Tuesday, July 31, 2007

Signs of a sleep disorder

Could you have a sleep disorder?

Are you spending enough time in bed and still wake up tired or feel very sleepy during the day, you may be one of the estimated 40million Americans with a sleep disorder.

The most common sleep disorders are insomnia, sleep apnea (sleep–disordered breathing), restless legs syndrome , and narcolepsy. Although sleep disorders can significantly affect your health, safety, and well–being, they can be treated.

Talk to your doctor if you have any of these signs of a sleep disorder:
  • You consistently take more than 30 minutes each night to fall asleep.
  • You consistently awaken several time each night and then have trouble falling back to sleep, or you awaken too early in the morning.
  • You often feel sleepy during the day, you take frequent naps, or you fall asleep at inappropriate times during the day.
  • Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods.
  • You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall alseep.
  • Your bed partner notices that your legs or arms jerk often during sleep.
  • You have vivid, dreamlike experiences while falling asleep or dozing.
  • You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh.
  • You feel as though you cannot move when you first wake up.
Keep in mind that children can have some of these same signs when they have a sleep disorder, but they often do not show signs of excessive daytime sleepiness. Instead they may seem overactive and have difficulty focusing or doing their best in school.

Source: U.S. Department of Health and Services, National Institutes of Health

Monday, July 30, 2007

Good night's sleep: 13 tips to help you

Get a good night's sleep

Like eating well and being physically active, getting a good night's sleep is vital to your well–being.

Here are 13 tips to help you:

Stick to a sleep schedule. Go to bed and wake up at the same time each day—even on the weekends.
Exercise is great but not too late in the day. Avoid exercising closer than 5 or 6 hours before bedtime.
caffeine and nicotine. The stimulating effects of caffeine in coffee, colas, teas, and chocolate can take as long as 8 hours to wear off fully. Nicotine is also a stimulant.
Avoid alcoholic drinks before bed. A "nightcap" might help you get to sleep, but alcohol keeps you in the lights stages of sleep. You also tend to wake up in the middle of the night when the sedating effects have worn off.
Avoid large meals and beverages late at night. A large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause you to awaken frequently to urinate.
Avoid medicines that delay or disrupt your sleep, if possible. Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns.
Don't take naps after 3 p.m. Naps can boost your brain power, but late afternoon naps can make it harder to fall asleep at night. Also keep naps to under an hour.
Relax before bed. Take time to unwind. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual.
Take a hot bath before bed. The drop in body temperature after the bath may help you feel sleepy, and the bath can help relax you.
Have a good sleeping environment. Get rid of anything that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or a TV or computer in the bedroom. Also, keeping the temperature in your bedroom on the cool side can help you sleep better.
Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least 30 minutes each day.
Don't lie in bed awake. If you find yourself still awake after staying in bed for more than 20 minutes, get up and so some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.
See a doctor if you continue to have trouble sleeping. If you consistently find yourself feeling tired or not well rested during the day despite spending enough time in bed at night, you may have a sleep disorder. Your family doctor or a sleep specialist should be able to help you.

Friday, July 27, 2007

Mental Illness: Long-Term Employment Trajectories

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

Deborah Becker, M.Ed., Rob Whitley, Ph.D., Edward L. Bailey, M.S. and Robert E. Drake, M.D., Ph.D.

