Heidi Splete

WASHINGTON — Most primary care physicians in West Virginia believe that their resources are adequate for colorectal cancer screening despite perceived barriers including patient inconvenience and physician reimbursement, Cathy A. Coyne, Ph.D., reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Dr. Coyne, of the department of community medicine at West Virginia University, Charleston, compared the attitudes and practices of West Virginia physicians with a national survey conducted by the National Cancer Institute in 2000.

In a survey of 569 West Virginia-based primary care physicians, more than 96% said that they recommended colorectal cancer screening to average-risk patients. Of these, 31% reported recommending a colonoscopy, compared with 3%-13% of primary care doctors who responded to the NCI survey. By contrast, 7.5% of the West Virginia doctors reported recommending a fecal occult blood test, compared with 22%-30% of doctors in the NCI survey. Although 19% of West Virginia physicians reported using a digital rectal exam plus a fecal occult blood test in their offices, the NCI survey did not include a DRE, since it is not a nationally recommended screening method.

The U.S. Agency for Healthcare Research and Quality recommends colorectal screening for all average-risk adults aged 50 years and older using any of several methods including fecal occult blood testing every year, flexible sigmoidoscopy every 5 years, combined use of fecal occult blood testing every year and flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 to 10 years, or colonoscopy every 10 years.

Colonoscopy was the most frequently recommended screening method, but it was also the procedure most often associated with barriers. Nearly 60% of the West Virginia physicians reported patient inconvenience as a barrier to colonoscopy, 47% reported patient refusal or poor compliance, and 39% reported reimbursement problems. Test inconvenience for patients, patient refusal or poor compliance, and physician reimbursement were also the most common barriers to fecal occult blood tests and flexible sigmoidoscopy reported by the physicians.

Given these perceived barriers, “we were surprised that most of the doctors reported that their capacity to conduct colorectal screening was sufficient to meet the local demand,” Dr. Coyne said in an interview.

Although 77% of the physicians reported that more than 50% of their patients were complying with recommended colorectal screening guidelines, data from the 2001 Behavioral Risk Factor Surveillance System in West Virginia show that only 30% of adults aged 50 years and older were screened for colorectal cancer.

WASHINGTON — Most primary care physicians in West Virginia believe that their resources are adequate for colorectal cancer screening despite perceived barriers including patient inconvenience and physician reimbursement, Cathy A. Coyne, Ph.D., reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Dr. Coyne, of the department of community medicine at West Virginia University, Charleston, compared the attitudes and practices of West Virginia physicians with a national survey conducted by the National Cancer Institute in 2000.

In a survey of 569 West Virginia-based primary care physicians, more than 96% said that they recommended colorectal cancer screening to average-risk patients. Of these, 31% reported recommending a colonoscopy, compared with 3%-13% of primary care doctors who responded to the NCI survey. By contrast, 7.5% of the West Virginia doctors reported recommending a fecal occult blood test, compared with 22%-30% of doctors in the NCI survey. Although 19% of West Virginia physicians reported using a digital rectal exam plus a fecal occult blood test in their offices, the NCI survey did not include a DRE, since it is not a nationally recommended screening method.

The U.S. Agency for Healthcare Research and Quality recommends colorectal screening for all average-risk adults aged 50 years and older using any of several methods including fecal occult blood testing every year, flexible sigmoidoscopy every 5 years, combined use of fecal occult blood testing every year and flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 to 10 years, or colonoscopy every 10 years.

Colonoscopy was the most frequently recommended screening method, but it was also the procedure most often associated with barriers. Nearly 60% of the West Virginia physicians reported patient inconvenience as a barrier to colonoscopy, 47% reported patient refusal or poor compliance, and 39% reported reimbursement problems. Test inconvenience for patients, patient refusal or poor compliance, and physician reimbursement were also the most common barriers to fecal occult blood tests and flexible sigmoidoscopy reported by the physicians.

Given these perceived barriers, “we were surprised that most of the doctors reported that their capacity to conduct colorectal screening was sufficient to meet the local demand,” Dr. Coyne said in an interview.

Although 77% of the physicians reported that more than 50% of their patients were complying with recommended colorectal screening guidelines, data from the 2001 Behavioral Risk Factor Surveillance System in West Virginia show that only 30% of adults aged 50 years and older were screened for colorectal cancer.

WASHINGTON — Most primary care physicians in West Virginia believe that their resources are adequate for colorectal cancer screening despite perceived barriers including patient inconvenience and physician reimbursement, Cathy A. Coyne, Ph.D., reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Dr. Coyne, of the department of community medicine at West Virginia University, Charleston, compared the attitudes and practices of West Virginia physicians with a national survey conducted by the National Cancer Institute in 2000.

In a survey of 569 West Virginia-based primary care physicians, more than 96% said that they recommended colorectal cancer screening to average-risk patients. Of these, 31% reported recommending a colonoscopy, compared with 3%-13% of primary care doctors who responded to the NCI survey. By contrast, 7.5% of the West Virginia doctors reported recommending a fecal occult blood test, compared with 22%-30% of doctors in the NCI survey. Although 19% of West Virginia physicians reported using a digital rectal exam plus a fecal occult blood test in their offices, the NCI survey did not include a DRE, since it is not a nationally recommended screening method.

The U.S. Agency for Healthcare Research and Quality recommends colorectal screening for all average-risk adults aged 50 years and older using any of several methods including fecal occult blood testing every year, flexible sigmoidoscopy every 5 years, combined use of fecal occult blood testing every year and flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 to 10 years, or colonoscopy every 10 years.

Colonoscopy was the most frequently recommended screening method, but it was also the procedure most often associated with barriers. Nearly 60% of the West Virginia physicians reported patient inconvenience as a barrier to colonoscopy, 47% reported patient refusal or poor compliance, and 39% reported reimbursement problems. Test inconvenience for patients, patient refusal or poor compliance, and physician reimbursement were also the most common barriers to fecal occult blood tests and flexible sigmoidoscopy reported by the physicians.

Given these perceived barriers, “we were surprised that most of the doctors reported that their capacity to conduct colorectal screening was sufficient to meet the local demand,” Dr. Coyne said in an interview.

Although 77% of the physicians reported that more than 50% of their patients were complying with recommended colorectal screening guidelines, data from the 2001 Behavioral Risk Factor Surveillance System in West Virginia show that only 30% of adults aged 50 years and older were screened for colorectal cancer.

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 rates of new HIV infections, wrote Dr. Cadoff of the University of Medicine and Dentistry of New Jersey.

The test requires an oral fluid sample, rather than a blood sample, and delivers results in 20-40 minutes.

Rapid testing in New Jersey began in November 2003 at publicly funded counseling and testing sites throughout the state. After the first 1,000 results, the seropositive rate increased to 4.72%, almost double the 2.36% seropositive rate recorded with traditional testing during the previous year.

Overall, 63% of the people who tested positive had not previously 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 rates of new HIV infections, wrote Dr. Cadoff of the University of Medicine and Dentistry of New Jersey.

The test requires an oral fluid sample, rather than a blood sample, and delivers results in 20-40 minutes.

Rapid testing in New Jersey began in November 2003 at publicly funded counseling and testing sites throughout the state. After the first 1,000 results, the seropositive rate increased to 4.72%, almost double the 2.36% seropositive rate recorded with traditional testing during the previous year.

Overall, 63% of the people who tested positive had not previously 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 rates of new HIV infections, wrote Dr. Cadoff of the University of Medicine and Dentistry of New Jersey.

The test requires an oral fluid sample, rather than a blood sample, and delivers results in 20-40 minutes.

Rapid testing in New Jersey began in November 2003 at publicly funded counseling and testing sites throughout the state. After the first 1,000 results, the seropositive rate increased to 4.72%, almost double the 2.36% seropositive rate recorded with traditional testing during the previous year.

Overall, 63% of the people who tested positive had not previously 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.

BETHESDA, MD. — Alcohol, diethylstilbestrol exposure, and family history are potential risk factors for fibroids, according to several recent studies presented at an international conference on uterine leiomyoma research.

Data from one study of nearly 1,500 women conducted by the National Institute of Environmental Health Sciences identified prenatal diethylstilbestrol (DES) exposure and young age at menarche as fibroid risk factors. The study's purpose was to explore the epidemiology of fibroids by examining hormonal, inflammatory, and metabolic risk factors, reported Donna Day Baird, Ph.D.

Dr. Baird, a senior epidemiologist with the NIEHS, and her colleagues used data from the Nurses' Health Study and the Black Women's Health Study to identify a random sample of 1,482 pre- and postmenopausal women (aged 39-49 years) who had fibroids. The presence of fibroids was confirmed by ultrasound (73%), surgery (6%), or self-reports (21%).

Results from the study supported previously known fibroid risk factors of African American ethnicity and age older than 35 years. Approximately half the African American women had been diagnosed with fibroids before enrolling in the study. Among all the women without a previous diagnosis, fibroids also were more common among African American women, especially among the younger age groups.

In a logistic regression analysis, the cumulative incidence of fibroids among black women was 60% at age 35 years and 80% by the age of menopause. Among white women, the incidence was less than 40% at age 35 years and almost 70% by the age of menopause.

Prenatal exposure to DES was significantly associated with the presence of fibroids, Dr. Baird said at the conference sponsored by the National Institutes of Health.

The women in the study all had the potential for DES exposure, since they were born during the time when DES was used as potential therapy for problem pregnancies. The exposure data were based on self-reports, categorized as “yes,” “no,” and “maybe.” Five black women reported definite exposure, and all five had fibroids, as did 14 of 19 white women who reported exposure. “Adjusting for age, there is a significant association between DES exposure and the development of fibroids, and it is stronger for large fibroids than for small fibroids,” Dr. Baird said.

Overall, 26% of the women who reported definite DES exposure had fibroids that were at least 4 cm, compared with 20% of those who reported possible exposure and 15% of those who reported no exposure. This association remained statistically significant after controlling for several factors, including age at menarche, BMI, parity, and maternal history of fibroids.

An examination of other hormonal and reproductive factors showed that an older age of menarche was protective in both blacks and whites, with adjusted odds ratios of 0.8 for both races. An age of younger than 25 years at the birth of the first child tended toward increased risk, but the association was not statistically significant.

As for metabolism-related factors, body mass index was related to increased risk among blacks, but not whites, and exercise was protective regardless of race.

Factors that were not significantly associated with fibroids in the study population included infertility, breast-feeding, oral contraceptive use, IUD use, caffeine use, and smoking.

A poster presented at the meeting by Aimee A. D'Aloisi of the University of North Carolina, Chapel Hill, and associates used data on 1,324 women from Dr. Baird's NIEHS data set to assess alcohol consumption as a risk factor for fibroids.

