Kerri Wachter

A novel imaging technique seems to be better than standard mammography at detecting breast cancer in high-risk women with dense breast tissue, according to findings from a study involving 940 women.

Molecular breast imaging detected three times as many cancers as mammography did in this group of women, Carrie B. Hruska, Ph.D., said at a media briefing on Sept. 3 that was held in advance of the American Society of Clinical Oncology's annual Breast Cancer Symposium.

“Molecular breast imaging may be a promising adjunct to screening mammography for women with dense breasts and who are at increased risk,” she said. It is estimated that roughly a quarter of women 40 years and older have dense breast patterns.

Molecular breast imaging (MBI) relies on increased uptake of the radiotracer Tc-99m sestamibi by cancer cells, compared with healthy breast tissue, to identify tumors that might go undetected by conventional mammography, according to Dr. Hruska, a research fellow in radiology at the Mayo Clinic in Rochester, Minn.

For the investigation, a total of 940 women underwent mammography and molecular breast imaging.

All of the participants had previously been determined to have mammographically dense breasts and had at least one cancer risk factor, including personal or family history, genetic mutation, previous precancerous finding, a history of chest irradiation, or elevated risk by Gail model.

For MBI, the women were injected with 740 MBq of Tc-99m sestamibi. The location of accumulated radiotracer was then detected using two opposing semiconductor-based gamma cameras. The novel dual-camera configuration was developed at the Mayo Clinic and the sestamibi tracer was supplied by Bristol-Myers Squibb Co.

Craniocaudal and mediolateral oblique views of each breast were obtained (10 minutes per view). The MBIs were read by two radiologists, who were blinded to the mammographic interpretation and all ancillary patient information.

Breast cancer status for each participant was determined using a combination of pathology findings and clinical and/or imaging findings within a 15-month follow-up period.

In all, 13 cancers were diagnosed in 12 patients. Eight cancers were detected by MBI alone, two by both techniques, and two by mammography alone.

In the subset of 375 patients for whom more than 15 months of follow-up had passed since they had MBI, the sensitivity of MBI was 75%, compared with 25% for mammography. The specificity of MBI was 93%, compared with 91% for mammography.

Of the 17 biopsies prompted by mammography in 1.8% of patients, 18% were found to be positive for cancer (positive predictive value).

In comparison, of 36 biopsies that were prompted by MBI in 3.5% of patients, 28% were found to be positive for cancer (positive predictive value).

“To put this in context, probably somewhere in the range of 10%–15% of all breast cancers are clinically occult on mammography. … That is a more common problem in women who have dense breasts,” said moderator Dr. Eric Winer, who is the director of the Breast Oncology Center at the Dana-Farber Cancer Institute in Boston.

MBI was developed based on incidental findings on myocardial perfusion scans, which use Tc-99m sestamibi.

“The reason that MBI [was investigated for] breast imaging is that during cardiac scans in women, people noticed that there was uptake in breast cancers,” Dr. Hruska said.

Tumor uptake of the tracer appears to be “somewhat related to mitochondrial activity, but nobody really knows the true mechanism,” she added.

The researchers are also looking at alternative tracers. “One of them is very exciting. It actually is taken up in tumors based on their angiogenesis, so we think we can find even smaller cancers,” Dr. Hruska said.

The researchers disclosed that they had no conflicts of interest relevant to their study.

Molecular breast imaging (right) found a tumor (bottom arrow) that was not seen on standard mammography (left). Images courtesy Dr. Carrie B. Hruska

A novel imaging technique seems to be better than standard mammography at detecting breast cancer in high-risk women with dense breast tissue, according to findings from a study involving 940 women.

Molecular breast imaging detected three times as many cancers as mammography did in this group of women, Carrie B. Hruska, Ph.D., said at a media briefing on Sept. 3 that was held in advance of the American Society of Clinical Oncology's annual Breast Cancer Symposium.

“Molecular breast imaging may be a promising adjunct to screening mammography for women with dense breasts and who are at increased risk,” she said. It is estimated that roughly a quarter of women 40 years and older have dense breast patterns.

Molecular breast imaging (MBI) relies on increased uptake of the radiotracer Tc-99m sestamibi by cancer cells, compared with healthy breast tissue, to identify tumors that might go undetected by conventional mammography, according to Dr. Hruska, a research fellow in radiology at the Mayo Clinic in Rochester, Minn.

For the investigation, a total of 940 women underwent mammography and molecular breast imaging.

All of the participants had previously been determined to have mammographically dense breasts and had at least one cancer risk factor, including personal or family history, genetic mutation, previous precancerous finding, a history of chest irradiation, or elevated risk by Gail model.

For MBI, the women were injected with 740 MBq of Tc-99m sestamibi. The location of accumulated radiotracer was then detected using two opposing semiconductor-based gamma cameras. The novel dual-camera configuration was developed at the Mayo Clinic and the sestamibi tracer was supplied by Bristol-Myers Squibb Co.

Craniocaudal and mediolateral oblique views of each breast were obtained (10 minutes per view). The MBIs were read by two radiologists, who were blinded to the mammographic interpretation and all ancillary patient information.

Breast cancer status for each participant was determined using a combination of pathology findings and clinical and/or imaging findings within a 15-month follow-up period.

In all, 13 cancers were diagnosed in 12 patients. Eight cancers were detected by MBI alone, two by both techniques, and two by mammography alone.

In the subset of 375 patients for whom more than 15 months of follow-up had passed since they had MBI, the sensitivity of MBI was 75%, compared with 25% for mammography. The specificity of MBI was 93%, compared with 91% for mammography.

Of the 17 biopsies prompted by mammography in 1.8% of patients, 18% were found to be positive for cancer (positive predictive value).

In comparison, of 36 biopsies that were prompted by MBI in 3.5% of patients, 28% were found to be positive for cancer (positive predictive value).

“To put this in context, probably somewhere in the range of 10%–15% of all breast cancers are clinically occult on mammography. … That is a more common problem in women who have dense breasts,” said moderator Dr. Eric Winer, who is the director of the Breast Oncology Center at the Dana-Farber Cancer Institute in Boston.

MBI was developed based on incidental findings on myocardial perfusion scans, which use Tc-99m sestamibi.

“The reason that MBI [was investigated for] breast imaging is that during cardiac scans in women, people noticed that there was uptake in breast cancers,” Dr. Hruska said.

Tumor uptake of the tracer appears to be “somewhat related to mitochondrial activity, but nobody really knows the true mechanism,” she added.

The researchers are also looking at alternative tracers. “One of them is very exciting. It actually is taken up in tumors based on their angiogenesis, so we think we can find even smaller cancers,” Dr. Hruska said.

The researchers disclosed that they had no conflicts of interest relevant to their study.

Molecular breast imaging (right) found a tumor (bottom arrow) that was not seen on standard mammography (left). Images courtesy Dr. Carrie B. Hruska

A novel imaging technique seems to be better than standard mammography at detecting breast cancer in high-risk women with dense breast tissue, according to findings from a study involving 940 women.

Molecular breast imaging detected three times as many cancers as mammography did in this group of women, Carrie B. Hruska, Ph.D., said at a media briefing on Sept. 3 that was held in advance of the American Society of Clinical Oncology's annual Breast Cancer Symposium.

“Molecular breast imaging may be a promising adjunct to screening mammography for women with dense breasts and who are at increased risk,” she said. It is estimated that roughly a quarter of women 40 years and older have dense breast patterns.

Molecular breast imaging (MBI) relies on increased uptake of the radiotracer Tc-99m sestamibi by cancer cells, compared with healthy breast tissue, to identify tumors that might go undetected by conventional mammography, according to Dr. Hruska, a research fellow in radiology at the Mayo Clinic in Rochester, Minn.

For the investigation, a total of 940 women underwent mammography and molecular breast imaging.

All of the participants had previously been determined to have mammographically dense breasts and had at least one cancer risk factor, including personal or family history, genetic mutation, previous precancerous finding, a history of chest irradiation, or elevated risk by Gail model.

For MBI, the women were injected with 740 MBq of Tc-99m sestamibi. The location of accumulated radiotracer was then detected using two opposing semiconductor-based gamma cameras. The novel dual-camera configuration was developed at the Mayo Clinic and the sestamibi tracer was supplied by Bristol-Myers Squibb Co.

Craniocaudal and mediolateral oblique views of each breast were obtained (10 minutes per view). The MBIs were read by two radiologists, who were blinded to the mammographic interpretation and all ancillary patient information.

Breast cancer status for each participant was determined using a combination of pathology findings and clinical and/or imaging findings within a 15-month follow-up period.

In all, 13 cancers were diagnosed in 12 patients. Eight cancers were detected by MBI alone, two by both techniques, and two by mammography alone.

In the subset of 375 patients for whom more than 15 months of follow-up had passed since they had MBI, the sensitivity of MBI was 75%, compared with 25% for mammography. The specificity of MBI was 93%, compared with 91% for mammography.

Of the 17 biopsies prompted by mammography in 1.8% of patients, 18% were found to be positive for cancer (positive predictive value).

