Heidi Splete

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

Less than 12% of 312 pediatricians experienced or expected a notable decrease in revenue from using Pediarix, the combined vaccine from GlaxoSmithKline, based on a nationwide survey.

About 11% of the practices reported a moderate decrease in revenue and less than 1% reported a significant decrease, said Dr. Gary L. Freed and his colleagues at the University of Michigan in Ann Arbor (Pediatrics 2006;118:251–7). The researchers had no financial relationships related to the study.

Pediarix, which includes diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated polio vaccines, was licensed by the Food and Drug Administration in December 2002 and accounted for more than 30% of all diphtheria, tetanus, acellular pertussis vaccine administered in the United States by the end of 2003. The researchers conducted the survey to determine factors that influenced Pediarix use.

Overall, 123 pediatricians (39%) reported purchasing Pediarix for in-office use. Another 18% were considering a Pediarix purchase, and 40% were not considering a purchase. The remaining 3% said they did not know, or left the question blank.

Fewer administration fees and a decreased profit from the Pediarix vaccine itself were the most common reasons for decreased revenue (69% and 51%, respectively), and 74 practices had raised or planned to raise fees to recoup their losses. Some practices simply charged more for the vaccine—23% of practices charged payers more for the vaccine, while 12% charged patients more for it. In addition, 16% of practices charged payers higher administration fees, 9% charged patients higher administration fees, 7% charged payers more for office visits, and 3% charged patients more for office visits.

Despite the increased costs in some practices, combination vaccines were generally popular with patients and providers because they reduced the number of injections given to a child at a single visit.

Overall, 51% of the 241 pediatricians who reported factors that influenced their vaccine purchase decisions said that parent and provider interest in decreasing the number of injections was a factor.

“The study nicely depicts the multiple factors involved in making that decision [about combined vaccine use], and different physicians and parents will weigh the factors differently,” said Dr. Edgar K. Marcuse, a professor of pediatrics at the University of Washington, Seattle, and a member of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

The combination vaccines can decrease missed opportunities and missed vaccine coverage, which is something of importance to all pediatricians, he added.

The financial impact of combined vaccine use is likely to vary by region and by payer contracts. Some state and private insurance programs limit the number of administrative fees that physicians can charge, which may reduce the impact of combination vaccine use on total practice revenue.

For some, “given the circumstances of their practice and the socioeconomic status of their patients, the price is not off-putting; for others price may be the key driver,” Dr. Marcuse said.

“Parents and physicians will look at the factors identified in the study, and those who are enthusiastic about this particular combination and who value the decreased injections will use it, while those who are hesitant may look at the increased cost and refrain for now,” he said.

But some practices are reluctant to maintain two supplies of vaccine and two standards of care: one for those covered by state-funded vaccine programs and one for those funded by private purchasers.

The practices surveyed were less likely to purchase Pediarix when they did not order it through the federal Vaccines for Children program, which highlights the reluctance of most physicians to use one vaccine for certain patients and not for others, the researchers noted.

Less than 12% of 312 pediatricians experienced or expected a notable decrease in revenue from using Pediarix, the combined vaccine from GlaxoSmithKline, based on a nationwide survey.

About 11% of the practices reported a moderate decrease in revenue and less than 1% reported a significant decrease, said Dr. Gary L. Freed and his colleagues at the University of Michigan in Ann Arbor (Pediatrics 2006;118:251–7). The researchers had no financial relationships related to the study.

Pediarix, which includes diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated polio vaccines, was licensed by the Food and Drug Administration in December 2002 and accounted for more than 30% of all diphtheria, tetanus, acellular pertussis vaccine administered in the United States by the end of 2003. The researchers conducted the survey to determine factors that influenced Pediarix use.

Overall, 123 pediatricians (39%) reported purchasing Pediarix for in-office use. Another 18% were considering a Pediarix purchase, and 40% were not considering a purchase. The remaining 3% said they did not know, or left the question blank.

Fewer administration fees and a decreased profit from the Pediarix vaccine itself were the most common reasons for decreased revenue (69% and 51%, respectively), and 74 practices had raised or planned to raise fees to recoup their losses. Some practices simply charged more for the vaccine—23% of practices charged payers more for the vaccine, while 12% charged patients more for it. In addition, 16% of practices charged payers higher administration fees, 9% charged patients higher administration fees, 7% charged payers more for office visits, and 3% charged patients more for office visits.

Despite the increased costs in some practices, combination vaccines were generally popular with patients and providers because they reduced the number of injections given to a child at a single visit.

Overall, 51% of the 241 pediatricians who reported factors that influenced their vaccine purchase decisions said that parent and provider interest in decreasing the number of injections was a factor.

“The study nicely depicts the multiple factors involved in making that decision [about combined vaccine use], and different physicians and parents will weigh the factors differently,” said Dr. Edgar K. Marcuse, a professor of pediatrics at the University of Washington, Seattle, and a member of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

The combination vaccines can decrease missed opportunities and missed vaccine coverage, which is something of importance to all pediatricians, he added.

The financial impact of combined vaccine use is likely to vary by region and by payer contracts. Some state and private insurance programs limit the number of administrative fees that physicians can charge, which may reduce the impact of combination vaccine use on total practice revenue.

For some, “given the circumstances of their practice and the socioeconomic status of their patients, the price is not off-putting; for others price may be the key driver,” Dr. Marcuse said.

“Parents and physicians will look at the factors identified in the study, and those who are enthusiastic about this particular combination and who value the decreased injections will use it, while those who are hesitant may look at the increased cost and refrain for now,” he said.

But some practices are reluctant to maintain two supplies of vaccine and two standards of care: one for those covered by state-funded vaccine programs and one for those funded by private purchasers.

The practices surveyed were less likely to purchase Pediarix when they did not order it through the federal Vaccines for Children program, which highlights the reluctance of most physicians to use one vaccine for certain patients and not for others, the researchers noted.

Less than 12% of 312 pediatricians experienced or expected a notable decrease in revenue from using Pediarix, the combined vaccine from GlaxoSmithKline, based on a nationwide survey.

About 11% of the practices reported a moderate decrease in revenue and less than 1% reported a significant decrease, said Dr. Gary L. Freed and his colleagues at the University of Michigan in Ann Arbor (Pediatrics 2006;118:251–7). The researchers had no financial relationships related to the study.

Pediarix, which includes diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated polio vaccines, was licensed by the Food and Drug Administration in December 2002 and accounted for more than 30% of all diphtheria, tetanus, acellular pertussis vaccine administered in the United States by the end of 2003. The researchers conducted the survey to determine factors that influenced Pediarix use.

Overall, 123 pediatricians (39%) reported purchasing Pediarix for in-office use. Another 18% were considering a Pediarix purchase, and 40% were not considering a purchase. The remaining 3% said they did not know, or left the question blank.

Fewer administration fees and a decreased profit from the Pediarix vaccine itself were the most common reasons for decreased revenue (69% and 51%, respectively), and 74 practices had raised or planned to raise fees to recoup their losses. Some practices simply charged more for the vaccine—23% of practices charged payers more for the vaccine, while 12% charged patients more for it. In addition, 16% of practices charged payers higher administration fees, 9% charged patients higher administration fees, 7% charged payers more for office visits, and 3% charged patients more for office visits.

Despite the increased costs in some practices, combination vaccines were generally popular with patients and providers because they reduced the number of injections given to a child at a single visit.

Overall, 51% of the 241 pediatricians who reported factors that influenced their vaccine purchase decisions said that parent and provider interest in decreasing the number of injections was a factor.

“The study nicely depicts the multiple factors involved in making that decision [about combined vaccine use], and different physicians and parents will weigh the factors differently,” said Dr. Edgar K. Marcuse, a professor of pediatrics at the University of Washington, Seattle, and a member of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

The combination vaccines can decrease missed opportunities and missed vaccine coverage, which is something of importance to all pediatricians, he added.

The financial impact of combined vaccine use is likely to vary by region and by payer contracts. Some state and private insurance programs limit the number of administrative fees that physicians can charge, which may reduce the impact of combination vaccine use on total practice revenue.

For some, “given the circumstances of their practice and the socioeconomic status of their patients, the price is not off-putting; for others price may be the key driver,” Dr. Marcuse said.

“Parents and physicians will look at the factors identified in the study, and those who are enthusiastic about this particular combination and who value the decreased injections will use it, while those who are hesitant may look at the increased cost and refrain for now,” he said.

