Heidi Splete

Predicting STIs in Adolescents

In a prospective cohort study of 11,594 adolescents, those who believed that their parents strongly disapproved of adolescent sex had a significantly lower rate of sexually transmitted infection (5.5%), compared with those who believed that their parents' disapproval was moderate (8.0%) or low (8.9%), said Carol A. Ford, M.D., of the University of North Carolina at Chapel Hill and her colleagues.

The data were collected as part of the ongoing National Longitudinal Study on Adolescent Health. All students who participated in the first wave of that study as 7th–12th graders in 1995 were invited to participate in the follow-up approximately 6 years later, and 81% responded (Arch. Pediatr. Adolesc. Med. 2005;159:657–64).

Overall, 6.2% of the respondents tested positive for a sexually transmitted infection (STI). Approximately half of the study population was white (54.2%) and female (52.8%).

Early Asthma and Behavior

In a prospective, longitudinal study of 5,135 children, those who had developed asthma or bronchitis by age 5 years were significantly more likely to have internalizing behavior problems at age 14 years, reported Rosa Alati, Ph.D., of the University of Queensland (Australia) and her colleagues (Psychosom. Med. 2005;67:462–70).

The children's mothers completed the Child Behavior Checklist at 5 years and 14 years, and the children completed the Youth Self-Report at age 14 years. The mothers' reports suggested that the odds of internalizing behavior at age 14 were twice as high in children who had asthma/bronchitis at age 5 for both boys and girls, but based on the adolescents' own reports, early asthma had a significant effect on adolescent internalizing behavior in boys but not in girls.

The subscales of internalizing behavior showed that the strongest associations were for somatic and anxiety/depression symptoms in boys and somatic symptoms in girls. However, internalizing behavior at 5 years was not associated with the development of asthma at age 14 years.

Teachers Report on Atomoxetine

Children aged 8–12 years with attention-deficit hyperactivity disorder who took a once-daily dose of atomoxetine showed a significant reduction in symptoms after 7 weeks, reported Margaret Weiss, M.D., of the University of British Columbia in Vancouver, and her associates.

The randomized, placebo-controlled study was sponsored in part by Eli Lilly & Co. (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:647–55). Overall, the mean changes from baseline on the problem behavior subscale of the Social Skills Rating System-Teacher test and the Conners Global Index-Teacher test were significantly greater in the patients taking atomoxetine, compared with those taking a placebo. Adverse events were generally mild and gastrointestinal, similar to those observed in studies of twice-daily doses.

Metoclopramide Treats Tourette's

A daily dose of metoclopramide decreased tic severity by 38.7% in children aged 7–18 years with Tourette's disorder, compared with a 12.6% reduction in a placebo group, reported Rob Nicholson, M.D., of the University of Western Ontario in London, and his colleagues.

In a randomized, double-blind, placebo-controlled study of 27 children, 14 received metoclopramide starting at 5 mg daily, titrated as needed to a maximum 40-mg daily dose, and 13 received a placebo (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:640–6).

The average dose after 8 weeks was 32.9 mg. Adverse events were mild; the most common was increased appetite, but weight gain did not differ significantly from that in the placebo group. One patient had a 30-fold increase in prolactin levels that resolved with discontinuation of the drug at the study's end.

Teens Embrace Alternative Medicine

In a cross-sectional survey of 401 adolescents aged 12–18 years, 68.1% reported using one or more forms of alternative or complementary medicine, said Carie A. Braun, Ph.D., of the College of St. Benedict, St. Joseph, Minn., and her associates. Overall, 27.2% of the adolescents reported using herbal medicines, 26.7% reported using massage therapy, and 21.7% reported taking megavitamins (J. Adolesc. Health 2005;37:76.e1–9). Most of the adolescents (66.3%) said “alleviation of physical pain” was their desired outcome from the alternative treatments.

The survey mentioned 19 therapies, including chiropractic, herbal medicine, acupuncture, hypnosis, spiritual healing, and megavitamins. Of note, only 13.8% of the adolescents disclosed their use of alternative therapies to their health care providers, even though 37.9% of those who reported taking megavitamins or nutritional supplements were also taking prescription medications.

Predicting STIs in Adolescents

In a prospective cohort study of 11,594 adolescents, those who believed that their parents strongly disapproved of adolescent sex had a significantly lower rate of sexually transmitted infection (5.5%), compared with those who believed that their parents' disapproval was moderate (8.0%) or low (8.9%), said Carol A. Ford, M.D., of the University of North Carolina at Chapel Hill and her colleagues.

The data were collected as part of the ongoing National Longitudinal Study on Adolescent Health. All students who participated in the first wave of that study as 7th–12th graders in 1995 were invited to participate in the follow-up approximately 6 years later, and 81% responded (Arch. Pediatr. Adolesc. Med. 2005;159:657–64).

Overall, 6.2% of the respondents tested positive for a sexually transmitted infection (STI). Approximately half of the study population was white (54.2%) and female (52.8%).

Early Asthma and Behavior

In a prospective, longitudinal study of 5,135 children, those who had developed asthma or bronchitis by age 5 years were significantly more likely to have internalizing behavior problems at age 14 years, reported Rosa Alati, Ph.D., of the University of Queensland (Australia) and her colleagues (Psychosom. Med. 2005;67:462–70).

The children's mothers completed the Child Behavior Checklist at 5 years and 14 years, and the children completed the Youth Self-Report at age 14 years. The mothers' reports suggested that the odds of internalizing behavior at age 14 were twice as high in children who had asthma/bronchitis at age 5 for both boys and girls, but based on the adolescents' own reports, early asthma had a significant effect on adolescent internalizing behavior in boys but not in girls.

The subscales of internalizing behavior showed that the strongest associations were for somatic and anxiety/depression symptoms in boys and somatic symptoms in girls. However, internalizing behavior at 5 years was not associated with the development of asthma at age 14 years.

Teachers Report on Atomoxetine

Children aged 8–12 years with attention-deficit hyperactivity disorder who took a once-daily dose of atomoxetine showed a significant reduction in symptoms after 7 weeks, reported Margaret Weiss, M.D., of the University of British Columbia in Vancouver, and her associates.

The randomized, placebo-controlled study was sponsored in part by Eli Lilly & Co. (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:647–55). Overall, the mean changes from baseline on the problem behavior subscale of the Social Skills Rating System-Teacher test and the Conners Global Index-Teacher test were significantly greater in the patients taking atomoxetine, compared with those taking a placebo. Adverse events were generally mild and gastrointestinal, similar to those observed in studies of twice-daily doses.

Metoclopramide Treats Tourette's

A daily dose of metoclopramide decreased tic severity by 38.7% in children aged 7–18 years with Tourette's disorder, compared with a 12.6% reduction in a placebo group, reported Rob Nicholson, M.D., of the University of Western Ontario in London, and his colleagues.

In a randomized, double-blind, placebo-controlled study of 27 children, 14 received metoclopramide starting at 5 mg daily, titrated as needed to a maximum 40-mg daily dose, and 13 received a placebo (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:640–6).

The average dose after 8 weeks was 32.9 mg. Adverse events were mild; the most common was increased appetite, but weight gain did not differ significantly from that in the placebo group. One patient had a 30-fold increase in prolactin levels that resolved with discontinuation of the drug at the study's end.

Teens Embrace Alternative Medicine

In a cross-sectional survey of 401 adolescents aged 12–18 years, 68.1% reported using one or more forms of alternative or complementary medicine, said Carie A. Braun, Ph.D., of the College of St. Benedict, St. Joseph, Minn., and her associates. Overall, 27.2% of the adolescents reported using herbal medicines, 26.7% reported using massage therapy, and 21.7% reported taking megavitamins (J. Adolesc. Health 2005;37:76.e1–9). Most of the adolescents (66.3%) said “alleviation of physical pain” was their desired outcome from the alternative treatments.

