From Staff Reports

Teens Unaware of Hepatitis Risk

Adolescents showed a significant lack of understanding of the risk of hepatitis B from contaminated piercing and tattoo tools, as well as from infected needles and risky sexual behaviors, according to Amy B. Slonim, Ph.D., of the Michigan Public Health Institute in Okemos, and her associates.

In a survey of 17,063 adolescents and young adults aged 13–21 years, 27% could not provide information about hepatitis B vaccination and 20% could provide only incorrect information. Nearly half of those who gave incorrect information thought a vaccination was “something bad.”

Clinic staff members who conducted the surveys suggested a strategy for educating teens about hepatitis including examples of how it is contracted, emphasis of the possible severity of the illness (cirrhosis), and the safety and effectiveness of the vaccine (J. Adolesc. Health 2005;36:178–86).

Tularemia From Hamster Bite

A 3-year-old boy who was bitten by a hamster was diagnosed with tularemia, reported the Colorado Department of Public Health and the U.S. Centers for Disease Control and Prevention (MMWR 2005;53:1202–3).

The boy recovered after an excisional biopsy of a left axillary lymph node to relieve lymphadenopathy and intermittent fever; he was also treated with ciprofloxacin.

The boy was exposed to six hamsters purchased from a pet store, each of which died from diarrhea within a week of purchase.

One hamster bit the boy shortly before it died, and 7 days later, the child developed fever, malaise, painful left axillary lymphadenopathy, and skin sloughing at the bite site on the finger. No other exposures to tularemia risk factors were identified, so the hamster was presumed to be the cause, although the delay between the child's onset of illness and final diagnosis meant that the implicated hamsters were not available for testing.

An adult customer and a pet store employee who developed fevers after being bitten by hamsters from the store tested negative for Francisella tularensis. However, a cat in the store tested positive for F. tularensis, which suggested that other animals in the store might have been exposed to infection.

More Options for HIV

A combination of atovaquone-azithromycin (AT-AZ) is as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) for the prevention of serious bacterial infections in children with HIV aged 3 months to 19 years, said Walter T. Hughes, M.D., of St. Jude Children's Research Hospital, Memphis, and his colleagues.

TMP-SMZ is widely used against bacterial infections in children with and without HIV, but some children experience adverse reactions and need an alternative treatment.

In a randomized, double-blind, placebo-controlled study, 366 children were followed for an average of 3 years (Clin. Infect. Dis. 2005;40:136–45). Serious bacterial infections were 12.9/100 person-years in the AT-AZ group, compared with 18.5/100 person-years in the TMP-SMZ group.

Hematologic problems were the most common adverse events, occurring in 39% of the AT-AZ children and 37% of the TMP-SMZ children. While the high cost of atovaquone-azithromycin prevents its use in most cases, it presents a viable alternative for children who experience adverse effects from TMP-SMZ, researchers said.

Teens and Tobacco Addiction

Adolescents appear to become addicted to cigarettes more easily than adults, according to a study of 220 ninth-graders who smoke.

Other studies have suggested this susceptibility to addiction but have not been able to measure tobacco exposure as well, Mark Rubinstein, M.D., said at the annual meeting of the Society for Adolescent Medicine.

This study measured cotinine levels in saliva, and correlated it with self-reports of craving and an addiction measure. Cotinine, a metabolite of nicotine, persists longer in saliva than nicotine does in blood.

The study found that even among the 20% of adolescents who reported smoking daily, cotinine levels generally were much lower than typically seen in adult smokers. The cotinine level that defines addiction in adults is 200 ng/mL. But only one of the adolescents had a level equal to or above that.

Still, cotinine levels did correlate with addiction, and 34% of the daily smokers were identified as addicted, either by self-report of craving or on a nicotine dependence syndrome scale. Twenty-eight percent of those had undetectable cotinine levels.

Teens Unaware of Hepatitis Risk

Adolescents showed a significant lack of understanding of the risk of hepatitis B from contaminated piercing and tattoo tools, as well as from infected needles and risky sexual behaviors, according to Amy B. Slonim, Ph.D., of the Michigan Public Health Institute in Okemos, and her associates.

In a survey of 17,063 adolescents and young adults aged 13–21 years, 27% could not provide information about hepatitis B vaccination and 20% could provide only incorrect information. Nearly half of those who gave incorrect information thought a vaccination was “something bad.”

Clinic staff members who conducted the surveys suggested a strategy for educating teens about hepatitis including examples of how it is contracted, emphasis of the possible severity of the illness (cirrhosis), and the safety and effectiveness of the vaccine (J. Adolesc. Health 2005;36:178–86).

Tularemia From Hamster Bite

A 3-year-old boy who was bitten by a hamster was diagnosed with tularemia, reported the Colorado Department of Public Health and the U.S. Centers for Disease Control and Prevention (MMWR 2005;53:1202–3).

The boy recovered after an excisional biopsy of a left axillary lymph node to relieve lymphadenopathy and intermittent fever; he was also treated with ciprofloxacin.

The boy was exposed to six hamsters purchased from a pet store, each of which died from diarrhea within a week of purchase.

One hamster bit the boy shortly before it died, and 7 days later, the child developed fever, malaise, painful left axillary lymphadenopathy, and skin sloughing at the bite site on the finger. No other exposures to tularemia risk factors were identified, so the hamster was presumed to be the cause, although the delay between the child's onset of illness and final diagnosis meant that the implicated hamsters were not available for testing.

An adult customer and a pet store employee who developed fevers after being bitten by hamsters from the store tested negative for Francisella tularensis. However, a cat in the store tested positive for F. tularensis, which suggested that other animals in the store might have been exposed to infection.

More Options for HIV

A combination of atovaquone-azithromycin (AT-AZ) is as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) for the prevention of serious bacterial infections in children with HIV aged 3 months to 19 years, said Walter T. Hughes, M.D., of St. Jude Children's Research Hospital, Memphis, and his colleagues.

TMP-SMZ is widely used against bacterial infections in children with and without HIV, but some children experience adverse reactions and need an alternative treatment.

In a randomized, double-blind, placebo-controlled study, 366 children were followed for an average of 3 years (Clin. Infect. Dis. 2005;40:136–45). Serious bacterial infections were 12.9/100 person-years in the AT-AZ group, compared with 18.5/100 person-years in the TMP-SMZ group.

Hematologic problems were the most common adverse events, occurring in 39% of the AT-AZ children and 37% of the TMP-SMZ children. While the high cost of atovaquone-azithromycin prevents its use in most cases, it presents a viable alternative for children who experience adverse effects from TMP-SMZ, researchers said.

Teens and Tobacco Addiction

Adolescents appear to become addicted to cigarettes more easily than adults, according to a study of 220 ninth-graders who smoke.

Other studies have suggested this susceptibility to addiction but have not been able to measure tobacco exposure as well, Mark Rubinstein, M.D., said at the annual meeting of the Society for Adolescent Medicine.

This study measured cotinine levels in saliva, and correlated it with self-reports of craving and an addiction measure. Cotinine, a metabolite of nicotine, persists longer in saliva than nicotine does in blood.

The study found that even among the 20% of adolescents who reported smoking daily, cotinine levels generally were much lower than typically seen in adult smokers. The cotinine level that defines addiction in adults is 200 ng/mL. But only one of the adolescents had a level equal to or above that.

Still, cotinine levels did correlate with addiction, and 34% of the daily smokers were identified as addicted, either by self-report of craving or on a nicotine dependence syndrome scale. Twenty-eight percent of those had undetectable cotinine levels.

Teens Unaware of Hepatitis Risk

Adolescents showed a significant lack of understanding of the risk of hepatitis B from contaminated piercing and tattoo tools, as well as from infected needles and risky sexual behaviors, according to Amy B. Slonim, Ph.D., of the Michigan Public Health Institute in Okemos, and her associates.

In a survey of 17,063 adolescents and young adults aged 13–21 years, 27% could not provide information about hepatitis B vaccination and 20% could provide only incorrect information. Nearly half of those who gave incorrect information thought a vaccination was “something bad.”

Clinic staff members who conducted the surveys suggested a strategy for educating teens about hepatitis including examples of how it is contracted, emphasis of the possible severity of the illness (cirrhosis), and the safety and effectiveness of the vaccine (J. Adolesc. Health 2005;36:178–86).

Tularemia From Hamster Bite

A 3-year-old boy who was bitten by a hamster was diagnosed with tularemia, reported the Colorado Department of Public Health and the U.S. Centers for Disease Control and Prevention (MMWR 2005;53:1202–3).

The boy recovered after an excisional biopsy of a left axillary lymph node to relieve lymphadenopathy and intermittent fever; he was also treated with ciprofloxacin.

The boy was exposed to six hamsters purchased from a pet store, each of which died from diarrhea within a week of purchase.

One hamster bit the boy shortly before it died, and 7 days later, the child developed fever, malaise, painful left axillary lymphadenopathy, and skin sloughing at the bite site on the finger. No other exposures to tularemia risk factors were identified, so the hamster was presumed to be the cause, although the delay between the child's onset of illness and final diagnosis meant that the implicated hamsters were not available for testing.

An adult customer and a pet store employee who developed fevers after being bitten by hamsters from the store tested negative for Francisella tularensis. However, a cat in the store tested positive for F. tularensis, which suggested that other animals in the store might have been exposed to infection.

More Options for HIV

A combination of atovaquone-azithromycin (AT-AZ) is as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) for the prevention of serious bacterial infections in children with HIV aged 3 months to 19 years, said Walter T. Hughes, M.D., of St. Jude Children's Research Hospital, Memphis, and his colleagues.

TMP-SMZ is widely used against bacterial infections in children with and without HIV, but some children experience adverse reactions and need an alternative treatment.

In a randomized, double-blind, placebo-controlled study, 366 children were followed for an average of 3 years (Clin. Infect. Dis. 2005;40:136–45). Serious bacterial infections were 12.9/100 person-years in the AT-AZ group, compared with 18.5/100 person-years in the TMP-SMZ group.

Hematologic problems were the most common adverse events, occurring in 39% of the AT-AZ children and 37% of the TMP-SMZ children. While the high cost of atovaquone-azithromycin prevents its use in most cases, it presents a viable alternative for children who experience adverse effects from TMP-SMZ, researchers said.

Teens and Tobacco Addiction

Adolescents appear to become addicted to cigarettes more easily than adults, according to a study of 220 ninth-graders who smoke.

Other studies have suggested this susceptibility to addiction but have not been able to measure tobacco exposure as well, Mark Rubinstein, M.D., said at the annual meeting of the Society for Adolescent Medicine.

This study measured cotinine levels in saliva, and correlated it with self-reports of craving and an addiction measure. Cotinine, a metabolite of nicotine, persists longer in saliva than nicotine does in blood.

The study found that even among the 20% of adolescents who reported smoking daily, cotinine levels generally were much lower than typically seen in adult smokers. The cotinine level that defines addiction in adults is 200 ng/mL. But only one of the adolescents had a level equal to or above that.

Still, cotinine levels did correlate with addiction, and 34% of the daily smokers were identified as addicted, either by self-report of craving or on a nicotine dependence syndrome scale. Twenty-eight percent of those had undetectable cotinine levels.

Aneuploidy Risk Assessed

Women who have had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and her associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

Because the review found an escalating rate with each additional known pregnancy loss, the study needs to be replicated to see if this holds true for younger women, Dr. Bianco said in an interview.

Essure Safe for at Least 5 Years

Hysteroscopic sterilization with Essure microinserts appears safe and effective for at least 5 years after the procedure, according to a poster presented by John F. Kerin, M.D., at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Kerin of Flinders Medical Centre, Adelaide, Australia, and his colleagues from the Selective Tubal Occlusion Procedure 2000 Investigators Group followed 643 women for up to 5 years after they underwent the procedure. All women had received bilateral placements of Essure microinserts as part of phase II or phase III clinical trials sponsored by Conceptus Inc., the device's manufacturer.

Not a single pregnancy occurred in 29,357 woman-months of follow-up, Dr. Kerin reported. The age-adjusted cumulative bayesian effectiveness rate at 5 years was 99.74%.

Patient tolerance, comfort, and satisfaction were measured at seven or eight visits during the follow-up period. At all visits, 99% of women rated their tolerance of Essure as “good” or “excellent,” 99% rated their comfort as “good” or “excellent,” and 97% rated their satisfaction as “satisfied” or “very satisfied.” No women reported persistent pain or bleeding.

NuvaRing Has Low Expulsion Rate

In a year's experience with the NuvaRing contraceptive, only 2.3% of women had an expulsion of the device, according to the pooled results of four large, phase III clinical trials, Marc Kaptein, M.D., and Edio Zampaglione, M.D., reported in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

In a retrospective analysis of 3,333 women and 33,462 cycles, expulsion occurred in only 0.5% of cycles, according to the investigators, who were from Organon International Inc., Roseland, N.J. Organon is the manufacturer of NuvaRing.

The proportion of cycles with expulsions decreased over time, an effect the investigators attributed to users' increasing experience with the NuvaRing. During the first three cycles, 1.7% of women experienced an expulsion. The studies followed the women for 13 cycles. During the 11th, 12th, and 13th cycles, only 0.2% of women experienced expulsions.

Surgery for Brachial Plexus Injuries

Surgery is the best option for treatment in children with global brachial plexus birth palsies, according to one study.

Final shoulder function in 36 infants with such injuries who underwent surgery was fair in 22% of patients, satisfactory in 50%, good in 22%, and excellent in 6%. Final shoulder function was poor in 100% of 12 control patients who did not undergo surgery, Patricia DiTaranto, M.D., said at the annual meeting of the American Association for Hand Surgery.

Hand function in the surgery patients was fair in 19%, satisfactory in 58%, good in 17%, and excellent in 6%. Hand function in controls was poor in 25% and fair in 75%, said Dr. DiTaranto of Miami Children's Hospital.

Function was assessed with the Gilbert-Raimondi system, she noted. The children studied were born at a single institution over a 4-year period and were followed for at least 2.5 years. All had global brachial plexus injuries at birth, and the clinical findings persisted at 6-month follow-up.

The goal of the surgical reconstruction of the brachial plexus was to recover shoulder stability and hand function, she said.

