Betsy Bates

SANTA BARBARA, CALIF. – Enhancing positive thinking may be the best way to help severely mentally ill alcohol abusers reduce their dependence on alcohol, a State University of New York at Buffalo study suggests.

Clara M. Bradizza, Ph.D., and associates at the Research Institute on Addictions at the State University of New York at Buffalo studied the relationship between coping behaviors and substance abuse recovery in 171 patients with bipolar disorder or schizophrenia-spectrum disorder.

Participants were recruited from a university-affiliated, mental health center, dual-diagnosis treatment program.

At the completion of 6 months of substance abuse treatment, they were asked which of four coping strategies they used most to avoid alcohol relapse:

▸ Positive thinking (e.g., “Thinking how much better off I am without drinking”)

▸ Negative thinking (e.g., “Thinking of the mess I've got myself in because of drinking”)

▸ Avoidance/distraction (e.g., “Keeping away from people who drink”)

▸ Seeking social support (e.g., “Going to an AA meeting”)

Positive thinking was negatively related to the total number of drinks over the previous 60 days, the percentage of days patients consumed alcohol, and the average number of drinks during the 60-day period, and was positively related to the percentage of days abstinent from alcohol, Dr. Bradizza and her associates reported at the annual meeting of the Research Society on Alcoholism.

In other words, participants who drew on positive thinking most often during their recovery were doing a better job of reducing their alcohol consumption.

Negative thinking was associated with higher rates of drinking on two outcome measures: total number of drinks during the 60-day period and average number of drinks over the 60-day period.

Social support was marginally correlated with a reduction in drug use and abstinence from drugs, although the researchers said the connections need “further exploration.”

“Overall, these results indicate that alcohol-specific coping strategies may be a productive avenue of research aimed at improving treatments for seriously mentally ill individuals diagnosed with an alcohol or drug-use disorder,” the authors concluded in a poster presented at the meeting.

SANTA BARBARA, CALIF. – Enhancing positive thinking may be the best way to help severely mentally ill alcohol abusers reduce their dependence on alcohol, a State University of New York at Buffalo study suggests.

Clara M. Bradizza, Ph.D., and associates at the Research Institute on Addictions at the State University of New York at Buffalo studied the relationship between coping behaviors and substance abuse recovery in 171 patients with bipolar disorder or schizophrenia-spectrum disorder.

Participants were recruited from a university-affiliated, mental health center, dual-diagnosis treatment program.

At the completion of 6 months of substance abuse treatment, they were asked which of four coping strategies they used most to avoid alcohol relapse:

▸ Positive thinking (e.g., “Thinking how much better off I am without drinking”)

▸ Negative thinking (e.g., “Thinking of the mess I've got myself in because of drinking”)

▸ Avoidance/distraction (e.g., “Keeping away from people who drink”)

▸ Seeking social support (e.g., “Going to an AA meeting”)

Positive thinking was negatively related to the total number of drinks over the previous 60 days, the percentage of days patients consumed alcohol, and the average number of drinks during the 60-day period, and was positively related to the percentage of days abstinent from alcohol, Dr. Bradizza and her associates reported at the annual meeting of the Research Society on Alcoholism.

In other words, participants who drew on positive thinking most often during their recovery were doing a better job of reducing their alcohol consumption.

Negative thinking was associated with higher rates of drinking on two outcome measures: total number of drinks during the 60-day period and average number of drinks over the 60-day period.

Social support was marginally correlated with a reduction in drug use and abstinence from drugs, although the researchers said the connections need “further exploration.”

“Overall, these results indicate that alcohol-specific coping strategies may be a productive avenue of research aimed at improving treatments for seriously mentally ill individuals diagnosed with an alcohol or drug-use disorder,” the authors concluded in a poster presented at the meeting.

SANTA BARBARA, CALIF. – Enhancing positive thinking may be the best way to help severely mentally ill alcohol abusers reduce their dependence on alcohol, a State University of New York at Buffalo study suggests.

Clara M. Bradizza, Ph.D., and associates at the Research Institute on Addictions at the State University of New York at Buffalo studied the relationship between coping behaviors and substance abuse recovery in 171 patients with bipolar disorder or schizophrenia-spectrum disorder.

Participants were recruited from a university-affiliated, mental health center, dual-diagnosis treatment program.

At the completion of 6 months of substance abuse treatment, they were asked which of four coping strategies they used most to avoid alcohol relapse:

▸ Positive thinking (e.g., “Thinking how much better off I am without drinking”)

▸ Negative thinking (e.g., “Thinking of the mess I've got myself in because of drinking”)

▸ Avoidance/distraction (e.g., “Keeping away from people who drink”)

▸ Seeking social support (e.g., “Going to an AA meeting”)

Positive thinking was negatively related to the total number of drinks over the previous 60 days, the percentage of days patients consumed alcohol, and the average number of drinks during the 60-day period, and was positively related to the percentage of days abstinent from alcohol, Dr. Bradizza and her associates reported at the annual meeting of the Research Society on Alcoholism.

In other words, participants who drew on positive thinking most often during their recovery were doing a better job of reducing their alcohol consumption.

Negative thinking was associated with higher rates of drinking on two outcome measures: total number of drinks during the 60-day period and average number of drinks over the 60-day period.

Social support was marginally correlated with a reduction in drug use and abstinence from drugs, although the researchers said the connections need “further exploration.”

“Overall, these results indicate that alcohol-specific coping strategies may be a productive avenue of research aimed at improving treatments for seriously mentally ill individuals diagnosed with an alcohol or drug-use disorder,” the authors concluded in a poster presented at the meeting.

SANTA BARBARA, CALIF. – A comprehensive 10-year study of Alcoholics Anonymous participants has unveiled several surprising, sometimes counterintuitive findings about the program's influence over a membership that numbers more than 1.2 million in the United States and 2 million worldwide.

Perhaps most notably, J. Scott Tonigan, Ph.D., and his associates at the University of New Mexico, Albuquerque, found that many one-time AA participants rarely or never attend meetings and may not place much stock in a higher power's role in their recovery, yet continue to read AA literature and believe that the organization helps them stay sober.

One of the underlying premises of AA is that, to be successful, members must commit to lifelong abstinence and meeting attendance, as well as dedication to a “spiritual awakening” that includes turning over to “a power greater than themselves” the control alcohol holds over their lives.

'A Little Bit of Heresy'

Eight of the 12 steps forming AA's core framework mention a higher power, “God, as we understand Him,” and/or prayer.

“It's a little bit of heresy to say one can benefit from a 12-step program without believing in a higher power, but there are people who do just that,” Dr. Tonigan said in an interview after his presentation of 10 posters detailing his study at the annual meeting of the Research Society on Alcoholism.

Dr. Tonigan and his associates at the university's Center on Alcoholism, Substance Abuse, and Addictions followed up on participants in the Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH) study, which, in the mid-1990s, recruited 226 heavy drinkers and randomly assigned them to one of three manual-guided, therapist-client therapies: cognitive-behavioral therapy (CBT), motivational enhancement training (MET), or 12-step facilitation aimed at “engaging clients into the lifelong program of AA.”

In the ensuing 10 years, some participants died and others were lost to follow-up, but investigators achieved a remarkable 85% follow-up rate among 175 eligible subjects. They conducted lengthy interviews and obtained detailed drinking and lifestyle information from 50 participants who had undergone CBT, 48 who received MET, and 52 assigned to 12-step facilitation.

“This study offered a rare, long-term view of treatment outcome,” Dr. Tonigan and coinvestigator William R. Miller, Ph.D., also of the University of New Mexico, noted in a poster.

Dr. Tonigan and Dr. Miller found that people in all three groups were doing quite well 10 years after the intervention, both in terms of the number of days they remained abstinent and in their total number of drinks per drinking day, compared with baseline drinking patterns.

There was no relationship, however, between which therapy they had received and their current abstinence or drinking intensity. “In fact, while at the end of year 1 and year 3, 12-step facilitation clients reported significantly higher rates of complete abstinence relative to CBT and MET, this advantage was lost such that the 12-step facilitation clients reported the lowest rates of abstinence (24%) at 10-year follow-up,” they reported.

Total abstinence rates in the CBT group and MET group were 31% and 35%, respectively.

Meetings: 'One Dimension'

A closer look at 51 of the clients originally assigned to the 12-step group found that just 5 achieved sustained and regular 10-year attendance at AA meetings. Sixteen more attended erratically over the years, but at the time of follow-up fewer than half were attending AA meetings.

Dr. Tonigan stressed that meeting attendance is “but one dimension of the AA experience.”

Members of the original 12-step group still drew on AA for support, with 22 of 51 reporting that they still read AA core literature and 25 saying that they considered themselves members of AA. Moreover, AA appeared to be “an important resource” for study participants assigned to the non-12-step arms of the study, he said.

Overall, 66% of all 151 Project MATCH clients who participated in the follow-up said they attended AA during or after the original study. Recent AA attendance was reported by 39%.

“This percentage increased to 49% when non-AA meeting behaviors and beliefs were included to define commitment to AA doctrine, e.g., reading core AA literature. It is clear, therefore, that problem drinkers view AA as a valuable resource regardless of formal treatment orientation,” Dr. Tonigan wrote.

A separate analysis found that regular attendees of AA meetings were more likely than were erratic or former attendees to express commitment to core elements of the program, including making amends, believing in and deferring to a higher power, and participating in fellowship and step activities of AA. Some of these activities predicted abstinence or total alcohol consumed among consistent AA attendees, but belief in a higher power and deferring to that power did not.

Among erratic or former AAattendees, no relationship could be seen between commitment to the core elements of the program and abstinence or a reduction in drinking, despite the fact that one in four said AA was “pretty helpful” or “very helpful” in combating their drinking problems.

Dr. Tonigan said it is vital to find out which elements of AA are successful, so that those elements can be integrated into therapy for people who choose not to stay in the formal AA program.

Of the 12 Steps, 8 Are Godly

Eight of the 12 steps forming Alcoholics Anonymous' core framework mention a higher power, “God, as we understand Him,” and/or prayer. The 12 steps describe the experience of the organization's early members:

1. We admitted we were powerless over alcohol–that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Reprinted with permission of Alcoholics Anonymous World Services Inc.

SANTA BARBARA, CALIF. – A comprehensive 10-year study of Alcoholics Anonymous participants has unveiled several surprising, sometimes counterintuitive findings about the program's influence over a membership that numbers more than 1.2 million in the United States and 2 million worldwide.

