Mary Ann Moon

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer in a study of more than 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it produced an adequate booster response in those who had been vaccinated previously.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates. “Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack,” the investigators noted.

The investigators assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of “takes”—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies. The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated, Dr. Saito and colleagues wrote.

There were no severe adverse events such as autoinoculation/contact inoculation, eczema vaccinatum, progressive vaccinia, generalized vaccinia, encephalitis, or the myopericarditis that has been “a major concern” in the U.S. smallpox vaccination program.

The researchers noted that while the total sample size in the study limited their ability to “conclusively confirm the absence of severe adverse events,” their results support the conclusion that LC16m8 “causes minimal local manifestations and systemic adverse effects.”

The study findings suggest that LC16m8 is “a viable alternative.”

A safe vaccine “is crucial to constructing a prevention plan in the event of a bioterrorist attack” involving smallpox (maculopapular smallpox lesions in the pustular phase shown at left). CDC/Dr. John Noble Jr.

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer in a study of more than 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it produced an adequate booster response in those who had been vaccinated previously.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates. “Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack,” the investigators noted.

The investigators assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of “takes”—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies. The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated, Dr. Saito and colleagues wrote.

There were no severe adverse events such as autoinoculation/contact inoculation, eczema vaccinatum, progressive vaccinia, generalized vaccinia, encephalitis, or the myopericarditis that has been “a major concern” in the U.S. smallpox vaccination program.

The researchers noted that while the total sample size in the study limited their ability to “conclusively confirm the absence of severe adverse events,” their results support the conclusion that LC16m8 “causes minimal local manifestations and systemic adverse effects.”

The study findings suggest that LC16m8 is “a viable alternative.”

A safe vaccine “is crucial to constructing a prevention plan in the event of a bioterrorist attack” involving smallpox (maculopapular smallpox lesions in the pustular phase shown at left). CDC/Dr. John Noble Jr.

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer in a study of more than 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it produced an adequate booster response in those who had been vaccinated previously.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates. “Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack,” the investigators noted.

The investigators assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of “takes”—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies. The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated, Dr. Saito and colleagues wrote.

There were no severe adverse events such as autoinoculation/contact inoculation, eczema vaccinatum, progressive vaccinia, generalized vaccinia, encephalitis, or the myopericarditis that has been “a major concern” in the U.S. smallpox vaccination program.

The researchers noted that while the total sample size in the study limited their ability to “conclusively confirm the absence of severe adverse events,” their results support the conclusion that LC16m8 “causes minimal local manifestations and systemic adverse effects.”

The study findings suggest that LC16m8 is “a viable alternative.”

A safe vaccine “is crucial to constructing a prevention plan in the event of a bioterrorist attack” involving smallpox (maculopapular smallpox lesions in the pustular phase shown at left). CDC/Dr. John Noble Jr.

Maternal obesity is associated with a significantly increased risk of fetal structural anomalies, including neural tube defects and cardiac malformations, according to a meta-analysis.

The risk for some of these anomalies also was elevated among women who were overweight but not obese. Future studies should investigate whether there is a dose-response relationship between maternal weight and risk of structural abnormalities, said Katherine J. Stothard, Ph.D., and her associates at Newcastle University, Newcastle upon Tyne, England (JAMA 2009;301:636–50).

The researchers reviewed 39 relevant articles in the English literature and performed a meta-analysis of 18 that were the most scientifically sound, excluding studies with fewer than 150 cases of a particular congenital anomaly and studies of abnormalities that were chromosomal or syndromic in origin. They included cases in which pregnancies were terminated when congenital anomalies were discovered.

Compared with mothers at recommended body weights, obese mothers were nearly twice as likely to have a pregnancy affected by neural tube defects, including spina bifida and anencephaly. Their risk ranged from 1.2 to 1.7 times to have a fetus with a heart anomaly, a facial anomaly such as cleft palate or cleft lip, or other anomalies including anorectal atresia, hydrocephaly, and limb reduction.

Some anomalies could not be examined in this meta-analysis because studies of those defects were not sufficiently powered to detect significant effects. However, the review showed that the association with maternal obesity approached significance for omphalocele, craniosynostosis, and simultaneous multiple anomalies.

Both neural tube defects and cardiac anomalies also were more likely to occur in mothers who were overweight but not frankly obese. Future studies should assess structural congenital anomalies across “the complete range of [body mass index],” Dr. Stothard and her associates said.

“Many of the congenital anomalies implicated in this review have similar developmental timing and responsiveness to folic acid, suggesting a common underlying etiology,” they added.

Dr. Stothard received funding from BDF Newlife.

Maternal obesity is associated with a significantly increased risk of fetal structural anomalies, including neural tube defects and cardiac malformations, according to a meta-analysis.

The risk for some of these anomalies also was elevated among women who were overweight but not obese. Future studies should investigate whether there is a dose-response relationship between maternal weight and risk of structural abnormalities, said Katherine J. Stothard, Ph.D., and her associates at Newcastle University, Newcastle upon Tyne, England (JAMA 2009;301:636–50).

The researchers reviewed 39 relevant articles in the English literature and performed a meta-analysis of 18 that were the most scientifically sound, excluding studies with fewer than 150 cases of a particular congenital anomaly and studies of abnormalities that were chromosomal or syndromic in origin. They included cases in which pregnancies were terminated when congenital anomalies were discovered.

Compared with mothers at recommended body weights, obese mothers were nearly twice as likely to have a pregnancy affected by neural tube defects, including spina bifida and anencephaly. Their risk ranged from 1.2 to 1.7 times to have a fetus with a heart anomaly, a facial anomaly such as cleft palate or cleft lip, or other anomalies including anorectal atresia, hydrocephaly, and limb reduction.

Some anomalies could not be examined in this meta-analysis because studies of those defects were not sufficiently powered to detect significant effects. However, the review showed that the association with maternal obesity approached significance for omphalocele, craniosynostosis, and simultaneous multiple anomalies.

Both neural tube defects and cardiac anomalies also were more likely to occur in mothers who were overweight but not frankly obese. Future studies should assess structural congenital anomalies across “the complete range of [body mass index],” Dr. Stothard and her associates said.

“Many of the congenital anomalies implicated in this review have similar developmental timing and responsiveness to folic acid, suggesting a common underlying etiology,” they added.

Dr. Stothard received funding from BDF Newlife.

Maternal obesity is associated with a significantly increased risk of fetal structural anomalies, including neural tube defects and cardiac malformations, according to a meta-analysis.

The risk for some of these anomalies also was elevated among women who were overweight but not obese. Future studies should investigate whether there is a dose-response relationship between maternal weight and risk of structural abnormalities, said Katherine J. Stothard, Ph.D., and her associates at Newcastle University, Newcastle upon Tyne, England (JAMA 2009;301:636–50).

