Heidi Splete

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.

DENVER — Both social isolation and depression hampered health behaviors in a study of 492 patients who suffered acute coronary syndrome events, reported Dr. Manual Paz-Yepes at the annual meeting of the American Psychosomatic Society.

The 174 patients without life partners were significantly less likely than the 318 patients with partners to participate in cardiac rehabilitation (35% vs. 64%) or exercise (46% vs. 57%), and were more likely to smoke (15% vs. 8%) 3 months after an acute coronary syndrome (ACS) event.

Within 7 days of their ACS event and after 3 months, patients completed the Beck Depression Inventory as well as the UCLA loneliness scale, a measure of social isolation, wrote Dr. Paz-Yepes of the Cardiovascular Institute at Mount Sinai School of Medicine, New York, in a poster.

In a hierarchical regression analysis, depression, but not loneliness or partner status, was significantly tied to reduced likelihood of participation in cardiac rehab or exercise, and with reduced medication adherence. Loneliness was significantly linked with decreased medication adherence, lack of exercise, and smoking likelihood.

DENVER — Both social isolation and depression hampered health behaviors in a study of 492 patients who suffered acute coronary syndrome events, reported Dr. Manual Paz-Yepes at the annual meeting of the American Psychosomatic Society.

The 174 patients without life partners were significantly less likely than the 318 patients with partners to participate in cardiac rehabilitation (35% vs. 64%) or exercise (46% vs. 57%), and were more likely to smoke (15% vs. 8%) 3 months after an acute coronary syndrome (ACS) event.

Within 7 days of their ACS event and after 3 months, patients completed the Beck Depression Inventory as well as the UCLA loneliness scale, a measure of social isolation, wrote Dr. Paz-Yepes of the Cardiovascular Institute at Mount Sinai School of Medicine, New York, in a poster.

In a hierarchical regression analysis, depression, but not loneliness or partner status, was significantly tied to reduced likelihood of participation in cardiac rehab or exercise, and with reduced medication adherence. Loneliness was significantly linked with decreased medication adherence, lack of exercise, and smoking likelihood.

DENVER — Both social isolation and depression hampered health behaviors in a study of 492 patients who suffered acute coronary syndrome events, reported Dr. Manual Paz-Yepes at the annual meeting of the American Psychosomatic Society.

The 174 patients without life partners were significantly less likely than the 318 patients with partners to participate in cardiac rehabilitation (35% vs. 64%) or exercise (46% vs. 57%), and were more likely to smoke (15% vs. 8%) 3 months after an acute coronary syndrome (ACS) event.

Within 7 days of their ACS event and after 3 months, patients completed the Beck Depression Inventory as well as the UCLA loneliness scale, a measure of social isolation, wrote Dr. Paz-Yepes of the Cardiovascular Institute at Mount Sinai School of Medicine, New York, in a poster.

In a hierarchical regression analysis, depression, but not loneliness or partner status, was significantly tied to reduced likelihood of participation in cardiac rehab or exercise, and with reduced medication adherence. Loneliness was significantly linked with decreased medication adherence, lack of exercise, and smoking likelihood.

WASHINGTON – Two-year-olds whose mothers smoke regularly during pregnancy are significantly more likely to exhibit clinically disruptive behavior than are children of nonsmoking mothers, according to a review presented at a conference on tobacco control sponsored by the American Cancer Society.

“What we found was that nicotine exposure was linked to aggressive behavior, defiance, and lower social skills,” said Lauren S. Wakschlag, Ph.D., of the University of Illinois, Chicago.

“We still don't know that there is a causal link,” she said. “But the evidence that nicotine-exposed children are more likely to have behavior problems is there, and it is very consistent.”

To the researchers' surprise, nicotine exposure was not associated with emotional dysregulation–for reasons that remain unclear.

Ninety-three children were involved in the study. Overall, the 44 children exposed to nicotine in the womb were more defiant, more aggressive, and less social, compared with the 49 children who were not exposed–even after controlling for multiple variables.

The mothers were primarily non-Hispanic white and working class, which reflects the demographics of the typical pregnant smoker in the United States. Mothers of the nicotine-exposed children reported smoking consistently during at least two trimesters of their pregnancies, and 47% of them smoked more than half a pack (about 15 cigarettes) daily.

The children were assessed at 12, 18, and 24 months of age using maternal reports on the Infant-Toddler Social Emotional Assessment test. The 24-item ITSEA provides a clinical measurement of behavior in children as young as 1 year and rates traits such as peer aggression on a three-point scale. The children also were observed during a 20-minute interaction with their mothers in a laboratory setting.

