Tara Haelle

An increasing number of teens were hospitalized for restrictive eating despite not meeting the clinical definition for anorexia nervosa, according to a recent study.

Over 6 years, the proportion of patients admitted with a diagnosis of eating disorder not otherwise specified (EDNOS-Wt) increased from 8% (1 of 13) in 2005 to 47% (9 of 19) in 2009, compared with patients admitted with anorexia nervosa. Further, both groups showed similar clinical characteristics, Melissa Whitelaw of the Royal Children’s Hospital, Melbourne, and her colleagues reported (Pediatrics 2014;134:e758-64).

CDC/ Debora Cartagena

Among 174 patients admitted to the hospital’s specialist eating disorder program, 99 were included in the study. Patients were excluded for a bulimia diagnosis, a previous eating disorder hospitalization, age less than 12 years, no psychological symptoms, menstruation in the past 3 months, or for logistical reasons.

Although the anorexia patients had lower admission weights and body mass index (BMI) measurements, the amount and duration of weight loss before admission did not significantly differ between the two groups. Anorexia patients had lost a median 12.7 kg, compared with 13.2 kg among EDNOS-Wt patients. Acute medical complications also were similar between the groups, except lowest lying systolic blood pressure, which was lower in anorexia patients, the investigators said.

The lowest pulse rate was 45.1 beats per minute among anorexia patients and 47.1 bpm in EDNOS-Wt patients. Severe sinus bradycardia average pulse rates were 35 bpm in anorexia patients and 34 bpm in EDNOS-Wt patients. Incidence of low phosphate levels was similar in both groups. Enteral feeding was required for 30% of anorexia patients and 38% of EDNOS-Wt patients.

"Although not underweight, this [ENDOS-Wt] group was more medically compromised in some outcomes than the anorexia nervosa group," Ms. Whitelaw and her group noted. The team suggested that clinicians consulting with adolescents with significant weight loss, regardless of the teens’ actual weight, should "review the patient’s weight loss strategies to ensure they are sustainable and safe" as well as "carefully assess the patient’s cardiovascular health and consider the development of an eating disorder."

The study received no external funding, and the authors reported no disclosures.

An increasing number of teens were hospitalized for restrictive eating despite not meeting the clinical definition for anorexia nervosa, according to a recent study.

Over 6 years, the proportion of patients admitted with a diagnosis of eating disorder not otherwise specified (EDNOS-Wt) increased from 8% (1 of 13) in 2005 to 47% (9 of 19) in 2009, compared with patients admitted with anorexia nervosa. Further, both groups showed similar clinical characteristics, Melissa Whitelaw of the Royal Children’s Hospital, Melbourne, and her colleagues reported (Pediatrics 2014;134:e758-64).

CDC/ Debora Cartagena

Among 174 patients admitted to the hospital’s specialist eating disorder program, 99 were included in the study. Patients were excluded for a bulimia diagnosis, a previous eating disorder hospitalization, age less than 12 years, no psychological symptoms, menstruation in the past 3 months, or for logistical reasons.

Although the anorexia patients had lower admission weights and body mass index (BMI) measurements, the amount and duration of weight loss before admission did not significantly differ between the two groups. Anorexia patients had lost a median 12.7 kg, compared with 13.2 kg among EDNOS-Wt patients. Acute medical complications also were similar between the groups, except lowest lying systolic blood pressure, which was lower in anorexia patients, the investigators said.

The lowest pulse rate was 45.1 beats per minute among anorexia patients and 47.1 bpm in EDNOS-Wt patients. Severe sinus bradycardia average pulse rates were 35 bpm in anorexia patients and 34 bpm in EDNOS-Wt patients. Incidence of low phosphate levels was similar in both groups. Enteral feeding was required for 30% of anorexia patients and 38% of EDNOS-Wt patients.

"Although not underweight, this [ENDOS-Wt] group was more medically compromised in some outcomes than the anorexia nervosa group," Ms. Whitelaw and her group noted. The team suggested that clinicians consulting with adolescents with significant weight loss, regardless of the teens’ actual weight, should "review the patient’s weight loss strategies to ensure they are sustainable and safe" as well as "carefully assess the patient’s cardiovascular health and consider the development of an eating disorder."

The study received no external funding, and the authors reported no disclosures.

An increasing number of teens were hospitalized for restrictive eating despite not meeting the clinical definition for anorexia nervosa, according to a recent study.

Over 6 years, the proportion of patients admitted with a diagnosis of eating disorder not otherwise specified (EDNOS-Wt) increased from 8% (1 of 13) in 2005 to 47% (9 of 19) in 2009, compared with patients admitted with anorexia nervosa. Further, both groups showed similar clinical characteristics, Melissa Whitelaw of the Royal Children’s Hospital, Melbourne, and her colleagues reported (Pediatrics 2014;134:e758-64).

CDC/ Debora Cartagena

Among 174 patients admitted to the hospital’s specialist eating disorder program, 99 were included in the study. Patients were excluded for a bulimia diagnosis, a previous eating disorder hospitalization, age less than 12 years, no psychological symptoms, menstruation in the past 3 months, or for logistical reasons.

Although the anorexia patients had lower admission weights and body mass index (BMI) measurements, the amount and duration of weight loss before admission did not significantly differ between the two groups. Anorexia patients had lost a median 12.7 kg, compared with 13.2 kg among EDNOS-Wt patients. Acute medical complications also were similar between the groups, except lowest lying systolic blood pressure, which was lower in anorexia patients, the investigators said.

The lowest pulse rate was 45.1 beats per minute among anorexia patients and 47.1 bpm in EDNOS-Wt patients. Severe sinus bradycardia average pulse rates were 35 bpm in anorexia patients and 34 bpm in EDNOS-Wt patients. Incidence of low phosphate levels was similar in both groups. Enteral feeding was required for 30% of anorexia patients and 38% of EDNOS-Wt patients.

"Although not underweight, this [ENDOS-Wt] group was more medically compromised in some outcomes than the anorexia nervosa group," Ms. Whitelaw and her group noted. The team suggested that clinicians consulting with adolescents with significant weight loss, regardless of the teens’ actual weight, should "review the patient’s weight loss strategies to ensure they are sustainable and safe" as well as "carefully assess the patient’s cardiovascular health and consider the development of an eating disorder."

The study received no external funding, and the authors reported no disclosures.

Immunity to four strains of human papillomavirus from the quadrivalent vaccine lasted in most cases at least 8 years, according to a new study.

The vaccine covers the HPV strains 6, 11, 16, and 18.

"Three doses of HPV4 vaccine provided high protection against disease and persistent infection," Dr. Daron Ferris of Georgia Regents University, Augusta, and his colleagues reported online Aug. 18 (Pediatrics 2014;134:e657-65).

Among 1,661 girls and boys aged 9-15 years, two-thirds (1,179) were assigned to receive the quadrivalent vaccine at the start of the study, with additional doses 2 and 6 months later. The other "catch-up" group (482) received a saline placebo at those times and then, 30 months after the start of the study, received the same three-dose series of the vaccine.

Eight years after the study began, the anti-HPV immune response remained high for all four strains in both groups, although the geometric mean titers at 8 years were approximately 11-34 times lower than those at 7 months into the study.

During follow-up, no cases of HPV-related disease and four cases of HPV-related infection lasting longer than 1 year occurred in the early-vaccination group – 2 each among the females and the males. In the catch-up group, one case of disease and six cases of infection occurred among the females, and one infection occurred among the males.

The researchers observed no serious adverse events related to the vaccine during follow-up except one case of Bell’s palsy that fully resolved after 2.7 weeks.

The research was funded by Merck. Dr. Sings, Dr. Shou, Dr. Saah, and Mr. Sausser are Merck employees and stock/stock options holders. Dr. Ferris, Dr. Block, Dr. Mehlsen, Dr. Chatterjee, and Dr. Iversen have received grant funding, consulting fees, and/or speaker fees from, and/or have served on advisory boards for Merck, and Dr. Chatterjee and Dr. Iversen, for GlaxoSmithKline. The remaining authors had no financial disclosures.

Immunity to four strains of human papillomavirus from the quadrivalent vaccine lasted in most cases at least 8 years, according to a new study.

The vaccine covers the HPV strains 6, 11, 16, and 18.

