Heidi Splete

For a related video, go to www.youtube.com/InternalMedicineNews

WASHINGTON — Drug abuse among U.S. adolescents remained steady in 2008, compared with recent years, but cigarette smoking is at a historic low, according to the 2008 Monitoring the Future survey, released by the National Institute on Drug Abuse.

Students in grades 8, 10, and 12 continue to show a gradual decline in their use of certain drugs, specifically amphetamines, methamphetamine, crystal methamphetamine, cocaine, and crack, according to the latest survey. However, the results, which were announced at a press conference, are “very, very fragile,” said John Walters, director of the Office of National Drug Control Policy. “We still have more work to do.” Contributing to the decline in use are efforts by the federal government to reduce drug availability.

The survey, entitled “Monitoring the Future: National Survey Results on Drug Use” (MTF), has been conducted annually among 12th-grade students in the United States since 1975, and among 8th and 10th graders since 1991. This year's survey included data from 46,348 students in 386 public and private schools in the continental United States.

Overall, 14.6% of teens reported using illicit drugs in the previous month, representing a 25% decrease in use from 2001, which is statistically significant. In addition, 15.4% of 12th graders reported abusing prescription drugs during 2008, with 9.7% of this student group reporting nonmedical use of the prescription painkiller Vicodin, and 4.7% reporting abuse of OxyContin. These rates are essentially unchanged from 2007.

In addition, marijuana use plateaued: 10.9%, 23.9%, and 32.4% of 8th, 10th, and 12th graders, respectively, reported using marijuana in the past year, basically mirroring 2007 findings. However, fewer eighth graders said they thought smoking marijuana was harmful or said that they disapproved of using it. Also, fewer eighth graders said they thought inhalants were harmful or said that they disapproved of their use, compared with responses from the previous year's survey.

Notable data on older teens' attitudes about drugs included a continuing downward trend in the numbers of 12th graders who said they thought LSD use was harmful.

On a positive note, cigarette smoking rates continued to show a steady decline for all grades. The percentage of teens who reported cigarette use was 12.6% in 2008, compared with 20.2% in 2001. But smoking remains a significant threat to adolescent health. More than 1 in 10 of 12th graders who participated in the survey reported daily cigarette smoking, and 5.4% reported smoking half a pack of cigarettes daily.

Alcohol use continued to decline at all three grade levels, but underage drinking remains a problem, especially among older teens. Nearly 25% of 12th graders reported having five or more consecutive drinks at least once during the 2 weeks prior to taking the survey.

“Drug addiction is a disease of the brain,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. She said physicians should be vigilant about screening teenagers and, when appropriate, providing interventions.

The MTF survey is conducted by a team of researchers at the University of Michigan, Ann Arbor, and is funded by a grant from the National Institute on Drug Abuse, part of the National Institutes of Health and the United States Department of Health and Human Services.

For the full report and more information on substance use among teenagers, visit monitoringthefuture.org.

Be vigilant about screening teenagers and, when appropriate, provide interventions. DR. VOLKOW

For a related video, go to www.youtube.com/InternalMedicineNews

WASHINGTON — Drug abuse among U.S. adolescents remained steady in 2008, compared with recent years, but cigarette smoking is at a historic low, according to the 2008 Monitoring the Future survey, released by the National Institute on Drug Abuse.

Students in grades 8, 10, and 12 continue to show a gradual decline in their use of certain drugs, specifically amphetamines, methamphetamine, crystal methamphetamine, cocaine, and crack, according to the latest survey. However, the results, which were announced at a press conference, are “very, very fragile,” said John Walters, director of the Office of National Drug Control Policy. “We still have more work to do.” Contributing to the decline in use are efforts by the federal government to reduce drug availability.

The survey, entitled “Monitoring the Future: National Survey Results on Drug Use” (MTF), has been conducted annually among 12th-grade students in the United States since 1975, and among 8th and 10th graders since 1991. This year's survey included data from 46,348 students in 386 public and private schools in the continental United States.

Overall, 14.6% of teens reported using illicit drugs in the previous month, representing a 25% decrease in use from 2001, which is statistically significant. In addition, 15.4% of 12th graders reported abusing prescription drugs during 2008, with 9.7% of this student group reporting nonmedical use of the prescription painkiller Vicodin, and 4.7% reporting abuse of OxyContin. These rates are essentially unchanged from 2007.

In addition, marijuana use plateaued: 10.9%, 23.9%, and 32.4% of 8th, 10th, and 12th graders, respectively, reported using marijuana in the past year, basically mirroring 2007 findings. However, fewer eighth graders said they thought smoking marijuana was harmful or said that they disapproved of using it. Also, fewer eighth graders said they thought inhalants were harmful or said that they disapproved of their use, compared with responses from the previous year's survey.

Notable data on older teens' attitudes about drugs included a continuing downward trend in the numbers of 12th graders who said they thought LSD use was harmful.

On a positive note, cigarette smoking rates continued to show a steady decline for all grades. The percentage of teens who reported cigarette use was 12.6% in 2008, compared with 20.2% in 2001. But smoking remains a significant threat to adolescent health. More than 1 in 10 of 12th graders who participated in the survey reported daily cigarette smoking, and 5.4% reported smoking half a pack of cigarettes daily.

Alcohol use continued to decline at all three grade levels, but underage drinking remains a problem, especially among older teens. Nearly 25% of 12th graders reported having five or more consecutive drinks at least once during the 2 weeks prior to taking the survey.

“Drug addiction is a disease of the brain,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. She said physicians should be vigilant about screening teenagers and, when appropriate, providing interventions.

The MTF survey is conducted by a team of researchers at the University of Michigan, Ann Arbor, and is funded by a grant from the National Institute on Drug Abuse, part of the National Institutes of Health and the United States Department of Health and Human Services.

For the full report and more information on substance use among teenagers, visit monitoringthefuture.org.

Be vigilant about screening teenagers and, when appropriate, provide interventions. DR. VOLKOW

For a related video, go to www.youtube.com/InternalMedicineNews

WASHINGTON — Drug abuse among U.S. adolescents remained steady in 2008, compared with recent years, but cigarette smoking is at a historic low, according to the 2008 Monitoring the Future survey, released by the National Institute on Drug Abuse.

Students in grades 8, 10, and 12 continue to show a gradual decline in their use of certain drugs, specifically amphetamines, methamphetamine, crystal methamphetamine, cocaine, and crack, according to the latest survey. However, the results, which were announced at a press conference, are “very, very fragile,” said John Walters, director of the Office of National Drug Control Policy. “We still have more work to do.” Contributing to the decline in use are efforts by the federal government to reduce drug availability.

The survey, entitled “Monitoring the Future: National Survey Results on Drug Use” (MTF), has been conducted annually among 12th-grade students in the United States since 1975, and among 8th and 10th graders since 1991. This year's survey included data from 46,348 students in 386 public and private schools in the continental United States.

Overall, 14.6% of teens reported using illicit drugs in the previous month, representing a 25% decrease in use from 2001, which is statistically significant. In addition, 15.4% of 12th graders reported abusing prescription drugs during 2008, with 9.7% of this student group reporting nonmedical use of the prescription painkiller Vicodin, and 4.7% reporting abuse of OxyContin. These rates are essentially unchanged from 2007.

In addition, marijuana use plateaued: 10.9%, 23.9%, and 32.4% of 8th, 10th, and 12th graders, respectively, reported using marijuana in the past year, basically mirroring 2007 findings. However, fewer eighth graders said they thought smoking marijuana was harmful or said that they disapproved of using it. Also, fewer eighth graders said they thought inhalants were harmful or said that they disapproved of their use, compared with responses from the previous year's survey.

Notable data on older teens' attitudes about drugs included a continuing downward trend in the numbers of 12th graders who said they thought LSD use was harmful.

On a positive note, cigarette smoking rates continued to show a steady decline for all grades. The percentage of teens who reported cigarette use was 12.6% in 2008, compared with 20.2% in 2001. But smoking remains a significant threat to adolescent health. More than 1 in 10 of 12th graders who participated in the survey reported daily cigarette smoking, and 5.4% reported smoking half a pack of cigarettes daily.

