Luis Mazariegos

The number of adults with diagnosed diabetes reporting visual impairment has increased, but the age-adjusted percentage has decreased significantly, according to the 14-year National Health Interview Survey conducted by the Centers for Disease Control and Prevention.

Respondents were asked if they had been diagnosed with diabetes, and then they were asked if they had trouble seeing even with eyeglasses or contact lenses. People who said yes to both questions were considered to have diabetes and visual impairment (VI).

Respondents also were asked if they had visited an eye-care provider within the last year. The percentage of people who answered yes to that question remained mostly constant, at around 63% throughout the 14-year period.

Demographic data, including sex, ethnicity, and race, were collected as well (MMWR Morb. Mortal. Wkly. Rep. 2011;60:1549-53).

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010. Age-adjusted prevalence of VI dropped from 23.7% in 1997 to 16.7% in 2010, falling most sharply among whites, Hispanics, those with some college or higher education, those diagnosed with diabetes for at least 3 years, and people aged 45 years or older, according to the findings.

On the other hand, prevalence did not decrease significantly among blacks, people who had been diagnosed with diabetes for less than 3 years, and people aged 18-44 years. Among those with a high school education or less, the prevalence dropped significantly, from 26.4% in 1997 to 18.2% in 2005, but rebounded and increased – although not significantly – to 20.7% in 2010.

This decrease may be attributable in part to better control of VI risk factors (such as blood glucose, blood pressure, and lipid control), improved detection and treatment of eye problems, or other factors. Alternatively, the drop may be explained by the large and sustained increase of new cases of diabetes since the 1990s, resulting in a large number of people who have not had diabetes long enough to develop VI.

This alternative explanation would mean that the encouraging trends may reverse in the coming years. Additionally, the number of people going for their recommended annual dilated-eye examination has languished. Continued monitoring for VI among people with diabetes as well as improving the level of care are recommended.

Response rates for the survey varied, ranging from a high of 80.4% in 1997 to a low of 60.8% in 2010, averaging at 70.5% for the 14-year period.

There were no relevant financial disclosures.

The number of adults with diagnosed diabetes reporting visual impairment has increased, but the age-adjusted percentage has decreased significantly, according to the 14-year National Health Interview Survey conducted by the Centers for Disease Control and Prevention.

Respondents were asked if they had been diagnosed with diabetes, and then they were asked if they had trouble seeing even with eyeglasses or contact lenses. People who said yes to both questions were considered to have diabetes and visual impairment (VI).

Respondents also were asked if they had visited an eye-care provider within the last year. The percentage of people who answered yes to that question remained mostly constant, at around 63% throughout the 14-year period.

Demographic data, including sex, ethnicity, and race, were collected as well (MMWR Morb. Mortal. Wkly. Rep. 2011;60:1549-53).

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010. Age-adjusted prevalence of VI dropped from 23.7% in 1997 to 16.7% in 2010, falling most sharply among whites, Hispanics, those with some college or higher education, those diagnosed with diabetes for at least 3 years, and people aged 45 years or older, according to the findings.

On the other hand, prevalence did not decrease significantly among blacks, people who had been diagnosed with diabetes for less than 3 years, and people aged 18-44 years. Among those with a high school education or less, the prevalence dropped significantly, from 26.4% in 1997 to 18.2% in 2005, but rebounded and increased – although not significantly – to 20.7% in 2010.

This decrease may be attributable in part to better control of VI risk factors (such as blood glucose, blood pressure, and lipid control), improved detection and treatment of eye problems, or other factors. Alternatively, the drop may be explained by the large and sustained increase of new cases of diabetes since the 1990s, resulting in a large number of people who have not had diabetes long enough to develop VI.

This alternative explanation would mean that the encouraging trends may reverse in the coming years. Additionally, the number of people going for their recommended annual dilated-eye examination has languished. Continued monitoring for VI among people with diabetes as well as improving the level of care are recommended.

Response rates for the survey varied, ranging from a high of 80.4% in 1997 to a low of 60.8% in 2010, averaging at 70.5% for the 14-year period.

There were no relevant financial disclosures.

The number of adults with diagnosed diabetes reporting visual impairment has increased, but the age-adjusted percentage has decreased significantly, according to the 14-year National Health Interview Survey conducted by the Centers for Disease Control and Prevention.

Respondents were asked if they had been diagnosed with diabetes, and then they were asked if they had trouble seeing even with eyeglasses or contact lenses. People who said yes to both questions were considered to have diabetes and visual impairment (VI).

Respondents also were asked if they had visited an eye-care provider within the last year. The percentage of people who answered yes to that question remained mostly constant, at around 63% throughout the 14-year period.

Demographic data, including sex, ethnicity, and race, were collected as well (MMWR Morb. Mortal. Wkly. Rep. 2011;60:1549-53).

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010. Age-adjusted prevalence of VI dropped from 23.7% in 1997 to 16.7% in 2010, falling most sharply among whites, Hispanics, those with some college or higher education, those diagnosed with diabetes for at least 3 years, and people aged 45 years or older, according to the findings.

On the other hand, prevalence did not decrease significantly among blacks, people who had been diagnosed with diabetes for less than 3 years, and people aged 18-44 years. Among those with a high school education or less, the prevalence dropped significantly, from 26.4% in 1997 to 18.2% in 2005, but rebounded and increased – although not significantly – to 20.7% in 2010.

This decrease may be attributable in part to better control of VI risk factors (such as blood glucose, blood pressure, and lipid control), improved detection and treatment of eye problems, or other factors. Alternatively, the drop may be explained by the large and sustained increase of new cases of diabetes since the 1990s, resulting in a large number of people who have not had diabetes long enough to develop VI.

This alternative explanation would mean that the encouraging trends may reverse in the coming years. Additionally, the number of people going for their recommended annual dilated-eye examination has languished. Continued monitoring for VI among people with diabetes as well as improving the level of care are recommended.

Response rates for the survey varied, ranging from a high of 80.4% in 1997 to a low of 60.8% in 2010, averaging at 70.5% for the 14-year period.

There were no relevant financial disclosures.

The number of adults with diagnosed diabetes reporting visual impairment has increased, but the age-adjusted percentage has decreased significantly, according to the 14-year National Health Interview Survey conducted by the Centers for Disease Control and Prevention and reported Nov. 17 in the Morbidity and Mortality Weekly Report.

Respondents were asked if they had been diagnosed with diabetes and then asked if they had trouble seeing even with eyeglasses or contacts. People who said yes to both questions were considered to have diabetes and visual impairment (VI). Respondents also were asked if they had visited an eye-care provider in the last year. The percentage of people who answered yes to that question remained mostly constant, at around 63% throughout the 14-year period. Demographic data, including sex, ethnicity, and race, were collected as well (MMWR 2011;60:1549-53).

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010. Age-adjusted prevalence of VI dropped from 23.7% in 1997 to 16.7% in 2010, falling most sharply among whites, Hispanics, those with some college or higher education, those diagnosed with diabetes for at least 3 years, and people aged 45 years or older.

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010.

On the other hand, prevalence did not decrease significantly among blacks, people who had been diagnosed with diabetes for less than 3 years, and people aged 18-44 years. Among those with a high school education or less, the prevalence dropped significantly, from 26.4% in 1997 to 18.2% in 2005, but rebounded and increased – although not significantly – to 20.7% in 2010.

This decrease may be attributable in part to better control of VI risk factors (such as blood glucose, blood pressure, and lipid control), improved detection and treatment of eye problems, or other factors. Alternatively, the drop may be explained by the large and sustained increase of new cases of diabetes since the 1990s, resulting in a large number of people who have not had diabetes long enough to develop VI.

This alternative explanation would mean that the encouraging trends may reverse in the coming years. Additionally, the number of people going for their recommended annual dilated-eye examination has languished at around 63%. Continued monitoring for VI among people with diabetes as well as improving the level of care are recommended.

Response rates for the survey varied, ranging from a high of 80.4% in 1997 to a low of 60.8% in 2010, averaging at 70.5% for the 14-year period.

