Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth

This study reports the temporal pattern of milk output in 2 groups of lactating mothers during the first 6 weeks postpartum. A study aim was to examine if the average milk output for postpartum days 6 and 7 (baseline) predicts milk adequacy at week 6 postpartum. Mothers of preterm (< or = 31 weeks) infants (n = 95) used mechanical expression to initiate and maintain their milk supply; mothers of a singleton healthy term infant (n = 98) fed their infant at the breast. Baseline milk output was predictive of milk adequacy, defined as > or = 500 mL/d at week 6 (P = .000). Preterm mothers were 2.81 times more at risk of not producing adequately than term mothers were. Study findings suggest that interventions that promote the initiation and maintenance of an adequate milk supply during the first week postbirth are critical.

Relationship of clinical features with psychological status in primary fibromyalgia

Clinical features and psychological status determined by the Minnesota Multiphasic Personality Inventory (MMPI) in 103 patients with primary fibromyalgia syndrome (PFS) were analyzed by univariate and multivariate techniques to determine if clinical features were related to psychological status or were intrinsic to PFS per se. The central features of PFS, e.g., number of pain sites, number of tender points, fatigue, and poor sleep, were independent of psychological status. However, discriminant analysis identified 4 variables--patient-reported depression, anxiety, stress, and pain severity--which together predicted 3 MMPI subgroups with an accuracy of 55% (P less than 0.001); the only musculoskeletal feature--pain severity--alone provided an accuracy of only 34% (P greater than 0.05). These data suggest a new concept, that the central features of fibromyalgia are independent of the psychological status and are more likely related to the PFS itself. However, pain severity may be influenced by psychological factors.

Relationship between body mass index and fibromyalgia features

OBJECTIVE

to evaluate the relationship between body mass index (BMI) and features of the fibromyalgia syndrome (FMS).

METHODS

211 female patients with FMS seen consecutively in our rheumatology clinic were analyzed. Spearman correlation was used. Further, FMS features were compared at different levels of BMI (kg/m2), e.g., < 25.00 vs > or = 25.00 (normal vs overweight). P value of < or = 0.01 was accepted as significant.

RESULTS

A significant positive correlation was found between BMI and age (p<0.001) and a negative correlation between BMI and education (p<0.009). Health Assessment Questionnaire (HAQ) score was significantly correlated with BMI (p<0.001), whereas fatigue and number of tender points (TP) showed a trend (p=0.035 and 0.037, respectively).

CONCLUSION

The HAQ score is significantly associated with BMI in FMS with a trend towards significance for fatigue and TP. Weight loss may improve physical functioning in this disorder.

Epidemiology of bacteremia in febrile infants in the United States

BACKGROUND

Fever in infants is a common clinical dilemma. The objective of this study was to present data from hospital systems across the northeast, southeast, mid-west, and western United States to identify the pathogens causing bacteremia in febrile infants admitted to general care units.

METHODS

This was a retrospective review of positive blood culture results in febrile infants aged ≤90 days admitted to a general care unit across 6 hospital systems. Data were collected from January 1, 2006 through December 31, 2012 from emergency departments and general inpatient units. Cultures from ICUs, central lines, or infants who had complex comorbidities were excluded, as were repeat cultures positive for the same bacteria. Common contaminants were considered pathogens if they were treated as such.

RESULTS

We identified 181 cases of bacteremia in 177 infants. The most common pathogen was Escherichia coli (42%), followed by group B Streptococcus (23%). Streptococcus pneumoniae was more likely in older infants (P = .01). Non-low-risk bacteremic infants were more likely to have E. coli or group B Streptococcus than low-risk bacteremic infants. We identified no cases of Listeria monocytogenes. Variation between sites was minimal.

CONCLUSIONS

This is the largest and most geographically diverse study to date examining the epidemiology of bacteremia in infants. We suggest E. coli is the most common cause of bacteremia in previously healthy febrile infants admitted to a general inpatient unit. We identified no cases of L monocytogenes and question whether empirical therapy remains necessary for this pathogen.

