Tara Haelle

U.S. children’s and teens’ average blood pressure levels have dropped over the past decade, with a commensurate drop in elevated and high blood pressure among those under 18, according to a new study.

“Inconsistent with previous four studies, results of the current study may indicate promising effects of public health improvement on healthy lifestyles and dietary behaviors on blood pressure control in children and adolescents,” reported Dr. Bo Xi of Shandong University, Jinan, China, and associates. “Reduction of daily intakes of energy, carbohydrate, total fat, and total saturated fatty acids among U.S. children and adolescents may help explain the decrease in mean blood pressure levels and prevalence of elevated blood pressure” (Am. J. Hypertens. 2015 July 8 [doi:10.1093/ajh/hpv091]).

The researchers grouped data from the 14,270 children, aged 8-17 years, in the seven National Health and Nutrition Examination Surveys from 1999 to 2012 into three time periods: 1999-2002, 2003-2008, and 2009-2012. They defined high blood pressure as a systolic and/or diastolic blood pressure at the 95th percentile or higher for a child’s sex, age, and height. Elevated blood pressure fell between the 90th and 95th percentile or at least 120/80 mm Hg.

From 1999-2002 to 2009-2012, both average systolic and diastolic blood pressure dropped overall, 0.7 and 4.2 mm Hg, respectively. Diastolic blood pressure dropped for both males and females, for those in the lower (8-12) and higher (13-17) age groups, and across all race/ethnicity groups. Only girls, whites, and those aged 8-12 years saw overall drops in average systolic blood pressure.

From 2009 to 2012, nearly one in 10 children and teens (9.6%) had elevated blood pressure, and 1.6% had high blood pressure. The prevalence of elevated blood pressure and high blood pressure had dropped 2.8 percentage points and 1.3 percentage points, respectively, since 1999-2002. However, teens remained more likely to have elevated blood pressure (odds ratio, 2.62), compared with children, and blacks had higher odds than did whites (OR = 1.39). Girls had half the odds that boys had (OR = 0.5). The trends were similar for high blood pressure.

The total daily calories, carbohydrates, fat, and saturated fatty acids intake among children and teens also decreased from 1999-2002 to 2009-2012, while polyunsaturated fatty acids and dietary fiber intake increased. Sodium, potassium, protein, cholesterol, and caffeine intake did not change during this time, independent of adjustments for body mass index–Z scores. The researchers also found a sodium intake of more than 3,450 mg/d was linked to a higher systolic blood pressure and prevalence of elevated blood pressure, compared with an intake remaining at or below 2,300 mg/d, the recommended daily intake level.

The National Institutes of Health, the Scientific Research Organization Construction Project of Shandong University, and the Research Fund for the Doctoral Program of Higher Education of China supported the study. The authors reported no conflicts of interest.

U.S. children’s and teens’ average blood pressure levels have dropped over the past decade, with a commensurate drop in elevated and high blood pressure among those under 18, according to a new study.

“Inconsistent with previous four studies, results of the current study may indicate promising effects of public health improvement on healthy lifestyles and dietary behaviors on blood pressure control in children and adolescents,” reported Dr. Bo Xi of Shandong University, Jinan, China, and associates. “Reduction of daily intakes of energy, carbohydrate, total fat, and total saturated fatty acids among U.S. children and adolescents may help explain the decrease in mean blood pressure levels and prevalence of elevated blood pressure” (Am. J. Hypertens. 2015 July 8 [doi:10.1093/ajh/hpv091]).

The researchers grouped data from the 14,270 children, aged 8-17 years, in the seven National Health and Nutrition Examination Surveys from 1999 to 2012 into three time periods: 1999-2002, 2003-2008, and 2009-2012. They defined high blood pressure as a systolic and/or diastolic blood pressure at the 95th percentile or higher for a child’s sex, age, and height. Elevated blood pressure fell between the 90th and 95th percentile or at least 120/80 mm Hg.

From 1999-2002 to 2009-2012, both average systolic and diastolic blood pressure dropped overall, 0.7 and 4.2 mm Hg, respectively. Diastolic blood pressure dropped for both males and females, for those in the lower (8-12) and higher (13-17) age groups, and across all race/ethnicity groups. Only girls, whites, and those aged 8-12 years saw overall drops in average systolic blood pressure.

From 2009 to 2012, nearly one in 10 children and teens (9.6%) had elevated blood pressure, and 1.6% had high blood pressure. The prevalence of elevated blood pressure and high blood pressure had dropped 2.8 percentage points and 1.3 percentage points, respectively, since 1999-2002. However, teens remained more likely to have elevated blood pressure (odds ratio, 2.62), compared with children, and blacks had higher odds than did whites (OR = 1.39). Girls had half the odds that boys had (OR = 0.5). The trends were similar for high blood pressure.

The total daily calories, carbohydrates, fat, and saturated fatty acids intake among children and teens also decreased from 1999-2002 to 2009-2012, while polyunsaturated fatty acids and dietary fiber intake increased. Sodium, potassium, protein, cholesterol, and caffeine intake did not change during this time, independent of adjustments for body mass index–Z scores. The researchers also found a sodium intake of more than 3,450 mg/d was linked to a higher systolic blood pressure and prevalence of elevated blood pressure, compared with an intake remaining at or below 2,300 mg/d, the recommended daily intake level.

The National Institutes of Health, the Scientific Research Organization Construction Project of Shandong University, and the Research Fund for the Doctoral Program of Higher Education of China supported the study. The authors reported no conflicts of interest.

U.S. children’s and teens’ average blood pressure levels have dropped over the past decade, with a commensurate drop in elevated and high blood pressure among those under 18, according to a new study.

“Inconsistent with previous four studies, results of the current study may indicate promising effects of public health improvement on healthy lifestyles and dietary behaviors on blood pressure control in children and adolescents,” reported Dr. Bo Xi of Shandong University, Jinan, China, and associates. “Reduction of daily intakes of energy, carbohydrate, total fat, and total saturated fatty acids among U.S. children and adolescents may help explain the decrease in mean blood pressure levels and prevalence of elevated blood pressure” (Am. J. Hypertens. 2015 July 8 [doi:10.1093/ajh/hpv091]).

The researchers grouped data from the 14,270 children, aged 8-17 years, in the seven National Health and Nutrition Examination Surveys from 1999 to 2012 into three time periods: 1999-2002, 2003-2008, and 2009-2012. They defined high blood pressure as a systolic and/or diastolic blood pressure at the 95th percentile or higher for a child’s sex, age, and height. Elevated blood pressure fell between the 90th and 95th percentile or at least 120/80 mm Hg.

From 1999-2002 to 2009-2012, both average systolic and diastolic blood pressure dropped overall, 0.7 and 4.2 mm Hg, respectively. Diastolic blood pressure dropped for both males and females, for those in the lower (8-12) and higher (13-17) age groups, and across all race/ethnicity groups. Only girls, whites, and those aged 8-12 years saw overall drops in average systolic blood pressure.

From 2009 to 2012, nearly one in 10 children and teens (9.6%) had elevated blood pressure, and 1.6% had high blood pressure. The prevalence of elevated blood pressure and high blood pressure had dropped 2.8 percentage points and 1.3 percentage points, respectively, since 1999-2002. However, teens remained more likely to have elevated blood pressure (odds ratio, 2.62), compared with children, and blacks had higher odds than did whites (OR = 1.39). Girls had half the odds that boys had (OR = 0.5). The trends were similar for high blood pressure.

The total daily calories, carbohydrates, fat, and saturated fatty acids intake among children and teens also decreased from 1999-2002 to 2009-2012, while polyunsaturated fatty acids and dietary fiber intake increased. Sodium, potassium, protein, cholesterol, and caffeine intake did not change during this time, independent of adjustments for body mass index–Z scores. The researchers also found a sodium intake of more than 3,450 mg/d was linked to a higher systolic blood pressure and prevalence of elevated blood pressure, compared with an intake remaining at or below 2,300 mg/d, the recommended daily intake level.

The National Institutes of Health, the Scientific Research Organization Construction Project of Shandong University, and the Research Fund for the Doctoral Program of Higher Education of China supported the study. The authors reported no conflicts of interest.

U.S. children’s and teens’ average blood pressure levels have dropped over the past decade, with a commensurate drop in elevated and high blood pressure among those under 18, according to a new study.

“Inconsistent with previous four studies, results of the current study may indicate promising effects of public health improvement on healthy lifestyles and dietary behaviors on blood pressure control in children and adolescents,” reported Dr. Bo Xi of Shandong University, Jinan, China, and associates. “Reduction of daily intakes of energy, carbohydrate, total fat, and total saturated fatty acids among U.S. children and adolescents may help explain the decrease in mean blood pressure levels and prevalence of elevated blood pressure” (Am. J. Hypertens. 2015 July 8 [doi:10.1093/ajh/hpv091]).

