Michele G. Sullivan

Major Finding: Of the 574 parents eligible to receive the flu vaccine, 550 accepted, for a total immunization rate of 96%. Infants of the case mothers, the majority of whom received Tdap vaccination immediately post partum, were significantly more likely to have received their first set of immunizations by 3 months (88% vs. 82%), and significantly more likely to have completed their primary series by 8 months (67% vs. 59%) and 9 months (75% vs. 65%).

Data Source: Two retrospective studies of in-hospital immunization, one involving flu vaccination of 753 parents of infants in the NICU and the other involving Tdap vaccination of mothers immediately post partum.

Disclosures: None was reported.

PHILADELPHIA — Providing new parents with immunization opportunities before they leave the hospital with their infant benefits the babies and their parents, the results of two retrospective studies showed.

The studies focused on such in-hospital vaccination programs. One found that parents in the neonatal intensive care unit almost universally accepted a seasonal influenza vaccine; the other, that new mothers who accepted the tetanus-diphtheria-pertussis vaccine during their postpartum stay were significantly more likely to be on track with their infant's primary vaccination schedule than mothers who didn't accept the shot.

Infants younger than 6 months suffer the highest influenza mortality. Infants who have been hospitalized—including those with a NICU stay—are at particularly high risk. Because these young babies cannot be vaccinated against the flu, the best way to protect them is to create “a cocoon of immunization” around them, by vaccinating their caregivers and household contacts,” Angeline Seah of Stony Brook (N.Y.) University said at the annual meeting of the Eastern Society for Pediatric Research.

Ms. Seah and neonatologist Shetal Shah, theorized that the NICU would be a near-ideal place to educate parents about the benefits of a flu shot and to give the vaccine.

They conducted a retrospective analysis of three flu seasons to determine parental vaccination rates. The study periods were November through March during 2004-2005, 2006-2007, and 2008-2009.

During each season, all parents of NICU patients were educated about the risks and benefits of the flu vaccine. If they consented, parents were immunized at their child's bedside. The vaccine was available 20 out of every 24 hours. Parents were told that their decision to accept or reject the vaccine would have no impact on their ability to visit and care for their child.

The study included 753 parents and 455 infants. About a quarter of the parents (179) had been vaccinated before their child was born. Of the 574 eligible to receive the flu vaccine, 550 accepted, for a total immunization rate of 96%. Only 4% of the parents (24) refused the vaccine.

NICU immunization rates varied significantly from year to year, Ms. Seah said. In the first year, 64% of parents were vaccinated in the NICU and 23% had been previously vaccinated.

In year 2, 12% had been vaccinated before arriving at the NICU and 80% were vaccinated in the NICU, and in year 3, one-third of parents had already been vaccinated before arriving in the NICU.

“This probably represents an increased awareness of the seriousness of flu infections in newborns,” she said.

Vaccination rates also varied significantly between mothers and fathers. Paternal rates were significantly lower than maternal rates in the years when they were measured (years 2 and 3). This might reflect the availability of flu vaccine at the obstetrician's office, Ms. Seah said.

A second study found that mothers receiving a tetanus-diphtheria-pertussis (Tdap) vaccine education packet and the Tdap immunization in the immediate postpartum period were more likely to be up to date with their baby's immunizations months later.

“Our Tdap initiative had a positive effect on the timeliness of both start and completion of the infant's primary immunization series,” said Dr. Ishminder Kaur of the Albert Einstein Medical Center, Philadelphia. “We should consider expanding this initiative to other caregivers to increase infant protection.”

The Philadelphia Department of Public Health launched the postpartum education/vaccine program in three city hospitals in 2008, a year after two Philadelphia infants died of pertussis contracted from their mothers.

“The numbers of mothers vaccinated at discharge increased tremendously within the first 3 weeks of this initiative, from 49% to 90%,” she said.

The program consists of standing orders for Tdap vaccine for all postpartum mothers, verbal consent for immunization, and a written opt-out for patients refusing. Dr. Kaur and her colleagues conducted a retrospective cohort study to determine the programs' effect on infant immunizations.

The study comprised two groups of patients from the Einstein Medical Center: 238 mothers who gave birth in July 2007 before the initiative (controls), and 250 mothers who gave birth during July 2009 (cases). Among the cases, 12 mothers refused the vaccine. Infant immunization rates were tracked through the city's public immunization registry. Because the hospital serves predominantly a Medicaid population, the city records capture most of the infants born there.

The investigators looked at immunization rates at 3, 8, and 9 months. Infants of the case mothers were significantly more likely to have received their first set of immunizations by 3 months (88% vs. 82%), and were significantly more likely to have completed their primary series by 8 months (67% vs. 59%) and 9 months (75% vs. 65%).

Major Finding: Of the 574 parents eligible to receive the flu vaccine, 550 accepted, for a total immunization rate of 96%. Infants of the case mothers, the majority of whom received Tdap vaccination immediately post partum, were significantly more likely to have received their first set of immunizations by 3 months (88% vs. 82%), and significantly more likely to have completed their primary series by 8 months (67% vs. 59%) and 9 months (75% vs. 65%).

Data Source: Two retrospective studies of in-hospital immunization, one involving flu vaccination of 753 parents of infants in the NICU and the other involving Tdap vaccination of mothers immediately post partum.

Disclosures: None was reported.

PHILADELPHIA — Providing new parents with immunization opportunities before they leave the hospital with their infant benefits the babies and their parents, the results of two retrospective studies showed.

The studies focused on such in-hospital vaccination programs. One found that parents in the neonatal intensive care unit almost universally accepted a seasonal influenza vaccine; the other, that new mothers who accepted the tetanus-diphtheria-pertussis vaccine during their postpartum stay were significantly more likely to be on track with their infant's primary vaccination schedule than mothers who didn't accept the shot.

Infants younger than 6 months suffer the highest influenza mortality. Infants who have been hospitalized—including those with a NICU stay—are at particularly high risk. Because these young babies cannot be vaccinated against the flu, the best way to protect them is to create “a cocoon of immunization” around them, by vaccinating their caregivers and household contacts,” Angeline Seah of Stony Brook (N.Y.) University said at the annual meeting of the Eastern Society for Pediatric Research.

Ms. Seah and neonatologist Shetal Shah, theorized that the NICU would be a near-ideal place to educate parents about the benefits of a flu shot and to give the vaccine.

They conducted a retrospective analysis of three flu seasons to determine parental vaccination rates. The study periods were November through March during 2004-2005, 2006-2007, and 2008-2009.

During each season, all parents of NICU patients were educated about the risks and benefits of the flu vaccine. If they consented, parents were immunized at their child's bedside. The vaccine was available 20 out of every 24 hours. Parents were told that their decision to accept or reject the vaccine would have no impact on their ability to visit and care for their child.

The study included 753 parents and 455 infants. About a quarter of the parents (179) had been vaccinated before their child was born. Of the 574 eligible to receive the flu vaccine, 550 accepted, for a total immunization rate of 96%. Only 4% of the parents (24) refused the vaccine.

NICU immunization rates varied significantly from year to year, Ms. Seah said. In the first year, 64% of parents were vaccinated in the NICU and 23% had been previously vaccinated.

In year 2, 12% had been vaccinated before arriving at the NICU and 80% were vaccinated in the NICU, and in year 3, one-third of parents had already been vaccinated before arriving in the NICU.

“This probably represents an increased awareness of the seriousness of flu infections in newborns,” she said.

Vaccination rates also varied significantly between mothers and fathers. Paternal rates were significantly lower than maternal rates in the years when they were measured (years 2 and 3). This might reflect the availability of flu vaccine at the obstetrician's office, Ms. Seah said.

A second study found that mothers receiving a tetanus-diphtheria-pertussis (Tdap) vaccine education packet and the Tdap immunization in the immediate postpartum period were more likely to be up to date with their baby's immunizations months later.

“Our Tdap initiative had a positive effect on the timeliness of both start and completion of the infant's primary immunization series,” said Dr. Ishminder Kaur of the Albert Einstein Medical Center, Philadelphia. “We should consider expanding this initiative to other caregivers to increase infant protection.”

The Philadelphia Department of Public Health launched the postpartum education/vaccine program in three city hospitals in 2008, a year after two Philadelphia infants died of pertussis contracted from their mothers.

“The numbers of mothers vaccinated at discharge increased tremendously within the first 3 weeks of this initiative, from 49% to 90%,” she said.

The program consists of standing orders for Tdap vaccine for all postpartum mothers, verbal consent for immunization, and a written opt-out for patients refusing. Dr. Kaur and her colleagues conducted a retrospective cohort study to determine the programs' effect on infant immunizations.

The study comprised two groups of patients from the Einstein Medical Center: 238 mothers who gave birth in July 2007 before the initiative (controls), and 250 mothers who gave birth during July 2009 (cases). Among the cases, 12 mothers refused the vaccine. Infant immunization rates were tracked through the city's public immunization registry. Because the hospital serves predominantly a Medicaid population, the city records capture most of the infants born there.

The investigators looked at immunization rates at 3, 8, and 9 months. Infants of the case mothers were significantly more likely to have received their first set of immunizations by 3 months (88% vs. 82%), and were significantly more likely to have completed their primary series by 8 months (67% vs. 59%) and 9 months (75% vs. 65%).

Major Finding: Of the 574 parents eligible to receive the flu vaccine, 550 accepted, for a total immunization rate of 96%. Infants of the case mothers, the majority of whom received Tdap vaccination immediately post partum, were significantly more likely to have received their first set of immunizations by 3 months (88% vs. 82%), and significantly more likely to have completed their primary series by 8 months (67% vs. 59%) and 9 months (75% vs. 65%).

Data Source: Two retrospective studies of in-hospital immunization, one involving flu vaccination of 753 parents of infants in the NICU and the other involving Tdap vaccination of mothers immediately post partum.

Disclosures: None was reported.

PHILADELPHIA — Providing new parents with immunization opportunities before they leave the hospital with their infant benefits the babies and their parents, the results of two retrospective studies showed.

The studies focused on such in-hospital vaccination programs. One found that parents in the neonatal intensive care unit almost universally accepted a seasonal influenza vaccine; the other, that new mothers who accepted the tetanus-diphtheria-pertussis vaccine during their postpartum stay were significantly more likely to be on track with their infant's primary vaccination schedule than mothers who didn't accept the shot.

Infants younger than 6 months suffer the highest influenza mortality. Infants who have been hospitalized—including those with a NICU stay—are at particularly high risk. Because these young babies cannot be vaccinated against the flu, the best way to protect them is to create “a cocoon of immunization” around them, by vaccinating their caregivers and household contacts,” Angeline Seah of Stony Brook (N.Y.) University said at the annual meeting of the Eastern Society for Pediatric Research.

Ms. Seah and neonatologist Shetal Shah, theorized that the NICU would be a near-ideal place to educate parents about the benefits of a flu shot and to give the vaccine.

They conducted a retrospective analysis of three flu seasons to determine parental vaccination rates. The study periods were November through March during 2004-2005, 2006-2007, and 2008-2009.

During each season, all parents of NICU patients were educated about the risks and benefits of the flu vaccine. If they consented, parents were immunized at their child's bedside. The vaccine was available 20 out of every 24 hours. Parents were told that their decision to accept or reject the vaccine would have no impact on their ability to visit and care for their child.

The study included 753 parents and 455 infants. About a quarter of the parents (179) had been vaccinated before their child was born. Of the 574 eligible to receive the flu vaccine, 550 accepted, for a total immunization rate of 96%. Only 4% of the parents (24) refused the vaccine.