Alcohol exposure was based on patient interviews and self-reports of alcohol intake at age 30 years. Based on the Bayesian method of assessing tumor incidence followed by growth, an increased number of drinks consumed weekly was strongly associated with an increased incidence of uterine fibroids (Bayes factor 244), but only minimally associated with an increase in tumor growth (Bayes factor 1.8). The increase in incidence was evident even among women who reported as few as 0.5-2 drinks weekly.

Among black women, a strong association appeared between increasing incidence of fibroids and increasing number of drinks weekly (Bayes factor 15). However, the increased incidence of fibroids among black women occurred primarily among those who reported consuming seven or more drinks weekly, rather than among those who reported a lower weekly alcohol intake. The association between increased alcohol consumption and tumor growth was only slightly higher among black women compared with the overall cohort (Bayes factor 3.9). Overall, the results suggest that alcohol intake may be involved in the onset, but not necessarily the progression, of uterine fibroids.

Data from a separate study indicated that having a mother who had fibroids was highly predictive of fibroids in her daughter. In a regression analysis of 400 fibroid patients and 146 controls aged 25-64 years, the odds ratio for fibroids was 6.8 in daughters of mothers with fibroids, wrote Kristen Kjerulff, Ph.D., of Pennsylvania State University, and colleagues, in a poster presented at the meeting.

The association between a daughter's development of fibroids if her mother had them was highly significant after controlling for age, race, years of oral contraceptive use, smoking status, body mass index, age of first menarche, parity, and education.

BETHESDA, MD. — Alcohol, diethylstilbestrol exposure, and family history are potential risk factors for fibroids, according to several recent studies presented at an international conference on uterine leiomyoma research.

Data from one study of nearly 1,500 women conducted by the National Institute of Environmental Health Sciences identified prenatal diethylstilbestrol (DES) exposure and young age at menarche as fibroid risk factors. The study's purpose was to explore the epidemiology of fibroids by examining hormonal, inflammatory, and metabolic risk factors, reported Donna Day Baird, Ph.D.

Dr. Baird, a senior epidemiologist with the NIEHS, and her colleagues used data from the Nurses' Health Study and the Black Women's Health Study to identify a random sample of 1,482 pre- and postmenopausal women (aged 39-49 years) who had fibroids. The presence of fibroids was confirmed by ultrasound (73%), surgery (6%), or self-reports (21%).

Results from the study supported previously known fibroid risk factors of African American ethnicity and age older than 35 years. Approximately half the African American women had been diagnosed with fibroids before enrolling in the study. Among all the women without a previous diagnosis, fibroids also were more common among African American women, especially among the younger age groups.

In a logistic regression analysis, the cumulative incidence of fibroids among black women was 60% at age 35 years and 80% by the age of menopause. Among white women, the incidence was less than 40% at age 35 years and almost 70% by the age of menopause.

Prenatal exposure to DES was significantly associated with the presence of fibroids, Dr. Baird said at the conference sponsored by the National Institutes of Health.

The women in the study all had the potential for DES exposure, since they were born during the time when DES was used as potential therapy for problem pregnancies. The exposure data were based on self-reports, categorized as “yes,” “no,” and “maybe.” Five black women reported definite exposure, and all five had fibroids, as did 14 of 19 white women who reported exposure. “Adjusting for age, there is a significant association between DES exposure and the development of fibroids, and it is stronger for large fibroids than for small fibroids,” Dr. Baird said.

Overall, 26% of the women who reported definite DES exposure had fibroids that were at least 4 cm, compared with 20% of those who reported possible exposure and 15% of those who reported no exposure. This association remained statistically significant after controlling for several factors, including age at menarche, BMI, parity, and maternal history of fibroids.

An examination of other hormonal and reproductive factors showed that an older age of menarche was protective in both blacks and whites, with adjusted odds ratios of 0.8 for both races. An age of younger than 25 years at the birth of the first child tended toward increased risk, but the association was not statistically significant.

As for metabolism-related factors, body mass index was related to increased risk among blacks, but not whites, and exercise was protective regardless of race.

Factors that were not significantly associated with fibroids in the study population included infertility, breast-feeding, oral contraceptive use, IUD use, caffeine use, and smoking.

A poster presented at the meeting by Aimee A. D'Aloisi of the University of North Carolina, Chapel Hill, and associates used data on 1,324 women from Dr. Baird's NIEHS data set to assess alcohol consumption as a risk factor for fibroids.

Alcohol exposure was based on patient interviews and self-reports of alcohol intake at age 30 years. Based on the Bayesian method of assessing tumor incidence followed by growth, an increased number of drinks consumed weekly was strongly associated with an increased incidence of uterine fibroids (Bayes factor 244), but only minimally associated with an increase in tumor growth (Bayes factor 1.8). The increase in incidence was evident even among women who reported as few as 0.5-2 drinks weekly.

Among black women, a strong association appeared between increasing incidence of fibroids and increasing number of drinks weekly (Bayes factor 15). However, the increased incidence of fibroids among black women occurred primarily among those who reported consuming seven or more drinks weekly, rather than among those who reported a lower weekly alcohol intake. The association between increased alcohol consumption and tumor growth was only slightly higher among black women compared with the overall cohort (Bayes factor 3.9). Overall, the results suggest that alcohol intake may be involved in the onset, but not necessarily the progression, of uterine fibroids.

Data from a separate study indicated that having a mother who had fibroids was highly predictive of fibroids in her daughter. In a regression analysis of 400 fibroid patients and 146 controls aged 25-64 years, the odds ratio for fibroids was 6.8 in daughters of mothers with fibroids, wrote Kristen Kjerulff, Ph.D., of Pennsylvania State University, and colleagues, in a poster presented at the meeting.

The association between a daughter's development of fibroids if her mother had them was highly significant after controlling for age, race, years of oral contraceptive use, smoking status, body mass index, age of first menarche, parity, and education.

BETHESDA, MD. — Alcohol, diethylstilbestrol exposure, and family history are potential risk factors for fibroids, according to several recent studies presented at an international conference on uterine leiomyoma research.

Data from one study of nearly 1,500 women conducted by the National Institute of Environmental Health Sciences identified prenatal diethylstilbestrol (DES) exposure and young age at menarche as fibroid risk factors. The study's purpose was to explore the epidemiology of fibroids by examining hormonal, inflammatory, and metabolic risk factors, reported Donna Day Baird, Ph.D.

Dr. Baird, a senior epidemiologist with the NIEHS, and her colleagues used data from the Nurses' Health Study and the Black Women's Health Study to identify a random sample of 1,482 pre- and postmenopausal women (aged 39-49 years) who had fibroids. The presence of fibroids was confirmed by ultrasound (73%), surgery (6%), or self-reports (21%).

Results from the study supported previously known fibroid risk factors of African American ethnicity and age older than 35 years. Approximately half the African American women had been diagnosed with fibroids before enrolling in the study. Among all the women without a previous diagnosis, fibroids also were more common among African American women, especially among the younger age groups.

In a logistic regression analysis, the cumulative incidence of fibroids among black women was 60% at age 35 years and 80% by the age of menopause. Among white women, the incidence was less than 40% at age 35 years and almost 70% by the age of menopause.

Prenatal exposure to DES was significantly associated with the presence of fibroids, Dr. Baird said at the conference sponsored by the National Institutes of Health.

The women in the study all had the potential for DES exposure, since they were born during the time when DES was used as potential therapy for problem pregnancies. The exposure data were based on self-reports, categorized as “yes,” “no,” and “maybe.” Five black women reported definite exposure, and all five had fibroids, as did 14 of 19 white women who reported exposure. “Adjusting for age, there is a significant association between DES exposure and the development of fibroids, and it is stronger for large fibroids than for small fibroids,” Dr. Baird said.

Overall, 26% of the women who reported definite DES exposure had fibroids that were at least 4 cm, compared with 20% of those who reported possible exposure and 15% of those who reported no exposure. This association remained statistically significant after controlling for several factors, including age at menarche, BMI, parity, and maternal history of fibroids.

An examination of other hormonal and reproductive factors showed that an older age of menarche was protective in both blacks and whites, with adjusted odds ratios of 0.8 for both races. An age of younger than 25 years at the birth of the first child tended toward increased risk, but the association was not statistically significant.

As for metabolism-related factors, body mass index was related to increased risk among blacks, but not whites, and exercise was protective regardless of race.

Factors that were not significantly associated with fibroids in the study population included infertility, breast-feeding, oral contraceptive use, IUD use, caffeine use, and smoking.

A poster presented at the meeting by Aimee A. D'Aloisi of the University of North Carolina, Chapel Hill, and associates used data on 1,324 women from Dr. Baird's NIEHS data set to assess alcohol consumption as a risk factor for fibroids.

Alcohol exposure was based on patient interviews and self-reports of alcohol intake at age 30 years. Based on the Bayesian method of assessing tumor incidence followed by growth, an increased number of drinks consumed weekly was strongly associated with an increased incidence of uterine fibroids (Bayes factor 244), but only minimally associated with an increase in tumor growth (Bayes factor 1.8). The increase in incidence was evident even among women who reported as few as 0.5-2 drinks weekly.

Among black women, a strong association appeared between increasing incidence of fibroids and increasing number of drinks weekly (Bayes factor 15). However, the increased incidence of fibroids among black women occurred primarily among those who reported consuming seven or more drinks weekly, rather than among those who reported a lower weekly alcohol intake. The association between increased alcohol consumption and tumor growth was only slightly higher among black women compared with the overall cohort (Bayes factor 3.9). Overall, the results suggest that alcohol intake may be involved in the onset, but not necessarily the progression, of uterine fibroids.

Data from a separate study indicated that having a mother who had fibroids was highly predictive of fibroids in her daughter. In a regression analysis of 400 fibroid patients and 146 controls aged 25-64 years, the odds ratio for fibroids was 6.8 in daughters of mothers with fibroids, wrote Kristen Kjerulff, Ph.D., of Pennsylvania State University, and colleagues, in a poster presented at the meeting.

The association between a daughter's development of fibroids if her mother had them was highly significant after controlling for age, race, years of oral contraceptive use, smoking status, body mass index, age of first menarche, parity, and education.

