Heidi Splete

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.

The cause of osteochondritis dissecans (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. 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 versus medial location had no apparent effect on healing, and no significant complications were reported in any patients.

There were four cases of unhealed lesions after the procedure (15%). Two of these were treated with chondral resurfacing, and 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.

The cause of osteochondritis dissecans (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. 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 versus medial location had no apparent effect on healing, and no significant complications were reported in any patients.

There were four cases of unhealed lesions after the procedure (15%). Two of these were treated with chondral resurfacing, and 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.

The cause of osteochondritis dissecans (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. 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 versus medial location had no apparent effect on healing, and no significant complications were reported in any patients.

There were four cases of unhealed lesions after the procedure (15%). Two of these were treated with chondral resurfacing, and 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.”

Children with rhinovirus who received oral prednisolone suffered significantly less recurrent wheezing compared with children with respiratory syncytial virus who also received the steroid or children who received placebo.

Dr. Tuomas Jartti, of the department of pediatrics at Turku (Finland) University Hospital, and associates analyzed 78 children aged 3–35 months who completed hospitalization for rhinovirus (40 children) or respiratory syncytial virus (RSV) infections (38 children). The children were randomized to receive an initial oral dose of 2 mg/kg prednisolone, followed by 2 mg/kg per day in three divided doses for 3 days (46 patients), or placebo (32 patients). The children with rhinovirus were significantly more likely to be older, atopic, and recurrent wheezers, and they had significantly higher blood eosinophil levels and exhaled nitric oxide levels than did the children with RSV (Pediatr. Infect. Dis. J. 2006;25:482–8). Children in the RSV group were significantly more likely to have acute otitis media and to have been treated with antibiotics than were those in the rhinovirus group.

Children with rhinovirus or RSV who received oral prednisolone did not leave the hospital more quickly than children in the placebo group (22 hours vs. 30 hours).

By reducing recurrent wheezing, prednisolone use significantly decreased the need for outpatient visits in children with rhinovirus infections—but not in children with RSV infections—compared with children who received placebo.

“We speculate that an early asthma-like inflammation could explain the beneficial effect of prednisolone in the rhinovirus group,” the investigators said.

Prednisolone was well tolerated; no significant adverse events were reported.

Children with rhinovirus who received oral prednisolone suffered significantly less recurrent wheezing compared with children with respiratory syncytial virus who also received the steroid or children who received placebo.

Dr. Tuomas Jartti, of the department of pediatrics at Turku (Finland) University Hospital, and associates analyzed 78 children aged 3–35 months who completed hospitalization for rhinovirus (40 children) or respiratory syncytial virus (RSV) infections (38 children). The children were randomized to receive an initial oral dose of 2 mg/kg prednisolone, followed by 2 mg/kg per day in three divided doses for 3 days (46 patients), or placebo (32 patients). The children with rhinovirus were significantly more likely to be older, atopic, and recurrent wheezers, and they had significantly higher blood eosinophil levels and exhaled nitric oxide levels than did the children with RSV (Pediatr. Infect. Dis. J. 2006;25:482–8). Children in the RSV group were significantly more likely to have acute otitis media and to have been treated with antibiotics than were those in the rhinovirus group.

Children with rhinovirus or RSV who received oral prednisolone did not leave the hospital more quickly than children in the placebo group (22 hours vs. 30 hours).

By reducing recurrent wheezing, prednisolone use significantly decreased the need for outpatient visits in children with rhinovirus infections—but not in children with RSV infections—compared with children who received placebo.

“We speculate that an early asthma-like inflammation could explain the beneficial effect of prednisolone in the rhinovirus group,” the investigators said.

Prednisolone was well tolerated; no significant adverse events were reported.

Children with rhinovirus who received oral prednisolone suffered significantly less recurrent wheezing compared with children with respiratory syncytial virus who also received the steroid or children who received placebo.

Dr. Tuomas Jartti, of the department of pediatrics at Turku (Finland) University Hospital, and associates analyzed 78 children aged 3–35 months who completed hospitalization for rhinovirus (40 children) or respiratory syncytial virus (RSV) infections (38 children). The children were randomized to receive an initial oral dose of 2 mg/kg prednisolone, followed by 2 mg/kg per day in three divided doses for 3 days (46 patients), or placebo (32 patients). The children with rhinovirus were significantly more likely to be older, atopic, and recurrent wheezers, and they had significantly higher blood eosinophil levels and exhaled nitric oxide levels than did the children with RSV (Pediatr. Infect. Dis. J. 2006;25:482–8). Children in the RSV group were significantly more likely to have acute otitis media and to have been treated with antibiotics than were those in the rhinovirus group.

Children with rhinovirus or RSV who received oral prednisolone did not leave the hospital more quickly than children in the placebo group (22 hours vs. 30 hours).

By reducing recurrent wheezing, prednisolone use significantly decreased the need for outpatient visits in children with rhinovirus infections—but not in children with RSV infections—compared with children who received placebo.

“We speculate that an early asthma-like inflammation could explain the beneficial effect of prednisolone in the rhinovirus group,” the investigators said.

Prednisolone was well tolerated; no significant adverse events were reported.

More Miss Day Care With Rotavirus

Rotavirus is a common cause of gastroenteritis that, in a review of 284 cases, was significantly more likely to keep children younger than 3 years of age away from day care, compared with nonrotavirus gastroenteritis.

A total of 115 cases (40%) were confirmed rotavirus infections. Overall, 70% of children with rotavirus gastroenteritis missed at least 1 day of day care, compared with 55% of children with nonrotavirus gastroenteritis, reported Dr. Susan E. Coffin of the University of Pennsylvania, Philadelphia, and her colleagues (Pediatr. Infect. Dis. J. 2006;25:584–9).

Children aged 7–12 months were the hardest hit; 54% of both the 7- to 9-month-olds and the 10- to 12-month-olds had rotavirus infections. By contrast, nonrotavirus infections peaked in children aged 4–6 months (72%).

The researchers collected stool samples from children with acute gastroenteritis at five urban and suburban pediatric practices during the winter-to-spring seasons of 2002–2003 and 2003–2004. The study was supported by Merck and Co.

Children with rotavirus infections were significantly more likely than those with nonrotavirus infections to exhibit vomiting (83% vs. 66%), a combination of diarrhea and vomiting (75% vs. 50%), or fever (60% vs. 43%).

Rotavirus had a significant impact on parents, too. Parents or guardians of the children with rotavirus were significantly more likely to miss at least 1 day of work than parents of children with nonrotavirus infections (62% vs. 40%).

The proportion of children who needed additional medical care, including hospitalization, was similar among both rotavirus and nonrotavirus cases.

Extreme Fevers May Merit Antibiotics

Children with very high fevers are at increased risk for both bacterial and viral illness, and clinical features don't reliably distinguish between the two conditions.

Dr. Barbara W. Trautner of Baylor College of Medicine, Houston, and her colleagues identified 103 cases of hyperpyrexia—defined as a rectal temperature of 106 ° F or higher—in a review of 130,828 patient visits (1 case per 1,270 visits).

The researchers found that 20 of these children (19%) had serious bacterial infections and 22 (21.4%) had laboratory-confirmed viral illness (Pediatrics 2006;118;34–40).

About a third of the children (35%) had fevers that lasted longer than 48 hours, and the cause of the fever was unknown in 60 children (58%).

The incidence of serious bacterial infection in children with underlying illnesses was more than double that in children without underlying illness (37% vs. 16%). But no other factors, including age and maximum temperature, were significantly predictive of serious bacterial infection compared with viral infection. Notably, the differences in white blood cell counts were not significant enough to be helpful in distinguishing bacterial vs. viral illness, although the median WBC was insignificantly higher in cases of viral illness.

The increased use of rapid testing continues to raise awareness of bacterial and viral coinfection, but only one child of 103 had a coinfection, which suggests that a positive rapid viral test alone may not be sufficient to rule out treatment with antibiotics.

