Heidi Splete

WASHINGTON — No significant differences in neonatal outcomes were found among premature infants of women who had spinal anesthesia versus general anesthesia for cesarean delivery, based on the results of a study of 78 deliveries.

Most data on anesthesia and elective C-sections come from studies of term infants, said Dr. Robin Russell and colleagues at the John Radcliffe Hospital in Oxford, England. Data from one recent review of premature infants suggested that neonatal mortality risk was greater with spinal anesthesia than with general anesthesia, the researchers noted.

In this study, Dr. Russell and associates reviewed information from 78 women who were delivered at less than 33 weeks' gestation at a single hospital (69 singleton and 9 twin deliveries); the average age of the women was 31 years. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Spinal anesthesia (SA) was used in 58 cases, general anesthesia (GA) in 18 cases, and an epidural in 2 cases. The researchers compared the outcomes for the SA and GA cases based on Apgar scores and umbilical blood gas levels.

Overall, Apgar scores were not significantly different between the spinal and general anesthesia groups. The median 1-minute Apgar score was 8 in the SA group (range, 2-10) and 7 in the GA group (range, 3-9), and the median 5-minute Apgar scores were 8 in the SA group and 9 in the GA group.

Measures of umbilical venous gases were available for 49 SA deliveries and 15 GA deliveries, and measures of umbilical arterial gases were available for 51 SA deliveries and 13 GA deliveries. Based on these measures, there were no significant differences between the groups.

In addition, the birth weights were similar between the two groups, and no significant differences were observed in the health of the infants at 28 days or 3 months of age.

The results contrast with findings from previous research, but the study was limited by its small size and retrospective design, the researchers said. “Further work is needed to determine the optimal mode of anesthesia for cesarean section in premature infants,” they wrote. The investigators reported that they had no financial conflicts to disclose.

WASHINGTON — No significant differences in neonatal outcomes were found among premature infants of women who had spinal anesthesia versus general anesthesia for cesarean delivery, based on the results of a study of 78 deliveries.

Most data on anesthesia and elective C-sections come from studies of term infants, said Dr. Robin Russell and colleagues at the John Radcliffe Hospital in Oxford, England. Data from one recent review of premature infants suggested that neonatal mortality risk was greater with spinal anesthesia than with general anesthesia, the researchers noted.

In this study, Dr. Russell and associates reviewed information from 78 women who were delivered at less than 33 weeks' gestation at a single hospital (69 singleton and 9 twin deliveries); the average age of the women was 31 years. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Spinal anesthesia (SA) was used in 58 cases, general anesthesia (GA) in 18 cases, and an epidural in 2 cases. The researchers compared the outcomes for the SA and GA cases based on Apgar scores and umbilical blood gas levels.

Overall, Apgar scores were not significantly different between the spinal and general anesthesia groups. The median 1-minute Apgar score was 8 in the SA group (range, 2-10) and 7 in the GA group (range, 3-9), and the median 5-minute Apgar scores were 8 in the SA group and 9 in the GA group.

Measures of umbilical venous gases were available for 49 SA deliveries and 15 GA deliveries, and measures of umbilical arterial gases were available for 51 SA deliveries and 13 GA deliveries. Based on these measures, there were no significant differences between the groups.

In addition, the birth weights were similar between the two groups, and no significant differences were observed in the health of the infants at 28 days or 3 months of age.

The results contrast with findings from previous research, but the study was limited by its small size and retrospective design, the researchers said. “Further work is needed to determine the optimal mode of anesthesia for cesarean section in premature infants,” they wrote. The investigators reported that they had no financial conflicts to disclose.

WASHINGTON — No significant differences in neonatal outcomes were found among premature infants of women who had spinal anesthesia versus general anesthesia for cesarean delivery, based on the results of a study of 78 deliveries.

Most data on anesthesia and elective C-sections come from studies of term infants, said Dr. Robin Russell and colleagues at the John Radcliffe Hospital in Oxford, England. Data from one recent review of premature infants suggested that neonatal mortality risk was greater with spinal anesthesia than with general anesthesia, the researchers noted.

In this study, Dr. Russell and associates reviewed information from 78 women who were delivered at less than 33 weeks' gestation at a single hospital (69 singleton and 9 twin deliveries); the average age of the women was 31 years. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Spinal anesthesia (SA) was used in 58 cases, general anesthesia (GA) in 18 cases, and an epidural in 2 cases. The researchers compared the outcomes for the SA and GA cases based on Apgar scores and umbilical blood gas levels.

Overall, Apgar scores were not significantly different between the spinal and general anesthesia groups. The median 1-minute Apgar score was 8 in the SA group (range, 2-10) and 7 in the GA group (range, 3-9), and the median 5-minute Apgar scores were 8 in the SA group and 9 in the GA group.

Measures of umbilical venous gases were available for 49 SA deliveries and 15 GA deliveries, and measures of umbilical arterial gases were available for 51 SA deliveries and 13 GA deliveries. Based on these measures, there were no significant differences between the groups.

In addition, the birth weights were similar between the two groups, and no significant differences were observed in the health of the infants at 28 days or 3 months of age.

The results contrast with findings from previous research, but the study was limited by its small size and retrospective design, the researchers said. “Further work is needed to determine the optimal mode of anesthesia for cesarean section in premature infants,” they wrote. The investigators reported that they had no financial conflicts to disclose.