Salmonella From Turtles

Small pet turtles were linked to four cases of salmonella in children in 2004, according to the Centers for Disease Control and Prevention and the public health departments of Wisconsin and Wyoming (MMWR 2005;54:223-6). A 4-year-old girl from Kansas developed diarrhea and a 4-day fever shortly after vacationing in Wisconsin and purchasing a small turtle at a souvenir store. The girl was treated with trimethoprim/sulfamethoxazole for 3 days and had recovered after 5 days. A 2-year-old boy and a 10-year-old boy in Wisconsin developed similar symptoms, including diarrhea and fever, which were traced to pet turtles purchased from different souvenir shops in Wisconsin. In addition, a 6-year-old boy in Wyoming presented with nausea, diarrhea, vomiting, and a persistent fever. A stool sample yielded S. typhimurium, which was traced to the boy's two pet turtles. Although salmonella infections generally resolve after mild gastroenteritis, they can develop into serious illnesses. Despite an FDA ban on the sale of turtles with a carapace less than 4 inches, local health and environmental officials must consider the potential for infections transmitted by turtles that are sold illegally.

Oseltamivir Eases Asthma During Flu

Treatment with oseltamivir (Tamiflu) within 24 hours of the onset of flu symptoms reduced exacerbations of asthma in children aged 6-12 years, wrote Sebastian L. Johnston, M.D., of Imperial College, London, and his associates (Pediatr. Infect. Dis. J. 2005;24:225-32). In a randomized, double-blind, placebo-controlled 4-week study, the asthmatic children received either 2 mg/kg of oseltamivir or a placebo twice daily as an oral syrup (6 mg/mL). The primary end point—median time to freedom from flu illness—was not significantly different within the intent-to-treat infected population of 179 children; the median was 124 hours in the treatment group, compared with 134 hours in the placebo group. A greater difference appeared in the per protocol population, in which 170 children who took oseltamivir had a 17% reduction in the median length of illness (24 hours). However, children treated with oseltamivir within 24 hours of symptom onset experienced rapid improvement in asthma exacerbation, whereas those in the placebo group initially showed worse symptoms, then improved gradually. Children who presented later than 24 hours after symptom onset recovered steadily regardless of randomization, although the treated children had a higher rate of improvement of asthma. Although oseltamivir generally was well tolerated, approximately half of all the children reported at least one adverse event. Gastrointestinal problems were the most common problem, reported by 16% on oseltamivir and 11% on placebo. In addition, improvement in pulmonary function (FEV1) was significantly greater among the oseltamivir group, compared with the placebo group, after 6 days of treatment (10% vs. 5%).

Bacterial Infections Rare With Flu

Serious bacterial illness occurred in only 16 of 163 (9.8%) children with influenza, compared with 153 of 542 (28.2%) children without flu in a retrospective study of 705 infants aged 0-36 months, according to Hannah F. Smitherman, M.D., and her colleagues at Baylor College of Medicine in Houston. The evaluation of febrile children consumes much office time, and the relatively low prevalence of serious bacterial infections suggests that febrile children with the flu may not need to have blood drawn for cultures, the investigators wrote (Pediatrics 2005;115:710-8). The study included four flu seasons, and children who presented with fever underwent viral testing and blood cultures. Bacteremia was 86% less likely among the children with the flu, compared with those who did not have the flu. In addition, of the 110 children with the flu who underwent urine cultures, only 2 (1.8%) tested positive for urinary tract infections.

Teens Unaware of Hepatitis Risk

Adolescents showed a significant lack of understanding of the risk of hepatitis B from contaminated piercing and tattoo tools, as well as from infected needles and risky sexual behaviors, wrote Amy B. Slonim, Ph.D., of the Michigan Public Health Institute in Okemos, and her associates. In a survey of 17,063 adolescents and young adults aged 13-21 years, 47% could not provide any correct information about hepatitis B vaccination, including 27% who gave no information and 20% who gave incorrect information. Nearly half of those who gave incorrect information thought a vaccination was “something bad.” Clinic staff members who conducted the surveys suggested a strategy for educating teens about hepatitis including examples of how it is contracted, emphasis of the possible severity of the illness (liver cirrhosis) and the safety and effectiveness of the vaccine (J. Adolesc. Health 2005;36:178-86).

Salmonella From Turtles

Small pet turtles were linked to four cases of salmonella in children in 2004, according to the Centers for Disease Control and Prevention and the public health departments of Wisconsin and Wyoming (MMWR 2005;54:223-6). A 4-year-old girl from Kansas developed diarrhea and a 4-day fever shortly after vacationing in Wisconsin and purchasing a small turtle at a souvenir store. The girl was treated with trimethoprim/sulfamethoxazole for 3 days and had recovered after 5 days. A 2-year-old boy and a 10-year-old boy in Wisconsin developed similar symptoms, including diarrhea and fever, which were traced to pet turtles purchased from different souvenir shops in Wisconsin. In addition, a 6-year-old boy in Wyoming presented with nausea, diarrhea, vomiting, and a persistent fever. A stool sample yielded S. typhimurium, which was traced to the boy's two pet turtles. Although salmonella infections generally resolve after mild gastroenteritis, they can develop into serious illnesses. Despite an FDA ban on the sale of turtles with a carapace less than 4 inches, local health and environmental officials must consider the potential for infections transmitted by turtles that are sold illegally.

Oseltamivir Eases Asthma During Flu

Treatment with oseltamivir (Tamiflu) within 24 hours of the onset of flu symptoms reduced exacerbations of asthma in children aged 6-12 years, wrote Sebastian L. Johnston, M.D., of Imperial College, London, and his associates (Pediatr. Infect. Dis. J. 2005;24:225-32). In a randomized, double-blind, placebo-controlled 4-week study, the asthmatic children received either 2 mg/kg of oseltamivir or a placebo twice daily as an oral syrup (6 mg/mL). The primary end point—median time to freedom from flu illness—was not significantly different within the intent-to-treat infected population of 179 children; the median was 124 hours in the treatment group, compared with 134 hours in the placebo group. A greater difference appeared in the per protocol population, in which 170 children who took oseltamivir had a 17% reduction in the median length of illness (24 hours). However, children treated with oseltamivir within 24 hours of symptom onset experienced rapid improvement in asthma exacerbation, whereas those in the placebo group initially showed worse symptoms, then improved gradually. Children who presented later than 24 hours after symptom onset recovered steadily regardless of randomization, although the treated children had a higher rate of improvement of asthma. Although oseltamivir generally was well tolerated, approximately half of all the children reported at least one adverse event. Gastrointestinal problems were the most common problem, reported by 16% on oseltamivir and 11% on placebo. In addition, improvement in pulmonary function (FEV1) was significantly greater among the oseltamivir group, compared with the placebo group, after 6 days of treatment (10% vs. 5%).

Bacterial Infections Rare With Flu

Serious bacterial illness occurred in only 16 of 163 (9.8%) children with influenza, compared with 153 of 542 (28.2%) children without flu in a retrospective study of 705 infants aged 0-36 months, according to Hannah F. Smitherman, M.D., and her colleagues at Baylor College of Medicine in Houston. The evaluation of febrile children consumes much office time, and the relatively low prevalence of serious bacterial infections suggests that febrile children with the flu may not need to have blood drawn for cultures, the investigators wrote (Pediatrics 2005;115:710-8). The study included four flu seasons, and children who presented with fever underwent viral testing and blood cultures. Bacteremia was 86% less likely among the children with the flu, compared with those who did not have the flu. In addition, of the 110 children with the flu who underwent urine cultures, only 2 (1.8%) tested positive for urinary tract infections.

Teens Unaware of Hepatitis Risk

Adolescents showed a significant lack of understanding of the risk of hepatitis B from contaminated piercing and tattoo tools, as well as from infected needles and risky sexual behaviors, wrote Amy B. Slonim, Ph.D., of the Michigan Public Health Institute in Okemos, and her associates. In a survey of 17,063 adolescents and young adults aged 13-21 years, 47% could not provide any correct information about hepatitis B vaccination, including 27% who gave no information and 20% who gave incorrect information. Nearly half of those who gave incorrect information thought a vaccination was “something bad.” Clinic staff members who conducted the surveys suggested a strategy for educating teens about hepatitis including examples of how it is contracted, emphasis of the possible severity of the illness (liver cirrhosis) and the safety and effectiveness of the vaccine (J. Adolesc. Health 2005;36:178-86).

Salmonella From Turtles

Small pet turtles were linked to four cases of salmonella in children in 2004, according to the Centers for Disease Control and Prevention and the public health departments of Wisconsin and Wyoming (MMWR 2005;54:223-6). A 4-year-old girl from Kansas developed diarrhea and a 4-day fever shortly after vacationing in Wisconsin and purchasing a small turtle at a souvenir store. The girl was treated with trimethoprim/sulfamethoxazole for 3 days and had recovered after 5 days. A 2-year-old boy and a 10-year-old boy in Wisconsin developed similar symptoms, including diarrhea and fever, which were traced to pet turtles purchased from different souvenir shops in Wisconsin. In addition, a 6-year-old boy in Wyoming presented with nausea, diarrhea, vomiting, and a persistent fever. A stool sample yielded S. typhimurium, which was traced to the boy's two pet turtles. Although salmonella infections generally resolve after mild gastroenteritis, they can develop into serious illnesses. Despite an FDA ban on the sale of turtles with a carapace less than 4 inches, local health and environmental officials must consider the potential for infections transmitted by turtles that are sold illegally.

Oseltamivir Eases Asthma During Flu

Treatment with oseltamivir (Tamiflu) within 24 hours of the onset of flu symptoms reduced exacerbations of asthma in children aged 6-12 years, wrote Sebastian L. Johnston, M.D., of Imperial College, London, and his associates (Pediatr. Infect. Dis. J. 2005;24:225-32). In a randomized, double-blind, placebo-controlled 4-week study, the asthmatic children received either 2 mg/kg of oseltamivir or a placebo twice daily as an oral syrup (6 mg/mL). The primary end point—median time to freedom from flu illness—was not significantly different within the intent-to-treat infected population of 179 children; the median was 124 hours in the treatment group, compared with 134 hours in the placebo group. A greater difference appeared in the per protocol population, in which 170 children who took oseltamivir had a 17% reduction in the median length of illness (24 hours). However, children treated with oseltamivir within 24 hours of symptom onset experienced rapid improvement in asthma exacerbation, whereas those in the placebo group initially showed worse symptoms, then improved gradually. Children who presented later than 24 hours after symptom onset recovered steadily regardless of randomization, although the treated children had a higher rate of improvement of asthma. Although oseltamivir generally was well tolerated, approximately half of all the children reported at least one adverse event. Gastrointestinal problems were the most common problem, reported by 16% on oseltamivir and 11% on placebo. In addition, improvement in pulmonary function (FEV1) was significantly greater among the oseltamivir group, compared with the placebo group, after 6 days of treatment (10% vs. 5%).

