Heidi Splete

DENVER — Both social isolation and depression hampered health behaviors in a study of 492 patients who suffered acute coronary syndrome events, reported Dr. Manual Paz-Yepes at the annual meeting of the American Psychosomatic Society.

The 174 patients without life partners were significantly less likely than the 318 patients with partners to participate in cardiac rehabilitation (35% vs. 64%) or exercise (46% vs. 57%), and were more likely to smoke (15% vs. 8%) 3 months after an acute coronary syndrome (ACS) event.

Within 7 days of their ACS event and after 3 months, patients completed the Beck Depression Inventory as well as the UCLA loneliness scale, a measure of social isolation, wrote Dr. Paz-Yepes of the Cardiovascular Institute at Mount Sinai School of Medicine, New York, in a poster.

In a hierarchical regression analysis, depression, but not loneliness or partner status, was significantly tied to reduced likelihood of participation in cardiac rehab or exercise, and with reduced medication adherence. Loneliness was significantly linked with decreased medication adherence, lack of exercise, and smoking likelihood.

DENVER — Both social isolation and depression hampered health behaviors in a study of 492 patients who suffered acute coronary syndrome events, reported Dr. Manual Paz-Yepes at the annual meeting of the American Psychosomatic Society.

The 174 patients without life partners were significantly less likely than the 318 patients with partners to participate in cardiac rehabilitation (35% vs. 64%) or exercise (46% vs. 57%), and were more likely to smoke (15% vs. 8%) 3 months after an acute coronary syndrome (ACS) event.

Within 7 days of their ACS event and after 3 months, patients completed the Beck Depression Inventory as well as the UCLA loneliness scale, a measure of social isolation, wrote Dr. Paz-Yepes of the Cardiovascular Institute at Mount Sinai School of Medicine, New York, in a poster.

In a hierarchical regression analysis, depression, but not loneliness or partner status, was significantly tied to reduced likelihood of participation in cardiac rehab or exercise, and with reduced medication adherence. Loneliness was significantly linked with decreased medication adherence, lack of exercise, and smoking likelihood.

DENVER — Both social isolation and depression hampered health behaviors in a study of 492 patients who suffered acute coronary syndrome events, reported Dr. Manual Paz-Yepes at the annual meeting of the American Psychosomatic Society.

The 174 patients without life partners were significantly less likely than the 318 patients with partners to participate in cardiac rehabilitation (35% vs. 64%) or exercise (46% vs. 57%), and were more likely to smoke (15% vs. 8%) 3 months after an acute coronary syndrome (ACS) event.

Within 7 days of their ACS event and after 3 months, patients completed the Beck Depression Inventory as well as the UCLA loneliness scale, a measure of social isolation, wrote Dr. Paz-Yepes of the Cardiovascular Institute at Mount Sinai School of Medicine, New York, in a poster.

In a hierarchical regression analysis, depression, but not loneliness or partner status, was significantly tied to reduced likelihood of participation in cardiac rehab or exercise, and with reduced medication adherence. Loneliness was significantly linked with decreased medication adherence, lack of exercise, and smoking likelihood.

WASHINGTON – Two-year-olds whose mothers smoke regularly during pregnancy are significantly more likely to exhibit clinically disruptive behavior than are children of nonsmoking mothers, according to a review presented at a conference on tobacco control sponsored by the American Cancer Society.

“What we found was that nicotine exposure was linked to aggressive behavior, defiance, and lower social skills,” said Lauren S. Wakschlag, Ph.D., of the University of Illinois, Chicago.

“We still don't know that there is a causal link,” she said. “But the evidence that nicotine-exposed children are more likely to have behavior problems is there, and it is very consistent.”

To the researchers' surprise, nicotine exposure was not associated with emotional dysregulation–for reasons that remain unclear.

Ninety-three children were involved in the study. Overall, the 44 children exposed to nicotine in the womb were more defiant, more aggressive, and less social, compared with the 49 children who were not exposed–even after controlling for multiple variables.

The mothers were primarily non-Hispanic white and working class, which reflects the demographics of the typical pregnant smoker in the United States. Mothers of the nicotine-exposed children reported smoking consistently during at least two trimesters of their pregnancies, and 47% of them smoked more than half a pack (about 15 cigarettes) daily.

The children were assessed at 12, 18, and 24 months of age using maternal reports on the Infant-Toddler Social Emotional Assessment test. The 24-item ITSEA provides a clinical measurement of behavior in children as young as 1 year and rates traits such as peer aggression on a three-point scale. The children also were observed during a 20-minute interaction with their mothers in a laboratory setting.

Overall, nicotine-exposed children were almost 12 times as likely to have clinically significant behavior problems; 14 of 16 children with ITSEA scores in the clinical range were in the nicotine-exposed group, Dr. Wakschlag noted.

Mild behavior problems are common in toddlers, but the behavior of the nicotine-exposed toddlers was worse than that of the unexposed toddlers at the start of the study. In addition, the differences between the groups were significant by age 24 months, and the nicotine-exposed toddlers' behavior significantly worsened between ages 18 months and 24 months–the age at which some problem behaviors typically associated with the “terrible twos” start to decline, Dr. Wakschlag observed.

Identifying a pattern of behavior in toddlers who were prenatally exposed to nicotine could be useful in examining how other prenatal experiences affect behavior in early childhood.

“We have more work to do, but it is striking to see this level of coherence in the first year of life, and the specificity of the findings can help take the research further,” Dr. Wakschlag said. The next step, she said, is to link the behavior patterns of children who have been exposed to nicotine to neuroscientific investigations and to think about how nicotine exposure might interact with types of causal risks.

The data, which were published recently (Child Dev. 2006;77:893–906), support similar findings from another study. In the previous study, investigators found that maternal smoking during pregnancy was significantly associated with observed negativity in 52 toddlers whose mothers smoked throughout pregnancy, compared with 47 toddlers whose mothers did not smoke during pregnancy (Arch. Pediatr. Adolesc. Med. 2000;154:381–5).

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Two-year-olds whose mothers smoke regularly during pregnancy are significantly more likely to exhibit clinically disruptive behavior than are children of nonsmoking mothers, according to a review presented at a conference on tobacco control sponsored by the American Cancer Society.

“What we found was that nicotine exposure was linked to aggressive behavior, defiance, and lower social skills,” said Lauren S. Wakschlag, Ph.D., of the University of Illinois, Chicago.

“We still don't know that there is a causal link,” she said. “But the evidence that nicotine-exposed children are more likely to have behavior problems is there, and it is very consistent.”

To the researchers' surprise, nicotine exposure was not associated with emotional dysregulation–for reasons that remain unclear.

Ninety-three children were involved in the study. Overall, the 44 children exposed to nicotine in the womb were more defiant, more aggressive, and less social, compared with the 49 children who were not exposed–even after controlling for multiple variables.

The mothers were primarily non-Hispanic white and working class, which reflects the demographics of the typical pregnant smoker in the United States. Mothers of the nicotine-exposed children reported smoking consistently during at least two trimesters of their pregnancies, and 47% of them smoked more than half a pack (about 15 cigarettes) daily.

The children were assessed at 12, 18, and 24 months of age using maternal reports on the Infant-Toddler Social Emotional Assessment test. The 24-item ITSEA provides a clinical measurement of behavior in children as young as 1 year and rates traits such as peer aggression on a three-point scale. The children also were observed during a 20-minute interaction with their mothers in a laboratory setting.

Overall, nicotine-exposed children were almost 12 times as likely to have clinically significant behavior problems; 14 of 16 children with ITSEA scores in the clinical range were in the nicotine-exposed group, Dr. Wakschlag noted.

Mild behavior problems are common in toddlers, but the behavior of the nicotine-exposed toddlers was worse than that of the unexposed toddlers at the start of the study. In addition, the differences between the groups were significant by age 24 months, and the nicotine-exposed toddlers' behavior significantly worsened between ages 18 months and 24 months–the age at which some problem behaviors typically associated with the “terrible twos” start to decline, Dr. Wakschlag observed.

Identifying a pattern of behavior in toddlers who were prenatally exposed to nicotine could be useful in examining how other prenatal experiences affect behavior in early childhood.

“We have more work to do, but it is striking to see this level of coherence in the first year of life, and the specificity of the findings can help take the research further,” Dr. Wakschlag said. The next step, she said, is to link the behavior patterns of children who have been exposed to nicotine to neuroscientific investigations and to think about how nicotine exposure might interact with types of causal risks.

The data, which were published recently (Child Dev. 2006;77:893–906), support similar findings from another study. In the previous study, investigators found that maternal smoking during pregnancy was significantly associated with observed negativity in 52 toddlers whose mothers smoked throughout pregnancy, compared with 47 toddlers whose mothers did not smoke during pregnancy (Arch. Pediatr. Adolesc. Med. 2000;154:381–5).

