Heidi Splete

WASHINGTON — Postmenopausal women with osteoporosis who can't tolerate oral ibandronate may welcome an intravenous option, Michael Bolognese, M.D., reported at an international symposium sponsored by the National Osteoporosis Foundation.

One-year results from the Dosing Intravenous Administration (DIVA) study, an ongoing randomized, double-blind, phase III trial, showed that rapid injections of ibandronate (Boniva) in amounts of 2 mg every 2 months or 3 mg every 3 months were more effective than the standard oral daily dose of 2.5 mg at increasing bone mineral density (BMD), Dr. Bolognese of Bethesda (Md.) Health Research and his colleagues wrote in a poster presentation of their findings.

The increases in the BMD at the lumbar spine were significantly greater for women on both the 2-mg/2 mo (5.1%) and 3-mg/3 mo (4.8%) regimens compared with the 2.5-mg daily oral dosage (3.8%). In addition, significantly more patients demonstrated increased BMD from baseline in both the lumbar spine and total hip in the 2-mg/mo and 3-mg/mo groups compared with the daily oral 2.5-mg group.

The study included 1,395 women aged 55-80 years with postmenopausal osteoporosis. In addition to their ibandronate regimens, women in all treatment groups received 500 mg of calcium and 400 IU of vitamin D daily. The incidence of renal adverse events such as urinary incontinence, renal impairment, or nephrolithiasis, was 3% or less across all treatment arms, and there were no significant changes in serum creatinine levels in any of the patients compared with baseline. The incidence of flu-like illness was low as well—3.3%, 3.2%, and 0.6% in the 2-mg/2 mo, 3-mg/3 mo, and 2.5-mg oral groups, respectively.

In addition, the overall incidence of clinical fractures, including vertebral fractures, was 3.1%, and did not differ significantly among the three groups, although it was slightly higher in the oral group (3.7%) compared with the 2-mg/2 mo group (2.9%) and the 3-mg/3 mo group (2.8%).

Dr. Bolognese is a consultant for Eli Lilly & Co. and Procter & Gamble Co., and has received grants or research support from Aventis Pharmaceuticals Inc., Pfizer Inc., Lilly, and Wyeth.

WASHINGTON — Postmenopausal women with osteoporosis who can't tolerate oral ibandronate may welcome an intravenous option, Michael Bolognese, M.D., reported at an international symposium sponsored by the National Osteoporosis Foundation.

One-year results from the Dosing Intravenous Administration (DIVA) study, an ongoing randomized, double-blind, phase III trial, showed that rapid injections of ibandronate (Boniva) in amounts of 2 mg every 2 months or 3 mg every 3 months were more effective than the standard oral daily dose of 2.5 mg at increasing bone mineral density (BMD), Dr. Bolognese of Bethesda (Md.) Health Research and his colleagues wrote in a poster presentation of their findings.

The increases in the BMD at the lumbar spine were significantly greater for women on both the 2-mg/2 mo (5.1%) and 3-mg/3 mo (4.8%) regimens compared with the 2.5-mg daily oral dosage (3.8%). In addition, significantly more patients demonstrated increased BMD from baseline in both the lumbar spine and total hip in the 2-mg/mo and 3-mg/mo groups compared with the daily oral 2.5-mg group.

The study included 1,395 women aged 55-80 years with postmenopausal osteoporosis. In addition to their ibandronate regimens, women in all treatment groups received 500 mg of calcium and 400 IU of vitamin D daily. The incidence of renal adverse events such as urinary incontinence, renal impairment, or nephrolithiasis, was 3% or less across all treatment arms, and there were no significant changes in serum creatinine levels in any of the patients compared with baseline. The incidence of flu-like illness was low as well—3.3%, 3.2%, and 0.6% in the 2-mg/2 mo, 3-mg/3 mo, and 2.5-mg oral groups, respectively.

In addition, the overall incidence of clinical fractures, including vertebral fractures, was 3.1%, and did not differ significantly among the three groups, although it was slightly higher in the oral group (3.7%) compared with the 2-mg/2 mo group (2.9%) and the 3-mg/3 mo group (2.8%).

Dr. Bolognese is a consultant for Eli Lilly & Co. and Procter & Gamble Co., and has received grants or research support from Aventis Pharmaceuticals Inc., Pfizer Inc., Lilly, and Wyeth.

WASHINGTON — Postmenopausal women with osteoporosis who can't tolerate oral ibandronate may welcome an intravenous option, Michael Bolognese, M.D., reported at an international symposium sponsored by the National Osteoporosis Foundation.

One-year results from the Dosing Intravenous Administration (DIVA) study, an ongoing randomized, double-blind, phase III trial, showed that rapid injections of ibandronate (Boniva) in amounts of 2 mg every 2 months or 3 mg every 3 months were more effective than the standard oral daily dose of 2.5 mg at increasing bone mineral density (BMD), Dr. Bolognese of Bethesda (Md.) Health Research and his colleagues wrote in a poster presentation of their findings.

The increases in the BMD at the lumbar spine were significantly greater for women on both the 2-mg/2 mo (5.1%) and 3-mg/3 mo (4.8%) regimens compared with the 2.5-mg daily oral dosage (3.8%). In addition, significantly more patients demonstrated increased BMD from baseline in both the lumbar spine and total hip in the 2-mg/mo and 3-mg/mo groups compared with the daily oral 2.5-mg group.

The study included 1,395 women aged 55-80 years with postmenopausal osteoporosis. In addition to their ibandronate regimens, women in all treatment groups received 500 mg of calcium and 400 IU of vitamin D daily. The incidence of renal adverse events such as urinary incontinence, renal impairment, or nephrolithiasis, was 3% or less across all treatment arms, and there were no significant changes in serum creatinine levels in any of the patients compared with baseline. The incidence of flu-like illness was low as well—3.3%, 3.2%, and 0.6% in the 2-mg/2 mo, 3-mg/3 mo, and 2.5-mg oral groups, respectively.

In addition, the overall incidence of clinical fractures, including vertebral fractures, was 3.1%, and did not differ significantly among the three groups, although it was slightly higher in the oral group (3.7%) compared with the 2-mg/2 mo group (2.9%) and the 3-mg/3 mo group (2.8%).

Dr. Bolognese is a consultant for Eli Lilly & Co. and Procter & Gamble Co., and has received grants or research support from Aventis Pharmaceuticals Inc., Pfizer Inc., Lilly, and Wyeth.

WASHINGTON — Vitamin D levels are inadequate in up to half of postmenopausal women who receive treatment for osteoporosis, Ethel S. Siris, M.D., reported at an international symposium sponsored by the National Osteoporosis Foundation.

Vitamin D inadequacy was significantly worse among women who took less than 400 IU of vitamin D supplementation daily, compared with women who took at least 400 IU of vitamin D daily (63% vs. 45%).

