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VIDEO: Treating your atopic dermatitis patients more effectively
ORLANDO – A “hard and soft” approach to treating atopic dermatitis – treating more frequently while symptoms persist, then pulling back on treatment to keep symptoms at bay – is an effective way to keep the condition manageable for your patients.
“This is not an easy disease to manage, and that’s the key,” explained Dr. Adam Friedman of the George Washington University in Washington, at the Orlando Dermatology Aesthetic and Clinical annual meeting, adding that it’s important to educate patients that atopic dermatitis is “something that they will always have” and does not have one-shot cures.
In this video interview, Dr. Friedman, who is a Dermatology News board member, discusses the best way to talk to new patients about what atopic dermatitis treatment will entail, and offers methods to make management of the disease more effective and, consequently, improve patients’ quality of life.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ORLANDO – A “hard and soft” approach to treating atopic dermatitis – treating more frequently while symptoms persist, then pulling back on treatment to keep symptoms at bay – is an effective way to keep the condition manageable for your patients.
“This is not an easy disease to manage, and that’s the key,” explained Dr. Adam Friedman of the George Washington University in Washington, at the Orlando Dermatology Aesthetic and Clinical annual meeting, adding that it’s important to educate patients that atopic dermatitis is “something that they will always have” and does not have one-shot cures.
In this video interview, Dr. Friedman, who is a Dermatology News board member, discusses the best way to talk to new patients about what atopic dermatitis treatment will entail, and offers methods to make management of the disease more effective and, consequently, improve patients’ quality of life.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ORLANDO – A “hard and soft” approach to treating atopic dermatitis – treating more frequently while symptoms persist, then pulling back on treatment to keep symptoms at bay – is an effective way to keep the condition manageable for your patients.
“This is not an easy disease to manage, and that’s the key,” explained Dr. Adam Friedman of the George Washington University in Washington, at the Orlando Dermatology Aesthetic and Clinical annual meeting, adding that it’s important to educate patients that atopic dermatitis is “something that they will always have” and does not have one-shot cures.
In this video interview, Dr. Friedman, who is a Dermatology News board member, discusses the best way to talk to new patients about what atopic dermatitis treatment will entail, and offers methods to make management of the disease more effective and, consequently, improve patients’ quality of life.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ODAC 2016
Pertussis Vaccine Possibly Ineffective in Preschoolers
Preschool-age children who have been fully vaccinated against pertussis can still develop symptoms of illness consistent with a whooping cough diagnosis, according to a study of toddlers in a Tallahassee, Fla., school that experienced an outbreak of pertussis in late 2013 (Emerg Infect Dis. 2016 Feb;22[2]. doi: 10.3201/eid2202.150325)
The study, published in Emerging Infectious Diseases by the Centers for Disease Control and Prevention, is the result of an outbreak investigation at the preschool that began after a 1-year-old and two 3-year-old children developed illness consistent with pertussis, and were confirmed to have pertussis after undergoing a polymerase chain reaction (PCR) test.
The Florida Department of Health administered a questionnaire to be completed by families of the 117 students (ages 10 months to 6 years) and 26 staff members. Questionnaire completion rate was 98%, with three student households and one staff household failing to complete it.
Overall, 28 cases were determined to be “probable” pertussis and 11 were confirmed as pertussis via PCR or other laboratory testing methods. Of these, 26 were students aged 1-5 years (22% of total student population), 2 were attributed to the staff (7%), and 11 were linked to the preschool, of which 9 originated from the households of the individual students and 2 from “camp counselors who had contact with a sibling of a laboratory-confirmed case-patient who attended the preschool.”
However, 28 of the students who had pertussis had received at least three vaccinations, with 23 of them having received at least four vaccinations, meaning they were classified as being fully vaccinated against the disease. Only 5 out of the school’s 117 children had not received the complete series of vaccinations, out of which 2 ended up being case-patients; both of those children, however, had received at least one vaccination prior to falling sick.
“Poor performance of a vaccine in a defined cohort might suggest a provider-level failure to store, use, and administer the vaccine properly,” noted the researchers, led by Dr. James Matthias of the Florida Department of Health. “Although we did not assess vaccine storage and handling practices, children from this investigation were seen by multiple providers in the community [and] no general increase in reported pertussis incidence was observed in the county at the same time as this outbreak.”
The bottom line, the authors concluded, is for pediatricians and primary care doctors to be wary that vaccination against pertussis doesn’t necessarily mean patients can’t ever get it. If pertussis symptoms arise in a vaccinated child, especially one 5 years old or younger, it may still be whooping cough.
The CDC supported the study. Dr. Matthias and his coauthors are all affiliated with the Florida Department of Health and the CDC, but reported no other relevant financial disclosures.
Preschool-age children who have been fully vaccinated against pertussis can still develop symptoms of illness consistent with a whooping cough diagnosis, according to a study of toddlers in a Tallahassee, Fla., school that experienced an outbreak of pertussis in late 2013 (Emerg Infect Dis. 2016 Feb;22[2]. doi: 10.3201/eid2202.150325)
The study, published in Emerging Infectious Diseases by the Centers for Disease Control and Prevention, is the result of an outbreak investigation at the preschool that began after a 1-year-old and two 3-year-old children developed illness consistent with pertussis, and were confirmed to have pertussis after undergoing a polymerase chain reaction (PCR) test.
The Florida Department of Health administered a questionnaire to be completed by families of the 117 students (ages 10 months to 6 years) and 26 staff members. Questionnaire completion rate was 98%, with three student households and one staff household failing to complete it.
Overall, 28 cases were determined to be “probable” pertussis and 11 were confirmed as pertussis via PCR or other laboratory testing methods. Of these, 26 were students aged 1-5 years (22% of total student population), 2 were attributed to the staff (7%), and 11 were linked to the preschool, of which 9 originated from the households of the individual students and 2 from “camp counselors who had contact with a sibling of a laboratory-confirmed case-patient who attended the preschool.”
However, 28 of the students who had pertussis had received at least three vaccinations, with 23 of them having received at least four vaccinations, meaning they were classified as being fully vaccinated against the disease. Only 5 out of the school’s 117 children had not received the complete series of vaccinations, out of which 2 ended up being case-patients; both of those children, however, had received at least one vaccination prior to falling sick.
“Poor performance of a vaccine in a defined cohort might suggest a provider-level failure to store, use, and administer the vaccine properly,” noted the researchers, led by Dr. James Matthias of the Florida Department of Health. “Although we did not assess vaccine storage and handling practices, children from this investigation were seen by multiple providers in the community [and] no general increase in reported pertussis incidence was observed in the county at the same time as this outbreak.”
The bottom line, the authors concluded, is for pediatricians and primary care doctors to be wary that vaccination against pertussis doesn’t necessarily mean patients can’t ever get it. If pertussis symptoms arise in a vaccinated child, especially one 5 years old or younger, it may still be whooping cough.
The CDC supported the study. Dr. Matthias and his coauthors are all affiliated with the Florida Department of Health and the CDC, but reported no other relevant financial disclosures.
Preschool-age children who have been fully vaccinated against pertussis can still develop symptoms of illness consistent with a whooping cough diagnosis, according to a study of toddlers in a Tallahassee, Fla., school that experienced an outbreak of pertussis in late 2013 (Emerg Infect Dis. 2016 Feb;22[2]. doi: 10.3201/eid2202.150325)
The study, published in Emerging Infectious Diseases by the Centers for Disease Control and Prevention, is the result of an outbreak investigation at the preschool that began after a 1-year-old and two 3-year-old children developed illness consistent with pertussis, and were confirmed to have pertussis after undergoing a polymerase chain reaction (PCR) test.
The Florida Department of Health administered a questionnaire to be completed by families of the 117 students (ages 10 months to 6 years) and 26 staff members. Questionnaire completion rate was 98%, with three student households and one staff household failing to complete it.
Overall, 28 cases were determined to be “probable” pertussis and 11 were confirmed as pertussis via PCR or other laboratory testing methods. Of these, 26 were students aged 1-5 years (22% of total student population), 2 were attributed to the staff (7%), and 11 were linked to the preschool, of which 9 originated from the households of the individual students and 2 from “camp counselors who had contact with a sibling of a laboratory-confirmed case-patient who attended the preschool.”
However, 28 of the students who had pertussis had received at least three vaccinations, with 23 of them having received at least four vaccinations, meaning they were classified as being fully vaccinated against the disease. Only 5 out of the school’s 117 children had not received the complete series of vaccinations, out of which 2 ended up being case-patients; both of those children, however, had received at least one vaccination prior to falling sick.
“Poor performance of a vaccine in a defined cohort might suggest a provider-level failure to store, use, and administer the vaccine properly,” noted the researchers, led by Dr. James Matthias of the Florida Department of Health. “Although we did not assess vaccine storage and handling practices, children from this investigation were seen by multiple providers in the community [and] no general increase in reported pertussis incidence was observed in the county at the same time as this outbreak.”
The bottom line, the authors concluded, is for pediatricians and primary care doctors to be wary that vaccination against pertussis doesn’t necessarily mean patients can’t ever get it. If pertussis symptoms arise in a vaccinated child, especially one 5 years old or younger, it may still be whooping cough.
The CDC supported the study. Dr. Matthias and his coauthors are all affiliated with the Florida Department of Health and the CDC, but reported no other relevant financial disclosures.
FROM EMERGING INFECTIOUS DISEASES
Pertussis vaccine possibly ineffective in preschoolers
Preschool-age children who have been fully vaccinated against pertussis can still develop symptoms of illness consistent with a whooping cough diagnosis, according to a study of toddlers in a Tallahassee, Fla., school that experienced an outbreak of pertussis in late 2013 (Emerg Infect Dis. 2016 Feb;22[2]. doi: 10.3201/eid2202.150325)
The study, published in Emerging Infectious Diseases by the Centers for Disease Control and Prevention, is the result of an outbreak investigation at the preschool that began after a 1-year-old and two 3-year-old children developed illness consistent with pertussis, and were confirmed to have pertussis after undergoing a polymerase chain reaction (PCR) test.
The Florida Department of Health administered a questionnaire to be completed by families of the 117 students (ages 10 months to 6 years) and 26 staff members. Questionnaire completion rate was 98%, with three student households and one staff household failing to complete it.
Overall, 28 cases were determined to be “probable” pertussis and 11 were confirmed as pertussis via PCR or other laboratory testing methods. Of these, 26 were students aged 1-5 years (22% of total student population), 2 were attributed to the staff (7%), and 11 were linked to the preschool, of which 9 originated from the households of the individual students and 2 from “camp counselors who had contact with a sibling of a laboratory-confirmed case-patient who attended the preschool.”
However, 28 of the students who had pertussis had received at least three vaccinations, with 23 of them having received at least four vaccinations, meaning they were classified as being fully vaccinated against the disease. Only 5 out of the school’s 117 children had not received the complete series of vaccinations, out of which 2 ended up being case-patients; both of those children, however, had received at least one vaccination prior to falling sick.
“Poor performance of a vaccine in a defined cohort might suggest a provider-level failure to store, use, and administer the vaccine properly,” noted the researchers, led by Dr. James Matthias of the Florida Department of Health. “Although we did not assess vaccine storage and handling practices, children from this investigation were seen by multiple providers in the community [and] no general increase in reported pertussis incidence was observed in the county at the same time as this outbreak.”
The bottom line, the authors concluded, is for pediatricians and primary care doctors to be wary that vaccination against pertussis doesn’t necessarily mean patients can’t ever get it. If pertussis symptoms arise in a vaccinated child, especially one 5 years old or younger, it may still be whooping cough.
The CDC supported the study. Dr. Matthias and his coauthors are all affiliated with the Florida Department of Health and the CDC, but reported no other relevant financial disclosures.
Preschool-age children who have been fully vaccinated against pertussis can still develop symptoms of illness consistent with a whooping cough diagnosis, according to a study of toddlers in a Tallahassee, Fla., school that experienced an outbreak of pertussis in late 2013 (Emerg Infect Dis. 2016 Feb;22[2]. doi: 10.3201/eid2202.150325)
The study, published in Emerging Infectious Diseases by the Centers for Disease Control and Prevention, is the result of an outbreak investigation at the preschool that began after a 1-year-old and two 3-year-old children developed illness consistent with pertussis, and were confirmed to have pertussis after undergoing a polymerase chain reaction (PCR) test.
The Florida Department of Health administered a questionnaire to be completed by families of the 117 students (ages 10 months to 6 years) and 26 staff members. Questionnaire completion rate was 98%, with three student households and one staff household failing to complete it.
Overall, 28 cases were determined to be “probable” pertussis and 11 were confirmed as pertussis via PCR or other laboratory testing methods. Of these, 26 were students aged 1-5 years (22% of total student population), 2 were attributed to the staff (7%), and 11 were linked to the preschool, of which 9 originated from the households of the individual students and 2 from “camp counselors who had contact with a sibling of a laboratory-confirmed case-patient who attended the preschool.”
