Carolyn Sachs

HONOLULU — Lessons learned from the earthquake that shook the island of Hawaii on Oct. 15, 2006, include the need for prompt communications, strongly functional and coordinated partnerships, and plans developed and regularly updated for all kinds of emergencies, according to Dr. Chiyome Leinaala Fukino, director of the Hawaii State Health Department.

When the earthquake, which registered 6.7 on the Richter scale, struck in the early morning, “most people weren't sure what to do,” she said. There was widespread loss of electricity. Early public communications by radio simply assured islanders that no tsunami was expected as a result of the earthquake, she said at the annual meeting of the National Medical Association. The immediate medical emergency was the breakdown of the local Kona Community Hospital, a 90-bed facility on the western side of the island, near the area where the earthquake struck hardest, said her co-lecturer, Toby L. Clairmont, R.N., director of emergency services for the Healthcare Association of Hawaii. “It seems to have gotten basically the brunt of most of what happened,” he said.

The suspended ceilings in the hospital collapsed, and the hospital's emergency power generator system moved off its foundation and had to be shut down so that the diesel fuel used in the system would not spew onto the floor.

“It was pretty chaotic,” Mr. Clairmont commented. The lights went out. Alarms sounded. Staff members were crawling on the floor with flashlights, trying to find their patients. The operating room, full of dust and debris, was shut down.

The first stage of medical response was to set up a triage shelter, which was used to perform “reverse triage,” he said. The hospital was completely evacuated, with decisions made about which patients should go home, which should be moved to a local hotel, and which should be transported to another hospital. Nine patients were flown to the other side of the island and admitted to a hospital in Hilo.

Dr. Fukino said the lessons learned included the following:

▸ Prepare now. Make plans for all disasters. Preparing for a tsunami is different from preparing for a hurricane or an infectious disease. The plans need to be updated regularly.

▸ Prepare the public. Encourage the public to prepare to be self-sustaining, first for 3 days. Then encourage preparation to be self-sustaining for 3 weeks, and later go for 3 months.

▸ Identify partners and practice with them. Partners that are not core to your responsibilities can affect your ability to carry out your responsibilities.

▸ In an emergency, communications must be prompt. Keep in mind that “bad news seldom gets better with age.”

▸ Establish a “media center” or a “joint information center.” Establish a location where professionals can gather during a crisis for mutual assistance.

HONOLULU — Lessons learned from the earthquake that shook the island of Hawaii on Oct. 15, 2006, include the need for prompt communications, strongly functional and coordinated partnerships, and plans developed and regularly updated for all kinds of emergencies, according to Dr. Chiyome Leinaala Fukino, director of the Hawaii State Health Department.

When the earthquake, which registered 6.7 on the Richter scale, struck in the early morning, “most people weren't sure what to do,” she said. There was widespread loss of electricity. Early public communications by radio simply assured islanders that no tsunami was expected as a result of the earthquake, she said at the annual meeting of the National Medical Association. The immediate medical emergency was the breakdown of the local Kona Community Hospital, a 90-bed facility on the western side of the island, near the area where the earthquake struck hardest, said her co-lecturer, Toby L. Clairmont, R.N., director of emergency services for the Healthcare Association of Hawaii. “It seems to have gotten basically the brunt of most of what happened,” he said.

The suspended ceilings in the hospital collapsed, and the hospital's emergency power generator system moved off its foundation and had to be shut down so that the diesel fuel used in the system would not spew onto the floor.

“It was pretty chaotic,” Mr. Clairmont commented. The lights went out. Alarms sounded. Staff members were crawling on the floor with flashlights, trying to find their patients. The operating room, full of dust and debris, was shut down.

The first stage of medical response was to set up a triage shelter, which was used to perform “reverse triage,” he said. The hospital was completely evacuated, with decisions made about which patients should go home, which should be moved to a local hotel, and which should be transported to another hospital. Nine patients were flown to the other side of the island and admitted to a hospital in Hilo.

Dr. Fukino said the lessons learned included the following:

▸ Prepare now. Make plans for all disasters. Preparing for a tsunami is different from preparing for a hurricane or an infectious disease. The plans need to be updated regularly.

▸ Prepare the public. Encourage the public to prepare to be self-sustaining, first for 3 days. Then encourage preparation to be self-sustaining for 3 weeks, and later go for 3 months.

▸ Identify partners and practice with them. Partners that are not core to your responsibilities can affect your ability to carry out your responsibilities.

▸ In an emergency, communications must be prompt. Keep in mind that “bad news seldom gets better with age.”

▸ Establish a “media center” or a “joint information center.” Establish a location where professionals can gather during a crisis for mutual assistance.

HONOLULU — Lessons learned from the earthquake that shook the island of Hawaii on Oct. 15, 2006, include the need for prompt communications, strongly functional and coordinated partnerships, and plans developed and regularly updated for all kinds of emergencies, according to Dr. Chiyome Leinaala Fukino, director of the Hawaii State Health Department.

When the earthquake, which registered 6.7 on the Richter scale, struck in the early morning, “most people weren't sure what to do,” she said. There was widespread loss of electricity. Early public communications by radio simply assured islanders that no tsunami was expected as a result of the earthquake, she said at the annual meeting of the National Medical Association. The immediate medical emergency was the breakdown of the local Kona Community Hospital, a 90-bed facility on the western side of the island, near the area where the earthquake struck hardest, said her co-lecturer, Toby L. Clairmont, R.N., director of emergency services for the Healthcare Association of Hawaii. “It seems to have gotten basically the brunt of most of what happened,” he said.

The suspended ceilings in the hospital collapsed, and the hospital's emergency power generator system moved off its foundation and had to be shut down so that the diesel fuel used in the system would not spew onto the floor.

“It was pretty chaotic,” Mr. Clairmont commented. The lights went out. Alarms sounded. Staff members were crawling on the floor with flashlights, trying to find their patients. The operating room, full of dust and debris, was shut down.

The first stage of medical response was to set up a triage shelter, which was used to perform “reverse triage,” he said. The hospital was completely evacuated, with decisions made about which patients should go home, which should be moved to a local hotel, and which should be transported to another hospital. Nine patients were flown to the other side of the island and admitted to a hospital in Hilo.

