From Staff Reports

HPV Is Age Blind, Keep Screening

Women aged 51 years are at least as likely as were younger women to become infected with human papillomavirus, a study suggests; the findings indicate that cervical screening should not be discontinued after age 50.

To compare rates of HPV acquisition in older and younger women, paired archived cervical smears taken an average of 3 years apart from 656 women were tested. Of these, 567 were negative for HPV at baseline, Dr. Matthew J. Grainge of the University of Nottingham (England) and his colleagues reported.

Of 333 women aged 51 years at the time of a baseline smear that was HPV negative, 21% had a positive smear 3 years later, compared with 15% of 66 women aged 21 years, 14% of 85 women aged 31, and 13% of 83 women aged 41 at the time of a negative baseline smear. The differences were not statistically significant, the investigators noted (Emerg. Infect. Dis. 2005;11:1680–5).

Prospective research is needed on the effects of HPV acquisition during middle age, such as the associated risk for high-grade cervical intraepithelial neoplasia and cervical cancer, they concluded.

BV and Cytomegalovirus in Cahoots

Bacterial vaginosis appears to facilitate local cytomegalovirus replication as well as infection with multiple CMV strains, Dr. Shannon A. Ross of the University of Alabama at Birmingham and her colleagues have found.

Conversely, the presence of CMV infection may facilitate BV, the investigators noted. An analysis of vaginal wash specimens from 52 women who presented to a sexually transmitted disease clinic showed that CMV shedding was significantly more common in women with BV (52% of 21 women), compared with those without BV (19% of 31 women). Multiple CMV strains were found in 91% of women with CMV shedding and BV vs. 83% of those with CMV shedding and no BV (J. Infect. Dis. 2005;192:1727–30).

Additional study of the correlations between BV and CMV is needed, and could provide insight regarding the effects of BV treatment on CMV replication and local inflammatory response, they concluded.

Girls' Body Images Depend on Moms

Adolescent girls who reported peer and parental attitudes that encouraged healthy behavior and exercise, rather than weight loss, were significantly more likely to report high levels of body satisfaction, said Dr. Amy M. Kelly and her colleagues at the University of Minnesota, Minneapolis.

Overall, 26.7% of 2,357 middle and high school students surveyed in 1998–1999 reported high body satisfaction (J. Adolesc. Health 2005;37:391–6). The study population included 46% whites, 21% Asian Americans, 20% African Americans, and 5% Hispanics.

Body satisfaction was significantly higher among African American girls (40%) and underweight girls (39%) after controlling for ethnicity, socioeconomic status, and age. Girls with high body satisfaction were more likely to report having mothers who exercised for fitness and who encouraged them to be active and eat healthfully.

In addition, girls who reported high body satisfaction were more likely to report that they cared about their health, being fit, and exercising.

HCM More Severe in Women

Hypertrophic cardiomyopathy is diagnosed later in women than in men, and it is more likely to progress to severe, disabling symptoms or death, reported Dr. Iacopo Olivotto of Azienda Ospedaliera Universitaria Careggi, Florence, Italy, and associates.

Both findings “underscore the importance of heightened suspicion for HCM in women,” the researchers said (J. Am. Coll. Cardiol. 2005;46:480–7).

They assessed disease progression over an average of 6 years in 969 consecutive patients treated for HCM at three medical centers in Italy and the United States. The 393 women were an average of 9 years older than the 576 men at diagnosis.

Nearly 60% of the women had severe symptoms, including exertional dyspnea, chest pain, and syncope, compared with fewer than 40% of the men.

Women were more likely to have left ventricular outflow obstruction, possibly because of the smaller dimensions of their left ventricular cavities.

Although treatment was equivalent for men and women once they were diagnosed, women were much more likely to show symptomatic progression and to die from heart failure or embolic stroke. This was due in part to the delay in diagnosis and treatment, but the data also suggest that some other, as yet unknown, mechanism related to female gender may make women more prone to HCM progression, the researchers said.

HPV Is Age Blind, Keep Screening

Women aged 51 years are at least as likely as were younger women to become infected with human papillomavirus, a study suggests; the findings indicate that cervical screening should not be discontinued after age 50.

To compare rates of HPV acquisition in older and younger women, paired archived cervical smears taken an average of 3 years apart from 656 women were tested. Of these, 567 were negative for HPV at baseline, Dr. Matthew J. Grainge of the University of Nottingham (England) and his colleagues reported.

Of 333 women aged 51 years at the time of a baseline smear that was HPV negative, 21% had a positive smear 3 years later, compared with 15% of 66 women aged 21 years, 14% of 85 women aged 31, and 13% of 83 women aged 41 at the time of a negative baseline smear. The differences were not statistically significant, the investigators noted (Emerg. Infect. Dis. 2005;11:1680–5).

Prospective research is needed on the effects of HPV acquisition during middle age, such as the associated risk for high-grade cervical intraepithelial neoplasia and cervical cancer, they concluded.

BV and Cytomegalovirus in Cahoots

Bacterial vaginosis appears to facilitate local cytomegalovirus replication as well as infection with multiple CMV strains, Dr. Shannon A. Ross of the University of Alabama at Birmingham and her colleagues have found.

Conversely, the presence of CMV infection may facilitate BV, the investigators noted. An analysis of vaginal wash specimens from 52 women who presented to a sexually transmitted disease clinic showed that CMV shedding was significantly more common in women with BV (52% of 21 women), compared with those without BV (19% of 31 women). Multiple CMV strains were found in 91% of women with CMV shedding and BV vs. 83% of those with CMV shedding and no BV (J. Infect. Dis. 2005;192:1727–30).

Additional study of the correlations between BV and CMV is needed, and could provide insight regarding the effects of BV treatment on CMV replication and local inflammatory response, they concluded.

Girls' Body Images Depend on Moms

Adolescent girls who reported peer and parental attitudes that encouraged healthy behavior and exercise, rather than weight loss, were significantly more likely to report high levels of body satisfaction, said Dr. Amy M. Kelly and her colleagues at the University of Minnesota, Minneapolis.

Overall, 26.7% of 2,357 middle and high school students surveyed in 1998–1999 reported high body satisfaction (J. Adolesc. Health 2005;37:391–6). The study population included 46% whites, 21% Asian Americans, 20% African Americans, and 5% Hispanics.

Body satisfaction was significantly higher among African American girls (40%) and underweight girls (39%) after controlling for ethnicity, socioeconomic status, and age. Girls with high body satisfaction were more likely to report having mothers who exercised for fitness and who encouraged them to be active and eat healthfully.

In addition, girls who reported high body satisfaction were more likely to report that they cared about their health, being fit, and exercising.

HCM More Severe in Women

Hypertrophic cardiomyopathy is diagnosed later in women than in men, and it is more likely to progress to severe, disabling symptoms or death, reported Dr. Iacopo Olivotto of Azienda Ospedaliera Universitaria Careggi, Florence, Italy, and associates.

Both findings “underscore the importance of heightened suspicion for HCM in women,” the researchers said (J. Am. Coll. Cardiol. 2005;46:480–7).

They assessed disease progression over an average of 6 years in 969 consecutive patients treated for HCM at three medical centers in Italy and the United States. The 393 women were an average of 9 years older than the 576 men at diagnosis.

Nearly 60% of the women had severe symptoms, including exertional dyspnea, chest pain, and syncope, compared with fewer than 40% of the men.

Women were more likely to have left ventricular outflow obstruction, possibly because of the smaller dimensions of their left ventricular cavities.

Although treatment was equivalent for men and women once they were diagnosed, women were much more likely to show symptomatic progression and to die from heart failure or embolic stroke. This was due in part to the delay in diagnosis and treatment, but the data also suggest that some other, as yet unknown, mechanism related to female gender may make women more prone to HCM progression, the researchers said.

HPV Is Age Blind, Keep Screening

Women aged 51 years are at least as likely as were younger women to become infected with human papillomavirus, a study suggests; the findings indicate that cervical screening should not be discontinued after age 50.

To compare rates of HPV acquisition in older and younger women, paired archived cervical smears taken an average of 3 years apart from 656 women were tested. Of these, 567 were negative for HPV at baseline, Dr. Matthew J. Grainge of the University of Nottingham (England) and his colleagues reported.

Of 333 women aged 51 years at the time of a baseline smear that was HPV negative, 21% had a positive smear 3 years later, compared with 15% of 66 women aged 21 years, 14% of 85 women aged 31, and 13% of 83 women aged 41 at the time of a negative baseline smear. The differences were not statistically significant, the investigators noted (Emerg. Infect. Dis. 2005;11:1680–5).

Prospective research is needed on the effects of HPV acquisition during middle age, such as the associated risk for high-grade cervical intraepithelial neoplasia and cervical cancer, they concluded.

BV and Cytomegalovirus in Cahoots

Bacterial vaginosis appears to facilitate local cytomegalovirus replication as well as infection with multiple CMV strains, Dr. Shannon A. Ross of the University of Alabama at Birmingham and her colleagues have found.

Conversely, the presence of CMV infection may facilitate BV, the investigators noted. An analysis of vaginal wash specimens from 52 women who presented to a sexually transmitted disease clinic showed that CMV shedding was significantly more common in women with BV (52% of 21 women), compared with those without BV (19% of 31 women). Multiple CMV strains were found in 91% of women with CMV shedding and BV vs. 83% of those with CMV shedding and no BV (J. Infect. Dis. 2005;192:1727–30).

Additional study of the correlations between BV and CMV is needed, and could provide insight regarding the effects of BV treatment on CMV replication and local inflammatory response, they concluded.

Girls' Body Images Depend on Moms

Adolescent girls who reported peer and parental attitudes that encouraged healthy behavior and exercise, rather than weight loss, were significantly more likely to report high levels of body satisfaction, said Dr. Amy M. Kelly and her colleagues at the University of Minnesota, Minneapolis.

Overall, 26.7% of 2,357 middle and high school students surveyed in 1998–1999 reported high body satisfaction (J. Adolesc. Health 2005;37:391–6). The study population included 46% whites, 21% Asian Americans, 20% African Americans, and 5% Hispanics.

Body satisfaction was significantly higher among African American girls (40%) and underweight girls (39%) after controlling for ethnicity, socioeconomic status, and age. Girls with high body satisfaction were more likely to report having mothers who exercised for fitness and who encouraged them to be active and eat healthfully.

In addition, girls who reported high body satisfaction were more likely to report that they cared about their health, being fit, and exercising.

HCM More Severe in Women

Hypertrophic cardiomyopathy is diagnosed later in women than in men, and it is more likely to progress to severe, disabling symptoms or death, reported Dr. Iacopo Olivotto of Azienda Ospedaliera Universitaria Careggi, Florence, Italy, and associates.

Both findings “underscore the importance of heightened suspicion for HCM in women,” the researchers said (J. Am. Coll. Cardiol. 2005;46:480–7).

They assessed disease progression over an average of 6 years in 969 consecutive patients treated for HCM at three medical centers in Italy and the United States. The 393 women were an average of 9 years older than the 576 men at diagnosis.

Nearly 60% of the women had severe symptoms, including exertional dyspnea, chest pain, and syncope, compared with fewer than 40% of the men.

Women were more likely to have left ventricular outflow obstruction, possibly because of the smaller dimensions of their left ventricular cavities.

Although treatment was equivalent for men and women once they were diagnosed, women were much more likely to show symptomatic progression and to die from heart failure or embolic stroke. This was due in part to the delay in diagnosis and treatment, but the data also suggest that some other, as yet unknown, mechanism related to female gender may make women more prone to HCM progression, the researchers said.

PPI Use Boosts CDAD Risk

The use of gastric acid-suppressive drugs was linked to increased risk of community-acquired Clostridium difficile-associated disease in a population-based case-control study, reported Dr. Sandra Dial and her associates at McGill University, Montreal.

Prior hospitalization, recent exposure to antibiotics, and age also significantly increased the risk of C. difficile-associated disease (CDAD), they found.

An association between proton pump inhibitor use and hospital-acquired CDAD has been shown in several case-control studies. The researchers sought to determine whether the same relationship applied to community-acquired CDAD.

Using data from the United Kingdom General Practice Research Database (GPRD), which holds medical records on about 3 million patients in more than 400 medical practices, Dr. Dial and her associates compared records of all the patients in the GPRD with a first occurrence of CDAD during 1994–2004 (1,672) with those of 10 age-matched controls from the same medical practice. They then compared the subset of CDAD patients who had not been hospitalized in the year before the index date (1,233) with 10 controls from the same practices. These patients were considered to have community-acquired CDAD (JAMA 2005;294:2989–95).

The researchers found an “exponential increase” in CDAD during the study period, from less than 1/100,000 patients in 1994 to 22/100,000 in 2004, although this may be partly explained by increased reporting and testing during that time.

U.S. Measles Cases Hit All-Time Low

Measles cases in the United States have hit an all-time low, the Centers for Disease Control and Prevention has reported.

During 2004, just 37 cases of measles were reported to the CDC. This number—the lowest ever reported in 1 year in the United States—represents a 16% drop from the 44 cases reported in 2002, the CDC reported (MMWR 2005;54:1229–31).

