User login
Gene mutations may predispose women to alopecia subtype
in a study of women of African ancestry.
Central centrifugal cicatricial alopecia (CCCA) often runs in families, suggesting a possible genetic component, but specific genes have not been explored, wrote Liron Malki, of Tel Aviv Medical Center and his colleagues.
In a study published in the New England Journal of Medicine, the researchers used a genetic sequencing procedure to examine genes in 16 women with African ancestry with CCCA who served as a discovery set; they identified four heterozygous mutations in the PAD13 gene in 5 women, which included one splice site and three missense mutations. The PAD13 gene “is responsible for mediating the modification of proteins critical for normal hair shaft formation and shaping, such as trichohyalin, and may also play a role in interfollicular epidermal differentiation,” they wrote.
Mr. Malki and his associates then identified an additional 42 patients of African descent with CCCA and directly sequenced PADI3; they found 9 patients with genetic variations.
Overall, the researchers found six mutations in PAD13 that appeared in 14 of the 58 patients (24%) with CCCA.
In a post hoc analysis, the mutations were significantly more prevalent among CCCA patients, compared with 2,702 control women of African ancestry (P = .03 by the chi-square test and P = 0.04 by Fisher’s exact test after adjusting for relatedness of study participants).
The results were limited by several factors, including the small sample size and lack of data on individual hair grooming habits. However, the findings support data from previous studies indicating that PAD13 plays an important role in proper hair shaft formation, the researchers wrote.
“The different properties of hair among persons of African ancestry and those of European ancestry may explain, in part, the different clinical consequences of PADI3 mutations in CCCA and in the uncombable hair syndrome,” Mr. Malki and his associates wrote. “Alternatively, the distinct variants in PADI3 in each of the disorders may account for the difference in clinical outcomes.”
The study was supported in part by a grant to Eli Sprecher, MD, PhD, from the Ram Family Foundation and a grant to Dr. Sprecher and Regina C. Betz, MD, from the German-Israeli Foundation, a L’Oreal African Hair and Skin Research grant to Ncoza C. Dlova, a research grant from the Skin of Color Society to Amy McMichael, MD, and the Deutsche Forschungsgemeinschaft–funded Cluster of Excellence ImmunoSensation grant to Dr. Betz. Several other researchers – but not all – reported numerous financial disclosures from pharmaceutical and technology companies and universities and organizations.
SOURCE: Malki L et al. N Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMoa1816614.
Central centrifugal cicatricial alopecia (CCCA) is characterized by hair loss with rapid, progressive, and permanent hair follicle destruction, Jouni Uitto, MD, PhD, wrote in an accompanying editorial.
The current study showed six distinct genetic mutations in PAD13, a gene that allows normal hair follicle development, in 14 of 58 women with CCCA. The researchers also found that genes involved in hair shaft formation were expressed differently in women with CCCA than in unaffected women. Dr. Uitto wrote. Thus, variants in other genes likely contribute to CCCA pathogenesis.
“The observations by Malki et al. suggest that PADI3 mutations predispose persons to CCCA, which is then clinically manifested when hairstyling practices damage the hair. Thus, in the familial setting, such practices should be discouraged in both symptomatic and asymptomatic family members.” he wrote.
Dr. Uitto also noted that uncombable hair syndrome, a rare disorder not associated with alopecia or scarring, also has been associated with mutations in PAD13. However, uncombable hair syndrome is most common in children, who usually outgrow the condition, and it appears not to be inherited. “The mutations in PADI3 in these two conditions are distinct, which suggests different pathogenic consequences of specific PADI3 variants on hair development.”
The PAD13 mutations may predispose women to CCCA, but the data do not support screening asymptomatic women, Dr. Uitto wrote.
“The presence of variants in PADI3 in both CCCA and uncombable hair syndrome suggests that this gene has a pleiotropic effect on the determination of hair texture, and the finding holds implications for future development of therapy, such as the restoration of PADI3 activity,” he concluded.
Dr. Uitto is affiliated with the department of dermatology and cutaneous biology at Jefferson Medical College, Philadelphia. This is a summary of his editorial accompanying the article by Malki et al. (New Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMe1900042). He reported no relevant financial disclosures.
Central centrifugal cicatricial alopecia (CCCA) is characterized by hair loss with rapid, progressive, and permanent hair follicle destruction, Jouni Uitto, MD, PhD, wrote in an accompanying editorial.
The current study showed six distinct genetic mutations in PAD13, a gene that allows normal hair follicle development, in 14 of 58 women with CCCA. The researchers also found that genes involved in hair shaft formation were expressed differently in women with CCCA than in unaffected women. Dr. Uitto wrote. Thus, variants in other genes likely contribute to CCCA pathogenesis.
“The observations by Malki et al. suggest that PADI3 mutations predispose persons to CCCA, which is then clinically manifested when hairstyling practices damage the hair. Thus, in the familial setting, such practices should be discouraged in both symptomatic and asymptomatic family members.” he wrote.
Dr. Uitto also noted that uncombable hair syndrome, a rare disorder not associated with alopecia or scarring, also has been associated with mutations in PAD13. However, uncombable hair syndrome is most common in children, who usually outgrow the condition, and it appears not to be inherited. “The mutations in PADI3 in these two conditions are distinct, which suggests different pathogenic consequences of specific PADI3 variants on hair development.”
The PAD13 mutations may predispose women to CCCA, but the data do not support screening asymptomatic women, Dr. Uitto wrote.
“The presence of variants in PADI3 in both CCCA and uncombable hair syndrome suggests that this gene has a pleiotropic effect on the determination of hair texture, and the finding holds implications for future development of therapy, such as the restoration of PADI3 activity,” he concluded.
Dr. Uitto is affiliated with the department of dermatology and cutaneous biology at Jefferson Medical College, Philadelphia. This is a summary of his editorial accompanying the article by Malki et al. (New Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMe1900042). He reported no relevant financial disclosures.
Central centrifugal cicatricial alopecia (CCCA) is characterized by hair loss with rapid, progressive, and permanent hair follicle destruction, Jouni Uitto, MD, PhD, wrote in an accompanying editorial.
