The effect of peer review on professionalism, autonomy, and accountability

In this article, the authors describe the relevance and impact of peer review on professional nursing practice. The healthcare, business, education, and social science literature are reviewed. Although the benefits of peer review often are assumed to contribute to increased professionalism, autonomy, and accountability, there is little formal research evidence to support these assumptions. Regardless, empirical data show potential for increased professionalism, improved performance, and valuable feedback provided to nursing personnel. In addition, the authors explore the potential of peer review in developing and maintaining professional accountability among practicing staff nurses.

Evaluation of social status as a contributing factor to the stroke belt region of the United States

BACKGROUND AND PURPOSE

The southeastern United States has stroke mortality rates above the national average. The causes for this excess mortality are unknown; however, lower socioeconomic status (SES) is a risk factor for stroke, and the lower SES in the Southeast is a potential cause. In this report we assess the proportion of the excess stroke mortality attributable to SES.

METHODS

The more than 400,000 participants in the National Longitudinal Mortality Study were categorized into three regions: the coastal plain region of North Carolina, South Carolina, and Georgia ("stroke buckle"); the remainder of these states plus five other southern states ("stroke belt"); and the remainder of the United States. The stroke mortality rates were calculated with and without adjustment for SES, and the proportion of the excess mortality attributable to SES was estimated.

RESULTS

In persons between the ages of 35 and 54 years, stroke mortality in the stroke buckle is estimated to be more than twice that of the rest of the nation and 1.7 times greater for ages 55 to 74 years. For persons in the stroke belt, the stroke mortality was 1.3 times greater than that in the rest of the nation for the ages of 35 to 54 and 55 to 74 years. Less than 16% of this excess stroke morality was attributable to SES.

CONCLUSIONS

SES does not appear to be a major contributor to the excess mortality in the southeastern United States. Of additional concern is the stroke buckle region, which was shown to have stroke mortality rates substantially greater than those in the traditionally recognized stroke belt.

Shifting cerebral dominance in a woman with schizoaffective psychosis: a case study

We describe a case of an intelligent, artistic 50-year-old woman with schizoaffective disorder with a long history of delusional preoccupation with laterality and episodes of reported shifts in handedness. Investigations including dichotic listening and lateralised visual imagery tasks indicated unusual patterns of asymmetry. Executive functions were found to be intact, and EEG and CT scan were normal. Interview schedules revealed high scores for schizotypy, and no evidence of a dissociative disorder, whereas psychotic symptoms with mood lability were evident on mental status examination. The subject's preoccupations are illustrated with a selection of her artistic productions. The case is discussed in the context of reports of a relationship between schizophrenia and ambiguous handedness. A cognitive neuropsychiatric formulation briefly explores the possibility of alternative cerebral hemispheres affecting cognitive-perceptual operations.

Expression of members of a novel membrane linked metalloproteinase family (ADAM) in human articular chondrocytes

Using resting chondrocytes derived from human articular femoral head and a conditionally immortalised human articular chondrocyte cell line we have studied the expression of members of the novel metalloproteinase/disintegrin family termed ADAM. Using RT-PCR we can detect the expression of ADAM-12 a novel family member isolated from myeloma cells [1]. We also find expression of ADAM 10 a functional metalloproteinase/disintegrin first isolated from bovine brain and ADAM-15 a metallodisintegrin isolated from mammary derived epithelial cells. Northern blotting was used to confirm expression. One main transcript is visible for ADAM-12 whereas both ADAM-10 and ADAM-15 have multiple transcripts indicating possible RNA variants potentially derived from alternative splicing or alternative use of polyadenylation sites. Since chondrocytes are proposed as an important source of metalloproteinase enzymes involved in joint pathology the potential relevance of the expression of these molecules to connective tissue disorders is discussed.

Identification of the location, extent, and pathway of sensory neurologic feedback after mechanical stimulation of a lateral spinal ligament in chickens

STUDY DESIGN

This study traced the location, extent, and pathway of sensory feedback after the mechanical stretching of a lateral spinal ligament in young chickens. The pathway was traced by locating the sites of Fos protein production in neuronal cell bodies at various sites in the nervous system.

OBJECTIVES

To trace the location, extent, and pathway of sensory feedback after the mechanical stretching of a lateral spinal ligament in young chickens.

SUMMARY OF BACKGROUND DATA

The innervation of ligaments is thought to form part of a protective feedback mechanism to provide stability for joints. The precise pathway and extent of the feedback for spinal ligaments is currently unknown. Such information would provide a clear focus for future studies, especially for diseases such as scoliosis where it has been suggested that there is abnormality in perception of sensory feedback.

