Michele G. Sullivan

Major Finding: The complication rate for cholecystectomy was 21% for obese patients and 16.5% for nonobese. For appendectomy, the complication rate was 21% for obese patients and 18.8% for nonobese patients.

Data Source: A review of the insurance claims of 36,483 patients included in seven Blue Cross/Blue Shield databases.

Disclosures: None reported.

NEW ORLEANS — Obese patients have a significantly increased risk of complications after cholecystectomy and appendectomy, which drives up the costs of these common procedures.

Because insurance companies are footing the bill, any move to institute pay-for-performance policies could work against obese patients, Dr. Kenzo Hirose said at the annual Digestive Disease Week.

If pay-for-performance is adopted based on outcomes, providers would be paid less for patients at risk of complications, said Dr. Hirose of Johns Hopkins Hospital, Baltimore. “Hospitals that have a higher burden of patients at a high risk of obesity—blacks, Hispanics, inner-city patients, and those at a lower socioeconomic status—could actually end up being penalized for caring for them.”

Dr. Hirose and his colleagues reviewed insurance claims for cholecystectomy and appendicitis in seven Blue Cross/Blue Shield databases for the period 2002–2006. For each procedure, they compared 30-day complication rates and total direct medical costs for inpatient surgery.

Cholecystectomy for cholecystitis was performed on 31,028 patients, and another 5,455 patients underwent appendectomy for acute appendicitis. For both procedures, obese patients had a significantly greater complication rate and significantly higher costs than did nonobese patients.

The mean complication rate for cholecystectomy was 21% for obese patients and 16.5% for nonobese. The mean cost was $2,000 less in nonobese patients ($16,992 vs. $18,653).

For appendectomy, the mean complication rate was 21% for obese patients and 18.8% for nonobese patients. The mean cost was $1,220 more for obese patients ($15,400 vs. $14,180).

Surgical site infections constituted most of the complications. The differences in complication rates remained significant even after the researchers controlled for diabetes, hypertension, dyslipidemia, and obstructive sleep apnea.

“What sounds good in theory turns out in reality to punish doctors who take care of more high-risk patients and actually financially incentivizes discrimination,” lead study author Dr. Martin Makary said in a statement.

Surgical site infections constituted most of the complications.

Source DR. HIROSE

Major Finding: The complication rate for cholecystectomy was 21% for obese patients and 16.5% for nonobese. For appendectomy, the complication rate was 21% for obese patients and 18.8% for nonobese patients.

Data Source: A review of the insurance claims of 36,483 patients included in seven Blue Cross/Blue Shield databases.

Disclosures: None reported.

NEW ORLEANS — Obese patients have a significantly increased risk of complications after cholecystectomy and appendectomy, which drives up the costs of these common procedures.

Because insurance companies are footing the bill, any move to institute pay-for-performance policies could work against obese patients, Dr. Kenzo Hirose said at the annual Digestive Disease Week.

If pay-for-performance is adopted based on outcomes, providers would be paid less for patients at risk of complications, said Dr. Hirose of Johns Hopkins Hospital, Baltimore. “Hospitals that have a higher burden of patients at a high risk of obesity—blacks, Hispanics, inner-city patients, and those at a lower socioeconomic status—could actually end up being penalized for caring for them.”

Dr. Hirose and his colleagues reviewed insurance claims for cholecystectomy and appendicitis in seven Blue Cross/Blue Shield databases for the period 2002–2006. For each procedure, they compared 30-day complication rates and total direct medical costs for inpatient surgery.

Cholecystectomy for cholecystitis was performed on 31,028 patients, and another 5,455 patients underwent appendectomy for acute appendicitis. For both procedures, obese patients had a significantly greater complication rate and significantly higher costs than did nonobese patients.

The mean complication rate for cholecystectomy was 21% for obese patients and 16.5% for nonobese. The mean cost was $2,000 less in nonobese patients ($16,992 vs. $18,653).

For appendectomy, the mean complication rate was 21% for obese patients and 18.8% for nonobese patients. The mean cost was $1,220 more for obese patients ($15,400 vs. $14,180).

Surgical site infections constituted most of the complications. The differences in complication rates remained significant even after the researchers controlled for diabetes, hypertension, dyslipidemia, and obstructive sleep apnea.

“What sounds good in theory turns out in reality to punish doctors who take care of more high-risk patients and actually financially incentivizes discrimination,” lead study author Dr. Martin Makary said in a statement.

Surgical site infections constituted most of the complications.

Source DR. HIROSE

Major Finding: The complication rate for cholecystectomy was 21% for obese patients and 16.5% for nonobese. For appendectomy, the complication rate was 21% for obese patients and 18.8% for nonobese patients.

Data Source: A review of the insurance claims of 36,483 patients included in seven Blue Cross/Blue Shield databases.

Disclosures: None reported.

NEW ORLEANS — Obese patients have a significantly increased risk of complications after cholecystectomy and appendectomy, which drives up the costs of these common procedures.

Because insurance companies are footing the bill, any move to institute pay-for-performance policies could work against obese patients, Dr. Kenzo Hirose said at the annual Digestive Disease Week.

If pay-for-performance is adopted based on outcomes, providers would be paid less for patients at risk of complications, said Dr. Hirose of Johns Hopkins Hospital, Baltimore. “Hospitals that have a higher burden of patients at a high risk of obesity—blacks, Hispanics, inner-city patients, and those at a lower socioeconomic status—could actually end up being penalized for caring for them.”

Dr. Hirose and his colleagues reviewed insurance claims for cholecystectomy and appendicitis in seven Blue Cross/Blue Shield databases for the period 2002–2006. For each procedure, they compared 30-day complication rates and total direct medical costs for inpatient surgery.

Cholecystectomy for cholecystitis was performed on 31,028 patients, and another 5,455 patients underwent appendectomy for acute appendicitis. For both procedures, obese patients had a significantly greater complication rate and significantly higher costs than did nonobese patients.

The mean complication rate for cholecystectomy was 21% for obese patients and 16.5% for nonobese. The mean cost was $2,000 less in nonobese patients ($16,992 vs. $18,653).

For appendectomy, the mean complication rate was 21% for obese patients and 18.8% for nonobese patients. The mean cost was $1,220 more for obese patients ($15,400 vs. $14,180).

Surgical site infections constituted most of the complications. The differences in complication rates remained significant even after the researchers controlled for diabetes, hypertension, dyslipidemia, and obstructive sleep apnea.

“What sounds good in theory turns out in reality to punish doctors who take care of more high-risk patients and actually financially incentivizes discrimination,” lead study author Dr. Martin Makary said in a statement.

Surgical site infections constituted most of the complications.

Source DR. HIROSE

Major Finding: The results of a rapid HIV test performed on cord plasma or newborn blood were consistent with ELISA results in 54 neonates studied.

Data Source: A prospective study of the infants born to 14 mothers who were HIV positive and 40 mothers who were HIV negative.

Disclosures: None reported.

PHILADELPHIA — Rapid testing of umbilical cord or newborn blood quickly and reliably identified infants exposed in utero to HIV, according to Dr. Prabi Rajbhandari.

The rapid test was just as accurate as the standard enzyme-linked immunosorbent assay (ELISA), with 100% sensitivity and 100% negative predictive value in a small prospective study, Dr. Rajbhandari said at the annual meeting of the Eastern Society for Pediatric Research.

Time is of the essence for babies who have been exposed to the virus, Dr. Rajbhandari said in an interview. “The rapid test is complete in 20–30 minutes, compared to the ELISA, which can take days or even weeks to get a confirmed result,” Dr. Rajbhandari of the Bronx-Lebanon Hospital Center, New York, said in an interview. “This is a very important factor, because if we know the baby has been exposed, we can start interventions right away to prevent vertical transmission, with no danger of missing the critical period of intervention.”

None of the rapid HIV test kits have been studied in newborns. One kit, the OraQuick, has been approved for use in children as young as 12 years, but has not been studied in younger patients. None of the six rapid test kits has been studied using cord or newborn blood, she noted.

In New York, all pregnant women are offered HIV testing in the first trimester and, if living in an area of high HIV rates, again in the third trimester. If there is no record of the mother's HIV status at the time of labor, she is asked again to provide a blood sample. Infants of mothers who refuse that test can be tested for HIV exposure without consent. Abandoned newborns also are tested.

The prospective study by Dr. Rajbhandari and her associates included infants born to 14 HIV-positive mothers and 40 HIV-negative mothers. Test samples—blood collected at newborn screening, or cord plasma—were tested with the OraQuick test and ELISA.

