Heidi Splete

Rates of methicillin-resistant Staphylococcus aureus infections were reduced by more than half when all newly admitted hospital patients were tested for MRSA, according to results from three hospitals.

Methicillin-resistant S. aureus (MRSA) has become a fixture in many hospitals in the United States, and the resulting MRSA infections are causing poor health outcomes and increasing health care costs, reported Dr. Ari Robicsek of Evanston (Ill.) Northwestern Healthcare and his colleagues.

To cut MRSA infection rates, the researchers implemented a universal MRSA surveillance program at a three-hospital organization in Chicago.

Their observational study compared MRSA rates during a baseline year when patients were not universally screened at the time of hospital admission with MRSA rates after conducting polymerase chain reaction-based nasal tests for MRSA. The tests were conducted on all patients admitted to the ICU for 1 year and on all patients admitted to the hospital for another year (Ann. Intern. Med. 2008;148:409–18).

During the ICU surveillance year, 3,334 of 4,392 patients (76%) admitted to the ICU were tested for MRSA and 277 (8%) were positive. During the universal screening year, 62,035 of 73,464 patients (84%) admitted to the hospital were tested for MRSA and 3,926 (6%) were positive. Patients who tested positive were isolated. Of the 2,085 patients for whom mupirocin data were available, 1,288 (62%) received at least four doses of mupirocin.

During the year of universal surveillance, the total number of isolation days was 11,454 across the three hospitals. “With no surveillance, clinical cultures alone would have captured 2,036 of those days,” the investigators noted. “Thus, 9,418 MRSA patient-days would have been spent without infection control contact precautions to limit MRSA spread.”

Overall, the prevalence density of clinical infections caused by MRSA decreased from 8.9/10,000 patient-days during the baseline year to 7.4/10,000 patient days during the ICU screening year, but this difference was not statistically significant. By contrast, prevalence density decreased significantly from baseline to 3.9/10,000 patient-days during the universal screening year.

In addition, the prevalence density of four types of MRSA infections—bloodstream, respiratory tract, urinary tract, and surgical site infections—dropped significantly between baseline and the end of the universal screening year.

This improvement in MRSA rates following universal screening persisted for up to 30 days after the patients left the hospital but had no apparent effect on infection rates from 31 days to 180 days. The types of infections represented the major body sites that might be affected by culture-confirmed MRSA, the researchers noted.

To control for a possible unrecognized coinfection, the researchers also compared changes in rates of hospital-associated MRSA bacteremia with rates of hospital-associated methicillin-susceptible S. aureus (MSSA) bacteremia. The MRSA bacteremia rates decreased significantly after the surveillance program was implemented, but MSSA bacteremia rates did not.

The study was limited by the lack of an unscreened control group and the inclusion of only one hospital organization, but the findings support results from previous studies in which anything less than universal screening detected fewer than 20% of patients with MRSA infections.

“Given the intermediate size and community-based nature of our three hospitals, our experience is probably representative of most U.S. hospitals,” the investigators wrote.

But using the same MRSA screening strategy for every hospital may not be feasible. In an editorial, Dr. Ebbing Lautenbach of the University of Pennsylvania, Philadelphia, observed that commitment and support of each hospital's administration is needed for universal MRSA screening to succeed and that the cost of rapid screening tests may be a barrier for some facilities (Ann. Intern. Med. 2008;148:474–6). “We need better evidence to point us toward what works best in the complex universe of MRSA screening,” he said.

ELSEVIER GLOBAL MEDICAL NEWS

Rates of methicillin-resistant Staphylococcus aureus infections were reduced by more than half when all newly admitted hospital patients were tested for MRSA, according to results from three hospitals.

Methicillin-resistant S. aureus (MRSA) has become a fixture in many hospitals in the United States, and the resulting MRSA infections are causing poor health outcomes and increasing health care costs, reported Dr. Ari Robicsek of Evanston (Ill.) Northwestern Healthcare and his colleagues.

To cut MRSA infection rates, the researchers implemented a universal MRSA surveillance program at a three-hospital organization in Chicago.

Their observational study compared MRSA rates during a baseline year when patients were not universally screened at the time of hospital admission with MRSA rates after conducting polymerase chain reaction-based nasal tests for MRSA. The tests were conducted on all patients admitted to the ICU for 1 year and on all patients admitted to the hospital for another year (Ann. Intern. Med. 2008;148:409–18).

During the ICU surveillance year, 3,334 of 4,392 patients (76%) admitted to the ICU were tested for MRSA and 277 (8%) were positive. During the universal screening year, 62,035 of 73,464 patients (84%) admitted to the hospital were tested for MRSA and 3,926 (6%) were positive. Patients who tested positive were isolated. Of the 2,085 patients for whom mupirocin data were available, 1,288 (62%) received at least four doses of mupirocin.

During the year of universal surveillance, the total number of isolation days was 11,454 across the three hospitals. “With no surveillance, clinical cultures alone would have captured 2,036 of those days,” the investigators noted. “Thus, 9,418 MRSA patient-days would have been spent without infection control contact precautions to limit MRSA spread.”

Overall, the prevalence density of clinical infections caused by MRSA decreased from 8.9/10,000 patient-days during the baseline year to 7.4/10,000 patient days during the ICU screening year, but this difference was not statistically significant. By contrast, prevalence density decreased significantly from baseline to 3.9/10,000 patient-days during the universal screening year.

In addition, the prevalence density of four types of MRSA infections—bloodstream, respiratory tract, urinary tract, and surgical site infections—dropped significantly between baseline and the end of the universal screening year.

This improvement in MRSA rates following universal screening persisted for up to 30 days after the patients left the hospital but had no apparent effect on infection rates from 31 days to 180 days. The types of infections represented the major body sites that might be affected by culture-confirmed MRSA, the researchers noted.

To control for a possible unrecognized coinfection, the researchers also compared changes in rates of hospital-associated MRSA bacteremia with rates of hospital-associated methicillin-susceptible S. aureus (MSSA) bacteremia. The MRSA bacteremia rates decreased significantly after the surveillance program was implemented, but MSSA bacteremia rates did not.

The study was limited by the lack of an unscreened control group and the inclusion of only one hospital organization, but the findings support results from previous studies in which anything less than universal screening detected fewer than 20% of patients with MRSA infections.

“Given the intermediate size and community-based nature of our three hospitals, our experience is probably representative of most U.S. hospitals,” the investigators wrote.

But using the same MRSA screening strategy for every hospital may not be feasible. In an editorial, Dr. Ebbing Lautenbach of the University of Pennsylvania, Philadelphia, observed that commitment and support of each hospital's administration is needed for universal MRSA screening to succeed and that the cost of rapid screening tests may be a barrier for some facilities (Ann. Intern. Med. 2008;148:474–6). “We need better evidence to point us toward what works best in the complex universe of MRSA screening,” he said.

ELSEVIER GLOBAL MEDICAL NEWS

Rates of methicillin-resistant Staphylococcus aureus infections were reduced by more than half when all newly admitted hospital patients were tested for MRSA, according to results from three hospitals.

Methicillin-resistant S. aureus (MRSA) has become a fixture in many hospitals in the United States, and the resulting MRSA infections are causing poor health outcomes and increasing health care costs, reported Dr. Ari Robicsek of Evanston (Ill.) Northwestern Healthcare and his colleagues.

To cut MRSA infection rates, the researchers implemented a universal MRSA surveillance program at a three-hospital organization in Chicago.

Their observational study compared MRSA rates during a baseline year when patients were not universally screened at the time of hospital admission with MRSA rates after conducting polymerase chain reaction-based nasal tests for MRSA. The tests were conducted on all patients admitted to the ICU for 1 year and on all patients admitted to the hospital for another year (Ann. Intern. Med. 2008;148:409–18).

During the ICU surveillance year, 3,334 of 4,392 patients (76%) admitted to the ICU were tested for MRSA and 277 (8%) were positive. During the universal screening year, 62,035 of 73,464 patients (84%) admitted to the hospital were tested for MRSA and 3,926 (6%) were positive. Patients who tested positive were isolated. Of the 2,085 patients for whom mupirocin data were available, 1,288 (62%) received at least four doses of mupirocin.

During the year of universal surveillance, the total number of isolation days was 11,454 across the three hospitals. “With no surveillance, clinical cultures alone would have captured 2,036 of those days,” the investigators noted. “Thus, 9,418 MRSA patient-days would have been spent without infection control contact precautions to limit MRSA spread.”

Overall, the prevalence density of clinical infections caused by MRSA decreased from 8.9/10,000 patient-days during the baseline year to 7.4/10,000 patient days during the ICU screening year, but this difference was not statistically significant. By contrast, prevalence density decreased significantly from baseline to 3.9/10,000 patient-days during the universal screening year.

In addition, the prevalence density of four types of MRSA infections—bloodstream, respiratory tract, urinary tract, and surgical site infections—dropped significantly between baseline and the end of the universal screening year.

This improvement in MRSA rates following universal screening persisted for up to 30 days after the patients left the hospital but had no apparent effect on infection rates from 31 days to 180 days. The types of infections represented the major body sites that might be affected by culture-confirmed MRSA, the researchers noted.

