Heidi Splete

Most patients with heart conditions don't need to take antibiotics to reduce the risk of infection prior to a dental procedure, according to revised American Heart Association guidelines.

The previous recommendations advised that patients with any heart abnormality, from mild valve prolapse to severe birth defects, should take amoxicillin prior to a dental procedure to reduce the risk of developing infective endocarditis (IE). Many types of fungi and bacteria can cause the infection, and dental procedures had been seen as opening the door for these organisms to attack vulnerable patients.

But the guidelines writing group, led by Dr. Walter Wilson of the Mayo Clinic in Rochester, Minn., reviewed the latest research and found no significant evidence that taking antibiotics before a dental procedure prevents IE in patients who are at risk for infections (Circulation 2007 May 8 [Epub doi:10.1161/circulationaha.106.183095]).

In addition, no prospective randomized, placebo-controlled studies have shown that antibiotic use prior to a dental procedure prevents IE. And daily activities such as toothbrushing and flossing cause transient bacteremia. (See story below.)

In fact, severe adverse events resulting from IE are associated with only a small subgroup of cardiac conditions, the writing group noted, and these patients should continue to receive antibiotics prior to dental procedures.

Patients who should receive antibiotics prior to dental procedures are those with prosthetic cardiac valves or previous episodes of infective endocarditis, and heart transplant patients with abnormal cardiac valves.

In addition, patients who meet the following criteria should receive antibiotics prior to dental procedures:

▸ Patients with repaired congenital heart disease (CHD) who have remaining defects at or near the site of a patch or prosthetic that inhibit the healing of the inner surfaces of the heart vessels.

▸ Patients with unrepaired cyanotic CHD, including those with palliative shunts or conduits.

▸ Patients with repaired CHD with no remaining defects who are within 6 months of the procedure (because the inner vessel surfaces are still healing).

Such patients should receive antibiotics prior to any dental procedure that involves work on the gums, the apex of the tooth, or perforation of oral mucosa. The guidelines apply to children as well as adults and have been endorsed by the Infectious Diseases Society of America, Pediatric Infectious Disease Society, and American Dental Association.

The previous guidelines, last revised in 1997, called for 2 g of amoxicillin to be given orally 1 hour before a procedure. But amoxicillin use carries risks of its own, including fostering the development of amoxicillin-resistant organisms, and data have not supported any reduced risk of IE as a result of prophylactic antibiotic use prior to dental procedures.

The new guidelines emphasize that antibiotic use should be based on the odds of a heart patient having a severe adverse reaction if he or she developed IE, rather than lumping all heart patients together as being at increased risk for IE.

“In fact, maintaining good oral health and hygiene appears to be more protective than prophylactic antibiotics,” Dr. Wilson said in a statement. Dr. Wilson had no financial disclosures related to his work on the guidelines.

Similarly, only cardiac patients who meet the above criteria need to receive antibiotics prior to respiratory tract, skin, or musculoskeletal procedures, according to the new guidelines.

Physicians might need to reassure patients with heart conditions other than the high-risk conditions specified in the guidelines that their risk for developing IE is low, and remind them that the ability of antibiotics to reduce the risk of IE is equally low, the writing group noted.

Most patients with heart conditions don't need to take antibiotics to reduce the risk of infection prior to a dental procedure, according to revised American Heart Association guidelines.

The previous recommendations advised that patients with any heart abnormality, from mild valve prolapse to severe birth defects, should take amoxicillin prior to a dental procedure to reduce the risk of developing infective endocarditis (IE). Many types of fungi and bacteria can cause the infection, and dental procedures had been seen as opening the door for these organisms to attack vulnerable patients.

But the guidelines writing group, led by Dr. Walter Wilson of the Mayo Clinic in Rochester, Minn., reviewed the latest research and found no significant evidence that taking antibiotics before a dental procedure prevents IE in patients who are at risk for infections (Circulation 2007 May 8 [Epub doi:10.1161/circulationaha.106.183095]).

In addition, no prospective randomized, placebo-controlled studies have shown that antibiotic use prior to a dental procedure prevents IE. And daily activities such as toothbrushing and flossing cause transient bacteremia. (See story below.)

In fact, severe adverse events resulting from IE are associated with only a small subgroup of cardiac conditions, the writing group noted, and these patients should continue to receive antibiotics prior to dental procedures.

Patients who should receive antibiotics prior to dental procedures are those with prosthetic cardiac valves or previous episodes of infective endocarditis, and heart transplant patients with abnormal cardiac valves.

In addition, patients who meet the following criteria should receive antibiotics prior to dental procedures:

▸ Patients with repaired congenital heart disease (CHD) who have remaining defects at or near the site of a patch or prosthetic that inhibit the healing of the inner surfaces of the heart vessels.

▸ Patients with unrepaired cyanotic CHD, including those with palliative shunts or conduits.

▸ Patients with repaired CHD with no remaining defects who are within 6 months of the procedure (because the inner vessel surfaces are still healing).

Such patients should receive antibiotics prior to any dental procedure that involves work on the gums, the apex of the tooth, or perforation of oral mucosa. The guidelines apply to children as well as adults and have been endorsed by the Infectious Diseases Society of America, Pediatric Infectious Disease Society, and American Dental Association.

The previous guidelines, last revised in 1997, called for 2 g of amoxicillin to be given orally 1 hour before a procedure. But amoxicillin use carries risks of its own, including fostering the development of amoxicillin-resistant organisms, and data have not supported any reduced risk of IE as a result of prophylactic antibiotic use prior to dental procedures.

The new guidelines emphasize that antibiotic use should be based on the odds of a heart patient having a severe adverse reaction if he or she developed IE, rather than lumping all heart patients together as being at increased risk for IE.

“In fact, maintaining good oral health and hygiene appears to be more protective than prophylactic antibiotics,” Dr. Wilson said in a statement. Dr. Wilson had no financial disclosures related to his work on the guidelines.

Similarly, only cardiac patients who meet the above criteria need to receive antibiotics prior to respiratory tract, skin, or musculoskeletal procedures, according to the new guidelines.

Physicians might need to reassure patients with heart conditions other than the high-risk conditions specified in the guidelines that their risk for developing IE is low, and remind them that the ability of antibiotics to reduce the risk of IE is equally low, the writing group noted.

Most patients with heart conditions don't need to take antibiotics to reduce the risk of infection prior to a dental procedure, according to revised American Heart Association guidelines.

The previous recommendations advised that patients with any heart abnormality, from mild valve prolapse to severe birth defects, should take amoxicillin prior to a dental procedure to reduce the risk of developing infective endocarditis (IE). Many types of fungi and bacteria can cause the infection, and dental procedures had been seen as opening the door for these organisms to attack vulnerable patients.

But the guidelines writing group, led by Dr. Walter Wilson of the Mayo Clinic in Rochester, Minn., reviewed the latest research and found no significant evidence that taking antibiotics before a dental procedure prevents IE in patients who are at risk for infections (Circulation 2007 May 8 [Epub doi:10.1161/circulationaha.106.183095]).

In addition, no prospective randomized, placebo-controlled studies have shown that antibiotic use prior to a dental procedure prevents IE. And daily activities such as toothbrushing and flossing cause transient bacteremia. (See story below.)

In fact, severe adverse events resulting from IE are associated with only a small subgroup of cardiac conditions, the writing group noted, and these patients should continue to receive antibiotics prior to dental procedures.

Patients who should receive antibiotics prior to dental procedures are those with prosthetic cardiac valves or previous episodes of infective endocarditis, and heart transplant patients with abnormal cardiac valves.

In addition, patients who meet the following criteria should receive antibiotics prior to dental procedures:

▸ Patients with repaired congenital heart disease (CHD) who have remaining defects at or near the site of a patch or prosthetic that inhibit the healing of the inner surfaces of the heart vessels.

▸ Patients with unrepaired cyanotic CHD, including those with palliative shunts or conduits.

▸ Patients with repaired CHD with no remaining defects who are within 6 months of the procedure (because the inner vessel surfaces are still healing).

Such patients should receive antibiotics prior to any dental procedure that involves work on the gums, the apex of the tooth, or perforation of oral mucosa. The guidelines apply to children as well as adults and have been endorsed by the Infectious Diseases Society of America, Pediatric Infectious Disease Society, and American Dental Association.

The previous guidelines, last revised in 1997, called for 2 g of amoxicillin to be given orally 1 hour before a procedure. But amoxicillin use carries risks of its own, including fostering the development of amoxicillin-resistant organisms, and data have not supported any reduced risk of IE as a result of prophylactic antibiotic use prior to dental procedures.

The new guidelines emphasize that antibiotic use should be based on the odds of a heart patient having a severe adverse reaction if he or she developed IE, rather than lumping all heart patients together as being at increased risk for IE.

“In fact, maintaining good oral health and hygiene appears to be more protective than prophylactic antibiotics,” Dr. Wilson said in a statement. Dr. Wilson had no financial disclosures related to his work on the guidelines.

Similarly, only cardiac patients who meet the above criteria need to receive antibiotics prior to respiratory tract, skin, or musculoskeletal procedures, according to the new guidelines.

Physicians might need to reassure patients with heart conditions other than the high-risk conditions specified in the guidelines that their risk for developing IE is low, and remind them that the ability of antibiotics to reduce the risk of IE is equally low, the writing group noted.

WASHINGTON – Many fibromyalgia patients could benefit from the care and expertise provided by psychiatrists, Dr. Lesley M. Arnold said at the annual meeting of the American Academy of Clinical Psychiatrists.

Psychiatrists are in a position to evaluate fibromyalgia patients for psychiatric comorbidities and consider prescribing antidepressants as part of a treatment plan, said Dr. Arnold, associate professor of psychiatry at the University of Cincinnati.

Tricyclics have been shown to reduce chronic pain independent of any effects on the patient's mood, which suggests a common neurochemical channel for persistent pain and psychiatric conditions that remains unexplored, she said.

