead author Dr. Lisa L. Bakhos said in an interview. She had conducted the study while she was a teaching fellow at Brown University in Providence, R.I. (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009-3101]).

First, many adults feel that because these athletes are so young, they could not possibly get seriously hurt. “This is, of course, not the case,” said Dr. Bakhos, an emergency physician at the Jersey Shore University Medical Center in Neptune, N.J.

“Also, a few good studies have shown that head injury in younger children can have more long-term effects, as you are essentially damaging a developing brain,” she explained. More data have surfaced about cognitive deficits in older children after concussion, she said, “which leads to conjecture that younger children would suffer the same — if not more — deficits long term.” However, this link needs further study. The American Academy of Pediatrics has just released “Sport-Related Concussion in Children and Adolescents” (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2010-2005]).

Dr. Bakhos and her colleagues reviewed 1997-2007 data from the NEISS (National Electronic Injury Surveillance System), and 2001-2005 data from the NEISS-AIP (All-Injury Program). The NEISS system allows researchers to investigate injury- and product-related ED visits.

In 2001-2005, about half of all ED visits for concussion across older and younger age groups were related to sports, including 58% of visits in children aged 8-13 years and 46% of visits in those aged 14-19 years. About 4 in 1,000 children aged 8-13 years and 6 in 1,000 of those aged 14-19 years went to the ED for a sports-related concussion.

During the 1997-2007 period, ED visits for the most popular organized team sports (football, ice hockey, soccer, basketball, and baseball) doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.

“The take-home message for pediatricians is, take concussion seriously even in the very young athlete,” said Dr. Bakhos. “Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents.”

“We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly [by] the use of helmets at all times,” she noted.

The study was limited by the exclusion of sports-related concussions that were treated in non-ED settings, and by underreporting of sports-related concussions, the researchers noted. The AAP has published a new clinical report that “outlines the current state of knowledge on pediatric and adolescent sport-related concussions,” wrote lead authors Dr. Mark E. Halstead and Dr. Kevin D. Walter, on behalf of the AAP's Council on Sports Medicine and Fitness. It includes the SCAT 2 (Sport Concussion Assessment Tool 2), a standardized method of evaluating concussion in athletes aged 10 and older.

The report includes the following recommendations:

▸ Stay off the field. Even if symptoms subside, young athletes should never return to play on the same day they have a concussion. They need more recovery time than do older athletes.

▸ See a doctor. Any children or adolescents who suffer concussions during sports should be medically cleared by a physician before they return to activity.

▸ Rest mind and body. All young athletes should refrain from physical and mental activity until they are asymptomatic at rest and when active. Evidence suggests that cognitive exertion — including doing homework, watching TV, and playing video games — can exacerbate symptoms post concussion.

In the last few years, several states have passed laws requiring educational materials about sports-related concussion for school-aged athletes, coaches, and parents. The AAP began working on the report before the first law was passed, said Dr. Halstead, director of the sports concussion program at Washington University in St. Louis. “We felt there was a need to address specifically the [pediatric] athlete and address all the recent research that has been published on this topic,” he said in an interview.

“The recommendations presented aren't significantly different from other recent documents published, but these were primarily published in sports medicine journals, which many pediatricians do not review. We wanted to bring these recommendations to the forefront to the pediatric community, and expand upon the details provided in previous documents published. We have highlighted some of the new research on neuroimaging, balance assessments, long-term complications, education, and neuropsychological testing,” Dr. Halstead said.

Dr. Walter added, “I think it is also important to recognize that because we have learned more about concussion diagnosis, treatment, and complications, the treatment that coaches and parents received when they had a concussion themselves at a young age is likely different [from treatment] today.” Many parents and coaches don't think concussion is a big deal because they had one when they were younger and they “toughed it out” and “are fine now,” said Dr. Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin in Milwaukee.

The authors acknowledged the lack of published baseline neuropsychological data on children younger than 12 years, and noted that assessment by a neuropsychologist might be helpful for children who have had more than one concussion, or whose postconcussive symptoms persist for several months.

