Michele G. Sullivan

ST. LOUIS — Higher income, binge drinking, and student status are all independent risk factors for sunburn, Tamu Brown reported at the annual meeting of the Society for Investigative Dermatology.

“We suggest targeting young adults, students, and those with higher socioeconomic status for preventive measures,” said Ms. Brown, a medical student at the University of Pennsylvania, Philadelphia.

Not only is sunburn a significant risk factor for melanoma, it has significant economic impact, Ms. Brown said. A 2003 study published in the Archives of Dermatology concluded that sunburn might account for as many as 93,000 lost workdays each year in Galveston, Tex., alone (2003;139:1003–6).

Ms. Brown analyzed data from the 2003 Behavioral Risk Factor Surveillance System, a nationwide telephone survey administered annually by the Centers for Disease Control and Prevention. In the survey, sunburn was defined as sun exposure that left even a small portion of the skin reddened for at least 24 hours.

The 2003 survey included more than 248,000 people; the respondents' mean age was 45 years. Of those, almost 34% reported having had at least one sunburn within the past 12 months; 22% reported have had two sunburns; 13% reported three sunburns; and 8% reported four or more.

The highest prevalence of sunburn occurred in those aged 18–24 years (49%). Compared with respondents aged 45–55, this represented an increased risk of 2.6.

Student status and higher socioeconomic status were also associated with an increased risk of sunburn, Ms. Brown said. Respondents with a college degree had an increased risk of 1.6, compared with those with a high school diploma. Those making more than $50,000 per year had an increased risk of 2.7, compared with those making less than $20,000 per year. Students had an increased risk of 1.4, compared with those who were unemployed.

Alcohol consumption—particularly binge drinking (more than five drinks per day anytime within the past 30 days)—was also a risk factor. The association with smoking was statistically significant but of a low magnitude, she added.

ST. LOUIS — Higher income, binge drinking, and student status are all independent risk factors for sunburn, Tamu Brown reported at the annual meeting of the Society for Investigative Dermatology.

“We suggest targeting young adults, students, and those with higher socioeconomic status for preventive measures,” said Ms. Brown, a medical student at the University of Pennsylvania, Philadelphia.

Not only is sunburn a significant risk factor for melanoma, it has significant economic impact, Ms. Brown said. A 2003 study published in the Archives of Dermatology concluded that sunburn might account for as many as 93,000 lost workdays each year in Galveston, Tex., alone (2003;139:1003–6).

Ms. Brown analyzed data from the 2003 Behavioral Risk Factor Surveillance System, a nationwide telephone survey administered annually by the Centers for Disease Control and Prevention. In the survey, sunburn was defined as sun exposure that left even a small portion of the skin reddened for at least 24 hours.

The 2003 survey included more than 248,000 people; the respondents' mean age was 45 years. Of those, almost 34% reported having had at least one sunburn within the past 12 months; 22% reported have had two sunburns; 13% reported three sunburns; and 8% reported four or more.

The highest prevalence of sunburn occurred in those aged 18–24 years (49%). Compared with respondents aged 45–55, this represented an increased risk of 2.6.

Student status and higher socioeconomic status were also associated with an increased risk of sunburn, Ms. Brown said. Respondents with a college degree had an increased risk of 1.6, compared with those with a high school diploma. Those making more than $50,000 per year had an increased risk of 2.7, compared with those making less than $20,000 per year. Students had an increased risk of 1.4, compared with those who were unemployed.

Alcohol consumption—particularly binge drinking (more than five drinks per day anytime within the past 30 days)—was also a risk factor. The association with smoking was statistically significant but of a low magnitude, she added.

ST. LOUIS — Higher income, binge drinking, and student status are all independent risk factors for sunburn, Tamu Brown reported at the annual meeting of the Society for Investigative Dermatology.

“We suggest targeting young adults, students, and those with higher socioeconomic status for preventive measures,” said Ms. Brown, a medical student at the University of Pennsylvania, Philadelphia.

Not only is sunburn a significant risk factor for melanoma, it has significant economic impact, Ms. Brown said. A 2003 study published in the Archives of Dermatology concluded that sunburn might account for as many as 93,000 lost workdays each year in Galveston, Tex., alone (2003;139:1003–6).

Ms. Brown analyzed data from the 2003 Behavioral Risk Factor Surveillance System, a nationwide telephone survey administered annually by the Centers for Disease Control and Prevention. In the survey, sunburn was defined as sun exposure that left even a small portion of the skin reddened for at least 24 hours.

The 2003 survey included more than 248,000 people; the respondents' mean age was 45 years. Of those, almost 34% reported having had at least one sunburn within the past 12 months; 22% reported have had two sunburns; 13% reported three sunburns; and 8% reported four or more.

The highest prevalence of sunburn occurred in those aged 18–24 years (49%). Compared with respondents aged 45–55, this represented an increased risk of 2.6.

Student status and higher socioeconomic status were also associated with an increased risk of sunburn, Ms. Brown said. Respondents with a college degree had an increased risk of 1.6, compared with those with a high school diploma. Those making more than $50,000 per year had an increased risk of 2.7, compared with those making less than $20,000 per year. Students had an increased risk of 1.4, compared with those who were unemployed.

Alcohol consumption—particularly binge drinking (more than five drinks per day anytime within the past 30 days)—was also a risk factor. The association with smoking was statistically significant but of a low magnitude, she added.

Most healthy children with conjunctivitis will get better by themselves and don't need an ophthalmic antibiotic, Peter W. Rose, M.B., and his colleagues reported.

“Parents should be encouraged to treat children themselves without medical consultation, unless their child develops unusual symptoms or the symptoms persist for more than a week,” said Dr. Rose of Oxford (England) University, and his associates. They suggested that parents cleanse their children's eyes with lubricating eyedrops instead of rushing them off to the pediatrician at the first sign of conjunctivitis (Lancet 2005;366:37–43).

The investigators randomized 326 children (mean age 3.3 years) with a clinical diagnosis of conjunctivitis to either chloramphenicol eyedrops (0.5%) or placebo (distilled water containing 1.5% boric acid and 0.3% borax). Parents applied the drops every 2 hours for the first 24 hours when the child was awake and four times a day until 48 hours after symptoms resolved.

After 7 days, 86% of those in the antibiotic group were clinically cured, compared with 83% of those in the placebo group. When 307 of the children were followed up at 6 weeks, fewer than 5% in each group had experienced a relapse or new infection. Only one reaction—a case of swollen eyelids and face—was attributed to antibiotic treatment.

Baseline cultures showed that 80% of the children had bacterial infections. Among this group, the clinical cure rate did not differ significantly between chloramphenicol and placebo (85% vs. 80%), but more of the chloramphenicol group than the placebo group experienced bacterial eradication (40% vs. 23%).

Although eradication is not necessary for a clinical cure, Dr. Rose and his associates said failure to achieve it could impact transmission. “Despite our results, antibiotic treatment might still reduce the absolute number, and, hence, transmissibility of pathogens, and further research might be necessary if antibiotics cease to be prescribed for this disorder.”

Most healthy children with conjunctivitis will get better by themselves and don't need an ophthalmic antibiotic, Peter W. Rose, M.B., and his colleagues reported.

