Heidi Splete

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.

HERSHEY, PA. — Otherwise healthy adolescents who had internal fixation surgery for osteochondritis dissecans of the knee returned to their sports activities about 8 months later, Dr. Mininder S. Kocher reported at the annual meeting of the American Orthopaedic Society for Sports Medicine.

The data argue in favor of internal fixation, especially for children approaching skeletal maturity who have less time to heal nonoperatively.

The overall healing rate was 85%, based on at least 2 years of follow-up data from 26 knees in 24 patients whose average age was 14 years, said Dr. Kocher, an orthopedic surgeon at Children's Hospital Boston. The cases included 9 stage II lesions (fissured), 11 stage III lesions (partly attached), and 6 stage IV lesions (detached). Other studies have shown similar healing rates of 80% or higher.

The cause of osteochondritis dissecans (OCD) remains unclear, although possible causes include repetitive microtrauma, poor bone growth, and genetic predisposition. Most cases occur in active boys aged 10–20 years, but the diagnoses in girls have increased. Dr. Kocher's study included 13 boys and 11 girls.

Healing was evident 6 months after surgery based on several scores, including the International Knee Documentation Committee, Lysholm, and Tegner scales, which measure knee function in athletic patients. The average Tegner activity level score, which uses a scale of 1–10, increased from 4.9 before surgery to 7.4 after surgery.

The healing rate was slightly lower in the seven patients who had undergone previous surgery for OCD than in those with no prior OCD surgery (71% vs. 89%).

After surgery, the patients recovered by performing careful weight-bearing and range-of-motion exercises, and gradually returning to sports.

There were no significant differences in healing rate based on the type of lesion and, in fact, all six of the cases of stage IV (unstable lesions) healed. A lateral versus medial location had no apparent effect on healing, and no significant complications were reported in any patients.

There were four cases of unhealed lesions after the procedure (15%). Two of these were treated with chondral resurfacing, and two were treated with a second internal fixation; all four patients were able to resume their sports activities.

The study was limited by its small size—which prevented subgroup comparisons—and by its retrospective nature.

“When faced with an unstable juvenile OCD lesion of the knee, we are often forced to choose between internal fixation or fragment removal with a chondral resurfacing technique,” Dr. Kocher said. “Given the relatively high healing rate, good functional outcome, and low complication rate, we would advocate internal fixation of these lesions when technically possible.”

HERSHEY, PA. — Otherwise healthy adolescents who had internal fixation surgery for osteochondritis dissecans of the knee returned to their sports activities about 8 months later, Dr. Mininder S. Kocher reported at the annual meeting of the American Orthopaedic Society for Sports Medicine.

The data argue in favor of internal fixation, especially for children approaching skeletal maturity who have less time to heal nonoperatively.

The overall healing rate was 85%, based on at least 2 years of follow-up data from 26 knees in 24 patients whose average age was 14 years, said Dr. Kocher, an orthopedic surgeon at Children's Hospital Boston. The cases included 9 stage II lesions (fissured), 11 stage III lesions (partly attached), and 6 stage IV lesions (detached). Other studies have shown similar healing rates of 80% or higher.

The cause of osteochondritis dissecans (OCD) remains unclear, although possible causes include repetitive microtrauma, poor bone growth, and genetic predisposition. Most cases occur in active boys aged 10–20 years, but the diagnoses in girls have increased. Dr. Kocher's study included 13 boys and 11 girls.

Healing was evident 6 months after surgery based on several scores, including the International Knee Documentation Committee, Lysholm, and Tegner scales, which measure knee function in athletic patients. The average Tegner activity level score, which uses a scale of 1–10, increased from 4.9 before surgery to 7.4 after surgery.

The healing rate was slightly lower in the seven patients who had undergone previous surgery for OCD than in those with no prior OCD surgery (71% vs. 89%).

After surgery, the patients recovered by performing careful weight-bearing and range-of-motion exercises, and gradually returning to sports.

There were no significant differences in healing rate based on the type of lesion and, in fact, all six of the cases of stage IV (unstable lesions) healed. A lateral versus medial location had no apparent effect on healing, and no significant complications were reported in any patients.

There were four cases of unhealed lesions after the procedure (15%). Two of these were treated with chondral resurfacing, and two were treated with a second internal fixation; all four patients were able to resume their sports activities.

The study was limited by its small size—which prevented subgroup comparisons—and by its retrospective nature.

