Heidi Splete

WASHINGTON — Anxiety—but not depression—was higher among women with twin pregnancies than in women with singleton pregnancies after in vitro fertilization, reported Dr. Farnaz Jahangiri of Northwestern University, Chicago.

In this study, presented at the annual meeting of the American Society for Reproductive Medicine, Dr. Jahangiri and colleagues interviewed women at the confirmation of their pregnancies and again at 10–12 weeks' gestation and 21–22 weeks' gestation. The study included 48 singleton pregnancies and 13 sets of twins, and there were no significant demographic differences between the two groups.

The investigators found no differences in depression scores between the women with singleton vs. twin pregnancies at any of the three time points. By contrast, the women with twin pregnancies averaged higher (but not significantly higher) anxiety scores than the singleton group at 10–12 weeks and significantly higher anxiety scores at 22–23 weeks.

Psychological traits in singleton vs. twin IVF pregnancies have not been widely studied. But previous research has shown that women who are pregnant after IVF become less anxious as their pregnancies progress and their self-esteem increases.

The new findings of increased anxiety among women with IVF twin pregnancies during the second trimester can help clinicians discuss the risks associated with multiple gestations when they counsel women who are undergoing infertility treatments, according to the researchers. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Anxiety was assessed using the Spielberger State and Trait Anxiety Inventory.

WASHINGTON — Anxiety—but not depression—was higher among women with twin pregnancies than in women with singleton pregnancies after in vitro fertilization, reported Dr. Farnaz Jahangiri of Northwestern University, Chicago.

In this study, presented at the annual meeting of the American Society for Reproductive Medicine, Dr. Jahangiri and colleagues interviewed women at the confirmation of their pregnancies and again at 10–12 weeks' gestation and 21–22 weeks' gestation. The study included 48 singleton pregnancies and 13 sets of twins, and there were no significant demographic differences between the two groups.

The investigators found no differences in depression scores between the women with singleton vs. twin pregnancies at any of the three time points. By contrast, the women with twin pregnancies averaged higher (but not significantly higher) anxiety scores than the singleton group at 10–12 weeks and significantly higher anxiety scores at 22–23 weeks.

Psychological traits in singleton vs. twin IVF pregnancies have not been widely studied. But previous research has shown that women who are pregnant after IVF become less anxious as their pregnancies progress and their self-esteem increases.

The new findings of increased anxiety among women with IVF twin pregnancies during the second trimester can help clinicians discuss the risks associated with multiple gestations when they counsel women who are undergoing infertility treatments, according to the researchers. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Anxiety was assessed using the Spielberger State and Trait Anxiety Inventory.

WASHINGTON — Anxiety—but not depression—was higher among women with twin pregnancies than in women with singleton pregnancies after in vitro fertilization, reported Dr. Farnaz Jahangiri of Northwestern University, Chicago.

In this study, presented at the annual meeting of the American Society for Reproductive Medicine, Dr. Jahangiri and colleagues interviewed women at the confirmation of their pregnancies and again at 10–12 weeks' gestation and 21–22 weeks' gestation. The study included 48 singleton pregnancies and 13 sets of twins, and there were no significant demographic differences between the two groups.

The investigators found no differences in depression scores between the women with singleton vs. twin pregnancies at any of the three time points. By contrast, the women with twin pregnancies averaged higher (but not significantly higher) anxiety scores than the singleton group at 10–12 weeks and significantly higher anxiety scores at 22–23 weeks.

Psychological traits in singleton vs. twin IVF pregnancies have not been widely studied. But previous research has shown that women who are pregnant after IVF become less anxious as their pregnancies progress and their self-esteem increases.

The new findings of increased anxiety among women with IVF twin pregnancies during the second trimester can help clinicians discuss the risks associated with multiple gestations when they counsel women who are undergoing infertility treatments, according to the researchers. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Anxiety was assessed using the Spielberger State and Trait Anxiety Inventory.

WASHINGTON – About half of 1,005 American adults who were surveyed by the National Foundation for Infectious Diseases said they were unconcerned that either they or a family member would become infected with a vaccine-preventable disease, despite the fact that more than half a million U.S. adults die each year from such diseases, reported Dr. Kristin L. Nichol, who presented the survey findings at a press conference.

“Americans don't know much about the [available] vaccines, and they have too little concern about getting these diseases,” said Dr. Nichol, who is chair of the advisory committee of the National Coalition for Adult Immunization.

“Most people say they would get a vaccine if their doctor recommends it,” said Dr. Nichol, a professor of medicine at the University of Minnesota, Minneapolis. Specifically, 87% of the respondents said they would be “somewhat likely” or “very likely” to get a vaccine based on a doctor's recommendation.

Although 49% of the respondents could name influenza as a vaccine-preventable illness, awareness for other such illnesses dropped drastically, ranging from 18% who named pneumonia, to only 3% who named acellular pertussis and meningitis.

Adult vaccinations should be part of the overall discussion of wellness, along with nutrition, physical activity, and preventive screenings, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention in Atlanta, who presented data from a first-time survey of immunization coverage in adults. “We have a long way to go to reach the targets we have set for the nation.”

A National Immunization Survey was conducted of about 7,000 adults aged 18 years and older in the summer of 2007. The respondents were selected at random and contacted by phone, similar to the annual survey of childhood vaccination conducted by the CDC and other agencies.

Overall, 69% of adults aged 65 years and older said they had received a flu vaccination during the 2006-2007 flu season. In addition, 66% had received pneumococcal vaccinations, and 44% had received a tetanus shot within the past 10 years.

Coverage was especially low for two newly licensed vaccines, Dr. Schuchat said. The Tdap vaccine, which is recommended for adults aged 18-64 years to prevent tetanus, diphtheria, and acellular pertussis was licensed in 2005, but only 2% of the respondents reported having received it. Similarly, about 2% of the respondents said they had received the shingles vaccine, which was licensed in 2006 and approved for adults aged 60 years and older.

About 10% of female respondents said they had received at least one of the three-dose series of the HPV vaccine to prevent cervical cancer, which was licensed in 2006 and approved for females aged 9-26 years.

“Health care providers [need] to know about these new tools and take advantage of them themselves,” Dr. Schuchat said, adding that adults should understand that vaccines are for everyone, not just kids.

Through its Part B, Medicare covers the pneumococcal polysaccharide vaccine, the influenza vaccine, and (for high-risk adults) the hepatitis B vaccine, and it covers most other adult vaccinations through Part D, including the shingles vaccine. Adult patients should be reminded that many vaccinations are covered by insurance, said Dr. Schuchat.

Younger adults often have insurance coverage for preventive vaccines, she added, citing a recent survey of insurance companies in which more than 90% covered the influenza and pneumococcal vaccines and most covered at least five vaccines for adults. “We strongly encourage insurance companies to cover vaccines,” she said.

Finding time to coordinate adult vaccination presents another challenge. “If we are going to try to improve immunization rates in the physician practice, it needs to be a team effort,” said Dr. Robert H. Hopkins Jr., an internal medicine physician and pediatrician at the University of Arkansas, Little Rock. He suggested increasing in-office adult vaccination by having nurses ask patients about their vaccination status and by providing educational flyers in the office.

Alternative settings for vaccinations, such as pharmacies or workplaces should also be considered, suggested Dr. Hopkins, who is governor of the Arkansas chapter of the American College of Physicians.

For more vaccination information, visit www.cdc.gov

WASHINGTON – About half of 1,005 American adults who were surveyed by the National Foundation for Infectious Diseases said they were unconcerned that either they or a family member would become infected with a vaccine-preventable disease, despite the fact that more than half a million U.S. adults die each year from such diseases, reported Dr. Kristin L. Nichol, who presented the survey findings at a press conference.

“Americans don't know much about the [available] vaccines, and they have too little concern about getting these diseases,” said Dr. Nichol, who is chair of the advisory committee of the National Coalition for Adult Immunization.

“Most people say they would get a vaccine if their doctor recommends it,” said Dr. Nichol, a professor of medicine at the University of Minnesota, Minneapolis. Specifically, 87% of the respondents said they would be “somewhat likely” or “very likely” to get a vaccine based on a doctor's recommendation.

Although 49% of the respondents could name influenza as a vaccine-preventable illness, awareness for other such illnesses dropped drastically, ranging from 18% who named pneumonia, to only 3% who named acellular pertussis and meningitis.