To control for a possible unrecognized coinfection, the researchers also compared changes in rates of hospital-associated MRSA bacteremia with rates of hospital-associated methicillin-susceptible S. aureus (MSSA) bacteremia. The MRSA bacteremia rates decreased significantly after the surveillance program was implemented, but MSSA bacteremia rates did not.

The study was limited by the lack of an unscreened control group and the inclusion of only one hospital organization, but the findings support results from previous studies in which anything less than universal screening detected fewer than 20% of patients with MRSA infections.

“Given the intermediate size and community-based nature of our three hospitals, our experience is probably representative of most U.S. hospitals,” the investigators wrote.

But using the same MRSA screening strategy for every hospital may not be feasible. In an editorial, Dr. Ebbing Lautenbach of the University of Pennsylvania, Philadelphia, observed that commitment and support of each hospital's administration is needed for universal MRSA screening to succeed and that the cost of rapid screening tests may be a barrier for some facilities (Ann. Intern. Med. 2008;148:474–6). “We need better evidence to point us toward what works best in the complex universe of MRSA screening,” he said.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — The dermatologists who successfully add aesthetic services to their practices are those who use their expertise to show patients that they are the safe, smart choice, Catherine Maley said at the annual meeting of the American Academy for Facial Plastic and Reconstructive Surgery.

"Aesthetic dermatology is the business of feelings and emotions," said Ms. Maley, president of Cosmetic Image Marketing, a San Francisco-based marketing, public relations, and advertising firm that specializes in helping physicians build aesthetic practices.

"What you want to do is differentiate yourself from the medispas," she pointed out. A dermatologist competing in the aesthetic market should emphasize his or her medical training so patients recognize that they are paying for expertise.

"The aesthetic patient needs to understand that you are not the cheapest: You are the best," she said.

"Think of the psychology of the aesthetic patient. The bottom line is that she wants to look and feel better but she wants peace of mind. She wants to know that she is not going to regret anything and she is going to get a good result every time," Ms. Maley said.

Don't try to compete with medispas on price. Instead, sell the value. "You want those preferred patients who care about safety and credibility," she said.

How do dermatologists sell value? By emphasizing their credentials.

Use the logo from every society to which you belong on your cards, flyers, and promotional materials, including hospital and school affiliations. Put those logos everywhere because it enhances credibility with patients. "If you are board certified, say so in your promotional materials and explain to patients just what that means in terms of extra training," Ms. Maley said.

"If you work with vendors, use those affiliations and let patients know that you have been called on to speak or do research or train others," she added.

Create high-quality promotional handouts and cards to promote the aesthetic practice. A public relations agent can help create promotional materials, or there may be an interested and talented staff member who can design promotional pieces. Be sure to include patient photos and testimonials in your in-office and external promotional material. A dermatologist who is lucky enough to have a celebrity patient should ask for his or her permission to display a photo and short testimonial in the office.

Use testimonials generously, Ms. Maley emphasized. Provide high-quality photo albums with patients from a range of ages and ethnic backgrounds. Create a "what our patients say about us" album for written thank-you notes, e-mails, or postprocedure surveys.

"It's very compelling for patients to read about how great you are from other patients, not just from you," Ms. Maley said. The more testimonials, the better. Patient survey data have shown that prospective aesthetic patients associate quantity of patient testimonials with experience and expertise. Consider taking videos of patients who want to share their positive experiences, and put the videos together on a loop to show in the waiting room or post them on a Web site, Ms. Maley suggested.

And don't underestimate the importance of appearing in print.

"Any time you publish or you are quoted, don't miss that opportunity for public relations," she said.

Pull together a collection of quotes and design a PR piece for patient information packets and for the practice's Web site. One way to get written about or interviewed is to send a media kit to local print and TV reporters and to follow up with a personal phone call to pitch story ideas related to your expertise.

"Remember that it is not about you. It is about what you can do for their readers and viewers," Ms. Maley cautioned. "But the PR can really pay off and set you up as an expert in your community."

WASHINGTON — The dermatologists who successfully add aesthetic services to their practices are those who use their expertise to show patients that they are the safe, smart choice, Catherine Maley said at the annual meeting of the American Academy for Facial Plastic and Reconstructive Surgery.

"Aesthetic dermatology is the business of feelings and emotions," said Ms. Maley, president of Cosmetic Image Marketing, a San Francisco-based marketing, public relations, and advertising firm that specializes in helping physicians build aesthetic practices.

"What you want to do is differentiate yourself from the medispas," she pointed out. A dermatologist competing in the aesthetic market should emphasize his or her medical training so patients recognize that they are paying for expertise.

"The aesthetic patient needs to understand that you are not the cheapest: You are the best," she said.

"Think of the psychology of the aesthetic patient. The bottom line is that she wants to look and feel better but she wants peace of mind. She wants to know that she is not going to regret anything and she is going to get a good result every time," Ms. Maley said.

Don't try to compete with medispas on price. Instead, sell the value. "You want those preferred patients who care about safety and credibility," she said.

How do dermatologists sell value? By emphasizing their credentials.

Use the logo from every society to which you belong on your cards, flyers, and promotional materials, including hospital and school affiliations. Put those logos everywhere because it enhances credibility with patients. "If you are board certified, say so in your promotional materials and explain to patients just what that means in terms of extra training," Ms. Maley said.

"If you work with vendors, use those affiliations and let patients know that you have been called on to speak or do research or train others," she added.

Create high-quality promotional handouts and cards to promote the aesthetic practice. A public relations agent can help create promotional materials, or there may be an interested and talented staff member who can design promotional pieces. Be sure to include patient photos and testimonials in your in-office and external promotional material. A dermatologist who is lucky enough to have a celebrity patient should ask for his or her permission to display a photo and short testimonial in the office.

Use testimonials generously, Ms. Maley emphasized. Provide high-quality photo albums with patients from a range of ages and ethnic backgrounds. Create a "what our patients say about us" album for written thank-you notes, e-mails, or postprocedure surveys.

"It's very compelling for patients to read about how great you are from other patients, not just from you," Ms. Maley said. The more testimonials, the better. Patient survey data have shown that prospective aesthetic patients associate quantity of patient testimonials with experience and expertise. Consider taking videos of patients who want to share their positive experiences, and put the videos together on a loop to show in the waiting room or post them on a Web site, Ms. Maley suggested.

And don't underestimate the importance of appearing in print.

"Any time you publish or you are quoted, don't miss that opportunity for public relations," she said.

Pull together a collection of quotes and design a PR piece for patient information packets and for the practice's Web site. One way to get written about or interviewed is to send a media kit to local print and TV reporters and to follow up with a personal phone call to pitch story ideas related to your expertise.

"Remember that it is not about you. It is about what you can do for their readers and viewers," Ms. Maley cautioned. "But the PR can really pay off and set you up as an expert in your community."

WASHINGTON — The dermatologists who successfully add aesthetic services to their practices are those who use their expertise to show patients that they are the safe, smart choice, Catherine Maley said at the annual meeting of the American Academy for Facial Plastic and Reconstructive Surgery.

"Aesthetic dermatology is the business of feelings and emotions," said Ms. Maley, president of Cosmetic Image Marketing, a San Francisco-based marketing, public relations, and advertising firm that specializes in helping physicians build aesthetic practices.

"What you want to do is differentiate yourself from the medispas," she pointed out. A dermatologist competing in the aesthetic market should emphasize his or her medical training so patients recognize that they are paying for expertise.

"The aesthetic patient needs to understand that you are not the cheapest: You are the best," she said.

"Think of the psychology of the aesthetic patient. The bottom line is that she wants to look and feel better but she wants peace of mind. She wants to know that she is not going to regret anything and she is going to get a good result every time," Ms. Maley said.

Don't try to compete with medispas on price. Instead, sell the value. "You want those preferred patients who care about safety and credibility," she said.

How do dermatologists sell value? By emphasizing their credentials.

Use the logo from every society to which you belong on your cards, flyers, and promotional materials, including hospital and school affiliations. Put those logos everywhere because it enhances credibility with patients. "If you are board certified, say so in your promotional materials and explain to patients just what that means in terms of extra training," Ms. Maley said.

"If you work with vendors, use those affiliations and let patients know that you have been called on to speak or do research or train others," she added.

Create high-quality promotional handouts and cards to promote the aesthetic practice. A public relations agent can help create promotional materials, or there may be an interested and talented staff member who can design promotional pieces. Be sure to include patient photos and testimonials in your in-office and external promotional material. A dermatologist who is lucky enough to have a celebrity patient should ask for his or her permission to display a photo and short testimonial in the office.

Use testimonials generously, Ms. Maley emphasized. Provide high-quality photo albums with patients from a range of ages and ethnic backgrounds. Create a "what our patients say about us" album for written thank-you notes, e-mails, or postprocedure surveys.

"It's very compelling for patients to read about how great you are from other patients, not just from you," Ms. Maley said. The more testimonials, the better. Patient survey data have shown that prospective aesthetic patients associate quantity of patient testimonials with experience and expertise. Consider taking videos of patients who want to share their positive experiences, and put the videos together on a loop to show in the waiting room or post them on a Web site, Ms. Maley suggested.