In comparison, of 36 biopsies that were prompted by MBI in 3.5% of patients, 28% were found to be positive for cancer (positive predictive value).

“To put this in context, probably somewhere in the range of 10%–15% of all breast cancers are clinically occult on mammography. … That is a more common problem in women who have dense breasts,” said moderator Dr. Eric Winer, who is the director of the Breast Oncology Center at the Dana-Farber Cancer Institute in Boston.

MBI was developed based on incidental findings on myocardial perfusion scans, which use Tc-99m sestamibi.

“The reason that MBI [was investigated for] breast imaging is that during cardiac scans in women, people noticed that there was uptake in breast cancers,” Dr. Hruska said.

Tumor uptake of the tracer appears to be “somewhat related to mitochondrial activity, but nobody really knows the true mechanism,” she added.

The researchers are also looking at alternative tracers. “One of them is very exciting. It actually is taken up in tumors based on their angiogenesis, so we think we can find even smaller cancers,” Dr. Hruska said.

The researchers disclosed that they had no conflicts of interest relevant to their study.

Molecular breast imaging (right) found a tumor (bottom arrow) that was not seen on standard mammography (left). Images courtesy Dr. Carrie B. Hruska

WASHINGTON – Drinking behavior varies considerably across Hispanic national groups, with Puerto Rican men, Mexican men, and Puerto Rican women at the greatest risk for binge drinking.

In a study of more than 5,000 Hispanics, Mexican American men reported the greatest rate of binge drinking at least once a month; Puerto Rican men reported the greatest rate of binge drinking less than once a month.

Among women, Puerto Ricans had the greatest rate of binge drinking less than once an month and at least once a month, reported Suhasini Ramisetty-Mikler, Ph.D., in a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism

Dr. Ramisetty-Mikler, of the epidemiology department at the University of Texas in Dallas, and her colleagues surveyed 5,224 individuals 18 years and older (50.3% male). Participants belonged to one of four Hispanic national groups: Puerto Ricans (25.6%), Cuban Americans (25.4%), Mexican Americans (24.7%), and South/Central Americans (24.4%). Participants lived in one of five metropolitan areas–Miami, New York, Philadelphia, Houston, and Los Angeles.

The surveys were computer-assisted personal interviews that lasted 1 hour on average and were conducted in the respondent's home.

Variables included in the model were drinking status (current, ex-drinkers, lifetime abstainers), average number of drinks per week (over the last 12 months), frequency of binge drinking (over the last 12 months), age of initiation, Hispanic national origin, birthplace, and other socioeconomic variables (age, marital status, education, income). Binge drinking was defined as four standard drinks for women or five standard drinks for men within a 2-hour period.

Overall, men had greater drinking rates than women. Drinking rates were greatest for younger individuals (18-29 years and 30-39 years). However, Mexican American women were an exception, with an increase in drinking among women aged 50 years and older.

The study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism.

WASHINGTON – Drinking behavior varies considerably across Hispanic national groups, with Puerto Rican men, Mexican men, and Puerto Rican women at the greatest risk for binge drinking.

In a study of more than 5,000 Hispanics, Mexican American men reported the greatest rate of binge drinking at least once a month; Puerto Rican men reported the greatest rate of binge drinking less than once a month.

Among women, Puerto Ricans had the greatest rate of binge drinking less than once an month and at least once a month, reported Suhasini Ramisetty-Mikler, Ph.D., in a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism

Dr. Ramisetty-Mikler, of the epidemiology department at the University of Texas in Dallas, and her colleagues surveyed 5,224 individuals 18 years and older (50.3% male). Participants belonged to one of four Hispanic national groups: Puerto Ricans (25.6%), Cuban Americans (25.4%), Mexican Americans (24.7%), and South/Central Americans (24.4%). Participants lived in one of five metropolitan areas–Miami, New York, Philadelphia, Houston, and Los Angeles.

The surveys were computer-assisted personal interviews that lasted 1 hour on average and were conducted in the respondent's home.

Variables included in the model were drinking status (current, ex-drinkers, lifetime abstainers), average number of drinks per week (over the last 12 months), frequency of binge drinking (over the last 12 months), age of initiation, Hispanic national origin, birthplace, and other socioeconomic variables (age, marital status, education, income). Binge drinking was defined as four standard drinks for women or five standard drinks for men within a 2-hour period.

Overall, men had greater drinking rates than women. Drinking rates were greatest for younger individuals (18-29 years and 30-39 years). However, Mexican American women were an exception, with an increase in drinking among women aged 50 years and older.

The study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism.

WASHINGTON – Drinking behavior varies considerably across Hispanic national groups, with Puerto Rican men, Mexican men, and Puerto Rican women at the greatest risk for binge drinking.

In a study of more than 5,000 Hispanics, Mexican American men reported the greatest rate of binge drinking at least once a month; Puerto Rican men reported the greatest rate of binge drinking less than once a month.

Among women, Puerto Ricans had the greatest rate of binge drinking less than once an month and at least once a month, reported Suhasini Ramisetty-Mikler, Ph.D., in a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism

Dr. Ramisetty-Mikler, of the epidemiology department at the University of Texas in Dallas, and her colleagues surveyed 5,224 individuals 18 years and older (50.3% male). Participants belonged to one of four Hispanic national groups: Puerto Ricans (25.6%), Cuban Americans (25.4%), Mexican Americans (24.7%), and South/Central Americans (24.4%). Participants lived in one of five metropolitan areas–Miami, New York, Philadelphia, Houston, and Los Angeles.

The surveys were computer-assisted personal interviews that lasted 1 hour on average and were conducted in the respondent's home.

Variables included in the model were drinking status (current, ex-drinkers, lifetime abstainers), average number of drinks per week (over the last 12 months), frequency of binge drinking (over the last 12 months), age of initiation, Hispanic national origin, birthplace, and other socioeconomic variables (age, marital status, education, income). Binge drinking was defined as four standard drinks for women or five standard drinks for men within a 2-hour period.

Overall, men had greater drinking rates than women. Drinking rates were greatest for younger individuals (18-29 years and 30-39 years). However, Mexican American women were an exception, with an increase in drinking among women aged 50 years and older.

The study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism.

WASHINGTON – Chronic medical conditions are very common among patients with co-occurring schizophrenia and alcohol use disorder. In one study of 80 patients, 83% of the patients had at least one chronic illness.

The most common chronic illnesses in the study were hypertension (46.3%), gastroesophageal reflex disease (26.3%), asthma (23.8%), hyperlipidemia (22.5%), and osteoarthritis/degenerative joint disease (21.3%), according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

“Comparing our sample to that of the CATIE (Clinical Antipsychotic Trials in Intervention Effectiveness) trial, medical illness burden appears to be markedly higher in patients with both schizophrenia and alcohol dependence than in patients with schizophrenia only,” wrote Dr. Zsuzsa S. Mezaros, who is with the psychiatry department of the State University of New York, Syracuse, and her colleagues.

The study involved 80 outpatients with schizophrenia or schizoaffective disorder and co-occurring alcohol dependence or abuse who were enrolled in a trial of directly monitored naltrexone treatment. Patients were prescribed antipsychotic medications by their clinical treatment providers. However, they were not prescribed acamprosate (Campral), naltrexone (Revia), or disulfiram (Antabuse).

Patients ranged in age from 18 to 69 years; mean age was 42. Almost three-quarters (72.5%) were male. Forty-five percent were white, 39% were African American, 2% were American Indian, and 14% were mixed or other. Slightly more than half (55%) had a diagnosis of schizophrenia; 45% had schizoaffective disorder.

Almost all (95%) were diagnosed with alcohol dependence; 5% were diagnosed with alcohol abuse. Roughly three-quarters (77.5%) reported having a primary care provider at the study start.

In the past 6 months, 26% reported a psychiatric hospitalization, 4% reported a medical hospitalization, and 3% reported a substance-related hospitalization. Also in the past 6 months, 29% reported an emergency department visit for medical reasons, and 16% reported an ED visit for psychiatric reasons.

Illness burden was predicted by demographic factors (e.g., age) and alcohol use severity (e.g., γ-glutamyl-transferase) and was less influenced by psychiatric severity. “The positive correlation between alcohol use severity and medical illness is mainly related to γ-glutamyl-transferase (GGT) levels, an objective measure of transaminase elevation possibly due to alcohol-related liver injury,” the researchers wrote.

Patient-reported levels of alcohol/drug use were not significantly related to medical severity. “This raises the possibility that biological markers of alcohol use may be a more reliable or sensitive correlate of medical status than self-report in patients with schizophrenia.”

The study was supported by a grant from the National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism.

WASHINGTON – Chronic medical conditions are very common among patients with co-occurring schizophrenia and alcohol use disorder. In one study of 80 patients, 83% of the patients had at least one chronic illness.