NICU immunization rates varied significantly from year to year, Ms. Seah said. In the first year, 64% of parents were vaccinated in the NICU and 23% had been previously vaccinated.

In year 2, 12% had been vaccinated before arriving at the NICU and 80% were vaccinated in the NICU, and in year 3, one-third of parents had already been vaccinated before arriving in the NICU.

“This probably represents an increased awareness of the seriousness of flu infections in newborns,” she said.

Vaccination rates also varied significantly between mothers and fathers. Paternal rates were significantly lower than maternal rates in the years when they were measured (years 2 and 3). This might reflect the availability of flu vaccine at the obstetrician's office, Ms. Seah said.

A second study found that mothers receiving a tetanus-diphtheria-pertussis (Tdap) vaccine education packet and the Tdap immunization in the immediate postpartum period were more likely to be up to date with their baby's immunizations months later.

“Our Tdap initiative had a positive effect on the timeliness of both start and completion of the infant's primary immunization series,” said Dr. Ishminder Kaur of the Albert Einstein Medical Center, Philadelphia. “We should consider expanding this initiative to other caregivers to increase infant protection.”

The Philadelphia Department of Public Health launched the postpartum education/vaccine program in three city hospitals in 2008, a year after two Philadelphia infants died of pertussis contracted from their mothers.

“The numbers of mothers vaccinated at discharge increased tremendously within the first 3 weeks of this initiative, from 49% to 90%,” she said.

The program consists of standing orders for Tdap vaccine for all postpartum mothers, verbal consent for immunization, and a written opt-out for patients refusing. Dr. Kaur and her colleagues conducted a retrospective cohort study to determine the programs' effect on infant immunizations.

The study comprised two groups of patients from the Einstein Medical Center: 238 mothers who gave birth in July 2007 before the initiative (controls), and 250 mothers who gave birth during July 2009 (cases). Among the cases, 12 mothers refused the vaccine. Infant immunization rates were tracked through the city's public immunization registry. Because the hospital serves predominantly a Medicaid population, the city records capture most of the infants born there.

The investigators looked at immunization rates at 3, 8, and 9 months. Infants of the case mothers were significantly more likely to have received their first set of immunizations by 3 months (88% vs. 82%), and were significantly more likely to have completed their primary series by 8 months (67% vs. 59%) and 9 months (75% vs. 65%).

Major Finding: Of patients with irritable bowel syndrome, 18% were using narcotic pain medications to relieve bowel pain.

Data Source: An internet survey of 1,787 patients with irritable bowel syndrome.

Disclosures: The University of North Carolina and the International Foundation for Functional GI and Motility Disorders sponsored the study. Dr. Dorn had no relevant financial disclosures.

NEW ORLEANS — Many patients with irritable bowel syndrome appear to be taking narcotics for bowel pain—drugs that may exacerbate their painful symptoms.

A survey of nearly 2,000 patients with irritable bowel syndrome (IBS) found that nearly 20% were currently taking a narcotic for their symptoms. “Narcotic use of that magnitude in this population has not been previously described,” Dr. Spencer Dorn said at the meeting.

Patients who took narcotics were more likely to report poor health-related quality of life, to also use antidepressants and anxiolytic drugs, and to have more hospitalizations and surgeries than IBS patients who don't use narcotics.

“In the current U.S. health care system, clinicians often lack the time, infrastructure, and incentive needed to provide integrative care to patients with chronic conditions, including IBS,” said Dr. Dorn. “Instead, very often physicians take the path of least resistance. Narcotic prescriptions are a quick and easy way to get patients out of the office,” even though the long-term effects can be harmful.

“The broad literature suggests that narcotic use in noncancer pain syndromes may not improve functional status and help people live their lives more effectively,” he said. “It is also very well known that narcotics affect bowel habits; narcotic-induced constipation is very common.”

Additionally, he said, narcotics always carry a risk of drug dependence, leading to the need for increasing amounts of medication. “Narcotic bowel syndrome is gaining recognition” as a consequence of long-term narcotic use, he said. “Even though we are using narcotics to treat pain, escalating the dose may paradoxically worsen the symptoms we are trying to treat.”

Dr. Dorn, of the Center for Functional GI and Motility Disorders at the University of North Carolina, Chapel Hill, and his colleagues at the International Foundation for Functional Gastrointestinal Disorders in Milwaukee, conducted an Internet survey of 1,787 adults in the United States and Canada who fit the Rome II criteria for IBS diagnosis. Results of this survey were initially published last year (J. Clin. Gastroenterol. 2009;43:541-50) and used as the basis for an informational brochure (www.aboutibs.org/pdfs/IBSpatients.pdf

Respondents were mostly women (83%) and white (91%). IBS types were 29% diarrhea predominant, 61% mixed diarrhea/constipation/unspecified, and 10% constipation predominant. As determined by the Functional Bowel Disorder Severity Index, 31% had mild symptoms, 48% had moderate symptoms, and 21% had severe symptoms. Diagnosis of IBS was not made until a mean of almost 7 years after their symptoms began.

Most of the respondents (80%) said that pain was a major contributing factor to the severity of their IBS, with 30% saying it was the most troublesome symptom, and 78% saying their pain was continuous or frequent in the prior 6 months.

Most of the respondents were taking at least one medication, including nonnarcotic pain medications (31%), antidepressants for pain (31%), antacids (28%), antidiarrheals (24%), antispasmodics (19%), and narcotics (18%).

A regression analysis found that narcotic use was significantly associated with low health-related quality of life; rating pain as the most bothersome symptom; having a larger number of hospitalizations and surgeries; and the concurrent use of antidepressants, anxiolytics, and antacid medications.

The preferred approach to IBS treatment is a holistic one, Dr. Dorn said.

“We suggest an integrated approach in which clinicians first consider the medical and psychosocial factors that influence their patients' illness, and then address their patients' main concerns, educate them about IBS, offer strategies to enhance their self-management, and, if appropriate, address any maladaptive coping styles and the possible role of psychological stressors. This approach is often best delivered by a multidisciplinary treatment team.”

'Narcotic bowel syndrome is gaining recognition' as a consequence of long-term narcotic use.

Source DR. DORN

Major Finding: Of patients with irritable bowel syndrome, 18% were using narcotic pain medications to relieve bowel pain.

Data Source: An internet survey of 1,787 patients with irritable bowel syndrome.

Disclosures: The University of North Carolina and the International Foundation for Functional GI and Motility Disorders sponsored the study. Dr. Dorn had no relevant financial disclosures.

NEW ORLEANS — Many patients with irritable bowel syndrome appear to be taking narcotics for bowel pain—drugs that may exacerbate their painful symptoms.

A survey of nearly 2,000 patients with irritable bowel syndrome (IBS) found that nearly 20% were currently taking a narcotic for their symptoms. “Narcotic use of that magnitude in this population has not been previously described,” Dr. Spencer Dorn said at the meeting.

Patients who took narcotics were more likely to report poor health-related quality of life, to also use antidepressants and anxiolytic drugs, and to have more hospitalizations and surgeries than IBS patients who don't use narcotics.

“In the current U.S. health care system, clinicians often lack the time, infrastructure, and incentive needed to provide integrative care to patients with chronic conditions, including IBS,” said Dr. Dorn. “Instead, very often physicians take the path of least resistance. Narcotic prescriptions are a quick and easy way to get patients out of the office,” even though the long-term effects can be harmful.

“The broad literature suggests that narcotic use in noncancer pain syndromes may not improve functional status and help people live their lives more effectively,” he said. “It is also very well known that narcotics affect bowel habits; narcotic-induced constipation is very common.”

Additionally, he said, narcotics always carry a risk of drug dependence, leading to the need for increasing amounts of medication. “Narcotic bowel syndrome is gaining recognition” as a consequence of long-term narcotic use, he said. “Even though we are using narcotics to treat pain, escalating the dose may paradoxically worsen the symptoms we are trying to treat.”

Dr. Dorn, of the Center for Functional GI and Motility Disorders at the University of North Carolina, Chapel Hill, and his colleagues at the International Foundation for Functional Gastrointestinal Disorders in Milwaukee, conducted an Internet survey of 1,787 adults in the United States and Canada who fit the Rome II criteria for IBS diagnosis. Results of this survey were initially published last year (J. Clin. Gastroenterol. 2009;43:541-50) and used as the basis for an informational brochure (www.aboutibs.org/pdfs/IBSpatients.pdf

Respondents were mostly women (83%) and white (91%). IBS types were 29% diarrhea predominant, 61% mixed diarrhea/constipation/unspecified, and 10% constipation predominant. As determined by the Functional Bowel Disorder Severity Index, 31% had mild symptoms, 48% had moderate symptoms, and 21% had severe symptoms. Diagnosis of IBS was not made until a mean of almost 7 years after their symptoms began.

Most of the respondents (80%) said that pain was a major contributing factor to the severity of their IBS, with 30% saying it was the most troublesome symptom, and 78% saying their pain was continuous or frequent in the prior 6 months.

Most of the respondents were taking at least one medication, including nonnarcotic pain medications (31%), antidepressants for pain (31%), antacids (28%), antidiarrheals (24%), antispasmodics (19%), and narcotics (18%).

A regression analysis found that narcotic use was significantly associated with low health-related quality of life; rating pain as the most bothersome symptom; having a larger number of hospitalizations and surgeries; and the concurrent use of antidepressants, anxiolytics, and antacid medications.

The preferred approach to IBS treatment is a holistic one, Dr. Dorn said.

“We suggest an integrated approach in which clinicians first consider the medical and psychosocial factors that influence their patients' illness, and then address their patients' main concerns, educate them about IBS, offer strategies to enhance their self-management, and, if appropriate, address any maladaptive coping styles and the possible role of psychological stressors. This approach is often best delivered by a multidisciplinary treatment team.”

'Narcotic bowel syndrome is gaining recognition' as a consequence of long-term narcotic use.

Source DR. DORN

Major Finding: Of patients with irritable bowel syndrome, 18% were using narcotic pain medications to relieve bowel pain.

Data Source: An internet survey of 1,787 patients with irritable bowel syndrome.

Disclosures: The University of North Carolina and the International Foundation for Functional GI and Motility Disorders sponsored the study. Dr. Dorn had no relevant financial disclosures.

NEW ORLEANS — Many patients with irritable bowel syndrome appear to be taking narcotics for bowel pain—drugs that may exacerbate their painful symptoms.

A survey of nearly 2,000 patients with irritable bowel syndrome (IBS) found that nearly 20% were currently taking a narcotic for their symptoms. “Narcotic use of that magnitude in this population has not been previously described,” Dr. Spencer Dorn said at the meeting.

Patients who took narcotics were more likely to report poor health-related quality of life, to also use antidepressants and anxiolytic drugs, and to have more hospitalizations and surgeries than IBS patients who don't use narcotics.

“In the current U.S. health care system, clinicians often lack the time, infrastructure, and incentive needed to provide integrative care to patients with chronic conditions, including IBS,” said Dr. Dorn. “Instead, very often physicians take the path of least resistance. Narcotic prescriptions are a quick and easy way to get patients out of the office,” even though the long-term effects can be harmful.

“The broad literature suggests that narcotic use in noncancer pain syndromes may not improve functional status and help people live their lives more effectively,” he said. “It is also very well known that narcotics affect bowel habits; narcotic-induced constipation is very common.”

Additionally, he said, narcotics always carry a risk of drug dependence, leading to the need for increasing amounts of medication. “Narcotic bowel syndrome is gaining recognition” as a consequence of long-term narcotic use, he said. “Even though we are using narcotics to treat pain, escalating the dose may paradoxically worsen the symptoms we are trying to treat.”