Previous study findings suggest that serum 25-hydroxyvitamin D concentrations of at least 30 ng/mL are needed to stabilize serum parathyroid hormone levels, Dr. Siris, director of the metabolic bone diseases program at Columbia University, New York, and her colleagues, wrote in a poster presentation.

In a cross-sectional, observational study conducted between November 2003 and March 2004, the investigators collected blood samples from 1,536 postmenopausal women, mean age 71 years, at 61 sites throughout North America. They used several cut points of serum 25-hydroxyvitamin D to define inadequacy—less than 9 ng/mL, less than 20 ng/mL, less than 25 ng/mL, and less than 30 ng/mL.

Parathyroid hormone values stabilized among patients with serum 25-hydroxyvitamin D concentrations of at least 29.8 ng/mL, which suggests that concentrations of approximately 30 ng/mL are important for healthy parathyroid levels.

Additional factors significantly related to vitamin D inadequacy in a multivariate analysis included age older than 80 years, BMI greater than 30, lack of exercise, and lack of physician counseling about the importance of vitamin D. More than half (59%) of the women reported that they had not discussed vitamin D with a doctor.

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

WASHINGTON — Vitamin D levels are inadequate in up to half of postmenopausal women who receive treatment for osteoporosis, Ethel S. Siris, M.D., reported at an international symposium sponsored by the National Osteoporosis Foundation.

Vitamin D inadequacy was significantly worse among women who took less than 400 IU of vitamin D supplementation daily, compared with women who took at least 400 IU of vitamin D daily (63% vs. 45%).

Previous study findings suggest that serum 25-hydroxyvitamin D concentrations of at least 30 ng/mL are needed to stabilize serum parathyroid hormone levels, Dr. Siris, director of the metabolic bone diseases program at Columbia University, New York, and her colleagues, wrote in a poster presentation.

In a cross-sectional, observational study conducted between November 2003 and March 2004, the investigators collected blood samples from 1,536 postmenopausal women, mean age 71 years, at 61 sites throughout North America. They used several cut points of serum 25-hydroxyvitamin D to define inadequacy—less than 9 ng/mL, less than 20 ng/mL, less than 25 ng/mL, and less than 30 ng/mL.

Parathyroid hormone values stabilized among patients with serum 25-hydroxyvitamin D concentrations of at least 29.8 ng/mL, which suggests that concentrations of approximately 30 ng/mL are important for healthy parathyroid levels.

Additional factors significantly related to vitamin D inadequacy in a multivariate analysis included age older than 80 years, BMI greater than 30, lack of exercise, and lack of physician counseling about the importance of vitamin D. More than half (59%) of the women reported that they had not discussed vitamin D with a doctor.

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

WASHINGTON — Vitamin D levels are inadequate in up to half of postmenopausal women who receive treatment for osteoporosis, Ethel S. Siris, M.D., reported at an international symposium sponsored by the National Osteoporosis Foundation.

Vitamin D inadequacy was significantly worse among women who took less than 400 IU of vitamin D supplementation daily, compared with women who took at least 400 IU of vitamin D daily (63% vs. 45%).

Previous study findings suggest that serum 25-hydroxyvitamin D concentrations of at least 30 ng/mL are needed to stabilize serum parathyroid hormone levels, Dr. Siris, director of the metabolic bone diseases program at Columbia University, New York, and her colleagues, wrote in a poster presentation.

In a cross-sectional, observational study conducted between November 2003 and March 2004, the investigators collected blood samples from 1,536 postmenopausal women, mean age 71 years, at 61 sites throughout North America. They used several cut points of serum 25-hydroxyvitamin D to define inadequacy—less than 9 ng/mL, less than 20 ng/mL, less than 25 ng/mL, and less than 30 ng/mL.

Parathyroid hormone values stabilized among patients with serum 25-hydroxyvitamin D concentrations of at least 29.8 ng/mL, which suggests that concentrations of approximately 30 ng/mL are important for healthy parathyroid levels.

Additional factors significantly related to vitamin D inadequacy in a multivariate analysis included age older than 80 years, BMI greater than 30, lack of exercise, and lack of physician counseling about the importance of vitamin D. More than half (59%) of the women reported that they had not discussed vitamin D with a doctor.

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

WASHINGTON — The risk of vertebral fragility fractures is threefold higher among postmenopausal women with at least one prevalent radiographic fracture, compared with those without such a history, Ethel S. Siris, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Awareness of previous vertebral fractures can help physicians evaluate vertebral fragility and target osteoporosis therapy appropriately, Dr. Siris, a professor of clinical medicine at Columbia University, New York and her colleagues, said in a poster presented at the meeting.

Their review of data on 2,651 postmenopausal women, mean age 67 years, included 1,181 women with prevalent vertebral fractures and assessed fracture risk independent of lumbar spine bone mineral density. Overall, the greater the number of prevalent vertebral fractures, the greater the risk of sustaining subsequent fractures.

Patients with three or more fractures had as much as an eightfold increased risk. Greater severity scores on the semi-quantitative deformity scale were associated with as much as an 11-fold increase in the risk of fracture.

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

WASHINGTON — The risk of vertebral fragility fractures is threefold higher among postmenopausal women with at least one prevalent radiographic fracture, compared with those without such a history, Ethel S. Siris, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Awareness of previous vertebral fractures can help physicians evaluate vertebral fragility and target osteoporosis therapy appropriately, Dr. Siris, a professor of clinical medicine at Columbia University, New York and her colleagues, said in a poster presented at the meeting.

Their review of data on 2,651 postmenopausal women, mean age 67 years, included 1,181 women with prevalent vertebral fractures and assessed fracture risk independent of lumbar spine bone mineral density. Overall, the greater the number of prevalent vertebral fractures, the greater the risk of sustaining subsequent fractures.

Patients with three or more fractures had as much as an eightfold increased risk. Greater severity scores on the semi-quantitative deformity scale were associated with as much as an 11-fold increase in the risk of fracture.

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

WASHINGTON — The risk of vertebral fragility fractures is threefold higher among postmenopausal women with at least one prevalent radiographic fracture, compared with those without such a history, Ethel S. Siris, M.D., said at an international symposium sponsored by the National Osteoporosis Foundation.

Awareness of previous vertebral fractures can help physicians evaluate vertebral fragility and target osteoporosis therapy appropriately, Dr. Siris, a professor of clinical medicine at Columbia University, New York and her colleagues, said in a poster presented at the meeting.

Their review of data on 2,651 postmenopausal women, mean age 67 years, included 1,181 women with prevalent vertebral fractures and assessed fracture risk independent of lumbar spine bone mineral density. Overall, the greater the number of prevalent vertebral fractures, the greater the risk of sustaining subsequent fractures.