The most common chronic illnesses in the study were hypertension (46.3%), gastroesophageal reflex disease (26.3%), asthma (23.8%), hyperlipidemia (22.5%), and osteoarthritis/degenerative joint disease (21.3%), according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

“Comparing our sample to that of the CATIE (Clinical Antipsychotic Trials in Intervention Effectiveness) trial, medical illness burden appears to be markedly higher in patients with both schizophrenia and alcohol dependence than in patients with schizophrenia only,” wrote Dr. Zsuzsa S. Mezaros, who is with the psychiatry department of the State University of New York, Syracuse, and her colleagues.

The study involved 80 outpatients with schizophrenia or schizoaffective disorder and co-occurring alcohol dependence or abuse who were enrolled in a trial of directly monitored naltrexone treatment. Patients were prescribed antipsychotic medications by their clinical treatment providers. However, they were not prescribed acamprosate (Campral), naltrexone (Revia), or disulfiram (Antabuse).

Patients ranged in age from 18 to 69 years; mean age was 42. Almost three-quarters (72.5%) were male. Forty-five percent were white, 39% were African American, 2% were American Indian, and 14% were mixed or other. Slightly more than half (55%) had a diagnosis of schizophrenia; 45% had schizoaffective disorder.

Almost all (95%) were diagnosed with alcohol dependence; 5% were diagnosed with alcohol abuse. Roughly three-quarters (77.5%) reported having a primary care provider at the study start.

In the past 6 months, 26% reported a psychiatric hospitalization, 4% reported a medical hospitalization, and 3% reported a substance-related hospitalization. Also in the past 6 months, 29% reported an emergency department visit for medical reasons, and 16% reported an ED visit for psychiatric reasons.

Illness burden was predicted by demographic factors (e.g., age) and alcohol use severity (e.g., γ-glutamyl-transferase) and was less influenced by psychiatric severity. “The positive correlation between alcohol use severity and medical illness is mainly related to γ-glutamyl-transferase (GGT) levels, an objective measure of transaminase elevation possibly due to alcohol-related liver injury,” the researchers wrote.

Patient-reported levels of alcohol/drug use were not significantly related to medical severity. “This raises the possibility that biological markers of alcohol use may be a more reliable or sensitive correlate of medical status than self-report in patients with schizophrenia.”

The study was supported by a grant from the National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism.

WASHINGTON – Chronic medical conditions are very common among patients with co-occurring schizophrenia and alcohol use disorder. In one study of 80 patients, 83% of the patients had at least one chronic illness.

The most common chronic illnesses in the study were hypertension (46.3%), gastroesophageal reflex disease (26.3%), asthma (23.8%), hyperlipidemia (22.5%), and osteoarthritis/degenerative joint disease (21.3%), according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

“Comparing our sample to that of the CATIE (Clinical Antipsychotic Trials in Intervention Effectiveness) trial, medical illness burden appears to be markedly higher in patients with both schizophrenia and alcohol dependence than in patients with schizophrenia only,” wrote Dr. Zsuzsa S. Mezaros, who is with the psychiatry department of the State University of New York, Syracuse, and her colleagues.

The study involved 80 outpatients with schizophrenia or schizoaffective disorder and co-occurring alcohol dependence or abuse who were enrolled in a trial of directly monitored naltrexone treatment. Patients were prescribed antipsychotic medications by their clinical treatment providers. However, they were not prescribed acamprosate (Campral), naltrexone (Revia), or disulfiram (Antabuse).

Patients ranged in age from 18 to 69 years; mean age was 42. Almost three-quarters (72.5%) were male. Forty-five percent were white, 39% were African American, 2% were American Indian, and 14% were mixed or other. Slightly more than half (55%) had a diagnosis of schizophrenia; 45% had schizoaffective disorder.

Almost all (95%) were diagnosed with alcohol dependence; 5% were diagnosed with alcohol abuse. Roughly three-quarters (77.5%) reported having a primary care provider at the study start.

In the past 6 months, 26% reported a psychiatric hospitalization, 4% reported a medical hospitalization, and 3% reported a substance-related hospitalization. Also in the past 6 months, 29% reported an emergency department visit for medical reasons, and 16% reported an ED visit for psychiatric reasons.

Illness burden was predicted by demographic factors (e.g., age) and alcohol use severity (e.g., γ-glutamyl-transferase) and was less influenced by psychiatric severity. “The positive correlation between alcohol use severity and medical illness is mainly related to γ-glutamyl-transferase (GGT) levels, an objective measure of transaminase elevation possibly due to alcohol-related liver injury,” the researchers wrote.

Patient-reported levels of alcohol/drug use were not significantly related to medical severity. “This raises the possibility that biological markers of alcohol use may be a more reliable or sensitive correlate of medical status than self-report in patients with schizophrenia.”

The study was supported by a grant from the National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism.

BALTIMORE – Drinking clear liquors–such as vodka and gin–and drinking more than one type of alcoholic beverage are both associated with an increased risk of having a hangover among college students, even after controlling for the number of drinks.

Students who drank clear liquors were twice as likely to have a hangover as those who drank beer, even after controlling for the number of drinks, according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Likewise, consuming more than one type of beverage also was associated with hangover, even after controlling for the number of drinks.

“Although these results suggest that consuming more than one beverage type or consuming clear liquors is associated with hangover endorsement, it is not clear whether this is due to the specific beverages consumed or to other factors than may contribute to hangover, such as rate of consumption and drinking style,” wrote Amee J. Epler, a graduate student in psychological sciences at the University of Missouri, Columbia, and her colleagues.

The researchers studied the drinking habits of 127 students at a large Midwestern university over a 14-day period. The sample was predominantly white (85%), with slightly more women (61%). Smokers accounted for 43%.

The students monitored their experiences several times a day during a 14-day period using an electronic diary. The first question asked each day was whether the student had drunk alcohol on the previous day. Those who answered “yes” were asked several follow-up questions about the drinking episode: number of drinks, duration of the episode, types of beverages consumed, and presence of a hangover.

The researchers also found that women might be more susceptible to hangover at similar levels of consumption.

In addition, the students were asked about several hangover symptoms and mood states, regardless of whether they reported a hangover.

Hangover symptoms included these categories: “more tired than usual,” “headache,” “nauseous,” “very weak,” “extremely thirsty,” or “dehydrated.”

The mood states included “scared,” “upset,” “distressed,” “enthusiastic,” “interested,” and “proud.”

Almost three-quarters (73%) reported at least one drinking episode over the 14-day study; 41% reported at least one hangover. Among participants who reported at least one hangover, the number of hangovers ranged from one to seven (median two). Drinking episodes and reports of hangover were associated primarily with weekends–75% of each occurred on Fridays, Saturdays, or Sundays.

Students reporting a hangover consumed 10 drinks, compared with 6 drinks for those without a hangover. The number of drinks consumed was a significant predictor of hangover.

The most frequently consumed beverage was beer–74% of drinking records. Beer was followed by clear liquors (37%), dark liquors (24%), non-beer malt beverages (9%), white wine (6%), liqueur/schnapps (5%), and red wine (4%), the investigators found.

Symptoms more likely to be reported on hangover days included “extreme thirst or dehydration,” “more tired than usual,” “headache,” and “nausea.”

“Interestingly, none of the mood symptoms (with the possible exception of 'upset') were significantly associated with hangover,” the investigators wrote.

BALTIMORE – Drinking clear liquors–such as vodka and gin–and drinking more than one type of alcoholic beverage are both associated with an increased risk of having a hangover among college students, even after controlling for the number of drinks.

Students who drank clear liquors were twice as likely to have a hangover as those who drank beer, even after controlling for the number of drinks, according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Likewise, consuming more than one type of beverage also was associated with hangover, even after controlling for the number of drinks.

“Although these results suggest that consuming more than one beverage type or consuming clear liquors is associated with hangover endorsement, it is not clear whether this is due to the specific beverages consumed or to other factors than may contribute to hangover, such as rate of consumption and drinking style,” wrote Amee J. Epler, a graduate student in psychological sciences at the University of Missouri, Columbia, and her colleagues.

The researchers studied the drinking habits of 127 students at a large Midwestern university over a 14-day period. The sample was predominantly white (85%), with slightly more women (61%). Smokers accounted for 43%.

The students monitored their experiences several times a day during a 14-day period using an electronic diary. The first question asked each day was whether the student had drunk alcohol on the previous day. Those who answered “yes” were asked several follow-up questions about the drinking episode: number of drinks, duration of the episode, types of beverages consumed, and presence of a hangover.

The researchers also found that women might be more susceptible to hangover at similar levels of consumption.

In addition, the students were asked about several hangover symptoms and mood states, regardless of whether they reported a hangover.

Hangover symptoms included these categories: “more tired than usual,” “headache,” “nauseous,” “very weak,” “extremely thirsty,” or “dehydrated.”

The mood states included “scared,” “upset,” “distressed,” “enthusiastic,” “interested,” and “proud.”

Almost three-quarters (73%) reported at least one drinking episode over the 14-day study; 41% reported at least one hangover. Among participants who reported at least one hangover, the number of hangovers ranged from one to seven (median two). Drinking episodes and reports of hangover were associated primarily with weekends–75% of each occurred on Fridays, Saturdays, or Sundays.