The researchers grouped data from the 14,270 children, aged 8-17 years, in the seven National Health and Nutrition Examination Surveys from 1999 to 2012 into three time periods: 1999-2002, 2003-2008, and 2009-2012. They defined high blood pressure as a systolic and/or diastolic blood pressure at the 95th percentile or higher for a child’s sex, age, and height. Elevated blood pressure fell between the 90th and 95th percentile or at least 120/80 mm Hg.

From 1999-2002 to 2009-2012, both average systolic and diastolic blood pressure dropped overall, 0.7 and 4.2 mm Hg, respectively. Diastolic blood pressure dropped for both males and females, for those in the lower (8-12) and higher (13-17) age groups, and across all race/ethnicity groups. Only girls, whites, and those aged 8-12 years saw overall drops in average systolic blood pressure.

From 2009 to 2012, nearly one in 10 children and teens (9.6%) had elevated blood pressure, and 1.6% had high blood pressure. The prevalence of elevated blood pressure and high blood pressure had dropped 2.8 percentage points and 1.3 percentage points, respectively, since 1999-2002. However, teens remained more likely to have elevated blood pressure (odds ratio, 2.62), compared with children, and blacks had higher odds than did whites (OR = 1.39). Girls had half the odds that boys had (OR = 0.5). The trends were similar for high blood pressure.

The total daily calories, carbohydrates, fat, and saturated fatty acids intake among children and teens also decreased from 1999-2002 to 2009-2012, while polyunsaturated fatty acids and dietary fiber intake increased. Sodium, potassium, protein, cholesterol, and caffeine intake did not change during this time, independent of adjustments for body mass index–Z scores. The researchers also found a sodium intake of more than 3,450 mg/d was linked to a higher systolic blood pressure and prevalence of elevated blood pressure, compared with an intake remaining at or below 2,300 mg/d, the recommended daily intake level.

The National Institutes of Health, the Scientific Research Organization Construction Project of Shandong University, and the Research Fund for the Doctoral Program of Higher Education of China supported the study. The authors reported no conflicts of interest.

U.S. children’s and teens’ average blood pressure levels have dropped over the past decade, with a commensurate drop in elevated and high blood pressure among those under 18, according to a new study.

“Inconsistent with previous four studies, results of the current study may indicate promising effects of public health improvement on healthy lifestyles and dietary behaviors on blood pressure control in children and adolescents,” reported Dr. Bo Xi of Shandong University, Jinan, China, and associates. “Reduction of daily intakes of energy, carbohydrate, total fat, and total saturated fatty acids among U.S. children and adolescents may help explain the decrease in mean blood pressure levels and prevalence of elevated blood pressure” (Am. J. Hypertens. 2015 July 8 [doi:10.1093/ajh/hpv091]).

The researchers grouped data from the 14,270 children, aged 8-17 years, in the seven National Health and Nutrition Examination Surveys from 1999 to 2012 into three time periods: 1999-2002, 2003-2008, and 2009-2012. They defined high blood pressure as a systolic and/or diastolic blood pressure at the 95th percentile or higher for a child’s sex, age, and height. Elevated blood pressure fell between the 90th and 95th percentile or at least 120/80 mm Hg.

From 1999-2002 to 2009-2012, both average systolic and diastolic blood pressure dropped overall, 0.7 and 4.2 mm Hg, respectively. Diastolic blood pressure dropped for both males and females, for those in the lower (8-12) and higher (13-17) age groups, and across all race/ethnicity groups. Only girls, whites, and those aged 8-12 years saw overall drops in average systolic blood pressure.

From 2009 to 2012, nearly one in 10 children and teens (9.6%) had elevated blood pressure, and 1.6% had high blood pressure. The prevalence of elevated blood pressure and high blood pressure had dropped 2.8 percentage points and 1.3 percentage points, respectively, since 1999-2002. However, teens remained more likely to have elevated blood pressure (odds ratio, 2.62), compared with children, and blacks had higher odds than did whites (OR = 1.39). Girls had half the odds that boys had (OR = 0.5). The trends were similar for high blood pressure.

The total daily calories, carbohydrates, fat, and saturated fatty acids intake among children and teens also decreased from 1999-2002 to 2009-2012, while polyunsaturated fatty acids and dietary fiber intake increased. Sodium, potassium, protein, cholesterol, and caffeine intake did not change during this time, independent of adjustments for body mass index–Z scores. The researchers also found a sodium intake of more than 3,450 mg/d was linked to a higher systolic blood pressure and prevalence of elevated blood pressure, compared with an intake remaining at or below 2,300 mg/d, the recommended daily intake level.

The National Institutes of Health, the Scientific Research Organization Construction Project of Shandong University, and the Research Fund for the Doctoral Program of Higher Education of China supported the study. The authors reported no conflicts of interest.

U.S. children’s and teens’ average blood pressure levels have dropped over the past decade, with a commensurate drop in elevated and high blood pressure among those under 18, according to a new study.

“Inconsistent with previous four studies, results of the current study may indicate promising effects of public health improvement on healthy lifestyles and dietary behaviors on blood pressure control in children and adolescents,” reported Dr. Bo Xi of Shandong University, Jinan, China, and associates. “Reduction of daily intakes of energy, carbohydrate, total fat, and total saturated fatty acids among U.S. children and adolescents may help explain the decrease in mean blood pressure levels and prevalence of elevated blood pressure” (Am. J. Hypertens. 2015 July 8 [doi:10.1093/ajh/hpv091]).

The researchers grouped data from the 14,270 children, aged 8-17 years, in the seven National Health and Nutrition Examination Surveys from 1999 to 2012 into three time periods: 1999-2002, 2003-2008, and 2009-2012. They defined high blood pressure as a systolic and/or diastolic blood pressure at the 95th percentile or higher for a child’s sex, age, and height. Elevated blood pressure fell between the 90th and 95th percentile or at least 120/80 mm Hg.

From 1999-2002 to 2009-2012, both average systolic and diastolic blood pressure dropped overall, 0.7 and 4.2 mm Hg, respectively. Diastolic blood pressure dropped for both males and females, for those in the lower (8-12) and higher (13-17) age groups, and across all race/ethnicity groups. Only girls, whites, and those aged 8-12 years saw overall drops in average systolic blood pressure.

From 2009 to 2012, nearly one in 10 children and teens (9.6%) had elevated blood pressure, and 1.6% had high blood pressure. The prevalence of elevated blood pressure and high blood pressure had dropped 2.8 percentage points and 1.3 percentage points, respectively, since 1999-2002. However, teens remained more likely to have elevated blood pressure (odds ratio, 2.62), compared with children, and blacks had higher odds than did whites (OR = 1.39). Girls had half the odds that boys had (OR = 0.5). The trends were similar for high blood pressure.

The total daily calories, carbohydrates, fat, and saturated fatty acids intake among children and teens also decreased from 1999-2002 to 2009-2012, while polyunsaturated fatty acids and dietary fiber intake increased. Sodium, potassium, protein, cholesterol, and caffeine intake did not change during this time, independent of adjustments for body mass index–Z scores. The researchers also found a sodium intake of more than 3,450 mg/d was linked to a higher systolic blood pressure and prevalence of elevated blood pressure, compared with an intake remaining at or below 2,300 mg/d, the recommended daily intake level.

The National Institutes of Health, the Scientific Research Organization Construction Project of Shandong University, and the Research Fund for the Doctoral Program of Higher Education of China supported the study. The authors reported no conflicts of interest.

Children with early symptoms of attention-deficit/hyperactivity disorder (ADHD) or oppositional-defiant disorder (ODD) are more likely to become bullies or bully/victims, according to a recent study.

“ADHD and ODD at preschool age predicted children’s risk of bullying involvement in the first years of elementary school, suggesting a possible antecedent effect,” reported Marina Verlinden, Ph.D., of Erasmus University Medical Center Rotterdam (the Netherlands) and her associates.

©Mikael Damkier/Thinkstockphotos.com

“The effects in the group of bully/victims were rather pronounced, and this is consistent with the studies showing that bully/victims are the most troubled group with the greatest levels of concurrent psychopathology,” the researchers wrote (J. Am. Acad. Child Adolesc. Psychiatry 2015;54:571-9).

The team tracked 3,192 children from a larger population-based birth cohort for at least 5 years after parents filled out reports about their children’s behavior using the Child Behavior Checklist. The children, assessed at 1.5 years, 3 years, and/or 5 years, were born between April 2002 and January 2006 in Rotterdam, the Netherlands.

