Heidi Splete

WASHINGTON — A whopping 97% of 78 patients hospitalized for minimal trauma fractures had vitamin D levels of less than 30 nanograms per mL, Christine Simonelli, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Even the patients who took at least 400 IU of vitamin D demonstrated inadequate vitamin D levels, added Dr. Simonelli of HealthEast Medical Research Institute, St. Paul, Minn. More than 90% of 39 patients who took at least 400 IU of vitamin D still had serum vitamin D levels below 30 nanograms per mL.

However, there was a significant difference overall in the mean serum vitamin D levels between those patients who took at least 400 IU of vitamin D compared with those who took 400 IU of vitamin D supplementation or less (16.4 ng/mL vs. 11.9 ng/mL).

Patients who took at least 400 IU of vitamin D as a daily supplement were significantly less likely to have vitamin D levels in the lowest cutoff group—less than 9 ng/mL—compared with patients who took less than 400 IU of vitamin D daily.

The mean vitamin D levels were not significantly different based on age, gender, or use of an osteoporosis medication.

Overall, the mean serum 25-hydroxyvitamin D level was 14.1 among the 61 women in the study, and 14.3 among the 17 men. All the patients were aged 50 years or older, all except one were white, and were hospitalized with a fracture between August 1, 2001 and January 31, 2002.

Almost all (97%) of the patients had hip fractures, and 10 (12%) of them were taking an osteoporosis medication prior to their hospital admissions. The investigators excluded patients with high impact trauma fractures and metastatic cancer diagnoses.

A total of 14 patients (18%) were taking vitamin D only, while 36 (46%) reported taking a multivitamin only and 39 (50%) reported taking vitamin D and/or multivitamins. The study was limited by its small size, lack of ethnic minorities, and possible lack of generalizability to other populations, Dr. Simonelli and her colleagues wrote.

“Half of the patients had little or no vitamin D supplementation,” Dr. Simonelli noted. Physicians should encourage patients at risk for fractures to increase their vitamin D intake, she added. Dr. Simonelli received research support from Merck & Co. for this study.

WASHINGTON — A whopping 97% of 78 patients hospitalized for minimal trauma fractures had vitamin D levels of less than 30 nanograms per mL, Christine Simonelli, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Even the patients who took at least 400 IU of vitamin D demonstrated inadequate vitamin D levels, added Dr. Simonelli of HealthEast Medical Research Institute, St. Paul, Minn. More than 90% of 39 patients who took at least 400 IU of vitamin D still had serum vitamin D levels below 30 nanograms per mL.

However, there was a significant difference overall in the mean serum vitamin D levels between those patients who took at least 400 IU of vitamin D compared with those who took 400 IU of vitamin D supplementation or less (16.4 ng/mL vs. 11.9 ng/mL).

Patients who took at least 400 IU of vitamin D as a daily supplement were significantly less likely to have vitamin D levels in the lowest cutoff group—less than 9 ng/mL—compared with patients who took less than 400 IU of vitamin D daily.

The mean vitamin D levels were not significantly different based on age, gender, or use of an osteoporosis medication.

Overall, the mean serum 25-hydroxyvitamin D level was 14.1 among the 61 women in the study, and 14.3 among the 17 men. All the patients were aged 50 years or older, all except one were white, and were hospitalized with a fracture between August 1, 2001 and January 31, 2002.

Almost all (97%) of the patients had hip fractures, and 10 (12%) of them were taking an osteoporosis medication prior to their hospital admissions. The investigators excluded patients with high impact trauma fractures and metastatic cancer diagnoses.

A total of 14 patients (18%) were taking vitamin D only, while 36 (46%) reported taking a multivitamin only and 39 (50%) reported taking vitamin D and/or multivitamins. The study was limited by its small size, lack of ethnic minorities, and possible lack of generalizability to other populations, Dr. Simonelli and her colleagues wrote.

“Half of the patients had little or no vitamin D supplementation,” Dr. Simonelli noted. Physicians should encourage patients at risk for fractures to increase their vitamin D intake, she added. Dr. Simonelli received research support from Merck & Co. for this study.

WASHINGTON — A whopping 97% of 78 patients hospitalized for minimal trauma fractures had vitamin D levels of less than 30 nanograms per mL, Christine Simonelli, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Even the patients who took at least 400 IU of vitamin D demonstrated inadequate vitamin D levels, added Dr. Simonelli of HealthEast Medical Research Institute, St. Paul, Minn. More than 90% of 39 patients who took at least 400 IU of vitamin D still had serum vitamin D levels below 30 nanograms per mL.

However, there was a significant difference overall in the mean serum vitamin D levels between those patients who took at least 400 IU of vitamin D compared with those who took 400 IU of vitamin D supplementation or less (16.4 ng/mL vs. 11.9 ng/mL).

Patients who took at least 400 IU of vitamin D as a daily supplement were significantly less likely to have vitamin D levels in the lowest cutoff group—less than 9 ng/mL—compared with patients who took less than 400 IU of vitamin D daily.

The mean vitamin D levels were not significantly different based on age, gender, or use of an osteoporosis medication.

Overall, the mean serum 25-hydroxyvitamin D level was 14.1 among the 61 women in the study, and 14.3 among the 17 men. All the patients were aged 50 years or older, all except one were white, and were hospitalized with a fracture between August 1, 2001 and January 31, 2002.

Almost all (97%) of the patients had hip fractures, and 10 (12%) of them were taking an osteoporosis medication prior to their hospital admissions. The investigators excluded patients with high impact trauma fractures and metastatic cancer diagnoses.

A total of 14 patients (18%) were taking vitamin D only, while 36 (46%) reported taking a multivitamin only and 39 (50%) reported taking vitamin D and/or multivitamins. The study was limited by its small size, lack of ethnic minorities, and possible lack of generalizability to other populations, Dr. Simonelli and her colleagues wrote.

“Half of the patients had little or no vitamin D supplementation,” Dr. Simonelli noted. Physicians should encourage patients at risk for fractures to increase their vitamin D intake, she added. Dr. Simonelli received research support from Merck & Co. for this study.

WASHINGTON — Elective hip replacement and hip fracture repair may be roughly equivalent in terms of their degree of invasiveness, but there is often a world of difference between the outcomes these procedures help patients achieve, Joseph Zuckerman, M.D., observed at an international symposium sponsored by the National Osteoporosis Foundation.

Even among patients of the same age, those who undergo elective hip replacement surgery are far more likely to have favorable outcomes compared with those who undergo hip fracture repair.

And while both groups have a history of long-standing chronic disease, osteoporosis patients with fractures often present with complex medical, surgical, and psychological issues that involve challenges well beyond mending the fracture itself.

In fact, “in many ways the surgical treatment we provide is less challenging than the medical and psychosocial problems associated with the disease,” he said. Ultimately, it's these other issues that determine a patient's ability to achieve their pre-fracture level of function and independence, said the chairman of the department of orthopedic surgery at the New York University-Hospital for Joint Diseases in New York City.

“Hip and knee replacements are among the most successful operations in medicine in general,” he said. “You can assure patients with a 90–95% certainty that they will have a successful result.”

By comparison, the literature suggests that 50%–65% of hip fracture patients will regain their previous levels of ambulation, 10%–15% become home ambulators, and up to 20% will become nonambulatory.

In his own series of 366 hip fracture patients aged 65 and older, Dr. Zuckerman reported that following surgery, 41% regained their prefracture ambulation. However, the degree of improvement was often minor. In addition, 12% became home ambulators, and 8% became nonambulatory.

In general, the infection rate among hip fracture patients ranges from 2% to 15%, compared with a less than 1% infection rate among hip replacements performed electively.

Likewise, when dislocations occur in approximately 1%–10% of hip fracture patients vs. 1%–3% of hip replacement patients, they tend to be due to circumstances that cause the dislocation to reoccur and necessitate additional surgery.