Overall, nicotine-exposed children were almost 12 times as likely to have clinically significant behavior problems; 14 of 16 children with ITSEA scores in the clinical range were in the nicotine-exposed group, Dr. Wakschlag noted.

Mild behavior problems are common in toddlers, but the behavior of the nicotine-exposed toddlers was worse than that of the unexposed toddlers at the start of the study. In addition, the differences between the groups were significant by age 24 months, and the nicotine-exposed toddlers' behavior significantly worsened between ages 18 months and 24 months–the age at which some problem behaviors typically associated with the “terrible twos” start to decline, Dr. Wakschlag observed.

Identifying a pattern of behavior in toddlers who were prenatally exposed to nicotine could be useful in examining how other prenatal experiences affect behavior in early childhood.

“We have more work to do, but it is striking to see this level of coherence in the first year of life, and the specificity of the findings can help take the research further,” Dr. Wakschlag said. The next step, she said, is to link the behavior patterns of children who have been exposed to nicotine to neuroscientific investigations and to think about how nicotine exposure might interact with types of causal risks.

The data, which were published recently (Child Dev. 2006;77:893–906), support similar findings from another study. In the previous study, investigators found that maternal smoking during pregnancy was significantly associated with observed negativity in 52 toddlers whose mothers smoked throughout pregnancy, compared with 47 toddlers whose mothers did not smoke during pregnancy (Arch. Pediatr. Adolesc. Med. 2000;154:381–5).

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Two-year-olds whose mothers smoke regularly during pregnancy are significantly more likely to exhibit clinically disruptive behavior than are children of nonsmoking mothers, according to a review presented at a conference on tobacco control sponsored by the American Cancer Society.

“What we found was that nicotine exposure was linked to aggressive behavior, defiance, and lower social skills,” said Lauren S. Wakschlag, Ph.D., of the University of Illinois, Chicago.

“We still don't know that there is a causal link,” she said. “But the evidence that nicotine-exposed children are more likely to have behavior problems is there, and it is very consistent.”

To the researchers' surprise, nicotine exposure was not associated with emotional dysregulation–for reasons that remain unclear.

Ninety-three children were involved in the study. Overall, the 44 children exposed to nicotine in the womb were more defiant, more aggressive, and less social, compared with the 49 children who were not exposed–even after controlling for multiple variables.

The mothers were primarily non-Hispanic white and working class, which reflects the demographics of the typical pregnant smoker in the United States. Mothers of the nicotine-exposed children reported smoking consistently during at least two trimesters of their pregnancies, and 47% of them smoked more than half a pack (about 15 cigarettes) daily.

The children were assessed at 12, 18, and 24 months of age using maternal reports on the Infant-Toddler Social Emotional Assessment test. The 24-item ITSEA provides a clinical measurement of behavior in children as young as 1 year and rates traits such as peer aggression on a three-point scale. The children also were observed during a 20-minute interaction with their mothers in a laboratory setting.

Overall, nicotine-exposed children were almost 12 times as likely to have clinically significant behavior problems; 14 of 16 children with ITSEA scores in the clinical range were in the nicotine-exposed group, Dr. Wakschlag noted.

Mild behavior problems are common in toddlers, but the behavior of the nicotine-exposed toddlers was worse than that of the unexposed toddlers at the start of the study. In addition, the differences between the groups were significant by age 24 months, and the nicotine-exposed toddlers' behavior significantly worsened between ages 18 months and 24 months–the age at which some problem behaviors typically associated with the “terrible twos” start to decline, Dr. Wakschlag observed.

Identifying a pattern of behavior in toddlers who were prenatally exposed to nicotine could be useful in examining how other prenatal experiences affect behavior in early childhood.

“We have more work to do, but it is striking to see this level of coherence in the first year of life, and the specificity of the findings can help take the research further,” Dr. Wakschlag said. The next step, she said, is to link the behavior patterns of children who have been exposed to nicotine to neuroscientific investigations and to think about how nicotine exposure might interact with types of causal risks.

The data, which were published recently (Child Dev. 2006;77:893–906), support similar findings from another study. In the previous study, investigators found that maternal smoking during pregnancy was significantly associated with observed negativity in 52 toddlers whose mothers smoked throughout pregnancy, compared with 47 toddlers whose mothers did not smoke during pregnancy (Arch. Pediatr. Adolesc. Med. 2000;154:381–5).

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Two-year-olds whose mothers smoke regularly during pregnancy are significantly more likely to exhibit clinically disruptive behavior than are children of nonsmoking mothers, according to a review presented at a conference on tobacco control sponsored by the American Cancer Society.