WASHINGTON — The intensity of women's labor pain at the time of neuraxial anesthesia placement didn't influence the mode of delivery, based on data from a study of 555 nulliparous women.

No previous study has addressed whether timing of neuraxial anesthesia with regard to the degree of the patient's pain has an impact on the mode of delivery, Dr. Yaakov Beilin said in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

In this study, Dr. Beilin and Diana H. Mungall, both of Mount Sinai Hospital in New York, reviewed data from term, nulliparous women who presented to the labor floor of a single hospital between July 2005 and September 2008. Pain scores at the time of neuraxial analgesia placement were determined using a scale of 0-10 and divided into three groups: low (0-3), moderate (4-6), and high (7-10).

The cesarean section rate was 41%, 36%, and 34%, in the low-, moderate-, and high-pain groups, respectively; the differences were not significant.

Similarly, the operative delivery rate (which included cesarean plus instrumental assisted vaginal delivery) was 49%, 45%, and 45% in the low-, moderate-, and high-pain groups, respectively; these values were not significantly different. And the vaginal delivery rate of 51%, 55%, and 55% for the low-, moderate-, and high-pain groups, respectively, were not significantly different.

The results were limited by the retrospective nature of the study, but the data suggest that neuraxial analgesia can be safely placed in women with varying degrees of labor pain, Dr. Beilin said.

The researchers had no financial conflicts to disclose.

WASHINGTON — The intensity of women's labor pain at the time of neuraxial anesthesia placement didn't influence the mode of delivery, based on data from a study of 555 nulliparous women.

No previous study has addressed whether timing of neuraxial anesthesia with regard to the degree of the patient's pain has an impact on the mode of delivery, Dr. Yaakov Beilin said in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

In this study, Dr. Beilin and Diana H. Mungall, both of Mount Sinai Hospital in New York, reviewed data from term, nulliparous women who presented to the labor floor of a single hospital between July 2005 and September 2008. Pain scores at the time of neuraxial analgesia placement were determined using a scale of 0-10 and divided into three groups: low (0-3), moderate (4-6), and high (7-10).

The cesarean section rate was 41%, 36%, and 34%, in the low-, moderate-, and high-pain groups, respectively; the differences were not significant.

Similarly, the operative delivery rate (which included cesarean plus instrumental assisted vaginal delivery) was 49%, 45%, and 45% in the low-, moderate-, and high-pain groups, respectively; these values were not significantly different. And the vaginal delivery rate of 51%, 55%, and 55% for the low-, moderate-, and high-pain groups, respectively, were not significantly different.

The results were limited by the retrospective nature of the study, but the data suggest that neuraxial analgesia can be safely placed in women with varying degrees of labor pain, Dr. Beilin said.

The researchers had no financial conflicts to disclose.

WASHINGTON — The intensity of women's labor pain at the time of neuraxial anesthesia placement didn't influence the mode of delivery, based on data from a study of 555 nulliparous women.

No previous study has addressed whether timing of neuraxial anesthesia with regard to the degree of the patient's pain has an impact on the mode of delivery, Dr. Yaakov Beilin said in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

In this study, Dr. Beilin and Diana H. Mungall, both of Mount Sinai Hospital in New York, reviewed data from term, nulliparous women who presented to the labor floor of a single hospital between July 2005 and September 2008. Pain scores at the time of neuraxial analgesia placement were determined using a scale of 0-10 and divided into three groups: low (0-3), moderate (4-6), and high (7-10).

The cesarean section rate was 41%, 36%, and 34%, in the low-, moderate-, and high-pain groups, respectively; the differences were not significant.

Similarly, the operative delivery rate (which included cesarean plus instrumental assisted vaginal delivery) was 49%, 45%, and 45% in the low-, moderate-, and high-pain groups, respectively; these values were not significantly different. And the vaginal delivery rate of 51%, 55%, and 55% for the low-, moderate-, and high-pain groups, respectively, were not significantly different.

The results were limited by the retrospective nature of the study, but the data suggest that neuraxial analgesia can be safely placed in women with varying degrees of labor pain, Dr. Beilin said.

The researchers had no financial conflicts to disclose.

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, based on data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease remains uncertain, Dr. Nielsen said at the annual Digestive Disease Week. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, as well as 26,216 controls without a history of these infections. The researchers followed the study population for up to 15 years, with an average follow-up period of 7.5 years.

A first-time diagnosis of inflammatory bowel disease (IBD) during the follow-up period was reported in 107 individuals with a history of Salmonella or Campylobacter infections, compared with 73 controls. The risk of IBD was independent of age and sex, and it was similar for both pathogens. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 if the first year after infection was excluded.

“We documented both short-term and long-term increased risk of IBD following confirmed infections,” Dr. Nielsen said. The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD as more research is done, he added.

The findings also emphasize the importance of food safety for disease prevention, Dr. Nielsen said at a press conference. The increased volume of imported foods and changes in food production may create more challenges for safe food handling, he said.

Dr. Nielsen had no financial conflicts to disclose.