“Parents should be encouraged to treat children themselves without medical consultation, unless their child develops unusual symptoms or the symptoms persist for more than a week,” said Dr. Rose of Oxford (England) University, and his associates. They suggested that parents cleanse their children's eyes with lubricating eyedrops instead of rushing them off to the pediatrician at the first sign of conjunctivitis (Lancet 2005;366:37–43).

The investigators randomized 326 children (mean age 3.3 years) with a clinical diagnosis of conjunctivitis to either chloramphenicol eyedrops (0.5%) or placebo (distilled water containing 1.5% boric acid and 0.3% borax). Parents applied the drops every 2 hours for the first 24 hours when the child was awake and four times a day until 48 hours after symptoms resolved.

After 7 days, 86% of those in the antibiotic group were clinically cured, compared with 83% of those in the placebo group. When 307 of the children were followed up at 6 weeks, fewer than 5% in each group had experienced a relapse or new infection. Only one reaction—a case of swollen eyelids and face—was attributed to antibiotic treatment.

Baseline cultures showed that 80% of the children had bacterial infections. Among this group, the clinical cure rate did not differ significantly between chloramphenicol and placebo (85% vs. 80%), but more of the chloramphenicol group than the placebo group experienced bacterial eradication (40% vs. 23%).

Although eradication is not necessary for a clinical cure, Dr. Rose and his associates said failure to achieve it could impact transmission. “Despite our results, antibiotic treatment might still reduce the absolute number, and, hence, transmissibility of pathogens, and further research might be necessary if antibiotics cease to be prescribed for this disorder.”

Most healthy children with conjunctivitis will get better by themselves and don't need an ophthalmic antibiotic, Peter W. Rose, M.B., and his colleagues reported.

“Parents should be encouraged to treat children themselves without medical consultation, unless their child develops unusual symptoms or the symptoms persist for more than a week,” said Dr. Rose of Oxford (England) University, and his associates. They suggested that parents cleanse their children's eyes with lubricating eyedrops instead of rushing them off to the pediatrician at the first sign of conjunctivitis (Lancet 2005;366:37–43).

The investigators randomized 326 children (mean age 3.3 years) with a clinical diagnosis of conjunctivitis to either chloramphenicol eyedrops (0.5%) or placebo (distilled water containing 1.5% boric acid and 0.3% borax). Parents applied the drops every 2 hours for the first 24 hours when the child was awake and four times a day until 48 hours after symptoms resolved.

After 7 days, 86% of those in the antibiotic group were clinically cured, compared with 83% of those in the placebo group. When 307 of the children were followed up at 6 weeks, fewer than 5% in each group had experienced a relapse or new infection. Only one reaction—a case of swollen eyelids and face—was attributed to antibiotic treatment.

Baseline cultures showed that 80% of the children had bacterial infections. Among this group, the clinical cure rate did not differ significantly between chloramphenicol and placebo (85% vs. 80%), but more of the chloramphenicol group than the placebo group experienced bacterial eradication (40% vs. 23%).

Although eradication is not necessary for a clinical cure, Dr. Rose and his associates said failure to achieve it could impact transmission. “Despite our results, antibiotic treatment might still reduce the absolute number, and, hence, transmissibility of pathogens, and further research might be necessary if antibiotics cease to be prescribed for this disorder.”

ST. LOUIS — Patients previously vaccinated for smallpox will, with revaccination, experience a smaller erythematous response, a quicker time to pustulation, and a fourfold increase in antibody titers, compared with vaccine-naive patients.

“This provides important clinical evidence of retained immunity to smallpox, even in individuals vaccinated more than 30 years ago,” Eric Simpson, M.D., said at the annual meeting of the Society of Investigational Dermatology.

Additionally, said Dr. Simpson of Oregon Health and Science University, Portland, povidone ointment is an effective method of controlling viral shedding at the vaccination site, because within 2 hours, it decreases shedding to 0, and it has no effect on antibody titers.

Two recent studies have challenged the long-held theory that smallpox immunity lasts less than 10 years after vaccination, he said. A 2002 study showed that previously vaccinated individuals retained humoral immunity up to 75 years after vaccination.

A 2003 study concluded that previously vaccinated individuals could be successfully revaccinated with diluted vaccine, because of their more robust immune response.

Dr. Simpson vaccinated 26 healthy adult volunteers, 17 of whom had been vaccinated an average of 33 years earlier (range 2–50 years). The rest of the cohort was vaccine naive. He used a standard vaccination protocol, with the previously vaccinated group receiving 15 pokes with a bifurcated needle, while the vaccine-naive group received 3 pokes.

Measurements included maximum erythema at the vaccine site and maximum time to pustulation. Dr. Simpson also studied the effect of povidone ointment on viral shedding, when applied beginning at day 7.

The previously vaccinated group had a significantly smaller maximum diameter of erythema around the vaccination site, compared with the naive group (1.9 cm vs 3.9 cm).

The previously vaccinated group developed an erythematous reaction more quickly, beginning at day 3, compared with day 6 for the naive group. Erythema for both groups peaked around day 10.

It's important that physicians be familiar with the differences in vaccination site reactions, he said. “This type of response is not a cellulitis and doesn't need to be treated with antibiotics.”

Maximum time to pustulation was significantly shorter in the previously vaccinated group than in the naive group (about 7 days vs 9.6 days).

The previously vaccinated group developed four times the antibody titers of the naive group, he said. “This explains the earlier finding that you can successfully vaccinate these patients with diluted vaccine.”

To study the effect of povidone ointment on viral shedding, Dr. Simpson applied the ointment to the vaccination site every 2–3 days, beginning at day 7. Viral shedding was measured 1 hour after the ointment was applied. “The shedding dropped to 0 within 1–2 hours and stayed that way throughout the entire vaccine response,” he said. “In the untreated group, viral shedding continued to occur until approximately day 20, which is around the time the eschar was shed.”

Vaccine-naive patients typically show a robust vaccination site reaction.

Patients who have been previously vaccinated evince a lesser reaction. Photos courtesy Dr. Eric Simpson

ST. LOUIS — Patients previously vaccinated for smallpox will, with revaccination, experience a smaller erythematous response, a quicker time to pustulation, and a fourfold increase in antibody titers, compared with vaccine-naive patients.

“This provides important clinical evidence of retained immunity to smallpox, even in individuals vaccinated more than 30 years ago,” Eric Simpson, M.D., said at the annual meeting of the Society of Investigational Dermatology.

Additionally, said Dr. Simpson of Oregon Health and Science University, Portland, povidone ointment is an effective method of controlling viral shedding at the vaccination site, because within 2 hours, it decreases shedding to 0, and it has no effect on antibody titers.

Two recent studies have challenged the long-held theory that smallpox immunity lasts less than 10 years after vaccination, he said. A 2002 study showed that previously vaccinated individuals retained humoral immunity up to 75 years after vaccination.

A 2003 study concluded that previously vaccinated individuals could be successfully revaccinated with diluted vaccine, because of their more robust immune response.

Dr. Simpson vaccinated 26 healthy adult volunteers, 17 of whom had been vaccinated an average of 33 years earlier (range 2–50 years). The rest of the cohort was vaccine naive. He used a standard vaccination protocol, with the previously vaccinated group receiving 15 pokes with a bifurcated needle, while the vaccine-naive group received 3 pokes.