“What we found was that nicotine exposure was linked to aggressive behavior, defiance, and lower social skills,” said Lauren S. Wakschlag, Ph.D., of the University of Illinois, Chicago.

“We still don't know that there is a causal link,” she said. “But the evidence that nicotine-exposed children are more likely to have behavior problems is there, and it is very consistent.”

To the researchers' surprise, nicotine exposure was not associated with emotional dysregulation–for reasons that remain unclear.

Ninety-three children were involved in the study. Overall, the 44 children exposed to nicotine in the womb were more defiant, more aggressive, and less social, compared with the 49 children who were not exposed–even after controlling for multiple variables.

The mothers were primarily non-Hispanic white and working class, which reflects the demographics of the typical pregnant smoker in the United States. Mothers of the nicotine-exposed children reported smoking consistently during at least two trimesters of their pregnancies, and 47% of them smoked more than half a pack (about 15 cigarettes) daily.

The children were assessed at 12, 18, and 24 months of age using maternal reports on the Infant-Toddler Social Emotional Assessment test. The 24-item ITSEA provides a clinical measurement of behavior in children as young as 1 year and rates traits such as peer aggression on a three-point scale. The children also were observed during a 20-minute interaction with their mothers in a laboratory setting.

Overall, nicotine-exposed children were almost 12 times as likely to have clinically significant behavior problems; 14 of 16 children with ITSEA scores in the clinical range were in the nicotine-exposed group, Dr. Wakschlag noted.

Mild behavior problems are common in toddlers, but the behavior of the nicotine-exposed toddlers was worse than that of the unexposed toddlers at the start of the study. In addition, the differences between the groups were significant by age 24 months, and the nicotine-exposed toddlers' behavior significantly worsened between ages 18 months and 24 months–the age at which some problem behaviors typically associated with the “terrible twos” start to decline, Dr. Wakschlag observed.

Identifying a pattern of behavior in toddlers who were prenatally exposed to nicotine could be useful in examining how other prenatal experiences affect behavior in early childhood.

“We have more work to do, but it is striking to see this level of coherence in the first year of life, and the specificity of the findings can help take the research further,” Dr. Wakschlag said. The next step, she said, is to link the behavior patterns of children who have been exposed to nicotine to neuroscientific investigations and to think about how nicotine exposure might interact with types of causal risks.

The data, which were published recently (Child Dev. 2006;77:893–906), support similar findings from another study. In the previous study, investigators found that maternal smoking during pregnancy was significantly associated with observed negativity in 52 toddlers whose mothers smoked throughout pregnancy, compared with 47 toddlers whose mothers did not smoke during pregnancy (Arch. Pediatr. Adolesc. Med. 2000;154:381–5).

ELSEVIER GLOBAL MEDICAL NEWS

Inpatients + Cigarettes = Comorbidities

Nearly half of psychiatric inpatients with at least one medical comorbidity were smokers, based on data from 1,097 adults aged 18–93 years admitted to a psychiatric hospital over 10 months.

Overall, 48% of the patients had multiple medical comorbidities, reported Cynthia L. Dakin, Ph.D., in a poster at a conference on tobacco control sponsored by the American Cancer Society.

Tobacco use data were available for 784 patients. Dr. Dakin and her associates at Northeastern University, Boston, found that 55% of the 784 patients smoked, and 66% of them smoked at least one pack of cigarettes daily. Another 26% smoked between 15 and 20 cigarettes daily, and 8% smoked fewer than 15 cigarettes daily.

Tobacco use was significantly associated with hypertension, diabetes, cancer, osteoporosis, heart disease, and a history of stroke.

The most common DSM-IV diagnoses in the overall sample were major depressive disorder; substance intoxication, dependence, or abuse; bipolar disorder; and schizophrenia.

This study did not review the associations between tobacco use and psychiatric diagnoses, but previous research has shown significant associations between smoking and psychiatric conditions. One study of 2,774 psychiatric patients (of which 61% were smokers) found that bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking (Psychol. Addict. Behav. 2003;17:259–65).

Dr. Dakin and her colleagues plan to conduct follow-up research on smoking cessation efforts for psychiatric inpatients.

Ask Blue-Collar Patients About Smoking

Significantly fewer white-collar workers than blue-collar workers are smokers, according to National Health Interview Survey data from more than 140,000 respondents.

Pooled smoking data from 1997 to 2004 showed the highest reported rates among construction workers (39%) and the lowest reported rates among health professionals (5%), said David J. Lee, Ph.D., who presented the findings at a conference on tobacco control sponsored by the American Cancer Society.

