Heidi Splete

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health in Bethesda, Md.

“Our goals are straightforward; to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

Of all the announcements submitted, one will be chosen by the government for widespread distribution, she said. A $2,500 prize will go to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said.

If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to “make sure that plans are in place so the functions of government continue,” and encouraged state and local leaders to host their own local flu preparedness summits to be sure that backups for essential services are in place.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early,” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

It's possible that the 2009-H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health in Bethesda, Md.

“Our goals are straightforward; to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

Of all the announcements submitted, one will be chosen by the government for widespread distribution, she said. A $2,500 prize will go to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said.

If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to “make sure that plans are in place so the functions of government continue,” and encouraged state and local leaders to host their own local flu preparedness summits to be sure that backups for essential services are in place.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early,” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

It's possible that the 2009-H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health in Bethesda, Md.

“Our goals are straightforward; to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

Of all the announcements submitted, one will be chosen by the government for widespread distribution, she said. A $2,500 prize will go to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said.

If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to “make sure that plans are in place so the functions of government continue,” and encouraged state and local leaders to host their own local flu preparedness summits to be sure that backups for essential services are in place.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early,” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

It's possible that the 2009-H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said. But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

Two additional studies on the effects of stimulant use and cardiovascular outcomes are in progress, one in children and one in adults, said Dr. Gerald Dal Pan, director of the Office of Surveillance and Epidemiology at the Center for Drug Evaluation and Research.

These studies will evaluate the impact of stimulant use on sudden cardiac death, heart attack, and stroke. Results of the child study are expected in the fall, and results of the adult study are expected early next year, he said.

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said. But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

Two additional studies on the effects of stimulant use and cardiovascular outcomes are in progress, one in children and one in adults, said Dr. Gerald Dal Pan, director of the Office of Surveillance and Epidemiology at the Center for Drug Evaluation and Research.

These studies will evaluate the impact of stimulant use on sudden cardiac death, heart attack, and stroke. Results of the child study are expected in the fall, and results of the adult study are expected early next year, he said.

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said. But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

Two additional studies on the effects of stimulant use and cardiovascular outcomes are in progress, one in children and one in adults, said Dr. Gerald Dal Pan, director of the Office of Surveillance and Epidemiology at the Center for Drug Evaluation and Research.

These studies will evaluate the impact of stimulant use on sudden cardiac death, heart attack, and stroke. Results of the child study are expected in the fall, and results of the adult study are expected early next year, he said.

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Not a single state showed signs of a decline in adult obesity rates in the past year, according to the annual obesity report released by the Trust for America's Health and the Robert Wood Johnson Foundation.

The report, “F as in Fat: How Obesity Policies Are Failing in America 2009,” ranks states by obesity rates in adults 18 and older and overweight or obesity rates in children aged 10-17 years.

The data suggest that children may be especially at risk—adult obesity rates in the United States increased in 23 states compared with last year's data, but obesity rates in children aged 10-17 years have tripled since 1980.

The prevalence of obesity in adults and the prevalence of either overweight or obesity in children was highest in Mississippi (33% and 44%) and lowest in Colorado for adults (19%) and Utah and Minnesota for children (tied at 23%).

Overweight was defined as at or above the 85th percentile for height and weight, and obesity was defined as at or above the 95th percentile for height and weight.

Despite the apparent lack of progress, “we are beginning to see early signs of hope,” in efforts to prevent overweight and obesity, especially in policies that are designed to improve children's school environments, Dr. James S. Marks, a pediatrician and the senior vice president of the Robert Wood Johnson Foundation, Princeton, N.J., said at a press conference.

For example, a total of 19 states currently have school nutrition standards that are stricter than the national standards, Dr. Marks said.

But all parts of the community need to work together to create solutions to the obesity problem, he noted.

For doctors, the take-home message is to tell people whether they are overweight or obese. Hearing from their physician is critical in getting people to get serious about the changes they need to make, Dr. Marks said.