“When faced with an unstable juvenile OCD lesion of the knee, we are often forced to choose between internal fixation or fragment removal with a chondral resurfacing technique,” Dr. Kocher said. “Given the relatively high healing rate, good functional outcome, and low complication rate, we would advocate internal fixation of these lesions when technically possible.”

HERSHEY, PA. — Otherwise healthy adolescents who had internal fixation surgery for osteochondritis dissecans of the knee returned to their sports activities about 8 months later, Dr. Mininder S. Kocher reported at the annual meeting of the American Orthopaedic Society for Sports Medicine.

The data argue in favor of internal fixation, especially for children approaching skeletal maturity who have less time to heal nonoperatively.

The overall healing rate was 85%, based on at least 2 years of follow-up data from 26 knees in 24 patients whose average age was 14 years, said Dr. Kocher, an orthopedic surgeon at Children's Hospital Boston. The cases included 9 stage II lesions (fissured), 11 stage III lesions (partly attached), and 6 stage IV lesions (detached). Other studies have shown similar healing rates of 80% or higher.

The cause of osteochondritis dissecans (OCD) remains unclear, although possible causes include repetitive microtrauma, poor bone growth, and genetic predisposition. Most cases occur in active boys aged 10–20 years, but the diagnoses in girls have increased. Dr. Kocher's study included 13 boys and 11 girls.

Healing was evident 6 months after surgery based on several scores, including the International Knee Documentation Committee, Lysholm, and Tegner scales, which measure knee function in athletic patients. The average Tegner activity level score, which uses a scale of 1–10, increased from 4.9 before surgery to 7.4 after surgery.

The healing rate was slightly lower in the seven patients who had undergone previous surgery for OCD than in those with no prior OCD surgery (71% vs. 89%).

After surgery, the patients recovered by performing careful weight-bearing and range-of-motion exercises, and gradually returning to sports.

There were no significant differences in healing rate based on the type of lesion and, in fact, all six of the cases of stage IV (unstable lesions) healed. A lateral versus medial location had no apparent effect on healing, and no significant complications were reported in any patients.

There were four cases of unhealed lesions after the procedure (15%). Two of these were treated with chondral resurfacing, and two were treated with a second internal fixation; all four patients were able to resume their sports activities.

The study was limited by its small size—which prevented subgroup comparisons—and by its retrospective nature.

“When faced with an unstable juvenile OCD lesion of the knee, we are often forced to choose between internal fixation or fragment removal with a chondral resurfacing technique,” Dr. Kocher said. “Given the relatively high healing rate, good functional outcome, and low complication rate, we would advocate internal fixation of these lesions when technically possible.”

Children with rhinovirus who received oral prednisolone suffered significantly less recurrent wheezing compared with children with respiratory syncytial virus who also received the steroid or children who received placebo.

Dr. Tuomas Jartti, of the department of pediatrics at Turku (Finland) University Hospital, and associates analyzed 78 children aged 3–35 months who completed hospitalization for rhinovirus (40 children) or respiratory syncytial virus (RSV) infections (38 children). The children were randomized to receive an initial oral dose of 2 mg/kg prednisolone, followed by 2 mg/kg per day in three divided doses for 3 days (46 patients), or placebo (32 patients). The children with rhinovirus were significantly more likely to be older, atopic, and recurrent wheezers, and they had significantly higher blood eosinophil levels and exhaled nitric oxide levels than did the children with RSV (Pediatr. Infect. Dis. J. 2006;25:482–8). Children in the RSV group were significantly more likely to have acute otitis media and to have been treated with antibiotics than were those in the rhinovirus group.

Children with rhinovirus or RSV who received oral prednisolone did not leave the hospital more quickly than children in the placebo group (22 hours vs. 30 hours).

By reducing recurrent wheezing, prednisolone use significantly decreased the need for outpatient visits in children with rhinovirus infections—but not in children with RSV infections—compared with children who received placebo.

“We speculate that an early asthma-like inflammation could explain the beneficial effect of prednisolone in the rhinovirus group,” the investigators said.

Prednisolone was well tolerated; no significant adverse events were reported.

Children with rhinovirus who received oral prednisolone suffered significantly less recurrent wheezing compared with children with respiratory syncytial virus who also received the steroid or children who received placebo.

