Diana Mahoney

BOSTON — Doppler tissue imaging can detect early changes in the heart muscle of children with Duchenne muscular dystrophy before the onset of disease-induced myocardial dysfunction, Shuping Ge, M.D., said at the annual meeting of the American Society of Echocardiography.

The ability to identify these preclinical changes offers a “window of opportunity” for initiating preventive and therapeutic interventions to delay the irreversible left ventricular remodeling and subsequent heart failure that is the fate of many children with the degenerative musculoskeletal disease as the condition progresses, Dr. Ge said.

To identify and assess changes in global and regional myocardial function, Dr. Ge and colleagues from Baylor College of Medicine, Houston, measured myocardial contraction and relaxation using Doppler tissue imaging (DTI) in 50 children with and without Duchenne muscular dystrophy (DMD) and with and without clinical pump dysfunction. The children enrolled in the study were divided into groups by age, disease presence, and clinical myocardial status, Dr. Ge said.

The first two groups included 15 children whose mean age was 11.7 years and who had DMD and no cardiac pump dysfunction, and a control group of 15 children mean age 12.8 years without DMD. The second two groups included 10 children whose mean age was 17.6 years with DMD and pump dysfunction, and 10 children mean age 16 years without DMD.

All of the children in the study underwent conventional and DTI ultrasound to measure left ventricular dimensions, global pump function, and regional systolic and diastolic function.

Global pump function or left ventricular size did not differ among the younger patients regardless of whether they had DMD. However, DTI showed significant myocardial systolic and diastolic dysfunction in the children with DMD. “Even though the hearts were still pumping correctly, the velocity at which the walls of the heart were moving was often abnormal in patients [with DMD],” Dr. Ge said.

In the two older groups, the differences in DTI measurements were more pronounced, which was consistent with the clinical pump dysfunction, Dr. Ge noted. Heart failure usually occurs in DMD patients when they enter their late teenage years, when the progressive heart muscle weakness keeps it from pumping enough blood to sustain the rest of the body.

The fact that regional myocardial function alterations were discovered using DTI in the younger patients despite no changes in global ventricular function as assessed via conventional echocardiographic measures suggests that DTI should be part of the screening process for the early diagnosis of cardiomyopathy in DMD patients. The results show that DTI “is more sensitive than conventional echocardiography in detecting preclinical myocardial abnormalities before the occurrence of left ventricular dilation and dysfunction,” Dr. Ge said.

The early detection of myocardial abnormalities associated with DMD might aid in the prevention of irreversible myocardial fibrosis and further left ventricular remodeling, Dr. Ge said.

Abnormalities of the lateral wall of the left ventricle are shown on Doppler tissue imaging.

Pulsed wave Doppler tracings and velocities show myocardial abnormalities much later. Photos courtesy Dr. Shuping Ge

BOSTON — Doppler tissue imaging can detect early changes in the heart muscle of children with Duchenne muscular dystrophy before the onset of disease-induced myocardial dysfunction, Shuping Ge, M.D., said at the annual meeting of the American Society of Echocardiography.

The ability to identify these preclinical changes offers a “window of opportunity” for initiating preventive and therapeutic interventions to delay the irreversible left ventricular remodeling and subsequent heart failure that is the fate of many children with the degenerative musculoskeletal disease as the condition progresses, Dr. Ge said.

To identify and assess changes in global and regional myocardial function, Dr. Ge and colleagues from Baylor College of Medicine, Houston, measured myocardial contraction and relaxation using Doppler tissue imaging (DTI) in 50 children with and without Duchenne muscular dystrophy (DMD) and with and without clinical pump dysfunction. The children enrolled in the study were divided into groups by age, disease presence, and clinical myocardial status, Dr. Ge said.

The first two groups included 15 children whose mean age was 11.7 years and who had DMD and no cardiac pump dysfunction, and a control group of 15 children mean age 12.8 years without DMD. The second two groups included 10 children whose mean age was 17.6 years with DMD and pump dysfunction, and 10 children mean age 16 years without DMD.

All of the children in the study underwent conventional and DTI ultrasound to measure left ventricular dimensions, global pump function, and regional systolic and diastolic function.

Global pump function or left ventricular size did not differ among the younger patients regardless of whether they had DMD. However, DTI showed significant myocardial systolic and diastolic dysfunction in the children with DMD. “Even though the hearts were still pumping correctly, the velocity at which the walls of the heart were moving was often abnormal in patients [with DMD],” Dr. Ge said.

In the two older groups, the differences in DTI measurements were more pronounced, which was consistent with the clinical pump dysfunction, Dr. Ge noted. Heart failure usually occurs in DMD patients when they enter their late teenage years, when the progressive heart muscle weakness keeps it from pumping enough blood to sustain the rest of the body.

The fact that regional myocardial function alterations were discovered using DTI in the younger patients despite no changes in global ventricular function as assessed via conventional echocardiographic measures suggests that DTI should be part of the screening process for the early diagnosis of cardiomyopathy in DMD patients. The results show that DTI “is more sensitive than conventional echocardiography in detecting preclinical myocardial abnormalities before the occurrence of left ventricular dilation and dysfunction,” Dr. Ge said.

The early detection of myocardial abnormalities associated with DMD might aid in the prevention of irreversible myocardial fibrosis and further left ventricular remodeling, Dr. Ge said.

Abnormalities of the lateral wall of the left ventricle are shown on Doppler tissue imaging.

Pulsed wave Doppler tracings and velocities show myocardial abnormalities much later. Photos courtesy Dr. Shuping Ge

BOSTON — Doppler tissue imaging can detect early changes in the heart muscle of children with Duchenne muscular dystrophy before the onset of disease-induced myocardial dysfunction, Shuping Ge, M.D., said at the annual meeting of the American Society of Echocardiography.

The ability to identify these preclinical changes offers a “window of opportunity” for initiating preventive and therapeutic interventions to delay the irreversible left ventricular remodeling and subsequent heart failure that is the fate of many children with the degenerative musculoskeletal disease as the condition progresses, Dr. Ge said.

To identify and assess changes in global and regional myocardial function, Dr. Ge and colleagues from Baylor College of Medicine, Houston, measured myocardial contraction and relaxation using Doppler tissue imaging (DTI) in 50 children with and without Duchenne muscular dystrophy (DMD) and with and without clinical pump dysfunction. The children enrolled in the study were divided into groups by age, disease presence, and clinical myocardial status, Dr. Ge said.

The first two groups included 15 children whose mean age was 11.7 years and who had DMD and no cardiac pump dysfunction, and a control group of 15 children mean age 12.8 years without DMD. The second two groups included 10 children whose mean age was 17.6 years with DMD and pump dysfunction, and 10 children mean age 16 years without DMD.

All of the children in the study underwent conventional and DTI ultrasound to measure left ventricular dimensions, global pump function, and regional systolic and diastolic function.

Global pump function or left ventricular size did not differ among the younger patients regardless of whether they had DMD. However, DTI showed significant myocardial systolic and diastolic dysfunction in the children with DMD. “Even though the hearts were still pumping correctly, the velocity at which the walls of the heart were moving was often abnormal in patients [with DMD],” Dr. Ge said.

In the two older groups, the differences in DTI measurements were more pronounced, which was consistent with the clinical pump dysfunction, Dr. Ge noted. Heart failure usually occurs in DMD patients when they enter their late teenage years, when the progressive heart muscle weakness keeps it from pumping enough blood to sustain the rest of the body.

The fact that regional myocardial function alterations were discovered using DTI in the younger patients despite no changes in global ventricular function as assessed via conventional echocardiographic measures suggests that DTI should be part of the screening process for the early diagnosis of cardiomyopathy in DMD patients. The results show that DTI “is more sensitive than conventional echocardiography in detecting preclinical myocardial abnormalities before the occurrence of left ventricular dilation and dysfunction,” Dr. Ge said.

