Patrice Wendling

NEW ORLEANS — Infections with genotypes not contained in the newly approved human papillomavirus vaccine are common among adolescent girls positive for the virus, Dr. Roshan George said at the Southern regional meeting of the American Federation for Medical Research.

She presented results from the first 32 patients, aged 16–18 years, in an ongoing genotype study of adolescents with atypical squamous cells of undetermined significance and human papillomavirus (HPV) infection. None of the girls had been immunized with the new vaccine containing HPV genotypes 6, 11, 16, and 18 (Gardasil).

Genotype results available from 29 of the 32 girls identified 53 isolates, of which 38% were vaccine genotypes and 62% were nonvaccine genotypes.

Sixteen girls (55%) were infected with more than one genotype, seven (24%) with more than two genotypes, and two girls (7%) were infected with four genotypes, said Dr. George, a pediatrician with Louisiana State University Health Sciences Center in Shreveport. Just 17% of girls were infected only with genotypes covered by the vaccine, 38% were infected with the vaccine genotypes plus other types, and 45% were infected only with genotypes not covered by the vaccine.

“[These data support] recommendations that cervical screening should be continued even in females receiving the vaccine,” Dr. George said.

Epidemiology studies have shown an HPV prevalence rate of 25%–40% in young women. Adolescents acquire HPV rapidly after sexual initiation, and often have concomitant sexually transmitted diseases.

“I was definitely not surprised that almost 55% had a concomitant STD, but I was surprised to see that 50% were pregnant, two had four genotypes, and 45% were not covered by vaccine strains,” Dr. George said in an interview. “That's why it's important we keep screening.”

Dr. George recommends that HPV genotyping, which is not federally approved for this application, should be performed only in those patients with abnormal cytology or carcinoma in situ on their routine Pap test.

The investigators extracted DNA from ThinPrep liquid Pap smear specimens taken from the patients and used polymerase chain reaction to amplify HPV targets overnight before using xMAP (Luminex) bead-based assay technology to detect the DNA. The reagent beads or microspheres are embedded with HPV probes that are color coded into subsets specific for 1 of 19 HPV genotypes. Thus, each of the 19 probes is associated with a microsphere of a specific dye color and will bind to its complementary target DNA.

High-risk HPV genotypes 16 and 18, which cause 70% of cervical cancers, were found in 19% and 5.6% of isolates. Low-risk types 6 and 11, which can cause genital warts and lead to low-grade dysplasia, were found in 5.6% and 7.6% of isolates. HPV genotypes 57, 45, 31, 35, and 58 were also found in roughly 7.5% of isolates. No detectable genotype was found in two specimens, and one patient had a low-risk type not detected by the assay, the investigators reported.

The study was funded by the Digene Corp., which markets the reagents used in the study.

These data suggest cervical screening should be continued even in girls and women receiving the vaccine. DR. GEORGE

NEW ORLEANS — Infections with genotypes not contained in the newly approved human papillomavirus vaccine are common among adolescent girls positive for the virus, Dr. Roshan George said at the Southern regional meeting of the American Federation for Medical Research.

She presented results from the first 32 patients, aged 16–18 years, in an ongoing genotype study of adolescents with atypical squamous cells of undetermined significance and human papillomavirus (HPV) infection. None of the girls had been immunized with the new vaccine containing HPV genotypes 6, 11, 16, and 18 (Gardasil).

Genotype results available from 29 of the 32 girls identified 53 isolates, of which 38% were vaccine genotypes and 62% were nonvaccine genotypes.

Sixteen girls (55%) were infected with more than one genotype, seven (24%) with more than two genotypes, and two girls (7%) were infected with four genotypes, said Dr. George, a pediatrician with Louisiana State University Health Sciences Center in Shreveport. Just 17% of girls were infected only with genotypes covered by the vaccine, 38% were infected with the vaccine genotypes plus other types, and 45% were infected only with genotypes not covered by the vaccine.

“[These data support] recommendations that cervical screening should be continued even in females receiving the vaccine,” Dr. George said.

Epidemiology studies have shown an HPV prevalence rate of 25%–40% in young women. Adolescents acquire HPV rapidly after sexual initiation, and often have concomitant sexually transmitted diseases.

“I was definitely not surprised that almost 55% had a concomitant STD, but I was surprised to see that 50% were pregnant, two had four genotypes, and 45% were not covered by vaccine strains,” Dr. George said in an interview. “That's why it's important we keep screening.”

Dr. George recommends that HPV genotyping, which is not federally approved for this application, should be performed only in those patients with abnormal cytology or carcinoma in situ on their routine Pap test.

The investigators extracted DNA from ThinPrep liquid Pap smear specimens taken from the patients and used polymerase chain reaction to amplify HPV targets overnight before using xMAP (Luminex) bead-based assay technology to detect the DNA. The reagent beads or microspheres are embedded with HPV probes that are color coded into subsets specific for 1 of 19 HPV genotypes. Thus, each of the 19 probes is associated with a microsphere of a specific dye color and will bind to its complementary target DNA.

High-risk HPV genotypes 16 and 18, which cause 70% of cervical cancers, were found in 19% and 5.6% of isolates. Low-risk types 6 and 11, which can cause genital warts and lead to low-grade dysplasia, were found in 5.6% and 7.6% of isolates. HPV genotypes 57, 45, 31, 35, and 58 were also found in roughly 7.5% of isolates. No detectable genotype was found in two specimens, and one patient had a low-risk type not detected by the assay, the investigators reported.

The study was funded by the Digene Corp., which markets the reagents used in the study.

These data suggest cervical screening should be continued even in girls and women receiving the vaccine. DR. GEORGE

NEW ORLEANS — Infections with genotypes not contained in the newly approved human papillomavirus vaccine are common among adolescent girls positive for the virus, Dr. Roshan George said at the Southern regional meeting of the American Federation for Medical Research.

She presented results from the first 32 patients, aged 16–18 years, in an ongoing genotype study of adolescents with atypical squamous cells of undetermined significance and human papillomavirus (HPV) infection. None of the girls had been immunized with the new vaccine containing HPV genotypes 6, 11, 16, and 18 (Gardasil).

Genotype results available from 29 of the 32 girls identified 53 isolates, of which 38% were vaccine genotypes and 62% were nonvaccine genotypes.

Sixteen girls (55%) were infected with more than one genotype, seven (24%) with more than two genotypes, and two girls (7%) were infected with four genotypes, said Dr. George, a pediatrician with Louisiana State University Health Sciences Center in Shreveport. Just 17% of girls were infected only with genotypes covered by the vaccine, 38% were infected with the vaccine genotypes plus other types, and 45% were infected only with genotypes not covered by the vaccine.

“[These data support] recommendations that cervical screening should be continued even in females receiving the vaccine,” Dr. George said.

Epidemiology studies have shown an HPV prevalence rate of 25%–40% in young women. Adolescents acquire HPV rapidly after sexual initiation, and often have concomitant sexually transmitted diseases.

“I was definitely not surprised that almost 55% had a concomitant STD, but I was surprised to see that 50% were pregnant, two had four genotypes, and 45% were not covered by vaccine strains,” Dr. George said in an interview. “That's why it's important we keep screening.”

Dr. George recommends that HPV genotyping, which is not federally approved for this application, should be performed only in those patients with abnormal cytology or carcinoma in situ on their routine Pap test.

The investigators extracted DNA from ThinPrep liquid Pap smear specimens taken from the patients and used polymerase chain reaction to amplify HPV targets overnight before using xMAP (Luminex) bead-based assay technology to detect the DNA. The reagent beads or microspheres are embedded with HPV probes that are color coded into subsets specific for 1 of 19 HPV genotypes. Thus, each of the 19 probes is associated with a microsphere of a specific dye color and will bind to its complementary target DNA.

High-risk HPV genotypes 16 and 18, which cause 70% of cervical cancers, were found in 19% and 5.6% of isolates. Low-risk types 6 and 11, which can cause genital warts and lead to low-grade dysplasia, were found in 5.6% and 7.6% of isolates. HPV genotypes 57, 45, 31, 35, and 58 were also found in roughly 7.5% of isolates. No detectable genotype was found in two specimens, and one patient had a low-risk type not detected by the assay, the investigators reported.

The study was funded by the Digene Corp., which markets the reagents used in the study.

These data suggest cervical screening should be continued even in girls and women receiving the vaccine. DR. GEORGE

NEW YORK — Medication should almost never be the first line of treatment for children and adolescents with insomnia, Dr. Judith Owens said at a psychopharmacology update that was sponsored by the American Academy of Child and Adolescent Psychiatrists.

Instead, proven behavioral strategies should be used; caffeine alcohol, and nicotine intake controlled; and good sleep hygiene practices such as regular sleep-wake times and limited late-night stimulation should be optimized.

“Combining pharmacologic treatment with behavioral therapy really is the key here,” said Dr. Owens in the pediatrics department at Brown University and director of the Pediatric Sleep Disorders Clinic at the Hasbro Children's Hospital, both in Providence, R.I.

This general principle is supported in a recent consensus statement on the pharmacologic management of pediatric insomnia (Pediatrics 2006;117:e1223–32), developed by the National Sleep Foundation in collaboration with Best Practice Project Management Inc. The expert panel behind the statement unanimously agreed there is a need for pharmacotherapy for insomnia, but also for clinical safety and efficacy trials to fill in “important knowledge gaps” about current pharmacotherapies such as sedatives and hypnotics.

“We don't have a lot of empirical data, but a lot of us are using these drugs in practice, anyway,” Dr. Owens said.

The first-ever practice parameters for the behavioral treatment of bedtime problems and night wakings in infants and young children, also published last year, indicate that behavioral treatment produces reliable and durable changes in most (80%) children (Sleep 2006;29:1263–76).

Treatment of pediatric insomnia is complicated by the paucity of pediatric data, but also because the definition of pediatric insomnia is complicated, Dr. Owens said. Unlike insomnia in adults, pediatric insomnia is often dependent on parental recognition and definitions; occurs in an evolving developmental context; and can be the result of multiple etiologies, including medical, behavioral, environmental, psychiatric, and psychosocial.

“If you have [children not] falling asleep, it could be that they're drinking a six-pack of Mountain Dew a night; it could be restless legs syndrome; it could be a limit-setting issue, or a sleep-onset associated-type of behavioral insomnia; and each of those has a distinctly different treatment approach,” Dr. Owens said. “That's why it's so important to understand what the etiology is.”

Other general pharmacologic management principles highlighted by Dr. Owens include:

▸ Select appropriate medications: short-acting medications for sleep onset and longer-acting ones for sleep maintenance.

▸ Screen adolescents for alcohol, drug use, and pregnancy.

▸ Screen patients for the use of over-the-counter sleep medications and herbal remedies to avoid combined effects with prescribed medications.

▸ Review side effects with family.

▸ Monitor efficacy and side effects frequently.

▸ Avoid abrupt discontinuation of medications to minimize withdrawal or rebound effects.