Dr. Tuomas Jartti, of the department of pediatrics at Turku (Finland) University Hospital, and associates analyzed 78 children aged 3–35 months who completed hospitalization for rhinovirus (40 children) or respiratory syncytial virus (RSV) infections (38 children). The children were randomized to receive an initial oral dose of 2 mg/kg prednisolone, followed by 2 mg/kg per day in three divided doses for 3 days (46 patients), or placebo (32 patients). The children with rhinovirus were significantly more likely to be older, atopic, and recurrent wheezers, and they had significantly higher blood eosinophil levels and exhaled nitric oxide levels than did the children with RSV (Pediatr. Infect. Dis. J. 2006;25:482–8). Children in the RSV group were significantly more likely to have acute otitis media and to have been treated with antibiotics than were those in the rhinovirus group.

Children with rhinovirus or RSV who received oral prednisolone did not leave the hospital more quickly than children in the placebo group (22 hours vs. 30 hours).

By reducing recurrent wheezing, prednisolone use significantly decreased the need for outpatient visits in children with rhinovirus infections—but not in children with RSV infections—compared with children who received placebo.

“We speculate that an early asthma-like inflammation could explain the beneficial effect of prednisolone in the rhinovirus group,” the investigators said.

Prednisolone was well tolerated; no significant adverse events were reported.

Children with rhinovirus who received oral prednisolone suffered significantly less recurrent wheezing compared with children with respiratory syncytial virus who also received the steroid or children who received placebo.

Dr. Tuomas Jartti, of the department of pediatrics at Turku (Finland) University Hospital, and associates analyzed 78 children aged 3–35 months who completed hospitalization for rhinovirus (40 children) or respiratory syncytial virus (RSV) infections (38 children). The children were randomized to receive an initial oral dose of 2 mg/kg prednisolone, followed by 2 mg/kg per day in three divided doses for 3 days (46 patients), or placebo (32 patients). The children with rhinovirus were significantly more likely to be older, atopic, and recurrent wheezers, and they had significantly higher blood eosinophil levels and exhaled nitric oxide levels than did the children with RSV (Pediatr. Infect. Dis. J. 2006;25:482–8). Children in the RSV group were significantly more likely to have acute otitis media and to have been treated with antibiotics than were those in the rhinovirus group.

Children with rhinovirus or RSV who received oral prednisolone did not leave the hospital more quickly than children in the placebo group (22 hours vs. 30 hours).

By reducing recurrent wheezing, prednisolone use significantly decreased the need for outpatient visits in children with rhinovirus infections—but not in children with RSV infections—compared with children who received placebo.

“We speculate that an early asthma-like inflammation could explain the beneficial effect of prednisolone in the rhinovirus group,” the investigators said.

Prednisolone was well tolerated; no significant adverse events were reported.

More Miss Day Care With Rotavirus

Rotavirus is a common cause of gastroenteritis that, in a review of 284 cases, was significantly more likely to keep children younger than 3 years of age away from day care, compared with nonrotavirus gastroenteritis.

A total of 115 cases (40%) were confirmed rotavirus infections. Overall, 70% of children with rotavirus gastroenteritis missed at least 1 day of day care, compared with 55% of children with nonrotavirus gastroenteritis, reported Dr. Susan E. Coffin of the University of Pennsylvania, Philadelphia, and her colleagues (Pediatr. Infect. Dis. J. 2006;25:584–9).

Children aged 7–12 months were the hardest hit; 54% of both the 7- to 9-month-olds and the 10- to 12-month-olds had rotavirus infections. By contrast, nonrotavirus infections peaked in children aged 4–6 months (72%).

The researchers collected stool samples from children with acute gastroenteritis at five urban and suburban pediatric practices during the winter-to-spring seasons of 2002–2003 and 2003–2004. The study was supported by Merck and Co.

Children with rotavirus infections were significantly more likely than those with nonrotavirus infections to exhibit vomiting (83% vs. 66%), a combination of diarrhea and vomiting (75% vs. 50%), or fever (60% vs. 43%).

Rotavirus had a significant impact on parents, too. Parents or guardians of the children with rotavirus were significantly more likely to miss at least 1 day of work than parents of children with nonrotavirus infections (62% vs. 40%).

The proportion of children who needed additional medical care, including hospitalization, was similar among both rotavirus and nonrotavirus cases.

Extreme Fevers May Merit Antibiotics

Children with very high fevers are at increased risk for both bacterial and viral illness, and clinical features don't reliably distinguish between the two conditions.

Dr. Barbara W. Trautner of Baylor College of Medicine, Houston, and her colleagues identified 103 cases of hyperpyrexia—defined as a rectal temperature of 106 ° F or higher—in a review of 130,828 patient visits (1 case per 1,270 visits).