The early detection of myocardial abnormalities associated with DMD might aid in the prevention of irreversible myocardial fibrosis and further left ventricular remodeling, Dr. Ge said.

Abnormalities of the lateral wall of the left ventricle are shown on Doppler tissue imaging.

Pulsed wave Doppler tracings and velocities show myocardial abnormalities much later. Photos courtesy Dr. Shuping Ge

BOSTON — Many women with newly diagnosed ductal carcinoma in situ harbor grossly inaccurate perceptions of the breast cancer risks they face, which in turn can influence their decision making and health behaviors as well as psychosocial outcomes, reported Ann H. Partridge, M.D.

The most common type of noninvasive breast cancer, ductal carcinoma in situ (DCIS) is a relatively low-risk disease. With early detection, the 5-year survival rate is nearly 100%, “thus it has a very small impact on a woman's overall survival,” Dr. Partridge said in a presentation at a breast cancer meeting sponsored by Harvard Medical School.

In contrast, a longitudinal study has shown the perception of risk among women diagnosed with the condition to be “substantial,” she said.

In a cohort of 499 women newly diagnosed with DCIS participating in a study of psychosocial concerns, risk perceptions, and health behaviors, 55% believed that it was at least moderately likely the disease would recur within 5 years. Additionally, 68% of the women reported a moderate or greater likelihood of lifetime recurrence; 38% thought they were at risk for invasive disease in the next 5 years; 53% perceived a greater lifetime risk of invasive disease; and 28% indicated a moderate or greater likelihood of their breast cancer spreading to other parts of their body, reported Dr. Partridge of the Dana-Farber Cancer Institute in Boston.

A multivariate model showed that anxiety at baseline, as measured by the Hospitalized Anxiety and Depression Scale and the Revised Impact of Event Scale, was associated with the belief that DCIS would spread. These perceptions were independent of age, race, education, marital status, employment, financial status, comorbidity, anxiety, oncology consultation, treatment, and satisfaction with treatment.

Preliminary follow-up data indicated that patients' risk perceptions persisted over time, with nearly one-quarter of those surveyed at 18 months believing there was a moderate or greater chance that DCIS would spread to other parts of their body. “Some patients' perception of risk increased over time and others' decreased without a consistent trend,” Dr. Partridge said.

Multivariate analysis of the 18-month data showed that nonwhite race, less than full-time employment status, lack of satisfaction with treatment, and having taken tamoxifen were associated with heightened risk perceptions.

Given the possibility that the pervasive risk misperceptions could have a negative impact on psychosocial functioning and health-related decision making, “clinicians caring for women with ductal carcinoma in situ should be aware of these inaccurate perceptions” and should encourage women to communicate their fears and provide education and support for dispelling altered risk beliefs, Dr. Partridge said.

BOSTON — Many women with newly diagnosed ductal carcinoma in situ harbor grossly inaccurate perceptions of the breast cancer risks they face, which in turn can influence their decision making and health behaviors as well as psychosocial outcomes, reported Ann H. Partridge, M.D.

The most common type of noninvasive breast cancer, ductal carcinoma in situ (DCIS) is a relatively low-risk disease. With early detection, the 5-year survival rate is nearly 100%, “thus it has a very small impact on a woman's overall survival,” Dr. Partridge said in a presentation at a breast cancer meeting sponsored by Harvard Medical School.

In contrast, a longitudinal study has shown the perception of risk among women diagnosed with the condition to be “substantial,” she said.

In a cohort of 499 women newly diagnosed with DCIS participating in a study of psychosocial concerns, risk perceptions, and health behaviors, 55% believed that it was at least moderately likely the disease would recur within 5 years. Additionally, 68% of the women reported a moderate or greater likelihood of lifetime recurrence; 38% thought they were at risk for invasive disease in the next 5 years; 53% perceived a greater lifetime risk of invasive disease; and 28% indicated a moderate or greater likelihood of their breast cancer spreading to other parts of their body, reported Dr. Partridge of the Dana-Farber Cancer Institute in Boston.

A multivariate model showed that anxiety at baseline, as measured by the Hospitalized Anxiety and Depression Scale and the Revised Impact of Event Scale, was associated with the belief that DCIS would spread. These perceptions were independent of age, race, education, marital status, employment, financial status, comorbidity, anxiety, oncology consultation, treatment, and satisfaction with treatment.

Preliminary follow-up data indicated that patients' risk perceptions persisted over time, with nearly one-quarter of those surveyed at 18 months believing there was a moderate or greater chance that DCIS would spread to other parts of their body. “Some patients' perception of risk increased over time and others' decreased without a consistent trend,” Dr. Partridge said.

Multivariate analysis of the 18-month data showed that nonwhite race, less than full-time employment status, lack of satisfaction with treatment, and having taken tamoxifen were associated with heightened risk perceptions.

Given the possibility that the pervasive risk misperceptions could have a negative impact on psychosocial functioning and health-related decision making, “clinicians caring for women with ductal carcinoma in situ should be aware of these inaccurate perceptions” and should encourage women to communicate their fears and provide education and support for dispelling altered risk beliefs, Dr. Partridge said.

BOSTON — Many women with newly diagnosed ductal carcinoma in situ harbor grossly inaccurate perceptions of the breast cancer risks they face, which in turn can influence their decision making and health behaviors as well as psychosocial outcomes, reported Ann H. Partridge, M.D.

The most common type of noninvasive breast cancer, ductal carcinoma in situ (DCIS) is a relatively low-risk disease. With early detection, the 5-year survival rate is nearly 100%, “thus it has a very small impact on a woman's overall survival,” Dr. Partridge said in a presentation at a breast cancer meeting sponsored by Harvard Medical School.

In contrast, a longitudinal study has shown the perception of risk among women diagnosed with the condition to be “substantial,” she said.

In a cohort of 499 women newly diagnosed with DCIS participating in a study of psychosocial concerns, risk perceptions, and health behaviors, 55% believed that it was at least moderately likely the disease would recur within 5 years. Additionally, 68% of the women reported a moderate or greater likelihood of lifetime recurrence; 38% thought they were at risk for invasive disease in the next 5 years; 53% perceived a greater lifetime risk of invasive disease; and 28% indicated a moderate or greater likelihood of their breast cancer spreading to other parts of their body, reported Dr. Partridge of the Dana-Farber Cancer Institute in Boston.

A multivariate model showed that anxiety at baseline, as measured by the Hospitalized Anxiety and Depression Scale and the Revised Impact of Event Scale, was associated with the belief that DCIS would spread. These perceptions were independent of age, race, education, marital status, employment, financial status, comorbidity, anxiety, oncology consultation, treatment, and satisfaction with treatment.

Preliminary follow-up data indicated that patients' risk perceptions persisted over time, with nearly one-quarter of those surveyed at 18 months believing there was a moderate or greater chance that DCIS would spread to other parts of their body. “Some patients' perception of risk increased over time and others' decreased without a consistent trend,” Dr. Partridge said.

Multivariate analysis of the 18-month data showed that nonwhite race, less than full-time employment status, lack of satisfaction with treatment, and having taken tamoxifen were associated with heightened risk perceptions.

Given the possibility that the pervasive risk misperceptions could have a negative impact on psychosocial functioning and health-related decision making, “clinicians caring for women with ductal carcinoma in situ should be aware of these inaccurate perceptions” and should encourage women to communicate their fears and provide education and support for dispelling altered risk beliefs, Dr. Partridge said.

The Food and Drug Administration's recent approval of the first combination vaccine designed to protect children against measles, mumps, rubella, and varicella is raising expectations of improved immunization rates, but is also eliciting some concerns.

The quadrivalent MMRV vaccine Proquad, developed by Merck and Co., Inc., is a combination of the company's measles, mumps, and rubella (MMR II) and varicella (Varivax) vaccines.

