Heidi Splete

FluMist Found Safe and Effective

The live, attenuated, cold-adapted influenza vaccine, also known as CAIV-T (FluMist), was safe and effective in children aged 60 months to 17 years in the second year of its use for prevention of flu. The CAIV-T vaccine was first available for use during the 2003-2004 season and was designed to contain three flu strains that matched those recommended by the FDA for the annual trivalent inactivated vaccine. Robert B. Belshe, M.D., of St. Louis University and colleagues reviewed a safety trial that included 6,657 children aged 5-17 years and an efficacy trial including 312 children aged 60-71 months. (Clin. Infect. Dis. 2004;39;920-7). The safety trial evaluated medically attended events within 42 days of vaccine administration. Overall, the frequency of events in four categories—acute respiratory events, acute gastrointestinal events, systemic bacterial infections, and rare events possibly associated with wild-type influenza—was not significantly different between the 4,452 children in the vaccine group and the 2,205 children in a placebo group. Results from the efficacy study showed an efficacy rate of 87% for children aged 60 months and older and no significant increase in the frequency of fevers greater than 37.8° C. In addition, no significant increase in frequencies of runny nose, nasal congestion, vomiting, or muscle aches was noted among the vaccine recipients compared with the placebo group. The data confirm that the efficacy of CAIV-T extends to the youngest children in the age range for which it is currently recommended, Peter F. Wright, M.D., of Vanderbilt University, Nashville, Tenn., said in an accompanying editorial (Clin. Infect. Dis. 2004;39:928-9).

Teen With Rabies Recovering

A teenaged girl who contracted rabies from a bat and received an experimental treatment has been upgraded to fair condition at the Children's Hospital of Wisconsin (Wauwatosa), a hospital spokesperson said in an interview at press time. The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl on Sept. 12, 2004. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine. She presented to Children's Hospital on Oct. 18 with symptoms of rabies, including slurred speech and fluctuating consciousness. The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment and the specifics of the drugs used are under wraps until the doctors publish their findings in a medical journal. A rabies vaccine will prevent the disease only if given within days of exposure; it is useless in saving the patient's life in advanced cases.

Neonatal Infections Limit Growth

Extremely low-birth-weight infants (401-1,000 g) who developed neonatal infections were significantly more likely to have neurodevelopmental problems in early childhood, compared with noninfected infants in a cohort study of 6,093 children, said Barbara J. Stoll, M.D., of Emory University, Atlanta, and her colleagues. The infants were assessed at 18-22 months' corrected gestational age and classified as uninfected (2,161 infants), clinical infection only (1,538 infants), sepsis (1,922 infants), sepsis and necrotizing enterocolitis (279 infants), or meningitis, either with or without sepsis (193 infants). At follow-up, 41% of the children had at least one neurodevelopmental problem (JAMA 2004;292:2357-65). Scores of less than 70 on the Mental Development Index and the Psychomotor Development Index were significantly more common among children with any of the previously mentioned infections, compared with uninfected children. In addition, children in any of the infection groups were significantly more likely to have cerebral palsy, vision impairment, and neurodevelopmental impairment, and to have a head circumference in less than the 10th percentile, compared with uninfected children.

11-Valent Vaccine Shows Promise

A new 11-valent pneumococcal conjugate vaccine (Pn-PD) was safe and effective in a randomized, single-blind study of 154 infants who received the vaccine at ages 2, 4, 6, and 12-15 months, reported Anu Nurkka of the National Public Health Institute in Helsinki, Finland, and colleagues. The vaccine used Haemophilus influenzae protein D as a carrier and contained pneumococcal capsular polysaccharides of serotypes 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Overall, three doses of Pn-PD provoked a strong antibody response, compared with a control vaccine, with a significant booster response after the fourth dose (Pediatr. Infect. Dis. J. 2004;23:1008-14). Mild local skin reactions were common.

FluMist Found Safe and Effective

The live, attenuated, cold-adapted influenza vaccine, also known as CAIV-T (FluMist), was safe and effective in children aged 60 months to 17 years in the second year of its use for prevention of flu. The CAIV-T vaccine was first available for use during the 2003-2004 season and was designed to contain three flu strains that matched those recommended by the FDA for the annual trivalent inactivated vaccine. Robert B. Belshe, M.D., of St. Louis University and colleagues reviewed a safety trial that included 6,657 children aged 5-17 years and an efficacy trial including 312 children aged 60-71 months. (Clin. Infect. Dis. 2004;39;920-7). The safety trial evaluated medically attended events within 42 days of vaccine administration. Overall, the frequency of events in four categories—acute respiratory events, acute gastrointestinal events, systemic bacterial infections, and rare events possibly associated with wild-type influenza—was not significantly different between the 4,452 children in the vaccine group and the 2,205 children in a placebo group. Results from the efficacy study showed an efficacy rate of 87% for children aged 60 months and older and no significant increase in the frequency of fevers greater than 37.8° C. In addition, no significant increase in frequencies of runny nose, nasal congestion, vomiting, or muscle aches was noted among the vaccine recipients compared with the placebo group. The data confirm that the efficacy of CAIV-T extends to the youngest children in the age range for which it is currently recommended, Peter F. Wright, M.D., of Vanderbilt University, Nashville, Tenn., said in an accompanying editorial (Clin. Infect. Dis. 2004;39:928-9).

Teen With Rabies Recovering

A teenaged girl who contracted rabies from a bat and received an experimental treatment has been upgraded to fair condition at the Children's Hospital of Wisconsin (Wauwatosa), a hospital spokesperson said in an interview at press time. The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl on Sept. 12, 2004. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine. She presented to Children's Hospital on Oct. 18 with symptoms of rabies, including slurred speech and fluctuating consciousness. The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment and the specifics of the drugs used are under wraps until the doctors publish their findings in a medical journal. A rabies vaccine will prevent the disease only if given within days of exposure; it is useless in saving the patient's life in advanced cases.

Neonatal Infections Limit Growth

Extremely low-birth-weight infants (401-1,000 g) who developed neonatal infections were significantly more likely to have neurodevelopmental problems in early childhood, compared with noninfected infants in a cohort study of 6,093 children, said Barbara J. Stoll, M.D., of Emory University, Atlanta, and her colleagues. The infants were assessed at 18-22 months' corrected gestational age and classified as uninfected (2,161 infants), clinical infection only (1,538 infants), sepsis (1,922 infants), sepsis and necrotizing enterocolitis (279 infants), or meningitis, either with or without sepsis (193 infants). At follow-up, 41% of the children had at least one neurodevelopmental problem (JAMA 2004;292:2357-65). Scores of less than 70 on the Mental Development Index and the Psychomotor Development Index were significantly more common among children with any of the previously mentioned infections, compared with uninfected children. In addition, children in any of the infection groups were significantly more likely to have cerebral palsy, vision impairment, and neurodevelopmental impairment, and to have a head circumference in less than the 10th percentile, compared with uninfected children.

11-Valent Vaccine Shows Promise

A new 11-valent pneumococcal conjugate vaccine (Pn-PD) was safe and effective in a randomized, single-blind study of 154 infants who received the vaccine at ages 2, 4, 6, and 12-15 months, reported Anu Nurkka of the National Public Health Institute in Helsinki, Finland, and colleagues. The vaccine used Haemophilus influenzae protein D as a carrier and contained pneumococcal capsular polysaccharides of serotypes 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Overall, three doses of Pn-PD provoked a strong antibody response, compared with a control vaccine, with a significant booster response after the fourth dose (Pediatr. Infect. Dis. J. 2004;23:1008-14). Mild local skin reactions were common.

FluMist Found Safe and Effective

The live, attenuated, cold-adapted influenza vaccine, also known as CAIV-T (FluMist), was safe and effective in children aged 60 months to 17 years in the second year of its use for prevention of flu. The CAIV-T vaccine was first available for use during the 2003-2004 season and was designed to contain three flu strains that matched those recommended by the FDA for the annual trivalent inactivated vaccine. Robert B. Belshe, M.D., of St. Louis University and colleagues reviewed a safety trial that included 6,657 children aged 5-17 years and an efficacy trial including 312 children aged 60-71 months. (Clin. Infect. Dis. 2004;39;920-7). The safety trial evaluated medically attended events within 42 days of vaccine administration. Overall, the frequency of events in four categories—acute respiratory events, acute gastrointestinal events, systemic bacterial infections, and rare events possibly associated with wild-type influenza—was not significantly different between the 4,452 children in the vaccine group and the 2,205 children in a placebo group. Results from the efficacy study showed an efficacy rate of 87% for children aged 60 months and older and no significant increase in the frequency of fevers greater than 37.8° C. In addition, no significant increase in frequencies of runny nose, nasal congestion, vomiting, or muscle aches was noted among the vaccine recipients compared with the placebo group. The data confirm that the efficacy of CAIV-T extends to the youngest children in the age range for which it is currently recommended, Peter F. Wright, M.D., of Vanderbilt University, Nashville, Tenn., said in an accompanying editorial (Clin. Infect. Dis. 2004;39:928-9).

