Miriam E. Tucker

Measles cases in the United States have hit an all-time low, the Centers for Disease Control and Prevention reported.

During 2004, just 37 cases of measles were reported to the CDC. This number—the lowest ever reported in 1 year in the United States—represents a 16% drop from the 44 cases reported in 2002, the CDC said (MMWR 2005;54:1229–31).

Nearly half (18) of the 37 cases were children aged 1–4 years, another 7 were aged 5–19 years, 5 were younger than 12 months of age, 5 were 20–34 years old, and 2 were aged 35 years or older.

Three states—Washington, California, and New York—accounted for 49% of the cases, whereas 11 states reported one to three cases each.

Of the 37 cases, 27 (73%) were imported, including 14 in U.S. residents who had acquired measles while traveling abroad, and 13 in foreign nationals who acquired the disease abroad and subsequently traveled to the United States. China was the most frequent country from which measles was imported, accounting for 13 of the cases.

All 14 of the U.S. residents with imported measles cases were vaccine eligible. Of those, nine were not vaccinated, three had unknown vaccination status, and two had received at least one dose of measles vaccine.

Of the 13 non-U.S. residents with imported measles, 10 had not been vaccinated and 3 had unknown vaccination status.

Ten of the cases were indigenous (infected in the United States), of which six were linked to imported cases and four had unknown sources of exposure.

It will be necessary to maintain greater than 90% vaccination coverage in the United States as long as measles is endemic in most countries worldwide, the CDC said.

Measles cases in the United States have hit an all-time low, the Centers for Disease Control and Prevention reported.

During 2004, just 37 cases of measles were reported to the CDC. This number—the lowest ever reported in 1 year in the United States—represents a 16% drop from the 44 cases reported in 2002, the CDC said (MMWR 2005;54:1229–31).

Nearly half (18) of the 37 cases were children aged 1–4 years, another 7 were aged 5–19 years, 5 were younger than 12 months of age, 5 were 20–34 years old, and 2 were aged 35 years or older.

Three states—Washington, California, and New York—accounted for 49% of the cases, whereas 11 states reported one to three cases each.

Of the 37 cases, 27 (73%) were imported, including 14 in U.S. residents who had acquired measles while traveling abroad, and 13 in foreign nationals who acquired the disease abroad and subsequently traveled to the United States. China was the most frequent country from which measles was imported, accounting for 13 of the cases.

All 14 of the U.S. residents with imported measles cases were vaccine eligible. Of those, nine were not vaccinated, three had unknown vaccination status, and two had received at least one dose of measles vaccine.

Of the 13 non-U.S. residents with imported measles, 10 had not been vaccinated and 3 had unknown vaccination status.

Ten of the cases were indigenous (infected in the United States), of which six were linked to imported cases and four had unknown sources of exposure.

It will be necessary to maintain greater than 90% vaccination coverage in the United States as long as measles is endemic in most countries worldwide, the CDC said.

Measles cases in the United States have hit an all-time low, the Centers for Disease Control and Prevention reported.

During 2004, just 37 cases of measles were reported to the CDC. This number—the lowest ever reported in 1 year in the United States—represents a 16% drop from the 44 cases reported in 2002, the CDC said (MMWR 2005;54:1229–31).

Nearly half (18) of the 37 cases were children aged 1–4 years, another 7 were aged 5–19 years, 5 were younger than 12 months of age, 5 were 20–34 years old, and 2 were aged 35 years or older.

Three states—Washington, California, and New York—accounted for 49% of the cases, whereas 11 states reported one to three cases each.

Of the 37 cases, 27 (73%) were imported, including 14 in U.S. residents who had acquired measles while traveling abroad, and 13 in foreign nationals who acquired the disease abroad and subsequently traveled to the United States. China was the most frequent country from which measles was imported, accounting for 13 of the cases.

All 14 of the U.S. residents with imported measles cases were vaccine eligible. Of those, nine were not vaccinated, three had unknown vaccination status, and two had received at least one dose of measles vaccine.

Of the 13 non-U.S. residents with imported measles, 10 had not been vaccinated and 3 had unknown vaccination status.

Ten of the cases were indigenous (infected in the United States), of which six were linked to imported cases and four had unknown sources of exposure.

It will be necessary to maintain greater than 90% vaccination coverage in the United States as long as measles is endemic in most countries worldwide, the CDC said.

Consider congenital rubella syndrome in infants with compatible signs, particularly immigrants from countries without rubella control programs, the Centers for Disease Control and Prevention advised.

In 2004, a 10-week-old infant born to a mother who had emigrated from Côte d'Ivoire was brought to a New Hampshire emergency department with fever, vomiting, irritability, and poor feeding. While hospitalized, the infant—who had been born with a cataract in her left eye—was diagnosed with microcephaly, patent ductus arteriosus, bilateral hearing impairment, hepatosplenomegaly, and failure to thrive (MMWR 2005;54:1160–1).

Congenital rubella syndrome was suspected and confirmed by positive rubella IgM and positive urine and nasopharyngeal cultures. The genetic sequence was found to be that of a wild-type rubella virus similar to one found in Uganda in 2001, the CDC said.

Soon after conception, the mother had come into contact with refugees from one of four transit centers in Cote d'Ivoire where there had been a rubella outbreak during February-April 2004. She had reported no history of symptoms of acute rubella infection such as rash, fever, lymphadenopathy, or arthralgia. However, subclinical infections are estimated to occur in up to 50% of rubella cases.

Consider congenital rubella syndrome in infants with compatible signs, particularly immigrants from countries without rubella control programs, the Centers for Disease Control and Prevention advised.

In 2004, a 10-week-old infant born to a mother who had emigrated from Côte d'Ivoire was brought to a New Hampshire emergency department with fever, vomiting, irritability, and poor feeding. While hospitalized, the infant—who had been born with a cataract in her left eye—was diagnosed with microcephaly, patent ductus arteriosus, bilateral hearing impairment, hepatosplenomegaly, and failure to thrive (MMWR 2005;54:1160–1).

Congenital rubella syndrome was suspected and confirmed by positive rubella IgM and positive urine and nasopharyngeal cultures. The genetic sequence was found to be that of a wild-type rubella virus similar to one found in Uganda in 2001, the CDC said.

Soon after conception, the mother had come into contact with refugees from one of four transit centers in Cote d'Ivoire where there had been a rubella outbreak during February-April 2004. She had reported no history of symptoms of acute rubella infection such as rash, fever, lymphadenopathy, or arthralgia. However, subclinical infections are estimated to occur in up to 50% of rubella cases.

Consider congenital rubella syndrome in infants with compatible signs, particularly immigrants from countries without rubella control programs, the Centers for Disease Control and Prevention advised.

In 2004, a 10-week-old infant born to a mother who had emigrated from Côte d'Ivoire was brought to a New Hampshire emergency department with fever, vomiting, irritability, and poor feeding. While hospitalized, the infant—who had been born with a cataract in her left eye—was diagnosed with microcephaly, patent ductus arteriosus, bilateral hearing impairment, hepatosplenomegaly, and failure to thrive (MMWR 2005;54:1160–1).

Congenital rubella syndrome was suspected and confirmed by positive rubella IgM and positive urine and nasopharyngeal cultures. The genetic sequence was found to be that of a wild-type rubella virus similar to one found in Uganda in 2001, the CDC said.