To view a video interview of Dr. Nielsen, go to: www.youtube.com/watch?v=GDVlFRfYojI

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, based on data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease remains uncertain, Dr. Nielsen said at the annual Digestive Disease Week. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, as well as 26,216 controls without a history of these infections. The researchers followed the study population for up to 15 years, with an average follow-up period of 7.5 years.

A first-time diagnosis of inflammatory bowel disease (IBD) during the follow-up period was reported in 107 individuals with a history of Salmonella or Campylobacter infections, compared with 73 controls. The risk of IBD was independent of age and sex, and it was similar for both pathogens. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 if the first year after infection was excluded.

“We documented both short-term and long-term increased risk of IBD following confirmed infections,” Dr. Nielsen said. The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD as more research is done, he added.

The findings also emphasize the importance of food safety for disease prevention, Dr. Nielsen said at a press conference. The increased volume of imported foods and changes in food production may create more challenges for safe food handling, he said.

Dr. Nielsen had no financial conflicts to disclose.

To view a video interview of Dr. Nielsen, go to: www.youtube.com/watch?v=GDVlFRfYojI

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, based on data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease remains uncertain, Dr. Nielsen said at the annual Digestive Disease Week. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, as well as 26,216 controls without a history of these infections. The researchers followed the study population for up to 15 years, with an average follow-up period of 7.5 years.

A first-time diagnosis of inflammatory bowel disease (IBD) during the follow-up period was reported in 107 individuals with a history of Salmonella or Campylobacter infections, compared with 73 controls. The risk of IBD was independent of age and sex, and it was similar for both pathogens. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 if the first year after infection was excluded.

“We documented both short-term and long-term increased risk of IBD following confirmed infections,” Dr. Nielsen said. The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD as more research is done, he added.

The findings also emphasize the importance of food safety for disease prevention, Dr. Nielsen said at a press conference. The increased volume of imported foods and changes in food production may create more challenges for safe food handling, he said.

Dr. Nielsen had no financial conflicts to disclose.

To view a video interview of Dr. Nielsen, go to: www.youtube.com/watch?v=GDVlFRfYojI

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on data from the CDC's Morbidity and Mortality Weekly Report presented at a press briefing on June 18.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill; washing hands frequently; and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't over-represented among reported cases of the H1N1 virus so far. The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene.

Data on additional cases in health care providers are under review, Dr. Bell said.

The complete report on the novel influenza A (H1N1) cases in the 26 health care workers will be available in the CDC's June 19 Morbidity and Mortality Weekly Report (2009;58:641-5).

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

The CDC has posted H1N1 guidance for summer camps on its Web site, Dr. Jernigan said. “It's important than aspirin not be used in children with influenza-like illness,” he added, because of the potential for complications.

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on data from the CDC's Morbidity and Mortality Weekly Report presented at a press briefing on June 18.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill; washing hands frequently; and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't over-represented among reported cases of the H1N1 virus so far. The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene.

Data on additional cases in health care providers are under review, Dr. Bell said.

The complete report on the novel influenza A (H1N1) cases in the 26 health care workers will be available in the CDC's June 19 Morbidity and Mortality Weekly Report (2009;58:641-5).

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

The CDC has posted H1N1 guidance for summer camps on its Web site, Dr. Jernigan said. “It's important than aspirin not be used in children with influenza-like illness,” he added, because of the potential for complications.

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on data from the CDC's Morbidity and Mortality Weekly Report presented at a press briefing on June 18.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill; washing hands frequently; and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't over-represented among reported cases of the H1N1 virus so far. The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene.

Data on additional cases in health care providers are under review, Dr. Bell said.

The complete report on the novel influenza A (H1N1) cases in the 26 health care workers will be available in the CDC's June 19 Morbidity and Mortality Weekly Report (2009;58:641-5).

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

The CDC has posted H1N1 guidance for summer camps on its Web site, Dr. Jernigan said. “It's important than aspirin not be used in children with influenza-like illness,” he added, because of the potential for complications.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said.

But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472]).

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said.

But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472]).

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said.

But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472]).

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

WASHINGTON — Approximately 87% of large, high-volume emergency departments “board” admitted patients for more than 2 hours, based on the latest estimates from the National Hospital Ambulatory Medical Care Survey of 337 emergency departments.

Large emergency departments—defined as those that handle more than 50,000 visits per year—make up only 18% of all EDs in the United States, but they manage approximately 44% of all ED visits, Linda McCaig of the Centers for Disease Control and Prevention said at a workshop sponsored by the Institute of Medicine.

Ms. McCaig shared ED estimates for items that were added to the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) hospital induction interview in the wake of the 2006 IOM report on emergency care in the United States.

The report raised concerns about overcrowding, fragmentation of care, lack of disaster preparedness, and the need for better emergency care for children.

The NHAMCS was designed to collect, analyze, and share information about the health care in emergency departments and outpatient medical departments. The data are collected from a national sample of hospitals across the United States, excluding federal, military, and Veterans Affairs facilities.

Data are taken from patient record forms, which are completed by hospital staff based on instructions from the CDC.

Overall, 63% of EDs board patients, including 83% of medium-sized EDs (20,000-50,000 visits per year) and 39% of small EDs (fewer than 20,000 visits per year).

Just over half (51%) of all EDs reported having a designated inpatient bed coordinator to help manage patient flow, including 71% of large EDs, 63% of medium EDs, and 34% of small EDs.