Teen With Rabies Recovering

A teenaged girl who contracted rabies from a bat and received an experimental treatment has been upgraded to fair condition at the Children's Hospital of Wisconsin (Wauwatosa), a hospital spokesperson said in an interview at press time. The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl on Sept. 12, 2004. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine. She presented to Children's Hospital on Oct. 18 with symptoms of rabies, including slurred speech and fluctuating consciousness. The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment and the specifics of the drugs used are under wraps until the doctors publish their findings in a medical journal. A rabies vaccine will prevent the disease only if given within days of exposure; it is useless in saving the patient's life in advanced cases.

Neonatal Infections Limit Growth

Extremely low-birth-weight infants (401-1,000 g) who developed neonatal infections were significantly more likely to have neurodevelopmental problems in early childhood, compared with noninfected infants in a cohort study of 6,093 children, said Barbara J. Stoll, M.D., of Emory University, Atlanta, and her colleagues. The infants were assessed at 18-22 months' corrected gestational age and classified as uninfected (2,161 infants), clinical infection only (1,538 infants), sepsis (1,922 infants), sepsis and necrotizing enterocolitis (279 infants), or meningitis, either with or without sepsis (193 infants). At follow-up, 41% of the children had at least one neurodevelopmental problem (JAMA 2004;292:2357-65). Scores of less than 70 on the Mental Development Index and the Psychomotor Development Index were significantly more common among children with any of the previously mentioned infections, compared with uninfected children. In addition, children in any of the infection groups were significantly more likely to have cerebral palsy, vision impairment, and neurodevelopmental impairment, and to have a head circumference in less than the 10th percentile, compared with uninfected children.

11-Valent Vaccine Shows Promise

A new 11-valent pneumococcal conjugate vaccine (Pn-PD) was safe and effective in a randomized, single-blind study of 154 infants who received the vaccine at ages 2, 4, 6, and 12-15 months, reported Anu Nurkka of the National Public Health Institute in Helsinki, Finland, and colleagues. The vaccine used Haemophilus influenzae protein D as a carrier and contained pneumococcal capsular polysaccharides of serotypes 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Overall, three doses of Pn-PD provoked a strong antibody response, compared with a control vaccine, with a significant booster response after the fourth dose (Pediatr. Infect. Dis. J. 2004;23:1008-14). Mild local skin reactions were common.

The U.S. Food and Drug Administration has added a black box warning to Depo-Provera to emphasize the potential for bone mineral density loss with long-term use of the injectable contraceptive.

Depo-Provera has been used throughout the world for decades and remains a safe and effective method of birth control, the FDA said in a statement. However, a recent review of the drug's long-term effects on bone mineral density (BMD) by the FDA and Pfizer Inc., which manufactures the drug, prompted the addition to the label.

The black box warning notes that women who use Depo-Provera may experience a significant decrease in BMD that might not be completely reversible after discontinuing use. Consequently, Depo-Provera should be used as a long-term birth control method (more than 2 years) only if other methods are inadequate.

The warning also states that it's not known whether Depo-Provera use during adolescence or early adulthood will reduce peak bone mass and increase the risk of osteoporotic fracture in later life.

Since the U.S. approval of Depo-Provera in 1992, the prescribing information has included a warning that use of the contraceptive may be considered among the risk factors for development of osteoporosis, Pfizer noted in a statement. Additional clinical research was initiated in the 1990s to clarify the effects of Depo-Provera on BMD. Results of those studies were considered in the review and led to the labeling revisions.

One of the studies included 540 women aged 25-38 years who used Depo-Provera for 5 years and were then followed for 2 years.

The review also included data from an ongoing study of nearly 400 adolescents aged 12-18 years that will end in 2006 after 5 years of treatment and 2 years of follow-up, said Pfizer spokesperson Rebecca Hamm.

Physicians should encourage patients to consider other contraceptive options for long-term use, Ms. Hamm noted.

If women choose to continue using Depo-Provera long-term, physicians should consider periodic BMD tests and advise these patients to take calcium supplements, quit smoking, and engage in moderate exercise to help prevent BMD loss, she said.

The U.S. Food and Drug Administration has added a black box warning to Depo-Provera to emphasize the potential for bone mineral density loss with long-term use of the injectable contraceptive.

Depo-Provera has been used throughout the world for decades and remains a safe and effective method of birth control, the FDA said in a statement. However, a recent review of the drug's long-term effects on bone mineral density (BMD) by the FDA and Pfizer Inc., which manufactures the drug, prompted the addition to the label.

The black box warning notes that women who use Depo-Provera may experience a significant decrease in BMD that might not be completely reversible after discontinuing use. Consequently, Depo-Provera should be used as a long-term birth control method (more than 2 years) only if other methods are inadequate.

The warning also states that it's not known whether Depo-Provera use during adolescence or early adulthood will reduce peak bone mass and increase the risk of osteoporotic fracture in later life.

Since the U.S. approval of Depo-Provera in 1992, the prescribing information has included a warning that use of the contraceptive may be considered among the risk factors for development of osteoporosis, Pfizer noted in a statement. Additional clinical research was initiated in the 1990s to clarify the effects of Depo-Provera on BMD. Results of those studies were considered in the review and led to the labeling revisions.

One of the studies included 540 women aged 25-38 years who used Depo-Provera for 5 years and were then followed for 2 years.

The review also included data from an ongoing study of nearly 400 adolescents aged 12-18 years that will end in 2006 after 5 years of treatment and 2 years of follow-up, said Pfizer spokesperson Rebecca Hamm.

Physicians should encourage patients to consider other contraceptive options for long-term use, Ms. Hamm noted.

If women choose to continue using Depo-Provera long-term, physicians should consider periodic BMD tests and advise these patients to take calcium supplements, quit smoking, and engage in moderate exercise to help prevent BMD loss, she said.

The U.S. Food and Drug Administration has added a black box warning to Depo-Provera to emphasize the potential for bone mineral density loss with long-term use of the injectable contraceptive.

Depo-Provera has been used throughout the world for decades and remains a safe and effective method of birth control, the FDA said in a statement. However, a recent review of the drug's long-term effects on bone mineral density (BMD) by the FDA and Pfizer Inc., which manufactures the drug, prompted the addition to the label.

The black box warning notes that women who use Depo-Provera may experience a significant decrease in BMD that might not be completely reversible after discontinuing use. Consequently, Depo-Provera should be used as a long-term birth control method (more than 2 years) only if other methods are inadequate.

The warning also states that it's not known whether Depo-Provera use during adolescence or early adulthood will reduce peak bone mass and increase the risk of osteoporotic fracture in later life.

Since the U.S. approval of Depo-Provera in 1992, the prescribing information has included a warning that use of the contraceptive may be considered among the risk factors for development of osteoporosis, Pfizer noted in a statement. Additional clinical research was initiated in the 1990s to clarify the effects of Depo-Provera on BMD. Results of those studies were considered in the review and led to the labeling revisions.

One of the studies included 540 women aged 25-38 years who used Depo-Provera for 5 years and were then followed for 2 years.

The review also included data from an ongoing study of nearly 400 adolescents aged 12-18 years that will end in 2006 after 5 years of treatment and 2 years of follow-up, said Pfizer spokesperson Rebecca Hamm.

Physicians should encourage patients to consider other contraceptive options for long-term use, Ms. Hamm noted.

If women choose to continue using Depo-Provera long-term, physicians should consider periodic BMD tests and advise these patients to take calcium supplements, quit smoking, and engage in moderate exercise to help prevent BMD loss, she said.