But some practices are reluctant to maintain two supplies of vaccine and two standards of care: one for those covered by state-funded vaccine programs and one for those funded by private purchasers.

The practices surveyed were less likely to purchase Pediarix when they did not order it through the federal Vaccines for Children program, which highlights the reluctance of most physicians to use one vaccine for certain patients and not for others, the researchers noted.

A standard daily dose of 40–45 mg/kg per day amoxicillin is an appropriate first-line antibiotic for children with acute otitis media who have received at least three doses of the heptavalent pneumococcal conjugate vaccine, if treatment is needed, reported Dr. Jane Garbutt and her colleagues at Washington University, St. Louis.

The investigators reviewed data from 327 children younger than 7 years old with new diagnoses of acute otitis media, otitis media with effusion, acute sinusitis, streptococcal pharyngitis, nonspecific upper respiratory tract infections, or a cough illness during the 4-year period (Pediatrics 2006;117:1087–94).

The prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP) was significantly reduced in children with any diagnosis who had received at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7), compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine. In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

A standard daily dose of 40–45 mg/kg per day amoxicillin is an appropriate first-line antibiotic for children with acute otitis media who have received at least three doses of the heptavalent pneumococcal conjugate vaccine, if treatment is needed, reported Dr. Jane Garbutt and her colleagues at Washington University, St. Louis.

The investigators reviewed data from 327 children younger than 7 years old with new diagnoses of acute otitis media, otitis media with effusion, acute sinusitis, streptococcal pharyngitis, nonspecific upper respiratory tract infections, or a cough illness during the 4-year period (Pediatrics 2006;117:1087–94).

The prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP) was significantly reduced in children with any diagnosis who had received at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7), compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine. In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

A standard daily dose of 40–45 mg/kg per day amoxicillin is an appropriate first-line antibiotic for children with acute otitis media who have received at least three doses of the heptavalent pneumococcal conjugate vaccine, if treatment is needed, reported Dr. Jane Garbutt and her colleagues at Washington University, St. Louis.

The investigators reviewed data from 327 children younger than 7 years old with new diagnoses of acute otitis media, otitis media with effusion, acute sinusitis, streptococcal pharyngitis, nonspecific upper respiratory tract infections, or a cough illness during the 4-year period (Pediatrics 2006;117:1087–94).

The prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP) was significantly reduced in children with any diagnosis who had received at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7), compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine. In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

WASHINGTON — Clinicians should be proactive in checking their HIV patients for herpes and syphilis because of the risk of coinfection, Dr. Connie Celum said at the Ryan White CARE Act meeting on HIV treatment.

“If you don't look for STDs in HIV patients, you won't find them,” said Dr. Celum of the University of Washington, Seattle.

Individuals with STDs are two to five times more likely than those without STDs to become infected with HIV if they are exposed through sexual contact, according to data from the Centers for Disease Control and Prevention.

Comorbid STDs often go undetected in HIV patients, but an HIV-infected person who is coinfected with an STD is more likely to transmit HIV than an HIV-infected person without a comorbid STD.

Genital herpes is the most common sexually-transmitted infection among HIV-positive persons, Dr. Celum said. Previous studies have shown that the herpes virus (HSV-2) increases one's risk of acquiring HIV and increases HIV RNA levels in plasma and in the genital tract; the presence of herpes also makes a person more likely to transmit HIV.

Conversely, the presence of HIV can reactivate herpes that has been dormant. HIV also increases the frequency of HSV-2 shedding in persons with herpes and increases the risk of acquiring and transmitting the herpes virus. A recent study by Dr. Celum and her colleagues at the University of Washington found that 50 HIV-positive men with herpes were 2.7 times more likely to shed the herpes virus orally, compared with 59 HIV-negative men with herpes (J. Infect. Dis. 2006;194:420–7).

A key question is, if you suppress herpes, can you reduce the likelihood of HIV infection? Suppression of herpes may be a strategy that buys more time for researchers who continue to work on other HIV treatments and interventions, Dr. Celum said.

Data from a proof-of-concept study including 140 women coinfected with HIV and herpes showed that treating herpes with valacyclovir significantly reduced HIV levels in plasma and the genital tract. The results were presented at the Conference on Retroviruses and Opportunistic Infections earlier this year, but useful clinical data are still 1–2 years away, she said.

Most herpes patients shed the virus in the genital tract. Although highly active antiretroviral treatment (HAART) may reduce symptoms of herpes, it does not reduce subclinical herpes shedding. Even if suppressing herpes infections with HAART can suppress the viral load in HIV patients, it remains to be seen whether treating herpes also reduces the likelihood of HIV infection.

Clinicians should also be vigilant in evaluating their HIV patients for syphilis because the annual incidence of syphilis is rising, especially among men who have sex with men, Dr. Celum explained.

The reasons for the resurgence of syphilis remain unclear, but some epidemiologic data suggest that improved therapy for HIV and improved survival and well-being among HIV patients may be driving the increase in cases, particularly among men who have sex with men. Most clinicians have limited experience in diagnosing syphilis, and they may not know it when they see it. Syphilis is a great imitator; the appearance of rashes and other signs of secondary syphilis vary from person to person.

Syphilis rashes may be widespread or subtle. The rashes are not usually itchy or vesicular, but they may include papules, macules, pustules, or ring- or lens-shaped lesions. A syphilis rash appears on the palms and soles in 60% of cases, not 100% of cases, so look elsewhere on the body for signs of infection after checking the palms and soles, Dr. Celum said. These symptoms usually appear after the chancres of primary syphilis have resolved.

Syphilis manifestations are especially easy to miss in HIV-positive patients on HAART because these patients often develop rashes that resemble syphilis as a side effect of the medication.

Consequently, Dr. Celum recommends maintaining a high level of suspicion for syphilis in HIV-positive patients because of the increased risk of HIV transmission. She suggests treating for syphilis in possible as well as definite cases, and re-examining the patients clinically and serologically every 6 months.

The most current treatment guidelines for syphilis and other STDs are available on the Centers for Disease Control and Prevention Web site at www.cdc.gov/std

WASHINGTON — Clinicians should be proactive in checking their HIV patients for herpes and syphilis because of the risk of coinfection, Dr. Connie Celum said at the Ryan White CARE Act meeting on HIV treatment.

“If you don't look for STDs in HIV patients, you won't find them,” said Dr. Celum of the University of Washington, Seattle.

Individuals with STDs are two to five times more likely than those without STDs to become infected with HIV if they are exposed through sexual contact, according to data from the Centers for Disease Control and Prevention.

Comorbid STDs often go undetected in HIV patients, but an HIV-infected person who is coinfected with an STD is more likely to transmit HIV than an HIV-infected person without a comorbid STD.

Genital herpes is the most common sexually-transmitted infection among HIV-positive persons, Dr. Celum said. Previous studies have shown that the herpes virus (HSV-2) increases one's risk of acquiring HIV and increases HIV RNA levels in plasma and in the genital tract; the presence of herpes also makes a person more likely to transmit HIV.

Conversely, the presence of HIV can reactivate herpes that has been dormant. HIV also increases the frequency of HSV-2 shedding in persons with herpes and increases the risk of acquiring and transmitting the herpes virus. A recent study by Dr. Celum and her colleagues at the University of Washington found that 50 HIV-positive men with herpes were 2.7 times more likely to shed the herpes virus orally, compared with 59 HIV-negative men with herpes (J. Infect. Dis. 2006;194:420–7).

A key question is, if you suppress herpes, can you reduce the likelihood of HIV infection? Suppression of herpes may be a strategy that buys more time for researchers who continue to work on other HIV treatments and interventions, Dr. Celum said.

Data from a proof-of-concept study including 140 women coinfected with HIV and herpes showed that treating herpes with valacyclovir significantly reduced HIV levels in plasma and the genital tract. The results were presented at the Conference on Retroviruses and Opportunistic Infections earlier this year, but useful clinical data are still 1–2 years away, she said.

Most herpes patients shed the virus in the genital tract. Although highly active antiretroviral treatment (HAART) may reduce symptoms of herpes, it does not reduce subclinical herpes shedding. Even if suppressing herpes infections with HAART can suppress the viral load in HIV patients, it remains to be seen whether treating herpes also reduces the likelihood of HIV infection.

Clinicians should also be vigilant in evaluating their HIV patients for syphilis because the annual incidence of syphilis is rising, especially among men who have sex with men, Dr. Celum explained.