The current study showed six distinct genetic mutations in PAD13, a gene that allows normal hair follicle development, in 14 of 58 women with CCCA. The researchers also found that genes involved in hair shaft formation were expressed differently in women with CCCA than in unaffected women. Dr. Uitto wrote. Thus, variants in other genes likely contribute to CCCA pathogenesis.
“The observations by Malki et al. suggest that PADI3 mutations predispose persons to CCCA, which is then clinically manifested when hairstyling practices damage the hair. Thus, in the familial setting, such practices should be discouraged in both symptomatic and asymptomatic family members.” he wrote.
Dr. Uitto also noted that uncombable hair syndrome, a rare disorder not associated with alopecia or scarring, also has been associated with mutations in PAD13. However, uncombable hair syndrome is most common in children, who usually outgrow the condition, and it appears not to be inherited. “The mutations in PADI3 in these two conditions are distinct, which suggests different pathogenic consequences of specific PADI3 variants on hair development.”
The PAD13 mutations may predispose women to CCCA, but the data do not support screening asymptomatic women, Dr. Uitto wrote.
“The presence of variants in PADI3 in both CCCA and uncombable hair syndrome suggests that this gene has a pleiotropic effect on the determination of hair texture, and the finding holds implications for future development of therapy, such as the restoration of PADI3 activity,” he concluded.
Dr. Uitto is affiliated with the department of dermatology and cutaneous biology at Jefferson Medical College, Philadelphia. This is a summary of his editorial accompanying the article by Malki et al. (New Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMe1900042). He reported no relevant financial disclosures.
in a study of women of African ancestry.
Central centrifugal cicatricial alopecia (CCCA) often runs in families, suggesting a possible genetic component, but specific genes have not been explored, wrote Liron Malki, of Tel Aviv Medical Center and his colleagues.
In a study published in the New England Journal of Medicine, the researchers used a genetic sequencing procedure to examine genes in 16 women with African ancestry with CCCA who served as a discovery set; they identified four heterozygous mutations in the PAD13 gene in 5 women, which included one splice site and three missense mutations. The PAD13 gene “is responsible for mediating the modification of proteins critical for normal hair shaft formation and shaping, such as trichohyalin, and may also play a role in interfollicular epidermal differentiation,” they wrote.
Mr. Malki and his associates then identified an additional 42 patients of African descent with CCCA and directly sequenced PADI3; they found 9 patients with genetic variations.
Overall, the researchers found six mutations in PAD13 that appeared in 14 of the 58 patients (24%) with CCCA.
In a post hoc analysis, the mutations were significantly more prevalent among CCCA patients, compared with 2,702 control women of African ancestry (P = .03 by the chi-square test and P = 0.04 by Fisher’s exact test after adjusting for relatedness of study participants).
The results were limited by several factors, including the small sample size and lack of data on individual hair grooming habits. However, the findings support data from previous studies indicating that PAD13 plays an important role in proper hair shaft formation, the researchers wrote.
“The different properties of hair among persons of African ancestry and those of European ancestry may explain, in part, the different clinical consequences of PADI3 mutations in CCCA and in the uncombable hair syndrome,” Mr. Malki and his associates wrote. “Alternatively, the distinct variants in PADI3 in each of the disorders may account for the difference in clinical outcomes.”
The study was supported in part by a grant to Eli Sprecher, MD, PhD, from the Ram Family Foundation and a grant to Dr. Sprecher and Regina C. Betz, MD, from the German-Israeli Foundation, a L’Oreal African Hair and Skin Research grant to Ncoza C. Dlova, a research grant from the Skin of Color Society to Amy McMichael, MD, and the Deutsche Forschungsgemeinschaft–funded Cluster of Excellence ImmunoSensation grant to Dr. Betz. Several other researchers – but not all – reported numerous financial disclosures from pharmaceutical and technology companies and universities and organizations.
SOURCE: Malki L et al. N Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMoa1816614.
in a study of women of African ancestry.
Central centrifugal cicatricial alopecia (CCCA) often runs in families, suggesting a possible genetic component, but specific genes have not been explored, wrote Liron Malki, of Tel Aviv Medical Center and his colleagues.
In a study published in the New England Journal of Medicine, the researchers used a genetic sequencing procedure to examine genes in 16 women with African ancestry with CCCA who served as a discovery set; they identified four heterozygous mutations in the PAD13 gene in 5 women, which included one splice site and three missense mutations. The PAD13 gene “is responsible for mediating the modification of proteins critical for normal hair shaft formation and shaping, such as trichohyalin, and may also play a role in interfollicular epidermal differentiation,” they wrote.
Mr. Malki and his associates then identified an additional 42 patients of African descent with CCCA and directly sequenced PADI3; they found 9 patients with genetic variations.
Overall, the researchers found six mutations in PAD13 that appeared in 14 of the 58 patients (24%) with CCCA.
In a post hoc analysis, the mutations were significantly more prevalent among CCCA patients, compared with 2,702 control women of African ancestry (P = .03 by the chi-square test and P = 0.04 by Fisher’s exact test after adjusting for relatedness of study participants).
The results were limited by several factors, including the small sample size and lack of data on individual hair grooming habits. However, the findings support data from previous studies indicating that PAD13 plays an important role in proper hair shaft formation, the researchers wrote.
“The different properties of hair among persons of African ancestry and those of European ancestry may explain, in part, the different clinical consequences of PADI3 mutations in CCCA and in the uncombable hair syndrome,” Mr. Malki and his associates wrote. “Alternatively, the distinct variants in PADI3 in each of the disorders may account for the difference in clinical outcomes.”
The study was supported in part by a grant to Eli Sprecher, MD, PhD, from the Ram Family Foundation and a grant to Dr. Sprecher and Regina C. Betz, MD, from the German-Israeli Foundation, a L’Oreal African Hair and Skin Research grant to Ncoza C. Dlova, a research grant from the Skin of Color Society to Amy McMichael, MD, and the Deutsche Forschungsgemeinschaft–funded Cluster of Excellence ImmunoSensation grant to Dr. Betz. Several other researchers – but not all – reported numerous financial disclosures from pharmaceutical and technology companies and universities and organizations.