WASHINGTON — Gel lubrication to ease the pain of vaginal speculum insertion does not adversely affect the quality or viability of cervical samples, William Griffith, M.D., reported at the annual meeting of the Association of Reproductive Health Professionals.

The results of his randomized study of 3,460 Pap smears and 5,535 combination DNA probe assays appear to refute dogma long etched in textbooks that warns clinicians to beware of gel lubrication because of purported interference with cervical microbiology or with interpretation of a Pap smear.

The study found no statistically significant difference in the integrity of samples when vaginal insertion was aided by a dime-sized dab of a water-soluble bacteriostatic gel lubricant, compared with samples in which water was used as a lubricant, Dr. Griffith of the University of Texas Southwestern Medical Center in Dallas said.

He cited data suggesting that the pain of speculum insertion may lead women to delay pelvic exams—87% reporting it a “significant barrier”—and called for efforts to minimize that pain. Dr. Griffith said he had no financial interest in the bacteriostatic gel product.

The study included 9,500 women, 20-44 years old, who underwent pelvic examinations involving a vaginal speculum from July 2003 to February 2004 at a rural family planning clinic. Each of the 8 months was randomly designated as a “gel month” or a “water month,” and the assigned lubrication method was used on all patients that month. A total of 6,538 women had a Pap smear or a DNA assay to screen for sexually transmitted disease, or both.

There were 20 unsatisfactory Pap smear samples among 1,828 women screened during the gel months (1·1%), compared with 24 unsatisfactory samples among 1,632 women screened during the water lubricant months (1·5%). The difference between groups was not statistically significant.

In addition, the type of speculum lubricant did not affect chlamydia and gonorrhea detection rates.

Chlamydia was detected in 44 of 2,909 patients (1·5%) screened by combination DNA probe during the gel months and 28 of 2,626 patients (1·1%) screened during the water months, resulting in equal detection rates.

Gonorrhea detection rates were also similar: No cases of gonorrhea were detected among patients examined during the gel lubricant months, compared with 3 (0·1%) during the water lubrication months.

WASHINGTON — Gel lubrication to ease the pain of vaginal speculum insertion does not adversely affect the quality or viability of cervical samples, William Griffith, M.D., reported at the annual meeting of the Association of Reproductive Health Professionals.

The results of his randomized study of 3,460 Pap smears and 5,535 combination DNA probe assays appear to refute dogma long etched in textbooks that warns clinicians to beware of gel lubrication because of purported interference with cervical microbiology or with interpretation of a Pap smear.

The study found no statistically significant difference in the integrity of samples when vaginal insertion was aided by a dime-sized dab of a water-soluble bacteriostatic gel lubricant, compared with samples in which water was used as a lubricant, Dr. Griffith of the University of Texas Southwestern Medical Center in Dallas said.

He cited data suggesting that the pain of speculum insertion may lead women to delay pelvic exams—87% reporting it a “significant barrier”—and called for efforts to minimize that pain. Dr. Griffith said he had no financial interest in the bacteriostatic gel product.

The study included 9,500 women, 20-44 years old, who underwent pelvic examinations involving a vaginal speculum from July 2003 to February 2004 at a rural family planning clinic. Each of the 8 months was randomly designated as a “gel month” or a “water month,” and the assigned lubrication method was used on all patients that month. A total of 6,538 women had a Pap smear or a DNA assay to screen for sexually transmitted disease, or both.

There were 20 unsatisfactory Pap smear samples among 1,828 women screened during the gel months (1·1%), compared with 24 unsatisfactory samples among 1,632 women screened during the water lubricant months (1·5%). The difference between groups was not statistically significant.

In addition, the type of speculum lubricant did not affect chlamydia and gonorrhea detection rates.

Chlamydia was detected in 44 of 2,909 patients (1·5%) screened by combination DNA probe during the gel months and 28 of 2,626 patients (1·1%) screened during the water months, resulting in equal detection rates.

Gonorrhea detection rates were also similar: No cases of gonorrhea were detected among patients examined during the gel lubricant months, compared with 3 (0·1%) during the water lubrication months.

WASHINGTON — Gel lubrication to ease the pain of vaginal speculum insertion does not adversely affect the quality or viability of cervical samples, William Griffith, M.D., reported at the annual meeting of the Association of Reproductive Health Professionals.

The results of his randomized study of 3,460 Pap smears and 5,535 combination DNA probe assays appear to refute dogma long etched in textbooks that warns clinicians to beware of gel lubrication because of purported interference with cervical microbiology or with interpretation of a Pap smear.

The study found no statistically significant difference in the integrity of samples when vaginal insertion was aided by a dime-sized dab of a water-soluble bacteriostatic gel lubricant, compared with samples in which water was used as a lubricant, Dr. Griffith of the University of Texas Southwestern Medical Center in Dallas said.

He cited data suggesting that the pain of speculum insertion may lead women to delay pelvic exams—87% reporting it a “significant barrier”—and called for efforts to minimize that pain. Dr. Griffith said he had no financial interest in the bacteriostatic gel product.

The study included 9,500 women, 20-44 years old, who underwent pelvic examinations involving a vaginal speculum from July 2003 to February 2004 at a rural family planning clinic. Each of the 8 months was randomly designated as a “gel month” or a “water month,” and the assigned lubrication method was used on all patients that month. A total of 6,538 women had a Pap smear or a DNA assay to screen for sexually transmitted disease, or both.

There were 20 unsatisfactory Pap smear samples among 1,828 women screened during the gel months (1·1%), compared with 24 unsatisfactory samples among 1,632 women screened during the water lubricant months (1·5%). The difference between groups was not statistically significant.

In addition, the type of speculum lubricant did not affect chlamydia and gonorrhea detection rates.

Chlamydia was detected in 44 of 2,909 patients (1·5%) screened by combination DNA probe during the gel months and 28 of 2,626 patients (1·1%) screened during the water months, resulting in equal detection rates.

Gonorrhea detection rates were also similar: No cases of gonorrhea were detected among patients examined during the gel lubricant months, compared with 3 (0·1%) during the water lubrication months.

BETHESDA, MD. — Formaldehyde resins found in permanent press clothes may cause some cases of contact dermatitis.

“Clinically, you have to have a high index of suspicion whenever anyone comes in with a chronic eczematous rash,” Ryan Carlson, D.O., reported at a meeting on contact dermatitis.

If the rash site corresponds to a place where clothing fits tightly to the skin—such as the waistband, posterior neck, upper back, and the anterior and posterior axillary folds—then consider textiles as a source of the dermatitis.

Sometimes atypical presentations occur, said Dr. Carlson, an intern at the University Hospitals of Cleveland.

For example, one patient developed a rash on his forehead from a baseball cap that had formaldehyde resins in the fabric of the lining.

Previous investigators have found that patch testing with formaldehyde alone identifies 70% of patients who are sensitive to formaldehyde resins. Therefore, it is also necessary to patch test the resins to confirm the presence of textile dermatitis.

Some permanent press finishes that are used in patch testing for textile-related allergic contact dermatitis include dimethylol dihydroxyethylene urea 4.5% aqueous (Fixapret CPN) and ethylene urea melamine formaldehyde 5% mix in petroleum (Fixapret AC).

Dr. Carlson reviewed patch test results for 574 women and 278 men with contact dermatitis who were tested for a formaldehyde allergy between August 1999 and April 2004.

Overall, 7.2% of the cases—33 women (5.7%) and 28 men (10.1%)—tested positive, Dr. Carlson said…

In addition, 13 of the 574 women (2.3%) and 4 of the 278 men (1.4%) tested positive for Fixapret AC.

“Historically, women have been more susceptible to textile dermatitis than men, with ratios in the 3:1 and 5:1 range, but our data show a ratio of approximately 1:1,” he said.

Many patients with textile resin allergy are originally sensitized to formaldehyde in the workplace and react to formaldehyde resins in textiles later in life, Dr. Carlson noted.

He cited the case of a woman who developed an allergy to formaldehyde when a disinfectant containing formaldehyde was used in her workplace, and then later reacted to a formaldehyde resin in her lab coat.

The condition resolved when she stopped wearing the coat, Dr. Carlson said.

Allergens such as formaldehyde are rarely noted on clothing labels, nor do recommended wash cycle instructions indicate whether the clothing has some type of permanent press finish.

In general, advise patients with a history of textile-related contact dermatitis to read clothing labels and avoid any permanent press or wrinkle-resistant fabrics as well as rayon and 100% cotton fabrics that do not wrinkle.