The reasons for the resurgence of syphilis remain unclear, but some epidemiologic data suggest that improved therapy for HIV and improved survival and well-being among HIV patients may be driving the increase in cases, particularly among men who have sex with men. Most clinicians have limited experience in diagnosing syphilis, and they may not know it when they see it. Syphilis is a great imitator; the appearance of rashes and other signs of secondary syphilis vary from person to person.

Syphilis rashes may be widespread or subtle. The rashes are not usually itchy or vesicular, but they may include papules, macules, pustules, or ring- or lens-shaped lesions. A syphilis rash appears on the palms and soles in 60% of cases, not 100% of cases, so look elsewhere on the body for signs of infection after checking the palms and soles, Dr. Celum said. These symptoms usually appear after the chancres of primary syphilis have resolved.

Syphilis manifestations are especially easy to miss in HIV-positive patients on HAART because these patients often develop rashes that resemble syphilis as a side effect of the medication.

Consequently, Dr. Celum recommends maintaining a high level of suspicion for syphilis in HIV-positive patients because of the increased risk of HIV transmission. She suggests treating for syphilis in possible as well as definite cases, and re-examining the patients clinically and serologically every 6 months.

The most current treatment guidelines for syphilis and other STDs are available on the Centers for Disease Control and Prevention Web site at www.cdc.gov/std

WASHINGTON — Clinicians should be proactive in checking their HIV patients for herpes and syphilis because of the risk of coinfection, Dr. Connie Celum said at the Ryan White CARE Act meeting on HIV treatment.

“If you don't look for STDs in HIV patients, you won't find them,” said Dr. Celum of the University of Washington, Seattle.

Individuals with STDs are two to five times more likely than those without STDs to become infected with HIV if they are exposed through sexual contact, according to data from the Centers for Disease Control and Prevention.

Comorbid STDs often go undetected in HIV patients, but an HIV-infected person who is coinfected with an STD is more likely to transmit HIV than an HIV-infected person without a comorbid STD.

Genital herpes is the most common sexually-transmitted infection among HIV-positive persons, Dr. Celum said. Previous studies have shown that the herpes virus (HSV-2) increases one's risk of acquiring HIV and increases HIV RNA levels in plasma and in the genital tract; the presence of herpes also makes a person more likely to transmit HIV.

Conversely, the presence of HIV can reactivate herpes that has been dormant. HIV also increases the frequency of HSV-2 shedding in persons with herpes and increases the risk of acquiring and transmitting the herpes virus. A recent study by Dr. Celum and her colleagues at the University of Washington found that 50 HIV-positive men with herpes were 2.7 times more likely to shed the herpes virus orally, compared with 59 HIV-negative men with herpes (J. Infect. Dis. 2006;194:420–7).

A key question is, if you suppress herpes, can you reduce the likelihood of HIV infection? Suppression of herpes may be a strategy that buys more time for researchers who continue to work on other HIV treatments and interventions, Dr. Celum said.

Data from a proof-of-concept study including 140 women coinfected with HIV and herpes showed that treating herpes with valacyclovir significantly reduced HIV levels in plasma and the genital tract. The results were presented at the Conference on Retroviruses and Opportunistic Infections earlier this year, but useful clinical data are still 1–2 years away, she said.

Most herpes patients shed the virus in the genital tract. Although highly active antiretroviral treatment (HAART) may reduce symptoms of herpes, it does not reduce subclinical herpes shedding. Even if suppressing herpes infections with HAART can suppress the viral load in HIV patients, it remains to be seen whether treating herpes also reduces the likelihood of HIV infection.

Clinicians should also be vigilant in evaluating their HIV patients for syphilis because the annual incidence of syphilis is rising, especially among men who have sex with men, Dr. Celum explained.

The reasons for the resurgence of syphilis remain unclear, but some epidemiologic data suggest that improved therapy for HIV and improved survival and well-being among HIV patients may be driving the increase in cases, particularly among men who have sex with men. Most clinicians have limited experience in diagnosing syphilis, and they may not know it when they see it. Syphilis is a great imitator; the appearance of rashes and other signs of secondary syphilis vary from person to person.

Syphilis rashes may be widespread or subtle. The rashes are not usually itchy or vesicular, but they may include papules, macules, pustules, or ring- or lens-shaped lesions. A syphilis rash appears on the palms and soles in 60% of cases, not 100% of cases, so look elsewhere on the body for signs of infection after checking the palms and soles, Dr. Celum said. These symptoms usually appear after the chancres of primary syphilis have resolved.

Syphilis manifestations are especially easy to miss in HIV-positive patients on HAART because these patients often develop rashes that resemble syphilis as a side effect of the medication.

Consequently, Dr. Celum recommends maintaining a high level of suspicion for syphilis in HIV-positive patients because of the increased risk of HIV transmission. She suggests treating for syphilis in possible as well as definite cases, and re-examining the patients clinically and serologically every 6 months.

The most current treatment guidelines for syphilis and other STDs are available on the Centers for Disease Control and Prevention Web site at www.cdc.gov/std

WASHINGTON — Teen vaccine educational material must be quick, accurate, understandable, and relevant, said Dr. Sharon Humiston at a meeting of the National Vaccine Advisory Committee.

The bottom line is that no single information source will hit everyone in a target audience, and some sources will hit unexpected targets, said Dr. Humiston, a pediatrician at the University of Rochester (N.Y.).

Dr. Humiston presented data to NVAC on behalf of the subcommittee on Communications and Public Engagement, and she cited results from a survey of 150 adolescents conducted by Parents of Kids with Infectious Diseases, a national nonprofit group. The goal of the survey was to determine where and how teens get their health information, and the data can be used to develop educational strategies for adolescent vaccination.

Surprisingly, some adolescents surveyed said that they actually read the one-page vaccine information statements available in many physicians' offices. “Most parents don't look at those information sheets,” Dr. Humiston noted. The survey results included responses from 150 adolescents, 53% of whom were male.

Half of the adolescents said that they had talked with parents about immunizations within the past year and that parents had initiated the conversation in 70% of the cases. In addition, 70 of 150 (47%) reported having talked with a health professional about immunizations.

Although 91% of the respondents said that they had ever been immunized, only 16% believed that they knew all their necessary immunizations.

The adolescents were asked to choose all sources from which they remembered receiving any health information.

A doctor's office was the most popular resource, chosen by of 80% of the respondents, followed by school (78%) and home (75%). In addition, 57% reported receiving health information from the Internet at home.

For the complete survey results, visit www.pkids.org/pdf/pkidstvireport.pdf

WASHINGTON — Teen vaccine educational material must be quick, accurate, understandable, and relevant, said Dr. Sharon Humiston at a meeting of the National Vaccine Advisory Committee.

The bottom line is that no single information source will hit everyone in a target audience, and some sources will hit unexpected targets, said Dr. Humiston, a pediatrician at the University of Rochester (N.Y.).

Dr. Humiston presented data to NVAC on behalf of the subcommittee on Communications and Public Engagement, and she cited results from a survey of 150 adolescents conducted by Parents of Kids with Infectious Diseases, a national nonprofit group. The goal of the survey was to determine where and how teens get their health information, and the data can be used to develop educational strategies for adolescent vaccination.

Surprisingly, some adolescents surveyed said that they actually read the one-page vaccine information statements available in many physicians' offices. “Most parents don't look at those information sheets,” Dr. Humiston noted. The survey results included responses from 150 adolescents, 53% of whom were male.

Half of the adolescents said that they had talked with parents about immunizations within the past year and that parents had initiated the conversation in 70% of the cases. In addition, 70 of 150 (47%) reported having talked with a health professional about immunizations.

Although 91% of the respondents said that they had ever been immunized, only 16% believed that they knew all their necessary immunizations.

The adolescents were asked to choose all sources from which they remembered receiving any health information.

A doctor's office was the most popular resource, chosen by of 80% of the respondents, followed by school (78%) and home (75%). In addition, 57% reported receiving health information from the Internet at home.

For the complete survey results, visit www.pkids.org/pdf/pkidstvireport.pdf

WASHINGTON — Teen vaccine educational material must be quick, accurate, understandable, and relevant, said Dr. Sharon Humiston at a meeting of the National Vaccine Advisory Committee.

The bottom line is that no single information source will hit everyone in a target audience, and some sources will hit unexpected targets, said Dr. Humiston, a pediatrician at the University of Rochester (N.Y.).

