Lorinda Bullock

WASHINGTON – As researchers take a closer look at stress in families with children who have cerebral palsy, they are finding that parents – particularly those with children who have the greatest activity limitations – expressed a need for more resources on coping strategies and ways to ease their burden.

Previous studies that focus on stress in families of children with CP have either examined a large age range of children, or focused on a particular age group such as preschoolers or infants. Meanwhile, there is a lack of studies on school-aged children with CP and their families, Dr. Annette Majnemer said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine. “We need vigilance in terms of ongoing evaluation of family functioning in all stages.”

Dr. Majnemer of the School of Physical and Occupational Therapy at McGill University in Montreal, and her colleagues, found that nearly half of families with children who have CP exhibit a high level of stress. Parents of 95 children aged 6-12 years with CP were recruited for the study and asked to complete questionnaires. About 82%-92% completed all three measures on the Parenting Stress Index (PSI), Impact on Family (IOF) Scale, and Child Health Questionnaire (CHQ). Forty-five percent of parents were described as “highly stressed” and 11% were described as “defensive,” as measured by the PSI.

About half of the parents (49%-59%) said their children’s health “impacted on their time, emotional status, and family activities, but not family cohesion.”

Sociodemographics were not important and did not play a role in the levels of stress in this study. However, parents of children with gross motor difficulties and activity limitations tended to report higher levels of stress, Dr. Majnemer said. Hyperactivity and conduct was associated with the disruption of family cohesion, she said. “Internalizing behavior problems contributed to higher emotional effect on the family.”

Child factors associated with better family functioning were higher cognitive ability and prosocial behaviors. “If a child was very good at socializing with others, the family had less strain,” the occupational therapist said.

Dr. Majnemer said she had no relevant disclosures. The study was funded by the Cerebral Palsy International Research Foundation.

WASHINGTON – As researchers take a closer look at stress in families with children who have cerebral palsy, they are finding that parents – particularly those with children who have the greatest activity limitations – expressed a need for more resources on coping strategies and ways to ease their burden.

Previous studies that focus on stress in families of children with CP have either examined a large age range of children, or focused on a particular age group such as preschoolers or infants. Meanwhile, there is a lack of studies on school-aged children with CP and their families, Dr. Annette Majnemer said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine. “We need vigilance in terms of ongoing evaluation of family functioning in all stages.”

Dr. Majnemer of the School of Physical and Occupational Therapy at McGill University in Montreal, and her colleagues, found that nearly half of families with children who have CP exhibit a high level of stress. Parents of 95 children aged 6-12 years with CP were recruited for the study and asked to complete questionnaires. About 82%-92% completed all three measures on the Parenting Stress Index (PSI), Impact on Family (IOF) Scale, and Child Health Questionnaire (CHQ). Forty-five percent of parents were described as “highly stressed” and 11% were described as “defensive,” as measured by the PSI.

About half of the parents (49%-59%) said their children’s health “impacted on their time, emotional status, and family activities, but not family cohesion.”

Sociodemographics were not important and did not play a role in the levels of stress in this study. However, parents of children with gross motor difficulties and activity limitations tended to report higher levels of stress, Dr. Majnemer said. Hyperactivity and conduct was associated with the disruption of family cohesion, she said. “Internalizing behavior problems contributed to higher emotional effect on the family.”

Child factors associated with better family functioning were higher cognitive ability and prosocial behaviors. “If a child was very good at socializing with others, the family had less strain,” the occupational therapist said.

Dr. Majnemer said she had no relevant disclosures. The study was funded by the Cerebral Palsy International Research Foundation.

WASHINGTON – As researchers take a closer look at stress in families with children who have cerebral palsy, they are finding that parents – particularly those with children who have the greatest activity limitations – expressed a need for more resources on coping strategies and ways to ease their burden.

Previous studies that focus on stress in families of children with CP have either examined a large age range of children, or focused on a particular age group such as preschoolers or infants. Meanwhile, there is a lack of studies on school-aged children with CP and their families, Dr. Annette Majnemer said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine. “We need vigilance in terms of ongoing evaluation of family functioning in all stages.”

Dr. Majnemer of the School of Physical and Occupational Therapy at McGill University in Montreal, and her colleagues, found that nearly half of families with children who have CP exhibit a high level of stress. Parents of 95 children aged 6-12 years with CP were recruited for the study and asked to complete questionnaires. About 82%-92% completed all three measures on the Parenting Stress Index (PSI), Impact on Family (IOF) Scale, and Child Health Questionnaire (CHQ). Forty-five percent of parents were described as “highly stressed” and 11% were described as “defensive,” as measured by the PSI.

About half of the parents (49%-59%) said their children’s health “impacted on their time, emotional status, and family activities, but not family cohesion.”

Sociodemographics were not important and did not play a role in the levels of stress in this study. However, parents of children with gross motor difficulties and activity limitations tended to report higher levels of stress, Dr. Majnemer said. Hyperactivity and conduct was associated with the disruption of family cohesion, she said. “Internalizing behavior problems contributed to higher emotional effect on the family.”

Child factors associated with better family functioning were higher cognitive ability and prosocial behaviors. “If a child was very good at socializing with others, the family had less strain,” the occupational therapist said.

Dr. Majnemer said she had no relevant disclosures. The study was funded by the Cerebral Palsy International Research Foundation.

WASHINGTON – The use of virtual reality games not only improved functional balance and mobility in adolescents with cerebral palsy, but also had lasting effects even 1 month after training.

Dr. Marie Brien of the Ottawa (Ont.) Children’s Treatment Centre, said these results are promising, especially for adolescents with CP who tend to have a “lack of motivation and engagement.”

According to Dr. Brien, this age group has been reported to reach a plateau in gross motor skills, and virtual reality can open the door for occupational therapists to give these youngsters more intensive therapy. Adolescents with CP do “respond to short duration and high intensity virtual reality training,” she said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

Although it was a small study of four males aged 13-18 years, the results were significant for every participant, Dr. Brien said.

After a month of 90-minute intensive virtual reality-based training (two 45-minute daily training sessions for 5 consecutive days), the participants showed improvement in Community Balance and Mobility Scale (CB&M) scores and the 6-Minute Walking Test (6MWT). In fact, improvement in both measures for all patients was seen as early as week 1.

Three of the adolescents were diagnosed with spastic diplegia and one with choreoathetosis. To assess balance and functional mobility, Dr. Brien and her colleagues used the CB&M, the 6MWT, the Timed Up and Down Stairs (TUDS) test, and the Gross Motor Function Measure (GMFM)–Dimension E. Each participant served as his own control, Dr. Brien said.

The patients chose from a variety of 2D scenarios including soccer (goalie), snowboarding, and “shark bait.” They were evaluated between three and six times in the baseline phase, five times in the intervention phase, and four times in the follow-up phase (three times at 1 week and once at 1-month post training). GestureTek’s Interactive Rehabilitation and Exercise System (IREX) applications lasted 2 minutes, and patients were given a 10-second rest interval between each application.

