Heidi Splete

WASHINGTON — Data from 597 cesarean sections suggest that smoking may slow wound healing, Dr. Cecilia Avila reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Both smoking and chorioamnionitis were significantly associated with wound complications in 20 cases of infection and 10 cases of hematoma that were identified in a case-control review of patients who had cesarean sections during a 7-year period.

Overall, wound complications were about three times more likely in smokers, wrote Dr. Avila of Stony Brook (N.Y.) University Hospital.

About 47% of the patients with wound complications were smokers, compared with 28% of the patients without wound complications.

In addition, chorioamnionitis was about five times more common in patients with wound complications, compared with patients without wound complications (28% vs. 7%).

The independent associations between smoking and wound complications and between chorioamnionitis and wound complications remained significant in a logistic regression analysis, the investigators noted.

Younger maternal age, premature membrane rupture, primary cesarean delivery, and earlier gestational age showed trends toward an association with wound complications, but these associations did not reach statistical significance. No associations were found between wound complications and several other clinical variables including body mass index, diabetes, and substance use.

WASHINGTON — Data from 597 cesarean sections suggest that smoking may slow wound healing, Dr. Cecilia Avila reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Both smoking and chorioamnionitis were significantly associated with wound complications in 20 cases of infection and 10 cases of hematoma that were identified in a case-control review of patients who had cesarean sections during a 7-year period.

Overall, wound complications were about three times more likely in smokers, wrote Dr. Avila of Stony Brook (N.Y.) University Hospital.

About 47% of the patients with wound complications were smokers, compared with 28% of the patients without wound complications.

In addition, chorioamnionitis was about five times more common in patients with wound complications, compared with patients without wound complications (28% vs. 7%).

The independent associations between smoking and wound complications and between chorioamnionitis and wound complications remained significant in a logistic regression analysis, the investigators noted.

Younger maternal age, premature membrane rupture, primary cesarean delivery, and earlier gestational age showed trends toward an association with wound complications, but these associations did not reach statistical significance. No associations were found between wound complications and several other clinical variables including body mass index, diabetes, and substance use.

WASHINGTON — Data from 597 cesarean sections suggest that smoking may slow wound healing, Dr. Cecilia Avila reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Both smoking and chorioamnionitis were significantly associated with wound complications in 20 cases of infection and 10 cases of hematoma that were identified in a case-control review of patients who had cesarean sections during a 7-year period.

Overall, wound complications were about three times more likely in smokers, wrote Dr. Avila of Stony Brook (N.Y.) University Hospital.

About 47% of the patients with wound complications were smokers, compared with 28% of the patients without wound complications.

In addition, chorioamnionitis was about five times more common in patients with wound complications, compared with patients without wound complications (28% vs. 7%).

The independent associations between smoking and wound complications and between chorioamnionitis and wound complications remained significant in a logistic regression analysis, the investigators noted.

Younger maternal age, premature membrane rupture, primary cesarean delivery, and earlier gestational age showed trends toward an association with wound complications, but these associations did not reach statistical significance. No associations were found between wound complications and several other clinical variables including body mass index, diabetes, and substance use.

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjusting for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjusting for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjusting for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Only 9% of 276 physicians surveyed use standardized screening measures to assess patients for postpartum depression, reported Randy Fingerhut, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that as many as 50% of all cases of postpartum depression remain undetected by physicians, wrote Dr. Fingerhut and his colleagues at La Salle University in Philadelphia.

The study included 95 obstetricians and 181 pediatricians based in Pennsylvania.

Overall, 77% of obstetricians reported screening patients for postpartum depression prenatally, and 93% screened postnatally. By contrast, only 47% of pediatricians reported assessing mothers for postpartum depression.

The physicians completed the Postpartum Depression Survey, which asks true/false questions about postpartum depression, and the Postpartum Screening and Assessment Questionnaire, which includes questions about physician procedures for handling cases of postpartum depression.

A slight majority (58%) of the physicians estimated that 0%–10% of their patients experienced postpartum depression, which is lower than the 10%–20% shown in previous studies. This discrepancy may be attributable to the infrequent use of a standard screening method, the investigators noted. The physicians reported a range of interventions, including medication and psychotherapy, and most believed that medication was superior to psychotherapy for postpartum depression.

Although only 11% of the physicians considered themselves to be “extremely knowledgeable” about postpartum depression, 87% said they were interested in learning more about the condition.

WASHINGTON — Only 9% of 276 physicians surveyed use standardized screening measures to assess patients for postpartum depression, reported Randy Fingerhut, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that as many as 50% of all cases of postpartum depression remain undetected by physicians, wrote Dr. Fingerhut and his colleagues at La Salle University in Philadelphia.

The study included 95 obstetricians and 181 pediatricians based in Pennsylvania.

Overall, 77% of obstetricians reported screening patients for postpartum depression prenatally, and 93% screened postnatally. By contrast, only 47% of pediatricians reported assessing mothers for postpartum depression.

The physicians completed the Postpartum Depression Survey, which asks true/false questions about postpartum depression, and the Postpartum Screening and Assessment Questionnaire, which includes questions about physician procedures for handling cases of postpartum depression.

A slight majority (58%) of the physicians estimated that 0%–10% of their patients experienced postpartum depression, which is lower than the 10%–20% shown in previous studies. This discrepancy may be attributable to the infrequent use of a standard screening method, the investigators noted. The physicians reported a range of interventions, including medication and psychotherapy, and most believed that medication was superior to psychotherapy for postpartum depression.

Although only 11% of the physicians considered themselves to be “extremely knowledgeable” about postpartum depression, 87% said they were interested in learning more about the condition.

WASHINGTON — Only 9% of 276 physicians surveyed use standardized screening measures to assess patients for postpartum depression, reported Randy Fingerhut, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that as many as 50% of all cases of postpartum depression remain undetected by physicians, wrote Dr. Fingerhut and his colleagues at La Salle University in Philadelphia.

The study included 95 obstetricians and 181 pediatricians based in Pennsylvania.