Aneuploidy Risk Assessed

Women who have had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and her associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

Because the review found an escalating rate with each additional known pregnancy loss, the study needs to be replicated to see if this holds true for younger women, Dr. Bianco said in an interview.

Essure Safe for at Least 5 Years

Hysteroscopic sterilization with Essure microinserts appears safe and effective for at least 5 years after the procedure, according to a poster presented by John F. Kerin, M.D., at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Kerin of Flinders Medical Centre, Adelaide, Australia, and his colleagues from the Selective Tubal Occlusion Procedure 2000 Investigators Group followed 643 women for up to 5 years after they underwent the procedure. All women had received bilateral placements of Essure microinserts as part of phase II or phase III clinical trials sponsored by Conceptus Inc., the device's manufacturer.

Not a single pregnancy occurred in 29,357 woman-months of follow-up, Dr. Kerin reported. The age-adjusted cumulative bayesian effectiveness rate at 5 years was 99.74%.

Patient tolerance, comfort, and satisfaction were measured at seven or eight visits during the follow-up period. At all visits, 99% of women rated their tolerance of Essure as “good” or “excellent,” 99% rated their comfort as “good” or “excellent,” and 97% rated their satisfaction as “satisfied” or “very satisfied.” No women reported persistent pain or bleeding.

NuvaRing Has Low Expulsion Rate

In a year's experience with the NuvaRing contraceptive, only 2.3% of women had an expulsion of the device, according to the pooled results of four large, phase III clinical trials, Marc Kaptein, M.D., and Edio Zampaglione, M.D., reported in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

In a retrospective analysis of 3,333 women and 33,462 cycles, expulsion occurred in only 0.5% of cycles, according to the investigators, who were from Organon International Inc., Roseland, N.J. Organon is the manufacturer of NuvaRing.

The proportion of cycles with expulsions decreased over time, an effect the investigators attributed to users' increasing experience with the NuvaRing. During the first three cycles, 1.7% of women experienced an expulsion. The studies followed the women for 13 cycles. During the 11th, 12th, and 13th cycles, only 0.2% of women experienced expulsions.

Surgery for Brachial Plexus Injuries

Surgery is the best option for treatment in children with global brachial plexus birth palsies, according to one study.

Final shoulder function in 36 infants with such injuries who underwent surgery was fair in 22% of patients, satisfactory in 50%, good in 22%, and excellent in 6%. Final shoulder function was poor in 100% of 12 control patients who did not undergo surgery, Patricia DiTaranto, M.D., said at the annual meeting of the American Association for Hand Surgery.

Hand function in the surgery patients was fair in 19%, satisfactory in 58%, good in 17%, and excellent in 6%. Hand function in controls was poor in 25% and fair in 75%, said Dr. DiTaranto of Miami Children's Hospital.

Function was assessed with the Gilbert-Raimondi system, she noted. The children studied were born at a single institution over a 4-year period and were followed for at least 2.5 years. All had global brachial plexus injuries at birth, and the clinical findings persisted at 6-month follow-up.

The goal of the surgical reconstruction of the brachial plexus was to recover shoulder stability and hand function, she said.

Aneuploidy Risk Assessed

Women who have had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and her associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

Because the review found an escalating rate with each additional known pregnancy loss, the study needs to be replicated to see if this holds true for younger women, Dr. Bianco said in an interview.

Essure Safe for at Least 5 Years

Hysteroscopic sterilization with Essure microinserts appears safe and effective for at least 5 years after the procedure, according to a poster presented by John F. Kerin, M.D., at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Kerin of Flinders Medical Centre, Adelaide, Australia, and his colleagues from the Selective Tubal Occlusion Procedure 2000 Investigators Group followed 643 women for up to 5 years after they underwent the procedure. All women had received bilateral placements of Essure microinserts as part of phase II or phase III clinical trials sponsored by Conceptus Inc., the device's manufacturer.

Not a single pregnancy occurred in 29,357 woman-months of follow-up, Dr. Kerin reported. The age-adjusted cumulative bayesian effectiveness rate at 5 years was 99.74%.

Patient tolerance, comfort, and satisfaction were measured at seven or eight visits during the follow-up period. At all visits, 99% of women rated their tolerance of Essure as “good” or “excellent,” 99% rated their comfort as “good” or “excellent,” and 97% rated their satisfaction as “satisfied” or “very satisfied.” No women reported persistent pain or bleeding.

NuvaRing Has Low Expulsion Rate

In a year's experience with the NuvaRing contraceptive, only 2.3% of women had an expulsion of the device, according to the pooled results of four large, phase III clinical trials, Marc Kaptein, M.D., and Edio Zampaglione, M.D., reported in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

In a retrospective analysis of 3,333 women and 33,462 cycles, expulsion occurred in only 0.5% of cycles, according to the investigators, who were from Organon International Inc., Roseland, N.J. Organon is the manufacturer of NuvaRing.

The proportion of cycles with expulsions decreased over time, an effect the investigators attributed to users' increasing experience with the NuvaRing. During the first three cycles, 1.7% of women experienced an expulsion. The studies followed the women for 13 cycles. During the 11th, 12th, and 13th cycles, only 0.2% of women experienced expulsions.

Surgery for Brachial Plexus Injuries

Surgery is the best option for treatment in children with global brachial plexus birth palsies, according to one study.

Final shoulder function in 36 infants with such injuries who underwent surgery was fair in 22% of patients, satisfactory in 50%, good in 22%, and excellent in 6%. Final shoulder function was poor in 100% of 12 control patients who did not undergo surgery, Patricia DiTaranto, M.D., said at the annual meeting of the American Association for Hand Surgery.

Hand function in the surgery patients was fair in 19%, satisfactory in 58%, good in 17%, and excellent in 6%. Hand function in controls was poor in 25% and fair in 75%, said Dr. DiTaranto of Miami Children's Hospital.

Function was assessed with the Gilbert-Raimondi system, she noted. The children studied were born at a single institution over a 4-year period and were followed for at least 2.5 years. All had global brachial plexus injuries at birth, and the clinical findings persisted at 6-month follow-up.

The goal of the surgical reconstruction of the brachial plexus was to recover shoulder stability and hand function, she said.

Children of Preeclamptic Mothers

Children born to preeclamptic mothers are more likely to have pulmonary hypertension, compared with children born from uncomplicated pregnancies, according to a study presented at a meeting sponsored by the American Physiological Society.

The finding provides “the very first evidence that preeclampsia leaves a persistent and potentially fatal imprint in the pulmonary circulation of the offspring,” said Pierre-Yves Jayet, M.D.

Dr. Jayet and his associates hypothesized that children born to mothers who had preeclampsia are predisposed to pulmonary hypertension at high altitude. To test this hypothesis, the investigators used echocardiography to measure systolic pulmonary artery pressure in 11 children aged 6–8 years who were born to preeclamptic mothers from La Paz, Bolivia, where the elevation is 12,000–13,000 feet above sea level. For a control group, they evaluated 13 age- and gender-matched children in La Paz born from normal pregnancies, said Dr. Jayet of University Hospital, Lausanne, Switzerland.

The mean systolic pulmonary artery pressure was about 33% higher in children born to preeclamptic mothers, compared with those born from uncomplicated pregnancies (36 mm Hg vs. 27 mm Hg, respectively). Hypoxic pulmonary vasoconstriction was not related to more severe hypoxemia or exaggerated polyglobulia, Dr. Jayet noted. The Swiss National Science Foundation supported the study.

Emotional Writing Helps Fibromyalgia

Fibromyalgia patients demonstrated short-term improvement in psychological well-being, fatigue, and pain by writing about personal traumatic experiences, reported Joan E. Broderick, Ph.D., of the State University of New York at Stony Brook. Women at an average age of 50 years who reported an onset of fibromyalgia about 9 years before the study were randomized into three groups: 31 in the emotional-disclosure (ED) group, 32 in the neutral-writing (NW) group, and 29 in the usual-care (UC) group. Those in the ED group wrote about personal traumatic experiences in three lab sessions; those in the NW group wrote about day-to-day activities over three lab sessions (Psychosom. Med. 2005;67:326–34).

Psychological well-being, fatigue, and pain were assessed at pretreatment, 4-month follow-up, and 10-month follow-up. Since no significant differences were found from pretreatment and 4-month follow-up in the NW and UC groups, they were combined into a single control group, the investigators said. At 4 months, the ED group showed a significant reduction in fatigue and pain and improvements in psychological well-being, compared with controls. But none of the benefits were sustained at 10-month follow-up.

Larger Fibroids, Heavy Bleeding

Heavy bleeding in women with fibroids was significantly associated with increased fibroid volume but not pelvic pain, according to Kristen Kjerulff, Ph.D., of Pennsylvania State University, Hershey, and colleagues. In a linear regression analysis of 714 premenopausal women with fibroids, the number of days of heavy bleeding was significantly associated with increased uterine volume but not with pelvic pain, they wrote in a poster presented at an international conference sponsored by the National Institutes of Health.

In addition, intramural fibroids were associated with both excessive bleeding and pelvic pain; submucosal fibroids were associated with excessive bleeding but not with pelvic pain. The presence of at least seven fibroids was significantly associated with frequent abdominal bloating.

The women were interviewed regarding risk factors, symptom severity, and other quality of life measures. Assessment of fibroids was conducted with transvaginal ultrasound for nonhysterectomy patients and pathology for hysterectomy patients.

HSV-2 Shedding Risk

Hormonal contraception and two common genital tract conditions appear to be among the risk factors for shedding of herpes simplex virus type 2 in women.

In a 12-month study of 330 women who were evaluated every 4 months, independent predictors of genital tract shedding of HSV-2 were HSV-2 seroconversion during the previous 4 months (adjusted odds ratio [OR] 3.0), bacterial vaginosis (adjusted OR 2.3), heavy colonization with group B streptococcus (adjusted OR 2.2), and use of hormonal contraceptives (adjusted OR 1.8), reported Thomas L. Cherpes, M.D., and his colleagues at the University of Pittsburgh (Clin. Infect. Dis. 2005;40:1422–8).

Because use of hormonal contraception is widespread, and bacterial vaginosis and vaginal group B streptococcus colonization are two of the most common genital conditions in women of reproductive age, the associations between these variables and increased genital tract shedding of HSV-2 is of concern.

Children of Preeclamptic Mothers

Children born to preeclamptic mothers are more likely to have pulmonary hypertension, compared with children born from uncomplicated pregnancies, according to a study presented at a meeting sponsored by the American Physiological Society.

The finding provides “the very first evidence that preeclampsia leaves a persistent and potentially fatal imprint in the pulmonary circulation of the offspring,” said Pierre-Yves Jayet, M.D.

Dr. Jayet and his associates hypothesized that children born to mothers who had preeclampsia are predisposed to pulmonary hypertension at high altitude. To test this hypothesis, the investigators used echocardiography to measure systolic pulmonary artery pressure in 11 children aged 6–8 years who were born to preeclamptic mothers from La Paz, Bolivia, where the elevation is 12,000–13,000 feet above sea level. For a control group, they evaluated 13 age- and gender-matched children in La Paz born from normal pregnancies, said Dr. Jayet of University Hospital, Lausanne, Switzerland.

The mean systolic pulmonary artery pressure was about 33% higher in children born to preeclamptic mothers, compared with those born from uncomplicated pregnancies (36 mm Hg vs. 27 mm Hg, respectively). Hypoxic pulmonary vasoconstriction was not related to more severe hypoxemia or exaggerated polyglobulia, Dr. Jayet noted. The Swiss National Science Foundation supported the study.

Emotional Writing Helps Fibromyalgia

Fibromyalgia patients demonstrated short-term improvement in psychological well-being, fatigue, and pain by writing about personal traumatic experiences, reported Joan E. Broderick, Ph.D., of the State University of New York at Stony Brook. Women at an average age of 50 years who reported an onset of fibromyalgia about 9 years before the study were randomized into three groups: 31 in the emotional-disclosure (ED) group, 32 in the neutral-writing (NW) group, and 29 in the usual-care (UC) group. Those in the ED group wrote about personal traumatic experiences in three lab sessions; those in the NW group wrote about day-to-day activities over three lab sessions (Psychosom. Med. 2005;67:326–34).

Psychological well-being, fatigue, and pain were assessed at pretreatment, 4-month follow-up, and 10-month follow-up. Since no significant differences were found from pretreatment and 4-month follow-up in the NW and UC groups, they were combined into a single control group, the investigators said. At 4 months, the ED group showed a significant reduction in fatigue and pain and improvements in psychological well-being, compared with controls. But none of the benefits were sustained at 10-month follow-up.

Larger Fibroids, Heavy Bleeding

Heavy bleeding in women with fibroids was significantly associated with increased fibroid volume but not pelvic pain, according to Kristen Kjerulff, Ph.D., of Pennsylvania State University, Hershey, and colleagues. In a linear regression analysis of 714 premenopausal women with fibroids, the number of days of heavy bleeding was significantly associated with increased uterine volume but not with pelvic pain, they wrote in a poster presented at an international conference sponsored by the National Institutes of Health.

In addition, intramural fibroids were associated with both excessive bleeding and pelvic pain; submucosal fibroids were associated with excessive bleeding but not with pelvic pain. The presence of at least seven fibroids was significantly associated with frequent abdominal bloating.

The women were interviewed regarding risk factors, symptom severity, and other quality of life measures. Assessment of fibroids was conducted with transvaginal ultrasound for nonhysterectomy patients and pathology for hysterectomy patients.

HSV-2 Shedding Risk

Hormonal contraception and two common genital tract conditions appear to be among the risk factors for shedding of herpes simplex virus type 2 in women.

In a 12-month study of 330 women who were evaluated every 4 months, independent predictors of genital tract shedding of HSV-2 were HSV-2 seroconversion during the previous 4 months (adjusted odds ratio [OR] 3.0), bacterial vaginosis (adjusted OR 2.3), heavy colonization with group B streptococcus (adjusted OR 2.2), and use of hormonal contraceptives (adjusted OR 1.8), reported Thomas L. Cherpes, M.D., and his colleagues at the University of Pittsburgh (Clin. Infect. Dis. 2005;40:1422–8).