“The overarching goal of Healthy People 2010 is to reduce health disparities in the U.S. population, and I think you'll agree that we have a health disparity here with respect to smoking groups,” said Dr. Lee, who is with the epidemiology and public health department at the University of Miami.

Dr. Lee cited his study of 8-year smoking trends by occupational category based on NHIS data in which the 20 occupations with the highest smoking rates (all greater than 40%) were blue-collar jobs, and included bartenders, waiters, maintenance workers, truck drivers, and carpenters (J. Occup. Environ. Med. 2004;46:538–48).

“We saw some evidence of a smoking decline [among] roofers (who topped the list with a 58% smoking rate), but it was not statistically significant,” he said.

By contrast, the occupations with the 20 lowest smoking rates were classified as white-collar jobs, and ranged from 15% among airline pilots to 4% among clergy and physicians.

Despite evidence of declining smoking rates in some blue-collar professions, the findings suggest that blue-collar workers need more attention from their employers and health professionals if they are going to stop smoking.

Workplace health and safety programs offer excellent opportunities to encourage smokers to quit, especially those who rarely see a physician in the office, Dr. Lee said. But office-based physicians who ask their blue-collar patients about smoking and assist those who want to quit are essential to reducing the occupational disparity, he emphasized.

The National Health Interview Survey provides an annual representative sample of noninstitutionalized U.S. workers older than 18 years. The survey places workers in 1 of 41 occupational categories, and smoking information has been collected consistently since 1997.

Tobacco Tx Guidelines to Be Updated

The U.S. government's guidelines for the treatment of tobacco dependence are due for a checkup, and clinicians can help.

An updated version of the government-sponsored publication, “Treating Tobacco Use and Dependence,” will be published in 2008, Dr. Michael C. Fiore said at a conference on tobacco control sponsored by the American Cancer Society.

“The guidelines will remain treatment-based; this will not be a soup-to-nuts rewrite,” said Dr. Fiore, a professor of medicine at the University of Wisconsin, Madison, and chair of the panel charged with writing the update.

The panel welcomes input from inside and outside the medical community on significant research in tobacco dependence treatment and issues that were not addressed in the current guidelines (published in 2000), Dr. Fiore said.

Topics submitted so far include the clinical efficacy of the “five A's” (a method of assessing willingness to change behavior), the effectiveness of telephone hotlines, and the safety and efficacy of combination drug therapies. The update will address counseling and pharmacotherapy for pregnant smokers and smokers with comorbid mental illness. Suggested topics for or improvements to the guidelines should be sent before October 2006 to

[email protected]

Inpatients + Cigarettes = Comorbidities

Nearly half of psychiatric inpatients with at least one medical comorbidity were smokers, based on data from 1,097 adults aged 18–93 years admitted to a psychiatric hospital over 10 months.

Overall, 48% of the patients had multiple medical comorbidities, reported Cynthia L. Dakin, Ph.D., in a poster at a conference on tobacco control sponsored by the American Cancer Society.

Tobacco use data were available for 784 patients. Dr. Dakin and her associates at Northeastern University, Boston, found that 55% of the 784 patients smoked, and 66% of them smoked at least one pack of cigarettes daily. Another 26% smoked between 15 and 20 cigarettes daily, and 8% smoked fewer than 15 cigarettes daily.

Tobacco use was significantly associated with hypertension, diabetes, cancer, osteoporosis, heart disease, and a history of stroke.

The most common DSM-IV diagnoses in the overall sample were major depressive disorder; substance intoxication, dependence, or abuse; bipolar disorder; and schizophrenia.

This study did not review the associations between tobacco use and psychiatric diagnoses, but previous research has shown significant associations between smoking and psychiatric conditions. One study of 2,774 psychiatric patients (of which 61% were smokers) found that bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking (Psychol. Addict. Behav. 2003;17:259–65).

Dr. Dakin and her colleagues plan to conduct follow-up research on smoking cessation efforts for psychiatric inpatients.

Ask Blue-Collar Patients About Smoking

Significantly fewer white-collar workers than blue-collar workers are smokers, according to National Health Interview Survey data from more than 140,000 respondents.

Pooled smoking data from 1997 to 2004 showed the highest reported rates among construction workers (39%) and the lowest reported rates among health professionals (5%), said David J. Lee, Ph.D., who presented the findings at a conference on tobacco control sponsored by the American Cancer Society.

“The overarching goal of Healthy People 2010 is to reduce health disparities in the U.S. population, and I think you'll agree that we have a health disparity here with respect to smoking groups,” said Dr. Lee, who is with the epidemiology and public health department at the University of Miami.