Measurements included maximum erythema at the vaccine site and maximum time to pustulation. Dr. Simpson also studied the effect of povidone ointment on viral shedding, when applied beginning at day 7.

The previously vaccinated group had a significantly smaller maximum diameter of erythema around the vaccination site, compared with the naive group (1.9 cm vs 3.9 cm).

The previously vaccinated group developed an erythematous reaction more quickly, beginning at day 3, compared with day 6 for the naive group. Erythema for both groups peaked around day 10.

It's important that physicians be familiar with the differences in vaccination site reactions, he said. “This type of response is not a cellulitis and doesn't need to be treated with antibiotics.”

Maximum time to pustulation was significantly shorter in the previously vaccinated group than in the naive group (about 7 days vs 9.6 days).

The previously vaccinated group developed four times the antibody titers of the naive group, he said. “This explains the earlier finding that you can successfully vaccinate these patients with diluted vaccine.”

To study the effect of povidone ointment on viral shedding, Dr. Simpson applied the ointment to the vaccination site every 2–3 days, beginning at day 7. Viral shedding was measured 1 hour after the ointment was applied. “The shedding dropped to 0 within 1–2 hours and stayed that way throughout the entire vaccine response,” he said. “In the untreated group, viral shedding continued to occur until approximately day 20, which is around the time the eschar was shed.”

Vaccine-naive patients typically show a robust vaccination site reaction.

Patients who have been previously vaccinated evince a lesser reaction. Photos courtesy Dr. Eric Simpson

ST. LOUIS — Patients previously vaccinated for smallpox will, with revaccination, experience a smaller erythematous response, a quicker time to pustulation, and a fourfold increase in antibody titers, compared with vaccine-naive patients.

“This provides important clinical evidence of retained immunity to smallpox, even in individuals vaccinated more than 30 years ago,” Eric Simpson, M.D., said at the annual meeting of the Society of Investigational Dermatology.

Additionally, said Dr. Simpson of Oregon Health and Science University, Portland, povidone ointment is an effective method of controlling viral shedding at the vaccination site, because within 2 hours, it decreases shedding to 0, and it has no effect on antibody titers.

Two recent studies have challenged the long-held theory that smallpox immunity lasts less than 10 years after vaccination, he said. A 2002 study showed that previously vaccinated individuals retained humoral immunity up to 75 years after vaccination.

A 2003 study concluded that previously vaccinated individuals could be successfully revaccinated with diluted vaccine, because of their more robust immune response.

Dr. Simpson vaccinated 26 healthy adult volunteers, 17 of whom had been vaccinated an average of 33 years earlier (range 2–50 years). The rest of the cohort was vaccine naive. He used a standard vaccination protocol, with the previously vaccinated group receiving 15 pokes with a bifurcated needle, while the vaccine-naive group received 3 pokes.

Measurements included maximum erythema at the vaccine site and maximum time to pustulation. Dr. Simpson also studied the effect of povidone ointment on viral shedding, when applied beginning at day 7.

The previously vaccinated group had a significantly smaller maximum diameter of erythema around the vaccination site, compared with the naive group (1.9 cm vs 3.9 cm).

The previously vaccinated group developed an erythematous reaction more quickly, beginning at day 3, compared with day 6 for the naive group. Erythema for both groups peaked around day 10.

It's important that physicians be familiar with the differences in vaccination site reactions, he said. “This type of response is not a cellulitis and doesn't need to be treated with antibiotics.”

Maximum time to pustulation was significantly shorter in the previously vaccinated group than in the naive group (about 7 days vs 9.6 days).

The previously vaccinated group developed four times the antibody titers of the naive group, he said. “This explains the earlier finding that you can successfully vaccinate these patients with diluted vaccine.”

To study the effect of povidone ointment on viral shedding, Dr. Simpson applied the ointment to the vaccination site every 2–3 days, beginning at day 7. Viral shedding was measured 1 hour after the ointment was applied. “The shedding dropped to 0 within 1–2 hours and stayed that way throughout the entire vaccine response,” he said. “In the untreated group, viral shedding continued to occur until approximately day 20, which is around the time the eschar was shed.”

Vaccine-naive patients typically show a robust vaccination site reaction.

Patients who have been previously vaccinated evince a lesser reaction. Photos courtesy Dr. Eric Simpson

A drink a day appears to protect elderly women from cognitive decline, according to new data from the ongoing Nurses' Health Study.

During a 2-year follow-up study, interviewers administered four cognitive tests to more than 11,000 women aged 70–81 years, said Meir Stampfer, M.D., of Brigham and Women's Hospital, Boston, and colleagues. They found that moderate drinkers (about one drink/day) had a 20% lower risk of cognitive decline than either nondrinkers or those who drank two or more drinks/day. Both wine and beer were associated with the protective effect (N. Engl. J. Med. 2005;3:245–53).

Moderate alcohol intake elevates the HDL level and reduces that of fibrinogen and other thrombic factors. “Thus, moderate intake of alcohol may help preserve brain vasculature, may prevent subclinical strokes, and could thus result in better cognitive function,” the authors said.

But more studies are needed before doctors advise elderly women to start hitting the bottle, Denis Evans, M.D., of Rush University, Chicago, said in an accompanying editorial: “Persons seeking to maximize cognition in old age must keep in mind both the uncertainty of the current results and the knowledge that alcohol consumption can be a double-edged sword, with the dangers of overindulgence being all too familiar.”

A drink a day appears to protect elderly women from cognitive decline, according to new data from the ongoing Nurses' Health Study.

During a 2-year follow-up study, interviewers administered four cognitive tests to more than 11,000 women aged 70–81 years, said Meir Stampfer, M.D., of Brigham and Women's Hospital, Boston, and colleagues. They found that moderate drinkers (about one drink/day) had a 20% lower risk of cognitive decline than either nondrinkers or those who drank two or more drinks/day. Both wine and beer were associated with the protective effect (N. Engl. J. Med. 2005;3:245–53).

Moderate alcohol intake elevates the HDL level and reduces that of fibrinogen and other thrombic factors. “Thus, moderate intake of alcohol may help preserve brain vasculature, may prevent subclinical strokes, and could thus result in better cognitive function,” the authors said.

But more studies are needed before doctors advise elderly women to start hitting the bottle, Denis Evans, M.D., of Rush University, Chicago, said in an accompanying editorial: “Persons seeking to maximize cognition in old age must keep in mind both the uncertainty of the current results and the knowledge that alcohol consumption can be a double-edged sword, with the dangers of overindulgence being all too familiar.”

A drink a day appears to protect elderly women from cognitive decline, according to new data from the ongoing Nurses' Health Study.

During a 2-year follow-up study, interviewers administered four cognitive tests to more than 11,000 women aged 70–81 years, said Meir Stampfer, M.D., of Brigham and Women's Hospital, Boston, and colleagues. They found that moderate drinkers (about one drink/day) had a 20% lower risk of cognitive decline than either nondrinkers or those who drank two or more drinks/day. Both wine and beer were associated with the protective effect (N. Engl. J. Med. 2005;3:245–53).

Moderate alcohol intake elevates the HDL level and reduces that of fibrinogen and other thrombic factors. “Thus, moderate intake of alcohol may help preserve brain vasculature, may prevent subclinical strokes, and could thus result in better cognitive function,” the authors said.

