Heidi Splete

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.

Rhinoviruses are the most common pathogens in the upper and lower respiratory tract of infants in their first year of life, according to findings from a study of 263 infants in an upper-class community who were followed up from birth until 1 year of age.

Although respiratory syncytial virus (RSV) accounts for many acute respiratory illnesses that are severe enough for hospitalization, other pathogens have been underrecognized because it is difficult to identify them, reported Dr. Merci Kusel of the University of Western Australia in West Perth and colleagues.

The expanded use of polymerase chain reaction detection gives physicians a look at the pathogens behind respiratory tract illnesses. Nasopharyngeal aspirates were collected from children during 984 episodes of acute respiratory illnesses and compared with 456 control samples taken when the children were healthy (Pediatr. Infect. Dis. J. 2006;25:680–6).

Rhinoviruses appeared in 52% of upper respiratory tract illnesses (URIs), 41% of lower respiratory tract illnesses (LRIs), and 45% of LRIs with wheezing. By comparison, RSV appeared in 9% of URIs, 15% of LRIs, and 17% of LRIs with wheezing. Additionally, parainfluenza viruses appeared in 5% of URIs and 7% of LRIs, and human metapneumoviruses appeared in 3% of LRIs.

Rhinoviruses were the viruses most often detected in both LRIs and URIs, but rhinoviruses were twice as likely to cause URIs as LRIs in the cases when these viruses were detected. The other pathogens (RSV, parainfluenza, and human metapneumovirus) were equally likely to cause either URIs or LRIs. Rhinoviruses may have a particular affinity for the upper respiratory tract in infants younger than 1 year of age, but additional research is needed in a diverse population, they noted.

Rhinoviruses are the most common pathogens in the upper and lower respiratory tract of infants in their first year of life, according to findings from a study of 263 infants in an upper-class community who were followed up from birth until 1 year of age.

Although respiratory syncytial virus (RSV) accounts for many acute respiratory illnesses that are severe enough for hospitalization, other pathogens have been underrecognized because it is difficult to identify them, reported Dr. Merci Kusel of the University of Western Australia in West Perth and colleagues.

The expanded use of polymerase chain reaction detection gives physicians a look at the pathogens behind respiratory tract illnesses. Nasopharyngeal aspirates were collected from children during 984 episodes of acute respiratory illnesses and compared with 456 control samples taken when the children were healthy (Pediatr. Infect. Dis. J. 2006;25:680–6).

Rhinoviruses appeared in 52% of upper respiratory tract illnesses (URIs), 41% of lower respiratory tract illnesses (LRIs), and 45% of LRIs with wheezing. By comparison, RSV appeared in 9% of URIs, 15% of LRIs, and 17% of LRIs with wheezing. Additionally, parainfluenza viruses appeared in 5% of URIs and 7% of LRIs, and human metapneumoviruses appeared in 3% of LRIs.

Rhinoviruses were the viruses most often detected in both LRIs and URIs, but rhinoviruses were twice as likely to cause URIs as LRIs in the cases when these viruses were detected. The other pathogens (RSV, parainfluenza, and human metapneumovirus) were equally likely to cause either URIs or LRIs. Rhinoviruses may have a particular affinity for the upper respiratory tract in infants younger than 1 year of age, but additional research is needed in a diverse population, they noted.

Rhinoviruses are the most common pathogens in the upper and lower respiratory tract of infants in their first year of life, according to findings from a study of 263 infants in an upper-class community who were followed up from birth until 1 year of age.

Although respiratory syncytial virus (RSV) accounts for many acute respiratory illnesses that are severe enough for hospitalization, other pathogens have been underrecognized because it is difficult to identify them, reported Dr. Merci Kusel of the University of Western Australia in West Perth and colleagues.

The expanded use of polymerase chain reaction detection gives physicians a look at the pathogens behind respiratory tract illnesses. Nasopharyngeal aspirates were collected from children during 984 episodes of acute respiratory illnesses and compared with 456 control samples taken when the children were healthy (Pediatr. Infect. Dis. J. 2006;25:680–6).

Rhinoviruses appeared in 52% of upper respiratory tract illnesses (URIs), 41% of lower respiratory tract illnesses (LRIs), and 45% of LRIs with wheezing. By comparison, RSV appeared in 9% of URIs, 15% of LRIs, and 17% of LRIs with wheezing. Additionally, parainfluenza viruses appeared in 5% of URIs and 7% of LRIs, and human metapneumoviruses appeared in 3% of LRIs.