The poor bone quality among hip fracture patients means they're more likely to have bone fragments that complicate the repair. Newer surgical techniques, however, have helped minimized such complications, compared with 20 years ago, he observed.

Fixation failures, usually due to inferior bone quality or poor surgical technique, occur in 12%–20% of hip fracture patients, and reoperations are often needed. By comparison, fewer than 1% of hip replacement patients experience fixation failure.

Similarly, healing complications can occur in 5%–35% of hip fracture patients, compared with fewer than 1% of hip replacement patients.

Overall, mortality rates in the elderly population following a hip fracture can be as high as 40%, compared with a mortality of less than 1% during the year following a hip replacement.

Dr. Zuckerman had no financial relationships to disclose.

WASHINGTON — Elective hip replacement and hip fracture repair may be roughly equivalent in terms of their degree of invasiveness, but there is often a world of difference between the outcomes these procedures help patients achieve, Joseph Zuckerman, M.D., observed at an international symposium sponsored by the National Osteoporosis Foundation.

Even among patients of the same age, those who undergo elective hip replacement surgery are far more likely to have favorable outcomes compared with those who undergo hip fracture repair.

And while both groups have a history of long-standing chronic disease, osteoporosis patients with fractures often present with complex medical, surgical, and psychological issues that involve challenges well beyond mending the fracture itself.

In fact, “in many ways the surgical treatment we provide is less challenging than the medical and psychosocial problems associated with the disease,” he said. Ultimately, it's these other issues that determine a patient's ability to achieve their pre-fracture level of function and independence, said the chairman of the department of orthopedic surgery at the New York University-Hospital for Joint Diseases in New York City.

“Hip and knee replacements are among the most successful operations in medicine in general,” he said. “You can assure patients with a 90–95% certainty that they will have a successful result.”

By comparison, the literature suggests that 50%–65% of hip fracture patients will regain their previous levels of ambulation, 10%–15% become home ambulators, and up to 20% will become nonambulatory.

In his own series of 366 hip fracture patients aged 65 and older, Dr. Zuckerman reported that following surgery, 41% regained their prefracture ambulation. However, the degree of improvement was often minor. In addition, 12% became home ambulators, and 8% became nonambulatory.

In general, the infection rate among hip fracture patients ranges from 2% to 15%, compared with a less than 1% infection rate among hip replacements performed electively.

Likewise, when dislocations occur in approximately 1%–10% of hip fracture patients vs. 1%–3% of hip replacement patients, they tend to be due to circumstances that cause the dislocation to reoccur and necessitate additional surgery.

The poor bone quality among hip fracture patients means they're more likely to have bone fragments that complicate the repair. Newer surgical techniques, however, have helped minimized such complications, compared with 20 years ago, he observed.

Fixation failures, usually due to inferior bone quality or poor surgical technique, occur in 12%–20% of hip fracture patients, and reoperations are often needed. By comparison, fewer than 1% of hip replacement patients experience fixation failure.

Similarly, healing complications can occur in 5%–35% of hip fracture patients, compared with fewer than 1% of hip replacement patients.

Overall, mortality rates in the elderly population following a hip fracture can be as high as 40%, compared with a mortality of less than 1% during the year following a hip replacement.

Dr. Zuckerman had no financial relationships to disclose.

WASHINGTON — Elective hip replacement and hip fracture repair may be roughly equivalent in terms of their degree of invasiveness, but there is often a world of difference between the outcomes these procedures help patients achieve, Joseph Zuckerman, M.D., observed at an international symposium sponsored by the National Osteoporosis Foundation.

Even among patients of the same age, those who undergo elective hip replacement surgery are far more likely to have favorable outcomes compared with those who undergo hip fracture repair.

And while both groups have a history of long-standing chronic disease, osteoporosis patients with fractures often present with complex medical, surgical, and psychological issues that involve challenges well beyond mending the fracture itself.

In fact, “in many ways the surgical treatment we provide is less challenging than the medical and psychosocial problems associated with the disease,” he said. Ultimately, it's these other issues that determine a patient's ability to achieve their pre-fracture level of function and independence, said the chairman of the department of orthopedic surgery at the New York University-Hospital for Joint Diseases in New York City.

“Hip and knee replacements are among the most successful operations in medicine in general,” he said. “You can assure patients with a 90–95% certainty that they will have a successful result.”

By comparison, the literature suggests that 50%–65% of hip fracture patients will regain their previous levels of ambulation, 10%–15% become home ambulators, and up to 20% will become nonambulatory.

In his own series of 366 hip fracture patients aged 65 and older, Dr. Zuckerman reported that following surgery, 41% regained their prefracture ambulation. However, the degree of improvement was often minor. In addition, 12% became home ambulators, and 8% became nonambulatory.

In general, the infection rate among hip fracture patients ranges from 2% to 15%, compared with a less than 1% infection rate among hip replacements performed electively.

Likewise, when dislocations occur in approximately 1%–10% of hip fracture patients vs. 1%–3% of hip replacement patients, they tend to be due to circumstances that cause the dislocation to reoccur and necessitate additional surgery.

The poor bone quality among hip fracture patients means they're more likely to have bone fragments that complicate the repair. Newer surgical techniques, however, have helped minimized such complications, compared with 20 years ago, he observed.

Fixation failures, usually due to inferior bone quality or poor surgical technique, occur in 12%–20% of hip fracture patients, and reoperations are often needed. By comparison, fewer than 1% of hip replacement patients experience fixation failure.

Similarly, healing complications can occur in 5%–35% of hip fracture patients, compared with fewer than 1% of hip replacement patients.

Overall, mortality rates in the elderly population following a hip fracture can be as high as 40%, compared with a mortality of less than 1% during the year following a hip replacement.

Dr. Zuckerman had no financial relationships to disclose.

WASHINGTON — New 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 Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included approximately 2,600 women who were treated daily with either 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 both 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. In addition, this increase was associated with 12% and 17% increases in the mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

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 previously reported similar results when they used histomorphometry to assess iliac crest biopsies in the TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, respectively, among PTH-treated women, compared with placebo-treated women.

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 — New 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 Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included approximately 2,600 women who were treated daily with either 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 both 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. In addition, this increase was associated with 12% and 17% increases in the mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

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 previously reported similar results when they used histomorphometry to assess iliac crest biopsies in the TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, respectively, among PTH-treated women, compared with placebo-treated women.

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 — New 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 Treatment of Osteoporosis with Parathyroid Hormone (TOP) study, sponsored by Salt Lake City-based NPS Pharmaceuticals, included approximately 2,600 women who were treated daily with either 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 both 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. In addition, this increase was associated with 12% and 17% increases in the mean trabecular number and thickness, respectively, in the PTH group, compared with the placebo group.

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 previously reported similar results when they used histomorphometry to assess iliac crest biopsies in the TOP study patients: 48%, 24%, and 17% increases in cancellous bone volume, trabecular number, and trabecular thickness, respectively, among PTH-treated women, compared with placebo-treated women.

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.

Reasons for Vaccine Refusal

Approximately 69% of 277 parents of nonvaccinated children cited concerns that vaccines might cause harm, said Daniel A. Salmon, Ph.D., of Johns Hopkins University, and his colleagues (Arch. Pediatr. Adolesc. Med. 2005;159:470–6). In a case-control study, the investigators reviewed data from surveys of 976 parents of vaccinated children and 277 parents of children who received nonmedical exemptions to school vaccination requirements.

Varicella was the most often refused vaccine and was not given to 147 (53%) of the 277 exempt children. Polio was the least often refused vaccine and was not given to 45 (16%) children. Other reasons for refusing vaccination included concerns that the vaccines might overload the immune system (49%), belief that the child was not at risk for the disease (37%), that the disease was not dangerous (20%), and that that vaccines might not work (13%).

Parents of exempt children were less likely to report that their child's primary health provider was a physician, compared with parents of vaccinated children (76% vs. 94%) and more likely to report that the primary health provider was a nurse practitioner or alternative medicine professional. In general, parents of exempt children were more likely to be older than the median age of 36–40 years and to have a higher level of education compared with parents of vaccinated children. The parents of exempt and vaccinated children were similar in terms of family income and race.