Then, when the children were an average 6.6 years of age, teachers reported whether the children were involved in or victimized by any physical, verbal, relational, or material bullying. In addition, classmates rated the bullying involvement of 1,098 of the children when they were an average 7.6 years old. An overall 907 children from the cohort were assessed by both their teachers and their peers, with 66% agreement regarding bullying involvement.

Higher behavioral scores – indicating more symptoms of ADHD or ODD – at age 1.5 years were not associated with later bullying involvement. By 3 years old, however, those with greater ADHD symptoms had 20% greater odds of being a bully, and 28% greater odds of being a bully/victim. Those with symptoms of ODD at age 3 years had 17% greater odds of being a bully.

Behavioral scores at age 5 years had a stronger correlation with bullying involvement. Those with ADHD symptoms had 32% greater odds of bullying, 22% greater odds of being victimized, and 46% greater odds of being a bully/victim. Similarly, those with ODD symptoms had 30% greater odds of bullying and 35% greater odds of being a bully/victim, compared with those without high ODD symptom scores.

The researchers adjusted their calculations for the child’s age, gender, national origin, and daycare attendance, as well as the mother’s age, parity, educational level, marital status, household income, depression symptoms, parenting stress, and discipline practices. Additional adjustments for combined ADHD and ODD symptoms attenuated the association, but did not eliminate it.

“Because of the high comorbidity of ADHD and ODD conditions, it is difficult to disentangle their individual effects on children’s bullying involvement,” Dr. Verlinden and her associates wrote.

Overall, 69.9% of the children were not involved in bullying, based on teacher ratings, while 14.1% were bullies, 4.2% were victims, and 11.8% were both. Based on peer ratings, 70.1% were uninvolved in bullying, 10.8% were bullies, 13.1% were victims, and 6% were both.

The research was funded by the Erasmus University Medical Center, the Netherlands Organization for Health Research and Development, the Netherlands Organization for Scientific Research, and the Sophia Foundation for Medical Research. One author was paid as a contributing author of the Achenbach System of Empirically Based Assessment, and one author has received grants from the National Institutes of Health. Dr. Verlinden and the remaining authors had no relevant financial disclosures.

Children with early symptoms of attention-deficit/hyperactivity disorder (ADHD) or oppositional-defiant disorder (ODD) are more likely to become bullies or bully/victims, according to a recent study.

“ADHD and ODD at preschool age predicted children’s risk of bullying involvement in the first years of elementary school, suggesting a possible antecedent effect,” reported Marina Verlinden, Ph.D., of Erasmus University Medical Center Rotterdam (the Netherlands) and her associates.

©Mikael Damkier/Thinkstockphotos.com

“The effects in the group of bully/victims were rather pronounced, and this is consistent with the studies showing that bully/victims are the most troubled group with the greatest levels of concurrent psychopathology,” the researchers wrote (J. Am. Acad. Child Adolesc. Psychiatry 2015;54:571-9).

The team tracked 3,192 children from a larger population-based birth cohort for at least 5 years after parents filled out reports about their children’s behavior using the Child Behavior Checklist. The children, assessed at 1.5 years, 3 years, and/or 5 years, were born between April 2002 and January 2006 in Rotterdam, the Netherlands.

Then, when the children were an average 6.6 years of age, teachers reported whether the children were involved in or victimized by any physical, verbal, relational, or material bullying. In addition, classmates rated the bullying involvement of 1,098 of the children when they were an average 7.6 years old. An overall 907 children from the cohort were assessed by both their teachers and their peers, with 66% agreement regarding bullying involvement.

Higher behavioral scores – indicating more symptoms of ADHD or ODD – at age 1.5 years were not associated with later bullying involvement. By 3 years old, however, those with greater ADHD symptoms had 20% greater odds of being a bully, and 28% greater odds of being a bully/victim. Those with symptoms of ODD at age 3 years had 17% greater odds of being a bully.

Behavioral scores at age 5 years had a stronger correlation with bullying involvement. Those with ADHD symptoms had 32% greater odds of bullying, 22% greater odds of being victimized, and 46% greater odds of being a bully/victim. Similarly, those with ODD symptoms had 30% greater odds of bullying and 35% greater odds of being a bully/victim, compared with those without high ODD symptom scores.

The researchers adjusted their calculations for the child’s age, gender, national origin, and daycare attendance, as well as the mother’s age, parity, educational level, marital status, household income, depression symptoms, parenting stress, and discipline practices. Additional adjustments for combined ADHD and ODD symptoms attenuated the association, but did not eliminate it.

“Because of the high comorbidity of ADHD and ODD conditions, it is difficult to disentangle their individual effects on children’s bullying involvement,” Dr. Verlinden and her associates wrote.

Overall, 69.9% of the children were not involved in bullying, based on teacher ratings, while 14.1% were bullies, 4.2% were victims, and 11.8% were both. Based on peer ratings, 70.1% were uninvolved in bullying, 10.8% were bullies, 13.1% were victims, and 6% were both.

The research was funded by the Erasmus University Medical Center, the Netherlands Organization for Health Research and Development, the Netherlands Organization for Scientific Research, and the Sophia Foundation for Medical Research. One author was paid as a contributing author of the Achenbach System of Empirically Based Assessment, and one author has received grants from the National Institutes of Health. Dr. Verlinden and the remaining authors had no relevant financial disclosures.

Children with early symptoms of attention-deficit/hyperactivity disorder (ADHD) or oppositional-defiant disorder (ODD) are more likely to become bullies or bully/victims, according to a recent study.

“ADHD and ODD at preschool age predicted children’s risk of bullying involvement in the first years of elementary school, suggesting a possible antecedent effect,” reported Marina Verlinden, Ph.D., of Erasmus University Medical Center Rotterdam (the Netherlands) and her associates.

©Mikael Damkier/Thinkstockphotos.com

“The effects in the group of bully/victims were rather pronounced, and this is consistent with the studies showing that bully/victims are the most troubled group with the greatest levels of concurrent psychopathology,” the researchers wrote (J. Am. Acad. Child Adolesc. Psychiatry 2015;54:571-9).

The team tracked 3,192 children from a larger population-based birth cohort for at least 5 years after parents filled out reports about their children’s behavior using the Child Behavior Checklist. The children, assessed at 1.5 years, 3 years, and/or 5 years, were born between April 2002 and January 2006 in Rotterdam, the Netherlands.

Then, when the children were an average 6.6 years of age, teachers reported whether the children were involved in or victimized by any physical, verbal, relational, or material bullying. In addition, classmates rated the bullying involvement of 1,098 of the children when they were an average 7.6 years old. An overall 907 children from the cohort were assessed by both their teachers and their peers, with 66% agreement regarding bullying involvement.

Higher behavioral scores – indicating more symptoms of ADHD or ODD – at age 1.5 years were not associated with later bullying involvement. By 3 years old, however, those with greater ADHD symptoms had 20% greater odds of being a bully, and 28% greater odds of being a bully/victim. Those with symptoms of ODD at age 3 years had 17% greater odds of being a bully.

Behavioral scores at age 5 years had a stronger correlation with bullying involvement. Those with ADHD symptoms had 32% greater odds of bullying, 22% greater odds of being victimized, and 46% greater odds of being a bully/victim. Similarly, those with ODD symptoms had 30% greater odds of bullying and 35% greater odds of being a bully/victim, compared with those without high ODD symptom scores.

The researchers adjusted their calculations for the child’s age, gender, national origin, and daycare attendance, as well as the mother’s age, parity, educational level, marital status, household income, depression symptoms, parenting stress, and discipline practices. Additional adjustments for combined ADHD and ODD symptoms attenuated the association, but did not eliminate it.

“Because of the high comorbidity of ADHD and ODD conditions, it is difficult to disentangle their individual effects on children’s bullying involvement,” Dr. Verlinden and her associates wrote.

Overall, 69.9% of the children were not involved in bullying, based on teacher ratings, while 14.1% were bullies, 4.2% were victims, and 11.8% were both. Based on peer ratings, 70.1% were uninvolved in bullying, 10.8% were bullies, 13.1% were victims, and 6% were both.

The research was funded by the Erasmus University Medical Center, the Netherlands Organization for Health Research and Development, the Netherlands Organization for Scientific Research, and the Sophia Foundation for Medical Research. One author was paid as a contributing author of the Achenbach System of Empirically Based Assessment, and one author has received grants from the National Institutes of Health. Dr. Verlinden and the remaining authors had no relevant financial disclosures.

Participation in Michigan’s statewide Medicaid enhanced prenatal care program led to significant reductions in infant mortality and newborn deaths among families insured by Medicaid, according to a recent study.

Researchers determined that every 1,000 additional Medicaid-insured births in which the mother participates in the state’s Maternal Infant Health Program (MIHP) would prevent two infant deaths.