The researchers reviewed 39 relevant articles in the English literature and performed a meta-analysis of 18 that were the most scientifically sound, excluding studies with fewer than 150 cases of a particular congenital anomaly and studies of abnormalities that were chromosomal or syndromic in origin. They included cases in which pregnancies were terminated when congenital anomalies were discovered.

Compared with mothers at recommended body weights, obese mothers were nearly twice as likely to have a pregnancy affected by neural tube defects, including spina bifida and anencephaly. Their risk ranged from 1.2 to 1.7 times to have a fetus with a heart anomaly, a facial anomaly such as cleft palate or cleft lip, or other anomalies including anorectal atresia, hydrocephaly, and limb reduction.

Some anomalies could not be examined in this meta-analysis because studies of those defects were not sufficiently powered to detect significant effects. However, the review showed that the association with maternal obesity approached significance for omphalocele, craniosynostosis, and simultaneous multiple anomalies.

Both neural tube defects and cardiac anomalies also were more likely to occur in mothers who were overweight but not frankly obese. Future studies should assess structural congenital anomalies across “the complete range of [body mass index],” Dr. Stothard and her associates said.

“Many of the congenital anomalies implicated in this review have similar developmental timing and responsiveness to folic acid, suggesting a common underlying etiology,” they added.

Dr. Stothard received funding from BDF Newlife.

Weight-loss diets emphasizing different proportions of fat, protein, and carbohydrate content were found to be equally successful in a population-based study.

However, the author of an editorial commenting on this report argued that the dietary goals were only partly achieved.

In a direct comparison of four different diets, all study groups showed similar weight losses, decreases in waist circumference, and improvements in cardiovascular risk profiles. Satiety, hunger, satisfaction with the diet, and attendance at group support sessions also were similar across all four groups, regardless of the percentages of fat, protein, and carbohydrates the diets allowed.

“These divergent results suggest that any type of diet, when taught for the purpose of weight loss with enthusiasm and persistence, can be effective,” said Dr. Frank M. Sacks of Harvard School of Public Health, Boston, and his associates.

They assessed the diets of 811 subjects aged 30–70 years who had a BMI of 25–40 kg/m

Approximately one-third of the participants lost at least 5% of their initial body weight. Weight reductions differed by less than 0.5 kg across the four diet groups, and decreases in waist circumference differed by less than 0.5 cm. Cardiovascular risk factors such as cholesterol levels and blood pressure improved to the same degree in all groups.

“In conclusion, diets that are successful in causing weight loss can emphasize a range of fat, protein, and carbohydrate compositions.” Such diets can “be tailored to individual patients on the basis of their personal and cultural preferences and may therefore have the best chance for long-term success,” the investigators wrote (N. Engl. J. Med. 2009;360:859–73).

None of the diets in this study was particularly effective in the long term, Martijn B. Katan, Ph.D., of VU University, Amsterdam, said in an editorial comment accompanying this report. Weight loss averaged 6 kg at 6 months, but thereafter subjects tended to regain weight so that final losses averaged only 3–4 kg at 2 years. Even these relatively small losses might not have been sustained if the trial had continued, Dr. Katan said (N. Engl. J. Med. 2009;360:923–5).

“The participants were highly educated, enthusiastic, and carefully selected. They were offered 59 group and 13 individual training sessions [with expert professionals] over the course of 2 years. Nonetheless, their body mass index … averaged 31–32 and was moving up again” as the trial ended, he said.

Moreover, the macronutrient goals for each of the four diets were not reached. Protein intake was intended to differ among the four groups by 10% of energy, but it differed by only 1%–2%. Similarly, carbohydrate intake was supposed to differ by 30% among the groups, but both extremely low and extremely high carbohydrate intakes proved difficult to achieve, so the actual difference turned out to be only 6% of energy, Dr. Katan said.

The study investigators said that attendance at group behavioral counseling sessions “had a strong association with weight loss” and that the effect was seen across diet groups. Participants who attended two-thirds of their sessions during the 2 years lost about 9 kg, and regain after 6–12 months was about 20% of that seen in previous studies, the investigators reported. This suggests that “behavioral factors rather than micronutrient metabolism” have a greater influence on weight loss.

The editorial noted that it is difficult to quantify behavior as a factor in weight loss. “Cognition and feelings have a huge impact” on food consumption, Dr. Katan said. “Participants may eat less not because of the protein or carbohydrate content of a diet but because of the diet's reputation or novelty or because of the taste of particular foods in the diet.” Studies that can determine the effects of macronutrients on food intake and weight loss have used foods that necessarily look and taste the same such as “porridges (similar to oatmeal) and standardized snacks,” Dr. Katan explained. That was not done in the current study. “Few subjects would be willing to eat those foods for the several years that would be needed to examine long-term effects,” he wrote.

No relevant potential conflicts of interest were reported by Dr. Sacks or Dr. Katan.

Weight-loss diets emphasizing different proportions of fat, protein, and carbohydrate content were found to be equally successful in a population-based study.

However, the author of an editorial commenting on this report argued that the dietary goals were only partly achieved.

In a direct comparison of four different diets, all study groups showed similar weight losses, decreases in waist circumference, and improvements in cardiovascular risk profiles. Satiety, hunger, satisfaction with the diet, and attendance at group support sessions also were similar across all four groups, regardless of the percentages of fat, protein, and carbohydrates the diets allowed.

“These divergent results suggest that any type of diet, when taught for the purpose of weight loss with enthusiasm and persistence, can be effective,” said Dr. Frank M. Sacks of Harvard School of Public Health, Boston, and his associates.

They assessed the diets of 811 subjects aged 30–70 years who had a BMI of 25–40 kg/m

Approximately one-third of the participants lost at least 5% of their initial body weight. Weight reductions differed by less than 0.5 kg across the four diet groups, and decreases in waist circumference differed by less than 0.5 cm. Cardiovascular risk factors such as cholesterol levels and blood pressure improved to the same degree in all groups.

“In conclusion, diets that are successful in causing weight loss can emphasize a range of fat, protein, and carbohydrate compositions.” Such diets can “be tailored to individual patients on the basis of their personal and cultural preferences and may therefore have the best chance for long-term success,” the investigators wrote (N. Engl. J. Med. 2009;360:859–73).

None of the diets in this study was particularly effective in the long term, Martijn B. Katan, Ph.D., of VU University, Amsterdam, said in an editorial comment accompanying this report. Weight loss averaged 6 kg at 6 months, but thereafter subjects tended to regain weight so that final losses averaged only 3–4 kg at 2 years. Even these relatively small losses might not have been sustained if the trial had continued, Dr. Katan said (N. Engl. J. Med. 2009;360:923–5).

