Robert Finn

LONG BEACH, CALIF. — People with diabetes have far higher scores on a depression scale than do those without diabetes, according to a large epidemiologic study.

Furthermore, depression also is associated with increased 10-year mortality in people with diabetes, but not in those without the condition.

The mortality risk goes up 54% in diabetic patients with clinical depression, compared with those without depression, after adjustment for a large number of covariates, according to Xuanping Zhang, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and his colleagues. Dr. Zhang presented the results at a conference on diabetes sponsored by the CDC.

The study used data collected between 1982 and 1992 by the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Survey (NHEFS).

The investigators compared 558 people with diabetes to 7,063 people without the disease, and included all individuals for whom they had complete survival data and scores on the Centers for Epidemiologic Studies Depression (CES-D) scale. Scores of 16 and above indicate clinical depression, scores of 16-21 indicate moderate depression, and scores of 22 or greater indicate severe depression.

Among people with diabetes, the mean CES-D score was 26.3, compared with 15.8 among those without diabetes, a significant difference.

In a multivariate analysis that adjusted for age, gender, race, marital status, education, working status, smoking status, physical activity, alcohol consumption, body mass index, self-rated health, and the presence of other serious diseases, people with diabetes who also had a CES-D score of 16 or above were 54% more likely to die over 10 years than were those with lower depression scores, a statistically significant increase in risk.

Among people who did not have diabetes, high depression scores conferred a 3% increase in mortality risk, and that increase was not statistically significant.

Dr. Zhang stated that he had no conflicts of interest to disclose regarding his presentation.

LONG BEACH, CALIF. — People with diabetes have far higher scores on a depression scale than do those without diabetes, according to a large epidemiologic study.

Furthermore, depression also is associated with increased 10-year mortality in people with diabetes, but not in those without the condition.

The mortality risk goes up 54% in diabetic patients with clinical depression, compared with those without depression, after adjustment for a large number of covariates, according to Xuanping Zhang, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and his colleagues. Dr. Zhang presented the results at a conference on diabetes sponsored by the CDC.

The study used data collected between 1982 and 1992 by the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Survey (NHEFS).

The investigators compared 558 people with diabetes to 7,063 people without the disease, and included all individuals for whom they had complete survival data and scores on the Centers for Epidemiologic Studies Depression (CES-D) scale. Scores of 16 and above indicate clinical depression, scores of 16-21 indicate moderate depression, and scores of 22 or greater indicate severe depression.

Among people with diabetes, the mean CES-D score was 26.3, compared with 15.8 among those without diabetes, a significant difference.

In a multivariate analysis that adjusted for age, gender, race, marital status, education, working status, smoking status, physical activity, alcohol consumption, body mass index, self-rated health, and the presence of other serious diseases, people with diabetes who also had a CES-D score of 16 or above were 54% more likely to die over 10 years than were those with lower depression scores, a statistically significant increase in risk.

Among people who did not have diabetes, high depression scores conferred a 3% increase in mortality risk, and that increase was not statistically significant.

Dr. Zhang stated that he had no conflicts of interest to disclose regarding his presentation.

LONG BEACH, CALIF. — People with diabetes have far higher scores on a depression scale than do those without diabetes, according to a large epidemiologic study.

Furthermore, depression also is associated with increased 10-year mortality in people with diabetes, but not in those without the condition.

The mortality risk goes up 54% in diabetic patients with clinical depression, compared with those without depression, after adjustment for a large number of covariates, according to Xuanping Zhang, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and his colleagues. Dr. Zhang presented the results at a conference on diabetes sponsored by the CDC.

The study used data collected between 1982 and 1992 by the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Survey (NHEFS).

The investigators compared 558 people with diabetes to 7,063 people without the disease, and included all individuals for whom they had complete survival data and scores on the Centers for Epidemiologic Studies Depression (CES-D) scale. Scores of 16 and above indicate clinical depression, scores of 16-21 indicate moderate depression, and scores of 22 or greater indicate severe depression.

Among people with diabetes, the mean CES-D score was 26.3, compared with 15.8 among those without diabetes, a significant difference.

In a multivariate analysis that adjusted for age, gender, race, marital status, education, working status, smoking status, physical activity, alcohol consumption, body mass index, self-rated health, and the presence of other serious diseases, people with diabetes who also had a CES-D score of 16 or above were 54% more likely to die over 10 years than were those with lower depression scores, a statistically significant increase in risk.

Among people who did not have diabetes, high depression scores conferred a 3% increase in mortality risk, and that increase was not statistically significant.

Dr. Zhang stated that he had no conflicts of interest to disclose regarding his presentation.

SAN FRANCISCO — Alcohol has little to do with the development of the facial redness, swelling, and vascular abnormalities characteristic of rosacea, despite conventional wisdom, study results have shown.

In a case-control study comparing 65 patients with rosacea with 65 control subjects, Dr. Alexa Boer Kimball of Harvard Medical School, Boston, found no relationship between rosacea and current or former alcohol consumption. On the other hand, people with rosacea were three times more likely than controls to have a family member who also had the condition. And people with rosacea were eight times more likely to have a history of blistering sunburn, she reported at the annual meeting of the American Academy of Dermatology.

Specifically, 34% of the patients with rosacea had an affected family member, compared with 10% of the controls. And 44% of the patients with rosacea reported having had a blistering sunburn at some point in their lives, compared with 5% of the controls. Both differences were statistically significant.

In an earlier retrospective study involving digital photographs of 2,933 women from around the world, Dr. Kimball and her colleagues found that women with rosacea had a significantly higher mean body mass index than controls (27.6 kg/m

The case-control study also failed to find significant differences between the groups in blood pressure, the use of sunscreen, smoking history in pack-years, heart disease, hypertension, or depression.

However, Dr. Kimball's study did confirm the stereotype of the rosy-cheeked Brit associated with comedian W.C. Fields, who had rosacea. The rate approached 25% among white women from London, significantly higher than the rate among white women from other parts of the world, even after controlling for Fitzpatrick skin type.

“There may be both genetic and environmental influences that are independent and beyond just [patients'] ability to manage sun radiation that might be important,” Dr. Kimball said during a press briefing. “We're very much at the beginning of understanding the prevalence of disease, what the risk factors might be, and whether there are ways to avoid the development of rosacea over time.”

Dr. Kimball's study also found no difference between patients and controls in rates of hypertension. “That was an important hypothesis,” she said in an interview, “since we do think that rosacea is related to some pathology in the vasculature system.”

But she said her study results were not as definitive regarding two other factors: “one, body mass index and how weight may be playing a role in the development of rosacea. The second finding that bears further analysis—because the findings are somewhat contradictory—has to do with smoking.” Smoking can cause premature aging of the face and also can damage small blood vessels.

Dr. Kimball said her study had several important take-home messages for physicians and patients. Physicians need to know that rosacea is very common in some populations, that the condition has strong negative effects on quality of life, and that it remains undertreated.

Patients also need to know that “we don't know yet how to prevent it well. But it would seem prudent in people with a family history of rosacea that is strong to take basic preventative measures, which include sun protection,” she said.

Dr. Kimball stated that she had no conflicts of interest related to her study.

Of rosacea patients, 44% reported having had a blistering sunburn, compared with 5% of controls. DR. KIMBALL

SAN FRANCISCO — Alcohol has little to do with the development of the facial redness, swelling, and vascular abnormalities characteristic of rosacea, despite conventional wisdom, study results have shown.

In a case-control study comparing 65 patients with rosacea with 65 control subjects, Dr. Alexa Boer Kimball of Harvard Medical School, Boston, found no relationship between rosacea and current or former alcohol consumption. On the other hand, people with rosacea were three times more likely than controls to have a family member who also had the condition. And people with rosacea were eight times more likely to have a history of blistering sunburn, she reported at the annual meeting of the American Academy of Dermatology.

Specifically, 34% of the patients with rosacea had an affected family member, compared with 10% of the controls. And 44% of the patients with rosacea reported having had a blistering sunburn at some point in their lives, compared with 5% of the controls. Both differences were statistically significant.

In an earlier retrospective study involving digital photographs of 2,933 women from around the world, Dr. Kimball and her colleagues found that women with rosacea had a significantly higher mean body mass index than controls (27.6 kg/m

The case-control study also failed to find significant differences between the groups in blood pressure, the use of sunscreen, smoking history in pack-years, heart disease, hypertension, or depression.

However, Dr. Kimball's study did confirm the stereotype of the rosy-cheeked Brit associated with comedian W.C. Fields, who had rosacea. The rate approached 25% among white women from London, significantly higher than the rate among white women from other parts of the world, even after controlling for Fitzpatrick skin type.

“There may be both genetic and environmental influences that are independent and beyond just [patients'] ability to manage sun radiation that might be important,” Dr. Kimball said during a press briefing. “We're very much at the beginning of understanding the prevalence of disease, what the risk factors might be, and whether there are ways to avoid the development of rosacea over time.”

Dr. Kimball's study also found no difference between patients and controls in rates of hypertension. “That was an important hypothesis,” she said in an interview, “since we do think that rosacea is related to some pathology in the vasculature system.”

But she said her study results were not as definitive regarding two other factors: “one, body mass index and how weight may be playing a role in the development of rosacea. The second finding that bears further analysis—because the findings are somewhat contradictory—has to do with smoking.” Smoking can cause premature aging of the face and also can damage small blood vessels.

Dr. Kimball said her study had several important take-home messages for physicians and patients. Physicians need to know that rosacea is very common in some populations, that the condition has strong negative effects on quality of life, and that it remains undertreated.

Patients also need to know that “we don't know yet how to prevent it well. But it would seem prudent in people with a family history of rosacea that is strong to take basic preventative measures, which include sun protection,” she said.

Dr. Kimball stated that she had no conflicts of interest related to her study.

Of rosacea patients, 44% reported having had a blistering sunburn, compared with 5% of controls. DR. KIMBALL

SAN FRANCISCO — Alcohol has little to do with the development of the facial redness, swelling, and vascular abnormalities characteristic of rosacea, despite conventional wisdom, study results have shown.

In a case-control study comparing 65 patients with rosacea with 65 control subjects, Dr. Alexa Boer Kimball of Harvard Medical School, Boston, found no relationship between rosacea and current or former alcohol consumption. On the other hand, people with rosacea were three times more likely than controls to have a family member who also had the condition. And people with rosacea were eight times more likely to have a history of blistering sunburn, she reported at the annual meeting of the American Academy of Dermatology.

Specifically, 34% of the patients with rosacea had an affected family member, compared with 10% of the controls. And 44% of the patients with rosacea reported having had a blistering sunburn at some point in their lives, compared with 5% of the controls. Both differences were statistically significant.

In an earlier retrospective study involving digital photographs of 2,933 women from around the world, Dr. Kimball and her colleagues found that women with rosacea had a significantly higher mean body mass index than controls (27.6 kg/m

The case-control study also failed to find significant differences between the groups in blood pressure, the use of sunscreen, smoking history in pack-years, heart disease, hypertension, or depression.

