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Single HPV Vaccine Dose Appears as Effective as Full Course
One or two doses of the bivalent human papillomavirus vaccine provide a level of protection against cervical HPV infection similar to that of the full three-dose schedule, according to post hoc analysis from two phase III, double-blind, randomized controlled trials with 4 years follow-up.
Data from the Costa Rica Vaccine Trial and PATRICIA trials of the HPV-16/18 vaccine, tested in 24,055 women, showed vaccine efficacy against HPV-16/18 infection for one dose was 85.7%, two doses, 76%, and three doses, 77%, according to a paper published online June 10 in Lancet Oncology.
The analysis also showed that vaccine efficacy was significantly improved in women who received two doses when the second dose was received 6 months after the first, rather than 1 month (Lancet Oncology 2015, June 10 [doi: dx.doi.org/10.1016/ S1470-2045(15)70199-3]). “If one-dose HPV vaccine administration provides strong protection against HPV-16/18 for the long term, this approach might be what is necessary to overcome the barriers prohibiting vaccine uptake in many world regions,” wrote Aimée R Kreimer, Ph.D., of the National Cancer Institute, Bethesda, Md., and her associates. “These data strongly argue for a direct assessment of one-dose efficacy of the HPV-16/18 vaccine.”
Because these results “were replicated in a cohort of women naive to HPV-16/18 infection at the time of vaccination” these results are “probably relevant to girls in the preferred age range for HPV vaccination (i.e., 11-12 years),” they said..
The study and included trials were supported by the U.S. National Cancer Institute, National Institutes of Health Office of Research on Women’s Health, and Ministry of Health of Costa Rica (CVT) and GlaxoSmithKline Biologicals SA (PATRICIA). Some authors disclosed ties with GlaxoSmithKline.
If human papillomavirus vaccines could be delivered as one dose, while retaining their efficacy against the most oncogenic HPV types 16 and 18, we could substantially decrease the global burden of cervical cancer, particularly in resource-poor settings where an annual vaccination program might be difficult to sustain.
Importantly, strong vaccine protection irrespective of dose also was shown for persistent infection, a recommended outcome measure for assessment of protection in prophylactic HPV vaccine trials.
Dr. Julia M.L. Brotherton is from the National HPV Vaccination Program Register, Melbourne. These comments were excerpted from an editorial (Lancet Oncology 2015, June 10 [http://dx.doi.org/10.1016/S1470-2045(15)70253-6]). She declared research grants from bioCSL/Merck.
If human papillomavirus vaccines could be delivered as one dose, while retaining their efficacy against the most oncogenic HPV types 16 and 18, we could substantially decrease the global burden of cervical cancer, particularly in resource-poor settings where an annual vaccination program might be difficult to sustain.
Importantly, strong vaccine protection irrespective of dose also was shown for persistent infection, a recommended outcome measure for assessment of protection in prophylactic HPV vaccine trials.
Dr. Julia M.L. Brotherton is from the National HPV Vaccination Program Register, Melbourne. These comments were excerpted from an editorial (Lancet Oncology 2015, June 10 [http://dx.doi.org/10.1016/S1470-2045(15)70253-6]). She declared research grants from bioCSL/Merck.
If human papillomavirus vaccines could be delivered as one dose, while retaining their efficacy against the most oncogenic HPV types 16 and 18, we could substantially decrease the global burden of cervical cancer, particularly in resource-poor settings where an annual vaccination program might be difficult to sustain.
Importantly, strong vaccine protection irrespective of dose also was shown for persistent infection, a recommended outcome measure for assessment of protection in prophylactic HPV vaccine trials.
Dr. Julia M.L. Brotherton is from the National HPV Vaccination Program Register, Melbourne. These comments were excerpted from an editorial (Lancet Oncology 2015, June 10 [http://dx.doi.org/10.1016/S1470-2045(15)70253-6]). She declared research grants from bioCSL/Merck.
One or two doses of the bivalent human papillomavirus vaccine provide a level of protection against cervical HPV infection similar to that of the full three-dose schedule, according to post hoc analysis from two phase III, double-blind, randomized controlled trials with 4 years follow-up.
Data from the Costa Rica Vaccine Trial and PATRICIA trials of the HPV-16/18 vaccine, tested in 24,055 women, showed vaccine efficacy against HPV-16/18 infection for one dose was 85.7%, two doses, 76%, and three doses, 77%, according to a paper published online June 10 in Lancet Oncology.
The analysis also showed that vaccine efficacy was significantly improved in women who received two doses when the second dose was received 6 months after the first, rather than 1 month (Lancet Oncology 2015, June 10 [doi: dx.doi.org/10.1016/ S1470-2045(15)70199-3]). “If one-dose HPV vaccine administration provides strong protection against HPV-16/18 for the long term, this approach might be what is necessary to overcome the barriers prohibiting vaccine uptake in many world regions,” wrote Aimée R Kreimer, Ph.D., of the National Cancer Institute, Bethesda, Md., and her associates. “These data strongly argue for a direct assessment of one-dose efficacy of the HPV-16/18 vaccine.”
Because these results “were replicated in a cohort of women naive to HPV-16/18 infection at the time of vaccination” these results are “probably relevant to girls in the preferred age range for HPV vaccination (i.e., 11-12 years),” they said..
The study and included trials were supported by the U.S. National Cancer Institute, National Institutes of Health Office of Research on Women’s Health, and Ministry of Health of Costa Rica (CVT) and GlaxoSmithKline Biologicals SA (PATRICIA). Some authors disclosed ties with GlaxoSmithKline.
One or two doses of the bivalent human papillomavirus vaccine provide a level of protection against cervical HPV infection similar to that of the full three-dose schedule, according to post hoc analysis from two phase III, double-blind, randomized controlled trials with 4 years follow-up.
Data from the Costa Rica Vaccine Trial and PATRICIA trials of the HPV-16/18 vaccine, tested in 24,055 women, showed vaccine efficacy against HPV-16/18 infection for one dose was 85.7%, two doses, 76%, and three doses, 77%, according to a paper published online June 10 in Lancet Oncology.
The analysis also showed that vaccine efficacy was significantly improved in women who received two doses when the second dose was received 6 months after the first, rather than 1 month (Lancet Oncology 2015, June 10 [doi: dx.doi.org/10.1016/ S1470-2045(15)70199-3]). “If one-dose HPV vaccine administration provides strong protection against HPV-16/18 for the long term, this approach might be what is necessary to overcome the barriers prohibiting vaccine uptake in many world regions,” wrote Aimée R Kreimer, Ph.D., of the National Cancer Institute, Bethesda, Md., and her associates. “These data strongly argue for a direct assessment of one-dose efficacy of the HPV-16/18 vaccine.”
Because these results “were replicated in a cohort of women naive to HPV-16/18 infection at the time of vaccination” these results are “probably relevant to girls in the preferred age range for HPV vaccination (i.e., 11-12 years),” they said..
The study and included trials were supported by the U.S. National Cancer Institute, National Institutes of Health Office of Research on Women’s Health, and Ministry of Health of Costa Rica (CVT) and GlaxoSmithKline Biologicals SA (PATRICIA). Some authors disclosed ties with GlaxoSmithKline.
FROM LANCET ONCOLOGY
Single HPV vaccine dose appears as effective as full course
One or two doses of the bivalent human papillomavirus vaccine provide a level of protection against cervical HPV infection similar to that of the full three-dose schedule, according to post hoc analysis from two phase III, double-blind, randomized controlled trials with 4 years follow-up.
Data from the Costa Rica Vaccine Trial and PATRICIA trials of the HPV-16/18 vaccine, tested in 24,055 women, showed vaccine efficacy against HPV-16/18 infection for one dose was 85.7%, two doses, 76%, and three doses, 77%, according to a paper published online June 10 in Lancet Oncology.
The analysis also showed that vaccine efficacy was significantly improved in women who received two doses when the second dose was received 6 months after the first, rather than 1 month (Lancet Oncology 2015, June 10 [doi: dx.doi.org/10.1016/ S1470-2045(15)70199-3]). “If one-dose HPV vaccine administration provides strong protection against HPV-16/18 for the long term, this approach might be what is necessary to overcome the barriers prohibiting vaccine uptake in many world regions,” wrote Aimée R Kreimer, Ph.D., of the National Cancer Institute, Bethesda, Md., and her associates. “These data strongly argue for a direct assessment of one-dose efficacy of the HPV-16/18 vaccine.”
Because these results “were replicated in a cohort of women naive to HPV-16/18 infection at the time of vaccination” these results are “probably relevant to girls in the preferred age range for HPV vaccination (i.e., 11-12 years),” they said..