Effects of pumping style on milk production in mothers of non-nursing preterm infants

Milk production was examined in 39 lactating mothers of non-nursing preterm infants from 2 tertiary care centers. The purposes of this study were (1) to compare milk production of those using sequential single (SEQ) or simultaneous double (SIM) breast-pumping regimen, and (2) to examine the relationship of selected variables to inadequate (< 3500 g/week) and adequate (> or = 3500 g/week) milk production. In multivariate analysis, mothers using SIM produced a similar amount of milk by weight during weeks 2 to 5 postpartum compared to those using SEQ. A logistic regression model including frequency of kangaroo care, frequency of pumping, high versus low income, and previous breastfeeding experience was predictive of mothers producing adequate versus inadequate milk volume 79% of the time. All of the mothers producing > 3500 g at week 2 produced adequate amounts of milk at weeks 4 and 5. None of the mothers producing < 1700 g at week 2 reached adequate production by weeks 4 and 5. Of the remaining mothers who produced 1700 g to 3500 g at week 2, 54% achieved adequate production during weeks 4 and 5 postpartum.

Relationship between fibromyalgia features and smoking

OBJECTIVE

The objective of this study was to examine a possible relationship between smoking and fibromyalgia features among 233 female patients with fibromyalgia syndrome.

METHODS

Data on clinical and psychological features were collected by a protocol. Smoking status was evaluated by a question inquiring about the packs of cigarettes smoked per day. Differences between the smokers and non-smokers were tested by Mann Whitney U test. To adjust data for age and education, a partial correlation test was used. A p value of < or = 0.01 was accepted as the level of significance.

RESULTS

Fifty-one patients (21.9%) smoked. After adjustment for age and education, significantly positive relationship was found between smoking and pain, patient global severity, functional disability, and numbness. There was no difference between smokers and non-smokers for fatigue, morning fatigue, sleep difficulties, tender points (TP), depression, anxiety and stress.

CONCLUSIONS

Smokers reported significantly more pain, numbness, patient global severity, and functional difficulties than non-smokers. There was no significant difference between smokers and non-smokers for fatigue and TP.

Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants

This secondary data analysis examined if time of initiation of milk expression and pumping frequency influenced milk weight weeks 2-5 postpartum. Of the 39 subjects in the convenience sample, 20 were in the early initiating (EI) group, (n = 12 high frequency [HF], n = 8 low frequency [LF]), and 19 were in the late intiating (LI) group, (n = 7 HF, n = 12 LF). The EI group initiated pumping < or = 48 hours after birth; the HF group pumped a minimum of 6.25 times daily. A two-way analysis of variance indicated that milk weight was significantly higher in the HF as compared to the LF group. While there was no significant difference in milk weight between the EI and LI groups, there was a significant interaction between frequency and initiation. Milk weight for the LF/EI group appeared to be positively influenced by the initiation of mechanical expression soon after birth.

Chronic subdural hematomas and seizures: the role of prophylactic anticonvulsive medication

BACKGROUND

The rates of seizure activity associated with surgical treatment of chronic subdural hematoma (CSH) reported in the literature has varied greatly. The efficacy of prophylactic anticonvulsive medication (ACM) has been debated and its use been erratic. With improved diagnosis, reduction of associated morbidity impacts greatly on the mortality rate, and so the use of ACM may be important to the patient with CSH.

METHODS

We conducted a retrospective analysis of the records of patients treated surgically for CSH and examined the prevalence of seizure activity, morbidity, and mortality and the effects of anticonvulsant medication.