Patients with three or more fractures had as much as an eightfold increased risk. Greater severity scores on the semi-quantitative deformity scale were associated with as much as an 11-fold increase in the risk of fracture.

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

Bronchiolitis Management Varies

Significant variations in the use of diagnostic tests and medications for bronchiolitis persisted among hospitals even after controlling for covariates in 17,397 patients younger than 1 year who were hospitalized, reported Dimitri A. Christakis, M.D., and colleagues at the Children's Hospital and Regional Medical Center, Seattle. The regression analysis included data from the Pediatric Health System database on patients at 36 freestanding, noncompeting children's hospitals. The mean age was 4 months, and 59% were male (Pediatrics 2005;115:878-84). Overall, the most common diagnostic or treatment approaches included chest radiographs (72%), antibiotics (45%), and systemic steroids (25%)—the use of chest radiographs ranged from 38% to 89%, and use of any antibiotics ranged from 28% to 62%. Severity of illness was controlled for and was probably not the main cause of the variations, the investigators noted.

The mean length of stay was 2.9 days. The use of antibiotics, bronchodilators, and corticosteroids was associated with increases in length of stay (LOS). The hospital itself was a significant contributor to mean LOS, which ranged from 2.4 to 3.9 days. However, children with an LOS of 2 days or more were significantly less likely to be readmitted compared with those with a 1-day LOS.

OK to Overlook Hematuria?

Diagnostic evaluation of microscopic hematuria in asymptomatic children may be unnecessary, said Jerry Bergstein, M.D., and his colleagues at Indiana University School of Medicine, Indianapolis (Arch. Pediatr. Adolesc. Med. 2005;159:353-5). A review of 342 children with microscopic hematuria yielded no cause in 274 patients. Hypercalciuria, the most common cause, occurred in 16% of the patients, followed by glomerulonephritis in 1%. Although hypercalciuria can increase the long-term risk for nephrolithiasis, no long-term studies indicate any preventive benefits from early detection. In addition, none of the children with microscopic hematuria had a urinary tract infection, which argues against urine cultures for asymptomatic patients. However, long-term follow-up remains essential to preempting significant renal disease. The recommendation to abstain from further evaluation in asymptomatic children “in no way repudiates the value of evaluating hematuria when found in a search for renal or urinary tract diseases,” F. Bruder Stapleton, M.D., of Children's Hospital and Medical Center, Seattle, wrote in an accompanying editorial (Arch. Pediatr. Adolesc. Med. 2005;159:398-9).

Heart Rate Impacts Sepsis

Abnormal heart rate characteristics (HRC) were significantly associated with sepsis in a prospective study of 678 consecutive infants, said M. Pamela Griffin, M.D., and her associates at the University of Virginia, Charlottesville (Pediatrics 2005;115:937-41).

HRC was measured every 6 hours and was available 92% of the time. Prior to showing clinical signs of sepsis, neonates demonstrated reduced heart rate variability and decelerations. Three levels of risk—high, intermediate, and low—were calculated based on HRC model values, with HRC values above the 90th percentile defined as high risk. Overall, 42% of readings within 6 hours of a positive blood culture landed in the high-risk range, and an additional 30% landed in the intermediate-risk range. The odds ratio for sepsis based on HRC monitoring remained unchanged when the investigators ignored data from the blood cultures, which suggests that HRC provides adjunct, independent information to laboratory tests for the diagnosis of sepsis. Dr. Griffin owns a partial share in Medical Predictive Science Corp. which supplied partial funding for the study.

Fecal H. pylori Test Is Effective

The Helicobacter pylori fecal test is simple, appropriate, and accurate for screening of H. pylori-positive patients, reported Tamara Sabbi, M.D., of Belcolle Hospital, Viterbo, Italy, and her associates. In a prospective study of 250 patients aged 3-18 years (mean age 11 years) with suspected upper gastrointestinal disease, 93 (37%) tested positive for H. pylori after undergoing the standard procedure—upper gastrointestinal endoscopy with gastric biopsy (Arch. Pediatr. Adolesc. Med. 2005;159:238-41). The fecal antigen test for H. pylori demonstrated 97% sensitivity, a 98% specificity, a positive predictive value of 97%, and a negative predictive value of 98% in this patient population. There were no significant clinical differences between the infected and noninfected children, which highlights the need for effective, noninvasive tests. The investigators also evaluated the urea breath test, which was extremely effective but significantly more expensive and less available than the fecal antigen test.

Bronchiolitis Management Varies

Significant variations in the use of diagnostic tests and medications for bronchiolitis persisted among hospitals even after controlling for covariates in 17,397 patients younger than 1 year who were hospitalized, reported Dimitri A. Christakis, M.D., and colleagues at the Children's Hospital and Regional Medical Center, Seattle. The regression analysis included data from the Pediatric Health System database on patients at 36 freestanding, noncompeting children's hospitals. The mean age was 4 months, and 59% were male (Pediatrics 2005;115:878-84). Overall, the most common diagnostic or treatment approaches included chest radiographs (72%), antibiotics (45%), and systemic steroids (25%)—the use of chest radiographs ranged from 38% to 89%, and use of any antibiotics ranged from 28% to 62%. Severity of illness was controlled for and was probably not the main cause of the variations, the investigators noted.

The mean length of stay was 2.9 days. The use of antibiotics, bronchodilators, and corticosteroids was associated with increases in length of stay (LOS). The hospital itself was a significant contributor to mean LOS, which ranged from 2.4 to 3.9 days. However, children with an LOS of 2 days or more were significantly less likely to be readmitted compared with those with a 1-day LOS.

OK to Overlook Hematuria?

Diagnostic evaluation of microscopic hematuria in asymptomatic children may be unnecessary, said Jerry Bergstein, M.D., and his colleagues at Indiana University School of Medicine, Indianapolis (Arch. Pediatr. Adolesc. Med. 2005;159:353-5). A review of 342 children with microscopic hematuria yielded no cause in 274 patients. Hypercalciuria, the most common cause, occurred in 16% of the patients, followed by glomerulonephritis in 1%. Although hypercalciuria can increase the long-term risk for nephrolithiasis, no long-term studies indicate any preventive benefits from early detection. In addition, none of the children with microscopic hematuria had a urinary tract infection, which argues against urine cultures for asymptomatic patients. However, long-term follow-up remains essential to preempting significant renal disease. The recommendation to abstain from further evaluation in asymptomatic children “in no way repudiates the value of evaluating hematuria when found in a search for renal or urinary tract diseases,” F. Bruder Stapleton, M.D., of Children's Hospital and Medical Center, Seattle, wrote in an accompanying editorial (Arch. Pediatr. Adolesc. Med. 2005;159:398-9).

Heart Rate Impacts Sepsis

Abnormal heart rate characteristics (HRC) were significantly associated with sepsis in a prospective study of 678 consecutive infants, said M. Pamela Griffin, M.D., and her associates at the University of Virginia, Charlottesville (Pediatrics 2005;115:937-41).