There were no relevant financial disclosures.

The number of adults with diagnosed diabetes reporting visual impairment has increased, but the age-adjusted percentage has decreased significantly, according to the 14-year National Health Interview Survey conducted by the Centers for Disease Control and Prevention and reported Nov. 17 in the Morbidity and Mortality Weekly Report.

Respondents were asked if they had been diagnosed with diabetes and then asked if they had trouble seeing even with eyeglasses or contacts. People who said yes to both questions were considered to have diabetes and visual impairment (VI). Respondents also were asked if they had visited an eye-care provider in the last year. The percentage of people who answered yes to that question remained mostly constant, at around 63% throughout the 14-year period. Demographic data, including sex, ethnicity, and race, were collected as well (MMWR 2011;60:1549-53).

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010. Age-adjusted prevalence of VI dropped from 23.7% in 1997 to 16.7% in 2010, falling most sharply among whites, Hispanics, those with some college or higher education, those diagnosed with diabetes for at least 3 years, and people aged 45 years or older.

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010.

On the other hand, prevalence did not decrease significantly among blacks, people who had been diagnosed with diabetes for less than 3 years, and people aged 18-44 years. Among those with a high school education or less, the prevalence dropped significantly, from 26.4% in 1997 to 18.2% in 2005, but rebounded and increased – although not significantly – to 20.7% in 2010.

This decrease may be attributable in part to better control of VI risk factors (such as blood glucose, blood pressure, and lipid control), improved detection and treatment of eye problems, or other factors. Alternatively, the drop may be explained by the large and sustained increase of new cases of diabetes since the 1990s, resulting in a large number of people who have not had diabetes long enough to develop VI.

This alternative explanation would mean that the encouraging trends may reverse in the coming years. Additionally, the number of people going for their recommended annual dilated-eye examination has languished at around 63%. Continued monitoring for VI among people with diabetes as well as improving the level of care are recommended.

Response rates for the survey varied, ranging from a high of 80.4% in 1997 to a low of 60.8% in 2010, averaging at 70.5% for the 14-year period.

There were no relevant financial disclosures.

The number of adults with diagnosed diabetes reporting visual impairment has increased, but the age-adjusted percentage has decreased significantly, according to the 14-year National Health Interview Survey conducted by the Centers for Disease Control and Prevention and reported Nov. 17 in the Morbidity and Mortality Weekly Report.

Respondents were asked if they had been diagnosed with diabetes and then asked if they had trouble seeing even with eyeglasses or contacts. People who said yes to both questions were considered to have diabetes and visual impairment (VI). Respondents also were asked if they had visited an eye-care provider in the last year. The percentage of people who answered yes to that question remained mostly constant, at around 63% throughout the 14-year period. Demographic data, including sex, ethnicity, and race, were collected as well (MMWR 2011;60:1549-53).

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010. Age-adjusted prevalence of VI dropped from 23.7% in 1997 to 16.7% in 2010, falling most sharply among whites, Hispanics, those with some college or higher education, those diagnosed with diabetes for at least 3 years, and people aged 45 years or older.

The number of adults with diabetes and visual impairment grew from 2.7 million in 1997 to 3.9 million in 2010.

On the other hand, prevalence did not decrease significantly among blacks, people who had been diagnosed with diabetes for less than 3 years, and people aged 18-44 years. Among those with a high school education or less, the prevalence dropped significantly, from 26.4% in 1997 to 18.2% in 2005, but rebounded and increased – although not significantly – to 20.7% in 2010.

This decrease may be attributable in part to better control of VI risk factors (such as blood glucose, blood pressure, and lipid control), improved detection and treatment of eye problems, or other factors. Alternatively, the drop may be explained by the large and sustained increase of new cases of diabetes since the 1990s, resulting in a large number of people who have not had diabetes long enough to develop VI.

This alternative explanation would mean that the encouraging trends may reverse in the coming years. Additionally, the number of people going for their recommended annual dilated-eye examination has languished at around 63%. Continued monitoring for VI among people with diabetes as well as improving the level of care are recommended.

Response rates for the survey varied, ranging from a high of 80.4% in 1997 to a low of 60.8% in 2010, averaging at 70.5% for the 14-year period.

There were no relevant financial disclosures.

A new formula accurately calculates the risk of pulmonary hypertension by predicting the mean pulmonary artery pressure using data obtained from pulmonary function testing and pulse oximetry, according to a report by Dr. Benjamin E. Schreiber, of the Royal Free Hampstead National Health Service Trust, London, and his associates.

They developed the formula based on findings in 257 patients with systemic sclerosis; the investigators validated it with data from another 129 similar patients.

Patients with a predicted mean pulmonary artery pressure (mPAP) below 25 mm Hg had a low pulmonary hypertension (PH) prevalence (4.4%). Those with a predicted mPAP between 25-35 mm Hg had an average PH prevalence (11.3%). Finally, those with a predicted mPAP above 35 mm Hg had a high PH prevalence (62.9%), which justifies using right-sided heart catheterization (RHC) (Arthritis Rheum. 2011;63:3531-9).

The study started with 838 patients who have systemic sclerosis (SSc) who had undergone an RHC. Of those, 386 patients had undergone pulmonary function testing (PFT) within 6 months of the RHC. Data on oxygen saturation as measured by pulse oximetry (SpO2) at the time of the RHC were included in the study. Of the total number of patients, 452 were excluded because they had incomplete PFT data.

The investigators randomly split the remaining 386 into two groups: the derivation and validation cohorts. The derivation cohort had 257 patients and its data were used to create the formula. The validation cohort had 129 subjects and its data were used to validate the formula. An additional 155 patients with connective tissue diseases other than SSc were obtained from the Royal Free Pulmonary Hypertension Service in London, United Kingdom.

The formula was derived using multivariable linear regression in the derivation cohort. Dr. Schreiber and his team examined the relationship between the SpO₂, PFTs, clinical subtype, autoimmune serologic features, and the mPAP on RHC and developed the following formula: predicted mPAP = 136 – SpO₂ –0.25 x diffusing capacity for carbon monoxide (DLCO)% predicted.

Applying the formula to the validation cohort gave an area under the curve (AUC) of 0.75. The formula performed best in patients with anticentromere antibodies, with an AUC of 0.87. In patients with connective tissue diseases other than SSc, the formula gave an AUC of 0.64.

The researchers suggested the PFT-derived formula can complement data obtained through echocardiography, and that both tests are predictive. Echocardiography is a good tool for diagnosing PH, but it cannot evaluate lung disease and is not always feasible to conduct. Therefore, the formula can calculate which patients are most likely to have PH.

Some of the limitations of this retrospective study included missing data, especially from echocardiograms and PFTs, and lack of rigorous selection of patients for RHC. There were no echocardiographic data available for most patients, and there may have been selection bias in the patients who had a second echocardiography performed.

Dr. Schreiber and his team suggested that further research should combine PFT data with other noninvasive information, such as symptoms, 6-minute walking distance, and brain natriuretic peptide levels. They also said that they plan to continue to validate their formula in patients recruited into the DETECT (Detection of Pulmonary Artery Hypertension in Systemic Sclerosis) study.

No relevant financial disclosures were reported.

A new formula accurately calculates the risk of pulmonary hypertension by predicting the mean pulmonary artery pressure using data obtained from pulmonary function testing and pulse oximetry, according to a report by Dr. Benjamin E. Schreiber, of the Royal Free Hampstead National Health Service Trust, London, and his associates.

They developed the formula based on findings in 257 patients with systemic sclerosis; the investigators validated it with data from another 129 similar patients.

Patients with a predicted mean pulmonary artery pressure (mPAP) below 25 mm Hg had a low pulmonary hypertension (PH) prevalence (4.4%). Those with a predicted mPAP between 25-35 mm Hg had an average PH prevalence (11.3%). Finally, those with a predicted mPAP above 35 mm Hg had a high PH prevalence (62.9%), which justifies using right-sided heart catheterization (RHC) (Arthritis Rheum. 2011;63:3531-9).

