Heidi Splete

Hormone therapy is associated with a significantly increased risk of stroke, based on studies involving nearly 40,000 patients.

A review of 28 studies ranging in size from 59 to 16,608 adults and with follow up times of 0.7–6.8 years showed a significant association between hormone therapy use and an increased risk of total stroke, with an odds ratio of 1.29. The review supports previous studies that showed an association between increased risk of stroke and hormone therapy, reported Philip Bath, M.D., and Laura Gray of the University of Nottingham (England) (BMJ [Epub ahead of print], January 2005. Article DOI number: 10.1136/bmj. 38331.655347.8F. Available from: www.bmj.com

Twelve studies included women taking estrogen only; 16 included women taking estrogen plus progesterone. The average ages ranged from 55 to 71 years, and three studies of estrogen combined with progesterone included men. All but five studies were placebo-controlled, and 11 small trials recorded no stroke events.

Overall, 2% of patients randomized to no hormone therapy suffered strokes, but the risk of stroke among women randomized to hormone therapy increased 29%, primarily because of the increase in ischemic stroke. In addition, severity of stroke increased with hormone therapy use; the chance of a poor functional outcome, defined as either death or disability and dependency, was 56% higher among women randomized to hormone therapy.

In particular, hormone therapy use was associated with a significant increase in the risk of ischemic stroke in 16 studies (OR 1.29). Hormone therapy use also was significantly associated with an increased risk of nonfatal stroke in 21 studies (OR 1.23), and with an increased risk of stroke leading to death or dependency in 14 studies (OR 1.56).

Hormone therapy was not significantly associated with hemorrhagic stroke or transient ischemic attacks in 17 studies and 22 studies, respectively. However, none of the studies showed any association between hormone therapy and a reduction of stroke risk, despite data from previous observational studies suggesting a protective effect of hormone therapy against cerebrovascular events.

The investigators suggested that phytoestrogens, which were not included in these studies, may have yielded different results. They also noted that the estrogen dose in several trials was higher than the standard starting doses of conjugated equine estrogen and estradiol in Great Britain, 0.625 mg and 1 mg, respectively, and studies of lower doses may yield different results.

Hormone therapy is associated with a significantly increased risk of stroke, based on studies involving nearly 40,000 patients.

A review of 28 studies ranging in size from 59 to 16,608 adults and with follow up times of 0.7–6.8 years showed a significant association between hormone therapy use and an increased risk of total stroke, with an odds ratio of 1.29. The review supports previous studies that showed an association between increased risk of stroke and hormone therapy, reported Philip Bath, M.D., and Laura Gray of the University of Nottingham (England) (BMJ [Epub ahead of print], January 2005. Article DOI number: 10.1136/bmj. 38331.655347.8F. Available from: www.bmj.com

Twelve studies included women taking estrogen only; 16 included women taking estrogen plus progesterone. The average ages ranged from 55 to 71 years, and three studies of estrogen combined with progesterone included men. All but five studies were placebo-controlled, and 11 small trials recorded no stroke events.

Overall, 2% of patients randomized to no hormone therapy suffered strokes, but the risk of stroke among women randomized to hormone therapy increased 29%, primarily because of the increase in ischemic stroke. In addition, severity of stroke increased with hormone therapy use; the chance of a poor functional outcome, defined as either death or disability and dependency, was 56% higher among women randomized to hormone therapy.

In particular, hormone therapy use was associated with a significant increase in the risk of ischemic stroke in 16 studies (OR 1.29). Hormone therapy use also was significantly associated with an increased risk of nonfatal stroke in 21 studies (OR 1.23), and with an increased risk of stroke leading to death or dependency in 14 studies (OR 1.56).

Hormone therapy was not significantly associated with hemorrhagic stroke or transient ischemic attacks in 17 studies and 22 studies, respectively. However, none of the studies showed any association between hormone therapy and a reduction of stroke risk, despite data from previous observational studies suggesting a protective effect of hormone therapy against cerebrovascular events.

The investigators suggested that phytoestrogens, which were not included in these studies, may have yielded different results. They also noted that the estrogen dose in several trials was higher than the standard starting doses of conjugated equine estrogen and estradiol in Great Britain, 0.625 mg and 1 mg, respectively, and studies of lower doses may yield different results.

Hormone therapy is associated with a significantly increased risk of stroke, based on studies involving nearly 40,000 patients.

A review of 28 studies ranging in size from 59 to 16,608 adults and with follow up times of 0.7–6.8 years showed a significant association between hormone therapy use and an increased risk of total stroke, with an odds ratio of 1.29. The review supports previous studies that showed an association between increased risk of stroke and hormone therapy, reported Philip Bath, M.D., and Laura Gray of the University of Nottingham (England) (BMJ [Epub ahead of print], January 2005. Article DOI number: 10.1136/bmj. 38331.655347.8F. Available from: www.bmj.com

Twelve studies included women taking estrogen only; 16 included women taking estrogen plus progesterone. The average ages ranged from 55 to 71 years, and three studies of estrogen combined with progesterone included men. All but five studies were placebo-controlled, and 11 small trials recorded no stroke events.

Overall, 2% of patients randomized to no hormone therapy suffered strokes, but the risk of stroke among women randomized to hormone therapy increased 29%, primarily because of the increase in ischemic stroke. In addition, severity of stroke increased with hormone therapy use; the chance of a poor functional outcome, defined as either death or disability and dependency, was 56% higher among women randomized to hormone therapy.

In particular, hormone therapy use was associated with a significant increase in the risk of ischemic stroke in 16 studies (OR 1.29). Hormone therapy use also was significantly associated with an increased risk of nonfatal stroke in 21 studies (OR 1.23), and with an increased risk of stroke leading to death or dependency in 14 studies (OR 1.56).

Hormone therapy was not significantly associated with hemorrhagic stroke or transient ischemic attacks in 17 studies and 22 studies, respectively. However, none of the studies showed any association between hormone therapy and a reduction of stroke risk, despite data from previous observational studies suggesting a protective effect of hormone therapy against cerebrovascular events.

The investigators suggested that phytoestrogens, which were not included in these studies, may have yielded different results. They also noted that the estrogen dose in several trials was higher than the standard starting doses of conjugated equine estrogen and estradiol in Great Britain, 0.625 mg and 1 mg, respectively, and studies of lower doses may yield different results.

The perioperative risks of carotid endarterectomy outweigh the benefits in symptomatic women with less than 70% stenosis, especially those with few other risk factors, Sonia Alamowich, M.D., reported

For women with lesser stenosis, medical management is both safer and more effective than surgery, according to Dr. Alamowich of Tenon Hospital in Paris, and her colleagues.

They performed subset analysis on pooled data from two trials of endarterectomy. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) involved 873 women and 2,012 men with internal carotid artery stenosis and a history of recent transient ischemic attack or nondisabling ischemic stroke, randomized to best medical treatment alone or in combination with carotid endarterectomy. The Aspirin and Carotid Endarterectomy (ACE) trial was designed to study the best dose of aspirin to reduce the risk of stroke and death in 2,804 women and men scheduled for endarterectomy.

