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Pigs infected with the zoonotic parasite Trichinella spiralis were detected on a farm in Maryland during an animal welfare investigation. Sera and/or tissues were collected from 49 pigs and three pig carcasses (7 weeks of age to adult, mixed sex). The tissues were tested for the presence of T. spiralis muscle larvae (ML) by tissue digestion, and the sera were tested for the presence of anti- Trichinella antibodies by ELISA. Seventeen of 50 (34%) pigs were infected with T. spiralis based on tissue digestion. Of these 17 pigs, sera were collected from 16; nine were serologically positive, three sera had OD values that were very close to the positive cut-off (0.30), but were still negative, and four were negative (suggesting that they had become infected within a few weeks of testing). All pigs that tested negative by tissue digestion for ML were also ELISA negative. The farm was subsequently depopulated of pigs. Six months later, testing of trapped scavenging mammals in the farm environment demonstrated that 41% were infected with T. spiralis. After 12 months, 10% of trapped animals were T. spiralis positive, and after 18 months, T. spiralis could not be detected in the scavenging mammal population surrounding the farm. Results of the study suggest that T. spiralis, typically transmitted in the peridomestic rat-pig-human cycle in the US, was not maintained in scavenging mammals in the absence of infected pigs. [ABSTRACT FROM AUTHOR]

( Headache 2010;50:937-942) Background.- Many clinicians use peripheral nerve blocks (NBs) and trigger point injections (TPIs) for the treatment of headaches. Little is known, however, about the patterns of use of these procedures among practitioners in the USA. Objectives.- The aim of this study was to obtain information on patterns of office-based use of peripheral NBs and TPIs by headache practitioners in the USA. Methods.- Using an Internet-based questionnaire, the Interventional Procedures Special Interest Section of the American Headache Society (AHS) conducted a survey among practitioners who were members of AHS on patterns of use of NBs and TPIs for headache treatment. Results.- Electronic invitations were sent to 1230 AHS members and 161 provided useable data (13.1%). Of the responders, 69% performed NBs and 75% performed TPIs. The most common indications for the use of NBs were occipital neuralgia and chronic migraine (CM), and the most common indications for the use of TPIs were chronic tension-type headache and CM. The most common symptom prompting the clinician to perform these procedures was local tenderness at the intended injection site. The most common local anesthetics used for these procedures were lidocaine and bupivacaine. Dosing regimens, volumes of injection, and injection schedules varied greatly. There was also a wide variation in the use of corticosteroids when performing the injections. Both NBs and TPIs were generally well tolerated. Conclusions.- Nerve blocks and TPIs are commonly used by headache practitioners in the USA for the treatment of various headache disorders, although the patterns of their use vary greatly. [ABSTRACT FROM AUTHOR]

( Headache 2010;50:943-952) Interventional procedures such as peripheral nerve blocks (PNBs) and trigger point injections (TPIs) have long been used in the treatment of various headache disorders. There are, however, little data on their efficacy for the treatment of specific headache syndromes. Moreover, there is no widely accepted agreement among headache specialists as to the optimal technique of injection, type, and doses of the local anesthetics used, and injection regimens. The role of corticosteroids in this setting is also debated. We performed a PubMed search of the literature to find studies on PNBs and TPIs for headache treatment. We classified the abstracted studies based on the procedure performed and the treated condition. We found few controlled studies on the efficacy of PNBs for headaches, and virtually none on the use of TPIs for this indication. The most widely examined procedure in this setting was greater occipital nerve block, with the majority of studies being small and non-controlled. The techniques, as well as the type and doses of local anesthetics used for nerve blockade, varied greatly among studies. The specific conditions treated also varied, and included both primary (eg, migraine, cluster headache) and secondary (eg, cervicogenic, posttraumatic) headache disorders. Trigeminal (eg, supraorbital) nerve blocks were used in few studies. Results were generally positive, but should be taken with reservation given the methodological limitations of the available studies. The procedures were generally well tolerated. Evidently, there is a need to perform more rigorous clinical trials to clarify the role of PNBs and TPIs in the management of various headache disorders, and to aim at standardizing the techniques used for the various procedures in this setting. [ABSTRACT FROM AUTHOR]

Expanded school mental health (ESMH) programs address the limitations of traditional mental health agencies in meeting the needs of youth by providing a full range of services in a familiar and nonstigmatizing setting. Because of the central role families play in the lives of children, their involvement in ESMH can enhance the effectiveness of treatments and ensure that services are responsive to the needs of the larger community. Increasing family involvement, however, is a complex and resource-intensive endeavor, and requires consideration of the goals of the ESMH program and potential obstacles to meeting those goals. The challenges of involving family members in ESMH, guidelines for determining the program's goals with respect to family involvement, and strategies for achieving these goals are described. Underlying the strategies is the need to be flexible, creative, and respectful of the beliefs and concerns of the families served by the ESMH program. [ABSTRACT FROM AUTHOR]