One Swab Is Enough

Use of two throat swabs did not significantly improve the sensitivity of the OIA MAX test for group A streptococcus in a randomized study of 363 children aged 5–18 years with acute pharyngitis, said Elias N. Ezike, M.D., of the Children's Hospital of Michigan, Detroit, and his associates (Arch. Pediatr. Adolesc. Med. 2005;159:486–90). One throat swab was obtained from a group of 117 children (group 1), and two swabs were obtained from a group of 186 children (group 2). The sensitivity was 94.7% and 100% for groups 1 and 2, respectively, and the specificity was 92.4% and 96.3% for groups 1 and 2, respectively. Overall, the OIA MAX test identified group A streptococcus in 148 of the 363 (40.8%) patients, including 71 in group 1 (40.1%) and 77 in group 2 (41.4%). Clinical presentations were not significantly different between children with and without group A streptococcus, and there was no association between the severity of pharyngitis and the sensitivity of the OIA MAX test.

Group B Strep Poorly Diagnosed

A differential diagnosis in adolescents with purulent vaginal discharge should include group B streptococci, said Liana R. Clark, M.D., and Marisa Atendido of the Children's Hospital of Philadelphia (J. Adolesc. Health 2005;36:437–40). The investigators conducted a retrospective analysis of 13 adolescents (mean age 16 years) who showed clinical signs of infection and tested positive for group B streptococci. Of these, 12 of 13 had a purulent cervicovaginal discharge. In addition, of the 12 whose examinations indicated cervical findings, 3 had cervicitis, 3 had inflamed vaginal mucosa, 2 had vaginal erythema, and 1 had vaginal bleeding. Only one girl was accurately diagnosed with group B streptococci at the time of her visit, and she was treated with cefuroxime axetil. Three of the girls were misdiagnosed with STDs, and such misdiagnosis might create unnecessary stigma, the investigators noted. Small numbers and lack of asymptomatic controls limited the study.

Pocket Pets May Pack Salmonella

The Centers for Disease Control and Prevention identified 28 cases of Salmonella enteritidis serotype typhimurium associated with pet rodents including hamsters, mice, and rats between December 2003 and October 2004 (MMWR 2005;54:429–32). The mean age of those affected was 16 years, and seven cases occurred in children younger than 7 years.

Particularly severe cases occurred in two 5-year-old boys. The first occurred in June 2004 in Minnesota, when a boy became ill 4 days after he received a pet mouse. The second case occurred in August 2004 in South Carolina, when a boy became ill 9 days after he received a pet hamster. In both cases, the children developed fevers, diarrhea, and abdominal cramping, and stool cultures yielded S. typhimurium. Both pet rodents died within a week of their purchase; a culture from the mouse also yielded S. typhimurium. Rodents linked to all 28 cases were purchased from multiple retail pet store chains and distributors, and S. typhimurium was recovered from pet transport containers and from bins containing rodent droppings.

Consequently, consumers, pet store employees, and others who work with and transport pet rodents should recognize the possibility for disease transmission and wash their hands thoroughly after handling the animals.

Reasons for Vaccine Refusal

Approximately 69% of 277 parents of nonvaccinated children cited concerns that vaccines might cause harm, said Daniel A. Salmon, Ph.D., of Johns Hopkins University, and his colleagues (Arch. Pediatr. Adolesc. Med. 2005;159:470–6). In a case-control study, the investigators reviewed data from surveys of 976 parents of vaccinated children and 277 parents of children who received nonmedical exemptions to school vaccination requirements.

Varicella was the most often refused vaccine and was not given to 147 (53%) of the 277 exempt children. Polio was the least often refused vaccine and was not given to 45 (16%) children. Other reasons for refusing vaccination included concerns that the vaccines might overload the immune system (49%), belief that the child was not at risk for the disease (37%), that the disease was not dangerous (20%), and that that vaccines might not work (13%).

Parents of exempt children were less likely to report that their child's primary health provider was a physician, compared with parents of vaccinated children (76% vs. 94%) and more likely to report that the primary health provider was a nurse practitioner or alternative medicine professional. In general, parents of exempt children were more likely to be older than the median age of 36–40 years and to have a higher level of education compared with parents of vaccinated children. The parents of exempt and vaccinated children were similar in terms of family income and race.

One Swab Is Enough

Use of two throat swabs did not significantly improve the sensitivity of the OIA MAX test for group A streptococcus in a randomized study of 363 children aged 5–18 years with acute pharyngitis, said Elias N. Ezike, M.D., of the Children's Hospital of Michigan, Detroit, and his associates (Arch. Pediatr. Adolesc. Med. 2005;159:486–90). One throat swab was obtained from a group of 117 children (group 1), and two swabs were obtained from a group of 186 children (group 2). The sensitivity was 94.7% and 100% for groups 1 and 2, respectively, and the specificity was 92.4% and 96.3% for groups 1 and 2, respectively. Overall, the OIA MAX test identified group A streptococcus in 148 of the 363 (40.8%) patients, including 71 in group 1 (40.1%) and 77 in group 2 (41.4%). Clinical presentations were not significantly different between children with and without group A streptococcus, and there was no association between the severity of pharyngitis and the sensitivity of the OIA MAX test.

Group B Strep Poorly Diagnosed

A differential diagnosis in adolescents with purulent vaginal discharge should include group B streptococci, said Liana R. Clark, M.D., and Marisa Atendido of the Children's Hospital of Philadelphia (J. Adolesc. Health 2005;36:437–40). The investigators conducted a retrospective analysis of 13 adolescents (mean age 16 years) who showed clinical signs of infection and tested positive for group B streptococci. Of these, 12 of 13 had a purulent cervicovaginal discharge. In addition, of the 12 whose examinations indicated cervical findings, 3 had cervicitis, 3 had inflamed vaginal mucosa, 2 had vaginal erythema, and 1 had vaginal bleeding. Only one girl was accurately diagnosed with group B streptococci at the time of her visit, and she was treated with cefuroxime axetil. Three of the girls were misdiagnosed with STDs, and such misdiagnosis might create unnecessary stigma, the investigators noted. Small numbers and lack of asymptomatic controls limited the study.

Pocket Pets May Pack Salmonella

The Centers for Disease Control and Prevention identified 28 cases of Salmonella enteritidis serotype typhimurium associated with pet rodents including hamsters, mice, and rats between December 2003 and October 2004 (MMWR 2005;54:429–32). The mean age of those affected was 16 years, and seven cases occurred in children younger than 7 years.

Particularly severe cases occurred in two 5-year-old boys. The first occurred in June 2004 in Minnesota, when a boy became ill 4 days after he received a pet mouse. The second case occurred in August 2004 in South Carolina, when a boy became ill 9 days after he received a pet hamster. In both cases, the children developed fevers, diarrhea, and abdominal cramping, and stool cultures yielded S. typhimurium. Both pet rodents died within a week of their purchase; a culture from the mouse also yielded S. typhimurium. Rodents linked to all 28 cases were purchased from multiple retail pet store chains and distributors, and S. typhimurium was recovered from pet transport containers and from bins containing rodent droppings.

Consequently, consumers, pet store employees, and others who work with and transport pet rodents should recognize the possibility for disease transmission and wash their hands thoroughly after handling the animals.

Reasons for Vaccine Refusal

Approximately 69% of 277 parents of nonvaccinated children cited concerns that vaccines might cause harm, said Daniel A. Salmon, Ph.D., of Johns Hopkins University, and his colleagues (Arch. Pediatr. Adolesc. Med. 2005;159:470–6). In a case-control study, the investigators reviewed data from surveys of 976 parents of vaccinated children and 277 parents of children who received nonmedical exemptions to school vaccination requirements.