However, Dr. Kimball's study did confirm the stereotype of the rosy-cheeked Brit associated with comedian W.C. Fields, who had rosacea. The rate approached 25% among white women from London, significantly higher than the rate among white women from other parts of the world, even after controlling for Fitzpatrick skin type.

“There may be both genetic and environmental influences that are independent and beyond just [patients'] ability to manage sun radiation that might be important,” Dr. Kimball said during a press briefing. “We're very much at the beginning of understanding the prevalence of disease, what the risk factors might be, and whether there are ways to avoid the development of rosacea over time.”

Dr. Kimball's study also found no difference between patients and controls in rates of hypertension. “That was an important hypothesis,” she said in an interview, “since we do think that rosacea is related to some pathology in the vasculature system.”

But she said her study results were not as definitive regarding two other factors: “one, body mass index and how weight may be playing a role in the development of rosacea. The second finding that bears further analysis—because the findings are somewhat contradictory—has to do with smoking.” Smoking can cause premature aging of the face and also can damage small blood vessels.

Dr. Kimball said her study had several important take-home messages for physicians and patients. Physicians need to know that rosacea is very common in some populations, that the condition has strong negative effects on quality of life, and that it remains undertreated.

Patients also need to know that “we don't know yet how to prevent it well. But it would seem prudent in people with a family history of rosacea that is strong to take basic preventative measures, which include sun protection,” she said.

Dr. Kimball stated that she had no conflicts of interest related to her study.

Of rosacea patients, 44% reported having had a blistering sunburn, compared with 5% of controls. DR. KIMBALL

Consumption of solid food while in labor is safe for most women, according to the results of a large randomized trial.

It's been common practice to deny food to women in labor. Clinicians have worried that if general anesthesia were to be required for an emergency cesarean section, a woman might aspirate food into her lungs. As a result, even as recently as 2007, the American Society of Anesthesiologists recommended that laboring patients not be allowed solid food.

But in a study of 2,426 women, Dr. Geraldine O'Sullivan, consultant anesthetist at St. Thomas's Hospital, London, and her colleagues found that eating a low-fat, low-residue diet had no effect on the rate of spontaneous vaginal delivery, the duration of labor, the cesarean delivery rate, or the incidence of vomiting. In addition, the babies born to women permitted to eat solid foods were just as healthy as the babies born to women who were restricted to consuming water and ice (BMJ 2009;338:b784).

A total of 2,426 women with a mean age of 29 years were studied. All women in the study were giving birth for the first time, all pregnancies were uncomplicated, and all babies were singletons. The study was large enough to detect a difference as small as 6.7% in the rate of spontaneous vaginal delivery. The investigators agreed that a difference of this magnitude would be clinically as well as statistically significant.

Instead, they found no statistically significant differences on any measure. The rate of normal vaginal delivery was 44% in both groups. Instrumental delivery was 27% in the eating group and 26% in the water-only group. Cesarean sections were necessary in 30% of the women in the eating group and 30% of the women in the water-only group. A total of 35% of the women in the eating group vomited, compared with 34% of the women in the water-only group. And the mean length of labor was 597 minutes in the eating group, compared with 612 minutes in the water-only group.

Dr. William Camann, director of obstetric anesthesiology at Brigham andWomen's Hospital in Boston and past president of the Society for Obstetric Anesthesia and Perinatology, pointed out that the findings of this study didn't answer the question posed in regard to obstetric anesthesia safety concerns. The investigators didn't report whether any of the cesarean section patients received general anesthesia.

“The reason that pulmonary aspiration is so low is probably because the majority of obstetric patients nowadays have regional anesthesia during elective or emergent cesarean sections instead of general anesthesia, rather than [because] oral intake is restricted during labor, although we don't know this for sure. At our hospital only about 2%–3% of cesarean sections are done under general anesthesia.

“We don't really know whether liberalization of oral intake during labor will have adverse consequences or not. And we probably never will because the incidence of pulmonary aspiration is so low that it would take a study enrolling a huge number of women to achieve the statistical power necessary to get that evidence,” he said in an interview.

“Labor is not scheduled and predictable, like elective surgery. Although inevitably some women will end up having cesarean deliveries, this is highly likely to be done under regional anesthesia. There has to be a balance between patient comfort and patient safety, but with regard to oral intake in labor, this balance is hard to define,” Dr. Camann noted.

Not all of the women in the eating group actually ate solid food, and not all of the women in the water-only group avoided eating. Among the 1,219 women in the eating group, 71% actually ate, and the remainder either drank only water or had no oral intake. Among the 1,207 women in the water-only group, 20% failed to adhere to the protocol and ate some solid food.

The women ate a variety of foods, including fruit juice, soup, cereal, biscuits, fruits, chocolate, toast, vegetable stew, Danish pastry, sandwiches, hamburgers, chicken, and rice.

Denying solid food to women in labor became common after a 1946 study showing pulmonary acid aspiration, called Mendelson's syndrome, in some women who had eaten. But the risk of this has decreased in recent years. Anesthesiologists are more likely to use regional than general anesthesia for cesarean deliveries. In addition, it's common to prescribe proton pump inhibitors or H2 receptor blockers for women undergoing operative births.

Dr. Camann noted that there have been changes to the guidelines over the years, allowing for clear liquid intake of beverages such as juices, tea, and sports drinks during labor. “In fact, obstetric patients should drink something with electrolytes in it rather than just water to avoid water intoxication, which has been known to occur.”

The investigators stated that they had no conflicts of interest related to the study. Dr. Camann also reported no conflicts of interest.

Consumption of solid food while in labor is safe for most women, according to the results of a large randomized trial.

It's been common practice to deny food to women in labor. Clinicians have worried that if general anesthesia were to be required for an emergency cesarean section, a woman might aspirate food into her lungs. As a result, even as recently as 2007, the American Society of Anesthesiologists recommended that laboring patients not be allowed solid food.

But in a study of 2,426 women, Dr. Geraldine O'Sullivan, consultant anesthetist at St. Thomas's Hospital, London, and her colleagues found that eating a low-fat, low-residue diet had no effect on the rate of spontaneous vaginal delivery, the duration of labor, the cesarean delivery rate, or the incidence of vomiting. In addition, the babies born to women permitted to eat solid foods were just as healthy as the babies born to women who were restricted to consuming water and ice (BMJ 2009;338:b784).

A total of 2,426 women with a mean age of 29 years were studied. All women in the study were giving birth for the first time, all pregnancies were uncomplicated, and all babies were singletons. The study was large enough to detect a difference as small as 6.7% in the rate of spontaneous vaginal delivery. The investigators agreed that a difference of this magnitude would be clinically as well as statistically significant.

Instead, they found no statistically significant differences on any measure. The rate of normal vaginal delivery was 44% in both groups. Instrumental delivery was 27% in the eating group and 26% in the water-only group. Cesarean sections were necessary in 30% of the women in the eating group and 30% of the women in the water-only group. A total of 35% of the women in the eating group vomited, compared with 34% of the women in the water-only group. And the mean length of labor was 597 minutes in the eating group, compared with 612 minutes in the water-only group.

Dr. William Camann, director of obstetric anesthesiology at Brigham andWomen's Hospital in Boston and past president of the Society for Obstetric Anesthesia and Perinatology, pointed out that the findings of this study didn't answer the question posed in regard to obstetric anesthesia safety concerns. The investigators didn't report whether any of the cesarean section patients received general anesthesia.

“The reason that pulmonary aspiration is so low is probably because the majority of obstetric patients nowadays have regional anesthesia during elective or emergent cesarean sections instead of general anesthesia, rather than [because] oral intake is restricted during labor, although we don't know this for sure. At our hospital only about 2%–3% of cesarean sections are done under general anesthesia.

“We don't really know whether liberalization of oral intake during labor will have adverse consequences or not. And we probably never will because the incidence of pulmonary aspiration is so low that it would take a study enrolling a huge number of women to achieve the statistical power necessary to get that evidence,” he said in an interview.

“Labor is not scheduled and predictable, like elective surgery. Although inevitably some women will end up having cesarean deliveries, this is highly likely to be done under regional anesthesia. There has to be a balance between patient comfort and patient safety, but with regard to oral intake in labor, this balance is hard to define,” Dr. Camann noted.

Not all of the women in the eating group actually ate solid food, and not all of the women in the water-only group avoided eating. Among the 1,219 women in the eating group, 71% actually ate, and the remainder either drank only water or had no oral intake. Among the 1,207 women in the water-only group, 20% failed to adhere to the protocol and ate some solid food.

The women ate a variety of foods, including fruit juice, soup, cereal, biscuits, fruits, chocolate, toast, vegetable stew, Danish pastry, sandwiches, hamburgers, chicken, and rice.

Denying solid food to women in labor became common after a 1946 study showing pulmonary acid aspiration, called Mendelson's syndrome, in some women who had eaten. But the risk of this has decreased in recent years. Anesthesiologists are more likely to use regional than general anesthesia for cesarean deliveries. In addition, it's common to prescribe proton pump inhibitors or H2 receptor blockers for women undergoing operative births.

Dr. Camann noted that there have been changes to the guidelines over the years, allowing for clear liquid intake of beverages such as juices, tea, and sports drinks during labor. “In fact, obstetric patients should drink something with electrolytes in it rather than just water to avoid water intoxication, which has been known to occur.”

The investigators stated that they had no conflicts of interest related to the study. Dr. Camann also reported no conflicts of interest.

Consumption of solid food while in labor is safe for most women, according to the results of a large randomized trial.

It's been common practice to deny food to women in labor. Clinicians have worried that if general anesthesia were to be required for an emergency cesarean section, a woman might aspirate food into her lungs. As a result, even as recently as 2007, the American Society of Anesthesiologists recommended that laboring patients not be allowed solid food.

But in a study of 2,426 women, Dr. Geraldine O'Sullivan, consultant anesthetist at St. Thomas's Hospital, London, and her colleagues found that eating a low-fat, low-residue diet had no effect on the rate of spontaneous vaginal delivery, the duration of labor, the cesarean delivery rate, or the incidence of vomiting. In addition, the babies born to women permitted to eat solid foods were just as healthy as the babies born to women who were restricted to consuming water and ice (BMJ 2009;338:b784).

A total of 2,426 women with a mean age of 29 years were studied. All women in the study were giving birth for the first time, all pregnancies were uncomplicated, and all babies were singletons. The study was large enough to detect a difference as small as 6.7% in the rate of spontaneous vaginal delivery. The investigators agreed that a difference of this magnitude would be clinically as well as statistically significant.

Instead, they found no statistically significant differences on any measure. The rate of normal vaginal delivery was 44% in both groups. Instrumental delivery was 27% in the eating group and 26% in the water-only group. Cesarean sections were necessary in 30% of the women in the eating group and 30% of the women in the water-only group. A total of 35% of the women in the eating group vomited, compared with 34% of the women in the water-only group. And the mean length of labor was 597 minutes in the eating group, compared with 612 minutes in the water-only group.

Dr. William Camann, director of obstetric anesthesiology at Brigham andWomen's Hospital in Boston and past president of the Society for Obstetric Anesthesia and Perinatology, pointed out that the findings of this study didn't answer the question posed in regard to obstetric anesthesia safety concerns. The investigators didn't report whether any of the cesarean section patients received general anesthesia.