One-third of all EDs in the United States don't use any type of electronic medical records, including 18% of large EDs, 26% of medium EDs, and 54% of small EDs, Ms. McCaig said.

These NHAMCS data provide an example of how EDs are responding to the recommendations from the 2006 IOM report, which include creating a coordinated, regionalized system for emergency care and putting an end to the practice of boarding ED patients and diverting ambulances.

“This meeting and the two that will follow in the next few months are an opportunity, 3 years later, to revisit the committee's recommendations, to assess what progress we have made in achieving the committee's overall vision of a regionalized, coordinated, and accountable emergency care system,” said Dr. Arthur Kellermann, a professor and associate dean for health policy at Emory University in Atlanta, who served as the workshop chair.

WASHINGTON — Approximately 87% of large, high-volume emergency departments “board” admitted patients for more than 2 hours, based on the latest estimates from the National Hospital Ambulatory Medical Care Survey of 337 emergency departments.

Large emergency departments—defined as those that handle more than 50,000 visits per year—make up only 18% of all EDs in the United States, but they manage approximately 44% of all ED visits, Linda McCaig of the Centers for Disease Control and Prevention said at a workshop sponsored by the Institute of Medicine.

Ms. McCaig shared ED estimates for items that were added to the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) hospital induction interview in the wake of the 2006 IOM report on emergency care in the United States.

The report raised concerns about overcrowding, fragmentation of care, lack of disaster preparedness, and the need for better emergency care for children.

The NHAMCS was designed to collect, analyze, and share information about the health care in emergency departments and outpatient medical departments. The data are collected from a national sample of hospitals across the United States, excluding federal, military, and Veterans Affairs facilities.

Data are taken from patient record forms, which are completed by hospital staff based on instructions from the CDC.

Overall, 63% of EDs board patients, including 83% of medium-sized EDs (20,000-50,000 visits per year) and 39% of small EDs (fewer than 20,000 visits per year).

Just over half (51%) of all EDs reported having a designated inpatient bed coordinator to help manage patient flow, including 71% of large EDs, 63% of medium EDs, and 34% of small EDs.

One-third of all EDs in the United States don't use any type of electronic medical records, including 18% of large EDs, 26% of medium EDs, and 54% of small EDs, Ms. McCaig said.

These NHAMCS data provide an example of how EDs are responding to the recommendations from the 2006 IOM report, which include creating a coordinated, regionalized system for emergency care and putting an end to the practice of boarding ED patients and diverting ambulances.

“This meeting and the two that will follow in the next few months are an opportunity, 3 years later, to revisit the committee's recommendations, to assess what progress we have made in achieving the committee's overall vision of a regionalized, coordinated, and accountable emergency care system,” said Dr. Arthur Kellermann, a professor and associate dean for health policy at Emory University in Atlanta, who served as the workshop chair.

WASHINGTON — Approximately 87% of large, high-volume emergency departments “board” admitted patients for more than 2 hours, based on the latest estimates from the National Hospital Ambulatory Medical Care Survey of 337 emergency departments.

Large emergency departments—defined as those that handle more than 50,000 visits per year—make up only 18% of all EDs in the United States, but they manage approximately 44% of all ED visits, Linda McCaig of the Centers for Disease Control and Prevention said at a workshop sponsored by the Institute of Medicine.

Ms. McCaig shared ED estimates for items that were added to the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) hospital induction interview in the wake of the 2006 IOM report on emergency care in the United States.

The report raised concerns about overcrowding, fragmentation of care, lack of disaster preparedness, and the need for better emergency care for children.

The NHAMCS was designed to collect, analyze, and share information about the health care in emergency departments and outpatient medical departments. The data are collected from a national sample of hospitals across the United States, excluding federal, military, and Veterans Affairs facilities.

Data are taken from patient record forms, which are completed by hospital staff based on instructions from the CDC.

Overall, 63% of EDs board patients, including 83% of medium-sized EDs (20,000-50,000 visits per year) and 39% of small EDs (fewer than 20,000 visits per year).

Just over half (51%) of all EDs reported having a designated inpatient bed coordinator to help manage patient flow, including 71% of large EDs, 63% of medium EDs, and 34% of small EDs.

One-third of all EDs in the United States don't use any type of electronic medical records, including 18% of large EDs, 26% of medium EDs, and 54% of small EDs, Ms. McCaig said.

These NHAMCS data provide an example of how EDs are responding to the recommendations from the 2006 IOM report, which include creating a coordinated, regionalized system for emergency care and putting an end to the practice of boarding ED patients and diverting ambulances.

“This meeting and the two that will follow in the next few months are an opportunity, 3 years later, to revisit the committee's recommendations, to assess what progress we have made in achieving the committee's overall vision of a regionalized, coordinated, and accountable emergency care system,” said Dr. Arthur Kellermann, a professor and associate dean for health policy at Emory University in Atlanta, who served as the workshop chair.

WASHINGTON — Exposure to environmental asthma triggers at home was significantly associated with an increased risk of asthma-related hospitalizations in children younger than 4 years, compared with older children, based on data from 306 children up to 18 years old.

The percentage of hospitalizations for asthma in younger children also rose significantly with the number of home triggers, said Elizabeth Banda of the University of Illinois at Chicago.