HRC was measured every 6 hours and was available 92% of the time. Prior to showing clinical signs of sepsis, neonates demonstrated reduced heart rate variability and decelerations. Three levels of risk—high, intermediate, and low—were calculated based on HRC model values, with HRC values above the 90th percentile defined as high risk. Overall, 42% of readings within 6 hours of a positive blood culture landed in the high-risk range, and an additional 30% landed in the intermediate-risk range. The odds ratio for sepsis based on HRC monitoring remained unchanged when the investigators ignored data from the blood cultures, which suggests that HRC provides adjunct, independent information to laboratory tests for the diagnosis of sepsis. Dr. Griffin owns a partial share in Medical Predictive Science Corp. which supplied partial funding for the study.

Fecal H. pylori Test Is Effective

The Helicobacter pylori fecal test is simple, appropriate, and accurate for screening of H. pylori-positive patients, reported Tamara Sabbi, M.D., of Belcolle Hospital, Viterbo, Italy, and her associates. In a prospective study of 250 patients aged 3-18 years (mean age 11 years) with suspected upper gastrointestinal disease, 93 (37%) tested positive for H. pylori after undergoing the standard procedure—upper gastrointestinal endoscopy with gastric biopsy (Arch. Pediatr. Adolesc. Med. 2005;159:238-41). The fecal antigen test for H. pylori demonstrated 97% sensitivity, a 98% specificity, a positive predictive value of 97%, and a negative predictive value of 98% in this patient population. There were no significant clinical differences between the infected and noninfected children, which highlights the need for effective, noninvasive tests. The investigators also evaluated the urea breath test, which was extremely effective but significantly more expensive and less available than the fecal antigen test.

Bronchiolitis Management Varies

Significant variations in the use of diagnostic tests and medications for bronchiolitis persisted among hospitals even after controlling for covariates in 17,397 patients younger than 1 year who were hospitalized, reported Dimitri A. Christakis, M.D., and colleagues at the Children's Hospital and Regional Medical Center, Seattle. The regression analysis included data from the Pediatric Health System database on patients at 36 freestanding, noncompeting children's hospitals. The mean age was 4 months, and 59% were male (Pediatrics 2005;115:878-84). Overall, the most common diagnostic or treatment approaches included chest radiographs (72%), antibiotics (45%), and systemic steroids (25%)—the use of chest radiographs ranged from 38% to 89%, and use of any antibiotics ranged from 28% to 62%. Severity of illness was controlled for and was probably not the main cause of the variations, the investigators noted.

The mean length of stay was 2.9 days. The use of antibiotics, bronchodilators, and corticosteroids was associated with increases in length of stay (LOS). The hospital itself was a significant contributor to mean LOS, which ranged from 2.4 to 3.9 days. However, children with an LOS of 2 days or more were significantly less likely to be readmitted compared with those with a 1-day LOS.

OK to Overlook Hematuria?

Diagnostic evaluation of microscopic hematuria in asymptomatic children may be unnecessary, said Jerry Bergstein, M.D., and his colleagues at Indiana University School of Medicine, Indianapolis (Arch. Pediatr. Adolesc. Med. 2005;159:353-5). A review of 342 children with microscopic hematuria yielded no cause in 274 patients. Hypercalciuria, the most common cause, occurred in 16% of the patients, followed by glomerulonephritis in 1%. Although hypercalciuria can increase the long-term risk for nephrolithiasis, no long-term studies indicate any preventive benefits from early detection. In addition, none of the children with microscopic hematuria had a urinary tract infection, which argues against urine cultures for asymptomatic patients. However, long-term follow-up remains essential to preempting significant renal disease. The recommendation to abstain from further evaluation in asymptomatic children “in no way repudiates the value of evaluating hematuria when found in a search for renal or urinary tract diseases,” F. Bruder Stapleton, M.D., of Children's Hospital and Medical Center, Seattle, wrote in an accompanying editorial (Arch. Pediatr. Adolesc. Med. 2005;159:398-9).

Heart Rate Impacts Sepsis

Abnormal heart rate characteristics (HRC) were significantly associated with sepsis in a prospective study of 678 consecutive infants, said M. Pamela Griffin, M.D., and her associates at the University of Virginia, Charlottesville (Pediatrics 2005;115:937-41).

HRC was measured every 6 hours and was available 92% of the time. Prior to showing clinical signs of sepsis, neonates demonstrated reduced heart rate variability and decelerations. Three levels of risk—high, intermediate, and low—were calculated based on HRC model values, with HRC values above the 90th percentile defined as high risk. Overall, 42% of readings within 6 hours of a positive blood culture landed in the high-risk range, and an additional 30% landed in the intermediate-risk range. The odds ratio for sepsis based on HRC monitoring remained unchanged when the investigators ignored data from the blood cultures, which suggests that HRC provides adjunct, independent information to laboratory tests for the diagnosis of sepsis. Dr. Griffin owns a partial share in Medical Predictive Science Corp. which supplied partial funding for the study.

Fecal H. pylori Test Is Effective

The Helicobacter pylori fecal test is simple, appropriate, and accurate for screening of H. pylori-positive patients, reported Tamara Sabbi, M.D., of Belcolle Hospital, Viterbo, Italy, and her associates. In a prospective study of 250 patients aged 3-18 years (mean age 11 years) with suspected upper gastrointestinal disease, 93 (37%) tested positive for H. pylori after undergoing the standard procedure—upper gastrointestinal endoscopy with gastric biopsy (Arch. Pediatr. Adolesc. Med. 2005;159:238-41). The fecal antigen test for H. pylori demonstrated 97% sensitivity, a 98% specificity, a positive predictive value of 97%, and a negative predictive value of 98% in this patient population. There were no significant clinical differences between the infected and noninfected children, which highlights the need for effective, noninvasive tests. The investigators also evaluated the urea breath test, which was extremely effective but significantly more expensive and less available than the fecal antigen test.

WASHINGTON — Parents whose autistic children turn life upside down might turn to a movement therapist for help.

Understanding children's nonverbal expressions can be a springboard for managing their tantrums and improving their socialization, Suzi Tortora, Ed.D., explained at a press conference on Parkinson's disease sponsored by the Laban/Bartenieff Institute of Movement Studies.

Dr. Tortora, a certified movement analyst and dance therapist with a private practice in New York City, works with a variety of children, including those with autism and pervasive development disorder, attention-deficit hyperactivity disorder, and unspecified developmental delays.

Dr. Tortora's strategies are based on harnessing the child's unique ways of coping and responding to the environment and using the child's nonverbal actions as communication tools. She observes and interacts with her clients and their parents and uses principles of movement analysis to interpret a child's particular movement expressions and determine how the child is responding to his or her environment.