"Three doses of HPV4 vaccine provided high protection against disease and persistent infection," Dr. Daron Ferris of Georgia Regents University, Augusta, and his colleagues reported online Aug. 18 (Pediatrics 2014;134:e657-65).

Among 1,661 girls and boys aged 9-15 years, two-thirds (1,179) were assigned to receive the quadrivalent vaccine at the start of the study, with additional doses 2 and 6 months later. The other "catch-up" group (482) received a saline placebo at those times and then, 30 months after the start of the study, received the same three-dose series of the vaccine.

Eight years after the study began, the anti-HPV immune response remained high for all four strains in both groups, although the geometric mean titers at 8 years were approximately 11-34 times lower than those at 7 months into the study.

During follow-up, no cases of HPV-related disease and four cases of HPV-related infection lasting longer than 1 year occurred in the early-vaccination group – 2 each among the females and the males. In the catch-up group, one case of disease and six cases of infection occurred among the females, and one infection occurred among the males.

The researchers observed no serious adverse events related to the vaccine during follow-up except one case of Bell’s palsy that fully resolved after 2.7 weeks.

The research was funded by Merck. Dr. Sings, Dr. Shou, Dr. Saah, and Mr. Sausser are Merck employees and stock/stock options holders. Dr. Ferris, Dr. Block, Dr. Mehlsen, Dr. Chatterjee, and Dr. Iversen have received grant funding, consulting fees, and/or speaker fees from, and/or have served on advisory boards for Merck, and Dr. Chatterjee and Dr. Iversen, for GlaxoSmithKline. The remaining authors had no financial disclosures.

Immunity to four strains of human papillomavirus from the quadrivalent vaccine lasted in most cases at least 8 years, according to a new study.

The vaccine covers the HPV strains 6, 11, 16, and 18.

"Three doses of HPV4 vaccine provided high protection against disease and persistent infection," Dr. Daron Ferris of Georgia Regents University, Augusta, and his colleagues reported online Aug. 18 (Pediatrics 2014;134:e657-65).

Among 1,661 girls and boys aged 9-15 years, two-thirds (1,179) were assigned to receive the quadrivalent vaccine at the start of the study, with additional doses 2 and 6 months later. The other "catch-up" group (482) received a saline placebo at those times and then, 30 months after the start of the study, received the same three-dose series of the vaccine.

Eight years after the study began, the anti-HPV immune response remained high for all four strains in both groups, although the geometric mean titers at 8 years were approximately 11-34 times lower than those at 7 months into the study.

During follow-up, no cases of HPV-related disease and four cases of HPV-related infection lasting longer than 1 year occurred in the early-vaccination group – 2 each among the females and the males. In the catch-up group, one case of disease and six cases of infection occurred among the females, and one infection occurred among the males.

The researchers observed no serious adverse events related to the vaccine during follow-up except one case of Bell’s palsy that fully resolved after 2.7 weeks.

The research was funded by Merck. Dr. Sings, Dr. Shou, Dr. Saah, and Mr. Sausser are Merck employees and stock/stock options holders. Dr. Ferris, Dr. Block, Dr. Mehlsen, Dr. Chatterjee, and Dr. Iversen have received grant funding, consulting fees, and/or speaker fees from, and/or have served on advisory boards for Merck, and Dr. Chatterjee and Dr. Iversen, for GlaxoSmithKline. The remaining authors had no financial disclosures.

Immunity to four strains of human papillomavirus from the quadrivalent vaccine lasted in most cases at least 8 years, according to a new study.

The vaccine covers the HPV strains 6, 11, 16, and 18.

"Three doses of HPV4 vaccine provided high protection against disease and persistent infection," Dr. Daron Ferris of Georgia Regents University, Augusta, and his colleagues reported online Aug. 18 (Pediatrics 2014;134:e657-65).

Among 1,661 girls and boys aged 9-15 years, two-thirds (1,179) were assigned to receive the quadrivalent vaccine at the start of the study, with additional doses 2 and 6 months later. The other "catch-up" group (482) received a saline placebo at those times and then, 30 months after the start of the study, received the same three-dose series of the vaccine.

Eight years after the study began, the anti-HPV immune response remained high for all four strains in both groups, although the geometric mean titers at 8 years were approximately 11-34 times lower than those at 7 months into the study.

During follow-up, no cases of HPV-related disease and four cases of HPV-related infection lasting longer than 1 year occurred in the early-vaccination group – 2 each among the females and the males. In the catch-up group, one case of disease and six cases of infection occurred among the females, and one infection occurred among the males.

The researchers observed no serious adverse events related to the vaccine during follow-up except one case of Bell’s palsy that fully resolved after 2.7 weeks.

The research was funded by Merck. Dr. Sings, Dr. Shou, Dr. Saah, and Mr. Sausser are Merck employees and stock/stock options holders. Dr. Ferris, Dr. Block, Dr. Mehlsen, Dr. Chatterjee, and Dr. Iversen have received grant funding, consulting fees, and/or speaker fees from, and/or have served on advisory boards for Merck, and Dr. Chatterjee and Dr. Iversen, for GlaxoSmithKline. The remaining authors had no financial disclosures.

Immunity to four strains of human papillomavirus from the quadrivalent vaccine lasted in most cases at least 8 years, according to a new study.

The vaccine covers the HPV strains 6, 11, 16, and 18.

"Three doses of HPV4 vaccine provided high protection against disease and persistent infection," Dr. Daron Ferris of Georgia Regents University, Augusta, and his colleagues reported online Aug. 18 (Pediatrics 2014;134:e657-65).

Among 1,661 girls and boys aged 9-15 years, two-thirds (1,179) were assigned to receive the quadrivalent vaccine at the start of the study, with additional doses 2 and 6 months later. The other "catch-up" group (482) received a saline placebo at those times and then, 30 months after the start of the study, received the same three-dose series of the vaccine.

Eight years after the study began, the anti-HPV immune response remained high for all four strains in both groups, although the geometric mean titers at 8 years were approximately 11-34 times lower than those at 7 months into the study.

During follow-up, no cases of HPV-related disease and four cases of HPV-related infection lasting longer than 1 year occurred in the early-vaccination group – 2 each among the females and the males. In the catch-up group, one case of disease and six cases of infection occurred among the females, and one infection occurred among the males.

The researchers observed no serious adverse events related to the vaccine during follow-up except one case of Bell’s palsy that fully resolved after 2.7 weeks.

The research was funded by Merck. Dr. Sings, Dr. Shou, Dr. Saah, and Mr. Sausser are Merck employees and stock/stock options holders. Dr. Ferris, Dr. Block, Dr. Mehlsen, Dr. Chatterjee, and Dr. Iversen have received grant funding, consulting fees, and/or speaker fees from, and/or have served on advisory boards for Merck, and Dr. Chatterjee and Dr. Iversen, for GlaxoSmithKline. The remaining authors had no financial disclosures.

Immunity to four strains of human papillomavirus from the quadrivalent vaccine lasted in most cases at least 8 years, according to a new study.

The vaccine covers the HPV strains 6, 11, 16, and 18.

"Three doses of HPV4 vaccine provided high protection against disease and persistent infection," Dr. Daron Ferris of Georgia Regents University, Augusta, and his colleagues reported online Aug. 18 (Pediatrics 2014;134:e657-65).

Among 1,661 girls and boys aged 9-15 years, two-thirds (1,179) were assigned to receive the quadrivalent vaccine at the start of the study, with additional doses 2 and 6 months later. The other "catch-up" group (482) received a saline placebo at those times and then, 30 months after the start of the study, received the same three-dose series of the vaccine.

Eight years after the study began, the anti-HPV immune response remained high for all four strains in both groups, although the geometric mean titers at 8 years were approximately 11-34 times lower than those at 7 months into the study.

During follow-up, no cases of HPV-related disease and four cases of HPV-related infection lasting longer than 1 year occurred in the early-vaccination group – 2 each among the females and the males. In the catch-up group, one case of disease and six cases of infection occurred among the females, and one infection occurred among the males.

The researchers observed no serious adverse events related to the vaccine during follow-up except one case of Bell’s palsy that fully resolved after 2.7 weeks.