Instead, they should look for 100% linen, polyester, nylon, denim, flannel clothes, or lyocell (Tencel).

An allergic reaction can be reduced by wearing silk undergarments and loose-fitting clothing and by keeping the skin cool, Dr. Carlson said at the meeting, which was sponsored by the Experimental Contact Dermatitis Research Group and the American Contact Dermatitis Society.

He and his associates inquired about the textiles used at several major clothing companies.

Among those who claimed to use little or no formaldehyde-releasing resin in the production of their textiles were Gap, Talbots, J.Crew, Eddie Bauer, and Liz Claiborne.

In addition to their use in textiles, formaldehyde-releasing preservatives are frequently used in skin care products, industrial products, and topical steroid treatments.

BETHESDA, MD. — Formaldehyde resins found in permanent press clothes may cause some cases of contact dermatitis.

“Clinically, you have to have a high index of suspicion whenever anyone comes in with a chronic eczematous rash,” Ryan Carlson, D.O., reported at a meeting on contact dermatitis.

If the rash site corresponds to a place where clothing fits tightly to the skin—such as the waistband, posterior neck, upper back, and the anterior and posterior axillary folds—then consider textiles as a source of the dermatitis.

Sometimes atypical presentations occur, said Dr. Carlson, an intern at the University Hospitals of Cleveland.

For example, one patient developed a rash on his forehead from a baseball cap that had formaldehyde resins in the fabric of the lining.

Previous investigators have found that patch testing with formaldehyde alone identifies 70% of patients who are sensitive to formaldehyde resins. Therefore, it is also necessary to patch test the resins to confirm the presence of textile dermatitis.

Some permanent press finishes that are used in patch testing for textile-related allergic contact dermatitis include dimethylol dihydroxyethylene urea 4.5% aqueous (Fixapret CPN) and ethylene urea melamine formaldehyde 5% mix in petroleum (Fixapret AC).

Dr. Carlson reviewed patch test results for 574 women and 278 men with contact dermatitis who were tested for a formaldehyde allergy between August 1999 and April 2004.

Overall, 7.2% of the cases—33 women (5.7%) and 28 men (10.1%)—tested positive, Dr. Carlson said…

In addition, 13 of the 574 women (2.3%) and 4 of the 278 men (1.4%) tested positive for Fixapret AC.

“Historically, women have been more susceptible to textile dermatitis than men, with ratios in the 3:1 and 5:1 range, but our data show a ratio of approximately 1:1,” he said.

Many patients with textile resin allergy are originally sensitized to formaldehyde in the workplace and react to formaldehyde resins in textiles later in life, Dr. Carlson noted.

He cited the case of a woman who developed an allergy to formaldehyde when a disinfectant containing formaldehyde was used in her workplace, and then later reacted to a formaldehyde resin in her lab coat.

The condition resolved when she stopped wearing the coat, Dr. Carlson said.

Allergens such as formaldehyde are rarely noted on clothing labels, nor do recommended wash cycle instructions indicate whether the clothing has some type of permanent press finish.

In general, advise patients with a history of textile-related contact dermatitis to read clothing labels and avoid any permanent press or wrinkle-resistant fabrics as well as rayon and 100% cotton fabrics that do not wrinkle.

Instead, they should look for 100% linen, polyester, nylon, denim, flannel clothes, or lyocell (Tencel).

An allergic reaction can be reduced by wearing silk undergarments and loose-fitting clothing and by keeping the skin cool, Dr. Carlson said at the meeting, which was sponsored by the Experimental Contact Dermatitis Research Group and the American Contact Dermatitis Society.

He and his associates inquired about the textiles used at several major clothing companies.

Among those who claimed to use little or no formaldehyde-releasing resin in the production of their textiles were Gap, Talbots, J.Crew, Eddie Bauer, and Liz Claiborne.

In addition to their use in textiles, formaldehyde-releasing preservatives are frequently used in skin care products, industrial products, and topical steroid treatments.

BETHESDA, MD. — Formaldehyde resins found in permanent press clothes may cause some cases of contact dermatitis.

“Clinically, you have to have a high index of suspicion whenever anyone comes in with a chronic eczematous rash,” Ryan Carlson, D.O., reported at a meeting on contact dermatitis.

If the rash site corresponds to a place where clothing fits tightly to the skin—such as the waistband, posterior neck, upper back, and the anterior and posterior axillary folds—then consider textiles as a source of the dermatitis.

Sometimes atypical presentations occur, said Dr. Carlson, an intern at the University Hospitals of Cleveland.

For example, one patient developed a rash on his forehead from a baseball cap that had formaldehyde resins in the fabric of the lining.

Previous investigators have found that patch testing with formaldehyde alone identifies 70% of patients who are sensitive to formaldehyde resins. Therefore, it is also necessary to patch test the resins to confirm the presence of textile dermatitis.

Some permanent press finishes that are used in patch testing for textile-related allergic contact dermatitis include dimethylol dihydroxyethylene urea 4.5% aqueous (Fixapret CPN) and ethylene urea melamine formaldehyde 5% mix in petroleum (Fixapret AC).

Dr. Carlson reviewed patch test results for 574 women and 278 men with contact dermatitis who were tested for a formaldehyde allergy between August 1999 and April 2004.

Overall, 7.2% of the cases—33 women (5.7%) and 28 men (10.1%)—tested positive, Dr. Carlson said…

In addition, 13 of the 574 women (2.3%) and 4 of the 278 men (1.4%) tested positive for Fixapret AC.

“Historically, women have been more susceptible to textile dermatitis than men, with ratios in the 3:1 and 5:1 range, but our data show a ratio of approximately 1:1,” he said.

Many patients with textile resin allergy are originally sensitized to formaldehyde in the workplace and react to formaldehyde resins in textiles later in life, Dr. Carlson noted.

He cited the case of a woman who developed an allergy to formaldehyde when a disinfectant containing formaldehyde was used in her workplace, and then later reacted to a formaldehyde resin in her lab coat.

The condition resolved when she stopped wearing the coat, Dr. Carlson said.

Allergens such as formaldehyde are rarely noted on clothing labels, nor do recommended wash cycle instructions indicate whether the clothing has some type of permanent press finish.

In general, advise patients with a history of textile-related contact dermatitis to read clothing labels and avoid any permanent press or wrinkle-resistant fabrics as well as rayon and 100% cotton fabrics that do not wrinkle.

Instead, they should look for 100% linen, polyester, nylon, denim, flannel clothes, or lyocell (Tencel).

An allergic reaction can be reduced by wearing silk undergarments and loose-fitting clothing and by keeping the skin cool, Dr. Carlson said at the meeting, which was sponsored by the Experimental Contact Dermatitis Research Group and the American Contact Dermatitis Society.

He and his associates inquired about the textiles used at several major clothing companies.

Among those who claimed to use little or no formaldehyde-releasing resin in the production of their textiles were Gap, Talbots, J.Crew, Eddie Bauer, and Liz Claiborne.

In addition to their use in textiles, formaldehyde-releasing preservatives are frequently used in skin care products, industrial products, and topical steroid treatments.

WASHINGTON – Depression is underdiagnosed in patients with acute coronary syndrome, Alpesh A. Amin, M.D., said in a poster at a scientific forum sponsored by the American Heart Association.

In a prospective study of 1,199 patients, scores on the Patient Health Questionnaire-9 consistent with depression were found in 183 (15%) at the time of hospital admission for ACS. Of those, 57 of 153 patients younger than 70 years (37%) and 4 of 30 patients aged 70 years and older (13.3%) had been clinically recognized as depressed. Only 32% of those under 70 years and 13.3% of those aged 70 years and older were taking medication to treat their depressive symptoms, said Dr. Amin of St. Luke's Hospital, Kansas City, Mo.

Recognition and treatment of depression were low across all age groups but significantly worse among patients aged 70 years and older, compared with those younger than 70 years. That gap highlights the need for improved psychiatric assessment of coronary patients, he noted.

WASHINGTON – Depression is underdiagnosed in patients with acute coronary syndrome, Alpesh A. Amin, M.D., said in a poster at a scientific forum sponsored by the American Heart Association.