Ms. Banda and her colleagues reviewed data from children with asthma enrolled in an asthma prevention program. The children were divided into three age groups: 0-4 years, 5-11 years, and 12 and older. The researchers collected data on hospitalizations and on the indoor allergens in each child's home via questionnaires.

Compared with older children, asthma hospitalizations in children aged 0-4 years were more than three times as likely to be associated with smoke, molds, or dampness; more than four times as likely to be associated with basement use and rodents; and more than five times as likely to be associated with roaches and clutter. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Also, in children 0-4 years of age, the risk of asthma hospitalization was 9 times greater if they were exposed to five to six of these home conditions, compared with zero to four, and nearly 16 times greater if they were exposed to more than six.

The results were limited by the small sample size, cross-sectional design, and a lack of information about the degree of exposure to indoor environmental allergens. The findings suggest that younger children may be at greater risk because they spend more time in the home being exposed to indoor environmental triggers, compared with older children, the researchers said.

The study was supported by Merck Childhood Asthma Network Inc. Ms. Banda said she had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Exposure to environmental asthma triggers at home was significantly associated with an increased risk of asthma-related hospitalizations in children younger than 4 years, compared with older children, based on data from 306 children up to 18 years old.

The percentage of hospitalizations for asthma in younger children also rose significantly with the number of home triggers, said Elizabeth Banda of the University of Illinois at Chicago.

Ms. Banda and her colleagues reviewed data from children with asthma enrolled in an asthma prevention program. The children were divided into three age groups: 0-4 years, 5-11 years, and 12 and older. The researchers collected data on hospitalizations and on the indoor allergens in each child's home via questionnaires.

Compared with older children, asthma hospitalizations in children aged 0-4 years were more than three times as likely to be associated with smoke, molds, or dampness; more than four times as likely to be associated with basement use and rodents; and more than five times as likely to be associated with roaches and clutter. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Also, in children 0-4 years of age, the risk of asthma hospitalization was 9 times greater if they were exposed to five to six of these home conditions, compared with zero to four, and nearly 16 times greater if they were exposed to more than six.

The results were limited by the small sample size, cross-sectional design, and a lack of information about the degree of exposure to indoor environmental allergens. The findings suggest that younger children may be at greater risk because they spend more time in the home being exposed to indoor environmental triggers, compared with older children, the researchers said.

The study was supported by Merck Childhood Asthma Network Inc. Ms. Banda said she had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Exposure to environmental asthma triggers at home was significantly associated with an increased risk of asthma-related hospitalizations in children younger than 4 years, compared with older children, based on data from 306 children up to 18 years old.

The percentage of hospitalizations for asthma in younger children also rose significantly with the number of home triggers, said Elizabeth Banda of the University of Illinois at Chicago.

Ms. Banda and her colleagues reviewed data from children with asthma enrolled in an asthma prevention program. The children were divided into three age groups: 0-4 years, 5-11 years, and 12 and older. The researchers collected data on hospitalizations and on the indoor allergens in each child's home via questionnaires.

Compared with older children, asthma hospitalizations in children aged 0-4 years were more than three times as likely to be associated with smoke, molds, or dampness; more than four times as likely to be associated with basement use and rodents; and more than five times as likely to be associated with roaches and clutter. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Also, in children 0-4 years of age, the risk of asthma hospitalization was 9 times greater if they were exposed to five to six of these home conditions, compared with zero to four, and nearly 16 times greater if they were exposed to more than six.

The results were limited by the small sample size, cross-sectional design, and a lack of information about the degree of exposure to indoor environmental allergens. The findings suggest that younger children may be at greater risk because they spend more time in the home being exposed to indoor environmental triggers, compared with older children, the researchers said.

The study was supported by Merck Childhood Asthma Network Inc. Ms. Banda said she had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on CDC data presented at a press briefing.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill, washing hands frequently, and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't overrepresented among reported cases of the H1N1 virus so far.

The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene, the CDC researchers wrote (MMWR 2009;58:641-5).

Data on additional cases in health care providers are under review, Dr. Bell said.

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

On its Web site, the CDC has posted H1N1 guidance for those attending summer camps, Dr. Jernigan said.

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on CDC data presented at a press briefing.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill, washing hands frequently, and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't overrepresented among reported cases of the H1N1 virus so far.

The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene, the CDC researchers wrote (MMWR 2009;58:641-5).

Data on additional cases in health care providers are under review, Dr. Bell said.

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

On its Web site, the CDC has posted H1N1 guidance for those attending summer camps, Dr. Jernigan said.

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on CDC data presented at a press briefing.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill, washing hands frequently, and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't overrepresented among reported cases of the H1N1 virus so far.

The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene, the CDC researchers wrote (MMWR 2009;58:641-5).

Data on additional cases in health care providers are under review, Dr. Bell said.

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

On its Web site, the CDC has posted H1N1 guidance for those attending summer camps, Dr. Jernigan said.

WASHINGTON — The prevalence of asthma as a principal reason for hospitalization has remained steady, but its prevalence as a secondary diagnosis has increased by 113% in hospitalized adults and by 54% in hospitalized children, based on approximately 9 years of data from two large databases.