The research was funded by Merck. Dr. Sings, Dr. Shou, Dr. Saah, and Mr. Sausser are Merck employees and stock/stock options holders. Dr. Ferris, Dr. Block, Dr. Mehlsen, Dr. Chatterjee, and Dr. Iversen have received grant funding, consulting fees, and/or speaker fees from, and/or have served on advisory boards for Merck, and Dr. Chatterjee and Dr. Iversen, for GlaxoSmithKline. The remaining authors had no financial disclosures.

Emphasizing the benefits of the MMR vaccine for children appears to increase parents’ likelihood of vaccinating their child with it, according to a recent study.

But highlighting the societal benefits of giving their child the MMR (measles, mumps, and rubella) vaccine neither increased nor decreased their willingness to get their child the vaccine, Kristin Hendrix, Ph.D., of Indiana University in Indianapolis, and her colleagues reported online Aug. 18 (Pediatrics 2014;134:e675-e683).

In May 2012, the researchers provided one of four messages about the MMR vaccine to 802 parents of children less than 12 months of age. In a national online survey with the messages, the researchers asked the parents how likely they were, on a scale of 0 to 100 (extremely likely), to vaccinate their child with the MMR vaccine. Each message appeared online for 15 seconds, during which the parent could not navigate away.

Among the parents, 13% said they had ever refused a vaccine for their infant, 42% reported that all their children had received all the recommended vaccines, and 52% had no other children besides their infant. These parents were divided evenly across the four message groups.

One message was the Vaccine Information Statement (VIS) from the Centers for Disease Control and Prevention. The second was the VIS with additional information emphasizing the benefits of the MMR for their child, as follows: "The MMR vaccine protects your child from getting the diseases measles, mumps, or rubella or the complications caused by these diseases. After receiving this vaccine, your child will not miss school or activities due to these illnesses and will be able to play with friends during an outbreak."

The third message was the VIS and information emphasizing how society benefits from the MMR vaccine. It stated: "The MMR vaccine prevents your child from spreading measles, mumps, or rubella to those who cannot get the shot," and then listed those who could not get the shot. The fourth message emphasized both the child’s and society’s benefit, along with the VIS.

Parents rated the VIS-only message with an average of 86.3 on the likelihood-of-vaccinating scale. The VIS and society-only message did not increase parents’ likelihood of vaccinating (average, 86.4; P = .97), but the additional materials emphasizing the benefits to their child or to their child and society did (91.6 and 90.8; P = .01 and .03, respectively).

The research was supported by the Indiana Clinical and Translational Sciences Institute and the National Institutes of Health. The authors reported no disclosures.

Emphasizing the benefits of the MMR vaccine for children appears to increase parents’ likelihood of vaccinating their child with it, according to a recent study.

But highlighting the societal benefits of giving their child the MMR (measles, mumps, and rubella) vaccine neither increased nor decreased their willingness to get their child the vaccine, Kristin Hendrix, Ph.D., of Indiana University in Indianapolis, and her colleagues reported online Aug. 18 (Pediatrics 2014;134:e675-e683).

In May 2012, the researchers provided one of four messages about the MMR vaccine to 802 parents of children less than 12 months of age. In a national online survey with the messages, the researchers asked the parents how likely they were, on a scale of 0 to 100 (extremely likely), to vaccinate their child with the MMR vaccine. Each message appeared online for 15 seconds, during which the parent could not navigate away.

Among the parents, 13% said they had ever refused a vaccine for their infant, 42% reported that all their children had received all the recommended vaccines, and 52% had no other children besides their infant. These parents were divided evenly across the four message groups.

One message was the Vaccine Information Statement (VIS) from the Centers for Disease Control and Prevention. The second was the VIS with additional information emphasizing the benefits of the MMR for their child, as follows: "The MMR vaccine protects your child from getting the diseases measles, mumps, or rubella or the complications caused by these diseases. After receiving this vaccine, your child will not miss school or activities due to these illnesses and will be able to play with friends during an outbreak."

The third message was the VIS and information emphasizing how society benefits from the MMR vaccine. It stated: "The MMR vaccine prevents your child from spreading measles, mumps, or rubella to those who cannot get the shot," and then listed those who could not get the shot. The fourth message emphasized both the child’s and society’s benefit, along with the VIS.

Parents rated the VIS-only message with an average of 86.3 on the likelihood-of-vaccinating scale. The VIS and society-only message did not increase parents’ likelihood of vaccinating (average, 86.4; P = .97), but the additional materials emphasizing the benefits to their child or to their child and society did (91.6 and 90.8; P = .01 and .03, respectively).

The research was supported by the Indiana Clinical and Translational Sciences Institute and the National Institutes of Health. The authors reported no disclosures.

Emphasizing the benefits of the MMR vaccine for children appears to increase parents’ likelihood of vaccinating their child with it, according to a recent study.

But highlighting the societal benefits of giving their child the MMR (measles, mumps, and rubella) vaccine neither increased nor decreased their willingness to get their child the vaccine, Kristin Hendrix, Ph.D., of Indiana University in Indianapolis, and her colleagues reported online Aug. 18 (Pediatrics 2014;134:e675-e683).

In May 2012, the researchers provided one of four messages about the MMR vaccine to 802 parents of children less than 12 months of age. In a national online survey with the messages, the researchers asked the parents how likely they were, on a scale of 0 to 100 (extremely likely), to vaccinate their child with the MMR vaccine. Each message appeared online for 15 seconds, during which the parent could not navigate away.

Among the parents, 13% said they had ever refused a vaccine for their infant, 42% reported that all their children had received all the recommended vaccines, and 52% had no other children besides their infant. These parents were divided evenly across the four message groups.

One message was the Vaccine Information Statement (VIS) from the Centers for Disease Control and Prevention. The second was the VIS with additional information emphasizing the benefits of the MMR for their child, as follows: "The MMR vaccine protects your child from getting the diseases measles, mumps, or rubella or the complications caused by these diseases. After receiving this vaccine, your child will not miss school or activities due to these illnesses and will be able to play with friends during an outbreak."

The third message was the VIS and information emphasizing how society benefits from the MMR vaccine. It stated: "The MMR vaccine prevents your child from spreading measles, mumps, or rubella to those who cannot get the shot," and then listed those who could not get the shot. The fourth message emphasized both the child’s and society’s benefit, along with the VIS.

Parents rated the VIS-only message with an average of 86.3 on the likelihood-of-vaccinating scale. The VIS and society-only message did not increase parents’ likelihood of vaccinating (average, 86.4; P = .97), but the additional materials emphasizing the benefits to their child or to their child and society did (91.6 and 90.8; P = .01 and .03, respectively).

The research was supported by the Indiana Clinical and Translational Sciences Institute and the National Institutes of Health. The authors reported no disclosures.

Just over one-third of college students were at risk for one sleeping disorder, and one in five were at risk for a mental disorder, a recent study found.

"Participants at risk for sleep disorders were more likely to have poor health, lower working memory capacity, and more psychological symptoms than normal sleepers," Megan Petrov of the University of Alabama, Tuscaloosa, and her associates reported in the July issue of the Journal of Adolescence (2014;37:587-97).

The researchers used online questionnaires to assess insomnia symptoms, sleep quality, working memory, and the physical and mental health of 1,684 undergraduate college students at the university. The students, recruited in 2010 and 2011, were primarily women (77%). In addition, most were non-Hispanic white (77%), and the mean body mass index (BMI) was 23.5 plus or minus 4.7.

The researchers found that 36% of the students screened positive for having a sleep disorder, most commonly insomnia, restless legs syndrome, and periodic limb movement disorder, and 6.3% screened positive for at least two sleeping disorders. Only 10% of the students reported having a mental disorder diagnosis, but 20% reported frequent symptoms of sadness and anxiety.

Although nightmares and obstructive sleep apnea were less common, those with nightmares or parasomnias were more likely to have mental disorders. Women had a higher risk than men for sleep disorders – especially insomnia – and were more likely to report mental health problems. Meanwhile, African American respondents had fewer mental health diagnoses but higher BMIs, and were more likely to report having poorer physical health, compared with other ethnic groups.

Overall, the researchers reported that daytime sleepiness and other difficulties in daytime functioning due to sleep disturbances were common among these college students.