For newborn blood, the tests showed perfect concordance for the exposed infants, she said. “The rapid test and the ELISA were both positive for all 14 samples from the positive mothers.”

There were 33 blood samples available for testing from the 40 infants from HIV-negative mothers; seven samples did not have enough blood for the additional test. Again, the rapid test and ELISA were in complete agreement, showing negative results for all 33 samples.

There were 11 cord blood samples available from HIV-positive mothers; all of these samples tested positive by both the rapid test and ELISA. The tests were also perfectly concordant with the 32 cord blood samples available for HIV-negative mothers.

An obvious limitation of the study is its small sample size, Dr. Rajbhandari noted. “We need to have a larger sample, and this study is ongoing in order to achieve that.”

Major Finding: The results of a rapid HIV test performed on cord plasma or newborn blood were consistent with ELISA results in 54 neonates studied.

Data Source: A prospective study of the infants born to 14 mothers who were HIV positive and 40 mothers who were HIV negative.

Disclosures: None reported.

PHILADELPHIA — Rapid testing of umbilical cord or newborn blood quickly and reliably identified infants exposed in utero to HIV, according to Dr. Prabi Rajbhandari.

The rapid test was just as accurate as the standard enzyme-linked immunosorbent assay (ELISA), with 100% sensitivity and 100% negative predictive value in a small prospective study, Dr. Rajbhandari said at the annual meeting of the Eastern Society for Pediatric Research.

Time is of the essence for babies who have been exposed to the virus, Dr. Rajbhandari said in an interview. “The rapid test is complete in 20–30 minutes, compared to the ELISA, which can take days or even weeks to get a confirmed result,” Dr. Rajbhandari of the Bronx-Lebanon Hospital Center, New York, said in an interview. “This is a very important factor, because if we know the baby has been exposed, we can start interventions right away to prevent vertical transmission, with no danger of missing the critical period of intervention.”

None of the rapid HIV test kits have been studied in newborns. One kit, the OraQuick, has been approved for use in children as young as 12 years, but has not been studied in younger patients. None of the six rapid test kits has been studied using cord or newborn blood, she noted.

In New York, all pregnant women are offered HIV testing in the first trimester and, if living in an area of high HIV rates, again in the third trimester. If there is no record of the mother's HIV status at the time of labor, she is asked again to provide a blood sample. Infants of mothers who refuse that test can be tested for HIV exposure without consent. Abandoned newborns also are tested.

The prospective study by Dr. Rajbhandari and her associates included infants born to 14 HIV-positive mothers and 40 HIV-negative mothers. Test samples—blood collected at newborn screening, or cord plasma—were tested with the OraQuick test and ELISA.

For newborn blood, the tests showed perfect concordance for the exposed infants, she said. “The rapid test and the ELISA were both positive for all 14 samples from the positive mothers.”

There were 33 blood samples available for testing from the 40 infants from HIV-negative mothers; seven samples did not have enough blood for the additional test. Again, the rapid test and ELISA were in complete agreement, showing negative results for all 33 samples.

There were 11 cord blood samples available from HIV-positive mothers; all of these samples tested positive by both the rapid test and ELISA. The tests were also perfectly concordant with the 32 cord blood samples available for HIV-negative mothers.

An obvious limitation of the study is its small sample size, Dr. Rajbhandari noted. “We need to have a larger sample, and this study is ongoing in order to achieve that.”

Major Finding: The results of a rapid HIV test performed on cord plasma or newborn blood were consistent with ELISA results in 54 neonates studied.

Data Source: A prospective study of the infants born to 14 mothers who were HIV positive and 40 mothers who were HIV negative.

Disclosures: None reported.

PHILADELPHIA — Rapid testing of umbilical cord or newborn blood quickly and reliably identified infants exposed in utero to HIV, according to Dr. Prabi Rajbhandari.

The rapid test was just as accurate as the standard enzyme-linked immunosorbent assay (ELISA), with 100% sensitivity and 100% negative predictive value in a small prospective study, Dr. Rajbhandari said at the annual meeting of the Eastern Society for Pediatric Research.

Time is of the essence for babies who have been exposed to the virus, Dr. Rajbhandari said in an interview. “The rapid test is complete in 20–30 minutes, compared to the ELISA, which can take days or even weeks to get a confirmed result,” Dr. Rajbhandari of the Bronx-Lebanon Hospital Center, New York, said in an interview. “This is a very important factor, because if we know the baby has been exposed, we can start interventions right away to prevent vertical transmission, with no danger of missing the critical period of intervention.”

None of the rapid HIV test kits have been studied in newborns. One kit, the OraQuick, has been approved for use in children as young as 12 years, but has not been studied in younger patients. None of the six rapid test kits has been studied using cord or newborn blood, she noted.

In New York, all pregnant women are offered HIV testing in the first trimester and, if living in an area of high HIV rates, again in the third trimester. If there is no record of the mother's HIV status at the time of labor, she is asked again to provide a blood sample. Infants of mothers who refuse that test can be tested for HIV exposure without consent. Abandoned newborns also are tested.

The prospective study by Dr. Rajbhandari and her associates included infants born to 14 HIV-positive mothers and 40 HIV-negative mothers. Test samples—blood collected at newborn screening, or cord plasma—were tested with the OraQuick test and ELISA.

For newborn blood, the tests showed perfect concordance for the exposed infants, she said. “The rapid test and the ELISA were both positive for all 14 samples from the positive mothers.”

There were 33 blood samples available for testing from the 40 infants from HIV-negative mothers; seven samples did not have enough blood for the additional test. Again, the rapid test and ELISA were in complete agreement, showing negative results for all 33 samples.

There were 11 cord blood samples available from HIV-positive mothers; all of these samples tested positive by both the rapid test and ELISA. The tests were also perfectly concordant with the 32 cord blood samples available for HIV-negative mothers.

An obvious limitation of the study is its small sample size, Dr. Rajbhandari noted. “We need to have a larger sample, and this study is ongoing in order to achieve that.”

Major Finding: At one hospital, the incidence of late-onset bloodstream infections among very low-birth-weight infants was 38% before the start of a comprehensive infection-control program, and 23% afterward, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None reported.

PHILADELPHIA — A comprehensive infection-control protocol was associated with a significant decrease in the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

After implementation of the protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, the rate of infections fell from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital. “The reported incidence of these late-onset bloodstream infections ranges from 7% to 20%. Before 2004, the incidence in our NICU was about 38%. The comprehensive infection-control measures were instituted in January 2005 to reduce this rate.”

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches, and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines.

Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection-control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69, or 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.

Major Finding: At one hospital, the incidence of late-onset bloodstream infections among very low-birth-weight infants was 38% before the start of a comprehensive infection-control program, and 23% afterward, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None reported.

PHILADELPHIA — A comprehensive infection-control protocol was associated with a significant decrease in the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

After implementation of the protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, the rate of infections fell from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital. “The reported incidence of these late-onset bloodstream infections ranges from 7% to 20%. Before 2004, the incidence in our NICU was about 38%. The comprehensive infection-control measures were instituted in January 2005 to reduce this rate.”

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches, and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines.

Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection-control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69, or 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.

Major Finding: At one hospital, the incidence of late-onset bloodstream infections among very low-birth-weight infants was 38% before the start of a comprehensive infection-control program, and 23% afterward, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None reported.

PHILADELPHIA — A comprehensive infection-control protocol was associated with a significant decrease in the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

After implementation of the protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, the rate of infections fell from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital. “The reported incidence of these late-onset bloodstream infections ranges from 7% to 20%. Before 2004, the incidence in our NICU was about 38%. The comprehensive infection-control measures were instituted in January 2005 to reduce this rate.”

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches, and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines.

Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection-control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69, or 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.

WASHINGTON — Alzheimer's disease is twice as likely to develop in blacks as it is in whites, and 1.5 times more common among Hispanics, a new national report has found.

The discrepancy appears to stem from a combination of higher rates of chronic illness and lower socioeconomic status in the minority populations, Maria Carrillo, Ph.D., said at a meeting of Alzheimer's disease activists on Capitol Hill.

“We can't pinpoint any known genetic factors as the cause of this discrepancy,” said Dr. Carrillo, the senior director of medical and scientific relations for the Alzheimer's Association, which sponsored the meeting. “Instead, we think this is due to other factors, especially a higher prevalence of hypertension and diabetes in the minority communities, and socioeconomic risks that reduce access to health care.”

The good news, she said in an interview, is that physicians have a chance to identify these risk factors and intervene early, minimizing the effects on cognition.