The 30-day risk of death after endarterectomy was higher in women than men (2.3% vs. 0.8%). Women's higher mortality was due largely to fatal stroke, based on a subgroup analysis of 1,415 patients in the surgery arm of NASCET and 1,148 symptomatic patients from ACE (Stroke 2005;36:27–31).

With stenosis of at least 70%, the absolute stroke risk reduction 5 years after endarterectomy was 15.1% for women and 17.3% for men. When carotid stenosis fell within the 50% to 69% range, endarterectomy reduced women's absolute stroke risk by only 3% versus 10% for men. Endarterectomy bestowed no significant benefit on either women or men with carotid stenosis under 50%.

When managed medically, men and women with at least 70% stenosis of the carotid had a similar 5-year absolute relative risk of ipsilateral ischemic stroke (28.9% vs. 29.8%). With stenosis from 50% to 69%, medically managed women had a lower risk of stroke, compared with men (16.1% vs. 25.3%).

Women scoring 0–3 on the stroke prognosis instrument measuring risk factors had no likelihood of stroke, and those scoring 2–5 had 6.3% risk of stroke. The stroke risk in men in the same two score categories were 18.5% and 19.2%, respectively. Thus, men with moderate stenosis benefit from surgery, regardless of their risk score.

Only 29% of the women with 50%–69% stenosis fell in that group with the highest risk score of 8–15. Carotid endarterectomy reduced their absolute relative risk of stroke by 8.9%; surgery provided little or no benefit to women with low risk scores and only moderate stenosis.

Certain stroke risk factors were significantly more common among women: obesity, smoking, hypertension, and hyperlipidemia. Other risk factors were significantly more likely among men: prior stroke and/or myocardial infarction, intermittent leg pain, irregular or ulcerated internal carotid artery plaques, occluded contralateral internal carotid arteries, and brain infarct on imaging.

The perioperative risks of carotid endarterectomy outweigh the benefits in symptomatic women with less than 70% stenosis, especially those with few other risk factors, Sonia Alamowich, M.D., reported

For women with lesser stenosis, medical management is both safer and more effective than surgery, according to Dr. Alamowich of Tenon Hospital in Paris, and her colleagues.

They performed subset analysis on pooled data from two trials of endarterectomy. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) involved 873 women and 2,012 men with internal carotid artery stenosis and a history of recent transient ischemic attack or nondisabling ischemic stroke, randomized to best medical treatment alone or in combination with carotid endarterectomy. The Aspirin and Carotid Endarterectomy (ACE) trial was designed to study the best dose of aspirin to reduce the risk of stroke and death in 2,804 women and men scheduled for endarterectomy.

The 30-day risk of death after endarterectomy was higher in women than men (2.3% vs. 0.8%). Women's higher mortality was due largely to fatal stroke, based on a subgroup analysis of 1,415 patients in the surgery arm of NASCET and 1,148 symptomatic patients from ACE (Stroke 2005;36:27–31).

With stenosis of at least 70%, the absolute stroke risk reduction 5 years after endarterectomy was 15.1% for women and 17.3% for men. When carotid stenosis fell within the 50% to 69% range, endarterectomy reduced women's absolute stroke risk by only 3% versus 10% for men. Endarterectomy bestowed no significant benefit on either women or men with carotid stenosis under 50%.

When managed medically, men and women with at least 70% stenosis of the carotid had a similar 5-year absolute relative risk of ipsilateral ischemic stroke (28.9% vs. 29.8%). With stenosis from 50% to 69%, medically managed women had a lower risk of stroke, compared with men (16.1% vs. 25.3%).

Women scoring 0–3 on the stroke prognosis instrument measuring risk factors had no likelihood of stroke, and those scoring 2–5 had 6.3% risk of stroke. The stroke risk in men in the same two score categories were 18.5% and 19.2%, respectively. Thus, men with moderate stenosis benefit from surgery, regardless of their risk score.

Only 29% of the women with 50%–69% stenosis fell in that group with the highest risk score of 8–15. Carotid endarterectomy reduced their absolute relative risk of stroke by 8.9%; surgery provided little or no benefit to women with low risk scores and only moderate stenosis.

Certain stroke risk factors were significantly more common among women: obesity, smoking, hypertension, and hyperlipidemia. Other risk factors were significantly more likely among men: prior stroke and/or myocardial infarction, intermittent leg pain, irregular or ulcerated internal carotid artery plaques, occluded contralateral internal carotid arteries, and brain infarct on imaging.

The perioperative risks of carotid endarterectomy outweigh the benefits in symptomatic women with less than 70% stenosis, especially those with few other risk factors, Sonia Alamowich, M.D., reported

For women with lesser stenosis, medical management is both safer and more effective than surgery, according to Dr. Alamowich of Tenon Hospital in Paris, and her colleagues.

They performed subset analysis on pooled data from two trials of endarterectomy. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) involved 873 women and 2,012 men with internal carotid artery stenosis and a history of recent transient ischemic attack or nondisabling ischemic stroke, randomized to best medical treatment alone or in combination with carotid endarterectomy. The Aspirin and Carotid Endarterectomy (ACE) trial was designed to study the best dose of aspirin to reduce the risk of stroke and death in 2,804 women and men scheduled for endarterectomy.

The 30-day risk of death after endarterectomy was higher in women than men (2.3% vs. 0.8%). Women's higher mortality was due largely to fatal stroke, based on a subgroup analysis of 1,415 patients in the surgery arm of NASCET and 1,148 symptomatic patients from ACE (Stroke 2005;36:27–31).

With stenosis of at least 70%, the absolute stroke risk reduction 5 years after endarterectomy was 15.1% for women and 17.3% for men. When carotid stenosis fell within the 50% to 69% range, endarterectomy reduced women's absolute stroke risk by only 3% versus 10% for men. Endarterectomy bestowed no significant benefit on either women or men with carotid stenosis under 50%.

When managed medically, men and women with at least 70% stenosis of the carotid had a similar 5-year absolute relative risk of ipsilateral ischemic stroke (28.9% vs. 29.8%). With stenosis from 50% to 69%, medically managed women had a lower risk of stroke, compared with men (16.1% vs. 25.3%).

Women scoring 0–3 on the stroke prognosis instrument measuring risk factors had no likelihood of stroke, and those scoring 2–5 had 6.3% risk of stroke. The stroke risk in men in the same two score categories were 18.5% and 19.2%, respectively. Thus, men with moderate stenosis benefit from surgery, regardless of their risk score.

Only 29% of the women with 50%–69% stenosis fell in that group with the highest risk score of 8–15. Carotid endarterectomy reduced their absolute relative risk of stroke by 8.9%; surgery provided little or no benefit to women with low risk scores and only moderate stenosis.