But more studies are needed before doctors advise elderly women to start hitting the bottle, Denis Evans, M.D., of Rush University, Chicago, said in an accompanying editorial: “Persons seeking to maximize cognition in old age must keep in mind both the uncertainty of the current results and the knowledge that alcohol consumption can be a double-edged sword, with the dangers of overindulgence being all too familiar.”

Teens who take a sexual abstinence pledge delay their sexual debut for a few years, but they have just as many sexually transmitted infections as nonpledgers, probably because they are more likely to engage in noncoital sex and aren't as likely to use a condom during any sexual activity.

Hannah Brückner, Ph.D., and Peter Bearman, Ph.D., said their findings might put a new spin on programs that stress abstinence as the only way to avoid STDs and pregnancy. “The all-or-nothing approach … may create additional barriers to knowledge and protection for adolescents. For example, the emphasis on virginity may encourage adolescents to limit their sexual activity to noncoital behaviors, which may nevertheless expose them to risks of infection” (J. Adolesc. Health 2005;36:271–8).

Health care behavior by pledgers further complicates the problem, they noted. “It is important to know that pledgers are less likely than nonpledgers to be tested for STDs and to have ever seen a doctor because they are worried about an STD,” said the investigators of Yale University, New Haven, Conn. and Columbia University, New York.

The researchers extracted data gathered from 2001 to 2002, during the third wave of the National Longitudinal Study of Adolescent Health. During this wave, respondents were age 18–24 years. A total of 11,471 respondents provided urine samples for STD testing (chlamydia, gonorrhea, and trichomoniasis). An additional 3,317 sexually active female respondents were randomly selected for human papilloma virus (HPV) testing.

Pledge status was collected from all three waves of the survey. Nonpledgers reported no abstinence pledge during any of the waves. Consistent pledgers reported pledging during all waves or pledging for the first time during wave 3. Inconsistent pledgers reported pledging during an early wave but not a subsequent wave. Most of the group (80%) were nonpledgers. Only 7% were consistent pledgers; 13% were inconsistent pledgers.

Consistent and inconsistent pledgers delayed their time to first coitus by several years, compared with nonpledgers. Among nonpledgers, 75% reported first intercourse by age 18. Inconsistent pledgers reached the 75th percentile by age 20, and consistent pledgers by age 24.

Male pledgers delayed intercourse the longest. By age 25, 25% of consistent male pledgers were still virgins, compared with 15% of inconsistent pledgers and 7% of nonpledgers. By age 25, 21% of female consistent pledgers were still virgins, compared with 10% of inconsistent pledgers and 6% of nonpledgers.

Delaying first intercourse had no significant effect on STD incidence in the groups, however. About 6.9% of nonpledgers, 6.4% of inconsistent pledgers, and 4.6% of consistent pledgers tested positive for trichomoniasis, chlamydia, and/or gonorrhea.

For HPV infection, the rates were 26.5% among nonpledgers, 28.5% among inconsistent pledgers, and 26.7% among consistent pledgers.

Pledgers did have fewer sexual partners than nonpledgers (average of 1.5 partners vs. 2.4 partners), and were not exposed as long to STD risk. However, they were more likely to engage in noncoital sexual contact.

About 3% of respondents reported oral sex but no vaginal sex. About 2% of nonpledgers fell into that group, compared with 13% of consistent pledgers and 5% of inconsistent pledgers. About 0.7% of nonpledgers reported anal sex but not vaginal sex, compared with 1.2% of pledgers.

About 1% of male nonpledgers reported anal, but not vaginal, sex, compared with 3% of male inconsistent pledgers and 4% of male consistent pledgers.

Condom use during these experiences was very low for all respondents: Only 4% reported using a condom during oral sex, and about 30% reported using one for anal sex.

“The combination of low condom use and overrepresentation of pledgers [in noncoital sex] provides some support for the hypothesis that this behavioral pattern is associated with greater than expected STD acquisition among pledgers, although the numbers are small and provide an insufficient basis from which to make inference,” the authors said.

Teens who take a sexual abstinence pledge delay their sexual debut for a few years, but they have just as many sexually transmitted infections as nonpledgers, probably because they are more likely to engage in noncoital sex and aren't as likely to use a condom during any sexual activity.

Hannah Brückner, Ph.D., and Peter Bearman, Ph.D., said their findings might put a new spin on programs that stress abstinence as the only way to avoid STDs and pregnancy. “The all-or-nothing approach … may create additional barriers to knowledge and protection for adolescents. For example, the emphasis on virginity may encourage adolescents to limit their sexual activity to noncoital behaviors, which may nevertheless expose them to risks of infection” (J. Adolesc. Health 2005;36:271–8).

Health care behavior by pledgers further complicates the problem, they noted. “It is important to know that pledgers are less likely than nonpledgers to be tested for STDs and to have ever seen a doctor because they are worried about an STD,” said the investigators of Yale University, New Haven, Conn. and Columbia University, New York.

The researchers extracted data gathered from 2001 to 2002, during the third wave of the National Longitudinal Study of Adolescent Health. During this wave, respondents were age 18–24 years. A total of 11,471 respondents provided urine samples for STD testing (chlamydia, gonorrhea, and trichomoniasis). An additional 3,317 sexually active female respondents were randomly selected for human papilloma virus (HPV) testing.

Pledge status was collected from all three waves of the survey. Nonpledgers reported no abstinence pledge during any of the waves. Consistent pledgers reported pledging during all waves or pledging for the first time during wave 3. Inconsistent pledgers reported pledging during an early wave but not a subsequent wave. Most of the group (80%) were nonpledgers. Only 7% were consistent pledgers; 13% were inconsistent pledgers.

Consistent and inconsistent pledgers delayed their time to first coitus by several years, compared with nonpledgers. Among nonpledgers, 75% reported first intercourse by age 18. Inconsistent pledgers reached the 75th percentile by age 20, and consistent pledgers by age 24.

Male pledgers delayed intercourse the longest. By age 25, 25% of consistent male pledgers were still virgins, compared with 15% of inconsistent pledgers and 7% of nonpledgers. By age 25, 21% of female consistent pledgers were still virgins, compared with 10% of inconsistent pledgers and 6% of nonpledgers.

Delaying first intercourse had no significant effect on STD incidence in the groups, however. About 6.9% of nonpledgers, 6.4% of inconsistent pledgers, and 4.6% of consistent pledgers tested positive for trichomoniasis, chlamydia, and/or gonorrhea.

For HPV infection, the rates were 26.5% among nonpledgers, 28.5% among inconsistent pledgers, and 26.7% among consistent pledgers.

Pledgers did have fewer sexual partners than nonpledgers (average of 1.5 partners vs. 2.4 partners), and were not exposed as long to STD risk. However, they were more likely to engage in noncoital sexual contact.

About 3% of respondents reported oral sex but no vaginal sex. About 2% of nonpledgers fell into that group, compared with 13% of consistent pledgers and 5% of inconsistent pledgers. About 0.7% of nonpledgers reported anal sex but not vaginal sex, compared with 1.2% of pledgers.

About 1% of male nonpledgers reported anal, but not vaginal, sex, compared with 3% of male inconsistent pledgers and 4% of male consistent pledgers.

Condom use during these experiences was very low for all respondents: Only 4% reported using a condom during oral sex, and about 30% reported using one for anal sex.