Soon after conception, the mother had come into contact with refugees from one of four transit centers in Cote d'Ivoire where there had been a rubella outbreak during February-April 2004. She had reported no history of symptoms of acute rubella infection such as rash, fever, lymphadenopathy, or arthralgia. However, subclinical infections are estimated to occur in up to 50% of rubella cases.

The annual incidence of HIV/AIDS among African Americans dropped significantly between 2001 and 2004, the Centers for Disease Control and Prevention reported.

As a result of advances in treatment with highly active antiretroviral therapy, individuals with HIV infection are living longer than before, and progression to AIDS has declined sharply. AIDS surveillance no longer provides an accurate estimate of HIV infection rates, so the CDC now recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infection.

Data from 33 state and local health departments with name-based reporting indicate that the incidence of HIV infection among blacks declined about 5% per year, from 88.7/100,000 in 2001 to 76.3/100,000 in 2004. Nonetheless, the HIV/AIDS rate among blacks in 2004 was still 8.4 times higher than that of whites, the CDC said (MMWR 2005;54:1149-53). An estimated 157,252 individuals were diagnosed with HIV/AIDS in the 33 states during 2001-2004, of whom 71% were male. Blacks accounted for 51% of those diagnosed with HIV/AIDS, whites 29%, Hispanics 18%, and Asian/Pacific Islanders 1%.

Among males, the route of HIV infection was male-to-male contact for 61%, high-risk heterosexual contact in 17%, and injection drug use in 16%. For females, on the other hand, the majority (76%) were exposed through high-risk heterosexual contact and 21% through injection drug use. Among black males, approximately one-fourth of HIV transmission occurred via high-risk heterosexual contact, the CDC noted.

In addition to the statistically significant decline among blacks, there was a significant 9.1% annual drop among injection drug users. Overall, the average annual rate of HIV/AIDS diagnoses dropped insignificantly, from 22.8/100,000 in 2001 to 20.7/100,000 in 2004.

A significant 9% annual increase in HIV/AIDS diagnosis rates occurred among Asian/Pacific Islanders, from 5.6/100,000 in 2001 to 7.2/100,000 in 2004, although this group continues to have the lowest rates of all U.S. racial/ethnic populations.

The 33 states analyzed in the report represent about 63% of all U.S. AIDS cases during 2001-2004. But California is not included, so the estimates may underrepresent the number of cases in the West, according to the CDC.

The annual incidence of HIV/AIDS among African Americans dropped significantly between 2001 and 2004, the Centers for Disease Control and Prevention reported.

As a result of advances in treatment with highly active antiretroviral therapy, individuals with HIV infection are living longer than before, and progression to AIDS has declined sharply. AIDS surveillance no longer provides an accurate estimate of HIV infection rates, so the CDC now recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infection.

Data from 33 state and local health departments with name-based reporting indicate that the incidence of HIV infection among blacks declined about 5% per year, from 88.7/100,000 in 2001 to 76.3/100,000 in 2004. Nonetheless, the HIV/AIDS rate among blacks in 2004 was still 8.4 times higher than that of whites, the CDC said (MMWR 2005;54:1149-53). An estimated 157,252 individuals were diagnosed with HIV/AIDS in the 33 states during 2001-2004, of whom 71% were male. Blacks accounted for 51% of those diagnosed with HIV/AIDS, whites 29%, Hispanics 18%, and Asian/Pacific Islanders 1%.

Among males, the route of HIV infection was male-to-male contact for 61%, high-risk heterosexual contact in 17%, and injection drug use in 16%. For females, on the other hand, the majority (76%) were exposed through high-risk heterosexual contact and 21% through injection drug use. Among black males, approximately one-fourth of HIV transmission occurred via high-risk heterosexual contact, the CDC noted.

In addition to the statistically significant decline among blacks, there was a significant 9.1% annual drop among injection drug users. Overall, the average annual rate of HIV/AIDS diagnoses dropped insignificantly, from 22.8/100,000 in 2001 to 20.7/100,000 in 2004.

A significant 9% annual increase in HIV/AIDS diagnosis rates occurred among Asian/Pacific Islanders, from 5.6/100,000 in 2001 to 7.2/100,000 in 2004, although this group continues to have the lowest rates of all U.S. racial/ethnic populations.

The 33 states analyzed in the report represent about 63% of all U.S. AIDS cases during 2001-2004. But California is not included, so the estimates may underrepresent the number of cases in the West, according to the CDC.

The annual incidence of HIV/AIDS among African Americans dropped significantly between 2001 and 2004, the Centers for Disease Control and Prevention reported.

As a result of advances in treatment with highly active antiretroviral therapy, individuals with HIV infection are living longer than before, and progression to AIDS has declined sharply. AIDS surveillance no longer provides an accurate estimate of HIV infection rates, so the CDC now recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infection.

Data from 33 state and local health departments with name-based reporting indicate that the incidence of HIV infection among blacks declined about 5% per year, from 88.7/100,000 in 2001 to 76.3/100,000 in 2004. Nonetheless, the HIV/AIDS rate among blacks in 2004 was still 8.4 times higher than that of whites, the CDC said (MMWR 2005;54:1149-53). An estimated 157,252 individuals were diagnosed with HIV/AIDS in the 33 states during 2001-2004, of whom 71% were male. Blacks accounted for 51% of those diagnosed with HIV/AIDS, whites 29%, Hispanics 18%, and Asian/Pacific Islanders 1%.

Among males, the route of HIV infection was male-to-male contact for 61%, high-risk heterosexual contact in 17%, and injection drug use in 16%. For females, on the other hand, the majority (76%) were exposed through high-risk heterosexual contact and 21% through injection drug use. Among black males, approximately one-fourth of HIV transmission occurred via high-risk heterosexual contact, the CDC noted.

In addition to the statistically significant decline among blacks, there was a significant 9.1% annual drop among injection drug users. Overall, the average annual rate of HIV/AIDS diagnoses dropped insignificantly, from 22.8/100,000 in 2001 to 20.7/100,000 in 2004.

A significant 9% annual increase in HIV/AIDS diagnosis rates occurred among Asian/Pacific Islanders, from 5.6/100,000 in 2001 to 7.2/100,000 in 2004, although this group continues to have the lowest rates of all U.S. racial/ethnic populations.

The 33 states analyzed in the report represent about 63% of all U.S. AIDS cases during 2001-2004. But California is not included, so the estimates may underrepresent the number of cases in the West, according to the CDC.

WASHINGTON – When a child is sleep deprived, it shows at school.

In a study of 74 healthy 6− to 12-year-old students, experimentally reducing the duration of their sleep at home for 1 week resulted in academic and attention problems significant enough that teachers could detect differences between children who had had enough sleep and those who had not–without being told which ones were which (Sleep 2005;28:1280–6).

The results strongly suggest that information about sleep should be obtained for all children who present with academic difficulty or behavior problems, particularly those with inattentive symptoms, Gahan Fallone, Ph.D., said during a report of his findings at a conference for science reporters sponsored by the American Medical Association.

“As clinicians, we have to ask about sleep in patients who present with these behavior indicators,” said Dr. Fallone of the Forest Institute of Professional Psychology, Springfield, Mo.

Increasing evidence suggests that children and adolescents are not getting as much sleep as they need to function optimally in school. Most of the studies demonstrating a link between lack of sleep and adverse effects on school performance have used either self-reports of sleep duration or laboratory-induced sleep deprivation.

This study attempted to isolate the specific effects of sleep loss by using home-based sleep restriction in healthy, well-functioning children who had no mood or psychiatric diagnoses, including attention-deficit hyperactivity disorder.