Overall, 77% of obstetricians reported screening patients for postpartum depression prenatally, and 93% screened postnatally. By contrast, only 47% of pediatricians reported assessing mothers for postpartum depression.

The physicians completed the Postpartum Depression Survey, which asks true/false questions about postpartum depression, and the Postpartum Screening and Assessment Questionnaire, which includes questions about physician procedures for handling cases of postpartum depression.

A slight majority (58%) of the physicians estimated that 0%–10% of their patients experienced postpartum depression, which is lower than the 10%–20% shown in previous studies. This discrepancy may be attributable to the infrequent use of a standard screening method, the investigators noted. The physicians reported a range of interventions, including medication and psychotherapy, and most believed that medication was superior to psychotherapy for postpartum depression.

Although only 11% of the physicians considered themselves to be “extremely knowledgeable” about postpartum depression, 87% said they were interested in learning more about the condition.

ATLANTA — Blacks, Asians, and Hispanics were significantly more likely to be hospitalized for influenza during the 2004–2005 flu season in Utah, compared with non-Hispanic whites, Lisa Wyman reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Overall, the hospitalization rate per 100,000 person-years was 22.2 cases among blacks, 22.6 cases among Asians/Pacific Islanders, and 19.0 cases among Hispanics, compared with 7.2 cases among non-Hispanic whites.

Children younger than 5 years had the highest hospitalization rates of any age group, and these rates were significantly higher among minority children, compared with non-Hispanic whites.

Ms. Wyman and her colleagues at the Utah Department of Health reviewed all cases of laboratory-confirmed cases of influenza reported in Utah during the 2004–2005 season. A total of 253 hospitalizations were reported, and complete race and ethnicity data were available for 209 cases. The type of influenza virus was determined for 224 hospitalized cases; 136 were associated with the influenza A virus, and 88 were associated with the influenza B virus. Hispanics and Asians/Pacific Islanders were significantly more likely to have the influenza B virus (46% and 69%, respectively), compared with non-Hispanic whites. In addition, Hispanics aged 25 years and older were more likely to have the influenza B virus, compared with non-Hispanic whites.

Although the study was limited by relatively small numbers, a preliminary review of data from the 2005–2006 flu season showed similar trends with regard to ethnic disparities in hospitalization rates, the investigators noted.

ATLANTA — Blacks, Asians, and Hispanics were significantly more likely to be hospitalized for influenza during the 2004–2005 flu season in Utah, compared with non-Hispanic whites, Lisa Wyman reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Overall, the hospitalization rate per 100,000 person-years was 22.2 cases among blacks, 22.6 cases among Asians/Pacific Islanders, and 19.0 cases among Hispanics, compared with 7.2 cases among non-Hispanic whites.

Children younger than 5 years had the highest hospitalization rates of any age group, and these rates were significantly higher among minority children, compared with non-Hispanic whites.

Ms. Wyman and her colleagues at the Utah Department of Health reviewed all cases of laboratory-confirmed cases of influenza reported in Utah during the 2004–2005 season. A total of 253 hospitalizations were reported, and complete race and ethnicity data were available for 209 cases. The type of influenza virus was determined for 224 hospitalized cases; 136 were associated with the influenza A virus, and 88 were associated with the influenza B virus. Hispanics and Asians/Pacific Islanders were significantly more likely to have the influenza B virus (46% and 69%, respectively), compared with non-Hispanic whites. In addition, Hispanics aged 25 years and older were more likely to have the influenza B virus, compared with non-Hispanic whites.

Although the study was limited by relatively small numbers, a preliminary review of data from the 2005–2006 flu season showed similar trends with regard to ethnic disparities in hospitalization rates, the investigators noted.

ATLANTA — Blacks, Asians, and Hispanics were significantly more likely to be hospitalized for influenza during the 2004–2005 flu season in Utah, compared with non-Hispanic whites, Lisa Wyman reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Overall, the hospitalization rate per 100,000 person-years was 22.2 cases among blacks, 22.6 cases among Asians/Pacific Islanders, and 19.0 cases among Hispanics, compared with 7.2 cases among non-Hispanic whites.

Children younger than 5 years had the highest hospitalization rates of any age group, and these rates were significantly higher among minority children, compared with non-Hispanic whites.

Ms. Wyman and her colleagues at the Utah Department of Health reviewed all cases of laboratory-confirmed cases of influenza reported in Utah during the 2004–2005 season. A total of 253 hospitalizations were reported, and complete race and ethnicity data were available for 209 cases. The type of influenza virus was determined for 224 hospitalized cases; 136 were associated with the influenza A virus, and 88 were associated with the influenza B virus. Hispanics and Asians/Pacific Islanders were significantly more likely to have the influenza B virus (46% and 69%, respectively), compared with non-Hispanic whites. In addition, Hispanics aged 25 years and older were more likely to have the influenza B virus, compared with non-Hispanic whites.

Although the study was limited by relatively small numbers, a preliminary review of data from the 2005–2006 flu season showed similar trends with regard to ethnic disparities in hospitalization rates, the investigators noted.

MRSA and Thrombosis in Osteomyelitis

Although venous thrombosis is rare in osteomyelitis patients, the community-acquired methicillin-resistant Staphylococcus aureus that predominates in Texas may have a unique ability to cause VT in these patients, reported Dr. Blanca E. Gonzalez of Baylor College of Medicine in Houston.

Venous thrombosis occurred near the sites of infection in 9 children with osteomyelitis and pyomyositis attributed to community-acquired S. aureus. All 9 patients were male, with a mean age of 10.6 years (range 2.5–12 years). About half of the patients experienced thrombosis in the femoral veins, and most of the VTs were identified while evaluating the patients' infections.

Community-acquired methicillin-resistant S. aureus (MRSA) was the cause of infections in 7 patients, who were treated with vancomycin for at least 42 days. Infections in the other 2 patients were caused by community-acquired methicillin-susceptible S. aureus; these patients were treated with nafcillin for 2 weeks, followed by intravenous cefazolin for a total of 42 days of therapy (Pediatrics 2006;117:1673–9).