Dr. Halstead emphasized the following take-home tips for clinicians:

▸ Never should young athletes return to play on the day of their concussion, nor should they return to play until they are symptom free both at rest and at exertion.

▸ A concussion is an injury to the brain, and rest is paramount. “If an athlete injures an ankle or knee and cannot run on it, we wouldn't think twice about resting that injury until it healed. Why should we treat the brain any differently?”

▸ Doctors are interested in getting an athlete back to play and activity as soon as possible. “But we need to be smart about it and make sure it is safe for that young athlete first.”

▸ Continue to educate everyone involved — coaches, parents, teachers, and athletes — in preventing and managing sports-related concussions.

None of the researchers mentioned in this story had any financial conflicts to disclose.

View on the News

Awareness Drives Rise in Reports

I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the ED, there are even more injuries occurring that are not being reported.

I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis. (My 2003 paper shows that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.

As we continue to peel the onion on concussion, we realize that it is an extremely complex injury. We now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.

Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.

One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.

Vitals

MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians. He disclosed that he is a cofounder of ImPACT, a computerized neurocognitive testing tool.

Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8-13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005.

There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead author Dr. Lisa L. Bakhos said in an interview. She had conducted the study while she was a teaching fellow at Brown University in Providence, R.I. (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009-3101]).

First, many adults feel that because these athletes are so young, they could not possibly get seriously hurt. “This is, of course, not the case,” said Dr. Bakhos, an emergency physician at the Jersey Shore University Medical Center in Neptune, N.J.

“Also, a few good studies have shown that head injury in younger children can have more long-term effects, as you are essentially damaging a developing brain,” she explained. More data have surfaced about cognitive deficits in older children after concussion, she said, “which leads to conjecture that younger children would suffer the same — if not more — deficits long term.” However, this link needs further study. The American Academy of Pediatrics has just released “Sport-Related Concussion in Children and Adolescents” (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2010-2005]).

Dr. Bakhos and her colleagues reviewed 1997-2007 data from the NEISS (National Electronic Injury Surveillance System), and 2001-2005 data from the NEISS-AIP (All-Injury Program). The NEISS system allows researchers to investigate injury- and product-related ED visits.

In 2001-2005, about half of all ED visits for concussion across older and younger age groups were related to sports, including 58% of visits in children aged 8-13 years and 46% of visits in those aged 14-19 years. About 4 in 1,000 children aged 8-13 years and 6 in 1,000 of those aged 14-19 years went to the ED for a sports-related concussion.

During the 1997-2007 period, ED visits for the most popular organized team sports (football, ice hockey, soccer, basketball, and baseball) doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.

“The take-home message for pediatricians is, take concussion seriously even in the very young athlete,” said Dr. Bakhos. “Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents.”

“We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly [by] the use of helmets at all times,” she noted.

The study was limited by the exclusion of sports-related concussions that were treated in non-ED settings, and by underreporting of sports-related concussions, the researchers noted. The AAP has published a new clinical report that “outlines the current state of knowledge on pediatric and adolescent sport-related concussions,” wrote lead authors Dr. Mark E. Halstead and Dr. Kevin D. Walter, on behalf of the AAP's Council on Sports Medicine and Fitness. It includes the SCAT 2 (Sport Concussion Assessment Tool 2), a standardized method of evaluating concussion in athletes aged 10 and older.

The report includes the following recommendations:

▸ Stay off the field. Even if symptoms subside, young athletes should never return to play on the same day they have a concussion. They need more recovery time than do older athletes.

▸ See a doctor. Any children or adolescents who suffer concussions during sports should be medically cleared by a physician before they return to activity.

▸ Rest mind and body. All young athletes should refrain from physical and mental activity until they are asymptomatic at rest and when active. Evidence suggests that cognitive exertion — including doing homework, watching TV, and playing video games — can exacerbate symptoms post concussion.