Dr. Fukino said the lessons learned included the following:

▸ Prepare now. Make plans for all disasters. Preparing for a tsunami is different from preparing for a hurricane or an infectious disease. The plans need to be updated regularly.

▸ Prepare the public. Encourage the public to prepare to be self-sustaining, first for 3 days. Then encourage preparation to be self-sustaining for 3 weeks, and later go for 3 months.

▸ Identify partners and practice with them. Partners that are not core to your responsibilities can affect your ability to carry out your responsibilities.

▸ In an emergency, communications must be prompt. Keep in mind that “bad news seldom gets better with age.”

▸ Establish a “media center” or a “joint information center.” Establish a location where professionals can gather during a crisis for mutual assistance.

HONOLULU — Many overweight black and Hispanic adults' estimates of their obesity-related health problems are more optimistic than are practice-based statistical findings, according to research presented at the annual meeting of the National Medical Association.

Data from a telephone survey “point to an important opportunity for physicians to communicate to their minority patients the serious health consequences associated with excess weight,” concluded Dr. Valentine J. Burroughs, chief medical officer of North General Hospital, New York, and colleagues.

The researchers reported that “self-reported rates of obesity-related comorbidities among African-American and Hispanic adults,” self-described as overweight, “fall below what would be expected based on clinical data, suggesting a lack of awareness of actual risk.”

The study also found that in spite of greater self-reported prevalence of certain risk factors for poor health, “African Americans have a more optimistic view of their overall health and weight status compared to Hispanics.”

Information for the study was collected from a telephone survey of 537 black and 526 Hispanic adults; 30.1% of black respondents were male, as were 35.4% of Hispanic respondents. The researchers recruited only candidates who described themselves as being either “slightly” or “very overweight.” A higher percentage of Hispanic participants (81.9%) reported themselves as being “slightly overweight,” compared with black participants (76.6%). Survey participants' body mass index was calculated from self-reported height and weight.

The obesity-related comorbidities that were most frequently self-reported by black participants were high blood pressure (33.0%), arthritis (20.4%), and high cholesterol (18.4%); Hispanic participants most frequently reported high cholesterol (17.2%), high blood pressure (15.0%), and difficulty sleeping (12.5%).

Survey participants were also asked to rate their overall health. Only 3% of Hispanics rated their health as poor, as did 5% of blacks. On the other hand, 33% of blacks rated their health as either “very good” or “excellent,” compared with 23% of Hispanics.

The study was funded by GlaxoSmithKline Consumer Healthcare; all the study authors either consulted for the company or were employed by them.

HONOLULU — Many overweight black and Hispanic adults' estimates of their obesity-related health problems are more optimistic than are practice-based statistical findings, according to research presented at the annual meeting of the National Medical Association.

Data from a telephone survey “point to an important opportunity for physicians to communicate to their minority patients the serious health consequences associated with excess weight,” concluded Dr. Valentine J. Burroughs, chief medical officer of North General Hospital, New York, and colleagues.

The researchers reported that “self-reported rates of obesity-related comorbidities among African-American and Hispanic adults,” self-described as overweight, “fall below what would be expected based on clinical data, suggesting a lack of awareness of actual risk.”

The study also found that in spite of greater self-reported prevalence of certain risk factors for poor health, “African Americans have a more optimistic view of their overall health and weight status compared to Hispanics.”

Information for the study was collected from a telephone survey of 537 black and 526 Hispanic adults; 30.1% of black respondents were male, as were 35.4% of Hispanic respondents. The researchers recruited only candidates who described themselves as being either “slightly” or “very overweight.” A higher percentage of Hispanic participants (81.9%) reported themselves as being “slightly overweight,” compared with black participants (76.6%). Survey participants' body mass index was calculated from self-reported height and weight.

The obesity-related comorbidities that were most frequently self-reported by black participants were high blood pressure (33.0%), arthritis (20.4%), and high cholesterol (18.4%); Hispanic participants most frequently reported high cholesterol (17.2%), high blood pressure (15.0%), and difficulty sleeping (12.5%).

Survey participants were also asked to rate their overall health. Only 3% of Hispanics rated their health as poor, as did 5% of blacks. On the other hand, 33% of blacks rated their health as either “very good” or “excellent,” compared with 23% of Hispanics.

The study was funded by GlaxoSmithKline Consumer Healthcare; all the study authors either consulted for the company or were employed by them.

HONOLULU — Many overweight black and Hispanic adults' estimates of their obesity-related health problems are more optimistic than are practice-based statistical findings, according to research presented at the annual meeting of the National Medical Association.

Data from a telephone survey “point to an important opportunity for physicians to communicate to their minority patients the serious health consequences associated with excess weight,” concluded Dr. Valentine J. Burroughs, chief medical officer of North General Hospital, New York, and colleagues.

The researchers reported that “self-reported rates of obesity-related comorbidities among African-American and Hispanic adults,” self-described as overweight, “fall below what would be expected based on clinical data, suggesting a lack of awareness of actual risk.”

The study also found that in spite of greater self-reported prevalence of certain risk factors for poor health, “African Americans have a more optimistic view of their overall health and weight status compared to Hispanics.”

Information for the study was collected from a telephone survey of 537 black and 526 Hispanic adults; 30.1% of black respondents were male, as were 35.4% of Hispanic respondents. The researchers recruited only candidates who described themselves as being either “slightly” or “very overweight.” A higher percentage of Hispanic participants (81.9%) reported themselves as being “slightly overweight,” compared with black participants (76.6%). Survey participants' body mass index was calculated from self-reported height and weight.

The obesity-related comorbidities that were most frequently self-reported by black participants were high blood pressure (33.0%), arthritis (20.4%), and high cholesterol (18.4%); Hispanic participants most frequently reported high cholesterol (17.2%), high blood pressure (15.0%), and difficulty sleeping (12.5%).

Survey participants were also asked to rate their overall health. Only 3% of Hispanics rated their health as poor, as did 5% of blacks. On the other hand, 33% of blacks rated their health as either “very good” or “excellent,” compared with 23% of Hispanics.

The study was funded by GlaxoSmithKline Consumer Healthcare; all the study authors either consulted for the company or were employed by them.