Risk factors were not easily identified; 6 of the 9 patients had no family history of VT or predisposing conditions. Septic emboli were detected in 3 patients based on chest imaging at the time of hospital admission. Two of these patients were intubated and one was placed on bilevel positive airway pressure; these 3 patients had intravascular filters. Ultimately, the thromboses resolved in 7 patients after about 10 weeks on average (range 2.5–32 weeks).

One of 3 patients with emboli had radiologic resolution of VT by 12 weeks, a second patient continued to use a filter with anticoagulation therapy that was discontinued after 10 months, and a third patient continued to use a filter with ongoing anticoagulation.

Vancomycin Linked to Hearing Loss

A significant increase in hearing loss occurred among children with pneumococcal meningitis who received vancomycin less than 2 hours after a first dose of cefotaxime or ceftriaxone, reported Dr. Steven C. Buckingham of the University of Tennessee Health Science Center in Memphis and his associates.

The retrospective study included 114 children with an average age of 10 months. Of these, 109 received vancomycin and either cefotaxime or ceftriaxone given previously or concomitantly (Pediatrics 2006;117:1688–94).

Audiometric tests were conducted on 67 of the children who were discharged from the hospital, and 37 (55%) demonstrated moderate to profound sensorineural hearing loss in at least one ear.

Data on vancomycin start times were available for 98 children. The vancomycin start time after receiving a cephalosporin was less than 1 hour in 38 children, 1–2 hours in 16 children, 2–5 hours in 16 children, and more than 5 hours in 28 children.

Overall, the median vancomycin start time was less than 1 hour after receiving a cephalosporin among the children with hearing loss, compared with a median start time of 4 hours among children without hearing loss. The proportion of children with hearing loss decreased as the vancomycin start time from the administration of a cephalosporin increased: 18 of 23 (78%) at less than 1 hour, 6 of 9 (67%) at 1–2 hours, 3 of 9 (33%) at 2–5 hours, and 5 of 18 (28%) at greater than 5 hours.

Although combination therapy has been recommended for children with pneumococcal meningitis, the data showed no clinical benefit from early vancomycin dosing. Physicians might consider delaying the first dose of vancomycin until at least 2 hours after the first dose of cephalosporins, the investigators wrote.

Hispanic Neonates and Pertussis

Low concentrations of pertussis toxin-specific immunoglobulin G (PT-specific IgG) might explain the increased risk of pertussis that has been consistently reported in Hispanic infants, reported Dr. C. Mary Healy of Baylor College of Medicine, Houston, and her colleagues.

The investigators evaluated data from singleton infants born in the same hospital during July and August of 2004. The geometric mean concentration of PT-specific IgG in umbilical cord serum samples taken from 220 Hispanic neonates was 8.45 EU/mL. This level dropped significantly, to 4.63 EU/mL, if the mothers were 19 years old or younger (CID 2006;42:1439–42). Both of these mean concentrations of antibodies were too low to be associated with protection from pertussis antigens, the investigators noted.

The finding that PT-specific IgG levels were especially low among neonates of adolescent mothers supports data from previous studies, but the levels were low enough among neonates of women aged 30 years and older (8.55 EU/mL) to suggest that babies born to older mothers are vulnerable to pertussis as well.

MRSA and Thrombosis in Osteomyelitis

Although venous thrombosis is rare in osteomyelitis patients, the community-acquired methicillin-resistant Staphylococcus aureus that predominates in Texas may have a unique ability to cause VT in these patients, reported Dr. Blanca E. Gonzalez of Baylor College of Medicine in Houston.

Venous thrombosis occurred near the sites of infection in 9 children with osteomyelitis and pyomyositis attributed to community-acquired S. aureus. All 9 patients were male, with a mean age of 10.6 years (range 2.5–12 years). About half of the patients experienced thrombosis in the femoral veins, and most of the VTs were identified while evaluating the patients' infections.

Community-acquired methicillin-resistant S. aureus (MRSA) was the cause of infections in 7 patients, who were treated with vancomycin for at least 42 days. Infections in the other 2 patients were caused by community-acquired methicillin-susceptible S. aureus; these patients were treated with nafcillin for 2 weeks, followed by intravenous cefazolin for a total of 42 days of therapy (Pediatrics 2006;117:1673–9).

Risk factors were not easily identified; 6 of the 9 patients had no family history of VT or predisposing conditions. Septic emboli were detected in 3 patients based on chest imaging at the time of hospital admission. Two of these patients were intubated and one was placed on bilevel positive airway pressure; these 3 patients had intravascular filters. Ultimately, the thromboses resolved in 7 patients after about 10 weeks on average (range 2.5–32 weeks).

One of 3 patients with emboli had radiologic resolution of VT by 12 weeks, a second patient continued to use a filter with anticoagulation therapy that was discontinued after 10 months, and a third patient continued to use a filter with ongoing anticoagulation.

Vancomycin Linked to Hearing Loss

A significant increase in hearing loss occurred among children with pneumococcal meningitis who received vancomycin less than 2 hours after a first dose of cefotaxime or ceftriaxone, reported Dr. Steven C. Buckingham of the University of Tennessee Health Science Center in Memphis and his associates.

The retrospective study included 114 children with an average age of 10 months. Of these, 109 received vancomycin and either cefotaxime or ceftriaxone given previously or concomitantly (Pediatrics 2006;117:1688–94).

Audiometric tests were conducted on 67 of the children who were discharged from the hospital, and 37 (55%) demonstrated moderate to profound sensorineural hearing loss in at least one ear.

Data on vancomycin start times were available for 98 children. The vancomycin start time after receiving a cephalosporin was less than 1 hour in 38 children, 1–2 hours in 16 children, 2–5 hours in 16 children, and more than 5 hours in 28 children.

Overall, the median vancomycin start time was less than 1 hour after receiving a cephalosporin among the children with hearing loss, compared with a median start time of 4 hours among children without hearing loss. The proportion of children with hearing loss decreased as the vancomycin start time from the administration of a cephalosporin increased: 18 of 23 (78%) at less than 1 hour, 6 of 9 (67%) at 1–2 hours, 3 of 9 (33%) at 2–5 hours, and 5 of 18 (28%) at greater than 5 hours.