In a 3-week period during the school year, children slept on their typical schedule the first week. During week 2, they were randomized to either an optimized sleep condition in which they spent 10 or more hours in bed or to a restricted condition in which children in third grade and above spent 6.5 hours or less in bed while those in first and second grade were allowed no more than 8 hours in bed. In week 3, the children switched sleep conditions.

Several methods were used to ensure compliance, including daily sleep diaries, twice-daily phone calls, and wrist activity monitors. At the end of each week, teachers were asked to rate the children on 34 items that assessed attention problems, academic performance, hyperactive-impulsive behavior, oppositional-aggressive behavior, and mood. The teachers were not told which schedule the students were following.

Significant differences from baseline were seen on the academic problems portion of the questionnaire, which had a scoring range of 2–18. Compared with a baseline score of 6.86, the mean rating during the optimized sleep condition was 7.03; the mean rose to 7.67 for the sleep-restricted condition. On the School Situations Questionnaire, children in the sleep-restricted period had significantly more attention problems and a greater mean severity of attention problems, compared with baseline: From a possible 0–9 range, mean severity was 1.26 during restricted sleep, compared with 0.99 during optimized sleep periods and 0.80 at baseline.

In contrast, there were no significant changes during the 3 weeks in the areas of hyperactive-impulsive behavior, oppositional-aggressive behavior, or mood, said Dr. Fallone, who did this research while working at Brown Medical School, Providence, R.I.

Based on these findings and data from other studies, Dr. Fallone suggested the following advice for parents:

▸ Remove media (such as television and video games) and other distractions from your child's bedroom.

▸ Consider getting your child to bed on time as important as getting him or her to school on time.

▸ Use the average time in bed for the healthy children in this study during the baseline week as a guideline: 10 hours for first and second graders; 9.75 hours for third and fourth graders; and 9.2 hours for fifth through seventh graders.

▸ Eliminate the use of caffeine.

▸ Keep children's bedtimes and wake-up times the same on weekends as they are on school days.

These results suggest that while insufficient sleep may be the core deficit in some children with attention problems, it is not likely to be the core problem when excessive hyperactivity and impulsivity are present. Dr. Fallone and his associates currently are analyzing data from a follow-up study in children aged 12–17 who have attention-deficit hyperactivity disorder. The study's aim is to assess the amount of sleep these children get and the impact of sleep duration on their response to stimulant medication.

Significant increases were seen in academic and attention problems, but not in hyperactivity, aggressiveness, or mood. COURTESY DONNA FRANKI

WASHINGTON – When a child is sleep deprived, it shows at school.

In a study of 74 healthy 6− to 12-year-old students, experimentally reducing the duration of their sleep at home for 1 week resulted in academic and attention problems significant enough that teachers could detect differences between children who had had enough sleep and those who had not–without being told which ones were which (Sleep 2005;28:1280–6).

The results strongly suggest that information about sleep should be obtained for all children who present with academic difficulty or behavior problems, particularly those with inattentive symptoms, Gahan Fallone, Ph.D., said during a report of his findings at a conference for science reporters sponsored by the American Medical Association.

“As clinicians, we have to ask about sleep in patients who present with these behavior indicators,” said Dr. Fallone of the Forest Institute of Professional Psychology, Springfield, Mo.

Increasing evidence suggests that children and adolescents are not getting as much sleep as they need to function optimally in school. Most of the studies demonstrating a link between lack of sleep and adverse effects on school performance have used either self-reports of sleep duration or laboratory-induced sleep deprivation.

This study attempted to isolate the specific effects of sleep loss by using home-based sleep restriction in healthy, well-functioning children who had no mood or psychiatric diagnoses, including attention-deficit hyperactivity disorder.

In a 3-week period during the school year, children slept on their typical schedule the first week. During week 2, they were randomized to either an optimized sleep condition in which they spent 10 or more hours in bed or to a restricted condition in which children in third grade and above spent 6.5 hours or less in bed while those in first and second grade were allowed no more than 8 hours in bed. In week 3, the children switched sleep conditions.

Several methods were used to ensure compliance, including daily sleep diaries, twice-daily phone calls, and wrist activity monitors. At the end of each week, teachers were asked to rate the children on 34 items that assessed attention problems, academic performance, hyperactive-impulsive behavior, oppositional-aggressive behavior, and mood. The teachers were not told which schedule the students were following.

Significant differences from baseline were seen on the academic problems portion of the questionnaire, which had a scoring range of 2–18. Compared with a baseline score of 6.86, the mean rating during the optimized sleep condition was 7.03; the mean rose to 7.67 for the sleep-restricted condition. On the School Situations Questionnaire, children in the sleep-restricted period had significantly more attention problems and a greater mean severity of attention problems, compared with baseline: From a possible 0–9 range, mean severity was 1.26 during restricted sleep, compared with 0.99 during optimized sleep periods and 0.80 at baseline.

In contrast, there were no significant changes during the 3 weeks in the areas of hyperactive-impulsive behavior, oppositional-aggressive behavior, or mood, said Dr. Fallone, who did this research while working at Brown Medical School, Providence, R.I.

Based on these findings and data from other studies, Dr. Fallone suggested the following advice for parents:

▸ Remove media (such as television and video games) and other distractions from your child's bedroom.

▸ Consider getting your child to bed on time as important as getting him or her to school on time.

▸ Use the average time in bed for the healthy children in this study during the baseline week as a guideline: 10 hours for first and second graders; 9.75 hours for third and fourth graders; and 9.2 hours for fifth through seventh graders.

▸ Eliminate the use of caffeine.

▸ Keep children's bedtimes and wake-up times the same on weekends as they are on school days.

These results suggest that while insufficient sleep may be the core deficit in some children with attention problems, it is not likely to be the core problem when excessive hyperactivity and impulsivity are present. Dr. Fallone and his associates currently are analyzing data from a follow-up study in children aged 12–17 who have attention-deficit hyperactivity disorder. The study's aim is to assess the amount of sleep these children get and the impact of sleep duration on their response to stimulant medication.

Significant increases were seen in academic and attention problems, but not in hyperactivity, aggressiveness, or mood. COURTESY DONNA FRANKI

WASHINGTON – When a child is sleep deprived, it shows at school.

In a study of 74 healthy 6− to 12-year-old students, experimentally reducing the duration of their sleep at home for 1 week resulted in academic and attention problems significant enough that teachers could detect differences between children who had had enough sleep and those who had not–without being told which ones were which (Sleep 2005;28:1280–6).

The results strongly suggest that information about sleep should be obtained for all children who present with academic difficulty or behavior problems, particularly those with inattentive symptoms, Gahan Fallone, Ph.D., said during a report of his findings at a conference for science reporters sponsored by the American Medical Association.

“As clinicians, we have to ask about sleep in patients who present with these behavior indicators,” said Dr. Fallone of the Forest Institute of Professional Psychology, Springfield, Mo.

Increasing evidence suggests that children and adolescents are not getting as much sleep as they need to function optimally in school. Most of the studies demonstrating a link between lack of sleep and adverse effects on school performance have used either self-reports of sleep duration or laboratory-induced sleep deprivation.

This study attempted to isolate the specific effects of sleep loss by using home-based sleep restriction in healthy, well-functioning children who had no mood or psychiatric diagnoses, including attention-deficit hyperactivity disorder.

