Heidi Splete

WASHINGTON — A regular exercise program not only promotes flexibility, balance, and strength in elderly people with dementia, but it also might improve their mental function.

“You won't get oxygen to the brain if you don't get air down into the alveoli,” said Marge A. Coalman, Ed.D., vice president of wellness and programs at Touchmark, an Oregon-based company that builds and operates retirement communities in the United States and Canada. She spoke at a joint conference of the American Society on Aging and the National Council on Aging.

The World Health Organization and the President's Council on Physical Fitness and Sport endorse exercise for people with Alzheimer's disease (AD) and other dementias, Dr. Coalman pointed out. The first research confirming that stand came 5 years ago in a randomized, controlled trial of 153 AD patients, she added. Those who participated in supervised exercise for at least 60 minutes per week had significantly better physical function and less depression than did patients who didn't exercise (JAMA 2003;290:2015-22). Since then, studies in mice and people have suggested that exercise creates new cells in areas of the brain that are affected by age-related memory loss.

If nothing else, exercise offers hope to people with dementia that they can improve their condition.

The “memory care exercise program” developed for residents with dementia and used at Touchmark communities rests on four fundamentals—deep breathing, posture, range of motion, and strength. The degree of participation varies according to the resident's condition. Some patients continue exercising for as long as 30 minutes, but the average is 7 minutes.

Dr. Coalman's tips for conducting an exercise program with elderly dementia residents include keeping the movements slow but smooth, using straight-backed chairs with good back support, and invoking visual imagery such as marching in place to make the movements purposeful and fun.

Dr. Coalman described one exercise program developed by a physical therapist for Touchmark that starts with participants taking one to three deep breaths while raising their arms overhead. This promotes airflow into the lower lungs.

The program then addresses posture, which is important for balance and stability. Chest muscles tend to become weak with age, so it's hard for many older long-term care residents to draw the shoulder blades together and sit up straight.

A caregiver places a rolled-up towel or small inflatable ball behind a resident's back to help the person sit upright and attain maximum movement. The resident then rotates his or her neck, bending the head forward and towards each shoulder (never tilting it back), which promotes range of motion in the neck. Shoulder range of motion exercises include “pick an apple,” which is reaching up and across the body and back down to the opposite side, and “swing the bat,” in which the person holds an imaginary baseball bat on one shoulder and swings it down and across the body.

To strengthen the lower body, residents make circles with their ankles and to straighten one knee at a time and hold the lower leg up for a few seconds.

The exercise class ends with “stand-up sit-down” exercises for residents who are willing and able to rise from a sitting position with little or no assistance. Start patients with one repetition and work toward five rounds of stand-up sit-down, Dr. Coalman advised.

A small ball is placed behind the patient's back to help her sit upright and attain maximum movement. Touchmark

WASHINGTON — A regular exercise program not only promotes flexibility, balance, and strength in elderly people with dementia, but it also might improve their mental function.

“You won't get oxygen to the brain if you don't get air down into the alveoli,” said Marge A. Coalman, Ed.D., vice president of wellness and programs at Touchmark, an Oregon-based company that builds and operates retirement communities in the United States and Canada. She spoke at a joint conference of the American Society on Aging and the National Council on Aging.

The World Health Organization and the President's Council on Physical Fitness and Sport endorse exercise for people with Alzheimer's disease (AD) and other dementias, Dr. Coalman pointed out. The first research confirming that stand came 5 years ago in a randomized, controlled trial of 153 AD patients, she added. Those who participated in supervised exercise for at least 60 minutes per week had significantly better physical function and less depression than did patients who didn't exercise (JAMA 2003;290:2015-22). Since then, studies in mice and people have suggested that exercise creates new cells in areas of the brain that are affected by age-related memory loss.

If nothing else, exercise offers hope to people with dementia that they can improve their condition.

The “memory care exercise program” developed for residents with dementia and used at Touchmark communities rests on four fundamentals—deep breathing, posture, range of motion, and strength. The degree of participation varies according to the resident's condition. Some patients continue exercising for as long as 30 minutes, but the average is 7 minutes.

Dr. Coalman's tips for conducting an exercise program with elderly dementia residents include keeping the movements slow but smooth, using straight-backed chairs with good back support, and invoking visual imagery such as marching in place to make the movements purposeful and fun.

Dr. Coalman described one exercise program developed by a physical therapist for Touchmark that starts with participants taking one to three deep breaths while raising their arms overhead. This promotes airflow into the lower lungs.

The program then addresses posture, which is important for balance and stability. Chest muscles tend to become weak with age, so it's hard for many older long-term care residents to draw the shoulder blades together and sit up straight.

A caregiver places a rolled-up towel or small inflatable ball behind a resident's back to help the person sit upright and attain maximum movement. The resident then rotates his or her neck, bending the head forward and towards each shoulder (never tilting it back), which promotes range of motion in the neck. Shoulder range of motion exercises include “pick an apple,” which is reaching up and across the body and back down to the opposite side, and “swing the bat,” in which the person holds an imaginary baseball bat on one shoulder and swings it down and across the body.

To strengthen the lower body, residents make circles with their ankles and to straighten one knee at a time and hold the lower leg up for a few seconds.

The exercise class ends with “stand-up sit-down” exercises for residents who are willing and able to rise from a sitting position with little or no assistance. Start patients with one repetition and work toward five rounds of stand-up sit-down, Dr. Coalman advised.

A small ball is placed behind the patient's back to help her sit upright and attain maximum movement. Touchmark

WASHINGTON — A regular exercise program not only promotes flexibility, balance, and strength in elderly people with dementia, but it also might improve their mental function.

“You won't get oxygen to the brain if you don't get air down into the alveoli,” said Marge A. Coalman, Ed.D., vice president of wellness and programs at Touchmark, an Oregon-based company that builds and operates retirement communities in the United States and Canada. She spoke at a joint conference of the American Society on Aging and the National Council on Aging.

The World Health Organization and the President's Council on Physical Fitness and Sport endorse exercise for people with Alzheimer's disease (AD) and other dementias, Dr. Coalman pointed out. The first research confirming that stand came 5 years ago in a randomized, controlled trial of 153 AD patients, she added. Those who participated in supervised exercise for at least 60 minutes per week had significantly better physical function and less depression than did patients who didn't exercise (JAMA 2003;290:2015-22). Since then, studies in mice and people have suggested that exercise creates new cells in areas of the brain that are affected by age-related memory loss.

If nothing else, exercise offers hope to people with dementia that they can improve their condition.

The “memory care exercise program” developed for residents with dementia and used at Touchmark communities rests on four fundamentals—deep breathing, posture, range of motion, and strength. The degree of participation varies according to the resident's condition. Some patients continue exercising for as long as 30 minutes, but the average is 7 minutes.

Dr. Coalman's tips for conducting an exercise program with elderly dementia residents include keeping the movements slow but smooth, using straight-backed chairs with good back support, and invoking visual imagery such as marching in place to make the movements purposeful and fun.

Dr. Coalman described one exercise program developed by a physical therapist for Touchmark that starts with participants taking one to three deep breaths while raising their arms overhead. This promotes airflow into the lower lungs.

The program then addresses posture, which is important for balance and stability. Chest muscles tend to become weak with age, so it's hard for many older long-term care residents to draw the shoulder blades together and sit up straight.

A caregiver places a rolled-up towel or small inflatable ball behind a resident's back to help the person sit upright and attain maximum movement. The resident then rotates his or her neck, bending the head forward and towards each shoulder (never tilting it back), which promotes range of motion in the neck. Shoulder range of motion exercises include “pick an apple,” which is reaching up and across the body and back down to the opposite side, and “swing the bat,” in which the person holds an imaginary baseball bat on one shoulder and swings it down and across the body.

To strengthen the lower body, residents make circles with their ankles and to straighten one knee at a time and hold the lower leg up for a few seconds.

The exercise class ends with “stand-up sit-down” exercises for residents who are willing and able to rise from a sitting position with little or no assistance. Start patients with one repetition and work toward five rounds of stand-up sit-down, Dr. Coalman advised.

A small ball is placed behind the patient's back to help her sit upright and attain maximum movement. Touchmark

Modafinil significantly improved symptoms in children with inattentive and combined subtypes of attention-deficit/hyperactivity disorder, based on data from 638 children aged 6–17 years.

Pooled results from one 7-week study and two 9-week studies showed that modafinil was well tolerated and improved attention-deficit hyperactivity disorder (ADHD) symptoms both at home and in school. The studies were funded by Cephalon Inc., which markets modafinil as Provigil in the United States.

Dr. Joseph Biederman of Massachusetts General Hospital, Boston, and Dr. Steven R. Pliszka of the University of Texas Health Science Center, San Antonio, reviewed the pooled data to analyze the effectiveness of modafinil on three ADHD subtypes: inattentive, combined, and hyperactive impulsive (J. Pediatr. 2008;152:394-9). Few studies have examined the effectiveness of drug treatments for ADHD by subtype.