The study and included trials were supported by the U.S. National Cancer Institute, National Institutes of Health Office of Research on Women’s Health, and Ministry of Health of Costa Rica (CVT) and GlaxoSmithKline Biologicals SA (PATRICIA). Some authors disclosed ties with GlaxoSmithKline.
If human papillomavirus vaccines could be delivered as one dose, while retaining their efficacy against the most oncogenic HPV types 16 and 18, we could substantially decrease the global burden of cervical cancer, particularly in resource-poor settings where an annual vaccination program might be difficult to sustain.
Importantly, strong vaccine protection irrespective of dose also was shown for persistent infection, a recommended outcome measure for assessment of protection in prophylactic HPV vaccine trials.
Dr. Julia M.L. Brotherton is from the National HPV Vaccination Program Register, Melbourne. These comments were excerpted from an editorial (Lancet Oncology 2015, June 10 [http://dx.doi.org/10.1016/S1470-2045(15)70253-6]). She declared research grants from bioCSL/Merck.
If human papillomavirus vaccines could be delivered as one dose, while retaining their efficacy against the most oncogenic HPV types 16 and 18, we could substantially decrease the global burden of cervical cancer, particularly in resource-poor settings where an annual vaccination program might be difficult to sustain.
Importantly, strong vaccine protection irrespective of dose also was shown for persistent infection, a recommended outcome measure for assessment of protection in prophylactic HPV vaccine trials.
Dr. Julia M.L. Brotherton is from the National HPV Vaccination Program Register, Melbourne. These comments were excerpted from an editorial (Lancet Oncology 2015, June 10 [http://dx.doi.org/10.1016/S1470-2045(15)70253-6]). She declared research grants from bioCSL/Merck.
If human papillomavirus vaccines could be delivered as one dose, while retaining their efficacy against the most oncogenic HPV types 16 and 18, we could substantially decrease the global burden of cervical cancer, particularly in resource-poor settings where an annual vaccination program might be difficult to sustain.
Importantly, strong vaccine protection irrespective of dose also was shown for persistent infection, a recommended outcome measure for assessment of protection in prophylactic HPV vaccine trials.
Dr. Julia M.L. Brotherton is from the National HPV Vaccination Program Register, Melbourne. These comments were excerpted from an editorial (Lancet Oncology 2015, June 10 [http://dx.doi.org/10.1016/S1470-2045(15)70253-6]). She declared research grants from bioCSL/Merck.
One or two doses of the bivalent human papillomavirus vaccine provide a level of protection against cervical HPV infection similar to that of the full three-dose schedule, according to post hoc analysis from two phase III, double-blind, randomized controlled trials with 4 years follow-up.
Data from the Costa Rica Vaccine Trial and PATRICIA trials of the HPV-16/18 vaccine, tested in 24,055 women, showed vaccine efficacy against HPV-16/18 infection for one dose was 85.7%, two doses, 76%, and three doses, 77%, according to a paper published online June 10 in Lancet Oncology.
The analysis also showed that vaccine efficacy was significantly improved in women who received two doses when the second dose was received 6 months after the first, rather than 1 month (Lancet Oncology 2015, June 10 [doi: dx.doi.org/10.1016/ S1470-2045(15)70199-3]). “If one-dose HPV vaccine administration provides strong protection against HPV-16/18 for the long term, this approach might be what is necessary to overcome the barriers prohibiting vaccine uptake in many world regions,” wrote Aimée R Kreimer, Ph.D., of the National Cancer Institute, Bethesda, Md., and her associates. “These data strongly argue for a direct assessment of one-dose efficacy of the HPV-16/18 vaccine.”
Because these results “were replicated in a cohort of women naive to HPV-16/18 infection at the time of vaccination” these results are “probably relevant to girls in the preferred age range for HPV vaccination (i.e., 11-12 years),” they said..
The study and included trials were supported by the U.S. National Cancer Institute, National Institutes of Health Office of Research on Women’s Health, and Ministry of Health of Costa Rica (CVT) and GlaxoSmithKline Biologicals SA (PATRICIA). Some authors disclosed ties with GlaxoSmithKline.
One or two doses of the bivalent human papillomavirus vaccine provide a level of protection against cervical HPV infection similar to that of the full three-dose schedule, according to post hoc analysis from two phase III, double-blind, randomized controlled trials with 4 years follow-up.
Data from the Costa Rica Vaccine Trial and PATRICIA trials of the HPV-16/18 vaccine, tested in 24,055 women, showed vaccine efficacy against HPV-16/18 infection for one dose was 85.7%, two doses, 76%, and three doses, 77%, according to a paper published online June 10 in Lancet Oncology.
The analysis also showed that vaccine efficacy was significantly improved in women who received two doses when the second dose was received 6 months after the first, rather than 1 month (Lancet Oncology 2015, June 10 [doi: dx.doi.org/10.1016/ S1470-2045(15)70199-3]). “If one-dose HPV vaccine administration provides strong protection against HPV-16/18 for the long term, this approach might be what is necessary to overcome the barriers prohibiting vaccine uptake in many world regions,” wrote Aimée R Kreimer, Ph.D., of the National Cancer Institute, Bethesda, Md., and her associates. “These data strongly argue for a direct assessment of one-dose efficacy of the HPV-16/18 vaccine.”
Because these results “were replicated in a cohort of women naive to HPV-16/18 infection at the time of vaccination” these results are “probably relevant to girls in the preferred age range for HPV vaccination (i.e., 11-12 years),” they said..
The study and included trials were supported by the U.S. National Cancer Institute, National Institutes of Health Office of Research on Women’s Health, and Ministry of Health of Costa Rica (CVT) and GlaxoSmithKline Biologicals SA (PATRICIA). Some authors disclosed ties with GlaxoSmithKline.
FROM LANCET ONCOLOGY
Key clinical point: One or two doses of the bivalent human papillomavirus vaccine provide a level of protection against cervical HPV infection similar to that of the full three-dose schedule.
Major finding: Vaccine efficacy against HPV16/18 infection was 85.7% for one dose, 76% for two doses, and 77% for three doses.
Data source: Post hoc analysis from two phase III, double-blind, randomized controlled trials of 24,055 women.
Disclosures: The study and included trials were supported by the U.S. National Cancer Institute, National Institutes of Health Office of Research on Women’s Health, and Ministry of Health of Costa Rica (CVT) and GlaxoSmithKline Biologicals SA (PATRICIA). Some authors disclosed ties with GlaxoSmithKline.
Causal mechanism for schizophrenia identified
Disruption of GABAergic and glutamatergic neurotransmission in the brain might play a causative role in schizophrenia, data from a large genomewide study show.
Researchers compared genetic data of 11,355 individuals with schizophrenia and 16,416 controls – looking specifically at copy number variant mutations in which large stretches of DNA are deleted or duplicated, and what impact those mutations might have.
They found that these mutations most commonly affect genes involved in inhibitory GABAergic and excitatory glutamatergic signaling, according to a paper published June 3 in Neuron.
“Given the strong functional links between the major inhibitory GABAergic and excitatory glutamatergic systems, our findings converge on a broad, coherent set of pathogenic processes, providing firm foundations for studies aimed at dissecting disease mechanisms,” wrote Dr. Andrew J. Pocklington and his coauthors.
Read the full report here: (Neuron 2015;86:1203-14).
Disruption of GABAergic and glutamatergic neurotransmission in the brain might play a causative role in schizophrenia, data from a large genomewide study show.
Researchers compared genetic data of 11,355 individuals with schizophrenia and 16,416 controls – looking specifically at copy number variant mutations in which large stretches of DNA are deleted or duplicated, and what impact those mutations might have.
They found that these mutations most commonly affect genes involved in inhibitory GABAergic and excitatory glutamatergic signaling, according to a paper published June 3 in Neuron.
“Given the strong functional links between the major inhibitory GABAergic and excitatory glutamatergic systems, our findings converge on a broad, coherent set of pathogenic processes, providing firm foundations for studies aimed at dissecting disease mechanisms,” wrote Dr. Andrew J. Pocklington and his coauthors.
Read the full report here: (Neuron 2015;86:1203-14).
Disruption of GABAergic and glutamatergic neurotransmission in the brain might play a causative role in schizophrenia, data from a large genomewide study show.
Researchers compared genetic data of 11,355 individuals with schizophrenia and 16,416 controls – looking specifically at copy number variant mutations in which large stretches of DNA are deleted or duplicated, and what impact those mutations might have.
They found that these mutations most commonly affect genes involved in inhibitory GABAergic and excitatory glutamatergic signaling, according to a paper published June 3 in Neuron.