Nearly half (18) of the 37 cases were children aged 1–4 years, another 7 were aged 5–19 years, 5 were younger than 12 months of age, 5 were 20–34 years old, and 2 were aged 35 years or older. Three states—Washington, California, and New York—accounted for 49% of the cases, whereas 11 states reported one to three cases each.

Of the 37 cases, 27 (73%) were imported, including 14 in U.S. residents who had acquired measles while traveling abroad, and 13 in foreign nationals who acquired the disease abroad and subsequently traveled to the United States. China was the most frequent country from which measles was imported, accounting for 13 of the cases.

All 14 of the U.S. residents with imported measles cases were vaccine eligible. Of those, nine were not vaccinated, three had unknown vaccination status, and two had received at least one dose of measles vaccine.

Of the 13 non-U.S. residents with imported measles, 10 had not been vaccinated and 3 had unknown vaccination status. Ten of the cases were indigenous (infected in the United States), of which six were linked to imported cases and four had unknown sources of exposure.

It will be necessary to maintain greater than 90% vaccination coverage in the United States as long as measles is endemic in most countries worldwide, the CDC said.

Transmission of Hepatitis C

Two recently published studies demonstrate that the risk of transmission of hepatitis C from mother to infant is increased by concomitant HIV infection, but unlike HIV, the risk of vertical transmission of hepatitis C is not reduced by elective cesarean section.

Additionally, the larger of the two studies turned up the surprising result that girl babies are at twice the risk of vertical transmission as are boys (J. Infect. Dis. 2005;192:1872–9).

That study, by the European Paediatric Hepatitis C Virus Network, involved 1,479 pregnant women with confirmed hepatitis C infections from 33 sites across Europe. They and their babies were followed prospectively over at least 24 months.

The overall vertical transmission rate in this study was 3.7%. Women who were coinfected with HIV were 6.5 times more likely to transmit hepatitis C than those who were not coinfected.

Among the HIV-negative women, vertical hepatitis C transmission was significantly associated with several factors, including membrane rupture more than 6 hours before delivery and the use of internal fetal monitoring devices.

The investigators concluded that avoiding internal fetal monitoring and/or performing a cesarean section before or soon after membrane rupture could decrease the risk of vertical hepatitis C transmission.

PPI Use Boosts CDAD Risk

The use of gastric acid-suppressive drugs was linked to increased risk of community-acquired Clostridium difficile-associated disease in a population-based case-control study, reported Dr. Sandra Dial and her associates at McGill University, Montreal.

Prior hospitalization, recent exposure to antibiotics, and age also significantly increased the risk of C. difficile-associated disease (CDAD), they found.

An association between proton pump inhibitor use and hospital-acquired CDAD has been shown in several case-control studies. The researchers sought to determine whether the same relationship applied to community-acquired CDAD.

Using data from the United Kingdom General Practice Research Database (GPRD), which holds medical records on about 3 million patients in more than 400 medical practices, Dr. Dial and her associates compared records of all the patients in the GPRD with a first occurrence of CDAD during 1994–2004 (1,672) with those of 10 age-matched controls from the same medical practice. They then compared the subset of CDAD patients who had not been hospitalized in the year before the index date (1,233) with 10 controls from the same practices. These patients were considered to have community-acquired CDAD (JAMA 2005;294:2989–95).

The researchers found an “exponential increase” in CDAD during the study period, from less than 1/100,000 patients in 1994 to 22/100,000 in 2004, although this may be partly explained by increased reporting and testing during that time.

U.S. Measles Cases Hit All-Time Low

Measles cases in the United States have hit an all-time low, the Centers for Disease Control and Prevention has reported.

During 2004, just 37 cases of measles were reported to the CDC. This number—the lowest ever reported in 1 year in the United States—represents a 16% drop from the 44 cases reported in 2002, the CDC reported (MMWR 2005;54:1229–31).

Nearly half (18) of the 37 cases were children aged 1–4 years, another 7 were aged 5–19 years, 5 were younger than 12 months of age, 5 were 20–34 years old, and 2 were aged 35 years or older. Three states—Washington, California, and New York—accounted for 49% of the cases, whereas 11 states reported one to three cases each.

Of the 37 cases, 27 (73%) were imported, including 14 in U.S. residents who had acquired measles while traveling abroad, and 13 in foreign nationals who acquired the disease abroad and subsequently traveled to the United States. China was the most frequent country from which measles was imported, accounting for 13 of the cases.

All 14 of the U.S. residents with imported measles cases were vaccine eligible. Of those, nine were not vaccinated, three had unknown vaccination status, and two had received at least one dose of measles vaccine.

Of the 13 non-U.S. residents with imported measles, 10 had not been vaccinated and 3 had unknown vaccination status. Ten of the cases were indigenous (infected in the United States), of which six were linked to imported cases and four had unknown sources of exposure.

It will be necessary to maintain greater than 90% vaccination coverage in the United States as long as measles is endemic in most countries worldwide, the CDC said.

Transmission of Hepatitis C

Two recently published studies demonstrate that the risk of transmission of hepatitis C from mother to infant is increased by concomitant HIV infection, but unlike HIV, the risk of vertical transmission of hepatitis C is not reduced by elective cesarean section.

Additionally, the larger of the two studies turned up the surprising result that girl babies are at twice the risk of vertical transmission as are boys (J. Infect. Dis. 2005;192:1872–9).

That study, by the European Paediatric Hepatitis C Virus Network, involved 1,479 pregnant women with confirmed hepatitis C infections from 33 sites across Europe. They and their babies were followed prospectively over at least 24 months.

The overall vertical transmission rate in this study was 3.7%. Women who were coinfected with HIV were 6.5 times more likely to transmit hepatitis C than those who were not coinfected.

Among the HIV-negative women, vertical hepatitis C transmission was significantly associated with several factors, including membrane rupture more than 6 hours before delivery and the use of internal fetal monitoring devices.

The investigators concluded that avoiding internal fetal monitoring and/or performing a cesarean section before or soon after membrane rupture could decrease the risk of vertical hepatitis C transmission.

PPI Use Boosts CDAD Risk

The use of gastric acid-suppressive drugs was linked to increased risk of community-acquired Clostridium difficile-associated disease in a population-based case-control study, reported Dr. Sandra Dial and her associates at McGill University, Montreal.

Prior hospitalization, recent exposure to antibiotics, and age also significantly increased the risk of C. difficile-associated disease (CDAD), they found.

An association between proton pump inhibitor use and hospital-acquired CDAD has been shown in several case-control studies. The researchers sought to determine whether the same relationship applied to community-acquired CDAD.

Using data from the United Kingdom General Practice Research Database (GPRD), which holds medical records on about 3 million patients in more than 400 medical practices, Dr. Dial and her associates compared records of all the patients in the GPRD with a first occurrence of CDAD during 1994–2004 (1,672) with those of 10 age-matched controls from the same medical practice. They then compared the subset of CDAD patients who had not been hospitalized in the year before the index date (1,233) with 10 controls from the same practices. These patients were considered to have community-acquired CDAD (JAMA 2005;294:2989–95).

The researchers found an “exponential increase” in CDAD during the study period, from less than 1/100,000 patients in 1994 to 22/100,000 in 2004, although this may be partly explained by increased reporting and testing during that time.

U.S. Measles Cases Hit All-Time Low

Measles cases in the United States have hit an all-time low, the Centers for Disease Control and Prevention has reported.

During 2004, just 37 cases of measles were reported to the CDC. This number—the lowest ever reported in 1 year in the United States—represents a 16% drop from the 44 cases reported in 2002, the CDC reported (MMWR 2005;54:1229–31).

Nearly half (18) of the 37 cases were children aged 1–4 years, another 7 were aged 5–19 years, 5 were younger than 12 months of age, 5 were 20–34 years old, and 2 were aged 35 years or older. Three states—Washington, California, and New York—accounted for 49% of the cases, whereas 11 states reported one to three cases each.

Of the 37 cases, 27 (73%) were imported, including 14 in U.S. residents who had acquired measles while traveling abroad, and 13 in foreign nationals who acquired the disease abroad and subsequently traveled to the United States. China was the most frequent country from which measles was imported, accounting for 13 of the cases.

All 14 of the U.S. residents with imported measles cases were vaccine eligible. Of those, nine were not vaccinated, three had unknown vaccination status, and two had received at least one dose of measles vaccine.

Of the 13 non-U.S. residents with imported measles, 10 had not been vaccinated and 3 had unknown vaccination status. Ten of the cases were indigenous (infected in the United States), of which six were linked to imported cases and four had unknown sources of exposure.

It will be necessary to maintain greater than 90% vaccination coverage in the United States as long as measles is endemic in most countries worldwide, the CDC said.

Transmission of Hepatitis C

Two recently published studies demonstrate that the risk of transmission of hepatitis C from mother to infant is increased by concomitant HIV infection, but unlike HIV, the risk of vertical transmission of hepatitis C is not reduced by elective cesarean section.

Additionally, the larger of the two studies turned up the surprising result that girl babies are at twice the risk of vertical transmission as are boys (J. Infect. Dis. 2005;192:1872–9).

That study, by the European Paediatric Hepatitis C Virus Network, involved 1,479 pregnant women with confirmed hepatitis C infections from 33 sites across Europe. They and their babies were followed prospectively over at least 24 months.

The overall vertical transmission rate in this study was 3.7%. Women who were coinfected with HIV were 6.5 times more likely to transmit hepatitis C than those who were not coinfected.

Among the HIV-negative women, vertical hepatitis C transmission was significantly associated with several factors, including membrane rupture more than 6 hours before delivery and the use of internal fetal monitoring devices.

The investigators concluded that avoiding internal fetal monitoring and/or performing a cesarean section before or soon after membrane rupture could decrease the risk of vertical hepatitis C transmission.

Placental Syndromes and CVD Risk

Women who have had placental syndromes are at high risk for premature cardiovascular disease, particularly if the fetus was compromised, Dr. Joel G. Ray of the University of Toronto and his associates said.

The level of cardiovascular risk that was conferred by a placental syndrome—preeclampsia, gestational hypertension, or placental abruption or infarction—was found to be comparable to that of conventional risk factors such as hypertension, obesity, diabetes, and dyslipidemia.

Dr. Ray and his associates assessed cardiovascular outcomes in a population-based study of Ontario residents who gave birth between 1990 and 2004. The mean maternal age at delivery was 28 years; of the 1,026,265 subjects, 75,380 (7%) had a placental syndrome (Lancet 2005;366:1797–803).

After a mean of 8.7 years' follow-up, cardiovascular events had occurred in more than twice as many women with placental syndromes as in women without placental syndromes; irrespective of the presence of potential confounders such as diabetes, 500 events per million person-years occurred among those with the syndromes, compared with 200 events per million person-years in women without. The mean age was 38 years at the time of the first cardiovascular event—coronary, cerebrovascular, or peripheral artery events—or the need for a revascularization procedure.

The risk for cardiovascular events was even higher if the placental syndromes led to fetal growth restriction or intrauterine fetal death. It was higher still in women who had preexisting cardiovascular risk factors when they became pregnant. The findings do not imply that placental disorders cause cardiovascular events to occur in the near future, the investigators cautioned. “Rather, a more plausible explanation relates to a woman's abnormal metabolic milieu that predates her pregnancy and continues after delivery.”

ACS Outcomes in High-Risk Patients

High-risk patients with acute coronary syndromes remain likely candidates for further cardiovascular events and death at 1-year follow-up despite aggressive intervention, according to Dr. Kenneth W. Mahaffey and his associates.

The Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial involved more than 10,000 patients with ACS, treated in 12 countries, who were randomly assigned to receive either low-molecular-weight heparin (enoxaparin) or unfractionated heparin, and who were also treated with an early invasive management strategy—over 70% had percutaneous coronary intervention or coronary artery bypass graft surgery. Most patients (92%) also received aspirin, clopidogrel (54%), β-blockers (85%), ACE inhibitors (73%), and/or statins (81%), at the discretion of their clinicians.

“Overall, nearly 18% died or experienced nonfatal MI [at] 6 months of follow-up, and 7% died by 1-year follow-up, despite aggressive coronary revascularization and high use of evidence-based therapies at the time of hospital discharge,” reported Dr. Mahaffey of Duke Clinical Research Institute, Durham, N.C., and his associates (JAMA 2005;294:2594–600).

Outcomes were even worse for the highest-risk patients, defined as those who were 60 years or older, had elevated levels of cardiac biomarkers, or had adverse ECG changes. Among such patients, 21% had either died or sustained a nonfatal MI within 6 months of their initial ACS, and 10% had died within 1 year.

The two anticoagulants were found to perform as well over the long term as they had in the short term.

Erectile Dysfunction and CVD

Erectile dysfunction should be considered a red flag that a man is at increased risk for cardiovascular disease, Dr. Ian M. Thompson of the University of Texas, San Antonio, and his associates wrote.

They prospectively assessed a cohort of 9,457 men for both of these diseases over the course of 7 years. The men were the subset of participants in the Prostate Cancer Prevention Trial who were randomized to placebo (JAMA 2005;294:2996–3002).

At baseline, 8,063 (85%) of the 9,457 men had no CVD. Of these men, 3,816 (47%) had erectile dysfunction (ED) at study entry. Among the 4,247 men without ED at study entry, 2,420 (57%) reported incident ED after 5 years. Risk factors for CVD and ED are similar, judging from findings from proportional hazards regression models.