In a 3-week period during the school year, children slept on their typical schedule the first week. During week 2, they were randomized to either an optimized sleep condition in which they spent 10 or more hours in bed or to a restricted condition in which children in third grade and above spent 6.5 hours or less in bed while those in first and second grade were allowed no more than 8 hours in bed. In week 3, the children switched sleep conditions.

Several methods were used to ensure compliance, including daily sleep diaries, twice-daily phone calls, and wrist activity monitors. At the end of each week, teachers were asked to rate the children on 34 items that assessed attention problems, academic performance, hyperactive-impulsive behavior, oppositional-aggressive behavior, and mood. The teachers were not told which schedule the students were following.

Significant differences from baseline were seen on the academic problems portion of the questionnaire, which had a scoring range of 2–18. Compared with a baseline score of 6.86, the mean rating during the optimized sleep condition was 7.03; the mean rose to 7.67 for the sleep-restricted condition. On the School Situations Questionnaire, children in the sleep-restricted period had significantly more attention problems and a greater mean severity of attention problems, compared with baseline: From a possible 0–9 range, mean severity was 1.26 during restricted sleep, compared with 0.99 during optimized sleep periods and 0.80 at baseline.

In contrast, there were no significant changes during the 3 weeks in the areas of hyperactive-impulsive behavior, oppositional-aggressive behavior, or mood, said Dr. Fallone, who did this research while working at Brown Medical School, Providence, R.I.

Based on these findings and data from other studies, Dr. Fallone suggested the following advice for parents:

▸ Remove media (such as television and video games) and other distractions from your child's bedroom.

▸ Consider getting your child to bed on time as important as getting him or her to school on time.

▸ Use the average time in bed for the healthy children in this study during the baseline week as a guideline: 10 hours for first and second graders; 9.75 hours for third and fourth graders; and 9.2 hours for fifth through seventh graders.

▸ Eliminate the use of caffeine.

▸ Keep children's bedtimes and wake-up times the same on weekends as they are on school days.

These results suggest that while insufficient sleep may be the core deficit in some children with attention problems, it is not likely to be the core problem when excessive hyperactivity and impulsivity are present. Dr. Fallone and his associates currently are analyzing data from a follow-up study in children aged 12–17 who have attention-deficit hyperactivity disorder. The study's aim is to assess the amount of sleep these children get and the impact of sleep duration on their response to stimulant medication.

Significant increases were seen in academic and attention problems, but not in hyperactivity, aggressiveness, or mood. COURTESY DONNA FRANKI

The annual incidence of HIV/AIDS among African Americans dropped significantly between 2001 and 2004, the Centers for Disease Control and Prevention reported.

As a result of advances in treatment with highly active antiretroviral therapy, individuals with HIV infection are living longer than before, and progression to AIDS has declined sharply. AIDS surveillance no longer provides an accurate estimate of HIV infection rates, so the CDC now recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infection.

Data from 33 state and local health departments with name-based reporting indicate that the incidence of HIV infection among blacks declined about 5% per year, from 88.7/100,000 in 2001 to 76.3/100,000 in 2004. Nonetheless, the HIV/AIDS rate among blacks in 2004 was still 8.4 times higher than that of whites, the CDC said (MMWR 2005;54:1149-53).

In addition to the statistically significant decline among blacks, there was a significant 9.1% annual drop among injection drug users. Overall, the average annual rate of HIV/AIDS diagnoses dropped insignificantly, from 22.8/100,000 in 2001 to 20.7/100,000 in 2004.

An estimated 157,252 individuals were diagnosed with HIV/AIDS in the 33 states during 2001-2004, of whom 71% were male. Blacks accounted for 51% of those diagnosed with HIV/AIDS, whites 29%, Hispanics 18%, and Asian/Pacific Islanders 1%.

Among males, the route of HIV infection was male-to-male contact for 61%, high-risk heterosexual contact in 17%, and injection drug use in 16%. For females, on the other hand, the majority (76%) were exposed through high-risk heterosexual contact and 21% through injection drug use. Among black males, approximately one-fourth of HIV transmission occurred via high-risk heterosexual contact, the CDC noted.

A significant 9% annual increase in HIV/AIDS diagnosis rates occurred among Asian/Pacific Islanders, from 5.6/100,000 in 2001 to 7.2/100,000 in 2004, although this group continues to have the lowest rates of all U.S. racial/ethnic populations.

The annual incidence of HIV/AIDS among African Americans dropped significantly between 2001 and 2004, the Centers for Disease Control and Prevention reported.

As a result of advances in treatment with highly active antiretroviral therapy, individuals with HIV infection are living longer than before, and progression to AIDS has declined sharply. AIDS surveillance no longer provides an accurate estimate of HIV infection rates, so the CDC now recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infection.

Data from 33 state and local health departments with name-based reporting indicate that the incidence of HIV infection among blacks declined about 5% per year, from 88.7/100,000 in 2001 to 76.3/100,000 in 2004. Nonetheless, the HIV/AIDS rate among blacks in 2004 was still 8.4 times higher than that of whites, the CDC said (MMWR 2005;54:1149-53).

In addition to the statistically significant decline among blacks, there was a significant 9.1% annual drop among injection drug users. Overall, the average annual rate of HIV/AIDS diagnoses dropped insignificantly, from 22.8/100,000 in 2001 to 20.7/100,000 in 2004.

An estimated 157,252 individuals were diagnosed with HIV/AIDS in the 33 states during 2001-2004, of whom 71% were male. Blacks accounted for 51% of those diagnosed with HIV/AIDS, whites 29%, Hispanics 18%, and Asian/Pacific Islanders 1%.

Among males, the route of HIV infection was male-to-male contact for 61%, high-risk heterosexual contact in 17%, and injection drug use in 16%. For females, on the other hand, the majority (76%) were exposed through high-risk heterosexual contact and 21% through injection drug use. Among black males, approximately one-fourth of HIV transmission occurred via high-risk heterosexual contact, the CDC noted.

A significant 9% annual increase in HIV/AIDS diagnosis rates occurred among Asian/Pacific Islanders, from 5.6/100,000 in 2001 to 7.2/100,000 in 2004, although this group continues to have the lowest rates of all U.S. racial/ethnic populations.

The annual incidence of HIV/AIDS among African Americans dropped significantly between 2001 and 2004, the Centers for Disease Control and Prevention reported.

As a result of advances in treatment with highly active antiretroviral therapy, individuals with HIV infection are living longer than before, and progression to AIDS has declined sharply. AIDS surveillance no longer provides an accurate estimate of HIV infection rates, so the CDC now recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infection.

Data from 33 state and local health departments with name-based reporting indicate that the incidence of HIV infection among blacks declined about 5% per year, from 88.7/100,000 in 2001 to 76.3/100,000 in 2004. Nonetheless, the HIV/AIDS rate among blacks in 2004 was still 8.4 times higher than that of whites, the CDC said (MMWR 2005;54:1149-53).

In addition to the statistically significant decline among blacks, there was a significant 9.1% annual drop among injection drug users. Overall, the average annual rate of HIV/AIDS diagnoses dropped insignificantly, from 22.8/100,000 in 2001 to 20.7/100,000 in 2004.

An estimated 157,252 individuals were diagnosed with HIV/AIDS in the 33 states during 2001-2004, of whom 71% were male. Blacks accounted for 51% of those diagnosed with HIV/AIDS, whites 29%, Hispanics 18%, and Asian/Pacific Islanders 1%.