“The participants were highly educated, enthusiastic, and carefully selected. They were offered 59 group and 13 individual training sessions [with expert professionals] over the course of 2 years. Nonetheless, their body mass index … averaged 31–32 and was moving up again” as the trial ended, he said.

Moreover, the macronutrient goals for each of the four diets were not reached. Protein intake was intended to differ among the four groups by 10% of energy, but it differed by only 1%–2%. Similarly, carbohydrate intake was supposed to differ by 30% among the groups, but both extremely low and extremely high carbohydrate intakes proved difficult to achieve, so the actual difference turned out to be only 6% of energy, Dr. Katan said.

The study investigators said that attendance at group behavioral counseling sessions “had a strong association with weight loss” and that the effect was seen across diet groups. Participants who attended two-thirds of their sessions during the 2 years lost about 9 kg, and regain after 6–12 months was about 20% of that seen in previous studies, the investigators reported. This suggests that “behavioral factors rather than micronutrient metabolism” have a greater influence on weight loss.

The editorial noted that it is difficult to quantify behavior as a factor in weight loss. “Cognition and feelings have a huge impact” on food consumption, Dr. Katan said. “Participants may eat less not because of the protein or carbohydrate content of a diet but because of the diet's reputation or novelty or because of the taste of particular foods in the diet.” Studies that can determine the effects of macronutrients on food intake and weight loss have used foods that necessarily look and taste the same such as “porridges (similar to oatmeal) and standardized snacks,” Dr. Katan explained. That was not done in the current study. “Few subjects would be willing to eat those foods for the several years that would be needed to examine long-term effects,” he wrote.

No relevant potential conflicts of interest were reported by Dr. Sacks or Dr. Katan.

Weight-loss diets emphasizing different proportions of fat, protein, and carbohydrate content were found to be equally successful in a population-based study.

However, the author of an editorial commenting on this report argued that the dietary goals were only partly achieved.

In a direct comparison of four different diets, all study groups showed similar weight losses, decreases in waist circumference, and improvements in cardiovascular risk profiles. Satiety, hunger, satisfaction with the diet, and attendance at group support sessions also were similar across all four groups, regardless of the percentages of fat, protein, and carbohydrates the diets allowed.

“These divergent results suggest that any type of diet, when taught for the purpose of weight loss with enthusiasm and persistence, can be effective,” said Dr. Frank M. Sacks of Harvard School of Public Health, Boston, and his associates.

They assessed the diets of 811 subjects aged 30–70 years who had a BMI of 25–40 kg/m

Approximately one-third of the participants lost at least 5% of their initial body weight. Weight reductions differed by less than 0.5 kg across the four diet groups, and decreases in waist circumference differed by less than 0.5 cm. Cardiovascular risk factors such as cholesterol levels and blood pressure improved to the same degree in all groups.

“In conclusion, diets that are successful in causing weight loss can emphasize a range of fat, protein, and carbohydrate compositions.” Such diets can “be tailored to individual patients on the basis of their personal and cultural preferences and may therefore have the best chance for long-term success,” the investigators wrote (N. Engl. J. Med. 2009;360:859–73).

None of the diets in this study was particularly effective in the long term, Martijn B. Katan, Ph.D., of VU University, Amsterdam, said in an editorial comment accompanying this report. Weight loss averaged 6 kg at 6 months, but thereafter subjects tended to regain weight so that final losses averaged only 3–4 kg at 2 years. Even these relatively small losses might not have been sustained if the trial had continued, Dr. Katan said (N. Engl. J. Med. 2009;360:923–5).

“The participants were highly educated, enthusiastic, and carefully selected. They were offered 59 group and 13 individual training sessions [with expert professionals] over the course of 2 years. Nonetheless, their body mass index … averaged 31–32 and was moving up again” as the trial ended, he said.

Moreover, the macronutrient goals for each of the four diets were not reached. Protein intake was intended to differ among the four groups by 10% of energy, but it differed by only 1%–2%. Similarly, carbohydrate intake was supposed to differ by 30% among the groups, but both extremely low and extremely high carbohydrate intakes proved difficult to achieve, so the actual difference turned out to be only 6% of energy, Dr. Katan said.

The study investigators said that attendance at group behavioral counseling sessions “had a strong association with weight loss” and that the effect was seen across diet groups. Participants who attended two-thirds of their sessions during the 2 years lost about 9 kg, and regain after 6–12 months was about 20% of that seen in previous studies, the investigators reported. This suggests that “behavioral factors rather than micronutrient metabolism” have a greater influence on weight loss.

The editorial noted that it is difficult to quantify behavior as a factor in weight loss. “Cognition and feelings have a huge impact” on food consumption, Dr. Katan said. “Participants may eat less not because of the protein or carbohydrate content of a diet but because of the diet's reputation or novelty or because of the taste of particular foods in the diet.” Studies that can determine the effects of macronutrients on food intake and weight loss have used foods that necessarily look and taste the same such as “porridges (similar to oatmeal) and standardized snacks,” Dr. Katan explained. That was not done in the current study. “Few subjects would be willing to eat those foods for the several years that would be needed to examine long-term effects,” he wrote.

No relevant potential conflicts of interest were reported by Dr. Sacks or Dr. Katan.

Pregnant women and new mothers with any type of diabetes appear to have twice the risk of developing perinatal depression as do those without diabetes, according to an analysis of Medicaid records.

This finding is consistent with reports showing a doubling of the odds of depression among adults with diabetes in the general population, said Katy Backes Kozhimannil of Harvard Medical School, Boston, and her associates.

The researchers explored a possible link between diabetes and depression in the perinatal period using a Medicaid database on 11,024 low-income women who gave birth in New Jersey between 2004 and 2006. A total of 657 of these women had diabetes, comprising 57 with nongestational diabetes who were taking insulin, 254 with nongestational diabetes who were not taking insulin, 163 with gestational diabetes who were taking insulin, and 183 with gestational diabetes who were not taking insulin.

Both prenatal and postpartum depression were twice as prevalent among the women who had diabetes than among those who did not. This association did not vary by diabetes classification.

After the data were controlled to account for the effects of age, race, and preterm delivery, women with diabetes still had nearly double the chance (odds ratio 1.9) of developing depression during the perinatal period (15%) than those without diabetes (8%).

“When cesarean delivery was included in the regression models in addition to the other covariates, the results remained virtually unchanged,” Ms. Kozhimannil and her colleagues wrote (JAMA 2009;301:842–7).

The findings were the same in the large subset of women who had no indication of depression before delivery. Those with diabetes had nearly twice the risk of developing new onset depression during the postpartum period. Perinatal depression is underdiagnosed and therefore inadequately treated. These findings should “encourage health care providers to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period,” the researchers said.