“The virtual reality scenarios presented ever-changing challenges,” Dr. Brien said, including repeated sustained and unpredictable patterns of movement such as side lunges or rapid changes in direction.

Difficulty and speed increased as the participant skill level improved. There were also statistically significant improvements for one patient in the TUDS, and for another in the GMFM–Dimension E test.

Dr. Brien reported no relevant disclosures.

WASHINGTON – The use of virtual reality games not only improved functional balance and mobility in adolescents with cerebral palsy, but also had lasting effects even 1 month after training.

Dr. Marie Brien of the Ottawa (Ont.) Children’s Treatment Centre, said these results are promising, especially for adolescents with CP who tend to have a “lack of motivation and engagement.”

According to Dr. Brien, this age group has been reported to reach a plateau in gross motor skills, and virtual reality can open the door for occupational therapists to give these youngsters more intensive therapy. Adolescents with CP do “respond to short duration and high intensity virtual reality training,” she said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

Although it was a small study of four males aged 13-18 years, the results were significant for every participant, Dr. Brien said.

After a month of 90-minute intensive virtual reality-based training (two 45-minute daily training sessions for 5 consecutive days), the participants showed improvement in Community Balance and Mobility Scale (CB&M) scores and the 6-Minute Walking Test (6MWT). In fact, improvement in both measures for all patients was seen as early as week 1.

Three of the adolescents were diagnosed with spastic diplegia and one with choreoathetosis. To assess balance and functional mobility, Dr. Brien and her colleagues used the CB&M, the 6MWT, the Timed Up and Down Stairs (TUDS) test, and the Gross Motor Function Measure (GMFM)–Dimension E. Each participant served as his own control, Dr. Brien said.

The patients chose from a variety of 2D scenarios including soccer (goalie), snowboarding, and “shark bait.” They were evaluated between three and six times in the baseline phase, five times in the intervention phase, and four times in the follow-up phase (three times at 1 week and once at 1-month post training). GestureTek’s Interactive Rehabilitation and Exercise System (IREX) applications lasted 2 minutes, and patients were given a 10-second rest interval between each application.

“The virtual reality scenarios presented ever-changing challenges,” Dr. Brien said, including repeated sustained and unpredictable patterns of movement such as side lunges or rapid changes in direction.

Difficulty and speed increased as the participant skill level improved. There were also statistically significant improvements for one patient in the TUDS, and for another in the GMFM–Dimension E test.

Dr. Brien reported no relevant disclosures.

WASHINGTON – The use of virtual reality games not only improved functional balance and mobility in adolescents with cerebral palsy, but also had lasting effects even 1 month after training.

Dr. Marie Brien of the Ottawa (Ont.) Children’s Treatment Centre, said these results are promising, especially for adolescents with CP who tend to have a “lack of motivation and engagement.”

According to Dr. Brien, this age group has been reported to reach a plateau in gross motor skills, and virtual reality can open the door for occupational therapists to give these youngsters more intensive therapy. Adolescents with CP do “respond to short duration and high intensity virtual reality training,” she said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

Although it was a small study of four males aged 13-18 years, the results were significant for every participant, Dr. Brien said.

After a month of 90-minute intensive virtual reality-based training (two 45-minute daily training sessions for 5 consecutive days), the participants showed improvement in Community Balance and Mobility Scale (CB&M) scores and the 6-Minute Walking Test (6MWT). In fact, improvement in both measures for all patients was seen as early as week 1.

Three of the adolescents were diagnosed with spastic diplegia and one with choreoathetosis. To assess balance and functional mobility, Dr. Brien and her colleagues used the CB&M, the 6MWT, the Timed Up and Down Stairs (TUDS) test, and the Gross Motor Function Measure (GMFM)–Dimension E. Each participant served as his own control, Dr. Brien said.

The patients chose from a variety of 2D scenarios including soccer (goalie), snowboarding, and “shark bait.” They were evaluated between three and six times in the baseline phase, five times in the intervention phase, and four times in the follow-up phase (three times at 1 week and once at 1-month post training). GestureTek’s Interactive Rehabilitation and Exercise System (IREX) applications lasted 2 minutes, and patients were given a 10-second rest interval between each application.

“The virtual reality scenarios presented ever-changing challenges,” Dr. Brien said, including repeated sustained and unpredictable patterns of movement such as side lunges or rapid changes in direction.

Difficulty and speed increased as the participant skill level improved. There were also statistically significant improvements for one patient in the TUDS, and for another in the GMFM–Dimension E test.

Dr. Brien reported no relevant disclosures.

WASHINGTON – Hospital stays for children with cerebral palsy are getting shorter, but the costs for those stays are steadily increasing, putting an even greater financial burden on a population that accounts for a large percentage of all pediatric medical costs.

Inpatient charges for the care of children with cerebral palsy is on pace to increase faster than the rate of inflation, said Dr. Amy Newmeyer of Ohio State University, Columbus.

“Because there’s not a cure [for cerebral palsy], the economic burden over a lifetime is high,” she said at the American Academy for Cerebral Palsy and Developmental Medicine meeting. According to data from a national cost analysis developed by Dr. Newmeyer and her colleagues, in the mid-1990s, lifetime health care costs for children with CP were estimated at $500,000 per patient. By 2006, the estimated pediatric inpatient cost for CP exceeded $810 million per year.

Thirteen percent of all children are considered Children with Special Health Care Needs (CSHCN), but they account for about 70% of all pediatric medical costs. Of the children that fall into that category, cerebral palsy represents the highest costs of 18 evaluated congenital disorders. Dr. Newmeyer and her colleagues extracted data from the Kids’ Inpatient Database of the Healthcare Costs and Utilization Project (HCUP-KID) for the years 1997, 2000, 2003, and 2006.

In 2006, there were 37,006 hospital admissions of children with CP – this may include multiple admissions for a single child, Dr. Newmeyer noted. The length of stay did decrease from 6.22 days to 5.84 days, yet hospital charges per day increased 48% from $2,989 in 1997 to $4,411 in 2006. All of the data were corrected for an estimated 5% per year health care inflation rate.

Dr. Newmeyer reported children’s hospitals showed the largest increases in total charge per admission, compared with general hospitals. The mean charge per stay at children’s hospitals increased from $19,258 in 1997 to $24,328 in 2006.

The most common admissions were lower respiratory infections (20%) and epilepsy (17%) among this population. Dr. Newmeyer emphasized the importance of improving comprehensive and outpatient care to help reduce the number of potentially preventable admissions.

Dr. Newmeyer said she had no relevant disclosures.

WASHINGTON – Hospital stays for children with cerebral palsy are getting shorter, but the costs for those stays are steadily increasing, putting an even greater financial burden on a population that accounts for a large percentage of all pediatric medical costs.