Incident ED signaled an increased risk for subsequent cardiovascular events (hazard ratio of 1.25). For men with either incident or prevalent erectile dysfunction, the risk was greater (hazard ratio 1.45). The association was in the range of risk linked to current smoking or a family history of MI, Dr. Thompson and his colleagues reported.

Placental Syndromes and CVD Risk

Women who have had placental syndromes are at high risk for premature cardiovascular disease, particularly if the fetus was compromised, Dr. Joel G. Ray of the University of Toronto and his associates said.

The level of cardiovascular risk that was conferred by a placental syndrome—preeclampsia, gestational hypertension, or placental abruption or infarction—was found to be comparable to that of conventional risk factors such as hypertension, obesity, diabetes, and dyslipidemia.

Dr. Ray and his associates assessed cardiovascular outcomes in a population-based study of Ontario residents who gave birth between 1990 and 2004. The mean maternal age at delivery was 28 years; of the 1,026,265 subjects, 75,380 (7%) had a placental syndrome (Lancet 2005;366:1797–803).

After a mean of 8.7 years' follow-up, cardiovascular events had occurred in more than twice as many women with placental syndromes as in women without placental syndromes; irrespective of the presence of potential confounders such as diabetes, 500 events per million person-years occurred among those with the syndromes, compared with 200 events per million person-years in women without. The mean age was 38 years at the time of the first cardiovascular event—coronary, cerebrovascular, or peripheral artery events—or the need for a revascularization procedure.

The risk for cardiovascular events was even higher if the placental syndromes led to fetal growth restriction or intrauterine fetal death. It was higher still in women who had preexisting cardiovascular risk factors when they became pregnant. The findings do not imply that placental disorders cause cardiovascular events to occur in the near future, the investigators cautioned. “Rather, a more plausible explanation relates to a woman's abnormal metabolic milieu that predates her pregnancy and continues after delivery.”

ACS Outcomes in High-Risk Patients

High-risk patients with acute coronary syndromes remain likely candidates for further cardiovascular events and death at 1-year follow-up despite aggressive intervention, according to Dr. Kenneth W. Mahaffey and his associates.

The Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial involved more than 10,000 patients with ACS, treated in 12 countries, who were randomly assigned to receive either low-molecular-weight heparin (enoxaparin) or unfractionated heparin, and who were also treated with an early invasive management strategy—over 70% had percutaneous coronary intervention or coronary artery bypass graft surgery. Most patients (92%) also received aspirin, clopidogrel (54%), β-blockers (85%), ACE inhibitors (73%), and/or statins (81%), at the discretion of their clinicians.

“Overall, nearly 18% died or experienced nonfatal MI [at] 6 months of follow-up, and 7% died by 1-year follow-up, despite aggressive coronary revascularization and high use of evidence-based therapies at the time of hospital discharge,” reported Dr. Mahaffey of Duke Clinical Research Institute, Durham, N.C., and his associates (JAMA 2005;294:2594–600).

Outcomes were even worse for the highest-risk patients, defined as those who were 60 years or older, had elevated levels of cardiac biomarkers, or had adverse ECG changes. Among such patients, 21% had either died or sustained a nonfatal MI within 6 months of their initial ACS, and 10% had died within 1 year.

The two anticoagulants were found to perform as well over the long term as they had in the short term.

Erectile Dysfunction and CVD

Erectile dysfunction should be considered a red flag that a man is at increased risk for cardiovascular disease, Dr. Ian M. Thompson of the University of Texas, San Antonio, and his associates wrote.

They prospectively assessed a cohort of 9,457 men for both of these diseases over the course of 7 years. The men were the subset of participants in the Prostate Cancer Prevention Trial who were randomized to placebo (JAMA 2005;294:2996–3002).

At baseline, 8,063 (85%) of the 9,457 men had no CVD. Of these men, 3,816 (47%) had erectile dysfunction (ED) at study entry. Among the 4,247 men without ED at study entry, 2,420 (57%) reported incident ED after 5 years. Risk factors for CVD and ED are similar, judging from findings from proportional hazards regression models.

Incident ED signaled an increased risk for subsequent cardiovascular events (hazard ratio of 1.25). For men with either incident or prevalent erectile dysfunction, the risk was greater (hazard ratio 1.45). The association was in the range of risk linked to current smoking or a family history of MI, Dr. Thompson and his colleagues reported.

Placental Syndromes and CVD Risk

Women who have had placental syndromes are at high risk for premature cardiovascular disease, particularly if the fetus was compromised, Dr. Joel G. Ray of the University of Toronto and his associates said.

The level of cardiovascular risk that was conferred by a placental syndrome—preeclampsia, gestational hypertension, or placental abruption or infarction—was found to be comparable to that of conventional risk factors such as hypertension, obesity, diabetes, and dyslipidemia.

Dr. Ray and his associates assessed cardiovascular outcomes in a population-based study of Ontario residents who gave birth between 1990 and 2004. The mean maternal age at delivery was 28 years; of the 1,026,265 subjects, 75,380 (7%) had a placental syndrome (Lancet 2005;366:1797–803).

After a mean of 8.7 years' follow-up, cardiovascular events had occurred in more than twice as many women with placental syndromes as in women without placental syndromes; irrespective of the presence of potential confounders such as diabetes, 500 events per million person-years occurred among those with the syndromes, compared with 200 events per million person-years in women without. The mean age was 38 years at the time of the first cardiovascular event—coronary, cerebrovascular, or peripheral artery events—or the need for a revascularization procedure.

The risk for cardiovascular events was even higher if the placental syndromes led to fetal growth restriction or intrauterine fetal death. It was higher still in women who had preexisting cardiovascular risk factors when they became pregnant. The findings do not imply that placental disorders cause cardiovascular events to occur in the near future, the investigators cautioned. “Rather, a more plausible explanation relates to a woman's abnormal metabolic milieu that predates her pregnancy and continues after delivery.”

ACS Outcomes in High-Risk Patients

High-risk patients with acute coronary syndromes remain likely candidates for further cardiovascular events and death at 1-year follow-up despite aggressive intervention, according to Dr. Kenneth W. Mahaffey and his associates.

The Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial involved more than 10,000 patients with ACS, treated in 12 countries, who were randomly assigned to receive either low-molecular-weight heparin (enoxaparin) or unfractionated heparin, and who were also treated with an early invasive management strategy—over 70% had percutaneous coronary intervention or coronary artery bypass graft surgery. Most patients (92%) also received aspirin, clopidogrel (54%), β-blockers (85%), ACE inhibitors (73%), and/or statins (81%), at the discretion of their clinicians.

“Overall, nearly 18% died or experienced nonfatal MI [at] 6 months of follow-up, and 7% died by 1-year follow-up, despite aggressive coronary revascularization and high use of evidence-based therapies at the time of hospital discharge,” reported Dr. Mahaffey of Duke Clinical Research Institute, Durham, N.C., and his associates (JAMA 2005;294:2594–600).

Outcomes were even worse for the highest-risk patients, defined as those who were 60 years or older, had elevated levels of cardiac biomarkers, or had adverse ECG changes. Among such patients, 21% had either died or sustained a nonfatal MI within 6 months of their initial ACS, and 10% had died within 1 year.

The two anticoagulants were found to perform as well over the long term as they had in the short term.

Erectile Dysfunction and CVD

Erectile dysfunction should be considered a red flag that a man is at increased risk for cardiovascular disease, Dr. Ian M. Thompson of the University of Texas, San Antonio, and his associates wrote.

They prospectively assessed a cohort of 9,457 men for both of these diseases over the course of 7 years. The men were the subset of participants in the Prostate Cancer Prevention Trial who were randomized to placebo (JAMA 2005;294:2996–3002).

At baseline, 8,063 (85%) of the 9,457 men had no CVD. Of these men, 3,816 (47%) had erectile dysfunction (ED) at study entry. Among the 4,247 men without ED at study entry, 2,420 (57%) reported incident ED after 5 years. Risk factors for CVD and ED are similar, judging from findings from proportional hazards regression models.

Incident ED signaled an increased risk for subsequent cardiovascular events (hazard ratio of 1.25). For men with either incident or prevalent erectile dysfunction, the risk was greater (hazard ratio 1.45). The association was in the range of risk linked to current smoking or a family history of MI, Dr. Thompson and his colleagues reported.

Intranasal Flu Vaccine Looks Safe

No unexpected serious adverse events were reported with appropriate use of live, attenuated intranasal influenza vaccine in the first two seasons after its U.S. approval.

About 2.5 million people have received the vaccine since June 2003. As of July 2005, 460 adverse events–mostly in the first season, and with no fatalities–were reported to the vaccine adverse event reporting system, said Dr. Hector S. Izurieta of the Food and Drug Administration and his colleagues (JAMA 2005;294:2720-5).

Of the reported events, 217 were respiratory (including 8 cases of asthma exacerbations), 67 were constitutional, 54 were allergic, 33 involved abdominal symptoms, 18 involved ear-nose-throat symptoms, 7 were ocular, 10 were neurologic, 10 were cardiovascular, and 44 were classified as “other.” Fewer than 10% were considered serious, and 16% of events occurred in persons for whom the vaccine was not indicated. Secondary transmission of vaccine virus was reported in 22 cases.

The findings suggest that continued monitoring for neurologic events–such as Guillain-Barré syndrome, reported in two cases–is warranted, as is closer attention to the package insert, given the number of vaccine administration errors and use of the vaccine in persons for whom it is not indicated, the investigators concluded.

West Nile Virus Assay Approved

An assay used to screen blood, organ, cell, and tissue donations for West Nile virus recently has been approved by the Food and Drug Administration.

The Procleix West Nile Virus Assay has been used on an investigational basis to screen more than 29 million units of blood since June 2003. The assay has intercepted more than 1,500 WNV-positive donations that might otherwise have been given to as many as 4,500 people, according to Gen-Probe Inc., which developed the test, and Chiron Corp., which will market the test.

The test detects viral RNA and is approved for use on the Procleix enhanced semiautomated instrument system. Since 2002, when it was first discovered that West Nile Virus could be transmitted via blood, 30 cases of West Nile Virus that were most likely acquired through blood transfusions have been documented, and 9 of the affected patients have died, according to the FDA.

Pneumonia Hospitalization Up for Aged

The burden of pneumonia among U.S. patients aged 65 and older is large and increasing, according to Dr. Alicia M. Fry and her colleagues at the Centers for Disease Control and Prevention, Atlanta.

Among the 173 million people aged over 64 years hospitalized from 1988 through 2002, about 9% had pneumonia as a discharge code, and 6% had pneumonia as a first-listed discharge code. From 2000 to 2002, compared with 1988-1990, pneumonia hospitalizations rose 20%-25% among those aged 65-74 years and 75-84 years. The hospitalization rate for those aged over 84 years held steady (JAMA 2005;294:2712-9).

Of 9 million deaths among hospitalized patients, 22% were among those with a pneumonia-related hospitalization; the risk of death in these patients was 1.5 times greater than the risk in patients with any of the 10 other most common causes of hospitalization. Additionally, the proportion of comorbid conditions, including chronic cardiac or pulmonary disease and diabetes, increased from 66% during 1988-1990 to 80% during 2000-2002.

An increase in chronic underlying conditions appears to be a contributing factor in pneumonia hospitalizations in older adults; efforts to prevent pneumonia in this population should focus on reducing comorbidity and improving vaccine programs and effectiveness, the researchers said.

Infection Tied to Macular Degeneration

A common infection may trigger the development of neovascular age-related macular degeneration in genetically susceptible individuals.

Dr. Murat Kalayoglu and his colleagues at the Massachusetts Eye and Ear Infirmary at Harvard Medical School, Boston, detected Chlamydia pneumoniae in the ocular tissue of five of nine patients with neovascular age-related macular degeneration (AMD) but in none of 20 people who did not have macular degeneration (Graefes. Arch. Clin. Exp. Ophthalmol. [Epub ahead of print] May 21, 2005. Article DOI: 10.1007/s00417-005-1169-y).

In addition, in vitro studies on human monocyte-derived macrophages and retinal pigment epithelial (RPE) cells showed that infection with C. pneumoniae induced production of vascular endothelial growth factor (VEGF), interleukin-8 (Il-8), and monocyte chemotactic protein 1 (MCP-1). This suggests that C. pneumoniae can alter cell function in ways that may cause neovascular AMD, the authors reported.

“It may be possible to stop or reverse progression of AMD by identifying susceptible patients by diagnostic testing and then treating these susceptible patients,” Dr. Kalayoglu said in a statement.

Intranasal Flu Vaccine Looks Safe

No unexpected serious adverse events were reported with appropriate use of live, attenuated intranasal influenza vaccine in the first two seasons after its U.S. approval.

About 2.5 million people have received the vaccine since June 2003. As of July 2005, 460 adverse events–mostly in the first season, and with no fatalities–were reported to the vaccine adverse event reporting system, said Dr. Hector S. Izurieta of the Food and Drug Administration and his colleagues (JAMA 2005;294:2720-5).