SOURCE: Malki L et al. N Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMoa1816614.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: Women with central centrifugal cicatricial alopecia (CCCA) were more likely to have a mutation of the PAD13 gene than unaffected women.
Major finding: Researchers identified six mutations in PAD13 that appeared in 24% of 58 women with CCCA.
Study details: The data come from 58 adult women with African ancestry who had a diagnosis of CCCA.
Disclosures: The study was supported in part by a grant to Eli Sprecher, MD, PhD, from the Ram Family Foundation and a grant to Dr. Sprecher and Regina C. Betz, MD, from the German-Israeli Foundation, a L’Oreal African Hair and Skin Research grant to Ncoza C. Dlova, a research grant from the Skin of Color Society to Amy McMichael, MD, and the Deutsche Forschungsgemeinschaft–funded Cluster of Excellence ImmunoSensation grant to Dr. Betz. Several other researchers – but not all – reported numerous financial disclosures from pharmaceutical and technology companies and universities and organizations.
Source: Malki L et al. N Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMoa1816614.
Swedish strategies improve survival for premature infants
based on data from a study of two cohorts including 2,205 births at 22-26 weeks’ gestational age.
The impact of the recommendations has not been well studied, wrote Mikael Norman, MD, PhD, of the Karolinska Institutet, Stockholm, and his colleagues in JAMA. To determine the impact, the researchers compared data from 1,009 births at 22-26 weeks’ gestational age during 2004-2007 with 1,196 births at 22-26 weeks’ gestational age during 2014-2016, after the implementation of guidelines on “centralization of care, antenatal corticosteroid treatment, mode of delivery, a neonatologist attending at the birth, and resuscitation of infants delivered at 22, 23, and 24 weeks’ gestational age.”
The 1-year survival increased from 70% during 2004-2007 to 77% during 2014-2016; a significant improvement (P = .003).
In addition, 1-year survival with no major morbidity improved significantly between the two time periods, from 32% to 38%, respectively (P = .008).
The mothers and infants were part of EXPRESS (Extremely Preterm Infants in Sweden Study), a national, population-based, prospective cohort study. In most cases, gestational age was determined by routine antenatal ultrasound early in the second trimester, or by date of embryo transfer in cases of in vitro fertilization. The primary outcome was survival at the age of 1 year; the secondary outcome was survival at 1 year with no major neonatal comorbidity.
Among premature infants who survived at 1 year, some conditions were significantly more prevalent in the earlier birth cohort, compared with the later cohort, notably cystic periventricular leukomalacia (6% vs. 2%), any bronchopulmonary dysplasia (73% vs. 62%), and severe bronchopulmonary dysplasia (25% vs. 14%).
Although the proportion of premature births with a neonatologist attending was similar between the two cohorts, significantly more premature infants were born outside of university hospitals and transported to a level III neonatal ICU after birth during 2004-2007, compared with 2014-2016, the researchers noted.
The study findings were limited by several factors including the retrospective design of the second cohort, inability to account for fetal losses prior to 22 weeks’ gestational age, lack of data on the causes of fetal and infant deaths, potentially unknown confounding variables that impacted infant survival, and the small sample size of some gestational age groups, the researchers noted. However, the results show improvements in 1-year survival in the wake of specific guidelines on perinatal management.
Dr. Norman reported receiving grants from the Swedish Heart Lung Foundation and the H2020/European Union, as well as personal fees from a Swedish medical journal, the Swedish patient insurance, Liber, Studentlitteratur, and AbbVie. The study was funded by the Swedish Order of Freemasons’ Foundation for Children’s Welfare.
SOURCE: Norman M et al. JAMA. 2019;321:1188-99.
The wide variation in outcomes for preterm birth worldwide raise questions as to whether the success seen in Sweden is possible in other countries, Matthew A. Rysavy, MD, PhD, and Danielle E. Y. Ehret, MD, MPH, wrote in an accompanying editorial. Considerations include population demographics, current guidelines, gestational age at which intensive care is offered, and the nature of follow-up care.
Sweden already has low rates of perinatal mortality, and current guidelines call for use of antenatal corticosteroids for births at 22 weeks’ gestation. By contrast, in the United States, antenatal corticosteroids are not recommended until 23-24 weeks’ gestation, they noted.
The editorialists called particular attention to the improvements in survival at 1 year and survival without major morbidity at 22-23 weeks’ gestation. “At 22 weeks’ gestation, the stillbirth rate decreased from 65% of all births during 2004-2007 to 35% during 2014-2016, with a reciprocal increase in live births.”
Although the results are promising, and show the possibilities for improving survival, the editorialists wrote that ongoing follow up of children born prematurely is essential to inform future research, as “much remains unknown about the later-life effects of being born so early and of the therapies used to sustain life after birth.”
Dr. Rysavy is affiliated with the department of pediatrics at the University of Iowa, Iowa City; Dr. Ehret is affiliated with the department of pediatrics at the University of Vermont, Burlington. This is a summary of their editorial accompanying the article by Norman et al. (JAMA. 2019 Mar 26;321:1163-64). They reported no financial conflicts.
The wide variation in outcomes for preterm birth worldwide raise questions as to whether the success seen in Sweden is possible in other countries, Matthew A. Rysavy, MD, PhD, and Danielle E. Y. Ehret, MD, MPH, wrote in an accompanying editorial. Considerations include population demographics, current guidelines, gestational age at which intensive care is offered, and the nature of follow-up care.
Sweden already has low rates of perinatal mortality, and current guidelines call for use of antenatal corticosteroids for births at 22 weeks’ gestation. By contrast, in the United States, antenatal corticosteroids are not recommended until 23-24 weeks’ gestation, they noted.
The editorialists called particular attention to the improvements in survival at 1 year and survival without major morbidity at 22-23 weeks’ gestation. “At 22 weeks’ gestation, the stillbirth rate decreased from 65% of all births during 2004-2007 to 35% during 2014-2016, with a reciprocal increase in live births.”
Although the results are promising, and show the possibilities for improving survival, the editorialists wrote that ongoing follow up of children born prematurely is essential to inform future research, as “much remains unknown about the later-life effects of being born so early and of the therapies used to sustain life after birth.”