Bacterial Infections Rare With Flu

Serious bacterial illness occurred in only 16 of 163 (9.8%) children with influenza, compared with 153 of 542 (28.2%) children without flu in a retrospective study of 705 infants aged 0-36 months, according to Hannah F. Smitherman, M.D., and her colleagues at Baylor College of Medicine in Houston. The evaluation of febrile children consumes much office time, and the relatively low prevalence of serious bacterial infections suggests that febrile children with the flu may not need to have blood drawn for cultures, the investigators wrote (Pediatrics 2005;115:710-8). The study included four flu seasons, and children who presented with fever underwent viral testing and blood cultures. Bacteremia was 86% less likely among the children with the flu, compared with those who did not have the flu. In addition, of the 110 children with the flu who underwent urine cultures, only 2 (1.8%) tested positive for urinary tract infections.

Teens Unaware of Hepatitis Risk

Adolescents showed a significant lack of understanding of the risk of hepatitis B from contaminated piercing and tattoo tools, as well as from infected needles and risky sexual behaviors, wrote Amy B. Slonim, Ph.D., of the Michigan Public Health Institute in Okemos, and her associates. In a survey of 17,063 adolescents and young adults aged 13-21 years, 47% could not provide any correct information about hepatitis B vaccination, including 27% who gave no information and 20% who gave incorrect information. Nearly half of those who gave incorrect information thought a vaccination was “something bad.” Clinic staff members who conducted the surveys suggested a strategy for educating teens about hepatitis including examples of how it is contracted, emphasis of the possible severity of the illness (liver cirrhosis) and the safety and effectiveness of the vaccine (J. Adolesc. Health 2005;36:178-86).

BETHESDA, MD. — Alcohol, diethylstilbestrol exposure, and family history are potential risk factors for fibroids, several recent studies have found. The results were presented at an international conference on uterine leiomyoma research, sponsored by the National Institutes of Health.

Data from one study of nearly 1,500 women conducted by the National Institute of Environmental Health Sciences identified prenatal diethylstilbestrol (DES) exposure and young age at menarche as fibroid risk factors. The study's purpose was to explore the epidemiology of fibroids by examining hormonal, inflammatory, and metabolic risk factors, reported Donna Day Baird, Ph.D.

Dr. Baird, a senior epidemiologist with the NIEHS, and her colleagues used data from the Nurses' Health Study and the Black Women's Health Study to identify a random sample of 1,482 pre- and postmenopausal women (aged 39-49 years) who had fibroids. The presence of fibroids was confirmed by ultrasound (73%), surgery (6%), or self-reports (21%).

Results from the study supported previously known fibroid risk factors of African American ethnicity and age older than 35 years. Approximately half the African American women had been diagnosed with fibroids before enrolling in the study. Among all the women without a previous diagnosis, fibroids also were more common among African American women, especially among the younger age groups.

In a logistic regression analysis, the cumulative incidence of fibroids among black women was 60% at age 35 years and 80% by the age of menopause. Among white women, the incidence was less than 40% at age 35 years and almost 70% by the age of menopause.

Prenatal exposure to DES was significantly associated with the presence of fibroids, Dr. Baird said.

The women in the study all had the potential for DES exposure, since they were born during the time when DES was used as potential therapy for problem pregnancies. The exposure data were based on self-reports, categorized as “yes,” “no,” and “maybe.” Five black women reported definite exposure, and all five had fibroids, as did 14 of 19 white women who reported exposure. “Adjusting for age, there is a significant association between DES exposure and the development of fibroids, and it is stronger for large fibroids than for small fibroids,” Dr. Baird said.

Overall, 26% of the women who reported definite DES exposure had fibroids that were at least 4 cm, compared with 20% of those who reported possible exposure and 15% of those who reported no exposure. This association remained statistically significant after controlling for several factors, including age at menarche, BMI, parity, and maternal history of fibroids.

An examination of other hormonal and reproductive factors showed that an older age of menarche was protective in both blacks and whites, with adjusted odds ratios of 0.8 for both races.

As for metabolism-related factors, body mass index was related to increased risk among blacks, but not whites, and exercise was protective regardless of race.

Factors that were not significantly associated with fibroids in the study population included infertility, breast-feeding, oral contraceptive use, IUD use, caffeine use, and smoking.

A poster presented at the meeting by Aimee A. D'Aloisi of the University of North Carolina, Chapel Hill, and associates used data on 1,324 women from Dr. Baird's NIEHS data set to assess alcohol consumption as a risk factor for fibroids.

Alcohol exposure was based on patient interviews and self-reports of alcohol intake at age 30 years. Based on the Bayesian method of assessing tumor incidence followed by growth, an increased number of drinks consumed weekly was strongly associated with an increased incidence of uterine fibroids (Bayes factor 244), but only minimally associated with an increase in tumor growth (Bayes factor 1.8). The increase in incidence was evident even among women who reported as few as 0.5-2 drinks weekly.

Among black women, a strong association appeared between increasing incidence of fibroids and increasing number of drinks weekly (Bayes factor 15). However, the increased incidence of fibroids among black women occurred primarily among those who reported consuming seven or more drinks weekly, rather than among those who reported a lower weekly alcohol intake. The association between increased alcohol consumption and tumor growth was only slightly higher among black women compared with the overall cohort (Bayes factor 3.9). Overall, the results suggest that alcohol intake may be involved in the onset, but not necessarily the progression, of uterine fibroids.

Data from a separate study indicated that having a mother who had fibroids was highly predictive of fibroids in her daughter. In a regression analysis of 400 fibroid patients and 146 controls aged 25-64 years, the odds ratio for fibroids was 6.8 in daughters of mothers with fibroids, wrote Kristen Kjerulff, Ph.D., of Pennsylvania State University, and colleagues, in a poster presented at the meeting.

The association between a daughter's development of fibroids if her mother had them was highly significant after controlling for factors such as age, race, years of oral contraceptive use and smoking status.

BETHESDA, MD. — Alcohol, diethylstilbestrol exposure, and family history are potential risk factors for fibroids, several recent studies have found. The results were presented at an international conference on uterine leiomyoma research, sponsored by the National Institutes of Health.

Data from one study of nearly 1,500 women conducted by the National Institute of Environmental Health Sciences identified prenatal diethylstilbestrol (DES) exposure and young age at menarche as fibroid risk factors. The study's purpose was to explore the epidemiology of fibroids by examining hormonal, inflammatory, and metabolic risk factors, reported Donna Day Baird, Ph.D.

Dr. Baird, a senior epidemiologist with the NIEHS, and her colleagues used data from the Nurses' Health Study and the Black Women's Health Study to identify a random sample of 1,482 pre- and postmenopausal women (aged 39-49 years) who had fibroids. The presence of fibroids was confirmed by ultrasound (73%), surgery (6%), or self-reports (21%).

Results from the study supported previously known fibroid risk factors of African American ethnicity and age older than 35 years. Approximately half the African American women had been diagnosed with fibroids before enrolling in the study. Among all the women without a previous diagnosis, fibroids also were more common among African American women, especially among the younger age groups.

In a logistic regression analysis, the cumulative incidence of fibroids among black women was 60% at age 35 years and 80% by the age of menopause. Among white women, the incidence was less than 40% at age 35 years and almost 70% by the age of menopause.

Prenatal exposure to DES was significantly associated with the presence of fibroids, Dr. Baird said.

The women in the study all had the potential for DES exposure, since they were born during the time when DES was used as potential therapy for problem pregnancies. The exposure data were based on self-reports, categorized as “yes,” “no,” and “maybe.” Five black women reported definite exposure, and all five had fibroids, as did 14 of 19 white women who reported exposure. “Adjusting for age, there is a significant association between DES exposure and the development of fibroids, and it is stronger for large fibroids than for small fibroids,” Dr. Baird said.

Overall, 26% of the women who reported definite DES exposure had fibroids that were at least 4 cm, compared with 20% of those who reported possible exposure and 15% of those who reported no exposure. This association remained statistically significant after controlling for several factors, including age at menarche, BMI, parity, and maternal history of fibroids.

An examination of other hormonal and reproductive factors showed that an older age of menarche was protective in both blacks and whites, with adjusted odds ratios of 0.8 for both races.

As for metabolism-related factors, body mass index was related to increased risk among blacks, but not whites, and exercise was protective regardless of race.

Factors that were not significantly associated with fibroids in the study population included infertility, breast-feeding, oral contraceptive use, IUD use, caffeine use, and smoking.

A poster presented at the meeting by Aimee A. D'Aloisi of the University of North Carolina, Chapel Hill, and associates used data on 1,324 women from Dr. Baird's NIEHS data set to assess alcohol consumption as a risk factor for fibroids.

Alcohol exposure was based on patient interviews and self-reports of alcohol intake at age 30 years. Based on the Bayesian method of assessing tumor incidence followed by growth, an increased number of drinks consumed weekly was strongly associated with an increased incidence of uterine fibroids (Bayes factor 244), but only minimally associated with an increase in tumor growth (Bayes factor 1.8). The increase in incidence was evident even among women who reported as few as 0.5-2 drinks weekly.

Among black women, a strong association appeared between increasing incidence of fibroids and increasing number of drinks weekly (Bayes factor 15). However, the increased incidence of fibroids among black women occurred primarily among those who reported consuming seven or more drinks weekly, rather than among those who reported a lower weekly alcohol intake. The association between increased alcohol consumption and tumor growth was only slightly higher among black women compared with the overall cohort (Bayes factor 3.9). Overall, the results suggest that alcohol intake may be involved in the onset, but not necessarily the progression, of uterine fibroids.

Data from a separate study indicated that having a mother who had fibroids was highly predictive of fibroids in her daughter. In a regression analysis of 400 fibroid patients and 146 controls aged 25-64 years, the odds ratio for fibroids was 6.8 in daughters of mothers with fibroids, wrote Kristen Kjerulff, Ph.D., of Pennsylvania State University, and colleagues, in a poster presented at the meeting.

The association between a daughter's development of fibroids if her mother had them was highly significant after controlling for factors such as age, race, years of oral contraceptive use and smoking status.

BETHESDA, MD. — Alcohol, diethylstilbestrol exposure, and family history are potential risk factors for fibroids, several recent studies have found. The results were presented at an international conference on uterine leiomyoma research, sponsored by the National Institutes of Health.

Data from one study of nearly 1,500 women conducted by the National Institute of Environmental Health Sciences identified prenatal diethylstilbestrol (DES) exposure and young age at menarche as fibroid risk factors. The study's purpose was to explore the epidemiology of fibroids by examining hormonal, inflammatory, and metabolic risk factors, reported Donna Day Baird, Ph.D.

Dr. Baird, a senior epidemiologist with the NIEHS, and her colleagues used data from the Nurses' Health Study and the Black Women's Health Study to identify a random sample of 1,482 pre- and postmenopausal women (aged 39-49 years) who had fibroids. The presence of fibroids was confirmed by ultrasound (73%), surgery (6%), or self-reports (21%).