However, 28 of the students who had pertussis had received at least three vaccinations, with 23 of them having received at least four vaccinations, meaning they were classified as being fully vaccinated against the disease. Only 5 out of the school’s 117 children had not received the complete series of vaccinations, out of which 2 ended up being case-patients; both of those children, however, had received at least one vaccination prior to falling sick.
“Poor performance of a vaccine in a defined cohort might suggest a provider-level failure to store, use, and administer the vaccine properly,” noted the researchers, led by Dr. James Matthias of the Florida Department of Health. “Although we did not assess vaccine storage and handling practices, children from this investigation were seen by multiple providers in the community [and] no general increase in reported pertussis incidence was observed in the county at the same time as this outbreak.”
The bottom line, the authors concluded, is for pediatricians and primary care doctors to be wary that vaccination against pertussis doesn’t necessarily mean patients can’t ever get it. If pertussis symptoms arise in a vaccinated child, especially one 5 years old or younger, it may still be whooping cough.
The CDC supported the study. Dr. Matthias and his coauthors are all affiliated with the Florida Department of Health and the CDC, but reported no other relevant financial disclosures.
Preschool-age children who have been fully vaccinated against pertussis can still develop symptoms of illness consistent with a whooping cough diagnosis, according to a study of toddlers in a Tallahassee, Fla., school that experienced an outbreak of pertussis in late 2013 (Emerg Infect Dis. 2016 Feb;22[2]. doi: 10.3201/eid2202.150325)
The study, published in Emerging Infectious Diseases by the Centers for Disease Control and Prevention, is the result of an outbreak investigation at the preschool that began after a 1-year-old and two 3-year-old children developed illness consistent with pertussis, and were confirmed to have pertussis after undergoing a polymerase chain reaction (PCR) test.
The Florida Department of Health administered a questionnaire to be completed by families of the 117 students (ages 10 months to 6 years) and 26 staff members. Questionnaire completion rate was 98%, with three student households and one staff household failing to complete it.
Overall, 28 cases were determined to be “probable” pertussis and 11 were confirmed as pertussis via PCR or other laboratory testing methods. Of these, 26 were students aged 1-5 years (22% of total student population), 2 were attributed to the staff (7%), and 11 were linked to the preschool, of which 9 originated from the households of the individual students and 2 from “camp counselors who had contact with a sibling of a laboratory-confirmed case-patient who attended the preschool.”
However, 28 of the students who had pertussis had received at least three vaccinations, with 23 of them having received at least four vaccinations, meaning they were classified as being fully vaccinated against the disease. Only 5 out of the school’s 117 children had not received the complete series of vaccinations, out of which 2 ended up being case-patients; both of those children, however, had received at least one vaccination prior to falling sick.
“Poor performance of a vaccine in a defined cohort might suggest a provider-level failure to store, use, and administer the vaccine properly,” noted the researchers, led by Dr. James Matthias of the Florida Department of Health. “Although we did not assess vaccine storage and handling practices, children from this investigation were seen by multiple providers in the community [and] no general increase in reported pertussis incidence was observed in the county at the same time as this outbreak.”
The bottom line, the authors concluded, is for pediatricians and primary care doctors to be wary that vaccination against pertussis doesn’t necessarily mean patients can’t ever get it. If pertussis symptoms arise in a vaccinated child, especially one 5 years old or younger, it may still be whooping cough.
The CDC supported the study. Dr. Matthias and his coauthors are all affiliated with the Florida Department of Health and the CDC, but reported no other relevant financial disclosures.
FROM EMERGING INFECTIOUS DISEASES
Key clinical point: Preschoolers vaccinated against pertussis may still develop whooping cough or similar symptoms.
Major finding: Children who had received full series of pertussis vaccinations still developed whooping cough during an outbreak at a school of 117 children.
Data source: Survey of 117 students and 26 staff members at a Tallahassee, Fla., school in 2014.
Disclosures: The CDC supported the study. Dr. Matthias and his coauthors are all affiliated with the Florida Department of Health and the CDC, but reported no other relevant financial disclosures.
SecA inhibitors show in vitro efficacy against MRSA
A promising approach to treating methicillin-resistant Staphylococcus aureus (MRSA) infections may lie in small molecules that target SecA, an indispensable ATPase of the general protein translocation machinery present in bacteria, according to Jinshan Jin, Ph.D.
Dr. Jin and his coinvestigators at Georgia State University developed small molecule analogs of Rose Bengal that target SecA. In in vitro studies, the analogs had potent antimicrobial activities, reduced the secretion of toxins, and overcame the effect of efflux pumps, which are responsible for multi-drug resistance. The ability to inhibit virulence factor secretion is something most currently available and commonly prescribed antibiotics are unable to do, making small molecule treatments an attractive option if such treatments are proven effective in vivo. The small molecule inhibitors reduced the secretion of three toxins from S. aureus and exerted potent bacteriostatic effects against three MRSA strains, the researchers reported (Bioorganic & Medicinal Chemistry Vol. 23; 2015, 7061–68). “Our best inhibitor SCA-50 showed potent concentration-dependent bactericidal activity against MRSA Mu50 strain and very importantly, 2–60 fold more potent inhibitory effect on MRSA Mu50 than all the commonly used antibiotics including vancomycin, which is considered the last resort option in treating MRSA-related infections.”
“The results obtained demonstrated an important proof of concept [that] targeting SecA could achieve antimicrobial effect through three mechanisms, which are not seen with any single class of antimicrobial agents,” Dr. Jin and his coauthors wrote.
This study was funded by the National Institutes of Health and by Georgia State University. Dr. Jin is now with the National Center of Toxicological Research, in Jefferson, Ariz.
A promising approach to treating methicillin-resistant Staphylococcus aureus (MRSA) infections may lie in small molecules that target SecA, an indispensable ATPase of the general protein translocation machinery present in bacteria, according to Jinshan Jin, Ph.D.
Dr. Jin and his coinvestigators at Georgia State University developed small molecule analogs of Rose Bengal that target SecA. In in vitro studies, the analogs had potent antimicrobial activities, reduced the secretion of toxins, and overcame the effect of efflux pumps, which are responsible for multi-drug resistance. The ability to inhibit virulence factor secretion is something most currently available and commonly prescribed antibiotics are unable to do, making small molecule treatments an attractive option if such treatments are proven effective in vivo. The small molecule inhibitors reduced the secretion of three toxins from S. aureus and exerted potent bacteriostatic effects against three MRSA strains, the researchers reported (Bioorganic & Medicinal Chemistry Vol. 23; 2015, 7061–68). “Our best inhibitor SCA-50 showed potent concentration-dependent bactericidal activity against MRSA Mu50 strain and very importantly, 2–60 fold more potent inhibitory effect on MRSA Mu50 than all the commonly used antibiotics including vancomycin, which is considered the last resort option in treating MRSA-related infections.”
“The results obtained demonstrated an important proof of concept [that] targeting SecA could achieve antimicrobial effect through three mechanisms, which are not seen with any single class of antimicrobial agents,” Dr. Jin and his coauthors wrote.
This study was funded by the National Institutes of Health and by Georgia State University. Dr. Jin is now with the National Center of Toxicological Research, in Jefferson, Ariz.
A promising approach to treating methicillin-resistant Staphylococcus aureus (MRSA) infections may lie in small molecules that target SecA, an indispensable ATPase of the general protein translocation machinery present in bacteria, according to Jinshan Jin, Ph.D.
Dr. Jin and his coinvestigators at Georgia State University developed small molecule analogs of Rose Bengal that target SecA. In in vitro studies, the analogs had potent antimicrobial activities, reduced the secretion of toxins, and overcame the effect of efflux pumps, which are responsible for multi-drug resistance. The ability to inhibit virulence factor secretion is something most currently available and commonly prescribed antibiotics are unable to do, making small molecule treatments an attractive option if such treatments are proven effective in vivo. The small molecule inhibitors reduced the secretion of three toxins from S. aureus and exerted potent bacteriostatic effects against three MRSA strains, the researchers reported (Bioorganic & Medicinal Chemistry Vol. 23; 2015, 7061–68). “Our best inhibitor SCA-50 showed potent concentration-dependent bactericidal activity against MRSA Mu50 strain and very importantly, 2–60 fold more potent inhibitory effect on MRSA Mu50 than all the commonly used antibiotics including vancomycin, which is considered the last resort option in treating MRSA-related infections.”
“The results obtained demonstrated an important proof of concept [that] targeting SecA could achieve antimicrobial effect through three mechanisms, which are not seen with any single class of antimicrobial agents,” Dr. Jin and his coauthors wrote.
This study was funded by the National Institutes of Health and by Georgia State University. Dr. Jin is now with the National Center of Toxicological Research, in Jefferson, Ariz.
FROM BIOORGANIC & MEDICINAL CHEMISTRY
How new dietary guidelines affect health care providers
The U.S. Department of Health and Human Services and the U.S. Department of Agriculture have released the eighth iteration of the Dietary Guidelines for Americans, a set of recommendations for healthy eating habits Americans should adopt to prevent development of hypertension, heart disease, and type 2 diabetes, among other conditions.
The new guidelines, effective through 2020, highlight the importance of eating a wide variety of fruits, vegetables, grains, and dairy products, while staying away from processed foods heavy in saturated fats, sugar, and cholesterol as much as possible. The difference between this and earlier editions of the guidelines, the health agencies say, is to promote the importance of a wider variety of foods Americans should be consuming, rather than focusing on just a few isolated foods that should be integrated into an otherwise inadequate diet.
“Protecting the health of the American public includes empowering them with the tools they need to make healthy choices in their daily lives,” Secretary of Health and Human Services Sylvia M. Burwell said in a statement. “By focusing on small shifts in what we eat and drink, eating healthy becomes more manageable. The Dietary Guidelines provide science-based recommendations on food and nutrition so people can make decisions that may help keep their weight under control, and prevent chronic conditions, like Type 2 diabetes, hypertension, and heart disease.”
The American Medical Association voiced their support of the new guidelines, saying that they are “extremely pleased that the new recommendations call for significantly reducing the amount of added sugars and sugar sweetened beverages from the American diet.” Similarly, the American College of Cardiology issued a statement saying that the existence of “a source of clear science-based information about diet” is more important than ever for Americans in the face of increasingly omnipresent and often confusing information available; the college also lauded the recommendations to limit the intake of added sugars, saturated and trans fats, and sodium. The American Heart Association released a new Authoritative Review of data on the topic of nutritional balance as it related to chronic diseases.
While the recommendations may seem common sense and geared more towards patients and laymen, they are of equal importance to health care providers. Dr. Carolyn Lopez – a Chicago-area family physician and adjunct professor of medicine at Northwestern University – called the guidelines an important resource for physicians, with several elements that will be of particular benefit to physicians and clinicians looking to improve the quality of care given to their patients.
“People [should] understand that while individual food choices are important, the pattern of eating is paramount,” Dr. Lopez explained in an interview. “It’s not impossible to bring vegetables into breakfast – veggie omelettes are great – but it’s hard to imagine bringing a vegetable into the whole grain cereals with skim milk breakfast.”
As a family practitioner, however, Dr. Lopez stressed the difficulty of any doctor having a significant enough amount of time with each patient to really go in-depth into what needs to be done to enact meaningful nutritional and lifestyle changes. “These guidelines can only be effective if the whole team is talking to patients,” she explained. “On its own, it would be extraordinarily difficult [or] impossible to accomplish.
Dr. Nazrat Mirza, a pediatrician who is medical director of the IDEAL Pediatric Weight Management Clinic at Children’s National Health System, Washington, said in an interview that the guidelines are “significant in that they are leading us even closer to healthier dietary living – and from my pediatric perspective, healthier children who will grow into healthier adults. We must keep in mind that these guidelines are not prescriptive – but generalized to relatively healthy people. In particular, the recommendation to reduce sugar intake with specification of an upper limit of 10% of calories from added sugar factored into the suggested daily nutritional intake is an excellent update. Added sugar consumption is linked to diabetes, so any reduction in recommended intake will steer people away from potentially developing diabetes.”
She continued, “In my clinic and day-to-day counseling of patients, being able to point to helpful resources such as these guidelines is crucial. These guidelines will continue to serve as yet another way to reach parents and affect the daily dietary habits they practice at home. I was happy to see resources such as MyPlate.gov referenced in the guidelines; that is a tool I use regularly. When educating families on what a healthy plate looks like, I’m able to point directly to the MyPlate.gov posters hanging in the clinic. Comprehensive resources such as these guidelines, [which] give parents actual examples of foods, and deliver the information in a clear, concise, implementable way, are the best methods to reach parents and kids.”