Perhaps most notably, J. Scott Tonigan, Ph.D., and his associates at the University of New Mexico, Albuquerque, found that many one-time AA participants rarely or never attend meetings and may not place much stock in a higher power's role in their recovery, yet continue to read AA literature and believe that the organization helps them stay sober.

One of the underlying premises of AA is that, to be successful, members must commit to lifelong abstinence and meeting attendance, as well as dedication to a “spiritual awakening” that includes turning over to “a power greater than themselves” the control alcohol holds over their lives.

'A Little Bit of Heresy'

Eight of the 12 steps forming AA's core framework mention a higher power, “God, as we understand Him,” and/or prayer.

“It's a little bit of heresy to say one can benefit from a 12-step program without believing in a higher power, but there are people who do just that,” Dr. Tonigan said in an interview after his presentation of 10 posters detailing his study at the annual meeting of the Research Society on Alcoholism.

Dr. Tonigan and his associates at the university's Center on Alcoholism, Substance Abuse, and Addictions followed up on participants in the Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH) study, which, in the mid-1990s, recruited 226 heavy drinkers and randomly assigned them to one of three manual-guided, therapist-client therapies: cognitive-behavioral therapy (CBT), motivational enhancement training (MET), or 12-step facilitation aimed at “engaging clients into the lifelong program of AA.”

In the ensuing 10 years, some participants died and others were lost to follow-up, but investigators achieved a remarkable 85% follow-up rate among 175 eligible subjects. They conducted lengthy interviews and obtained detailed drinking and lifestyle information from 50 participants who had undergone CBT, 48 who received MET, and 52 assigned to 12-step facilitation.

“This study offered a rare, long-term view of treatment outcome,” Dr. Tonigan and coinvestigator William R. Miller, Ph.D., also of the University of New Mexico, noted in a poster.

Dr. Tonigan and Dr. Miller found that people in all three groups were doing quite well 10 years after the intervention, both in terms of the number of days they remained abstinent and in their total number of drinks per drinking day, compared with baseline drinking patterns.

There was no relationship, however, between which therapy they had received and their current abstinence or drinking intensity. “In fact, while at the end of year 1 and year 3, 12-step facilitation clients reported significantly higher rates of complete abstinence relative to CBT and MET, this advantage was lost such that the 12-step facilitation clients reported the lowest rates of abstinence (24%) at 10-year follow-up,” they reported.

Total abstinence rates in the CBT group and MET group were 31% and 35%, respectively.

Meetings: 'One Dimension'

A closer look at 51 of the clients originally assigned to the 12-step group found that just 5 achieved sustained and regular 10-year attendance at AA meetings. Sixteen more attended erratically over the years, but at the time of follow-up fewer than half were attending AA meetings.

Dr. Tonigan stressed that meeting attendance is “but one dimension of the AA experience.”

Members of the original 12-step group still drew on AA for support, with 22 of 51 reporting that they still read AA core literature and 25 saying that they considered themselves members of AA. Moreover, AA appeared to be “an important resource” for study participants assigned to the non-12-step arms of the study, he said.

Overall, 66% of all 151 Project MATCH clients who participated in the follow-up said they attended AA during or after the original study. Recent AA attendance was reported by 39%.

“This percentage increased to 49% when non-AA meeting behaviors and beliefs were included to define commitment to AA doctrine, e.g., reading core AA literature. It is clear, therefore, that problem drinkers view AA as a valuable resource regardless of formal treatment orientation,” Dr. Tonigan wrote.

A separate analysis found that regular attendees of AA meetings were more likely than were erratic or former attendees to express commitment to core elements of the program, including making amends, believing in and deferring to a higher power, and participating in fellowship and step activities of AA. Some of these activities predicted abstinence or total alcohol consumed among consistent AA attendees, but belief in a higher power and deferring to that power did not.

Among erratic or former AAattendees, no relationship could be seen between commitment to the core elements of the program and abstinence or a reduction in drinking, despite the fact that one in four said AA was “pretty helpful” or “very helpful” in combating their drinking problems.

Dr. Tonigan said it is vital to find out which elements of AA are successful, so that those elements can be integrated into therapy for people who choose not to stay in the formal AA program.

Of the 12 Steps, 8 Are Godly

Eight of the 12 steps forming Alcoholics Anonymous' core framework mention a higher power, “God, as we understand Him,” and/or prayer. The 12 steps describe the experience of the organization's early members:

1. We admitted we were powerless over alcohol–that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Reprinted with permission of Alcoholics Anonymous World Services Inc.

SANTA BARBARA, CALIF. – A comprehensive 10-year study of Alcoholics Anonymous participants has unveiled several surprising, sometimes counterintuitive findings about the program's influence over a membership that numbers more than 1.2 million in the United States and 2 million worldwide.

Perhaps most notably, J. Scott Tonigan, Ph.D., and his associates at the University of New Mexico, Albuquerque, found that many one-time AA participants rarely or never attend meetings and may not place much stock in a higher power's role in their recovery, yet continue to read AA literature and believe that the organization helps them stay sober.

One of the underlying premises of AA is that, to be successful, members must commit to lifelong abstinence and meeting attendance, as well as dedication to a “spiritual awakening” that includes turning over to “a power greater than themselves” the control alcohol holds over their lives.

'A Little Bit of Heresy'

Eight of the 12 steps forming AA's core framework mention a higher power, “God, as we understand Him,” and/or prayer.

“It's a little bit of heresy to say one can benefit from a 12-step program without believing in a higher power, but there are people who do just that,” Dr. Tonigan said in an interview after his presentation of 10 posters detailing his study at the annual meeting of the Research Society on Alcoholism.

Dr. Tonigan and his associates at the university's Center on Alcoholism, Substance Abuse, and Addictions followed up on participants in the Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH) study, which, in the mid-1990s, recruited 226 heavy drinkers and randomly assigned them to one of three manual-guided, therapist-client therapies: cognitive-behavioral therapy (CBT), motivational enhancement training (MET), or 12-step facilitation aimed at “engaging clients into the lifelong program of AA.”

In the ensuing 10 years, some participants died and others were lost to follow-up, but investigators achieved a remarkable 85% follow-up rate among 175 eligible subjects. They conducted lengthy interviews and obtained detailed drinking and lifestyle information from 50 participants who had undergone CBT, 48 who received MET, and 52 assigned to 12-step facilitation.

“This study offered a rare, long-term view of treatment outcome,” Dr. Tonigan and coinvestigator William R. Miller, Ph.D., also of the University of New Mexico, noted in a poster.

Dr. Tonigan and Dr. Miller found that people in all three groups were doing quite well 10 years after the intervention, both in terms of the number of days they remained abstinent and in their total number of drinks per drinking day, compared with baseline drinking patterns.

There was no relationship, however, between which therapy they had received and their current abstinence or drinking intensity. “In fact, while at the end of year 1 and year 3, 12-step facilitation clients reported significantly higher rates of complete abstinence relative to CBT and MET, this advantage was lost such that the 12-step facilitation clients reported the lowest rates of abstinence (24%) at 10-year follow-up,” they reported.

Total abstinence rates in the CBT group and MET group were 31% and 35%, respectively.

Meetings: 'One Dimension'

A closer look at 51 of the clients originally assigned to the 12-step group found that just 5 achieved sustained and regular 10-year attendance at AA meetings. Sixteen more attended erratically over the years, but at the time of follow-up fewer than half were attending AA meetings.

Dr. Tonigan stressed that meeting attendance is “but one dimension of the AA experience.”

Members of the original 12-step group still drew on AA for support, with 22 of 51 reporting that they still read AA core literature and 25 saying that they considered themselves members of AA. Moreover, AA appeared to be “an important resource” for study participants assigned to the non-12-step arms of the study, he said.

Overall, 66% of all 151 Project MATCH clients who participated in the follow-up said they attended AA during or after the original study. Recent AA attendance was reported by 39%.

“This percentage increased to 49% when non-AA meeting behaviors and beliefs were included to define commitment to AA doctrine, e.g., reading core AA literature. It is clear, therefore, that problem drinkers view AA as a valuable resource regardless of formal treatment orientation,” Dr. Tonigan wrote.

A separate analysis found that regular attendees of AA meetings were more likely than were erratic or former attendees to express commitment to core elements of the program, including making amends, believing in and deferring to a higher power, and participating in fellowship and step activities of AA. Some of these activities predicted abstinence or total alcohol consumed among consistent AA attendees, but belief in a higher power and deferring to that power did not.

Among erratic or former AAattendees, no relationship could be seen between commitment to the core elements of the program and abstinence or a reduction in drinking, despite the fact that one in four said AA was “pretty helpful” or “very helpful” in combating their drinking problems.

Dr. Tonigan said it is vital to find out which elements of AA are successful, so that those elements can be integrated into therapy for people who choose not to stay in the formal AA program.

Of the 12 Steps, 8 Are Godly

Eight of the 12 steps forming Alcoholics Anonymous' core framework mention a higher power, “God, as we understand Him,” and/or prayer. The 12 steps describe the experience of the organization's early members:

1. We admitted we were powerless over alcohol–that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Reprinted with permission of Alcoholics Anonymous World Services Inc.

SANTA BARBARA, CALIF. – Longitudinal data from a large national alcohol abuse survey suggests that the gender gap is narrowing with regard to drinking and driving: Women's rates of risky alcohol-related driving behaviors are actually increasing in some cases.

“The worldwide decline in alcohol-related traffic fatalities seems to have leveled off or reversed in recent years,” said S. Patricia Chou, Ph.D., at the annual meeting of the Research Society on Alcoholism.

A careful look at trends in drinking and driving patterns may help to explain why.

Some news was positive when Dr. Chou reported on data collected in 1991–1992 and then again in 2001–2002 as part of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a landmark, long-term survey of the National Institute of Alcohol Abuse and Alcoholism.

Over the 10-year period, driving after drinking declined a remarkable 22%, from a prevalence of 3.7% down to 2.9% of the nationally representative sample of 43,093 people.

The decline was greatest (33%) among 18- to 29-year-olds.

Despite that trend, the number of Americans who drive after drinking is still high, “posing significant risks on America's roadways,” she said.

The data showed the behavior peaked among 22- and 23-year-olds in 2001–2002, with the prevalence rates of driving after drinking at those ages of 11.5% and 10.4%.

The study highlighted several potentially worrisome patterns over time.

More 21- and 23-year-old females were driving after drinking in 2001–2002 than they were in 1991–1992. Although the difference was not statistically significant, there was certainly no decline in this behavior among young women.

Drinking while actually driving also declined overall in the 10-year time period, but not among females aged 45–64 years, or among Hispanic females aged 18–29 years. These two groups posted significant increases in drinking while driving, according to the survey.