Of the reported events, 217 were respiratory (including 8 cases of asthma exacerbations), 67 were constitutional, 54 were allergic, 33 involved abdominal symptoms, 18 involved ear-nose-throat symptoms, 7 were ocular, 10 were neurologic, 10 were cardiovascular, and 44 were classified as “other.” Fewer than 10% were considered serious, and 16% of events occurred in persons for whom the vaccine was not indicated. Secondary transmission of vaccine virus was reported in 22 cases.

The findings suggest that continued monitoring for neurologic events–such as Guillain-Barré syndrome, reported in two cases–is warranted, as is closer attention to the package insert, given the number of vaccine administration errors and use of the vaccine in persons for whom it is not indicated, the investigators concluded.

West Nile Virus Assay Approved

An assay used to screen blood, organ, cell, and tissue donations for West Nile virus recently has been approved by the Food and Drug Administration.

The Procleix West Nile Virus Assay has been used on an investigational basis to screen more than 29 million units of blood since June 2003. The assay has intercepted more than 1,500 WNV-positive donations that might otherwise have been given to as many as 4,500 people, according to Gen-Probe Inc., which developed the test, and Chiron Corp., which will market the test.

The test detects viral RNA and is approved for use on the Procleix enhanced semiautomated instrument system. Since 2002, when it was first discovered that West Nile Virus could be transmitted via blood, 30 cases of West Nile Virus that were most likely acquired through blood transfusions have been documented, and 9 of the affected patients have died, according to the FDA.

Pneumonia Hospitalization Up for Aged

The burden of pneumonia among U.S. patients aged 65 and older is large and increasing, according to Dr. Alicia M. Fry and her colleagues at the Centers for Disease Control and Prevention, Atlanta.

Among the 173 million people aged over 64 years hospitalized from 1988 through 2002, about 9% had pneumonia as a discharge code, and 6% had pneumonia as a first-listed discharge code. From 2000 to 2002, compared with 1988-1990, pneumonia hospitalizations rose 20%-25% among those aged 65-74 years and 75-84 years. The hospitalization rate for those aged over 84 years held steady (JAMA 2005;294:2712-9).

Of 9 million deaths among hospitalized patients, 22% were among those with a pneumonia-related hospitalization; the risk of death in these patients was 1.5 times greater than the risk in patients with any of the 10 other most common causes of hospitalization. Additionally, the proportion of comorbid conditions, including chronic cardiac or pulmonary disease and diabetes, increased from 66% during 1988-1990 to 80% during 2000-2002.

An increase in chronic underlying conditions appears to be a contributing factor in pneumonia hospitalizations in older adults; efforts to prevent pneumonia in this population should focus on reducing comorbidity and improving vaccine programs and effectiveness, the researchers said.

Infection Tied to Macular Degeneration

A common infection may trigger the development of neovascular age-related macular degeneration in genetically susceptible individuals.

Dr. Murat Kalayoglu and his colleagues at the Massachusetts Eye and Ear Infirmary at Harvard Medical School, Boston, detected Chlamydia pneumoniae in the ocular tissue of five of nine patients with neovascular age-related macular degeneration (AMD) but in none of 20 people who did not have macular degeneration (Graefes. Arch. Clin. Exp. Ophthalmol. [Epub ahead of print] May 21, 2005. Article DOI: 10.1007/s00417-005-1169-y).

In addition, in vitro studies on human monocyte-derived macrophages and retinal pigment epithelial (RPE) cells showed that infection with C. pneumoniae induced production of vascular endothelial growth factor (VEGF), interleukin-8 (Il-8), and monocyte chemotactic protein 1 (MCP-1). This suggests that C. pneumoniae can alter cell function in ways that may cause neovascular AMD, the authors reported.

“It may be possible to stop or reverse progression of AMD by identifying susceptible patients by diagnostic testing and then treating these susceptible patients,” Dr. Kalayoglu said in a statement.

Intranasal Flu Vaccine Looks Safe

No unexpected serious adverse events were reported with appropriate use of live, attenuated intranasal influenza vaccine in the first two seasons after its U.S. approval.

About 2.5 million people have received the vaccine since June 2003. As of July 2005, 460 adverse events–mostly in the first season, and with no fatalities–were reported to the vaccine adverse event reporting system, said Dr. Hector S. Izurieta of the Food and Drug Administration and his colleagues (JAMA 2005;294:2720-5).

Of the reported events, 217 were respiratory (including 8 cases of asthma exacerbations), 67 were constitutional, 54 were allergic, 33 involved abdominal symptoms, 18 involved ear-nose-throat symptoms, 7 were ocular, 10 were neurologic, 10 were cardiovascular, and 44 were classified as “other.” Fewer than 10% were considered serious, and 16% of events occurred in persons for whom the vaccine was not indicated. Secondary transmission of vaccine virus was reported in 22 cases.

The findings suggest that continued monitoring for neurologic events–such as Guillain-Barré syndrome, reported in two cases–is warranted, as is closer attention to the package insert, given the number of vaccine administration errors and use of the vaccine in persons for whom it is not indicated, the investigators concluded.

West Nile Virus Assay Approved

An assay used to screen blood, organ, cell, and tissue donations for West Nile virus recently has been approved by the Food and Drug Administration.

The Procleix West Nile Virus Assay has been used on an investigational basis to screen more than 29 million units of blood since June 2003. The assay has intercepted more than 1,500 WNV-positive donations that might otherwise have been given to as many as 4,500 people, according to Gen-Probe Inc., which developed the test, and Chiron Corp., which will market the test.

The test detects viral RNA and is approved for use on the Procleix enhanced semiautomated instrument system. Since 2002, when it was first discovered that West Nile Virus could be transmitted via blood, 30 cases of West Nile Virus that were most likely acquired through blood transfusions have been documented, and 9 of the affected patients have died, according to the FDA.

Pneumonia Hospitalization Up for Aged

The burden of pneumonia among U.S. patients aged 65 and older is large and increasing, according to Dr. Alicia M. Fry and her colleagues at the Centers for Disease Control and Prevention, Atlanta.

Among the 173 million people aged over 64 years hospitalized from 1988 through 2002, about 9% had pneumonia as a discharge code, and 6% had pneumonia as a first-listed discharge code. From 2000 to 2002, compared with 1988-1990, pneumonia hospitalizations rose 20%-25% among those aged 65-74 years and 75-84 years. The hospitalization rate for those aged over 84 years held steady (JAMA 2005;294:2712-9).

Of 9 million deaths among hospitalized patients, 22% were among those with a pneumonia-related hospitalization; the risk of death in these patients was 1.5 times greater than the risk in patients with any of the 10 other most common causes of hospitalization. Additionally, the proportion of comorbid conditions, including chronic cardiac or pulmonary disease and diabetes, increased from 66% during 1988-1990 to 80% during 2000-2002.

An increase in chronic underlying conditions appears to be a contributing factor in pneumonia hospitalizations in older adults; efforts to prevent pneumonia in this population should focus on reducing comorbidity and improving vaccine programs and effectiveness, the researchers said.

Infection Tied to Macular Degeneration

A common infection may trigger the development of neovascular age-related macular degeneration in genetically susceptible individuals.

Dr. Murat Kalayoglu and his colleagues at the Massachusetts Eye and Ear Infirmary at Harvard Medical School, Boston, detected Chlamydia pneumoniae in the ocular tissue of five of nine patients with neovascular age-related macular degeneration (AMD) but in none of 20 people who did not have macular degeneration (Graefes. Arch. Clin. Exp. Ophthalmol. [Epub ahead of print] May 21, 2005. Article DOI: 10.1007/s00417-005-1169-y).

In addition, in vitro studies on human monocyte-derived macrophages and retinal pigment epithelial (RPE) cells showed that infection with C. pneumoniae induced production of vascular endothelial growth factor (VEGF), interleukin-8 (Il-8), and monocyte chemotactic protein 1 (MCP-1). This suggests that C. pneumoniae can alter cell function in ways that may cause neovascular AMD, the authors reported.

“It may be possible to stop or reverse progression of AMD by identifying susceptible patients by diagnostic testing and then treating these susceptible patients,” Dr. Kalayoglu said in a statement.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene, M.D., of Kaunas University of Medicine, Kaunas, Lithuania, and colleagues found that 8–10 mg/kg daily of ursodeoxycholic acid (UDCA) outperformed 8 g daily of cholestyramine in reducing the pruritus that characterizes intrahepatic cholestasis.

Pruritus scores were reduced by 67% with UDCA and 19% with cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for intrahepatic cholestasis, the researchers stated (Gastroenterology 2005;129:894–901).

Intimate-Partner Violence Missed in ED

Physicians may be failing to identify victims of intimate-partner violence when they present to the emergency department, according to a study of cases brought to the prosecuting attorney in one county.

Karin Rhodes, M.D., of the department of emergency medicine at the University of Chicago and her colleague identified 964 women who were listed as victims of intimate partner violence (IPV) in cases brought to the prosecuting attorney of Kalamazoo County, Mich., during 2000.

Of these 964 women, 82% had been seen by at least one of eight EDs in the county in 1999–2001; they averaged 5.7 ED visits in that period, Dr. Rhodes reported in a poster at the annual meeting of the Society for Academic Emergency Medicine.

Even though 60% had injuries on police records, Dr. Rhodes and her associate found in a chart review that only 5.8% of the victims had a visit to an ED during 1999–2001 that corresponded to the IPV assault. The other victims either screened negative for IPV during ED visits (24.4%) or were not screened for IPV (69.8%).

Who Undergoes Carrier Status Testing?

Patients referred for genetic testing are more likely to agree to carrier status testing if they already have accepted an invasive procedure.

A study of 3,131 patients referred for genetic testing found that individuals were more likely to accept cystic fibrosis (CF) carrier testing and were more likely to accept both CF and fragile X syndrome (FXS) carrier testing if they underwent an invasive procedure such as amniocentesis.

“Patients who underwent such a procedure were more than twice as likely to accept both screening tests, compared with patients who had declined invasive testing,” said Amy Cronister, the study's lead author and regional manager of genetic services, Genzyme Genetics, Phoenix, Ariz.

Overall, 33% of referrals agreed to carrier status testing for CF and 28% for FXS; 25% accepted CF and FXS testing; and 64% declined both. Significantly fewer (11%) accepted one test but declined the other.

The study included patients referred for prenatal genetic counseling during a 22-month period because of maternal age, positive maternal serum screening, chemical exposure, or parental anxiety. The patients were offered both CF and FXS carrier testing on the basis of population screening only.

Because they would be more likely than the general population to accept CF and FSX screening, patients with a known or suggestive family history of either disease were excluded. Additionally, because CF risk is linked to ethnicity, only patients of white and Ashkenazi Jewish backgrounds, for whom the risk of being a CF carrier is 1 in 25 people, were included.

Oral Tocolysis Prolongs Pregnancy

While many physicians commonly use oral tocolysis maintenance after intravenous tocolysis in patients with preterm labor because they have a clinical impression of its effectiveness, solid evidence for this practice has been lacking until recently, according to Perkin Stang, M.D., of Wayne State University, Detroit, and colleagues.

Their population-based historical cohort study suggests that patients who are not maintained on oral tocolysis are more than twice as likely to deliver prematurely as are those who do receive oral maintenance, the investigators reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Investigators compared 4,936 women who received oral maintenance tocolysis with a β-sympathomimetic agent to 4,536 who did not receive oral tocolysis, from a perinatal database in the state of Schleswig-Holstein, Germany. Women with premature rupture of membranes and medically indicated inductions before 37 weeks of gestation were excluded from the analysis.

In the oral tocolysis group, 366 patients (7%) delivered prematurely versus 1,094 patients (24%) in the control group.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene, M.D., of Kaunas University of Medicine, Kaunas, Lithuania, and colleagues found that 8–10 mg/kg daily of ursodeoxycholic acid (UDCA) outperformed 8 g daily of cholestyramine in reducing the pruritus that characterizes intrahepatic cholestasis.

Pruritus scores were reduced by 67% with UDCA and 19% with cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for intrahepatic cholestasis, the researchers stated (Gastroenterology 2005;129:894–901).

Intimate-Partner Violence Missed in ED

Physicians may be failing to identify victims of intimate-partner violence when they present to the emergency department, according to a study of cases brought to the prosecuting attorney in one county.

Karin Rhodes, M.D., of the department of emergency medicine at the University of Chicago and her colleague identified 964 women who were listed as victims of intimate partner violence (IPV) in cases brought to the prosecuting attorney of Kalamazoo County, Mich., during 2000.

Of these 964 women, 82% had been seen by at least one of eight EDs in the county in 1999–2001; they averaged 5.7 ED visits in that period, Dr. Rhodes reported in a poster at the annual meeting of the Society for Academic Emergency Medicine.

Even though 60% had injuries on police records, Dr. Rhodes and her associate found in a chart review that only 5.8% of the victims had a visit to an ED during 1999–2001 that corresponded to the IPV assault. The other victims either screened negative for IPV during ED visits (24.4%) or were not screened for IPV (69.8%).

Who Undergoes Carrier Status Testing?

Patients referred for genetic testing are more likely to agree to carrier status testing if they already have accepted an invasive procedure.