Consequently, fibromyalgia patients might benefit from a multidisciplinary approach, said Dr. Arnold, who has received grants and research support from several pharmaceutical companies, including Eli Lilly, Pfizer, and Cypress Bioscience. She also has served as a consultant for these and other pharmaceutical companies.

The American College of Rheumatology criteria for fibromyalgia include chronic widespread pain of more than 3 months' duration and pain in at least 11 of 18 pressure point areas of the body. Patients must report pain with about 4 kg of pressure (enough to blanch your thumb when you press on the area).

But the muscular criteria are only part of the disorder. Patients with fibromyalgia may have hyperalgesia throughout the body rather than at specific points, and patients who do not report pressure on at least 11 of the 18 tender points will often report other symptoms of fibromyalgia, including debilitating fatigue, Dr. Arnold said.

“Fatigue really knocks people out, and that impairs their function more than the pain,” she commented. Fibromyalgia patients also report difficulty falling asleep, difficulty staying asleep, and unrefreshing sleep.

Patients with fibromyalgia report depression and anxiety symptoms, too. The fibromyalgia literature suggests that about one-third of patients with a fibromyalgia diagnosis have a comorbid psychiatric condition, which contributes to the rationale for treating fibromyalgia patients with antidepressants, Dr. Arnold said.

To further assess the relationship between psychiatric comorbidity and fibromyalgia, Dr. Arnold and colleagues conducted a family study. They recruited 78 patients with fibromyalgia and 533 of their relatives, and compared the prevalence of mood disorders between this population and 40 patients with rheumatoid arthritis and 272 of their relatives (Arthritis Rheum. 2004;50;944–52).

“Mood disorders were much more common in the relatives of the fibromyalgia patients than the RA patients,” she said. Overall, 32% of relatives of fibromyalgia patients had any mood disorder versus 19% of relatives of rheumatoid arthritis patients. On further analysis, the odds ratio for bipolar disorder was much higher in patients with fibromyalgia, compared with those who didn't have fibromyalgia, she added.

When prescribing antidepressants off label to fibromyalgia patients with comorbid mood disorders, be sure to titrate the medication to a high enough dose for a long enough time to allow a response, Dr. Arnold said.

“There is a tendency to use low doses when treating chronic pain, but I encourage people to use the full standard dose,” she said. Also consider combining a tricyclic antidepressant with a selective serotonin reuptake inhibitor, but be aware of drug interactions. “Sometimes you need to do two treatments–one for mood and one for pain,” she added.

Dr. Arnold and her colleagues conducted two randomized trials to assess the effectiveness of duloxetine (Cymbalta) on reducing pain in fibromyalgia patients with and without major depressive disorder. Overall, duloxetine was associated with significantly less pain than a placebo, whether or not the patients had major depressive disorder (Arthritis Rheum. 2004;50:2974–84).

Similarly, pregabalin and gabapentin are approved by the Food and Drug Administration for treating some types of neuropathic pain and neuralgia, and they are being studied as treatments for anxiety disorders and fibromyalgia.

WASHINGTON – Many fibromyalgia patients could benefit from the care and expertise provided by psychiatrists, Dr. Lesley M. Arnold said at the annual meeting of the American Academy of Clinical Psychiatrists.

Psychiatrists are in a position to evaluate fibromyalgia patients for psychiatric comorbidities and consider prescribing antidepressants as part of a treatment plan, said Dr. Arnold, associate professor of psychiatry at the University of Cincinnati.

Tricyclics have been shown to reduce chronic pain independent of any effects on the patient's mood, which suggests a common neurochemical channel for persistent pain and psychiatric conditions that remains unexplored, she said.

Consequently, fibromyalgia patients might benefit from a multidisciplinary approach, said Dr. Arnold, who has received grants and research support from several pharmaceutical companies, including Eli Lilly, Pfizer, and Cypress Bioscience. She also has served as a consultant for these and other pharmaceutical companies.

The American College of Rheumatology criteria for fibromyalgia include chronic widespread pain of more than 3 months' duration and pain in at least 11 of 18 pressure point areas of the body. Patients must report pain with about 4 kg of pressure (enough to blanch your thumb when you press on the area).

But the muscular criteria are only part of the disorder. Patients with fibromyalgia may have hyperalgesia throughout the body rather than at specific points, and patients who do not report pressure on at least 11 of the 18 tender points will often report other symptoms of fibromyalgia, including debilitating fatigue, Dr. Arnold said.

“Fatigue really knocks people out, and that impairs their function more than the pain,” she commented. Fibromyalgia patients also report difficulty falling asleep, difficulty staying asleep, and unrefreshing sleep.

Patients with fibromyalgia report depression and anxiety symptoms, too. The fibromyalgia literature suggests that about one-third of patients with a fibromyalgia diagnosis have a comorbid psychiatric condition, which contributes to the rationale for treating fibromyalgia patients with antidepressants, Dr. Arnold said.

To further assess the relationship between psychiatric comorbidity and fibromyalgia, Dr. Arnold and colleagues conducted a family study. They recruited 78 patients with fibromyalgia and 533 of their relatives, and compared the prevalence of mood disorders between this population and 40 patients with rheumatoid arthritis and 272 of their relatives (Arthritis Rheum. 2004;50;944–52).

“Mood disorders were much more common in the relatives of the fibromyalgia patients than the RA patients,” she said. Overall, 32% of relatives of fibromyalgia patients had any mood disorder versus 19% of relatives of rheumatoid arthritis patients. On further analysis, the odds ratio for bipolar disorder was much higher in patients with fibromyalgia, compared with those who didn't have fibromyalgia, she added.

When prescribing antidepressants off label to fibromyalgia patients with comorbid mood disorders, be sure to titrate the medication to a high enough dose for a long enough time to allow a response, Dr. Arnold said.

“There is a tendency to use low doses when treating chronic pain, but I encourage people to use the full standard dose,” she said. Also consider combining a tricyclic antidepressant with a selective serotonin reuptake inhibitor, but be aware of drug interactions. “Sometimes you need to do two treatments–one for mood and one for pain,” she added.

Dr. Arnold and her colleagues conducted two randomized trials to assess the effectiveness of duloxetine (Cymbalta) on reducing pain in fibromyalgia patients with and without major depressive disorder. Overall, duloxetine was associated with significantly less pain than a placebo, whether or not the patients had major depressive disorder (Arthritis Rheum. 2004;50:2974–84).

Similarly, pregabalin and gabapentin are approved by the Food and Drug Administration for treating some types of neuropathic pain and neuralgia, and they are being studied as treatments for anxiety disorders and fibromyalgia.

WASHINGTON – Many fibromyalgia patients could benefit from the care and expertise provided by psychiatrists, Dr. Lesley M. Arnold said at the annual meeting of the American Academy of Clinical Psychiatrists.

Psychiatrists are in a position to evaluate fibromyalgia patients for psychiatric comorbidities and consider prescribing antidepressants as part of a treatment plan, said Dr. Arnold, associate professor of psychiatry at the University of Cincinnati.

Tricyclics have been shown to reduce chronic pain independent of any effects on the patient's mood, which suggests a common neurochemical channel for persistent pain and psychiatric conditions that remains unexplored, she said.

Consequently, fibromyalgia patients might benefit from a multidisciplinary approach, said Dr. Arnold, who has received grants and research support from several pharmaceutical companies, including Eli Lilly, Pfizer, and Cypress Bioscience. She also has served as a consultant for these and other pharmaceutical companies.

The American College of Rheumatology criteria for fibromyalgia include chronic widespread pain of more than 3 months' duration and pain in at least 11 of 18 pressure point areas of the body. Patients must report pain with about 4 kg of pressure (enough to blanch your thumb when you press on the area).

But the muscular criteria are only part of the disorder. Patients with fibromyalgia may have hyperalgesia throughout the body rather than at specific points, and patients who do not report pressure on at least 11 of the 18 tender points will often report other symptoms of fibromyalgia, including debilitating fatigue, Dr. Arnold said.

“Fatigue really knocks people out, and that impairs their function more than the pain,” she commented. Fibromyalgia patients also report difficulty falling asleep, difficulty staying asleep, and unrefreshing sleep.

Patients with fibromyalgia report depression and anxiety symptoms, too. The fibromyalgia literature suggests that about one-third of patients with a fibromyalgia diagnosis have a comorbid psychiatric condition, which contributes to the rationale for treating fibromyalgia patients with antidepressants, Dr. Arnold said.

To further assess the relationship between psychiatric comorbidity and fibromyalgia, Dr. Arnold and colleagues conducted a family study. They recruited 78 patients with fibromyalgia and 533 of their relatives, and compared the prevalence of mood disorders between this population and 40 patients with rheumatoid arthritis and 272 of their relatives (Arthritis Rheum. 2004;50;944–52).

“Mood disorders were much more common in the relatives of the fibromyalgia patients than the RA patients,” she said. Overall, 32% of relatives of fibromyalgia patients had any mood disorder versus 19% of relatives of rheumatoid arthritis patients. On further analysis, the odds ratio for bipolar disorder was much higher in patients with fibromyalgia, compared with those who didn't have fibromyalgia, she added.

When prescribing antidepressants off label to fibromyalgia patients with comorbid mood disorders, be sure to titrate the medication to a high enough dose for a long enough time to allow a response, Dr. Arnold said.

“There is a tendency to use low doses when treating chronic pain, but I encourage people to use the full standard dose,” she said. Also consider combining a tricyclic antidepressant with a selective serotonin reuptake inhibitor, but be aware of drug interactions. “Sometimes you need to do two treatments–one for mood and one for pain,” she added.

Dr. Arnold and her colleagues conducted two randomized trials to assess the effectiveness of duloxetine (Cymbalta) on reducing pain in fibromyalgia patients with and without major depressive disorder. Overall, duloxetine was associated with significantly less pain than a placebo, whether or not the patients had major depressive disorder (Arthritis Rheum. 2004;50:2974–84).