Students reporting a hangover consumed 10 drinks, compared with 6 drinks for those without a hangover. The number of drinks consumed was a significant predictor of hangover.

The most frequently consumed beverage was beer–74% of drinking records. Beer was followed by clear liquors (37%), dark liquors (24%), non-beer malt beverages (9%), white wine (6%), liqueur/schnapps (5%), and red wine (4%), the investigators found.

Symptoms more likely to be reported on hangover days included “extreme thirst or dehydration,” “more tired than usual,” “headache,” and “nausea.”

“Interestingly, none of the mood symptoms (with the possible exception of 'upset') were significantly associated with hangover,” the investigators wrote.

BALTIMORE – Drinking clear liquors–such as vodka and gin–and drinking more than one type of alcoholic beverage are both associated with an increased risk of having a hangover among college students, even after controlling for the number of drinks.

Students who drank clear liquors were twice as likely to have a hangover as those who drank beer, even after controlling for the number of drinks, according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Likewise, consuming more than one type of beverage also was associated with hangover, even after controlling for the number of drinks.

“Although these results suggest that consuming more than one beverage type or consuming clear liquors is associated with hangover endorsement, it is not clear whether this is due to the specific beverages consumed or to other factors than may contribute to hangover, such as rate of consumption and drinking style,” wrote Amee J. Epler, a graduate student in psychological sciences at the University of Missouri, Columbia, and her colleagues.

The researchers studied the drinking habits of 127 students at a large Midwestern university over a 14-day period. The sample was predominantly white (85%), with slightly more women (61%). Smokers accounted for 43%.

The students monitored their experiences several times a day during a 14-day period using an electronic diary. The first question asked each day was whether the student had drunk alcohol on the previous day. Those who answered “yes” were asked several follow-up questions about the drinking episode: number of drinks, duration of the episode, types of beverages consumed, and presence of a hangover.

The researchers also found that women might be more susceptible to hangover at similar levels of consumption.

In addition, the students were asked about several hangover symptoms and mood states, regardless of whether they reported a hangover.

Hangover symptoms included these categories: “more tired than usual,” “headache,” “nauseous,” “very weak,” “extremely thirsty,” or “dehydrated.”

The mood states included “scared,” “upset,” “distressed,” “enthusiastic,” “interested,” and “proud.”

Almost three-quarters (73%) reported at least one drinking episode over the 14-day study; 41% reported at least one hangover. Among participants who reported at least one hangover, the number of hangovers ranged from one to seven (median two). Drinking episodes and reports of hangover were associated primarily with weekends–75% of each occurred on Fridays, Saturdays, or Sundays.

Students reporting a hangover consumed 10 drinks, compared with 6 drinks for those without a hangover. The number of drinks consumed was a significant predictor of hangover.

The most frequently consumed beverage was beer–74% of drinking records. Beer was followed by clear liquors (37%), dark liquors (24%), non-beer malt beverages (9%), white wine (6%), liqueur/schnapps (5%), and red wine (4%), the investigators found.

Symptoms more likely to be reported on hangover days included “extreme thirst or dehydration,” “more tired than usual,” “headache,” and “nausea.”

“Interestingly, none of the mood symptoms (with the possible exception of 'upset') were significantly associated with hangover,” the investigators wrote.

Cerebral amyloid angiopathy is associated with a high prevalence of markers of small-vessel disease, including white matter hyperintensities and cerebral microbleeds and is a major cause of lobar intracerebral hemorrhage and cognitive impairment in the elderly.

“Because CAA is a relatively homogeneous small-vessel disease of the brain, we wondered whether other markers, such as mean diffusivity, as measured by diffusion tensor imaging would be predictive of either the severity of CAA or cognitive impairment prior to large hemorrhages associated with CAA,” said Dr. Anand Viswanathan of the hemorrhagic stroke research program and the stroke service at Massachusetts General Hospital in Boston.

Diffusion tensor imaging (DTI) has already been used in a number of other small-vessel diseases to detect microstructural changes in cerebral tissue—even in areas that appear normal on conventional MRI. Dr. Viswanathan and his colleagues had previously studied patients with another small-vessel disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and had found a strong correlation between the apparent diffusion coefficient (ADC)—an average measure of water diffusion in all directions in brain tissue—and functional changes (see images). In fact, ADC changes were much more predictive of functional impairment than were white matter changes on fluid-attentuated inversion recovery (FLAIR) imaging, which are typically seen quite early in this disease process (Stroke 2007;38:1786-90).

For the current study, the researchers recruited subjects from an ongoing single-center, prospective longitudinal cohort study of CAA. The patients had to be at least 55 years of age at the time of presentation and have a symptomatic lobar intracerebral hemorrhage (ICH). They had MRI with diffusion-weighted sequences within 90 days of the index event. Those with other potential causes of ICH were excluded (Stroke 2008;39:1988-92).

Under the Boston Criteria, 5 of the patients had definite CAA with tissue diagnosis, 19 had probable, and 25 had possible. Pre-ICH cognitive function was assessed after an interview with patients and informants and review of medical records and results of a standardized questionnaire. Pre-ICH cognitive impairment was defined as the presence of deficits in memory or other cognitive areas sufficient to interfere with tasks of daily living before ICH.

Images were acquired with a 1.5T-scanner and included diffusion-weighted, FLAIR, and gradient echo. Mean ADC was determined for the hemisphere contralateral to the hema- toma. Seven of 10 patients (70%) with pre-ICH cognitive impairment had a diagnosis of probable CAA, compared with 11 of 38 (29%) without pre-ICH cognitive impairment. Patients with pre-ICH cognitive impairment had greater mean ADC values, compared with those without pre-ICH cognitive impairment.

After adjustment for age and amount of visible cerebral atrophy, only the mean ADC was independently associated with pre-ICH cognitive impairment. The effect of visible cerebral atrophy on pre-ICH cognitive impairment wasn't significant. “ADC changes [seem to] occur even in normal-appearing white matter, as [shown] by conventional FLAIR imaging, suggesting DTI may be more sensitive [for detecting] tissue changes in CAA and other small-vessel diseases in the brain,” Dr. Viswanathan said.

FLAIR imaging reveals areas of white matter hyperintensities in this patient with CAA.

Left to right: T1-weighted images show degree of brain atrophy, FLAIR shows WMH, and ADC maps show tissue microstructural changes. Images courtesy Dr. Anand Viswanathan

Cerebral amyloid angiopathy is associated with a high prevalence of markers of small-vessel disease, including white matter hyperintensities and cerebral microbleeds and is a major cause of lobar intracerebral hemorrhage and cognitive impairment in the elderly.

“Because CAA is a relatively homogeneous small-vessel disease of the brain, we wondered whether other markers, such as mean diffusivity, as measured by diffusion tensor imaging would be predictive of either the severity of CAA or cognitive impairment prior to large hemorrhages associated with CAA,” said Dr. Anand Viswanathan of the hemorrhagic stroke research program and the stroke service at Massachusetts General Hospital in Boston.

Diffusion tensor imaging (DTI) has already been used in a number of other small-vessel diseases to detect microstructural changes in cerebral tissue—even in areas that appear normal on conventional MRI. Dr. Viswanathan and his colleagues had previously studied patients with another small-vessel disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and had found a strong correlation between the apparent diffusion coefficient (ADC)—an average measure of water diffusion in all directions in brain tissue—and functional changes (see images). In fact, ADC changes were much more predictive of functional impairment than were white matter changes on fluid-attentuated inversion recovery (FLAIR) imaging, which are typically seen quite early in this disease process (Stroke 2007;38:1786-90).

For the current study, the researchers recruited subjects from an ongoing single-center, prospective longitudinal cohort study of CAA. The patients had to be at least 55 years of age at the time of presentation and have a symptomatic lobar intracerebral hemorrhage (ICH). They had MRI with diffusion-weighted sequences within 90 days of the index event. Those with other potential causes of ICH were excluded (Stroke 2008;39:1988-92).

Under the Boston Criteria, 5 of the patients had definite CAA with tissue diagnosis, 19 had probable, and 25 had possible. Pre-ICH cognitive function was assessed after an interview with patients and informants and review of medical records and results of a standardized questionnaire. Pre-ICH cognitive impairment was defined as the presence of deficits in memory or other cognitive areas sufficient to interfere with tasks of daily living before ICH.

Images were acquired with a 1.5T-scanner and included diffusion-weighted, FLAIR, and gradient echo. Mean ADC was determined for the hemisphere contralateral to the hema- toma. Seven of 10 patients (70%) with pre-ICH cognitive impairment had a diagnosis of probable CAA, compared with 11 of 38 (29%) without pre-ICH cognitive impairment. Patients with pre-ICH cognitive impairment had greater mean ADC values, compared with those without pre-ICH cognitive impairment.