“Right now, at the 1-year visit, we're giving kids four or five shots. That's a lot. Anything that gets the number down while providing the same protection is a good thing. It's not revolutionary, but it's beneficial,” said Robert W. Frenck Jr., M.D., a member of the American Academy of Pediatrics' Committee on Infectious Diseases and a professor of pediatrics at the University of California, Los Angeles.

The need for one less shot, and potentially one fewer office visit, might close the gap between vaccination rates for varicella and for measles, mumps, and rubella. “It's likely that use of the combination vaccine will help get the varicella vaccination numbers up,” said Jay Lieberman, M.D., of the UCLA Center for Vaccine Research in Torrance, California.

In 2004, the immunization rate for varicella was estimated to be 87.5%, compared with 93% for measles, mumps, and rubella, according to a press release issued by Merck.

Dr. Lieberman coauthored one of a handful of studies comparing the immunogenicity of the MMVR injection with the standard two-shot MMR II and varicella immunizations.

The Merck-funded study showed that seroconversion rates were similar in children receiving the one- and two-shot regimens, as well as among children who received different lots of the MMRV vaccine. The latter measure, which was necessary for FDA approval, demonstrated the ability to manufacture the vaccine consistently, said Dr. Lieberman.

In this and similar studies, children injected with the MMRV vaccine suffered more fevers following the inoculations than those who received the independent MMR and varicella vaccines; however, “the fevers were mild and not clinically relevant,” according to Dr. Lieberman. There was no statistically significant difference in the incidence of more worrisome adverse febrile events, including febrile seizures, he said, noting that overall the one- and two-shot regimens appear to be similarly tolerated.

The FDA approved the quadrivalent vaccine for children between the ages of 12 months and 12 years, including those in need of a second dose of the MMR II vaccine.

Because the recommendation for MMR II has been to give two doses—the first at age 12–15 months and the second prior to school entry at age 4–6 years—adoption of the quadrivalent vaccine would make the ongoing debate over the need for a second dose of the varicella vaccine irrelevant, said Richard K. Zimmerman, M.D., of the department of family medicine at the University of Pittsburgh, Pennsylvania, and a voting member of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP).

“A second dose of varicella vaccine should reduce the number of breakthrough cases of chickenpox that we've seen, but the ACIP has not yet recommended a second dose,” Dr. Zimmerman said. In fact, in June of this year, the ACIP rejected a proposal recommending children be given booster shots of the varicella vaccine after age 4. “This was due in part to questions about cost and waiting for a combination vaccine such as MMRV to make it more feasible.”

If the ACIP recommends a second dose of varicella vaccine, “then MMRV should be easily accepted, although cost could be a barrier,” said Dr. Zimmerman.

According to Merck, the price for Proquad is $114.61 per shot, compared with $104 for the combination of the MMR II and Varivax vaccines, which cost $38 and $66, respectively.

Some immunization watchdog groups are urging caution. “Combining this many live viruses into one vaccine is something that has never been done before, and there is not enough information about possible long-term effects,” said Barbara Loe Fisher, president of the National Vaccine Information Center.

“There may be some concerns about delivering more antigens in a single shot, but there is no scientific evidence that this is a problem,” said Dr. Frenck. “These viruses are all attenuated, and four is nothing compared to the number of viruses and bacteria that we are all exposed to every day.”

The Food and Drug Administration's recent approval of the first combination vaccine designed to protect children against measles, mumps, rubella, and varicella is raising expectations of improved immunization rates, but is also eliciting some concerns.

The quadrivalent MMRV vaccine Proquad, developed by Merck and Co., Inc., is a combination of the company's measles, mumps, and rubella (MMR II) and varicella (Varivax) vaccines.

“Right now, at the 1-year visit, we're giving kids four or five shots. That's a lot. Anything that gets the number down while providing the same protection is a good thing. It's not revolutionary, but it's beneficial,” said Robert W. Frenck Jr., M.D., a member of the American Academy of Pediatrics' Committee on Infectious Diseases and a professor of pediatrics at the University of California, Los Angeles.

The need for one less shot, and potentially one fewer office visit, might close the gap between vaccination rates for varicella and for measles, mumps, and rubella. “It's likely that use of the combination vaccine will help get the varicella vaccination numbers up,” said Jay Lieberman, M.D., of the UCLA Center for Vaccine Research in Torrance, California.

In 2004, the immunization rate for varicella was estimated to be 87.5%, compared with 93% for measles, mumps, and rubella, according to a press release issued by Merck.

Dr. Lieberman coauthored one of a handful of studies comparing the immunogenicity of the MMVR injection with the standard two-shot MMR II and varicella immunizations.

The Merck-funded study showed that seroconversion rates were similar in children receiving the one- and two-shot regimens, as well as among children who received different lots of the MMRV vaccine. The latter measure, which was necessary for FDA approval, demonstrated the ability to manufacture the vaccine consistently, said Dr. Lieberman.

In this and similar studies, children injected with the MMRV vaccine suffered more fevers following the inoculations than those who received the independent MMR and varicella vaccines; however, “the fevers were mild and not clinically relevant,” according to Dr. Lieberman. There was no statistically significant difference in the incidence of more worrisome adverse febrile events, including febrile seizures, he said, noting that overall the one- and two-shot regimens appear to be similarly tolerated.

The FDA approved the quadrivalent vaccine for children between the ages of 12 months and 12 years, including those in need of a second dose of the MMR II vaccine.

Because the recommendation for MMR II has been to give two doses—the first at age 12–15 months and the second prior to school entry at age 4–6 years—adoption of the quadrivalent vaccine would make the ongoing debate over the need for a second dose of the varicella vaccine irrelevant, said Richard K. Zimmerman, M.D., of the department of family medicine at the University of Pittsburgh, Pennsylvania, and a voting member of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP).

“A second dose of varicella vaccine should reduce the number of breakthrough cases of chickenpox that we've seen, but the ACIP has not yet recommended a second dose,” Dr. Zimmerman said. In fact, in June of this year, the ACIP rejected a proposal recommending children be given booster shots of the varicella vaccine after age 4. “This was due in part to questions about cost and waiting for a combination vaccine such as MMRV to make it more feasible.”

If the ACIP recommends a second dose of varicella vaccine, “then MMRV should be easily accepted, although cost could be a barrier,” said Dr. Zimmerman.

According to Merck, the price for Proquad is $114.61 per shot, compared with $104 for the combination of the MMR II and Varivax vaccines, which cost $38 and $66, respectively.

Some immunization watchdog groups are urging caution. “Combining this many live viruses into one vaccine is something that has never been done before, and there is not enough information about possible long-term effects,” said Barbara Loe Fisher, president of the National Vaccine Information Center.

“There may be some concerns about delivering more antigens in a single shot, but there is no scientific evidence that this is a problem,” said Dr. Frenck. “These viruses are all attenuated, and four is nothing compared to the number of viruses and bacteria that we are all exposed to every day.”

The Food and Drug Administration's recent approval of the first combination vaccine designed to protect children against measles, mumps, rubella, and varicella is raising expectations of improved immunization rates, but is also eliciting some concerns.

The quadrivalent MMRV vaccine Proquad, developed by Merck and Co., Inc., is a combination of the company's measles, mumps, and rubella (MMR II) and varicella (Varivax) vaccines.

“Right now, at the 1-year visit, we're giving kids four or five shots. That's a lot. Anything that gets the number down while providing the same protection is a good thing. It's not revolutionary, but it's beneficial,” said Robert W. Frenck Jr., M.D., a member of the American Academy of Pediatrics' Committee on Infectious Diseases and a professor of pediatrics at the University of California, Los Angeles.

The need for one less shot, and potentially one fewer office visit, might close the gap between vaccination rates for varicella and for measles, mumps, and rubella. “It's likely that use of the combination vaccine will help get the varicella vaccination numbers up,” said Jay Lieberman, M.D., of the UCLA Center for Vaccine Research in Torrance, California.