Medication use is contraindicated if insomnia occurs in the presence of untreated sleep-disordered breathing; if it is attributable to developmentally based normal sleep behavior or a self-limited condition; if there is a potential for drug interactions; or if there is limited ability to monitor the medication, Dr. Owens said.

NEW YORK — Medication should almost never be the first line of treatment for children and adolescents with insomnia, Dr. Judith Owens said at a psychopharmacology update that was sponsored by the American Academy of Child and Adolescent Psychiatrists.

Instead, proven behavioral strategies should be used; caffeine alcohol, and nicotine intake controlled; and good sleep hygiene practices such as regular sleep-wake times and limited late-night stimulation should be optimized.

“Combining pharmacologic treatment with behavioral therapy really is the key here,” said Dr. Owens in the pediatrics department at Brown University and director of the Pediatric Sleep Disorders Clinic at the Hasbro Children's Hospital, both in Providence, R.I.

This general principle is supported in a recent consensus statement on the pharmacologic management of pediatric insomnia (Pediatrics 2006;117:e1223–32), developed by the National Sleep Foundation in collaboration with Best Practice Project Management Inc. The expert panel behind the statement unanimously agreed there is a need for pharmacotherapy for insomnia, but also for clinical safety and efficacy trials to fill in “important knowledge gaps” about current pharmacotherapies such as sedatives and hypnotics.

“We don't have a lot of empirical data, but a lot of us are using these drugs in practice, anyway,” Dr. Owens said.

The first-ever practice parameters for the behavioral treatment of bedtime problems and night wakings in infants and young children, also published last year, indicate that behavioral treatment produces reliable and durable changes in most (80%) children (Sleep 2006;29:1263–76).

Treatment of pediatric insomnia is complicated by the paucity of pediatric data, but also because the definition of pediatric insomnia is complicated, Dr. Owens said. Unlike insomnia in adults, pediatric insomnia is often dependent on parental recognition and definitions; occurs in an evolving developmental context; and can be the result of multiple etiologies, including medical, behavioral, environmental, psychiatric, and psychosocial.

“If you have [children not] falling asleep, it could be that they're drinking a six-pack of Mountain Dew a night; it could be restless legs syndrome; it could be a limit-setting issue, or a sleep-onset associated-type of behavioral insomnia; and each of those has a distinctly different treatment approach,” Dr. Owens said. “That's why it's so important to understand what the etiology is.”

Other general pharmacologic management principles highlighted by Dr. Owens include:

▸ Select appropriate medications: short-acting medications for sleep onset and longer-acting ones for sleep maintenance.

▸ Screen adolescents for alcohol, drug use, and pregnancy.

▸ Screen patients for the use of over-the-counter sleep medications and herbal remedies to avoid combined effects with prescribed medications.

▸ Review side effects with family.

▸ Monitor efficacy and side effects frequently.

▸ Avoid abrupt discontinuation of medications to minimize withdrawal or rebound effects.

Medication use is contraindicated if insomnia occurs in the presence of untreated sleep-disordered breathing; if it is attributable to developmentally based normal sleep behavior or a self-limited condition; if there is a potential for drug interactions; or if there is limited ability to monitor the medication, Dr. Owens said.

NEW YORK — Medication should almost never be the first line of treatment for children and adolescents with insomnia, Dr. Judith Owens said at a psychopharmacology update that was sponsored by the American Academy of Child and Adolescent Psychiatrists.

Instead, proven behavioral strategies should be used; caffeine alcohol, and nicotine intake controlled; and good sleep hygiene practices such as regular sleep-wake times and limited late-night stimulation should be optimized.

“Combining pharmacologic treatment with behavioral therapy really is the key here,” said Dr. Owens in the pediatrics department at Brown University and director of the Pediatric Sleep Disorders Clinic at the Hasbro Children's Hospital, both in Providence, R.I.

This general principle is supported in a recent consensus statement on the pharmacologic management of pediatric insomnia (Pediatrics 2006;117:e1223–32), developed by the National Sleep Foundation in collaboration with Best Practice Project Management Inc. The expert panel behind the statement unanimously agreed there is a need for pharmacotherapy for insomnia, but also for clinical safety and efficacy trials to fill in “important knowledge gaps” about current pharmacotherapies such as sedatives and hypnotics.

“We don't have a lot of empirical data, but a lot of us are using these drugs in practice, anyway,” Dr. Owens said.

The first-ever practice parameters for the behavioral treatment of bedtime problems and night wakings in infants and young children, also published last year, indicate that behavioral treatment produces reliable and durable changes in most (80%) children (Sleep 2006;29:1263–76).

Treatment of pediatric insomnia is complicated by the paucity of pediatric data, but also because the definition of pediatric insomnia is complicated, Dr. Owens said. Unlike insomnia in adults, pediatric insomnia is often dependent on parental recognition and definitions; occurs in an evolving developmental context; and can be the result of multiple etiologies, including medical, behavioral, environmental, psychiatric, and psychosocial.

“If you have [children not] falling asleep, it could be that they're drinking a six-pack of Mountain Dew a night; it could be restless legs syndrome; it could be a limit-setting issue, or a sleep-onset associated-type of behavioral insomnia; and each of those has a distinctly different treatment approach,” Dr. Owens said. “That's why it's so important to understand what the etiology is.”

Other general pharmacologic management principles highlighted by Dr. Owens include:

▸ Select appropriate medications: short-acting medications for sleep onset and longer-acting ones for sleep maintenance.

▸ Screen adolescents for alcohol, drug use, and pregnancy.

▸ Screen patients for the use of over-the-counter sleep medications and herbal remedies to avoid combined effects with prescribed medications.

▸ Review side effects with family.

▸ Monitor efficacy and side effects frequently.

▸ Avoid abrupt discontinuation of medications to minimize withdrawal or rebound effects.

Medication use is contraindicated if insomnia occurs in the presence of untreated sleep-disordered breathing; if it is attributable to developmentally based normal sleep behavior or a self-limited condition; if there is a potential for drug interactions; or if there is limited ability to monitor the medication, Dr. Owens said.

NEW YORK — The use of sleep medications in children is considerable in clinical practice in inpatient and outpatient settings, data from two new studies show.

A survey of 1,271 practicing child psychiatrists indicates that 25% of school-age and 30% of adolescent outpatients with primary insomnia are being treated with sleep medication.

“Even 17% of preschoolers are being treated with medication,” Dr. Judith Owens said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.

The survey respondents were members of AACAP, 47% of the respondents were female, 84% were white, and 58% were affiliated with a medical school. Many of the respondents (33%) had been in practice for more than 20 years.

The respondents reported seeing a median of 70 children per month, most of them were aged 6 years or older. They indicated that insomnia was a major problem in 28% of their school-age and 32% of their adolescent patients, Dr. Owens, a pediatrician at Brown University and director of the Pediatric Sleep Disorders Clinic at the Hasbro Children's Hospital, both in Providence, R.I., and her colleagues reported.

The percentage of respondents who recommended medication for insomnia one-half of the time or more was high in primary insomnia (75%) and delayed sleep phase syndrome (51%), as well as psychiatric disorders such as bipolar disorder (62%), posttraumatic stress disorder (59%), depressive disorders (53%), and anxiety disorders (43%).

About two-thirds of psychiatrists reported recommending over-the-counter antihistamines and nearly 40% had recommended melatonin, although it is not clear whether this was at bedtime for its mild hypnotic effects or earlier in the evening as a chronobiotic for circadian rhythm disruption, Dr. Owens said. Use of herbal remedies was fairly low (19% or less) in the study, which was funded by Sanofi-Aventis.

Overall use of these agents was similar across four clinical groups: mental retardation and developmental disabilities (MR/DD), attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, and mood disorders. Significant differences did emerge across groups for prescription medication use.

α-Agonists such as clonidine (Catapres) were the most commonly prescribed insomnia medications for children with ADHD (81%). The rate was comparable to that found in an earlier survey involving 671 community-based pediatricians conducted by Dr. Owens and her colleagues (Pediatrics 2003;111[5 pt.1]:e628–35).

The use of α-agonists was significantly higher among children with ADHD than among those with MR/DD or mood and anxiety disorders.

Trazodone (Desyrel) was the medication of choice for children with mood (78%) and anxiety disorders (72%), whereas α-agonist use dropped considerably (31% and 40%, respectively). Somewhat understandably, there was an increase in prescriptions for antidepressants of all types, Dr. Owens said.

Anticonvulsants were significantly more likely to be prescribed for children with mood disorders than for all other groups.

Prescription antihistamines were used by at least one-third of psychiatrists to manage insomnia in each of the clinical groups; while the use of benzodiazepines increased in the groups from ADHD (12%), MR/DD (21%), and mood disorders (36%) to anxiety disorder (47%), Dr. Owens said in an interview.

Non-benzodiazepine short-acting hypnotics were used fairly infrequently in any group by child psychiatrists, despite their benign side-effect profile and being the only ones listed specifically developed for insomnia. This finding was true also among pediatricians in Dr. Owens' earlier survey.

Atypical antipsychotics were used significantly more often in the MR/DD group and mood-disordered group (greater than 50%) than they were in the ADHD or anxiety-disordered group (less than 33%).

The relatively high use in the two groups was somewhat surprising, given the drugs' side-effect profile and limited pediatric experience with this class of medication in general, Dr. Owens reported.

Finally, use of adult sleep medications such as chloral hydrate (4%–8%) and barbiturates (0.5%–1.3%) was too low among all four clinical groups for comparison.

The second study involving 9,440 pediatric inpatients (mean age 7.4 years) at three children's hospitals indicates that 562 (6%) of all hospitalized patients and 993 (22%) of the 4,513 children in the inpatient psychiatric unit were prescribed sleep medication, Dr. Owens said.

Overall, 22 medications in eight classes were included as sleep medications if the child received the medication as a once-daily or an as-needed dosing between the hours of 6 p.m. and 4 a.m.

Sleep medications were more likely to be prescribed for shorter hospitalizations and almost three times more likely if the patient had a psychiatric diagnosis, especially children with autism spectrum disorders and ADHD, regardless of whether they were in a psychiatric unit or not, Dr. Owens said.

Antihistamines were the most commonly prescribed agent, followed by benzodiazepines, antipsychotics, α agonists, antidepressants, selective serotonin reuptake inhibitors, chloral hydrate, and non-benzodiazepine hypnotics, Dr. Owens said.

ELSEVIER GLOBAL MEDICAL NEWS

NEW YORK — The use of sleep medications in children is considerable in clinical practice in inpatient and outpatient settings, data from two new studies show.

A survey of 1,271 practicing child psychiatrists indicates that 25% of school-age and 30% of adolescent outpatients with primary insomnia are being treated with sleep medication.

“Even 17% of preschoolers are being treated with medication,” Dr. Judith Owens said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.

The survey respondents were members of AACAP, 47% of the respondents were female, 84% were white, and 58% were affiliated with a medical school. Many of the respondents (33%) had been in practice for more than 20 years.