In a prospective study of 1,199 patients, scores on the Patient Health Questionnaire-9 consistent with depression were found in 183 (15%) at the time of hospital admission for ACS. Of those, 57 of 153 patients younger than 70 years (37%) and 4 of 30 patients aged 70 years and older (13.3%) had been clinically recognized as depressed. Only 32% of those under 70 years and 13.3% of those aged 70 years and older were taking medication to treat their depressive symptoms, said Dr. Amin of St. Luke's Hospital, Kansas City, Mo.

Recognition and treatment of depression were low across all age groups but significantly worse among patients aged 70 years and older, compared with those younger than 70 years. That gap highlights the need for improved psychiatric assessment of coronary patients, he noted.

WASHINGTON – Depression is underdiagnosed in patients with acute coronary syndrome, Alpesh A. Amin, M.D., said in a poster at a scientific forum sponsored by the American Heart Association.

In a prospective study of 1,199 patients, scores on the Patient Health Questionnaire-9 consistent with depression were found in 183 (15%) at the time of hospital admission for ACS. Of those, 57 of 153 patients younger than 70 years (37%) and 4 of 30 patients aged 70 years and older (13.3%) had been clinically recognized as depressed. Only 32% of those under 70 years and 13.3% of those aged 70 years and older were taking medication to treat their depressive symptoms, said Dr. Amin of St. Luke's Hospital, Kansas City, Mo.

Recognition and treatment of depression were low across all age groups but significantly worse among patients aged 70 years and older, compared with those younger than 70 years. That gap highlights the need for improved psychiatric assessment of coronary patients, he noted.

WASHINGTON – Buprenorphine was approved for the treatment of opioid dependence in 2002, but many physicians are hesitant to prescribe it despite being licensed to do so.

Of more than 2.5 million opiate addiction patients in the United States, only 200,000 are receiving opiate agonist treatment with methadone or buprenorphine, David Fiellin, M.D., reported at the annual conference of the Association for Medical Education and Research in Substance Abuse.

“There is clearly a need to evaluate the provision of treatment in alternative settings, such as physician offices,” said Dr. Fiellin of the department of internal medicine at Yale University, New Haven.

In 2000, Congress passed the Drug Addiction Treatment Act, which allows qualified office-based physicians to use approved narcotics for the treatment of opioid dependence. Buprenorphine was approved for this purpose in 2002. Physicians can qualify to provide treatment by participating in an 8-hour training program on caring for opioid-dependent patients.

As of 2004, approximately 65,000 physicians have received the training. Of these, 4,000 have notified the Substance Abuse and Mental Health Services Administration (SAMHSA) that they want registration to prescribe buprenorphine, and 3,600 physicians have received their registrations. Of these, 80% have agreed to be listed on a Web site so patients and colleagues can locate them.

The gap between the number of physicians who have been trained in treating opioid addiction and the number who are prescribing suggests a need to examine barriers to treatment. Kevin Irwin and his colleagues at Yale University conducted a study, supported in part by the Robert Wood Johnson Foundation, to assess barriers that keep physicians from incorporating buprenorphine, and Dr. Fiellin presented the results.

The investigators conducted in-depth interviews with physicians in one of four categories: general internists with no specific interest in providing buprenorphine treatment, those who received training but weren't registered with SAMHSA, those who were registered but not prescribing the drug, and those who were registered and were prescribing it. Barriers described by physicians fell into four categories:

▸ Physician discomfort. “People do get sort of difficult,” commented one physician during the interview. Several physicians expressed similar concerns about addiction patients becoming combative. Others said that they weren't in the habit of treating addictions, and that they did not think their staff members were prepared to handle such patients.

▸ Medical marginalization. Treatment of addiction “seems like something outside of medicine, a subspecialty of psychiatry,” one physician said. “It's something we weren't really taught about,” another doctor commented. Others speculated that the implementation of buprenorphine treatment would mean a culture shift in the office, reflecting a shift in how addiction patients are treated compared with methadone clinics.

▸ Need for support. Physicians said that they would be more inclined to provide buprenorphine treatment if they had an avenue of communication to an addiction specialist. “It would be helpful to know ahead of time what can go wrong,” one doctor commented. Other physicians acknowledged that treating addiction is more than writing a prescription, and that some type of partnership with a specialist would be helpful.

▸ Policy restrictions. The physicians who were treating addiction patients with buprenorphine mentioned this issue more frequently. The current policy states that a maximum of 30 patients can be treated in any medical practice. The number 30 is arbitrary, and some physicians expressed frustration. “I prescribe all kinds of things that are much more dangerous,” one doctor commented. The intent of the limit was to prevent any one office from becoming a prescription mill, but no evidence supports a specific number of patients as appropriate for one office to manage.

These concerns may explain the sluggish adoption of buprenorphine treatment, Dr. Fiellin said. “We have been working on a physician clinical support system to provide physician mentors,” he noted. Office-based buprenorphine treatment has promise, and clinical support in the form of a mentorship program may help expand care.

An outreach plan, the Physician Clinical Support System, funded by SAMHSA, calls for medical societies to have information for physicians at buprenorphine training events, with local mentors available to whom they can pose questions after the training. Concerns about undesirable patients are unwarranted, because patients with addiction problems are often already part of any patient population, Dr. Fiellin said.

Location of training programs is another concern. Most buprenorphine prescribers are in the Northeast and on the West Coast. Although locations have not always been convenient for physicians, online training courses are also available.

Cost is an issue as well. The science behind buprenorphine is solid, but the financing remains in flux, in part because the cost has not been standardized. Payment for the treatment varies, with some providers taking insurance and others taking cash.

Despite the potential problems, doctors who initiate buprenorphine treatment continue to prescribe it because they see the good they can do for patients, Dr. Fiellin said. “If you talk to physicians who have implemented buprenorphine treatments, you find the rewards outweigh the barriers.”

WASHINGTON – Buprenorphine was approved for the treatment of opioid dependence in 2002, but many physicians are hesitant to prescribe it despite being licensed to do so.

Of more than 2.5 million opiate addiction patients in the United States, only 200,000 are receiving opiate agonist treatment with methadone or buprenorphine, David Fiellin, M.D., reported at the annual conference of the Association for Medical Education and Research in Substance Abuse.

“There is clearly a need to evaluate the provision of treatment in alternative settings, such as physician offices,” said Dr. Fiellin of the department of internal medicine at Yale University, New Haven.

In 2000, Congress passed the Drug Addiction Treatment Act, which allows qualified office-based physicians to use approved narcotics for the treatment of opioid dependence. Buprenorphine was approved for this purpose in 2002. Physicians can qualify to provide treatment by participating in an 8-hour training program on caring for opioid-dependent patients.

As of 2004, approximately 65,000 physicians have received the training. Of these, 4,000 have notified the Substance Abuse and Mental Health Services Administration (SAMHSA) that they want registration to prescribe buprenorphine, and 3,600 physicians have received their registrations. Of these, 80% have agreed to be listed on a Web site so patients and colleagues can locate them.

The gap between the number of physicians who have been trained in treating opioid addiction and the number who are prescribing suggests a need to examine barriers to treatment. Kevin Irwin and his colleagues at Yale University conducted a study, supported in part by the Robert Wood Johnson Foundation, to assess barriers that keep physicians from incorporating buprenorphine, and Dr. Fiellin presented the results.

The investigators conducted in-depth interviews with physicians in one of four categories: general internists with no specific interest in providing buprenorphine treatment, those who received training but weren't registered with SAMHSA, those who were registered but not prescribing the drug, and those who were registered and were prescribing it. Barriers described by physicians fell into four categories:

▸ Physician discomfort. “People do get sort of difficult,” commented one physician during the interview. Several physicians expressed similar concerns about addiction patients becoming combative. Others said that they weren't in the habit of treating addictions, and that they did not think their staff members were prepared to handle such patients.

▸ Medical marginalization. Treatment of addiction “seems like something outside of medicine, a subspecialty of psychiatry,” one physician said. “It's something we weren't really taught about,” another doctor commented. Others speculated that the implementation of buprenorphine treatment would mean a culture shift in the office, reflecting a shift in how addiction patients are treated compared with methadone clinics.

▸ Need for support. Physicians said that they would be more inclined to provide buprenorphine treatment if they had an avenue of communication to an addiction specialist. “It would be helpful to know ahead of time what can go wrong,” one doctor commented. Other physicians acknowledged that treating addiction is more than writing a prescription, and that some type of partnership with a specialist would be helpful.