Adult vaccinations should be part of the overall discussion of wellness, along with nutrition, physical activity, and preventive screenings, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention in Atlanta, who presented data from a first-time survey of immunization coverage in adults. “We have a long way to go to reach the targets we have set for the nation.”

A National Immunization Survey was conducted of about 7,000 adults aged 18 years and older in the summer of 2007. The respondents were selected at random and contacted by phone, similar to the annual survey of childhood vaccination conducted by the CDC and other agencies.

Overall, 69% of adults aged 65 years and older said they had received a flu vaccination during the 2006-2007 flu season. In addition, 66% had received pneumococcal vaccinations, and 44% had received a tetanus shot within the past 10 years.

Coverage was especially low for two newly licensed vaccines, Dr. Schuchat said. The Tdap vaccine, which is recommended for adults aged 18-64 years to prevent tetanus, diphtheria, and acellular pertussis was licensed in 2005, but only 2% of the respondents reported having received it. Similarly, about 2% of the respondents said they had received the shingles vaccine, which was licensed in 2006 and approved for adults aged 60 years and older.

About 10% of female respondents said they had received at least one of the three-dose series of the HPV vaccine to prevent cervical cancer, which was licensed in 2006 and approved for females aged 9-26 years.

“Health care providers [need] to know about these new tools and take advantage of them themselves,” Dr. Schuchat said, adding that adults should understand that vaccines are for everyone, not just kids.

Through its Part B, Medicare covers the pneumococcal polysaccharide vaccine, the influenza vaccine, and (for high-risk adults) the hepatitis B vaccine, and it covers most other adult vaccinations through Part D, including the shingles vaccine. Adult patients should be reminded that many vaccinations are covered by insurance, said Dr. Schuchat.

Younger adults often have insurance coverage for preventive vaccines, she added, citing a recent survey of insurance companies in which more than 90% covered the influenza and pneumococcal vaccines and most covered at least five vaccines for adults. “We strongly encourage insurance companies to cover vaccines,” she said.

Finding time to coordinate adult vaccination presents another challenge. “If we are going to try to improve immunization rates in the physician practice, it needs to be a team effort,” said Dr. Robert H. Hopkins Jr., an internal medicine physician and pediatrician at the University of Arkansas, Little Rock. He suggested increasing in-office adult vaccination by having nurses ask patients about their vaccination status and by providing educational flyers in the office.

Alternative settings for vaccinations, such as pharmacies or workplaces should also be considered, suggested Dr. Hopkins, who is governor of the Arkansas chapter of the American College of Physicians.

For more vaccination information, visit www.cdc.gov

WASHINGTON – About half of 1,005 American adults who were surveyed by the National Foundation for Infectious Diseases said they were unconcerned that either they or a family member would become infected with a vaccine-preventable disease, despite the fact that more than half a million U.S. adults die each year from such diseases, reported Dr. Kristin L. Nichol, who presented the survey findings at a press conference.

“Americans don't know much about the [available] vaccines, and they have too little concern about getting these diseases,” said Dr. Nichol, who is chair of the advisory committee of the National Coalition for Adult Immunization.

“Most people say they would get a vaccine if their doctor recommends it,” said Dr. Nichol, a professor of medicine at the University of Minnesota, Minneapolis. Specifically, 87% of the respondents said they would be “somewhat likely” or “very likely” to get a vaccine based on a doctor's recommendation.

Although 49% of the respondents could name influenza as a vaccine-preventable illness, awareness for other such illnesses dropped drastically, ranging from 18% who named pneumonia, to only 3% who named acellular pertussis and meningitis.

Adult vaccinations should be part of the overall discussion of wellness, along with nutrition, physical activity, and preventive screenings, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention in Atlanta, who presented data from a first-time survey of immunization coverage in adults. “We have a long way to go to reach the targets we have set for the nation.”

A National Immunization Survey was conducted of about 7,000 adults aged 18 years and older in the summer of 2007. The respondents were selected at random and contacted by phone, similar to the annual survey of childhood vaccination conducted by the CDC and other agencies.

Overall, 69% of adults aged 65 years and older said they had received a flu vaccination during the 2006-2007 flu season. In addition, 66% had received pneumococcal vaccinations, and 44% had received a tetanus shot within the past 10 years.

Coverage was especially low for two newly licensed vaccines, Dr. Schuchat said. The Tdap vaccine, which is recommended for adults aged 18-64 years to prevent tetanus, diphtheria, and acellular pertussis was licensed in 2005, but only 2% of the respondents reported having received it. Similarly, about 2% of the respondents said they had received the shingles vaccine, which was licensed in 2006 and approved for adults aged 60 years and older.

About 10% of female respondents said they had received at least one of the three-dose series of the HPV vaccine to prevent cervical cancer, which was licensed in 2006 and approved for females aged 9-26 years.

“Health care providers [need] to know about these new tools and take advantage of them themselves,” Dr. Schuchat said, adding that adults should understand that vaccines are for everyone, not just kids.

Through its Part B, Medicare covers the pneumococcal polysaccharide vaccine, the influenza vaccine, and (for high-risk adults) the hepatitis B vaccine, and it covers most other adult vaccinations through Part D, including the shingles vaccine. Adult patients should be reminded that many vaccinations are covered by insurance, said Dr. Schuchat.

Younger adults often have insurance coverage for preventive vaccines, she added, citing a recent survey of insurance companies in which more than 90% covered the influenza and pneumococcal vaccines and most covered at least five vaccines for adults. “We strongly encourage insurance companies to cover vaccines,” she said.

Finding time to coordinate adult vaccination presents another challenge. “If we are going to try to improve immunization rates in the physician practice, it needs to be a team effort,” said Dr. Robert H. Hopkins Jr., an internal medicine physician and pediatrician at the University of Arkansas, Little Rock. He suggested increasing in-office adult vaccination by having nurses ask patients about their vaccination status and by providing educational flyers in the office.

Alternative settings for vaccinations, such as pharmacies or workplaces should also be considered, suggested Dr. Hopkins, who is governor of the Arkansas chapter of the American College of Physicians.

For more vaccination information, visit www.cdc.gov

ROCKVILLE, MD. — Prophylactic use of dietary prebiotics could benefit patients with ulcerative colitis and Crohn's disease, based on data from preliminary but promising studies, said Dr. Leo Dieleman of the division of gastroenterology at the University of Alberta, Edmonton.

In contrast to probiotics, which are live microorganisms that benefit their hosts, prebiotics are nondigestible fermentable dietary oligosaccharides that affect the growth and activity of certain types of protective bacteria found in the gastrointestinal tract.

Previous studies of probiotics have shown that adding probiotic bacteria to the diets of patients with inflammatory bowel disease (IBD) improved their symptoms, Dr. Dieleman said. Certain types of probiotics such as Lactobacilli and Bifidobacteria species, when added to the diet, can be protective against IBD, he added.

But for probiotics to be effective, patients must consume large amounts of them, which can be difficult and inconvenient, Dr. Dieleman said at a meeting sponsored by the National Institutes of Health. Prebiotics might be a viable alternative because they are inexpensive, easy to administer in the diet—in powder form, for example—and they have been shown to be safe, he said.

Based on the promising results of probiotic research, investigators have begun to study prebiotics for treating IBD patients.

“Everyone has a unique intestinal microbiotic profile,” Dr. Dieleman said. But inflammation tends to reduce the diversity of microflora in the gut, and studies have shown that a subset of Crohn's disease and ulcerative colitis patients have distinctly abnormal microflora, compared with non-IBD controls.

Patients with IBD tend to have a microbiotic profile that is deficient in firmicutes and bacteroidetes, organisms that are thought to be associated with a healthy gastrointestinal tract. Sometimes ingesting probiotics can help these patients. “But not all probiotics are effective for each patient,” Dr. Dieleman said.

Because prebiotics stimulate the growth of several different intestinal protective bacteria, there may a place for prebiotics in IBD treatment.

Dr. Dieleman identified three criteria that make prebiotics potentially useful for treating gastrointestinal disorders.

First, prebiotics are nondigestible ingredients. As such, they transfer unchanged into the large intestine. Second, prebiotics are fermented by colonic bacteria that already exist in the large intestine. Third, prebiotics induce selective stimulation of bacterial growth and activity. Studies have shown that prebiotics change the profile of intestinal microflora by increasing the growth of specific protective intestinal bacteria. After ingestion of prebiotics, there will be more protective bacteria in the gut.

The prebiotics that have been used most often in clinical trials completed to date are the compounds inulin and oligofructose. Studies of other compounds are ongoing, he said.