METHODS

The intertransverse ligament on the right side at T3-T4 in 4-week-old chickens was exposed by blunt dissection. After Fos production resulting from the surgery had been stopped, the ligament was stretched mechanically and repeatedly for 60 minutes using a 300-g weight. Various areas of the nervous system then were sectioned and processed immunohistochemically to identify areas of Fos production in nerve cell bodies. The presence of Fos indicated neurons that had been stimulated by the stretching the ligament, including interneurons along the feedback pathway.

RESULTS

Fos protein was identified in nerve cell bodies in the dorsal root ganglia and intermediate gray matter of the spinal cord at the level of stimulation as well as at several spinal cord levels above and below the site of stimulation. Identification was made on the ipsilateral and the contralateral sides, although the extent of Fos production was less on the contralateral side. Fos presence also was identified in sympathetic ganglia at these sites. Nerve cell bodies in the combined nucleus cuneatus and gracilis in the medulla oblongata, the vestibular nuclei, and the thalamus also contained Fos-positive particles.

CONCLUSIONS

Stretching a single lateral ligament of the spine produces a barrage of sensory feedback from several spinal cord levels on both sides of the spinal cord. This sensory information also is transferred to higher levels in the brain, including the nucleus gracilis and cuneatus, the vestibular nuclei, and the thalamus. These sites of Fos production suggest the locations of pathways for this sensory information, which include the dorsal columns and the spinocerebellar tracts. The information obtained from this study provides a clear focus for future studies in this area, particularly for diseases such as scoliosis where it is thought that incorrect perception of sensory information from the ligaments might be a major contributing factor.

Wheeze, cough, atopy, and indoor environment in the Scottish Highlands

A questionnaire which included items on wheeze, cough, eczema, hay fever, and indoor environment, including parental smoking habits, pet ownership, heating and cooking methods, home insulation, damp, mould, and years lived in their houses, was given to 1801 children, aged 12 and 14 from the Highland Region in Scotland. Of the 1537 (85%) who replied, 267 (17%) reported current wheeze, 135 (9%) cough for three months in the year, 272 (18%) eczema, and 317 (21%) hay fever. There was no consistent relationship between respiratory symptoms and indoor environment although cough was associated with damp, double glazing, and maternal smoking. The prevalence of wheeze, cough, and atopy was higher in children who had lived in more than one house during their lifetime. These results suggest that increasing mobility of families in recent years may be more important in the aetiology of asthma than exposure to any one individual allergen or pollutant.

Antimutagens from Plumeria acuminata Ait

Four isolates, A1, C1, D3, and F2, from the ethanol extract of the green leaves of Plumeria acuminata Ait, showed antimutagenic activity. The antimutagens were isolated from the bioactive hexane and carbon tetrachloride fractions following a bioactivity-directed fractionation scheme and using the micronucleus test to monitor the antimutagenic activities. Structure elucidation studies indicated that C1 is stigmast-7-enol[1], D3 is lupeol carboxylic acid [2] and F2 is ursolic acid [3]. The structure of A1 was not fully elucidated but MS data suggested that it contained a long hydrocarbon chain. At a dosage of 2 mg isolate/25 g mouse, A1 reduced the number of micronucleated polychromatic erythrocytes (MPCE) induced by the mutagen, mitomycin C, by 75%, C1 by 80%, D3 by 57%, and F2 by 76%. Compound A2 was also isolated but was found inactive. Its structure was identified to be lupeol acetate [4].

Melatonin levels in idiopathic scoliosis. Diurnal and nocturnal serum melatonin levels in girls with adolescent idiopathic scoliosis

STUDY DESIGN

Matched pairs of adolescent girls were used to compare serum melatonin levels in adolescent patients and control subjects with idiopathic scoliosis during the day and in the middle of the night.

OBJECTIVES

To compare serum melatonin levels in patients with adolescent idiopathic scoliosis and matched control subjects during the day and in the middle of the night.

SUMMARY OF BACKGROUND DATA

Recent studies using the chick as the animal model have suggested that the pineal gland and its main product, melatonin, might be involved in the cause of scoliosis. There have been no studies of melatonin levels in patients with adolescent idiopathic scoliosis.