Drinking while driving was rare among young Hispanic females in 1991–1992, when the prevalence in that group was 0.5%. That rate rose to 2% in 2001–2002.

Overall, males in 2001–2002 still drank while driving at rates 2–3 times higher than females.

Among racial and ethnic groups, Dr. Chou reported that Native Americans had the highest rates of drinking while driving, followed by whites. Both groups had significantly higher rates of the risky behavior than did Hispanics, African Americans, or Asian Americans.

Other high-risk groups for drinking and driving included underage youths, males, and 18- to 29-year-olds.

Dr. Chou and her associates at the NIAA division of intramural clinical and biological research surveyed four drinking and driving behaviors: drinking while driving, driving after drinking, riding as a passenger in a car driven by a drinking driver, and riding as a passenger while drinking.

SANTA BARBARA, CALIF. – Longitudinal data from a large national alcohol abuse survey suggests that the gender gap is narrowing with regard to drinking and driving: Women's rates of risky alcohol-related driving behaviors are actually increasing in some cases.

“The worldwide decline in alcohol-related traffic fatalities seems to have leveled off or reversed in recent years,” said S. Patricia Chou, Ph.D., at the annual meeting of the Research Society on Alcoholism.

A careful look at trends in drinking and driving patterns may help to explain why.

Some news was positive when Dr. Chou reported on data collected in 1991–1992 and then again in 2001–2002 as part of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a landmark, long-term survey of the National Institute of Alcohol Abuse and Alcoholism.

Over the 10-year period, driving after drinking declined a remarkable 22%, from a prevalence of 3.7% down to 2.9% of the nationally representative sample of 43,093 people.

The decline was greatest (33%) among 18- to 29-year-olds.

Despite that trend, the number of Americans who drive after drinking is still high, “posing significant risks on America's roadways,” she said.

The data showed the behavior peaked among 22- and 23-year-olds in 2001–2002, with the prevalence rates of driving after drinking at those ages of 11.5% and 10.4%.

The study highlighted several potentially worrisome patterns over time.

More 21- and 23-year-old females were driving after drinking in 2001–2002 than they were in 1991–1992. Although the difference was not statistically significant, there was certainly no decline in this behavior among young women.

Drinking while actually driving also declined overall in the 10-year time period, but not among females aged 45–64 years, or among Hispanic females aged 18–29 years. These two groups posted significant increases in drinking while driving, according to the survey.

Drinking while driving was rare among young Hispanic females in 1991–1992, when the prevalence in that group was 0.5%. That rate rose to 2% in 2001–2002.

Overall, males in 2001–2002 still drank while driving at rates 2–3 times higher than females.

Among racial and ethnic groups, Dr. Chou reported that Native Americans had the highest rates of drinking while driving, followed by whites. Both groups had significantly higher rates of the risky behavior than did Hispanics, African Americans, or Asian Americans.

Other high-risk groups for drinking and driving included underage youths, males, and 18- to 29-year-olds.

Dr. Chou and her associates at the NIAA division of intramural clinical and biological research surveyed four drinking and driving behaviors: drinking while driving, driving after drinking, riding as a passenger in a car driven by a drinking driver, and riding as a passenger while drinking.

SANTA BARBARA, CALIF. – Longitudinal data from a large national alcohol abuse survey suggests that the gender gap is narrowing with regard to drinking and driving: Women's rates of risky alcohol-related driving behaviors are actually increasing in some cases.

“The worldwide decline in alcohol-related traffic fatalities seems to have leveled off or reversed in recent years,” said S. Patricia Chou, Ph.D., at the annual meeting of the Research Society on Alcoholism.

A careful look at trends in drinking and driving patterns may help to explain why.

Some news was positive when Dr. Chou reported on data collected in 1991–1992 and then again in 2001–2002 as part of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a landmark, long-term survey of the National Institute of Alcohol Abuse and Alcoholism.

Over the 10-year period, driving after drinking declined a remarkable 22%, from a prevalence of 3.7% down to 2.9% of the nationally representative sample of 43,093 people.

The decline was greatest (33%) among 18- to 29-year-olds.

Despite that trend, the number of Americans who drive after drinking is still high, “posing significant risks on America's roadways,” she said.

The data showed the behavior peaked among 22- and 23-year-olds in 2001–2002, with the prevalence rates of driving after drinking at those ages of 11.5% and 10.4%.

The study highlighted several potentially worrisome patterns over time.

More 21- and 23-year-old females were driving after drinking in 2001–2002 than they were in 1991–1992. Although the difference was not statistically significant, there was certainly no decline in this behavior among young women.

Drinking while actually driving also declined overall in the 10-year time period, but not among females aged 45–64 years, or among Hispanic females aged 18–29 years. These two groups posted significant increases in drinking while driving, according to the survey.

Drinking while driving was rare among young Hispanic females in 1991–1992, when the prevalence in that group was 0.5%. That rate rose to 2% in 2001–2002.

Overall, males in 2001–2002 still drank while driving at rates 2–3 times higher than females.

Among racial and ethnic groups, Dr. Chou reported that Native Americans had the highest rates of drinking while driving, followed by whites. Both groups had significantly higher rates of the risky behavior than did Hispanics, African Americans, or Asian Americans.

Other high-risk groups for drinking and driving included underage youths, males, and 18- to 29-year-olds.

Dr. Chou and her associates at the NIAA division of intramural clinical and biological research surveyed four drinking and driving behaviors: drinking while driving, driving after drinking, riding as a passenger in a car driven by a drinking driver, and riding as a passenger while drinking.

SANTA BARBARA, CALIF. – The psychiatric and behavioral consequences of heavy prenatal alcohol exposure on children are abundantly clear by midchildhood and adolescence, based on studies presented at the annual meeting of the Research Society on Alcoholism.

One study found that children exposed prenatally to alcohol were far more likely than their peers to meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, tic disorders, and mood disorders by the time they were 8–14 years old.

Another study assessed social problem-solving skills and executive functioning in adolescents who were heavily exposed to alcohol in utero. Profound impairments were found in both types of skills, which are integral to academic achievement and social interaction.

The studies were conducted by researchers from the Center for Behavioral Teratology at San Diego State University and were presented in poster form.

Sarah N. Mattson, Ph.D., a senior author on the studies, said in an interview that “heavy alcohol exposure” was equivalent to about a case of beer or a fifth of hard liquor a day.

Susanna L. Fryer, a doctoral student at the center, explored childhood psychopathologies in 43 alcohol-exposed and 22 nonexposed children using structured interviews with primary caregivers.

“The difference within the ADHD category was, by far, the largest [group] effect observed,” she concluded. By the numbers, 42 of 43 alcohol-exposed children met diagnostic criteria for ADHD, compared with 1 of 22 nonexposed children matched by age and socioeconomic status.

Nearly a third (13 of 43) of the alcohol-exposed children had oppositional defiant disorder, but just one nonexposed child met the criteria for that diagnosis. Mood disorders were found in eight alcohol-exposed children, tic disorders in four, and conduct disorder in five. No child in the control group met the diagnostic criteria for any of those illnesses.

“Certain psychiatric disorders may be more prevalent than others in fetal alcohol spectrum disorders; disruptive psychopathologies were particularly common in our sample, while anxiety disorders were not,” wrote Ms. Fryer.

Similarly, children exposed to alcohol prenatally were no more likely than controls to have simple phobias.

Christie L. McGee, who is also a doctoral student at the center, reported on social problem-solving deficits in 43 adolescents aged 13–18 years, 24 of whom were prenatally exposed to heavy alcohol use.

The adolescents completed the Revised Social Problem-Solving Inventory (SPSI-R), which measures an individual's ability to resolve the problems of everyday living. Their parents or caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF), which includes subscales on such characteristics as a child's emotional control, working memory, and ability to plan and organize. Responses were anonymous.

Very large differences were found between the alcohol-exposed and nonexposed adolescents, with effect sizes ranging from 1.32 to 1.41 for problem solving skills and 1.96 to 4.61 for executive functioning. Those exposed to alcohol in utero “approached problems with a pessimistic orientation and indicated a low frustration tolerance,” said Ms. McGee.

“[They] rated themselves as less effective at identifying problems, generating solutions, making decisions, and implementing and verifying the chosen solution … [and were] more likely to endorse an avoidant, careless, or impulsive approach to solving their everyday problems,” she continued.

Their most pronounced deficits in executive function were in the subscales of planning and organizing, monitoring, initiation, and working memory.

“Such difficulties may result in increased disruptive behaviors, poor self-esteem, reduced seeking of meaningful relationships, and isolation,” Ms. McGee noted.

SANTA BARBARA, CALIF. – The psychiatric and behavioral consequences of heavy prenatal alcohol exposure on children are abundantly clear by midchildhood and adolescence, based on studies presented at the annual meeting of the Research Society on Alcoholism.

One study found that children exposed prenatally to alcohol were far more likely than their peers to meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, tic disorders, and mood disorders by the time they were 8–14 years old.

Another study assessed social problem-solving skills and executive functioning in adolescents who were heavily exposed to alcohol in utero. Profound impairments were found in both types of skills, which are integral to academic achievement and social interaction.

The studies were conducted by researchers from the Center for Behavioral Teratology at San Diego State University and were presented in poster form.

Sarah N. Mattson, Ph.D., a senior author on the studies, said in an interview that “heavy alcohol exposure” was equivalent to about a case of beer or a fifth of hard liquor a day.

Susanna L. Fryer, a doctoral student at the center, explored childhood psychopathologies in 43 alcohol-exposed and 22 nonexposed children using structured interviews with primary caregivers.

“The difference within the ADHD category was, by far, the largest [group] effect observed,” she concluded. By the numbers, 42 of 43 alcohol-exposed children met diagnostic criteria for ADHD, compared with 1 of 22 nonexposed children matched by age and socioeconomic status.

Nearly a third (13 of 43) of the alcohol-exposed children had oppositional defiant disorder, but just one nonexposed child met the criteria for that diagnosis. Mood disorders were found in eight alcohol-exposed children, tic disorders in four, and conduct disorder in five. No child in the control group met the diagnostic criteria for any of those illnesses.

“Certain psychiatric disorders may be more prevalent than others in fetal alcohol spectrum disorders; disruptive psychopathologies were particularly common in our sample, while anxiety disorders were not,” wrote Ms. Fryer.

Similarly, children exposed to alcohol prenatally were no more likely than controls to have simple phobias.

Christie L. McGee, who is also a doctoral student at the center, reported on social problem-solving deficits in 43 adolescents aged 13–18 years, 24 of whom were prenatally exposed to heavy alcohol use.