Inpatient charges for the care of children with cerebral palsy is on pace to increase faster than the rate of inflation, said Dr. Amy Newmeyer of Ohio State University, Columbus.

“Because there’s not a cure [for cerebral palsy], the economic burden over a lifetime is high,” she said at the American Academy for Cerebral Palsy and Developmental Medicine meeting. According to data from a national cost analysis developed by Dr. Newmeyer and her colleagues, in the mid-1990s, lifetime health care costs for children with CP were estimated at $500,000 per patient. By 2006, the estimated pediatric inpatient cost for CP exceeded $810 million per year.

Thirteen percent of all children are considered Children with Special Health Care Needs (CSHCN), but they account for about 70% of all pediatric medical costs. Of the children that fall into that category, cerebral palsy represents the highest costs of 18 evaluated congenital disorders. Dr. Newmeyer and her colleagues extracted data from the Kids’ Inpatient Database of the Healthcare Costs and Utilization Project (HCUP-KID) for the years 1997, 2000, 2003, and 2006.

In 2006, there were 37,006 hospital admissions of children with CP – this may include multiple admissions for a single child, Dr. Newmeyer noted. The length of stay did decrease from 6.22 days to 5.84 days, yet hospital charges per day increased 48% from $2,989 in 1997 to $4,411 in 2006. All of the data were corrected for an estimated 5% per year health care inflation rate.

Dr. Newmeyer reported children’s hospitals showed the largest increases in total charge per admission, compared with general hospitals. The mean charge per stay at children’s hospitals increased from $19,258 in 1997 to $24,328 in 2006.

The most common admissions were lower respiratory infections (20%) and epilepsy (17%) among this population. Dr. Newmeyer emphasized the importance of improving comprehensive and outpatient care to help reduce the number of potentially preventable admissions.

Dr. Newmeyer said she had no relevant disclosures.

WASHINGTON – Hospital stays for children with cerebral palsy are getting shorter, but the costs for those stays are steadily increasing, putting an even greater financial burden on a population that accounts for a large percentage of all pediatric medical costs.

Inpatient charges for the care of children with cerebral palsy is on pace to increase faster than the rate of inflation, said Dr. Amy Newmeyer of Ohio State University, Columbus.

“Because there’s not a cure [for cerebral palsy], the economic burden over a lifetime is high,” she said at the American Academy for Cerebral Palsy and Developmental Medicine meeting. According to data from a national cost analysis developed by Dr. Newmeyer and her colleagues, in the mid-1990s, lifetime health care costs for children with CP were estimated at $500,000 per patient. By 2006, the estimated pediatric inpatient cost for CP exceeded $810 million per year.

Thirteen percent of all children are considered Children with Special Health Care Needs (CSHCN), but they account for about 70% of all pediatric medical costs. Of the children that fall into that category, cerebral palsy represents the highest costs of 18 evaluated congenital disorders. Dr. Newmeyer and her colleagues extracted data from the Kids’ Inpatient Database of the Healthcare Costs and Utilization Project (HCUP-KID) for the years 1997, 2000, 2003, and 2006.

In 2006, there were 37,006 hospital admissions of children with CP – this may include multiple admissions for a single child, Dr. Newmeyer noted. The length of stay did decrease from 6.22 days to 5.84 days, yet hospital charges per day increased 48% from $2,989 in 1997 to $4,411 in 2006. All of the data were corrected for an estimated 5% per year health care inflation rate.

Dr. Newmeyer reported children’s hospitals showed the largest increases in total charge per admission, compared with general hospitals. The mean charge per stay at children’s hospitals increased from $19,258 in 1997 to $24,328 in 2006.

The most common admissions were lower respiratory infections (20%) and epilepsy (17%) among this population. Dr. Newmeyer emphasized the importance of improving comprehensive and outpatient care to help reduce the number of potentially preventable admissions.

Dr. Newmeyer said she had no relevant disclosures.

In an effort to gather important data to help better recognize risk factors and other problems facing Americans with amyotrophic lateral sclerosis, the federal Agency for Toxic Substances and Disease Registry has launched the National ALS Registry.

The agency announced the registry’s launch in a written statement Oct. 20 in which it said it is seeking information that can “help researchers evaluate shared risk factors common among patients such as heredity or possible environmental exposures, and help estimate the number of ALS cases diagnosed each year.”

Christopher Portier, Ph.D., the agency’s director, explained that the registry will seek to understand pathogenic mechanisms of the disease. “Presently, the cause or causes of ALS are largely unknown; this registry is our first nation-wide effort to enhance our knowledge about this disease,” he said in the statement.

“The more people participate in the registry, the more comprehensive and diverse that data will be to help researchers and physicians better understand the disease,” Kevin Horton, DrPH, the agency’s ALS program administrator, noted in the statement. Dr. Horton added that the registry can also help researchers share information and promote more clinical trials in this area.

According to the ATSDR, each registry entry will include a patient health history, work experiences, and family medical histories. All information will be confidential and will not be released publicly. Patients who want to participate are encouraged to visit www.cdc.gov/als to register.

ALS –also known as Lou Gehrig’s disease – is considered one of the most common neuromuscular diseases worldwide, and it is estimated that 30,000 people currently live with the disease in the United States. According to the Centers for Disease Control and Prevention, about 5,000 people are diagnosed with ALS each year.

In an effort to gather important data to help better recognize risk factors and other problems facing Americans with amyotrophic lateral sclerosis, the federal Agency for Toxic Substances and Disease Registry has launched the National ALS Registry.

The agency announced the registry’s launch in a written statement Oct. 20 in which it said it is seeking information that can “help researchers evaluate shared risk factors common among patients such as heredity or possible environmental exposures, and help estimate the number of ALS cases diagnosed each year.”

Christopher Portier, Ph.D., the agency’s director, explained that the registry will seek to understand pathogenic mechanisms of the disease. “Presently, the cause or causes of ALS are largely unknown; this registry is our first nation-wide effort to enhance our knowledge about this disease,” he said in the statement.

“The more people participate in the registry, the more comprehensive and diverse that data will be to help researchers and physicians better understand the disease,” Kevin Horton, DrPH, the agency’s ALS program administrator, noted in the statement. Dr. Horton added that the registry can also help researchers share information and promote more clinical trials in this area.

According to the ATSDR, each registry entry will include a patient health history, work experiences, and family medical histories. All information will be confidential and will not be released publicly. Patients who want to participate are encouraged to visit www.cdc.gov/als to register.

ALS –also known as Lou Gehrig’s disease – is considered one of the most common neuromuscular diseases worldwide, and it is estimated that 30,000 people currently live with the disease in the United States. According to the Centers for Disease Control and Prevention, about 5,000 people are diagnosed with ALS each year.

