Controversy exists about the safety of the parenteral iron dextran products, Dexferrum and INFeD, which have been associated with rare, serious anaphylactic-type reactions. In the United States, their product labels carry boxed warnings of this adverse event; some have called for the withdrawal from marketing of the higher molecular weight Dexferrum. Between 2002 and 2007, sales of Dexferrum, INFeD, and iron gluconate Ferrlecit declined 32.5%, 21%, and 4.8%, respectively, while sales of iron sucrose Venofer increased 160%. Voluntary reports submitted to the Food and Drug Administration show anaphylactic reactions and symptoms for the four parenteral iron products. Because of underreporting, possible differential reporting, absence of iron dextran brand names, and incomplete use (denominator) data, incidence rates and relative risk estimates cannot be calculated. U.S. death certificate data show that for most years from 1979 through 2006, no more than 3 deaths per year were coded to ''adverse events in therapeutic use of iron preparations;'' brand names were not consistently recorded. Emergency department data show small numbers of visits for treatment of allergic reactions with intravenous iron preparations. The data presented herein show that allergic reactions are possible with all four parenteral iron products, and it is difficult to determine which product has the largest risk based on sales data, voluntarily submitted adverse event reports, death certificates, ED visits, and observational studies performed to date. To help differentiate risk among the parenteral iron products, the brand name of the product always should be provided on medical records, death certificates, and adverse drug reaction reports. Am. J.

This report sheds new light on adolescent drug experiences in Panama, the five Spanish-heritage countries of Central America, and the Dominican Republic, and presents the first estimates of school-level clustering of youthful drug involvement in these seven countries. Placed in relation to school survey findings from North America and Europe, these estimates indicate lower levels of drug involvement in these seven countries of the Americas. For example, in the United States of America 70% of surveyed youths had tried alcohol and 59% had smoked tobacco. By comparison, in these seven countries, only 51% have tried alcohol and only 29% have smoked tobacco. Future research will help to clarify explanations for the observed variations across different countries of the world. In the meantime, strengthening of school-based and other prevention efforts in the seven-country PACARDO area may help these countries slow the spread of youthful drug involvement, reduce school-level clustering, and avoid the periodic epidemics of illegal drug use that have been experienced in North America.

To investigate the role of religiosity in the earliest stages of drug involvement, the authors studied recent-onset occurrence of first chances to try a drug and first actual drug use, expressed as a function of religious practice behaviors, levels of religious devotion, and religious affiliation. Based upon standardized questionnaire assessments of nationally representative samples of school-attending youths drawn in Panama, the five Spanish heritage countries of Central America, and the Dominican Republic (n = 12,797), the 1999-2000 study estimates indicate that higher levels of religious practice are inversely associated with the earliest stages of tobacco and cannabis experiences (i.e., the first chance to try and the first actual use) but not so for alcohol. To illustrate, for each unit increase in levels of religious practice behaviors, there was an associated reduced occurrence of the first chance to try tobacco (odds ratio = 0.76, 95% confidence interval: 0.62, 0.94). Occurrence of first actual use of tobacco and cannabis was not associated with levels of religious practice behaviors among youths exposed to the opportunity to try these drugs. As such, these behaviors apparently have not strengthened resistance. Rather, autarcesis may be at work, functioning to shield youths from drug exposure opportunities.

Moving forward, it is important that there be a common understanding in the scientific community regarding how to select appropriate measures to serve as numerators and denominators in AR calculations, and how to interpret the resultant findings. There is no single best measure of abuse for use as a numerator in an AR, and each must be chosen and interpreted in the context of what it measures. For public health considerations, one must always look at both absolute numbers and adjusted numbers. When conducting multiple analyses using different measures of exposure as denominators, differences in ARs are not unexpected, but one should explore why there are differences and assess the appropriateness of each of the denominators.

The study evidence lends some support for behavioral autarcesis. Manipulation of selected ABR dimensions might help prevent or reduce adolescent drug involvement, enhancing autarcesis as a protective mechanism.