The study started with 838 patients who have systemic sclerosis (SSc) who had undergone an RHC. Of those, 386 patients had undergone pulmonary function testing (PFT) within 6 months of the RHC. Data on oxygen saturation as measured by pulse oximetry (SpO2) at the time of the RHC were included in the study. Of the total number of patients, 452 were excluded because they had incomplete PFT data.

The investigators randomly split the remaining 386 into two groups: the derivation and validation cohorts. The derivation cohort had 257 patients and its data were used to create the formula. The validation cohort had 129 subjects and its data were used to validate the formula. An additional 155 patients with connective tissue diseases other than SSc were obtained from the Royal Free Pulmonary Hypertension Service in London, United Kingdom.

The formula was derived using multivariable linear regression in the derivation cohort. Dr. Schreiber and his team examined the relationship between the SpO₂, PFTs, clinical subtype, autoimmune serologic features, and the mPAP on RHC and developed the following formula: predicted mPAP = 136 – SpO₂ –0.25 x diffusing capacity for carbon monoxide (DLCO)% predicted.

Applying the formula to the validation cohort gave an area under the curve (AUC) of 0.75. The formula performed best in patients with anticentromere antibodies, with an AUC of 0.87. In patients with connective tissue diseases other than SSc, the formula gave an AUC of 0.64.

The researchers suggested the PFT-derived formula can complement data obtained through echocardiography, and that both tests are predictive. Echocardiography is a good tool for diagnosing PH, but it cannot evaluate lung disease and is not always feasible to conduct. Therefore, the formula can calculate which patients are most likely to have PH.

Some of the limitations of this retrospective study included missing data, especially from echocardiograms and PFTs, and lack of rigorous selection of patients for RHC. There were no echocardiographic data available for most patients, and there may have been selection bias in the patients who had a second echocardiography performed.

Dr. Schreiber and his team suggested that further research should combine PFT data with other noninvasive information, such as symptoms, 6-minute walking distance, and brain natriuretic peptide levels. They also said that they plan to continue to validate their formula in patients recruited into the DETECT (Detection of Pulmonary Artery Hypertension in Systemic Sclerosis) study.

No relevant financial disclosures were reported.

A new formula accurately calculates the risk of pulmonary hypertension by predicting the mean pulmonary artery pressure using data obtained from pulmonary function testing and pulse oximetry, according to a report by Dr. Benjamin E. Schreiber, of the Royal Free Hampstead National Health Service Trust, London, and his associates.

They developed the formula based on findings in 257 patients with systemic sclerosis; the investigators validated it with data from another 129 similar patients.

Patients with a predicted mean pulmonary artery pressure (mPAP) below 25 mm Hg had a low pulmonary hypertension (PH) prevalence (4.4%). Those with a predicted mPAP between 25-35 mm Hg had an average PH prevalence (11.3%). Finally, those with a predicted mPAP above 35 mm Hg had a high PH prevalence (62.9%), which justifies using right-sided heart catheterization (RHC) (Arthritis Rheum. 2011;63:3531-9).

The study started with 838 patients who have systemic sclerosis (SSc) who had undergone an RHC. Of those, 386 patients had undergone pulmonary function testing (PFT) within 6 months of the RHC. Data on oxygen saturation as measured by pulse oximetry (SpO2) at the time of the RHC were included in the study. Of the total number of patients, 452 were excluded because they had incomplete PFT data.

The investigators randomly split the remaining 386 into two groups: the derivation and validation cohorts. The derivation cohort had 257 patients and its data were used to create the formula. The validation cohort had 129 subjects and its data were used to validate the formula. An additional 155 patients with connective tissue diseases other than SSc were obtained from the Royal Free Pulmonary Hypertension Service in London, United Kingdom.

The formula was derived using multivariable linear regression in the derivation cohort. Dr. Schreiber and his team examined the relationship between the SpO₂, PFTs, clinical subtype, autoimmune serologic features, and the mPAP on RHC and developed the following formula: predicted mPAP = 136 – SpO₂ –0.25 x diffusing capacity for carbon monoxide (DLCO)% predicted.

Applying the formula to the validation cohort gave an area under the curve (AUC) of 0.75. The formula performed best in patients with anticentromere antibodies, with an AUC of 0.87. In patients with connective tissue diseases other than SSc, the formula gave an AUC of 0.64.

The researchers suggested the PFT-derived formula can complement data obtained through echocardiography, and that both tests are predictive. Echocardiography is a good tool for diagnosing PH, but it cannot evaluate lung disease and is not always feasible to conduct. Therefore, the formula can calculate which patients are most likely to have PH.

Some of the limitations of this retrospective study included missing data, especially from echocardiograms and PFTs, and lack of rigorous selection of patients for RHC. There were no echocardiographic data available for most patients, and there may have been selection bias in the patients who had a second echocardiography performed.

Dr. Schreiber and his team suggested that further research should combine PFT data with other noninvasive information, such as symptoms, 6-minute walking distance, and brain natriuretic peptide levels. They also said that they plan to continue to validate their formula in patients recruited into the DETECT (Detection of Pulmonary Artery Hypertension in Systemic Sclerosis) study.

No relevant financial disclosures were reported.

Intentional drug poisonings resulted in 14,720 emergency department visits in 2009, with females accounting for nearly two-thirds of the number, according to a report released by the Substance Abuse and Mental Health Services Administration.

Perpetrators used a wide range of substances, including alcohol, illicit drugs, and pharmaceuticals to intentionally harm their victims or render them defenseless. The victims ingested, inhaled, or in some way took in these potentially harmful substances without their knowledge.

Alcohol was involved in the majority (60%) of cases, while illicit drugs such as marijuana, ecstasy, stimulants, and cocaine were used 30% of the time. Pharmaceuticals, such as drugs for insomnia, anxiety, and pain, were involved in about one-fifth (21 %) of the cases. In addition, 73% of drug-related emergency department (ED) visits tied to intentional poisoning were made by patients who were aged 21 years or older, according to the report, which was released Nov. 3.

A combination of drugs and alcohol was used 46% of the time. These combinations can be especially dangerous, because alcohol can amplify the other drug’s effect.

"The danger of being tricked into ingesting an unknown substance is all too real at bars, raves, parties, or concerts where alcohol and other substances are shared in a social manner," Pamela S. Hyde, administrator of the Substance Abuse and Mental Health Services Administration, said in a statement. "Not only is the health of the person who is poisoned compromised, they are in jeopardy of falling prey to other crimes such as robbery and sexual assault."

Victims can experience drowsiness, loss of consciousness, or memory loss because of intentional poisoning, and therefore can be extremely vulnerable.

The report recommends educational campaigns aimed at promoting using the "buddy system," in which friends ensure each other’s safety and to encourage people to seek medical care immediately if poisoning is suspected. It also supported the use of informational campaigns that would raise public awareness about the risks involved with leaving beverages unattended and accepting alcohol or other drugs from others – either from strangers or from people they know.

For physicians, the report contains important messages, Dr. Mark S. Gold said in an interview.

"On college campuses and cities around the USA, these data should remind us to listen to the patient, examine them, take them very seriously, and test them when the evidence points toward a medication, drug, and/or alcohol poisoning," said Dr. Gold, chairman of the department of psychiatry at the University of Florida, Gainesville.

Dr. Robert L. DuPont said in an interview that the findings are reminiscent of an adage from Alcoholics Anonymous: "If you don’t want to slip, avoid slippery places.

"Intentional poisonings occur almost exclusively in very slippery places," said Dr. DuPont, the first director of the National Institute on Drug Abuse and now head of the Institute for Behavior and Health, a drug policy nonprofit in Rockville, Md. "The public health message from these disturbing new statistics is: ‘Stay out of slippery places.’ "

The report, "Drug-Related Emergency Department Visits Attributed to Intentional Poisoning," was developed from data obtained from the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network, a nationwide health surveillance system that monitors drug-related emergency visits.