Alcohol use continued to decline at all three grade levels, but underage drinking remains a problem, especially among older teens. Nearly 25% of 12th graders reported having five or more consecutive drinks at least once during the 2 weeks prior to taking the survey.

“Drug addiction is a disease of the brain,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. She said physicians should be vigilant about screening teenagers and, when appropriate, providing interventions.

The MTF survey is conducted by a team of researchers at the University of Michigan, Ann Arbor, and is funded by a grant from the National Institute on Drug Abuse, part of the National Institutes of Health and the United States Department of Health and Human Services.

For the full report and more information on substance use among teenagers, visit monitoringthefuture.org.

Be vigilant about screening teenagers and, when appropriate, provide interventions. DR. VOLKOW

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, of the McLennan County Medical Education and Research Foundation, Waco, Tex.

Previous studies of osteoporosis in women have focused mainly on white women because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded from the study.

About 50% of the study participants met the criteria for osteopenia and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine. Overall, the left femoral neck had the lowest regional BMD. Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Dr. Weaver had no financial conflicts to disclose.

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, of the McLennan County Medical Education and Research Foundation, Waco, Tex.

Previous studies of osteoporosis in women have focused mainly on white women because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded from the study.

About 50% of the study participants met the criteria for osteopenia and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine. Overall, the left femoral neck had the lowest regional BMD. Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Dr. Weaver had no financial conflicts to disclose.

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, of the McLennan County Medical Education and Research Foundation, Waco, Tex.

Previous studies of osteoporosis in women have focused mainly on white women because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded from the study.

About 50% of the study participants met the criteria for osteopenia and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine. Overall, the left femoral neck had the lowest regional BMD. Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Dr. Weaver had no financial conflicts to disclose.

WASHINGTON — Behavioral and demographic factors were more predictive of herpes simplex virus type 2 than were clinical symptoms in a study of 127 adolescents, approximately one-third of whom were infected with the disease.

Data from population-based studies have shown that herpes simplex virus type 2 (HSV-2) most often is acquired by women between the ages of 20 and 29 years, but many of them have no clinical symptoms, said Dr. Kenneth Fife of Indiana University, Indianapolis.

To determine the demographic and behavioral factors associated with HSV-2 infection in young women, Dr. Fife and his colleagues collected data for 4–6 years from 127 adolescents aged 14–18 years at baseline. The researchers presented their results in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

Of the study population, 92% were black and 7% were white; 33% were antibody positive for HSV-2 at baseline. Only three participants had a history of clinically diagnosed herpes when they entered the study, and the participants underwent quarterly screening for incident STDs. Each participant kept a detailed behavioral diary for two 12-week periods each year and collected weekly vaginal swab samples during these 12-week periods. At the conclusion of the study, the average age of the participants was 21 years.

“Only increasing age, increased time since sexual debut, and an increased number of lifetime sexual partners were significantly correlated with a positive HSV-2 test,” Dr. Fife noted. The odds ratios for these factors were 1.36, 1.17, and 1.09, respectively.

The researchers found no significant association between a positive test result and recorded clinical symptoms of genital pain or discharge.

Of 121 participants for whom complete behavioral data were available, 67 had previous sera available for HSV-2 antibody testing, and 17 (25%) of these women seroconverted from negative to positive during the course of the study.

The DNA testing for HSV-2 in the study population is ongoing, but preliminary results from 13 women with positive results on PCR tests showed that most of the participants shed virus from the genital tract and most had several positive DNA tests over a single 12-week period.

The study was limited by the use of self-reports, but the results suggest that HSV-2 control programs should include young women because they shed virus frequently despite a lack of clinical symptoms, and early signs of infection may go unrecognized, Dr. Fife said.

The study was supported by a grant to Dr. Fife from GlaxoSmithKline and funding from the National Institutes of Health.

WASHINGTON — Behavioral and demographic factors were more predictive of herpes simplex virus type 2 than were clinical symptoms in a study of 127 adolescents, approximately one-third of whom were infected with the disease.

Data from population-based studies have shown that herpes simplex virus type 2 (HSV-2) most often is acquired by women between the ages of 20 and 29 years, but many of them have no clinical symptoms, said Dr. Kenneth Fife of Indiana University, Indianapolis.

To determine the demographic and behavioral factors associated with HSV-2 infection in young women, Dr. Fife and his colleagues collected data for 4–6 years from 127 adolescents aged 14–18 years at baseline. The researchers presented their results in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

Of the study population, 92% were black and 7% were white; 33% were antibody positive for HSV-2 at baseline. Only three participants had a history of clinically diagnosed herpes when they entered the study, and the participants underwent quarterly screening for incident STDs. Each participant kept a detailed behavioral diary for two 12-week periods each year and collected weekly vaginal swab samples during these 12-week periods. At the conclusion of the study, the average age of the participants was 21 years.

“Only increasing age, increased time since sexual debut, and an increased number of lifetime sexual partners were significantly correlated with a positive HSV-2 test,” Dr. Fife noted. The odds ratios for these factors were 1.36, 1.17, and 1.09, respectively.

The researchers found no significant association between a positive test result and recorded clinical symptoms of genital pain or discharge.

Of 121 participants for whom complete behavioral data were available, 67 had previous sera available for HSV-2 antibody testing, and 17 (25%) of these women seroconverted from negative to positive during the course of the study.

The DNA testing for HSV-2 in the study population is ongoing, but preliminary results from 13 women with positive results on PCR tests showed that most of the participants shed virus from the genital tract and most had several positive DNA tests over a single 12-week period.

The study was limited by the use of self-reports, but the results suggest that HSV-2 control programs should include young women because they shed virus frequently despite a lack of clinical symptoms, and early signs of infection may go unrecognized, Dr. Fife said.

The study was supported by a grant to Dr. Fife from GlaxoSmithKline and funding from the National Institutes of Health.

WASHINGTON — Behavioral and demographic factors were more predictive of herpes simplex virus type 2 than were clinical symptoms in a study of 127 adolescents, approximately one-third of whom were infected with the disease.

Data from population-based studies have shown that herpes simplex virus type 2 (HSV-2) most often is acquired by women between the ages of 20 and 29 years, but many of them have no clinical symptoms, said Dr. Kenneth Fife of Indiana University, Indianapolis.

To determine the demographic and behavioral factors associated with HSV-2 infection in young women, Dr. Fife and his colleagues collected data for 4–6 years from 127 adolescents aged 14–18 years at baseline. The researchers presented their results in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

Of the study population, 92% were black and 7% were white; 33% were antibody positive for HSV-2 at baseline. Only three participants had a history of clinically diagnosed herpes when they entered the study, and the participants underwent quarterly screening for incident STDs. Each participant kept a detailed behavioral diary for two 12-week periods each year and collected weekly vaginal swab samples during these 12-week periods. At the conclusion of the study, the average age of the participants was 21 years.

“Only increasing age, increased time since sexual debut, and an increased number of lifetime sexual partners were significantly correlated with a positive HSV-2 test,” Dr. Fife noted. The odds ratios for these factors were 1.36, 1.17, and 1.09, respectively.

The researchers found no significant association between a positive test result and recorded clinical symptoms of genital pain or discharge.

Of 121 participants for whom complete behavioral data were available, 67 had previous sera available for HSV-2 antibody testing, and 17 (25%) of these women seroconverted from negative to positive during the course of the study.

The DNA testing for HSV-2 in the study population is ongoing, but preliminary results from 13 women with positive results on PCR tests showed that most of the participants shed virus from the genital tract and most had several positive DNA tests over a single 12-week period.

The study was limited by the use of self-reports, but the results suggest that HSV-2 control programs should include young women because they shed virus frequently despite a lack of clinical symptoms, and early signs of infection may go unrecognized, Dr. Fife said.

The study was supported by a grant to Dr. Fife from GlaxoSmithKline and funding from the National Institutes of Health.

RIO GRANDE, PUERTO RICO — Intranasal corticosteroids were no better than placebo for curing otitis media in children aged 4-11 years, based on data from a study of more than 200 children.