Certain stroke risk factors were significantly more common among women: obesity, smoking, hypertension, and hyperlipidemia. Other risk factors were significantly more likely among men: prior stroke and/or myocardial infarction, intermittent leg pain, irregular or ulcerated internal carotid artery plaques, occluded contralateral internal carotid arteries, and brain infarct on imaging.

Hormone therapy is associated with a significantly increased risk of stroke, based on studies involving nearly 40,000 patients.

A review of 28 studies ranging in size from 59 to 16,608 adults and with follow-up times of 0.7–6.8 years showed a significant association between HT use and an increased risk of total stroke, with an odds ratio of 1.29. The review supports previous studies that showed an association between increased risk of stroke and hormone therapy, reported Philip Bath, M.D., and Laura Gray of the University of Nottingham, Nottingham, England (BMJ [Epub ahead of print], January 2005. Article DOI number: 10.1136/bmj.38331.655347.8F. Available from: www.bmj.com

Twelve studies included women taking estrogen only; 16 included women taking estrogen plus progesterone. The average ages ranged from 55 to 71 years, and three studies of estrogen combined with progesterone included men. All but five studies were placebo-controlled, and 11 small trials recorded no stroke events.

Overall, 2% of patients randomized to no HT suffered strokes, but the risk of stroke among women randomized to HT increased 29%, primarily because of the increase in ischemic stroke.

In addition, the severity of stroke increased with HT use; the chance of a poor functional outcome, defined as either death or disability and dependency, was 56% higher among women randomized to HT.

In particular, HT use was associated with a significant increase in the risk of ischemic stroke in 16 studies (OR 1.29). HT use also was significantly associated with an increased risk of nonfatal stroke in 21 studies (OR 1.23), and with an increased risk of stroke leading to death or dependency in 14 studies (OR 1.56).

HT was not significantly associated with hemorrhagic stroke or transient ischemic attacks in 17 studies and 22 studies, respectively. However, none of the studies showed any association between HT and a reduction of stroke risk, despite data from previous observational studies suggesting a protective effect of HT against cerebrovascular events.

The investigators suggested that phytoestrogens, which were not included in these studies, may have yielded different results.

They also noted that the estrogen dose in several trials was higher than the standard starting doses of conjugated equine estrogen and estradiol in Great Britain, 0.625 mg and 1 mg, respectively, and studies of lower doses may yield different results.

Hormone therapy is associated with a significantly increased risk of stroke, based on studies involving nearly 40,000 patients.

A review of 28 studies ranging in size from 59 to 16,608 adults and with follow-up times of 0.7–6.8 years showed a significant association between HT use and an increased risk of total stroke, with an odds ratio of 1.29. The review supports previous studies that showed an association between increased risk of stroke and hormone therapy, reported Philip Bath, M.D., and Laura Gray of the University of Nottingham, Nottingham, England (BMJ [Epub ahead of print], January 2005. Article DOI number: 10.1136/bmj.38331.655347.8F. Available from: www.bmj.com

Twelve studies included women taking estrogen only; 16 included women taking estrogen plus progesterone. The average ages ranged from 55 to 71 years, and three studies of estrogen combined with progesterone included men. All but five studies were placebo-controlled, and 11 small trials recorded no stroke events.

Overall, 2% of patients randomized to no HT suffered strokes, but the risk of stroke among women randomized to HT increased 29%, primarily because of the increase in ischemic stroke.

In addition, the severity of stroke increased with HT use; the chance of a poor functional outcome, defined as either death or disability and dependency, was 56% higher among women randomized to HT.

In particular, HT use was associated with a significant increase in the risk of ischemic stroke in 16 studies (OR 1.29). HT use also was significantly associated with an increased risk of nonfatal stroke in 21 studies (OR 1.23), and with an increased risk of stroke leading to death or dependency in 14 studies (OR 1.56).

HT was not significantly associated with hemorrhagic stroke or transient ischemic attacks in 17 studies and 22 studies, respectively. However, none of the studies showed any association between HT and a reduction of stroke risk, despite data from previous observational studies suggesting a protective effect of HT against cerebrovascular events.

The investigators suggested that phytoestrogens, which were not included in these studies, may have yielded different results.

They also noted that the estrogen dose in several trials was higher than the standard starting doses of conjugated equine estrogen and estradiol in Great Britain, 0.625 mg and 1 mg, respectively, and studies of lower doses may yield different results.

Hormone therapy is associated with a significantly increased risk of stroke, based on studies involving nearly 40,000 patients.

A review of 28 studies ranging in size from 59 to 16,608 adults and with follow-up times of 0.7–6.8 years showed a significant association between HT use and an increased risk of total stroke, with an odds ratio of 1.29. The review supports previous studies that showed an association between increased risk of stroke and hormone therapy, reported Philip Bath, M.D., and Laura Gray of the University of Nottingham, Nottingham, England (BMJ [Epub ahead of print], January 2005. Article DOI number: 10.1136/bmj.38331.655347.8F. Available from: www.bmj.com

Twelve studies included women taking estrogen only; 16 included women taking estrogen plus progesterone. The average ages ranged from 55 to 71 years, and three studies of estrogen combined with progesterone included men. All but five studies were placebo-controlled, and 11 small trials recorded no stroke events.

Overall, 2% of patients randomized to no HT suffered strokes, but the risk of stroke among women randomized to HT increased 29%, primarily because of the increase in ischemic stroke.

In addition, the severity of stroke increased with HT use; the chance of a poor functional outcome, defined as either death or disability and dependency, was 56% higher among women randomized to HT.

In particular, HT use was associated with a significant increase in the risk of ischemic stroke in 16 studies (OR 1.29). HT use also was significantly associated with an increased risk of nonfatal stroke in 21 studies (OR 1.23), and with an increased risk of stroke leading to death or dependency in 14 studies (OR 1.56).

HT was not significantly associated with hemorrhagic stroke or transient ischemic attacks in 17 studies and 22 studies, respectively. However, none of the studies showed any association between HT and a reduction of stroke risk, despite data from previous observational studies suggesting a protective effect of HT against cerebrovascular events.

The investigators suggested that phytoestrogens, which were not included in these studies, may have yielded different results.

They also noted that the estrogen dose in several trials was higher than the standard starting doses of conjugated equine estrogen and estradiol in Great Britain, 0.625 mg and 1 mg, respectively, and studies of lower doses may yield different results.

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

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

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

Mean scores on the Center for Epidemiologic Studies-Depression (CES-D) scale were similar for older adults in the United States (9.3) and Australia (8.2). Overall, 47% of the adults surveyed reported pain in the past week, and the risk of depression was independently related to the presence, type, and number of musculoskeletal problems. In addition, reports of pain more than doubled an individual's risk for exceeding a score of 20 on the CES-D—the cutoff point for clinical depression.