"Swift and accurate diagnosis and treatment of sleep disorders, particularly among vulnerable subgroups of college students, may improve academic performance, cognition and working memory, [and] physical and mental health, and reduce dropout rates," the researchers concluded.

The researchers cited several limitations of their study. Because the sample was not selected randomly, it is not possible to generalize the results beyond college students with similar characteristics.

The research did not use external funding, and the authors reported no disclosures.

Just over one-third of college students were at risk for one sleeping disorder, and one in five were at risk for a mental disorder, a recent study found.

"Participants at risk for sleep disorders were more likely to have poor health, lower working memory capacity, and more psychological symptoms than normal sleepers," Megan Petrov of the University of Alabama, Tuscaloosa, and her associates reported in the July issue of the Journal of Adolescence (2014;37:587-97).

The researchers used online questionnaires to assess insomnia symptoms, sleep quality, working memory, and the physical and mental health of 1,684 undergraduate college students at the university. The students, recruited in 2010 and 2011, were primarily women (77%). In addition, most were non-Hispanic white (77%), and the mean body mass index (BMI) was 23.5 plus or minus 4.7.

The researchers found that 36% of the students screened positive for having a sleep disorder, most commonly insomnia, restless legs syndrome, and periodic limb movement disorder, and 6.3% screened positive for at least two sleeping disorders. Only 10% of the students reported having a mental disorder diagnosis, but 20% reported frequent symptoms of sadness and anxiety.

Although nightmares and obstructive sleep apnea were less common, those with nightmares or parasomnias were more likely to have mental disorders. Women had a higher risk than men for sleep disorders – especially insomnia – and were more likely to report mental health problems. Meanwhile, African American respondents had fewer mental health diagnoses but higher BMIs, and were more likely to report having poorer physical health, compared with other ethnic groups.

Overall, the researchers reported that daytime sleepiness and other difficulties in daytime functioning due to sleep disturbances were common among these college students.

"Swift and accurate diagnosis and treatment of sleep disorders, particularly among vulnerable subgroups of college students, may improve academic performance, cognition and working memory, [and] physical and mental health, and reduce dropout rates," the researchers concluded.

The researchers cited several limitations of their study. Because the sample was not selected randomly, it is not possible to generalize the results beyond college students with similar characteristics.

The research did not use external funding, and the authors reported no disclosures.

Just over one-third of college students were at risk for one sleeping disorder, and one in five were at risk for a mental disorder, a recent study found.

"Participants at risk for sleep disorders were more likely to have poor health, lower working memory capacity, and more psychological symptoms than normal sleepers," Megan Petrov of the University of Alabama, Tuscaloosa, and her associates reported in the July issue of the Journal of Adolescence (2014;37:587-97).

The researchers used online questionnaires to assess insomnia symptoms, sleep quality, working memory, and the physical and mental health of 1,684 undergraduate college students at the university. The students, recruited in 2010 and 2011, were primarily women (77%). In addition, most were non-Hispanic white (77%), and the mean body mass index (BMI) was 23.5 plus or minus 4.7.

The researchers found that 36% of the students screened positive for having a sleep disorder, most commonly insomnia, restless legs syndrome, and periodic limb movement disorder, and 6.3% screened positive for at least two sleeping disorders. Only 10% of the students reported having a mental disorder diagnosis, but 20% reported frequent symptoms of sadness and anxiety.

Although nightmares and obstructive sleep apnea were less common, those with nightmares or parasomnias were more likely to have mental disorders. Women had a higher risk than men for sleep disorders – especially insomnia – and were more likely to report mental health problems. Meanwhile, African American respondents had fewer mental health diagnoses but higher BMIs, and were more likely to report having poorer physical health, compared with other ethnic groups.

Overall, the researchers reported that daytime sleepiness and other difficulties in daytime functioning due to sleep disturbances were common among these college students.

"Swift and accurate diagnosis and treatment of sleep disorders, particularly among vulnerable subgroups of college students, may improve academic performance, cognition and working memory, [and] physical and mental health, and reduce dropout rates," the researchers concluded.

The researchers cited several limitations of their study. Because the sample was not selected randomly, it is not possible to generalize the results beyond college students with similar characteristics.

The research did not use external funding, and the authors reported no disclosures.

More than half of schizophrenia patients have a vitamin D deficiency, according to a recent systematic review.

A meta-analysis of 13 of the total 19 studies in the review revealed that schizophrenia patients had an average 5.91 ng/mL lower serum 25-hydroxyvitamin D (25[OH])D) levels than control participants, Ghazaleh Valipour of Isfahan (Iran) University, and her colleagues reported online (J. Clin. Endocrinol. Metab. 2014 [doi:10.1210/jc.2014-1887]).

The 19 studies, published between 1988 and 2013, measured serum vitamin D levels in schizophrenic patients, including those with schizoaffective or other schizophrenia spectrum disorders. The articles included 8 cross-sectional studies, 10 case-control studies, and 1 nested case-control study, with a total of 2,804 participants aged 18-65. Sample sizes ranged from 17 to 848 participants.

A second meta-analysis of 8 of the 19 studies found that 65% of schizophrenia patients had a vitamin D deficiency, with prevalence ranging from 14% to 98% across studies. A third meta-analysis of eight studies found participants with a vitamin D deficiency had twice the odds of schizophrenia (odds ratio, 2.16) than those with sufficient levels of vitamin D, with studies’ odds ratios ranging from 0.6 to 13.6. Differences in findings across the studies could not be attributed to study design, the patient’s hospitalization status, study quality or study location; but use of 25-dihydroxyvitamin D₃ (25[OH]D₃) to measure serum levels explained some variation.

However, in all but one study, odds ratios "were calculated using the prevalence of schizophrenia in vitamin D–sufficient and –deficient persons," the researchers wrote. "Therefore, causality cannot be inferred from this finding because in most studies the exposure and the outcome coexisted."

The research was funded by the Research Council of the Food Security Research Center at Isfahan University. The authors had no disclosures.

More than half of schizophrenia patients have a vitamin D deficiency, according to a recent systematic review.

A meta-analysis of 13 of the total 19 studies in the review revealed that schizophrenia patients had an average 5.91 ng/mL lower serum 25-hydroxyvitamin D (25[OH])D) levels than control participants, Ghazaleh Valipour of Isfahan (Iran) University, and her colleagues reported online (J. Clin. Endocrinol. Metab. 2014 [doi:10.1210/jc.2014-1887]).

The 19 studies, published between 1988 and 2013, measured serum vitamin D levels in schizophrenic patients, including those with schizoaffective or other schizophrenia spectrum disorders. The articles included 8 cross-sectional studies, 10 case-control studies, and 1 nested case-control study, with a total of 2,804 participants aged 18-65. Sample sizes ranged from 17 to 848 participants.

A second meta-analysis of 8 of the 19 studies found that 65% of schizophrenia patients had a vitamin D deficiency, with prevalence ranging from 14% to 98% across studies. A third meta-analysis of eight studies found participants with a vitamin D deficiency had twice the odds of schizophrenia (odds ratio, 2.16) than those with sufficient levels of vitamin D, with studies’ odds ratios ranging from 0.6 to 13.6. Differences in findings across the studies could not be attributed to study design, the patient’s hospitalization status, study quality or study location; but use of 25-dihydroxyvitamin D₃ (25[OH]D₃) to measure serum levels explained some variation.

However, in all but one study, odds ratios "were calculated using the prevalence of schizophrenia in vitamin D–sufficient and –deficient persons," the researchers wrote. "Therefore, causality cannot be inferred from this finding because in most studies the exposure and the outcome coexisted."

The research was funded by the Research Council of the Food Security Research Center at Isfahan University. The authors had no disclosures.

More than half of schizophrenia patients have a vitamin D deficiency, according to a recent systematic review.

A meta-analysis of 13 of the total 19 studies in the review revealed that schizophrenia patients had an average 5.91 ng/mL lower serum 25-hydroxyvitamin D (25[OH])D) levels than control participants, Ghazaleh Valipour of Isfahan (Iran) University, and her colleagues reported online (J. Clin. Endocrinol. Metab. 2014 [doi:10.1210/jc.2014-1887]).