MAUI, HAWAII — Taking blood pressure measurements as part of routine checkups for very young children can help reveal underlying problems early, said Dr. Carl M. Grushkin, head of the division of nephrology at Childrens Hospital Los Angeles.

New data showing a disturbing upturn in high blood pressure rates among children aged 8–17 years shore up efforts to diagnose the problem earlier. After decades of a downward trend from 1963 to 1988, prevalence rates of pre-high blood pressure and high blood pressure increased 2.3% and 1%, respectively, between 1988 and 1999, according to surveys conducted by the National Center for Health Statistics (Circulation 2007;116:1392–400).

Yet, “the [American Academy of Pediatrics], in its recommendations, still says that you don't have to take blood pressures in kids until they're 3,” Dr. Grushkin said, speaking at a meeting sponsored by the University Childrens Medical Group and the American Academy of Pediatrics. “I think that's absolutely insane.”

“In kids up to 10 years of age who have severe hypertension, essentially you will always find a cause,” and “almost always it's something that can be fixed,” Dr. Grushkin observed at the meeting, also sponsored by the California Chapter 2 of the AAP. He categorized severe hypertension as being “frequently symptomatic, with systolic, or especially diastolic, blood pressure 15–20 mm Hg greater than 95th percentile for age and height.”

To highlight the usefulness of blood pressure measurement in the very young, Dr. Grushkin referred to a case in which a girl had a systolic blood pressure of 90 mm Hg by palpation at her routine checkup at age 1 year and a blood pressure measurement of 140/100 mm Hg at her checkup at age 2.

The little girl's history was negative, she was not on medication, and her height and weight were at the 50th percentile at both her 1- and 2-year checkups. “The femoral pulses were fine,” Dr. Grushkin recalled, “and the rest of the physical exam was normal,” as were the results of a series of laboratory tests.

Having been able to rule out most possible underlying causes of the child's hypertension, Dr. Grushkin narrowed his focus to the girl's kidneys. He knew that at least one kidney had to be functioning normally, since there was no renal insufficiency, but was concerned about a possible congenital abnormality or a renovascular problem.

Following a normal ultrasound upon admission to the hospital, the child was started on medication to control the blood pressure; 36 hours later she had a renal angiogram, which showed that while the main renal arteries were normal, the upper polar vessel to one of the kidneys was stenotic.

Deciding that the child was a little small to be a candidate for an operation, and that it was not possible to put in a stent, Dr. Grushkin and the primary care physician kept the child on therapy for 3 years, after which time they brought her back to the hospital and corrected the stenosis. “She came out of surgery and didn't need any more antihypertensives,” he said. “She was in the hospital 4 days, went home, and has been fine ever since.”

Dr. Grushkin said although many physicians do measure blood pressure in older children routinely, the very young are often overlooked.

Noting concerns among physicians about how to take blood-pressure measurements in very young patients, he offered recommendations from his own practice.

The “old standard way” of measuring blood pressure with a sphygmomanometer has, over the years, moved more and more toward involving automated inflating devices, he observed. “Those work fairly well for kids probably 4 and above, as long as with the little kids you tell them what to expect: that it's going to make a noise, that it's going to squeeze the arm, and it may hurt just a tiny bit,” said Dr. Grushkin, also professor of clinical pediatrics at the University of Southern California, Los Angeles.

“They don't work particularly well for very young infants, for the same reason. There's a noise, the cuff is pumped up well above the systolic blood pressure, it's pumped up very quickly, and it hurts.”

With babies in his clinic, he said, he always does a palpable systolic blood pressure. “We simply let the mother or the dad hold the baby, put the appropriate size cuff on the baby—usually on the right arm—and put a pacifier in the baby's mouth.”

Then put a finger on the brachial artery, and slowly pump the cuff up. “Where the pulse disappears is the systolic blood pressure. You then release the pressure, and let it come down. You feel it again, and you're done,” Dr. Grushkin said. “It takes about 30 seconds to do, and it's reproducible.”

'It takes about 30 seconds to [measure a child's blood pressure], and it's reproducible.' DR. GRUSHKIN

MAUI, HAWAII — Taking blood pressure measurements as part of routine checkups for very young children can help reveal underlying problems early, said Dr. Carl M. Grushkin, head of the division of nephrology at Childrens Hospital Los Angeles.

New data showing a disturbing upturn in high blood pressure rates among children aged 8–17 years shore up efforts to diagnose the problem earlier. After decades of a downward trend from 1963 to 1988, prevalence rates of pre-high blood pressure and high blood pressure increased 2.3% and 1%, respectively, between 1988 and 1999, according to surveys conducted by the National Center for Health Statistics (Circulation 2007;116:1392–400).

Yet, “the [American Academy of Pediatrics], in its recommendations, still says that you don't have to take blood pressures in kids until they're 3,” Dr. Grushkin said, speaking at a meeting sponsored by the University Childrens Medical Group and the American Academy of Pediatrics. “I think that's absolutely insane.”

“In kids up to 10 years of age who have severe hypertension, essentially you will always find a cause,” and “almost always it's something that can be fixed,” Dr. Grushkin observed at the meeting, also sponsored by the California Chapter 2 of the AAP. He categorized severe hypertension as being “frequently symptomatic, with systolic, or especially diastolic, blood pressure 15–20 mm Hg greater than 95th percentile for age and height.”

To highlight the usefulness of blood pressure measurement in the very young, Dr. Grushkin referred to a case in which a girl had a systolic blood pressure of 90 mm Hg by palpation at her routine checkup at age 1 year and a blood pressure measurement of 140/100 mm Hg at her checkup at age 2.

The little girl's history was negative, she was not on medication, and her height and weight were at the 50th percentile at both her 1- and 2-year checkups. “The femoral pulses were fine,” Dr. Grushkin recalled, “and the rest of the physical exam was normal,” as were the results of a series of laboratory tests.

Having been able to rule out most possible underlying causes of the child's hypertension, Dr. Grushkin narrowed his focus to the girl's kidneys. He knew that at least one kidney had to be functioning normally, since there was no renal insufficiency, but was concerned about a possible congenital abnormality or a renovascular problem.

