<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_432"
                     title="Short Needle May Short HBV Protection for Obese (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Pediatrics/Vaccines/tb/18348?impressionId=1265806501862"
                     
      &lt;p&gt;Obese adolescents and young adults may not generate an adequate immune response to hepatitis B (HBV) vaccine because the needles used to vaccinate them are too short, a randomized study suggests.&lt;/p&gt;
&lt;p&gt;Immunization with a 1.5-inch needle was associated with 80% higher anti-HBV titers than a 1.0-inch needle, researchers reported online in &lt;em&gt;Pediatrics.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;The difference persisted in analyses performed to correct for imbalances in the study population.&lt;/p&gt;
&lt;p&gt;&quot;This supports the hypothesis that inadequate muscle penetration is responsible, at least in part, for lower immune response to HBV vaccine among obese adolescent and adult vaccine recipients,&quot; Amy Middleman, MD, of Baylor College of Medicine in Houston, and colleagues concluded.&lt;/p&gt;
&lt;p&gt;Several studies have shown that adolescents and adults with a higher body mass index (BMI) have lower antibody titers after HBV vaccination. The observations have taken on new significance, given that an increasing number of vaccines target a population that has a rising BMI, the authors wrote.&lt;/p&gt;
&lt;p&gt;Researchers hypothesize that standard-length needles do not penetrate through the deltoid fat and into the muscle of obese adolescents and adults. Because of its less abundant blood supply, adipose tissue may delay antigen presentation to B and T cells responsible for immune response, the authors continued.&lt;/p&gt;
&lt;p&gt;To test the hypothesis, Middleman and colleagues conducted a randomized, clinical trial involving adolescents and adults ages 14 to 24 with no prior exposure to HBV vaccine. Eligibility criteria included weight &amp;gt;90 kg for female patients and &amp;gt;120 kg for male patients.&lt;/p&gt;
&lt;p&gt;Patients were randomized to receive the HBV vaccine series with a standard one-inch needle or a 1.5-inch needle. Patients younger than 19 received 0.5-mL injections, and older patients received 1.0-mL injections.&lt;/p&gt;
&lt;p&gt;Investigators used a standardized injection procedure: insertion of the needle at a 90&amp;#176; angle to the deltoid muscle, leaving 2 to 3 mm of needle visible between the skin and the hub.&lt;/p&gt;
&lt;p&gt;Patients received three doses of vaccine at baseline, one month, and four months. Blood samples were obtained at baseline and two months after the final injection.&lt;/p&gt;
&lt;p&gt;The two groups did not differ significantly with respect to median age (21), BMI (~40), deltoid skinfold (41 mm), triceps skinfold (~40 mm), days between vaccine doses one and three (~135), and days from third vaccine dose to titer assessment (65).&lt;/p&gt;
&lt;p&gt;At the end of the study, 24 patients had completed the immunization protocol, 10 in the one-inch group and 14 in the 1.5-inch group.&lt;/p&gt;
&lt;p&gt;Patients vaccinated with a one-inch needle had a median antibody titer of 189.8 mIU/mL compared with 345.4 mIU/mL for patients vaccinated with the 1.5-inch needle (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;The between-group difference remained significant in analyses that excluded an outlier from the 1.5-inch group (&lt;em&gt;P&lt;/em&gt;=0.047) and that excluded the only two male patients in the study (&lt;em&gt;P&lt;/em&gt;=0.035).&lt;/p&gt;
&lt;p&gt;&quot;As we continue to experience high rates of obesity in the U.S. and throughout the world, additional evidence-based research on optimizing the effective delivery of immunizations to adolescents and young adults will be critical,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Following updated needle length recommendations will be a first step toward improving the health of our youth and young adults by preventing vaccine-preventable diseases.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by federal grants and awards. GlaxoSmithKline provided the vaccine.&lt;/p&gt;&lt;p&gt;The authors had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_405"
                     title="Difficult Childhood Lingers in the Mind (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18312?impressionId=1265806501862"
                     
      &lt;p&gt;Adversities faced in childhood have effects on mental health far into the future, researchers affirmed.&lt;/p&gt;