Because use of hormonal contraception is widespread, and bacterial vaginosis and vaginal group B streptococcus colonization are two of the most common genital conditions in women of reproductive age, the associations between these variables and increased genital tract shedding of HSV-2 is of concern.

Children of Preeclamptic Mothers

Children born to preeclamptic mothers are more likely to have pulmonary hypertension, compared with children born from uncomplicated pregnancies, according to a study presented at a meeting sponsored by the American Physiological Society.

The finding provides “the very first evidence that preeclampsia leaves a persistent and potentially fatal imprint in the pulmonary circulation of the offspring,” said Pierre-Yves Jayet, M.D.

Dr. Jayet and his associates hypothesized that children born to mothers who had preeclampsia are predisposed to pulmonary hypertension at high altitude. To test this hypothesis, the investigators used echocardiography to measure systolic pulmonary artery pressure in 11 children aged 6–8 years who were born to preeclamptic mothers from La Paz, Bolivia, where the elevation is 12,000–13,000 feet above sea level. For a control group, they evaluated 13 age- and gender-matched children in La Paz born from normal pregnancies, said Dr. Jayet of University Hospital, Lausanne, Switzerland.

The mean systolic pulmonary artery pressure was about 33% higher in children born to preeclamptic mothers, compared with those born from uncomplicated pregnancies (36 mm Hg vs. 27 mm Hg, respectively). Hypoxic pulmonary vasoconstriction was not related to more severe hypoxemia or exaggerated polyglobulia, Dr. Jayet noted. The Swiss National Science Foundation supported the study.

Emotional Writing Helps Fibromyalgia

Fibromyalgia patients demonstrated short-term improvement in psychological well-being, fatigue, and pain by writing about personal traumatic experiences, reported Joan E. Broderick, Ph.D., of the State University of New York at Stony Brook. Women at an average age of 50 years who reported an onset of fibromyalgia about 9 years before the study were randomized into three groups: 31 in the emotional-disclosure (ED) group, 32 in the neutral-writing (NW) group, and 29 in the usual-care (UC) group. Those in the ED group wrote about personal traumatic experiences in three lab sessions; those in the NW group wrote about day-to-day activities over three lab sessions (Psychosom. Med. 2005;67:326–34).

Psychological well-being, fatigue, and pain were assessed at pretreatment, 4-month follow-up, and 10-month follow-up. Since no significant differences were found from pretreatment and 4-month follow-up in the NW and UC groups, they were combined into a single control group, the investigators said. At 4 months, the ED group showed a significant reduction in fatigue and pain and improvements in psychological well-being, compared with controls. But none of the benefits were sustained at 10-month follow-up.

Larger Fibroids, Heavy Bleeding

Heavy bleeding in women with fibroids was significantly associated with increased fibroid volume but not pelvic pain, according to Kristen Kjerulff, Ph.D., of Pennsylvania State University, Hershey, and colleagues. In a linear regression analysis of 714 premenopausal women with fibroids, the number of days of heavy bleeding was significantly associated with increased uterine volume but not with pelvic pain, they wrote in a poster presented at an international conference sponsored by the National Institutes of Health.

In addition, intramural fibroids were associated with both excessive bleeding and pelvic pain; submucosal fibroids were associated with excessive bleeding but not with pelvic pain. The presence of at least seven fibroids was significantly associated with frequent abdominal bloating.

The women were interviewed regarding risk factors, symptom severity, and other quality of life measures. Assessment of fibroids was conducted with transvaginal ultrasound for nonhysterectomy patients and pathology for hysterectomy patients.

HSV-2 Shedding Risk

Hormonal contraception and two common genital tract conditions appear to be among the risk factors for shedding of herpes simplex virus type 2 in women.

In a 12-month study of 330 women who were evaluated every 4 months, independent predictors of genital tract shedding of HSV-2 were HSV-2 seroconversion during the previous 4 months (adjusted odds ratio [OR] 3.0), bacterial vaginosis (adjusted OR 2.3), heavy colonization with group B streptococcus (adjusted OR 2.2), and use of hormonal contraceptives (adjusted OR 1.8), reported Thomas L. Cherpes, M.D., and his colleagues at the University of Pittsburgh (Clin. Infect. Dis. 2005;40:1422–8).

Because use of hormonal contraception is widespread, and bacterial vaginosis and vaginal group B streptococcus colonization are two of the most common genital conditions in women of reproductive age, the associations between these variables and increased genital tract shedding of HSV-2 is of concern.

E. coli in Acute Gastroenteritis

Diarrheagenic Escherichia coli was isolated significantly more often in children with acute gastroenteritis in an emergency department, compared with inpatients and controls, said Mitchell B. Cohen, M.D., of Cincinnati Children's Hospital Medical Center, and his associates. In a study of 684 children who presented to an emergency department, 643 inpatient children, and 555 controls, the investigators used DNA probes to evaluate stool samples. A majority in each group was aged 5 years or younger (J. Pediatr. 2005;146:54–61).

Diarrheagenic E. coli was present in 167 (24%) of 684 ED patients, compared with 78 (14%) of 555 control patients. However, there was no significant difference in prevalence of E. coli between the inpatients (13%) and controls (14%). There also was no significant difference in prevalence of E. coli between the inpatients and controls in the subset aged 5 years and younger (13.5% vs. 15.4%). In addition, the researchers found a significantly high isolation rate of enteroaggregative E. coli in ED patients less than 1 year old, compared with controls (10% vs. 1.4%). “Diarrheagenic E. coli may be an important, unrecognized cause of diarrhea in children in the [United States], perhaps accounting for 10% of all acute gastroenteritis,” the investigators said. Rotavirus was the most common single etiologic agent, found in 20.3% of inpatients and 20.2% of ED patients, compared with 1.1% of controls.

Antipsychotic Use in Young Children

Nearly one-quarter of insurance claims in 2001 for atypical antipsychotics in youth aged 19 years and younger were for children aged 9 years and younger, said Lesley H. Curtis, Ph.D., of Duke University Medical Center in Durham, N.C., and colleagues.

The investigators reviewed the administrative claims database of AdvancePCS, a large pharmaceutical benefits manager, for claims from January through December 2001 and evaluated claims for five drugs: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) (Arch. Pediatr. Adolesc. Med. 2005;159:362–6). Of 16,599 claims reported for patients aged 19 years and younger, 3,830 were for children aged 9 years and younger, and 80% of the subgroup 9 years and younger were boys.

Salmonella From Turtles

Small pet turtles were linked to four cases of salmonella in children in 2004, according to the Centers for Disease Control and Prevention and the public health departments of Wisconsin and Wyoming (MMWR 2005;54:223–6).

A 4-year-old girl from Kansas developed diarrhea and a 4-day fever shortly after vacationing in Wisconsin and purchasing a small turtle at a souvenir store. The girl was treated with trimethoprim/sulfamethoxazole for 3 days and had recovered after 5 days. A 2-year-old boy and a 10-year-old boy in Wisconsin developed similar symptoms, including diarrhea and fever, which were traced to pet turtles purchased from different souvenir shops in Wisconsin.

In addition, a 6-year-old boy in Wyoming presented with nausea, diarrhea, vomiting, and a persistent fever. A stool sample yielded Salmonella typhimurium, which was traced to the boy's two pet turtles. Although salmonella infections generally resolve after mild gastroenteritis, they can develop into serious illnesses.

Despite a Food and Drug Administration ban on the sale of turtles with a carapace of less than 4 inches, local health and environmental officials must consider the potential for infections transmitted by turtles that are sold illegally.

Continuum of Eating Disorders Seen

Subclinical eating disorders were diagnosed in 7% of 259 female students aged 17–20 years, reported Paolo Cotrufo, Ph.D., of the University of Naples, Caserta, Italy, and associates.

The investigators sought to characterize less severe forms of eating disorders. The girls completed a sociodemographic questionnaire, the General Health Questionnaire, and the Eating Disorder Inventory 2 (EDI 2). The EDI 2 consists of 11 subscales, including drive for thinness, bulimia, and body dissatisfaction. Two psychologists interviewed the 49 girls who scored at least 14 on the drive for thinness scale. Each girl completed the EDI 2 Symptom Checklist, which measures eating attitudes, compensatory strategies, and menstrual regularity (J. Adolesc. 2005;28:147–54).

Two girls met the criteria for full-blown bulimia nervosa, nine met partial criteria for bulimia, one met partial criteria for binge-eating disorder, 15 met the criteria for subclinical anorexia, and three met the criteria for subclinical bulimia. The other 19 were false-positive cases. The higher prevalence of subclinical anorexia vs. full and partial bulimia suggests that eating disorders might begin with the psychopathology of anorexia and evolve toward bulimia.

E. coli in Acute Gastroenteritis

Diarrheagenic Escherichia coli was isolated significantly more often in children with acute gastroenteritis in an emergency department, compared with inpatients and controls, said Mitchell B. Cohen, M.D., of Cincinnati Children's Hospital Medical Center, and his associates. In a study of 684 children who presented to an emergency department, 643 inpatient children, and 555 controls, the investigators used DNA probes to evaluate stool samples. A majority in each group was aged 5 years or younger (J. Pediatr. 2005;146:54–61).

Diarrheagenic E. coli was present in 167 (24%) of 684 ED patients, compared with 78 (14%) of 555 control patients. However, there was no significant difference in prevalence of E. coli between the inpatients (13%) and controls (14%). There also was no significant difference in prevalence of E. coli between the inpatients and controls in the subset aged 5 years and younger (13.5% vs. 15.4%). In addition, the researchers found a significantly high isolation rate of enteroaggregative E. coli in ED patients less than 1 year old, compared with controls (10% vs. 1.4%). “Diarrheagenic E. coli may be an important, unrecognized cause of diarrhea in children in the [United States], perhaps accounting for 10% of all acute gastroenteritis,” the investigators said. Rotavirus was the most common single etiologic agent, found in 20.3% of inpatients and 20.2% of ED patients, compared with 1.1% of controls.

Antipsychotic Use in Young Children

Nearly one-quarter of insurance claims in 2001 for atypical antipsychotics in youth aged 19 years and younger were for children aged 9 years and younger, said Lesley H. Curtis, Ph.D., of Duke University Medical Center in Durham, N.C., and colleagues.

The investigators reviewed the administrative claims database of AdvancePCS, a large pharmaceutical benefits manager, for claims from January through December 2001 and evaluated claims for five drugs: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) (Arch. Pediatr. Adolesc. Med. 2005;159:362–6). Of 16,599 claims reported for patients aged 19 years and younger, 3,830 were for children aged 9 years and younger, and 80% of the subgroup 9 years and younger were boys.

Salmonella From Turtles

Small pet turtles were linked to four cases of salmonella in children in 2004, according to the Centers for Disease Control and Prevention and the public health departments of Wisconsin and Wyoming (MMWR 2005;54:223–6).

A 4-year-old girl from Kansas developed diarrhea and a 4-day fever shortly after vacationing in Wisconsin and purchasing a small turtle at a souvenir store. The girl was treated with trimethoprim/sulfamethoxazole for 3 days and had recovered after 5 days. A 2-year-old boy and a 10-year-old boy in Wisconsin developed similar symptoms, including diarrhea and fever, which were traced to pet turtles purchased from different souvenir shops in Wisconsin.

In addition, a 6-year-old boy in Wyoming presented with nausea, diarrhea, vomiting, and a persistent fever. A stool sample yielded Salmonella typhimurium, which was traced to the boy's two pet turtles. Although salmonella infections generally resolve after mild gastroenteritis, they can develop into serious illnesses.

Despite a Food and Drug Administration ban on the sale of turtles with a carapace of less than 4 inches, local health and environmental officials must consider the potential for infections transmitted by turtles that are sold illegally.

Continuum of Eating Disorders Seen

Subclinical eating disorders were diagnosed in 7% of 259 female students aged 17–20 years, reported Paolo Cotrufo, Ph.D., of the University of Naples, Caserta, Italy, and associates.

The investigators sought to characterize less severe forms of eating disorders. The girls completed a sociodemographic questionnaire, the General Health Questionnaire, and the Eating Disorder Inventory 2 (EDI 2). The EDI 2 consists of 11 subscales, including drive for thinness, bulimia, and body dissatisfaction. Two psychologists interviewed the 49 girls who scored at least 14 on the drive for thinness scale. Each girl completed the EDI 2 Symptom Checklist, which measures eating attitudes, compensatory strategies, and menstrual regularity (J. Adolesc. 2005;28:147–54).

Two girls met the criteria for full-blown bulimia nervosa, nine met partial criteria for bulimia, one met partial criteria for binge-eating disorder, 15 met the criteria for subclinical anorexia, and three met the criteria for subclinical bulimia. The other 19 were false-positive cases. The higher prevalence of subclinical anorexia vs. full and partial bulimia suggests that eating disorders might begin with the psychopathology of anorexia and evolve toward bulimia.

E. coli in Acute Gastroenteritis

Diarrheagenic Escherichia coli was isolated significantly more often in children with acute gastroenteritis in an emergency department, compared with inpatients and controls, said Mitchell B. Cohen, M.D., of Cincinnati Children's Hospital Medical Center, and his associates. In a study of 684 children who presented to an emergency department, 643 inpatient children, and 555 controls, the investigators used DNA probes to evaluate stool samples. A majority in each group was aged 5 years or younger (J. Pediatr. 2005;146:54–61).

Diarrheagenic E. coli was present in 167 (24%) of 684 ED patients, compared with 78 (14%) of 555 control patients. However, there was no significant difference in prevalence of E. coli between the inpatients (13%) and controls (14%). There also was no significant difference in prevalence of E. coli between the inpatients and controls in the subset aged 5 years and younger (13.5% vs. 15.4%). In addition, the researchers found a significantly high isolation rate of enteroaggregative E. coli in ED patients less than 1 year old, compared with controls (10% vs. 1.4%). “Diarrheagenic E. coli may be an important, unrecognized cause of diarrhea in children in the [United States], perhaps accounting for 10% of all acute gastroenteritis,” the investigators said. Rotavirus was the most common single etiologic agent, found in 20.3% of inpatients and 20.2% of ED patients, compared with 1.1% of controls.

Antipsychotic Use in Young Children

Nearly one-quarter of insurance claims in 2001 for atypical antipsychotics in youth aged 19 years and younger were for children aged 9 years and younger, said Lesley H. Curtis, Ph.D., of Duke University Medical Center in Durham, N.C., and colleagues.