Dr. Ian Williamson of the University of Southampton (England) and his colleagues hypothesized that off-label intranasal corticosteroids might be effective against otitis media with effusion (OME), which is among the most common indications for surgery in young children in the United Kingdom.

The investigators randomized 217 children with OME diagnoses to receive 50 mcg of mometasone spray or a placebo spray in each nostril once daily for 3 months. The children were referred for the study from 99 family practices in the United Kingdom between 2004 and 2007.

The primary outcome was resolution of infection in at least one ear after 1 month, based on tympanometry data. Overall, the cure rate at 1 month was 41% among the 105 children who received corticosteroids and 45% among the 112 children who received the placebo spray. A secondary analysis at 3 months showed similar results, with cure rates of approximately 50% in each group, Dr. Williamson said at the annual meeting of the North American Primary Care Research Group.

Adverse events included nasal stinging, dry throat, cough, and nosebleed, but the incidence of these events was not significantly different.

Dr. Williamson stated that he had no financial conflicts to disclose.

RIO GRANDE, PUERTO RICO — Intranasal corticosteroids were no better than placebo for curing otitis media in children aged 4-11 years, based on data from a study of more than 200 children.

Dr. Ian Williamson of the University of Southampton (England) and his colleagues hypothesized that off-label intranasal corticosteroids might be effective against otitis media with effusion (OME), which is among the most common indications for surgery in young children in the United Kingdom.

The investigators randomized 217 children with OME diagnoses to receive 50 mcg of mometasone spray or a placebo spray in each nostril once daily for 3 months. The children were referred for the study from 99 family practices in the United Kingdom between 2004 and 2007.

The primary outcome was resolution of infection in at least one ear after 1 month, based on tympanometry data. Overall, the cure rate at 1 month was 41% among the 105 children who received corticosteroids and 45% among the 112 children who received the placebo spray. A secondary analysis at 3 months showed similar results, with cure rates of approximately 50% in each group, Dr. Williamson said at the annual meeting of the North American Primary Care Research Group.

Adverse events included nasal stinging, dry throat, cough, and nosebleed, but the incidence of these events was not significantly different.

Dr. Williamson stated that he had no financial conflicts to disclose.

RIO GRANDE, PUERTO RICO — Intranasal corticosteroids were no better than placebo for curing otitis media in children aged 4-11 years, based on data from a study of more than 200 children.

Dr. Ian Williamson of the University of Southampton (England) and his colleagues hypothesized that off-label intranasal corticosteroids might be effective against otitis media with effusion (OME), which is among the most common indications for surgery in young children in the United Kingdom.

The investigators randomized 217 children with OME diagnoses to receive 50 mcg of mometasone spray or a placebo spray in each nostril once daily for 3 months. The children were referred for the study from 99 family practices in the United Kingdom between 2004 and 2007.

The primary outcome was resolution of infection in at least one ear after 1 month, based on tympanometry data. Overall, the cure rate at 1 month was 41% among the 105 children who received corticosteroids and 45% among the 112 children who received the placebo spray. A secondary analysis at 3 months showed similar results, with cure rates of approximately 50% in each group, Dr. Williamson said at the annual meeting of the North American Primary Care Research Group.

Adverse events included nasal stinging, dry throat, cough, and nosebleed, but the incidence of these events was not significantly different.

Dr. Williamson stated that he had no financial conflicts to disclose.

To view a video interview of investigators discussing the survey results, go to http://www.youtube.com/watch?v=QfIL1ZUf5gI

WASHINGTON — Drug abuse among U.S. adolescents remained steady in 2008, compared with recent years, but cigarette smoking is at a historic low, according to the 2008 Monitoring the Future survey, released by the National Institute on Drug Abuse.

Students in grades 8, 10, and 12 continue to show a gradual decline in their use of certain drugs, specifically amphetamines, methamphetamine, crystal methamphetamine, cocaine, and crack, according to the latest survey. But the results, which were announced at a press conference, are “very, very fragile,” said John Walters, director of the Office of National Drug Control Policy. “We still have more work to do.” Contributing to the decline in use are efforts by the federal government to reduce drug availability.

The survey, entitled “Monitoring the Future: National Survey Results on Drug Use” (MTF), has been conducted annually among 12th-grade students in the United States since 1975, and among 8th and 10th graders since 1991. It includes data from classroom surveys, and this year included data from 46,348 students in 386 public and private schools in the continental United States.

Overall, 14.6% of teens reported using illicit drugs in the previous month, representing a 25% decrease in use from 2001, which is statistically significant. In addition, 15.4% of 12th graders reported abusing prescription drugs during 2008, with 9.7% of this student group reporting nonmedical use of the prescription painkiller Vicodin, and 4.7% reporting abuse of OxyContin. These rates are essentially unchanged from 2007.

In addition, marijuana use plateaued: 10.9%, 23.9%, and 32.4% of 8th, 10th, and 12th graders respectively reported using marijuana in the past year, basically mirroring 2007 findings. However, fewer eighth graders said they thought inhalants or smoking marijuana was harmful or said that they disapproved of their use, compared with responses from the previous year's survey.

Notable data on older teens' attitudes about drugs included a continuing downward trend in the numbers of 12th graders who think LSD use is harmful.

Cigarette smoking rates continued to show a steady decline for all grades. The percentage of teens reporting cigarette use was 12.6% in 2008 (20.2% in 2001). But smoking remains a significant threat to adolescent health. More than 1 in 10 of 12th-grade participant reported daily cigarette smoking, and 5.4% reported smoking half a pack of cigarettes daily.

Alcohol use continued to decline at all three grade levels. Yet, underage drinking remains a problem, especially among older teens. Nearly 25% of 12th graders reported having five or more consecutive drinks at least once during the 2 weeks prior to taking the survey.

“Drug addiction is a disease of the brain,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. She said physicians should be vigilant about screening teenagers and providing intervention that can improve their health.

Presenters at the press conference said those who deal in adolescent health cannot afford to become complacent; they must continue to put out the message about the dangers and consequences of smoking, alcohol, and drug use.

The MTF survey is conducted by researchers at the University of Michigan, Ann Arbor and funded by a grant from the National Institute on Drug Abuse, part of the National Institutes of Health and the United States Department of Health and Human Services. The full report is at www.monitoringthefuture.org

Physicians must be vigilant about screening for drug use and providing interventions that can improve teens' health. DR. VOLKOW

To view a video interview of investigators discussing the survey results, go to http://www.youtube.com/watch?v=QfIL1ZUf5gI

WASHINGTON — Drug abuse among U.S. adolescents remained steady in 2008, compared with recent years, but cigarette smoking is at a historic low, according to the 2008 Monitoring the Future survey, released by the National Institute on Drug Abuse.

Students in grades 8, 10, and 12 continue to show a gradual decline in their use of certain drugs, specifically amphetamines, methamphetamine, crystal methamphetamine, cocaine, and crack, according to the latest survey. But the results, which were announced at a press conference, are “very, very fragile,” said John Walters, director of the Office of National Drug Control Policy. “We still have more work to do.” Contributing to the decline in use are efforts by the federal government to reduce drug availability.

The survey, entitled “Monitoring the Future: National Survey Results on Drug Use” (MTF), has been conducted annually among 12th-grade students in the United States since 1975, and among 8th and 10th graders since 1991. It includes data from classroom surveys, and this year included data from 46,348 students in 386 public and private schools in the continental United States.

Overall, 14.6% of teens reported using illicit drugs in the previous month, representing a 25% decrease in use from 2001, which is statistically significant. In addition, 15.4% of 12th graders reported abusing prescription drugs during 2008, with 9.7% of this student group reporting nonmedical use of the prescription painkiller Vicodin, and 4.7% reporting abuse of OxyContin. These rates are essentially unchanged from 2007.

In addition, marijuana use plateaued: 10.9%, 23.9%, and 32.4% of 8th, 10th, and 12th graders respectively reported using marijuana in the past year, basically mirroring 2007 findings. However, fewer eighth graders said they thought inhalants or smoking marijuana was harmful or said that they disapproved of their use, compared with responses from the previous year's survey.

Notable data on older teens' attitudes about drugs included a continuing downward trend in the numbers of 12th graders who think LSD use is harmful.