Among males, the route of HIV infection was male-to-male contact for 61%, high-risk heterosexual contact in 17%, and injection drug use in 16%. For females, on the other hand, the majority (76%) were exposed through high-risk heterosexual contact and 21% through injection drug use. Among black males, approximately one-fourth of HIV transmission occurred via high-risk heterosexual contact, the CDC noted.

A significant 9% annual increase in HIV/AIDS diagnosis rates occurred among Asian/Pacific Islanders, from 5.6/100,000 in 2001 to 7.2/100,000 in 2004, although this group continues to have the lowest rates of all U.S. racial/ethnic populations.

WASHINGTON — Implementation of a Medicaid-funded program that would disburse child restraint systems to low-income children and educate families about their use would be more cost effective to Medicaid than are most currently administered vaccines, Jesse A. Goldstein reported at the annual meeting of the American Academy of Pediatrics.

As with all routine vaccines, such a program would be cost-saving to society in terms of parental work loss and future productivity. And, akin to what the federally funded Vaccines for Children accomplishes for vaccination, “this program would reduce the disparities in child passenger safety prevalent in low-income communities by addressing the major barriers to adequate restraint practices—namely, access and education,” said Mr. Goldstein, a fourth-year medical student at the University of Pennsylvania, Philadelphia.

The data come from the Partners for Child Passenger Safety (PCPS), a research collaboration of State Farm Insurance Companies, Children's Hospital of Philadelphia, and the University of Pennsylvania (www.traumalink.chop.edu

It uses telephone interviews, on-site crash investigations, and in-depth analysis in 15 states and the District of Columbia to determine how and why children are injured in crashes.

For the current analysis, a hypothetical group of 100,000 low-income children were enrolled at birth and followed through 8 years of recommended child restraint system (CRS) use. Injury rates were derived from the PCPS database of State Farm policyholders involved in crashes from 1999 to 2003 in which a child aged 8 years or younger was present. Mortality data came from the Fatality Analysis Reporting System, and other data came from published and unpublished sources.

Program costs included administration and education, initial disbursement of convertible seats beginning at birth, reinvestment for booster seats at age 4 years, and a 5% annual replacement rate.

It was assumed that the program would increase appropriate CRS use for low-income children by 23% for 0- to 3-year-olds and by 35% for children aged 4–7 years.

Under these assumptions, implementation of the program would prevent 63 injuries and 2 deaths per 100,000 children. Over the course of 8 years, it would prevent 400 injuries and 17 deaths, resulting in 564 life-years saved, Mr. Goldstein reported.

Without the proposed program, annual crash-related outcome costs were estimated at $4.2 million in medical costs, $350,000 in parental work loss, and $8.3 million in future victim productivity per 100,000 children. Implementation of CRS disbursement and education would reduce annual medical costs by about $1 million, parental work loss costs by $100,000, and future productivity costs by $2.7 million.

Over the 8-year projection, the program would save nearly $7 million in medical costs. At the same time, program administration costs were estimated at $6 million for the first year and $10 million cumulatively.

From the societal perspective (including all medical and nonmedical costs), the program would be cost saving. From Medicaid's perspective—including only medical costs—the program would need to spend $17,000 to save one life-year. “This value is well below the threshold of $50,000-$80,000 that most are willing to pay for an added year of life,” Mr. Goldstein noted.

Indeed, a CRS disbursement/education program falls into the lower-cost end of the list of vaccines currently funded under VFC, well below the cost per life-year saved for varicella vaccine ($19,700 or $65,000, depending on the vaccine price estimate), hepatitis B vaccine ($26,000), and pneumococcal vaccine ($147,000). Only Haemophilus influenzae type B (cost saving to insurer) and measles-mumps rubella ($6,000) were more cost effective.

Several states currently have programs that supply child safety seats among low-income populations using a variety of funding mechanisms, but most do not involve Medicaid.

A legislative proposal in Illinois would increase seatbelt violation fines from the current $25 to $200 in order to provide child safety seats on a sliding-scale fee to low-income families. It also would allow Medicaid to reimburse the time of certified child passenger safety technicians—who already are part of an established state network—at health departments, federally qualified health centers, and other eligible locations to educate families who receive sliding-fee child safety seats.

Details of that proposal are still being worked out, Jahari Piersol, occupant protection coordinator at the Illinois Department of Transportation, told FAMILY PRACTICE NEWS.

WASHINGTON — Implementation of a Medicaid-funded program that would disburse child restraint systems to low-income children and educate families about their use would be more cost effective to Medicaid than are most currently administered vaccines, Jesse A. Goldstein reported at the annual meeting of the American Academy of Pediatrics.

As with all routine vaccines, such a program would be cost-saving to society in terms of parental work loss and future productivity. And, akin to what the federally funded Vaccines for Children accomplishes for vaccination, “this program would reduce the disparities in child passenger safety prevalent in low-income communities by addressing the major barriers to adequate restraint practices—namely, access and education,” said Mr. Goldstein, a fourth-year medical student at the University of Pennsylvania, Philadelphia.

The data come from the Partners for Child Passenger Safety (PCPS), a research collaboration of State Farm Insurance Companies, Children's Hospital of Philadelphia, and the University of Pennsylvania (www.traumalink.chop.edu

It uses telephone interviews, on-site crash investigations, and in-depth analysis in 15 states and the District of Columbia to determine how and why children are injured in crashes.

For the current analysis, a hypothetical group of 100,000 low-income children were enrolled at birth and followed through 8 years of recommended child restraint system (CRS) use. Injury rates were derived from the PCPS database of State Farm policyholders involved in crashes from 1999 to 2003 in which a child aged 8 years or younger was present. Mortality data came from the Fatality Analysis Reporting System, and other data came from published and unpublished sources.

Program costs included administration and education, initial disbursement of convertible seats beginning at birth, reinvestment for booster seats at age 4 years, and a 5% annual replacement rate.

It was assumed that the program would increase appropriate CRS use for low-income children by 23% for 0- to 3-year-olds and by 35% for children aged 4–7 years.

Under these assumptions, implementation of the program would prevent 63 injuries and 2 deaths per 100,000 children. Over the course of 8 years, it would prevent 400 injuries and 17 deaths, resulting in 564 life-years saved, Mr. Goldstein reported.

Without the proposed program, annual crash-related outcome costs were estimated at $4.2 million in medical costs, $350,000 in parental work loss, and $8.3 million in future victim productivity per 100,000 children. Implementation of CRS disbursement and education would reduce annual medical costs by about $1 million, parental work loss costs by $100,000, and future productivity costs by $2.7 million.

Over the 8-year projection, the program would save nearly $7 million in medical costs. At the same time, program administration costs were estimated at $6 million for the first year and $10 million cumulatively.

From the societal perspective (including all medical and nonmedical costs), the program would be cost saving. From Medicaid's perspective—including only medical costs—the program would need to spend $17,000 to save one life-year. “This value is well below the threshold of $50,000-$80,000 that most are willing to pay for an added year of life,” Mr. Goldstein noted.

Indeed, a CRS disbursement/education program falls into the lower-cost end of the list of vaccines currently funded under VFC, well below the cost per life-year saved for varicella vaccine ($19,700 or $65,000, depending on the vaccine price estimate), hepatitis B vaccine ($26,000), and pneumococcal vaccine ($147,000). Only Haemophilus influenzae type B (cost saving to insurer) and measles-mumps rubella ($6,000) were more cost effective.

Several states currently have programs that supply child safety seats among low-income populations using a variety of funding mechanisms, but most do not involve Medicaid.