RESULTS

Ninety-eight patients (65 = male) were identified with a mean age of 72 years and a range of 4 to 97 years. Six patients had a preexisting seizure disorder; despite therapeutic serum levels of ACM, 3 of these 6 patients experienced seizures without mortality. Seizures occurred in 20/98 (20.4%) patients during hospitalization or follow-up. Of the 92 patients without a preexisting seizure disorder, 42 (46%) received prophylactic phenytoin with therapeutic serum levels. One patient among the 42 (2.4%) who received prophylactic ACM experienced seizure activity in comparison to 16 of 50 (32%) patients who did not receive adequate prophylactic ACM (P = < 0.001). Six of 11 deaths within one month of discharge occurred in patients with a new onset of seizures (P = < 0.005). Age, sex, history of trauma, Markwalder scores on admission, location of hematoma, or type of surgery were unrelated to the occurrence of seizures or mortality. Following hospital discharge, patients were continued on ACM for a mean duration of 8 months without seizures.

CONCLUSIONS

The onset of new seizures was found in 17 (18.5%) of 92 patients and was associated with increases in morbidity and mortality. Patients who received prophylactic ACM demonstrated a significant decrease in the occurrence of seizures, and we therefore recommend the use of phenytoin prophylaxis in patients treated surgically for chronic subdural hematoma.

Milk volume on day 4 and income predictive of lactation adequacy at 6 weeks of mothers of nonnursing preterm infants

Lactating mothers of preterm infants who are pump-dependent are at high risk for difficulty maintaining an adequate milk supply. This article reports the naturally occurring volume of milk removed from the breast by mechanical expression over time for 81 mothers of nonnursing preterm infants from 4 tertiary care centers in the Midwest. Baseline variables (infant gestation in weeks; intended length in weeks to breastfeed; number of hours post-delivery to first breast stimulation; infant weight in grams; timing of decision to provide mother's milk; income; maternal education, kangaroo care during week 1; previous breastfeeding experience; white, non-Hispanic) and day 4 variables (milk volume, frequency of pumping) were explored for predicting milk adequacy at week 6. Using the significant predictive variables of milk levels at day 4 and income, the logistic regression accurately classified 85% of the 40 mothers with inadequate milk production (<500 mL/d) and 85.5% of the 41 mothers with adequate milk production (> or = 500 mL/d). While controlling for income, the 27 mothers with lowest milk production at 4 days were 9.5 times more likely to have an inadequate milk supply at 6 weeks than the 54 mothers with higher milk production. While controlling for day 4 milk production, lower annual income mothers (< dollar 50,000) were 5 times more at risk of inadequate milk production than those with high income (> or = dollar 50,000) at week 6. This study emphasizes the importance of the amount of milk volume expressed in the early postpartum period during lactogenesis. In addition, neonatal nurses need to be cognizant that income levels may make a difference in milk production.

Maternal Postpartum Quality of Life Questionnaire

This article summarizes the development and psychometric properties of the first self-administered, paper-and-pencil instrument that measures maternal quality of life during the early postpartum period. The definition, domains, and conceptual model by Ferrans and Powers (QLI) were used to develop the Maternal Postpartum Quality of Life (MAPP-QOL) tool. A convenience sample of 184 mothers completed the MAPP-QOL at week 1 and 3 postpartum. Component analysis revealed five domains: psychological/baby; socioeconomic; relational/spouse-partner; relational/family-friends; and health & functioning. Internal consistency reliability for the five subscales resulted in Cronbach's alpha coefficients ranging from .82 to .96. Stability reliability ranged from .66 to .76. The MAPP-QOL and a single-item measure of life satisfaction correlated (r = .69), suggesting convergent validity; discriminant validity was supported by negative correlations with the three negative mood states of the Multiple Affect Adjective Check List-Revised (MAACL-R) as well as poor sleep and fatigue scores. Acceptable reliability and construct validity suggest that the MAPP-QOL may be used in research. Further testing with larger and more diverse samples is recommended.