Rhinoviruses were the viruses most often detected in both LRIs and URIs, but rhinoviruses were twice as likely to cause URIs as LRIs in the cases when these viruses were detected. The other pathogens (RSV, parainfluenza, and human metapneumovirus) were equally likely to cause either URIs or LRIs. Rhinoviruses may have a particular affinity for the upper respiratory tract in infants younger than 1 year of age, but additional research is needed in a diverse population, they noted.

The identification of emm types from acute rheumatic fever patients seen at Children's Hospital of Pittsburgh between 1994 and 2003 could aid in vaccine development.

Acute rheumatic fever (ARF) persists in western Pennsylvania despite declining rates in the United States overall. Dr. Judith Marie Martin of the University of Pittsburgh, and her colleagues reviewed 121 cases in children aged 3–18 years. They studied the throat cultures of family members of the patients to look for trends in emm types. Carditis, arthritis, and chorea were the most common major clinical manifestations of ARF, and they were present in 57%, 48%, and 29% of patients, respectively (J. Pediatr. 2006;149:58–63).

Throat cultures were performed on 84 of the children with ARF and 147 family members for a total of 231 cultures.

Acute rheumatic fever is caused by complications from group A streptococcus (GAS) pharyngitis. Group A streptococcus (Streptococcus pyogenes) isolates were found in throat cultures from 30 children (36%) and 20 family members (14%), but only one of the family members was symptomatic at the time of the culture. Six families had more than one member with a positive throat culture, and in these cases the GAS samples were always the same emm type (1, 2, 12, 18, or 75) and had the same field inversion gel electrophoresis patterns. A total of 12 isolates from ARF patients and all 20 isolates from family members were available for emm typing. Types 12 and 18 were the most common, with nine isolates each.

This finding and other factors suggest that emm 12 might be associated with rheumatism and could be considered for a candidate GAS vaccine, although it had not been previously described as rheumatogenic, according to the researchers.

The identification of emm types from acute rheumatic fever patients seen at Children's Hospital of Pittsburgh between 1994 and 2003 could aid in vaccine development.

Acute rheumatic fever (ARF) persists in western Pennsylvania despite declining rates in the United States overall. Dr. Judith Marie Martin of the University of Pittsburgh, and her colleagues reviewed 121 cases in children aged 3–18 years. They studied the throat cultures of family members of the patients to look for trends in emm types. Carditis, arthritis, and chorea were the most common major clinical manifestations of ARF, and they were present in 57%, 48%, and 29% of patients, respectively (J. Pediatr. 2006;149:58–63).

Throat cultures were performed on 84 of the children with ARF and 147 family members for a total of 231 cultures.

Acute rheumatic fever is caused by complications from group A streptococcus (GAS) pharyngitis. Group A streptococcus (Streptococcus pyogenes) isolates were found in throat cultures from 30 children (36%) and 20 family members (14%), but only one of the family members was symptomatic at the time of the culture. Six families had more than one member with a positive throat culture, and in these cases the GAS samples were always the same emm type (1, 2, 12, 18, or 75) and had the same field inversion gel electrophoresis patterns. A total of 12 isolates from ARF patients and all 20 isolates from family members were available for emm typing. Types 12 and 18 were the most common, with nine isolates each.

This finding and other factors suggest that emm 12 might be associated with rheumatism and could be considered for a candidate GAS vaccine, although it had not been previously described as rheumatogenic, according to the researchers.

The identification of emm types from acute rheumatic fever patients seen at Children's Hospital of Pittsburgh between 1994 and 2003 could aid in vaccine development.

Acute rheumatic fever (ARF) persists in western Pennsylvania despite declining rates in the United States overall. Dr. Judith Marie Martin of the University of Pittsburgh, and her colleagues reviewed 121 cases in children aged 3–18 years. They studied the throat cultures of family members of the patients to look for trends in emm types. Carditis, arthritis, and chorea were the most common major clinical manifestations of ARF, and they were present in 57%, 48%, and 29% of patients, respectively (J. Pediatr. 2006;149:58–63).

Throat cultures were performed on 84 of the children with ARF and 147 family members for a total of 231 cultures.

Acute rheumatic fever is caused by complications from group A streptococcus (GAS) pharyngitis. Group A streptococcus (Streptococcus pyogenes) isolates were found in throat cultures from 30 children (36%) and 20 family members (14%), but only one of the family members was symptomatic at the time of the culture. Six families had more than one member with a positive throat culture, and in these cases the GAS samples were always the same emm type (1, 2, 12, 18, or 75) and had the same field inversion gel electrophoresis patterns. A total of 12 isolates from ARF patients and all 20 isolates from family members were available for emm typing. Types 12 and 18 were the most common, with nine isolates each.