The number of adult hospital stays with asthma as a secondary diagnosis rose from 753,800 in 1997 to nearly 1.5 million in 2005. (For 2006, the number was estimated at slightly more than 1.6 million, based on incomplete data.) The number of pediatric hospital stays with asthma as a secondary diagnosis rose from 128,300 in 1997 to 197,000 in 2006.

The five most common reasons for hospital stays in 2006 in adults with asthma as secondary diagnosis were pneumonia (6.6%), heart failure (3.9%), nonspecific chest pain (3.8%), osteoarthritis (3.3%), and mood disorders (3.3%). The five most common reasons for hospital stays in children with asthma as a secondary diagnosis were pneumonia (27%), acute bronchitis (8.8%), mood disorders (5.5%), appendicitis (2.7%), and fluid and electrolyte disorders (2.4%), reported Chaya Merrill, M.P.H., Dr.P.H., of Thomson Reuters, and her colleagues.

They reviewed data from the Healthcare Cost and Utilization Project (HCUP), a collection of databases supported by the Agency for Healthcare Research and Quality. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The data for the study were obtained from the Nationwide Inpatient Sample (NIS), which includes 90% of adult hospitalizations, and the Kids' Inpatient Database (KID), which represents 80% of pediatric hospitalizations.

In adults, the hospitalizations involving asthma as either a primary or secondary diagnosis were highest in those aged 65 years and older. Overall, hospitalization rates rose with increasing age, starting at 18 years.

In children, hospitalizations involving asthma as a primary or secondary diagnosis were highest in those younger than 1 year (about 8 per 1,000 children) and lowest among those aged 15-17 years (about 2 per 1,000 children).

In adults, average rates of hospitalization with asthma as a secondary condition were highest in the Northwest and Midwest, and were lower in the South and West (10.6, 8.7, 6.9, and 6.0 stays per 1,000 persons, respectively). In children, average rates of hospitalization with asthma as a secondary condition were 3 stays per 1,000 persons in the Northeast, Midwest, and South, and 2 stays per 1,000 persons in the West.

For both adults and children, rates of hospitalization with asthma as either a primary or secondary diagnosis were higher in communities with a median income of $38,000 or less than in wealthier communities, the researchers noted.

The study was sponsored by the Agency for Healthcare Research and Quality, a branch of the United States Department of Health and Human Services.

WASHINGTON — The prevalence of asthma as a principal reason for hospitalization has remained steady, but its prevalence as a secondary diagnosis has increased by 113% in hospitalized adults and by 54% in hospitalized children, based on approximately 9 years of data from two large databases.

The number of adult hospital stays with asthma as a secondary diagnosis rose from 753,800 in 1997 to nearly 1.5 million in 2005. (For 2006, the number was estimated at slightly more than 1.6 million, based on incomplete data.) The number of pediatric hospital stays with asthma as a secondary diagnosis rose from 128,300 in 1997 to 197,000 in 2006.

The five most common reasons for hospital stays in 2006 in adults with asthma as secondary diagnosis were pneumonia (6.6%), heart failure (3.9%), nonspecific chest pain (3.8%), osteoarthritis (3.3%), and mood disorders (3.3%). The five most common reasons for hospital stays in children with asthma as a secondary diagnosis were pneumonia (27%), acute bronchitis (8.8%), mood disorders (5.5%), appendicitis (2.7%), and fluid and electrolyte disorders (2.4%), reported Chaya Merrill, M.P.H., Dr.P.H., of Thomson Reuters, and her colleagues.

They reviewed data from the Healthcare Cost and Utilization Project (HCUP), a collection of databases supported by the Agency for Healthcare Research and Quality. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The data for the study were obtained from the Nationwide Inpatient Sample (NIS), which includes 90% of adult hospitalizations, and the Kids' Inpatient Database (KID), which represents 80% of pediatric hospitalizations.

In adults, the hospitalizations involving asthma as either a primary or secondary diagnosis were highest in those aged 65 years and older. Overall, hospitalization rates rose with increasing age, starting at 18 years.

In children, hospitalizations involving asthma as a primary or secondary diagnosis were highest in those younger than 1 year (about 8 per 1,000 children) and lowest among those aged 15-17 years (about 2 per 1,000 children).

In adults, average rates of hospitalization with asthma as a secondary condition were highest in the Northwest and Midwest, and were lower in the South and West (10.6, 8.7, 6.9, and 6.0 stays per 1,000 persons, respectively). In children, average rates of hospitalization with asthma as a secondary condition were 3 stays per 1,000 persons in the Northeast, Midwest, and South, and 2 stays per 1,000 persons in the West.

For both adults and children, rates of hospitalization with asthma as either a primary or secondary diagnosis were higher in communities with a median income of $38,000 or less than in wealthier communities, the researchers noted.

The study was sponsored by the Agency for Healthcare Research and Quality, a branch of the United States Department of Health and Human Services.

WASHINGTON — The prevalence of asthma as a principal reason for hospitalization has remained steady, but its prevalence as a secondary diagnosis has increased by 113% in hospitalized adults and by 54% in hospitalized children, based on approximately 9 years of data from two large databases.

The number of adult hospital stays with asthma as a secondary diagnosis rose from 753,800 in 1997 to nearly 1.5 million in 2005. (For 2006, the number was estimated at slightly more than 1.6 million, based on incomplete data.) The number of pediatric hospital stays with asthma as a secondary diagnosis rose from 128,300 in 1997 to 197,000 in 2006.