Dr. Dorn, of the Center for Functional GI and Motility Disorders at the University of North Carolina, Chapel Hill, and his colleagues at the International Foundation for Functional Gastrointestinal Disorders in Milwaukee, conducted an Internet survey of 1,787 adults in the United States and Canada who fit the Rome II criteria for IBS diagnosis. Results of this survey were initially published last year (J. Clin. Gastroenterol. 2009;43:541-50) and used as the basis for an informational brochure (www.aboutibs.org/pdfs/IBSpatients.pdf

Respondents were mostly women (83%) and white (91%). IBS types were 29% diarrhea predominant, 61% mixed diarrhea/constipation/unspecified, and 10% constipation predominant. As determined by the Functional Bowel Disorder Severity Index, 31% had mild symptoms, 48% had moderate symptoms, and 21% had severe symptoms. Diagnosis of IBS was not made until a mean of almost 7 years after their symptoms began.

Most of the respondents (80%) said that pain was a major contributing factor to the severity of their IBS, with 30% saying it was the most troublesome symptom, and 78% saying their pain was continuous or frequent in the prior 6 months.

Most of the respondents were taking at least one medication, including nonnarcotic pain medications (31%), antidepressants for pain (31%), antacids (28%), antidiarrheals (24%), antispasmodics (19%), and narcotics (18%).

A regression analysis found that narcotic use was significantly associated with low health-related quality of life; rating pain as the most bothersome symptom; having a larger number of hospitalizations and surgeries; and the concurrent use of antidepressants, anxiolytics, and antacid medications.

The preferred approach to IBS treatment is a holistic one, Dr. Dorn said.

“We suggest an integrated approach in which clinicians first consider the medical and psychosocial factors that influence their patients' illness, and then address their patients' main concerns, educate them about IBS, offer strategies to enhance their self-management, and, if appropriate, address any maladaptive coping styles and the possible role of psychological stressors. This approach is often best delivered by a multidisciplinary treatment team.”

'Narcotic bowel syndrome is gaining recognition' as a consequence of long-term narcotic use.

Source DR. DORN

Major Finding: For every 1 million people who receive the pandemic influenza vaccine, about 1 additional person will develop Guillain-Barré syndrome.

Data Source: A nationwide federal Guillain Barré Syndrome surveillance system.

Disclosures: None noted.

The excess risk of developing Guillain-Barré syndrome associated with receipt of the pandemic influenza A(H1N1) vaccine is less than 1 case per 1 million vaccinations—a rate comparable to that seen for some trivalent seasonal influenza vaccines.

Preliminary results released in the Morbidity and Mortality Weekly Report found 326 confirmed new cases of the neurological disorder from Oct. 1, 2009 through May 10, 2010 (MMWR 2010;59:1-5).

Of these patients, 27 reported having had the pandemic flu vaccine within 42 days of the onset of GBS—the time period considered plausible for any biologic link between the two. Most of these patients reported an antecedent illness typically related to GBS onset (gastrointestinal illness or respiratory infection).

“Notably, this high proportion of antecedent illnesses associated with GBS suggests that a number of the GBS illnesses observed after vaccination might be attributable to other antecedent illnesses,” wrote C. Prothro of the California Emerging Infections Program, Oakland, and co-authors. “Historically, 40%-70% of GBS patients report experiencing antecedent infectious illness.”

If the preliminary analysis is confirmed—which the CDC expects to happen by this fall—then the attributable rate of GBS would be 0.71 per 100,000 person-years, corresponding to an excess GBS rate of 0.8 cases per 1 million vaccinations, the report said.

Although the report deemed the risk of vaccination-related GBS to be low with pandemic flu vaccine, it did recommend caution for patients with GBS who might consider vaccination.

“Persons with a history of GBS should discuss potential risks and benefits with their health-care providers before receiving any influenza vaccine,” K.R. Copeland of the National Opinion Research Center, Chicago, and co-authors wrote in an accompanying editorial note. “However, risk assessment should take into account that influenza and influenza-like illnesses are associated with significant morbidity and mortality, including a hospitalization rate of 222 per 1 million population and a death rate of 9.7 per 1 million population for H1N1-associated illnesses, as well as possible increased risk for GBS.”

Of the 326 confirmed GBS cases, 27 had documentation proving pandemic flu vaccination within the 42-day window; vaccination status could not be determined in 25, and 274 were not vaccinated.

Sixteen of the 27 (59%) who received the vaccine experienced antecedent symptoms before their GBS diagnosis. The program found no clustering of GBS between vaccination and illness onset.

Among the 27 with GBS who were vaccinated, 4 (15%) required ventilator support, and 1 was hospitalized for 30 days. Among the 274 GBS patients who were not vaccinated, 37 (14%) required ventilator support, and 34 (12%) were hospitalized for 30 days after illness onset. Eight GBS patients died (2%); none of them had received the pandemic flu vaccine.

The CDC study used data gathered by its Emerging Infections Program. The program has collaborated with state health centers and academic medical centers in 10 states to rapidly identify new GBS cases following pandemic flu vaccination.

The surveillance areas included Connecticut, Maryland, Minnesota, New Mexico, Tennessee, and New York state (excluding Manhattan), and selected metropolitan counties in California, Colorado, Georgia, and Oregon. GBS incidence was calculated and compared for the vaccinated and unvaccinated populations.

Major Finding: For every 1 million people who receive the pandemic influenza vaccine, about 1 additional person will develop Guillain-Barré syndrome.

Data Source: A nationwide federal Guillain Barré Syndrome surveillance system.

Disclosures: None noted.

The excess risk of developing Guillain-Barré syndrome associated with receipt of the pandemic influenza A(H1N1) vaccine is less than 1 case per 1 million vaccinations—a rate comparable to that seen for some trivalent seasonal influenza vaccines.

Preliminary results released in the Morbidity and Mortality Weekly Report found 326 confirmed new cases of the neurological disorder from Oct. 1, 2009 through May 10, 2010 (MMWR 2010;59:1-5).

Of these patients, 27 reported having had the pandemic flu vaccine within 42 days of the onset of GBS—the time period considered plausible for any biologic link between the two. Most of these patients reported an antecedent illness typically related to GBS onset (gastrointestinal illness or respiratory infection).

“Notably, this high proportion of antecedent illnesses associated with GBS suggests that a number of the GBS illnesses observed after vaccination might be attributable to other antecedent illnesses,” wrote C. Prothro of the California Emerging Infections Program, Oakland, and co-authors. “Historically, 40%-70% of GBS patients report experiencing antecedent infectious illness.”

If the preliminary analysis is confirmed—which the CDC expects to happen by this fall—then the attributable rate of GBS would be 0.71 per 100,000 person-years, corresponding to an excess GBS rate of 0.8 cases per 1 million vaccinations, the report said.

Although the report deemed the risk of vaccination-related GBS to be low with pandemic flu vaccine, it did recommend caution for patients with GBS who might consider vaccination.

“Persons with a history of GBS should discuss potential risks and benefits with their health-care providers before receiving any influenza vaccine,” K.R. Copeland of the National Opinion Research Center, Chicago, and co-authors wrote in an accompanying editorial note. “However, risk assessment should take into account that influenza and influenza-like illnesses are associated with significant morbidity and mortality, including a hospitalization rate of 222 per 1 million population and a death rate of 9.7 per 1 million population for H1N1-associated illnesses, as well as possible increased risk for GBS.”

Of the 326 confirmed GBS cases, 27 had documentation proving pandemic flu vaccination within the 42-day window; vaccination status could not be determined in 25, and 274 were not vaccinated.

Sixteen of the 27 (59%) who received the vaccine experienced antecedent symptoms before their GBS diagnosis. The program found no clustering of GBS between vaccination and illness onset.

Among the 27 with GBS who were vaccinated, 4 (15%) required ventilator support, and 1 was hospitalized for 30 days. Among the 274 GBS patients who were not vaccinated, 37 (14%) required ventilator support, and 34 (12%) were hospitalized for 30 days after illness onset. Eight GBS patients died (2%); none of them had received the pandemic flu vaccine.

The CDC study used data gathered by its Emerging Infections Program. The program has collaborated with state health centers and academic medical centers in 10 states to rapidly identify new GBS cases following pandemic flu vaccination.

The surveillance areas included Connecticut, Maryland, Minnesota, New Mexico, Tennessee, and New York state (excluding Manhattan), and selected metropolitan counties in California, Colorado, Georgia, and Oregon. GBS incidence was calculated and compared for the vaccinated and unvaccinated populations.

Major Finding: For every 1 million people who receive the pandemic influenza vaccine, about 1 additional person will develop Guillain-Barré syndrome.

Data Source: A nationwide federal Guillain Barré Syndrome surveillance system.

Disclosures: None noted.

The excess risk of developing Guillain-Barré syndrome associated with receipt of the pandemic influenza A(H1N1) vaccine is less than 1 case per 1 million vaccinations—a rate comparable to that seen for some trivalent seasonal influenza vaccines.

Preliminary results released in the Morbidity and Mortality Weekly Report found 326 confirmed new cases of the neurological disorder from Oct. 1, 2009 through May 10, 2010 (MMWR 2010;59:1-5).

Of these patients, 27 reported having had the pandemic flu vaccine within 42 days of the onset of GBS—the time period considered plausible for any biologic link between the two. Most of these patients reported an antecedent illness typically related to GBS onset (gastrointestinal illness or respiratory infection).

“Notably, this high proportion of antecedent illnesses associated with GBS suggests that a number of the GBS illnesses observed after vaccination might be attributable to other antecedent illnesses,” wrote C. Prothro of the California Emerging Infections Program, Oakland, and co-authors. “Historically, 40%-70% of GBS patients report experiencing antecedent infectious illness.”

If the preliminary analysis is confirmed—which the CDC expects to happen by this fall—then the attributable rate of GBS would be 0.71 per 100,000 person-years, corresponding to an excess GBS rate of 0.8 cases per 1 million vaccinations, the report said.

Although the report deemed the risk of vaccination-related GBS to be low with pandemic flu vaccine, it did recommend caution for patients with GBS who might consider vaccination.

“Persons with a history of GBS should discuss potential risks and benefits with their health-care providers before receiving any influenza vaccine,” K.R. Copeland of the National Opinion Research Center, Chicago, and co-authors wrote in an accompanying editorial note. “However, risk assessment should take into account that influenza and influenza-like illnesses are associated with significant morbidity and mortality, including a hospitalization rate of 222 per 1 million population and a death rate of 9.7 per 1 million population for H1N1-associated illnesses, as well as possible increased risk for GBS.”

Of the 326 confirmed GBS cases, 27 had documentation proving pandemic flu vaccination within the 42-day window; vaccination status could not be determined in 25, and 274 were not vaccinated.

Sixteen of the 27 (59%) who received the vaccine experienced antecedent symptoms before their GBS diagnosis. The program found no clustering of GBS between vaccination and illness onset.

Among the 27 with GBS who were vaccinated, 4 (15%) required ventilator support, and 1 was hospitalized for 30 days. Among the 274 GBS patients who were not vaccinated, 37 (14%) required ventilator support, and 34 (12%) were hospitalized for 30 days after illness onset. Eight GBS patients died (2%); none of them had received the pandemic flu vaccine.

The CDC study used data gathered by its Emerging Infections Program. The program has collaborated with state health centers and academic medical centers in 10 states to rapidly identify new GBS cases following pandemic flu vaccination.

The surveillance areas included Connecticut, Maryland, Minnesota, New Mexico, Tennessee, and New York state (excluding Manhattan), and selected metropolitan counties in California, Colorado, Georgia, and Oregon. GBS incidence was calculated and compared for the vaccinated and unvaccinated populations.