©Jupiterimages/thinkstockphotos.com

“Our study suggests that a state Medicaid-sponsored, population-based, home-visiting enhanced prenatal care program can be a successful approach to reduce mortality risk among Medicaid-insured infants of all races,” wrote Cristian I. Meghea, Ph.D., and his associates at Michigan State University in East Lansing. “The reduced risk of death among infants participating in the enhanced prenatal care program, compared with matched nonparticipants, is consistent with previous findings on the effects of the program on health care utilization and birth outcomes.”

They estimated that program participation could prevent 28% of potential infant deaths among MIHP participants, most likely because of reduced risks of adverse birth outcomes, they reported online (Pediatrics 2015 July 6 [doi:10.1542/peds.2015-0479]).

The researchers analyzed the birth and death records and Medicaid medical claims for all 248,059 Medicaid-insured singleton children born in Michigan between Jan. 1, 2009 and Dec. 31, 2012. The team investigated maternal medical claims running from 3 months before conception through the child’s first birthday. The researchers matched mothers who participated in MIHP by the end of her second trimester with those who had no MIHP involvement, taking into account age, marital status, race/ethnicity, socioeconomic status, county of residence, any smoking in pregnancy, and having a first birth or a birth within the previous 18 months before conception.

Children who participated at all in the MIHP had 27% lower odds of death (odds ratio 0.73) in their first year of life than those with no participation, a number that ranged from 29% reduced odds for black infants to 26% reduced odds for nonblack infants. Infants in the program also had 30% lower odds of neonatal death and 22% lower odds of post neonatal death, compared with those not involved in MIHP.

Further reductions occurred in all these mortality measures when mothers enrolled in MIHP and underwent screening by the end of the second trimester of pregnancy, followed by at least three more prenatal follow-ups in the program. Among this group, odds of infant mortality dropped 30%, odds of neonatal death dropped 33%, and post neonatal death odds dropped 26%.

“Programs targeting Medicaid-insured pregnant women that bundle interventions addressing multiple determinants at multiple levels can be an important mechanism to reach underserved women and their infants at greater risk of infant death,” the authors concluded.

The Michigan Department of Community Health supported the study. The authors reported no relevant financial disclosures.

Participation in Michigan’s statewide Medicaid enhanced prenatal care program led to significant reductions in infant mortality and newborn deaths among families insured by Medicaid, according to a recent study.

Researchers determined that every 1,000 additional Medicaid-insured births in which the mother participates in the state’s Maternal Infant Health Program (MIHP) would prevent two infant deaths.

©Jupiterimages/thinkstockphotos.com

“Our study suggests that a state Medicaid-sponsored, population-based, home-visiting enhanced prenatal care program can be a successful approach to reduce mortality risk among Medicaid-insured infants of all races,” wrote Cristian I. Meghea, Ph.D., and his associates at Michigan State University in East Lansing. “The reduced risk of death among infants participating in the enhanced prenatal care program, compared with matched nonparticipants, is consistent with previous findings on the effects of the program on health care utilization and birth outcomes.”

They estimated that program participation could prevent 28% of potential infant deaths among MIHP participants, most likely because of reduced risks of adverse birth outcomes, they reported online (Pediatrics 2015 July 6 [doi:10.1542/peds.2015-0479]).

The researchers analyzed the birth and death records and Medicaid medical claims for all 248,059 Medicaid-insured singleton children born in Michigan between Jan. 1, 2009 and Dec. 31, 2012. The team investigated maternal medical claims running from 3 months before conception through the child’s first birthday. The researchers matched mothers who participated in MIHP by the end of her second trimester with those who had no MIHP involvement, taking into account age, marital status, race/ethnicity, socioeconomic status, county of residence, any smoking in pregnancy, and having a first birth or a birth within the previous 18 months before conception.

Children who participated at all in the MIHP had 27% lower odds of death (odds ratio 0.73) in their first year of life than those with no participation, a number that ranged from 29% reduced odds for black infants to 26% reduced odds for nonblack infants. Infants in the program also had 30% lower odds of neonatal death and 22% lower odds of post neonatal death, compared with those not involved in MIHP.

Further reductions occurred in all these mortality measures when mothers enrolled in MIHP and underwent screening by the end of the second trimester of pregnancy, followed by at least three more prenatal follow-ups in the program. Among this group, odds of infant mortality dropped 30%, odds of neonatal death dropped 33%, and post neonatal death odds dropped 26%.

“Programs targeting Medicaid-insured pregnant women that bundle interventions addressing multiple determinants at multiple levels can be an important mechanism to reach underserved women and their infants at greater risk of infant death,” the authors concluded.

The Michigan Department of Community Health supported the study. The authors reported no relevant financial disclosures.

Participation in Michigan’s statewide Medicaid enhanced prenatal care program led to significant reductions in infant mortality and newborn deaths among families insured by Medicaid, according to a recent study.

Researchers determined that every 1,000 additional Medicaid-insured births in which the mother participates in the state’s Maternal Infant Health Program (MIHP) would prevent two infant deaths.

©Jupiterimages/thinkstockphotos.com

“Our study suggests that a state Medicaid-sponsored, population-based, home-visiting enhanced prenatal care program can be a successful approach to reduce mortality risk among Medicaid-insured infants of all races,” wrote Cristian I. Meghea, Ph.D., and his associates at Michigan State University in East Lansing. “The reduced risk of death among infants participating in the enhanced prenatal care program, compared with matched nonparticipants, is consistent with previous findings on the effects of the program on health care utilization and birth outcomes.”

They estimated that program participation could prevent 28% of potential infant deaths among MIHP participants, most likely because of reduced risks of adverse birth outcomes, they reported online (Pediatrics 2015 July 6 [doi:10.1542/peds.2015-0479]).

The researchers analyzed the birth and death records and Medicaid medical claims for all 248,059 Medicaid-insured singleton children born in Michigan between Jan. 1, 2009 and Dec. 31, 2012. The team investigated maternal medical claims running from 3 months before conception through the child’s first birthday. The researchers matched mothers who participated in MIHP by the end of her second trimester with those who had no MIHP involvement, taking into account age, marital status, race/ethnicity, socioeconomic status, county of residence, any smoking in pregnancy, and having a first birth or a birth within the previous 18 months before conception.

Children who participated at all in the MIHP had 27% lower odds of death (odds ratio 0.73) in their first year of life than those with no participation, a number that ranged from 29% reduced odds for black infants to 26% reduced odds for nonblack infants. Infants in the program also had 30% lower odds of neonatal death and 22% lower odds of post neonatal death, compared with those not involved in MIHP.

Further reductions occurred in all these mortality measures when mothers enrolled in MIHP and underwent screening by the end of the second trimester of pregnancy, followed by at least three more prenatal follow-ups in the program. Among this group, odds of infant mortality dropped 30%, odds of neonatal death dropped 33%, and post neonatal death odds dropped 26%.

“Programs targeting Medicaid-insured pregnant women that bundle interventions addressing multiple determinants at multiple levels can be an important mechanism to reach underserved women and their infants at greater risk of infant death,” the authors concluded.

The Michigan Department of Community Health supported the study. The authors reported no relevant financial disclosures.

The vast majority of doctors and other trained medical professionals at a hospital went to work while sick within the past year, even though they realized the risk that decision places on patients, according to a recent study.

In fact, almost 1 in 10 hospital clinicians worked while sick at least five times in the past year, primarily because of staffing concerns or not wanting to let colleagues down, reported Julia Szymczak, Ph.D., and her associates at the Children’s Hospital of Philadelphia (JAMA Pediatr. 2015 July 6 [doi: 10.1001/jamapediatrics.2015.0684]).

“A combination of closed- and open-ended questions illustrated that the decision to work while sick was shaped by systems-level and sociocultural factors that interacted to cause our respondents to work while symptomatic, despite recognizing that this choice may put patients and colleagues at risk,” the authors wrote.

nandyphotos/Thinkstock.com

Of 929 surveys sent out, 538 clinicians completed them, which included 280 of 459 physicians (61%) and 256 of 470 advanced-practice clinicians (54.5%). The advanced-practice clinicians included registered nurses, physician assistants, clinical nurse specialists, registered nurse anesthetists, and certified nurse midwives. Of those who responded, 15.7% worked in intensive care, 13.1% in surgery, 12.5% in general pediatrics, and 44.8% in another pediatric subspecialty.

Although 95.3% of respondents believed working while sick put patients at risk, 83.1% reported having done so at least once in the past year. Further, that proportion included 52% of all respondents who reported coming to work sick twice in the past year and 9.3% who worked while ill at least five times in the past year.

Nearly a third of respondents said they would work even if they had diarrhea (30%), while 16% said they would work with a fever, and 55.6% would work with acute respiratory symptoms, including cough, congestion, rhinorrhea, and sore throat.