After adjustment for age and amount of visible cerebral atrophy, only the mean ADC was independently associated with pre-ICH cognitive impairment. The effect of visible cerebral atrophy on pre-ICH cognitive impairment wasn't significant. “ADC changes [seem to] occur even in normal-appearing white matter, as [shown] by conventional FLAIR imaging, suggesting DTI may be more sensitive [for detecting] tissue changes in CAA and other small-vessel diseases in the brain,” Dr. Viswanathan said.

FLAIR imaging reveals areas of white matter hyperintensities in this patient with CAA.

Left to right: T1-weighted images show degree of brain atrophy, FLAIR shows WMH, and ADC maps show tissue microstructural changes. Images courtesy Dr. Anand Viswanathan

Cerebral amyloid angiopathy is associated with a high prevalence of markers of small-vessel disease, including white matter hyperintensities and cerebral microbleeds and is a major cause of lobar intracerebral hemorrhage and cognitive impairment in the elderly.

“Because CAA is a relatively homogeneous small-vessel disease of the brain, we wondered whether other markers, such as mean diffusivity, as measured by diffusion tensor imaging would be predictive of either the severity of CAA or cognitive impairment prior to large hemorrhages associated with CAA,” said Dr. Anand Viswanathan of the hemorrhagic stroke research program and the stroke service at Massachusetts General Hospital in Boston.

Diffusion tensor imaging (DTI) has already been used in a number of other small-vessel diseases to detect microstructural changes in cerebral tissue—even in areas that appear normal on conventional MRI. Dr. Viswanathan and his colleagues had previously studied patients with another small-vessel disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and had found a strong correlation between the apparent diffusion coefficient (ADC)—an average measure of water diffusion in all directions in brain tissue—and functional changes (see images). In fact, ADC changes were much more predictive of functional impairment than were white matter changes on fluid-attentuated inversion recovery (FLAIR) imaging, which are typically seen quite early in this disease process (Stroke 2007;38:1786-90).

For the current study, the researchers recruited subjects from an ongoing single-center, prospective longitudinal cohort study of CAA. The patients had to be at least 55 years of age at the time of presentation and have a symptomatic lobar intracerebral hemorrhage (ICH). They had MRI with diffusion-weighted sequences within 90 days of the index event. Those with other potential causes of ICH were excluded (Stroke 2008;39:1988-92).

Under the Boston Criteria, 5 of the patients had definite CAA with tissue diagnosis, 19 had probable, and 25 had possible. Pre-ICH cognitive function was assessed after an interview with patients and informants and review of medical records and results of a standardized questionnaire. Pre-ICH cognitive impairment was defined as the presence of deficits in memory or other cognitive areas sufficient to interfere with tasks of daily living before ICH.

Images were acquired with a 1.5T-scanner and included diffusion-weighted, FLAIR, and gradient echo. Mean ADC was determined for the hemisphere contralateral to the hema- toma. Seven of 10 patients (70%) with pre-ICH cognitive impairment had a diagnosis of probable CAA, compared with 11 of 38 (29%) without pre-ICH cognitive impairment. Patients with pre-ICH cognitive impairment had greater mean ADC values, compared with those without pre-ICH cognitive impairment.

After adjustment for age and amount of visible cerebral atrophy, only the mean ADC was independently associated with pre-ICH cognitive impairment. The effect of visible cerebral atrophy on pre-ICH cognitive impairment wasn't significant. “ADC changes [seem to] occur even in normal-appearing white matter, as [shown] by conventional FLAIR imaging, suggesting DTI may be more sensitive [for detecting] tissue changes in CAA and other small-vessel diseases in the brain,” Dr. Viswanathan said.

FLAIR imaging reveals areas of white matter hyperintensities in this patient with CAA.

Left to right: T1-weighted images show degree of brain atrophy, FLAIR shows WMH, and ADC maps show tissue microstructural changes. Images courtesy Dr. Anand Viswanathan

WASHINGTON — The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small study show.

Nondependent heavy drinkers taking varenicline (Chantix) were nine times more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4–8.

A total of 20 participants were enrolled—10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said. Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

The subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, flatulence, and vomiting. Dr. McKee said that she had no conflicts of interest.

WASHINGTON — The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small study show.

Nondependent heavy drinkers taking varenicline (Chantix) were nine times more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4–8.

A total of 20 participants were enrolled—10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said. Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

The subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, flatulence, and vomiting. Dr. McKee said that she had no conflicts of interest.

WASHINGTON — The antismoking drug varenicline also appears to curb alcohol cravings in smokers who are heavy drinkers, results of a small study show.

Nondependent heavy drinkers taking varenicline (Chantix) were nine times more likely to be abstinent during the 2-hour period of free access to alcoholic drinks than were those in the placebo group, based on logistic regression analysis, Sherry A. McKee, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants were male and female non-treatment seeking, nondependent heavy drinkers who also were daily smokers, said Dr. McKee of Yale University, New Haven, Conn.

Subjects were titrated to steady-state levels of varenicline (2 mg/day) or placebo over the course of a week. On day 8, all participants were given free access to cigarettes and were administered a priming drink, which was designed to raise blood alcohol levels to 0.03 g/dL.

Subjective and psychological responses to alcohol were then assessed. A 2-hour period of self-administration followed, during which time participants could choose to consume up to eight additional drinks (designed to raise blood alcohol levels by 0.015 g/dL) or to receive monetary reinforcement for drinks not consumed.

Participants had to have smoked at least 10 cigarettes/day for the last year. Men had to consume more than 14 drinks/week or 5 or more drinks on one occasion; women had to consume more than 7 drinks/week or 4 or more drinks on one occasion. Urine testing was used to assess varenicline compliance on days 4–8.

A total of 20 participants were enrolled—10 in each arm. The groups were matched in terms of age, gender, number of cigarettes per day, weekly frequency of drinking, and number of drinks per episode.

During the period of unrestricted access to alcohol, varenicline “significantly reduced drinking by about two drinks,” Dr. McKee said. Two subjects in the varenicline group consumed drinks, compared with seven in the placebo group. After the priming drink, no difference was found in blood alcohol levels between the two groups. However, a significant difference was found in alcohol craving. Those on varenicline reported a sharp decrease in alcohol craving; those on placebo reported an increase.

The subjective effects of alcohol remained steady for those in the varenicline group but increased in the placebo group. The difference was statistically significant. There was no effect of varenicline on tobacco craving in this period.

Adverse events were few and included nausea, sleep disturbance, abnormal dreams, constipation, flatulence, and vomiting. Dr. McKee said that she had no conflicts of interest.

CHICAGO – The prevalence of insomnia is roughly three times greater among cancer patients than it is among the general population, according to a secondary analysis of more than 500 patients.

The prevalence of insomnia that meets clinical criteria was 45.6% among cancer patients receiving chemotherapy, which compares with 19% in the general population. An additional 35% of cancer patients had insomnia symptoms, compared with 15% in the general population, reported Oxana Palesh, Ph.D., a radiation oncologist at the University of Rochester (N.Y.), at the annual meeting of the American Society of Clinical Oncology.

Roughly 80% of the patients continued to have insomnia problems throughout chemotherapy. “So insomnia does not go away on its own,” she said.

The researchers also found that the prevalence of insomnia was greatest among lung cancer patients (P less than .05). In addition, younger patients tended to have more insomnia (P less than .05). The researchers found no difference in the prevalence of insomnia between male and female cancer patients.

For the original study, 832 cancer patients were assessed during chemotherapy cycles 1 and 2.

Those found to have fatigue (547 patients) were randomized to receive either 20 mg paroxetine or placebo. Insomnia was assessed using the Hamilton Rating Scale for Depression (cycles 1, 2, 3, 4), and depression was assessed using the Center for Epidemiologic Studies-Depression scale. Fatigue was assessed using the Fatigue Symptom Checklist and the Multidimensional Assessment of Fatigue.

Patients were mostly female (72%) and white (89%), with a mean age of 57 years. Half had breast cancer, and overall 64% were undergoing adjuvant therapy. Fatigue and depression data were previously reported (J. Clin. Oncology 2003;21:4635-41). Although paroxetine did improve depressive symptoms, it had no effect on fatigue. In this analysis, the researchers reported that paroxetine had no significant effect on insomnia, compared with placebo.

Dr. Palesh reported that she has no relevant financial relationships.

CHICAGO – The prevalence of insomnia is roughly three times greater among cancer patients than it is among the general population, according to a secondary analysis of more than 500 patients.

The prevalence of insomnia that meets clinical criteria was 45.6% among cancer patients receiving chemotherapy, which compares with 19% in the general population. An additional 35% of cancer patients had insomnia symptoms, compared with 15% in the general population, reported Oxana Palesh, Ph.D., a radiation oncologist at the University of Rochester (N.Y.), at the annual meeting of the American Society of Clinical Oncology.

Roughly 80% of the patients continued to have insomnia problems throughout chemotherapy. “So insomnia does not go away on its own,” she said.

The researchers also found that the prevalence of insomnia was greatest among lung cancer patients (P less than .05). In addition, younger patients tended to have more insomnia (P less than .05). The researchers found no difference in the prevalence of insomnia between male and female cancer patients.

For the original study, 832 cancer patients were assessed during chemotherapy cycles 1 and 2.