Results from the study supported previously known fibroid risk factors of African American ethnicity and age older than 35 years. Approximately half the African American women had been diagnosed with fibroids before enrolling in the study. Among all the women without a previous diagnosis, fibroids also were more common among African American women, especially among the younger age groups.

In a logistic regression analysis, the cumulative incidence of fibroids among black women was 60% at age 35 years and 80% by the age of menopause. Among white women, the incidence was less than 40% at age 35 years and almost 70% by the age of menopause.

Prenatal exposure to DES was significantly associated with the presence of fibroids, Dr. Baird said.

The women in the study all had the potential for DES exposure, since they were born during the time when DES was used as potential therapy for problem pregnancies. The exposure data were based on self-reports, categorized as “yes,” “no,” and “maybe.” Five black women reported definite exposure, and all five had fibroids, as did 14 of 19 white women who reported exposure. “Adjusting for age, there is a significant association between DES exposure and the development of fibroids, and it is stronger for large fibroids than for small fibroids,” Dr. Baird said.

Overall, 26% of the women who reported definite DES exposure had fibroids that were at least 4 cm, compared with 20% of those who reported possible exposure and 15% of those who reported no exposure. This association remained statistically significant after controlling for several factors, including age at menarche, BMI, parity, and maternal history of fibroids.

An examination of other hormonal and reproductive factors showed that an older age of menarche was protective in both blacks and whites, with adjusted odds ratios of 0.8 for both races.

As for metabolism-related factors, body mass index was related to increased risk among blacks, but not whites, and exercise was protective regardless of race.

Factors that were not significantly associated with fibroids in the study population included infertility, breast-feeding, oral contraceptive use, IUD use, caffeine use, and smoking.

A poster presented at the meeting by Aimee A. D'Aloisi of the University of North Carolina, Chapel Hill, and associates used data on 1,324 women from Dr. Baird's NIEHS data set to assess alcohol consumption as a risk factor for fibroids.

Alcohol exposure was based on patient interviews and self-reports of alcohol intake at age 30 years. Based on the Bayesian method of assessing tumor incidence followed by growth, an increased number of drinks consumed weekly was strongly associated with an increased incidence of uterine fibroids (Bayes factor 244), but only minimally associated with an increase in tumor growth (Bayes factor 1.8). The increase in incidence was evident even among women who reported as few as 0.5-2 drinks weekly.

Among black women, a strong association appeared between increasing incidence of fibroids and increasing number of drinks weekly (Bayes factor 15). However, the increased incidence of fibroids among black women occurred primarily among those who reported consuming seven or more drinks weekly, rather than among those who reported a lower weekly alcohol intake. The association between increased alcohol consumption and tumor growth was only slightly higher among black women compared with the overall cohort (Bayes factor 3.9). Overall, the results suggest that alcohol intake may be involved in the onset, but not necessarily the progression, of uterine fibroids.

Data from a separate study indicated that having a mother who had fibroids was highly predictive of fibroids in her daughter. In a regression analysis of 400 fibroid patients and 146 controls aged 25-64 years, the odds ratio for fibroids was 6.8 in daughters of mothers with fibroids, wrote Kristen Kjerulff, Ph.D., of Pennsylvania State University, and colleagues, in a poster presented at the meeting.

The association between a daughter's development of fibroids if her mother had them was highly significant after controlling for factors such as age, race, years of oral contraceptive use and smoking status.

PARIS – Depressed children with persistent abdominal pain were significantly more likely than their nondepressed peers to report additional problems such as dizziness, weakness, and heart palpitations, Cheryl Little, M.D., said in a poster presentation at the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

In a study of 243 consecutive cases of children aged 8-15 years who were referred to gastroenterologists for persistent abdominal pain, 52 met the criteria for depression based on the Children's Depression Inventory. The presence of nebulous GI symptoms, such as an upset stomach, in addition to persistent abdominal pain should be a flag to primary care providers to screen for depression, Dr. Little noted.

Depressed children were significantly more likely than nondepressed children to report nonspecific nongastrointestinal symptoms including dizziness (57% vs. 28%, respectively), chest pain (43% vs. 22%), weakness (73% vs. 37%), back pain (47% vs. 26%), fatigue (75% vs. 53%), and heart palpitations (42% vs. 19%), said Dr. Little of Vanderbilt University in Nashville, Tenn.

In addition, the depressed children were significantly more likely than nondepressed children to report GI symptoms, including stomach upset (92% vs. 72%, respectively) and an urge to vomit (82% vs. 58%), in addition to their persistent abdominal pain. Complaints of feeling full were not significantly different between the two groups.

Headaches were common among both depressed (63%) and nondepressed (52%) children in addition to persistent abdominal pain, regardless of their other accompanying symptoms. No gender differences relating to specific symptoms appeared in this study.

PARIS – Depressed children with persistent abdominal pain were significantly more likely than their nondepressed peers to report additional problems such as dizziness, weakness, and heart palpitations, Cheryl Little, M.D., said in a poster presentation at the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

In a study of 243 consecutive cases of children aged 8-15 years who were referred to gastroenterologists for persistent abdominal pain, 52 met the criteria for depression based on the Children's Depression Inventory. The presence of nebulous GI symptoms, such as an upset stomach, in addition to persistent abdominal pain should be a flag to primary care providers to screen for depression, Dr. Little noted.

Depressed children were significantly more likely than nondepressed children to report nonspecific nongastrointestinal symptoms including dizziness (57% vs. 28%, respectively), chest pain (43% vs. 22%), weakness (73% vs. 37%), back pain (47% vs. 26%), fatigue (75% vs. 53%), and heart palpitations (42% vs. 19%), said Dr. Little of Vanderbilt University in Nashville, Tenn.

In addition, the depressed children were significantly more likely than nondepressed children to report GI symptoms, including stomach upset (92% vs. 72%, respectively) and an urge to vomit (82% vs. 58%), in addition to their persistent abdominal pain. Complaints of feeling full were not significantly different between the two groups.

Headaches were common among both depressed (63%) and nondepressed (52%) children in addition to persistent abdominal pain, regardless of their other accompanying symptoms. No gender differences relating to specific symptoms appeared in this study.

PARIS – Depressed children with persistent abdominal pain were significantly more likely than their nondepressed peers to report additional problems such as dizziness, weakness, and heart palpitations, Cheryl Little, M.D., said in a poster presentation at the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

In a study of 243 consecutive cases of children aged 8-15 years who were referred to gastroenterologists for persistent abdominal pain, 52 met the criteria for depression based on the Children's Depression Inventory. The presence of nebulous GI symptoms, such as an upset stomach, in addition to persistent abdominal pain should be a flag to primary care providers to screen for depression, Dr. Little noted.

Depressed children were significantly more likely than nondepressed children to report nonspecific nongastrointestinal symptoms including dizziness (57% vs. 28%, respectively), chest pain (43% vs. 22%), weakness (73% vs. 37%), back pain (47% vs. 26%), fatigue (75% vs. 53%), and heart palpitations (42% vs. 19%), said Dr. Little of Vanderbilt University in Nashville, Tenn.

In addition, the depressed children were significantly more likely than nondepressed children to report GI symptoms, including stomach upset (92% vs. 72%, respectively) and an urge to vomit (82% vs. 58%), in addition to their persistent abdominal pain. Complaints of feeling full were not significantly different between the two groups.

Headaches were common among both depressed (63%) and nondepressed (52%) children in addition to persistent abdominal pain, regardless of their other accompanying symptoms. No gender differences relating to specific symptoms appeared in this study.

A new treatment in the works for Alzheimer's disease is designed to act at the cellular level to reverse plaque formation and prevent development of further disease.

Prana Biotechnology Ltd. has received approval from the Medicines and Healthcare Products Regulatory Agency in the United Kingdom to begin a phase II/phase III study of clioquinol, also known as PBT-1. The investigators maintain that clioquinol will target the formation of amyloid plaques in the brain and thereby slow the progression of Alzheimer's disease (AD).

Ideally, clioquinol will both break up existing plaques and stop new ones from forming by redistributing the buildup of excess metals that are thought to cause plaques. “We believe that this is potentially a disease-modifying agent,” Jonas Alsenas, D.V.M., Prana's chief executive officer told this newspaper in an interview. Currently approved and available AD medications treat the symptoms; Prana is going after the source.

Vaccines to prevent AD have fallen short because they target amyloid beta indiscriminately, whereas clioquinol goes after the toxic, aggregated form of the protein, Dr. Alsenas noted.

Known as the Progression Limitation in Alzheimer's: Clioquinol's Efficacy (PLACQUE) trial, the 1-year, randomized, double-blind, placebo-controlled study will include 435 adults with moderate AD, defined as baseline scores between 12 and 20 on the Mini-Mental State Examination (MMSE). Patients will take one pill in the morning and a second in the evening. One-third of them will take two 125-mg pills daily, one-third will take two 250-mg pills daily, and a third group will take a placebo. The researchers are targeting patients at a moderate stage of illness because these patients normally decline most rapidly, allowing the investigators to show an effect within the limits of a 1-year study.

Researchers will enroll both patients who have taken no other AD medications and those who have taken memantine or similar medications for at least 4 months prior to the study.

In a pilot study of 36 patients, clioquinol effectively slowed cognitive loss in patients who scored greater than 25 on the AD assessment scale cognitive instrument. It was also significantly associated with an increased concentration of zinc in the patients' plasma (Arch. Neurol. 2003;60:1685-91).

The drug was generally well tolerated by the patients. Both folate and vitamin B12 were administered to all patients to counteract an observed association between oral clioquinol and myelo-opticoneuropathy that led to the drug's withdrawal from sale in 1970. A vitamin B12 deficiency was posited to be the cause of the neuropathy and levels of the vitamin were monitored throughout the trial, the researchers noted.

Many AD patients have slightly lower levels of zinc than would normally be expected. Craig Ritchie, M.B., of the department of psychiatry, University College London, explained that when clioquinol breaks up plaques, it has the added effect of returning zinc levels to normal. “One explanation is that some of the body's zinc is being sequestered into plaques in AD,” said Dr. Ritchie, the lead investigator on both the pilot study and the upcoming clinical trial.

However, the role of metals in maintaining the body's homeostatic functions is not fully understood, and a buildup of zinc has not been associated with dietary or environmental factors. “We are not saying that people should cut copper and zinc out of their diets,” Dr. Ritchie emphasized.