OBJECTIVE: The long-term trajectories of participants in supported employment have not been clear. This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment.
METHODS: We reinterviewed 38 of 78 participants (49%) with severe mental illness eight to 12 years after they enrolled in supported employment studies in a small urban mental health center in New England. Data were analyzed by using quantitative and qualitative methods.
RESULTS: All 38 participants worked during the follow-up period, a great majority (82%) in competitive jobs, and 71% worked for more than half of the follow-up years. Participants reported numerous benefits related to employment, including enhancements to self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to work; part-time employment and long-term supports were the major facilitators. Three overlapping themes emerged from the qualitative analysis as significant perceived influences on participants' work-related behavior. First, the successful management of symptoms and the deployment of appropriate coping skills appeared to play an important role in finding and maintaining work. Second, participants generally preferred to work part-time because of the lesser demands of this type of job and because it was perceived to allow for the maintenance of Social Security and health care entitlements. Third, participants saw the importance of ongoing individual placement and support services. Participants stated that this was imperative in making successful transitions between jobs or from unemployment to employment and in helping negotiate pay raises or changes in conditions.
CONCLUSIONS: The long-term trajectories of participants in supported employment programs, both vocational and nonvocational, appear to be positive.

Psychiatr Serv 58:922-928, July 2007
© 2007 American Psychiatric Association


Wednesday, July 25, 2007

National Survey of Children With Mental Illness

A National Survey of State Licensing, Regulating, and Monitoring of Residential Facilities for Children With Mental Illness

Judith L. Teich, M.S.W. and Henry T. Ireys, Ph.D.

OBJECTIVE: Little national information is available to help policy makers understand the methods that states use to regulate residential facilities for children with mental illness. This article describes the results of a government-sponsored survey of state officials that examined how states license, regulate, and monitor such facilities.

Questionnaires were mailed to selected officials in each of the 50 states and the District of Columbia, followed by extensive telephone and e-mail contacts. Questionnaire items covered program characteristics, licensing and accreditation, mandated services, monitoring and oversight methods, and payment sources.

Information was gathered on 71 types of residential facilities in 38 states, accounting for 3,628 separate residential facilities with 50,507 beds as of September 30, 2003. States differed widely in the types of residential facilities that they regulate and their mix of regulatory methods, which included requirements for announced and unannounced visits, mandated staff-to-client ratios, minimum levels of education for facility directors, specifications for licensing practices and critical incident reporting, mandated complaint review procedures, and accreditation from designated organizations. Welfare, mental health, and health departments all participated in regulating facilities.

States relied on at least several regulatory methods, but no state used all of the possible methods. The regulatory environment is complex in most states because several agencies are involved in licensing, regulating, and reviewing complaints. To ensure that residential facilities effectively address the needs of children with mental illness and their families, policy makers should review and improve their state's data on methods for regulating residential facilities.

Psychiatr Serv 58:991-998, July 2007
© 2007 American Psychiatric Association

Tuesday, July 24, 2007

Treatment-Refractory Schizophrenia

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Julie Kreyenbuhl, Pharm.D., Ph.D., Steven C. Marcus, Ph.D., Joyce C. West, Ph.D., M.P.P., Joshua Wilk, Ph.D. and Mark Olfson, M.D., M.P.H.

OBJECTIVE: This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported.
METHODS: Psychiatrists participating in a nationally representative mailed survey (N=209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year.
RESULTS: Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company.
CONCLUSIONS: Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.

Psychiatr Serv 58:983-990, July 2007
© 2007 American Psychiatric Association

Monday, July 23, 2007



Aretha Persaud, M.D.