A study of 3,131 patients referred for genetic testing found that individuals were more likely to accept cystic fibrosis (CF) carrier testing and were more likely to accept both CF and fragile X syndrome (FXS) carrier testing if they underwent an invasive procedure such as amniocentesis.

“Patients who underwent such a procedure were more than twice as likely to accept both screening tests, compared with patients who had declined invasive testing,” said Amy Cronister, the study's lead author and regional manager of genetic services, Genzyme Genetics, Phoenix, Ariz.

Overall, 33% of referrals agreed to carrier status testing for CF and 28% for FXS; 25% accepted CF and FXS testing; and 64% declined both. Significantly fewer (11%) accepted one test but declined the other.

The study included patients referred for prenatal genetic counseling during a 22-month period because of maternal age, positive maternal serum screening, chemical exposure, or parental anxiety. The patients were offered both CF and FXS carrier testing on the basis of population screening only.

Because they would be more likely than the general population to accept CF and FSX screening, patients with a known or suggestive family history of either disease were excluded. Additionally, because CF risk is linked to ethnicity, only patients of white and Ashkenazi Jewish backgrounds, for whom the risk of being a CF carrier is 1 in 25 people, were included.

Oral Tocolysis Prolongs Pregnancy

While many physicians commonly use oral tocolysis maintenance after intravenous tocolysis in patients with preterm labor because they have a clinical impression of its effectiveness, solid evidence for this practice has been lacking until recently, according to Perkin Stang, M.D., of Wayne State University, Detroit, and colleagues.

Their population-based historical cohort study suggests that patients who are not maintained on oral tocolysis are more than twice as likely to deliver prematurely as are those who do receive oral maintenance, the investigators reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Investigators compared 4,936 women who received oral maintenance tocolysis with a β-sympathomimetic agent to 4,536 who did not receive oral tocolysis, from a perinatal database in the state of Schleswig-Holstein, Germany. Women with premature rupture of membranes and medically indicated inductions before 37 weeks of gestation were excluded from the analysis.

In the oral tocolysis group, 366 patients (7%) delivered prematurely versus 1,094 patients (24%) in the control group.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene, M.D., of Kaunas University of Medicine, Kaunas, Lithuania, and colleagues found that 8–10 mg/kg daily of ursodeoxycholic acid (UDCA) outperformed 8 g daily of cholestyramine in reducing the pruritus that characterizes intrahepatic cholestasis.

Pruritus scores were reduced by 67% with UDCA and 19% with cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for intrahepatic cholestasis, the researchers stated (Gastroenterology 2005;129:894–901).

Intimate-Partner Violence Missed in ED

Physicians may be failing to identify victims of intimate-partner violence when they present to the emergency department, according to a study of cases brought to the prosecuting attorney in one county.

Karin Rhodes, M.D., of the department of emergency medicine at the University of Chicago and her colleague identified 964 women who were listed as victims of intimate partner violence (IPV) in cases brought to the prosecuting attorney of Kalamazoo County, Mich., during 2000.

Of these 964 women, 82% had been seen by at least one of eight EDs in the county in 1999–2001; they averaged 5.7 ED visits in that period, Dr. Rhodes reported in a poster at the annual meeting of the Society for Academic Emergency Medicine.

Even though 60% had injuries on police records, Dr. Rhodes and her associate found in a chart review that only 5.8% of the victims had a visit to an ED during 1999–2001 that corresponded to the IPV assault. The other victims either screened negative for IPV during ED visits (24.4%) or were not screened for IPV (69.8%).

Who Undergoes Carrier Status Testing?

Patients referred for genetic testing are more likely to agree to carrier status testing if they already have accepted an invasive procedure.

A study of 3,131 patients referred for genetic testing found that individuals were more likely to accept cystic fibrosis (CF) carrier testing and were more likely to accept both CF and fragile X syndrome (FXS) carrier testing if they underwent an invasive procedure such as amniocentesis.

“Patients who underwent such a procedure were more than twice as likely to accept both screening tests, compared with patients who had declined invasive testing,” said Amy Cronister, the study's lead author and regional manager of genetic services, Genzyme Genetics, Phoenix, Ariz.

Overall, 33% of referrals agreed to carrier status testing for CF and 28% for FXS; 25% accepted CF and FXS testing; and 64% declined both. Significantly fewer (11%) accepted one test but declined the other.

The study included patients referred for prenatal genetic counseling during a 22-month period because of maternal age, positive maternal serum screening, chemical exposure, or parental anxiety. The patients were offered both CF and FXS carrier testing on the basis of population screening only.

Because they would be more likely than the general population to accept CF and FSX screening, patients with a known or suggestive family history of either disease were excluded. Additionally, because CF risk is linked to ethnicity, only patients of white and Ashkenazi Jewish backgrounds, for whom the risk of being a CF carrier is 1 in 25 people, were included.

Oral Tocolysis Prolongs Pregnancy

While many physicians commonly use oral tocolysis maintenance after intravenous tocolysis in patients with preterm labor because they have a clinical impression of its effectiveness, solid evidence for this practice has been lacking until recently, according to Perkin Stang, M.D., of Wayne State University, Detroit, and colleagues.

Their population-based historical cohort study suggests that patients who are not maintained on oral tocolysis are more than twice as likely to deliver prematurely as are those who do receive oral maintenance, the investigators reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Investigators compared 4,936 women who received oral maintenance tocolysis with a β-sympathomimetic agent to 4,536 who did not receive oral tocolysis, from a perinatal database in the state of Schleswig-Holstein, Germany. Women with premature rupture of membranes and medically indicated inductions before 37 weeks of gestation were excluded from the analysis.

In the oral tocolysis group, 366 patients (7%) delivered prematurely versus 1,094 patients (24%) in the control group.

Norovirus Locates Katrina Evacuees

An outbreak of norovirus occurred from Sept. 2–12, 2005, among evacuees from Hurricane Katrina who were temporarily sheltered at Reliant Park, a recreation and convention complex in Houston.

During this period, approximately 6,500 of an estimated 24,000 evacuees visited the Reliant Park medical clinic, and 1,169 (18%) reported symptoms of acute gastroenteritis; one-quarter were under 18 years. The peak occurred on Sept. 5, when 211 people reported acute GI symptoms.

During peak days of the outbreak, approximately 40% of pediatric visits and 21% of adult visits to the clinic were related to acute gastroenteritis, according to a report from the Centers for Disease Control and Prevention in Atlanta (MMWR 2005;54:1016–8).

Samples from 44 patients were tested, and 22 (50%) of these yielded norovirus.

Overall, 511 (44%) of those who reported acute symptoms had diarrhea only, while 342 (29%) reported vomiting, and 316 (27%) reported both vomiting and diarrhea.

Local health authorities implemented preventive measures at the start of the outbreak. Despite this, the outbreak continued for at least a week but subsided before the evacuees left the temporary facility.

HPV Transmits Nonsexually

Anogenital warts in children with human papillomavirus were less predictive of sexual abuse with decreasing age, based on a review of 124 children younger than 13 years with anogenital and respiratory tract human papilloma virus (HPV) infections, said Kelly A. Sinclair, M.D., formerly of Wake Forest University, Winston-Salem, N.C., and her colleagues.

Of these, 55 children with anogenital warts were evaluated at a childhood sexual abuse clinic, and 17 (31%) were considered to have been abused.

Children younger than 4 years were 3 times less likely to have been sexually abused than those aged 4–8 years, and those younger than 4 years were 12 times less likely to have been abused than those older than 8 years.

These findings challenge the notion that 24 months of age is the upper limit for perinatal transmission of anogenital warts.

None of the 49 children evaluated for laryngeal or oral lesions were considered to have been sexually abused, and the onset of illness peaked between ages 2–5 years.

Since the majority of preadolescent anogenital HPV cases are older than 2 years, the use of 2 years as a cutoff to declare sexual abuse as the cause of infection could subject innocent families to unnecessary scrutiny, said Dr. Sinclair, currently at Children's Mercy Hospital, Kansas City, Mo., and her associates.

Thermometers Recalled

Omron Healthcare is voluntarily recalling certain 3-Way instant thermometers due to a potential problem that can cause the thermometer tip to overheat.

The recall applies to model numbers MC-600 and MC-600CAN. The recall was prompted by a limited number of consumer complaints indicating discomfort during and following use of the thermometers. None of the reports have involved serious injury.

Continued use of the affected thermometers may result in discomfort during use, possibly even redness or a blister on the skin. Very young children are at increased risk due to the inability to express themselves and their difficulty in pulling away from a thermometer held by an adult.

The thermometers were sold in the United States and Canada from Sept. 19, 2001, to Oct. 21, 2005. The potentially affected products have lot numbers beginning with 01–32, 01–36, 01–37, and 01–38. Lot numbers are located inside the battery compartment of the thermometers.

The company is requesting that consumers discontinue use of the affected thermometers and call 800-634-4350 for information about how to return the devices and receive a refund or exchange for a different thermometer model. Information can also be found on the company's Web site,

www.omronhealthcare.com

Smoking Stunts Girls' Growth

Persistent cigarette smoking retards physical growth in early adolescence, based on data from a 3-year follow-up study of 496 girls aged 11–15 years, said Eric Stice, Ph.D., and Erin E. Martinez, of the University of Texas at Austin.

Persistent smoking—defined as daily smoking between baseline and at 1-year follow-up or between 1-year and 2-year follow-up—was associated with a reduction of 34% in height, 53% in weight, and 71% in BMI during a 1-year interval compared with nonsmokers (J. Adolesc. Health 2005;37:363–70).

In addition, smoking initiation during adolescence was associated with a 36% reduction in weight gain and a 68% reduction in BMI but not with significant changes in height, compared with nonsmokers.

Norovirus Locates Katrina Evacuees

An outbreak of norovirus occurred from Sept. 2–12, 2005, among evacuees from Hurricane Katrina who were temporarily sheltered at Reliant Park, a recreation and convention complex in Houston.

During this period, approximately 6,500 of an estimated 24,000 evacuees visited the Reliant Park medical clinic, and 1,169 (18%) reported symptoms of acute gastroenteritis; one-quarter were under 18 years. The peak occurred on Sept. 5, when 211 people reported acute GI symptoms.

During peak days of the outbreak, approximately 40% of pediatric visits and 21% of adult visits to the clinic were related to acute gastroenteritis, according to a report from the Centers for Disease Control and Prevention in Atlanta (MMWR 2005;54:1016–8).

Samples from 44 patients were tested, and 22 (50%) of these yielded norovirus.

Overall, 511 (44%) of those who reported acute symptoms had diarrhea only, while 342 (29%) reported vomiting, and 316 (27%) reported both vomiting and diarrhea.

Local health authorities implemented preventive measures at the start of the outbreak. Despite this, the outbreak continued for at least a week but subsided before the evacuees left the temporary facility.

HPV Transmits Nonsexually

Anogenital warts in children with human papillomavirus were less predictive of sexual abuse with decreasing age, based on a review of 124 children younger than 13 years with anogenital and respiratory tract human papilloma virus (HPV) infections, said Kelly A. Sinclair, M.D., formerly of Wake Forest University, Winston-Salem, N.C., and her colleagues.

Of these, 55 children with anogenital warts were evaluated at a childhood sexual abuse clinic, and 17 (31%) were considered to have been abused.

Children younger than 4 years were 3 times less likely to have been sexually abused than those aged 4–8 years, and those younger than 4 years were 12 times less likely to have been abused than those older than 8 years.

These findings challenge the notion that 24 months of age is the upper limit for perinatal transmission of anogenital warts.

None of the 49 children evaluated for laryngeal or oral lesions were considered to have been sexually abused, and the onset of illness peaked between ages 2–5 years.

Since the majority of preadolescent anogenital HPV cases are older than 2 years, the use of 2 years as a cutoff to declare sexual abuse as the cause of infection could subject innocent families to unnecessary scrutiny, said Dr. Sinclair, currently at Children's Mercy Hospital, Kansas City, Mo., and her associates.

Thermometers Recalled

Omron Healthcare is voluntarily recalling certain 3-Way instant thermometers due to a potential problem that can cause the thermometer tip to overheat.

The recall applies to model numbers MC-600 and MC-600CAN. The recall was prompted by a limited number of consumer complaints indicating discomfort during and following use of the thermometers. None of the reports have involved serious injury.

Continued use of the affected thermometers may result in discomfort during use, possibly even redness or a blister on the skin. Very young children are at increased risk due to the inability to express themselves and their difficulty in pulling away from a thermometer held by an adult.

The thermometers were sold in the United States and Canada from Sept. 19, 2001, to Oct. 21, 2005. The potentially affected products have lot numbers beginning with 01–32, 01–36, 01–37, and 01–38. Lot numbers are located inside the battery compartment of the thermometers.

The company is requesting that consumers discontinue use of the affected thermometers and call 800-634-4350 for information about how to return the devices and receive a refund or exchange for a different thermometer model. Information can also be found on the company's Web site,

www.omronhealthcare.com

Smoking Stunts Girls' Growth

Persistent cigarette smoking retards physical growth in early adolescence, based on data from a 3-year follow-up study of 496 girls aged 11–15 years, said Eric Stice, Ph.D., and Erin E. Martinez, of the University of Texas at Austin.