Although combination therapy has been recommended for children with pneumococcal meningitis, the data showed no clinical benefit from early vancomycin dosing. Physicians might consider delaying the first dose of vancomycin until at least 2 hours after the first dose of cephalosporins, the investigators wrote.

Hispanic Neonates and Pertussis

Low concentrations of pertussis toxin-specific immunoglobulin G (PT-specific IgG) might explain the increased risk of pertussis that has been consistently reported in Hispanic infants, reported Dr. C. Mary Healy of Baylor College of Medicine, Houston, and her colleagues.

The investigators evaluated data from singleton infants born in the same hospital during July and August of 2004. The geometric mean concentration of PT-specific IgG in umbilical cord serum samples taken from 220 Hispanic neonates was 8.45 EU/mL. This level dropped significantly, to 4.63 EU/mL, if the mothers were 19 years old or younger (CID 2006;42:1439–42). Both of these mean concentrations of antibodies were too low to be associated with protection from pertussis antigens, the investigators noted.

The finding that PT-specific IgG levels were especially low among neonates of adolescent mothers supports data from previous studies, but the levels were low enough among neonates of women aged 30 years and older (8.55 EU/mL) to suggest that babies born to older mothers are vulnerable to pertussis as well.

MRSA and Thrombosis in Osteomyelitis

Although venous thrombosis is rare in osteomyelitis patients, the community-acquired methicillin-resistant Staphylococcus aureus that predominates in Texas may have a unique ability to cause VT in these patients, reported Dr. Blanca E. Gonzalez of Baylor College of Medicine in Houston.

Venous thrombosis occurred near the sites of infection in 9 children with osteomyelitis and pyomyositis attributed to community-acquired S. aureus. All 9 patients were male, with a mean age of 10.6 years (range 2.5–12 years). About half of the patients experienced thrombosis in the femoral veins, and most of the VTs were identified while evaluating the patients' infections.

Community-acquired methicillin-resistant S. aureus (MRSA) was the cause of infections in 7 patients, who were treated with vancomycin for at least 42 days. Infections in the other 2 patients were caused by community-acquired methicillin-susceptible S. aureus; these patients were treated with nafcillin for 2 weeks, followed by intravenous cefazolin for a total of 42 days of therapy (Pediatrics 2006;117:1673–9).

Risk factors were not easily identified; 6 of the 9 patients had no family history of VT or predisposing conditions. Septic emboli were detected in 3 patients based on chest imaging at the time of hospital admission. Two of these patients were intubated and one was placed on bilevel positive airway pressure; these 3 patients had intravascular filters. Ultimately, the thromboses resolved in 7 patients after about 10 weeks on average (range 2.5–32 weeks).

One of 3 patients with emboli had radiologic resolution of VT by 12 weeks, a second patient continued to use a filter with anticoagulation therapy that was discontinued after 10 months, and a third patient continued to use a filter with ongoing anticoagulation.

Vancomycin Linked to Hearing Loss

A significant increase in hearing loss occurred among children with pneumococcal meningitis who received vancomycin less than 2 hours after a first dose of cefotaxime or ceftriaxone, reported Dr. Steven C. Buckingham of the University of Tennessee Health Science Center in Memphis and his associates.

The retrospective study included 114 children with an average age of 10 months. Of these, 109 received vancomycin and either cefotaxime or ceftriaxone given previously or concomitantly (Pediatrics 2006;117:1688–94).

Audiometric tests were conducted on 67 of the children who were discharged from the hospital, and 37 (55%) demonstrated moderate to profound sensorineural hearing loss in at least one ear.

Data on vancomycin start times were available for 98 children. The vancomycin start time after receiving a cephalosporin was less than 1 hour in 38 children, 1–2 hours in 16 children, 2–5 hours in 16 children, and more than 5 hours in 28 children.

Overall, the median vancomycin start time was less than 1 hour after receiving a cephalosporin among the children with hearing loss, compared with a median start time of 4 hours among children without hearing loss. The proportion of children with hearing loss decreased as the vancomycin start time from the administration of a cephalosporin increased: 18 of 23 (78%) at less than 1 hour, 6 of 9 (67%) at 1–2 hours, 3 of 9 (33%) at 2–5 hours, and 5 of 18 (28%) at greater than 5 hours.

Although combination therapy has been recommended for children with pneumococcal meningitis, the data showed no clinical benefit from early vancomycin dosing. Physicians might consider delaying the first dose of vancomycin until at least 2 hours after the first dose of cephalosporins, the investigators wrote.

Hispanic Neonates and Pertussis

Low concentrations of pertussis toxin-specific immunoglobulin G (PT-specific IgG) might explain the increased risk of pertussis that has been consistently reported in Hispanic infants, reported Dr. C. Mary Healy of Baylor College of Medicine, Houston, and her colleagues.

The investigators evaluated data from singleton infants born in the same hospital during July and August of 2004. The geometric mean concentration of PT-specific IgG in umbilical cord serum samples taken from 220 Hispanic neonates was 8.45 EU/mL. This level dropped significantly, to 4.63 EU/mL, if the mothers were 19 years old or younger (CID 2006;42:1439–42). Both of these mean concentrations of antibodies were too low to be associated with protection from pertussis antigens, the investigators noted.

The finding that PT-specific IgG levels were especially low among neonates of adolescent mothers supports data from previous studies, but the levels were low enough among neonates of women aged 30 years and older (8.55 EU/mL) to suggest that babies born to older mothers are vulnerable to pertussis as well.

The measles, mumps, rubella, and varicella vaccine can safely be given at the same time as other childhood vaccines are administered, reported Dr. Henry Shinefield of the University of California, San Francisco, and his colleagues.