Following a normal ultrasound upon admission to the hospital, the child was started on medication to control the blood pressure; 36 hours later she had a renal angiogram, which showed that while the main renal arteries were normal, the upper polar vessel to one of the kidneys was stenotic.

Deciding that the child was a little small to be a candidate for an operation, and that it was not possible to put in a stent, Dr. Grushkin and the primary care physician kept the child on therapy for 3 years, after which time they brought her back to the hospital and corrected the stenosis. “She came out of surgery and didn't need any more antihypertensives,” he said. “She was in the hospital 4 days, went home, and has been fine ever since.”

Dr. Grushkin said although many physicians do measure blood pressure in older children routinely, the very young are often overlooked.

Noting concerns among physicians about how to take blood-pressure measurements in very young patients, he offered recommendations from his own practice.

The “old standard way” of measuring blood pressure with a sphygmomanometer has, over the years, moved more and more toward involving automated inflating devices, he observed. “Those work fairly well for kids probably 4 and above, as long as with the little kids you tell them what to expect: that it's going to make a noise, that it's going to squeeze the arm, and it may hurt just a tiny bit,” said Dr. Grushkin, also professor of clinical pediatrics at the University of Southern California, Los Angeles.

“They don't work particularly well for very young infants, for the same reason. There's a noise, the cuff is pumped up well above the systolic blood pressure, it's pumped up very quickly, and it hurts.”

With babies in his clinic, he said, he always does a palpable systolic blood pressure. “We simply let the mother or the dad hold the baby, put the appropriate size cuff on the baby—usually on the right arm—and put a pacifier in the baby's mouth.”

Then put a finger on the brachial artery, and slowly pump the cuff up. “Where the pulse disappears is the systolic blood pressure. You then release the pressure, and let it come down. You feel it again, and you're done,” Dr. Grushkin said. “It takes about 30 seconds to do, and it's reproducible.”

'It takes about 30 seconds to [measure a child's blood pressure], and it's reproducible.' DR. GRUSHKIN

MAUI, HAWAII — Taking blood pressure measurements as part of routine checkups for very young children can help reveal underlying problems early, said Dr. Carl M. Grushkin, head of the division of nephrology at Childrens Hospital Los Angeles.

New data showing a disturbing upturn in high blood pressure rates among children aged 8–17 years shore up efforts to diagnose the problem earlier. After decades of a downward trend from 1963 to 1988, prevalence rates of pre-high blood pressure and high blood pressure increased 2.3% and 1%, respectively, between 1988 and 1999, according to surveys conducted by the National Center for Health Statistics (Circulation 2007;116:1392–400).

Yet, “the [American Academy of Pediatrics], in its recommendations, still says that you don't have to take blood pressures in kids until they're 3,” Dr. Grushkin said, speaking at a meeting sponsored by the University Childrens Medical Group and the American Academy of Pediatrics. “I think that's absolutely insane.”

“In kids up to 10 years of age who have severe hypertension, essentially you will always find a cause,” and “almost always it's something that can be fixed,” Dr. Grushkin observed at the meeting, also sponsored by the California Chapter 2 of the AAP. He categorized severe hypertension as being “frequently symptomatic, with systolic, or especially diastolic, blood pressure 15–20 mm Hg greater than 95th percentile for age and height.”

To highlight the usefulness of blood pressure measurement in the very young, Dr. Grushkin referred to a case in which a girl had a systolic blood pressure of 90 mm Hg by palpation at her routine checkup at age 1 year and a blood pressure measurement of 140/100 mm Hg at her checkup at age 2.

The little girl's history was negative, she was not on medication, and her height and weight were at the 50th percentile at both her 1- and 2-year checkups. “The femoral pulses were fine,” Dr. Grushkin recalled, “and the rest of the physical exam was normal,” as were the results of a series of laboratory tests.

Having been able to rule out most possible underlying causes of the child's hypertension, Dr. Grushkin narrowed his focus to the girl's kidneys. He knew that at least one kidney had to be functioning normally, since there was no renal insufficiency, but was concerned about a possible congenital abnormality or a renovascular problem.

Following a normal ultrasound upon admission to the hospital, the child was started on medication to control the blood pressure; 36 hours later she had a renal angiogram, which showed that while the main renal arteries were normal, the upper polar vessel to one of the kidneys was stenotic.

Deciding that the child was a little small to be a candidate for an operation, and that it was not possible to put in a stent, Dr. Grushkin and the primary care physician kept the child on therapy for 3 years, after which time they brought her back to the hospital and corrected the stenosis. “She came out of surgery and didn't need any more antihypertensives,” he said. “She was in the hospital 4 days, went home, and has been fine ever since.”

Dr. Grushkin said although many physicians do measure blood pressure in older children routinely, the very young are often overlooked.

Noting concerns among physicians about how to take blood-pressure measurements in very young patients, he offered recommendations from his own practice.

The “old standard way” of measuring blood pressure with a sphygmomanometer has, over the years, moved more and more toward involving automated inflating devices, he observed. “Those work fairly well for kids probably 4 and above, as long as with the little kids you tell them what to expect: that it's going to make a noise, that it's going to squeeze the arm, and it may hurt just a tiny bit,” said Dr. Grushkin, also professor of clinical pediatrics at the University of Southern California, Los Angeles.

“They don't work particularly well for very young infants, for the same reason. There's a noise, the cuff is pumped up well above the systolic blood pressure, it's pumped up very quickly, and it hurts.”

With babies in his clinic, he said, he always does a palpable systolic blood pressure. “We simply let the mother or the dad hold the baby, put the appropriate size cuff on the baby—usually on the right arm—and put a pacifier in the baby's mouth.”

Then put a finger on the brachial artery, and slowly pump the cuff up. “Where the pulse disappears is the systolic blood pressure. You then release the pressure, and let it come down. You feel it again, and you're done,” Dr. Grushkin said. “It takes about 30 seconds to do, and it's reproducible.”

'It takes about 30 seconds to [measure a child's blood pressure], and it's reproducible.' DR. GRUSHKIN

MAUI, HAWAII — There is increasing evidence that sleep deprivation might be related to the risk of obesity and insulin resistance in children, according to Dr. Sally Ward, head of pediatric pulmonology at Childrens Hospital Los Angeles.