They noted that the design of this study did not allow them to determine whether the link between diabetes and perinatal depression is causal.

Pregnant women and new mothers with any type of diabetes appear to have twice the risk of developing perinatal depression as do those without diabetes, according to an analysis of Medicaid records.

This finding is consistent with reports showing a doubling of the odds of depression among adults with diabetes in the general population, said Katy Backes Kozhimannil of Harvard Medical School, Boston, and her associates.

The researchers explored a possible link between diabetes and depression in the perinatal period using a Medicaid database on 11,024 low-income women who gave birth in New Jersey between 2004 and 2006. A total of 657 of these women had diabetes, comprising 57 with nongestational diabetes who were taking insulin, 254 with nongestational diabetes who were not taking insulin, 163 with gestational diabetes who were taking insulin, and 183 with gestational diabetes who were not taking insulin.

Both prenatal and postpartum depression were twice as prevalent among the women who had diabetes than among those who did not. This association did not vary by diabetes classification.

After the data were controlled to account for the effects of age, race, and preterm delivery, women with diabetes still had nearly double the chance (odds ratio 1.9) of developing depression during the perinatal period (15%) than those without diabetes (8%).

“When cesarean delivery was included in the regression models in addition to the other covariates, the results remained virtually unchanged,” Ms. Kozhimannil and her colleagues wrote (JAMA 2009;301:842–7).

The findings were the same in the large subset of women who had no indication of depression before delivery. Those with diabetes had nearly twice the risk of developing new onset depression during the postpartum period. Perinatal depression is underdiagnosed and therefore inadequately treated. These findings should “encourage health care providers to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period,” the researchers said.

They noted that the design of this study did not allow them to determine whether the link between diabetes and perinatal depression is causal.

Pregnant women and new mothers with any type of diabetes appear to have twice the risk of developing perinatal depression as do those without diabetes, according to an analysis of Medicaid records.

This finding is consistent with reports showing a doubling of the odds of depression among adults with diabetes in the general population, said Katy Backes Kozhimannil of Harvard Medical School, Boston, and her associates.

The researchers explored a possible link between diabetes and depression in the perinatal period using a Medicaid database on 11,024 low-income women who gave birth in New Jersey between 2004 and 2006. A total of 657 of these women had diabetes, comprising 57 with nongestational diabetes who were taking insulin, 254 with nongestational diabetes who were not taking insulin, 163 with gestational diabetes who were taking insulin, and 183 with gestational diabetes who were not taking insulin.

Both prenatal and postpartum depression were twice as prevalent among the women who had diabetes than among those who did not. This association did not vary by diabetes classification.

After the data were controlled to account for the effects of age, race, and preterm delivery, women with diabetes still had nearly double the chance (odds ratio 1.9) of developing depression during the perinatal period (15%) than those without diabetes (8%).

“When cesarean delivery was included in the regression models in addition to the other covariates, the results remained virtually unchanged,” Ms. Kozhimannil and her colleagues wrote (JAMA 2009;301:842–7).

The findings were the same in the large subset of women who had no indication of depression before delivery. Those with diabetes had nearly twice the risk of developing new onset depression during the postpartum period. Perinatal depression is underdiagnosed and therefore inadequately treated. These findings should “encourage health care providers to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period,” the researchers said.

They noted that the design of this study did not allow them to determine whether the link between diabetes and perinatal depression is causal.

Maternal obesity is associated with a significantly increased risk of fetal structural anomalies, including neural tube defects and cardiac malformations, according to a meta-analysis.

The risk for some of these anomalies also was elevated among women who were overweight but not obese. Future studies should investigate whether there is a dose-response relationship between maternal weight and risk of structural abnormalities, said Katherine J. Stothard, Ph.D., and her associates at Newcastle University, Newcastle upon Tyne, England (JAMA 2009;301:636–50).

The researchers reviewed 39 relevant articles in the English literature and performed a meta-analysis of 18 of those that were the most scientifically sound, excluding studies with fewer than 150 cases of a particular congenital anomaly and studies of abnormalities that were chromosomal or syndromic in origin.

The investigators included cases in which pregnancies were terminated when congenital anomalies were discovered.

Compared with mothers at recommended body weights, obese mothers were nearly twice as likely to have a pregnancy affected by neural tube defects, including spina bifida and anencephaly. Their risk ranged from 1.2 to 1.7 times to have a fetus with a cardiovascular anomaly such as a septal defect, a facial malformation such as cleft palate or cleft lip, or other anomalies including anorectal atresia, hydrocephaly, and limb reduction.

Some types of anomalies could not be examined in this meta-analysis because the studies of those defects were not sufficiently powered to detect significant effects.

However, the literature review showed that the association with maternal obesity approached significance for omphalocele, craniosynostosis, and simultaneous multiple anomalies.

Both neural tube defects and cardiac anomalies also were more likely to occur in mothers who were overweight but not frankly obese. Future studies should assess structural congenital anomalies across “the complete range of [body mass index],” Dr. Stothard and her associates said.

“It is notable that many of the congenital anomalies implicated in this review have similar developmental timing and responsiveness to folic acid, suggesting a common underlying etiology,” they added.

Dr. Stothard received funding from BDF Newlife.

Maternal obesity is associated with a significantly increased risk of fetal structural anomalies, including neural tube defects and cardiac malformations, according to a meta-analysis.

The risk for some of these anomalies also was elevated among women who were overweight but not obese. Future studies should investigate whether there is a dose-response relationship between maternal weight and risk of structural abnormalities, said Katherine J. Stothard, Ph.D., and her associates at Newcastle University, Newcastle upon Tyne, England (JAMA 2009;301:636–50).

The researchers reviewed 39 relevant articles in the English literature and performed a meta-analysis of 18 of those that were the most scientifically sound, excluding studies with fewer than 150 cases of a particular congenital anomaly and studies of abnormalities that were chromosomal or syndromic in origin.

The investigators included cases in which pregnancies were terminated when congenital anomalies were discovered.

Compared with mothers at recommended body weights, obese mothers were nearly twice as likely to have a pregnancy affected by neural tube defects, including spina bifida and anencephaly. Their risk ranged from 1.2 to 1.7 times to have a fetus with a cardiovascular anomaly such as a septal defect, a facial malformation such as cleft palate or cleft lip, or other anomalies including anorectal atresia, hydrocephaly, and limb reduction.

Some types of anomalies could not be examined in this meta-analysis because the studies of those defects were not sufficiently powered to detect significant effects.

However, the literature review showed that the association with maternal obesity approached significance for omphalocele, craniosynostosis, and simultaneous multiple anomalies.

Both neural tube defects and cardiac anomalies also were more likely to occur in mothers who were overweight but not frankly obese. Future studies should assess structural congenital anomalies across “the complete range of [body mass index],” Dr. Stothard and her associates said.