Similarly, pregabalin and gabapentin are approved by the Food and Drug Administration for treating some types of neuropathic pain and neuralgia, and they are being studied as treatments for anxiety disorders and fibromyalgia.

Children and adolescents with obsessive-compulsive disorder responded equally well to daily and weekly cognitive-behavioral therapy, Eric A. Storch, Ph.D., and his colleagues at the University of Florida, Gainesville, have reported.

To compare the effectiveness of intensive cognitive-behavioral therapy (CBT) with less frequent treatments in terms of reducing obsessive-compulsive symptoms, the researchers randomized 40 children aged 7–17 years who met the diagnostic criteria for obsessive-compulsive disorder to receive intensive (daily) sessions of CBT or weekly sessions, which are a current standard of care (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:469–78).

Dr. Storch and his colleagues assessed the children at baseline, after 14 sessions of daily or weekly therapy, and at a 3-month follow-up visit.

Symptoms were compared using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), which is a clinician-rated measure of obsessive-compulsive disorder severity.

Overall, children in both daily and weekly groups showed improvements on the CY-BOS scores, with posttreatment effect sizes of 2.62 and 1.73 respectively at the 3-month follow-up visit.

The findings suggest that additional care, perhaps in the form of weekly visits or phone calls, might be needed to sustain the benefits of intensive CBT over time. Both approaches eventually yield the same result, but a short program of intensive therapy might speed up a patient's progress, the researchers wrote.

Children and adolescents with obsessive-compulsive disorder responded equally well to daily and weekly cognitive-behavioral therapy, Eric A. Storch, Ph.D., and his colleagues at the University of Florida, Gainesville, have reported.

To compare the effectiveness of intensive cognitive-behavioral therapy (CBT) with less frequent treatments in terms of reducing obsessive-compulsive symptoms, the researchers randomized 40 children aged 7–17 years who met the diagnostic criteria for obsessive-compulsive disorder to receive intensive (daily) sessions of CBT or weekly sessions, which are a current standard of care (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:469–78).

Dr. Storch and his colleagues assessed the children at baseline, after 14 sessions of daily or weekly therapy, and at a 3-month follow-up visit.

Symptoms were compared using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), which is a clinician-rated measure of obsessive-compulsive disorder severity.

Overall, children in both daily and weekly groups showed improvements on the CY-BOS scores, with posttreatment effect sizes of 2.62 and 1.73 respectively at the 3-month follow-up visit.

The findings suggest that additional care, perhaps in the form of weekly visits or phone calls, might be needed to sustain the benefits of intensive CBT over time. Both approaches eventually yield the same result, but a short program of intensive therapy might speed up a patient's progress, the researchers wrote.

Children and adolescents with obsessive-compulsive disorder responded equally well to daily and weekly cognitive-behavioral therapy, Eric A. Storch, Ph.D., and his colleagues at the University of Florida, Gainesville, have reported.

To compare the effectiveness of intensive cognitive-behavioral therapy (CBT) with less frequent treatments in terms of reducing obsessive-compulsive symptoms, the researchers randomized 40 children aged 7–17 years who met the diagnostic criteria for obsessive-compulsive disorder to receive intensive (daily) sessions of CBT or weekly sessions, which are a current standard of care (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:469–78).

Dr. Storch and his colleagues assessed the children at baseline, after 14 sessions of daily or weekly therapy, and at a 3-month follow-up visit.

Symptoms were compared using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), which is a clinician-rated measure of obsessive-compulsive disorder severity.

Overall, children in both daily and weekly groups showed improvements on the CY-BOS scores, with posttreatment effect sizes of 2.62 and 1.73 respectively at the 3-month follow-up visit.

The findings suggest that additional care, perhaps in the form of weekly visits or phone calls, might be needed to sustain the benefits of intensive CBT over time. Both approaches eventually yield the same result, but a short program of intensive therapy might speed up a patient's progress, the researchers wrote.

Treatment with antidepressants kept adolescent patients in the prepsychotic phase of schizophrenia from progressing to full psychosis or bipolar disorder more effectively than did treatment with antipsychotics, said Barbara A. Cornblatt, Ph.D., of Albert Einstein College of Medicine, New York, and her colleagues.

Because data from previous studies suggest that mental deterioration in schizophrenia patients might begin before the first psychotic episode, treating patients before they progress to full-blown psychosis might slow progression of illness and preserve psychosocial skills, the researchers said.

To assess the effectiveness of antidepressants on preventing progression to psychosis in adolescents, Dr. Cornblatt and her associates prescribed either antidepressants or second-generation antipsychotics to 48 adolescents who met criteria for prepsychotic schizophrenia (J. Clin. Psychiatry 2007;68:546–57). Dr. Cornblatt is a consultant for Eli Lilly & Co., and she has received financial support from Janssen L.P.

The antidepressant group included 20 patients who had never been treated with antipsychotics but had received antidepressants and other medications.

The second-generation antipsychotic group included 28 patients who had previously received antipsychotics alone or in combination with other medications.

The patients were assessed every 6 months during a follow-up period that lasted from 6 months to 5 years, and the symptoms were compared over time using the Scale of Prodromal Symptoms.

Overall, 12 of the 28 patients in the antipsychotic group but none of the patients in the antidepressant group converted to psychosis during the course of the study.

Of the 12 patients who converted, 7 progressed to syndromal schizophrenia, 4 progressed from an earlier prodromal phase to stronger schizophrenia symptoms, and 1 patient developed bipolar disorder with psychotic features.

The use of antipsychotics to treat prepsychotic adolescents is on the rise despite a lack of data, and more research is needed before such treatment becomes a standard practice, the researchers said. Their results suggest that medications other than antipsychotics might be beneficial for early intervention in patients at risk for developing full-blown schizophrenia.

Treatment with antidepressants kept adolescent patients in the prepsychotic phase of schizophrenia from progressing to full psychosis or bipolar disorder more effectively than did treatment with antipsychotics, said Barbara A. Cornblatt, Ph.D., of Albert Einstein College of Medicine, New York, and her colleagues.

Because data from previous studies suggest that mental deterioration in schizophrenia patients might begin before the first psychotic episode, treating patients before they progress to full-blown psychosis might slow progression of illness and preserve psychosocial skills, the researchers said.

To assess the effectiveness of antidepressants on preventing progression to psychosis in adolescents, Dr. Cornblatt and her associates prescribed either antidepressants or second-generation antipsychotics to 48 adolescents who met criteria for prepsychotic schizophrenia (J. Clin. Psychiatry 2007;68:546–57). Dr. Cornblatt is a consultant for Eli Lilly & Co., and she has received financial support from Janssen L.P.

The antidepressant group included 20 patients who had never been treated with antipsychotics but had received antidepressants and other medications.

The second-generation antipsychotic group included 28 patients who had previously received antipsychotics alone or in combination with other medications.

The patients were assessed every 6 months during a follow-up period that lasted from 6 months to 5 years, and the symptoms were compared over time using the Scale of Prodromal Symptoms.

Overall, 12 of the 28 patients in the antipsychotic group but none of the patients in the antidepressant group converted to psychosis during the course of the study.

Of the 12 patients who converted, 7 progressed to syndromal schizophrenia, 4 progressed from an earlier prodromal phase to stronger schizophrenia symptoms, and 1 patient developed bipolar disorder with psychotic features.

The use of antipsychotics to treat prepsychotic adolescents is on the rise despite a lack of data, and more research is needed before such treatment becomes a standard practice, the researchers said. Their results suggest that medications other than antipsychotics might be beneficial for early intervention in patients at risk for developing full-blown schizophrenia.

Treatment with antidepressants kept adolescent patients in the prepsychotic phase of schizophrenia from progressing to full psychosis or bipolar disorder more effectively than did treatment with antipsychotics, said Barbara A. Cornblatt, Ph.D., of Albert Einstein College of Medicine, New York, and her colleagues.

Because data from previous studies suggest that mental deterioration in schizophrenia patients might begin before the first psychotic episode, treating patients before they progress to full-blown psychosis might slow progression of illness and preserve psychosocial skills, the researchers said.

To assess the effectiveness of antidepressants on preventing progression to psychosis in adolescents, Dr. Cornblatt and her associates prescribed either antidepressants or second-generation antipsychotics to 48 adolescents who met criteria for prepsychotic schizophrenia (J. Clin. Psychiatry 2007;68:546–57). Dr. Cornblatt is a consultant for Eli Lilly & Co., and she has received financial support from Janssen L.P.

The antidepressant group included 20 patients who had never been treated with antipsychotics but had received antidepressants and other medications.

The second-generation antipsychotic group included 28 patients who had previously received antipsychotics alone or in combination with other medications.

The patients were assessed every 6 months during a follow-up period that lasted from 6 months to 5 years, and the symptoms were compared over time using the Scale of Prodromal Symptoms.

Overall, 12 of the 28 patients in the antipsychotic group but none of the patients in the antidepressant group converted to psychosis during the course of the study.

Of the 12 patients who converted, 7 progressed to syndromal schizophrenia, 4 progressed from an earlier prodromal phase to stronger schizophrenia symptoms, and 1 patient developed bipolar disorder with psychotic features.

The use of antipsychotics to treat prepsychotic adolescents is on the rise despite a lack of data, and more research is needed before such treatment becomes a standard practice, the researchers said. Their results suggest that medications other than antipsychotics might be beneficial for early intervention in patients at risk for developing full-blown schizophrenia.

MIAMI — At-home tests that involve self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggest findings from a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“We thought maybe we could reach out and get out of the clinic and encourage asymptomatic women to collect samples at home,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

Surmising that the Internet might be an effective way to promote such at-home tests, the researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31 show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The test kit includes sterile swabs for collecting vaginal samples and a questionnaire seeking demographics, sexual history, and the participants' opinions about at-home testing and their preferences for methods to receive test results.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. “The NAATs are the best tests there are today; they are very powerful,” Dr. Gaydos said.

Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for those women with positive test results.

So far, most of the women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of the 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23 years, but those who tested positive tended to be younger, and the average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15- to 19-year-olds (16%), followed by 20- to 24-year-olds (8.5%) and 25- to 29-year-olds (8%).

After the researchers controlled for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

In addition, more than 50% of the participants reported a history of STDs; 40% reported a history of chlamydia, and 15% reported a history of gonorrhea.

Results of the questionnaires that accompanied the kits suggest participants were receptive to the idea of at-home STD testing. On a Likert scale of 1 to 5, 96% said that the sampling process was “easy” or “very easy” and 93% said that they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said. Under the current protocol, participants calling the toll-free number give the kit number and a secret password that they chose to ensure confidentiality.

Even with the current phone-in method of requesting results, the success of the Web site in recruiting patients for home sampling and in treating those who test positive is encouraging, he added.

A test kit for men was recently developed, and it is promoted on www.iwantthekit.org

MIAMI — At-home tests that involve self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggest findings from a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“We thought maybe we could reach out and get out of the clinic and encourage asymptomatic women to collect samples at home,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

Surmising that the Internet might be an effective way to promote such at-home tests, the researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31 show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The test kit includes sterile swabs for collecting vaginal samples and a questionnaire seeking demographics, sexual history, and the participants' opinions about at-home testing and their preferences for methods to receive test results.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. “The NAATs are the best tests there are today; they are very powerful,” Dr. Gaydos said.

Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for those women with positive test results.

So far, most of the women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of the 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23 years, but those who tested positive tended to be younger, and the average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15- to 19-year-olds (16%), followed by 20- to 24-year-olds (8.5%) and 25- to 29-year-olds (8%).

After the researchers controlled for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

In addition, more than 50% of the participants reported a history of STDs; 40% reported a history of chlamydia, and 15% reported a history of gonorrhea.

Results of the questionnaires that accompanied the kits suggest participants were receptive to the idea of at-home STD testing. On a Likert scale of 1 to 5, 96% said that the sampling process was “easy” or “very easy” and 93% said that they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said. Under the current protocol, participants calling the toll-free number give the kit number and a secret password that they chose to ensure confidentiality.

Even with the current phone-in method of requesting results, the success of the Web site in recruiting patients for home sampling and in treating those who test positive is encouraging, he added.

A test kit for men was recently developed, and it is promoted on www.iwantthekit.org

MIAMI — At-home tests that involve self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggest findings from a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“We thought maybe we could reach out and get out of the clinic and encourage asymptomatic women to collect samples at home,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

Surmising that the Internet might be an effective way to promote such at-home tests, the researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31 show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The test kit includes sterile swabs for collecting vaginal samples and a questionnaire seeking demographics, sexual history, and the participants' opinions about at-home testing and their preferences for methods to receive test results.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. “The NAATs are the best tests there are today; they are very powerful,” Dr. Gaydos said.

Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for those women with positive test results.

So far, most of the women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of the 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23 years, but those who tested positive tended to be younger, and the average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15- to 19-year-olds (16%), followed by 20- to 24-year-olds (8.5%) and 25- to 29-year-olds (8%).

After the researchers controlled for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

In addition, more than 50% of the participants reported a history of STDs; 40% reported a history of chlamydia, and 15% reported a history of gonorrhea.

Results of the questionnaires that accompanied the kits suggest participants were receptive to the idea of at-home STD testing. On a Likert scale of 1 to 5, 96% said that the sampling process was “easy” or “very easy” and 93% said that they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said. Under the current protocol, participants calling the toll-free number give the kit number and a secret password that they chose to ensure confidentiality.

Even with the current phone-in method of requesting results, the success of the Web site in recruiting patients for home sampling and in treating those who test positive is encouraging, he added.

A test kit for men was recently developed, and it is promoted on www.iwantthekit.org

MIAMI — “Dusting,” or inhaling gas from computer keyboard cleaner in order to become high, is a practice that is becoming alarmingly popular among adolescents, Dr. Robin McFee said at the annual meeting of the American College of Preventive Medicine.

Using inhalants to get high is nothing new, said Dr. McFee, a toxicologist and adolescent health expert at the State University of New York in Stony Brook, and a toxicologist at the Long Island Regional Poison & Drug Information Center. However, what is new is the use of compressed-air computer keyboard cleaners as euphoriants. Dust-Off (hence the term “dusting”) and other brands of computer keyboard cleaning products are sold in pressurized cans for about $5 and contain freon propellant/refrigerants, usually difluoroethane or tetrafluoroethane. These are not regulated by the Food and Drug Administration.

Contrary to the popular perception among many teenagers, inhalants are not low risk. Even after a single use, the toxins contained in products such as Dust-Off have been associated with death. Data from cases of dusting reported to the poison control center suggest that a fifth of dusters die after their first use, Dr. McFee said.

“We can't predict who is going to die from one of these drugs,” she said. “It is a Russian roulette effect,” a fact that presents a challenge to health care providers who must translate the extreme dangers for an adolescent mind that thinks concretely and nonconsequentially. Long-term morbidity from acute and chronic use of inhalants includes impaired learning, labile emotion, and decreased memory. Inhalants can impair development long after the child has stopped abusing inhalants.

A common misunderstanding among teenagers is that getting high from computer keyboard cleaners is not drug abuse. “That is the perception of every adolescent that I have worked with who has dusted,” Dr. McFee said. “They say that the products are air, not drugs. But they are wrong. They are inhaling a gas.” That gas immediately replaces the air in the user's lungs and is rapidly absorbed, creating an anesthetic effect. The adverse effects are exerted primarily on the heart and brain.

Clinical signs associated with dusting include frostbite and asthmalike symptoms. When treating a suspected user who has pulmonary symptoms, remember that patients who use asthma medications will be more sensitive to the catecholaminergic medications that are the first-line treatment for shortness of breath and bronchospasms, Dr. McFee said in an interview.

In low concentrations, the gases in the keyboard cleaners can cause transient irritation of the eyes, nose, and throat, so frequent use of eyedrops may be a sign of dusting, Dr. McFee noted. The products also can cause headaches, heart palpitations, and light-headedness.

If enough of the gas is absorbed, it can lead to ventricular dysrhythmias, pulmonary edema, cardiac arrest, and sudden death. It's difficult to predict what dose and what frequency of dusting are lethal, Dr. McFee said.

Dr. McFee presented data collected by the Long Island Regional Poison & Drug Information Center that showed a total of 34 cases of poisoning caused by inhaling Dust-Off or a similar product. Five cases per year were reported from 2000 to 2004, but that number nearly doubled to nine cases in 2005 alone. The patients ranged in age from 4 to 48 years, with an average age of 17 years. Five of these dusters died, and 10% suffered significant multisystem damage as a result of dusting.

Multiply these numbers by 70 poison control centers across the country with similar data, Dr. McFee said.

“Statistics are like bikinis; what they reveal is interesting, but what they hide is essential,” she said.

The numbers recorded by poison control centers do not include those who dusted but survived. They may have suffered headaches, red eyes, and vomiting, but these cases aren't reflected in public health poison control data.

Anticipatory guidance and awareness are key to preventing inhalant abuse. “We need to make the most of opportunities to identify and discuss health risks, including inhalant use,” Dr. McFee said.

“Take time to be with [young patients] one on one, build a trust relationship, and provide information about inhalant use and abuse,” she said in an interview.

MIAMI — “Dusting,” or inhaling gas from computer keyboard cleaner in order to become high, is a practice that is becoming alarmingly popular among adolescents, Dr. Robin McFee said at the annual meeting of the American College of Preventive Medicine.

Using inhalants to get high is nothing new, said Dr. McFee, a toxicologist and adolescent health expert at the State University of New York in Stony Brook, and a toxicologist at the Long Island Regional Poison & Drug Information Center. However, what is new is the use of compressed-air computer keyboard cleaners as euphoriants. Dust-Off (hence the term “dusting”) and other brands of computer keyboard cleaning products are sold in pressurized cans for about $5 and contain freon propellant/refrigerants, usually difluoroethane or tetrafluoroethane. These are not regulated by the Food and Drug Administration.

Contrary to the popular perception among many teenagers, inhalants are not low risk. Even after a single use, the toxins contained in products such as Dust-Off have been associated with death. Data from cases of dusting reported to the poison control center suggest that a fifth of dusters die after their first use, Dr. McFee said.

“We can't predict who is going to die from one of these drugs,” she said. “It is a Russian roulette effect,” a fact that presents a challenge to health care providers who must translate the extreme dangers for an adolescent mind that thinks concretely and nonconsequentially. Long-term morbidity from acute and chronic use of inhalants includes impaired learning, labile emotion, and decreased memory. Inhalants can impair development long after the child has stopped abusing inhalants.

A common misunderstanding among teenagers is that getting high from computer keyboard cleaners is not drug abuse. “That is the perception of every adolescent that I have worked with who has dusted,” Dr. McFee said. “They say that the products are air, not drugs. But they are wrong. They are inhaling a gas.” That gas immediately replaces the air in the user's lungs and is rapidly absorbed, creating an anesthetic effect. The adverse effects are exerted primarily on the heart and brain.

Clinical signs associated with dusting include frostbite and asthmalike symptoms. When treating a suspected user who has pulmonary symptoms, remember that patients who use asthma medications will be more sensitive to the catecholaminergic medications that are the first-line treatment for shortness of breath and bronchospasms, Dr. McFee said in an interview.

In low concentrations, the gases in the keyboard cleaners can cause transient irritation of the eyes, nose, and throat, so frequent use of eyedrops may be a sign of dusting, Dr. McFee noted. The products also can cause headaches, heart palpitations, and light-headedness.