Dr. Lee cited his study of 8-year smoking trends by occupational category based on NHIS data in which the 20 occupations with the highest smoking rates (all greater than 40%) were blue-collar jobs, and included bartenders, waiters, maintenance workers, truck drivers, and carpenters (J. Occup. Environ. Med. 2004;46:538–48).

“We saw some evidence of a smoking decline [among] roofers (who topped the list with a 58% smoking rate), but it was not statistically significant,” he said.

By contrast, the occupations with the 20 lowest smoking rates were classified as white-collar jobs, and ranged from 15% among airline pilots to 4% among clergy and physicians.

Despite evidence of declining smoking rates in some blue-collar professions, the findings suggest that blue-collar workers need more attention from their employers and health professionals if they are going to stop smoking.

Workplace health and safety programs offer excellent opportunities to encourage smokers to quit, especially those who rarely see a physician in the office, Dr. Lee said. But office-based physicians who ask their blue-collar patients about smoking and assist those who want to quit are essential to reducing the occupational disparity, he emphasized.

The National Health Interview Survey provides an annual representative sample of noninstitutionalized U.S. workers older than 18 years. The survey places workers in 1 of 41 occupational categories, and smoking information has been collected consistently since 1997.

Tobacco Tx Guidelines to Be Updated

The U.S. government's guidelines for the treatment of tobacco dependence are due for a checkup, and clinicians can help.

An updated version of the government-sponsored publication, “Treating Tobacco Use and Dependence,” will be published in 2008, Dr. Michael C. Fiore said at a conference on tobacco control sponsored by the American Cancer Society.

“The guidelines will remain treatment-based; this will not be a soup-to-nuts rewrite,” said Dr. Fiore, a professor of medicine at the University of Wisconsin, Madison, and chair of the panel charged with writing the update.

The panel welcomes input from inside and outside the medical community on significant research in tobacco dependence treatment and issues that were not addressed in the current guidelines (published in 2000), Dr. Fiore said.

Topics submitted so far include the clinical efficacy of the “five A's” (a method of assessing willingness to change behavior), the effectiveness of telephone hotlines, and the safety and efficacy of combination drug therapies. The update will address counseling and pharmacotherapy for pregnant smokers and smokers with comorbid mental illness. Suggested topics for or improvements to the guidelines should be sent before October 2006 to

[email protected]

Inpatients + Cigarettes = Comorbidities

Nearly half of psychiatric inpatients with at least one medical comorbidity were smokers, based on data from 1,097 adults aged 18–93 years admitted to a psychiatric hospital over 10 months.

Overall, 48% of the patients had multiple medical comorbidities, reported Cynthia L. Dakin, Ph.D., in a poster at a conference on tobacco control sponsored by the American Cancer Society.

Tobacco use data were available for 784 patients. Dr. Dakin and her associates at Northeastern University, Boston, found that 55% of the 784 patients smoked, and 66% of them smoked at least one pack of cigarettes daily. Another 26% smoked between 15 and 20 cigarettes daily, and 8% smoked fewer than 15 cigarettes daily.

Tobacco use was significantly associated with hypertension, diabetes, cancer, osteoporosis, heart disease, and a history of stroke.

The most common DSM-IV diagnoses in the overall sample were major depressive disorder; substance intoxication, dependence, or abuse; bipolar disorder; and schizophrenia.

This study did not review the associations between tobacco use and psychiatric diagnoses, but previous research has shown significant associations between smoking and psychiatric conditions. One study of 2,774 psychiatric patients (of which 61% were smokers) found that bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking (Psychol. Addict. Behav. 2003;17:259–65).

Dr. Dakin and her colleagues plan to conduct follow-up research on smoking cessation efforts for psychiatric inpatients.

Ask Blue-Collar Patients About Smoking

Significantly fewer white-collar workers than blue-collar workers are smokers, according to National Health Interview Survey data from more than 140,000 respondents.

Pooled smoking data from 1997 to 2004 showed the highest reported rates among construction workers (39%) and the lowest reported rates among health professionals (5%), said David J. Lee, Ph.D., who presented the findings at a conference on tobacco control sponsored by the American Cancer Society.

“The overarching goal of Healthy People 2010 is to reduce health disparities in the U.S. population, and I think you'll agree that we have a health disparity here with respect to smoking groups,” said Dr. Lee, who is with the epidemiology and public health department at the University of Miami.

Dr. Lee cited his study of 8-year smoking trends by occupational category based on NHIS data in which the 20 occupations with the highest smoking rates (all greater than 40%) were blue-collar jobs, and included bartenders, waiters, maintenance workers, truck drivers, and carpenters (J. Occup. Environ. Med. 2004;46:538–48).