The researchers conducted an open, multicenter trial in which 1,779 healthy children aged 11–16 months were randomized into three groups. Group 1 received the measles, mumps, rubella, and varicella vaccine (MMRV), the combined Haemophilus influenzae type b conjugate-hepatitis B vaccine (HH), and the combined diphtheria-tetanus-acellular pertussis vaccine (DTaP) at the same visit. Group 2 received the MMRV at the initial visit, followed by HH and DTaP 42 days later. Group 3 received separate MMR and varicella vaccines at the initial visit, followed by HH and DTaP 42 days later.

Overall, the antibody response rates and geometric mean antibody titers to measles, mumps, rubella, and varicella were similar, regardless of whether MMRV was given at the same time as the other vaccines or 42 days earlier. When MMRV was given at the same time as HH and DTaP, the antibody response rates for measles, mumps, rubella, and varicella were 97.8%, 95.4%, 98.6%, and 89.7%—higher than the previously established acceptability criteria.

Children who received all the vaccines at once were significantly more likely to report pain or tenderness at the injection site, compared with the other groups. Other safety results, including rates of fever, congestion, and cough, were comparable among the groups.

Dr. Shinefield has received an honorarium for preparing informational material for doctors about the MMRV vaccine ProQuad, and he is a member of the Merck Advisory Committee on Varicella and ProQuad.

The measles, mumps, rubella, and varicella vaccine can safely be given at the same time as other childhood vaccines are administered, reported Dr. Henry Shinefield of the University of California, San Francisco, and his colleagues.

The researchers conducted an open, multicenter trial in which 1,779 healthy children aged 11–16 months were randomized into three groups. Group 1 received the measles, mumps, rubella, and varicella vaccine (MMRV), the combined Haemophilus influenzae type b conjugate-hepatitis B vaccine (HH), and the combined diphtheria-tetanus-acellular pertussis vaccine (DTaP) at the same visit. Group 2 received the MMRV at the initial visit, followed by HH and DTaP 42 days later. Group 3 received separate MMR and varicella vaccines at the initial visit, followed by HH and DTaP 42 days later.

Overall, the antibody response rates and geometric mean antibody titers to measles, mumps, rubella, and varicella were similar, regardless of whether MMRV was given at the same time as the other vaccines or 42 days earlier. When MMRV was given at the same time as HH and DTaP, the antibody response rates for measles, mumps, rubella, and varicella were 97.8%, 95.4%, 98.6%, and 89.7%—higher than the previously established acceptability criteria.

Children who received all the vaccines at once were significantly more likely to report pain or tenderness at the injection site, compared with the other groups. Other safety results, including rates of fever, congestion, and cough, were comparable among the groups.

Dr. Shinefield has received an honorarium for preparing informational material for doctors about the MMRV vaccine ProQuad, and he is a member of the Merck Advisory Committee on Varicella and ProQuad.

The measles, mumps, rubella, and varicella vaccine can safely be given at the same time as other childhood vaccines are administered, reported Dr. Henry Shinefield of the University of California, San Francisco, and his colleagues.

The researchers conducted an open, multicenter trial in which 1,779 healthy children aged 11–16 months were randomized into three groups. Group 1 received the measles, mumps, rubella, and varicella vaccine (MMRV), the combined Haemophilus influenzae type b conjugate-hepatitis B vaccine (HH), and the combined diphtheria-tetanus-acellular pertussis vaccine (DTaP) at the same visit. Group 2 received the MMRV at the initial visit, followed by HH and DTaP 42 days later. Group 3 received separate MMR and varicella vaccines at the initial visit, followed by HH and DTaP 42 days later.

Overall, the antibody response rates and geometric mean antibody titers to measles, mumps, rubella, and varicella were similar, regardless of whether MMRV was given at the same time as the other vaccines or 42 days earlier. When MMRV was given at the same time as HH and DTaP, the antibody response rates for measles, mumps, rubella, and varicella were 97.8%, 95.4%, 98.6%, and 89.7%—higher than the previously established acceptability criteria.

Children who received all the vaccines at once were significantly more likely to report pain or tenderness at the injection site, compared with the other groups. Other safety results, including rates of fever, congestion, and cough, were comparable among the groups.

Dr. Shinefield has received an honorarium for preparing informational material for doctors about the MMRV vaccine ProQuad, and he is a member of the Merck Advisory Committee on Varicella and ProQuad.

A significant increase in hearing loss occurred among children with pneumococcal meningitis who received vancomycin less than 2 hours after a first dose of cefotaxime or ceftriaxone, reported Dr. Steven C. Buckingham of the University of Tennessee Health Science Center in Memphis and his associates.

The retrospective study included 114 children with an average age of 10 months. Of these, 109 received vancomycin and either cefotaxime or ceftriaxone given previously or concomitantly (Pediatrics 2006;117:1688–94).

Audiometric tests were conducted on 67 of the children who were discharged from the hospital, and 37 (55%) demonstrated moderate to profound sensorineural hearing loss in at least one ear.

Data on vancomycin start times were available for 98 children. The vancomycin start time after receiving a cephalosporin was less than 1 hour in 38 children, 1–2 hours in 16 children, 2–5 hours in 16 children, and more than 5 hours in 28 children.

Overall, the median vancomycin start time was less than 1 hour after receiving a cephalosporin among the children with hearing loss, compared with a median start time of 4 hours among children without hearing loss. The proportion of children with hearing loss decreased as the vancomycin start time from the administration of a cephalosporin increased: 18 of 23 (78%) at less than 1 hour, 6 of 9 (67%) at 1–2 hours, 3 of 9 (33%) at 2–5 hours, and 5 of 18 (28%) at greater than 5 hours.

Although combination therapy has been recommended for children with pneumococcal meningitis, the data showed no clinical benefit from early vancomycin dosing. Physicians might consider delaying the first dose of vancomycin until at least 2 hours after the first dose of cephalosporins, the investigators wrote.

A significant increase in hearing loss occurred among children with pneumococcal meningitis who received vancomycin less than 2 hours after a first dose of cefotaxime or ceftriaxone, reported Dr. Steven C. Buckingham of the University of Tennessee Health Science Center in Memphis and his associates.