“The combination of low condom use and overrepresentation of pledgers [in noncoital sex] provides some support for the hypothesis that this behavioral pattern is associated with greater than expected STD acquisition among pledgers, although the numbers are small and provide an insufficient basis from which to make inference,” the authors said.

Teens who take a sexual abstinence pledge delay their sexual debut for a few years, but they have just as many sexually transmitted infections as nonpledgers, probably because they are more likely to engage in noncoital sex and aren't as likely to use a condom during any sexual activity.

Hannah Brückner, Ph.D., and Peter Bearman, Ph.D., said their findings might put a new spin on programs that stress abstinence as the only way to avoid STDs and pregnancy. “The all-or-nothing approach … may create additional barriers to knowledge and protection for adolescents. For example, the emphasis on virginity may encourage adolescents to limit their sexual activity to noncoital behaviors, which may nevertheless expose them to risks of infection” (J. Adolesc. Health 2005;36:271–8).

Health care behavior by pledgers further complicates the problem, they noted. “It is important to know that pledgers are less likely than nonpledgers to be tested for STDs and to have ever seen a doctor because they are worried about an STD,” said the investigators of Yale University, New Haven, Conn. and Columbia University, New York.

The researchers extracted data gathered from 2001 to 2002, during the third wave of the National Longitudinal Study of Adolescent Health. During this wave, respondents were age 18–24 years. A total of 11,471 respondents provided urine samples for STD testing (chlamydia, gonorrhea, and trichomoniasis). An additional 3,317 sexually active female respondents were randomly selected for human papilloma virus (HPV) testing.

Pledge status was collected from all three waves of the survey. Nonpledgers reported no abstinence pledge during any of the waves. Consistent pledgers reported pledging during all waves or pledging for the first time during wave 3. Inconsistent pledgers reported pledging during an early wave but not a subsequent wave. Most of the group (80%) were nonpledgers. Only 7% were consistent pledgers; 13% were inconsistent pledgers.

Consistent and inconsistent pledgers delayed their time to first coitus by several years, compared with nonpledgers. Among nonpledgers, 75% reported first intercourse by age 18. Inconsistent pledgers reached the 75th percentile by age 20, and consistent pledgers by age 24.

Male pledgers delayed intercourse the longest. By age 25, 25% of consistent male pledgers were still virgins, compared with 15% of inconsistent pledgers and 7% of nonpledgers. By age 25, 21% of female consistent pledgers were still virgins, compared with 10% of inconsistent pledgers and 6% of nonpledgers.

Delaying first intercourse had no significant effect on STD incidence in the groups, however. About 6.9% of nonpledgers, 6.4% of inconsistent pledgers, and 4.6% of consistent pledgers tested positive for trichomoniasis, chlamydia, and/or gonorrhea.

For HPV infection, the rates were 26.5% among nonpledgers, 28.5% among inconsistent pledgers, and 26.7% among consistent pledgers.

Pledgers did have fewer sexual partners than nonpledgers (average of 1.5 partners vs. 2.4 partners), and were not exposed as long to STD risk. However, they were more likely to engage in noncoital sexual contact.

About 3% of respondents reported oral sex but no vaginal sex. About 2% of nonpledgers fell into that group, compared with 13% of consistent pledgers and 5% of inconsistent pledgers. About 0.7% of nonpledgers reported anal sex but not vaginal sex, compared with 1.2% of pledgers.

About 1% of male nonpledgers reported anal, but not vaginal, sex, compared with 3% of male inconsistent pledgers and 4% of male consistent pledgers.

Condom use during these experiences was very low for all respondents: Only 4% reported using a condom during oral sex, and about 30% reported using one for anal sex.

“The combination of low condom use and overrepresentation of pledgers [in noncoital sex] provides some support for the hypothesis that this behavioral pattern is associated with greater than expected STD acquisition among pledgers, although the numbers are small and provide an insufficient basis from which to make inference,” the authors said.

Meningococcal disease is almost 12 times more likely to occur in a child whose mother is pregnant, possibly due to hormonal alterations in the mucosal barriers of pregnant women that predispose them to carry the bacteria.

Elske van Gils and colleagues at the University of Amsterdam examined family composition in 176 hospitalized children (mean age about 4 years); 88 were admitted with confirmed meningococcal disease and 88 for other reasons, mostly surgery.

Among the meningococcal cases, 17 (19%) of the patients' mothers were pregnant during the hospitalization; 6 were in their first or second trimester, and the rest were in their third trimester (Pediatrics 2005;115:590–3).

Among the controls, only 2 (2%) of the mothers were pregnant. Pregnancy was associated with an increased odds ratio of 11.7, multivariate analysis showed.

Other studies have found that meningococcal infections in children are related to maternal carriage.

The authors hypothesized that pregnant women may have increased or prolonged carriage rates.

Meningococcal disease is almost 12 times more likely to occur in a child whose mother is pregnant, possibly due to hormonal alterations in the mucosal barriers of pregnant women that predispose them to carry the bacteria.

Elske van Gils and colleagues at the University of Amsterdam examined family composition in 176 hospitalized children (mean age about 4 years); 88 were admitted with confirmed meningococcal disease and 88 for other reasons, mostly surgery.

Among the meningococcal cases, 17 (19%) of the patients' mothers were pregnant during the hospitalization; 6 were in their first or second trimester, and the rest were in their third trimester (Pediatrics 2005;115:590–3).

Among the controls, only 2 (2%) of the mothers were pregnant. Pregnancy was associated with an increased odds ratio of 11.7, multivariate analysis showed.

Other studies have found that meningococcal infections in children are related to maternal carriage.

The authors hypothesized that pregnant women may have increased or prolonged carriage rates.

Meningococcal disease is almost 12 times more likely to occur in a child whose mother is pregnant, possibly due to hormonal alterations in the mucosal barriers of pregnant women that predispose them to carry the bacteria.

Elske van Gils and colleagues at the University of Amsterdam examined family composition in 176 hospitalized children (mean age about 4 years); 88 were admitted with confirmed meningococcal disease and 88 for other reasons, mostly surgery.

Among the meningococcal cases, 17 (19%) of the patients' mothers were pregnant during the hospitalization; 6 were in their first or second trimester, and the rest were in their third trimester (Pediatrics 2005;115:590–3).

Among the controls, only 2 (2%) of the mothers were pregnant. Pregnancy was associated with an increased odds ratio of 11.7, multivariate analysis showed.

Other studies have found that meningococcal infections in children are related to maternal carriage.

The authors hypothesized that pregnant women may have increased or prolonged carriage rates.

ST. LOUIS — An investigational ointment containing extract of green tea successfully clears genital warts in about 60% of patients, Karl Beutner, M.D., said at the annual meeting of the Society for Investigative Dermatology.

The ointment, polyphenon E, is being developed by MediGene AG, Martinsried, Germany. The active ingredient is 80% tea polyphenols. The main catechin in the extract is (−)-epigallocatechin gallate (EGCG), which has been shown to induce apoptosis in human carcinoma cell lines.

“It's a strong antioxidant that inhibits a number of different enzymes,” said Dr. Beutner, chief medical officer at Dow Pharmaceutical Sciences, Petaluma, Calif. “Unpublished reports indicate that it induces a pro-Th1 cytokine profile not dissimilar to that of imiquimod.”