In the 7-week study, children were randomized to receive 340 mg or 425 mg of modafinil or a placebo daily. In the 9-week studies, children were randomized to receive a flexible dose from 170 mg to 425 mg or a placebo daily. A total of 423 children received modafinil and 215 received a placebo.

The researchers used the ADHD-RS-IV School Version, which includes teacher and investigator ratings to assess symptoms.

Children in the inattentive and combined subgroups who received modafinil showed significant improvements in the ADHD-RS-IV School Version total scores, compared with placebo patients. Children in the hyperactive-impulsive subgroup who received modafinil showed a greater improvement in total scores (demonstrated by lower numbers) than placebo patients, but this difference was not statistically significant.

The average score for modafinil patients across all subgroups was 57 at the study's end versus 73 for placebo patients. Results were similar for scores on the ADHD-RS-IV Home Version, which were detailed in a separate analysis.

Forty-eight percent of the inattentive subgroup who received modafinil versus 15% of those who were given a placebo received “much improved” or “very much improved” ratings from investigators. Similarly, 44% of the combined subgroup who received modafinil versus 18% of those who received placebo were rated “much improved” or “very much improved” by the investigators.

Children in the inattentive and combined subtype groups who received modafinil showed significant improvements in subscale scores for cognitive problems/inattention, hyperactivity, and the ADHD index, compared with placebo patients.

The combined subtype of ADHD is the most commonly diagnosed and is most often associated with psychiatric comorbidity and other behavioral, social, and academic problems, the researchers noted. A total of 65% of the children met criteria for the combined ADHD subtype, and this group had the largest percentage (18%) of children who were ranked “severely ill” or “extremely ill” at baseline.

Dr. Biederman receives research support from multiple drug companies, including this study's sponsor, Cephalon (for whom he also serves as a speaker and a member of the advisory board). He also serves as a speaker and advisory board member for many other pharmaceutical companies.

Dr. Pliszka receives research support from Cephalon and Eli Lilly & Co., and serves on speakers bureaus sponsored by Shire Pharmaceuticals and McNeil.

Modafinil significantly improved symptoms in children with inattentive and combined subtypes of attention-deficit/hyperactivity disorder, based on data from 638 children aged 6–17 years.

Pooled results from one 7-week study and two 9-week studies showed that modafinil was well tolerated and improved attention-deficit hyperactivity disorder (ADHD) symptoms both at home and in school. The studies were funded by Cephalon Inc., which markets modafinil as Provigil in the United States.

Dr. Joseph Biederman of Massachusetts General Hospital, Boston, and Dr. Steven R. Pliszka of the University of Texas Health Science Center, San Antonio, reviewed the pooled data to analyze the effectiveness of modafinil on three ADHD subtypes: inattentive, combined, and hyperactive impulsive (J. Pediatr. 2008;152:394-9). Few studies have examined the effectiveness of drug treatments for ADHD by subtype.

In the 7-week study, children were randomized to receive 340 mg or 425 mg of modafinil or a placebo daily. In the 9-week studies, children were randomized to receive a flexible dose from 170 mg to 425 mg or a placebo daily. A total of 423 children received modafinil and 215 received a placebo.

The researchers used the ADHD-RS-IV School Version, which includes teacher and investigator ratings to assess symptoms.

Children in the inattentive and combined subgroups who received modafinil showed significant improvements in the ADHD-RS-IV School Version total scores, compared with placebo patients. Children in the hyperactive-impulsive subgroup who received modafinil showed a greater improvement in total scores (demonstrated by lower numbers) than placebo patients, but this difference was not statistically significant.

The average score for modafinil patients across all subgroups was 57 at the study's end versus 73 for placebo patients. Results were similar for scores on the ADHD-RS-IV Home Version, which were detailed in a separate analysis.

Forty-eight percent of the inattentive subgroup who received modafinil versus 15% of those who were given a placebo received “much improved” or “very much improved” ratings from investigators. Similarly, 44% of the combined subgroup who received modafinil versus 18% of those who received placebo were rated “much improved” or “very much improved” by the investigators.

Children in the inattentive and combined subtype groups who received modafinil showed significant improvements in subscale scores for cognitive problems/inattention, hyperactivity, and the ADHD index, compared with placebo patients.

The combined subtype of ADHD is the most commonly diagnosed and is most often associated with psychiatric comorbidity and other behavioral, social, and academic problems, the researchers noted. A total of 65% of the children met criteria for the combined ADHD subtype, and this group had the largest percentage (18%) of children who were ranked “severely ill” or “extremely ill” at baseline.

Dr. Biederman receives research support from multiple drug companies, including this study's sponsor, Cephalon (for whom he also serves as a speaker and a member of the advisory board). He also serves as a speaker and advisory board member for many other pharmaceutical companies.

Dr. Pliszka receives research support from Cephalon and Eli Lilly & Co., and serves on speakers bureaus sponsored by Shire Pharmaceuticals and McNeil.

Modafinil significantly improved symptoms in children with inattentive and combined subtypes of attention-deficit/hyperactivity disorder, based on data from 638 children aged 6–17 years.

Pooled results from one 7-week study and two 9-week studies showed that modafinil was well tolerated and improved attention-deficit hyperactivity disorder (ADHD) symptoms both at home and in school. The studies were funded by Cephalon Inc., which markets modafinil as Provigil in the United States.

Dr. Joseph Biederman of Massachusetts General Hospital, Boston, and Dr. Steven R. Pliszka of the University of Texas Health Science Center, San Antonio, reviewed the pooled data to analyze the effectiveness of modafinil on three ADHD subtypes: inattentive, combined, and hyperactive impulsive (J. Pediatr. 2008;152:394-9). Few studies have examined the effectiveness of drug treatments for ADHD by subtype.

In the 7-week study, children were randomized to receive 340 mg or 425 mg of modafinil or a placebo daily. In the 9-week studies, children were randomized to receive a flexible dose from 170 mg to 425 mg or a placebo daily. A total of 423 children received modafinil and 215 received a placebo.

The researchers used the ADHD-RS-IV School Version, which includes teacher and investigator ratings to assess symptoms.

Children in the inattentive and combined subgroups who received modafinil showed significant improvements in the ADHD-RS-IV School Version total scores, compared with placebo patients. Children in the hyperactive-impulsive subgroup who received modafinil showed a greater improvement in total scores (demonstrated by lower numbers) than placebo patients, but this difference was not statistically significant.

The average score for modafinil patients across all subgroups was 57 at the study's end versus 73 for placebo patients. Results were similar for scores on the ADHD-RS-IV Home Version, which were detailed in a separate analysis.

Forty-eight percent of the inattentive subgroup who received modafinil versus 15% of those who were given a placebo received “much improved” or “very much improved” ratings from investigators. Similarly, 44% of the combined subgroup who received modafinil versus 18% of those who received placebo were rated “much improved” or “very much improved” by the investigators.

Children in the inattentive and combined subtype groups who received modafinil showed significant improvements in subscale scores for cognitive problems/inattention, hyperactivity, and the ADHD index, compared with placebo patients.

The combined subtype of ADHD is the most commonly diagnosed and is most often associated with psychiatric comorbidity and other behavioral, social, and academic problems, the researchers noted. A total of 65% of the children met criteria for the combined ADHD subtype, and this group had the largest percentage (18%) of children who were ranked “severely ill” or “extremely ill” at baseline.

Dr. Biederman receives research support from multiple drug companies, including this study's sponsor, Cephalon (for whom he also serves as a speaker and a member of the advisory board). He also serves as a speaker and advisory board member for many other pharmaceutical companies.

Dr. Pliszka receives research support from Cephalon and Eli Lilly & Co., and serves on speakers bureaus sponsored by Shire Pharmaceuticals and McNeil.

Social anxiety stemming from acne or other skin conditions might keep people from exercising, say results of a survey of 50 adults selected from an acne support group.

Exercise is important for overall health and skin health, but data from previous studies have shown that people are often inclined to avoid participating in sports and other activities because of anxiety about their appearance.

To examine the link between skin-related social anxiety and the intention to play sports or exercise, Tom Loney, a Ph.D. student at the University of Bath (England) and his colleagues surveyed 20 men and 30 women with an average age of 33 years (J. Health Psychol. 2008;13:47–54).

The participants responded to questionnaires that addressed dermatologic social anxiety, intention to participate in sports and exercise, self-esteem, and quality of life related to skin conditions.

Based on responses to dermatologic social anxiety statements such as, “When in a bathing suit, I often feel nervous about the appearance of my skin,” the average score was 3.97 on a scale of 1 (not at all) to 5 (extremely).

The average score for intent-to-exercise statements such as “I am determined to exercise/play sport at least three times a week during the next month” was 4.04 on a scale of 1 (very unlikely) to 7 (very likely). For self-esteem statements such as “I feel that I have a number of good qualities,” the average response was 1.56 on a scale of 1 (strongly disagree) to 4 (strongly agree).