Data from a randomized pilot study of 20 adults with ulcerative colitis showed that those who took Synergyl, an oral combination of oligofructose and inulin, at a dose of 12 g/day for 2 weeks showed significant improvement in disease activity scores and significant reductions in levels of fecal calprotectin (a calcium-binding inflammatory protein found in feces), compared with those who took a placebo (Aliment. Pharmacol. Ther. 2007;25:1061–7).

Prebiotics also have shown positive effects on adults with Crohn's disease, Dr. Dieleman said. The results from a recent open-label study of 10 patients with mild to moderate Crohn's disease showed that treatment for 3 weeks with 15 g/day of a 30% inulin/70% oligofructose combination supplement was associated with improved disease activity and increased expression of the anti-inflammatory interleukin-10, which is expressed in dendritic cells (Gut 2006;55:348–55).

Dr. Dieleman also described an ongoing open-label study at his institution, the University of Alberta, in which 25 patients with active ulcerative colitis are being treated with oligofructose-enriched inulin when they experience flaring on a stable dose of 5-aminosalicylate. The patient evaluations will include assessment of disease activity, including endoscopy results, and analyses of microflora and mucosal cytokines.

“Animal models have taught us a lot about the pathogenesis of IBD,” Dr. Dieleman said. But larger studies in humans are needed to better characterize the role of prebiotics, he added.

ROCKVILLE, MD. — Prophylactic use of dietary prebiotics could benefit patients with ulcerative colitis and Crohn's disease, based on data from preliminary but promising studies, said Dr. Leo Dieleman of the division of gastroenterology at the University of Alberta, Edmonton.

In contrast to probiotics, which are live microorganisms that benefit their hosts, prebiotics are nondigestible fermentable dietary oligosaccharides that affect the growth and activity of certain types of protective bacteria found in the gastrointestinal tract.

Previous studies of probiotics have shown that adding probiotic bacteria to the diets of patients with inflammatory bowel disease (IBD) improved their symptoms, Dr. Dieleman said. Certain types of probiotics such as Lactobacilli and Bifidobacteria species, when added to the diet, can be protective against IBD, he added.

But for probiotics to be effective, patients must consume large amounts of them, which can be difficult and inconvenient, Dr. Dieleman said at a meeting sponsored by the National Institutes of Health. Prebiotics might be a viable alternative because they are inexpensive, easy to administer in the diet—in powder form, for example—and they have been shown to be safe, he said.

Based on the promising results of probiotic research, investigators have begun to study prebiotics for treating IBD patients.

“Everyone has a unique intestinal microbiotic profile,” Dr. Dieleman said. But inflammation tends to reduce the diversity of microflora in the gut, and studies have shown that a subset of Crohn's disease and ulcerative colitis patients have distinctly abnormal microflora, compared with non-IBD controls.

Patients with IBD tend to have a microbiotic profile that is deficient in firmicutes and bacteroidetes, organisms that are thought to be associated with a healthy gastrointestinal tract. Sometimes ingesting probiotics can help these patients. “But not all probiotics are effective for each patient,” Dr. Dieleman said.

Because prebiotics stimulate the growth of several different intestinal protective bacteria, there may a place for prebiotics in IBD treatment.

Dr. Dieleman identified three criteria that make prebiotics potentially useful for treating gastrointestinal disorders.

First, prebiotics are nondigestible ingredients. As such, they transfer unchanged into the large intestine. Second, prebiotics are fermented by colonic bacteria that already exist in the large intestine. Third, prebiotics induce selective stimulation of bacterial growth and activity. Studies have shown that prebiotics change the profile of intestinal microflora by increasing the growth of specific protective intestinal bacteria. After ingestion of prebiotics, there will be more protective bacteria in the gut.

The prebiotics that have been used most often in clinical trials completed to date are the compounds inulin and oligofructose. Studies of other compounds are ongoing, he said.

Data from a randomized pilot study of 20 adults with ulcerative colitis showed that those who took Synergyl, an oral combination of oligofructose and inulin, at a dose of 12 g/day for 2 weeks showed significant improvement in disease activity scores and significant reductions in levels of fecal calprotectin (a calcium-binding inflammatory protein found in feces), compared with those who took a placebo (Aliment. Pharmacol. Ther. 2007;25:1061–7).

Prebiotics also have shown positive effects on adults with Crohn's disease, Dr. Dieleman said. The results from a recent open-label study of 10 patients with mild to moderate Crohn's disease showed that treatment for 3 weeks with 15 g/day of a 30% inulin/70% oligofructose combination supplement was associated with improved disease activity and increased expression of the anti-inflammatory interleukin-10, which is expressed in dendritic cells (Gut 2006;55:348–55).

Dr. Dieleman also described an ongoing open-label study at his institution, the University of Alberta, in which 25 patients with active ulcerative colitis are being treated with oligofructose-enriched inulin when they experience flaring on a stable dose of 5-aminosalicylate. The patient evaluations will include assessment of disease activity, including endoscopy results, and analyses of microflora and mucosal cytokines.

“Animal models have taught us a lot about the pathogenesis of IBD,” Dr. Dieleman said. But larger studies in humans are needed to better characterize the role of prebiotics, he added.

ROCKVILLE, MD. — Prophylactic use of dietary prebiotics could benefit patients with ulcerative colitis and Crohn's disease, based on data from preliminary but promising studies, said Dr. Leo Dieleman of the division of gastroenterology at the University of Alberta, Edmonton.

In contrast to probiotics, which are live microorganisms that benefit their hosts, prebiotics are nondigestible fermentable dietary oligosaccharides that affect the growth and activity of certain types of protective bacteria found in the gastrointestinal tract.

Previous studies of probiotics have shown that adding probiotic bacteria to the diets of patients with inflammatory bowel disease (IBD) improved their symptoms, Dr. Dieleman said. Certain types of probiotics such as Lactobacilli and Bifidobacteria species, when added to the diet, can be protective against IBD, he added.

But for probiotics to be effective, patients must consume large amounts of them, which can be difficult and inconvenient, Dr. Dieleman said at a meeting sponsored by the National Institutes of Health. Prebiotics might be a viable alternative because they are inexpensive, easy to administer in the diet—in powder form, for example—and they have been shown to be safe, he said.

Based on the promising results of probiotic research, investigators have begun to study prebiotics for treating IBD patients.

“Everyone has a unique intestinal microbiotic profile,” Dr. Dieleman said. But inflammation tends to reduce the diversity of microflora in the gut, and studies have shown that a subset of Crohn's disease and ulcerative colitis patients have distinctly abnormal microflora, compared with non-IBD controls.

Patients with IBD tend to have a microbiotic profile that is deficient in firmicutes and bacteroidetes, organisms that are thought to be associated with a healthy gastrointestinal tract. Sometimes ingesting probiotics can help these patients. “But not all probiotics are effective for each patient,” Dr. Dieleman said.

Because prebiotics stimulate the growth of several different intestinal protective bacteria, there may a place for prebiotics in IBD treatment.

Dr. Dieleman identified three criteria that make prebiotics potentially useful for treating gastrointestinal disorders.

First, prebiotics are nondigestible ingredients. As such, they transfer unchanged into the large intestine. Second, prebiotics are fermented by colonic bacteria that already exist in the large intestine. Third, prebiotics induce selective stimulation of bacterial growth and activity. Studies have shown that prebiotics change the profile of intestinal microflora by increasing the growth of specific protective intestinal bacteria. After ingestion of prebiotics, there will be more protective bacteria in the gut.

The prebiotics that have been used most often in clinical trials completed to date are the compounds inulin and oligofructose. Studies of other compounds are ongoing, he said.

Data from a randomized pilot study of 20 adults with ulcerative colitis showed that those who took Synergyl, an oral combination of oligofructose and inulin, at a dose of 12 g/day for 2 weeks showed significant improvement in disease activity scores and significant reductions in levels of fecal calprotectin (a calcium-binding inflammatory protein found in feces), compared with those who took a placebo (Aliment. Pharmacol. Ther. 2007;25:1061–7).

Prebiotics also have shown positive effects on adults with Crohn's disease, Dr. Dieleman said. The results from a recent open-label study of 10 patients with mild to moderate Crohn's disease showed that treatment for 3 weeks with 15 g/day of a 30% inulin/70% oligofructose combination supplement was associated with improved disease activity and increased expression of the anti-inflammatory interleukin-10, which is expressed in dendritic cells (Gut 2006;55:348–55).

