Miriam E. Tucker

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention recently reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project. Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%-1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four cases were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005:54;380-3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents, and of bleeding associated with anticoagulants such as warfarin and heparin.

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention recently reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project. Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%-1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four cases were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005:54;380-3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents, and of bleeding associated with anticoagulants such as warfarin and heparin.

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention recently reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project. Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%-1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four cases were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005:54;380-3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents, and of bleeding associated with anticoagulants such as warfarin and heparin.

WASHINGTON — Physicians should routinely inform women of childbearing age about the availability of emergency contraception before the need arises, James Trussell, Ph.D., said at a conference on contraceptive technology sponsored by Contemporary Forums.

In fact, he recommends prescribing or dispensing the pills in advance to make the option immediately available if necessary.

Nearly half of all pregnancies in the United States, or about 3 million per year, are unintended. If emergency contraception were widely available and widely used, that number could be cut in half and result in 0.7 million fewer abortions and 22,000 fewer pregnancies due to rape, said Dr. Trussell, professor of economics and public affairs and director of the Office of Population Research at Princeton University, N.J.

“That's the potential, but we're nowhere near realizing that potential,” he said.

Indeed, according to Dr. Trussell's estimates based on a national study, there were just 2 million sales of Plan B to pharmacies and family planning programs last year, but there were 75 million cycles per year in which unprotected intercourse occurred among women at risk of an unintended pregnancy.

In 1997, the Food and Drug Administration declared six brands of regular oral contraceptives safe and effective for use as emergency contraception. That number now is up to 19, although Plan B (two 0.75-mg levonorgestrel tablets taken 12 hours apart within 72 hours of unprotected intercourse) currently is the only product approved and licensed in the United States for that purpose. (Preven was licensed in 1998 but Barr Laboratories, which also owns Plan B, removed it from the U.S. market in 2004.)

In a 2003 survey by the Kaiser Family Foundation, 80% of ob.gyns. and 36% of generalists (including internists, family physicians, and general practitioners) said they had prescribed emergency contraceptives in the past year. Among those who reported prescribing them, 25% of ob.gyns. and 14% of generalists reported routinely discussing emergency contraception with their patients.

Meanwhile, Kaiser's 2003 survey of women aged 18ndash;44 found 68% had heard of emergency contraception or the “morning after pill,” but only 6% had used it.

“Clinicians are waiting for women to ask for emergency contraception, but women do not know to ask,” he said.

In an effort to increase access to emergency contraception, the Office of Population Research at Princeton, along with the Association of Reproductive Health Professionals, has started a hotline, 1-888-NOT-2-LATE, and a Web site, www.not-2-late

Six states (Wash., Calif., Ala., Maine, N.M., and Hawaii) allow customers to obtain emergency contraception from a pharmacist without a prescription. The Food and Drug Administration has yet to rule on Barr Laboratories' application to make Plan B available over the counter for women aged 16 and older.

But, even if access to emergency contraception were improved, some point to the need for more education. That's why the Princeton group has begun a public education campaign to promote the 1-888-NOT-2-LATE number. The campaign is funded by a grant from the William and Flora Hewlett Foundation and receives no money from contraceptive manufacturers or distributors.

In other countries, marketing efforts are a lot bolder with TV commercials in Norway and Sweden and print hotline ads in London—all depicting humorous condom-breaking scenarios. “It's hard to imagine an American pharmaceutical company using humor to advertise contraception,” Dr. Trussell said.

WASHINGTON — Physicians should routinely inform women of childbearing age about the availability of emergency contraception before the need arises, James Trussell, Ph.D., said at a conference on contraceptive technology sponsored by Contemporary Forums.

In fact, he recommends prescribing or dispensing the pills in advance to make the option immediately available if necessary.

Nearly half of all pregnancies in the United States, or about 3 million per year, are unintended. If emergency contraception were widely available and widely used, that number could be cut in half and result in 0.7 million fewer abortions and 22,000 fewer pregnancies due to rape, said Dr. Trussell, professor of economics and public affairs and director of the Office of Population Research at Princeton University, N.J.

“That's the potential, but we're nowhere near realizing that potential,” he said.

Indeed, according to Dr. Trussell's estimates based on a national study, there were just 2 million sales of Plan B to pharmacies and family planning programs last year, but there were 75 million cycles per year in which unprotected intercourse occurred among women at risk of an unintended pregnancy.

In 1997, the Food and Drug Administration declared six brands of regular oral contraceptives safe and effective for use as emergency contraception. That number now is up to 19, although Plan B (two 0.75-mg levonorgestrel tablets taken 12 hours apart within 72 hours of unprotected intercourse) currently is the only product approved and licensed in the United States for that purpose. (Preven was licensed in 1998 but Barr Laboratories, which also owns Plan B, removed it from the U.S. market in 2004.)

In a 2003 survey by the Kaiser Family Foundation, 80% of ob.gyns. and 36% of generalists (including internists, family physicians, and general practitioners) said they had prescribed emergency contraceptives in the past year. Among those who reported prescribing them, 25% of ob.gyns. and 14% of generalists reported routinely discussing emergency contraception with their patients.

Meanwhile, Kaiser's 2003 survey of women aged 18ndash;44 found 68% had heard of emergency contraception or the “morning after pill,” but only 6% had used it.

“Clinicians are waiting for women to ask for emergency contraception, but women do not know to ask,” he said.

In an effort to increase access to emergency contraception, the Office of Population Research at Princeton, along with the Association of Reproductive Health Professionals, has started a hotline, 1-888-NOT-2-LATE, and a Web site, www.not-2-late

Six states (Wash., Calif., Ala., Maine, N.M., and Hawaii) allow customers to obtain emergency contraception from a pharmacist without a prescription. The Food and Drug Administration has yet to rule on Barr Laboratories' application to make Plan B available over the counter for women aged 16 and older.

But, even if access to emergency contraception were improved, some point to the need for more education. That's why the Princeton group has begun a public education campaign to promote the 1-888-NOT-2-LATE number. The campaign is funded by a grant from the William and Flora Hewlett Foundation and receives no money from contraceptive manufacturers or distributors.

In other countries, marketing efforts are a lot bolder with TV commercials in Norway and Sweden and print hotline ads in London—all depicting humorous condom-breaking scenarios. “It's hard to imagine an American pharmaceutical company using humor to advertise contraception,” Dr. Trussell said.

WASHINGTON — Physicians should routinely inform women of childbearing age about the availability of emergency contraception before the need arises, James Trussell, Ph.D., said at a conference on contraceptive technology sponsored by Contemporary Forums.

In fact, he recommends prescribing or dispensing the pills in advance to make the option immediately available if necessary.

Nearly half of all pregnancies in the United States, or about 3 million per year, are unintended. If emergency contraception were widely available and widely used, that number could be cut in half and result in 0.7 million fewer abortions and 22,000 fewer pregnancies due to rape, said Dr. Trussell, professor of economics and public affairs and director of the Office of Population Research at Princeton University, N.J.

