CHICAGO—The low level of pain reported after mammography is useful information for patients and practitioners and may increase adherence to screening recommendations, according to an article in the April 14 issue of the Archives of Internal Medicine, one of the JAMA & Archives Journals publications.

Breast cancer is the leading cancer in women, and the second leading cause of cancer death in women, with an estimated 40 000 deaths in 2002, according to the article. Mammography screening for older women with no signs of breast cancer has been shown to be effective in reducing deaths caused by breast cancer. Many women report pain as a major barrier to getting screened, but few studies have reported on the degree and type of pain women experience during mammographies.

Penny C. Sharp, EdD, of Wake Forest University School of Medicine, Winston-Salem, NC, and colleagues interviewed 200 women 40 years and older immediately after undergoing a screening mammography. They were questioned about any pain they experienced during the procedure, the difference between the mammography experience and what their expectations were in terms of pain, and what they thought the most stressful part of the procedure was.

The researchers found that 72% of the women reported pain ranked as a 4 or less on a scale of 0 to 10 (with 10 being the most intense pain). The highest level of pain reported was during the compression of the breasts. Ninety-six percent of the women reported that the pain was "less than" or "about as expected." Most (94%) said they were very likely or somewhat likely to get a mammogram next year."

Thirty-nine percent of the women reported that waiting for the results was the most stressful part of the examination.

CHICAGO—Patient characteristics and the location of care were both factors that influenced the choice of antibiotic prescribed for patients with community-acquired pneumonia (CAP), according to an article in the April 14 issue of the Archives of Internal Medicine, one of the JAMA & Archives Journals publications.

Community-acquired pneumonia is a common disease in North America that is caused by a bacterial infection and can lead to serious illness and death, according to the article. In about 50% of cases of CAP, the exact agent causing the pneumonia is unidentified, making prescribing the right antibiotic difficult. Choosing the right antibiotic is important because of the possibility of the multidrug-resistant Streptococcus pneumoniae (the bacteria that causes CAP), and the fact that choosing a broad-spectrum antibiotic or misusing a specific antibiotic can result in antibiotic resistance or even death.

Christine Malcolm, BSc, and Thomas J. Marrie, MD, of the University of Alberta, Edmonton, Alberta, studied the factors that influence the choice of antibiotic therapy for patients with CAP who were treated on an ambulatory basis (were not admitted) in an emergency department setting.

The researchers studied 768 patients with CAP who visited one of 6 hospitals in the Capital Health Authority, Edmonton, Alberta, between November 15, 2000, and April 30, 2001. The patients had an average age of 51 years. The researchers report that the antibiotics most commonly prescribed were azithromycin (36%), levofloxacin (32%), and clarithromycin (17%). Site of care was associated with frequency of prescription of clarithromycin and levofloxacin.

Older age, presence of chronic obstructive pulmonary disease, currently receiving antibiotic therapy, and site of care were independently predictive of levofloxacin use.

CHICAGO—Prenatal alcohol exposure may be a risk factor for the development of drinking problems as an adult, according to an article in the April issue of the Archives of General Psychiatry, one of the JAMA & Archives Journals publications.

Several determinants have been identified as risk factors for alcoholism, but prenatal exposure to alcohol has not been studied as a potential cause of alcohol problems later in life. Fetal exposure to alcohol has been linked to attention problems, memory problems, impulsivity, and deficits in cognitive functioning, each of which are risk factors for the development of alcohol use disorders. In previous studies, adult adoptees with fetal exposure to alcohol reported more symptoms of alcohol, nicotine, and other drug dependence compared with those not exposed.

Ann P. Streissguth, PhD, of the Fetal Alcohol and Drug Unit, University of Washington School of Medicine, Seattle, and colleagues obtained information from 433 families and offspring of mothers who were first studied in 1974-1975 when they were about 5 months pregnant. Maternal drinking during pregnancy was assessed along with measures of smoking, use of caffeine and other drugs, and demographic factors. Family history of alcohol problems was determined through interviews with the parents when their children were 14 years old, and updated when the children were 21 years old. Parental alcohol and drug use were assessed at 7 time points over 21 years with the first measurement during the mother's pregnancy. When the children were 21 years old, they provided self-reports on drinking habits, including quantity and frequency of alcohol consumption, and completed the Alcohol Dependence Scale as a measure of alcohol-related problems and dependence.

Of the 433 offspring, 359 (82.9%) reported themselves as current drinkers and 74 (17.1%) as lifelong or current abstainers at the 21 year follow up. They reported drinking, on average, 5.77 times per month, with an average of 3.79 drinks per occasion. Consistent with national survey samples, 36.5% reported drinking 5 or more drinks on at least one occasion during the past month. Thirty-five (8.1%) of the 433 offspring scored at or above 10 on the Alcohol Dependence Scale, indicating at least mild alcohol dependence.