“The reason that pulmonary aspiration is so low is probably because the majority of obstetric patients nowadays have regional anesthesia during elective or emergent cesarean sections instead of general anesthesia, rather than [because] oral intake is restricted during labor, although we don't know this for sure. At our hospital only about 2%–3% of cesarean sections are done under general anesthesia.

“We don't really know whether liberalization of oral intake during labor will have adverse consequences or not. And we probably never will because the incidence of pulmonary aspiration is so low that it would take a study enrolling a huge number of women to achieve the statistical power necessary to get that evidence,” he said in an interview.

“Labor is not scheduled and predictable, like elective surgery. Although inevitably some women will end up having cesarean deliveries, this is highly likely to be done under regional anesthesia. There has to be a balance between patient comfort and patient safety, but with regard to oral intake in labor, this balance is hard to define,” Dr. Camann noted.

Not all of the women in the eating group actually ate solid food, and not all of the women in the water-only group avoided eating. Among the 1,219 women in the eating group, 71% actually ate, and the remainder either drank only water or had no oral intake. Among the 1,207 women in the water-only group, 20% failed to adhere to the protocol and ate some solid food.

The women ate a variety of foods, including fruit juice, soup, cereal, biscuits, fruits, chocolate, toast, vegetable stew, Danish pastry, sandwiches, hamburgers, chicken, and rice.

Denying solid food to women in labor became common after a 1946 study showing pulmonary acid aspiration, called Mendelson's syndrome, in some women who had eaten. But the risk of this has decreased in recent years. Anesthesiologists are more likely to use regional than general anesthesia for cesarean deliveries. In addition, it's common to prescribe proton pump inhibitors or H2 receptor blockers for women undergoing operative births.

Dr. Camann noted that there have been changes to the guidelines over the years, allowing for clear liquid intake of beverages such as juices, tea, and sports drinks during labor. “In fact, obstetric patients should drink something with electrolytes in it rather than just water to avoid water intoxication, which has been known to occur.”

The investigators stated that they had no conflicts of interest related to the study. Dr. Camann also reported no conflicts of interest.

SAN FRANCISCO — Emergency contraception is available in 69% of Los Angeles pharmacies, and patients usually receive accurate information when inquiring about it, according to a study using sham patients.

However, in one-third of encounters in the study, the patients received the information only after multiple calls and multiple recitations of their situation, Dr. Anita L. Nelson said at a conference on contraceptive technology sponsored by Contemporary Forums.

Some pharmacies provided inaccurate information. For example, of 1,206 pharmacies contacted, 74 (6%) referred the woman to her clinician for a prescription. Another 12 pharmacies (1%) said that they knew that emergency contraception was available without a prescription, but that nevertheless they required women of any age to have a prescription.

At the time of the study, Plan B was available without a prescription to women aged 18 years and older. Recently, however, a U.S. federal judge ordered the Food and Drug Administration to make the emergency contraceptive Plan B (levonorgestrel) available to 17- year-olds without a prescription within 30 days, and the FDA complied.

Dr. Nelson and Dr. Cindy M. Jaime of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif., conducted the study between October 2007 and October 2008. They attempted to contact all 1,440 unduplicated telephone numbers for pharmacies listed in the Yellow Pages for Los Angeles County; many of the phone numbers had been disconnected or were numbers for businesses selling medical marijuana or herbal remedies (Contraception 2009;79:206–10).

Female interviewers were trained to speak hesitantly to the person who answered and to say that she and her boyfriend had had sex the day before and that he had just told her that he had not used a condom. She then said that she had heard that maybe there was something she could take to keep from getting pregnant, and asked the person on the telephone if he or she knew about this.

Of the 1,206 pharmacies the investigators were able to contact, 835 (69%) responded that they carried emergency contraception and had it available on site without a prescription. An additional 232 (19%) responded that they did not have it in stock or did not carry it themselves but referred the caller to other pharmacies. Only 15% of those referrals, however, were to a specific local pharmacy. More commonly, the caller was referred to “any pharmacy” or to specific chains.

“What was very heartening is that when we finally got through to somebody, most of them gave very accurate information,” Dr. Nelson said. Beyond that, some pharmacies responded in ways that Dr. Nelson described as “inspiring” and “heartwarming.” For example, one person said, “We were going to close in about 10 minutes, but if you can get down here, I'll stay open for you.”

But then there were the people who responded by telling the caller: “You need a doctor first to get a prescription for those pills,” or “You could have a beautiful baby.” Other comments included: “Next time be more careful,” “Why are you not on the birth control pill?” and “Did you really have sex without a condom?”

Others provided inaccurate information. Plan B is most effective when taken within 72 hours after unprotected intercourse. However, three pharmacies said that emergency contraception had to be taken within 12 hours, three said 24 hours, and six said 48 hours. One pharmacy said that it was too early for the caller to use Plan B— that the pills needed to be taken 2–3 days after intercourse.

One pharmacist said that Plan B used to be available over the counter but was not any more, and two said that the person needed to be at least 21 years old to receive it.

Seventeen pharmacists hung up the phone after hearing the caller's question, and several hung up repeatedly upon being called back. Others asked overly personal questions such as “Are you married or single?” or “How long have you known him?”

As much as 29% of the time the women first spoke to a person who was not able to answer very basic questions, suggesting that pharmacies need to bolster their training of staff members. Dr. Nelson urged clinicians to consider prescribing emergency contraception in advance of need.

She stated that the study received no outside funding and disclosed that she has served on advisory boards and speakers bureaus, and has received research funding from, Duramed/Barr Pharmaceuticals Inc., which manufactures Plan B.

Contemporary Forums and this news organization are owned by Elsevier.

SAN FRANCISCO — Emergency contraception is available in 69% of Los Angeles pharmacies, and patients usually receive accurate information when inquiring about it, according to a study using sham patients.

However, in one-third of encounters in the study, the patients received the information only after multiple calls and multiple recitations of their situation, Dr. Anita L. Nelson said at a conference on contraceptive technology sponsored by Contemporary Forums.

Some pharmacies provided inaccurate information. For example, of 1,206 pharmacies contacted, 74 (6%) referred the woman to her clinician for a prescription. Another 12 pharmacies (1%) said that they knew that emergency contraception was available without a prescription, but that nevertheless they required women of any age to have a prescription.

At the time of the study, Plan B was available without a prescription to women aged 18 years and older. Recently, however, a U.S. federal judge ordered the Food and Drug Administration to make the emergency contraceptive Plan B (levonorgestrel) available to 17- year-olds without a prescription within 30 days, and the FDA complied.

Dr. Nelson and Dr. Cindy M. Jaime of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif., conducted the study between October 2007 and October 2008. They attempted to contact all 1,440 unduplicated telephone numbers for pharmacies listed in the Yellow Pages for Los Angeles County; many of the phone numbers had been disconnected or were numbers for businesses selling medical marijuana or herbal remedies (Contraception 2009;79:206–10).

Female interviewers were trained to speak hesitantly to the person who answered and to say that she and her boyfriend had had sex the day before and that he had just told her that he had not used a condom. She then said that she had heard that maybe there was something she could take to keep from getting pregnant, and asked the person on the telephone if he or she knew about this.

Of the 1,206 pharmacies the investigators were able to contact, 835 (69%) responded that they carried emergency contraception and had it available on site without a prescription. An additional 232 (19%) responded that they did not have it in stock or did not carry it themselves but referred the caller to other pharmacies. Only 15% of those referrals, however, were to a specific local pharmacy. More commonly, the caller was referred to “any pharmacy” or to specific chains.

“What was very heartening is that when we finally got through to somebody, most of them gave very accurate information,” Dr. Nelson said. Beyond that, some pharmacies responded in ways that Dr. Nelson described as “inspiring” and “heartwarming.” For example, one person said, “We were going to close in about 10 minutes, but if you can get down here, I'll stay open for you.”

But then there were the people who responded by telling the caller: “You need a doctor first to get a prescription for those pills,” or “You could have a beautiful baby.” Other comments included: “Next time be more careful,” “Why are you not on the birth control pill?” and “Did you really have sex without a condom?”

Others provided inaccurate information. Plan B is most effective when taken within 72 hours after unprotected intercourse. However, three pharmacies said that emergency contraception had to be taken within 12 hours, three said 24 hours, and six said 48 hours. One pharmacy said that it was too early for the caller to use Plan B— that the pills needed to be taken 2–3 days after intercourse.

One pharmacist said that Plan B used to be available over the counter but was not any more, and two said that the person needed to be at least 21 years old to receive it.

Seventeen pharmacists hung up the phone after hearing the caller's question, and several hung up repeatedly upon being called back. Others asked overly personal questions such as “Are you married or single?” or “How long have you known him?”

As much as 29% of the time the women first spoke to a person who was not able to answer very basic questions, suggesting that pharmacies need to bolster their training of staff members. Dr. Nelson urged clinicians to consider prescribing emergency contraception in advance of need.

She stated that the study received no outside funding and disclosed that she has served on advisory boards and speakers bureaus, and has received research funding from, Duramed/Barr Pharmaceuticals Inc., which manufactures Plan B.

Contemporary Forums and this news organization are owned by Elsevier.

SAN FRANCISCO — Emergency contraception is available in 69% of Los Angeles pharmacies, and patients usually receive accurate information when inquiring about it, according to a study using sham patients.

However, in one-third of encounters in the study, the patients received the information only after multiple calls and multiple recitations of their situation, Dr. Anita L. Nelson said at a conference on contraceptive technology sponsored by Contemporary Forums.

Some pharmacies provided inaccurate information. For example, of 1,206 pharmacies contacted, 74 (6%) referred the woman to her clinician for a prescription. Another 12 pharmacies (1%) said that they knew that emergency contraception was available without a prescription, but that nevertheless they required women of any age to have a prescription.

At the time of the study, Plan B was available without a prescription to women aged 18 years and older. Recently, however, a U.S. federal judge ordered the Food and Drug Administration to make the emergency contraceptive Plan B (levonorgestrel) available to 17- year-olds without a prescription within 30 days, and the FDA complied.

Dr. Nelson and Dr. Cindy M. Jaime of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif., conducted the study between October 2007 and October 2008. They attempted to contact all 1,440 unduplicated telephone numbers for pharmacies listed in the Yellow Pages for Los Angeles County; many of the phone numbers had been disconnected or were numbers for businesses selling medical marijuana or herbal remedies (Contraception 2009;79:206–10).

Female interviewers were trained to speak hesitantly to the person who answered and to say that she and her boyfriend had had sex the day before and that he had just told her that he had not used a condom. She then said that she had heard that maybe there was something she could take to keep from getting pregnant, and asked the person on the telephone if he or she knew about this.

Of the 1,206 pharmacies the investigators were able to contact, 835 (69%) responded that they carried emergency contraception and had it available on site without a prescription. An additional 232 (19%) responded that they did not have it in stock or did not carry it themselves but referred the caller to other pharmacies. Only 15% of those referrals, however, were to a specific local pharmacy. More commonly, the caller was referred to “any pharmacy” or to specific chains.