“Neurologists and general practice physicians need to understand the importance of managing those risk factors. This is key to delaying cognitive decline and perhaps preventing Alzheimer's and other dementias.”

The numbers were drawn from the Alzheimer's Association's report, “2010 Alzheimer's Facts and Figures.” The report based its findings on several national studies of cognitive impairment and Alzheimer's disease in different groups, especially the 2006 Health and Retirement Study (HRS) and the Washington Heights–Inwood Columbia Aging Project (WHICAP).

The HRS study examined the prevalence of cognitive impairment in 16,273 Americans aged 55 years and older. The data can be extrapolated to represent 16 million Americans in that age group, the report noted.

The overall prevalence of cognitive impairment in the study was 11% for those aged 65 years and older. However, whites had the lowest rate (9%). The rate among blacks was 24%, and among Hispanics, 18%.

The discrepancies were higher among younger people. For example, among those aged 55–64 years, blacks were four times more likely to have cognitive impairment than whites; among those aged 85 and older, blacks were twice as likely as whites to have cognitive impairment.

The report also described a similar discrepancy between Hispanics and whites. Among those aged 55–64 years, Hispanics were three times more likely to have cognitive impairment. Among those aged 85 and older, the difference dropped, with Hispanics 1.6 times more likely to have the problem.

The WHICAP study examined rates of Alzheimer's disease and other dementias in a random sampling of 2,126 healthy Medicare beneficiaries aged 65 years and older.

The prevalence of Alzheimer's was 8% in whites, 19% in blacks, and 21% in Hispanics. Again, the differences in prevalence were more pronounced in younger subjects.

According to the report, the HRS study is just one of several that have shown that comorbid hypertension, diabetes, cardiovascular disease, and stroke are more common among people with cognitive impairment than in those with normal cognition.

“It is clear that high blood pressure is more common in African Americans overall and diabetes is more common in both African Americans and Hispanics compared with whites,” the report said. “It is likely that the greater prevalence of these conditions in African Americans and Hispanics than in whites accounts for at least some of the differences among these groups in prevalence of Alzheimer's and other dementias.”

Although Alzheimer's appears more common in both minority groups than in whites, it is much less likely to be formally diagnosed, the report noted. The HRS study showed that 46% of whites with cognitive impairment had a formal diagnosis of a “memory-related disease,” compared with 33% of blacks and 34% of Hispanics.

“This is very worrisome,” Dr. Carrillo said. “It means that these populations are unable to get access to medications that may be able to help them, especially in the early phases of the disease.”

The full report is available at www.alz.org/alzheimers_disease_facts_figures.asp

WASHINGTON — Alzheimer's disease is twice as likely to develop in blacks as it is in whites, and 1.5 times more common among Hispanics, a new national report has found.

The discrepancy appears to stem from a combination of higher rates of chronic illness and lower socioeconomic status in the minority populations, Maria Carrillo, Ph.D., said at a meeting of Alzheimer's disease activists on Capitol Hill.

“We can't pinpoint any known genetic factors as the cause of this discrepancy,” said Dr. Carrillo, the senior director of medical and scientific relations for the Alzheimer's Association, which sponsored the meeting. “Instead, we think this is due to other factors, especially a higher prevalence of hypertension and diabetes in the minority communities, and socioeconomic risks that reduce access to health care.”

The good news, she said in an interview, is that physicians have a chance to identify these risk factors and intervene early, minimizing the effects on cognition.

“Neurologists and general practice physicians need to understand the importance of managing those risk factors. This is key to delaying cognitive decline and perhaps preventing Alzheimer's and other dementias.”

The numbers were drawn from the Alzheimer's Association's report, “2010 Alzheimer's Facts and Figures.” The report based its findings on several national studies of cognitive impairment and Alzheimer's disease in different groups, especially the 2006 Health and Retirement Study (HRS) and the Washington Heights–Inwood Columbia Aging Project (WHICAP).

The HRS study examined the prevalence of cognitive impairment in 16,273 Americans aged 55 years and older. The data can be extrapolated to represent 16 million Americans in that age group, the report noted.

The overall prevalence of cognitive impairment in the study was 11% for those aged 65 years and older. However, whites had the lowest rate (9%). The rate among blacks was 24%, and among Hispanics, 18%.

The discrepancies were higher among younger people. For example, among those aged 55–64 years, blacks were four times more likely to have cognitive impairment than whites; among those aged 85 and older, blacks were twice as likely as whites to have cognitive impairment.

The report also described a similar discrepancy between Hispanics and whites. Among those aged 55–64 years, Hispanics were three times more likely to have cognitive impairment. Among those aged 85 and older, the difference dropped, with Hispanics 1.6 times more likely to have the problem.

The WHICAP study examined rates of Alzheimer's disease and other dementias in a random sampling of 2,126 healthy Medicare beneficiaries aged 65 years and older.

The prevalence of Alzheimer's was 8% in whites, 19% in blacks, and 21% in Hispanics. Again, the differences in prevalence were more pronounced in younger subjects.

According to the report, the HRS study is just one of several that have shown that comorbid hypertension, diabetes, cardiovascular disease, and stroke are more common among people with cognitive impairment than in those with normal cognition.

“It is clear that high blood pressure is more common in African Americans overall and diabetes is more common in both African Americans and Hispanics compared with whites,” the report said. “It is likely that the greater prevalence of these conditions in African Americans and Hispanics than in whites accounts for at least some of the differences among these groups in prevalence of Alzheimer's and other dementias.”

Although Alzheimer's appears more common in both minority groups than in whites, it is much less likely to be formally diagnosed, the report noted. The HRS study showed that 46% of whites with cognitive impairment had a formal diagnosis of a “memory-related disease,” compared with 33% of blacks and 34% of Hispanics.

“This is very worrisome,” Dr. Carrillo said. “It means that these populations are unable to get access to medications that may be able to help them, especially in the early phases of the disease.”

The full report is available at www.alz.org/alzheimers_disease_facts_figures.asp

WASHINGTON — Alzheimer's disease is twice as likely to develop in blacks as it is in whites, and 1.5 times more common among Hispanics, a new national report has found.

The discrepancy appears to stem from a combination of higher rates of chronic illness and lower socioeconomic status in the minority populations, Maria Carrillo, Ph.D., said at a meeting of Alzheimer's disease activists on Capitol Hill.

“We can't pinpoint any known genetic factors as the cause of this discrepancy,” said Dr. Carrillo, the senior director of medical and scientific relations for the Alzheimer's Association, which sponsored the meeting. “Instead, we think this is due to other factors, especially a higher prevalence of hypertension and diabetes in the minority communities, and socioeconomic risks that reduce access to health care.”

The good news, she said in an interview, is that physicians have a chance to identify these risk factors and intervene early, minimizing the effects on cognition.

“Neurologists and general practice physicians need to understand the importance of managing those risk factors. This is key to delaying cognitive decline and perhaps preventing Alzheimer's and other dementias.”

The numbers were drawn from the Alzheimer's Association's report, “2010 Alzheimer's Facts and Figures.” The report based its findings on several national studies of cognitive impairment and Alzheimer's disease in different groups, especially the 2006 Health and Retirement Study (HRS) and the Washington Heights–Inwood Columbia Aging Project (WHICAP).

The HRS study examined the prevalence of cognitive impairment in 16,273 Americans aged 55 years and older. The data can be extrapolated to represent 16 million Americans in that age group, the report noted.

The overall prevalence of cognitive impairment in the study was 11% for those aged 65 years and older. However, whites had the lowest rate (9%). The rate among blacks was 24%, and among Hispanics, 18%.

The discrepancies were higher among younger people. For example, among those aged 55–64 years, blacks were four times more likely to have cognitive impairment than whites; among those aged 85 and older, blacks were twice as likely as whites to have cognitive impairment.

The report also described a similar discrepancy between Hispanics and whites. Among those aged 55–64 years, Hispanics were three times more likely to have cognitive impairment. Among those aged 85 and older, the difference dropped, with Hispanics 1.6 times more likely to have the problem.

The WHICAP study examined rates of Alzheimer's disease and other dementias in a random sampling of 2,126 healthy Medicare beneficiaries aged 65 years and older.

The prevalence of Alzheimer's was 8% in whites, 19% in blacks, and 21% in Hispanics. Again, the differences in prevalence were more pronounced in younger subjects.

According to the report, the HRS study is just one of several that have shown that comorbid hypertension, diabetes, cardiovascular disease, and stroke are more common among people with cognitive impairment than in those with normal cognition.