In an effort to gather important data to help better recognize risk factors and other problems facing Americans with amyotrophic lateral sclerosis, the federal Agency for Toxic Substances and Disease Registry has launched the National ALS Registry.

The agency announced the registry’s launch in a written statement Oct. 20 in which it said it is seeking information that can “help researchers evaluate shared risk factors common among patients such as heredity or possible environmental exposures, and help estimate the number of ALS cases diagnosed each year.”

Christopher Portier, Ph.D., the agency’s director, explained that the registry will seek to understand pathogenic mechanisms of the disease. “Presently, the cause or causes of ALS are largely unknown; this registry is our first nation-wide effort to enhance our knowledge about this disease,” he said in the statement.

“The more people participate in the registry, the more comprehensive and diverse that data will be to help researchers and physicians better understand the disease,” Kevin Horton, DrPH, the agency’s ALS program administrator, noted in the statement. Dr. Horton added that the registry can also help researchers share information and promote more clinical trials in this area.

According to the ATSDR, each registry entry will include a patient health history, work experiences, and family medical histories. All information will be confidential and will not be released publicly. Patients who want to participate are encouraged to visit www.cdc.gov/als to register.

ALS –also known as Lou Gehrig’s disease – is considered one of the most common neuromuscular diseases worldwide, and it is estimated that 30,000 people currently live with the disease in the United States. According to the Centers for Disease Control and Prevention, about 5,000 people are diagnosed with ALS each year.

WASHINGTON – Over the last decade, researchers have been steadily building a case for the use of cerebral and whole-body cooling to treat neonatal hypoxic-ischemic encephalopathy, said Dr. David Durand, director of neonatology at the Children’s Hospital and Research Center, Oakland, Calif.

“I think cooling is here to stay, in the [neonatal intensive care unit] and immediately out of the delivery room,” he said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine. “The consensus is pretty clear that cooling is no longer experimental.”

Cerebral cooling may aid in slowing the inflammation in the brain that leads to cell death in newborns who have moderate to severe hypoxic-ischemic encephalopathy, Dr. Durand said. In one study, cerebral cooling was shown to safely improve survival in 234 term infants with less-severe abnormalities on amplitude integrated electroencephalography (aEEG). The study found that death or severe disability occurred in 55% of the infants who were treated with cooling, compared with 66% of the controls, at 18 months’ follow-up (Lancet 2005;365:663-70).

Cooling should begin within 90 minutes of the acute event, and the brain must remain at 32°-34° C to offer adequate neuroprotection. If the cooling process is started later than 8 hours after birth, its neuroprotective value is lost completely, Dr. Durand said.

Previous studies have shown that neuronal death occurs in two phases after a reversible hypoxic-ischemic global insult. The first phase, “primary neuronal death,” is related to cellular hypoxia with exhaustion of the cell’s energy stores (Cochrane Database Syst. Rev. 2007 [doi:10.1002/14651858.CD003311.pub2]).

During the second phase – the next 6-48 hours – delayed neuronal death begins, according to the Cochrane review. Cerebral cooling that is applied during the first period of injury may help prevent the “secondary cascade,” Dr. Durand said. The second phase “is associated with encephalopathy and increased seizure activity, and accounts for a significant proportion of the final cell loss even after very severe insults,” he said.

Whole-body cooling also may be effective for these patients, Dr. Durand said. A randomized study of the use of cooling blankets at 33.5° C for 72 hours showed that death or severe disability occurred in 45 of the 102 infants (44%) who had the intervention, compared with 64 of the 103 patients (62%) in the control group. In all, 24 infants (24%) in the cooling group died, compared with 38 (37%) in the control group (N. Engl. J. Med. 2005;353:1574-84).

For babies who need a number of other tests, whole-body cooling provides easier access, Dr. Durand noted.

“Cooling is not all that hard to do [but] only should be done in a well-organized program,” he emphasized.

Other therapies for treatment of hypoxic-ischemic encephalopathy are also emerging. In one Chinese randomized trial, newborns who were treated with erythropoietin had less mortality or moderate/severe disability outcomes, compared with infants who were given conventional treatment. The infants were given either 300 U/kg (n = 52) or 500 U/kg (n = 31) every other day for 2 weeks, beginning less than 48 hours after birth. Death or moderate/severe disability occurred in 18 of 73 infants (24.6%) in the erythropoietin group, compared with 35 of 80 infants (43.8%) in the control group, with no adverse effects reported (Pediatrics 2009;124;e218-e226).

Dr. Durand said he had no relevant conflicts of interest.

WASHINGTON – Over the last decade, researchers have been steadily building a case for the use of cerebral and whole-body cooling to treat neonatal hypoxic-ischemic encephalopathy, said Dr. David Durand, director of neonatology at the Children’s Hospital and Research Center, Oakland, Calif.

“I think cooling is here to stay, in the [neonatal intensive care unit] and immediately out of the delivery room,” he said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine. “The consensus is pretty clear that cooling is no longer experimental.”

Cerebral cooling may aid in slowing the inflammation in the brain that leads to cell death in newborns who have moderate to severe hypoxic-ischemic encephalopathy, Dr. Durand said. In one study, cerebral cooling was shown to safely improve survival in 234 term infants with less-severe abnormalities on amplitude integrated electroencephalography (aEEG). The study found that death or severe disability occurred in 55% of the infants who were treated with cooling, compared with 66% of the controls, at 18 months’ follow-up (Lancet 2005;365:663-70).

Cooling should begin within 90 minutes of the acute event, and the brain must remain at 32°-34° C to offer adequate neuroprotection. If the cooling process is started later than 8 hours after birth, its neuroprotective value is lost completely, Dr. Durand said.

Previous studies have shown that neuronal death occurs in two phases after a reversible hypoxic-ischemic global insult. The first phase, “primary neuronal death,” is related to cellular hypoxia with exhaustion of the cell’s energy stores (Cochrane Database Syst. Rev. 2007 [doi:10.1002/14651858.CD003311.pub2]).

During the second phase – the next 6-48 hours – delayed neuronal death begins, according to the Cochrane review. Cerebral cooling that is applied during the first period of injury may help prevent the “secondary cascade,” Dr. Durand said. The second phase “is associated with encephalopathy and increased seizure activity, and accounts for a significant proportion of the final cell loss even after very severe insults,” he said.

Whole-body cooling also may be effective for these patients, Dr. Durand said. A randomized study of the use of cooling blankets at 33.5° C for 72 hours showed that death or severe disability occurred in 45 of the 102 infants (44%) who had the intervention, compared with 64 of the 103 patients (62%) in the control group. In all, 24 infants (24%) in the cooling group died, compared with 38 (37%) in the control group (N. Engl. J. Med. 2005;353:1574-84).

For babies who need a number of other tests, whole-body cooling provides easier access, Dr. Durand noted.

“Cooling is not all that hard to do [but] only should be done in a well-organized program,” he emphasized.