The 19 studies, published between 1988 and 2013, measured serum vitamin D levels in schizophrenic patients, including those with schizoaffective or other schizophrenia spectrum disorders. The articles included 8 cross-sectional studies, 10 case-control studies, and 1 nested case-control study, with a total of 2,804 participants aged 18-65. Sample sizes ranged from 17 to 848 participants.

A second meta-analysis of 8 of the 19 studies found that 65% of schizophrenia patients had a vitamin D deficiency, with prevalence ranging from 14% to 98% across studies. A third meta-analysis of eight studies found participants with a vitamin D deficiency had twice the odds of schizophrenia (odds ratio, 2.16) than those with sufficient levels of vitamin D, with studies’ odds ratios ranging from 0.6 to 13.6. Differences in findings across the studies could not be attributed to study design, the patient’s hospitalization status, study quality or study location; but use of 25-dihydroxyvitamin D₃ (25[OH]D₃) to measure serum levels explained some variation.

However, in all but one study, odds ratios "were calculated using the prevalence of schizophrenia in vitamin D–sufficient and –deficient persons," the researchers wrote. "Therefore, causality cannot be inferred from this finding because in most studies the exposure and the outcome coexisted."

The research was funded by the Research Council of the Food Security Research Center at Isfahan University. The authors had no disclosures.

High sodium intake can double the risk of cardiovascular disease in type 2 diabetes patients – and increase it nearly 10-fold if the diabetes is poorly controlled, according to a recent study.

"It was suggested that dietary salt restriction as medical nutritional treatment would be useful to prevent complications of diabetes in patients with type 2 diabetes," Chika Horikawa of the University of Niigata, Japan, and her colleagues reported online (J. Clin. Endocrinol. Metab. 2014 July 22 [doi:10.1210/jc.2013-4315]).

© Schlegelfotos/iStockphoto

The researchers assessed mean daily sodium intake from a baseline dietary survey of 1,588 participants, aged 40-70 years, with type 2 diabetes and hemoglobin A_1c levels of at least 6.5%. The participants were recruited from 59 university and general hospitals in Japan and then tracked from intake, from January 1995 to March 1996, until March 2003 for cardiovascular disease, overt nephropathy, diabetic retinopathy, and all-cause mortality.

Over the 8 years of follow-up, cardiovascular disease occurred at a rate of 13.61 incidents/1,000 patient-years. Participants consuming the highest quartile of sodium – a mean 5.9 g/day – were twice as likely (hazard ratio, 2.07) as those consuming the lowest quartile – a mean 2.8 g/day – to develop cardiovascular disease, a significant difference. A sodium intake in the second and third quartiles increased cardiovascular disease risk 1.70 and 1.47 times, respectively, compared to the first quartile.

Patients with HbA_1c greater than 9% and consuming sodium in the highest quartile were 9.91 times more likely to develop cardiovascular disease than were those in the first quartile with HbA_1c less than 9%. The researchers found no association between sodium intake and risk of overt nephropathy, diabetic retinopathy, or all-cause mortality.

The research was funded by Honjo International Scholarship Foundation, the University of Tsukuba Research Infrastructure Support Program, the Japan Society for the Promotion of Science and the Japanese Ministry of Health, Labor and Welfare. The authors had no disclosures.

High sodium intake can double the risk of cardiovascular disease in type 2 diabetes patients – and increase it nearly 10-fold if the diabetes is poorly controlled, according to a recent study.

"It was suggested that dietary salt restriction as medical nutritional treatment would be useful to prevent complications of diabetes in patients with type 2 diabetes," Chika Horikawa of the University of Niigata, Japan, and her colleagues reported online (J. Clin. Endocrinol. Metab. 2014 July 22 [doi:10.1210/jc.2013-4315]).

© Schlegelfotos/iStockphoto

The researchers assessed mean daily sodium intake from a baseline dietary survey of 1,588 participants, aged 40-70 years, with type 2 diabetes and hemoglobin A_1c levels of at least 6.5%. The participants were recruited from 59 university and general hospitals in Japan and then tracked from intake, from January 1995 to March 1996, until March 2003 for cardiovascular disease, overt nephropathy, diabetic retinopathy, and all-cause mortality.

Over the 8 years of follow-up, cardiovascular disease occurred at a rate of 13.61 incidents/1,000 patient-years. Participants consuming the highest quartile of sodium – a mean 5.9 g/day – were twice as likely (hazard ratio, 2.07) as those consuming the lowest quartile – a mean 2.8 g/day – to develop cardiovascular disease, a significant difference. A sodium intake in the second and third quartiles increased cardiovascular disease risk 1.70 and 1.47 times, respectively, compared to the first quartile.

Patients with HbA_1c greater than 9% and consuming sodium in the highest quartile were 9.91 times more likely to develop cardiovascular disease than were those in the first quartile with HbA_1c less than 9%. The researchers found no association between sodium intake and risk of overt nephropathy, diabetic retinopathy, or all-cause mortality.

The research was funded by Honjo International Scholarship Foundation, the University of Tsukuba Research Infrastructure Support Program, the Japan Society for the Promotion of Science and the Japanese Ministry of Health, Labor and Welfare. The authors had no disclosures.

High sodium intake can double the risk of cardiovascular disease in type 2 diabetes patients – and increase it nearly 10-fold if the diabetes is poorly controlled, according to a recent study.

"It was suggested that dietary salt restriction as medical nutritional treatment would be useful to prevent complications of diabetes in patients with type 2 diabetes," Chika Horikawa of the University of Niigata, Japan, and her colleagues reported online (J. Clin. Endocrinol. Metab. 2014 July 22 [doi:10.1210/jc.2013-4315]).

© Schlegelfotos/iStockphoto

The researchers assessed mean daily sodium intake from a baseline dietary survey of 1,588 participants, aged 40-70 years, with type 2 diabetes and hemoglobin A_1c levels of at least 6.5%. The participants were recruited from 59 university and general hospitals in Japan and then tracked from intake, from January 1995 to March 1996, until March 2003 for cardiovascular disease, overt nephropathy, diabetic retinopathy, and all-cause mortality.

Over the 8 years of follow-up, cardiovascular disease occurred at a rate of 13.61 incidents/1,000 patient-years. Participants consuming the highest quartile of sodium – a mean 5.9 g/day – were twice as likely (hazard ratio, 2.07) as those consuming the lowest quartile – a mean 2.8 g/day – to develop cardiovascular disease, a significant difference. A sodium intake in the second and third quartiles increased cardiovascular disease risk 1.70 and 1.47 times, respectively, compared to the first quartile.

Patients with HbA_1c greater than 9% and consuming sodium in the highest quartile were 9.91 times more likely to develop cardiovascular disease than were those in the first quartile with HbA_1c less than 9%. The researchers found no association between sodium intake and risk of overt nephropathy, diabetic retinopathy, or all-cause mortality.

The research was funded by Honjo International Scholarship Foundation, the University of Tsukuba Research Infrastructure Support Program, the Japan Society for the Promotion of Science and the Japanese Ministry of Health, Labor and Welfare. The authors had no disclosures.

One in three (35.3%) children developed complications with influenzalike illnesses, and children with neurologic or neuromuscular conditions were at highest risk for complications, according to a recent study.

The most commonly developed complication was pneumonia (26.1% of the participants), but the overall rate of complications did not vary among those who had influenza, compared with those with a different virus, Dr. Rakesh D. Mistry of the University of Colorado in Aurora, and his colleagues reported online (Pediatrics 2014 Aug. 4 [doi:10.1542/peds.2014-0505]). The next most common complications were respiratory failure (7.1%) and seizures (5.8%).

The researchers prospectively assessed 241 children aged 0-19 years who presented to a children’s hospital emergency department with influenzalike illness – fever plus a cough or sore throat without another cause – from early winter 2008 to late spring 2010. The study included only children with moderate to severe symptoms (defined by physicians’ decision to do venipuncture and respiratory viral testing) who did not already have severe complications. Severe complications included seizures, encephalopathy, pneumonia, bacteremia, bacterial tracheitis, respiratory failure, myocarditis, or death.

Overall, 24.9% of the children had influenza, 28.2% had no virus detected, 14.5% had rhinovirus, 11.6% had respiratory syncytial virus, and the remainder had human metapneumovirus, adenovirus or parainfluenza viruses. Among children with influenza, the risk of developing pneumonia was 7.6 times higher with the H1N1 strain than with other strains.

