Trigger Point Management.

Trigger points producing myofascial pain syndromes are common in primary care. Located within skeletal muscle, trigger points are taut, band-like nodules capable of producing pain and disability. Some evidence from clinical trials supports massage, physical therapy, and osteopathic manual medicine as first-line less invasive treatment strategies. Trigger points are often treated with injections; although randomized trials have found statistically significant results with trigger point injections, conclusions are limited by low numbers of study participants, difficulty in blinding, the potential for a placebo effect, and lack of posttreatment follow-up. No single pharmacologic agent used in trigger point injections has been proven superior to another, nor has any single agent been proven superior to placebo. Trigger point injections, therefore, should be reserved for patients whose myofascial pain has been refractory to other measures, and family physicians should first employ less invasive treatment strategies. Trigger point management is only one part of a comprehensive, multimodal, and team-based approach to patients with myofascial pain.

Building Capacity in Pediatric Environmental Health: The Academic Pediatric Association's Professional Development Program.

BACKGROUND: Environmental exposures contribute to multiple diseases in children; yet, few pediatricians have training in pediatric environmental health (PEH), and few academic health centers have PEH expertise. To build national capacity in PEH, the Academic Pediatric Association (APA) launched a professional development program that since 2002 has encouraged the establishment of post-residency/post-doctoral training programs, supported a special interest group, and convened an annual mentored retreat for PEH trainees. OBJECTIVE: Describe the APA's professional development program in PEH and assess its impact by tracking careers of former trainees. METHODS: Careers were tracked through interviews with trainees and program directors supplemented by searches of institutional websites. Publication listings were obtained through PubMed. Publication impact was assessed using bibliometric and altmetric measures. Grant histories were accessed through the National Institutes of Health RePORTER project. Information on advocacy work was obtained through interviews with program directors. RESULTS: Fifty-five trainees (36 physicians and 19 health scientists) completed PEH training and attended the APA retreat between 2002 and 2017. Forty-one (75%) are pursuing academic careers, 11 are associate or full professors, 11 are practicing general pediatrics or a pediatric subspecialty, 2 are Centers for Disease Control and Prevention epidemiologists, and 1 is a data scientist. Forty-two former trainees (76%) listed "environment" or "environmental" in their job titles or on their websites. Former trainees have published 632 scientific papers. These papers have been cited 3094times, have a relative citation ratio of 2.97, and have been read or viewed 1,274,388times. Twenty-one former trainees have been awarded 43 National Institutes of Health grants. Trainees have developed education and advocacy skills by teaching medical students and residents, presenting grand rounds, preparing policy papers, presenting legislative testimony, and making presentations to public audiences. CONCLUSIONS: The APA's professional development program has contributed to the expansion of national capacity in PEH. Former trainees are populating the field, generating new knowledge, and moving into leadership positions.

Developmental Exposure to Polybrominated Diphenyl Ethers and Neurodevelopment.

Exposure to polybrominated diphenyl ethers (PBDE) during sensitive developmental windows can interfere with cognitive function and behavior, which are critical components of neurodevelopment. The association between developmental exposure to PBDEs and neurodevelopment has been extensively studied using animal models. In this review, we focus on the accumulating evidence in humans. Despite methodological, geographical, and temporal differences between studies, the majority of the epidemiologic evidence supports that early life exposure to PBDEs measured during pregnancy and/or during childhood is detrimental to child neurodevelopment in domains related to child behavior, cognition, and motor skills. While the precise mechanism of action of PBDEs on neurodevelopment is unknown, PBDE-induced neurotoxicity via thyroid hormone disruption and direct action of PBDEs on the developing brain have been proposed and tested. Additional studies are suggested to better understand how early life and/or childhood PBDE exposures, including exposure to specific PBDE congeners, impact neurodevelopmental indices.