Other therapies for treatment of hypoxic-ischemic encephalopathy are also emerging. In one Chinese randomized trial, newborns who were treated with erythropoietin had less mortality or moderate/severe disability outcomes, compared with infants who were given conventional treatment. The infants were given either 300 U/kg (n = 52) or 500 U/kg (n = 31) every other day for 2 weeks, beginning less than 48 hours after birth. Death or moderate/severe disability occurred in 18 of 73 infants (24.6%) in the erythropoietin group, compared with 35 of 80 infants (43.8%) in the control group, with no adverse effects reported (Pediatrics 2009;124;e218-e226).

Dr. Durand said he had no relevant conflicts of interest.

WASHINGTON – Over the last decade, researchers have been steadily building a case for the use of cerebral and whole-body cooling to treat neonatal hypoxic-ischemic encephalopathy, said Dr. David Durand, director of neonatology at the Children’s Hospital and Research Center, Oakland, Calif.

“I think cooling is here to stay, in the [neonatal intensive care unit] and immediately out of the delivery room,” he said at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine. “The consensus is pretty clear that cooling is no longer experimental.”

Cerebral cooling may aid in slowing the inflammation in the brain that leads to cell death in newborns who have moderate to severe hypoxic-ischemic encephalopathy, Dr. Durand said. In one study, cerebral cooling was shown to safely improve survival in 234 term infants with less-severe abnormalities on amplitude integrated electroencephalography (aEEG). The study found that death or severe disability occurred in 55% of the infants who were treated with cooling, compared with 66% of the controls, at 18 months’ follow-up (Lancet 2005;365:663-70).

Cooling should begin within 90 minutes of the acute event, and the brain must remain at 32°-34° C to offer adequate neuroprotection. If the cooling process is started later than 8 hours after birth, its neuroprotective value is lost completely, Dr. Durand said.

Previous studies have shown that neuronal death occurs in two phases after a reversible hypoxic-ischemic global insult. The first phase, “primary neuronal death,” is related to cellular hypoxia with exhaustion of the cell’s energy stores (Cochrane Database Syst. Rev. 2007 [doi:10.1002/14651858.CD003311.pub2]).

During the second phase – the next 6-48 hours – delayed neuronal death begins, according to the Cochrane review. Cerebral cooling that is applied during the first period of injury may help prevent the “secondary cascade,” Dr. Durand said. The second phase “is associated with encephalopathy and increased seizure activity, and accounts for a significant proportion of the final cell loss even after very severe insults,” he said.

Whole-body cooling also may be effective for these patients, Dr. Durand said. A randomized study of the use of cooling blankets at 33.5° C for 72 hours showed that death or severe disability occurred in 45 of the 102 infants (44%) who had the intervention, compared with 64 of the 103 patients (62%) in the control group. In all, 24 infants (24%) in the cooling group died, compared with 38 (37%) in the control group (N. Engl. J. Med. 2005;353:1574-84).

For babies who need a number of other tests, whole-body cooling provides easier access, Dr. Durand noted.

“Cooling is not all that hard to do [but] only should be done in a well-organized program,” he emphasized.

Other therapies for treatment of hypoxic-ischemic encephalopathy are also emerging. In one Chinese randomized trial, newborns who were treated with erythropoietin had less mortality or moderate/severe disability outcomes, compared with infants who were given conventional treatment. The infants were given either 300 U/kg (n = 52) or 500 U/kg (n = 31) every other day for 2 weeks, beginning less than 48 hours after birth. Death or moderate/severe disability occurred in 18 of 73 infants (24.6%) in the erythropoietin group, compared with 35 of 80 infants (43.8%) in the control group, with no adverse effects reported (Pediatrics 2009;124;e218-e226).

Dr. Durand said he had no relevant conflicts of interest.

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

Louise A. Koenig

According to the CDC’s Morbidity and Mortality Weekly Report, released Oct. 7, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years “no later than the 2009-10 season” were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-09 season to 55.7% in 2009-2010. Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.” The last CDC update on influenza activity was July 30, 2010.

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

Louise A. Koenig

According to the CDC’s Morbidity and Mortality Weekly Report, released Oct. 7, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years “no later than the 2009-10 season” were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-09 season to 55.7% in 2009-2010. Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.” The last CDC update on influenza activity was July 30, 2010.

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

Louise A. Koenig

According to the CDC’s Morbidity and Mortality Weekly Report, released Oct. 7, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years “no later than the 2009-10 season” were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-09 season to 55.7% in 2009-2010. Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.” The last CDC update on influenza activity was July 30, 2010.

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

Louise A. Koenig

According to the CDC’s Morbidity and Mortality Weekly Report, released Oct. 7, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years “no later than the 2009-10 season” were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-09 season to 55.7% in 2009-2010. Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.” The last CDC update on influenza activity was July 30, 2010.

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

Louise A. Koenig

According to the CDC’s Morbidity and Mortality Weekly Report, released Oct. 7, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years “no later than the 2009-10 season” were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-09 season to 55.7% in 2009-2010. Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.” The last CDC update on influenza activity was July 30, 2010.

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

Louise A. Koenig

According to the CDC’s Morbidity and Mortality Weekly Report, released Oct. 7, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years “no later than the 2009-10 season” were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-09 season to 55.7% in 2009-2010. Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.” The last CDC update on influenza activity was July 30, 2010.

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly because of H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

According to the CDC's Morbidity and Mortality Weekly Report, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009–2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008–2009 season. The researchers also determined that full vaccination coverage was low during the 2009–2010 season, ranging from 34.7% among children aged 6–23 months to 15.3% among children aged 13–18 years (MMWR 2010;59:1266–9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5–18 years "no later than the 2009–10 season" were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5–12 years showed the largest increase in vaccination coverage − 19.0% to 27.1% over the last two flu seasons – while coverage among children 6–23 months only increased from 55.2% in the 2008–2009 season to 55.7% in 2009–2010. Seasonal flu vaccination coverage among children aged 2–4 years and 13–18 years increased at similar rates: 38.4% (from 33.0% in 2008–2009) and 15.3% (from 10.9%), respectively.

"The increase in coverage from the 2008–09 season to the 2009–10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons," the report said.

"These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage," the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include "vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs."

In other influenza news announced in the same weekly report (MMWR 2010;59:1270–3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, "with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating."

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly because of H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

According to the CDC's Morbidity and Mortality Weekly Report, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009–2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008–2009 season. The researchers also determined that full vaccination coverage was low during the 2009–2010 season, ranging from 34.7% among children aged 6–23 months to 15.3% among children aged 13–18 years (MMWR 2010;59:1266–9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5–18 years "no later than the 2009–10 season" were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5–12 years showed the largest increase in vaccination coverage − 19.0% to 27.1% over the last two flu seasons – while coverage among children 6–23 months only increased from 55.2% in the 2008–2009 season to 55.7% in 2009–2010. Seasonal flu vaccination coverage among children aged 2–4 years and 13–18 years increased at similar rates: 38.4% (from 33.0% in 2008–2009) and 15.3% (from 10.9%), respectively.