The excess risk of developing Guillain-Barré syndrome associated with receipt of the pandemic influenza A(H1N1) vaccine is less than 1 case per 1 million vaccinations – a rate comparable to that seen for some trivalent seasonal influenza vaccines.

Preliminary results released in the June 2 issue of the Morbidity and Mortality Weekly Report found 326 confirmed new cases of the neurological disorder from Oct. 1, 2009 – May 10, 2010 (MMWR 2010; 59:1-5). Of these patients, 27 reported having had the pandemic flu vaccine within 42 days of the onset of GBS – the time period considered plausible for any biologic link between the two. Most of these patients reported an antecedent illness typically related to GBS onset (gastrointestinal illness or respiratory infection).

“Notably, this high proportion of antecedent illnesses associated with GBS suggests that a number of the GBS illnesses observed after vaccination might be attributable to other antecedent illnesses,” wrote C. Prothro of the California Emerging Infections Program, Oakland, and co-authors. “Historically, 40%-70% of GBS patients report experiencing antecedent infectious illness.”

If the preliminary analysis is confirmed – which the CDC expects to happen by this fall – then the attributable rate of GBS would be 0.71 per 100,000 person-years, corresponding to an excess GBS rate of 0.8 cases per 1 million vaccinations, the report said.

Although the report deemed the risk of vaccination-related GBS to be low with pandemic flu vaccine, it did recommend caution for patients with GBS who might consider vaccination.

“Persons with a history of GBS should discuss potential risks and benefits with their health-care providers before receiving any influenza vaccine,” K.R. Copeland of the National Opinion Research Center, Chicago, and co-authors wrote in an accompanying editorial note. “However, risk assessment should take into account that influenza and influenza-like illnesses are associated with significant morbidity and mortality, including a hospitalization rate of 222 per 1 million population and a death rate of 9.7 per 1 million population for H1N1-associated illnesses, as well as possible increased risk for GBS.”

Of the 326 confirmed GBS cases, 27 had documentation proving pandemic flu vaccination within the 42-day window; vaccination status could not be determined in 25, and 274 did not take the vaccine.

Sixteen of the 27 (59%) who received the vaccine experienced antecedent symptoms before their GBS diagnosis. The program found no clustering of GBS between vaccination and illness onset.

Among the 27 with the disorder who were vaccinated, 4 (15%) required ventilator support, and 1 was hospitalized for 30 days. Among the 274 GBS patients who were not vaccinated, 37 (14%) required ventilator support, and 34 (12%) were hospitalized for 30 days after illness onset. Eight GBS patients died (2%); none of them had received the pandemic flu vaccine.

The CDC study used data gathered by its own Emerging Infections Program. The program has collaborated with the CDC, state health centers, and academic centers in 10 states to rapidly identify new GBS cases following pandemic flu vaccination. The surveillance areas included Connecticut, Maryland, Minnesota, New Mexico, Tennessee, and New York state (excluding Manhattan), and selected metropolitan counties in California, Colorado, Georgia, and Oregon. GBS incidence was calculated and compared for the vaccinated and unvaccinated populations.

No financial conflicts were reported in the study.

The excess risk of developing Guillain-Barré syndrome associated with receipt of the pandemic influenza A(H1N1) vaccine is less than 1 case per 1 million vaccinations – a rate comparable to that seen for some trivalent seasonal influenza vaccines.

Preliminary results released in the June 2 issue of the Morbidity and Mortality Weekly Report found 326 confirmed new cases of the neurological disorder from Oct. 1, 2009 – May 10, 2010 (MMWR 2010; 59:1-5). Of these patients, 27 reported having had the pandemic flu vaccine within 42 days of the onset of GBS – the time period considered plausible for any biologic link between the two. Most of these patients reported an antecedent illness typically related to GBS onset (gastrointestinal illness or respiratory infection).

“Notably, this high proportion of antecedent illnesses associated with GBS suggests that a number of the GBS illnesses observed after vaccination might be attributable to other antecedent illnesses,” wrote C. Prothro of the California Emerging Infections Program, Oakland, and co-authors. “Historically, 40%-70% of GBS patients report experiencing antecedent infectious illness.”

If the preliminary analysis is confirmed – which the CDC expects to happen by this fall – then the attributable rate of GBS would be 0.71 per 100,000 person-years, corresponding to an excess GBS rate of 0.8 cases per 1 million vaccinations, the report said.

Although the report deemed the risk of vaccination-related GBS to be low with pandemic flu vaccine, it did recommend caution for patients with GBS who might consider vaccination.

“Persons with a history of GBS should discuss potential risks and benefits with their health-care providers before receiving any influenza vaccine,” K.R. Copeland of the National Opinion Research Center, Chicago, and co-authors wrote in an accompanying editorial note. “However, risk assessment should take into account that influenza and influenza-like illnesses are associated with significant morbidity and mortality, including a hospitalization rate of 222 per 1 million population and a death rate of 9.7 per 1 million population for H1N1-associated illnesses, as well as possible increased risk for GBS.”

Of the 326 confirmed GBS cases, 27 had documentation proving pandemic flu vaccination within the 42-day window; vaccination status could not be determined in 25, and 274 did not take the vaccine.

Sixteen of the 27 (59%) who received the vaccine experienced antecedent symptoms before their GBS diagnosis. The program found no clustering of GBS between vaccination and illness onset.

Among the 27 with the disorder who were vaccinated, 4 (15%) required ventilator support, and 1 was hospitalized for 30 days. Among the 274 GBS patients who were not vaccinated, 37 (14%) required ventilator support, and 34 (12%) were hospitalized for 30 days after illness onset. Eight GBS patients died (2%); none of them had received the pandemic flu vaccine.

The CDC study used data gathered by its own Emerging Infections Program. The program has collaborated with the CDC, state health centers, and academic centers in 10 states to rapidly identify new GBS cases following pandemic flu vaccination. The surveillance areas included Connecticut, Maryland, Minnesota, New Mexico, Tennessee, and New York state (excluding Manhattan), and selected metropolitan counties in California, Colorado, Georgia, and Oregon. GBS incidence was calculated and compared for the vaccinated and unvaccinated populations.

No financial conflicts were reported in the study.

The excess risk of developing Guillain-Barré syndrome associated with receipt of the pandemic influenza A(H1N1) vaccine is less than 1 case per 1 million vaccinations – a rate comparable to that seen for some trivalent seasonal influenza vaccines.

Preliminary results released in the June 2 issue of the Morbidity and Mortality Weekly Report found 326 confirmed new cases of the neurological disorder from Oct. 1, 2009 – May 10, 2010 (MMWR 2010; 59:1-5). Of these patients, 27 reported having had the pandemic flu vaccine within 42 days of the onset of GBS – the time period considered plausible for any biologic link between the two. Most of these patients reported an antecedent illness typically related to GBS onset (gastrointestinal illness or respiratory infection).

“Notably, this high proportion of antecedent illnesses associated with GBS suggests that a number of the GBS illnesses observed after vaccination might be attributable to other antecedent illnesses,” wrote C. Prothro of the California Emerging Infections Program, Oakland, and co-authors. “Historically, 40%-70% of GBS patients report experiencing antecedent infectious illness.”

If the preliminary analysis is confirmed – which the CDC expects to happen by this fall – then the attributable rate of GBS would be 0.71 per 100,000 person-years, corresponding to an excess GBS rate of 0.8 cases per 1 million vaccinations, the report said.

Although the report deemed the risk of vaccination-related GBS to be low with pandemic flu vaccine, it did recommend caution for patients with GBS who might consider vaccination.

“Persons with a history of GBS should discuss potential risks and benefits with their health-care providers before receiving any influenza vaccine,” K.R. Copeland of the National Opinion Research Center, Chicago, and co-authors wrote in an accompanying editorial note. “However, risk assessment should take into account that influenza and influenza-like illnesses are associated with significant morbidity and mortality, including a hospitalization rate of 222 per 1 million population and a death rate of 9.7 per 1 million population for H1N1-associated illnesses, as well as possible increased risk for GBS.”

Of the 326 confirmed GBS cases, 27 had documentation proving pandemic flu vaccination within the 42-day window; vaccination status could not be determined in 25, and 274 did not take the vaccine.

Sixteen of the 27 (59%) who received the vaccine experienced antecedent symptoms before their GBS diagnosis. The program found no clustering of GBS between vaccination and illness onset.

Among the 27 with the disorder who were vaccinated, 4 (15%) required ventilator support, and 1 was hospitalized for 30 days. Among the 274 GBS patients who were not vaccinated, 37 (14%) required ventilator support, and 34 (12%) were hospitalized for 30 days after illness onset. Eight GBS patients died (2%); none of them had received the pandemic flu vaccine.

The CDC study used data gathered by its own Emerging Infections Program. The program has collaborated with the CDC, state health centers, and academic centers in 10 states to rapidly identify new GBS cases following pandemic flu vaccination. The surveillance areas included Connecticut, Maryland, Minnesota, New Mexico, Tennessee, and New York state (excluding Manhattan), and selected metropolitan counties in California, Colorado, Georgia, and Oregon. GBS incidence was calculated and compared for the vaccinated and unvaccinated populations.

No financial conflicts were reported in the study.

A patient's medical costs may depend not only on the person's state of health but also on where he or she lives in the United States, according to two studies showing regional differences in Medicare spending that couldn't be fully explained by demographic variables or overall health status.

So strong was the finding of regionalized spending differences that, in one study, patients who moved from the lowest-spending region to a higher-spending region experienced a 100% increase in their number of diagnoses, a 66% increase in imaging services, and a 74% increase in lab testing. The increase did not buy any additional years of life, however. “At 3 years, there was no evidence of a survival benefit,” wrote Yunjie Song, Ph.D., and colleagues (NEJM 2010 May 12 [doi10.1056/NEJMsa0910881]).

The second study, by Stephen Zuckerman, Ph.D., of the Urban Institute, Washington, and colleagues, found that unadjusted Medicare spending was 52% higher in the highest-spending region than in the lowest-spending region. Even after adjusting for more than a dozen variables, the investigators could not account for up to 63% of the health-spending difference.

“In the absence of better information about the sources, causes, and consequences of geographic differences in Medicare spending, policy makers should resist the appeal of simple solutions for limiting expenditures in high-cost areas,” they said.

Dr. Song of Dartmouth College, Lebanon, N.H., and coauthors examined Medicare claims data from 1999 to 2006 among 52,000 beneficiaries who moved their homes during that time and almost 3 million who did not. More than 300 hospital referral regions were sorted into quintiles according to the intensity of practice within them.

Overall, residents of higher-intensity regions had more office visits, more diagnostic tests, more medical diagnoses, and higher risk scores than did residents of lower-intensity regions. There was a strong trend toward increasing rates of diagnostic testing and diagnosed conditions, but this increase varied significantly among the quintile groups.

The findings have implications for health reform, Dr. Song's team said, since studies to determine variations in health care effectiveness—and how compensation should be structured—are probably biased from the start because of the regional differences in diagnostic intensity.

The study by Dr. Zuckerman used Medicare claims data from 2000 to 2002 to examine spending in U.S. hospital referral regions (NEJM 2010 May 12 [doi:10.1056/NEJMsa0909253]).

The investigators conducted six multivariate regression analyses, each building on the other. The final model controlled for almost two dozen variables.

Medicare spending varied significantly between quintiles, with beneficiaries in quintile 1 accounting for a mean of $4,721, while those in quintile 5 accounting for $7,183—a 52% difference.