Varicella was the most often refused vaccine and was not given to 147 (53%) of the 277 exempt children. Polio was the least often refused vaccine and was not given to 45 (16%) children. Other reasons for refusing vaccination included concerns that the vaccines might overload the immune system (49%), belief that the child was not at risk for the disease (37%), that the disease was not dangerous (20%), and that that vaccines might not work (13%).

Parents of exempt children were less likely to report that their child's primary health provider was a physician, compared with parents of vaccinated children (76% vs. 94%) and more likely to report that the primary health provider was a nurse practitioner or alternative medicine professional. In general, parents of exempt children were more likely to be older than the median age of 36–40 years and to have a higher level of education compared with parents of vaccinated children. The parents of exempt and vaccinated children were similar in terms of family income and race.

One Swab Is Enough

Use of two throat swabs did not significantly improve the sensitivity of the OIA MAX test for group A streptococcus in a randomized study of 363 children aged 5–18 years with acute pharyngitis, said Elias N. Ezike, M.D., of the Children's Hospital of Michigan, Detroit, and his associates (Arch. Pediatr. Adolesc. Med. 2005;159:486–90). One throat swab was obtained from a group of 117 children (group 1), and two swabs were obtained from a group of 186 children (group 2). The sensitivity was 94.7% and 100% for groups 1 and 2, respectively, and the specificity was 92.4% and 96.3% for groups 1 and 2, respectively. Overall, the OIA MAX test identified group A streptococcus in 148 of the 363 (40.8%) patients, including 71 in group 1 (40.1%) and 77 in group 2 (41.4%). Clinical presentations were not significantly different between children with and without group A streptococcus, and there was no association between the severity of pharyngitis and the sensitivity of the OIA MAX test.

Group B Strep Poorly Diagnosed

A differential diagnosis in adolescents with purulent vaginal discharge should include group B streptococci, said Liana R. Clark, M.D., and Marisa Atendido of the Children's Hospital of Philadelphia (J. Adolesc. Health 2005;36:437–40). The investigators conducted a retrospective analysis of 13 adolescents (mean age 16 years) who showed clinical signs of infection and tested positive for group B streptococci. Of these, 12 of 13 had a purulent cervicovaginal discharge. In addition, of the 12 whose examinations indicated cervical findings, 3 had cervicitis, 3 had inflamed vaginal mucosa, 2 had vaginal erythema, and 1 had vaginal bleeding. Only one girl was accurately diagnosed with group B streptococci at the time of her visit, and she was treated with cefuroxime axetil. Three of the girls were misdiagnosed with STDs, and such misdiagnosis might create unnecessary stigma, the investigators noted. Small numbers and lack of asymptomatic controls limited the study.

Pocket Pets May Pack Salmonella

The Centers for Disease Control and Prevention identified 28 cases of Salmonella enteritidis serotype typhimurium associated with pet rodents including hamsters, mice, and rats between December 2003 and October 2004 (MMWR 2005;54:429–32). The mean age of those affected was 16 years, and seven cases occurred in children younger than 7 years.

Particularly severe cases occurred in two 5-year-old boys. The first occurred in June 2004 in Minnesota, when a boy became ill 4 days after he received a pet mouse. The second case occurred in August 2004 in South Carolina, when a boy became ill 9 days after he received a pet hamster. In both cases, the children developed fevers, diarrhea, and abdominal cramping, and stool cultures yielded S. typhimurium. Both pet rodents died within a week of their purchase; a culture from the mouse also yielded S. typhimurium. Rodents linked to all 28 cases were purchased from multiple retail pet store chains and distributors, and S. typhimurium was recovered from pet transport containers and from bins containing rodent droppings.

Consequently, consumers, pet store employees, and others who work with and transport pet rodents should recognize the possibility for disease transmission and wash their hands thoroughly after handling the animals.

WASHINGTON — Postmenopausal women with osteoporosis can reduce their risk for fractures by 26% if they stick to their bisphosphonate regimens, Ethel Siris, M.D., reported in a poster presented at an international symposium sponsored by the National Osteoporosis Foundation.

However, that “if” is a very big one, said Dr. Siris, director of the metabolic bone diseases program at Columbia University Medical Center, New York.

“We assume that there is a relationship between actually taking the drug and having a positive outcome, but it has not been previously demonstrated for bisphosphonate therapy,” she said in her oral presentation.

In a retrospective study of 6,285 women, 48% were compliant in terms of refilling their prescriptions, and 21% were persistent in terms of staying on the medication beyond the 2-year follow-up.

Overall, the relative risk of fracture over a 2-year period was 26% lower among refill-compliant women, compared with noncompliant women (9.4% vs. 12.6%) and 21% lower among treatment persistent women compared with nonpersistent women (9.1% vs. 11.6%).

More than half (52%) of the women were noncompliant, based on insufficient refills, and approximately 21% were nonpersistent, defined as having a discontinuation of therapy within the 2-year period.

Data on the pharmaceutical claims of women aged 45 years and older who met the criteria for postmenopausal osteoporosis were taken from the Medstat MarketScan Research Database. The women had received at least one prescription for a bisphosphonate; 85% received alendronate (Fosamax) and 15% received risedronate (Actonel).

Bisphosphonates' effectiveness depends on compliance over an extended period of time. And compliance with bisphosphonate therapy is notoriously poor.

The currently approved daily dose must be taken while sitting or standing upright immediately after waking in the morning, and the patient must allow one hour before eating or drinking anything except water.

“If we actually get people to take these drugs, we might cut as many as 400,000 fractures in a given year,” Dr. Siris said.

Studies on less frequent dosing regimens, such as the once-monthly regimen for the newly approved ibandronate (Boniva), suggest they are effective and may improve compliance.

Dr. Siris is a consultant for and has received honoraria from Eli Lilly & Co., Merck & Co., Sanofi Aventis, Procter and Gamble Pharmaceuticals, and Novartis.

WASHINGTON — Postmenopausal women with osteoporosis can reduce their risk for fractures by 26% if they stick to their bisphosphonate regimens, Ethel Siris, M.D., reported in a poster presented at an international symposium sponsored by the National Osteoporosis Foundation.

However, that “if” is a very big one, said Dr. Siris, director of the metabolic bone diseases program at Columbia University Medical Center, New York.

“We assume that there is a relationship between actually taking the drug and having a positive outcome, but it has not been previously demonstrated for bisphosphonate therapy,” she said in her oral presentation.

In a retrospective study of 6,285 women, 48% were compliant in terms of refilling their prescriptions, and 21% were persistent in terms of staying on the medication beyond the 2-year follow-up.

Overall, the relative risk of fracture over a 2-year period was 26% lower among refill-compliant women, compared with noncompliant women (9.4% vs. 12.6%) and 21% lower among treatment persistent women compared with nonpersistent women (9.1% vs. 11.6%).

More than half (52%) of the women were noncompliant, based on insufficient refills, and approximately 21% were nonpersistent, defined as having a discontinuation of therapy within the 2-year period.

Data on the pharmaceutical claims of women aged 45 years and older who met the criteria for postmenopausal osteoporosis were taken from the Medstat MarketScan Research Database. The women had received at least one prescription for a bisphosphonate; 85% received alendronate (Fosamax) and 15% received risedronate (Actonel).

Bisphosphonates' effectiveness depends on compliance over an extended period of time. And compliance with bisphosphonate therapy is notoriously poor.

The currently approved daily dose must be taken while sitting or standing upright immediately after waking in the morning, and the patient must allow one hour before eating or drinking anything except water.

“If we actually get people to take these drugs, we might cut as many as 400,000 fractures in a given year,” Dr. Siris said.

Studies on less frequent dosing regimens, such as the once-monthly regimen for the newly approved ibandronate (Boniva), suggest they are effective and may improve compliance.

Dr. Siris is a consultant for and has received honoraria from Eli Lilly & Co., Merck & Co., Sanofi Aventis, Procter and Gamble Pharmaceuticals, and Novartis.