The retrospective study included 114 children with an average age of 10 months. Of these, 109 received vancomycin and either cefotaxime or ceftriaxone given previously or concomitantly (Pediatrics 2006;117:1688–94).

Audiometric tests were conducted on 67 of the children who were discharged from the hospital, and 37 (55%) demonstrated moderate to profound sensorineural hearing loss in at least one ear.

Data on vancomycin start times were available for 98 children. The vancomycin start time after receiving a cephalosporin was less than 1 hour in 38 children, 1–2 hours in 16 children, 2–5 hours in 16 children, and more than 5 hours in 28 children.

Overall, the median vancomycin start time was less than 1 hour after receiving a cephalosporin among the children with hearing loss, compared with a median start time of 4 hours among children without hearing loss. The proportion of children with hearing loss decreased as the vancomycin start time from the administration of a cephalosporin increased: 18 of 23 (78%) at less than 1 hour, 6 of 9 (67%) at 1–2 hours, 3 of 9 (33%) at 2–5 hours, and 5 of 18 (28%) at greater than 5 hours.

Although combination therapy has been recommended for children with pneumococcal meningitis, the data showed no clinical benefit from early vancomycin dosing. Physicians might consider delaying the first dose of vancomycin until at least 2 hours after the first dose of cephalosporins, the investigators wrote.

A significant increase in hearing loss occurred among children with pneumococcal meningitis who received vancomycin less than 2 hours after a first dose of cefotaxime or ceftriaxone, reported Dr. Steven C. Buckingham of the University of Tennessee Health Science Center in Memphis and his associates.

The retrospective study included 114 children with an average age of 10 months. Of these, 109 received vancomycin and either cefotaxime or ceftriaxone given previously or concomitantly (Pediatrics 2006;117:1688–94).

Audiometric tests were conducted on 67 of the children who were discharged from the hospital, and 37 (55%) demonstrated moderate to profound sensorineural hearing loss in at least one ear.

Data on vancomycin start times were available for 98 children. The vancomycin start time after receiving a cephalosporin was less than 1 hour in 38 children, 1–2 hours in 16 children, 2–5 hours in 16 children, and more than 5 hours in 28 children.

Overall, the median vancomycin start time was less than 1 hour after receiving a cephalosporin among the children with hearing loss, compared with a median start time of 4 hours among children without hearing loss. The proportion of children with hearing loss decreased as the vancomycin start time from the administration of a cephalosporin increased: 18 of 23 (78%) at less than 1 hour, 6 of 9 (67%) at 1–2 hours, 3 of 9 (33%) at 2–5 hours, and 5 of 18 (28%) at greater than 5 hours.

Although combination therapy has been recommended for children with pneumococcal meningitis, the data showed no clinical benefit from early vancomycin dosing. Physicians might consider delaying the first dose of vancomycin until at least 2 hours after the first dose of cephalosporins, the investigators wrote.

DENVER – Increased risk of coronary heart disease is significantly associated with stronger symptoms of depression in diabetic adults, Susan M. Barry-Bianchi, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Barry-Bianchi of the Behavioural Cardiology Research Unit at the University Health Network in Toronto, and her colleagues recruited 353 patients for the study from an ongoing investigation, the Community Outreach and Health Risk Reduction Trial. The average patient age was 56 years.

The average score on the Beck Depression Inventory (BDI) was 11.1 among the 184 patients at high risk for coronary heart disease (CHD), compared with 8.8 among the 169 patients at low risk for CHD, Dr. Barry-Bianchi wrote. The 10-year absolute risk for CHD was nearly 22% for high-risk patients and 9% for the low-risk patients. CHD risk for each patient was determined using the Framingham index.

Given the significant difference in the depression levels based on the risk for developing heart disease, depression and CHD risk should be evaluated jointly, when investigating morbidity and mortality in diabetic patients, the investigators suggested. They also suggested that treatment of CHD risk factors in diabetic patients may correspond with a reduction in depressive symptoms and improved overall health.

In addition, the results supported previous findings of increased depression among women and patients with low levels of emotional support. Women demonstrated a significantly higher average BDI score, compared with men (11.4 vs. 8.4). Patients with low reported levels of emotional support demonstrated a significantly higher average BDI score, compared with those who reported more support (12 vs. 8).

DENVER – Increased risk of coronary heart disease is significantly associated with stronger symptoms of depression in diabetic adults, Susan M. Barry-Bianchi, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Barry-Bianchi of the Behavioural Cardiology Research Unit at the University Health Network in Toronto, and her colleagues recruited 353 patients for the study from an ongoing investigation, the Community Outreach and Health Risk Reduction Trial. The average patient age was 56 years.

The average score on the Beck Depression Inventory (BDI) was 11.1 among the 184 patients at high risk for coronary heart disease (CHD), compared with 8.8 among the 169 patients at low risk for CHD, Dr. Barry-Bianchi wrote. The 10-year absolute risk for CHD was nearly 22% for high-risk patients and 9% for the low-risk patients. CHD risk for each patient was determined using the Framingham index.

Given the significant difference in the depression levels based on the risk for developing heart disease, depression and CHD risk should be evaluated jointly, when investigating morbidity and mortality in diabetic patients, the investigators suggested. They also suggested that treatment of CHD risk factors in diabetic patients may correspond with a reduction in depressive symptoms and improved overall health.

In addition, the results supported previous findings of increased depression among women and patients with low levels of emotional support. Women demonstrated a significantly higher average BDI score, compared with men (11.4 vs. 8.4). Patients with low reported levels of emotional support demonstrated a significantly higher average BDI score, compared with those who reported more support (12 vs. 8).

DENVER – Increased risk of coronary heart disease is significantly associated with stronger symptoms of depression in diabetic adults, Susan M. Barry-Bianchi, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Barry-Bianchi of the Behavioural Cardiology Research Unit at the University Health Network in Toronto, and her colleagues recruited 353 patients for the study from an ongoing investigation, the Community Outreach and Health Risk Reduction Trial. The average patient age was 56 years.