Asthma was the most common chronic medical condition among the 53.5% of children who had one. Although children with neurologic or neuromuscular conditions were four times more likely to develop complications, no other high-risk conditions were linked to complications, and 41.2% of children developing complications had no underlying conditions.

The authors wrote that their findings regarding children with underlying conditions "support the need for increased preventive measures in this subgroup of children, including influenza vaccination and early institution of antiviral treatment."

The study was supported in part by the Commonwealth of Pennsylvania Department of Health. The authors reported no disclosures.

One in three (35.3%) children developed complications with influenzalike illnesses, and children with neurologic or neuromuscular conditions were at highest risk for complications, according to a recent study.

The most commonly developed complication was pneumonia (26.1% of the participants), but the overall rate of complications did not vary among those who had influenza, compared with those with a different virus, Dr. Rakesh D. Mistry of the University of Colorado in Aurora, and his colleagues reported online (Pediatrics 2014 Aug. 4 [doi:10.1542/peds.2014-0505]). The next most common complications were respiratory failure (7.1%) and seizures (5.8%).

The researchers prospectively assessed 241 children aged 0-19 years who presented to a children’s hospital emergency department with influenzalike illness – fever plus a cough or sore throat without another cause – from early winter 2008 to late spring 2010. The study included only children with moderate to severe symptoms (defined by physicians’ decision to do venipuncture and respiratory viral testing) who did not already have severe complications. Severe complications included seizures, encephalopathy, pneumonia, bacteremia, bacterial tracheitis, respiratory failure, myocarditis, or death.

Overall, 24.9% of the children had influenza, 28.2% had no virus detected, 14.5% had rhinovirus, 11.6% had respiratory syncytial virus, and the remainder had human metapneumovirus, adenovirus or parainfluenza viruses. Among children with influenza, the risk of developing pneumonia was 7.6 times higher with the H1N1 strain than with other strains.

Asthma was the most common chronic medical condition among the 53.5% of children who had one. Although children with neurologic or neuromuscular conditions were four times more likely to develop complications, no other high-risk conditions were linked to complications, and 41.2% of children developing complications had no underlying conditions.

The authors wrote that their findings regarding children with underlying conditions "support the need for increased preventive measures in this subgroup of children, including influenza vaccination and early institution of antiviral treatment."

The study was supported in part by the Commonwealth of Pennsylvania Department of Health. The authors reported no disclosures.

One in three (35.3%) children developed complications with influenzalike illnesses, and children with neurologic or neuromuscular conditions were at highest risk for complications, according to a recent study.

The most commonly developed complication was pneumonia (26.1% of the participants), but the overall rate of complications did not vary among those who had influenza, compared with those with a different virus, Dr. Rakesh D. Mistry of the University of Colorado in Aurora, and his colleagues reported online (Pediatrics 2014 Aug. 4 [doi:10.1542/peds.2014-0505]). The next most common complications were respiratory failure (7.1%) and seizures (5.8%).

The researchers prospectively assessed 241 children aged 0-19 years who presented to a children’s hospital emergency department with influenzalike illness – fever plus a cough or sore throat without another cause – from early winter 2008 to late spring 2010. The study included only children with moderate to severe symptoms (defined by physicians’ decision to do venipuncture and respiratory viral testing) who did not already have severe complications. Severe complications included seizures, encephalopathy, pneumonia, bacteremia, bacterial tracheitis, respiratory failure, myocarditis, or death.

Overall, 24.9% of the children had influenza, 28.2% had no virus detected, 14.5% had rhinovirus, 11.6% had respiratory syncytial virus, and the remainder had human metapneumovirus, adenovirus or parainfluenza viruses. Among children with influenza, the risk of developing pneumonia was 7.6 times higher with the H1N1 strain than with other strains.

Asthma was the most common chronic medical condition among the 53.5% of children who had one. Although children with neurologic or neuromuscular conditions were four times more likely to develop complications, no other high-risk conditions were linked to complications, and 41.2% of children developing complications had no underlying conditions.

The authors wrote that their findings regarding children with underlying conditions "support the need for increased preventive measures in this subgroup of children, including influenza vaccination and early institution of antiviral treatment."

The study was supported in part by the Commonwealth of Pennsylvania Department of Health. The authors reported no disclosures.

Breastfeeding among newborns is on the rise, according to the 2014 Breastfeeding Report Card released by the Centers for Disease Control and Prevention.

Among babies born in 2011, 79.2% were breastfed at some point, up from the previous year’s report card in which only 76.5% reached that mark.*

In addition, breastfeeding was reported in 49% at age 6 months and 27% at age 12 months, findings that held steady from the last report. Two in five infants (41%) were exclusively breastfeeding at age 3 months and 19% at age 6 months. These findings are based on the 2012 and 2013 U.S. National Immunization Surveys conducted using calls to families with children aged 19-35 months.

The report card provides data on several goals included as part of the Healthy People 2020 Objectives, which aims to increase the percentage of babies who were ever breastfed to 82%. Additionally, the percentage of breastfeeding babies at age 6 months should be at least 61%, and at 1 year, at least 34%.

The objectives also include ensuring that at least 46% of babies are exclusively breastfeeding at 3 months and that at least 26% are doing so at 6 months.

Currently, 19% of breastfed infants received formula before they were 2 days old, which is higher than the 14% goal for Healthy People 2020.

The report card also shows closer progress toward the goal of 8% of live births occurring at Baby-Friendly facilities, which provide the recommended care for lactating mothers and their babies. Baby-Friendly hospitals must follow the “Ten Steps to Successful Breastfeeding” and the International Code of Marketing of Breast-milk Substitutes established by the World Health Organization.

In addition to the Baby-Friendly Initiative, the CDC also conducts a survey to establish a Maternity Practices in Infant Nutrition and Care (mPINC) score, which measures breastfeeding-related maternity care practices across the United States. The national average in this year’s report card is 75, with numbers that range from a low of 59 in Mississippi to a high of 91 in New Hampshire.

The breastfeeding report card tracks the number of those providing professional lactation support, which has been increasing since the metric was added in 2006. The number of International Board Certified Lactation Consultants (IBCLCs) has climbed from 2.1 to 3.5 per 1,000 live births between 2006 and 2013, based on data provided from the International Board of Lactation Consultant Examiners.

The number of Certified Lactation Counselors (CLCs) also has increased from 2.5 to 3.8 CLCs per 1,000 live births from 2011 to 2013. In addition, at least six CLCs per 1,000 births exist in 19 states, according to the Academy of Lactation Policy and Practice. The number of La Leche League Leaders per 1,000 births is 0.9, about the same as the 0.92 number from last year’s report card.

The research is supported by the Centers for Disease Control and Prevention. No disclosures were noted.

*Correction, 8/1/2014: A previous version of this article misstated the birth year addressed in the 2014 report.

Breastfeeding among newborns is on the rise, according to the 2014 Breastfeeding Report Card released by the Centers for Disease Control and Prevention.

Among babies born in 2011, 79.2% were breastfed at some point, up from the previous year’s report card in which only 76.5% reached that mark.*

In addition, breastfeeding was reported in 49% at age 6 months and 27% at age 12 months, findings that held steady from the last report. Two in five infants (41%) were exclusively breastfeeding at age 3 months and 19% at age 6 months. These findings are based on the 2012 and 2013 U.S. National Immunization Surveys conducted using calls to families with children aged 19-35 months.

The report card provides data on several goals included as part of the Healthy People 2020 Objectives, which aims to increase the percentage of babies who were ever breastfed to 82%. Additionally, the percentage of breastfeeding babies at age 6 months should be at least 61%, and at 1 year, at least 34%.

The objectives also include ensuring that at least 46% of babies are exclusively breastfeeding at 3 months and that at least 26% are doing so at 6 months.

Currently, 19% of breastfed infants received formula before they were 2 days old, which is higher than the 14% goal for Healthy People 2020.

The report card also shows closer progress toward the goal of 8% of live births occurring at Baby-Friendly facilities, which provide the recommended care for lactating mothers and their babies. Baby-Friendly hospitals must follow the “Ten Steps to Successful Breastfeeding” and the International Code of Marketing of Breast-milk Substitutes established by the World Health Organization.