Cigarette smoking rates continued to show a steady decline for all grades. The percentage of teens reporting cigarette use was 12.6% in 2008 (20.2% in 2001). But smoking remains a significant threat to adolescent health. More than 1 in 10 of 12th-grade participant reported daily cigarette smoking, and 5.4% reported smoking half a pack of cigarettes daily.

Alcohol use continued to decline at all three grade levels. Yet, underage drinking remains a problem, especially among older teens. Nearly 25% of 12th graders reported having five or more consecutive drinks at least once during the 2 weeks prior to taking the survey.

“Drug addiction is a disease of the brain,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. She said physicians should be vigilant about screening teenagers and providing intervention that can improve their health.

Presenters at the press conference said those who deal in adolescent health cannot afford to become complacent; they must continue to put out the message about the dangers and consequences of smoking, alcohol, and drug use.

The MTF survey is conducted by researchers at the University of Michigan, Ann Arbor and funded by a grant from the National Institute on Drug Abuse, part of the National Institutes of Health and the United States Department of Health and Human Services. The full report is at www.monitoringthefuture.org

Physicians must be vigilant about screening for drug use and providing interventions that can improve teens' health. DR. VOLKOW

To view a video interview of investigators discussing the survey results, go to http://www.youtube.com/watch?v=QfIL1ZUf5gI

WASHINGTON — Drug abuse among U.S. adolescents remained steady in 2008, compared with recent years, but cigarette smoking is at a historic low, according to the 2008 Monitoring the Future survey, released by the National Institute on Drug Abuse.

Students in grades 8, 10, and 12 continue to show a gradual decline in their use of certain drugs, specifically amphetamines, methamphetamine, crystal methamphetamine, cocaine, and crack, according to the latest survey. But the results, which were announced at a press conference, are “very, very fragile,” said John Walters, director of the Office of National Drug Control Policy. “We still have more work to do.” Contributing to the decline in use are efforts by the federal government to reduce drug availability.

The survey, entitled “Monitoring the Future: National Survey Results on Drug Use” (MTF), has been conducted annually among 12th-grade students in the United States since 1975, and among 8th and 10th graders since 1991. It includes data from classroom surveys, and this year included data from 46,348 students in 386 public and private schools in the continental United States.

Overall, 14.6% of teens reported using illicit drugs in the previous month, representing a 25% decrease in use from 2001, which is statistically significant. In addition, 15.4% of 12th graders reported abusing prescription drugs during 2008, with 9.7% of this student group reporting nonmedical use of the prescription painkiller Vicodin, and 4.7% reporting abuse of OxyContin. These rates are essentially unchanged from 2007.

In addition, marijuana use plateaued: 10.9%, 23.9%, and 32.4% of 8th, 10th, and 12th graders respectively reported using marijuana in the past year, basically mirroring 2007 findings. However, fewer eighth graders said they thought inhalants or smoking marijuana was harmful or said that they disapproved of their use, compared with responses from the previous year's survey.

Notable data on older teens' attitudes about drugs included a continuing downward trend in the numbers of 12th graders who think LSD use is harmful.

Cigarette smoking rates continued to show a steady decline for all grades. The percentage of teens reporting cigarette use was 12.6% in 2008 (20.2% in 2001). But smoking remains a significant threat to adolescent health. More than 1 in 10 of 12th-grade participant reported daily cigarette smoking, and 5.4% reported smoking half a pack of cigarettes daily.

Alcohol use continued to decline at all three grade levels. Yet, underage drinking remains a problem, especially among older teens. Nearly 25% of 12th graders reported having five or more consecutive drinks at least once during the 2 weeks prior to taking the survey.

“Drug addiction is a disease of the brain,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. She said physicians should be vigilant about screening teenagers and providing intervention that can improve their health.

Presenters at the press conference said those who deal in adolescent health cannot afford to become complacent; they must continue to put out the message about the dangers and consequences of smoking, alcohol, and drug use.

The MTF survey is conducted by researchers at the University of Michigan, Ann Arbor and funded by a grant from the National Institute on Drug Abuse, part of the National Institutes of Health and the United States Department of Health and Human Services. The full report is at www.monitoringthefuture.org

Physicians must be vigilant about screening for drug use and providing interventions that can improve teens' health. DR. VOLKOW

Worldwide deaths from measles across all age groups dropped by 74% between 2000 and 2007, from an estimated 750,000 to 197,000 deaths annually.

The most striking reduction during this time period occurred in the Eastern Mediterranean region (including Pakistan, Somalia, and the Sudan), where deaths from measles fell by 90%, from an estimated 96,000 to 10,000 deaths annually. In doing so, the region has already achieved the United Nations goal of reducing measles deaths by 90% by 2010.

The measles statistics were presented at a press conference by representatives of the Measles Initiative, a collaboration of the American Red Cross, the Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF, and the World Health Organization. The data were also published in the CDC's Morbidity and Mortality Weekly Report (MMWR 2008;57:1303-6) and the WHO's Weekly Epidemiological Record (Wkly Epidemiol. Rec. 2008;83:441-8).

Routine childhood immunization for measles increased globally from 72% in 2000 to 82% in 2007, said Dr. Peter Strebel of the World Health Organization.

About 90% of the 197,000 deaths in 2007 occurred in children aged younger than 5 years, he said. Most of the remaining 10% occurred in children aged 5-15 years, although a small number occurred in individuals older than 15 years.

Nevertheless, the organizations and governments working to reduce deaths from measles can't rest on their laurels, he emphasized. “Routine health services need to be expanded, but while this is being done, countries must plan and budget for periodic nationwide vaccination campaigns.”

Dr. Steve Cochi of the CDC said that the progress being made internationally “is a reminder to us in the United States that measles is still an ever-present disease … and a reminder to parents and pediatricians of the importance of continuing to vaccinate against measles to maintain [protection] for the children of the United States.”

In 2007, the United States had about 135 cases of measles, which is the highest level in the country since 1996, Dr. Cochi added.

Dr. Julie Gerberding, director of the CDC, said the success of the Measles Initiative has resulted from a combination of disease prevention and surveillance.

The key strategy of the initiative is to prevent measles by increasing routine immunization as part of childhood medical care. Based on the current data “the vast majority of children on a global scale are receiving the appropriate measles vaccine at the appropriate age,” she said.

Another 600 million children were not reached for routine vaccinations, but 3.6 million deaths were prevented between 2000 and 2007 by supplemental activities such as vaccination campaigns involving governments and local volunteers to get people to vaccination centers, she added.

The Measles Initiative's strategy also involves identifying outbreaks quickly so that an immunization campaign can focus on the area of the outbreak and prevent the spread of disease.

In addition, the program provides vitamin A supplements and other care to prevent deaths from measles in those children who become ill, Dr. Gerberding said. “The success of the last few years indicates that when we can apply these strategies, we save lives.”

But about 540 children die from measles worldwide each day, she added. The goal of the Measles Initiative is to reduce measles deaths by 90% worldwide by 2010, compared with 2000.

“We have to refocus our efforts in countries where the immunization rates are low,” Dr. Gerberding said.

The Southeast Asia region (as defined by the WHO) is “the hot spot for measles transmission,” she said. According to the WHO, about 130,000 of the estimated 136,000 measles deaths in that region occurred in India, when about 8.5 million children did not receive a measles vaccine through routine immunization services. Of the estimated 136,000 deaths from measles in the region in 2007, about 130,000 occurred in India, according to the WHO.

The Measles Initiative was launched in 2001 with the goal of reducing deaths from measles worldwide. In addition to the five health organizations, the initiative is supported by funding from other business and charitable partners including the Bill and Melinda Gates Foundation, the Kessler Family Foundation, and Merck & Co.

A Pakistani child is vaccinated; she is one of 66 million immunized during the nationwide measles campaign. ©Stacey Winston/IFRC

Worldwide deaths from measles across all age groups dropped by 74% between 2000 and 2007, from an estimated 750,000 to 197,000 deaths annually.