The average score on the Beck Depression Inventory (BDI) was 11.1 among the 184 patients at high risk for coronary heart disease (CHD), compared with 8.8 among the 169 patients at low risk for CHD, Dr. Barry-Bianchi wrote. The 10-year absolute risk for CHD was nearly 22% for high-risk patients and 9% for the low-risk patients. CHD risk for each patient was determined using the Framingham index.

Given the significant difference in the depression levels based on the risk for developing heart disease, depression and CHD risk should be evaluated jointly, when investigating morbidity and mortality in diabetic patients, the investigators suggested. They also suggested that treatment of CHD risk factors in diabetic patients may correspond with a reduction in depressive symptoms and improved overall health.

In addition, the results supported previous findings of increased depression among women and patients with low levels of emotional support. Women demonstrated a significantly higher average BDI score, compared with men (11.4 vs. 8.4). Patients with low reported levels of emotional support demonstrated a significantly higher average BDI score, compared with those who reported more support (12 vs. 8).

Dieting Linked to Risky Behavior

Adolescents who dieted were significantly more likely to engage in risky health behaviors and to demonstrate psychosocial symptoms, compared with teens who did not diet, reported Dr. Scott Crow and his colleagues at the University of Minnesota, Minneapolis.

Overall, 55% of the girls and 26% of the boys in a study of 4,746 adolescents reported dieting. Approximately 32% of the adolescents were actually overweight, and these subjects were 1.5 to 3 times more likely to report dieting, extreme weight control behaviors, and body dissatisfaction than were normal-weight adolescents (J. Adolesc. Health 2006;38:569–74).

Girls who were dieting, regardless of weight status, were significantly more likely than nondieting girls to exhibit extreme weight control behaviors, low self-esteem, body dissatisfaction, and depressive symptoms, and were significantly more likely to use alcohol, marijuana, or tobacco. Similarly, boys who were dieting, regardless of weight status, were significantly more likely than nondieting boys to exhibit extreme weight control behaviors, low self-esteem, body dissatisfaction, and depressive symptoms, and significantly more likely to use alcohol or tobacco. Marijuana use was more common among the nondieting boys.

The findings suggest that the psychosocial and behavioral risks associated with dieting may outweigh the possible benefits of weight loss, especially since the increased likelihood of risky health behaviors and depressive symptoms was not limited by weight status, the researchers said.

Friends Inspire Smoking Initiation

A close friend's smoking habits were 12% more influential than parents' habits in an adolescent's first transition to smoking, reported Jonathan B. Bricker, Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and his colleagues.

According to data from 4,744 adolescents involved in the Hutchinson Smoking Prevention Project, there were no significant differences in the influence of parents vs. friends on a second smoking transition, the investigators said (Addictive Behaviors 2006;31:889–900).

By contrast, each close friend's smoking was 16% less influential than a parent's smoking on adolescents' transition to a third level of smoking. Transitions through levels of smoking, such as a transition from monthly to daily smoking, may take months or years to occur, the researchers noted.

Overall, the probability that a close friend who smoked had inspired the adolescent's smoking behavior was 38% for a first transition, 10% for a second transition, and 11% for a third transition. The probability that a parent who smoked had inspired the adolescent's smoking behavior was 26% for a first transition, 13% for a second transition, and 27% for a third transition.

The researchers also analyzed random saliva samples from 12.6% of 12th graders' saliva specimens, and only 1.2% of adolescents who said that they did not smoke had saliva samples with evidence of smoking.

Depression May Be Catching

Depression in a best friend was significantly associated with the development of depressive symptoms in adolescents under conditions of social anxiety, Mitchell Prinstein, Ph.D., said at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Peer relationships during adolescence are characterized by high levels of emotional disclosure and intimacy. Adolescents often use feedback from peers, and their perceived standing among peers is a primary source of their own identity, said Dr. Prinstein of the University of North Carolina, Chapel Hill.

Dr. Prinstein and his colleagues studied 100 community-dwelling adolescents, each of whom chose a friend who was also in the data set. No friend was allowed to be selected more than once. The mean age was 16 years at baseline, and 60% were female.

Overall, among girls, a best friend's depression as reported by that friend was associated with depression in the primary adolescent under conditions of social anxiety. Among boys, a lesser level of friendship intimacy was associated with a greater level of association between a best friend's depression and the development of depressive symptoms in the primary adolescent. Among both girls and boys, the higher the level of the best friend's popularity, as rated by peers, the stronger the association between depression in that best friend and the development of depressive symptoms in the primary adolescent.

“Interventions should not seek to detach teens from relationships, but [should] work to influence adolescent resilience by moderating factors such as anxiety,” Dr. Prinstein said. “Getting adolescents to change who their friends are is generally unsuccessful.”

Dieting Linked to Risky Behavior

Adolescents who dieted were significantly more likely to engage in risky health behaviors and to demonstrate psychosocial symptoms, compared with teens who did not diet, reported Dr. Scott Crow and his colleagues at the University of Minnesota, Minneapolis.

Overall, 55% of the girls and 26% of the boys in a study of 4,746 adolescents reported dieting. Approximately 32% of the adolescents were actually overweight, and these subjects were 1.5 to 3 times more likely to report dieting, extreme weight control behaviors, and body dissatisfaction than were normal-weight adolescents (J. Adolesc. Health 2006;38:569–74).

Girls who were dieting, regardless of weight status, were significantly more likely than nondieting girls to exhibit extreme weight control behaviors, low self-esteem, body dissatisfaction, and depressive symptoms, and were significantly more likely to use alcohol, marijuana, or tobacco. Similarly, boys who were dieting, regardless of weight status, were significantly more likely than nondieting boys to exhibit extreme weight control behaviors, low self-esteem, body dissatisfaction, and depressive symptoms, and significantly more likely to use alcohol or tobacco. Marijuana use was more common among the nondieting boys.

The findings suggest that the psychosocial and behavioral risks associated with dieting may outweigh the possible benefits of weight loss, especially since the increased likelihood of risky health behaviors and depressive symptoms was not limited by weight status, the researchers said.