The investigators reviewed the administrative claims database of AdvancePCS, a large pharmaceutical benefits manager, for claims from January through December 2001 and evaluated claims for five drugs: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) (Arch. Pediatr. Adolesc. Med. 2005;159:362–6). Of 16,599 claims reported for patients aged 19 years and younger, 3,830 were for children aged 9 years and younger, and 80% of the subgroup 9 years and younger were boys.

Salmonella From Turtles

Small pet turtles were linked to four cases of salmonella in children in 2004, according to the Centers for Disease Control and Prevention and the public health departments of Wisconsin and Wyoming (MMWR 2005;54:223–6).

A 4-year-old girl from Kansas developed diarrhea and a 4-day fever shortly after vacationing in Wisconsin and purchasing a small turtle at a souvenir store. The girl was treated with trimethoprim/sulfamethoxazole for 3 days and had recovered after 5 days. A 2-year-old boy and a 10-year-old boy in Wisconsin developed similar symptoms, including diarrhea and fever, which were traced to pet turtles purchased from different souvenir shops in Wisconsin.

In addition, a 6-year-old boy in Wyoming presented with nausea, diarrhea, vomiting, and a persistent fever. A stool sample yielded Salmonella typhimurium, which was traced to the boy's two pet turtles. Although salmonella infections generally resolve after mild gastroenteritis, they can develop into serious illnesses.

Despite a Food and Drug Administration ban on the sale of turtles with a carapace of less than 4 inches, local health and environmental officials must consider the potential for infections transmitted by turtles that are sold illegally.

Continuum of Eating Disorders Seen

Subclinical eating disorders were diagnosed in 7% of 259 female students aged 17–20 years, reported Paolo Cotrufo, Ph.D., of the University of Naples, Caserta, Italy, and associates.

The investigators sought to characterize less severe forms of eating disorders. The girls completed a sociodemographic questionnaire, the General Health Questionnaire, and the Eating Disorder Inventory 2 (EDI 2). The EDI 2 consists of 11 subscales, including drive for thinness, bulimia, and body dissatisfaction. Two psychologists interviewed the 49 girls who scored at least 14 on the drive for thinness scale. Each girl completed the EDI 2 Symptom Checklist, which measures eating attitudes, compensatory strategies, and menstrual regularity (J. Adolesc. 2005;28:147–54).

Two girls met the criteria for full-blown bulimia nervosa, nine met partial criteria for bulimia, one met partial criteria for binge-eating disorder, 15 met the criteria for subclinical anorexia, and three met the criteria for subclinical bulimia. The other 19 were false-positive cases. The higher prevalence of subclinical anorexia vs. full and partial bulimia suggests that eating disorders might begin with the psychopathology of anorexia and evolve toward bulimia.

A Toast for the Aging Brain

A drink a day appears to protect elderly women from cognitive decline, according to new data from the ongoing Nurses' Health Study.

During a 2-year follow-up study, interviewers administered four cognitive tests to more than 11,000 women aged 70-81 years, said Meir Stampfer, M.D., of Brigham and Women's Hospital, Boston, and colleagues. They found that moderate drinkers (about one drink/day) had a 20% lower risk of cognitive decline than nondrinkers or those who drank two or more drinks/day. Both wine and beer were associated with the protective effect (N. Engl. J. Med. 2005;3:245-53).

Moderate alcohol intake elevates the HDL cholesterol level and reduces the level of fibrinogen and other thrombic factors. “Thus, moderate intake of alcohol may help preserve brain vasculature, may prevent subclinical strokes and could thus result in better cognitive function,” the authors said.

Denis Evans, M.D., of Rush University, Chicago, said in an accompanying editorial: “Persons seeking to maximize cognition in old age must keep in mind both the uncertainty of the current results and the knowledge that alcohol consumption can be a double-edged sword, with the dangers of overindulgence being all too familiar.”

Symptoms Predict Hysterectomy

Persistence of symptoms and dissatisfaction with their health are significant predictors of hysterectomy in women with fibroids.

A total of 633 ethnically diverse women with fibroids who sought care were followed for 2 years. They completed questionnaires about quality of life and their interest in a hysterectomy, investigators wrote in a poster presented at an international conference on uterine leiomyoma research sponsored by the National Institutes of Health.

A total of 58 women had a hysterectomy by the end of 2 years. Overall, baseline dissatisfaction with health and persistence of symptoms were highly predictive of hysterectomy in a multivariate analysis, with odds ratios of 2.54 and 3.11, respectively.

The most frequently reported symptoms were bleeding (58%), pressure (24%), and pain (19%), said Miriam Kuppermann, Ph.D., and her associates at the University of California, San Francisco.

At baseline, 43% of the women said they felt their pelvic problems remained unresolved, and 13% were “mostly” or “very” dissatisfied with their health. In addition, 29% reported that pelvic problems interfered “a lot” with their sex lives.

Women's CV Risk Underestimated

Fewer than 20% of 500 physicians participating in a national survey realized that heart disease kills more women than men every year. When assessing hypothetical patient profiles, many of the physicians surveyed consistently underestimated cardiovascular risk and failed to prescribe recommended treatments for women.

A total of 300 primary care physicians, 100 cardiologists, and 100 ob.gyns. participated in the 30-minute online survey in late 2004. These physicians had been in full-time clinical practice for a mean of 17 years. A total of 81% of the primary care physicians, 85% of the ob.gyns., and 98% of the cardiologists were men, according to Lori Mosca, M.D., of Columbia University College of Physicians and Surgeons, New York, and her associates (Circulation 2005;111:499-510).

Only 8% of the primary care physicians, 13% of the ob.gyns., and 17% of the cardiologists recognized that every year heart disease kills more women (nearly 500,000) than men. When assessing hypothetical case profiles, physicians in all three specialties designated women as lower risk than men who had identical risk profiles. They also were much more likely to correctly categorize cardiovascular risks of male patients than of female patients and to correctly prescribe recommended treatments to men, the investigators said.

Excessive Vomiting Poses OB Problems

Women who experienced hyperemesis gravidarum had a significantly increased risk of preeclampsia, compared with controls, wrote Michele Soltis, M.D., and colleagues in a poster presented at the annual meeting of the American College of Preventive Medicine. In this retrospective study, Dr. Soltis of Madigan Army Medical Center in Tacoma, Washington, and her associates compared 4,808 women hospitalized for hyperemesis gravidarum with 9,616 controls and calculated the relative risks for certain obstetric outcomes.

Women with hyperemesis gravidarum had relative risks of 1.3 for preeclampsia, 1.3 for infant birth weight less than 2,500 g, and 2.1 for premature deliveries before 28 weeks' gestation. The relative risk of premature delivery at 28-32 weeks or at 33-36 weeks was 1.5.

A Toast for the Aging Brain

A drink a day appears to protect elderly women from cognitive decline, according to new data from the ongoing Nurses' Health Study.

During a 2-year follow-up study, interviewers administered four cognitive tests to more than 11,000 women aged 70-81 years, said Meir Stampfer, M.D., of Brigham and Women's Hospital, Boston, and colleagues. They found that moderate drinkers (about one drink/day) had a 20% lower risk of cognitive decline than nondrinkers or those who drank two or more drinks/day. Both wine and beer were associated with the protective effect (N. Engl. J. Med. 2005;3:245-53).

Moderate alcohol intake elevates the HDL cholesterol level and reduces the level of fibrinogen and other thrombic factors. “Thus, moderate intake of alcohol may help preserve brain vasculature, may prevent subclinical strokes and could thus result in better cognitive function,” the authors said.

Denis Evans, M.D., of Rush University, Chicago, said in an accompanying editorial: “Persons seeking to maximize cognition in old age must keep in mind both the uncertainty of the current results and the knowledge that alcohol consumption can be a double-edged sword, with the dangers of overindulgence being all too familiar.”

Symptoms Predict Hysterectomy

Persistence of symptoms and dissatisfaction with their health are significant predictors of hysterectomy in women with fibroids.

A total of 633 ethnically diverse women with fibroids who sought care were followed for 2 years. They completed questionnaires about quality of life and their interest in a hysterectomy, investigators wrote in a poster presented at an international conference on uterine leiomyoma research sponsored by the National Institutes of Health.

A total of 58 women had a hysterectomy by the end of 2 years. Overall, baseline dissatisfaction with health and persistence of symptoms were highly predictive of hysterectomy in a multivariate analysis, with odds ratios of 2.54 and 3.11, respectively.

The most frequently reported symptoms were bleeding (58%), pressure (24%), and pain (19%), said Miriam Kuppermann, Ph.D., and her associates at the University of California, San Francisco.

At baseline, 43% of the women said they felt their pelvic problems remained unresolved, and 13% were “mostly” or “very” dissatisfied with their health. In addition, 29% reported that pelvic problems interfered “a lot” with their sex lives.

Women's CV Risk Underestimated

Fewer than 20% of 500 physicians participating in a national survey realized that heart disease kills more women than men every year. When assessing hypothetical patient profiles, many of the physicians surveyed consistently underestimated cardiovascular risk and failed to prescribe recommended treatments for women.

A total of 300 primary care physicians, 100 cardiologists, and 100 ob.gyns. participated in the 30-minute online survey in late 2004. These physicians had been in full-time clinical practice for a mean of 17 years. A total of 81% of the primary care physicians, 85% of the ob.gyns., and 98% of the cardiologists were men, according to Lori Mosca, M.D., of Columbia University College of Physicians and Surgeons, New York, and her associates (Circulation 2005;111:499-510).

Only 8% of the primary care physicians, 13% of the ob.gyns., and 17% of the cardiologists recognized that every year heart disease kills more women (nearly 500,000) than men. When assessing hypothetical case profiles, physicians in all three specialties designated women as lower risk than men who had identical risk profiles. They also were much more likely to correctly categorize cardiovascular risks of male patients than of female patients and to correctly prescribe recommended treatments to men, the investigators said.

Excessive Vomiting Poses OB Problems

Women who experienced hyperemesis gravidarum had a significantly increased risk of preeclampsia, compared with controls, wrote Michele Soltis, M.D., and colleagues in a poster presented at the annual meeting of the American College of Preventive Medicine. In this retrospective study, Dr. Soltis of Madigan Army Medical Center in Tacoma, Washington, and her associates compared 4,808 women hospitalized for hyperemesis gravidarum with 9,616 controls and calculated the relative risks for certain obstetric outcomes.

Women with hyperemesis gravidarum had relative risks of 1.3 for preeclampsia, 1.3 for infant birth weight less than 2,500 g, and 2.1 for premature deliveries before 28 weeks' gestation. The relative risk of premature delivery at 28-32 weeks or at 33-36 weeks was 1.5.

A Toast for the Aging Brain

A drink a day appears to protect elderly women from cognitive decline, according to new data from the ongoing Nurses' Health Study.

During a 2-year follow-up study, interviewers administered four cognitive tests to more than 11,000 women aged 70-81 years, said Meir Stampfer, M.D., of Brigham and Women's Hospital, Boston, and colleagues. They found that moderate drinkers (about one drink/day) had a 20% lower risk of cognitive decline than nondrinkers or those who drank two or more drinks/day. Both wine and beer were associated with the protective effect (N. Engl. J. Med. 2005;3:245-53).

Moderate alcohol intake elevates the HDL cholesterol level and reduces the level of fibrinogen and other thrombic factors. “Thus, moderate intake of alcohol may help preserve brain vasculature, may prevent subclinical strokes and could thus result in better cognitive function,” the authors said.

Denis Evans, M.D., of Rush University, Chicago, said in an accompanying editorial: “Persons seeking to maximize cognition in old age must keep in mind both the uncertainty of the current results and the knowledge that alcohol consumption can be a double-edged sword, with the dangers of overindulgence being all too familiar.”

Symptoms Predict Hysterectomy

Persistence of symptoms and dissatisfaction with their health are significant predictors of hysterectomy in women with fibroids.

A total of 633 ethnically diverse women with fibroids who sought care were followed for 2 years. They completed questionnaires about quality of life and their interest in a hysterectomy, investigators wrote in a poster presented at an international conference on uterine leiomyoma research sponsored by the National Institutes of Health.

A total of 58 women had a hysterectomy by the end of 2 years. Overall, baseline dissatisfaction with health and persistence of symptoms were highly predictive of hysterectomy in a multivariate analysis, with odds ratios of 2.54 and 3.11, respectively.

The most frequently reported symptoms were bleeding (58%), pressure (24%), and pain (19%), said Miriam Kuppermann, Ph.D., and her associates at the University of California, San Francisco.

At baseline, 43% of the women said they felt their pelvic problems remained unresolved, and 13% were “mostly” or “very” dissatisfied with their health. In addition, 29% reported that pelvic problems interfered “a lot” with their sex lives.

Women's CV Risk Underestimated

Fewer than 20% of 500 physicians participating in a national survey realized that heart disease kills more women than men every year. When assessing hypothetical patient profiles, many of the physicians surveyed consistently underestimated cardiovascular risk and failed to prescribe recommended treatments for women.

A total of 300 primary care physicians, 100 cardiologists, and 100 ob.gyns. participated in the 30-minute online survey in late 2004. These physicians had been in full-time clinical practice for a mean of 17 years. A total of 81% of the primary care physicians, 85% of the ob.gyns., and 98% of the cardiologists were men, according to Lori Mosca, M.D., of Columbia University College of Physicians and Surgeons, New York, and her associates (Circulation 2005;111:499-510).

Only 8% of the primary care physicians, 13% of the ob.gyns., and 17% of the cardiologists recognized that every year heart disease kills more women (nearly 500,000) than men. When assessing hypothetical case profiles, physicians in all three specialties designated women as lower risk than men who had identical risk profiles. They also were much more likely to correctly categorize cardiovascular risks of male patients than of female patients and to correctly prescribe recommended treatments to men, the investigators said.

Excessive Vomiting Poses OB Problems

Women who experienced hyperemesis gravidarum had a significantly increased risk of preeclampsia, compared with controls, wrote Michele Soltis, M.D., and colleagues in a poster presented at the annual meeting of the American College of Preventive Medicine. In this retrospective study, Dr. Soltis of Madigan Army Medical Center in Tacoma, Washington, and her associates compared 4,808 women hospitalized for hyperemesis gravidarum with 9,616 controls and calculated the relative risks for certain obstetric outcomes.