In addition to the Baby-Friendly Initiative, the CDC also conducts a survey to establish a Maternity Practices in Infant Nutrition and Care (mPINC) score, which measures breastfeeding-related maternity care practices across the United States. The national average in this year’s report card is 75, with numbers that range from a low of 59 in Mississippi to a high of 91 in New Hampshire.

The breastfeeding report card tracks the number of those providing professional lactation support, which has been increasing since the metric was added in 2006. The number of International Board Certified Lactation Consultants (IBCLCs) has climbed from 2.1 to 3.5 per 1,000 live births between 2006 and 2013, based on data provided from the International Board of Lactation Consultant Examiners.

The number of Certified Lactation Counselors (CLCs) also has increased from 2.5 to 3.8 CLCs per 1,000 live births from 2011 to 2013. In addition, at least six CLCs per 1,000 births exist in 19 states, according to the Academy of Lactation Policy and Practice. The number of La Leche League Leaders per 1,000 births is 0.9, about the same as the 0.92 number from last year’s report card.

The research is supported by the Centers for Disease Control and Prevention. No disclosures were noted.

*Correction, 8/1/2014: A previous version of this article misstated the birth year addressed in the 2014 report.

Breastfeeding among newborns is on the rise, according to the 2014 Breastfeeding Report Card released by the Centers for Disease Control and Prevention.

Among babies born in 2011, 79.2% were breastfed at some point, up from the previous year’s report card in which only 76.5% reached that mark.*

In addition, breastfeeding was reported in 49% at age 6 months and 27% at age 12 months, findings that held steady from the last report. Two in five infants (41%) were exclusively breastfeeding at age 3 months and 19% at age 6 months. These findings are based on the 2012 and 2013 U.S. National Immunization Surveys conducted using calls to families with children aged 19-35 months.

The report card provides data on several goals included as part of the Healthy People 2020 Objectives, which aims to increase the percentage of babies who were ever breastfed to 82%. Additionally, the percentage of breastfeeding babies at age 6 months should be at least 61%, and at 1 year, at least 34%.

The objectives also include ensuring that at least 46% of babies are exclusively breastfeeding at 3 months and that at least 26% are doing so at 6 months.

Currently, 19% of breastfed infants received formula before they were 2 days old, which is higher than the 14% goal for Healthy People 2020.

The report card also shows closer progress toward the goal of 8% of live births occurring at Baby-Friendly facilities, which provide the recommended care for lactating mothers and their babies. Baby-Friendly hospitals must follow the “Ten Steps to Successful Breastfeeding” and the International Code of Marketing of Breast-milk Substitutes established by the World Health Organization.

In addition to the Baby-Friendly Initiative, the CDC also conducts a survey to establish a Maternity Practices in Infant Nutrition and Care (mPINC) score, which measures breastfeeding-related maternity care practices across the United States. The national average in this year’s report card is 75, with numbers that range from a low of 59 in Mississippi to a high of 91 in New Hampshire.

The breastfeeding report card tracks the number of those providing professional lactation support, which has been increasing since the metric was added in 2006. The number of International Board Certified Lactation Consultants (IBCLCs) has climbed from 2.1 to 3.5 per 1,000 live births between 2006 and 2013, based on data provided from the International Board of Lactation Consultant Examiners.

The number of Certified Lactation Counselors (CLCs) also has increased from 2.5 to 3.8 CLCs per 1,000 live births from 2011 to 2013. In addition, at least six CLCs per 1,000 births exist in 19 states, according to the Academy of Lactation Policy and Practice. The number of La Leche League Leaders per 1,000 births is 0.9, about the same as the 0.92 number from last year’s report card.

The research is supported by the Centers for Disease Control and Prevention. No disclosures were noted.

*Correction, 8/1/2014: A previous version of this article misstated the birth year addressed in the 2014 report.

New guidelines regarding the use of palivizumab to reduce the risk of respiratory syncytial virus now further restrict which infants should receive the prophylaxis. The new guidelines, issued by the American Academy of Pediatrics, replace the previous ones from 2012.

Approximately 2.1 million children under age 5 develop an RSV infection requiring medical care each year, including about 58,000 who are hospitalized during their first few years of life. The highest-risk age for RSV hospitalization is 2 months.

However, palivizumab (Synagis), an immunoglobulin monoclonal antibody, can reduce the risk of hospitalization for RSV. The standard prophylactic dose is 15 mg/kg every 30 days during RSV season, for up to five doses. Palivizumab does not interfere with immunizations and can be administered at the same time as vaccines.

The main changes in the updated guidelines reduce the number of infants who will qualify for the prophylaxis, according to the policy statement published online by the AAP Committee on Infectious Diseases, chaired by Red Book Associate Editor Michael T. Brady, and the AAP Bronchiolitis Guidelines Committee (Pediatrics 2014 July 28 [doi: 10.1542/peds.2014-1665]).

Whereas all otherwise healthy preterm infants born at less than 32 weeks were previously recommended to receive palivizumab, now only those born at less than 29 weeks are recommended to receive it.

However, recommendations for palivizumab remain in place for preterm infants younger than 32 weeks’ gestational age who have chronic lung disease of prematurity and needed more than 21% oxygen for at least the first 28 days after birth. In addition, as in the previous guidelines, these children should receive palivizumab only during their first year of life unless, in their second year, they still need medical support in the 6 months before RSV season starts. Medical support includes supplemental oxygen, chronic corticosteroid therapy, or diuretic therapy.

Infants less than 12 months old with hemodynamically significant congenital heart disease should still receive palivizumab, particularly if they have moderate to severe pulmonary hypertension or if they have acyanotic heart disease and either take medication to control congestive heart failure or else will need heart surgery. However, children older than 12 months are no longer recommended to receive the prophylaxis (previous guidelines went up to 24 months), nor are those who have hemodynamically insignificant heart disease, who have surgically corrected lesions, who do not need drugs for congestive heart failure, or who have mild cardiomyopathy but do not need therapy.

Unless they have another qualifying condition, children with Down syndrome or cystic fibrosis also are not recommended to receive palivizumab, even though some evidence shows that these children may be at higher risk for RSV. The 2012 guidelines did not have a recommendation for or against palivizumab for children with cystic fibrosis, but data from studies since then bolster the case to exclude these children from receiving the prophylaxis because of limited evidence of clinical benefit.

Further, a group no longer recommended to receive palivizumab are those born between 32 and 35 weeks who were born within 3 months of RSV season and either attended childcare or had a sibling under age 5.

As in 2012, palivizumab "may be considered" for two groups of children: those less than 24 months old undergoing chemotherapy or otherwise severely immunocompromised, and those with pulmonary abnormalities or neuromuscular disorders that prevent them from coughing sufficiently to clear upper-airway secretions.

Another change in the updated recommendations is to cease prophylactic doses of palivizumab if a child is hospitalized with a breakthrough RSV infection. Previous guidelines advised that doses continue through the maximum recommended amount, but this has been removed in the new statement because fewer than 0.5% of infants are rehospitalized with RSV in the same season. Palivizumab is still not recommended for prevention of health care–associated RSV or to treat RSV.

The updated guidelines are based on new data, including revised (lower) estimates of RSV mortality in hospitalized children, information on RSV seasonality, declining bronchiolitis hospitalizations, data on palivizumab benefits for children with cystic fibrosis or Down syndrome, and "reports describing palivizumab-resistant RSV isolates from hospitalized patients who receive prophylaxis." These data are summarized in the technical report by the AAP Committee on Infectious Diseases (Pediatrics 2014 July 28 [doi: 10.1542/peds.2014-1666]).

Palivizumab was licensed by the Food and Drug Administration in June 1998, largely based on the results of a randomized controlled trial in 1996-1997 involving 1,501 preterm infants and young children (some with chronic lung disease of prematurity). A second randomized controlled trial was performed in 1998-2002 involving 1,287 children with hemodynamically significant congenital heart disease.

No external funding was used to develop the guidelines. No disclosures were reported for the members of the AAP Committee on Infectious Diseases.

New guidelines regarding the use of palivizumab to reduce the risk of respiratory syncytial virus now further restrict which infants should receive the prophylaxis. The new guidelines, issued by the American Academy of Pediatrics, replace the previous ones from 2012.