The adolescents completed the Revised Social Problem-Solving Inventory (SPSI-R), which measures an individual's ability to resolve the problems of everyday living. Their parents or caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF), which includes subscales on such characteristics as a child's emotional control, working memory, and ability to plan and organize. Responses were anonymous.

Very large differences were found between the alcohol-exposed and nonexposed adolescents, with effect sizes ranging from 1.32 to 1.41 for problem solving skills and 1.96 to 4.61 for executive functioning. Those exposed to alcohol in utero “approached problems with a pessimistic orientation and indicated a low frustration tolerance,” said Ms. McGee.

“[They] rated themselves as less effective at identifying problems, generating solutions, making decisions, and implementing and verifying the chosen solution … [and were] more likely to endorse an avoidant, careless, or impulsive approach to solving their everyday problems,” she continued.

Their most pronounced deficits in executive function were in the subscales of planning and organizing, monitoring, initiation, and working memory.

“Such difficulties may result in increased disruptive behaviors, poor self-esteem, reduced seeking of meaningful relationships, and isolation,” Ms. McGee noted.

SANTA BARBARA, CALIF. – The psychiatric and behavioral consequences of heavy prenatal alcohol exposure on children are abundantly clear by midchildhood and adolescence, based on studies presented at the annual meeting of the Research Society on Alcoholism.

One study found that children exposed prenatally to alcohol were far more likely than their peers to meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, tic disorders, and mood disorders by the time they were 8–14 years old.

Another study assessed social problem-solving skills and executive functioning in adolescents who were heavily exposed to alcohol in utero. Profound impairments were found in both types of skills, which are integral to academic achievement and social interaction.

The studies were conducted by researchers from the Center for Behavioral Teratology at San Diego State University and were presented in poster form.

Sarah N. Mattson, Ph.D., a senior author on the studies, said in an interview that “heavy alcohol exposure” was equivalent to about a case of beer or a fifth of hard liquor a day.

Susanna L. Fryer, a doctoral student at the center, explored childhood psychopathologies in 43 alcohol-exposed and 22 nonexposed children using structured interviews with primary caregivers.

“The difference within the ADHD category was, by far, the largest [group] effect observed,” she concluded. By the numbers, 42 of 43 alcohol-exposed children met diagnostic criteria for ADHD, compared with 1 of 22 nonexposed children matched by age and socioeconomic status.

Nearly a third (13 of 43) of the alcohol-exposed children had oppositional defiant disorder, but just one nonexposed child met the criteria for that diagnosis. Mood disorders were found in eight alcohol-exposed children, tic disorders in four, and conduct disorder in five. No child in the control group met the diagnostic criteria for any of those illnesses.

“Certain psychiatric disorders may be more prevalent than others in fetal alcohol spectrum disorders; disruptive psychopathologies were particularly common in our sample, while anxiety disorders were not,” wrote Ms. Fryer.

Similarly, children exposed to alcohol prenatally were no more likely than controls to have simple phobias.

Christie L. McGee, who is also a doctoral student at the center, reported on social problem-solving deficits in 43 adolescents aged 13–18 years, 24 of whom were prenatally exposed to heavy alcohol use.

The adolescents completed the Revised Social Problem-Solving Inventory (SPSI-R), which measures an individual's ability to resolve the problems of everyday living. Their parents or caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF), which includes subscales on such characteristics as a child's emotional control, working memory, and ability to plan and organize. Responses were anonymous.

Very large differences were found between the alcohol-exposed and nonexposed adolescents, with effect sizes ranging from 1.32 to 1.41 for problem solving skills and 1.96 to 4.61 for executive functioning. Those exposed to alcohol in utero “approached problems with a pessimistic orientation and indicated a low frustration tolerance,” said Ms. McGee.

“[They] rated themselves as less effective at identifying problems, generating solutions, making decisions, and implementing and verifying the chosen solution … [and were] more likely to endorse an avoidant, careless, or impulsive approach to solving their everyday problems,” she continued.

Their most pronounced deficits in executive function were in the subscales of planning and organizing, monitoring, initiation, and working memory.

“Such difficulties may result in increased disruptive behaviors, poor self-esteem, reduced seeking of meaningful relationships, and isolation,” Ms. McGee noted.

SAN DIEGO — Waist to height ratio is more strongly linked to cardiovascular risk than body mass index (BMI), particularly in middle age, according to a large European study that was presented at the annual meeting of the Endocrine Society.

Harald J. Schneider, M.D., of the Max Planck Institute of Psychiatry in Munich, and associates in Germany and Austria, examined weight, height, and waist and hip circumference and 18 single or combined cardiovascular risk factors in 48,353 primary care patients.

Waist to height ratio was most predictive of risk in the entire cohort in both men and women, followed by waist circumference and BMI.

Overall cardiovascular risk was highest at or above a waist to height ratio of 0.53 for women and 0.55 for men.

When investigators examined specific age groups, they found that waist to height ratio was linked most strongly to cardiovascular risk in men aged 35–54 years and women aged 55–64 years—pivotal ages for the development of cardiovascular disease.

In the other age groups, the BMI had a better association, Dr. Schneider told this newspaper following the meeting.

These findings, however, should be interpreted cautiously because not all differences are significant in the single age groups. Moreover, it should be born in mind that this is a cross-sectional study; therefore, we cannot say which anthropometric parameter best predicts the future occurrence of cardiovascular risk factors and events, he continued.

He suggested that the cutoffs be considered an orientation rather than a strict definition of risk.

That said, study investigators have recommended using the waist to height ratio to define treatment goals for abdominal obesity in middle-aged men and women.

The study was conducted as part of the Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment (the DETECT study), a very large, nationally representative epidemiological study in Germany.

The DETECT study involved the examination of 55,518 patients in 3,795 primary care settings to assess prevalence of cardiovascular disease.

Dr. Schneider's study was supported by an unrestricted educational grant by Pfizer Inc.

SAN DIEGO — Waist to height ratio is more strongly linked to cardiovascular risk than body mass index (BMI), particularly in middle age, according to a large European study that was presented at the annual meeting of the Endocrine Society.

Harald J. Schneider, M.D., of the Max Planck Institute of Psychiatry in Munich, and associates in Germany and Austria, examined weight, height, and waist and hip circumference and 18 single or combined cardiovascular risk factors in 48,353 primary care patients.

Waist to height ratio was most predictive of risk in the entire cohort in both men and women, followed by waist circumference and BMI.

Overall cardiovascular risk was highest at or above a waist to height ratio of 0.53 for women and 0.55 for men.

When investigators examined specific age groups, they found that waist to height ratio was linked most strongly to cardiovascular risk in men aged 35–54 years and women aged 55–64 years—pivotal ages for the development of cardiovascular disease.

In the other age groups, the BMI had a better association, Dr. Schneider told this newspaper following the meeting.

These findings, however, should be interpreted cautiously because not all differences are significant in the single age groups. Moreover, it should be born in mind that this is a cross-sectional study; therefore, we cannot say which anthropometric parameter best predicts the future occurrence of cardiovascular risk factors and events, he continued.

He suggested that the cutoffs be considered an orientation rather than a strict definition of risk.

That said, study investigators have recommended using the waist to height ratio to define treatment goals for abdominal obesity in middle-aged men and women.

The study was conducted as part of the Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment (the DETECT study), a very large, nationally representative epidemiological study in Germany.

The DETECT study involved the examination of 55,518 patients in 3,795 primary care settings to assess prevalence of cardiovascular disease.

Dr. Schneider's study was supported by an unrestricted educational grant by Pfizer Inc.

SAN DIEGO — Waist to height ratio is more strongly linked to cardiovascular risk than body mass index (BMI), particularly in middle age, according to a large European study that was presented at the annual meeting of the Endocrine Society.

Harald J. Schneider, M.D., of the Max Planck Institute of Psychiatry in Munich, and associates in Germany and Austria, examined weight, height, and waist and hip circumference and 18 single or combined cardiovascular risk factors in 48,353 primary care patients.

Waist to height ratio was most predictive of risk in the entire cohort in both men and women, followed by waist circumference and BMI.

Overall cardiovascular risk was highest at or above a waist to height ratio of 0.53 for women and 0.55 for men.

When investigators examined specific age groups, they found that waist to height ratio was linked most strongly to cardiovascular risk in men aged 35–54 years and women aged 55–64 years—pivotal ages for the development of cardiovascular disease.

In the other age groups, the BMI had a better association, Dr. Schneider told this newspaper following the meeting.

These findings, however, should be interpreted cautiously because not all differences are significant in the single age groups. Moreover, it should be born in mind that this is a cross-sectional study; therefore, we cannot say which anthropometric parameter best predicts the future occurrence of cardiovascular risk factors and events, he continued.

He suggested that the cutoffs be considered an orientation rather than a strict definition of risk.

That said, study investigators have recommended using the waist to height ratio to define treatment goals for abdominal obesity in middle-aged men and women.

The study was conducted as part of the Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment (the DETECT study), a very large, nationally representative epidemiological study in Germany.

The DETECT study involved the examination of 55,518 patients in 3,795 primary care settings to assess prevalence of cardiovascular disease.

Dr. Schneider's study was supported by an unrestricted educational grant by Pfizer Inc.

LAS VEGAS — A novel device that transfers energy from nitrogen gas into the skin may be capable of producing improvements in skin quality and texture comparable with those produced by the carbon dioxide laser, but with a less traumatic recovery.

Ronald L. Moy, M.D., a Los Angeles-based dermatologic surgeon, reviewed early results that were produced by the Portrait PSR3 system at a facial cosmetic surgery symposium sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

A 40%–50% improvement in wrinkles, 10%–15% skin contraction, and significant improvement in skin texture have been demonstrated in a small number of patients who were followed for 2 years after Portrait PSR3 treatments by Dr. Moy and colleagues investigating the new device.

The technology consists of a handpiece that produces nitrogen plasma, which is converted into a heated gas for delivery into the skin in millisecond pulses.

"It hits the skin but leaves the epidermis intact," said Dr. Moy, who serves on the scientific advisory panel of Rhytec Inc., the device's manufacturer.

A popping sound can be heard as energy pulses impact the skin, but topical anesthesia and nerve blocks are adequate for patients' pain control during the 10- to 15-minute full-face procedure.

Over several days after the procedure, a zone of thermal damage develops below the skin surface, eventually stimulating new collagen formation. The epidermis develops a bronze hue and flakes away.

Variable settings can produce modest skin surface changes roughly equivalent to a "long-weekend peel" with healing complete in 3–4 days, or a deep effect that requires about 7 days of healing.