“What was very heartening is that when we finally got through to somebody, most of them gave very accurate information,” Dr. Nelson said. Beyond that, some pharmacies responded in ways that Dr. Nelson described as “inspiring” and “heartwarming.” For example, one person said, “We were going to close in about 10 minutes, but if you can get down here, I'll stay open for you.”

But then there were the people who responded by telling the caller: “You need a doctor first to get a prescription for those pills,” or “You could have a beautiful baby.” Other comments included: “Next time be more careful,” “Why are you not on the birth control pill?” and “Did you really have sex without a condom?”

Others provided inaccurate information. Plan B is most effective when taken within 72 hours after unprotected intercourse. However, three pharmacies said that emergency contraception had to be taken within 12 hours, three said 24 hours, and six said 48 hours. One pharmacy said that it was too early for the caller to use Plan B— that the pills needed to be taken 2–3 days after intercourse.

One pharmacist said that Plan B used to be available over the counter but was not any more, and two said that the person needed to be at least 21 years old to receive it.

Seventeen pharmacists hung up the phone after hearing the caller's question, and several hung up repeatedly upon being called back. Others asked overly personal questions such as “Are you married or single?” or “How long have you known him?”

As much as 29% of the time the women first spoke to a person who was not able to answer very basic questions, suggesting that pharmacies need to bolster their training of staff members. Dr. Nelson urged clinicians to consider prescribing emergency contraception in advance of need.

She stated that the study received no outside funding and disclosed that she has served on advisory boards and speakers bureaus, and has received research funding from, Duramed/Barr Pharmaceuticals Inc., which manufactures Plan B.

Contemporary Forums and this news organization are owned by Elsevier.

SAN DIEGO — Women who reach menopause before the age of 42 years are twice as likely to suffer a stroke in later life as women who reach menopause after age 42, according to a new analysis of data from the Framingham Heart Study presented at the International Stroke Conference.

The study involved prospectively collected data from 1,430 women who were followed for an average of 22 years, said Lynda Lisabeth, Ph.D., of the University of Michigan, Ann Arbor. All participants were stroke-free at 60 years of age, experienced natural menopause, and had never taken estrogen before menopause. The use of self-reported data on the age of menopause was a limitation of the study, Dr. Lisabeth acknowledged.

In all, the women had 234 ischemic strokes at an average age of 80 years. The unadjusted rate of strokes was 23% among women who reached menopause before the age of 42 years, 16% among women who reached menopause between the ages of 42 and 54 years, and 11% among women who reached menopause at age 55 years or older.

After adjustment for age, systolic blood pressure, atrial fibrillation, diabetes, current smoking, cardiovascular disease, and estrogen use after menopause, the investigators determined that the age of menopause was an independent predictor of ischemic stroke.

Compared with women who reached menopause before age 42 years, women who reached menopause between ages 42 and 54 years were half as likely to experience a stroke, and those who reached menopause at age 55 or older were 69% less likely to experience a stroke.

In other words, women who reached menopause before age 42 years were 2.03-fold more likely to have a stroke than the other women. This difference was statistically significant.

The study showed that 4%–5% of strokes in women can be attributed to menopause before age 42, Dr. Lisabeth said.

About 1%–2% of women reach menopause at or before age 40 years, which is referred to as “premature ovarian failure.” The etiology of this condition remains unknown, but investigators are certain that it's different than natural menopause. About 3%–10% of women experience “early” menopause, defined as natural menopause before age 45 years.

Several possible mechanisms could account for the increased rate of stroke, Dr. Lisabeth said. Estrogen may play a role, since estrogen deficiency is thought to promote cardiovascular disease through functional or structural changes in arteries. Androgens and sex hormone-binding globulin are also risk factors for cardiovascular disease.

Additional studies with measures of endogenous hormones would be needed to unravel the relationship between the hormonal changes of menopause and ischemic stroke, she said.

The study was supported by the National Heart, Lung, and Blood Institute and the National Institute of Neurological Disorders and Stroke. Dr. Lisabeth said that she had no conflicts of interest.

SAN DIEGO — Women who reach menopause before the age of 42 years are twice as likely to suffer a stroke in later life as women who reach menopause after age 42, according to a new analysis of data from the Framingham Heart Study presented at the International Stroke Conference.

The study involved prospectively collected data from 1,430 women who were followed for an average of 22 years, said Lynda Lisabeth, Ph.D., of the University of Michigan, Ann Arbor. All participants were stroke-free at 60 years of age, experienced natural menopause, and had never taken estrogen before menopause. The use of self-reported data on the age of menopause was a limitation of the study, Dr. Lisabeth acknowledged.

In all, the women had 234 ischemic strokes at an average age of 80 years. The unadjusted rate of strokes was 23% among women who reached menopause before the age of 42 years, 16% among women who reached menopause between the ages of 42 and 54 years, and 11% among women who reached menopause at age 55 years or older.

After adjustment for age, systolic blood pressure, atrial fibrillation, diabetes, current smoking, cardiovascular disease, and estrogen use after menopause, the investigators determined that the age of menopause was an independent predictor of ischemic stroke.

Compared with women who reached menopause before age 42 years, women who reached menopause between ages 42 and 54 years were half as likely to experience a stroke, and those who reached menopause at age 55 or older were 69% less likely to experience a stroke.

In other words, women who reached menopause before age 42 years were 2.03-fold more likely to have a stroke than the other women. This difference was statistically significant.

The study showed that 4%–5% of strokes in women can be attributed to menopause before age 42, Dr. Lisabeth said.

About 1%–2% of women reach menopause at or before age 40 years, which is referred to as “premature ovarian failure.” The etiology of this condition remains unknown, but investigators are certain that it's different than natural menopause. About 3%–10% of women experience “early” menopause, defined as natural menopause before age 45 years.

Several possible mechanisms could account for the increased rate of stroke, Dr. Lisabeth said. Estrogen may play a role, since estrogen deficiency is thought to promote cardiovascular disease through functional or structural changes in arteries. Androgens and sex hormone-binding globulin are also risk factors for cardiovascular disease.

Additional studies with measures of endogenous hormones would be needed to unravel the relationship between the hormonal changes of menopause and ischemic stroke, she said.

The study was supported by the National Heart, Lung, and Blood Institute and the National Institute of Neurological Disorders and Stroke. Dr. Lisabeth said that she had no conflicts of interest.

SAN DIEGO — Women who reach menopause before the age of 42 years are twice as likely to suffer a stroke in later life as women who reach menopause after age 42, according to a new analysis of data from the Framingham Heart Study presented at the International Stroke Conference.

The study involved prospectively collected data from 1,430 women who were followed for an average of 22 years, said Lynda Lisabeth, Ph.D., of the University of Michigan, Ann Arbor. All participants were stroke-free at 60 years of age, experienced natural menopause, and had never taken estrogen before menopause. The use of self-reported data on the age of menopause was a limitation of the study, Dr. Lisabeth acknowledged.

In all, the women had 234 ischemic strokes at an average age of 80 years. The unadjusted rate of strokes was 23% among women who reached menopause before the age of 42 years, 16% among women who reached menopause between the ages of 42 and 54 years, and 11% among women who reached menopause at age 55 years or older.

After adjustment for age, systolic blood pressure, atrial fibrillation, diabetes, current smoking, cardiovascular disease, and estrogen use after menopause, the investigators determined that the age of menopause was an independent predictor of ischemic stroke.

Compared with women who reached menopause before age 42 years, women who reached menopause between ages 42 and 54 years were half as likely to experience a stroke, and those who reached menopause at age 55 or older were 69% less likely to experience a stroke.

In other words, women who reached menopause before age 42 years were 2.03-fold more likely to have a stroke than the other women. This difference was statistically significant.

The study showed that 4%–5% of strokes in women can be attributed to menopause before age 42, Dr. Lisabeth said.

About 1%–2% of women reach menopause at or before age 40 years, which is referred to as “premature ovarian failure.” The etiology of this condition remains unknown, but investigators are certain that it's different than natural menopause. About 3%–10% of women experience “early” menopause, defined as natural menopause before age 45 years.

Several possible mechanisms could account for the increased rate of stroke, Dr. Lisabeth said. Estrogen may play a role, since estrogen deficiency is thought to promote cardiovascular disease through functional or structural changes in arteries. Androgens and sex hormone-binding globulin are also risk factors for cardiovascular disease.

Additional studies with measures of endogenous hormones would be needed to unravel the relationship between the hormonal changes of menopause and ischemic stroke, she said.

The study was supported by the National Heart, Lung, and Blood Institute and the National Institute of Neurological Disorders and Stroke. Dr. Lisabeth said that she had no conflicts of interest.

SAN FRANCISCO — Half of the 28 million U.S. women who are at risk for unintended pregnancy are not fully protected by contraception, according to a nationally representative survey.

Despite a stated desire not to become pregnant, 8% of women didn't use contraception at all during the prior year, 15% reported an at-risk gap in contraception use, and 27% reported inconsistent use.

The survey identified five key factors linked to inconsistent or nonuse of contraception, Jennifer J. Frost, Dr.P.H., said at a meeting on contraceptive technology sponsored by Contemporary Forums.

Those factors were significant life changes, difficulty paying for and accessing care, low or mixed motivation to avoid pregnancy, negative attitudes and experiences with methods, and negative attitudes and experiences with health care providers.

A companion survey of public and private providers of contraception led investigators to suggest potential remedies related to each of those factors, said Dr. Frost of the Guttmacher Institute, New York.

Investigators from the institute conducted a telephone survey of 1,978 women at risk of unintended pregnancy in 2004. In 2005 they conducted a separate mail-, Internet-, and fax-based survey of 1,256 private family practice physicians, private ob.gyns., and public contraceptive care providers and community health centers, hospitals, Planned Parenthood clinics, and other sites.

“One of the great things about this research is that it expands on the evidence base supporting a more patient-centered approach to contraceptive care,” Dr. Frost said. “It also suggests that such an approach may be one of the key ways to reduce unintended pregnancy in the U.S.”

Among the women who used contraception inconsistently or not at all, 40% cited problems accessing or using methods as one of the reasons for nonuse, and 18% said they didn't care if they got pregnant. (See chart.)

Fully 53% of women with gaps in contraception use reported at least one major life event around the time of that gap. Twenty-six percent said they stopped or started a relationship, 22% said they moved, 21% said they started or stopped a job or school, and 22% reported some other personal crisis.

The survey of providers revealed that fewer than half discussed the disruptive effects of such life changes with women at follow-up contraceptive visits. This suggests that the impact of life changes might be lessened if more providers made regular assessments of changes in women's lives during such visits, if they counseled women about the potential impact of such life events on contraceptive use, and if they provided women with backup methods for emergency contraception.

Gaps in contraceptive use were strongly linked to a lack of education and to poverty. For example, 36% of women with less than a high school education reported gaps in use, compared with 30% of women who completed high school, 24% who attended some college, and 15% who completed college. Hispanic, black, and Asian women were more likely to have gaps than were white women (27%–31% vs. 19%).