“As a medical provider, such guidelines provide us with tools and reinforcement to say ‘this is policy,’ when approaching schools about the food and drink options they offer children on a daily basis – because the schools are going to have to follow these guidelines. If these guidelines can enforce public policy for the kids to eat healthy, ... and we can implement changes according to the guidelines, that would help greatly in the prevention of chronic disorders such as obesity, hypertension and diabetes – which is a step in the right direction,” said Dr. Mirza, also of George Washington University, Washington.
“Most physicians are so rushed nowadays by the health care system that they typically do not have adequate time to discuss these very important issues,” Dr. Rodbard said in an interview. “It takes time and perseverance to educate the patient and provide individualized care, assessing their current diet, assessing their willingness or potential for changing their diet or increasing their physical activity.”
On that last point. Dr. Rodbard criticized the new guidelines for not emphasizing the importance of exercise enough. “More clarity and emphasis on physical activity should have been provided,” she said, adding that “people need continual, gentle reminders with repetition and long-term follow-up.” Dr. Rodbard summed up the guidelines as “marginally adequate” but “a step in the right direction.”
An endocrinologist who practices in Winter Park, Fla., Dr. Victor L. Roberts – a Fellow of the ACP and ACE – agreed that time with the patients is critical in order for these guidelines to have any effect, calling the guidelines “just the GPS, not the destination.”
Preaching an ABC strategy – accountability, behavior, and calories, the latter of which he stressed is the most important part of any dietary strategy – Dr. Roberts explained that clinicians and physicians should leave the more specific dietary advice to nutritional experts and focus on telling their patients to watch calories, watch the amount of food they’re eating of any given type, and to exercise more.
“These guidelines crystallize and summarize what we’ve already known, and what we should have been practicing and advocating, for decades,” Dr. Roberts said in an interview, adding that “the difficulty is putting these recommendations into practice and having patients and doctors accept responsibility.”
Ultimately, the three doctors who treat adult patients concurred that the new guidelines are imperfect, and likely won’t result in any automatic widespread change. Dr. Rodbard admitted that she does not anticipate the guidelines affecting the way she treats her patients very much, if at all, while Dr. Lopez said that she’s “not sure it’s going to have a major effect.” Furthermore, the sheer volume of data and information available often leads to patients simply not knowing what to believe, which Dr. Roberts described as a “glazed over” effect of being told so many different things from so many different sources, patients just tune everything out.
Ultimately, while it’s important for health care providers to give advice and recommendations as necessary, these should be done on an individual basis. And, if a patient requires extensive dietary and nutritional intervention, that should be left in the hands of specialist who can accurately determine what the patient is capable of, what their goals should be, and how to tailor a plan specifically for them.
“I don’t know many clinicians, even in my own specialty, who know much about what specifically to eat,” said Dr. Roberts. “That should come from nutritional medicine people, not us.”
Dr. Lopez, Dr. Rodbard, and Dr. Roberts did not report any relevant financial disclosures.
*This article was updated 1/12/2016.
The U.S. Department of Health and Human Services and the U.S. Department of Agriculture have released the eighth iteration of the Dietary Guidelines for Americans, a set of recommendations for healthy eating habits Americans should adopt to prevent development of hypertension, heart disease, and type 2 diabetes, among other conditions.
The new guidelines, effective through 2020, highlight the importance of eating a wide variety of fruits, vegetables, grains, and dairy products, while staying away from processed foods heavy in saturated fats, sugar, and cholesterol as much as possible. The difference between this and earlier editions of the guidelines, the health agencies say, is to promote the importance of a wider variety of foods Americans should be consuming, rather than focusing on just a few isolated foods that should be integrated into an otherwise inadequate diet.
“Protecting the health of the American public includes empowering them with the tools they need to make healthy choices in their daily lives,” Secretary of Health and Human Services Sylvia M. Burwell said in a statement. “By focusing on small shifts in what we eat and drink, eating healthy becomes more manageable. The Dietary Guidelines provide science-based recommendations on food and nutrition so people can make decisions that may help keep their weight under control, and prevent chronic conditions, like Type 2 diabetes, hypertension, and heart disease.”
The American Medical Association voiced their support of the new guidelines, saying that they are “extremely pleased that the new recommendations call for significantly reducing the amount of added sugars and sugar sweetened beverages from the American diet.” Similarly, the American College of Cardiology issued a statement saying that the existence of “a source of clear science-based information about diet” is more important than ever for Americans in the face of increasingly omnipresent and often confusing information available; the college also lauded the recommendations to limit the intake of added sugars, saturated and trans fats, and sodium. The American Heart Association released a new Authoritative Review of data on the topic of nutritional balance as it related to chronic diseases.
While the recommendations may seem common sense and geared more towards patients and laymen, they are of equal importance to health care providers. Dr. Carolyn Lopez – a Chicago-area family physician and adjunct professor of medicine at Northwestern University – called the guidelines an important resource for physicians, with several elements that will be of particular benefit to physicians and clinicians looking to improve the quality of care given to their patients.
“People [should] understand that while individual food choices are important, the pattern of eating is paramount,” Dr. Lopez explained in an interview. “It’s not impossible to bring vegetables into breakfast – veggie omelettes are great – but it’s hard to imagine bringing a vegetable into the whole grain cereals with skim milk breakfast.”
As a family practitioner, however, Dr. Lopez stressed the difficulty of any doctor having a significant enough amount of time with each patient to really go in-depth into what needs to be done to enact meaningful nutritional and lifestyle changes. “These guidelines can only be effective if the whole team is talking to patients,” she explained. “On its own, it would be extraordinarily difficult [or] impossible to accomplish.
Dr. Nazrat Mirza, a pediatrician who is medical director of the IDEAL Pediatric Weight Management Clinic at Children’s National Health System, Washington, said in an interview that the guidelines are “significant in that they are leading us even closer to healthier dietary living – and from my pediatric perspective, healthier children who will grow into healthier adults. We must keep in mind that these guidelines are not prescriptive – but generalized to relatively healthy people. In particular, the recommendation to reduce sugar intake with specification of an upper limit of 10% of calories from added sugar factored into the suggested daily nutritional intake is an excellent update. Added sugar consumption is linked to diabetes, so any reduction in recommended intake will steer people away from potentially developing diabetes.”
She continued, “In my clinic and day-to-day counseling of patients, being able to point to helpful resources such as these guidelines is crucial. These guidelines will continue to serve as yet another way to reach parents and affect the daily dietary habits they practice at home. I was happy to see resources such as MyPlate.gov referenced in the guidelines; that is a tool I use regularly. When educating families on what a healthy plate looks like, I’m able to point directly to the MyPlate.gov posters hanging in the clinic. Comprehensive resources such as these guidelines, [which] give parents actual examples of foods, and deliver the information in a clear, concise, implementable way, are the best methods to reach parents and kids.”
“As a medical provider, such guidelines provide us with tools and reinforcement to say ‘this is policy,’ when approaching schools about the food and drink options they offer children on a daily basis – because the schools are going to have to follow these guidelines. If these guidelines can enforce public policy for the kids to eat healthy, ... and we can implement changes according to the guidelines, that would help greatly in the prevention of chronic disorders such as obesity, hypertension and diabetes – which is a step in the right direction,” said Dr. Mirza, also of George Washington University, Washington.
“Most physicians are so rushed nowadays by the health care system that they typically do not have adequate time to discuss these very important issues,” Dr. Rodbard said in an interview. “It takes time and perseverance to educate the patient and provide individualized care, assessing their current diet, assessing their willingness or potential for changing their diet or increasing their physical activity.”
On that last point. Dr. Rodbard criticized the new guidelines for not emphasizing the importance of exercise enough. “More clarity and emphasis on physical activity should have been provided,” she said, adding that “people need continual, gentle reminders with repetition and long-term follow-up.” Dr. Rodbard summed up the guidelines as “marginally adequate” but “a step in the right direction.”
An endocrinologist who practices in Winter Park, Fla., Dr. Victor L. Roberts – a Fellow of the ACP and ACE – agreed that time with the patients is critical in order for these guidelines to have any effect, calling the guidelines “just the GPS, not the destination.”
Preaching an ABC strategy – accountability, behavior, and calories, the latter of which he stressed is the most important part of any dietary strategy – Dr. Roberts explained that clinicians and physicians should leave the more specific dietary advice to nutritional experts and focus on telling their patients to watch calories, watch the amount of food they’re eating of any given type, and to exercise more.
“These guidelines crystallize and summarize what we’ve already known, and what we should have been practicing and advocating, for decades,” Dr. Roberts said in an interview, adding that “the difficulty is putting these recommendations into practice and having patients and doctors accept responsibility.”
Ultimately, the three doctors who treat adult patients concurred that the new guidelines are imperfect, and likely won’t result in any automatic widespread change. Dr. Rodbard admitted that she does not anticipate the guidelines affecting the way she treats her patients very much, if at all, while Dr. Lopez said that she’s “not sure it’s going to have a major effect.” Furthermore, the sheer volume of data and information available often leads to patients simply not knowing what to believe, which Dr. Roberts described as a “glazed over” effect of being told so many different things from so many different sources, patients just tune everything out.
Ultimately, while it’s important for health care providers to give advice and recommendations as necessary, these should be done on an individual basis. And, if a patient requires extensive dietary and nutritional intervention, that should be left in the hands of specialist who can accurately determine what the patient is capable of, what their goals should be, and how to tailor a plan specifically for them.
“I don’t know many clinicians, even in my own specialty, who know much about what specifically to eat,” said Dr. Roberts. “That should come from nutritional medicine people, not us.”
Dr. Lopez, Dr. Rodbard, and Dr. Roberts did not report any relevant financial disclosures.
*This article was updated 1/12/2016.
The U.S. Department of Health and Human Services and the U.S. Department of Agriculture have released the eighth iteration of the Dietary Guidelines for Americans, a set of recommendations for healthy eating habits Americans should adopt to prevent development of hypertension, heart disease, and type 2 diabetes, among other conditions.
The new guidelines, effective through 2020, highlight the importance of eating a wide variety of fruits, vegetables, grains, and dairy products, while staying away from processed foods heavy in saturated fats, sugar, and cholesterol as much as possible. The difference between this and earlier editions of the guidelines, the health agencies say, is to promote the importance of a wider variety of foods Americans should be consuming, rather than focusing on just a few isolated foods that should be integrated into an otherwise inadequate diet.
“Protecting the health of the American public includes empowering them with the tools they need to make healthy choices in their daily lives,” Secretary of Health and Human Services Sylvia M. Burwell said in a statement. “By focusing on small shifts in what we eat and drink, eating healthy becomes more manageable. The Dietary Guidelines provide science-based recommendations on food and nutrition so people can make decisions that may help keep their weight under control, and prevent chronic conditions, like Type 2 diabetes, hypertension, and heart disease.”
The American Medical Association voiced their support of the new guidelines, saying that they are “extremely pleased that the new recommendations call for significantly reducing the amount of added sugars and sugar sweetened beverages from the American diet.” Similarly, the American College of Cardiology issued a statement saying that the existence of “a source of clear science-based information about diet” is more important than ever for Americans in the face of increasingly omnipresent and often confusing information available; the college also lauded the recommendations to limit the intake of added sugars, saturated and trans fats, and sodium. The American Heart Association released a new Authoritative Review of data on the topic of nutritional balance as it related to chronic diseases.
While the recommendations may seem common sense and geared more towards patients and laymen, they are of equal importance to health care providers. Dr. Carolyn Lopez – a Chicago-area family physician and adjunct professor of medicine at Northwestern University – called the guidelines an important resource for physicians, with several elements that will be of particular benefit to physicians and clinicians looking to improve the quality of care given to their patients.
“People [should] understand that while individual food choices are important, the pattern of eating is paramount,” Dr. Lopez explained in an interview. “It’s not impossible to bring vegetables into breakfast – veggie omelettes are great – but it’s hard to imagine bringing a vegetable into the whole grain cereals with skim milk breakfast.”
As a family practitioner, however, Dr. Lopez stressed the difficulty of any doctor having a significant enough amount of time with each patient to really go in-depth into what needs to be done to enact meaningful nutritional and lifestyle changes. “These guidelines can only be effective if the whole team is talking to patients,” she explained. “On its own, it would be extraordinarily difficult [or] impossible to accomplish.
Dr. Nazrat Mirza, a pediatrician who is medical director of the IDEAL Pediatric Weight Management Clinic at Children’s National Health System, Washington, said in an interview that the guidelines are “significant in that they are leading us even closer to healthier dietary living – and from my pediatric perspective, healthier children who will grow into healthier adults. We must keep in mind that these guidelines are not prescriptive – but generalized to relatively healthy people. In particular, the recommendation to reduce sugar intake with specification of an upper limit of 10% of calories from added sugar factored into the suggested daily nutritional intake is an excellent update. Added sugar consumption is linked to diabetes, so any reduction in recommended intake will steer people away from potentially developing diabetes.”
