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ORIGINAL CONTRIBUTION: Exclusive Breastfeeding and the Risk of Postpartum Relapses in Women With Multiple Sclerosis Langer-Gould, A., Huang, S. M., Gupta, R., Leimpeter, A. D., Greenwood, E., Albers, K. B., Van Den Eeden, S. K., Nelson, L. M. Mon, 08 Jun 2009 00:00:00 -0000 Objective To determine if exclusive breastfeeding protects against postpartum relapses of multiple sclerosis (MS) and, if so, whether this protection is related to prolonged lactational amenorrhea.Design We conducted structured interviews to assess clinical, menstrual, and breastfeeding history during each trimester and 2, 4, 6, 9, and 12 months postpartum and collected neurological examination findings from the treating physicians of women with MS. Hazards ratios (HRs) were adjusted for measures of disease severity and age.Setting Kaiser Permanente Northern California and Stanford University.Participants We prospectively enrolled 32 pregnant women with MS and 29 age-matched, pregnant controls.Main Outcome Measure Postpartum relapse.Results Of the 52% of women with MS who did not breastfeed or began regular supplemental feedings within 2 months postpartum, 87% had a postpartum relapse, compared with 36% of the women with MS who breastfed exclusively for at least 2 months postpartum (unadjusted HR, 5.0; 95% confidence interval, 1.7-14.2; P = .003; adjusted HR, 7.1; 95% confidence interval, 2.1-24.3; P = .002). Sixty percent reported that the primary reason for foregoing exclusive breastfeeding was to resume MS therapies. Women who breastfed exclusively had a later return of menses (P = .001) than women who did not, and lactational amenorrhea was associated with a reduced risk of postpartum relapses (P = .01).Conclusions Our findings suggest that exclusive breastfeeding and concomitant suppression of menses significantly reduce the risk of postpartum relapses in MS. Our findings call into question the benefit of foregoing breastfeeding to start MS therapies and should be confirmed in a larger study.Published online June 8, 2009 (doi:10.1001/archneurol.2009.132). ORIGINAL CONTRIBUTION: Validity of Self-reported Stroke in Elderly African Americans, Caribbean Hispanics, and Whites Reitz, C., Schupf, N., Luchsinger, J. A., Brickman, A. M., Manly, J. J., Andrews, H., Tang, M. X., DeCarli, C., Brown, T. R., Mayeux, R. Mon, 11 May 2009 00:00:00 -0000 Background The validity of a self-reported stroke remains inconclusive.Objective To validate the diagnosis of self-reported stroke using stroke identified by magnetic resonance imaging (MRI) as the standard.Design, Setting, and Participants Community-based cohort study of nondemented, ethnically diverse elderly persons in northern Manhattan.Methods High-resolution quantitative MRIs were acquired for 717 participants without dementia. Sensitivity and specificity of stroke by self-report were examined using cross-sectional analyses and the 2 test. Putative relationships between factors potentially influencing the reporting of stroke, including memory performance, cognitive function, and vascular risk factors, were assessed using logistic regression models. Subsequently, all analyses were repeated, stratified by age, sex, ethnic group, and level of education.Results In analyses of the whole sample, sensitivity of stroke self-report for a diagnosis of stroke on MRI was 32.4%, and specificity was 78.9%. In analyses stratified by median age (80.1 years), the validity between reported stroke and detection of stroke on MRI was significantly better in the younger than the older age group (for all vascular territories: sensitivity and specificity, 36.7% and 81.3% vs 27.6% and 26.2%; P = .02). Impaired memory, cognitive skills, or language ability and the presence of hypertension or myocardial infarction were associated with higher rates of false-negative results.Conclusions Using brain MRI as the standard, specificity and sensitivity of stroke self-report are low. Accuracy of self-report is influenced by age, presence of vascular disease, and cognitive function. In stroke research, sensitive neuroimaging techniques rather than stroke self-report should be used to determine stroke history.Published online May 11, 2009 (doi:10.1001/archneurol.2009.83). ABOUT THIS JOURNAL: About This Journal Mon, 08 Jun 2009 00:00:00 -0000
Child Neurology Residency Program - Explains the requirements and objectives of the course provided by the Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Meta Description: [ , Department of Neurology ]
Child Neurology Training - Provides details of the residency program at Loma Linda University Medical Center, California, USA. Includes training schedule, contact details and conference calendar.
Meta Description: [ Pediatric neurology residency program at Loma Linda University Medical Center ]
Division of Pediatric Neurology - Part of the State University of New York, with details of the clinical facilities and the fellowship training program.
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Emory Pediatric Neurology - Featuring the teaching syllabus and a patient information sheet for this department of Emory University, Atlanta, Georgia, USA.
404Pediatric Neurology Fellowship - Describes entry requirements, clinical training rotations, and research opportunities. Offered at the University of Michigan, Ann Arbor, USA.
Meta Description: [ Welcome to the University of Michigan C. S. Mott Children's Hospital, one of the nation's leading pediatric institutions known around the world for the excellence of our clinical, educational, and research programs. ]
Pediatric Neurology Fellowship - Details of the requirements, teaching program and specialty clinics, with an application form to download. Run by the State University of New York, Brooklyn, USA.
Pediatric Neurology Fellowship Program - Provided by the University of Rochester Medical Center, New York, USA. Features course requirements and details of clinical rotations and conferences.
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Section of Pediatric Neurology - Presents faculty profiles, course details and information on research programs. Part of Yale University's School of Medicine in New Haven, Connecticut, USA.
Meta Description: [ Yale-New Haven Medical Center ]