In 2004, the immunization rate for varicella was estimated to be 87.5%, compared with 93% for measles, mumps, and rubella, according to a press release issued by Merck.

Dr. Lieberman coauthored one of a handful of studies comparing the immunogenicity of the MMVR injection with the standard two-shot MMR II and varicella immunizations.

The Merck-funded study showed that seroconversion rates were similar in children receiving the one- and two-shot regimens, as well as among children who received different lots of the MMRV vaccine. The latter measure, which was necessary for FDA approval, demonstrated the ability to manufacture the vaccine consistently, said Dr. Lieberman.

In this and similar studies, children injected with the MMRV vaccine suffered more fevers following the inoculations than those who received the independent MMR and varicella vaccines; however, “the fevers were mild and not clinically relevant,” according to Dr. Lieberman. There was no statistically significant difference in the incidence of more worrisome adverse febrile events, including febrile seizures, he said, noting that overall the one- and two-shot regimens appear to be similarly tolerated.

The FDA approved the quadrivalent vaccine for children between the ages of 12 months and 12 years, including those in need of a second dose of the MMR II vaccine.

Because the recommendation for MMR II has been to give two doses—the first at age 12–15 months and the second prior to school entry at age 4–6 years—adoption of the quadrivalent vaccine would make the ongoing debate over the need for a second dose of the varicella vaccine irrelevant, said Richard K. Zimmerman, M.D., of the department of family medicine at the University of Pittsburgh, Pennsylvania, and a voting member of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP).

“A second dose of varicella vaccine should reduce the number of breakthrough cases of chickenpox that we've seen, but the ACIP has not yet recommended a second dose,” Dr. Zimmerman said. In fact, in June of this year, the ACIP rejected a proposal recommending children be given booster shots of the varicella vaccine after age 4. “This was due in part to questions about cost and waiting for a combination vaccine such as MMRV to make it more feasible.”

If the ACIP recommends a second dose of varicella vaccine, “then MMRV should be easily accepted, although cost could be a barrier,” said Dr. Zimmerman.

According to Merck, the price for Proquad is $114.61 per shot, compared with $104 for the combination of the MMR II and Varivax vaccines, which cost $38 and $66, respectively.

Some immunization watchdog groups are urging caution. “Combining this many live viruses into one vaccine is something that has never been done before, and there is not enough information about possible long-term effects,” said Barbara Loe Fisher, president of the National Vaccine Information Center.

“There may be some concerns about delivering more antigens in a single shot, but there is no scientific evidence that this is a problem,” said Dr. Frenck. “These viruses are all attenuated, and four is nothing compared to the number of viruses and bacteria that we are all exposed to every day.”

BOSTON – A worksite-based stress and anger management program may improve the cardiovascular health of at-risk employees, Lynn Clemow, Ph.D., said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

Preliminary results from a randomized, controlled trial indicate that participants who underwent a brief psychoeducational intervention program had reductions in systolic blood pressure. The participants were a diverse group of hospital employees classified as hypertensive on screening.

The employees in the intervention group also reported significant reductions in stress, hostility, burnout, and passive interpersonal behavior, all of which have been implicated in the development of cardiovascular disease, said Dr. Clemow of the behavioral cardiovascular health and hypertension program at Columbia University, New York.

Participants underwent baseline and posttrial blood pressure testing and structured interviews to measure hostility, perceived stress, depression, work stress, and interpersonal behavior. The 32 individuals in the intervention group participated in 10 weekly, 1-hour stress and anger management sessions based on materials from the Williams LifeSkills program. The intervention was delivered in small groups by trained clinicians, Dr. Clemow said.

Individuals randomized to the control group received usual care, which included apprising the participants' primary care providers of blood pressure readings at screening and giving the participants a summary of blood pressure management guidelines. Individuals in both groups were stratified by hostility level.

The intervention group participants with a high level of hostility had reductions from baseline in systolic blood pressure during the high stress periods of the stress/anger structured interview, while their control counterparts did not show reductions. No differences were found in resting clinical blood pressure readings between the two groups over time, but the preliminary findings suggest the utility of such workplace interventions with respect to improving blood pressure under stressful conditions, according to Dr. Clemow.

The intervention group also showed posttreatment improvement in scores of self-reported stress, job burnout, hostility, and passive-unassertive behavior. As hypothesized, “the effects were more pronounced among individuals with higher baseline hostility,” Dr. Clemow said.

BOSTON – A worksite-based stress and anger management program may improve the cardiovascular health of at-risk employees, Lynn Clemow, Ph.D., said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

Preliminary results from a randomized, controlled trial indicate that participants who underwent a brief psychoeducational intervention program had reductions in systolic blood pressure. The participants were a diverse group of hospital employees classified as hypertensive on screening.

The employees in the intervention group also reported significant reductions in stress, hostility, burnout, and passive interpersonal behavior, all of which have been implicated in the development of cardiovascular disease, said Dr. Clemow of the behavioral cardiovascular health and hypertension program at Columbia University, New York.

Participants underwent baseline and posttrial blood pressure testing and structured interviews to measure hostility, perceived stress, depression, work stress, and interpersonal behavior. The 32 individuals in the intervention group participated in 10 weekly, 1-hour stress and anger management sessions based on materials from the Williams LifeSkills program. The intervention was delivered in small groups by trained clinicians, Dr. Clemow said.

Individuals randomized to the control group received usual care, which included apprising the participants' primary care providers of blood pressure readings at screening and giving the participants a summary of blood pressure management guidelines. Individuals in both groups were stratified by hostility level.

The intervention group participants with a high level of hostility had reductions from baseline in systolic blood pressure during the high stress periods of the stress/anger structured interview, while their control counterparts did not show reductions. No differences were found in resting clinical blood pressure readings between the two groups over time, but the preliminary findings suggest the utility of such workplace interventions with respect to improving blood pressure under stressful conditions, according to Dr. Clemow.

The intervention group also showed posttreatment improvement in scores of self-reported stress, job burnout, hostility, and passive-unassertive behavior. As hypothesized, “the effects were more pronounced among individuals with higher baseline hostility,” Dr. Clemow said.

BOSTON – A worksite-based stress and anger management program may improve the cardiovascular health of at-risk employees, Lynn Clemow, Ph.D., said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

Preliminary results from a randomized, controlled trial indicate that participants who underwent a brief psychoeducational intervention program had reductions in systolic blood pressure. The participants were a diverse group of hospital employees classified as hypertensive on screening.

The employees in the intervention group also reported significant reductions in stress, hostility, burnout, and passive interpersonal behavior, all of which have been implicated in the development of cardiovascular disease, said Dr. Clemow of the behavioral cardiovascular health and hypertension program at Columbia University, New York.

Participants underwent baseline and posttrial blood pressure testing and structured interviews to measure hostility, perceived stress, depression, work stress, and interpersonal behavior. The 32 individuals in the intervention group participated in 10 weekly, 1-hour stress and anger management sessions based on materials from the Williams LifeSkills program. The intervention was delivered in small groups by trained clinicians, Dr. Clemow said.

Individuals randomized to the control group received usual care, which included apprising the participants' primary care providers of blood pressure readings at screening and giving the participants a summary of blood pressure management guidelines. Individuals in both groups were stratified by hostility level.

The intervention group participants with a high level of hostility had reductions from baseline in systolic blood pressure during the high stress periods of the stress/anger structured interview, while their control counterparts did not show reductions. No differences were found in resting clinical blood pressure readings between the two groups over time, but the preliminary findings suggest the utility of such workplace interventions with respect to improving blood pressure under stressful conditions, according to Dr. Clemow.

The intervention group also showed posttreatment improvement in scores of self-reported stress, job burnout, hostility, and passive-unassertive behavior. As hypothesized, “the effects were more pronounced among individuals with higher baseline hostility,” Dr. Clemow said.