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Two-year-olds whose mothers smoke regularly during pregnancy are significantly more likely to exhibit clinically disruptive behavior than are children of nonsmoking mothers, according to a review presented at a conference on tobacco control sponsored by the American Cancer Society.

“What we found was that nicotine exposure was linked to aggressive behavior, defiance, and lower social skills,” said Lauren S. Wakschlag, Ph.D., of the University of Illinois, Chicago.

“We still don't know that there is a causal link,” she said. “But the evidence that nicotine-exposed children are more likely to have behavior problems is there, and it is very consistent.”

To the researchers' surprise, nicotine exposure was not associated with emotional dysregulation–for reasons that remain unclear.

Ninety-three children were involved in the study. Overall, the 44 children exposed to nicotine in the womb were more defiant, more aggressive, and less social, compared with the 49 children who were not exposed–even after controlling for multiple variables.

The mothers were primarily non-Hispanic white and working class, which reflects the demographics of the typical pregnant smoker in the United States. Mothers of the nicotine-exposed children reported smoking consistently during at least two trimesters of their pregnancies, and 47% of them smoked more than half a pack (about 15 cigarettes) daily.

The children were assessed at 12, 18, and 24 months of age using maternal reports on the Infant-Toddler Social Emotional Assessment test. The 24-item ITSEA provides a clinical measurement of behavior in children as young as 1 year and rates traits such as peer aggression on a three-point scale. The children also were observed during a 20-minute interaction with their mothers in a laboratory setting.

Overall, nicotine-exposed children were almost 12 times as likely to have clinically significant behavior problems; 14 of 16 children with ITSEA scores in the clinical range were in the nicotine-exposed group, Dr. Wakschlag noted.

Mild behavior problems are common in toddlers, but the behavior of the nicotine-exposed toddlers was worse than that of the unexposed toddlers at the start of the study. In addition, the differences between the groups were significant by age 24 months, and the nicotine-exposed toddlers' behavior significantly worsened between ages 18 months and 24 months–the age at which some problem behaviors typically associated with the “terrible twos” start to decline, Dr. Wakschlag observed.

Identifying a pattern of behavior in toddlers who were prenatally exposed to nicotine could be useful in examining how other prenatal experiences affect behavior in early childhood.

“We have more work to do, but it is striking to see this level of coherence in the first year of life, and the specificity of the findings can help take the research further,” Dr. Wakschlag said. The next step, she said, is to link the behavior patterns of children who have been exposed to nicotine to neuroscientific investigations and to think about how nicotine exposure might interact with types of causal risks.

The data, which were published recently (Child Dev. 2006;77:893–906), support similar findings from another study. In the previous study, investigators found that maternal smoking during pregnancy was significantly associated with observed negativity in 52 toddlers whose mothers smoked throughout pregnancy, compared with 47 toddlers whose mothers did not smoke during pregnancy (Arch. Pediatr. Adolesc. Med. 2000;154:381–5).

ELSEVIER GLOBAL MEDICAL NEWS

Inpatients + Cigarettes = Comorbidities

Nearly half of psychiatric inpatients with at least one medical comorbidity were smokers, based on data from 1,097 adults aged 18–93 years admitted to a psychiatric hospital over 10 months.

Overall, 48% of the patients had multiple medical comorbidities, reported Cynthia L. Dakin, Ph.D., in a poster at a conference on tobacco control sponsored by the American Cancer Society.

Tobacco use data were available for 784 patients. Dr. Dakin and her associates at Northeastern University, Boston, found that 55% of the 784 patients smoked, and 66% of them smoked at least one pack of cigarettes daily. Another 26% smoked between 15 and 20 cigarettes daily, and 8% smoked fewer than 15 cigarettes daily.

Tobacco use was significantly associated with hypertension, diabetes, cancer, osteoporosis, heart disease, and a history of stroke.

The most common DSM-IV diagnoses in the overall sample were major depressive disorder; substance intoxication, dependence, or abuse; bipolar disorder; and schizophrenia.

This study did not review the associations between tobacco use and psychiatric diagnoses, but previous research has shown significant associations between smoking and psychiatric conditions. One study of 2,774 psychiatric patients (of which 61% were smokers) found that bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking (Psychol. Addict. Behav. 2003;17:259–65).

Dr. Dakin and her colleagues plan to conduct follow-up research on smoking cessation efforts for psychiatric inpatients.

Ask Blue-Collar Patients About Smoking

Significantly fewer white-collar workers than blue-collar workers are smokers, according to National Health Interview Survey data from more than 140,000 respondents.

Pooled smoking data from 1997 to 2004 showed the highest reported rates among construction workers (39%) and the lowest reported rates among health professionals (5%), said David J. Lee, Ph.D., who presented the findings at a conference on tobacco control sponsored by the American Cancer Society.

“The overarching goal of Healthy People 2010 is to reduce health disparities in the U.S. population, and I think you'll agree that we have a health disparity here with respect to smoking groups,” said Dr. Lee, who is with the epidemiology and public health department at the University of Miami.

Dr. Lee cited his study of 8-year smoking trends by occupational category based on NHIS data in which the 20 occupations with the highest smoking rates (all greater than 40%) were blue-collar jobs, and included bartenders, waiters, maintenance workers, truck drivers, and carpenters (J. Occup. Environ. Med. 2004;46:538–48).

“We saw some evidence of a smoking decline [among] roofers (who topped the list with a 58% smoking rate), but it was not statistically significant,” he said.

By contrast, the occupations with the 20 lowest smoking rates were classified as white-collar jobs, and ranged from 15% among airline pilots to 4% among clergy and physicians.

Despite evidence of declining smoking rates in some blue-collar professions, the findings suggest that blue-collar workers need more attention from their employers and health professionals if they are going to stop smoking.

Workplace health and safety programs offer excellent opportunities to encourage smokers to quit, especially those who rarely see a physician in the office, Dr. Lee said. But office-based physicians who ask their blue-collar patients about smoking and assist those who want to quit are essential to reducing the occupational disparity, he emphasized.

The National Health Interview Survey provides an annual representative sample of noninstitutionalized U.S. workers older than 18 years. The survey places workers in 1 of 41 occupational categories, and smoking information has been collected consistently since 1997.

Tobacco Tx Guidelines to Be Updated

The U.S. government's guidelines for the treatment of tobacco dependence are due for a checkup, and clinicians can help.

An updated version of the government-sponsored publication, “Treating Tobacco Use and Dependence,” will be published in 2008, Dr. Michael C. Fiore said at a conference on tobacco control sponsored by the American Cancer Society.

“The guidelines will remain treatment-based; this will not be a soup-to-nuts rewrite,” said Dr. Fiore, a professor of medicine at the University of Wisconsin, Madison, and chair of the panel charged with writing the update.

The panel welcomes input from inside and outside the medical community on significant research in tobacco dependence treatment and issues that were not addressed in the current guidelines (published in 2000), Dr. Fiore said.

Topics submitted so far include the clinical efficacy of the “five A's” (a method of assessing willingness to change behavior), the effectiveness of telephone hotlines, and the safety and efficacy of combination drug therapies. The update will address counseling and pharmacotherapy for pregnant smokers and smokers with comorbid mental illness. Suggested topics for or improvements to the guidelines should be sent before October 2006 to

[email protected]

Inpatients + Cigarettes = Comorbidities

Nearly half of psychiatric inpatients with at least one medical comorbidity were smokers, based on data from 1,097 adults aged 18–93 years admitted to a psychiatric hospital over 10 months.

Overall, 48% of the patients had multiple medical comorbidities, reported Cynthia L. Dakin, Ph.D., in a poster at a conference on tobacco control sponsored by the American Cancer Society.

Tobacco use data were available for 784 patients. Dr. Dakin and her associates at Northeastern University, Boston, found that 55% of the 784 patients smoked, and 66% of them smoked at least one pack of cigarettes daily. Another 26% smoked between 15 and 20 cigarettes daily, and 8% smoked fewer than 15 cigarettes daily.

Tobacco use was significantly associated with hypertension, diabetes, cancer, osteoporosis, heart disease, and a history of stroke.

The most common DSM-IV diagnoses in the overall sample were major depressive disorder; substance intoxication, dependence, or abuse; bipolar disorder; and schizophrenia.

This study did not review the associations between tobacco use and psychiatric diagnoses, but previous research has shown significant associations between smoking and psychiatric conditions. One study of 2,774 psychiatric patients (of which 61% were smokers) found that bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking (Psychol. Addict. Behav. 2003;17:259–65).

Dr. Dakin and her colleagues plan to conduct follow-up research on smoking cessation efforts for psychiatric inpatients.