“A few things that providers can do to reduce the impact of disadvantage in contraceptive use is to first assess a woman's ability to pay for contraceptive services and supplies and to help them choose a method that they will be able to afford over time,” Dr. Frost said. “Second, [providers should] ensure that women know about and use all the available subsidized services in funding for which they may be eligible. And finally, the providers themselves [should] make sure they use all existing mechanisms for reimbursement.”

The providers in public clinics were more likely to discuss pregnancy motivations with patients than were private physicians. For example, 69% of health departments reported having this discussion with patients, compared with 56% of ob.gyns. and 32% of family physicians.

Women who are unhappy with their contraceptive options often rely on less-effective methods. For example, among women who mostly like their chosen method, 46% use pills and another 22% use long-acting methods, while only 22% use condoms. Among women who say they don't like using other methods, only 24% use pills and another 11% use long-acting methods, while 49% use condoms.

The survey of providers revealed that they are far more likely to discuss the side effects of, and satisfaction with, contraceptive methods with patients than the concrete details of how to remember daily pill use. Among public clinics 87% discussed side effects and satisfaction with methods, but only 58% discussed how to remember daily pill use. Among ob.gyns. 80% discussed side effects, but only 30% discussed daily pill use.

Dr. Frost suggested that providers assess patients' motivations for choosing methods and ensure that positive choices are being made. They should review experiences and satisfaction with methods at each visit, and they should facilitate method switching to find the best option for each woman.

Finally, “although providers universally told us that women can call them if they have problems with their method …, women did not always report that they felt that they could call the providers with questions,” Dr. Frost said. Among women who said that they could call a provider with questions, 21% had gaps in contraceptive use, compared with 39% of the women who said that they could not call their provider. And inconsistent pill use was related to low levels of patient satisfaction and continuity of care.

Among the women who were very satisfied with their provider, 34% had inconsistent pill use, compared with 47% of those who were not very satisfied. Inconsistent pill use was seen among 36% of the women who usually saw the same physician, compared with 51% of those who did not.

“Many providers might benefit from communication training that can improve client provider interactions,” Dr. Frost said. “Finally, although it may appear self-evident, it is important for providers to confirm that all questions have been answered, and that clients feel that they have an easy way to contact the office of the provider with additional questions or problems with their method.”

The studies were supported by grants from the National Institute of Child Health and Human Development. Dr. Frost stated that she had no conflicting commercial relationships.

Contemporary Forums and this news organization are both owned by Elsevier.

Patient survey results were published in three articles appearing in Perspectives on Sexual and Reproductive Health (2007;39:48–55, 2007;39:90–9, and 2008;40:94–104). Results of the provider survey were published in Contraception (2008;78:42–51). Links to these articles are available at www.guttmacher.org

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Half of the 28 million U.S. women who are at risk for unintended pregnancy are not fully protected by contraception, according to a nationally representative survey.

Despite a stated desire not to become pregnant, 8% of women didn't use contraception at all during the prior year, 15% reported an at-risk gap in contraception use, and 27% reported inconsistent use.

The survey identified five key factors linked to inconsistent or nonuse of contraception, Jennifer J. Frost, Dr.P.H., said at a meeting on contraceptive technology sponsored by Contemporary Forums.

Those factors were significant life changes, difficulty paying for and accessing care, low or mixed motivation to avoid pregnancy, negative attitudes and experiences with methods, and negative attitudes and experiences with health care providers.

A companion survey of public and private providers of contraception led investigators to suggest potential remedies related to each of those factors, said Dr. Frost of the Guttmacher Institute, New York.

Investigators from the institute conducted a telephone survey of 1,978 women at risk of unintended pregnancy in 2004. In 2005 they conducted a separate mail-, Internet-, and fax-based survey of 1,256 private family practice physicians, private ob.gyns., and public contraceptive care providers and community health centers, hospitals, Planned Parenthood clinics, and other sites.

“One of the great things about this research is that it expands on the evidence base supporting a more patient-centered approach to contraceptive care,” Dr. Frost said. “It also suggests that such an approach may be one of the key ways to reduce unintended pregnancy in the U.S.”

Among the women who used contraception inconsistently or not at all, 40% cited problems accessing or using methods as one of the reasons for nonuse, and 18% said they didn't care if they got pregnant. (See chart.)

Fully 53% of women with gaps in contraception use reported at least one major life event around the time of that gap. Twenty-six percent said they stopped or started a relationship, 22% said they moved, 21% said they started or stopped a job or school, and 22% reported some other personal crisis.

The survey of providers revealed that fewer than half discussed the disruptive effects of such life changes with women at follow-up contraceptive visits. This suggests that the impact of life changes might be lessened if more providers made regular assessments of changes in women's lives during such visits, if they counseled women about the potential impact of such life events on contraceptive use, and if they provided women with backup methods for emergency contraception.

Gaps in contraceptive use were strongly linked to a lack of education and to poverty. For example, 36% of women with less than a high school education reported gaps in use, compared with 30% of women who completed high school, 24% who attended some college, and 15% who completed college. Hispanic, black, and Asian women were more likely to have gaps than were white women (27%–31% vs. 19%).

“A few things that providers can do to reduce the impact of disadvantage in contraceptive use is to first assess a woman's ability to pay for contraceptive services and supplies and to help them choose a method that they will be able to afford over time,” Dr. Frost said. “Second, [providers should] ensure that women know about and use all the available subsidized services in funding for which they may be eligible. And finally, the providers themselves [should] make sure they use all existing mechanisms for reimbursement.”

The providers in public clinics were more likely to discuss pregnancy motivations with patients than were private physicians. For example, 69% of health departments reported having this discussion with patients, compared with 56% of ob.gyns. and 32% of family physicians.

Women who are unhappy with their contraceptive options often rely on less-effective methods. For example, among women who mostly like their chosen method, 46% use pills and another 22% use long-acting methods, while only 22% use condoms. Among women who say they don't like using other methods, only 24% use pills and another 11% use long-acting methods, while 49% use condoms.

The survey of providers revealed that they are far more likely to discuss the side effects of, and satisfaction with, contraceptive methods with patients than the concrete details of how to remember daily pill use. Among public clinics 87% discussed side effects and satisfaction with methods, but only 58% discussed how to remember daily pill use. Among ob.gyns. 80% discussed side effects, but only 30% discussed daily pill use.

Dr. Frost suggested that providers assess patients' motivations for choosing methods and ensure that positive choices are being made. They should review experiences and satisfaction with methods at each visit, and they should facilitate method switching to find the best option for each woman.

Finally, “although providers universally told us that women can call them if they have problems with their method …, women did not always report that they felt that they could call the providers with questions,” Dr. Frost said. Among women who said that they could call a provider with questions, 21% had gaps in contraceptive use, compared with 39% of the women who said that they could not call their provider. And inconsistent pill use was related to low levels of patient satisfaction and continuity of care.

Among the women who were very satisfied with their provider, 34% had inconsistent pill use, compared with 47% of those who were not very satisfied. Inconsistent pill use was seen among 36% of the women who usually saw the same physician, compared with 51% of those who did not.

“Many providers might benefit from communication training that can improve client provider interactions,” Dr. Frost said. “Finally, although it may appear self-evident, it is important for providers to confirm that all questions have been answered, and that clients feel that they have an easy way to contact the office of the provider with additional questions or problems with their method.”

The studies were supported by grants from the National Institute of Child Health and Human Development. Dr. Frost stated that she had no conflicting commercial relationships.

Contemporary Forums and this news organization are both owned by Elsevier.

Patient survey results were published in three articles appearing in Perspectives on Sexual and Reproductive Health (2007;39:48–55, 2007;39:90–9, and 2008;40:94–104). Results of the provider survey were published in Contraception (2008;78:42–51). Links to these articles are available at www.guttmacher.org

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Half of the 28 million U.S. women who are at risk for unintended pregnancy are not fully protected by contraception, according to a nationally representative survey.

Despite a stated desire not to become pregnant, 8% of women didn't use contraception at all during the prior year, 15% reported an at-risk gap in contraception use, and 27% reported inconsistent use.

The survey identified five key factors linked to inconsistent or nonuse of contraception, Jennifer J. Frost, Dr.P.H., said at a meeting on contraceptive technology sponsored by Contemporary Forums.

Those factors were significant life changes, difficulty paying for and accessing care, low or mixed motivation to avoid pregnancy, negative attitudes and experiences with methods, and negative attitudes and experiences with health care providers.

A companion survey of public and private providers of contraception led investigators to suggest potential remedies related to each of those factors, said Dr. Frost of the Guttmacher Institute, New York.

Investigators from the institute conducted a telephone survey of 1,978 women at risk of unintended pregnancy in 2004. In 2005 they conducted a separate mail-, Internet-, and fax-based survey of 1,256 private family practice physicians, private ob.gyns., and public contraceptive care providers and community health centers, hospitals, Planned Parenthood clinics, and other sites.

“One of the great things about this research is that it expands on the evidence base supporting a more patient-centered approach to contraceptive care,” Dr. Frost said. “It also suggests that such an approach may be one of the key ways to reduce unintended pregnancy in the U.S.”

Among the women who used contraception inconsistently or not at all, 40% cited problems accessing or using methods as one of the reasons for nonuse, and 18% said they didn't care if they got pregnant. (See chart.)

Fully 53% of women with gaps in contraception use reported at least one major life event around the time of that gap. Twenty-six percent said they stopped or started a relationship, 22% said they moved, 21% said they started or stopped a job or school, and 22% reported some other personal crisis.

The survey of providers revealed that fewer than half discussed the disruptive effects of such life changes with women at follow-up contraceptive visits. This suggests that the impact of life changes might be lessened if more providers made regular assessments of changes in women's lives during such visits, if they counseled women about the potential impact of such life events on contraceptive use, and if they provided women with backup methods for emergency contraception.

Gaps in contraceptive use were strongly linked to a lack of education and to poverty. For example, 36% of women with less than a high school education reported gaps in use, compared with 30% of women who completed high school, 24% who attended some college, and 15% who completed college. Hispanic, black, and Asian women were more likely to have gaps than were white women (27%–31% vs. 19%).

“A few things that providers can do to reduce the impact of disadvantage in contraceptive use is to first assess a woman's ability to pay for contraceptive services and supplies and to help them choose a method that they will be able to afford over time,” Dr. Frost said. “Second, [providers should] ensure that women know about and use all the available subsidized services in funding for which they may be eligible. And finally, the providers themselves [should] make sure they use all existing mechanisms for reimbursement.”

The providers in public clinics were more likely to discuss pregnancy motivations with patients than were private physicians. For example, 69% of health departments reported having this discussion with patients, compared with 56% of ob.gyns. and 32% of family physicians.

Women who are unhappy with their contraceptive options often rely on less-effective methods. For example, among women who mostly like their chosen method, 46% use pills and another 22% use long-acting methods, while only 22% use condoms. Among women who say they don't like using other methods, only 24% use pills and another 11% use long-acting methods, while 49% use condoms.

The survey of providers revealed that they are far more likely to discuss the side effects of, and satisfaction with, contraceptive methods with patients than the concrete details of how to remember daily pill use. Among public clinics 87% discussed side effects and satisfaction with methods, but only 58% discussed how to remember daily pill use. Among ob.gyns. 80% discussed side effects, but only 30% discussed daily pill use.