At a setting of 4 J/cm

LAS VEGAS — A novel device that transfers energy from nitrogen gas into the skin may be capable of producing improvements in skin quality and texture comparable with those produced by the carbon dioxide laser, but with a less traumatic recovery.

Ronald L. Moy, M.D., a Los Angeles-based dermatologic surgeon, reviewed early results that were produced by the Portrait PSR3 system at a facial cosmetic surgery symposium sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

A 40%–50% improvement in wrinkles, 10%–15% skin contraction, and significant improvement in skin texture have been demonstrated in a small number of patients who were followed for 2 years after Portrait PSR3 treatments by Dr. Moy and colleagues investigating the new device.

The technology consists of a handpiece that produces nitrogen plasma, which is converted into a heated gas for delivery into the skin in millisecond pulses.

"It hits the skin but leaves the epidermis intact," said Dr. Moy, who serves on the scientific advisory panel of Rhytec Inc., the device's manufacturer.

A popping sound can be heard as energy pulses impact the skin, but topical anesthesia and nerve blocks are adequate for patients' pain control during the 10- to 15-minute full-face procedure.

Over several days after the procedure, a zone of thermal damage develops below the skin surface, eventually stimulating new collagen formation. The epidermis develops a bronze hue and flakes away.

Variable settings can produce modest skin surface changes roughly equivalent to a "long-weekend peel" with healing complete in 3–4 days, or a deep effect that requires about 7 days of healing.

At a setting of 4 J/cm

LAS VEGAS — A novel device that transfers energy from nitrogen gas into the skin may be capable of producing improvements in skin quality and texture comparable with those produced by the carbon dioxide laser, but with a less traumatic recovery.

Ronald L. Moy, M.D., a Los Angeles-based dermatologic surgeon, reviewed early results that were produced by the Portrait PSR3 system at a facial cosmetic surgery symposium sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

A 40%–50% improvement in wrinkles, 10%–15% skin contraction, and significant improvement in skin texture have been demonstrated in a small number of patients who were followed for 2 years after Portrait PSR3 treatments by Dr. Moy and colleagues investigating the new device.

The technology consists of a handpiece that produces nitrogen plasma, which is converted into a heated gas for delivery into the skin in millisecond pulses.

"It hits the skin but leaves the epidermis intact," said Dr. Moy, who serves on the scientific advisory panel of Rhytec Inc., the device's manufacturer.

A popping sound can be heard as energy pulses impact the skin, but topical anesthesia and nerve blocks are adequate for patients' pain control during the 10- to 15-minute full-face procedure.

Over several days after the procedure, a zone of thermal damage develops below the skin surface, eventually stimulating new collagen formation. The epidermis develops a bronze hue and flakes away.

Variable settings can produce modest skin surface changes roughly equivalent to a "long-weekend peel" with healing complete in 3–4 days, or a deep effect that requires about 7 days of healing.

At a setting of 4 J/cm

LAS VEGAS — Don't overpromise results to patients considering facial soft tissue augmentation with Radiesse, says a facial plastic and reconstructive surgeon who has now treated 1,174 patients with the filler previously known as Radiance FN.

"I think like most technologies, when we first get them, we kind of oversell them. We think they're a lot better than they really are," said Thomas L. Tzikas, M.D., a physician in private practice in Del Ray, Fla.

The early word on Radiesse, a filler made of spherical particles of synthetic calcium hydroxylapatite, was that it would last between 3 and 5 years, justifying its high price tag. Current prices for a 1-vial treatment range from $800 to $1,400.

But Dr. Tzikas told colleagues at a facial cosmetic surgery symposium that 1 vial often isn't enough to achieve satisfactory correction of facial structures, such as the nasolabial folds. Moreover, its results are unpredictable after 2 years.

"How long does it last? In my experience, it definitely lasts 1 year. There are variable results at 1.5 years and longer," he said at the meeting sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

Dr. Tzikas' experience with Radiesse, manufactured by BioForm Inc., is considerable. He conducted a pivotal trial of the filler in 90 patients, concluding that it was highly effective and well tolerated, with excellent results and high patient satisfaction at 6 months (Arch. Facial Plast. Surg. 2004;6:234–9).

Over time, he's treated more than 10 times that number of patients, ranging in age from 21 to 85.

He continues to praise the product's convenience (delivered, as it is, in prefilled vials) and safety (requiring no sensitivity testing and resulting in no serious adverse events in years of use in otolaryngology, oral surgery, or orthopedics).

He likes it as subdermal filler for deep rhytids, marionette lines, deep acne and traumatic scars, and the nasolabial folds.

"It's a very nice bulking agent," he explained, comparing the results achieved by 1 syringe of Radiesse (1 mL) with what can be accomplished using 2.5 cc of Zyplast, a bovine collagen filler.

But he has virtually ceased using Radiesse for the lips or for vertical lip rhytids.

"I don't think it's a user-friendly material in the lips," said Dr. Tzikas.

He found a 5.9% incidence of lip nodules in 341 patients whose lips he treated, and despite the reduction in nodules as his experience increased, he still feels the results don't justify the risks in treating that area.

Specifically, he said 12% of his first 100 lip patients developed nodules, compared with 2% of his second hundred patients.

"It really, really decreases with just being more conservative. Don't go too superficial in lips," he said.

Lip nodules generally resolve on their own within 6–9 months, but they can also be treated with Kenalog injections and massage, or by disrupting them with a 22-gauge needle and manual compression.

Using too much Radiesse superficially can also result in nodules along the nasolabial grooves, which can take up to a year to resolve, he said at the meeting.

Dr. Tzikas noted that older patients may require larger volumes of Radiesse or more treatments, since their diminished fibroblastic response prevents robust long-term correction.

"I would advise taking very good [before and after] photos of patients. They spend a fair amount of money, and they expect more from fillers," he said, showing an image of a patient who received 3 cc of Radiance FN 2 years before the photo was taken. Although the material could still be palpated under the skin, "the clinical effect is basically gone," he said.

BioForm of Franksville, Wisc., has supported Dr. Tzikas' studies of Radiesse, but he has no financial interest in the company.

LAS VEGAS — Don't overpromise results to patients considering facial soft tissue augmentation with Radiesse, says a facial plastic and reconstructive surgeon who has now treated 1,174 patients with the filler previously known as Radiance FN.

"I think like most technologies, when we first get them, we kind of oversell them. We think they're a lot better than they really are," said Thomas L. Tzikas, M.D., a physician in private practice in Del Ray, Fla.

The early word on Radiesse, a filler made of spherical particles of synthetic calcium hydroxylapatite, was that it would last between 3 and 5 years, justifying its high price tag. Current prices for a 1-vial treatment range from $800 to $1,400.

But Dr. Tzikas told colleagues at a facial cosmetic surgery symposium that 1 vial often isn't enough to achieve satisfactory correction of facial structures, such as the nasolabial folds. Moreover, its results are unpredictable after 2 years.

"How long does it last? In my experience, it definitely lasts 1 year. There are variable results at 1.5 years and longer," he said at the meeting sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

Dr. Tzikas' experience with Radiesse, manufactured by BioForm Inc., is considerable. He conducted a pivotal trial of the filler in 90 patients, concluding that it was highly effective and well tolerated, with excellent results and high patient satisfaction at 6 months (Arch. Facial Plast. Surg. 2004;6:234–9).

Over time, he's treated more than 10 times that number of patients, ranging in age from 21 to 85.

He continues to praise the product's convenience (delivered, as it is, in prefilled vials) and safety (requiring no sensitivity testing and resulting in no serious adverse events in years of use in otolaryngology, oral surgery, or orthopedics).

He likes it as subdermal filler for deep rhytids, marionette lines, deep acne and traumatic scars, and the nasolabial folds.

"It's a very nice bulking agent," he explained, comparing the results achieved by 1 syringe of Radiesse (1 mL) with what can be accomplished using 2.5 cc of Zyplast, a bovine collagen filler.

But he has virtually ceased using Radiesse for the lips or for vertical lip rhytids.

"I don't think it's a user-friendly material in the lips," said Dr. Tzikas.

He found a 5.9% incidence of lip nodules in 341 patients whose lips he treated, and despite the reduction in nodules as his experience increased, he still feels the results don't justify the risks in treating that area.

Specifically, he said 12% of his first 100 lip patients developed nodules, compared with 2% of his second hundred patients.

"It really, really decreases with just being more conservative. Don't go too superficial in lips," he said.

Lip nodules generally resolve on their own within 6–9 months, but they can also be treated with Kenalog injections and massage, or by disrupting them with a 22-gauge needle and manual compression.

Using too much Radiesse superficially can also result in nodules along the nasolabial grooves, which can take up to a year to resolve, he said at the meeting.

Dr. Tzikas noted that older patients may require larger volumes of Radiesse or more treatments, since their diminished fibroblastic response prevents robust long-term correction.

"I would advise taking very good [before and after] photos of patients. They spend a fair amount of money, and they expect more from fillers," he said, showing an image of a patient who received 3 cc of Radiance FN 2 years before the photo was taken. Although the material could still be palpated under the skin, "the clinical effect is basically gone," he said.

BioForm of Franksville, Wisc., has supported Dr. Tzikas' studies of Radiesse, but he has no financial interest in the company.

LAS VEGAS — Don't overpromise results to patients considering facial soft tissue augmentation with Radiesse, says a facial plastic and reconstructive surgeon who has now treated 1,174 patients with the filler previously known as Radiance FN.

"I think like most technologies, when we first get them, we kind of oversell them. We think they're a lot better than they really are," said Thomas L. Tzikas, M.D., a physician in private practice in Del Ray, Fla.

The early word on Radiesse, a filler made of spherical particles of synthetic calcium hydroxylapatite, was that it would last between 3 and 5 years, justifying its high price tag. Current prices for a 1-vial treatment range from $800 to $1,400.

But Dr. Tzikas told colleagues at a facial cosmetic surgery symposium that 1 vial often isn't enough to achieve satisfactory correction of facial structures, such as the nasolabial folds. Moreover, its results are unpredictable after 2 years.

"How long does it last? In my experience, it definitely lasts 1 year. There are variable results at 1.5 years and longer," he said at the meeting sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

Dr. Tzikas' experience with Radiesse, manufactured by BioForm Inc., is considerable. He conducted a pivotal trial of the filler in 90 patients, concluding that it was highly effective and well tolerated, with excellent results and high patient satisfaction at 6 months (Arch. Facial Plast. Surg. 2004;6:234–9).

Over time, he's treated more than 10 times that number of patients, ranging in age from 21 to 85.