Those found to have fatigue (547 patients) were randomized to receive either 20 mg paroxetine or placebo. Insomnia was assessed using the Hamilton Rating Scale for Depression (cycles 1, 2, 3, 4), and depression was assessed using the Center for Epidemiologic Studies-Depression scale. Fatigue was assessed using the Fatigue Symptom Checklist and the Multidimensional Assessment of Fatigue.

Patients were mostly female (72%) and white (89%), with a mean age of 57 years. Half had breast cancer, and overall 64% were undergoing adjuvant therapy. Fatigue and depression data were previously reported (J. Clin. Oncology 2003;21:4635-41). Although paroxetine did improve depressive symptoms, it had no effect on fatigue. In this analysis, the researchers reported that paroxetine had no significant effect on insomnia, compared with placebo.

Dr. Palesh reported that she has no relevant financial relationships.

CHICAGO – The prevalence of insomnia is roughly three times greater among cancer patients than it is among the general population, according to a secondary analysis of more than 500 patients.

The prevalence of insomnia that meets clinical criteria was 45.6% among cancer patients receiving chemotherapy, which compares with 19% in the general population. An additional 35% of cancer patients had insomnia symptoms, compared with 15% in the general population, reported Oxana Palesh, Ph.D., a radiation oncologist at the University of Rochester (N.Y.), at the annual meeting of the American Society of Clinical Oncology.

Roughly 80% of the patients continued to have insomnia problems throughout chemotherapy. “So insomnia does not go away on its own,” she said.

The researchers also found that the prevalence of insomnia was greatest among lung cancer patients (P less than .05). In addition, younger patients tended to have more insomnia (P less than .05). The researchers found no difference in the prevalence of insomnia between male and female cancer patients.

For the original study, 832 cancer patients were assessed during chemotherapy cycles 1 and 2.

Those found to have fatigue (547 patients) were randomized to receive either 20 mg paroxetine or placebo. Insomnia was assessed using the Hamilton Rating Scale for Depression (cycles 1, 2, 3, 4), and depression was assessed using the Center for Epidemiologic Studies-Depression scale. Fatigue was assessed using the Fatigue Symptom Checklist and the Multidimensional Assessment of Fatigue.

Patients were mostly female (72%) and white (89%), with a mean age of 57 years. Half had breast cancer, and overall 64% were undergoing adjuvant therapy. Fatigue and depression data were previously reported (J. Clin. Oncology 2003;21:4635-41). Although paroxetine did improve depressive symptoms, it had no effect on fatigue. In this analysis, the researchers reported that paroxetine had no significant effect on insomnia, compared with placebo.

Dr. Palesh reported that she has no relevant financial relationships.

WASHINGTON – Drug-using heavy drinkers who continue to get drunk at least weekly after alcohol treatment are more than four times as likely to engage in HIV-related sexual behaviors as are those who abstain after treatment, a study of more than 200 patients shows.

Among participants who got drunk at least weekly before treatment, those who continued to get drunk on a weekly basis were 4.3 times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers, after adjustment for pretreatment levels of risky sex and alcohol treatment duration.

Using the same model, researchers found that those who got drunk on a less-than-weekly basis were almost three times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers, according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Even after additional controlling for changes in illicit drug use, receipt of HIV services, mental health counseling, and demographics, those who continued to get drunk on a weekly basis after treatment were three times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers.

“Heavy drinkers with comorbid drug abuse problems who enter treatment maintain lower HIV risk behavior involvement 12 months post treatment. Continued heavy drinking substantially increased the likelihood of HIV risk behavior,” wrote Robert C. Freeman, Ph.D., and Daniel E. Falk, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md.

The data come from the National Institute of Drug Abuse's Drug Abuse Treatment Outcome Studies, which involved more than 10,000 adults who were entering drug abuse treatment programs in 11 U.S. cities between 1991 and 1993.

This subsample includes 236 individuals who received treatment and who got drunk at least weekly during the 12 months before treatment. They were also available for reinterview 12 months after treatment. These individuals also used drug such as marijuana/hashish/THC, crack/cocaine, heroin, narcotics/opiates, sedatives/tranquilizers, amphetamines/stimulants, hallucinogens, or inhalants.

Individuals were asked about risky sexual behavior associated with HIV exposure during the 12-month periods before and after treatment. Risky sexual behavior included sex for money/drugs, sex with a needle user, sex with an HIV-positive partner, sex with a partner who had sex with a prostitute, sex with a partner who exchanged money/drugs for sex, or sex with two or more partners with no or inconsistent condom use.

Based on reported drinking status and frequency of drunkenness (before and after treatment), individuals were categorized as abstainers, drinkers but without drunkenness, drinking 1–51 days per year (less than weekly), and drinking at least 52 times per year (weekly). Almost three-quarters of the participants were male (72%). Slightly more than half of the participants were white (55%), followed by African American (33%), Hispanic (10%), and other (2%). Almost three-quarters (73%) participated in alcohol treatment lasting 2 months or less.

After treatment, 43% were abstinent, 31% drank less than weekly, 13% drank at least weekly, and 13% drank but not to drunkenness. In terms of drug use, half (49%) decreased their drug use from weekly to less than weekly. However, 31% continued to use drugs weekly, 18% continued to use drugs on a less-than-weekly basis, and 2% increased their use from less than weekly to weekly. Three-quarters (74%) received HIV-related services, which could include scheduled services for HIV infection/AIDS or services concerning how to reduce the risk of spreading HIV.

Slightly more than half (53%) received non-mental health-related counseling.

The prevalence of risky sexual behavior before and after alcohol treatment was 59% and 37%, respectively. Among individuals who reported weekly drunkenness prior to treatment, those who reported abstaining post treatment had a 33% decrease in the prevalence of risky sexual behavior, followed by those who drank without drunkenness (31%), those who drank less than weekly (12%), and those who drank at least weekly (1%).

WASHINGTON – Drug-using heavy drinkers who continue to get drunk at least weekly after alcohol treatment are more than four times as likely to engage in HIV-related sexual behaviors as are those who abstain after treatment, a study of more than 200 patients shows.

Among participants who got drunk at least weekly before treatment, those who continued to get drunk on a weekly basis were 4.3 times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers, after adjustment for pretreatment levels of risky sex and alcohol treatment duration.

Using the same model, researchers found that those who got drunk on a less-than-weekly basis were almost three times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers, according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Even after additional controlling for changes in illicit drug use, receipt of HIV services, mental health counseling, and demographics, those who continued to get drunk on a weekly basis after treatment were three times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers.

“Heavy drinkers with comorbid drug abuse problems who enter treatment maintain lower HIV risk behavior involvement 12 months post treatment. Continued heavy drinking substantially increased the likelihood of HIV risk behavior,” wrote Robert C. Freeman, Ph.D., and Daniel E. Falk, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md.

The data come from the National Institute of Drug Abuse's Drug Abuse Treatment Outcome Studies, which involved more than 10,000 adults who were entering drug abuse treatment programs in 11 U.S. cities between 1991 and 1993.

This subsample includes 236 individuals who received treatment and who got drunk at least weekly during the 12 months before treatment. They were also available for reinterview 12 months after treatment. These individuals also used drug such as marijuana/hashish/THC, crack/cocaine, heroin, narcotics/opiates, sedatives/tranquilizers, amphetamines/stimulants, hallucinogens, or inhalants.

Individuals were asked about risky sexual behavior associated with HIV exposure during the 12-month periods before and after treatment. Risky sexual behavior included sex for money/drugs, sex with a needle user, sex with an HIV-positive partner, sex with a partner who had sex with a prostitute, sex with a partner who exchanged money/drugs for sex, or sex with two or more partners with no or inconsistent condom use.

Based on reported drinking status and frequency of drunkenness (before and after treatment), individuals were categorized as abstainers, drinkers but without drunkenness, drinking 1–51 days per year (less than weekly), and drinking at least 52 times per year (weekly). Almost three-quarters of the participants were male (72%). Slightly more than half of the participants were white (55%), followed by African American (33%), Hispanic (10%), and other (2%). Almost three-quarters (73%) participated in alcohol treatment lasting 2 months or less.

After treatment, 43% were abstinent, 31% drank less than weekly, 13% drank at least weekly, and 13% drank but not to drunkenness. In terms of drug use, half (49%) decreased their drug use from weekly to less than weekly. However, 31% continued to use drugs weekly, 18% continued to use drugs on a less-than-weekly basis, and 2% increased their use from less than weekly to weekly. Three-quarters (74%) received HIV-related services, which could include scheduled services for HIV infection/AIDS or services concerning how to reduce the risk of spreading HIV.

Slightly more than half (53%) received non-mental health-related counseling.

The prevalence of risky sexual behavior before and after alcohol treatment was 59% and 37%, respectively. Among individuals who reported weekly drunkenness prior to treatment, those who reported abstaining post treatment had a 33% decrease in the prevalence of risky sexual behavior, followed by those who drank without drunkenness (31%), those who drank less than weekly (12%), and those who drank at least weekly (1%).