In addition, physicians and other practitioners must “be advocates for changes that their community needs,” such as eliminating junk food vending machines in schools, he said. “Their voices will carry a lot of weight.”

Data from the report also suggested that obesity rates in youth increased during the summer months. “That was a surprising finding for us in the field,” Dr. Marks said.

The data suggest that despite the break from sitting at school desks all day, young people “are eating more and exercising or playing less” than expected, he said.

The report also emphasized that programs to reduce obesity should address baby boomers before they reach Medicare age and place additional strain on the health care system.

“Our health care costs have grown along with our waistlines,” Jeff Levi, Ph.D., executive director of the Trust for America's Health, said at the press conference.

Obesity-related health care costs become more significant as people age. Recent data suggest that the baby boomers are more obese than previous generations, and as they reach Medicare age, the percentage of obese seniors could increase significantly over the current obesity rates among seniors.

The report also called for a national strategy to combat obesity that involves federal, state, and local governments and promotes community efforts outside of the doctor's office, stating that economic and neighborhood factors continue to thwart the efforts of youth and adults to eat well and exercise regularly.

The complete report is available at www.healthyamericans.org

Not a single state showed signs of a decline in adult obesity rates in the past year, according to the annual obesity report released by the Trust for America's Health and the Robert Wood Johnson Foundation.

The report, “F as in Fat: How Obesity Policies Are Failing in America 2009,” ranks states by obesity rates in adults 18 and older and overweight or obesity rates in children aged 10-17 years.

The data suggest that children may be especially at risk—adult obesity rates in the United States increased in 23 states compared with last year's data, but obesity rates in children aged 10-17 years have tripled since 1980.

The prevalence of obesity in adults and the prevalence of either overweight or obesity in children was highest in Mississippi (33% and 44%) and lowest in Colorado for adults (19%) and Utah and Minnesota for children (tied at 23%).

Overweight was defined as at or above the 85th percentile for height and weight, and obesity was defined as at or above the 95th percentile for height and weight.

Despite the apparent lack of progress, “we are beginning to see early signs of hope,” in efforts to prevent overweight and obesity, especially in policies that are designed to improve children's school environments, Dr. James S. Marks, a pediatrician and the senior vice president of the Robert Wood Johnson Foundation, Princeton, N.J., said at a press conference.

For example, a total of 19 states currently have school nutrition standards that are stricter than the national standards, Dr. Marks said.

But all parts of the community need to work together to create solutions to the obesity problem, he noted.

For doctors, the take-home message is to tell people whether they are overweight or obese. Hearing from their physician is critical in getting people to get serious about the changes they need to make, Dr. Marks said.

In addition, physicians and other practitioners must “be advocates for changes that their community needs,” such as eliminating junk food vending machines in schools, he said. “Their voices will carry a lot of weight.”

Data from the report also suggested that obesity rates in youth increased during the summer months. “That was a surprising finding for us in the field,” Dr. Marks said.

The data suggest that despite the break from sitting at school desks all day, young people “are eating more and exercising or playing less” than expected, he said.

The report also emphasized that programs to reduce obesity should address baby boomers before they reach Medicare age and place additional strain on the health care system.

“Our health care costs have grown along with our waistlines,” Jeff Levi, Ph.D., executive director of the Trust for America's Health, said at the press conference.

Obesity-related health care costs become more significant as people age. Recent data suggest that the baby boomers are more obese than previous generations, and as they reach Medicare age, the percentage of obese seniors could increase significantly over the current obesity rates among seniors.

The report also called for a national strategy to combat obesity that involves federal, state, and local governments and promotes community efforts outside of the doctor's office, stating that economic and neighborhood factors continue to thwart the efforts of youth and adults to eat well and exercise regularly.

The complete report is available at www.healthyamericans.org

Not a single state showed signs of a decline in adult obesity rates in the past year, according to the annual obesity report released by the Trust for America's Health and the Robert Wood Johnson Foundation.