When working with autistic children, Dr. Tortora tries to help them transition from the experience of physical dysregulation to regulation.

“The key is that children with autistic spectrum disorder have a difficult time relating,” she said. “They are idiosyncratic in their movements. They are sensorially over- or understimulated, and they can quickly escalate to a place of total body dysregulation.”

Her therapy includes riding out a tantrum with the child by using movement and dance as a way to stay connected nonverbally. She mirrors the type and emotional quality of the child's movements to keep the child relating to her instead of disappearing into his or her own world. The goal is to help the child learn to communicate and stay connected during a tantrum to regain control. Although such therapy is not available everywhere, pediatricians can introduce it as a drug-free intervention for children with autism or other developmental delays or behavioral problems.

For more information about Dr. Tortora and the use of movement therapy in children, visit www.suzitortora.org

WASHINGTON — Parents whose autistic children turn life upside down might turn to a movement therapist for help.

Understanding children's nonverbal expressions can be a springboard for managing their tantrums and improving their socialization, Suzi Tortora, Ed.D., explained at a press conference on Parkinson's disease sponsored by the Laban/Bartenieff Institute of Movement Studies.

Dr. Tortora, a certified movement analyst and dance therapist with a private practice in New York City, works with a variety of children, including those with autism and pervasive development disorder, attention-deficit hyperactivity disorder, and unspecified developmental delays.

Dr. Tortora's strategies are based on harnessing the child's unique ways of coping and responding to the environment and using the child's nonverbal actions as communication tools. She observes and interacts with her clients and their parents and uses principles of movement analysis to interpret a child's particular movement expressions and determine how the child is responding to his or her environment.

When working with autistic children, Dr. Tortora tries to help them transition from the experience of physical dysregulation to regulation.

“The key is that children with autistic spectrum disorder have a difficult time relating,” she said. “They are idiosyncratic in their movements. They are sensorially over- or understimulated, and they can quickly escalate to a place of total body dysregulation.”

Her therapy includes riding out a tantrum with the child by using movement and dance as a way to stay connected nonverbally. She mirrors the type and emotional quality of the child's movements to keep the child relating to her instead of disappearing into his or her own world. The goal is to help the child learn to communicate and stay connected during a tantrum to regain control. Although such therapy is not available everywhere, pediatricians can introduce it as a drug-free intervention for children with autism or other developmental delays or behavioral problems.

For more information about Dr. Tortora and the use of movement therapy in children, visit www.suzitortora.org

WASHINGTON — Parents whose autistic children turn life upside down might turn to a movement therapist for help.

Understanding children's nonverbal expressions can be a springboard for managing their tantrums and improving their socialization, Suzi Tortora, Ed.D., explained at a press conference on Parkinson's disease sponsored by the Laban/Bartenieff Institute of Movement Studies.

Dr. Tortora, a certified movement analyst and dance therapist with a private practice in New York City, works with a variety of children, including those with autism and pervasive development disorder, attention-deficit hyperactivity disorder, and unspecified developmental delays.

Dr. Tortora's strategies are based on harnessing the child's unique ways of coping and responding to the environment and using the child's nonverbal actions as communication tools. She observes and interacts with her clients and their parents and uses principles of movement analysis to interpret a child's particular movement expressions and determine how the child is responding to his or her environment.

When working with autistic children, Dr. Tortora tries to help them transition from the experience of physical dysregulation to regulation.

“The key is that children with autistic spectrum disorder have a difficult time relating,” she said. “They are idiosyncratic in their movements. They are sensorially over- or understimulated, and they can quickly escalate to a place of total body dysregulation.”

Her therapy includes riding out a tantrum with the child by using movement and dance as a way to stay connected nonverbally. She mirrors the type and emotional quality of the child's movements to keep the child relating to her instead of disappearing into his or her own world. The goal is to help the child learn to communicate and stay connected during a tantrum to regain control. Although such therapy is not available everywhere, pediatricians can introduce it as a drug-free intervention for children with autism or other developmental delays or behavioral problems.

For more information about Dr. Tortora and the use of movement therapy in children, visit www.suzitortora.org

WASHINGTON — The first 1,000 uses of the OraQuick Advance Rapid HIV-1 Antibody Test in New Jersey identified nearly double the number of HIV-positive patients, compared with the traditional blood tests, Evan Cadoff, M.D., wrote in a poster presented at the annual meeting of the American College of Preventive Medicine.

However, the data represent rates of seropositivity, not necessarily new infections, wrote Dr. Cadoff of the University of Medicine and Dentistry of New Jersey.

The test requires an oral fluid sample and gives results in 20-40 minutes. Rapid testing in New Jersey began in November 2003 at publicly funded counseling and test sites. After the first 1,000 results, the seropositive rate rose to 4.72%, almost double the 2.36% seropositive rate recorded with traditional testing in the previous year.

Overall, 63% of the people who tested positive had not been diagnosed with HIV. However, whether the numbers represent improved detection rates in previously targeted at-risk populations or new groups of patients who previously went untested remains uncertain, the investigators noted.

WASHINGTON — The first 1,000 uses of the OraQuick Advance Rapid HIV-1 Antibody Test in New Jersey identified nearly double the number of HIV-positive patients, compared with the traditional blood tests, Evan Cadoff, M.D., wrote in a poster presented at the annual meeting of the American College of Preventive Medicine.

However, the data represent rates of seropositivity, not necessarily new infections, wrote Dr. Cadoff of the University of Medicine and Dentistry of New Jersey.

The test requires an oral fluid sample and gives results in 20-40 minutes. Rapid testing in New Jersey began in November 2003 at publicly funded counseling and test sites. After the first 1,000 results, the seropositive rate rose to 4.72%, almost double the 2.36% seropositive rate recorded with traditional testing in the previous year.

Overall, 63% of the people who tested positive had not been diagnosed with HIV. However, whether the numbers represent improved detection rates in previously targeted at-risk populations or new groups of patients who previously went untested remains uncertain, the investigators noted.

WASHINGTON — The first 1,000 uses of the OraQuick Advance Rapid HIV-1 Antibody Test in New Jersey identified nearly double the number of HIV-positive patients, compared with the traditional blood tests, Evan Cadoff, M.D., wrote in a poster presented at the annual meeting of the American College of Preventive Medicine.

However, the data represent rates of seropositivity, not necessarily new infections, wrote Dr. Cadoff of the University of Medicine and Dentistry of New Jersey.

The test requires an oral fluid sample and gives results in 20-40 minutes. Rapid testing in New Jersey began in November 2003 at publicly funded counseling and test sites. After the first 1,000 results, the seropositive rate rose to 4.72%, almost double the 2.36% seropositive rate recorded with traditional testing in the previous year.

Overall, 63% of the people who tested positive had not been diagnosed with HIV. However, whether the numbers represent improved detection rates in previously targeted at-risk populations or new groups of patients who previously went untested remains uncertain, the investigators noted.