Ask Blue-Collar Patients About Smoking

Significantly fewer white-collar workers than blue-collar workers are smokers, according to National Health Interview Survey data from more than 140,000 respondents.

Pooled smoking data from 1997 to 2004 showed the highest reported rates among construction workers (39%) and the lowest reported rates among health professionals (5%), said David J. Lee, Ph.D., who presented the findings at a conference on tobacco control sponsored by the American Cancer Society.

“The overarching goal of Healthy People 2010 is to reduce health disparities in the U.S. population, and I think you'll agree that we have a health disparity here with respect to smoking groups,” said Dr. Lee, who is with the epidemiology and public health department at the University of Miami.

Dr. Lee cited his study of 8-year smoking trends by occupational category based on NHIS data in which the 20 occupations with the highest smoking rates (all greater than 40%) were blue-collar jobs, and included bartenders, waiters, maintenance workers, truck drivers, and carpenters (J. Occup. Environ. Med. 2004;46:538–48).

“We saw some evidence of a smoking decline [among] roofers (who topped the list with a 58% smoking rate), but it was not statistically significant,” he said.

By contrast, the occupations with the 20 lowest smoking rates were classified as white-collar jobs, and ranged from 15% among airline pilots to 4% among clergy and physicians.

Despite evidence of declining smoking rates in some blue-collar professions, the findings suggest that blue-collar workers need more attention from their employers and health professionals if they are going to stop smoking.

Workplace health and safety programs offer excellent opportunities to encourage smokers to quit, especially those who rarely see a physician in the office, Dr. Lee said. But office-based physicians who ask their blue-collar patients about smoking and assist those who want to quit are essential to reducing the occupational disparity, he emphasized.

The National Health Interview Survey provides an annual representative sample of noninstitutionalized U.S. workers older than 18 years. The survey places workers in 1 of 41 occupational categories, and smoking information has been collected consistently since 1997.

Tobacco Tx Guidelines to Be Updated

The U.S. government's guidelines for the treatment of tobacco dependence are due for a checkup, and clinicians can help.

An updated version of the government-sponsored publication, “Treating Tobacco Use and Dependence,” will be published in 2008, Dr. Michael C. Fiore said at a conference on tobacco control sponsored by the American Cancer Society.

“The guidelines will remain treatment-based; this will not be a soup-to-nuts rewrite,” said Dr. Fiore, a professor of medicine at the University of Wisconsin, Madison, and chair of the panel charged with writing the update.

The panel welcomes input from inside and outside the medical community on significant research in tobacco dependence treatment and issues that were not addressed in the current guidelines (published in 2000), Dr. Fiore said.

Topics submitted so far include the clinical efficacy of the “five A's” (a method of assessing willingness to change behavior), the effectiveness of telephone hotlines, and the safety and efficacy of combination drug therapies. The update will address counseling and pharmacotherapy for pregnant smokers and smokers with comorbid mental illness. Suggested topics for or improvements to the guidelines should be sent before October 2006 to

[email protected]

Inpatients + Cigarettes = Comorbidities

Nearly half of psychiatric inpatients with at least one medical comorbidity were smokers, based on data from 1,097 adults aged 18–93 years admitted to a psychiatric hospital over 10 months.

Overall, 48% of the patients had multiple medical comorbidities, reported Cynthia L. Dakin, Ph.D., in a poster at a conference on tobacco control sponsored by the American Cancer Society.

Tobacco use data were available for 784 patients. Dr. Dakin and her associates at Northeastern University, Boston, found that 55% of the 784 patients smoked, and 66% of them smoked at least one pack of cigarettes daily. Another 26% smoked between 15 and 20 cigarettes daily, and 8% smoked fewer than 15 cigarettes daily.

Tobacco use was significantly associated with hypertension, diabetes, cancer, osteoporosis, heart disease, and a history of stroke.

The most common DSM-IV diagnoses in the overall sample were major depressive disorder; substance intoxication, dependence, or abuse; bipolar disorder; and schizophrenia.

This study did not review the associations between tobacco use and psychiatric diagnoses, but previous research has shown significant associations between smoking and psychiatric conditions. One study of 2,774 psychiatric patients (of which 61% were smokers) found that bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking (Psychol. Addict. Behav. 2003;17:259–65).

Dr. Dakin and her colleagues plan to conduct follow-up research on smoking cessation efforts for psychiatric inpatients.

Ask Blue-Collar Patients About Smoking

Significantly fewer white-collar workers than blue-collar workers are smokers, according to National Health Interview Survey data from more than 140,000 respondents.

Pooled smoking data from 1997 to 2004 showed the highest reported rates among construction workers (39%) and the lowest reported rates among health professionals (5%), said David J. Lee, Ph.D., who presented the findings at a conference on tobacco control sponsored by the American Cancer Society.

“The overarching goal of Healthy People 2010 is to reduce health disparities in the U.S. population, and I think you'll agree that we have a health disparity here with respect to smoking groups,” said Dr. Lee, who is with the epidemiology and public health department at the University of Miami.

Dr. Lee cited his study of 8-year smoking trends by occupational category based on NHIS data in which the 20 occupations with the highest smoking rates (all greater than 40%) were blue-collar jobs, and included bartenders, waiters, maintenance workers, truck drivers, and carpenters (J. Occup. Environ. Med. 2004;46:538–48).

“We saw some evidence of a smoking decline [among] roofers (who topped the list with a 58% smoking rate), but it was not statistically significant,” he said.

By contrast, the occupations with the 20 lowest smoking rates were classified as white-collar jobs, and ranged from 15% among airline pilots to 4% among clergy and physicians.

Despite evidence of declining smoking rates in some blue-collar professions, the findings suggest that blue-collar workers need more attention from their employers and health professionals if they are going to stop smoking.

Workplace health and safety programs offer excellent opportunities to encourage smokers to quit, especially those who rarely see a physician in the office, Dr. Lee said. But office-based physicians who ask their blue-collar patients about smoking and assist those who want to quit are essential to reducing the occupational disparity, he emphasized.

The National Health Interview Survey provides an annual representative sample of noninstitutionalized U.S. workers older than 18 years. The survey places workers in 1 of 41 occupational categories, and smoking information has been collected consistently since 1997.

Tobacco Tx Guidelines to Be Updated

The U.S. government's guidelines for the treatment of tobacco dependence are due for a checkup, and clinicians can help.

An updated version of the government-sponsored publication, “Treating Tobacco Use and Dependence,” will be published in 2008, Dr. Michael C. Fiore said at a conference on tobacco control sponsored by the American Cancer Society.

“The guidelines will remain treatment-based; this will not be a soup-to-nuts rewrite,” said Dr. Fiore, a professor of medicine at the University of Wisconsin, Madison, and chair of the panel charged with writing the update.

The panel welcomes input from inside and outside the medical community on significant research in tobacco dependence treatment and issues that were not addressed in the current guidelines (published in 2000), Dr. Fiore said.

Topics submitted so far include the clinical efficacy of the “five A's” (a method of assessing willingness to change behavior), the effectiveness of telephone hotlines, and the safety and efficacy of combination drug therapies. The update will address counseling and pharmacotherapy for pregnant smokers and smokers with comorbid mental illness. Suggested topics for or improvements to the guidelines should be sent before October 2006 to

[email protected]

Body Dissatisfaction, Health Behavior

Adolescents who are unhappy with their bodies are more motivated to engage in health-compromising behavior than in health-promoting behavior, said Dianne Neumark-Sztainer, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues.

Their goal in Project EAT (Eating Among Teens)-II was to compare the associations between body dissatisfaction in 1999 and health behaviors in 2004 after adjusting for demographic variables (J. Adolesc. Health 2006;39:244–51).

The investigators contacted 1,130 boys and 1,386 girls from the EAT-I study (about 55% of the participants), a survey of adolescent eating patterns and weight status that was conducted during the 1998–1999 school year.

Overall, about 34% of the girls reported low body satisfaction, 26% reported low-middle satisfaction, 22% reported high-middle satisfaction, and 18% reported high satisfaction. Low body satisfaction in girls predicted dieting, binge eating, less physical activity, eating fewer fruits and vegetables, and weight control behaviors that were defined as “unhealthy” or “very unhealthy.”

About 24% of boys reported low body satisfaction, 26% reported low-middle, 24% reported high-middle, and 26% reported high. Low body satisfaction in boys significantly predicted dieting, binge eating, smoking, less physical activity, and a range of weight control behaviors that included “healthy” but also “unhealthy,” and “very unhealthy.”

Bullying Stresses Boys More Than Girls

A lower perceived risk of being bullied significantly mitigated the effect of past bullying experiences on psychological distress in girls, but not boys, based on a survey of 100 girls and 86 boys aged 11–14 years.