The report, “F as in Fat: How Obesity Policies Are Failing in America 2009,” ranks states by obesity rates in adults 18 and older and overweight or obesity rates in children aged 10-17 years.

The data suggest that children may be especially at risk—adult obesity rates in the United States increased in 23 states compared with last year's data, but obesity rates in children aged 10-17 years have tripled since 1980.

The prevalence of obesity in adults and the prevalence of either overweight or obesity in children was highest in Mississippi (33% and 44%) and lowest in Colorado for adults (19%) and Utah and Minnesota for children (tied at 23%).

Overweight was defined as at or above the 85th percentile for height and weight, and obesity was defined as at or above the 95th percentile for height and weight.

Despite the apparent lack of progress, “we are beginning to see early signs of hope,” in efforts to prevent overweight and obesity, especially in policies that are designed to improve children's school environments, Dr. James S. Marks, a pediatrician and the senior vice president of the Robert Wood Johnson Foundation, Princeton, N.J., said at a press conference.

For example, a total of 19 states currently have school nutrition standards that are stricter than the national standards, Dr. Marks said.

But all parts of the community need to work together to create solutions to the obesity problem, he noted.

For doctors, the take-home message is to tell people whether they are overweight or obese. Hearing from their physician is critical in getting people to get serious about the changes they need to make, Dr. Marks said.

In addition, physicians and other practitioners must “be advocates for changes that their community needs,” such as eliminating junk food vending machines in schools, he said. “Their voices will carry a lot of weight.”

Data from the report also suggested that obesity rates in youth increased during the summer months. “That was a surprising finding for us in the field,” Dr. Marks said.

The data suggest that despite the break from sitting at school desks all day, young people “are eating more and exercising or playing less” than expected, he said.

The report also emphasized that programs to reduce obesity should address baby boomers before they reach Medicare age and place additional strain on the health care system.

“Our health care costs have grown along with our waistlines,” Jeff Levi, Ph.D., executive director of the Trust for America's Health, said at the press conference.

Obesity-related health care costs become more significant as people age. Recent data suggest that the baby boomers are more obese than previous generations, and as they reach Medicare age, the percentage of obese seniors could increase significantly over the current obesity rates among seniors.

The report also called for a national strategy to combat obesity that involves federal, state, and local governments and promotes community efforts outside of the doctor's office, stating that economic and neighborhood factors continue to thwart the efforts of youth and adults to eat well and exercise regularly.

The complete report is available at www.healthyamericans.org

BETHESDA, MD — President Obama joined other U.S. government and health leaders at a preparedness summit urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

"We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation," President Obama, who was in Italy, said by phone during the summit on July 9 at the National Institutes of Health in Bethesda, Md.

"Our goals are straightforward; to reduce illness and death and minimize social disruption," said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and "get the shots in the arms of the people who need them most." A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help prepare for the potential surge.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to "make sure that plans are in place so the functions of government continue," and encouraged state and local leaders to host their own local flu preparedness summits.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to "get clear guidance out early," to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

'Our goals are straightforward; to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

BETHESDA, MD — President Obama joined other U.S. government and health leaders at a preparedness summit urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

"We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation," President Obama, who was in Italy, said by phone during the summit on July 9 at the National Institutes of Health in Bethesda, Md.

"Our goals are straightforward; to reduce illness and death and minimize social disruption," said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and "get the shots in the arms of the people who need them most." A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help prepare for the potential surge.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to "make sure that plans are in place so the functions of government continue," and encouraged state and local leaders to host their own local flu preparedness summits.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to "get clear guidance out early," to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

'Our goals are straightforward; to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

BETHESDA, MD — President Obama joined other U.S. government and health leaders at a preparedness summit urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

"We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation," President Obama, who was in Italy, said by phone during the summit on July 9 at the National Institutes of Health in Bethesda, Md.

