Diana Mahoney

BOSTON — The estimated prevalence of serious mental illness among Hurricane Katrina survivors doubled in the months after the disaster. But suicidal ideation among this population decreased significantly during that period, compared with several years ago, a new study has shown.

The jump in mental illness post-Katrina could be predicted, but the decrease in the prevalence of suicidal thoughts among those with serious mental illness “was a surprise,” lead author Robert C. Kessler, Ph.D., said in a teleconference announcing the findings of the first Hurricane Katrina Community Advisory Group survey.

Through questions designed to assess several dimensions of personal growth resulting from the trauma of the hurricane, Dr. Kessler and his colleagues at Harvard Medical School, Boston, determined that the lower conditional prevalence of suicidality was a function of individuals' faith in their ability to rebuild their lives and realization of their inner strength. “The lowering of suicidal tendencies appears to be strongly associated with optimistic expectations for recovery efforts,” he said.

To estimate the impact of Hurricane Katrina on mental illness and suicidality, the investigators surveyed a statistically representative sample of 1,043 adults from Alabama, Louisiana, and Mississippi, and compared the results with those of the National Comorbidity Survey-Replication conducted between February 2001 and February 2003.

The NCS-R included interviews with 826 adults in the regions later affected by Hurricane Katrina. Both surveys asked identical questions about mental illness and suicidality, and the post-Katrina survey included items associated with trauma-related personal growth.

“The [post-Katrina] survey also assessed personal cognitions that have been identified in previous research to predict adjustment to disasters,” Dr. Kessler said. The survey focused on five dimensions of personal growth, including posttraumatic increases in “emotional closeness to loved ones, faith in the ability to rebuild one's life, spirituality or religiosity, meaning or purpose in life, and recognition of inner strength or competence.”

The comparison of the pre- and posthurricane surveys showed the prevalence of serious mental illness in respondents was 11.3% after Katrina, compared with 6.1% before it, and the prevalence of mild-moderate mental illness was 19.9% after the hurricane, compared with 9.7% before it.

The prevalence of suicidal ideation and plans among respondents estimated to have mental illness was 0.7% after Katrina, compared with 8.4% before it. “The lower conditional prevalence of suicidality was strongly related to two dimensions of personal growth after the trauma,” including faith in individuals' own ability to rebuild their lives and realization of inner strength, Dr. Kessler said. Without these two dimensions, “between-survey differences in suicidality [among mentally ill respondents] were insignificant,” he said.

The investigators hypothesized that the ability to create positive thoughts about the future provide protective “psychological scaffolding” against the suicidality that is often associated with extreme distress. The post-Katrina study “is, to our knowledge, the first to provide quantitative evidence regarding such a pattern in an epidemiological sample of a population that has survived a disaster,” Dr. Kessler said.

The concern, however, “is that the lowering of suicidal tendencies appears to be strongly associated with expectations for recovery efforts that might not be realistic,” he said, noting that it's important to recognize the low prevalence of suicidality might be temporary if positive expectations are not met as time goes on.

The findings could have significant implications in the development of future disaster planning efforts. “A systematic investigation of posttraumatic [positive cognitions and] personal growth might be useful in guiding public health efforts delivered through the mass media in the aftermath of disasters,” said Dr. Kessler, noting that previous studies have shown that public health messages can have a significant impact on psychological reactions to disasters.

The message for policy makers “is that communications with survivors can sometimes build on the temporary reprieve from suicidal tendencies afforded by these protective cognitions,” Dr. Kessler said. “Efforts on the part of public officials to control expectations as recovery moves forward without destroying the positive cognitions related to these expectations could prove crucial in the process of continued psychological recovery.”

The current report, published in a special online edition of the Bulletin of the World Health Organization (www.who.int/bulletin/en

The National Institute of Mental Health and the Office of the Assistant Secretary of Health and Human Services for Planning and Evaluation are funding the project.

Anxiety and Personal Growth Emerged

Baseline interviews with the Hurricane Community Advisory Group, a statistically representative sample of 1,043 Hurricane Katrina survivors from Alabama, Louisiana, and Mississippi provide important insight into the posttraumatic stress reactions and personal growth experienced by this population.

In addition to a doubling of positive screens for clinically significant anxiety or mood disorders, compared with a survey conducted 2 years before the hurricane, the interviews identified the following posttraumatic stressors:

▸ A substantial proportion of respondents reported having emotional problems related to their experiences in the hurricane.

▸ One-fourth (25.3%) of survey respondents reported having nightmares about their experiences in the hurricane in the past month.

▸ Nearly half (49.6%) of the respondents who were prehurricane residents of New Orleans reported having nightmares.

▸ More than half (51.8% of the total survey population and 79.4% of pre-hurricane residents of New Orleans) reported being more irritable or angry than usual.

Results also showed posttraumatic personal growth:

▸ Most respondents (88.5%) reported that they had developed a deeper sense of meaning or purpose in life as a result of their experiences with the hurricane.

▸ More than three-quarters of the respondents (77.3%) said they had become more spiritual or religious through their hurricane experiences.

▸ Almost half of the respondents (45%) rated the discovery of inner strength as having happened “a lot” during and after the hurricane.

▸ Non-Hispanic blacks (62.4%) and people with low pre-hurricane incomes (57.8%) were most likely to report the discovery of “a lot” of inner strength.

▸ Most respondents (83.4%) reported having “a lot” of faith in their own abilities to rebuild their lives.

A complete copy of the report of the baseline interviews with survivors can be found at

www.hurricanekatrina.med.harvard.edu/baseline.php

BOSTON — The estimated prevalence of serious mental illness among Hurricane Katrina survivors doubled in the months after the disaster. But suicidal ideation among this population decreased significantly during that period, compared with several years ago, a new study has shown.

The jump in mental illness post-Katrina could be predicted, but the decrease in the prevalence of suicidal thoughts among those with serious mental illness “was a surprise,” lead author Robert C. Kessler, Ph.D., said in a teleconference announcing the findings of the first Hurricane Katrina Community Advisory Group survey.

Through questions designed to assess several dimensions of personal growth resulting from the trauma of the hurricane, Dr. Kessler and his colleagues at Harvard Medical School, Boston, determined that the lower conditional prevalence of suicidality was a function of individuals' faith in their ability to rebuild their lives and realization of their inner strength. “The lowering of suicidal tendencies appears to be strongly associated with optimistic expectations for recovery efforts,” he said.

To estimate the impact of Hurricane Katrina on mental illness and suicidality, the investigators surveyed a statistically representative sample of 1,043 adults from Alabama, Louisiana, and Mississippi, and compared the results with those of the National Comorbidity Survey-Replication conducted between February 2001 and February 2003.

The NCS-R included interviews with 826 adults in the regions later affected by Hurricane Katrina. Both surveys asked identical questions about mental illness and suicidality, and the post-Katrina survey included items associated with trauma-related personal growth.

“The [post-Katrina] survey also assessed personal cognitions that have been identified in previous research to predict adjustment to disasters,” Dr. Kessler said. The survey focused on five dimensions of personal growth, including posttraumatic increases in “emotional closeness to loved ones, faith in the ability to rebuild one's life, spirituality or religiosity, meaning or purpose in life, and recognition of inner strength or competence.”

The comparison of the pre- and posthurricane surveys showed the prevalence of serious mental illness in respondents was 11.3% after Katrina, compared with 6.1% before it, and the prevalence of mild-moderate mental illness was 19.9% after the hurricane, compared with 9.7% before it.

The prevalence of suicidal ideation and plans among respondents estimated to have mental illness was 0.7% after Katrina, compared with 8.4% before it. “The lower conditional prevalence of suicidality was strongly related to two dimensions of personal growth after the trauma,” including faith in individuals' own ability to rebuild their lives and realization of inner strength, Dr. Kessler said. Without these two dimensions, “between-survey differences in suicidality [among mentally ill respondents] were insignificant,” he said.

The investigators hypothesized that the ability to create positive thoughts about the future provide protective “psychological scaffolding” against the suicidality that is often associated with extreme distress. The post-Katrina study “is, to our knowledge, the first to provide quantitative evidence regarding such a pattern in an epidemiological sample of a population that has survived a disaster,” Dr. Kessler said.

The concern, however, “is that the lowering of suicidal tendencies appears to be strongly associated with expectations for recovery efforts that might not be realistic,” he said, noting that it's important to recognize the low prevalence of suicidality might be temporary if positive expectations are not met as time goes on.

The findings could have significant implications in the development of future disaster planning efforts. “A systematic investigation of posttraumatic [positive cognitions and] personal growth might be useful in guiding public health efforts delivered through the mass media in the aftermath of disasters,” said Dr. Kessler, noting that previous studies have shown that public health messages can have a significant impact on psychological reactions to disasters.

The message for policy makers “is that communications with survivors can sometimes build on the temporary reprieve from suicidal tendencies afforded by these protective cognitions,” Dr. Kessler said. “Efforts on the part of public officials to control expectations as recovery moves forward without destroying the positive cognitions related to these expectations could prove crucial in the process of continued psychological recovery.”

The current report, published in a special online edition of the Bulletin of the World Health Organization (www.who.int/bulletin/en

The National Institute of Mental Health and the Office of the Assistant Secretary of Health and Human Services for Planning and Evaluation are funding the project.

Anxiety and Personal Growth Emerged

Baseline interviews with the Hurricane Community Advisory Group, a statistically representative sample of 1,043 Hurricane Katrina survivors from Alabama, Louisiana, and Mississippi provide important insight into the posttraumatic stress reactions and personal growth experienced by this population.

In addition to a doubling of positive screens for clinically significant anxiety or mood disorders, compared with a survey conducted 2 years before the hurricane, the interviews identified the following posttraumatic stressors:

▸ A substantial proportion of respondents reported having emotional problems related to their experiences in the hurricane.

▸ One-fourth (25.3%) of survey respondents reported having nightmares about their experiences in the hurricane in the past month.

▸ Nearly half (49.6%) of the respondents who were prehurricane residents of New Orleans reported having nightmares.

▸ More than half (51.8% of the total survey population and 79.4% of pre-hurricane residents of New Orleans) reported being more irritable or angry than usual.

Results also showed posttraumatic personal growth:

▸ Most respondents (88.5%) reported that they had developed a deeper sense of meaning or purpose in life as a result of their experiences with the hurricane.