Intentional drug poisonings resulted in 14,720 emergency department visits in 2009, with females accounting for nearly two-thirds of the number, according to a report released by the Substance Abuse and Mental Health Services Administration.

Perpetrators used a wide range of substances, including alcohol, illicit drugs, and pharmaceuticals to intentionally harm their victims or render them defenseless. The victims ingested, inhaled, or in some way took in these potentially harmful substances without their knowledge.

Alcohol was involved in the majority (60%) of cases, while illicit drugs such as marijuana, ecstasy, stimulants, and cocaine were used 30% of the time. Pharmaceuticals, such as drugs for insomnia, anxiety, and pain, were involved in about one-fifth (21 %) of the cases. In addition, 73% of drug-related emergency department (ED) visits tied to intentional poisoning were made by patients who were aged 21 years or older, according to the report, which was released Nov. 3.

A combination of drugs and alcohol was used 46% of the time. These combinations can be especially dangerous, because alcohol can amplify the other drug’s effect.

"The danger of being tricked into ingesting an unknown substance is all too real at bars, raves, parties, or concerts where alcohol and other substances are shared in a social manner," Pamela S. Hyde, administrator of the Substance Abuse and Mental Health Services Administration, said in a statement. "Not only is the health of the person who is poisoned compromised, they are in jeopardy of falling prey to other crimes such as robbery and sexual assault."

Victims can experience drowsiness, loss of consciousness, or memory loss because of intentional poisoning, and therefore can be extremely vulnerable.

The report recommends educational campaigns aimed at promoting using the "buddy system," in which friends ensure each other’s safety and to encourage people to seek medical care immediately if poisoning is suspected. It also supported the use of informational campaigns that would raise public awareness about the risks involved with leaving beverages unattended and accepting alcohol or other drugs from others – either from strangers or from people they know.

For physicians, the report contains important messages, Dr. Mark S. Gold said in an interview.

"On college campuses and cities around the USA, these data should remind us to listen to the patient, examine them, take them very seriously, and test them when the evidence points toward a medication, drug, and/or alcohol poisoning," said Dr. Gold, chairman of the department of psychiatry at the University of Florida, Gainesville.

Dr. Robert L. DuPont said in an interview that the findings are reminiscent of an adage from Alcoholics Anonymous: "If you don’t want to slip, avoid slippery places.

"Intentional poisonings occur almost exclusively in very slippery places," said Dr. DuPont, the first director of the National Institute on Drug Abuse and now head of the Institute for Behavior and Health, a drug policy nonprofit in Rockville, Md. "The public health message from these disturbing new statistics is: ‘Stay out of slippery places.’ "

The report, "Drug-Related Emergency Department Visits Attributed to Intentional Poisoning," was developed from data obtained from the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network, a nationwide health surveillance system that monitors drug-related emergency visits.

Intentional drug poisonings resulted in 14,720 emergency department visits in 2009, with females accounting for nearly two-thirds of the number, according to a report released by the Substance Abuse and Mental Health Services Administration.

Perpetrators used a wide range of substances, including alcohol, illicit drugs, and pharmaceuticals to intentionally harm their victims or render them defenseless. The victims ingested, inhaled, or in some way took in these potentially harmful substances without their knowledge.

Alcohol was involved in the majority (60%) of cases, while illicit drugs such as marijuana, ecstasy, stimulants, and cocaine were used 30% of the time. Pharmaceuticals, such as drugs for insomnia, anxiety, and pain, were involved in about one-fifth (21 %) of the cases. In addition, 73% of drug-related emergency department (ED) visits tied to intentional poisoning were made by patients who were aged 21 years or older, according to the report, which was released Nov. 3.

A combination of drugs and alcohol was used 46% of the time. These combinations can be especially dangerous, because alcohol can amplify the other drug’s effect.

"The danger of being tricked into ingesting an unknown substance is all too real at bars, raves, parties, or concerts where alcohol and other substances are shared in a social manner," Pamela S. Hyde, administrator of the Substance Abuse and Mental Health Services Administration, said in a statement. "Not only is the health of the person who is poisoned compromised, they are in jeopardy of falling prey to other crimes such as robbery and sexual assault."

Victims can experience drowsiness, loss of consciousness, or memory loss because of intentional poisoning, and therefore can be extremely vulnerable.

The report recommends educational campaigns aimed at promoting using the "buddy system," in which friends ensure each other’s safety and to encourage people to seek medical care immediately if poisoning is suspected. It also supported the use of informational campaigns that would raise public awareness about the risks involved with leaving beverages unattended and accepting alcohol or other drugs from others – either from strangers or from people they know.

For physicians, the report contains important messages, Dr. Mark S. Gold said in an interview.

"On college campuses and cities around the USA, these data should remind us to listen to the patient, examine them, take them very seriously, and test them when the evidence points toward a medication, drug, and/or alcohol poisoning," said Dr. Gold, chairman of the department of psychiatry at the University of Florida, Gainesville.

Dr. Robert L. DuPont said in an interview that the findings are reminiscent of an adage from Alcoholics Anonymous: "If you don’t want to slip, avoid slippery places.

"Intentional poisonings occur almost exclusively in very slippery places," said Dr. DuPont, the first director of the National Institute on Drug Abuse and now head of the Institute for Behavior and Health, a drug policy nonprofit in Rockville, Md. "The public health message from these disturbing new statistics is: ‘Stay out of slippery places.’ "

The report, "Drug-Related Emergency Department Visits Attributed to Intentional Poisoning," was developed from data obtained from the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network, a nationwide health surveillance system that monitors drug-related emergency visits.

Health care providers should take advantage of opportunities at all visits to give the supplemental dose of the new 13-valent pneumococcal conjugate vaccine to all eligible children aged 14-59 months because of the potential for missed doses.

Younger children should receive the full PCV13 primary series because recent data have shown that children who were vaccinated with the 7-valent vaccine (PCV7) are susceptible to serotypes that can cause invasive pneumococcal disease (IPD) and even death.

Photo (c) Yarinca/iStock.com

The Advisory Committee on Immunization Practices (ACIP) published recommendations in 2010 for PCV13 to replace PCV7 for all children at ages 2, 4, and 6 months and for a supplemental dose for those aged 14-59 months.

According to Immunization Information Systems (IIS) sentinel site data from March 2010 to June 2011, only 37% of children who had received PCV7 received the supplemental PCV13 dose, and only 46% of children aged 59 months and younger who required additional primary series doses received the required PCV13 (MMWR 2011;60:1477-81).

A 2-year-old girl in California died from IPD caused by serotype 19A, which is covered by PCV13 but not by PCV7. The girl had received three doses of PCV7 but had not been vaccinated with PCV13. The California Department of Public Health found 30 children who had developed IPD caused by serotypes that were not covered by the PCV7.

Between May 1, 2010, and April 30, 2011, the Centers for Disease Control and Prevention (CDC) studied children younger than 59 months in 12 geographical regions, and found that 63 vaccine-eligible children developed IPD because of a serotype that would have been prevented by PCV13.

The data came from eight IIS sentinel sites, 10 Active Bacterial Core surveillance sites (Connecticut, Minnesota, and New Mexico, and selected counties in California, Colorado, Georgia, Maryland, New York, Oregon, and Tennessee), and two Epidemiology and Laboratory Capacity for Infectious Diseases sites (Utah and Los Angeles County).

In all, 76% of those 63 children were hospitalized, but no deaths were reported. Some 62% had received four doses of PCV7 but did not receive the supplemental PCV13, whereas 18% had received three doses of PCV7 but no fourth dose, which should have been a PCV13 dose.

The data have three limitations: First, the data were collected from select regions and thus may not be representative for the whole country. Second, although the IIS sentinel site data are checked for accuracy, PCV13 doses could have been erroneously reported as PCV7 doses. Finally, although no problems were reported, providers may have experienced delays in receiving the new vaccines.