She continued, “In my clinic and day-to-day counseling of patients, being able to point to helpful resources such as these guidelines is crucial. These guidelines will continue to serve as yet another way to reach parents and affect the daily dietary habits they practice at home. I was happy to see resources such as MyPlate.gov referenced in the guidelines; that is a tool I use regularly. When educating families on what a healthy plate looks like, I’m able to point directly to the MyPlate.gov posters hanging in the clinic. Comprehensive resources such as these guidelines, [which] give parents actual examples of foods, and deliver the information in a clear, concise, implementable way, are the best methods to reach parents and kids.”
“As a medical provider, such guidelines provide us with tools and reinforcement to say ‘this is policy,’ when approaching schools about the food and drink options they offer children on a daily basis – because the schools are going to have to follow these guidelines. If these guidelines can enforce public policy for the kids to eat healthy, ... and we can implement changes according to the guidelines, that would help greatly in the prevention of chronic disorders such as obesity, hypertension and diabetes – which is a step in the right direction,” said Dr. Mirza, also of George Washington University, Washington.
“Most physicians are so rushed nowadays by the health care system that they typically do not have adequate time to discuss these very important issues,” Dr. Rodbard said in an interview. “It takes time and perseverance to educate the patient and provide individualized care, assessing their current diet, assessing their willingness or potential for changing their diet or increasing their physical activity.”
On that last point. Dr. Rodbard criticized the new guidelines for not emphasizing the importance of exercise enough. “More clarity and emphasis on physical activity should have been provided,” she said, adding that “people need continual, gentle reminders with repetition and long-term follow-up.” Dr. Rodbard summed up the guidelines as “marginally adequate” but “a step in the right direction.”
An endocrinologist who practices in Winter Park, Fla., Dr. Victor L. Roberts – a Fellow of the ACP and ACE – agreed that time with the patients is critical in order for these guidelines to have any effect, calling the guidelines “just the GPS, not the destination.”
Preaching an ABC strategy – accountability, behavior, and calories, the latter of which he stressed is the most important part of any dietary strategy – Dr. Roberts explained that clinicians and physicians should leave the more specific dietary advice to nutritional experts and focus on telling their patients to watch calories, watch the amount of food they’re eating of any given type, and to exercise more.
“These guidelines crystallize and summarize what we’ve already known, and what we should have been practicing and advocating, for decades,” Dr. Roberts said in an interview, adding that “the difficulty is putting these recommendations into practice and having patients and doctors accept responsibility.”
Ultimately, the three doctors who treat adult patients concurred that the new guidelines are imperfect, and likely won’t result in any automatic widespread change. Dr. Rodbard admitted that she does not anticipate the guidelines affecting the way she treats her patients very much, if at all, while Dr. Lopez said that she’s “not sure it’s going to have a major effect.” Furthermore, the sheer volume of data and information available often leads to patients simply not knowing what to believe, which Dr. Roberts described as a “glazed over” effect of being told so many different things from so many different sources, patients just tune everything out.
Ultimately, while it’s important for health care providers to give advice and recommendations as necessary, these should be done on an individual basis. And, if a patient requires extensive dietary and nutritional intervention, that should be left in the hands of specialist who can accurately determine what the patient is capable of, what their goals should be, and how to tailor a plan specifically for them.
“I don’t know many clinicians, even in my own specialty, who know much about what specifically to eat,” said Dr. Roberts. “That should come from nutritional medicine people, not us.”
Dr. Lopez, Dr. Rodbard, and Dr. Roberts did not report any relevant financial disclosures.
*This article was updated 1/12/2016.
FROM THE USDA AND HHS
LAIV, IIV almost equally effective against influenza
When vaccinating children against influenza, inactivated and live attenuated influenza vaccines show little significant difference in effectiveness against nearly all strains of the virus, according to a new study in Pediatrics.
However, the study – which examined the effectiveness of IIV and LAIV across four consecutive influenza seasons between 2010 and 2014 – cautions that the 2013-2014 season’s A/(H1N1)pdm09 showed an uncharacteristically large gap in effectiveness favoring IIV, a discrepancy likely due to a problem with a vaccine component in LAIV. (Pediatrics. 2016;137(2):e20153279)
“We found that lower LAIV effectiveness in 2013-2014 was specific to the A/(H1N1)pdm09 vaccine component and was consistent with a previously unexamined effect during the 2010-2011 influenza season,” Jessie R. Chung of the influenza division at the Centers for Disease Control and Prevention and associates wrote, adding that the impetus for the study was the lack of available data “from observational studies after the 2009 pandemic on relative effectiveness of LAIV and IIV in children and adolescents.”
Ms. Chung* and coinvestigators enrolled children aged 2-17 years from clinics and hospitals in Michigan, New York, Pennsylvania, Tennessee, Texas, Washington, and Wisconsin during the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 influenza seasons. Children brought in with symptoms of acute respiratory illness – cough, fever, or feverishness – had nasal and throat swabs collected to test for presence and type of influenza.
In total, 7,718 subjects were evaluated across the four influenza seasons, but after excluding subjects for various reasons – unknown vaccine type, indeterminate vaccine status, and inconclusive reverse transcription polymerase chain reaction results, among others – 6,819 subjects were included for vaccine effectiveness analysis, of which 2,703 were ultimately matched age appropriately and placed into IIV and LAIV cohorts for comparison. The IIV cohort consisted of 2,066 individuals (76.4%), while the LAIV cohort had 637 (23.6%).
During the 2010-2011 season, 66 of the 477 IIV subjects contracted influenza, versus 21 of 116 who received LAIV (14% vs. 18%, respectively). In the 2011-2012 season, 51 of the 499 IIV subjects (10%) contracted influenza, compared with 12 of the 152 LAIV subjects (8%). In the 2012-2013 season, 198 of the 622 IIV subjects (32%) contracted influenza, versus 61 of the 205 LAIV subjects (30%). But, in the 2013-2014 season, 36 of the 468 IIV subjects (8%) contracted influenza, versus 34 of the 164 LAIV subjects (21%).
After adjustment for age and season, the odds ratio for the 2013-2014 season was significantly higher than those of the other seasons across the entire age spectrum of 2-17 years: 2.88, compared with 1.49 (2010-2011), 0.67 (2011-2012), and 0.92 (2012-2013).
When comparing influenza type/subtype, adjusted odds ratio was 5.53 for those with A/(H1N1)pdm09 in the 2010-2011 season, compared with 2.65 for those with the same in the 2013-2014 season. Those with A/H3N2 did not show as significant a difference across seasons (2010-2013), nor did those with influenza type B (2010-2011, 2012-2013).
“We found no statistically significant difference in LAIV effectiveness compared with IIV against medically attended, laboratory-confirmed influenza illness due to A/H3N2 or B viruses,” Ms. Chung and colleagues concluded. “We found significantly higher odds of influenza A/(H1N1)pdm09 among participants vaccinated with LAIV, compared with IIV, [but] reasons for lower effectiveness of LAIV against the A/(H1N1)pdm09 virus, compared with IIV are not fully understood.”
The investigators added that “the finding appears to be specific to the A/(H1N1)pdm09 vaccine component; we did not detect any statistically significant differences in effectiveness for the other components.” Three previous randomized controlled trials indicated that trivalent LAIV was just as effective, if not more so, than IIV, making the findings of this study surprising and “unexpected,” the authors noted.
This study was supported by the CDC through cooperative agreements with a variety of universities and foundations, and funded by the National Institutes of Health. Ms. Chung and associates reported no relevant financial disclosures.
*A previous version of this story misstated Jessie Chung’s academic title. Ms. Chung holds a Master’s in public health.
Influenza vaccination has been recommended for everyone for the past few years. Acceptance of this recommendation has been variable, and vaccine failures do not help the cause of convincing our patients to accept vaccination. In the paper by Chung et al. from the CDC and other coinvestigators who are prominent in influenza research, we learn that the live attenuated intranasally administered flu vaccine was significantly inferior to the killed injection administered flu vaccine for one of the type A flu strains. As a consequence, more kids vaccinated with the live attenuated vaccine got the flu. So parents who claim “the flu shot does not work” were partially correct more often since the 2009 flu season, if their child got the intranasal flu vaccine. However, neither the intranasal nor the injectable flu vaccine have an exceptionally high efficacy because the calculations by the authors for the study described and by citation of prior studies we are reminded that vaccine efficacy varies by strain and yearly by the season between 45% and 71%. We need to have better flu vaccines.
 |
Dr. Michael E. Pichichero |
At Legacy Pediatrics, where I am in part-time private practice, we have seen increasing requests for the intranasal flu vaccine each year because parents and kids who can voice their wishes don’t want the shot. Our nurses like it, too, because the crying, wailing, and fighting to hold the kid down is avoided. There had been some reports before 2009 that the intranasal flu vaccine was more effective than the shot. But those of us who have been around long enough practicing medicine have learned about the pendulum of data and opinion sometimes swings back and forth. The article by Chung et al. reminds us once again of this reality.
Dr. Michael E. Pichichero is at the University of Rochester (N.Y.) Medical Center. He has received investigator-initiated grants from Sanofi Pasteur to study novel pneumococcal protein vaccines over the past 3 years and currently but has received no funding from Sanofi regarding injectable influenza vaccine. He also has conducted research with study coauthor Dr. John J. Treanor that was supported by MedImmune, who makes the intranasal flu vaccine.
Influenza vaccination has been recommended for everyone for the past few years. Acceptance of this recommendation has been variable, and vaccine failures do not help the cause of convincing our patients to accept vaccination. In the paper by Chung et al. from the CDC and other coinvestigators who are prominent in influenza research, we learn that the live attenuated intranasally administered flu vaccine was significantly inferior to the killed injection administered flu vaccine for one of the type A flu strains. As a consequence, more kids vaccinated with the live attenuated vaccine got the flu. So parents who claim “the flu shot does not work” were partially correct more often since the 2009 flu season, if their child got the intranasal flu vaccine. However, neither the intranasal nor the injectable flu vaccine have an exceptionally high efficacy because the calculations by the authors for the study described and by citation of prior studies we are reminded that vaccine efficacy varies by strain and yearly by the season between 45% and 71%. We need to have better flu vaccines.
|
Dr. Michael E. Pichichero |
At Legacy Pediatrics, where I am in part-time private practice, we have seen increasing requests for the intranasal flu vaccine each year because parents and kids who can voice their wishes don’t want the shot. Our nurses like it, too, because the crying, wailing, and fighting to hold the kid down is avoided. There had been some reports before 2009 that the intranasal flu vaccine was more effective than the shot. But those of us who have been around long enough practicing medicine have learned about the pendulum of data and opinion sometimes swings back and forth. The article by Chung et al. reminds us once again of this reality.
Dr. Michael E. Pichichero is at the University of Rochester (N.Y.) Medical Center. He has received investigator-initiated grants from Sanofi Pasteur to study novel pneumococcal protein vaccines over the past 3 years and currently but has received no funding from Sanofi regarding injectable influenza vaccine. He also has conducted research with study coauthor Dr. John J. Treanor that was supported by MedImmune, who makes the intranasal flu vaccine.
Influenza vaccination has been recommended for everyone for the past few years. Acceptance of this recommendation has been variable, and vaccine failures do not help the cause of convincing our patients to accept vaccination. In the paper by Chung et al. from the CDC and other coinvestigators who are prominent in influenza research, we learn that the live attenuated intranasally administered flu vaccine was significantly inferior to the killed injection administered flu vaccine for one of the type A flu strains. As a consequence, more kids vaccinated with the live attenuated vaccine got the flu. So parents who claim “the flu shot does not work” were partially correct more often since the 2009 flu season, if their child got the intranasal flu vaccine. However, neither the intranasal nor the injectable flu vaccine have an exceptionally high efficacy because the calculations by the authors for the study described and by citation of prior studies we are reminded that vaccine efficacy varies by strain and yearly by the season between 45% and 71%. We need to have better flu vaccines.
|
Dr. Michael E. Pichichero |
At Legacy Pediatrics, where I am in part-time private practice, we have seen increasing requests for the intranasal flu vaccine each year because parents and kids who can voice their wishes don’t want the shot. Our nurses like it, too, because the crying, wailing, and fighting to hold the kid down is avoided. There had been some reports before 2009 that the intranasal flu vaccine was more effective than the shot. But those of us who have been around long enough practicing medicine have learned about the pendulum of data and opinion sometimes swings back and forth. The article by Chung et al. reminds us once again of this reality.
Dr. Michael E. Pichichero is at the University of Rochester (N.Y.) Medical Center. He has received investigator-initiated grants from Sanofi Pasteur to study novel pneumococcal protein vaccines over the past 3 years and currently but has received no funding from Sanofi regarding injectable influenza vaccine. He also has conducted research with study coauthor Dr. John J. Treanor that was supported by MedImmune, who makes the intranasal flu vaccine.