Dr. Rysavy is affiliated with the department of pediatrics at the University of Iowa, Iowa City; Dr. Ehret is affiliated with the department of pediatrics at the University of Vermont, Burlington. This is a summary of their editorial accompanying the article by Norman et al. (JAMA. 2019 Mar 26;321:1163-64). They reported no financial conflicts.
The wide variation in outcomes for preterm birth worldwide raise questions as to whether the success seen in Sweden is possible in other countries, Matthew A. Rysavy, MD, PhD, and Danielle E. Y. Ehret, MD, MPH, wrote in an accompanying editorial. Considerations include population demographics, current guidelines, gestational age at which intensive care is offered, and the nature of follow-up care.
Sweden already has low rates of perinatal mortality, and current guidelines call for use of antenatal corticosteroids for births at 22 weeks’ gestation. By contrast, in the United States, antenatal corticosteroids are not recommended until 23-24 weeks’ gestation, they noted.
The editorialists called particular attention to the improvements in survival at 1 year and survival without major morbidity at 22-23 weeks’ gestation. “At 22 weeks’ gestation, the stillbirth rate decreased from 65% of all births during 2004-2007 to 35% during 2014-2016, with a reciprocal increase in live births.”
Although the results are promising, and show the possibilities for improving survival, the editorialists wrote that ongoing follow up of children born prematurely is essential to inform future research, as “much remains unknown about the later-life effects of being born so early and of the therapies used to sustain life after birth.”
Dr. Rysavy is affiliated with the department of pediatrics at the University of Iowa, Iowa City; Dr. Ehret is affiliated with the department of pediatrics at the University of Vermont, Burlington. This is a summary of their editorial accompanying the article by Norman et al. (JAMA. 2019 Mar 26;321:1163-64). They reported no financial conflicts.
based on data from a study of two cohorts including 2,205 births at 22-26 weeks’ gestational age.
The impact of the recommendations has not been well studied, wrote Mikael Norman, MD, PhD, of the Karolinska Institutet, Stockholm, and his colleagues in JAMA. To determine the impact, the researchers compared data from 1,009 births at 22-26 weeks’ gestational age during 2004-2007 with 1,196 births at 22-26 weeks’ gestational age during 2014-2016, after the implementation of guidelines on “centralization of care, antenatal corticosteroid treatment, mode of delivery, a neonatologist attending at the birth, and resuscitation of infants delivered at 22, 23, and 24 weeks’ gestational age.”
The 1-year survival increased from 70% during 2004-2007 to 77% during 2014-2016; a significant improvement (P = .003).
In addition, 1-year survival with no major morbidity improved significantly between the two time periods, from 32% to 38%, respectively (P = .008).
The mothers and infants were part of EXPRESS (Extremely Preterm Infants in Sweden Study), a national, population-based, prospective cohort study. In most cases, gestational age was determined by routine antenatal ultrasound early in the second trimester, or by date of embryo transfer in cases of in vitro fertilization. The primary outcome was survival at the age of 1 year; the secondary outcome was survival at 1 year with no major neonatal comorbidity.
Among premature infants who survived at 1 year, some conditions were significantly more prevalent in the earlier birth cohort, compared with the later cohort, notably cystic periventricular leukomalacia (6% vs. 2%), any bronchopulmonary dysplasia (73% vs. 62%), and severe bronchopulmonary dysplasia (25% vs. 14%).
Although the proportion of premature births with a neonatologist attending was similar between the two cohorts, significantly more premature infants were born outside of university hospitals and transported to a level III neonatal ICU after birth during 2004-2007, compared with 2014-2016, the researchers noted.
The study findings were limited by several factors including the retrospective design of the second cohort, inability to account for fetal losses prior to 22 weeks’ gestational age, lack of data on the causes of fetal and infant deaths, potentially unknown confounding variables that impacted infant survival, and the small sample size of some gestational age groups, the researchers noted. However, the results show improvements in 1-year survival in the wake of specific guidelines on perinatal management.
Dr. Norman reported receiving grants from the Swedish Heart Lung Foundation and the H2020/European Union, as well as personal fees from a Swedish medical journal, the Swedish patient insurance, Liber, Studentlitteratur, and AbbVie. The study was funded by the Swedish Order of Freemasons’ Foundation for Children’s Welfare.
SOURCE: Norman M et al. JAMA. 2019;321:1188-99.
based on data from a study of two cohorts including 2,205 births at 22-26 weeks’ gestational age.
The impact of the recommendations has not been well studied, wrote Mikael Norman, MD, PhD, of the Karolinska Institutet, Stockholm, and his colleagues in JAMA. To determine the impact, the researchers compared data from 1,009 births at 22-26 weeks’ gestational age during 2004-2007 with 1,196 births at 22-26 weeks’ gestational age during 2014-2016, after the implementation of guidelines on “centralization of care, antenatal corticosteroid treatment, mode of delivery, a neonatologist attending at the birth, and resuscitation of infants delivered at 22, 23, and 24 weeks’ gestational age.”
The 1-year survival increased from 70% during 2004-2007 to 77% during 2014-2016; a significant improvement (P = .003).
In addition, 1-year survival with no major morbidity improved significantly between the two time periods, from 32% to 38%, respectively (P = .008).
The mothers and infants were part of EXPRESS (Extremely Preterm Infants in Sweden Study), a national, population-based, prospective cohort study. In most cases, gestational age was determined by routine antenatal ultrasound early in the second trimester, or by date of embryo transfer in cases of in vitro fertilization. The primary outcome was survival at the age of 1 year; the secondary outcome was survival at 1 year with no major neonatal comorbidity.
Among premature infants who survived at 1 year, some conditions were significantly more prevalent in the earlier birth cohort, compared with the later cohort, notably cystic periventricular leukomalacia (6% vs. 2%), any bronchopulmonary dysplasia (73% vs. 62%), and severe bronchopulmonary dysplasia (25% vs. 14%).
Although the proportion of premature births with a neonatologist attending was similar between the two cohorts, significantly more premature infants were born outside of university hospitals and transported to a level III neonatal ICU after birth during 2004-2007, compared with 2014-2016, the researchers noted.