“It is clear that high blood pressure is more common in African Americans overall and diabetes is more common in both African Americans and Hispanics compared with whites,” the report said. “It is likely that the greater prevalence of these conditions in African Americans and Hispanics than in whites accounts for at least some of the differences among these groups in prevalence of Alzheimer's and other dementias.”

Although Alzheimer's appears more common in both minority groups than in whites, it is much less likely to be formally diagnosed, the report noted. The HRS study showed that 46% of whites with cognitive impairment had a formal diagnosis of a “memory-related disease,” compared with 33% of blacks and 34% of Hispanics.

“This is very worrisome,” Dr. Carrillo said. “It means that these populations are unable to get access to medications that may be able to help them, especially in the early phases of the disease.”

The full report is available at www.alz.org/alzheimers_disease_facts_figures.asp

WAIKOLOA, HAWAII — Two studies—both conducted by gastroenterologists—refute the notion that isotretinoin causes inflammatory bowel disease.

Neither found a basis for allegations of an increased risk of IBD in patients who were treated with isotretinoin. “You can't say anything with certainty in life, but at least thus far the data we have are very reassuring that there is no association,” Dr. Sheila Fallon Friedlander said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

She cited a retrospective, nested case-control study by investigators at the University of Manitoba, Winnipeg, who used the comprehensive provincial IBD database to demonstrate that patients with IBD were no more likely to have used isotretinoin before diagnosis than were matched controls, the investigators concluded (Am. J. Gastroenterol. 2009;104:2774–8).

Dr. J. Mark Jackson of the University of Louisville (Ky.) characterized the Manitoba study as “a really well-done study coming at a critical time,” conducted by physicians who deal with IBD and, therefore, have no stake in protecting a drug that could cause it.

The second study was a seven-country, systematic data search led by gastroenterologists at the University of North Carolina at Chapel Hill. Unlike the earlier study, this analysis used the rigorous Chapel Hill criteria designed to weigh the strength, consistency, specificity, and plausibility of scientific evidence, and on that basis, the investigators determined no causal association had been established (Am. J. Gastroenterol. 2009;104:2387–93).

“We now have some very good data reviews showing that IBD is not overrepresented in patients who use isotretinoin,” Dr. Jackson said in an interview. “When this issue comes up [in prescribing], we need to make people aware that this rumor has not been validated.”

Personal injury lawyers seized on an earlier study that concluded it was “highly probable” that isotretinoin was the cause of four cases of IBD reported to the Food and Drug Administration's MedWatch program, with the oral retinoid being deemed the “probable” cause of another 58 (Am. J. Gastroenterol. 2006;101:1569–73). Trial investigator Dr. Sunanda Kane of the University of Chicago was contacted for an interview, but was unable to comment because of pending litigation. The other three study investigators never responded to interview requests.

“This is a situation where there are conflicting data, but a bottom line of interest to all of us is that a New Jersey jury has awarded $12.9 million to patients who've taken isotretinoin and developed IBD,” said Dr. Friedlander, a dermatologist who is a clinical professor of pediatrics and medicine at the University of California, San Diego.

Lawyers shooting for claims have found isotretinoin to be an easy mark for years. The finding that it could increase birth defects by up to 30% left it “an open target,” Dr. Jackson said. “It's always been on the legal radar because of this past issue, and it tends to get put back in the forefront frequently—it's an easy medicine to beat up.” He said he makes it a practice to discuss reports of these issues with patients before prescribing isotretinoin. “I bring it up with my patients because I don't want them hearing it from some other source first,” he said.

At the meeting, when Dr. Jackson asked how many audience members have fielded questions from their patients regarding a putative isotretinoin-IBD link, the majority of dermatologists' hands shot up.

Dr. Seth D. Crockett, a coauthor of the University of North Carolina study, tried to bring some perspective to the issue in an interview with this news organization. “Our study was a critical appraisal of the literature and an assessment of causality. Basically we found that the only published evidence is case reports, which generally is considered poor evidence to establish causality. The best evidence is from epidemiologic studies such as the University of Manitoba study,” he said.

“It's important to recognize that the absence of published evidence does not mean the absence of an association; it just means that there's insufficient evidence in the scientific literature thus far to support a causal connection between isotretinoin and IBD,” added Dr. Crockett of the division of gastroenterology and hepatology at the University of North Carolina at Chapel Hill.

Isotretinoin is now available only in generic form.

Disclosures: Dr. Jackson and Dr. Friedlander indicated that they are long-time prescribers of isotretinoin in severe cases of acne. Dr. Jackson has received support from Roche Pharmaceuticals (manufacturer of Accutane). Dr. Crockett had no relevant conflicts of interest. SDEF and this news organization are owned by Elsevier.

Dr. J. Mark Jackson talks with patients before he prescribes isotretinoin.

Source © Tom Fougerousse/University of Louisville

WAIKOLOA, HAWAII — Two studies—both conducted by gastroenterologists—refute the notion that isotretinoin causes inflammatory bowel disease.

Neither found a basis for allegations of an increased risk of IBD in patients who were treated with isotretinoin. “You can't say anything with certainty in life, but at least thus far the data we have are very reassuring that there is no association,” Dr. Sheila Fallon Friedlander said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

She cited a retrospective, nested case-control study by investigators at the University of Manitoba, Winnipeg, who used the comprehensive provincial IBD database to demonstrate that patients with IBD were no more likely to have used isotretinoin before diagnosis than were matched controls, the investigators concluded (Am. J. Gastroenterol. 2009;104:2774–8).

Dr. J. Mark Jackson of the University of Louisville (Ky.) characterized the Manitoba study as “a really well-done study coming at a critical time,” conducted by physicians who deal with IBD and, therefore, have no stake in protecting a drug that could cause it.

The second study was a seven-country, systematic data search led by gastroenterologists at the University of North Carolina at Chapel Hill. Unlike the earlier study, this analysis used the rigorous Chapel Hill criteria designed to weigh the strength, consistency, specificity, and plausibility of scientific evidence, and on that basis, the investigators determined no causal association had been established (Am. J. Gastroenterol. 2009;104:2387–93).

“We now have some very good data reviews showing that IBD is not overrepresented in patients who use isotretinoin,” Dr. Jackson said in an interview. “When this issue comes up [in prescribing], we need to make people aware that this rumor has not been validated.”

Personal injury lawyers seized on an earlier study that concluded it was “highly probable” that isotretinoin was the cause of four cases of IBD reported to the Food and Drug Administration's MedWatch program, with the oral retinoid being deemed the “probable” cause of another 58 (Am. J. Gastroenterol. 2006;101:1569–73). Trial investigator Dr. Sunanda Kane of the University of Chicago was contacted for an interview, but was unable to comment because of pending litigation. The other three study investigators never responded to interview requests.

“This is a situation where there are conflicting data, but a bottom line of interest to all of us is that a New Jersey jury has awarded $12.9 million to patients who've taken isotretinoin and developed IBD,” said Dr. Friedlander, a dermatologist who is a clinical professor of pediatrics and medicine at the University of California, San Diego.

Lawyers shooting for claims have found isotretinoin to be an easy mark for years. The finding that it could increase birth defects by up to 30% left it “an open target,” Dr. Jackson said. “It's always been on the legal radar because of this past issue, and it tends to get put back in the forefront frequently—it's an easy medicine to beat up.” He said he makes it a practice to discuss reports of these issues with patients before prescribing isotretinoin. “I bring it up with my patients because I don't want them hearing it from some other source first,” he said.

At the meeting, when Dr. Jackson asked how many audience members have fielded questions from their patients regarding a putative isotretinoin-IBD link, the majority of dermatologists' hands shot up.

Dr. Seth D. Crockett, a coauthor of the University of North Carolina study, tried to bring some perspective to the issue in an interview with this news organization. “Our study was a critical appraisal of the literature and an assessment of causality. Basically we found that the only published evidence is case reports, which generally is considered poor evidence to establish causality. The best evidence is from epidemiologic studies such as the University of Manitoba study,” he said.

“It's important to recognize that the absence of published evidence does not mean the absence of an association; it just means that there's insufficient evidence in the scientific literature thus far to support a causal connection between isotretinoin and IBD,” added Dr. Crockett of the division of gastroenterology and hepatology at the University of North Carolina at Chapel Hill.

Isotretinoin is now available only in generic form.

Disclosures: Dr. Jackson and Dr. Friedlander indicated that they are long-time prescribers of isotretinoin in severe cases of acne. Dr. Jackson has received support from Roche Pharmaceuticals (manufacturer of Accutane). Dr. Crockett had no relevant conflicts of interest. SDEF and this news organization are owned by Elsevier.