"Our goals are straightforward; to reduce illness and death and minimize social disruption," said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and "get the shots in the arms of the people who need them most." A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help prepare for the potential surge.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to "make sure that plans are in place so the functions of government continue," and encouraged state and local leaders to host their own local flu preparedness summits.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to "get clear guidance out early," to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

'Our goals are straightforward; to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

BETHESDA, MD — The most likely scenario involving the influenza A (H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

"We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine," Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

Final recommendations for prioritizing H1N1 vaccination are expected to come from the CDC's Advisory Committee on Immunization Practices. In the meantime, the CDC's H1N1 Vaccine Task Force has developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to "keep our children safe and keep them learning," Arne Duncan, secretary of the Department of Education said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, "most school districts have developed good emergency plans," he added.

BETHESDA, MD — The most likely scenario involving the influenza A (H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

"We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine," Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

Final recommendations for prioritizing H1N1 vaccination are expected to come from the CDC's Advisory Committee on Immunization Practices. In the meantime, the CDC's H1N1 Vaccine Task Force has developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to "keep our children safe and keep them learning," Arne Duncan, secretary of the Department of Education said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, "most school districts have developed good emergency plans," he added.

BETHESDA, MD — The most likely scenario involving the influenza A (H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

"We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine," Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

Final recommendations for prioritizing H1N1 vaccination are expected to come from the CDC's Advisory Committee on Immunization Practices. In the meantime, the CDC's H1N1 Vaccine Task Force has developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to "keep our children safe and keep them learning," Arne Duncan, secretary of the Department of Education said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, "most school districts have developed good emergency plans," he added.

WASHINGTON — No significant differences in neonatal outcomes were found among premature infants of women who had spinal anesthesia versus general anesthesia for cesarean delivery, based on the results of a study of 78 deliveries.

Most data on anesthesia and elective C-sections come from studies of term infants, said Dr. Robin Russell and colleagues at the John Radcliffe Hospital in Oxford, England. Data from one recent review of premature infants suggested that neonatal mortality risk was greater with spinal anesthesia than with general anesthesia, the researchers noted.

In this study, Dr. Russell and associates reviewed information from 78 women who were delivered at less than 33 weeks' gestation at a single hospital (69 singleton and 9 twin deliveries); the average age of the women was 31 years. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Spinal anesthesia (SA) was used in 58 cases, general anesthesia (GA) in 18 cases, and an epidural in 2 cases. The researchers compared the outcomes for the SA and GA cases based on Apgar scores and umbilical blood gas levels.

Overall, Apgar scores were not significantly different between the spinal and general anesthesia groups. The median 1-minute Apgar score was 8 in the SA group (range, 2-10) and 7 in the GA group (range, 3-9), and the median 5-minute Apgar scores were 8 in the SA group and 9 in the GA group.

Measures of umbilical venous gases were available for 49 SA deliveries and 15 GA deliveries, and measures of umbilical arterial gases were available for 51 SA deliveries and 13 GA deliveries. Based on these measures, there were no significant differences between the groups.

In addition, the birth weights were similar between the two groups, and no significant differences were observed in the health of the infants at 28 days or 3 months of age.

The results contrast with findings from previous research, but the study was limited by its small size and retrospective design, the researchers said. “Further work is needed to determine the optimal mode of anesthesia for cesarean section in premature infants,” they wrote. The investigators reported that they had no financial conflicts to disclose.

WASHINGTON — No significant differences in neonatal outcomes were found among premature infants of women who had spinal anesthesia versus general anesthesia for cesarean delivery, based on the results of a study of 78 deliveries.

Most data on anesthesia and elective C-sections come from studies of term infants, said Dr. Robin Russell and colleagues at the John Radcliffe Hospital in Oxford, England. Data from one recent review of premature infants suggested that neonatal mortality risk was greater with spinal anesthesia than with general anesthesia, the researchers noted.

In this study, Dr. Russell and associates reviewed information from 78 women who were delivered at less than 33 weeks' gestation at a single hospital (69 singleton and 9 twin deliveries); the average age of the women was 31 years. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Spinal anesthesia (SA) was used in 58 cases, general anesthesia (GA) in 18 cases, and an epidural in 2 cases. The researchers compared the outcomes for the SA and GA cases based on Apgar scores and umbilical blood gas levels.