WASHINGTON — Postmenopausal women with osteoporosis can reduce their risk for fractures by 26% if they stick to their bisphosphonate regimens, Ethel Siris, M.D., reported in a poster presented at an international symposium sponsored by the National Osteoporosis Foundation.

However, that “if” is a very big one, said Dr. Siris, director of the metabolic bone diseases program at Columbia University Medical Center, New York.

“We assume that there is a relationship between actually taking the drug and having a positive outcome, but it has not been previously demonstrated for bisphosphonate therapy,” she said in her oral presentation.

In a retrospective study of 6,285 women, 48% were compliant in terms of refilling their prescriptions, and 21% were persistent in terms of staying on the medication beyond the 2-year follow-up.

Overall, the relative risk of fracture over a 2-year period was 26% lower among refill-compliant women, compared with noncompliant women (9.4% vs. 12.6%) and 21% lower among treatment persistent women compared with nonpersistent women (9.1% vs. 11.6%).

More than half (52%) of the women were noncompliant, based on insufficient refills, and approximately 21% were nonpersistent, defined as having a discontinuation of therapy within the 2-year period.

Data on the pharmaceutical claims of women aged 45 years and older who met the criteria for postmenopausal osteoporosis were taken from the Medstat MarketScan Research Database. The women had received at least one prescription for a bisphosphonate; 85% received alendronate (Fosamax) and 15% received risedronate (Actonel).

Bisphosphonates' effectiveness depends on compliance over an extended period of time. And compliance with bisphosphonate therapy is notoriously poor.

The currently approved daily dose must be taken while sitting or standing upright immediately after waking in the morning, and the patient must allow one hour before eating or drinking anything except water.

“If we actually get people to take these drugs, we might cut as many as 400,000 fractures in a given year,” Dr. Siris said.

Studies on less frequent dosing regimens, such as the once-monthly regimen for the newly approved ibandronate (Boniva), suggest they are effective and may improve compliance.

Dr. Siris is a consultant for and has received honoraria from Eli Lilly & Co., Merck & Co., Sanofi Aventis, Procter and Gamble Pharmaceuticals, and Novartis.

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.

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.

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 them lose weight and reduce associated cardiovascular risk factors, they 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.

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.

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 them lose weight and reduce associated cardiovascular risk factors, they 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.

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.

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 them lose weight and reduce associated cardiovascular risk factors, they noted.

Spinal surgery patients exposed to increased sunlight in their hospital rooms used 22% less pain medication per hour than those not exposed to the additional sunlight, said Jeffrey M. Walch of the University of Pittsburgh and his colleagues.

In the prospective study, 44 patients were situated on the bright side and 45 patients on the dim side of the same hospital unit. Their mean age was 59 years, and the mean length of stay was 3.5 days (Psychosom. Med. 2005;67:156–63).

Patients on the bright side of the unit received 46% more natural light than the patients on the dim side. The colors of the hospital rooms and the patients' gowns were alike, so they were not confounding factors.

Patients exposed to additional sunlight spent 21% less on pain medication, compared with the other patients. Upon discharge from the hospital, those patients who were from the bright side also reported significantly less perceived stress and slightly less pain, although the difference in reported pain was not statistically significant.

“An optimal therapeutic hospital design may maximize sunlight exposure for patients with high use of analgesic medication,” Mr. Walch and his associates noted. A reduction in opioid use, they added, could improve the dose-dependent side effects common in postoperative patients.

Spinal surgery patients exposed to increased sunlight in their hospital rooms used 22% less pain medication per hour than those not exposed to the additional sunlight, said Jeffrey M. Walch of the University of Pittsburgh and his colleagues.

In the prospective study, 44 patients were situated on the bright side and 45 patients on the dim side of the same hospital unit. Their mean age was 59 years, and the mean length of stay was 3.5 days (Psychosom. Med. 2005;67:156–63).

Patients on the bright side of the unit received 46% more natural light than the patients on the dim side. The colors of the hospital rooms and the patients' gowns were alike, so they were not confounding factors.

Patients exposed to additional sunlight spent 21% less on pain medication, compared with the other patients. Upon discharge from the hospital, those patients who were from the bright side also reported significantly less perceived stress and slightly less pain, although the difference in reported pain was not statistically significant.

“An optimal therapeutic hospital design may maximize sunlight exposure for patients with high use of analgesic medication,” Mr. Walch and his associates noted. A reduction in opioid use, they added, could improve the dose-dependent side effects common in postoperative patients.

Spinal surgery patients exposed to increased sunlight in their hospital rooms used 22% less pain medication per hour than those not exposed to the additional sunlight, said Jeffrey M. Walch of the University of Pittsburgh and his colleagues.

In the prospective study, 44 patients were situated on the bright side and 45 patients on the dim side of the same hospital unit. Their mean age was 59 years, and the mean length of stay was 3.5 days (Psychosom. Med. 2005;67:156–63).

Patients on the bright side of the unit received 46% more natural light than the patients on the dim side. The colors of the hospital rooms and the patients' gowns were alike, so they were not confounding factors.

Patients exposed to additional sunlight spent 21% less on pain medication, compared with the other patients. Upon discharge from the hospital, those patients who were from the bright side also reported significantly less perceived stress and slightly less pain, although the difference in reported pain was not statistically significant.

“An optimal therapeutic hospital design may maximize sunlight exposure for patients with high use of analgesic medication,” Mr. Walch and his associates noted. A reduction in opioid use, they added, could improve the dose-dependent side effects common in postoperative patients.

WASHINGTON – If sleep disturbance can be managed, patients in the early stages of treatment for alcoholism may be less likely to relapse, said Peter D. Friedmann, M.D.

A growing literature suggests that the sleep abnormalities that accompany both acute and chronic abstinence from alcohol may contribute to craving and urges to resume drinking. “We became interested in this notion of whether we could intervene in sleep and therefore improve abstinence,” said Dr. Friedmann of Brown University in Providence, R.I.

Dr. Friedmann found significant associations between poor sleep quality and the presence of risk factors for relapse among 130 sleep-disturbed adults in recovery from alcohol dependence. He presented a cross-sectional analysis of baseline patient data at the annual conference of the Association for Medical Education and Research in Substance Abuse. The data stem from a recently initiated study in which the patients are taking 50–150 mg of trazodone for 12 weeks to improve sleep quality.

Overall, patients who reported poor sleep quality were significantly more likely to be in worse physical health based on the SF-12 Health Survey physical health subscale, to have worse depressive symptoms based on the Beck Depression Inventory, and to report a desire to drink when they couldn't fall asleep, Dr. Friedmann said at the conference, which was sponsored by Brown Medical School.

Most of the patients were male (84%) and white (83%), with an average age of 41 years. They were highly dependent drinkers who had consumed alcohol on approximately 25 of the 30 days before they were admitted to the detox program. The average score on the Beck inventory was 20.8, and the average global score on the Pittsburgh Sleep Quality Index–in which sleep disturbance is a score higher than 5–was 11.7.

The study excluded people with brain disorders and those who were actively suicidal, as well as patients who had medical conditions that affected sleep, those taking psychotropic medications, or those with contraindications to trazodone. The patients completed a 19-item self-report questionnaire, with variables including the number of drinks per day and questions about depression, physical health, and psychiatric status.

Despite the limitation of the self-reports, “I'm going to conclude that sleep disturbances relate to some significant factors for relapse [in alcohol-dependent patients], including depression,” Dr. Friedmann said. However, separating the antidepressant effects from the sleep-inducing effects of trazodone at the study's end will be a challenge, he noted.

WASHINGTON – If sleep disturbance can be managed, patients in the early stages of treatment for alcoholism may be less likely to relapse, said Peter D. Friedmann, M.D.

A growing literature suggests that the sleep abnormalities that accompany both acute and chronic abstinence from alcohol may contribute to craving and urges to resume drinking. “We became interested in this notion of whether we could intervene in sleep and therefore improve abstinence,” said Dr. Friedmann of Brown University in Providence, R.I.