Dr. J. Mark Jackson talks with patients before he prescribes isotretinoin.

Source © Tom Fougerousse/University of Louisville

WAIKOLOA, HAWAII — Two studies—both conducted by gastroenterologists—refute the notion that isotretinoin causes inflammatory bowel disease.

Neither found a basis for allegations of an increased risk of IBD in patients who were treated with isotretinoin. “You can't say anything with certainty in life, but at least thus far the data we have are very reassuring that there is no association,” Dr. Sheila Fallon Friedlander said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

She cited a retrospective, nested case-control study by investigators at the University of Manitoba, Winnipeg, who used the comprehensive provincial IBD database to demonstrate that patients with IBD were no more likely to have used isotretinoin before diagnosis than were matched controls, the investigators concluded (Am. J. Gastroenterol. 2009;104:2774–8).

Dr. J. Mark Jackson of the University of Louisville (Ky.) characterized the Manitoba study as “a really well-done study coming at a critical time,” conducted by physicians who deal with IBD and, therefore, have no stake in protecting a drug that could cause it.

The second study was a seven-country, systematic data search led by gastroenterologists at the University of North Carolina at Chapel Hill. Unlike the earlier study, this analysis used the rigorous Chapel Hill criteria designed to weigh the strength, consistency, specificity, and plausibility of scientific evidence, and on that basis, the investigators determined no causal association had been established (Am. J. Gastroenterol. 2009;104:2387–93).

“We now have some very good data reviews showing that IBD is not overrepresented in patients who use isotretinoin,” Dr. Jackson said in an interview. “When this issue comes up [in prescribing], we need to make people aware that this rumor has not been validated.”

Personal injury lawyers seized on an earlier study that concluded it was “highly probable” that isotretinoin was the cause of four cases of IBD reported to the Food and Drug Administration's MedWatch program, with the oral retinoid being deemed the “probable” cause of another 58 (Am. J. Gastroenterol. 2006;101:1569–73). Trial investigator Dr. Sunanda Kane of the University of Chicago was contacted for an interview, but was unable to comment because of pending litigation. The other three study investigators never responded to interview requests.

“This is a situation where there are conflicting data, but a bottom line of interest to all of us is that a New Jersey jury has awarded $12.9 million to patients who've taken isotretinoin and developed IBD,” said Dr. Friedlander, a dermatologist who is a clinical professor of pediatrics and medicine at the University of California, San Diego.

Lawyers shooting for claims have found isotretinoin to be an easy mark for years. The finding that it could increase birth defects by up to 30% left it “an open target,” Dr. Jackson said. “It's always been on the legal radar because of this past issue, and it tends to get put back in the forefront frequently—it's an easy medicine to beat up.” He said he makes it a practice to discuss reports of these issues with patients before prescribing isotretinoin. “I bring it up with my patients because I don't want them hearing it from some other source first,” he said.

At the meeting, when Dr. Jackson asked how many audience members have fielded questions from their patients regarding a putative isotretinoin-IBD link, the majority of dermatologists' hands shot up.

Dr. Seth D. Crockett, a coauthor of the University of North Carolina study, tried to bring some perspective to the issue in an interview with this news organization. “Our study was a critical appraisal of the literature and an assessment of causality. Basically we found that the only published evidence is case reports, which generally is considered poor evidence to establish causality. The best evidence is from epidemiologic studies such as the University of Manitoba study,” he said.

“It's important to recognize that the absence of published evidence does not mean the absence of an association; it just means that there's insufficient evidence in the scientific literature thus far to support a causal connection between isotretinoin and IBD,” added Dr. Crockett of the division of gastroenterology and hepatology at the University of North Carolina at Chapel Hill.

Isotretinoin is now available only in generic form.

Disclosures: Dr. Jackson and Dr. Friedlander indicated that they are long-time prescribers of isotretinoin in severe cases of acne. Dr. Jackson has received support from Roche Pharmaceuticals (manufacturer of Accutane). Dr. Crockett had no relevant conflicts of interest. SDEF and this news organization are owned by Elsevier.

Dr. J. Mark Jackson talks with patients before he prescribes isotretinoin.

Source © Tom Fougerousse/University of Louisville

Major Finding: Of 200 hospitalized children tested for rotavirus before approval of the vaccine, 27% tested positive. Of 161 and 180 hospitalized children tested in the subsequent 2 years after vaccine approval, 12% and 14% tested positive for rotavirus infections.

Data Source: A retrospective cohort study of 1,996 children admitted to a single hospital.

Disclosures: Dr. Hamwi said he had no relevant financial conflicts of interest. One of the coinvestigators, Dr. David DiJohn, disclosed that he is on the speakers bureau for both GlaxoSmithKline and Sanofi-Aventis.

PHILADELPHIA — The introduction of the rotavirus vaccine was associated with a significant decrease in the number of children admitted to a New York City hospital for rotavirus infections, as well as a decline in the severity of the rotavirus season.

The annual percentage of admitted patients who tested positive for the virus decreased from more than 12% before the vaccine was available to 3% afterward, Dr. Haytham Hamwi said at the annual meeting of the Eastern Society for Pediatric Research.

Dr. Hamwi of the Flushing (N.Y.) Hospital Medical Center discussed a retrospective study of rotavirus testing and admissions spanning three time periods: September 2004 through August 2005 (before the vaccine was available), and after the vaccine was available, September 2007 through August 2008 and September 2008 through August 2009.

The hospital database and the New York City vaccine registry provided the data for the study.

Dr. Hamwi and his colleagues included in their study all patients aged 0–6 years who were admitted to the hospital during those periods, except any child who had received the rotavirus vaccine within 3 weeks of a hospital admission.

“The vaccine can cause shedding of antigen in the stool, leading to a false-positive result,” Dr. Hamwi explained.

During the first study period (2004–2005), 442 patients aged 0–6 years were admitted to the hospital; 200 of those were tested for rotavirus. Of these, 55 (27%) tested positive for the virus. Patients with rotavirus infections comprised 12% of all hospital admissions among 0–6 year olds.

During the second study period (2007–2008), 744 children aged 0–6 years were admitted to the hospital. The surge in admissions occurred because several neighboring hospitals had closed, Dr. Hamwi said. Of the admissions, 161 were tested for rotavirus and 20 (12%) tested positive. Rotavirus accounted for 2.6% of admissions for 0- to 6-year-old children during that time.

In the third study period (2008–2009), there were 810 admissions. Of these, 180 were tested for the virus and 26 (14%) tested positive. Children with rotavirus accounted for 3% of the admissions.

A vaccination history was available for 76 children who tested positive for the virus in the study. Of these, 75 were unvaccinated against rotavirus and 1 had been incompletely vaccinated, Dr. Hamwi said. No rotavirus was found in unvaccinated children.

The investigators also examined the relationship between the vaccine and rotavirus seasonality. In the prevaccine study periods, rotavirus appeared in November, peaked in February, and had a second peak in April. In both postvaccination study periods, the disease appeared later and did not show the typical winter peak. A smaller peak occurred in March and April of the second of the two study periods.

Major Finding: Of 200 hospitalized children tested for rotavirus before approval of the vaccine, 27% tested positive. Of 161 and 180 hospitalized children tested in the subsequent 2 years after vaccine approval, 12% and 14% tested positive for rotavirus infections.

Data Source: A retrospective cohort study of 1,996 children admitted to a single hospital.

Disclosures: Dr. Hamwi said he had no relevant financial conflicts of interest. One of the coinvestigators, Dr. David DiJohn, disclosed that he is on the speakers bureau for both GlaxoSmithKline and Sanofi-Aventis.

PHILADELPHIA — The introduction of the rotavirus vaccine was associated with a significant decrease in the number of children admitted to a New York City hospital for rotavirus infections, as well as a decline in the severity of the rotavirus season.

The annual percentage of admitted patients who tested positive for the virus decreased from more than 12% before the vaccine was available to 3% afterward, Dr. Haytham Hamwi said at the annual meeting of the Eastern Society for Pediatric Research.

Dr. Hamwi of the Flushing (N.Y.) Hospital Medical Center discussed a retrospective study of rotavirus testing and admissions spanning three time periods: September 2004 through August 2005 (before the vaccine was available), and after the vaccine was available, September 2007 through August 2008 and September 2008 through August 2009.

The hospital database and the New York City vaccine registry provided the data for the study.