&lt;p&gt;Mental illness in adulthood was increasingly likely the more traumas faced in childhood, Ronald C. Kessler, PhD, of Harvard, and colleagues reported in the February issue of the &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Childhood difficulties potentially explained 32.4% of all the psychiatric disorders examined, they said, based on analyses of the National Comorbidity Survey Replication.&lt;/p&gt;
&lt;p&gt;Adversities relating to family dysfunction  --  substance-abusing parents, sexual or physical abuse in the home, neglect, etc.  --  appeared to have the strongest link to onset and persistence of psychiatric disorders, they reported.&lt;/p&gt;
&lt;p&gt;These findings match folk wisdom and decades of research into the negative effects of child maltreatment, commented John McGrath, MD, PhD, of the Queensland Centre for Mental Health Research in Wacol, Australia, and colleagues in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;But the lack of specificity between certain exposures to particular mental health outcomes  --  such as the death of one&apos;s mother leading to depression  --  was notable, the editorialists said.&lt;/p&gt;
&lt;p&gt;&quot;Thus, childhood trauma upsets the orderly psychological and biological cascades of development, leaving the affected individual at increased risk of a wide range of adverse mental health outcomes,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Rather than continue to rehash the epidemiology, it&apos;s time to focus on prevention and intervention, McGrath&apos;s group emphasized.&lt;/p&gt;
&lt;p&gt;&quot;It is unrealistic to think that we could protect all children from all adversities, but can we identify factors that bolster resilience and focus our efforts on the most vulnerable subgroups?&quot; they asked.&lt;/p&gt;
&lt;p&gt;The researchers examined joint associations of 12 retrospectively reported childhood adversities with lifetime incidence of disorders meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria in the National Comorbidity Survey Replication I, a cross-sectional survey of a nationally-representative sample of adults in 9,282 American households.&lt;/p&gt;
&lt;p&gt;Among the respondents, 53.4% reported at least one childhood adversity, most commonly parental divorce (17.5%), family violence (14.0%), family economic problems (10.6%), and parental mental illness (10.3%).&lt;/p&gt;
&lt;p&gt;These adversities were all individually and significantly linked to first onset of psychiatric disorders with odds ratios of 1.5 to 1.9 for dysfunctional family factors (physical abuse, sexual abuse, neglect, parental mental illness, parental substance abuse, parental criminality, or family violence) and 1.0 to 1.5 for other factors like life-threatening childhood physical illness, extreme poverty, parental divorce, or loss of or separation from parents.&lt;/p&gt;
&lt;p&gt;Despite some apparent but not significantly meaningful variation in type of adversity with type of psychiatric disorder, the researchers said they could rule out that all types were the same for future mental health risk (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Problems tended to cluster, though. Among people who faced one adversity in childhood, 51.2% to 95.1% faced others as well, depending on the adversity.&lt;/p&gt;
&lt;p&gt;Risk of mental illness rose with number of issues faced in childhood from an odds ratio of 1.3 for one up to 3.4 for six and 3.2 for seven or more adversities.&lt;/p&gt;
&lt;p&gt;&quot;This subadditive pattern has important implications for intervention because it means that prevention or amelioration of only a single childhood adversity in youths exposed to many childhood adversities is unlikely to have important preventive effects,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Overall, childhood adversities were projected to account for 44.6% of childhood-onset disorders, 32.0% of adolescent-onset disorders, and 28.6% of adult-onset disorders.&lt;/p&gt;
&lt;p&gt;The researchers also looked at persistence through the second part of the National Comorbidity Survey Replication which went beyond just core diagnostic assessment in 5,692 respondents.&lt;/p&gt;
&lt;p&gt;In a complex multivariate interactive analysis, childhood adversity from dysfunctional family factors appeared significantly linked to persistence in a given year (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) whereas the number of factors was not significant.&lt;/p&gt;
&lt;p&gt;These significant factors were parental mental illness, physical abuse, sexual abuse, and neglect, but they carried modest effects individually with odds ratios of 1.2.&lt;/p&gt;
&lt;p&gt;But in one simulation, not being exposed to childhood trauma would only increase the time since the most recent episode of psychiatric illness by 1.6%, suggesting &quot;quite modest&quot; substantive importance in determining persistence.&lt;/p&gt;