A 10-year experience with postpump chorea

Postpump chorea (PPC) is the development of choreoathetoid movements within 2 weeks following cardiopulmonary bypass. Over a 10-year period, 668 children underwent open cardiac surgery, of whom 8 (1.2%) developed PPC. Age at surgery ranged from 8 to 34 months. The onset of chorea was 3 to 12 days following surgery. Computed tomography and magnetic resonance imaging showed atrophy but no focal lesions. Cerebral positron emission tomography using [18F]fluorodeoxyglucose in a patient following 12 months of chorea showed patchy areas of decreased glucose metabolism. None of the patients were developmentally normal 22 to 130 months following surgery. Three patients have had transient and 5 have persistent chorea. Neurological deficits ranged from a mild learning disability to progressive hypotonia and obtundation ending in death. One of 4 patients who received haloperidol had a decrease in the severity of chorea. We compared PPC patients with 39 randomly selected controls. During surgery, affected patients spent significantly more time on pump and at temperatures under 36 degrees C, were cooled to lower temperatures than controls, and were more likely to have had a circulatory arrest. One patient developed chorea without a history of circulatory arrest. We conclude that (1) there is a strong association between PPC, deep hypothermia, and circulatory arrest, (2) absence of characteristic macroscopic changes suggests a biochemical or microembolic etiology in some cases, (3) chorea is frequently associated with developmental delay, and (4) the prognosis for complete resolution of chorea is guarded.

Ketorolac versus meperidine and hydroxyzine in the treatment of acute migraine headache: a randomized, prospective, double-blind trial

STUDY OBJECTIVE

To compare the effectiveness of IM ketorolac with that of meperidine and hydroxyzine in the treatment of acute migraine headache.

DESIGN

Prospective, randomized, double-blind trial.

SETTING

Urban emergency department with an annual census of 42,000 patients.

PARTICIPANTS

Forty-seven adult patients with migraines enrolled on 50 visits.

INTERVENTIONS

Patients were randomly assigned to receive a single injection of either 60 mg ketorolac (group 1) or 100 mg meperidine and 50 mg hydroxyzine (group 2). Pain assessment was made using both visual-analog and verbal descriptor scales.

RESULTS

At 60 minutes, 15 patients (60%) from group 1 (25) and 14 patients (56%) from group 2 (25) reported a great deal of complete relief (P = .77) Sixty-minute mean pain relief scores (3.35 versus 3.37) were different (P = .76). Nine patients (36%) from group 1 and seven patients (28%) from group 2 required additional analgesia (P = .76).

CONCLUSION

Ketorolac is as effective as meperidine and hydroxyzine for the treatment of acute migraine headache.

Maternal Perceived Quality of Life Following Childbirth

OBJECTIVE

To examine preterm, near-term, and term mothers' self-reported quality of life in the early postpartum period.

DESIGN

Prospective, longitudinal repeated measures design.

SETTING

Four medical centers in the Midwest.

PATIENTS/PARTICIPANTS

A convenience sample of 184 mothers of either a preterm, near-term, or term infant.

MAIN OUTCOME MEASURE

Maternal Postpartum Quality of Life tool.

RESULTS

Mothers of preterm infants scored significantly lower on the subscale psychological/baby of the Maternal Postpartum Quality of Life tool compared to mothers of near-term and term infants.

CONCLUSIONS

Infant gestational age at birth has relevance for maternal quality of life during the postpartum period. Health care professionals need to be cognizant relative to infant gestational age and individualize nursing care.

Primary and secondary mediators' influence on milk output in lactating mothers of preterm and term infants

This study examined potential primary mediators, such as intended length to breastfeed, maternal education, income, and infant gestation, and secondary mediators, such as early frequency of breast stimulation, early milk output, and supplementation with artificial milks that may influence milk output in mothers of preterm and term infants the first 6 weeks postpartum. Analysis suggested that for mothers of a preterm infant (n = 95), the primary mediators, income and infant gestation, and the secondary mediators, early milk output/d and early frequency/d, accounted for 53.5% of the variance in milk output/d at week 6. For mothers of a term infant (n = 98), the primary mediator, income, and secondary mediators, early milk output/d and supplementation, accounted for 48.4% of the variance in milk output/d at week 6. Further research is needed to determine what early interventions may improve milk output in mothers at risk for lactation failure.