Acne affects many individuals of all ages. Acne is a skin disorder characterized by clogged pores and pimples. Although acne is not a serious medical condition, it often causes emotional distress and can lead to scarring of the skin.
Acne can appear anywhere on the body, typically affecting the face, neck, chest, back and shoulders, which are the areas with the largest amount of oil glands. Acne appears in several forms. Whiteheads occur when the openings of hair follicles become clogged and blocked with oil secretions and dead skin. Blackheads are similar but are open to the skin surface and darken. Pimples are red, raised spots that indicate infection and inflammation in the hair follicle. Finally, cysts occur when there is a buildup of secretions beneath the surface of the skin deep within the hair follicles.
There are three main factors responsible for acne: overproduction of oil or sebum, irregular shedding of dead skin cells and buildup of bacteria. Pores, the openings of the sweat glands on your skin, are not normally involved in acne.
Contrary to common belief, foods have little effect on acne. Acne usually occurs when there are hormonal changes in your body—for females, during menstruation and pregnancy. Acne is also associated with certain medicines, such as cortisone or steroids.
Other causes include exposing the skin to greasy or oily substances. Scrubbing the skin too hard or with harsh chemicals can cause irritation and worsen acne. If there is a family history of acne, you have a greater risk of developing it. Friction or pressure on the skin caused by phones, collars or backpacks can lead to acne.
Treatment for acne focuses on reducing oil production, speeding up skin cell turnover and fighting bacterial infection. The treatment usually takes weeks before results are noted and the skin may appear worse before it gets better. Topical treatments that contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as the active ingredients, are usually found over the counter. Prescription topical treatments include Tretinoin (Retin-A) or adapalene (Differin) which are derived from Vitamin A. These agents promote cell turnover and prevent plugging of the hair follicles. Topical antibiotics are also available and kill excess bacteria. Combining these products helps achieve optimal results.
Oral antibiotics are used for moderate to severe acne. Isotretinoin or Accutane is useful to treat deep cysts when oral antibiotics have failed. However, there are several serious side effects associated with Accutane. Severe birth defects may occur in females taking Accutane. Cholesterol, triglycerides and liver enzymes in the body may become elevated, so baseline blood testing and follow-up labs should be done routinely when Accutane is prescribed for acne treatment. Oral contraceptives have also been shown to improve acne but are associated with other side effects. Finally, cosmetic procedures, including microdermabrasion, chemical peels, IPL (intense pulse light) therapy or laser resurfacing, are options to diminish scarring caused by acne and enhance your complexion.


Thursday, July 19, 2007

Prednisolone and Withdrawal headache

Prednisolone does not reduce withdrawal headache
A randomized, double-blind study

Magne G. Bøe, MD, Åse Mygland, MD, PhD and Rolf Salvesen, MD, PhD

From the Department of Neurology, Sørlandet Hospital, Kristiansand, Norway (M.G.B., Å.M.); Hospital of Rehabilitation, Rikshospitalet University Hospital, Kristiansand, Norway (Å.M.); Institute of Clinical Medicine, University of Bergen, Bergen, Norway (Å.M.); Department of Neurology, Nordland Hospital, Bodø, Norway (R.S.); and Department of Neurology, University of Tromsø, Tromsø, Norway (R.S.)

Introduction: Medication overuse headache is a condition where abrupt drug withdrawal is considered the treatment of choice.

Objective: To study whether prednisolone given orally the first 6 days after medication withdrawal reduces headache intensity during the same period.

Methods: From August 2003 through November 2005, we included patients aged 18 to 70 years with probable medication overuse headache. The study was randomized, double-blind, and placebo controlled. The patients were hospitalized for 3 days to start medication withdrawal. They were randomly assigned to receive prednisolone 60 mg on days 1 and 2, 40 mg on days 3 and 4, and 20 mg on days 5 and 6 (Group A) or placebo tablets for 6 days (Group B). Headache intensity was recorded in a diary for a month before withdrawal (baseline) and throughout the study period of 28 days. The primary endpoint was a calculated mean headache (MH), based on number of days with headache and mean intensity the first 6 days after withdrawal.

Results: We included 26 men and 74 women. Sixty-five had migraine, 13 had tension-type headache, and 22 had both migraine and tension-type headache. Baseline headache days were 25.4 (CI 24.3 to 26.4). Baseline MH was 1.6 (CI 1.41 to 1.69). Fifty-one received Regimen A, and 49 received Regimen B. Baseline features were similar. During the first 6 days after withdrawal, headache was similar in Groups A and B (MH 1.48 [CI 1.28 to 1.68] vs 1.61 [CI 1.41 to 1.82], p = 0.34).

Conclusion: Prednisolone has no effect on withdrawal headache in unselected patients with chronic daily headache and medication overuse.