In the last few years, several states have passed laws requiring educational materials about sports-related concussion for school-aged athletes, coaches, and parents. The AAP began working on the report before the first law was passed, said Dr. Halstead, director of the sports concussion program at Washington University in St. Louis. “We felt there was a need to address specifically the [pediatric] athlete and address all the recent research that has been published on this topic,” he said in an interview.

“The recommendations presented aren't significantly different from other recent documents published, but these were primarily published in sports medicine journals, which many pediatricians do not review. We wanted to bring these recommendations to the forefront to the pediatric community, and expand upon the details provided in previous documents published. We have highlighted some of the new research on neuroimaging, balance assessments, long-term complications, education, and neuropsychological testing,” Dr. Halstead said.

Dr. Walter added, “I think it is also important to recognize that because we have learned more about concussion diagnosis, treatment, and complications, the treatment that coaches and parents received when they had a concussion themselves at a young age is likely different [from treatment] today.” Many parents and coaches don't think concussion is a big deal because they had one when they were younger and they “toughed it out” and “are fine now,” said Dr. Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin in Milwaukee.

The authors acknowledged the lack of published baseline neuropsychological data on children younger than 12 years, and noted that assessment by a neuropsychologist might be helpful for children who have had more than one concussion, or whose postconcussive symptoms persist for several months.

Dr. Halstead emphasized the following take-home tips for clinicians:

▸ Never should young athletes return to play on the day of their concussion, nor should they return to play until they are symptom free both at rest and at exertion.

▸ A concussion is an injury to the brain, and rest is paramount. “If an athlete injures an ankle or knee and cannot run on it, we wouldn't think twice about resting that injury until it healed. Why should we treat the brain any differently?”

▸ Doctors are interested in getting an athlete back to play and activity as soon as possible. “But we need to be smart about it and make sure it is safe for that young athlete first.”

▸ Continue to educate everyone involved — coaches, parents, teachers, and athletes — in preventing and managing sports-related concussions.

None of the researchers mentioned in this story had any financial conflicts to disclose.

View on the News

Awareness Drives Rise in Reports

I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the ED, there are even more injuries occurring that are not being reported.

I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis. (My 2003 paper shows that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.

As we continue to peel the onion on concussion, we realize that it is an extremely complex injury. We now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.

Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.

One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.

Vitals

MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians. He disclosed that he is a cofounder of ImPACT, a computerized neurocognitive testing tool.

Women with fibromyalgia who participated in an 8-week yoga program reported significant improvements on measures of fibromyalgia symptoms and function, based on data from a pilot study of 53 women.

The positive findings have become the basis of a grant proposal to the National Institutes of Health to fund a larger clinical trial, said lead investigator James Carson, Ph.D.

Many fibromyalgia patients find standard medical care ineffective for reducing their symptoms, including pain and fatigue, Dr. Carson of Oregon Health and Science University, Portland, said in an interview.

More effective treatments for fibromyalgia are needed, said Dr. Carson. “Exercise is often prescribed for fibromyalgia, but for many patients it is hard to find an exercise program that is tolerable for them. Yoga poses done in a gentle way may be a good option,” he said.

Dr. Carson and colleagues randomized 53 women who met the American College of Rheumatology criteria for fibromyalgia in an 8-week Yoga of Awareness program (25 women) or standard care (28 women). The program consisted of gentle yoga poses, modified as needed to accommodate conditions such as knee osteoarthritis or carpal tunnel syndrome (Pain 2010;151:530–9).

The primary outcome measure was the total score on the Fibromyalgia Impact Questionnaire Revised (FIQR). After 8 weeks, the mean FIQR total score dropped from 48.32 at baseline to 35.49 in the yoga group (a statistically significant difference), compared with a change from 49.26 at baseline to 48.69 in the control group. More than half (56%) of the yoga group had at least a 30% reduction in overall FIQR scores, which is slightly more than twice the 14% reduction that is recommended to show clinical significance, the researchers noted. In addition, 50% of patients in the yoga group had at least a 30% reduction in the pain subscale of the FIQR.