Health care providers should take advantage of opportunities at all visits to give the supplemental dose of the new 13-valent pneumococcal conjugate vaccine to all eligible children aged 14-59 months because of the potential for missed doses.

Younger children should receive the full PCV13 primary series because recent data have shown that children who were vaccinated with the 7-valent vaccine (PCV7) are susceptible to serotypes that can cause invasive pneumococcal disease (IPD) and even death.

Photo (c) Yarinca/iStock.com

The Advisory Committee on Immunization Practices (ACIP) published recommendations in 2010 for PCV13 to replace PCV7 for all children at ages 2, 4, and 6 months and for a supplemental dose for those aged 14-59 months.

According to Immunization Information Systems (IIS) sentinel site data from March 2010 to June 2011, only 37% of children who had received PCV7 received the supplemental PCV13 dose, and only 46% of children aged 59 months and younger who required additional primary series doses received the required PCV13 (MMWR 2011;60:1477-81).

A 2-year-old girl in California died from IPD caused by serotype 19A, which is covered by PCV13 but not by PCV7. The girl had received three doses of PCV7 but had not been vaccinated with PCV13. The California Department of Public Health found 30 children who had developed IPD caused by serotypes that were not covered by the PCV7.

Between May 1, 2010, and April 30, 2011, the Centers for Disease Control and Prevention (CDC) studied children younger than 59 months in 12 geographical regions, and found that 63 vaccine-eligible children developed IPD because of a serotype that would have been prevented by PCV13.

The data came from eight IIS sentinel sites, 10 Active Bacterial Core surveillance sites (Connecticut, Minnesota, and New Mexico, and selected counties in California, Colorado, Georgia, Maryland, New York, Oregon, and Tennessee), and two Epidemiology and Laboratory Capacity for Infectious Diseases sites (Utah and Los Angeles County).

In all, 76% of those 63 children were hospitalized, but no deaths were reported. Some 62% had received four doses of PCV7 but did not receive the supplemental PCV13, whereas 18% had received three doses of PCV7 but no fourth dose, which should have been a PCV13 dose.

The data have three limitations: First, the data were collected from select regions and thus may not be representative for the whole country. Second, although the IIS sentinel site data are checked for accuracy, PCV13 doses could have been erroneously reported as PCV7 doses. Finally, although no problems were reported, providers may have experienced delays in receiving the new vaccines.

Health care providers should take advantage of opportunities at all visits to give the supplemental dose of the new 13-valent pneumococcal conjugate vaccine to all eligible children aged 14-59 months because of the potential for missed doses.

Younger children should receive the full PCV13 primary series because recent data have shown that children who were vaccinated with the 7-valent vaccine (PCV7) are susceptible to serotypes that can cause invasive pneumococcal disease (IPD) and even death.

Photo (c) Yarinca/iStock.com

The Advisory Committee on Immunization Practices (ACIP) published recommendations in 2010 for PCV13 to replace PCV7 for all children at ages 2, 4, and 6 months and for a supplemental dose for those aged 14-59 months.

According to Immunization Information Systems (IIS) sentinel site data from March 2010 to June 2011, only 37% of children who had received PCV7 received the supplemental PCV13 dose, and only 46% of children aged 59 months and younger who required additional primary series doses received the required PCV13 (MMWR 2011;60:1477-81).

A 2-year-old girl in California died from IPD caused by serotype 19A, which is covered by PCV13 but not by PCV7. The girl had received three doses of PCV7 but had not been vaccinated with PCV13. The California Department of Public Health found 30 children who had developed IPD caused by serotypes that were not covered by the PCV7.

Between May 1, 2010, and April 30, 2011, the Centers for Disease Control and Prevention (CDC) studied children younger than 59 months in 12 geographical regions, and found that 63 vaccine-eligible children developed IPD because of a serotype that would have been prevented by PCV13.

The data came from eight IIS sentinel sites, 10 Active Bacterial Core surveillance sites (Connecticut, Minnesota, and New Mexico, and selected counties in California, Colorado, Georgia, Maryland, New York, Oregon, and Tennessee), and two Epidemiology and Laboratory Capacity for Infectious Diseases sites (Utah and Los Angeles County).

In all, 76% of those 63 children were hospitalized, but no deaths were reported. Some 62% had received four doses of PCV7 but did not receive the supplemental PCV13, whereas 18% had received three doses of PCV7 but no fourth dose, which should have been a PCV13 dose.

The data have three limitations: First, the data were collected from select regions and thus may not be representative for the whole country. Second, although the IIS sentinel site data are checked for accuracy, PCV13 doses could have been erroneously reported as PCV7 doses. Finally, although no problems were reported, providers may have experienced delays in receiving the new vaccines.

Treatment for systemic sclerosis–associated active interstitial lung disease with a relatively high dose of imatinib can be effective, but it carries many side effects, judging from findings of a 20-person study.

The study subjects met the American College of Rheumatology criteria for systemic sclerosis (SSc). The mean disease duration was less than 10 years, their mean forced vital capacity (FVC) was less than 85% of predicted, their dyspnea on exertion was at least grade 2 on the magnitude of task component of the Mahler Baseline Dyspnea Index, and high-resolution computed tomography showed the presence of ground-glass opacifications.

Patients with SSc received oral therapy with imatinib up to 600 mg/day for a period of 1 year. The researchers recorded adverse events and tested pulmonary function. In addition, the modified Rodnan skin thickness score (MRSS) was assessed every 3 months, according to Dr. Dinesh Khanna of the University of California at Los Angeles.

Imatinib treatment increased FVC by 1.74%, though this was not statistically significant. In addition, the MRSS increased by 3.9 units. The total lung capacity increased by 4.17% over predicted and the diffusing capacity for carbon monoxide increased improved by 1.46% versus predicted, according to the investigators (Arthritis Rheum. 2011;63:3540-6 [doi 10.1002/art.30548]).

Of the 20 who participated, 5 did not complete the study due to adverse events that were caused by the treatment itself. A further two dropped out due to adverse events caused by SSc, and one was lost due to follow-up. The rest completed the study.

Some of the common adverse events the participants experienced were fatigue, edema of the face and/or lower extremities, nausea and vomiting, diarrhea, generalized rash, and new-onset proteinuria.

Because of its efficacy, the authors suggest further research with smaller doses of imatinib, so as to reduce AEs while maintaining the positive effects.

The researchers reported no relevant financial disclosures. Novartis Pharmaceuticals provided the study drug and partial support for the study.

Treatment for systemic sclerosis–associated active interstitial lung disease with a relatively high dose of imatinib can be effective, but it carries many side effects, judging from findings of a 20-person study.

The study subjects met the American College of Rheumatology criteria for systemic sclerosis (SSc). The mean disease duration was less than 10 years, their mean forced vital capacity (FVC) was less than 85% of predicted, their dyspnea on exertion was at least grade 2 on the magnitude of task component of the Mahler Baseline Dyspnea Index, and high-resolution computed tomography showed the presence of ground-glass opacifications.

Patients with SSc received oral therapy with imatinib up to 600 mg/day for a period of 1 year. The researchers recorded adverse events and tested pulmonary function. In addition, the modified Rodnan skin thickness score (MRSS) was assessed every 3 months, according to Dr. Dinesh Khanna of the University of California at Los Angeles.

Imatinib treatment increased FVC by 1.74%, though this was not statistically significant. In addition, the MRSS increased by 3.9 units. The total lung capacity increased by 4.17% over predicted and the diffusing capacity for carbon monoxide increased improved by 1.46% versus predicted, according to the investigators (Arthritis Rheum. 2011;63:3540-6 [doi 10.1002/art.30548]).

Of the 20 who participated, 5 did not complete the study due to adverse events that were caused by the treatment itself. A further two dropped out due to adverse events caused by SSc, and one was lost due to follow-up. The rest completed the study.

Some of the common adverse events the participants experienced were fatigue, edema of the face and/or lower extremities, nausea and vomiting, diarrhea, generalized rash, and new-onset proteinuria.