Persistent smoking—defined as daily smoking between baseline and at 1-year follow-up or between 1-year and 2-year follow-up—was associated with a reduction of 34% in height, 53% in weight, and 71% in BMI during a 1-year interval compared with nonsmokers (J. Adolesc. Health 2005;37:363–70).

In addition, smoking initiation during adolescence was associated with a 36% reduction in weight gain and a 68% reduction in BMI but not with significant changes in height, compared with nonsmokers.

Norovirus Locates Katrina Evacuees

An outbreak of norovirus occurred from Sept. 2–12, 2005, among evacuees from Hurricane Katrina who were temporarily sheltered at Reliant Park, a recreation and convention complex in Houston.

During this period, approximately 6,500 of an estimated 24,000 evacuees visited the Reliant Park medical clinic, and 1,169 (18%) reported symptoms of acute gastroenteritis; one-quarter were under 18 years. The peak occurred on Sept. 5, when 211 people reported acute GI symptoms.

During peak days of the outbreak, approximately 40% of pediatric visits and 21% of adult visits to the clinic were related to acute gastroenteritis, according to a report from the Centers for Disease Control and Prevention in Atlanta (MMWR 2005;54:1016–8).

Samples from 44 patients were tested, and 22 (50%) of these yielded norovirus.

Overall, 511 (44%) of those who reported acute symptoms had diarrhea only, while 342 (29%) reported vomiting, and 316 (27%) reported both vomiting and diarrhea.

Local health authorities implemented preventive measures at the start of the outbreak. Despite this, the outbreak continued for at least a week but subsided before the evacuees left the temporary facility.

HPV Transmits Nonsexually

Anogenital warts in children with human papillomavirus were less predictive of sexual abuse with decreasing age, based on a review of 124 children younger than 13 years with anogenital and respiratory tract human papilloma virus (HPV) infections, said Kelly A. Sinclair, M.D., formerly of Wake Forest University, Winston-Salem, N.C., and her colleagues.

Of these, 55 children with anogenital warts were evaluated at a childhood sexual abuse clinic, and 17 (31%) were considered to have been abused.

Children younger than 4 years were 3 times less likely to have been sexually abused than those aged 4–8 years, and those younger than 4 years were 12 times less likely to have been abused than those older than 8 years.

These findings challenge the notion that 24 months of age is the upper limit for perinatal transmission of anogenital warts.

None of the 49 children evaluated for laryngeal or oral lesions were considered to have been sexually abused, and the onset of illness peaked between ages 2–5 years.

Since the majority of preadolescent anogenital HPV cases are older than 2 years, the use of 2 years as a cutoff to declare sexual abuse as the cause of infection could subject innocent families to unnecessary scrutiny, said Dr. Sinclair, currently at Children's Mercy Hospital, Kansas City, Mo., and her associates.

Thermometers Recalled

Omron Healthcare is voluntarily recalling certain 3-Way instant thermometers due to a potential problem that can cause the thermometer tip to overheat.

The recall applies to model numbers MC-600 and MC-600CAN. The recall was prompted by a limited number of consumer complaints indicating discomfort during and following use of the thermometers. None of the reports have involved serious injury.

Continued use of the affected thermometers may result in discomfort during use, possibly even redness or a blister on the skin. Very young children are at increased risk due to the inability to express themselves and their difficulty in pulling away from a thermometer held by an adult.

The thermometers were sold in the United States and Canada from Sept. 19, 2001, to Oct. 21, 2005. The potentially affected products have lot numbers beginning with 01–32, 01–36, 01–37, and 01–38. Lot numbers are located inside the battery compartment of the thermometers.

The company is requesting that consumers discontinue use of the affected thermometers and call 800-634-4350 for information about how to return the devices and receive a refund or exchange for a different thermometer model. Information can also be found on the company's Web site,

www.omronhealthcare.com

Smoking Stunts Girls' Growth

Persistent cigarette smoking retards physical growth in early adolescence, based on data from a 3-year follow-up study of 496 girls aged 11–15 years, said Eric Stice, Ph.D., and Erin E. Martinez, of the University of Texas at Austin.

Persistent smoking—defined as daily smoking between baseline and at 1-year follow-up or between 1-year and 2-year follow-up—was associated with a reduction of 34% in height, 53% in weight, and 71% in BMI during a 1-year interval compared with nonsmokers (J. Adolesc. Health 2005;37:363–70).

In addition, smoking initiation during adolescence was associated with a 36% reduction in weight gain and a 68% reduction in BMI but not with significant changes in height, compared with nonsmokers.

Liver Tumors From Breast Cancer

The liver is a common site of breast cancer metastases, and surgically aggressive approaches—which can include resection, radiofrequency ablation, or a combination of the two—appear to provide a survival benefit, according to Steven Curley, M.D.

Depending on the location of the tumor, resection can be difficult. Radiofrequency ablation (RFA), by itself or along with resection, has been used as a successful alternative to resection alone for these difficult tumors, said Dr. Curley of M.D. Anderson Cancer Center, Houston.

A review of M.D. Anderson cases showed that of nearly 1,400 patients treated for liver cancers, only 362 patients had noncolorectal metastases, and of these, 62 (17%) had breast cancer metastases, he said.

Of the 62 patients with breast cancer metastases, 41 underwent resection only, 11 underwent RFA only, and 10 had combined resection and RFA. At a median follow-up of 30 months, 27 patients were alive with no evidence of disease, and of 35 with recurrent disease, 10 had died. The actuarial overall survival rate was 47%.

Pregnancy GBS Screening Disparities

Hispanic women and those who received prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists jointly recommended universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation.

The same year, the CDC began analyzing GBS screening rates in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population- based monthly mail/telephone survey of randomly selected women in the state who had recently given birth to a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005;54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department (versus private physician/HMO), and lack of prenatal HIV testing.

Obesity Linked to Infant Clefts

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, Swedish investigators reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” they said.

Another possible explanation could be deficient folic acid intake in early pregnancy, wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

The investigators examined the association between maternal body mass index and orofacial clefting in almost 1 million infants born in Sweden from 1992 to 2001. Women with a body mass index of at least 29 kg/m2 were considered obese.

A total of 1,686 infants were born with orofacial clefts.

Compared with infants born of normal-weight mothers, infants of obese mothers had a 28% higher risk for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, compared with those treated with cholestyramine, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas (Lithuania) University of Medicine and colleagues found that ursodeoxycholic acid (UDCA; 8–10 mg/kg body weight daily) outperformed cholestyramine (8 g daily) in reducing the pruritus that characterizes ICP (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 66.6% and 19.0%, respectively, with UDCA and cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after treatment with UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for ICP, the researchers stated.

Liver Tumors From Breast Cancer

The liver is a common site of breast cancer metastases, and surgically aggressive approaches—which can include resection, radiofrequency ablation, or a combination of the two—appear to provide a survival benefit, according to Steven Curley, M.D.

Depending on the location of the tumor, resection can be difficult. Radiofrequency ablation (RFA), by itself or along with resection, has been used as a successful alternative to resection alone for these difficult tumors, said Dr. Curley of M.D. Anderson Cancer Center, Houston.

A review of M.D. Anderson cases showed that of nearly 1,400 patients treated for liver cancers, only 362 patients had noncolorectal metastases, and of these, 62 (17%) had breast cancer metastases, he said.

Of the 62 patients with breast cancer metastases, 41 underwent resection only, 11 underwent RFA only, and 10 had combined resection and RFA. At a median follow-up of 30 months, 27 patients were alive with no evidence of disease, and of 35 with recurrent disease, 10 had died. The actuarial overall survival rate was 47%.

Pregnancy GBS Screening Disparities

Hispanic women and those who received prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists jointly recommended universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation.

The same year, the CDC began analyzing GBS screening rates in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population- based monthly mail/telephone survey of randomly selected women in the state who had recently given birth to a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005;54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department (versus private physician/HMO), and lack of prenatal HIV testing.

Obesity Linked to Infant Clefts

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, Swedish investigators reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” they said.

Another possible explanation could be deficient folic acid intake in early pregnancy, wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

The investigators examined the association between maternal body mass index and orofacial clefting in almost 1 million infants born in Sweden from 1992 to 2001. Women with a body mass index of at least 29 kg/m2 were considered obese.

A total of 1,686 infants were born with orofacial clefts.

Compared with infants born of normal-weight mothers, infants of obese mothers had a 28% higher risk for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, compared with those treated with cholestyramine, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas (Lithuania) University of Medicine and colleagues found that ursodeoxycholic acid (UDCA; 8–10 mg/kg body weight daily) outperformed cholestyramine (8 g daily) in reducing the pruritus that characterizes ICP (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 66.6% and 19.0%, respectively, with UDCA and cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after treatment with UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for ICP, the researchers stated.

Liver Tumors From Breast Cancer

The liver is a common site of breast cancer metastases, and surgically aggressive approaches—which can include resection, radiofrequency ablation, or a combination of the two—appear to provide a survival benefit, according to Steven Curley, M.D.

Depending on the location of the tumor, resection can be difficult. Radiofrequency ablation (RFA), by itself or along with resection, has been used as a successful alternative to resection alone for these difficult tumors, said Dr. Curley of M.D. Anderson Cancer Center, Houston.

A review of M.D. Anderson cases showed that of nearly 1,400 patients treated for liver cancers, only 362 patients had noncolorectal metastases, and of these, 62 (17%) had breast cancer metastases, he said.

Of the 62 patients with breast cancer metastases, 41 underwent resection only, 11 underwent RFA only, and 10 had combined resection and RFA. At a median follow-up of 30 months, 27 patients were alive with no evidence of disease, and of 35 with recurrent disease, 10 had died. The actuarial overall survival rate was 47%.

Pregnancy GBS Screening Disparities

Hispanic women and those who received prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists jointly recommended universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation.

The same year, the CDC began analyzing GBS screening rates in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population- based monthly mail/telephone survey of randomly selected women in the state who had recently given birth to a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005;54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department (versus private physician/HMO), and lack of prenatal HIV testing.

Obesity Linked to Infant Clefts

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, Swedish investigators reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” they said.

Another possible explanation could be deficient folic acid intake in early pregnancy, wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

The investigators examined the association between maternal body mass index and orofacial clefting in almost 1 million infants born in Sweden from 1992 to 2001. Women with a body mass index of at least 29 kg/m2 were considered obese.

A total of 1,686 infants were born with orofacial clefts.

Compared with infants born of normal-weight mothers, infants of obese mothers had a 28% higher risk for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, compared with those treated with cholestyramine, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas (Lithuania) University of Medicine and colleagues found that ursodeoxycholic acid (UDCA; 8–10 mg/kg body weight daily) outperformed cholestyramine (8 g daily) in reducing the pruritus that characterizes ICP (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 66.6% and 19.0%, respectively, with UDCA and cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after treatment with UDCA, but by only 21.4% each after cholestyramine.

The study results confirm that UDCA should be used as first-line therapy for ICP, the researchers stated.

Child Transmits MSSA to Doctor

A 4-month-old boy with fatal pneumonia transmitted Panton-Valentine leukocidin-producing Staphylococcus aureus to a physician who had attempted resuscitation.

This represents the first reported incident of Panton-Valentine leukocidin-producing S. aureus transmission during resuscitation, said Martin Chalumeau, M.D., of the Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris, and colleagues (Clin. Infect. Dis. 2005;41:e29–30).

The child had presented with 3 days of coughing and 1 day of fever, with normal chest radiography, but had developed progressive respiratory failure within 12 hours after hospital admission.

The resuscitation occurred in the general pediatric ward, when the child went into cardiac arrest while being examined by a physician. Necroscopy results revealed right lobar pneumonia, a necrotizing hemorrhage of the right lung and half of the left lung, and a tracheal aspirate culture that yielded methicillin-susceptible S. aureus (MSSA).

Five days after the incident, the physician who had performed the oral intubation developed furuncles on the fingers and face. MSSA was found in cultures from the physician's skin lesions, and in cultures collected from 5 of the 15 health care workers involved in the resuscitation.

The presence of Panton-Valentine leukocidin, a cytotoxin associated with tissue necrosis and leukocyte destruction, was confirmed in the child and the infected physician, but not in the other health care workers. None of the health care personnel involved in the resuscitation efforts was wearing a face mask or gloves.

Varicella Hospitalizations Down 88%

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “the declines reflect the reduced force of varicella infection in the population (i.e., herd immunity), as do declining rates among adults” and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou of the Centers for Disease Control and Prevention examined varicella treatment codes from a national health plan database of about 4 million consumers, from 1994 to 2002 and found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants, 91% for children aged 9 years and younger, 92% for children aged 10–19 years, and 78% for adults aged 20–49 years. Ambulatory visits also decreased significantly, declining 59% over the period. Again, the decrease was most apparent among infants (90%). The rate declined 63% for children aged 9 years and younger, 42% for those aged 10–19 years, and 60% for adults aged 20–49 years.

National spending on varicella hospitalizations and ambulatory visits declined from $85 million in 1994 and 1995 to $22 million in 2002, a 74% decrease.

Child Transmits MSSA to Doctor

A 4-month-old boy with fatal pneumonia transmitted Panton-Valentine leukocidin-producing Staphylococcus aureus to a physician who had attempted resuscitation.