The findings suggest that perception of possible bullying predicts distress in girls, while distress in boys is more likely to be affected by both the perceived risk of bullying and past experience of being bullied.

To determine the roles of past bullying and perceived risk of bullying on psychological distress, Tam K. Dao of Florida State University, Tallahassee, and associates surveyed middle-school children in north Florida and compiled a victimization composite score. They also used a measurement of symptoms related to depression and anxiety (the K-10 scale) to assess nonspecific emotional distress (J. Adolesc. Health 2006;39:277–82).

Overall, boys reported more physical aggression and attacks on their property, while girls reported more emotional aggression. Reports of sexual aggression were not significantly different between the genders, Mr. Dao and his associates said.

A significantly strong relationship among nonspecific psychological distress, perceived risk of victimization, and past experience of victimization was evident in a multiple regression analysis. On further review by gender, girls were significantly more likely than boys to report a perceived risk of bullying, but boys' and girls' ratings of past experiences of victimization and nonspecific psychological distress were not significantly different.

Combination Improves Insomnia

Sleep hygiene combined with melatonin is safe and effective for initial insomnia in children aged 6–14 years with attention-deficit hyperactivity disorder who take stimulants, reported Dr. Margaret D. Weiss of the Children's and Women's Health Care Centre of Vancouver, B.C., and her associates.

The dysregulation that characterizes ADHD may play a role in the arousal that prevents these children from falling asleep, the researchers explained. If so, a combination of sleep hygiene and melatonin could improve the dysregulation without the need for hypnotic medication.

Twenty-eight patients modified their sleeping behaviors by setting consistent bedtimes and wake-up times, and eliminating naps and caffeine intake. Five of the 28 patients who began the study responded favorably to the sleep protocol during the 10-day screening phase and did not progress to receive melatonin. The remaining 23 children received either 5 mg melatonin or a placebo 20 minutes before bedtime; 19 completed the 30-day double-blind study (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:512–19).

In response to the sleep modification, the average minutes of sleep-onset latency dropped significantly from baseline to follow-up based on data from wrist activity monitors worn by the children (98 minutes vs. 73 minutes) and sleep logs completed by their parents (92 minutes vs. 69 minutes). The average sleep-onset latency dropped by 16 minutes more in response to melatonin, compared with the placebo based on sleep log data.

The study was sponsored by Circa Dia BV, which manufactures short-acting, pharmaceutical-grade melatonin, and Dr. Weiss has a research grant from the company.

Body Dissatisfaction, Health Behavior

Adolescents who are unhappy with their bodies are more motivated to engage in health-compromising behavior than in health-promoting behavior, said Dianne Neumark-Sztainer, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues.

Their goal in Project EAT (Eating Among Teens)-II was to compare the associations between body dissatisfaction in 1999 and health behaviors in 2004 after adjusting for demographic variables (J. Adolesc. Health 2006;39:244–51).

The investigators contacted 1,130 boys and 1,386 girls from the EAT-I study (about 55% of the participants), a survey of adolescent eating patterns and weight status that was conducted during the 1998–1999 school year.

Overall, about 34% of the girls reported low body satisfaction, 26% reported low-middle satisfaction, 22% reported high-middle satisfaction, and 18% reported high satisfaction. Low body satisfaction in girls predicted dieting, binge eating, less physical activity, eating fewer fruits and vegetables, and weight control behaviors that were defined as “unhealthy” or “very unhealthy.”

About 24% of boys reported low body satisfaction, 26% reported low-middle, 24% reported high-middle, and 26% reported high. Low body satisfaction in boys significantly predicted dieting, binge eating, smoking, less physical activity, and a range of weight control behaviors that included “healthy” but also “unhealthy,” and “very unhealthy.”

Bullying Stresses Boys More Than Girls

A lower perceived risk of being bullied significantly mitigated the effect of past bullying experiences on psychological distress in girls, but not boys, based on a survey of 100 girls and 86 boys aged 11–14 years.

The findings suggest that perception of possible bullying predicts distress in girls, while distress in boys is more likely to be affected by both the perceived risk of bullying and past experience of being bullied.

To determine the roles of past bullying and perceived risk of bullying on psychological distress, Tam K. Dao of Florida State University, Tallahassee, and associates surveyed middle-school children in north Florida and compiled a victimization composite score. They also used a measurement of symptoms related to depression and anxiety (the K-10 scale) to assess nonspecific emotional distress (J. Adolesc. Health 2006;39:277–82).

Overall, boys reported more physical aggression and attacks on their property, while girls reported more emotional aggression. Reports of sexual aggression were not significantly different between the genders, Mr. Dao and his associates said.

A significantly strong relationship among nonspecific psychological distress, perceived risk of victimization, and past experience of victimization was evident in a multiple regression analysis. On further review by gender, girls were significantly more likely than boys to report a perceived risk of bullying, but boys' and girls' ratings of past experiences of victimization and nonspecific psychological distress were not significantly different.

Combination Improves Insomnia

Sleep hygiene combined with melatonin is safe and effective for initial insomnia in children aged 6–14 years with attention-deficit hyperactivity disorder who take stimulants, reported Dr. Margaret D. Weiss of the Children's and Women's Health Care Centre of Vancouver, B.C., and her associates.

The dysregulation that characterizes ADHD may play a role in the arousal that prevents these children from falling asleep, the researchers explained. If so, a combination of sleep hygiene and melatonin could improve the dysregulation without the need for hypnotic medication.

Twenty-eight patients modified their sleeping behaviors by setting consistent bedtimes and wake-up times, and eliminating naps and caffeine intake. Five of the 28 patients who began the study responded favorably to the sleep protocol during the 10-day screening phase and did not progress to receive melatonin. The remaining 23 children received either 5 mg melatonin or a placebo 20 minutes before bedtime; 19 completed the 30-day double-blind study (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:512–19).

In response to the sleep modification, the average minutes of sleep-onset latency dropped significantly from baseline to follow-up based on data from wrist activity monitors worn by the children (98 minutes vs. 73 minutes) and sleep logs completed by their parents (92 minutes vs. 69 minutes). The average sleep-onset latency dropped by 16 minutes more in response to melatonin, compared with the placebo based on sleep log data.

The study was sponsored by Circa Dia BV, which manufactures short-acting, pharmaceutical-grade melatonin, and Dr. Weiss has a research grant from the company.

Body Dissatisfaction, Health Behavior

Adolescents who are unhappy with their bodies are more motivated to engage in health-compromising behavior than in health-promoting behavior, said Dianne Neumark-Sztainer, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues.

Their goal in Project EAT (Eating Among Teens)-II was to compare the associations between body dissatisfaction in 1999 and health behaviors in 2004 after adjusting for demographic variables (J. Adolesc. Health 2006;39:244–51).

The investigators contacted 1,130 boys and 1,386 girls from the EAT-I study (about 55% of the participants), a survey of adolescent eating patterns and weight status that was conducted during the 1998–1999 school year.

Overall, about 34% of the girls reported low body satisfaction, 26% reported low-middle satisfaction, 22% reported high-middle satisfaction, and 18% reported high satisfaction. Low body satisfaction in girls predicted dieting, binge eating, less physical activity, eating fewer fruits and vegetables, and weight control behaviors that were defined as “unhealthy” or “very unhealthy.”

About 24% of boys reported low body satisfaction, 26% reported low-middle, 24% reported high-middle, and 26% reported high. Low body satisfaction in boys significantly predicted dieting, binge eating, smoking, less physical activity, and a range of weight control behaviors that included “healthy” but also “unhealthy,” and “very unhealthy.”

Bullying Stresses Boys More Than Girls

A lower perceived risk of being bullied significantly mitigated the effect of past bullying experiences on psychological distress in girls, but not boys, based on a survey of 100 girls and 86 boys aged 11–14 years.

The findings suggest that perception of possible bullying predicts distress in girls, while distress in boys is more likely to be affected by both the perceived risk of bullying and past experience of being bullied.

To determine the roles of past bullying and perceived risk of bullying on psychological distress, Tam K. Dao of Florida State University, Tallahassee, and associates surveyed middle-school children in north Florida and compiled a victimization composite score. They also used a measurement of symptoms related to depression and anxiety (the K-10 scale) to assess nonspecific emotional distress (J. Adolesc. Health 2006;39:277–82).

Overall, boys reported more physical aggression and attacks on their property, while girls reported more emotional aggression. Reports of sexual aggression were not significantly different between the genders, Mr. Dao and his associates said.

A significantly strong relationship among nonspecific psychological distress, perceived risk of victimization, and past experience of victimization was evident in a multiple regression analysis. On further review by gender, girls were significantly more likely than boys to report a perceived risk of bullying, but boys' and girls' ratings of past experiences of victimization and nonspecific psychological distress were not significantly different.