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

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

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

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

Mean scores on the Center for Epidemiologic Studies-Depression (CES-D) scale were similar for older adults in the United States (9.3) and Australia (8.2). Overall, 47% of the adults surveyed reported pain in the past week, and the risk of depression was independently related to the presence, type, and number of musculoskeletal problems. In addition, reports of pain more than doubled an individual's risk for exceeding a score of 20 on the CES-D—the cutoff point for clinical depression.

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

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

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

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

Mean scores on the Center for Epidemiologic Studies-Depression (CES-D) scale were similar for older adults in the United States (9.3) and Australia (8.2). Overall, 47% of the adults surveyed reported pain in the past week, and the risk of depression was independently related to the presence, type, and number of musculoskeletal problems. In addition, reports of pain more than doubled an individual's risk for exceeding a score of 20 on the CES-D—the cutoff point for clinical depression.

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

More Options for HIV

A combination of atovaquone-azithromycin (AT-AZ) is as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) for the prevention of serious bacterial infections in children with HIV aged 3 months to 19 years, said Walter T. Hughes, M.D., of St. Jude Children's Research Hospital, Memphis, and his colleagues. TMP-SMZ is widely used against bacterial infections in children with and without AIDS. But some children experience adverse reactions and need an alternative treatment. In a randomized, double-blind, placebo-controlled study, 366 children were followed for an average of 3 years (Clin. Infect. Dis. 2005;40:136–45). Serious bacterial infections were 12.9/100 person-years in the AT-AZ group, compared with 18.5/100 person-years in the TMP-SMZ group. Hematologic problems were the most common adverse events, occurring in 39% of the AT-AZ children and 37% of the TMP-SMZ children. While the high cost of atovaquone-azithromycin prevents its use in most cases, it presents a viable alternative for children who experience adverse effects from TMP-SMZ, they said.

Tularemia From Hamster Bite

A 3-year-old boy who was bitten by a hamster was diagnosed with tularemia, reported the Colorado Department of Public Health and the Centers for Disease Control and Prevention (MMWR 2005;53:1202–3). The boy recovered after an excisional biopsy of a left axillary lymph node to relieve lymphadenopathy and intermittent fever; he was also treated with ciprofloxacin. The boy was exposed to six hamsters purchased from a pet store, each of which died from diarrhea within a week of purchase. One hamster bit the boy shortly before it died, and 7 days later, the child developed fever, malaise, painful left axillary lymphadenopathy, and skin sloughing at the bite site on the finger. No other exposures to tularemia risk factors were identified, so the hamster was presumed to be the cause, although the delay between the child's onset of illness and final diagnosis meant that the implicated hamsters were not available for testing. An adult customer and a pet store employee who developed fevers after being bitten by hamsters from the store tested negative for Francisella tularensis. However, a cat in the store tested positive for F. tularensis, which suggested that other animals in the store might have been exposed to infection.

Sepsis in VLBW Infants Surveyed

Klebsiella species and Pseudomonas species accounted for 42% of early deaths linked to late-onset sepsis of 2,644 very-low-birth-weight infants in a national survey between 1995 and 2001. Imad R. Makhoul, M.D., of Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel, and his colleagues assessed the adjusted risk of mortality from each of 10 groups of pathogens. Although coagulase-negative staphylococci (CoNS) caused approximately half of the 3,462 late-onset sepsis events, they accounted for only 17.3% of all early deaths (Clin. Infect. Dis. 2005;40:218–24). Overall, Klebsiella species caused 12.9% of sepsis events and was associated with 25% of early deaths. Pseudomonas species caused only 3.8% of sepsis events but was associated with 16.8% of early deaths. In an adjusted logistic regression analysis, infants with sepsis due to Pseudomonas, Klebsiella, Serratia, Escherichia, Enterobacter, and Candida species were at increased risk for early mortality, compared with those who had sepsis due to CoNS. The researchers suggested that a modified empiric antimicrobial protocol might reduce mortality in this high-risk population.

Multiple HPV Types Found in Teens

Infections with multiple types of genital human papillomavirus (HPV) infection were common among 60 sexually active teens aged 14–17 years enrolled in a 27-month longitudinal study, reported Darron R. Brown, M.D., and his associates at Indiana University, Indianapolis (J. Infect. Dis. 2005;191:182–92). Approximately 85% of the girls were black, 12% were white, and 3% were Hispanic; 57 of 60 reported being sexually active. The girls visited their local clinics every 3 months, where they participated in interviews and underwent pelvic exams that included screening for sexually transmitted infections and testing for HPV. The mean number of HPV types per HPV-positive teen was 4.9, and over the study period, more than 80% of the girls had evidence of HPV infection. High-risk HPV types were detected in 38.6% of the specimens, and low-risk HPV types were detected in 19.6%. In addition, 37% of the girls had abnormal cervical cytology that was significantly associated with high-risk HPV. An important etiologic question that remains unanswered is whether HPV infections at a very young age are ones that resurge and are detected later in life or whether the infections are newly acquired, the investigators said.

More Options for HIV

A combination of atovaquone-azithromycin (AT-AZ) is as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) for the prevention of serious bacterial infections in children with HIV aged 3 months to 19 years, said Walter T. Hughes, M.D., of St. Jude Children's Research Hospital, Memphis, and his colleagues. TMP-SMZ is widely used against bacterial infections in children with and without AIDS. But some children experience adverse reactions and need an alternative treatment. In a randomized, double-blind, placebo-controlled study, 366 children were followed for an average of 3 years (Clin. Infect. Dis. 2005;40:136–45). Serious bacterial infections were 12.9/100 person-years in the AT-AZ group, compared with 18.5/100 person-years in the TMP-SMZ group. Hematologic problems were the most common adverse events, occurring in 39% of the AT-AZ children and 37% of the TMP-SMZ children. While the high cost of atovaquone-azithromycin prevents its use in most cases, it presents a viable alternative for children who experience adverse effects from TMP-SMZ, they said.

Tularemia From Hamster Bite

A 3-year-old boy who was bitten by a hamster was diagnosed with tularemia, reported the Colorado Department of Public Health and the Centers for Disease Control and Prevention (MMWR 2005;53:1202–3). The boy recovered after an excisional biopsy of a left axillary lymph node to relieve lymphadenopathy and intermittent fever; he was also treated with ciprofloxacin. The boy was exposed to six hamsters purchased from a pet store, each of which died from diarrhea within a week of purchase. One hamster bit the boy shortly before it died, and 7 days later, the child developed fever, malaise, painful left axillary lymphadenopathy, and skin sloughing at the bite site on the finger. No other exposures to tularemia risk factors were identified, so the hamster was presumed to be the cause, although the delay between the child's onset of illness and final diagnosis meant that the implicated hamsters were not available for testing. An adult customer and a pet store employee who developed fevers after being bitten by hamsters from the store tested negative for Francisella tularensis. However, a cat in the store tested positive for F. tularensis, which suggested that other animals in the store might have been exposed to infection.