“We saw some evidence of a smoking decline [among] roofers (who topped the list with a 58% smoking rate), but it was not statistically significant,” he said.

By contrast, the occupations with the 20 lowest smoking rates were classified as white-collar jobs, and ranged from 15% among airline pilots to 4% among clergy and physicians.

Despite evidence of declining smoking rates in some blue-collar professions, the findings suggest that blue-collar workers need more attention from their employers and health professionals if they are going to stop smoking.

Workplace health and safety programs offer excellent opportunities to encourage smokers to quit, especially those who rarely see a physician in the office, Dr. Lee said. But office-based physicians who ask their blue-collar patients about smoking and assist those who want to quit are essential to reducing the occupational disparity, he emphasized.

The National Health Interview Survey provides an annual representative sample of noninstitutionalized U.S. workers older than 18 years. The survey places workers in 1 of 41 occupational categories, and smoking information has been collected consistently since 1997.

Tobacco Tx Guidelines to Be Updated

The U.S. government's guidelines for the treatment of tobacco dependence are due for a checkup, and clinicians can help.

An updated version of the government-sponsored publication, “Treating Tobacco Use and Dependence,” will be published in 2008, Dr. Michael C. Fiore said at a conference on tobacco control sponsored by the American Cancer Society.

“The guidelines will remain treatment-based; this will not be a soup-to-nuts rewrite,” said Dr. Fiore, a professor of medicine at the University of Wisconsin, Madison, and chair of the panel charged with writing the update.

The panel welcomes input from inside and outside the medical community on significant research in tobacco dependence treatment and issues that were not addressed in the current guidelines (published in 2000), Dr. Fiore said.

Topics submitted so far include the clinical efficacy of the “five A's” (a method of assessing willingness to change behavior), the effectiveness of telephone hotlines, and the safety and efficacy of combination drug therapies. The update will address counseling and pharmacotherapy for pregnant smokers and smokers with comorbid mental illness. Suggested topics for or improvements to the guidelines should be sent before October 2006 to

[email protected]

Body Dissatisfaction, Health Behavior

Adolescents who are unhappy with their bodies are more motivated to engage in health-compromising behavior than in health-promoting behavior, said Dianne Neumark-Sztainer, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues.

Their goal in Project EAT (Eating Among Teens)-II was to compare the associations between body dissatisfaction in 1999 and health behaviors in 2004 after adjusting for demographic variables (J. Adolesc. Health 2006;39:244–51).

The investigators contacted 1,130 boys and 1,386 girls from the EAT-I study (about 55% of the participants), a survey of adolescent eating patterns and weight status that was conducted during the 1998–1999 school year.

Overall, about 34% of the girls reported low body satisfaction, 26% reported low-middle satisfaction, 22% reported high-middle satisfaction, and 18% reported high satisfaction. Low body satisfaction in girls predicted dieting, binge eating, less physical activity, eating fewer fruits and vegetables, and weight control behaviors that were defined as “unhealthy” or “very unhealthy.”

About 24% of boys reported low body satisfaction, 26% reported low-middle, 24% reported high-middle, and 26% reported high. Low body satisfaction in boys significantly predicted dieting, binge eating, smoking, less physical activity, and a range of weight control behaviors that included “healthy” but also “unhealthy,” and “very unhealthy.”

Bullying Stresses Boys More Than Girls

A lower perceived risk of being bullied significantly mitigated the effect of past bullying experiences on psychological distress in girls, but not boys, based on a survey of 100 girls and 86 boys aged 11–14 years.

The findings suggest that perception of possible bullying predicts distress in girls, while distress in boys is more likely to be affected by both the perceived risk of bullying and past experience of being bullied.

To determine the roles of past bullying and perceived risk of bullying on psychological distress, Tam K. Dao of Florida State University, Tallahassee, and associates surveyed middle-school children in north Florida and compiled a victimization composite score. They also used a measurement of symptoms related to depression and anxiety (the K-10 scale) to assess nonspecific emotional distress (J. Adolesc. Health 2006;39:277–82).

Overall, boys reported more physical aggression and attacks on their property, while girls reported more emotional aggression. Reports of sexual aggression were not significantly different between the genders, Mr. Dao and his associates said.

A significantly strong relationship among nonspecific psychological distress, perceived risk of victimization, and past experience of victimization was evident in a multiple regression analysis. On further review by gender, girls were significantly more likely than boys to report a perceived risk of bullying, but boys' and girls' ratings of past experiences of victimization and nonspecific psychological distress were not significantly different.