Bocavirus and Respiratory Illness

Human bocavirus DNA was identified in 82 (5.6%) of 1,474 nasal specimens from children with upper and lower respiratory tract infections collected over a 20-month period in a San Diego children's hospital.

The prevalence of the human bocavirus (HBoV) infections peaked at 14% between March and May in both 2004 and 2005, although the reason for the spring peak was unclear, reported Dr. John C. Arnold of Children's Hospital, San Diego, and his colleagues. The study included children up to age 18 years, but most (63%) were less than 1 year old (Clin. Infect. Dis. 2006;43:283–8).

The researchers reviewed the records of 68 (83%) of the 82 patients with HBoV to discover the clinical characteristics associated with the infection in children. They found underlying illnesses in 21 (31%) children including 11 patients with asthma and 7 patients with neuromuscular disorders.

Cough was the most common symptom, based on data from 54 patients with no obvious coinfections or detectable viral antigens. Cough occurred in 46 (85%) of these children, and 10 (19%) had coughs described as “paroxysmal.” A total of 33 patients (62%) showed clinical signs of lower respiratory tract infections, and bronchiolitis was the most common diagnosis (26%). Difficulty breathing, nasal congestion, fever, and diarrhea were also common in patients with HBoV, and five patients had a rash.

More Miss Day Care With Rotavirus

Rotavirus is a common cause of gastroenteritis that, in a review of 284 cases, was significantly more likely to keep children younger than 3 years of age away from day care, compared with nonrotavirus gastroenteritis.

A total of 115 cases (40%) were confirmed rotavirus infections. Overall, 70% of children with rotavirus gastroenteritis missed at least 1 day of day care, compared with 55% of children with nonrotavirus gastroenteritis, reported Dr. Susan E. Coffin of the University of Pennsylvania, Philadelphia, and her colleagues (Pediatr. Infect. Dis. J. 2006;25:584–9).

Children aged 7–12 months were the hardest hit; 54% of both the 7- to 9-month-olds and the 10- to 12-month-olds had rotavirus infections. By contrast, nonrotavirus infections peaked in children aged 4–6 months (72%).

The researchers collected stool samples from children with acute gastroenteritis at five urban and suburban pediatric practices during the winter-to-spring seasons of 2002–2003 and 2003–2004. The study was supported by Merck and Co.

Children with rotavirus infections were significantly more likely than those with nonrotavirus infections to exhibit vomiting (83% vs. 66%), a combination of diarrhea and vomiting (75% vs. 50%), or fever (60% vs. 43%).

Rotavirus had a significant impact on parents, too. Parents or guardians of the children with rotavirus were significantly more likely to miss at least 1 day of work than parents of children with nonrotavirus infections (62% vs. 40%).

The proportion of children who needed additional medical care, including hospitalization, was similar among both rotavirus and nonrotavirus cases.

Extreme Fevers May Merit Antibiotics

Children with very high fevers are at increased risk for both bacterial and viral illness, and clinical features don't reliably distinguish between the two conditions.

Dr. Barbara W. Trautner of Baylor College of Medicine, Houston, and her colleagues identified 103 cases of hyperpyrexia—defined as a rectal temperature of 106 ° F or higher—in a review of 130,828 patient visits (1 case per 1,270 visits).

The researchers found that 20 of these children (19%) had serious bacterial infections and 22 (21.4%) had laboratory-confirmed viral illness (Pediatrics 2006;118;34–40).

About a third of the children (35%) had fevers that lasted longer than 48 hours, and the cause of the fever was unknown in 60 children (58%).

The incidence of serious bacterial infection in children with underlying illnesses was more than double that in children without underlying illness (37% vs. 16%). But no other factors, including age and maximum temperature, were significantly predictive of serious bacterial infection compared with viral infection. Notably, the differences in white blood cell counts were not significant enough to be helpful in distinguishing bacterial vs. viral illness, although the median WBC was insignificantly higher in cases of viral illness.

The increased use of rapid testing continues to raise awareness of bacterial and viral coinfection, but only one child of 103 had a coinfection, which suggests that a positive rapid viral test alone may not be sufficient to rule out treatment with antibiotics.

Bocavirus and Respiratory Illness

Human bocavirus DNA was identified in 82 (5.6%) of 1,474 nasal specimens from children with upper and lower respiratory tract infections collected over a 20-month period in a San Diego children's hospital.

The prevalence of the human bocavirus (HBoV) infections peaked at 14% between March and May in both 2004 and 2005, although the reason for the spring peak was unclear, reported Dr. John C. Arnold of Children's Hospital, San Diego, and his colleagues. The study included children up to age 18 years, but most (63%) were less than 1 year old (Clin. Infect. Dis. 2006;43:283–8).

The researchers reviewed the records of 68 (83%) of the 82 patients with HBoV to discover the clinical characteristics associated with the infection in children. They found underlying illnesses in 21 (31%) children including 11 patients with asthma and 7 patients with neuromuscular disorders.

Cough was the most common symptom, based on data from 54 patients with no obvious coinfections or detectable viral antigens. Cough occurred in 46 (85%) of these children, and 10 (19%) had coughs described as “paroxysmal.” A total of 33 patients (62%) showed clinical signs of lower respiratory tract infections, and bronchiolitis was the most common diagnosis (26%). Difficulty breathing, nasal congestion, fever, and diarrhea were also common in patients with HBoV, and five patients had a rash.

More Miss Day Care With Rotavirus

Rotavirus is a common cause of gastroenteritis that, in a review of 284 cases, was significantly more likely to keep children younger than 3 years of age away from day care, compared with nonrotavirus gastroenteritis.

A total of 115 cases (40%) were confirmed rotavirus infections. Overall, 70% of children with rotavirus gastroenteritis missed at least 1 day of day care, compared with 55% of children with nonrotavirus gastroenteritis, reported Dr. Susan E. Coffin of the University of Pennsylvania, Philadelphia, and her colleagues (Pediatr. Infect. Dis. J. 2006;25:584–9).

Children aged 7–12 months were the hardest hit; 54% of both the 7- to 9-month-olds and the 10- to 12-month-olds had rotavirus infections. By contrast, nonrotavirus infections peaked in children aged 4–6 months (72%).

The researchers collected stool samples from children with acute gastroenteritis at five urban and suburban pediatric practices during the winter-to-spring seasons of 2002–2003 and 2003–2004. The study was supported by Merck and Co.

Children with rotavirus infections were significantly more likely than those with nonrotavirus infections to exhibit vomiting (83% vs. 66%), a combination of diarrhea and vomiting (75% vs. 50%), or fever (60% vs. 43%).

Rotavirus had a significant impact on parents, too. Parents or guardians of the children with rotavirus were significantly more likely to miss at least 1 day of work than parents of children with nonrotavirus infections (62% vs. 40%).

The proportion of children who needed additional medical care, including hospitalization, was similar among both rotavirus and nonrotavirus cases.

Extreme Fevers May Merit Antibiotics

Children with very high fevers are at increased risk for both bacterial and viral illness, and clinical features don't reliably distinguish between the two conditions.

Dr. Barbara W. Trautner of Baylor College of Medicine, Houston, and her colleagues identified 103 cases of hyperpyrexia—defined as a rectal temperature of 106 ° F or higher—in a review of 130,828 patient visits (1 case per 1,270 visits).

The researchers found that 20 of these children (19%) had serious bacterial infections and 22 (21.4%) had laboratory-confirmed viral illness (Pediatrics 2006;118;34–40).

About a third of the children (35%) had fevers that lasted longer than 48 hours, and the cause of the fever was unknown in 60 children (58%).

The incidence of serious bacterial infection in children with underlying illnesses was more than double that in children without underlying illness (37% vs. 16%). But no other factors, including age and maximum temperature, were significantly predictive of serious bacterial infection compared with viral infection. Notably, the differences in white blood cell counts were not significant enough to be helpful in distinguishing bacterial vs. viral illness, although the median WBC was insignificantly higher in cases of viral illness.

The increased use of rapid testing continues to raise awareness of bacterial and viral coinfection, but only one child of 103 had a coinfection, which suggests that a positive rapid viral test alone may not be sufficient to rule out treatment with antibiotics.