The survey mentioned 19 therapies, including chiropractic, herbal medicine, acupuncture, hypnosis, spiritual healing, and megavitamins. Of note, only 13.8% of the adolescents disclosed their use of alternative therapies to their health care providers, even though 37.9% of those who reported taking megavitamins or nutritional supplements were also taking prescription medications.

Predicting STIs in Adolescents

In a prospective cohort study of 11,594 adolescents, those who believed that their parents strongly disapproved of adolescent sex had a significantly lower rate of sexually transmitted infection (5.5%), compared with those who believed that their parents' disapproval was moderate (8.0%) or low (8.9%), said Carol A. Ford, M.D., of the University of North Carolina at Chapel Hill and her colleagues.

The data were collected as part of the ongoing National Longitudinal Study on Adolescent Health. All students who participated in the first wave of that study as 7th–12th graders in 1995 were invited to participate in the follow-up approximately 6 years later, and 81% responded (Arch. Pediatr. Adolesc. Med. 2005;159:657–64).

Overall, 6.2% of the respondents tested positive for a sexually transmitted infection (STI). Approximately half of the study population was white (54.2%) and female (52.8%).

Early Asthma and Behavior

In a prospective, longitudinal study of 5,135 children, those who had developed asthma or bronchitis by age 5 years were significantly more likely to have internalizing behavior problems at age 14 years, reported Rosa Alati, Ph.D., of the University of Queensland (Australia) and her colleagues (Psychosom. Med. 2005;67:462–70).

The children's mothers completed the Child Behavior Checklist at 5 years and 14 years, and the children completed the Youth Self-Report at age 14 years. The mothers' reports suggested that the odds of internalizing behavior at age 14 were twice as high in children who had asthma/bronchitis at age 5 for both boys and girls, but based on the adolescents' own reports, early asthma had a significant effect on adolescent internalizing behavior in boys but not in girls.

The subscales of internalizing behavior showed that the strongest associations were for somatic and anxiety/depression symptoms in boys and somatic symptoms in girls. However, internalizing behavior at 5 years was not associated with the development of asthma at age 14 years.

Teachers Report on Atomoxetine

Children aged 8–12 years with attention-deficit hyperactivity disorder who took a once-daily dose of atomoxetine showed a significant reduction in symptoms after 7 weeks, reported Margaret Weiss, M.D., of the University of British Columbia in Vancouver, and her associates.

The randomized, placebo-controlled study was sponsored in part by Eli Lilly & Co. (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:647–55). Overall, the mean changes from baseline on the problem behavior subscale of the Social Skills Rating System-Teacher test and the Conners Global Index-Teacher test were significantly greater in the patients taking atomoxetine, compared with those taking a placebo. Adverse events were generally mild and gastrointestinal, similar to those observed in studies of twice-daily doses.

Metoclopramide Treats Tourette's

A daily dose of metoclopramide decreased tic severity by 38.7% in children aged 7–18 years with Tourette's disorder, compared with a 12.6% reduction in a placebo group, reported Rob Nicholson, M.D., of the University of Western Ontario in London, and his colleagues.

In a randomized, double-blind, placebo-controlled study of 27 children, 14 received metoclopramide starting at 5 mg daily, titrated as needed to a maximum 40-mg daily dose, and 13 received a placebo (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:640–6).

The average dose after 8 weeks was 32.9 mg. Adverse events were mild; the most common was increased appetite, but weight gain did not differ significantly from that in the placebo group. One patient had a 30-fold increase in prolactin levels that resolved with discontinuation of the drug at the study's end.

Teens Embrace Alternative Medicine

In a cross-sectional survey of 401 adolescents aged 12–18 years, 68.1% reported using one or more forms of alternative or complementary medicine, said Carie A. Braun, Ph.D., of the College of St. Benedict, St. Joseph, Minn., and her associates. Overall, 27.2% of the adolescents reported using herbal medicines, 26.7% reported using massage therapy, and 21.7% reported taking megavitamins (J. Adolesc. Health 2005;37:76.e1–9). Most of the adolescents (66.3%) said “alleviation of physical pain” was their desired outcome from the alternative treatments.

The survey mentioned 19 therapies, including chiropractic, herbal medicine, acupuncture, hypnosis, spiritual healing, and megavitamins. Of note, only 13.8% of the adolescents disclosed their use of alternative therapies to their health care providers, even though 37.9% of those who reported taking megavitamins or nutritional supplements were also taking prescription medications.

MIAMI — In a prospective, 6-month study of 210 consecutive trauma patients, 15% had at least one nasal swab that was positive for methicillin-resistant Staphylococcus aureus, Grant V. Bochicchio, M.D., wrote in a poster presented at the joint annual meeting of the Surgical Infection Society and the Surgical Infection Society-Europe.

Of the 210 patients, 17 (8%) had a positive MRSA swab on admission, and 14 (7%) had a positive MRSA swab subsequently, said Dr. Bochicchio, a surgeon with the R. Adams Cowley Shock Trauma Center in Baltimore. Of the 17 patients with positive MRSA swabs on admission, 5 (29%) were diagnosed and treated for their infections. Of the 14 patients who had a positive MRSA swab later, 10 (71%) were diagnosed with MRSA infections; these 10 had been exposed to MRSA-positive patients.

Overall, patients who were MRSA positive on admission were significantly more likely to have a history of renal failure, diabetes, and drug abuse; patients who acquired MRSA infections later were significantly more likely to be obese and to have a history of renal or liver disease than were non-MRSA patients. A total of 42% of the patients who had positive MRSA swabs at any point during the study were treated with antibiotics within 6 months of their current hospital admission.

Also, hospital stays for MRSA-diagnosed patients and those who had MRSA-positive nasal swabs were significantly longer (25 days and 19.5 days, respectively) than for non-MRSA patients (14 days).

MIAMI — In a prospective, 6-month study of 210 consecutive trauma patients, 15% had at least one nasal swab that was positive for methicillin-resistant Staphylococcus aureus, Grant V. Bochicchio, M.D., wrote in a poster presented at the joint annual meeting of the Surgical Infection Society and the Surgical Infection Society-Europe.

Of the 210 patients, 17 (8%) had a positive MRSA swab on admission, and 14 (7%) had a positive MRSA swab subsequently, said Dr. Bochicchio, a surgeon with the R. Adams Cowley Shock Trauma Center in Baltimore. Of the 17 patients with positive MRSA swabs on admission, 5 (29%) were diagnosed and treated for their infections. Of the 14 patients who had a positive MRSA swab later, 10 (71%) were diagnosed with MRSA infections; these 10 had been exposed to MRSA-positive patients.

Overall, patients who were MRSA positive on admission were significantly more likely to have a history of renal failure, diabetes, and drug abuse; patients who acquired MRSA infections later were significantly more likely to be obese and to have a history of renal or liver disease than were non-MRSA patients. A total of 42% of the patients who had positive MRSA swabs at any point during the study were treated with antibiotics within 6 months of their current hospital admission.

Also, hospital stays for MRSA-diagnosed patients and those who had MRSA-positive nasal swabs were significantly longer (25 days and 19.5 days, respectively) than for non-MRSA patients (14 days).

MIAMI — In a prospective, 6-month study of 210 consecutive trauma patients, 15% had at least one nasal swab that was positive for methicillin-resistant Staphylococcus aureus, Grant V. Bochicchio, M.D., wrote in a poster presented at the joint annual meeting of the Surgical Infection Society and the Surgical Infection Society-Europe.

Of the 210 patients, 17 (8%) had a positive MRSA swab on admission, and 14 (7%) had a positive MRSA swab subsequently, said Dr. Bochicchio, a surgeon with the R. Adams Cowley Shock Trauma Center in Baltimore. Of the 17 patients with positive MRSA swabs on admission, 5 (29%) were diagnosed and treated for their infections. Of the 14 patients who had a positive MRSA swab later, 10 (71%) were diagnosed with MRSA infections; these 10 had been exposed to MRSA-positive patients.