“And having children sleep more might certainly be an easier intervention than some of the other things that we use to help with obesity,” she said at a meeting sponsored by the University Childrens Medical Group and the American Academy of Pediatrics.

Dr. Ward cited a recent study in which obese children with fewer than 6 hours of sleep on an overnight sleep study had increased insulin resistance, compared with children with equivalent body mass indices who had more than 6 hours of sleep (J. Pediatr. 2007;150:364–9). “So a high-risk group for insulin insensitivity can be made at further risk by sleep deprivation,” she noted at the meeting, also sponsored by the California Chapter of the AAP.

A large cross-sectional study of Japanese children showed that children with fewer than 8 hours of sleep were three times more likely to be obese than were children who had 10 hours or more of sleep (Child Care Health Dev. 2002;28:163–70).

She also referred to a prospective study of 150 children, from birth to 9.5 years, in which less sleep time in childhood was found to be an independent risk factor for obesity, along with parental overweight and lack of concern about the child's size (J. Pediatr. 2004;145:20–5).

MAUI, HAWAII — There is increasing evidence that sleep deprivation might be related to the risk of obesity and insulin resistance in children, according to Dr. Sally Ward, head of pediatric pulmonology at Childrens Hospital Los Angeles.

“And having children sleep more might certainly be an easier intervention than some of the other things that we use to help with obesity,” she said at a meeting sponsored by the University Childrens Medical Group and the American Academy of Pediatrics.

Dr. Ward cited a recent study in which obese children with fewer than 6 hours of sleep on an overnight sleep study had increased insulin resistance, compared with children with equivalent body mass indices who had more than 6 hours of sleep (J. Pediatr. 2007;150:364–9). “So a high-risk group for insulin insensitivity can be made at further risk by sleep deprivation,” she noted at the meeting, also sponsored by the California Chapter of the AAP.

A large cross-sectional study of Japanese children showed that children with fewer than 8 hours of sleep were three times more likely to be obese than were children who had 10 hours or more of sleep (Child Care Health Dev. 2002;28:163–70).

She also referred to a prospective study of 150 children, from birth to 9.5 years, in which less sleep time in childhood was found to be an independent risk factor for obesity, along with parental overweight and lack of concern about the child's size (J. Pediatr. 2004;145:20–5).

MAUI, HAWAII — There is increasing evidence that sleep deprivation might be related to the risk of obesity and insulin resistance in children, according to Dr. Sally Ward, head of pediatric pulmonology at Childrens Hospital Los Angeles.

“And having children sleep more might certainly be an easier intervention than some of the other things that we use to help with obesity,” she said at a meeting sponsored by the University Childrens Medical Group and the American Academy of Pediatrics.

Dr. Ward cited a recent study in which obese children with fewer than 6 hours of sleep on an overnight sleep study had increased insulin resistance, compared with children with equivalent body mass indices who had more than 6 hours of sleep (J. Pediatr. 2007;150:364–9). “So a high-risk group for insulin insensitivity can be made at further risk by sleep deprivation,” she noted at the meeting, also sponsored by the California Chapter of the AAP.

A large cross-sectional study of Japanese children showed that children with fewer than 8 hours of sleep were three times more likely to be obese than were children who had 10 hours or more of sleep (Child Care Health Dev. 2002;28:163–70).

She also referred to a prospective study of 150 children, from birth to 9.5 years, in which less sleep time in childhood was found to be an independent risk factor for obesity, along with parental overweight and lack of concern about the child's size (J. Pediatr. 2004;145:20–5).

HONOLULU — Many overweight black and Hispanic adults' estimates of their obesity-related health problems are more optimistic than are practice-based statistical findings, according to research presented in a poster at the annual meeting of the National Medical Association.

Data from a telephone survey “point to an important opportunity for physicians to communicate to their minority patients” regarding the health consequences of obesity, wrote Dr. Valentine J. Burroughs, chief medical officer of North General Hospital, New York, and colleagues.

The researchers reported that “self-reported rates of obesity-related comorbidities among African-American and Hispanic adults,” self-described as overweight, “fall below what would be expected … suggesting a lack of awareness of actual risk.”

Information for the study was collected from a telephone survey of 537 black and 526 Hispanic adults; 30.1% of black respondents and 35.4% of Hispanic respondents were male. The researchers recruited only those candidates who described themselves as being either “slightly” or “very” overweight. A higher percentage of Hispanic participants (81.9%) reported themselves as being “slightly overweight,” compared with black participants (76.6%).

The obesity-related comorbidities that were most frequently self-reported by black participants were high blood pressure (33.0%), arthritis (20.4%), and high cholesterol (18.4%); Hispanic participants most frequently reported high cholesterol (17.2%), high blood pressure (15.0%), and difficulty sleeping (12.5%).

Survey participants were also asked to rate their overall health. Only 3% of Hispanics rated their health as poor, as did 5% of blacks. (See box.)

The study was funded by GlaxoSmithKline Consumer Healthcare; all the study authors either consulted for the company or were employed by them.

ELSEVIER GLOBAL MEDICAL NEWS

HONOLULU — Many overweight black and Hispanic adults' estimates of their obesity-related health problems are more optimistic than are practice-based statistical findings, according to research presented in a poster at the annual meeting of the National Medical Association.

Data from a telephone survey “point to an important opportunity for physicians to communicate to their minority patients” regarding the health consequences of obesity, wrote Dr. Valentine J. Burroughs, chief medical officer of North General Hospital, New York, and colleagues.

The researchers reported that “self-reported rates of obesity-related comorbidities among African-American and Hispanic adults,” self-described as overweight, “fall below what would be expected … suggesting a lack of awareness of actual risk.”

Information for the study was collected from a telephone survey of 537 black and 526 Hispanic adults; 30.1% of black respondents and 35.4% of Hispanic respondents were male. The researchers recruited only those candidates who described themselves as being either “slightly” or “very” overweight. A higher percentage of Hispanic participants (81.9%) reported themselves as being “slightly overweight,” compared with black participants (76.6%).

The obesity-related comorbidities that were most frequently self-reported by black participants were high blood pressure (33.0%), arthritis (20.4%), and high cholesterol (18.4%); Hispanic participants most frequently reported high cholesterol (17.2%), high blood pressure (15.0%), and difficulty sleeping (12.5%).