The study findings were limited by several factors including the retrospective design of the second cohort, inability to account for fetal losses prior to 22 weeks’ gestational age, lack of data on the causes of fetal and infant deaths, potentially unknown confounding variables that impacted infant survival, and the small sample size of some gestational age groups, the researchers noted. However, the results show improvements in 1-year survival in the wake of specific guidelines on perinatal management.
Dr. Norman reported receiving grants from the Swedish Heart Lung Foundation and the H2020/European Union, as well as personal fees from a Swedish medical journal, the Swedish patient insurance, Liber, Studentlitteratur, and AbbVie. The study was funded by the Swedish Order of Freemasons’ Foundation for Children’s Welfare.
SOURCE: Norman M et al. JAMA. 2019;321:1188-99.
FROM JAMA
Syncope session showcases latest research and guidance for practice
Syncope is a common problem, but an area in which practice likely varies by region and provider, according to Carrie Herzke, MD, SFHM, of Johns Hopkins University in Baltimore.
The variation in practice also suggests opportunities to safely cut costs, Dr. Herzke said in an interview.
Dr. Herzke will review the recent literature and summarize the current guidelines related to the treatment of syncope in her session, “SyncopE – Effective, Efficient and Economic Evaluations,” on Monday, March 25, at HM19.
“At the end of this session I am hopeful attendees will have a better understanding of the current guidelines, as well as which tests are most likely to be high value in the evaluation of syncope,” Dr. Herzke said. But before testing, clinicians should keep in mind that a history and physical examination are key components to evaluating syncope, she noted.
The European Society of Cardiology Guidelines for Syncope, published in 2018, feature several new concepts for evaluating and managing syncope in clinical settings and testing, including tilt testing, a greater role for prolonged ECG monitoring, use of video recording for suspected syncope, consideration of adenosine sensitive syncope, and consideration of neurological causes of syncope.
The ESC guidelines include using algorithms to determine the appropriate therapy for reflex syncope based on age, severity, and clinical forms. The guidelines also address diagnostic tests, monitoring in and out of the hospital, and treatment options including lifestyle changes and education as well as pharmacotherapy.
Dr. Herzke also will review the 2017 ACC/AHA/HRS Guideline for Patients With Syncope, published in 2017 in the journal Circulation. This guideline has an algorithm for initial evaluation of patients with syncope that includes a history, physical, and ECG. If the cause is known, patients should be assessed for risk and treated; syncope of unknown cause requires further evaluation, and the guideline presents recommendations for additional assessment through means including cardiac imaging, stress testing, blood testing, neurological testing, and tilt table testing.
“The selection of a given diagnostic test, after the initial history, physical examination, and baseline ECG, is a clinical decision based on the patient’s clinical presentation, risk stratification, and a clear understanding of diagnostic and prognostic value of any further testing,” according to the guideline authors.
The 2017 ACC/AHA/HRS Guideline for Patients With Syncope also provides recommendations for the management of cardiovascular conditions, including arrhythmic and structural conditions.
Dr. Herzke said she thinks that the topic of pulmonary embolism and syncope may prompt the liveliest discussion, and she will include several recent articles on this topic in her literature review.
“There has been some debate about how often PE is present in patients presenting after a syncopal episode,” she said. A recent study published in JAMA Internal Medicine found a prevalence of PE from 0.06% to 0.55% among all adults presenting to an ED with syncope and a prevalence of PE from 0.14% to 0.83%.
SyncopE – Effective, Efficient and Economic Evaluations
Monday 1:10 pm
Maryland BD/4-6
Syncope is a common problem, but an area in which practice likely varies by region and provider, according to Carrie Herzke, MD, SFHM, of Johns Hopkins University in Baltimore.
The variation in practice also suggests opportunities to safely cut costs, Dr. Herzke said in an interview.
Dr. Herzke will review the recent literature and summarize the current guidelines related to the treatment of syncope in her session, “SyncopE – Effective, Efficient and Economic Evaluations,” on Monday, March 25, at HM19.
“At the end of this session I am hopeful attendees will have a better understanding of the current guidelines, as well as which tests are most likely to be high value in the evaluation of syncope,” Dr. Herzke said. But before testing, clinicians should keep in mind that a history and physical examination are key components to evaluating syncope, she noted.
The European Society of Cardiology Guidelines for Syncope, published in 2018, feature several new concepts for evaluating and managing syncope in clinical settings and testing, including tilt testing, a greater role for prolonged ECG monitoring, use of video recording for suspected syncope, consideration of adenosine sensitive syncope, and consideration of neurological causes of syncope.
The ESC guidelines include using algorithms to determine the appropriate therapy for reflex syncope based on age, severity, and clinical forms. The guidelines also address diagnostic tests, monitoring in and out of the hospital, and treatment options including lifestyle changes and education as well as pharmacotherapy.
Dr. Herzke also will review the 2017 ACC/AHA/HRS Guideline for Patients With Syncope, published in 2017 in the journal Circulation. This guideline has an algorithm for initial evaluation of patients with syncope that includes a history, physical, and ECG. If the cause is known, patients should be assessed for risk and treated; syncope of unknown cause requires further evaluation, and the guideline presents recommendations for additional assessment through means including cardiac imaging, stress testing, blood testing, neurological testing, and tilt table testing.
“The selection of a given diagnostic test, after the initial history, physical examination, and baseline ECG, is a clinical decision based on the patient’s clinical presentation, risk stratification, and a clear understanding of diagnostic and prognostic value of any further testing,” according to the guideline authors.
The 2017 ACC/AHA/HRS Guideline for Patients With Syncope also provides recommendations for the management of cardiovascular conditions, including arrhythmic and structural conditions.
Dr. Herzke said she thinks that the topic of pulmonary embolism and syncope may prompt the liveliest discussion, and she will include several recent articles on this topic in her literature review.
“There has been some debate about how often PE is present in patients presenting after a syncopal episode,” she said. A recent study published in JAMA Internal Medicine found a prevalence of PE from 0.06% to 0.55% among all adults presenting to an ED with syncope and a prevalence of PE from 0.14% to 0.83%.