When vaccinating children against influenza, inactivated and live attenuated influenza vaccines show little significant difference in effectiveness against nearly all strains of the virus, according to a new study in Pediatrics.
However, the study – which examined the effectiveness of IIV and LAIV across four consecutive influenza seasons between 2010 and 2014 – cautions that the 2013-2014 season’s A/(H1N1)pdm09 showed an uncharacteristically large gap in effectiveness favoring IIV, a discrepancy likely due to a problem with a vaccine component in LAIV. (Pediatrics. 2016;137(2):e20153279)
“We found that lower LAIV effectiveness in 2013-2014 was specific to the A/(H1N1)pdm09 vaccine component and was consistent with a previously unexamined effect during the 2010-2011 influenza season,” Jessie R. Chung of the influenza division at the Centers for Disease Control and Prevention and associates wrote, adding that the impetus for the study was the lack of available data “from observational studies after the 2009 pandemic on relative effectiveness of LAIV and IIV in children and adolescents.”
Ms. Chung* and coinvestigators enrolled children aged 2-17 years from clinics and hospitals in Michigan, New York, Pennsylvania, Tennessee, Texas, Washington, and Wisconsin during the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 influenza seasons. Children brought in with symptoms of acute respiratory illness – cough, fever, or feverishness – had nasal and throat swabs collected to test for presence and type of influenza.
In total, 7,718 subjects were evaluated across the four influenza seasons, but after excluding subjects for various reasons – unknown vaccine type, indeterminate vaccine status, and inconclusive reverse transcription polymerase chain reaction results, among others – 6,819 subjects were included for vaccine effectiveness analysis, of which 2,703 were ultimately matched age appropriately and placed into IIV and LAIV cohorts for comparison. The IIV cohort consisted of 2,066 individuals (76.4%), while the LAIV cohort had 637 (23.6%).
During the 2010-2011 season, 66 of the 477 IIV subjects contracted influenza, versus 21 of 116 who received LAIV (14% vs. 18%, respectively). In the 2011-2012 season, 51 of the 499 IIV subjects (10%) contracted influenza, compared with 12 of the 152 LAIV subjects (8%). In the 2012-2013 season, 198 of the 622 IIV subjects (32%) contracted influenza, versus 61 of the 205 LAIV subjects (30%). But, in the 2013-2014 season, 36 of the 468 IIV subjects (8%) contracted influenza, versus 34 of the 164 LAIV subjects (21%).
After adjustment for age and season, the odds ratio for the 2013-2014 season was significantly higher than those of the other seasons across the entire age spectrum of 2-17 years: 2.88, compared with 1.49 (2010-2011), 0.67 (2011-2012), and 0.92 (2012-2013).
When comparing influenza type/subtype, adjusted odds ratio was 5.53 for those with A/(H1N1)pdm09 in the 2010-2011 season, compared with 2.65 for those with the same in the 2013-2014 season. Those with A/H3N2 did not show as significant a difference across seasons (2010-2013), nor did those with influenza type B (2010-2011, 2012-2013).
“We found no statistically significant difference in LAIV effectiveness compared with IIV against medically attended, laboratory-confirmed influenza illness due to A/H3N2 or B viruses,” Ms. Chung and colleagues concluded. “We found significantly higher odds of influenza A/(H1N1)pdm09 among participants vaccinated with LAIV, compared with IIV, [but] reasons for lower effectiveness of LAIV against the A/(H1N1)pdm09 virus, compared with IIV are not fully understood.”
The investigators added that “the finding appears to be specific to the A/(H1N1)pdm09 vaccine component; we did not detect any statistically significant differences in effectiveness for the other components.” Three previous randomized controlled trials indicated that trivalent LAIV was just as effective, if not more so, than IIV, making the findings of this study surprising and “unexpected,” the authors noted.
This study was supported by the CDC through cooperative agreements with a variety of universities and foundations, and funded by the National Institutes of Health. Ms. Chung and associates reported no relevant financial disclosures.
*A previous version of this story misstated Jessie Chung’s academic title. Ms. Chung holds a Master’s in public health.
When vaccinating children against influenza, inactivated and live attenuated influenza vaccines show little significant difference in effectiveness against nearly all strains of the virus, according to a new study in Pediatrics.
However, the study – which examined the effectiveness of IIV and LAIV across four consecutive influenza seasons between 2010 and 2014 – cautions that the 2013-2014 season’s A/(H1N1)pdm09 showed an uncharacteristically large gap in effectiveness favoring IIV, a discrepancy likely due to a problem with a vaccine component in LAIV. (Pediatrics. 2016;137(2):e20153279)
“We found that lower LAIV effectiveness in 2013-2014 was specific to the A/(H1N1)pdm09 vaccine component and was consistent with a previously unexamined effect during the 2010-2011 influenza season,” Jessie R. Chung of the influenza division at the Centers for Disease Control and Prevention and associates wrote, adding that the impetus for the study was the lack of available data “from observational studies after the 2009 pandemic on relative effectiveness of LAIV and IIV in children and adolescents.”
Ms. Chung* and coinvestigators enrolled children aged 2-17 years from clinics and hospitals in Michigan, New York, Pennsylvania, Tennessee, Texas, Washington, and Wisconsin during the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 influenza seasons. Children brought in with symptoms of acute respiratory illness – cough, fever, or feverishness – had nasal and throat swabs collected to test for presence and type of influenza.
In total, 7,718 subjects were evaluated across the four influenza seasons, but after excluding subjects for various reasons – unknown vaccine type, indeterminate vaccine status, and inconclusive reverse transcription polymerase chain reaction results, among others – 6,819 subjects were included for vaccine effectiveness analysis, of which 2,703 were ultimately matched age appropriately and placed into IIV and LAIV cohorts for comparison. The IIV cohort consisted of 2,066 individuals (76.4%), while the LAIV cohort had 637 (23.6%).
During the 2010-2011 season, 66 of the 477 IIV subjects contracted influenza, versus 21 of 116 who received LAIV (14% vs. 18%, respectively). In the 2011-2012 season, 51 of the 499 IIV subjects (10%) contracted influenza, compared with 12 of the 152 LAIV subjects (8%). In the 2012-2013 season, 198 of the 622 IIV subjects (32%) contracted influenza, versus 61 of the 205 LAIV subjects (30%). But, in the 2013-2014 season, 36 of the 468 IIV subjects (8%) contracted influenza, versus 34 of the 164 LAIV subjects (21%).
After adjustment for age and season, the odds ratio for the 2013-2014 season was significantly higher than those of the other seasons across the entire age spectrum of 2-17 years: 2.88, compared with 1.49 (2010-2011), 0.67 (2011-2012), and 0.92 (2012-2013).
When comparing influenza type/subtype, adjusted odds ratio was 5.53 for those with A/(H1N1)pdm09 in the 2010-2011 season, compared with 2.65 for those with the same in the 2013-2014 season. Those with A/H3N2 did not show as significant a difference across seasons (2010-2013), nor did those with influenza type B (2010-2011, 2012-2013).
“We found no statistically significant difference in LAIV effectiveness compared with IIV against medically attended, laboratory-confirmed influenza illness due to A/H3N2 or B viruses,” Ms. Chung and colleagues concluded. “We found significantly higher odds of influenza A/(H1N1)pdm09 among participants vaccinated with LAIV, compared with IIV, [but] reasons for lower effectiveness of LAIV against the A/(H1N1)pdm09 virus, compared with IIV are not fully understood.”
The investigators added that “the finding appears to be specific to the A/(H1N1)pdm09 vaccine component; we did not detect any statistically significant differences in effectiveness for the other components.” Three previous randomized controlled trials indicated that trivalent LAIV was just as effective, if not more so, than IIV, making the findings of this study surprising and “unexpected,” the authors noted.
This study was supported by the CDC through cooperative agreements with a variety of universities and foundations, and funded by the National Institutes of Health. Ms. Chung and associates reported no relevant financial disclosures.
*A previous version of this story misstated Jessie Chung’s academic title. Ms. Chung holds a Master’s in public health.
FROM PEDIATRICS
Key clinical point: Inactivated influenza vaccine was significantly more effective against at least one strain of influenza than live attenuated influenza vaccine in 2013-2014.
Major finding: While no significant differences were seen in influenza rates between the IIV and LAIV cohorts for three consecutive seasons (2010-2013), the A/(H1N1)pdm09 strain of 2013-2014 affected subjects with LAIV at a significantly higher rate than did those with IIV.
Data source: Prospective cohort study of 2,703 children aged 2-17 years vaccinated between 2010 and 2014 with either IIV or LAIV.
Disclosures: This study was supported by the CDC through cooperative agreements with a variety of universities and foundations, and funded by the National Institutes of Health. Dr. Chung and his associates reported no relevant financial disclosures.
Jury still out on appendectomy vs. antibiotics-first approach
Despite a growing movement toward the antibiotics-first approach instead of surgical intervention for uncomplicated appendicitis, a new review of existing literature shows that the jury is still out on how to advise patients about their choices, according to Dr. Anne P. Ehlers and her colleagues who undertook the study.
The findings show that surgical intervention should continue to be considered a viable option and that appendectomy is not necessarily any better or worse in terms of long-term complication rates and length of hospital stay (J Am Coll Surg. 2015. doi:10.1016/j.jamcollsurg.2015.11.009).
“What we found is that treatment of acute, uncomplicated appendicitis with antibiotics first is probably a safe approach, but that there are many questions that need to be answered before we can fully inform our patients about the long-term outcomes of this treatment strategy,” Dr. Ehlers of the department of surgery at the University of Washington, Seattle, said in an interview.
Dr. Ehlers and her coinvestigators combed the PubMed and EMBASE databases for all English-language randomized controlled trials involving comparisons of antibiotic and appendectomy-based treatments for acute appendicitis. Studies were excluded if they lacked adult population investigation.
“Our study is a critical review of the literature [available] on this topic to understand the current state of evidence,” explained Dr. Ehlers, adding that the study’s main goal was to answer the most common questions she and her coauthors encountered when talking to physicians and patients about the benefits and risks of antibiotics-first over appendectomy; namely, “Is my appendicitis going to come back?” “Am I going to have a lot of extra trips to the hospital?” and “What’s my quality of life going to be?”
Ultimately, six trials, comprising 1,720 patients, were selected for inclusion. These studies were led by Dr. S. Eriksson (40 subjects), Dr. J. Styrud (252 subjects), Dr. A.N. Turhan (290 subjects), Dr. J. Hansson (369 subjects), Dr. C. Vons (239 subjects), and Dr. P. Salminen (530 subjects). The Styrud study did not enroll any women, and no study enrolled subjects older than 75 years of age, but the average age of each study’s patients ranged from 26 to 38 years.
Length-of-stay comparisons between appendectomy and antibiotics-first cohorts varied among the studies, but most showed the same or longer LOS for antibiotics-first subjects. Mean LOS was 3.3 for surgical patients vs. 3.1 for antibiotics (Eriksson), 2.6 surgical vs. 3.0 antibiotics (Styrud), 2.4 surgical vs. 3.14 antibiotics (Turhan), 3.0 for both (Hansson), 3.04 surgical vs. 3.96 antibiotics (Vons), and 3.0 for both (Salminen).
Rates of appendectomy among patients treated with an antibiotics-first approach varied as well, with a 35% rate in the Eriksson study (7 out of the 20 subjects treated with antibiotics-first) and a 24% rate in the Styrud and Turhan studies. The Hansson trial reported an unusually high crossover between cohorts of 60%, the investigators noted.
Two studies – those led by Turhan and Vons – noted higher rates of complications in antibiotics-first patients versus those who received surgical intervention: 4.7% vs. 4.4%, and 2.5% vs. less than 1%, respectively. All other studies had high rates of complications in the surgical cohorts, with the Eriksson study reporting no complications whatsoever among antibiotics-first subjects.
These findings, Dr. Ehlers stressed, are just a first step. This review’s relatively low sample size and limiting factors require that further studies be done to more firmly ascertain which option for appendicitis treatment is the most beneficial. To that end, Dr. Ehlers said that she and her coinvestigators are working on that next step.
“Our group is currently working on a study called the CODA [Comparing Outcomes of Drugs in Appendectomy] Study,” she said, with the goal of answering “questions about long-term patient-centered outcomes related to the antibiotics-first approach.” These questions include patients’ quality of life, whether patients have decisional regret about choosing one treatment strategy over another, if they develop long-term anxiety any time they experience even a small abdominal pain, how much time they miss from school or work by choosing one treatment option over another, and so on.
The goal of this study is that physicians “will be able to give [patients] a more informed view of what each treatment entails,” she said. Funded by the Patient-Centered Outcomes Research Institute, the study has no firm date of publication.
Dr. Ehlers disclosed receiving support via a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. No other conflicts of interest were reported.