Dr. Humiston presented data to NVAC on behalf of the subcommittee on Communications and Public Engagement, and she cited results from a survey of 150 adolescents conducted by Parents of Kids with Infectious Diseases, a national nonprofit group. The goal of the survey was to determine where and how teens get their health information, and the data can be used to develop educational strategies for adolescent vaccination.

Surprisingly, some adolescents surveyed said that they actually read the one-page vaccine information statements available in many physicians' offices. “Most parents don't look at those information sheets,” Dr. Humiston noted. The survey results included responses from 150 adolescents, 53% of whom were male.

Half of the adolescents said that they had talked with parents about immunizations within the past year and that parents had initiated the conversation in 70% of the cases. In addition, 70 of 150 (47%) reported having talked with a health professional about immunizations.

Although 91% of the respondents said that they had ever been immunized, only 16% believed that they knew all their necessary immunizations.

The adolescents were asked to choose all sources from which they remembered receiving any health information.

A doctor's office was the most popular resource, chosen by of 80% of the respondents, followed by school (78%) and home (75%). In addition, 57% reported receiving health information from the Internet at home.

For the complete survey results, visit www.pkids.org/pdf/pkidstvireport.pdf

Amoxicillin and GAS Pharyngitis

Amoxicillin given once daily to treat group A streptococcal pharyngitis was no less effective than a twice-daily dose, based on data from 652 children seen in a private pediatric practice during a 2-year period.

Although once-daily penicillin has less effectiveness against group A streptococcal (GAS) pharyngitis than twice-daily dosing, the researchers proposed that amoxicillin, with its longer serum half-life, might be just as effective in one daily dose as in two daily doses, which could improve adherence in some cases.

Dr. Herbert W. Clegg, a pediatrician in group practice in Charlotte, N.C., and his colleagues recruited children aged 3–18 years with signs and symptoms of GAS pharyngitis. The children were randomized to a once-daily dose of either 750 or 1,000 mg or a twice-daily dose of 375 or 500 mg, depending on the child's weight. The treatment duration was 10 days for both groups, and patient demographics and compliance with therapy were similar in both groups.

The researchers assessed bacteriologic failure rates based on pharyngeal swabs taken at 14–21 days (visit 2) and 28–35 days (visit 3) after the start of treatment (Pediatr. Infect. Dis. J. 2006;25:761–7).

Not all children returned for visits 2 and 3 for various reasons, but the bacteriologic failure rate was 33% for both groups in an intent-to-treat analysis that included all patients, the researchers noted. The rates between the groups were not significantly different on further analysis.

Failure rates at visit 2 were 20% (59 of 294) in the once-daily group vs. 16% (46 of 296) in the twice-daily group. Failure rates at visit 3 were 3% (6 of 216) in the once-daily group vs. 7% (16 of 225) in the twice-daily group.

Pertussis Booster May Be Needed

Children may need a booster dose of the acellular pertussis vaccine between the ages of 5 and 7 years to ensure protection from illness, according to data from a 7-year population-based study.

A total of 1,293 cases of culture-confirmed pertussis were seen in Swedish children born in 1996 or later during the period from October 1997 to September 2004—after the introduction and widespread use of an acellular pertussis vaccine in Sweden, reported Lennart Gustafsson, Ph.D., of the Swedish Institute for Infectious Disease Control in Solna, and his colleagues (Pediatrics 2006;118:978–84).

Overall, 516 cases of pertussis occurred in unvaccinated children (225 per 100,000 person-years in children aged 2 months and younger). But the reported incidence of pertussis dropped significantly after the second and third doses of vaccine. The incidence was 31 per 100,000 person-years between dose two and dose three, and 8 per 100,000 person-years in fully vaccinated children within a year of the third dose (children aged 2 years and younger).

The incidence at 6 years among vaccinated children who had received at least two doses was similar to the incidence shortly after the second dose at ages 5–12 months (32 per 100,000 person-years vs. 31 per 100,000 person-years). But the incidence had increased to 48 per 100,000 person-years in children aged 7–8 years, which suggests a waning of vaccine protection after 6–7 years, the researchers said.

Infant Flu Vaccination Rates Are Low

Only 7.4% and 17.5% of children aged 6–23 months received at least one dose of the influenza vaccine during 2002–2003 and 2003–2004, respectively, based on a representative sample of 13,881 children from the 2003 and 2004 National Immunization Surveys.

The 2002–2003 and 2003–2004 seasons were the first two flu seasons in which vaccination was encouraged, but not formally recommended, for children aged 6–23 months, and more work is needed to ensure at least two doses for previously unvaccinated children in this age group, said Tammy A. Santibanez, Ph.D., and her colleagues at the Centers for Disease Control and Prevention in Atlanta.

Of the children who received at least one dose of flu vaccine, about 40% and 52% went on to be fully vaccinated during the 2002–2003 and 2003–2004 seasons, respectively. Overall, 4.4% and 8.4% of children aged 6–23 months were fully vaccinated during these two seasons.

“Receipt of two doses for previously unvaccinated children is paramount, because receipt of only one dose may provide little to no protection,” the researchers said.

Vaccination rates were significantly lower among children living below the poverty level, non-Hispanic black children, and children with less-educated mothers (Pediatrics 2006;118:1167–75). Receipt of at least one vaccination was significantly associated with white or Asian race, younger age at the start of flu season, and vaccine receipt at a private practice or a hospital, after controlling for multiple demographic variables.

Amoxicillin and GAS Pharyngitis

Amoxicillin given once daily to treat group A streptococcal pharyngitis was no less effective than a twice-daily dose, based on data from 652 children seen in a private pediatric practice during a 2-year period.

Although once-daily penicillin has less effectiveness against group A streptococcal (GAS) pharyngitis than twice-daily dosing, the researchers proposed that amoxicillin, with its longer serum half-life, might be just as effective in one daily dose as in two daily doses, which could improve adherence in some cases.

Dr. Herbert W. Clegg, a pediatrician in group practice in Charlotte, N.C., and his colleagues recruited children aged 3–18 years with signs and symptoms of GAS pharyngitis. The children were randomized to a once-daily dose of either 750 or 1,000 mg or a twice-daily dose of 375 or 500 mg, depending on the child's weight. The treatment duration was 10 days for both groups, and patient demographics and compliance with therapy were similar in both groups.

The researchers assessed bacteriologic failure rates based on pharyngeal swabs taken at 14–21 days (visit 2) and 28–35 days (visit 3) after the start of treatment (Pediatr. Infect. Dis. J. 2006;25:761–7).

Not all children returned for visits 2 and 3 for various reasons, but the bacteriologic failure rate was 33% for both groups in an intent-to-treat analysis that included all patients, the researchers noted. The rates between the groups were not significantly different on further analysis.

Failure rates at visit 2 were 20% (59 of 294) in the once-daily group vs. 16% (46 of 296) in the twice-daily group. Failure rates at visit 3 were 3% (6 of 216) in the once-daily group vs. 7% (16 of 225) in the twice-daily group.

Pertussis Booster May Be Needed

Children may need a booster dose of the acellular pertussis vaccine between the ages of 5 and 7 years to ensure protection from illness, according to data from a 7-year population-based study.

A total of 1,293 cases of culture-confirmed pertussis were seen in Swedish children born in 1996 or later during the period from October 1997 to September 2004—after the introduction and widespread use of an acellular pertussis vaccine in Sweden, reported Lennart Gustafsson, Ph.D., of the Swedish Institute for Infectious Disease Control in Solna, and his colleagues (Pediatrics 2006;118:978–84).

Overall, 516 cases of pertussis occurred in unvaccinated children (225 per 100,000 person-years in children aged 2 months and younger). But the reported incidence of pertussis dropped significantly after the second and third doses of vaccine. The incidence was 31 per 100,000 person-years between dose two and dose three, and 8 per 100,000 person-years in fully vaccinated children within a year of the third dose (children aged 2 years and younger).

The incidence at 6 years among vaccinated children who had received at least two doses was similar to the incidence shortly after the second dose at ages 5–12 months (32 per 100,000 person-years vs. 31 per 100,000 person-years). But the incidence had increased to 48 per 100,000 person-years in children aged 7–8 years, which suggests a waning of vaccine protection after 6–7 years, the researchers said.

Infant Flu Vaccination Rates Are Low

Only 7.4% and 17.5% of children aged 6–23 months received at least one dose of the influenza vaccine during 2002–2003 and 2003–2004, respectively, based on a representative sample of 13,881 children from the 2003 and 2004 National Immunization Surveys.