The most striking reduction during this time period occurred in the Eastern Mediterranean region (including Pakistan, Somalia, and the Sudan), where deaths from measles fell by 90%, from an estimated 96,000 to 10,000 deaths annually. In doing so, the region has already achieved the United Nations goal of reducing measles deaths by 90% by 2010.

The measles statistics were presented at a press conference by representatives of the Measles Initiative, a collaboration of the American Red Cross, the Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF, and the World Health Organization. The data were also published in the CDC's Morbidity and Mortality Weekly Report (MMWR 2008;57:1303-6) and the WHO's Weekly Epidemiological Record (Wkly Epidemiol. Rec. 2008;83:441-8).

Routine childhood immunization for measles increased globally from 72% in 2000 to 82% in 2007, said Dr. Peter Strebel of the World Health Organization.

About 90% of the 197,000 deaths in 2007 occurred in children aged younger than 5 years, he said. Most of the remaining 10% occurred in children aged 5-15 years, although a small number occurred in individuals older than 15 years.

Nevertheless, the organizations and governments working to reduce deaths from measles can't rest on their laurels, he emphasized. “Routine health services need to be expanded, but while this is being done, countries must plan and budget for periodic nationwide vaccination campaigns.”

Dr. Steve Cochi of the CDC said that the progress being made internationally “is a reminder to us in the United States that measles is still an ever-present disease … and a reminder to parents and pediatricians of the importance of continuing to vaccinate against measles to maintain [protection] for the children of the United States.”

In 2007, the United States had about 135 cases of measles, which is the highest level in the country since 1996, Dr. Cochi added.

Dr. Julie Gerberding, director of the CDC, said the success of the Measles Initiative has resulted from a combination of disease prevention and surveillance.

The key strategy of the initiative is to prevent measles by increasing routine immunization as part of childhood medical care. Based on the current data “the vast majority of children on a global scale are receiving the appropriate measles vaccine at the appropriate age,” she said.

Another 600 million children were not reached for routine vaccinations, but 3.6 million deaths were prevented between 2000 and 2007 by supplemental activities such as vaccination campaigns involving governments and local volunteers to get people to vaccination centers, she added.

The Measles Initiative's strategy also involves identifying outbreaks quickly so that an immunization campaign can focus on the area of the outbreak and prevent the spread of disease.

In addition, the program provides vitamin A supplements and other care to prevent deaths from measles in those children who become ill, Dr. Gerberding said. “The success of the last few years indicates that when we can apply these strategies, we save lives.”

But about 540 children die from measles worldwide each day, she added. The goal of the Measles Initiative is to reduce measles deaths by 90% worldwide by 2010, compared with 2000.

“We have to refocus our efforts in countries where the immunization rates are low,” Dr. Gerberding said.

The Southeast Asia region (as defined by the WHO) is “the hot spot for measles transmission,” she said. According to the WHO, about 130,000 of the estimated 136,000 measles deaths in that region occurred in India, when about 8.5 million children did not receive a measles vaccine through routine immunization services. Of the estimated 136,000 deaths from measles in the region in 2007, about 130,000 occurred in India, according to the WHO.

The Measles Initiative was launched in 2001 with the goal of reducing deaths from measles worldwide. In addition to the five health organizations, the initiative is supported by funding from other business and charitable partners including the Bill and Melinda Gates Foundation, the Kessler Family Foundation, and Merck & Co.

A Pakistani child is vaccinated; she is one of 66 million immunized during the nationwide measles campaign. ©Stacey Winston/IFRC

Worldwide deaths from measles across all age groups dropped by 74% between 2000 and 2007, from an estimated 750,000 to 197,000 deaths annually.

The most striking reduction during this time period occurred in the Eastern Mediterranean region (including Pakistan, Somalia, and the Sudan), where deaths from measles fell by 90%, from an estimated 96,000 to 10,000 deaths annually. In doing so, the region has already achieved the United Nations goal of reducing measles deaths by 90% by 2010.

The measles statistics were presented at a press conference by representatives of the Measles Initiative, a collaboration of the American Red Cross, the Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF, and the World Health Organization. The data were also published in the CDC's Morbidity and Mortality Weekly Report (MMWR 2008;57:1303-6) and the WHO's Weekly Epidemiological Record (Wkly Epidemiol. Rec. 2008;83:441-8).

Routine childhood immunization for measles increased globally from 72% in 2000 to 82% in 2007, said Dr. Peter Strebel of the World Health Organization.

About 90% of the 197,000 deaths in 2007 occurred in children aged younger than 5 years, he said. Most of the remaining 10% occurred in children aged 5-15 years, although a small number occurred in individuals older than 15 years.

Nevertheless, the organizations and governments working to reduce deaths from measles can't rest on their laurels, he emphasized. “Routine health services need to be expanded, but while this is being done, countries must plan and budget for periodic nationwide vaccination campaigns.”

Dr. Steve Cochi of the CDC said that the progress being made internationally “is a reminder to us in the United States that measles is still an ever-present disease … and a reminder to parents and pediatricians of the importance of continuing to vaccinate against measles to maintain [protection] for the children of the United States.”

In 2007, the United States had about 135 cases of measles, which is the highest level in the country since 1996, Dr. Cochi added.

Dr. Julie Gerberding, director of the CDC, said the success of the Measles Initiative has resulted from a combination of disease prevention and surveillance.

The key strategy of the initiative is to prevent measles by increasing routine immunization as part of childhood medical care. Based on the current data “the vast majority of children on a global scale are receiving the appropriate measles vaccine at the appropriate age,” she said.

Another 600 million children were not reached for routine vaccinations, but 3.6 million deaths were prevented between 2000 and 2007 by supplemental activities such as vaccination campaigns involving governments and local volunteers to get people to vaccination centers, she added.

The Measles Initiative's strategy also involves identifying outbreaks quickly so that an immunization campaign can focus on the area of the outbreak and prevent the spread of disease.

In addition, the program provides vitamin A supplements and other care to prevent deaths from measles in those children who become ill, Dr. Gerberding said. “The success of the last few years indicates that when we can apply these strategies, we save lives.”

But about 540 children die from measles worldwide each day, she added. The goal of the Measles Initiative is to reduce measles deaths by 90% worldwide by 2010, compared with 2000.

“We have to refocus our efforts in countries where the immunization rates are low,” Dr. Gerberding said.

The Southeast Asia region (as defined by the WHO) is “the hot spot for measles transmission,” she said. According to the WHO, about 130,000 of the estimated 136,000 measles deaths in that region occurred in India, when about 8.5 million children did not receive a measles vaccine through routine immunization services. Of the estimated 136,000 deaths from measles in the region in 2007, about 130,000 occurred in India, according to the WHO.

The Measles Initiative was launched in 2001 with the goal of reducing deaths from measles worldwide. In addition to the five health organizations, the initiative is supported by funding from other business and charitable partners including the Bill and Melinda Gates Foundation, the Kessler Family Foundation, and Merck & Co.

A Pakistani child is vaccinated; she is one of 66 million immunized during the nationwide measles campaign. ©Stacey Winston/IFRC

RIO GRANDE, PUERTO RICO — Antibiotics were used less frequently on day 1 and during 28 days of follow-up among patients who underwent C-reactive protein tests to determine the presence of bacterial infections, data from a study of adults with respiratory tract infections suggest.

Previous research has shown that a C-reactive protein (CRP) test performed in the primary care setting can decrease diagnostic uncertainty about respiratory tract infections, said Dr. Rogier Hopstaken of Maastricht (the Netherlands) University.

The CRP test can confirm the presence—but not the specific site—of inflammation, he noted.

To determine the effects of a CRP test (in addition to a standard history and physical exam) on antibiotic prescribing rates in primary care, Dr. Hopstaken and his colleagues reviewed data about 258 adult patients with lower respiratory tract infections (LRTIs) who were recruited by 31 family physicians in the Netherlands between November 2007 and April 2008.

The patients were randomized to receive a standard diagnostic workup for LRTIs or the standard workup plus a CRP test. Patients who needed immediate hospitalization or who had taken antibiotics in the previous 2 weeks were excluded from the study.