This finding and other factors suggest that emm 12 might be associated with rheumatism and could be considered for a candidate GAS vaccine, although it had not been previously described as rheumatogenic, according to the researchers.

Rheumatic Fever Subtypes Pinpointed

Identification of emm types from acute rheumatic fever patients seen at Children's Hospital of Pittsburgh between 1994 and 2003 could aid in vaccine development.

Acute rheumatic fever (ARF) persists in western Pennsylvania despite declining rates in the United States overall, and Dr. Judith Marie Martin, of the University of Pittsburgh, and her colleagues reviewed 121 cases in children aged 3–18 years. They also studied the throat cultures of family members of the patients to look for trends in emm types.

Carditis, arthritis, and chorea were the most common major clinical manifestations of ARF, and they were present in 57%, 48%, and 29% of patients, respectively (J. Pediatr. 2006;149:58–63).

Throat cultures were performed on 84 of the children with ARF and 147 family members for a total of 231 cultures.

Acute rheumatic fever is caused by complications from group A streptococcus (GAS) pharyngitis. Group A streptococcus (Streptococcus pyogenes) isolates were found in throat cultures from 30 children (36%) and 20 family members (14%), but only one of the family members was symptomatic at the time of the culture. Six families had more than one member with a positive throat culture, and in these cases the GAS samples were always the same emm type (1, 2, 12, 18, or 75) and had the same field inversion gel electrophoresis patterns.

Protein Values and Meningitis

Procalcitonin and cerebrospinal fluid protein values were significantly more effective than other biologic tests at distinguishing bacterial from aseptic meningitis based on data from 167 hospitalized children who ranged in age from about 1 month to 15 years.

Dr. Francois Dubos of Paris Descartes University and his associates reviewed the predictive blood values for procalcitonin (PCT), C-reactive protein (CRP), WBC, and neutrophils, as well as the predictive cerebrospinal fluid (CSF) findings for protein, glucose, WBC, and neutrophils (J. Pediatr. 2006;149:72–6).

A total of 21 patients had bacterial meningitis and 146 had aseptic meningitis. All 21 patients who were diagnosed with bacterial meningitis had either a serum PCT value greater than or equal to 0.5 ng/mL or a CSF protein level of 0.5 g/L or greater.

Overall, serum PCT levels of at least 0.5 ng/mL and CSF protein levels of at least 0.5 g/L were the strongest independent predictors of bacterial meningitis after a logistic regression analysis. PCT had the highest specificity rate (89%) in distinguishing bacterial from aseptic meningitis, compared with rates below 83% in the other tests. CRP had the highest sensitivity rate (91%), followed by PCT (89%) and CSF protein (86%).

Streptococcus pneumoniae was the most common pathogen (10 cases), followed by Neisseria meningitidis (9 cases). Haemophilus influenzae and group B streptococci each caused one infection. The researchers noted that the widespread use of antipneumococcal vaccines is changing the etiology of bacterial meningitis and reducing the overall rate of illness.

Rhinovirus and Respiratory Illnesses

Rhinoviruses are the most common pathogens in the upper and lower respiratory tract of infants in their first year of life, according to findings from a study of 263 infants in an upper-class community who were followed up from birth until 1 year of age.

Although respiratory syncytial virus (RSV) accounts for many acute respiratory illnesses that are severe enough for hospitalization, other pathogens have been underrecognized because it is difficult to identify them, reported Dr. Merci Kusel of the University of Western Australia in West Perth and colleagues.

But the expanded use of polymerase chain reaction detection gives physicians a closer look at the pathogens behind respiratory tract illnesses. Nasopharyngeal aspirates were collected from children during 984 episodes of acute respiratory illnesses and compared with 456 control samples taken when the children were healthy (Pediatr. Infect. Dis. J. 2006;25:680–6).

Rhinoviruses appeared in 52% of upper respiratory tract illnesses (URIs), 41% of lower respiratory tract illnesses (LRIs), and 45% of LRIs with wheezing. By comparison, RSV appeared in 9% of URIs, 15% of LRIs, and 17% of LRIs with wheezing.

Rhinoviruses were the viruses most often detected in both LRIs and URIs, but rhinoviruses were twice as likely to cause URIs as LRIs in the cases when these viruses were detected. The other pathogens (RSV, parainfluenza, and human metapneumovirus) were equally likely to cause either URIs or LRIs. This finding suggests that rhinoviruses have a particular affinity for the upper respiratory tract in infants younger than 1 year of age, but additional research is needed in a diverse population, the researchers noted.

Rheumatic Fever Subtypes Pinpointed

Identification of emm types from acute rheumatic fever patients seen at Children's Hospital of Pittsburgh between 1994 and 2003 could aid in vaccine development.