Survey participants were also asked to rate their overall health. Only 3% of Hispanics rated their health as poor, as did 5% of blacks. (See box.)

The study was funded by GlaxoSmithKline Consumer Healthcare; all the study authors either consulted for the company or were employed by them.

ELSEVIER GLOBAL MEDICAL NEWS

HONOLULU — Many overweight black and Hispanic adults' estimates of their obesity-related health problems are more optimistic than are practice-based statistical findings, according to research presented in a poster at the annual meeting of the National Medical Association.

Data from a telephone survey “point to an important opportunity for physicians to communicate to their minority patients” regarding the health consequences of obesity, wrote Dr. Valentine J. Burroughs, chief medical officer of North General Hospital, New York, and colleagues.

The researchers reported that “self-reported rates of obesity-related comorbidities among African-American and Hispanic adults,” self-described as overweight, “fall below what would be expected … suggesting a lack of awareness of actual risk.”

Information for the study was collected from a telephone survey of 537 black and 526 Hispanic adults; 30.1% of black respondents and 35.4% of Hispanic respondents were male. The researchers recruited only those candidates who described themselves as being either “slightly” or “very” overweight. A higher percentage of Hispanic participants (81.9%) reported themselves as being “slightly overweight,” compared with black participants (76.6%).

The obesity-related comorbidities that were most frequently self-reported by black participants were high blood pressure (33.0%), arthritis (20.4%), and high cholesterol (18.4%); Hispanic participants most frequently reported high cholesterol (17.2%), high blood pressure (15.0%), and difficulty sleeping (12.5%).

Survey participants were also asked to rate their overall health. Only 3% of Hispanics rated their health as poor, as did 5% of blacks. (See box.)

The study was funded by GlaxoSmithKline Consumer Healthcare; all the study authors either consulted for the company or were employed by them.

ELSEVIER GLOBAL MEDICAL NEWS

MAUI, HAWAII — "If you do Botox, you can certainly do fillers," Dr. Howard K. Steinman said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

Dr. Steinman stressed the importance of developing skills with injectable fillers, noting their ease of use, minimal risk and downtime, efficacy, and high patient and clinician satisfaction. "They're rapidly becoming the 'go to' treatment for lots of types of facial rejuvenation," he said.

Honing skills using temporary fillers, he suggested, is a good way to learn. "I would start with temporary fillers, before you [use] semipermanent fillers, and certainly before you go to permanent fillers," said Dr. Steinman of the University of California, San Diego.

He acknowledged that temporary fillers present a conundrum. For the patient, the problem with temporary fillers is that they're temporary. "They only last 3–6 or 9 months. My patients don't like it [because] they have to keep coming back," Dr. Steinman noted. But for those who are learning to use them, the advantage of temporary fillers is that they're temporary.

"If you're thinking of doing lips, I would suggest first learning with a temporary filler before you mess up somebody's lips permanently," he cautioned.

More important, if a woman has never had her lips or nasolabial folds face enlarged and she's not sure that she wants it, do not give her a semipermanent or permanent filler since she may not like the results, he said.

A "cool thing" about the temporary filler hyaluronic acid, Dr. Steinman noted, is that it is dissolved by hyaluronidase, which is readily available. In one situation in which a lump had appeared when he was using a hyaluronic acid filler, he was able to eliminate the lump by injecting hyaluronidase.

While learning on temporary fillers, treat forgiving areas first. The easiest way to do that is to treat patients after botulinum toxin type A injections. "They already trust you to stick needles in their face," he explained, "and many of them have wrinkles that won't completely go away."

Dr. Steinman recalled a patient whom he had told, "Your glabellar rhytid is not going to completely resolve with the Botox." As he predicted, she had a good result with Botox but still had a rhytid. "That's a great place to learn," he said.

"There's a synergy between the places I inject Botox and the places where you can learn to inject hyaluronic acid." (See box.) For instance, he said, "Nasolabial folds are an excellent location—and glabellar lines."

Using fillers after Botox is a highly effective, versatile, nonablative, low-risk treatment option that can be useful for resistant resting rhytids.

Use the filler after waiting for maximal botulinum effect. Fillers often last longer when placed after botulinum, said Dr. Steinman, who stated that he had no conflicts of interest.

After learning on more forgiving areas, move on to other areas. He started treating lip patients once he had developed his skills.

"The last place I would suggest you learn is the teardrop of the eyelid," he said. Above all, he urged, "use common sense."

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

ELSEVIER GLOBAL MEDICAL NEWS

MAUI, HAWAII — "If you do Botox, you can certainly do fillers," Dr. Howard K. Steinman said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

Dr. Steinman stressed the importance of developing skills with injectable fillers, noting their ease of use, minimal risk and downtime, efficacy, and high patient and clinician satisfaction. "They're rapidly becoming the 'go to' treatment for lots of types of facial rejuvenation," he said.

Honing skills using temporary fillers, he suggested, is a good way to learn. "I would start with temporary fillers, before you [use] semipermanent fillers, and certainly before you go to permanent fillers," said Dr. Steinman of the University of California, San Diego.

He acknowledged that temporary fillers present a conundrum. For the patient, the problem with temporary fillers is that they're temporary. "They only last 3–6 or 9 months. My patients don't like it [because] they have to keep coming back," Dr. Steinman noted. But for those who are learning to use them, the advantage of temporary fillers is that they're temporary.

"If you're thinking of doing lips, I would suggest first learning with a temporary filler before you mess up somebody's lips permanently," he cautioned.

More important, if a woman has never had her lips or nasolabial folds face enlarged and she's not sure that she wants it, do not give her a semipermanent or permanent filler since she may not like the results, he said.

A "cool thing" about the temporary filler hyaluronic acid, Dr. Steinman noted, is that it is dissolved by hyaluronidase, which is readily available. In one situation in which a lump had appeared when he was using a hyaluronic acid filler, he was able to eliminate the lump by injecting hyaluronidase.

While learning on temporary fillers, treat forgiving areas first. The easiest way to do that is to treat patients after botulinum toxin type A injections. "They already trust you to stick needles in their face," he explained, "and many of them have wrinkles that won't completely go away."

