Ruling Out Unneeded Ankle X-Rays for Kids

Applying simple rule for low-risk injuries helped ER docs cut use by 22 percent

By using a simple rule to assess children's ankle injuries, doctors could reduce the use of X-rays by 22 percent -- and so spare kids unneeded radiation exposure, according to a new study.

The research appears in the current issue of the CMAJ (Canadian Medical Association Journal). While X-rays are used to diagnose 85 percent to 95 percent of ankle injuries in children, only 12 percent of X-rays show fractures, according to a journal news release.

"Radiography is unnecessary for most children's ankle injuries, and these high rates of radiography needlessly expose children to radiation and are a questionable use of resources," wrote Dr. Kathy Boutis, a pediatric emergency department physician at the Hospital for Sick Children and the University of Toronto, and colleagues.

The investigators applied the "low risk ankle rule" in more than 2,100 children, aged 3 to 16, who arrived at six Canadian emergency departments with non-penetrating ankle injuries.

The rule states that if an examination of a child's injured ankle suggests that there is a low risk of fracture, an X-ray may not be necessary. If doctors miss a certain category of fractures, evidence shows that they are stable, pose a low risk for any future problems, and can be treated like an ankle sprain.

The 22 percent reduction in the use of X-rays when using the rule was consistent in the different emergency departments.

"The ankle rule has potential broad applicability to emergency departments throughout most of the developed world, and widespread implementation of this rule could safely lead to reduction of unnecessary radiography in this radiosensitive population and a more efficient use of health care resources," the researchers concluded.

SOURCE: CMAJ (Canadian Medical Association Journal), news release, Aug. 12, 2013

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Pregnant and Obese: Early Deaths Noted Among Offspring

Study findings suggest need for weight control before conception

Here's another reason for young women to get their bad eating habits under control: Kids born to obese mothers are likely to die earlier than those born to normal-weight mothers, a new Scottish study suggests.

In the United States and Europe, about two-thirds of women of reproductive age are overweight and more than one-third are obese, according to the study. Previous research has suggested that obesity during pregnancy may boost the risk of high blood pressure and high blood sugar, which are linked to cardiovascular disease, in their offspring. The findings of the new study are even more ominous.

"We need to think about targeting children of obese mothers for lifestyle interventions to maintain a healthy weight," said study author Rebecca Reynolds, a professor of metabolic medicine at the University of Edinburgh.

But the findings aren't conclusive, and it could be that the mothers' weight has nothing to do with the life spans of their children. It's possible, for example, that families with poor diets produce heavier moms and sicker kids.

Also, even if the link is confirmed, it's not clear if these offspring can alter their extra risk of dying earlier, the researchers added.

Earlier this year, a committee of the American College of Obstetricians and Gynecologists said all overweight or obese women should be offered nutrition counseling and be encouraged to follow an exercise program.

But the results of the new study suggest that weight-loss interventions should begin before pregnancy, according to Pam Factor-Litvak, author of an accompanying journal editorial.

For the study, published online Aug. 13 in the journal BMJ, the researchers tracked almost 38,000 people born in Scotland from 1950 onward who were aged 34 to 61 in 2011. They looked for data on the mothers body-mass index (BMI) -- a measurement of body fat based on height and weight -- and any deaths or heart disease among their children through that year.

Overall, more than 6,500 deaths from any cause were reported, and the leading causes of death were cardiovascular disease and cancer.

Those whose mothers were obese at birth -- meaning they had a BMI of 30 or higher -- were 35 percent more likely to have died by 2011 than those whose mothers were a normal weight.

These young and middle-aged adults were also about 29 percent more likely to have been admitted to a hospital because of a heart problem; overall, 8 percent were admitted for that reason.

The researchers came up with these numbers after adjusting their statistics to account for factors such as income level, gender, or maternal age at birth.

Children of mothers who were overweight -- a BMI of 25 to 29 -- were 11 percent more likely to die than those of mothers of normal weight.

The mechanisms behind this association aren't clear, and the researchers were lacking one crucial piece of information: whether the kids of obese pregnant moms became obese themselves. However, Reynolds said it's possible that genes play a role. Or, it's possible that the families of obese pregnant moms had poor eating habits that affected their children's health later on.

Shinga Feresu, an associate professor at Indiana University School of Public Health, said it's also possible that health conditions such as diabetes, kidney disease and high blood pressure could have thrown off the results. Overweight and obese children and teens are more likely to develop type 2 diabetes, putting them at a higher risk of early heart disease, Feresu said.

Nonetheless, it's clear that "women who are obese need to reduce their weight to a healthy level before they become pregnant," Feresu said. "They will have a much healthier baby, with reduced risk of long-term disease and premature death."

Previous research has highlighted other obesity-related pregnancy problems. A study published in June in the Journal of the American Medical Association found that overweight or obese women who are pregnant are more likely to give birth prematurely, and the risk of preterm delivery increases with their amount of excess weight.

SOURCES: Rebecca Reynolds, Ph.D., professor, metabolic medicine, University of Edinburgh, Scotland; Shinga Feresu, Ph.D., MPH, associate professor, epidemiology, biostatistics and medicine, Indiana University School of Public Health, Bloomington, Ind.; Aug. 13, 2013, BMJ, online

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Many Risk Factors for Early Dementia Can Show Up in Teens

Alcohol abuse topped the list in large study of Swedish men

Swedish researchers have identified nine risk factors -- many occurring during a person's teens -- that are tied to early onset dementia.

The good news is that several of these symptoms and behaviors can be prevented or treated, experts noted.