The respondents reported seeing a median of 70 children per month, most of them were aged 6 years or older. They indicated that insomnia was a major problem in 28% of their school-age and 32% of their adolescent patients, Dr. Owens, a pediatrician at Brown University and director of the Pediatric Sleep Disorders Clinic at the Hasbro Children's Hospital, both in Providence, R.I., and her colleagues reported.

The percentage of respondents who recommended medication for insomnia one-half of the time or more was high in primary insomnia (75%) and delayed sleep phase syndrome (51%), as well as psychiatric disorders such as bipolar disorder (62%), posttraumatic stress disorder (59%), depressive disorders (53%), and anxiety disorders (43%).

About two-thirds of psychiatrists reported recommending over-the-counter antihistamines and nearly 40% had recommended melatonin, although it is not clear whether this was at bedtime for its mild hypnotic effects or earlier in the evening as a chronobiotic for circadian rhythm disruption, Dr. Owens said. Use of herbal remedies was fairly low (19% or less) in the study, which was funded by Sanofi-Aventis.

Overall use of these agents was similar across four clinical groups: mental retardation and developmental disabilities (MR/DD), attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, and mood disorders. Significant differences did emerge across groups for prescription medication use.

α-Agonists such as clonidine (Catapres) were the most commonly prescribed insomnia medications for children with ADHD (81%). The rate was comparable to that found in an earlier survey involving 671 community-based pediatricians conducted by Dr. Owens and her colleagues (Pediatrics 2003;111[5 pt.1]:e628–35).

The use of α-agonists was significantly higher among children with ADHD than among those with MR/DD or mood and anxiety disorders.

Trazodone (Desyrel) was the medication of choice for children with mood (78%) and anxiety disorders (72%), whereas α-agonist use dropped considerably (31% and 40%, respectively). Somewhat understandably, there was an increase in prescriptions for antidepressants of all types, Dr. Owens said.

Anticonvulsants were significantly more likely to be prescribed for children with mood disorders than for all other groups.

Prescription antihistamines were used by at least one-third of psychiatrists to manage insomnia in each of the clinical groups; while the use of benzodiazepines increased in the groups from ADHD (12%), MR/DD (21%), and mood disorders (36%) to anxiety disorder (47%), Dr. Owens said in an interview.

Non-benzodiazepine short-acting hypnotics were used fairly infrequently in any group by child psychiatrists, despite their benign side-effect profile and being the only ones listed specifically developed for insomnia. This finding was true also among pediatricians in Dr. Owens' earlier survey.

Atypical antipsychotics were used significantly more often in the MR/DD group and mood-disordered group (greater than 50%) than they were in the ADHD or anxiety-disordered group (less than 33%).

The relatively high use in the two groups was somewhat surprising, given the drugs' side-effect profile and limited pediatric experience with this class of medication in general, Dr. Owens reported.

Finally, use of adult sleep medications such as chloral hydrate (4%–8%) and barbiturates (0.5%–1.3%) was too low among all four clinical groups for comparison.

The second study involving 9,440 pediatric inpatients (mean age 7.4 years) at three children's hospitals indicates that 562 (6%) of all hospitalized patients and 993 (22%) of the 4,513 children in the inpatient psychiatric unit were prescribed sleep medication, Dr. Owens said.

Overall, 22 medications in eight classes were included as sleep medications if the child received the medication as a once-daily or an as-needed dosing between the hours of 6 p.m. and 4 a.m.

Sleep medications were more likely to be prescribed for shorter hospitalizations and almost three times more likely if the patient had a psychiatric diagnosis, especially children with autism spectrum disorders and ADHD, regardless of whether they were in a psychiatric unit or not, Dr. Owens said.

Antihistamines were the most commonly prescribed agent, followed by benzodiazepines, antipsychotics, α agonists, antidepressants, selective serotonin reuptake inhibitors, chloral hydrate, and non-benzodiazepine hypnotics, Dr. Owens said.

ELSEVIER GLOBAL MEDICAL NEWS

NEW YORK — The use of sleep medications in children is considerable in clinical practice in inpatient and outpatient settings, data from two new studies show.

A survey of 1,271 practicing child psychiatrists indicates that 25% of school-age and 30% of adolescent outpatients with primary insomnia are being treated with sleep medication.

“Even 17% of preschoolers are being treated with medication,” Dr. Judith Owens said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.

The survey respondents were members of AACAP, 47% of the respondents were female, 84% were white, and 58% were affiliated with a medical school. Many of the respondents (33%) had been in practice for more than 20 years.

The respondents reported seeing a median of 70 children per month, most of them were aged 6 years or older. They indicated that insomnia was a major problem in 28% of their school-age and 32% of their adolescent patients, Dr. Owens, a pediatrician at Brown University and director of the Pediatric Sleep Disorders Clinic at the Hasbro Children's Hospital, both in Providence, R.I., and her colleagues reported.

The percentage of respondents who recommended medication for insomnia one-half of the time or more was high in primary insomnia (75%) and delayed sleep phase syndrome (51%), as well as psychiatric disorders such as bipolar disorder (62%), posttraumatic stress disorder (59%), depressive disorders (53%), and anxiety disorders (43%).

About two-thirds of psychiatrists reported recommending over-the-counter antihistamines and nearly 40% had recommended melatonin, although it is not clear whether this was at bedtime for its mild hypnotic effects or earlier in the evening as a chronobiotic for circadian rhythm disruption, Dr. Owens said. Use of herbal remedies was fairly low (19% or less) in the study, which was funded by Sanofi-Aventis.

Overall use of these agents was similar across four clinical groups: mental retardation and developmental disabilities (MR/DD), attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, and mood disorders. Significant differences did emerge across groups for prescription medication use.

α-Agonists such as clonidine (Catapres) were the most commonly prescribed insomnia medications for children with ADHD (81%). The rate was comparable to that found in an earlier survey involving 671 community-based pediatricians conducted by Dr. Owens and her colleagues (Pediatrics 2003;111[5 pt.1]:e628–35).

The use of α-agonists was significantly higher among children with ADHD than among those with MR/DD or mood and anxiety disorders.

Trazodone (Desyrel) was the medication of choice for children with mood (78%) and anxiety disorders (72%), whereas α-agonist use dropped considerably (31% and 40%, respectively). Somewhat understandably, there was an increase in prescriptions for antidepressants of all types, Dr. Owens said.

Anticonvulsants were significantly more likely to be prescribed for children with mood disorders than for all other groups.

Prescription antihistamines were used by at least one-third of psychiatrists to manage insomnia in each of the clinical groups; while the use of benzodiazepines increased in the groups from ADHD (12%), MR/DD (21%), and mood disorders (36%) to anxiety disorder (47%), Dr. Owens said in an interview.

Non-benzodiazepine short-acting hypnotics were used fairly infrequently in any group by child psychiatrists, despite their benign side-effect profile and being the only ones listed specifically developed for insomnia. This finding was true also among pediatricians in Dr. Owens' earlier survey.

Atypical antipsychotics were used significantly more often in the MR/DD group and mood-disordered group (greater than 50%) than they were in the ADHD or anxiety-disordered group (less than 33%).

The relatively high use in the two groups was somewhat surprising, given the drugs' side-effect profile and limited pediatric experience with this class of medication in general, Dr. Owens reported.

Finally, use of adult sleep medications such as chloral hydrate (4%–8%) and barbiturates (0.5%–1.3%) was too low among all four clinical groups for comparison.

The second study involving 9,440 pediatric inpatients (mean age 7.4 years) at three children's hospitals indicates that 562 (6%) of all hospitalized patients and 993 (22%) of the 4,513 children in the inpatient psychiatric unit were prescribed sleep medication, Dr. Owens said.

Overall, 22 medications in eight classes were included as sleep medications if the child received the medication as a once-daily or an as-needed dosing between the hours of 6 p.m. and 4 a.m.

Sleep medications were more likely to be prescribed for shorter hospitalizations and almost three times more likely if the patient had a psychiatric diagnosis, especially children with autism spectrum disorders and ADHD, regardless of whether they were in a psychiatric unit or not, Dr. Owens said.

Antihistamines were the most commonly prescribed agent, followed by benzodiazepines, antipsychotics, α agonists, antidepressants, selective serotonin reuptake inhibitors, chloral hydrate, and non-benzodiazepine hypnotics, Dr. Owens said.

ELSEVIER GLOBAL MEDICAL NEWS

KANSAS CITY, MO. — Almost 1 in 10 foreign-born Asian Americans is chronically infected with hepatitis B virus, according to data from the largest study of hepatitis B infection in Asian Americans to date.

Free serological screening that was conducted from 2001 to 2006 in 3,163 Asian American adults who were living in the San Francisco Bay area revealed that 283 (9%) were chronically infected with hepatitis B.

Two-thirds (65%) of those chronically infected were unaware that they were infected, reported Steven Lin, Ellen Chang, Sc.D., and Dr. Samuel So in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Blood samples were collected by venipuncture and tested for both hepatitis B surface antigen (HBsAg) and surface antibody (HBsAb) or for HBsAg alone.

The volunteer sample included participants from China (1,016), East Asia excluding China (1,072), Southeast Asia/Pacific Islands (298), the United States (153), other Asian countries (15), and unknown or missing locations (609).

The mean age of the participants was 53 years (range, 18–101).

Participants who were born in East Asia, Southeast Asia, or the Pacific Islands were about 20 times more likely to be chronically infected than were those participants who had been born in the United States (10.7% HBsAg-positive vs. 0.7%, respectively).

The rates of infection for each group were as follows: 113 (11%) from China, 103 (9.6%) from East Asia excluding China, 40 (13.4%) from Southeast Asia/Pacific Islands, 1 (0.7%) from the United States, 0 from other Asian countries, and 26 (4.3%) from unknown or missing locations.

Of the 1,523 individuals who were tested for HBsAb, 682 (45%) lacked protective antibodies against HBV and were susceptible to future infection, reported Mr. Lin, a medical student at Stanford (Calif.) University, and his colleagues from Stanford's Asian Liver Center.

Only 381 participants (12%) reported having been vaccinated against HBV. Of these, 20 (5.2%) were found to be chronically infected with HBV. The researchers found that U.S.-born Asian Americans had a higher risk of being unprotected than did their China-born counterparts (47% vs. 42%).

In December 2006, the CDC published a comprehensive immunization strategy to increase hepatitis B vaccination coverage among adults, who in 2005 accounted for 95% of an estimated 51,000 new hepatitis B infections in the U.S.

HBV infection is associated with a 25% risk of death if it is left unmonitored or untreated. Asian Americans are more than twice as likely as their white counterparts to die from liver cancer, because of their high prevalence of chronic HBV infection

“Given the serious medical implications of this study, a strong public health response is needed,” the authors concluded in their presentation.

“In support of the newly released Centers for Disease Control and Prevention recommendations, we call for all foreign-born Asian American adults to be screened for HBV—regardless of their vaccination status.”