“That's the potential, but we're nowhere near realizing that potential,” he said.

Indeed, according to Dr. Trussell's estimates based on a national study, there were just 2 million sales of Plan B to pharmacies and family planning programs last year, but there were 75 million cycles per year in which unprotected intercourse occurred among women at risk of an unintended pregnancy.

In 1997, the Food and Drug Administration declared six brands of regular oral contraceptives safe and effective for use as emergency contraception. That number now is up to 19, although Plan B (two 0.75-mg levonorgestrel tablets taken 12 hours apart within 72 hours of unprotected intercourse) currently is the only product approved and licensed in the United States for that purpose. (Preven was licensed in 1998 but Barr Laboratories, which also owns Plan B, removed it from the U.S. market in 2004.)

In a 2003 survey by the Kaiser Family Foundation, 80% of ob.gyns. and 36% of generalists (including internists, family physicians, and general practitioners) said they had prescribed emergency contraceptives in the past year. Among those who reported prescribing them, 25% of ob.gyns. and 14% of generalists reported routinely discussing emergency contraception with their patients.

Meanwhile, Kaiser's 2003 survey of women aged 18ndash;44 found 68% had heard of emergency contraception or the “morning after pill,” but only 6% had used it.

“Clinicians are waiting for women to ask for emergency contraception, but women do not know to ask,” he said.

In an effort to increase access to emergency contraception, the Office of Population Research at Princeton, along with the Association of Reproductive Health Professionals, has started a hotline, 1-888-NOT-2-LATE, and a Web site, www.not-2-late

Six states (Wash., Calif., Ala., Maine, N.M., and Hawaii) allow customers to obtain emergency contraception from a pharmacist without a prescription. The Food and Drug Administration has yet to rule on Barr Laboratories' application to make Plan B available over the counter for women aged 16 and older.

But, even if access to emergency contraception were improved, some point to the need for more education. That's why the Princeton group has begun a public education campaign to promote the 1-888-NOT-2-LATE number. The campaign is funded by a grant from the William and Flora Hewlett Foundation and receives no money from contraceptive manufacturers or distributors.

In other countries, marketing efforts are a lot bolder with TV commercials in Norway and Sweden and print hotline ads in London—all depicting humorous condom-breaking scenarios. “It's hard to imagine an American pharmaceutical company using humor to advertise contraception,” Dr. Trussell said.

Immunization rates for hepatitis A in children aged 24–35 months vary widely across areas and populations in the United States, the Centers for Disease Control and Prevention said.

In 1999, the CDC recommended routine immunization against hepatitis A for children residing in 11 states in which the average annual incidence during 1987–1997 was at least 20 per 100,000 population, or twice the national average. Those states are Alaska, Arizona, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah, and Washington. They also advised that hepatitis A vaccination be considered in another six states (Arkansas, Colorado, Missouri, Montana, Texas, and Wyoming) where the average incidence was 10–20/100,000 population (MMWR 2005;54:141–5).

Data were collected from provider immunization records for 13,731 children during 2003. In the 11 states in which routine vaccination is recommended, the proportion of children aged 24–35 months who had received at least one dose of vaccine varied from a low of 6.4% (South Dakota) to a high of 72.7% (Alaska).

In the six states where hepatitis A vaccination should be considered, 25.0% of children aged 24–35 months had been vaccinated, compared with just 1.4% in the other 33 states with no recommendation. The wide variation in coverage is likely due to targeted programs. For example, vaccination requirements in Texas border counties for all children attending day care programs probably account for the higher coverage in El Paso County (71%), compared with the rest of the state, the CDC said.

Immunization rates for hepatitis A in children aged 24–35 months vary widely across areas and populations in the United States, the Centers for Disease Control and Prevention said.

In 1999, the CDC recommended routine immunization against hepatitis A for children residing in 11 states in which the average annual incidence during 1987–1997 was at least 20 per 100,000 population, or twice the national average. Those states are Alaska, Arizona, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah, and Washington. They also advised that hepatitis A vaccination be considered in another six states (Arkansas, Colorado, Missouri, Montana, Texas, and Wyoming) where the average incidence was 10–20/100,000 population (MMWR 2005;54:141–5).

Data were collected from provider immunization records for 13,731 children during 2003. In the 11 states in which routine vaccination is recommended, the proportion of children aged 24–35 months who had received at least one dose of vaccine varied from a low of 6.4% (South Dakota) to a high of 72.7% (Alaska).

In the six states where hepatitis A vaccination should be considered, 25.0% of children aged 24–35 months had been vaccinated, compared with just 1.4% in the other 33 states with no recommendation. The wide variation in coverage is likely due to targeted programs. For example, vaccination requirements in Texas border counties for all children attending day care programs probably account for the higher coverage in El Paso County (71%), compared with the rest of the state, the CDC said.

Immunization rates for hepatitis A in children aged 24–35 months vary widely across areas and populations in the United States, the Centers for Disease Control and Prevention said.

In 1999, the CDC recommended routine immunization against hepatitis A for children residing in 11 states in which the average annual incidence during 1987–1997 was at least 20 per 100,000 population, or twice the national average. Those states are Alaska, Arizona, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah, and Washington. They also advised that hepatitis A vaccination be considered in another six states (Arkansas, Colorado, Missouri, Montana, Texas, and Wyoming) where the average incidence was 10–20/100,000 population (MMWR 2005;54:141–5).

Data were collected from provider immunization records for 13,731 children during 2003. In the 11 states in which routine vaccination is recommended, the proportion of children aged 24–35 months who had received at least one dose of vaccine varied from a low of 6.4% (South Dakota) to a high of 72.7% (Alaska).

In the six states where hepatitis A vaccination should be considered, 25.0% of children aged 24–35 months had been vaccinated, compared with just 1.4% in the other 33 states with no recommendation. The wide variation in coverage is likely due to targeted programs. For example, vaccination requirements in Texas border counties for all children attending day care programs probably account for the higher coverage in El Paso County (71%), compared with the rest of the state, the CDC said.

Varicella is still around despite the vaccine—and in some cases it can still be fatal, according to the Centers for Disease Control and Prevention.

Varicella vaccination is more than 95% effective against severe disease, and, since 1996, has been recommended for routine administration to children aged 12–18 months and to all susceptible persons aged 13 years and older. For children aged 19–35 months, national estimates of varicella vaccine coverage increased from 26% in 1997 to 85% in 2003, resulting in substantial reductions in varicella morbidity and mortality.

In two Varicella Active Surveillance Project sites—Antelope Valley, Calif., and West Philadelphia, Pa.—the number of reported cases dropped by approximately 85% during 1995–2003, and hospitalizations by about 70%.

Yet, cases are still occurring among both vaccinated and unvaccinated individuals, as are a small number of varicella-related deaths among those not vaccinated or whose vaccination status is unknown, the CDC said in two separate reports (MMWR 2005;54:272–6).