Overall, patients who were MRSA positive on admission were significantly more likely to have a history of renal failure, diabetes, and drug abuse; patients who acquired MRSA infections later were significantly more likely to be obese and to have a history of renal or liver disease than were non-MRSA patients. A total of 42% of the patients who had positive MRSA swabs at any point during the study were treated with antibiotics within 6 months of their current hospital admission.

Also, hospital stays for MRSA-diagnosed patients and those who had MRSA-positive nasal swabs were significantly longer (25 days and 19.5 days, respectively) than for non-MRSA patients (14 days).

MIAMI — Linezolid was superior to vancomycin for treatment of presumed methicillin-resistant Staphylococcus aureus-based infections in 717 patients, reported Kamal Itani, M.D., and associates in a poster presented at the joint annual meeting of the Surgical Infection Society and the Surgical Infection Society-Europe.

“We expected linezolid to be better, but it was even better than we expected,” Dr. Itani, chief of surgery at VA Boston Health Care System, said in an interview.

In this large, multinational, open-label study, patients were randomized to receive 600 mg of linezolid every 12 hours either via IV or orally, or 1 g of vancomycin via IV every 12 hours.

The treatment duration was planned to be 7–14 days, but some patients were treated for up to 21 days.

In the initial population of 717 patients, those on linezolid had a shorter mean duration of IV therapy than did those on vancomycin (1.7 days vs. 9.1 days).

Of this population, MRSA infection was confirmed in 226 patients whose mean duration of IV therapy was 1.4 days on linezolid compared with 12.4 days on vancomycin.

The clinical cure rates for all patient demographics were significantly higher among linezolid patients compared with vancomycin patients (91.7% vs. 86.0%). The most significant difference in cure rates appeared in the MRSA population—94.2% in the linezolid group vs. 83.7% in the vancomycin group.

Approximately 20% of the linezolid patients could begin with oral therapy, whereas all of the vancomycin patients had IV therapy, Dr. Itani noted in an interview.

In addition, the overall mean length of hospital stay for linezolid patients was approximately 2–3 days less than that of the vancomycin patients. These data support linezolid as the more efficient choice for complicated skin and soft tissue infections due to suspected or proven MRSA, according to Dr. Itani.

The study, supported in part by Pfizer Inc., represents the largest known superiority study of linezolid, he added.

MIAMI — Linezolid was superior to vancomycin for treatment of presumed methicillin-resistant Staphylococcus aureus-based infections in 717 patients, reported Kamal Itani, M.D., and associates in a poster presented at the joint annual meeting of the Surgical Infection Society and the Surgical Infection Society-Europe.

“We expected linezolid to be better, but it was even better than we expected,” Dr. Itani, chief of surgery at VA Boston Health Care System, said in an interview.

In this large, multinational, open-label study, patients were randomized to receive 600 mg of linezolid every 12 hours either via IV or orally, or 1 g of vancomycin via IV every 12 hours.

The treatment duration was planned to be 7–14 days, but some patients were treated for up to 21 days.

In the initial population of 717 patients, those on linezolid had a shorter mean duration of IV therapy than did those on vancomycin (1.7 days vs. 9.1 days).

Of this population, MRSA infection was confirmed in 226 patients whose mean duration of IV therapy was 1.4 days on linezolid compared with 12.4 days on vancomycin.

The clinical cure rates for all patient demographics were significantly higher among linezolid patients compared with vancomycin patients (91.7% vs. 86.0%). The most significant difference in cure rates appeared in the MRSA population—94.2% in the linezolid group vs. 83.7% in the vancomycin group.

Approximately 20% of the linezolid patients could begin with oral therapy, whereas all of the vancomycin patients had IV therapy, Dr. Itani noted in an interview.

In addition, the overall mean length of hospital stay for linezolid patients was approximately 2–3 days less than that of the vancomycin patients. These data support linezolid as the more efficient choice for complicated skin and soft tissue infections due to suspected or proven MRSA, according to Dr. Itani.

The study, supported in part by Pfizer Inc., represents the largest known superiority study of linezolid, he added.

MIAMI — Linezolid was superior to vancomycin for treatment of presumed methicillin-resistant Staphylococcus aureus-based infections in 717 patients, reported Kamal Itani, M.D., and associates in a poster presented at the joint annual meeting of the Surgical Infection Society and the Surgical Infection Society-Europe.

“We expected linezolid to be better, but it was even better than we expected,” Dr. Itani, chief of surgery at VA Boston Health Care System, said in an interview.

In this large, multinational, open-label study, patients were randomized to receive 600 mg of linezolid every 12 hours either via IV or orally, or 1 g of vancomycin via IV every 12 hours.

The treatment duration was planned to be 7–14 days, but some patients were treated for up to 21 days.

In the initial population of 717 patients, those on linezolid had a shorter mean duration of IV therapy than did those on vancomycin (1.7 days vs. 9.1 days).

Of this population, MRSA infection was confirmed in 226 patients whose mean duration of IV therapy was 1.4 days on linezolid compared with 12.4 days on vancomycin.

The clinical cure rates for all patient demographics were significantly higher among linezolid patients compared with vancomycin patients (91.7% vs. 86.0%). The most significant difference in cure rates appeared in the MRSA population—94.2% in the linezolid group vs. 83.7% in the vancomycin group.

Approximately 20% of the linezolid patients could begin with oral therapy, whereas all of the vancomycin patients had IV therapy, Dr. Itani noted in an interview.

In addition, the overall mean length of hospital stay for linezolid patients was approximately 2–3 days less than that of the vancomycin patients. These data support linezolid as the more efficient choice for complicated skin and soft tissue infections due to suspected or proven MRSA, according to Dr. Itani.

The study, supported in part by Pfizer Inc., represents the largest known superiority study of linezolid, he added.

BETHESDA, MD. — Community-acquired methicillin-resistant Staphylococcus aureus was three times more prevalent than nosocomial MRSA in a small, nonteaching community hospital, reported Ananthakrishnan Ramini, M.D., at the annual conference on antimicrobial resistance sponsored by the National Foundation for Infectious Diseases.

MRSA was once limited to tertiary care centers and large hospitals but is rapidly becoming a dominant community pathogen, said Dr. Ramini, a physician at Columbia Memorial Hospital, a 192-bed facility in Hudson, N.Y.

Dr. Ramini and his colleagues conducted a prospective study of all MRSA infections in the hospital from January to December 2004. The investigators identified 78 cases of MRSA, of which 58 (74%) were community acquired.

The definition of community-acquired infection was an infection that surfaced within 48 hours of hospital admission.

Among the 51 patients older than 70 years, 47 had MRSA resistant to both clindamycin and erythromycin, which suggests more comorbidities in older patients, Dr. Ramini said. None of the organisms was resistant to oxacillin.

In addition, more of the MRSA cases (both community acquired and nosocomial) occurred outside than inside the ICU (56 vs. 22).

“There was a very high mortality among these patients,” Dr. Ramini noted.

Of the infected patients, 21 died, 39 were discharged to a nursing home, 15 went home, and 3 entered a tertiary care facility. “What was surprising was that community MRSA was so much more prevalent than nosocomial MRSA,” Dr. Ramini said.

“We need to be aware that treatment with a β-lactam alone is no longer a reliable empiric therapy,” he added.

He had no conflicts of interest to report.

BETHESDA, MD. — Community-acquired methicillin-resistant Staphylococcus aureus was three times more prevalent than nosocomial MRSA in a small, nonteaching community hospital, reported Ananthakrishnan Ramini, M.D., at the annual conference on antimicrobial resistance sponsored by the National Foundation for Infectious Diseases.

MRSA was once limited to tertiary care centers and large hospitals but is rapidly becoming a dominant community pathogen, said Dr. Ramini, a physician at Columbia Memorial Hospital, a 192-bed facility in Hudson, N.Y.