Combination Improves Insomnia

Sleep hygiene combined with melatonin is safe and effective for initial insomnia in children aged 6–14 years with attention-deficit hyperactivity disorder who take stimulants, reported Dr. Margaret D. Weiss of the Children's and Women's Health Care Centre of Vancouver, B.C., and her associates.

The dysregulation that characterizes ADHD may play a role in the arousal that prevents these children from falling asleep, the researchers explained. If so, a combination of sleep hygiene and melatonin could improve the dysregulation without the need for hypnotic medication.

Twenty-eight patients modified their sleeping behaviors by setting consistent bedtimes and wake-up times, and eliminating naps and caffeine intake. Five of the 28 patients who began the study responded favorably to the sleep protocol during the 10-day screening phase and did not progress to receive melatonin. The remaining 23 children received either 5 mg melatonin or a placebo 20 minutes before bedtime; 19 completed the 30-day double-blind study (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:512–19).

In response to the sleep modification, the average minutes of sleep-onset latency dropped significantly from baseline to follow-up based on data from wrist activity monitors worn by the children (98 minutes vs. 73 minutes) and sleep logs completed by their parents (92 minutes vs. 69 minutes). The average sleep-onset latency dropped by 16 minutes more in response to melatonin, compared with the placebo based on sleep log data.

The study was sponsored by Circa Dia BV, which manufactures short-acting, pharmaceutical-grade melatonin, and Dr. Weiss has a research grant from the company.

Diabetic children and adolescents who are bullied are significantly less likely to adhere to glucose testing or attend to their diets, reported Eric A. Storch, Ph.D., and his associates at the University of Florida, Gainesville.

Previous studies have shown that bullied children often avoid situations where they are more likely to be bullied.

Similarly, Dr. Storch, who is with the department of psychiatry at the university, and his colleagues suspected that diabetic children might avoid overt self-management behaviors, such as dietary limitations or insulin shots, which would attract the attention of bullies (J. Pediatr. 2006;148:784–7).

Reports of diabetes-related bullying were significantly associated with overall poor diabetes care and increased HbA_1c concentrations. Children and their parents completed questionnaires designed to assess diabetes management and experiences with bullying.

Specifically, diabetes-related bullying significantly predicted 9% of the variation in self-management and nearly 6% of the variation in self-reported depression in a review of 167 type 1 diabetic patients aged 8–17 years. The results were based on measures of bullying and depression that included statements such as “Other kids tease me about not being able to eat certain foods.”

Self-reported depression mediated the link between diabetes-related bullying and diabetes self-management, but it did not reduce the significance of bullying to poor self-management in this study, Dr. Storch and his assoicates said.

The results suggest that physicians need to ask about peer relationships when a child with diabetes struggles to maintain treatment adherence.

It remains unclear, however, whether a diabetic child is automatically more susceptible to bullying or whether having diabetes increases the risk of bullying in a child who is vulnerable to bullies for other reasons, the researchers noted.

Diabetic children and adolescents who are bullied are significantly less likely to adhere to glucose testing or attend to their diets, reported Eric A. Storch, Ph.D., and his associates at the University of Florida, Gainesville.

Previous studies have shown that bullied children often avoid situations where they are more likely to be bullied.

Similarly, Dr. Storch, who is with the department of psychiatry at the university, and his colleagues suspected that diabetic children might avoid overt self-management behaviors, such as dietary limitations or insulin shots, which would attract the attention of bullies (J. Pediatr. 2006;148:784–7).

Reports of diabetes-related bullying were significantly associated with overall poor diabetes care and increased HbA_1c concentrations. Children and their parents completed questionnaires designed to assess diabetes management and experiences with bullying.

Specifically, diabetes-related bullying significantly predicted 9% of the variation in self-management and nearly 6% of the variation in self-reported depression in a review of 167 type 1 diabetic patients aged 8–17 years. The results were based on measures of bullying and depression that included statements such as “Other kids tease me about not being able to eat certain foods.”

Self-reported depression mediated the link between diabetes-related bullying and diabetes self-management, but it did not reduce the significance of bullying to poor self-management in this study, Dr. Storch and his assoicates said.

The results suggest that physicians need to ask about peer relationships when a child with diabetes struggles to maintain treatment adherence.

It remains unclear, however, whether a diabetic child is automatically more susceptible to bullying or whether having diabetes increases the risk of bullying in a child who is vulnerable to bullies for other reasons, the researchers noted.

Diabetic children and adolescents who are bullied are significantly less likely to adhere to glucose testing or attend to their diets, reported Eric A. Storch, Ph.D., and his associates at the University of Florida, Gainesville.

Previous studies have shown that bullied children often avoid situations where they are more likely to be bullied.

Similarly, Dr. Storch, who is with the department of psychiatry at the university, and his colleagues suspected that diabetic children might avoid overt self-management behaviors, such as dietary limitations or insulin shots, which would attract the attention of bullies (J. Pediatr. 2006;148:784–7).

Reports of diabetes-related bullying were significantly associated with overall poor diabetes care and increased HbA_1c concentrations. Children and their parents completed questionnaires designed to assess diabetes management and experiences with bullying.

Specifically, diabetes-related bullying significantly predicted 9% of the variation in self-management and nearly 6% of the variation in self-reported depression in a review of 167 type 1 diabetic patients aged 8–17 years. The results were based on measures of bullying and depression that included statements such as “Other kids tease me about not being able to eat certain foods.”

Self-reported depression mediated the link between diabetes-related bullying and diabetes self-management, but it did not reduce the significance of bullying to poor self-management in this study, Dr. Storch and his assoicates said.

The results suggest that physicians need to ask about peer relationships when a child with diabetes struggles to maintain treatment adherence.

It remains unclear, however, whether a diabetic child is automatically more susceptible to bullying or whether having diabetes increases the risk of bullying in a child who is vulnerable to bullies for other reasons, the researchers noted.

WASHINGTON — The Food and Drug Administration and the Institute for Safe Medication Practices have launched a national education campaign aimed at health care professionals and pharmaceutical companies with the goal of reducing the number of medical mistakes caused by confusing medical abbreviations.

Each year, more than 7,000 deaths occur in the United States as a result of medication errors, and many of these are caused by the misinterpretation of medical abbreviations, Carol Holquist, director of the Division of Medication Errors and Technical Support at the FDA's Center for Drug Evaluation and Research, said at a press conference.

When a “U” looks like a zero, a patient may receive a 10-fold overdose—40 units of insulin rather than 4 units, for example. Dosage designations represent another danger zone: A misplaced or deleted decimal point can turn 1.0 mg into 10 mg, or 0.1 mg into 1 mg.

Yet the ongoing use of error-prone abbreviations, symbols, and dosage designations has not been addressed as the systemic problem that it is, said Michael Cohen, Sc.D., president of the Institute for Safe Medication Practices (ISMP).

The use of electronic prescribing information doesn't solve the problem, Dr. Cohen noted. “Depending on the screen fonts, a U can still look like a zero,” he said. The ISMP has seen cases of misinterpreted abbreviations that have been typed in addition to those that were handwritten, he added.

Additionally, some abbreviations for vastly different drugs are similar. For example, morphine sulfate (MS04) has been mistaken as magnesium sulfate (MgS04).

The campaign strategy involves working with publishers to change style manuals and journals, making materials available to medical schools and pharmaceutical companies, and encouraging anyone who uses these abbreviations to stop using the most dangerous ones, Dr. Cohen said.

An online package includes a slide presentation, reference guide, pocket card, abbreviation list, and patient safety video. Additional strategies include the distribution of brochures to health professionals and the pharmaceutical industry, and the use of public service announcements and posters for medical associations and organizations.

To obtain a complete list of potentially dangerous abbreviations and more educational materials, visit www.fda.gov/cder/drug/mederrorswww.ismp.org/tools/abbreviations

WASHINGTON — The Food and Drug Administration and the Institute for Safe Medication Practices have launched a national education campaign aimed at health care professionals and pharmaceutical companies with the goal of reducing the number of medical mistakes caused by confusing medical abbreviations.

Each year, more than 7,000 deaths occur in the United States as a result of medication errors, and many of these are caused by the misinterpretation of medical abbreviations, Carol Holquist, director of the Division of Medication Errors and Technical Support at the FDA's Center for Drug Evaluation and Research, said at a press conference.

When a “U” looks like a zero, a patient may receive a 10-fold overdose—40 units of insulin rather than 4 units, for example. Dosage designations represent another danger zone: A misplaced or deleted decimal point can turn 1.0 mg into 10 mg, or 0.1 mg into 1 mg.

Yet the ongoing use of error-prone abbreviations, symbols, and dosage designations has not been addressed as the systemic problem that it is, said Michael Cohen, Sc.D., president of the Institute for Safe Medication Practices (ISMP).