SyncopE – Effective, Efficient and Economic Evaluations
Monday 1:10 pm
Maryland BD/4-6
Syncope is a common problem, but an area in which practice likely varies by region and provider, according to Carrie Herzke, MD, SFHM, of Johns Hopkins University in Baltimore.
The variation in practice also suggests opportunities to safely cut costs, Dr. Herzke said in an interview.
Dr. Herzke will review the recent literature and summarize the current guidelines related to the treatment of syncope in her session, “SyncopE – Effective, Efficient and Economic Evaluations,” on Monday, March 25, at HM19.
“At the end of this session I am hopeful attendees will have a better understanding of the current guidelines, as well as which tests are most likely to be high value in the evaluation of syncope,” Dr. Herzke said. But before testing, clinicians should keep in mind that a history and physical examination are key components to evaluating syncope, she noted.
The European Society of Cardiology Guidelines for Syncope, published in 2018, feature several new concepts for evaluating and managing syncope in clinical settings and testing, including tilt testing, a greater role for prolonged ECG monitoring, use of video recording for suspected syncope, consideration of adenosine sensitive syncope, and consideration of neurological causes of syncope.
The ESC guidelines include using algorithms to determine the appropriate therapy for reflex syncope based on age, severity, and clinical forms. The guidelines also address diagnostic tests, monitoring in and out of the hospital, and treatment options including lifestyle changes and education as well as pharmacotherapy.
Dr. Herzke also will review the 2017 ACC/AHA/HRS Guideline for Patients With Syncope, published in 2017 in the journal Circulation. This guideline has an algorithm for initial evaluation of patients with syncope that includes a history, physical, and ECG. If the cause is known, patients should be assessed for risk and treated; syncope of unknown cause requires further evaluation, and the guideline presents recommendations for additional assessment through means including cardiac imaging, stress testing, blood testing, neurological testing, and tilt table testing.
“The selection of a given diagnostic test, after the initial history, physical examination, and baseline ECG, is a clinical decision based on the patient’s clinical presentation, risk stratification, and a clear understanding of diagnostic and prognostic value of any further testing,” according to the guideline authors.
The 2017 ACC/AHA/HRS Guideline for Patients With Syncope also provides recommendations for the management of cardiovascular conditions, including arrhythmic and structural conditions.
Dr. Herzke said she thinks that the topic of pulmonary embolism and syncope may prompt the liveliest discussion, and she will include several recent articles on this topic in her literature review.
“There has been some debate about how often PE is present in patients presenting after a syncopal episode,” she said. A recent study published in JAMA Internal Medicine found a prevalence of PE from 0.06% to 0.55% among all adults presenting to an ED with syncope and a prevalence of PE from 0.14% to 0.83%.
SyncopE – Effective, Efficient and Economic Evaluations
Monday 1:10 pm
Maryland BD/4-6
Premature death from heart disease hits Asian subgroups hard
Among Asian American subgroups, Asian Indian, Filipino, and Vietnamese populations showed significantly higher premature death rates from ischemic heart disease, compared with other Asian subgroups, based on data from the National Center for Health Statistics for the years 2003 to 2012.
Previous studies have described death rates from cardiovascular disease in Asian subgroups, but premature death in particular has not been well studied, wrote Latha Palaniappan, MD, of the division of primary care and population health at the Stanford (Calif.) University, and her colleagues.
To examine premature mortality from cardiovascular disease in Asian subgroups, the researchers used years of potential life lost (YPLL) to measure premature mortality. “[Years of potential life lost ] compares age at death with average life expectancy to estimate the average time an individual would have lived had he/she not died prematurely from a specific disease,” they explained.
The study population included 354,256 Asian American decedents aged 25 years or older. Of that total, 59,936 died of ischemic heart disease and 28,489 died of cerebrovascular disease.
Overall, Asian men lost 779 years/100,000 people in 2003 and 574 years/100,000 in 2012. However, in 2003, Asian Indian men in particular lost 1,216 years/100,000, more than other Asian male subgroups and non-Hispanic white men.
“Use of race-specific life expectancy revealed greater heterogeneity in YPLL across all Asian subgroups,” the researchers wrote. Similarly, Asian Indian women had the highest years of potential life lost throughout the study period, with a high of 818 years/100,000 people in 2003 and 477 years/100,00 in 2012, compared with 577/100,000 and 426/100,000, respectively, among non-Hispanic white women.
All Asian male subgroups also lost more years of life to cerebrovascular disease, compared with non-Hispanic white men, and women in each Asian subgroup had a higher years of potential life lost, compared with non-Hispanic white women. Filipino men had the highest YPLL values for the period, followed by Vietnamese men, and the patterns were similar for Filipino and Vietnamese women.
Possible explanations for the high rate of premature death from ischemic heart disease in Asian Indians include greater prevalence of risk factors at younger age (including elevated apolipoprotein B100/apolipoprotein A-1 ratios), type 2 diabetes, and cardiometabolic abnormalities in people of normal weight that might go unnoticed in a clinical exam, the researchers said. In the case of cerebrovascular disease, possible risk factors for high years of potential life lost in certain subgroups include hypertension in Filipino populations, limited health literacy about stroke in Vietnamese populations, and high rates of smoking in Vietnamese men.
The study findings were limited by several factors, including the small amount of data on mortality in Asian Americans from census reports, the researchers noted. However, the use of years of potential life lost as a measure of the impact of cardiovascular disease provided a useful model of the impact of cardiovascular disease on life expectancy and total disease burden of cerebrovascular disease on Asian ethnic subgroups, they said.
“Our study also provides evidence that evaluating the Asian population together as one group underestimates the burden of [cerebrovascular disease],” they noted.
The National Institute of Minority Health and Health Disparities Research Project and the National Heart, Lung, and Blood Institute supported the study in part by grants to researchers. The researchers had no financial conflicts to disclose.
SOURCE: Iyer DG et al. J Am Heart Assoc. 2019 Mar 20. doi: 10.1161/JAHA.118.010744.