And don't underestimate the importance of appearing in print.

"Any time you publish or you are quoted, don't miss that opportunity for public relations," she said.

Pull together a collection of quotes and design a PR piece for patient information packets and for the practice's Web site. One way to get written about or interviewed is to send a media kit to local print and TV reporters and to follow up with a personal phone call to pitch story ideas related to your expertise.

"Remember that it is not about you. It is about what you can do for their readers and viewers," Ms. Maley cautioned. "But the PR can really pay off and set you up as an expert in your community."

WASHINGTON — Preimplantation genetic diagnosis before in vitro fertilization reduced the rate of pregnancy loss for couples with a history of miscarriage after natural conception, and especially for couples with three to five prior miscarriages, according to findings presented at the annual meeting of the American Society for Reproductive Medicine.

“Half of the miscarriages in recurrent pregnancy loss patients are due to aneuploidy,” said John Garrisi, Ph.D., laboratory director of the Institute for Reproductive Medicine and Science at Saint Barnabas in Livingston, N.J.

Previous studies have revealed a higher rate of chromosomal abnormalities in the embryos of patients with recurrent pregnancy losses, compared with age-matched controls, he added.

The effects of both aneuploidy and preimplantation genetic diagnosis (PGD) on pregnancy loss remain controversial. “In any case, we want to reduce the miscarriage rates,” Dr. Garrisi said.

To determine the effectiveness of PGD for reducing pregnancy loss in couples with a history of such losses, Dr. Garrisi and colleagues reviewed data from 135 women with a history of pregnancy loss after natural conception who then underwent IVF and PGD.

The researchers compared the results with those of 117 infertile women with a history of recurrent pregnancy loss after IVF who then underwent PGD, and they also compared the results with those of 45 control patients with a history of recurrent pregnancy loss who underwent IVF without PGD.

Overall, the miscarriage rate after PGD was lower than the predicted loss rate (based on patient history of loss) across all groups. When the data were separated by the number of losses, the greatest difference between the observed loss rate and predicted loss rate was seen among women with histories of three to five losses (41% vs. 24%). The observed and predicted loss rates were 28% vs. 32% among women with histories of two pregnancy losses and 44% vs. 47% among women with histories of more than five pregnancy losses.

But the statistically significant differences appeared in the natural conception group. The observed pregnancy loss rate in these patients after IVF and PGD was 17%, compared with the predicted loss rate of 41%.

The reduction in miscarriage rates was not statistically significant among the infertile women or the controls.

The average age of women in all groups was 37 years. When the data were analyzed by age, the difference between observed and predicted miscarriage rates was significantly greater among women younger than 38 years (18% vs. 33%) compared with women aged 38 years and older (39% vs. 43%).

Of note, the aneuploidy rate was significantly higher in women younger than 37 years compared with women aged 38 and older, independent of the number of pregnancy losses.

As for clinical implications, the lack of a significant reduction in the miscarriage rate for infertile patients who underwent PGD with IVF suggests that other confounding infertility factors may mask potential benefits from preimplantation genetic screening (PGS) to identify abnormal embryos, Dr. Garrisi said.

But Dr. Garrisi noted that he and his colleagues continue to use PGS in ART patients. “For the patients in this group who experience recurrent pregnancy loss, we expect PGS to benefit as PGD does in the spontaneous conception group,” Dr. Garrisi noted.

WASHINGTON — Preimplantation genetic diagnosis before in vitro fertilization reduced the rate of pregnancy loss for couples with a history of miscarriage after natural conception, and especially for couples with three to five prior miscarriages, according to findings presented at the annual meeting of the American Society for Reproductive Medicine.

“Half of the miscarriages in recurrent pregnancy loss patients are due to aneuploidy,” said John Garrisi, Ph.D., laboratory director of the Institute for Reproductive Medicine and Science at Saint Barnabas in Livingston, N.J.

Previous studies have revealed a higher rate of chromosomal abnormalities in the embryos of patients with recurrent pregnancy losses, compared with age-matched controls, he added.

The effects of both aneuploidy and preimplantation genetic diagnosis (PGD) on pregnancy loss remain controversial. “In any case, we want to reduce the miscarriage rates,” Dr. Garrisi said.

To determine the effectiveness of PGD for reducing pregnancy loss in couples with a history of such losses, Dr. Garrisi and colleagues reviewed data from 135 women with a history of pregnancy loss after natural conception who then underwent IVF and PGD.

The researchers compared the results with those of 117 infertile women with a history of recurrent pregnancy loss after IVF who then underwent PGD, and they also compared the results with those of 45 control patients with a history of recurrent pregnancy loss who underwent IVF without PGD.

Overall, the miscarriage rate after PGD was lower than the predicted loss rate (based on patient history of loss) across all groups. When the data were separated by the number of losses, the greatest difference between the observed loss rate and predicted loss rate was seen among women with histories of three to five losses (41% vs. 24%). The observed and predicted loss rates were 28% vs. 32% among women with histories of two pregnancy losses and 44% vs. 47% among women with histories of more than five pregnancy losses.

But the statistically significant differences appeared in the natural conception group. The observed pregnancy loss rate in these patients after IVF and PGD was 17%, compared with the predicted loss rate of 41%.

The reduction in miscarriage rates was not statistically significant among the infertile women or the controls.

The average age of women in all groups was 37 years. When the data were analyzed by age, the difference between observed and predicted miscarriage rates was significantly greater among women younger than 38 years (18% vs. 33%) compared with women aged 38 years and older (39% vs. 43%).

Of note, the aneuploidy rate was significantly higher in women younger than 37 years compared with women aged 38 and older, independent of the number of pregnancy losses.

As for clinical implications, the lack of a significant reduction in the miscarriage rate for infertile patients who underwent PGD with IVF suggests that other confounding infertility factors may mask potential benefits from preimplantation genetic screening (PGS) to identify abnormal embryos, Dr. Garrisi said.

But Dr. Garrisi noted that he and his colleagues continue to use PGS in ART patients. “For the patients in this group who experience recurrent pregnancy loss, we expect PGS to benefit as PGD does in the spontaneous conception group,” Dr. Garrisi noted.

WASHINGTON — Preimplantation genetic diagnosis before in vitro fertilization reduced the rate of pregnancy loss for couples with a history of miscarriage after natural conception, and especially for couples with three to five prior miscarriages, according to findings presented at the annual meeting of the American Society for Reproductive Medicine.

“Half of the miscarriages in recurrent pregnancy loss patients are due to aneuploidy,” said John Garrisi, Ph.D., laboratory director of the Institute for Reproductive Medicine and Science at Saint Barnabas in Livingston, N.J.

Previous studies have revealed a higher rate of chromosomal abnormalities in the embryos of patients with recurrent pregnancy losses, compared with age-matched controls, he added.

The effects of both aneuploidy and preimplantation genetic diagnosis (PGD) on pregnancy loss remain controversial. “In any case, we want to reduce the miscarriage rates,” Dr. Garrisi said.

To determine the effectiveness of PGD for reducing pregnancy loss in couples with a history of such losses, Dr. Garrisi and colleagues reviewed data from 135 women with a history of pregnancy loss after natural conception who then underwent IVF and PGD.

The researchers compared the results with those of 117 infertile women with a history of recurrent pregnancy loss after IVF who then underwent PGD, and they also compared the results with those of 45 control patients with a history of recurrent pregnancy loss who underwent IVF without PGD.

Overall, the miscarriage rate after PGD was lower than the predicted loss rate (based on patient history of loss) across all groups. When the data were separated by the number of losses, the greatest difference between the observed loss rate and predicted loss rate was seen among women with histories of three to five losses (41% vs. 24%). The observed and predicted loss rates were 28% vs. 32% among women with histories of two pregnancy losses and 44% vs. 47% among women with histories of more than five pregnancy losses.

But the statistically significant differences appeared in the natural conception group. The observed pregnancy loss rate in these patients after IVF and PGD was 17%, compared with the predicted loss rate of 41%.

The reduction in miscarriage rates was not statistically significant among the infertile women or the controls.

The average age of women in all groups was 37 years. When the data were analyzed by age, the difference between observed and predicted miscarriage rates was significantly greater among women younger than 38 years (18% vs. 33%) compared with women aged 38 years and older (39% vs. 43%).

Of note, the aneuploidy rate was significantly higher in women younger than 37 years compared with women aged 38 and older, independent of the number of pregnancy losses.

As for clinical implications, the lack of a significant reduction in the miscarriage rate for infertile patients who underwent PGD with IVF suggests that other confounding infertility factors may mask potential benefits from preimplantation genetic screening (PGS) to identify abnormal embryos, Dr. Garrisi said.

But Dr. Garrisi noted that he and his colleagues continue to use PGS in ART patients. “For the patients in this group who experience recurrent pregnancy loss, we expect PGS to benefit as PGD does in the spontaneous conception group,” Dr. Garrisi noted.

WASHINGTON — Children who were conceived from surgically retrieved sperm had no greater risk of cognitive and behavioral problems than did those conceived from ejaculated sperm, according to a study of 3-year follow-up data from 874 children.