The Patient Global Impression of Change (PGIC) scale scores for overall improvement in fibromyalgia symptoms were significantly higher in the yoga group vs. the control group (5.05 vs. 3.69). The PGIC was measured only once, at the end of the study. As part of the PGIC, approximately 90% of the patients in the yoga group reported feeling “a little better,” “much better,” or “very much better,” compared with 19% of the controls.

The average age of the participants was 54 years, and 68% had been symptomatic for more than 10 years. Patients who were already engaged in a yoga practice, those who were too disabled for meaningful participation in the yoga program, and those who were scheduled for elective surgery were excluded from the study.

“The most surprising finding for us was that most patients became so fully engaged in the home yoga practices they were assigned,” Dr. Carson said. On average, the patients spent 40 minutes practicing yoga at home, including about 19 minutes of postures, 13 minutes of seated meditation, and 8 minutes of breathing exercises. Those who practiced more had better results on several of the study outcomes, he noted.

“This finding suggests that yoga practices, if taught in a tailored, accessible manner, are not only well tolerated and effective; they are practiced with an unexpected degree of enthusiasm,” he said.

The results also showed that patients in the yoga group were more likely to use positive pain-management strategies such as problem solving, religion, acceptance, and relaxation, and less likely to resort to negative pain-management strategies such as self-isolation, disengagement, and catastrophizing.

“We are preparing a grant proposal to the National Institutes of Health to fund a larger clinical trial that will include comparison with another active treatment, so that we can make sure that the improvements seen in this first study can be reliably replicated in another group of patients, and that the improvements are not attributable to simply receiving extra attention from caregivers or to a placebo effect,” Dr. Carson said.

The researchers had no conflicts to disclose.

On average, the patients spent 13 minutes on seated meditation.

Source ©BRANDXPICTURES

Women with fibromyalgia who participated in an 8-week yoga program reported significant improvements on measures of fibromyalgia symptoms and function, based on data from a pilot study of 53 women.

The positive findings have become the basis of a grant proposal to the National Institutes of Health to fund a larger clinical trial, said lead investigator James Carson, Ph.D.

Many fibromyalgia patients find standard medical care ineffective for reducing their symptoms, including pain and fatigue, Dr. Carson of Oregon Health and Science University, Portland, said in an interview.

More effective treatments for fibromyalgia are needed, said Dr. Carson. “Exercise is often prescribed for fibromyalgia, but for many patients it is hard to find an exercise program that is tolerable for them. Yoga poses done in a gentle way may be a good option,” he said.

Dr. Carson and colleagues randomized 53 women who met the American College of Rheumatology criteria for fibromyalgia in an 8-week Yoga of Awareness program (25 women) or standard care (28 women). The program consisted of gentle yoga poses, modified as needed to accommodate conditions such as knee osteoarthritis or carpal tunnel syndrome (Pain 2010;151:530–9).

The primary outcome measure was the total score on the Fibromyalgia Impact Questionnaire Revised (FIQR). After 8 weeks, the mean FIQR total score dropped from 48.32 at baseline to 35.49 in the yoga group (a statistically significant difference), compared with a change from 49.26 at baseline to 48.69 in the control group. More than half (56%) of the yoga group had at least a 30% reduction in overall FIQR scores, which is slightly more than twice the 14% reduction that is recommended to show clinical significance, the researchers noted. In addition, 50% of patients in the yoga group had at least a 30% reduction in the pain subscale of the FIQR.

The Patient Global Impression of Change (PGIC) scale scores for overall improvement in fibromyalgia symptoms were significantly higher in the yoga group vs. the control group (5.05 vs. 3.69). The PGIC was measured only once, at the end of the study. As part of the PGIC, approximately 90% of the patients in the yoga group reported feeling “a little better,” “much better,” or “very much better,” compared with 19% of the controls.

The average age of the participants was 54 years, and 68% had been symptomatic for more than 10 years. Patients who were already engaged in a yoga practice, those who were too disabled for meaningful participation in the yoga program, and those who were scheduled for elective surgery were excluded from the study.