&lt;p&gt;&quot;These results indirectly suggest that the public health implications of childhood adversities are greater for primary than for secondary prevention because the associations of childhood adversities with disorder onset are much stronger than the associations with persistence,&quot; Kessler&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that recall bias may have limited their study such that the results could be considered an &quot;upper bound&quot; for the real association and that the study could not prove causality.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Comorbidity Survey Replication is supported by a grant from the National Institute of Mental Health with supplemental support from the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, a grant from the Robert Wood Johnson Foundation, and the John W. Alden Trust.&lt;/p&gt;&lt;p&gt;The analyses were supported by a grant from the NIMH; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; grants from the U.S. Public Health Service; an award from the Fogarty International Center; the Pan American Health Organization; Eli Lilly; Ortho-McNeil Pharmaceutical; GlaxoSmithKline; and Bristol-Myers Squibb.&lt;/p&gt;&lt;p&gt;Kessler reported financial conflicts of interest with GlaxoSmithKline, Kaiser Permanente, Pfizer, sanofi-aventis, Shire Pharmaceuticals, Wyeth-Ayerst, Eli Lilly, Bristol-Myers Squibb, Johnson &amp;amp; Johnson Pharmaceuticals, and Ortho-McNeil Pharmaceutical.&lt;/p&gt;&lt;p&gt;The editorialists reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_362"
                     title="Some Benefit Seen for Abstinence-Only Sex Ed (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Pediatrics/PreventiveCare/tb/18245?impressionId=1265806501862"
                     
      &lt;p&gt;An education program for middle-schoolers promoting chastity significantly reduced their self-reported sexual activity two years later, compared with other sex education approaches, researchers conducting a randomized trial said.&lt;/p&gt;
&lt;p&gt;The number of adolescents reporting they had lost their virginity was cut by one-third with an abstinence-only program delivered in sixth and seventh grade, according to John B. Jemmott III, PhD, of the University of Pennsylvania, and colleagues in the February &lt;em&gt;Archives of Pediatric and Adolescent Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The proportion of teens receiving the abstinence-only program who reported they had had intercourse at least once was 32.6%, compared with 41% to 52% among participants assigned to other interventions. These included comprehensive education covering both abstinence and methods to prevent pregnancy and sexually transmitted diseases (STDs), as well as a program focusing on &quot;safer sex.&quot;&lt;/p&gt;
&lt;p&gt;At least superficially, the findings contrast with earlier studies in which abstinence-only interventions appeared ineffective. (See &lt;a href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/12300&quot; mce_href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/12300&quot; target=&quot;_blank&quot;&gt;Teen Vows of Abstinence Do Not Change Sexual Behavior&lt;/a&gt; and &lt;a href=&quot;http://www.medpagetoday.com/HIVAIDS/HIVAIDS/6336&quot; mce_href=&quot;http://www.medpagetoday.com/HIVAIDS/HIVAIDS/6336&quot; target=&quot;_blank&quot;&gt;Abstinence Ineffective in HIV, Pregnancy Prevention&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Although the reliance on participants&apos; self-reports of sexual behavior was a significant limitation, Jemmott and colleagues cautioned, they called the results &quot;promising.&quot;&lt;/p&gt;
&lt;p&gt;&quot;They suggest that theory-based abstinence-only interventions can have positive effects on adolescents&apos; sexual involvement,&quot; they wrote. &quot;This is important because abstinence is the only approach that is acceptable in some communities and settings in both the U.S. and other countries.&quot;&lt;/p&gt;
&lt;p&gt;Jemmott and colleagues indicated that the abstinence-only program used in the study was unusual. In fact, it would not have qualified for abstinence-only federal funding because it did not rely on moral principles, nor did it criticize condom usage.&lt;/p&gt;
&lt;p&gt;But its benefits in the study appeared limited to delaying sexual initiation, with no reductions in risky behaviors such as unprotected sex and having multiple partners.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, two other researchers warned against interpreting the study to justify policies to promote abstinence-only education.&lt;/p&gt;