Brief scale measuring patient preparedness for hospital discharge to home: Psychometric properties

BACKGROUND

Adverse events occur when patients transition from the hospital to outpatient care. For quality improvement and research purposes, clinicians need appropriate, reliable, and valid survey instruments to measure and improve the discharge processes.

OBJECTIVE

The object was to describe psychometric properties of the Brief PREPARED (B-PREPARED) instrument to measure preparedness for hospital discharge from the patient's perspective.

METHODS

The study was a prospective cohort of 460 patient or proxy telephone interviews following hospital discharge home. We administered the Satisfaction with Information about Medicines Scale and the PREPARED instrument 1 week after discharge. PREPARED measured patients' perceptions of quality and outcome of the discharge-planning processes. Four weeks after discharge, interviewers elicited emergency department visits. The main outcome was the B-PREPARED scale value: the sum of scores from 11 items. Internal consistency, construct, and predictive validity were assessed.

RESULTS

: The mean B-PREPARED scale value was 17.3 +/- 4.2 (SD) with a range of 3 to 22. High scores reflected high preparedness. Principal component analysis identified 3 domains: self-care information, equipment/services, and confidence. The B-PREPARED had acceptable internal consistency (Cronbach's alpha 0.76) and construct validity. The B-PREPARED correlated with medication information satisfaction (P < 0.001). Higher median B-PREPARED scores appropriately discriminated patients with no worry about managing at home from worriers (P < 0.001) and predicted patients without emergency department visits after discharge from those who had visits (P = 0.011).

CONCLUSIONS

The B-PREPARED scale measured patients' perceptions of their preparedness for hospital discharge home with acceptable internal consistency and construct and predictive validity. Brevity may potentiate use by patients and proxies. Clinicians and researchers may use B-PREPARED to evaluate discharge interventions.

Injury patterns and safety practices of rock climbers

BACKGROUND

Rock climbing is gaining popularity. The injury patterns and safety practices of climbers have not been well described. This study seeks to identify the general injury patterns and safety practices associated with rock climbing.

METHODS

An anonymous multiple choice, Likert scale, and short-answer Internet survey was posted on several rock climbing Websites. Data were collected autonomously for a 2-month period in 2004. Demographic data were obtained and subjects self-identified their three most significant injuries. Participants were also surveyed regarding safety practices and training. SPSS 12.0 was used for statistical analysis and p < 0.05 was considered significant.

RESULTS

In all, 1,887 subjects reported a total of 2,472 injuries. The mean number of injuries reported was 2.3 (SE 0.14) and 17.9% reported no injuries. Sprains and overuse were the most commonly described injuries, whereas fingers, ankles, elbows, and shoulders were the most commonly injured body parts. Some participants (28%) reported climbing under the influence of drugs or alcohol and these climbers documented more injuries (p < 0.008). Most of the injuries (77%) occurred while climbing at or below the subject's normal climbing level. Climbers who participated in traditional climbing (p < 0.001) or solo climbing (p < 0.001) documented more injuries. Males had less helmet use (p = 0.019) and more illicit substance use (p < 0.001).

CONCLUSIONS

Sprains and overuse were common climbing injuries, with the upper extremity being the most frequently injured body part. Rock climbers who participated in traditional or solo climbing, or who have climbed while under the influence or drugs or alcohol, reported more injuries.