KANSAS CITY, MO. — Almost 1 in 10 foreign-born Asian Americans is chronically infected with hepatitis B virus, according to data from the largest study of hepatitis B infection in Asian Americans to date.

Free serological screening that was conducted from 2001 to 2006 in 3,163 Asian American adults who were living in the San Francisco Bay area revealed that 283 (9%) were chronically infected with hepatitis B.

Two-thirds (65%) of those chronically infected were unaware that they were infected, reported Steven Lin, Ellen Chang, Sc.D., and Dr. Samuel So in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Blood samples were collected by venipuncture and tested for both hepatitis B surface antigen (HBsAg) and surface antibody (HBsAb) or for HBsAg alone.

The volunteer sample included participants from China (1,016), East Asia excluding China (1,072), Southeast Asia/Pacific Islands (298), the United States (153), other Asian countries (15), and unknown or missing locations (609).

The mean age of the participants was 53 years (range, 18–101).

Participants who were born in East Asia, Southeast Asia, or the Pacific Islands were about 20 times more likely to be chronically infected than were those participants who had been born in the United States (10.7% HBsAg-positive vs. 0.7%, respectively).

The rates of infection for each group were as follows: 113 (11%) from China, 103 (9.6%) from East Asia excluding China, 40 (13.4%) from Southeast Asia/Pacific Islands, 1 (0.7%) from the United States, 0 from other Asian countries, and 26 (4.3%) from unknown or missing locations.

Of the 1,523 individuals who were tested for HBsAb, 682 (45%) lacked protective antibodies against HBV and were susceptible to future infection, reported Mr. Lin, a medical student at Stanford (Calif.) University, and his colleagues from Stanford's Asian Liver Center.

Only 381 participants (12%) reported having been vaccinated against HBV. Of these, 20 (5.2%) were found to be chronically infected with HBV. The researchers found that U.S.-born Asian Americans had a higher risk of being unprotected than did their China-born counterparts (47% vs. 42%).

In December 2006, the CDC published a comprehensive immunization strategy to increase hepatitis B vaccination coverage among adults, who in 2005 accounted for 95% of an estimated 51,000 new hepatitis B infections in the U.S.

HBV infection is associated with a 25% risk of death if it is left unmonitored or untreated. Asian Americans are more than twice as likely as their white counterparts to die from liver cancer, because of their high prevalence of chronic HBV infection

“Given the serious medical implications of this study, a strong public health response is needed,” the authors concluded in their presentation.

“In support of the newly released Centers for Disease Control and Prevention recommendations, we call for all foreign-born Asian American adults to be screened for HBV—regardless of their vaccination status.”

KANSAS CITY, MO. — Almost 1 in 10 foreign-born Asian Americans is chronically infected with hepatitis B virus, according to data from the largest study of hepatitis B infection in Asian Americans to date.

Free serological screening that was conducted from 2001 to 2006 in 3,163 Asian American adults who were living in the San Francisco Bay area revealed that 283 (9%) were chronically infected with hepatitis B.

Two-thirds (65%) of those chronically infected were unaware that they were infected, reported Steven Lin, Ellen Chang, Sc.D., and Dr. Samuel So in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Blood samples were collected by venipuncture and tested for both hepatitis B surface antigen (HBsAg) and surface antibody (HBsAb) or for HBsAg alone.

The volunteer sample included participants from China (1,016), East Asia excluding China (1,072), Southeast Asia/Pacific Islands (298), the United States (153), other Asian countries (15), and unknown or missing locations (609).

The mean age of the participants was 53 years (range, 18–101).

Participants who were born in East Asia, Southeast Asia, or the Pacific Islands were about 20 times more likely to be chronically infected than were those participants who had been born in the United States (10.7% HBsAg-positive vs. 0.7%, respectively).

The rates of infection for each group were as follows: 113 (11%) from China, 103 (9.6%) from East Asia excluding China, 40 (13.4%) from Southeast Asia/Pacific Islands, 1 (0.7%) from the United States, 0 from other Asian countries, and 26 (4.3%) from unknown or missing locations.

Of the 1,523 individuals who were tested for HBsAb, 682 (45%) lacked protective antibodies against HBV and were susceptible to future infection, reported Mr. Lin, a medical student at Stanford (Calif.) University, and his colleagues from Stanford's Asian Liver Center.

Only 381 participants (12%) reported having been vaccinated against HBV. Of these, 20 (5.2%) were found to be chronically infected with HBV. The researchers found that U.S.-born Asian Americans had a higher risk of being unprotected than did their China-born counterparts (47% vs. 42%).

In December 2006, the CDC published a comprehensive immunization strategy to increase hepatitis B vaccination coverage among adults, who in 2005 accounted for 95% of an estimated 51,000 new hepatitis B infections in the U.S.

HBV infection is associated with a 25% risk of death if it is left unmonitored or untreated. Asian Americans are more than twice as likely as their white counterparts to die from liver cancer, because of their high prevalence of chronic HBV infection

“Given the serious medical implications of this study, a strong public health response is needed,” the authors concluded in their presentation.

“In support of the newly released Centers for Disease Control and Prevention recommendations, we call for all foreign-born Asian American adults to be screened for HBV—regardless of their vaccination status.”

NEW ORLEANS — Serum alanine aminotransferase, a noninvasive marker commonly used to assess nonalcoholic fatty liver and related liver dysfunction, appears to be useful in identifying children with metabolic syndrome and its components.

“Elevations of alanine aminotransferase within normal range relate strongly to metabolic syndrome and its components and may help improve the risk assessment of this condition in the pediatric population,” Dr. Dharmendrakumar Patel said at the Southern regional meeting of the American Federation for Medical Research.

Dr. Patel and colleagues from the Tulane (University) Center for Cardiovascular Health in New Orleans reported data from 1,524 children aged 4–11 years (62% white, 51% male) and 1,060 adolescents aged 12–18 years (58% white, 51% male) examined as part of the Bogalusa Heart Study.

Serum alanine aminotransferase (ALT) and cardiovascular risk factors were measured at baseline. The acceptable cutoff points for the metabolic variables aren't established for children, so adverse levels were defined as values above the age-, race-, and gender-specific 75th percentiles of body mass index (BMI), systolic blood pressure, ratio of total cholesterol to HDL cholesterol, and homeostatis model assessment: insulin resistance (HOMA-IR). A clustering of adverse levels of all four variables denoted metabolic syndrome. Age-, race-, and gender-specific quartiles of ALT were used for analysis.

Overall, 25% of children and 29% of adolescents in the top quartile of ALT had adverse levels of three or four metabolic syndrome risk factors. This clustering was significantly higher than expected, Dr. Patel said.

When the researchers used an area under the receiver operating curve, the diagnostic accuracy of ALT to classify pediatric patients with metabolic syndrome was 67% in children and 82% in adolescents.

ALT levels were significantly higher in white children, compared with black children and in male adolescents, compared with female adolescents, said Dr. Patel, a research analyst and field epidemiologist at the center.

In children, the average ALT level was 17 U/L in both white boys and girls, compared with 16 U/L in black boys and 15.3 U/L in black girls.

In adolescents, the average ALT level was 19 U/L in both white and black boys, compared with 16 U/L in white girls and 14.6 U/L in black girls.

Children and adolescents with ALT levels in the top quartiles, compared with the bottom quartiles, had an increased prevalence of adverse levels of body mass index, systolic blood pressure, ratio of total cholesterol to HDL cholesterol, and HOMA-IR index, as well as metabolic syndrome.

Upon multivariate analyses, body mass index was the most important independent predictor of ALT levels in both groups. The odds ratio for an abnormal or elevated ALT level was 2.2 for children and 1.8 for adolescents with BMIs above the 75th percentile for age, gender, and race. Other significant independent predictors were white race in children; and total cholesterol to HDL cholesterol ratio, HOMA-IR, and male gender in adolescents.

NEW ORLEANS — Serum alanine aminotransferase, a noninvasive marker commonly used to assess nonalcoholic fatty liver and related liver dysfunction, appears to be useful in identifying children with metabolic syndrome and its components.

“Elevations of alanine aminotransferase within normal range relate strongly to metabolic syndrome and its components and may help improve the risk assessment of this condition in the pediatric population,” Dr. Dharmendrakumar Patel said at the Southern regional meeting of the American Federation for Medical Research.

Dr. Patel and colleagues from the Tulane (University) Center for Cardiovascular Health in New Orleans reported data from 1,524 children aged 4–11 years (62% white, 51% male) and 1,060 adolescents aged 12–18 years (58% white, 51% male) examined as part of the Bogalusa Heart Study.

Serum alanine aminotransferase (ALT) and cardiovascular risk factors were measured at baseline. The acceptable cutoff points for the metabolic variables aren't established for children, so adverse levels were defined as values above the age-, race-, and gender-specific 75th percentiles of body mass index (BMI), systolic blood pressure, ratio of total cholesterol to HDL cholesterol, and homeostatis model assessment: insulin resistance (HOMA-IR). A clustering of adverse levels of all four variables denoted metabolic syndrome. Age-, race-, and gender-specific quartiles of ALT were used for analysis.

Overall, 25% of children and 29% of adolescents in the top quartile of ALT had adverse levels of three or four metabolic syndrome risk factors. This clustering was significantly higher than expected, Dr. Patel said.

When the researchers used an area under the receiver operating curve, the diagnostic accuracy of ALT to classify pediatric patients with metabolic syndrome was 67% in children and 82% in adolescents.

ALT levels were significantly higher in white children, compared with black children and in male adolescents, compared with female adolescents, said Dr. Patel, a research analyst and field epidemiologist at the center.

In children, the average ALT level was 17 U/L in both white boys and girls, compared with 16 U/L in black boys and 15.3 U/L in black girls.

In adolescents, the average ALT level was 19 U/L in both white and black boys, compared with 16 U/L in white girls and 14.6 U/L in black girls.

Children and adolescents with ALT levels in the top quartiles, compared with the bottom quartiles, had an increased prevalence of adverse levels of body mass index, systolic blood pressure, ratio of total cholesterol to HDL cholesterol, and HOMA-IR index, as well as metabolic syndrome.

Upon multivariate analyses, body mass index was the most important independent predictor of ALT levels in both groups. The odds ratio for an abnormal or elevated ALT level was 2.2 for children and 1.8 for adolescents with BMIs above the 75th percentile for age, gender, and race. Other significant independent predictors were white race in children; and total cholesterol to HDL cholesterol ratio, HOMA-IR, and male gender in adolescents.

NEW ORLEANS — Serum alanine aminotransferase, a noninvasive marker commonly used to assess nonalcoholic fatty liver and related liver dysfunction, appears to be useful in identifying children with metabolic syndrome and its components.

“Elevations of alanine aminotransferase within normal range relate strongly to metabolic syndrome and its components and may help improve the risk assessment of this condition in the pediatric population,” Dr. Dharmendrakumar Patel said at the Southern regional meeting of the American Federation for Medical Research.