The patients in the intervention group were categorized based on their CRP levels. Physicians were advised not to prescribe antibiotics if CRP levels were less than 20 mg/L, to delay antibiotics if CRP levels were between 20 mg/L and 99 mg/L, and to prescribe antibiotics immediately if CRP levels were greater than 100 mg/L, Dr. Hopstaken explained at the annual meeting of the North American Primary Care Research Group.

Overall, antibiotic use was significantly reduced in the CRP group, compared with the control group: 43% of the patients in the CRP group filled their prescriptions on day 1, compared with 57% of patients in the control group. The difference in antibiotic use remained significant after 28 days, when 53% of the CRP group had filled prescriptions, compared with 65% of the control group, Dr. Hopstaken reported.

In an analysis of secondary outcomes, patient-reported recovery times and reconsultation rates were about the same in both of the study groups, Dr. Hopstaken said.

On further analysis, patients in the intervention group who had CRP levels less than 20 mg/L had a 50% reduction in antibiotic use, compared with the control group. But 25% of the patients in the intervention group who had CRP levels less than 20 mg/L received antibiotics even though they were in the group for which antibiotics were not recommended.

“The CRP is just a guideline,” Dr. Hopstaken emphasized, noting that the final decision about whether to prescribe antibiotics rests with the physician.

However, the CRP test “helps target the delayed prescription strategy to the right patients,” Dr. Hopstaken said. Based on these findings, “it is safe to say that CRP-guided prescribing reduced antibiotic use on day 1 and day 28.”

The percentage of patients who said that they were satisfied with their care was significantly higher in the CRP group than in the control group (78% vs. 65%, respectively).

The CRP test is not widely used as a diagnostic aid in the United States, but the results of this study suggest that use of the test may help physicians and patients feel more comfortable about delaying antibiotics for lower respiratory tract infections, Dr. Hopstaken said.

Dr. Hopstaken had no financial conflicts to disclose.

RIO GRANDE, PUERTO RICO — Antibiotics were used less frequently on day 1 and during 28 days of follow-up among patients who underwent C-reactive protein tests to determine the presence of bacterial infections, data from a study of adults with respiratory tract infections suggest.

Previous research has shown that a C-reactive protein (CRP) test performed in the primary care setting can decrease diagnostic uncertainty about respiratory tract infections, said Dr. Rogier Hopstaken of Maastricht (the Netherlands) University.

The CRP test can confirm the presence—but not the specific site—of inflammation, he noted.

To determine the effects of a CRP test (in addition to a standard history and physical exam) on antibiotic prescribing rates in primary care, Dr. Hopstaken and his colleagues reviewed data about 258 adult patients with lower respiratory tract infections (LRTIs) who were recruited by 31 family physicians in the Netherlands between November 2007 and April 2008.

The patients were randomized to receive a standard diagnostic workup for LRTIs or the standard workup plus a CRP test. Patients who needed immediate hospitalization or who had taken antibiotics in the previous 2 weeks were excluded from the study.

The patients in the intervention group were categorized based on their CRP levels. Physicians were advised not to prescribe antibiotics if CRP levels were less than 20 mg/L, to delay antibiotics if CRP levels were between 20 mg/L and 99 mg/L, and to prescribe antibiotics immediately if CRP levels were greater than 100 mg/L, Dr. Hopstaken explained at the annual meeting of the North American Primary Care Research Group.

Overall, antibiotic use was significantly reduced in the CRP group, compared with the control group: 43% of the patients in the CRP group filled their prescriptions on day 1, compared with 57% of patients in the control group. The difference in antibiotic use remained significant after 28 days, when 53% of the CRP group had filled prescriptions, compared with 65% of the control group, Dr. Hopstaken reported.

In an analysis of secondary outcomes, patient-reported recovery times and reconsultation rates were about the same in both of the study groups, Dr. Hopstaken said.

On further analysis, patients in the intervention group who had CRP levels less than 20 mg/L had a 50% reduction in antibiotic use, compared with the control group. But 25% of the patients in the intervention group who had CRP levels less than 20 mg/L received antibiotics even though they were in the group for which antibiotics were not recommended.

“The CRP is just a guideline,” Dr. Hopstaken emphasized, noting that the final decision about whether to prescribe antibiotics rests with the physician.

However, the CRP test “helps target the delayed prescription strategy to the right patients,” Dr. Hopstaken said. Based on these findings, “it is safe to say that CRP-guided prescribing reduced antibiotic use on day 1 and day 28.”

The percentage of patients who said that they were satisfied with their care was significantly higher in the CRP group than in the control group (78% vs. 65%, respectively).

The CRP test is not widely used as a diagnostic aid in the United States, but the results of this study suggest that use of the test may help physicians and patients feel more comfortable about delaying antibiotics for lower respiratory tract infections, Dr. Hopstaken said.

Dr. Hopstaken had no financial conflicts to disclose.

RIO GRANDE, PUERTO RICO — Antibiotics were used less frequently on day 1 and during 28 days of follow-up among patients who underwent C-reactive protein tests to determine the presence of bacterial infections, data from a study of adults with respiratory tract infections suggest.

Previous research has shown that a C-reactive protein (CRP) test performed in the primary care setting can decrease diagnostic uncertainty about respiratory tract infections, said Dr. Rogier Hopstaken of Maastricht (the Netherlands) University.

The CRP test can confirm the presence—but not the specific site—of inflammation, he noted.

To determine the effects of a CRP test (in addition to a standard history and physical exam) on antibiotic prescribing rates in primary care, Dr. Hopstaken and his colleagues reviewed data about 258 adult patients with lower respiratory tract infections (LRTIs) who were recruited by 31 family physicians in the Netherlands between November 2007 and April 2008.

The patients were randomized to receive a standard diagnostic workup for LRTIs or the standard workup plus a CRP test. Patients who needed immediate hospitalization or who had taken antibiotics in the previous 2 weeks were excluded from the study.

The patients in the intervention group were categorized based on their CRP levels. Physicians were advised not to prescribe antibiotics if CRP levels were less than 20 mg/L, to delay antibiotics if CRP levels were between 20 mg/L and 99 mg/L, and to prescribe antibiotics immediately if CRP levels were greater than 100 mg/L, Dr. Hopstaken explained at the annual meeting of the North American Primary Care Research Group.

Overall, antibiotic use was significantly reduced in the CRP group, compared with the control group: 43% of the patients in the CRP group filled their prescriptions on day 1, compared with 57% of patients in the control group. The difference in antibiotic use remained significant after 28 days, when 53% of the CRP group had filled prescriptions, compared with 65% of the control group, Dr. Hopstaken reported.

In an analysis of secondary outcomes, patient-reported recovery times and reconsultation rates were about the same in both of the study groups, Dr. Hopstaken said.

On further analysis, patients in the intervention group who had CRP levels less than 20 mg/L had a 50% reduction in antibiotic use, compared with the control group. But 25% of the patients in the intervention group who had CRP levels less than 20 mg/L received antibiotics even though they were in the group for which antibiotics were not recommended.

“The CRP is just a guideline,” Dr. Hopstaken emphasized, noting that the final decision about whether to prescribe antibiotics rests with the physician.

However, the CRP test “helps target the delayed prescription strategy to the right patients,” Dr. Hopstaken said. Based on these findings, “it is safe to say that CRP-guided prescribing reduced antibiotic use on day 1 and day 28.”

The percentage of patients who said that they were satisfied with their care was significantly higher in the CRP group than in the control group (78% vs. 65%, respectively).

The CRP test is not widely used as a diagnostic aid in the United States, but the results of this study suggest that use of the test may help physicians and patients feel more comfortable about delaying antibiotics for lower respiratory tract infections, Dr. Hopstaken said.

Dr. Hopstaken had no financial conflicts to disclose.

WASHINGTON — People infected with the herpes simplex virus shed virus no matter how long they have been infected or how frequently they have outbreaks, according to data from adults aged 18 years and older with newly acquired and long-term herpes infections.

Previous studies have suggested that herpes recurrences are more frequent within the first year after infection, and that viral shedding occurs on nearly 40% of days in patients with herpes simplex virus (HSV) infection for 6 months or less, said Clare A. Brennan and Cathy K. Heitman, Ph.D., of the infectious diseases medicine development center for GlaxoSmithKline in Research Triangle Park, N.C.