If enough of the gas is absorbed, it can lead to ventricular dysrhythmias, pulmonary edema, cardiac arrest, and sudden death. It's difficult to predict what dose and what frequency of dusting are lethal, Dr. McFee said.

Dr. McFee presented data collected by the Long Island Regional Poison & Drug Information Center that showed a total of 34 cases of poisoning caused by inhaling Dust-Off or a similar product. Five cases per year were reported from 2000 to 2004, but that number nearly doubled to nine cases in 2005 alone. The patients ranged in age from 4 to 48 years, with an average age of 17 years. Five of these dusters died, and 10% suffered significant multisystem damage as a result of dusting.

Multiply these numbers by 70 poison control centers across the country with similar data, Dr. McFee said.

“Statistics are like bikinis; what they reveal is interesting, but what they hide is essential,” she said.

The numbers recorded by poison control centers do not include those who dusted but survived. They may have suffered headaches, red eyes, and vomiting, but these cases aren't reflected in public health poison control data.

Anticipatory guidance and awareness are key to preventing inhalant abuse. “We need to make the most of opportunities to identify and discuss health risks, including inhalant use,” Dr. McFee said.

“Take time to be with [young patients] one on one, build a trust relationship, and provide information about inhalant use and abuse,” she said in an interview.

MIAMI — “Dusting,” or inhaling gas from computer keyboard cleaner in order to become high, is a practice that is becoming alarmingly popular among adolescents, Dr. Robin McFee said at the annual meeting of the American College of Preventive Medicine.

Using inhalants to get high is nothing new, said Dr. McFee, a toxicologist and adolescent health expert at the State University of New York in Stony Brook, and a toxicologist at the Long Island Regional Poison & Drug Information Center. However, what is new is the use of compressed-air computer keyboard cleaners as euphoriants. Dust-Off (hence the term “dusting”) and other brands of computer keyboard cleaning products are sold in pressurized cans for about $5 and contain freon propellant/refrigerants, usually difluoroethane or tetrafluoroethane. These are not regulated by the Food and Drug Administration.

Contrary to the popular perception among many teenagers, inhalants are not low risk. Even after a single use, the toxins contained in products such as Dust-Off have been associated with death. Data from cases of dusting reported to the poison control center suggest that a fifth of dusters die after their first use, Dr. McFee said.

“We can't predict who is going to die from one of these drugs,” she said. “It is a Russian roulette effect,” a fact that presents a challenge to health care providers who must translate the extreme dangers for an adolescent mind that thinks concretely and nonconsequentially. Long-term morbidity from acute and chronic use of inhalants includes impaired learning, labile emotion, and decreased memory. Inhalants can impair development long after the child has stopped abusing inhalants.

A common misunderstanding among teenagers is that getting high from computer keyboard cleaners is not drug abuse. “That is the perception of every adolescent that I have worked with who has dusted,” Dr. McFee said. “They say that the products are air, not drugs. But they are wrong. They are inhaling a gas.” That gas immediately replaces the air in the user's lungs and is rapidly absorbed, creating an anesthetic effect. The adverse effects are exerted primarily on the heart and brain.

Clinical signs associated with dusting include frostbite and asthmalike symptoms. When treating a suspected user who has pulmonary symptoms, remember that patients who use asthma medications will be more sensitive to the catecholaminergic medications that are the first-line treatment for shortness of breath and bronchospasms, Dr. McFee said in an interview.

In low concentrations, the gases in the keyboard cleaners can cause transient irritation of the eyes, nose, and throat, so frequent use of eyedrops may be a sign of dusting, Dr. McFee noted. The products also can cause headaches, heart palpitations, and light-headedness.

If enough of the gas is absorbed, it can lead to ventricular dysrhythmias, pulmonary edema, cardiac arrest, and sudden death. It's difficult to predict what dose and what frequency of dusting are lethal, Dr. McFee said.

Dr. McFee presented data collected by the Long Island Regional Poison & Drug Information Center that showed a total of 34 cases of poisoning caused by inhaling Dust-Off or a similar product. Five cases per year were reported from 2000 to 2004, but that number nearly doubled to nine cases in 2005 alone. The patients ranged in age from 4 to 48 years, with an average age of 17 years. Five of these dusters died, and 10% suffered significant multisystem damage as a result of dusting.

Multiply these numbers by 70 poison control centers across the country with similar data, Dr. McFee said.

“Statistics are like bikinis; what they reveal is interesting, but what they hide is essential,” she said.

The numbers recorded by poison control centers do not include those who dusted but survived. They may have suffered headaches, red eyes, and vomiting, but these cases aren't reflected in public health poison control data.

Anticipatory guidance and awareness are key to preventing inhalant abuse. “We need to make the most of opportunities to identify and discuss health risks, including inhalant use,” Dr. McFee said.

“Take time to be with [young patients] one on one, build a trust relationship, and provide information about inhalant use and abuse,” she said in an interview.

GRAND CAYMAN, CAYMAN ISLANDS — Consider the possibility of acquired zinc deficiency in patients with persistent red, scaly skin on the hands and feet, Dr. Christopher O'Connell proposed at the Caribbean Dermatology Symposium.

Dr. O'Connell, a dermatology resident at St. Luke's-Roosevelt Hospital Center in New York, described the case of a 49-year-old black woman who presented with severe erythema, edema, and scaling on her palms and soles, as well as scaly patches and fissures on the backs of her hands. In addition, she had edema and erythema on her lower legs, as well as nonblanchable brown and red patches on her upper thighs. At follow-up exams, some of the nonblanchable patches had become scaly, and some of the scaly patches had progressed to form bullae and erosions.

The patient's medical history included type 2 diabetes, end-stage renal disease, hypertension, and alcohol abuse. She had completed a 2-week course of vancomycin and gentamycin for Staphylococcus aureus bacteremia one week prior to her evaluation in the dermatology department.

“This patient's alcohol abuse and renal disease were the likely causes of her acquired zinc deficiency and consequent acrodermatitis,” Dr. O'Connell said.

The initial laboratory tests revealed chronic anemia. All other blood work was normal, and blood cultures were negative. The initial differential diagnosis included staphylococcal scalded skin syndrome, a drug reaction, and vasculitis.

“A skin biopsy was performed and the histopathology was consistent with nutritional deficiency,” he said. Histologic findings that supported the final diagnosis included compact parakeratosis, pallor of the upper epidermis, hypogranulosis, intraepidermal vesiculation, keratinocyte necrosis, and architectural disarray.

Based in part on the histology findings, the differential diagnosis was expanded to include necrolytic migratory erythema, pellagra, and zinc deficiency.

Necrolytic migratory erythema was unlikely because the patient's glucose levels were well controlled on low-dose insulin glargine and a CT scan of the abdomen showed no signs of pancreatic neoplasm. Pellagra was ruled out because the rash was not photodistributed.

On further testing, the patient's zinc level was 615 mcg/L, compared with the normal, healthy range of 670–1,240 mcg/L. The diagnosis of zinc deficiency was confirmed when the patient's skin improved after zinc supplementation. The patient died, however, of complications from her renal disease.

“The skin contains 6% of the body's supply of zinc and it is the most common organ to demonstrate clinical signs of zinc deficiency,” Dr. O'Connell noted.

Acquired zinc deficiency has been reported in association with many medical disorders, including alcoholism, renal disease, gastrointestinal malabsorption syndromes, food allergies, anorexia, and severe burns. Research has shown that more than 300 enzymes require zinc in order to function. Zinc is essential for protein, carbohydrate, and fat metabolism, as well as for healthy immune system function, cell growth, and wound healing.

Hereditary zinc deficiency presents with a clinical picture similar to acquired zinc deficiency; however, it is an autosomal recessive disorder that usually presents within the first 4–10 weeks of life, he said.

The presentation of acquired zinc deficiency included non-blanchable brown and red patches on the upper thighs. Courtesy Dr. Christopher O'Connell

GRAND CAYMAN, CAYMAN ISLANDS — Consider the possibility of acquired zinc deficiency in patients with persistent red, scaly skin on the hands and feet, Dr. Christopher O'Connell proposed at the Caribbean Dermatology Symposium.

Dr. O'Connell, a dermatology resident at St. Luke's-Roosevelt Hospital Center in New York, described the case of a 49-year-old black woman who presented with severe erythema, edema, and scaling on her palms and soles, as well as scaly patches and fissures on the backs of her hands. In addition, she had edema and erythema on her lower legs, as well as nonblanchable brown and red patches on her upper thighs. At follow-up exams, some of the nonblanchable patches had become scaly, and some of the scaly patches had progressed to form bullae and erosions.

The patient's medical history included type 2 diabetes, end-stage renal disease, hypertension, and alcohol abuse. She had completed a 2-week course of vancomycin and gentamycin for Staphylococcus aureus bacteremia one week prior to her evaluation in the dermatology department.

“This patient's alcohol abuse and renal disease were the likely causes of her acquired zinc deficiency and consequent acrodermatitis,” Dr. O'Connell said.

The initial laboratory tests revealed chronic anemia. All other blood work was normal, and blood cultures were negative. The initial differential diagnosis included staphylococcal scalded skin syndrome, a drug reaction, and vasculitis.

“A skin biopsy was performed and the histopathology was consistent with nutritional deficiency,” he said. Histologic findings that supported the final diagnosis included compact parakeratosis, pallor of the upper epidermis, hypogranulosis, intraepidermal vesiculation, keratinocyte necrosis, and architectural disarray.

Based in part on the histology findings, the differential diagnosis was expanded to include necrolytic migratory erythema, pellagra, and zinc deficiency.

Necrolytic migratory erythema was unlikely because the patient's glucose levels were well controlled on low-dose insulin glargine and a CT scan of the abdomen showed no signs of pancreatic neoplasm. Pellagra was ruled out because the rash was not photodistributed.

On further testing, the patient's zinc level was 615 mcg/L, compared with the normal, healthy range of 670–1,240 mcg/L. The diagnosis of zinc deficiency was confirmed when the patient's skin improved after zinc supplementation. The patient died, however, of complications from her renal disease.