The researchers found that 20 of these children (19%) had serious bacterial infections and 22 (21.4%) had laboratory-confirmed viral illness (Pediatrics 2006;118;34–40).

About a third of the children (35%) had fevers that lasted longer than 48 hours, and the cause of the fever was unknown in 60 children (58%).

The incidence of serious bacterial infection in children with underlying illnesses was more than double that in children without underlying illness (37% vs. 16%). But no other factors, including age and maximum temperature, were significantly predictive of serious bacterial infection compared with viral infection. Notably, the differences in white blood cell counts were not significant enough to be helpful in distinguishing bacterial vs. viral illness, although the median WBC was insignificantly higher in cases of viral illness.

The increased use of rapid testing continues to raise awareness of bacterial and viral coinfection, but only one child of 103 had a coinfection, which suggests that a positive rapid viral test alone may not be sufficient to rule out treatment with antibiotics.

Bocavirus and Respiratory Illness

Human bocavirus DNA was identified in 82 (5.6%) of 1,474 nasal specimens from children with upper and lower respiratory tract infections collected over a 20-month period in a San Diego children's hospital.

The prevalence of the human bocavirus (HBoV) infections peaked at 14% between March and May in both 2004 and 2005, although the reason for the spring peak was unclear, reported Dr. John C. Arnold of Children's Hospital, San Diego, and his colleagues. The study included children up to age 18 years, but most (63%) were less than 1 year old (Clin. Infect. Dis. 2006;43:283–8).

The researchers reviewed the records of 68 (83%) of the 82 patients with HBoV to discover the clinical characteristics associated with the infection in children. They found underlying illnesses in 21 (31%) children including 11 patients with asthma and 7 patients with neuromuscular disorders.

Cough was the most common symptom, based on data from 54 patients with no obvious coinfections or detectable viral antigens. Cough occurred in 46 (85%) of these children, and 10 (19%) had coughs described as “paroxysmal.” A total of 33 patients (62%) showed clinical signs of lower respiratory tract infections, and bronchiolitis was the most common diagnosis (26%). Difficulty breathing, nasal congestion, fever, and diarrhea were also common in patients with HBoV, and five patients had a rash.

More Miss Day Care With Rotavirus

Rotavirus is a common cause of gastroenteritis that, in a review of 284 cases, was significantly more likely to keep children younger than 3 years of age away from day care, compared with nonrotavirus gastroenteritis.

A total of 115 cases (40%) were confirmed rotavirus infections. Overall, 70% of children with rotavirus gastroenteritis missed at least 1 day of day care, compared with 55% of children with nonrotavirus gastroenteritis, reported Dr. Susan E. Coffin of the University of Pennsylvania, Philadelphia, and her colleagues (Pediatr. Infect. Dis. J. 2006;25:584–9).

Children aged 7–12 months were the hardest hit; 54% of both the 7- to 9-month-olds and the 10- to 12-month-olds had rotavirus infections. By contrast, nonrotavirus infections peaked in children aged 4–6 months (72%).

The researchers collected stool samples from children with acute gastroenteritis at five urban and suburban pediatric practices during the winter-to-spring seasons of 2002–2003 and 2003–2004. The study was supported by Merck and Co.

Children with rotavirus infections were significantly more likely than those with nonrotavirus infections to exhibit vomiting (83% vs. 66%), a combination of diarrhea and vomiting (75% vs. 50%), or fever (60% vs. 43%).

Rotavirus had a significant impact on parents, too. Parents or guardians of the children with rotavirus were significantly more likely to miss at least 1 day of work than parents of children with nonrotavirus infections (62% vs. 40%).

The proportion of children who needed additional medical care, including hospitalization, was similar among both rotavirus and nonrotavirus cases.

Extreme Fevers May Merit Antibiotics

Children with very high fevers are at increased risk for both bacterial and viral illness, and clinical features don't reliably distinguish between the two conditions.

Dr. Barbara W. Trautner of Baylor College of Medicine, Houston, and her colleagues identified 103 cases of hyperpyrexia—defined as a rectal temperature of 106 ° F or higher—in a review of 130,828 patient visits (1 case per 1,270 visits).

The researchers found that 20 of these children (19%) had serious bacterial infections and 22 (21.4%) had laboratory-confirmed viral illness (Pediatrics 2006;118;34–40).