&lt;p&gt;&quot;No public policy should be based on the results of one study, nor should policy makers selectively use scientific literature to formulate a policy that meets preconceived ideologies,&quot; wrote Frederick Rivara, MD, MPH, of the University of Washington in Seattle, and Alain Joffe, MD, MPH, of the Johns Hopkins University.&lt;/p&gt;
&lt;p&gt;Rather, they urged, the new study&apos;s results must be combined with earlier research to &quot;become part of the knowledge base for the formation of public policy on sexuality education.&quot;&lt;/p&gt;
&lt;p&gt;Jemmott and colleagues tested five different programs on 662 African-American sixth- and seventh-graders in four schools in low-income areas of a northeastern U.S. city.&lt;/p&gt;
&lt;p&gt;The programs included: &lt;ul&gt; &lt;li&gt;Eight hours of abstinence-only education addressing risks of HIV and other STDs as well as pregnancy, seeking to promote waiting to engage in oral, anal, and vaginal intercourse &quot;until later in life when the adolescent is more prepared to handle the consequences of sex&quot;&lt;/li&gt; &lt;li&gt;Eight hours of safer-sex instruction, encouraging condom use but not sexual abstinence&lt;/li&gt; &lt;li&gt;Eight hours of comprehensive education combining support for abstinence as well as safer-sex content&lt;/li&gt; &lt;li&gt;Twelve hours of comprehensive education&lt;/li&gt; &lt;li&gt;Eight hours of general health education and promotion regarding chronic diseases, not addressing sexual behaviors&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Each of these were delivered in one-hour modules over two weekend sessions, except for the 12-hour comprehensive program that was given in three sessions.&lt;/p&gt;
&lt;p&gt;In addition, half the participants in each program were randomly selected to receive &quot;booster&quot; education, including three-hour sessions given six weeks and three months after the initial program, six issues of a newsletter, and six 20-minute individual counseling sessions with the original instructors over a 21-month period.&lt;/p&gt;
&lt;p&gt;The children were quizzed about their sexual behaviors at baseline and five more times for two years after the initial intervention.&lt;/p&gt;
&lt;p&gt;Although the abstinence-only program appeared more effective in delaying sexual initiation, it had little or no effect on other sexual behaviors including multiple sex partners, engaging in unprotected sex, and consistency in condom use.&lt;/p&gt;
&lt;p&gt;After adjusting for covariates, Jemmott and colleagues found the following relative risks at the two-year point in the abstinence-only group for engaging in sexual behaviors, relative to the teens who only received the general health promotion program: &lt;ul&gt; &lt;li&gt;Ever had sexual intercourse: RR 0.67 (95% CI 0.48 to 0.96)&lt;/li&gt; &lt;li&gt;Sexual intercourse in past three months: RR 0.94 (95% CI 0.90 to 0.99)&lt;/li&gt; &lt;li&gt;Multiple partners in past three months: RR 0.97 (95% CI 0.93 to 1.01)&lt;/li&gt; &lt;li&gt;Unprotected intercourse in past three months: RR 0.98 (95% CI 0.95 to 1.01)&lt;/li&gt; &lt;li&gt;Consistent condom use, among those with recent sexual activity: RR 1.03 (95% CO 0.88 to 1.21)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;None of the other sex education programs showed any advantage over the general health promotion instruction in any outcome, with one exception: the 12-hour comprehensive intervention slightly reduced the risk of having multiple sex partners (RR 0.95, 95% CI 0.91 to 0.99).&lt;/p&gt;
&lt;p&gt;The booster education had little effect on outcomes, Jemmott and colleagues indicated.&lt;/p&gt;
&lt;p&gt;It did not affect the effectiveness of any program in reducing sexual initiation, recent intercourse, or unprotected sex, they found.&lt;/p&gt;
&lt;p&gt;The researchers did find some benefit for the follow-up education in decreasing the incidence of multiple-sex partners following the abstinence-only and 12-hour comprehensive programs.&lt;/p&gt;
&lt;p&gt;Even so, however, the relative risks in both groups for having multiple partners were still higher than 0.90 compared with the general health promotion control even among those who received the follow-up education.&lt;/p&gt;
&lt;p&gt;Jemmott and colleagues said the findings could help dispel one criticism of abstinence-only education, which is that it may discourage condom use among teens who choose to have sex anyway. Although their study found no improvement in condom usage among those in the abstinence-only group, it also showed no reduction, they pointed out.&lt;/p&gt;
&lt;p&gt;In addition to relying on participants&apos; self-reports for the outcome measures, limitations of the study included small numbers of sexually active teens in the sample, and the focus on urban African-American middle schoolers.&lt;/p&gt;