Approximately 2.1 million children under age 5 develop an RSV infection requiring medical care each year, including about 58,000 who are hospitalized during their first few years of life. The highest-risk age for RSV hospitalization is 2 months.

However, palivizumab (Synagis), an immunoglobulin monoclonal antibody, can reduce the risk of hospitalization for RSV. The standard prophylactic dose is 15 mg/kg every 30 days during RSV season, for up to five doses. Palivizumab does not interfere with immunizations and can be administered at the same time as vaccines.

The main changes in the updated guidelines reduce the number of infants who will qualify for the prophylaxis, according to the policy statement published online by the AAP Committee on Infectious Diseases, chaired by Red Book Associate Editor Michael T. Brady, and the AAP Bronchiolitis Guidelines Committee (Pediatrics 2014 July 28 [doi: 10.1542/peds.2014-1665]).

Whereas all otherwise healthy preterm infants born at less than 32 weeks were previously recommended to receive palivizumab, now only those born at less than 29 weeks are recommended to receive it.

However, recommendations for palivizumab remain in place for preterm infants younger than 32 weeks’ gestational age who have chronic lung disease of prematurity and needed more than 21% oxygen for at least the first 28 days after birth. In addition, as in the previous guidelines, these children should receive palivizumab only during their first year of life unless, in their second year, they still need medical support in the 6 months before RSV season starts. Medical support includes supplemental oxygen, chronic corticosteroid therapy, or diuretic therapy.

Infants less than 12 months old with hemodynamically significant congenital heart disease should still receive palivizumab, particularly if they have moderate to severe pulmonary hypertension or if they have acyanotic heart disease and either take medication to control congestive heart failure or else will need heart surgery. However, children older than 12 months are no longer recommended to receive the prophylaxis (previous guidelines went up to 24 months), nor are those who have hemodynamically insignificant heart disease, who have surgically corrected lesions, who do not need drugs for congestive heart failure, or who have mild cardiomyopathy but do not need therapy.

Unless they have another qualifying condition, children with Down syndrome or cystic fibrosis also are not recommended to receive palivizumab, even though some evidence shows that these children may be at higher risk for RSV. The 2012 guidelines did not have a recommendation for or against palivizumab for children with cystic fibrosis, but data from studies since then bolster the case to exclude these children from receiving the prophylaxis because of limited evidence of clinical benefit.

Further, a group no longer recommended to receive palivizumab are those born between 32 and 35 weeks who were born within 3 months of RSV season and either attended childcare or had a sibling under age 5.

As in 2012, palivizumab "may be considered" for two groups of children: those less than 24 months old undergoing chemotherapy or otherwise severely immunocompromised, and those with pulmonary abnormalities or neuromuscular disorders that prevent them from coughing sufficiently to clear upper-airway secretions.

Another change in the updated recommendations is to cease prophylactic doses of palivizumab if a child is hospitalized with a breakthrough RSV infection. Previous guidelines advised that doses continue through the maximum recommended amount, but this has been removed in the new statement because fewer than 0.5% of infants are rehospitalized with RSV in the same season. Palivizumab is still not recommended for prevention of health care–associated RSV or to treat RSV.

The updated guidelines are based on new data, including revised (lower) estimates of RSV mortality in hospitalized children, information on RSV seasonality, declining bronchiolitis hospitalizations, data on palivizumab benefits for children with cystic fibrosis or Down syndrome, and "reports describing palivizumab-resistant RSV isolates from hospitalized patients who receive prophylaxis." These data are summarized in the technical report by the AAP Committee on Infectious Diseases (Pediatrics 2014 July 28 [doi: 10.1542/peds.2014-1666]).

Palivizumab was licensed by the Food and Drug Administration in June 1998, largely based on the results of a randomized controlled trial in 1996-1997 involving 1,501 preterm infants and young children (some with chronic lung disease of prematurity). A second randomized controlled trial was performed in 1998-2002 involving 1,287 children with hemodynamically significant congenital heart disease.

No external funding was used to develop the guidelines. No disclosures were reported for the members of the AAP Committee on Infectious Diseases.

New guidelines regarding the use of palivizumab to reduce the risk of respiratory syncytial virus now further restrict which infants should receive the prophylaxis. The new guidelines, issued by the American Academy of Pediatrics, replace the previous ones from 2012.

Approximately 2.1 million children under age 5 develop an RSV infection requiring medical care each year, including about 58,000 who are hospitalized during their first few years of life. The highest-risk age for RSV hospitalization is 2 months.

However, palivizumab (Synagis), an immunoglobulin monoclonal antibody, can reduce the risk of hospitalization for RSV. The standard prophylactic dose is 15 mg/kg every 30 days during RSV season, for up to five doses. Palivizumab does not interfere with immunizations and can be administered at the same time as vaccines.

The main changes in the updated guidelines reduce the number of infants who will qualify for the prophylaxis, according to the policy statement published online by the AAP Committee on Infectious Diseases, chaired by Red Book Associate Editor Michael T. Brady, and the AAP Bronchiolitis Guidelines Committee (Pediatrics 2014 July 28 [doi: 10.1542/peds.2014-1665]).

Whereas all otherwise healthy preterm infants born at less than 32 weeks were previously recommended to receive palivizumab, now only those born at less than 29 weeks are recommended to receive it.

However, recommendations for palivizumab remain in place for preterm infants younger than 32 weeks’ gestational age who have chronic lung disease of prematurity and needed more than 21% oxygen for at least the first 28 days after birth. In addition, as in the previous guidelines, these children should receive palivizumab only during their first year of life unless, in their second year, they still need medical support in the 6 months before RSV season starts. Medical support includes supplemental oxygen, chronic corticosteroid therapy, or diuretic therapy.

Infants less than 12 months old with hemodynamically significant congenital heart disease should still receive palivizumab, particularly if they have moderate to severe pulmonary hypertension or if they have acyanotic heart disease and either take medication to control congestive heart failure or else will need heart surgery. However, children older than 12 months are no longer recommended to receive the prophylaxis (previous guidelines went up to 24 months), nor are those who have hemodynamically insignificant heart disease, who have surgically corrected lesions, who do not need drugs for congestive heart failure, or who have mild cardiomyopathy but do not need therapy.

Unless they have another qualifying condition, children with Down syndrome or cystic fibrosis also are not recommended to receive palivizumab, even though some evidence shows that these children may be at higher risk for RSV. The 2012 guidelines did not have a recommendation for or against palivizumab for children with cystic fibrosis, but data from studies since then bolster the case to exclude these children from receiving the prophylaxis because of limited evidence of clinical benefit.

Further, a group no longer recommended to receive palivizumab are those born between 32 and 35 weeks who were born within 3 months of RSV season and either attended childcare or had a sibling under age 5.

As in 2012, palivizumab "may be considered" for two groups of children: those less than 24 months old undergoing chemotherapy or otherwise severely immunocompromised, and those with pulmonary abnormalities or neuromuscular disorders that prevent them from coughing sufficiently to clear upper-airway secretions.

Another change in the updated recommendations is to cease prophylactic doses of palivizumab if a child is hospitalized with a breakthrough RSV infection. Previous guidelines advised that doses continue through the maximum recommended amount, but this has been removed in the new statement because fewer than 0.5% of infants are rehospitalized with RSV in the same season. Palivizumab is still not recommended for prevention of health care–associated RSV or to treat RSV.

The updated guidelines are based on new data, including revised (lower) estimates of RSV mortality in hospitalized children, information on RSV seasonality, declining bronchiolitis hospitalizations, data on palivizumab benefits for children with cystic fibrosis or Down syndrome, and "reports describing palivizumab-resistant RSV isolates from hospitalized patients who receive prophylaxis." These data are summarized in the technical report by the AAP Committee on Infectious Diseases (Pediatrics 2014 July 28 [doi: 10.1542/peds.2014-1666]).

Palivizumab was licensed by the Food and Drug Administration in June 1998, largely based on the results of a randomized controlled trial in 1996-1997 involving 1,501 preterm infants and young children (some with chronic lung disease of prematurity). A second randomized controlled trial was performed in 1998-2002 involving 1,287 children with hemodynamically significant congenital heart disease.

No external funding was used to develop the guidelines. No disclosures were reported for the members of the AAP Committee on Infectious Diseases.