During 2003 and the first half of 2004, the CDC received reports of eight varicella-related deaths, of whom six were unvaccinated and vaccine status unknown for the other two. The decedents ranged from 1 to 40 years, including six children and adolescents younger than 20 years of age. Three of the children had preexisting immunosuppressive conditions.

The other three, all initially healthy, were a 12-year-old boy, a 10-year-old girl, and a 14-month-old girl. None had been vaccinated or previously had the disease. Two had been exposed to classmates with varicella, while the source for the third child was unknown. All three had been brought to the emergency room with rashes consistent with varicella.

The 12-year-old was having repetitive episodes of vomiting, shortness of breath, and weakness. He was afebrile and initially had a 97% pulse oximetry, which dropped to 69% after he was hospitalized. He died on the second hospital day after having a seizure and becoming apneic. The 10-year-old died on the fourth hospital day after hospitalization for fever, ataxia, and changes in mental status.

The third child was brought to the hospital with vomiting, diarrhea, fever, and reduced oral intake 3 days after her rash appeared. She became hypotensive and was diagnosed with varicella and septic shock. Despite fluid resuscitation, intravenous ceftriaxone, vancomycin, and acetaminophen and transfer to a children's hospital, she developed respiratory and cardiac arrest and died less than an hour after arriving, the CDC reported.

To prevent varicella from occurring among children in the age range of the older two who died, middle- and high-school entry vaccination requirements will be necessary. By June 2004, a total of 44 states had implemented child care and/or school entry requirements for varicella vaccination. However, as of March 2005, only 18 states had included middle- or high-school entry requirements, the CDC said.

In Oregon, which has requirements for vaccination prior to out-of-home child care, kindergarten, and seventh grade, the Multnomah County school district has been conducting surveillance since the 2002–2003 school year for 37,850 students in 109 public elementary schools in kindergarten through fifth grade (5–10 years old).

Overall for the 2002–2003 and 2003–2004 school years, approximately 60% of varicella cases occurred as a single case in classrooms, while 40% were part of classroom outbreaks (defined as two or more cases within 21 days). Twenty-two percent were among students aged 7 years, while 19% occurred in 6-year-olds. Overall, 69% with varicella had been vaccinated, and 28% lacked evidence of immunity, having neither a history of vaccination nor of disease. Information was missing for the other 3%.

This school-based surveillance method detected more cases than physician-based surveillance alone would have. School nurses reported 90% of new varicella cases, with 88% subsequently confirmed by physicians, nurses, or parents. However, only 34% of the 2002–2003 cases and 44% of the 2003–2004 cases had been initially diagnosed by physicians, according to the CDC.

Varicella is still around despite the vaccine—and in some cases it can still be fatal, according to the Centers for Disease Control and Prevention.

Varicella vaccination is more than 95% effective against severe disease, and, since 1996, has been recommended for routine administration to children aged 12–18 months and to all susceptible persons aged 13 years and older. For children aged 19–35 months, national estimates of varicella vaccine coverage increased from 26% in 1997 to 85% in 2003, resulting in substantial reductions in varicella morbidity and mortality.

In two Varicella Active Surveillance Project sites—Antelope Valley, Calif., and West Philadelphia, Pa.—the number of reported cases dropped by approximately 85% during 1995–2003, and hospitalizations by about 70%.

Yet, cases are still occurring among both vaccinated and unvaccinated individuals, as are a small number of varicella-related deaths among those not vaccinated or whose vaccination status is unknown, the CDC said in two separate reports (MMWR 2005;54:272–6).

During 2003 and the first half of 2004, the CDC received reports of eight varicella-related deaths, of whom six were unvaccinated and vaccine status unknown for the other two. The decedents ranged from 1 to 40 years, including six children and adolescents younger than 20 years of age. Three of the children had preexisting immunosuppressive conditions.

The other three, all initially healthy, were a 12-year-old boy, a 10-year-old girl, and a 14-month-old girl. None had been vaccinated or previously had the disease. Two had been exposed to classmates with varicella, while the source for the third child was unknown. All three had been brought to the emergency room with rashes consistent with varicella.

The 12-year-old was having repetitive episodes of vomiting, shortness of breath, and weakness. He was afebrile and initially had a 97% pulse oximetry, which dropped to 69% after he was hospitalized. He died on the second hospital day after having a seizure and becoming apneic. The 10-year-old died on the fourth hospital day after hospitalization for fever, ataxia, and changes in mental status.

The third child was brought to the hospital with vomiting, diarrhea, fever, and reduced oral intake 3 days after her rash appeared. She became hypotensive and was diagnosed with varicella and septic shock. Despite fluid resuscitation, intravenous ceftriaxone, vancomycin, and acetaminophen and transfer to a children's hospital, she developed respiratory and cardiac arrest and died less than an hour after arriving, the CDC reported.

To prevent varicella from occurring among children in the age range of the older two who died, middle- and high-school entry vaccination requirements will be necessary. By June 2004, a total of 44 states had implemented child care and/or school entry requirements for varicella vaccination. However, as of March 2005, only 18 states had included middle- or high-school entry requirements, the CDC said.

In Oregon, which has requirements for vaccination prior to out-of-home child care, kindergarten, and seventh grade, the Multnomah County school district has been conducting surveillance since the 2002–2003 school year for 37,850 students in 109 public elementary schools in kindergarten through fifth grade (5–10 years old).

Overall for the 2002–2003 and 2003–2004 school years, approximately 60% of varicella cases occurred as a single case in classrooms, while 40% were part of classroom outbreaks (defined as two or more cases within 21 days). Twenty-two percent were among students aged 7 years, while 19% occurred in 6-year-olds. Overall, 69% with varicella had been vaccinated, and 28% lacked evidence of immunity, having neither a history of vaccination nor of disease. Information was missing for the other 3%.

This school-based surveillance method detected more cases than physician-based surveillance alone would have. School nurses reported 90% of new varicella cases, with 88% subsequently confirmed by physicians, nurses, or parents. However, only 34% of the 2002–2003 cases and 44% of the 2003–2004 cases had been initially diagnosed by physicians, according to the CDC.

Varicella is still around despite the vaccine—and in some cases it can still be fatal, according to the Centers for Disease Control and Prevention.

Varicella vaccination is more than 95% effective against severe disease, and, since 1996, has been recommended for routine administration to children aged 12–18 months and to all susceptible persons aged 13 years and older. For children aged 19–35 months, national estimates of varicella vaccine coverage increased from 26% in 1997 to 85% in 2003, resulting in substantial reductions in varicella morbidity and mortality.

In two Varicella Active Surveillance Project sites—Antelope Valley, Calif., and West Philadelphia, Pa.—the number of reported cases dropped by approximately 85% during 1995–2003, and hospitalizations by about 70%.

Yet, cases are still occurring among both vaccinated and unvaccinated individuals, as are a small number of varicella-related deaths among those not vaccinated or whose vaccination status is unknown, the CDC said in two separate reports (MMWR 2005;54:272–6).