Surgically retrieved sperm have been associated with an increased risk of genetic defects in previous studies. Because intracytoplasmic sperm injection (ICSI) is the technique of choice in cases of male infertility, concerns have been raised about an increased risk of developmental delays in children conceived from surgically retrieved sperm.

But the clinical implications of this study are that the origin of the sperm was not a factor in the percentage of IVF children who were at risk for cognitive and behavioral problems, Queenie V. Neri, a biologist at the Center for Reproductive Medicine and Infertility at the Cornell University Medical School, New York, reported in a presentation at the annual meeting of the American Society for Reproductive Medicine.

To investigate the cognitive and behavioral profiles of children conceived using assisted reproductive technology according to sperm origin, Ms. Neri compared data from 74 children conceived via ICSI with surgically retrieved sperm, 516 children conceived via ICSI with ejaculated sperm, and 284 children conceived via IVF but not ICSI.

Ms. Neri worked under the guidance of Dr. Zev Rosenwaks and Dr. Gianpiero D. Palermo, both of Cornell University.

The Ages & Stages Questionnaire (ASQ) and Social Skills Rating System (SSRS) were used to assess the children's communication skills, fine motor skills, gross motor skills, social skills, and problem-solving skills at 3 years of age.

Overall, 87.1% of the children had ASQ scores in the normal range, compared with 12.9% who scored in the at-risk range (meaning at risk for further developmental delays or abnormalities). The at-risk group included 10.4% of the IVF children, 11.4% of the children conceived via ICSI with ejaculated sperm, and significantly fewer (2.8%) of the children conceived via ICSI with surgically retrieved sperm.

Within the subset of at-risk children conceived via ICSI, those conceived from surgically retrieved sperm scored significantly higher on measures of gross and fine-motor skills on the ASQ than did those conceived from ejaculated sperm.

These children also scored higher on measures of communication, problem solving, and personal/social development, but the differences were not statistically significant.

Similarly, 81.8% of the children overall had SSRS scores in the normal range, compared with 18.2% of children in the at-risk range.

The at-risk group included 17.2% of the IVF children, 20.1% of the children conceived via ICSI from ejaculated sperm, and 15.8% of those conceived via ICSI from surgically retrieved sperm.

In the subset of children conceived via ICSI, the percentage of children at risk for problems with social skills was significantly lower among those conceived with surgically retrieved sperm, compared with those who were conceived with ejaculated sperm.

In addition, children who were part of multiple gestations were significantly more likely to be in the at-risk score range for the SSRS in both the IVF (non-ICSI) group and the ICSI group conceived from ejaculated sperm.

However, the difference in at-risk SSRS scores between multiples and singletons was not significant for children who were conceived via ICSI with surgically retrieved sperm.

Although the results from this study suggest that there is no negative association between sperm characteristics and child development, ongoing follow-up is important in detecting malformations that appear after birth, Ms. Neri said.

WASHINGTON — Children who were conceived from surgically retrieved sperm had no greater risk of cognitive and behavioral problems than did those conceived from ejaculated sperm, according to a study of 3-year follow-up data from 874 children.

Surgically retrieved sperm have been associated with an increased risk of genetic defects in previous studies. Because intracytoplasmic sperm injection (ICSI) is the technique of choice in cases of male infertility, concerns have been raised about an increased risk of developmental delays in children conceived from surgically retrieved sperm.

But the clinical implications of this study are that the origin of the sperm was not a factor in the percentage of IVF children who were at risk for cognitive and behavioral problems, Queenie V. Neri, a biologist at the Center for Reproductive Medicine and Infertility at the Cornell University Medical School, New York, reported in a presentation at the annual meeting of the American Society for Reproductive Medicine.

To investigate the cognitive and behavioral profiles of children conceived using assisted reproductive technology according to sperm origin, Ms. Neri compared data from 74 children conceived via ICSI with surgically retrieved sperm, 516 children conceived via ICSI with ejaculated sperm, and 284 children conceived via IVF but not ICSI.

Ms. Neri worked under the guidance of Dr. Zev Rosenwaks and Dr. Gianpiero D. Palermo, both of Cornell University.

The Ages & Stages Questionnaire (ASQ) and Social Skills Rating System (SSRS) were used to assess the children's communication skills, fine motor skills, gross motor skills, social skills, and problem-solving skills at 3 years of age.

Overall, 87.1% of the children had ASQ scores in the normal range, compared with 12.9% who scored in the at-risk range (meaning at risk for further developmental delays or abnormalities). The at-risk group included 10.4% of the IVF children, 11.4% of the children conceived via ICSI with ejaculated sperm, and significantly fewer (2.8%) of the children conceived via ICSI with surgically retrieved sperm.

Within the subset of at-risk children conceived via ICSI, those conceived from surgically retrieved sperm scored significantly higher on measures of gross and fine-motor skills on the ASQ than did those conceived from ejaculated sperm.

These children also scored higher on measures of communication, problem solving, and personal/social development, but the differences were not statistically significant.

Similarly, 81.8% of the children overall had SSRS scores in the normal range, compared with 18.2% of children in the at-risk range.

The at-risk group included 17.2% of the IVF children, 20.1% of the children conceived via ICSI from ejaculated sperm, and 15.8% of those conceived via ICSI from surgically retrieved sperm.

In the subset of children conceived via ICSI, the percentage of children at risk for problems with social skills was significantly lower among those conceived with surgically retrieved sperm, compared with those who were conceived with ejaculated sperm.

In addition, children who were part of multiple gestations were significantly more likely to be in the at-risk score range for the SSRS in both the IVF (non-ICSI) group and the ICSI group conceived from ejaculated sperm.

However, the difference in at-risk SSRS scores between multiples and singletons was not significant for children who were conceived via ICSI with surgically retrieved sperm.

Although the results from this study suggest that there is no negative association between sperm characteristics and child development, ongoing follow-up is important in detecting malformations that appear after birth, Ms. Neri said.

WASHINGTON — Children who were conceived from surgically retrieved sperm had no greater risk of cognitive and behavioral problems than did those conceived from ejaculated sperm, according to a study of 3-year follow-up data from 874 children.

Surgically retrieved sperm have been associated with an increased risk of genetic defects in previous studies. Because intracytoplasmic sperm injection (ICSI) is the technique of choice in cases of male infertility, concerns have been raised about an increased risk of developmental delays in children conceived from surgically retrieved sperm.

But the clinical implications of this study are that the origin of the sperm was not a factor in the percentage of IVF children who were at risk for cognitive and behavioral problems, Queenie V. Neri, a biologist at the Center for Reproductive Medicine and Infertility at the Cornell University Medical School, New York, reported in a presentation at the annual meeting of the American Society for Reproductive Medicine.

To investigate the cognitive and behavioral profiles of children conceived using assisted reproductive technology according to sperm origin, Ms. Neri compared data from 74 children conceived via ICSI with surgically retrieved sperm, 516 children conceived via ICSI with ejaculated sperm, and 284 children conceived via IVF but not ICSI.

Ms. Neri worked under the guidance of Dr. Zev Rosenwaks and Dr. Gianpiero D. Palermo, both of Cornell University.

The Ages & Stages Questionnaire (ASQ) and Social Skills Rating System (SSRS) were used to assess the children's communication skills, fine motor skills, gross motor skills, social skills, and problem-solving skills at 3 years of age.

Overall, 87.1% of the children had ASQ scores in the normal range, compared with 12.9% who scored in the at-risk range (meaning at risk for further developmental delays or abnormalities). The at-risk group included 10.4% of the IVF children, 11.4% of the children conceived via ICSI with ejaculated sperm, and significantly fewer (2.8%) of the children conceived via ICSI with surgically retrieved sperm.

Within the subset of at-risk children conceived via ICSI, those conceived from surgically retrieved sperm scored significantly higher on measures of gross and fine-motor skills on the ASQ than did those conceived from ejaculated sperm.

These children also scored higher on measures of communication, problem solving, and personal/social development, but the differences were not statistically significant.

Similarly, 81.8% of the children overall had SSRS scores in the normal range, compared with 18.2% of children in the at-risk range.

The at-risk group included 17.2% of the IVF children, 20.1% of the children conceived via ICSI from ejaculated sperm, and 15.8% of those conceived via ICSI from surgically retrieved sperm.

In the subset of children conceived via ICSI, the percentage of children at risk for problems with social skills was significantly lower among those conceived with surgically retrieved sperm, compared with those who were conceived with ejaculated sperm.

In addition, children who were part of multiple gestations were significantly more likely to be in the at-risk score range for the SSRS in both the IVF (non-ICSI) group and the ICSI group conceived from ejaculated sperm.

However, the difference in at-risk SSRS scores between multiples and singletons was not significant for children who were conceived via ICSI with surgically retrieved sperm.

Although the results from this study suggest that there is no negative association between sperm characteristics and child development, ongoing follow-up is important in detecting malformations that appear after birth, Ms. Neri said.

Capacitively coupled electrical field stimulation did not significantly shorten the healing time when it was used to treat tibial stress fractures, according to the results of a randomized trial.