“The skin contains 6% of the body's supply of zinc and it is the most common organ to demonstrate clinical signs of zinc deficiency,” Dr. O'Connell noted.

Acquired zinc deficiency has been reported in association with many medical disorders, including alcoholism, renal disease, gastrointestinal malabsorption syndromes, food allergies, anorexia, and severe burns. Research has shown that more than 300 enzymes require zinc in order to function. Zinc is essential for protein, carbohydrate, and fat metabolism, as well as for healthy immune system function, cell growth, and wound healing.

Hereditary zinc deficiency presents with a clinical picture similar to acquired zinc deficiency; however, it is an autosomal recessive disorder that usually presents within the first 4–10 weeks of life, he said.

The presentation of acquired zinc deficiency included non-blanchable brown and red patches on the upper thighs. Courtesy Dr. Christopher O'Connell

GRAND CAYMAN, CAYMAN ISLANDS — Consider the possibility of acquired zinc deficiency in patients with persistent red, scaly skin on the hands and feet, Dr. Christopher O'Connell proposed at the Caribbean Dermatology Symposium.

Dr. O'Connell, a dermatology resident at St. Luke's-Roosevelt Hospital Center in New York, described the case of a 49-year-old black woman who presented with severe erythema, edema, and scaling on her palms and soles, as well as scaly patches and fissures on the backs of her hands. In addition, she had edema and erythema on her lower legs, as well as nonblanchable brown and red patches on her upper thighs. At follow-up exams, some of the nonblanchable patches had become scaly, and some of the scaly patches had progressed to form bullae and erosions.

The patient's medical history included type 2 diabetes, end-stage renal disease, hypertension, and alcohol abuse. She had completed a 2-week course of vancomycin and gentamycin for Staphylococcus aureus bacteremia one week prior to her evaluation in the dermatology department.

“This patient's alcohol abuse and renal disease were the likely causes of her acquired zinc deficiency and consequent acrodermatitis,” Dr. O'Connell said.

The initial laboratory tests revealed chronic anemia. All other blood work was normal, and blood cultures were negative. The initial differential diagnosis included staphylococcal scalded skin syndrome, a drug reaction, and vasculitis.

“A skin biopsy was performed and the histopathology was consistent with nutritional deficiency,” he said. Histologic findings that supported the final diagnosis included compact parakeratosis, pallor of the upper epidermis, hypogranulosis, intraepidermal vesiculation, keratinocyte necrosis, and architectural disarray.

Based in part on the histology findings, the differential diagnosis was expanded to include necrolytic migratory erythema, pellagra, and zinc deficiency.

Necrolytic migratory erythema was unlikely because the patient's glucose levels were well controlled on low-dose insulin glargine and a CT scan of the abdomen showed no signs of pancreatic neoplasm. Pellagra was ruled out because the rash was not photodistributed.

On further testing, the patient's zinc level was 615 mcg/L, compared with the normal, healthy range of 670–1,240 mcg/L. The diagnosis of zinc deficiency was confirmed when the patient's skin improved after zinc supplementation. The patient died, however, of complications from her renal disease.

“The skin contains 6% of the body's supply of zinc and it is the most common organ to demonstrate clinical signs of zinc deficiency,” Dr. O'Connell noted.

Acquired zinc deficiency has been reported in association with many medical disorders, including alcoholism, renal disease, gastrointestinal malabsorption syndromes, food allergies, anorexia, and severe burns. Research has shown that more than 300 enzymes require zinc in order to function. Zinc is essential for protein, carbohydrate, and fat metabolism, as well as for healthy immune system function, cell growth, and wound healing.

Hereditary zinc deficiency presents with a clinical picture similar to acquired zinc deficiency; however, it is an autosomal recessive disorder that usually presents within the first 4–10 weeks of life, he said.

The presentation of acquired zinc deficiency included non-blanchable brown and red patches on the upper thighs. Courtesy Dr. Christopher O'Connell

MIAMI — At-home tests that involve self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggest findings from a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“We thought maybe we could reach out and get out of the clinic and encourage asymptomatic women to collect samples at home,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

Surmising that the Internet might be an effective way to promote such at-home tests, the researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31, 2007, show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The test kit includes sterile swabs for collecting vaginal samples and a questionnaire soliciting information on demographics, sexual history, and the participants' opinions about at-home testing and their preferences for methods to receive test results.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. “The NAATs are the best tests there are today; they are very powerful,” Dr. Gaydos said.

Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for those women with positive test results.

So far, most of the women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of the 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23 years, but those who tested positive tended to be younger, and the average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15− to 19-year-olds (16%), followed by 20− to 24-year-olds (8.5%) and 25− to 29-year-olds (8%).

After the researchers controlled for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

In addition, more than 50% of the participants reported a history of STDs; 40% reported a history of chlamydia, and 15% reported a history of gonorrhea.

Results of the questionnaires that accompanied the kits suggest participants were receptive to the idea of at-home STD testing. On a Likert scale of 1 to 5, 96% said that the sampling process was “easy” or “very easy” and 93% said that they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said. Under the current protocol, participants calling the toll-free number give the kit number and a password that they chose to ensure confidentiality.

Even with the current phone-in method of requesting results, the success of the Web site in recruiting patients for home sampling and in treating those who test positive is encouraging, she added. “This may be another tool that we can use to reach out of the clinic and to save money. You can save a lot of money if you don't have to pay clinicians to collect the samples.”

A test kit for men was recently developed, and it is promoted on www.iwantthekit.org

MIAMI — At-home tests that involve self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggest findings from a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“We thought maybe we could reach out and get out of the clinic and encourage asymptomatic women to collect samples at home,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

Surmising that the Internet might be an effective way to promote such at-home tests, the researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31, 2007, show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The test kit includes sterile swabs for collecting vaginal samples and a questionnaire soliciting information on demographics, sexual history, and the participants' opinions about at-home testing and their preferences for methods to receive test results.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. “The NAATs are the best tests there are today; they are very powerful,” Dr. Gaydos said.

Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for those women with positive test results.

So far, most of the women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of the 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23 years, but those who tested positive tended to be younger, and the average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15− to 19-year-olds (16%), followed by 20− to 24-year-olds (8.5%) and 25− to 29-year-olds (8%).

After the researchers controlled for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

In addition, more than 50% of the participants reported a history of STDs; 40% reported a history of chlamydia, and 15% reported a history of gonorrhea.

Results of the questionnaires that accompanied the kits suggest participants were receptive to the idea of at-home STD testing. On a Likert scale of 1 to 5, 96% said that the sampling process was “easy” or “very easy” and 93% said that they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said. Under the current protocol, participants calling the toll-free number give the kit number and a password that they chose to ensure confidentiality.

Even with the current phone-in method of requesting results, the success of the Web site in recruiting patients for home sampling and in treating those who test positive is encouraging, she added. “This may be another tool that we can use to reach out of the clinic and to save money. You can save a lot of money if you don't have to pay clinicians to collect the samples.”

A test kit for men was recently developed, and it is promoted on www.iwantthekit.org

MIAMI — At-home tests that involve self-collected vaginal samples that are sent to a lab for analysis are effective at identifying women with sexually transmitted diseases, suggest findings from a pilot study presented at the annual meeting of the American College of Preventive Medicine.

“We thought maybe we could reach out and get out of the clinic and encourage asymptomatic women to collect samples at home,” said Charlotte A. Gaydos, Dr.P.H., a microbiologist in the division of infectious diseases at Johns Hopkins University, Baltimore.

Surmising that the Internet might be an effective way to promote such at-home tests, the researchers established a Web site (www.iwantthekit.org

Data from 778 samples that had been analyzed as of Jan. 31, 2007, show 71 samples (9%) were positive for Chlamydia trachomatis and 12 (1%) were positive for Neisseria gonorrhoeae. Four samples showed coinfection with chlamydia and gonorrhea. Samples collected since September 2006 were tested for Trichomonas vaginalis, and 13 of 115 samples (11%) tested positive.

The test kit includes sterile swabs for collecting vaginal samples and a questionnaire soliciting information on demographics, sexual history, and the participants' opinions about at-home testing and their preferences for methods to receive test results.

“We require two positive assays for a positive diagnosis,” Dr. Gaydos said. Samples are analyzed using nucleic acid amplification tests (NAATs), which are more than 90% sensitive, compared with the 85% sensitivity associated with cultures. “The NAATs are the best tests there are today; they are very powerful,” Dr. Gaydos said.

Participants received their test results via a toll-free number. A study coordinator arranged treatment appointments at a free local clinic for those women with positive test results.

So far, most of the women who tested positive have been treated, Dr. Gaydos noted. All 11 patients with gonorrhea were treated, as were 66 of 69 (96%) chlamydia cases.

Of the 760 participants who identified their race, 70% were black, 22% were white, and the remainder were another race or mixed race. Chlamydia rates were significantly higher among black women, compared with white women (12% vs. 2%).

The participants ranged from 14 to 63 years of age, with an average age of 23 years, but those who tested positive tended to be younger, and the average age at first sex was 15 years, Dr. Gaydos noted.

Positive tests were most common in the 15− to 19-year-olds (16%), followed by 20− to 24-year-olds (8.5%) and 25− to 29-year-olds (8%).

After the researchers controlled for multiple factors including age and race, the strongest risk factors for positive test results were use of birth control, nonconsensual sex, and multiple partners.

In addition, more than 50% of the participants reported a history of STDs; 40% reported a history of chlamydia, and 15% reported a history of gonorrhea.

Results of the questionnaires that accompanied the kits suggest participants were receptive to the idea of at-home STD testing. On a Likert scale of 1 to 5, 96% said that the sampling process was “easy” or “very easy” and 93% said that they would use it again.