Combination Improves Insomnia

Sleep hygiene combined with melatonin is safe and effective for initial insomnia in children aged 6–14 years with attention-deficit hyperactivity disorder who take stimulants, reported Dr. Margaret D. Weiss of the Children's and Women's Health Care Centre of Vancouver, B.C., and her associates.

The dysregulation that characterizes ADHD may play a role in the arousal that prevents these children from falling asleep, the researchers explained. If so, a combination of sleep hygiene and melatonin could improve the dysregulation without the need for hypnotic medication.

Twenty-eight patients modified their sleeping behaviors by setting consistent bedtimes and wake-up times, and eliminating naps and caffeine intake. Five of the 28 patients who began the study responded favorably to the sleep protocol during the 10-day screening phase and did not progress to receive melatonin. The remaining 23 children received either 5 mg melatonin or a placebo 20 minutes before bedtime; 19 completed the 30-day double-blind study (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:512–19).

In response to the sleep modification, the average minutes of sleep-onset latency dropped significantly from baseline to follow-up based on data from wrist activity monitors worn by the children (98 minutes vs. 73 minutes) and sleep logs completed by their parents (92 minutes vs. 69 minutes). The average sleep-onset latency dropped by 16 minutes more in response to melatonin, compared with the placebo based on sleep log data.

The study was sponsored by Circa Dia BV, which manufactures short-acting, pharmaceutical-grade melatonin, and Dr. Weiss has a research grant from the company.

Body Dissatisfaction, Health Behavior

Adolescents who are unhappy with their bodies are more motivated to engage in health-compromising behavior than in health-promoting behavior, said Dianne Neumark-Sztainer, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues.

Their goal in Project EAT (Eating Among Teens)-II was to compare the associations between body dissatisfaction in 1999 and health behaviors in 2004 after adjusting for demographic variables (J. Adolesc. Health 2006;39:244–51).

The investigators contacted 1,130 boys and 1,386 girls from the EAT-I study (about 55% of the participants), a survey of adolescent eating patterns and weight status that was conducted during the 1998–1999 school year.

Overall, about 34% of the girls reported low body satisfaction, 26% reported low-middle satisfaction, 22% reported high-middle satisfaction, and 18% reported high satisfaction. Low body satisfaction in girls predicted dieting, binge eating, less physical activity, eating fewer fruits and vegetables, and weight control behaviors that were defined as “unhealthy” or “very unhealthy.”

About 24% of boys reported low body satisfaction, 26% reported low-middle, 24% reported high-middle, and 26% reported high. Low body satisfaction in boys significantly predicted dieting, binge eating, smoking, less physical activity, and a range of weight control behaviors that included “healthy” but also “unhealthy,” and “very unhealthy.”

Bullying Stresses Boys More Than Girls

A lower perceived risk of being bullied significantly mitigated the effect of past bullying experiences on psychological distress in girls, but not boys, based on a survey of 100 girls and 86 boys aged 11–14 years.

The findings suggest that perception of possible bullying predicts distress in girls, while distress in boys is more likely to be affected by both the perceived risk of bullying and past experience of being bullied.

To determine the roles of past bullying and perceived risk of bullying on psychological distress, Tam K. Dao of Florida State University, Tallahassee, and associates surveyed middle-school children in north Florida and compiled a victimization composite score. They also used a measurement of symptoms related to depression and anxiety (the K-10 scale) to assess nonspecific emotional distress (J. Adolesc. Health 2006;39:277–82).

Overall, boys reported more physical aggression and attacks on their property, while girls reported more emotional aggression. Reports of sexual aggression were not significantly different between the genders, Mr. Dao and his associates said.

A significantly strong relationship among nonspecific psychological distress, perceived risk of victimization, and past experience of victimization was evident in a multiple regression analysis. On further review by gender, girls were significantly more likely than boys to report a perceived risk of bullying, but boys' and girls' ratings of past experiences of victimization and nonspecific psychological distress were not significantly different.

Combination Improves Insomnia

Sleep hygiene combined with melatonin is safe and effective for initial insomnia in children aged 6–14 years with attention-deficit hyperactivity disorder who take stimulants, reported Dr. Margaret D. Weiss of the Children's and Women's Health Care Centre of Vancouver, B.C., and her associates.

The dysregulation that characterizes ADHD may play a role in the arousal that prevents these children from falling asleep, the researchers explained. If so, a combination of sleep hygiene and melatonin could improve the dysregulation without the need for hypnotic medication.

Twenty-eight patients modified their sleeping behaviors by setting consistent bedtimes and wake-up times, and eliminating naps and caffeine intake. Five of the 28 patients who began the study responded favorably to the sleep protocol during the 10-day screening phase and did not progress to receive melatonin. The remaining 23 children received either 5 mg melatonin or a placebo 20 minutes before bedtime; 19 completed the 30-day double-blind study (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:512–19).

