<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_437"
                     title="Autism Risk Linked to Maternal Age (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Pediatrics/Autism/tb/18341?impressionId=1265819586684"
                     
      Older women are more likely to give birth to a child who develops autism than younger women, but the father&apos;s age is a factor only when moms are younger, a large case-control study showed.&lt;br&gt;
&lt;br&gt;In an analysis of nearly five million births and more than 12,000 autism cases, every five-year increase in maternal age at delivery was associated with an 18% greater risk of the child later being diagnosed with autism, according to Janie Shelton, MPH, a doctoral student at the University of California Davis, and colleagues.&lt;br&gt;
&lt;br&gt;Mothers who gave birth when they were 40 or older had a 51% increased risk of having a child with autism compared with those who were 25 to 29, the largest age group (OR 1.51, 95% CI 1.35 to 1.70), the researchers reported in the February issue of &lt;em&gt;Autism Research&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The effect of the biological father&apos;s age appeared to depend on the mother&apos;s. When the mothers were 30 and older, paternal age did not significantly increase the risk of having a child develop autism. In mothers younger than 30, paternal age did contribute to the autism risk.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;This study builds upon earlier work that has demonstrated associations between parental age and autism risk,&quot; commented Bryan King, MD, program director of the Seattle Children&apos;s Autism Center, in an e-mail.&lt;/p&gt;
&lt;p&gt;But previous studies have yielded mixed results on the relative contributions of the mothers&apos; and fathers&apos; ages.&lt;/p&gt;
&lt;p&gt;&quot;I think the size of the sample used in the present study (close to five million births) has resulted in a clear signal that both maternal and paternal age are involved,&quot; said King, who was not involved in the study.&lt;/p&gt;
&lt;p&gt;He noted, however, that parental age &quot;does not account for the big increase in autism prevalence, although it may be contributing somewhat.&quot;&lt;/p&gt;
&lt;p&gt;Shelton and her colleagues calculated that the rising average maternal age during their study  --  covering 1990 to 1999  --  contributed to a 4.6% increase in autism incidence. That compares with about a six-fold increase in autism rates in that decade, Shelton said in an interview.&lt;/p&gt;
&lt;p&gt;&quot;I worry a little bit that in the media attention on this issue that mothers who had children at ages 37, 38, 39 might think that, &apos;Okay, well that&apos;s why my child had autism,&apos;&quot; she said. &quot;And so, I think it&apos;s important to stress that the increased number of cases that we&apos;ve observed can&apos;t be attributable towards women having children later.&quot;&lt;/p&gt;
&lt;p&gt;The researchers looked at data from 4,935,776 singleton births in California in the 1990&apos;s using records from the state Department of Development Services. Records identified 12,159 cases of &quot;Full Syndrome Autism&quot; diagnosed before age 6.&lt;/p&gt;
&lt;p&gt;That diagnosis may include autistic disorder, as well as Asperger&apos;s disorder and pervasive developmental disorder not otherwise specified. However, the breakdown of specific diagnoses could not be determined from this data set, Shelton said.&lt;/p&gt;
&lt;p&gt;Even after controlling for parental education, the year of the child&apos;s birth, the race/ethnicity of the parents, the mother&apos;s parity, and insurance payment type, older maternal age was associated with an increased risk of autism in the child.&lt;/p&gt;
&lt;p&gt;Nancy Minshew, MD, director of the Center of Excellence in Autism Research at the University of Pittsburgh, said in an e-mail that the results were not surprising because genetic errors are more common with older parents.&lt;/p&gt;
&lt;p&gt;King said genetics were one possible mechanism underlying the relationship.&lt;/p&gt;
&lt;p&gt;&quot;The mechanisms by which risk goes up might include a greater likelihood of chromosomal changes, a greater likelihood of problems at birth like prematurity, and many other factors,&quot; he said. &quot;The possibility of environmental exposures would also be expected to increase with age, and so this finding does not necessarily help narrow our focus on causes.&quot;&lt;/p&gt;
&lt;p&gt;Sheldon and her colleagues wrote, &quot;It is plausible that multiple exposure types may increase the risk of autism through a common pathway or pathways (i.e., mitochondrial function, thyroid function, epigenetics, hormonal alterations) and be represented as a generalized increased risk with age.&quot;&lt;/p&gt;