METHODS

Blood was collected from seven adolescent girls with idiopathic scoliosis and a group of seven age-matched control subjects. Two samples were collected, one in the middle of the day and one in the middle of the night, to examine the diurnal variation of melatonin production. Serum melatonin levels were measured using a radioimmunoassay technique.

RESULTS

No significant differences were found in serum melatonin levels between experimental and control groups either during the day, when melatonin levels were low, or during the night, when melatonin levels were high.

CONCLUSIONS

Whereas pinealectomy in young chickens leads to reduced melatonin levels and the development of scoliosis, the results of this study suggest that melatonin levels in mature patients who already have severe scoliosis do not differ from healthy subjects. Whether melatonin levels differ in humans between healthy subjects and patients with scoliosis at the time of onset of the disease remains to be seen.

The spatiotemporal development of innervation in spinal ligaments of chickens

The development of the innervation of both central and lateral (intertransverse) spinal ligaments was investigated in chickens between the time of hatching and 13 wk of age. A total of 36 White Leghorn chickens in 4 groups of 9 at ages 0, 2, 7, and 13 wk were used. The spinal ligaments were dissected, serially sectioned and labelled with a monoclonal antibody against neurofilament protein and observed using either conventional fluorescence or confocal microscopy. Only a few nerve elements were found in the ligaments at hatching and these consisted simply of single nerve fibres and small nerve bundles. The number of nerve elements increased rapidly up to 7 wk of age when large nerve bundles and Ruffini corpuscles were also found. The number of nerve elements decreased between 7 and 13 wk birds when the ligaments had begun to ossify and the amount of collagenous ligamentous tissue was significantly reduced. The fluctuation in numbers of neural elements was due to changes in numbers of single nerve fibres and small nerve bundles rather than large nerve bundles and Ruffini corpuscles which remained constant. In contrast to this significant increase in numbers of nerve elements, the innervation density of the ligaments decreased because of the overwhelming increase of the ligament volume due to growth. There were no differences between ligaments on the left and right sides of the body, but there was an unequal distribution of the neural elements within the ligaments; most were found in the cranial third of the intertransverse ligaments. These results show that significant changes in innervation of spinal ligaments occur during development and reflect the possibility that damage to the ligaments during this time could produce significant and permanent damage, especially in relation to the maintenance of an erect spine.

Prevalence of cytolethal distending toxin production in Campylobacter jejuni and relatedness of Campylobacter sp. cdtB gene

Campylobacter jejuni produces a toxin called cytolethal distending toxin (CDT). The genes encoding this toxin in C. jejuni 81-176 were cloned and sequenced. The nucleotide sequence of the genes revealed that there are three genes, cdtA, cdtB, and cdtC, encoding proteins with predicted sizes of 30,11-6, 28,989, and 21,157 Da, respectively. All three proteins were found to be related to the Escherichia coli CDT proteins, yet the amino acid sequences have diverged significantly. All three genes were required for toxic activity in a HeLa cell assay. HeLa cell assays of a variety of C. jejuni and C. coli strains suggested that most C. jejuni strains produce significantly higher CDT titers than do C. coli strains. Southern hybridization experiments demonstrated that the cdtB gene is present on a 6.0-kb ClaI fragment in all but one of the C. jejuni strains tested; the cdtB gene was on a 6.9-kb ClaI fragment in one strain. The C. jejuni 81-176 cdtB probe hybridized weakly to DNAs from C. coli strains. The C. jejuni 81-176 cdtB probe did not hybridize to DNAs from representative C. fetus, C. lari, C. "upsaliensis," and C. hyointestinalis strains, although the HeLa cell assay indicated that these strains make CDT. PCR experiments indicated the probable presence of cdtB sequences in all of these Campylobacter species.

Recurrent limb pain in schoolchildren

OBJECTIVES

To determine the prevalence, causes and clinical features of short lasting recurrent limb pain (recurrent limb pain) in children.

DESIGN

Population-based study in two stages, with an initial screening questionnaire followed by clinical interviews and physical examination of symptomatic children.

SETTING

67 primary and secondary schools in the city of Aberdeen.

SUBJECTS

2165 children representing a random 10% sample of all schoolchildren aged between 5-15 years.

MAIN OUTCOME MEASURES

(a) The causes of limb pain in children, (b) the prevalence of recurrent limb pain in schoolchildren, (c) the relationship of recurrent limb pain to childhood migraine.

RESULTS

Sports and playground injuries were the most common cause of limb pain, affecting 9% of all children. The prevalence rate of recurrent limb pain was 2.6% (95% confidence interval 1.9 to 3.4). Episodes of recurrent limb pain had similar trigger factors, associated symptoms, and relieving factors to episodes of headache in children with migraine.