NEUROLOGY 2007;69:26-31
© 2007 American Academy of Neurology

Monday, July 16, 2007

Migraine: Association with socioeconomic status

Migraine in adolescents
Association with socioeconomic status and family history

M. E. Bigal, MD, PhD, R. B. Lipton, MD, P. Winner, DO, M. L. Reed, PhD, S. Diamond, MD, W. F. Stewart, PhD On behalf of the AMPP advisory group*

From the Departments of Neurology (M.E.B., R.B.L.) and Epidemiology and Population Health (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; The Montefiore Headache Center (M.E.B., R.B.L.), Bronx, NY; The New England Center for Headache (M.E.B.), Stamford, CT; The Palm Beach Headache Center (P.W.), Palm Beach, FL; Vedanta Research (M.L.R.), Chapel Hill, NC; The Diamond Headache Center (S.D.), Chicago, IL; and The Center for Health Research and Rural Advocacy (W.F.S.), Danville, PA.

Objective: The influence of socioeconomic status on the prevalence of migraine is unknown in adolescents. Accordingly, we investigated the prevalence of migraine in a large sample of adolescents by sociodemographic features.

Methods: A validated headache questionnaire was mailed to 120,000 households representative of the US population. All individuals in the household were interviewed (probands and their parents). We calculated sex-specific prevalence estimates of migraine in adolescents derived by age, race, urban vs rural residence, household income, region of the country, and parental status of migraine, using log-linear models.

Results: A total of 32,015 adolescents were identified. Surveys were returned by 18,714 of them (58.4% response rate).The 1-year prevalence of migraine was 6.3% (5.0% in boys and 7.7% in girls). The prevalence was higher in girls than in boys older than 12 and in whites than African Americans. In families with an annual income lower than $22,500, the adjusted prevalence of migraine in adolescents without a parental history of migraine was 4.4%; in families earning $90,000 or more, it was 2.9% (OR = 0.49, 95% CI 0.38 to 0.63). In adolescents with a parental history of migraine, the prevalence in the lower vs the higher income group was 8.6% vs 8.4% (OR = 0.97, 0.81 to 1.15).

Conclusions: In adolescents with family history of migraine, household income does not have a significant effect, probably because of the higher biologic predisposition. In those without a strong predisposition, household income is associated with prevalence. This suggests social causation rather than social selection, highlighting the need for exploration of environmental risk factors related to low income and migraine and the search for specific comorbidities and stressors in this group.

NEUROLOGY 2007;69:16-25
© 2007 American Academy of Neurology

Friday, July 13, 2007

Predictors of Mental Health

Predictors of Mental Health Service Utilization by People Using Resources for Homeless People in Canada

Jean-Pierre Bonin, Ph.D., Louise Fournier, Ph.D. and Régis Blais, Ph.D.

OBJECTIVE: This study used Pescosolido's network episode model to examine mental health service utilization among impoverished people accessing resources for the homeless in Canada's universal health care setting.

METHODS: The sample consisted of 439 people who met DSM-IV criteria for affective or psychotic disorders who were assessed as part of a larger study of resources for homeless or impoverished people in Montreal and Quebec City. Interviews were organized into the framework of four network episode model concepts: sociodemographic characteristics, illness characteristics, illness history, and social network. These blocks of variables were then analyzed in terms of their accuracy in predicting mental health service utilization.

RESULTS: Eighty-four percent of the sample were male, the mean±SD age was 41±12 years, and 36% were homeless at the time of the interview, but nearly half (48%) of the population had been homeless previously. The research shows that each network episode model concept except illness history significantly predicted utilization of mental health services. Female gender, youth, never being homeless (sociodemographic characteristics), presence of antisocial personality disorders within the preceding year, past or current alcohol-related disorders (illness characteristics), hospitalization before the preceding year (illness history), and a larger social support network were related to utilization of mental health services.

CONCLUSIONS: In the absence of economic barriers to health care, there are other significant barriers to the use of mental health services for people who live in poverty. A better understanding of these factors will help in meeting the service needs of impoverished mentally ill people.