Dr. Hamwi and his colleagues included in their study all patients aged 0–6 years who were admitted to the hospital during those periods, except any child who had received the rotavirus vaccine within 3 weeks of a hospital admission.

“The vaccine can cause shedding of antigen in the stool, leading to a false-positive result,” Dr. Hamwi explained.

During the first study period (2004–2005), 442 patients aged 0–6 years were admitted to the hospital; 200 of those were tested for rotavirus. Of these, 55 (27%) tested positive for the virus. Patients with rotavirus infections comprised 12% of all hospital admissions among 0–6 year olds.

During the second study period (2007–2008), 744 children aged 0–6 years were admitted to the hospital. The surge in admissions occurred because several neighboring hospitals had closed, Dr. Hamwi said. Of the admissions, 161 were tested for rotavirus and 20 (12%) tested positive. Rotavirus accounted for 2.6% of admissions for 0- to 6-year-old children during that time.

In the third study period (2008–2009), there were 810 admissions. Of these, 180 were tested for the virus and 26 (14%) tested positive. Children with rotavirus accounted for 3% of the admissions.

A vaccination history was available for 76 children who tested positive for the virus in the study. Of these, 75 were unvaccinated against rotavirus and 1 had been incompletely vaccinated, Dr. Hamwi said. No rotavirus was found in unvaccinated children.

The investigators also examined the relationship between the vaccine and rotavirus seasonality. In the prevaccine study periods, rotavirus appeared in November, peaked in February, and had a second peak in April. In both postvaccination study periods, the disease appeared later and did not show the typical winter peak. A smaller peak occurred in March and April of the second of the two study periods.

Major Finding: Of 200 hospitalized children tested for rotavirus before approval of the vaccine, 27% tested positive. Of 161 and 180 hospitalized children tested in the subsequent 2 years after vaccine approval, 12% and 14% tested positive for rotavirus infections.

Data Source: A retrospective cohort study of 1,996 children admitted to a single hospital.

Disclosures: Dr. Hamwi said he had no relevant financial conflicts of interest. One of the coinvestigators, Dr. David DiJohn, disclosed that he is on the speakers bureau for both GlaxoSmithKline and Sanofi-Aventis.

PHILADELPHIA — The introduction of the rotavirus vaccine was associated with a significant decrease in the number of children admitted to a New York City hospital for rotavirus infections, as well as a decline in the severity of the rotavirus season.

The annual percentage of admitted patients who tested positive for the virus decreased from more than 12% before the vaccine was available to 3% afterward, Dr. Haytham Hamwi said at the annual meeting of the Eastern Society for Pediatric Research.

Dr. Hamwi of the Flushing (N.Y.) Hospital Medical Center discussed a retrospective study of rotavirus testing and admissions spanning three time periods: September 2004 through August 2005 (before the vaccine was available), and after the vaccine was available, September 2007 through August 2008 and September 2008 through August 2009.

The hospital database and the New York City vaccine registry provided the data for the study.

Dr. Hamwi and his colleagues included in their study all patients aged 0–6 years who were admitted to the hospital during those periods, except any child who had received the rotavirus vaccine within 3 weeks of a hospital admission.

“The vaccine can cause shedding of antigen in the stool, leading to a false-positive result,” Dr. Hamwi explained.

During the first study period (2004–2005), 442 patients aged 0–6 years were admitted to the hospital; 200 of those were tested for rotavirus. Of these, 55 (27%) tested positive for the virus. Patients with rotavirus infections comprised 12% of all hospital admissions among 0–6 year olds.

During the second study period (2007–2008), 744 children aged 0–6 years were admitted to the hospital. The surge in admissions occurred because several neighboring hospitals had closed, Dr. Hamwi said. Of the admissions, 161 were tested for rotavirus and 20 (12%) tested positive. Rotavirus accounted for 2.6% of admissions for 0- to 6-year-old children during that time.

In the third study period (2008–2009), there were 810 admissions. Of these, 180 were tested for the virus and 26 (14%) tested positive. Children with rotavirus accounted for 3% of the admissions.

A vaccination history was available for 76 children who tested positive for the virus in the study. Of these, 75 were unvaccinated against rotavirus and 1 had been incompletely vaccinated, Dr. Hamwi said. No rotavirus was found in unvaccinated children.

The investigators also examined the relationship between the vaccine and rotavirus seasonality. In the prevaccine study periods, rotavirus appeared in November, peaked in February, and had a second peak in April. In both postvaccination study periods, the disease appeared later and did not show the typical winter peak. A smaller peak occurred in March and April of the second of the two study periods.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy.

“Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161–6).

Dr. Parker, of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy.

The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills approximately 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer.

On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen. “Further studies are needed to confirm these unexpected findings,” he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed.

Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%). The risk of death was highest for women who had the surgery before they turned 50; they had a 40% increase in the risk of all-cause mortality.

The NHS also found that women who had oophorectomy without estrogen replacement had twice the risk of myocardial infarction compared with age-matched premenopausal women. The surgery was associated with an 85% increase in the risk of stroke in women who didn't use hormones after menopause.

Whether women used estrogens or not, oophorectomy was associated with a 28% increased risk of death from coronary artery disease in all women.

Dr. Parker found several studies that explored the relationship between oophorectomy and osteoporosis and hip fracture.

One study of 340 postmenopausal women who had the surgery (median age, 62 years) found that these women had 54% more osteoporotic fractures than women with intact ovaries. Two other studies, however, found no such association.

The Mayo Clinic Cohort Study of Oophorectomy and Aging, which followed more than 3,400 women for 25 years, found significant relationships between bilateral oophorectomy and Parkinson's disease (80% increased risk in women who had the surgery compared with women with intact ovaries), anxiety (greater than 200% increased risk), depression (54% increased risk), and cognitive impairment or dementia (70% increased risk).

Other studies suggest that bilateral oophorectomy throws women into a sudden, unnatural menopause that negatively affects mood, thought, memory, energy, libido, and sexual response.

Dr. Parker noted that a randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life.

“Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment.

“Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case,” he noted.

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141–2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy.

“This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely,” he noted.

Neither Dr. Parker nor Dr. Adamson reported any conflicts of interest.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy.

“Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161–6).

Dr. Parker, of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy.

The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills approximately 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer.

On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen. “Further studies are needed to confirm these unexpected findings,” he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed.

Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%). The risk of death was highest for women who had the surgery before they turned 50; they had a 40% increase in the risk of all-cause mortality.

The NHS also found that women who had oophorectomy without estrogen replacement had twice the risk of myocardial infarction compared with age-matched premenopausal women. The surgery was associated with an 85% increase in the risk of stroke in women who didn't use hormones after menopause.

Whether women used estrogens or not, oophorectomy was associated with a 28% increased risk of death from coronary artery disease in all women.

Dr. Parker found several studies that explored the relationship between oophorectomy and osteoporosis and hip fracture.

One study of 340 postmenopausal women who had the surgery (median age, 62 years) found that these women had 54% more osteoporotic fractures than women with intact ovaries. Two other studies, however, found no such association.

The Mayo Clinic Cohort Study of Oophorectomy and Aging, which followed more than 3,400 women for 25 years, found significant relationships between bilateral oophorectomy and Parkinson's disease (80% increased risk in women who had the surgery compared with women with intact ovaries), anxiety (greater than 200% increased risk), depression (54% increased risk), and cognitive impairment or dementia (70% increased risk).

Other studies suggest that bilateral oophorectomy throws women into a sudden, unnatural menopause that negatively affects mood, thought, memory, energy, libido, and sexual response.

Dr. Parker noted that a randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life.

“Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment.

“Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case,” he noted.

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141–2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy.

“This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely,” he noted.

Neither Dr. Parker nor Dr. Adamson reported any conflicts of interest.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy.

“Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161–6).

Dr. Parker, of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy.

The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills approximately 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer.

On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen. “Further studies are needed to confirm these unexpected findings,” he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed.

Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%). The risk of death was highest for women who had the surgery before they turned 50; they had a 40% increase in the risk of all-cause mortality.

The NHS also found that women who had oophorectomy without estrogen replacement had twice the risk of myocardial infarction compared with age-matched premenopausal women. The surgery was associated with an 85% increase in the risk of stroke in women who didn't use hormones after menopause.

Whether women used estrogens or not, oophorectomy was associated with a 28% increased risk of death from coronary artery disease in all women.

Dr. Parker found several studies that explored the relationship between oophorectomy and osteoporosis and hip fracture.

One study of 340 postmenopausal women who had the surgery (median age, 62 years) found that these women had 54% more osteoporotic fractures than women with intact ovaries. Two other studies, however, found no such association.