Dr. Ramini and his colleagues conducted a prospective study of all MRSA infections in the hospital from January to December 2004. The investigators identified 78 cases of MRSA, of which 58 (74%) were community acquired.

The definition of community-acquired infection was an infection that surfaced within 48 hours of hospital admission.

Among the 51 patients older than 70 years, 47 had MRSA resistant to both clindamycin and erythromycin, which suggests more comorbidities in older patients, Dr. Ramini said. None of the organisms was resistant to oxacillin.

In addition, more of the MRSA cases (both community acquired and nosocomial) occurred outside than inside the ICU (56 vs. 22).

“There was a very high mortality among these patients,” Dr. Ramini noted.

Of the infected patients, 21 died, 39 were discharged to a nursing home, 15 went home, and 3 entered a tertiary care facility. “What was surprising was that community MRSA was so much more prevalent than nosocomial MRSA,” Dr. Ramini said.

“We need to be aware that treatment with a β-lactam alone is no longer a reliable empiric therapy,” he added.

He had no conflicts of interest to report.

BETHESDA, MD. — Community-acquired methicillin-resistant Staphylococcus aureus was three times more prevalent than nosocomial MRSA in a small, nonteaching community hospital, reported Ananthakrishnan Ramini, M.D., at the annual conference on antimicrobial resistance sponsored by the National Foundation for Infectious Diseases.

MRSA was once limited to tertiary care centers and large hospitals but is rapidly becoming a dominant community pathogen, said Dr. Ramini, a physician at Columbia Memorial Hospital, a 192-bed facility in Hudson, N.Y.

Dr. Ramini and his colleagues conducted a prospective study of all MRSA infections in the hospital from January to December 2004. The investigators identified 78 cases of MRSA, of which 58 (74%) were community acquired.

The definition of community-acquired infection was an infection that surfaced within 48 hours of hospital admission.

Among the 51 patients older than 70 years, 47 had MRSA resistant to both clindamycin and erythromycin, which suggests more comorbidities in older patients, Dr. Ramini said. None of the organisms was resistant to oxacillin.

In addition, more of the MRSA cases (both community acquired and nosocomial) occurred outside than inside the ICU (56 vs. 22).

“There was a very high mortality among these patients,” Dr. Ramini noted.

Of the infected patients, 21 died, 39 were discharged to a nursing home, 15 went home, and 3 entered a tertiary care facility. “What was surprising was that community MRSA was so much more prevalent than nosocomial MRSA,” Dr. Ramini said.

“We need to be aware that treatment with a β-lactam alone is no longer a reliable empiric therapy,” he added.

He had no conflicts of interest to report.

WASHINGTON — The hypofibrinolytic plasminogen activator inhibitor was an independent predictor of miscarriage in a cohort of 441 women with polycystic ovary syndrome who had previous pregnancies, Charles J. Glueck, M.D., reported at the Clinical Research 2005 meeting.

PAI-Fx is highly correlated with fasting serum insulin resistance, and Glucophage (metformin) (2.25–2.5 g/day) sharply lowers both insulin and PAI-Fx levels, significantly improving the odds of live births for women with PCOS, said Dr. Glueck, director of the Jewish Hospital Cholesterol Center in Cincinnati.

The 441 women were part of a larger cohort of 968 women with PCOS. Of these 441 women, 206 had only live births, 118 had at least one live birth and one miscarriage, and 75 had only miscarriages.

In addition, of 926 women with PCOS for whom genetic data were available, 727 (79%) had the 4G5G or 4G4G genotype vs. 87 of 126 (69%) healthy female controls.

This PAI-1 genetic mutation was significantly associated with miscarriage, in part through its gene product, PAI-Fx, and appears to be more common in women with PCOS than in healthy women, Dr. Glueck said at the meeting, sponsored by the American Federation for Medical Research.

The overall frequency of the 4G allele was 53% among PCOS women, compared with 46% of the controls.

Dr. Glueck and his associates also evaluated 30 women who took metformin during pregnancy and had live births and 23 women who took it and had first-trimester miscarriages. The PAI-Fx level fell by approximately 44% among the women who had live births, but it rose approximately 19% among the women who had early miscarriages. Among the women who had live births, PAI-Fx fell consistently from pre-pregnancy treatment through the first trimester, from 16.8 to 6.7 units/mL.

Left untreated, approximately 50% of pregnant women with PCOS experience first-trimester miscarriages; treatment with metformin, combined with dietary changes, reduces this figure to approximately 15% (the national average in the United States).

PCOS-associated obesity, hyperinsulinemia, and hypertriglyceridemia can contribute to the high PAI-Fx levels that promote miscarriage in women with PCOS, Dr. Glueck noted.

Physicians can optimize pregnancy outcomes by prescribing metformin and diet, which has been shown to reduce obesity, hyperinsulinemia, hypertriglyceridemia, and PAI-Fx levels.

WASHINGTON — The hypofibrinolytic plasminogen activator inhibitor was an independent predictor of miscarriage in a cohort of 441 women with polycystic ovary syndrome who had previous pregnancies, Charles J. Glueck, M.D., reported at the Clinical Research 2005 meeting.

PAI-Fx is highly correlated with fasting serum insulin resistance, and Glucophage (metformin) (2.25–2.5 g/day) sharply lowers both insulin and PAI-Fx levels, significantly improving the odds of live births for women with PCOS, said Dr. Glueck, director of the Jewish Hospital Cholesterol Center in Cincinnati.

The 441 women were part of a larger cohort of 968 women with PCOS. Of these 441 women, 206 had only live births, 118 had at least one live birth and one miscarriage, and 75 had only miscarriages.

In addition, of 926 women with PCOS for whom genetic data were available, 727 (79%) had the 4G5G or 4G4G genotype vs. 87 of 126 (69%) healthy female controls.

This PAI-1 genetic mutation was significantly associated with miscarriage, in part through its gene product, PAI-Fx, and appears to be more common in women with PCOS than in healthy women, Dr. Glueck said at the meeting, sponsored by the American Federation for Medical Research.

The overall frequency of the 4G allele was 53% among PCOS women, compared with 46% of the controls.

Dr. Glueck and his associates also evaluated 30 women who took metformin during pregnancy and had live births and 23 women who took it and had first-trimester miscarriages. The PAI-Fx level fell by approximately 44% among the women who had live births, but it rose approximately 19% among the women who had early miscarriages. Among the women who had live births, PAI-Fx fell consistently from pre-pregnancy treatment through the first trimester, from 16.8 to 6.7 units/mL.

Left untreated, approximately 50% of pregnant women with PCOS experience first-trimester miscarriages; treatment with metformin, combined with dietary changes, reduces this figure to approximately 15% (the national average in the United States).

PCOS-associated obesity, hyperinsulinemia, and hypertriglyceridemia can contribute to the high PAI-Fx levels that promote miscarriage in women with PCOS, Dr. Glueck noted.

Physicians can optimize pregnancy outcomes by prescribing metformin and diet, which has been shown to reduce obesity, hyperinsulinemia, hypertriglyceridemia, and PAI-Fx levels.

WASHINGTON — The hypofibrinolytic plasminogen activator inhibitor was an independent predictor of miscarriage in a cohort of 441 women with polycystic ovary syndrome who had previous pregnancies, Charles J. Glueck, M.D., reported at the Clinical Research 2005 meeting.

PAI-Fx is highly correlated with fasting serum insulin resistance, and Glucophage (metformin) (2.25–2.5 g/day) sharply lowers both insulin and PAI-Fx levels, significantly improving the odds of live births for women with PCOS, said Dr. Glueck, director of the Jewish Hospital Cholesterol Center in Cincinnati.

The 441 women were part of a larger cohort of 968 women with PCOS. Of these 441 women, 206 had only live births, 118 had at least one live birth and one miscarriage, and 75 had only miscarriages.

In addition, of 926 women with PCOS for whom genetic data were available, 727 (79%) had the 4G5G or 4G4G genotype vs. 87 of 126 (69%) healthy female controls.