HOUSTON — Mental health issues can loom large in the treatment of diabetes in adolescents, especially when barriers to compliance arise, Scot G. McAfee, M.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

It's especially important to stay alert to signs of depression—which is three times more likely to strike diabetics as nondiabetics, said Dr. McAfee, who has lived with diabetes since his youth.

Diabetes is considered to be one of the most demanding of all chronic illnesses, mostly because 95% of diabetes management is conducted by the patient. Some children with diabetes as young as 7 or 8 years old understand how to manage the disease effectively. But when children with diabetes reach puberty or are diagnosed in adolescence, they might develop compliance issues because of feelings of rebellion and desires to be like their peers, said Dr. McAfee, a psychiatrist at St. Vincent's Hospital, New York.

Children and adolescents with diabetes who learn about their condition immediately and learn to monitor themselves have a better chance of avoiding complications.

But some find it too difficult to figure out insulin doses and don't want to stand out at the lunch table. “So they eat whatever everyone else is eating,” Dr. McAfee noted at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

In addition to managing their illness, adolescents with diabetes must face the daily traumas of teenage life. For example, anxiety and stress about a test or about a relationship with a friend can increase blood sugar levels. And diabetic adolescents who exercise during a gym class or an after-school sports practice require additional carbohydrates.

Weight maintenance is a difficult issue for diabetic adolescents. A diabetic girl may want to lose weight and eat less, but if she is exercising, she will need to eat more to avoid hypoglycemia. This makes losing weight more of a challenge. “It's important to understand that weight loss must be a gradual process,” he said.

Adolescents require guidance in learning to compromise and achieve a livable balance between the demands of diabetes, the life stresses that all adolescents endure, and a desire for a normal lifestyle.

“If an adolescent with diabetes enters a psychiatric hospital after a suicide attempt with [his or her] diabetes medications, I recommend finding someone with experience in adolescent diabetes to talk with the patient and verify that this was in fact a suicide attempt and not an attempt at overly close diabetes management,” he added.

A diabetic child or adolescent puts stress on the family unit as well. “Adjustments to a diagnosis of diabetes can take 6 months for children and 9 months for parents,” Dr. McAfee said. Family issues include social stigma, possible economic burdens, and marital strife, especially when one parent wants to be more coddling of the diabetic child. Health care providers should reassess the families' knowledge of diabetes and coping strategies every 2 years, he said.

Any health care provider, whether a family physician, psychiatrist, or pediatrician, can remind children and adolescents that the treatment plan for diabetes is an interplay between exercise, diet, and insulin. Physicians can help children and adolescents set specific goals, whether it is testing their insulin three times each day, or eating a vegetable as part of their lunch. “Goals should be specific and measurable—and don't make them too complicated,” Dr. McAfee said.

Peer support groups show children and teens with diabetes that they are not alone, and adolescents in particular are often more receptive to learning from their peers. Online chat rooms and summer camps provide opportunities to learn from and be inspired by other children and adolescents. Those outlets also offer hints for managing diabetes during transitions, such as starting high school or college.

Dr. McAfee is a consultant to Janssen and Otsuka, and is a member of the speakers' bureau of AstraZeneca.

HOUSTON — Mental health issues can loom large in the treatment of diabetes in adolescents, especially when barriers to compliance arise, Scot G. McAfee, M.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

It's especially important to stay alert to signs of depression—which is three times more likely to strike diabetics as nondiabetics, said Dr. McAfee, who has lived with diabetes since his youth.

Diabetes is considered to be one of the most demanding of all chronic illnesses, mostly because 95% of diabetes management is conducted by the patient. Some children with diabetes as young as 7 or 8 years old understand how to manage the disease effectively. But when children with diabetes reach puberty or are diagnosed in adolescence, they might develop compliance issues because of feelings of rebellion and desires to be like their peers, said Dr. McAfee, a psychiatrist at St. Vincent's Hospital, New York.

Children and adolescents with diabetes who learn about their condition immediately and learn to monitor themselves have a better chance of avoiding complications.

But some find it too difficult to figure out insulin doses and don't want to stand out at the lunch table. “So they eat whatever everyone else is eating,” Dr. McAfee noted at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

In addition to managing their illness, adolescents with diabetes must face the daily traumas of teenage life. For example, anxiety and stress about a test or about a relationship with a friend can increase blood sugar levels. And diabetic adolescents who exercise during a gym class or an after-school sports practice require additional carbohydrates.

Weight maintenance is a difficult issue for diabetic adolescents. A diabetic girl may want to lose weight and eat less, but if she is exercising, she will need to eat more to avoid hypoglycemia. This makes losing weight more of a challenge. “It's important to understand that weight loss must be a gradual process,” he said.

Adolescents require guidance in learning to compromise and achieve a livable balance between the demands of diabetes, the life stresses that all adolescents endure, and a desire for a normal lifestyle.

“If an adolescent with diabetes enters a psychiatric hospital after a suicide attempt with [his or her] diabetes medications, I recommend finding someone with experience in adolescent diabetes to talk with the patient and verify that this was in fact a suicide attempt and not an attempt at overly close diabetes management,” he added.

A diabetic child or adolescent puts stress on the family unit as well. “Adjustments to a diagnosis of diabetes can take 6 months for children and 9 months for parents,” Dr. McAfee said. Family issues include social stigma, possible economic burdens, and marital strife, especially when one parent wants to be more coddling of the diabetic child. Health care providers should reassess the families' knowledge of diabetes and coping strategies every 2 years, he said.

Any health care provider, whether a family physician, psychiatrist, or pediatrician, can remind children and adolescents that the treatment plan for diabetes is an interplay between exercise, diet, and insulin. Physicians can help children and adolescents set specific goals, whether it is testing their insulin three times each day, or eating a vegetable as part of their lunch. “Goals should be specific and measurable—and don't make them too complicated,” Dr. McAfee said.

Peer support groups show children and teens with diabetes that they are not alone, and adolescents in particular are often more receptive to learning from their peers. Online chat rooms and summer camps provide opportunities to learn from and be inspired by other children and adolescents. Those outlets also offer hints for managing diabetes during transitions, such as starting high school or college.

Dr. McAfee is a consultant to Janssen and Otsuka, and is a member of the speakers' bureau of AstraZeneca.

HOUSTON — Mental health issues can loom large in the treatment of diabetes in adolescents, especially when barriers to compliance arise, Scot G. McAfee, M.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

It's especially important to stay alert to signs of depression—which is three times more likely to strike diabetics as nondiabetics, said Dr. McAfee, who has lived with diabetes since his youth.