Overall, Apgar scores were not significantly different between the spinal and general anesthesia groups. The median 1-minute Apgar score was 8 in the SA group (range, 2-10) and 7 in the GA group (range, 3-9), and the median 5-minute Apgar scores were 8 in the SA group and 9 in the GA group.

Measures of umbilical venous gases were available for 49 SA deliveries and 15 GA deliveries, and measures of umbilical arterial gases were available for 51 SA deliveries and 13 GA deliveries. Based on these measures, there were no significant differences between the groups.

In addition, the birth weights were similar between the two groups, and no significant differences were observed in the health of the infants at 28 days or 3 months of age.

The results contrast with findings from previous research, but the study was limited by its small size and retrospective design, the researchers said. “Further work is needed to determine the optimal mode of anesthesia for cesarean section in premature infants,” they wrote. The investigators reported that they had no financial conflicts to disclose.

WASHINGTON — No significant differences in neonatal outcomes were found among premature infants of women who had spinal anesthesia versus general anesthesia for cesarean delivery, based on the results of a study of 78 deliveries.

Most data on anesthesia and elective C-sections come from studies of term infants, said Dr. Robin Russell and colleagues at the John Radcliffe Hospital in Oxford, England. Data from one recent review of premature infants suggested that neonatal mortality risk was greater with spinal anesthesia than with general anesthesia, the researchers noted.

In this study, Dr. Russell and associates reviewed information from 78 women who were delivered at less than 33 weeks' gestation at a single hospital (69 singleton and 9 twin deliveries); the average age of the women was 31 years. The results were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Spinal anesthesia (SA) was used in 58 cases, general anesthesia (GA) in 18 cases, and an epidural in 2 cases. The researchers compared the outcomes for the SA and GA cases based on Apgar scores and umbilical blood gas levels.

Overall, Apgar scores were not significantly different between the spinal and general anesthesia groups. The median 1-minute Apgar score was 8 in the SA group (range, 2-10) and 7 in the GA group (range, 3-9), and the median 5-minute Apgar scores were 8 in the SA group and 9 in the GA group.

Measures of umbilical venous gases were available for 49 SA deliveries and 15 GA deliveries, and measures of umbilical arterial gases were available for 51 SA deliveries and 13 GA deliveries. Based on these measures, there were no significant differences between the groups.

In addition, the birth weights were similar between the two groups, and no significant differences were observed in the health of the infants at 28 days or 3 months of age.

The results contrast with findings from previous research, but the study was limited by its small size and retrospective design, the researchers said. “Further work is needed to determine the optimal mode of anesthesia for cesarean section in premature infants,” they wrote. The investigators reported that they had no financial conflicts to disclose.

WASHINGTON — The intensity of women's labor pain at the time of neuraxial anesthesia placement didn't influence the mode of delivery, based on data from a study of 555 nulliparous women.

No previous study has addressed whether timing of neuraxial anesthesia with regard to the degree of the patient's pain has an impact on the mode of delivery, Dr. Yaakov Beilin said in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

In this study, Dr. Beilin and Diana H. Mungall, both of Mount Sinai Hospital in New York, reviewed data from term, nulliparous women who presented to the labor floor of a single hospital between July 2005 and September 2008. Pain scores at the time of neuraxial analgesia placement were determined using a scale of 0-10 and divided into three groups: low (0-3), moderate (4-6), and high (7-10).

The cesarean section rate was 41%, 36%, and 34%, in the low-, moderate-, and high-pain groups, respectively; the differences were not significant.

Similarly, the operative delivery rate (which included cesarean plus instrumental assisted vaginal delivery) was 49%, 45%, and 45% in the low-, moderate-, and high-pain groups, respectively; these values were not significantly different. And the vaginal delivery rate of 51%, 55%, and 55% for the low-, moderate-, and high-pain groups, respectively, were not significantly different.