This PAI-1 genetic mutation was significantly associated with miscarriage, in part through its gene product, PAI-Fx, and appears to be more common in women with PCOS than in healthy women, Dr. Glueck said at the meeting, sponsored by the American Federation for Medical Research.

The overall frequency of the 4G allele was 53% among PCOS women, compared with 46% of the controls.

Dr. Glueck and his associates also evaluated 30 women who took metformin during pregnancy and had live births and 23 women who took it and had first-trimester miscarriages. The PAI-Fx level fell by approximately 44% among the women who had live births, but it rose approximately 19% among the women who had early miscarriages. Among the women who had live births, PAI-Fx fell consistently from pre-pregnancy treatment through the first trimester, from 16.8 to 6.7 units/mL.

Left untreated, approximately 50% of pregnant women with PCOS experience first-trimester miscarriages; treatment with metformin, combined with dietary changes, reduces this figure to approximately 15% (the national average in the United States).

PCOS-associated obesity, hyperinsulinemia, and hypertriglyceridemia can contribute to the high PAI-Fx levels that promote miscarriage in women with PCOS, Dr. Glueck noted.

Physicians can optimize pregnancy outcomes by prescribing metformin and diet, which has been shown to reduce obesity, hyperinsulinemia, hypertriglyceridemia, and PAI-Fx levels.

ORLANDO, FLA. — “When will Suzie be old enough to lift weights?” Family physicians may have heard this question from eager parents.

It's important to remind parents that strength is only one aspect of a young athlete's performance, David Bernhardt, M.D., said at a meeting sponsored by the American Academy of Pediatrics.

“Our job is to keep kids active, but excessive weight lifting does not necessarily equal athletic success,” said Dr. Bernhardt, a pediatrics and sports medicine specialist at the University of Wisconsin, Madison. That said, there is no need to discourage children from sensible, moderate strength training, but children should be discouraged from power weight lifting and aesthetic body building, which are not appropriate activities for skeletally immature athletes.

Strength-training exercises using one's own body weight, such as push-ups and sit-ups, and free weights (including small dumbbells, stretching bands, and fitness balls), are better than using weight machines, which are not sized for children, Dr. Bernhardt said.

Safe and effective strength training starts with the proper technique. Children need to learn the techniques of a strength exercise with little or no resistance before adding weight gradually, and they should be able to complete 8–15 repetitions easily, using proper form, before increasing the weight.

Remind them to work all the muscle groups, not just the muscles they see in the mirror.

The question of whether strength training will truly improve performance is difficult to prove, he added. Gains between 30% and 40% have been observed in previous studies, and a 1996 metaanalysis showed that the percentage gains are similar to those in skeletally mature athletes (Sports Med. 1996;22:176–86).

“But, you are looking at smaller quantitative amounts,” Dr. Bernhardt cautioned. In addition, a child's strength naturally increases as he or she grows, which may mask any effects from a specific strength-training program.

“There's a myth out there that strength gains aren't possible without pubertal hormones, and therefore kids who are prepubertal shouldn't be participating in a strength-training program,” Dr. Bernhardt said.

However, short study durations, small numbers, mixed pubertal stages, and lack of controls can confound research in this area.

“The reality is that children can gain significant strength with little risk of injury, but they do need appropriate supervision and technique,” Dr. Bernhardt said.

For example, he cited one study of nine boys and nine girls aged 10–11 years who participated in a 30-minute resistance-training program, three times per week for 9 weeks. The program consisted of three sets of 10 repetitions of various exercises, including thigh presses, chest presses, and back rows. The children demonstrated a mean 30% increase in strength compared with controls. Other equally important outcomes were that the children maintained their baseline flexibility, and no injuries were reported during the 9-week period, Dr. Bernhardt noted.

When a child expresses an interest in strength training, consider the child's motivation, goals, maturity, and whether the strength training would be supervised, he added. The most common reasons for injuries include inadequate coaching, weight training at home, use of free weights without spotters, and inexperience.

The most often-reported strength-training injuries in children are lower back strains. Remind children and parents that although the effect of strength training on body size and composition is difficult to measure while children are growing, there is no evidence that weight training has any detrimental effect on linear growth.

When children and teens ask about strength training, “you should use this as a jumping off point for anticipatory guidance,” Dr. Bernhardt said. Ask what else they are doing to improve their strength. Ask them about nutritional supplements, and talk to them about steroids. Question them about their reasons for wanting to do strength training. Serious overuse injuries to the arms and shoulders due to strength training are more common in older adolescents than in young children. If a child or teenager is lifting enough weight to rupture a biceps or pectoralis muscle, investigate the possibility of steroid use.

Strength training likely has some benefit on overall sports performance, simply because someone who is stronger may be faster or more agile on the athletic field, but such benefits are difficult to prove, and whether increased strength will directly improve flexibility or stamina remains impossible to say, Dr. Bernhardt noted.

However, consider introducing children and parents to the concept of “functional fitness,” which means training the body to move three-dimensionally, as it does in sports, rather than the two-dimensional motions of traditional weight lifting.

For example, suggest that a child do lunges forward, backward, and to the side, rather than forward only. Such triplanar activity, which young children engage in naturally while climbing on monkey bars, for example, can be lost when children become narrowly focused on one sport. Also, consider the sport. If you put a cross-country runner on a heavy muscle-building program, you may not do him or her any favors.

“The goal of keeping children active and participating in their sports until their bodies mature is a message we should deliver to parents,” Dr. Bernhardt said.

The bottom line is to keep kids motivated and active, and if they want to do some strength training and understand the correct way to go about it, it should not be the doctor's job to discourage them, he added.

Appropriate strength training for children involves small free weights, stretching bands, and fitness balls, not machines. Lolita Jones

ORLANDO, FLA. — “When will Suzie be old enough to lift weights?” Family physicians may have heard this question from eager parents.

It's important to remind parents that strength is only one aspect of a young athlete's performance, David Bernhardt, M.D., said at a meeting sponsored by the American Academy of Pediatrics.

“Our job is to keep kids active, but excessive weight lifting does not necessarily equal athletic success,” said Dr. Bernhardt, a pediatrics and sports medicine specialist at the University of Wisconsin, Madison. That said, there is no need to discourage children from sensible, moderate strength training, but children should be discouraged from power weight lifting and aesthetic body building, which are not appropriate activities for skeletally immature athletes.

Strength-training exercises using one's own body weight, such as push-ups and sit-ups, and free weights (including small dumbbells, stretching bands, and fitness balls), are better than using weight machines, which are not sized for children, Dr. Bernhardt said.

Safe and effective strength training starts with the proper technique. Children need to learn the techniques of a strength exercise with little or no resistance before adding weight gradually, and they should be able to complete 8–15 repetitions easily, using proper form, before increasing the weight.

Remind them to work all the muscle groups, not just the muscles they see in the mirror.

The question of whether strength training will truly improve performance is difficult to prove, he added. Gains between 30% and 40% have been observed in previous studies, and a 1996 metaanalysis showed that the percentage gains are similar to those in skeletally mature athletes (Sports Med. 1996;22:176–86).

“But, you are looking at smaller quantitative amounts,” Dr. Bernhardt cautioned. In addition, a child's strength naturally increases as he or she grows, which may mask any effects from a specific strength-training program.

“There's a myth out there that strength gains aren't possible without pubertal hormones, and therefore kids who are prepubertal shouldn't be participating in a strength-training program,” Dr. Bernhardt said.

However, short study durations, small numbers, mixed pubertal stages, and lack of controls can confound research in this area.

“The reality is that children can gain significant strength with little risk of injury, but they do need appropriate supervision and technique,” Dr. Bernhardt said.

For example, he cited one study of nine boys and nine girls aged 10–11 years who participated in a 30-minute resistance-training program, three times per week for 9 weeks. The program consisted of three sets of 10 repetitions of various exercises, including thigh presses, chest presses, and back rows. The children demonstrated a mean 30% increase in strength compared with controls. Other equally important outcomes were that the children maintained their baseline flexibility, and no injuries were reported during the 9-week period, Dr. Bernhardt noted.