BOSTON – The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress vary depending on the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines published in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said.

“Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adults with cancer or their partners to help them address the needs of their children during cancer treatment, Dr. Schapira explained. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clearly, clinicians cannot be the only source of psychosocial support for their younger breast cancer patients; they should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

BOSTON – The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress vary depending on the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines published in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said.

“Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adults with cancer or their partners to help them address the needs of their children during cancer treatment, Dr. Schapira explained. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clearly, clinicians cannot be the only source of psychosocial support for their younger breast cancer patients; they should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

BOSTON – The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress vary depending on the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines published in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said.

“Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adults with cancer or their partners to help them address the needs of their children during cancer treatment, Dr. Schapira explained. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clearly, clinicians cannot be the only source of psychosocial support for their younger breast cancer patients; they should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

BOSTON – Many parents of children who are overweight or at risk for becoming overweight don't perceive their children's weight accurately, Patricia A. Cluss, Ph.D., and colleagues said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

These findings “have significant implications for public health and clinical interventions aimed at decreasing the pediatric obesity epidemic,” wrote Dr. Cluss and her associates.

Parental awareness of and concern that their child's weight is above the normal range is “intrinsic to the success” of physicians' efforts to identify and target children for prevention or intervention, she said in an oral presentation.

As a way to determine the accuracy of parental weight perceptions, the parents of 616 children aged 3–12 years seen at two community pediatric practices completed eight-item, self-administered questionnaires. Medical assistants weighed, measured, and calculated the body mass index (BMI) of each child.

The study included totals of 281 girls and 335 boys. Of the girls, 15% were at risk for being overweight, with BMIs in the 85th to 94th percentiles, and 25% were overweight, with BMIs above the 94th percentile. With the same criteria, 15% of the boys were at risk for being overweight, and 22% were overweight.

Only 49% of the parents surveyed accurately recognized their overweight children as being overweight, reported Dr. Cluss of the University of Pittsburgh.

“The parents of overweight girls were more likely to accurately perceive their child as being overweight, compared [with] the parents of boys, particularly preadolescents,” said Dr. Cluss. Whereas 63% of overweight girls' parents recognized their children's weight status, only 29% of overweight boys' parents had accurate perceptions.

The results also showed that parental perceptions were more often correct for children aged 6–12 years than for children younger than 6 years old.

Only 8% of the parents whose children were at risk for becoming overweight were aware of it.

The findings add gravitas to a growing collection of data indicating that many parents do not correctly perceive their child's weight status–a fact that may hinder parents' readiness to engage with the pediatrician in tracking and intervention strategies, said Dr. Cluss.

As such, physicians “have an important role to play in identifying at-risk children and communicating early concern to parents,” she said. In addition, special attention should be given to communicating with parents of younger children who may be overweight or at risk of becoming so and with parents of overweight boys, considering both groups had low accuracy rates, Dr. Cluss said.

BOSTON – Many parents of children who are overweight or at risk for becoming overweight don't perceive their children's weight accurately, Patricia A. Cluss, Ph.D., and colleagues said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

These findings “have significant implications for public health and clinical interventions aimed at decreasing the pediatric obesity epidemic,” wrote Dr. Cluss and her associates.

Parental awareness of and concern that their child's weight is above the normal range is “intrinsic to the success” of physicians' efforts to identify and target children for prevention or intervention, she said in an oral presentation.

As a way to determine the accuracy of parental weight perceptions, the parents of 616 children aged 3–12 years seen at two community pediatric practices completed eight-item, self-administered questionnaires. Medical assistants weighed, measured, and calculated the body mass index (BMI) of each child.

The study included totals of 281 girls and 335 boys. Of the girls, 15% were at risk for being overweight, with BMIs in the 85th to 94th percentiles, and 25% were overweight, with BMIs above the 94th percentile. With the same criteria, 15% of the boys were at risk for being overweight, and 22% were overweight.

Only 49% of the parents surveyed accurately recognized their overweight children as being overweight, reported Dr. Cluss of the University of Pittsburgh.

“The parents of overweight girls were more likely to accurately perceive their child as being overweight, compared [with] the parents of boys, particularly preadolescents,” said Dr. Cluss. Whereas 63% of overweight girls' parents recognized their children's weight status, only 29% of overweight boys' parents had accurate perceptions.

The results also showed that parental perceptions were more often correct for children aged 6–12 years than for children younger than 6 years old.

Only 8% of the parents whose children were at risk for becoming overweight were aware of it.

The findings add gravitas to a growing collection of data indicating that many parents do not correctly perceive their child's weight status–a fact that may hinder parents' readiness to engage with the pediatrician in tracking and intervention strategies, said Dr. Cluss.

As such, physicians “have an important role to play in identifying at-risk children and communicating early concern to parents,” she said. In addition, special attention should be given to communicating with parents of younger children who may be overweight or at risk of becoming so and with parents of overweight boys, considering both groups had low accuracy rates, Dr. Cluss said.

BOSTON – Many parents of children who are overweight or at risk for becoming overweight don't perceive their children's weight accurately, Patricia A. Cluss, Ph.D., and colleagues said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

These findings “have significant implications for public health and clinical interventions aimed at decreasing the pediatric obesity epidemic,” wrote Dr. Cluss and her associates.

Parental awareness of and concern that their child's weight is above the normal range is “intrinsic to the success” of physicians' efforts to identify and target children for prevention or intervention, she said in an oral presentation.

As a way to determine the accuracy of parental weight perceptions, the parents of 616 children aged 3–12 years seen at two community pediatric practices completed eight-item, self-administered questionnaires. Medical assistants weighed, measured, and calculated the body mass index (BMI) of each child.

The study included totals of 281 girls and 335 boys. Of the girls, 15% were at risk for being overweight, with BMIs in the 85th to 94th percentiles, and 25% were overweight, with BMIs above the 94th percentile. With the same criteria, 15% of the boys were at risk for being overweight, and 22% were overweight.

Only 49% of the parents surveyed accurately recognized their overweight children as being overweight, reported Dr. Cluss of the University of Pittsburgh.

“The parents of overweight girls were more likely to accurately perceive their child as being overweight, compared [with] the parents of boys, particularly preadolescents,” said Dr. Cluss. Whereas 63% of overweight girls' parents recognized their children's weight status, only 29% of overweight boys' parents had accurate perceptions.

The results also showed that parental perceptions were more often correct for children aged 6–12 years than for children younger than 6 years old.

Only 8% of the parents whose children were at risk for becoming overweight were aware of it.

The findings add gravitas to a growing collection of data indicating that many parents do not correctly perceive their child's weight status–a fact that may hinder parents' readiness to engage with the pediatrician in tracking and intervention strategies, said Dr. Cluss.

As such, physicians “have an important role to play in identifying at-risk children and communicating early concern to parents,” she said. In addition, special attention should be given to communicating with parents of younger children who may be overweight or at risk of becoming so and with parents of overweight boys, considering both groups had low accuracy rates, Dr. Cluss said.

The antibiotic ceftriaxone is an effective treatment for early syphilis in pregnancy, a small study has shown.

Researchers studied the efficacy of broad-spectrum cephalosporin in 11 HIV-negative pregnant women with early syphilis and histories of penicillin allergy or skin test reactions to penicillin antigen. Gestation at the initiation of treatment was 4 to 18 weeks (Sex. Transm. Dis. 2005;32:495–8).

Three women were diagnosed with primary syphilis and eight with secondary syphilis. Those with primary syphilis received intramuscular injections of 250 mg ceftriaxone (Rocephin) once daily for 7 days. Those with secondary syphilis got once-daily injections for 10 days. The same course was repeated for both groups at 28 weeks' gestation, said Dr. Pingyu Zhou, M.D., Ph.D., and colleagues at Shanghai (China) Skin and STD Hospital.