The three-armed, placebo-controlled trial randomized 502 patients to an active ointment of 10% or 15% concentration, or the vehicle, which contains isopropyl myristate. Patients had an average of eight warts (2–30), covering an average area of 95 mm

Patients applied the ointment three times a day for up to 16 weeks, or until all warts cleared. Those who cleared completely were enrolled in a 12-week follow-up trial to assess recurrence rates.

“The primary end point was clearance of all warts—the baseline warts and any warts that developed during treatment,” Dr. Beutner said. “This is an important distinction because other trials report the response in terms of only clearing the baseline warts. This was a stringent end point. They had to be clear of all warts.”

At the end of the 16-week treatment period, about 59% of patients in both active groups had complete clearance of their baseline warts, compared with about 34% of vehicle patients. Complete clearance of all warts occurred in 56% of the 10% group, 57% of the 15% group, and almost 34% of the vehicle group. Average time to response was 11 weeks.

About 80% of those in both active groups had more than 50% clearance. Less than 10% in either active group failed to respond. Women responded better than men, with about 65% of women and 50% of men in both active groups achieving complete clearance. Ongoing investigation is looking at whether the ointment is more effective on the moist skin of the vulvar area than on the dry skin of the penis, Dr. Beutner said.

During the 12-week follow-up period, 8.8% of those in the vehicle group experienced recurrence of baseline warts, compared with 6.5% of the group receiving the 15% formulation and 8.3% of the group receiving the 10% formulation. No new warts appeared in the vehicle group, however, while new warts did appear in 8% of the group receiving the 10% formulation and in 3.7% of the group receiving the 15% formulation.

About 87% of the active patients and 72% of the vehicle patients experienced at least one adverse event; events peaked at 2 weeks and then declined throughout the trial. Most were mild to moderate and included erythema, erosion, excoriation/flaking, edema, and induration. Only 1% of the patients discontinued use because of an adverse event. About 20% of the vehicle patients also had a mild to moderate local reaction.

The only serious events related to the study drug were two cases of vulvovaginitis, judged to be application site reactions.

Clinical trials for the ointment have been completed for the genital warts indication, Dr. Beutner said. MediGene AG also is conducting a phase II trial of the ointment for the treatment of actinic keratosis. Dr. Beutner is a consultant for the company.

ST. LOUIS — An investigational ointment containing extract of green tea successfully clears genital warts in about 60% of patients, Karl Beutner, M.D., said at the annual meeting of the Society for Investigative Dermatology.

The ointment, polyphenon E, is being developed by MediGene AG, Martinsried, Germany. The active ingredient is 80% tea polyphenols. The main catechin in the extract is (−)-epigallocatechin gallate (EGCG), which has been shown to induce apoptosis in human carcinoma cell lines.

“It's a strong antioxidant that inhibits a number of different enzymes,” said Dr. Beutner, chief medical officer at Dow Pharmaceutical Sciences, Petaluma, Calif. “Unpublished reports indicate that it induces a pro-Th1 cytokine profile not dissimilar to that of imiquimod.”

The three-armed, placebo-controlled trial randomized 502 patients to an active ointment of 10% or 15% concentration, or the vehicle, which contains isopropyl myristate. Patients had an average of eight warts (2–30), covering an average area of 95 mm

Patients applied the ointment three times a day for up to 16 weeks, or until all warts cleared. Those who cleared completely were enrolled in a 12-week follow-up trial to assess recurrence rates.

“The primary end point was clearance of all warts—the baseline warts and any warts that developed during treatment,” Dr. Beutner said. “This is an important distinction because other trials report the response in terms of only clearing the baseline warts. This was a stringent end point. They had to be clear of all warts.”

At the end of the 16-week treatment period, about 59% of patients in both active groups had complete clearance of their baseline warts, compared with about 34% of vehicle patients. Complete clearance of all warts occurred in 56% of the 10% group, 57% of the 15% group, and almost 34% of the vehicle group. Average time to response was 11 weeks.

About 80% of those in both active groups had more than 50% clearance. Less than 10% in either active group failed to respond. Women responded better than men, with about 65% of women and 50% of men in both active groups achieving complete clearance. Ongoing investigation is looking at whether the ointment is more effective on the moist skin of the vulvar area than on the dry skin of the penis, Dr. Beutner said.

During the 12-week follow-up period, 8.8% of those in the vehicle group experienced recurrence of baseline warts, compared with 6.5% of the group receiving the 15% formulation and 8.3% of the group receiving the 10% formulation. No new warts appeared in the vehicle group, however, while new warts did appear in 8% of the group receiving the 10% formulation and in 3.7% of the group receiving the 15% formulation.

About 87% of the active patients and 72% of the vehicle patients experienced at least one adverse event; events peaked at 2 weeks and then declined throughout the trial. Most were mild to moderate and included erythema, erosion, excoriation/flaking, edema, and induration. Only 1% of the patients discontinued use because of an adverse event. About 20% of the vehicle patients also had a mild to moderate local reaction.

The only serious events related to the study drug were two cases of vulvovaginitis, judged to be application site reactions.

Clinical trials for the ointment have been completed for the genital warts indication, Dr. Beutner said. MediGene AG also is conducting a phase II trial of the ointment for the treatment of actinic keratosis. Dr. Beutner is a consultant for the company.

ST. LOUIS — An investigational ointment containing extract of green tea successfully clears genital warts in about 60% of patients, Karl Beutner, M.D., said at the annual meeting of the Society for Investigative Dermatology.

The ointment, polyphenon E, is being developed by MediGene AG, Martinsried, Germany. The active ingredient is 80% tea polyphenols. The main catechin in the extract is (−)-epigallocatechin gallate (EGCG), which has been shown to induce apoptosis in human carcinoma cell lines.

“It's a strong antioxidant that inhibits a number of different enzymes,” said Dr. Beutner, chief medical officer at Dow Pharmaceutical Sciences, Petaluma, Calif. “Unpublished reports indicate that it induces a pro-Th1 cytokine profile not dissimilar to that of imiquimod.”

The three-armed, placebo-controlled trial randomized 502 patients to an active ointment of 10% or 15% concentration, or the vehicle, which contains isopropyl myristate. Patients had an average of eight warts (2–30), covering an average area of 95 mm

Patients applied the ointment three times a day for up to 16 weeks, or until all warts cleared. Those who cleared completely were enrolled in a 12-week follow-up trial to assess recurrence rates.

“The primary end point was clearance of all warts—the baseline warts and any warts that developed during treatment,” Dr. Beutner said. “This is an important distinction because other trials report the response in terms of only clearing the baseline warts. This was a stringent end point. They had to be clear of all warts.”

At the end of the 16-week treatment period, about 59% of patients in both active groups had complete clearance of their baseline warts, compared with about 34% of vehicle patients. Complete clearance of all warts occurred in 56% of the 10% group, 57% of the 15% group, and almost 34% of the vehicle group. Average time to response was 11 weeks.

About 80% of those in both active groups had more than 50% clearance. Less than 10% in either active group failed to respond. Women responded better than men, with about 65% of women and 50% of men in both active groups achieving complete clearance. Ongoing investigation is looking at whether the ointment is more effective on the moist skin of the vulvar area than on the dry skin of the penis, Dr. Beutner said.