When a child expresses an interest in strength training, consider the child's motivation, goals, maturity, and whether the strength training would be supervised, he added. The most common reasons for injuries include inadequate coaching, weight training at home, use of free weights without spotters, and inexperience.

The most often-reported strength-training injuries in children are lower back strains. Remind children and parents that although the effect of strength training on body size and composition is difficult to measure while children are growing, there is no evidence that weight training has any detrimental effect on linear growth.

When children and teens ask about strength training, “you should use this as a jumping off point for anticipatory guidance,” Dr. Bernhardt said. Ask what else they are doing to improve their strength. Ask them about nutritional supplements, and talk to them about steroids. Question them about their reasons for wanting to do strength training. Serious overuse injuries to the arms and shoulders due to strength training are more common in older adolescents than in young children. If a child or teenager is lifting enough weight to rupture a biceps or pectoralis muscle, investigate the possibility of steroid use.

Strength training likely has some benefit on overall sports performance, simply because someone who is stronger may be faster or more agile on the athletic field, but such benefits are difficult to prove, and whether increased strength will directly improve flexibility or stamina remains impossible to say, Dr. Bernhardt noted.

However, consider introducing children and parents to the concept of “functional fitness,” which means training the body to move three-dimensionally, as it does in sports, rather than the two-dimensional motions of traditional weight lifting.

For example, suggest that a child do lunges forward, backward, and to the side, rather than forward only. Such triplanar activity, which young children engage in naturally while climbing on monkey bars, for example, can be lost when children become narrowly focused on one sport. Also, consider the sport. If you put a cross-country runner on a heavy muscle-building program, you may not do him or her any favors.

“The goal of keeping children active and participating in their sports until their bodies mature is a message we should deliver to parents,” Dr. Bernhardt said.

The bottom line is to keep kids motivated and active, and if they want to do some strength training and understand the correct way to go about it, it should not be the doctor's job to discourage them, he added.

Appropriate strength training for children involves small free weights, stretching bands, and fitness balls, not machines. Lolita Jones

ORLANDO, FLA. — “When will Suzie be old enough to lift weights?” Family physicians may have heard this question from eager parents.

It's important to remind parents that strength is only one aspect of a young athlete's performance, David Bernhardt, M.D., said at a meeting sponsored by the American Academy of Pediatrics.

“Our job is to keep kids active, but excessive weight lifting does not necessarily equal athletic success,” said Dr. Bernhardt, a pediatrics and sports medicine specialist at the University of Wisconsin, Madison. That said, there is no need to discourage children from sensible, moderate strength training, but children should be discouraged from power weight lifting and aesthetic body building, which are not appropriate activities for skeletally immature athletes.

Strength-training exercises using one's own body weight, such as push-ups and sit-ups, and free weights (including small dumbbells, stretching bands, and fitness balls), are better than using weight machines, which are not sized for children, Dr. Bernhardt said.

Safe and effective strength training starts with the proper technique. Children need to learn the techniques of a strength exercise with little or no resistance before adding weight gradually, and they should be able to complete 8–15 repetitions easily, using proper form, before increasing the weight.

Remind them to work all the muscle groups, not just the muscles they see in the mirror.

The question of whether strength training will truly improve performance is difficult to prove, he added. Gains between 30% and 40% have been observed in previous studies, and a 1996 metaanalysis showed that the percentage gains are similar to those in skeletally mature athletes (Sports Med. 1996;22:176–86).

“But, you are looking at smaller quantitative amounts,” Dr. Bernhardt cautioned. In addition, a child's strength naturally increases as he or she grows, which may mask any effects from a specific strength-training program.

“There's a myth out there that strength gains aren't possible without pubertal hormones, and therefore kids who are prepubertal shouldn't be participating in a strength-training program,” Dr. Bernhardt said.

However, short study durations, small numbers, mixed pubertal stages, and lack of controls can confound research in this area.

“The reality is that children can gain significant strength with little risk of injury, but they do need appropriate supervision and technique,” Dr. Bernhardt said.

For example, he cited one study of nine boys and nine girls aged 10–11 years who participated in a 30-minute resistance-training program, three times per week for 9 weeks. The program consisted of three sets of 10 repetitions of various exercises, including thigh presses, chest presses, and back rows. The children demonstrated a mean 30% increase in strength compared with controls. Other equally important outcomes were that the children maintained their baseline flexibility, and no injuries were reported during the 9-week period, Dr. Bernhardt noted.

When a child expresses an interest in strength training, consider the child's motivation, goals, maturity, and whether the strength training would be supervised, he added. The most common reasons for injuries include inadequate coaching, weight training at home, use of free weights without spotters, and inexperience.

The most often-reported strength-training injuries in children are lower back strains. Remind children and parents that although the effect of strength training on body size and composition is difficult to measure while children are growing, there is no evidence that weight training has any detrimental effect on linear growth.

When children and teens ask about strength training, “you should use this as a jumping off point for anticipatory guidance,” Dr. Bernhardt said. Ask what else they are doing to improve their strength. Ask them about nutritional supplements, and talk to them about steroids. Question them about their reasons for wanting to do strength training. Serious overuse injuries to the arms and shoulders due to strength training are more common in older adolescents than in young children. If a child or teenager is lifting enough weight to rupture a biceps or pectoralis muscle, investigate the possibility of steroid use.

Strength training likely has some benefit on overall sports performance, simply because someone who is stronger may be faster or more agile on the athletic field, but such benefits are difficult to prove, and whether increased strength will directly improve flexibility or stamina remains impossible to say, Dr. Bernhardt noted.

However, consider introducing children and parents to the concept of “functional fitness,” which means training the body to move three-dimensionally, as it does in sports, rather than the two-dimensional motions of traditional weight lifting.

For example, suggest that a child do lunges forward, backward, and to the side, rather than forward only. Such triplanar activity, which young children engage in naturally while climbing on monkey bars, for example, can be lost when children become narrowly focused on one sport. Also, consider the sport. If you put a cross-country runner on a heavy muscle-building program, you may not do him or her any favors.

“The goal of keeping children active and participating in their sports until their bodies mature is a message we should deliver to parents,” Dr. Bernhardt said.

The bottom line is to keep kids motivated and active, and if they want to do some strength training and understand the correct way to go about it, it should not be the doctor's job to discourage them, he added.

Appropriate strength training for children involves small free weights, stretching bands, and fitness balls, not machines. Lolita Jones

WASHINGTON — Body temperature below 36° C at hospital admission was independently associated with a lower survival rate in a study of 56,659 patients with advanced heart failure.

Disordered thermoregulation is common in patients with advanced heart failure, and body temperature measurements may improve risk assessment in these patients, Brahmajee K. Nallamothu, M.D., wrote in a poster presented at the Clinical Research 2005 meeting sponsored by the American Federation for Medical Research.

Dr. Nallamothu, a cardiologist at the University of Michigan, Ann Arbor, and his associates reviewed data on patients aged 65 years and older who were participating in the National Heart Care Project.

The mean body temperature upon hospital admission was 36.5° C, and most of the patients' admission temperatures were between 36° and 38° C. However, 10,754 (18.5%) of the patients had body temperatures below 36° C and 1,145 (1.9%) had body temperatures above 38° C.

After multivariate analysis, patients with body temperatures below 36° had significantly higher mortality, both in hospital (adjusted risk ratio, 1.28) and at 1 year after their hospitalizations (adjusted risk ratio, 1.14).

WASHINGTON — Body temperature below 36° C at hospital admission was independently associated with a lower survival rate in a study of 56,659 patients with advanced heart failure.

Disordered thermoregulation is common in patients with advanced heart failure, and body temperature measurements may improve risk assessment in these patients, Brahmajee K. Nallamothu, M.D., wrote in a poster presented at the Clinical Research 2005 meeting sponsored by the American Federation for Medical Research.