WASHINGTON – Drug-using heavy drinkers who continue to get drunk at least weekly after alcohol treatment are more than four times as likely to engage in HIV-related sexual behaviors as are those who abstain after treatment, a study of more than 200 patients shows.

Among participants who got drunk at least weekly before treatment, those who continued to get drunk on a weekly basis were 4.3 times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers, after adjustment for pretreatment levels of risky sex and alcohol treatment duration.

Using the same model, researchers found that those who got drunk on a less-than-weekly basis were almost three times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers, according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Even after additional controlling for changes in illicit drug use, receipt of HIV services, mental health counseling, and demographics, those who continued to get drunk on a weekly basis after treatment were three times as likely to engage in risky sexual behaviors at 12-month follow-up as were abstainers.

“Heavy drinkers with comorbid drug abuse problems who enter treatment maintain lower HIV risk behavior involvement 12 months post treatment. Continued heavy drinking substantially increased the likelihood of HIV risk behavior,” wrote Robert C. Freeman, Ph.D., and Daniel E. Falk, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md.

The data come from the National Institute of Drug Abuse's Drug Abuse Treatment Outcome Studies, which involved more than 10,000 adults who were entering drug abuse treatment programs in 11 U.S. cities between 1991 and 1993.

This subsample includes 236 individuals who received treatment and who got drunk at least weekly during the 12 months before treatment. They were also available for reinterview 12 months after treatment. These individuals also used drug such as marijuana/hashish/THC, crack/cocaine, heroin, narcotics/opiates, sedatives/tranquilizers, amphetamines/stimulants, hallucinogens, or inhalants.

Individuals were asked about risky sexual behavior associated with HIV exposure during the 12-month periods before and after treatment. Risky sexual behavior included sex for money/drugs, sex with a needle user, sex with an HIV-positive partner, sex with a partner who had sex with a prostitute, sex with a partner who exchanged money/drugs for sex, or sex with two or more partners with no or inconsistent condom use.

Based on reported drinking status and frequency of drunkenness (before and after treatment), individuals were categorized as abstainers, drinkers but without drunkenness, drinking 1–51 days per year (less than weekly), and drinking at least 52 times per year (weekly). Almost three-quarters of the participants were male (72%). Slightly more than half of the participants were white (55%), followed by African American (33%), Hispanic (10%), and other (2%). Almost three-quarters (73%) participated in alcohol treatment lasting 2 months or less.

After treatment, 43% were abstinent, 31% drank less than weekly, 13% drank at least weekly, and 13% drank but not to drunkenness. In terms of drug use, half (49%) decreased their drug use from weekly to less than weekly. However, 31% continued to use drugs weekly, 18% continued to use drugs on a less-than-weekly basis, and 2% increased their use from less than weekly to weekly. Three-quarters (74%) received HIV-related services, which could include scheduled services for HIV infection/AIDS or services concerning how to reduce the risk of spreading HIV.

Slightly more than half (53%) received non-mental health-related counseling.

The prevalence of risky sexual behavior before and after alcohol treatment was 59% and 37%, respectively. Among individuals who reported weekly drunkenness prior to treatment, those who reported abstaining post treatment had a 33% decrease in the prevalence of risky sexual behavior, followed by those who drank without drunkenness (31%), those who drank less than weekly (12%), and those who drank at least weekly (1%).

WASHINGTON – Tobacco use and the expectation of social and physical pleasure from alcohol consumption significantly predict the transition to heavy drinking among adolescents and young adults, a 5-year study of more than 200 people shows.

Tobacco use (100 or more cigarettes lifetime) and alcohol expectancies for social/physical pleasure significantly predicted increased rates of transition from first drink to heavy drinking with hazard ratios of 1.64 and 1.06 (P is less than .05), reported Karen G. Chartier, Ph.D., of the University of Connecticut Health Center in Farmington.

Interestingly, an early age of first drink (younger than 15 years) significantly predicted decreased rates of progression to heavy drinking, with a hazard ratio of 0.51 (P is less than .05).

The data were presented as a poster at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants in the study came from a community sample drawn from the greater Hartford, Conn., area. Initially, participants interviewed were between the ages of 13 and 21 years. Five years later, they were interviewed again. A total of 281 completed the second interview.

The researchers looked at a number of potential risk factors for progression to heavy drinking, including gender, parental history of alcoholism, disinhibition and thrill/adventure seeking, conduct disorder, negative affectivity, age of first drink, positive alcohol expectancies, marijuana use, and tobacco use.

At the 5-year follow-up, almost all (96%) reported ever having had a drink. Of these, slightly more were female (60%). More were white (62%) followed by black (23%), Hispanic (13%), and other (2%). The average age at follow-up was 16.5 years. The average age of the first drink was 15.5 years. The average number of drinks per day was 1.5, and the average number of drinks per occasion was 3.

Of those who reported ever drinking, one-third (35%) were heavy drinkers, defined as consuming alcohol at least 4 days per week and consuming three or more drinks per day. The average age of onset for heavy drinking was 20 years. The median time from the first drink to the start of heavy drinking was 9 years.

The study results suggest that interventions for heavy drinking in adolescence might need to target positive beliefs about alcohol, co-occurring tobacco use, and sensation-seeking behaviors, the researchers noted.

WASHINGTON – Tobacco use and the expectation of social and physical pleasure from alcohol consumption significantly predict the transition to heavy drinking among adolescents and young adults, a 5-year study of more than 200 people shows.

Tobacco use (100 or more cigarettes lifetime) and alcohol expectancies for social/physical pleasure significantly predicted increased rates of transition from first drink to heavy drinking with hazard ratios of 1.64 and 1.06 (P is less than .05), reported Karen G. Chartier, Ph.D., of the University of Connecticut Health Center in Farmington.

Interestingly, an early age of first drink (younger than 15 years) significantly predicted decreased rates of progression to heavy drinking, with a hazard ratio of 0.51 (P is less than .05).

The data were presented as a poster at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants in the study came from a community sample drawn from the greater Hartford, Conn., area. Initially, participants interviewed were between the ages of 13 and 21 years. Five years later, they were interviewed again. A total of 281 completed the second interview.

The researchers looked at a number of potential risk factors for progression to heavy drinking, including gender, parental history of alcoholism, disinhibition and thrill/adventure seeking, conduct disorder, negative affectivity, age of first drink, positive alcohol expectancies, marijuana use, and tobacco use.

At the 5-year follow-up, almost all (96%) reported ever having had a drink. Of these, slightly more were female (60%). More were white (62%) followed by black (23%), Hispanic (13%), and other (2%). The average age at follow-up was 16.5 years. The average age of the first drink was 15.5 years. The average number of drinks per day was 1.5, and the average number of drinks per occasion was 3.

Of those who reported ever drinking, one-third (35%) were heavy drinkers, defined as consuming alcohol at least 4 days per week and consuming three or more drinks per day. The average age of onset for heavy drinking was 20 years. The median time from the first drink to the start of heavy drinking was 9 years.

The study results suggest that interventions for heavy drinking in adolescence might need to target positive beliefs about alcohol, co-occurring tobacco use, and sensation-seeking behaviors, the researchers noted.

WASHINGTON – Tobacco use and the expectation of social and physical pleasure from alcohol consumption significantly predict the transition to heavy drinking among adolescents and young adults, a 5-year study of more than 200 people shows.

Tobacco use (100 or more cigarettes lifetime) and alcohol expectancies for social/physical pleasure significantly predicted increased rates of transition from first drink to heavy drinking with hazard ratios of 1.64 and 1.06 (P is less than .05), reported Karen G. Chartier, Ph.D., of the University of Connecticut Health Center in Farmington.

Interestingly, an early age of first drink (younger than 15 years) significantly predicted decreased rates of progression to heavy drinking, with a hazard ratio of 0.51 (P is less than .05).

The data were presented as a poster at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.

Participants in the study came from a community sample drawn from the greater Hartford, Conn., area. Initially, participants interviewed were between the ages of 13 and 21 years. Five years later, they were interviewed again. A total of 281 completed the second interview.

The researchers looked at a number of potential risk factors for progression to heavy drinking, including gender, parental history of alcoholism, disinhibition and thrill/adventure seeking, conduct disorder, negative affectivity, age of first drink, positive alcohol expectancies, marijuana use, and tobacco use.

At the 5-year follow-up, almost all (96%) reported ever having had a drink. Of these, slightly more were female (60%). More were white (62%) followed by black (23%), Hispanic (13%), and other (2%). The average age at follow-up was 16.5 years. The average age of the first drink was 15.5 years. The average number of drinks per day was 1.5, and the average number of drinks per occasion was 3.

Of those who reported ever drinking, one-third (35%) were heavy drinkers, defined as consuming alcohol at least 4 days per week and consuming three or more drinks per day. The average age of onset for heavy drinking was 20 years. The median time from the first drink to the start of heavy drinking was 9 years.

The study results suggest that interventions for heavy drinking in adolescence might need to target positive beliefs about alcohol, co-occurring tobacco use, and sensation-seeking behaviors, the researchers noted.