Dr. Patel and colleagues from the Tulane (University) Center for Cardiovascular Health in New Orleans reported data from 1,524 children aged 4–11 years (62% white, 51% male) and 1,060 adolescents aged 12–18 years (58% white, 51% male) examined as part of the Bogalusa Heart Study.

Serum alanine aminotransferase (ALT) and cardiovascular risk factors were measured at baseline. The acceptable cutoff points for the metabolic variables aren't established for children, so adverse levels were defined as values above the age-, race-, and gender-specific 75th percentiles of body mass index (BMI), systolic blood pressure, ratio of total cholesterol to HDL cholesterol, and homeostatis model assessment: insulin resistance (HOMA-IR). A clustering of adverse levels of all four variables denoted metabolic syndrome. Age-, race-, and gender-specific quartiles of ALT were used for analysis.

Overall, 25% of children and 29% of adolescents in the top quartile of ALT had adverse levels of three or four metabolic syndrome risk factors. This clustering was significantly higher than expected, Dr. Patel said.

When the researchers used an area under the receiver operating curve, the diagnostic accuracy of ALT to classify pediatric patients with metabolic syndrome was 67% in children and 82% in adolescents.

ALT levels were significantly higher in white children, compared with black children and in male adolescents, compared with female adolescents, said Dr. Patel, a research analyst and field epidemiologist at the center.

In children, the average ALT level was 17 U/L in both white boys and girls, compared with 16 U/L in black boys and 15.3 U/L in black girls.

In adolescents, the average ALT level was 19 U/L in both white and black boys, compared with 16 U/L in white girls and 14.6 U/L in black girls.

Children and adolescents with ALT levels in the top quartiles, compared with the bottom quartiles, had an increased prevalence of adverse levels of body mass index, systolic blood pressure, ratio of total cholesterol to HDL cholesterol, and HOMA-IR index, as well as metabolic syndrome.

Upon multivariate analyses, body mass index was the most important independent predictor of ALT levels in both groups. The odds ratio for an abnormal or elevated ALT level was 2.2 for children and 1.8 for adolescents with BMIs above the 75th percentile for age, gender, and race. Other significant independent predictors were white race in children; and total cholesterol to HDL cholesterol ratio, HOMA-IR, and male gender in adolescents.

NEW ORLEANS — Infections with genotypes not contained in the newly approved human papillomavirus vaccine are common among adolescent girls positive for the virus, Dr. Roshan George said at the Southern regional meeting of the American Federation for Medical Research.

She presented results from the first 32 patients, aged 16–18 years, in an ongoing genotype study of adolescents with atypical squamous cells of undetermined significance and human papillomavirus (HPV) infection. None of the girls had been immunized with the new vaccine containing HPV genotypes 6, 11, 16, and 18 (Gardasil).

Genotype results available from 29 of the 32 girls identified 53 isolates, of which 38% were vaccine genotypes and 62% were nonvaccine genotypes.

Sixteen girls (55%) were infected with more than one genotype, seven (24%) with more than two genotypes, and two girls (7%) were infected with four genotypes, said Dr. George, a pediatrician with Louisiana State University Health Sciences Center in Shreveport.

Just 17% of girls were infected only with genotypes covered by the vaccine, 38% were infected with the vaccine genotypes plus other types, and 45% were infected only with genotypes not covered by the vaccine.

“[These data support] recommendations that cervical screening should be continued even in females receiving the vaccine,” Dr. George said.

Epidemiology studies have shown an HPV prevalence rate of 25%–40% in young women. Adolescents acquire HPV rapidly after sexual initiation, and often have concomitant sexually transmitted diseases.

“I was definitely not surprised that almost 55% had a concomitant STD, but I was surprised to see that 50% were pregnant, two had four genotypes, and 45% were not covered by vaccine strains,” Dr. George said in an interview. “That's why it's important we keep screening.”

Dr. George recommends that HPV genotyping, which is not federally approved for this application, should be performed only in those patients with abnormal cytology or carcinoma in situ on their routine Pap test.

The investigators extracted DNA from ThinPrep liquid Pap smear specimens taken from the patients and used polymerase chain reaction to amplify HPV targets overnight before using xMAP (Luminex) bead-based assay technology to detect the DNA.

The reagent beads or microspheres are embedded with HPV probes that are color coded into subsets specific for 1 of 19 HPV genotypes. Thus, each of the 19 probes is associated with a microsphere of a specific dye color and will bind to its complementary target DNA, Dr. George explained.

High-risk HPV genotypes 16 and 18, which cause 70% of cervical cancers, were found in 19% and 5.6% of isolates. Low-risk types 6 and 11, which can cause genital warts and lead to low-grade dysplasia, were found in 5.6% and 7.6% of isolates. HPV genotypes 57, 45, 31, 35, and 58 were also found in roughly 7.5% of isolates. No detectable genotype was found in two specimens and one patient had a low-risk type not detected by the assay, the investigators reported.

The study was funded by the Digene Corp., which markets the reagents used in the study.

Of 53 isolates identified in results from 29 of 32 girls, 62% were nonvaccine genotypes. DR. GEORGE

NEW ORLEANS — Infections with genotypes not contained in the newly approved human papillomavirus vaccine are common among adolescent girls positive for the virus, Dr. Roshan George said at the Southern regional meeting of the American Federation for Medical Research.

She presented results from the first 32 patients, aged 16–18 years, in an ongoing genotype study of adolescents with atypical squamous cells of undetermined significance and human papillomavirus (HPV) infection. None of the girls had been immunized with the new vaccine containing HPV genotypes 6, 11, 16, and 18 (Gardasil).

Genotype results available from 29 of the 32 girls identified 53 isolates, of which 38% were vaccine genotypes and 62% were nonvaccine genotypes.

Sixteen girls (55%) were infected with more than one genotype, seven (24%) with more than two genotypes, and two girls (7%) were infected with four genotypes, said Dr. George, a pediatrician with Louisiana State University Health Sciences Center in Shreveport.

Just 17% of girls were infected only with genotypes covered by the vaccine, 38% were infected with the vaccine genotypes plus other types, and 45% were infected only with genotypes not covered by the vaccine.

“[These data support] recommendations that cervical screening should be continued even in females receiving the vaccine,” Dr. George said.

Epidemiology studies have shown an HPV prevalence rate of 25%–40% in young women. Adolescents acquire HPV rapidly after sexual initiation, and often have concomitant sexually transmitted diseases.

“I was definitely not surprised that almost 55% had a concomitant STD, but I was surprised to see that 50% were pregnant, two had four genotypes, and 45% were not covered by vaccine strains,” Dr. George said in an interview. “That's why it's important we keep screening.”

Dr. George recommends that HPV genotyping, which is not federally approved for this application, should be performed only in those patients with abnormal cytology or carcinoma in situ on their routine Pap test.

The investigators extracted DNA from ThinPrep liquid Pap smear specimens taken from the patients and used polymerase chain reaction to amplify HPV targets overnight before using xMAP (Luminex) bead-based assay technology to detect the DNA.

The reagent beads or microspheres are embedded with HPV probes that are color coded into subsets specific for 1 of 19 HPV genotypes. Thus, each of the 19 probes is associated with a microsphere of a specific dye color and will bind to its complementary target DNA, Dr. George explained.

High-risk HPV genotypes 16 and 18, which cause 70% of cervical cancers, were found in 19% and 5.6% of isolates. Low-risk types 6 and 11, which can cause genital warts and lead to low-grade dysplasia, were found in 5.6% and 7.6% of isolates. HPV genotypes 57, 45, 31, 35, and 58 were also found in roughly 7.5% of isolates. No detectable genotype was found in two specimens and one patient had a low-risk type not detected by the assay, the investigators reported.

The study was funded by the Digene Corp., which markets the reagents used in the study.

Of 53 isolates identified in results from 29 of 32 girls, 62% were nonvaccine genotypes. DR. GEORGE

NEW ORLEANS — Infections with genotypes not contained in the newly approved human papillomavirus vaccine are common among adolescent girls positive for the virus, Dr. Roshan George said at the Southern regional meeting of the American Federation for Medical Research.

She presented results from the first 32 patients, aged 16–18 years, in an ongoing genotype study of adolescents with atypical squamous cells of undetermined significance and human papillomavirus (HPV) infection. None of the girls had been immunized with the new vaccine containing HPV genotypes 6, 11, 16, and 18 (Gardasil).

Genotype results available from 29 of the 32 girls identified 53 isolates, of which 38% were vaccine genotypes and 62% were nonvaccine genotypes.

Sixteen girls (55%) were infected with more than one genotype, seven (24%) with more than two genotypes, and two girls (7%) were infected with four genotypes, said Dr. George, a pediatrician with Louisiana State University Health Sciences Center in Shreveport.

Just 17% of girls were infected only with genotypes covered by the vaccine, 38% were infected with the vaccine genotypes plus other types, and 45% were infected only with genotypes not covered by the vaccine.

“[These data support] recommendations that cervical screening should be continued even in females receiving the vaccine,” Dr. George said.

Epidemiology studies have shown an HPV prevalence rate of 25%–40% in young women. Adolescents acquire HPV rapidly after sexual initiation, and often have concomitant sexually transmitted diseases.

“I was definitely not surprised that almost 55% had a concomitant STD, but I was surprised to see that 50% were pregnant, two had four genotypes, and 45% were not covered by vaccine strains,” Dr. George said in an interview. “That's why it's important we keep screening.”

Dr. George recommends that HPV genotyping, which is not federally approved for this application, should be performed only in those patients with abnormal cytology or carcinoma in situ on their routine Pap test.

The investigators extracted DNA from ThinPrep liquid Pap smear specimens taken from the patients and used polymerase chain reaction to amplify HPV targets overnight before using xMAP (Luminex) bead-based assay technology to detect the DNA.

The reagent beads or microspheres are embedded with HPV probes that are color coded into subsets specific for 1 of 19 HPV genotypes. Thus, each of the 19 probes is associated with a microsphere of a specific dye color and will bind to its complementary target DNA, Dr. George explained.

High-risk HPV genotypes 16 and 18, which cause 70% of cervical cancers, were found in 19% and 5.6% of isolates. Low-risk types 6 and 11, which can cause genital warts and lead to low-grade dysplasia, were found in 5.6% and 7.6% of isolates. HPV genotypes 57, 45, 31, 35, and 58 were also found in roughly 7.5% of isolates. No detectable genotype was found in two specimens and one patient had a low-risk type not detected by the assay, the investigators reported.

The study was funded by the Digene Corp., which markets the reagents used in the study.

Of 53 isolates identified in results from 29 of 32 girls, 62% were nonvaccine genotypes. DR. GEORGE

NEW ORLEANS — Race affects diabetes control and abnormal lipid profiles in children with type 1 diabetes, Dr. Ambika Ashraf said at the Southern regional meeting of the American Federation for Medical Research.

Total cholesterol, LDL cholesterol, HDL cholesterol, and non-HDL cholesterol levels are significantly affected by chronic glycemic control over time, and “in our cohort, African Americans exhibited poor glycemic control,” she said.