Sepsis in VLBW Infants Surveyed

Klebsiella species and Pseudomonas species accounted for 42% of early deaths linked to late-onset sepsis of 2,644 very-low-birth-weight infants in a national survey between 1995 and 2001. Imad R. Makhoul, M.D., of Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel, and his colleagues assessed the adjusted risk of mortality from each of 10 groups of pathogens. Although coagulase-negative staphylococci (CoNS) caused approximately half of the 3,462 late-onset sepsis events, they accounted for only 17.3% of all early deaths (Clin. Infect. Dis. 2005;40:218–24). Overall, Klebsiella species caused 12.9% of sepsis events and was associated with 25% of early deaths. Pseudomonas species caused only 3.8% of sepsis events but was associated with 16.8% of early deaths. In an adjusted logistic regression analysis, infants with sepsis due to Pseudomonas, Klebsiella, Serratia, Escherichia, Enterobacter, and Candida species were at increased risk for early mortality, compared with those who had sepsis due to CoNS. The researchers suggested that a modified empiric antimicrobial protocol might reduce mortality in this high-risk population.

Multiple HPV Types Found in Teens

Infections with multiple types of genital human papillomavirus (HPV) infection were common among 60 sexually active teens aged 14–17 years enrolled in a 27-month longitudinal study, reported Darron R. Brown, M.D., and his associates at Indiana University, Indianapolis (J. Infect. Dis. 2005;191:182–92). Approximately 85% of the girls were black, 12% were white, and 3% were Hispanic; 57 of 60 reported being sexually active. The girls visited their local clinics every 3 months, where they participated in interviews and underwent pelvic exams that included screening for sexually transmitted infections and testing for HPV. The mean number of HPV types per HPV-positive teen was 4.9, and over the study period, more than 80% of the girls had evidence of HPV infection. High-risk HPV types were detected in 38.6% of the specimens, and low-risk HPV types were detected in 19.6%. In addition, 37% of the girls had abnormal cervical cytology that was significantly associated with high-risk HPV. An important etiologic question that remains unanswered is whether HPV infections at a very young age are ones that resurge and are detected later in life or whether the infections are newly acquired, the investigators said.

More Options for HIV

A combination of atovaquone-azithromycin (AT-AZ) is as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) for the prevention of serious bacterial infections in children with HIV aged 3 months to 19 years, said Walter T. Hughes, M.D., of St. Jude Children's Research Hospital, Memphis, and his colleagues. TMP-SMZ is widely used against bacterial infections in children with and without AIDS. But some children experience adverse reactions and need an alternative treatment. In a randomized, double-blind, placebo-controlled study, 366 children were followed for an average of 3 years (Clin. Infect. Dis. 2005;40:136–45). Serious bacterial infections were 12.9/100 person-years in the AT-AZ group, compared with 18.5/100 person-years in the TMP-SMZ group. Hematologic problems were the most common adverse events, occurring in 39% of the AT-AZ children and 37% of the TMP-SMZ children. While the high cost of atovaquone-azithromycin prevents its use in most cases, it presents a viable alternative for children who experience adverse effects from TMP-SMZ, they said.

Tularemia From Hamster Bite

A 3-year-old boy who was bitten by a hamster was diagnosed with tularemia, reported the Colorado Department of Public Health and the Centers for Disease Control and Prevention (MMWR 2005;53:1202–3). The boy recovered after an excisional biopsy of a left axillary lymph node to relieve lymphadenopathy and intermittent fever; he was also treated with ciprofloxacin. The boy was exposed to six hamsters purchased from a pet store, each of which died from diarrhea within a week of purchase. One hamster bit the boy shortly before it died, and 7 days later, the child developed fever, malaise, painful left axillary lymphadenopathy, and skin sloughing at the bite site on the finger. No other exposures to tularemia risk factors were identified, so the hamster was presumed to be the cause, although the delay between the child's onset of illness and final diagnosis meant that the implicated hamsters were not available for testing. An adult customer and a pet store employee who developed fevers after being bitten by hamsters from the store tested negative for Francisella tularensis. However, a cat in the store tested positive for F. tularensis, which suggested that other animals in the store might have been exposed to infection.

Sepsis in VLBW Infants Surveyed

Klebsiella species and Pseudomonas species accounted for 42% of early deaths linked to late-onset sepsis of 2,644 very-low-birth-weight infants in a national survey between 1995 and 2001. Imad R. Makhoul, M.D., of Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel, and his colleagues assessed the adjusted risk of mortality from each of 10 groups of pathogens. Although coagulase-negative staphylococci (CoNS) caused approximately half of the 3,462 late-onset sepsis events, they accounted for only 17.3% of all early deaths (Clin. Infect. Dis. 2005;40:218–24). Overall, Klebsiella species caused 12.9% of sepsis events and was associated with 25% of early deaths. Pseudomonas species caused only 3.8% of sepsis events but was associated with 16.8% of early deaths. In an adjusted logistic regression analysis, infants with sepsis due to Pseudomonas, Klebsiella, Serratia, Escherichia, Enterobacter, and Candida species were at increased risk for early mortality, compared with those who had sepsis due to CoNS. The researchers suggested that a modified empiric antimicrobial protocol might reduce mortality in this high-risk population.

Multiple HPV Types Found in Teens

Infections with multiple types of genital human papillomavirus (HPV) infection were common among 60 sexually active teens aged 14–17 years enrolled in a 27-month longitudinal study, reported Darron R. Brown, M.D., and his associates at Indiana University, Indianapolis (J. Infect. Dis. 2005;191:182–92). Approximately 85% of the girls were black, 12% were white, and 3% were Hispanic; 57 of 60 reported being sexually active. The girls visited their local clinics every 3 months, where they participated in interviews and underwent pelvic exams that included screening for sexually transmitted infections and testing for HPV. The mean number of HPV types per HPV-positive teen was 4.9, and over the study period, more than 80% of the girls had evidence of HPV infection. High-risk HPV types were detected in 38.6% of the specimens, and low-risk HPV types were detected in 19.6%. In addition, 37% of the girls had abnormal cervical cytology that was significantly associated with high-risk HPV. An important etiologic question that remains unanswered is whether HPV infections at a very young age are ones that resurge and are detected later in life or whether the infections are newly acquired, the investigators said.

WASHINGTON — Only 2.5% of adults aged 65 years and older use outpatient mental health services compared with 7.1% of adults aged 18–64 years, Bradley E. Karlin said at the annual meeting of the Gerontological Society of America.

These results, based on data from the 2001 National Survey on Drug Use and Health, show that older Americans continue to underuse mental health services, despite their need for them, said Mr. Karlin, a doctoral candidate in clinical psychology at Texas A&M University, College Station.

“One of the most disconcerting findings in the mental health literature is the underuse of mental health services by the older population,” he noted.