"Prenatal alcohol exposure is significantly associated with alcohol-related problems assessed in offspring at 21 years of age," the researchers write. "This relationship remains when we account for sex, other demographic factors, family history of alcohol problems, prenatal exposure to nicotine and other drugs, and other aspects of the family environment."

CHICAGO—Birthplace, socioeconomic status, and sex may be linked to attempted suicide, according to an article in the April issue of the Archives of General Psychiatry, one of the JAMA & Archives Journals publications.

According to background information given in the article, refugees and labor migrants have an increased risk of psychological distress, an established risk factor for attempted suicide. Low socioeconomic status, unemployment, young age, female sex, and living alone are well-documented risk factors for attempted suicide.

Jeanette Westman, RN, BD, of the Karolinska Institutet MigraMed, Family Medicine, Stockholm, Sweden, and colleagues conducted a population study in 1993 of approximately 4.5 million Swedes aged 25 to 64 years, of whom 570 000 had been born abroad. Participants were tracked until attempted suicide, remigration (moving out of Sweden), death, or the end of the study on December 31, 1998.

The researchers found that labor migrants from Finland and other OECD (Organisation for Economic Cooperation and Development) countries and refugees from Poland and Iran had higher rates of attempted suicides than Swedish-born control subjects. Women born in Latin America, Asia, and Eastern Europe had significantly higher rates of attempted suicide than Swedish-born women.

In contrast, the researchers found that men born in Southern Europe and Asia had significantly lower rates of attempted suicide. The rates of attempted suicide among women from Iran, Asia, southern Europe, Latin America, and eastern Europe considerably exceeded those of men from the same countries.

When the researchers figured in socioeconomic status (defined as individual income), the rates remained high for women while the rates of attempted suicide declined sharply among men as income increased.

CHICAGO—Bullying should not be considered a normal part of growing up, but as a marker for more serious violent behaviors including carrying weapons, frequent fighting, and getting injured in a fight, according to an article in the April issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA & Archives Journals publications.

Almost 30% of children in grades 6 through 10 report being involved in bullying as either the bully, the target, or both, according to information in the article. Bullying involves an intention to harm someone else and a power differential between the bully and target. The abusive nature of bullying and the lack of regard for others may be an important risk factor for involvement in more serious violent behaviors.

Tonja R. Nansel, PhD, of the National Institute of Child Health and Human Development, Bethesda, Md, and colleagues investigated the extent to which bullying and being the target of bullying is associated with later violent behavior.

The authors used data from 15 686 US school children in grades 6 through 10 in public and private schools who completed the World Health Organization's Health Behavior in School-Aged Children survey in 1998. This survey asked children to report carrying weapons (such as a gun, knife, or club for self defense), history of fighting, and if they were ever injured in a fight.

The researchers found that involvement in any violence-related behaviors ranged from 13% to 23% for boys and 4% to 11% for girls. Bullying and being bullied were related to violent behavior for both boys and girls. The risk of engaging in violent behavior was higher in those who described themselves as bullies as opposed to those who were bullied. The risk was even greater if the bullying took place away from school.

For example, the odds for weapon carrying associated with being bullied in school weekly was 1.5, for bullying others in school was 2.6, for being bullied away from school was 4.1, and for bullying others away from school was 5.9.

CHICAGO—The prevalence of visual impairment for patients who have AIDS and are diagnosed with cytomegalovirus (CMV) retinitis is high, but varies with demographic characteristics, according to an article in the April issue of the Archives of Ophthalmology, one of the JAMA & Archives Journals publications.

Cytomegalovirus retinitis infection is a major opportunistic complication of AIDS, according to information in the article. Retinitis accounts for 71% to 85% of CMV disease in these patients. Before the availability of highly active antiretroviral therapy (HAART, now a commonly prescribed drug regimen for patients infected with human immunodeficiency virus, the virus that causes AIDS), it was estimated that about 30% percent of patients with AIDS would develop CMV retinitis during their lifetime. Cytomegalovirus retinitis has declined since the introduction of HAART.

John H. Kempen, MD, PhD, of the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md, and colleagues studied the effect of CMV retinitis and its treatment on visual impairment in 648 patients with AIDS. Patients were evaluated at 1 center to determine the prevalence of visual impairment at the time of CMV retinitis diagnosis and were followed up to assess the development of visual impairment over time.

The researchers found that among patients whose eyes were affected by CMV retinitis, 33% of affected eyes had a visual acuity measurement of 20/50 or worse (mild impairment) and 17% had a visual acuity measurement of 20/200 or worse (severe impairment) at the time of diagnosis. Being white was associated with a lower prevalence of visual impairment, whereas injection drug use was associated with a higher prevalence of visual impairment, the researchers report.

Among 607 eyes of 426 patients who were followed up, the incidence of development of visual impairment to 20/50 or worse and 20/200 or worse at 1 year was 34% and 24%, respectively.

Patients who received HAART (93 participants with 126 affected eyes) had an approximately 75% lower risk of visual impairment, with the greatest improvement among patients who experienced immune recovery.