He continues to praise the product's convenience (delivered, as it is, in prefilled vials) and safety (requiring no sensitivity testing and resulting in no serious adverse events in years of use in otolaryngology, oral surgery, or orthopedics).

He likes it as subdermal filler for deep rhytids, marionette lines, deep acne and traumatic scars, and the nasolabial folds.

"It's a very nice bulking agent," he explained, comparing the results achieved by 1 syringe of Radiesse (1 mL) with what can be accomplished using 2.5 cc of Zyplast, a bovine collagen filler.

But he has virtually ceased using Radiesse for the lips or for vertical lip rhytids.

"I don't think it's a user-friendly material in the lips," said Dr. Tzikas.

He found a 5.9% incidence of lip nodules in 341 patients whose lips he treated, and despite the reduction in nodules as his experience increased, he still feels the results don't justify the risks in treating that area.

Specifically, he said 12% of his first 100 lip patients developed nodules, compared with 2% of his second hundred patients.

"It really, really decreases with just being more conservative. Don't go too superficial in lips," he said.

Lip nodules generally resolve on their own within 6–9 months, but they can also be treated with Kenalog injections and massage, or by disrupting them with a 22-gauge needle and manual compression.

Using too much Radiesse superficially can also result in nodules along the nasolabial grooves, which can take up to a year to resolve, he said at the meeting.

Dr. Tzikas noted that older patients may require larger volumes of Radiesse or more treatments, since their diminished fibroblastic response prevents robust long-term correction.

"I would advise taking very good [before and after] photos of patients. They spend a fair amount of money, and they expect more from fillers," he said, showing an image of a patient who received 3 cc of Radiance FN 2 years before the photo was taken. Although the material could still be palpated under the skin, "the clinical effect is basically gone," he said.

BioForm of Franksville, Wisc., has supported Dr. Tzikas' studies of Radiesse, but he has no financial interest in the company.

SAN DIEGO — High doses of soy containing isoflavones were associated with significant improvements in energy, vasomotor symptoms, and psychosocial functioning among postmenopausal women, according to an interim analysis of data from a randomized, placebo-controlled study.

Among the first 35 subjects to complete a 3-month study, the 18 receiving active soy had a 40% reduction in psychosocial symptoms, a 36% reduction in vasomotor symptoms, and a 30% reduction in physical complaints, compared with those receiving placebo.

The study ultimately will enroll 100 healthy women who have not taken hormone therapy for the 6 months prior to enrollment, Kendall Dupree, M.D., said at the annual meeting of the Endocrine Society.

“At this point, we're pretty happy about the results. We think that soy may show an improvement in quality of life in women who have postmenopausal symptoms,” said Dr. Dupree, who works in the division of endocrinology and metabolism at Johns Hopkins University in Baltimore.

The primary outcome of the study is to determine whether high doses of a carefully studied formulation of a product containing the isoflavonoids genistein and daidzein can produce a quantified impact on quality of life in postmenopausal women.

Results were calculated using the Menopause-Specific Quality of Life questionnaire at baseline, 6 weeks, and 3 months.

Within the survey are questions that specifically address physical functioning, including energy and activities of daily life. There also are questions about vasomotor symptoms, including hot flashes and night sweats, as well as questions about psychosocial symptoms, including mood and depression, and sexual functioning.

The mean age of the women who participated in the interim analysis was 55. Despite the improvement in their reported menopausal symptoms, there were no changes noted in their serum sex hormones.

Previous studies of soy and post-menopausal symptoms have been largely unconvincing, with a systematic review identifying few well-designed trials that show a significant impact on hot flashes or other symptoms (Obstet. Gynecol. 2004;104:824–36).

However, many previous trials have used relatively low doses of phytoestrogens, often 50 mg/day to about 85 mg/day. The dose in this study was 160 mg/day.

The preparation was dehydrated and did not use alcohol extraction during processing, according to Dr. Dupree who also spoke at a press conference at the meeting.

“Alcohol extraction removes the proteins, which in combination with isoflavones seem to be important,” she said.

A commercial product (Revival Soy, manufactured by Physicians Laboratories Inc., of Kernersville, N.C.) was used in the study.

However, study investigators pointed out that they also conducted an independent analysis to ensure that the dosages listed on the label were actually contained in the product.

Physicians Laboratories also helped to fund the study, which was done in conjunction with the National Center for Complementary and Alternative Medicine within the National Institutes of Health.

“I think this is really hot stuff,” said Mary Lee Vance, M.D., who served as moderator of the press conference and who is a professor of endocrinology and metabolism and is associate director of the General Clinical Research Center at the University of Virginia in Charlottesville.

“Other studies have not shown that soy is very beneficial.”

SAN DIEGO — High doses of soy containing isoflavones were associated with significant improvements in energy, vasomotor symptoms, and psychosocial functioning among postmenopausal women, according to an interim analysis of data from a randomized, placebo-controlled study.

Among the first 35 subjects to complete a 3-month study, the 18 receiving active soy had a 40% reduction in psychosocial symptoms, a 36% reduction in vasomotor symptoms, and a 30% reduction in physical complaints, compared with those receiving placebo.

The study ultimately will enroll 100 healthy women who have not taken hormone therapy for the 6 months prior to enrollment, Kendall Dupree, M.D., said at the annual meeting of the Endocrine Society.

“At this point, we're pretty happy about the results. We think that soy may show an improvement in quality of life in women who have postmenopausal symptoms,” said Dr. Dupree, who works in the division of endocrinology and metabolism at Johns Hopkins University in Baltimore.

The primary outcome of the study is to determine whether high doses of a carefully studied formulation of a product containing the isoflavonoids genistein and daidzein can produce a quantified impact on quality of life in postmenopausal women.

Results were calculated using the Menopause-Specific Quality of Life questionnaire at baseline, 6 weeks, and 3 months.

Within the survey are questions that specifically address physical functioning, including energy and activities of daily life. There also are questions about vasomotor symptoms, including hot flashes and night sweats, as well as questions about psychosocial symptoms, including mood and depression, and sexual functioning.

The mean age of the women who participated in the interim analysis was 55. Despite the improvement in their reported menopausal symptoms, there were no changes noted in their serum sex hormones.

Previous studies of soy and post-menopausal symptoms have been largely unconvincing, with a systematic review identifying few well-designed trials that show a significant impact on hot flashes or other symptoms (Obstet. Gynecol. 2004;104:824–36).

However, many previous trials have used relatively low doses of phytoestrogens, often 50 mg/day to about 85 mg/day. The dose in this study was 160 mg/day.

The preparation was dehydrated and did not use alcohol extraction during processing, according to Dr. Dupree who also spoke at a press conference at the meeting.

“Alcohol extraction removes the proteins, which in combination with isoflavones seem to be important,” she said.

A commercial product (Revival Soy, manufactured by Physicians Laboratories Inc., of Kernersville, N.C.) was used in the study.

However, study investigators pointed out that they also conducted an independent analysis to ensure that the dosages listed on the label were actually contained in the product.

Physicians Laboratories also helped to fund the study, which was done in conjunction with the National Center for Complementary and Alternative Medicine within the National Institutes of Health.

“I think this is really hot stuff,” said Mary Lee Vance, M.D., who served as moderator of the press conference and who is a professor of endocrinology and metabolism and is associate director of the General Clinical Research Center at the University of Virginia in Charlottesville.

“Other studies have not shown that soy is very beneficial.”

SAN DIEGO — High doses of soy containing isoflavones were associated with significant improvements in energy, vasomotor symptoms, and psychosocial functioning among postmenopausal women, according to an interim analysis of data from a randomized, placebo-controlled study.

Among the first 35 subjects to complete a 3-month study, the 18 receiving active soy had a 40% reduction in psychosocial symptoms, a 36% reduction in vasomotor symptoms, and a 30% reduction in physical complaints, compared with those receiving placebo.

The study ultimately will enroll 100 healthy women who have not taken hormone therapy for the 6 months prior to enrollment, Kendall Dupree, M.D., said at the annual meeting of the Endocrine Society.

“At this point, we're pretty happy about the results. We think that soy may show an improvement in quality of life in women who have postmenopausal symptoms,” said Dr. Dupree, who works in the division of endocrinology and metabolism at Johns Hopkins University in Baltimore.

The primary outcome of the study is to determine whether high doses of a carefully studied formulation of a product containing the isoflavonoids genistein and daidzein can produce a quantified impact on quality of life in postmenopausal women.

Results were calculated using the Menopause-Specific Quality of Life questionnaire at baseline, 6 weeks, and 3 months.

Within the survey are questions that specifically address physical functioning, including energy and activities of daily life. There also are questions about vasomotor symptoms, including hot flashes and night sweats, as well as questions about psychosocial symptoms, including mood and depression, and sexual functioning.

The mean age of the women who participated in the interim analysis was 55. Despite the improvement in their reported menopausal symptoms, there were no changes noted in their serum sex hormones.

Previous studies of soy and post-menopausal symptoms have been largely unconvincing, with a systematic review identifying few well-designed trials that show a significant impact on hot flashes or other symptoms (Obstet. Gynecol. 2004;104:824–36).

However, many previous trials have used relatively low doses of phytoestrogens, often 50 mg/day to about 85 mg/day. The dose in this study was 160 mg/day.

The preparation was dehydrated and did not use alcohol extraction during processing, according to Dr. Dupree who also spoke at a press conference at the meeting.

“Alcohol extraction removes the proteins, which in combination with isoflavones seem to be important,” she said.

A commercial product (Revival Soy, manufactured by Physicians Laboratories Inc., of Kernersville, N.C.) was used in the study.

However, study investigators pointed out that they also conducted an independent analysis to ensure that the dosages listed on the label were actually contained in the product.

Physicians Laboratories also helped to fund the study, which was done in conjunction with the National Center for Complementary and Alternative Medicine within the National Institutes of Health.

“I think this is really hot stuff,” said Mary Lee Vance, M.D., who served as moderator of the press conference and who is a professor of endocrinology and metabolism and is associate director of the General Clinical Research Center at the University of Virginia in Charlottesville.

“Other studies have not shown that soy is very beneficial.”

SAN DIEGO — Testosterone supplementation trims visceral fat, builds skeletal muscle, improves muscle strength, and promotes overall sexual function in healthy older men, according to studies presented at the annual meeting of the Endocrine Society.

The findings from small but well-controlled trials, although not definitive, add credence to the theory that testosterone can have a positive impact on the health and vigor of older, as well as younger, men.

In a cautionary note, however, researchers found an alarming number of adverse effects—some of them severe—in men who received the highest doses of testosterone, 600 mg/wk.