Acute rheumatic fever (ARF) persists in western Pennsylvania despite declining rates in the United States overall, and Dr. Judith Marie Martin, of the University of Pittsburgh, and her colleagues reviewed 121 cases in children aged 3–18 years. They also studied the throat cultures of family members of the patients to look for trends in emm types.

Carditis, arthritis, and chorea were the most common major clinical manifestations of ARF, and they were present in 57%, 48%, and 29% of patients, respectively (J. Pediatr. 2006;149:58–63).

Throat cultures were performed on 84 of the children with ARF and 147 family members for a total of 231 cultures.

Acute rheumatic fever is caused by complications from group A streptococcus (GAS) pharyngitis. Group A streptococcus (Streptococcus pyogenes) isolates were found in throat cultures from 30 children (36%) and 20 family members (14%), but only one of the family members was symptomatic at the time of the culture. Six families had more than one member with a positive throat culture, and in these cases the GAS samples were always the same emm type (1, 2, 12, 18, or 75) and had the same field inversion gel electrophoresis patterns.

Protein Values and Meningitis

Procalcitonin and cerebrospinal fluid protein values were significantly more effective than other biologic tests at distinguishing bacterial from aseptic meningitis based on data from 167 hospitalized children who ranged in age from about 1 month to 15 years.

Dr. Francois Dubos of Paris Descartes University and his associates reviewed the predictive blood values for procalcitonin (PCT), C-reactive protein (CRP), WBC, and neutrophils, as well as the predictive cerebrospinal fluid (CSF) findings for protein, glucose, WBC, and neutrophils (J. Pediatr. 2006;149:72–6).

A total of 21 patients had bacterial meningitis and 146 had aseptic meningitis. All 21 patients who were diagnosed with bacterial meningitis had either a serum PCT value greater than or equal to 0.5 ng/mL or a CSF protein level of 0.5 g/L or greater.

Overall, serum PCT levels of at least 0.5 ng/mL and CSF protein levels of at least 0.5 g/L were the strongest independent predictors of bacterial meningitis after a logistic regression analysis. PCT had the highest specificity rate (89%) in distinguishing bacterial from aseptic meningitis, compared with rates below 83% in the other tests. CRP had the highest sensitivity rate (91%), followed by PCT (89%) and CSF protein (86%).

Streptococcus pneumoniae was the most common pathogen (10 cases), followed by Neisseria meningitidis (9 cases). Haemophilus influenzae and group B streptococci each caused one infection. The researchers noted that the widespread use of antipneumococcal vaccines is changing the etiology of bacterial meningitis and reducing the overall rate of illness.

Rhinovirus and Respiratory Illnesses

Rhinoviruses are the most common pathogens in the upper and lower respiratory tract of infants in their first year of life, according to findings from a study of 263 infants in an upper-class community who were followed up from birth until 1 year of age.

Although respiratory syncytial virus (RSV) accounts for many acute respiratory illnesses that are severe enough for hospitalization, other pathogens have been underrecognized because it is difficult to identify them, reported Dr. Merci Kusel of the University of Western Australia in West Perth and colleagues.

But the expanded use of polymerase chain reaction detection gives physicians a closer look at the pathogens behind respiratory tract illnesses. Nasopharyngeal aspirates were collected from children during 984 episodes of acute respiratory illnesses and compared with 456 control samples taken when the children were healthy (Pediatr. Infect. Dis. J. 2006;25:680–6).

Rhinoviruses appeared in 52% of upper respiratory tract illnesses (URIs), 41% of lower respiratory tract illnesses (LRIs), and 45% of LRIs with wheezing. By comparison, RSV appeared in 9% of URIs, 15% of LRIs, and 17% of LRIs with wheezing.

Rhinoviruses were the viruses most often detected in both LRIs and URIs, but rhinoviruses were twice as likely to cause URIs as LRIs in the cases when these viruses were detected. The other pathogens (RSV, parainfluenza, and human metapneumovirus) were equally likely to cause either URIs or LRIs. This finding suggests that rhinoviruses have a particular affinity for the upper respiratory tract in infants younger than 1 year of age, but additional research is needed in a diverse population, the researchers noted.

Rheumatic Fever Subtypes Pinpointed

Identification of emm types from acute rheumatic fever patients seen at Children's Hospital of Pittsburgh between 1994 and 2003 could aid in vaccine development.

Acute rheumatic fever (ARF) persists in western Pennsylvania despite declining rates in the United States overall, and Dr. Judith Marie Martin, of the University of Pittsburgh, and her colleagues reviewed 121 cases in children aged 3–18 years. They also studied the throat cultures of family members of the patients to look for trends in emm types.