Dr. Friedmann found significant associations between poor sleep quality and the presence of risk factors for relapse among 130 sleep-disturbed adults in recovery from alcohol dependence. He presented a cross-sectional analysis of baseline patient data at the annual conference of the Association for Medical Education and Research in Substance Abuse. The data stem from a recently initiated study in which the patients are taking 50–150 mg of trazodone for 12 weeks to improve sleep quality.

Overall, patients who reported poor sleep quality were significantly more likely to be in worse physical health based on the SF-12 Health Survey physical health subscale, to have worse depressive symptoms based on the Beck Depression Inventory, and to report a desire to drink when they couldn't fall asleep, Dr. Friedmann said at the conference, which was sponsored by Brown Medical School.

Most of the patients were male (84%) and white (83%), with an average age of 41 years. They were highly dependent drinkers who had consumed alcohol on approximately 25 of the 30 days before they were admitted to the detox program. The average score on the Beck inventory was 20.8, and the average global score on the Pittsburgh Sleep Quality Index–in which sleep disturbance is a score higher than 5–was 11.7.

The study excluded people with brain disorders and those who were actively suicidal, as well as patients who had medical conditions that affected sleep, those taking psychotropic medications, or those with contraindications to trazodone. The patients completed a 19-item self-report questionnaire, with variables including the number of drinks per day and questions about depression, physical health, and psychiatric status.

Despite the limitation of the self-reports, “I'm going to conclude that sleep disturbances relate to some significant factors for relapse [in alcohol-dependent patients], including depression,” Dr. Friedmann said. However, separating the antidepressant effects from the sleep-inducing effects of trazodone at the study's end will be a challenge, he noted.

WASHINGTON – If sleep disturbance can be managed, patients in the early stages of treatment for alcoholism may be less likely to relapse, said Peter D. Friedmann, M.D.

A growing literature suggests that the sleep abnormalities that accompany both acute and chronic abstinence from alcohol may contribute to craving and urges to resume drinking. “We became interested in this notion of whether we could intervene in sleep and therefore improve abstinence,” said Dr. Friedmann of Brown University in Providence, R.I.

Dr. Friedmann found significant associations between poor sleep quality and the presence of risk factors for relapse among 130 sleep-disturbed adults in recovery from alcohol dependence. He presented a cross-sectional analysis of baseline patient data at the annual conference of the Association for Medical Education and Research in Substance Abuse. The data stem from a recently initiated study in which the patients are taking 50–150 mg of trazodone for 12 weeks to improve sleep quality.

Overall, patients who reported poor sleep quality were significantly more likely to be in worse physical health based on the SF-12 Health Survey physical health subscale, to have worse depressive symptoms based on the Beck Depression Inventory, and to report a desire to drink when they couldn't fall asleep, Dr. Friedmann said at the conference, which was sponsored by Brown Medical School.

Most of the patients were male (84%) and white (83%), with an average age of 41 years. They were highly dependent drinkers who had consumed alcohol on approximately 25 of the 30 days before they were admitted to the detox program. The average score on the Beck inventory was 20.8, and the average global score on the Pittsburgh Sleep Quality Index–in which sleep disturbance is a score higher than 5–was 11.7.

The study excluded people with brain disorders and those who were actively suicidal, as well as patients who had medical conditions that affected sleep, those taking psychotropic medications, or those with contraindications to trazodone. The patients completed a 19-item self-report questionnaire, with variables including the number of drinks per day and questions about depression, physical health, and psychiatric status.

Despite the limitation of the self-reports, “I'm going to conclude that sleep disturbances relate to some significant factors for relapse [in alcohol-dependent patients], including depression,” Dr. Friedmann said. However, separating the antidepressant effects from the sleep-inducing effects of trazodone at the study's end will be a challenge, he noted.

Medication Use Reduces Recidivism

Bipolar juvenile offenders committed 80% fewer offenses while taking medication than when they were off medication, reported Larry F. Dailey, M.D., of the University of Minnesota, Minneapolis, and his colleagues.

The investigators followed 36 adolescents for 1 year after they left a juvenile correction facility; 31 (6 girls, 25 boys) completed the study (J. Clin. Psychiatry 2005;66:477–84). The patients agreed to continue their medications as prescribed and to attend follow-up appointments. Of the original 36 patients, 31 took lithium for their bipolar disorder. Overall, the patients stayed on their medications for a total of 2,992 days (34% of the study period) and were off their medications for 6,108 days (66% of the study). One offense was committed for every 157 days that patients were on medication, compared with one offense for every 46 days when they were off medication. In addition, 100% of four recidivist behaviors–truancy, suicide attempts, medical trauma due to deviant behavior, and driving-related offenses–occurred while patients were off medication.

Sex Often Precedes Violence

In a study of 6,548 adolescents aged 12–21 years who took part in the National Longitudinal Study of Adolescent Health, 27% reported some form of violence victimization from their romantic partners.

Overall, 37% of those who reported sexual relationships had experienced at least one incident of physical or verbal violence, compared with 19% of those who did not report sexual relationships, said Christine E. Kaestle and Carolyn T. Halpern, Ph.D., of the University of North Carolina, Chapel Hill. In most cases in which adolescents experienced both sex and violence, the violence, whether physical or verbal, came after the relationship became sexual (J. Adolesc. Health 2005;36:386–92). For instance, for 74% of adolescents who reported both having sex and being insulted in public by their partners, the sex occurred before the first incident of public insult.

Adolescents Stratify Stigmas

Substance abuse was associated with greater stigma than mental disorders, based on a survey of 303 high school students in Southern California, said Patrick W. Corrigan, Psy. D., of Evanston (Ill.) Northwestern Healthcare and his associates.

Overall, the students stigmatized alcohol abuse more than mental illness, leukemia, or a brain tumor. Leukemia was the least stigmatized condition, and mental illness due to a brain tumor was less stigmatized than mental illness without an organic cause (Psychiatr. Serv. 2005;56:544–50). Surprisingly, contact with someone who had mental illness seemed to increase stigma rather than diminish it.

Depression and Diabetes

In a study of 231 adolescents aged 11–18 years with type 1 diabetes, those who also demonstrated depressive symptoms were at increased risk for hospitalization from diabetes complications during a 2-year follow-up, said Sunita M. Stewart, Ph.D., and her colleagues at the University of Texas Southwestern Medical Center, Dallas.

Overall, 33% of the patients scored below the cutoff point on the Center for Epidemiological Studies-Depression Scale (Pediatrics 2005;115:1315–9). The cutoff points were 12 for boys and 22 for girls. The mean score was significantly higher among the 26 hospitalized patients, compared with the 205 nonhospitalized patients (18.50 vs. 14.28). The results indicate that adolescents' self-reports are accurate predictors of medical outcomes, and that treatment of mood problems in adolescents with diabetes might reduce the odds of hospitalization.

Teens and Tobacco Addiction

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

Other studies have suggested this susceptibility to addiction but have not been able to measure tobacco exposure as well, Mark Rubinstein, M.D., said at the annual meeting of the Society for Adolescent Medicine. This study measured cotinine levels in saliva, and correlated it with self-reports of craving and an addiction measure. Cotinine, a metabolite of nicotine, persists longer in saliva than nicotine does in blood.

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

Still, cotinine levels did correlate with addiction, and 34% of the daily smokers were identified as addicted. Twenty-eight percent of those had undetectable cotinine levels. “This may represent susceptibility at the receptor level, which has been shown in animal models,” said Dr. Rubinstein of the University of California, San Francisco.

Medication Use Reduces Recidivism

Bipolar juvenile offenders committed 80% fewer offenses while taking medication than when they were off medication, reported Larry F. Dailey, M.D., of the University of Minnesota, Minneapolis, and his colleagues.