&lt;p&gt;&quot;In this case,&quot; they continued, &quot;maternal or paternal age would serve as an index of lifetime exposure status and be a proxy for the true underlying etiologic agent.&quot;&lt;/p&gt;
&lt;p&gt;Shelton said further research is needed to determine why biological age is serving as a risk factor for autism.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institute of Environmental Health Sciences and the Environmental Protection Agency and by the University of California Davis School of Medicine and Office of Graduate Studies.&lt;/p&gt;&lt;p&gt;The researchers did not report any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_372"
                     title="Low Serotonin Eyed as Mechanism for SIDS (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/18262?impressionId=1265819586684"
                     
      Low brainstem levels of serotonin and the enzyme that makes it could underlie sudden infant death syndrome (SIDS), researchers suggested.&lt;br&gt;
&lt;br&gt;In an autopsy study, SIDS cases showed 26% lower serotonin levels in two major components of the medulla&apos;s serotonin system  --  the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.05) and paragigantocellularis lateralis (&lt;em&gt;P&lt;/em&gt;=0.04)  --  compared with age-adjusted controls who died from known causes.&lt;br&gt;
&lt;br&gt;These brainstem circuits control breathing, blood pressure, and heart rate during sleep, Hannah C. Kinney, MD, of Children&apos;s Hospital Boston, and colleagues reported in the Feb. 3 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;A baby with an abnormality in control of these systems might not be able to respond to a life-threatening challenge like asphyxia by rousing from sleep or turning its head the researchers explained.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;SIDS occurs in the &quot;critical first year of life, when homeostatic systems are still maturing,&quot; they noted.&lt;/p&gt;
&lt;p&gt;Mary McClain, RN, MS, of Boston University Medical Center, who counsels families that have lost a baby to SIDS, commented that these findings help establish the biological basis for urging parents to place their babies on their backs to sleep.&lt;/p&gt;
&lt;p&gt;The researchers obtained tissue samples from autopsies of 41 children who died from SIDS, seven who died acutely from known causes (including a car accident, drowning, pneumonia, and unsuspected congenital heart disease), and five who died in the hospital with chronic conditions causing hypoxia-ischemia.&lt;/p&gt;
&lt;p&gt;SIDS cases had mean serotonin levels of 31.4 pmol/mg of protein in the paragigantocellularis lateralis, compared with 40.0 pmol/mg among the controls who died acutely (&lt;em&gt;P&lt;/em&gt;=0.04).&lt;/p&gt;
&lt;p&gt;Levels averaged 55.4 versus 75.5 pmol/mg of protein, respectively, in the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.05).&lt;/p&gt;
&lt;p&gt;These abnormalities in the medulla did not appear to involve the catecholamine system. Catecholamine levels were similar between SIDS cases and controls.&lt;/p&gt;
&lt;p&gt;Nor was there evidence for excessive degradation of dopamine or neurotransmitter turnover in SIDS cases, supporting the idea that the key abnormality is reduced synthesis of serotonin, the researchers said.&lt;/p&gt;
&lt;p&gt;Another marker of serotonin function  --  tryptophan hydroxylase (TPH2), the key enzyme involved in synthesis of serotonin  --  also supported this conclusion, with 22% lower levels in the raph&amp;#233; obscurus in SIDS than in controls (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;Serotonin receptor binding was 29% to 55% lower in three medullary nuclei that receive serotonin projections, notable for a decrease in binding with older age in SIDS cases, but not controls, the researchers noted.&lt;/p&gt;
&lt;p&gt;Given similar findings in three previous investigations, this &quot;may reflect a progressive decrease with age in those infants with the &apos;SIDS abnormality,&apos;&quot; they wrote. Or it&apos;s possible that those with a &quot;stronger abnormality take longer to outgrow the risk period for SIDS and continue to die at older ages,&quot; Kinney&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;Likewise, serotonin receptor binding in infants who died from SIDS was significantly lower in those without known risk factors for SIDS, such as &lt;a href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/17365&quot; mce_href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/17365&quot; target=&quot;_blank&quot;&gt;sleeping face down&lt;/a&gt;, &quot;suggesting that additional risk factors are necessary to precipitate death when the medullary serotonin system is less compromised,&quot; they added.&lt;/p&gt;
&lt;p&gt;Although repetitive apnea and agonal &lt;a href=&quot;http://www.medpagetoday.com/Pulmonology/SleepDisorders/2817&quot; mce_href=&quot;http://www.medpagetoday.com/Pulmonology/SleepDisorders/2817&quot; target=&quot;_blank&quot;&gt;impaired gasping&lt;/a&gt; before death have been reported in some SIDS cases, chronic impaired oxygenation in the hospitalized children in the study produced a very different serotonin pattern than that seen in SIDS.&lt;/p&gt;