Psychiatr Serv 58:936-941, July 2007
© 2007 American Psychiatric Association

Wednesday, July 11, 2007

Assessment of Body Fatness

  Do Skinfold Measurements Provide Additional Information to Body Mass Index in the Assessment of Body Fatness Among Children and Adolescents?

Zuguo Mei, MD (a), Laurence M. Grummer-Strawn, PhD (a), Jack Wang, MS (b), John C. Thornton, PhD (b), David S. Freedman, PhD (a), Richard N. Pierson, Jr, MD (b), William H. Dietz, MD, PhD (a) and Mary Horlick, MD (c)
a) Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Georgia; b) Body Composition Unit, Department of Medicine, Obesity Research Center, St Luke's-Roosevelt Hospital, New York, New York; c) National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland

OBJECTIVES. The purpose of this work was to validate the performance of age- and gender-specific BMI, triceps, and subscapular skinfold for the classification of excess of body fat in children and adolescents and to examine how much additional information these 2 skinfold measurements provide to BMI-for-age.
METHODS. The receiver operating characteristic curve was used to characterize the sensitivity and specificity of these 3 indices in classifying excess body fat. Percentage of body fat was determined by dual-energy radiograph absorptiometry. Both 85th and 95th percentile of percentage of body fat were used to define excess body fat. Data from the New York Pediatric Rosetta Body Composition Project were examined (n = 1196; aged 5–18 years).
RESULTS. For children aged 5 to 18 years, BMI-for-age, triceps skinfold-for-age, and subscapular skinfold-for-age each performed equally well alone in the receiver operating characteristic curves in the identification of excess body fat defined by either the 85th or 95th percentile of percentage of body fat by dual-energy radiograph absorptiometry. However, if BMI-for-age was already known and was >95th percentile, the additional measurement of skinfolds did not significantly increase the sensitivity or specificity in the identification of excess body fat.
CONCLUSIONS. In contrast to the recommendations of expert panels, skinfold measurements do not seem to provide additional information about excess body fat beyond BMI-for-age alone if the BMI-for-age is >95th percentile.

Key Words: dual-energy radiograph absorptiometry • BMI • skinfold • anthropometry • receiver operating characteristic curve • sensitivity • specificity

Abbreviations: DXA—dual-energy radiograph absorptiometry • CDC—Centers for Disease Control and Prevention • %BF—percentage of body fat • CV—coefficient of variation • ROC—receiver operating characteristic

PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1306-e1313

Thursday, July 05, 2007

Violence of Film

Violent Entertainment Pitched to Adolescents: An Analysis of PG-13 Films

Theresa Webb, PhD (a), Lucille Jenkins, MPH (a), Nickolas Browne, EdD (b), Abdelmonen A. Afifi, PhD (a) and Jess Kraus, PhD, MPH (a)
a) Southern California Injury Prevention Research Center, UCLA School of Public Health
b) UCLA School of Film, Television, and Digital Media, University of California–Los Angeles, Los Angeles, California

OBJECTIVE. The purpose of this study was to evaluate the violence content of the top-grossing PG-13 films of 1999 and 2000 to determine what percentage of it had potential for negative effects on young viewers and what percentage of it had potential for prosocial or beneficial effects.

METHODS. A large, multidimensional analytic instrument was designed for systematic coding of each act of violence and its contextualization by features that have been shown either to enhance or to protect against harmful effects that are associated with violent media exposure: perpetrators and victims of violence, motivation for violence, presence of weapons, degree of realism, and consequences of violence. Descriptive statistics by genre were performed for each film. An ordinal logistic regression model was used to examine the association between the seriousness of violence and weapons, motive, and genre.

RESULTS. In the sample of 77 PG-13 films, a total of 2251 violent actions were observed with roughly half (47%) of lethal magnitude. A total of 118 acts contained justified violence that were initiated by major characters and were extremely serious, and approximately two thirds of the films (49 [64%]) were rated PG-13 for reasons other than violence.