About a third of the children (35%) had fevers that lasted longer than 48 hours, and the cause of the fever was unknown in 60 children (58%).

The incidence of serious bacterial infection in children with underlying illnesses was more than double that in children without underlying illness (37% vs. 16%). But no other factors, including age and maximum temperature, were significantly predictive of serious bacterial infection compared with viral infection. Notably, the differences in white blood cell counts were not significant enough to be helpful in distinguishing bacterial vs. viral illness, although the median WBC was insignificantly higher in cases of viral illness.

The increased use of rapid testing continues to raise awareness of bacterial and viral coinfection, but only one child of 103 had a coinfection, which suggests that a positive rapid viral test alone may not be sufficient to rule out treatment with antibiotics.

Bocavirus and Respiratory Illness

Human bocavirus DNA was identified in 82 (5.6%) of 1,474 nasal specimens from children with upper and lower respiratory tract infections collected over a 20-month period in a San Diego children's hospital.

The prevalence of the human bocavirus (HBoV) infections peaked at 14% between March and May in both 2004 and 2005, although the reason for the spring peak was unclear, reported Dr. John C. Arnold of Children's Hospital, San Diego, and his colleagues. The study included children up to age 18 years, but most (63%) were less than 1 year old (Clin. Infect. Dis. 2006;43:283–8).

The researchers reviewed the records of 68 (83%) of the 82 patients with HBoV to discover the clinical characteristics associated with the infection in children. They found underlying illnesses in 21 (31%) children including 11 patients with asthma and 7 patients with neuromuscular disorders.

Cough was the most common symptom, based on data from 54 patients with no obvious coinfections or detectable viral antigens. Cough occurred in 46 (85%) of these children, and 10 (19%) had coughs described as “paroxysmal.” A total of 33 patients (62%) showed clinical signs of lower respiratory tract infections, and bronchiolitis was the most common diagnosis (26%). Difficulty breathing, nasal congestion, fever, and diarrhea were also common in patients with HBoV, and five patients had a rash.

More Miss Day Care With Rotavirus

Rotavirus is a common cause of gastroenteritis that, in a review of 284 cases, was significantly more likely to keep children younger than 3 years of age away from day care, compared with nonrotavirus gastroenteritis.

A total of 115 cases (40%) were confirmed rotavirus infections. Overall, 70% of children with rotavirus gastroenteritis missed at least 1 day of day care, compared with 55% of children with nonrotavirus gastroenteritis, reported Dr. Susan E. Coffin of the University of Pennsylvania, Philadelphia, and her colleagues (Pediatr. Infect. Dis. J. 2006;25:584–9).

Children aged 7–12 months were the hardest hit; 54% of both the 7- to 9-month-olds and the 10- to 12-month-olds had rotavirus infections. By contrast, nonrotavirus infections peaked in children aged 4–6 months (72%).

The researchers collected stool samples from children with acute gastroenteritis at five urban and suburban pediatric practices during the winter-to-spring seasons of 2002–2003 and 2003–2004. The study was supported by Merck and Co.

Children with rotavirus infections were significantly more likely than those with nonrotavirus infections to exhibit vomiting (83% vs. 66%), a combination of diarrhea and vomiting (75% vs. 50%), or fever (60% vs. 43%).

Rotavirus had a significant impact on parents, too. Parents or guardians of the children with rotavirus were significantly more likely to miss at least 1 day of work than parents of children with nonrotavirus infections (62% vs. 40%).

The proportion of children who needed additional medical care, including hospitalization, was similar among both rotavirus and nonrotavirus cases.

Extreme Fevers May Merit Antibiotics

Children with very high fevers are at increased risk for both bacterial and viral illness, and clinical features don't reliably distinguish between the two conditions.

Dr. Barbara W. Trautner of Baylor College of Medicine, Houston, and her colleagues identified 103 cases of hyperpyrexia—defined as a rectal temperature of 106 ° F or higher—in a review of 130,828 patient visits (1 case per 1,270 visits).

The researchers found that 20 of these children (19%) had serious bacterial infections and 22 (21.4%) had laboratory-confirmed viral illness (Pediatrics 2006;118;34–40).

About a third of the children (35%) had fevers that lasted longer than 48 hours, and the cause of the fever was unknown in 60 children (58%).