Tibial stress fractures have become an increasingly common problem, especially among athletes and military recruits. Few effective management techniques exist to treat stress fractures, but electrical stimulation has been shown to enhance healing of regular fractures, Belinda R. Beck, Ph.D., of Griffith University in Queensland, Australia, and her colleagues wrote.

The investigators conducted a randomized trial that yielded complete results for 19 men and 24 women with acute posteromedial tibial stress fractures. The average ages of the 8 men who received treatment and 11 men who received the placebo were 28 years and 26 years, respectively. The average ages of the 14 women who received treatment and the 10 women who received the placebo were 28 years and 24 years, respectively. More than half of the subjects (10 men and 14 women) reported distance running as their primary sporting activity.

The patients were randomized to receive either actual or sham electrical field stimulation for 15 hours/day until the stress fracture was healed. Healing was defined as the time when a patient could hop on the injured leg to a height of 10 cm for 30 seconds without pain.

Treatment was delivered via a portable, battery-powered capacitively coupled electrical field (CCEF) device worn around the lower leg (Am. J. Sports. Med. 2007 [Epub doi: 10.1177/0363546507310076]). In addition, all patients were instructed to consume one 500-mg chewable calcium supplement each day and to avoid weight-bearing activities.

Overall, no difference in the average time to healing was found between the treatment and placebo groups (29 days vs. 26 days), although women in the treatment group took significantly longer to heal, compared with the men in the treatment group (31 days vs. 23 days). No sex differences in healing times were noted in the placebo group.

But those patients in either group who were the most compliant with their treatment protocols healed significantly faster than those who were less compliant.

More hours of daily device use were significantly associated with a shorter healing time within the test group. Specifically, patients who used the device for more than 12.25 hours/day healed significantly faster than those who used the device for less than 12.25 hours/day. No similar association was noted in the placebo group.

Engaging in more weight-bearing activity (which was noncompliant with instructions to rest and avoid excessive weight-bearing activity) was significantly associated with a longer healing time from baseline in the test group, compared with the placebo group.

Although there were no discernible effects of injury severity on healing within the treatment group, the patients with grades 3 and 4 tibial stress fractures in the treatment group healed 24.5 days faster than patients with grades 3 and 4 tibial stress fractures in the placebo group.

The researchers had no financial conflicts to disclose, but the Ortho-Pak devices used in the study were supplied by Biolectron Inc.

Capacitively coupled electrical field stimulation did not significantly shorten the healing time when it was used to treat tibial stress fractures, according to the results of a randomized trial.

Tibial stress fractures have become an increasingly common problem, especially among athletes and military recruits. Few effective management techniques exist to treat stress fractures, but electrical stimulation has been shown to enhance healing of regular fractures, Belinda R. Beck, Ph.D., of Griffith University in Queensland, Australia, and her colleagues wrote.

The investigators conducted a randomized trial that yielded complete results for 19 men and 24 women with acute posteromedial tibial stress fractures. The average ages of the 8 men who received treatment and 11 men who received the placebo were 28 years and 26 years, respectively. The average ages of the 14 women who received treatment and the 10 women who received the placebo were 28 years and 24 years, respectively. More than half of the subjects (10 men and 14 women) reported distance running as their primary sporting activity.

The patients were randomized to receive either actual or sham electrical field stimulation for 15 hours/day until the stress fracture was healed. Healing was defined as the time when a patient could hop on the injured leg to a height of 10 cm for 30 seconds without pain.

Treatment was delivered via a portable, battery-powered capacitively coupled electrical field (CCEF) device worn around the lower leg (Am. J. Sports. Med. 2007 [Epub doi: 10.1177/0363546507310076]). In addition, all patients were instructed to consume one 500-mg chewable calcium supplement each day and to avoid weight-bearing activities.

Overall, no difference in the average time to healing was found between the treatment and placebo groups (29 days vs. 26 days), although women in the treatment group took significantly longer to heal, compared with the men in the treatment group (31 days vs. 23 days). No sex differences in healing times were noted in the placebo group.

But those patients in either group who were the most compliant with their treatment protocols healed significantly faster than those who were less compliant.

More hours of daily device use were significantly associated with a shorter healing time within the test group. Specifically, patients who used the device for more than 12.25 hours/day healed significantly faster than those who used the device for less than 12.25 hours/day. No similar association was noted in the placebo group.

Engaging in more weight-bearing activity (which was noncompliant with instructions to rest and avoid excessive weight-bearing activity) was significantly associated with a longer healing time from baseline in the test group, compared with the placebo group.

Although there were no discernible effects of injury severity on healing within the treatment group, the patients with grades 3 and 4 tibial stress fractures in the treatment group healed 24.5 days faster than patients with grades 3 and 4 tibial stress fractures in the placebo group.

The researchers had no financial conflicts to disclose, but the Ortho-Pak devices used in the study were supplied by Biolectron Inc.

Capacitively coupled electrical field stimulation did not significantly shorten the healing time when it was used to treat tibial stress fractures, according to the results of a randomized trial.

Tibial stress fractures have become an increasingly common problem, especially among athletes and military recruits. Few effective management techniques exist to treat stress fractures, but electrical stimulation has been shown to enhance healing of regular fractures, Belinda R. Beck, Ph.D., of Griffith University in Queensland, Australia, and her colleagues wrote.

The investigators conducted a randomized trial that yielded complete results for 19 men and 24 women with acute posteromedial tibial stress fractures. The average ages of the 8 men who received treatment and 11 men who received the placebo were 28 years and 26 years, respectively. The average ages of the 14 women who received treatment and the 10 women who received the placebo were 28 years and 24 years, respectively. More than half of the subjects (10 men and 14 women) reported distance running as their primary sporting activity.

The patients were randomized to receive either actual or sham electrical field stimulation for 15 hours/day until the stress fracture was healed. Healing was defined as the time when a patient could hop on the injured leg to a height of 10 cm for 30 seconds without pain.

Treatment was delivered via a portable, battery-powered capacitively coupled electrical field (CCEF) device worn around the lower leg (Am. J. Sports. Med. 2007 [Epub doi: 10.1177/0363546507310076]). In addition, all patients were instructed to consume one 500-mg chewable calcium supplement each day and to avoid weight-bearing activities.

Overall, no difference in the average time to healing was found between the treatment and placebo groups (29 days vs. 26 days), although women in the treatment group took significantly longer to heal, compared with the men in the treatment group (31 days vs. 23 days). No sex differences in healing times were noted in the placebo group.

But those patients in either group who were the most compliant with their treatment protocols healed significantly faster than those who were less compliant.

More hours of daily device use were significantly associated with a shorter healing time within the test group. Specifically, patients who used the device for more than 12.25 hours/day healed significantly faster than those who used the device for less than 12.25 hours/day. No similar association was noted in the placebo group.

Engaging in more weight-bearing activity (which was noncompliant with instructions to rest and avoid excessive weight-bearing activity) was significantly associated with a longer healing time from baseline in the test group, compared with the placebo group.

Although there were no discernible effects of injury severity on healing within the treatment group, the patients with grades 3 and 4 tibial stress fractures in the treatment group healed 24.5 days faster than patients with grades 3 and 4 tibial stress fractures in the placebo group.

The researchers had no financial conflicts to disclose, but the Ortho-Pak devices used in the study were supplied by Biolectron Inc.

Use of helmets by skiers and snowboarders could reduce head injury risk–a leading cause of injury and death in this population–by as much as 60%, according to the findings of a meta-analysis.

To characterize traumatic brain injuries (TBI) and spinal cord injuries (SCI) in skiers and snowboarders and to assess prevention strategies, Alun Ackery, a medical student at the University of Toronto and colleagues reviewed 24 articles from 10 countries published between January 1990 and December 2004 that were associated with skiing, snowboarding, or both.

The findings show an increasing incidence of both TBI and SCI, in part because of the growing popularity of high-speed and acrobatic maneuvers on skis and snowboards (Inj. Prev. 2007;13[6]:368-75).

A study from the United States found that 88% of all skiing and snowboarding deaths resulted from head injuries, based on data from a trauma registry. And a Canadian study found that a majority of SCIs occurred among expert snowboarders during jumps ranging from 2 feet to 25 feet.

Young men sustain the most head and spine injuries from skiing and snowboarding, according to several studies in the meta-analysis. A study of data from two complete ski seasons in British Columbia, Canada, found that 70% of SCIs in skiers and 100% of SCIs in snowboarders occurred in men. The mean age of the injured male skiers was 35 years and the mean age of the injured snowboarders was 22 years.

In addition, data from a 10-year study conducted by researchers at the Innsbruck (Austria) University Hospital showed an increase in winter sports injuries between 1982 and 1992 that could be attributed to speed and collisions, and that nearly 40% of spinal injuries from winter sports occurred in young men aged 15-25 years.

Data from the Consumer Product Safety Commission showed an increased percentage of head injuries in skiers from 12% in 1993 to 15% in 1997, and the estimated number of head injuries in snowboarders jumped from 1,000 in 1993 to 5,200 in 1997. Head injuries accounted for 14% of all ski and snowboard injuries in children and teens aged 15 years and younger.