"The increase in coverage from the 2008–09 season to the 2009–10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons," the report said.

"These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage," the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include "vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs."

In other influenza news announced in the same weekly report (MMWR 2010;59:1270–3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, "with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating."

New data from the Centers for Disease Control and Prevention show that, while older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly because of H1N1 concerns – vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same.

According to the CDC's Morbidity and Mortality Weekly Report, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009–2010. The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008–2009 season. The researchers also determined that full vaccination coverage was low during the 2009–2010 season, ranging from 34.7% among children aged 6–23 months to 15.3% among children aged 13–18 years (MMWR 2010;59:1266–9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5–18 years "no later than the 2009–10 season" were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5–12 years showed the largest increase in vaccination coverage − 19.0% to 27.1% over the last two flu seasons – while coverage among children 6–23 months only increased from 55.2% in the 2008–2009 season to 55.7% in 2009–2010. Seasonal flu vaccination coverage among children aged 2–4 years and 13–18 years increased at similar rates: 38.4% (from 33.0% in 2008–2009) and 15.3% (from 10.9%), respectively.

"The increase in coverage from the 2008–09 season to the 2009–10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons," the report said.

"These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage," the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include "vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs."

In other influenza news announced in the same weekly report (MMWR 2010;59:1270–3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13-Sept. 25, 2010), with the majority of it seasonal influenza. Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, "with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating."

Major Finding: Several meta-analyses indicate that smokeless tobacco use was associated with an increased risk of heart disease (relative risk 1.12,) and fatal stroke (RR 1.42 and RR 1.40).

Data Source: Nonsystematic review of meta-analyses, randomized clinical trials, cohort or case control, and comparative studies regarding CV risk and ST product use primarily conducted in Sweden and the United States.

Disclosures: None was reported.

Smokeless tobacco products are not safer alternatives to cigarette smoking, they do not help smokers quit, and their long-term use can, in fact, increase the risk of fatal heart attack, fatal stroke, and cancer, the American Heart Association warned in a scientific statement.

The researchers, led by Mariann R. Piano, Ph.D., examined several international studies to compare smokeless tobacco use and its health risks.

Meta-analysis data involving male, Swedish smokers for 1976-2002 showed a significant decrease in cigarette smoking that corresponded with an increase in use of smokeless tobacco products, the investigators wrote in the AHA journal, Circulation. Despite the decline in cigarette use, concern is warranted, Dr. Piano, professor of biobehavioral science at the University of Illinois at Chicago, explained: “Smokeless tobacco products are harmful and addictive – that does not translate to a better alternative,” Dr. Piano, said in a written statement released by the association.

“Scientists and policy makers need to assess the effect of 'reduced risk' messages related to smokeless tobacco use on public perception, especially among smokers who might be trying to quit,” Dr. Piano and her colleagues wrote.

Citing “inadequate evidence of smoking cessation efficacy and safety,” the researchers deemed as inappropriate the promotion of smokeless tobacco as a way to reduce smoking-related diseases.

The American Heart Association does recommend nicotine replacement therapy (nicotine gum or a nicotine-releasing patch placed on the skin) as a safer option for cigarette smokers wanting to quit. “Clinical studies have found no increased risk of heart attack or stroke with either type of nicotine replacement therapy,” the AHA said in the written statement.

Metaanalysis data in the association's scientific statement http://circ.ahajournals.org/cgi/reprint/CIR.0b013e3181f432c3.indicated

Additionally, a subanalysis of INTERHEART (a study of 15,152 cases of first myocardial infarction in 52 countries) showed that tobacco chewers had a significantly increased risk of first myocardial infarction (odds ratio 2.23) compared with those who never used tobacco. Two other meta-analyses indicated that smokeless tobacco use was also associated with an increased risk of fatal stroke (RR 1.42, n = 5 studies, and RR 1.40, n = 5 studies).

The researchers explained that, like cigarettes, smokeless tobacco (ST) products still contain nicotine of varying concentrations as well as a number of carcinogens that are just as harmful.

Cigarettes and oral snuff have similar amounts of nicotine (milligrams per gram of tobacco), while chewing tobacco appears to have “somewhat lower” amounts compared with cigarettes, Dr. Piano and her colleagues wrote.

“Even though certain manufacturing techniques are used to reduce the level of these compounds in some products, they remain present in substantial concentrations in ST products, including Swedish snus,” they said.

In a comparison of nicotine concentration between three types of smokeless tobacco products (chewing tobacco, dry snuff, and moist snuff) and cigarettes sold in the United States, all of the smokeless tobacco products had nicotine concentrations that were similar to cigarettes with the highest concentrations (see chart).

Dr. Piano and her colleagues found that unlike the aforementioned Swedish cohorts, there was no reduction in smoking rates among people in the United States using smokeless tobacco. (The sale of smokeless tobacco products such as moist snuff or snus is banned in most of the European Union with the exception of Sweden and Norway.)

In the United States about 8.1 million people are users of smokeless tobacco and its use is more prevalent in men than women, and people between the ages of 18-25 are the most likely to use smokeless tobacco, the researchers wrote.

It also appears that although U.S. chewing tobacco use has been on the decline since the 1980s, snuff consumption and production are increasing, the researchers said.

Elsevier Global Medical News

Major Finding: Several meta-analyses indicate that smokeless tobacco use was associated with an increased risk of heart disease (relative risk 1.12,) and fatal stroke (RR 1.42 and RR 1.40).

Data Source: Nonsystematic review of meta-analyses, randomized clinical trials, cohort or case control, and comparative studies regarding CV risk and ST product use primarily conducted in Sweden and the United States.

Disclosures: None was reported.

Smokeless tobacco products are not safer alternatives to cigarette smoking, they do not help smokers quit, and their long-term use can, in fact, increase the risk of fatal heart attack, fatal stroke, and cancer, the American Heart Association warned in a scientific statement.

The researchers, led by Mariann R. Piano, Ph.D., examined several international studies to compare smokeless tobacco use and its health risks.

Meta-analysis data involving male, Swedish smokers for 1976-2002 showed a significant decrease in cigarette smoking that corresponded with an increase in use of smokeless tobacco products, the investigators wrote in the AHA journal, Circulation. Despite the decline in cigarette use, concern is warranted, Dr. Piano, professor of biobehavioral science at the University of Illinois at Chicago, explained: “Smokeless tobacco products are harmful and addictive – that does not translate to a better alternative,” Dr. Piano, said in a written statement released by the association.

“Scientists and policy makers need to assess the effect of 'reduced risk' messages related to smokeless tobacco use on public perception, especially among smokers who might be trying to quit,” Dr. Piano and her colleagues wrote.