Diabetes is considered to be one of the most demanding of all chronic illnesses, mostly because 95% of diabetes management is conducted by the patient. Some children with diabetes as young as 7 or 8 years old understand how to manage the disease effectively. But when children with diabetes reach puberty or are diagnosed in adolescence, they might develop compliance issues because of feelings of rebellion and desires to be like their peers, said Dr. McAfee, a psychiatrist at St. Vincent's Hospital, New York.

Children and adolescents with diabetes who learn about their condition immediately and learn to monitor themselves have a better chance of avoiding complications.

But some find it too difficult to figure out insulin doses and don't want to stand out at the lunch table. “So they eat whatever everyone else is eating,” Dr. McAfee noted at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

In addition to managing their illness, adolescents with diabetes must face the daily traumas of teenage life. For example, anxiety and stress about a test or about a relationship with a friend can increase blood sugar levels. And diabetic adolescents who exercise during a gym class or an after-school sports practice require additional carbohydrates.

Weight maintenance is a difficult issue for diabetic adolescents. A diabetic girl may want to lose weight and eat less, but if she is exercising, she will need to eat more to avoid hypoglycemia. This makes losing weight more of a challenge. “It's important to understand that weight loss must be a gradual process,” he said.

Adolescents require guidance in learning to compromise and achieve a livable balance between the demands of diabetes, the life stresses that all adolescents endure, and a desire for a normal lifestyle.

“If an adolescent with diabetes enters a psychiatric hospital after a suicide attempt with [his or her] diabetes medications, I recommend finding someone with experience in adolescent diabetes to talk with the patient and verify that this was in fact a suicide attempt and not an attempt at overly close diabetes management,” he added.

A diabetic child or adolescent puts stress on the family unit as well. “Adjustments to a diagnosis of diabetes can take 6 months for children and 9 months for parents,” Dr. McAfee said. Family issues include social stigma, possible economic burdens, and marital strife, especially when one parent wants to be more coddling of the diabetic child. Health care providers should reassess the families' knowledge of diabetes and coping strategies every 2 years, he said.

Any health care provider, whether a family physician, psychiatrist, or pediatrician, can remind children and adolescents that the treatment plan for diabetes is an interplay between exercise, diet, and insulin. Physicians can help children and adolescents set specific goals, whether it is testing their insulin three times each day, or eating a vegetable as part of their lunch. “Goals should be specific and measurable—and don't make them too complicated,” Dr. McAfee said.

Peer support groups show children and teens with diabetes that they are not alone, and adolescents in particular are often more receptive to learning from their peers. Online chat rooms and summer camps provide opportunities to learn from and be inspired by other children and adolescents. Those outlets also offer hints for managing diabetes during transitions, such as starting high school or college.

Dr. McAfee is a consultant to Janssen and Otsuka, and is a member of the speakers' bureau of AstraZeneca.

Women who feel chronic anxiety or suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with those who are generally less anxious, said Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

The investigators examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each woman completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). They completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared POMS scores before and after biopsy results among the eight subgroups.

In women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit. The total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of the diagnosis.

Women who feel chronic anxiety or suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with those who are generally less anxious, said Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

The investigators examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each woman completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). They completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared POMS scores before and after biopsy results among the eight subgroups.

In women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit. The total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of the diagnosis.

Women who feel chronic anxiety or suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with those who are generally less anxious, said Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

The investigators examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each woman completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). They completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared POMS scores before and after biopsy results among the eight subgroups.

In women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit. The total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of the diagnosis.

WASHINGTON – Increased doses of methadone may be good for opioid dependence, but they might not be good for a patient's sex life.

“Although it hasn't been well studied in [methadone patients], we know that sexual dysfunction as a side effect can interfere with compliance in a clinical setting,” Randall Brown, M.D., said at the annual conference of the Association for Medical Education and Research in Substance Abuse.

Methadone is among the most popular treatments for opioid dependence; it has been shown to reduce opiate use and mortality, and psychosocial outcomes for patients include lower crime rates and improved employment status.

Side effects from methadone use include weight gain, insomnia, and constipation, but sexual dysfunction could be a “deal breaker” for some patients.

Between 30% and 100% of methadone patients report sexual dysfunction problems, with men mostly reporting problems with libido and maintaining erections, said Dr. Brown, who conducted a cross-sectional study as part of a primary care fellowship at the University of Wisconsin.

Dr. Brown's work was funded in part by an NIH research grant. To assess whether the likelihood and severity of sexual dysfunction increased with higher doses, he compared 16 new patients who started methadone as therapy for opioid addiction with 76 men who had been involved in methadone maintenance for at least 60 days.

Overall, 14% of the men across both groups reported some sexual dysfunction, which is similar to male sexual dysfunction rates in the general population. A dose increase was significantly associated with orgasm dysfunction, before and after adjusting for the duration of methadone treatment.

However, no significant increase in dysfunction was associated with either serum testosterone or serum prolactin levels.

There was a significant association between TSH and duration of treatment, but levels remained within the normal range.

Sexual function was evaluated with a 28-question form using rating scales from 1 to 100 for libido, erectile dysfunction, and orgasm dysfunction, and with patient interviews about medical history and ongoing use of alcohol or other drugs.

“We didn't find the alterations in testosterone [with methadone dosage] that we expected,” Dr. Brown said.

In the 1970s, several studies measured testosterone levels of methadone patients without relating it to dosage, he noted at the conference, also sponsored by Brown Medical School.

Some studies showed a drop in testosterone associated with dosage greater than 60 mg, but other studies failed to show any difference.

“Sexual dysfunction in men on methadone maintenance should be evaluated in accordance with guidelines established for the general population,” he said.

However, if orgasm dysfunction negatively affects a patient's quality of life to the extent that he considers discontinuing the methadone, a trial short-term dose reduction may be helpful.

WASHINGTON – Increased doses of methadone may be good for opioid dependence, but they might not be good for a patient's sex life.

“Although it hasn't been well studied in [methadone patients], we know that sexual dysfunction as a side effect can interfere with compliance in a clinical setting,” Randall Brown, M.D., said at the annual conference of the Association for Medical Education and Research in Substance Abuse.

Methadone is among the most popular treatments for opioid dependence; it has been shown to reduce opiate use and mortality, and psychosocial outcomes for patients include lower crime rates and improved employment status.

Side effects from methadone use include weight gain, insomnia, and constipation, but sexual dysfunction could be a “deal breaker” for some patients.

Between 30% and 100% of methadone patients report sexual dysfunction problems, with men mostly reporting problems with libido and maintaining erections, said Dr. Brown, who conducted a cross-sectional study as part of a primary care fellowship at the University of Wisconsin.

Dr. Brown's work was funded in part by an NIH research grant. To assess whether the likelihood and severity of sexual dysfunction increased with higher doses, he compared 16 new patients who started methadone as therapy for opioid addiction with 76 men who had been involved in methadone maintenance for at least 60 days.