In response to the sleep modification, the average minutes of sleep-onset latency dropped significantly from baseline to follow-up based on data from wrist activity monitors worn by the children (98 minutes vs. 73 minutes) and sleep logs completed by their parents (92 minutes vs. 69 minutes). The average sleep-onset latency dropped by 16 minutes more in response to melatonin, compared with the placebo based on sleep log data.

The study was sponsored by Circa Dia BV, which manufactures short-acting, pharmaceutical-grade melatonin, and Dr. Weiss has a research grant from the company.

Body Dissatisfaction, Health Behavior

Adolescents who are unhappy with their bodies are more motivated to engage in health-compromising behavior than in health-promoting behavior, said Dianne Neumark-Sztainer, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues.

Their goal in Project EAT (Eating Among Teens)-II was to compare the associations between body dissatisfaction in 1999 and health behaviors in 2004 after adjusting for demographic variables (J. Adolesc. Health 2006;39:244–51).

The investigators contacted 1,130 boys and 1,386 girls from the EAT-I study (about 55% of the participants), a survey of adolescent eating patterns and weight status that was conducted during the 1998–1999 school year.

Overall, about 34% of the girls reported low body satisfaction, 26% reported low-middle satisfaction, 22% reported high-middle satisfaction, and 18% reported high satisfaction. Low body satisfaction in girls predicted dieting, binge eating, less physical activity, eating fewer fruits and vegetables, and weight control behaviors that were defined as “unhealthy” or “very unhealthy.”

About 24% of boys reported low body satisfaction, 26% reported low-middle, 24% reported high-middle, and 26% reported high. Low body satisfaction in boys significantly predicted dieting, binge eating, smoking, less physical activity, and a range of weight control behaviors that included “healthy” but also “unhealthy,” and “very unhealthy.”

Bullying Stresses Boys More Than Girls

A lower perceived risk of being bullied significantly mitigated the effect of past bullying experiences on psychological distress in girls, but not boys, based on a survey of 100 girls and 86 boys aged 11–14 years.

The findings suggest that perception of possible bullying predicts distress in girls, while distress in boys is more likely to be affected by both the perceived risk of bullying and past experience of being bullied.

To determine the roles of past bullying and perceived risk of bullying on psychological distress, Tam K. Dao of Florida State University, Tallahassee, and associates surveyed middle-school children in north Florida and compiled a victimization composite score. They also used a measurement of symptoms related to depression and anxiety (the K-10 scale) to assess nonspecific emotional distress (J. Adolesc. Health 2006;39:277–82).

Overall, boys reported more physical aggression and attacks on their property, while girls reported more emotional aggression. Reports of sexual aggression were not significantly different between the genders, Mr. Dao and his associates said.

A significantly strong relationship among nonspecific psychological distress, perceived risk of victimization, and past experience of victimization was evident in a multiple regression analysis. On further review by gender, girls were significantly more likely than boys to report a perceived risk of bullying, but boys' and girls' ratings of past experiences of victimization and nonspecific psychological distress were not significantly different.

Combination Improves Insomnia

Sleep hygiene combined with melatonin is safe and effective for initial insomnia in children aged 6–14 years with attention-deficit hyperactivity disorder who take stimulants, reported Dr. Margaret D. Weiss of the Children's and Women's Health Care Centre of Vancouver, B.C., and her associates.

The dysregulation that characterizes ADHD may play a role in the arousal that prevents these children from falling asleep, the researchers explained. If so, a combination of sleep hygiene and melatonin could improve the dysregulation without the need for hypnotic medication.

Twenty-eight patients modified their sleeping behaviors by setting consistent bedtimes and wake-up times, and eliminating naps and caffeine intake. Five of the 28 patients who began the study responded favorably to the sleep protocol during the 10-day screening phase and did not progress to receive melatonin. The remaining 23 children received either 5 mg melatonin or a placebo 20 minutes before bedtime; 19 completed the 30-day double-blind study (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:512–19).

In response to the sleep modification, the average minutes of sleep-onset latency dropped significantly from baseline to follow-up based on data from wrist activity monitors worn by the children (98 minutes vs. 73 minutes) and sleep logs completed by their parents (92 minutes vs. 69 minutes). The average sleep-onset latency dropped by 16 minutes more in response to melatonin, compared with the placebo based on sleep log data.

The study was sponsored by Circa Dia BV, which manufactures short-acting, pharmaceutical-grade melatonin, and Dr. Weiss has a research grant from the company.