The 2002–2003 and 2003–2004 seasons were the first two flu seasons in which vaccination was encouraged, but not formally recommended, for children aged 6–23 months, and more work is needed to ensure at least two doses for previously unvaccinated children in this age group, said Tammy A. Santibanez, Ph.D., and her colleagues at the Centers for Disease Control and Prevention in Atlanta.

Of the children who received at least one dose of flu vaccine, about 40% and 52% went on to be fully vaccinated during the 2002–2003 and 2003–2004 seasons, respectively. Overall, 4.4% and 8.4% of children aged 6–23 months were fully vaccinated during these two seasons.

“Receipt of two doses for previously unvaccinated children is paramount, because receipt of only one dose may provide little to no protection,” the researchers said.

Vaccination rates were significantly lower among children living below the poverty level, non-Hispanic black children, and children with less-educated mothers (Pediatrics 2006;118:1167–75). Receipt of at least one vaccination was significantly associated with white or Asian race, younger age at the start of flu season, and vaccine receipt at a private practice or a hospital, after controlling for multiple demographic variables.

Amoxicillin and GAS Pharyngitis

Amoxicillin given once daily to treat group A streptococcal pharyngitis was no less effective than a twice-daily dose, based on data from 652 children seen in a private pediatric practice during a 2-year period.

Although once-daily penicillin has less effectiveness against group A streptococcal (GAS) pharyngitis than twice-daily dosing, the researchers proposed that amoxicillin, with its longer serum half-life, might be just as effective in one daily dose as in two daily doses, which could improve adherence in some cases.

Dr. Herbert W. Clegg, a pediatrician in group practice in Charlotte, N.C., and his colleagues recruited children aged 3–18 years with signs and symptoms of GAS pharyngitis. The children were randomized to a once-daily dose of either 750 or 1,000 mg or a twice-daily dose of 375 or 500 mg, depending on the child's weight. The treatment duration was 10 days for both groups, and patient demographics and compliance with therapy were similar in both groups.

The researchers assessed bacteriologic failure rates based on pharyngeal swabs taken at 14–21 days (visit 2) and 28–35 days (visit 3) after the start of treatment (Pediatr. Infect. Dis. J. 2006;25:761–7).

Not all children returned for visits 2 and 3 for various reasons, but the bacteriologic failure rate was 33% for both groups in an intent-to-treat analysis that included all patients, the researchers noted. The rates between the groups were not significantly different on further analysis.

Failure rates at visit 2 were 20% (59 of 294) in the once-daily group vs. 16% (46 of 296) in the twice-daily group. Failure rates at visit 3 were 3% (6 of 216) in the once-daily group vs. 7% (16 of 225) in the twice-daily group.

Pertussis Booster May Be Needed

Children may need a booster dose of the acellular pertussis vaccine between the ages of 5 and 7 years to ensure protection from illness, according to data from a 7-year population-based study.

A total of 1,293 cases of culture-confirmed pertussis were seen in Swedish children born in 1996 or later during the period from October 1997 to September 2004—after the introduction and widespread use of an acellular pertussis vaccine in Sweden, reported Lennart Gustafsson, Ph.D., of the Swedish Institute for Infectious Disease Control in Solna, and his colleagues (Pediatrics 2006;118:978–84).

Overall, 516 cases of pertussis occurred in unvaccinated children (225 per 100,000 person-years in children aged 2 months and younger). But the reported incidence of pertussis dropped significantly after the second and third doses of vaccine. The incidence was 31 per 100,000 person-years between dose two and dose three, and 8 per 100,000 person-years in fully vaccinated children within a year of the third dose (children aged 2 years and younger).

The incidence at 6 years among vaccinated children who had received at least two doses was similar to the incidence shortly after the second dose at ages 5–12 months (32 per 100,000 person-years vs. 31 per 100,000 person-years). But the incidence had increased to 48 per 100,000 person-years in children aged 7–8 years, which suggests a waning of vaccine protection after 6–7 years, the researchers said.

Infant Flu Vaccination Rates Are Low

Only 7.4% and 17.5% of children aged 6–23 months received at least one dose of the influenza vaccine during 2002–2003 and 2003–2004, respectively, based on a representative sample of 13,881 children from the 2003 and 2004 National Immunization Surveys.

The 2002–2003 and 2003–2004 seasons were the first two flu seasons in which vaccination was encouraged, but not formally recommended, for children aged 6–23 months, and more work is needed to ensure at least two doses for previously unvaccinated children in this age group, said Tammy A. Santibanez, Ph.D., and her colleagues at the Centers for Disease Control and Prevention in Atlanta.

Of the children who received at least one dose of flu vaccine, about 40% and 52% went on to be fully vaccinated during the 2002–2003 and 2003–2004 seasons, respectively. Overall, 4.4% and 8.4% of children aged 6–23 months were fully vaccinated during these two seasons.

“Receipt of two doses for previously unvaccinated children is paramount, because receipt of only one dose may provide little to no protection,” the researchers said.

Vaccination rates were significantly lower among children living below the poverty level, non-Hispanic black children, and children with less-educated mothers (Pediatrics 2006;118:1167–75). Receipt of at least one vaccination was significantly associated with white or Asian race, younger age at the start of flu season, and vaccine receipt at a private practice or a hospital, after controlling for multiple demographic variables.

Child-reported depressive symptoms are more strongly associated with asthma than are clinician- or parent-reported symptoms, reported Dr. James Waxmonsky and his colleagues at the State University of New York at Buffalo.

Dr. Waxmonsky and his colleagues found that clinically significant depressive symptoms were reported in more than one-quarter of the children (26%) in the study, which looked at 129 asthmatic inner city children aged 7–17 years.

The researchers evaluated the prevalence of depression and the best ways to measure symptoms in inner city children with asthma, because this population is understudied and may be predisposed to physical and emotional illnesses (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:945–54).

Each child's depression was assessed using several measures, including the Child Depression Inventory, Children's Depression Rating Scale-Revised, and Child Behavior Checklist-Internalizing Scale.

The depression rating scales were significantly correlated with one another, but self-report measures, such as the CDI, may be the most effective at assessing the link between depression and asthma “because they may best capture depressive symptoms that compromise airway conductivity,” the researchers wrote.

Overall, 96 children (74%) had moderate to severe asthma, and the mean lung function, based on forced expiratory volume in 1 second, was 88.1 FEV₁. Asthma was significantly associated with minority race.

Previous studies have shown associations between parental depression and children's asthma, but no significant association between those factors was found in this study–although 43% of mothers and 32% of fathers met the criteria for depression based on Beck's Depression Inventory.

Child-reported depressive symptoms are more strongly associated with asthma than are clinician- or parent-reported symptoms, reported Dr. James Waxmonsky and his colleagues at the State University of New York at Buffalo.

Dr. Waxmonsky and his colleagues found that clinically significant depressive symptoms were reported in more than one-quarter of the children (26%) in the study, which looked at 129 asthmatic inner city children aged 7–17 years.

The researchers evaluated the prevalence of depression and the best ways to measure symptoms in inner city children with asthma, because this population is understudied and may be predisposed to physical and emotional illnesses (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:945–54).

Each child's depression was assessed using several measures, including the Child Depression Inventory, Children's Depression Rating Scale-Revised, and Child Behavior Checklist-Internalizing Scale.

The depression rating scales were significantly correlated with one another, but self-report measures, such as the CDI, may be the most effective at assessing the link between depression and asthma “because they may best capture depressive symptoms that compromise airway conductivity,” the researchers wrote.

Overall, 96 children (74%) had moderate to severe asthma, and the mean lung function, based on forced expiratory volume in 1 second, was 88.1 FEV₁. Asthma was significantly associated with minority race.

Previous studies have shown associations between parental depression and children's asthma, but no significant association between those factors was found in this study–although 43% of mothers and 32% of fathers met the criteria for depression based on Beck's Depression Inventory.

Child-reported depressive symptoms are more strongly associated with asthma than are clinician- or parent-reported symptoms, reported Dr. James Waxmonsky and his colleagues at the State University of New York at Buffalo.

Dr. Waxmonsky and his colleagues found that clinically significant depressive symptoms were reported in more than one-quarter of the children (26%) in the study, which looked at 129 asthmatic inner city children aged 7–17 years.

The researchers evaluated the prevalence of depression and the best ways to measure symptoms in inner city children with asthma, because this population is understudied and may be predisposed to physical and emotional illnesses (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:945–54).