CONCLUSIONS. Violence permeated nearly 90% of the films in our study. Although only a small subset of this content contained violence that was associated with negative effects, only 1 film contained violence that was associated with protective or beneficial effects.

Key Words: violence • film • media • MPAA rating system

Abbreviations: MPAA—Motion Picture Association of America • FTC—Federal Trade Commission • NTVS—National Television Violence Study • OR—odds ratio

PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1219-e1229

Wednesday, July 04, 2007

Risk of Allergic and Respiratory Diseases Later in Childhood

  Infant Swimming Practice, Pulmonary Epithelium Integrity, and the Risk of Allergic and Respiratory Diseases Later in Childhood

Alfred Bernard, PhD, Sylviane Carbonnelle, MD, Xavier Dumont, BSc and Marc Nickmilder, PhD
Unit of Toxicology, Department of Public Health, Faculty of Medicine, Catholic University of Louvain, Brussels, Belgium

OBJECTIVE. Irritant gases and aerosols contaminating the air of indoor swimming pools can affect the lung epithelium and increase asthma risk in children. We evaluated the impact of infant swimming practice on allergic status and respiratory health later in childhood.
METHODS. Clara cell protein, surfactant-associated protein D, and total and aeroallergen-specific immunoglobulin E were measured in the serum of 341 schoolchildren aged 10 to 13 years, among whom 43 had followed an infant swimming program. Asthma was defined as doctor-diagnosed asthma and/or positive exercise-induced bronchoconstriction (15% decrease in postexercise forced expiratory volume).
RESULTS. There were no significant differences between the infant swimming group and the other children regarding the levels of exhaled nitric oxide and total or aeroallergen-specific serum immunoglobulin E. Children who swam as infants showed, by contrast, a significant decrease of serum Clara cell protein and of the serum Clara cell protein/surfactant-associated protein D ratio integrating Clara cell damage and permeability changes of the lung epithelial barrier. These effects were associated with higher risks of asthma and of recurrent bronchitis. Passive exposure to tobacco alone had no effect on these outcomes but seemed to interact with infant swimming practice to increase the risk of asthma or of recurrent bronchitis.
CONCLUSIONS. Our data suggest that infant swimming practice in chlorinated indoor swimming pools is associated with airways changes that, along with other factors, seem to predispose children to the development of asthma and recurrent bronchitis.

Key Words: chlorine • trichloramine • nitrogen trichloride • baby swimming • Clara cell protein • CC16 • childhood asthma • recurrent bronchitis

PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1095-1103

Tuesday, July 03, 2007

Smoking during pregnancy

Maternal Asthma and Maternal Smoking Are Associated With Increased Risk of Bronchiolitis During Infancy

Kecia N. Carroll, MD, MPH (a,b,c), Tebeb Gebretsadik, MPH (d), Marie R. Griffin, MD, MPH (e,f,g,h,i), William D. Dupont, PhD (d,f), Edward F. Mitchel, MS (f), Pingsheng Wu, PhD (d,j), Rachel Enriquez, RN, PhD (j) and Tina V. Hartert, MD, MPH (e,j,k,l,m)
a) Department of Pediatrics; e) Department of Medicine; f) Department of Preventive Medicine; d) Department of Biostatistics, Divisions of; b) Division of General Pediatrics; g) Division of General Internal Medicine; j) Division of Allergy, Pulmonary and Critical Care Medicine; c) Division of Child and Adolescent Health Research Unit; h) Division of Center for Education and Research on Therapeutics; k) Division of Center for Health Services Research; l) Division of General Clinical Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee; i) Mid-South Geriatric Research Education and Clinical Center and Clinical Research Center of Excellence, Veterans Affairs Tennessee Valley Health Care System, Nashville, Tennessee; m) Meharry/Vanderbilt Center for Reducing Asthma Disparities, Nashville, Tennessee

OBJECTIVE. Our goal was to determine whether maternal asthma and maternal smoking during pregnancy are associated with the incidence and severity of clinically significant bronchiolitis in term, otherwise healthy infants without the confounding factors of small lung size or underlying cardiac or pulmonary disease.