Dr. Steinman recalled a patient whom he had told, "Your glabellar rhytid is not going to completely resolve with the Botox." As he predicted, she had a good result with Botox but still had a rhytid. "That's a great place to learn," he said.

"There's a synergy between the places I inject Botox and the places where you can learn to inject hyaluronic acid." (See box.) For instance, he said, "Nasolabial folds are an excellent location—and glabellar lines."

Using fillers after Botox is a highly effective, versatile, nonablative, low-risk treatment option that can be useful for resistant resting rhytids.

Use the filler after waiting for maximal botulinum effect. Fillers often last longer when placed after botulinum, said Dr. Steinman, who stated that he had no conflicts of interest.

After learning on more forgiving areas, move on to other areas. He started treating lip patients once he had developed his skills.

"The last place I would suggest you learn is the teardrop of the eyelid," he said. Above all, he urged, "use common sense."

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

ELSEVIER GLOBAL MEDICAL NEWS

MAUI, HAWAII — "If you do Botox, you can certainly do fillers," Dr. Howard K. Steinman said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

Dr. Steinman stressed the importance of developing skills with injectable fillers, noting their ease of use, minimal risk and downtime, efficacy, and high patient and clinician satisfaction. "They're rapidly becoming the 'go to' treatment for lots of types of facial rejuvenation," he said.

Honing skills using temporary fillers, he suggested, is a good way to learn. "I would start with temporary fillers, before you [use] semipermanent fillers, and certainly before you go to permanent fillers," said Dr. Steinman of the University of California, San Diego.

He acknowledged that temporary fillers present a conundrum. For the patient, the problem with temporary fillers is that they're temporary. "They only last 3–6 or 9 months. My patients don't like it [because] they have to keep coming back," Dr. Steinman noted. But for those who are learning to use them, the advantage of temporary fillers is that they're temporary.

"If you're thinking of doing lips, I would suggest first learning with a temporary filler before you mess up somebody's lips permanently," he cautioned.

More important, if a woman has never had her lips or nasolabial folds face enlarged and she's not sure that she wants it, do not give her a semipermanent or permanent filler since she may not like the results, he said.

A "cool thing" about the temporary filler hyaluronic acid, Dr. Steinman noted, is that it is dissolved by hyaluronidase, which is readily available. In one situation in which a lump had appeared when he was using a hyaluronic acid filler, he was able to eliminate the lump by injecting hyaluronidase.

While learning on temporary fillers, treat forgiving areas first. The easiest way to do that is to treat patients after botulinum toxin type A injections. "They already trust you to stick needles in their face," he explained, "and many of them have wrinkles that won't completely go away."

Dr. Steinman recalled a patient whom he had told, "Your glabellar rhytid is not going to completely resolve with the Botox." As he predicted, she had a good result with Botox but still had a rhytid. "That's a great place to learn," he said.

"There's a synergy between the places I inject Botox and the places where you can learn to inject hyaluronic acid." (See box.) For instance, he said, "Nasolabial folds are an excellent location—and glabellar lines."

Using fillers after Botox is a highly effective, versatile, nonablative, low-risk treatment option that can be useful for resistant resting rhytids.

Use the filler after waiting for maximal botulinum effect. Fillers often last longer when placed after botulinum, said Dr. Steinman, who stated that he had no conflicts of interest.

After learning on more forgiving areas, move on to other areas. He started treating lip patients once he had developed his skills.

"The last place I would suggest you learn is the teardrop of the eyelid," he said. Above all, he urged, "use common sense."

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

ELSEVIER GLOBAL MEDICAL NEWS

MAUI, HAWAII — An upper and lower lip mucosal block provides fast, easy, and effective regional anesthesia for lip procedures, Dr. Howard K. Steinman said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

"Learn this mucosal block," he urged. "It has revolutionized my practice more than any other simple technique I have learned in the last 5 years."

"When patients come to your office, they're secretly praying that what you're going to do is going to be painless," said Dr. Steinman of the University of California, San Diego.

"When you get patients ready for what they expect to be a happy, painless, rejuvenating experience, and they're unhappy," he explained, "everyone in the room is unhappy." Using the mucosal block greatly improves the satisfaction of patients.

Equipment required for the mucosal block procedure is simple and modestly priced.

"You don't need a multithousand-dollar energy device," Dr. Steinman said.

The supplies needed include topical anesthetic (such as Hurricaine gel), dental needles, lidocaine Carpules, and a Carpule syringe. Dental syringes, which can be purchased from dental supply companies, are "incredibly" inexpensive, he noted.

The anesthesia requires nothing that is not already in the office, including anesthetic gel and "lots and lots of Q tips," he said.

If there's going to be a lot of dental gel in a patient's mouth during a cosmetic procedure, be sure to have some bottled water available, because many people really don't like the gel's taste.

Injected anesthetics that can be used to perform the mucosal block include lidocaine, bupivacaine, mepivacaine, and others.

Dr. Steinman outlined the procedure for performing the upper- and lower-lip mucosal block. "What you're blocking is the infraorbital nerve," he explained.

The first step in the procedure is to apply topical anesthetic. Then, at the gingival-buccal sulcus, just lateral to the apex of the canine tooth, inject a small amount of anesthetic approximately 0.5 cm upward along the maxilla. The next step is to inject from this point medially—in the potential space between the mucosa and the periosteum—along the sulcus to the frenulum.

The procedure should be repeated on the contralateral side. Inject a small amount from the sulcus next to the frenulum toward the anterior nasal spine, he added.

For the patient's lower lip, inject submucosally in the sulcus from the point below the oral commissure to the contralateral side.

Finally, because the nerve block does not reach the corners of the mouth, it is necessary to apply topical anesthetic on the mucosal surface of the oral commissures and then inject a small amount of anesthetic to anesthetize the corners of the mouth. Injecting these areas takes a total of about 15 seconds, Dr. Steinman noted.

It is also important to keep in mind that facial blocks do not impart any vasoconstriction, so consider injecting locally for procedures that result in bleeding, he added.

Dr. Steinman emphasized that the mucosal block works fast.

"This block will numb up someone's lip in approximately 10–15 seconds," he said. "As a matter of fact, when I'm doing it, the side I've numbed up will largely be numb by the time I get to the other side of the lip.