Fibromyalgia syndrome among the elderly. Comparison with younger patients

Thirty-one elderly fibromyalgia (EFM) patients (60 years of age and older) were studied by protocol and compared with 63 younger fibromyalgia (YFM) patients with this syndrome. Common and characteristic features of fibromyalgia among the elderly included diffuse musculoskeletal aching and stiffness at multiple sites; modulation of aches and pains by physical fatigue, poor sleep and weather factors; associated symptoms of general fatigue, poor sleep, anxiety/tension and subjective soft tissue swelling; and multiple tender points on physical examination. These features were similar to those among the younger patients, with the exception of chronic functional headaches, self-assessed anxiety/tension, and symptom aggravation by weather factors, mental stress, and by poor sleep, all of which were significantly less common among the elderly (P less than .05). Importantly, fibromyalgia was recognized by referring physicians in only 17% of the elderly patients with this condition. Misdiagnoses and inappropriate treatment were common among these patients, with corticosteroid therapy in 40% before their rheumatology consultation.

Accuracy of interpretations of emergency department radiographs: effect of confidence levels

We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. A second radiologist was consulted to resolve disagreements. The overall rate of interpretive agreement was 94.6%. Agreement varied significantly (P less than .001) as a function of confidence level and by type of radiograph, but not by training level. Agreement varied significantly (P less than .001) as a function of confidence level for some types of radiographs (eg, chest, extremities) and for some types of radiographic findings (acute positive). No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist.

Smoking and breastfeeding status

In women who breastfeed, cigarette smoking is associated with early termination of lactation. The relationship among smoking, demographic variable, and breastfeeding status at 8 weeks postpartum was examined in 400 mothers of term infants and 110 mothers of low-birth-weight (LBW) infants using multivariate analysis. Women who smoked were more apt to stop breastfeeding early in both study samples. In addition, in the term sample, older and married women more frequently reported breastfeeding at 8 weeks than younger, nonmarried women. In the LBW sample, those who were employed were less apt to report breastfeeding at 8 weeks than those who were unemployed. Also, a greater proportion of smokers in both samples indicated insufficient milk as a reason for a decline in breastfeeding compared to nonsmokers. The effects of cigarette smoking should be examined in subsequent studies of breastfeeding patterns.

Effects of parity and weaning practices on breastfeeding duration

The purpose of this project was to examine (a) patterns of breastfeeding and (b) duration with parity and breastfeeding experience, and (c) mothers' reasons for termination of breastfeeding. A convenience sample of 120 breastfeeding mothers was followed by home visits and telephone for 20 weeks after delivery. The sample consisted of 69 primiparas, 40 multiparas with previous breastfeeding experience, and 11 multiparas with no prior breastfeeding experience. Parity was not significantly associated with the continuation of breastfeeding but there was a trend toward a difference made by breastfeeding experience. Inadequate milk supply and employment were the two most common reasons reported for weaning. Implications for support in the workplace and for first-time breastfeeding mothers are discussed.

A comparison of epinephrine and methoxamine for resuscitation from electromechanical dissociation in human beings

Electromechanical dissociation (EMD) is an organized electrical depolarization of the heart without synchronous myocardial fiber shortening and, therefore, without cardiac output. Patients in EMD have a poor prognosis for resuscitation and long-term survival. The beneficial effect in resuscitation of epinephrine, the adrenergic agent currently recommended, has been shown to depend on stimulation of alpha-adrenergic vasoconstriction. The beta-adrenergic inotropic and chronotropic effects of epinephrine are theoretically detrimental by increasing myocardial oxygen consumption and subendocardial ischemia. The purpose of our study was to determine whether the pure alpha agonist methoxamine was superior to epinephrine in human beings in EMD as determined by survival at one hour. These two agents were compared in a prospective, randomized, and double-blinded study involving 80 patients with EMD of various causes seen in the emergency department and internal medicine inpatient service. The advanced cardiac life support (ACLS) algorithm (current at the time of our study) for resuscitation from EMD was used, with the blinded study drug (epinephrine 1 mg or methoxamine 10 mg) administered where the algorithm calls for epinephrine. Calcium and isoproterenol also were used in the majority of cases according to ACLS standards but never prior to the use of methoxamine or epinephrine. Survival data are summarized as: survival less than one hour, 22 patients receiving methoxamine, 22 receiving epinephrine; one to six hours, 15 patients receiving methoxamine, 13 patients receiving epinephrine; six to 12 hours, one patient receiving epinephrine; more than 24 hours but not surviving to discharge, three patients receiving methoxamine, two patients receiving epinephrine; and survival to discharge, one patient receiving epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypoglycemia in Inpatients After Gatifloxacin or Levofloxacin Therapy: Nested Case-Control Study