▸ More than three-quarters of the respondents (77.3%) said they had become more spiritual or religious through their hurricane experiences.

▸ Almost half of the respondents (45%) rated the discovery of inner strength as having happened “a lot” during and after the hurricane.

▸ Non-Hispanic blacks (62.4%) and people with low pre-hurricane incomes (57.8%) were most likely to report the discovery of “a lot” of inner strength.

▸ Most respondents (83.4%) reported having “a lot” of faith in their own abilities to rebuild their lives.

A complete copy of the report of the baseline interviews with survivors can be found at

www.hurricanekatrina.med.harvard.edu/baseline.php

BOSTON — The estimated prevalence of serious mental illness among Hurricane Katrina survivors doubled in the months after the disaster. But suicidal ideation among this population decreased significantly during that period, compared with several years ago, a new study has shown.

The jump in mental illness post-Katrina could be predicted, but the decrease in the prevalence of suicidal thoughts among those with serious mental illness “was a surprise,” lead author Robert C. Kessler, Ph.D., said in a teleconference announcing the findings of the first Hurricane Katrina Community Advisory Group survey.

Through questions designed to assess several dimensions of personal growth resulting from the trauma of the hurricane, Dr. Kessler and his colleagues at Harvard Medical School, Boston, determined that the lower conditional prevalence of suicidality was a function of individuals' faith in their ability to rebuild their lives and realization of their inner strength. “The lowering of suicidal tendencies appears to be strongly associated with optimistic expectations for recovery efforts,” he said.

To estimate the impact of Hurricane Katrina on mental illness and suicidality, the investigators surveyed a statistically representative sample of 1,043 adults from Alabama, Louisiana, and Mississippi, and compared the results with those of the National Comorbidity Survey-Replication conducted between February 2001 and February 2003.

The NCS-R included interviews with 826 adults in the regions later affected by Hurricane Katrina. Both surveys asked identical questions about mental illness and suicidality, and the post-Katrina survey included items associated with trauma-related personal growth.

“The [post-Katrina] survey also assessed personal cognitions that have been identified in previous research to predict adjustment to disasters,” Dr. Kessler said. The survey focused on five dimensions of personal growth, including posttraumatic increases in “emotional closeness to loved ones, faith in the ability to rebuild one's life, spirituality or religiosity, meaning or purpose in life, and recognition of inner strength or competence.”

The comparison of the pre- and posthurricane surveys showed the prevalence of serious mental illness in respondents was 11.3% after Katrina, compared with 6.1% before it, and the prevalence of mild-moderate mental illness was 19.9% after the hurricane, compared with 9.7% before it.

The prevalence of suicidal ideation and plans among respondents estimated to have mental illness was 0.7% after Katrina, compared with 8.4% before it. “The lower conditional prevalence of suicidality was strongly related to two dimensions of personal growth after the trauma,” including faith in individuals' own ability to rebuild their lives and realization of inner strength, Dr. Kessler said. Without these two dimensions, “between-survey differences in suicidality [among mentally ill respondents] were insignificant,” he said.

The investigators hypothesized that the ability to create positive thoughts about the future provide protective “psychological scaffolding” against the suicidality that is often associated with extreme distress. The post-Katrina study “is, to our knowledge, the first to provide quantitative evidence regarding such a pattern in an epidemiological sample of a population that has survived a disaster,” Dr. Kessler said.

The concern, however, “is that the lowering of suicidal tendencies appears to be strongly associated with expectations for recovery efforts that might not be realistic,” he said, noting that it's important to recognize the low prevalence of suicidality might be temporary if positive expectations are not met as time goes on.

The findings could have significant implications in the development of future disaster planning efforts. “A systematic investigation of posttraumatic [positive cognitions and] personal growth might be useful in guiding public health efforts delivered through the mass media in the aftermath of disasters,” said Dr. Kessler, noting that previous studies have shown that public health messages can have a significant impact on psychological reactions to disasters.

The message for policy makers “is that communications with survivors can sometimes build on the temporary reprieve from suicidal tendencies afforded by these protective cognitions,” Dr. Kessler said. “Efforts on the part of public officials to control expectations as recovery moves forward without destroying the positive cognitions related to these expectations could prove crucial in the process of continued psychological recovery.”

The current report, published in a special online edition of the Bulletin of the World Health Organization (www.who.int/bulletin/en

The National Institute of Mental Health and the Office of the Assistant Secretary of Health and Human Services for Planning and Evaluation are funding the project.

Anxiety and Personal Growth Emerged

Baseline interviews with the Hurricane Community Advisory Group, a statistically representative sample of 1,043 Hurricane Katrina survivors from Alabama, Louisiana, and Mississippi provide important insight into the posttraumatic stress reactions and personal growth experienced by this population.

In addition to a doubling of positive screens for clinically significant anxiety or mood disorders, compared with a survey conducted 2 years before the hurricane, the interviews identified the following posttraumatic stressors:

▸ A substantial proportion of respondents reported having emotional problems related to their experiences in the hurricane.

▸ One-fourth (25.3%) of survey respondents reported having nightmares about their experiences in the hurricane in the past month.

▸ Nearly half (49.6%) of the respondents who were prehurricane residents of New Orleans reported having nightmares.

▸ More than half (51.8% of the total survey population and 79.4% of pre-hurricane residents of New Orleans) reported being more irritable or angry than usual.

Results also showed posttraumatic personal growth:

▸ Most respondents (88.5%) reported that they had developed a deeper sense of meaning or purpose in life as a result of their experiences with the hurricane.

▸ More than three-quarters of the respondents (77.3%) said they had become more spiritual or religious through their hurricane experiences.

▸ Almost half of the respondents (45%) rated the discovery of inner strength as having happened “a lot” during and after the hurricane.

▸ Non-Hispanic blacks (62.4%) and people with low pre-hurricane incomes (57.8%) were most likely to report the discovery of “a lot” of inner strength.

▸ Most respondents (83.4%) reported having “a lot” of faith in their own abilities to rebuild their lives.

A complete copy of the report of the baseline interviews with survivors can be found at

www.hurricanekatrina.med.harvard.edu/baseline.php

Comorbid depression in type 2 diabetic males is significantly associated with a range of adverse heart events, a study has shown. Treatment with antidepressant medications, however, appears to substantially moderate this link, according to Dr. Thomas S. Higgins Jr. of the University of Louisville (Ky.) and colleagues.

Previous studies have shown an increased prevalence of depression among type 2 diabetics. Because diabetes is a known risk factor for heart disease and because depressive symptoms have been associated with an increased prevalence of comorbid myocardial infraction, hypertension, and angina in certain diabetic populations, Dr. Higgins and colleagues sought to determine whether comorbid depression and diabetes together produce greater cardiac health risk than either condition alone.

The investigators reviewed data for 8,185 males over age 40 collected from the electronic medical record system of a Midwestern Veterans Affairs Medical Center (VAMC). All of the subjects had a history of type 2 diabetes and had visited the VAMC within the previous 6 years (Diabetes Res. Clin. Pract. 2006, Jul. 31 [Epub ahead of print]).

Of the 8,815 subjects, 691 had been diagnosed with depression. These individuals tended to be younger and unmarried relative to their nondepressed counterparts, and they were more likely to have a history of smoking and non-heart-related chronic diseases. More than half (57.2%) had been prescribed antidepressant medication.

A total of 2,358 subjects had been diagnosed with heart disease, such as coronary artery disease or myocardial infarction, or had undergone a heart disease-related procedure, such as angioplasty or coronary artery bypass graft (CABG). Subjects in this “adverse heart event” category were more likely to have diagnoses of depression, chronic obstructive pulmonary disease, stroke, hypertension, prostate cancer, and hyperlipidemia than subjects without prior heart events. They were also more likely to be white and to have been prescribed antidepressants.

The investigators used odds ratios to examine the link between depression status and the occurrence of each adverse heart event, and they used logistic regression to control for potential confounding variables. They performed an additional logistic regression analysis in which antidepressant medication status was included as a confounding variable, to evaluate antidepressant prescription status as a moderating variable and the interaction between depression and antidepressant status.

After adjustment for all significant confounders, the analysis demonstrated significant positive associations between depression and any adverse heart event and with each individual heart event except CABG. There was also a significant interaction between depression and antidepressant prescription status for any adverse heart event, coronary artery disease, and angioplasty. After adjustment for this interaction, the associations between depression and adverse cardiac events were no longer significant among the subjects who had been prescribed antidepressant medications; however, they remained significant for those not given antidepressants, the authors wrote.

Although the findings suggest that depressed diabetics are at increased risk for heart disease and that treating depression in diabetics may reduce this increased risk, the study has several limitations, the authors noted. Its cross-sectional design precludes determining which condition presented first and thus cannot be used to suggest a causal relationship. Also, there may be inconsistencies in data quality across the study population, the study may have missed patients who died at the time of their first adverse cardiac event or who received treatment at another hospital, and there is no information on level and duration of antidepressant use. Finally, the inclusion of only older male patients from one center limits the generalizability of the data, they said.

Comorbid depression in type 2 diabetic males is significantly associated with a range of adverse heart events, a study has shown. Treatment with antidepressant medications, however, appears to substantially moderate this link, according to Dr. Thomas S. Higgins Jr. of the University of Louisville (Ky.) and colleagues.

Previous studies have shown an increased prevalence of depression among type 2 diabetics. Because diabetes is a known risk factor for heart disease and because depressive symptoms have been associated with an increased prevalence of comorbid myocardial infraction, hypertension, and angina in certain diabetic populations, Dr. Higgins and colleagues sought to determine whether comorbid depression and diabetes together produce greater cardiac health risk than either condition alone.

The investigators reviewed data for 8,185 males over age 40 collected from the electronic medical record system of a Midwestern Veterans Affairs Medical Center (VAMC). All of the subjects had a history of type 2 diabetes and had visited the VAMC within the previous 6 years (Diabetes Res. Clin. Pract. 2006, Jul. 31 [Epub ahead of print]).

Of the 8,815 subjects, 691 had been diagnosed with depression. These individuals tended to be younger and unmarried relative to their nondepressed counterparts, and they were more likely to have a history of smoking and non-heart-related chronic diseases. More than half (57.2%) had been prescribed antidepressant medication.