But the current study is the first to show a viral shedding rate on more than 50% of days in patients with new infections, they noted.

To study the natural history of viral shedding in patients with HSV-2, the researchers conducted a post hoc analysis of a placebo group of 69 patients who were part of a larger study that compared valacyclovir, acyclovir, and placebo. The group comprised 27 patients who had had HSV-2 for 6 months or less, and 42 patients with HSV-2 for longer than 6 months and at least six recurrences per year. The new-infection group comprised 9 men and 18 women, and the established-infection group comprised 18 men and 24 women.

The researchers presented their results in a poster session at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Overall, subclinical shedding was more than twice as high in patients with newly acquired infections as it was in those with established infections (31% vs. 14%, respectively).

When the researchers examined subclinical shedding as a function of HSV-2 duration, the rate of subclinical shedding was 33% in 29 patients diagnosed within a year, 14% in 17 patients infected for 1–5 years, 15% in 9 patients infected for 6–10 years, and 11% in 13 patients infected for 11 years or longer. (Complete data were not available for one patient.)

Patients with the least number of outbreaks shed virus at the highest rate, the researchers noted. The percentage of days with subclinical shedding for the patients who had 0–3, 4–5, and more than 5 outbreaks within the past 6 months was 24%, 17%, and 16%, respectively.

The results suggest that people with few HSV outbreaks or with long-term infections are not exempt from subclinical shedding, and they could still transmit the virus to an uninfected partner, the researchers noted.

The study was sponsored by GlaxoSmithKline.

WASHINGTON — People infected with the herpes simplex virus shed virus no matter how long they have been infected or how frequently they have outbreaks, according to data from adults aged 18 years and older with newly acquired and long-term herpes infections.

Previous studies have suggested that herpes recurrences are more frequent within the first year after infection, and that viral shedding occurs on nearly 40% of days in patients with herpes simplex virus (HSV) infection for 6 months or less, said Clare A. Brennan and Cathy K. Heitman, Ph.D., of the infectious diseases medicine development center for GlaxoSmithKline in Research Triangle Park, N.C.

But the current study is the first to show a viral shedding rate on more than 50% of days in patients with new infections, they noted.

To study the natural history of viral shedding in patients with HSV-2, the researchers conducted a post hoc analysis of a placebo group of 69 patients who were part of a larger study that compared valacyclovir, acyclovir, and placebo. The group comprised 27 patients who had had HSV-2 for 6 months or less, and 42 patients with HSV-2 for longer than 6 months and at least six recurrences per year. The new-infection group comprised 9 men and 18 women, and the established-infection group comprised 18 men and 24 women.

The researchers presented their results in a poster session at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Overall, subclinical shedding was more than twice as high in patients with newly acquired infections as it was in those with established infections (31% vs. 14%, respectively).

When the researchers examined subclinical shedding as a function of HSV-2 duration, the rate of subclinical shedding was 33% in 29 patients diagnosed within a year, 14% in 17 patients infected for 1–5 years, 15% in 9 patients infected for 6–10 years, and 11% in 13 patients infected for 11 years or longer. (Complete data were not available for one patient.)

Patients with the least number of outbreaks shed virus at the highest rate, the researchers noted. The percentage of days with subclinical shedding for the patients who had 0–3, 4–5, and more than 5 outbreaks within the past 6 months was 24%, 17%, and 16%, respectively.

The results suggest that people with few HSV outbreaks or with long-term infections are not exempt from subclinical shedding, and they could still transmit the virus to an uninfected partner, the researchers noted.

The study was sponsored by GlaxoSmithKline.

WASHINGTON — People infected with the herpes simplex virus shed virus no matter how long they have been infected or how frequently they have outbreaks, according to data from adults aged 18 years and older with newly acquired and long-term herpes infections.

Previous studies have suggested that herpes recurrences are more frequent within the first year after infection, and that viral shedding occurs on nearly 40% of days in patients with herpes simplex virus (HSV) infection for 6 months or less, said Clare A. Brennan and Cathy K. Heitman, Ph.D., of the infectious diseases medicine development center for GlaxoSmithKline in Research Triangle Park, N.C.

But the current study is the first to show a viral shedding rate on more than 50% of days in patients with new infections, they noted.

To study the natural history of viral shedding in patients with HSV-2, the researchers conducted a post hoc analysis of a placebo group of 69 patients who were part of a larger study that compared valacyclovir, acyclovir, and placebo. The group comprised 27 patients who had had HSV-2 for 6 months or less, and 42 patients with HSV-2 for longer than 6 months and at least six recurrences per year. The new-infection group comprised 9 men and 18 women, and the established-infection group comprised 18 men and 24 women.

The researchers presented their results in a poster session at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Overall, subclinical shedding was more than twice as high in patients with newly acquired infections as it was in those with established infections (31% vs. 14%, respectively).

When the researchers examined subclinical shedding as a function of HSV-2 duration, the rate of subclinical shedding was 33% in 29 patients diagnosed within a year, 14% in 17 patients infected for 1–5 years, 15% in 9 patients infected for 6–10 years, and 11% in 13 patients infected for 11 years or longer. (Complete data were not available for one patient.)

Patients with the least number of outbreaks shed virus at the highest rate, the researchers noted. The percentage of days with subclinical shedding for the patients who had 0–3, 4–5, and more than 5 outbreaks within the past 6 months was 24%, 17%, and 16%, respectively.

The results suggest that people with few HSV outbreaks or with long-term infections are not exempt from subclinical shedding, and they could still transmit the virus to an uninfected partner, the researchers noted.

The study was sponsored by GlaxoSmithKline.

WASHINGTON — Women with a history of preeclampsia or eclampsia had more than twice the risk of developing cardiovascular disease than that of women with uncomplicated pregnancies, based on results of a meta-analysis that included more than 100,000 preeclamptic women.

Results from previous studies have shown associations between preeclampsia and increased risk of stroke and hypertension later in life.

To evaluate the long-term risk for cardiovascular problems in women with preeclampsia or eclampsia (referred to as PET), Dr. Sarah McDonald and her colleagues at McMaster University, Hamilton, Ont., conducted a meta-analysis of 5 case-control studies and 10 cohort studies. The studies included data from 118,990 preeclamptic women and 2.3 million women without PET.

The selected studies examined the development of cardiovascular disease or mortality at more than 6 weeks post partum in women with and without PET. Most (11 of 15) studies focused on women aged younger than 56 years.

The results were presented in a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy. Overall, there was a graded relationship between the severity of PET and the risk of cardiac disease. Women with severe PET had a fivefold increase in risk compared with women who did not have PET. The risk ratios for cardiac disease for mild, moderate, and severe PET were 2.00, 2.99, and 5.36, respectively.

In a pooled analysis of the case-control studies, women with a history of PET were more than twice as likely to develop cardiac disease (odds ratio 2.47). In a pooled analysis of the cohort studies, women with history of preeclampsia had a significantly increased risk of cardiac disease (relative risk 2.33), cardiovascular mortality (relative risk 2.29), cerebrovascular disease (relative risk 2.03), and peripheral artery disease (relative risk 1.87).

Despite the large numbers of patients in this meta-analysis, more research is needed to determine the mechanisms behind the association between PET and heart disease, and to develop interventions to prevent these complications, the researchers noted.

Dr. McDonald stated that she had no financial conflicts to disclose.

WASHINGTON — Women with a history of preeclampsia or eclampsia had more than twice the risk of developing cardiovascular disease than that of women with uncomplicated pregnancies, based on results of a meta-analysis that included more than 100,000 preeclamptic women.

Results from previous studies have shown associations between preeclampsia and increased risk of stroke and hypertension later in life.

To evaluate the long-term risk for cardiovascular problems in women with preeclampsia or eclampsia (referred to as PET), Dr. Sarah McDonald and her colleagues at McMaster University, Hamilton, Ont., conducted a meta-analysis of 5 case-control studies and 10 cohort studies. The studies included data from 118,990 preeclamptic women and 2.3 million women without PET.