Women with hyperemesis gravidarum had relative risks of 1.3 for preeclampsia, 1.3 for infant birth weight less than 2,500 g, and 2.1 for premature deliveries before 28 weeks' gestation. The relative risk of premature delivery at 28-32 weeks or at 33-36 weeks was 1.5.

Calcium and Colorectal Cancer Risk

High intake of dietary calcium in women is significantly associated with reduction in the risk of colorectal cancer in a dose-response fashion, according to a report by Andrew Flood, Ph.D., of the University of Minnesota, Minneapolis, and his colleagues.

In a prospective cohort of 45,354 women who completed dietary questionnaires over an average of 8.5 years, those in the highest quintile of calcium consumption (median 985 mg /day) had a significant, 26% reduction in risk of colorectal cancer, compared with women in the lowest quintile (median of 337 mg /day), after adjustment for age. Supplemental calcium alone did not show the same dose-response relationship with colorectal cancer risk.

But women who had high intakes of calcium from their diet and supplements had a significant, 46% reduction in the risk of colorectal cancer after adjustment for age. None of the associations changed after adjustment for other confounding factors (Cancer Epidemiol. Biomarkers Prev. 2005;14:126-32).

Black Women and HIV

Black women account for the majority of new cases of HIV and AIDS among U.S. women, and this is particularly true in North Carolina, according to the Centers for Disease Control and Prevention.

In 2003, the HIV infection rate in that state was 14 times higher for black women, compared with white women (MMWR 2005;54:89-94).

An epidemiologic investigation of 31 of the 208 black women aged 18-40 years in North Carolina who were diagnosed with HIV between January 2003 and August 2004 and 101 controls showed that most women in both groups engaged in HIV sexual risk behaviors. Those receiving public assistance were more likely to be HIV positive (adjusted odds ratio 7.3), as were those with a history of genital herpes (adjusted OR 10.6). Women who discussed sexual behaviors and history with their male partners were less likely to be HIV positive (adjusted OR 0.6).

The most common reasons given for engaging in risky sexual behaviors were financial dependence on male partners, feeling invincible, low self-esteem, coupled with a need to feel loved by a male and alcohol/drug use.

The findings underscore the need for a multifaceted approach to reducing HIV infection among black women, including programs that encourage delayed sexual activity, condom use, monogamy, and communication.

Improved availability of HIV and STD testing and treatment and attention to the economic constraints that appear to contribute to increased HIV risk in black women are also needed, according to the CDC.

Resistant UTIs

Urinary tract infections caused by drug-resistant Escherichia coli may have an animal origin, Meena Ramchandani, M.D., of the University of California, Berkeley, and colleagues reported.

A number of cases across the United States caused by a trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant E. coli strain belonging to a single clonal group sparked concerns about a possible association with contaminated food products.

An investigation of 495 animal isolates showed that 128 had an electrophoretic pattern indistinguishable from that of the resistant strain in humans, and 14 of those were TMP-SMZ resistant. One, from a cow, was 94% similar to the pattern of a uropathogenic E. coli strain recovered from a human patient (Clin. Infect. Dis. 2005;40:251-7).

However, in an editorial, Thomas Hooten, M.D., and Mansour Samadpour, M.D., of the University of Washington, Seattle, said that although they agree with the basic premise of the article, the study failed to provide clear epidemiologic linkage between the strains (Clin. Infect. Dis. 2005;40:258-9).

Health Advisory Issued for Nevirapine

The Food and Drug Administration has issued a public health advisory to alert physicians to label changes for nevirapine (Viramune), addressing an increased risk of liver toxicity in certain women.

The Indications and Usage section of the HIV drug's label now cautions against starting nevirapine treatment in women with CD4+ cell counts greater than 250 cells/μL unless benefits clearly outweigh risks.

The recommendation is based on a higher observed risk of serious liver toxicity in patients with higher CD4+ cell counts prior to the initiation of therapy. The revised label also includes a medication guide informing patients of the risks associated with nevirapine when used to treat HIV.

The advisory is available at

www.fda.gov/cder/drug/advisory/nevirapine.htm

Calcium and Colorectal Cancer Risk

High intake of dietary calcium in women is significantly associated with reduction in the risk of colorectal cancer in a dose-response fashion, according to a report by Andrew Flood, Ph.D., of the University of Minnesota, Minneapolis, and his colleagues.

In a prospective cohort of 45,354 women who completed dietary questionnaires over an average of 8.5 years, those in the highest quintile of calcium consumption (median 985 mg /day) had a significant, 26% reduction in risk of colorectal cancer, compared with women in the lowest quintile (median of 337 mg /day), after adjustment for age. Supplemental calcium alone did not show the same dose-response relationship with colorectal cancer risk.

But women who had high intakes of calcium from their diet and supplements had a significant, 46% reduction in the risk of colorectal cancer after adjustment for age. None of the associations changed after adjustment for other confounding factors (Cancer Epidemiol. Biomarkers Prev. 2005;14:126-32).

Black Women and HIV

Black women account for the majority of new cases of HIV and AIDS among U.S. women, and this is particularly true in North Carolina, according to the Centers for Disease Control and Prevention.

In 2003, the HIV infection rate in that state was 14 times higher for black women, compared with white women (MMWR 2005;54:89-94).

An epidemiologic investigation of 31 of the 208 black women aged 18-40 years in North Carolina who were diagnosed with HIV between January 2003 and August 2004 and 101 controls showed that most women in both groups engaged in HIV sexual risk behaviors. Those receiving public assistance were more likely to be HIV positive (adjusted odds ratio 7.3), as were those with a history of genital herpes (adjusted OR 10.6). Women who discussed sexual behaviors and history with their male partners were less likely to be HIV positive (adjusted OR 0.6).

The most common reasons given for engaging in risky sexual behaviors were financial dependence on male partners, feeling invincible, low self-esteem, coupled with a need to feel loved by a male and alcohol/drug use.

The findings underscore the need for a multifaceted approach to reducing HIV infection among black women, including programs that encourage delayed sexual activity, condom use, monogamy, and communication.

Improved availability of HIV and STD testing and treatment and attention to the economic constraints that appear to contribute to increased HIV risk in black women are also needed, according to the CDC.

Resistant UTIs

Urinary tract infections caused by drug-resistant Escherichia coli may have an animal origin, Meena Ramchandani, M.D., of the University of California, Berkeley, and colleagues reported.

A number of cases across the United States caused by a trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant E. coli strain belonging to a single clonal group sparked concerns about a possible association with contaminated food products.

An investigation of 495 animal isolates showed that 128 had an electrophoretic pattern indistinguishable from that of the resistant strain in humans, and 14 of those were TMP-SMZ resistant. One, from a cow, was 94% similar to the pattern of a uropathogenic E. coli strain recovered from a human patient (Clin. Infect. Dis. 2005;40:251-7).

However, in an editorial, Thomas Hooten, M.D., and Mansour Samadpour, M.D., of the University of Washington, Seattle, said that although they agree with the basic premise of the article, the study failed to provide clear epidemiologic linkage between the strains (Clin. Infect. Dis. 2005;40:258-9).

Health Advisory Issued for Nevirapine

The Food and Drug Administration has issued a public health advisory to alert physicians to label changes for nevirapine (Viramune), addressing an increased risk of liver toxicity in certain women.

The Indications and Usage section of the HIV drug's label now cautions against starting nevirapine treatment in women with CD4+ cell counts greater than 250 cells/μL unless benefits clearly outweigh risks.

The recommendation is based on a higher observed risk of serious liver toxicity in patients with higher CD4+ cell counts prior to the initiation of therapy. The revised label also includes a medication guide informing patients of the risks associated with nevirapine when used to treat HIV.

The advisory is available at

www.fda.gov/cder/drug/advisory/nevirapine.htm

Calcium and Colorectal Cancer Risk

High intake of dietary calcium in women is significantly associated with reduction in the risk of colorectal cancer in a dose-response fashion, according to a report by Andrew Flood, Ph.D., of the University of Minnesota, Minneapolis, and his colleagues.

In a prospective cohort of 45,354 women who completed dietary questionnaires over an average of 8.5 years, those in the highest quintile of calcium consumption (median 985 mg /day) had a significant, 26% reduction in risk of colorectal cancer, compared with women in the lowest quintile (median of 337 mg /day), after adjustment for age. Supplemental calcium alone did not show the same dose-response relationship with colorectal cancer risk.

But women who had high intakes of calcium from their diet and supplements had a significant, 46% reduction in the risk of colorectal cancer after adjustment for age. None of the associations changed after adjustment for other confounding factors (Cancer Epidemiol. Biomarkers Prev. 2005;14:126-32).

Black Women and HIV

Black women account for the majority of new cases of HIV and AIDS among U.S. women, and this is particularly true in North Carolina, according to the Centers for Disease Control and Prevention.

In 2003, the HIV infection rate in that state was 14 times higher for black women, compared with white women (MMWR 2005;54:89-94).

An epidemiologic investigation of 31 of the 208 black women aged 18-40 years in North Carolina who were diagnosed with HIV between January 2003 and August 2004 and 101 controls showed that most women in both groups engaged in HIV sexual risk behaviors. Those receiving public assistance were more likely to be HIV positive (adjusted odds ratio 7.3), as were those with a history of genital herpes (adjusted OR 10.6). Women who discussed sexual behaviors and history with their male partners were less likely to be HIV positive (adjusted OR 0.6).

The most common reasons given for engaging in risky sexual behaviors were financial dependence on male partners, feeling invincible, low self-esteem, coupled with a need to feel loved by a male and alcohol/drug use.

The findings underscore the need for a multifaceted approach to reducing HIV infection among black women, including programs that encourage delayed sexual activity, condom use, monogamy, and communication.

Improved availability of HIV and STD testing and treatment and attention to the economic constraints that appear to contribute to increased HIV risk in black women are also needed, according to the CDC.

Resistant UTIs

Urinary tract infections caused by drug-resistant Escherichia coli may have an animal origin, Meena Ramchandani, M.D., of the University of California, Berkeley, and colleagues reported.

A number of cases across the United States caused by a trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant E. coli strain belonging to a single clonal group sparked concerns about a possible association with contaminated food products.

An investigation of 495 animal isolates showed that 128 had an electrophoretic pattern indistinguishable from that of the resistant strain in humans, and 14 of those were TMP-SMZ resistant. One, from a cow, was 94% similar to the pattern of a uropathogenic E. coli strain recovered from a human patient (Clin. Infect. Dis. 2005;40:251-7).

However, in an editorial, Thomas Hooten, M.D., and Mansour Samadpour, M.D., of the University of Washington, Seattle, said that although they agree with the basic premise of the article, the study failed to provide clear epidemiologic linkage between the strains (Clin. Infect. Dis. 2005;40:258-9).

Health Advisory Issued for Nevirapine

The Food and Drug Administration has issued a public health advisory to alert physicians to label changes for nevirapine (Viramune), addressing an increased risk of liver toxicity in certain women.

The Indications and Usage section of the HIV drug's label now cautions against starting nevirapine treatment in women with CD4+ cell counts greater than 250 cells/μL unless benefits clearly outweigh risks.

The recommendation is based on a higher observed risk of serious liver toxicity in patients with higher CD4+ cell counts prior to the initiation of therapy. The revised label also includes a medication guide informing patients of the risks associated with nevirapine when used to treat HIV.

The advisory is available at

www.fda.gov/cder/drug/advisory/nevirapine.htm

Varicella Vaccination Cuts Mortality

Mortality due to varicella fell from an average of 0.32 deaths per million between 1990 and 1994 to an average of 0.07 deaths per million between 1999 and 2001 among children aged 1-4 years, as a result of the adoption of universal childhood varicella vaccination in the United States, with the lowest rates for all groups in 2001, said Huong Q. Nguyen and colleagues at the Centers for Disease Control and Prevention (N. Engl. J. Med. 2005;352:450-8).

In addition, deaths due to varicella fell significantly among children aged 10-19 years (67%) and among infants (66%) between the two periods. Among children at high risk due to preexisting conditions, the decline in mortality was 100% in those aged 1-4 years and in those aged 5-9 years; however, children with preexisting conditions might have received aggressive treatment when they developed varicella, the researchers noted.

Overall, mortality was similar across racial and ethnic groups and similar among children born in the United States, compared with foreign-born children, they reported.

Refractory Epilepsy's Costs for Kids

Controlling seizures often lessens behavioral and neuropsychological problems ubiquitous in children with refractory epilepsy, said Marc Boel, M.D., of University Hospitals Gasthuisberg, Leuven, Belgium. Among 573 such children seen in his clinic, 80% showed behavioral problems, and 15% showed significant mental decline related to their epilepsy. About half of the entire group had an IQ below 50 (Eur. J. Pediatr. Neurol. 2005;8:291-7).

Most children had either partial epilepsy (29%) or secondary generalized tonic-clonic epilepsy (25%). About 4% had Lennox-Gastaut syndrome. Other diagnoses included absence, photosensitive epilepsies, tuberous sclerosis, West's syndrome, severe myoclonic epilepsy of infancy, and continuous spike waves during slow-wave sleep.

The most frequent neurobehavioral disorders were pervasive developmental disorder (8%); attention-deficit hyperactivity disorder (7.5%); loss of self-esteem (9%), and self-induction of seizures (7%). Psychosis, anxiety disorders, intermittent explosive disorder, and cursive seizures were seen at lower rates.

Seizure control contributes greatly to reducing these symptoms, Dr. Boel said. In 101 of the 220 children who achieved seizure control, behavioral problems disappeared or were minimized. Seizure control had only a limited effect on patients with mental decline, psychosis, pervasive developmental disorder, or attention disorders.

Hostility Drives Smoking Initiation

An interaction between depressive symptoms and hostility was strongly associated with initiation of smoking in middle school students, reported Jie Wu Weiss, Ph.D., and colleagues at the University of Southern California, Alhambra.