The results were limited by the retrospective nature of the study, but the data suggest that neuraxial analgesia can be safely placed in women with varying degrees of labor pain, Dr. Beilin said.

The researchers had no financial conflicts to disclose.

WASHINGTON — The intensity of women's labor pain at the time of neuraxial anesthesia placement didn't influence the mode of delivery, based on data from a study of 555 nulliparous women.

No previous study has addressed whether timing of neuraxial anesthesia with regard to the degree of the patient's pain has an impact on the mode of delivery, Dr. Yaakov Beilin said in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

In this study, Dr. Beilin and Diana H. Mungall, both of Mount Sinai Hospital in New York, reviewed data from term, nulliparous women who presented to the labor floor of a single hospital between July 2005 and September 2008. Pain scores at the time of neuraxial analgesia placement were determined using a scale of 0-10 and divided into three groups: low (0-3), moderate (4-6), and high (7-10).

The cesarean section rate was 41%, 36%, and 34%, in the low-, moderate-, and high-pain groups, respectively; the differences were not significant.

Similarly, the operative delivery rate (which included cesarean plus instrumental assisted vaginal delivery) was 49%, 45%, and 45% in the low-, moderate-, and high-pain groups, respectively; these values were not significantly different. And the vaginal delivery rate of 51%, 55%, and 55% for the low-, moderate-, and high-pain groups, respectively, were not significantly different.

The results were limited by the retrospective nature of the study, but the data suggest that neuraxial analgesia can be safely placed in women with varying degrees of labor pain, Dr. Beilin said.

The researchers had no financial conflicts to disclose.

WASHINGTON — The intensity of women's labor pain at the time of neuraxial anesthesia placement didn't influence the mode of delivery, based on data from a study of 555 nulliparous women.

No previous study has addressed whether timing of neuraxial anesthesia with regard to the degree of the patient's pain has an impact on the mode of delivery, Dr. Yaakov Beilin said in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

In this study, Dr. Beilin and Diana H. Mungall, both of Mount Sinai Hospital in New York, reviewed data from term, nulliparous women who presented to the labor floor of a single hospital between July 2005 and September 2008. Pain scores at the time of neuraxial analgesia placement were determined using a scale of 0-10 and divided into three groups: low (0-3), moderate (4-6), and high (7-10).

The cesarean section rate was 41%, 36%, and 34%, in the low-, moderate-, and high-pain groups, respectively; the differences were not significant.

Similarly, the operative delivery rate (which included cesarean plus instrumental assisted vaginal delivery) was 49%, 45%, and 45% in the low-, moderate-, and high-pain groups, respectively; these values were not significantly different. And the vaginal delivery rate of 51%, 55%, and 55% for the low-, moderate-, and high-pain groups, respectively, were not significantly different.

The results were limited by the retrospective nature of the study, but the data suggest that neuraxial analgesia can be safely placed in women with varying degrees of labor pain, Dr. Beilin said.

The researchers had no financial conflicts to disclose.

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, based on data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease remains uncertain, Dr. Nielsen said at the annual Digestive Disease Week. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, as well as 26,216 controls without a history of these infections. The researchers followed the study population for up to 15 years, with an average follow-up period of 7.5 years.

A first-time diagnosis of inflammatory bowel disease (IBD) during the follow-up period was reported in 107 individuals with a history of Salmonella or Campylobacter infections, compared with 73 controls. The risk of IBD was independent of age and sex, and it was similar for both pathogens. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 if the first year after infection was excluded.

“We documented both short-term and long-term increased risk of IBD following confirmed infections,” Dr. Nielsen said. The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD as more research is done, he added.

The findings also emphasize the importance of food safety for disease prevention, Dr. Nielsen said at a press conference. The increased volume of imported foods and changes in food production may create more challenges for safe food handling, he said.

Dr. Nielsen had no financial conflicts to disclose.