During the 12-week follow-up period, 8.8% of those in the vehicle group experienced recurrence of baseline warts, compared with 6.5% of the group receiving the 15% formulation and 8.3% of the group receiving the 10% formulation. No new warts appeared in the vehicle group, however, while new warts did appear in 8% of the group receiving the 10% formulation and in 3.7% of the group receiving the 15% formulation.

About 87% of the active patients and 72% of the vehicle patients experienced at least one adverse event; events peaked at 2 weeks and then declined throughout the trial. Most were mild to moderate and included erythema, erosion, excoriation/flaking, edema, and induration. Only 1% of the patients discontinued use because of an adverse event. About 20% of the vehicle patients also had a mild to moderate local reaction.

The only serious events related to the study drug were two cases of vulvovaginitis, judged to be application site reactions.

Clinical trials for the ointment have been completed for the genital warts indication, Dr. Beutner said. MediGene AG also is conducting a phase II trial of the ointment for the treatment of actinic keratosis. Dr. Beutner is a consultant for the company.

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, investigators have reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

Of almost 1 million infants born in Sweden from 1992 to 2001, 1,686 infants were born with orofacial clefts; 84% of the clefts were not associated with another major congenital malformation. Compared with infants born of normal weight mothers, infants of obese mothers had their risk increase by 28% for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

The risk of orofacial clefting among these infants was significantly higher (odds ratio 1.88) when associated with other congential defects, but still elevated (OR 1.20) when clefting was the only defect.

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, investigators have reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

Of almost 1 million infants born in Sweden from 1992 to 2001, 1,686 infants were born with orofacial clefts; 84% of the clefts were not associated with another major congenital malformation. Compared with infants born of normal weight mothers, infants of obese mothers had their risk increase by 28% for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

The risk of orofacial clefting among these infants was significantly higher (odds ratio 1.88) when associated with other congential defects, but still elevated (OR 1.20) when clefting was the only defect.

Obese women are 30% more likely than women of normal weight to give birth to an infant with an orofacial cleft, investigators have reported.

“One possible explanation is undetected type 2 diabetes. Obese women, in the absence of overt diabetes, have been found to have an impaired glucose metabolism, which may be associated with an increased risk for orofacial clefts,” wrote Marie Cedergren, M.D., of the University of Linköping, and her coinvestigator, Bengt Kallen, M.D., of Tornblad Institute at the University of Lund (Cleft Palate Craniofac. J. 2005;42:367–71).

Of almost 1 million infants born in Sweden from 1992 to 2001, 1,686 infants were born with orofacial clefts; 84% of the clefts were not associated with another major congenital malformation. Compared with infants born of normal weight mothers, infants of obese mothers had their risk increase by 28% for cleft palate, 14% for cleft lip, and 31% for both abnormalities.

The risk of orofacial clefting among these infants was significantly higher (odds ratio 1.88) when associated with other congential defects, but still elevated (OR 1.20) when clefting was the only defect.

Not only are planned home births in North America safe for mother and baby, they are associated with a lower rate of medical intervention than are low-risk hospital births in the United States, results of the largest prospective analysis of such births suggest.

“Our study of certified professional midwives suggests they achieve good outcomes among low-risk women without routine use of expensive hospital intervention,” said study authors Kenneth C. Johnson, M.D., senior epidemiologist for the Public Health Agency of Canada, and Betty-Anne Daviss, a certified professional midwife from Canada.

“A high degree of safety and maternal satisfaction were reported, and more than 87% of mothers and neonates did not require transfer to hospital,” the study authors said.

The cohort included information from 5,418 women whose births during the year 2000 were attended by 409 of the 534 registered professional midwives in the United States and Canada (BMJ 2005;330:1416–9).

The researchers compared outcomes in that group with outcomes among more than 3.3 million term, singleton vertex hospital births the same year in the United States.

There were no maternal deaths in the home-birth group. Three infants died from fatal birth defects. There were five intrapartum fetal deaths and six neonatal deaths.

There were no deaths among the 80 planned home-delivered breeches, nor among the 13 sets of twins.

When the researchers excluded planned breech deliveries and twins (not considered low-risk), the rate of intrapartum and neonatal death was 1.7/1,000 planned low-risk home births.

About 12% of the mothers were transferred to a hospital either intrapartum or post partum.

Five of every six who went to a hospital did so before delivery: 51% went for failure to progress, pain relief, and/or exhaustion, according to the investigators.

After delivery, 1.3% of mothers and 0.7% of newborns were transferred. The most common reasons mentioned were maternal hemorrhage (0.6% of total births), retained placenta (0.5% of total births), or respiratory problems in the infant (0.5% of total births).

The midwives reportedly considered transfers urgent in 3.4% of cases. Transfers were four times more common among primiparous women (25%) than multiparous women (6%).

Compared with low-risk hospital births, planned home births had a significantly lower rate of induction of labor (9.6% vs. 21%), stimulation of labor (9.2% vs. 18.9%), episiotomy (2.1% vs. 33%), forceps (1% vs. 2.2%), and vacuum extractions (0.6% vs. 5.2%).

The rate of cesarean section for women transferred to a hospital also was lower than the rate among low-risk hospital births (3.7% vs. 18%).

Not only are planned home births in North America safe for mother and baby, they are associated with a lower rate of medical intervention than are low-risk hospital births in the United States, results of the largest prospective analysis of such births suggest.

“Our study of certified professional midwives suggests they achieve good outcomes among low-risk women without routine use of expensive hospital intervention,” said study authors Kenneth C. Johnson, M.D., senior epidemiologist for the Public Health Agency of Canada, and Betty-Anne Daviss, a certified professional midwife from Canada.

“A high degree of safety and maternal satisfaction were reported, and more than 87% of mothers and neonates did not require transfer to hospital,” the study authors said.

The cohort included information from 5,418 women whose births during the year 2000 were attended by 409 of the 534 registered professional midwives in the United States and Canada (BMJ 2005;330:1416–9).

The researchers compared outcomes in that group with outcomes among more than 3.3 million term, singleton vertex hospital births the same year in the United States.

There were no maternal deaths in the home-birth group. Three infants died from fatal birth defects. There were five intrapartum fetal deaths and six neonatal deaths.

There were no deaths among the 80 planned home-delivered breeches, nor among the 13 sets of twins.

When the researchers excluded planned breech deliveries and twins (not considered low-risk), the rate of intrapartum and neonatal death was 1.7/1,000 planned low-risk home births.

About 12% of the mothers were transferred to a hospital either intrapartum or post partum.

Five of every six who went to a hospital did so before delivery: 51% went for failure to progress, pain relief, and/or exhaustion, according to the investigators.

After delivery, 1.3% of mothers and 0.7% of newborns were transferred. The most common reasons mentioned were maternal hemorrhage (0.6% of total births), retained placenta (0.5% of total births), or respiratory problems in the infant (0.5% of total births).

The midwives reportedly considered transfers urgent in 3.4% of cases. Transfers were four times more common among primiparous women (25%) than multiparous women (6%).

Compared with low-risk hospital births, planned home births had a significantly lower rate of induction of labor (9.6% vs. 21%), stimulation of labor (9.2% vs. 18.9%), episiotomy (2.1% vs. 33%), forceps (1% vs. 2.2%), and vacuum extractions (0.6% vs. 5.2%).

The rate of cesarean section for women transferred to a hospital also was lower than the rate among low-risk hospital births (3.7% vs. 18%).