▸ Policy restrictions. The physicians who were treating addiction patients with buprenorphine mentioned this issue more frequently. The current policy states that a maximum of 30 patients can be treated in any medical practice. The number 30 is arbitrary, and some physicians expressed frustration. “I prescribe all kinds of things that are much more dangerous,” one doctor commented. The intent of the limit was to prevent any one office from becoming a prescription mill, but no evidence supports a specific number of patients as appropriate for one office to manage.

These concerns may explain the sluggish adoption of buprenorphine treatment, Dr. Fiellin said. “We have been working on a physician clinical support system to provide physician mentors,” he noted. Office-based buprenorphine treatment has promise, and clinical support in the form of a mentorship program may help expand care.

An outreach plan, the Physician Clinical Support System, funded by SAMHSA, calls for medical societies to have information for physicians at buprenorphine training events, with local mentors available to whom they can pose questions after the training. Concerns about undesirable patients are unwarranted, because patients with addiction problems are often already part of any patient population, Dr. Fiellin said.

Location of training programs is another concern. Most buprenorphine prescribers are in the Northeast and on the West Coast. Although locations have not always been convenient for physicians, online training courses are also available.

Cost is an issue as well. The science behind buprenorphine is solid, but the financing remains in flux, in part because the cost has not been standardized. Payment for the treatment varies, with some providers taking insurance and others taking cash.

Despite the potential problems, doctors who initiate buprenorphine treatment continue to prescribe it because they see the good they can do for patients, Dr. Fiellin said. “If you talk to physicians who have implemented buprenorphine treatments, you find the rewards outweigh the barriers.”

WASHINGTON – Buprenorphine was approved for the treatment of opioid dependence in 2002, but many physicians are hesitant to prescribe it despite being licensed to do so.

Of more than 2.5 million opiate addiction patients in the United States, only 200,000 are receiving opiate agonist treatment with methadone or buprenorphine, David Fiellin, M.D., reported at the annual conference of the Association for Medical Education and Research in Substance Abuse.

“There is clearly a need to evaluate the provision of treatment in alternative settings, such as physician offices,” said Dr. Fiellin of the department of internal medicine at Yale University, New Haven.

In 2000, Congress passed the Drug Addiction Treatment Act, which allows qualified office-based physicians to use approved narcotics for the treatment of opioid dependence. Buprenorphine was approved for this purpose in 2002. Physicians can qualify to provide treatment by participating in an 8-hour training program on caring for opioid-dependent patients.

As of 2004, approximately 65,000 physicians have received the training. Of these, 4,000 have notified the Substance Abuse and Mental Health Services Administration (SAMHSA) that they want registration to prescribe buprenorphine, and 3,600 physicians have received their registrations. Of these, 80% have agreed to be listed on a Web site so patients and colleagues can locate them.

The gap between the number of physicians who have been trained in treating opioid addiction and the number who are prescribing suggests a need to examine barriers to treatment. Kevin Irwin and his colleagues at Yale University conducted a study, supported in part by the Robert Wood Johnson Foundation, to assess barriers that keep physicians from incorporating buprenorphine, and Dr. Fiellin presented the results.

The investigators conducted in-depth interviews with physicians in one of four categories: general internists with no specific interest in providing buprenorphine treatment, those who received training but weren't registered with SAMHSA, those who were registered but not prescribing the drug, and those who were registered and were prescribing it. Barriers described by physicians fell into four categories:

▸ Physician discomfort. “People do get sort of difficult,” commented one physician during the interview. Several physicians expressed similar concerns about addiction patients becoming combative. Others said that they weren't in the habit of treating addictions, and that they did not think their staff members were prepared to handle such patients.

▸ Medical marginalization. Treatment of addiction “seems like something outside of medicine, a subspecialty of psychiatry,” one physician said. “It's something we weren't really taught about,” another doctor commented. Others speculated that the implementation of buprenorphine treatment would mean a culture shift in the office, reflecting a shift in how addiction patients are treated compared with methadone clinics.

▸ Need for support. Physicians said that they would be more inclined to provide buprenorphine treatment if they had an avenue of communication to an addiction specialist. “It would be helpful to know ahead of time what can go wrong,” one doctor commented. Other physicians acknowledged that treating addiction is more than writing a prescription, and that some type of partnership with a specialist would be helpful.

▸ Policy restrictions. The physicians who were treating addiction patients with buprenorphine mentioned this issue more frequently. The current policy states that a maximum of 30 patients can be treated in any medical practice. The number 30 is arbitrary, and some physicians expressed frustration. “I prescribe all kinds of things that are much more dangerous,” one doctor commented. The intent of the limit was to prevent any one office from becoming a prescription mill, but no evidence supports a specific number of patients as appropriate for one office to manage.

These concerns may explain the sluggish adoption of buprenorphine treatment, Dr. Fiellin said. “We have been working on a physician clinical support system to provide physician mentors,” he noted. Office-based buprenorphine treatment has promise, and clinical support in the form of a mentorship program may help expand care.

An outreach plan, the Physician Clinical Support System, funded by SAMHSA, calls for medical societies to have information for physicians at buprenorphine training events, with local mentors available to whom they can pose questions after the training. Concerns about undesirable patients are unwarranted, because patients with addiction problems are often already part of any patient population, Dr. Fiellin said.

Location of training programs is another concern. Most buprenorphine prescribers are in the Northeast and on the West Coast. Although locations have not always been convenient for physicians, online training courses are also available.

Cost is an issue as well. The science behind buprenorphine is solid, but the financing remains in flux, in part because the cost has not been standardized. Payment for the treatment varies, with some providers taking insurance and others taking cash.

Despite the potential problems, doctors who initiate buprenorphine treatment continue to prescribe it because they see the good they can do for patients, Dr. Fiellin said. “If you talk to physicians who have implemented buprenorphine treatments, you find the rewards outweigh the barriers.”

WASHINGTON – Social workers are providing care for individuals with substance use disorders at increasing rates, Mickey J.W. Smith said in a poster presentation at the annual meeting of the Association for Medical Education and Research in Substance Abuse.

The study data were collected by the National Association of Social Workers as part of a survey of 2,000 social workers funded in part by the Center for Substance Abuse Treatment, said Mr. Smith of the NASW.

The social workers reported that 27% of their clients in 2002 had a primary or secondary substance use disorder, up from 25% in 2000. Clients seen by social workers in organizational settings had higher rates of primary diagnoses, compared with those seen by social workers in private practice in 2000 and 2002 (9% vs. 6% both years). Clients seen in organizational settings also had higher rates of secondary diagnoses, compared with private practice in 2000 (20% vs. 13%) and 2002 (21% vs. 17%).

The total average number of hours social workers spent in addictions-specific training decreased slightly, from 4.4 hours in 2000 to 4.3 hours in 2002, Mr. Smith reported.

Overall, 65% of social workers took part in addictions-specific continuing education in 2002, compared with 68% in 2000. But participation in several other types of addictions-specific training increased: 39% of the social workers took formal coursework in 2002, up from 38% in 2000, and 26% engaged in clinical supervision activities in 2002, up from 24% in 2000. In addition, 18% of respondents took part in field placement in 2002, up from 16% in 2000, and 6% did volunteer work in 2002, compared with 5% in 2000.

WASHINGTON – Social workers are providing care for individuals with substance use disorders at increasing rates, Mickey J.W. Smith said in a poster presentation at the annual meeting of the Association for Medical Education and Research in Substance Abuse.

The study data were collected by the National Association of Social Workers as part of a survey of 2,000 social workers funded in part by the Center for Substance Abuse Treatment, said Mr. Smith of the NASW.

The social workers reported that 27% of their clients in 2002 had a primary or secondary substance use disorder, up from 25% in 2000. Clients seen by social workers in organizational settings had higher rates of primary diagnoses, compared with those seen by social workers in private practice in 2000 and 2002 (9% vs. 6% both years). Clients seen in organizational settings also had higher rates of secondary diagnoses, compared with private practice in 2000 (20% vs. 13%) and 2002 (21% vs. 17%).

The total average number of hours social workers spent in addictions-specific training decreased slightly, from 4.4 hours in 2000 to 4.3 hours in 2002, Mr. Smith reported.