Carditis, arthritis, and chorea were the most common major clinical manifestations of ARF, and they were present in 57%, 48%, and 29% of patients, respectively (J. Pediatr. 2006;149:58–63).

Throat cultures were performed on 84 of the children with ARF and 147 family members for a total of 231 cultures.

Acute rheumatic fever is caused by complications from group A streptococcus (GAS) pharyngitis. Group A streptococcus (Streptococcus pyogenes) isolates were found in throat cultures from 30 children (36%) and 20 family members (14%), but only one of the family members was symptomatic at the time of the culture. Six families had more than one member with a positive throat culture, and in these cases the GAS samples were always the same emm type (1, 2, 12, 18, or 75) and had the same field inversion gel electrophoresis patterns.

Protein Values and Meningitis

Procalcitonin and cerebrospinal fluid protein values were significantly more effective than other biologic tests at distinguishing bacterial from aseptic meningitis based on data from 167 hospitalized children who ranged in age from about 1 month to 15 years.

Dr. Francois Dubos of Paris Descartes University and his associates reviewed the predictive blood values for procalcitonin (PCT), C-reactive protein (CRP), WBC, and neutrophils, as well as the predictive cerebrospinal fluid (CSF) findings for protein, glucose, WBC, and neutrophils (J. Pediatr. 2006;149:72–6).

A total of 21 patients had bacterial meningitis and 146 had aseptic meningitis. All 21 patients who were diagnosed with bacterial meningitis had either a serum PCT value greater than or equal to 0.5 ng/mL or a CSF protein level of 0.5 g/L or greater.

Overall, serum PCT levels of at least 0.5 ng/mL and CSF protein levels of at least 0.5 g/L were the strongest independent predictors of bacterial meningitis after a logistic regression analysis. PCT had the highest specificity rate (89%) in distinguishing bacterial from aseptic meningitis, compared with rates below 83% in the other tests. CRP had the highest sensitivity rate (91%), followed by PCT (89%) and CSF protein (86%).

Streptococcus pneumoniae was the most common pathogen (10 cases), followed by Neisseria meningitidis (9 cases). Haemophilus influenzae and group B streptococci each caused one infection. The researchers noted that the widespread use of antipneumococcal vaccines is changing the etiology of bacterial meningitis and reducing the overall rate of illness.

Rhinovirus and Respiratory Illnesses

Rhinoviruses are the most common pathogens in the upper and lower respiratory tract of infants in their first year of life, according to findings from a study of 263 infants in an upper-class community who were followed up from birth until 1 year of age.

Although respiratory syncytial virus (RSV) accounts for many acute respiratory illnesses that are severe enough for hospitalization, other pathogens have been underrecognized because it is difficult to identify them, reported Dr. Merci Kusel of the University of Western Australia in West Perth and colleagues.

But the expanded use of polymerase chain reaction detection gives physicians a closer look at the pathogens behind respiratory tract illnesses. Nasopharyngeal aspirates were collected from children during 984 episodes of acute respiratory illnesses and compared with 456 control samples taken when the children were healthy (Pediatr. Infect. Dis. J. 2006;25:680–6).

Rhinoviruses appeared in 52% of upper respiratory tract illnesses (URIs), 41% of lower respiratory tract illnesses (LRIs), and 45% of LRIs with wheezing. By comparison, RSV appeared in 9% of URIs, 15% of LRIs, and 17% of LRIs with wheezing.

Rhinoviruses were the viruses most often detected in both LRIs and URIs, but rhinoviruses were twice as likely to cause URIs as LRIs in the cases when these viruses were detected. The other pathogens (RSV, parainfluenza, and human metapneumovirus) were equally likely to cause either URIs or LRIs. This finding suggests that rhinoviruses have a particular affinity for the upper respiratory tract in infants younger than 1 year of age, but additional research is needed in a diverse population, 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.

Pediarix purchase was significantly more likely among pediatricians in hospital-owned practices or health systems, compared with those in solo or group practices (56% vs. 34%).

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.

Pediatricians are still trying to determine how to incorporate combination vaccines into their practices, 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, Dr. Marcuse said in an interview.

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 pediatricians, 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.

“Combination vaccines absolutely have a future, but how they are incorporated into pediatric practices will vary greatly by region and by community,” Dr. Marcuse said.

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.

Pediarix purchase was significantly more likely among pediatricians in hospital-owned practices or health systems, compared with those in solo or group practices (56% vs. 34%).

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.

Pediatricians are still trying to determine how to incorporate combination vaccines into their practices, 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, Dr. Marcuse said in an interview.