Because of its efficacy, the authors suggest further research with smaller doses of imatinib, so as to reduce AEs while maintaining the positive effects.

The researchers reported no relevant financial disclosures. Novartis Pharmaceuticals provided the study drug and partial support for the study.

Treatment for systemic sclerosis–associated active interstitial lung disease with a relatively high dose of imatinib can be effective, but it carries many side effects, judging from findings of a 20-person study.

The study subjects met the American College of Rheumatology criteria for systemic sclerosis (SSc). The mean disease duration was less than 10 years, their mean forced vital capacity (FVC) was less than 85% of predicted, their dyspnea on exertion was at least grade 2 on the magnitude of task component of the Mahler Baseline Dyspnea Index, and high-resolution computed tomography showed the presence of ground-glass opacifications.

Patients with SSc received oral therapy with imatinib up to 600 mg/day for a period of 1 year. The researchers recorded adverse events and tested pulmonary function. In addition, the modified Rodnan skin thickness score (MRSS) was assessed every 3 months, according to Dr. Dinesh Khanna of the University of California at Los Angeles.

Imatinib treatment increased FVC by 1.74%, though this was not statistically significant. In addition, the MRSS increased by 3.9 units. The total lung capacity increased by 4.17% over predicted and the diffusing capacity for carbon monoxide increased improved by 1.46% versus predicted, according to the investigators (Arthritis Rheum. 2011;63:3540-6 [doi 10.1002/art.30548]).

Of the 20 who participated, 5 did not complete the study due to adverse events that were caused by the treatment itself. A further two dropped out due to adverse events caused by SSc, and one was lost due to follow-up. The rest completed the study.

Some of the common adverse events the participants experienced were fatigue, edema of the face and/or lower extremities, nausea and vomiting, diarrhea, generalized rash, and new-onset proteinuria.

Because of its efficacy, the authors suggest further research with smaller doses of imatinib, so as to reduce AEs while maintaining the positive effects.

The researchers reported no relevant financial disclosures. Novartis Pharmaceuticals provided the study drug and partial support for the study.

New guidelines by the American College of Physicians recommend doctors individually assess the risk of thromboembolism or bleeding problems in patients hospitalized for medical illnesses including stroke before starting treatment to prevent venous thromboembolism.

Most hospitalized patients are at risk for developing venous thromboembolism (VTE), a serious clinical problem that is a combination of pulmonary embolism (PE) and deep venous thrombosis (DVT).

Doctors have used blood thinners, such as heparin, as well as mechanical prophylaxis with graduated compression stockings to prevent VTE. However, these treatments carry risks such as causing bleeding problems.

In a written statement, Dr. Amir Qaseem, one of the guideline’s authors and the director of clinical policy at the ACP, said that "the evidence does not support routine VTE prophylaxis in patients hospitalized for medical illnesses, including stroke." He said that for patients at risk of VTE, physicians should "prescribe heparin or related blood thinners, unless the assessed risk of bleeding outweighs likely benefits."

According to a meta-analysis led by Dr. Frank A. Lederle of the Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, which included 40 randomized trials involving more than 52,000 patients, heparin did not significantly reduce total mortality but did reduce PEs with an odds ratio of 0.69. However, it also increased bleeding with a risk ratio of 1.34 (Ann. Intern. Med. 2011;155:602-15).

In most cases, the reduction in PEs will outweigh the risk in bleeding events, but doctors should evaluate each case individually, the guidelines state.

According to the ACP guidelines, mechanical prophylaxis with graduated compression stockings was not effective in preventing VTE or reducing mortality and resulted in clinically important lower extremity skin damage (Ann. Intern. Med. 2011;155:625-32).

Thus, pharmacologic prophylaxis with heparin or related drugs is recommended for VTE in medical patients including those with stroke unless the risk for bleeding outweighs the probable benefits, according to the guidelines. For patients at risk for bleeding or for whom heparin is contraindicated for other reasons, intermittent pneumatic compression may be the best option, although research is still ongoing on its effectiveness.

The ACP guidelines do not recommend performance measures that promote universal VTE prophylaxis for patients, as they do not take into account each individual’s risk level.

Dr. Linda L. Humphrey, one of the guideline’s authors, has served as a consultant for the U.S. Preventive Services Task Force and received royalties from UpToDate. Another author, Dr. Paul Shekelle, has served as a consultant for the ECRI Institute and been employed at the Department of Veterans Affairs, as well as received grants or has grants pending from the Agency for Healthcare Research and Quality, the Department of Veterans Affairs, and the Centers for Medicare & Medicaid Services. Finally, he also has received royalties from UpToDate.

New guidelines by the American College of Physicians recommend doctors individually assess the risk of thromboembolism or bleeding problems in patients hospitalized for medical illnesses including stroke before starting treatment to prevent venous thromboembolism.

Most hospitalized patients are at risk for developing venous thromboembolism (VTE), a serious clinical problem that is a combination of pulmonary embolism (PE) and deep venous thrombosis (DVT).

Doctors have used blood thinners, such as heparin, as well as mechanical prophylaxis with graduated compression stockings to prevent VTE. However, these treatments carry risks such as causing bleeding problems.

In a written statement, Dr. Amir Qaseem, one of the guideline’s authors and the director of clinical policy at the ACP, said that "the evidence does not support routine VTE prophylaxis in patients hospitalized for medical illnesses, including stroke." He said that for patients at risk of VTE, physicians should "prescribe heparin or related blood thinners, unless the assessed risk of bleeding outweighs likely benefits."

According to a meta-analysis led by Dr. Frank A. Lederle of the Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, which included 40 randomized trials involving more than 52,000 patients, heparin did not significantly reduce total mortality but did reduce PEs with an odds ratio of 0.69. However, it also increased bleeding with a risk ratio of 1.34 (Ann. Intern. Med. 2011;155:602-15).

In most cases, the reduction in PEs will outweigh the risk in bleeding events, but doctors should evaluate each case individually, the guidelines state.

According to the ACP guidelines, mechanical prophylaxis with graduated compression stockings was not effective in preventing VTE or reducing mortality and resulted in clinically important lower extremity skin damage (Ann. Intern. Med. 2011;155:625-32).

Thus, pharmacologic prophylaxis with heparin or related drugs is recommended for VTE in medical patients including those with stroke unless the risk for bleeding outweighs the probable benefits, according to the guidelines. For patients at risk for bleeding or for whom heparin is contraindicated for other reasons, intermittent pneumatic compression may be the best option, although research is still ongoing on its effectiveness.

The ACP guidelines do not recommend performance measures that promote universal VTE prophylaxis for patients, as they do not take into account each individual’s risk level.

Dr. Linda L. Humphrey, one of the guideline’s authors, has served as a consultant for the U.S. Preventive Services Task Force and received royalties from UpToDate. Another author, Dr. Paul Shekelle, has served as a consultant for the ECRI Institute and been employed at the Department of Veterans Affairs, as well as received grants or has grants pending from the Agency for Healthcare Research and Quality, the Department of Veterans Affairs, and the Centers for Medicare & Medicaid Services. Finally, he also has received royalties from UpToDate.

New guidelines by the American College of Physicians recommend doctors individually assess the risk of thromboembolism or bleeding problems in patients hospitalized for medical illnesses including stroke before starting treatment to prevent venous thromboembolism.

Most hospitalized patients are at risk for developing venous thromboembolism (VTE), a serious clinical problem that is a combination of pulmonary embolism (PE) and deep venous thrombosis (DVT).

Doctors have used blood thinners, such as heparin, as well as mechanical prophylaxis with graduated compression stockings to prevent VTE. However, these treatments carry risks such as causing bleeding problems.

In a written statement, Dr. Amir Qaseem, one of the guideline’s authors and the director of clinical policy at the ACP, said that "the evidence does not support routine VTE prophylaxis in patients hospitalized for medical illnesses, including stroke." He said that for patients at risk of VTE, physicians should "prescribe heparin or related blood thinners, unless the assessed risk of bleeding outweighs likely benefits."