A total of 2,358 subjects had been diagnosed with heart disease, such as coronary artery disease or myocardial infarction, or had undergone a heart disease-related procedure, such as angioplasty or coronary artery bypass graft (CABG). Subjects in this “adverse heart event” category were more likely to have diagnoses of depression, chronic obstructive pulmonary disease, stroke, hypertension, prostate cancer, and hyperlipidemia than subjects without prior heart events. They were also more likely to be white and to have been prescribed antidepressants.

The investigators used odds ratios to examine the link between depression status and the occurrence of each adverse heart event, and they used logistic regression to control for potential confounding variables. They performed an additional logistic regression analysis in which antidepressant medication status was included as a confounding variable, to evaluate antidepressant prescription status as a moderating variable and the interaction between depression and antidepressant status.

After adjustment for all significant confounders, the analysis demonstrated significant positive associations between depression and any adverse heart event and with each individual heart event except CABG. There was also a significant interaction between depression and antidepressant prescription status for any adverse heart event, coronary artery disease, and angioplasty. After adjustment for this interaction, the associations between depression and adverse cardiac events were no longer significant among the subjects who had been prescribed antidepressant medications; however, they remained significant for those not given antidepressants, the authors wrote.

Although the findings suggest that depressed diabetics are at increased risk for heart disease and that treating depression in diabetics may reduce this increased risk, the study has several limitations, the authors noted. Its cross-sectional design precludes determining which condition presented first and thus cannot be used to suggest a causal relationship. Also, there may be inconsistencies in data quality across the study population, the study may have missed patients who died at the time of their first adverse cardiac event or who received treatment at another hospital, and there is no information on level and duration of antidepressant use. Finally, the inclusion of only older male patients from one center limits the generalizability of the data, they said.

Comorbid depression in type 2 diabetic males is significantly associated with a range of adverse heart events, a study has shown. Treatment with antidepressant medications, however, appears to substantially moderate this link, according to Dr. Thomas S. Higgins Jr. of the University of Louisville (Ky.) and colleagues.

Previous studies have shown an increased prevalence of depression among type 2 diabetics. Because diabetes is a known risk factor for heart disease and because depressive symptoms have been associated with an increased prevalence of comorbid myocardial infraction, hypertension, and angina in certain diabetic populations, Dr. Higgins and colleagues sought to determine whether comorbid depression and diabetes together produce greater cardiac health risk than either condition alone.

The investigators reviewed data for 8,185 males over age 40 collected from the electronic medical record system of a Midwestern Veterans Affairs Medical Center (VAMC). All of the subjects had a history of type 2 diabetes and had visited the VAMC within the previous 6 years (Diabetes Res. Clin. Pract. 2006, Jul. 31 [Epub ahead of print]).

Of the 8,815 subjects, 691 had been diagnosed with depression. These individuals tended to be younger and unmarried relative to their nondepressed counterparts, and they were more likely to have a history of smoking and non-heart-related chronic diseases. More than half (57.2%) had been prescribed antidepressant medication.

A total of 2,358 subjects had been diagnosed with heart disease, such as coronary artery disease or myocardial infarction, or had undergone a heart disease-related procedure, such as angioplasty or coronary artery bypass graft (CABG). Subjects in this “adverse heart event” category were more likely to have diagnoses of depression, chronic obstructive pulmonary disease, stroke, hypertension, prostate cancer, and hyperlipidemia than subjects without prior heart events. They were also more likely to be white and to have been prescribed antidepressants.

The investigators used odds ratios to examine the link between depression status and the occurrence of each adverse heart event, and they used logistic regression to control for potential confounding variables. They performed an additional logistic regression analysis in which antidepressant medication status was included as a confounding variable, to evaluate antidepressant prescription status as a moderating variable and the interaction between depression and antidepressant status.

After adjustment for all significant confounders, the analysis demonstrated significant positive associations between depression and any adverse heart event and with each individual heart event except CABG. There was also a significant interaction between depression and antidepressant prescription status for any adverse heart event, coronary artery disease, and angioplasty. After adjustment for this interaction, the associations between depression and adverse cardiac events were no longer significant among the subjects who had been prescribed antidepressant medications; however, they remained significant for those not given antidepressants, the authors wrote.

Although the findings suggest that depressed diabetics are at increased risk for heart disease and that treating depression in diabetics may reduce this increased risk, the study has several limitations, the authors noted. Its cross-sectional design precludes determining which condition presented first and thus cannot be used to suggest a causal relationship. Also, there may be inconsistencies in data quality across the study population, the study may have missed patients who died at the time of their first adverse cardiac event or who received treatment at another hospital, and there is no information on level and duration of antidepressant use. Finally, the inclusion of only older male patients from one center limits the generalizability of the data, they said.

BOSTON – Depression, metabolic syndrome, and lack of exercise exacerbate daytime sleepiness in obese patients with sleep apnea, Dr. Alexios Sarrigiannidis said at the annual meeting of the Endocrine Society.

Dr. Sarrigiannidis and his colleagues in the Sleep Research and Treatment Center at Pennsylvania State University, Hershey, reviewed data for 708 consecutive patients, 470 men and 238 women, mean age 50 years, who had been referred for symptoms consistent with sleep apnea and had at least five episodes of apnea/hypopnea per hour. Mean body mass index was 34.9 kg/m

All of the participants completed the General Health Questionnaire to assess for depression, diabetes, cardiovascular disease, hypertension, and sleep habits; the Epworth Sleepiness Scale; and the Physical Activity Questionnaire. They were all assessed for metabolic syndrome and underwent one standard, 8-hour nocturnal polysomnographic recording.

Among men, the mean apnea/hypopnea index score (representing the total number of either apnea or hypopnea episodes/hr of sleep) was 39.9, significantly higher than the 29.2 reported in the women. Measures of sleepiness and physical activity were similar for both groups.

Of the study population, 39% of the men and 62% of the women met the diagnostic criteria for major depressive disorder, and 69% of the men and 68% of the women fulfilled the criteria for metabolic syndrome. In both groups, approximately 43% did not get regular physical exercise, the investigators said.

Using logistic regression analysis, “exercise was the strongest [statistically significant] predictor of excess daytime sleepiness in men, followed by depression,” Dr. Sarrigiannidis reported in a poster presentation. “In the women, depression and metabolic syndrome, in that order, were the most important predictors.”

Independent of body weight, “participating in regular exercise appears to have somewhat of a protective effect in terms of daytime sleepiness, particularly among men,” Dr. Sarrigiannidis said. Exercise improves insulin resistance and reduces visceral adiposity, he said, noting that clinicians should encourage physical activity as a way to help combat daytime fatigue in individuals with sleep apnea.

Additionally, Dr. Sarrigiannidis advised physicians to evaluate sleep apnea patients routinely for depression and metabolic syndrome and to refer them for appropriate treatment when necessary.

Dr. Sarrigiannidis reported having no conflicts of interest with respect to his presentation.

BOSTON – Depression, metabolic syndrome, and lack of exercise exacerbate daytime sleepiness in obese patients with sleep apnea, Dr. Alexios Sarrigiannidis said at the annual meeting of the Endocrine Society.

Dr. Sarrigiannidis and his colleagues in the Sleep Research and Treatment Center at Pennsylvania State University, Hershey, reviewed data for 708 consecutive patients, 470 men and 238 women, mean age 50 years, who had been referred for symptoms consistent with sleep apnea and had at least five episodes of apnea/hypopnea per hour. Mean body mass index was 34.9 kg/m

All of the participants completed the General Health Questionnaire to assess for depression, diabetes, cardiovascular disease, hypertension, and sleep habits; the Epworth Sleepiness Scale; and the Physical Activity Questionnaire. They were all assessed for metabolic syndrome and underwent one standard, 8-hour nocturnal polysomnographic recording.

Among men, the mean apnea/hypopnea index score (representing the total number of either apnea or hypopnea episodes/hr of sleep) was 39.9, significantly higher than the 29.2 reported in the women. Measures of sleepiness and physical activity were similar for both groups.

Of the study population, 39% of the men and 62% of the women met the diagnostic criteria for major depressive disorder, and 69% of the men and 68% of the women fulfilled the criteria for metabolic syndrome. In both groups, approximately 43% did not get regular physical exercise, the investigators said.

Using logistic regression analysis, “exercise was the strongest [statistically significant] predictor of excess daytime sleepiness in men, followed by depression,” Dr. Sarrigiannidis reported in a poster presentation. “In the women, depression and metabolic syndrome, in that order, were the most important predictors.”

Independent of body weight, “participating in regular exercise appears to have somewhat of a protective effect in terms of daytime sleepiness, particularly among men,” Dr. Sarrigiannidis said. Exercise improves insulin resistance and reduces visceral adiposity, he said, noting that clinicians should encourage physical activity as a way to help combat daytime fatigue in individuals with sleep apnea.

Additionally, Dr. Sarrigiannidis advised physicians to evaluate sleep apnea patients routinely for depression and metabolic syndrome and to refer them for appropriate treatment when necessary.

Dr. Sarrigiannidis reported having no conflicts of interest with respect to his presentation.

BOSTON – Depression, metabolic syndrome, and lack of exercise exacerbate daytime sleepiness in obese patients with sleep apnea, Dr. Alexios Sarrigiannidis said at the annual meeting of the Endocrine Society.

Dr. Sarrigiannidis and his colleagues in the Sleep Research and Treatment Center at Pennsylvania State University, Hershey, reviewed data for 708 consecutive patients, 470 men and 238 women, mean age 50 years, who had been referred for symptoms consistent with sleep apnea and had at least five episodes of apnea/hypopnea per hour. Mean body mass index was 34.9 kg/m

All of the participants completed the General Health Questionnaire to assess for depression, diabetes, cardiovascular disease, hypertension, and sleep habits; the Epworth Sleepiness Scale; and the Physical Activity Questionnaire. They were all assessed for metabolic syndrome and underwent one standard, 8-hour nocturnal polysomnographic recording.

Among men, the mean apnea/hypopnea index score (representing the total number of either apnea or hypopnea episodes/hr of sleep) was 39.9, significantly higher than the 29.2 reported in the women. Measures of sleepiness and physical activity were similar for both groups.

Of the study population, 39% of the men and 62% of the women met the diagnostic criteria for major depressive disorder, and 69% of the men and 68% of the women fulfilled the criteria for metabolic syndrome. In both groups, approximately 43% did not get regular physical exercise, the investigators said.