Overall, 14% of the men across both groups reported some sexual dysfunction, which is similar to male sexual dysfunction rates in the general population. A dose increase was significantly associated with orgasm dysfunction, before and after adjusting for the duration of methadone treatment.

However, no significant increase in dysfunction was associated with either serum testosterone or serum prolactin levels.

There was a significant association between TSH and duration of treatment, but levels remained within the normal range.

Sexual function was evaluated with a 28-question form using rating scales from 1 to 100 for libido, erectile dysfunction, and orgasm dysfunction, and with patient interviews about medical history and ongoing use of alcohol or other drugs.

“We didn't find the alterations in testosterone [with methadone dosage] that we expected,” Dr. Brown said.

In the 1970s, several studies measured testosterone levels of methadone patients without relating it to dosage, he noted at the conference, also sponsored by Brown Medical School.

Some studies showed a drop in testosterone associated with dosage greater than 60 mg, but other studies failed to show any difference.

“Sexual dysfunction in men on methadone maintenance should be evaluated in accordance with guidelines established for the general population,” he said.

However, if orgasm dysfunction negatively affects a patient's quality of life to the extent that he considers discontinuing the methadone, a trial short-term dose reduction may be helpful.

WASHINGTON – Increased doses of methadone may be good for opioid dependence, but they might not be good for a patient's sex life.

“Although it hasn't been well studied in [methadone patients], we know that sexual dysfunction as a side effect can interfere with compliance in a clinical setting,” Randall Brown, M.D., said at the annual conference of the Association for Medical Education and Research in Substance Abuse.

Methadone is among the most popular treatments for opioid dependence; it has been shown to reduce opiate use and mortality, and psychosocial outcomes for patients include lower crime rates and improved employment status.

Side effects from methadone use include weight gain, insomnia, and constipation, but sexual dysfunction could be a “deal breaker” for some patients.

Between 30% and 100% of methadone patients report sexual dysfunction problems, with men mostly reporting problems with libido and maintaining erections, said Dr. Brown, who conducted a cross-sectional study as part of a primary care fellowship at the University of Wisconsin.

Dr. Brown's work was funded in part by an NIH research grant. To assess whether the likelihood and severity of sexual dysfunction increased with higher doses, he compared 16 new patients who started methadone as therapy for opioid addiction with 76 men who had been involved in methadone maintenance for at least 60 days.

Overall, 14% of the men across both groups reported some sexual dysfunction, which is similar to male sexual dysfunction rates in the general population. A dose increase was significantly associated with orgasm dysfunction, before and after adjusting for the duration of methadone treatment.

However, no significant increase in dysfunction was associated with either serum testosterone or serum prolactin levels.

There was a significant association between TSH and duration of treatment, but levels remained within the normal range.

Sexual function was evaluated with a 28-question form using rating scales from 1 to 100 for libido, erectile dysfunction, and orgasm dysfunction, and with patient interviews about medical history and ongoing use of alcohol or other drugs.

“We didn't find the alterations in testosterone [with methadone dosage] that we expected,” Dr. Brown said.

In the 1970s, several studies measured testosterone levels of methadone patients without relating it to dosage, he noted at the conference, also sponsored by Brown Medical School.

Some studies showed a drop in testosterone associated with dosage greater than 60 mg, but other studies failed to show any difference.

“Sexual dysfunction in men on methadone maintenance should be evaluated in accordance with guidelines established for the general population,” he said.

However, if orgasm dysfunction negatively affects a patient's quality of life to the extent that he considers discontinuing the methadone, a trial short-term dose reduction may be helpful.

WASHINGTON – The presence of pain in older adults is a significant risk factor for clinical depression, Stephen Harkins, Ph.D., said at the annual meeting of the Gerontological Society of America.

Poorly managed pain lowers quality of life in older persons across cultures, said Dr. Harkins, professor in the departments of gerontology, psychiatry, and biomedical engineering at Virginia Commonwealth University in Richmond.

He reviewed data on 2,900 adults (mean age 75 years) from the National Health and Nutrition Examination Survey and 2,081 adults (mean age 78 years) from the Australian Longitudinal Study on Aging. Both the American and Australian studies included data on musculoskeletal pain, including swollen joints and hip, back, knee, and neck pain.

Mean scores on the Center for Epidemiologic Studies-Depression (CES-D) scale were similar for older adults in the United States (9.3) and Australia (8.2). Overall, 47% of the adults surveyed reported pain in the past week, and the risk of depression was independently related to the presence, type, and number of musculoskeletal problems.

“The take-home message is that pain increases the probability of scoring high on a depression scale,” said Dr. Harkins, who also is director of the psychophysiology and memory laboratory at the university.

WASHINGTON – The presence of pain in older adults is a significant risk factor for clinical depression, Stephen Harkins, Ph.D., said at the annual meeting of the Gerontological Society of America.

Poorly managed pain lowers quality of life in older persons across cultures, said Dr. Harkins, professor in the departments of gerontology, psychiatry, and biomedical engineering at Virginia Commonwealth University in Richmond.

He reviewed data on 2,900 adults (mean age 75 years) from the National Health and Nutrition Examination Survey and 2,081 adults (mean age 78 years) from the Australian Longitudinal Study on Aging. Both the American and Australian studies included data on musculoskeletal pain, including swollen joints and hip, back, knee, and neck pain.

Mean scores on the Center for Epidemiologic Studies-Depression (CES-D) scale were similar for older adults in the United States (9.3) and Australia (8.2). Overall, 47% of the adults surveyed reported pain in the past week, and the risk of depression was independently related to the presence, type, and number of musculoskeletal problems.

“The take-home message is that pain increases the probability of scoring high on a depression scale,” said Dr. Harkins, who also is director of the psychophysiology and memory laboratory at the university.

WASHINGTON – The presence of pain in older adults is a significant risk factor for clinical depression, Stephen Harkins, Ph.D., said at the annual meeting of the Gerontological Society of America.

Poorly managed pain lowers quality of life in older persons across cultures, said Dr. Harkins, professor in the departments of gerontology, psychiatry, and biomedical engineering at Virginia Commonwealth University in Richmond.

He reviewed data on 2,900 adults (mean age 75 years) from the National Health and Nutrition Examination Survey and 2,081 adults (mean age 78 years) from the Australian Longitudinal Study on Aging. Both the American and Australian studies included data on musculoskeletal pain, including swollen joints and hip, back, knee, and neck pain.

Mean scores on the Center for Epidemiologic Studies-Depression (CES-D) scale were similar for older adults in the United States (9.3) and Australia (8.2). Overall, 47% of the adults surveyed reported pain in the past week, and the risk of depression was independently related to the presence, type, and number of musculoskeletal problems.

“The take-home message is that pain increases the probability of scoring high on a depression scale,” said Dr. Harkins, who also is director of the psychophysiology and memory laboratory at the university.