Dr. Nallamothu, a cardiologist at the University of Michigan, Ann Arbor, and his associates reviewed data on patients aged 65 years and older who were participating in the National Heart Care Project.

The mean body temperature upon hospital admission was 36.5° C, and most of the patients' admission temperatures were between 36° and 38° C. However, 10,754 (18.5%) of the patients had body temperatures below 36° C and 1,145 (1.9%) had body temperatures above 38° C.

After multivariate analysis, patients with body temperatures below 36° had significantly higher mortality, both in hospital (adjusted risk ratio, 1.28) and at 1 year after their hospitalizations (adjusted risk ratio, 1.14).

WASHINGTON — Body temperature below 36° C at hospital admission was independently associated with a lower survival rate in a study of 56,659 patients with advanced heart failure.

Disordered thermoregulation is common in patients with advanced heart failure, and body temperature measurements may improve risk assessment in these patients, Brahmajee K. Nallamothu, M.D., wrote in a poster presented at the Clinical Research 2005 meeting sponsored by the American Federation for Medical Research.

Dr. Nallamothu, a cardiologist at the University of Michigan, Ann Arbor, and his associates reviewed data on patients aged 65 years and older who were participating in the National Heart Care Project.

The mean body temperature upon hospital admission was 36.5° C, and most of the patients' admission temperatures were between 36° and 38° C. However, 10,754 (18.5%) of the patients had body temperatures below 36° C and 1,145 (1.9%) had body temperatures above 38° C.

After multivariate analysis, patients with body temperatures below 36° had significantly higher mortality, both in hospital (adjusted risk ratio, 1.28) and at 1 year after their hospitalizations (adjusted risk ratio, 1.14).

WASHINGTON — Imaging data from a phase III study confirm that treatment with parathyroid hormone significantly improves bone microarchitecture in postmenopausal osteoporotic women, David W. Dempster, Ph.D., reported in a poster at an international symposium sponsored by the National Osteoporosis Foundation.

The use of micro-CT supports research by Dr. Dempster, professor of clinical pathology at Columbia University, New York, and director of the regional bone center at Helen Hayes Hospital, West Haverstraw, N.Y., and his colleagues on the use of parathyroid hormone (PTH) as a bone builder.

The Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included about 2,600 women treated daily with 100-mcg injections of PTH or a placebo for 18 months. In addition, all patients received 700 mg of calcium and 400 IU of vitamin D daily. The researchers obtained iliac crest biopsies from women in the PTH and placebo groups.

Based on the micro-CT data, the mean cancellous bone volume was significantly higher (45%) among women treated with PTH, compared with the placebo group. This increase also was associated with 12% and 17% increases in mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

Dr. Dempster and his colleagues had reported similar results when they used histomorphometry to assess iliac crest biopsies in TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, for the PTH group versus the placebo group.

Although both techniques similarly illustrated improvements in bone volume and thickness in the PTH group, they each contribute some unique information and thus complement each other. Micro-CT is rapid and nondestructive, and provides quantitative information on the 3-D architecture of the bone, while histomorphometry provides details about the impact of PTH on bone turnover and bone cell populations.

Dr. Dempster is a consultant for NPS Pharmaceuticals.

WASHINGTON — Imaging data from a phase III study confirm that treatment with parathyroid hormone significantly improves bone microarchitecture in postmenopausal osteoporotic women, David W. Dempster, Ph.D., reported in a poster at an international symposium sponsored by the National Osteoporosis Foundation.

The use of micro-CT supports research by Dr. Dempster, professor of clinical pathology at Columbia University, New York, and director of the regional bone center at Helen Hayes Hospital, West Haverstraw, N.Y., and his colleagues on the use of parathyroid hormone (PTH) as a bone builder.

The Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included about 2,600 women treated daily with 100-mcg injections of PTH or a placebo for 18 months. In addition, all patients received 700 mg of calcium and 400 IU of vitamin D daily. The researchers obtained iliac crest biopsies from women in the PTH and placebo groups.

Based on the micro-CT data, the mean cancellous bone volume was significantly higher (45%) among women treated with PTH, compared with the placebo group. This increase also was associated with 12% and 17% increases in mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

Dr. Dempster and his colleagues had reported similar results when they used histomorphometry to assess iliac crest biopsies in TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, for the PTH group versus the placebo group.

Although both techniques similarly illustrated improvements in bone volume and thickness in the PTH group, they each contribute some unique information and thus complement each other. Micro-CT is rapid and nondestructive, and provides quantitative information on the 3-D architecture of the bone, while histomorphometry provides details about the impact of PTH on bone turnover and bone cell populations.

Dr. Dempster is a consultant for NPS Pharmaceuticals.

WASHINGTON — Imaging data from a phase III study confirm that treatment with parathyroid hormone significantly improves bone microarchitecture in postmenopausal osteoporotic women, David W. Dempster, Ph.D., reported in a poster at an international symposium sponsored by the National Osteoporosis Foundation.

The use of micro-CT supports research by Dr. Dempster, professor of clinical pathology at Columbia University, New York, and director of the regional bone center at Helen Hayes Hospital, West Haverstraw, N.Y., and his colleagues on the use of parathyroid hormone (PTH) as a bone builder.

The Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included about 2,600 women treated daily with 100-mcg injections of PTH or a placebo for 18 months. In addition, all patients received 700 mg of calcium and 400 IU of vitamin D daily. The researchers obtained iliac crest biopsies from women in the PTH and placebo groups.

Based on the micro-CT data, the mean cancellous bone volume was significantly higher (45%) among women treated with PTH, compared with the placebo group. This increase also was associated with 12% and 17% increases in mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

Dr. Dempster and his colleagues had reported similar results when they used histomorphometry to assess iliac crest biopsies in TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, for the PTH group versus the placebo group.

Although both techniques similarly illustrated improvements in bone volume and thickness in the PTH group, they each contribute some unique information and thus complement each other. Micro-CT is rapid and nondestructive, and provides quantitative information on the 3-D architecture of the bone, while histomorphometry provides details about the impact of PTH on bone turnover and bone cell populations.

Dr. Dempster is a consultant for NPS Pharmaceuticals.

WASHINGTON — Metformin combined with a reduced-calorie diet reduced cardiovascular risk in a study of 791 women with polycystic ovary syndrome, Mofiz Haque, M.D., reported in a poster presented at the Clinical Research 2005 meeting.

The metformin-diet (MET-D) combination was effective in reducing weight, triglycerides, and LDL cholesterol, while increasing HDL cholesterol, reported Dr. Haque of the cholesterol center at the Jewish Hospital, Cincinnati, and his colleagues.

At baseline, the women had a median weight of 95 kg; 15% were overweight, 46% were obese, and 29% were severely obese. At baseline, the mean triglyceride level was 108 mg/dL, LDL cholesterol was 116 mg/dL, and HDL cholesterol was 46 mg/dL.

Women with a BMI less than 25 kg/m

Overall, metformin targeted to 2,500 mg/day in combination with dietary restriction was associated with significant reductions in weight, triglycerides, LDL cholesterol, and blood pressure levels.

The mean weight loss was 5 kg (5%), 6 kg (6%), and 5 kg (5%) for women who took medication for 12–18 months, 18–24 months, and more than 24 months, respectively. In those three groups, 13%, 14%, and 15% of the women lost at least 15% of their body weight.

Triglyceride levels dropped significantly—by 17 mg/dL—among the 65 women who followed the MET-D regimen for 18–24 months.

LDL cholesterol levels fell an average of 6 mg/dL (4%) and 9 mg/dL (7%), respectively, among the 102 women who followed the regimen for 12–18 months and the 210 women who followed the regimen for more than 24 months.

HDL cholesterol levels rose an average of 2 mg/dL (6%) and 4 mg/dL (8%) among women who followed the regimen for 18–24 months and more than 24 months, respectively. Both increases were statistically significant.