The incidence of serious bacterial infection in children with underlying illnesses was more than double that in children without underlying illness (37% vs. 16%). But no other factors, including age and maximum temperature, were significantly predictive of serious bacterial infection compared with viral infection. Notably, the differences in white blood cell counts were not significant enough to be helpful in distinguishing bacterial vs. viral illness, although the median WBC was insignificantly higher in cases of viral illness.

The increased use of rapid testing continues to raise awareness of bacterial and viral coinfection, but only one child of 103 had a coinfection, which suggests that a positive rapid viral test alone may not be sufficient to rule out treatment with antibiotics.

Bocavirus and Respiratory Illness

Human bocavirus DNA was identified in 82 (5.6%) of 1,474 nasal specimens from children with upper and lower respiratory tract infections collected over a 20-month period in a San Diego children's hospital.

The prevalence of the human bocavirus (HBoV) infections peaked at 14% between March and May in both 2004 and 2005, although the reason for the spring peak was unclear, reported Dr. John C. Arnold of Children's Hospital, San Diego, and his colleagues. The study included children up to age 18 years, but most (63%) were less than 1 year old (Clin. Infect. Dis. 2006;43:283–8).

The researchers reviewed the records of 68 (83%) of the 82 patients with HBoV to discover the clinical characteristics associated with the infection in children. They found underlying illnesses in 21 (31%) children including 11 patients with asthma and 7 patients with neuromuscular disorders.

Cough was the most common symptom, based on data from 54 patients with no obvious coinfections or detectable viral antigens. Cough occurred in 46 (85%) of these children, and 10 (19%) had coughs described as “paroxysmal.” A total of 33 patients (62%) showed clinical signs of lower respiratory tract infections, and bronchiolitis was the most common diagnosis (26%). Difficulty breathing, nasal congestion, fever, and diarrhea were also common in patients with HBoV, and five patients had a rash.

PTSD Seen in Teens Near Ground Zero

A total of 83 (7.4%) of 1,122 high school students who lived in the borough of the Bronx in New York City at the time of the Sept. 11, 2001, terrorist attacks met the criteria for posttraumatic stress disorder (PTSD) based on questionnaires completed at school 8 months after the attacks.

Michele E. Calderoni, D.O., of Albert Einstein College of Medicine, New York and her colleagues designed the study to assess whether the high incidence of violent crime and poverty in the Bronx caused stress in these students that would make them especially vulnerable to PTSD after a major traumatic event (J. Adolesc. Health 2006;39:57–65).

Students who reported financial difficulties in the wake of the attacks were about five times more likely to have PTSD than were those without financial difficulties, and students who reported psychotropic medication use prior to Sept. 11 were nearly four times as likely to meet criteria for PTSD than were students who did not take medication. Students who reported feeling more vulnerable and less protected by the government were about four times more likely to have PTSD than were students without these characteristics.

Several specific PTSD symptoms–including flashbacks about the event and emotional reactions to reminders of the event–were significantly more common in girls than in boys, but gender and ethnicity were not significant factors in the overall PTSD rates.

The 7.4% rate was significantly higher than the 2% rate of PTSD found in a National Institute of Mental Health-sponsored study of children in four geographic areas other than New York City before Sept. 11, 2001.

Race and Mother/Daughter Sex Talks

Ethnicity was a significant predictor of mothers' discomfort in discussing sex-related topics with their daughters, according to data from surveys of 6,929 adolescent girls and their biological mothers.

Compared with white mothers, Asian mothers were more than five times as likely, Latina mothers more than four times as likely, and black mothers more than twice as likely to report discomfort in discussing sex with their daughters, reported Lisa M. Meneses, M.P.H., of the University of California, Berkeley, and her colleagues (J. Adolesc. Health 2006;39:128–31).

Overall, 57% of the mothers were white, 21% were black, 14% were Latina, 4% were Asian, and 4% were mixed ethnicity or didn't respond to the survey. Data were taken from the National Longitudinal Study of Adolescent Health.

The surveys also measured how often the mothers and daughters talked about sex and whether the mothers had correct information about their daughters' sexual activities. Compared with white mothers, Asian mothers were more than six times as likely and Latina mothers about 1.5 times as likely to report that they talked to their daughters about sex infrequently. Compared with black mothers, both Latina and Asian mothers were less likely to have discussed sex with their daughters but were more likely to be accurate about their daughters' sexual status.

The ethnic differences in maternal discomfort with sex talks, frequency of such talks, and awareness of sexual status persisted after controlling for confounding factors including mothers' and daughters' age, education, and religious beliefs.