Among Asian American subgroups, Asian Indian, Filipino, and Vietnamese populations showed significantly higher premature death rates from ischemic heart disease, compared with other Asian subgroups, based on data from the National Center for Health Statistics for the years 2003 to 2012.
Previous studies have described death rates from cardiovascular disease in Asian subgroups, but premature death in particular has not been well studied, wrote Latha Palaniappan, MD, of the division of primary care and population health at the Stanford (Calif.) University, and her colleagues.
To examine premature mortality from cardiovascular disease in Asian subgroups, the researchers used years of potential life lost (YPLL) to measure premature mortality. “[Years of potential life lost ] compares age at death with average life expectancy to estimate the average time an individual would have lived had he/she not died prematurely from a specific disease,” they explained.
The study population included 354,256 Asian American decedents aged 25 years or older. Of that total, 59,936 died of ischemic heart disease and 28,489 died of cerebrovascular disease.
Overall, Asian men lost 779 years/100,000 people in 2003 and 574 years/100,000 in 2012. However, in 2003, Asian Indian men in particular lost 1,216 years/100,000, more than other Asian male subgroups and non-Hispanic white men.
“Use of race-specific life expectancy revealed greater heterogeneity in YPLL across all Asian subgroups,” the researchers wrote. Similarly, Asian Indian women had the highest years of potential life lost throughout the study period, with a high of 818 years/100,000 people in 2003 and 477 years/100,00 in 2012, compared with 577/100,000 and 426/100,000, respectively, among non-Hispanic white women.
All Asian male subgroups also lost more years of life to cerebrovascular disease, compared with non-Hispanic white men, and women in each Asian subgroup had a higher years of potential life lost, compared with non-Hispanic white women. Filipino men had the highest YPLL values for the period, followed by Vietnamese men, and the patterns were similar for Filipino and Vietnamese women.
Possible explanations for the high rate of premature death from ischemic heart disease in Asian Indians include greater prevalence of risk factors at younger age (including elevated apolipoprotein B100/apolipoprotein A-1 ratios), type 2 diabetes, and cardiometabolic abnormalities in people of normal weight that might go unnoticed in a clinical exam, the researchers said. In the case of cerebrovascular disease, possible risk factors for high years of potential life lost in certain subgroups include hypertension in Filipino populations, limited health literacy about stroke in Vietnamese populations, and high rates of smoking in Vietnamese men.
The study findings were limited by several factors, including the small amount of data on mortality in Asian Americans from census reports, the researchers noted. However, the use of years of potential life lost as a measure of the impact of cardiovascular disease provided a useful model of the impact of cardiovascular disease on life expectancy and total disease burden of cerebrovascular disease on Asian ethnic subgroups, they said.
“Our study also provides evidence that evaluating the Asian population together as one group underestimates the burden of [cerebrovascular disease],” they noted.
The National Institute of Minority Health and Health Disparities Research Project and the National Heart, Lung, and Blood Institute supported the study in part by grants to researchers. The researchers had no financial conflicts to disclose.
SOURCE: Iyer DG et al. J Am Heart Assoc. 2019 Mar 20. doi: 10.1161/JAHA.118.010744.
Among Asian American subgroups, Asian Indian, Filipino, and Vietnamese populations showed significantly higher premature death rates from ischemic heart disease, compared with other Asian subgroups, based on data from the National Center for Health Statistics for the years 2003 to 2012.
Previous studies have described death rates from cardiovascular disease in Asian subgroups, but premature death in particular has not been well studied, wrote Latha Palaniappan, MD, of the division of primary care and population health at the Stanford (Calif.) University, and her colleagues.
To examine premature mortality from cardiovascular disease in Asian subgroups, the researchers used years of potential life lost (YPLL) to measure premature mortality. “[Years of potential life lost ] compares age at death with average life expectancy to estimate the average time an individual would have lived had he/she not died prematurely from a specific disease,” they explained.
The study population included 354,256 Asian American decedents aged 25 years or older. Of that total, 59,936 died of ischemic heart disease and 28,489 died of cerebrovascular disease.
Overall, Asian men lost 779 years/100,000 people in 2003 and 574 years/100,000 in 2012. However, in 2003, Asian Indian men in particular lost 1,216 years/100,000, more than other Asian male subgroups and non-Hispanic white men.
“Use of race-specific life expectancy revealed greater heterogeneity in YPLL across all Asian subgroups,” the researchers wrote. Similarly, Asian Indian women had the highest years of potential life lost throughout the study period, with a high of 818 years/100,000 people in 2003 and 477 years/100,00 in 2012, compared with 577/100,000 and 426/100,000, respectively, among non-Hispanic white women.
All Asian male subgroups also lost more years of life to cerebrovascular disease, compared with non-Hispanic white men, and women in each Asian subgroup had a higher years of potential life lost, compared with non-Hispanic white women. Filipino men had the highest YPLL values for the period, followed by Vietnamese men, and the patterns were similar for Filipino and Vietnamese women.
Possible explanations for the high rate of premature death from ischemic heart disease in Asian Indians include greater prevalence of risk factors at younger age (including elevated apolipoprotein B100/apolipoprotein A-1 ratios), type 2 diabetes, and cardiometabolic abnormalities in people of normal weight that might go unnoticed in a clinical exam, the researchers said. In the case of cerebrovascular disease, possible risk factors for high years of potential life lost in certain subgroups include hypertension in Filipino populations, limited health literacy about stroke in Vietnamese populations, and high rates of smoking in Vietnamese men.
The study findings were limited by several factors, including the small amount of data on mortality in Asian Americans from census reports, the researchers noted. However, the use of years of potential life lost as a measure of the impact of cardiovascular disease provided a useful model of the impact of cardiovascular disease on life expectancy and total disease burden of cerebrovascular disease on Asian ethnic subgroups, they said.
“Our study also provides evidence that evaluating the Asian population together as one group underestimates the burden of [cerebrovascular disease],” they noted.
The National Institute of Minority Health and Health Disparities Research Project and the National Heart, Lung, and Blood Institute supported the study in part by grants to researchers. The researchers had no financial conflicts to disclose.