Brains of patients with AD are known to contain higher than expected levels of some metals, an observation that provided some of the inspiration for clioquinol treatment. Postmortem research by Ashley Bush, Ph.D., a senior scientist at Prana and coauthor of the pilot study, involved the use of strong chelators such as edetic acid to break up the plaques and access the amyloid beta proteins. The chelation idea is part of the science behind the study, although clioquinol works by combining with metals only long enough to break up the aggregates.

The study will be done at sites in the United Kingdom, Australia, and South Africa. The company's goal is to have results from the study by the end of 2006, Dr. Alsenas said.

A new treatment in the works for Alzheimer's disease is designed to act at the cellular level to reverse plaque formation and prevent development of further disease.

Prana Biotechnology Ltd. has received approval from the Medicines and Healthcare Products Regulatory Agency in the United Kingdom to begin a phase II/phase III study of clioquinol, also known as PBT-1. The investigators maintain that clioquinol will target the formation of amyloid plaques in the brain and thereby slow the progression of Alzheimer's disease (AD).

Ideally, clioquinol will both break up existing plaques and stop new ones from forming by redistributing the buildup of excess metals that are thought to cause plaques. “We believe that this is potentially a disease-modifying agent,” Jonas Alsenas, D.V.M., Prana's chief executive officer told this newspaper in an interview. Currently approved and available AD medications treat the symptoms; Prana is going after the source.

Vaccines to prevent AD have fallen short because they target amyloid beta indiscriminately, whereas clioquinol goes after the toxic, aggregated form of the protein, Dr. Alsenas noted.

Known as the Progression Limitation in Alzheimer's: Clioquinol's Efficacy (PLACQUE) trial, the 1-year, randomized, double-blind, placebo-controlled study will include 435 adults with moderate AD, defined as baseline scores between 12 and 20 on the Mini-Mental State Examination (MMSE). Patients will take one pill in the morning and a second in the evening. One-third of them will take two 125-mg pills daily, one-third will take two 250-mg pills daily, and a third group will take a placebo. The researchers are targeting patients at a moderate stage of illness because these patients normally decline most rapidly, allowing the investigators to show an effect within the limits of a 1-year study.

Researchers will enroll both patients who have taken no other AD medications and those who have taken memantine or similar medications for at least 4 months prior to the study.

In a pilot study of 36 patients, clioquinol effectively slowed cognitive loss in patients who scored greater than 25 on the AD assessment scale cognitive instrument. It was also significantly associated with an increased concentration of zinc in the patients' plasma (Arch. Neurol. 2003;60:1685-91).

The drug was generally well tolerated by the patients. Both folate and vitamin B12 were administered to all patients to counteract an observed association between oral clioquinol and myelo-opticoneuropathy that led to the drug's withdrawal from sale in 1970. A vitamin B12 deficiency was posited to be the cause of the neuropathy and levels of the vitamin were monitored throughout the trial, the researchers noted.

Many AD patients have slightly lower levels of zinc than would normally be expected. Craig Ritchie, M.B., of the department of psychiatry, University College London, explained that when clioquinol breaks up plaques, it has the added effect of returning zinc levels to normal. “One explanation is that some of the body's zinc is being sequestered into plaques in AD,” said Dr. Ritchie, the lead investigator on both the pilot study and the upcoming clinical trial.

However, the role of metals in maintaining the body's homeostatic functions is not fully understood, and a buildup of zinc has not been associated with dietary or environmental factors. “We are not saying that people should cut copper and zinc out of their diets,” Dr. Ritchie emphasized.

Brains of patients with AD are known to contain higher than expected levels of some metals, an observation that provided some of the inspiration for clioquinol treatment. Postmortem research by Ashley Bush, Ph.D., a senior scientist at Prana and coauthor of the pilot study, involved the use of strong chelators such as edetic acid to break up the plaques and access the amyloid beta proteins. The chelation idea is part of the science behind the study, although clioquinol works by combining with metals only long enough to break up the aggregates.

The study will be done at sites in the United Kingdom, Australia, and South Africa. The company's goal is to have results from the study by the end of 2006, Dr. Alsenas said.

A new treatment in the works for Alzheimer's disease is designed to act at the cellular level to reverse plaque formation and prevent development of further disease.

Prana Biotechnology Ltd. has received approval from the Medicines and Healthcare Products Regulatory Agency in the United Kingdom to begin a phase II/phase III study of clioquinol, also known as PBT-1. The investigators maintain that clioquinol will target the formation of amyloid plaques in the brain and thereby slow the progression of Alzheimer's disease (AD).

Ideally, clioquinol will both break up existing plaques and stop new ones from forming by redistributing the buildup of excess metals that are thought to cause plaques. “We believe that this is potentially a disease-modifying agent,” Jonas Alsenas, D.V.M., Prana's chief executive officer told this newspaper in an interview. Currently approved and available AD medications treat the symptoms; Prana is going after the source.

Vaccines to prevent AD have fallen short because they target amyloid beta indiscriminately, whereas clioquinol goes after the toxic, aggregated form of the protein, Dr. Alsenas noted.

Known as the Progression Limitation in Alzheimer's: Clioquinol's Efficacy (PLACQUE) trial, the 1-year, randomized, double-blind, placebo-controlled study will include 435 adults with moderate AD, defined as baseline scores between 12 and 20 on the Mini-Mental State Examination (MMSE). Patients will take one pill in the morning and a second in the evening. One-third of them will take two 125-mg pills daily, one-third will take two 250-mg pills daily, and a third group will take a placebo. The researchers are targeting patients at a moderate stage of illness because these patients normally decline most rapidly, allowing the investigators to show an effect within the limits of a 1-year study.

Researchers will enroll both patients who have taken no other AD medications and those who have taken memantine or similar medications for at least 4 months prior to the study.

In a pilot study of 36 patients, clioquinol effectively slowed cognitive loss in patients who scored greater than 25 on the AD assessment scale cognitive instrument. It was also significantly associated with an increased concentration of zinc in the patients' plasma (Arch. Neurol. 2003;60:1685-91).

The drug was generally well tolerated by the patients. Both folate and vitamin B12 were administered to all patients to counteract an observed association between oral clioquinol and myelo-opticoneuropathy that led to the drug's withdrawal from sale in 1970. A vitamin B12 deficiency was posited to be the cause of the neuropathy and levels of the vitamin were monitored throughout the trial, the researchers noted.

Many AD patients have slightly lower levels of zinc than would normally be expected. Craig Ritchie, M.B., of the department of psychiatry, University College London, explained that when clioquinol breaks up plaques, it has the added effect of returning zinc levels to normal. “One explanation is that some of the body's zinc is being sequestered into plaques in AD,” said Dr. Ritchie, the lead investigator on both the pilot study and the upcoming clinical trial.

However, the role of metals in maintaining the body's homeostatic functions is not fully understood, and a buildup of zinc has not been associated with dietary or environmental factors. “We are not saying that people should cut copper and zinc out of their diets,” Dr. Ritchie emphasized.

Brains of patients with AD are known to contain higher than expected levels of some metals, an observation that provided some of the inspiration for clioquinol treatment. Postmortem research by Ashley Bush, Ph.D., a senior scientist at Prana and coauthor of the pilot study, involved the use of strong chelators such as edetic acid to break up the plaques and access the amyloid beta proteins. The chelation idea is part of the science behind the study, although clioquinol works by combining with metals only long enough to break up the aggregates.

The study will be done at sites in the United Kingdom, Australia, and South Africa. The company's goal is to have results from the study by the end of 2006, Dr. Alsenas said.

Family Structure, Affective Disorders

The makeup of the family in which a child lives and stressful life events are associated with affective disorders at baseline and follow-up, reported Steven P. Cuffe, M.D., of the University of South Carolina, Columbia, and his colleagues.

The investigators interviewed 490 adolescents in grades 7-9 who scored in the top 10% on the Center for Epidemiological Studies Depression Scale. Six years later, the adolescents were interviewed again.

Dr. Cuffe and his colleagues found that not living with both biological parents at baseline was associated with a fourfold risk of an affective disorder at both time points (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:121-9).

Undesirable life events and low family cohesion also were associated with affective disorders and with any psychiatric disorder at baseline, but not at follow-up–after controlling for gender, race, and socioeconomic status.

Improve Working Memory in ADHD

Computerized, systematic practice of working memory tasks improved working memory in a study of 53 children with attention deficit hyperactivity disorder, said Torkel Klingberg, M.D., of the Karolinska Institute, Stockholm (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:177-86).

The children in this study, aged 7-12 years, met the criteria for ADHD but were not taking stimulants.

They were randomized to a 5-week intervention of daily working memory exercises, including videospatial and verbal tasks, done on a personal computer.

Those in the control group performed simple tasks that were unlikely to yield improvement.

The exercises took about 40 minutes to complete.

When the children were evaluated 3 months later, those in the treatment group showed significant improvement from baseline, compared with the controls.

Predictors of Marijuana Use

The presence of three factors–delinquency, school problems, and use of other substances by self or peers–significantly increased the risk of experimental and regular marijuana use in adolescents, reported Marianne B.M. van den Bree, Ph.D., of Cardiff (Wales) University, and Wallace B. Pickworth, Ph.D., formerly of the National Institutes of Health, Bethesda, Md.

In a logistic regression analysis of 13,718 teens aged 11-21 years who were part of the National Longitudinal Study of Adolescent Health, 28% of the 1,386 teens who scored in the upper third for the three risk factors tried marijuana in the following year.

That compared with 2% of a low-risk group (Arch. Gen. Psychiatry 2005;62:311-9).

Medical and Psychiatric Comorbidity

Coexisting medical illness appeared in 29,535 of 32,214 children aged 6-12 years who were diagnosed with at least one psychiatric disorder, reported Donald W. Spady, M.D., of the University of Alberta, Canada, and his associates.

Children with a psychiatric disorder were more likely to use health services, as well as nonpsychiatric medical services, than were children without a psychiatric disorder.

The most common comorbid medical condition was developmental delay (41.5%).

The least common comorbid medical condition was skin disorders (7.2%) (Arch. Pediatr. Adolesc. Med. 2005;159:231-7).

Problems related to pregnancy, contraception, and menstruation made up four of six categories with a greater than 20% prevalence.

The other two were developmental delay and poisoning.

Latinas and Eating Disorders

Latina adolescents, regardless of their country of origin, are at risk for developing anorexia nervosa and bulimia nervosa symptoms, reported Teresa Granillo and her associates at the University of Arizona, Tucson.

For the study, Ms. Granillo and her colleagues identified 1,866 Latina adolescents aged 11-20 years from across the United States. A range of behavioral and biological eating disorder outcomes were examined.

Overall, 2.5% of the adolescent Latinas reported a body mass index of 17 or less, 5.5% had ceased menstruation, 53.3% reported dieting, and 1.9% had bulimic symptoms.

