The impact of physician training on child maltreatment reporting: a multi-specialty study.

BACKGROUND: Past studies have suggested that physicians underreport suspected child maltreatment (CM) cases, possibly because of a lack of knowledge of the subject. OBJECTIVES: To evaluate the amount, format, and content of CM training received in residency (graduate medical education) and continuing medical education (CME), and to compare its relationship to the likelihood of reporting CM. METHODS: A total of 482 U.S. Air Force emergency physicians, family practice physicians, and pediatricians were surveyed regarding the amount/type of CM training received as well as their CM reporting practices. RESULTS: Pediatricians report receiving more CM training during CME than either emergency physicians or family practice physicians, whereas during residency, both pediatricians and emergency physicians received more training than family practice physicians. Two-thirds of the training related solely to physical and sexual abuse, with little attention paid to other forms of CM. Regression analysis indicated that the only factor associated with the likelihood of reporting maltreatment was the amount of CME received. CONCLUSION: CME seems to positively influence physician reporting practices for CM cases, suggesting a need for universal training protocols.

Neuroendocrine responses to running in women after zinc and vitamin E supplementation.

PURPOSE: The study was undertaken to determine whether acute supplementation with zinc or vitamin E would modify neuroendocrine responses to physiologic stress. METHODS: Specifically, the effects of exhaustive running on blood glucose, lactate, ACTH, cortisol, growth hormone, prolactin, catecholamine, and interleukin 6 (IL-6) concentrations were determined in 10 eumenorrheic runners after supplementation with zinc (25 mg), vitamin E (400 IU), or placebo. Subjects ran at 65-70% of their VO2max, to exhaustion, on a treadmill during the follicular phase of their menstrual cycles over three cycles. RESULTS: There were no significant differences associated with supplementation for any of the hormonal and metabolic measures. Exercise, however, significantly (P<0.05) increased plasma lactate, ACTH, prolactin, and catecholamine concentrations, all of which peaked immediately after exercise (POST). Plasma cortisol concentrations were significantly (P<0.05) elevated at POST, and a further increase was noted 1 h after exercise. IL-6 concentrations rose linearly throughout exercise and reached peak values at POST. Exercise-induced changes were transient in that all measures returned to baseline within 24 h. CONCLUSIONS: Acute supplementation with zinc or vitamin E did not influence the effects of exhaustive running on metabolic and endocrine responses in women. The effects of chronic supplementation on neuroendocrine responses to exercise remain to be determined.

The limping child.

A child who limps or complains of limb pain presents a diagnostic challenge for the emergency physician. Fortunately, only a few causes require emergency treatment. This article provides the physician with a systematic approach for evaluating these patients. Detailed discussion is provided for some of the more prevalent, urgent, and age-specific diagnoses of limb pain and limping.