“It is notable that many of the congenital anomalies implicated in this review have similar developmental timing and responsiveness to folic acid, suggesting a common underlying etiology,” they added.

Dr. Stothard received funding from BDF Newlife.

Maternal obesity is associated with a significantly increased risk of fetal structural anomalies, including neural tube defects and cardiac malformations, according to a meta-analysis.

The risk for some of these anomalies also was elevated among women who were overweight but not obese. Future studies should investigate whether there is a dose-response relationship between maternal weight and risk of structural abnormalities, said Katherine J. Stothard, Ph.D., and her associates at Newcastle University, Newcastle upon Tyne, England (JAMA 2009;301:636–50).

The researchers reviewed 39 relevant articles in the English literature and performed a meta-analysis of 18 of those that were the most scientifically sound, excluding studies with fewer than 150 cases of a particular congenital anomaly and studies of abnormalities that were chromosomal or syndromic in origin.

The investigators included cases in which pregnancies were terminated when congenital anomalies were discovered.

Compared with mothers at recommended body weights, obese mothers were nearly twice as likely to have a pregnancy affected by neural tube defects, including spina bifida and anencephaly. Their risk ranged from 1.2 to 1.7 times to have a fetus with a cardiovascular anomaly such as a septal defect, a facial malformation such as cleft palate or cleft lip, or other anomalies including anorectal atresia, hydrocephaly, and limb reduction.

Some types of anomalies could not be examined in this meta-analysis because the studies of those defects were not sufficiently powered to detect significant effects.

However, the literature review showed that the association with maternal obesity approached significance for omphalocele, craniosynostosis, and simultaneous multiple anomalies.

Both neural tube defects and cardiac anomalies also were more likely to occur in mothers who were overweight but not frankly obese. Future studies should assess structural congenital anomalies across “the complete range of [body mass index],” Dr. Stothard and her associates said.

“It is notable that many of the congenital anomalies implicated in this review have similar developmental timing and responsiveness to folic acid, suggesting a common underlying etiology,” they added.

Dr. Stothard received funding from BDF Newlife.

The number of pediatric head and neck infections caused by methicillin-resistant Staphylococcus aureus shot up at an “alarming” rate across the United States between 2001 and 2006, according to a recent report.

Sixty percent of these MRSA cases were community acquired rather than nosocomial, and nearly half were resistant to clindamycin—reversals of the patterns that methicillin-resistant S. aureus (MRSA) infections have shown until now.

“Expeditious culture of suspected head and neck infections is highly recommended to avoid further resistant patterns,” said Dr. Iman Naseri of the department of otolaryngology, head and neck surgery, at Emory University, Atlanta, and his associates (Arch. Otolaryngol. Head Neck Surg. 2009;135:14–6).

The investigators used a national microbiology database to assess trends in MRSA prevalence, “in light of the clinical and epidemiologic concerns regarding increasing [anecdotal] reports of MRSA nationally.” The database includes strain-specific antimicrobial drug resistance test results from clinical laboratories that serve more than 300 hospitals.

Dr. Naseri and colleagues reviewed the reports on 21,009 patients aged 0–18 years (mean age, 7 years) whose head and neck infections were cultured between 2001 and 2006. The cultures were taken from the oropharynx/neck (60%), nasal or sinus cavity (38%), and middle or external ear (2%).

Overall, a total of 4,534 samples (22%) were infected with MRSA. In 2001, approximately 12% of S. aureus infections were methicillin resistant. This proportion rose steadily during the 5 years of the study to more than 28%.

Approximately 60% of these MRSA infections developed in outpatients, suggesting that community-acquired MRSA may now be more common than hospital-acquired infection.

Also, about 47% of the MRSA infections were resistant to clindamycin. Previously, 93% of community-acquired MRSA has been susceptible to clindamycin, Dr. Naseri and his associates reported.

The number of pediatric head and neck infections caused by methicillin-resistant Staphylococcus aureus shot up at an “alarming” rate across the United States between 2001 and 2006, according to a recent report.

Sixty percent of these MRSA cases were community acquired rather than nosocomial, and nearly half were resistant to clindamycin—reversals of the patterns that methicillin-resistant S. aureus (MRSA) infections have shown until now.

“Expeditious culture of suspected head and neck infections is highly recommended to avoid further resistant patterns,” said Dr. Iman Naseri of the department of otolaryngology, head and neck surgery, at Emory University, Atlanta, and his associates (Arch. Otolaryngol. Head Neck Surg. 2009;135:14–6).

The investigators used a national microbiology database to assess trends in MRSA prevalence, “in light of the clinical and epidemiologic concerns regarding increasing [anecdotal] reports of MRSA nationally.” The database includes strain-specific antimicrobial drug resistance test results from clinical laboratories that serve more than 300 hospitals.

Dr. Naseri and colleagues reviewed the reports on 21,009 patients aged 0–18 years (mean age, 7 years) whose head and neck infections were cultured between 2001 and 2006. The cultures were taken from the oropharynx/neck (60%), nasal or sinus cavity (38%), and middle or external ear (2%).

Overall, a total of 4,534 samples (22%) were infected with MRSA. In 2001, approximately 12% of S. aureus infections were methicillin resistant. This proportion rose steadily during the 5 years of the study to more than 28%.

Approximately 60% of these MRSA infections developed in outpatients, suggesting that community-acquired MRSA may now be more common than hospital-acquired infection.

Also, about 47% of the MRSA infections were resistant to clindamycin. Previously, 93% of community-acquired MRSA has been susceptible to clindamycin, Dr. Naseri and his associates reported.

The number of pediatric head and neck infections caused by methicillin-resistant Staphylococcus aureus shot up at an “alarming” rate across the United States between 2001 and 2006, according to a recent report.

Sixty percent of these MRSA cases were community acquired rather than nosocomial, and nearly half were resistant to clindamycin—reversals of the patterns that methicillin-resistant S. aureus (MRSA) infections have shown until now.

“Expeditious culture of suspected head and neck infections is highly recommended to avoid further resistant patterns,” said Dr. Iman Naseri of the department of otolaryngology, head and neck surgery, at Emory University, Atlanta, and his associates (Arch. Otolaryngol. Head Neck Surg. 2009;135:14–6).

The investigators used a national microbiology database to assess trends in MRSA prevalence, “in light of the clinical and epidemiologic concerns regarding increasing [anecdotal] reports of MRSA nationally.” The database includes strain-specific antimicrobial drug resistance test results from clinical laboratories that serve more than 300 hospitals.

Dr. Naseri and colleagues reviewed the reports on 21,009 patients aged 0–18 years (mean age, 7 years) whose head and neck infections were cultured between 2001 and 2006. The cultures were taken from the oropharynx/neck (60%), nasal or sinus cavity (38%), and middle or external ear (2%).