Adjusting for only demographic characteristics reduced the difference to 40%, leaving most of the gap between quintiles 1 and 5 unexplained. Factoring in general health data further reduced the unexplained difference among some quintiles but not others (reductions of 21%-33%).

The team identified death during the study as the most important variable in spending. Death rates ranged from 2% in quintile 1 to 3% in quintile 5. “Although this is not a large absolute difference … approximately 8% of the $2,462 difference in per-beneficiary spending between quintiles 1 and 5 was accounted for by this variable alone,” they wrote.

“Policies that focus on area-level spending without adequate adjustment for differences in beneficiaries' health status could inappropriately reward or penalize certain geographic areas,” they said.

Disclosures: Dr. Zuckerman has received support from the Robert Wood Johnson Foundation. Dr. Song reported receiving grants from the National Institute on Aging and the Robert Wood Johnson, California Healthcare, United Healthcare, and Wellpoint Foundations.

A patient's medical costs may depend not only on the person's state of health but also on where he or she lives in the United States, according to two studies showing regional differences in Medicare spending that couldn't be fully explained by demographic variables or overall health status.

So strong was the finding of regionalized spending differences that, in one study, patients who moved from the lowest-spending region to a higher-spending region experienced a 100% increase in their number of diagnoses, a 66% increase in imaging services, and a 74% increase in lab testing. The increase did not buy any additional years of life, however. “At 3 years, there was no evidence of a survival benefit,” wrote Yunjie Song, Ph.D., and colleagues (NEJM 2010 May 12 [doi10.1056/NEJMsa0910881]).

The second study, by Stephen Zuckerman, Ph.D., of the Urban Institute, Washington, and colleagues, found that unadjusted Medicare spending was 52% higher in the highest-spending region than in the lowest-spending region. Even after adjusting for more than a dozen variables, the investigators could not account for up to 63% of the health-spending difference.

“In the absence of better information about the sources, causes, and consequences of geographic differences in Medicare spending, policy makers should resist the appeal of simple solutions for limiting expenditures in high-cost areas,” they said.

Dr. Song of Dartmouth College, Lebanon, N.H., and coauthors examined Medicare claims data from 1999 to 2006 among 52,000 beneficiaries who moved their homes during that time and almost 3 million who did not. More than 300 hospital referral regions were sorted into quintiles according to the intensity of practice within them.

Overall, residents of higher-intensity regions had more office visits, more diagnostic tests, more medical diagnoses, and higher risk scores than did residents of lower-intensity regions. There was a strong trend toward increasing rates of diagnostic testing and diagnosed conditions, but this increase varied significantly among the quintile groups.

The findings have implications for health reform, Dr. Song's team said, since studies to determine variations in health care effectiveness—and how compensation should be structured—are probably biased from the start because of the regional differences in diagnostic intensity.

The study by Dr. Zuckerman used Medicare claims data from 2000 to 2002 to examine spending in U.S. hospital referral regions (NEJM 2010 May 12 [doi:10.1056/NEJMsa0909253]).

The investigators conducted six multivariate regression analyses, each building on the other. The final model controlled for almost two dozen variables.

Medicare spending varied significantly between quintiles, with beneficiaries in quintile 1 accounting for a mean of $4,721, while those in quintile 5 accounting for $7,183—a 52% difference.

Adjusting for only demographic characteristics reduced the difference to 40%, leaving most of the gap between quintiles 1 and 5 unexplained. Factoring in general health data further reduced the unexplained difference among some quintiles but not others (reductions of 21%-33%).

The team identified death during the study as the most important variable in spending. Death rates ranged from 2% in quintile 1 to 3% in quintile 5. “Although this is not a large absolute difference … approximately 8% of the $2,462 difference in per-beneficiary spending between quintiles 1 and 5 was accounted for by this variable alone,” they wrote.

“Policies that focus on area-level spending without adequate adjustment for differences in beneficiaries' health status could inappropriately reward or penalize certain geographic areas,” they said.

Disclosures: Dr. Zuckerman has received support from the Robert Wood Johnson Foundation. Dr. Song reported receiving grants from the National Institute on Aging and the Robert Wood Johnson, California Healthcare, United Healthcare, and Wellpoint Foundations.

A patient's medical costs may depend not only on the person's state of health but also on where he or she lives in the United States, according to two studies showing regional differences in Medicare spending that couldn't be fully explained by demographic variables or overall health status.

So strong was the finding of regionalized spending differences that, in one study, patients who moved from the lowest-spending region to a higher-spending region experienced a 100% increase in their number of diagnoses, a 66% increase in imaging services, and a 74% increase in lab testing. The increase did not buy any additional years of life, however. “At 3 years, there was no evidence of a survival benefit,” wrote Yunjie Song, Ph.D., and colleagues (NEJM 2010 May 12 [doi10.1056/NEJMsa0910881]).

The second study, by Stephen Zuckerman, Ph.D., of the Urban Institute, Washington, and colleagues, found that unadjusted Medicare spending was 52% higher in the highest-spending region than in the lowest-spending region. Even after adjusting for more than a dozen variables, the investigators could not account for up to 63% of the health-spending difference.

“In the absence of better information about the sources, causes, and consequences of geographic differences in Medicare spending, policy makers should resist the appeal of simple solutions for limiting expenditures in high-cost areas,” they said.

Dr. Song of Dartmouth College, Lebanon, N.H., and coauthors examined Medicare claims data from 1999 to 2006 among 52,000 beneficiaries who moved their homes during that time and almost 3 million who did not. More than 300 hospital referral regions were sorted into quintiles according to the intensity of practice within them.

Overall, residents of higher-intensity regions had more office visits, more diagnostic tests, more medical diagnoses, and higher risk scores than did residents of lower-intensity regions. There was a strong trend toward increasing rates of diagnostic testing and diagnosed conditions, but this increase varied significantly among the quintile groups.

The findings have implications for health reform, Dr. Song's team said, since studies to determine variations in health care effectiveness—and how compensation should be structured—are probably biased from the start because of the regional differences in diagnostic intensity.

The study by Dr. Zuckerman used Medicare claims data from 2000 to 2002 to examine spending in U.S. hospital referral regions (NEJM 2010 May 12 [doi:10.1056/NEJMsa0909253]).

The investigators conducted six multivariate regression analyses, each building on the other. The final model controlled for almost two dozen variables.

Medicare spending varied significantly between quintiles, with beneficiaries in quintile 1 accounting for a mean of $4,721, while those in quintile 5 accounting for $7,183—a 52% difference.

Adjusting for only demographic characteristics reduced the difference to 40%, leaving most of the gap between quintiles 1 and 5 unexplained. Factoring in general health data further reduced the unexplained difference among some quintiles but not others (reductions of 21%-33%).

The team identified death during the study as the most important variable in spending. Death rates ranged from 2% in quintile 1 to 3% in quintile 5. “Although this is not a large absolute difference … approximately 8% of the $2,462 difference in per-beneficiary spending between quintiles 1 and 5 was accounted for by this variable alone,” they wrote.

“Policies that focus on area-level spending without adequate adjustment for differences in beneficiaries' health status could inappropriately reward or penalize certain geographic areas,” they said.

Disclosures: Dr. Zuckerman has received support from the Robert Wood Johnson Foundation. Dr. Song reported receiving grants from the National Institute on Aging and the Robert Wood Johnson, California Healthcare, United Healthcare, and Wellpoint Foundations.

Major Finding: Available information on the burden of VTE has been based on two epidemiologic studies and on limited data from hospital discharge surveys or analysis of provider claims databases.

Data Source: A workshop and a review of the literature by a national work group convened by the Centers for Disease Control and Prevention and the American Society of Hematology.

Disclosures: Dr. Raskob disclosed that he has received consulting fees from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Pfizer, GlaxoSmithKline, Johnson & Johnson, Daiichi Sankyo, Sanofi-Aventis, and Takeda.

There is no shortage of clinical guidelines describing the risk factors for deep vein thrombosis and pulmonary embolism and how to effectively treat and prevent them.

What is lacking, a national work group has concluded, is any way to track whether those guidelines are being implemented.

Also missing is information about how such guidelines might affect the incidence of venous thromboembolism (VTE). These questions can be answered only through collection of data by a national surveillance program, according to Gary E. Raskob, Ph.D., and his colleagues.

The work group, convened by the Centers for Disease Control and Prevention and the American Society of Hematology, consisted of physicians, epidemiologists, and health care policy experts. Following a 1-day workshop, the group summarized the literature on the clinical impact of deep vein thrombosis (DVT) and pulmonary embolism (PE) in several areas of medicine, wrote Dr. Raskob, of the University of Oklahoma Health Sciences Center, Oklahoma City, and his coauthors (Am. J. Prev. Med. 2010; 38:S502-9).

The available information on the clinical and economic burden of VTE “has been based on two population-based epidemiologic studies and on limited data from hospital discharge surveys or analysis of healthcare provider claims databases,” the work group wrote.

Each year, about 900,000 cases of VTE occur in the United States. The risk of VTE increases with age, and is somewhat higher for men than for women (114 vs. 105/100,000). There are few data on whether DVT incidence varies by ethnic group, and available studies vary widely in methodology and conclusions.

A California patient discharge review that spanned 1991–1994 found an annual incidence among whites of 230/1 million population, compared with 293/1 million for blacks, 139/1 million for Hispanics, and 60/1 million for Asian/Pacific Islanders.

Most VTEs are associated with a recent hospitalization; therefore, the work group said, hospitalization is an opportune time to institute prevention measures and to educate patients on the risks of blood clots.

Among its recommendations, the work group suggested that the CDC:

▸ Establish a demographic picture of DVT and PE in the United States.

▸ Determine whether there are incidence differences among minorities, compared with white populations.

▸ Further define risk factors among various patient groups (pregnant patients, surgical patients, children, residents of long-term care facilities, and patients with a family history of VTE).

▸ Evaluate whether evidence-based preventive measures are being appropriately applied.

▸ Detect changes in the incidence of DVT and PE and relate these changes to any increase in the use of preventive measures.

The group also recommended that the CDC initiate a two-pronged national public awareness campaign, focusing on increasing overall understanding of the disorder and its risk factors, and encouraging patients who are about to undergo surgery or hospitalization to discuss the subject with their physicians.

My Take

Stop Underestimating VTE Risk

It's time for physicians and the public to take an in-depth look at this issue. Although at least four clinical treatment and prevention guidelines are available, they are not always employed in practice. We all know that everyone in the hospital should be receiving VTE prophylaxis, for example. Unfortunately, not everyone is getting it.

Several factors probably contribute to the problem. In some cases, we simply forget about VTE prevention. When a physician is dealing with acute problems in a very sick patient, VTE prevention might not be the first thing on that doctor's mind. Also, there are physicians who simply are not aware of the prevention guidelines, and so they don't implement them.

Finally, physicians who see discharged patients in the community—where 75% of VTEs occur—might not appreciate the importance of continuing prophylaxis after discharge. Physicians who don't provide care for patients in the hospital can go for years without seeing a clot, so they may underestimate the magnitude of the problem.

Franklin A. Michota, M.D., is the director of academic affairs in the Department of Hospital Medicine at the Cleveland Clinic. He reported no relevant conflicts of interest.

VITALS

Major Finding: Available information on the burden of VTE has been based on two epidemiologic studies and on limited data from hospital discharge surveys or analysis of provider claims databases.

Data Source: A workshop and a review of the literature by a national work group convened by the Centers for Disease Control and Prevention and the American Society of Hematology.

Disclosures: Dr. Raskob disclosed that he has received consulting fees from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Pfizer, GlaxoSmithKline, Johnson & Johnson, Daiichi Sankyo, Sanofi-Aventis, and Takeda.