During 2003 and the first half of 2004, the CDC received reports of eight varicella-related deaths, of whom six were unvaccinated and vaccine status unknown for the other two. The decedents ranged from 1 to 40 years, including six children and adolescents younger than 20 years of age. Three of the children had preexisting immunosuppressive conditions.

The other three, all initially healthy, were a 12-year-old boy, a 10-year-old girl, and a 14-month-old girl. None had been vaccinated or previously had the disease. Two had been exposed to classmates with varicella, while the source for the third child was unknown. All three had been brought to the emergency room with rashes consistent with varicella.

The 12-year-old was having repetitive episodes of vomiting, shortness of breath, and weakness. He was afebrile and initially had a 97% pulse oximetry, which dropped to 69% after he was hospitalized. He died on the second hospital day after having a seizure and becoming apneic. The 10-year-old died on the fourth hospital day after hospitalization for fever, ataxia, and changes in mental status.

The third child was brought to the hospital with vomiting, diarrhea, fever, and reduced oral intake 3 days after her rash appeared. She became hypotensive and was diagnosed with varicella and septic shock. Despite fluid resuscitation, intravenous ceftriaxone, vancomycin, and acetaminophen and transfer to a children's hospital, she developed respiratory and cardiac arrest and died less than an hour after arriving, the CDC reported.

To prevent varicella from occurring among children in the age range of the older two who died, middle- and high-school entry vaccination requirements will be necessary. By June 2004, a total of 44 states had implemented child care and/or school entry requirements for varicella vaccination. However, as of March 2005, only 18 states had included middle- or high-school entry requirements, the CDC said.

In Oregon, which has requirements for vaccination prior to out-of-home child care, kindergarten, and seventh grade, the Multnomah County school district has been conducting surveillance since the 2002–2003 school year for 37,850 students in 109 public elementary schools in kindergarten through fifth grade (5–10 years old).

Overall for the 2002–2003 and 2003–2004 school years, approximately 60% of varicella cases occurred as a single case in classrooms, while 40% were part of classroom outbreaks (defined as two or more cases within 21 days). Twenty-two percent were among students aged 7 years, while 19% occurred in 6-year-olds. Overall, 69% with varicella had been vaccinated, and 28% lacked evidence of immunity, having neither a history of vaccination nor of disease. Information was missing for the other 3%.

This school-based surveillance method detected more cases than physician-based surveillance alone would have. School nurses reported 90% of new varicella cases, with 88% subsequently confirmed by physicians, nurses, or parents. However, only 34% of the 2002–2003 cases and 44% of the 2003–2004 cases had been initially diagnosed by physicians, according to the CDC.

WASHINGTON — Whether or not a child receives at least three doses of pneumococcal conjugate vaccine depends upon the vaccine financing policy of the state he or she resides in, Shannon Stokley and her associates reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

With a price tag of $51.58 per dose for the federal government and $61.65 in the private sector, pneumococcal conjugate vaccine (PCV7 or Prevnar) is the second-most-expensive routine childhood vaccine (after the new meningococcal conjugate vaccine), said Ms. Stokley, an epidemiologist with the national immunization branch of the Centers for Disease Control and Prevention, Atlanta.

All states receive federal funds to purchase vaccine for children eligible for the Vaccines for Children (VFC) program, which covers all routine childhood vaccines for children who are Medicaid eligible, uninsured, Native American or Alaska Native, and those who are underinsured and receive vaccine at a federally qualified health clinic.

States have the ability to use other state and federal funds to purchase additional vaccine for children who aren't VFC eligible. But because PCV7 is so expensive, some states have specifically excluded it from that additional coverage, she said.

Data were analyzed from the 2001–2003 National Immunization Survey for children aged 19–35 months living in 34 states plus one city with the following vaccine financing policies:

▸ VFC only (Ala., Colo., Ind., Iowa, La., Miss., Neb., N.J., Ohio, Ore., Pa., Tenn., Wis.). Supplies only VFC vaccine to all VFC-enrolled providers. Public health clinics may provide all vaccines to all children who present for immunization.

▸ VFC and underinsured (Ariz., Fla., Ga., Md., Mich., Minn., N.Y., S.C., San Antonio). Supplies all vaccines for VFC-eligible and underinsured children to all VFC-enrolled providers.

▸ VFC and underinsured-select (Ill.). Supplies all vaccines for VFC eligible and all vaccines except PCV7 for underinsured children to all VFC-enrolled providers.

▸ Universal (Ark., Idaho, Mass., Maine, N.H., N.M., R.I., Wash.). Supplies all vaccines to all providers.

▸ Universal-select (Conn., Nev., S.D., Vt.). Supplies all vaccines except PCV7 for children who are underinsured or fully insured, to all providers.

Overall, the proportion of children who received one or more doses of PCV7 rose from 37.3% in 2001 (the year after it was licensed) to 88.5% in 2003. The proportion receiving at least the first three doses rose from 6.7% in 2001 to 69% in 2003.

The likelihood of receiving three or more doses of PCV7 for children living in universal purchase states was 1.73 times greater than for children living in universal-select states, while the odds of receiving three or more doses of PCV7 for children in the VFC and underinsured states (plus San Antonio) were 1.06 times higher than for children in the VFC and underinsured-select states, Ms. Stokley and her associates reported.

After adjustment for child and provider factors, children living in universal-select or VFC and underinsured states had significantly lower odds of receiving three or more doses of PCV7, compared with children living in VFC-only states.

WASHINGTON — Whether or not a child receives at least three doses of pneumococcal conjugate vaccine depends upon the vaccine financing policy of the state he or she resides in, Shannon Stokley and her associates reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

With a price tag of $51.58 per dose for the federal government and $61.65 in the private sector, pneumococcal conjugate vaccine (PCV7 or Prevnar) is the second-most-expensive routine childhood vaccine (after the new meningococcal conjugate vaccine), said Ms. Stokley, an epidemiologist with the national immunization branch of the Centers for Disease Control and Prevention, Atlanta.

All states receive federal funds to purchase vaccine for children eligible for the Vaccines for Children (VFC) program, which covers all routine childhood vaccines for children who are Medicaid eligible, uninsured, Native American or Alaska Native, and those who are underinsured and receive vaccine at a federally qualified health clinic.

States have the ability to use other state and federal funds to purchase additional vaccine for children who aren't VFC eligible. But because PCV7 is so expensive, some states have specifically excluded it from that additional coverage, she said.

Data were analyzed from the 2001–2003 National Immunization Survey for children aged 19–35 months living in 34 states plus one city with the following vaccine financing policies:

▸ VFC only (Ala., Colo., Ind., Iowa, La., Miss., Neb., N.J., Ohio, Ore., Pa., Tenn., Wis.). Supplies only VFC vaccine to all VFC-enrolled providers. Public health clinics may provide all vaccines to all children who present for immunization.

▸ VFC and underinsured (Ariz., Fla., Ga., Md., Mich., Minn., N.Y., S.C., San Antonio). Supplies all vaccines for VFC-eligible and underinsured children to all VFC-enrolled providers.