We conducted a population-based retrospective cohort study of term, non–low birth weight infants enrolled in the Tennessee Medicaid Program from 1995 to 2003. The cohort of infants was followed through the first year of life to determine the incidence and severity of bronchiolitis as determined by health care visits and prolonged hospitalization.

A total of 101245 infants were included. Overall, 20% of infants had 1 health care visit for bronchiolitis. Compared with infants with neither factor, the risk of bronchiolitis was increased in infants with maternal smoking only, maternal asthma only, or both. Infants with maternal asthma only or with both maternal smoking and asthma had the highest risks for emergency department visits and hospitalizations. Infants with a mother with asthma had the highest risk of a hospitalization >3 days, followed by infants with both maternal asthma and smoking, and maternal smoking only.

Maternal asthma and maternal smoking during pregnancy are independently associated with the development of bronchiolitis in term, non–low birth weight infants without preexisting cardiac or pulmonary disease. The risk of bronchiolitis among infants with mothers who both have asthma and smoke during pregnancy is 50% greater than that of infants with neither risk factor. Efforts to decrease the illness associated with these 2 risk factors will lead to decreased morbidity from bronchiolitis, the leading cause of hospitalization for severe lower respiratory tract infections during infancy.

Key Words:
bronchiolitis • risk factors • infant • smoking • asthma

PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1104-1112

Monday, July 02, 2007

Thyroid Problems After Pregnancy

Thyroid Problems After Pregnancy

One of every twenty women develop thyroid inflammation within a few months after delivery of their baby, a condition called postpartum thyroiditis. This form of thyroid inflammation is painless and causes little or no gland enlargement. However, the condition interferes with the gland's production of thyroid hormones. Thyroid hormone may leak out of the inflamed gland in large amounts, causing hyperthyroidism that lasts for several weeks. Later on, the injured gland may not be able to make enough thyroid hormone, resulting in temporary hypothyroidism. Symptoms of hyperthyroidism and hypothyroidism may not be recognized when they occur in a new mother. They may be simply attributed to lack of sleep, nervousness, or depression.

Thyroid Symptoms Occasionally Overlooked in New Mothers

Easily upset
Trouble losing weight
Postpartum thyroiditis goes away on its own after one to four months. While it is active, however, women often benefit from treatment for their thyroid hormone excess or deficiency. Some of the symptoms caused by too much thyroid hormone, such as tremor or palpitations, can be improved promptly by medications called beta-blockers (e.g., propranolol). Antithyroid drugs, radioactive iodine, and surgery do not need to be considered because this form of hyperthyroidism is only temporary. If thyroid hormone deficiency develops, it can be treated for one to six months with levothyroxine. Women who have had an episode of postpartum thyroiditis are very likely to develop the problem again after future pregnancies. Although each episode usually resolves completely, one out of four women with postpartum thyroiditis goes on to develop a permanently underactive thyroid gland in future. Of course, levothyroxine fully corrects their thyroid hormone deficiency, and when used in the correct dose, can be safely taken without side effects or complications.

Thyroid Problems in the Baby
Rarely, a baby may be born without a thyroid gland. This birth defect is not caused by thyroid problems in the mother. If an infant's hypothyroidism is not recognized and treated promptly, he/she will not develop normally. Therefore, all newborn babies in the United States routinely have a blood test to be sure that hypothyroidism is diagnosed and treated. Most thyroid medications will have no effect on the baby. The exception to this generality is the administration of radioactive iodine to the mother during pregnancy. Radioactive iodine can cross the placenta and it can destroy thyroid cells in
the fetus.