“Given the strong functional links between the major inhibitory GABAergic and excitatory glutamatergic systems, our findings converge on a broad, coherent set of pathogenic processes, providing firm foundations for studies aimed at dissecting disease mechanisms,” wrote Dr. Andrew J. Pocklington and his coauthors.
Read the full report here: (Neuron 2015;86:1203-14).
FROM NEURON
Thoracic gray matter atrophy linked to MS disability
Atrophy of gray matter in the thoracic cords of multiple sclerosis patients can be assessed in vivo using magnetic resonance imaging, and this shows a significant association between the area of gray matter in the lower thoracic cord and disease type and disability, according to a paper published online June 8.
A cross-sectional observational study of 142 patients with multiple sclerosis (MS) and 20 healthy controls, using phase-sensitive inversion recovery MRI, showed that, while patients with relapsing multiple sclerosis had smaller thoracic cord gray matter areas than controls, patients with progressive MS showed even more substantial reductions in thoracic cord gray matter.
Researchers also found an inverse correlation between lower thoracic cord gray matter and Expanded Disability Status Scale score, even after accounting for cervical gray matter area, Dr. Regina Schlaeger and her associates reported in JAMA Neurology.
“Magnetic resonance imaging–based estimations of cord GM [gray matter] that have strong correlations with MS disability may better track the disease process in the context of both clinical trials and longitudinal observational studies,” wrote Dr. Schlaeger of the department of neurology at the University of California, San Francisco, and her coauthors (JAMA Neurology 2015 June 8 [doi:10.1001/jamaneurol.2015.0993]).
The study was supported by the National Multiple Sclerosis Society, the Conrad H. Hilton Foundation, the Department of Defense, the National Institutes of Health, the National Defense Science and Engineering Fellowship, and the Nancy Davis Foundation. Some authors reported personal fees, committee roles, consultancies, board positions and support from numerous pharmaceutical companies.
Atrophy of gray matter in the thoracic cords of multiple sclerosis patients can be assessed in vivo using magnetic resonance imaging, and this shows a significant association between the area of gray matter in the lower thoracic cord and disease type and disability, according to a paper published online June 8.
A cross-sectional observational study of 142 patients with multiple sclerosis (MS) and 20 healthy controls, using phase-sensitive inversion recovery MRI, showed that, while patients with relapsing multiple sclerosis had smaller thoracic cord gray matter areas than controls, patients with progressive MS showed even more substantial reductions in thoracic cord gray matter.
Researchers also found an inverse correlation between lower thoracic cord gray matter and Expanded Disability Status Scale score, even after accounting for cervical gray matter area, Dr. Regina Schlaeger and her associates reported in JAMA Neurology.
“Magnetic resonance imaging–based estimations of cord GM [gray matter] that have strong correlations with MS disability may better track the disease process in the context of both clinical trials and longitudinal observational studies,” wrote Dr. Schlaeger of the department of neurology at the University of California, San Francisco, and her coauthors (JAMA Neurology 2015 June 8 [doi:10.1001/jamaneurol.2015.0993]).
The study was supported by the National Multiple Sclerosis Society, the Conrad H. Hilton Foundation, the Department of Defense, the National Institutes of Health, the National Defense Science and Engineering Fellowship, and the Nancy Davis Foundation. Some authors reported personal fees, committee roles, consultancies, board positions and support from numerous pharmaceutical companies.
Atrophy of gray matter in the thoracic cords of multiple sclerosis patients can be assessed in vivo using magnetic resonance imaging, and this shows a significant association between the area of gray matter in the lower thoracic cord and disease type and disability, according to a paper published online June 8.
A cross-sectional observational study of 142 patients with multiple sclerosis (MS) and 20 healthy controls, using phase-sensitive inversion recovery MRI, showed that, while patients with relapsing multiple sclerosis had smaller thoracic cord gray matter areas than controls, patients with progressive MS showed even more substantial reductions in thoracic cord gray matter.
Researchers also found an inverse correlation between lower thoracic cord gray matter and Expanded Disability Status Scale score, even after accounting for cervical gray matter area, Dr. Regina Schlaeger and her associates reported in JAMA Neurology.
“Magnetic resonance imaging–based estimations of cord GM [gray matter] that have strong correlations with MS disability may better track the disease process in the context of both clinical trials and longitudinal observational studies,” wrote Dr. Schlaeger of the department of neurology at the University of California, San Francisco, and her coauthors (JAMA Neurology 2015 June 8 [doi:10.1001/jamaneurol.2015.0993]).
The study was supported by the National Multiple Sclerosis Society, the Conrad H. Hilton Foundation, the Department of Defense, the National Institutes of Health, the National Defense Science and Engineering Fellowship, and the Nancy Davis Foundation. Some authors reported personal fees, committee roles, consultancies, board positions and support from numerous pharmaceutical companies.
FROM JAMA NEUROLOGY
Key clinical point: Atrophy of gray matter in the thoracic cord in multiple sclerosis patients can be assessed in vivo and is associated with disease type and disability.
Major finding: Patients with relapsing multiple sclerosis had smaller thoracic cord gray matter areas than controls, while patients with progressive MS showed even more substantial reductions in thoracic cord gray matter.
Data source: A cross-sectional observational study of 142 patients with MS and 20 healthy controls.
Disclosures: The study was supported by the National Multiple Sclerosis Society, the Conrad H. Hilton Foundation, the Department of Defense, the National Institutes of Health, the National Defense Science and Engineering Fellowship, and the Nancy Davis Foundation. Some authors reported personal fees, committee roles, consultancies, board positions, and support from numerous pharmaceutical companies.
Many people with alcohol use disorder not getting treatment
Nearly one-third of Americans have experienced alcohol use disorder during their lifetimes, and more than one in 10 have experienced it within the previous year, according to research published online June 3.
Data from 36,309 adults who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III showed that 12-month and lifetime prevalences of alcohol use were 13.9% and 29.1% respectively, with the incidence being higher among men, younger, white, and Native American respondents.
According to the paper, in JAMA Psychiatry, respondents with lower incomes were at the greatest risk of severe alcohol use disorder (AUD), and overall, 19.8% of respondents with lifetime alcohol use disorder had received treatment (JAMA Psychiatry 2015 June 3 [doi:10.1001/jamapsychiatry.2015.0584]).
“Most importantly, this study highlighted the urgency of educating the public and policy makers about AUD and its treatments, destigmatizing the disorder, and encouraging ... those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” wrote Bridget F. Grant, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and her coauthors.
The study was supported by NIAAA, and the National Institute on Drug Abuse. No conflicts of interest were declared.
Nearly one-third of Americans have experienced alcohol use disorder during their lifetimes, and more than one in 10 have experienced it within the previous year, according to research published online June 3.
Data from 36,309 adults who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III showed that 12-month and lifetime prevalences of alcohol use were 13.9% and 29.1% respectively, with the incidence being higher among men, younger, white, and Native American respondents.
According to the paper, in JAMA Psychiatry, respondents with lower incomes were at the greatest risk of severe alcohol use disorder (AUD), and overall, 19.8% of respondents with lifetime alcohol use disorder had received treatment (JAMA Psychiatry 2015 June 3 [doi:10.1001/jamapsychiatry.2015.0584]).
“Most importantly, this study highlighted the urgency of educating the public and policy makers about AUD and its treatments, destigmatizing the disorder, and encouraging ... those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” wrote Bridget F. Grant, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and her coauthors.
The study was supported by NIAAA, and the National Institute on Drug Abuse. No conflicts of interest were declared.
Nearly one-third of Americans have experienced alcohol use disorder during their lifetimes, and more than one in 10 have experienced it within the previous year, according to research published online June 3.
Data from 36,309 adults who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III showed that 12-month and lifetime prevalences of alcohol use were 13.9% and 29.1% respectively, with the incidence being higher among men, younger, white, and Native American respondents.
According to the paper, in JAMA Psychiatry, respondents with lower incomes were at the greatest risk of severe alcohol use disorder (AUD), and overall, 19.8% of respondents with lifetime alcohol use disorder had received treatment (JAMA Psychiatry 2015 June 3 [doi:10.1001/jamapsychiatry.2015.0584]).
“Most importantly, this study highlighted the urgency of educating the public and policy makers about AUD and its treatments, destigmatizing the disorder, and encouraging ... those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” wrote Bridget F. Grant, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and her coauthors.
The study was supported by NIAAA, and the National Institute on Drug Abuse. No conflicts of interest were declared.
Key clinical point: Alcohol use disorder has a high prevalence among American adults, but many are not receiving treatment.
Major finding: Twelve-month and lifetime prevalences of alcohol use were 13.9% and 29.1% respectively, and 19.8% with lifetime use disorder have received treatment.
Data source: Information from 36,309 adults who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III.