The use of electronic prescribing information doesn't solve the problem, Dr. Cohen noted. “Depending on the screen fonts, a U can still look like a zero,” he said. The ISMP has seen cases of misinterpreted abbreviations that have been typed in addition to those that were handwritten, he added.

Additionally, some abbreviations for vastly different drugs are similar. For example, morphine sulfate (MS04) has been mistaken as magnesium sulfate (MgS04).

The campaign strategy involves working with publishers to change style manuals and journals, making materials available to medical schools and pharmaceutical companies, and encouraging anyone who uses these abbreviations to stop using the most dangerous ones, Dr. Cohen said.

An online package includes a slide presentation, reference guide, pocket card, abbreviation list, and patient safety video. Additional strategies include the distribution of brochures to health professionals and the pharmaceutical industry, and the use of public service announcements and posters for medical associations and organizations.

To obtain a complete list of potentially dangerous abbreviations and more educational materials, visit www.fda.gov/cder/drug/mederrorswww.ismp.org/tools/abbreviations

WASHINGTON — The Food and Drug Administration and the Institute for Safe Medication Practices have launched a national education campaign aimed at health care professionals and pharmaceutical companies with the goal of reducing the number of medical mistakes caused by confusing medical abbreviations.

Each year, more than 7,000 deaths occur in the United States as a result of medication errors, and many of these are caused by the misinterpretation of medical abbreviations, Carol Holquist, director of the Division of Medication Errors and Technical Support at the FDA's Center for Drug Evaluation and Research, said at a press conference.

When a “U” looks like a zero, a patient may receive a 10-fold overdose—40 units of insulin rather than 4 units, for example. Dosage designations represent another danger zone: A misplaced or deleted decimal point can turn 1.0 mg into 10 mg, or 0.1 mg into 1 mg.

Yet the ongoing use of error-prone abbreviations, symbols, and dosage designations has not been addressed as the systemic problem that it is, said Michael Cohen, Sc.D., president of the Institute for Safe Medication Practices (ISMP).

The use of electronic prescribing information doesn't solve the problem, Dr. Cohen noted. “Depending on the screen fonts, a U can still look like a zero,” he said. The ISMP has seen cases of misinterpreted abbreviations that have been typed in addition to those that were handwritten, he added.

Additionally, some abbreviations for vastly different drugs are similar. For example, morphine sulfate (MS04) has been mistaken as magnesium sulfate (MgS04).

The campaign strategy involves working with publishers to change style manuals and journals, making materials available to medical schools and pharmaceutical companies, and encouraging anyone who uses these abbreviations to stop using the most dangerous ones, Dr. Cohen said.

An online package includes a slide presentation, reference guide, pocket card, abbreviation list, and patient safety video. Additional strategies include the distribution of brochures to health professionals and the pharmaceutical industry, and the use of public service announcements and posters for medical associations and organizations.

To obtain a complete list of potentially dangerous abbreviations and more educational materials, visit www.fda.gov/cder/drug/mederrorswww.ismp.org/tools/abbreviations

BALTIMORE — Be sure to reevaluate a diagnosis of Parkinson's disease in a patient at every visit, Dr. Stephen G. Reich advised at a meeting sponsored by the American Geriatrics Society and Johns Hopkins University.

The false-positive rate for a Parkinson's disease (PD) diagnosis is about 35% at the initial diagnosis and 24% at final diagnosis, according to data from several autopsy studies. Autopsy results remain the preferred method for confirming a diagnosis of PD, noted Dr. Reich, professor of neurology at the University of Maryland and codirector of its Maryland Parkinson's Disease and Movement Disorders Center.

In a study of more than 470,000 U.S. nursing-home residents, the three best predictors of PD were the presence of a resting tremor, a unilateral onset of symptoms, and a beneficial and sustained response to levodopa, the investigators noted (Pharmacotherapy 1999;19:1321–7).

Not everyone with PD has a resting tremor, but many do, and this tremor improves with movement. Classic PD starts on one side of the body, unrelated to right- or left-handedness. Some patients with Parkinson's-like syndromes (rather than Parkinson's disease) have an initial response to levodopa, but it won't be sustained.

Based on his research and experience, Dr. Reich listed the top 10 pitfalls of PD diagnosis. The first six are false positives:

▸ Essential tremor (ET). This is the condition most often misdiagnosed as PD. “The best way to distinguish ET from PD is the history and physical,” Dr. Reich said. Patients presenting with ET usually report that the tremor has been present for years. But most tremor patients with PD present to a primary care physician within about 6 months of the initiation of symptoms.

Also, ask tremor patients about their responses to alcohol. About 60% or more of patients with ET notice that a little alcohol temporarily alleviates the problem, he said.

When conducting the physical exam, remember that PD is a resting tremor and thus tends to improve with movement, but essential tremor worsens with movement. A strictly unilateral tremor is probably PD. “Essential tremor, although it might be asymmetrical, is almost always bilateral,” he said. Tremor of the head or voice is usually an essential tremor, he added.

Handwriting in patients with PD tends to be micrographic but is not tremulous, even if patients have tremor at rest. Patients with ET have full-sized handwriting, but it looks shaky. Patients with PD also may have cogwheel rigidity, a masked face, and trouble rising from a chair.

▸ Lower-half Parkinsonism. “These are the patients geriatricians see day in and day out. They are disproportionately fine from the waist up,” Dr. Reich said. This is not PD. It appears clinically as a shuffling, broad-based gait, difficulty rising from a seated position, with impaired posture and balance. Most patients with this condition present at an age older than 70 years, and the symptoms occur below the waist.

Some of these patients respond well to shunts for normal-pressure hydrocephalus, he noted.

▸ Drug-induced Parkinsonism. This condition often goes unrecognized because it might take up to 1 year to resolve after taking a particular drug. “You have to ask what medicines patients have taken in the past,” Dr. Reich said.

Check hospital records to confirm medications, and be cautious about diagnosing PD—especially if patients have taken antipsychotics, metoclopramide, or dopamine depleters such as reserpine, because the PD symptoms might resolve with time.

▸ Parkinson's disease vs. Parkinson's syndrome. Red flags that differentiate a Parkinson's syndrome (such as progressive supranuclear palsy or multiple system atrophy) from PD include impaired downward gaze, little or no response to levodopa, early hallucinations, early dementia, and falls early in the course, as well as symmetric onset and absence of tremor.

▸ Alzheimer's disease presenting as Parkinsonism. “The physical symptoms of Parkinsonism, such as lack of balance, may bring the patient to your office, but if it is accompanied by dementia, it is probably Parkinsonism rather than clinical PD,” Dr. Reich said.

▸ Parkinsonism of “normal aging.” PD tends to peak at about 60 years of age, so be cautious about diagnosing it after age 75 years, he said.

The last four pitfalls of PD diagnoses are false negatives:

▸ Sensory or pain presentation of PD. Dr. Reich said he often sees patients who have recovered from a frozen shoulder, for example, but they still have trouble moving one hand. Foot pain, particularly in young-onset PD patients, as well as tingling or numbness, fibromyalgia, or restless legs syndrome, can be symptoms of PD.

▸ Young-onset PD. PD is often not recognized in patients in their 30s and 40s. “You can be too old for PD but not too young,” Dr. Reich said. “It is uncommon, but it is out there,” he said.

▸ Unilateral lower extremity presentation. “When a patient presents with one lower-extremity symptom, even if he or she complains of pain or weakness, don't discount PD,” Dr. Reich said.

▸ Atremulous PD. Patients with atremulous PD are most often misdiagnosed with stroke, but the fact that only half the body is affected by stiffness or balance problems is a tip-off that the problem might be PD instead, Dr. Reich said.

BALTIMORE — Be sure to reevaluate a diagnosis of Parkinson's disease in a patient at every visit, Dr. Stephen G. Reich advised at a meeting sponsored by the American Geriatrics Society and Johns Hopkins University.

The false-positive rate for a Parkinson's disease (PD) diagnosis is about 35% at the initial diagnosis and 24% at final diagnosis, according to data from several autopsy studies. Autopsy results remain the preferred method for confirming a diagnosis of PD, noted Dr. Reich, professor of neurology at the University of Maryland and codirector of its Maryland Parkinson's Disease and Movement Disorders Center.

In a study of more than 470,000 U.S. nursing-home residents, the three best predictors of PD were the presence of a resting tremor, a unilateral onset of symptoms, and a beneficial and sustained response to levodopa, the investigators noted (Pharmacotherapy 1999;19:1321–7).

Not everyone with PD has a resting tremor, but many do, and this tremor improves with movement. Classic PD starts on one side of the body, unrelated to right- or left-handedness. Some patients with Parkinson's-like syndromes (rather than Parkinson's disease) have an initial response to levodopa, but it won't be sustained.