Finally, the average score on the Dermatology Life Quality Index, which includes 10 items such as, “Over the last week, how much has your skin affected any social or leisure activities?” was 0.99 on a scale of 3 (very much) to 0 (not at all).

Statistical analyses of the responses yielded significant negative relationships between skin-related social anxiety and each of three variables: intention to exercise, self-esteem, and dermatologic-related quality of life.

“Participants who experience greater levels of skin-related social anxiety report lower intention to participate in sport and exercise, experience lower self-esteem,” and have a poorer quality of life related to skin conditions, Mr. Loney and his associates wrote.

The extent to which people are apprehensive about having their skin evaluated by others has implications for the intention to participate in sports and exercise and for self-perception, but more studies are needed to determine the impact of skin-related social anxiety within specific sports and exercise settings, they said. For example, team sports or group exercise settings might cause more anxiety than exercising alone, and people with high skin-related social anxiety might avoid those situations.

Although the results were limited by the use of a global perception of acne severity rather than symptom-specific ratings, the data support findings from previous studies and contribute to the limited field of research involving both physical and psychological health, Mr. Loney and his colleagues said. None of the researchers disclosed any conflicts of interest.

Social anxiety stemming from acne or other skin conditions might keep people from exercising, say results of a survey of 50 adults selected from an acne support group.

Exercise is important for overall health and skin health, but data from previous studies have shown that people are often inclined to avoid participating in sports and other activities because of anxiety about their appearance.

To examine the link between skin-related social anxiety and the intention to play sports or exercise, Tom Loney, a Ph.D. student at the University of Bath (England) and his colleagues surveyed 20 men and 30 women with an average age of 33 years (J. Health Psychol. 2008;13:47–54).

The participants responded to questionnaires that addressed dermatologic social anxiety, intention to participate in sports and exercise, self-esteem, and quality of life related to skin conditions.

Based on responses to dermatologic social anxiety statements such as, “When in a bathing suit, I often feel nervous about the appearance of my skin,” the average score was 3.97 on a scale of 1 (not at all) to 5 (extremely).

The average score for intent-to-exercise statements such as “I am determined to exercise/play sport at least three times a week during the next month” was 4.04 on a scale of 1 (very unlikely) to 7 (very likely). For self-esteem statements such as “I feel that I have a number of good qualities,” the average response was 1.56 on a scale of 1 (strongly disagree) to 4 (strongly agree).

Finally, the average score on the Dermatology Life Quality Index, which includes 10 items such as, “Over the last week, how much has your skin affected any social or leisure activities?” was 0.99 on a scale of 3 (very much) to 0 (not at all).

Statistical analyses of the responses yielded significant negative relationships between skin-related social anxiety and each of three variables: intention to exercise, self-esteem, and dermatologic-related quality of life.

“Participants who experience greater levels of skin-related social anxiety report lower intention to participate in sport and exercise, experience lower self-esteem,” and have a poorer quality of life related to skin conditions, Mr. Loney and his associates wrote.

The extent to which people are apprehensive about having their skin evaluated by others has implications for the intention to participate in sports and exercise and for self-perception, but more studies are needed to determine the impact of skin-related social anxiety within specific sports and exercise settings, they said. For example, team sports or group exercise settings might cause more anxiety than exercising alone, and people with high skin-related social anxiety might avoid those situations.

Although the results were limited by the use of a global perception of acne severity rather than symptom-specific ratings, the data support findings from previous studies and contribute to the limited field of research involving both physical and psychological health, Mr. Loney and his colleagues said. None of the researchers disclosed any conflicts of interest.

Social anxiety stemming from acne or other skin conditions might keep people from exercising, say results of a survey of 50 adults selected from an acne support group.

Exercise is important for overall health and skin health, but data from previous studies have shown that people are often inclined to avoid participating in sports and other activities because of anxiety about their appearance.

To examine the link between skin-related social anxiety and the intention to play sports or exercise, Tom Loney, a Ph.D. student at the University of Bath (England) and his colleagues surveyed 20 men and 30 women with an average age of 33 years (J. Health Psychol. 2008;13:47–54).

The participants responded to questionnaires that addressed dermatologic social anxiety, intention to participate in sports and exercise, self-esteem, and quality of life related to skin conditions.

Based on responses to dermatologic social anxiety statements such as, “When in a bathing suit, I often feel nervous about the appearance of my skin,” the average score was 3.97 on a scale of 1 (not at all) to 5 (extremely).

The average score for intent-to-exercise statements such as “I am determined to exercise/play sport at least three times a week during the next month” was 4.04 on a scale of 1 (very unlikely) to 7 (very likely). For self-esteem statements such as “I feel that I have a number of good qualities,” the average response was 1.56 on a scale of 1 (strongly disagree) to 4 (strongly agree).

Finally, the average score on the Dermatology Life Quality Index, which includes 10 items such as, “Over the last week, how much has your skin affected any social or leisure activities?” was 0.99 on a scale of 3 (very much) to 0 (not at all).

Statistical analyses of the responses yielded significant negative relationships between skin-related social anxiety and each of three variables: intention to exercise, self-esteem, and dermatologic-related quality of life.

“Participants who experience greater levels of skin-related social anxiety report lower intention to participate in sport and exercise, experience lower self-esteem,” and have a poorer quality of life related to skin conditions, Mr. Loney and his associates wrote.

The extent to which people are apprehensive about having their skin evaluated by others has implications for the intention to participate in sports and exercise and for self-perception, but more studies are needed to determine the impact of skin-related social anxiety within specific sports and exercise settings, they said. For example, team sports or group exercise settings might cause more anxiety than exercising alone, and people with high skin-related social anxiety might avoid those situations.

Although the results were limited by the use of a global perception of acne severity rather than symptom-specific ratings, the data support findings from previous studies and contribute to the limited field of research involving both physical and psychological health, Mr. Loney and his colleagues said. None of the researchers disclosed any conflicts of interest.

WASHINGTON – A regular exercise program not only promotes flexibility, balance, and strength in elderly people with dementia, but it also might improve their mental function.

“You won't get oxygen to the brain if you don't get air down into the alveoli,” said Marge A. Coalman, Ed.D., vice president of wellness and programs at Touchmark, an Oregon-based company that operates a range of retirement communities including nursing homes and skilled nursing facilities in the United States and Canada. She spoke at a joint conference of the American Society on Aging and the National Council on Aging.

The World Health Organization and the President's Council on Physical Fitness and Sport endorse exercise for people with Alzheimer's disease (AD) and other dementias, Dr. Coalman pointed out. The first research confirming that stand came 5 years ago in a randomized, controlled trial of 153 AD patients, she added. Those who participated in supervised exercise for at least 60 minutes per week had significantly better physical function and less depression than did patients who didn't exercise (JAMA 2003;290:2015–22). Since then, studies in mice and people have suggested that exercise creates new cells in areas of the brain that are affected by age-related memory loss.

If nothing else, exercise offers hope to people with dementia that they can improve their condition. “There's so little hope you can hold out to people with this diagnosis,” Dr. Coalman said. “Something as simple as a predictable exercise routine makes a huge difference.”

The “memory care exercise program” developed for residents with dementia and used at Touchmark facilities rests on four fundamentals–deep breathing, posture, range of motion, and strength. The degree of participation varies according to the resident's condition. Some patients continue exercising for as long as 30 minutes, but the average is 7 minutes.

Dr. Coalman's tips for conducting an exercise program with elderly dementia patients include keeping the movements slow but smooth, using straight-backed chairs with good back support, and invoking visual imagery such as marching in place to make the movements purposeful and fun.

Dr. Coalman described one exercise program developed by a physical therapist for Touchmark that starts with participants taking one to three deep breaths while raising their arms overhead. This promotes airflow into the lower parts of the lungs.

The program then addresses posture, which is important for balance and stability. A caregiver places a rolled-up towel or small inflatable ball behind a resident's back to help the person sit upright and attain maximum movement. The resident then rotates his or her neck and bends the head toward each shoulder, promoting range of motion in the neck.

To strengthen the lower body, residents are instructed to make circles with their ankles and to straighten one knee at a time and hold the lower leg up for a few seconds.

Finally, the exercise class ends with “stand-up sit-down” exercises for residents who are willing and able to rise from a sitting position with little or no assistance. A caregiver should stand next to each resident and assist the person slightly, as needed.

To stand, residents are encouraged to scoot to the fronts of their chairs and use the chair's armrests to push themselves up. To sit, they are reminded to simply reverse the process. Start patients with one repetition and work toward five rounds of stand-up sit-down, Dr. Coalman advised. The primary goal of any exercise program for people with dementia is “to keep [them] away from assistive devices as long as possible,” said Dr. Coalman. Greater independence promotes a better quality of life, she said.

An inflatable ball behind the back helps the person attain maximum movement. Touchmark

WASHINGTON – A regular exercise program not only promotes flexibility, balance, and strength in elderly people with dementia, but it also might improve their mental function.