According to a meta-analysis led by Dr. Frank A. Lederle of the Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, which included 40 randomized trials involving more than 52,000 patients, heparin did not significantly reduce total mortality but did reduce PEs with an odds ratio of 0.69. However, it also increased bleeding with a risk ratio of 1.34 (Ann. Intern. Med. 2011;155:602-15).

In most cases, the reduction in PEs will outweigh the risk in bleeding events, but doctors should evaluate each case individually, the guidelines state.

According to the ACP guidelines, mechanical prophylaxis with graduated compression stockings was not effective in preventing VTE or reducing mortality and resulted in clinically important lower extremity skin damage (Ann. Intern. Med. 2011;155:625-32).

Thus, pharmacologic prophylaxis with heparin or related drugs is recommended for VTE in medical patients including those with stroke unless the risk for bleeding outweighs the probable benefits, according to the guidelines. For patients at risk for bleeding or for whom heparin is contraindicated for other reasons, intermittent pneumatic compression may be the best option, although research is still ongoing on its effectiveness.

The ACP guidelines do not recommend performance measures that promote universal VTE prophylaxis for patients, as they do not take into account each individual’s risk level.

Dr. Linda L. Humphrey, one of the guideline’s authors, has served as a consultant for the U.S. Preventive Services Task Force and received royalties from UpToDate. Another author, Dr. Paul Shekelle, has served as a consultant for the ECRI Institute and been employed at the Department of Veterans Affairs, as well as received grants or has grants pending from the Agency for Healthcare Research and Quality, the Department of Veterans Affairs, and the Centers for Medicare & Medicaid Services. Finally, he also has received royalties from UpToDate.

Exposure to bisphenol A, which is widely used in consumer products, may lead to behavioral problems in children, according to a study by Joe M. Braun, Ph.D., of the Harvard School of Public Health, Boston, and his associates.

Bisphenol A (BPA) can be found widely in items such as dental sealants, medical equipment, thermal receipts, and food and beverage containers and linings. Because of its ubiquity, exposure is nearly inescapable.

Data was collected from 244 mother-child pairs participating in the HOME (Health Outcomes and Measures of the Environment) study, a prospective birth cohort in the Cincinnati metropolitan area. Maternal spot urine samples were collected at approximately 16 and 26 weeks’ gestation and within 24 hours after birth during 2004-2006. Children’s spot urine samples were collected once per year for the first 3 years of their lives (Pediatrics 2011 Oct. 24 [doi:10.1542/peds.2011-1335]).

The concentrations of total (free plus conjugated) species of BPA were measured at the Centers for Disease Control and Prevention. Researchers used the mean of at least two samples each for the gestational and childhood periods.

At 3 years of age, children were evaluated by their parents using the BASC-2 (Behavior Assessment System for Children–2) Parent Rating Scale for preschoolers. The BASC-2 is a valid, reliable, 134-item, parent-report assessment of a child’s problem behaviors. The parents also evaluated the children’s executive functions using the BRIEF-P (Behavior Rating Inventory of Executive Function–Preschool).

The mothers’ BPA levels were relatively stable from the first sample until birth. Children’s levels, on the other hand, decreased steadily from the first year to the third.

Gestational BPA concentrations were associated with an increase in BASC-2 hyperactivity scores by 0.5, anxiety by 7.0, and depression by 4.9. The increases were sharper in girls, suggesting that they are more susceptible to gestational BPA. Girls saw increases of 9.1 in hyperactivity, 12 in anxiety, and 11 in depression, whereas boys actually saw 6.3 and 0.5 decreases in hyperactivity and depression, respectively, coupled with a smaller increase of 1.3 in anxiety, Dr. Braun and his associates said.

In an accompanying e-letter, biologist James M. Howard suggested that a possible explanation of the more pronounced effect of BPA in girls occurs because BPA increases maternal testosterone (Endocr. J. 2004;51:165-9), and this increase should affect female fetuses more than male fetuses.

In contrast, gestational BPA concentrations were positively associated with emotional control and inhibition scores on the BRIEF-P assessment, and there was no association between BPA and executive function at 3 years of age.

The effects of gestational BPA are still unclear, but patients can attempt to avoid it as a precaution. Health professionals should remind patients that it is not easy to completely steer clear of BPA, and more research is needed to fully understand its effects, Dr. Braun and his associates said.

The study was funded by the National Institutes of Health and the U.S. Environmental Protection Agency. Dr. Braun and his associates said they have no relevant financial disclosures.

Exposure to bisphenol A, which is widely used in consumer products, may lead to behavioral problems in children, according to a study by Joe M. Braun, Ph.D., of the Harvard School of Public Health, Boston, and his associates.

Bisphenol A (BPA) can be found widely in items such as dental sealants, medical equipment, thermal receipts, and food and beverage containers and linings. Because of its ubiquity, exposure is nearly inescapable.

Data was collected from 244 mother-child pairs participating in the HOME (Health Outcomes and Measures of the Environment) study, a prospective birth cohort in the Cincinnati metropolitan area. Maternal spot urine samples were collected at approximately 16 and 26 weeks’ gestation and within 24 hours after birth during 2004-2006. Children’s spot urine samples were collected once per year for the first 3 years of their lives (Pediatrics 2011 Oct. 24 [doi:10.1542/peds.2011-1335]).

The concentrations of total (free plus conjugated) species of BPA were measured at the Centers for Disease Control and Prevention. Researchers used the mean of at least two samples each for the gestational and childhood periods.

At 3 years of age, children were evaluated by their parents using the BASC-2 (Behavior Assessment System for Children–2) Parent Rating Scale for preschoolers. The BASC-2 is a valid, reliable, 134-item, parent-report assessment of a child’s problem behaviors. The parents also evaluated the children’s executive functions using the BRIEF-P (Behavior Rating Inventory of Executive Function–Preschool).

The mothers’ BPA levels were relatively stable from the first sample until birth. Children’s levels, on the other hand, decreased steadily from the first year to the third.

Gestational BPA concentrations were associated with an increase in BASC-2 hyperactivity scores by 0.5, anxiety by 7.0, and depression by 4.9. The increases were sharper in girls, suggesting that they are more susceptible to gestational BPA. Girls saw increases of 9.1 in hyperactivity, 12 in anxiety, and 11 in depression, whereas boys actually saw 6.3 and 0.5 decreases in hyperactivity and depression, respectively, coupled with a smaller increase of 1.3 in anxiety, Dr. Braun and his associates said.

In an accompanying e-letter, biologist James M. Howard suggested that a possible explanation of the more pronounced effect of BPA in girls occurs because BPA increases maternal testosterone (Endocr. J. 2004;51:165-9), and this increase should affect female fetuses more than male fetuses.

In contrast, gestational BPA concentrations were positively associated with emotional control and inhibition scores on the BRIEF-P assessment, and there was no association between BPA and executive function at 3 years of age.

The effects of gestational BPA are still unclear, but patients can attempt to avoid it as a precaution. Health professionals should remind patients that it is not easy to completely steer clear of BPA, and more research is needed to fully understand its effects, Dr. Braun and his associates said.

The study was funded by the National Institutes of Health and the U.S. Environmental Protection Agency. Dr. Braun and his associates said they have no relevant financial disclosures.

Exposure to bisphenol A, which is widely used in consumer products, may lead to behavioral problems in children, according to a study by Joe M. Braun, Ph.D., of the Harvard School of Public Health, Boston, and his associates.

Bisphenol A (BPA) can be found widely in items such as dental sealants, medical equipment, thermal receipts, and food and beverage containers and linings. Because of its ubiquity, exposure is nearly inescapable.

Data was collected from 244 mother-child pairs participating in the HOME (Health Outcomes and Measures of the Environment) study, a prospective birth cohort in the Cincinnati metropolitan area. Maternal spot urine samples were collected at approximately 16 and 26 weeks’ gestation and within 24 hours after birth during 2004-2006. Children’s spot urine samples were collected once per year for the first 3 years of their lives (Pediatrics 2011 Oct. 24 [doi:10.1542/peds.2011-1335]).