A legislative proposal in Illinois would increase seatbelt violation fines from the current $25 to $200 in order to provide child safety seats on a sliding-scale fee to low-income families. It also would allow Medicaid to reimburse the time of certified child passenger safety technicians—who already are part of an established state network—at health departments, federally qualified health centers, and other eligible locations to educate families who receive sliding-fee child safety seats.

Details of that proposal are still being worked out, Jahari Piersol, occupant protection coordinator at the Illinois Department of Transportation, told FAMILY PRACTICE NEWS.

WASHINGTON — Implementation of a Medicaid-funded program that would disburse child restraint systems to low-income children and educate families about their use would be more cost effective to Medicaid than are most currently administered vaccines, Jesse A. Goldstein reported at the annual meeting of the American Academy of Pediatrics.

As with all routine vaccines, such a program would be cost-saving to society in terms of parental work loss and future productivity. And, akin to what the federally funded Vaccines for Children accomplishes for vaccination, “this program would reduce the disparities in child passenger safety prevalent in low-income communities by addressing the major barriers to adequate restraint practices—namely, access and education,” said Mr. Goldstein, a fourth-year medical student at the University of Pennsylvania, Philadelphia.

The data come from the Partners for Child Passenger Safety (PCPS), a research collaboration of State Farm Insurance Companies, Children's Hospital of Philadelphia, and the University of Pennsylvania (www.traumalink.chop.edu

It uses telephone interviews, on-site crash investigations, and in-depth analysis in 15 states and the District of Columbia to determine how and why children are injured in crashes.

For the current analysis, a hypothetical group of 100,000 low-income children were enrolled at birth and followed through 8 years of recommended child restraint system (CRS) use. Injury rates were derived from the PCPS database of State Farm policyholders involved in crashes from 1999 to 2003 in which a child aged 8 years or younger was present. Mortality data came from the Fatality Analysis Reporting System, and other data came from published and unpublished sources.

Program costs included administration and education, initial disbursement of convertible seats beginning at birth, reinvestment for booster seats at age 4 years, and a 5% annual replacement rate.

It was assumed that the program would increase appropriate CRS use for low-income children by 23% for 0- to 3-year-olds and by 35% for children aged 4–7 years.

Under these assumptions, implementation of the program would prevent 63 injuries and 2 deaths per 100,000 children. Over the course of 8 years, it would prevent 400 injuries and 17 deaths, resulting in 564 life-years saved, Mr. Goldstein reported.

Without the proposed program, annual crash-related outcome costs were estimated at $4.2 million in medical costs, $350,000 in parental work loss, and $8.3 million in future victim productivity per 100,000 children. Implementation of CRS disbursement and education would reduce annual medical costs by about $1 million, parental work loss costs by $100,000, and future productivity costs by $2.7 million.

Over the 8-year projection, the program would save nearly $7 million in medical costs. At the same time, program administration costs were estimated at $6 million for the first year and $10 million cumulatively.

From the societal perspective (including all medical and nonmedical costs), the program would be cost saving. From Medicaid's perspective—including only medical costs—the program would need to spend $17,000 to save one life-year. “This value is well below the threshold of $50,000-$80,000 that most are willing to pay for an added year of life,” Mr. Goldstein noted.

Indeed, a CRS disbursement/education program falls into the lower-cost end of the list of vaccines currently funded under VFC, well below the cost per life-year saved for varicella vaccine ($19,700 or $65,000, depending on the vaccine price estimate), hepatitis B vaccine ($26,000), and pneumococcal vaccine ($147,000). Only Haemophilus influenzae type B (cost saving to insurer) and measles-mumps rubella ($6,000) were more cost effective.

Several states currently have programs that supply child safety seats among low-income populations using a variety of funding mechanisms, but most do not involve Medicaid.

A legislative proposal in Illinois would increase seatbelt violation fines from the current $25 to $200 in order to provide child safety seats on a sliding-scale fee to low-income families. It also would allow Medicaid to reimburse the time of certified child passenger safety technicians—who already are part of an established state network—at health departments, federally qualified health centers, and other eligible locations to educate families who receive sliding-fee child safety seats.

Details of that proposal are still being worked out, Jahari Piersol, occupant protection coordinator at the Illinois Department of Transportation, told FAMILY PRACTICE NEWS.

Finally, there's some good diabetes news: The incidence of end-stage renal disease in people with the condition dropped between 1997 and 2002, the Centers for Disease Control and Prevention reported.

Data for 1990–2002 obtained from the National Health Interview Survey and the United States Renal Data System reveal trends that vary by age, gender, race/ethnicity, and the time period evaluated during the total 12 years. Although the number of new cases of end-stage renal disease (ESRD) attributed to diabetes mellitus (ESRD-DM) increased overall, the incidence did not increase among blacks, Hispanics, men, and individuals aged 65–74 years and it declined among diabetics aged younger than 65 years, women, and whites (MMWR 2005:54;1097–100).

The age-adjusted incidence of ESRD-DM increased from 247 per 100,000 diabetic individuals in 1990 to 305 in 1996, but declined after that from 293/100,000 in 1997 to 232 in 2002. The magnitude of this decline varied by age group: During 1997–2002, incidence decreased for those aged younger than 65 years, by 28% for those aged younger than 45 years, and by 19% for those aged 45–64 years. Incidence increased by 10% for those aged 75 and older.

During 1990–2002, the age-adjusted incidence was greater among men than women and higher among blacks than whites. During the latter 6 years, the rate decreased among women and among whites, but not among men or blacks.

Reasons for the improvements might include a reduction in the prevalence of cardiovascular disease risks, improved diabetes care practices, or new pharmacologic agents developed to reduce the prevalence of kidney disease risks, according to the CDC.

Finally, there's some good diabetes news: The incidence of end-stage renal disease in people with the condition dropped between 1997 and 2002, the Centers for Disease Control and Prevention reported.

Data for 1990–2002 obtained from the National Health Interview Survey and the United States Renal Data System reveal trends that vary by age, gender, race/ethnicity, and the time period evaluated during the total 12 years. Although the number of new cases of end-stage renal disease (ESRD) attributed to diabetes mellitus (ESRD-DM) increased overall, the incidence did not increase among blacks, Hispanics, men, and individuals aged 65–74 years and it declined among diabetics aged younger than 65 years, women, and whites (MMWR 2005:54;1097–100).

The age-adjusted incidence of ESRD-DM increased from 247 per 100,000 diabetic individuals in 1990 to 305 in 1996, but declined after that from 293/100,000 in 1997 to 232 in 2002. The magnitude of this decline varied by age group: During 1997–2002, incidence decreased for those aged younger than 65 years, by 28% for those aged younger than 45 years, and by 19% for those aged 45–64 years. Incidence increased by 10% for those aged 75 and older.

During 1990–2002, the age-adjusted incidence was greater among men than women and higher among blacks than whites. During the latter 6 years, the rate decreased among women and among whites, but not among men or blacks.

Reasons for the improvements might include a reduction in the prevalence of cardiovascular disease risks, improved diabetes care practices, or new pharmacologic agents developed to reduce the prevalence of kidney disease risks, according to the CDC.

Finally, there's some good diabetes news: The incidence of end-stage renal disease in people with the condition dropped between 1997 and 2002, the Centers for Disease Control and Prevention reported.