“You won't get oxygen to the brain if you don't get air down into the alveoli,” said Marge A. Coalman, Ed.D., vice president of wellness and programs at Touchmark, an Oregon-based company that operates a range of retirement communities including nursing homes and skilled nursing facilities in the United States and Canada. She spoke at a joint conference of the American Society on Aging and the National Council on Aging.

The World Health Organization and the President's Council on Physical Fitness and Sport endorse exercise for people with Alzheimer's disease (AD) and other dementias, Dr. Coalman pointed out. The first research confirming that stand came 5 years ago in a randomized, controlled trial of 153 AD patients, she added. Those who participated in supervised exercise for at least 60 minutes per week had significantly better physical function and less depression than did patients who didn't exercise (JAMA 2003;290:2015–22). Since then, studies in mice and people have suggested that exercise creates new cells in areas of the brain that are affected by age-related memory loss.

If nothing else, exercise offers hope to people with dementia that they can improve their condition. “There's so little hope you can hold out to people with this diagnosis,” Dr. Coalman said. “Something as simple as a predictable exercise routine makes a huge difference.”

The “memory care exercise program” developed for residents with dementia and used at Touchmark facilities rests on four fundamentals–deep breathing, posture, range of motion, and strength. The degree of participation varies according to the resident's condition. Some patients continue exercising for as long as 30 minutes, but the average is 7 minutes.

Dr. Coalman's tips for conducting an exercise program with elderly dementia patients include keeping the movements slow but smooth, using straight-backed chairs with good back support, and invoking visual imagery such as marching in place to make the movements purposeful and fun.

Dr. Coalman described one exercise program developed by a physical therapist for Touchmark that starts with participants taking one to three deep breaths while raising their arms overhead. This promotes airflow into the lower parts of the lungs.

The program then addresses posture, which is important for balance and stability. A caregiver places a rolled-up towel or small inflatable ball behind a resident's back to help the person sit upright and attain maximum movement. The resident then rotates his or her neck and bends the head toward each shoulder, promoting range of motion in the neck.

To strengthen the lower body, residents are instructed to make circles with their ankles and to straighten one knee at a time and hold the lower leg up for a few seconds.

Finally, the exercise class ends with “stand-up sit-down” exercises for residents who are willing and able to rise from a sitting position with little or no assistance. A caregiver should stand next to each resident and assist the person slightly, as needed.

To stand, residents are encouraged to scoot to the fronts of their chairs and use the chair's armrests to push themselves up. To sit, they are reminded to simply reverse the process. Start patients with one repetition and work toward five rounds of stand-up sit-down, Dr. Coalman advised. The primary goal of any exercise program for people with dementia is “to keep [them] away from assistive devices as long as possible,” said Dr. Coalman. Greater independence promotes a better quality of life, she said.

An inflatable ball behind the back helps the person attain maximum movement. Touchmark

WASHINGTON – A regular exercise program not only promotes flexibility, balance, and strength in elderly people with dementia, but it also might improve their mental function.

“You won't get oxygen to the brain if you don't get air down into the alveoli,” said Marge A. Coalman, Ed.D., vice president of wellness and programs at Touchmark, an Oregon-based company that operates a range of retirement communities including nursing homes and skilled nursing facilities in the United States and Canada. She spoke at a joint conference of the American Society on Aging and the National Council on Aging.

The World Health Organization and the President's Council on Physical Fitness and Sport endorse exercise for people with Alzheimer's disease (AD) and other dementias, Dr. Coalman pointed out. The first research confirming that stand came 5 years ago in a randomized, controlled trial of 153 AD patients, she added. Those who participated in supervised exercise for at least 60 minutes per week had significantly better physical function and less depression than did patients who didn't exercise (JAMA 2003;290:2015–22). Since then, studies in mice and people have suggested that exercise creates new cells in areas of the brain that are affected by age-related memory loss.

If nothing else, exercise offers hope to people with dementia that they can improve their condition. “There's so little hope you can hold out to people with this diagnosis,” Dr. Coalman said. “Something as simple as a predictable exercise routine makes a huge difference.”

The “memory care exercise program” developed for residents with dementia and used at Touchmark facilities rests on four fundamentals–deep breathing, posture, range of motion, and strength. The degree of participation varies according to the resident's condition. Some patients continue exercising for as long as 30 minutes, but the average is 7 minutes.

Dr. Coalman's tips for conducting an exercise program with elderly dementia patients include keeping the movements slow but smooth, using straight-backed chairs with good back support, and invoking visual imagery such as marching in place to make the movements purposeful and fun.

Dr. Coalman described one exercise program developed by a physical therapist for Touchmark that starts with participants taking one to three deep breaths while raising their arms overhead. This promotes airflow into the lower parts of the lungs.

The program then addresses posture, which is important for balance and stability. A caregiver places a rolled-up towel or small inflatable ball behind a resident's back to help the person sit upright and attain maximum movement. The resident then rotates his or her neck and bends the head toward each shoulder, promoting range of motion in the neck.

To strengthen the lower body, residents are instructed to make circles with their ankles and to straighten one knee at a time and hold the lower leg up for a few seconds.

Finally, the exercise class ends with “stand-up sit-down” exercises for residents who are willing and able to rise from a sitting position with little or no assistance. A caregiver should stand next to each resident and assist the person slightly, as needed.

To stand, residents are encouraged to scoot to the fronts of their chairs and use the chair's armrests to push themselves up. To sit, they are reminded to simply reverse the process. Start patients with one repetition and work toward five rounds of stand-up sit-down, Dr. Coalman advised. The primary goal of any exercise program for people with dementia is “to keep [them] away from assistive devices as long as possible,” said Dr. Coalman. Greater independence promotes a better quality of life, she said.

An inflatable ball behind the back helps the person attain maximum movement. Touchmark

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from approximately 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented.

However, an association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established.

The nature of the association–which emerged both among people living in nursing homes and in those in the community–remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women of average age 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function.

The exam rated seven people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment.

The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during 1 night in each person's usual sleep setting.

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements (Sleep 2008;31:224–30).

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake; less total sleep time and nonrapid eye movement sleep; less sleep efficiency; and a lower apnea-hypopnea index than did study participants with lower PLMI.

When the researchers controlled for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time.

On the other hand, the analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study showed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities.

“This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless leg syndrome, may be a cause for poor sleep in elders with cognitive impairment,” Dr. Richards and her colleagues wrote.

In a statement, Dr. Richards called that finding “important because treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

The study was limited by a lack of data on the potential role of upper airway resistance as a cause of nighttime leg movement, according to Dr. Richards and her colleagues.

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from approximately 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented.

However, an association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established.

The nature of the association–which emerged both among people living in nursing homes and in those in the community–remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women of average age 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function.

The exam rated seven people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment.

The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during 1 night in each person's usual sleep setting.

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements (Sleep 2008;31:224–30).

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake; less total sleep time and nonrapid eye movement sleep; less sleep efficiency; and a lower apnea-hypopnea index than did study participants with lower PLMI.

When the researchers controlled for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time.

On the other hand, the analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study showed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities.

“This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless leg syndrome, may be a cause for poor sleep in elders with cognitive impairment,” Dr. Richards and her colleagues wrote.

In a statement, Dr. Richards called that finding “important because treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

The study was limited by a lack of data on the potential role of upper airway resistance as a cause of nighttime leg movement, according to Dr. Richards and her colleagues.

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

Frequent nighttime leg movements were significantly associated with sleep disturbance and less total sleep in a study of 102 elderly people with cognitive impairment.

Previous research had shown that sleep time varies from approximately 6 to 10 hours in nursing home residents who have moderate to severe cognitive impairment, and that this sleep is quite fragmented.

However, an association between periodic limb movements in sleep and total sleep time in older people with cognitive impairment hadn't been established.

The nature of the association–which emerged both among people living in nursing homes and in those in the community–remains unclear.

Kathy C. Richards, Ph.D., of the Polisher Research Institute, Horsham, Pa., and her colleagues measured sleep variables in 58 men and 44 women of average age 82 years. Of those, 66 people lived in nursing homes or assisted-living facilities and the rest resided at home.

The participants scored an average of 17.3 on the Mini-Mental State Examination (MMSE), in which a score of 30 signifies the highest cognitive function.

The exam rated seven people as having profound cognitive impairment, 14 with severe cognitive impairment, and 33 within the criteria for moderate cognitive impairment. The test rated 21 people as mildly impaired and 27 with early cognitive impairment.

The researchers then used polysomnography to collect data on variables including leg movement, oxygen saturation, time spent in bed, total sleep time, and the apnea-hypopnea index. The team conducted the test during 1 night in each person's usual sleep setting.