The patients were reexamined eight times over 24 months. All completed the first course of treatment, and 8 of the 11 completed the second course.

Within 1 month of the first course of treatment, syphilitic skin lesions disappeared in all patients and did not recur in the follow-up period. Within 3 months, there was a fourfold reduction in serum rapid plasma reagin (RPR) titers with no increase in the follow-up period. Ten women developed negative RPR measures in the follow-up period.

None of the neonates had clinical or radiographic manifestations of congenital syphilis at birth or in the 2-year follow-up period. At birth, 5 infants had serum RPR measures equal to those of their mothers at delivery, but all were negative within 12 months.

Although the study is limited by its size and the fact that the patients studied were less likely to transmit syphilis to their newborns than other risk groups, the findings suggest ceftriaxone can be considered as a therapeutic alternative for the treatment of early syphilis “in the appropriate clinical setting,” the authors wrote.

There was no evidence of the necessity of the second course of therapy, Dr. Zhou and associates said.

The antibiotic ceftriaxone is an effective treatment for early syphilis in pregnancy, a small study has shown.

Researchers studied the efficacy of broad-spectrum cephalosporin in 11 HIV-negative pregnant women with early syphilis and histories of penicillin allergy or skin test reactions to penicillin antigen. Gestation at the initiation of treatment was 4 to 18 weeks (Sex. Transm. Dis. 2005;32:495–8).

Three women were diagnosed with primary syphilis and eight with secondary syphilis. Those with primary syphilis received intramuscular injections of 250 mg ceftriaxone (Rocephin) once daily for 7 days. Those with secondary syphilis got once-daily injections for 10 days. The same course was repeated for both groups at 28 weeks' gestation, said Dr. Pingyu Zhou, M.D., Ph.D., and colleagues at Shanghai (China) Skin and STD Hospital.

The patients were reexamined eight times over 24 months. All completed the first course of treatment, and 8 of the 11 completed the second course.

Within 1 month of the first course of treatment, syphilitic skin lesions disappeared in all patients and did not recur in the follow-up period. Within 3 months, there was a fourfold reduction in serum rapid plasma reagin (RPR) titers with no increase in the follow-up period. Ten women developed negative RPR measures in the follow-up period.

None of the neonates had clinical or radiographic manifestations of congenital syphilis at birth or in the 2-year follow-up period. At birth, 5 infants had serum RPR measures equal to those of their mothers at delivery, but all were negative within 12 months.

Although the study is limited by its size and the fact that the patients studied were less likely to transmit syphilis to their newborns than other risk groups, the findings suggest ceftriaxone can be considered as a therapeutic alternative for the treatment of early syphilis “in the appropriate clinical setting,” the authors wrote.

There was no evidence of the necessity of the second course of therapy, Dr. Zhou and associates said.

The antibiotic ceftriaxone is an effective treatment for early syphilis in pregnancy, a small study has shown.

Researchers studied the efficacy of broad-spectrum cephalosporin in 11 HIV-negative pregnant women with early syphilis and histories of penicillin allergy or skin test reactions to penicillin antigen. Gestation at the initiation of treatment was 4 to 18 weeks (Sex. Transm. Dis. 2005;32:495–8).

Three women were diagnosed with primary syphilis and eight with secondary syphilis. Those with primary syphilis received intramuscular injections of 250 mg ceftriaxone (Rocephin) once daily for 7 days. Those with secondary syphilis got once-daily injections for 10 days. The same course was repeated for both groups at 28 weeks' gestation, said Dr. Pingyu Zhou, M.D., Ph.D., and colleagues at Shanghai (China) Skin and STD Hospital.

The patients were reexamined eight times over 24 months. All completed the first course of treatment, and 8 of the 11 completed the second course.

Within 1 month of the first course of treatment, syphilitic skin lesions disappeared in all patients and did not recur in the follow-up period. Within 3 months, there was a fourfold reduction in serum rapid plasma reagin (RPR) titers with no increase in the follow-up period. Ten women developed negative RPR measures in the follow-up period.

None of the neonates had clinical or radiographic manifestations of congenital syphilis at birth or in the 2-year follow-up period. At birth, 5 infants had serum RPR measures equal to those of their mothers at delivery, but all were negative within 12 months.

Although the study is limited by its size and the fact that the patients studied were less likely to transmit syphilis to their newborns than other risk groups, the findings suggest ceftriaxone can be considered as a therapeutic alternative for the treatment of early syphilis “in the appropriate clinical setting,” the authors wrote.

There was no evidence of the necessity of the second course of therapy, Dr. Zhou and associates said.

BOSTON — Ductal lavage is technically feasible in patients diagnosed with lobular neoplasia, reported Marie Ward, M.D.

The minimally invasive procedure yields a sufficient amount of ductal epithelial cells for a determination of atypia and therefore can help further stratify patients who are at risk for developing breast cancer, Dr. Ward said in a poster presentation at a breast cancer conference sponsored by Harvard Medical School.

Lobular neoplasia, or lobular carcinoma in situ, refers to the entire spectrum of atypical epithelial proliferations in the milk-producing lobules of the breast. The condition is not considered a cancer per se; however, women who are diagnosed with it are at a higher risk of developing breast cancer later in life.

While ductal lavage is indicated in women at high risk for breast cancer, its use in women with lobular neoplasia specifically has never been examined, Dr. Ward said.

To investigate whether the ductal lavage technique could extract enough cellular material to be useful in the diagnosis and management of lobular neoplasia and to determine the incidence of abnormal lavage findings in patients with the condition, Dr. Ward and her colleagues at the Columbia University Comprehensive Breast Center in New York conducted a feasibility pilot study.

Using an outcomes database called the Ductal Lavage Outcomes Tracking System, the investigators identified 31 women with lobular neoplasia who underwent ductal lavage. The database showed that the procedure retrieved sufficient cellular material in all except 2 of the 31 women, whose average age was 52.5 years.

Of the 29 women from whom sufficient cellular material was collected, 19 had benign cytology findings. The researchers said 3 of the women had evidence of mild atypia. Moderate atypia was not noted for any of the women, and the findings were unreported or incomplete for seven of the women, Dr. Ward noted.

The results of the pilot study suggest that “ductal lavage may assist in risk stratification of this high-risk group, which in turn can enable clinicians and patients to make more accurate decisions regarding risk-reduction strategies,” said Dr. Ward.

BOSTON — Ductal lavage is technically feasible in patients diagnosed with lobular neoplasia, reported Marie Ward, M.D.

The minimally invasive procedure yields a sufficient amount of ductal epithelial cells for a determination of atypia and therefore can help further stratify patients who are at risk for developing breast cancer, Dr. Ward said in a poster presentation at a breast cancer conference sponsored by Harvard Medical School.

Lobular neoplasia, or lobular carcinoma in situ, refers to the entire spectrum of atypical epithelial proliferations in the milk-producing lobules of the breast. The condition is not considered a cancer per se; however, women who are diagnosed with it are at a higher risk of developing breast cancer later in life.

While ductal lavage is indicated in women at high risk for breast cancer, its use in women with lobular neoplasia specifically has never been examined, Dr. Ward said.

To investigate whether the ductal lavage technique could extract enough cellular material to be useful in the diagnosis and management of lobular neoplasia and to determine the incidence of abnormal lavage findings in patients with the condition, Dr. Ward and her colleagues at the Columbia University Comprehensive Breast Center in New York conducted a feasibility pilot study.

Using an outcomes database called the Ductal Lavage Outcomes Tracking System, the investigators identified 31 women with lobular neoplasia who underwent ductal lavage. The database showed that the procedure retrieved sufficient cellular material in all except 2 of the 31 women, whose average age was 52.5 years.

Of the 29 women from whom sufficient cellular material was collected, 19 had benign cytology findings. The researchers said 3 of the women had evidence of mild atypia. Moderate atypia was not noted for any of the women, and the findings were unreported or incomplete for seven of the women, Dr. Ward noted.