&lt;p&gt;&quot;Whether the results would be similar with older adolescents or those of other races or in other countries is unclear,&quot; the researchers wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Institute of Mental Health.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported by study authors or editorialists.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_349"
                     title="Motavizumab Reduces Preemie Lung Infections (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Pediatrics/Vaccines/tb/18232?impressionId=1265806501862"
                     
      &lt;p&gt;Premature babies who received preventative treatment with motavizumab (Medi-524) suffered fewer outpatient respiratory infections than those taking palivizumab (Synagis), the current standard of treatment, a large new trial found.&lt;/p&gt;
&lt;p&gt;Compared with children who received palivizumab, those treated with motavizumab had similar rates of hospitalization for respiratory syncytial virus, or RSV (RR 0.74; 95% CI 0.503 to 1.083) and a 50% reduction in outpatient, RSV-specific, medically attended lower respiratory tract infection, or MALRI (2.0% vs 3.9%; &lt;em&gt;P&lt;/em&gt;=0.005), according to a report in the January issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Although not better than palivizumab in reducing RSV-associated hospitalizations, motavizumab did demonstrate a significant reduction in outpatient MALRI compared with palivizumab,&quot; Xavier Carbonell-Estrany, MD, PhD, of Hospital Cl&amp;#237;nic, in Barcelona, Spain, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;As such, motavizumab may offer an improved alternative for preventing serious RSV disease in high-risk infants and children.&quot;&lt;/p&gt;
&lt;p&gt;Most otherwise healthy patients recover within a week or two from RSV, which infects the lungs and breathing passages. However, the infection can be severe in people who are vulnerable, including premature infants and older children who were born prematurely. It&apos;s the most common cause of bronchiolitis and pneumonia in U.S. children in their first year of life, researchers noted.&lt;/p&gt;
&lt;p&gt;Palivizumab is a humanized monoclonal antibody recommended for prevention of RSV in children at high risk. Monthly treatments of high-risk youngsters have been found to reduce RSV-related hospitalizations by 50%, compared with placebo.&lt;/p&gt;
&lt;p&gt;Motavizumab, an investigational monoclonal antibody related to palivizumab, proved more potent at neutralizing the RSV virus in animal studies. Early trials indicated the drug was well-tolerated at treatment doses and reduced viral counts in the nasal aspirates of children hospitalized with RSV.&lt;/p&gt;
&lt;p&gt;Both drugs are manufactured by MedImmune, the sponsor of this phase III clinical trial.&lt;/p&gt;
&lt;p&gt;In the double-blind, multinational study, Carbonell-Estrany and colleagues randomly assembled 6,635 preterm infants (6 months and younger) and children (2 years and younger) suffering from chronic lung disease resulting from premature birth.&lt;/p&gt;
&lt;p&gt;They were randomized to five 15 mg/kg monthly doses of palivizumab or motavizumab between November 2004 and May 2006. The trial was conducted in 24 countries.&lt;/p&gt;
&lt;p&gt;The primary objective was to compare the efficacy of the two drugs at preventing a child from being hospitalized due to respiratory symptoms from an RSV infection, preventing a child already hospitalized from contracting a new infection, and preventing deaths from RSV.&lt;/p&gt;
&lt;p&gt;Of the 6,513 children who received full treatment with the drugs, 43 (1.4%) of those who received motavizumab and 59 (1.9%) of those who received palivizumab were hospitalized for RSV infections (95% CI 0.490 to 1.081).&lt;/p&gt;
&lt;p&gt;The study also compared the drugs&apos; efficacy at preventing RSV-specific outpatient MALRIs. Of the 2,283 outpatients who received full treatment with the drugs, 23 (2%) who received motavizumab and 45 (3.9%) who received palivizumab contracted RSV infections (&lt;em&gt;P&lt;/em&gt;=0.005).&lt;/p&gt;
&lt;p&gt;The authors noted that while the drugs had similar overall safety profiles, participants who took motavizumab had more cutaneous reactions.&lt;/p&gt;
&lt;p&gt;&quot;In this large, multinational, well controlled trial, motavizumab was shown to be noninferior to palivizumab for prevention of RSV hospitalization (primary end point) and was superior to palivizumab for reduction of RSV-specific outpatient MALRI (a secondary end point),&quot; the authors wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by MedImmune, the manufacturer of motavizumab.&lt;/p&gt;&lt;p&gt;Several of the authors reported being employees of MedImmune or receiving consulting and research services fees from MedImmune and Abbott International.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_346"