Mr. Karlin and his coauthor, Michael Duffy, Ph.D., of Texas A&M University, conducted a logistic regression analysis to identify factors relating to unmet mental health needs and use of outpatient treatment. Older adults identified fewer mental health problems than did younger adults in the survey and had lower rates of serious mental illness. However, only 9% of older adults with serious mental illness and 10% with mental health syndromes used outpatient mental health services.

“Virtually nothing is known about predictors of mental health care in the elderly population. We don't know who the health seekers are,” Mr. Karlin said. A greater understanding of the role of mental health in aging in the general population may increase the use of outpatient services, and older adults who hear about a friend's positive experience may be more likely to try outpatient care themselves, he added.

Overall, no differences appeared in the extent to which mental health treatment improves ability to manage daily activities, suggesting that older adults who do use outpatient mental health services derive at least as much benefit as younger adults, Dr. Karlin noted.

WASHINGTON — Only 2.5% of adults aged 65 years and older use outpatient mental health services compared with 7.1% of adults aged 18–64 years, Bradley E. Karlin said at the annual meeting of the Gerontological Society of America.

These results, based on data from the 2001 National Survey on Drug Use and Health, show that older Americans continue to underuse mental health services, despite their need for them, said Mr. Karlin, a doctoral candidate in clinical psychology at Texas A&M University, College Station.

“One of the most disconcerting findings in the mental health literature is the underuse of mental health services by the older population,” he noted.

Mr. Karlin and his coauthor, Michael Duffy, Ph.D., of Texas A&M University, conducted a logistic regression analysis to identify factors relating to unmet mental health needs and use of outpatient treatment. Older adults identified fewer mental health problems than did younger adults in the survey and had lower rates of serious mental illness. However, only 9% of older adults with serious mental illness and 10% with mental health syndromes used outpatient mental health services.

“Virtually nothing is known about predictors of mental health care in the elderly population. We don't know who the health seekers are,” Mr. Karlin said. A greater understanding of the role of mental health in aging in the general population may increase the use of outpatient services, and older adults who hear about a friend's positive experience may be more likely to try outpatient care themselves, he added.

Overall, no differences appeared in the extent to which mental health treatment improves ability to manage daily activities, suggesting that older adults who do use outpatient mental health services derive at least as much benefit as younger adults, Dr. Karlin noted.

WASHINGTON — Only 2.5% of adults aged 65 years and older use outpatient mental health services compared with 7.1% of adults aged 18–64 years, Bradley E. Karlin said at the annual meeting of the Gerontological Society of America.

These results, based on data from the 2001 National Survey on Drug Use and Health, show that older Americans continue to underuse mental health services, despite their need for them, said Mr. Karlin, a doctoral candidate in clinical psychology at Texas A&M University, College Station.

“One of the most disconcerting findings in the mental health literature is the underuse of mental health services by the older population,” he noted.

Mr. Karlin and his coauthor, Michael Duffy, Ph.D., of Texas A&M University, conducted a logistic regression analysis to identify factors relating to unmet mental health needs and use of outpatient treatment. Older adults identified fewer mental health problems than did younger adults in the survey and had lower rates of serious mental illness. However, only 9% of older adults with serious mental illness and 10% with mental health syndromes used outpatient mental health services.

“Virtually nothing is known about predictors of mental health care in the elderly population. We don't know who the health seekers are,” Mr. Karlin said. A greater understanding of the role of mental health in aging in the general population may increase the use of outpatient services, and older adults who hear about a friend's positive experience may be more likely to try outpatient care themselves, he added.

Overall, no differences appeared in the extent to which mental health treatment improves ability to manage daily activities, suggesting that older adults who do use outpatient mental health services derive at least as much benefit as younger adults, Dr. Karlin noted.

SALT LAKE CITY — For every 1,000 deliveries in the United States between 1991 and 2000, 4.6 women experienced severe morbidity, William M. Callaghan, M.D., said at the annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research.

Even relatively uncommon complications of pregnancy will impact large numbers of women, and hospitals should know where to focus their attention, said Dr. Callaghan of the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta.

He used data from the National Hospital Discharge Survey to examine ICD-9 codes and identify women who likely had severe morbidity during or shortly after delivery. The severe morbidity rate was based on a 3-day hospital stay, which was above the median length of stay for a pregnancy.

On examination of approximately 318,000 records, it was found that nearly 1,500 women experienced severe morbidity. Of these, almost 17% had a code for eclampsia. Respiratory failure, sepsis, renal failure, and cardiac arrest were among other causes of severe morbidity. In addition, nearly half of the women received transfusions, although the transfusion may have been as little as one unit of blood, Dr. Callaghan noted.

Older women, black women, and women with other than private insurance had a higher incidence of morbidity than their counterparts, as did women who delivered later in the decade. The incidence of severe morbidity increased gradually during the last 4 years of the study, but the reason for this increase was unclear, Dr. Callaghan said. He suggested that hospitals should use discharge codes to monitor severe morbidity as a way to review what types of services are being used and how to improve them.

“Identification and review of women with severe morbidity has potential to provide insight into opportunities for prevention along the continuum of morbidity,” he said.

SALT LAKE CITY — For every 1,000 deliveries in the United States between 1991 and 2000, 4.6 women experienced severe morbidity, William M. Callaghan, M.D., said at the annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research.

Even relatively uncommon complications of pregnancy will impact large numbers of women, and hospitals should know where to focus their attention, said Dr. Callaghan of the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta.

He used data from the National Hospital Discharge Survey to examine ICD-9 codes and identify women who likely had severe morbidity during or shortly after delivery. The severe morbidity rate was based on a 3-day hospital stay, which was above the median length of stay for a pregnancy.

On examination of approximately 318,000 records, it was found that nearly 1,500 women experienced severe morbidity. Of these, almost 17% had a code for eclampsia. Respiratory failure, sepsis, renal failure, and cardiac arrest were among other causes of severe morbidity. In addition, nearly half of the women received transfusions, although the transfusion may have been as little as one unit of blood, Dr. Callaghan noted.

Older women, black women, and women with other than private insurance had a higher incidence of morbidity than their counterparts, as did women who delivered later in the decade. The incidence of severe morbidity increased gradually during the last 4 years of the study, but the reason for this increase was unclear, Dr. Callaghan said. He suggested that hospitals should use discharge codes to monitor severe morbidity as a way to review what types of services are being used and how to improve them.

“Identification and review of women with severe morbidity has potential to provide insight into opportunities for prevention along the continuum of morbidity,” he said.

SALT LAKE CITY — For every 1,000 deliveries in the United States between 1991 and 2000, 4.6 women experienced severe morbidity, William M. Callaghan, M.D., said at the annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research.

Even relatively uncommon complications of pregnancy will impact large numbers of women, and hospitals should know where to focus their attention, said Dr. Callaghan of the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta.

He used data from the National Hospital Discharge Survey to examine ICD-9 codes and identify women who likely had severe morbidity during or shortly after delivery. The severe morbidity rate was based on a 3-day hospital stay, which was above the median length of stay for a pregnancy.