Adolescents who have difficulty controlling their anger often use smoking as a coping mechanism, the researchers noted. An ethnically diverse sample of 1,699 students completed 160-item surveys in both the sixth and seventh grades (J. Adolesc. 2005;28:49-62). Overall, 141 children (8.3%) said they had smoked at least once by sixth grade. Compared with those who had never smoked, those who had smoked scored significantly higher on baseline depressive symptoms, hostility, and socioeconomic status. An additional 141 of the original never-smokers reported smoking at least once by seventh grade, and higher depression and hostility scores at baseline were significantly associated with smoking initiation.

Romantic Stress in Teen Girls

Highly sensitive teenage girls are more likely to develop depression in response to romantic stress, Shannon E. Daley, Ph.D., said at a meeting sponsored by the Society for Research on Adolescence.

In this longitudinal study, 87 girls were studied using questionnaires and telephone interviews; 21% were African American, and 79% were Hispanic. Data were collected 6 months apart, and the measuring tools used were the Structured Clinical Interview for DSM-IV, the Interpersonal Sensitivity Measure, the Chronic Strain Interview, and the Episodic Stress Interview.

Participants, who were 16 years old, were questioned about romantic life events, and their lifetime history of depression was evaluated at the start of the study. Chronic romantic stress was assessed over the 6-month follow-up period, along with any more depressive symptoms, reported Dr. Daley of the University of Southern California.

“Girls who experience a heightened sensitivity to interpersonal processes are especially likely to become depressed when confronted with romantic stress or low-quality romantic relationships,” the researchers concluded.

Varicella Vaccination Cuts Mortality

Mortality due to varicella fell from an average of 0.32 deaths per million between 1990 and 1994 to an average of 0.07 deaths per million between 1999 and 2001 among children aged 1-4 years, as a result of the adoption of universal childhood varicella vaccination in the United States, with the lowest rates for all groups in 2001, said Huong Q. Nguyen and colleagues at the Centers for Disease Control and Prevention (N. Engl. J. Med. 2005;352:450-8).

In addition, deaths due to varicella fell significantly among children aged 10-19 years (67%) and among infants (66%) between the two periods. Among children at high risk due to preexisting conditions, the decline in mortality was 100% in those aged 1-4 years and in those aged 5-9 years; however, children with preexisting conditions might have received aggressive treatment when they developed varicella, the researchers noted.

Overall, mortality was similar across racial and ethnic groups and similar among children born in the United States, compared with foreign-born children, they reported.

Refractory Epilepsy's Costs for Kids

Controlling seizures often lessens behavioral and neuropsychological problems ubiquitous in children with refractory epilepsy, said Marc Boel, M.D., of University Hospitals Gasthuisberg, Leuven, Belgium. Among 573 such children seen in his clinic, 80% showed behavioral problems, and 15% showed significant mental decline related to their epilepsy. About half of the entire group had an IQ below 50 (Eur. J. Pediatr. Neurol. 2005;8:291-7).

Most children had either partial epilepsy (29%) or secondary generalized tonic-clonic epilepsy (25%). About 4% had Lennox-Gastaut syndrome. Other diagnoses included absence, photosensitive epilepsies, tuberous sclerosis, West's syndrome, severe myoclonic epilepsy of infancy, and continuous spike waves during slow-wave sleep.

The most frequent neurobehavioral disorders were pervasive developmental disorder (8%); attention-deficit hyperactivity disorder (7.5%); loss of self-esteem (9%), and self-induction of seizures (7%). Psychosis, anxiety disorders, intermittent explosive disorder, and cursive seizures were seen at lower rates.

Seizure control contributes greatly to reducing these symptoms, Dr. Boel said. In 101 of the 220 children who achieved seizure control, behavioral problems disappeared or were minimized. Seizure control had only a limited effect on patients with mental decline, psychosis, pervasive developmental disorder, or attention disorders.

Hostility Drives Smoking Initiation

An interaction between depressive symptoms and hostility was strongly associated with initiation of smoking in middle school students, reported Jie Wu Weiss, Ph.D., and colleagues at the University of Southern California, Alhambra.

Adolescents who have difficulty controlling their anger often use smoking as a coping mechanism, the researchers noted. An ethnically diverse sample of 1,699 students completed 160-item surveys in both the sixth and seventh grades (J. Adolesc. 2005;28:49-62). Overall, 141 children (8.3%) said they had smoked at least once by sixth grade. Compared with those who had never smoked, those who had smoked scored significantly higher on baseline depressive symptoms, hostility, and socioeconomic status. An additional 141 of the original never-smokers reported smoking at least once by seventh grade, and higher depression and hostility scores at baseline were significantly associated with smoking initiation.

Romantic Stress in Teen Girls

Highly sensitive teenage girls are more likely to develop depression in response to romantic stress, Shannon E. Daley, Ph.D., said at a meeting sponsored by the Society for Research on Adolescence.

In this longitudinal study, 87 girls were studied using questionnaires and telephone interviews; 21% were African American, and 79% were Hispanic. Data were collected 6 months apart, and the measuring tools used were the Structured Clinical Interview for DSM-IV, the Interpersonal Sensitivity Measure, the Chronic Strain Interview, and the Episodic Stress Interview.

Participants, who were 16 years old, were questioned about romantic life events, and their lifetime history of depression was evaluated at the start of the study. Chronic romantic stress was assessed over the 6-month follow-up period, along with any more depressive symptoms, reported Dr. Daley of the University of Southern California.

“Girls who experience a heightened sensitivity to interpersonal processes are especially likely to become depressed when confronted with romantic stress or low-quality romantic relationships,” the researchers concluded.

Varicella Vaccination Cuts Mortality

Mortality due to varicella fell from an average of 0.32 deaths per million between 1990 and 1994 to an average of 0.07 deaths per million between 1999 and 2001 among children aged 1-4 years, as a result of the adoption of universal childhood varicella vaccination in the United States, with the lowest rates for all groups in 2001, said Huong Q. Nguyen and colleagues at the Centers for Disease Control and Prevention (N. Engl. J. Med. 2005;352:450-8).

In addition, deaths due to varicella fell significantly among children aged 10-19 years (67%) and among infants (66%) between the two periods. Among children at high risk due to preexisting conditions, the decline in mortality was 100% in those aged 1-4 years and in those aged 5-9 years; however, children with preexisting conditions might have received aggressive treatment when they developed varicella, the researchers noted.

Overall, mortality was similar across racial and ethnic groups and similar among children born in the United States, compared with foreign-born children, they reported.

Refractory Epilepsy's Costs for Kids

Controlling seizures often lessens behavioral and neuropsychological problems ubiquitous in children with refractory epilepsy, said Marc Boel, M.D., of University Hospitals Gasthuisberg, Leuven, Belgium. Among 573 such children seen in his clinic, 80% showed behavioral problems, and 15% showed significant mental decline related to their epilepsy. About half of the entire group had an IQ below 50 (Eur. J. Pediatr. Neurol. 2005;8:291-7).

Most children had either partial epilepsy (29%) or secondary generalized tonic-clonic epilepsy (25%). About 4% had Lennox-Gastaut syndrome. Other diagnoses included absence, photosensitive epilepsies, tuberous sclerosis, West's syndrome, severe myoclonic epilepsy of infancy, and continuous spike waves during slow-wave sleep.

The most frequent neurobehavioral disorders were pervasive developmental disorder (8%); attention-deficit hyperactivity disorder (7.5%); loss of self-esteem (9%), and self-induction of seizures (7%). Psychosis, anxiety disorders, intermittent explosive disorder, and cursive seizures were seen at lower rates.

Seizure control contributes greatly to reducing these symptoms, Dr. Boel said. In 101 of the 220 children who achieved seizure control, behavioral problems disappeared or were minimized. Seizure control had only a limited effect on patients with mental decline, psychosis, pervasive developmental disorder, or attention disorders.

Hostility Drives Smoking Initiation

An interaction between depressive symptoms and hostility was strongly associated with initiation of smoking in middle school students, reported Jie Wu Weiss, Ph.D., and colleagues at the University of Southern California, Alhambra.

Adolescents who have difficulty controlling their anger often use smoking as a coping mechanism, the researchers noted. An ethnically diverse sample of 1,699 students completed 160-item surveys in both the sixth and seventh grades (J. Adolesc. 2005;28:49-62). Overall, 141 children (8.3%) said they had smoked at least once by sixth grade. Compared with those who had never smoked, those who had smoked scored significantly higher on baseline depressive symptoms, hostility, and socioeconomic status. An additional 141 of the original never-smokers reported smoking at least once by seventh grade, and higher depression and hostility scores at baseline were significantly associated with smoking initiation.

Romantic Stress in Teen Girls

Highly sensitive teenage girls are more likely to develop depression in response to romantic stress, Shannon E. Daley, Ph.D., said at a meeting sponsored by the Society for Research on Adolescence.

In this longitudinal study, 87 girls were studied using questionnaires and telephone interviews; 21% were African American, and 79% were Hispanic. Data were collected 6 months apart, and the measuring tools used were the Structured Clinical Interview for DSM-IV, the Interpersonal Sensitivity Measure, the Chronic Strain Interview, and the Episodic Stress Interview.

Participants, who were 16 years old, were questioned about romantic life events, and their lifetime history of depression was evaluated at the start of the study. Chronic romantic stress was assessed over the 6-month follow-up period, along with any more depressive symptoms, reported Dr. Daley of the University of Southern California.

“Girls who experience a heightened sensitivity to interpersonal processes are especially likely to become depressed when confronted with romantic stress or low-quality romantic relationships,” the researchers concluded.

Define Staph in Neonates

Skin rashes occurred significantly more often among the confirmed and probable Staphylococcus aureus (SA) cases, compared with coagulase-negative staphylococci (CoNS) cases (20% vs. 4%) in a cohort of 191 neonates in intensive care, said C. Mary Healy, M.D., of Baylor College of Medicine, Houston, and her colleagues. Invasive staphylococcal disease remains a risk among preterm and very-low-birth-weight infants, but data on the clinical presentations of these infections are limited. Six of 41 infants with confirmed and probable SA (14%) had significantly more bone and joint complications, compared with 2 of 108 (2%) with CoNS.

Recreational Ritalin on the Rise

Approximately 4% of a national sample of 8th, 10th, and 12th graders reported illicit use of methylphenidate (Ritalin) within the past year, said Sean Esteban McCabe, Ph.D., and his associates at the University of Michigan, Ann Arbor.

Based on data from the 2001 Monitoring the Future Survey, students in grades 10 (4.6%) and 12 (5%) were significantly more likely to report illicit use than were 8th graders (2.7%).

Illegal methylphenidate use was significantly more common among students with grade point averages of C or D (6.4%), compared with those with a B average (3.9%) or A average (2.6%).

In addition, white students (4.8%) were significantly more likely to report illegal use than were black students (0.8%), which mirrored racial differences in prescription patterns (J. Adolesc. Health 2004;35:501–4).

Sleep-Disordered Breathing, Behavior

Children with mild to moderate sleep-disordered breathing demonstrated significantly more problem behaviors, compared with controls in a cross-sectional study of 829 8- to 11-year-olds, said Carol L. Rosen, M.D., of Case Western Reserve University, Cleveland, and her associates.

The children were assessed with unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate. Overall, children with sleep-disordered breathing were at least twice as likely to score in the borderline or clinically abnormal range on the Child Behavior Checklist (CBCL) externalizing and internalizing scales (Pediatrics 2004;114:1640–8).

The children with sleep-disordered breathing were significantly more likely to demonstrate hyperactivity, emotional lability, aggression, and opposition, compared with controls. Black ethnicity was a significant predictor for the CBCL total problem scale, while preterm birth was a significant predictor for the CBCL total and social problem scales and a hyperactivity scale. The significantly higher odds of behavior problems in black children as a subgroup may be the result of a greater vulnerability to sleep disruption in this group, the researchers said.

Talk Therapy for IBD Depression

Adolescents with inflammatory bowel disease and either major or minor depression showed a significant reduction in depressive symptoms after 12 sessions of a manual-based cognitive-behavioral therapy program, reported Eva Szigethy, M.D., of Children's Hospital Boston and her associates.

In a pilot study, 11 adolescents aged 12–17 years participated. Seven patients had Crohn's disease and four had ulcerative colitis, with an average of 40 months' duration. Scores on the Children's Depression Inventory dropped from 16.18 before treatment to 4.82 after treatment. At baseline, all the teens reported depressed mood and anhedonia; ten reported sleep disturbance and fatigue (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469–77).

Although illness severity remained the same, the adolescents' own perception of their physical functioning improved by the end of the study period.

EC Knowledge Doesn't Raise Risk

Knowledge of emergency contraception (EC) was not associated with increased sexual risk-taking according to a telephone survey of 1,158 adolescents aged 14–19 years in Monroe County, N.Y., Dr. Elizabeth Kelts of the University of Rochester (N.Y.) said at the annual meeting of the Association of Reproductive Health Professionals.

Teens were asked whether they were sexually active and, if so, when they became sexually active, and whether they knew of the “morning-after pill.”

Overall, 73% of the teens reported awareness of EC, and 41% reported being sexually active. Sexually active teens who were aware of EC were significantly more likely to have used birth control during their last sexual encounter than were teens not familiar with EC (83% vs. 17%).

The average age of first sex for adolescents aware of EC was slightly older than for those who were not aware of EC (17.6 years vs. 16.7 years).

Define Staph in Neonates

Skin rashes occurred significantly more often among the confirmed and probable Staphylococcus aureus (SA) cases, compared with coagulase-negative staphylococci (CoNS) cases (20% vs. 4%) in a cohort of 191 neonates in intensive care, said C. Mary Healy, M.D., of Baylor College of Medicine, Houston, and her colleagues. Invasive staphylococcal disease remains a risk among preterm and very-low-birth-weight infants, but data on the clinical presentations of these infections are limited. Six of 41 infants with confirmed and probable SA (14%) had significantly more bone and joint complications, compared with 2 of 108 (2%) with CoNS.

Recreational Ritalin on the Rise

Approximately 4% of a national sample of 8th, 10th, and 12th graders reported illicit use of methylphenidate (Ritalin) within the past year, said Sean Esteban McCabe, Ph.D., and his associates at the University of Michigan, Ann Arbor.

Based on data from the 2001 Monitoring the Future Survey, students in grades 10 (4.6%) and 12 (5%) were significantly more likely to report illicit use than were 8th graders (2.7%).