Dr. Dieleman also described an ongoing open-label study at his institution, the University of Alberta, in which 25 patients with active ulcerative colitis are being treated with oligofructose-enriched inulin when they experience flaring on a stable dose of 5-aminosalicylate. The patient evaluations will include assessment of disease activity, including endoscopy results, and analyses of microflora and mucosal cytokines.

“Animal models have taught us a lot about the pathogenesis of IBD,” Dr. Dieleman said. But larger studies in humans are needed to better characterize the role of prebiotics, he added.

WASHINGTON – Postmenopausal women who took a low-dose estrogen/progestin medication reported significant improvements in vasomotor symptoms and quality of life after 6 months, according to findings from an open-label efficacy study.

The therapy caused a significant increase in triglycerides, from an average of 129 mg/dL at baseline to an average of 168 mg/dL after 6 months. But the women had no other significant changes in their lipid profiles or in their body weight, body mass index, or blood glucose during the study period, Dr. Fernando Ayala Aguilera of the Hospital Universitario, Monterrey (Mexico) and colleagues reported in a poster presentation at the annual meeting of the American Society for Reproductive Medicine.

In the study, sponsored by Wyeth Pharmaceuticals, 68 postmenopausal women aged 45-55 years who reported at least four hot flashes per day received a combination of 1 mg 17β-estradiol and 0.125 mg trimegestone orally each day for 6 months. The study criteria excluded women without an intact uterus, with known or suspected breast cancer, or with abnormal bleeding.

Overall, patient scores on the MENQOL (a questionnaire designed specifically to evaluate the quality of life symptoms in menopausal women) dropped from an average of 78 at baseline to an average of 5 after 6 months of treatment.

Similarly, average scores on the Blatt-Kupperman menopausal index dropped from 40 at baseline to 8 after 6 months.

The average total cholesterol remained stable between baseline and 6 months (201.3 vs. 200.2 mg/dL). Blood glucose, body weight, and body mass index were essentially unchanged from baseline to the 6-month follow-up: Average blood glucose was 92 at both baseline and 6 months, average body weight was 67 kg at baseline vs. 66 kg at 6 months, and average BMI was 27 kg/m

WASHINGTON – Postmenopausal women who took a low-dose estrogen/progestin medication reported significant improvements in vasomotor symptoms and quality of life after 6 months, according to findings from an open-label efficacy study.

The therapy caused a significant increase in triglycerides, from an average of 129 mg/dL at baseline to an average of 168 mg/dL after 6 months. But the women had no other significant changes in their lipid profiles or in their body weight, body mass index, or blood glucose during the study period, Dr. Fernando Ayala Aguilera of the Hospital Universitario, Monterrey (Mexico) and colleagues reported in a poster presentation at the annual meeting of the American Society for Reproductive Medicine.

In the study, sponsored by Wyeth Pharmaceuticals, 68 postmenopausal women aged 45-55 years who reported at least four hot flashes per day received a combination of 1 mg 17β-estradiol and 0.125 mg trimegestone orally each day for 6 months. The study criteria excluded women without an intact uterus, with known or suspected breast cancer, or with abnormal bleeding.

Overall, patient scores on the MENQOL (a questionnaire designed specifically to evaluate the quality of life symptoms in menopausal women) dropped from an average of 78 at baseline to an average of 5 after 6 months of treatment.

Similarly, average scores on the Blatt-Kupperman menopausal index dropped from 40 at baseline to 8 after 6 months.

The average total cholesterol remained stable between baseline and 6 months (201.3 vs. 200.2 mg/dL). Blood glucose, body weight, and body mass index were essentially unchanged from baseline to the 6-month follow-up: Average blood glucose was 92 at both baseline and 6 months, average body weight was 67 kg at baseline vs. 66 kg at 6 months, and average BMI was 27 kg/m

WASHINGTON – Postmenopausal women who took a low-dose estrogen/progestin medication reported significant improvements in vasomotor symptoms and quality of life after 6 months, according to findings from an open-label efficacy study.

The therapy caused a significant increase in triglycerides, from an average of 129 mg/dL at baseline to an average of 168 mg/dL after 6 months. But the women had no other significant changes in their lipid profiles or in their body weight, body mass index, or blood glucose during the study period, Dr. Fernando Ayala Aguilera of the Hospital Universitario, Monterrey (Mexico) and colleagues reported in a poster presentation at the annual meeting of the American Society for Reproductive Medicine.

In the study, sponsored by Wyeth Pharmaceuticals, 68 postmenopausal women aged 45-55 years who reported at least four hot flashes per day received a combination of 1 mg 17β-estradiol and 0.125 mg trimegestone orally each day for 6 months. The study criteria excluded women without an intact uterus, with known or suspected breast cancer, or with abnormal bleeding.

Overall, patient scores on the MENQOL (a questionnaire designed specifically to evaluate the quality of life symptoms in menopausal women) dropped from an average of 78 at baseline to an average of 5 after 6 months of treatment.

Similarly, average scores on the Blatt-Kupperman menopausal index dropped from 40 at baseline to 8 after 6 months.

The average total cholesterol remained stable between baseline and 6 months (201.3 vs. 200.2 mg/dL). Blood glucose, body weight, and body mass index were essentially unchanged from baseline to the 6-month follow-up: Average blood glucose was 92 at both baseline and 6 months, average body weight was 67 kg at baseline vs. 66 kg at 6 months, and average BMI was 27 kg/m

Adults who suffered transient neurological attacks with nonfocal symptoms were at increased risk of developing major vascular disease and dementia in a study of more than 6,000 adults aged 55 years and older.

The findings challenge the perception that nonfocal transient neurological attacks (TNAs) are harmless. “TNAs with nonfocal symptoms were almost as frequent as focal TNAs, and had an equally unfavorable overall subsequent clinical course with a slightly higher risk of stroke and a higher risk of vascular dementia than persons without TNA,” the investigators wrote. The authors defined TNA as an episode of neurological dysfunction lasting less than 24 hours (usually from 2 to 15 minutes).

Although focal TNAs (better known as transient ischemic attacks or TIAs) have been characterized, a variety of diagnoses have been applied to nonfocal and mixed TNAs (focal and nonfocal symptoms in the same attack). Focal and mixed TNAs are often considered benign and have not been well studied, Dr. Michiel J. Bos of Erasmus University Medical Centre in Rotterdam, the Netherlands, and colleagues, noted.

To study the incidence and prognosis of each of these three types of TNA, the investigators followed 6,062 community-dwelling adults with no history of stroke, myocardial infarction, or dementia. The participants were part of the Rotterdam Study, an ongoing population-based cohort study.

The subjects enrolled between 1990 and 1993 and were followed until Jan. 1, 2005. The median age of the patients at baseline was 68 years, and 3,758 (62%) were women (JAMA 2007;298:2877–85).

A total of 548 individuals experienced TNAs during the study period of 60,535 person-years. Categorized by their symptoms, 282 TNAs were considered focal, 228 were nonfocal, and 38 were mixed.

Overall, focal and nonfocal TNAs occurred with similar frequency, with incidence rates of 4.7 per 1,000 person-years and 3.8 per 1,000 person-years, respectively. The incidence rates for both types increased with age. The incidence rate for mixed TNAs was much lower—0.6 per 1,000 person years—and the incidence was not clearly associated with age.

Those who met criteria for focal TNAs had a higher risk of subsequent stroke (hazard ratio 2.14) than did those without TNA, after adjustment for age and sex, but there was no observable difference in the risk for MI or dementia.

The participants with nonfocal TNAs were at greater risk of both stroke (HR, 1.56) and dementia (HR, 1.59), compared with subjects without TNAs. And they were at especially high risk for vascular dementia (HR, 5.05). There was no difference in risk for MI in this subgroup.

Those with mixed TNAs also were at increased risk of stroke (HR, 2.48), ischemic heart disease (HR, 2.26), vascular death (HR, 2.54), and dementia (HR, 3.46), compared with individuals who didn't experience TNAs. Notably, the risk of vascular dementia was much higher among those with mixed TNAs (HR, 21.5).

The clinical implication of the findings is that nonfocal TNAs deserve to be taken seriously, Dr. S. Claiborne Johnston, a neurologist at the University of California, San Francisco, wrote in an accompanying editorial (JAMA 2007;298:2912–3).

“The study argues that, whatever is causing these events, the prognosis justifies greater attention,” according to Dr. Johnston.