Overall, a total of 4,534 samples (22%) were infected with MRSA. In 2001, approximately 12% of S. aureus infections were methicillin resistant. This proportion rose steadily during the 5 years of the study to more than 28%.

Approximately 60% of these MRSA infections developed in outpatients, suggesting that community-acquired MRSA may now be more common than hospital-acquired infection.

Also, about 47% of the MRSA infections were resistant to clindamycin. Previously, 93% of community-acquired MRSA has been susceptible to clindamycin, Dr. Naseri and his associates reported.

Pregnant women and new mothers with any type of diabetes appear to have twice the risk of developing perinatal depression as do those without diabetes, according to an analysis of Medicaid records.

This finding is consistent with reports showing a doubling of the odds of depression among adults with diabetes in the general population, said Katy Backes Kozhimannil of Harvard Medical School, Boston, and her associates.

The researchers explored a possible link between diabetes and depression in the perinatal period using a Medicaid database on 11,024 low-income women who gave birth in New Jersey between 2004 and 2006.

A total of 657 of these women had diabetes, comprising 57 with nongestational diabetes who were taking insulin, 254 with nongestational diabetes who were not taking insulin, 163 with gestational diabetes who were taking insulin, and 183 with gestational diabetes who were not taking insulin.

Both prenatal and postpartum depression were twice as prevalent among the women who had diabetes than among those who did not. This association did not vary by diabetes classification.

After the data were controlled to account for the effects of age, race, and preterm delivery, women with diabetes still had nearly double the chance (odds ratio 1.9) of developing depression during the perinatal period (15%) than those without diabetes (8%).

“When cesarean delivery was included in the regression models in addition to the other covariates, the results remained virtually unchanged,” Ms. Kozhimannil and her colleagues wrote (JAMA 2009;301:842–7).

The findings were the same in the large subset of women who had no indication of depression before delivery. Those with diabetes had nearly twice the risk of developing new onset depression during the postpartum period.

Perinatal depression is underdiagnosed and therefore inadequately treated. These findings should “encourage health care providers to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period,” the researchers said.

They noted that the design of this study did not allow them to determine whether the link between diabetes and perinatal depression is causal. It is plausible that diabetes-related changes in glycemic control and thyroid function could impact hormonal changes and contribute to perinatal depression, or that the stress of managing “a chronic illness that poses risks to the woman and the infant” may exacerbate depressive symptoms in pregnant women and new mothers.

It is also possible, however, that perinatal depression may be related to other factors, such as sleep disorders and obesity, both of which are common among diabetic women, the investigators added.

Pregnant women and new mothers with any type of diabetes appear to have twice the risk of developing perinatal depression as do those without diabetes, according to an analysis of Medicaid records.

This finding is consistent with reports showing a doubling of the odds of depression among adults with diabetes in the general population, said Katy Backes Kozhimannil of Harvard Medical School, Boston, and her associates.

The researchers explored a possible link between diabetes and depression in the perinatal period using a Medicaid database on 11,024 low-income women who gave birth in New Jersey between 2004 and 2006.

A total of 657 of these women had diabetes, comprising 57 with nongestational diabetes who were taking insulin, 254 with nongestational diabetes who were not taking insulin, 163 with gestational diabetes who were taking insulin, and 183 with gestational diabetes who were not taking insulin.

Both prenatal and postpartum depression were twice as prevalent among the women who had diabetes than among those who did not. This association did not vary by diabetes classification.

After the data were controlled to account for the effects of age, race, and preterm delivery, women with diabetes still had nearly double the chance (odds ratio 1.9) of developing depression during the perinatal period (15%) than those without diabetes (8%).

“When cesarean delivery was included in the regression models in addition to the other covariates, the results remained virtually unchanged,” Ms. Kozhimannil and her colleagues wrote (JAMA 2009;301:842–7).

The findings were the same in the large subset of women who had no indication of depression before delivery. Those with diabetes had nearly twice the risk of developing new onset depression during the postpartum period.

Perinatal depression is underdiagnosed and therefore inadequately treated. These findings should “encourage health care providers to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period,” the researchers said.

They noted that the design of this study did not allow them to determine whether the link between diabetes and perinatal depression is causal. It is plausible that diabetes-related changes in glycemic control and thyroid function could impact hormonal changes and contribute to perinatal depression, or that the stress of managing “a chronic illness that poses risks to the woman and the infant” may exacerbate depressive symptoms in pregnant women and new mothers.

It is also possible, however, that perinatal depression may be related to other factors, such as sleep disorders and obesity, both of which are common among diabetic women, the investigators added.

Pregnant women and new mothers with any type of diabetes appear to have twice the risk of developing perinatal depression as do those without diabetes, according to an analysis of Medicaid records.

This finding is consistent with reports showing a doubling of the odds of depression among adults with diabetes in the general population, said Katy Backes Kozhimannil of Harvard Medical School, Boston, and her associates.

The researchers explored a possible link between diabetes and depression in the perinatal period using a Medicaid database on 11,024 low-income women who gave birth in New Jersey between 2004 and 2006.

A total of 657 of these women had diabetes, comprising 57 with nongestational diabetes who were taking insulin, 254 with nongestational diabetes who were not taking insulin, 163 with gestational diabetes who were taking insulin, and 183 with gestational diabetes who were not taking insulin.

Both prenatal and postpartum depression were twice as prevalent among the women who had diabetes than among those who did not. This association did not vary by diabetes classification.

After the data were controlled to account for the effects of age, race, and preterm delivery, women with diabetes still had nearly double the chance (odds ratio 1.9) of developing depression during the perinatal period (15%) than those without diabetes (8%).

“When cesarean delivery was included in the regression models in addition to the other covariates, the results remained virtually unchanged,” Ms. Kozhimannil and her colleagues wrote (JAMA 2009;301:842–7).

The findings were the same in the large subset of women who had no indication of depression before delivery. Those with diabetes had nearly twice the risk of developing new onset depression during the postpartum period.

Perinatal depression is underdiagnosed and therefore inadequately treated. These findings should “encourage health care providers to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period,” the researchers said.

They noted that the design of this study did not allow them to determine whether the link between diabetes and perinatal depression is causal. It is plausible that diabetes-related changes in glycemic control and thyroid function could impact hormonal changes and contribute to perinatal depression, or that the stress of managing “a chronic illness that poses risks to the woman and the infant” may exacerbate depressive symptoms in pregnant women and new mothers.

It is also possible, however, that perinatal depression may be related to other factors, such as sleep disorders and obesity, both of which are common among diabetic women, the investigators added.

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer, according to a study of over 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it also produced an adequate booster response in those who had been vaccinated previously.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates.

“Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack,” the investigators noted.

They assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of “takes”—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies. The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated.

There were none of the severe adverse events that had been “a major concern” in the U.S. smallpox vaccination program.

The researchers noted that while the total sample size in the study limited their ability to “conclusively confirm that absence of severe adverse events,” their results support the conclusion that LC16m8 “causes minimal local manifestations and systemic adverse effects.”

The study findings suggest that LC16m8 is “a viable alternative to first-, second-, and other third-generation vaccines in a smallpox preparedness program,” they added.

Maculopapular lesions on this patient'sarm were caused by variola major. CDC/Dr. John Noble Jr.

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer, according to a study of over 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it also produced an adequate booster response in those who had been vaccinated previously.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates.

“Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack,” the investigators noted.

They assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of “takes”—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies. The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated.

There were none of the severe adverse events that had been “a major concern” in the U.S. smallpox vaccination program.

The researchers noted that while the total sample size in the study limited their ability to “conclusively confirm that absence of severe adverse events,” their results support the conclusion that LC16m8 “causes minimal local manifestations and systemic adverse effects.”

The study findings suggest that LC16m8 is “a viable alternative to first-, second-, and other third-generation vaccines in a smallpox preparedness program,” they added.

Maculopapular lesions on this patient'sarm were caused by variola major. CDC/Dr. John Noble Jr.

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer, according to a study of over 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it also produced an adequate booster response in those who had been vaccinated previously.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates.

“Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack,” the investigators noted.

They assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of “takes”—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies. The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated.

There were none of the severe adverse events that had been “a major concern” in the U.S. smallpox vaccination program.

The researchers noted that while the total sample size in the study limited their ability to “conclusively confirm that absence of severe adverse events,” their results support the conclusion that LC16m8 “causes minimal local manifestations and systemic adverse effects.”

The study findings suggest that LC16m8 is “a viable alternative to first-, second-, and other third-generation vaccines in a smallpox preparedness program,” they added.

Maculopapular lesions on this patient'sarm were caused by variola major. CDC/Dr. John Noble Jr.

Two distinct patterns of cerebral injury were associated with dementia in autopsy studies, depending on whether or not the subject had diabetes.

In subjects without diabetes, dementia was associated with a greater load of amyloid-β peptide and greater free radical damage. In those with diabetes, dementia was associated with more microvascular infarcts and greater activation of neuroinflammation, said Dr. Joshua A. Sonnen of the department of pathology, University of Washington, Seattle, and his associates (Arch. Neurol. 2009;66:315–22).

These findings suggest that the pathogenesis of dementia differs between patients with diabetes and those without it.

The researchers examined autopsy data from subjects in an ongoing community-based study of brain aging and incident dementia. The subjects included 196 elderly men and women divided into four groups: those who had no diabetes and no dementia (92 cases), those who had diabetes but no dementia (33 cases), those who did not have diabetes but did have dementia (45 cases), and those who had both diabetes and dementia (26 cases).

Subjects with both diabetes and dementia died with a lower burden of amyloid-β peptide in brain parenchyma and cerebral blood vessels, compared with those who had dementia but no diabetes. They also showed significantly more deep microvascular injuries, suggesting “the basal-penetrating vessels may be especially vulnerable to damage from diabetes,” the researchers reported.

These subjects also had higher levels of neuroinflammation than did their nondiabetic counterparts, which may be related to their higher numbers of microvascular injuries, the authors wrote.

Two distinct patterns of cerebral injury were associated with dementia in autopsy studies, depending on whether or not the subject had diabetes.

In subjects without diabetes, dementia was associated with a greater load of amyloid-β peptide and greater free radical damage. In those with diabetes, dementia was associated with more microvascular infarcts and greater activation of neuroinflammation, said Dr. Joshua A. Sonnen of the department of pathology, University of Washington, Seattle, and his associates (Arch. Neurol. 2009;66:315–22).

These findings suggest that the pathogenesis of dementia differs between patients with diabetes and those without it.

The researchers examined autopsy data from subjects in an ongoing community-based study of brain aging and incident dementia. The subjects included 196 elderly men and women divided into four groups: those who had no diabetes and no dementia (92 cases), those who had diabetes but no dementia (33 cases), those who did not have diabetes but did have dementia (45 cases), and those who had both diabetes and dementia (26 cases).

Subjects with both diabetes and dementia died with a lower burden of amyloid-β peptide in brain parenchyma and cerebral blood vessels, compared with those who had dementia but no diabetes. They also showed significantly more deep microvascular injuries, suggesting “the basal-penetrating vessels may be especially vulnerable to damage from diabetes,” the researchers reported.

These subjects also had higher levels of neuroinflammation than did their nondiabetic counterparts, which may be related to their higher numbers of microvascular injuries, the authors wrote.

Two distinct patterns of cerebral injury were associated with dementia in autopsy studies, depending on whether or not the subject had diabetes.

In subjects without diabetes, dementia was associated with a greater load of amyloid-β peptide and greater free radical damage. In those with diabetes, dementia was associated with more microvascular infarcts and greater activation of neuroinflammation, said Dr. Joshua A. Sonnen of the department of pathology, University of Washington, Seattle, and his associates (Arch. Neurol. 2009;66:315–22).

These findings suggest that the pathogenesis of dementia differs between patients with diabetes and those without it.

The researchers examined autopsy data from subjects in an ongoing community-based study of brain aging and incident dementia. The subjects included 196 elderly men and women divided into four groups: those who had no diabetes and no dementia (92 cases), those who had diabetes but no dementia (33 cases), those who did not have diabetes but did have dementia (45 cases), and those who had both diabetes and dementia (26 cases).

Subjects with both diabetes and dementia died with a lower burden of amyloid-β peptide in brain parenchyma and cerebral blood vessels, compared with those who had dementia but no diabetes. They also showed significantly more deep microvascular injuries, suggesting “the basal-penetrating vessels may be especially vulnerable to damage from diabetes,” the researchers reported.

These subjects also had higher levels of neuroinflammation than did their nondiabetic counterparts, which may be related to their higher numbers of microvascular injuries, the authors wrote.

The rate of major catheter-related infections among patients in the intensive care unit decreased by 60% when dressings impregnated with chlorhexidine gluconate were secured over insertion sites for arterial or central venous catheters, investigators reported.

That decrease was achieved among ICU patients participating in a multicenter study in France, even though the background rate of catheter-related infections already was extremely low, said Dr. Jean-Francois Timsit of University Joseph Fourier, Grenoble, France, and his associates.

They conducted a randomized, controlled trial to assess chlorhexidine-impregnated sponges because small, unpublished studies of the dressings had yielded promising results.

The trial involved 1,636 medical and surgical patients treated in seven ICUs at three university hospitals and two general hospitals. The patients were randomly assigned to receive either chlorhexidine dressings or standard dressings over catheter insertion sites.