"So it's very effective for lip procedures, very effective for fillers especially," he said. "As we say in Southern California," he concluded, "this block rocks."

Dr. Steinman said that he had no relevant conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Your patients are secretly praying that what you're going to do is going to be painless. DR. STEINMAN

MAUI, HAWAII — An upper and lower lip mucosal block provides fast, easy, and effective regional anesthesia for lip procedures, Dr. Howard K. Steinman said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

"Learn this mucosal block," he urged. "It has revolutionized my practice more than any other simple technique I have learned in the last 5 years."

"When patients come to your office, they're secretly praying that what you're going to do is going to be painless," said Dr. Steinman of the University of California, San Diego.

"When you get patients ready for what they expect to be a happy, painless, rejuvenating experience, and they're unhappy," he explained, "everyone in the room is unhappy." Using the mucosal block greatly improves the satisfaction of patients.

Equipment required for the mucosal block procedure is simple and modestly priced.

"You don't need a multithousand-dollar energy device," Dr. Steinman said.

The supplies needed include topical anesthetic (such as Hurricaine gel), dental needles, lidocaine Carpules, and a Carpule syringe. Dental syringes, which can be purchased from dental supply companies, are "incredibly" inexpensive, he noted.

The anesthesia requires nothing that is not already in the office, including anesthetic gel and "lots and lots of Q tips," he said.

If there's going to be a lot of dental gel in a patient's mouth during a cosmetic procedure, be sure to have some bottled water available, because many people really don't like the gel's taste.

Injected anesthetics that can be used to perform the mucosal block include lidocaine, bupivacaine, mepivacaine, and others.

Dr. Steinman outlined the procedure for performing the upper- and lower-lip mucosal block. "What you're blocking is the infraorbital nerve," he explained.

The first step in the procedure is to apply topical anesthetic. Then, at the gingival-buccal sulcus, just lateral to the apex of the canine tooth, inject a small amount of anesthetic approximately 0.5 cm upward along the maxilla. The next step is to inject from this point medially—in the potential space between the mucosa and the periosteum—along the sulcus to the frenulum.

The procedure should be repeated on the contralateral side. Inject a small amount from the sulcus next to the frenulum toward the anterior nasal spine, he added.

For the patient's lower lip, inject submucosally in the sulcus from the point below the oral commissure to the contralateral side.

Finally, because the nerve block does not reach the corners of the mouth, it is necessary to apply topical anesthetic on the mucosal surface of the oral commissures and then inject a small amount of anesthetic to anesthetize the corners of the mouth. Injecting these areas takes a total of about 15 seconds, Dr. Steinman noted.

It is also important to keep in mind that facial blocks do not impart any vasoconstriction, so consider injecting locally for procedures that result in bleeding, he added.

Dr. Steinman emphasized that the mucosal block works fast.

"This block will numb up someone's lip in approximately 10–15 seconds," he said. "As a matter of fact, when I'm doing it, the side I've numbed up will largely be numb by the time I get to the other side of the lip.

"So it's very effective for lip procedures, very effective for fillers especially," he said. "As we say in Southern California," he concluded, "this block rocks."

Dr. Steinman said that he had no relevant conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Your patients are secretly praying that what you're going to do is going to be painless. DR. STEINMAN

MAUI, HAWAII — An upper and lower lip mucosal block provides fast, easy, and effective regional anesthesia for lip procedures, Dr. Howard K. Steinman said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

"Learn this mucosal block," he urged. "It has revolutionized my practice more than any other simple technique I have learned in the last 5 years."

"When patients come to your office, they're secretly praying that what you're going to do is going to be painless," said Dr. Steinman of the University of California, San Diego.

"When you get patients ready for what they expect to be a happy, painless, rejuvenating experience, and they're unhappy," he explained, "everyone in the room is unhappy." Using the mucosal block greatly improves the satisfaction of patients.

Equipment required for the mucosal block procedure is simple and modestly priced.

"You don't need a multithousand-dollar energy device," Dr. Steinman said.

The supplies needed include topical anesthetic (such as Hurricaine gel), dental needles, lidocaine Carpules, and a Carpule syringe. Dental syringes, which can be purchased from dental supply companies, are "incredibly" inexpensive, he noted.

The anesthesia requires nothing that is not already in the office, including anesthetic gel and "lots and lots of Q tips," he said.

If there's going to be a lot of dental gel in a patient's mouth during a cosmetic procedure, be sure to have some bottled water available, because many people really don't like the gel's taste.

Injected anesthetics that can be used to perform the mucosal block include lidocaine, bupivacaine, mepivacaine, and others.

Dr. Steinman outlined the procedure for performing the upper- and lower-lip mucosal block. "What you're blocking is the infraorbital nerve," he explained.

The first step in the procedure is to apply topical anesthetic. Then, at the gingival-buccal sulcus, just lateral to the apex of the canine tooth, inject a small amount of anesthetic approximately 0.5 cm upward along the maxilla. The next step is to inject from this point medially—in the potential space between the mucosa and the periosteum—along the sulcus to the frenulum.

The procedure should be repeated on the contralateral side. Inject a small amount from the sulcus next to the frenulum toward the anterior nasal spine, he added.

For the patient's lower lip, inject submucosally in the sulcus from the point below the oral commissure to the contralateral side.

Finally, because the nerve block does not reach the corners of the mouth, it is necessary to apply topical anesthetic on the mucosal surface of the oral commissures and then inject a small amount of anesthetic to anesthetize the corners of the mouth. Injecting these areas takes a total of about 15 seconds, Dr. Steinman noted.

It is also important to keep in mind that facial blocks do not impart any vasoconstriction, so consider injecting locally for procedures that result in bleeding, he added.

Dr. Steinman emphasized that the mucosal block works fast.

"This block will numb up someone's lip in approximately 10–15 seconds," he said. "As a matter of fact, when I'm doing it, the side I've numbed up will largely be numb by the time I get to the other side of the lip.

"So it's very effective for lip procedures, very effective for fillers especially," he said. "As we say in Southern California," he concluded, "this block rocks."

Dr. Steinman said that he had no relevant conflicts of interest.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Your patients are secretly praying that what you're going to do is going to be painless. DR. STEINMAN