▸ VFC and underinsured-select (Ill.). Supplies all vaccines for VFC eligible and all vaccines except PCV7 for underinsured children to all VFC-enrolled providers.

▸ Universal (Ark., Idaho, Mass., Maine, N.H., N.M., R.I., Wash.). Supplies all vaccines to all providers.

▸ Universal-select (Conn., Nev., S.D., Vt.). Supplies all vaccines except PCV7 for children who are underinsured or fully insured, to all providers.

Overall, the proportion of children who received one or more doses of PCV7 rose from 37.3% in 2001 (the year after it was licensed) to 88.5% in 2003. The proportion receiving at least the first three doses rose from 6.7% in 2001 to 69% in 2003.

The likelihood of receiving three or more doses of PCV7 for children living in universal purchase states was 1.73 times greater than for children living in universal-select states, while the odds of receiving three or more doses of PCV7 for children in the VFC and underinsured states (plus San Antonio) were 1.06 times higher than for children in the VFC and underinsured-select states, Ms. Stokley and her associates reported.

After adjustment for child and provider factors, children living in universal-select or VFC and underinsured states had significantly lower odds of receiving three or more doses of PCV7, compared with children living in VFC-only states.

WASHINGTON — Whether or not a child receives at least three doses of pneumococcal conjugate vaccine depends upon the vaccine financing policy of the state he or she resides in, Shannon Stokley and her associates reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

With a price tag of $51.58 per dose for the federal government and $61.65 in the private sector, pneumococcal conjugate vaccine (PCV7 or Prevnar) is the second-most-expensive routine childhood vaccine (after the new meningococcal conjugate vaccine), said Ms. Stokley, an epidemiologist with the national immunization branch of the Centers for Disease Control and Prevention, Atlanta.

All states receive federal funds to purchase vaccine for children eligible for the Vaccines for Children (VFC) program, which covers all routine childhood vaccines for children who are Medicaid eligible, uninsured, Native American or Alaska Native, and those who are underinsured and receive vaccine at a federally qualified health clinic.

States have the ability to use other state and federal funds to purchase additional vaccine for children who aren't VFC eligible. But because PCV7 is so expensive, some states have specifically excluded it from that additional coverage, she said.

Data were analyzed from the 2001–2003 National Immunization Survey for children aged 19–35 months living in 34 states plus one city with the following vaccine financing policies:

▸ VFC only (Ala., Colo., Ind., Iowa, La., Miss., Neb., N.J., Ohio, Ore., Pa., Tenn., Wis.). Supplies only VFC vaccine to all VFC-enrolled providers. Public health clinics may provide all vaccines to all children who present for immunization.

▸ VFC and underinsured (Ariz., Fla., Ga., Md., Mich., Minn., N.Y., S.C., San Antonio). Supplies all vaccines for VFC-eligible and underinsured children to all VFC-enrolled providers.

▸ VFC and underinsured-select (Ill.). Supplies all vaccines for VFC eligible and all vaccines except PCV7 for underinsured children to all VFC-enrolled providers.

▸ Universal (Ark., Idaho, Mass., Maine, N.H., N.M., R.I., Wash.). Supplies all vaccines to all providers.

▸ Universal-select (Conn., Nev., S.D., Vt.). Supplies all vaccines except PCV7 for children who are underinsured or fully insured, to all providers.

Overall, the proportion of children who received one or more doses of PCV7 rose from 37.3% in 2001 (the year after it was licensed) to 88.5% in 2003. The proportion receiving at least the first three doses rose from 6.7% in 2001 to 69% in 2003.

The likelihood of receiving three or more doses of PCV7 for children living in universal purchase states was 1.73 times greater than for children living in universal-select states, while the odds of receiving three or more doses of PCV7 for children in the VFC and underinsured states (plus San Antonio) were 1.06 times higher than for children in the VFC and underinsured-select states, Ms. Stokley and her associates reported.

After adjustment for child and provider factors, children living in universal-select or VFC and underinsured states had significantly lower odds of receiving three or more doses of PCV7, compared with children living in VFC-only states.

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project. Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%–1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005:54;380–3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents (just 3 of 16 were detected), and of bleeding associated with anticoagulants such as warfarin and heparin (1 of 9 were detected).

When those two types of cases were excluded, sensitivity of the NEISS-CADES increased to 0.45. This figure compares favorably with the FDA's Adverse Event Reporting System, a passive surveillance system estimated to capture 1%–38% of serious adverse drug reactions. It is a system which is influenced by factors such as the length of time the drug has been on the market and media attention, the CDC noted.

Due to these findings, NEISS-CADES coders now receive a streamlined ADE flow sheet and are trained to identify unintentional overdoses of diabetes agents and anticoagulants.

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project. Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%–1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005:54;380–3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents (just 3 of 16 were detected), and of bleeding associated with anticoagulants such as warfarin and heparin (1 of 9 were detected).

When those two types of cases were excluded, sensitivity of the NEISS-CADES increased to 0.45. This figure compares favorably with the FDA's Adverse Event Reporting System, a passive surveillance system estimated to capture 1%–38% of serious adverse drug reactions. It is a system which is influenced by factors such as the length of time the drug has been on the market and media attention, the CDC noted.

Due to these findings, NEISS-CADES coders now receive a streamlined ADE flow sheet and are trained to identify unintentional overdoses of diabetes agents and anticoagulants.

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project. Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%–1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005:54;380–3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents (just 3 of 16 were detected), and of bleeding associated with anticoagulants such as warfarin and heparin (1 of 9 were detected).

When those two types of cases were excluded, sensitivity of the NEISS-CADES increased to 0.45. This figure compares favorably with the FDA's Adverse Event Reporting System, a passive surveillance system estimated to capture 1%–38% of serious adverse drug reactions. It is a system which is influenced by factors such as the length of time the drug has been on the market and media attention, the CDC noted.

Due to these findings, NEISS-CADES coders now receive a streamlined ADE flow sheet and are trained to identify unintentional overdoses of diabetes agents and anticoagulants.

Gestational diabetes is on the rise. The finding is not surprising given the dramatic increases in obesity and type 2 diabetes, but few studies have examined trends in gestational diabetes mellitus, reported Dana Dabelea, M.D., of the University of Colorado, Denver, and her associates.

The findings from Kaiser Permanente of Colorado's perinatal database include 36,403 pregnancies among 30,216 initially nondiabetic women who delivered singleton infants from 1994 to 2002 and had been screened at 24–28 weeks by the same protocol: a 1-hour 50-g oral glucose tolerance test, followed by a diagnostic 3-hour 100-g test in those with glucose values of at least 140 mg/dL on the 50-g test (Diabetes Care 2005;28:579–84).

A total of 1,183 pregnancies were complicated by gestational diabetes mellitus (GDM). The prevalence of GDM almost doubled—from 2.1% in 1994 to 4.1% in 2002. The rate increased by an average of 12% per year during that period.