The investigators followed 36 adolescents for 1 year after they left a juvenile correction facility; 31 (6 girls, 25 boys) completed the study (J. Clin. Psychiatry 2005;66:477–84). The patients agreed to continue their medications as prescribed and to attend follow-up appointments. Of the original 36 patients, 31 took lithium for their bipolar disorder. Overall, the patients stayed on their medications for a total of 2,992 days (34% of the study period) and were off their medications for 6,108 days (66% of the study). One offense was committed for every 157 days that patients were on medication, compared with one offense for every 46 days when they were off medication. In addition, 100% of four recidivist behaviors–truancy, suicide attempts, medical trauma due to deviant behavior, and driving-related offenses–occurred while patients were off medication.

Sex Often Precedes Violence

In a study of 6,548 adolescents aged 12–21 years who took part in the National Longitudinal Study of Adolescent Health, 27% reported some form of violence victimization from their romantic partners.

Overall, 37% of those who reported sexual relationships had experienced at least one incident of physical or verbal violence, compared with 19% of those who did not report sexual relationships, said Christine E. Kaestle and Carolyn T. Halpern, Ph.D., of the University of North Carolina, Chapel Hill. In most cases in which adolescents experienced both sex and violence, the violence, whether physical or verbal, came after the relationship became sexual (J. Adolesc. Health 2005;36:386–92). For instance, for 74% of adolescents who reported both having sex and being insulted in public by their partners, the sex occurred before the first incident of public insult.

Adolescents Stratify Stigmas

Substance abuse was associated with greater stigma than mental disorders, based on a survey of 303 high school students in Southern California, said Patrick W. Corrigan, Psy. D., of Evanston (Ill.) Northwestern Healthcare and his associates.

Overall, the students stigmatized alcohol abuse more than mental illness, leukemia, or a brain tumor. Leukemia was the least stigmatized condition, and mental illness due to a brain tumor was less stigmatized than mental illness without an organic cause (Psychiatr. Serv. 2005;56:544–50). Surprisingly, contact with someone who had mental illness seemed to increase stigma rather than diminish it.

Depression and Diabetes

In a study of 231 adolescents aged 11–18 years with type 1 diabetes, those who also demonstrated depressive symptoms were at increased risk for hospitalization from diabetes complications during a 2-year follow-up, said Sunita M. Stewart, Ph.D., and her colleagues at the University of Texas Southwestern Medical Center, Dallas.

Overall, 33% of the patients scored below the cutoff point on the Center for Epidemiological Studies-Depression Scale (Pediatrics 2005;115:1315–9). The cutoff points were 12 for boys and 22 for girls. The mean score was significantly higher among the 26 hospitalized patients, compared with the 205 nonhospitalized patients (18.50 vs. 14.28). The results indicate that adolescents' self-reports are accurate predictors of medical outcomes, and that treatment of mood problems in adolescents with diabetes might reduce the odds of hospitalization.

Teens and Tobacco Addiction

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

Other studies have suggested this susceptibility to addiction but have not been able to measure tobacco exposure as well, Mark Rubinstein, M.D., said at the annual meeting of the Society for Adolescent Medicine. This study measured cotinine levels in saliva, and correlated it with self-reports of craving and an addiction measure. Cotinine, a metabolite of nicotine, persists longer in saliva than nicotine does in blood.

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

Still, cotinine levels did correlate with addiction, and 34% of the daily smokers were identified as addicted. Twenty-eight percent of those had undetectable cotinine levels. “This may represent susceptibility at the receptor level, which has been shown in animal models,” said Dr. Rubinstein of the University of California, San Francisco.

Medication Use Reduces Recidivism

Bipolar juvenile offenders committed 80% fewer offenses while taking medication than when they were off medication, reported Larry F. Dailey, M.D., of the University of Minnesota, Minneapolis, and his colleagues.

The investigators followed 36 adolescents for 1 year after they left a juvenile correction facility; 31 (6 girls, 25 boys) completed the study (J. Clin. Psychiatry 2005;66:477–84). The patients agreed to continue their medications as prescribed and to attend follow-up appointments. Of the original 36 patients, 31 took lithium for their bipolar disorder. Overall, the patients stayed on their medications for a total of 2,992 days (34% of the study period) and were off their medications for 6,108 days (66% of the study). One offense was committed for every 157 days that patients were on medication, compared with one offense for every 46 days when they were off medication. In addition, 100% of four recidivist behaviors–truancy, suicide attempts, medical trauma due to deviant behavior, and driving-related offenses–occurred while patients were off medication.

Sex Often Precedes Violence

In a study of 6,548 adolescents aged 12–21 years who took part in the National Longitudinal Study of Adolescent Health, 27% reported some form of violence victimization from their romantic partners.

Overall, 37% of those who reported sexual relationships had experienced at least one incident of physical or verbal violence, compared with 19% of those who did not report sexual relationships, said Christine E. Kaestle and Carolyn T. Halpern, Ph.D., of the University of North Carolina, Chapel Hill. In most cases in which adolescents experienced both sex and violence, the violence, whether physical or verbal, came after the relationship became sexual (J. Adolesc. Health 2005;36:386–92). For instance, for 74% of adolescents who reported both having sex and being insulted in public by their partners, the sex occurred before the first incident of public insult.

Adolescents Stratify Stigmas

Substance abuse was associated with greater stigma than mental disorders, based on a survey of 303 high school students in Southern California, said Patrick W. Corrigan, Psy. D., of Evanston (Ill.) Northwestern Healthcare and his associates.

Overall, the students stigmatized alcohol abuse more than mental illness, leukemia, or a brain tumor. Leukemia was the least stigmatized condition, and mental illness due to a brain tumor was less stigmatized than mental illness without an organic cause (Psychiatr. Serv. 2005;56:544–50). Surprisingly, contact with someone who had mental illness seemed to increase stigma rather than diminish it.

Depression and Diabetes

In a study of 231 adolescents aged 11–18 years with type 1 diabetes, those who also demonstrated depressive symptoms were at increased risk for hospitalization from diabetes complications during a 2-year follow-up, said Sunita M. Stewart, Ph.D., and her colleagues at the University of Texas Southwestern Medical Center, Dallas.

Overall, 33% of the patients scored below the cutoff point on the Center for Epidemiological Studies-Depression Scale (Pediatrics 2005;115:1315–9). The cutoff points were 12 for boys and 22 for girls. The mean score was significantly higher among the 26 hospitalized patients, compared with the 205 nonhospitalized patients (18.50 vs. 14.28). The results indicate that adolescents' self-reports are accurate predictors of medical outcomes, and that treatment of mood problems in adolescents with diabetes might reduce the odds of hospitalization.

Teens and Tobacco Addiction

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

Other studies have suggested this susceptibility to addiction but have not been able to measure tobacco exposure as well, Mark Rubinstein, M.D., said at the annual meeting of the Society for Adolescent Medicine. This study measured cotinine levels in saliva, and correlated it with self-reports of craving and an addiction measure. Cotinine, a metabolite of nicotine, persists longer in saliva than nicotine does in blood.

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

Still, cotinine levels did correlate with addiction, and 34% of the daily smokers were identified as addicted. Twenty-eight percent of those had undetectable cotinine levels. “This may represent susceptibility at the receptor level, which has been shown in animal models,” said Dr. Rubinstein of the University of California, San Francisco.

HOUSTON – Relatively few adolescents develop a serious problem with gambling, so the issue may be one of “harm reduction” rather than the treatment of an addiction, said Gagan Dhaliwal, M.D., at the annual meeting of the American Society for Adolescent Psychiatry.

For most people, gambling is a form of entertainment without serious negative consequences, since it lacks the element of physical harm to the body caused by substance abuse. Yet some adolescents develop a preoccupation with gambling and find themselves unable to stop despite repeated attempts and a desire to do so. Those teens may need treatment similar to that used for other addictions, said Dr. Dhaliwal, of the University of South Alabama, Mobile.

At any age, problem gambling involves complex dynamic interactions among psychophysiologic, developmental, cognitive, and behavioral components. Given that adolescence is a developmental period marked by risk-taking behaviors, adolescents generally do not seek treatment for gambling. They have a sense of invincibility and they think they can stop anytime they choose.