Disclosures: The National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse supported the study. No conflicts of interest were declared.
June 2015: Click for Credit
Here are 6 articles in the June issue of Clinician Reviews (accreditation valid until January 1, 2016):
1. ACCP and CTS Issue Joint Guideline on COPD Exacerbations
To take the posttest, go to: http://bit.ly/1EIadmv
VITALS
Key clinical point: The American College of Chest Physicians and the Canadian Thoracic Society have issued a guideline for prevention of acute exacerbations of COPD.
Major finding: COPD exacerbations are acute, trajectory changing, and often deadly manifestations of a chronic disease.
Data source: A comprehensive literature review on prevention of acute COPD exacerbations and a compilation of 33 recommendations and suggestions for clinicians in clinical practice.
Disclosures: The American College of Chest Physicians, the Canadian Thoracic Society, and the American Thoracic Society supported the project. Dr Criner reported having no relevant financial disclosures; his associates reported ties to numerous industry sources.
2. GI Symptoms Common in Parkinson Disease and Related Disorders
To take the posttest, go to: http://bit.ly/1AZSaXA
VITALS
Key clinical point: GI symptoms were linked with specific motor and nonmotor features of Parkinson disease and related disorders.
Major finding: Constipation was the most common symptom among all three parkinsonian disorders.
Data source: Multicenter, cross-sectional survey of 473 patients with Parkinson disease, atypical parkinsonism, or vascular parkinsonism.
Disclosures: The Collaborative Clinical Research Fund of Boramae Medical Center partially funded the work. The authors declared no relevant conflicts of interest.
3. Aerosolized Measles Vaccine Inferior to Subcutaneous
To take the posttest, go to: http://bit.ly/1RKJizC
VITALS
Key clinical point: An aerosolized measles vaccine was immunogenic but inferior to the subcutaneous vaccine at inducing seropositivity among babies residing in rural India.
Major finding: The primary endpoint—seropositivity for antibodies against measles at 91 days after vaccination—was 85.4% for aerosolized vaccine and 94.6% for subcutaneous.
Data source: An open-label, randomized noninferiority trial comparing aerosolized vs subcutaneous measles vaccination in 2,004 infants ages 9 to 11.9 months in villages in India.
Disclosures: This study was funded by the Bill and Melinda Gates Foundation. The Serum Institute of India provided vaccines free of charge, and Aerogen provided the delivery devices free of charge. Dr Low reported several grants plus monies paid to her institution from the World Health Organization for projects about vaccines and sexually transmitted infections; her associates reported ties to the Serum Institute of India, Aerogen, and Dance Biopharm. One associate has a patent pending on an aerosol device licensed to Novartis and another has a patent pending related to vaccine nebulizers.
4. Unrecognized Diabetes Common in Acute MI
To take the posttest, go to: http://bit.ly/1IB9sC8
VITALS
Key clinical point: Many patients presenting with acute MI had unrecognized diabetes, which, in most cases, remained undiagnosed, untreated, and unrecorded.
Major finding: Of 2,854 (10%) patients enrolled in an MI registry, 287 had A1C levels of 6.5% or higher on routine laboratory testing during hospitalization for acute MI, but treating physicians recognized only 101 of these cases of diabetes (35%).
Data source: A retrospective cohort study involving 2,854 adults presenting with acute MI to 24 US medical centers in a 3.5-year period.
Disclosures: This study was sponsored by the National Heart, Lung, and Blood Institute and supported by a research grant from Genentech. Dr Arnold reported receiving honoraria from Novartis; her associates reported ties to numerous industry sources.
5. Methotrexate and Biologics Linked to Higher Zoster Risk in Psoriasis
To take the posttest, go to: http://bit.ly/1AZScyF
VITALS
Key clinical point: The combination of methotrexate and biologics for the treatment of psoriasis may increase risk for herpes zoster.
Major finding: Combination therapy with both biologic medications and methotrexate was associated with a significant 66% increase in the incidence of herpes zoster over more than 11 years of follow-up.
Data source: Analysis of medical records for 95,941 patients with psoriasis.
Disclosures: One author reported consultancies and research grants from a range of pharmaceutical companies. There were no other disclosures.
6. ACP: Avoid ECG, MPI Cardiac Screening in Low-risk Patients
To take the posttest, go to: http://bit.ly/1e3NLha
Here are 6 articles in the June issue of Clinician Reviews (accreditation valid until January 1, 2016):
1. ACCP and CTS Issue Joint Guideline on COPD Exacerbations
To take the posttest, go to: http://bit.ly/1EIadmv
VITALS
Key clinical point: The American College of Chest Physicians and the Canadian Thoracic Society have issued a guideline for prevention of acute exacerbations of COPD.
Major finding: COPD exacerbations are acute, trajectory changing, and often deadly manifestations of a chronic disease.
Data source: A comprehensive literature review on prevention of acute COPD exacerbations and a compilation of 33 recommendations and suggestions for clinicians in clinical practice.
Disclosures: The American College of Chest Physicians, the Canadian Thoracic Society, and the American Thoracic Society supported the project. Dr Criner reported having no relevant financial disclosures; his associates reported ties to numerous industry sources.
2. GI Symptoms Common in Parkinson Disease and Related Disorders
To take the posttest, go to: http://bit.ly/1AZSaXA
VITALS
Key clinical point: GI symptoms were linked with specific motor and nonmotor features of Parkinson disease and related disorders.
Major finding: Constipation was the most common symptom among all three parkinsonian disorders.
Data source: Multicenter, cross-sectional survey of 473 patients with Parkinson disease, atypical parkinsonism, or vascular parkinsonism.
Disclosures: The Collaborative Clinical Research Fund of Boramae Medical Center partially funded the work. The authors declared no relevant conflicts of interest.
3. Aerosolized Measles Vaccine Inferior to Subcutaneous
To take the posttest, go to: http://bit.ly/1RKJizC
VITALS
Key clinical point: An aerosolized measles vaccine was immunogenic but inferior to the subcutaneous vaccine at inducing seropositivity among babies residing in rural India.
Major finding: The primary endpoint—seropositivity for antibodies against measles at 91 days after vaccination—was 85.4% for aerosolized vaccine and 94.6% for subcutaneous.
Data source: An open-label, randomized noninferiority trial comparing aerosolized vs subcutaneous measles vaccination in 2,004 infants ages 9 to 11.9 months in villages in India.
Disclosures: This study was funded by the Bill and Melinda Gates Foundation. The Serum Institute of India provided vaccines free of charge, and Aerogen provided the delivery devices free of charge. Dr Low reported several grants plus monies paid to her institution from the World Health Organization for projects about vaccines and sexually transmitted infections; her associates reported ties to the Serum Institute of India, Aerogen, and Dance Biopharm. One associate has a patent pending on an aerosol device licensed to Novartis and another has a patent pending related to vaccine nebulizers.
4. Unrecognized Diabetes Common in Acute MI
To take the posttest, go to: http://bit.ly/1IB9sC8
VITALS
Key clinical point: Many patients presenting with acute MI had unrecognized diabetes, which, in most cases, remained undiagnosed, untreated, and unrecorded.
Major finding: Of 2,854 (10%) patients enrolled in an MI registry, 287 had A1C levels of 6.5% or higher on routine laboratory testing during hospitalization for acute MI, but treating physicians recognized only 101 of these cases of diabetes (35%).
Data source: A retrospective cohort study involving 2,854 adults presenting with acute MI to 24 US medical centers in a 3.5-year period.
Disclosures: This study was sponsored by the National Heart, Lung, and Blood Institute and supported by a research grant from Genentech. Dr Arnold reported receiving honoraria from Novartis; her associates reported ties to numerous industry sources.
5. Methotrexate and Biologics Linked to Higher Zoster Risk in Psoriasis
To take the posttest, go to: http://bit.ly/1AZScyF
VITALS
Key clinical point: The combination of methotrexate and biologics for the treatment of psoriasis may increase risk for herpes zoster.
Major finding: Combination therapy with both biologic medications and methotrexate was associated with a significant 66% increase in the incidence of herpes zoster over more than 11 years of follow-up.
Data source: Analysis of medical records for 95,941 patients with psoriasis.
Disclosures: One author reported consultancies and research grants from a range of pharmaceutical companies. There were no other disclosures.
6. ACP: Avoid ECG, MPI Cardiac Screening in Low-risk Patients
To take the posttest, go to: http://bit.ly/1e3NLha
Here are 6 articles in the June issue of Clinician Reviews (accreditation valid until January 1, 2016):
1. ACCP and CTS Issue Joint Guideline on COPD Exacerbations
To take the posttest, go to: http://bit.ly/1EIadmv
VITALS
Key clinical point: The American College of Chest Physicians and the Canadian Thoracic Society have issued a guideline for prevention of acute exacerbations of COPD.