The results of the pilot study suggest that “ductal lavage may assist in risk stratification of this high-risk group, which in turn can enable clinicians and patients to make more accurate decisions regarding risk-reduction strategies,” said Dr. Ward.

BOSTON — Ductal lavage is technically feasible in patients diagnosed with lobular neoplasia, reported Marie Ward, M.D.

The minimally invasive procedure yields a sufficient amount of ductal epithelial cells for a determination of atypia and therefore can help further stratify patients who are at risk for developing breast cancer, Dr. Ward said in a poster presentation at a breast cancer conference sponsored by Harvard Medical School.

Lobular neoplasia, or lobular carcinoma in situ, refers to the entire spectrum of atypical epithelial proliferations in the milk-producing lobules of the breast. The condition is not considered a cancer per se; however, women who are diagnosed with it are at a higher risk of developing breast cancer later in life.

While ductal lavage is indicated in women at high risk for breast cancer, its use in women with lobular neoplasia specifically has never been examined, Dr. Ward said.

To investigate whether the ductal lavage technique could extract enough cellular material to be useful in the diagnosis and management of lobular neoplasia and to determine the incidence of abnormal lavage findings in patients with the condition, Dr. Ward and her colleagues at the Columbia University Comprehensive Breast Center in New York conducted a feasibility pilot study.

Using an outcomes database called the Ductal Lavage Outcomes Tracking System, the investigators identified 31 women with lobular neoplasia who underwent ductal lavage. The database showed that the procedure retrieved sufficient cellular material in all except 2 of the 31 women, whose average age was 52.5 years.

Of the 29 women from whom sufficient cellular material was collected, 19 had benign cytology findings. The researchers said 3 of the women had evidence of mild atypia. Moderate atypia was not noted for any of the women, and the findings were unreported or incomplete for seven of the women, Dr. Ward noted.

The results of the pilot study suggest that “ductal lavage may assist in risk stratification of this high-risk group, which in turn can enable clinicians and patients to make more accurate decisions regarding risk-reduction strategies,” said Dr. Ward.

NEW ORLEANS — Spanish-language users of a bilingual interactive computer program in an urgent care clinic reaped the most educational benefit from the system, a study has shown.

The findings suggest that computerized educational modules may be an important tool to help reduce health care disparities among medically underserved populations, Bonnie Leeman-Castillo said in a presentation at the annual meeting of the Society of General Internal Medicine.

During a 4-month period, 296 adults seeking care for acute respiratory tract infections at an urgent care facility in Denver were referred to a free-standing computer that housed an audiovisual education module that provided information in both English and Spanish. The module prompted the patients to provide information about demographics, knowledge and attitudes about antibiotics and acute respiratory infections, reasons for seeking care for their illness, and a symptom inventory.

“The computer then suggested a likely diagnosis based on the patients' symptoms and provided information about how to best treat the illness,” said Ms. Leeman-Castillo, a Ph.D. candidate in the Health and Behavioral Science Program at the University of Colorado at Denver.

Patients were asked to rate their experience with the program in terms of complexity, understanding, and usefulness. The main outcome measures, she said, “were whether the patient learned something new about colds and flu and whether they trusted the computer information.”

With respect to demographics, 81% of the users were aged 18–44, 59% were female, 54% were Hispanic, 50% had household incomes of less than $10,000, and 16% completed the Spanish-language version of the module.

Patients who answered questions in Spanish were less likely to report prior computer experience and more likely to require help using the system. In terms of ease of use and understanding the computer messages, the differences between those who responded in English and Spanish were small but significant.

About 84% of the English-speaking respondents, compared with 71% of those who responded in Spanish, rated the program as easy to use, and 87% of those who answered in English said they understood the information, compared with 81% of the Spanish-speaking group.

After adjustment for patient demographics and computer module qualities, Spanish-language users were significantly more likely to report learning something new from the program and trusting the information, Ms. Leeman-Castillo said.

“Interestingly, we found that prior computer experience was a strong negative predictor of learning something new and trusting the information,” suggesting that populations with the least experience with interactive computer media may get the most out of such health tools, she said.

In general, the interactive module seemed to be well received by patients and effective at disseminating important health information, particularly to populations that may not otherwise be getting important public health information about such things as antibiotic overuse, she noted.

She stated that she had no financial interests or other relationship with the manufacturers of the commercial products or suppliers of the commercial services relative to the health-information module.

NEW ORLEANS — Spanish-language users of a bilingual interactive computer program in an urgent care clinic reaped the most educational benefit from the system, a study has shown.

The findings suggest that computerized educational modules may be an important tool to help reduce health care disparities among medically underserved populations, Bonnie Leeman-Castillo said in a presentation at the annual meeting of the Society of General Internal Medicine.

During a 4-month period, 296 adults seeking care for acute respiratory tract infections at an urgent care facility in Denver were referred to a free-standing computer that housed an audiovisual education module that provided information in both English and Spanish. The module prompted the patients to provide information about demographics, knowledge and attitudes about antibiotics and acute respiratory infections, reasons for seeking care for their illness, and a symptom inventory.

“The computer then suggested a likely diagnosis based on the patients' symptoms and provided information about how to best treat the illness,” said Ms. Leeman-Castillo, a Ph.D. candidate in the Health and Behavioral Science Program at the University of Colorado at Denver.

Patients were asked to rate their experience with the program in terms of complexity, understanding, and usefulness. The main outcome measures, she said, “were whether the patient learned something new about colds and flu and whether they trusted the computer information.”

With respect to demographics, 81% of the users were aged 18–44, 59% were female, 54% were Hispanic, 50% had household incomes of less than $10,000, and 16% completed the Spanish-language version of the module.

Patients who answered questions in Spanish were less likely to report prior computer experience and more likely to require help using the system. In terms of ease of use and understanding the computer messages, the differences between those who responded in English and Spanish were small but significant.

About 84% of the English-speaking respondents, compared with 71% of those who responded in Spanish, rated the program as easy to use, and 87% of those who answered in English said they understood the information, compared with 81% of the Spanish-speaking group.

After adjustment for patient demographics and computer module qualities, Spanish-language users were significantly more likely to report learning something new from the program and trusting the information, Ms. Leeman-Castillo said.

“Interestingly, we found that prior computer experience was a strong negative predictor of learning something new and trusting the information,” suggesting that populations with the least experience with interactive computer media may get the most out of such health tools, she said.

In general, the interactive module seemed to be well received by patients and effective at disseminating important health information, particularly to populations that may not otherwise be getting important public health information about such things as antibiotic overuse, she noted.

She stated that she had no financial interests or other relationship with the manufacturers of the commercial products or suppliers of the commercial services relative to the health-information module.

NEW ORLEANS — Spanish-language users of a bilingual interactive computer program in an urgent care clinic reaped the most educational benefit from the system, a study has shown.

The findings suggest that computerized educational modules may be an important tool to help reduce health care disparities among medically underserved populations, Bonnie Leeman-Castillo said in a presentation at the annual meeting of the Society of General Internal Medicine.

During a 4-month period, 296 adults seeking care for acute respiratory tract infections at an urgent care facility in Denver were referred to a free-standing computer that housed an audiovisual education module that provided information in both English and Spanish. The module prompted the patients to provide information about demographics, knowledge and attitudes about antibiotics and acute respiratory infections, reasons for seeking care for their illness, and a symptom inventory.

“The computer then suggested a likely diagnosis based on the patients' symptoms and provided information about how to best treat the illness,” said Ms. Leeman-Castillo, a Ph.D. candidate in the Health and Behavioral Science Program at the University of Colorado at Denver.

Patients were asked to rate their experience with the program in terms of complexity, understanding, and usefulness. The main outcome measures, she said, “were whether the patient learned something new about colds and flu and whether they trusted the computer information.”