Using logistic regression analysis, “exercise was the strongest [statistically significant] predictor of excess daytime sleepiness in men, followed by depression,” Dr. Sarrigiannidis reported in a poster presentation. “In the women, depression and metabolic syndrome, in that order, were the most important predictors.”

Independent of body weight, “participating in regular exercise appears to have somewhat of a protective effect in terms of daytime sleepiness, particularly among men,” Dr. Sarrigiannidis said. Exercise improves insulin resistance and reduces visceral adiposity, he said, noting that clinicians should encourage physical activity as a way to help combat daytime fatigue in individuals with sleep apnea.

Additionally, Dr. Sarrigiannidis advised physicians to evaluate sleep apnea patients routinely for depression and metabolic syndrome and to refer them for appropriate treatment when necessary.

Dr. Sarrigiannidis reported having no conflicts of interest with respect to his presentation.

MONTREAL – Measles found in the intestines of a cohort of autistic children with bowel disease should not be perceived as proof of an association between the measles vaccine and autism, Stephen J. Walker, Ph.D., stressed at the 5th International Meeting for Autism Research.

“We haven't done anything to demonstrate that the measles virus is causing autism or even causing bowel disease. We have simply shown that there is measles virus in the guts of a large number of children who have regressive autism,” said Dr. Walker of Wake Forest University in Winston-Salem, N.C.

A high percentage of children with autism have chronic bowel disease, which can have a direct influence on cognitive and behavioral issues associated with the condition, Dr. Walker said.

To explore the potential causes of autistic enterocolitis, the nonspecific ileocolitis with ileocolonic lymphonodular hyperplasia that plagues many of these children, Dr. Walker and colleagues have so far assayed terminal ileum biopsy tissue from 82 of 275 autistic children who had been referred to a pediatric gastroenterologist for evaluation. Eighty-five percent of the children tested, all of whom have the regressive form of autism in which an apparently normal child loses skills, have tested positive for the measles virus.

In addition, Dr. Walker noted, “of the handful of results we have in so far, all of the measles viruses are vaccine strains and none are wild measles.”

In emphasizing that the findings are preliminary, Dr. Walker noted that “there are lots of viruses in the gut and any one of them could be the cause of chronic inflammation in these kids.” While the findings do not confirm a causative link between the measles component of the measles/mumps/rubella virus suggested by a British scientist in 2002 and causing a maelstrom of accusations and protests, “if the virus from the vaccine is the cause of inflammation and chronic bowel disease in some susceptible children, that is something that needs to be known,” he said.

Because of the long-standing controversy surrounding the MMR vaccine-autism theory, Dr. Walker suggested that the objectives and findings of this study be considered in the “proper context,” noting that “our goal is to discover the biology of bowel disease in these children and to gain insight into the most effective ways to treat it.”

Relieving the bowel discomfort is a top priority. “These kids experience severe stomachaches every hour of every day, and many of them are nonverbal, so they can't communicate their pain,” he said. Instead, they exhibit certain behaviors that are often considered characteristic of their autism, such as leaning over the edge of a table or chair for hours at a time.

Identification and treatment of the bowel disease can lead to improvements in other areas, Dr. Walker noted. “There is case after case where kids improve cognitively, behaviorally, and biomedically when the bowel disease is treated. Right now, that is our goal.”

MONTREAL – Measles found in the intestines of a cohort of autistic children with bowel disease should not be perceived as proof of an association between the measles vaccine and autism, Stephen J. Walker, Ph.D., stressed at the 5th International Meeting for Autism Research.

“We haven't done anything to demonstrate that the measles virus is causing autism or even causing bowel disease. We have simply shown that there is measles virus in the guts of a large number of children who have regressive autism,” said Dr. Walker of Wake Forest University in Winston-Salem, N.C.

A high percentage of children with autism have chronic bowel disease, which can have a direct influence on cognitive and behavioral issues associated with the condition, Dr. Walker said.

To explore the potential causes of autistic enterocolitis, the nonspecific ileocolitis with ileocolonic lymphonodular hyperplasia that plagues many of these children, Dr. Walker and colleagues have so far assayed terminal ileum biopsy tissue from 82 of 275 autistic children who had been referred to a pediatric gastroenterologist for evaluation. Eighty-five percent of the children tested, all of whom have the regressive form of autism in which an apparently normal child loses skills, have tested positive for the measles virus.

In addition, Dr. Walker noted, “of the handful of results we have in so far, all of the measles viruses are vaccine strains and none are wild measles.”

In emphasizing that the findings are preliminary, Dr. Walker noted that “there are lots of viruses in the gut and any one of them could be the cause of chronic inflammation in these kids.” While the findings do not confirm a causative link between the measles component of the measles/mumps/rubella virus suggested by a British scientist in 2002 and causing a maelstrom of accusations and protests, “if the virus from the vaccine is the cause of inflammation and chronic bowel disease in some susceptible children, that is something that needs to be known,” he said.

Because of the long-standing controversy surrounding the MMR vaccine-autism theory, Dr. Walker suggested that the objectives and findings of this study be considered in the “proper context,” noting that “our goal is to discover the biology of bowel disease in these children and to gain insight into the most effective ways to treat it.”

Relieving the bowel discomfort is a top priority. “These kids experience severe stomachaches every hour of every day, and many of them are nonverbal, so they can't communicate their pain,” he said. Instead, they exhibit certain behaviors that are often considered characteristic of their autism, such as leaning over the edge of a table or chair for hours at a time.

Identification and treatment of the bowel disease can lead to improvements in other areas, Dr. Walker noted. “There is case after case where kids improve cognitively, behaviorally, and biomedically when the bowel disease is treated. Right now, that is our goal.”

MONTREAL – Measles found in the intestines of a cohort of autistic children with bowel disease should not be perceived as proof of an association between the measles vaccine and autism, Stephen J. Walker, Ph.D., stressed at the 5th International Meeting for Autism Research.

“We haven't done anything to demonstrate that the measles virus is causing autism or even causing bowel disease. We have simply shown that there is measles virus in the guts of a large number of children who have regressive autism,” said Dr. Walker of Wake Forest University in Winston-Salem, N.C.

A high percentage of children with autism have chronic bowel disease, which can have a direct influence on cognitive and behavioral issues associated with the condition, Dr. Walker said.

To explore the potential causes of autistic enterocolitis, the nonspecific ileocolitis with ileocolonic lymphonodular hyperplasia that plagues many of these children, Dr. Walker and colleagues have so far assayed terminal ileum biopsy tissue from 82 of 275 autistic children who had been referred to a pediatric gastroenterologist for evaluation. Eighty-five percent of the children tested, all of whom have the regressive form of autism in which an apparently normal child loses skills, have tested positive for the measles virus.

In addition, Dr. Walker noted, “of the handful of results we have in so far, all of the measles viruses are vaccine strains and none are wild measles.”

In emphasizing that the findings are preliminary, Dr. Walker noted that “there are lots of viruses in the gut and any one of them could be the cause of chronic inflammation in these kids.” While the findings do not confirm a causative link between the measles component of the measles/mumps/rubella virus suggested by a British scientist in 2002 and causing a maelstrom of accusations and protests, “if the virus from the vaccine is the cause of inflammation and chronic bowel disease in some susceptible children, that is something that needs to be known,” he said.

Because of the long-standing controversy surrounding the MMR vaccine-autism theory, Dr. Walker suggested that the objectives and findings of this study be considered in the “proper context,” noting that “our goal is to discover the biology of bowel disease in these children and to gain insight into the most effective ways to treat it.”

Relieving the bowel discomfort is a top priority. “These kids experience severe stomachaches every hour of every day, and many of them are nonverbal, so they can't communicate their pain,” he said. Instead, they exhibit certain behaviors that are often considered characteristic of their autism, such as leaning over the edge of a table or chair for hours at a time.

Identification and treatment of the bowel disease can lead to improvements in other areas, Dr. Walker noted. “There is case after case where kids improve cognitively, behaviorally, and biomedically when the bowel disease is treated. Right now, that is our goal.”

MONTREAL – Intensive intervention programs that focus on joint attention using a child-directed teaching approach can affect change in autistic children's attention states, and potentially improve social functioning and their long-term prognosis, Tanya Paparella, Ph.D., said at the 5th International Meeting for Autism Research.

Joint attention–which refers to the propensity of a child to engage others' attention through eye contact, referential eye gaze, and pointing as a way to share their experience of objects or events–is a critical area in normal development that typically emerges between the ages of 9 and 15 months. Studies have indicated that joint attention behaviors lay the foundation for later emerging skills, including more complex expressive language and symbolic play.

Impairment in the development of joint attention is characteristic of children with autism spectrum disorders, and it is one of the core deficits addressed in the Early Childhood Partial Hospitalization Program (ECPHP) in the division of child psychiatry at the University of California at Los Angeles. The ECPHP is a 12-week program for children with autism between the ages of 2 and 7 years in which structured, intensive, individualized treatment is provided to 12 children at a time for 6 hours per day, 5 days per week.

The comprehensive program is made up of direct intervention in core areas of functional deficit: educational, behavioral, and social intervention plans; parent education and support; and liaison with community agencies. All children in the program receive speech therapy, occupational therapy, and recreational therapy interventions. They also are seen individually or in therapeutic groups to promote language usage, socialization, and appropriate interaction with others, Dr. Paparella said in a poster presentation.

In a study designed to assess whether participation in a comprehensive treatment intervention can affect the development of joint attention behaviors, Dr. Paparella and her colleagues evaluated the outcomes of 10 ECPHP participants using an observational measure designed to examine the proportion of time each child spent in any of six engagement states.

The states of engagement were defined as: unengaged, in which the child is not involved with any object or event; onlooking, whereby the child is observing another's activity but is not taking part in it; object engaged, in which the child is focused solely on an object by himself, minus any type of communication with another person; person engaged, where the child is engaged in an interaction with another person but does not shift his or her attention between the person and object; supported joint attention, in which the child and another individual are actively involved in the same object, but the child shows little awareness of the other's involvement; and coordinated joint attention, where the child actively attempts to coordinate his or her attention to both another person and the object resulting in a shared social experience.

All of the children were evaluated using the Mullen Scales of Early Learning, which assess early cognitive ability and motor development. Of the 10 children–6 males and 4 females with a mean age of 38 months–4 were defined as lower functioning based on their Mullen scores; 6 were considered higher functioning.