There is no shortage of clinical guidelines describing the risk factors for deep vein thrombosis and pulmonary embolism and how to effectively treat and prevent them.

What is lacking, a national work group has concluded, is any way to track whether those guidelines are being implemented.

Also missing is information about how such guidelines might affect the incidence of venous thromboembolism (VTE). These questions can be answered only through collection of data by a national surveillance program, according to Gary E. Raskob, Ph.D., and his colleagues.

The work group, convened by the Centers for Disease Control and Prevention and the American Society of Hematology, consisted of physicians, epidemiologists, and health care policy experts. Following a 1-day workshop, the group summarized the literature on the clinical impact of deep vein thrombosis (DVT) and pulmonary embolism (PE) in several areas of medicine, wrote Dr. Raskob, of the University of Oklahoma Health Sciences Center, Oklahoma City, and his coauthors (Am. J. Prev. Med. 2010; 38:S502-9).

The available information on the clinical and economic burden of VTE “has been based on two population-based epidemiologic studies and on limited data from hospital discharge surveys or analysis of healthcare provider claims databases,” the work group wrote.

Each year, about 900,000 cases of VTE occur in the United States. The risk of VTE increases with age, and is somewhat higher for men than for women (114 vs. 105/100,000). There are few data on whether DVT incidence varies by ethnic group, and available studies vary widely in methodology and conclusions.

A California patient discharge review that spanned 1991–1994 found an annual incidence among whites of 230/1 million population, compared with 293/1 million for blacks, 139/1 million for Hispanics, and 60/1 million for Asian/Pacific Islanders.

Most VTEs are associated with a recent hospitalization; therefore, the work group said, hospitalization is an opportune time to institute prevention measures and to educate patients on the risks of blood clots.

Among its recommendations, the work group suggested that the CDC:

▸ Establish a demographic picture of DVT and PE in the United States.

▸ Determine whether there are incidence differences among minorities, compared with white populations.

▸ Further define risk factors among various patient groups (pregnant patients, surgical patients, children, residents of long-term care facilities, and patients with a family history of VTE).

▸ Evaluate whether evidence-based preventive measures are being appropriately applied.

▸ Detect changes in the incidence of DVT and PE and relate these changes to any increase in the use of preventive measures.

The group also recommended that the CDC initiate a two-pronged national public awareness campaign, focusing on increasing overall understanding of the disorder and its risk factors, and encouraging patients who are about to undergo surgery or hospitalization to discuss the subject with their physicians.

My Take

Stop Underestimating VTE Risk

It's time for physicians and the public to take an in-depth look at this issue. Although at least four clinical treatment and prevention guidelines are available, they are not always employed in practice. We all know that everyone in the hospital should be receiving VTE prophylaxis, for example. Unfortunately, not everyone is getting it.

Several factors probably contribute to the problem. In some cases, we simply forget about VTE prevention. When a physician is dealing with acute problems in a very sick patient, VTE prevention might not be the first thing on that doctor's mind. Also, there are physicians who simply are not aware of the prevention guidelines, and so they don't implement them.

Finally, physicians who see discharged patients in the community—where 75% of VTEs occur—might not appreciate the importance of continuing prophylaxis after discharge. Physicians who don't provide care for patients in the hospital can go for years without seeing a clot, so they may underestimate the magnitude of the problem.

Franklin A. Michota, M.D., is the director of academic affairs in the Department of Hospital Medicine at the Cleveland Clinic. He reported no relevant conflicts of interest.

VITALS

Major Finding: Available information on the burden of VTE has been based on two epidemiologic studies and on limited data from hospital discharge surveys or analysis of provider claims databases.

Data Source: A workshop and a review of the literature by a national work group convened by the Centers for Disease Control and Prevention and the American Society of Hematology.

Disclosures: Dr. Raskob disclosed that he has received consulting fees from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Pfizer, GlaxoSmithKline, Johnson & Johnson, Daiichi Sankyo, Sanofi-Aventis, and Takeda.

There is no shortage of clinical guidelines describing the risk factors for deep vein thrombosis and pulmonary embolism and how to effectively treat and prevent them.

What is lacking, a national work group has concluded, is any way to track whether those guidelines are being implemented.

Also missing is information about how such guidelines might affect the incidence of venous thromboembolism (VTE). These questions can be answered only through collection of data by a national surveillance program, according to Gary E. Raskob, Ph.D., and his colleagues.

The work group, convened by the Centers for Disease Control and Prevention and the American Society of Hematology, consisted of physicians, epidemiologists, and health care policy experts. Following a 1-day workshop, the group summarized the literature on the clinical impact of deep vein thrombosis (DVT) and pulmonary embolism (PE) in several areas of medicine, wrote Dr. Raskob, of the University of Oklahoma Health Sciences Center, Oklahoma City, and his coauthors (Am. J. Prev. Med. 2010; 38:S502-9).

The available information on the clinical and economic burden of VTE “has been based on two population-based epidemiologic studies and on limited data from hospital discharge surveys or analysis of healthcare provider claims databases,” the work group wrote.

Each year, about 900,000 cases of VTE occur in the United States. The risk of VTE increases with age, and is somewhat higher for men than for women (114 vs. 105/100,000). There are few data on whether DVT incidence varies by ethnic group, and available studies vary widely in methodology and conclusions.

A California patient discharge review that spanned 1991–1994 found an annual incidence among whites of 230/1 million population, compared with 293/1 million for blacks, 139/1 million for Hispanics, and 60/1 million for Asian/Pacific Islanders.

Most VTEs are associated with a recent hospitalization; therefore, the work group said, hospitalization is an opportune time to institute prevention measures and to educate patients on the risks of blood clots.

Among its recommendations, the work group suggested that the CDC:

▸ Establish a demographic picture of DVT and PE in the United States.

▸ Determine whether there are incidence differences among minorities, compared with white populations.

▸ Further define risk factors among various patient groups (pregnant patients, surgical patients, children, residents of long-term care facilities, and patients with a family history of VTE).

▸ Evaluate whether evidence-based preventive measures are being appropriately applied.

▸ Detect changes in the incidence of DVT and PE and relate these changes to any increase in the use of preventive measures.

The group also recommended that the CDC initiate a two-pronged national public awareness campaign, focusing on increasing overall understanding of the disorder and its risk factors, and encouraging patients who are about to undergo surgery or hospitalization to discuss the subject with their physicians.

My Take

Stop Underestimating VTE Risk

It's time for physicians and the public to take an in-depth look at this issue. Although at least four clinical treatment and prevention guidelines are available, they are not always employed in practice. We all know that everyone in the hospital should be receiving VTE prophylaxis, for example. Unfortunately, not everyone is getting it.

Several factors probably contribute to the problem. In some cases, we simply forget about VTE prevention. When a physician is dealing with acute problems in a very sick patient, VTE prevention might not be the first thing on that doctor's mind. Also, there are physicians who simply are not aware of the prevention guidelines, and so they don't implement them.

Finally, physicians who see discharged patients in the community—where 75% of VTEs occur—might not appreciate the importance of continuing prophylaxis after discharge. Physicians who don't provide care for patients in the hospital can go for years without seeing a clot, so they may underestimate the magnitude of the problem.

Franklin A. Michota, M.D., is the director of academic affairs in the Department of Hospital Medicine at the Cleveland Clinic. He reported no relevant conflicts of interest.

VITALS

Major Finding: After radiofrequency ablation had achieved complete eradication of intestinal metaplasia, eradication was maintained in 92% of Barrett's esophagus patients at 5 years.

Data Source: A 5-year follow-up study that included 50 patients.

Disclosures: Dr. Fleischer has received research support and “other financial benefit” from BARRX Medical and research support from AstraZeneca, the study sponsors.

NEW ORLEANS — In a prospective, multicenter trial of Barrett's esophagus patients, radiofrequency ablation achieved complete eradication of intestinal metaplasia, which was maintained for at least 5 years in 92% of 50 patients.

The findings may have implications for future Barrett's surveillance recommendations, said Dr. David E. Fleischer.

Since annual rates of progression to esophageal carcinoma are low—less than 1% according to most studies—watchful waiting is the usual approach for patients with intestinal metaplasia. Although national guidelines recommend surveillance only, ablation offers an alternative for some patients.

“When I explain [that] this could be an alternative to surveillance to my patients, they almost always prefer to have the procedure done,” said Dr. Fleischer of the Mayo Clinic, Scottsdale, Ariz.

He presented 5-year follow-up data on patients enrolled in the Ablation of Intestinal Metaplasia (AIM-II) Trial. The 70 patients originally enrolled in this study had 2 cm to 6 cm of Barrett's esophagus and histologic evidence of intestinal metaplasia without dysplasia. All received circumferential radiofrequency ablation of the affected area. The treatment was repeated in 4 months if a follow-up endoscopy showed residual disease.

A prior study reported 2.5-year outcomes in this group (Gastrointest. Endosc. 2008;68:867-76). For the 5-year follow-up, 50 patients who had complete eradication of intestinal metaplasia at 2.5 years (37 men, mean age 59 years) underwent a repeat endoscopy at 5 years, with a mean of 31 biopsy specimens obtained.

None of the patients had esophageal stricture or mucosal lesions. In 46 patients (92%), there was complete eradication of intestinal metaplasia. The other four patients (8%) had low levels of residual disease and underwent a single session of radiofrequency ablation. A repeat endoscopy and biopsy 2 months later showed no evidence of disease in all four patients.

“Radiofrequency ablation represents a durable, long-term approach to treating Barrett's esophagus and restoring cells to normal,” Dr. Fleischer said. “We've shown that by treating patients with early Barrett's, we were able to eliminate the disease in most instances, and we hope that will lead to a reduction in the cancer associated with [Barrett's esophagus].”

He pointed out that only additional long-term follow-up with many more patients would be able to determine if radiofrequency ablation offers a complete cure for Barrett's.

Vitals

Major Finding: After radiofrequency ablation had achieved complete eradication of intestinal metaplasia, eradication was maintained in 92% of Barrett's esophagus patients at 5 years.

Data Source: A 5-year follow-up study that included 50 patients.

Disclosures: Dr. Fleischer has received research support and “other financial benefit” from BARRX Medical and research support from AstraZeneca, the study sponsors.

NEW ORLEANS — In a prospective, multicenter trial of Barrett's esophagus patients, radiofrequency ablation achieved complete eradication of intestinal metaplasia, which was maintained for at least 5 years in 92% of 50 patients.

The findings may have implications for future Barrett's surveillance recommendations, said Dr. David E. Fleischer.

Since annual rates of progression to esophageal carcinoma are low—less than 1% according to most studies—watchful waiting is the usual approach for patients with intestinal metaplasia. Although national guidelines recommend surveillance only, ablation offers an alternative for some patients.

“When I explain [that] this could be an alternative to surveillance to my patients, they almost always prefer to have the procedure done,” said Dr. Fleischer of the Mayo Clinic, Scottsdale, Ariz.

He presented 5-year follow-up data on patients enrolled in the Ablation of Intestinal Metaplasia (AIM-II) Trial. The 70 patients originally enrolled in this study had 2 cm to 6 cm of Barrett's esophagus and histologic evidence of intestinal metaplasia without dysplasia. All received circumferential radiofrequency ablation of the affected area. The treatment was repeated in 4 months if a follow-up endoscopy showed residual disease.

A prior study reported 2.5-year outcomes in this group (Gastrointest. Endosc. 2008;68:867-76). For the 5-year follow-up, 50 patients who had complete eradication of intestinal metaplasia at 2.5 years (37 men, mean age 59 years) underwent a repeat endoscopy at 5 years, with a mean of 31 biopsy specimens obtained.