On examination of approximately 318,000 records, it was found that nearly 1,500 women experienced severe morbidity. Of these, almost 17% had a code for eclampsia. Respiratory failure, sepsis, renal failure, and cardiac arrest were among other causes of severe morbidity. In addition, nearly half of the women received transfusions, although the transfusion may have been as little as one unit of blood, Dr. Callaghan noted.

Older women, black women, and women with other than private insurance had a higher incidence of morbidity than their counterparts, as did women who delivered later in the decade. The incidence of severe morbidity increased gradually during the last 4 years of the study, but the reason for this increase was unclear, Dr. Callaghan said. He suggested that hospitals should use discharge codes to monitor severe morbidity as a way to review what types of services are being used and how to improve them.

“Identification and review of women with severe morbidity has potential to provide insight into opportunities for prevention along the continuum of morbidity,” he said.

WASHINGTON— A majority of parents in rural Kansas think children should know about problem drinkers in the family, reported Kimber Richter, Ph.D.

Approximately 45% of alcoholism is genetic, and knowledge of family history might help children make better choices about alcohol consumption, said Dr. Richter at the annual conference of the Association for Medical and Education in Research and Substance Abuse.

Dr. Richter and a group of medical students surveyed parents to better understand parent-child communication regarding a family history of alcohol problems. They surveyed 24 sets of parents aged 18 years or older living in rural Kansas who had children aged 10–20 years.

In response to the questionnaire, 100% of the parents said that they had talked to their children about alcohol, and 100% agreed that a family history of alcohol problems increased children's risk. Most (96%) said they believed families with a history of alcohol problems should inform their children. Of the 83% of parents who reported a family history of problems, 57% said they had informed the children about this history. Overall, 63% had family rules concerning drinking, with punishments for breaking the rules. The children were not interviewed about their alcohol use. They averaged 15 years old, the average age of first alcohol use in Kansas, Dr. Richter noted at the conference, also sponsored by Brown Medical School.

Parents who had discussed a family history of alcohol problems with children said they didn't want their children to repeat the mistakes of other family members and that they had lost many family members to alcohol problems. Parents who had not discussed a family history of alcohol problems with children cited young age of children and the fact that alcohol was “not an issue yet” as reasons for not broaching the topic.

WASHINGTON— A majority of parents in rural Kansas think children should know about problem drinkers in the family, reported Kimber Richter, Ph.D.

Approximately 45% of alcoholism is genetic, and knowledge of family history might help children make better choices about alcohol consumption, said Dr. Richter at the annual conference of the Association for Medical and Education in Research and Substance Abuse.

Dr. Richter and a group of medical students surveyed parents to better understand parent-child communication regarding a family history of alcohol problems. They surveyed 24 sets of parents aged 18 years or older living in rural Kansas who had children aged 10–20 years.

In response to the questionnaire, 100% of the parents said that they had talked to their children about alcohol, and 100% agreed that a family history of alcohol problems increased children's risk. Most (96%) said they believed families with a history of alcohol problems should inform their children. Of the 83% of parents who reported a family history of problems, 57% said they had informed the children about this history. Overall, 63% had family rules concerning drinking, with punishments for breaking the rules. The children were not interviewed about their alcohol use. They averaged 15 years old, the average age of first alcohol use in Kansas, Dr. Richter noted at the conference, also sponsored by Brown Medical School.

Parents who had discussed a family history of alcohol problems with children said they didn't want their children to repeat the mistakes of other family members and that they had lost many family members to alcohol problems. Parents who had not discussed a family history of alcohol problems with children cited young age of children and the fact that alcohol was “not an issue yet” as reasons for not broaching the topic.

WASHINGTON— A majority of parents in rural Kansas think children should know about problem drinkers in the family, reported Kimber Richter, Ph.D.

Approximately 45% of alcoholism is genetic, and knowledge of family history might help children make better choices about alcohol consumption, said Dr. Richter at the annual conference of the Association for Medical and Education in Research and Substance Abuse.

Dr. Richter and a group of medical students surveyed parents to better understand parent-child communication regarding a family history of alcohol problems. They surveyed 24 sets of parents aged 18 years or older living in rural Kansas who had children aged 10–20 years.

In response to the questionnaire, 100% of the parents said that they had talked to their children about alcohol, and 100% agreed that a family history of alcohol problems increased children's risk. Most (96%) said they believed families with a history of alcohol problems should inform their children. Of the 83% of parents who reported a family history of problems, 57% said they had informed the children about this history. Overall, 63% had family rules concerning drinking, with punishments for breaking the rules. The children were not interviewed about their alcohol use. They averaged 15 years old, the average age of first alcohol use in Kansas, Dr. Richter noted at the conference, also sponsored by Brown Medical School.

Parents who had discussed a family history of alcohol problems with children said they didn't want their children to repeat the mistakes of other family members and that they had lost many family members to alcohol problems. Parents who had not discussed a family history of alcohol problems with children cited young age of children and the fact that alcohol was “not an issue yet” as reasons for not broaching the topic.

More timely psychiatric consultations could improve patient outcomes and cut costs by reducing hospital stays, reported Yasuhiro Kishi, M.D., and associates at the University of Minnesota, Minneapolis.

They reviewed the medical records of 541 consecutive patients referred for psychiatric consultation at the Fairview-University Medical Center at the university between Jan. 1, 2001, and Dec. 31, 2001 (Psychosomatics 2004;45:470–6).

The mean length of a hospital stay during the study period was 5.7 days for all patients and 18 days for patients who received psychiatric consultation. Referral time was the most predictive factor; a longer time to referral was significantly associated with a longer length of stay.

The two recommendations from a psychiatric consultation that predicted shorter stays were transfer to inpatient psychiatry and follow-up in outpatient psychiatry.

A pharmacotherapy recommendation was significantly associated with a longer stay. Although 191 patients (35%) were referred for depression, 23% of these patients were not diagnosed with depression by a psychiatrist during their referral consultations.

Overall, patients with blatant psychiatric problems were not at risk of delayed treatment, but women and patients with nonpsychiatric disorders who were in greater need of psychosocial intervention rather than psychiatric interventions were at risk for postponed care, the researchers noted.

More timely psychiatric consultations could improve patient outcomes and cut costs by reducing hospital stays, reported Yasuhiro Kishi, M.D., and associates at the University of Minnesota, Minneapolis.

They reviewed the medical records of 541 consecutive patients referred for psychiatric consultation at the Fairview-University Medical Center at the university between Jan. 1, 2001, and Dec. 31, 2001 (Psychosomatics 2004;45:470–6).

The mean length of a hospital stay during the study period was 5.7 days for all patients and 18 days for patients who received psychiatric consultation. Referral time was the most predictive factor; a longer time to referral was significantly associated with a longer length of stay.

The two recommendations from a psychiatric consultation that predicted shorter stays were transfer to inpatient psychiatry and follow-up in outpatient psychiatry.