At four equally spaced time points during the 12-week program from the time of admission to discharge, each child was observed for 15 minutes in each of four different contexts, including one-on-one instruction, structured play, circle time, and unstructured play. For observational coding, each 15-minute session was divided into 30-second time intervals, at the end of which the child's predominant engagement state was recorded. For each time point, a total score for each state was calculated across all four contexts to represent the mean number of intervals that the child was engaged in a specific engagement state.

Over the 12-week study period, “all of the children demonstrated decreases in the proportions of time spent in unengaged and on-looking states, and all increased the proportion of time spent in person-engaged, supported joint attention, and coordinated joint attention states,” Dr. Paparella reported. The trajectories of change in the various engagement states varied, depending on the child's functional level, she noted. “The four lower-functioning children showed good increases in the lower-level engagement states and more gradual trajectories of change with the successively advanced states.” In contrast, “the higher-functioning children showed dramatic increases in the more socially complex joint attention states.”

The ability to change autistic children's attention states–and, in particular, to aid in the development of joint attention behaviors–through intensive behavioral intervention may play an important role in developing more complex social behaviors and communication skills, Dr. Paparella said. Simply decreasing the amount of time spent in passive states relative to active, engaged states can have a substantial impact on how children with autism experience the world. Further studies are needed to examine which aspects of the intervention have the most impact on attention states, she said.

MONTREAL – Intensive intervention programs that focus on joint attention using a child-directed teaching approach can affect change in autistic children's attention states, and potentially improve social functioning and their long-term prognosis, Tanya Paparella, Ph.D., said at the 5th International Meeting for Autism Research.

Joint attention–which refers to the propensity of a child to engage others' attention through eye contact, referential eye gaze, and pointing as a way to share their experience of objects or events–is a critical area in normal development that typically emerges between the ages of 9 and 15 months. Studies have indicated that joint attention behaviors lay the foundation for later emerging skills, including more complex expressive language and symbolic play.

Impairment in the development of joint attention is characteristic of children with autism spectrum disorders, and it is one of the core deficits addressed in the Early Childhood Partial Hospitalization Program (ECPHP) in the division of child psychiatry at the University of California at Los Angeles. The ECPHP is a 12-week program for children with autism between the ages of 2 and 7 years in which structured, intensive, individualized treatment is provided to 12 children at a time for 6 hours per day, 5 days per week.

The comprehensive program is made up of direct intervention in core areas of functional deficit: educational, behavioral, and social intervention plans; parent education and support; and liaison with community agencies. All children in the program receive speech therapy, occupational therapy, and recreational therapy interventions. They also are seen individually or in therapeutic groups to promote language usage, socialization, and appropriate interaction with others, Dr. Paparella said in a poster presentation.

In a study designed to assess whether participation in a comprehensive treatment intervention can affect the development of joint attention behaviors, Dr. Paparella and her colleagues evaluated the outcomes of 10 ECPHP participants using an observational measure designed to examine the proportion of time each child spent in any of six engagement states.

The states of engagement were defined as: unengaged, in which the child is not involved with any object or event; onlooking, whereby the child is observing another's activity but is not taking part in it; object engaged, in which the child is focused solely on an object by himself, minus any type of communication with another person; person engaged, where the child is engaged in an interaction with another person but does not shift his or her attention between the person and object; supported joint attention, in which the child and another individual are actively involved in the same object, but the child shows little awareness of the other's involvement; and coordinated joint attention, where the child actively attempts to coordinate his or her attention to both another person and the object resulting in a shared social experience.

All of the children were evaluated using the Mullen Scales of Early Learning, which assess early cognitive ability and motor development. Of the 10 children–6 males and 4 females with a mean age of 38 months–4 were defined as lower functioning based on their Mullen scores; 6 were considered higher functioning.

At four equally spaced time points during the 12-week program from the time of admission to discharge, each child was observed for 15 minutes in each of four different contexts, including one-on-one instruction, structured play, circle time, and unstructured play. For observational coding, each 15-minute session was divided into 30-second time intervals, at the end of which the child's predominant engagement state was recorded. For each time point, a total score for each state was calculated across all four contexts to represent the mean number of intervals that the child was engaged in a specific engagement state.

Over the 12-week study period, “all of the children demonstrated decreases in the proportions of time spent in unengaged and on-looking states, and all increased the proportion of time spent in person-engaged, supported joint attention, and coordinated joint attention states,” Dr. Paparella reported. The trajectories of change in the various engagement states varied, depending on the child's functional level, she noted. “The four lower-functioning children showed good increases in the lower-level engagement states and more gradual trajectories of change with the successively advanced states.” In contrast, “the higher-functioning children showed dramatic increases in the more socially complex joint attention states.”

The ability to change autistic children's attention states–and, in particular, to aid in the development of joint attention behaviors–through intensive behavioral intervention may play an important role in developing more complex social behaviors and communication skills, Dr. Paparella said. Simply decreasing the amount of time spent in passive states relative to active, engaged states can have a substantial impact on how children with autism experience the world. Further studies are needed to examine which aspects of the intervention have the most impact on attention states, she said.

MONTREAL – Intensive intervention programs that focus on joint attention using a child-directed teaching approach can affect change in autistic children's attention states, and potentially improve social functioning and their long-term prognosis, Tanya Paparella, Ph.D., said at the 5th International Meeting for Autism Research.

Joint attention–which refers to the propensity of a child to engage others' attention through eye contact, referential eye gaze, and pointing as a way to share their experience of objects or events–is a critical area in normal development that typically emerges between the ages of 9 and 15 months. Studies have indicated that joint attention behaviors lay the foundation for later emerging skills, including more complex expressive language and symbolic play.

Impairment in the development of joint attention is characteristic of children with autism spectrum disorders, and it is one of the core deficits addressed in the Early Childhood Partial Hospitalization Program (ECPHP) in the division of child psychiatry at the University of California at Los Angeles. The ECPHP is a 12-week program for children with autism between the ages of 2 and 7 years in which structured, intensive, individualized treatment is provided to 12 children at a time for 6 hours per day, 5 days per week.

The comprehensive program is made up of direct intervention in core areas of functional deficit: educational, behavioral, and social intervention plans; parent education and support; and liaison with community agencies. All children in the program receive speech therapy, occupational therapy, and recreational therapy interventions. They also are seen individually or in therapeutic groups to promote language usage, socialization, and appropriate interaction with others, Dr. Paparella said in a poster presentation.

In a study designed to assess whether participation in a comprehensive treatment intervention can affect the development of joint attention behaviors, Dr. Paparella and her colleagues evaluated the outcomes of 10 ECPHP participants using an observational measure designed to examine the proportion of time each child spent in any of six engagement states.

The states of engagement were defined as: unengaged, in which the child is not involved with any object or event; onlooking, whereby the child is observing another's activity but is not taking part in it; object engaged, in which the child is focused solely on an object by himself, minus any type of communication with another person; person engaged, where the child is engaged in an interaction with another person but does not shift his or her attention between the person and object; supported joint attention, in which the child and another individual are actively involved in the same object, but the child shows little awareness of the other's involvement; and coordinated joint attention, where the child actively attempts to coordinate his or her attention to both another person and the object resulting in a shared social experience.

All of the children were evaluated using the Mullen Scales of Early Learning, which assess early cognitive ability and motor development. Of the 10 children–6 males and 4 females with a mean age of 38 months–4 were defined as lower functioning based on their Mullen scores; 6 were considered higher functioning.

At four equally spaced time points during the 12-week program from the time of admission to discharge, each child was observed for 15 minutes in each of four different contexts, including one-on-one instruction, structured play, circle time, and unstructured play. For observational coding, each 15-minute session was divided into 30-second time intervals, at the end of which the child's predominant engagement state was recorded. For each time point, a total score for each state was calculated across all four contexts to represent the mean number of intervals that the child was engaged in a specific engagement state.

Over the 12-week study period, “all of the children demonstrated decreases in the proportions of time spent in unengaged and on-looking states, and all increased the proportion of time spent in person-engaged, supported joint attention, and coordinated joint attention states,” Dr. Paparella reported. The trajectories of change in the various engagement states varied, depending on the child's functional level, she noted. “The four lower-functioning children showed good increases in the lower-level engagement states and more gradual trajectories of change with the successively advanced states.” In contrast, “the higher-functioning children showed dramatic increases in the more socially complex joint attention states.”

The ability to change autistic children's attention states–and, in particular, to aid in the development of joint attention behaviors–through intensive behavioral intervention may play an important role in developing more complex social behaviors and communication skills, Dr. Paparella said. Simply decreasing the amount of time spent in passive states relative to active, engaged states can have a substantial impact on how children with autism experience the world. Further studies are needed to examine which aspects of the intervention have the most impact on attention states, she said.

BOSTON — Depression, metabolic syndrome, and lack of exercise exacerbate daytime sleepiness in obese patients with sleep apnea, Dr. Alexios Sarrigiannidis said at the annual meeting of the Endocrine Society.

Dr. Sarrigiannidis and his colleagues in the Sleep Research and Treatment Center at Pennsylvania State University, Hershey, reviewed data for 708 consecutive patients, 470 men and 238 women, mean age 50 years, who had been referred for symptoms consistent with sleep apnea and had at least five episodes of apnea/hypopnea per hour. Mean body mass index was 34.9 kg/m

Participants completed the General Health Questionnaire; the Epworth Sleepiness Scale; and the Physical Activity Questionnaire. All were assessed for metabolic syndrome and underwent a standard, 8-hour nocturnal polysomnographic recording.

Among men, the mean apnea/hypopnea index score (representing the total number of either apnea or hypopnea episodes/hr of sleep) was 39.9, significantly higher than the 29.2 reported in the women. Measures of sleepiness and physical activity were similar for both groups.

Of the study population, 39% of the men and 62% of the women met the diagnostic criteria for major depressive disorder, and 69% of the men and 68% of the women fulfilled the criteria for metabolic syndrome. In both groups, about 43% did not get regular physical exercise.

Using logistic regression analysis, “exercise was the strongest [statistically significant] predictor of excess daytime sleepiness in men, followed by depression,” Dr. Sarrigiannidis reported in a poster presentation. “In the women, depression and metabolic syndrome, in that order, were the most important predictors.”