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 pediatricians, 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.

“Combination vaccines absolutely have a future, but how they are incorporated into pediatric practices will vary greatly by region and by community,” Dr. Marcuse said.

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.

Pediarix purchase was significantly more likely among pediatricians in hospital-owned practices or health systems, compared with those in solo or group practices (56% vs. 34%).

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.

Pediatricians are still trying to determine how to incorporate combination vaccines into their practices, 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, Dr. Marcuse said in an interview.

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 pediatricians, 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.

“Combination vaccines absolutely have a future, but how they are incorporated into pediatric practices will vary greatly by region and by community,” Dr. Marcuse said.

HERSHEY, PA. — Otherwise healthy adolescents who had internal fixation surgery for osteochondritis dissecans of the knee returned to their sports activities about 8 months later, Dr. Mininder S. Kocher reported at the annual meeting of the American Orthopaedic Society for Sports Medicine.

The data argue in favor of internal fixation, especially for children approaching skeletal maturity who have less time to heal nonoperatively.

The overall healing rate was 85%, based on at least 2 years of follow-up data from 26 knees in 24 patients whose average age was 14 years, said Dr. Kocher, an orthopedic surgeon at Children's Hospital Boston. The cases included 9 stage II lesions (fissured), 11 stage III lesions (partly attached), and 6 stage IV lesions (detached). Other studies have shown similar healing rates of 80% or higher.

Osteochondritis dissecans (OCD) is a relatively rare disease (about 15–30 cases per 100,000 persons in the year 2000) in which a loose piece of bone and cartilage separates partly or completely from the joint. Symptoms include pain, stiffness, locking of the joint, and a sensation that the joint is giving way.

The cause of OCD remains unclear, although possible causes include repetitive microtrauma, poor bone growth, and genetic predisposition. Most cases occur in active boys aged 10–20 years, but the diagnoses in girls have increased as more girls play competitive sports. Dr. Kocher's study included 13 boys and 11 girls.

Healing was evident 6 months after surgery based on several scores, including the International Knee Documentation Committee, Lysholm, and Tegner scales, which measure knee function in athletic patients.

The average Tegner activity level score, which uses a scale of 1–10, increased from 4.9 before surgery to 7.4 after surgery.

The healing rate was slightly lower in the seven patients who had undergone previous surgery for OCD than in those with no prior OCD surgery (71% vs. 89%).

After surgery, the patients recovered by performing careful weight-bearing and range-of-motion exercises, and gradually returning to sports.

There were no significant differences in healing rate based on the type of lesion and, in fact, all six of the cases of stage IV (unstable lesions) healed. A lateral vs. medial location had no apparent effect on healing, and no significant complications were reported in any of the patients.

There were four cases of unhealed lesions after the procedure (15%).

Two of the cases were treated with chondral resurfacing, and the other two were treated with a second internal fixation; all four patients were able to resume their sports activities.

The study was limited by its small size—which prevented subgroup comparisons—and by its retrospective nature.

“When faced with an unstable juvenile OCD lesion of the knee, we are often forced to choose between internal fixation or fragment removal with a chondral resurfacing technique,” Dr. Kocher said. “Given the relatively high healing rate, good functional outcome, and low complication rate, we would advocate internal fixation of these lesions when technically possible.”

HERSHEY, PA. — Otherwise healthy adolescents who had internal fixation surgery for osteochondritis dissecans of the knee returned to their sports activities about 8 months later, Dr. Mininder S. Kocher reported at the annual meeting of the American Orthopaedic Society for Sports Medicine.

The data argue in favor of internal fixation, especially for children approaching skeletal maturity who have less time to heal nonoperatively.

The overall healing rate was 85%, based on at least 2 years of follow-up data from 26 knees in 24 patients whose average age was 14 years, said Dr. Kocher, an orthopedic surgeon at Children's Hospital Boston. The cases included 9 stage II lesions (fissured), 11 stage III lesions (partly attached), and 6 stage IV lesions (detached). Other studies have shown similar healing rates of 80% or higher.

Osteochondritis dissecans (OCD) is a relatively rare disease (about 15–30 cases per 100,000 persons in the year 2000) in which a loose piece of bone and cartilage separates partly or completely from the joint. Symptoms include pain, stiffness, locking of the joint, and a sensation that the joint is giving way.

The cause of OCD remains unclear, although possible causes include repetitive microtrauma, poor bone growth, and genetic predisposition. Most cases occur in active boys aged 10–20 years, but the diagnoses in girls have increased as more girls play competitive sports. Dr. Kocher's study included 13 boys and 11 girls.