Dr. Frost suggested that providers assess patients' motivations for choosing methods and ensure that positive choices are being made. They should review experiences and satisfaction with methods at each visit, and they should facilitate method switching to find the best option for each woman.

Finally, “although providers universally told us that women can call them if they have problems with their method …, women did not always report that they felt that they could call the providers with questions,” Dr. Frost said. Among women who said that they could call a provider with questions, 21% had gaps in contraceptive use, compared with 39% of the women who said that they could not call their provider. And inconsistent pill use was related to low levels of patient satisfaction and continuity of care.

Among the women who were very satisfied with their provider, 34% had inconsistent pill use, compared with 47% of those who were not very satisfied. Inconsistent pill use was seen among 36% of the women who usually saw the same physician, compared with 51% of those who did not.

“Many providers might benefit from communication training that can improve client provider interactions,” Dr. Frost said. “Finally, although it may appear self-evident, it is important for providers to confirm that all questions have been answered, and that clients feel that they have an easy way to contact the office of the provider with additional questions or problems with their method.”

The studies were supported by grants from the National Institute of Child Health and Human Development. Dr. Frost stated that she had no conflicting commercial relationships.

Contemporary Forums and this news organization are both owned by Elsevier.

Patient survey results were published in three articles appearing in Perspectives on Sexual and Reproductive Health (2007;39:48–55, 2007;39:90–9, and 2008;40:94–104). Results of the provider survey were published in Contraception (2008;78:42–51). Links to these articles are available at www.guttmacher.org

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — When used intravaginally in combination with a condom, the investigational microbicide PRO 2000/5 gel appeared to reduce HIV transmission by 30% in a large, international, randomized clinical trial.

The finding, which fell short of statistical significance, was seen in a study called HPTN 035 (Phase II/IIb Safety and Effectiveness Study of the Vaginal Microbicides BufferGel and 0.5% PRO 2000/5 Gel [P] for the Prevention of HIV Infection in Women). A reduction of 33% would have reached statistical significance, according to Dr. Willard Cates, Jr., president of research at Family Health International, which designed and launched the trial. FHI is a nonprofit foundation in Research Triangle Park. N.C.

The study followed 3,099 women at one U.S. site and at sites in five African countries. All women were given free condoms, HIV risk reduction counseling, and diagnosis and treatment of sexually transmitted diseases. The study participants were then randomized to one of four groups. One-quarter were given PRO 2000/5 gel, one-quarter were given another microbicide called BufferGel, one-quarter were given a placebo gel, and the remaining women did not receive any gel. The gels were provided as single-use, prefilled applicators and the study participants were instructed to apply one dose of the contents intravaginally up to 60 minutes before each vaginal intercourse. The women were followed for an average of 20 months and were evaluated monthly; 94% of the women completed study visits through the follow-up period.

Participants in the three gel groups reported using the gel during 81% of all sex acts, and nearly all women (99%) said they would use the products if approved for HIV prevention. Women in the three gel groups reported using condoms 72% of the time, and women in the no-gel group reported using condoms 81% of the time.

In all, 194 of the women acquired HIV; 36 women in the PRO 2000/5 group, 54 in the BufferGel group, 51 in the placebo gel group, and 53 among participants who used no gel. This corresponds to an effectiveness rate of 30% for PRO 2000/5; a rate of 33% would have been statistically significant. In a subanalysis based on reliability of condom use, there was little difference in the infection rate among women who used condoms more than 85% of the time. However, the infection rate was 4.6 per 100 person-years among the low-condom-use women given the placebo gel compared to 1.0 per 100 person-years among the low-condom-use women given PRO 2000/5 gel. The variation corresponded to an effectiveness rate of 78% for the microbicide.

Dr. Cates acknowledged at a meeting on contraceptive technology sponsored by Contemporary Forums that this post hoc subanalysis did not carry the statistical weight of a primary outcome. “It's not conclusive, not etiologic reasoning in its purest, but at least it's a hint and a ray of hope in a field that was looking for any good news,” he said.

Dr. Cates said that a separate trial of PRO 2000/5 gel, involving about 9,000 women, is expected to be completed by the end of 2009, with data available early in 2010.

The investigational microbicide PRO 2000/5 gel (0.5% dose) was developed by Indevus Pharmaceuticals Inc. of Lexington, Mass., and is an entry/fusion inhibitor designed to make it difficult for HIV to attach to and infect healthy cells. The investigational microbicide BufferGel was developed by ReProtect Inc. of Baltimore and is thought to work by boosting the natural acidity of the vagina in the presence of seminal fluid.

The study was funded by the National Institute of Allergy and Infectious Diseases (NCT00074425). Invedus and ReProtect provided the microbicide gels, and the U.S. Agency for International Development provided funding to manufacture BufferGel for the study. Dr. Cates disclosed that he had no conflicts of interest.

Contemporary Forums and this news organization are both owned by Elsevier.

SAN FRANCISCO — When used intravaginally in combination with a condom, the investigational microbicide PRO 2000/5 gel appeared to reduce HIV transmission by 30% in a large, international, randomized clinical trial.

The finding, which fell short of statistical significance, was seen in a study called HPTN 035 (Phase II/IIb Safety and Effectiveness Study of the Vaginal Microbicides BufferGel and 0.5% PRO 2000/5 Gel [P] for the Prevention of HIV Infection in Women). A reduction of 33% would have reached statistical significance, according to Dr. Willard Cates, Jr., president of research at Family Health International, which designed and launched the trial. FHI is a nonprofit foundation in Research Triangle Park. N.C.

The study followed 3,099 women at one U.S. site and at sites in five African countries. All women were given free condoms, HIV risk reduction counseling, and diagnosis and treatment of sexually transmitted diseases. The study participants were then randomized to one of four groups. One-quarter were given PRO 2000/5 gel, one-quarter were given another microbicide called BufferGel, one-quarter were given a placebo gel, and the remaining women did not receive any gel. The gels were provided as single-use, prefilled applicators and the study participants were instructed to apply one dose of the contents intravaginally up to 60 minutes before each vaginal intercourse. The women were followed for an average of 20 months and were evaluated monthly; 94% of the women completed study visits through the follow-up period.

Participants in the three gel groups reported using the gel during 81% of all sex acts, and nearly all women (99%) said they would use the products if approved for HIV prevention. Women in the three gel groups reported using condoms 72% of the time, and women in the no-gel group reported using condoms 81% of the time.

In all, 194 of the women acquired HIV; 36 women in the PRO 2000/5 group, 54 in the BufferGel group, 51 in the placebo gel group, and 53 among participants who used no gel. This corresponds to an effectiveness rate of 30% for PRO 2000/5; a rate of 33% would have been statistically significant. In a subanalysis based on reliability of condom use, there was little difference in the infection rate among women who used condoms more than 85% of the time. However, the infection rate was 4.6 per 100 person-years among the low-condom-use women given the placebo gel compared to 1.0 per 100 person-years among the low-condom-use women given PRO 2000/5 gel. The variation corresponded to an effectiveness rate of 78% for the microbicide.

Dr. Cates acknowledged at a meeting on contraceptive technology sponsored by Contemporary Forums that this post hoc subanalysis did not carry the statistical weight of a primary outcome. “It's not conclusive, not etiologic reasoning in its purest, but at least it's a hint and a ray of hope in a field that was looking for any good news,” he said.

Dr. Cates said that a separate trial of PRO 2000/5 gel, involving about 9,000 women, is expected to be completed by the end of 2009, with data available early in 2010.

The investigational microbicide PRO 2000/5 gel (0.5% dose) was developed by Indevus Pharmaceuticals Inc. of Lexington, Mass., and is an entry/fusion inhibitor designed to make it difficult for HIV to attach to and infect healthy cells. The investigational microbicide BufferGel was developed by ReProtect Inc. of Baltimore and is thought to work by boosting the natural acidity of the vagina in the presence of seminal fluid.

The study was funded by the National Institute of Allergy and Infectious Diseases (NCT00074425). Invedus and ReProtect provided the microbicide gels, and the U.S. Agency for International Development provided funding to manufacture BufferGel for the study. Dr. Cates disclosed that he had no conflicts of interest.

Contemporary Forums and this news organization are both owned by Elsevier.

SAN FRANCISCO — When used intravaginally in combination with a condom, the investigational microbicide PRO 2000/5 gel appeared to reduce HIV transmission by 30% in a large, international, randomized clinical trial.

The finding, which fell short of statistical significance, was seen in a study called HPTN 035 (Phase II/IIb Safety and Effectiveness Study of the Vaginal Microbicides BufferGel and 0.5% PRO 2000/5 Gel [P] for the Prevention of HIV Infection in Women). A reduction of 33% would have reached statistical significance, according to Dr. Willard Cates, Jr., president of research at Family Health International, which designed and launched the trial. FHI is a nonprofit foundation in Research Triangle Park. N.C.

The study followed 3,099 women at one U.S. site and at sites in five African countries. All women were given free condoms, HIV risk reduction counseling, and diagnosis and treatment of sexually transmitted diseases. The study participants were then randomized to one of four groups. One-quarter were given PRO 2000/5 gel, one-quarter were given another microbicide called BufferGel, one-quarter were given a placebo gel, and the remaining women did not receive any gel. The gels were provided as single-use, prefilled applicators and the study participants were instructed to apply one dose of the contents intravaginally up to 60 minutes before each vaginal intercourse. The women were followed for an average of 20 months and were evaluated monthly; 94% of the women completed study visits through the follow-up period.

Participants in the three gel groups reported using the gel during 81% of all sex acts, and nearly all women (99%) said they would use the products if approved for HIV prevention. Women in the three gel groups reported using condoms 72% of the time, and women in the no-gel group reported using condoms 81% of the time.

In all, 194 of the women acquired HIV; 36 women in the PRO 2000/5 group, 54 in the BufferGel group, 51 in the placebo gel group, and 53 among participants who used no gel. This corresponds to an effectiveness rate of 30% for PRO 2000/5; a rate of 33% would have been statistically significant. In a subanalysis based on reliability of condom use, there was little difference in the infection rate among women who used condoms more than 85% of the time. However, the infection rate was 4.6 per 100 person-years among the low-condom-use women given the placebo gel compared to 1.0 per 100 person-years among the low-condom-use women given PRO 2000/5 gel. The variation corresponded to an effectiveness rate of 78% for the microbicide.

Dr. Cates acknowledged at a meeting on contraceptive technology sponsored by Contemporary Forums that this post hoc subanalysis did not carry the statistical weight of a primary outcome. “It's not conclusive, not etiologic reasoning in its purest, but at least it's a hint and a ray of hope in a field that was looking for any good news,” he said.

Dr. Cates said that a separate trial of PRO 2000/5 gel, involving about 9,000 women, is expected to be completed by the end of 2009, with data available early in 2010.

The investigational microbicide PRO 2000/5 gel (0.5% dose) was developed by Indevus Pharmaceuticals Inc. of Lexington, Mass., and is an entry/fusion inhibitor designed to make it difficult for HIV to attach to and infect healthy cells. The investigational microbicide BufferGel was developed by ReProtect Inc. of Baltimore and is thought to work by boosting the natural acidity of the vagina in the presence of seminal fluid.