The study participants averaged 5.5 hours of total sleep time, ranging from less than 1 hour to nearly 9 hours. Although the average time spent in bed was 8 hours, only 67% of that time was spent sleeping, and nonrapid eye movement sleep made up 87% of the total sleep time. The study subjects awoke an average of 34 times during the night, but only an average of 1.8 awakenings was related to leg movements (Sleep 2008;31:224–30).

Participants' scores on the Periodic Leg Movement Index (PLMI) ranged from 0 to 112, with an average of 17. A total of 34 persons (33%) had PLMI scores greater than 15, which is the cutoff point for a diagnosis of periodic limb movement disorder.

Overall, people with a PLMI greater than 15 experienced significantly more minutes awake; less total sleep time and nonrapid eye movement sleep; less sleep efficiency; and a lower apnea-hypopnea index than did study participants with lower PLMI.

When the researchers controlled for multiple variables, a combination of time spent in bed, older age, and higher PLMI accounted for 44% of the study population's variance in total sleep time.

On the other hand, the analysis found no relationship between PLMI and other sleep variables or participants' age or MMSE scores.

The study showed no significant difference in total sleep time between people in private homes and those in nursing homes or assisted-living facilities.

“This was surprising considering the pervasive nursing care practices in nursing homes of awakening residents for incontinence and other care and the noise from other residents and staff,” the researchers noted.

“An elevated PLMI was associated with a consistent pattern of sleep disturbance, suggesting that [periodic leg movements] or other related comorbidities, such as restless leg syndrome, may be a cause for poor sleep in elders with cognitive impairment,” Dr. Richards and her colleagues wrote.

In a statement, Dr. Richards called that finding “important because treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

The study was limited by a lack of data on the potential role of upper airway resistance as a cause of nighttime leg movement, according to Dr. Richards and her colleagues.

Dr. Richards has received research support from Beverly Healthcare Corp., but the study had no industry sponsorship.

SAN DIEGO — Older age was the strongest predictor of early mortality in adults with gastrointestinal bleeding after investigators controlled for medications and comorbidities, according to data from more than 1,000 adults treated at a single medical center.

In recent years, more clinicians have turned to low-dose aspirin and antithrombotic agents for the prevention of cardiovascular disease, but the interaction of these products with other risk factors for GI bleeding has not been studied thoroughly.

“We aimed to assess the 30-day mortality after upper gastrointestinal bleeding in association with the use of NSAIDs, low-dose aspirin, and other antithrombotic drugs,” Dr. Ali S. Taha of Crosshouse Hospital and the University of Glasgow, Scotland, and associates wrote in a poster presented at the annual Digestive Disease Week.

The investigators analyzed data from 1,014 adults who presented with a first episode of upper GI bleeding. A total of 45% of the patients were aged 65 years and older, and 8.1% of these patients died within 30 days of bleeding, compared with 1.3% of the younger patients.

After adjustment for multiple variables, patients who were aged 65 years and older had a significantly greater risk of 30-day mortality, compared with their younger counterparts.

In a univariate analysis, cerebrovascular disease, cardiovascular disease, and the use of diuretics, digoxin, and either low-dose aspirin or other antithrombotic drugs were significantly associated with an increased risk of 30-day mortality.

Low-dose aspirin was defined as 75 mg/day, and the antithrombotic drugs included clopidogrel, dipyridamole, and warfarin.

Use of NSAIDs had no significant impact on 30-day mortality, and the specific withdrawal of rofecoxib (Vioxx) had no apparent effect on 30-day mortality rates in this population.

The Blatchford score (an accepted measure of risk in patients with upper GI bleeding) was calculated using both clinical and laboratory data at each patient's presentation.

Patients scoring higher than 10 on this measure had five times the risk of early death, compared with patients who scored 0-2.

Despite the importance of comorbidities and medication use, the results suggest that age is a strong and independent predictor of early mortality in patients with upper GI bleeding. However, more studies are needed to determine the clinical implications for treatment, Dr. Taha said in an interview.

“Ulcer prevention should be considered seriously in elderly patients, particularly in the presence of other comorbid conditions and use of ulcerogenic drugs,” Dr. Taha said. “And once bleeding has taken place, such patients should be targeted for intensive management.”

Dr. Taha stated that he has received grants and research support from Astellas Pharma Inc., AstraZeneca Pharmaceuticals, Merck & Co., and Yamanouchi Pharmaceutical Co.

ELSEVIER GLOBAL MEDICAL NEWS

SAN DIEGO — Older age was the strongest predictor of early mortality in adults with gastrointestinal bleeding after investigators controlled for medications and comorbidities, according to data from more than 1,000 adults treated at a single medical center.

In recent years, more clinicians have turned to low-dose aspirin and antithrombotic agents for the prevention of cardiovascular disease, but the interaction of these products with other risk factors for GI bleeding has not been studied thoroughly.

“We aimed to assess the 30-day mortality after upper gastrointestinal bleeding in association with the use of NSAIDs, low-dose aspirin, and other antithrombotic drugs,” Dr. Ali S. Taha of Crosshouse Hospital and the University of Glasgow, Scotland, and associates wrote in a poster presented at the annual Digestive Disease Week.

The investigators analyzed data from 1,014 adults who presented with a first episode of upper GI bleeding. A total of 45% of the patients were aged 65 years and older, and 8.1% of these patients died within 30 days of bleeding, compared with 1.3% of the younger patients.

After adjustment for multiple variables, patients who were aged 65 years and older had a significantly greater risk of 30-day mortality, compared with their younger counterparts.

In a univariate analysis, cerebrovascular disease, cardiovascular disease, and the use of diuretics, digoxin, and either low-dose aspirin or other antithrombotic drugs were significantly associated with an increased risk of 30-day mortality.

Low-dose aspirin was defined as 75 mg/day, and the antithrombotic drugs included clopidogrel, dipyridamole, and warfarin.

Use of NSAIDs had no significant impact on 30-day mortality, and the specific withdrawal of rofecoxib (Vioxx) had no apparent effect on 30-day mortality rates in this population.

The Blatchford score (an accepted measure of risk in patients with upper GI bleeding) was calculated using both clinical and laboratory data at each patient's presentation.

Patients scoring higher than 10 on this measure had five times the risk of early death, compared with patients who scored 0-2.

Despite the importance of comorbidities and medication use, the results suggest that age is a strong and independent predictor of early mortality in patients with upper GI bleeding. However, more studies are needed to determine the clinical implications for treatment, Dr. Taha said in an interview.

“Ulcer prevention should be considered seriously in elderly patients, particularly in the presence of other comorbid conditions and use of ulcerogenic drugs,” Dr. Taha said. “And once bleeding has taken place, such patients should be targeted for intensive management.”

Dr. Taha stated that he has received grants and research support from Astellas Pharma Inc., AstraZeneca Pharmaceuticals, Merck & Co., and Yamanouchi Pharmaceutical Co.

ELSEVIER GLOBAL MEDICAL NEWS

SAN DIEGO — Older age was the strongest predictor of early mortality in adults with gastrointestinal bleeding after investigators controlled for medications and comorbidities, according to data from more than 1,000 adults treated at a single medical center.

In recent years, more clinicians have turned to low-dose aspirin and antithrombotic agents for the prevention of cardiovascular disease, but the interaction of these products with other risk factors for GI bleeding has not been studied thoroughly.

“We aimed to assess the 30-day mortality after upper gastrointestinal bleeding in association with the use of NSAIDs, low-dose aspirin, and other antithrombotic drugs,” Dr. Ali S. Taha of Crosshouse Hospital and the University of Glasgow, Scotland, and associates wrote in a poster presented at the annual Digestive Disease Week.

The investigators analyzed data from 1,014 adults who presented with a first episode of upper GI bleeding. A total of 45% of the patients were aged 65 years and older, and 8.1% of these patients died within 30 days of bleeding, compared with 1.3% of the younger patients.

After adjustment for multiple variables, patients who were aged 65 years and older had a significantly greater risk of 30-day mortality, compared with their younger counterparts.

In a univariate analysis, cerebrovascular disease, cardiovascular disease, and the use of diuretics, digoxin, and either low-dose aspirin or other antithrombotic drugs were significantly associated with an increased risk of 30-day mortality.

Low-dose aspirin was defined as 75 mg/day, and the antithrombotic drugs included clopidogrel, dipyridamole, and warfarin.

Use of NSAIDs had no significant impact on 30-day mortality, and the specific withdrawal of rofecoxib (Vioxx) had no apparent effect on 30-day mortality rates in this population.

The Blatchford score (an accepted measure of risk in patients with upper GI bleeding) was calculated using both clinical and laboratory data at each patient's presentation.

Patients scoring higher than 10 on this measure had five times the risk of early death, compared with patients who scored 0-2.

Despite the importance of comorbidities and medication use, the results suggest that age is a strong and independent predictor of early mortality in patients with upper GI bleeding. However, more studies are needed to determine the clinical implications for treatment, Dr. Taha said in an interview.