Citing “inadequate evidence of smoking cessation efficacy and safety,” the researchers deemed as inappropriate the promotion of smokeless tobacco as a way to reduce smoking-related diseases.

The American Heart Association does recommend nicotine replacement therapy (nicotine gum or a nicotine-releasing patch placed on the skin) as a safer option for cigarette smokers wanting to quit. “Clinical studies have found no increased risk of heart attack or stroke with either type of nicotine replacement therapy,” the AHA said in the written statement.

Metaanalysis data in the association's scientific statement http://circ.ahajournals.org/cgi/reprint/CIR.0b013e3181f432c3.indicated

Additionally, a subanalysis of INTERHEART (a study of 15,152 cases of first myocardial infarction in 52 countries) showed that tobacco chewers had a significantly increased risk of first myocardial infarction (odds ratio 2.23) compared with those who never used tobacco. Two other meta-analyses indicated that smokeless tobacco use was also associated with an increased risk of fatal stroke (RR 1.42, n = 5 studies, and RR 1.40, n = 5 studies).

The researchers explained that, like cigarettes, smokeless tobacco (ST) products still contain nicotine of varying concentrations as well as a number of carcinogens that are just as harmful.

Cigarettes and oral snuff have similar amounts of nicotine (milligrams per gram of tobacco), while chewing tobacco appears to have “somewhat lower” amounts compared with cigarettes, Dr. Piano and her colleagues wrote.

“Even though certain manufacturing techniques are used to reduce the level of these compounds in some products, they remain present in substantial concentrations in ST products, including Swedish snus,” they said.

In a comparison of nicotine concentration between three types of smokeless tobacco products (chewing tobacco, dry snuff, and moist snuff) and cigarettes sold in the United States, all of the smokeless tobacco products had nicotine concentrations that were similar to cigarettes with the highest concentrations (see chart).

Dr. Piano and her colleagues found that unlike the aforementioned Swedish cohorts, there was no reduction in smoking rates among people in the United States using smokeless tobacco. (The sale of smokeless tobacco products such as moist snuff or snus is banned in most of the European Union with the exception of Sweden and Norway.)

In the United States about 8.1 million people are users of smokeless tobacco and its use is more prevalent in men than women, and people between the ages of 18-25 are the most likely to use smokeless tobacco, the researchers wrote.

It also appears that although U.S. chewing tobacco use has been on the decline since the 1980s, snuff consumption and production are increasing, the researchers said.

Elsevier Global Medical News

Major Finding: Several meta-analyses indicate that smokeless tobacco use was associated with an increased risk of heart disease (relative risk 1.12,) and fatal stroke (RR 1.42 and RR 1.40).

Data Source: Nonsystematic review of meta-analyses, randomized clinical trials, cohort or case control, and comparative studies regarding CV risk and ST product use primarily conducted in Sweden and the United States.

Disclosures: None was reported.

Smokeless tobacco products are not safer alternatives to cigarette smoking, they do not help smokers quit, and their long-term use can, in fact, increase the risk of fatal heart attack, fatal stroke, and cancer, the American Heart Association warned in a scientific statement.

The researchers, led by Mariann R. Piano, Ph.D., examined several international studies to compare smokeless tobacco use and its health risks.

Meta-analysis data involving male, Swedish smokers for 1976-2002 showed a significant decrease in cigarette smoking that corresponded with an increase in use of smokeless tobacco products, the investigators wrote in the AHA journal, Circulation. Despite the decline in cigarette use, concern is warranted, Dr. Piano, professor of biobehavioral science at the University of Illinois at Chicago, explained: “Smokeless tobacco products are harmful and addictive – that does not translate to a better alternative,” Dr. Piano, said in a written statement released by the association.

“Scientists and policy makers need to assess the effect of 'reduced risk' messages related to smokeless tobacco use on public perception, especially among smokers who might be trying to quit,” Dr. Piano and her colleagues wrote.

Citing “inadequate evidence of smoking cessation efficacy and safety,” the researchers deemed as inappropriate the promotion of smokeless tobacco as a way to reduce smoking-related diseases.

The American Heart Association does recommend nicotine replacement therapy (nicotine gum or a nicotine-releasing patch placed on the skin) as a safer option for cigarette smokers wanting to quit. “Clinical studies have found no increased risk of heart attack or stroke with either type of nicotine replacement therapy,” the AHA said in the written statement.

Metaanalysis data in the association's scientific statement http://circ.ahajournals.org/cgi/reprint/CIR.0b013e3181f432c3.indicated

Additionally, a subanalysis of INTERHEART (a study of 15,152 cases of first myocardial infarction in 52 countries) showed that tobacco chewers had a significantly increased risk of first myocardial infarction (odds ratio 2.23) compared with those who never used tobacco. Two other meta-analyses indicated that smokeless tobacco use was also associated with an increased risk of fatal stroke (RR 1.42, n = 5 studies, and RR 1.40, n = 5 studies).

The researchers explained that, like cigarettes, smokeless tobacco (ST) products still contain nicotine of varying concentrations as well as a number of carcinogens that are just as harmful.

Cigarettes and oral snuff have similar amounts of nicotine (milligrams per gram of tobacco), while chewing tobacco appears to have “somewhat lower” amounts compared with cigarettes, Dr. Piano and her colleagues wrote.

“Even though certain manufacturing techniques are used to reduce the level of these compounds in some products, they remain present in substantial concentrations in ST products, including Swedish snus,” they said.

In a comparison of nicotine concentration between three types of smokeless tobacco products (chewing tobacco, dry snuff, and moist snuff) and cigarettes sold in the United States, all of the smokeless tobacco products had nicotine concentrations that were similar to cigarettes with the highest concentrations (see chart).

Dr. Piano and her colleagues found that unlike the aforementioned Swedish cohorts, there was no reduction in smoking rates among people in the United States using smokeless tobacco. (The sale of smokeless tobacco products such as moist snuff or snus is banned in most of the European Union with the exception of Sweden and Norway.)

In the United States about 8.1 million people are users of smokeless tobacco and its use is more prevalent in men than women, and people between the ages of 18-25 are the most likely to use smokeless tobacco, the researchers wrote.

It also appears that although U.S. chewing tobacco use has been on the decline since the 1980s, snuff consumption and production are increasing, the researchers said.

Elsevier Global Medical News

New data from the Centers for Disease Control and Prevention reveal that nearly 1 in 10 U.S. adults met criteria for current depression. Women and nonwhites are at the greatest risk.

The CDC said that by the year 2020, depression is expected to be second only to cardiovascular disease in disease burden. In 2004, depression was the third leading cause of disease burden worldwide and a leading cause of disability in high-income countries.

The CDC warned that depression can exacerbate chronic conditions such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity, all of which can contribute to increased work absenteeism, short-term disability, and decreased productivity.