Bocavirus and Respiratory Illness

Human bocavirus DNA was identified in 82 (5.6%) of 1,474 nasal specimens from children with upper and lower respiratory tract infections collected over a 20-month period in a San Diego children's hospital.

The prevalence of the human bocavirus (HBoV) infections peaked at 14% between March and May in both 2004 and 2005, although the reason for the spring peak was unclear, reported Dr. John C. Arnold of Children's Hospital, San Diego, and his colleagues. The study included children up to age 18 years, but most (63%) were less than 1 year old (Clin. Infect. Dis. 2006;43:283–8).

The researchers reviewed the records of 68 (83%) of the 82 patients with HBoV to discover the clinical characteristics associated with the infection in children. They found underlying illnesses in 21 (31%) children including 11 patients with asthma and 7 patients with neuromuscular disorders.

Cough was the most common symptom, based on data from 54 patients with no obvious coinfections or detectable viral antigens. Cough occurred in 46 (85%) of these children, and 10 (19%) had coughs described as “paroxysmal.” A total of 33 patients (62%) showed clinical signs of lower respiratory tract infections, and bronchiolitis was the most common diagnosis (26%). Difficulty breathing, nasal congestion, fever, and diarrhea were also common in patients with HBoV, and five patients had a rash.

PTSD Seen in Teens Near Ground Zero

A total of 83 (7.4%) of 1,122 high school students who lived in the borough of the Bronx in New York City at the time of the Sept. 11, 2001, terrorist attacks met the criteria for posttraumatic stress disorder (PTSD) based on questionnaires completed at school 8 months after the attacks.

Michele E. Calderoni, D.O., of Albert Einstein College of Medicine, New York and her colleagues designed the study to assess whether the high incidence of violent crime and poverty in the Bronx caused stress in these students that would make them especially vulnerable to PTSD after a major traumatic event (J. Adolesc. Health 2006;39:57–65).

Students who reported financial difficulties in the wake of the attacks were about five times more likely to have PTSD than were those without financial difficulties, and students who reported psychotropic medication use prior to Sept. 11 were nearly four times as likely to meet criteria for PTSD than were students who did not take medication. Students who reported feeling more vulnerable and less protected by the government were about four times more likely to have PTSD than were students without these characteristics.

Several specific PTSD symptoms–including flashbacks about the event and emotional reactions to reminders of the event–were significantly more common in girls than in boys, but gender and ethnicity were not significant factors in the overall PTSD rates.

The 7.4% rate was significantly higher than the 2% rate of PTSD found in a National Institute of Mental Health-sponsored study of children in four geographic areas other than New York City before Sept. 11, 2001.

Race and Mother/Daughter Sex Talks

Ethnicity was a significant predictor of mothers' discomfort in discussing sex-related topics with their daughters, according to data from surveys of 6,929 adolescent girls and their biological mothers.

Compared with white mothers, Asian mothers were more than five times as likely, Latina mothers more than four times as likely, and black mothers more than twice as likely to report discomfort in discussing sex with their daughters, reported Lisa M. Meneses, M.P.H., of the University of California, Berkeley, and her colleagues (J. Adolesc. Health 2006;39:128–31).

Overall, 57% of the mothers were white, 21% were black, 14% were Latina, 4% were Asian, and 4% were mixed ethnicity or didn't respond to the survey. Data were taken from the National Longitudinal Study of Adolescent Health.

The surveys also measured how often the mothers and daughters talked about sex and whether the mothers had correct information about their daughters' sexual activities. Compared with white mothers, Asian mothers were more than six times as likely and Latina mothers about 1.5 times as likely to report that they talked to their daughters about sex infrequently. Compared with black mothers, both Latina and Asian mothers were less likely to have discussed sex with their daughters but were more likely to be accurate about their daughters' sexual status.

The ethnic differences in maternal discomfort with sex talks, frequency of such talks, and awareness of sexual status persisted after controlling for confounding factors including mothers' and daughters' age, education, and religious beliefs.

Stutterers Struggle With Emotions

Children who stutter are significantly more emotional in stressful situations compared with their non-stuttering peers, a study shows.

To compare the differences in emotional regulation, Jan Karrass, Ph.D., and colleagues at Vanderbilt University in Nashville, Tenn., examined data from parents' reports on the behavior of 65 children who stuttered and 56 age-matched children who did not. The children were aged 3–5 years.

The scores on 31 selected items from a 100-item questionnaire suggested that, in addition to being easily stressed, stutterers were significantly less able to regulate emotions and calm down after being stressed.

They were also significantly less able to disengage themselves from an emotional stimulus and refocus their attention, compared with non-stuttering peers. The results were statistically significant after the investigators controlled for age, gender, language ability, and socioeconomic status (J. Commun. Disord. doi:10.1016/j.jcomdis.2005.12.004).

The interaction between speech errors and emotions may make stuttering worse over time if the child does not outgrow the condition or receives no treatment, Dr. Karrass and colleagues reported.

The study is among the first to identify a link between stuttering and emotional regulation, although previous studies in preschool and school-aged children have suggested that stutterers are less attentive and adaptable than are non-stutterers.

PTSD Seen in Teens Near Ground Zero

A total of 83 (7.4%) of 1,122 high school students who lived in the borough of the Bronx in New York City at the time of the Sept. 11, 2001, terrorist attacks met the criteria for posttraumatic stress disorder (PTSD) based on questionnaires completed at school 8 months after the attacks.

Michele E. Calderoni, D.O., of Albert Einstein College of Medicine, New York and her colleagues designed the study to assess whether the high incidence of violent crime and poverty in the Bronx caused stress in these students that would make them especially vulnerable to PTSD after a major traumatic event (J. Adolesc. Health 2006;39:57–65).

Students who reported financial difficulties in the wake of the attacks were about five times more likely to have PTSD than were those without financial difficulties, and students who reported psychotropic medication use prior to Sept. 11 were nearly four times as likely to meet criteria for PTSD than were students who did not take medication. Students who reported feeling more vulnerable and less protected by the government were about four times more likely to have PTSD than were students without these characteristics.

Several specific PTSD symptoms–including flashbacks about the event and emotional reactions to reminders of the event–were significantly more common in girls than in boys, but gender and ethnicity were not significant factors in the overall PTSD rates.

The 7.4% rate was significantly higher than the 2% rate of PTSD found in a National Institute of Mental Health-sponsored study of children in four geographic areas other than New York City before Sept. 11, 2001.

Race and Mother/Daughter Sex Talks

Ethnicity was a significant predictor of mothers' discomfort in discussing sex-related topics with their daughters, according to data from surveys of 6,929 adolescent girls and their biological mothers.

Compared with white mothers, Asian mothers were more than five times as likely, Latina mothers more than four times as likely, and black mothers more than twice as likely to report discomfort in discussing sex with their daughters, reported Lisa M. Meneses, M.P.H., of the University of California, Berkeley, and her colleagues (J. Adolesc. Health 2006;39:128–31).

Overall, 57% of the mothers were white, 21% were black, 14% were Latina, 4% were Asian, and 4% were mixed ethnicity or didn't respond to the survey. Data were taken from the National Longitudinal Study of Adolescent Health.

The surveys also measured how often the mothers and daughters talked about sex and whether the mothers had correct information about their daughters' sexual activities. Compared with white mothers, Asian mothers were more than six times as likely and Latina mothers about 1.5 times as likely to report that they talked to their daughters about sex infrequently. Compared with black mothers, both Latina and Asian mothers were less likely to have discussed sex with their daughters but were more likely to be accurate about their daughters' sexual status.

The ethnic differences in maternal discomfort with sex talks, frequency of such talks, and awareness of sexual status persisted after controlling for confounding factors including mothers' and daughters' age, education, and religious beliefs.

Stutterers Struggle With Emotions

Children who stutter are significantly more emotional in stressful situations compared with their non-stuttering peers, a study shows.