Major finding: COPD exacerbations are acute, trajectory changing, and often deadly manifestations of a chronic disease.
Data source: A comprehensive literature review on prevention of acute COPD exacerbations and a compilation of 33 recommendations and suggestions for clinicians in clinical practice.
Disclosures: The American College of Chest Physicians, the Canadian Thoracic Society, and the American Thoracic Society supported the project. Dr Criner reported having no relevant financial disclosures; his associates reported ties to numerous industry sources.
2. GI Symptoms Common in Parkinson Disease and Related Disorders
To take the posttest, go to: http://bit.ly/1AZSaXA
VITALS
Key clinical point: GI symptoms were linked with specific motor and nonmotor features of Parkinson disease and related disorders.
Major finding: Constipation was the most common symptom among all three parkinsonian disorders.
Data source: Multicenter, cross-sectional survey of 473 patients with Parkinson disease, atypical parkinsonism, or vascular parkinsonism.
Disclosures: The Collaborative Clinical Research Fund of Boramae Medical Center partially funded the work. The authors declared no relevant conflicts of interest.
3. Aerosolized Measles Vaccine Inferior to Subcutaneous
To take the posttest, go to: http://bit.ly/1RKJizC
VITALS
Key clinical point: An aerosolized measles vaccine was immunogenic but inferior to the subcutaneous vaccine at inducing seropositivity among babies residing in rural India.
Major finding: The primary endpoint—seropositivity for antibodies against measles at 91 days after vaccination—was 85.4% for aerosolized vaccine and 94.6% for subcutaneous.
Data source: An open-label, randomized noninferiority trial comparing aerosolized vs subcutaneous measles vaccination in 2,004 infants ages 9 to 11.9 months in villages in India.
Disclosures: This study was funded by the Bill and Melinda Gates Foundation. The Serum Institute of India provided vaccines free of charge, and Aerogen provided the delivery devices free of charge. Dr Low reported several grants plus monies paid to her institution from the World Health Organization for projects about vaccines and sexually transmitted infections; her associates reported ties to the Serum Institute of India, Aerogen, and Dance Biopharm. One associate has a patent pending on an aerosol device licensed to Novartis and another has a patent pending related to vaccine nebulizers.
4. Unrecognized Diabetes Common in Acute MI
To take the posttest, go to: http://bit.ly/1IB9sC8
VITALS
Key clinical point: Many patients presenting with acute MI had unrecognized diabetes, which, in most cases, remained undiagnosed, untreated, and unrecorded.
Major finding: Of 2,854 (10%) patients enrolled in an MI registry, 287 had A1C levels of 6.5% or higher on routine laboratory testing during hospitalization for acute MI, but treating physicians recognized only 101 of these cases of diabetes (35%).
Data source: A retrospective cohort study involving 2,854 adults presenting with acute MI to 24 US medical centers in a 3.5-year period.
Disclosures: This study was sponsored by the National Heart, Lung, and Blood Institute and supported by a research grant from Genentech. Dr Arnold reported receiving honoraria from Novartis; her associates reported ties to numerous industry sources.
5. Methotrexate and Biologics Linked to Higher Zoster Risk in Psoriasis
To take the posttest, go to: http://bit.ly/1AZScyF
VITALS
Key clinical point: The combination of methotrexate and biologics for the treatment of psoriasis may increase risk for herpes zoster.
Major finding: Combination therapy with both biologic medications and methotrexate was associated with a significant 66% increase in the incidence of herpes zoster over more than 11 years of follow-up.
Data source: Analysis of medical records for 95,941 patients with psoriasis.
Disclosures: One author reported consultancies and research grants from a range of pharmaceutical companies. There were no other disclosures.
6. ACP: Avoid ECG, MPI Cardiac Screening in Low-risk Patients
To take the posttest, go to: http://bit.ly/1e3NLha
Thyroid surgery on the rise
There was a steady rise in the number of endocrine procedures being performed in the United States over the past decade, according to a new publication from the Endocrine Society.
Thyroid disease treatment costs in U.S. women alone totaled $4.3 billion in 2008, representing a cost of $343 per patient, according to the report, authored by the Endocrine Society under the guidance of an advisory committee chaired by Dr. Robert A. Vigersky, head of the Diabetes Institute at Walter Reed National Military Medical Center in Bethesda, Md.
The number of endocrine procedures also has increased steadily, mainly because of new and improved surgical techniques, but the annual case number is predicted to go as high as 173,000 by 2020.
Thyroid conditions affect five times as many women as men, particularly in the case of Hashimoto’s disease – the incidence in women is more than eight times that in men – and Graves’ disease, where women have a nearly sixfold higher incidence than men, according to the report, which is available online.
The most common thyroid disease is thyroid nodules, which international studies estimate affect up to 60% of the population. In the United States, findings from a study using chest radiography found nearly one in four adult outpatients had thyroid nodules.
The diagnosis of thyroid nodules has increased as imaging technologies such as CT scanning, ultrasound, and MRI improve on the traditional diagnostic method of physical examination. The increase in thyroid surgery for this condition has raised questions about whether this has led to improved outcomes.
Hyperthyroidism and hypothyroidism have a lower prevalence, although estimates suggest as much as 13% of the U.S. population has subclinical hypothyroidism.
This has implications particularly in pregnancy, as subclinical hypothyroidism may increase the risk of pregnancy complications, including preeclampsia, placental abruption, preterm birth, and neonatal mortality.
One study found that 12.4% of healthy pregnant women with no known thyroid disease had subclinical hypothyroidism. Overt hypothyroidism affects around 0.8% of adults, while overt hyperthyroidism affects just 0.5% of adults, the report stated.
Graves’ disease is one form of hyperthyroidism, and it has a prevalence in the U.S. population of 0.63%-1.49%, mostly affecting women, African Americans, and Asian/Pacific Islanders.
This condition is most commonly treated with antithyroid drugs or radioactive iodine therapy, although around 0.7% of patients undergo thyroidectomies.
Another group of thyroid diseases, grouped under the umbrella term of thyroiditis, includes a common element of inflammation of the thyroid gland. Among them is the autoimmune condition Hashimoto’s thyroiditis, which is thought to affect around 4.6% of the population.
Postpartum thyroiditis – an inflammatory autoimmune condition that develops in the first year after delivery – is estimated to have a prevalence around 4.5%, according to one review.
“Evidence is emerging that as women age subclinical hypothyroidism – as a sequel of postpartum thyroiditis – predisposes them to cardiovascular disease,” wrote Dr. Vigersky, also of the Uniformed Services University of the Health Sciences, and the other panel members.
“Hence, postpartum thyroiditis is no longer considered a mild and transient disorder.”
The report was produced by the Endocrine Society. There were no conflicts of interest declared.
There was a steady rise in the number of endocrine procedures being performed in the United States over the past decade, according to a new publication from the Endocrine Society.
Thyroid disease treatment costs in U.S. women alone totaled $4.3 billion in 2008, representing a cost of $343 per patient, according to the report, authored by the Endocrine Society under the guidance of an advisory committee chaired by Dr. Robert A. Vigersky, head of the Diabetes Institute at Walter Reed National Military Medical Center in Bethesda, Md.
The number of endocrine procedures also has increased steadily, mainly because of new and improved surgical techniques, but the annual case number is predicted to go as high as 173,000 by 2020.
Thyroid conditions affect five times as many women as men, particularly in the case of Hashimoto’s disease – the incidence in women is more than eight times that in men – and Graves’ disease, where women have a nearly sixfold higher incidence than men, according to the report, which is available online.
The most common thyroid disease is thyroid nodules, which international studies estimate affect up to 60% of the population. In the United States, findings from a study using chest radiography found nearly one in four adult outpatients had thyroid nodules.
The diagnosis of thyroid nodules has increased as imaging technologies such as CT scanning, ultrasound, and MRI improve on the traditional diagnostic method of physical examination. The increase in thyroid surgery for this condition has raised questions about whether this has led to improved outcomes.
Hyperthyroidism and hypothyroidism have a lower prevalence, although estimates suggest as much as 13% of the U.S. population has subclinical hypothyroidism.
This has implications particularly in pregnancy, as subclinical hypothyroidism may increase the risk of pregnancy complications, including preeclampsia, placental abruption, preterm birth, and neonatal mortality.
One study found that 12.4% of healthy pregnant women with no known thyroid disease had subclinical hypothyroidism. Overt hypothyroidism affects around 0.8% of adults, while overt hyperthyroidism affects just 0.5% of adults, the report stated.