Use of the chlorhexidine dressings cut the rate of major catheter-related infections from 1.4/1,000 catheter-days to 0.6/1,000 catheter-days.

That protective effect was consistent both for gram-negative and gram-positive organisms, as well as for arterial and central venous catheters, the investigators said (JAMA 2009;301:1231–41).

Skin and catheter cultures showed a significant decrease in bacterial colonization with the chlorhexidine dressings.

The researchers estimated that the number needed to treat to prevent one major infection was 117 catheters.

Eight patients who were treated with the chlorhexidine dressings developed contact dermatitis, which resolved when the dressings were removed. All of these eight patients had multiple organ failures, subcutaneous edema, and fragile skin.

Dr. Timsit and his colleagues also studied whether decreasing the number of dressing changes (following the first such change at 24 hours after catheter insertion) would affect infection outcomes.

The group of patients who were assigned to a delayed dressing change every 7 days showed a rate of catheter-related infection similar to the rate of the group assigned to the standard number of dressing changes (every 3 days).

That finding suggests that it is probably safe to delay dressing changes in order to minimize occasions for potential catheter contamination—“provided the dressings are closely monitored and changed immediately should separation or soiling be detected,” the investigators added.

The study results “have the potential to change the standard of care for insertion and maintenance of intravascular catheters,” noted Dr. Eli N. Perencevich of the University of Maryland, Baltimore, and Dr. Didier Pittet of the University of Geneva Hospitals and the World Health Organization Alliance for Patient Safety, in an editorial comment that accompanied the report.

The “relatively simple” use of a chlorhexidine-impregnated dressing may decrease further the already low rates of infection that are achieved through the use of optimal ICU practices, they said in their commentary (JAMA 2009;301:1285–7).

The rate of major catheter-related infections among patients in the intensive care unit decreased by 60% when dressings impregnated with chlorhexidine gluconate were secured over insertion sites for arterial or central venous catheters, investigators reported.

That decrease was achieved among ICU patients participating in a multicenter study in France, even though the background rate of catheter-related infections already was extremely low, said Dr. Jean-Francois Timsit of University Joseph Fourier, Grenoble, France, and his associates.

They conducted a randomized, controlled trial to assess chlorhexidine-impregnated sponges because small, unpublished studies of the dressings had yielded promising results.

The trial involved 1,636 medical and surgical patients treated in seven ICUs at three university hospitals and two general hospitals. The patients were randomly assigned to receive either chlorhexidine dressings or standard dressings over catheter insertion sites.

Use of the chlorhexidine dressings cut the rate of major catheter-related infections from 1.4/1,000 catheter-days to 0.6/1,000 catheter-days.

That protective effect was consistent both for gram-negative and gram-positive organisms, as well as for arterial and central venous catheters, the investigators said (JAMA 2009;301:1231–41).

Skin and catheter cultures showed a significant decrease in bacterial colonization with the chlorhexidine dressings.

The researchers estimated that the number needed to treat to prevent one major infection was 117 catheters.

Eight patients who were treated with the chlorhexidine dressings developed contact dermatitis, which resolved when the dressings were removed. All of these eight patients had multiple organ failures, subcutaneous edema, and fragile skin.

Dr. Timsit and his colleagues also studied whether decreasing the number of dressing changes (following the first such change at 24 hours after catheter insertion) would affect infection outcomes.

The group of patients who were assigned to a delayed dressing change every 7 days showed a rate of catheter-related infection similar to the rate of the group assigned to the standard number of dressing changes (every 3 days).

That finding suggests that it is probably safe to delay dressing changes in order to minimize occasions for potential catheter contamination—“provided the dressings are closely monitored and changed immediately should separation or soiling be detected,” the investigators added.

The study results “have the potential to change the standard of care for insertion and maintenance of intravascular catheters,” noted Dr. Eli N. Perencevich of the University of Maryland, Baltimore, and Dr. Didier Pittet of the University of Geneva Hospitals and the World Health Organization Alliance for Patient Safety, in an editorial comment that accompanied the report.

The “relatively simple” use of a chlorhexidine-impregnated dressing may decrease further the already low rates of infection that are achieved through the use of optimal ICU practices, they said in their commentary (JAMA 2009;301:1285–7).

The rate of major catheter-related infections among patients in the intensive care unit decreased by 60% when dressings impregnated with chlorhexidine gluconate were secured over insertion sites for arterial or central venous catheters, investigators reported.

That decrease was achieved among ICU patients participating in a multicenter study in France, even though the background rate of catheter-related infections already was extremely low, said Dr. Jean-Francois Timsit of University Joseph Fourier, Grenoble, France, and his associates.

They conducted a randomized, controlled trial to assess chlorhexidine-impregnated sponges because small, unpublished studies of the dressings had yielded promising results.

The trial involved 1,636 medical and surgical patients treated in seven ICUs at three university hospitals and two general hospitals. The patients were randomly assigned to receive either chlorhexidine dressings or standard dressings over catheter insertion sites.

Use of the chlorhexidine dressings cut the rate of major catheter-related infections from 1.4/1,000 catheter-days to 0.6/1,000 catheter-days.

That protective effect was consistent both for gram-negative and gram-positive organisms, as well as for arterial and central venous catheters, the investigators said (JAMA 2009;301:1231–41).

Skin and catheter cultures showed a significant decrease in bacterial colonization with the chlorhexidine dressings.

The researchers estimated that the number needed to treat to prevent one major infection was 117 catheters.

Eight patients who were treated with the chlorhexidine dressings developed contact dermatitis, which resolved when the dressings were removed. All of these eight patients had multiple organ failures, subcutaneous edema, and fragile skin.

Dr. Timsit and his colleagues also studied whether decreasing the number of dressing changes (following the first such change at 24 hours after catheter insertion) would affect infection outcomes.

The group of patients who were assigned to a delayed dressing change every 7 days showed a rate of catheter-related infection similar to the rate of the group assigned to the standard number of dressing changes (every 3 days).

That finding suggests that it is probably safe to delay dressing changes in order to minimize occasions for potential catheter contamination—“provided the dressings are closely monitored and changed immediately should separation or soiling be detected,” the investigators added.

The study results “have the potential to change the standard of care for insertion and maintenance of intravascular catheters,” noted Dr. Eli N. Perencevich of the University of Maryland, Baltimore, and Dr. Didier Pittet of the University of Geneva Hospitals and the World Health Organization Alliance for Patient Safety, in an editorial comment that accompanied the report.

The “relatively simple” use of a chlorhexidine-impregnated dressing may decrease further the already low rates of infection that are achieved through the use of optimal ICU practices, they said in their commentary (JAMA 2009;301:1285–7).