Friends Inspire Smoking Initiation

A close friend's smoking habits were 12% more influential than parents' habits in an adolescent's first transition to smoking, reported Jonathan B. Bricker, Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and his colleagues.

According to data from 4,744 adolescents involved in the Hutchinson Smoking Prevention Project, there were no significant differences in the influence of parents vs. friends on a second smoking transition, the investigators said (Addictive Behaviors 2006;31:889–900).

By contrast, each close friend's smoking was 16% less influential than a parent's smoking on adolescents' transition to a third level of smoking. Transitions through levels of smoking, such as a transition from monthly to daily smoking, may take months or years to occur, the researchers noted.

Overall, the probability that a close friend who smoked had inspired the adolescent's smoking behavior was 38% for a first transition, 10% for a second transition, and 11% for a third transition. The probability that a parent who smoked had inspired the adolescent's smoking behavior was 26% for a first transition, 13% for a second transition, and 27% for a third transition.

The researchers also analyzed random saliva samples from 12.6% of 12th graders' saliva specimens, and only 1.2% of adolescents who said that they did not smoke had saliva samples with evidence of smoking.

Depression May Be Catching

Depression in a best friend was significantly associated with the development of depressive symptoms in adolescents under conditions of social anxiety, Mitchell Prinstein, Ph.D., said at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Peer relationships during adolescence are characterized by high levels of emotional disclosure and intimacy. Adolescents often use feedback from peers, and their perceived standing among peers is a primary source of their own identity, said Dr. Prinstein of the University of North Carolina, Chapel Hill.

Dr. Prinstein and his colleagues studied 100 community-dwelling adolescents, each of whom chose a friend who was also in the data set. No friend was allowed to be selected more than once. The mean age was 16 years at baseline, and 60% were female.

Overall, among girls, a best friend's depression as reported by that friend was associated with depression in the primary adolescent under conditions of social anxiety. Among boys, a lesser level of friendship intimacy was associated with a greater level of association between a best friend's depression and the development of depressive symptoms in the primary adolescent. Among both girls and boys, the higher the level of the best friend's popularity, as rated by peers, the stronger the association between depression in that best friend and the development of depressive symptoms in the primary adolescent.

“Interventions should not seek to detach teens from relationships, but [should] work to influence adolescent resilience by moderating factors such as anxiety,” Dr. Prinstein said. “Getting adolescents to change who their friends are is generally unsuccessful.”

Dieting Linked to Risky Behavior

Adolescents who dieted were significantly more likely to engage in risky health behaviors and to demonstrate psychosocial symptoms, compared with teens who did not diet, reported Dr. Scott Crow and his colleagues at the University of Minnesota, Minneapolis.

Overall, 55% of the girls and 26% of the boys in a study of 4,746 adolescents reported dieting. Approximately 32% of the adolescents were actually overweight, and these subjects were 1.5 to 3 times more likely to report dieting, extreme weight control behaviors, and body dissatisfaction than were normal-weight adolescents (J. Adolesc. Health 2006;38:569–74).

Girls who were dieting, regardless of weight status, were significantly more likely than nondieting girls to exhibit extreme weight control behaviors, low self-esteem, body dissatisfaction, and depressive symptoms, and were significantly more likely to use alcohol, marijuana, or tobacco. Similarly, boys who were dieting, regardless of weight status, were significantly more likely than nondieting boys to exhibit extreme weight control behaviors, low self-esteem, body dissatisfaction, and depressive symptoms, and significantly more likely to use alcohol or tobacco. Marijuana use was more common among the nondieting boys.

The findings suggest that the psychosocial and behavioral risks associated with dieting may outweigh the possible benefits of weight loss, especially since the increased likelihood of risky health behaviors and depressive symptoms was not limited by weight status, the researchers said.

Friends Inspire Smoking Initiation

A close friend's smoking habits were 12% more influential than parents' habits in an adolescent's first transition to smoking, reported Jonathan B. Bricker, Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and his colleagues.

According to data from 4,744 adolescents involved in the Hutchinson Smoking Prevention Project, there were no significant differences in the influence of parents vs. friends on a second smoking transition, the investigators said (Addictive Behaviors 2006;31:889–900).

By contrast, each close friend's smoking was 16% less influential than a parent's smoking on adolescents' transition to a third level of smoking. Transitions through levels of smoking, such as a transition from monthly to daily smoking, may take months or years to occur, the researchers noted.

Overall, the probability that a close friend who smoked had inspired the adolescent's smoking behavior was 38% for a first transition, 10% for a second transition, and 11% for a third transition. The probability that a parent who smoked had inspired the adolescent's smoking behavior was 26% for a first transition, 13% for a second transition, and 27% for a third transition.

The researchers also analyzed random saliva samples from 12.6% of 12th graders' saliva specimens, and only 1.2% of adolescents who said that they did not smoke had saliva samples with evidence of smoking.

Depression May Be Catching

Depression in a best friend was significantly associated with the development of depressive symptoms in adolescents under conditions of social anxiety, Mitchell Prinstein, Ph.D., said at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Peer relationships during adolescence are characterized by high levels of emotional disclosure and intimacy. Adolescents often use feedback from peers, and their perceived standing among peers is a primary source of their own identity, said Dr. Prinstein of the University of North Carolina, Chapel Hill.

Dr. Prinstein and his colleagues studied 100 community-dwelling adolescents, each of whom chose a friend who was also in the data set. No friend was allowed to be selected more than once. The mean age was 16 years at baseline, and 60% were female.

Overall, among girls, a best friend's depression as reported by that friend was associated with depression in the primary adolescent under conditions of social anxiety. Among boys, a lesser level of friendship intimacy was associated with a greater level of association between a best friend's depression and the development of depressive symptoms in the primary adolescent. Among both girls and boys, the higher the level of the best friend's popularity, as rated by peers, the stronger the association between depression in that best friend and the development of depressive symptoms in the primary adolescent.

“Interventions should not seek to detach teens from relationships, but [should] work to influence adolescent resilience by moderating factors such as anxiety,” Dr. Prinstein said. “Getting adolescents to change who their friends are is generally unsuccessful.”