The Mayo Clinic Cohort Study of Oophorectomy and Aging, which followed more than 3,400 women for 25 years, found significant relationships between bilateral oophorectomy and Parkinson's disease (80% increased risk in women who had the surgery compared with women with intact ovaries), anxiety (greater than 200% increased risk), depression (54% increased risk), and cognitive impairment or dementia (70% increased risk).

Other studies suggest that bilateral oophorectomy throws women into a sudden, unnatural menopause that negatively affects mood, thought, memory, energy, libido, and sexual response.

Dr. Parker noted that a randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life.

“Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment.

“Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case,” he noted.

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141–2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy.

“This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely,” he noted.

Neither Dr. Parker nor Dr. Adamson reported any conflicts of interest.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy. “Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161-6).

Dr. Parker of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy. The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills approximately 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer. On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen. “Further studies are needed to confirm these unexpected findings,” he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed. Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%). The risk of death was highest for women who had the surgery before they turned 50; they had a 40% increase in the risk of all-cause mortality.

The NHS also found that women who had oophorectomy without estrogen replacement had twice the risk of myocardial infarction compared with age-matched premenopausal women. The surgery was associated with an 85% increase in the risk of stroke in women who didn't use hormones after menopause.

Whether women used estrogens or not, oophorectomy was associated with a 28% increased risk of death from coronary artery disease in all women.

Dr. Parker found several studies that explored the relationship between oophorectomy and osteoporosis and hip fracture. One study of 340 postmenopausal women who had the surgery (median age, 62 years) found that these women had 54% more osteoporotic fractures than women with intact ovaries. Two other studies, however, found no such association.

The Mayo Clinic Cohort Study of Oophorectomy and Aging, which followed more than 3,400 women for 25 years, found significant relationships between bilateral oophorectomy and Parkinson's disease (80% increased risk in women who had the surgery compared with women with intact ovaries), anxiety (greater than 200% increased risk) depression (54% increased risk), and cognitive impairment or dementia (70% increased risk).

Other studies suggest that bilateral oophorectomy throws women into a sudden, unnatural menopause that negatively affects mood, thought, memory, energy, libido, and sexual response.

Dr. Parker noted that a randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life. “Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment. “Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case.”

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141-2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy. This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely.”

Disclosures: Neither Dr. Parker nor Dr Adamson reported any conflicts of interest.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy. “Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161-6).

Dr. Parker of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy. The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills approximately 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer. On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen. “Further studies are needed to confirm these unexpected findings,” he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed. Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%). The risk of death was highest for women who had the surgery before they turned 50; they had a 40% increase in the risk of all-cause mortality.

The NHS also found that women who had oophorectomy without estrogen replacement had twice the risk of myocardial infarction compared with age-matched premenopausal women. The surgery was associated with an 85% increase in the risk of stroke in women who didn't use hormones after menopause.

Whether women used estrogens or not, oophorectomy was associated with a 28% increased risk of death from coronary artery disease in all women.

Dr. Parker found several studies that explored the relationship between oophorectomy and osteoporosis and hip fracture. One study of 340 postmenopausal women who had the surgery (median age, 62 years) found that these women had 54% more osteoporotic fractures than women with intact ovaries. Two other studies, however, found no such association.

The Mayo Clinic Cohort Study of Oophorectomy and Aging, which followed more than 3,400 women for 25 years, found significant relationships between bilateral oophorectomy and Parkinson's disease (80% increased risk in women who had the surgery compared with women with intact ovaries), anxiety (greater than 200% increased risk) depression (54% increased risk), and cognitive impairment or dementia (70% increased risk).

Other studies suggest that bilateral oophorectomy throws women into a sudden, unnatural menopause that negatively affects mood, thought, memory, energy, libido, and sexual response.

Dr. Parker noted that a randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life. “Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment. “Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case.”

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141-2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy. This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely.”

Disclosures: Neither Dr. Parker nor Dr Adamson reported any conflicts of interest.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy. “Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161-6).

Dr. Parker of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy. The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills approximately 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer. On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen. “Further studies are needed to confirm these unexpected findings,” he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed. Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%). The risk of death was highest for women who had the surgery before they turned 50; they had a 40% increase in the risk of all-cause mortality.

The NHS also found that women who had oophorectomy without estrogen replacement had twice the risk of myocardial infarction compared with age-matched premenopausal women. The surgery was associated with an 85% increase in the risk of stroke in women who didn't use hormones after menopause.

Whether women used estrogens or not, oophorectomy was associated with a 28% increased risk of death from coronary artery disease in all women.

Dr. Parker found several studies that explored the relationship between oophorectomy and osteoporosis and hip fracture. One study of 340 postmenopausal women who had the surgery (median age, 62 years) found that these women had 54% more osteoporotic fractures than women with intact ovaries. Two other studies, however, found no such association.

The Mayo Clinic Cohort Study of Oophorectomy and Aging, which followed more than 3,400 women for 25 years, found significant relationships between bilateral oophorectomy and Parkinson's disease (80% increased risk in women who had the surgery compared with women with intact ovaries), anxiety (greater than 200% increased risk) depression (54% increased risk), and cognitive impairment or dementia (70% increased risk).

Other studies suggest that bilateral oophorectomy throws women into a sudden, unnatural menopause that negatively affects mood, thought, memory, energy, libido, and sexual response.

Dr. Parker noted that a randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life. “Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment. “Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case.”

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141-2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy. This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely.”

Disclosures: Neither Dr. Parker nor Dr Adamson reported any conflicts of interest.

Major Finding: Of 200 hospitalized children tested for rotavirus before approval of the vaccine, 27% tested positive. Of 161 and 180 hospitalized children tested in the subsequent 2 years after vaccine approval, 12% and 14% tested positive for rotavirus infections.

Data Source: A retrospective cohort study of 1,996 children admitted to a single hospital.

Disclosures: Dr. Hamwi said he had no relevant financial conflicts of interest. One of the coinvestigators, Dr. David DiJohn, disclosed that he is on the speakers bureau for both GlaxoSmithKline and Sanofi-Aventis.

PHILADELPHIA — The introduction of the rotavirus vaccine was associated with a significant decrease in the number of children admitted to a New York City hospital for rotavirus infections, as well as a decline in the severity of the rotavirus season.

The annual percentage of admitted patients who tested positive for the virus decreased from more than 12% before the vaccine was available to 3% afterward, Dr. Haytham Hamwi said at the annual meeting of the Eastern Society for Pediatric Research.

Dr. Hamwi of the Flushing (N.Y.) Hospital Medical Center discussed a retrospective study of rotavirus testing and admissions spanning three time periods: September 2004 through August 2005 (before the vaccine was available), and after the vaccine was available, September 2007 through August 2008 and September 2008 through August 2009. The hospital database and the New York City vaccine registry provided the data for the study.

Dr. Hamwi and his colleagues included in their study all patients aged 0–6 years who were admitted to the hospital during those periods, except any child who had received the rotavirus vaccine within 3 weeks of a hospital admission.

“The vaccine can cause shedding of antigen in the stool, leading to a false-positive result,” Dr. Hamwi said.

During the first study period (2004–2005), 442 patients aged 0–6 years were admitted to the hospital; 200 of those were tested for rotavirus.

Of these, 55 (27%) tested positive for the virus. Patients with rotavirus infections comprised 12% of all hospital admissions among 0–6 year olds.

During the second study period (2007–2008), 744 children aged 0–6 years were admitted to the hospital.

The surge in admissions occurred because several neighboring hospitals had closed, Dr. Hamwi said.

Of the admissions, 161 were tested for rotavirus and 20 (12%) tested positive. Rotavirus accounted for 2.6% of admissions for 0- to 6-year-old children during that time.

In the third study period (2008–2009), there were 810 admissions. Of these, 180 were tested for the virus and 26 (14%) tested positive. Children with rotavirus accounted for 3% of the admissions.

A vaccination history was available for 76 children who tested positive for the virus in the study.

Of these, 75 were unvaccinated against rotavirus and 1 had been incompletely vaccinated, Dr. Hamwi said. No rotavirus was found in unvaccinated children.

The investigators also examined the relationship between the vaccine and rotavirus seasonality.

In the prevaccine study periods, rotavirus appeared in November, peaked in February, and had a second peak in April.

In both postvaccination study periods, the disease appeared later and did not show the typical winter peak.

A smaller peak occurred in March and April of the second of the two study periods.