Graves’ disease is one form of hyperthyroidism, and it has a prevalence in the U.S. population of 0.63%-1.49%, mostly affecting women, African Americans, and Asian/Pacific Islanders.
This condition is most commonly treated with antithyroid drugs or radioactive iodine therapy, although around 0.7% of patients undergo thyroidectomies.
Another group of thyroid diseases, grouped under the umbrella term of thyroiditis, includes a common element of inflammation of the thyroid gland. Among them is the autoimmune condition Hashimoto’s thyroiditis, which is thought to affect around 4.6% of the population.
Postpartum thyroiditis – an inflammatory autoimmune condition that develops in the first year after delivery – is estimated to have a prevalence around 4.5%, according to one review.
“Evidence is emerging that as women age subclinical hypothyroidism – as a sequel of postpartum thyroiditis – predisposes them to cardiovascular disease,” wrote Dr. Vigersky, also of the Uniformed Services University of the Health Sciences, and the other panel members.
“Hence, postpartum thyroiditis is no longer considered a mild and transient disorder.”
The report was produced by the Endocrine Society. There were no conflicts of interest declared.
There was a steady rise in the number of endocrine procedures being performed in the United States over the past decade, according to a new publication from the Endocrine Society.
Thyroid disease treatment costs in U.S. women alone totaled $4.3 billion in 2008, representing a cost of $343 per patient, according to the report, authored by the Endocrine Society under the guidance of an advisory committee chaired by Dr. Robert A. Vigersky, head of the Diabetes Institute at Walter Reed National Military Medical Center in Bethesda, Md.
The number of endocrine procedures also has increased steadily, mainly because of new and improved surgical techniques, but the annual case number is predicted to go as high as 173,000 by 2020.
Thyroid conditions affect five times as many women as men, particularly in the case of Hashimoto’s disease – the incidence in women is more than eight times that in men – and Graves’ disease, where women have a nearly sixfold higher incidence than men, according to the report, which is available online.
The most common thyroid disease is thyroid nodules, which international studies estimate affect up to 60% of the population. In the United States, findings from a study using chest radiography found nearly one in four adult outpatients had thyroid nodules.
The diagnosis of thyroid nodules has increased as imaging technologies such as CT scanning, ultrasound, and MRI improve on the traditional diagnostic method of physical examination. The increase in thyroid surgery for this condition has raised questions about whether this has led to improved outcomes.
Hyperthyroidism and hypothyroidism have a lower prevalence, although estimates suggest as much as 13% of the U.S. population has subclinical hypothyroidism.
This has implications particularly in pregnancy, as subclinical hypothyroidism may increase the risk of pregnancy complications, including preeclampsia, placental abruption, preterm birth, and neonatal mortality.
One study found that 12.4% of healthy pregnant women with no known thyroid disease had subclinical hypothyroidism. Overt hypothyroidism affects around 0.8% of adults, while overt hyperthyroidism affects just 0.5% of adults, the report stated.
Graves’ disease is one form of hyperthyroidism, and it has a prevalence in the U.S. population of 0.63%-1.49%, mostly affecting women, African Americans, and Asian/Pacific Islanders.
This condition is most commonly treated with antithyroid drugs or radioactive iodine therapy, although around 0.7% of patients undergo thyroidectomies.
Another group of thyroid diseases, grouped under the umbrella term of thyroiditis, includes a common element of inflammation of the thyroid gland. Among them is the autoimmune condition Hashimoto’s thyroiditis, which is thought to affect around 4.6% of the population.
Postpartum thyroiditis – an inflammatory autoimmune condition that develops in the first year after delivery – is estimated to have a prevalence around 4.5%, according to one review.
“Evidence is emerging that as women age subclinical hypothyroidism – as a sequel of postpartum thyroiditis – predisposes them to cardiovascular disease,” wrote Dr. Vigersky, also of the Uniformed Services University of the Health Sciences, and the other panel members.
“Hence, postpartum thyroiditis is no longer considered a mild and transient disorder.”
The report was produced by the Endocrine Society. There were no conflicts of interest declared.
Key clinical point: There was a steady rise in the number of endocrine procedures performed in the United States over the past decade.
Major finding: In 2008, thyroid disease treatment costs in women alone totaled $4.3 billion.
Data source: A publication of the Endocrine Society.
Disclosures: The report was produced by the Endocrine Society. There were no conflicts of interest declared.
Subclinical hyperthyroidism linked to higher fracture risk
Individuals with subclinical hyperthyroidism are at increased risk of hip and other fractures, according to the authors of a meta-analysis.
Researchers examined data from 70,298 individuals – 4,092 with subclinical hypothyroidism and 2,219 with subclinical hyperthyroidism – enrolled in 13 prospective cohort studies.
After adjusting for age, sex, and other fracture risk factors, the researchers found that individuals with subclinical hyperthyroidism had a 28% increase in the risk of any fracture and a 36% increased risk of hip fracture compared to individuals with normal thyroid function.
Subclinical hyperthyroidism – defined as a thyroid-stimulating hormone (TSH) level of less than 0.45 mIU/L with normal FT4 levels – was also associated with a 16% increase in the risk of nonspine fracture, according to a paper published online in the May 26 edition of JAMA.
Men with subclinical hyperthyroidism had a more than 3.5-fold increased in the risk of spine fracture, but the increase was not significant in women.
Lower TSH was associated with higher fracture rates, and the analysis showed a 61% increase in the risk of hip fracture and more than a 3.5-fold increase in spine fracture risk among individuals with a TSH less than 0.10 mIU/L.
The analysis yielded no link between subclinical hypothyroidism and fracture risk, and a comparison of fracture risk between individuals treated with thyroxine at baseline and untreated participants also showed no impact of thyroxine therapy on fracture outcomes (JAMA 2015, May 26 [doi:10.1001/jama.2015.5161].
“In prospective cohort studies, data about the association between subclinical thyroid dysfunction and fracture risk are in conflict because of inclusion of participants with overt thyroid disease and small sample sizes of participants with thyroid dysfunction or fracture events,” wrote Dr. Manuel R. Blum of Bern University Hospital, Switzerland, and an international team of coauthors.
They proposed three mechanisms by which thyroid dysfunction may affect fracture risk.
“First, thyroid hormones have been shown to have effects on osteoclasts and osteoblasts, with thyroid status in the upper normal range or excess thyroid hormones leading to accelerated bone turnover with bone loss and increased fracture risk,” they wrote.
Subclinical hyperthyroidism may also increase the risk of falls by affecting muscle strength and coordination, and thyroxine supplementation was also suggested as impacting fracture risk.
“Endogenous subclinical hyperthyroidism may be undetected for years because symptoms of subclinical hyperthyroidism are often nonspecific or absent,” the authors wrote. “This phenomenon has the potential to lead to a greater length of time for adverse associations with bone metabolism.”
The authors stressed the limitations of the observational data; for example, that thyroid function was assessed only at baseline and that some individuals may have progressed to overt thyroid dysfunction over the course of the study, and a lack of uniform definition of fracture type across the cohorts.
They said their findings supported current guideline recommendations that anyone aged 65 years or older, with subclinical hyperthyroidism and a TSH persistently lower than 0.1 mIU/L, should be treated, and treatment should be considered in those individuals with low TSH but still above 0.1 mIU/L.
The Swiss National Science Foundation and Swiss Heart Foundation supported the study. Some authors disclosed personal fees, grants and funding from a range of pharmaceutical companies.
Individuals with subclinical hyperthyroidism are at increased risk of hip and other fractures, according to the authors of a meta-analysis.
Researchers examined data from 70,298 individuals – 4,092 with subclinical hypothyroidism and 2,219 with subclinical hyperthyroidism – enrolled in 13 prospective cohort studies.
After adjusting for age, sex, and other fracture risk factors, the researchers found that individuals with subclinical hyperthyroidism had a 28% increase in the risk of any fracture and a 36% increased risk of hip fracture compared to individuals with normal thyroid function.
Subclinical hyperthyroidism – defined as a thyroid-stimulating hormone (TSH) level of less than 0.45 mIU/L with normal FT4 levels – was also associated with a 16% increase in the risk of nonspine fracture, according to a paper published online in the May 26 edition of JAMA.
Men with subclinical hyperthyroidism had a more than 3.5-fold increased in the risk of spine fracture, but the increase was not significant in women.
Lower TSH was associated with higher fracture rates, and the analysis showed a 61% increase in the risk of hip fracture and more than a 3.5-fold increase in spine fracture risk among individuals with a TSH less than 0.10 mIU/L.