“The most surprising finding for us was that most patients became so fully engaged in the home yoga practices they were assigned,” Dr. Carson said. On average, the patients spent 40 minutes practicing yoga at home, including about 19 minutes of postures, 13 minutes of seated meditation, and 8 minutes of breathing exercises. Those who practiced more had better results on several of the study outcomes, he noted.

“This finding suggests that yoga practices, if taught in a tailored, accessible manner, are not only well tolerated and effective; they are practiced with an unexpected degree of enthusiasm,” he said.

The results also showed that patients in the yoga group were more likely to use positive pain-management strategies such as problem solving, religion, acceptance, and relaxation, and less likely to resort to negative pain-management strategies such as self-isolation, disengagement, and catastrophizing.

“We are preparing a grant proposal to the National Institutes of Health to fund a larger clinical trial that will include comparison with another active treatment, so that we can make sure that the improvements seen in this first study can be reliably replicated in another group of patients, and that the improvements are not attributable to simply receiving extra attention from caregivers or to a placebo effect,” Dr. Carson said.

The researchers had no conflicts to disclose.

On average, the patients spent 13 minutes on seated meditation.

Source ©BRANDXPICTURES

Women with fibromyalgia who participated in an 8-week yoga program reported significant improvements on measures of fibromyalgia symptoms and function, based on data from a pilot study of 53 women.

The positive findings have become the basis of a grant proposal to the National Institutes of Health to fund a larger clinical trial, said lead investigator James Carson, Ph.D.

Many fibromyalgia patients find standard medical care ineffective for reducing their symptoms, including pain and fatigue, Dr. Carson of Oregon Health and Science University, Portland, said in an interview.

More effective treatments for fibromyalgia are needed, said Dr. Carson. “Exercise is often prescribed for fibromyalgia, but for many patients it is hard to find an exercise program that is tolerable for them. Yoga poses done in a gentle way may be a good option,” he said.

Dr. Carson and colleagues randomized 53 women who met the American College of Rheumatology criteria for fibromyalgia in an 8-week Yoga of Awareness program (25 women) or standard care (28 women). The program consisted of gentle yoga poses, modified as needed to accommodate conditions such as knee osteoarthritis or carpal tunnel syndrome (Pain 2010;151:530–9).

The primary outcome measure was the total score on the Fibromyalgia Impact Questionnaire Revised (FIQR). After 8 weeks, the mean FIQR total score dropped from 48.32 at baseline to 35.49 in the yoga group (a statistically significant difference), compared with a change from 49.26 at baseline to 48.69 in the control group. More than half (56%) of the yoga group had at least a 30% reduction in overall FIQR scores, which is slightly more than twice the 14% reduction that is recommended to show clinical significance, the researchers noted. In addition, 50% of patients in the yoga group had at least a 30% reduction in the pain subscale of the FIQR.

The Patient Global Impression of Change (PGIC) scale scores for overall improvement in fibromyalgia symptoms were significantly higher in the yoga group vs. the control group (5.05 vs. 3.69). The PGIC was measured only once, at the end of the study. As part of the PGIC, approximately 90% of the patients in the yoga group reported feeling “a little better,” “much better,” or “very much better,” compared with 19% of the controls.

The average age of the participants was 54 years, and 68% had been symptomatic for more than 10 years. Patients who were already engaged in a yoga practice, those who were too disabled for meaningful participation in the yoga program, and those who were scheduled for elective surgery were excluded from the study.

“The most surprising finding for us was that most patients became so fully engaged in the home yoga practices they were assigned,” Dr. Carson said. On average, the patients spent 40 minutes practicing yoga at home, including about 19 minutes of postures, 13 minutes of seated meditation, and 8 minutes of breathing exercises. Those who practiced more had better results on several of the study outcomes, he noted.

“This finding suggests that yoga practices, if taught in a tailored, accessible manner, are not only well tolerated and effective; they are practiced with an unexpected degree of enthusiasm,” he said.