Overall, 65% of social workers took part in addictions-specific continuing education in 2002, compared with 68% in 2000. But participation in several other types of addictions-specific training increased: 39% of the social workers took formal coursework in 2002, up from 38% in 2000, and 26% engaged in clinical supervision activities in 2002, up from 24% in 2000. In addition, 18% of respondents took part in field placement in 2002, up from 16% in 2000, and 6% did volunteer work in 2002, compared with 5% in 2000.

WASHINGTON – Social workers are providing care for individuals with substance use disorders at increasing rates, Mickey J.W. Smith said in a poster presentation at the annual meeting of the Association for Medical Education and Research in Substance Abuse.

The study data were collected by the National Association of Social Workers as part of a survey of 2,000 social workers funded in part by the Center for Substance Abuse Treatment, said Mr. Smith of the NASW.

The social workers reported that 27% of their clients in 2002 had a primary or secondary substance use disorder, up from 25% in 2000. Clients seen by social workers in organizational settings had higher rates of primary diagnoses, compared with those seen by social workers in private practice in 2000 and 2002 (9% vs. 6% both years). Clients seen in organizational settings also had higher rates of secondary diagnoses, compared with private practice in 2000 (20% vs. 13%) and 2002 (21% vs. 17%).

The total average number of hours social workers spent in addictions-specific training decreased slightly, from 4.4 hours in 2000 to 4.3 hours in 2002, Mr. Smith reported.

Overall, 65% of social workers took part in addictions-specific continuing education in 2002, compared with 68% in 2000. But participation in several other types of addictions-specific training increased: 39% of the social workers took formal coursework in 2002, up from 38% in 2000, and 26% engaged in clinical supervision activities in 2002, up from 24% in 2000. In addition, 18% of respondents took part in field placement in 2002, up from 16% in 2000, and 6% did volunteer work in 2002, compared with 5% in 2000.

Sleep-Disordered Breathing, Behavior

Children with mild to moderate sleep-disordered breathing demonstrated significantly more problem behaviors, compared with controls in a cross-sectional study of 829 8- to 11-year-olds, said Carol L. Rosen, M.D., of Case Western Reserve University, Cleveland, and her associates.

The children were assessed with unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate. Overall, children with sleep-disordered breathing were at least twice as likely to score in the borderline or clinically abnormal range on the Child Behavior Checklist (CBCL) externalizing and internalizing scales (Pediatrics 2004;114:1640-8).

The children with sleep-disordered breathing were significantly more likely to demonstrate hyperactivity, emotional lability, aggression, and opposition, compared with controls. Black ethnicity was a significant predictor for the CBCL total problem scale, while preterm birth was a significant predictor for the CBCL total and social problem scales and a hyperactivity scale. The significantly higher odds of behavior problems in black children as a subgroup may be the result of a greater vulnerability to sleep disruption in this group.

CBT Relieves Depression in IBD Patients

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. 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 (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469-77).

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

Recreational Ritalin on the Rise

Approximately 4% of a national sample of 8th, 10th, and 12th graders reported illicit use of methylphenidate (Ritalin) within the past year, said Sean Esteban McCabe, Ph.D., and his associates at the University of Michigan, Ann Arbor.

Based on data from the 2001 Monitoring the Future Survey, students in grades 10 (4.6%) and 12 (5%) were significantly more likely to report illicit use than eighth graders (2.7%). Illegal methylphenidate use was significantly more common among students with grade point averages of C or D (6.4%), compared with those with a B average (3.9%) or A average (2.6%). In addition, white students (4.8%) were significantly more likely to report illegal use than black students (0.8%), which mirrored racial differences in prescription patterns (J. Adolesc. Health 2004;35:501-4).

Iron Deficiency's Role in ADHD

Children with attention-deficit hyperactivity disorder had significantly lower levels of iron, compared with controls in a study of 53 children aged 4-14 years, said Eric Konofal, M.D., of Hôpitaux de Paris, and his colleagues.

The mean serum iron level was 23 ng/mL in the children with ADHD, compared with 44 ng/mL in the controls. In addition, 42 (84%) of the ADHD children had iron levels considered abnormally low–below 30 ng/mL–compared with 5 (18%) of the 27 controls (Arch. Pediatr. Adolesc. Med. 2004;158:1113-5). Low levels of iron may hamper the development of the central nervous system and consequently contribute to the likelihood of behavioral disorders, so children with ADHD might benefit from iron supplements.

Nature and Neighborhoods

Adolescent girls who mature early and live in economically disadvantaged neighborhoods committed three times as many violent acts as early maturers in less disadvantaged neighborhoods, said Dawn Obeidallah, Ph.D., of Harvard Medical School, Boston, and her colleagues.

The investigators used census data to characterize neighborhoods in the Chicago area and interviewed 501 adolescent girls and their families twice during a 3-year period (J. Am. Acad. Child. Adolesc. Psychiatry 2004;43:1460-8).

Overall, 121 girls had engaged in violent behavior at the time of the second interview: 18% of the early maturers, 48% of on-time maturers, and 33% of late maturers. Approximately 50% of the girls were Hispanic, 36% were black, and 14% were white, and 20% of early maturing black girls, 14% of early maturing Hispanic girls, and 7% of early maturing white girls had engaged in violence at the time of the second interview.

Sleep-Disordered Breathing, Behavior

Children with mild to moderate sleep-disordered breathing demonstrated significantly more problem behaviors, compared with controls in a cross-sectional study of 829 8- to 11-year-olds, said Carol L. Rosen, M.D., of Case Western Reserve University, Cleveland, and her associates.

The children were assessed with unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate. Overall, children with sleep-disordered breathing were at least twice as likely to score in the borderline or clinically abnormal range on the Child Behavior Checklist (CBCL) externalizing and internalizing scales (Pediatrics 2004;114:1640-8).

The children with sleep-disordered breathing were significantly more likely to demonstrate hyperactivity, emotional lability, aggression, and opposition, compared with controls. Black ethnicity was a significant predictor for the CBCL total problem scale, while preterm birth was a significant predictor for the CBCL total and social problem scales and a hyperactivity scale. The significantly higher odds of behavior problems in black children as a subgroup may be the result of a greater vulnerability to sleep disruption in this group.

CBT Relieves Depression in IBD Patients

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. 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 (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469-77).

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

Recreational Ritalin on the Rise

Approximately 4% of a national sample of 8th, 10th, and 12th graders reported illicit use of methylphenidate (Ritalin) within the past year, said Sean Esteban McCabe, Ph.D., and his associates at the University of Michigan, Ann Arbor.

Based on data from the 2001 Monitoring the Future Survey, students in grades 10 (4.6%) and 12 (5%) were significantly more likely to report illicit use than eighth graders (2.7%). Illegal methylphenidate use was significantly more common among students with grade point averages of C or D (6.4%), compared with those with a B average (3.9%) or A average (2.6%). In addition, white students (4.8%) were significantly more likely to report illegal use than black students (0.8%), which mirrored racial differences in prescription patterns (J. Adolesc. Health 2004;35:501-4).

Iron Deficiency's Role in ADHD

Children with attention-deficit hyperactivity disorder had significantly lower levels of iron, compared with controls in a study of 53 children aged 4-14 years, said Eric Konofal, M.D., of Hôpitaux de Paris, and his colleagues.

The mean serum iron level was 23 ng/mL in the children with ADHD, compared with 44 ng/mL in the controls. In addition, 42 (84%) of the ADHD children had iron levels considered abnormally low–below 30 ng/mL–compared with 5 (18%) of the 27 controls (Arch. Pediatr. Adolesc. Med. 2004;158:1113-5). Low levels of iron may hamper the development of the central nervous system and consequently contribute to the likelihood of behavioral disorders, so children with ADHD might benefit from iron supplements.

Nature and Neighborhoods

Adolescent girls who mature early and live in economically disadvantaged neighborhoods committed three times as many violent acts as early maturers in less disadvantaged neighborhoods, said Dawn Obeidallah, Ph.D., of Harvard Medical School, Boston, and her colleagues.

The investigators used census data to characterize neighborhoods in the Chicago area and interviewed 501 adolescent girls and their families twice during a 3-year period (J. Am. Acad. Child. Adolesc. Psychiatry 2004;43:1460-8).

Overall, 121 girls had engaged in violent behavior at the time of the second interview: 18% of the early maturers, 48% of on-time maturers, and 33% of late maturers. Approximately 50% of the girls were Hispanic, 36% were black, and 14% were white, and 20% of early maturing black girls, 14% of early maturing Hispanic girls, and 7% of early maturing white girls had engaged in violence at the time of the second interview.