Healing was evident 6 months after surgery based on several scores, including the International Knee Documentation Committee, Lysholm, and Tegner scales, which measure knee function in athletic patients.

The average Tegner activity level score, which uses a scale of 1–10, increased from 4.9 before surgery to 7.4 after surgery.

The healing rate was slightly lower in the seven patients who had undergone previous surgery for OCD than in those with no prior OCD surgery (71% vs. 89%).

After surgery, the patients recovered by performing careful weight-bearing and range-of-motion exercises, and gradually returning to sports.

There were no significant differences in healing rate based on the type of lesion and, in fact, all six of the cases of stage IV (unstable lesions) healed. A lateral vs. medial location had no apparent effect on healing, and no significant complications were reported in any of the patients.

There were four cases of unhealed lesions after the procedure (15%).

Two of the cases were treated with chondral resurfacing, and the other two were treated with a second internal fixation; all four patients were able to resume their sports activities.

The study was limited by its small size—which prevented subgroup comparisons—and by its retrospective nature.

“When faced with an unstable juvenile OCD lesion of the knee, we are often forced to choose between internal fixation or fragment removal with a chondral resurfacing technique,” Dr. Kocher said. “Given the relatively high healing rate, good functional outcome, and low complication rate, we would advocate internal fixation of these lesions when technically possible.”

HERSHEY, PA. — Otherwise healthy adolescents who had internal fixation surgery for osteochondritis dissecans of the knee returned to their sports activities about 8 months later, Dr. Mininder S. Kocher reported at the annual meeting of the American Orthopaedic Society for Sports Medicine.

The data argue in favor of internal fixation, especially for children approaching skeletal maturity who have less time to heal nonoperatively.

The overall healing rate was 85%, based on at least 2 years of follow-up data from 26 knees in 24 patients whose average age was 14 years, said Dr. Kocher, an orthopedic surgeon at Children's Hospital Boston. The cases included 9 stage II lesions (fissured), 11 stage III lesions (partly attached), and 6 stage IV lesions (detached). Other studies have shown similar healing rates of 80% or higher.

Osteochondritis dissecans (OCD) is a relatively rare disease (about 15–30 cases per 100,000 persons in the year 2000) in which a loose piece of bone and cartilage separates partly or completely from the joint. Symptoms include pain, stiffness, locking of the joint, and a sensation that the joint is giving way.

The cause of OCD remains unclear, although possible causes include repetitive microtrauma, poor bone growth, and genetic predisposition. Most cases occur in active boys aged 10–20 years, but the diagnoses in girls have increased as more girls play competitive sports. Dr. Kocher's study included 13 boys and 11 girls.

Healing was evident 6 months after surgery based on several scores, including the International Knee Documentation Committee, Lysholm, and Tegner scales, which measure knee function in athletic patients.

The average Tegner activity level score, which uses a scale of 1–10, increased from 4.9 before surgery to 7.4 after surgery.

The healing rate was slightly lower in the seven patients who had undergone previous surgery for OCD than in those with no prior OCD surgery (71% vs. 89%).

After surgery, the patients recovered by performing careful weight-bearing and range-of-motion exercises, and gradually returning to sports.

There were no significant differences in healing rate based on the type of lesion and, in fact, all six of the cases of stage IV (unstable lesions) healed. A lateral vs. medial location had no apparent effect on healing, and no significant complications were reported in any of the patients.

There were four cases of unhealed lesions after the procedure (15%).

Two of the cases were treated with chondral resurfacing, and the other two were treated with a second internal fixation; all four patients were able to resume their sports activities.

The study was limited by its small size—which prevented subgroup comparisons—and by its retrospective nature.

“When faced with an unstable juvenile OCD lesion of the knee, we are often forced to choose between internal fixation or fragment removal with a chondral resurfacing technique,” Dr. Kocher said. “Given the relatively high healing rate, good functional outcome, and low complication rate, we would advocate internal fixation of these lesions when technically possible.”

The recipe for the 2006–2007 influenza vaccine calls for A (H3N2) and B strains that differ from last year's version, according to analyses of recently isolated flu viruses, epidemiologic data, and postvaccination serologic studies in humans.

Vaccine manufacturers should include the A/New Caledonia/20/99-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and B/Malaysia/2506/2004-like viruses in formulations of the 2006–2007 influenza vaccine, recommends the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee (MMWR 2006;55:648–53). Last year's vaccine included the emerging strain A/California/7/2004 (H3N2) and retained the H1N1 and B strains from the previous year.