With respect to demographics, 81% of the users were aged 18–44, 59% were female, 54% were Hispanic, 50% had household incomes of less than $10,000, and 16% completed the Spanish-language version of the module.

Patients who answered questions in Spanish were less likely to report prior computer experience and more likely to require help using the system. In terms of ease of use and understanding the computer messages, the differences between those who responded in English and Spanish were small but significant.

About 84% of the English-speaking respondents, compared with 71% of those who responded in Spanish, rated the program as easy to use, and 87% of those who answered in English said they understood the information, compared with 81% of the Spanish-speaking group.

After adjustment for patient demographics and computer module qualities, Spanish-language users were significantly more likely to report learning something new from the program and trusting the information, Ms. Leeman-Castillo said.

“Interestingly, we found that prior computer experience was a strong negative predictor of learning something new and trusting the information,” suggesting that populations with the least experience with interactive computer media may get the most out of such health tools, she said.

In general, the interactive module seemed to be well received by patients and effective at disseminating important health information, particularly to populations that may not otherwise be getting important public health information about such things as antibiotic overuse, she noted.

She stated that she had no financial interests or other relationship with the manufacturers of the commercial products or suppliers of the commercial services relative to the health-information module.

BOSTON — A prescription for exercise may do more than boost obese children's physical health. It also may improve how they think, results of a study have shown.

The findings are consistent with recent work demonstrating exercise-induced improvements in cognition in older adults and add fuel to the argument for increasing physical education requirements in schools and community-based opportunities for physical activity, according to Mathew Gregoski of the Georgia Prevention Institute of the Medical College of Georgia in Augusta.

As part of an ongoing investigation of a possible dose-response relationship between a 3-month exercise program and adiposity, insulin sensitivity, and executive functioning in overweight youth, 30 children aged 8–11 years with a body mass index at or above the 85th percentile for their age and gender were randomized to one of three intervention conditions—no exercise, low-dose exercise (20 min/day), and high-dose exercise (40 min/day)—to test the effect of aerobic exercise training on cognitive measures. Both of the exercise conditions included vigorous aerobic activities and games that maintained average heart rate above 150 beats per minute, Mr. Gregoski reported at the annual meeting of the Society for Behavioral Medicine.

Before and after the interventions, all participants underwent standardized mental functioning testing using the Cognitive Assessment System (CAS). The investigators calculated the changes from baseline in four scales of the CAS, including planning, attention, successive, and simultaneous, said Mr. Gregoski, who conducted the investigation under the direction of Catherine Davis, Ph.D.

The planning scale measures an individual's ability to generate and implement hypotheses and to use decision-making structures to evaluate them. This aspect of mental functioning is thought to underlie cognitive control, intentionality, and self-regulation—all of which have been identified as challenges for obese children.

The attention scale measures an individual's ability to focus attention, take in information, and maintain sufficient alertness to attempt problem solving. The successive scale is associated with the ability to integrate information in serial order, and the simultaneous scale is associated with mental operations that require consideration of all elements of a complex stimulus concurrently.

Analysis of variance revealed significant improvement following both exercise interventions in the planning scale of the CAS, with the high-dose exercise group experiencing the most change from baseline. The other cognitive measures did not show an effect, he said.

That a significant cognitive benefit was observed with the 20-minute intervention in addition to the longer duration is notable in that such a program could readily be introduced during regular physical education sessions.

These results “provide evidence for a direct relationship between physical activity and children's cognitive development,” Mr. Gregoski said.

BOSTON — A prescription for exercise may do more than boost obese children's physical health. It also may improve how they think, results of a study have shown.

The findings are consistent with recent work demonstrating exercise-induced improvements in cognition in older adults and add fuel to the argument for increasing physical education requirements in schools and community-based opportunities for physical activity, according to Mathew Gregoski of the Georgia Prevention Institute of the Medical College of Georgia in Augusta.

As part of an ongoing investigation of a possible dose-response relationship between a 3-month exercise program and adiposity, insulin sensitivity, and executive functioning in overweight youth, 30 children aged 8–11 years with a body mass index at or above the 85th percentile for their age and gender were randomized to one of three intervention conditions—no exercise, low-dose exercise (20 min/day), and high-dose exercise (40 min/day)—to test the effect of aerobic exercise training on cognitive measures. Both of the exercise conditions included vigorous aerobic activities and games that maintained average heart rate above 150 beats per minute, Mr. Gregoski reported at the annual meeting of the Society for Behavioral Medicine.

Before and after the interventions, all participants underwent standardized mental functioning testing using the Cognitive Assessment System (CAS). The investigators calculated the changes from baseline in four scales of the CAS, including planning, attention, successive, and simultaneous, said Mr. Gregoski, who conducted the investigation under the direction of Catherine Davis, Ph.D.

The planning scale measures an individual's ability to generate and implement hypotheses and to use decision-making structures to evaluate them. This aspect of mental functioning is thought to underlie cognitive control, intentionality, and self-regulation—all of which have been identified as challenges for obese children.

The attention scale measures an individual's ability to focus attention, take in information, and maintain sufficient alertness to attempt problem solving. The successive scale is associated with the ability to integrate information in serial order, and the simultaneous scale is associated with mental operations that require consideration of all elements of a complex stimulus concurrently.

Analysis of variance revealed significant improvement following both exercise interventions in the planning scale of the CAS, with the high-dose exercise group experiencing the most change from baseline. The other cognitive measures did not show an effect, he said.

That a significant cognitive benefit was observed with the 20-minute intervention in addition to the longer duration is notable in that such a program could readily be introduced during regular physical education sessions.

These results “provide evidence for a direct relationship between physical activity and children's cognitive development,” Mr. Gregoski said.

BOSTON — A prescription for exercise may do more than boost obese children's physical health. It also may improve how they think, results of a study have shown.

The findings are consistent with recent work demonstrating exercise-induced improvements in cognition in older adults and add fuel to the argument for increasing physical education requirements in schools and community-based opportunities for physical activity, according to Mathew Gregoski of the Georgia Prevention Institute of the Medical College of Georgia in Augusta.

As part of an ongoing investigation of a possible dose-response relationship between a 3-month exercise program and adiposity, insulin sensitivity, and executive functioning in overweight youth, 30 children aged 8–11 years with a body mass index at or above the 85th percentile for their age and gender were randomized to one of three intervention conditions—no exercise, low-dose exercise (20 min/day), and high-dose exercise (40 min/day)—to test the effect of aerobic exercise training on cognitive measures. Both of the exercise conditions included vigorous aerobic activities and games that maintained average heart rate above 150 beats per minute, Mr. Gregoski reported at the annual meeting of the Society for Behavioral Medicine.

Before and after the interventions, all participants underwent standardized mental functioning testing using the Cognitive Assessment System (CAS). The investigators calculated the changes from baseline in four scales of the CAS, including planning, attention, successive, and simultaneous, said Mr. Gregoski, who conducted the investigation under the direction of Catherine Davis, Ph.D.

The planning scale measures an individual's ability to generate and implement hypotheses and to use decision-making structures to evaluate them. This aspect of mental functioning is thought to underlie cognitive control, intentionality, and self-regulation—all of which have been identified as challenges for obese children.

The attention scale measures an individual's ability to focus attention, take in information, and maintain sufficient alertness to attempt problem solving. The successive scale is associated with the ability to integrate information in serial order, and the simultaneous scale is associated with mental operations that require consideration of all elements of a complex stimulus concurrently.

Analysis of variance revealed significant improvement following both exercise interventions in the planning scale of the CAS, with the high-dose exercise group experiencing the most change from baseline. The other cognitive measures did not show an effect, he said.

That a significant cognitive benefit was observed with the 20-minute intervention in addition to the longer duration is notable in that such a program could readily be introduced during regular physical education sessions.

These results “provide evidence for a direct relationship between physical activity and children's cognitive development,” Mr. Gregoski said.