Each child's depression was assessed using several measures, including the Child Depression Inventory, Children's Depression Rating Scale-Revised, and Child Behavior Checklist-Internalizing Scale.

The depression rating scales were significantly correlated with one another, but self-report measures, such as the CDI, may be the most effective at assessing the link between depression and asthma “because they may best capture depressive symptoms that compromise airway conductivity,” the researchers wrote.

Overall, 96 children (74%) had moderate to severe asthma, and the mean lung function, based on forced expiratory volume in 1 second, was 88.1 FEV₁. Asthma was significantly associated with minority race.

Previous studies have shown associations between parental depression and children's asthma, but no significant association between those factors was found in this study–although 43% of mothers and 32% of fathers met the criteria for depression based on Beck's Depression Inventory.

WASHINGTON — Juggling the needs of HIV patients during planned visits can stretch the time management skills of any health care provider.

“If we rely on memory alone for everything we're supposed to do for a patient, we will forget 30%–40%,” Dr. Donna Sweet said in a workshop at the Ryan White CARE Act clinical meeting.

Dr. Sweet breaks down the HIV patient's planned visit into three components: HIV care, social and behavioral care, and general health maintenance.

The planned visit is first and foremost an HIV visit, said Dr. Sweet, an internist and professor of internal medicine at the University of Kansas, Wichita. “You have to review what drugs they are taking, and check their viral loads, and make sure that their HIV is as well controlled as possible,” she said.

To help providers remember the HIV-specific information they need to address with patients, Dr. Sweet and her staff designed a Patient Assessment Stamp—an actual ink stamp—that stamps a list of items on each HIV patient's chart.

The Patient Assessment Stamp lists a total of eight items: patient education, nutritional assessment, medication adherence counseling, risk reduction counseling, tobacco evaluation, mental health evaluation, substance abuse evaluation, and oral health evaluation.

Although all eight items are important, Dr. Sweet emphasizes medication adherence counseling in particular and makes it a priority for her medical residents when they work with HIV patients.

The assessment stamp prompts residents to ask patients what medications they are taking, whether they understand why they are taking the drugs, and how many pills they have missed in the last week.

Dr. Sweet also stressed the importance of tobacco evaluation in HIV patients.

“The smoking cessation message is as important as the risk reduction message for HIV patients,” she said. “When it comes to the health of my patients, I don't want them spreading the disease, but smoking may be what kills them, based on what we know about lung cancer and the increased risk in HIV patients.”

Oral health is included on the HIV assessment stamp because it is an important, but often-neglected, aspect of HIV care, Dr. Sweet said.

“Oral hygiene in these patients can be awful, especially if they get dental abscesses and get infected,” she said. Offering toothpaste or toothbrushes to HIV patients at planned visits can be a springboard into the second—social and preventive—component of the visit, she added.

The social and preventive component of the planned visit includes asking whether patients have jobs or homes and whether they are trying to avoid spreading their disease.

The third component—general health maintenance—includes the basic care that every patient needs, and this list is expanding as HIV patients live longer.

“My oldest HIV patient is 75 years old,” Dr. Sweet noted.

But general health maintenance will be postponed if patients are acutely ill when they arrive for planned visits, Dr. Sweet emphasized. “Sometimes you have a patient who has been ill for 2 weeks, but he knew he had a planned visit, so he just waited to see you.”

In those instances, Dr. Sweet treats the acute problem and reschedules the regular planned visit for as soon as possible within 1–2 weeks to address the HIV issues.

“The patient assessment stamp is a process that helps us ask questions and not miss important things, such as whether they have been using drugs,” she said. A stamp—or any type of checklist on a chart—reminds every provider what to ask HIV patients at every visit. “It may not always save time, but it improves the overall quality of care, in my opinion,” Dr. Sweet said.

WASHINGTON — Juggling the needs of HIV patients during planned visits can stretch the time management skills of any health care provider.

“If we rely on memory alone for everything we're supposed to do for a patient, we will forget 30%–40%,” Dr. Donna Sweet said in a workshop at the Ryan White CARE Act clinical meeting.

Dr. Sweet breaks down the HIV patient's planned visit into three components: HIV care, social and behavioral care, and general health maintenance.

The planned visit is first and foremost an HIV visit, said Dr. Sweet, an internist and professor of internal medicine at the University of Kansas, Wichita. “You have to review what drugs they are taking, and check their viral loads, and make sure that their HIV is as well controlled as possible,” she said.

To help providers remember the HIV-specific information they need to address with patients, Dr. Sweet and her staff designed a Patient Assessment Stamp—an actual ink stamp—that stamps a list of items on each HIV patient's chart.

The Patient Assessment Stamp lists a total of eight items: patient education, nutritional assessment, medication adherence counseling, risk reduction counseling, tobacco evaluation, mental health evaluation, substance abuse evaluation, and oral health evaluation.

Although all eight items are important, Dr. Sweet emphasizes medication adherence counseling in particular and makes it a priority for her medical residents when they work with HIV patients.

The assessment stamp prompts residents to ask patients what medications they are taking, whether they understand why they are taking the drugs, and how many pills they have missed in the last week.

Dr. Sweet also stressed the importance of tobacco evaluation in HIV patients.

“The smoking cessation message is as important as the risk reduction message for HIV patients,” she said. “When it comes to the health of my patients, I don't want them spreading the disease, but smoking may be what kills them, based on what we know about lung cancer and the increased risk in HIV patients.”

Oral health is included on the HIV assessment stamp because it is an important, but often-neglected, aspect of HIV care, Dr. Sweet said.

“Oral hygiene in these patients can be awful, especially if they get dental abscesses and get infected,” she said. Offering toothpaste or toothbrushes to HIV patients at planned visits can be a springboard into the second—social and preventive—component of the visit, she added.

The social and preventive component of the planned visit includes asking whether patients have jobs or homes and whether they are trying to avoid spreading their disease.

The third component—general health maintenance—includes the basic care that every patient needs, and this list is expanding as HIV patients live longer.

“My oldest HIV patient is 75 years old,” Dr. Sweet noted.

But general health maintenance will be postponed if patients are acutely ill when they arrive for planned visits, Dr. Sweet emphasized. “Sometimes you have a patient who has been ill for 2 weeks, but he knew he had a planned visit, so he just waited to see you.”

In those instances, Dr. Sweet treats the acute problem and reschedules the regular planned visit for as soon as possible within 1–2 weeks to address the HIV issues.

“The patient assessment stamp is a process that helps us ask questions and not miss important things, such as whether they have been using drugs,” she said. A stamp—or any type of checklist on a chart—reminds every provider what to ask HIV patients at every visit. “It may not always save time, but it improves the overall quality of care, in my opinion,” Dr. Sweet said.

WASHINGTON — Juggling the needs of HIV patients during planned visits can stretch the time management skills of any health care provider.

“If we rely on memory alone for everything we're supposed to do for a patient, we will forget 30%–40%,” Dr. Donna Sweet said in a workshop at the Ryan White CARE Act clinical meeting.

Dr. Sweet breaks down the HIV patient's planned visit into three components: HIV care, social and behavioral care, and general health maintenance.

The planned visit is first and foremost an HIV visit, said Dr. Sweet, an internist and professor of internal medicine at the University of Kansas, Wichita. “You have to review what drugs they are taking, and check their viral loads, and make sure that their HIV is as well controlled as possible,” she said.

To help providers remember the HIV-specific information they need to address with patients, Dr. Sweet and her staff designed a Patient Assessment Stamp—an actual ink stamp—that stamps a list of items on each HIV patient's chart.

The Patient Assessment Stamp lists a total of eight items: patient education, nutritional assessment, medication adherence counseling, risk reduction counseling, tobacco evaluation, mental health evaluation, substance abuse evaluation, and oral health evaluation.

Although all eight items are important, Dr. Sweet emphasizes medication adherence counseling in particular and makes it a priority for her medical residents when they work with HIV patients.

The assessment stamp prompts residents to ask patients what medications they are taking, whether they understand why they are taking the drugs, and how many pills they have missed in the last week.

Dr. Sweet also stressed the importance of tobacco evaluation in HIV patients.

“The smoking cessation message is as important as the risk reduction message for HIV patients,” she said. “When it comes to the health of my patients, I don't want them spreading the disease, but smoking may be what kills them, based on what we know about lung cancer and the increased risk in HIV patients.”

Oral health is included on the HIV assessment stamp because it is an important, but often-neglected, aspect of HIV care, Dr. Sweet said.