“Even though TNA is likely to be only of transient utility because clinicians must quickly move to more specific diagnoses to provide appropriate treatment for patients, this entity should be considered a rally cry for more extensive evaluation or consultation in these patients, as well as for further research,” he wrote.

None of the researchers or Dr. Johnston reported any financial conflicts related to this study.

Occurrence of a TNA is a rally cry for extensive evaluation in these patients and further research. DR. JOHNSTON

Adults who suffered transient neurological attacks with nonfocal symptoms were at increased risk of developing major vascular disease and dementia in a study of more than 6,000 adults aged 55 years and older.

The findings challenge the perception that nonfocal transient neurological attacks (TNAs) are harmless. “TNAs with nonfocal symptoms were almost as frequent as focal TNAs, and had an equally unfavorable overall subsequent clinical course with a slightly higher risk of stroke and a higher risk of vascular dementia than persons without TNA,” the investigators wrote. The authors defined TNA as an episode of neurological dysfunction lasting less than 24 hours (usually from 2 to 15 minutes).

Although focal TNAs (better known as transient ischemic attacks or TIAs) have been characterized, a variety of diagnoses have been applied to nonfocal and mixed TNAs (focal and nonfocal symptoms in the same attack). Focal and mixed TNAs are often considered benign and have not been well studied, Dr. Michiel J. Bos of Erasmus University Medical Centre in Rotterdam, the Netherlands, and colleagues, noted.

To study the incidence and prognosis of each of these three types of TNA, the investigators followed 6,062 community-dwelling adults with no history of stroke, myocardial infarction, or dementia. The participants were part of the Rotterdam Study, an ongoing population-based cohort study.

The subjects enrolled between 1990 and 1993 and were followed until Jan. 1, 2005. The median age of the patients at baseline was 68 years, and 3,758 (62%) were women (JAMA 2007;298:2877–85).

A total of 548 individuals experienced TNAs during the study period of 60,535 person-years. Categorized by their symptoms, 282 TNAs were considered focal, 228 were nonfocal, and 38 were mixed.

Overall, focal and nonfocal TNAs occurred with similar frequency, with incidence rates of 4.7 per 1,000 person-years and 3.8 per 1,000 person-years, respectively. The incidence rates for both types increased with age. The incidence rate for mixed TNAs was much lower—0.6 per 1,000 person years—and the incidence was not clearly associated with age.

Those who met criteria for focal TNAs had a higher risk of subsequent stroke (hazard ratio 2.14) than did those without TNA, after adjustment for age and sex, but there was no observable difference in the risk for MI or dementia.

The participants with nonfocal TNAs were at greater risk of both stroke (HR, 1.56) and dementia (HR, 1.59), compared with subjects without TNAs. And they were at especially high risk for vascular dementia (HR, 5.05). There was no difference in risk for MI in this subgroup.

Those with mixed TNAs also were at increased risk of stroke (HR, 2.48), ischemic heart disease (HR, 2.26), vascular death (HR, 2.54), and dementia (HR, 3.46), compared with individuals who didn't experience TNAs. Notably, the risk of vascular dementia was much higher among those with mixed TNAs (HR, 21.5).

The clinical implication of the findings is that nonfocal TNAs deserve to be taken seriously, Dr. S. Claiborne Johnston, a neurologist at the University of California, San Francisco, wrote in an accompanying editorial (JAMA 2007;298:2912–3).

“The study argues that, whatever is causing these events, the prognosis justifies greater attention,” according to Dr. Johnston.

“Even though TNA is likely to be only of transient utility because clinicians must quickly move to more specific diagnoses to provide appropriate treatment for patients, this entity should be considered a rally cry for more extensive evaluation or consultation in these patients, as well as for further research,” he wrote.

None of the researchers or Dr. Johnston reported any financial conflicts related to this study.

Occurrence of a TNA is a rally cry for extensive evaluation in these patients and further research. DR. JOHNSTON

Adults who suffered transient neurological attacks with nonfocal symptoms were at increased risk of developing major vascular disease and dementia in a study of more than 6,000 adults aged 55 years and older.

The findings challenge the perception that nonfocal transient neurological attacks (TNAs) are harmless. “TNAs with nonfocal symptoms were almost as frequent as focal TNAs, and had an equally unfavorable overall subsequent clinical course with a slightly higher risk of stroke and a higher risk of vascular dementia than persons without TNA,” the investigators wrote. The authors defined TNA as an episode of neurological dysfunction lasting less than 24 hours (usually from 2 to 15 minutes).

Although focal TNAs (better known as transient ischemic attacks or TIAs) have been characterized, a variety of diagnoses have been applied to nonfocal and mixed TNAs (focal and nonfocal symptoms in the same attack). Focal and mixed TNAs are often considered benign and have not been well studied, Dr. Michiel J. Bos of Erasmus University Medical Centre in Rotterdam, the Netherlands, and colleagues, noted.

To study the incidence and prognosis of each of these three types of TNA, the investigators followed 6,062 community-dwelling adults with no history of stroke, myocardial infarction, or dementia. The participants were part of the Rotterdam Study, an ongoing population-based cohort study.

The subjects enrolled between 1990 and 1993 and were followed until Jan. 1, 2005. The median age of the patients at baseline was 68 years, and 3,758 (62%) were women (JAMA 2007;298:2877–85).

A total of 548 individuals experienced TNAs during the study period of 60,535 person-years. Categorized by their symptoms, 282 TNAs were considered focal, 228 were nonfocal, and 38 were mixed.

Overall, focal and nonfocal TNAs occurred with similar frequency, with incidence rates of 4.7 per 1,000 person-years and 3.8 per 1,000 person-years, respectively. The incidence rates for both types increased with age. The incidence rate for mixed TNAs was much lower—0.6 per 1,000 person years—and the incidence was not clearly associated with age.

Those who met criteria for focal TNAs had a higher risk of subsequent stroke (hazard ratio 2.14) than did those without TNA, after adjustment for age and sex, but there was no observable difference in the risk for MI or dementia.

The participants with nonfocal TNAs were at greater risk of both stroke (HR, 1.56) and dementia (HR, 1.59), compared with subjects without TNAs. And they were at especially high risk for vascular dementia (HR, 5.05). There was no difference in risk for MI in this subgroup.

Those with mixed TNAs also were at increased risk of stroke (HR, 2.48), ischemic heart disease (HR, 2.26), vascular death (HR, 2.54), and dementia (HR, 3.46), compared with individuals who didn't experience TNAs. Notably, the risk of vascular dementia was much higher among those with mixed TNAs (HR, 21.5).

The clinical implication of the findings is that nonfocal TNAs deserve to be taken seriously, Dr. S. Claiborne Johnston, a neurologist at the University of California, San Francisco, wrote in an accompanying editorial (JAMA 2007;298:2912–3).

“The study argues that, whatever is causing these events, the prognosis justifies greater attention,” according to Dr. Johnston.

“Even though TNA is likely to be only of transient utility because clinicians must quickly move to more specific diagnoses to provide appropriate treatment for patients, this entity should be considered a rally cry for more extensive evaluation or consultation in these patients, as well as for further research,” he wrote.

None of the researchers or Dr. Johnston reported any financial conflicts related to this study.

Occurrence of a TNA is a rally cry for extensive evaluation in these patients and further research. DR. JOHNSTON

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, according to a recent study.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury—the type associated with the consumption of fish—but so far, few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.), and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points between 12 hours and 30 days after vaccination, depending on the age group.

The study population included 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208–14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds.

Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements—12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds.

In all of the age groups, blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels following vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Even the highest level of mercury was relatively low. The overall highest level detected in the study was 8.0 ng/mL, and it was noted in a newborn 12 hours after a birth dose of a hepatitis B virus (HBV) vaccine that included 32.5 mcg of mercury.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds. This suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers commented.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps.

“So every pediatrician in America is going to face parents who see this fictional program,” added Dr. Pichichero. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero feels that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

The results were limited by the combination of methyl and ethyl mercury in the blood samples from some children and by the researchers' inability to identify the exact proportion of mercury excreted through the stool and urine.

However, the short half-life of ethyl mercury in the blood suggests a need to reassess the risk of thimerosal as a preservative, they wrote.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

The findings support results from recent studies, including a study conducted by the Centers for Disease Control and Prevention that showed no association between exposure to ethyl mercury from thimerosal-containing vaccines during infancy and neuropsychological outcomes at age 7–10 years (N. Engl. J. Med. 2007;357:1281–92).