The concentrations of total (free plus conjugated) species of BPA were measured at the Centers for Disease Control and Prevention. Researchers used the mean of at least two samples each for the gestational and childhood periods.

At 3 years of age, children were evaluated by their parents using the BASC-2 (Behavior Assessment System for Children–2) Parent Rating Scale for preschoolers. The BASC-2 is a valid, reliable, 134-item, parent-report assessment of a child’s problem behaviors. The parents also evaluated the children’s executive functions using the BRIEF-P (Behavior Rating Inventory of Executive Function–Preschool).

The mothers’ BPA levels were relatively stable from the first sample until birth. Children’s levels, on the other hand, decreased steadily from the first year to the third.

Gestational BPA concentrations were associated with an increase in BASC-2 hyperactivity scores by 0.5, anxiety by 7.0, and depression by 4.9. The increases were sharper in girls, suggesting that they are more susceptible to gestational BPA. Girls saw increases of 9.1 in hyperactivity, 12 in anxiety, and 11 in depression, whereas boys actually saw 6.3 and 0.5 decreases in hyperactivity and depression, respectively, coupled with a smaller increase of 1.3 in anxiety, Dr. Braun and his associates said.

In an accompanying e-letter, biologist James M. Howard suggested that a possible explanation of the more pronounced effect of BPA in girls occurs because BPA increases maternal testosterone (Endocr. J. 2004;51:165-9), and this increase should affect female fetuses more than male fetuses.

In contrast, gestational BPA concentrations were positively associated with emotional control and inhibition scores on the BRIEF-P assessment, and there was no association between BPA and executive function at 3 years of age.

The effects of gestational BPA are still unclear, but patients can attempt to avoid it as a precaution. Health professionals should remind patients that it is not easy to completely steer clear of BPA, and more research is needed to fully understand its effects, Dr. Braun and his associates said.

The study was funded by the National Institutes of Health and the U.S. Environmental Protection Agency. Dr. Braun and his associates said they have no relevant financial disclosures.

Although long postulated, the link between recurrent urinary tract infections during childhood and chronic kidney disease later in life has little support, according to a study led by Dr. Jarmo Salo.

As many as 5% of children experience one or more urinary tract infections (UTIs) before puberty, making it one of the most common bacterial infections during childhood.

A systematic literature review of articles published between January 1966 and August 2009 to explore the connection between UTIs and chronic kidney disease (CKD) yielded 781 articles; Dr. Salo and his team further narrowed their search to 39 articles and ultimately included 10 articles in their analysis. None of the studies was designed to determine the etiology of CKD. The researchers found that of the 1,576 subjects included in these studies, only 3 (0.2%) cases of CKD could be attributed to a childhood UTI. However, it was not possible to tell definitively if any of those three cases of CKD were caused by UTIs because the structures of the patients’ kidneys were not evaluated or reported prior to development of the recurrent UTIs (Pediatrics 2011 Oct. 10 [doi:10.1542/peds.2010-3520]).

In addition, the researchers monitored 366 patients at the University of Oulu (Finland). Through evaluating patient records and interviews, the researchers found that of the 366 children, only 13 patients with CKD had no specific noninfectious cause, such as glomerulonephritis or diabetic nephropathy, but did have a history of childhood UTIs.

Of the 13, 6 exhibited urethral obstructions or congenital anomalies that can cause kidney failure on their own. Four others demonstrated dysplastic or hypoplastic kidneys in their first kidney imaging studies and experienced only one or two UTIs in childhood. The remaining three cases of CKD may have had childhood UTIs as a major contributing factor to the development of CKD. This means that, at most, only 0.3% of CKD cases were caused by childhood UTIs.

Because the risk of developing CKD after the first UTI is small, Dr. Salo and associates recommend focusing imaging procedures on finding severe urinary tract abnormalities.

The Juho Vainio Foundation, the Päivikki and Sakari Sohlberg Foundation, and the Paulo Foundation provided financial support for the study. Dr. Salo and associates did not report any relevant financial disclosures.

Although long postulated, the link between recurrent urinary tract infections during childhood and chronic kidney disease later in life has little support, according to a study led by Dr. Jarmo Salo.

As many as 5% of children experience one or more urinary tract infections (UTIs) before puberty, making it one of the most common bacterial infections during childhood.

A systematic literature review of articles published between January 1966 and August 2009 to explore the connection between UTIs and chronic kidney disease (CKD) yielded 781 articles; Dr. Salo and his team further narrowed their search to 39 articles and ultimately included 10 articles in their analysis. None of the studies was designed to determine the etiology of CKD. The researchers found that of the 1,576 subjects included in these studies, only 3 (0.2%) cases of CKD could be attributed to a childhood UTI. However, it was not possible to tell definitively if any of those three cases of CKD were caused by UTIs because the structures of the patients’ kidneys were not evaluated or reported prior to development of the recurrent UTIs (Pediatrics 2011 Oct. 10 [doi:10.1542/peds.2010-3520]).

In addition, the researchers monitored 366 patients at the University of Oulu (Finland). Through evaluating patient records and interviews, the researchers found that of the 366 children, only 13 patients with CKD had no specific noninfectious cause, such as glomerulonephritis or diabetic nephropathy, but did have a history of childhood UTIs.

Of the 13, 6 exhibited urethral obstructions or congenital anomalies that can cause kidney failure on their own. Four others demonstrated dysplastic or hypoplastic kidneys in their first kidney imaging studies and experienced only one or two UTIs in childhood. The remaining three cases of CKD may have had childhood UTIs as a major contributing factor to the development of CKD. This means that, at most, only 0.3% of CKD cases were caused by childhood UTIs.

Because the risk of developing CKD after the first UTI is small, Dr. Salo and associates recommend focusing imaging procedures on finding severe urinary tract abnormalities.

The Juho Vainio Foundation, the Päivikki and Sakari Sohlberg Foundation, and the Paulo Foundation provided financial support for the study. Dr. Salo and associates did not report any relevant financial disclosures.

Although long postulated, the link between recurrent urinary tract infections during childhood and chronic kidney disease later in life has little support, according to a study led by Dr. Jarmo Salo.

As many as 5% of children experience one or more urinary tract infections (UTIs) before puberty, making it one of the most common bacterial infections during childhood.

A systematic literature review of articles published between January 1966 and August 2009 to explore the connection between UTIs and chronic kidney disease (CKD) yielded 781 articles; Dr. Salo and his team further narrowed their search to 39 articles and ultimately included 10 articles in their analysis. None of the studies was designed to determine the etiology of CKD. The researchers found that of the 1,576 subjects included in these studies, only 3 (0.2%) cases of CKD could be attributed to a childhood UTI. However, it was not possible to tell definitively if any of those three cases of CKD were caused by UTIs because the structures of the patients’ kidneys were not evaluated or reported prior to development of the recurrent UTIs (Pediatrics 2011 Oct. 10 [doi:10.1542/peds.2010-3520]).

In addition, the researchers monitored 366 patients at the University of Oulu (Finland). Through evaluating patient records and interviews, the researchers found that of the 366 children, only 13 patients with CKD had no specific noninfectious cause, such as glomerulonephritis or diabetic nephropathy, but did have a history of childhood UTIs.

Of the 13, 6 exhibited urethral obstructions or congenital anomalies that can cause kidney failure on their own. Four others demonstrated dysplastic or hypoplastic kidneys in their first kidney imaging studies and experienced only one or two UTIs in childhood. The remaining three cases of CKD may have had childhood UTIs as a major contributing factor to the development of CKD. This means that, at most, only 0.3% of CKD cases were caused by childhood UTIs.

Because the risk of developing CKD after the first UTI is small, Dr. Salo and associates recommend focusing imaging procedures on finding severe urinary tract abnormalities.

The Juho Vainio Foundation, the Päivikki and Sakari Sohlberg Foundation, and the Paulo Foundation provided financial support for the study. Dr. Salo and associates did not report any relevant financial disclosures.