&lt;p&gt;Children who died with chronic hypoxia conditions had 55% higher serotonin levels in the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.02) and 126% higher levels in the paragigantocellularis lateralis (&lt;em&gt;P&lt;/em&gt;=0.002) than the SIDS cases.&lt;/p&gt;
&lt;p&gt;They also had 640% higher dopamine levels in the raph&amp;#233; obscurus than the SIDS cases (&lt;em&gt;P&lt;/em&gt;=0.006).&lt;/p&gt;
&lt;p&gt;This suggested &quot;that the primary mechanisms underlying serotonin abnormalities in SIDS are not mediated by chronic hypoxia-ischemia,&quot; Kinney&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that their neurotransmitter measurements may have been off somewhat due to prolonged postmortem intervals.&lt;/p&gt;
&lt;p&gt;They also warned that the study was limited by inability to perform these measurements at the synapse in postmortem tissues and by the small sample of controls.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the First Candle/SIDS Alliance, CJ Martin Overseas Fellowship (National Health and Medical Research Council of Australia), CJ Murphy Foundation for Solving the Puzzle of SIDS, CJ Foundation for SIDS, National Institute of Child Health and Development, and the Developmental Disabilities Research Center at Children&apos;s Hospital Boston.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;McClain provided no information on conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_368"
                     title="Lancet Retracts 1998 MMR-Autism Paper"
                     score="0.01"
                     href="http://www.medpagetoday.com/Pediatrics/Vaccines/tb/18255?impressionId=1265819586684"
                     
      &lt;p&gt;Editors of &lt;em&gt;The Lancet&lt;/em&gt; have retracted the 1998 study that first suggested autism might be caused by the MMR vaccine, less than a week after an official rebuke to the paper&apos;s lead author, Andrew Wakefield, MBBS, and two co-authors.&lt;/p&gt;
&lt;p&gt;In a brief note posted on the journal&apos;s Web site, &lt;em&gt;Lancet&lt;/em&gt; editors wrote, &quot;It has become clear that several elements of the 1998 paper by Wakefield et al. are incorrect, contrary to the findings of an earlier investigation.... Therefore, we fully retract this paper from the published record.&quot;&lt;/p&gt;
&lt;p&gt;Evidence presented in a Jan. 28 hearing before the U.K. General Medical Council&apos;s Fitness to Practise Panel persuaded the journal that the paper had misrepresented how the study was conducted.&lt;/p&gt;
&lt;p&gt;&lt;span class=&quot;msgBody&quot;&gt;The council, which has no direct American equivalent, is an independent, nationwide regulatory body that registers doctors and enforces standards of medical practice in the U.K.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;Hospital records and other sources contradicted findings of a 2004 investigation by Wakefield&apos;s institution, the Royal Free and University College, that the study had been properly vetted by an institutional review board.&lt;/p&gt;
&lt;p&gt;&quot;The claims in the original paper that children were &apos;consecutively referred&apos; and that investigations were &apos;approved&apos; by the local ethics committee have been proven to be false,&quot; according to the &lt;em&gt;Lancet&lt;/em&gt; editors.&lt;/p&gt;
&lt;p&gt;The editor of Britain&apos;s other leading medical journal, &lt;em&gt;BMJ&lt;/em&gt;, congratulated &lt;em&gt;The Lancet&lt;/em&gt; for its action.&lt;/p&gt;
&lt;p&gt;&quot;This will help to restore faith in this globally important vaccine and in the integrity of the scientific literature,&quot; according to a statement from Fiona Godlee, MB, BChir, BSc.&lt;/p&gt;
&lt;p&gt;In the 1998 paper, Wakefield and colleagues reported on findings in 12 children who, they said, had developed intestinal inflammation and autistic symptoms following MMR vaccination. They suggested that the inflammation released gut proteins into the circulation that eventually migrated to the brain, causing permanent damage reflected in autism symptoms.&lt;/p&gt;
&lt;p&gt;The report and the ensuing mass-media publicity sparked consternation among parents and the medical community. Vaccination rates in Britain and the U.S. dropped sharply, and measles rates spiked in consequence.&lt;/p&gt;
&lt;p&gt;Although subsequent population-based research and other studies have failed to confirm a causal link between MMR vaccines and autism, a vocal group of parents of autistic children continues to insist that it is real. They call Wakefield a hero.&lt;/p&gt;