But doctors were more likely than other professionals to say they would go to work with these symptoms: 38.9% of doctors would work despite diarrhea, compared with 19.9% of advanced-practice clinicians. Doctors and advanced-practice clinicians would also work with acute respiratory symptoms (60% vs. 50.8%, respectively), a fever only (21.8% vs. 9.8%), and fever and chills with body aches (18.6% vs. 10.9%, all P < .03).

Nearly every respondent (98.7%) said they worked despite being sick because they did not want to let their colleagues down, just as almost all of them worried the hospital would not have enough staff (94.9%) or that they would let their patients down (92.5%).

Smaller majorities of respondents also worked because others also work while sick (65%), worried their colleagues would ostracize them (64%) if they didn’t work, were concerned about their patients’ continuity of care (63.8%), had unsupportive leadership (56.2%), or believed they could not be easily replaced (52.6%).

Among the 316 respondents who filled in additional reasons, 64.9% said they had a very hard time finding someone to cover their shift, 61.1% described a strong cultural norm to work unless extremely sick, and 57% expressed uncertainty about what is considered “too sick to work.”

The Centers for Disease Control and Prevention funded the research. The authors reported no disclosures.

The vast majority of doctors and other trained medical professionals at a hospital went to work while sick within the past year, even though they realized the risk that decision places on patients, according to a recent study.

In fact, almost 1 in 10 hospital clinicians worked while sick at least five times in the past year, primarily because of staffing concerns or not wanting to let colleagues down, reported Julia Szymczak, Ph.D., and her associates at the Children’s Hospital of Philadelphia (JAMA Pediatr. 2015 July 6 [doi: 10.1001/jamapediatrics.2015.0684]).

“A combination of closed- and open-ended questions illustrated that the decision to work while sick was shaped by systems-level and sociocultural factors that interacted to cause our respondents to work while symptomatic, despite recognizing that this choice may put patients and colleagues at risk,” the authors wrote.

nandyphotos/Thinkstock.com

Of 929 surveys sent out, 538 clinicians completed them, which included 280 of 459 physicians (61%) and 256 of 470 advanced-practice clinicians (54.5%). The advanced-practice clinicians included registered nurses, physician assistants, clinical nurse specialists, registered nurse anesthetists, and certified nurse midwives. Of those who responded, 15.7% worked in intensive care, 13.1% in surgery, 12.5% in general pediatrics, and 44.8% in another pediatric subspecialty.

Although 95.3% of respondents believed working while sick put patients at risk, 83.1% reported having done so at least once in the past year. Further, that proportion included 52% of all respondents who reported coming to work sick twice in the past year and 9.3% who worked while ill at least five times in the past year.

Nearly a third of respondents said they would work even if they had diarrhea (30%), while 16% said they would work with a fever, and 55.6% would work with acute respiratory symptoms, including cough, congestion, rhinorrhea, and sore throat.

But doctors were more likely than other professionals to say they would go to work with these symptoms: 38.9% of doctors would work despite diarrhea, compared with 19.9% of advanced-practice clinicians. Doctors and advanced-practice clinicians would also work with acute respiratory symptoms (60% vs. 50.8%, respectively), a fever only (21.8% vs. 9.8%), and fever and chills with body aches (18.6% vs. 10.9%, all P < .03).

Nearly every respondent (98.7%) said they worked despite being sick because they did not want to let their colleagues down, just as almost all of them worried the hospital would not have enough staff (94.9%) or that they would let their patients down (92.5%).

Smaller majorities of respondents also worked because others also work while sick (65%), worried their colleagues would ostracize them (64%) if they didn’t work, were concerned about their patients’ continuity of care (63.8%), had unsupportive leadership (56.2%), or believed they could not be easily replaced (52.6%).

Among the 316 respondents who filled in additional reasons, 64.9% said they had a very hard time finding someone to cover their shift, 61.1% described a strong cultural norm to work unless extremely sick, and 57% expressed uncertainty about what is considered “too sick to work.”

The Centers for Disease Control and Prevention funded the research. The authors reported no disclosures.

The vast majority of doctors and other trained medical professionals at a hospital went to work while sick within the past year, even though they realized the risk that decision places on patients, according to a recent study.

In fact, almost 1 in 10 hospital clinicians worked while sick at least five times in the past year, primarily because of staffing concerns or not wanting to let colleagues down, reported Julia Szymczak, Ph.D., and her associates at the Children’s Hospital of Philadelphia (JAMA Pediatr. 2015 July 6 [doi: 10.1001/jamapediatrics.2015.0684]).

“A combination of closed- and open-ended questions illustrated that the decision to work while sick was shaped by systems-level and sociocultural factors that interacted to cause our respondents to work while symptomatic, despite recognizing that this choice may put patients and colleagues at risk,” the authors wrote.

nandyphotos/Thinkstock.com

Of 929 surveys sent out, 538 clinicians completed them, which included 280 of 459 physicians (61%) and 256 of 470 advanced-practice clinicians (54.5%). The advanced-practice clinicians included registered nurses, physician assistants, clinical nurse specialists, registered nurse anesthetists, and certified nurse midwives. Of those who responded, 15.7% worked in intensive care, 13.1% in surgery, 12.5% in general pediatrics, and 44.8% in another pediatric subspecialty.

Although 95.3% of respondents believed working while sick put patients at risk, 83.1% reported having done so at least once in the past year. Further, that proportion included 52% of all respondents who reported coming to work sick twice in the past year and 9.3% who worked while ill at least five times in the past year.

Nearly a third of respondents said they would work even if they had diarrhea (30%), while 16% said they would work with a fever, and 55.6% would work with acute respiratory symptoms, including cough, congestion, rhinorrhea, and sore throat.

But doctors were more likely than other professionals to say they would go to work with these symptoms: 38.9% of doctors would work despite diarrhea, compared with 19.9% of advanced-practice clinicians. Doctors and advanced-practice clinicians would also work with acute respiratory symptoms (60% vs. 50.8%, respectively), a fever only (21.8% vs. 9.8%), and fever and chills with body aches (18.6% vs. 10.9%, all P < .03).

Nearly every respondent (98.7%) said they worked despite being sick because they did not want to let their colleagues down, just as almost all of them worried the hospital would not have enough staff (94.9%) or that they would let their patients down (92.5%).

Smaller majorities of respondents also worked because others also work while sick (65%), worried their colleagues would ostracize them (64%) if they didn’t work, were concerned about their patients’ continuity of care (63.8%), had unsupportive leadership (56.2%), or believed they could not be easily replaced (52.6%).

Among the 316 respondents who filled in additional reasons, 64.9% said they had a very hard time finding someone to cover their shift, 61.1% described a strong cultural norm to work unless extremely sick, and 57% expressed uncertainty about what is considered “too sick to work.”

The Centers for Disease Control and Prevention funded the research. The authors reported no disclosures.

Here are 7 articles in the July issue of Clinician Reviews (accreditation valid until January 1, 2016):

1. BSR: Multiple Benefits Seen With Intensive Psoriatic Arthritis Therapy
Multiple joint and skin benefits can be achieved by intensively treating patients with psoriatic arthritis (PsA) until they achieve a set of minimal disease activity (MDA) criteria (see Table), an expert said at the British Society for Rheumatology annual conference.

To take the posttest, go to: http://bit.ly/1KaikxW

2. Subclinical Hyperthyroidism Linked to Higher Fracture Risk
Individuals with subclinical hyperthyroidism are at increased risk for hip and other fractures, according to the authors of a meta-analysis. The researchers examined data from 70,298 individuals—4,092 with subclinical hypothyroidism and 2,219 with subclinical hyperthyroidism—enrolled in 13 prospective cohort studies.

To take the posttest, go to: http://bit.ly/1H13j0t

3. Newer Oral Contraceptives Pose Higher VTE Risk
The risk for venous thromboembolism (VTE) is generally greater for women using oral contraceptives with newer types of progestogen hormones than for those taking older, second-generation birth control pills, study results showed.

To take the posttest, go to: http://bit.ly/1AKQert

4. Statins, Fibrates Lower Stroke Risk in Elderly
Both statin and fibrate therapies taken to improve lipid profiles decreased risk for stroke by 30% in a community-dwelling population of elderly people, according to a prospective European study published online in the British Medical Journal.

To take the posttest, go to: http://bit.ly/1FuyYCb

5. Cystic Fibrosis–related Diabetes Requires Different Approach
Cystic fibrosis–related diabetes (CFRD) is a unique disease that requires a different mindset on the part of the treating clinician.

To take the posttest, go to: http://bit.ly/1BKGZCm

6. CVD Risk Persists for 40 Years in Hodgkin Survivors
People who survive Hodgkin lymphoma in adolescence or young adulthood remain at very high risk for cardiovascular disease (CVD) for at least 40 years—the longest period for which they have been followed, according to the results of a retrospective cohort study of more than 2,500 patients.