Early onset (or young-onset) dementia occurs before the age of 65. Alcohol abuse was the most important risk factor found in the study, said lead researcher Peter Nordstrom. "In contrast, the influence of hereditary factors, that is dementia in the parents, was very small."

For the study, published online Aug. 12 in the journal JAMA Internal Medicine, Nordstrom's group collected data on men drafted into the Swedish military from mid-1969 through 1979. They were about 18 years old when they were drafted.

During the follow-up period of roughly 37 years, 487 men developed young-onset dementia at an average age of 54, the researchers found.

The risk factors identified "were multiplicative, most were potentially modifiable and could be traced to adolescence, suggesting excellent opportunities for early prevention," said Nordstrom, from the department of community medicine and rehabilitation at Umea University

Alcohol intoxication, stroke, use of antipsychotic drugs, depression, drug abuse, a father with dementia, poor mental function as a teen, being short and having high blood pressure were the risk factors they found.

Taken together, these accounted for 68 percent of the cases of young-onset dementia, the researchers said. Men with at least two risk factors and in the lowest third of overall mental ability had a 20-fold increased risk.

"Young-onset dementia, before age 65, is a devastating condition for patients and their families," said Dr. Deborah Levine, an assistant professor of medicine at the University of Michigan and author of an accompanying journal editorial.

One priority for young-onset dementia is research that identifies ways to prevent it, she said. Another is to improve care and access to long-term services for adults who are diagnosed with dementia before 65.

"This is urgent because adults with young-onset dementia and their families really need our help," she said. "More Americans may develop young-onset dementia because of increases in traumatic brain injury among young veterans and stroke among young African-Americans and middle-aged adults."

Dr. Sam Gandy, director of the Mount Sinai Center for Cognitive Health in New York City, said the new study is "extraordinary and deserves attention by others studying adolescent populations to see whether this Swedish experience can be confirmed elsewhere and independently.

"I always prefer to see replication of data -- especially 'game-changing' data like these -- before I sound any alarm, but given the treatability of these risks, I would say that these observations should prompt aggressive attention by physicians with access to adolescents," Gandy said.

Dementia affects an estimated 35 million people worldwide and is expected to rise sharply by 2050, according to study background information.

SOURCES: Peter Nordstrom, Ph.D., department of community medicine and rehabilitation, Umea University, Sweden; Deborah Levine, M.D., M.P.H., assistant professor, medicine, University of Michigan, Ann Arbor; Sam Gandy, M.D., Ph.D., director, Mount Sinai Center for Cognitive Health, New York City; Aug. 12, 2013, JAMA Internal Medicine, online

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Eye Photography May Reveal Stroke Risk, Study Finds

Your eyes may provide a window into your risk for a stroke, a new study suggests.

By photographing the retina, researchers say they can predict the potential for stroke in people with high blood pressure.

"High blood pressure is one of the most important factors involved in the development of stroke," said lead researcher Dr. Mohammad Kamran Ikram, an assistant professor at the Singapore Eye Research Institute of the National University of Singapore. But determining which hypertensive patients face the highest risk of stroke isn't possible.

Now, a simple eye examination may provide that information, Ikram said. He said, however, that other studies are needed to confirm the findings, which were published Aug. 12 in the journal Hypertension.

High blood pressure can damage blood vessels in the retina. When that happens, the condition is known as hypertensive retinopathy. Retinal imaging is a non-invasive way to view blood vessel damage and possibly assess risk for stroke, a leading killer of Americans.

Stroke occurs when blood flow to the brain stops, either because of a clot or a hemorrhage.

One expert, Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine, welcomed the study results. He said the findings add to previous research on the value of retinopathy as an indicator of small vessel disease and increased risk of stroke.

"More aggressive management of blood pressure may be needed in patients with signs of retinopathy in order to reduce stroke risk," Sacco said.

"We often do not pay enough attention to even mild to moderate findings on a retina exam and should include this assessment in our global evaluation of vascular and stroke risk," he added.

For the study, Ikram's team followed nearly 3,000 people with high blood pressure for an average of 13 years. At the start of the study, each participant had photos taken of their retinas -- the light-sensitive layer of cells at the back of the eye.

The researchers rated each patient's hypertensive retinopathy as none, mild or moderate/severe based on the damage evident in the photographs.

During the follow-up period, 165 participants suffered a stroke. The researchers found those with mild hypertensive retinopathy had a 35 percent higher risk for stroke, while those with moderate or severe retinopathy had a 137 percent increased risk.

Retinal damage also predicted increased risk for stroke in patients taking medication to keep their blood pressure under control, the researchers found. In this group, mild hypertensive retinopathy corresponded with a 96 percent increased risk for stroke and for those with moderate to severe hypertensive retinopathy, a 198 percent increased risk.

The risk for stroke remained even after taking into account factors such as age, sex, race, cholesterol levels, smoking, blood pressure readings and body-mass index (a measurement of body fat based on height and weight), the researchers said.

Although the researchers found an apparent link between retinal damage and increased stroke risk, the study did not prove a definitive cause-and-effect relationship.

Although these results are preliminary and need to be replicated, they suggest that retinal imaging could be a good addition to a stroke-risk evaluation, said Dr. Floyd Warren, chief of neuro-ophthalmology at Lenox Hill Hospital in New York City.

"There may be a need for more aggressive blood pressure management," he said.

SOURCES: Mohammad Kamran Ikram, M.D., Ph.D., assistant professor, Singapore Eye Research Institute, National University of Singapore; Floyd Warren, M.D., chief, neuro-ophthalmology, Lenox Hill Hospital, New York City; Ralph Sacco, M.D., chairman, neurology, University of Miami Miller School of Medicine.

Here's a video, explaining a little about Retinal Camera's :)

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