WASHINGTON — Identifying newly admitted patients who are colonized with Staphylococcus aureus and beginning decolonization within the first 24 hours can reduce nosocomial infections by almost two-thirds, according to the results of a randomized study of more than 900 patients.

The occurrence of nosocomial S. aureus infection in patients at risk for such infections “can be reduced by almost 60% if carriers are treated with mupirocin and chlorhexidine within 24 hours of admission,” Dr. Lonneke Bode said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

In the trial, Dr. Bode and her colleagues evaluated whether the identification of S. aureus carriers by using real-time polymerase chain reaction (PCR) on nasal specimens, followed by prompt treatment with mupirocin nasal ointment and chlorhexidine gluconate medicated soap, reduced the risk of nosocomial S. aureus infection in carriers.

Several earlier studies looked at the decolonization of newly admitted patients, but the results to date have been mixed. “Our study differed from previous studies in several aspects,” noted Dr. Bode of the department of medical microbiology and infectious diseases at Erasmus Medical Centre, Rotterdam, the Netherlands.

First, they targeted only nasal S. aureus carriers for intervention. Second, they assessed carriage using real-time PCR on the day of admission, allowing decolonization of carriers to be started within 24 hours of admission. Third, they aimed to eradicate S. aureus carriage not only from the nose but also from the skin. This was accomplished by using twice-daily intranasal mupirocin in combination with daily total body washes using chlorhexidine soap for 5 days. Last, recolonization of patients with extended hospital stays was prevented by repeating this procedure at weeks 3 and 6.

The trial was conducted at three university hospitals and two general hospitals in the Netherlands. They included patients from wards predetermined to have a high incidence of S. aureus nosocomial infections. Immediately on admission, a nasal swab was collected and assessed by PCR. A total of 6,771 patients was assessed between October 2005 and June 2007.

Patients who were positive for S. aureus were randomized to the intervention or to placebo nasal treatment and soap. Intervention or placebo was started within 24 hours of admission, in patients with an expected length of stay of at least 4 days. Exclusion criteria included S. aureus infection at the time of randomization and the use of mupirocin in the preceding 4 weeks. Patients were followed for up to 6 weeks after discharge. Nosocomial infections were defined by Centers for Disease Control and Prevention criteria.

In all, 917 patients were randomized—504 to the intervention and 413 to placebo. The S. aureus infection rate was 3.4% in the intervention group and 7.7% in the placebo group, a difference that was statistically significant. This resulted in a relative risk of infection of 0.42 with the intervention.

Though most of the infections were endogenous, the number of endogenous infections was significantly lower in the intervention group (2%) than in the placebo group (6%). The relative risk of endogenous infection with the intervention was 0.39.

Surgical site infections also were significantly less common in the intervention group (2%) than in the placebo group (7%), for a relative risk of 0.30.

Although there was no significant difference between the two groups in terms of all-cause mortality, the mean length of stay was significantly shorter for the intervention group (12 days), compared with the placebo group (14 days).

Dr. Bode did not report whether she had any potential conflicts of interest.

WASHINGTON — Identifying newly admitted patients who are colonized with Staphylococcus aureus and beginning decolonization within the first 24 hours can reduce nosocomial infections by almost two-thirds, according to the results of a randomized study of more than 900 patients.

The occurrence of nosocomial S. aureus infection in patients at risk for such infections “can be reduced by almost 60% if carriers are treated with mupirocin and chlorhexidine within 24 hours of admission,” Dr. Lonneke Bode said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

In the trial, Dr. Bode and her colleagues evaluated whether the identification of S. aureus carriers by using real-time polymerase chain reaction (PCR) on nasal specimens, followed by prompt treatment with mupirocin nasal ointment and chlorhexidine gluconate medicated soap, reduced the risk of nosocomial S. aureus infection in carriers.

Several earlier studies looked at the decolonization of newly admitted patients, but the results to date have been mixed. “Our study differed from previous studies in several aspects,” noted Dr. Bode of the department of medical microbiology and infectious diseases at Erasmus Medical Centre, Rotterdam, the Netherlands.

First, they targeted only nasal S. aureus carriers for intervention. Second, they assessed carriage using real-time PCR on the day of admission, allowing decolonization of carriers to be started within 24 hours of admission. Third, they aimed to eradicate S. aureus carriage not only from the nose but also from the skin. This was accomplished by using twice-daily intranasal mupirocin in combination with daily total body washes using chlorhexidine soap for 5 days. Last, recolonization of patients with extended hospital stays was prevented by repeating this procedure at weeks 3 and 6.

The trial was conducted at three university hospitals and two general hospitals in the Netherlands. They included patients from wards predetermined to have a high incidence of S. aureus nosocomial infections. Immediately on admission, a nasal swab was collected and assessed by PCR. A total of 6,771 patients was assessed between October 2005 and June 2007.

Patients who were positive for S. aureus were randomized to the intervention or to placebo nasal treatment and soap. Intervention or placebo was started within 24 hours of admission, in patients with an expected length of stay of at least 4 days. Exclusion criteria included S. aureus infection at the time of randomization and the use of mupirocin in the preceding 4 weeks. Patients were followed for up to 6 weeks after discharge. Nosocomial infections were defined by Centers for Disease Control and Prevention criteria.

In all, 917 patients were randomized—504 to the intervention and 413 to placebo. The S. aureus infection rate was 3.4% in the intervention group and 7.7% in the placebo group, a difference that was statistically significant. This resulted in a relative risk of infection of 0.42 with the intervention.

Though most of the infections were endogenous, the number of endogenous infections was significantly lower in the intervention group (2%) than in the placebo group (6%). The relative risk of endogenous infection with the intervention was 0.39.

Surgical site infections also were significantly less common in the intervention group (2%) than in the placebo group (7%), for a relative risk of 0.30.

Although there was no significant difference between the two groups in terms of all-cause mortality, the mean length of stay was significantly shorter for the intervention group (12 days), compared with the placebo group (14 days).

Dr. Bode did not report whether she had any potential conflicts of interest.

WASHINGTON — Identifying newly admitted patients who are colonized with Staphylococcus aureus and beginning decolonization within the first 24 hours can reduce nosocomial infections by almost two-thirds, according to the results of a randomized study of more than 900 patients.

The occurrence of nosocomial S. aureus infection in patients at risk for such infections “can be reduced by almost 60% if carriers are treated with mupirocin and chlorhexidine within 24 hours of admission,” Dr. Lonneke Bode said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

In the trial, Dr. Bode and her colleagues evaluated whether the identification of S. aureus carriers by using real-time polymerase chain reaction (PCR) on nasal specimens, followed by prompt treatment with mupirocin nasal ointment and chlorhexidine gluconate medicated soap, reduced the risk of nosocomial S. aureus infection in carriers.

Several earlier studies looked at the decolonization of newly admitted patients, but the results to date have been mixed. “Our study differed from previous studies in several aspects,” noted Dr. Bode of the department of medical microbiology and infectious diseases at Erasmus Medical Centre, Rotterdam, the Netherlands.

First, they targeted only nasal S. aureus carriers for intervention. Second, they assessed carriage using real-time PCR on the day of admission, allowing decolonization of carriers to be started within 24 hours of admission. Third, they aimed to eradicate S. aureus carriage not only from the nose but also from the skin. This was accomplished by using twice-daily intranasal mupirocin in combination with daily total body washes using chlorhexidine soap for 5 days. Last, recolonization of patients with extended hospital stays was prevented by repeating this procedure at weeks 3 and 6.

The trial was conducted at three university hospitals and two general hospitals in the Netherlands. They included patients from wards predetermined to have a high incidence of S. aureus nosocomial infections. Immediately on admission, a nasal swab was collected and assessed by PCR. A total of 6,771 patients was assessed between October 2005 and June 2007.

Patients who were positive for S. aureus were randomized to the intervention or to placebo nasal treatment and soap. Intervention or placebo was started within 24 hours of admission, in patients with an expected length of stay of at least 4 days. Exclusion criteria included S. aureus infection at the time of randomization and the use of mupirocin in the preceding 4 weeks. Patients were followed for up to 6 weeks after discharge. Nosocomial infections were defined by Centers for Disease Control and Prevention criteria.

In all, 917 patients were randomized—504 to the intervention and 413 to placebo. The S. aureus infection rate was 3.4% in the intervention group and 7.7% in the placebo group, a difference that was statistically significant. This resulted in a relative risk of infection of 0.42 with the intervention.

Though most of the infections were endogenous, the number of endogenous infections was significantly lower in the intervention group (2%) than in the placebo group (6%). The relative risk of endogenous infection with the intervention was 0.39.

Surgical site infections also were significantly less common in the intervention group (2%) than in the placebo group (7%), for a relative risk of 0.30.

Although there was no significant difference between the two groups in terms of all-cause mortality, the mean length of stay was significantly shorter for the intervention group (12 days), compared with the placebo group (14 days).

Dr. Bode did not report whether she had any potential conflicts of interest.