CONCLUSIONS

Recurrent limb pain is a common cause of limb pain, with a prevalence rate of 2.6%. The close clinical and epidemiological similarities between recurrent limb pain and childhood migraine suggest a common pathogenesis.

Significant others' contribution to early adolescents' perceptions of their competence

This study measures perceptions of competence in the scholastic and athletic domains and also examines gender differences in these areas. It explores the relative contributions of significant others (namely, parents, teachers, classmates and close friends) for an Australian cohort of early adolescents. A total of 264 children (average age, 11.7 years; 40% female) in Grade 6, their parents and their classroom teachers were surveyed using six modified Harter scales. Analyses supported the notion that the sources related to early adolescents' perceptions were different and that the relative predictive utility of the five sources varied as a function of gender and the domain type. Scholastic competence for males is related to external (father and teacher) perceptions as well as internal (child's) perceptions whereas for females, scholastic competence is related entirely to internal (child's) perceptions. In contrast, athletic competence for males is related only to external (teacher) perceptions, whereas for females athletic competence is related to external (mother) perceptions as well as internal (child's) perceptions. The findings are discussed in terms of their theoretical and practical implications in educational practice.

Calprotectin as a marker of inflammation in cystic fibrosis

Calprotectin is an abundant neutrophil cytosolic protein released during neutrophil activation or death. The use of plasma calprotectin concentration as a marker of pulmonary inflammation was tested in 31 children with cystic fibrosis, none of whom was acutely unwell or pyrexic. Twenty three were receiving antibiotics, 21 had positive sputum cultures, but none of the traditional tests clearly diagnosed ongoing infection. Plasma calprotectin was significantly higher in the cystic fibrosis group than in matched controls. Sixteen children with cystic fibrosis had values above the control range (320-1570 micrograms/l). Their chest radiograph Northern score, an index of accumulated pulmonary involvement, and their plasma copper, an index of acute phase response, both correlated with plasma calprotectin. Plasma gamma-glutamyltransferase also correlated weakly with plasma calprotectin: thus, hepatic pathology may be a confounding variable. However, the data still suggested that plasma calprotectin is a better index of inflammation than the traditional indices in general use.

Schistosomiasis: a review of cases in Wellington 1993-4

AIM

To review those cases of Schistosoma haematobium presenting in Wellington during 1993 and 1994.

METHOD

All patients receiving praziquantel during 1993 and 1994 were traced through local pharmacy records. Their clinical records were reviewed and they were contacted by phone to ensure a complete set of information was obtained. This included timing of possible exposure to the parasite, symptoms, investigations and response to treatment.

RESULTS

Nine patients were identified who had been treated with praziquantel during this period. The records of six patients were available for review, all of whom had recently travelled to Africa and had swum in water contaminated with the parasite. Four had presented to medical practitioners with irritative voiding symptoms and scant intermittent haematuria. One presented with haematospermia and one after becoming aware that a friend had contracted schistosomiasis. All were treated with a single dose of praziquantel.

CONCLUSIONS

This paper has demonstrated an increased number of cases of Schistosoma haematobium being identified in Wellington. The prevalence of this condition is low, but has been seen to increase recently and relates to the increasing numbers of New Zealanders touring Africa. Patients present with relatively mild, nonspecific symptoms which require a high index of suspicion to ensure that appropriate investigations are ordered. The currently available treatment is efficacious and relatively well tolerated.

Maintaining adequate nutrition on dialysis

Patients with kidney failure are at particular risk from malnutrition and they must be regularly monitored and assessed if it is to be avoided. This article examines a multidisciplinary approach in a dialysis unit and discusses methods of nutritional assessment and treatment that are available.