The study was funded by the National Institute of Allergy and Infectious Diseases (NCT00074425). Invedus and ReProtect provided the microbicide gels, and the U.S. Agency for International Development provided funding to manufacture BufferGel for the study. Dr. Cates disclosed that he had no conflicts of interest.

Contemporary Forums and this news organization are both owned by Elsevier.

A 7-year program of intense surveillance and isolation in a neonatal intensive care unit failed to eradicate methicillin-resistant Staphylococcus aureus colonization.

At the beginning of the period, in August 2000, the incidence of colonization with methicillin-resistant Staphylococcus aureus (MRSA) at Boston's Brigham and Women's Hospital neonatal ICU was 1.79 cases per 1,000 patient-days. By 2005 the incidence had declined substantially—to 0.15 cases per 1,000 patient-days—but it rose to 1.26 cases per 1,000 patient-days in 2007 (Pediatrics 2009;123:e790-6).

During that time investigators isolated 14 different MRSA strains from infants in the NICU, suggesting that MRSA was introduced repeatedly and by multiple sources. “This may explain why our continuous MRSA surveillance program did not result in permanent eradication of MRSA in the unit,” wrote Dr. Mary Lucia Gregory of the department of neonatology, Beth Israel Deaconess Medical Center, Boston, and her colleagues.

Strains found from 2000 to 2004 tended to be hospital associated, while those found from 2006 to 2007 tended to be community associated, the investigators said.

The retrospective study involved 7,997 infants, 102 of whom were either colonized or infected with MRSA (1.3%). All infants were screened weekly with nasal/rectal cultures. In all, 19,090 screening cultures were collected and analyzed during the surveillance program. Hospital charges, which were not billed to insurers, exceeded $1.5 million during this period.

Not all infants who were colonized with MRSA had an invasive infection. The proportion with an invasive infection ranged from 8% in 2001 to 33% in 2005. Investigators detected no statistically significant differences between the 15 infants who were infected and the 87 who were merely colonized. There was a trend, however, toward lower gestational age and older postmenstrual age at discharge for the infected infants.

Of the 15 infected infants, 9 (60%) had a soft tissue infection without bloodstream infections, and the other 6 (40%) had MRSA in blood cultures.

Seven of the infants with soft tissue infections had skin pustules, and the other two had ear drainage. Two of the infants with bacteremia developed septic arthritis. There were no confirmed cases of meningitis, although one infant's condition was judged too unstable for a lumbar puncture, and that patient was treated for presumed meningitis. One infant died of MRSA sepsis.

All six of the infants with bloodstream infections received treatment with intravenous vancomycin, as did six of the nine infants with soft tissue infections. The remaining three were treated with topical or oral antibiotics. Treatment failed to eradicate MRSA colonization in one of the six bloodstream infections and in eight of the nine soft tissue infections.

Infants developed positive MRSA cultures a median of 12 days following admission to the NICU, with a range of 1-119 days. Clinicians made no attempt to decolonize infants during the study period, and investigators were unable to determine the total duration of MRSA colonization. At discharge, 63 (62%) of the 102 infants remained colonized.

In comparing the 63 infants who remained colonized at discharge with the 39 who did not, the investigators found two statistically significant differences. The infants who were colonized at discharge had a higher median gestational age (32 weeks vs. 27 weeks) and a higher median birth weight (1,650 g vs. 1,120 g).

The investigators indicated that they had no financial relationships relevant to the study.

A 7-year program of intense surveillance and isolation in a neonatal intensive care unit failed to eradicate methicillin-resistant Staphylococcus aureus colonization.

At the beginning of the period, in August 2000, the incidence of colonization with methicillin-resistant Staphylococcus aureus (MRSA) at Boston's Brigham and Women's Hospital neonatal ICU was 1.79 cases per 1,000 patient-days. By 2005 the incidence had declined substantially—to 0.15 cases per 1,000 patient-days—but it rose to 1.26 cases per 1,000 patient-days in 2007 (Pediatrics 2009;123:e790-6).

During that time investigators isolated 14 different MRSA strains from infants in the NICU, suggesting that MRSA was introduced repeatedly and by multiple sources. “This may explain why our continuous MRSA surveillance program did not result in permanent eradication of MRSA in the unit,” wrote Dr. Mary Lucia Gregory of the department of neonatology, Beth Israel Deaconess Medical Center, Boston, and her colleagues.

Strains found from 2000 to 2004 tended to be hospital associated, while those found from 2006 to 2007 tended to be community associated, the investigators said.

The retrospective study involved 7,997 infants, 102 of whom were either colonized or infected with MRSA (1.3%). All infants were screened weekly with nasal/rectal cultures. In all, 19,090 screening cultures were collected and analyzed during the surveillance program. Hospital charges, which were not billed to insurers, exceeded $1.5 million during this period.

Not all infants who were colonized with MRSA had an invasive infection. The proportion with an invasive infection ranged from 8% in 2001 to 33% in 2005. Investigators detected no statistically significant differences between the 15 infants who were infected and the 87 who were merely colonized. There was a trend, however, toward lower gestational age and older postmenstrual age at discharge for the infected infants.

Of the 15 infected infants, 9 (60%) had a soft tissue infection without bloodstream infections, and the other 6 (40%) had MRSA in blood cultures.

Seven of the infants with soft tissue infections had skin pustules, and the other two had ear drainage. Two of the infants with bacteremia developed septic arthritis. There were no confirmed cases of meningitis, although one infant's condition was judged too unstable for a lumbar puncture, and that patient was treated for presumed meningitis. One infant died of MRSA sepsis.

All six of the infants with bloodstream infections received treatment with intravenous vancomycin, as did six of the nine infants with soft tissue infections. The remaining three were treated with topical or oral antibiotics. Treatment failed to eradicate MRSA colonization in one of the six bloodstream infections and in eight of the nine soft tissue infections.

Infants developed positive MRSA cultures a median of 12 days following admission to the NICU, with a range of 1-119 days. Clinicians made no attempt to decolonize infants during the study period, and investigators were unable to determine the total duration of MRSA colonization. At discharge, 63 (62%) of the 102 infants remained colonized.

In comparing the 63 infants who remained colonized at discharge with the 39 who did not, the investigators found two statistically significant differences. The infants who were colonized at discharge had a higher median gestational age (32 weeks vs. 27 weeks) and a higher median birth weight (1,650 g vs. 1,120 g).

The investigators indicated that they had no financial relationships relevant to the study.

A 7-year program of intense surveillance and isolation in a neonatal intensive care unit failed to eradicate methicillin-resistant Staphylococcus aureus colonization.

At the beginning of the period, in August 2000, the incidence of colonization with methicillin-resistant Staphylococcus aureus (MRSA) at Boston's Brigham and Women's Hospital neonatal ICU was 1.79 cases per 1,000 patient-days. By 2005 the incidence had declined substantially—to 0.15 cases per 1,000 patient-days—but it rose to 1.26 cases per 1,000 patient-days in 2007 (Pediatrics 2009;123:e790-6).

During that time investigators isolated 14 different MRSA strains from infants in the NICU, suggesting that MRSA was introduced repeatedly and by multiple sources. “This may explain why our continuous MRSA surveillance program did not result in permanent eradication of MRSA in the unit,” wrote Dr. Mary Lucia Gregory of the department of neonatology, Beth Israel Deaconess Medical Center, Boston, and her colleagues.

Strains found from 2000 to 2004 tended to be hospital associated, while those found from 2006 to 2007 tended to be community associated, the investigators said.

The retrospective study involved 7,997 infants, 102 of whom were either colonized or infected with MRSA (1.3%). All infants were screened weekly with nasal/rectal cultures. In all, 19,090 screening cultures were collected and analyzed during the surveillance program. Hospital charges, which were not billed to insurers, exceeded $1.5 million during this period.

Not all infants who were colonized with MRSA had an invasive infection. The proportion with an invasive infection ranged from 8% in 2001 to 33% in 2005. Investigators detected no statistically significant differences between the 15 infants who were infected and the 87 who were merely colonized. There was a trend, however, toward lower gestational age and older postmenstrual age at discharge for the infected infants.

Of the 15 infected infants, 9 (60%) had a soft tissue infection without bloodstream infections, and the other 6 (40%) had MRSA in blood cultures.

Seven of the infants with soft tissue infections had skin pustules, and the other two had ear drainage. Two of the infants with bacteremia developed septic arthritis. There were no confirmed cases of meningitis, although one infant's condition was judged too unstable for a lumbar puncture, and that patient was treated for presumed meningitis. One infant died of MRSA sepsis.

All six of the infants with bloodstream infections received treatment with intravenous vancomycin, as did six of the nine infants with soft tissue infections. The remaining three were treated with topical or oral antibiotics. Treatment failed to eradicate MRSA colonization in one of the six bloodstream infections and in eight of the nine soft tissue infections.

Infants developed positive MRSA cultures a median of 12 days following admission to the NICU, with a range of 1-119 days. Clinicians made no attempt to decolonize infants during the study period, and investigators were unable to determine the total duration of MRSA colonization. At discharge, 63 (62%) of the 102 infants remained colonized.

In comparing the 63 infants who remained colonized at discharge with the 39 who did not, the investigators found two statistically significant differences. The infants who were colonized at discharge had a higher median gestational age (32 weeks vs. 27 weeks) and a higher median birth weight (1,650 g vs. 1,120 g).

The investigators indicated that they had no financial relationships relevant to the study.

Aggressive control of gastro-esophageal reflux does not appear to improve asthma symptoms, a study has shown.

The findings challenge the theory that people with poorly controlled asthma frequently have reflux, and that treatment would lead to better asthma control.

The multicenter, double-blind, randomized controlled trial involved 412 adults whose symptoms of asthma were inadequately controlled despite the use of moderate to high doses of inhaled corticosteroids. Participants were assigned to receive either a placebo or 40 mg of esomeprazole, a prescription proton pump inhibitor, twice daily for 24 weeks. This dose was higher than that typically used to treat symptomatic gastroesophageal reflux (N. Engl. J. Med. 2009;360:1487–99).

The study was conducted by the research group of the American Lung Association Asthma Clinical Research Centers, and the article was prepared by a writing committee led by Dr. John G. Mastronarde of Ohio State University Medical College, Columbus.

Although only 15% of the participants reported a history of gastroesophageal reflux, ambulatory pH monitoring revealed that 41% of patients in the placebo group and 40% in the esomeprazole group had evidence of reflux. This is a common finding among patients with asthma—for many, their reflux is asymptomatic.

Patients kept daily diaries of their asthma symptoms, and they were assessed by spirometry every 4 weeks. Depending on the definition of poor asthma control, between 42% and 61% of all participants experienced at least one episode, and 18% required an urgent-care visit or a course of prednisone. There were no significant differences in any of those measures between patients taking placebo and those taking esomeprazole.

About half of the participants reported night awakening caused by asthma symptoms, and that rate also did not differ significantly between the two groups.

The study was powered to detect a difference of 33% in the proportion of participants having one or more episodes of poor asthma control.