The analysis yielded no link between subclinical hypothyroidism and fracture risk, and a comparison of fracture risk between individuals treated with thyroxine at baseline and untreated participants also showed no impact of thyroxine therapy on fracture outcomes (JAMA 2015, May 26 [doi:10.1001/jama.2015.5161].
“In prospective cohort studies, data about the association between subclinical thyroid dysfunction and fracture risk are in conflict because of inclusion of participants with overt thyroid disease and small sample sizes of participants with thyroid dysfunction or fracture events,” wrote Dr. Manuel R. Blum of Bern University Hospital, Switzerland, and an international team of coauthors.
They proposed three mechanisms by which thyroid dysfunction may affect fracture risk.
“First, thyroid hormones have been shown to have effects on osteoclasts and osteoblasts, with thyroid status in the upper normal range or excess thyroid hormones leading to accelerated bone turnover with bone loss and increased fracture risk,” they wrote.
Subclinical hyperthyroidism may also increase the risk of falls by affecting muscle strength and coordination, and thyroxine supplementation was also suggested as impacting fracture risk.
“Endogenous subclinical hyperthyroidism may be undetected for years because symptoms of subclinical hyperthyroidism are often nonspecific or absent,” the authors wrote. “This phenomenon has the potential to lead to a greater length of time for adverse associations with bone metabolism.”
The authors stressed the limitations of the observational data; for example, that thyroid function was assessed only at baseline and that some individuals may have progressed to overt thyroid dysfunction over the course of the study, and a lack of uniform definition of fracture type across the cohorts.
They said their findings supported current guideline recommendations that anyone aged 65 years or older, with subclinical hyperthyroidism and a TSH persistently lower than 0.1 mIU/L, should be treated, and treatment should be considered in those individuals with low TSH but still above 0.1 mIU/L.
The Swiss National Science Foundation and Swiss Heart Foundation supported the study. Some authors disclosed personal fees, grants and funding from a range of pharmaceutical companies.
Individuals with subclinical hyperthyroidism are at increased risk of hip and other fractures, according to the authors of a meta-analysis.
Researchers examined data from 70,298 individuals – 4,092 with subclinical hypothyroidism and 2,219 with subclinical hyperthyroidism – enrolled in 13 prospective cohort studies.
After adjusting for age, sex, and other fracture risk factors, the researchers found that individuals with subclinical hyperthyroidism had a 28% increase in the risk of any fracture and a 36% increased risk of hip fracture compared to individuals with normal thyroid function.
Subclinical hyperthyroidism – defined as a thyroid-stimulating hormone (TSH) level of less than 0.45 mIU/L with normal FT4 levels – was also associated with a 16% increase in the risk of nonspine fracture, according to a paper published online in the May 26 edition of JAMA.
Men with subclinical hyperthyroidism had a more than 3.5-fold increased in the risk of spine fracture, but the increase was not significant in women.
Lower TSH was associated with higher fracture rates, and the analysis showed a 61% increase in the risk of hip fracture and more than a 3.5-fold increase in spine fracture risk among individuals with a TSH less than 0.10 mIU/L.
The analysis yielded no link between subclinical hypothyroidism and fracture risk, and a comparison of fracture risk between individuals treated with thyroxine at baseline and untreated participants also showed no impact of thyroxine therapy on fracture outcomes (JAMA 2015, May 26 [doi:10.1001/jama.2015.5161].
“In prospective cohort studies, data about the association between subclinical thyroid dysfunction and fracture risk are in conflict because of inclusion of participants with overt thyroid disease and small sample sizes of participants with thyroid dysfunction or fracture events,” wrote Dr. Manuel R. Blum of Bern University Hospital, Switzerland, and an international team of coauthors.
They proposed three mechanisms by which thyroid dysfunction may affect fracture risk.
“First, thyroid hormones have been shown to have effects on osteoclasts and osteoblasts, with thyroid status in the upper normal range or excess thyroid hormones leading to accelerated bone turnover with bone loss and increased fracture risk,” they wrote.
Subclinical hyperthyroidism may also increase the risk of falls by affecting muscle strength and coordination, and thyroxine supplementation was also suggested as impacting fracture risk.
“Endogenous subclinical hyperthyroidism may be undetected for years because symptoms of subclinical hyperthyroidism are often nonspecific or absent,” the authors wrote. “This phenomenon has the potential to lead to a greater length of time for adverse associations with bone metabolism.”
The authors stressed the limitations of the observational data; for example, that thyroid function was assessed only at baseline and that some individuals may have progressed to overt thyroid dysfunction over the course of the study, and a lack of uniform definition of fracture type across the cohorts.
They said their findings supported current guideline recommendations that anyone aged 65 years or older, with subclinical hyperthyroidism and a TSH persistently lower than 0.1 mIU/L, should be treated, and treatment should be considered in those individuals with low TSH but still above 0.1 mIU/L.
The Swiss National Science Foundation and Swiss Heart Foundation supported the study. Some authors disclosed personal fees, grants and funding from a range of pharmaceutical companies.
FROM JAMA
Key clinical point: Subclinical hyperthyroidism is associated with an increased risk of hip and other fractures.
Major finding: Individuals with subclinical hyperthyroidism had a 28% increase in their risk of any fracture compared to individuals with normal thyroid function.
Data source: A meta-analysis of 13 prospective cohort studies comprising 70,298 individuals.
Disclosures: The Swiss National Science Foundation and Swiss Heart Foundation supported the study. Some authors disclosed personal fees, grants, and funding from a range of pharmaceutical companies.
Warfarin bridge therapy ups bleeding risk, with no reduction in VTE
Bridge therapy for warfarin patients undergoing invasive therapy is unnecessary for most, said investigators who found an increased risk of bleeding associated with the use of short-acting anticoagulant at the time of the procedure.
A retrospective cohort study of 1,812 procedures in 1,178 patients – most of whom were considered to be at low risk of venous thromboembolism recurrence – showed a 17-fold increase in the risk of clinically relevant bleeding in the group that received bridge anticoagulant therapy, compared with the group that didn’t (2.7% vs. 0.2%).
There was, however, no significant difference in the rate of recurrent venous thromboembolism between the bridge-therapy and non–bridge-therapy groups (0 vs. 3), and no deaths were observed in either group, according to an article published online May 26 (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.1843].
“Our results confirm and strengthen the findings of those previous studies and highlight the need for a risk categorization scheme that identifies patients at highest risk for recurrent VTE who may benefit from bridge therapy,” wrote Thomas Delate, Ph.D., from Kaiser Permanente Colorado, and coauthors.
The study was conducted and supported by Kaiser Permanente Colorado. One author reported consultancies with Astra-Zeneca, Boehringer-Ingelheim, Pfizer, and Sanofi.
|
| Dr. Daniel J. Brotman |
There are undoubtedly some patients at such high risk for recurrent venous thromboembolism that bridge therapy is a necessary evil, such as those with acute VTE in the preceding month and those with a prior pattern of brisk VTE recurrence during short-term interruption of anticoagulation therapy.
However, for the vast majority of patients receiving oral anticoagulants for VTE, it is probably safer to simply allow the oral anticoagulant to wash out before the procedure and, if indicated based on the type of surgery, to use routine prophylactic-dose anticoagulation therapy afterward.
Dr. Daniel J. Brotman and Dr. Michael B. Streiff are from Johns Hopkins University, Baltimore. These comments are taken from an accompanying editorial (JAMA Intern. Med. 2015 May 26 [doi:10.1001/jamainternmed.2015.1858]). Dr Streiff declared research funding from Bristol-Myers Squibb and Portola and consultancies for Boehringer-Ingelheim, Daiichi-Sankyo, Eisai, Janssen HealthCare, Pfizer, and Sanofi.
|
|
| Dr. Daniel J. Brotman |
There are undoubtedly some patients at such high risk for recurrent venous thromboembolism that bridge therapy is a necessary evil, such as those with acute VTE in the preceding month and those with a prior pattern of brisk VTE recurrence during short-term interruption of anticoagulation therapy.
However, for the vast majority of patients receiving oral anticoagulants for VTE, it is probably safer to simply allow the oral anticoagulant to wash out before the procedure and, if indicated based on the type of surgery, to use routine prophylactic-dose anticoagulation therapy afterward.
Dr. Daniel J. Brotman and Dr. Michael B. Streiff are from Johns Hopkins University, Baltimore. These comments are taken from an accompanying editorial (JAMA Intern. Med. 2015 May 26 [doi:10.1001/jamainternmed.2015.1858]). Dr Streiff declared research funding from Bristol-Myers Squibb and Portola and consultancies for Boehringer-Ingelheim, Daiichi-Sankyo, Eisai, Janssen HealthCare, Pfizer, and Sanofi.
|
|
| Dr. Daniel J. Brotman |
There are undoubtedly some patients at such high risk for recurrent venous thromboembolism that bridge therapy is a necessary evil, such as those with acute VTE in the preceding month and those with a prior pattern of brisk VTE recurrence during short-term interruption of anticoagulation therapy.