“Ulcer prevention should be considered seriously in elderly patients, particularly in the presence of other comorbid conditions and use of ulcerogenic drugs,” Dr. Taha said. “And once bleeding has taken place, such patients should be targeted for intensive management.”

Dr. Taha stated that he has received grants and research support from Astellas Pharma Inc., AstraZeneca Pharmaceuticals, Merck & Co., and Yamanouchi Pharmaceutical Co.

ELSEVIER GLOBAL MEDICAL NEWS

Rates of methicillin-resistant Staphylococcus aureus infections were reduced by more than half when all new patients were tested for MRSA, according to results from three hospitals.

With methicillin-resistant S. aureus (MRSA) has become a fixture in many hospitals, and the resulting MRSA infections are causing poor health outcomes and increasing health care costs, reported Dr. Ari Robicsek of Evanston (Ill.) Northwestern Healthcare and his colleagues.

To cut MRSA infection rates, the researchers implemented a universal MRSA surveillance program at a three-hospital organization in Chicago.

Their observational study compared MRSA rates during a baseline year when patients were not universally screened at admission with rates after conducting polymerase chain reaction-based nasal tests for MRSA. The tests were conducted on all patients admitted to the ICU for 1 year and on all patients admitted to the hospital for another year (Ann. Intern. Med. 2008;148:409–18).

During the ICU surveillance year, 3,334 of 4,392 patients (76%) admitted to the ICU were tested for MRSA and 277 (8%) were positive. During the universal screening year, 62,035 of 73,464 patients (84%) admitted to the hospital were tested for MRSA and 3,926 (6%) were positive. Patients who tested positive were isolated. Of the 2,085 patients for whom mupirocin data were available, 1,288 (62%) received at least four doses of mupirocin.

During the year of universal surveillance, the total number of isolation days was 11,454 across the three hospitals. "With no surveillance, clinical cultures alone would have captured 2,036 of those days," the investigators noted. "Thus, 9,418 MRSA patient-days would have been spent without infection control contact precautions to limit MRSA spread."

Overall prevalence density of clinical infections caused by MRSA decreased from 8.9/10,000 patient days during the baseline year to 7.4/10,000 patient days during the ICU screening year, but this difference was not statistically significant. By contrast, prevalence density decreased significantly from baseline to 3.9/10,000 patient days during the universal screening year.

In addition, the prevalence density of four types of MRSA infections—bloodstream, respiratory tract, urinary tract, and surgical site infections—dropped significantly between baseline and the end of the universal screening year.

This improvement following universal screening persisted for up to 30 days after the patients left the hospital but had no apparent effect on infection rates from 31 days to 180 days, the researchers noted.

To control for a possible unrecognized coinfection, the researchers also compared changes in rates of hospital-associated MRSA bacteremia with rates of hospital-associated methicillin-susceptible S. aureus (MSSA) bacteremia. The MRSA bacteremia rates decreased significantly after the surveillance program was implemented, but MSSA bacteremia rates did not.

The study was limited by the lack of an unscreened control group and the inclusion of only one hospital organization, but the findings support results from previous studies in which anything less than universal screening detected fewer than 20% of patients with MRSA infections.

"However, given the intermediate size and community-based nature of our three hospitals, our experience is probably representative of most U.S. hospitals," the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Rates of methicillin-resistant Staphylococcus aureus infections were reduced by more than half when all new patients were tested for MRSA, according to results from three hospitals.

With methicillin-resistant S. aureus (MRSA) has become a fixture in many hospitals, and the resulting MRSA infections are causing poor health outcomes and increasing health care costs, reported Dr. Ari Robicsek of Evanston (Ill.) Northwestern Healthcare and his colleagues.

To cut MRSA infection rates, the researchers implemented a universal MRSA surveillance program at a three-hospital organization in Chicago.

Their observational study compared MRSA rates during a baseline year when patients were not universally screened at admission with rates after conducting polymerase chain reaction-based nasal tests for MRSA. The tests were conducted on all patients admitted to the ICU for 1 year and on all patients admitted to the hospital for another year (Ann. Intern. Med. 2008;148:409–18).

During the ICU surveillance year, 3,334 of 4,392 patients (76%) admitted to the ICU were tested for MRSA and 277 (8%) were positive. During the universal screening year, 62,035 of 73,464 patients (84%) admitted to the hospital were tested for MRSA and 3,926 (6%) were positive. Patients who tested positive were isolated. Of the 2,085 patients for whom mupirocin data were available, 1,288 (62%) received at least four doses of mupirocin.

During the year of universal surveillance, the total number of isolation days was 11,454 across the three hospitals. "With no surveillance, clinical cultures alone would have captured 2,036 of those days," the investigators noted. "Thus, 9,418 MRSA patient-days would have been spent without infection control contact precautions to limit MRSA spread."

Overall prevalence density of clinical infections caused by MRSA decreased from 8.9/10,000 patient days during the baseline year to 7.4/10,000 patient days during the ICU screening year, but this difference was not statistically significant. By contrast, prevalence density decreased significantly from baseline to 3.9/10,000 patient days during the universal screening year.

In addition, the prevalence density of four types of MRSA infections—bloodstream, respiratory tract, urinary tract, and surgical site infections—dropped significantly between baseline and the end of the universal screening year.

This improvement following universal screening persisted for up to 30 days after the patients left the hospital but had no apparent effect on infection rates from 31 days to 180 days, the researchers noted.

To control for a possible unrecognized coinfection, the researchers also compared changes in rates of hospital-associated MRSA bacteremia with rates of hospital-associated methicillin-susceptible S. aureus (MSSA) bacteremia. The MRSA bacteremia rates decreased significantly after the surveillance program was implemented, but MSSA bacteremia rates did not.

The study was limited by the lack of an unscreened control group and the inclusion of only one hospital organization, but the findings support results from previous studies in which anything less than universal screening detected fewer than 20% of patients with MRSA infections.

"However, given the intermediate size and community-based nature of our three hospitals, our experience is probably representative of most U.S. hospitals," the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Rates of methicillin-resistant Staphylococcus aureus infections were reduced by more than half when all new patients were tested for MRSA, according to results from three hospitals.

With methicillin-resistant S. aureus (MRSA) has become a fixture in many hospitals, and the resulting MRSA infections are causing poor health outcomes and increasing health care costs, reported Dr. Ari Robicsek of Evanston (Ill.) Northwestern Healthcare and his colleagues.

To cut MRSA infection rates, the researchers implemented a universal MRSA surveillance program at a three-hospital organization in Chicago.

Their observational study compared MRSA rates during a baseline year when patients were not universally screened at admission with rates after conducting polymerase chain reaction-based nasal tests for MRSA. The tests were conducted on all patients admitted to the ICU for 1 year and on all patients admitted to the hospital for another year (Ann. Intern. Med. 2008;148:409–18).

During the ICU surveillance year, 3,334 of 4,392 patients (76%) admitted to the ICU were tested for MRSA and 277 (8%) were positive. During the universal screening year, 62,035 of 73,464 patients (84%) admitted to the hospital were tested for MRSA and 3,926 (6%) were positive. Patients who tested positive were isolated. Of the 2,085 patients for whom mupirocin data were available, 1,288 (62%) received at least four doses of mupirocin.

During the year of universal surveillance, the total number of isolation days was 11,454 across the three hospitals. "With no surveillance, clinical cultures alone would have captured 2,036 of those days," the investigators noted. "Thus, 9,418 MRSA patient-days would have been spent without infection control contact precautions to limit MRSA spread."

Overall prevalence density of clinical infections caused by MRSA decreased from 8.9/10,000 patient days during the baseline year to 7.4/10,000 patient days during the ICU screening year, but this difference was not statistically significant. By contrast, prevalence density decreased significantly from baseline to 3.9/10,000 patient days during the universal screening year.

In addition, the prevalence density of four types of MRSA infections—bloodstream, respiratory tract, urinary tract, and surgical site infections—dropped significantly between baseline and the end of the universal screening year.

This improvement following universal screening persisted for up to 30 days after the patients left the hospital but had no apparent effect on infection rates from 31 days to 180 days, the researchers noted.

To control for a possible unrecognized coinfection, the researchers also compared changes in rates of hospital-associated MRSA bacteremia with rates of hospital-associated methicillin-susceptible S. aureus (MSSA) bacteremia. The MRSA bacteremia rates decreased significantly after the surveillance program was implemented, but MSSA bacteremia rates did not.

The study was limited by the lack of an unscreened control group and the inclusion of only one hospital organization, but the findings support results from previous studies in which anything less than universal screening detected fewer than 20% of patients with MRSA infections.

"However, given the intermediate size and community-based nature of our three hospitals, our experience is probably representative of most U.S. hospitals," the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Breast-fed babies may be protected against developing type 2 diabetes during childhood, regardless of ethnicity, according to results from an adjunct study to the ongoing SEARCH for Diabetes in Youth study.

The dramatic increase in type 2 diabetes in youth has inspired researchers to identify behaviors that might prevent both obesity and type 2 diabetes, wrote Elizabeth J. Mayer-Davis, Ph.D., of the University of South Carolina, Columbia, and her colleagues.