Data for 1990–2002 obtained from the National Health Interview Survey and the United States Renal Data System reveal trends that vary by age, gender, race/ethnicity, and the time period evaluated during the total 12 years. Although the number of new cases of end-stage renal disease (ESRD) attributed to diabetes mellitus (ESRD-DM) increased overall, the incidence did not increase among blacks, Hispanics, men, and individuals aged 65–74 years and it declined among diabetics aged younger than 65 years, women, and whites (MMWR 2005:54;1097–100).

The age-adjusted incidence of ESRD-DM increased from 247 per 100,000 diabetic individuals in 1990 to 305 in 1996, but declined after that from 293/100,000 in 1997 to 232 in 2002. The magnitude of this decline varied by age group: During 1997–2002, incidence decreased for those aged younger than 65 years, by 28% for those aged younger than 45 years, and by 19% for those aged 45–64 years. Incidence increased by 10% for those aged 75 and older.

During 1990–2002, the age-adjusted incidence was greater among men than women and higher among blacks than whites. During the latter 6 years, the rate decreased among women and among whites, but not among men or blacks.

Reasons for the improvements might include a reduction in the prevalence of cardiovascular disease risks, improved diabetes care practices, or new pharmacologic agents developed to reduce the prevalence of kidney disease risks, according to the CDC.

SAN DIEGO — Real-world weight changes that occur in diabetic patients with initiation of glucose-lowering drugs generally mirror what is seen in carefully controlled clinical trials, Gregory A. Nichols, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

Chart reviews of 12,521 new diabetes drug initiations among 9,546 diabetic enrollees in Kaiser Permanente Northwest revealed that patients typically gained about 2 pounds within a year of starting a sulfonylurea, 9 pounds after initiation of insulin, and 11 pounds with thiazolidinedione therapy. With metformin, on the other hand, patients lost about 5 pounds. Differences between all the groups were statistically significant.

“We make no value judgments about the drugs or their weight effects. Tight control, however achieved, is undoubtedly more important than any of the weight changes we observed,” said Dr. Nichols, of Kaiser Permanente's Center for Health Research, Portland, Ore.

Age, sex, hemoglobin A_1c, history of peripheral artery disease, use of selective serotonin reuptake inhibitors, and whether the agent was the first diabetes drug the patient had been treated with were all significant predictors of weight change. However, adjusting for those and other demographic and clinical characteristics made little difference in the results, he noted.

Although metformin has been increasingly used as first-line glucose-lowering therapy, sulfonylureas were still the most common first-line treatment (54%) among the 1,549 who were subsequently started on a second diabetes drug. Weight changes with the addition of the second agent in this subgroup followed similar patterns. For example, the 833 in whom metformin was added to sulfonylurea first gained 6.4 pounds, then lost 5.6 pounds. At the other extreme, the 26 in whom thiazolidinediones were added to insulin gained 14.7 pounds, then gained 11.2 more.

SAN DIEGO — Real-world weight changes that occur in diabetic patients with initiation of glucose-lowering drugs generally mirror what is seen in carefully controlled clinical trials, Gregory A. Nichols, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

Chart reviews of 12,521 new diabetes drug initiations among 9,546 diabetic enrollees in Kaiser Permanente Northwest revealed that patients typically gained about 2 pounds within a year of starting a sulfonylurea, 9 pounds after initiation of insulin, and 11 pounds with thiazolidinedione therapy. With metformin, on the other hand, patients lost about 5 pounds. Differences between all the groups were statistically significant.

“We make no value judgments about the drugs or their weight effects. Tight control, however achieved, is undoubtedly more important than any of the weight changes we observed,” said Dr. Nichols, of Kaiser Permanente's Center for Health Research, Portland, Ore.

Age, sex, hemoglobin A_1c, history of peripheral artery disease, use of selective serotonin reuptake inhibitors, and whether the agent was the first diabetes drug the patient had been treated with were all significant predictors of weight change. However, adjusting for those and other demographic and clinical characteristics made little difference in the results, he noted.

Although metformin has been increasingly used as first-line glucose-lowering therapy, sulfonylureas were still the most common first-line treatment (54%) among the 1,549 who were subsequently started on a second diabetes drug. Weight changes with the addition of the second agent in this subgroup followed similar patterns. For example, the 833 in whom metformin was added to sulfonylurea first gained 6.4 pounds, then lost 5.6 pounds. At the other extreme, the 26 in whom thiazolidinediones were added to insulin gained 14.7 pounds, then gained 11.2 more.

SAN DIEGO — Real-world weight changes that occur in diabetic patients with initiation of glucose-lowering drugs generally mirror what is seen in carefully controlled clinical trials, Gregory A. Nichols, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

Chart reviews of 12,521 new diabetes drug initiations among 9,546 diabetic enrollees in Kaiser Permanente Northwest revealed that patients typically gained about 2 pounds within a year of starting a sulfonylurea, 9 pounds after initiation of insulin, and 11 pounds with thiazolidinedione therapy. With metformin, on the other hand, patients lost about 5 pounds. Differences between all the groups were statistically significant.

“We make no value judgments about the drugs or their weight effects. Tight control, however achieved, is undoubtedly more important than any of the weight changes we observed,” said Dr. Nichols, of Kaiser Permanente's Center for Health Research, Portland, Ore.

Age, sex, hemoglobin A_1c, history of peripheral artery disease, use of selective serotonin reuptake inhibitors, and whether the agent was the first diabetes drug the patient had been treated with were all significant predictors of weight change. However, adjusting for those and other demographic and clinical characteristics made little difference in the results, he noted.

Although metformin has been increasingly used as first-line glucose-lowering therapy, sulfonylureas were still the most common first-line treatment (54%) among the 1,549 who were subsequently started on a second diabetes drug. Weight changes with the addition of the second agent in this subgroup followed similar patterns. For example, the 833 in whom metformin was added to sulfonylurea first gained 6.4 pounds, then lost 5.6 pounds. At the other extreme, the 26 in whom thiazolidinediones were added to insulin gained 14.7 pounds, then gained 11.2 more.

About 4.4 million children aged 4–17 years in the United States had been diagnosed with attention-deficit hyperactivity disorder in 2003, and more than half were taking medication for it, the Centers for Disease Control and Prevention reported.

The data come from surveys completed by 68% of parents and/or guardians of 102,353 children in the National Survey of Children's Health. Extrapolated out to the entire U.S. population, that number comprises 4,418,000 4- to 17-year-old children, the CDC reported (MMWR 2005;54:842–7).

The diagnosis was reported about 2.5 times more frequently among boys (11%) than girls (4.4%), and the prevalence increased with age, from 4.1% among 4- to 8-year-olds to 9.7% in those aged 9–17 years.

Reported ADHD diagnoses were higher among non-Hispanic, primarily English-speaking, and insured children, as well as in families in which the most highly educated adult was a high school graduate (8.6%), compared with those with more education (7.6%) or less education (6.5%).

A total of 4.3% of children in 2003 were taking medication for ADHD, comprising 56.3% of those with reported ADHD. Children aged 9–12 years had the highest rates (6.2%), followed by 13- to 17-year-old patients (4.6%). The youngest children (aged 4–8 years) were the least likely to be taking medication (2.6%).nGeographic variation in medication treatment for ADHD ranged from a low of 2.1% in California to a high of 6.5% in Arkansas, according to the CDC.

About 4.4 million children aged 4–17 years in the United States had been diagnosed with attention-deficit hyperactivity disorder in 2003, and more than half were taking medication for it, the Centers for Disease Control and Prevention reported.