To compare the differences in emotional regulation, Jan Karrass, Ph.D., and colleagues at Vanderbilt University in Nashville, Tenn., examined data from parents' reports on the behavior of 65 children who stuttered and 56 age-matched children who did not. The children were aged 3–5 years.

The scores on 31 selected items from a 100-item questionnaire suggested that, in addition to being easily stressed, stutterers were significantly less able to regulate emotions and calm down after being stressed.

They were also significantly less able to disengage themselves from an emotional stimulus and refocus their attention, compared with non-stuttering peers. The results were statistically significant after the investigators controlled for age, gender, language ability, and socioeconomic status (J. Commun. Disord. doi:10.1016/j.jcomdis.2005.12.004).

The interaction between speech errors and emotions may make stuttering worse over time if the child does not outgrow the condition or receives no treatment, Dr. Karrass and colleagues reported.

The study is among the first to identify a link between stuttering and emotional regulation, although previous studies in preschool and school-aged children have suggested that stutterers are less attentive and adaptable than are non-stutterers.

PTSD Seen in Teens Near Ground Zero

A total of 83 (7.4%) of 1,122 high school students who lived in the borough of the Bronx in New York City at the time of the Sept. 11, 2001, terrorist attacks met the criteria for posttraumatic stress disorder (PTSD) based on questionnaires completed at school 8 months after the attacks.

Michele E. Calderoni, D.O., of Albert Einstein College of Medicine, New York and her colleagues designed the study to assess whether the high incidence of violent crime and poverty in the Bronx caused stress in these students that would make them especially vulnerable to PTSD after a major traumatic event (J. Adolesc. Health 2006;39:57–65).

Students who reported financial difficulties in the wake of the attacks were about five times more likely to have PTSD than were those without financial difficulties, and students who reported psychotropic medication use prior to Sept. 11 were nearly four times as likely to meet criteria for PTSD than were students who did not take medication. Students who reported feeling more vulnerable and less protected by the government were about four times more likely to have PTSD than were students without these characteristics.

Several specific PTSD symptoms–including flashbacks about the event and emotional reactions to reminders of the event–were significantly more common in girls than in boys, but gender and ethnicity were not significant factors in the overall PTSD rates.

The 7.4% rate was significantly higher than the 2% rate of PTSD found in a National Institute of Mental Health-sponsored study of children in four geographic areas other than New York City before Sept. 11, 2001.

Race and Mother/Daughter Sex Talks

Ethnicity was a significant predictor of mothers' discomfort in discussing sex-related topics with their daughters, according to data from surveys of 6,929 adolescent girls and their biological mothers.

Compared with white mothers, Asian mothers were more than five times as likely, Latina mothers more than four times as likely, and black mothers more than twice as likely to report discomfort in discussing sex with their daughters, reported Lisa M. Meneses, M.P.H., of the University of California, Berkeley, and her colleagues (J. Adolesc. Health 2006;39:128–31).

Overall, 57% of the mothers were white, 21% were black, 14% were Latina, 4% were Asian, and 4% were mixed ethnicity or didn't respond to the survey. Data were taken from the National Longitudinal Study of Adolescent Health.

The surveys also measured how often the mothers and daughters talked about sex and whether the mothers had correct information about their daughters' sexual activities. Compared with white mothers, Asian mothers were more than six times as likely and Latina mothers about 1.5 times as likely to report that they talked to their daughters about sex infrequently. Compared with black mothers, both Latina and Asian mothers were less likely to have discussed sex with their daughters but were more likely to be accurate about their daughters' sexual status.

The ethnic differences in maternal discomfort with sex talks, frequency of such talks, and awareness of sexual status persisted after controlling for confounding factors including mothers' and daughters' age, education, and religious beliefs.

Stutterers Struggle With Emotions

Children who stutter are significantly more emotional in stressful situations compared with their non-stuttering peers, a study shows.

To compare the differences in emotional regulation, Jan Karrass, Ph.D., and colleagues at Vanderbilt University in Nashville, Tenn., examined data from parents' reports on the behavior of 65 children who stuttered and 56 age-matched children who did not. The children were aged 3–5 years.

The scores on 31 selected items from a 100-item questionnaire suggested that, in addition to being easily stressed, stutterers were significantly less able to regulate emotions and calm down after being stressed.

They were also significantly less able to disengage themselves from an emotional stimulus and refocus their attention, compared with non-stuttering peers. The results were statistically significant after the investigators controlled for age, gender, language ability, and socioeconomic status (J. Commun. Disord. doi:10.1016/j.jcomdis.2005.12.004).

The interaction between speech errors and emotions may make stuttering worse over time if the child does not outgrow the condition or receives no treatment, Dr. Karrass and colleagues reported.

The study is among the first to identify a link between stuttering and emotional regulation, although previous studies in preschool and school-aged children have suggested that stutterers are less attentive and adaptable than are non-stutterers.

CHICAGO – Adenotonsillectomy improved both sleep and behavior in a pair of studies presented at the Combined Otolaryngology Spring Meetings.

Children with either obstructive sleep apnea syndrome (OSAS) or mild sleep disordered breathing (SDB) demonstrated significantly improved scores on behavior measurements after adenotonsillectomy, compared with presurgery scores, which suggests that symptom severity does not affect improvement, said Dr. Ron B. Mitchell, a pediatric laryngologist at Virginia Commonwealth University in Richmond.

Of 40 children aged 3–18 years, 23 had OSAS and 17 had SDB; demographics were similar between the two groups. The mean apnea-hypopnea index prior to surgery was 25 among the children with OSAS and 3 among those with SDB.

At a follow-up evaluation an average of 3 months after an adenotonsillectomy, children in both the OSAS and SDB groups showed significant improvements, compared with presurgery scores on the Behavior Symptom Index, a global measure of behavior. Differences in postsurgery scores between the two groups were not significant, however.

In addition, scores on the Behavior Assessment System for Children subscales of depression, hyperactivity, atypicality, and somatization were significantly improved after surgery, compared with presurgery scores for children in both groups, and the scores did not differ significantly between the groups.

All children had been measured with polysomnography and had undergone comprehensive behavior assessments prior to surgery. Children with comorbidities were excluded. The study was limited by the absence of a control group, the short follow-up period, and the selection bias inherent in the use of a population at a specialized clinic for sleep problems.

“Without a control group, all we can say is that adenotonsillectomy and improved behavior were associated, not necessarily correlated,” said Dr. Mitchell.

However, the study suggests that SDB is associated with a significant amount of behavioral morbidity regardless of the severity of the condition, and that these problems improve after adenotonsillectomy regardless of whether the child has only mild SDB or OSAS, he said.

In a second study of children with SDB, the 71 for whom follow-up data were available showed significant improvement in both sleep and behavior based on the pediatric sleep questionnaire (PSQ) and the Conners' Parent Rating Scale-Revised (CPRS-RS).

In addition, Dr. Julie Wei and her colleagues at the University of Kansas in Kansas City examined whether children whose scores were worse prior to surgery show greater benefit after surgery.

“We wanted to explore whether the improvements were a function of the baseline scores,” said Dr. Wei.

The prospective study included children aged 3–17 years, with a mean age of 6.5 years, who were evaluated using the PSQ and CPRS-RS.

Six months after the surgery, the average scores on the questionnaires improved significantly, compared with scores prior to surgery, especially among the children with the worst scores. “There was almost a 20-point reduction among the children who were worse to begin with,” Dr. Wei said.

The CPRS-RS evaluated the children's behavior in four categories: opposition, cognitive/inattention, hyperactivity, and the Conners' ADHD index. A score of 60 in any category would place a child at risk for problems in that category, Dr. Wei said. Before surgery, the mean scores in these categories were 59.4, 59.5, 62, and 59.9, respectively; after surgery, the mean scores were 51, 51.2, 52.4, and 50.6, respectively.

The children were clinically evaluated for SDB based on the 22-item pediatric sleep subscale of the 74-item PSQ, rather than polysomnography. The subscale has been shown to accurately predict SDB.

Although polysomnography is the approved measure of SDB, it is not available in all areas, and is used rarely. “Less than 5% of children have polysomnography prior to surgery,” Dr. Wei said.