Nearly 25% said they preferred to receive results by e-mail, but a secure Web site to provide results is too expensive at this time, Dr. Gaydos said. Under the current protocol, participants calling the toll-free number give the kit number and a password that they chose to ensure confidentiality.

Even with the current phone-in method of requesting results, the success of the Web site in recruiting patients for home sampling and in treating those who test positive is encouraging, she added. “This may be another tool that we can use to reach out of the clinic and to save money. You can save a lot of money if you don't have to pay clinicians to collect the samples.”

A test kit for men was recently developed, and it is promoted on www.iwantthekit.org

Cannabis Use May Predict Later Anxiety

Young people who use cannabis at 15 years of age are significantly more likely to show symptoms of anxiety and depression in young adulthood, compared with non-cannabis users, data show.

From a clinical standpoint, reducing cannabis use in adolescents could reduce anxiety and depression in young adulthood, wrote Dr. Mohammad R. Hayatbakhsh and his colleagues at the University of Queensland in Brisbane, Australia.

To assess the relationships among cannabis use and anxiety and depression, the researchers reviewed data on 3,239 Australian young people from birth to age 21 and measured confounding factors at birth, age 14, and age 21 (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:408–17).

A total of 1,586 youth (49%) reported ever using cannabis; 36.8% were occasional users (an average of one use per month) and 12.2% were frequent users (an average of one use every few days). Symptoms of anxiety and depression were assessed using the Youth Self-Report questionnaire.

After the researchers controlled for multiple factors, including gender, mother's mental health, family income, and smoking and alcohol consumption, young people who were frequent cannabis users before 15 years of age were more than twice as likely to show signs of anxiety and depression as young adults than were non-cannabis users. The association persisted, whether or not the young people used other illicit drugs in addition to cannabis.

Conversely, the presence of anxiety and depression before age 15 was not significantly associated with cannabis use in young adulthood. However, the findings suggest that cannabis use in adolescence may predict mental health problems later in life, the researchers noted.

Risky Sex Linked to Sensation-Seeking

Black adolescent girls who reported risky sexual activities scored significantly higher on tests of sexual sensation-seeking traits than did those who didn't report risky sex, based on data from 1,245 sexually active females aged 15–21 years.

To examine the relationship between sexual sensation seeking and sexual risk taking in adolescents, Joshua Spitalnick, Ph.D., of Emory University, Atlanta, and his colleagues surveyed black girls who were seeking sexual health services at community health clinics (J. Adolescence 2007;30:165–73).

Most (84%) of these adolescents reported that they were involved in a sexual relationship. The average length of that relationship was 15 months, and the respondents reported an average of nine lifetime partners. The average age of the participants was 18 years.

They were evaluated using the Sexual Sensation Seeking for Adolescents (SSSA) scale, which included statements such as, “I enjoy the thrill of having sex in public places,” with answer choices ranging from 1 (strongly disagree) to 4 (strongly agree). Scores ranged from 9 to 36, with an average score of 17.53.

Overall, respondents with high SSSA scores were significantly more likely to report risky sexual behavior including more-frequent vaginal intercourse, more sexual partners, and inconsistent use of condoms or other protection than were girls who scored lower on the SSSA.

Delinquent Teens at Risk for Suicide

Teenage delinquency was significantly associated with an increased risk for suicidal behavior in girls, according to data from a nationally representative sample of American teens.

To prospectively examine the association between delinquency and suicide in teens, Martie P. Thompson, Ph.D., and her colleagues at Clemson (S.C.) University reviewed data on 15,034 teens aged 12–17 years from the National Longitudinal Study of Adolescent Health, a survey of factors that affect teens' health and behavior (J. Adolesc. Health 2007;40:232–7).

Delinquency was assessed using a 15-item survey of behaviors in the previous 12 months, with questions such as, “How often did you deliberately damage property that didn't belong to you?”

After the researchers controlled for age, race, gender, and urban dwelling status, delinquent teens were significantly more likely than their nondelinquent peers to report suicidal ideation, suicide attempts, and treatment for suicide attempts at both 1 and 7 years' follow-up. When the researchers controlled for behavioral risk factors such as depression, impulsivity, religiosity, and problem drinking, delinquency remained significantly associated with suicidal ideation 1 year later and with suicide attempts 1 and 7 years later among girls. The association for boys remained but was not statistically significant.

Minority teens were less likely than were white teens to report suicidal ideation after 1 year, but there were no significant racial differences in those who attempted suicide or who required medical treatment after attempting suicide, Dr. Thompson and her associates noted.

Cannabis Use May Predict Later Anxiety

Young people who use cannabis at 15 years of age are significantly more likely to show symptoms of anxiety and depression in young adulthood, compared with non-cannabis users, data show.

From a clinical standpoint, reducing cannabis use in adolescents could reduce anxiety and depression in young adulthood, wrote Dr. Mohammad R. Hayatbakhsh and his colleagues at the University of Queensland in Brisbane, Australia.

To assess the relationships among cannabis use and anxiety and depression, the researchers reviewed data on 3,239 Australian young people from birth to age 21 and measured confounding factors at birth, age 14, and age 21 (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:408–17).

A total of 1,586 youth (49%) reported ever using cannabis; 36.8% were occasional users (an average of one use per month) and 12.2% were frequent users (an average of one use every few days). Symptoms of anxiety and depression were assessed using the Youth Self-Report questionnaire.

After the researchers controlled for multiple factors, including gender, mother's mental health, family income, and smoking and alcohol consumption, young people who were frequent cannabis users before 15 years of age were more than twice as likely to show signs of anxiety and depression as young adults than were non-cannabis users. The association persisted, whether or not the young people used other illicit drugs in addition to cannabis.

Conversely, the presence of anxiety and depression before age 15 was not significantly associated with cannabis use in young adulthood. However, the findings suggest that cannabis use in adolescence may predict mental health problems later in life, the researchers noted.

Risky Sex Linked to Sensation-Seeking

Black adolescent girls who reported risky sexual activities scored significantly higher on tests of sexual sensation-seeking traits than did those who didn't report risky sex, based on data from 1,245 sexually active females aged 15–21 years.

To examine the relationship between sexual sensation seeking and sexual risk taking in adolescents, Joshua Spitalnick, Ph.D., of Emory University, Atlanta, and his colleagues surveyed black girls who were seeking sexual health services at community health clinics (J. Adolescence 2007;30:165–73).

Most (84%) of these adolescents reported that they were involved in a sexual relationship. The average length of that relationship was 15 months, and the respondents reported an average of nine lifetime partners. The average age of the participants was 18 years.

They were evaluated using the Sexual Sensation Seeking for Adolescents (SSSA) scale, which included statements such as, “I enjoy the thrill of having sex in public places,” with answer choices ranging from 1 (strongly disagree) to 4 (strongly agree). Scores ranged from 9 to 36, with an average score of 17.53.

Overall, respondents with high SSSA scores were significantly more likely to report risky sexual behavior including more-frequent vaginal intercourse, more sexual partners, and inconsistent use of condoms or other protection than were girls who scored lower on the SSSA.

Delinquent Teens at Risk for Suicide

Teenage delinquency was significantly associated with an increased risk for suicidal behavior in girls, according to data from a nationally representative sample of American teens.

To prospectively examine the association between delinquency and suicide in teens, Martie P. Thompson, Ph.D., and her colleagues at Clemson (S.C.) University reviewed data on 15,034 teens aged 12–17 years from the National Longitudinal Study of Adolescent Health, a survey of factors that affect teens' health and behavior (J. Adolesc. Health 2007;40:232–7).

Delinquency was assessed using a 15-item survey of behaviors in the previous 12 months, with questions such as, “How often did you deliberately damage property that didn't belong to you?”

After the researchers controlled for age, race, gender, and urban dwelling status, delinquent teens were significantly more likely than their nondelinquent peers to report suicidal ideation, suicide attempts, and treatment for suicide attempts at both 1 and 7 years' follow-up. When the researchers controlled for behavioral risk factors such as depression, impulsivity, religiosity, and problem drinking, delinquency remained significantly associated with suicidal ideation 1 year later and with suicide attempts 1 and 7 years later among girls. The association for boys remained but was not statistically significant.

Minority teens were less likely than were white teens to report suicidal ideation after 1 year, but there were no significant racial differences in those who attempted suicide or who required medical treatment after attempting suicide, Dr. Thompson and her associates noted.

Cannabis Use May Predict Later Anxiety

Young people who use cannabis at 15 years of age are significantly more likely to show symptoms of anxiety and depression in young adulthood, compared with non-cannabis users, data show.

From a clinical standpoint, reducing cannabis use in adolescents could reduce anxiety and depression in young adulthood, wrote Dr. Mohammad R. Hayatbakhsh and his colleagues at the University of Queensland in Brisbane, Australia.

To assess the relationships among cannabis use and anxiety and depression, the researchers reviewed data on 3,239 Australian young people from birth to age 21 and measured confounding factors at birth, age 14, and age 21 (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:408–17).

A total of 1,586 youth (49%) reported ever using cannabis; 36.8% were occasional users (an average of one use per month) and 12.2% were frequent users (an average of one use every few days). Symptoms of anxiety and depression were assessed using the Youth Self-Report questionnaire.

After the researchers controlled for multiple factors, including gender, mother's mental health, family income, and smoking and alcohol consumption, young people who were frequent cannabis users before 15 years of age were more than twice as likely to show signs of anxiety and depression as young adults than were non-cannabis users. The association persisted, whether or not the young people used other illicit drugs in addition to cannabis.

Conversely, the presence of anxiety and depression before age 15 was not significantly associated with cannabis use in young adulthood. However, the findings suggest that cannabis use in adolescence may predict mental health problems later in life, the researchers noted.

Risky Sex Linked to Sensation-Seeking

Black adolescent girls who reported risky sexual activities scored significantly higher on tests of sexual sensation-seeking traits than did those who didn't report risky sex, based on data from 1,245 sexually active females aged 15–21 years.

