Jewish World Review Dec. 7, 2001 / 22 Kislev, 5762

Update on school shootings

By Robert A. Wascher, M.D., F.A.C.S.

http://www.jewishworldreview.com -- This week's Journal of the American Medical Association includes a study of recent trends in schoolyard shootings in the United States between 1994 and 1999.

The authors compiled school-associated violence data from police agencies, school officials and media databases. During the 1994-1999 timeframe, 220 school shooting events were reported, resulting in 253 deaths. Students accounted for 68% of these deaths.

The rate of single-victim deaths from school shootings actually decreased significantly over the 5-year period encompassed by this study. At the same time, however, there was an increase in the rate of multiple-victim school homicides.

Most shooting events occurred near the beginning of the school day, the lunch period, or at the end of the school day. In 55% of the incidents, some sort of implied or actual threat was present prior to the shooting event.

These threats were usually in the form of written or spoken threats, or observed behavior that suggested planning for the attack. The shooters were also noted to have previously expressed suicidal thoughts more than 7 times as frequently as did their victims. Importantly, the assailants were 2-3 times more likely to have been bullied by their peers as compared to their victims.

This study's findings are, therefore, a mixed bag of good news and bad news. While school shootings appeared to have declined in overall frequency during the latter half of the past decade, the likelihood of multiple victims arising from such an event appears to have increased. Certain common themes are noted in the study, in the hope that preemptive action by school authorities and parents might lead to the prevention of at least some future schoolyard shootings.

NEW IMPLANTABLE HEART-ASSIST DEVICE APPROVED FOR FURTHER EVALUATION

The FDA has approved further study of a new implantable heart-assist device for patients suffering from chronic heart failure. Despite the recent death of the first recipient of a new completely implantable artificial heart, this area of research is of great priority, as there are as many as 100,000 patients in the United States with end-stage heart failure (heart failure that has become refractory to medical treatment).

Unfortunately, very few of these patients will be matched with a donor heart for transplantation before they die, as only approximately 2,000 donor hearts become available each year.

The new device does not replace the failing heart, as is the case with an artificial heart. Rather, it augments heart function through the use of a balloon-pumping device, which is placed inside the large artery that leads from the heart to the rest of the body (the aorta).

The new device can provide up to 50% of the pumping action of a normal heart, and is the first implantable heart-assist device that can be actually switched off by the patient. Thus, patients can activate the heart-assist device during periods of physical activity that strain their weakened hearts, and can turn it off during periods of rest when their residual heart function is adequate for their bodies' needs.

Such a device can be used to sustain the patient until a donor heart becomes available. In other patients, the improvement in heart function provided by this device may be sufficient to allow for long-term relief of heart failure symptoms without the need for transplantation.

The FDA has approved the device for further study to evaluate its safety and efficacy in humans. Patients may be eligible to participate in the study if they are 18-80 years of age, and have Class III or IV congestive heart failure that is no longer responsive to medical treatment. Prospective study participants must also not be on an active heart transplant waiting list, and must live within 100 miles of the study center for the duration of the implant (Journal of the American Medical Association).

PREVENTION OF FUNGAL INFECTIONS IN PRE-TERM BABIES

This week's issue of the New England Journal of Medicine reports on an interesting study of 100 pre-term babies weighing less than 1000 g (2.2 pounds). Half of the babies were given an anti-fungal medication (fluconazole) and half were given a placebo for 6 weeks following delivery. The study monitored the babies for signs of colonization with fungi (the growth of fungi in the nose, skin, urine, or stool, but without signs of clinical infection), as well as for evidence of fungal infection of the blood, urine or spinal fluid.

Fungal colonization (without overt infection) was observed in 60% of the infants receiving the placebo injections, but in only 22% of infants receiving fluconazole injections.

More importantly, clinically significant fungal infections developed in 20% of infants receiving placebo injections, while no infant receiving fluconazole developed such an infection. There was no evidence that the observed fungi developed resistance to fluconazole during the 6-week study period, although the brief duration of the study may have been inadequate for resistant strains to emerge. No adverse effects were noted in the preemies receiving fluconazole, either.

This study is important, because extremely premature infants (those born more than 12 weeks before their full-term due dates) have immature immune systems, and are highly susceptible to bacterial and fungal infections. Moreover, most of these babies require invasive monitoring in a neonatal intensive care unit.

The use of intravenous catheters, urethral catheters and mechanical ventilators further expose the normally sterile body compartments in these infants to the bacteria and fungi that are universally present in our environment (including the hospital!). These tiny babies often develop life-threatening infections, much as adult patients with AIDS, cancer or other immune-suppressing diseases do.

Further study is warranted in this area. Specifically, the development of resistant strains of fungi may occur with longer periods of fluconazole administration, as would be required in those preemies who require extended monitoring in the neonatal intensive care unit. However, the results of this study will likely change the way that extremely premature infants are treated during their first few months of life outside of the womb.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.