                     title="Daytime Sleepiness More Common in Young (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/PrimaryCare/SleepDisorders/tb/18221?impressionId=1265806501862"
                     
      &lt;p&gt;Compared with 20-somethings and seniors, middle-age adults are less likely to suffer daytime sleepiness when they don&apos;t get a good night&apos;s sleep, according to a small study.&lt;/p&gt;
&lt;p&gt;When three groups of healthy adults  --  young (20 to 30 years old), middle-age (40 to 55) and older (66 to 83)  --  were studied over four nights, slow wave sleep decreased and the number of nocturnal awakenings progressively increased with age, wrote Derk-Jan Dijk, PhD, of the Surrey Sleep Center at the University of Surrey in Guildford, England, and colleagues in the Feb. 1 issue of &lt;em&gt;Sleep.&lt;/em&gt;&lt;/p&gt;

&lt;p&gt;As the likelihood for eight hours of uninterrupted deep sleep decreased with age, there was no increase in the likelihood of daytime sleepiness, which led Dijk and colleagues to conclude that as people age there may be a change in the &quot;sleep (duration and depth) required to maintain alertness.&quot;&lt;/p&gt;
&lt;p&gt;Based on that observation, the authors wrote that it could be argued that &quot;an eight-hour episode rich in [slow wave sleep] is insufficient for young adults but that an eight-hour sleep episode with less [slow wave sleep] is sufficient for older adults.&quot;&lt;/p&gt;
&lt;p&gt;As a result, middle-age and older adults are less likely to build up &quot;sleep debt&quot; during the daylight hours, so they manage with less time in deep sleep at night, less homeostatic sleep pressure.&lt;/p&gt;
&lt;p&gt;The authors hypothesized that this apparent need for less sleep may be a factor in age-related insomnia.&lt;/p&gt;
&lt;p&gt;If older adults are unaware of the need for less sleep, &quot;their self-selected time in bed, which provides an input to the sleep homeostat, may become maladaptive and lead to reduced sleep consolidation and associated complaints.&quot;&lt;/p&gt;
&lt;p&gt;Dijk and colleagues recruited 44 young adults, 35 middle-age adults, and 31 older adults for their study. All were healthy at baseline and all were initially assessed for an eight-hour nocturnal sleep episode.&lt;/p&gt;
&lt;p&gt;They were then randomized to two nights of either selective short wave sleep interruption by acoustic stimuli or sleep without disruption, followed by one night of recovery sleep.&lt;/p&gt;
&lt;p&gt;Two standardized measurement tools, the Multiple Sleep Latency Test (MSLT) and the Karolinska Sleepiness Scale (KSS), were used to assess objective and subjective sleep propensity.&lt;/p&gt;
&lt;p&gt;&quot;Total sleep time per eight hour time in bed decreased significantly and progressively across the age groups such that older adults slept approximately 20 minutes less than middle-aged, who slept 23 minutes less than young adults,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The reduction in total sleep time &quot;was primarily related to an increase in the number of awakenings and the duration of wakefulness after sleep onset, rather than an increase in latency to sleep onset.&quot;&lt;/p&gt;
&lt;p&gt;As a result, sleep efficiency decreased significantly from 92.1% for the youngest group, to 82% for the older group (effect of age, &lt;em&gt;P&amp;lt;&lt;/em&gt;0.0001).&lt;/p&gt;
&lt;p&gt;The subjective sleep propensity tests revealed that &quot;young people were significantly sleepier than the middle-age people, who were the least sleepy of the three groups.&quot; Daytime sleepiness for the oldest group &quot;fell in between the other two groups [and] was not significantly different from either.&quot;&lt;/p&gt;
&lt;p&gt;All three groups, regardless of age, demonstrated increased daytime sleepiness following a night of experimental disruption of slow wave sleep, but when the participants had an uninterrupted eight hours of deep sleep, it was only the youngest group that was drowsy during the daytime hours.&lt;/p&gt;
&lt;p&gt;The authors noted that although there was less daytime sleepiness among middle-age and older adults in this study, sleep propensity was not measured during the evening hours, so it was possible that the age-related difference might diminish at twilight.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was sponsored by H. Lundbeck A/S.&lt;/p&gt;&lt;p&gt;Dijk reported receiving research support from the Air Force Office of Scientific Research, the Biotechnology and Biological Sciences Research Council, GlaxoSmithKline, H. Lundbeck A/S, Merck, Pfizer, Philips Lighting, sanofi-aventis, and Takeda.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>