Cyclical vomiting syndrome in children: a population-based study

We studied the prevalence and the characteristic features of cyclical vomiting syndrome (CVS) in the defined childhood population of the City of Aberdeen, in Scotland. Initial screening was done by questionnaire in 10% of all children between 5 and 15 years of age (2,165 children) attending schools in Aberdeen, followed by clinical interviews of symptomatic children. We invited for clinical interview 69 children (3.9%) with a history of unexplained vomiting; 46 (67%) attended. Of them, 34 fulfilled the criteria for the diagnosis of CVS (prevalence rate, 1.9%). Children with CVS had a mean age of 9.6 years and a mean age at onset of symptoms of 5.3 years (range, 1-13). The overall sex ratio was 1:1, although in younger children boys were more commonly affected than girls. Seven children (21%) also suffered from migraine, 10 (29%) from travel sickness, and 10 (29%) from atopic diseases. The attacks of vomiting occurred on average eight times per year, with a mean duration of 20 h. Travel was a frequent precipitating factor. Attacks were commonly associated with pallor, anorexia, and malaise and were often relieved by rest and sleep. The clinical features of CVS overlapped to a large extent with those of migraine, suggesting a common pathogenesis. Features common to both conditions included trigger factors, associated GI, sensory, and vasomotor symptoms, and factors that relieved attacks. There was also an association between CVS and headache, abdominal pain, atopic diseases, and travel sickness.

Salmeterol xinafoate in children on high dose inhaled steroids

BACKGROUND

Current UK and international guidelines on asthma management recommend that, in pediatric patients still symptomatic on treatment with high-dose inhaled corticosteroids, consideration should be given to the introduction of regular twice daily long-acting beta 2-agonists.

OBJECTIVE

The purpose of this study was to assess the efficacy and safety of inhaled salmeterol xinafoate 50 micrograms bid via the Diskhaler when added to the existing treatment of children with moderate to severe asthma.

METHODS

A 12-week multicenter, double-blind, placebo-controlled, parallel group study was conducted at 78 hospital centers throughout the United Kingdom, involving 210 asthmatic children aged between 4 and 16 years of age. Morning peak expiratory flow (PEF), evening PEF, night-time and daytime symptoms and relief medication usage were recorded daily by the patient or parent over a 12-week treatment period.

RESULTS

Compared with placebo, the addition of salmeterol xinafoate to existing high dose inhaled corticosteroid treatment significantly improved mean morning PEF expressed as percent predicted (PEF-PP) during the first 4 weeks of treatment (median increase 6.5 percentage points P < .001). This effect persisted throughout the 12-week treatment period (P < .05). Both groups demonstrated an overall improvement in mean morning PEF-PP, 7.5 percentage points for salmeterol xinafoate and 4 percentage points for placebo. The mean evening PEF-PP followed a similar although less pronounced trend which was significant only during the first 4 weeks of treatment (P = .014). Daytime relief medication and recorded symptoms were reduced significantly in both groups. There was a greater improvement in the number of symptom-free days during the first 4 weeks (P < .01) and the last 4 weeks (P < .05) of treatment for salmeterol xinafoate. The overall incidence and nature of minor adverse events was similar in both groups.

CONCLUSIONS

This study demonstrates that the addition of salmeterol xinafoate to inhaled corticosteroid therapy in symptomatic asthmatic children significantly improves morning PEF-PP, and reduces their symptoms and use of relief medication.

Persistent nocturnal cough in childhood: a population based study

A cross sectional epidemiological study was carried out to investigate the validity of persistent nocturnal cough (PNC) as an independent marker of childhood asthma. A screening questionnaire on respiratory symptoms was applied to 4003 children attending primary schools in Aberdeen, after which 799 symptomatic children and a random selection of 229 asymptomatic children were invited to attend for a diagnostic interview. Six hundred and seven (359 boys and 248 girls) symptomatic children and 135 asymptomatic children (57 boys and 78 girls) were selected from the screening questionnaires. Of 607 children with respiratory symptoms when interviewed, 27 (nine boys and 18 girls) had isolated PNC, and 97 (51 boys and 46 girls) had multiple symptoms (polysymptomatic asthma). The incidence of prematurity was highest in the group with PNC (19%). The prevalence of hay fever in children with PNC (11%) was similar to that of the asymptomatic group (15%) and less than that in the group with polysymptomatic asthma (41%). Eczema was twice as common in the PNC (19%) as in the asymptomatic children (10%) but only half as common in the polysymptomatic asthma group (35%). The prevalence of a parental history of hay fever was similar in all three groups. The prevalence of a parental history of eczema was similar in the PNC (7%) and asymptomatic (7%) groups but higher in the polysymptomatic asthma group (22%). The prevalence of a history of parental asthma was 30% in children with PNC, 13% in the asymptomatic group, and 42% in those with polysymptomatic asthma. The parents of three (11%) children with PNC were aware of a diagnosis of asthma; two of these children (7%) were on inhaled bronchodilator treatment and one (4%) was on a slow release theophylline preparation. Using a stepwise discriminant analysis procedure, in 18 (67%) children with PNC predicted membership was in the asymptomatic group and only nine (33%) children with PNC were grouped into the polysymptomatic asthma category. It is concluded that the clinical features of children with PNC resembled those of the asymptomatic population more closely than those of the polysymptomatic asthmatic population. In this age group PNC, in the absence of wheeze, shortness of breath or tightness in the chest, is likely to be a manifestation of atypical or hidden asthma in only a minority of cases.