Despite a growing movement toward the antibiotics-first approach instead of surgical intervention for uncomplicated appendicitis, a new review of existing literature shows that the jury is still out on how to advise patients about their choices, according to Dr. Anne P. Ehlers and her colleagues who undertook the study.
The findings show that surgical intervention should continue to be considered a viable option and that appendectomy is not necessarily any better or worse in terms of long-term complication rates and length of hospital stay (J Am Coll Surg. 2015. doi:10.1016/j.jamcollsurg.2015.11.009).
“What we found is that treatment of acute, uncomplicated appendicitis with antibiotics first is probably a safe approach, but that there are many questions that need to be answered before we can fully inform our patients about the long-term outcomes of this treatment strategy,” Dr. Ehlers of the department of surgery at the University of Washington, Seattle, said in an interview.
Dr. Ehlers and her coinvestigators combed the PubMed and EMBASE databases for all English-language randomized controlled trials involving comparisons of antibiotic and appendectomy-based treatments for acute appendicitis. Studies were excluded if they lacked adult population investigation.
“Our study is a critical review of the literature [available] on this topic to understand the current state of evidence,” explained Dr. Ehlers, adding that the study’s main goal was to answer the most common questions she and her coauthors encountered when talking to physicians and patients about the benefits and risks of antibiotics-first over appendectomy; namely, “Is my appendicitis going to come back?” “Am I going to have a lot of extra trips to the hospital?” and “What’s my quality of life going to be?”
Ultimately, six trials, comprising 1,720 patients, were selected for inclusion. These studies were led by Dr. S. Eriksson (40 subjects), Dr. J. Styrud (252 subjects), Dr. A.N. Turhan (290 subjects), Dr. J. Hansson (369 subjects), Dr. C. Vons (239 subjects), and Dr. P. Salminen (530 subjects). The Styrud study did not enroll any women, and no study enrolled subjects older than 75 years of age, but the average age of each study’s patients ranged from 26 to 38 years.
Length-of-stay comparisons between appendectomy and antibiotics-first cohorts varied among the studies, but most showed the same or longer LOS for antibiotics-first subjects. Mean LOS was 3.3 for surgical patients vs. 3.1 for antibiotics (Eriksson), 2.6 surgical vs. 3.0 antibiotics (Styrud), 2.4 surgical vs. 3.14 antibiotics (Turhan), 3.0 for both (Hansson), 3.04 surgical vs. 3.96 antibiotics (Vons), and 3.0 for both (Salminen).
Rates of appendectomy among patients treated with an antibiotics-first approach varied as well, with a 35% rate in the Eriksson study (7 out of the 20 subjects treated with antibiotics-first) and a 24% rate in the Styrud and Turhan studies. The Hansson trial reported an unusually high crossover between cohorts of 60%, the investigators noted.
Two studies – those led by Turhan and Vons – noted higher rates of complications in antibiotics-first patients versus those who received surgical intervention: 4.7% vs. 4.4%, and 2.5% vs. less than 1%, respectively. All other studies had high rates of complications in the surgical cohorts, with the Eriksson study reporting no complications whatsoever among antibiotics-first subjects.
These findings, Dr. Ehlers stressed, are just a first step. This review’s relatively low sample size and limiting factors require that further studies be done to more firmly ascertain which option for appendicitis treatment is the most beneficial. To that end, Dr. Ehlers said that she and her coinvestigators are working on that next step.
“Our group is currently working on a study called the CODA [Comparing Outcomes of Drugs in Appendectomy] Study,” she said, with the goal of answering “questions about long-term patient-centered outcomes related to the antibiotics-first approach.” These questions include patients’ quality of life, whether patients have decisional regret about choosing one treatment strategy over another, if they develop long-term anxiety any time they experience even a small abdominal pain, how much time they miss from school or work by choosing one treatment option over another, and so on.
The goal of this study is that physicians “will be able to give [patients] a more informed view of what each treatment entails,” she said. Funded by the Patient-Centered Outcomes Research Institute, the study has no firm date of publication.
Dr. Ehlers disclosed receiving support via a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. No other conflicts of interest were reported.
Despite a growing movement toward the antibiotics-first approach instead of surgical intervention for uncomplicated appendicitis, a new review of existing literature shows that the jury is still out on how to advise patients about their choices, according to Dr. Anne P. Ehlers and her colleagues who undertook the study.
The findings show that surgical intervention should continue to be considered a viable option and that appendectomy is not necessarily any better or worse in terms of long-term complication rates and length of hospital stay (J Am Coll Surg. 2015. doi:10.1016/j.jamcollsurg.2015.11.009).
“What we found is that treatment of acute, uncomplicated appendicitis with antibiotics first is probably a safe approach, but that there are many questions that need to be answered before we can fully inform our patients about the long-term outcomes of this treatment strategy,” Dr. Ehlers of the department of surgery at the University of Washington, Seattle, said in an interview.
Dr. Ehlers and her coinvestigators combed the PubMed and EMBASE databases for all English-language randomized controlled trials involving comparisons of antibiotic and appendectomy-based treatments for acute appendicitis. Studies were excluded if they lacked adult population investigation.
“Our study is a critical review of the literature [available] on this topic to understand the current state of evidence,” explained Dr. Ehlers, adding that the study’s main goal was to answer the most common questions she and her coauthors encountered when talking to physicians and patients about the benefits and risks of antibiotics-first over appendectomy; namely, “Is my appendicitis going to come back?” “Am I going to have a lot of extra trips to the hospital?” and “What’s my quality of life going to be?”
Ultimately, six trials, comprising 1,720 patients, were selected for inclusion. These studies were led by Dr. S. Eriksson (40 subjects), Dr. J. Styrud (252 subjects), Dr. A.N. Turhan (290 subjects), Dr. J. Hansson (369 subjects), Dr. C. Vons (239 subjects), and Dr. P. Salminen (530 subjects). The Styrud study did not enroll any women, and no study enrolled subjects older than 75 years of age, but the average age of each study’s patients ranged from 26 to 38 years.
Length-of-stay comparisons between appendectomy and antibiotics-first cohorts varied among the studies, but most showed the same or longer LOS for antibiotics-first subjects. Mean LOS was 3.3 for surgical patients vs. 3.1 for antibiotics (Eriksson), 2.6 surgical vs. 3.0 antibiotics (Styrud), 2.4 surgical vs. 3.14 antibiotics (Turhan), 3.0 for both (Hansson), 3.04 surgical vs. 3.96 antibiotics (Vons), and 3.0 for both (Salminen).
Rates of appendectomy among patients treated with an antibiotics-first approach varied as well, with a 35% rate in the Eriksson study (7 out of the 20 subjects treated with antibiotics-first) and a 24% rate in the Styrud and Turhan studies. The Hansson trial reported an unusually high crossover between cohorts of 60%, the investigators noted.
Two studies – those led by Turhan and Vons – noted higher rates of complications in antibiotics-first patients versus those who received surgical intervention: 4.7% vs. 4.4%, and 2.5% vs. less than 1%, respectively. All other studies had high rates of complications in the surgical cohorts, with the Eriksson study reporting no complications whatsoever among antibiotics-first subjects.
These findings, Dr. Ehlers stressed, are just a first step. This review’s relatively low sample size and limiting factors require that further studies be done to more firmly ascertain which option for appendicitis treatment is the most beneficial. To that end, Dr. Ehlers said that she and her coinvestigators are working on that next step.
“Our group is currently working on a study called the CODA [Comparing Outcomes of Drugs in Appendectomy] Study,” she said, with the goal of answering “questions about long-term patient-centered outcomes related to the antibiotics-first approach.” These questions include patients’ quality of life, whether patients have decisional regret about choosing one treatment strategy over another, if they develop long-term anxiety any time they experience even a small abdominal pain, how much time they miss from school or work by choosing one treatment option over another, and so on.
The goal of this study is that physicians “will be able to give [patients] a more informed view of what each treatment entails,” she said. Funded by the Patient-Centered Outcomes Research Institute, the study has no firm date of publication.
Dr. Ehlers disclosed receiving support via a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. No other conflicts of interest were reported.
FROM THE JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
Key clinical point: While the antibiotics-first approach to uncomplicated appendicitis has become increasingly popular in recent years, existing evidence shows that appendectomy is not inferior in terms of hospital stay and rates of complications.
Major finding: Length-of-stay and complication rates vary among all six included studies between antibiotics-first and surgical cohorts, indicating that neither one is definitively better or worse than the other.
Data source: Literature review of 1,720 appendicitis patients across six studies selected from PubMed and EMBASE databases.
Disclosures: The National Institute of Diabetes and Digestive and Kidney Diseases supported the study. No other conflicts of interest were reported.
Orchestrated protocols for treating CLABSI decreases hospitalizations
Hospitals and health centers that participate in orchestrated testing protocols for diagnosis and treatment of central line–associated bloodstream infections (CLABSI) have lower rates of hospital admissions, according to a new study published in Pediatrics.
“The purpose of the SLUG Bug (Standardizing Line Care Under Guideline Recommendations) collaborative was to provide potentially better practice recommendations for neonatal health care professionals in care and maintenance of CVCs [central venous catheters] and to prevent CLABSI [central line–associated bloodstream infections],” wrote Dr. Anthony J. Piazza of the department of pediatrics at Emory University, Atlanta, and his colleagues.
The researchers examined 17 health care centers, from which eight test groups were identified and evaluated via orchestrated testing methods. Each center was surveyed to compare CLABSI rates before and after implementation of SLUG Bug protocols, and to determine each center’s compliance rate on procedural aspects such as tubing change, hub care, and sterilization. The measurable target Dr. Piazza and his colleagues had in mind was to lower CLABSI rates by 15% – deemed “a clinically meaningful target” – over the course of 12 months (Pediatrics. 2016 Dec. 22. doi:10.1542/peds.2014-3642).
The mean CLABSI rate across centers declined from 1.333 per 1,000 line-days at baseline to 1.076 per 1,000 line-days at 12 months, a reduction of 19.28%, meeting the benchmark set by the investigators. Furthermore, all but 1 of the 17 centers included in the study recorded a compliance rate of 75% or higher. Of the eight study groups, only two did not see a reduction in CLABSI rates, with changes of 0.512 and 0.444; all other groups saw CLABSI rates decrease anywhere from –0.157 to –1.860.
“The CLABSI Clinical Practice Recommendation is generalizable to other settings in which prolonged CVC use is medically necessary,” the authors wrote, adding that the “results support strong consideration for the use of sterile [tubing change] in conjunction with [hub care] compliance monitoring to further reduce NICU rates of CLABSI.”
The study did not receive any outside funding. Dr. Piazza did not report any relevant financial disclosures, but several coauthors reported potential conflicts of their own.
Hospitals and health centers that participate in orchestrated testing protocols for diagnosis and treatment of central line–associated bloodstream infections (CLABSI) have lower rates of hospital admissions, according to a new study published in Pediatrics.
“The purpose of the SLUG Bug (Standardizing Line Care Under Guideline Recommendations) collaborative was to provide potentially better practice recommendations for neonatal health care professionals in care and maintenance of CVCs [central venous catheters] and to prevent CLABSI [central line–associated bloodstream infections],” wrote Dr. Anthony J. Piazza of the department of pediatrics at Emory University, Atlanta, and his colleagues.
The researchers examined 17 health care centers, from which eight test groups were identified and evaluated via orchestrated testing methods. Each center was surveyed to compare CLABSI rates before and after implementation of SLUG Bug protocols, and to determine each center’s compliance rate on procedural aspects such as tubing change, hub care, and sterilization. The measurable target Dr. Piazza and his colleagues had in mind was to lower CLABSI rates by 15% – deemed “a clinically meaningful target” – over the course of 12 months (Pediatrics. 2016 Dec. 22. doi:10.1542/peds.2014-3642).
The mean CLABSI rate across centers declined from 1.333 per 1,000 line-days at baseline to 1.076 per 1,000 line-days at 12 months, a reduction of 19.28%, meeting the benchmark set by the investigators. Furthermore, all but 1 of the 17 centers included in the study recorded a compliance rate of 75% or higher. Of the eight study groups, only two did not see a reduction in CLABSI rates, with changes of 0.512 and 0.444; all other groups saw CLABSI rates decrease anywhere from –0.157 to –1.860.
“The CLABSI Clinical Practice Recommendation is generalizable to other settings in which prolonged CVC use is medically necessary,” the authors wrote, adding that the “results support strong consideration for the use of sterile [tubing change] in conjunction with [hub care] compliance monitoring to further reduce NICU rates of CLABSI.”
The study did not receive any outside funding. Dr. Piazza did not report any relevant financial disclosures, but several coauthors reported potential conflicts of their own.
Hospitals and health centers that participate in orchestrated testing protocols for diagnosis and treatment of central line–associated bloodstream infections (CLABSI) have lower rates of hospital admissions, according to a new study published in Pediatrics.