Based on his research and experience, Dr. Reich listed the top 10 pitfalls of PD diagnosis. The first six are false positives:

▸ Essential tremor (ET). This is the condition most often misdiagnosed as PD. “The best way to distinguish ET from PD is the history and physical,” Dr. Reich said. Patients presenting with ET usually report that the tremor has been present for years. But most tremor patients with PD present to a primary care physician within about 6 months of the initiation of symptoms.

Also, ask tremor patients about their responses to alcohol. About 60% or more of patients with ET notice that a little alcohol temporarily alleviates the problem, he said.

When conducting the physical exam, remember that PD is a resting tremor and thus tends to improve with movement, but essential tremor worsens with movement. A strictly unilateral tremor is probably PD. “Essential tremor, although it might be asymmetrical, is almost always bilateral,” he said. Tremor of the head or voice is usually an essential tremor, he added.

Handwriting in patients with PD tends to be micrographic but is not tremulous, even if patients have tremor at rest. Patients with ET have full-sized handwriting, but it looks shaky. Patients with PD also may have cogwheel rigidity, a masked face, and trouble rising from a chair.

▸ Lower-half Parkinsonism. “These are the patients geriatricians see day in and day out. They are disproportionately fine from the waist up,” Dr. Reich said. This is not PD. It appears clinically as a shuffling, broad-based gait, difficulty rising from a seated position, with impaired posture and balance. Most patients with this condition present at an age older than 70 years, and the symptoms occur below the waist.

Some of these patients respond well to shunts for normal-pressure hydrocephalus, he noted.

▸ Drug-induced Parkinsonism. This condition often goes unrecognized because it might take up to 1 year to resolve after taking a particular drug. “You have to ask what medicines patients have taken in the past,” Dr. Reich said.

Check hospital records to confirm medications, and be cautious about diagnosing PD—especially if patients have taken antipsychotics, metoclopramide, or dopamine depleters such as reserpine, because the PD symptoms might resolve with time.

▸ Parkinson's disease vs. Parkinson's syndrome. Red flags that differentiate a Parkinson's syndrome (such as progressive supranuclear palsy or multiple system atrophy) from PD include impaired downward gaze, little or no response to levodopa, early hallucinations, early dementia, and falls early in the course, as well as symmetric onset and absence of tremor.

▸ Alzheimer's disease presenting as Parkinsonism. “The physical symptoms of Parkinsonism, such as lack of balance, may bring the patient to your office, but if it is accompanied by dementia, it is probably Parkinsonism rather than clinical PD,” Dr. Reich said.

▸ Parkinsonism of “normal aging.” PD tends to peak at about 60 years of age, so be cautious about diagnosing it after age 75 years, he said.

The last four pitfalls of PD diagnoses are false negatives:

▸ Sensory or pain presentation of PD. Dr. Reich said he often sees patients who have recovered from a frozen shoulder, for example, but they still have trouble moving one hand. Foot pain, particularly in young-onset PD patients, as well as tingling or numbness, fibromyalgia, or restless legs syndrome, can be symptoms of PD.

▸ Young-onset PD. PD is often not recognized in patients in their 30s and 40s. “You can be too old for PD but not too young,” Dr. Reich said. “It is uncommon, but it is out there,” he said.

▸ Unilateral lower extremity presentation. “When a patient presents with one lower-extremity symptom, even if he or she complains of pain or weakness, don't discount PD,” Dr. Reich said.

▸ Atremulous PD. Patients with atremulous PD are most often misdiagnosed with stroke, but the fact that only half the body is affected by stiffness or balance problems is a tip-off that the problem might be PD instead, Dr. Reich said.

BALTIMORE — Be sure to reevaluate a diagnosis of Parkinson's disease in a patient at every visit, Dr. Stephen G. Reich advised at a meeting sponsored by the American Geriatrics Society and Johns Hopkins University.

The false-positive rate for a Parkinson's disease (PD) diagnosis is about 35% at the initial diagnosis and 24% at final diagnosis, according to data from several autopsy studies. Autopsy results remain the preferred method for confirming a diagnosis of PD, noted Dr. Reich, professor of neurology at the University of Maryland and codirector of its Maryland Parkinson's Disease and Movement Disorders Center.

In a study of more than 470,000 U.S. nursing-home residents, the three best predictors of PD were the presence of a resting tremor, a unilateral onset of symptoms, and a beneficial and sustained response to levodopa, the investigators noted (Pharmacotherapy 1999;19:1321–7).

Not everyone with PD has a resting tremor, but many do, and this tremor improves with movement. Classic PD starts on one side of the body, unrelated to right- or left-handedness. Some patients with Parkinson's-like syndromes (rather than Parkinson's disease) have an initial response to levodopa, but it won't be sustained.

Based on his research and experience, Dr. Reich listed the top 10 pitfalls of PD diagnosis. The first six are false positives:

▸ Essential tremor (ET). This is the condition most often misdiagnosed as PD. “The best way to distinguish ET from PD is the history and physical,” Dr. Reich said. Patients presenting with ET usually report that the tremor has been present for years. But most tremor patients with PD present to a primary care physician within about 6 months of the initiation of symptoms.

Also, ask tremor patients about their responses to alcohol. About 60% or more of patients with ET notice that a little alcohol temporarily alleviates the problem, he said.

When conducting the physical exam, remember that PD is a resting tremor and thus tends to improve with movement, but essential tremor worsens with movement. A strictly unilateral tremor is probably PD. “Essential tremor, although it might be asymmetrical, is almost always bilateral,” he said. Tremor of the head or voice is usually an essential tremor, he added.

Handwriting in patients with PD tends to be micrographic but is not tremulous, even if patients have tremor at rest. Patients with ET have full-sized handwriting, but it looks shaky. Patients with PD also may have cogwheel rigidity, a masked face, and trouble rising from a chair.

▸ Lower-half Parkinsonism. “These are the patients geriatricians see day in and day out. They are disproportionately fine from the waist up,” Dr. Reich said. This is not PD. It appears clinically as a shuffling, broad-based gait, difficulty rising from a seated position, with impaired posture and balance. Most patients with this condition present at an age older than 70 years, and the symptoms occur below the waist.

Some of these patients respond well to shunts for normal-pressure hydrocephalus, he noted.

▸ Drug-induced Parkinsonism. This condition often goes unrecognized because it might take up to 1 year to resolve after taking a particular drug. “You have to ask what medicines patients have taken in the past,” Dr. Reich said.

Check hospital records to confirm medications, and be cautious about diagnosing PD—especially if patients have taken antipsychotics, metoclopramide, or dopamine depleters such as reserpine, because the PD symptoms might resolve with time.

▸ Parkinson's disease vs. Parkinson's syndrome. Red flags that differentiate a Parkinson's syndrome (such as progressive supranuclear palsy or multiple system atrophy) from PD include impaired downward gaze, little or no response to levodopa, early hallucinations, early dementia, and falls early in the course, as well as symmetric onset and absence of tremor.

▸ Alzheimer's disease presenting as Parkinsonism. “The physical symptoms of Parkinsonism, such as lack of balance, may bring the patient to your office, but if it is accompanied by dementia, it is probably Parkinsonism rather than clinical PD,” Dr. Reich said.

▸ Parkinsonism of “normal aging.” PD tends to peak at about 60 years of age, so be cautious about diagnosing it after age 75 years, he said.

The last four pitfalls of PD diagnoses are false negatives:

▸ Sensory or pain presentation of PD. Dr. Reich said he often sees patients who have recovered from a frozen shoulder, for example, but they still have trouble moving one hand. Foot pain, particularly in young-onset PD patients, as well as tingling or numbness, fibromyalgia, or restless legs syndrome, can be symptoms of PD.

▸ Young-onset PD. PD is often not recognized in patients in their 30s and 40s. “You can be too old for PD but not too young,” Dr. Reich said. “It is uncommon, but it is out there,” he said.

▸ Unilateral lower extremity presentation. “When a patient presents with one lower-extremity symptom, even if he or she complains of pain or weakness, don't discount PD,” Dr. Reich said.

▸ Atremulous PD. Patients with atremulous PD are most often misdiagnosed with stroke, but the fact that only half the body is affected by stiffness or balance problems is a tip-off that the problem might be PD instead, Dr. Reich said.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group.

Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines.

The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients in the study were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo.

These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups, respectively. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events seen in the study included headache, nausea, dizziness, and nasopharyngitis. The incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group.

Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines.

The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients in the study were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo.

These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups, respectively. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events seen in the study included headache, nausea, dizziness, and nasopharyngitis. The incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group.

Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines.

The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients in the study were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo.