This represents the first reported incident of Panton-Valentine leukocidin-producing S. aureus transmission during resuscitation, said Martin Chalumeau, M.D., of the Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris, and colleagues (Clin. Infect. Dis. 2005;41:e29–30).

The child had presented with 3 days of coughing and 1 day of fever, with normal chest radiography, but had developed progressive respiratory failure within 12 hours after hospital admission.

The resuscitation occurred in the general pediatric ward, when the child went into cardiac arrest while being examined by a physician. Necroscopy results revealed right lobar pneumonia, a necrotizing hemorrhage of the right lung and half of the left lung, and a tracheal aspirate culture that yielded methicillin-susceptible S. aureus (MSSA).

Five days after the incident, the physician who had performed the oral intubation developed furuncles on the fingers and face. MSSA was found in cultures from the physician's skin lesions, and in cultures collected from 5 of the 15 health care workers involved in the resuscitation.

The presence of Panton-Valentine leukocidin, a cytotoxin associated with tissue necrosis and leukocyte destruction, was confirmed in the child and the infected physician, but not in the other health care workers. None of the health care personnel involved in the resuscitation efforts was wearing a face mask or gloves.

Varicella Hospitalizations Down 88%

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “the declines reflect the reduced force of varicella infection in the population (i.e., herd immunity), as do declining rates among adults” and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou of the Centers for Disease Control and Prevention examined varicella treatment codes from a national health plan database of about 4 million consumers, from 1994 to 2002 and found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants, 91% for children aged 9 years and younger, 92% for children aged 10–19 years, and 78% for adults aged 20–49 years. Ambulatory visits also decreased significantly, declining 59% over the period. Again, the decrease was most apparent among infants (90%). The rate declined 63% for children aged 9 years and younger, 42% for those aged 10–19 years, and 60% for adults aged 20–49 years.

National spending on varicella hospitalizations and ambulatory visits declined from $85 million in 1994 and 1995 to $22 million in 2002, a 74% decrease.

Child Transmits MSSA to Doctor

A 4-month-old boy with fatal pneumonia transmitted Panton-Valentine leukocidin-producing Staphylococcus aureus to a physician who had attempted resuscitation.

This represents the first reported incident of Panton-Valentine leukocidin-producing S. aureus transmission during resuscitation, said Martin Chalumeau, M.D., of the Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris, and colleagues (Clin. Infect. Dis. 2005;41:e29–30).

The child had presented with 3 days of coughing and 1 day of fever, with normal chest radiography, but had developed progressive respiratory failure within 12 hours after hospital admission.

The resuscitation occurred in the general pediatric ward, when the child went into cardiac arrest while being examined by a physician. Necroscopy results revealed right lobar pneumonia, a necrotizing hemorrhage of the right lung and half of the left lung, and a tracheal aspirate culture that yielded methicillin-susceptible S. aureus (MSSA).

Five days after the incident, the physician who had performed the oral intubation developed furuncles on the fingers and face. MSSA was found in cultures from the physician's skin lesions, and in cultures collected from 5 of the 15 health care workers involved in the resuscitation.

The presence of Panton-Valentine leukocidin, a cytotoxin associated with tissue necrosis and leukocyte destruction, was confirmed in the child and the infected physician, but not in the other health care workers. None of the health care personnel involved in the resuscitation efforts was wearing a face mask or gloves.

Varicella Hospitalizations Down 88%

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “the declines reflect the reduced force of varicella infection in the population (i.e., herd immunity), as do declining rates among adults” and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou of the Centers for Disease Control and Prevention examined varicella treatment codes from a national health plan database of about 4 million consumers, from 1994 to 2002 and found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants, 91% for children aged 9 years and younger, 92% for children aged 10–19 years, and 78% for adults aged 20–49 years. Ambulatory visits also decreased significantly, declining 59% over the period. Again, the decrease was most apparent among infants (90%). The rate declined 63% for children aged 9 years and younger, 42% for those aged 10–19 years, and 60% for adults aged 20–49 years.

National spending on varicella hospitalizations and ambulatory visits declined from $85 million in 1994 and 1995 to $22 million in 2002, a 74% decrease.

Teens' PMS Mirrors Adult Women's

Premenstrual syndrome is common in adolescents, and symptoms are similar to those reported by women, a study suggests.

The findings debunk the “commonly accepted belief that adolescents suffer mostly from dysmenorrhea, and older women suffer mostly from PMS,” Michelle D. Vichnin, M.D., said.

A total of 94 girls aged 13–18 years took part in the 6-month study during which they completed the Daily Symptom Report (DSR), a validated tool for measuring 17 PMS symptoms in women.

A total of 31% had self-reported and confirmed PMS; 54% had self-reported PMS but did not meet the criteria for confirmed PMS; and 15% had no PMS, Dr. Vichnin reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Confirmed PMS was defined as a self-report of PMS along with a 50% increase in premenstrual vs. postmenstrual DSR scores, said Dr. Vichnin of the University of Pennsylvania, Philadelphia.

The worst symptoms among teens with PMS were mood swings, anxiety, irritability, food cravings, increased appetite, swelling and/or bloating, and cramps. These symptoms are identical to those reported in studies of women with PMS, she noted. As is also true in women, the greatest impact of these symptoms was on the home/family scale, she said.

In this study, older age and family history of PMS were significantly associated with PMS. Oral contraceptive use and dysmenorrhea were not associated with PMS.

Gender and Criminality

Women who have a dual diagnosis of rapid-cycling bipolar disorder and substance abuse/dependence are more at risk for engaging in criminal activity than are women in the general population, though their risk is lower than that of men with a dual diagnosis, reported Susan Hatters Friedman, M.D., of the University Hospitals of Cleveland, and her associates.

In a study of 55 women and 77 men with a dual diagnosis and a comparison group of 18 female and 13 male bipolar patients with no history of substance abuse, 53% of female and 79% of male dual-diagnosis patients reported ever being charged with a crime, while only 17% of women and 8% of men in the comparison group reported a history of criminal charges.

Nearly half of men and women in the dual-diagnosis group reported being incarcerated, with only one woman (6%) from the comparison female group reporting prior incarceration (J. Am. Acad. Psychiatry Law 2005;33:188–95).

Teen Girls React to Parental Rejection

Aggressive behavior in adolescents may be fueled in part by the depression associated with perceived parental rejection, said William W. Hale III, Ph.D., of Utrecht (the Netherlands) University and his colleagues.

In a study of 1,329 students aged 10–19 years, the investigators assessed aggressive and withdrawn behaviors with a 23-item questionnaire (J. Adolesc. Health 2005; 36:466–74).

Overall, significant associations appeared between perceived parental rejection and both aggression and depression.

When the population was divided into subgroups, the association between perceived parental rejection and depression was statistically significant for younger girls (aged 10–14 years) and older girls (aged 15–19 years) but not for boys, and the association was statistically significant for the older girls, compared with all other subgroups.

Rejection did not appear to have a significant impact on depression or aggression in the subgroups of older or younger boys.

The differences might reflect girls' stronger orientation toward interpersonal relationships, the investigators noted.

Paps Infrequent Among Immigrants

Foreign-born women living in the United States were significantly less likely to have had a Pap test within the past 3 years, compared with American-born women, Xu Wang, M.D., and colleagues reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Immigration status was associated with lower Pap test use independently of poverty, lack of insurance, and lack of a regular source of medical care, noted Dr. Wang and associates of Meharry Medical College in Nashville, Tennessee.

The logistic regression analysis included data on 16,505 women taken from the 2000 National Health Interview Survey. The age-adjusted percentage of women who had Pap tests within the past 3 years increased the longer they lived in the United States. Only 47% of women who immigrated less than 5 years ago had undergone Pap tests, compared with 58% of women who immigrated 5–9 years ago, and 78% of American-born women.

Teens' PMS Mirrors Adult Women's

Premenstrual syndrome is common in adolescents, and symptoms are similar to those reported by women, a study suggests.

The findings debunk the “commonly accepted belief that adolescents suffer mostly from dysmenorrhea, and older women suffer mostly from PMS,” Michelle D. Vichnin, M.D., said.

A total of 94 girls aged 13–18 years took part in the 6-month study during which they completed the Daily Symptom Report (DSR), a validated tool for measuring 17 PMS symptoms in women.

A total of 31% had self-reported and confirmed PMS; 54% had self-reported PMS but did not meet the criteria for confirmed PMS; and 15% had no PMS, Dr. Vichnin reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Confirmed PMS was defined as a self-report of PMS along with a 50% increase in premenstrual vs. postmenstrual DSR scores, said Dr. Vichnin of the University of Pennsylvania, Philadelphia.

The worst symptoms among teens with PMS were mood swings, anxiety, irritability, food cravings, increased appetite, swelling and/or bloating, and cramps. These symptoms are identical to those reported in studies of women with PMS, she noted. As is also true in women, the greatest impact of these symptoms was on the home/family scale, she said.

In this study, older age and family history of PMS were significantly associated with PMS. Oral contraceptive use and dysmenorrhea were not associated with PMS.

Gender and Criminality

Women who have a dual diagnosis of rapid-cycling bipolar disorder and substance abuse/dependence are more at risk for engaging in criminal activity than are women in the general population, though their risk is lower than that of men with a dual diagnosis, reported Susan Hatters Friedman, M.D., of the University Hospitals of Cleveland, and her associates.

In a study of 55 women and 77 men with a dual diagnosis and a comparison group of 18 female and 13 male bipolar patients with no history of substance abuse, 53% of female and 79% of male dual-diagnosis patients reported ever being charged with a crime, while only 17% of women and 8% of men in the comparison group reported a history of criminal charges.

Nearly half of men and women in the dual-diagnosis group reported being incarcerated, with only one woman (6%) from the comparison female group reporting prior incarceration (J. Am. Acad. Psychiatry Law 2005;33:188–95).

Teen Girls React to Parental Rejection

Aggressive behavior in adolescents may be fueled in part by the depression associated with perceived parental rejection, said William W. Hale III, Ph.D., of Utrecht (the Netherlands) University and his colleagues.

In a study of 1,329 students aged 10–19 years, the investigators assessed aggressive and withdrawn behaviors with a 23-item questionnaire (J. Adolesc. Health 2005; 36:466–74).

Overall, significant associations appeared between perceived parental rejection and both aggression and depression.

When the population was divided into subgroups, the association between perceived parental rejection and depression was statistically significant for younger girls (aged 10–14 years) and older girls (aged 15–19 years) but not for boys, and the association was statistically significant for the older girls, compared with all other subgroups.

Rejection did not appear to have a significant impact on depression or aggression in the subgroups of older or younger boys.

The differences might reflect girls' stronger orientation toward interpersonal relationships, the investigators noted.

Paps Infrequent Among Immigrants

Foreign-born women living in the United States were significantly less likely to have had a Pap test within the past 3 years, compared with American-born women, Xu Wang, M.D., and colleagues reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Immigration status was associated with lower Pap test use independently of poverty, lack of insurance, and lack of a regular source of medical care, noted Dr. Wang and associates of Meharry Medical College in Nashville, Tennessee.

The logistic regression analysis included data on 16,505 women taken from the 2000 National Health Interview Survey. The age-adjusted percentage of women who had Pap tests within the past 3 years increased the longer they lived in the United States. Only 47% of women who immigrated less than 5 years ago had undergone Pap tests, compared with 58% of women who immigrated 5–9 years ago, and 78% of American-born women.

Teens' PMS Mirrors Adult Women's

Premenstrual syndrome is common in adolescents, and symptoms are similar to those reported by women, a study suggests.

The findings debunk the “commonly accepted belief that adolescents suffer mostly from dysmenorrhea, and older women suffer mostly from PMS,” Michelle D. Vichnin, M.D., said.

A total of 94 girls aged 13–18 years took part in the 6-month study during which they completed the Daily Symptom Report (DSR), a validated tool for measuring 17 PMS symptoms in women.

A total of 31% had self-reported and confirmed PMS; 54% had self-reported PMS but did not meet the criteria for confirmed PMS; and 15% had no PMS, Dr. Vichnin reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Confirmed PMS was defined as a self-report of PMS along with a 50% increase in premenstrual vs. postmenstrual DSR scores, said Dr. Vichnin of the University of Pennsylvania, Philadelphia.

The worst symptoms among teens with PMS were mood swings, anxiety, irritability, food cravings, increased appetite, swelling and/or bloating, and cramps. These symptoms are identical to those reported in studies of women with PMS, she noted. As is also true in women, the greatest impact of these symptoms was on the home/family scale, she said.

In this study, older age and family history of PMS were significantly associated with PMS. Oral contraceptive use and dysmenorrhea were not associated with PMS.

Gender and Criminality

Women who have a dual diagnosis of rapid-cycling bipolar disorder and substance abuse/dependence are more at risk for engaging in criminal activity than are women in the general population, though their risk is lower than that of men with a dual diagnosis, reported Susan Hatters Friedman, M.D., of the University Hospitals of Cleveland, and her associates.

In a study of 55 women and 77 men with a dual diagnosis and a comparison group of 18 female and 13 male bipolar patients with no history of substance abuse, 53% of female and 79% of male dual-diagnosis patients reported ever being charged with a crime, while only 17% of women and 8% of men in the comparison group reported a history of criminal charges.