“The purpose of the SLUG Bug (Standardizing Line Care Under Guideline Recommendations) collaborative was to provide potentially better practice recommendations for neonatal health care professionals in care and maintenance of CVCs [central venous catheters] and to prevent CLABSI [central line–associated bloodstream infections],” wrote Dr. Anthony J. Piazza of the department of pediatrics at Emory University, Atlanta, and his colleagues.
The researchers examined 17 health care centers, from which eight test groups were identified and evaluated via orchestrated testing methods. Each center was surveyed to compare CLABSI rates before and after implementation of SLUG Bug protocols, and to determine each center’s compliance rate on procedural aspects such as tubing change, hub care, and sterilization. The measurable target Dr. Piazza and his colleagues had in mind was to lower CLABSI rates by 15% – deemed “a clinically meaningful target” – over the course of 12 months (Pediatrics. 2016 Dec. 22. doi:10.1542/peds.2014-3642).
The mean CLABSI rate across centers declined from 1.333 per 1,000 line-days at baseline to 1.076 per 1,000 line-days at 12 months, a reduction of 19.28%, meeting the benchmark set by the investigators. Furthermore, all but 1 of the 17 centers included in the study recorded a compliance rate of 75% or higher. Of the eight study groups, only two did not see a reduction in CLABSI rates, with changes of 0.512 and 0.444; all other groups saw CLABSI rates decrease anywhere from –0.157 to –1.860.
“The CLABSI Clinical Practice Recommendation is generalizable to other settings in which prolonged CVC use is medically necessary,” the authors wrote, adding that the “results support strong consideration for the use of sterile [tubing change] in conjunction with [hub care] compliance monitoring to further reduce NICU rates of CLABSI.”
The study did not receive any outside funding. Dr. Piazza did not report any relevant financial disclosures, but several coauthors reported potential conflicts of their own.
FROM PEDIATRICS
Key clinical point: Multicenter orchestrated testing for central line–associated bloodstream infection (CLABSI) leads to significantly decreased NICU admission rates.
Major finding: CLABSI rates decreased from 1.333 to 1.076 per 1,000 line-days (19.28%), with 16 of 17 centers achieving at least 75% compliance rates.
Data source: Cohort study of 17 hospital centers.
Disclosures: The study received no external funding. Several coauthors reported individual potential conflicts of interest.
Second dose of herpes zoster vaccine beneficial to seniors
The herpes zoster vaccine should be administered earlier rather than later in order to achieve optimal immune response, but an additional booster shot for individuals 70 years or older is also advisable.
This is according to a recent study published in the Journal of Infectious Diseases, which looked at four distinct cohorts – 200 subjects at least 70 years old who had already received the herpes zoster vaccine (ZV) 10 years or more prior (Group 1), 200 subjects at least 70 years old who had never received ZV (Group 2), 100 subjects ages 60-69 years old who had never received ZV (Group 3), and 100 subjects 50-59 years old who had never received ZV (Group 4) – to determine the efficacy of relatively late ZV administration on inducing an adequate immune response (J Infect Dis. 2016 Jan 1;213[1]:14-22. doi: 10.1093/infdis/jiv480).
“During aging there is a progressive decline in immune responsiveness to vaccination and a shortening of the duration of vaccine-induced immunity,” wrote Dr. Myron J. Levin of the University of Colorado, Denver, and his associates, who added that “as an initial step in investigating the potential for reversing this decline in efficacy, we determined that a booster dose of ZV administered to adults [at least] 70 years of age elicits a varicella-zoster virus (VZV) antibody response that is noninferior to that of ZV administered as a first dose.”
Dr. Levin and his coinvestigators separated subjects into one of the four aforementioned cohorts, enrolling individuals who had a history of varicella and had been U.S. residents for at least 30 years, but had no history of herpes zoster prior to enrollment. All individuals received a single, subcutaneous, deltoid region ZV (Zostavax) injection of 0.65 mL on the first day of the study, with subsequent blood samples collected and analyzed at 1, 6, and 52 weeks after receiving ZV. Subjects in Group 2 were matched with subjects in Group 1 based on age to compare results.
Baseline levels of both interferon gamma (IFN-gamma) and interleukin 2 (IL-2) were significantly higher in Group 1 than in Group 2. The geometric mean count of VZV-specific effector memory cells per million peripheral blood mononuclear cells in Group 1 was 47 at baseline, 88 at week 1, 90 at week 6, and 65 at week 52, vs. 36 at baseline, 65 at week 1, 73 at week 6, and 37 at week 52 in Group 2 (P less than .05). Similar disparities were seen between Groups 3 and 4, too, with Group 4 having consistently and significantly higher geometric mean counts at each collection of blood samples throughout the study.
“All age groups developed an increase in GMT [geometric mean titer] at week 1 after ZV receipt that peaked at week 6,” the authors explained. However, “the booster dose of ZV administered to adults [at least] 70 years old after [at least] 10 years elicited a GMT and geometric mean fold-rise in VZV antibody titer that was noninferior to that of ZV administered as a first dose to subjects [at least] 70 years old.”
The indication of that, the authors conclude, is that cell-mediated immunity is affected by ZV and enhanced by a stronger, or more recent, dose. This lends credence to the theory that although it is better to get a ZV shot earlier in life, those who are approaching age 70 years can – and, in many cases, should – get a booster shot to strengthen and maintain that immunity.
“Although the practical implications of the current findings are not fully understood, the similarity of [enzyme-linked immunosorbent spot] responses to those observed in the successful efficacy trial of ZV in vaccinees [at least] 60 years of age supports further investigation of administration of ZV at an early age vs. at a later age and further investigation of a booster dose for elderly individuals at an appropriate interval after initial immunization against HZ,” Dr. Levin and his coauthors concluded.
The study was funded by Merck, Sharp & Dohme. Dr. Levin reported having received grants, personal fees, and royalty payments from Merck. Several other coauthors disclosed individual potential conflicts of interest as well.
The herpes zoster vaccine should be administered earlier rather than later in order to achieve optimal immune response, but an additional booster shot for individuals 70 years or older is also advisable.
This is according to a recent study published in the Journal of Infectious Diseases, which looked at four distinct cohorts – 200 subjects at least 70 years old who had already received the herpes zoster vaccine (ZV) 10 years or more prior (Group 1), 200 subjects at least 70 years old who had never received ZV (Group 2), 100 subjects ages 60-69 years old who had never received ZV (Group 3), and 100 subjects 50-59 years old who had never received ZV (Group 4) – to determine the efficacy of relatively late ZV administration on inducing an adequate immune response (J Infect Dis. 2016 Jan 1;213[1]:14-22. doi: 10.1093/infdis/jiv480).
“During aging there is a progressive decline in immune responsiveness to vaccination and a shortening of the duration of vaccine-induced immunity,” wrote Dr. Myron J. Levin of the University of Colorado, Denver, and his associates, who added that “as an initial step in investigating the potential for reversing this decline in efficacy, we determined that a booster dose of ZV administered to adults [at least] 70 years of age elicits a varicella-zoster virus (VZV) antibody response that is noninferior to that of ZV administered as a first dose.”
Dr. Levin and his coinvestigators separated subjects into one of the four aforementioned cohorts, enrolling individuals who had a history of varicella and had been U.S. residents for at least 30 years, but had no history of herpes zoster prior to enrollment. All individuals received a single, subcutaneous, deltoid region ZV (Zostavax) injection of 0.65 mL on the first day of the study, with subsequent blood samples collected and analyzed at 1, 6, and 52 weeks after receiving ZV. Subjects in Group 2 were matched with subjects in Group 1 based on age to compare results.
Baseline levels of both interferon gamma (IFN-gamma) and interleukin 2 (IL-2) were significantly higher in Group 1 than in Group 2. The geometric mean count of VZV-specific effector memory cells per million peripheral blood mononuclear cells in Group 1 was 47 at baseline, 88 at week 1, 90 at week 6, and 65 at week 52, vs. 36 at baseline, 65 at week 1, 73 at week 6, and 37 at week 52 in Group 2 (P less than .05). Similar disparities were seen between Groups 3 and 4, too, with Group 4 having consistently and significantly higher geometric mean counts at each collection of blood samples throughout the study.
“All age groups developed an increase in GMT [geometric mean titer] at week 1 after ZV receipt that peaked at week 6,” the authors explained. However, “the booster dose of ZV administered to adults [at least] 70 years old after [at least] 10 years elicited a GMT and geometric mean fold-rise in VZV antibody titer that was noninferior to that of ZV administered as a first dose to subjects [at least] 70 years old.”
The indication of that, the authors conclude, is that cell-mediated immunity is affected by ZV and enhanced by a stronger, or more recent, dose. This lends credence to the theory that although it is better to get a ZV shot earlier in life, those who are approaching age 70 years can – and, in many cases, should – get a booster shot to strengthen and maintain that immunity.
“Although the practical implications of the current findings are not fully understood, the similarity of [enzyme-linked immunosorbent spot] responses to those observed in the successful efficacy trial of ZV in vaccinees [at least] 60 years of age supports further investigation of administration of ZV at an early age vs. at a later age and further investigation of a booster dose for elderly individuals at an appropriate interval after initial immunization against HZ,” Dr. Levin and his coauthors concluded.
The study was funded by Merck, Sharp & Dohme. Dr. Levin reported having received grants, personal fees, and royalty payments from Merck. Several other coauthors disclosed individual potential conflicts of interest as well.
The herpes zoster vaccine should be administered earlier rather than later in order to achieve optimal immune response, but an additional booster shot for individuals 70 years or older is also advisable.
This is according to a recent study published in the Journal of Infectious Diseases, which looked at four distinct cohorts – 200 subjects at least 70 years old who had already received the herpes zoster vaccine (ZV) 10 years or more prior (Group 1), 200 subjects at least 70 years old who had never received ZV (Group 2), 100 subjects ages 60-69 years old who had never received ZV (Group 3), and 100 subjects 50-59 years old who had never received ZV (Group 4) – to determine the efficacy of relatively late ZV administration on inducing an adequate immune response (J Infect Dis. 2016 Jan 1;213[1]:14-22. doi: 10.1093/infdis/jiv480).
“During aging there is a progressive decline in immune responsiveness to vaccination and a shortening of the duration of vaccine-induced immunity,” wrote Dr. Myron J. Levin of the University of Colorado, Denver, and his associates, who added that “as an initial step in investigating the potential for reversing this decline in efficacy, we determined that a booster dose of ZV administered to adults [at least] 70 years of age elicits a varicella-zoster virus (VZV) antibody response that is noninferior to that of ZV administered as a first dose.”
Dr. Levin and his coinvestigators separated subjects into one of the four aforementioned cohorts, enrolling individuals who had a history of varicella and had been U.S. residents for at least 30 years, but had no history of herpes zoster prior to enrollment. All individuals received a single, subcutaneous, deltoid region ZV (Zostavax) injection of 0.65 mL on the first day of the study, with subsequent blood samples collected and analyzed at 1, 6, and 52 weeks after receiving ZV. Subjects in Group 2 were matched with subjects in Group 1 based on age to compare results.
Baseline levels of both interferon gamma (IFN-gamma) and interleukin 2 (IL-2) were significantly higher in Group 1 than in Group 2. The geometric mean count of VZV-specific effector memory cells per million peripheral blood mononuclear cells in Group 1 was 47 at baseline, 88 at week 1, 90 at week 6, and 65 at week 52, vs. 36 at baseline, 65 at week 1, 73 at week 6, and 37 at week 52 in Group 2 (P less than .05). Similar disparities were seen between Groups 3 and 4, too, with Group 4 having consistently and significantly higher geometric mean counts at each collection of blood samples throughout the study.
“All age groups developed an increase in GMT [geometric mean titer] at week 1 after ZV receipt that peaked at week 6,” the authors explained. However, “the booster dose of ZV administered to adults [at least] 70 years old after [at least] 10 years elicited a GMT and geometric mean fold-rise in VZV antibody titer that was noninferior to that of ZV administered as a first dose to subjects [at least] 70 years old.”
The indication of that, the authors conclude, is that cell-mediated immunity is affected by ZV and enhanced by a stronger, or more recent, dose. This lends credence to the theory that although it is better to get a ZV shot earlier in life, those who are approaching age 70 years can – and, in many cases, should – get a booster shot to strengthen and maintain that immunity.
“Although the practical implications of the current findings are not fully understood, the similarity of [enzyme-linked immunosorbent spot] responses to those observed in the successful efficacy trial of ZV in vaccinees [at least] 60 years of age supports further investigation of administration of ZV at an early age vs. at a later age and further investigation of a booster dose for elderly individuals at an appropriate interval after initial immunization against HZ,” Dr. Levin and his coauthors concluded.
The study was funded by Merck, Sharp & Dohme. Dr. Levin reported having received grants, personal fees, and royalty payments from Merck. Several other coauthors disclosed individual potential conflicts of interest as well.