A pharmacotherapy recommendation was significantly associated with a longer stay. Although 191 patients (35%) were referred for depression, 23% of these patients were not diagnosed with depression by a psychiatrist during their referral consultations.

Overall, patients with blatant psychiatric problems were not at risk of delayed treatment, but women and patients with nonpsychiatric disorders who were in greater need of psychosocial intervention rather than psychiatric interventions were at risk for postponed care, the researchers noted.

More timely psychiatric consultations could improve patient outcomes and cut costs by reducing hospital stays, reported Yasuhiro Kishi, M.D., and associates at the University of Minnesota, Minneapolis.

They reviewed the medical records of 541 consecutive patients referred for psychiatric consultation at the Fairview-University Medical Center at the university between Jan. 1, 2001, and Dec. 31, 2001 (Psychosomatics 2004;45:470–6).

The mean length of a hospital stay during the study period was 5.7 days for all patients and 18 days for patients who received psychiatric consultation. Referral time was the most predictive factor; a longer time to referral was significantly associated with a longer length of stay.

The two recommendations from a psychiatric consultation that predicted shorter stays were transfer to inpatient psychiatry and follow-up in outpatient psychiatry.

A pharmacotherapy recommendation was significantly associated with a longer stay. Although 191 patients (35%) were referred for depression, 23% of these patients were not diagnosed with depression by a psychiatrist during their referral consultations.

Overall, patients with blatant psychiatric problems were not at risk of delayed treatment, but women and patients with nonpsychiatric disorders who were in greater need of psychosocial intervention rather than psychiatric interventions were at risk for postponed care, the researchers noted.

Depressive symptoms are not independent predictors of mortality, according to data from a national sample of 3,617 adults.

The findings of previous studies of associations between depressive symptoms and mortality have been inconsistent, and few of these studies have used population-based samples, said Susan A. Everson-Rose, Ph.D., of Rush University Medical Center, Chicago, and her colleagues (Psychosom. Med. 2004;66:823–30).

The investigators selected noninstitutionalized adults aged 25 years and older who were participating in an ongoing, longitudinal study called Americans' Changing Lives.

A total of 542 deaths occurred during 7.5 years of follow-up. Each increase of 1 standard unit on the Center for Epidemiological Studies Depression scale (CES-D) predicted a 21% increase in death from any cause after age, race, and gender were adjusted for. However, no excess risk of mortality was associated with CES-D scores in a fully adjusted model that included demographics, education, income, behavioral risk factors, and three indicators of health status (hypertension, functional impairment, and life-threatening conditions).

The physical complaints of patients with depression often resemble symptoms of other health problems, and distinguishing between clinical depression and poor physical health can be difficult, the investigators said.

Patients with scores in the highest quintile on the CES-D had an 85% greater risk of death from any cause, compared with participants with the lowest CES-D scores, but no other quintiles showed an increased mortality risk, Dr. Everson-Rose and her associates reported.

Depressive symptoms were not significantly associated with mortality risk in a healthy subgroup of 2,833 adults (with 306 deaths) who reported good or excellent health at baseline. In addition, depressive symptoms were not associated with increased mortality risk in patients without functional impairments at baseline.

Although depressive symptoms were associated with greater physical impairment over time after demographics, socioeconomic status, and baseline physical impairment were controlled for, the CES-D does not measure clinical depression, which has been studied as a possible link to mortality and cardiovascular health, the investigators noted.

Depressive symptoms are not independent predictors of mortality, according to data from a national sample of 3,617 adults.

The findings of previous studies of associations between depressive symptoms and mortality have been inconsistent, and few of these studies have used population-based samples, said Susan A. Everson-Rose, Ph.D., of Rush University Medical Center, Chicago, and her colleagues (Psychosom. Med. 2004;66:823–30).

The investigators selected noninstitutionalized adults aged 25 years and older who were participating in an ongoing, longitudinal study called Americans' Changing Lives.

A total of 542 deaths occurred during 7.5 years of follow-up. Each increase of 1 standard unit on the Center for Epidemiological Studies Depression scale (CES-D) predicted a 21% increase in death from any cause after age, race, and gender were adjusted for. However, no excess risk of mortality was associated with CES-D scores in a fully adjusted model that included demographics, education, income, behavioral risk factors, and three indicators of health status (hypertension, functional impairment, and life-threatening conditions).

The physical complaints of patients with depression often resemble symptoms of other health problems, and distinguishing between clinical depression and poor physical health can be difficult, the investigators said.

Patients with scores in the highest quintile on the CES-D had an 85% greater risk of death from any cause, compared with participants with the lowest CES-D scores, but no other quintiles showed an increased mortality risk, Dr. Everson-Rose and her associates reported.

Depressive symptoms were not significantly associated with mortality risk in a healthy subgroup of 2,833 adults (with 306 deaths) who reported good or excellent health at baseline. In addition, depressive symptoms were not associated with increased mortality risk in patients without functional impairments at baseline.

Although depressive symptoms were associated with greater physical impairment over time after demographics, socioeconomic status, and baseline physical impairment were controlled for, the CES-D does not measure clinical depression, which has been studied as a possible link to mortality and cardiovascular health, the investigators noted.

Depressive symptoms are not independent predictors of mortality, according to data from a national sample of 3,617 adults.

The findings of previous studies of associations between depressive symptoms and mortality have been inconsistent, and few of these studies have used population-based samples, said Susan A. Everson-Rose, Ph.D., of Rush University Medical Center, Chicago, and her colleagues (Psychosom. Med. 2004;66:823–30).

The investigators selected noninstitutionalized adults aged 25 years and older who were participating in an ongoing, longitudinal study called Americans' Changing Lives.

A total of 542 deaths occurred during 7.5 years of follow-up. Each increase of 1 standard unit on the Center for Epidemiological Studies Depression scale (CES-D) predicted a 21% increase in death from any cause after age, race, and gender were adjusted for. However, no excess risk of mortality was associated with CES-D scores in a fully adjusted model that included demographics, education, income, behavioral risk factors, and three indicators of health status (hypertension, functional impairment, and life-threatening conditions).

The physical complaints of patients with depression often resemble symptoms of other health problems, and distinguishing between clinical depression and poor physical health can be difficult, the investigators said.

Patients with scores in the highest quintile on the CES-D had an 85% greater risk of death from any cause, compared with participants with the lowest CES-D scores, but no other quintiles showed an increased mortality risk, Dr. Everson-Rose and her associates reported.

Depressive symptoms were not significantly associated with mortality risk in a healthy subgroup of 2,833 adults (with 306 deaths) who reported good or excellent health at baseline. In addition, depressive symptoms were not associated with increased mortality risk in patients without functional impairments at baseline.

Although depressive symptoms were associated with greater physical impairment over time after demographics, socioeconomic status, and baseline physical impairment were controlled for, the CES-D does not measure clinical depression, which has been studied as a possible link to mortality and cardiovascular health, the investigators noted.