STUDY OBJECTIVES

To compare the incidence of hypoglycemic events in patients exposed to gatifloxacin or levofloxacin, and to measure the odds of experiencing a hypoglycemic event after receiving gatifloxacin versus levofloxacin while adjusting for confounders.

DESIGN

Nested case-control study within a historical cohort.

SETTING

A tertiary care, 730-bed, teaching hospital in central Illinois.

PATIENTS

Seven thousand two hundred eighty-seven hospitalized patients who received gatifloxacin or levofloxacin therapy.

MEASUREMENTS AND MAIN RESULTS

A total of 113 patients (case patients) had blood glucose levels below 51 mg/dl; 113 control patients, matched for age and sex, had no hypoglycemia. Matched conditional logistic regression models adjusted the odds of having hypoglycemia for significant covariates. The 12-month incidence of hypoglycemia was 11/1000 patients after levofloxacin administration and 21/1000 patients after gatifloxacin (absolute risk increase 10/1000 patients, 95% confidence interval [CI] 4-16/1000). Renal failure, sepsis syndrome, and concomitant hypoglycemic drug therapy significantly predicted hypoglycemia. After adjustment for significant predictors, the odds of having hypoglycemia were 2.81 (95% CI 1.02-7.70) times higher after gatifloxacin than levofloxacin therapy.

CONCLUSION

Among inpatients, the incidence of hypoglycemic events is greater after treatment with gatifloxacin than levofloxacin. The odds of experiencing hypoglycemic events are greater with gatifloxacin even after adjusting for other hypoglycemia risk factors, such as concomitant hypoglycemic drugs, renal failure, and sepsis syndrome.

Positron emission tomography in patients with fibromyalgia syndrome and healthy controls

OBJECTIVE

Abnormal brain findings have previously been described in fibromyalgia syndrome (FMS) by single-photon-emission computed tomography. Our goal was to investigate change in regional cerebral glucose metabolism in people with FMS by positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG).

METHODS

Twelve patients with FMS and no comorbid psychiatric diagnosis and 7 healthy pain-free controls were studied with FDG-PET in a blinded manner. Those with a psychiatric diagnosis were excluded. Brain scans were obtained using a PET scanner. Semiquantitative analysis of regional 18F-FDG uptake was performed in both cortical and subcortical brain structures.

RESULTS

In the resting state, there were no significant differences in 18F-FDG uptake between patients and controls for all brain structures measured.

CONCLUSION

FDG-PET scan findings in FMS were not significantly different from healthy controls. Normal results in our study may be explained by discordance between regional cerebral blood flow and regional cerebral glucose metabolism.

Predictors of preterm infant feeding methods and perceived insufficient milk supply at week 12 postpartum

As part of a large, nonexperimental, prospective, longitudinal study, 94 pump-dependent mothers of a nonnursing preterm infant were queried via telephone at weeks 8 to 12 post-partum about their infant feeding method. At week 12, 44.6% provided own mother's milk, 26.6% provided own mother's milk + artificial milk, and 28.7% provided artificial milk only. Logistic regression analyses identified the following predictors for risk of artificial milk at week 12 postpartum: multiple birth, week 6 inadequate milk supply, maternal age younger than 29 years, and intended length of lactation less than 34 weeks. Predictors for risk of maternal perceived insufficient milk supply for weeks 8 to 12 postpartum included week 6 inadequate milk supply, unemployment, and infant hospital discharge after postpartum day 42. Further research is needed to assist pump-dependent mothers of preterm infants with sustaining their milk supply.