For example, an institutional safety review board cut short the high-dose arm of one study when 10 subjects experienced a total of 147 adverse events, including 12 serious adverse events, halfway into a 20-week trial conducted at Charles R. Drew Medical Center in Los Angeles.

The adverse events included polycythemia, leg edema, and two cases of prostate cancer that may have been indolent prior to the patients' receiving high-dose testosterone.

Despite some encouraging findings, principal investigator Thomas W. Storer, Ph.D., said, “It's very important to tell the public that when you get up to these very high doses, clearly you're going to have problems.”

Dr. Storer's study evaluated the effect of testosterone on muscle mass and strength in 60 healthy men aged 60–75 years and 61 healthy men aged 18–34 years. A long-acting GnRH agonist suppressed endogenous testosterone production in all subjects.

Participants were then randomly assigned to receive weekly testosterone enanthate in intramuscular doses of 25 mg, 50 mg, 125 mg, 300 mg, or 600 mg.

Both older and younger men significantly improved their muscle strength in a dose-dependent fashion, as measured by maximal performance on a leg press. Younger men, but not older men, also significantly increased leg power, the speed with which they were able to perform leg exercises.

In contrast to the many side effects encountered on the 600-mg dose and a substantial number of adverse events in men taking 300 mg, few side effects were seen in men assigned to the 125-mg dose. Yet the men taking the 125-mg dose had impressive gains.

“On average, they gained the equivalent of 10 pounds of lean muscle mass in 20 weeks,” Dr. Storer, an exercise physiologist, said at a press briefing. “You have to train pretty hard to gain 10 pounds of lean mass in 20 weeks.”

“We've gone on record as saying that we think the optimal dose, with the most improvement and the least adverse events, is 125 mg,” he added.

A related Drew University study of men in the same age ranges, directed by Peter Gray, Ph.D., found improvements in overall sexual function, a category including libido, sexual activity, and erectile function. Changes in these parameters were highly correlated with testosterone dose for overall sexual function (P = .0002). Libido improved, but only if men were engaged in a sexual relationship at the onset of the study.

No impact was seen on mood or on performance on visuospatial cognition tests in older or younger men taking testosterone.

Meanwhile, an Australian study examined the impact of testosterone replacement on fat and muscle in 60 nonobese men aged 55 years and older with symptoms of androgen deficiency.

Testosterone replacement therapy did not decrease total body fat or abdominal subcutaneous fat during the yearlong study, reported Carolyn Allan, Ph.D., and colleagues at Prince Henry's Institute of Medical Research at Monash University, Victoria, Australia.

Abdominal visceral fat, however, increased by 16.6% in the placebo group, and decreased by 6.8% in men taking testosterone. Those results represented a significant difference between the groups, according to the invesigators.

“These men were not obese, and yet we saw changes in visceral fat,” suggesting that testosterone replacement may have potential for modifying cardiovascular risk, Dr. Allan said.

SAN DIEGO — Testosterone supplementation trims visceral fat, builds skeletal muscle, improves muscle strength, and promotes overall sexual function in healthy older men, according to studies presented at the annual meeting of the Endocrine Society.

The findings from small but well-controlled trials, although not definitive, add credence to the theory that testosterone can have a positive impact on the health and vigor of older, as well as younger, men.

In a cautionary note, however, researchers found an alarming number of adverse effects—some of them severe—in men who received the highest doses of testosterone, 600 mg/wk.

For example, an institutional safety review board cut short the high-dose arm of one study when 10 subjects experienced a total of 147 adverse events, including 12 serious adverse events, halfway into a 20-week trial conducted at Charles R. Drew Medical Center in Los Angeles.

The adverse events included polycythemia, leg edema, and two cases of prostate cancer that may have been indolent prior to the patients' receiving high-dose testosterone.

Despite some encouraging findings, principal investigator Thomas W. Storer, Ph.D., said, “It's very important to tell the public that when you get up to these very high doses, clearly you're going to have problems.”

Dr. Storer's study evaluated the effect of testosterone on muscle mass and strength in 60 healthy men aged 60–75 years and 61 healthy men aged 18–34 years. A long-acting GnRH agonist suppressed endogenous testosterone production in all subjects.

Participants were then randomly assigned to receive weekly testosterone enanthate in intramuscular doses of 25 mg, 50 mg, 125 mg, 300 mg, or 600 mg.

Both older and younger men significantly improved their muscle strength in a dose-dependent fashion, as measured by maximal performance on a leg press. Younger men, but not older men, also significantly increased leg power, the speed with which they were able to perform leg exercises.

In contrast to the many side effects encountered on the 600-mg dose and a substantial number of adverse events in men taking 300 mg, few side effects were seen in men assigned to the 125-mg dose. Yet the men taking the 125-mg dose had impressive gains.

“On average, they gained the equivalent of 10 pounds of lean muscle mass in 20 weeks,” Dr. Storer, an exercise physiologist, said at a press briefing. “You have to train pretty hard to gain 10 pounds of lean mass in 20 weeks.”

“We've gone on record as saying that we think the optimal dose, with the most improvement and the least adverse events, is 125 mg,” he added.

A related Drew University study of men in the same age ranges, directed by Peter Gray, Ph.D., found improvements in overall sexual function, a category including libido, sexual activity, and erectile function. Changes in these parameters were highly correlated with testosterone dose for overall sexual function (P = .0002). Libido improved, but only if men were engaged in a sexual relationship at the onset of the study.

No impact was seen on mood or on performance on visuospatial cognition tests in older or younger men taking testosterone.

Meanwhile, an Australian study examined the impact of testosterone replacement on fat and muscle in 60 nonobese men aged 55 years and older with symptoms of androgen deficiency.

Testosterone replacement therapy did not decrease total body fat or abdominal subcutaneous fat during the yearlong study, reported Carolyn Allan, Ph.D., and colleagues at Prince Henry's Institute of Medical Research at Monash University, Victoria, Australia.

Abdominal visceral fat, however, increased by 16.6% in the placebo group, and decreased by 6.8% in men taking testosterone. Those results represented a significant difference between the groups, according to the invesigators.

“These men were not obese, and yet we saw changes in visceral fat,” suggesting that testosterone replacement may have potential for modifying cardiovascular risk, Dr. Allan said.

SAN DIEGO — Testosterone supplementation trims visceral fat, builds skeletal muscle, improves muscle strength, and promotes overall sexual function in healthy older men, according to studies presented at the annual meeting of the Endocrine Society.

The findings from small but well-controlled trials, although not definitive, add credence to the theory that testosterone can have a positive impact on the health and vigor of older, as well as younger, men.

In a cautionary note, however, researchers found an alarming number of adverse effects—some of them severe—in men who received the highest doses of testosterone, 600 mg/wk.

For example, an institutional safety review board cut short the high-dose arm of one study when 10 subjects experienced a total of 147 adverse events, including 12 serious adverse events, halfway into a 20-week trial conducted at Charles R. Drew Medical Center in Los Angeles.

The adverse events included polycythemia, leg edema, and two cases of prostate cancer that may have been indolent prior to the patients' receiving high-dose testosterone.

Despite some encouraging findings, principal investigator Thomas W. Storer, Ph.D., said, “It's very important to tell the public that when you get up to these very high doses, clearly you're going to have problems.”

Dr. Storer's study evaluated the effect of testosterone on muscle mass and strength in 60 healthy men aged 60–75 years and 61 healthy men aged 18–34 years. A long-acting GnRH agonist suppressed endogenous testosterone production in all subjects.

Participants were then randomly assigned to receive weekly testosterone enanthate in intramuscular doses of 25 mg, 50 mg, 125 mg, 300 mg, or 600 mg.

Both older and younger men significantly improved their muscle strength in a dose-dependent fashion, as measured by maximal performance on a leg press. Younger men, but not older men, also significantly increased leg power, the speed with which they were able to perform leg exercises.

In contrast to the many side effects encountered on the 600-mg dose and a substantial number of adverse events in men taking 300 mg, few side effects were seen in men assigned to the 125-mg dose. Yet the men taking the 125-mg dose had impressive gains.

“On average, they gained the equivalent of 10 pounds of lean muscle mass in 20 weeks,” Dr. Storer, an exercise physiologist, said at a press briefing. “You have to train pretty hard to gain 10 pounds of lean mass in 20 weeks.”

“We've gone on record as saying that we think the optimal dose, with the most improvement and the least adverse events, is 125 mg,” he added.

A related Drew University study of men in the same age ranges, directed by Peter Gray, Ph.D., found improvements in overall sexual function, a category including libido, sexual activity, and erectile function. Changes in these parameters were highly correlated with testosterone dose for overall sexual function (P = .0002). Libido improved, but only if men were engaged in a sexual relationship at the onset of the study.

No impact was seen on mood or on performance on visuospatial cognition tests in older or younger men taking testosterone.

Meanwhile, an Australian study examined the impact of testosterone replacement on fat and muscle in 60 nonobese men aged 55 years and older with symptoms of androgen deficiency.

Testosterone replacement therapy did not decrease total body fat or abdominal subcutaneous fat during the yearlong study, reported Carolyn Allan, Ph.D., and colleagues at Prince Henry's Institute of Medical Research at Monash University, Victoria, Australia.

Abdominal visceral fat, however, increased by 16.6% in the placebo group, and decreased by 6.8% in men taking testosterone. Those results represented a significant difference between the groups, according to the invesigators.

“These men were not obese, and yet we saw changes in visceral fat,” suggesting that testosterone replacement may have potential for modifying cardiovascular risk, Dr. Allan said.

RANCHO MIRAGE, CALIF. — Obstructive sleep apnea in children is associated with profound deficits in IQ, verbal comprehension, perceptual reasoning, and working memory, according to preliminary results of a case-control study at the Pediatric Sleep Disorders Center of Johns Hopkins University, Baltimore.

Ann C. Halbower, M.D., medical director of the center, reported that extensive cognitive deficits and cerebral metabolite alterations were powerfully evident in children from inner city Baltimore who suffered from moderate to severe obstructive sleep apnea (OSA).

Thus far, 17 children aged 7–16 years with OSA and 10 matched controls have completed sleep studies, neuropsychological tests, and magnetic resonance spectroscopy. The average age in both groups is 10.

“Our kids with OSA were severely impacted, their IQ scores being 10 to 15 or more points below normal. We saw huge differences in memory, especially in visual spatial processing, which is a parietal lobe function that has not received a lot of press,” Dr. Halbower said at a conference on sleep in infancy and childhood sponsored by the Annenberg Center for Health Sciences.