&lt;p&gt;However, a nearly decade-long investigation by a British journalist, Brian Deer, uncovered discrepancies between the &lt;em&gt;Lancet&lt;/em&gt; paper and hospital records and other sources. (See &lt;a href=&quot;http://www.medpagetoday.com/Pediatrics/Autism/12850&quot; mce_href=&quot;http://www.medpagetoday.com/Pediatrics/Autism/12850&quot; target=&quot;_blank&quot;&gt;Father of Vaccine-Autism Link Said to Have Fudged Data&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Whereas the &lt;em&gt;Lancet&lt;/em&gt; paper indicated that, in most cases, symptoms developed within days of vaccination, the records indicated that this was true only for one child, according to Deer&apos;s account in the &lt;em&gt;Times of London&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The patients&apos; records also indicated that five of the children had psychosocial problems before vaccination, said the &lt;em&gt;Times&lt;/em&gt;, but the &lt;em&gt;Lancet&lt;/em&gt; paper described them as &quot;developmentally normal.&quot;&lt;/p&gt;
&lt;p&gt;In addition, the &lt;em&gt;Lancet&lt;/em&gt; paper described abnormal intestinal pathology results in the children, but the hospital pathology reports showed no findings of inflammation, the &lt;em&gt;Times&lt;/em&gt; report said.&lt;/p&gt;
&lt;p&gt;At last week&apos;s hearing, the U.K.&apos;s General Medical Council panel heard evidence that Wakefield had taken blood samples from children attending his son&apos;s birthday party and performed spinal taps on other children in a hospital without due regard for their safety.&lt;/p&gt;
&lt;p&gt;The panel found Wakefield guilty of more than 30 charges that he had acted unethically in conducting the study. He could be stripped of his license to practice in Britain, but no ruling has been made yet.&lt;/p&gt;
&lt;p&gt;Two of Wakefield&apos;s 12 co-authors on the 1998 paper, John Walker-Smith, MD, and Simon Murch, PhD, were also found to have committed ethical violations. The other 10 co-authors had previously repudiated the paper&apos;s findings and were not charged.&lt;/p&gt;
&lt;p&gt;Wakefield was in London while the hearing took place but did not attend. Afterward, he told reporters he was innocent of wrongdoing and would continue his research.&lt;/p&gt;
&lt;p&gt;Wakefield is now based at Thoughtful House, a private autism research and treatment facility in Austin, Texas. After the panel&apos;s ruling, it issued a statement expressing disappointment and calling the charges &quot;unfounded and unfair.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_183"
                     title="Gastric Bypass Extends Life for Most Patients (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/PrimaryCare/Obesity/tb/18020?impressionId=1265819586684"
                     
      &lt;p&gt;For most patients in most categories, bariatric surgery increases life expectancy, according to a new mathematical model.&lt;/p&gt;
&lt;p&gt;Only when short-term mortality following bariatric surgery is expected to be high or the likelihood of success is low will the procedure fail to improve life expectancy, researchers reported in the January &lt;em&gt;Archives of Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Computer modeling predicted that a hypothetical &quot;base case&quot; patient  --  a 42-year-old woman with a body mass index of 45  --  would gain 2.95 years of additional survival following bariatric surgery, according to Daniel P. Schauer, MD, of the University of Cincinnati, and colleagues.&lt;/p&gt;
&lt;p&gt;Surgery failed to be beneficial in the model only when 30-day mortality reached 9.5% or the likelihood that surgery would not add life-years was 2% or less, they found.&lt;/p&gt;
&lt;p&gt;Baseline 30-day mortality in the model was 0.2%, and the baseline efficacy of surgery in extending life expectancy was 53%.&lt;/p&gt;
&lt;p&gt;&quot;While not all patients are guaranteed a good outcome, our model indicates that gastric bypass increases life expectancy for most patient subgroups,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;Their analysis was based on a Markov decision model using published data to estimate 30-day mortality following bariatric surgery and the efficacy of surgery in reducing long-term death rates.&lt;/p&gt;
&lt;p&gt;The latter had two components: reduction in excess mortality associated with obesity, and research data on long-term mortality following bariatric surgery.&lt;/p&gt;
&lt;p&gt;Excess mortality estimates came from National Health Interview Survey data on some 400,000 participants from 1991 to 1996 linked to the National Death Index. Inputs on surgery efficacy were derived from a 2007 study of nearly 8,000 patients who had undergone gastric bypass and the same number of medically treated or untreated obese controls.&lt;/p&gt;