Stutterers Struggle With Emotions

Children who stutter are significantly more emotional in stressful situations compared with their non-stuttering peers, a study shows.

To compare the differences in emotional regulation, Jan Karrass, Ph.D., and colleagues at Vanderbilt University in Nashville, Tenn., examined data from parents' reports on the behavior of 65 children who stuttered and 56 age-matched children who did not. The children were aged 3–5 years.

The scores on 31 selected items from a 100-item questionnaire suggested that, in addition to being easily stressed, stutterers were significantly less able to regulate emotions and calm down after being stressed.

They were also significantly less able to disengage themselves from an emotional stimulus and refocus their attention, compared with non-stuttering peers. The results were statistically significant after the investigators controlled for age, gender, language ability, and socioeconomic status (J. Commun. Disord. doi:10.1016/j.jcomdis.2005.12.004).

The interaction between speech errors and emotions may make stuttering worse over time if the child does not outgrow the condition or receives no treatment, Dr. Karrass and colleagues reported.

The study is among the first to identify a link between stuttering and emotional regulation, although previous studies in preschool and school-aged children have suggested that stutterers are less attentive and adaptable than are non-stutterers.

PTSD Seen in Teens Near Ground Zero

A total of 83 (7.4%) of 1,122 high school students who lived in the borough of the Bronx in New York City at the time of the Sept. 11, 2001, terrorist attacks met the criteria for posttraumatic stress disorder (PTSD) based on questionnaires completed at school 8 months after the attacks.

Michele E. Calderoni, D.O., of Albert Einstein College of Medicine, New York and her colleagues designed the study to assess whether the high incidence of violent crime and poverty in the Bronx caused stress in these students that would make them especially vulnerable to PTSD after a major traumatic event (J. Adolesc. Health 2006;39:57–65).

Students who reported financial difficulties in the wake of the attacks were about five times more likely to have PTSD than were those without financial difficulties, and students who reported psychotropic medication use prior to Sept. 11 were nearly four times as likely to meet criteria for PTSD than were students who did not take medication. Students who reported feeling more vulnerable and less protected by the government were about four times more likely to have PTSD than were students without these characteristics.

Several specific PTSD symptoms–including flashbacks about the event and emotional reactions to reminders of the event–were significantly more common in girls than in boys, but gender and ethnicity were not significant factors in the overall PTSD rates.

The 7.4% rate was significantly higher than the 2% rate of PTSD found in a National Institute of Mental Health-sponsored study of children in four geographic areas other than New York City before Sept. 11, 2001.

Race and Mother/Daughter Sex Talks

Ethnicity was a significant predictor of mothers' discomfort in discussing sex-related topics with their daughters, according to data from surveys of 6,929 adolescent girls and their biological mothers.

Compared with white mothers, Asian mothers were more than five times as likely, Latina mothers more than four times as likely, and black mothers more than twice as likely to report discomfort in discussing sex with their daughters, reported Lisa M. Meneses, M.P.H., of the University of California, Berkeley, and her colleagues (J. Adolesc. Health 2006;39:128–31).

Overall, 57% of the mothers were white, 21% were black, 14% were Latina, 4% were Asian, and 4% were mixed ethnicity or didn't respond to the survey. Data were taken from the National Longitudinal Study of Adolescent Health.

The surveys also measured how often the mothers and daughters talked about sex and whether the mothers had correct information about their daughters' sexual activities. Compared with white mothers, Asian mothers were more than six times as likely and Latina mothers about 1.5 times as likely to report that they talked to their daughters about sex infrequently. Compared with black mothers, both Latina and Asian mothers were less likely to have discussed sex with their daughters but were more likely to be accurate about their daughters' sexual status.

The ethnic differences in maternal discomfort with sex talks, frequency of such talks, and awareness of sexual status persisted after controlling for confounding factors including mothers' and daughters' age, education, and religious beliefs.

Stutterers Struggle With Emotions

Children who stutter are significantly more emotional in stressful situations compared with their non-stuttering peers, a study shows.

To compare the differences in emotional regulation, Jan Karrass, Ph.D., and colleagues at Vanderbilt University in Nashville, Tenn., examined data from parents' reports on the behavior of 65 children who stuttered and 56 age-matched children who did not. The children were aged 3–5 years.

The scores on 31 selected items from a 100-item questionnaire suggested that, in addition to being easily stressed, stutterers were significantly less able to regulate emotions and calm down after being stressed.