Additionally, a population-based study that was conducted in California last year showed an increase in the prevalence of autism in the years since thimerosal-containing vaccines were discontinued (Arch. Gen. Psychiatry 2008;65:19–24).

The blood half-life of mercury after administration was estimated to be 3.7 days, and did not vary by age group. DR. PICHICHERO

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, according to a recent study.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury—the type associated with the consumption of fish—but so far, few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.), and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points between 12 hours and 30 days after vaccination, depending on the age group.

The study population included 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208–14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds.

Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements—12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds.

In all of the age groups, blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels following vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Even the highest level of mercury was relatively low. The overall highest level detected in the study was 8.0 ng/mL, and it was noted in a newborn 12 hours after a birth dose of a hepatitis B virus (HBV) vaccine that included 32.5 mcg of mercury.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds. This suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers commented.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps.

“So every pediatrician in America is going to face parents who see this fictional program,” added Dr. Pichichero. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero feels that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

The results were limited by the combination of methyl and ethyl mercury in the blood samples from some children and by the researchers' inability to identify the exact proportion of mercury excreted through the stool and urine.

However, the short half-life of ethyl mercury in the blood suggests a need to reassess the risk of thimerosal as a preservative, they wrote.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

The findings support results from recent studies, including a study conducted by the Centers for Disease Control and Prevention that showed no association between exposure to ethyl mercury from thimerosal-containing vaccines during infancy and neuropsychological outcomes at age 7–10 years (N. Engl. J. Med. 2007;357:1281–92).

Additionally, a population-based study that was conducted in California last year showed an increase in the prevalence of autism in the years since thimerosal-containing vaccines were discontinued (Arch. Gen. Psychiatry 2008;65:19–24).

The blood half-life of mercury after administration was estimated to be 3.7 days, and did not vary by age group. DR. PICHICHERO

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, according to a recent study.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury—the type associated with the consumption of fish—but so far, few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.), and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points between 12 hours and 30 days after vaccination, depending on the age group.

The study population included 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208–14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds.

Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements—12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds.

In all of the age groups, blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels following vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Even the highest level of mercury was relatively low. The overall highest level detected in the study was 8.0 ng/mL, and it was noted in a newborn 12 hours after a birth dose of a hepatitis B virus (HBV) vaccine that included 32.5 mcg of mercury.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds. This suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers commented.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps.

“So every pediatrician in America is going to face parents who see this fictional program,” added Dr. Pichichero. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero feels that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

The results were limited by the combination of methyl and ethyl mercury in the blood samples from some children and by the researchers' inability to identify the exact proportion of mercury excreted through the stool and urine.

However, the short half-life of ethyl mercury in the blood suggests a need to reassess the risk of thimerosal as a preservative, they wrote.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

The findings support results from recent studies, including a study conducted by the Centers for Disease Control and Prevention that showed no association between exposure to ethyl mercury from thimerosal-containing vaccines during infancy and neuropsychological outcomes at age 7–10 years (N. Engl. J. Med. 2007;357:1281–92).

Additionally, a population-based study that was conducted in California last year showed an increase in the prevalence of autism in the years since thimerosal-containing vaccines were discontinued (Arch. Gen. Psychiatry 2008;65:19–24).

The blood half-life of mercury after administration was estimated to be 3.7 days, and did not vary by age group. DR. PICHICHERO

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, study results show.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury–the type associated with the consumption of fish–but few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.) and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points from 12 hours to 30 days after vaccination, depending on the age group. The study population comprised 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208-14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds. Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements–12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds. In all age groups, the blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels after vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds, which suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers noted.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps. “So every pediatrician in America is going to face parents who see this fictional program,” he said. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero feels that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, study results show.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury–the type associated with the consumption of fish–but few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.) and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points from 12 hours to 30 days after vaccination, depending on the age group. The study population comprised 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208-14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds. Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements–12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds. In all age groups, the blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels after vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds, which suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers noted.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps. “So every pediatrician in America is going to face parents who see this fictional program,” he said. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero feels that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, study results show.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury–the type associated with the consumption of fish–but few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.) and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points from 12 hours to 30 days after vaccination, depending on the age group. The study population comprised 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208-14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds. Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements–12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds. In all age groups, the blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels after vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds, which suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers noted.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps. “So every pediatrician in America is going to face parents who see this fictional program,” he said. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero feels that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

Adults who suffered transient neurological attacks with nonfocal symptoms were at increased risk of developing major vascular disease and dementia in a study of more than 6,000 adults aged 55 years and older.

The findings challenge the perception that nonfocal transient neurological attacks (TNAs) are harmless. “TNAs with nonfocal symptoms were almost as frequent as focal TNAs, and had an equally unfavorable overall subsequent clinical course with a slightly higher risk of stroke and a higher risk of vascular dementia than persons without TNA,” the investigators wrote.

The authors defined TNA as an episode of neurological dysfunction lasting less than 24 hours (usually from 2 to 15 minutes). Although focal TNAs (better known as transient ischemic attacks or TIAs) have been characterized, a variety of diagnoses have been applied to nonfocal and mixed TNAs (focal and nonfocal symptoms in the same attack). Focal and mixed TNAs are often considered benign and have not been well studied, Dr. Michiel J. Bos of Erasmus University Medical Centre in Rotterdam, the Netherlands, and colleagues, noted.

To study the incidence and prognosis of each of these three types of TNAs, the investigators followed 6,062 community-dwelling adults with no history of stroke, myocardial infarction, or dementia. The participants were part of the Rotterdam Study, an ongoing population-based cohort study. The subjects enrolled between 1990 and 1993 and were followed until Jan. 1, 2005. The median age of the patients at baseline was 68 years, and 3,758 (62%) were women (JAMA 2007;298: 2877–85).

A total of 548 individuals experienced TNAs during the study period of 60,535 person-years. Categorized by their symptoms, 282 TNAs were considered focal, 228 were nonfocal, and 38 were mixed.

Overall, focal and nonfocal TNAs occurred with similar frequency, with incidence rates of 4.7 per 1,000 person-years and 3.8 per 1,000 person-years, respectively. The incidence rates for both types increased with age. The incidence rate for mixed TNAs was much lower—0.6 per 1,000 person years—and the incidence was not clearly associated with age.

Those who met criteria for focal TNAs had a higher risk of subsequent stroke (hazard ratio, 2.14) than did those without TNA, after adjustment for age and sex, but there was no observable difference in the risk for MI or dementia.

The participants with nonfocal TNAs were at greater risk of both stroke (HR, 1.56) and dementia (HR, 1.59), compared with subjects without TNAs. And they were at especially high risk for vascular dementia (HR, 5.05). There was no difference in risk for MI in this subgroup.

Those with mixed TNAs also were at increased risk of stroke (HR, 2.48), ischemic heart disease (HR, 2.26), vascular death (HR, 2.54), and dementia (HR, 3.46), compared with individuals who didn't experience TNAs. Notably, the risk of vascular dementia was much higher among those with mixed TNAs (HR, 21.5).

The clinical implication of the findings is that nonfocal TNAs deserve to be taken seriously, according to Dr. S. Claiborne Johnston, a neurologist at the University of California, San Francisco, who wrote an accompanying editorial (JAMA 2007;298:2912–3).

“The study argues that, whatever is causing these events, the prognosis justifies greater attention,” Dr. Johnston noted. “Even though TNA is likely to be only of transient utility because clinicians must quickly move to more specific diagnoses to provide appropriate treatment for patients, this entity should be considered a rally cry for more extensive evaluation or consultation in these patients, as well as for further research,” he wrote.

None of the researchers or Dr. Johnston reported any financial conflicts related to this study.

Adults who suffered transient neurological attacks with nonfocal symptoms were at increased risk of developing major vascular disease and dementia in a study of more than 6,000 adults aged 55 years and older.

The findings challenge the perception that nonfocal transient neurological attacks (TNAs) are harmless. “TNAs with nonfocal symptoms were almost as frequent as focal TNAs, and had an equally unfavorable overall subsequent clinical course with a slightly higher risk of stroke and a higher risk of vascular dementia than persons without TNA,” the investigators wrote.

The authors defined TNA as an episode of neurological dysfunction lasting less than 24 hours (usually from 2 to 15 minutes). Although focal TNAs (better known as transient ischemic attacks or TIAs) have been characterized, a variety of diagnoses have been applied to nonfocal and mixed TNAs (focal and nonfocal symptoms in the same attack). Focal and mixed TNAs are often considered benign and have not been well studied, Dr. Michiel J. Bos of Erasmus University Medical Centre in Rotterdam, the Netherlands, and colleagues, noted.