To examine the relationship between sexual sensation seeking and sexual risk taking in adolescents, Joshua Spitalnick, Ph.D., of Emory University, Atlanta, and his colleagues surveyed black girls who were seeking sexual health services at community health clinics (J. Adolescence 2007;30:165–73).

Most (84%) of these adolescents reported that they were involved in a sexual relationship. The average length of that relationship was 15 months, and the respondents reported an average of nine lifetime partners. The average age of the participants was 18 years.

They were evaluated using the Sexual Sensation Seeking for Adolescents (SSSA) scale, which included statements such as, “I enjoy the thrill of having sex in public places,” with answer choices ranging from 1 (strongly disagree) to 4 (strongly agree). Scores ranged from 9 to 36, with an average score of 17.53.

Overall, respondents with high SSSA scores were significantly more likely to report risky sexual behavior including more-frequent vaginal intercourse, more sexual partners, and inconsistent use of condoms or other protection than were girls who scored lower on the SSSA.

Delinquent Teens at Risk for Suicide

Teenage delinquency was significantly associated with an increased risk for suicidal behavior in girls, according to data from a nationally representative sample of American teens.

To prospectively examine the association between delinquency and suicide in teens, Martie P. Thompson, Ph.D., and her colleagues at Clemson (S.C.) University reviewed data on 15,034 teens aged 12–17 years from the National Longitudinal Study of Adolescent Health, a survey of factors that affect teens' health and behavior (J. Adolesc. Health 2007;40:232–7).

Delinquency was assessed using a 15-item survey of behaviors in the previous 12 months, with questions such as, “How often did you deliberately damage property that didn't belong to you?”

After the researchers controlled for age, race, gender, and urban dwelling status, delinquent teens were significantly more likely than their nondelinquent peers to report suicidal ideation, suicide attempts, and treatment for suicide attempts at both 1 and 7 years' follow-up. When the researchers controlled for behavioral risk factors such as depression, impulsivity, religiosity, and problem drinking, delinquency remained significantly associated with suicidal ideation 1 year later and with suicide attempts 1 and 7 years later among girls. The association for boys remained but was not statistically significant.

Minority teens were less likely than were white teens to report suicidal ideation after 1 year, but there were no significant racial differences in those who attempted suicide or who required medical treatment after attempting suicide, Dr. Thompson and her associates noted.

GRAND CAYMAN, CAYMAN ISLANDS — "Read clinical research studies carefully and thoughtfully, and don't rely on anyone to think for you," Dr. Lee Zane advised at the Caribbean Dermatology Symposium.

An important skill to master is the ability to summarize a study in a single sentence that describes the study design, primary predictors, primary outcomes, and study population, said Dr. Zane, a dermatologist at the University of California, San Francisco.

Readers who adroitly summarize a study can communicate its essential elements to others and create a framework for evaluating the study's results. To that end, Dr. Zane offered several points to consider when reading a study.

All studies have limitations, such as bias or confounders, that may compromise the interpretation of the results. Such factors do not generally invalidate the results, but they invite readers to consider the results in the context of the limitations, Dr. Zane explained. "In fact, sometimes conclusions may be strengthened by the presence of a confounder," he said.

Randomized clinical trials are considered to provide some of the strongest clinical evidence, but even they have vulnerabilities that can compromise their interpretation.

Randomization itself is one such limitation. If not done properly, randomization can introduce bias into a study. For example, randomization by whether a patient comes in on Monday or Wednesday versus Tuesday or Thursday is not true randomization, Dr. Zane said. In addition, traits such as age and sex can confound the results if they aren't distributed equally among randomized groups.

"Always scrutinize Table 1," he advised. Table 1 shows the features of the randomized groups. "If there are differences among groups, you have to decide whether they may have had a significant effect on the outcome."

Don't confuse clinical significance with statistical significance. "Just because a result has a low P value doesn't mean it is an important or useful clinical finding," he said at the meeting.

"There is a general overreliance on P values in our literature," Dr. Zane said. He cited the historical origin of P greater than .05 as an indicator of statistical significance. The value was arbitrarily chosen by statistician Ronald Fisher in 1926 in a paper assessing the effectiveness of manure on crop growth.

"Investigators should report the actual P value rather than simply saying whether it is greater or less than .05," he said. "Knowing whether a P value is .06 or .98 provides much more information about how likely the result may have been simply due to chance."

Confidence intervals may be a preferable alternative to P values, Dr. Zane said. These intervals are a measure of precision, not the result of a statistical test, and they provide a range of values around an estimate that may be considered statistically similar to that estimate.

Don't forget to consider such methodologic factors as the size and composition of the sample population—as well as the level of blinding—when reading and evaluating a study, he said. "Are the subjects in the study similar to those that you see in your clinic? Could the lack of blinding in an open-label study have contributed to the observed results?"

All studies provide evidence of some sort. "The key is being able to determine the strength of that evidence," he said.

GRAND CAYMAN, CAYMAN ISLANDS — "Read clinical research studies carefully and thoughtfully, and don't rely on anyone to think for you," Dr. Lee Zane advised at the Caribbean Dermatology Symposium.

An important skill to master is the ability to summarize a study in a single sentence that describes the study design, primary predictors, primary outcomes, and study population, said Dr. Zane, a dermatologist at the University of California, San Francisco.

Readers who adroitly summarize a study can communicate its essential elements to others and create a framework for evaluating the study's results. To that end, Dr. Zane offered several points to consider when reading a study.

All studies have limitations, such as bias or confounders, that may compromise the interpretation of the results. Such factors do not generally invalidate the results, but they invite readers to consider the results in the context of the limitations, Dr. Zane explained. "In fact, sometimes conclusions may be strengthened by the presence of a confounder," he said.

Randomized clinical trials are considered to provide some of the strongest clinical evidence, but even they have vulnerabilities that can compromise their interpretation.

Randomization itself is one such limitation. If not done properly, randomization can introduce bias into a study. For example, randomization by whether a patient comes in on Monday or Wednesday versus Tuesday or Thursday is not true randomization, Dr. Zane said. In addition, traits such as age and sex can confound the results if they aren't distributed equally among randomized groups.

"Always scrutinize Table 1," he advised. Table 1 shows the features of the randomized groups. "If there are differences among groups, you have to decide whether they may have had a significant effect on the outcome."

Don't confuse clinical significance with statistical significance. "Just because a result has a low P value doesn't mean it is an important or useful clinical finding," he said at the meeting.

"There is a general overreliance on P values in our literature," Dr. Zane said. He cited the historical origin of P greater than .05 as an indicator of statistical significance. The value was arbitrarily chosen by statistician Ronald Fisher in 1926 in a paper assessing the effectiveness of manure on crop growth.

"Investigators should report the actual P value rather than simply saying whether it is greater or less than .05," he said. "Knowing whether a P value is .06 or .98 provides much more information about how likely the result may have been simply due to chance."

Confidence intervals may be a preferable alternative to P values, Dr. Zane said. These intervals are a measure of precision, not the result of a statistical test, and they provide a range of values around an estimate that may be considered statistically similar to that estimate.

Don't forget to consider such methodologic factors as the size and composition of the sample population—as well as the level of blinding—when reading and evaluating a study, he said. "Are the subjects in the study similar to those that you see in your clinic? Could the lack of blinding in an open-label study have contributed to the observed results?"

All studies provide evidence of some sort. "The key is being able to determine the strength of that evidence," he said.

GRAND CAYMAN, CAYMAN ISLANDS — "Read clinical research studies carefully and thoughtfully, and don't rely on anyone to think for you," Dr. Lee Zane advised at the Caribbean Dermatology Symposium.

An important skill to master is the ability to summarize a study in a single sentence that describes the study design, primary predictors, primary outcomes, and study population, said Dr. Zane, a dermatologist at the University of California, San Francisco.

Readers who adroitly summarize a study can communicate its essential elements to others and create a framework for evaluating the study's results. To that end, Dr. Zane offered several points to consider when reading a study.

All studies have limitations, such as bias or confounders, that may compromise the interpretation of the results. Such factors do not generally invalidate the results, but they invite readers to consider the results in the context of the limitations, Dr. Zane explained. "In fact, sometimes conclusions may be strengthened by the presence of a confounder," he said.

Randomized clinical trials are considered to provide some of the strongest clinical evidence, but even they have vulnerabilities that can compromise their interpretation.

Randomization itself is one such limitation. If not done properly, randomization can introduce bias into a study. For example, randomization by whether a patient comes in on Monday or Wednesday versus Tuesday or Thursday is not true randomization, Dr. Zane said. In addition, traits such as age and sex can confound the results if they aren't distributed equally among randomized groups.

"Always scrutinize Table 1," he advised. Table 1 shows the features of the randomized groups. "If there are differences among groups, you have to decide whether they may have had a significant effect on the outcome."

Don't confuse clinical significance with statistical significance. "Just because a result has a low P value doesn't mean it is an important or useful clinical finding," he said at the meeting.

"There is a general overreliance on P values in our literature," Dr. Zane said. He cited the historical origin of P greater than .05 as an indicator of statistical significance. The value was arbitrarily chosen by statistician Ronald Fisher in 1926 in a paper assessing the effectiveness of manure on crop growth.

"Investigators should report the actual P value rather than simply saying whether it is greater or less than .05," he said. "Knowing whether a P value is .06 or .98 provides much more information about how likely the result may have been simply due to chance."

Confidence intervals may be a preferable alternative to P values, Dr. Zane said. These intervals are a measure of precision, not the result of a statistical test, and they provide a range of values around an estimate that may be considered statistically similar to that estimate.

Don't forget to consider such methodologic factors as the size and composition of the sample population—as well as the level of blinding—when reading and evaluating a study, he said. "Are the subjects in the study similar to those that you see in your clinic? Could the lack of blinding in an open-label study have contributed to the observed results?"

All studies provide evidence of some sort. "The key is being able to determine the strength of that evidence," he said.