The rise in GDM occurred in all ethnic groups, from 1.9% to 3.4% in non-Hispanic whites, 2.8% to 5.1% in Hispanics, 2.5% to 4.6% in African Americans, and 6.3% to 8.6% in Asians. However, throughout the study period, the combined prevalence of GDMin women of all the minority ethnic groups was consistently twice that of white women.

When broken down by the mother's birth period, the prevalence of GDM was about 40% higher for each successive birth decade from 1946 to 1990. This finding probably reflects women's exposure to increasing rates with time. Obesity is one of the strongest risk factors for GDM, the researchers said. Even in Colorado, with the lowest estimated prevalence of obesity of any state, obesity among women more than doubled from 1990 to 2001, they noted.

Gestational diabetes is on the rise. The finding is not surprising given the dramatic increases in obesity and type 2 diabetes, but few studies have examined trends in gestational diabetes mellitus, reported Dana Dabelea, M.D., of the University of Colorado, Denver, and her associates.

The findings from Kaiser Permanente of Colorado's perinatal database include 36,403 pregnancies among 30,216 initially nondiabetic women who delivered singleton infants from 1994 to 2002 and had been screened at 24–28 weeks by the same protocol: a 1-hour 50-g oral glucose tolerance test, followed by a diagnostic 3-hour 100-g test in those with glucose values of at least 140 mg/dL on the 50-g test (Diabetes Care 2005;28:579–84).

A total of 1,183 pregnancies were complicated by gestational diabetes mellitus (GDM). The prevalence of GDM almost doubled—from 2.1% in 1994 to 4.1% in 2002. The rate increased by an average of 12% per year during that period.

The rise in GDM occurred in all ethnic groups, from 1.9% to 3.4% in non-Hispanic whites, 2.8% to 5.1% in Hispanics, 2.5% to 4.6% in African Americans, and 6.3% to 8.6% in Asians. However, throughout the study period, the combined prevalence of GDMin women of all the minority ethnic groups was consistently twice that of white women.

When broken down by the mother's birth period, the prevalence of GDM was about 40% higher for each successive birth decade from 1946 to 1990. This finding probably reflects women's exposure to increasing rates with time. Obesity is one of the strongest risk factors for GDM, the researchers said. Even in Colorado, with the lowest estimated prevalence of obesity of any state, obesity among women more than doubled from 1990 to 2001, they noted.

Gestational diabetes is on the rise. The finding is not surprising given the dramatic increases in obesity and type 2 diabetes, but few studies have examined trends in gestational diabetes mellitus, reported Dana Dabelea, M.D., of the University of Colorado, Denver, and her associates.

The findings from Kaiser Permanente of Colorado's perinatal database include 36,403 pregnancies among 30,216 initially nondiabetic women who delivered singleton infants from 1994 to 2002 and had been screened at 24–28 weeks by the same protocol: a 1-hour 50-g oral glucose tolerance test, followed by a diagnostic 3-hour 100-g test in those with glucose values of at least 140 mg/dL on the 50-g test (Diabetes Care 2005;28:579–84).

A total of 1,183 pregnancies were complicated by gestational diabetes mellitus (GDM). The prevalence of GDM almost doubled—from 2.1% in 1994 to 4.1% in 2002. The rate increased by an average of 12% per year during that period.

The rise in GDM occurred in all ethnic groups, from 1.9% to 3.4% in non-Hispanic whites, 2.8% to 5.1% in Hispanics, 2.5% to 4.6% in African Americans, and 6.3% to 8.6% in Asians. However, throughout the study period, the combined prevalence of GDMin women of all the minority ethnic groups was consistently twice that of white women.

When broken down by the mother's birth period, the prevalence of GDM was about 40% higher for each successive birth decade from 1946 to 1990. This finding probably reflects women's exposure to increasing rates with time. Obesity is one of the strongest risk factors for GDM, the researchers said. Even in Colorado, with the lowest estimated prevalence of obesity of any state, obesity among women more than doubled from 1990 to 2001, they noted.

VANCOUVER, B.C. — Transcendental meditation may improve vascular function in African American teenagers with high-normal blood pressure, Vernon A. Barnes, Ph.D., said at the annual meeting of the American Psychosomatic Society.

Transcendental meditation (TM), a process by which “the mind is allowed to settle down to a state of least mental activity,” has been shown to decrease sympathetic nervous system tone, hypothalamic-pituitary-adrenocortical axis activation, and cortisol levels, which are associated with reductions in blood pressure.

In a study by Dr. Barnes and his associates at the Medical College of Georgia, Augusta, systolic and diastolic blood pressures were significantly reduced in 50 African American adolescents with high-normal blood pressures who practiced TM twice a day for 4 months (Am. J. Hypertens. 2004;17:366–9).

In that study, 57 African American adolescents (mean age 16.2 years) were randomized to practicing TM for 15 minutes at a time. One session was held in school during homeroom, the other was at home. Another 54 teens received 15-minute didactic health education sessions about weight management, healthy diet, and physical activity each day at school, and also were assigned to walk 15 minutes a day.

At-home compliance with the meditation—in which “the ordinary thinking process becomes quiescent and a distinctive wakeful but deeply restful state” is achieved—was 76%, including weekends and holidays, Dr. Barnes told FAMILY PRACTICE NEWS.

Echocardiographic-derived measures of the subjects' endothelium-dependent vasodilation to reactive hyperemia (EDAD)—a functional measure of vascular remodeling that is inversely correlated with cardiac structure and function—were collected before and after the interventions, and again at 4 months' follow-up.

The procedure involved scanning the subjects' right brachial artery prior to and for 2 minutes following 4 minutes of hyperemia, which was induced by inflating the cuff to 200 mm Hg. EDAD was calculated as the percentage change from baseline diameter to maximum post-cuff release diameter. The sonographer was blinded to which group the subject was in, Dr. Barnes said.

From pre- to 4 months post intervention, EDAD in the TM group increased 21%, from 12.4% to 15%, compared with a 4% decrease of 12.3% to 11.8% in the health education group.

“If this improvement is replicated among other at-risk groups and in cohorts of cardiovascular disease patients, this will have important implications for inclusion of TM in the efforts to prevent and treat CVD and its clinical consequences,” he said.

Other benefits were seen as well. Anecdotes related by students corroborated school records documenting improved school-related behavior and fewer rule violations. Students also saw improvements in sleep, athletic and school performance, and personal relationships, Dr. Barnes said.

This study, funded by the National Heart, Lung, and Blood Institute, was singled out by the psychosomatic society as among those “having the highest potential to change clinical practice.”

VANCOUVER, B.C. — Transcendental meditation may improve vascular function in African American teenagers with high-normal blood pressure, Vernon A. Barnes, Ph.D., said at the annual meeting of the American Psychosomatic Society.

Transcendental meditation (TM), a process by which “the mind is allowed to settle down to a state of least mental activity,” has been shown to decrease sympathetic nervous system tone, hypothalamic-pituitary-adrenocortical axis activation, and cortisol levels, which are associated with reductions in blood pressure.