To study the incidence and prognosis of each of these three types of TNAs, the investigators followed 6,062 community-dwelling adults with no history of stroke, myocardial infarction, or dementia. The participants were part of the Rotterdam Study, an ongoing population-based cohort study. The subjects enrolled between 1990 and 1993 and were followed until Jan. 1, 2005. The median age of the patients at baseline was 68 years, and 3,758 (62%) were women (JAMA 2007;298: 2877–85).

A total of 548 individuals experienced TNAs during the study period of 60,535 person-years. Categorized by their symptoms, 282 TNAs were considered focal, 228 were nonfocal, and 38 were mixed.

Overall, focal and nonfocal TNAs occurred with similar frequency, with incidence rates of 4.7 per 1,000 person-years and 3.8 per 1,000 person-years, respectively. The incidence rates for both types increased with age. The incidence rate for mixed TNAs was much lower—0.6 per 1,000 person years—and the incidence was not clearly associated with age.

Those who met criteria for focal TNAs had a higher risk of subsequent stroke (hazard ratio, 2.14) than did those without TNA, after adjustment for age and sex, but there was no observable difference in the risk for MI or dementia.

The participants with nonfocal TNAs were at greater risk of both stroke (HR, 1.56) and dementia (HR, 1.59), compared with subjects without TNAs. And they were at especially high risk for vascular dementia (HR, 5.05). There was no difference in risk for MI in this subgroup.

Those with mixed TNAs also were at increased risk of stroke (HR, 2.48), ischemic heart disease (HR, 2.26), vascular death (HR, 2.54), and dementia (HR, 3.46), compared with individuals who didn't experience TNAs. Notably, the risk of vascular dementia was much higher among those with mixed TNAs (HR, 21.5).

The clinical implication of the findings is that nonfocal TNAs deserve to be taken seriously, according to Dr. S. Claiborne Johnston, a neurologist at the University of California, San Francisco, who wrote an accompanying editorial (JAMA 2007;298:2912–3).

“The study argues that, whatever is causing these events, the prognosis justifies greater attention,” Dr. Johnston noted. “Even though TNA is likely to be only of transient utility because clinicians must quickly move to more specific diagnoses to provide appropriate treatment for patients, this entity should be considered a rally cry for more extensive evaluation or consultation in these patients, as well as for further research,” he wrote.

None of the researchers or Dr. Johnston reported any financial conflicts related to this study.

Adults who suffered transient neurological attacks with nonfocal symptoms were at increased risk of developing major vascular disease and dementia in a study of more than 6,000 adults aged 55 years and older.

The findings challenge the perception that nonfocal transient neurological attacks (TNAs) are harmless. “TNAs with nonfocal symptoms were almost as frequent as focal TNAs, and had an equally unfavorable overall subsequent clinical course with a slightly higher risk of stroke and a higher risk of vascular dementia than persons without TNA,” the investigators wrote.

The authors defined TNA as an episode of neurological dysfunction lasting less than 24 hours (usually from 2 to 15 minutes). Although focal TNAs (better known as transient ischemic attacks or TIAs) have been characterized, a variety of diagnoses have been applied to nonfocal and mixed TNAs (focal and nonfocal symptoms in the same attack). Focal and mixed TNAs are often considered benign and have not been well studied, Dr. Michiel J. Bos of Erasmus University Medical Centre in Rotterdam, the Netherlands, and colleagues, noted.

To study the incidence and prognosis of each of these three types of TNAs, the investigators followed 6,062 community-dwelling adults with no history of stroke, myocardial infarction, or dementia. The participants were part of the Rotterdam Study, an ongoing population-based cohort study. The subjects enrolled between 1990 and 1993 and were followed until Jan. 1, 2005. The median age of the patients at baseline was 68 years, and 3,758 (62%) were women (JAMA 2007;298: 2877–85).

A total of 548 individuals experienced TNAs during the study period of 60,535 person-years. Categorized by their symptoms, 282 TNAs were considered focal, 228 were nonfocal, and 38 were mixed.

Overall, focal and nonfocal TNAs occurred with similar frequency, with incidence rates of 4.7 per 1,000 person-years and 3.8 per 1,000 person-years, respectively. The incidence rates for both types increased with age. The incidence rate for mixed TNAs was much lower—0.6 per 1,000 person years—and the incidence was not clearly associated with age.

Those who met criteria for focal TNAs had a higher risk of subsequent stroke (hazard ratio, 2.14) than did those without TNA, after adjustment for age and sex, but there was no observable difference in the risk for MI or dementia.

The participants with nonfocal TNAs were at greater risk of both stroke (HR, 1.56) and dementia (HR, 1.59), compared with subjects without TNAs. And they were at especially high risk for vascular dementia (HR, 5.05). There was no difference in risk for MI in this subgroup.

Those with mixed TNAs also were at increased risk of stroke (HR, 2.48), ischemic heart disease (HR, 2.26), vascular death (HR, 2.54), and dementia (HR, 3.46), compared with individuals who didn't experience TNAs. Notably, the risk of vascular dementia was much higher among those with mixed TNAs (HR, 21.5).

The clinical implication of the findings is that nonfocal TNAs deserve to be taken seriously, according to Dr. S. Claiborne Johnston, a neurologist at the University of California, San Francisco, who wrote an accompanying editorial (JAMA 2007;298:2912–3).

“The study argues that, whatever is causing these events, the prognosis justifies greater attention,” Dr. Johnston noted. “Even though TNA is likely to be only of transient utility because clinicians must quickly move to more specific diagnoses to provide appropriate treatment for patients, this entity should be considered a rally cry for more extensive evaluation or consultation in these patients, as well as for further research,” he wrote.

None of the researchers or Dr. Johnston reported any financial conflicts related to this study.

Low bone mineral density and a prevalent vertebral fracture were long-term independent predictors of an increased risk of vertebral fractures in women aged 65–99 who were followed for almost 15 years.

Previous studies have shown links between low BMD and an increased risk of a new vertebral fracture and between a prevalent vertebral fracture and an increased risk of a new vertebral fracture after an average of nearly 4 years.

But this study was the first to assess the long-term absolute risk of vertebral fracture based on follow-up evaluations of community-dwelling older women (JAMA 2007;298:2761–67).

In this study, Jane A. Cauley, Dr.PH., of the department of epidemiology at the University of Pittsburgh, and her colleagues reviewed data from 2,680 white women who took part in the longitudinal Study of Osteoporotic Fractures. The average age at baseline was 68.8 years and the average age at follow-up was 83.8 years.

After an average of 14.9 years, 487 women (18.2%) had incident vertebral fractures. This number included 163 of the 394 women (41.4%) who had a prevalent vertebral fracture at baseline and 324 of the 2,286 women (14.2%) who didn't have a vertebral fracture at baseline.

Overall, women with a prevalent fracture were more than four times as likely to suffer an incident vertebral fracture during the follow-up period, compared with those with no fracture history. The association remained significant after the researchers controlled for BMD and other risk factors for vertebral fracture, and the risk was greatest in women who had at least two prevalent vertebral fractures when they enrolled in the investigation.

In addition, a low baseline BMD at several sites (the calcaneus, distal radius, total hip, femoral neck, and lumbar spine) was a significant predictor of incident vertebral fractures during the follow-up period.

After adjustment for risk factors including smoking, body mass index, and estrogen use, about a third of women with a hip BMD T score of −2.5 or less (which is considered osteoporotic) developed incident fractures during the follow-up, compared with about 10% of those with normal BMD scores.

Women with both a prevalent vertebral fracture and total hip BMD T scores of −2.5 or less had an absolute risk of an incident vertebral fracture greater then 50%, compared with a 9% risk among women with a normal BMD and no fracture history.

But women with baseline prevalent vertebral fractures were at increased risk of additional fractures during the follow-up period regardless of BMD, and the interaction between BMD and prevalent vertebral fractures was not statistically significant.

This finding suggests that the presence of a vertebral fracture may indicate deterioration in bone quality, not just bone density, the investigators wrote. “Our results support the recommendation that older women with a prevalent vertebral fracture should be treated for osteoporosis irrespective of BMD.”