Additional data from the commission suggest that wearing a helmet could prevent 44% of head injuries while skiing or snowboarding and reduce head injuries in children and teens aged 15 years and younger by 53%. But many countries have no standards for helmet use in these sports.

The researchers recommended the use of helmets “by all skiing and snowboarding participants [and] the promotion and enforcement of standards for ski and snowboarding helmets in countries in which these activities are common.”

Although some concerns have been raised about increased risk of cervical spine injuries in children caused by helmet use, the accident data don't support this risk. And parents should be cautioned that helmets should be properly fitted to the child's current size, not bought larger to allow “room to grow,” the researchers noted.

Most countries do not require skiers or snowboarders to wear a helmet, even though doing so would reduce head injuries. CEZARY MACIOCHA/FOTOLIA

Use of helmets by skiers and snowboarders could reduce head injury risk–a leading cause of injury and death in this population–by as much as 60%, according to the findings of a meta-analysis.

To characterize traumatic brain injuries (TBI) and spinal cord injuries (SCI) in skiers and snowboarders and to assess prevention strategies, Alun Ackery, a medical student at the University of Toronto and colleagues reviewed 24 articles from 10 countries published between January 1990 and December 2004 that were associated with skiing, snowboarding, or both.

The findings show an increasing incidence of both TBI and SCI, in part because of the growing popularity of high-speed and acrobatic maneuvers on skis and snowboards (Inj. Prev. 2007;13[6]:368-75).

A study from the United States found that 88% of all skiing and snowboarding deaths resulted from head injuries, based on data from a trauma registry. And a Canadian study found that a majority of SCIs occurred among expert snowboarders during jumps ranging from 2 feet to 25 feet.

Young men sustain the most head and spine injuries from skiing and snowboarding, according to several studies in the meta-analysis. A study of data from two complete ski seasons in British Columbia, Canada, found that 70% of SCIs in skiers and 100% of SCIs in snowboarders occurred in men. The mean age of the injured male skiers was 35 years and the mean age of the injured snowboarders was 22 years.

In addition, data from a 10-year study conducted by researchers at the Innsbruck (Austria) University Hospital showed an increase in winter sports injuries between 1982 and 1992 that could be attributed to speed and collisions, and that nearly 40% of spinal injuries from winter sports occurred in young men aged 15-25 years.

Data from the Consumer Product Safety Commission showed an increased percentage of head injuries in skiers from 12% in 1993 to 15% in 1997, and the estimated number of head injuries in snowboarders jumped from 1,000 in 1993 to 5,200 in 1997. Head injuries accounted for 14% of all ski and snowboard injuries in children and teens aged 15 years and younger.

Additional data from the commission suggest that wearing a helmet could prevent 44% of head injuries while skiing or snowboarding and reduce head injuries in children and teens aged 15 years and younger by 53%. But many countries have no standards for helmet use in these sports.

The researchers recommended the use of helmets “by all skiing and snowboarding participants [and] the promotion and enforcement of standards for ski and snowboarding helmets in countries in which these activities are common.”

Although some concerns have been raised about increased risk of cervical spine injuries in children caused by helmet use, the accident data don't support this risk. And parents should be cautioned that helmets should be properly fitted to the child's current size, not bought larger to allow “room to grow,” the researchers noted.

Most countries do not require skiers or snowboarders to wear a helmet, even though doing so would reduce head injuries. CEZARY MACIOCHA/FOTOLIA

Use of helmets by skiers and snowboarders could reduce head injury risk–a leading cause of injury and death in this population–by as much as 60%, according to the findings of a meta-analysis.

To characterize traumatic brain injuries (TBI) and spinal cord injuries (SCI) in skiers and snowboarders and to assess prevention strategies, Alun Ackery, a medical student at the University of Toronto and colleagues reviewed 24 articles from 10 countries published between January 1990 and December 2004 that were associated with skiing, snowboarding, or both.

The findings show an increasing incidence of both TBI and SCI, in part because of the growing popularity of high-speed and acrobatic maneuvers on skis and snowboards (Inj. Prev. 2007;13[6]:368-75).

A study from the United States found that 88% of all skiing and snowboarding deaths resulted from head injuries, based on data from a trauma registry. And a Canadian study found that a majority of SCIs occurred among expert snowboarders during jumps ranging from 2 feet to 25 feet.

Young men sustain the most head and spine injuries from skiing and snowboarding, according to several studies in the meta-analysis. A study of data from two complete ski seasons in British Columbia, Canada, found that 70% of SCIs in skiers and 100% of SCIs in snowboarders occurred in men. The mean age of the injured male skiers was 35 years and the mean age of the injured snowboarders was 22 years.

In addition, data from a 10-year study conducted by researchers at the Innsbruck (Austria) University Hospital showed an increase in winter sports injuries between 1982 and 1992 that could be attributed to speed and collisions, and that nearly 40% of spinal injuries from winter sports occurred in young men aged 15-25 years.

Data from the Consumer Product Safety Commission showed an increased percentage of head injuries in skiers from 12% in 1993 to 15% in 1997, and the estimated number of head injuries in snowboarders jumped from 1,000 in 1993 to 5,200 in 1997. Head injuries accounted for 14% of all ski and snowboard injuries in children and teens aged 15 years and younger.

Additional data from the commission suggest that wearing a helmet could prevent 44% of head injuries while skiing or snowboarding and reduce head injuries in children and teens aged 15 years and younger by 53%. But many countries have no standards for helmet use in these sports.

The researchers recommended the use of helmets “by all skiing and snowboarding participants [and] the promotion and enforcement of standards for ski and snowboarding helmets in countries in which these activities are common.”

Although some concerns have been raised about increased risk of cervical spine injuries in children caused by helmet use, the accident data don't support this risk. And parents should be cautioned that helmets should be properly fitted to the child's current size, not bought larger to allow “room to grow,” the researchers noted.

Most countries do not require skiers or snowboarders to wear a helmet, even though doing so would reduce head injuries. CEZARY MACIOCHA/FOTOLIA

Vitamin D deficiency may increase the risk of cardiovascular disease in adults, especially in people who also have hypertension, based on data from the Framingham Offspring Study.

More studies are needed to show whether correcting vitamin D deficiency could prevent or reduce the risk of cardiovascular disease, but the clinical implication of the finding is that correcting the deficiency, which is prevalent worldwide, could have a significant effect on public health, according to the study's authors.

Previous clinical studies have shown associations between lower levels of vitamin D and an increased risk of problems including prevalent cardiovascular disease, coronary artery calcification, and plasma renin activity (an indicator of high blood pressure). These associations may occur in part because vitamin D receptors are found in a range of tissues including vascular smooth muscle tissue, the lining of the interior surface of blood vessels, and heart muscle tissue.

But more data are needed to show whether vitamin D deficiency is a result of cardiovascular disease or a contributing factor. To determine the relationship between vitamin D status and the incidence of cardiovascular events in a population with no history of cardiovascular disease, Dr. Thomas J. Wang of Harvard Medical School, Boston, and his colleagues followed 1,739 participants in the Framingham Offspring Study for at least 5 years. The average age of the participants was 59 years, 55% were women, and all were white. The study consists of the children of participants in the original Framingham Heart Study that began in 1948.

In this study, a 25-hydroxyvitamin D (25-OH D) level lower than 15 ng/mL was used to define vitamin D deficiency. This value was chosen for consistency with other cross-sectional studies of the Framingham data and with hospital-based samples, although 25-OH D levels greater than 30 ng/mL are considered preferable for promoting bone metabolism, the researchers noted.

At the start of the study, 28% of the participants had 25-OH D levels lower than 15 ng/mL, and 9% had levels lower than 10 ng/mL (Circulation 2008 Jan. 29 [Epub doi:10.1161/circulationaha.107.706127]).

A total of 120 participants had a cardiovascular event after an average of 5.4 years of follow-up (approximately 8,069 person-years). Overall, those with 25-OH D levels lower than 15 ng/mL were significantly more likely to have had a cardiovascular event than were those whose 25-OH D levels were 15 ng/mL or higher. After adjusting for age and sex, the 5-year incidence rate was more than twice as high in those with 25-OH D levels lower than 15 ng/mL than in those with higher levels (4.4 vs. 8.9).

In particular, the highest rates of cardiovascular event risk were observed in subjects with hypertension as well as vitamin D deficiency. The 5-year rate of cardiovascular disease was more than twice as high in the subjects with hypertension and vitamin D deficiency, compared with the hypertensive subjects who were not vitamin D deficient (5.8 vs. 14.2).

Furthermore, the higher cardiovascular risk appeared to increase as vitamin D decreased in the hypertensive patients. When vitamin D levels were divided into three categories, the hazard ratios were 1.00, 1.93, and 2.51 for those with 25-OH D levels of 15 ng/mL or higher, 10-15 ng/mL, and lower than 10 ng/mL, respectively. But no similar progressions across categories of 25-OH D deficiency were noted among nonhypertensive subjects.

The cardiovascular events included 65 fatal or nonfatal coronary heart disease events, 28 fatal or nonfatal cerebrovascular events, 19 cases of heart failure, and 8 instances of claudication.