The results also showed that patients in the yoga group were more likely to use positive pain-management strategies such as problem solving, religion, acceptance, and relaxation, and less likely to resort to negative pain-management strategies such as self-isolation, disengagement, and catastrophizing.

“We are preparing a grant proposal to the National Institutes of Health to fund a larger clinical trial that will include comparison with another active treatment, so that we can make sure that the improvements seen in this first study can be reliably replicated in another group of patients, and that the improvements are not attributable to simply receiving extra attention from caregivers or to a placebo effect,” Dr. Carson said.

The researchers had no conflicts to disclose.

On average, the patients spent 13 minutes on seated meditation.

Source ©BRANDXPICTURES

Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults.

To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.

The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).

For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.

The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.

In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.

“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.

Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), but the difference was not significant.

In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.

The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.

“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.

Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults.

To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.

The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).

For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.

The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.

In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.

“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.

Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), but the difference was not significant.

In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.

The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.

“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.

Black patients who received drug-eluting stents were significantly more likely to develop stent thrombosis compared with nonblack patients, based on data from more than 7,000 adults.

To determine the incidence of early, late, and very late stent thrombosis (ST) in black patients compared with nonblack patients, Dr. Sara D. Collins and her colleagues at the Washington (D.C.) Hospital Center reviewed data from 7,236 adults who underwent percutaneous coronary intervention at a single hospital from April 2003 through December 2008.

The study group included 1,594 black patients and 5,642 nonblack patients (Circulation 2010 Aug. 30 [doi:10.1161/CIRCULATIONAHA.109.907998]).

For all patients, the incidence of early ST at 30 days was 0.83%. The cumulative incidence of late ST was 0.24% per year between 30 days and 1 year, which rose to 0.36% per year between 1 and 2 years.

The rates of ST were more than twice as high in blacks vs. nonblacks across all time points. At 30 days, the rate of ST in blacks vs. nonblacks was 1.71% vs. 0.59%. At 1 year, 2 years, and 3 years, the ST rates in blacks were 2.25%, 2.78%, and 3.67%, respectively. In nonblacks, the ST rates were 0.79%, 1.09%, and 1.25%, respectively.

In a multivariate analysis, black race was the strongest significant independent predictor of ST more than 30 days after PCI, and it was a significant predictor of early ST at 30 days.

“Black race is an independent predictor of ST even when accounting for potential confounders such as socioeconomic status and comorbidities,” the researchers said.

Black patients were more likely than nonblack patients to be taking clopidogrel at the time of the ST (88% vs. 78%), but the difference was not significant.

In a univariate analysis, black patients were significantly more likely than nonblack patients to have a history of hypertension, chronic renal insufficiency, diabetes, and heart failure. Black patients were significantly younger than nonblack patients (average age, 63 years vs. 65 years), and the median household income was significantly lower for black patients, the researchers noted.

The results support data from previous studies suggesting that black patients are more likely to experience ST, but this study is the first to control for variables typically associated with racial disparities in health care, the investigators noted.

“Because our analysis adjusts for traditional variables associated with racial disparities in health care, further mechanisms such as genetic polymorphisms and responsiveness to antiplatelet therapy must be pursued,” they said.

ATLANTA – Got bunions? Thank your parents. Bunions were inherited in 89% of adults younger than 60 years, according to genetic data from more than 2,000 adults.

Bunions and other foot disorders can limit mobility and exacerbate other musculoskeletal weaknesses, but interventions are available, and they are most effective if foot deformities are identified early, said Marian Hannan, D.Sc., of Harvard Medical School, Boston.

Foot disorders occur in 20%-60% of adults. Researchers have long suspected genetic involvement, but this study is the first to examine specific associations between genes and foot deformities, Dr. Hannan said. She and her colleagues reviewed data from 959 men and 1,220 women in the Framingham Foot Study of 2002-2005. A trained examiner evaluated the study participants for any of 20 different foot disorders. In this study, Dr. Hannan reported data about the most common and least common of the disorders: hallux valgus (bunions) and pes cavus (high arches).