Further researcher should look at whether eating disorder services that have been developed primarily with white female adolescents in mind would be equally effective in treating Latina patients, the investigators said.

Family Structure, Affective Disorders

The makeup of the family in which a child lives and stressful life events are associated with affective disorders at baseline and follow-up, reported Steven P. Cuffe, M.D., of the University of South Carolina, Columbia, and his colleagues.

The investigators interviewed 490 adolescents in grades 7-9 who scored in the top 10% on the Center for Epidemiological Studies Depression Scale. Six years later, the adolescents were interviewed again.

Dr. Cuffe and his colleagues found that not living with both biological parents at baseline was associated with a fourfold risk of an affective disorder at both time points (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:121-9).

Undesirable life events and low family cohesion also were associated with affective disorders and with any psychiatric disorder at baseline, but not at follow-up–after controlling for gender, race, and socioeconomic status.

Improve Working Memory in ADHD

Computerized, systematic practice of working memory tasks improved working memory in a study of 53 children with attention deficit hyperactivity disorder, said Torkel Klingberg, M.D., of the Karolinska Institute, Stockholm (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:177-86).

The children in this study, aged 7-12 years, met the criteria for ADHD but were not taking stimulants.

They were randomized to a 5-week intervention of daily working memory exercises, including videospatial and verbal tasks, done on a personal computer.

Those in the control group performed simple tasks that were unlikely to yield improvement.

The exercises took about 40 minutes to complete.

When the children were evaluated 3 months later, those in the treatment group showed significant improvement from baseline, compared with the controls.

Predictors of Marijuana Use

The presence of three factors–delinquency, school problems, and use of other substances by self or peers–significantly increased the risk of experimental and regular marijuana use in adolescents, reported Marianne B.M. van den Bree, Ph.D., of Cardiff (Wales) University, and Wallace B. Pickworth, Ph.D., formerly of the National Institutes of Health, Bethesda, Md.

In a logistic regression analysis of 13,718 teens aged 11-21 years who were part of the National Longitudinal Study of Adolescent Health, 28% of the 1,386 teens who scored in the upper third for the three risk factors tried marijuana in the following year.

That compared with 2% of a low-risk group (Arch. Gen. Psychiatry 2005;62:311-9).

Medical and Psychiatric Comorbidity

Coexisting medical illness appeared in 29,535 of 32,214 children aged 6-12 years who were diagnosed with at least one psychiatric disorder, reported Donald W. Spady, M.D., of the University of Alberta, Canada, and his associates.

Children with a psychiatric disorder were more likely to use health services, as well as nonpsychiatric medical services, than were children without a psychiatric disorder.

The most common comorbid medical condition was developmental delay (41.5%).

The least common comorbid medical condition was skin disorders (7.2%) (Arch. Pediatr. Adolesc. Med. 2005;159:231-7).

Problems related to pregnancy, contraception, and menstruation made up four of six categories with a greater than 20% prevalence.

The other two were developmental delay and poisoning.

Latinas and Eating Disorders

Latina adolescents, regardless of their country of origin, are at risk for developing anorexia nervosa and bulimia nervosa symptoms, reported Teresa Granillo and her associates at the University of Arizona, Tucson.

For the study, Ms. Granillo and her colleagues identified 1,866 Latina adolescents aged 11-20 years from across the United States. A range of behavioral and biological eating disorder outcomes were examined.

Overall, 2.5% of the adolescent Latinas reported a body mass index of 17 or less, 5.5% had ceased menstruation, 53.3% reported dieting, and 1.9% had bulimic symptoms.

Further researcher should look at whether eating disorder services that have been developed primarily with white female adolescents in mind would be equally effective in treating Latina patients, the investigators said.

Family Structure, Affective Disorders

The makeup of the family in which a child lives and stressful life events are associated with affective disorders at baseline and follow-up, reported Steven P. Cuffe, M.D., of the University of South Carolina, Columbia, and his colleagues.

The investigators interviewed 490 adolescents in grades 7-9 who scored in the top 10% on the Center for Epidemiological Studies Depression Scale. Six years later, the adolescents were interviewed again.

Dr. Cuffe and his colleagues found that not living with both biological parents at baseline was associated with a fourfold risk of an affective disorder at both time points (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:121-9).

Undesirable life events and low family cohesion also were associated with affective disorders and with any psychiatric disorder at baseline, but not at follow-up–after controlling for gender, race, and socioeconomic status.

Improve Working Memory in ADHD

Computerized, systematic practice of working memory tasks improved working memory in a study of 53 children with attention deficit hyperactivity disorder, said Torkel Klingberg, M.D., of the Karolinska Institute, Stockholm (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:177-86).

The children in this study, aged 7-12 years, met the criteria for ADHD but were not taking stimulants.

They were randomized to a 5-week intervention of daily working memory exercises, including videospatial and verbal tasks, done on a personal computer.

Those in the control group performed simple tasks that were unlikely to yield improvement.

The exercises took about 40 minutes to complete.

When the children were evaluated 3 months later, those in the treatment group showed significant improvement from baseline, compared with the controls.

Predictors of Marijuana Use

The presence of three factors–delinquency, school problems, and use of other substances by self or peers–significantly increased the risk of experimental and regular marijuana use in adolescents, reported Marianne B.M. van den Bree, Ph.D., of Cardiff (Wales) University, and Wallace B. Pickworth, Ph.D., formerly of the National Institutes of Health, Bethesda, Md.

In a logistic regression analysis of 13,718 teens aged 11-21 years who were part of the National Longitudinal Study of Adolescent Health, 28% of the 1,386 teens who scored in the upper third for the three risk factors tried marijuana in the following year.

That compared with 2% of a low-risk group (Arch. Gen. Psychiatry 2005;62:311-9).

Medical and Psychiatric Comorbidity

Coexisting medical illness appeared in 29,535 of 32,214 children aged 6-12 years who were diagnosed with at least one psychiatric disorder, reported Donald W. Spady, M.D., of the University of Alberta, Canada, and his associates.

Children with a psychiatric disorder were more likely to use health services, as well as nonpsychiatric medical services, than were children without a psychiatric disorder.

The most common comorbid medical condition was developmental delay (41.5%).

The least common comorbid medical condition was skin disorders (7.2%) (Arch. Pediatr. Adolesc. Med. 2005;159:231-7).

Problems related to pregnancy, contraception, and menstruation made up four of six categories with a greater than 20% prevalence.

The other two were developmental delay and poisoning.

Latinas and Eating Disorders

Latina adolescents, regardless of their country of origin, are at risk for developing anorexia nervosa and bulimia nervosa symptoms, reported Teresa Granillo and her associates at the University of Arizona, Tucson.

For the study, Ms. Granillo and her colleagues identified 1,866 Latina adolescents aged 11-20 years from across the United States. A range of behavioral and biological eating disorder outcomes were examined.

Overall, 2.5% of the adolescent Latinas reported a body mass index of 17 or less, 5.5% had ceased menstruation, 53.3% reported dieting, and 1.9% had bulimic symptoms.

Further researcher should look at whether eating disorder services that have been developed primarily with white female adolescents in mind would be equally effective in treating Latina patients, the investigators said.

ARLINGTON, VA. — Can a surgeon who brings a gun to the operating room be trusted not to use it? That's an extreme example of the kinds of questions that psychiatrists must address when doctors are referred to them for evaluations.

Disruptive physicians are doctors whose behavior undermines their personal and professional effectiveness, Ronald Schouten, M.D., said at the annual conference of the Academy of Organizational and Occupational Psychiatry.

“We are talking about people who engage in problematic behavior that interferes with their relationships at work or at home and has a potential impact on patient care, productivity, and administrative functions,” said Dr. Schouten, director of the law and psychiatry service at Massachusetts General Hospital, Boston.

Dr. Schouten presented data from his experience with 82 cases of physicians who had been referred for disruptive behavior. The doctors studied were evaluated for Axis I disorders, but the primary problems proved to be disruptive or noncompliant behavior. The sample excluded disability cases.

Overall, 69 doctors were referred by Physicians' Health Services at their hospitals, 7 by their practices or facilities, 3 by attorneys, 2 by residency programs, and 1 by the medical board.

Surprisingly, 15 were internists and family practice physicians, compared with only 3 general surgeons. “We expected to see more surgical specialists,” since surgery is stereotypically considered to be a particularly stressful field, he said. The average age was 48 years, and most of the doctors (82%) were men. Six of the internal medicine physicians were cardiologists, making cardiology the most common subspecialty in the sample.

Anesthesia was the most common specialty, comprising 13 cases, followed by ob.gyn., with 12 cases. Four of the cases involved emergency medicine physicians, 3 involved neurologists, and 2 involved psychiatrists.

Displays of anger proved to be the most common reason for referrals. In 36 cases, doctors were referred because they had lashed out physically or verbally, or because they had spooked their colleagues with behaviors such as wearing a gun in the operating room.

An additional 19 cases involved performance and compliance issues, and 11 cases involved sexual misconduct by the doctors. Other problems included sexual harassment, suspicion of substance abuse, communication problems with staff or peers, theft, and antisocial behavior.

Dr. Schouten noted that in California, the state medical board investigates about 10,000 complaints about disruptive physicians per year. Typically, nearly 80% of these are closed after an initial inquiry, but 20% are investigated further.

Diagnosing disruptive doctors involves a caveat, Dr. Schouten said. When physician referral programs send doctors for a psychiatric evaluation, they often are unable to keep physicians in a behavior improvement program without a diagnosis of an Axis I or II disorder.

“There is a bias in favor of finding something to write on the form,” Dr. Schouten said. As a result of that bias, the most common diagnosis in his sample was “personality disorder not otherwise specified,” for 37 doctors, followed by 15 cases of major depression. There were also 10 cases of substance abuse, 9 diagnoses involving personality traits, 7 cases of adjustment disorder, and 6 cases each of bipolar disorder and sleep disorder. Other non-Axis I and II diagnoses included two cases of anxiety disorder, two cases of attention-deficit hyperactivity disorder, and one case of obsessive-compulsive disorder.

Complete medical screening is an important part of a fitness for work evaluation. Hypertension, found in six cases, was the most common medical problem in the group, followed by hypothyroidism in five cases, and sleep apnea in four.

Among the postevaluation recommendations for these physicians were initiation or continuation of psychiatric treatment, including psychotherapy with a focus on gaining insight into the reasons for the bad behavior; anger management; cognitive-behavioral therapy; and random urine screens in cases of substance abuse.

Dr. Schouten strongly recommended that physicians receive follow-up treatment from someone of the same cultural background who is not a colleague, if possible.