None of the patients had esophageal stricture or mucosal lesions. In 46 patients (92%), there was complete eradication of intestinal metaplasia. The other four patients (8%) had low levels of residual disease and underwent a single session of radiofrequency ablation. A repeat endoscopy and biopsy 2 months later showed no evidence of disease in all four patients.

“Radiofrequency ablation represents a durable, long-term approach to treating Barrett's esophagus and restoring cells to normal,” Dr. Fleischer said. “We've shown that by treating patients with early Barrett's, we were able to eliminate the disease in most instances, and we hope that will lead to a reduction in the cancer associated with [Barrett's esophagus].”

He pointed out that only additional long-term follow-up with many more patients would be able to determine if radiofrequency ablation offers a complete cure for Barrett's.

Vitals

Major Finding: After radiofrequency ablation had achieved complete eradication of intestinal metaplasia, eradication was maintained in 92% of Barrett's esophagus patients at 5 years.

Data Source: A 5-year follow-up study that included 50 patients.

Disclosures: Dr. Fleischer has received research support and “other financial benefit” from BARRX Medical and research support from AstraZeneca, the study sponsors.

NEW ORLEANS — In a prospective, multicenter trial of Barrett's esophagus patients, radiofrequency ablation achieved complete eradication of intestinal metaplasia, which was maintained for at least 5 years in 92% of 50 patients.

The findings may have implications for future Barrett's surveillance recommendations, said Dr. David E. Fleischer.

Since annual rates of progression to esophageal carcinoma are low—less than 1% according to most studies—watchful waiting is the usual approach for patients with intestinal metaplasia. Although national guidelines recommend surveillance only, ablation offers an alternative for some patients.

“When I explain [that] this could be an alternative to surveillance to my patients, they almost always prefer to have the procedure done,” said Dr. Fleischer of the Mayo Clinic, Scottsdale, Ariz.

He presented 5-year follow-up data on patients enrolled in the Ablation of Intestinal Metaplasia (AIM-II) Trial. The 70 patients originally enrolled in this study had 2 cm to 6 cm of Barrett's esophagus and histologic evidence of intestinal metaplasia without dysplasia. All received circumferential radiofrequency ablation of the affected area. The treatment was repeated in 4 months if a follow-up endoscopy showed residual disease.

A prior study reported 2.5-year outcomes in this group (Gastrointest. Endosc. 2008;68:867-76). For the 5-year follow-up, 50 patients who had complete eradication of intestinal metaplasia at 2.5 years (37 men, mean age 59 years) underwent a repeat endoscopy at 5 years, with a mean of 31 biopsy specimens obtained.

None of the patients had esophageal stricture or mucosal lesions. In 46 patients (92%), there was complete eradication of intestinal metaplasia. The other four patients (8%) had low levels of residual disease and underwent a single session of radiofrequency ablation. A repeat endoscopy and biopsy 2 months later showed no evidence of disease in all four patients.

“Radiofrequency ablation represents a durable, long-term approach to treating Barrett's esophagus and restoring cells to normal,” Dr. Fleischer said. “We've shown that by treating patients with early Barrett's, we were able to eliminate the disease in most instances, and we hope that will lead to a reduction in the cancer associated with [Barrett's esophagus].”

He pointed out that only additional long-term follow-up with many more patients would be able to determine if radiofrequency ablation offers a complete cure for Barrett's.

Vitals

Major Finding: Subjects who become overweight or obese in early adulthood are almost twice as likely to have colon adenomas than patients who maintain a normal weight.

Data Source: A prospective study of 1,865 people who underwent a screening colonoscopy.

Disclosures: None.

NEW ORLEANS — Adults who have been overweight since early adulthood are nearly twice as likely to have colon adenomas as those with a history of normal weight.

The findings reinforce the benefit of maintaining a healthy weight throughout life, Dr. Fritz Francois of New York University said in a written statement. “Our conclusions suggest that the chronicity of obesity is a significant risk factor for developing colon cancer. Given the continued rise in early-onset obesity, especially in minority populations, there is a need for interventions and lifestyle modifications earlier in life to help lessen this serious health risk later in life.”

Ian Fagan, who is a fourth-year medical student at the university, presented the data at the annual Digestive Disease Week. The colleagues conducted a prospective study of 1,865 patients who were referred for a screening colonoscopy. The patients' mean age was 57 years. Body mass index (BMI) was normal in 38%, whereas 39% were overweight and 23% were obese.

The researchers estimated BMI and waist circumference at age 10 and age 20 by having patients recall their clothing size and complete a validated questionnaire that included sketches of different body outlines. The subjects were divided into three groups: normal weight at age 20 years and at present; normal weight at 20 and now overweight or obese; and overweight or obese since age 20.

“We noticed right away … that race and ethnicity had a significant impact on weight change since early adulthood,” Mr. Fagan said. Sixty-one percent of Hispanics fell into the group that changed from normal weight to overweight or obese, as well as 50% of blacks, 46% of whites, and 7% of Asians.

Adenomas were significantly more common among patients who had been overweight or obese since age 10 (at a rate of 27%) and among those who went from normal weight to overweight (19%), compared with those who had maintained a normal weight (13%).

After controlling for age, gender, current BMI, U.S. birth, and red meat consumption, the investigators found that becoming overweight or obese in early adulthood almost doubled the risk of an adenoma on screening colonoscopy (odds ratio 1.8).

Becoming overweight or obese in early adulthood almost doubled the risk of an adenoma.

Source MR. FAGAN

Major Finding: Subjects who become overweight or obese in early adulthood are almost twice as likely to have colon adenomas than patients who maintain a normal weight.

Data Source: A prospective study of 1,865 people who underwent a screening colonoscopy.

Disclosures: None.

NEW ORLEANS — Adults who have been overweight since early adulthood are nearly twice as likely to have colon adenomas as those with a history of normal weight.

The findings reinforce the benefit of maintaining a healthy weight throughout life, Dr. Fritz Francois of New York University said in a written statement. “Our conclusions suggest that the chronicity of obesity is a significant risk factor for developing colon cancer. Given the continued rise in early-onset obesity, especially in minority populations, there is a need for interventions and lifestyle modifications earlier in life to help lessen this serious health risk later in life.”

Ian Fagan, who is a fourth-year medical student at the university, presented the data at the annual Digestive Disease Week. The colleagues conducted a prospective study of 1,865 patients who were referred for a screening colonoscopy. The patients' mean age was 57 years. Body mass index (BMI) was normal in 38%, whereas 39% were overweight and 23% were obese.

The researchers estimated BMI and waist circumference at age 10 and age 20 by having patients recall their clothing size and complete a validated questionnaire that included sketches of different body outlines. The subjects were divided into three groups: normal weight at age 20 years and at present; normal weight at 20 and now overweight or obese; and overweight or obese since age 20.

“We noticed right away … that race and ethnicity had a significant impact on weight change since early adulthood,” Mr. Fagan said. Sixty-one percent of Hispanics fell into the group that changed from normal weight to overweight or obese, as well as 50% of blacks, 46% of whites, and 7% of Asians.

Adenomas were significantly more common among patients who had been overweight or obese since age 10 (at a rate of 27%) and among those who went from normal weight to overweight (19%), compared with those who had maintained a normal weight (13%).

After controlling for age, gender, current BMI, U.S. birth, and red meat consumption, the investigators found that becoming overweight or obese in early adulthood almost doubled the risk of an adenoma on screening colonoscopy (odds ratio 1.8).

Becoming overweight or obese in early adulthood almost doubled the risk of an adenoma.

Source MR. FAGAN

Major Finding: Subjects who become overweight or obese in early adulthood are almost twice as likely to have colon adenomas than patients who maintain a normal weight.

Data Source: A prospective study of 1,865 people who underwent a screening colonoscopy.

Disclosures: None.

NEW ORLEANS — Adults who have been overweight since early adulthood are nearly twice as likely to have colon adenomas as those with a history of normal weight.

The findings reinforce the benefit of maintaining a healthy weight throughout life, Dr. Fritz Francois of New York University said in a written statement. “Our conclusions suggest that the chronicity of obesity is a significant risk factor for developing colon cancer. Given the continued rise in early-onset obesity, especially in minority populations, there is a need for interventions and lifestyle modifications earlier in life to help lessen this serious health risk later in life.”

Ian Fagan, who is a fourth-year medical student at the university, presented the data at the annual Digestive Disease Week. The colleagues conducted a prospective study of 1,865 patients who were referred for a screening colonoscopy. The patients' mean age was 57 years. Body mass index (BMI) was normal in 38%, whereas 39% were overweight and 23% were obese.

The researchers estimated BMI and waist circumference at age 10 and age 20 by having patients recall their clothing size and complete a validated questionnaire that included sketches of different body outlines. The subjects were divided into three groups: normal weight at age 20 years and at present; normal weight at 20 and now overweight or obese; and overweight or obese since age 20.

“We noticed right away … that race and ethnicity had a significant impact on weight change since early adulthood,” Mr. Fagan said. Sixty-one percent of Hispanics fell into the group that changed from normal weight to overweight or obese, as well as 50% of blacks, 46% of whites, and 7% of Asians.

Adenomas were significantly more common among patients who had been overweight or obese since age 10 (at a rate of 27%) and among those who went from normal weight to overweight (19%), compared with those who had maintained a normal weight (13%).

After controlling for age, gender, current BMI, U.S. birth, and red meat consumption, the investigators found that becoming overweight or obese in early adulthood almost doubled the risk of an adenoma on screening colonoscopy (odds ratio 1.8).

Becoming overweight or obese in early adulthood almost doubled the risk of an adenoma.

Source MR. FAGAN

Major Finding: Three of the nation's 13 vaccine safety monitoring systems have picked up weak signs between the H1N1 pandemic flu vaccine and Bell's palsy, Guillain-Barre Syndrome, and thrombocytopenia/idiopathic thrombocytopenia purpura.

Data Source: A data review by the H1N1 Vaccine Safety Risk Assessment Working Group.

Disclosures: None.

The federal government will step up its search for possible adverse reactions to the pandemic A(H1N1) flu vaccine, particularly looking for any cases of Guillain-Barr syndrome, Bell's palsy, and thrombocytopenia that might be linked to the vaccine, according to a report issued by the Department of Health and Human Services.

The National Vaccine Information Center recommended the expanded safety monitoring because 3 of the nation's 13 vaccine safety monitoring systems have picked up weak signals of a possible interaction between the pandemic flu shot and the disorders. The decision came after a meeting of the H1N1 Vaccine Safety Risk Assessment Working Group (VSRAWG).

The Vaccine Safety Datalink program is the largest of the three systems that found a possible link; it contains information on 1.5 million pandemic flu immunizations. This system picked up a weak signal for an association with Bell's palsy.

The Defense Medical Surveillance System, with information on 1.3 million pandemic flu immunizations, and the Veterans Affairs signal detection database, with almost 300,000 vaccination records, both showed a weak signal for thrombocytopenia and idiopathic thrombocytopenia purpura (ITP).

The Indian Health Service, with information on 2.2 million immunizations, showed a weak signal for both Bell's palsy and the blood disorders.

In systems that linked the vaccine and thrombocytopenia/ITP, “the cases are being reviewed to see if the diagnoses are evaluated,” the report noted.

The Guillain-Barre Syndrome enhanced surveillance database observed a “potential signal” for that disorder. The database monitors a population of 45 million, but no information was available on how many pandemic flu vaccinations had been examined to determine the possible link.