In a study by Dr. Barnes and his associates at the Medical College of Georgia, Augusta, systolic and diastolic blood pressures were significantly reduced in 50 African American adolescents with high-normal blood pressures who practiced TM twice a day for 4 months (Am. J. Hypertens. 2004;17:366–9).

In that study, 57 African American adolescents (mean age 16.2 years) were randomized to practicing TM for 15 minutes at a time. One session was held in school during homeroom, the other was at home. Another 54 teens received 15-minute didactic health education sessions about weight management, healthy diet, and physical activity each day at school, and also were assigned to walk 15 minutes a day.

At-home compliance with the meditation—in which “the ordinary thinking process becomes quiescent and a distinctive wakeful but deeply restful state” is achieved—was 76%, including weekends and holidays, Dr. Barnes told FAMILY PRACTICE NEWS.

Echocardiographic-derived measures of the subjects' endothelium-dependent vasodilation to reactive hyperemia (EDAD)—a functional measure of vascular remodeling that is inversely correlated with cardiac structure and function—were collected before and after the interventions, and again at 4 months' follow-up.

The procedure involved scanning the subjects' right brachial artery prior to and for 2 minutes following 4 minutes of hyperemia, which was induced by inflating the cuff to 200 mm Hg. EDAD was calculated as the percentage change from baseline diameter to maximum post-cuff release diameter. The sonographer was blinded to which group the subject was in, Dr. Barnes said.

From pre- to 4 months post intervention, EDAD in the TM group increased 21%, from 12.4% to 15%, compared with a 4% decrease of 12.3% to 11.8% in the health education group.

“If this improvement is replicated among other at-risk groups and in cohorts of cardiovascular disease patients, this will have important implications for inclusion of TM in the efforts to prevent and treat CVD and its clinical consequences,” he said.

Other benefits were seen as well. Anecdotes related by students corroborated school records documenting improved school-related behavior and fewer rule violations. Students also saw improvements in sleep, athletic and school performance, and personal relationships, Dr. Barnes said.

This study, funded by the National Heart, Lung, and Blood Institute, was singled out by the psychosomatic society as among those “having the highest potential to change clinical practice.”

VANCOUVER, B.C. — Transcendental meditation may improve vascular function in African American teenagers with high-normal blood pressure, Vernon A. Barnes, Ph.D., said at the annual meeting of the American Psychosomatic Society.

Transcendental meditation (TM), a process by which “the mind is allowed to settle down to a state of least mental activity,” has been shown to decrease sympathetic nervous system tone, hypothalamic-pituitary-adrenocortical axis activation, and cortisol levels, which are associated with reductions in blood pressure.

In a study by Dr. Barnes and his associates at the Medical College of Georgia, Augusta, systolic and diastolic blood pressures were significantly reduced in 50 African American adolescents with high-normal blood pressures who practiced TM twice a day for 4 months (Am. J. Hypertens. 2004;17:366–9).

In that study, 57 African American adolescents (mean age 16.2 years) were randomized to practicing TM for 15 minutes at a time. One session was held in school during homeroom, the other was at home. Another 54 teens received 15-minute didactic health education sessions about weight management, healthy diet, and physical activity each day at school, and also were assigned to walk 15 minutes a day.

At-home compliance with the meditation—in which “the ordinary thinking process becomes quiescent and a distinctive wakeful but deeply restful state” is achieved—was 76%, including weekends and holidays, Dr. Barnes told FAMILY PRACTICE NEWS.

Echocardiographic-derived measures of the subjects' endothelium-dependent vasodilation to reactive hyperemia (EDAD)—a functional measure of vascular remodeling that is inversely correlated with cardiac structure and function—were collected before and after the interventions, and again at 4 months' follow-up.

The procedure involved scanning the subjects' right brachial artery prior to and for 2 minutes following 4 minutes of hyperemia, which was induced by inflating the cuff to 200 mm Hg. EDAD was calculated as the percentage change from baseline diameter to maximum post-cuff release diameter. The sonographer was blinded to which group the subject was in, Dr. Barnes said.

From pre- to 4 months post intervention, EDAD in the TM group increased 21%, from 12.4% to 15%, compared with a 4% decrease of 12.3% to 11.8% in the health education group.

“If this improvement is replicated among other at-risk groups and in cohorts of cardiovascular disease patients, this will have important implications for inclusion of TM in the efforts to prevent and treat CVD and its clinical consequences,” he said.

Other benefits were seen as well. Anecdotes related by students corroborated school records documenting improved school-related behavior and fewer rule violations. Students also saw improvements in sleep, athletic and school performance, and personal relationships, Dr. Barnes said.

This study, funded by the National Heart, Lung, and Blood Institute, was singled out by the psychosomatic society as among those “having the highest potential to change clinical practice.”

Gestational diabetes is on the rise. The finding is not surprising given the dramatic increases in obesity and type 2 diabetes in recent years, but until now few studies have examined trends in gestational diabetes mellitus (GDM) in populations other than the Pima Indians, reported Dana Dabelea, M.D., of the University of Colorado, Denver, and her associates (Diabetes Care 2005;28:579-84).

The findings from Kaiser Permanente of Colorado's perinatal database include all 36,403 pregnancies among 30,216 initially nondiabetic women who delivered singleton infants from 1994 to 2002 and had been screened at 24-28 weeks by the same protocol: a 1-hour 50-g oral glucose tolerance test (OGTT), followed by a diagnostic 3-hour 100-g OGTT among those with glucose values at or above 140 mg/dL on the 50-g test.

A total of 1,183 pregnancies were complicated by GDM from 1994 to 2002. The prevalence of GDM during that time almost doubled—from 2.1% in 1994 to 4.1% in 2002. The rate increased by an average of 12% per year during that period.

The rise in GDM occurred in all ethnic groups, from 1.9% to 3.4% in non-Hispanic whites, 2.8% to 5.1% among Hispanics, 2.5% to 4.6% in African Americans, and 6.3% to 8.6% among Asians. Throughout the study period, pregnant women of all the minority ethnic groups combined consistently had a twofold higher prevalence of GDM than did white women.

When broken down by the mother's birth period, the prevalence of GDM was approximately 40% higher for each successive birth decade from 1946 to 1990. This finding probably reflects women's exposure to increasing rates of obesity in later versus earlier time periods. Obesity is one of the strongest risk factors for GDM, Dr. Dabelea and her associates said.

Gestational diabetes is on the rise. The finding is not surprising given the dramatic increases in obesity and type 2 diabetes in recent years, but until now few studies have examined trends in gestational diabetes mellitus (GDM) in populations other than the Pima Indians, reported Dana Dabelea, M.D., of the University of Colorado, Denver, and her associates (Diabetes Care 2005;28:579-84).