The study was supported by grants from the National Heart, Lung, and Blood Institute and the American Lung Association. Esomeprazole and placebo were supplied by AstraZeneca, which manufactures esomeprazole. Several members of the writing committee disclosed receiving consulting or lecture fees from AstraZeneca, and they also reported relationships with several other pharmaceutical companies.

Aggressive control of gastro-esophageal reflux does not appear to improve asthma symptoms, a study has shown.

The findings challenge the theory that people with poorly controlled asthma frequently have reflux, and that treatment would lead to better asthma control.

The multicenter, double-blind, randomized controlled trial involved 412 adults whose symptoms of asthma were inadequately controlled despite the use of moderate to high doses of inhaled corticosteroids. Participants were assigned to receive either a placebo or 40 mg of esomeprazole, a prescription proton pump inhibitor, twice daily for 24 weeks. This dose was higher than that typically used to treat symptomatic gastroesophageal reflux (N. Engl. J. Med. 2009;360:1487–99).

The study was conducted by the research group of the American Lung Association Asthma Clinical Research Centers, and the article was prepared by a writing committee led by Dr. John G. Mastronarde of Ohio State University Medical College, Columbus.

Although only 15% of the participants reported a history of gastroesophageal reflux, ambulatory pH monitoring revealed that 41% of patients in the placebo group and 40% in the esomeprazole group had evidence of reflux. This is a common finding among patients with asthma—for many, their reflux is asymptomatic.

Patients kept daily diaries of their asthma symptoms, and they were assessed by spirometry every 4 weeks. Depending on the definition of poor asthma control, between 42% and 61% of all participants experienced at least one episode, and 18% required an urgent-care visit or a course of prednisone. There were no significant differences in any of those measures between patients taking placebo and those taking esomeprazole.

About half of the participants reported night awakening caused by asthma symptoms, and that rate also did not differ significantly between the two groups.

The study was powered to detect a difference of 33% in the proportion of participants having one or more episodes of poor asthma control.

The study was supported by grants from the National Heart, Lung, and Blood Institute and the American Lung Association. Esomeprazole and placebo were supplied by AstraZeneca, which manufactures esomeprazole. Several members of the writing committee disclosed receiving consulting or lecture fees from AstraZeneca, and they also reported relationships with several other pharmaceutical companies.

Aggressive control of gastro-esophageal reflux does not appear to improve asthma symptoms, a study has shown.

The findings challenge the theory that people with poorly controlled asthma frequently have reflux, and that treatment would lead to better asthma control.

The multicenter, double-blind, randomized controlled trial involved 412 adults whose symptoms of asthma were inadequately controlled despite the use of moderate to high doses of inhaled corticosteroids. Participants were assigned to receive either a placebo or 40 mg of esomeprazole, a prescription proton pump inhibitor, twice daily for 24 weeks. This dose was higher than that typically used to treat symptomatic gastroesophageal reflux (N. Engl. J. Med. 2009;360:1487–99).

The study was conducted by the research group of the American Lung Association Asthma Clinical Research Centers, and the article was prepared by a writing committee led by Dr. John G. Mastronarde of Ohio State University Medical College, Columbus.

Although only 15% of the participants reported a history of gastroesophageal reflux, ambulatory pH monitoring revealed that 41% of patients in the placebo group and 40% in the esomeprazole group had evidence of reflux. This is a common finding among patients with asthma—for many, their reflux is asymptomatic.

Patients kept daily diaries of their asthma symptoms, and they were assessed by spirometry every 4 weeks. Depending on the definition of poor asthma control, between 42% and 61% of all participants experienced at least one episode, and 18% required an urgent-care visit or a course of prednisone. There were no significant differences in any of those measures between patients taking placebo and those taking esomeprazole.

About half of the participants reported night awakening caused by asthma symptoms, and that rate also did not differ significantly between the two groups.

The study was powered to detect a difference of 33% in the proportion of participants having one or more episodes of poor asthma control.

The study was supported by grants from the National Heart, Lung, and Blood Institute and the American Lung Association. Esomeprazole and placebo were supplied by AstraZeneca, which manufactures esomeprazole. Several members of the writing committee disclosed receiving consulting or lecture fees from AstraZeneca, and they also reported relationships with several other pharmaceutical companies.

The National Foundation for Infectious Diseases has unveiled a Web site that takes a multipronged approach to increasing the rate of adult vaccination in the United States.

Revealed during a Webcast for reporters, www.adultvaccination.com

Adult immunization rates are far too low, Dr. Rehm said during the Webcast: “Most vaccination rates in adults are below 50%. The highest rates are for influenza and pneumococcal vaccines in people 65 and older, but even in these groups vaccination rates are below 70%.”

Dr. Rehm attributed those higher rates to long-standing, comprehensive educational and awareness efforts aimed both at the public and health care providers. “Our mission here is to focus the same type of concentrated efforts on all adult vaccines, to support increases in vaccination rates across the entire adult spectrum. While we're at it we'll also aim to increase the influenza and pneumococcal vaccination rates to new target levels,” she said.

For patients, the Web site includes basic information on 13 vaccine-preventable diseases along with a short quiz that helps discern which vaccines they need. It also includes a simple fact sheet and the full schedule of adult immunizations recommended by the U.S. Centers for Disease Control and Prevention.

For health care providers, the Web site includes a “Professional Practice Toolkit,” with numerous resources. These include suggested text for reminder postcards, text to be added to the back of appointment reminder cards, and scripts for recorded telephone messages to be played when patients are on hold or when the office is closed. (See box.)

Dr. Rehm has used a number of these resources in her own practice, and has implemented other strategies as well. “We have posters in our waiting room regarding various immunizations, and in each of the individual examination rooms we have posted the adult vaccination recommendations from the CDC. People can take a look at those and then it's also a stimulus for us to talk about them,” she explained. “We have built in questions about vaccinations into our intake, so that when our assistants ask patients what medicines they're taking and they get their vital signs … they also update their vaccination immunization [records] and cue us to talk with patients about vaccines.”

The Web site is supported by unrestricted educational grants to the National Foundation for Infectious Diseases from GlaxoSmithKline, Merck, Sanofi Pasteur, and Wyeth Pharmaceuticals.

Items in the Online Toolkit:

▸ Appointment reminder cards

▸ “Office closed” message script

▸ “On hold” message script

▸ Patient fact sheet

▸ Patient Q&A

▸ Poster

▸ Tabletop tent cards

▸ Article for practice newsletter or physician's Web site

▸ Reminder postcards

▸ Resource list

▸ Sample standing orders

Source:

www.adultvaccination.com

The National Foundation for Infectious Diseases has unveiled a Web site that takes a multipronged approach to increasing the rate of adult vaccination in the United States.

Revealed during a Webcast for reporters, www.adultvaccination.com

Adult immunization rates are far too low, Dr. Rehm said during the Webcast: “Most vaccination rates in adults are below 50%. The highest rates are for influenza and pneumococcal vaccines in people 65 and older, but even in these groups vaccination rates are below 70%.”

Dr. Rehm attributed those higher rates to long-standing, comprehensive educational and awareness efforts aimed both at the public and health care providers. “Our mission here is to focus the same type of concentrated efforts on all adult vaccines, to support increases in vaccination rates across the entire adult spectrum. While we're at it we'll also aim to increase the influenza and pneumococcal vaccination rates to new target levels,” she said.

For patients, the Web site includes basic information on 13 vaccine-preventable diseases along with a short quiz that helps discern which vaccines they need. It also includes a simple fact sheet and the full schedule of adult immunizations recommended by the U.S. Centers for Disease Control and Prevention.

For health care providers, the Web site includes a “Professional Practice Toolkit,” with numerous resources. These include suggested text for reminder postcards, text to be added to the back of appointment reminder cards, and scripts for recorded telephone messages to be played when patients are on hold or when the office is closed. (See box.)

Dr. Rehm has used a number of these resources in her own practice, and has implemented other strategies as well. “We have posters in our waiting room regarding various immunizations, and in each of the individual examination rooms we have posted the adult vaccination recommendations from the CDC. People can take a look at those and then it's also a stimulus for us to talk about them,” she explained. “We have built in questions about vaccinations into our intake, so that when our assistants ask patients what medicines they're taking and they get their vital signs … they also update their vaccination immunization [records] and cue us to talk with patients about vaccines.”

The Web site is supported by unrestricted educational grants to the National Foundation for Infectious Diseases from GlaxoSmithKline, Merck, Sanofi Pasteur, and Wyeth Pharmaceuticals.

Items in the Online Toolkit:

▸ Appointment reminder cards

▸ “Office closed” message script

▸ “On hold” message script

▸ Patient fact sheet

▸ Patient Q&A

▸ Poster

▸ Tabletop tent cards

▸ Article for practice newsletter or physician's Web site

▸ Reminder postcards

▸ Resource list

▸ Sample standing orders

Source:

www.adultvaccination.com

The National Foundation for Infectious Diseases has unveiled a Web site that takes a multipronged approach to increasing the rate of adult vaccination in the United States.

Revealed during a Webcast for reporters, www.adultvaccination.com

Adult immunization rates are far too low, Dr. Rehm said during the Webcast: “Most vaccination rates in adults are below 50%. The highest rates are for influenza and pneumococcal vaccines in people 65 and older, but even in these groups vaccination rates are below 70%.”

Dr. Rehm attributed those higher rates to long-standing, comprehensive educational and awareness efforts aimed both at the public and health care providers. “Our mission here is to focus the same type of concentrated efforts on all adult vaccines, to support increases in vaccination rates across the entire adult spectrum. While we're at it we'll also aim to increase the influenza and pneumococcal vaccination rates to new target levels,” she said.

For patients, the Web site includes basic information on 13 vaccine-preventable diseases along with a short quiz that helps discern which vaccines they need. It also includes a simple fact sheet and the full schedule of adult immunizations recommended by the U.S. Centers for Disease Control and Prevention.

For health care providers, the Web site includes a “Professional Practice Toolkit,” with numerous resources. These include suggested text for reminder postcards, text to be added to the back of appointment reminder cards, and scripts for recorded telephone messages to be played when patients are on hold or when the office is closed. (See box.)

Dr. Rehm has used a number of these resources in her own practice, and has implemented other strategies as well. “We have posters in our waiting room regarding various immunizations, and in each of the individual examination rooms we have posted the adult vaccination recommendations from the CDC. People can take a look at those and then it's also a stimulus for us to talk about them,” she explained. “We have built in questions about vaccinations into our intake, so that when our assistants ask patients what medicines they're taking and they get their vital signs … they also update their vaccination immunization [records] and cue us to talk with patients about vaccines.”

The Web site is supported by unrestricted educational grants to the National Foundation for Infectious Diseases from GlaxoSmithKline, Merck, Sanofi Pasteur, and Wyeth Pharmaceuticals.

Items in the Online Toolkit:

▸ Appointment reminder cards

▸ “Office closed” message script

▸ “On hold” message script

▸ Patient fact sheet

▸ Patient Q&A

▸ Poster

▸ Tabletop tent cards

▸ Article for practice newsletter or physician's Web site

▸ Reminder postcards

▸ Resource list

▸ Sample standing orders

Source:

www.adultvaccination.com