The PSQ questionnaire can be a useful screening tool to determine candidacy for surgery as an adjunct to a history and physical exam, especially in areas where polysomnography is not available, Dr. Wei said.

The results of this study suggest that treatment of children who are diagnosed clinically using the pediatric sleep subscale show improved behavior and sleep even if their diagnosis is not confirmed by polysomnography, she said. The study was limited by the lack of a control group, the lack of data on behavior at school, and the use of a convenient sample of children with sleep problems. The evidence supported findings from previous research, including a study in which children with ADHD who underwent adenotonsillectomies no longer met ADHD criteria 1 year later (Pediatrics 2006;117:e769–e778).

CHICAGO – Adenotonsillectomy improved both sleep and behavior in a pair of studies presented at the Combined Otolaryngology Spring Meetings.

Children with either obstructive sleep apnea syndrome (OSAS) or mild sleep disordered breathing (SDB) demonstrated significantly improved scores on behavior measurements after adenotonsillectomy, compared with presurgery scores, which suggests that symptom severity does not affect improvement, said Dr. Ron B. Mitchell, a pediatric laryngologist at Virginia Commonwealth University in Richmond.

Of 40 children aged 3–18 years, 23 had OSAS and 17 had SDB; demographics were similar between the two groups. The mean apnea-hypopnea index prior to surgery was 25 among the children with OSAS and 3 among those with SDB.

At a follow-up evaluation an average of 3 months after an adenotonsillectomy, children in both the OSAS and SDB groups showed significant improvements, compared with presurgery scores on the Behavior Symptom Index, a global measure of behavior. Differences in postsurgery scores between the two groups were not significant, however.

In addition, scores on the Behavior Assessment System for Children subscales of depression, hyperactivity, atypicality, and somatization were significantly improved after surgery, compared with presurgery scores for children in both groups, and the scores did not differ significantly between the groups.

All children had been measured with polysomnography and had undergone comprehensive behavior assessments prior to surgery. Children with comorbidities were excluded. The study was limited by the absence of a control group, the short follow-up period, and the selection bias inherent in the use of a population at a specialized clinic for sleep problems.

“Without a control group, all we can say is that adenotonsillectomy and improved behavior were associated, not necessarily correlated,” said Dr. Mitchell.

However, the study suggests that SDB is associated with a significant amount of behavioral morbidity regardless of the severity of the condition, and that these problems improve after adenotonsillectomy regardless of whether the child has only mild SDB or OSAS, he said.

In a second study of children with SDB, the 71 for whom follow-up data were available showed significant improvement in both sleep and behavior based on the pediatric sleep questionnaire (PSQ) and the Conners' Parent Rating Scale-Revised (CPRS-RS).

In addition, Dr. Julie Wei and her colleagues at the University of Kansas in Kansas City examined whether children whose scores were worse prior to surgery show greater benefit after surgery.

“We wanted to explore whether the improvements were a function of the baseline scores,” said Dr. Wei.

The prospective study included children aged 3–17 years, with a mean age of 6.5 years, who were evaluated using the PSQ and CPRS-RS.

Six months after the surgery, the average scores on the questionnaires improved significantly, compared with scores prior to surgery, especially among the children with the worst scores. “There was almost a 20-point reduction among the children who were worse to begin with,” Dr. Wei said.

The CPRS-RS evaluated the children's behavior in four categories: opposition, cognitive/inattention, hyperactivity, and the Conners' ADHD index. A score of 60 in any category would place a child at risk for problems in that category, Dr. Wei said. Before surgery, the mean scores in these categories were 59.4, 59.5, 62, and 59.9, respectively; after surgery, the mean scores were 51, 51.2, 52.4, and 50.6, respectively.

The children were clinically evaluated for SDB based on the 22-item pediatric sleep subscale of the 74-item PSQ, rather than polysomnography. The subscale has been shown to accurately predict SDB.

Although polysomnography is the approved measure of SDB, it is not available in all areas, and is used rarely. “Less than 5% of children have polysomnography prior to surgery,” Dr. Wei said.

The PSQ questionnaire can be a useful screening tool to determine candidacy for surgery as an adjunct to a history and physical exam, especially in areas where polysomnography is not available, Dr. Wei said.

The results of this study suggest that treatment of children who are diagnosed clinically using the pediatric sleep subscale show improved behavior and sleep even if their diagnosis is not confirmed by polysomnography, she said. The study was limited by the lack of a control group, the lack of data on behavior at school, and the use of a convenient sample of children with sleep problems. The evidence supported findings from previous research, including a study in which children with ADHD who underwent adenotonsillectomies no longer met ADHD criteria 1 year later (Pediatrics 2006;117:e769–e778).

CHICAGO – Adenotonsillectomy improved both sleep and behavior in a pair of studies presented at the Combined Otolaryngology Spring Meetings.

Children with either obstructive sleep apnea syndrome (OSAS) or mild sleep disordered breathing (SDB) demonstrated significantly improved scores on behavior measurements after adenotonsillectomy, compared with presurgery scores, which suggests that symptom severity does not affect improvement, said Dr. Ron B. Mitchell, a pediatric laryngologist at Virginia Commonwealth University in Richmond.

Of 40 children aged 3–18 years, 23 had OSAS and 17 had SDB; demographics were similar between the two groups. The mean apnea-hypopnea index prior to surgery was 25 among the children with OSAS and 3 among those with SDB.

At a follow-up evaluation an average of 3 months after an adenotonsillectomy, children in both the OSAS and SDB groups showed significant improvements, compared with presurgery scores on the Behavior Symptom Index, a global measure of behavior. Differences in postsurgery scores between the two groups were not significant, however.

In addition, scores on the Behavior Assessment System for Children subscales of depression, hyperactivity, atypicality, and somatization were significantly improved after surgery, compared with presurgery scores for children in both groups, and the scores did not differ significantly between the groups.

All children had been measured with polysomnography and had undergone comprehensive behavior assessments prior to surgery. Children with comorbidities were excluded. The study was limited by the absence of a control group, the short follow-up period, and the selection bias inherent in the use of a population at a specialized clinic for sleep problems.

“Without a control group, all we can say is that adenotonsillectomy and improved behavior were associated, not necessarily correlated,” said Dr. Mitchell.

However, the study suggests that SDB is associated with a significant amount of behavioral morbidity regardless of the severity of the condition, and that these problems improve after adenotonsillectomy regardless of whether the child has only mild SDB or OSAS, he said.

In a second study of children with SDB, the 71 for whom follow-up data were available showed significant improvement in both sleep and behavior based on the pediatric sleep questionnaire (PSQ) and the Conners' Parent Rating Scale-Revised (CPRS-RS).

In addition, Dr. Julie Wei and her colleagues at the University of Kansas in Kansas City examined whether children whose scores were worse prior to surgery show greater benefit after surgery.

“We wanted to explore whether the improvements were a function of the baseline scores,” said Dr. Wei.

The prospective study included children aged 3–17 years, with a mean age of 6.5 years, who were evaluated using the PSQ and CPRS-RS.

Six months after the surgery, the average scores on the questionnaires improved significantly, compared with scores prior to surgery, especially among the children with the worst scores. “There was almost a 20-point reduction among the children who were worse to begin with,” Dr. Wei said.

The CPRS-RS evaluated the children's behavior in four categories: opposition, cognitive/inattention, hyperactivity, and the Conners' ADHD index. A score of 60 in any category would place a child at risk for problems in that category, Dr. Wei said. Before surgery, the mean scores in these categories were 59.4, 59.5, 62, and 59.9, respectively; after surgery, the mean scores were 51, 51.2, 52.4, and 50.6, respectively.

The children were clinically evaluated for SDB based on the 22-item pediatric sleep subscale of the 74-item PSQ, rather than polysomnography. The subscale has been shown to accurately predict SDB.

Although polysomnography is the approved measure of SDB, it is not available in all areas, and is used rarely. “Less than 5% of children have polysomnography prior to surgery,” Dr. Wei said.