“Oral hygiene in these patients can be awful, especially if they get dental abscesses and get infected,” she said. Offering toothpaste or toothbrushes to HIV patients at planned visits can be a springboard into the second—social and preventive—component of the visit, she added.

The social and preventive component of the planned visit includes asking whether patients have jobs or homes and whether they are trying to avoid spreading their disease.

The third component—general health maintenance—includes the basic care that every patient needs, and this list is expanding as HIV patients live longer.

“My oldest HIV patient is 75 years old,” Dr. Sweet noted.

But general health maintenance will be postponed if patients are acutely ill when they arrive for planned visits, Dr. Sweet emphasized. “Sometimes you have a patient who has been ill for 2 weeks, but he knew he had a planned visit, so he just waited to see you.”

In those instances, Dr. Sweet treats the acute problem and reschedules the regular planned visit for as soon as possible within 1–2 weeks to address the HIV issues.

“The patient assessment stamp is a process that helps us ask questions and not miss important things, such as whether they have been using drugs,” she said. A stamp—or any type of checklist on a chart—reminds every provider what to ask HIV patients at every visit. “It may not always save time, but it improves the overall quality of care, in my opinion,” Dr. Sweet said.

Software invented by and for emergency physicians has inspired Microsoft to jump into the medical information technology arena.

Microsoft has purchased Azyxxi (rhymes with “trixie”), a program developed by emergency physicians Dr. Craig Feied and Dr. Mark Smith at the Washington Hospital Center.

The partnership with Microsoft shows the leadership role that emergency departments continue to play in hospitals as a whole, said Dr. Jonathan A. Handler, director of development at the National Institute for Medical Informatics in Washington.

The Azyxxi system was built on a Microsoft technology platform, and Microsoft plans to make the product available to other hospital systems and to invest in research and development of the product.

“We are buying the Azyxxi technology because we believe in the vision and path of its developers—to improve health care delivery using unique and powerful information technology,” a Microsoft spokesperson said in an interview.

Azyxxi's successful 10-year track record was a strong selling point. Since its debut at the Washington Hospital Center in 1996, its developers said, the software has dramatically improved patient care in the seven Washington-area hospitals that use it. The hospitals are operated by MedStar Health, a nonprofit group.

“Data don't fall through the cracks, and people can manage much more complex situations,” said Dr. Feied, professor of emergency medicine at Georgetown University and director of the National Institute for Medical Informatics.

Azyxxi was not designed to replace or compete with other medical software systems, Dr. Feied said. Instead, it unifies all the preexisting software in a hospital.

Azyxxi accesses separate caches of information from any hospital software, no matter how old or new, and delivers the information to one computer in less than a second. Physicians can compare current clinical information with a patient's history almost immediately.

Improved data access translates into improved patient care.

In the emergency department setting, quick and easy access to information thanks to Azyxxi has allowed physicians to move patients out of the waiting room and treat, admit, or discharge them within a few hours, rather than half a day, Dr. Feied said.

“Azyxxi was born in an emergency department, but it is now utilized hospitalwide,” said Dr. Handler, who has worked on Azyxxi with Dr. Feied for the past few years. “Not everything transfers, but there are a lot of important lessons we learned in the emergency department that are equally applicable throughout the rest of the hospital,” he said.

The first steps under the Microsoft umbrella will be to get the software out to other institutions and to augment it and make it even more powerful, Dr. Handler said. Widespread distribution of the Azyxxi software also will help more emergency departments address the challenges documented in an Institute of Medicine report earlier this year, he added.

“We recognized early on, before 9/11, there is the risk of emerging disease and bioterrorism, and events that could overwhelm hospitals and emergency departments, as well as more mundane but worrisome trends, such as the shortage of nurses,” Dr. Handler said.

From a practical standpoint, widespread availability of a software system that anyone can walk in and use immediately makes a huge difference in a crisis. And easy access to patient information will help smaller emergency departments in rural or underserved areas if they are suddenly faced with 2,000 patients instead of their usual 20.

Dr. Feied and Dr. Handler will become Microsoft employees in addition to their other credentials once the deal is finalized.

“The opportunity to have the largest software company in the world standing behind us is tremendously energizing,” Dr. Feied said.

Software invented by and for emergency physicians has inspired Microsoft to jump into the medical information technology arena.

Microsoft has purchased Azyxxi (rhymes with “trixie”), a program developed by emergency physicians Dr. Craig Feied and Dr. Mark Smith at the Washington Hospital Center.

The partnership with Microsoft shows the leadership role that emergency departments continue to play in hospitals as a whole, said Dr. Jonathan A. Handler, director of development at the National Institute for Medical Informatics in Washington.

The Azyxxi system was built on a Microsoft technology platform, and Microsoft plans to make the product available to other hospital systems and to invest in research and development of the product.

“We are buying the Azyxxi technology because we believe in the vision and path of its developers—to improve health care delivery using unique and powerful information technology,” a Microsoft spokesperson said in an interview.

Azyxxi's successful 10-year track record was a strong selling point. Since its debut at the Washington Hospital Center in 1996, its developers said, the software has dramatically improved patient care in the seven Washington-area hospitals that use it. The hospitals are operated by MedStar Health, a nonprofit group.

“Data don't fall through the cracks, and people can manage much more complex situations,” said Dr. Feied, professor of emergency medicine at Georgetown University and director of the National Institute for Medical Informatics.

Azyxxi was not designed to replace or compete with other medical software systems, Dr. Feied said. Instead, it unifies all the preexisting software in a hospital.

Azyxxi accesses separate caches of information from any hospital software, no matter how old or new, and delivers the information to one computer in less than a second. Physicians can compare current clinical information with a patient's history almost immediately.

Improved data access translates into improved patient care.

In the emergency department setting, quick and easy access to information thanks to Azyxxi has allowed physicians to move patients out of the waiting room and treat, admit, or discharge them within a few hours, rather than half a day, Dr. Feied said.

“Azyxxi was born in an emergency department, but it is now utilized hospitalwide,” said Dr. Handler, who has worked on Azyxxi with Dr. Feied for the past few years. “Not everything transfers, but there are a lot of important lessons we learned in the emergency department that are equally applicable throughout the rest of the hospital,” he said.

The first steps under the Microsoft umbrella will be to get the software out to other institutions and to augment it and make it even more powerful, Dr. Handler said. Widespread distribution of the Azyxxi software also will help more emergency departments address the challenges documented in an Institute of Medicine report earlier this year, he added.

“We recognized early on, before 9/11, there is the risk of emerging disease and bioterrorism, and events that could overwhelm hospitals and emergency departments, as well as more mundane but worrisome trends, such as the shortage of nurses,” Dr. Handler said.

From a practical standpoint, widespread availability of a software system that anyone can walk in and use immediately makes a huge difference in a crisis. And easy access to patient information will help smaller emergency departments in rural or underserved areas if they are suddenly faced with 2,000 patients instead of their usual 20.

Dr. Feied and Dr. Handler will become Microsoft employees in addition to their other credentials once the deal is finalized.

“The opportunity to have the largest software company in the world standing behind us is tremendously energizing,” Dr. Feied said.

Software invented by and for emergency physicians has inspired Microsoft to jump into the medical information technology arena.

Microsoft has purchased Azyxxi (rhymes with “trixie”), a program developed by emergency physicians Dr. Craig Feied and Dr. Mark Smith at the Washington Hospital Center.

The partnership with Microsoft shows the leadership role that emergency departments continue to play in hospitals as a whole, said Dr. Jonathan A. Handler, director of development at the National Institute for Medical Informatics in Washington.

The Azyxxi system was built on a Microsoft technology platform, and Microsoft plans to make the product available to other hospital systems and to invest in research and development of the product.

“We are buying the Azyxxi technology because we believe in the vision and path of its developers—to improve health care delivery using unique and powerful information technology,” a Microsoft spokesperson said in an interview.

Azyxxi's successful 10-year track record was a strong selling point. Since its debut at the Washington Hospital Center in 1996, its developers said, the software has dramatically improved patient care in the seven Washington-area hospitals that use it. The hospitals are operated by MedStar Health, a nonprofit group.

“Data don't fall through the cracks, and people can manage much more complex situations,” said Dr. Feied, professor of emergency medicine at Georgetown University and director of the National Institute for Medical Informatics.

Azyxxi was not designed to replace or compete with other medical software systems, Dr. Feied said. Instead, it unifies all the preexisting software in a hospital.