Their case-control study, conducted at two of the SEARCH for Diabetes in Youth study sites, included 80 participants aged 10–21 years with type 2 diabetes and 167 age-matched controls (Diabetes Care 2008;31:470–5).

Overall, the prevalence of breast-feeding for any length of time was significantly lower among youth with type 2 diabetes, compared with controls (31% vs. 64%).

When the study population was divided into three ethnic groups, the prevalence of breast-feeding was lower among black youth with type 2 diabetes than among controls (20% vs. 27%), although this difference was not statistically significant. But the difference remained significant among Hispanics (50% vs. 84%), and among non-Hispanic whites (39% vs. 78%).

The researchers noted previous evidence that a lower prevalence of breast-feeding among blacks, compared with other ethnicities, might be a confounding variable.

Breast-fed babies may be protected against developing type 2 diabetes during childhood, regardless of ethnicity, according to results from an adjunct study to the ongoing SEARCH for Diabetes in Youth study.

The dramatic increase in type 2 diabetes in youth has inspired researchers to identify behaviors that might prevent both obesity and type 2 diabetes, wrote Elizabeth J. Mayer-Davis, Ph.D., of the University of South Carolina, Columbia, and her colleagues.

Their case-control study, conducted at two of the SEARCH for Diabetes in Youth study sites, included 80 participants aged 10–21 years with type 2 diabetes and 167 age-matched controls (Diabetes Care 2008;31:470–5).

Overall, the prevalence of breast-feeding for any length of time was significantly lower among youth with type 2 diabetes, compared with controls (31% vs. 64%).

When the study population was divided into three ethnic groups, the prevalence of breast-feeding was lower among black youth with type 2 diabetes than among controls (20% vs. 27%), although this difference was not statistically significant. But the difference remained significant among Hispanics (50% vs. 84%), and among non-Hispanic whites (39% vs. 78%).

The researchers noted previous evidence that a lower prevalence of breast-feeding among blacks, compared with other ethnicities, might be a confounding variable.

Breast-fed babies may be protected against developing type 2 diabetes during childhood, regardless of ethnicity, according to results from an adjunct study to the ongoing SEARCH for Diabetes in Youth study.

The dramatic increase in type 2 diabetes in youth has inspired researchers to identify behaviors that might prevent both obesity and type 2 diabetes, wrote Elizabeth J. Mayer-Davis, Ph.D., of the University of South Carolina, Columbia, and her colleagues.

Their case-control study, conducted at two of the SEARCH for Diabetes in Youth study sites, included 80 participants aged 10–21 years with type 2 diabetes and 167 age-matched controls (Diabetes Care 2008;31:470–5).

Overall, the prevalence of breast-feeding for any length of time was significantly lower among youth with type 2 diabetes, compared with controls (31% vs. 64%).

When the study population was divided into three ethnic groups, the prevalence of breast-feeding was lower among black youth with type 2 diabetes than among controls (20% vs. 27%), although this difference was not statistically significant. But the difference remained significant among Hispanics (50% vs. 84%), and among non-Hispanic whites (39% vs. 78%).

The researchers noted previous evidence that a lower prevalence of breast-feeding among blacks, compared with other ethnicities, might be a confounding variable.

Subtle nonpolypoid colorectal neoplasms were more predictive of colorectal cancer than the more obvious polypoid neoplasms, according to findings from a study of 1,819 adult patients.

Polypoid neoplasms are easy to detect during a colonoscopy, and they are routinely removed to prevent colorectal cancer. By contrast, nonpolypoid colorectal neoplasms (NP-CRNs) are flat or slightly depressed in shape and are harder to distinguish from the surrounding normal mucosa. Previous studies have shown that depressed NP-CRNs are more likely to be cancerous, but few studies have examined them as predictors of colorectal cancer.

In this cross-sectional study, Dr. Roy M. Soetikno of the Veterans Affairs Palo Alto (Calif.) Health Care System, and his colleagues reviewed the characteristics of colorectal neoplasms in asymptomatic and symptomatic adults.

The study included 616 asymptomatic patients (the screening patients), 654 asymptomatic patients with a personal or family history of colorectal neoplasms (surveillance patients), and 549 symptomatic patients. They had elective outpatient colonoscopies between July 2003 and June 2004 (JAMA 2008;299:1027–35). Average age was 64 years, 95% were men, and 79% were white. Those undergoing emergency colonoscopies were excluded.

NP-CRNs were found in 170 patients (9.4%). Prevalence in the screening, surveillance, and symptomatic subgroups was 5.8%, 15.4%, and 6.0%, respectively. In the screening group, nonpolypoid lesions were more than twice as likely as polypoid lesions to contain neoplasms, whereas in the surveillance and symptomatic groups, they were more than three times as likely to contain neoplasms.

“Nonpolypoid lesions accounted for 15% of neoplasms, [but] contributed to 54% of superficial carcinomas,” the authors said. NP-CRN lesions were almost 10 times as likely to be associated with in situ or submucosal invasive carcinoma, compared with polypoid lesions, regardless of size.

A total of 227 NP-CRNs were found; 209 were flat and 18 were depressed. Although the number of depressed neoplasms was too small to show statistical significance, 6 (33%) contained carcinoma, compared with 9 of the flat neoplasms (4.3%). The depressed NP-CRNs were also the smallest, averaging 9.77 mm in diameter, compared with an average of 19.2 mm for polypoid lesions and 15.9 mm for NP-CRNs overall. None of the researchers disclosed any conflicts of interest.

Nonpolypoid lesions accounted for 15% of neoplasms, [but] contributed to 54% of superficial carcinomas. DR. SOETIKNO

Subtle nonpolypoid colorectal neoplasms were more predictive of colorectal cancer than the more obvious polypoid neoplasms, according to findings from a study of 1,819 adult patients.

Polypoid neoplasms are easy to detect during a colonoscopy, and they are routinely removed to prevent colorectal cancer. By contrast, nonpolypoid colorectal neoplasms (NP-CRNs) are flat or slightly depressed in shape and are harder to distinguish from the surrounding normal mucosa. Previous studies have shown that depressed NP-CRNs are more likely to be cancerous, but few studies have examined them as predictors of colorectal cancer.

In this cross-sectional study, Dr. Roy M. Soetikno of the Veterans Affairs Palo Alto (Calif.) Health Care System, and his colleagues reviewed the characteristics of colorectal neoplasms in asymptomatic and symptomatic adults.

The study included 616 asymptomatic patients (the screening patients), 654 asymptomatic patients with a personal or family history of colorectal neoplasms (surveillance patients), and 549 symptomatic patients. They had elective outpatient colonoscopies between July 2003 and June 2004 (JAMA 2008;299:1027–35). Average age was 64 years, 95% were men, and 79% were white. Those undergoing emergency colonoscopies were excluded.

NP-CRNs were found in 170 patients (9.4%). Prevalence in the screening, surveillance, and symptomatic subgroups was 5.8%, 15.4%, and 6.0%, respectively. In the screening group, nonpolypoid lesions were more than twice as likely as polypoid lesions to contain neoplasms, whereas in the surveillance and symptomatic groups, they were more than three times as likely to contain neoplasms.

“Nonpolypoid lesions accounted for 15% of neoplasms, [but] contributed to 54% of superficial carcinomas,” the authors said. NP-CRN lesions were almost 10 times as likely to be associated with in situ or submucosal invasive carcinoma, compared with polypoid lesions, regardless of size.

A total of 227 NP-CRNs were found; 209 were flat and 18 were depressed. Although the number of depressed neoplasms was too small to show statistical significance, 6 (33%) contained carcinoma, compared with 9 of the flat neoplasms (4.3%). The depressed NP-CRNs were also the smallest, averaging 9.77 mm in diameter, compared with an average of 19.2 mm for polypoid lesions and 15.9 mm for NP-CRNs overall. None of the researchers disclosed any conflicts of interest.

Nonpolypoid lesions accounted for 15% of neoplasms, [but] contributed to 54% of superficial carcinomas. DR. SOETIKNO

Subtle nonpolypoid colorectal neoplasms were more predictive of colorectal cancer than the more obvious polypoid neoplasms, according to findings from a study of 1,819 adult patients.

Polypoid neoplasms are easy to detect during a colonoscopy, and they are routinely removed to prevent colorectal cancer. By contrast, nonpolypoid colorectal neoplasms (NP-CRNs) are flat or slightly depressed in shape and are harder to distinguish from the surrounding normal mucosa. Previous studies have shown that depressed NP-CRNs are more likely to be cancerous, but few studies have examined them as predictors of colorectal cancer.

In this cross-sectional study, Dr. Roy M. Soetikno of the Veterans Affairs Palo Alto (Calif.) Health Care System, and his colleagues reviewed the characteristics of colorectal neoplasms in asymptomatic and symptomatic adults.