These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups, respectively. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events seen in the study included headache, nausea, dizziness, and nasopharyngitis. The incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Complications were significantly more likely among pregnant women when their hyperemesis was managed with a peripherally inserted central catheter line than with either a Dobhoff tube or medication, Dr. Calla M. Holmgren reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Holmgren and her colleagues at the University of Utah, Salt Lake City, compared the three interventions in a prospective cohort study of 70 hyperemetic patients. Two of 24 patients whose mother's hyperemesis was managed with a PICC line developed sepsis and were admitted to the neonatal intensive care unit, and one fetus died as a direct result of PICC line use. Also, 7 of the 24 patients had thrombosis, 3 had skin infections, and 2 had bacteremia. One patient with bacteremia was admitted to the NICU.

By comparison, 1 of 13 women managed with a Dobhoff tube had tube displacement, and 2 of the 33 women managed with medication had adverse reactions.

WASHINGTON — Complications were significantly more likely among pregnant women when their hyperemesis was managed with a peripherally inserted central catheter line than with either a Dobhoff tube or medication, Dr. Calla M. Holmgren reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Holmgren and her colleagues at the University of Utah, Salt Lake City, compared the three interventions in a prospective cohort study of 70 hyperemetic patients. Two of 24 patients whose mother's hyperemesis was managed with a PICC line developed sepsis and were admitted to the neonatal intensive care unit, and one fetus died as a direct result of PICC line use. Also, 7 of the 24 patients had thrombosis, 3 had skin infections, and 2 had bacteremia. One patient with bacteremia was admitted to the NICU.

By comparison, 1 of 13 women managed with a Dobhoff tube had tube displacement, and 2 of the 33 women managed with medication had adverse reactions.

WASHINGTON — Complications were significantly more likely among pregnant women when their hyperemesis was managed with a peripherally inserted central catheter line than with either a Dobhoff tube or medication, Dr. Calla M. Holmgren reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Holmgren and her colleagues at the University of Utah, Salt Lake City, compared the three interventions in a prospective cohort study of 70 hyperemetic patients. Two of 24 patients whose mother's hyperemesis was managed with a PICC line developed sepsis and were admitted to the neonatal intensive care unit, and one fetus died as a direct result of PICC line use. Also, 7 of the 24 patients had thrombosis, 3 had skin infections, and 2 had bacteremia. One patient with bacteremia was admitted to the NICU.

By comparison, 1 of 13 women managed with a Dobhoff tube had tube displacement, and 2 of the 33 women managed with medication had adverse reactions.

HERSHEY, PA. — Short-term, nonsurgical management of hand fractures gets competitive athletes back in the game, Dr. Michael R. Redler said at the annual meeting of the American Orthopaedic Society for Sports Medicine.

But it is essential to remind the athlete of all possible outcomes, including the increased risk for additional injury if he or she returns to play too soon after a fracture.

Study results have shown that hand injuries account for 3%–25% of all athletic injuries, said Dr. Redler, a founding partner of the Orthopaedic and Sports Medicine Center in Trumbull, Conn.

The timing and feasibility of an injured athlete's return to play differ for each sport and each individual. Factors to consider include the patient's age and competitive level, the type of injury sustained, whether the athlete can perform the manual skill necessary for the sport, and whether the injury can be protected from further trauma.

Athletes who require explicit use of the wrist or fingers may not be able to participate in their sport during the stages of healing. Phalangeal fractures can usually be managed with external plastic or aluminum splints, and surgery is rarely needed. But metacarpal fractures are more complicated. Most phalangeal fractures are caused by trauma from crushing, bending, or twisting, whereas metacarpal fractures are usually the result of a direct impact from a ball, the ground, or another player.

Most sports-related metacarpal fractures can be treated with closed reduction and casting, and the periosteal sleeve and ligamentous attachments will allow for stable reduction.

But the take-home message is that athletes who resume competition after casting and immobilization require close and frequent radiographic follow-up to make sure there is no displacement of the fracture on a week-to-week basis, Dr. Redler said. Returning the athlete to play is a balancing act. Protection of the fracture must be a priority, but athletes who are returning to play need enough mobility to perform the necessary skills on the field or court.

To that end, thumb metacarpal fractures can be immobilized in a functional position.

Dr. Redler said that he and his colleagues have advised athletes in sports such as lacrosse or hockey to bring their sticks to the casting clinic or hand therapist to make certain that the cast is molded to match how they hold the sticks.

Fiberglass casts are permitted in many sports if they have enough external padding to protect the other athletes on the field.

If fiberglass is prohibited, thermoplastic splints can be used, but they may be too flexible and may require reinforcement in some cases.

HERSHEY, PA. — Short-term, nonsurgical management of hand fractures gets competitive athletes back in the game, Dr. Michael R. Redler said at the annual meeting of the American Orthopaedic Society for Sports Medicine.

But it is essential to remind the athlete of all possible outcomes, including the increased risk for additional injury if he or she returns to play too soon after a fracture.

Study results have shown that hand injuries account for 3%–25% of all athletic injuries, said Dr. Redler, a founding partner of the Orthopaedic and Sports Medicine Center in Trumbull, Conn.

The timing and feasibility of an injured athlete's return to play differ for each sport and each individual. Factors to consider include the patient's age and competitive level, the type of injury sustained, whether the athlete can perform the manual skill necessary for the sport, and whether the injury can be protected from further trauma.

Athletes who require explicit use of the wrist or fingers may not be able to participate in their sport during the stages of healing. Phalangeal fractures can usually be managed with external plastic or aluminum splints, and surgery is rarely needed. But metacarpal fractures are more complicated. Most phalangeal fractures are caused by trauma from crushing, bending, or twisting, whereas metacarpal fractures are usually the result of a direct impact from a ball, the ground, or another player.

Most sports-related metacarpal fractures can be treated with closed reduction and casting, and the periosteal sleeve and ligamentous attachments will allow for stable reduction.

But the take-home message is that athletes who resume competition after casting and immobilization require close and frequent radiographic follow-up to make sure there is no displacement of the fracture on a week-to-week basis, Dr. Redler said. Returning the athlete to play is a balancing act. Protection of the fracture must be a priority, but athletes who are returning to play need enough mobility to perform the necessary skills on the field or court.

To that end, thumb metacarpal fractures can be immobilized in a functional position.

Dr. Redler said that he and his colleagues have advised athletes in sports such as lacrosse or hockey to bring their sticks to the casting clinic or hand therapist to make certain that the cast is molded to match how they hold the sticks.

Fiberglass casts are permitted in many sports if they have enough external padding to protect the other athletes on the field.

If fiberglass is prohibited, thermoplastic splints can be used, but they may be too flexible and may require reinforcement in some cases.

HERSHEY, PA. — Short-term, nonsurgical management of hand fractures gets competitive athletes back in the game, Dr. Michael R. Redler said at the annual meeting of the American Orthopaedic Society for Sports Medicine.

But it is essential to remind the athlete of all possible outcomes, including the increased risk for additional injury if he or she returns to play too soon after a fracture.

Study results have shown that hand injuries account for 3%–25% of all athletic injuries, said Dr. Redler, a founding partner of the Orthopaedic and Sports Medicine Center in Trumbull, Conn.

The timing and feasibility of an injured athlete's return to play differ for each sport and each individual. Factors to consider include the patient's age and competitive level, the type of injury sustained, whether the athlete can perform the manual skill necessary for the sport, and whether the injury can be protected from further trauma.

Athletes who require explicit use of the wrist or fingers may not be able to participate in their sport during the stages of healing. Phalangeal fractures can usually be managed with external plastic or aluminum splints, and surgery is rarely needed. But metacarpal fractures are more complicated. Most phalangeal fractures are caused by trauma from crushing, bending, or twisting, whereas metacarpal fractures are usually the result of a direct impact from a ball, the ground, or another player.

Most sports-related metacarpal fractures can be treated with closed reduction and casting, and the periosteal sleeve and ligamentous attachments will allow for stable reduction.

But the take-home message is that athletes who resume competition after casting and immobilization require close and frequent radiographic follow-up to make sure there is no displacement of the fracture on a week-to-week basis, Dr. Redler said. Returning the athlete to play is a balancing act. Protection of the fracture must be a priority, but athletes who are returning to play need enough mobility to perform the necessary skills on the field or court.

To that end, thumb metacarpal fractures can be immobilized in a functional position.

Dr. Redler said that he and his colleagues have advised athletes in sports such as lacrosse or hockey to bring their sticks to the casting clinic or hand therapist to make certain that the cast is molded to match how they hold the sticks.

Fiberglass casts are permitted in many sports if they have enough external padding to protect the other athletes on the field.

If fiberglass is prohibited, thermoplastic splints can be used, but they may be too flexible and may require reinforcement in some cases.