Using Behavioral Risk Factor Surveillance System telephone survey data from 2006 and 2008 involving 235,067 adults aged 18 and older in 45 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, the CDC found that 9% met criteria for current depression, including 3.4% who met criteria for major depression (MMWR 2010;59:1229-35).

The criteria for current depression were based on the Patient Health Questionnaire 8. People were considered to have major depression if for “more than half the days” they met at least five of the eight criteria, including at least one of the following: “little interest or pleasure in doing things” or “feeling down, depressed, or hopeless.”

The report showed a significant difference in the prevalence of depression between men and women. Four percent of women reported major depression, compared with 2.7% of men. “The greater prevalence of depression among women is not fully understood, although potential contributors include different responses to stressful life events, genetic predisposition, and hormonal differences,” the report said.

Non-Hispanic blacks, Hispanics, and non-Hispanics of other races were all more likely to report major depression (4%, 4%, and 4.3%, respectively) than were non-Hispanic whites (3.1%). The researchers explained that this disparity is consistent with greater risk factors of mental illness in these populations stemming from “social and economic inequality, exposure to racism and discrimination, increased prevalence of some chronic diseases, and less access to care and treatment for mental health and health conditions.”

According to the report, increase in age reflected an increase in the prevalence of depression. The prevalence of major depression ranged from 2.8% among those aged 18-24 years to 4.6% among those aged 45-64. There was a decline to 1.6% among those older than 65.

In addition to age, factors such as socioeconomic status, amount of education, employment status, and access to health insurance played a significant role in the prevalence of depression. For example, people without health insurance also were more likely to have current depression.

In addition, the report found that 22.2% of people unable to work and 9.8% of those unemployed were more likely to report major depression compared with 3% of homemakers and students, and 2% of employed individuals.

By state, North Dakota reported the lowest prevalence of current and major depression (4.18% and 1.5%, respectively) and Mississippi reported the highest prevalence for current depression (14.8%) and major depression (5.3%).

Elsevier Global Medical News

New data from the Centers for Disease Control and Prevention reveal that nearly 1 in 10 U.S. adults met criteria for current depression. Women and nonwhites are at the greatest risk.

The CDC said that by the year 2020, depression is expected to be second only to cardiovascular disease in disease burden. In 2004, depression was the third leading cause of disease burden worldwide and a leading cause of disability in high-income countries.

The CDC warned that depression can exacerbate chronic conditions such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity, all of which can contribute to increased work absenteeism, short-term disability, and decreased productivity.

Using Behavioral Risk Factor Surveillance System telephone survey data from 2006 and 2008 involving 235,067 adults aged 18 and older in 45 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, the CDC found that 9% met criteria for current depression, including 3.4% who met criteria for major depression (MMWR 2010;59:1229-35).

The criteria for current depression were based on the Patient Health Questionnaire 8. People were considered to have major depression if for “more than half the days” they met at least five of the eight criteria, including at least one of the following: “little interest or pleasure in doing things” or “feeling down, depressed, or hopeless.”

The report showed a significant difference in the prevalence of depression between men and women. Four percent of women reported major depression, compared with 2.7% of men. “The greater prevalence of depression among women is not fully understood, although potential contributors include different responses to stressful life events, genetic predisposition, and hormonal differences,” the report said.

Non-Hispanic blacks, Hispanics, and non-Hispanics of other races were all more likely to report major depression (4%, 4%, and 4.3%, respectively) than were non-Hispanic whites (3.1%). The researchers explained that this disparity is consistent with greater risk factors of mental illness in these populations stemming from “social and economic inequality, exposure to racism and discrimination, increased prevalence of some chronic diseases, and less access to care and treatment for mental health and health conditions.”

According to the report, increase in age reflected an increase in the prevalence of depression. The prevalence of major depression ranged from 2.8% among those aged 18-24 years to 4.6% among those aged 45-64. There was a decline to 1.6% among those older than 65.

In addition to age, factors such as socioeconomic status, amount of education, employment status, and access to health insurance played a significant role in the prevalence of depression. For example, people without health insurance also were more likely to have current depression.

In addition, the report found that 22.2% of people unable to work and 9.8% of those unemployed were more likely to report major depression compared with 3% of homemakers and students, and 2% of employed individuals.

By state, North Dakota reported the lowest prevalence of current and major depression (4.18% and 1.5%, respectively) and Mississippi reported the highest prevalence for current depression (14.8%) and major depression (5.3%).

Elsevier Global Medical News

New data from the Centers for Disease Control and Prevention reveal that nearly 1 in 10 U.S. adults met criteria for current depression. Women and nonwhites are at the greatest risk.

The CDC said that by the year 2020, depression is expected to be second only to cardiovascular disease in disease burden. In 2004, depression was the third leading cause of disease burden worldwide and a leading cause of disability in high-income countries.

The CDC warned that depression can exacerbate chronic conditions such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity, all of which can contribute to increased work absenteeism, short-term disability, and decreased productivity.

Using Behavioral Risk Factor Surveillance System telephone survey data from 2006 and 2008 involving 235,067 adults aged 18 and older in 45 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, the CDC found that 9% met criteria for current depression, including 3.4% who met criteria for major depression (MMWR 2010;59:1229-35).

The criteria for current depression were based on the Patient Health Questionnaire 8. People were considered to have major depression if for “more than half the days” they met at least five of the eight criteria, including at least one of the following: “little interest or pleasure in doing things” or “feeling down, depressed, or hopeless.”

The report showed a significant difference in the prevalence of depression between men and women. Four percent of women reported major depression, compared with 2.7% of men. “The greater prevalence of depression among women is not fully understood, although potential contributors include different responses to stressful life events, genetic predisposition, and hormonal differences,” the report said.

Non-Hispanic blacks, Hispanics, and non-Hispanics of other races were all more likely to report major depression (4%, 4%, and 4.3%, respectively) than were non-Hispanic whites (3.1%). The researchers explained that this disparity is consistent with greater risk factors of mental illness in these populations stemming from “social and economic inequality, exposure to racism and discrimination, increased prevalence of some chronic diseases, and less access to care and treatment for mental health and health conditions.”

According to the report, increase in age reflected an increase in the prevalence of depression. The prevalence of major depression ranged from 2.8% among those aged 18-24 years to 4.6% among those aged 45-64. There was a decline to 1.6% among those older than 65.

In addition to age, factors such as socioeconomic status, amount of education, employment status, and access to health insurance played a significant role in the prevalence of depression. For example, people without health insurance also were more likely to have current depression.

In addition, the report found that 22.2% of people unable to work and 9.8% of those unemployed were more likely to report major depression compared with 3% of homemakers and students, and 2% of employed individuals.

By state, North Dakota reported the lowest prevalence of current and major depression (4.18% and 1.5%, respectively) and Mississippi reported the highest prevalence for current depression (14.8%) and major depression (5.3%).

Elsevier Global Medical News