A comparison of spinal ligaments--differences between bipeds and quadrupeds

Following dissection, the spinal ligaments were observed in a selection of bipedal, pseudobipedal and quadrupedal animals during a search for an appropriate animal model for investigating the innervation of these ligaments. Midline spinal ligaments were found in all animals while lateral spinal ligaments could only be observed in bipedal (human) and pseudobipedal (avian) species. The presence of lateral spinal ligaments in these animals and their absence in quadrupeds suggests that the development of the lateral ligaments reflects a mechanical challenge unique to the erect spine and that these lateral spinal ligaments are fundamental to the stability of an erect posture.

Social support and health-related quality of life in black and white dialysis patients

OBJECTIVES

To identify factors associated with health-related quality of life (HRQoL) in end stage renal disease (ESRD) patients treated with dialysis, and to identify potential racial differences in HRQoL.

DESIGN

Cross-sectional study. SAMPLE/SETTINGS: 256 dialysis patients; 72 black women, 59 black men, 61 white women, and 64 white men at Piedmont Dialysis Center, a university-affiliated dialysis center in northwest North Carolina.

METHODS

Information was obtained on perceived social support, social networks, blood chemistries, blood pressure, cause of renal failure, treatment-related factors, and socioeconomic factors. HRQoL indicators included two measures of life satisfaction, limitations in leisure-time activities, and Karnofsky's Physical Functioning Scale.

RESULTS

On all HRQoL indicators, blacks consistently rated their HRQoL better than whites. In univariate analyses, lack of social support was consistently related to poorer HRQoL. In multivariate regression analyses, good social support and black race were the two strongest predictors of more positive responses to each of the HRQoL indicators, after controlling for the effects of the other investigated factors. With respect to the Karnofsky scale, younger age and fewer medications taken were additional significant predictors of better functioning.

CONCLUSIONS

HRQoL was consistently rated better among blacks than among whites. In addition, perceived social support exerted a strong, independent influence on objectively and subjectively measured HRQoL of ESRD patients.

Posterior subcapsular cataract and inhaled corticosteroid therapy

BACKGROUND

Although posterior subcapsular cataract complicates both systemic and topical corticosteroid therapy, the literature on the effects of inhaled corticosteroids is conflicting.

METHODS

One hundred and forty children and young adults on inhaled corticosteroids were examined by slit lamp ophthalmoscopy after pupillary dilatation; 103 had received one or more short courses (< or = 7 days) of oral corticosteroids in the management of acute asthmatic attacks and four had also received one or more prolonged courses (> or = 4 weeks) of alternate day oral corticosteroid therapy.

RESULTS

Bilateral posterior subcapsular cataract was identified in one girl who had received several prolonged courses of oral corticosteroids, but was not identified in any other patient.

CONCLUSIONS

There is no evidence to support the contention that inhaled corticosteroid therapy on its own, or in association with short courses of oral corticosteroid therapy, might cause cataracts. Although children receiving long term systemic corticosteroid therapy should be screened for cataracts, this is unnecessary in children on inhaled corticosteroids alone.

Prevalence and clinical features of abdominal migraine compared with those of migraine headache

The prevalence and clinical features of migraine headache and abdominal migraine were studied in the well defined population of Aberdeen schoolchildren. Ten per cent of all children (2165) aged 5-15 years were given a questionnaire inquiring, among other symptoms, about the history of headache and abdominal pain over the past year. A total of 1754 children (81%) responded. Children with at least two episodes of severe headache and/or sever abdominal pain, attributed by the parents either to unknown causes or to migraine, were invited to attend for clinical interview and examination. After interview, 159 children fulfilled the International Headache Society's criteria for the diagnosis of migraine and 58 children had abdominal migraine giving estimated prevalence rates of 10.6% and 4.1% respectively. Children with abdominal migraine had demographic and social characteristics similar to those of children with migraine. They also had similar patterns of associated recurrent painful conditions, trigger and relieving factors, and associated symptoms during attacks. The similarities between the two conditions are so close as to suggest that they have a common pathogenesis.