The selected studies examined the development of cardiovascular disease or mortality at more than 6 weeks post partum in women with and without PET. Most (11 of 15) studies focused on women aged younger than 56 years.

The results were presented in a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy. Overall, there was a graded relationship between the severity of PET and the risk of cardiac disease. Women with severe PET had a fivefold increase in risk compared with women who did not have PET. The risk ratios for cardiac disease for mild, moderate, and severe PET were 2.00, 2.99, and 5.36, respectively.

In a pooled analysis of the case-control studies, women with a history of PET were more than twice as likely to develop cardiac disease (odds ratio 2.47). In a pooled analysis of the cohort studies, women with history of preeclampsia had a significantly increased risk of cardiac disease (relative risk 2.33), cardiovascular mortality (relative risk 2.29), cerebrovascular disease (relative risk 2.03), and peripheral artery disease (relative risk 1.87).

Despite the large numbers of patients in this meta-analysis, more research is needed to determine the mechanisms behind the association between PET and heart disease, and to develop interventions to prevent these complications, the researchers noted.

Dr. McDonald stated that she had no financial conflicts to disclose.

WASHINGTON — Women with a history of preeclampsia or eclampsia had more than twice the risk of developing cardiovascular disease than that of women with uncomplicated pregnancies, based on results of a meta-analysis that included more than 100,000 preeclamptic women.

Results from previous studies have shown associations between preeclampsia and increased risk of stroke and hypertension later in life.

To evaluate the long-term risk for cardiovascular problems in women with preeclampsia or eclampsia (referred to as PET), Dr. Sarah McDonald and her colleagues at McMaster University, Hamilton, Ont., conducted a meta-analysis of 5 case-control studies and 10 cohort studies. The studies included data from 118,990 preeclamptic women and 2.3 million women without PET.

The selected studies examined the development of cardiovascular disease or mortality at more than 6 weeks post partum in women with and without PET. Most (11 of 15) studies focused on women aged younger than 56 years.

The results were presented in a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy. Overall, there was a graded relationship between the severity of PET and the risk of cardiac disease. Women with severe PET had a fivefold increase in risk compared with women who did not have PET. The risk ratios for cardiac disease for mild, moderate, and severe PET were 2.00, 2.99, and 5.36, respectively.

In a pooled analysis of the case-control studies, women with a history of PET were more than twice as likely to develop cardiac disease (odds ratio 2.47). In a pooled analysis of the cohort studies, women with history of preeclampsia had a significantly increased risk of cardiac disease (relative risk 2.33), cardiovascular mortality (relative risk 2.29), cerebrovascular disease (relative risk 2.03), and peripheral artery disease (relative risk 1.87).

Despite the large numbers of patients in this meta-analysis, more research is needed to determine the mechanisms behind the association between PET and heart disease, and to develop interventions to prevent these complications, the researchers noted.

Dr. McDonald stated that she had no financial conflicts to disclose.

RIO GRANDE, PUERTO RICO — Erectile dysfunction seems strongly associated with an elevated risk of peripheral arterial disease even after controlling for other risk factors, according to study results involving 175 men aged older than 50 years.

The findings suggest primary care physicians should consider routinely using erectile dysfunction identification tools, such as the Sexual Health Inventory for Men (SHIM) questionnaire, to better identify those at risk for peripheral artery disease (PAD), Dr. J. Travers Edwards Jr. said at the annual meeting of the North American Primary Care Research Group.

“PAD is often missed until severe symptoms present in a family practice office,” said Dr. Edwards, a family physician in Newport News, Va. There seems to be a common pathway to erectile dysfunction (ED) and cardiovascular disease. Previous studies have shown a relationship between ED and angina, and it's been suggested that men who have ED should be screened annualy for coronary artery disease, he said.

Dr. Edwards and his colleagues evaluated men who presented to a regional medical practice and met criteria for ED based on the SHIM. They used the ankle brachial index to diagnose PAD.

The men had presented for an unrelated medical problem. They also had at least one of four additional PAD risk factors: hyperlipidemia, diabetes, hypertension, or tobacco use. Hyperlipidemia was the most common (81%) and hypertension the least common (14%). About a third had diabetes, and about a third were smokers.

About 40% of men had moderate or severe ED. Nine met the criteria for PAD and six of these also met the criteria for severe ED. The association between severe ED and PAD remained significant after controlling for hyperlipidemia, hypertension, diabetes, and tobacco use.

Hyperlipidemia was significantly associated with severe ED. Smoking seemed to be strongly associated with PAD, and dyslipidemia and diabetes were equally associated with ED. Hypertension had no apparent effect on PAD, said Dr. Edwards, who said he had no financial conflicts to disclose.

RIO GRANDE, PUERTO RICO — Erectile dysfunction seems strongly associated with an elevated risk of peripheral arterial disease even after controlling for other risk factors, according to study results involving 175 men aged older than 50 years.

The findings suggest primary care physicians should consider routinely using erectile dysfunction identification tools, such as the Sexual Health Inventory for Men (SHIM) questionnaire, to better identify those at risk for peripheral artery disease (PAD), Dr. J. Travers Edwards Jr. said at the annual meeting of the North American Primary Care Research Group.

“PAD is often missed until severe symptoms present in a family practice office,” said Dr. Edwards, a family physician in Newport News, Va. There seems to be a common pathway to erectile dysfunction (ED) and cardiovascular disease. Previous studies have shown a relationship between ED and angina, and it's been suggested that men who have ED should be screened annualy for coronary artery disease, he said.

Dr. Edwards and his colleagues evaluated men who presented to a regional medical practice and met criteria for ED based on the SHIM. They used the ankle brachial index to diagnose PAD.

The men had presented for an unrelated medical problem. They also had at least one of four additional PAD risk factors: hyperlipidemia, diabetes, hypertension, or tobacco use. Hyperlipidemia was the most common (81%) and hypertension the least common (14%). About a third had diabetes, and about a third were smokers.

About 40% of men had moderate or severe ED. Nine met the criteria for PAD and six of these also met the criteria for severe ED. The association between severe ED and PAD remained significant after controlling for hyperlipidemia, hypertension, diabetes, and tobacco use.

Hyperlipidemia was significantly associated with severe ED. Smoking seemed to be strongly associated with PAD, and dyslipidemia and diabetes were equally associated with ED. Hypertension had no apparent effect on PAD, said Dr. Edwards, who said he had no financial conflicts to disclose.

RIO GRANDE, PUERTO RICO — Erectile dysfunction seems strongly associated with an elevated risk of peripheral arterial disease even after controlling for other risk factors, according to study results involving 175 men aged older than 50 years.

The findings suggest primary care physicians should consider routinely using erectile dysfunction identification tools, such as the Sexual Health Inventory for Men (SHIM) questionnaire, to better identify those at risk for peripheral artery disease (PAD), Dr. J. Travers Edwards Jr. said at the annual meeting of the North American Primary Care Research Group.

“PAD is often missed until severe symptoms present in a family practice office,” said Dr. Edwards, a family physician in Newport News, Va. There seems to be a common pathway to erectile dysfunction (ED) and cardiovascular disease. Previous studies have shown a relationship between ED and angina, and it's been suggested that men who have ED should be screened annualy for coronary artery disease, he said.

Dr. Edwards and his colleagues evaluated men who presented to a regional medical practice and met criteria for ED based on the SHIM. They used the ankle brachial index to diagnose PAD.

The men had presented for an unrelated medical problem. They also had at least one of four additional PAD risk factors: hyperlipidemia, diabetes, hypertension, or tobacco use. Hyperlipidemia was the most common (81%) and hypertension the least common (14%). About a third had diabetes, and about a third were smokers.

About 40% of men had moderate or severe ED. Nine met the criteria for PAD and six of these also met the criteria for severe ED. The association between severe ED and PAD remained significant after controlling for hyperlipidemia, hypertension, diabetes, and tobacco use.

Hyperlipidemia was significantly associated with severe ED. Smoking seemed to be strongly associated with PAD, and dyslipidemia and diabetes were equally associated with ED. Hypertension had no apparent effect on PAD, said Dr. Edwards, who said he had no financial conflicts to disclose.