The five most common reasons for hospital stays in 2006 in adults with asthma as secondary diagnosis were pneumonia (6.6%), heart failure (3.9%), nonspecific chest pain (3.8%), osteoarthritis (3.3%), and mood disorders (3.3%). The five most common reasons for hospital stays in children with asthma as a secondary diagnosis were pneumonia (27%), acute bronchitis (8.8%), mood disorders (5.5%), appendicitis (2.7%), and fluid and electrolyte disorders (2.4%), reported Chaya Merrill, M.P.H., Dr.P.H., of Thomson Reuters, and her colleagues.

They reviewed data from the Healthcare Cost and Utilization Project (HCUP), a collection of databases supported by the Agency for Healthcare Research and Quality. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The data for the study were obtained from the Nationwide Inpatient Sample (NIS), which includes 90% of adult hospitalizations, and the Kids' Inpatient Database (KID), which represents 80% of pediatric hospitalizations.

In adults, the hospitalizations involving asthma as either a primary or secondary diagnosis were highest in those aged 65 years and older. Overall, hospitalization rates rose with increasing age, starting at 18 years.

In children, hospitalizations involving asthma as a primary or secondary diagnosis were highest in those younger than 1 year (about 8 per 1,000 children) and lowest among those aged 15-17 years (about 2 per 1,000 children).

In adults, average rates of hospitalization with asthma as a secondary condition were highest in the Northwest and Midwest, and were lower in the South and West (10.6, 8.7, 6.9, and 6.0 stays per 1,000 persons, respectively). In children, average rates of hospitalization with asthma as a secondary condition were 3 stays per 1,000 persons in the Northeast, Midwest, and South, and 2 stays per 1,000 persons in the West.

For both adults and children, rates of hospitalization with asthma as either a primary or secondary diagnosis were higher in communities with a median income of $38,000 or less than in wealthier communities, the researchers noted.

The study was sponsored by the Agency for Healthcare Research and Quality, a branch of the United States Department of Health and Human Services.

Dermatologists who master the use of facial nerve blocks can make nonsurgical procedures more comfortable for patients, according to Dr. Howard K. Steinman.

The concept of "nonsurgical" cosmetic procedures creates an expectation that the procedures may be painless, said Dr. Steinman, who is in private practice in Chula Vista, Calif. Facial nerve blocks help doctors deliver on that expectation.

Other advantages include minimizing tissue distortion and allowing physicians to use smaller doses of local anesthetic, which means less risk of systemic toxicity, he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

Because facial nerve blocks provide significant regional anesthesia with minimal vasoconstriction, physicians still may wish to inject local anesthesia containing epinephrine, he said. Prime locations include the forehead, nose, nasolabial fold, cheek and upper lip, and chin and lower lip.

The injections for forehead nerve blocks are placed to block the supraorbital, supratrochlear, and infratrochlear nerves as they exit the skull. "Enter just lateral to the supraorbital notch above the eyebrow and advance the needle submuscularly just above the brow to the middle of the medial canthus," Dr. Steinman explained.

For an external nasal nerve block, inject the block just lateral to the midline just below the junction of the lateral cartilage and the nasal bone, he said. Advance the needle from this single point.

An infraorbital block may be placed using either an external or internal (intraoral) approach. Dr. Steinman said that he prefers the intraoral approach. To take the intraoral route, place the third finger of the nondominant hand near the midline of the inferior orbital rim, and retract the lip between your nondominant thumb and index finger. "Insert the needle above the canine tooth at the gingival buccal sulcus—advance the needle about 1 cm towards your third finger while injecting," said Dr. Steinman. Alternatively, take the percutaneous route: Palpate for the infraorbital foramen and insert the needle perpendicular to the skin just below it to near the maxillary bone, and inject anesthetic.

Similarly, nerve blocks injected in the chin and lower lip can be performed with an internal or external approach.

Injections through the labial mucosa to anesthetize just the upper and lower lip also can be part of a facial nerve block protocol, said Dr. Steinman. Start with the upper lip by applying topical anesthesia gel and injecting small amounts of anesthesia approximately half a centimeter above the gingival-labial sulcus above the oral commissure, he explained.

Then inject submucosally, medially from this point along the sulcus to the frenulum and repeat on the opposite side. Be sure to inject a small amount of anesthesia at the midline, directly from the sulcus next to the frenulum toward the nasal septum, he added.

For the lower lip, start at the point below the oral commissure on the contralateral side and inject submucosally in the sulcus. The mucosal block will not anesthetize the skin at the oral commissures, so those areas must be anesthetized by direct submucosal injections after applying anesthetic gel.

He reported having no financial conflicts to disclose. SDEFand this news organization are owned by Elsevier.

An injection in the midline toward the nose will block the midline upper lip. COURTESY DR. HOWARD K. STEINMAN

Dermatologists who master the use of facial nerve blocks can make nonsurgical procedures more comfortable for patients, according to Dr. Howard K. Steinman.

The concept of "nonsurgical" cosmetic procedures creates an expectation that the procedures may be painless, said Dr. Steinman, who is in private practice in Chula Vista, Calif. Facial nerve blocks help doctors deliver on that expectation.