&lt;p&gt;That study found that the procedure cut death rates by half during about seven years of follow-up. (See &lt;a href=&quot;http://www.medpagetoday.com/PrimaryCare/Obesity/6480&quot; mce_href=&quot;http://www.medpagetoday.com/PrimaryCare/Obesity/6480&quot; target=&quot;_blank&quot;&gt;Missing Link Found: Bariatric Surgery Reduces Mortality&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Schauer and colleagues obtained rates of inhospital mortality following bariatric surgery from the 2005 National Inpatient Survey, then multiplied them by three to estimate 30-day mortality.&lt;/p&gt;
&lt;p&gt;The researchers explained that according to earlier research, inhospital death rates typically underestimate 30-day mortality by a factor of two to three.&lt;/p&gt;
&lt;p&gt;Their threefold correction factor represents &quot;a conservative estimate that biases the model against gastric bypass surgery,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Schauer and colleagues tested this correction factor and other aspects of the model in sensitivity analyses.&lt;/p&gt;
&lt;p&gt;The biggest gains in life expectancy occurred in younger women with relatively high BMI values, the model showed.&lt;/p&gt;
&lt;p&gt;The age effect was less important than BMI at the time of surgery. A 35-year-old woman with BMI of 45 would gain about 3.2 years of extra life, whereas at 55, a similarly obese woman would gain about 2.5 extra years.&lt;/p&gt;
&lt;p&gt;But a 35-year-old woman with BMI of 55 could expect to live five more years with surgery, the model indicated.&lt;/p&gt;
&lt;p&gt;Men in general derived less survival benefit from bariatric surgery, particularly with advancing age at the time of the procedure.&lt;/p&gt;
&lt;p&gt;At 35, the difference in life expectancy gained was roughly 10%, but by age 75 it had grown to about 50%.&lt;/p&gt;
&lt;p&gt;The sensitivity analyses found that relatively large changes in most parameters used in the model did not affect the overall results substantially.&lt;/p&gt;
&lt;p&gt;The effect of 30-day mortality on whether or not surgery was beneficial for long-term survival was related to BMI and gender.&lt;/p&gt;
&lt;p&gt;For women with a BMI of 40, 30-day mortality of more than 5% would mean surgery was not helpful, but short-term mortality had to exceed 15% for surgery not to be preferable for those with BMI of 55 or more. These thresholds were about 10% higher for men.&lt;/p&gt;
&lt;p&gt;The efficacy of surgery in reducing mortality was less important for older men, the analysis also showed. A 75-year-man with a BMI of 35 could expect only a very slight gain in life span  --  perhaps one or two months.&lt;/p&gt;
&lt;p&gt;&quot;Younger patients have lower surgical risk and more time over which to realize the benefits of surgery. For older patients, the gain is smaller, and for some, gastric bypass surgery will decrease life expectancy,&quot; Schauer and colleagues wrote.&lt;/p&gt;
&lt;p&gt;However, they identified several potentially serious limitations to the analysis.&lt;/p&gt;
&lt;p&gt;The study of long-term mortality following bariatric surgery was conducted at a single center and was not randomized. Additionally, long-term complications, such as need for repeat surgery, were not addressed in the model. Certain other risks that might be heightened after bariatric surgery were excluded as well, and quality of life was not modeled.&lt;/p&gt;
&lt;p&gt;&quot;The decision analysis presented here is a step forward in understanding optimal patient selection but also highlights some of the areas for which better data are needed,&quot; the researchers wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Institute of Diabetes and Digestive and Kidney Diseases funded the study.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_168"
                     title="Concussion Label Can be Confusing (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/18000?impressionId=1265819586684"
                     
      Whether a clinician calls a mild traumatic brain injury a concussion or not appears to influence how serious the injury is considered to be, researchers found.&lt;br&gt;
&lt;br&gt;Among children admitted for a traumatic brain injury, those who were told they had a concussion were discharged significantly earlier (OR 1.49, 95% CI 1.15 to 1.94) and returned to school sooner (OR 2.42, 95% CI 1.56 to 3.73) than those who were not given the label, Carol DeMatteo, MSc, of McMaster University in Hamilton, Ontario, and colleagues reported in the February issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The trends remained significant even after adjusting for the severity of the head injury and the presence of other injuries.&lt;/p&gt;
&lt;p&gt;&quot;We suggest that the [concussion] label itself conveys a message and also directs outcomes,&quot; the researchers wrote. &quot;If we want to encourage full reporting with subsequent adequate management and convalescence, perhaps we should use the term &apos;mild traumatic brain injury.&apos;&quot;


 &lt;p&gt;Disagreeing was Kenneth Perrine, PhD, a neuropsychologist at Hackensack University Medical Center in New Jersey.