The data on outcomes for doctors who have psychiatric referrals are soft, he admitted, but about 80% of physicians whom he has evaluated returned to work. About 9% went out on disability.

Many physicians who are referred for a psychiatric consultation resent any suggestion that they be held accountable for their actions, but the term “anger management” meets with less resistance than does “psychotherapy” because it lacks the stigma associated with a mental health problem, he noted.

“Physicians are amazingly lacking in insight into their own behavior,” Dr. Schouten said. “One of the things treatment programs struggle with is how to teach insight to these very bright, well-trained people.”

ARLINGTON, VA. — Can a surgeon who brings a gun to the operating room be trusted not to use it? That's an extreme example of the kinds of questions that psychiatrists must address when doctors are referred to them for evaluations.

Disruptive physicians are doctors whose behavior undermines their personal and professional effectiveness, Ronald Schouten, M.D., said at the annual conference of the Academy of Organizational and Occupational Psychiatry.

“We are talking about people who engage in problematic behavior that interferes with their relationships at work or at home and has a potential impact on patient care, productivity, and administrative functions,” said Dr. Schouten, director of the law and psychiatry service at Massachusetts General Hospital, Boston.

Dr. Schouten presented data from his experience with 82 cases of physicians who had been referred for disruptive behavior. The doctors studied were evaluated for Axis I disorders, but the primary problems proved to be disruptive or noncompliant behavior. The sample excluded disability cases.

Overall, 69 doctors were referred by Physicians' Health Services at their hospitals, 7 by their practices or facilities, 3 by attorneys, 2 by residency programs, and 1 by the medical board.

Surprisingly, 15 were internists and family practice physicians, compared with only 3 general surgeons. “We expected to see more surgical specialists,” since surgery is stereotypically considered to be a particularly stressful field, he said. The average age was 48 years, and most of the doctors (82%) were men. Six of the internal medicine physicians were cardiologists, making cardiology the most common subspecialty in the sample.

Anesthesia was the most common specialty, comprising 13 cases, followed by ob.gyn., with 12 cases. Four of the cases involved emergency medicine physicians, 3 involved neurologists, and 2 involved psychiatrists.

Displays of anger proved to be the most common reason for referrals. In 36 cases, doctors were referred because they had lashed out physically or verbally, or because they had spooked their colleagues with behaviors such as wearing a gun in the operating room.

An additional 19 cases involved performance and compliance issues, and 11 cases involved sexual misconduct by the doctors. Other problems included sexual harassment, suspicion of substance abuse, communication problems with staff or peers, theft, and antisocial behavior.

Dr. Schouten noted that in California, the state medical board investigates about 10,000 complaints about disruptive physicians per year. Typically, nearly 80% of these are closed after an initial inquiry, but 20% are investigated further.

Diagnosing disruptive doctors involves a caveat, Dr. Schouten said. When physician referral programs send doctors for a psychiatric evaluation, they often are unable to keep physicians in a behavior improvement program without a diagnosis of an Axis I or II disorder.

“There is a bias in favor of finding something to write on the form,” Dr. Schouten said. As a result of that bias, the most common diagnosis in his sample was “personality disorder not otherwise specified,” for 37 doctors, followed by 15 cases of major depression. There were also 10 cases of substance abuse, 9 diagnoses involving personality traits, 7 cases of adjustment disorder, and 6 cases each of bipolar disorder and sleep disorder. Other non-Axis I and II diagnoses included two cases of anxiety disorder, two cases of attention-deficit hyperactivity disorder, and one case of obsessive-compulsive disorder.

Complete medical screening is an important part of a fitness for work evaluation. Hypertension, found in six cases, was the most common medical problem in the group, followed by hypothyroidism in five cases, and sleep apnea in four.

Among the postevaluation recommendations for these physicians were initiation or continuation of psychiatric treatment, including psychotherapy with a focus on gaining insight into the reasons for the bad behavior; anger management; cognitive-behavioral therapy; and random urine screens in cases of substance abuse.

Dr. Schouten strongly recommended that physicians receive follow-up treatment from someone of the same cultural background who is not a colleague, if possible.

The data on outcomes for doctors who have psychiatric referrals are soft, he admitted, but about 80% of physicians whom he has evaluated returned to work. About 9% went out on disability.

Many physicians who are referred for a psychiatric consultation resent any suggestion that they be held accountable for their actions, but the term “anger management” meets with less resistance than does “psychotherapy” because it lacks the stigma associated with a mental health problem, he noted.

“Physicians are amazingly lacking in insight into their own behavior,” Dr. Schouten said. “One of the things treatment programs struggle with is how to teach insight to these very bright, well-trained people.”

ARLINGTON, VA. — Can a surgeon who brings a gun to the operating room be trusted not to use it? That's an extreme example of the kinds of questions that psychiatrists must address when doctors are referred to them for evaluations.

Disruptive physicians are doctors whose behavior undermines their personal and professional effectiveness, Ronald Schouten, M.D., said at the annual conference of the Academy of Organizational and Occupational Psychiatry.

“We are talking about people who engage in problematic behavior that interferes with their relationships at work or at home and has a potential impact on patient care, productivity, and administrative functions,” said Dr. Schouten, director of the law and psychiatry service at Massachusetts General Hospital, Boston.

Dr. Schouten presented data from his experience with 82 cases of physicians who had been referred for disruptive behavior. The doctors studied were evaluated for Axis I disorders, but the primary problems proved to be disruptive or noncompliant behavior. The sample excluded disability cases.

Overall, 69 doctors were referred by Physicians' Health Services at their hospitals, 7 by their practices or facilities, 3 by attorneys, 2 by residency programs, and 1 by the medical board.

Surprisingly, 15 were internists and family practice physicians, compared with only 3 general surgeons. “We expected to see more surgical specialists,” since surgery is stereotypically considered to be a particularly stressful field, he said. The average age was 48 years, and most of the doctors (82%) were men. Six of the internal medicine physicians were cardiologists, making cardiology the most common subspecialty in the sample.

Anesthesia was the most common specialty, comprising 13 cases, followed by ob.gyn., with 12 cases. Four of the cases involved emergency medicine physicians, 3 involved neurologists, and 2 involved psychiatrists.

Displays of anger proved to be the most common reason for referrals. In 36 cases, doctors were referred because they had lashed out physically or verbally, or because they had spooked their colleagues with behaviors such as wearing a gun in the operating room.

An additional 19 cases involved performance and compliance issues, and 11 cases involved sexual misconduct by the doctors. Other problems included sexual harassment, suspicion of substance abuse, communication problems with staff or peers, theft, and antisocial behavior.

Dr. Schouten noted that in California, the state medical board investigates about 10,000 complaints about disruptive physicians per year. Typically, nearly 80% of these are closed after an initial inquiry, but 20% are investigated further.

Diagnosing disruptive doctors involves a caveat, Dr. Schouten said. When physician referral programs send doctors for a psychiatric evaluation, they often are unable to keep physicians in a behavior improvement program without a diagnosis of an Axis I or II disorder.

“There is a bias in favor of finding something to write on the form,” Dr. Schouten said. As a result of that bias, the most common diagnosis in his sample was “personality disorder not otherwise specified,” for 37 doctors, followed by 15 cases of major depression. There were also 10 cases of substance abuse, 9 diagnoses involving personality traits, 7 cases of adjustment disorder, and 6 cases each of bipolar disorder and sleep disorder. Other non-Axis I and II diagnoses included two cases of anxiety disorder, two cases of attention-deficit hyperactivity disorder, and one case of obsessive-compulsive disorder.

Complete medical screening is an important part of a fitness for work evaluation. Hypertension, found in six cases, was the most common medical problem in the group, followed by hypothyroidism in five cases, and sleep apnea in four.

Among the postevaluation recommendations for these physicians were initiation or continuation of psychiatric treatment, including psychotherapy with a focus on gaining insight into the reasons for the bad behavior; anger management; cognitive-behavioral therapy; and random urine screens in cases of substance abuse.

Dr. Schouten strongly recommended that physicians receive follow-up treatment from someone of the same cultural background who is not a colleague, if possible.

The data on outcomes for doctors who have psychiatric referrals are soft, he admitted, but about 80% of physicians whom he has evaluated returned to work. About 9% went out on disability.

Many physicians who are referred for a psychiatric consultation resent any suggestion that they be held accountable for their actions, but the term “anger management” meets with less resistance than does “psychotherapy” because it lacks the stigma associated with a mental health problem, he noted.

“Physicians are amazingly lacking in insight into their own behavior,” Dr. Schouten said. “One of the things treatment programs struggle with is how to teach insight to these very bright, well-trained people.”

Adolescents with inflammatory bowel disease and either major or minor depression showed a significant reduction in depressive symptoms after 12 sessions of a manual-based cognitive-behavioral therapy program, reported Eva Szigethy, M.D., of Children's Hospital Boston and her associates.

In a pilot study, 11 adolescents aged 12-17 years participated. Seven patients had Crohn's disease and four had ulcerative colitis, with an average of 40 months' duration (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469-77).

Scores on the Children's Depression Inventory dropped from 16.18 before treatment to 4.82 after treatment. At baseline, all the teens reported depressed mood and anhedonia; 10 reported sleep disturbance and fatigue.

Although illness severity remained the same, the adolescents' own perception of their physical functioning improved by the end of the study period.

Adolescents with inflammatory bowel disease and either major or minor depression showed a significant reduction in depressive symptoms after 12 sessions of a manual-based cognitive-behavioral therapy program, reported Eva Szigethy, M.D., of Children's Hospital Boston and her associates.

In a pilot study, 11 adolescents aged 12-17 years participated. Seven patients had Crohn's disease and four had ulcerative colitis, with an average of 40 months' duration (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469-77).

Scores on the Children's Depression Inventory dropped from 16.18 before treatment to 4.82 after treatment. At baseline, all the teens reported depressed mood and anhedonia; 10 reported sleep disturbance and fatigue.

Although illness severity remained the same, the adolescents' own perception of their physical functioning improved by the end of the study period.

Adolescents with inflammatory bowel disease and either major or minor depression showed a significant reduction in depressive symptoms after 12 sessions of a manual-based cognitive-behavioral therapy program, reported Eva Szigethy, M.D., of Children's Hospital Boston and her associates.

In a pilot study, 11 adolescents aged 12-17 years participated. Seven patients had Crohn's disease and four had ulcerative colitis, with an average of 40 months' duration (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469-77).

Scores on the Children's Depression Inventory dropped from 16.18 before treatment to 4.82 after treatment. At baseline, all the teens reported depressed mood and anhedonia; 10 reported sleep disturbance and fatigue.

Although illness severity remained the same, the adolescents' own perception of their physical functioning improved by the end of the study period.