In addition, women who had incident fractures tended to be older, thinner, and less likely to report estrogen use. The results were consistent with the short-term findings from the Study of Osteoporotic Fractures and from other similar studies. But the study was limited by its inclusion of white women only, and the results may not be applicable to men or women of other ethnicities. Also, the absolute risk of vertebral fractures may be higher than reported because the study subjects who returned for the follow-up examinations were healthier at baseline than were patients who were lost to follow-up, the researchers noted.

Dr. Cauley has received research support from Merck & Co., Eli Lilly & Co., Pfizer Pharmaceuticals, and Novartis Pharmaceuticals. She also has received consulting fees from Novartis and Eli Lilly, and she serves on the speakers board for Merck. The Study of Osteoporotic Fractures is funded by the National Institutes of Health.

Low bone mineral density and a prevalent vertebral fracture were long-term independent predictors of an increased risk of vertebral fractures in women aged 65–99 who were followed for almost 15 years.

Previous studies have shown links between low BMD and an increased risk of a new vertebral fracture and between a prevalent vertebral fracture and an increased risk of a new vertebral fracture after an average of nearly 4 years.

But this study was the first to assess the long-term absolute risk of vertebral fracture based on follow-up evaluations of community-dwelling older women (JAMA 2007;298:2761–67).

In this study, Jane A. Cauley, Dr.PH., of the department of epidemiology at the University of Pittsburgh, and her colleagues reviewed data from 2,680 white women who took part in the longitudinal Study of Osteoporotic Fractures. The average age at baseline was 68.8 years and the average age at follow-up was 83.8 years.

After an average of 14.9 years, 487 women (18.2%) had incident vertebral fractures. This number included 163 of the 394 women (41.4%) who had a prevalent vertebral fracture at baseline and 324 of the 2,286 women (14.2%) who didn't have a vertebral fracture at baseline.

Overall, women with a prevalent fracture were more than four times as likely to suffer an incident vertebral fracture during the follow-up period, compared with those with no fracture history. The association remained significant after the researchers controlled for BMD and other risk factors for vertebral fracture, and the risk was greatest in women who had at least two prevalent vertebral fractures when they enrolled in the investigation.

In addition, a low baseline BMD at several sites (the calcaneus, distal radius, total hip, femoral neck, and lumbar spine) was a significant predictor of incident vertebral fractures during the follow-up period.

After adjustment for risk factors including smoking, body mass index, and estrogen use, about a third of women with a hip BMD T score of −2.5 or less (which is considered osteoporotic) developed incident fractures during the follow-up, compared with about 10% of those with normal BMD scores.

Women with both a prevalent vertebral fracture and total hip BMD T scores of −2.5 or less had an absolute risk of an incident vertebral fracture greater then 50%, compared with a 9% risk among women with a normal BMD and no fracture history.

But women with baseline prevalent vertebral fractures were at increased risk of additional fractures during the follow-up period regardless of BMD, and the interaction between BMD and prevalent vertebral fractures was not statistically significant.

This finding suggests that the presence of a vertebral fracture may indicate deterioration in bone quality, not just bone density, the investigators wrote. “Our results support the recommendation that older women with a prevalent vertebral fracture should be treated for osteoporosis irrespective of BMD.”

In addition, women who had incident fractures tended to be older, thinner, and less likely to report estrogen use. The results were consistent with the short-term findings from the Study of Osteoporotic Fractures and from other similar studies. But the study was limited by its inclusion of white women only, and the results may not be applicable to men or women of other ethnicities. Also, the absolute risk of vertebral fractures may be higher than reported because the study subjects who returned for the follow-up examinations were healthier at baseline than were patients who were lost to follow-up, the researchers noted.

Dr. Cauley has received research support from Merck & Co., Eli Lilly & Co., Pfizer Pharmaceuticals, and Novartis Pharmaceuticals. She also has received consulting fees from Novartis and Eli Lilly, and she serves on the speakers board for Merck. The Study of Osteoporotic Fractures is funded by the National Institutes of Health.

Low bone mineral density and a prevalent vertebral fracture were long-term independent predictors of an increased risk of vertebral fractures in women aged 65–99 who were followed for almost 15 years.

Previous studies have shown links between low BMD and an increased risk of a new vertebral fracture and between a prevalent vertebral fracture and an increased risk of a new vertebral fracture after an average of nearly 4 years.

But this study was the first to assess the long-term absolute risk of vertebral fracture based on follow-up evaluations of community-dwelling older women (JAMA 2007;298:2761–67).

In this study, Jane A. Cauley, Dr.PH., of the department of epidemiology at the University of Pittsburgh, and her colleagues reviewed data from 2,680 white women who took part in the longitudinal Study of Osteoporotic Fractures. The average age at baseline was 68.8 years and the average age at follow-up was 83.8 years.

After an average of 14.9 years, 487 women (18.2%) had incident vertebral fractures. This number included 163 of the 394 women (41.4%) who had a prevalent vertebral fracture at baseline and 324 of the 2,286 women (14.2%) who didn't have a vertebral fracture at baseline.

Overall, women with a prevalent fracture were more than four times as likely to suffer an incident vertebral fracture during the follow-up period, compared with those with no fracture history. The association remained significant after the researchers controlled for BMD and other risk factors for vertebral fracture, and the risk was greatest in women who had at least two prevalent vertebral fractures when they enrolled in the investigation.

In addition, a low baseline BMD at several sites (the calcaneus, distal radius, total hip, femoral neck, and lumbar spine) was a significant predictor of incident vertebral fractures during the follow-up period.

After adjustment for risk factors including smoking, body mass index, and estrogen use, about a third of women with a hip BMD T score of −2.5 or less (which is considered osteoporotic) developed incident fractures during the follow-up, compared with about 10% of those with normal BMD scores.

Women with both a prevalent vertebral fracture and total hip BMD T scores of −2.5 or less had an absolute risk of an incident vertebral fracture greater then 50%, compared with a 9% risk among women with a normal BMD and no fracture history.

But women with baseline prevalent vertebral fractures were at increased risk of additional fractures during the follow-up period regardless of BMD, and the interaction between BMD and prevalent vertebral fractures was not statistically significant.

This finding suggests that the presence of a vertebral fracture may indicate deterioration in bone quality, not just bone density, the investigators wrote. “Our results support the recommendation that older women with a prevalent vertebral fracture should be treated for osteoporosis irrespective of BMD.”

In addition, women who had incident fractures tended to be older, thinner, and less likely to report estrogen use. The results were consistent with the short-term findings from the Study of Osteoporotic Fractures and from other similar studies. But the study was limited by its inclusion of white women only, and the results may not be applicable to men or women of other ethnicities. Also, the absolute risk of vertebral fractures may be higher than reported because the study subjects who returned for the follow-up examinations were healthier at baseline than were patients who were lost to follow-up, the researchers noted.

Dr. Cauley has received research support from Merck & Co., Eli Lilly & Co., Pfizer Pharmaceuticals, and Novartis Pharmaceuticals. She also has received consulting fees from Novartis and Eli Lilly, and she serves on the speakers board for Merck. The Study of Osteoporotic Fractures is funded by the National Institutes of Health.

New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between January 15, 1981, and July 9, 2004.

They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52.3% compared with 23.6%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects.

But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

In an editorial that accompanied the article, Dr. Niels Teich, of the University of Leipzig in Germany wrote that there is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients (Gastroenterology 2008;134:344–5).

The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

“The data available today clearly suggest that diabetes mellitus can be both a long-standing cause of pancreatic cancer, and, as shown now, an early manifestation of the disease,” Dr. Teich said.

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New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between January 15, 1981, and July 9, 2004.

They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52.3% compared with 23.6%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects.

But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

In an editorial that accompanied the article, Dr. Niels Teich, of the University of Leipzig in Germany wrote that there is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients (Gastroenterology 2008;134:344–5).

The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

“The data available today clearly suggest that diabetes mellitus can be both a long-standing cause of pancreatic cancer, and, as shown now, an early manifestation of the disease,” Dr. Teich said.

ELSEVIER GLOBAL MEDICAL NEWS

New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between January 15, 1981, and July 9, 2004.

They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52.3% compared with 23.6%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects.

But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

In an editorial that accompanied the article, Dr. Niels Teich, of the University of Leipzig in Germany wrote that there is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients (Gastroenterology 2008;134:344–5).

The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

“The data available today clearly suggest that diabetes mellitus can be both a long-standing cause of pancreatic cancer, and, as shown now, an early manifestation of the disease,” Dr. Teich said.

ELSEVIER GLOBAL MEDICAL NEWS