The PSQ questionnaire can be a useful screening tool to determine candidacy for surgery as an adjunct to a history and physical exam, especially in areas where polysomnography is not available, Dr. Wei said.

The results of this study suggest that treatment of children who are diagnosed clinically using the pediatric sleep subscale show improved behavior and sleep even if their diagnosis is not confirmed by polysomnography, she said. The study was limited by the lack of a control group, the lack of data on behavior at school, and the use of a convenient sample of children with sleep problems. The evidence supported findings from previous research, including a study in which children with ADHD who underwent adenotonsillectomies no longer met ADHD criteria 1 year later (Pediatrics 2006;117:e769–e778).

WASHINGTON — Women who get plenty of vitamin D, especially early in life, are less likely to develop breast cancer than women who get smaller amounts of the vitamin, according to data from two studies presented at the annual meeting of the American Association for Cancer Research.

Julia Knight, Ph.D., of Mount Sinai Hospital in Toronto, and her colleagues conducted a case-control, population-based study of women aged 20–59 years from a Canadian cancer registry and the surrounding community. They identified 971 cases of breast cancer and 1,135 controls and asked the women about lifetime sun exposure and dietary vitamin D.

Logistic regression analyses adjusted for variables including age, ethnicity, age at menarche, age at first pregnancy, duration of breast-feeding, and family history of breast cancer.

Overall, participating in any outdoor work at any point in life resulted in about a 40% reduction in breast cancer risk (odds ratio 0.60). Participation in at least six types of outdoor activities at ages 10–19 years and at least five types of outdoor activities at ages 20–29 years reduced the risk by about 35%. Outdoor activities did not have to involve physical activity, Dr. Knight noted. However, the risk reduction was not as robust in women who reported that they had kept their arms and legs covered outside.

In addition, drinking at least nine glasses of milk per week at ages 20–29 years was significantly associated with reductions in breast cancer risk, as was the regular consumption of cod liver oil for at least 10 years.

“In general, most women drank more milk when they were younger,” Dr. Knight said. Vitamin D exposure during breast development or prior to pregnancy may be particularly important in preventing breast cancer later on, she added.

The evidence for the protective role of vitamin D appeared to weaken with age. By ages 45–54 years, there was some evidence of reduced risk associated with outdoor activity, but it was no longer significant, although the risk was no longer affected by whether the arms and legs were covered.

When asked about the role of vitamin D supplements, Dr. Knight admitted that supplements of any sort complicate the picture. “The problem with supplements is that there tends to be a reduced risk in anyone who takes any kind of vitamin supplements, whether they include vitamin D or not,” she said. People who take supplements tend to have other characteristics of a healthy lifestyle, she said.

“We did ask about sunscreen. We are still analyzing that because it is complicated, since sunblock use has only become common in the last 20 years,” she said.

Increasing the levels of serum vitamin D in the body, regardless of age, may reduce the risk of breast cancer, according to a second study presented at the meeting by Cedric F. Garland, Dr.P.H., of the University of California, San Diego.

Dr. Garland and his associates reviewed data on a total of 1,760 women in two studies. In the first, a serum 25-hydroxyvitamin D (25[OH]D) level of 35 ng/mL was associated with a 20% drop in breast cancer risk (Cancer Epidemiol. Biomarkers Prev. 2005;14:1991–7).

A second study of 179 women with breast cancer and 179 controls showed that as vitamin D levels in the blood increased, the risk of breast cancer decreased. Women with 25-(OH)D levels less than 50 ng/mL were six times more likely to develop breast cancer than those with levels greater than 50 ng/mL (Eur. J. Cancer 2005;41:1164–9).

Dr. Garland chose these two studies because 25 (OH) D has been shown to vary with geography. Death rates from breast cancer could be as much as three times higher in the Northeast, compared with the Southwest, because of reduced vitamin D intake from sunlight, he noted.

Based on these studies, “if we can get women up to 20–22 ng/mL of serum vitamin D, we could expect a 20% reduction in breast cancer risk. We think this is a good aim,” Dr. Garland said. Levels closer to 52 ng/mL—which are common among some women in sunny areas such as California—would be even better, he noted. Some women in the Northeast have vitamin D levels of about 15 ng/mL, and some women have levels so low that they are barely detectable, he added.

A vitamin D intake of 2,000 IU/day has been associated with vitamin D levels of 32 ng/mL. That intake is well above the average consumption of most American women, but below the upper limit of 2,400 IU that is currently recommended by the National Academy of Sciences. But even 1,000 IU/day may produce a vitamin D level of about 22 ng/mL.

“Levels above 2,400 IU are terra incognita,” Dr. Garland said. The lowest level of vitamin D associated with toxicity is 3,800 IU, according to the National Academy of Sciences. Some scientists have proposed daily intakes of 4,000 IU. In any case, supplements and vitamin-fortified foods, such as cereals and grains, will be necessary for most people to maintain optimal levels of vitamin D, he noted.

WASHINGTON — Women who get plenty of vitamin D, especially early in life, are less likely to develop breast cancer than women who get smaller amounts of the vitamin, according to data from two studies presented at the annual meeting of the American Association for Cancer Research.

Julia Knight, Ph.D., of Mount Sinai Hospital in Toronto, and her colleagues conducted a case-control, population-based study of women aged 20–59 years from a Canadian cancer registry and the surrounding community. They identified 971 cases of breast cancer and 1,135 controls and asked the women about lifetime sun exposure and dietary vitamin D.

Logistic regression analyses adjusted for variables including age, ethnicity, age at menarche, age at first pregnancy, duration of breast-feeding, and family history of breast cancer.

Overall, participating in any outdoor work at any point in life resulted in about a 40% reduction in breast cancer risk (odds ratio 0.60). Participation in at least six types of outdoor activities at ages 10–19 years and at least five types of outdoor activities at ages 20–29 years reduced the risk by about 35%. Outdoor activities did not have to involve physical activity, Dr. Knight noted. However, the risk reduction was not as robust in women who reported that they had kept their arms and legs covered outside.

In addition, drinking at least nine glasses of milk per week at ages 20–29 years was significantly associated with reductions in breast cancer risk, as was the regular consumption of cod liver oil for at least 10 years.

“In general, most women drank more milk when they were younger,” Dr. Knight said. Vitamin D exposure during breast development or prior to pregnancy may be particularly important in preventing breast cancer later on, she added.

The evidence for the protective role of vitamin D appeared to weaken with age. By ages 45–54 years, there was some evidence of reduced risk associated with outdoor activity, but it was no longer significant, although the risk was no longer affected by whether the arms and legs were covered.

When asked about the role of vitamin D supplements, Dr. Knight admitted that supplements of any sort complicate the picture. “The problem with supplements is that there tends to be a reduced risk in anyone who takes any kind of vitamin supplements, whether they include vitamin D or not,” she said. People who take supplements tend to have other characteristics of a healthy lifestyle, she said.

“We did ask about sunscreen. We are still analyzing that because it is complicated, since sunblock use has only become common in the last 20 years,” she said.

Increasing the levels of serum vitamin D in the body, regardless of age, may reduce the risk of breast cancer, according to a second study presented at the meeting by Cedric F. Garland, Dr.P.H., of the University of California, San Diego.

Dr. Garland and his associates reviewed data on a total of 1,760 women in two studies. In the first, a serum 25-hydroxyvitamin D (25[OH]D) level of 35 ng/mL was associated with a 20% drop in breast cancer risk (Cancer Epidemiol. Biomarkers Prev. 2005;14:1991–7).

A second study of 179 women with breast cancer and 179 controls showed that as vitamin D levels in the blood increased, the risk of breast cancer decreased. Women with 25-(OH)D levels less than 50 ng/mL were six times more likely to develop breast cancer than those with levels greater than 50 ng/mL (Eur. J. Cancer 2005;41:1164–9).

Dr. Garland chose these two studies because 25 (OH) D has been shown to vary with geography. Death rates from breast cancer could be as much as three times higher in the Northeast, compared with the Southwest, because of reduced vitamin D intake from sunlight, he noted.