African American children had significantly higher total cholesterol (TC) levels (175 mg/dL vs. 164 mg/dL), glycosylated hemoglobin (HbA_1c) levels (10.6% vs. 8.7%), and body mass indices (21 kg/m

However, the African American children had significantly higher levels of protective HDL cholesterol (66 mg/dL vs. 56 mg/dL) and better TC:HDL ratios (2.7 vs. 3.1), Dr. Ashraf, a pediatric endocrinologist at the University of Alabama, Birmingham, and colleagues reported.

The study is the first to shed light on racial differences in pediatric patients with type 1 diabetes, she said. Research has shown that HDL cholesterol levels are higher in African American adults with type 2 diabetes (Diabetes Care 2000;23:319–24) and that HDL and TC levels are higher in black children without type 1 diabetes (Prev. Med. 1998;27:879–90).

A recent study also demonstrated a significant association between HbA_1c, TC, and non-HDL cholesterol in children with type 1 diabetes, but did not evaluate racial differences (J. Pediatr. 2007;150:146–50e2).

Average values for the lipid variables were based on 528 tests performed at multiple time points. Triglyceride measurements were not evaluated because the investigators couldn't ensure the fasting status at the time of the lipid profiles, a fact that Dr. Ashraf acknowledged was a limitation of the study.

The average values for all children in the study were TC 168 mg/dL, HDL cholesterol 59 mg/dL, and LDL cholesterol 85 mg/dL. In comparison, the average values in the general population of children aged 4–19 years are TC 165 mg/dL, HDL cholesterol 50 mg/dL, and LDL cholesterol 95 mg/dL, based on 1999–2004 National Health and Nutrition Examination Survey (NHANES III) data.

Total cholesterol was greater than 200 mg/dL in 13% of patients, whereas LDL cholesterol was greater than 130 mg/dL in 5%, Dr. Ashraf said. HDL cholesterol was less than the optimal level in only 3% of patients. The optimal HDL cholesterol level for children with diabetes has been defined as greater than 35 mg/dL (Diabetes Care 2003;26:2194–7).

Significant differences were observed between genders. Females had higher BMI (21 kg/m

Using a multivariate regression analysis, the investigators identified a positive association between BMI and non-HDL cholesterol levels, LDL cholesterol levels, and TC:HDL cholesterol ratio; and a negative association between BMI and HDL cholesterol levels. There was no significant association between BMI and TC.

In mixed-model longitudinal data analyses, HbA_1c was significantly related to TC, TC:HDL cholesterol ratio, LDL cholesterol, and non-HDL cholesterol levels after controlling for age, sex, and gender, whereas HbA_1c was inversely related to HDL cholesterol levels.

African American children were more affected by the longitudinal variations in HbA_1c over time, with greater changes in their TC and LDL cholesterol levels versus white children. These trends were significant even after adjustment for the baseline lipid panel values.

African American children had significantly higher total cholesterol and HbA_1c levels than white children. DR. ASHRAF

NEW ORLEANS — Race affects diabetes control and abnormal lipid profiles in children with type 1 diabetes, Dr. Ambika Ashraf said at the Southern regional meeting of the American Federation for Medical Research.

Total cholesterol, LDL cholesterol, HDL cholesterol, and non-HDL cholesterol levels are significantly affected by chronic glycemic control over time, and “in our cohort, African Americans exhibited poor glycemic control,” she said.

African American children had significantly higher total cholesterol (TC) levels (175 mg/dL vs. 164 mg/dL), glycosylated hemoglobin (HbA_1c) levels (10.6% vs. 8.7%), and body mass indices (21 kg/m

However, the African American children had significantly higher levels of protective HDL cholesterol (66 mg/dL vs. 56 mg/dL) and better TC:HDL ratios (2.7 vs. 3.1), Dr. Ashraf, a pediatric endocrinologist at the University of Alabama, Birmingham, and colleagues reported.

The study is the first to shed light on racial differences in pediatric patients with type 1 diabetes, she said. Research has shown that HDL cholesterol levels are higher in African American adults with type 2 diabetes (Diabetes Care 2000;23:319–24) and that HDL and TC levels are higher in black children without type 1 diabetes (Prev. Med. 1998;27:879–90).

A recent study also demonstrated a significant association between HbA_1c, TC, and non-HDL cholesterol in children with type 1 diabetes, but did not evaluate racial differences (J. Pediatr. 2007;150:146–50e2).

Average values for the lipid variables were based on 528 tests performed at multiple time points. Triglyceride measurements were not evaluated because the investigators couldn't ensure the fasting status at the time of the lipid profiles, a fact that Dr. Ashraf acknowledged was a limitation of the study.

The average values for all children in the study were TC 168 mg/dL, HDL cholesterol 59 mg/dL, and LDL cholesterol 85 mg/dL. In comparison, the average values in the general population of children aged 4–19 years are TC 165 mg/dL, HDL cholesterol 50 mg/dL, and LDL cholesterol 95 mg/dL, based on 1999–2004 National Health and Nutrition Examination Survey (NHANES III) data.

Total cholesterol was greater than 200 mg/dL in 13% of patients, whereas LDL cholesterol was greater than 130 mg/dL in 5%, Dr. Ashraf said. HDL cholesterol was less than the optimal level in only 3% of patients. The optimal HDL cholesterol level for children with diabetes has been defined as greater than 35 mg/dL (Diabetes Care 2003;26:2194–7).

Significant differences were observed between genders. Females had higher BMI (21 kg/m

Using a multivariate regression analysis, the investigators identified a positive association between BMI and non-HDL cholesterol levels, LDL cholesterol levels, and TC:HDL cholesterol ratio; and a negative association between BMI and HDL cholesterol levels. There was no significant association between BMI and TC.

In mixed-model longitudinal data analyses, HbA_1c was significantly related to TC, TC:HDL cholesterol ratio, LDL cholesterol, and non-HDL cholesterol levels after controlling for age, sex, and gender, whereas HbA_1c was inversely related to HDL cholesterol levels.

African American children were more affected by the longitudinal variations in HbA_1c over time, with greater changes in their TC and LDL cholesterol levels versus white children. These trends were significant even after adjustment for the baseline lipid panel values.

African American children had significantly higher total cholesterol and HbA_1c levels than white children. DR. ASHRAF

NEW ORLEANS — Race affects diabetes control and abnormal lipid profiles in children with type 1 diabetes, Dr. Ambika Ashraf said at the Southern regional meeting of the American Federation for Medical Research.

Total cholesterol, LDL cholesterol, HDL cholesterol, and non-HDL cholesterol levels are significantly affected by chronic glycemic control over time, and “in our cohort, African Americans exhibited poor glycemic control,” she said.

African American children had significantly higher total cholesterol (TC) levels (175 mg/dL vs. 164 mg/dL), glycosylated hemoglobin (HbA_1c) levels (10.6% vs. 8.7%), and body mass indices (21 kg/m

However, the African American children had significantly higher levels of protective HDL cholesterol (66 mg/dL vs. 56 mg/dL) and better TC:HDL ratios (2.7 vs. 3.1), Dr. Ashraf, a pediatric endocrinologist at the University of Alabama, Birmingham, and colleagues reported.

The study is the first to shed light on racial differences in pediatric patients with type 1 diabetes, she said. Research has shown that HDL cholesterol levels are higher in African American adults with type 2 diabetes (Diabetes Care 2000;23:319–24) and that HDL and TC levels are higher in black children without type 1 diabetes (Prev. Med. 1998;27:879–90).

A recent study also demonstrated a significant association between HbA_1c, TC, and non-HDL cholesterol in children with type 1 diabetes, but did not evaluate racial differences (J. Pediatr. 2007;150:146–50e2).

Average values for the lipid variables were based on 528 tests performed at multiple time points. Triglyceride measurements were not evaluated because the investigators couldn't ensure the fasting status at the time of the lipid profiles, a fact that Dr. Ashraf acknowledged was a limitation of the study.

The average values for all children in the study were TC 168 mg/dL, HDL cholesterol 59 mg/dL, and LDL cholesterol 85 mg/dL. In comparison, the average values in the general population of children aged 4–19 years are TC 165 mg/dL, HDL cholesterol 50 mg/dL, and LDL cholesterol 95 mg/dL, based on 1999–2004 National Health and Nutrition Examination Survey (NHANES III) data.

Total cholesterol was greater than 200 mg/dL in 13% of patients, whereas LDL cholesterol was greater than 130 mg/dL in 5%, Dr. Ashraf said. HDL cholesterol was less than the optimal level in only 3% of patients. The optimal HDL cholesterol level for children with diabetes has been defined as greater than 35 mg/dL (Diabetes Care 2003;26:2194–7).

Significant differences were observed between genders. Females had higher BMI (21 kg/m

Using a multivariate regression analysis, the investigators identified a positive association between BMI and non-HDL cholesterol levels, LDL cholesterol levels, and TC:HDL cholesterol ratio; and a negative association between BMI and HDL cholesterol levels. There was no significant association between BMI and TC.

In mixed-model longitudinal data analyses, HbA_1c was significantly related to TC, TC:HDL cholesterol ratio, LDL cholesterol, and non-HDL cholesterol levels after controlling for age, sex, and gender, whereas HbA_1c was inversely related to HDL cholesterol levels.

African American children were more affected by the longitudinal variations in HbA_1c over time, with greater changes in their TC and LDL cholesterol levels versus white children. These trends were significant even after adjustment for the baseline lipid panel values.

African American children had significantly higher total cholesterol and HbA_1c levels than white children. DR. ASHRAF

NEW ORLEANS — Despite having a higher incidence of metabolic syndrome, women had less obstructive coronary artery disease in a study of 468 patients who presented for elective cardiac catheterization.

Nondiabetic women were significantly more likely to have metabolic syndrome than were their nondiabetic male counterparts (52% vs. 28%), although nondiabetic men had a significantly greater percentage of coronary artery disease (CAD) (42% vs. 18%). Dr. Andrew Weissman and colleagues from Lenox Hill Hospital in New York City reported their findings in a poster at the Southern regional meeting of the American Federation for Medical Research.

The results call into question whether lower cutoffs should be used to identify metabolic syndrome in women or whether the presence of metabolic syndrome itself is truly a risk factor for coronary artery disease, Dr. Weissman said in an interview.

“The goal of identifying metabolic syndrome is to try and pick out those people with a higher risk for coronary artery disease and it doesn't seem to be doing that in nondiabetic females according to the results of our study,” he said.

The study included 277 men (mean age 60 years) and 191 women (mean age 63 years) with no known history of CAD. Metabolic syndrome was evaluated using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria.

The NCEP criteria recommend that metabolic syndrome be identified if three or more of the following risk factors are present: waist circumference of 102 cm or more in men and 88 cm or more in women; elevated triglyceride level of 150 mg/dL or greater; reduced HDL cholesterol level of less than 40 mg/dL in men and less than 50 mg/dL in women; elevated blood pressure of 135/85 mm Hg or greater; and an elevated fasting glucose of 110 mg/dL or greater.