To take the posttest, go to: http://bit.ly/1M5ymYG

7. Asymptomatic Carotid Stenosis and Central Sleep Apnea Linked
More than two-thirds of patients with asymptomatic carotid stenosis are likely to have sleep apnea, according to an observational study. The polysomnography results of 96 patients with ­asymptomatic extracranial carotid stenosis revealed that 69% had sleep apnea: 42% had obstructive sleep apnea (OSA) and 27%, central sleep apnea (CSA).

To take the posttest, go to: http://bit.ly/1SWGPmb

Here are 7 articles in the July issue of Clinician Reviews (accreditation valid until January 1, 2016):

1. BSR: Multiple Benefits Seen With Intensive Psoriatic Arthritis Therapy
Multiple joint and skin benefits can be achieved by intensively treating patients with psoriatic arthritis (PsA) until they achieve a set of minimal disease activity (MDA) criteria (see Table), an expert said at the British Society for Rheumatology annual conference.

To take the posttest, go to: http://bit.ly/1KaikxW

2. Subclinical Hyperthyroidism Linked to Higher Fracture Risk
Individuals with subclinical hyperthyroidism are at increased risk for hip and other fractures, according to the authors of a meta-analysis. The researchers examined data from 70,298 individuals—4,092 with subclinical hypothyroidism and 2,219 with subclinical hyperthyroidism—enrolled in 13 prospective cohort studies.

To take the posttest, go to: http://bit.ly/1H13j0t

3. Newer Oral Contraceptives Pose Higher VTE Risk
The risk for venous thromboembolism (VTE) is generally greater for women using oral contraceptives with newer types of progestogen hormones than for those taking older, second-generation birth control pills, study results showed.

To take the posttest, go to: http://bit.ly/1AKQert

4. Statins, Fibrates Lower Stroke Risk in Elderly
Both statin and fibrate therapies taken to improve lipid profiles decreased risk for stroke by 30% in a community-dwelling population of elderly people, according to a prospective European study published online in the British Medical Journal.

To take the posttest, go to: http://bit.ly/1FuyYCb

5. Cystic Fibrosis–related Diabetes Requires Different Approach
Cystic fibrosis–related diabetes (CFRD) is a unique disease that requires a different mindset on the part of the treating clinician.

To take the posttest, go to: http://bit.ly/1BKGZCm

6. CVD Risk Persists for 40 Years in Hodgkin Survivors
People who survive Hodgkin lymphoma in adolescence or young adulthood remain at very high risk for cardiovascular disease (CVD) for at least 40 years—the longest period for which they have been followed, according to the results of a retrospective cohort study of more than 2,500 patients.

To take the posttest, go to: http://bit.ly/1M5ymYG

7. Asymptomatic Carotid Stenosis and Central Sleep Apnea Linked
More than two-thirds of patients with asymptomatic carotid stenosis are likely to have sleep apnea, according to an observational study. The polysomnography results of 96 patients with ­asymptomatic extracranial carotid stenosis revealed that 69% had sleep apnea: 42% had obstructive sleep apnea (OSA) and 27%, central sleep apnea (CSA).

To take the posttest, go to: http://bit.ly/1SWGPmb

Here are 7 articles in the July issue of Clinician Reviews (accreditation valid until January 1, 2016):

1. BSR: Multiple Benefits Seen With Intensive Psoriatic Arthritis Therapy
Multiple joint and skin benefits can be achieved by intensively treating patients with psoriatic arthritis (PsA) until they achieve a set of minimal disease activity (MDA) criteria (see Table), an expert said at the British Society for Rheumatology annual conference.

To take the posttest, go to: http://bit.ly/1KaikxW

2. Subclinical Hyperthyroidism Linked to Higher Fracture Risk
Individuals with subclinical hyperthyroidism are at increased risk for hip and other fractures, according to the authors of a meta-analysis. The researchers examined data from 70,298 individuals—4,092 with subclinical hypothyroidism and 2,219 with subclinical hyperthyroidism—enrolled in 13 prospective cohort studies.

To take the posttest, go to: http://bit.ly/1H13j0t

3. Newer Oral Contraceptives Pose Higher VTE Risk
The risk for venous thromboembolism (VTE) is generally greater for women using oral contraceptives with newer types of progestogen hormones than for those taking older, second-generation birth control pills, study results showed.

To take the posttest, go to: http://bit.ly/1AKQert

4. Statins, Fibrates Lower Stroke Risk in Elderly
Both statin and fibrate therapies taken to improve lipid profiles decreased risk for stroke by 30% in a community-dwelling population of elderly people, according to a prospective European study published online in the British Medical Journal.

To take the posttest, go to: http://bit.ly/1FuyYCb

5. Cystic Fibrosis–related Diabetes Requires Different Approach
Cystic fibrosis–related diabetes (CFRD) is a unique disease that requires a different mindset on the part of the treating clinician.

To take the posttest, go to: http://bit.ly/1BKGZCm

6. CVD Risk Persists for 40 Years in Hodgkin Survivors
People who survive Hodgkin lymphoma in adolescence or young adulthood remain at very high risk for cardiovascular disease (CVD) for at least 40 years—the longest period for which they have been followed, according to the results of a retrospective cohort study of more than 2,500 patients.

To take the posttest, go to: http://bit.ly/1M5ymYG

7. Asymptomatic Carotid Stenosis and Central Sleep Apnea Linked
More than two-thirds of patients with asymptomatic carotid stenosis are likely to have sleep apnea, according to an observational study. The polysomnography results of 96 patients with ­asymptomatic extracranial carotid stenosis revealed that 69% had sleep apnea: 42% had obstructive sleep apnea (OSA) and 27%, central sleep apnea (CSA).

To take the posttest, go to: http://bit.ly/1SWGPmb

Women may be receiving unnecessary antibiotics for overdiagnosed urinary tract infections while their sexually transmitted infections go undetected, according to a recent study in an urban academic emergency department.

“Our study is a reflection of what happens in current clinical practice in an ED setting including adult women 18-65 years of age for whom UTI diagnoses and empiric therapy for UTI are often given even in the absence of any UTI-related symptoms and without a urine culture,” Dr. Michelle T. Hecker of MetroHealth Medical Center, Cleveland, and her colleagues wrote in the Journal of Clinical Microbiology (J. Clin. Microbiol. 2015 [doi:10.1128/JCM.00670-15]).

Overdiagnosis of UTI was not only a common cause of unnecessary antibiotic use, it also contributed to underdiagnosis of STI since 64% of the patients with a missed STI were diagnosed as having a UTI instead, they reported.

The researchers compared urinalysis, culture, and nucleic acid amplification testing for gonorrhea, chlamydia, and trichomoniasis among 264 women, aged 18-65 years, who presented to an urban academic emergency department over a 2-month period. Although providers diagnosed 66% of these women with UTIs, less than half these women (48%) had a positive urine culture and more than half (57%) received treatment without a urine culture.

Among the 23% of women overall who had at least one positive STI test, 37% (22 of 60 women) did not receive treatment for their STI within 7 days of their visit, and 14 of those 22 women (64%) received a UTI diagnosis instead of an STI diagnosis.

Urinalysis was abnormal for 92% of all the women in the study and did not predict positive urine cultures. The researchers determined the positive predictive value of abnormal urinalysis to be 41% and the negative predictive value to be 76%.

“Based on our data and others, we believe that alternative test and treat strategies for managing women with [genitourinary] and nonspecific abdominal pain in the ED should be evaluated,” Dr. Hecker and her associates wrote.

They specifically recommended decreasing urinalysis testing and increasing urine culture and STI testing.

The research was supported by a grant from the Centers for Disease Control and Prevention. One of the researchers reported that he is an R&D scientist employed by Hologic.

Women may be receiving unnecessary antibiotics for overdiagnosed urinary tract infections while their sexually transmitted infections go undetected, according to a recent study in an urban academic emergency department.

“Our study is a reflection of what happens in current clinical practice in an ED setting including adult women 18-65 years of age for whom UTI diagnoses and empiric therapy for UTI are often given even in the absence of any UTI-related symptoms and without a urine culture,” Dr. Michelle T. Hecker of MetroHealth Medical Center, Cleveland, and her colleagues wrote in the Journal of Clinical Microbiology (J. Clin. Microbiol. 2015 [doi:10.1128/JCM.00670-15]).

Overdiagnosis of UTI was not only a common cause of unnecessary antibiotic use, it also contributed to underdiagnosis of STI since 64% of the patients with a missed STI were diagnosed as having a UTI instead, they reported.