The study included 616 asymptomatic patients (the screening patients), 654 asymptomatic patients with a personal or family history of colorectal neoplasms (surveillance patients), and 549 symptomatic patients. They had elective outpatient colonoscopies between July 2003 and June 2004 (JAMA 2008;299:1027–35). Average age was 64 years, 95% were men, and 79% were white. Those undergoing emergency colonoscopies were excluded.

NP-CRNs were found in 170 patients (9.4%). Prevalence in the screening, surveillance, and symptomatic subgroups was 5.8%, 15.4%, and 6.0%, respectively. In the screening group, nonpolypoid lesions were more than twice as likely as polypoid lesions to contain neoplasms, whereas in the surveillance and symptomatic groups, they were more than three times as likely to contain neoplasms.

“Nonpolypoid lesions accounted for 15% of neoplasms, [but] contributed to 54% of superficial carcinomas,” the authors said. NP-CRN lesions were almost 10 times as likely to be associated with in situ or submucosal invasive carcinoma, compared with polypoid lesions, regardless of size.

A total of 227 NP-CRNs were found; 209 were flat and 18 were depressed. Although the number of depressed neoplasms was too small to show statistical significance, 6 (33%) contained carcinoma, compared with 9 of the flat neoplasms (4.3%). The depressed NP-CRNs were also the smallest, averaging 9.77 mm in diameter, compared with an average of 19.2 mm for polypoid lesions and 15.9 mm for NP-CRNs overall. None of the researchers disclosed any conflicts of interest.

Nonpolypoid lesions accounted for 15% of neoplasms, [but] contributed to 54% of superficial carcinomas. DR. SOETIKNO

Talking frequently with adolescents about sexuality is more effective than having one “big talk” and then ignoring the topic, data from a study of 312 adolescents show.

Given this, it makes sense to advise parents about the value of repeatedly discussing sexual topics with their adolescent children.

Previous studies have shown that parents can play a key role in promoting healthy sexual development in their adolescents, but most parents are uncomfortable talking about sex and prefer to have a single talk about the subject.

But regular, shorter conversations might be more effective at building a stronger bond with adolescents and reinforcing messages, reported Steven C. Martino, Ph.D., of Rand Corp. in Pittsburgh and his colleagues.

This study, the first to examine the role of repeated talks about sex on adolescents, included adolescents (52% girls, 48% boys) aged an average of 13 years and their parents who were randomized to an 8-week intervention to promote better communication.

The average age of the participating parents was 44 years, and 70% were women (Pediatrics 2008;121:3612–8).

The adolescents and parents completed surveys at the start of the study, and again at 1 week, 3 months, and 9 months after the intervention.

The researchers asked which of 22 sex-related topics the adolescents and parents had discussed, including, “How will you make decisions about whether to have sex” and, “What it feels like to have sex.” They also asked the adolescents to answer questions about their relationship with the participating parent on a scale of 1 (terrible) to 7 (excellent).

Parents discussed an average of 7 of the 22 topics at baseline, and an average of 10 topics had been discussed repeatedly by the end of the study.

The parents in the control group completed the surveys but did not participate in the communication intervention.

Overall, repetition of sexual topics was significantly associated with an adolescent's perception of a close relationship with a parent, while the number of topics mentioned in a single talk or the number of talks had no apparent impact on relationship quality, the researchers said.

But that doesn't mean that addressing a range of sexual topics in one talk is negative.

Adolescents whose parents cover many topics during discussions about sex might be better equipped to make safe sexual decisions, compared with those whose parents limit discussions of sex to one or two topics, Dr. Martino and his associates said.

“Our results suggest, however, that parents who take a checklist approach to broadening their sexual discussions with their children are unlikely to have as great an influence on their children as parents who introduce new sexual topics and develop them through repeated discussions,” they wrote.

The study was limited by the use of adolescent reports and the fact that the study subjects were participants in a communication improvement program, the researchers noted.

More research is needed to determine whether the results are applicable to a broader population. In addition, the researchers said that it is important for future studies to “establish the roles of breadth and repetition of parent-adolescent sexual communication in adolescent sexual risk taking.”

Talking frequently with adolescents about sexuality is more effective than having one “big talk” and then ignoring the topic, data from a study of 312 adolescents show.

Given this, it makes sense to advise parents about the value of repeatedly discussing sexual topics with their adolescent children.

Previous studies have shown that parents can play a key role in promoting healthy sexual development in their adolescents, but most parents are uncomfortable talking about sex and prefer to have a single talk about the subject.

But regular, shorter conversations might be more effective at building a stronger bond with adolescents and reinforcing messages, reported Steven C. Martino, Ph.D., of Rand Corp. in Pittsburgh and his colleagues.

This study, the first to examine the role of repeated talks about sex on adolescents, included adolescents (52% girls, 48% boys) aged an average of 13 years and their parents who were randomized to an 8-week intervention to promote better communication.

The average age of the participating parents was 44 years, and 70% were women (Pediatrics 2008;121:3612–8).

The adolescents and parents completed surveys at the start of the study, and again at 1 week, 3 months, and 9 months after the intervention.

The researchers asked which of 22 sex-related topics the adolescents and parents had discussed, including, “How will you make decisions about whether to have sex” and, “What it feels like to have sex.” They also asked the adolescents to answer questions about their relationship with the participating parent on a scale of 1 (terrible) to 7 (excellent).

Parents discussed an average of 7 of the 22 topics at baseline, and an average of 10 topics had been discussed repeatedly by the end of the study.

The parents in the control group completed the surveys but did not participate in the communication intervention.

Overall, repetition of sexual topics was significantly associated with an adolescent's perception of a close relationship with a parent, while the number of topics mentioned in a single talk or the number of talks had no apparent impact on relationship quality, the researchers said.

But that doesn't mean that addressing a range of sexual topics in one talk is negative.

Adolescents whose parents cover many topics during discussions about sex might be better equipped to make safe sexual decisions, compared with those whose parents limit discussions of sex to one or two topics, Dr. Martino and his associates said.

“Our results suggest, however, that parents who take a checklist approach to broadening their sexual discussions with their children are unlikely to have as great an influence on their children as parents who introduce new sexual topics and develop them through repeated discussions,” they wrote.

The study was limited by the use of adolescent reports and the fact that the study subjects were participants in a communication improvement program, the researchers noted.

More research is needed to determine whether the results are applicable to a broader population. In addition, the researchers said that it is important for future studies to “establish the roles of breadth and repetition of parent-adolescent sexual communication in adolescent sexual risk taking.”

Talking frequently with adolescents about sexuality is more effective than having one “big talk” and then ignoring the topic, data from a study of 312 adolescents show.

Given this, it makes sense to advise parents about the value of repeatedly discussing sexual topics with their adolescent children.

Previous studies have shown that parents can play a key role in promoting healthy sexual development in their adolescents, but most parents are uncomfortable talking about sex and prefer to have a single talk about the subject.

But regular, shorter conversations might be more effective at building a stronger bond with adolescents and reinforcing messages, reported Steven C. Martino, Ph.D., of Rand Corp. in Pittsburgh and his colleagues.

This study, the first to examine the role of repeated talks about sex on adolescents, included adolescents (52% girls, 48% boys) aged an average of 13 years and their parents who were randomized to an 8-week intervention to promote better communication.

The average age of the participating parents was 44 years, and 70% were women (Pediatrics 2008;121:3612–8).

The adolescents and parents completed surveys at the start of the study, and again at 1 week, 3 months, and 9 months after the intervention.

The researchers asked which of 22 sex-related topics the adolescents and parents had discussed, including, “How will you make decisions about whether to have sex” and, “What it feels like to have sex.” They also asked the adolescents to answer questions about their relationship with the participating parent on a scale of 1 (terrible) to 7 (excellent).

Parents discussed an average of 7 of the 22 topics at baseline, and an average of 10 topics had been discussed repeatedly by the end of the study.

The parents in the control group completed the surveys but did not participate in the communication intervention.

Overall, repetition of sexual topics was significantly associated with an adolescent's perception of a close relationship with a parent, while the number of topics mentioned in a single talk or the number of talks had no apparent impact on relationship quality, the researchers said.

But that doesn't mean that addressing a range of sexual topics in one talk is negative.

Adolescents whose parents cover many topics during discussions about sex might be better equipped to make safe sexual decisions, compared with those whose parents limit discussions of sex to one or two topics, Dr. Martino and his associates said.

“Our results suggest, however, that parents who take a checklist approach to broadening their sexual discussions with their children are unlikely to have as great an influence on their children as parents who introduce new sexual topics and develop them through repeated discussions,” they wrote.

The study was limited by the use of adolescent reports and the fact that the study subjects were participants in a communication improvement program, the researchers noted.

More research is needed to determine whether the results are applicable to a broader population. In addition, the researchers said that it is important for future studies to “establish the roles of breadth and repetition of parent-adolescent sexual communication in adolescent sexual risk taking.”