Diabetes mellitus was present in 79 men (28.5%) and 49 women (25.6%), a difference that was not statistically significant.

Metabolic syndrome was present in 233 of 468 patients and was found in a significantly higher percentage of women (62%) than men (41%).

CAD, defined as the presence of 70% or greater stenosis in one of the three major coronary vessels or 50% stenosis in the left main coronary artery, was present in 48 (25%) women and in 132 (48%) men.

There was no significant difference between patients with and without metabolic syndrome with regard to mean Framingham risk score or for age, tobacco use, or family history of CAD, said Dr. Weissman, a third-year cardiology fellow at Lenox Hill Hospital.

However, both men and women with diabetes were significantly more likely to have CAD than were their nondiabetic counterparts.

There was no significant difference in percentage of CAD between men and women with diabetes (62% vs. 45%). There was a trend toward women with diabetes being more likely to have metabolic syndrome than were men with diabetes (90% vs. 75%), but it was not statistically significant, the authors wrote.

Although diabetes is considered a coronary risk equivalent, the independent significance of metabolic syndrome in practice remains controversial.

“The clinical implication is that our study results do not support the use of metabolic syndrome as a useful risk stratifier for coronary artery disease,” Dr. Weissman said.

NEW ORLEANS — Despite having a higher incidence of metabolic syndrome, women had less obstructive coronary artery disease in a study of 468 patients who presented for elective cardiac catheterization.

Nondiabetic women were significantly more likely to have metabolic syndrome than were their nondiabetic male counterparts (52% vs. 28%), although nondiabetic men had a significantly greater percentage of coronary artery disease (CAD) (42% vs. 18%). Dr. Andrew Weissman and colleagues from Lenox Hill Hospital in New York City reported their findings in a poster at the Southern regional meeting of the American Federation for Medical Research.

The results call into question whether lower cutoffs should be used to identify metabolic syndrome in women or whether the presence of metabolic syndrome itself is truly a risk factor for coronary artery disease, Dr. Weissman said in an interview.

“The goal of identifying metabolic syndrome is to try and pick out those people with a higher risk for coronary artery disease and it doesn't seem to be doing that in nondiabetic females according to the results of our study,” he said.

The study included 277 men (mean age 60 years) and 191 women (mean age 63 years) with no known history of CAD. Metabolic syndrome was evaluated using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria.

The NCEP criteria recommend that metabolic syndrome be identified if three or more of the following risk factors are present: waist circumference of 102 cm or more in men and 88 cm or more in women; elevated triglyceride level of 150 mg/dL or greater; reduced HDL cholesterol level of less than 40 mg/dL in men and less than 50 mg/dL in women; elevated blood pressure of 135/85 mm Hg or greater; and an elevated fasting glucose of 110 mg/dL or greater.

Diabetes mellitus was present in 79 men (28.5%) and 49 women (25.6%), a difference that was not statistically significant.

Metabolic syndrome was present in 233 of 468 patients and was found in a significantly higher percentage of women (62%) than men (41%).

CAD, defined as the presence of 70% or greater stenosis in one of the three major coronary vessels or 50% stenosis in the left main coronary artery, was present in 48 (25%) women and in 132 (48%) men.

There was no significant difference between patients with and without metabolic syndrome with regard to mean Framingham risk score or for age, tobacco use, or family history of CAD, said Dr. Weissman, a third-year cardiology fellow at Lenox Hill Hospital.

However, both men and women with diabetes were significantly more likely to have CAD than were their nondiabetic counterparts.

There was no significant difference in percentage of CAD between men and women with diabetes (62% vs. 45%). There was a trend toward women with diabetes being more likely to have metabolic syndrome than were men with diabetes (90% vs. 75%), but it was not statistically significant, the authors wrote.

Although diabetes is considered a coronary risk equivalent, the independent significance of metabolic syndrome in practice remains controversial.

“The clinical implication is that our study results do not support the use of metabolic syndrome as a useful risk stratifier for coronary artery disease,” Dr. Weissman said.

NEW ORLEANS — Despite having a higher incidence of metabolic syndrome, women had less obstructive coronary artery disease in a study of 468 patients who presented for elective cardiac catheterization.

Nondiabetic women were significantly more likely to have metabolic syndrome than were their nondiabetic male counterparts (52% vs. 28%), although nondiabetic men had a significantly greater percentage of coronary artery disease (CAD) (42% vs. 18%). Dr. Andrew Weissman and colleagues from Lenox Hill Hospital in New York City reported their findings in a poster at the Southern regional meeting of the American Federation for Medical Research.

The results call into question whether lower cutoffs should be used to identify metabolic syndrome in women or whether the presence of metabolic syndrome itself is truly a risk factor for coronary artery disease, Dr. Weissman said in an interview.

“The goal of identifying metabolic syndrome is to try and pick out those people with a higher risk for coronary artery disease and it doesn't seem to be doing that in nondiabetic females according to the results of our study,” he said.

The study included 277 men (mean age 60 years) and 191 women (mean age 63 years) with no known history of CAD. Metabolic syndrome was evaluated using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria.

The NCEP criteria recommend that metabolic syndrome be identified if three or more of the following risk factors are present: waist circumference of 102 cm or more in men and 88 cm or more in women; elevated triglyceride level of 150 mg/dL or greater; reduced HDL cholesterol level of less than 40 mg/dL in men and less than 50 mg/dL in women; elevated blood pressure of 135/85 mm Hg or greater; and an elevated fasting glucose of 110 mg/dL or greater.

Diabetes mellitus was present in 79 men (28.5%) and 49 women (25.6%), a difference that was not statistically significant.

Metabolic syndrome was present in 233 of 468 patients and was found in a significantly higher percentage of women (62%) than men (41%).

CAD, defined as the presence of 70% or greater stenosis in one of the three major coronary vessels or 50% stenosis in the left main coronary artery, was present in 48 (25%) women and in 132 (48%) men.

There was no significant difference between patients with and without metabolic syndrome with regard to mean Framingham risk score or for age, tobacco use, or family history of CAD, said Dr. Weissman, a third-year cardiology fellow at Lenox Hill Hospital.

However, both men and women with diabetes were significantly more likely to have CAD than were their nondiabetic counterparts.

There was no significant difference in percentage of CAD between men and women with diabetes (62% vs. 45%). There was a trend toward women with diabetes being more likely to have metabolic syndrome than were men with diabetes (90% vs. 75%), but it was not statistically significant, the authors wrote.

Although diabetes is considered a coronary risk equivalent, the independent significance of metabolic syndrome in practice remains controversial.

“The clinical implication is that our study results do not support the use of metabolic syndrome as a useful risk stratifier for coronary artery disease,” Dr. Weissman said.

NEW ORLEANS — Roughly one-quarter of overweight children were not identified as such by their parents in a survey of 308 child-parent pairs from an inner-city clinic.

This finding was true independent of race or ethnicity and occurred most commonly if the child was under 9 years of age, Dr. Maria Fernanda Nota and colleagues at the University of Louisville (Ky.) reported at the Southern regional meeting of the American Federation for Medical Research.

“I'm not sure why, but maybe it's because they're 'babies,'” Dr. Nota said in an interview.

Although obesity is prevalent in American children of all ages, especially in minorities, little is known about the role played by racial and ethnic differences in parents' perception of their children's weight status.

The investigators surveyed African American, Hispanic, and white parents of 2− to 17-year-old children. There were 104 African American parent-child pairs, 104 Hispanic pairs, and 102 white pairs.

Using a bilingual questionnaire, parents reported their own weight status and their perception of their child's weight as “underweight,” “just right,” or “overweight.” They also noted whether they were concerned about their child's weight. Children 9 years of age or older also identified their own weight status.

Weight and height measurements were recorded for all children. Weight status was defined by body mass index (BMI) as “normal” if it was in the 25th to 75th percentile or “overweight” if it exceeded the 95th percentile. The 76th to 94th percentile was intentionally excluded to provide a clear demarcation between groups, Dr. Nota said.

Parents identified their child's correct weight status in 76% of parent-child pairs. In all weight categories, accuracy of parental perception of their child's weight did not vary as a function of race or ethnicity, gender, or age.

Concerning the obese category, parents were significantly less likely to recognize 2− to 8-year-old girls as obese, compared with older girls (50% vs. 97%).

Comparable percentages of parents recognized obesity in both young (73%) and older (82%) boys.

Hispanic parents reported being concerned about their child's weight more often than did whites or African Americans, but this trend did not reach statistical significance.

One or both parents were obese in 50% of Hispanic pairs, 57% of white pairs, and 71% of African American pairs. Three-fourths of both obese and nonobese parents recognized obesity in their children, the authors reported.

Obese 9− to 17-year-old children with one or both obese parents recognized their own obesity as often as did children of normal-weight parents.

Dr. Nota was surprised that parents did not recognize obesity as well in younger children. But session comoderator Dr. Bryan Burke suggested that not all parents want to know about their child's weight.

In his home state, the Arkansas School BMI Assessment Project—initiated in 2003 to track the state's obesity epidemic—has been decried by parents as being bad for their children's self-image because it mandates that schools measure body mass index annually for all children in public school grades K-12 and send that information home with children's report cards.

Although the Centers for Disease Control and Prevention estimates that 60% of adult Arkansans are either overweight or obese, parent groups are now working to overturn the law, said Dr. Burke, a pediatrician with the Arkansas Children's Hospital in Little Rock.

NEW ORLEANS — Roughly one-quarter of overweight children were not identified as such by their parents in a survey of 308 child-parent pairs from an inner-city clinic.

This finding was true independent of race or ethnicity and occurred most commonly if the child was under 9 years of age, Dr. Maria Fernanda Nota and colleagues at the University of Louisville (Ky.) reported at the Southern regional meeting of the American Federation for Medical Research.

“I'm not sure why, but maybe it's because they're 'babies,'” Dr. Nota said in an interview.

Although obesity is prevalent in American children of all ages, especially in minorities, little is known about the role played by racial and ethnic differences in parents' perception of their children's weight status.

The investigators surveyed African American, Hispanic, and white parents of 2− to 17-year-old children. There were 104 African American parent-child pairs, 104 Hispanic pairs, and 102 white pairs.

Using a bilingual questionnaire, parents reported their own weight status and their perception of their child's weight as “underweight,” “just right,” or “overweight.” They also noted whether they were concerned about their child's weight. Children 9 years of age or older also identified their own weight status.

Weight and height measurements were recorded for all children. Weight status was defined by body mass index (BMI) as “normal” if it was in the 25th to 75th percentile or “overweight” if it exceeded the 95th percentile. The 76th to 94th percentile was intentionally excluded to provide a clear demarcation between groups, Dr. Nota said.

Parents identified their child's correct weight status in 76% of parent-child pairs. In all weight categories, accuracy of parental perception of their child's weight did not vary as a function of race or ethnicity, gender, or age.