The researchers compared urinalysis, culture, and nucleic acid amplification testing for gonorrhea, chlamydia, and trichomoniasis among 264 women, aged 18-65 years, who presented to an urban academic emergency department over a 2-month period. Although providers diagnosed 66% of these women with UTIs, less than half these women (48%) had a positive urine culture and more than half (57%) received treatment without a urine culture.

Among the 23% of women overall who had at least one positive STI test, 37% (22 of 60 women) did not receive treatment for their STI within 7 days of their visit, and 14 of those 22 women (64%) received a UTI diagnosis instead of an STI diagnosis.

Urinalysis was abnormal for 92% of all the women in the study and did not predict positive urine cultures. The researchers determined the positive predictive value of abnormal urinalysis to be 41% and the negative predictive value to be 76%.

“Based on our data and others, we believe that alternative test and treat strategies for managing women with [genitourinary] and nonspecific abdominal pain in the ED should be evaluated,” Dr. Hecker and her associates wrote.

They specifically recommended decreasing urinalysis testing and increasing urine culture and STI testing.

The research was supported by a grant from the Centers for Disease Control and Prevention. One of the researchers reported that he is an R&D scientist employed by Hologic.

Women may be receiving unnecessary antibiotics for overdiagnosed urinary tract infections while their sexually transmitted infections go undetected, according to a recent study in an urban academic emergency department.

“Our study is a reflection of what happens in current clinical practice in an ED setting including adult women 18-65 years of age for whom UTI diagnoses and empiric therapy for UTI are often given even in the absence of any UTI-related symptoms and without a urine culture,” Dr. Michelle T. Hecker of MetroHealth Medical Center, Cleveland, and her colleagues wrote in the Journal of Clinical Microbiology (J. Clin. Microbiol. 2015 [doi:10.1128/JCM.00670-15]).

Overdiagnosis of UTI was not only a common cause of unnecessary antibiotic use, it also contributed to underdiagnosis of STI since 64% of the patients with a missed STI were diagnosed as having a UTI instead, they reported.

The researchers compared urinalysis, culture, and nucleic acid amplification testing for gonorrhea, chlamydia, and trichomoniasis among 264 women, aged 18-65 years, who presented to an urban academic emergency department over a 2-month period. Although providers diagnosed 66% of these women with UTIs, less than half these women (48%) had a positive urine culture and more than half (57%) received treatment without a urine culture.

Among the 23% of women overall who had at least one positive STI test, 37% (22 of 60 women) did not receive treatment for their STI within 7 days of their visit, and 14 of those 22 women (64%) received a UTI diagnosis instead of an STI diagnosis.

Urinalysis was abnormal for 92% of all the women in the study and did not predict positive urine cultures. The researchers determined the positive predictive value of abnormal urinalysis to be 41% and the negative predictive value to be 76%.

“Based on our data and others, we believe that alternative test and treat strategies for managing women with [genitourinary] and nonspecific abdominal pain in the ED should be evaluated,” Dr. Hecker and her associates wrote.

They specifically recommended decreasing urinalysis testing and increasing urine culture and STI testing.

The research was supported by a grant from the Centers for Disease Control and Prevention. One of the researchers reported that he is an R&D scientist employed by Hologic.

Use of broad-spectrum antibiotics to treat pediatric pneumonia dropped considerably following the publication of national guidelines that recommended narrow-spectrum antibiotics, according to a recent study.

The guidelines released by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) in August 2011 “emphasized the use of a single, narrow-spectrum antibiotic (i.e., penicillin/ampicillin) for vaccinated children hospitalized with uncomplicated community-acquired pneumonia,” based on evidence that Streptococcus pneumoniae most commonly caused the illness and that incidence of penicillin-resistant pneumococcal disease had dropped after the vaccine’s introduction.

“Overall, use of third-generation cephalosporins declined significantly after release of the guidelines, whereas penicillin/ampicillin use increased,” reported Dr. Derek Williams of Monroe Carell Jr. Children’s Hospital and Vanderbilt University in Nashville, Tenn., and his associates. “We noted consistent trends across study sites, although changes were most apparent in institutions that conducted active hospital-based educational efforts to disseminate the PIDS/IDSA guidelines,” they wrote (Pediatrics 2015 June 22 [doi:10.1542/peds.2014-3047]).

The researchers analyzed the records of all 2,121 children hospitalized with community-acquired pneumonia between January 2010 and June 2012 at three hospitals in Tennessee and Utah. In the year before the new guidelines, all three hospitals most commonly used the broad-spectrum antibiotics, with prescription rates ranging from 43% to 61% for third-generation cephalosporins, compared with rates of 1%-9% for penicillin and ampicillin prescriptions. Overall, 52.8% of children received third-generation cephalosporins to treat their pneumonia and 2.7% received penicillin or ampicillin before the guidelines.

Nine months after the guidelines had been published, the use of third-generation cephalosporins dropped 12.4 percentage points and the use of penicillin and ampicillin increased 11.3 percentage points, Dr. Williams and his associates said.

The largest shift in prescribing patterns occurred at the two hospitals that held pediatric departmental educational conferences within 4 months of the new guidelines. The third hospital, which did not formally distribute information abut the guidelines, saw the smallest reduction in broad spectrum–antibiotic use.

Although all three hospitals reported having antimicrobial stewardship programs, none had a community-acquired pneumonia practice guideline during the study period and none of the programs specifically focused on community-acquired pneumonia or restrictions on third-generation cephalosporins, aminopenicillins, or macrolides.

The research was supported by the National Institute of Allergy and Infectious Diseases, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention. The authors reported no relevant financial disclosures.

Use of broad-spectrum antibiotics to treat pediatric pneumonia dropped considerably following the publication of national guidelines that recommended narrow-spectrum antibiotics, according to a recent study.

The guidelines released by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) in August 2011 “emphasized the use of a single, narrow-spectrum antibiotic (i.e., penicillin/ampicillin) for vaccinated children hospitalized with uncomplicated community-acquired pneumonia,” based on evidence that Streptococcus pneumoniae most commonly caused the illness and that incidence of penicillin-resistant pneumococcal disease had dropped after the vaccine’s introduction.

“Overall, use of third-generation cephalosporins declined significantly after release of the guidelines, whereas penicillin/ampicillin use increased,” reported Dr. Derek Williams of Monroe Carell Jr. Children’s Hospital and Vanderbilt University in Nashville, Tenn., and his associates. “We noted consistent trends across study sites, although changes were most apparent in institutions that conducted active hospital-based educational efforts to disseminate the PIDS/IDSA guidelines,” they wrote (Pediatrics 2015 June 22 [doi:10.1542/peds.2014-3047]).

The researchers analyzed the records of all 2,121 children hospitalized with community-acquired pneumonia between January 2010 and June 2012 at three hospitals in Tennessee and Utah. In the year before the new guidelines, all three hospitals most commonly used the broad-spectrum antibiotics, with prescription rates ranging from 43% to 61% for third-generation cephalosporins, compared with rates of 1%-9% for penicillin and ampicillin prescriptions. Overall, 52.8% of children received third-generation cephalosporins to treat their pneumonia and 2.7% received penicillin or ampicillin before the guidelines.

Nine months after the guidelines had been published, the use of third-generation cephalosporins dropped 12.4 percentage points and the use of penicillin and ampicillin increased 11.3 percentage points, Dr. Williams and his associates said.

The largest shift in prescribing patterns occurred at the two hospitals that held pediatric departmental educational conferences within 4 months of the new guidelines. The third hospital, which did not formally distribute information abut the guidelines, saw the smallest reduction in broad spectrum–antibiotic use.

Although all three hospitals reported having antimicrobial stewardship programs, none had a community-acquired pneumonia practice guideline during the study period and none of the programs specifically focused on community-acquired pneumonia or restrictions on third-generation cephalosporins, aminopenicillins, or macrolides.

The research was supported by the National Institute of Allergy and Infectious Diseases, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention. The authors reported no relevant financial disclosures.

Use of broad-spectrum antibiotics to treat pediatric pneumonia dropped considerably following the publication of national guidelines that recommended narrow-spectrum antibiotics, according to a recent study.

The guidelines released by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) in August 2011 “emphasized the use of a single, narrow-spectrum antibiotic (i.e., penicillin/ampicillin) for vaccinated children hospitalized with uncomplicated community-acquired pneumonia,” based on evidence that Streptococcus pneumoniae most commonly caused the illness and that incidence of penicillin-resistant pneumococcal disease had dropped after the vaccine’s introduction.

“Overall, use of third-generation cephalosporins declined significantly after release of the guidelines, whereas penicillin/ampicillin use increased,” reported Dr. Derek Williams of Monroe Carell Jr. Children’s Hospital and Vanderbilt University in Nashville, Tenn., and his associates. “We noted consistent trends across study sites, although changes were most apparent in institutions that conducted active hospital-based educational efforts to disseminate the PIDS/IDSA guidelines,” they wrote (Pediatrics 2015 June 22 [doi:10.1542/peds.2014-3047]).