To view a video interview of Dr. Nielsen, go to: www.youtube.com/watch?v=GDVlFRfYojI

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, based on data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease remains uncertain, Dr. Nielsen said at the annual Digestive Disease Week. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, as well as 26,216 controls without a history of these infections. The researchers followed the study population for up to 15 years, with an average follow-up period of 7.5 years.

A first-time diagnosis of inflammatory bowel disease (IBD) during the follow-up period was reported in 107 individuals with a history of Salmonella or Campylobacter infections, compared with 73 controls. The risk of IBD was independent of age and sex, and it was similar for both pathogens. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 if the first year after infection was excluded.

“We documented both short-term and long-term increased risk of IBD following confirmed infections,” Dr. Nielsen said. The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD as more research is done, he added.

The findings also emphasize the importance of food safety for disease prevention, Dr. Nielsen said at a press conference. The increased volume of imported foods and changes in food production may create more challenges for safe food handling, he said.

Dr. Nielsen had no financial conflicts to disclose.

To view a video interview of Dr. Nielsen, go to: www.youtube.com/watch?v=GDVlFRfYojI

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, based on data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease remains uncertain, Dr. Nielsen said at the annual Digestive Disease Week. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, as well as 26,216 controls without a history of these infections. The researchers followed the study population for up to 15 years, with an average follow-up period of 7.5 years.

A first-time diagnosis of inflammatory bowel disease (IBD) during the follow-up period was reported in 107 individuals with a history of Salmonella or Campylobacter infections, compared with 73 controls. The risk of IBD was independent of age and sex, and it was similar for both pathogens. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 if the first year after infection was excluded.

“We documented both short-term and long-term increased risk of IBD following confirmed infections,” Dr. Nielsen said. The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD as more research is done, he added.

The findings also emphasize the importance of food safety for disease prevention, Dr. Nielsen said at a press conference. The increased volume of imported foods and changes in food production may create more challenges for safe food handling, he said.

Dr. Nielsen had no financial conflicts to disclose.

To view a video interview of Dr. Nielsen, go to: www.youtube.com/watch?v=GDVlFRfYojI

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on data from the CDC's Morbidity and Mortality Weekly Report presented at a press briefing on June 18.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill; washing hands frequently; and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't over-represented among reported cases of the H1N1 virus so far. The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene.

Data on additional cases in health care providers are under review, Dr. Bell said.

The complete report on the novel influenza A (H1N1) cases in the 26 health care workers will be available in the CDC's June 19 Morbidity and Mortality Weekly Report (2009;58:641-5).

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

The CDC has posted H1N1 guidance for summer camps on its Web site, Dr. Jernigan said. “It's important than aspirin not be used in children with influenza-like illness,” he added, because of the potential for complications.

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on data from the CDC's Morbidity and Mortality Weekly Report presented at a press briefing on June 18.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill; washing hands frequently; and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't over-represented among reported cases of the H1N1 virus so far. The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene.

Data on additional cases in health care providers are under review, Dr. Bell said.

The complete report on the novel influenza A (H1N1) cases in the 26 health care workers will be available in the CDC's June 19 Morbidity and Mortality Weekly Report (2009;58:641-5).

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

The CDC has posted H1N1 guidance for summer camps on its Web site, Dr. Jernigan said. “It's important than aspirin not be used in children with influenza-like illness,” he added, because of the potential for complications.

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on data from the CDC's Morbidity and Mortality Weekly Report presented at a press briefing on June 18.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill; washing hands frequently; and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't over-represented among reported cases of the H1N1 virus so far. The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene.

Data on additional cases in health care providers are under review, Dr. Bell said.

The complete report on the novel influenza A (H1N1) cases in the 26 health care workers will be available in the CDC's June 19 Morbidity and Mortality Weekly Report (2009;58:641-5).

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

The CDC has posted H1N1 guidance for summer camps on its Web site, Dr. Jernigan said. “It's important than aspirin not be used in children with influenza-like illness,” he added, because of the potential for complications.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said.

But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472]).

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said.

But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472]).

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said.

But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472]).

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.