Sleep-Disordered Breathing, Behavior

Children with mild to moderate sleep-disordered breathing demonstrated significantly more problem behaviors, compared with controls in a cross-sectional study of 829 8- to 11-year-olds, said Carol L. Rosen, M.D., of Case Western Reserve University, Cleveland, and her associates.

The children were assessed with unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate. Overall, children with sleep-disordered breathing were at least twice as likely to score in the borderline or clinically abnormal range on the Child Behavior Checklist (CBCL) externalizing and internalizing scales (Pediatrics 2004;114:1640-8).

The children with sleep-disordered breathing were significantly more likely to demonstrate hyperactivity, emotional lability, aggression, and opposition, compared with controls. Black ethnicity was a significant predictor for the CBCL total problem scale, while preterm birth was a significant predictor for the CBCL total and social problem scales and a hyperactivity scale. The significantly higher odds of behavior problems in black children as a subgroup may be the result of a greater vulnerability to sleep disruption in this group.

CBT Relieves Depression in IBD Patients

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. 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 (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1469-77).

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

Recreational Ritalin on the Rise

Approximately 4% of a national sample of 8th, 10th, and 12th graders reported illicit use of methylphenidate (Ritalin) within the past year, said Sean Esteban McCabe, Ph.D., and his associates at the University of Michigan, Ann Arbor.

Based on data from the 2001 Monitoring the Future Survey, students in grades 10 (4.6%) and 12 (5%) were significantly more likely to report illicit use than eighth graders (2.7%). Illegal methylphenidate use was significantly more common among students with grade point averages of C or D (6.4%), compared with those with a B average (3.9%) or A average (2.6%). In addition, white students (4.8%) were significantly more likely to report illegal use than black students (0.8%), which mirrored racial differences in prescription patterns (J. Adolesc. Health 2004;35:501-4).

Iron Deficiency's Role in ADHD

Children with attention-deficit hyperactivity disorder had significantly lower levels of iron, compared with controls in a study of 53 children aged 4-14 years, said Eric Konofal, M.D., of Hôpitaux de Paris, and his colleagues.

The mean serum iron level was 23 ng/mL in the children with ADHD, compared with 44 ng/mL in the controls. In addition, 42 (84%) of the ADHD children had iron levels considered abnormally low–below 30 ng/mL–compared with 5 (18%) of the 27 controls (Arch. Pediatr. Adolesc. Med. 2004;158:1113-5). Low levels of iron may hamper the development of the central nervous system and consequently contribute to the likelihood of behavioral disorders, so children with ADHD might benefit from iron supplements.

Nature and Neighborhoods

Adolescent girls who mature early and live in economically disadvantaged neighborhoods committed three times as many violent acts as early maturers in less disadvantaged neighborhoods, said Dawn Obeidallah, Ph.D., of Harvard Medical School, Boston, and her colleagues.

The investigators used census data to characterize neighborhoods in the Chicago area and interviewed 501 adolescent girls and their families twice during a 3-year period (J. Am. Acad. Child. Adolesc. Psychiatry 2004;43:1460-8).

Overall, 121 girls had engaged in violent behavior at the time of the second interview: 18% of the early maturers, 48% of on-time maturers, and 33% of late maturers. Approximately 50% of the girls were Hispanic, 36% were black, and 14% were white, and 20% of early maturing black girls, 14% of early maturing Hispanic girls, and 7% of early maturing white girls had engaged in violence at the time of the second interview.

Use of Depo-Provera was significantly associated with the development of cervical infections in a study of 819 women, said Charles S. Morrison, Ph.D.

Even after adjustment for sexual behavior and demographic traits including condom use and multiple sex partners, women who used Depo-Provera (medroxypro-gesterone) were more likely to develop gonorrhea or chlamydia within a year, compared with both women who used oral contraceptives and controls, said Dr. Morrison of Family Health International, a research organization in Research Triangle Park, N.C.

The use of oral contraceptives was not associated with increased risk or development of infections.

After a mean follow-up of 337 days, 45 women in the prospective cohort study had developed at least one cervical infection. Most of the women were single (77%) and nulliparous (75%). They ranged in age from 15 to 45 years, with a median age of 22 years (Sex. Transm. Dis. 2004;31:561-7).

The researchers calculated risk based on how many women became infected within a year (woman-years) and found a rate of 13.7 infections/100 woman-years in the Depo-Provera group, significantly higher than women in the oral contraceptive group (3.9 infections/100 woman-years) and the control group (6/100 woman-years).

More research is needed to determine whether Depo-Provera itself creates a susceptibility to infection. Meanwhile, women taking Depo-Provera can reduce their risk of infection by using additional protection if they are in nonmonogamous relationships.

“All of the labeling and educational material for Depo-Provera includes information about how it doesn't protect women from sexually transmitted diseases,” said Rebecca Hamm, a spokesperson for Pfizer Inc., which markets Depo-Provera. The study seems to reinforce the need for women using hormonal contraception to receive not only those materials, but also additional reminders from their physicians about the need to protect themselves if they are at increased risk for STDs, she said.

Use of Depo-Provera was significantly associated with the development of cervical infections in a study of 819 women, said Charles S. Morrison, Ph.D.

Even after adjustment for sexual behavior and demographic traits including condom use and multiple sex partners, women who used Depo-Provera (medroxypro-gesterone) were more likely to develop gonorrhea or chlamydia within a year, compared with both women who used oral contraceptives and controls, said Dr. Morrison of Family Health International, a research organization in Research Triangle Park, N.C.

The use of oral contraceptives was not associated with increased risk or development of infections.

After a mean follow-up of 337 days, 45 women in the prospective cohort study had developed at least one cervical infection. Most of the women were single (77%) and nulliparous (75%). They ranged in age from 15 to 45 years, with a median age of 22 years (Sex. Transm. Dis. 2004;31:561-7).

The researchers calculated risk based on how many women became infected within a year (woman-years) and found a rate of 13.7 infections/100 woman-years in the Depo-Provera group, significantly higher than women in the oral contraceptive group (3.9 infections/100 woman-years) and the control group (6/100 woman-years).

More research is needed to determine whether Depo-Provera itself creates a susceptibility to infection. Meanwhile, women taking Depo-Provera can reduce their risk of infection by using additional protection if they are in nonmonogamous relationships.

“All of the labeling and educational material for Depo-Provera includes information about how it doesn't protect women from sexually transmitted diseases,” said Rebecca Hamm, a spokesperson for Pfizer Inc., which markets Depo-Provera. The study seems to reinforce the need for women using hormonal contraception to receive not only those materials, but also additional reminders from their physicians about the need to protect themselves if they are at increased risk for STDs, she said.

Use of Depo-Provera was significantly associated with the development of cervical infections in a study of 819 women, said Charles S. Morrison, Ph.D.

Even after adjustment for sexual behavior and demographic traits including condom use and multiple sex partners, women who used Depo-Provera (medroxypro-gesterone) were more likely to develop gonorrhea or chlamydia within a year, compared with both women who used oral contraceptives and controls, said Dr. Morrison of Family Health International, a research organization in Research Triangle Park, N.C.

The use of oral contraceptives was not associated with increased risk or development of infections.

After a mean follow-up of 337 days, 45 women in the prospective cohort study had developed at least one cervical infection. Most of the women were single (77%) and nulliparous (75%). They ranged in age from 15 to 45 years, with a median age of 22 years (Sex. Transm. Dis. 2004;31:561-7).

The researchers calculated risk based on how many women became infected within a year (woman-years) and found a rate of 13.7 infections/100 woman-years in the Depo-Provera group, significantly higher than women in the oral contraceptive group (3.9 infections/100 woman-years) and the control group (6/100 woman-years).

More research is needed to determine whether Depo-Provera itself creates a susceptibility to infection. Meanwhile, women taking Depo-Provera can reduce their risk of infection by using additional protection if they are in nonmonogamous relationships.

“All of the labeling and educational material for Depo-Provera includes information about how it doesn't protect women from sexually transmitted diseases,” said Rebecca Hamm, a spokesperson for Pfizer Inc., which markets Depo-Provera. The study seems to reinforce the need for women using hormonal contraception to receive not only those materials, but also additional reminders from their physicians about the need to protect themselves if they are at increased risk for STDs, she said.