The researchers analyzed the records of all 2,121 children hospitalized with community-acquired pneumonia between January 2010 and June 2012 at three hospitals in Tennessee and Utah. In the year before the new guidelines, all three hospitals most commonly used the broad-spectrum antibiotics, with prescription rates ranging from 43% to 61% for third-generation cephalosporins, compared with rates of 1%-9% for penicillin and ampicillin prescriptions. Overall, 52.8% of children received third-generation cephalosporins to treat their pneumonia and 2.7% received penicillin or ampicillin before the guidelines.

Nine months after the guidelines had been published, the use of third-generation cephalosporins dropped 12.4 percentage points and the use of penicillin and ampicillin increased 11.3 percentage points, Dr. Williams and his associates said.

The largest shift in prescribing patterns occurred at the two hospitals that held pediatric departmental educational conferences within 4 months of the new guidelines. The third hospital, which did not formally distribute information abut the guidelines, saw the smallest reduction in broad spectrum–antibiotic use.

Although all three hospitals reported having antimicrobial stewardship programs, none had a community-acquired pneumonia practice guideline during the study period and none of the programs specifically focused on community-acquired pneumonia or restrictions on third-generation cephalosporins, aminopenicillins, or macrolides.

The research was supported by the National Institute of Allergy and Infectious Diseases, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention. The authors reported no relevant financial disclosures.

Use of broad-spectrum antibiotics to treat pediatric pneumonia dropped considerably following the publication of national guidelines that recommended narrow-spectrum antibiotics, according to a recent study.

The guidelines released by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) in August 2011 “emphasized the use of a single, narrow-spectrum antibiotic (i.e., penicillin/ampicillin) for vaccinated children hospitalized with uncomplicated community-acquired pneumonia,” based on evidence that Streptococcus pneumoniae most commonly caused the illness and that incidence of penicillin-resistant pneumococcal disease had dropped after the vaccine’s introduction.

“Overall, use of third-generation cephalosporins declined significantly after release of the guidelines, whereas penicillin/ampicillin use increased,” reported Dr. Derek Williams of Monroe Carell Jr. Children’s Hospital and Vanderbilt University in Nashville, Tenn., and his associates. “We noted consistent trends across study sites, although changes were most apparent in institutions that conducted active hospital-based educational efforts to disseminate the PIDS/IDSA guidelines,” they wrote (Pediatrics 2015 June 22 [doi:10.1542/peds.2014-3047]).

The researchers analyzed the records of all 2,121 children hospitalized with community-acquired pneumonia between January 2010 and June 2012 at three hospitals in Tennessee and Utah. In the year before the new guidelines, all three hospitals most commonly used the broad-spectrum antibiotics, with prescription rates ranging from 43% to 61% for third-generation cephalosporins, compared with rates of 1%-9% for penicillin and ampicillin prescriptions. Overall, 52.8% of children received third-generation cephalosporins to treat their pneumonia and 2.7% received penicillin or ampicillin before the guidelines.

Nine months after the guidelines had been published, the use of third-generation cephalosporins dropped 12.4 percentage points and the use of penicillin and ampicillin increased 11.3 percentage points, Dr. Williams and his associates said.

The largest shift in prescribing patterns occurred at the two hospitals that held pediatric departmental educational conferences within 4 months of the new guidelines. The third hospital, which did not formally distribute information about the guidelines, saw the smallest reduction in broad spectrum–antibiotic use.

Although all three hospitals reported having antimicrobial stewardship programs, none had a community-acquired pneumonia practice guideline during the study period and none of the programs specifically focused on community-acquired pneumonia or restrictions on third-generation cephalosporins, aminopenicillins, or macrolides.

The research was supported by the National Institute of Allergy and Infectious Diseases, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention. The authors reported no relevant financial disclosures.

Use of broad-spectrum antibiotics to treat pediatric pneumonia dropped considerably following the publication of national guidelines that recommended narrow-spectrum antibiotics, according to a recent study.

The guidelines released by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) in August 2011 “emphasized the use of a single, narrow-spectrum antibiotic (i.e., penicillin/ampicillin) for vaccinated children hospitalized with uncomplicated community-acquired pneumonia,” based on evidence that Streptococcus pneumoniae most commonly caused the illness and that incidence of penicillin-resistant pneumococcal disease had dropped after the vaccine’s introduction.

“Overall, use of third-generation cephalosporins declined significantly after release of the guidelines, whereas penicillin/ampicillin use increased,” reported Dr. Derek Williams of Monroe Carell Jr. Children’s Hospital and Vanderbilt University in Nashville, Tenn., and his associates. “We noted consistent trends across study sites, although changes were most apparent in institutions that conducted active hospital-based educational efforts to disseminate the PIDS/IDSA guidelines,” they wrote (Pediatrics 2015 June 22 [doi:10.1542/peds.2014-3047]).

The researchers analyzed the records of all 2,121 children hospitalized with community-acquired pneumonia between January 2010 and June 2012 at three hospitals in Tennessee and Utah. In the year before the new guidelines, all three hospitals most commonly used the broad-spectrum antibiotics, with prescription rates ranging from 43% to 61% for third-generation cephalosporins, compared with rates of 1%-9% for penicillin and ampicillin prescriptions. Overall, 52.8% of children received third-generation cephalosporins to treat their pneumonia and 2.7% received penicillin or ampicillin before the guidelines.

Nine months after the guidelines had been published, the use of third-generation cephalosporins dropped 12.4 percentage points and the use of penicillin and ampicillin increased 11.3 percentage points, Dr. Williams and his associates said.

The largest shift in prescribing patterns occurred at the two hospitals that held pediatric departmental educational conferences within 4 months of the new guidelines. The third hospital, which did not formally distribute information about the guidelines, saw the smallest reduction in broad spectrum–antibiotic use.

Although all three hospitals reported having antimicrobial stewardship programs, none had a community-acquired pneumonia practice guideline during the study period and none of the programs specifically focused on community-acquired pneumonia or restrictions on third-generation cephalosporins, aminopenicillins, or macrolides.

The research was supported by the National Institute of Allergy and Infectious Diseases, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention. The authors reported no relevant financial disclosures.

Use of broad-spectrum antibiotics to treat pediatric pneumonia dropped considerably following the publication of national guidelines that recommended narrow-spectrum antibiotics, according to a recent study.

The guidelines released by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) in August 2011 “emphasized the use of a single, narrow-spectrum antibiotic (i.e., penicillin/ampicillin) for vaccinated children hospitalized with uncomplicated community-acquired pneumonia,” based on evidence that Streptococcus pneumoniae most commonly caused the illness and that incidence of penicillin-resistant pneumococcal disease had dropped after the vaccine’s introduction.

“Overall, use of third-generation cephalosporins declined significantly after release of the guidelines, whereas penicillin/ampicillin use increased,” reported Dr. Derek Williams of Monroe Carell Jr. Children’s Hospital and Vanderbilt University in Nashville, Tenn., and his associates. “We noted consistent trends across study sites, although changes were most apparent in institutions that conducted active hospital-based educational efforts to disseminate the PIDS/IDSA guidelines,” they wrote (Pediatrics 2015 June 22 [doi:10.1542/peds.2014-3047]).

The researchers analyzed the records of all 2,121 children hospitalized with community-acquired pneumonia between January 2010 and June 2012 at three hospitals in Tennessee and Utah. In the year before the new guidelines, all three hospitals most commonly used the broad-spectrum antibiotics, with prescription rates ranging from 43% to 61% for third-generation cephalosporins, compared with rates of 1%-9% for penicillin and ampicillin prescriptions. Overall, 52.8% of children received third-generation cephalosporins to treat their pneumonia and 2.7% received penicillin or ampicillin before the guidelines.

Nine months after the guidelines had been published, the use of third-generation cephalosporins dropped 12.4 percentage points and the use of penicillin and ampicillin increased 11.3 percentage points, Dr. Williams and his associates said.

The largest shift in prescribing patterns occurred at the two hospitals that held pediatric departmental educational conferences within 4 months of the new guidelines. The third hospital, which did not formally distribute information about the guidelines, saw the smallest reduction in broad spectrum–antibiotic use.

Although all three hospitals reported having antimicrobial stewardship programs, none had a community-acquired pneumonia practice guideline during the study period and none of the programs specifically focused on community-acquired pneumonia or restrictions on third-generation cephalosporins, aminopenicillins, or macrolides.

The research was supported by the National Institute of Allergy and Infectious Diseases, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention. The authors reported no relevant financial disclosures.