Independent of body weight, “participating in regular exercise appears to have somewhat of a protective effect in terms of daytime sleepiness, particularly among men,” Dr. Sarrigiannidis said. Exercise improves insulin resistance and reduces visceral adiposity, he said, noting that clinicians should encourage physical activity as a way to help combat daytime fatigue in individuals with sleep apnea.

BOSTON — Depression, metabolic syndrome, and lack of exercise exacerbate daytime sleepiness in obese patients with sleep apnea, Dr. Alexios Sarrigiannidis said at the annual meeting of the Endocrine Society.

Dr. Sarrigiannidis and his colleagues in the Sleep Research and Treatment Center at Pennsylvania State University, Hershey, reviewed data for 708 consecutive patients, 470 men and 238 women, mean age 50 years, who had been referred for symptoms consistent with sleep apnea and had at least five episodes of apnea/hypopnea per hour. Mean body mass index was 34.9 kg/m

Participants completed the General Health Questionnaire; the Epworth Sleepiness Scale; and the Physical Activity Questionnaire. All were assessed for metabolic syndrome and underwent a standard, 8-hour nocturnal polysomnographic recording.

Among men, the mean apnea/hypopnea index score (representing the total number of either apnea or hypopnea episodes/hr of sleep) was 39.9, significantly higher than the 29.2 reported in the women. Measures of sleepiness and physical activity were similar for both groups.

Of the study population, 39% of the men and 62% of the women met the diagnostic criteria for major depressive disorder, and 69% of the men and 68% of the women fulfilled the criteria for metabolic syndrome. In both groups, about 43% did not get regular physical exercise.

Using logistic regression analysis, “exercise was the strongest [statistically significant] predictor of excess daytime sleepiness in men, followed by depression,” Dr. Sarrigiannidis reported in a poster presentation. “In the women, depression and metabolic syndrome, in that order, were the most important predictors.”

Independent of body weight, “participating in regular exercise appears to have somewhat of a protective effect in terms of daytime sleepiness, particularly among men,” Dr. Sarrigiannidis said. Exercise improves insulin resistance and reduces visceral adiposity, he said, noting that clinicians should encourage physical activity as a way to help combat daytime fatigue in individuals with sleep apnea.

BOSTON — Depression, metabolic syndrome, and lack of exercise exacerbate daytime sleepiness in obese patients with sleep apnea, Dr. Alexios Sarrigiannidis said at the annual meeting of the Endocrine Society.

Dr. Sarrigiannidis and his colleagues in the Sleep Research and Treatment Center at Pennsylvania State University, Hershey, reviewed data for 708 consecutive patients, 470 men and 238 women, mean age 50 years, who had been referred for symptoms consistent with sleep apnea and had at least five episodes of apnea/hypopnea per hour. Mean body mass index was 34.9 kg/m

Participants completed the General Health Questionnaire; the Epworth Sleepiness Scale; and the Physical Activity Questionnaire. All were assessed for metabolic syndrome and underwent a standard, 8-hour nocturnal polysomnographic recording.

Among men, the mean apnea/hypopnea index score (representing the total number of either apnea or hypopnea episodes/hr of sleep) was 39.9, significantly higher than the 29.2 reported in the women. Measures of sleepiness and physical activity were similar for both groups.

Of the study population, 39% of the men and 62% of the women met the diagnostic criteria for major depressive disorder, and 69% of the men and 68% of the women fulfilled the criteria for metabolic syndrome. In both groups, about 43% did not get regular physical exercise.

Using logistic regression analysis, “exercise was the strongest [statistically significant] predictor of excess daytime sleepiness in men, followed by depression,” Dr. Sarrigiannidis reported in a poster presentation. “In the women, depression and metabolic syndrome, in that order, were the most important predictors.”

Independent of body weight, “participating in regular exercise appears to have somewhat of a protective effect in terms of daytime sleepiness, particularly among men,” Dr. Sarrigiannidis said. Exercise improves insulin resistance and reduces visceral adiposity, he said, noting that clinicians should encourage physical activity as a way to help combat daytime fatigue in individuals with sleep apnea.

Pregnant adolescents who receive interdisciplinary prenatal and postpartum care and psychosocial support have lower rates of rapid pregnancy recurrence, Amanda Melhado reported at the annual meeting of the Society for Adolescent Medicine.

In a prospective study of a “global care” model, Ms. Melhado, Dr. Maria José Carvalho Sant'Anna, and Dr. Verônica Coates of Faculdade de Ciências Médicas da Santa Casa in São Paolo, Brazil, compared the outcomes of 30 adolescents who received specialized prenatal medical care and psychoeducational support with those of 39 age-matched adolescents who received standard prenatal care only.

All the young women in the study were 18 years old or younger at the time of conception and gave birth at the same hospital between July 1, 2004, and June 30, 2005.

No significant differences were found between the two groups with respect to marital status or relationship with the babies' fathers. More than half of the young women in both groups were not married at the time of the study, and more than one-quarter in both groups no longer had contact with the child's father.

The psychoeducational support component included group and individual sessions with a team of providers—including mental health professionals, obstetricians, and pediatricians—focusing on such topics as self-esteem, contraception, relationships, and infant development.

As of March 2006, the rate of pregnancy recurrence among the young women who received the intervention was 3%, compared with 15% in the standard care group.

Pregnant adolescents who receive interdisciplinary prenatal and postpartum care and psychosocial support have lower rates of rapid pregnancy recurrence, Amanda Melhado reported at the annual meeting of the Society for Adolescent Medicine.

In a prospective study of a “global care” model, Ms. Melhado, Dr. Maria José Carvalho Sant'Anna, and Dr. Verônica Coates of Faculdade de Ciências Médicas da Santa Casa in São Paolo, Brazil, compared the outcomes of 30 adolescents who received specialized prenatal medical care and psychoeducational support with those of 39 age-matched adolescents who received standard prenatal care only.

All the young women in the study were 18 years old or younger at the time of conception and gave birth at the same hospital between July 1, 2004, and June 30, 2005.

No significant differences were found between the two groups with respect to marital status or relationship with the babies' fathers. More than half of the young women in both groups were not married at the time of the study, and more than one-quarter in both groups no longer had contact with the child's father.

The psychoeducational support component included group and individual sessions with a team of providers—including mental health professionals, obstetricians, and pediatricians—focusing on such topics as self-esteem, contraception, relationships, and infant development.

As of March 2006, the rate of pregnancy recurrence among the young women who received the intervention was 3%, compared with 15% in the standard care group.

Pregnant adolescents who receive interdisciplinary prenatal and postpartum care and psychosocial support have lower rates of rapid pregnancy recurrence, Amanda Melhado reported at the annual meeting of the Society for Adolescent Medicine.

In a prospective study of a “global care” model, Ms. Melhado, Dr. Maria José Carvalho Sant'Anna, and Dr. Verônica Coates of Faculdade de Ciências Médicas da Santa Casa in São Paolo, Brazil, compared the outcomes of 30 adolescents who received specialized prenatal medical care and psychoeducational support with those of 39 age-matched adolescents who received standard prenatal care only.

All the young women in the study were 18 years old or younger at the time of conception and gave birth at the same hospital between July 1, 2004, and June 30, 2005.

No significant differences were found between the two groups with respect to marital status or relationship with the babies' fathers. More than half of the young women in both groups were not married at the time of the study, and more than one-quarter in both groups no longer had contact with the child's father.

The psychoeducational support component included group and individual sessions with a team of providers—including mental health professionals, obstetricians, and pediatricians—focusing on such topics as self-esteem, contraception, relationships, and infant development.

As of March 2006, the rate of pregnancy recurrence among the young women who received the intervention was 3%, compared with 15% in the standard care group.

Sexually risky behaviors on the part of adolescents is nothing new, but the age at which these behaviors begin is. In fact, new data suggest that sexual risk taking often begins in middle school.

Baseline data collected in spring 2005 from 4,457 middle school students aged 11–14 years at 14 urban schools participating in Project Connect, an 8-year multilevel intervention study, showed that more than 9% of the students surveyed reported ever having sexual intercourse, and 8% reported ever having oral sex. In total, about 12% reported any sexual activity. Of those students who reported having had intercourse, 36% were aged 11 or younger at first sex, 27% were 12 years old, 28% were 13 years old, and 9% were aged 14 or older. Additionally, of those who reported having had intercourse, 43% reported having had multiple sex partners.

Given their young age at sexual onset, “these youth are at very high risk for adverse health outcomes,” Project Connect investigator Christine J. DeRosa, Ph.D., said at the annual meeting of the Society for Adolescent Medicine in Boston. As such, “behavioral and health education are imperative for all youth beginning early in middle school, and the involvement of parents, health care providers, and community leaders is also critical.”

The goal of such interventions should be to assist those youth who have already engaged in some sexual activity to return to abstinence, said Dr. DeRosa of Health Research Association Inc., a University of Southern California affiliate that is facilitating the Centers for Disease Control-sponsored project. “For the majority of youth who have not engaged in sexual activities, the goal should be to further delay the onset of sexual initiation.”

How the interventions should look and be implemented is a matter of much debate. Should they focus on abstinence or contraception? Should they be school or clinic based? Should they be voluntary or mandatory?

In reality, the “best” intervention is one that identifies and targets the range of risk factors and protective factors that influence initiation of sex, number of partners, condom use, and contraception use, and this will vary depending on the individuals or populations being served, according to Douglas Kirby, Ph.D., a senior research scientist with ETR Associates in Scotts Valley, Calif.

In a 2001 report for the National Campaign to Prevent Teen Pregnancy called “Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy” (www.teenpregnancy.org/resources/data/pdf/emeranswsum.pdf

At the community level, education, employment, income, and crime rate are important predictive factors. At the family level, family structure, dynamics, and values play a role. And at the individual level, age, hormones, peers, emotional well-being, relationship history, sexual abuse history, and attachment to school, religious groups, and proactive community organizations have an impact.

In the review, Dr. Kirby identified four groups of effective intervention programs. These included sex and HIV education programs that not only stated the target norm—whether abstinence or contraception—clearly and frequently with factual information to support it, but also engaged the youth in activities, such as role playing, to model, practice, and personalize the norm. Also effective were some programs within health, family planning, or STD clinics that similarly expressed clear norms, as well as focusing on perceived barriers, providing backup information, and offering structured follow-up.