Illegal methylphenidate use was significantly more common among students with grade point averages of C or D (6.4%), compared with those with a B average (3.9%) or A average (2.6%).

In addition, white students (4.8%) were significantly more likely to report illegal use than were black students (0.8%), which mirrored racial differences in prescription patterns (J. Adolesc. Health 2004;35:501–4).

Sleep-Disordered Breathing, Behavior

Children with mild to moderate sleep-disordered breathing demonstrated significantly more problem behaviors, compared with controls in a cross-sectional study of 829 8- to 11-year-olds, said Carol L. Rosen, M.D., of Case Western Reserve University, Cleveland, and her associates.

The children were assessed with unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate. Overall, children with sleep-disordered breathing were at least twice as likely to score in the borderline or clinically abnormal range on the Child Behavior Checklist (CBCL) externalizing and internalizing scales (Pediatrics 2004;114:1640–8).

The children with sleep-disordered breathing were significantly more likely to demonstrate hyperactivity, emotional lability, aggression, and opposition, compared with controls. Black ethnicity was a significant predictor for the CBCL total problem scale, while preterm birth was a significant predictor for the CBCL total and social problem scales and a hyperactivity scale. The significantly higher odds of behavior problems in black children as a subgroup may be the result of a greater vulnerability to sleep disruption in this group, the researchers said.

Talk Therapy for IBD Depression

Adolescents with inflammatory bowel disease and either major or minor depression showed a significant reduction in depressive symptoms after 12 sessions of a manual-based cognitive-behavioral therapy program, reported Eva Szigethy, M.D., of Children's Hospital Boston and her associates.

In a pilot study, 11 adolescents aged 12–17 years participated. Seven patients had Crohn's disease and four had ulcerative colitis, with an average of 40 months' duration. Scores on the Children's Depression Inventory dropped from 16.18 before treatment to 4.82 after treatment. At baseline, all the teens reported depressed mood and anhedonia; ten reported sleep disturbance and fatigue (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469–77).

Although illness severity remained the same, the adolescents' own perception of their physical functioning improved by the end of the study period.

EC Knowledge Doesn't Raise Risk

Knowledge of emergency contraception (EC) was not associated with increased sexual risk-taking according to a telephone survey of 1,158 adolescents aged 14–19 years in Monroe County, N.Y., Dr. Elizabeth Kelts of the University of Rochester (N.Y.) said at the annual meeting of the Association of Reproductive Health Professionals.

Teens were asked whether they were sexually active and, if so, when they became sexually active, and whether they knew of the “morning-after pill.”

Overall, 73% of the teens reported awareness of EC, and 41% reported being sexually active. Sexually active teens who were aware of EC were significantly more likely to have used birth control during their last sexual encounter than were teens not familiar with EC (83% vs. 17%).

The average age of first sex for adolescents aware of EC was slightly older than for those who were not aware of EC (17.6 years vs. 16.7 years).

Define Staph in Neonates

Skin rashes occurred significantly more often among the confirmed and probable Staphylococcus aureus (SA) cases, compared with coagulase-negative staphylococci (CoNS) cases (20% vs. 4%) in a cohort of 191 neonates in intensive care, said C. Mary Healy, M.D., of Baylor College of Medicine, Houston, and her colleagues. Invasive staphylococcal disease remains a risk among preterm and very-low-birth-weight infants, but data on the clinical presentations of these infections are limited. Six of 41 infants with confirmed and probable SA (14%) had significantly more bone and joint complications, compared with 2 of 108 (2%) with CoNS.

Recreational Ritalin on the Rise

Approximately 4% of a national sample of 8th, 10th, and 12th graders reported illicit use of methylphenidate (Ritalin) within the past year, said Sean Esteban McCabe, Ph.D., and his associates at the University of Michigan, Ann Arbor.

Based on data from the 2001 Monitoring the Future Survey, students in grades 10 (4.6%) and 12 (5%) were significantly more likely to report illicit use than were 8th graders (2.7%).

Illegal methylphenidate use was significantly more common among students with grade point averages of C or D (6.4%), compared with those with a B average (3.9%) or A average (2.6%).

In addition, white students (4.8%) were significantly more likely to report illegal use than were black students (0.8%), which mirrored racial differences in prescription patterns (J. Adolesc. Health 2004;35:501–4).

Sleep-Disordered Breathing, Behavior

Children with mild to moderate sleep-disordered breathing demonstrated significantly more problem behaviors, compared with controls in a cross-sectional study of 829 8- to 11-year-olds, said Carol L. Rosen, M.D., of Case Western Reserve University, Cleveland, and her associates.

The children were assessed with unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate. Overall, children with sleep-disordered breathing were at least twice as likely to score in the borderline or clinically abnormal range on the Child Behavior Checklist (CBCL) externalizing and internalizing scales (Pediatrics 2004;114:1640–8).

The children with sleep-disordered breathing were significantly more likely to demonstrate hyperactivity, emotional lability, aggression, and opposition, compared with controls. Black ethnicity was a significant predictor for the CBCL total problem scale, while preterm birth was a significant predictor for the CBCL total and social problem scales and a hyperactivity scale. The significantly higher odds of behavior problems in black children as a subgroup may be the result of a greater vulnerability to sleep disruption in this group, the researchers said.

Talk Therapy for IBD Depression

Adolescents with inflammatory bowel disease and either major or minor depression showed a significant reduction in depressive symptoms after 12 sessions of a manual-based cognitive-behavioral therapy program, reported Eva Szigethy, M.D., of Children's Hospital Boston and her associates.

In a pilot study, 11 adolescents aged 12–17 years participated. Seven patients had Crohn's disease and four had ulcerative colitis, with an average of 40 months' duration. Scores on the Children's Depression Inventory dropped from 16.18 before treatment to 4.82 after treatment. At baseline, all the teens reported depressed mood and anhedonia; ten reported sleep disturbance and fatigue (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469–77).

Although illness severity remained the same, the adolescents' own perception of their physical functioning improved by the end of the study period.

EC Knowledge Doesn't Raise Risk

Knowledge of emergency contraception (EC) was not associated with increased sexual risk-taking according to a telephone survey of 1,158 adolescents aged 14–19 years in Monroe County, N.Y., Dr. Elizabeth Kelts of the University of Rochester (N.Y.) said at the annual meeting of the Association of Reproductive Health Professionals.

Teens were asked whether they were sexually active and, if so, when they became sexually active, and whether they knew of the “morning-after pill.”

Overall, 73% of the teens reported awareness of EC, and 41% reported being sexually active. Sexually active teens who were aware of EC were significantly more likely to have used birth control during their last sexual encounter than were teens not familiar with EC (83% vs. 17%).

The average age of first sex for adolescents aware of EC was slightly older than for those who were not aware of EC (17.6 years vs. 16.7 years).

Oseltamivir in Pneumonia

Oseltamivir's (Tamiflu) benefits aren't limited to treating and preventing influenza, Beth L. Nordstrom, Ph.D., reported in a poster presentation at the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective cohort study of a U.S. insurer's claim data, sponsored by Hoffmann-La Roche Ltd, patients of all ages who had received oseltamivir were at significantly lower risk for pneumonia, particularly the oldest and youngest age groups.

Among children aged 1–12, the proportion with a diagnosis of pneumonia was 0.7% among the 586 for whom oseltamivir was dispensed on the day of influenza diagnosis, compared with 2.5% of the 17,886 who did not receive oseltamivir, a 66% risk reduction.

In patients aged 13–59, pneumonia was diagnosed in 1.3% of the 10,649 who received the drug, compared with 2.1% of the 41,007 who did not—a reduction of 19%. In adults aged 60 and above, the difference was 1.7% of 463 with oseltamivir versus 8.8% of 3,298 without, a 59% drop.

The impact of oseltamivir on antibiotic dispensing and hospitalization was also greater in the youngest and oldest age groups. Antibiotic use dropped with oseltamivir by 30% in the 1–12 year olds, by 9% in the 13–59 year olds, and 14% in the 60-plus group. Hospitalizations were reduced by 71% with oseltamivir in the 1–12 year olds, by 25% in the 13–59 age group and 45% in the 60-plus patients, Dr. Nordstrom reported.

Teen With Rabies Recovers

A teenaged girl who contracted rabies from a bat and received an experimental treatment has been upgraded to fair condition at the Children's Hospital of Wisconsin (Wauwatosa), a hospital spokesperson said in an interview at press time.

The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl last September. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine. She presented to Children's Hospital on October 18 with symptoms of rabies, including slurred speech and fluctuating consciousness.

The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment and the specifics of the drugs have been withheld pending publication.

A rabies vaccine will prevent the disease only if given within days of exposure; it is useless in saving the patient's life in advanced cases.

Neonatal Infections Limit Growth

Extremely low-birth-weight infants (401–1000 g) who developed neonatal infections were significantly more likely to have neurodevelopmental problems in early childhood, compared with noninfected infants in a cohort study of 6,093 children, said Barbara J. Stoll, M.D., of Emory University, Atlanta, and her colleagues.

The infants were assessed at 18–22 months' corrected gestational age and classified as uninfected (2,161 infants), clinical infection only (1,538 infants), sepsis (1,922 infants), sepsis and necrotizing enterocolitis (279 infants), or meningitis, either with or without sepsis (193 infants). At follow-up, 41% of the children had at least one neurodevelopmental problem (JAMA 2004;292:2357–65).

Scores of less than 70 on the Mental Development Index and the Psychomotor Development Index were significantly more common among children with any of the previously mentioned infections, compared with uninfected children. In addition, children in any of the infection groups were significantly more likely to have cerebral palsy, vision impairment, and neurodevelopmental impairment, and to have a head circumference in less than the 10th percentile, compared with uninfected children.

11-Valent Vaccine Shows Promise

A new 11-valent pneumococcal conjugate vaccine (Pn-PD) was safe and effective in a randomized, single-blind study of 154 infants who received the vaccine at ages 2, 4, 6, and 12–15 months, reported Anu Nurkka of the National Public Health Institute in Helsinki, Finland, and colleagues.

The vaccine used Haemophilus influenzae protein D as a carrier and contained pneumococcal capsular polysaccharides of serotypes 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Overall, three doses of Pn-PD provoked a strong antibody response, compared with a control vaccine, with a significant booster response after the fourth dose (Pediatr. Infect. Dis. J. 2004;23:1008–14). Mild local skin reactions were common.

Oseltamivir in Pneumonia

Oseltamivir's (Tamiflu) benefits aren't limited to treating and preventing influenza, Beth L. Nordstrom, Ph.D., reported in a poster presentation at the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective cohort study of a U.S. insurer's claim data, sponsored by Hoffmann-La Roche Ltd, patients of all ages who had received oseltamivir were at significantly lower risk for pneumonia, particularly the oldest and youngest age groups.

Among children aged 1–12, the proportion with a diagnosis of pneumonia was 0.7% among the 586 for whom oseltamivir was dispensed on the day of influenza diagnosis, compared with 2.5% of the 17,886 who did not receive oseltamivir, a 66% risk reduction.

In patients aged 13–59, pneumonia was diagnosed in 1.3% of the 10,649 who received the drug, compared with 2.1% of the 41,007 who did not—a reduction of 19%. In adults aged 60 and above, the difference was 1.7% of 463 with oseltamivir versus 8.8% of 3,298 without, a 59% drop.

The impact of oseltamivir on antibiotic dispensing and hospitalization was also greater in the youngest and oldest age groups. Antibiotic use dropped with oseltamivir by 30% in the 1–12 year olds, by 9% in the 13–59 year olds, and 14% in the 60-plus group. Hospitalizations were reduced by 71% with oseltamivir in the 1–12 year olds, by 25% in the 13–59 age group and 45% in the 60-plus patients, Dr. Nordstrom reported.

Teen With Rabies Recovers

A teenaged girl who contracted rabies from a bat and received an experimental treatment has been upgraded to fair condition at the Children's Hospital of Wisconsin (Wauwatosa), a hospital spokesperson said in an interview at press time.

The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl last September. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine. She presented to Children's Hospital on October 18 with symptoms of rabies, including slurred speech and fluctuating consciousness.

The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment and the specifics of the drugs have been withheld pending publication.

A rabies vaccine will prevent the disease only if given within days of exposure; it is useless in saving the patient's life in advanced cases.

Neonatal Infections Limit Growth

Extremely low-birth-weight infants (401–1000 g) who developed neonatal infections were significantly more likely to have neurodevelopmental problems in early childhood, compared with noninfected infants in a cohort study of 6,093 children, said Barbara J. Stoll, M.D., of Emory University, Atlanta, and her colleagues.

The infants were assessed at 18–22 months' corrected gestational age and classified as uninfected (2,161 infants), clinical infection only (1,538 infants), sepsis (1,922 infants), sepsis and necrotizing enterocolitis (279 infants), or meningitis, either with or without sepsis (193 infants). At follow-up, 41% of the children had at least one neurodevelopmental problem (JAMA 2004;292:2357–65).

Scores of less than 70 on the Mental Development Index and the Psychomotor Development Index were significantly more common among children with any of the previously mentioned infections, compared with uninfected children. In addition, children in any of the infection groups were significantly more likely to have cerebral palsy, vision impairment, and neurodevelopmental impairment, and to have a head circumference in less than the 10th percentile, compared with uninfected children.

11-Valent Vaccine Shows Promise

A new 11-valent pneumococcal conjugate vaccine (Pn-PD) was safe and effective in a randomized, single-blind study of 154 infants who received the vaccine at ages 2, 4, 6, and 12–15 months, reported Anu Nurkka of the National Public Health Institute in Helsinki, Finland, and colleagues.

The vaccine used Haemophilus influenzae protein D as a carrier and contained pneumococcal capsular polysaccharides of serotypes 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Overall, three doses of Pn-PD provoked a strong antibody response, compared with a control vaccine, with a significant booster response after the fourth dose (Pediatr. Infect. Dis. J. 2004;23:1008–14). Mild local skin reactions were common.