Other advantages include minimizing tissue distortion and allowing physicians to use smaller doses of local anesthetic, which means less risk of systemic toxicity, he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

Because facial nerve blocks provide significant regional anesthesia with minimal vasoconstriction, physicians still may wish to inject local anesthesia containing epinephrine, he said. Prime locations include the forehead, nose, nasolabial fold, cheek and upper lip, and chin and lower lip.

The injections for forehead nerve blocks are placed to block the supraorbital, supratrochlear, and infratrochlear nerves as they exit the skull. "Enter just lateral to the supraorbital notch above the eyebrow and advance the needle submuscularly just above the brow to the middle of the medial canthus," Dr. Steinman explained.

For an external nasal nerve block, inject the block just lateral to the midline just below the junction of the lateral cartilage and the nasal bone, he said. Advance the needle from this single point.

An infraorbital block may be placed using either an external or internal (intraoral) approach. Dr. Steinman said that he prefers the intraoral approach. To take the intraoral route, place the third finger of the nondominant hand near the midline of the inferior orbital rim, and retract the lip between your nondominant thumb and index finger. "Insert the needle above the canine tooth at the gingival buccal sulcus—advance the needle about 1 cm towards your third finger while injecting," said Dr. Steinman. Alternatively, take the percutaneous route: Palpate for the infraorbital foramen and insert the needle perpendicular to the skin just below it to near the maxillary bone, and inject anesthetic.

Similarly, nerve blocks injected in the chin and lower lip can be performed with an internal or external approach.

Injections through the labial mucosa to anesthetize just the upper and lower lip also can be part of a facial nerve block protocol, said Dr. Steinman. Start with the upper lip by applying topical anesthesia gel and injecting small amounts of anesthesia approximately half a centimeter above the gingival-labial sulcus above the oral commissure, he explained.

Then inject submucosally, medially from this point along the sulcus to the frenulum and repeat on the opposite side. Be sure to inject a small amount of anesthesia at the midline, directly from the sulcus next to the frenulum toward the nasal septum, he added.

For the lower lip, start at the point below the oral commissure on the contralateral side and inject submucosally in the sulcus. The mucosal block will not anesthetize the skin at the oral commissures, so those areas must be anesthetized by direct submucosal injections after applying anesthetic gel.

He reported having no financial conflicts to disclose. SDEFand this news organization are owned by Elsevier.

An injection in the midline toward the nose will block the midline upper lip. COURTESY DR. HOWARD K. STEINMAN

Dermatologists who master the use of facial nerve blocks can make nonsurgical procedures more comfortable for patients, according to Dr. Howard K. Steinman.

The concept of "nonsurgical" cosmetic procedures creates an expectation that the procedures may be painless, said Dr. Steinman, who is in private practice in Chula Vista, Calif. Facial nerve blocks help doctors deliver on that expectation.

Other advantages include minimizing tissue distortion and allowing physicians to use smaller doses of local anesthetic, which means less risk of systemic toxicity, he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

Because facial nerve blocks provide significant regional anesthesia with minimal vasoconstriction, physicians still may wish to inject local anesthesia containing epinephrine, he said. Prime locations include the forehead, nose, nasolabial fold, cheek and upper lip, and chin and lower lip.

The injections for forehead nerve blocks are placed to block the supraorbital, supratrochlear, and infratrochlear nerves as they exit the skull. "Enter just lateral to the supraorbital notch above the eyebrow and advance the needle submuscularly just above the brow to the middle of the medial canthus," Dr. Steinman explained.

For an external nasal nerve block, inject the block just lateral to the midline just below the junction of the lateral cartilage and the nasal bone, he said. Advance the needle from this single point.

An infraorbital block may be placed using either an external or internal (intraoral) approach. Dr. Steinman said that he prefers the intraoral approach. To take the intraoral route, place the third finger of the nondominant hand near the midline of the inferior orbital rim, and retract the lip between your nondominant thumb and index finger. "Insert the needle above the canine tooth at the gingival buccal sulcus—advance the needle about 1 cm towards your third finger while injecting," said Dr. Steinman. Alternatively, take the percutaneous route: Palpate for the infraorbital foramen and insert the needle perpendicular to the skin just below it to near the maxillary bone, and inject anesthetic.

Similarly, nerve blocks injected in the chin and lower lip can be performed with an internal or external approach.

Injections through the labial mucosa to anesthetize just the upper and lower lip also can be part of a facial nerve block protocol, said Dr. Steinman. Start with the upper lip by applying topical anesthesia gel and injecting small amounts of anesthesia approximately half a centimeter above the gingival-labial sulcus above the oral commissure, he explained.

Then inject submucosally, medially from this point along the sulcus to the frenulum and repeat on the opposite side. Be sure to inject a small amount of anesthesia at the midline, directly from the sulcus next to the frenulum toward the nasal septum, he added.

For the lower lip, start at the point below the oral commissure on the contralateral side and inject submucosally in the sulcus. The mucosal block will not anesthetize the skin at the oral commissures, so those areas must be anesthetized by direct submucosal injections after applying anesthetic gel.

He reported having no financial conflicts to disclose. SDEFand this news organization are owned by Elsevier.

An injection in the midline toward the nose will block the midline upper lip. COURTESY DR. HOWARD K. STEINMAN