Not only are planned home births in North America safe for mother and baby, they are associated with a lower rate of medical intervention than are low-risk hospital births in the United States, results of the largest prospective analysis of such births suggest.

“Our study of certified professional midwives suggests they achieve good outcomes among low-risk women without routine use of expensive hospital intervention,” said study authors Kenneth C. Johnson, M.D., senior epidemiologist for the Public Health Agency of Canada, and Betty-Anne Daviss, a certified professional midwife from Canada.

“A high degree of safety and maternal satisfaction were reported, and more than 87% of mothers and neonates did not require transfer to hospital,” the study authors said.

The cohort included information from 5,418 women whose births during the year 2000 were attended by 409 of the 534 registered professional midwives in the United States and Canada (BMJ 2005;330:1416–9).

The researchers compared outcomes in that group with outcomes among more than 3.3 million term, singleton vertex hospital births the same year in the United States.

There were no maternal deaths in the home-birth group. Three infants died from fatal birth defects. There were five intrapartum fetal deaths and six neonatal deaths.

There were no deaths among the 80 planned home-delivered breeches, nor among the 13 sets of twins.

When the researchers excluded planned breech deliveries and twins (not considered low-risk), the rate of intrapartum and neonatal death was 1.7/1,000 planned low-risk home births.

About 12% of the mothers were transferred to a hospital either intrapartum or post partum.

Five of every six who went to a hospital did so before delivery: 51% went for failure to progress, pain relief, and/or exhaustion, according to the investigators.

After delivery, 1.3% of mothers and 0.7% of newborns were transferred. The most common reasons mentioned were maternal hemorrhage (0.6% of total births), retained placenta (0.5% of total births), or respiratory problems in the infant (0.5% of total births).

The midwives reportedly considered transfers urgent in 3.4% of cases. Transfers were four times more common among primiparous women (25%) than multiparous women (6%).

Compared with low-risk hospital births, planned home births had a significantly lower rate of induction of labor (9.6% vs. 21%), stimulation of labor (9.2% vs. 18.9%), episiotomy (2.1% vs. 33%), forceps (1% vs. 2.2%), and vacuum extractions (0.6% vs. 5.2%).

The rate of cesarean section for women transferred to a hospital also was lower than the rate among low-risk hospital births (3.7% vs. 18%).

NASHVILLE, TENN. — High school coaches might not have the first-aid knowledge necessary to deal with athletic injuries, Kirk Armstrong reported in a poster at the annual meeting of the American College of Sports Medicine.

“Coaches will be the first to tell you they know about injury prevention, but they really don't possess the knowledge needed to deal with the injuries sustained, and medical personnel aren't available in most high schools,” Mr. Armstrong of Middle Tennessee State University, Murfreesboro, said in an interview.

Mr. Armstrong, a certified athletic trainer, asked 123 high school basketball coaches in Tennessee and Kentucky to complete a modified, 38-question American Red Cross first-aid exam. Most of the coaches (81%) were from Tennessee, and had an average of almost 15 years' experience. The Kentucky coaches had an average of 11 years' experience.

Only a third of the coaches achieved a passing score on the first-aid assessment; almost two-thirds (63%) lacked a current first-aid certification.

“This [number] is extremely low,” Mr. Armstrong told this newspaper, particularly in light of some of his other findings. At most high schools in those states, coaches are the only adult with first-aid knowledge available at either practices or games. Almost no schools had a physician at games or practices, and only 26% of Kentucky and 46% of Tennessee schools had a certified athletic trainer at practices and games.

A certified athletic trainer must have at least a bachelor's degree, hold current first-aid and automatic external defibrillator certification, and receive training in injury management, bandaging, splinting, wound care, and preparing patients for transport, Mr. Armstrong said.

The lack of first-aid skills among coaches is a worry, Mr. Armstrong said, but there's not much to be done about it. Only five states mandate coaches that be certified, although most state athletic associations impose bylaws requiring certification. “But that's not anything that can really be enforced,” he said.

NASHVILLE, TENN. — High school coaches might not have the first-aid knowledge necessary to deal with athletic injuries, Kirk Armstrong reported in a poster at the annual meeting of the American College of Sports Medicine.

“Coaches will be the first to tell you they know about injury prevention, but they really don't possess the knowledge needed to deal with the injuries sustained, and medical personnel aren't available in most high schools,” Mr. Armstrong of Middle Tennessee State University, Murfreesboro, said in an interview.

Mr. Armstrong, a certified athletic trainer, asked 123 high school basketball coaches in Tennessee and Kentucky to complete a modified, 38-question American Red Cross first-aid exam. Most of the coaches (81%) were from Tennessee, and had an average of almost 15 years' experience. The Kentucky coaches had an average of 11 years' experience.

Only a third of the coaches achieved a passing score on the first-aid assessment; almost two-thirds (63%) lacked a current first-aid certification.

“This [number] is extremely low,” Mr. Armstrong told this newspaper, particularly in light of some of his other findings. At most high schools in those states, coaches are the only adult with first-aid knowledge available at either practices or games. Almost no schools had a physician at games or practices, and only 26% of Kentucky and 46% of Tennessee schools had a certified athletic trainer at practices and games.

A certified athletic trainer must have at least a bachelor's degree, hold current first-aid and automatic external defibrillator certification, and receive training in injury management, bandaging, splinting, wound care, and preparing patients for transport, Mr. Armstrong said.

The lack of first-aid skills among coaches is a worry, Mr. Armstrong said, but there's not much to be done about it. Only five states mandate coaches that be certified, although most state athletic associations impose bylaws requiring certification. “But that's not anything that can really be enforced,” he said.

NASHVILLE, TENN. — High school coaches might not have the first-aid knowledge necessary to deal with athletic injuries, Kirk Armstrong reported in a poster at the annual meeting of the American College of Sports Medicine.

“Coaches will be the first to tell you they know about injury prevention, but they really don't possess the knowledge needed to deal with the injuries sustained, and medical personnel aren't available in most high schools,” Mr. Armstrong of Middle Tennessee State University, Murfreesboro, said in an interview.

Mr. Armstrong, a certified athletic trainer, asked 123 high school basketball coaches in Tennessee and Kentucky to complete a modified, 38-question American Red Cross first-aid exam. Most of the coaches (81%) were from Tennessee, and had an average of almost 15 years' experience. The Kentucky coaches had an average of 11 years' experience.

Only a third of the coaches achieved a passing score on the first-aid assessment; almost two-thirds (63%) lacked a current first-aid certification.

“This [number] is extremely low,” Mr. Armstrong told this newspaper, particularly in light of some of his other findings. At most high schools in those states, coaches are the only adult with first-aid knowledge available at either practices or games. Almost no schools had a physician at games or practices, and only 26% of Kentucky and 46% of Tennessee schools had a certified athletic trainer at practices and games.

A certified athletic trainer must have at least a bachelor's degree, hold current first-aid and automatic external defibrillator certification, and receive training in injury management, bandaging, splinting, wound care, and preparing patients for transport, Mr. Armstrong said.

The lack of first-aid skills among coaches is a worry, Mr. Armstrong said, but there's not much to be done about it. Only five states mandate coaches that be certified, although most state athletic associations impose bylaws requiring certification. “But that's not anything that can really be enforced,” he said.