The findings from Kaiser Permanente of Colorado's perinatal database include all 36,403 pregnancies among 30,216 initially nondiabetic women who delivered singleton infants from 1994 to 2002 and had been screened at 24-28 weeks by the same protocol: a 1-hour 50-g oral glucose tolerance test (OGTT), followed by a diagnostic 3-hour 100-g OGTT among those with glucose values at or above 140 mg/dL on the 50-g test.

A total of 1,183 pregnancies were complicated by GDM from 1994 to 2002. The prevalence of GDM during that time almost doubled—from 2.1% in 1994 to 4.1% in 2002. The rate increased by an average of 12% per year during that period.

The rise in GDM occurred in all ethnic groups, from 1.9% to 3.4% in non-Hispanic whites, 2.8% to 5.1% among Hispanics, 2.5% to 4.6% in African Americans, and 6.3% to 8.6% among Asians. Throughout the study period, pregnant women of all the minority ethnic groups combined consistently had a twofold higher prevalence of GDM than did white women.

When broken down by the mother's birth period, the prevalence of GDM was approximately 40% higher for each successive birth decade from 1946 to 1990. This finding probably reflects women's exposure to increasing rates of obesity in later versus earlier time periods. Obesity is one of the strongest risk factors for GDM, Dr. Dabelea and her associates said.

Gestational diabetes is on the rise. The finding is not surprising given the dramatic increases in obesity and type 2 diabetes in recent years, but until now few studies have examined trends in gestational diabetes mellitus (GDM) in populations other than the Pima Indians, reported Dana Dabelea, M.D., of the University of Colorado, Denver, and her associates (Diabetes Care 2005;28:579-84).

The findings from Kaiser Permanente of Colorado's perinatal database include all 36,403 pregnancies among 30,216 initially nondiabetic women who delivered singleton infants from 1994 to 2002 and had been screened at 24-28 weeks by the same protocol: a 1-hour 50-g oral glucose tolerance test (OGTT), followed by a diagnostic 3-hour 100-g OGTT among those with glucose values at or above 140 mg/dL on the 50-g test.

A total of 1,183 pregnancies were complicated by GDM from 1994 to 2002. The prevalence of GDM during that time almost doubled—from 2.1% in 1994 to 4.1% in 2002. The rate increased by an average of 12% per year during that period.

The rise in GDM occurred in all ethnic groups, from 1.9% to 3.4% in non-Hispanic whites, 2.8% to 5.1% among Hispanics, 2.5% to 4.6% in African Americans, and 6.3% to 8.6% among Asians. Throughout the study period, pregnant women of all the minority ethnic groups combined consistently had a twofold higher prevalence of GDM than did white women.

When broken down by the mother's birth period, the prevalence of GDM was approximately 40% higher for each successive birth decade from 1946 to 1990. This finding probably reflects women's exposure to increasing rates of obesity in later versus earlier time periods. Obesity is one of the strongest risk factors for GDM, Dr. Dabelea and her associates said.

WASHINGTON — Missed opportunities for immunizing asthmatic children occur frequently during the influenza season, as documented in a Michigan study, Kevin J. Dombkowski, Dr.P.H., and his colleagues reported in a poster presentation at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

In the study funded by the Michigan Department of Community Health, administrative claims and immunization registry records were analyzed for 5,993 children aged 5-18 years with persistent asthma who were continuously enrolled in the Michigan Medicaid program during 2001-2003, he reported.

In each year studied, 79% of the children had at least one office visit during the influenza season.

Yet, influenza vaccination had been documented for only 14% during the 2001-2002 season and 18% during the 2002-2003 season, with just 7% vaccinated in both seasons, said Dr. Dombkowski, who is senior research associate in the division of general pediatrics, University of Michigan, Ann Arbor.

Among children with no evidence of influenza vaccination, 77% had at least one missed opportunity in the 2001-2002 flu season and 75% in the 2002-2003 season, Dr. Dombkowski commented.

During both seasons, nearly all children (95%) with a missed opportunity had made at least one “sick” visit to an outpatient provider, and 22% had at least one preventive medicine visit, Dr. Dombkowski said in an interview.

A majority of the missed opportunities (55%) occurred October through November, the optimal period for influenza vaccination, while 77% occurred prior to February, the historical peak of flu season, he said.

“There's a lot of opportunity for improvement out there,” he told this newspaper.

WASHINGTON — Missed opportunities for immunizing asthmatic children occur frequently during the influenza season, as documented in a Michigan study, Kevin J. Dombkowski, Dr.P.H., and his colleagues reported in a poster presentation at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

In the study funded by the Michigan Department of Community Health, administrative claims and immunization registry records were analyzed for 5,993 children aged 5-18 years with persistent asthma who were continuously enrolled in the Michigan Medicaid program during 2001-2003, he reported.

In each year studied, 79% of the children had at least one office visit during the influenza season.

Yet, influenza vaccination had been documented for only 14% during the 2001-2002 season and 18% during the 2002-2003 season, with just 7% vaccinated in both seasons, said Dr. Dombkowski, who is senior research associate in the division of general pediatrics, University of Michigan, Ann Arbor.

Among children with no evidence of influenza vaccination, 77% had at least one missed opportunity in the 2001-2002 flu season and 75% in the 2002-2003 season, Dr. Dombkowski commented.

During both seasons, nearly all children (95%) with a missed opportunity had made at least one “sick” visit to an outpatient provider, and 22% had at least one preventive medicine visit, Dr. Dombkowski said in an interview.

A majority of the missed opportunities (55%) occurred October through November, the optimal period for influenza vaccination, while 77% occurred prior to February, the historical peak of flu season, he said.

“There's a lot of opportunity for improvement out there,” he told this newspaper.

WASHINGTON — Missed opportunities for immunizing asthmatic children occur frequently during the influenza season, as documented in a Michigan study, Kevin J. Dombkowski, Dr.P.H., and his colleagues reported in a poster presentation at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

In the study funded by the Michigan Department of Community Health, administrative claims and immunization registry records were analyzed for 5,993 children aged 5-18 years with persistent asthma who were continuously enrolled in the Michigan Medicaid program during 2001-2003, he reported.

In each year studied, 79% of the children had at least one office visit during the influenza season.

Yet, influenza vaccination had been documented for only 14% during the 2001-2002 season and 18% during the 2002-2003 season, with just 7% vaccinated in both seasons, said Dr. Dombkowski, who is senior research associate in the division of general pediatrics, University of Michigan, Ann Arbor.

Among children with no evidence of influenza vaccination, 77% had at least one missed opportunity in the 2001-2002 flu season and 75% in the 2002-2003 season, Dr. Dombkowski commented.

During both seasons, nearly all children (95%) with a missed opportunity had made at least one “sick” visit to an outpatient provider, and 22% had at least one preventive medicine visit, Dr. Dombkowski said in an interview.

A majority of the missed opportunities (55%) occurred October through November, the optimal period for influenza vaccination, while 77% occurred prior to February, the historical peak of flu season, he said.

“There's a lot of opportunity for improvement out there,” he told this newspaper.