Azyxxi accesses separate caches of information from any hospital software, no matter how old or new, and delivers the information to one computer in less than a second. Physicians can compare current clinical information with a patient's history almost immediately.

Improved data access translates into improved patient care.

In the emergency department setting, quick and easy access to information thanks to Azyxxi has allowed physicians to move patients out of the waiting room and treat, admit, or discharge them within a few hours, rather than half a day, Dr. Feied said.

“Azyxxi was born in an emergency department, but it is now utilized hospitalwide,” said Dr. Handler, who has worked on Azyxxi with Dr. Feied for the past few years. “Not everything transfers, but there are a lot of important lessons we learned in the emergency department that are equally applicable throughout the rest of the hospital,” he said.

The first steps under the Microsoft umbrella will be to get the software out to other institutions and to augment it and make it even more powerful, Dr. Handler said. Widespread distribution of the Azyxxi software also will help more emergency departments address the challenges documented in an Institute of Medicine report earlier this year, he added.

“We recognized early on, before 9/11, there is the risk of emerging disease and bioterrorism, and events that could overwhelm hospitals and emergency departments, as well as more mundane but worrisome trends, such as the shortage of nurses,” Dr. Handler said.

From a practical standpoint, widespread availability of a software system that anyone can walk in and use immediately makes a huge difference in a crisis. And easy access to patient information will help smaller emergency departments in rural or underserved areas if they are suddenly faced with 2,000 patients instead of their usual 20.

Dr. Feied and Dr. Handler will become Microsoft employees in addition to their other credentials once the deal is finalized.

“The opportunity to have the largest software company in the world standing behind us is tremendously energizing,” Dr. Feied said.

HERSHEY, PA. — Anyone who exercises even moderately in hot weather should be advised to drink more than water—something with salt and sugar—to replenish the carbohydrates and electrolytes that the body sweats out in order to avoid potentially life-threatening complications from a heat-related illness.

Remember that all-cause mortality from cardiac disease increases in hot weather, said Dr. Eric E. Coris at the annual meeting of the American Orthopaedic Society for Sports Medicine.

As the body heats up and dehydrates, less oxygen reaches the muscles, which causes muscle cramping. Dehydration also decreases blood volume, impairs gastric emptying, and hinders the flow of blood to the kidneys and other organs, said Dr. Coris, director of the Sports Medicine Institute at the University of South Florida, Tampa.

The presence of sodium in water or another beverage, such as lemonade or a sports drink, improves the body's ability to absorb fluids.

Although water alone is sufficient to rehydrate most athletes during events that last less than an hour, drinking something with carbohydrates prior to the event can help prevent dehydration in hot weather, Dr. Coris said. For events lasting an hour or longer, he recommends plain water before the event, followed by a solution with both sugar and salt during the event to maintain the carbohydrate and electrolyte balance and prevent hyponatremia.

The ideal sports drink for most activities contains 400–800 mg/L of sodium, with some sugar, in the form of 30–80 g/L of carbohydrates, and most commercial sports drinks meet these criteria, said Dr. Coris, who has no financial interest in any sports drink manufacturers.

“Athletes drink more of any beverage when there is sugar in it,” he said. But avoid denser drinks, such as orange juice, because too much sugar could cause stomach cramps, he emphasized. Standard sports drinks provide enough sodium for mild to moderate activities, but athletes who do long or intense workouts in hot weather may need even more sodium than sports drinks provide.

Even highly conditioned athletes can overheat in extreme conditions and find themselves dehydrated. Runners, for example, may sweat about 1.5 L/hr on a hot day, and most people can easily replace only 0.75 L/hr, Dr. Coris said.

“Football is one of the monsters of fluid loss,” he added. College football players have been known to lose 3–4 L of fluid during twice-daily practice regimens in August. For these athletes, a standard sports drink probably does not provide enough sodium. Adding one teaspoon of salt to a 32-ounce bottle of sports drink and drinking it slowly after the event is an effective way to rehydrate, he noted.

HERSHEY, PA. — Anyone who exercises even moderately in hot weather should be advised to drink more than water—something with salt and sugar—to replenish the carbohydrates and electrolytes that the body sweats out in order to avoid potentially life-threatening complications from a heat-related illness.

Remember that all-cause mortality from cardiac disease increases in hot weather, said Dr. Eric E. Coris at the annual meeting of the American Orthopaedic Society for Sports Medicine.

As the body heats up and dehydrates, less oxygen reaches the muscles, which causes muscle cramping. Dehydration also decreases blood volume, impairs gastric emptying, and hinders the flow of blood to the kidneys and other organs, said Dr. Coris, director of the Sports Medicine Institute at the University of South Florida, Tampa.

The presence of sodium in water or another beverage, such as lemonade or a sports drink, improves the body's ability to absorb fluids.

Although water alone is sufficient to rehydrate most athletes during events that last less than an hour, drinking something with carbohydrates prior to the event can help prevent dehydration in hot weather, Dr. Coris said. For events lasting an hour or longer, he recommends plain water before the event, followed by a solution with both sugar and salt during the event to maintain the carbohydrate and electrolyte balance and prevent hyponatremia.

The ideal sports drink for most activities contains 400–800 mg/L of sodium, with some sugar, in the form of 30–80 g/L of carbohydrates, and most commercial sports drinks meet these criteria, said Dr. Coris, who has no financial interest in any sports drink manufacturers.

“Athletes drink more of any beverage when there is sugar in it,” he said. But avoid denser drinks, such as orange juice, because too much sugar could cause stomach cramps, he emphasized. Standard sports drinks provide enough sodium for mild to moderate activities, but athletes who do long or intense workouts in hot weather may need even more sodium than sports drinks provide.

Even highly conditioned athletes can overheat in extreme conditions and find themselves dehydrated. Runners, for example, may sweat about 1.5 L/hr on a hot day, and most people can easily replace only 0.75 L/hr, Dr. Coris said.

“Football is one of the monsters of fluid loss,” he added. College football players have been known to lose 3–4 L of fluid during twice-daily practice regimens in August. For these athletes, a standard sports drink probably does not provide enough sodium. Adding one teaspoon of salt to a 32-ounce bottle of sports drink and drinking it slowly after the event is an effective way to rehydrate, he noted.

HERSHEY, PA. — Anyone who exercises even moderately in hot weather should be advised to drink more than water—something with salt and sugar—to replenish the carbohydrates and electrolytes that the body sweats out in order to avoid potentially life-threatening complications from a heat-related illness.

Remember that all-cause mortality from cardiac disease increases in hot weather, said Dr. Eric E. Coris at the annual meeting of the American Orthopaedic Society for Sports Medicine.

As the body heats up and dehydrates, less oxygen reaches the muscles, which causes muscle cramping. Dehydration also decreases blood volume, impairs gastric emptying, and hinders the flow of blood to the kidneys and other organs, said Dr. Coris, director of the Sports Medicine Institute at the University of South Florida, Tampa.

The presence of sodium in water or another beverage, such as lemonade or a sports drink, improves the body's ability to absorb fluids.

Although water alone is sufficient to rehydrate most athletes during events that last less than an hour, drinking something with carbohydrates prior to the event can help prevent dehydration in hot weather, Dr. Coris said. For events lasting an hour or longer, he recommends plain water before the event, followed by a solution with both sugar and salt during the event to maintain the carbohydrate and electrolyte balance and prevent hyponatremia.

The ideal sports drink for most activities contains 400–800 mg/L of sodium, with some sugar, in the form of 30–80 g/L of carbohydrates, and most commercial sports drinks meet these criteria, said Dr. Coris, who has no financial interest in any sports drink manufacturers.

“Athletes drink more of any beverage when there is sugar in it,” he said. But avoid denser drinks, such as orange juice, because too much sugar could cause stomach cramps, he emphasized. Standard sports drinks provide enough sodium for mild to moderate activities, but athletes who do long or intense workouts in hot weather may need even more sodium than sports drinks provide.

Even highly conditioned athletes can overheat in extreme conditions and find themselves dehydrated. Runners, for example, may sweat about 1.5 L/hr on a hot day, and most people can easily replace only 0.75 L/hr, Dr. Coris said.

“Football is one of the monsters of fluid loss,” he added. College football players have been known to lose 3–4 L of fluid during twice-daily practice regimens in August. For these athletes, a standard sports drink probably does not provide enough sodium. Adding one teaspoon of salt to a 32-ounce bottle of sports drink and drinking it slowly after the event is an effective way to rehydrate, he noted.