In general, about 75% of women with polycystic ovary syndrome are obese, with unhealthy triglyceride and cholesterol levels. MET-D appears to be an effective strategy for helping such patients lose weight and reduce cardiovascular risk factors associated with overweight and obesity, the investigators noted.

WASHINGTON — Metformin combined with a reduced-calorie diet reduced cardiovascular risk in a study of 791 women with polycystic ovary syndrome, Mofiz Haque, M.D., reported in a poster presented at the Clinical Research 2005 meeting.

The metformin-diet (MET-D) combination was effective in reducing weight, triglycerides, and LDL cholesterol, while increasing HDL cholesterol, reported Dr. Haque of the cholesterol center at the Jewish Hospital, Cincinnati, and his colleagues.

At baseline, the women had a median weight of 95 kg; 15% were overweight, 46% were obese, and 29% were severely obese. At baseline, the mean triglyceride level was 108 mg/dL, LDL cholesterol was 116 mg/dL, and HDL cholesterol was 46 mg/dL.

Women with a BMI less than 25 kg/m

Overall, metformin targeted to 2,500 mg/day in combination with dietary restriction was associated with significant reductions in weight, triglycerides, LDL cholesterol, and blood pressure levels.

The mean weight loss was 5 kg (5%), 6 kg (6%), and 5 kg (5%) for women who took medication for 12–18 months, 18–24 months, and more than 24 months, respectively. In those three groups, 13%, 14%, and 15% of the women lost at least 15% of their body weight.

Triglyceride levels dropped significantly—by 17 mg/dL—among the 65 women who followed the MET-D regimen for 18–24 months.

LDL cholesterol levels fell an average of 6 mg/dL (4%) and 9 mg/dL (7%), respectively, among the 102 women who followed the regimen for 12–18 months and the 210 women who followed the regimen for more than 24 months.

HDL cholesterol levels rose an average of 2 mg/dL (6%) and 4 mg/dL (8%) among women who followed the regimen for 18–24 months and more than 24 months, respectively. Both increases were statistically significant.

In general, about 75% of women with polycystic ovary syndrome are obese, with unhealthy triglyceride and cholesterol levels. MET-D appears to be an effective strategy for helping such patients lose weight and reduce cardiovascular risk factors associated with overweight and obesity, the investigators noted.

WASHINGTON — Metformin combined with a reduced-calorie diet reduced cardiovascular risk in a study of 791 women with polycystic ovary syndrome, Mofiz Haque, M.D., reported in a poster presented at the Clinical Research 2005 meeting.

The metformin-diet (MET-D) combination was effective in reducing weight, triglycerides, and LDL cholesterol, while increasing HDL cholesterol, reported Dr. Haque of the cholesterol center at the Jewish Hospital, Cincinnati, and his colleagues.

At baseline, the women had a median weight of 95 kg; 15% were overweight, 46% were obese, and 29% were severely obese. At baseline, the mean triglyceride level was 108 mg/dL, LDL cholesterol was 116 mg/dL, and HDL cholesterol was 46 mg/dL.

Women with a BMI less than 25 kg/m

Overall, metformin targeted to 2,500 mg/day in combination with dietary restriction was associated with significant reductions in weight, triglycerides, LDL cholesterol, and blood pressure levels.

The mean weight loss was 5 kg (5%), 6 kg (6%), and 5 kg (5%) for women who took medication for 12–18 months, 18–24 months, and more than 24 months, respectively. In those three groups, 13%, 14%, and 15% of the women lost at least 15% of their body weight.

Triglyceride levels dropped significantly—by 17 mg/dL—among the 65 women who followed the MET-D regimen for 18–24 months.

LDL cholesterol levels fell an average of 6 mg/dL (4%) and 9 mg/dL (7%), respectively, among the 102 women who followed the regimen for 12–18 months and the 210 women who followed the regimen for more than 24 months.

HDL cholesterol levels rose an average of 2 mg/dL (6%) and 4 mg/dL (8%) among women who followed the regimen for 18–24 months and more than 24 months, respectively. Both increases were statistically significant.

In general, about 75% of women with polycystic ovary syndrome are obese, with unhealthy triglyceride and cholesterol levels. MET-D appears to be an effective strategy for helping such patients lose weight and reduce cardiovascular risk factors associated with overweight and obesity, the investigators noted.

WASHINGTON — Osteoporosis patients demonstrate greater compliance with weekly bisphosphonate therapy than with daily medication, but the numbers are still suboptimal, Deborah T. Gold, Ph.D., reported in a poster she presented at an international symposium sponsored by the National Osteoporosis Foundation.

Patients often resist taking bisphosphonates because of their inconvenient and complex dosing procedures, explained Dr. Gold of Duke University Medical Center, Durham, N.C.

Dr. Gold and her associates analyzed data on 214,060 women aged 50 years and older who received bisphosphonate therapy; the information had been collected for two health claims and retail pharmacy databases. Overall, weekly doses led to improved compliance after 1 year, compared with daily doses (44%–55% vs. 32%–40%), but 42%–67% of the patients on the weekly regimen had discontinued the medication within a year.

In addition, the level of compliance with either a weekly or daily dose was often too low to benefit many patients. Sufficient compliance was defined as a “medication possession ratio” of at least 80%. At most, only 53% of patients who received weekly medication were deemed compliant enough to derive antifracture benefits from it, which was still significantly better than the up to 40% rate of sufficient compliance among patients who received daily medication. Dr. Gold serves as a consultant for multiple pharmaceutical companies.

WASHINGTON — Osteoporosis patients demonstrate greater compliance with weekly bisphosphonate therapy than with daily medication, but the numbers are still suboptimal, Deborah T. Gold, Ph.D., reported in a poster she presented at an international symposium sponsored by the National Osteoporosis Foundation.

Patients often resist taking bisphosphonates because of their inconvenient and complex dosing procedures, explained Dr. Gold of Duke University Medical Center, Durham, N.C.

Dr. Gold and her associates analyzed data on 214,060 women aged 50 years and older who received bisphosphonate therapy; the information had been collected for two health claims and retail pharmacy databases. Overall, weekly doses led to improved compliance after 1 year, compared with daily doses (44%–55% vs. 32%–40%), but 42%–67% of the patients on the weekly regimen had discontinued the medication within a year.

In addition, the level of compliance with either a weekly or daily dose was often too low to benefit many patients. Sufficient compliance was defined as a “medication possession ratio” of at least 80%. At most, only 53% of patients who received weekly medication were deemed compliant enough to derive antifracture benefits from it, which was still significantly better than the up to 40% rate of sufficient compliance among patients who received daily medication. Dr. Gold serves as a consultant for multiple pharmaceutical companies.

WASHINGTON — Osteoporosis patients demonstrate greater compliance with weekly bisphosphonate therapy than with daily medication, but the numbers are still suboptimal, Deborah T. Gold, Ph.D., reported in a poster she presented at an international symposium sponsored by the National Osteoporosis Foundation.

Patients often resist taking bisphosphonates because of their inconvenient and complex dosing procedures, explained Dr. Gold of Duke University Medical Center, Durham, N.C.

Dr. Gold and her associates analyzed data on 214,060 women aged 50 years and older who received bisphosphonate therapy; the information had been collected for two health claims and retail pharmacy databases. Overall, weekly doses led to improved compliance after 1 year, compared with daily doses (44%–55% vs. 32%–40%), but 42%–67% of the patients on the weekly regimen had discontinued the medication within a year.

In addition, the level of compliance with either a weekly or daily dose was often too low to benefit many patients. Sufficient compliance was defined as a “medication possession ratio” of at least 80%. At most, only 53% of patients who received weekly medication were deemed compliant enough to derive antifracture benefits from it, which was still significantly better than the up to 40% rate of sufficient compliance among patients who received daily medication. Dr. Gold serves as a consultant for multiple pharmaceutical companies.