However, for the vast majority of patients receiving oral anticoagulants for VTE, it is probably safer to simply allow the oral anticoagulant to wash out before the procedure and, if indicated based on the type of surgery, to use routine prophylactic-dose anticoagulation therapy afterward.
Dr. Daniel J. Brotman and Dr. Michael B. Streiff are from Johns Hopkins University, Baltimore. These comments are taken from an accompanying editorial (JAMA Intern. Med. 2015 May 26 [doi:10.1001/jamainternmed.2015.1858]). Dr Streiff declared research funding from Bristol-Myers Squibb and Portola and consultancies for Boehringer-Ingelheim, Daiichi-Sankyo, Eisai, Janssen HealthCare, Pfizer, and Sanofi.
Bridge therapy for warfarin patients undergoing invasive therapy is unnecessary for most, said investigators who found an increased risk of bleeding associated with the use of short-acting anticoagulant at the time of the procedure.
A retrospective cohort study of 1,812 procedures in 1,178 patients – most of whom were considered to be at low risk of venous thromboembolism recurrence – showed a 17-fold increase in the risk of clinically relevant bleeding in the group that received bridge anticoagulant therapy, compared with the group that didn’t (2.7% vs. 0.2%).
There was, however, no significant difference in the rate of recurrent venous thromboembolism between the bridge-therapy and non–bridge-therapy groups (0 vs. 3), and no deaths were observed in either group, according to an article published online May 26 (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.1843].
“Our results confirm and strengthen the findings of those previous studies and highlight the need for a risk categorization scheme that identifies patients at highest risk for recurrent VTE who may benefit from bridge therapy,” wrote Thomas Delate, Ph.D., from Kaiser Permanente Colorado, and coauthors.
The study was conducted and supported by Kaiser Permanente Colorado. One author reported consultancies with Astra-Zeneca, Boehringer-Ingelheim, Pfizer, and Sanofi.
Bridge therapy for warfarin patients undergoing invasive therapy is unnecessary for most, said investigators who found an increased risk of bleeding associated with the use of short-acting anticoagulant at the time of the procedure.
A retrospective cohort study of 1,812 procedures in 1,178 patients – most of whom were considered to be at low risk of venous thromboembolism recurrence – showed a 17-fold increase in the risk of clinically relevant bleeding in the group that received bridge anticoagulant therapy, compared with the group that didn’t (2.7% vs. 0.2%).
There was, however, no significant difference in the rate of recurrent venous thromboembolism between the bridge-therapy and non–bridge-therapy groups (0 vs. 3), and no deaths were observed in either group, according to an article published online May 26 (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.1843].
“Our results confirm and strengthen the findings of those previous studies and highlight the need for a risk categorization scheme that identifies patients at highest risk for recurrent VTE who may benefit from bridge therapy,” wrote Thomas Delate, Ph.D., from Kaiser Permanente Colorado, and coauthors.
The study was conducted and supported by Kaiser Permanente Colorado. One author reported consultancies with Astra-Zeneca, Boehringer-Ingelheim, Pfizer, and Sanofi.
Key clinical point: Bridge therapy for warfarin patients undergoing invasive therapy is associated with an increased risk of bleeding without a reduction in thromboembolism risk.
Major finding: Patients given bridge therapy during invasive therapy had a 17-fold increase in the risk of clinically significant bleeding.
Data source: A retrospective cohort study of 1,812 procedures in 1,178 patients.
Disclosures: The study was conducted and supported by Kaiser Permanente Colorado. One author reported consultancies with AstraZeneca, Boehringer-Ingelheim, Pfizer, and Sanofi.
DXA screening: You’re doing it wrong
Dual-energy x-ray absorptiometry to screen for osteoporosis is both underused in women who meet the U.S. Preventive Services Task Force criteria for screening, and overused in low-risk younger women, new data suggest.
A retrospective, longitudinal cohort study of 50,995 women attending 13 primary care clinics found that among previously unscreened women who met the criteria for screening, the 7-year cumulative incidence of DXA screening ranged from 58.8% in women aged 60-64 years with at least one risk factor, to 42.7% in women aged 75 years and older.
But among women who didn’t meet screening criteria, the 7-year cumulative incidence was 45.5% in women aged 50-59 years and 58.6% in women aged 60-64 years without risk factors, according to a paper published May 19 in the Journal of General Internal Medicine (doi:10.1007/s11606-015-3349-8).
The U.S. Preventive Services Task Force currently recommends screening for osteoporosis with DXA for women aged 65 and older, as well as young women at increased risk for fracture. The American Academy of Family Physicians also advised against DXA screening in women younger than age 65 without osteoporosis risk factors as part of the “Choosing Wisely” campaign.
“Additional research is needed to elucidate patient, physician, and health system barriers to evidence-based screening so that interventions can maximize the value of population screening for osteoporosis,” wrote Dr. Anna Lee D. Amarnath of the University of California, Davis Health System, and her coauthors.
The study was supported by the National Institutes of Health and the Agency for Healthcare Research and Quality. The researchers reported having no financial disclosures.
Dual-energy x-ray absorptiometry to screen for osteoporosis is both underused in women who meet the U.S. Preventive Services Task Force criteria for screening, and overused in low-risk younger women, new data suggest.
A retrospective, longitudinal cohort study of 50,995 women attending 13 primary care clinics found that among previously unscreened women who met the criteria for screening, the 7-year cumulative incidence of DXA screening ranged from 58.8% in women aged 60-64 years with at least one risk factor, to 42.7% in women aged 75 years and older.
But among women who didn’t meet screening criteria, the 7-year cumulative incidence was 45.5% in women aged 50-59 years and 58.6% in women aged 60-64 years without risk factors, according to a paper published May 19 in the Journal of General Internal Medicine (doi:10.1007/s11606-015-3349-8).
The U.S. Preventive Services Task Force currently recommends screening for osteoporosis with DXA for women aged 65 and older, as well as young women at increased risk for fracture. The American Academy of Family Physicians also advised against DXA screening in women younger than age 65 without osteoporosis risk factors as part of the “Choosing Wisely” campaign.
“Additional research is needed to elucidate patient, physician, and health system barriers to evidence-based screening so that interventions can maximize the value of population screening for osteoporosis,” wrote Dr. Anna Lee D. Amarnath of the University of California, Davis Health System, and her coauthors.
The study was supported by the National Institutes of Health and the Agency for Healthcare Research and Quality. The researchers reported having no financial disclosures.
Dual-energy x-ray absorptiometry to screen for osteoporosis is both underused in women who meet the U.S. Preventive Services Task Force criteria for screening, and overused in low-risk younger women, new data suggest.
A retrospective, longitudinal cohort study of 50,995 women attending 13 primary care clinics found that among previously unscreened women who met the criteria for screening, the 7-year cumulative incidence of DXA screening ranged from 58.8% in women aged 60-64 years with at least one risk factor, to 42.7% in women aged 75 years and older.
But among women who didn’t meet screening criteria, the 7-year cumulative incidence was 45.5% in women aged 50-59 years and 58.6% in women aged 60-64 years without risk factors, according to a paper published May 19 in the Journal of General Internal Medicine (doi:10.1007/s11606-015-3349-8).
The U.S. Preventive Services Task Force currently recommends screening for osteoporosis with DXA for women aged 65 and older, as well as young women at increased risk for fracture. The American Academy of Family Physicians also advised against DXA screening in women younger than age 65 without osteoporosis risk factors as part of the “Choosing Wisely” campaign.
“Additional research is needed to elucidate patient, physician, and health system barriers to evidence-based screening so that interventions can maximize the value of population screening for osteoporosis,” wrote Dr. Anna Lee D. Amarnath of the University of California, Davis Health System, and her coauthors.
The study was supported by the National Institutes of Health and the Agency for Healthcare Research and Quality. The researchers reported having no financial disclosures.
FROM THE JOURNAL OF GENERAL INTERNAL MEDICINE
Key clinical point: DXA is underused in women who meet the U.S. Preventive Services Task Force criteria for osteoporosis screening and overused in women who do not.
Major finding: The 7-year cumulative incidence of DXA screening was virtually the same for women aged 60-64 years whether they met screening criteria (58.8%) or did not (58.6%).
Data source: A retrospective longitudinal cohort study of 50,995 women attending 13 primary care clinics.
Disclosures: The study was supported by the National Institutes of Health and the Agency for Healthcare Research and Quality. The researchers reported having no financial disclosures.