The nation's primary—and largest—system, however, has picked up no worrisome safety signals. The Vaccine Adverse Event Reporting System (VAERS) has captured information on more than 126 million pandemic flu vaccinations. It found that adverse events after the shots were no different than those occurring after seasonal flu vaccine.

Major Finding: Three of the nation's 13 vaccine safety monitoring systems have picked up weak signs between the H1N1 pandemic flu vaccine and Bell's palsy, Guillain-Barre Syndrome, and thrombocytopenia/idiopathic thrombocytopenia purpura.

Data Source: A data review by the H1N1 Vaccine Safety Risk Assessment Working Group.

Disclosures: None.

The federal government will step up its search for possible adverse reactions to the pandemic A(H1N1) flu vaccine, particularly looking for any cases of Guillain-Barr syndrome, Bell's palsy, and thrombocytopenia that might be linked to the vaccine, according to a report issued by the Department of Health and Human Services.

The National Vaccine Information Center recommended the expanded safety monitoring because 3 of the nation's 13 vaccine safety monitoring systems have picked up weak signals of a possible interaction between the pandemic flu shot and the disorders. The decision came after a meeting of the H1N1 Vaccine Safety Risk Assessment Working Group (VSRAWG).

The Vaccine Safety Datalink program is the largest of the three systems that found a possible link; it contains information on 1.5 million pandemic flu immunizations. This system picked up a weak signal for an association with Bell's palsy.

The Defense Medical Surveillance System, with information on 1.3 million pandemic flu immunizations, and the Veterans Affairs signal detection database, with almost 300,000 vaccination records, both showed a weak signal for thrombocytopenia and idiopathic thrombocytopenia purpura (ITP).

The Indian Health Service, with information on 2.2 million immunizations, showed a weak signal for both Bell's palsy and the blood disorders.

In systems that linked the vaccine and thrombocytopenia/ITP, “the cases are being reviewed to see if the diagnoses are evaluated,” the report noted.

The Guillain-Barre Syndrome enhanced surveillance database observed a “potential signal” for that disorder. The database monitors a population of 45 million, but no information was available on how many pandemic flu vaccinations had been examined to determine the possible link.

The nation's primary—and largest—system, however, has picked up no worrisome safety signals. The Vaccine Adverse Event Reporting System (VAERS) has captured information on more than 126 million pandemic flu vaccinations. It found that adverse events after the shots were no different than those occurring after seasonal flu vaccine.

Major Finding: Three of the nation's 13 vaccine safety monitoring systems have picked up weak signs between the H1N1 pandemic flu vaccine and Bell's palsy, Guillain-Barre Syndrome, and thrombocytopenia/idiopathic thrombocytopenia purpura.

Data Source: A data review by the H1N1 Vaccine Safety Risk Assessment Working Group.

Disclosures: None.

The federal government will step up its search for possible adverse reactions to the pandemic A(H1N1) flu vaccine, particularly looking for any cases of Guillain-Barr syndrome, Bell's palsy, and thrombocytopenia that might be linked to the vaccine, according to a report issued by the Department of Health and Human Services.

The National Vaccine Information Center recommended the expanded safety monitoring because 3 of the nation's 13 vaccine safety monitoring systems have picked up weak signals of a possible interaction between the pandemic flu shot and the disorders. The decision came after a meeting of the H1N1 Vaccine Safety Risk Assessment Working Group (VSRAWG).

The Vaccine Safety Datalink program is the largest of the three systems that found a possible link; it contains information on 1.5 million pandemic flu immunizations. This system picked up a weak signal for an association with Bell's palsy.

The Defense Medical Surveillance System, with information on 1.3 million pandemic flu immunizations, and the Veterans Affairs signal detection database, with almost 300,000 vaccination records, both showed a weak signal for thrombocytopenia and idiopathic thrombocytopenia purpura (ITP).

The Indian Health Service, with information on 2.2 million immunizations, showed a weak signal for both Bell's palsy and the blood disorders.

In systems that linked the vaccine and thrombocytopenia/ITP, “the cases are being reviewed to see if the diagnoses are evaluated,” the report noted.

The Guillain-Barre Syndrome enhanced surveillance database observed a “potential signal” for that disorder. The database monitors a population of 45 million, but no information was available on how many pandemic flu vaccinations had been examined to determine the possible link.

The nation's primary—and largest—system, however, has picked up no worrisome safety signals. The Vaccine Adverse Event Reporting System (VAERS) has captured information on more than 126 million pandemic flu vaccinations. It found that adverse events after the shots were no different than those occurring after seasonal flu vaccine.

The federal government will step up its search for possible adverse reactions to the pandemic influenza A(H1N1) vaccine, particularly looking for any cases of Guillain-Barré syndrome, Bell's palsy, and thrombocytopenia that might be linked to the vaccine, according to a report issued by the Department of Health and Human Services.

The National Vaccine Information Center recommended the expanded safety monitoring because 3 of the nation's 13 vaccine safety monitoring systems have picked up weak signals of a possible interaction between the pandemic flu shot and the disorders. The decision came after a meeting of the H1N1 Vaccine Safety Risk Assessment Working Group (VSRAWG). As of March 31, almost 127 million doses of H1N1 pandemic flu vaccine have been distributed in the United States.

The Vaccine Safety Datalink program is the largest of the three systems that found a possible disease link; it contains information on 1.5 million pandemic flu immunizations. This system picked up a weak signal for an association with Bell's palsy.

The Defense Medical Surveillance System, with information on 1.3 million pandemic flu immunizations, and the Veterans Affairs signal detection database, with almost 300,000 vaccination records, both showed a weak signal for thrombocytopenia and idiopathic thrombocytopenia purpura (ITP).

The Indian Health Service, with information on 2.2 million immunizations, showed a weak signal for both Bell's palsy and the blood disorders.

In systems that linked the vaccine and thrombocytopenia/ITP, “the cases are being reviewed to see if the diagnoses are evaluated,” the report noted. “More rigorous comparisons between cohorts with H1N1 vaccine exposure and other vaccines or no exposures are planned.”

The Guillain-Barre Syndrome enhanced surveillance database observed a “potential signal” for that disorder. The database monitors a population of 45 million, but no information was available on how many pandemic flu vaccinations had been examined to determine the possible link. Five other systems are also exploring a possible GBS/pandemic flu vaccine link, the report noted. “Although some systems are reporting elevated relative risks, none have crossed the threshold for a signal. Of importance is the fact that, even if an association between H1N1 vaccine exposure and GBS were substantiated, the estimate is that the vaccine would account for only one extra case of GBS per 1 million persons vaccinated, based on currently available data.”

The nation's primary—and largest—system, however, has picked up no worrisome safety signals. The Vaccine Adverse Event Reporting System (VAERS) has captured information on more than 126 million pandemic flu vaccinations. It found that adverse events after the shots were no different than those occurring after seasonal flu vaccine.

Additional study is needed to determine whether the reported links represent a causal relationship, the report said.

The federal government will step up its search for possible adverse reactions to the pandemic influenza A(H1N1) vaccine, particularly looking for any cases of Guillain-Barré syndrome, Bell's palsy, and thrombocytopenia that might be linked to the vaccine, according to a report issued by the Department of Health and Human Services.

The National Vaccine Information Center recommended the expanded safety monitoring because 3 of the nation's 13 vaccine safety monitoring systems have picked up weak signals of a possible interaction between the pandemic flu shot and the disorders. The decision came after a meeting of the H1N1 Vaccine Safety Risk Assessment Working Group (VSRAWG). As of March 31, almost 127 million doses of H1N1 pandemic flu vaccine have been distributed in the United States.

The Vaccine Safety Datalink program is the largest of the three systems that found a possible disease link; it contains information on 1.5 million pandemic flu immunizations. This system picked up a weak signal for an association with Bell's palsy.

The Defense Medical Surveillance System, with information on 1.3 million pandemic flu immunizations, and the Veterans Affairs signal detection database, with almost 300,000 vaccination records, both showed a weak signal for thrombocytopenia and idiopathic thrombocytopenia purpura (ITP).

The Indian Health Service, with information on 2.2 million immunizations, showed a weak signal for both Bell's palsy and the blood disorders.

In systems that linked the vaccine and thrombocytopenia/ITP, “the cases are being reviewed to see if the diagnoses are evaluated,” the report noted. “More rigorous comparisons between cohorts with H1N1 vaccine exposure and other vaccines or no exposures are planned.”

The Guillain-Barre Syndrome enhanced surveillance database observed a “potential signal” for that disorder. The database monitors a population of 45 million, but no information was available on how many pandemic flu vaccinations had been examined to determine the possible link. Five other systems are also exploring a possible GBS/pandemic flu vaccine link, the report noted. “Although some systems are reporting elevated relative risks, none have crossed the threshold for a signal. Of importance is the fact that, even if an association between H1N1 vaccine exposure and GBS were substantiated, the estimate is that the vaccine would account for only one extra case of GBS per 1 million persons vaccinated, based on currently available data.”

The nation's primary—and largest—system, however, has picked up no worrisome safety signals. The Vaccine Adverse Event Reporting System (VAERS) has captured information on more than 126 million pandemic flu vaccinations. It found that adverse events after the shots were no different than those occurring after seasonal flu vaccine.

Additional study is needed to determine whether the reported links represent a causal relationship, the report said.

The federal government will step up its search for possible adverse reactions to the pandemic influenza A(H1N1) vaccine, particularly looking for any cases of Guillain-Barré syndrome, Bell's palsy, and thrombocytopenia that might be linked to the vaccine, according to a report issued by the Department of Health and Human Services.

The National Vaccine Information Center recommended the expanded safety monitoring because 3 of the nation's 13 vaccine safety monitoring systems have picked up weak signals of a possible interaction between the pandemic flu shot and the disorders. The decision came after a meeting of the H1N1 Vaccine Safety Risk Assessment Working Group (VSRAWG). As of March 31, almost 127 million doses of H1N1 pandemic flu vaccine have been distributed in the United States.

The Vaccine Safety Datalink program is the largest of the three systems that found a possible disease link; it contains information on 1.5 million pandemic flu immunizations. This system picked up a weak signal for an association with Bell's palsy.

The Defense Medical Surveillance System, with information on 1.3 million pandemic flu immunizations, and the Veterans Affairs signal detection database, with almost 300,000 vaccination records, both showed a weak signal for thrombocytopenia and idiopathic thrombocytopenia purpura (ITP).

The Indian Health Service, with information on 2.2 million immunizations, showed a weak signal for both Bell's palsy and the blood disorders.

In systems that linked the vaccine and thrombocytopenia/ITP, “the cases are being reviewed to see if the diagnoses are evaluated,” the report noted. “More rigorous comparisons between cohorts with H1N1 vaccine exposure and other vaccines or no exposures are planned.”

The Guillain-Barre Syndrome enhanced surveillance database observed a “potential signal” for that disorder. The database monitors a population of 45 million, but no information was available on how many pandemic flu vaccinations had been examined to determine the possible link. Five other systems are also exploring a possible GBS/pandemic flu vaccine link, the report noted. “Although some systems are reporting elevated relative risks, none have crossed the threshold for a signal. Of importance is the fact that, even if an association between H1N1 vaccine exposure and GBS were substantiated, the estimate is that the vaccine would account for only one extra case of GBS per 1 million persons vaccinated, based on currently available data.”

The nation's primary—and largest—system, however, has picked up no worrisome safety signals. The Vaccine Adverse Event Reporting System (VAERS) has captured information on more than 126 million pandemic flu vaccinations. It found that adverse events after the shots were no different than those occurring after seasonal flu vaccine.

Additional study is needed to determine whether the reported links represent a causal relationship, the report said.