Certain service-learning programs that include both intensive voluntary service in various capacities (tutors, teachers' aides, nursing home assistants) and ongoing small group discussions about the service, with or without discussion about sexual or contraceptive behavior, also had a demonstrable impact. The last group was long-term intensive programs with multiple components—including family life support, sexuality education, academic guidance, employment, opportunity for self-expression, and health care—in which norms were clearly stated and supported and staff consciously developed close relationships with the adolescents.

Most of the effective intervention strategies share a conceptual framework built on social norms and an adolescent's sense of connection to those expressing the norms, Dr. Kirby said. “If a group has clear norms for or against sex or contraceptive use, then adolescents associated with this group will be more or less likely to have sex and use contraceptives depending on the norm,” he said. The more closely an adolescent feels connected to the group, the greater the impact the group's norms will have.

Sexually risky behaviors on the part of adolescents is nothing new, but the age at which these behaviors begin is. In fact, new data suggest that sexual risk taking often begins in middle school.

Baseline data collected in spring 2005 from 4,457 middle school students aged 11–14 years at 14 urban schools participating in Project Connect, an 8-year multilevel intervention study, showed that more than 9% of the students surveyed reported ever having sexual intercourse, and 8% reported ever having oral sex. In total, about 12% reported any sexual activity. Of those students who reported having had intercourse, 36% were aged 11 or younger at first sex, 27% were 12 years old, 28% were 13 years old, and 9% were aged 14 or older. Additionally, of those who reported having had intercourse, 43% reported having had multiple sex partners.

Given their young age at sexual onset, “these youth are at very high risk for adverse health outcomes,” Project Connect investigator Christine J. DeRosa, Ph.D., said at the annual meeting of the Society for Adolescent Medicine in Boston. As such, “behavioral and health education are imperative for all youth beginning early in middle school, and the involvement of parents, health care providers, and community leaders is also critical.”

The goal of such interventions should be to assist those youth who have already engaged in some sexual activity to return to abstinence, said Dr. DeRosa of Health Research Association Inc., a University of Southern California affiliate that is facilitating the Centers for Disease Control-sponsored project. “For the majority of youth who have not engaged in sexual activities, the goal should be to further delay the onset of sexual initiation.”

How the interventions should look and be implemented is a matter of much debate. Should they focus on abstinence or contraception? Should they be school or clinic based? Should they be voluntary or mandatory?

In reality, the “best” intervention is one that identifies and targets the range of risk factors and protective factors that influence initiation of sex, number of partners, condom use, and contraception use, and this will vary depending on the individuals or populations being served, according to Douglas Kirby, Ph.D., a senior research scientist with ETR Associates in Scotts Valley, Calif.

In a 2001 report for the National Campaign to Prevent Teen Pregnancy called “Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy” (www.teenpregnancy.org/resources/data/pdf/emeranswsum.pdf

At the community level, education, employment, income, and crime rate are important predictive factors. At the family level, family structure, dynamics, and values play a role. And at the individual level, age, hormones, peers, emotional well-being, relationship history, sexual abuse history, and attachment to school, religious groups, and proactive community organizations have an impact.

In the review, Dr. Kirby identified four groups of effective intervention programs. These included sex and HIV education programs that not only stated the target norm—whether abstinence or contraception—clearly and frequently with factual information to support it, but also engaged the youth in activities, such as role playing, to model, practice, and personalize the norm. Also effective were some programs within health, family planning, or STD clinics that similarly expressed clear norms, as well as focusing on perceived barriers, providing backup information, and offering structured follow-up.

Certain service-learning programs that include both intensive voluntary service in various capacities (tutors, teachers' aides, nursing home assistants) and ongoing small group discussions about the service, with or without discussion about sexual or contraceptive behavior, also had a demonstrable impact. The last group was long-term intensive programs with multiple components—including family life support, sexuality education, academic guidance, employment, opportunity for self-expression, and health care—in which norms were clearly stated and supported and staff consciously developed close relationships with the adolescents.

Most of the effective intervention strategies share a conceptual framework built on social norms and an adolescent's sense of connection to those expressing the norms, Dr. Kirby said. “If a group has clear norms for or against sex or contraceptive use, then adolescents associated with this group will be more or less likely to have sex and use contraceptives depending on the norm,” he said. The more closely an adolescent feels connected to the group, the greater the impact the group's norms will have.

Sexually risky behaviors on the part of adolescents is nothing new, but the age at which these behaviors begin is. In fact, new data suggest that sexual risk taking often begins in middle school.

Baseline data collected in spring 2005 from 4,457 middle school students aged 11–14 years at 14 urban schools participating in Project Connect, an 8-year multilevel intervention study, showed that more than 9% of the students surveyed reported ever having sexual intercourse, and 8% reported ever having oral sex. In total, about 12% reported any sexual activity. Of those students who reported having had intercourse, 36% were aged 11 or younger at first sex, 27% were 12 years old, 28% were 13 years old, and 9% were aged 14 or older. Additionally, of those who reported having had intercourse, 43% reported having had multiple sex partners.

Given their young age at sexual onset, “these youth are at very high risk for adverse health outcomes,” Project Connect investigator Christine J. DeRosa, Ph.D., said at the annual meeting of the Society for Adolescent Medicine in Boston. As such, “behavioral and health education are imperative for all youth beginning early in middle school, and the involvement of parents, health care providers, and community leaders is also critical.”

The goal of such interventions should be to assist those youth who have already engaged in some sexual activity to return to abstinence, said Dr. DeRosa of Health Research Association Inc., a University of Southern California affiliate that is facilitating the Centers for Disease Control-sponsored project. “For the majority of youth who have not engaged in sexual activities, the goal should be to further delay the onset of sexual initiation.”

How the interventions should look and be implemented is a matter of much debate. Should they focus on abstinence or contraception? Should they be school or clinic based? Should they be voluntary or mandatory?

In reality, the “best” intervention is one that identifies and targets the range of risk factors and protective factors that influence initiation of sex, number of partners, condom use, and contraception use, and this will vary depending on the individuals or populations being served, according to Douglas Kirby, Ph.D., a senior research scientist with ETR Associates in Scotts Valley, Calif.

In a 2001 report for the National Campaign to Prevent Teen Pregnancy called “Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy” (www.teenpregnancy.org/resources/data/pdf/emeranswsum.pdf

At the community level, education, employment, income, and crime rate are important predictive factors. At the family level, family structure, dynamics, and values play a role. And at the individual level, age, hormones, peers, emotional well-being, relationship history, sexual abuse history, and attachment to school, religious groups, and proactive community organizations have an impact.

In the review, Dr. Kirby identified four groups of effective intervention programs. These included sex and HIV education programs that not only stated the target norm—whether abstinence or contraception—clearly and frequently with factual information to support it, but also engaged the youth in activities, such as role playing, to model, practice, and personalize the norm. Also effective were some programs within health, family planning, or STD clinics that similarly expressed clear norms, as well as focusing on perceived barriers, providing backup information, and offering structured follow-up.

Certain service-learning programs that include both intensive voluntary service in various capacities (tutors, teachers' aides, nursing home assistants) and ongoing small group discussions about the service, with or without discussion about sexual or contraceptive behavior, also had a demonstrable impact. The last group was long-term intensive programs with multiple components—including family life support, sexuality education, academic guidance, employment, opportunity for self-expression, and health care—in which norms were clearly stated and supported and staff consciously developed close relationships with the adolescents.

Most of the effective intervention strategies share a conceptual framework built on social norms and an adolescent's sense of connection to those expressing the norms, Dr. Kirby said. “If a group has clear norms for or against sex or contraceptive use, then adolescents associated with this group will be more or less likely to have sex and use contraceptives depending on the norm,” he said. The more closely an adolescent feels connected to the group, the greater the impact the group's norms will have.

BOSTON — The use of medroxyprogesterone may impair insulin and glucose metabolism in obese adolescents, thus increasing the long-term health risks of young women in an already vulnerable population, Dr. Nancy E. Fritz said at the annual meeting of the Society for Adolescent Medicine.

In a small retrospective study, Dr. Fritz and colleagues in the Cook County Bureau of Health Services' division of adolescent medicine in Chicago collected information on height, weight, laboratory values, contraceptive use, and obstetric history from the charts of 56 adolescent girls (mean age 17 years) from three urban school-based health centers who were participating in an obesity management program. With the exception of two Hispanic girls, all participants were African American.

All participants had a body mass index (BMI) of at least the 95th percentile for their age and all had at least one additional risk factor for type 2 diabetes mellitus. As part of the obesity management program, all of the young women had undergone screening for fasting glucose, lipids, and insulin levels.

The study participants were sorted into one of three groups based on contraceptive use: 22 medroxyprogesterone (Depo Provera) users, 13 oral contraceptive users, and 21 women who did not use hormonal contraception, Dr. Fritz reported in a poster presentation. The groups did not differ significantly by age, BMI, glucose, cholesterol, triglyceride, HDL cholesterol, or LDL cholesterol levels.

The medroxyprogesterone group was more likely to have gained weight before the time of blood work than were the other two groups, “which is consistent with data from previous studies showing an association between medroxyprogesterone use and weight gain,” Dr. Fritz noted. The results also showed significantly higher mean insulin levels in the medroxyprogesterone group, compared with both the oral contraceptive and nonhormone groups.

The insulin increases do not appear to be a function of weight gain in this population, as the insulin levels among oral contraceptive users and nonusers who were gaining weight were not significantly different from those who were losing weight, Dr. Fritz said. However, the association between insulin increases and weight gain and loss could not be reliably calculated for the medroxyprogesterone users because, she noted, “only three of this group did not gain weight.”

The association between medroxyprogesterone use and both increasing weight and increased insulin levels independent of BMI in obese at-risk adolescents raises the possibility that the contraceptive also may increase risks for metabolic syndrome and/or diabetes in this subgroup, Dr. Fritz said.

Although enlightening, the data from this study are “too preliminary, too retrospective, and too small” to make a definitive statement about how to address this issue clinically, she said. “We need a larger prospective study looking at this in teenagers of various weights, ethnicities, and other risks. For now we need to keep an open mind.”

Studies already have shown that medroxyprogesterone makes heavy teens heavier, “and that alone probably increases their risks for all of the bad things, so we can tell our patients that,” Dr. Fritz said. “If it also messes with insulin levels and glucose metabolism above and beyond the weight issue, which our work suggests, things get more complicated, as they do when you consider the fact that African American kids, who are already at higher risk for diabetes, are probably the ones most likely to use [medroxyprogesterone] these days, and therefore the ones most likely to get pregnant if we steer them away from it.”