The study was limited because not all variables that affect vitamin D were measured. But using an objective measure of vitamin D (25-OH D) rather than relying on subjects' self-reports of vitamin D intake makes the findings stronger.

Although the findings suggest that treating vitamin D deficiency could reduce the risk of heart disease, the findings are not enough to advise a treatment plan, and more clinical and experimental research is needed. The study was supported in part by grants from the American Heart Association, the U.S. Department of Agriculture, and the National Institutes of Health. Dr. Wang, the lead author, had no financial conflicts to disclose.

Vitamin D deficiency may increase the risk of cardiovascular disease in adults, especially in people who also have hypertension, based on data from the Framingham Offspring Study.

More studies are needed to show whether correcting vitamin D deficiency could prevent or reduce the risk of cardiovascular disease, but the clinical implication of the finding is that correcting the deficiency, which is prevalent worldwide, could have a significant effect on public health, according to the study's authors.

Previous clinical studies have shown associations between lower levels of vitamin D and an increased risk of problems including prevalent cardiovascular disease, coronary artery calcification, and plasma renin activity (an indicator of high blood pressure). These associations may occur in part because vitamin D receptors are found in a range of tissues including vascular smooth muscle tissue, the lining of the interior surface of blood vessels, and heart muscle tissue.

But more data are needed to show whether vitamin D deficiency is a result of cardiovascular disease or a contributing factor. To determine the relationship between vitamin D status and the incidence of cardiovascular events in a population with no history of cardiovascular disease, Dr. Thomas J. Wang of Harvard Medical School, Boston, and his colleagues followed 1,739 participants in the Framingham Offspring Study for at least 5 years. The average age of the participants was 59 years, 55% were women, and all were white. The study consists of the children of participants in the original Framingham Heart Study that began in 1948.

In this study, a 25-hydroxyvitamin D (25-OH D) level lower than 15 ng/mL was used to define vitamin D deficiency. This value was chosen for consistency with other cross-sectional studies of the Framingham data and with hospital-based samples, although 25-OH D levels greater than 30 ng/mL are considered preferable for promoting bone metabolism, the researchers noted.

At the start of the study, 28% of the participants had 25-OH D levels lower than 15 ng/mL, and 9% had levels lower than 10 ng/mL (Circulation 2008 Jan. 29 [Epub doi:10.1161/circulationaha.107.706127]).

A total of 120 participants had a cardiovascular event after an average of 5.4 years of follow-up (approximately 8,069 person-years). Overall, those with 25-OH D levels lower than 15 ng/mL were significantly more likely to have had a cardiovascular event than were those whose 25-OH D levels were 15 ng/mL or higher. After adjusting for age and sex, the 5-year incidence rate was more than twice as high in those with 25-OH D levels lower than 15 ng/mL than in those with higher levels (4.4 vs. 8.9).

In particular, the highest rates of cardiovascular event risk were observed in subjects with hypertension as well as vitamin D deficiency. The 5-year rate of cardiovascular disease was more than twice as high in the subjects with hypertension and vitamin D deficiency, compared with the hypertensive subjects who were not vitamin D deficient (5.8 vs. 14.2).

Furthermore, the higher cardiovascular risk appeared to increase as vitamin D decreased in the hypertensive patients. When vitamin D levels were divided into three categories, the hazard ratios were 1.00, 1.93, and 2.51 for those with 25-OH D levels of 15 ng/mL or higher, 10-15 ng/mL, and lower than 10 ng/mL, respectively. But no similar progressions across categories of 25-OH D deficiency were noted among nonhypertensive subjects.

The cardiovascular events included 65 fatal or nonfatal coronary heart disease events, 28 fatal or nonfatal cerebrovascular events, 19 cases of heart failure, and 8 instances of claudication.

The study was limited because not all variables that affect vitamin D were measured. But using an objective measure of vitamin D (25-OH D) rather than relying on subjects' self-reports of vitamin D intake makes the findings stronger.

Although the findings suggest that treating vitamin D deficiency could reduce the risk of heart disease, the findings are not enough to advise a treatment plan, and more clinical and experimental research is needed. The study was supported in part by grants from the American Heart Association, the U.S. Department of Agriculture, and the National Institutes of Health. Dr. Wang, the lead author, had no financial conflicts to disclose.

Vitamin D deficiency may increase the risk of cardiovascular disease in adults, especially in people who also have hypertension, based on data from the Framingham Offspring Study.

More studies are needed to show whether correcting vitamin D deficiency could prevent or reduce the risk of cardiovascular disease, but the clinical implication of the finding is that correcting the deficiency, which is prevalent worldwide, could have a significant effect on public health, according to the study's authors.

Previous clinical studies have shown associations between lower levels of vitamin D and an increased risk of problems including prevalent cardiovascular disease, coronary artery calcification, and plasma renin activity (an indicator of high blood pressure). These associations may occur in part because vitamin D receptors are found in a range of tissues including vascular smooth muscle tissue, the lining of the interior surface of blood vessels, and heart muscle tissue.

But more data are needed to show whether vitamin D deficiency is a result of cardiovascular disease or a contributing factor. To determine the relationship between vitamin D status and the incidence of cardiovascular events in a population with no history of cardiovascular disease, Dr. Thomas J. Wang of Harvard Medical School, Boston, and his colleagues followed 1,739 participants in the Framingham Offspring Study for at least 5 years. The average age of the participants was 59 years, 55% were women, and all were white. The study consists of the children of participants in the original Framingham Heart Study that began in 1948.

In this study, a 25-hydroxyvitamin D (25-OH D) level lower than 15 ng/mL was used to define vitamin D deficiency. This value was chosen for consistency with other cross-sectional studies of the Framingham data and with hospital-based samples, although 25-OH D levels greater than 30 ng/mL are considered preferable for promoting bone metabolism, the researchers noted.

At the start of the study, 28% of the participants had 25-OH D levels lower than 15 ng/mL, and 9% had levels lower than 10 ng/mL (Circulation 2008 Jan. 29 [Epub doi:10.1161/circulationaha.107.706127]).

A total of 120 participants had a cardiovascular event after an average of 5.4 years of follow-up (approximately 8,069 person-years). Overall, those with 25-OH D levels lower than 15 ng/mL were significantly more likely to have had a cardiovascular event than were those whose 25-OH D levels were 15 ng/mL or higher. After adjusting for age and sex, the 5-year incidence rate was more than twice as high in those with 25-OH D levels lower than 15 ng/mL than in those with higher levels (4.4 vs. 8.9).

In particular, the highest rates of cardiovascular event risk were observed in subjects with hypertension as well as vitamin D deficiency. The 5-year rate of cardiovascular disease was more than twice as high in the subjects with hypertension and vitamin D deficiency, compared with the hypertensive subjects who were not vitamin D deficient (5.8 vs. 14.2).

Furthermore, the higher cardiovascular risk appeared to increase as vitamin D decreased in the hypertensive patients. When vitamin D levels were divided into three categories, the hazard ratios were 1.00, 1.93, and 2.51 for those with 25-OH D levels of 15 ng/mL or higher, 10-15 ng/mL, and lower than 10 ng/mL, respectively. But no similar progressions across categories of 25-OH D deficiency were noted among nonhypertensive subjects.

The cardiovascular events included 65 fatal or nonfatal coronary heart disease events, 28 fatal or nonfatal cerebrovascular events, 19 cases of heart failure, and 8 instances of claudication.

The study was limited because not all variables that affect vitamin D were measured. But using an objective measure of vitamin D (25-OH D) rather than relying on subjects' self-reports of vitamin D intake makes the findings stronger.

Although the findings suggest that treating vitamin D deficiency could reduce the risk of heart disease, the findings are not enough to advise a treatment plan, and more clinical and experimental research is needed. The study was supported in part by grants from the American Heart Association, the U.S. Department of Agriculture, and the National Institutes of Health. Dr. Wang, the lead author, had no financial conflicts to disclose.

WASHINGTON — Postmenopausal women who took a low-dose estrogen/progestin hormone therapy 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 mean triglycerides, from 129 mg/dL at baseline to 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.

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

High triglycerides may be a cause for concern, but the triglycerides in this study did not reach unhealthy levels (above 200 mg/dL).

Although the findings were limited by a small number of patients and a short follow-up period, the preliminary results from this ongoing study suggest that a 17β-estradiol/trimegestone combination may provide enough relief from menopausal symptoms to outweigh the potential risks of increased triglycerides in the absence of other adverse effects on lipid profiles.

WASHINGTON — Postmenopausal women who took a low-dose estrogen/progestin hormone therapy 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 mean triglycerides, from 129 mg/dL at baseline to 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.

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

High triglycerides may be a cause for concern, but the triglycerides in this study did not reach unhealthy levels (above 200 mg/dL).

Although the findings were limited by a small number of patients and a short follow-up period, the preliminary results from this ongoing study suggest that a 17β-estradiol/trimegestone combination may provide enough relief from menopausal symptoms to outweigh the potential risks of increased triglycerides in the absence of other adverse effects on lipid profiles.

WASHINGTON — Postmenopausal women who took a low-dose estrogen/progestin hormone therapy 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 mean triglycerides, from 129 mg/dL at baseline to 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.