Nearly half of men and women in the dual-diagnosis group reported being incarcerated, with only one woman (6%) from the comparison female group reporting prior incarceration (J. Am. Acad. Psychiatry Law 2005;33:188–95).

Teen Girls React to Parental Rejection

Aggressive behavior in adolescents may be fueled in part by the depression associated with perceived parental rejection, said William W. Hale III, Ph.D., of Utrecht (the Netherlands) University and his colleagues.

In a study of 1,329 students aged 10–19 years, the investigators assessed aggressive and withdrawn behaviors with a 23-item questionnaire (J. Adolesc. Health 2005; 36:466–74).

Overall, significant associations appeared between perceived parental rejection and both aggression and depression.

When the population was divided into subgroups, the association between perceived parental rejection and depression was statistically significant for younger girls (aged 10–14 years) and older girls (aged 15–19 years) but not for boys, and the association was statistically significant for the older girls, compared with all other subgroups.

Rejection did not appear to have a significant impact on depression or aggression in the subgroups of older or younger boys.

The differences might reflect girls' stronger orientation toward interpersonal relationships, the investigators noted.

Paps Infrequent Among Immigrants

Foreign-born women living in the United States were significantly less likely to have had a Pap test within the past 3 years, compared with American-born women, Xu Wang, M.D., and colleagues reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Immigration status was associated with lower Pap test use independently of poverty, lack of insurance, and lack of a regular source of medical care, noted Dr. Wang and associates of Meharry Medical College in Nashville, Tennessee.

The logistic regression analysis included data on 16,505 women taken from the 2000 National Health Interview Survey. The age-adjusted percentage of women who had Pap tests within the past 3 years increased the longer they lived in the United States. Only 47% of women who immigrated less than 5 years ago had undergone Pap tests, compared with 58% of women who immigrated 5–9 years ago, and 78% of American-born women.

Gonorrhea Screening

Physicians should perform routine screening of all sexually active women at increased risk for gonorrhea, because of the high risk for pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain associated with asymptomatic gonorrhea infection, according to the U.S. Preventive Services Task Force.

Those at risk include sexually active women under age 25 years, those with previous gonorrhea or other sexually transmitted infections, those with new or multiple sex partners, those who don't consistently use condoms, sex workers, and drug users.

Pregnant women with these risk factors should be screened at the first prenatal visit, and those with ongoing or new risk factors should also be screened during the third trimester because gonorrhea increases the risk of preterm rupture of membranes, chorioamnionitis, and preterm labor (Ann. Fam. Med. 2005;3:263–7).

The task force recommended against routine screening in women and men at low risk for gonorrhea, and it found insufficient evidence to recommend for or against routine screening in men at high risk.

Soft Cheese Risks

Soft white cheeses made with raw milk present a health risk, the Food and Drug Administration has warned. Such cheeses can cause listeriosis, brucellosis, salmonellosis, and tuberculosis, and they pose a particular risk to pregnant women, newborns, older adults, and those with weakened immune systems.

Consumption of queso fresco-style cheeses imported from or eaten in Mexico were linked with recent cases of tuberculosis in New York City and found to be contaminated with Mycobacterium bovis, according to the FDA. The cheeses of greatest concern are those originating in Mexico and Central American countries and include queso panela, asadero, blanco, and ranchero. The FDA has warned against consumption of any unripened raw-milk soft cheeses, including those obtained at flea markets or from door-to-door sellers or vendors selling out of their trucks, cheeses made at home by individuals, and those shipped or carried in luggage from the areas of concern.

Vitamin B₆ Intake and Colorectal Ca

High intake of vitamin B₆ is associated with a protective effect against colorectal cancer in women, especially those who drink alcohol, reported Susanna C. Larsson of the Karolinska Institutet, Stockholm, and her associates.

In a population-based cohort study of 61,433 women, those who were in the top 20% of vitamin B₆ intake had a 34% lower relative risk of colorectal cancer than did women who were in the bottom 20% of vitamin B₆ intake; this reduction was significant. Among women who drank at least 30 g of alcohol (about two drinks) per week, those with the highest intake of vitamin B₆ had a 72% lower relative risk of colorectal cancer than did women who had the lowest intake (Gastroenterology 2005;128:1830–7).

Intake of vitamin B₆ in the study of 61,433 women from the Swedish Mammography Cohort ranged from less than 1.53 mg/day in the lowest 20% of women to 2.05 mg/day or more in the highest 20% of women. The recommended daily intake of vitamin B₆ for nonpregnant women in the United States is 1.3–1.5 mg. “Findings from our study suggest that women who consume alcohol may benefit from a vitamin B₆ intake above the recommendations,” the researchers wrote.

Treating Antipsychotic-Linked Adiposity

Topiramate appears to help alleviate the weight gain associated with olanzapine use in women, reported Marius K. Nickel, M.D., of Inntalklinik in Simbach/Inn, Germany, and associates.

In a 10-week trial of women on olanzapine (Zyprexa) for 3 months or more who had gained at least 5 kg since beginning treatment, 25 women were randomized to topiramate (Topamax) and 18 to placebo. Every 2 weeks the women were interviewed and weighed.

Topiramate patients had a significant mean weight loss of 4.1 kg at the end of the study, compared with placebo users, though treatment was more likely to be effective if the patients initially gained a lot of weight (J. Clin. Psychopharmacol. 2005;25:211–7).

Health-related measures of functioning and well-being were also significantly better in topiramate patients than placebo patients, except for measures of emotional problems interfering with work and other daily activities. Along with weight loss, “one can also expect an increase in the patients' health-related quality of life, improvement in their current emotional state of health, and a reduction of their psychological impairments,” Dr. Nickel and associates said.

Gonorrhea Screening

Physicians should perform routine screening of all sexually active women at increased risk for gonorrhea, because of the high risk for pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain associated with asymptomatic gonorrhea infection, according to the U.S. Preventive Services Task Force.

Those at risk include sexually active women under age 25 years, those with previous gonorrhea or other sexually transmitted infections, those with new or multiple sex partners, those who don't consistently use condoms, sex workers, and drug users.

Pregnant women with these risk factors should be screened at the first prenatal visit, and those with ongoing or new risk factors should also be screened during the third trimester because gonorrhea increases the risk of preterm rupture of membranes, chorioamnionitis, and preterm labor (Ann. Fam. Med. 2005;3:263–7).

The task force recommended against routine screening in women and men at low risk for gonorrhea, and it found insufficient evidence to recommend for or against routine screening in men at high risk.

Soft Cheese Risks

Soft white cheeses made with raw milk present a health risk, the Food and Drug Administration has warned. Such cheeses can cause listeriosis, brucellosis, salmonellosis, and tuberculosis, and they pose a particular risk to pregnant women, newborns, older adults, and those with weakened immune systems.

Consumption of queso fresco-style cheeses imported from or eaten in Mexico were linked with recent cases of tuberculosis in New York City and found to be contaminated with Mycobacterium bovis, according to the FDA. The cheeses of greatest concern are those originating in Mexico and Central American countries and include queso panela, asadero, blanco, and ranchero. The FDA has warned against consumption of any unripened raw-milk soft cheeses, including those obtained at flea markets or from door-to-door sellers or vendors selling out of their trucks, cheeses made at home by individuals, and those shipped or carried in luggage from the areas of concern.

Vitamin B₆ Intake and Colorectal Ca

High intake of vitamin B₆ is associated with a protective effect against colorectal cancer in women, especially those who drink alcohol, reported Susanna C. Larsson of the Karolinska Institutet, Stockholm, and her associates.

In a population-based cohort study of 61,433 women, those who were in the top 20% of vitamin B₆ intake had a 34% lower relative risk of colorectal cancer than did women who were in the bottom 20% of vitamin B₆ intake; this reduction was significant. Among women who drank at least 30 g of alcohol (about two drinks) per week, those with the highest intake of vitamin B₆ had a 72% lower relative risk of colorectal cancer than did women who had the lowest intake (Gastroenterology 2005;128:1830–7).

Intake of vitamin B₆ in the study of 61,433 women from the Swedish Mammography Cohort ranged from less than 1.53 mg/day in the lowest 20% of women to 2.05 mg/day or more in the highest 20% of women. The recommended daily intake of vitamin B₆ for nonpregnant women in the United States is 1.3–1.5 mg. “Findings from our study suggest that women who consume alcohol may benefit from a vitamin B₆ intake above the recommendations,” the researchers wrote.

Treating Antipsychotic-Linked Adiposity

Topiramate appears to help alleviate the weight gain associated with olanzapine use in women, reported Marius K. Nickel, M.D., of Inntalklinik in Simbach/Inn, Germany, and associates.

In a 10-week trial of women on olanzapine (Zyprexa) for 3 months or more who had gained at least 5 kg since beginning treatment, 25 women were randomized to topiramate (Topamax) and 18 to placebo. Every 2 weeks the women were interviewed and weighed.

Topiramate patients had a significant mean weight loss of 4.1 kg at the end of the study, compared with placebo users, though treatment was more likely to be effective if the patients initially gained a lot of weight (J. Clin. Psychopharmacol. 2005;25:211–7).

Health-related measures of functioning and well-being were also significantly better in topiramate patients than placebo patients, except for measures of emotional problems interfering with work and other daily activities. Along with weight loss, “one can also expect an increase in the patients' health-related quality of life, improvement in their current emotional state of health, and a reduction of their psychological impairments,” Dr. Nickel and associates said.

Gonorrhea Screening

Physicians should perform routine screening of all sexually active women at increased risk for gonorrhea, because of the high risk for pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain associated with asymptomatic gonorrhea infection, according to the U.S. Preventive Services Task Force.

Those at risk include sexually active women under age 25 years, those with previous gonorrhea or other sexually transmitted infections, those with new or multiple sex partners, those who don't consistently use condoms, sex workers, and drug users.

Pregnant women with these risk factors should be screened at the first prenatal visit, and those with ongoing or new risk factors should also be screened during the third trimester because gonorrhea increases the risk of preterm rupture of membranes, chorioamnionitis, and preterm labor (Ann. Fam. Med. 2005;3:263–7).

The task force recommended against routine screening in women and men at low risk for gonorrhea, and it found insufficient evidence to recommend for or against routine screening in men at high risk.

Soft Cheese Risks

Soft white cheeses made with raw milk present a health risk, the Food and Drug Administration has warned. Such cheeses can cause listeriosis, brucellosis, salmonellosis, and tuberculosis, and they pose a particular risk to pregnant women, newborns, older adults, and those with weakened immune systems.

Consumption of queso fresco-style cheeses imported from or eaten in Mexico were linked with recent cases of tuberculosis in New York City and found to be contaminated with Mycobacterium bovis, according to the FDA. The cheeses of greatest concern are those originating in Mexico and Central American countries and include queso panela, asadero, blanco, and ranchero. The FDA has warned against consumption of any unripened raw-milk soft cheeses, including those obtained at flea markets or from door-to-door sellers or vendors selling out of their trucks, cheeses made at home by individuals, and those shipped or carried in luggage from the areas of concern.

Vitamin B₆ Intake and Colorectal Ca

High intake of vitamin B₆ is associated with a protective effect against colorectal cancer in women, especially those who drink alcohol, reported Susanna C. Larsson of the Karolinska Institutet, Stockholm, and her associates.

In a population-based cohort study of 61,433 women, those who were in the top 20% of vitamin B₆ intake had a 34% lower relative risk of colorectal cancer than did women who were in the bottom 20% of vitamin B₆ intake; this reduction was significant. Among women who drank at least 30 g of alcohol (about two drinks) per week, those with the highest intake of vitamin B₆ had a 72% lower relative risk of colorectal cancer than did women who had the lowest intake (Gastroenterology 2005;128:1830–7).

Intake of vitamin B₆ in the study of 61,433 women from the Swedish Mammography Cohort ranged from less than 1.53 mg/day in the lowest 20% of women to 2.05 mg/day or more in the highest 20% of women. The recommended daily intake of vitamin B₆ for nonpregnant women in the United States is 1.3–1.5 mg. “Findings from our study suggest that women who consume alcohol may benefit from a vitamin B₆ intake above the recommendations,” the researchers wrote.

Treating Antipsychotic-Linked Adiposity

Topiramate appears to help alleviate the weight gain associated with olanzapine use in women, reported Marius K. Nickel, M.D., of Inntalklinik in Simbach/Inn, Germany, and associates.

In a 10-week trial of women on olanzapine (Zyprexa) for 3 months or more who had gained at least 5 kg since beginning treatment, 25 women were randomized to topiramate (Topamax) and 18 to placebo. Every 2 weeks the women were interviewed and weighed.

Topiramate patients had a significant mean weight loss of 4.1 kg at the end of the study, compared with placebo users, though treatment was more likely to be effective if the patients initially gained a lot of weight (J. Clin. Psychopharmacol. 2005;25:211–7).

Health-related measures of functioning and well-being were also significantly better in topiramate patients than placebo patients, except for measures of emotional problems interfering with work and other daily activities. Along with weight loss, “one can also expect an increase in the patients' health-related quality of life, improvement in their current emotional state of health, and a reduction of their psychological impairments,” Dr. Nickel and associates said.