Based on these studies, “if we can get women up to 20–22 ng/mL of serum vitamin D, we could expect a 20% reduction in breast cancer risk. We think this is a good aim,” Dr. Garland said. Levels closer to 52 ng/mL—which are common among some women in sunny areas such as California—would be even better, he noted. Some women in the Northeast have vitamin D levels of about 15 ng/mL, and some women have levels so low that they are barely detectable, he added.

A vitamin D intake of 2,000 IU/day has been associated with vitamin D levels of 32 ng/mL. That intake is well above the average consumption of most American women, but below the upper limit of 2,400 IU that is currently recommended by the National Academy of Sciences. But even 1,000 IU/day may produce a vitamin D level of about 22 ng/mL.

“Levels above 2,400 IU are terra incognita,” Dr. Garland said. The lowest level of vitamin D associated with toxicity is 3,800 IU, according to the National Academy of Sciences. Some scientists have proposed daily intakes of 4,000 IU. In any case, supplements and vitamin-fortified foods, such as cereals and grains, will be necessary for most people to maintain optimal levels of vitamin D, he noted.

WASHINGTON — Women who get plenty of vitamin D, especially early in life, are less likely to develop breast cancer than women who get smaller amounts of the vitamin, according to data from two studies presented at the annual meeting of the American Association for Cancer Research.

Julia Knight, Ph.D., of Mount Sinai Hospital in Toronto, and her colleagues conducted a case-control, population-based study of women aged 20–59 years from a Canadian cancer registry and the surrounding community. They identified 971 cases of breast cancer and 1,135 controls and asked the women about lifetime sun exposure and dietary vitamin D.

Logistic regression analyses adjusted for variables including age, ethnicity, age at menarche, age at first pregnancy, duration of breast-feeding, and family history of breast cancer.

Overall, participating in any outdoor work at any point in life resulted in about a 40% reduction in breast cancer risk (odds ratio 0.60). Participation in at least six types of outdoor activities at ages 10–19 years and at least five types of outdoor activities at ages 20–29 years reduced the risk by about 35%. Outdoor activities did not have to involve physical activity, Dr. Knight noted. However, the risk reduction was not as robust in women who reported that they had kept their arms and legs covered outside.

In addition, drinking at least nine glasses of milk per week at ages 20–29 years was significantly associated with reductions in breast cancer risk, as was the regular consumption of cod liver oil for at least 10 years.

“In general, most women drank more milk when they were younger,” Dr. Knight said. Vitamin D exposure during breast development or prior to pregnancy may be particularly important in preventing breast cancer later on, she added.

The evidence for the protective role of vitamin D appeared to weaken with age. By ages 45–54 years, there was some evidence of reduced risk associated with outdoor activity, but it was no longer significant, although the risk was no longer affected by whether the arms and legs were covered.

When asked about the role of vitamin D supplements, Dr. Knight admitted that supplements of any sort complicate the picture. “The problem with supplements is that there tends to be a reduced risk in anyone who takes any kind of vitamin supplements, whether they include vitamin D or not,” she said. People who take supplements tend to have other characteristics of a healthy lifestyle, she said.

“We did ask about sunscreen. We are still analyzing that because it is complicated, since sunblock use has only become common in the last 20 years,” she said.

Increasing the levels of serum vitamin D in the body, regardless of age, may reduce the risk of breast cancer, according to a second study presented at the meeting by Cedric F. Garland, Dr.P.H., of the University of California, San Diego.

Dr. Garland and his associates reviewed data on a total of 1,760 women in two studies. In the first, a serum 25-hydroxyvitamin D (25[OH]D) level of 35 ng/mL was associated with a 20% drop in breast cancer risk (Cancer Epidemiol. Biomarkers Prev. 2005;14:1991–7).

A second study of 179 women with breast cancer and 179 controls showed that as vitamin D levels in the blood increased, the risk of breast cancer decreased. Women with 25-(OH)D levels less than 50 ng/mL were six times more likely to develop breast cancer than those with levels greater than 50 ng/mL (Eur. J. Cancer 2005;41:1164–9).

Dr. Garland chose these two studies because 25 (OH) D has been shown to vary with geography. Death rates from breast cancer could be as much as three times higher in the Northeast, compared with the Southwest, because of reduced vitamin D intake from sunlight, he noted.

Based on these studies, “if we can get women up to 20–22 ng/mL of serum vitamin D, we could expect a 20% reduction in breast cancer risk. We think this is a good aim,” Dr. Garland said. Levels closer to 52 ng/mL—which are common among some women in sunny areas such as California—would be even better, he noted. Some women in the Northeast have vitamin D levels of about 15 ng/mL, and some women have levels so low that they are barely detectable, he added.

A vitamin D intake of 2,000 IU/day has been associated with vitamin D levels of 32 ng/mL. That intake is well above the average consumption of most American women, but below the upper limit of 2,400 IU that is currently recommended by the National Academy of Sciences. But even 1,000 IU/day may produce a vitamin D level of about 22 ng/mL.

“Levels above 2,400 IU are terra incognita,” Dr. Garland said. The lowest level of vitamin D associated with toxicity is 3,800 IU, according to the National Academy of Sciences. Some scientists have proposed daily intakes of 4,000 IU. In any case, supplements and vitamin-fortified foods, such as cereals and grains, will be necessary for most people to maintain optimal levels of vitamin D, he noted.

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved.

The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high.

For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved.

The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high.

For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved.

The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high.

For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. The manufacturer projects that 6 million doses will be available for 2006–2007, but the amount currently available for the summer months of 2006 is about the same as last year, and Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer.

To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. The manufacturer projects that 6 million doses will be available for 2006–2007, but the amount currently available for the summer months of 2006 is about the same as last year, and Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer.

To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. The manufacturer projects that 6 million doses will be available for 2006–2007, but the amount currently available for the summer months of 2006 is about the same as last year, and Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer.

To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Postmenopausal women who consumed higher amounts of the types of flavonoids found in tea and strawberries showed a decreased risk of breast cancer, according to data presented at the annual meeting of the American Association for Cancer Research.

Breast cancer risk was significantly reduced among postmenopausal women in the highest quintile of dietary flavonol intake compared with the lowest quintile, reported Brian Fink of the University of North Carolina, Chapel Hill, who analyzed data on 1,508 women who had breast cancer and 1,556 controls in the Long Island Women's Health Study. However, no reductions in breast cancer risk were observed among premenopausal women, he noted.

The population-based study included women aged 20–98 years in Nassau and Suffolk counties on Long Island in New York, and was conducted between Aug. 1, 1996, and July 31, 1997. The women answered questions about their reproductive histories, environment, occupations, and lifestyles, including dietary intake, during the past year.

When the flavonoids were broken down into specific types, the significant reduction in breast cancer risk applied to flavones, flavan-3-ols, and lignans only; it did not apply to flavanones, isoflavones, or anthocyanadins. Tea provided the main source of beneficial flavonoids in the women's diets, but strawberries and apples were among the other often-consumed sources.

In another study presented at the meeting, women who consumed kaempferol, a flavonoid found in tea, broccoli, and kale, had a reduced risk for ovarian cancer, said Margaret Gates, a doctoral candidate at Harvard University.

Ms. Gates and her colleagues reviewed data on 66,384 women from the Nurses' Health Study who completed baseline food frequency questionnaires in 1984, and again in 1990, 1994, and 1998. The study group included 344 cases of ovarian cancer diagnosed between 1984 and 2002.

Although overall flavonoid intake was not significantly associated with a reduction in risk for ovarian cancer, consumption of kaempferol was associated with a significant (38%) reduction in risk, Ms. Gates said.

Possible inverse associations with ovarian cancer risk were observed for two other flavonoids, myricetin and quercetin, but the results for these flavonoids were not conclusive.

No other known prospective analyses of the protective effects of flavonoids against ovarian cancer have been published, but if additional studies confirm these findings, dietary flavonoids could provide a target for disease prevention, Ms. Gates noted.