Group differences in IQ were mostly explained by sharply defined deficits in working memory, nonverbal reasoning, and verbal comprehension among children with OSA.

Magnetic resonance spectroscopy determined that neuropsychological deficits in the children correlated with hippocampal metabolite alterations, low oxygen saturation, and body mass index (BMI).

The study is ongoing, although Dr. Halbower said she and her team are having trouble finding normal, nonsnoring obese controls who do not have sleep apnea. The average BMI among children with OSA was 29 and among controls, 19. African American children whose mothers completed about 12–14 years of education comprise the majority of the study cohort.

Subjects in the control group had significantly higher IQs than did those with OSA, but still not as high as controls enrolled in previous studies of sleep apnea. The mean full-scale IQ among controls was 101, and among children with OSA, 86.

Children with an IQ below 75, a history of seizures or depression, or use of psychotropic medications were not enrolled.

Intriguingly, some of the neuropsychological functions most impacted by sleep apnea in adults were not significantly impaired in children with OSA. These included certain executive functions such as problem solving, planning, inhibitory control, sustained attention, and response preparation. Motor speed and cerebellar perceptual/motor timing appeared unaffected as well.

When respiratory parameters were assessed, children with OSA had a mean oxygen desaturation time at less than 95% of 70 minutes, compared with 0 for controls. To capture small, brief, intermediate hypoxic events, the oxygen saturation nadir also was studied, and was 75 for children with OSA and 93 for controls, a statistical difference with a significance of 0.0002.

The apnea/hypopnea index showed that children in the study had severe OSA, with a mean score of 29.1, compared with 0.3 for controls.

Researchers conducted two forms of magnetic resonance spectroscopy to attempt to pinpoint any cerebral metabolite changes that might be correlated with respiratory parameters and neuropsychological test results. A global brain assessment was conducted with general magnetic resonance spectroscopy imaging (MRSI) and a single voxel image was used to explore metabolites within the anterior hippocampus on the left side.

Just six children with OSA and six controls have completed these studies.

However, preliminary results identified a “very significant” decline in N-acetyl aspartate/choline (NAA/Cho) ratios and choline/creatine (Cho/Cr) ratios in the hippocampal regions of children with OSA, compared with controls.

Both oxygen saturation nadir and oxygen saturation time at less than 95% correlated with brain metabolite dysfunction, IQ deficits, and BMI.

The apnea/hypopnea index correlated with brain metabolite problems, IQ problems, parietal lobe function problems, and BMI; however, the arousal and awake index failed to correlate with brain metabolite dysfunction, IQ, or BMI, “indicating that hypoxemia may be involved in the mechanism of these alterations,” said Dr. Halbower.

Of interest, high BMI correlated with IQ deficits and low neuropsychological scores, but not with brain metabolites. The issue deserves further study, she said.

More subjects are being enrolled in the current investigation and researchers also are exploring possible reversibility of neurologic deficits with treatment of OSA.

RANCHO MIRAGE, CALIF. — Obstructive sleep apnea in children is associated with profound deficits in IQ, verbal comprehension, perceptual reasoning, and working memory, according to preliminary results of a case-control study at the Pediatric Sleep Disorders Center of Johns Hopkins University, Baltimore.

Ann C. Halbower, M.D., medical director of the center, reported that extensive cognitive deficits and cerebral metabolite alterations were powerfully evident in children from inner city Baltimore who suffered from moderate to severe obstructive sleep apnea (OSA).

Thus far, 17 children aged 7–16 years with OSA and 10 matched controls have completed sleep studies, neuropsychological tests, and magnetic resonance spectroscopy. The average age in both groups is 10.

“Our kids with OSA were severely impacted, their IQ scores being 10 to 15 or more points below normal. We saw huge differences in memory, especially in visual spatial processing, which is a parietal lobe function that has not received a lot of press,” Dr. Halbower said at a conference on sleep in infancy and childhood sponsored by the Annenberg Center for Health Sciences.

Group differences in IQ were mostly explained by sharply defined deficits in working memory, nonverbal reasoning, and verbal comprehension among children with OSA.

Magnetic resonance spectroscopy determined that neuropsychological deficits in the children correlated with hippocampal metabolite alterations, low oxygen saturation, and body mass index (BMI).

The study is ongoing, although Dr. Halbower said she and her team are having trouble finding normal, nonsnoring obese controls who do not have sleep apnea. The average BMI among children with OSA was 29 and among controls, 19. African American children whose mothers completed about 12–14 years of education comprise the majority of the study cohort.

Subjects in the control group had significantly higher IQs than did those with OSA, but still not as high as controls enrolled in previous studies of sleep apnea. The mean full-scale IQ among controls was 101, and among children with OSA, 86.

Children with an IQ below 75, a history of seizures or depression, or use of psychotropic medications were not enrolled.

Intriguingly, some of the neuropsychological functions most impacted by sleep apnea in adults were not significantly impaired in children with OSA. These included certain executive functions such as problem solving, planning, inhibitory control, sustained attention, and response preparation. Motor speed and cerebellar perceptual/motor timing appeared unaffected as well.

When respiratory parameters were assessed, children with OSA had a mean oxygen desaturation time at less than 95% of 70 minutes, compared with 0 for controls. To capture small, brief, intermediate hypoxic events, the oxygen saturation nadir also was studied, and was 75 for children with OSA and 93 for controls, a statistical difference with a significance of 0.0002.

The apnea/hypopnea index showed that children in the study had severe OSA, with a mean score of 29.1, compared with 0.3 for controls.

Researchers conducted two forms of magnetic resonance spectroscopy to attempt to pinpoint any cerebral metabolite changes that might be correlated with respiratory parameters and neuropsychological test results. A global brain assessment was conducted with general magnetic resonance spectroscopy imaging (MRSI) and a single voxel image was used to explore metabolites within the anterior hippocampus on the left side.

Just six children with OSA and six controls have completed these studies.

However, preliminary results identified a “very significant” decline in N-acetyl aspartate/choline (NAA/Cho) ratios and choline/creatine (Cho/Cr) ratios in the hippocampal regions of children with OSA, compared with controls.

Both oxygen saturation nadir and oxygen saturation time at less than 95% correlated with brain metabolite dysfunction, IQ deficits, and BMI.

The apnea/hypopnea index correlated with brain metabolite problems, IQ problems, parietal lobe function problems, and BMI; however, the arousal and awake index failed to correlate with brain metabolite dysfunction, IQ, or BMI, “indicating that hypoxemia may be involved in the mechanism of these alterations,” said Dr. Halbower.

Of interest, high BMI correlated with IQ deficits and low neuropsychological scores, but not with brain metabolites. The issue deserves further study, she said.

More subjects are being enrolled in the current investigation and researchers also are exploring possible reversibility of neurologic deficits with treatment of OSA.

RANCHO MIRAGE, CALIF. — Obstructive sleep apnea in children is associated with profound deficits in IQ, verbal comprehension, perceptual reasoning, and working memory, according to preliminary results of a case-control study at the Pediatric Sleep Disorders Center of Johns Hopkins University, Baltimore.

Ann C. Halbower, M.D., medical director of the center, reported that extensive cognitive deficits and cerebral metabolite alterations were powerfully evident in children from inner city Baltimore who suffered from moderate to severe obstructive sleep apnea (OSA).

Thus far, 17 children aged 7–16 years with OSA and 10 matched controls have completed sleep studies, neuropsychological tests, and magnetic resonance spectroscopy. The average age in both groups is 10.

“Our kids with OSA were severely impacted, their IQ scores being 10 to 15 or more points below normal. We saw huge differences in memory, especially in visual spatial processing, which is a parietal lobe function that has not received a lot of press,” Dr. Halbower said at a conference on sleep in infancy and childhood sponsored by the Annenberg Center for Health Sciences.

Group differences in IQ were mostly explained by sharply defined deficits in working memory, nonverbal reasoning, and verbal comprehension among children with OSA.

Magnetic resonance spectroscopy determined that neuropsychological deficits in the children correlated with hippocampal metabolite alterations, low oxygen saturation, and body mass index (BMI).

The study is ongoing, although Dr. Halbower said she and her team are having trouble finding normal, nonsnoring obese controls who do not have sleep apnea. The average BMI among children with OSA was 29 and among controls, 19. African American children whose mothers completed about 12–14 years of education comprise the majority of the study cohort.

Subjects in the control group had significantly higher IQs than did those with OSA, but still not as high as controls enrolled in previous studies of sleep apnea. The mean full-scale IQ among controls was 101, and among children with OSA, 86.

Children with an IQ below 75, a history of seizures or depression, or use of psychotropic medications were not enrolled.

Intriguingly, some of the neuropsychological functions most impacted by sleep apnea in adults were not significantly impaired in children with OSA. These included certain executive functions such as problem solving, planning, inhibitory control, sustained attention, and response preparation. Motor speed and cerebellar perceptual/motor timing appeared unaffected as well.

When respiratory parameters were assessed, children with OSA had a mean oxygen desaturation time at less than 95% of 70 minutes, compared with 0 for controls. To capture small, brief, intermediate hypoxic events, the oxygen saturation nadir also was studied, and was 75 for children with OSA and 93 for controls, a statistical difference with a significance of 0.0002.

The apnea/hypopnea index showed that children in the study had severe OSA, with a mean score of 29.1, compared with 0.3 for controls.

Researchers conducted two forms of magnetic resonance spectroscopy to attempt to pinpoint any cerebral metabolite changes that might be correlated with respiratory parameters and neuropsychological test results. A global brain assessment was conducted with general magnetic resonance spectroscopy imaging (MRSI) and a single voxel image was used to explore metabolites within the anterior hippocampus on the left side.

Just six children with OSA and six controls have completed these studies.

However, preliminary results identified a “very significant” decline in N-acetyl aspartate/choline (NAA/Cho) ratios and choline/creatine (Cho/Cr) ratios in the hippocampal regions of children with OSA, compared with controls.

Both oxygen saturation nadir and oxygen saturation time at less than 95% correlated with brain metabolite dysfunction, IQ deficits, and BMI.

The apnea/hypopnea index correlated with brain metabolite problems, IQ problems, parietal lobe function problems, and BMI; however, the arousal and awake index failed to correlate with brain metabolite dysfunction, IQ, or BMI, “indicating that hypoxemia may be involved in the mechanism of these alterations,” said Dr. Halbower.

Of interest, high BMI correlated with IQ deficits and low neuropsychological scores, but not with brain metabolites. The issue deserves further study, she said.

More subjects are being enrolled in the current investigation and researchers also are exploring possible reversibility of neurologic deficits with treatment of OSA.