The data come from surveys completed by 68% of parents and/or guardians of 102,353 children in the National Survey of Children's Health. Extrapolated out to the entire U.S. population, that number comprises 4,418,000 4- to 17-year-old children, the CDC reported (MMWR 2005;54:842–7).

The diagnosis was reported about 2.5 times more frequently among boys (11%) than girls (4.4%), and the prevalence increased with age, from 4.1% among 4- to 8-year-olds to 9.7% in those aged 9–17 years.

Reported ADHD diagnoses were higher among non-Hispanic, primarily English-speaking, and insured children, as well as in families in which the most highly educated adult was a high school graduate (8.6%), compared with those with more education (7.6%) or less education (6.5%).

A total of 4.3% of children in 2003 were taking medication for ADHD, comprising 56.3% of those with reported ADHD. Children aged 9–12 years had the highest rates (6.2%), followed by 13- to 17-year-old patients (4.6%). The youngest children (aged 4–8 years) were the least likely to be taking medication (2.6%).nGeographic variation in medication treatment for ADHD ranged from a low of 2.1% in California to a high of 6.5% in Arkansas, according to the CDC.

About 4.4 million children aged 4–17 years in the United States had been diagnosed with attention-deficit hyperactivity disorder in 2003, and more than half were taking medication for it, the Centers for Disease Control and Prevention reported.

The data come from surveys completed by 68% of parents and/or guardians of 102,353 children in the National Survey of Children's Health. Extrapolated out to the entire U.S. population, that number comprises 4,418,000 4- to 17-year-old children, the CDC reported (MMWR 2005;54:842–7).

The diagnosis was reported about 2.5 times more frequently among boys (11%) than girls (4.4%), and the prevalence increased with age, from 4.1% among 4- to 8-year-olds to 9.7% in those aged 9–17 years.

Reported ADHD diagnoses were higher among non-Hispanic, primarily English-speaking, and insured children, as well as in families in which the most highly educated adult was a high school graduate (8.6%), compared with those with more education (7.6%) or less education (6.5%).

A total of 4.3% of children in 2003 were taking medication for ADHD, comprising 56.3% of those with reported ADHD. Children aged 9–12 years had the highest rates (6.2%), followed by 13- to 17-year-old patients (4.6%). The youngest children (aged 4–8 years) were the least likely to be taking medication (2.6%).nGeographic variation in medication treatment for ADHD ranged from a low of 2.1% in California to a high of 6.5% in Arkansas, according to the CDC.

Emergency department data demonstrate that preschool children are the first to come down with influenza each year and could play an important role in the infection's spread, according to John S. Brownstein, Ph.D., of Children's Hospital Boston, and his associates.

Data collected from four emergency departments and one ambulatory care setting in Massachusetts during 2000–2004 suggest that children aged 3–4 years are consistently the first to seek care for respiratory illness during each influenza season, and that the temporal pattern of illness in that group strongly predicts mortality due to influenza and pneumonia among people of all ages.

The results bolster arguments in favor of universal vaccination of all preschool-aged children in addition to the 6- to 23-month-olds for whom the vaccine is currently recommended, the investigators said (Am. J. Epidemiol. 2005;162:686–93).

Among patients presenting to the different health care settings—including one pediatric emergency department, one adult emergency department, and two that treat both adults and children—children aged 3–4 years presented earliest in the influenza season, with a mean lead time of 34 days prior to the peak in overall mortality.

Children of that age group presenting to pediatric emergency departments had the longest lead time of all, with a mean of 50 days. In contrast, adults aged 18 years and older in the ambulatory care and emergency department settings had a mean lead time of just 12 days.

Prediction of influenza and pneumonia mortality varied by age. Children younger than 3 years were the best predictors, explaining 41% of the deviance, while those aged 3–4 years explained 37%, Dr. Brownstein and his associates reported.

“Although this finding does not necessarily prove that preschool-aged children are driving the yearly influenza epidemics, they intriguingly suggest that preschool-aged children are the initial group infected and may be important in the subsequent spread,” Dr. Brown and his associates wrote.

These and other data point to the idea that targeting yearly influenza vaccination to younger children may benefit the entire community.

The idea is currently under consideration by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

Emergency department data demonstrate that preschool children are the first to come down with influenza each year and could play an important role in the infection's spread, according to John S. Brownstein, Ph.D., of Children's Hospital Boston, and his associates.

Data collected from four emergency departments and one ambulatory care setting in Massachusetts during 2000–2004 suggest that children aged 3–4 years are consistently the first to seek care for respiratory illness during each influenza season, and that the temporal pattern of illness in that group strongly predicts mortality due to influenza and pneumonia among people of all ages.

The results bolster arguments in favor of universal vaccination of all preschool-aged children in addition to the 6- to 23-month-olds for whom the vaccine is currently recommended, the investigators said (Am. J. Epidemiol. 2005;162:686–93).

Among patients presenting to the different health care settings—including one pediatric emergency department, one adult emergency department, and two that treat both adults and children—children aged 3–4 years presented earliest in the influenza season, with a mean lead time of 34 days prior to the peak in overall mortality.

Children of that age group presenting to pediatric emergency departments had the longest lead time of all, with a mean of 50 days. In contrast, adults aged 18 years and older in the ambulatory care and emergency department settings had a mean lead time of just 12 days.

Prediction of influenza and pneumonia mortality varied by age. Children younger than 3 years were the best predictors, explaining 41% of the deviance, while those aged 3–4 years explained 37%, Dr. Brownstein and his associates reported.

“Although this finding does not necessarily prove that preschool-aged children are driving the yearly influenza epidemics, they intriguingly suggest that preschool-aged children are the initial group infected and may be important in the subsequent spread,” Dr. Brown and his associates wrote.

These and other data point to the idea that targeting yearly influenza vaccination to younger children may benefit the entire community.

The idea is currently under consideration by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

Emergency department data demonstrate that preschool children are the first to come down with influenza each year and could play an important role in the infection's spread, according to John S. Brownstein, Ph.D., of Children's Hospital Boston, and his associates.

Data collected from four emergency departments and one ambulatory care setting in Massachusetts during 2000–2004 suggest that children aged 3–4 years are consistently the first to seek care for respiratory illness during each influenza season, and that the temporal pattern of illness in that group strongly predicts mortality due to influenza and pneumonia among people of all ages.

The results bolster arguments in favor of universal vaccination of all preschool-aged children in addition to the 6- to 23-month-olds for whom the vaccine is currently recommended, the investigators said (Am. J. Epidemiol. 2005;162:686–93).

Among patients presenting to the different health care settings—including one pediatric emergency department, one adult emergency department, and two that treat both adults and children—children aged 3–4 years presented earliest in the influenza season, with a mean lead time of 34 days prior to the peak in overall mortality.

Children of that age group presenting to pediatric emergency departments had the longest lead time of all, with a mean of 50 days. In contrast, adults aged 18 years and older in the ambulatory care and emergency department settings had a mean lead time of just 12 days.

Prediction of influenza and pneumonia mortality varied by age. Children younger than 3 years were the best predictors, explaining 41% of the deviance, while those aged 3–4 years explained 37%, Dr. Brownstein and his associates reported.

“Although this finding does not necessarily prove that preschool-aged children are driving the yearly influenza epidemics, they intriguingly suggest that preschool-aged children are the initial group infected and may be important in the subsequent spread,” Dr. Brown and his associates wrote.

These and other data point to the idea that targeting yearly influenza vaccination to younger children may benefit the entire community.

The idea is currently under consideration by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.