In all, 675 individuals (31%) had bunions and 154 (7%) had high arches. A bunion was defined as a big toe angled at least 15 degrees toward the first metatarsal. High arches were identified by calculating weight-bearing arch width.

The researchers used statistical genetics software to determine the heritability of the two conditions. Across all ages, 39% of women and 38% of men inherited their bunions, and 68% of women and 20% of men inherited their high arches. Among individuals younger than 60 years, 99% of women and 63% of men inherited their high arches. The heritability estimates were statistically significant for both conditions. The average age of the study participants was 66 years, and 57% were women.

“Known interventions can slow the progression of disease” for patients with foot problems, Dr. Hannan emphasized. “We are continuing with research within the Framingham Foot Study to look at the other 18 foot conditions,” she added.

ATLANTA – Got bunions? Thank your parents. Bunions were inherited in 89% of adults younger than 60 years, according to genetic data from more than 2,000 adults.

Bunions and other foot disorders can limit mobility and exacerbate other musculoskeletal weaknesses, but interventions are available, and they are most effective if foot deformities are identified early, said Marian Hannan, D.Sc., of Harvard Medical School, Boston.

Foot disorders occur in 20%-60% of adults. Researchers have long suspected genetic involvement, but this study is the first to examine specific associations between genes and foot deformities, Dr. Hannan said. She and her colleagues reviewed data from 959 men and 1,220 women in the Framingham Foot Study of 2002-2005. A trained examiner evaluated the study participants for any of 20 different foot disorders. In this study, Dr. Hannan reported data about the most common and least common of the disorders: hallux valgus (bunions) and pes cavus (high arches).

In all, 675 individuals (31%) had bunions and 154 (7%) had high arches. A bunion was defined as a big toe angled at least 15 degrees toward the first metatarsal. High arches were identified by calculating weight-bearing arch width.

The researchers used statistical genetics software to determine the heritability of the two conditions. Across all ages, 39% of women and 38% of men inherited their bunions, and 68% of women and 20% of men inherited their high arches. Among individuals younger than 60 years, 99% of women and 63% of men inherited their high arches. The heritability estimates were statistically significant for both conditions. The average age of the study participants was 66 years, and 57% were women.

“Known interventions can slow the progression of disease” for patients with foot problems, Dr. Hannan emphasized. “We are continuing with research within the Framingham Foot Study to look at the other 18 foot conditions,” she added.

ATLANTA – Got bunions? Thank your parents. Bunions were inherited in 89% of adults younger than 60 years, according to genetic data from more than 2,000 adults.

Bunions and other foot disorders can limit mobility and exacerbate other musculoskeletal weaknesses, but interventions are available, and they are most effective if foot deformities are identified early, said Marian Hannan, D.Sc., of Harvard Medical School, Boston.

Foot disorders occur in 20%-60% of adults. Researchers have long suspected genetic involvement, but this study is the first to examine specific associations between genes and foot deformities, Dr. Hannan said. She and her colleagues reviewed data from 959 men and 1,220 women in the Framingham Foot Study of 2002-2005. A trained examiner evaluated the study participants for any of 20 different foot disorders. In this study, Dr. Hannan reported data about the most common and least common of the disorders: hallux valgus (bunions) and pes cavus (high arches).

In all, 675 individuals (31%) had bunions and 154 (7%) had high arches. A bunion was defined as a big toe angled at least 15 degrees toward the first metatarsal. High arches were identified by calculating weight-bearing arch width.

The researchers used statistical genetics software to determine the heritability of the two conditions. Across all ages, 39% of women and 38% of men inherited their bunions, and 68% of women and 20% of men inherited their high arches. Among individuals younger than 60 years, 99% of women and 63% of men inherited their high arches. The heritability estimates were statistically significant for both conditions. The average age of the study participants was 66 years, and 57% were women.

“Known interventions can slow the progression of disease” for patients with foot problems, Dr. Hannan emphasized. “We are continuing with research within the Framingham Foot Study to look at the other 18 foot conditions,” she added.