Oseltamivir in Pneumonia

Oseltamivir's (Tamiflu) benefits aren't limited to treating and preventing influenza, Beth L. Nordstrom, Ph.D., reported in a poster presentation at the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective cohort study of a U.S. insurer's claim data, sponsored by Hoffmann-La Roche Ltd, patients of all ages who had received oseltamivir were at significantly lower risk for pneumonia, particularly the oldest and youngest age groups.

Among children aged 1–12, the proportion with a diagnosis of pneumonia was 0.7% among the 586 for whom oseltamivir was dispensed on the day of influenza diagnosis, compared with 2.5% of the 17,886 who did not receive oseltamivir, a 66% risk reduction.

In patients aged 13–59, pneumonia was diagnosed in 1.3% of the 10,649 who received the drug, compared with 2.1% of the 41,007 who did not—a reduction of 19%. In adults aged 60 and above, the difference was 1.7% of 463 with oseltamivir versus 8.8% of 3,298 without, a 59% drop.

The impact of oseltamivir on antibiotic dispensing and hospitalization was also greater in the youngest and oldest age groups. Antibiotic use dropped with oseltamivir by 30% in the 1–12 year olds, by 9% in the 13–59 year olds, and 14% in the 60-plus group. Hospitalizations were reduced by 71% with oseltamivir in the 1–12 year olds, by 25% in the 13–59 age group and 45% in the 60-plus patients, Dr. Nordstrom reported.

Teen With Rabies Recovers

A teenaged girl who contracted rabies from a bat and received an experimental treatment has been upgraded to fair condition at the Children's Hospital of Wisconsin (Wauwatosa), a hospital spokesperson said in an interview at press time.

The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl last September. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine. She presented to Children's Hospital on October 18 with symptoms of rabies, including slurred speech and fluctuating consciousness.

The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment and the specifics of the drugs have been withheld pending publication.

A rabies vaccine will prevent the disease only if given within days of exposure; it is useless in saving the patient's life in advanced cases.

Neonatal Infections Limit Growth

Extremely low-birth-weight infants (401–1000 g) who developed neonatal infections were significantly more likely to have neurodevelopmental problems in early childhood, compared with noninfected infants in a cohort study of 6,093 children, said Barbara J. Stoll, M.D., of Emory University, Atlanta, and her colleagues.

The infants were assessed at 18–22 months' corrected gestational age and classified as uninfected (2,161 infants), clinical infection only (1,538 infants), sepsis (1,922 infants), sepsis and necrotizing enterocolitis (279 infants), or meningitis, either with or without sepsis (193 infants). At follow-up, 41% of the children had at least one neurodevelopmental problem (JAMA 2004;292:2357–65).

Scores of less than 70 on the Mental Development Index and the Psychomotor Development Index were significantly more common among children with any of the previously mentioned infections, compared with uninfected children. In addition, children in any of the infection groups were significantly more likely to have cerebral palsy, vision impairment, and neurodevelopmental impairment, and to have a head circumference in less than the 10th percentile, compared with uninfected children.

11-Valent Vaccine Shows Promise

A new 11-valent pneumococcal conjugate vaccine (Pn-PD) was safe and effective in a randomized, single-blind study of 154 infants who received the vaccine at ages 2, 4, 6, and 12–15 months, reported Anu Nurkka of the National Public Health Institute in Helsinki, Finland, and colleagues.

The vaccine used Haemophilus influenzae protein D as a carrier and contained pneumococcal capsular polysaccharides of serotypes 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Overall, three doses of Pn-PD provoked a strong antibody response, compared with a control vaccine, with a significant booster response after the fourth dose (Pediatr. Infect. Dis. J. 2004;23:1008–14). Mild local skin reactions were common.

Parental Notification

Florida voters recently passed a constitutional amendment that paves the way for required parental notification before a minor can have an abortion. The state's supreme court has twice struck down parental notification laws passed by the state legislature, saying that they run contrary to the privacy clause in the state's constitution. Florida Right to Life, which supported the amendment, said it is important for parents to be involved to ensure their child is receiving proper care. But the American Civil Liberties Union of Florida opposed the amendment, saying that mandating notification can jeopardize teens' health by causing delays that can increase risks to their physical and emotional health. Most teens who have abortions do involve at least one parent, ACLU said, but those who do not often have good reasons for keeping the information private.

Cervical Infection Risk

Use of Depo-Provera was significantly associated with the development of cervical infections in a study of 819 women, said Charles S. Morrison, Ph.D.

Even after adjustment for sexual behavior and demographic traits, including condom use and multiple sex partners, women who used Depo-Provera (medroxyprogesterone) were more likely to develop gonorrhea or chlamydia within a year, compared both with women who used oral contraceptives and controls, said Dr. Morrison of Family Health International, a research organization in Research Triangle Park, N.C.

The use of oral contraceptives was not associated with increased risk or development of infections.

After a mean follow-up of 337 days, 45 women in the prospective cohort study had developed at least one cervical infection. Most of the women were single (77%) and nulliparous (75%). They ranged in age from 15 to 45 years, with a median age of 22 years (Sex. Transm. Dis. 2004;31:561–7).

The researchers calculated risk based on how many women became infected within a year (woman-years) and found a rate of 13.7 infections/100 woman-years in the Depo-Provera group, significantly higher than women in the oral contraceptive group (3.9 infections/100 woman-years) and the control group (6/100 woman-years).

Off-Label Antinausea Drug

Ondansetron is increasingly prescribed off label for nausea and vomiting in pregnancy, and results of a new study suggest it is safe for this indication.

In the prospective observational study, the drug, which is typically used for treating nausea and vomiting in chemotherapy patients, was not associated with an increased risk of fetal malformations, reported Adrienne Einarson, R.N., of the University of Toronto and her colleagues (BJOG 2004;111:940–3).

The investigators studied women exposed to ondansetron (Zofran); other antiemetics, including Diclectin, metoclopramide, phenothiazines, and ginger; and/or no drugs or only drugs known to be nonteratogenic. To date, outcomes from 176 pregnancies in each group have been evaluated.

In the ondansetron group there were 169 live births, 5 miscarriages, and 2 therapeutic abortions. There were six major malformations, for a rate of 3.5%. The mean birth weight was 3,362 g. There were no statistical differences between the three groups in any of the study end points, the investigators said.

Ondansetron appears safe for the fetus, but the investigators noted that the sample size in this study is small and that many more cases would need to be studied before a definitive conclusion about the safety of the drug could be made.

Stretch Genes

Genetic factors appear to play a role in the development of striae gravidarum, rather than prepregnancy weight or increases in weight during pregnancy, Anne Chang, M.D., said at the annual meeting of the Society for Investigative Dermatology in Providence, R.I.

Dr. Chang and her associates surveyed a group of 161 women who had given birth and found that 55% had striae gravidarum (SG), which arose on average at a gestational age of 25 weeks. Ninety percent of the women who reported having SG said that they developed them during their first pregnancy, while 10% said that SG first developed during their second pregnancy.

Women were significantly more likely to develop SG if their mother or other family members had SG, if they had a personal history of breast or thigh striae, or if they were nonwhite. The genetic risk factors identified in the study suggest that an intrinsic dysregulation of elastic fibers may make women prone to developing SG, said Dr. Chang, a dermatology fellow at Stanford (Calif.) University.

Parental Notification

Florida voters recently passed a constitutional amendment that paves the way for required parental notification before a minor can have an abortion. The state's supreme court has twice struck down parental notification laws passed by the state legislature, saying that they run contrary to the privacy clause in the state's constitution. Florida Right to Life, which supported the amendment, said it is important for parents to be involved to ensure their child is receiving proper care. But the American Civil Liberties Union of Florida opposed the amendment, saying that mandating notification can jeopardize teens' health by causing delays that can increase risks to their physical and emotional health. Most teens who have abortions do involve at least one parent, ACLU said, but those who do not often have good reasons for keeping the information private.

Cervical Infection Risk

Use of Depo-Provera was significantly associated with the development of cervical infections in a study of 819 women, said Charles S. Morrison, Ph.D.

Even after adjustment for sexual behavior and demographic traits, including condom use and multiple sex partners, women who used Depo-Provera (medroxyprogesterone) were more likely to develop gonorrhea or chlamydia within a year, compared both with women who used oral contraceptives and controls, said Dr. Morrison of Family Health International, a research organization in Research Triangle Park, N.C.

The use of oral contraceptives was not associated with increased risk or development of infections.

After a mean follow-up of 337 days, 45 women in the prospective cohort study had developed at least one cervical infection. Most of the women were single (77%) and nulliparous (75%). They ranged in age from 15 to 45 years, with a median age of 22 years (Sex. Transm. Dis. 2004;31:561–7).

The researchers calculated risk based on how many women became infected within a year (woman-years) and found a rate of 13.7 infections/100 woman-years in the Depo-Provera group, significantly higher than women in the oral contraceptive group (3.9 infections/100 woman-years) and the control group (6/100 woman-years).

Off-Label Antinausea Drug

Ondansetron is increasingly prescribed off label for nausea and vomiting in pregnancy, and results of a new study suggest it is safe for this indication.

In the prospective observational study, the drug, which is typically used for treating nausea and vomiting in chemotherapy patients, was not associated with an increased risk of fetal malformations, reported Adrienne Einarson, R.N., of the University of Toronto and her colleagues (BJOG 2004;111:940–3).

The investigators studied women exposed to ondansetron (Zofran); other antiemetics, including Diclectin, metoclopramide, phenothiazines, and ginger; and/or no drugs or only drugs known to be nonteratogenic. To date, outcomes from 176 pregnancies in each group have been evaluated.

In the ondansetron group there were 169 live births, 5 miscarriages, and 2 therapeutic abortions. There were six major malformations, for a rate of 3.5%. The mean birth weight was 3,362 g. There were no statistical differences between the three groups in any of the study end points, the investigators said.

Ondansetron appears safe for the fetus, but the investigators noted that the sample size in this study is small and that many more cases would need to be studied before a definitive conclusion about the safety of the drug could be made.

Stretch Genes

Genetic factors appear to play a role in the development of striae gravidarum, rather than prepregnancy weight or increases in weight during pregnancy, Anne Chang, M.D., said at the annual meeting of the Society for Investigative Dermatology in Providence, R.I.

Dr. Chang and her associates surveyed a group of 161 women who had given birth and found that 55% had striae gravidarum (SG), which arose on average at a gestational age of 25 weeks. Ninety percent of the women who reported having SG said that they developed them during their first pregnancy, while 10% said that SG first developed during their second pregnancy.

Women were significantly more likely to develop SG if their mother or other family members had SG, if they had a personal history of breast or thigh striae, or if they were nonwhite. The genetic risk factors identified in the study suggest that an intrinsic dysregulation of elastic fibers may make women prone to developing SG, said Dr. Chang, a dermatology fellow at Stanford (Calif.) University.

Parental Notification

Florida voters recently passed a constitutional amendment that paves the way for required parental notification before a minor can have an abortion. The state's supreme court has twice struck down parental notification laws passed by the state legislature, saying that they run contrary to the privacy clause in the state's constitution. Florida Right to Life, which supported the amendment, said it is important for parents to be involved to ensure their child is receiving proper care. But the American Civil Liberties Union of Florida opposed the amendment, saying that mandating notification can jeopardize teens' health by causing delays that can increase risks to their physical and emotional health. Most teens who have abortions do involve at least one parent, ACLU said, but those who do not often have good reasons for keeping the information private.

Cervical Infection Risk

Use of Depo-Provera was significantly associated with the development of cervical infections in a study of 819 women, said Charles S. Morrison, Ph.D.

Even after adjustment for sexual behavior and demographic traits, including condom use and multiple sex partners, women who used Depo-Provera (medroxyprogesterone) were more likely to develop gonorrhea or chlamydia within a year, compared both with women who used oral contraceptives and controls, said Dr. Morrison of Family Health International, a research organization in Research Triangle Park, N.C.

The use of oral contraceptives was not associated with increased risk or development of infections.

After a mean follow-up of 337 days, 45 women in the prospective cohort study had developed at least one cervical infection. Most of the women were single (77%) and nulliparous (75%). They ranged in age from 15 to 45 years, with a median age of 22 years (Sex. Transm. Dis. 2004;31:561–7).

The researchers calculated risk based on how many women became infected within a year (woman-years) and found a rate of 13.7 infections/100 woman-years in the Depo-Provera group, significantly higher than women in the oral contraceptive group (3.9 infections/100 woman-years) and the control group (6/100 woman-years).

Off-Label Antinausea Drug

Ondansetron is increasingly prescribed off label for nausea and vomiting in pregnancy, and results of a new study suggest it is safe for this indication.

In the prospective observational study, the drug, which is typically used for treating nausea and vomiting in chemotherapy patients, was not associated with an increased risk of fetal malformations, reported Adrienne Einarson, R.N., of the University of Toronto and her colleagues (BJOG 2004;111:940–3).

The investigators studied women exposed to ondansetron (Zofran); other antiemetics, including Diclectin, metoclopramide, phenothiazines, and ginger; and/or no drugs or only drugs known to be nonteratogenic. To date, outcomes from 176 pregnancies in each group have been evaluated.

In the ondansetron group there were 169 live births, 5 miscarriages, and 2 therapeutic abortions. There were six major malformations, for a rate of 3.5%. The mean birth weight was 3,362 g. There were no statistical differences between the three groups in any of the study end points, the investigators said.

Ondansetron appears safe for the fetus, but the investigators noted that the sample size in this study is small and that many more cases would need to be studied before a definitive conclusion about the safety of the drug could be made.

Stretch Genes

Genetic factors appear to play a role in the development of striae gravidarum, rather than prepregnancy weight or increases in weight during pregnancy, Anne Chang, M.D., said at the annual meeting of the Society for Investigative Dermatology in Providence, R.I.

Dr. Chang and her associates surveyed a group of 161 women who had given birth and found that 55% had striae gravidarum (SG), which arose on average at a gestational age of 25 weeks. Ninety percent of the women who reported having SG said that they developed them during their first pregnancy, while 10% said that SG first developed during their second pregnancy.

Women were significantly more likely to develop SG if their mother or other family members had SG, if they had a personal history of breast or thigh striae, or if they were nonwhite. The genetic risk factors identified in the study suggest that an intrinsic dysregulation of elastic fibers may make women prone to developing SG, said Dr. Chang, a dermatology fellow at Stanford (Calif.) University.