Major Finding: Of 200 hospitalized children tested for rotavirus before approval of the vaccine, 27% tested positive. Of 161 and 180 hospitalized children tested in the subsequent 2 years after vaccine approval, 12% and 14% tested positive for rotavirus infections.

Data Source: A retrospective cohort study of 1,996 children admitted to a single hospital.

Disclosures: Dr. Hamwi said he had no relevant financial conflicts of interest. One of the coinvestigators, Dr. David DiJohn, disclosed that he is on the speakers bureau for both GlaxoSmithKline and Sanofi-Aventis.

PHILADELPHIA — The introduction of the rotavirus vaccine was associated with a significant decrease in the number of children admitted to a New York City hospital for rotavirus infections, as well as a decline in the severity of the rotavirus season.

The annual percentage of admitted patients who tested positive for the virus decreased from more than 12% before the vaccine was available to 3% afterward, Dr. Haytham Hamwi said at the annual meeting of the Eastern Society for Pediatric Research.

Dr. Hamwi of the Flushing (N.Y.) Hospital Medical Center discussed a retrospective study of rotavirus testing and admissions spanning three time periods: September 2004 through August 2005 (before the vaccine was available), and after the vaccine was available, September 2007 through August 2008 and September 2008 through August 2009. The hospital database and the New York City vaccine registry provided the data for the study.

Dr. Hamwi and his colleagues included in their study all patients aged 0–6 years who were admitted to the hospital during those periods, except any child who had received the rotavirus vaccine within 3 weeks of a hospital admission.

“The vaccine can cause shedding of antigen in the stool, leading to a false-positive result,” Dr. Hamwi said.

During the first study period (2004–2005), 442 patients aged 0–6 years were admitted to the hospital; 200 of those were tested for rotavirus.

Of these, 55 (27%) tested positive for the virus. Patients with rotavirus infections comprised 12% of all hospital admissions among 0–6 year olds.

During the second study period (2007–2008), 744 children aged 0–6 years were admitted to the hospital.

The surge in admissions occurred because several neighboring hospitals had closed, Dr. Hamwi said.

Of the admissions, 161 were tested for rotavirus and 20 (12%) tested positive. Rotavirus accounted for 2.6% of admissions for 0- to 6-year-old children during that time.

In the third study period (2008–2009), there were 810 admissions. Of these, 180 were tested for the virus and 26 (14%) tested positive. Children with rotavirus accounted for 3% of the admissions.

A vaccination history was available for 76 children who tested positive for the virus in the study.

Of these, 75 were unvaccinated against rotavirus and 1 had been incompletely vaccinated, Dr. Hamwi said. No rotavirus was found in unvaccinated children.

The investigators also examined the relationship between the vaccine and rotavirus seasonality.

In the prevaccine study periods, rotavirus appeared in November, peaked in February, and had a second peak in April.

In both postvaccination study periods, the disease appeared later and did not show the typical winter peak.

A smaller peak occurred in March and April of the second of the two study periods.

Major Finding: Of 200 hospitalized children tested for rotavirus before approval of the vaccine, 27% tested positive. Of 161 and 180 hospitalized children tested in the subsequent 2 years after vaccine approval, 12% and 14% tested positive for rotavirus infections.

Data Source: A retrospective cohort study of 1,996 children admitted to a single hospital.

Disclosures: Dr. Hamwi said he had no relevant financial conflicts of interest. One of the coinvestigators, Dr. David DiJohn, disclosed that he is on the speakers bureau for both GlaxoSmithKline and Sanofi-Aventis.

PHILADELPHIA — The introduction of the rotavirus vaccine was associated with a significant decrease in the number of children admitted to a New York City hospital for rotavirus infections, as well as a decline in the severity of the rotavirus season.

The annual percentage of admitted patients who tested positive for the virus decreased from more than 12% before the vaccine was available to 3% afterward, Dr. Haytham Hamwi said at the annual meeting of the Eastern Society for Pediatric Research.

Dr. Hamwi of the Flushing (N.Y.) Hospital Medical Center discussed a retrospective study of rotavirus testing and admissions spanning three time periods: September 2004 through August 2005 (before the vaccine was available), and after the vaccine was available, September 2007 through August 2008 and September 2008 through August 2009. The hospital database and the New York City vaccine registry provided the data for the study.

Dr. Hamwi and his colleagues included in their study all patients aged 0–6 years who were admitted to the hospital during those periods, except any child who had received the rotavirus vaccine within 3 weeks of a hospital admission.

“The vaccine can cause shedding of antigen in the stool, leading to a false-positive result,” Dr. Hamwi said.

During the first study period (2004–2005), 442 patients aged 0–6 years were admitted to the hospital; 200 of those were tested for rotavirus.

Of these, 55 (27%) tested positive for the virus. Patients with rotavirus infections comprised 12% of all hospital admissions among 0–6 year olds.

During the second study period (2007–2008), 744 children aged 0–6 years were admitted to the hospital.

The surge in admissions occurred because several neighboring hospitals had closed, Dr. Hamwi said.

Of the admissions, 161 were tested for rotavirus and 20 (12%) tested positive. Rotavirus accounted for 2.6% of admissions for 0- to 6-year-old children during that time.

In the third study period (2008–2009), there were 810 admissions. Of these, 180 were tested for the virus and 26 (14%) tested positive. Children with rotavirus accounted for 3% of the admissions.

A vaccination history was available for 76 children who tested positive for the virus in the study.

Of these, 75 were unvaccinated against rotavirus and 1 had been incompletely vaccinated, Dr. Hamwi said. No rotavirus was found in unvaccinated children.

The investigators also examined the relationship between the vaccine and rotavirus seasonality.

In the prevaccine study periods, rotavirus appeared in November, peaked in February, and had a second peak in April.

In both postvaccination study periods, the disease appeared later and did not show the typical winter peak.

A smaller peak occurred in March and April of the second of the two study periods.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy. “Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161-6).

Dr. Parker of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy. The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills about 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer. On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen, he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed. Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%).

A randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life. “Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment. “Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case.”

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141-2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy. This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely.”

Disclosures: Neither Dr. Parker nor Dr. Adamson reported any conflicts.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy. “Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161-6).

Dr. Parker of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy. The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills about 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer. On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen, he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed. Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%).

A randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life. “Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment. “Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case.”

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141-2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy. This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely.”

Disclosures: Neither Dr. Parker nor Dr. Adamson reported any conflicts.

Bilateral oophorectomy at the time of hysterectomy may do more harm than good, increasing the risk of death, cardiovascular disease, osteoporosis, and even lung cancer for a minimal trade-off in preventing ovarian cancer, according to an examination of available data.

An analysis of observational studies suggests that physicians and patients should fully discuss the issue before making a decision about which way to go at the time of hysterectomy. “Prudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision,” Dr. William H. Parker wrote (J. Min. Invas. Gyn. 2010;17:161-6).

Dr. Parker of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif., plumbed numerous studies to examine the long-term health implications of premenopausal bilateral oophorectomy. The surgery is usually recommended at the time of hysterectomy because it eliminates any later risk of ovarian cancer, which kills about 15,000 women every year in the United States.

However, Dr. Parker said, less than 1% of women who have a hysterectomy with ovarian conservation go on to develop ovarian cancer. On the other hand, the Nurses' Health Study (NHS) and a recent Canadian study found that bilateral oophorectomy is associated with a 26% increased risk of lung cancer; the risk is even higher when patients don't take postsurgical estrogen, he wrote.

The NHS also provided information about all-cause mortality in women who had both ovaries removed. Over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%).

A randomized trial is underway to examine the short-term associations of bilateral oophorectomy with cardiovascular, bone, and sexual health, as well as health-related quality of life. “Until these and other data are available, removing the ovaries at the time of hysterectomy should be approached with caution,” he said.

In an accompanying editorial, Dr. G. David Adamson of Palo Alto, Calif., agreed with Dr. Parker's assessment. “Oophorectomy is not necessarily the wrong decision for many women, but assessment of these data leads to the conclusion that more women are undergoing oophorectomy than should be the case.”

The reason for this remains unclear, Dr. Adamson wrote (J. Min. Invas. Gyn. 2010;17:141-2). “Given that the data do not support widespread oophorectomy at the time of hysterectomy, it is problematic that so many patients have oophorectomy. This implies that the data don't support ovarian conservation in most situations, which is not true, or that physicians are not giving patients a balanced rendition of the literature evidence, for whatever reason, or that women are choosing on their own to have oophorectomy, which does not seem likely.”

Disclosures: Neither Dr. Parker nor Dr. Adamson reported any conflicts.