They were also significantly less able to disengage themselves from an emotional stimulus and refocus their attention, compared with non-stuttering peers. The results were statistically significant after the investigators controlled for age, gender, language ability, and socioeconomic status (J. Commun. Disord. doi:10.1016/j.jcomdis.2005.12.004).

The interaction between speech errors and emotions may make stuttering worse over time if the child does not outgrow the condition or receives no treatment, Dr. Karrass and colleagues reported.

The study is among the first to identify a link between stuttering and emotional regulation, although previous studies in preschool and school-aged children have suggested that stutterers are less attentive and adaptable than are non-stutterers.

PTSD Seen in Teens Near Ground Zero

A total of 83 (7.4%) of 1,122 high school students who lived in the borough of the Bronx in New York City at the time of the Sept. 11, 2001, terrorist attacks met the criteria for posttraumatic stress disorder (PTSD) based on questionnaires completed at school 8 months after the attacks.

Michele E. Calderoni, D.O., of Albert Einstein College of Medicine, New York and her colleagues designed the study to assess whether the high incidence of violent crime and poverty in the Bronx caused stress in these students that would make them especially vulnerable to PTSD after a major traumatic event (J. Adolesc. Health 2006;39:57–65).

Students who reported financial difficulties in the wake of the attacks were about five times more likely to have PTSD than were those without financial difficulties, and students who reported psychotropic medication use prior to Sept. 11 were nearly four times as likely to meet criteria for PTSD than were students who did not take medication. Students who reported feeling more vulnerable and less protected by the government were about four times more likely to have PTSD than were students without these characteristics.

Several specific PTSD symptoms–including flashbacks about the event and emotional reactions to reminders of the event–were significantly more common in girls than in boys, but gender and ethnicity were not significant factors in the overall PTSD rates.

The 7.4% rate was significantly higher than the 2% rate of PTSD found in a National Institute of Mental Health-sponsored study of children in four geographic areas other than New York City before Sept. 11, 2001.

Race and Mother/Daughter Sex Talks

Ethnicity was a significant predictor of mothers' discomfort in discussing sex-related topics with their daughters, according to data from surveys of 6,929 adolescent girls and their biological mothers.

Compared with white mothers, Asian mothers were more than five times as likely, Latina mothers more than four times as likely, and black mothers more than twice as likely to report discomfort in discussing sex with their daughters, reported Lisa M. Meneses, M.P.H., of the University of California, Berkeley, and her colleagues (J. Adolesc. Health 2006;39:128–31).

Overall, 57% of the mothers were white, 21% were black, 14% were Latina, 4% were Asian, and 4% were mixed ethnicity or didn't respond to the survey. Data were taken from the National Longitudinal Study of Adolescent Health.

The surveys also measured how often the mothers and daughters talked about sex and whether the mothers had correct information about their daughters' sexual activities. Compared with white mothers, Asian mothers were more than six times as likely and Latina mothers about 1.5 times as likely to report that they talked to their daughters about sex infrequently. Compared with black mothers, both Latina and Asian mothers were less likely to have discussed sex with their daughters but were more likely to be accurate about their daughters' sexual status.

The ethnic differences in maternal discomfort with sex talks, frequency of such talks, and awareness of sexual status persisted after controlling for confounding factors including mothers' and daughters' age, education, and religious beliefs.

Stutterers Struggle With Emotions

Children who stutter are significantly more emotional in stressful situations compared with their non-stuttering peers, a study shows.

To compare the differences in emotional regulation, Jan Karrass, Ph.D., and colleagues at Vanderbilt University in Nashville, Tenn., examined data from parents' reports on the behavior of 65 children who stuttered and 56 age-matched children who did not. The children were aged 3–5 years.

The scores on 31 selected items from a 100-item questionnaire suggested that, in addition to being easily stressed, stutterers were significantly less able to regulate emotions and calm down after being stressed.

They were also significantly less able to disengage themselves from an emotional stimulus and refocus their attention, compared with non-stuttering peers. The results were statistically significant after the investigators controlled for age, gender, language ability, and socioeconomic status (J. Commun. Disord. doi:10.1016/j.jcomdis.2005.12.004).

The interaction between speech errors and emotions may make stuttering worse over time if the child does not outgrow the condition or receives no treatment, Dr. Karrass and colleagues reported.

The study is among the first to identify a link between stuttering and emotional regulation, although previous studies in preschool and school-aged children have suggested that stutterers are less attentive and adaptable than are non-stutterers.