During last year's flu season (from Oct. 2, 2005 to June 3, 2006), 35 deaths were reported among children aged less than 18 years, which were linked to laboratory-confirmed influenza infections from 13 states. Of the 31 children for whom the type of virus was known, 23 were infected with the influenza A virus, and 8 were infected with the influenza B virus. A total of 11 deaths occurred in children aged 6–23 months, 4 in children younger than 6 months of age, 4 in children aged 2–4 years, and 16 in children aged 5–17 years, the Centers for Disease Control and Prevention said.

Pediatric hospitalizations with lab-confirmed influenza infections were monitored in two networks. The pediatric hospitalization rates from last year's flu season showed an overall rate of 1.21/10,000 children aged 0–17 years, based on preliminary data from the Emerging Infections Program. When broken down into younger and older age groups, the rates were 2.76/10,000 among children aged 0–5 years and 0.38/10,000 among those aged 5–17 years. Furthermore, the laboratory-confirmed influenza-associated hospitalization rate was 5.4/10,000 children for children aged 0–4 years, based on preliminary data from the New Vaccine Surveillance Network.

In the 2005–2006 season, influenza A (H1N1), A (H3N2) and B viruses cocirculated all over the world, the CDC said.

The recipe for the 2006–2007 influenza vaccine calls for A (H3N2) and B strains that differ from last year's version, according to analyses of recently isolated flu viruses, epidemiologic data, and postvaccination serologic studies in humans.

Vaccine manufacturers should include the A/New Caledonia/20/99-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and B/Malaysia/2506/2004-like viruses in formulations of the 2006–2007 influenza vaccine, recommends the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee (MMWR 2006;55:648–53). Last year's vaccine included the emerging strain A/California/7/2004 (H3N2) and retained the H1N1 and B strains from the previous year.

During last year's flu season (from Oct. 2, 2005 to June 3, 2006), 35 deaths were reported among children aged less than 18 years, which were linked to laboratory-confirmed influenza infections from 13 states. Of the 31 children for whom the type of virus was known, 23 were infected with the influenza A virus, and 8 were infected with the influenza B virus. A total of 11 deaths occurred in children aged 6–23 months, 4 in children younger than 6 months of age, 4 in children aged 2–4 years, and 16 in children aged 5–17 years, the Centers for Disease Control and Prevention said.

Pediatric hospitalizations with lab-confirmed influenza infections were monitored in two networks. The pediatric hospitalization rates from last year's flu season showed an overall rate of 1.21/10,000 children aged 0–17 years, based on preliminary data from the Emerging Infections Program. When broken down into younger and older age groups, the rates were 2.76/10,000 among children aged 0–5 years and 0.38/10,000 among those aged 5–17 years. Furthermore, the laboratory-confirmed influenza-associated hospitalization rate was 5.4/10,000 children for children aged 0–4 years, based on preliminary data from the New Vaccine Surveillance Network.

In the 2005–2006 season, influenza A (H1N1), A (H3N2) and B viruses cocirculated all over the world, the CDC said.

The recipe for the 2006–2007 influenza vaccine calls for A (H3N2) and B strains that differ from last year's version, according to analyses of recently isolated flu viruses, epidemiologic data, and postvaccination serologic studies in humans.

Vaccine manufacturers should include the A/New Caledonia/20/99-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and B/Malaysia/2506/2004-like viruses in formulations of the 2006–2007 influenza vaccine, recommends the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee (MMWR 2006;55:648–53). Last year's vaccine included the emerging strain A/California/7/2004 (H3N2) and retained the H1N1 and B strains from the previous year.

During last year's flu season (from Oct. 2, 2005 to June 3, 2006), 35 deaths were reported among children aged less than 18 years, which were linked to laboratory-confirmed influenza infections from 13 states. Of the 31 children for whom the type of virus was known, 23 were infected with the influenza A virus, and 8 were infected with the influenza B virus. A total of 11 deaths occurred in children aged 6–23 months, 4 in children younger than 6 months of age, 4 in children aged 2–4 years, and 16 in children aged 5–17 years, the Centers for Disease Control and Prevention said.

Pediatric hospitalizations with lab-confirmed influenza infections were monitored in two networks. The pediatric hospitalization rates from last year's flu season showed an overall rate of 1.21/10,000 children aged 0–17 years, based on preliminary data from the Emerging Infections Program. When broken down into younger and older age groups, the rates were 2.76/10,000 among children aged 0–5 years and 0.38/10,000 among those aged 5–17 years. Furthermore, the laboratory-confirmed influenza-associated hospitalization rate was 5.4/10,000 children for children aged 0–4 years, based on preliminary data from the New Vaccine Surveillance Network.

In the 2005–2006 season, influenza A (H1N1), A (H3N2) and B viruses cocirculated all over the world, the CDC said.