FROM THE JOURNAL OF INFECTIOUS DISEASES
Key clinical point: Booster doses of the herpes zoster vaccine should be given earlier rather than later to induce effective immune responses in patients aged 70 years and older.
Major finding: Interferon gamma and interleukin 2 levels were significantly higher in cohorts of subjects at least 70 years of age who received booster doses, both at baseline and after vaccination, than other subjects.
Data source: Cohort study of 600 U.S. residents aged 50 years and older with a history of varicella but no history of herpes zoster.
Disclosures: Study funded by Merck, Sharp & Dohme; Dr. Levin disclosed receiving grants and fees from Merck; several other coauthors revealed individual potential conflicts of interest.
Use of e-cigarettes, marijuana remains high among U.S. teens
Cigarette smoking continues to decline among U.S. teens, but rates of daily use of e-cigarettes and marijuana remain high. In fact, high school seniors report smoking marijuana at higher rates than tobacco cigarettes.
Those are a few of the key findings of the 2015 Monitoring the Future report released Dec.16. Researchers surveyed 41,551 students from 377 public and private schools in the 8th, 10th, and 12th grades to determine drug use habits across the United States.
“We are heartened to see that most illicit drug use is not increasing, nonmedical use of prescription opioids is decreasing, and there is improvement in alcohol and cigarette use rates,” Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said in a statement. “However, continued areas of concern are the high rate of daily marijuana smoking seen among high school students because of marijuana’s potential deleterious effects on the developing brains of teenagers, and the high rates of overall tobacco products and nicotine containing e-cigarettes usage.”
The report found that 9.5% of 8th-graders, 14.0% of 10th-graders, and 16.2% of 12th-graders had used e-cigarettes in the month prior to being surveyed. Those numbers are roughly on par with what was reported last year, when the survey found that 9%, 16%, and 17% of 8th-, 10th-, and 12th-graders, respectively, recently had used e-cigarettes.
High school seniors alone reported relatively high rates of nicotine use (22.2%) and marijuana or hash oil (6.1%) inhalation, as well. Overall, 66.2% of high school seniors surveyed reported not knowing exactly what they had inhaled. The 2015 report also marks the first time daily cigarette use was lower than daily marijuana use among 12th-graders: 5.5% vs. 6%. Furthermore, 21.3% reported having used marijuana in the last month, compared with 11.4% who reported smoking cigarettes.
During a teleconference announcing the findings, Dr. Volkow said the higher prevalence of marijuana over cigarette smoking “reflects attitudes” among America’s youth – something that she stressed needs to be addressed by health care providers and policy makers. According to the report, 31.9% of seniors said regular use of marijuana could be harmful, compared with 36.1% last year.
Meanwhile, the use of heroin was at its lowest point since these surveys began in 1975. Overall, 95.3% of 12th-graders voiced a “continued high rate of disapproval” regarding occasional heroin use. Other drugs and addictive substances also showed similarly low rates among 12th-graders, compared with previous years, such as synthetic cannabinoids (5.2%), acetaminophen/hydrocodone (Vicodin) (4.4%), oxycodone (Oxycontin) (3.7%), and methylenedioxymethamphetamine, also known as MDMA, Ecstasy, or Molly (3.6%).
The 12th-graders reported relatively high rates of alcohol use: 58.2% reported prior use. But the report highlights that 5-year trends overall continue to show that alcohol use is declining, with 9.7%, 21.5%, and 35.3% of 8th-, 10th-, and 12th-graders, respectively, reporting consumption in the last month before being surveyed. Five years ago, those rates were 13.8%, 28.9%, and 41.2%, respectively. Also the rate of binge drinking, defined as consuming five or more drinks in a row over the past 2 weeks, dropped to 17.2% among seniors, compared with 19.4% the previous year and the peak rate of 31.5% in 1998.
The prevalence of hookah and small cigar smoking also remained relatively high, with 19.8% and 15.9%, respectively, reporting recent use.
Lloyd D. Johnston, Ph.D., senior research scientist at the University of Michigan, Ann Arbor, and principal investigator on the report, cautioned during the teleconference that despite the positive aspects of the latest findings, the health care community – providers, policy makers, and patients – need to remain vigilant.
“[This] reminds me a lot of 1990, when the country got substance abuse of most kinds down to very low levels, and I think the country took its eye off the problem,” Dr. Johnston said. “It’s like we said ‘that problem’s solved; let’s move to the next one,’ [but] this is not a problem that is ever solved,” he said. “This is like crime – you keep working to minimize it.”
The Monitoring the Future report, funded by the National Institute on Drug Abuse, is conducted by investigators from the University of Michigan. None of the authors reported relevant financial disclosures.
Cigarette smoking continues to decline among U.S. teens, but rates of daily use of e-cigarettes and marijuana remain high. In fact, high school seniors report smoking marijuana at higher rates than tobacco cigarettes.
Those are a few of the key findings of the 2015 Monitoring the Future report released Dec.16. Researchers surveyed 41,551 students from 377 public and private schools in the 8th, 10th, and 12th grades to determine drug use habits across the United States.
“We are heartened to see that most illicit drug use is not increasing, nonmedical use of prescription opioids is decreasing, and there is improvement in alcohol and cigarette use rates,” Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said in a statement. “However, continued areas of concern are the high rate of daily marijuana smoking seen among high school students because of marijuana’s potential deleterious effects on the developing brains of teenagers, and the high rates of overall tobacco products and nicotine containing e-cigarettes usage.”
The report found that 9.5% of 8th-graders, 14.0% of 10th-graders, and 16.2% of 12th-graders had used e-cigarettes in the month prior to being surveyed. Those numbers are roughly on par with what was reported last year, when the survey found that 9%, 16%, and 17% of 8th-, 10th-, and 12th-graders, respectively, recently had used e-cigarettes.
High school seniors alone reported relatively high rates of nicotine use (22.2%) and marijuana or hash oil (6.1%) inhalation, as well. Overall, 66.2% of high school seniors surveyed reported not knowing exactly what they had inhaled. The 2015 report also marks the first time daily cigarette use was lower than daily marijuana use among 12th-graders: 5.5% vs. 6%. Furthermore, 21.3% reported having used marijuana in the last month, compared with 11.4% who reported smoking cigarettes.
During a teleconference announcing the findings, Dr. Volkow said the higher prevalence of marijuana over cigarette smoking “reflects attitudes” among America’s youth – something that she stressed needs to be addressed by health care providers and policy makers. According to the report, 31.9% of seniors said regular use of marijuana could be harmful, compared with 36.1% last year.
Meanwhile, the use of heroin was at its lowest point since these surveys began in 1975. Overall, 95.3% of 12th-graders voiced a “continued high rate of disapproval” regarding occasional heroin use. Other drugs and addictive substances also showed similarly low rates among 12th-graders, compared with previous years, such as synthetic cannabinoids (5.2%), acetaminophen/hydrocodone (Vicodin) (4.4%), oxycodone (Oxycontin) (3.7%), and methylenedioxymethamphetamine, also known as MDMA, Ecstasy, or Molly (3.6%).
The 12th-graders reported relatively high rates of alcohol use: 58.2% reported prior use. But the report highlights that 5-year trends overall continue to show that alcohol use is declining, with 9.7%, 21.5%, and 35.3% of 8th-, 10th-, and 12th-graders, respectively, reporting consumption in the last month before being surveyed. Five years ago, those rates were 13.8%, 28.9%, and 41.2%, respectively. Also the rate of binge drinking, defined as consuming five or more drinks in a row over the past 2 weeks, dropped to 17.2% among seniors, compared with 19.4% the previous year and the peak rate of 31.5% in 1998.
The prevalence of hookah and small cigar smoking also remained relatively high, with 19.8% and 15.9%, respectively, reporting recent use.
Lloyd D. Johnston, Ph.D., senior research scientist at the University of Michigan, Ann Arbor, and principal investigator on the report, cautioned during the teleconference that despite the positive aspects of the latest findings, the health care community – providers, policy makers, and patients – need to remain vigilant.
“[This] reminds me a lot of 1990, when the country got substance abuse of most kinds down to very low levels, and I think the country took its eye off the problem,” Dr. Johnston said. “It’s like we said ‘that problem’s solved; let’s move to the next one,’ [but] this is not a problem that is ever solved,” he said. “This is like crime – you keep working to minimize it.”
The Monitoring the Future report, funded by the National Institute on Drug Abuse, is conducted by investigators from the University of Michigan. None of the authors reported relevant financial disclosures.
Cigarette smoking continues to decline among U.S. teens, but rates of daily use of e-cigarettes and marijuana remain high. In fact, high school seniors report smoking marijuana at higher rates than tobacco cigarettes.
Those are a few of the key findings of the 2015 Monitoring the Future report released Dec.16. Researchers surveyed 41,551 students from 377 public and private schools in the 8th, 10th, and 12th grades to determine drug use habits across the United States.
“We are heartened to see that most illicit drug use is not increasing, nonmedical use of prescription opioids is decreasing, and there is improvement in alcohol and cigarette use rates,” Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said in a statement. “However, continued areas of concern are the high rate of daily marijuana smoking seen among high school students because of marijuana’s potential deleterious effects on the developing brains of teenagers, and the high rates of overall tobacco products and nicotine containing e-cigarettes usage.”
The report found that 9.5% of 8th-graders, 14.0% of 10th-graders, and 16.2% of 12th-graders had used e-cigarettes in the month prior to being surveyed. Those numbers are roughly on par with what was reported last year, when the survey found that 9%, 16%, and 17% of 8th-, 10th-, and 12th-graders, respectively, recently had used e-cigarettes.
High school seniors alone reported relatively high rates of nicotine use (22.2%) and marijuana or hash oil (6.1%) inhalation, as well. Overall, 66.2% of high school seniors surveyed reported not knowing exactly what they had inhaled. The 2015 report also marks the first time daily cigarette use was lower than daily marijuana use among 12th-graders: 5.5% vs. 6%. Furthermore, 21.3% reported having used marijuana in the last month, compared with 11.4% who reported smoking cigarettes.
During a teleconference announcing the findings, Dr. Volkow said the higher prevalence of marijuana over cigarette smoking “reflects attitudes” among America’s youth – something that she stressed needs to be addressed by health care providers and policy makers. According to the report, 31.9% of seniors said regular use of marijuana could be harmful, compared with 36.1% last year.
Meanwhile, the use of heroin was at its lowest point since these surveys began in 1975. Overall, 95.3% of 12th-graders voiced a “continued high rate of disapproval” regarding occasional heroin use. Other drugs and addictive substances also showed similarly low rates among 12th-graders, compared with previous years, such as synthetic cannabinoids (5.2%), acetaminophen/hydrocodone (Vicodin) (4.4%), oxycodone (Oxycontin) (3.7%), and methylenedioxymethamphetamine, also known as MDMA, Ecstasy, or Molly (3.6%).
The 12th-graders reported relatively high rates of alcohol use: 58.2% reported prior use. But the report highlights that 5-year trends overall continue to show that alcohol use is declining, with 9.7%, 21.5%, and 35.3% of 8th-, 10th-, and 12th-graders, respectively, reporting consumption in the last month before being surveyed. Five years ago, those rates were 13.8%, 28.9%, and 41.2%, respectively. Also the rate of binge drinking, defined as consuming five or more drinks in a row over the past 2 weeks, dropped to 17.2% among seniors, compared with 19.4% the previous year and the peak rate of 31.5% in 1998.
The prevalence of hookah and small cigar smoking also remained relatively high, with 19.8% and 15.9%, respectively, reporting recent use.
Lloyd D. Johnston, Ph.D., senior research scientist at the University of Michigan, Ann Arbor, and principal investigator on the report, cautioned during the teleconference that despite the positive aspects of the latest findings, the health care community – providers, policy makers, and patients – need to remain vigilant.
“[This] reminds me a lot of 1990, when the country got substance abuse of most kinds down to very low levels, and I think the country took its eye off the problem,” Dr. Johnston said. “It’s like we said ‘that problem’s solved; let’s move to the next one,’ [but] this is not a problem that is ever solved,” he said. “This is like crime – you keep working to minimize it.”
The Monitoring the Future report, funded by the National Institute on Drug Abuse, is conducted by investigators from the University of Michigan. None of the authors reported relevant financial disclosures.
Key clinical point: While alcohol use and the use of several drugs remain on downward trends, the rates of e-cigarette and marijuana use remain high.
Major finding: Daily cigarette use among high school seniors was 5.5%, lower than daily marijuana use (6%) for the first time since survey began in 1975.
Data source: Survey of 41,551 8th-, 10th-, and 12th-grade students from 377 public and private schools across the United States.
Disclosures: The study was sponsored by the National Institute on Drug Abuse and conducted by the University of Michigan, Ann Arbor. The authors did not report any relevant financial disclosures.