The challenge, she added, “is figuring out how to factor all of those ethical decisions into a discussion with a concrete teenager. Which is worse, teenage pregnancy or increased diabetes mellitus risks? I would say the latter, but not everyone would agree with me.”

BOSTON — The use of medroxyprogesterone may impair insulin and glucose metabolism in obese adolescents, thus increasing the long-term health risks of young women in an already vulnerable population, Dr. Nancy E. Fritz said at the annual meeting of the Society for Adolescent Medicine.

In a small retrospective study, Dr. Fritz and colleagues in the Cook County Bureau of Health Services' division of adolescent medicine in Chicago collected information on height, weight, laboratory values, contraceptive use, and obstetric history from the charts of 56 adolescent girls (mean age 17 years) from three urban school-based health centers who were participating in an obesity management program. With the exception of two Hispanic girls, all participants were African American.

All participants had a body mass index (BMI) of at least the 95th percentile for their age and all had at least one additional risk factor for type 2 diabetes mellitus. As part of the obesity management program, all of the young women had undergone screening for fasting glucose, lipids, and insulin levels.

The study participants were sorted into one of three groups based on contraceptive use: 22 medroxyprogesterone (Depo Provera) users, 13 oral contraceptive users, and 21 women who did not use hormonal contraception, Dr. Fritz reported in a poster presentation. The groups did not differ significantly by age, BMI, glucose, cholesterol, triglyceride, HDL cholesterol, or LDL cholesterol levels.

The medroxyprogesterone group was more likely to have gained weight before the time of blood work than were the other two groups, “which is consistent with data from previous studies showing an association between medroxyprogesterone use and weight gain,” Dr. Fritz noted. The results also showed significantly higher mean insulin levels in the medroxyprogesterone group, compared with both the oral contraceptive and nonhormone groups.

The insulin increases do not appear to be a function of weight gain in this population, as the insulin levels among oral contraceptive users and nonusers who were gaining weight were not significantly different from those who were losing weight, Dr. Fritz said. However, the association between insulin increases and weight gain and loss could not be reliably calculated for the medroxyprogesterone users because, she noted, “only three of this group did not gain weight.”

The association between medroxyprogesterone use and both increasing weight and increased insulin levels independent of BMI in obese at-risk adolescents raises the possibility that the contraceptive also may increase risks for metabolic syndrome and/or diabetes in this subgroup, Dr. Fritz said.

Although enlightening, the data from this study are “too preliminary, too retrospective, and too small” to make a definitive statement about how to address this issue clinically, she said. “We need a larger prospective study looking at this in teenagers of various weights, ethnicities, and other risks. For now we need to keep an open mind.”

Studies already have shown that medroxyprogesterone makes heavy teens heavier, “and that alone probably increases their risks for all of the bad things, so we can tell our patients that,” Dr. Fritz said. “If it also messes with insulin levels and glucose metabolism above and beyond the weight issue, which our work suggests, things get more complicated, as they do when you consider the fact that African American kids, who are already at higher risk for diabetes, are probably the ones most likely to use [medroxyprogesterone] these days, and therefore the ones most likely to get pregnant if we steer them away from it.”

The challenge, she added, “is figuring out how to factor all of those ethical decisions into a discussion with a concrete teenager. Which is worse, teenage pregnancy or increased diabetes mellitus risks? I would say the latter, but not everyone would agree with me.”

BOSTON — The use of medroxyprogesterone may impair insulin and glucose metabolism in obese adolescents, thus increasing the long-term health risks of young women in an already vulnerable population, Dr. Nancy E. Fritz said at the annual meeting of the Society for Adolescent Medicine.

In a small retrospective study, Dr. Fritz and colleagues in the Cook County Bureau of Health Services' division of adolescent medicine in Chicago collected information on height, weight, laboratory values, contraceptive use, and obstetric history from the charts of 56 adolescent girls (mean age 17 years) from three urban school-based health centers who were participating in an obesity management program. With the exception of two Hispanic girls, all participants were African American.

All participants had a body mass index (BMI) of at least the 95th percentile for their age and all had at least one additional risk factor for type 2 diabetes mellitus. As part of the obesity management program, all of the young women had undergone screening for fasting glucose, lipids, and insulin levels.

The study participants were sorted into one of three groups based on contraceptive use: 22 medroxyprogesterone (Depo Provera) users, 13 oral contraceptive users, and 21 women who did not use hormonal contraception, Dr. Fritz reported in a poster presentation. The groups did not differ significantly by age, BMI, glucose, cholesterol, triglyceride, HDL cholesterol, or LDL cholesterol levels.

The medroxyprogesterone group was more likely to have gained weight before the time of blood work than were the other two groups, “which is consistent with data from previous studies showing an association between medroxyprogesterone use and weight gain,” Dr. Fritz noted. The results also showed significantly higher mean insulin levels in the medroxyprogesterone group, compared with both the oral contraceptive and nonhormone groups.

The insulin increases do not appear to be a function of weight gain in this population, as the insulin levels among oral contraceptive users and nonusers who were gaining weight were not significantly different from those who were losing weight, Dr. Fritz said. However, the association between insulin increases and weight gain and loss could not be reliably calculated for the medroxyprogesterone users because, she noted, “only three of this group did not gain weight.”

The association between medroxyprogesterone use and both increasing weight and increased insulin levels independent of BMI in obese at-risk adolescents raises the possibility that the contraceptive also may increase risks for metabolic syndrome and/or diabetes in this subgroup, Dr. Fritz said.

Although enlightening, the data from this study are “too preliminary, too retrospective, and too small” to make a definitive statement about how to address this issue clinically, she said. “We need a larger prospective study looking at this in teenagers of various weights, ethnicities, and other risks. For now we need to keep an open mind.”

Studies already have shown that medroxyprogesterone makes heavy teens heavier, “and that alone probably increases their risks for all of the bad things, so we can tell our patients that,” Dr. Fritz said. “If it also messes with insulin levels and glucose metabolism above and beyond the weight issue, which our work suggests, things get more complicated, as they do when you consider the fact that African American kids, who are already at higher risk for diabetes, are probably the ones most likely to use [medroxyprogesterone] these days, and therefore the ones most likely to get pregnant if we steer them away from it.”

The challenge, she added, “is figuring out how to factor all of those ethical decisions into a discussion with a concrete teenager. Which is worse, teenage pregnancy or increased diabetes mellitus risks? I would say the latter, but not everyone would agree with me.”

TORONTO — A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Additionally, partner participation significantly enhances the positive effects of the intervention.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” according to Dr. Chang of Brigham and Women's Hospital in Boston. Also, providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, whereas positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a 4-year college degree or the equivalent.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session consisting of four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors relative to alcohol use. “We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week—and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy and that any prenatal alcohol exposure can have negative consequences,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, “such as having something to eat or having a fake drink,” Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

The intervention and control subjects underwent a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy and changes in alcohol-related health habits since the time of enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang said. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment. The intervention was more effective for heavier drinking subjects when the partner was involved. It was really quite exciting to see that, because most of the previous research regarding partner influence has focused on two areas: prenatal cigarette smoking, where the partner's smoking habits are strong predictors of the woman's; and breast-feeding, where partner support is an important factor.”

The analyses also identified several additional variables that increased the risk of prenatal alcohol consumption: the amount of prenatal alcohol use before study enrollment, level of education, temptation to drink in social situations, and number of years of regular alcohol use. “We found that the strongest predictor was alcohol use at the previous time—lifetime use predicted prepregnancy use, prepregnancy use predicted early pregnancy use, and so on,” Dr. Chang said. “Partners' drinking was not a predictor, which was a surprise; nor was knowledge of risks a predictor.”

TORONTO — A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Additionally, partner participation significantly enhances the positive effects of the intervention.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” according to Dr. Chang of Brigham and Women's Hospital in Boston. Also, providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, whereas positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a 4-year college degree or the equivalent.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session consisting of four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors relative to alcohol use. “We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week—and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy and that any prenatal alcohol exposure can have negative consequences,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, “such as having something to eat or having a fake drink,” Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

The intervention and control subjects underwent a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy and changes in alcohol-related health habits since the time of enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang said. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment. The intervention was more effective for heavier drinking subjects when the partner was involved. It was really quite exciting to see that, because most of the previous research regarding partner influence has focused on two areas: prenatal cigarette smoking, where the partner's smoking habits are strong predictors of the woman's; and breast-feeding, where partner support is an important factor.”

The analyses also identified several additional variables that increased the risk of prenatal alcohol consumption: the amount of prenatal alcohol use before study enrollment, level of education, temptation to drink in social situations, and number of years of regular alcohol use. “We found that the strongest predictor was alcohol use at the previous time—lifetime use predicted prepregnancy use, prepregnancy use predicted early pregnancy use, and so on,” Dr. Chang said. “Partners' drinking was not a predictor, which was a surprise; nor was knowledge of risks a predictor.”

TORONTO — A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Additionally, partner participation significantly enhances the positive effects of the intervention.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” according to Dr. Chang of Brigham and Women's Hospital in Boston. Also, providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, whereas positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a 4-year college degree or the equivalent.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session consisting of four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors relative to alcohol use. “We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week—and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy and that any prenatal alcohol exposure can have negative consequences,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, “such as having something to eat or having a fake drink,” Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

The intervention and control subjects underwent a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy and changes in alcohol-related health habits since the time of enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang said. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment. The intervention was more effective for heavier drinking subjects when the partner was involved. It was really quite exciting to see that, because most of the previous research regarding partner influence has focused on two areas: prenatal cigarette smoking, where the partner's smoking habits are strong predictors of the woman's; and breast-feeding, where partner support is an important factor.”

The analyses also identified several additional variables that increased the risk of prenatal alcohol consumption: the amount of prenatal alcohol use before study enrollment, level of education, temptation to drink in social situations, and number of years of regular alcohol use. “We found that the strongest predictor was alcohol use at the previous time—lifetime use predicted prepregnancy use, prepregnancy use predicted early pregnancy use, and so on,” Dr. Chang said. “Partners' drinking was not a predictor, which was a surprise; nor was knowledge of risks a predictor.”