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

High triglycerides may be a cause for concern, but the triglycerides in this study did not reach unhealthy levels (above 200 mg/dL).

Although the findings were limited by a small number of patients and a short follow-up period, the preliminary results from this ongoing study suggest that a 17β-estradiol/trimegestone combination may provide enough relief from menopausal symptoms to outweigh the potential risks of increased triglycerides in the absence of other adverse effects on lipid profiles.

Peripheral visual field loss significantly increased the risk of falling in older adults, according to data from 2,375 community-dwelling adults aged 65 to 84 years.

Poor vision has been implicated in falls in previous studies, and many interventions to prevent falls in the elderly have included vision assessments. But few studies have examined the specific types of vision loss that contribute most to the risk of falling, according to the Salisbury Eye Evaluation (SEE) study.

Ellen E. Freeman, Ph.D., of the Wilmer Eye Institute at Johns Hopkins University in Baltimore, Md., and her colleagues tested the vision of community-dwelling elderly SEE participants and then prospectively collected their reports of falls for up to 20 months. The average follow-up period was 17 months (Invest. Ophthalmol. Vis. Sci. 2007;48:4445–50).

At least 4 months of follow-up data were available for 2,312 participants, of whom 680 (29%) reported at least one fall during the follow-up period.

Total visual field loss was the only visual element that significantly increased the risk of falling. For every 10% loss in visual field, the participants were 8% more likely to fall after adjusting for demographic and health variables. When visual field loss was broken down into central and peripheral, only peripheral visual field loss remained significantly associated with fall risk (participants were 6% more likely to fall). Central visual field loss was associated with increased fall risk but did not reach statistical significance. The researchers were not able to determine whether the upper or lower peripheral visual field was more important.

Neither visual acuity nor contrast sensitivity was significantly associated with increased fall risk. Nonvision variables that were independently associated with fall risk when combined with total visual field loss included poor balance, depression, sedative use, a history of stroke, Parkinson's disease, or arthritis, and being white and female.

The circumstances of the first reported falls were available for 743 participants. Of these, 50% said they were performing a “mildly displacing” activity such as standing or walking, compared with 46% who said that they were reaching, bending, or stepping (a “moderately displacing” activity) when the falls occurred. And 4% reported that the falls occurred during a “markedly displacing” activity such as climbing or participating in sports. The proportion of individuals in the study who had at least one fall in the study was consistent with findings in other community-based studies, according to the researchers.

“Visual field reduction is most likely related to the risk of falls, at least in part, through its effects on postural stability and the ability to maneuver around objects,” they wrote. “Persons with such deficits may benefit from mobility training to navigate the environment more safely and reduce the risk of falling.”

The researchers had no financial conflicts to disclose.

Peripheral visual field loss significantly increased the risk of falling in older adults, according to data from 2,375 community-dwelling adults aged 65 to 84 years.

Poor vision has been implicated in falls in previous studies, and many interventions to prevent falls in the elderly have included vision assessments. But few studies have examined the specific types of vision loss that contribute most to the risk of falling, according to the Salisbury Eye Evaluation (SEE) study.

Ellen E. Freeman, Ph.D., of the Wilmer Eye Institute at Johns Hopkins University in Baltimore, Md., and her colleagues tested the vision of community-dwelling elderly SEE participants and then prospectively collected their reports of falls for up to 20 months. The average follow-up period was 17 months (Invest. Ophthalmol. Vis. Sci. 2007;48:4445–50).

At least 4 months of follow-up data were available for 2,312 participants, of whom 680 (29%) reported at least one fall during the follow-up period.

Total visual field loss was the only visual element that significantly increased the risk of falling. For every 10% loss in visual field, the participants were 8% more likely to fall after adjusting for demographic and health variables. When visual field loss was broken down into central and peripheral, only peripheral visual field loss remained significantly associated with fall risk (participants were 6% more likely to fall). Central visual field loss was associated with increased fall risk but did not reach statistical significance. The researchers were not able to determine whether the upper or lower peripheral visual field was more important.

Neither visual acuity nor contrast sensitivity was significantly associated with increased fall risk. Nonvision variables that were independently associated with fall risk when combined with total visual field loss included poor balance, depression, sedative use, a history of stroke, Parkinson's disease, or arthritis, and being white and female.

The circumstances of the first reported falls were available for 743 participants. Of these, 50% said they were performing a “mildly displacing” activity such as standing or walking, compared with 46% who said that they were reaching, bending, or stepping (a “moderately displacing” activity) when the falls occurred. And 4% reported that the falls occurred during a “markedly displacing” activity such as climbing or participating in sports. The proportion of individuals in the study who had at least one fall in the study was consistent with findings in other community-based studies, according to the researchers.

“Visual field reduction is most likely related to the risk of falls, at least in part, through its effects on postural stability and the ability to maneuver around objects,” they wrote. “Persons with such deficits may benefit from mobility training to navigate the environment more safely and reduce the risk of falling.”

The researchers had no financial conflicts to disclose.

Peripheral visual field loss significantly increased the risk of falling in older adults, according to data from 2,375 community-dwelling adults aged 65 to 84 years.

Poor vision has been implicated in falls in previous studies, and many interventions to prevent falls in the elderly have included vision assessments. But few studies have examined the specific types of vision loss that contribute most to the risk of falling, according to the Salisbury Eye Evaluation (SEE) study.

Ellen E. Freeman, Ph.D., of the Wilmer Eye Institute at Johns Hopkins University in Baltimore, Md., and her colleagues tested the vision of community-dwelling elderly SEE participants and then prospectively collected their reports of falls for up to 20 months. The average follow-up period was 17 months (Invest. Ophthalmol. Vis. Sci. 2007;48:4445–50).

At least 4 months of follow-up data were available for 2,312 participants, of whom 680 (29%) reported at least one fall during the follow-up period.

Total visual field loss was the only visual element that significantly increased the risk of falling. For every 10% loss in visual field, the participants were 8% more likely to fall after adjusting for demographic and health variables. When visual field loss was broken down into central and peripheral, only peripheral visual field loss remained significantly associated with fall risk (participants were 6% more likely to fall). Central visual field loss was associated with increased fall risk but did not reach statistical significance. The researchers were not able to determine whether the upper or lower peripheral visual field was more important.

Neither visual acuity nor contrast sensitivity was significantly associated with increased fall risk. Nonvision variables that were independently associated with fall risk when combined with total visual field loss included poor balance, depression, sedative use, a history of stroke, Parkinson's disease, or arthritis, and being white and female.

The circumstances of the first reported falls were available for 743 participants. Of these, 50% said they were performing a “mildly displacing” activity such as standing or walking, compared with 46% who said that they were reaching, bending, or stepping (a “moderately displacing” activity) when the falls occurred. And 4% reported that the falls occurred during a “markedly displacing” activity such as climbing or participating in sports. The proportion of individuals in the study who had at least one fall in the study was consistent with findings in other community-based studies, according to the researchers.

“Visual field reduction is most likely related to the risk of falls, at least in part, through its effects on postural stability and the ability to maneuver around objects,” they wrote. “Persons with such deficits may benefit from mobility training to navigate the environment more safely and reduce the risk of falling.”

The researchers had no financial conflicts to disclose.

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 a day received a combination of 1 mg 17β-estradiol and 0.125 mg trimegestone orally each day for 6 months. Women without an intact uterus, with known or suspected breast cancer, or with abnormal bleeding were excluded.

Patient scores on the MENQOL (a questionnaire designed 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. Scores on the Blatt-Kupperman menopausal index dropped from an average of 40 at baseline to an average of 8 after 6 months. The average total cholesterol was stable between baseline and 6 months. Blood glucose, body weight, and body mass index were essentially also unchanged.

The preliminary results suggest the combination may provide enough relief from menopausal symptoms to outweigh the potential risks of increased triglycerides in the absence of other adverse effects on lipid profiles.

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 a day received a combination of 1 mg 17β-estradiol and 0.125 mg trimegestone orally each day for 6 months. Women without an intact uterus, with known or suspected breast cancer, or with abnormal bleeding were excluded.

Patient scores on the MENQOL (a questionnaire designed 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. Scores on the Blatt-Kupperman menopausal index dropped from an average of 40 at baseline to an average of 8 after 6 months. The average total cholesterol was stable between baseline and 6 months. Blood glucose, body weight, and body mass index were essentially also unchanged.

The preliminary results suggest the combination may provide enough relief from menopausal symptoms to outweigh the potential risks of increased triglycerides in the absence of other adverse effects on lipid profiles.

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 a day received a combination of 1 mg 17β-estradiol and 0.125 mg trimegestone orally each day for 6 months. Women without an intact uterus, with known or suspected breast cancer, or with abnormal bleeding were excluded.

Patient scores on the MENQOL (a questionnaire designed 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. Scores on the Blatt-Kupperman menopausal index dropped from an average of 40 at baseline to an average of 8 after 6 months. The average total cholesterol was stable between baseline and 6 months. Blood glucose, body weight, and body mass index were essentially also unchanged.

The preliminary results suggest the combination may provide enough relief from menopausal symptoms to outweigh the potential risks of increased triglycerides in the absence of other adverse effects on lipid profiles.