Lyme disease, while still an uncommon disease in the UK, is on the increase. Case numbers have increased by 3.6-fold since 2001, with over 950 cases reported by the Health Protection Agency (HPA) in 2011, compared with less than 500 cases annually pre-2004. HPA indications of the true incidence are suggested to be closer to 3000 cases/year, of which around 82% of cases are indigenously acquired. Three genospecies, Borrelia burgdorferi sensu stricto, Borrelia afzelli and Borrelia garinii, represent the predominant pathogenic variants in the UK. Erythema migrans is the commonest manifestation, occurring in 60%-91% of cases. In the UK, neuroborelliosis is the most common complication, while myocarditis is unusual, and death from either conduction disease or carditis is extremely rare. The role of Borrelia infection in chronic dilated cardiomyopathy in the UK remains unproven. Controversy over the existence of either 'chronic Lyme disease' and/or 'post-Lyme disease syndrome' continues unabated. National medical societies, patient advocacy groups, insurance companies, lawyers, doctors, the private health medical sector and scientific journals have all become embroiled in this bitter controversy. New developments include diagnostic tests able to detect Lyme disease at an earlier stage, shorter durations of antibiotic therapy and potential advances in vaccines against Borrelia.

Objective. Although Raynaud's phenomenon (RP) in adults is frequently reported as having been present since childhood, there have been no studies on the prevalence of RP in children. This study was undertaken to ascertain the prevalence of RP in children ages 12-15 years and to determine whether, as with other commonly reported symptoms, there were any associations with adverse psychosocial factors. Methods. A previously validated selfadministered RP questionnaire was distributed to 903 children ages 12-15 years, from 28 schools. The questionnaire also included questions on other common childhood symptoms and on adverse psychosocial factors.Results. Seven hundred twenty children responded (80%), in whom the prevalence of RP was 15%. This was higher in girls (18% versus 12%) and increased with age. After adjustment for age and sex, there was an association with reporting of current pain, both in the arm/shoulder region and elsewhere in the body. There were no associations with psychosocial variables.Conclusion. RP is frequent in children ages 12-15 years. Unlike other common childhood symptoms, RP showed no association with psychosocial factors in this study.Raynaud's phenomenon (RP) is a vasospastic disorder characterized by episodic color changes of blanching, cyanosis, and hyperemia in response to cold (1,2). It is frequently considered to be idiopathic, though it may be secondary to a number of different disease processes (3). Such processes, such as connective tissue diseases, are rare in the population. In contrast, population studies have shown that RP in adults is common, with prevalence estimates ranging from 4% to 30% (4-7). However, findings of all studies are consistent in suggesting a female excess (7-9). There have been no studies of the prevalence of RP in children, although the self-reported range of onset age in adults with RP frequently implies a childhood onset. Childhood is also a period in which other symptoms are frequently reported but are often considered to be of little, or unknown, pathologic significance, for example, limb pain, abdominal pain, headache (10-12). Such symptoms may be related to psychosocial factors: in a recent study of schoolchildren ages 11-14 years, we demonstrated that low back pain was more strongly associated with psychosocial and behavioral problems than with mechanical factors (13). The aim of the current study was to determine the prevalence of RP in children ages 12-15 years and its relationship to age and sex. We also investigated whether psychosocial factors, known to be associated with other childhood symptoms, were associated with RP. SUBJECTS AND METHODSStudy design. This was a cross-sectional prevalence study of RP in schoolchildren. Using validated instruments, we

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