Concerning the obese category, parents were significantly less likely to recognize 2− to 8-year-old girls as obese, compared with older girls (50% vs. 97%).

Comparable percentages of parents recognized obesity in both young (73%) and older (82%) boys.

Hispanic parents reported being concerned about their child's weight more often than did whites or African Americans, but this trend did not reach statistical significance.

One or both parents were obese in 50% of Hispanic pairs, 57% of white pairs, and 71% of African American pairs. Three-fourths of both obese and nonobese parents recognized obesity in their children, the authors reported.

Obese 9− to 17-year-old children with one or both obese parents recognized their own obesity as often as did children of normal-weight parents.

Dr. Nota was surprised that parents did not recognize obesity as well in younger children. But session comoderator Dr. Bryan Burke suggested that not all parents want to know about their child's weight.

In his home state, the Arkansas School BMI Assessment Project—initiated in 2003 to track the state's obesity epidemic—has been decried by parents as being bad for their children's self-image because it mandates that schools measure body mass index annually for all children in public school grades K-12 and send that information home with children's report cards.

Although the Centers for Disease Control and Prevention estimates that 60% of adult Arkansans are either overweight or obese, parent groups are now working to overturn the law, said Dr. Burke, a pediatrician with the Arkansas Children's Hospital in Little Rock.

NEW ORLEANS — Roughly one-quarter of overweight children were not identified as such by their parents in a survey of 308 child-parent pairs from an inner-city clinic.

This finding was true independent of race or ethnicity and occurred most commonly if the child was under 9 years of age, Dr. Maria Fernanda Nota and colleagues at the University of Louisville (Ky.) reported at the Southern regional meeting of the American Federation for Medical Research.

“I'm not sure why, but maybe it's because they're 'babies,'” Dr. Nota said in an interview.

Although obesity is prevalent in American children of all ages, especially in minorities, little is known about the role played by racial and ethnic differences in parents' perception of their children's weight status.

The investigators surveyed African American, Hispanic, and white parents of 2− to 17-year-old children. There were 104 African American parent-child pairs, 104 Hispanic pairs, and 102 white pairs.

Using a bilingual questionnaire, parents reported their own weight status and their perception of their child's weight as “underweight,” “just right,” or “overweight.” They also noted whether they were concerned about their child's weight. Children 9 years of age or older also identified their own weight status.

Weight and height measurements were recorded for all children. Weight status was defined by body mass index (BMI) as “normal” if it was in the 25th to 75th percentile or “overweight” if it exceeded the 95th percentile. The 76th to 94th percentile was intentionally excluded to provide a clear demarcation between groups, Dr. Nota said.

Parents identified their child's correct weight status in 76% of parent-child pairs. In all weight categories, accuracy of parental perception of their child's weight did not vary as a function of race or ethnicity, gender, or age.

Concerning the obese category, parents were significantly less likely to recognize 2− to 8-year-old girls as obese, compared with older girls (50% vs. 97%).

Comparable percentages of parents recognized obesity in both young (73%) and older (82%) boys.

Hispanic parents reported being concerned about their child's weight more often than did whites or African Americans, but this trend did not reach statistical significance.

One or both parents were obese in 50% of Hispanic pairs, 57% of white pairs, and 71% of African American pairs. Three-fourths of both obese and nonobese parents recognized obesity in their children, the authors reported.

Obese 9− to 17-year-old children with one or both obese parents recognized their own obesity as often as did children of normal-weight parents.

Dr. Nota was surprised that parents did not recognize obesity as well in younger children. But session comoderator Dr. Bryan Burke suggested that not all parents want to know about their child's weight.

In his home state, the Arkansas School BMI Assessment Project—initiated in 2003 to track the state's obesity epidemic—has been decried by parents as being bad for their children's self-image because it mandates that schools measure body mass index annually for all children in public school grades K-12 and send that information home with children's report cards.

Although the Centers for Disease Control and Prevention estimates that 60% of adult Arkansans are either overweight or obese, parent groups are now working to overturn the law, said Dr. Burke, a pediatrician with the Arkansas Children's Hospital in Little Rock.

TUCSON, ARIZ. — Monotherapy with sildenafil provides relief for men with both erectile dysfunction and lower urinary tract symptoms, Dr. Jay Young and his associates reported in a poster at the annual meeting of the North American Primary Care Research Group.

The study randomized 369 men, aged 45 years and older, with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) to sildenafil (Viagra) 50 mg or placebo nightly or 30–60 minutes before sexual activity. After 2 weeks, the sildenafil dose was titrated to 100 mg with the option of returning to 50 mg if 100 mg was not tolerated.

Overall, 189 patients were treated with sildenafil and 180 patients took placebo. The cause of ED was organic in the majority of patients, with an average duration of about 5 years in both groups.

The intent-to-treat analysis included 366 men. Those receiving sildenafil had significantly greater mean improvement in erectile function domain scores on the International Index of Erectile Function, compared with placebo-treated patients (9.2 vs. 1.9), and in their International Prostate Symptom Scores (IPSS) (−6.3 vs. −1.9), Dr. Young reported.

He has been an investigator for, owns stock in, and is on the speaker's bureau of Pfizer Inc., which sponsored the study.

Secondary end points were also significantly improved in sildenafil- vs. placebo-treated men, including irritative and obstructive symptoms, the IPSS quality-of-life question, and Benign Prostatic Hyperplasia Impact Index (BPHII) scores.

Maximum urinary flow rate (Qmax) increased slightly for both groups but was not significantly different between groups.

“The improvement in IPSS and BPHII score with no concomitant improvement in Qmax suggests that a new pathophysiology paradigm may be needed to explain the etiology of LUTS,” said Dr. Young, director of clinical research at South Orange County Medical Research Center in Laguna Woods, Calif.

A previous study, presented at the 2006 annual meeting of the European Association of Urology, reported that the combination of sildenafil 25 mg/day and the α₁-blocker alfuzosin (Uroxatral) 10 mg/day was more effective than either agent was alone in men with previously untreated LUTS and ED.

It is possible that further improvement in LUTS would have been observed if alfuzosin had been added to the sildenafil in the current trial; however, that was not done, said Carl Clay, Ph.D., senior medical writer with Complete Healthcare Communications, which fielded questions on the study for Dr. Young.

Nine sildenafil patients dropped out of the current study because of adverse events, compared with two in the placebo group. The most common events were headache, dyspepsia, and respiratory tract infection.

TUCSON, ARIZ. — Monotherapy with sildenafil provides relief for men with both erectile dysfunction and lower urinary tract symptoms, Dr. Jay Young and his associates reported in a poster at the annual meeting of the North American Primary Care Research Group.

The study randomized 369 men, aged 45 years and older, with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) to sildenafil (Viagra) 50 mg or placebo nightly or 30–60 minutes before sexual activity. After 2 weeks, the sildenafil dose was titrated to 100 mg with the option of returning to 50 mg if 100 mg was not tolerated.

Overall, 189 patients were treated with sildenafil and 180 patients took placebo. The cause of ED was organic in the majority of patients, with an average duration of about 5 years in both groups.

The intent-to-treat analysis included 366 men. Those receiving sildenafil had significantly greater mean improvement in erectile function domain scores on the International Index of Erectile Function, compared with placebo-treated patients (9.2 vs. 1.9), and in their International Prostate Symptom Scores (IPSS) (−6.3 vs. −1.9), Dr. Young reported.

He has been an investigator for, owns stock in, and is on the speaker's bureau of Pfizer Inc., which sponsored the study.

Secondary end points were also significantly improved in sildenafil- vs. placebo-treated men, including irritative and obstructive symptoms, the IPSS quality-of-life question, and Benign Prostatic Hyperplasia Impact Index (BPHII) scores.

Maximum urinary flow rate (Qmax) increased slightly for both groups but was not significantly different between groups.

“The improvement in IPSS and BPHII score with no concomitant improvement in Qmax suggests that a new pathophysiology paradigm may be needed to explain the etiology of LUTS,” said Dr. Young, director of clinical research at South Orange County Medical Research Center in Laguna Woods, Calif.

A previous study, presented at the 2006 annual meeting of the European Association of Urology, reported that the combination of sildenafil 25 mg/day and the α₁-blocker alfuzosin (Uroxatral) 10 mg/day was more effective than either agent was alone in men with previously untreated LUTS and ED.

It is possible that further improvement in LUTS would have been observed if alfuzosin had been added to the sildenafil in the current trial; however, that was not done, said Carl Clay, Ph.D., senior medical writer with Complete Healthcare Communications, which fielded questions on the study for Dr. Young.

Nine sildenafil patients dropped out of the current study because of adverse events, compared with two in the placebo group. The most common events were headache, dyspepsia, and respiratory tract infection.

TUCSON, ARIZ. — Monotherapy with sildenafil provides relief for men with both erectile dysfunction and lower urinary tract symptoms, Dr. Jay Young and his associates reported in a poster at the annual meeting of the North American Primary Care Research Group.

The study randomized 369 men, aged 45 years and older, with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) to sildenafil (Viagra) 50 mg or placebo nightly or 30–60 minutes before sexual activity. After 2 weeks, the sildenafil dose was titrated to 100 mg with the option of returning to 50 mg if 100 mg was not tolerated.

Overall, 189 patients were treated with sildenafil and 180 patients took placebo. The cause of ED was organic in the majority of patients, with an average duration of about 5 years in both groups.

The intent-to-treat analysis included 366 men. Those receiving sildenafil had significantly greater mean improvement in erectile function domain scores on the International Index of Erectile Function, compared with placebo-treated patients (9.2 vs. 1.9), and in their International Prostate Symptom Scores (IPSS) (−6.3 vs. −1.9), Dr. Young reported.

He has been an investigator for, owns stock in, and is on the speaker's bureau of Pfizer Inc., which sponsored the study.

Secondary end points were also significantly improved in sildenafil- vs. placebo-treated men, including irritative and obstructive symptoms, the IPSS quality-of-life question, and Benign Prostatic Hyperplasia Impact Index (BPHII) scores.

Maximum urinary flow rate (Qmax) increased slightly for both groups but was not significantly different between groups.

“The improvement in IPSS and BPHII score with no concomitant improvement in Qmax suggests that a new pathophysiology paradigm may be needed to explain the etiology of LUTS,” said Dr. Young, director of clinical research at South Orange County Medical Research Center in Laguna Woods, Calif.

A previous study, presented at the 2006 annual meeting of the European Association of Urology, reported that the combination of sildenafil 25 mg/day and the α₁-blocker alfuzosin (Uroxatral) 10 mg/day was more effective than either agent was alone in men with previously untreated LUTS and ED.

It is possible that further improvement in LUTS would have been observed if alfuzosin had been added to the sildenafil in the current trial; however, that was not done, said Carl Clay, Ph.D., senior medical writer with Complete Healthcare Communications, which fielded questions on the study for Dr. Young.

Nine sildenafil patients dropped out of the current study because of adverse events, compared with two in the placebo group. The most common events were headache, dyspepsia, and respiratory tract infection.