WASHINGTON — Postmenopausal women who consumed higher amounts of the types of flavonoids found in tea and strawberries showed a decreased risk of breast cancer, according to data presented at the annual meeting of the American Association for Cancer Research.

Breast cancer risk was significantly reduced among postmenopausal women in the highest quintile of dietary flavonol intake compared with the lowest quintile, reported Brian Fink of the University of North Carolina, Chapel Hill, who analyzed data on 1,508 women who had breast cancer and 1,556 controls in the Long Island Women's Health Study. However, no reductions in breast cancer risk were observed among premenopausal women, he noted.

The population-based study included women aged 20–98 years in Nassau and Suffolk counties on Long Island in New York, and was conducted between Aug. 1, 1996, and July 31, 1997. The women answered questions about their reproductive histories, environment, occupations, and lifestyles, including dietary intake, during the past year.

When the flavonoids were broken down into specific types, the significant reduction in breast cancer risk applied to flavones, flavan-3-ols, and lignans only; it did not apply to flavanones, isoflavones, or anthocyanadins. Tea provided the main source of beneficial flavonoids in the women's diets, but strawberries and apples were among the other often-consumed sources.

In another study presented at the meeting, women who consumed kaempferol, a flavonoid found in tea, broccoli, and kale, had a reduced risk for ovarian cancer, said Margaret Gates, a doctoral candidate at Harvard University.

Ms. Gates and her colleagues reviewed data on 66,384 women from the Nurses' Health Study who completed baseline food frequency questionnaires in 1984, and again in 1990, 1994, and 1998. The study group included 344 cases of ovarian cancer diagnosed between 1984 and 2002.

Although overall flavonoid intake was not significantly associated with a reduction in risk for ovarian cancer, consumption of kaempferol was associated with a significant (38%) reduction in risk, Ms. Gates said.

Possible inverse associations with ovarian cancer risk were observed for two other flavonoids, myricetin and quercetin, but the results for these flavonoids were not conclusive.

No other known prospective analyses of the protective effects of flavonoids against ovarian cancer have been published, but if additional studies confirm these findings, dietary flavonoids could provide a target for disease prevention, Ms. Gates noted.

WASHINGTON — Postmenopausal women who consumed higher amounts of the types of flavonoids found in tea and strawberries showed a decreased risk of breast cancer, according to data presented at the annual meeting of the American Association for Cancer Research.

Breast cancer risk was significantly reduced among postmenopausal women in the highest quintile of dietary flavonol intake compared with the lowest quintile, reported Brian Fink of the University of North Carolina, Chapel Hill, who analyzed data on 1,508 women who had breast cancer and 1,556 controls in the Long Island Women's Health Study. However, no reductions in breast cancer risk were observed among premenopausal women, he noted.

The population-based study included women aged 20–98 years in Nassau and Suffolk counties on Long Island in New York, and was conducted between Aug. 1, 1996, and July 31, 1997. The women answered questions about their reproductive histories, environment, occupations, and lifestyles, including dietary intake, during the past year.

When the flavonoids were broken down into specific types, the significant reduction in breast cancer risk applied to flavones, flavan-3-ols, and lignans only; it did not apply to flavanones, isoflavones, or anthocyanadins. Tea provided the main source of beneficial flavonoids in the women's diets, but strawberries and apples were among the other often-consumed sources.

In another study presented at the meeting, women who consumed kaempferol, a flavonoid found in tea, broccoli, and kale, had a reduced risk for ovarian cancer, said Margaret Gates, a doctoral candidate at Harvard University.

Ms. Gates and her colleagues reviewed data on 66,384 women from the Nurses' Health Study who completed baseline food frequency questionnaires in 1984, and again in 1990, 1994, and 1998. The study group included 344 cases of ovarian cancer diagnosed between 1984 and 2002.

Although overall flavonoid intake was not significantly associated with a reduction in risk for ovarian cancer, consumption of kaempferol was associated with a significant (38%) reduction in risk, Ms. Gates said.

Possible inverse associations with ovarian cancer risk were observed for two other flavonoids, myricetin and quercetin, but the results for these flavonoids were not conclusive.

No other known prospective analyses of the protective effects of flavonoids against ovarian cancer have been published, but if additional studies confirm these findings, dietary flavonoids could provide a target for disease prevention, Ms. Gates noted.

ATLANTA — Child care providers surveyed in 2004 were significantly less likely to exclude a sick child who had not received antibiotics, compared with child care providers surveyed in 2001, Shelly Feaver reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Of 1,409 Minnesota child care center teachers surveyed in 2004 and 421 surveyed in 2001, the 2004 teachers were significantly less likely to exclude a child with a fever, a runny nose without mucus, or a chest cold who had not received antibiotics. In addition, the teachers surveyed in 2004 were significantly more likely than those surveyed in 2001 to believe that physicians should not prescribe antibiotics for children with fevers, middle ear infections, runny noses with green or yellow mucus, conjunctivitis with pus, and conjunctivitis with watery discharge.

Ms. Feaver and her colleagues at the Minnesota Department of Health in St. Paul developed an educational intervention program based on the results of the 2001 surveys. The program included a child care provider curriculum with education slides, and viral excuse pads. The Minnesota Department of Human Services Child Care Licensing Division approved the curriculum for continuing education credit for licensed child care providers prior to the second survey in 2004, but there were no significant differences in the 2004 survey responses between teachers who reported completing the curriculum and those who had not completed the curriculum.

In addition, messages about judicious antibiotic use were distributed to child care health consultants and were posted on the Web site of the Minnesota Antibiotic Research Collaborative during the study period.

ATLANTA — Child care providers surveyed in 2004 were significantly less likely to exclude a sick child who had not received antibiotics, compared with child care providers surveyed in 2001, Shelly Feaver reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Of 1,409 Minnesota child care center teachers surveyed in 2004 and 421 surveyed in 2001, the 2004 teachers were significantly less likely to exclude a child with a fever, a runny nose without mucus, or a chest cold who had not received antibiotics. In addition, the teachers surveyed in 2004 were significantly more likely than those surveyed in 2001 to believe that physicians should not prescribe antibiotics for children with fevers, middle ear infections, runny noses with green or yellow mucus, conjunctivitis with pus, and conjunctivitis with watery discharge.

Ms. Feaver and her colleagues at the Minnesota Department of Health in St. Paul developed an educational intervention program based on the results of the 2001 surveys. The program included a child care provider curriculum with education slides, and viral excuse pads. The Minnesota Department of Human Services Child Care Licensing Division approved the curriculum for continuing education credit for licensed child care providers prior to the second survey in 2004, but there were no significant differences in the 2004 survey responses between teachers who reported completing the curriculum and those who had not completed the curriculum.

In addition, messages about judicious antibiotic use were distributed to child care health consultants and were posted on the Web site of the Minnesota Antibiotic Research Collaborative during the study period.

ATLANTA — Child care providers surveyed in 2004 were significantly less likely to exclude a sick child who had not received antibiotics, compared with child care providers surveyed in 2001, Shelly Feaver reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Of 1,409 Minnesota child care center teachers surveyed in 2004 and 421 surveyed in 2001, the 2004 teachers were significantly less likely to exclude a child with a fever, a runny nose without mucus, or a chest cold who had not received antibiotics. In addition, the teachers surveyed in 2004 were significantly more likely than those surveyed in 2001 to believe that physicians should not prescribe antibiotics for children with fevers, middle ear infections, runny noses with green or yellow mucus, conjunctivitis with pus, and conjunctivitis with watery discharge.

Ms. Feaver and her colleagues at the Minnesota Department of Health in St. Paul developed an educational intervention program based on the results of the 2001 surveys. The program included a child care provider curriculum with education slides, and viral excuse pads. The Minnesota Department of Human Services Child Care Licensing Division approved the curriculum for continuing education credit for licensed child care providers prior to the second survey in 2004, but there were no significant differences in the 2004 survey responses between teachers who reported completing the curriculum and those who had not completed the curriculum.

In addition, messages about judicious antibiotic use were distributed to child care health consultants and were posted on the Web site of the Minnesota Antibiotic Research Collaborative during the study period.