    &lt;p&gt;&quot;Granted, concussion is by definition a mild brain injury, but it&apos;s so transient that I think it would be a disservice both to the public and for research to continue to confuse mild traumatic brain injury with concussion,&quot; said Perrine, who was not involved in the study.
    &lt;p&gt;He said a true concussion is characterized by feeling like one is in a fog, fatigue, sensitivity to light and sound, headache, blurred vision or other visual disturbances, and feeling off balance.
    &lt;p&gt;A mild traumatic brain injury, on the other hand, has longer-lasting effects and is not usually accompanied by concussion symptoms. Retrograde amnesia, post-traumatic amnesia, and more severe memory loss would occur, he said.
    &lt;p&gt;&quot;They are two distinct entities both from what we call it and from a prognostic standpoint,&quot; said Perrine, who is also consulting neuropsychologist for the New York Jets.
    &lt;p&gt;But, although the term concussion is used widely in clinical records and has garnered much attention in recent years because of head injuries to athletes at all levels of sports, an accepted definition does not exist, according to DeMatteo and her colleagues.&lt;/p&gt;


&lt;p&gt;&quot;Clinicians may use the concussion label because it is less alarming to parents than the term &quot;mild brain injury,&quot; with the intent of implying that the injury is transient with no signi&amp;#64257;cant long-term health consequences,&quot; they said.&lt;/p&gt;

&lt;p&gt;Commenting on the study, Wendy Wright, MD, a neurologist at Emory University in Atlanta, said in an e-mail, &quot;This study puts a spotlight on the issue that concussion is not always taken as seriously as it should be, partly because concussion encompasses a spectrum of disease.&quot;&lt;/p&gt;
&lt;p&gt;She said parents, coaches, teammates, and the individual with the concussion may not believe the injury is serious because symptoms are transient.&lt;/p&gt;
&lt;p&gt;That perception appears to be held by both clinicians and parents alike. DeMatteo and colleagues noted in the journal that during recruitment of the current study, both groups were heard saying, &quot;He doesn&apos;t have a head injury, he has a concussion.&quot;&lt;/p&gt;
&lt;p&gt;However, Wright said, &quot;it must be noted that concussion means brain injury.&quot;&lt;/p&gt;


&lt;p&gt;To explore how the term is used clinically, DeMatteo and colleagues analyzed the records of 434 children admitted to McMaster Children&apos;s Hospital with a diagnosis of acquired brain injury.&lt;/p&gt;
&lt;p&gt;Of those determined to have a traumatic brain injury, 72.7% had a mild injury according to the Glasgow Coma Scale. Nearly one-third (32.4%) were said to have a concussion.&lt;/p&gt;
&lt;p&gt;The concussion label was more likely to be given to children with a mild injury (&lt;em&gt;P&lt;/em&gt;=0.03), but the association was weak, according to the researchers, and nearly one-quarter (24%) of children with moderate or severe scores were also said to have a concussion.&lt;/p&gt;
&lt;p&gt;&quot;This leads one to question the use of the term as being reflective of mild injury and again supports the existence of confusion about what a concussion really is and how the term should best be used in the care of children,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Our findings, both in the return-to-school data and the phenomenon we experienced during recruitment, suggest that if a child is given a diagnosis of concussion, then the family is less likely to consider it as a brain injury,&quot; the researchers said.&lt;/p&gt;
&lt;p&gt;They acknowledged some limitations of the study, including the fact that data from medical charts may have had missing information and a lack of control over the validity of measurements and that their use of only a single center might influence the results.&lt;/p&gt;
&lt;p&gt;Further, they wrote, some measures, such as CT frequency, might be inflated because only children who were admitted to the hospital were included in the study. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by a research grant from the Ontario Neurotrauma Foundation. The &lt;em&gt;CanChild&lt;/em&gt;&lt;em&gt;&lt;/em&gt; Center for Childhood Disability Research is supported by the Ontario Ministry of Health and Long-Term Care.&lt;/p&gt;&lt;p&gt;The authors reported that they had no relevant financial disclosures to make.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>