Adolescents with pathological gambling problems may have comorbid psychiatric conditions, and they use gambling as a coping strategy. Common comorbidities include depression, substance abuse, anxiety, and poor academic performance.

“Gambling is considered to be a way of escaping their problems, whether it is depression, anxiety, or relationship problems in their family,” Dr. Dhaliwal said. Peer pressure often plays a role as well.

Some evidence suggests that adolescents with antisocial and impulsive risk factors who become involved in gambling are more likely to develop a serious gambling problem later in life. However, someone who does not perceive that he or she has a problem won't seek treatment, and someone who is forced into treatment won't be motivated to change, Dr. Dhaliwal noted.

Cognitive-behavioral therapy is the first-line treatment of choice for adolescents who exhibit severe gambling problems. One focus of the CBT involves erasing the erroneous belief that gambling losses will be recovered, Dr. Dhaliwal said. The probability of making money at gambling is low, but there is an illusion of control that appeals to adolescents, he noted.

Given the easy access children and adolescents have to gambling, complete abstinence may not be a realistic approach. Instead, a focus on harm reduction and education about the dangers of excessive gambling may be the logical method.

“If we want to use the principle of abstinence in adolescent gambling, it is easy to say they shouldn't engage in gambling because they are too young,” Dr. Dhaliwal said. However, some professionals argue that a “just say no” strategy for adolescents results in inaccurate information and fosters distrust of all messages from adults. “Perhaps we should say 'just say know,' and educate adolescents about the risks associated with pathological gambling, and involve them in the decision-making process, rather than simply forbidding them from doing it,” he added.

Educating adolescents about the problems associated with excess gambling will work for some of them. Another strategy involves targeting multiple risky behaviors with a general mental health prevention program that includes both abstinence and harm reduction. However, anyone with a significant gambling problem should receive a message of abstinence, Dr. Dhaliwal said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

Future research priorities should include the rise of Internet gambling, which has made gambling more acceptable and more accessible to adolescents, and triggers for the transition from a minor to severe problem.

Dr. Dhaliwal did not have any financial interests to disclose.

HOUSTON – Relatively few adolescents develop a serious problem with gambling, so the issue may be one of “harm reduction” rather than the treatment of an addiction, said Gagan Dhaliwal, M.D., at the annual meeting of the American Society for Adolescent Psychiatry.

For most people, gambling is a form of entertainment without serious negative consequences, since it lacks the element of physical harm to the body caused by substance abuse. Yet some adolescents develop a preoccupation with gambling and find themselves unable to stop despite repeated attempts and a desire to do so. Those teens may need treatment similar to that used for other addictions, said Dr. Dhaliwal, of the University of South Alabama, Mobile.

At any age, problem gambling involves complex dynamic interactions among psychophysiologic, developmental, cognitive, and behavioral components. Given that adolescence is a developmental period marked by risk-taking behaviors, adolescents generally do not seek treatment for gambling. They have a sense of invincibility and they think they can stop anytime they choose.

Adolescents with pathological gambling problems may have comorbid psychiatric conditions, and they use gambling as a coping strategy. Common comorbidities include depression, substance abuse, anxiety, and poor academic performance.

“Gambling is considered to be a way of escaping their problems, whether it is depression, anxiety, or relationship problems in their family,” Dr. Dhaliwal said. Peer pressure often plays a role as well.

Some evidence suggests that adolescents with antisocial and impulsive risk factors who become involved in gambling are more likely to develop a serious gambling problem later in life. However, someone who does not perceive that he or she has a problem won't seek treatment, and someone who is forced into treatment won't be motivated to change, Dr. Dhaliwal noted.

Cognitive-behavioral therapy is the first-line treatment of choice for adolescents who exhibit severe gambling problems. One focus of the CBT involves erasing the erroneous belief that gambling losses will be recovered, Dr. Dhaliwal said. The probability of making money at gambling is low, but there is an illusion of control that appeals to adolescents, he noted.

Given the easy access children and adolescents have to gambling, complete abstinence may not be a realistic approach. Instead, a focus on harm reduction and education about the dangers of excessive gambling may be the logical method.

“If we want to use the principle of abstinence in adolescent gambling, it is easy to say they shouldn't engage in gambling because they are too young,” Dr. Dhaliwal said. However, some professionals argue that a “just say no” strategy for adolescents results in inaccurate information and fosters distrust of all messages from adults. “Perhaps we should say 'just say know,' and educate adolescents about the risks associated with pathological gambling, and involve them in the decision-making process, rather than simply forbidding them from doing it,” he added.

Educating adolescents about the problems associated with excess gambling will work for some of them. Another strategy involves targeting multiple risky behaviors with a general mental health prevention program that includes both abstinence and harm reduction. However, anyone with a significant gambling problem should receive a message of abstinence, Dr. Dhaliwal said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

Future research priorities should include the rise of Internet gambling, which has made gambling more acceptable and more accessible to adolescents, and triggers for the transition from a minor to severe problem.

Dr. Dhaliwal did not have any financial interests to disclose.

HOUSTON – Relatively few adolescents develop a serious problem with gambling, so the issue may be one of “harm reduction” rather than the treatment of an addiction, said Gagan Dhaliwal, M.D., at the annual meeting of the American Society for Adolescent Psychiatry.

For most people, gambling is a form of entertainment without serious negative consequences, since it lacks the element of physical harm to the body caused by substance abuse. Yet some adolescents develop a preoccupation with gambling and find themselves unable to stop despite repeated attempts and a desire to do so. Those teens may need treatment similar to that used for other addictions, said Dr. Dhaliwal, of the University of South Alabama, Mobile.

At any age, problem gambling involves complex dynamic interactions among psychophysiologic, developmental, cognitive, and behavioral components. Given that adolescence is a developmental period marked by risk-taking behaviors, adolescents generally do not seek treatment for gambling. They have a sense of invincibility and they think they can stop anytime they choose.

Adolescents with pathological gambling problems may have comorbid psychiatric conditions, and they use gambling as a coping strategy. Common comorbidities include depression, substance abuse, anxiety, and poor academic performance.

“Gambling is considered to be a way of escaping their problems, whether it is depression, anxiety, or relationship problems in their family,” Dr. Dhaliwal said. Peer pressure often plays a role as well.

Some evidence suggests that adolescents with antisocial and impulsive risk factors who become involved in gambling are more likely to develop a serious gambling problem later in life. However, someone who does not perceive that he or she has a problem won't seek treatment, and someone who is forced into treatment won't be motivated to change, Dr. Dhaliwal noted.

Cognitive-behavioral therapy is the first-line treatment of choice for adolescents who exhibit severe gambling problems. One focus of the CBT involves erasing the erroneous belief that gambling losses will be recovered, Dr. Dhaliwal said. The probability of making money at gambling is low, but there is an illusion of control that appeals to adolescents, he noted.

Given the easy access children and adolescents have to gambling, complete abstinence may not be a realistic approach. Instead, a focus on harm reduction and education about the dangers of excessive gambling may be the logical method.

“If we want to use the principle of abstinence in adolescent gambling, it is easy to say they shouldn't engage in gambling because they are too young,” Dr. Dhaliwal said. However, some professionals argue that a “just say no” strategy for adolescents results in inaccurate information and fosters distrust of all messages from adults. “Perhaps we should say 'just say know,' and educate adolescents about the risks associated with pathological gambling, and involve them in the decision-making process, rather than simply forbidding them from doing it,” he added.

Educating adolescents about the problems associated with excess gambling will work for some of them. Another strategy involves targeting multiple risky behaviors with a general mental health prevention program that includes both abstinence and harm reduction. However, anyone with a significant gambling problem should receive a message of abstinence, Dr. Dhaliwal said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

Future research priorities should include the rise of Internet gambling, which has made gambling more acceptable and more accessible to adolescents, and triggers for the transition from a minor to severe problem.

Dr. Dhaliwal did not have any financial interests to disclose.