SOURCE: Iyer DG et al. J Am Heart Assoc. 2019 Mar 20. doi: 10.1161/JAHA.118.010744.
FROM THE JOURNAL OF THE AMERICAN HEART ASSOCIATION
Key clinical point: Asian Indian, Filipino, and Vietnamese populations had the greatest loss of life from heart attacks and strokes among Asian population subgroups.
Major finding: Asian Indian men lost an average of 17 years of life to ischemic heart disease.
Study details: The data come from the National Center for Health Statistics Multiple Causes of Death mortality files from 2003 to 2012.
Disclosures: The National Institute of Minority Health and Health Disparities Research Project and the National Heart, Lung, and Blood Institute supported the study in part by grants to researchers. The researchers had no financial conflicts to disclose.
Source: Iyer DG et al. J Am Heart Assoc. 2019 Mar 20. doi: 10.1161/JAHA.118.010744.
Socioeconomic status affects scleroderma severity in African Americans
according to findings from an analysis of single-center cohort data over a 10-year period.
Indeed, among patients in the cohort of 402 scleroderma patients at MedStar Georgetown University Hospital in Washington, lower household income was predictive of higher mortality during follow-up, independent of race, according to first author Duncan F. Moore, MD, and his colleagues at the hospital.
Previous studies have demonstrated increased risk for scleroderma in African American patients, who also are more likely than non–African Americans to be diagnosed at a younger age and to have conditions including more diffuse cutaneous disease, more severe restrictive lung disease, more cardiac and renal involvement, and increased mortality, the authors wrote in Arthritis Care & Research.
“We did clearly show that African Americans have worse outcomes and severe pulmonary involvement, but I was surprised that there still was a major contribution of socioeconomic status affecting outcomes for all patients, even though only 10% of our patients were indigent and on medical assistance,” Virginia Steen, MD, senior author of the study and professor of rheumatology at Georgetown University, said in an interview. “I still feel strongly that there are likely genetic issues as to why African Americans have such severe disease. We are eager to learn more from the GRASP [Genome Research in African American Scleroderma Patients] study, which is specifically looking at the genetic issues in African American scleroderma patients,” she said.
Of the 402 scleroderma patients at MedStar Georgetown who were seen during 2006-2016, 202 were African American. A total of 186 African American and 184 non–African American patients in the study met the 2013 American College of Rheumatology/European League Against Rheumatism criteria for systemic sclerosis (SSc). Demographics including gender (87% female) and age (mean of 48 years) were similar between the groups.
Overall, the African American patients showed more severe lung disease, more pulmonary hypertension, and more severe cardiac involvement than did non–African American patients, and autoantibodies were significantly different between the groups.
During follow-up, mortality proved much higher among African Americans at 21%, compared with 11% in non–African Americans (P = .005). However, the unadjusted hazard ratio for death declined from 2.061 (P = .006) to a nonsignificant 1.256 after adjustment for socioeconomic variables.
All socioeconomic measures showed significant differences between the groups. African Americans were more likely to be single and disabled at the initial study visit and to have Medicaid, but they were less likely to be a homemaker, have private insurance, or have a college degree. African Americans’ $74,000 median household income (based on ZIP code) was also a statistically significant $23,000 less than non–African American patients. But the researchers noted that “for every additional $10,000 of household income, independent of race, the hazard of death during follow-up declined by 15.5%.”
Notable differences in antibodies appeared between the groups, with more African American patients having isolated nucleolar ANA, anti-U1RNP antibody, or other positive antinuclear antibodies without SSc-specific antibodies. African American patients also were less likely to have anticentromere or anti-RNA polymerase III antibodies.
The study findings were limited by several factors, including possible bias in the matching process and the use of only index values for socioeconomic variables, the researchers noted.
Regardless of relative socioeconomic and genetic influences, “it is clear that African Americans with scleroderma merit more intensive efforts to facilitate timely diagnosis and access to continued evaluation and suppressive treatment, particularly with respect to cardiopulmonary involvement,” they wrote.
Next steps for research, according to Dr. Steen, include studying clinical subsets of African American patients to try to identify factors to predict outcomes, including the nucleolar pattern ANA, overlap with lupus, history of hypertension, and the relationship with renal crisis.
“We are also looking at whether the African American patients are less responsive to mycophenolate than the non–African American patients. We definitely need to find ways to be more aggressive at identifying and treating African American patients early in their disease,” she added.
The researchers had no financial conflicts to disclose. Dr. Steen serves on the MDedge Rheumatology Editorial Advisory Board.
SOURCE: Moore DF et al. Arthritis Care Res. 2019 March 1. doi: 10.1002/acr.23861.
“Not only do patients who manifest the diffuse cutaneous subset of disease experience a more severe course, but so do affected persons of African American race,” Nadia D. Morgan, MBBS, and Allan C. Gelber, MD, wrote in an accompanying editorial. The effects of socioeconomic status should not be overlooked based on the current study, in which the inclusion of socioeconomic factors eliminated the significance of association between race and mortality among scleroderma patients, they wrote.
“Overall, and in the context of these published reports which underscore the disproportionate and adverse impact of scleroderma among African Americans, and in light of the ongoing efforts of the GRASP study, the current paper by Moore et al. emphasizes the importance of socioeconomic status, and of socioeconomic determinants of health, to account for differences in clinically relevant outcomes,” they wrote.
Dr. Gelber is affiliated with the division of rheumatology at Johns Hopkins University, Baltimore. Dr. Morgan, who was also with Johns Hopkins, died before publication of the editorial. They made no conflict of interest disclosures.
“Not only do patients who manifest the diffuse cutaneous subset of disease experience a more severe course, but so do affected persons of African American race,” Nadia D. Morgan, MBBS, and Allan C. Gelber, MD, wrote in an accompanying editorial. The effects of socioeconomic status should not be overlooked based on the current study, in which the inclusion of socioeconomic factors eliminated the significance of association between race and mortality among scleroderma patients, they wrote.
“Overall, and in the context of these published reports which underscore the disproportionate and adverse impact of scleroderma among African Americans, and in light of the ongoing efforts of the GRASP study, the current paper by Moore et al. emphasizes the importance of socioeconomic status, and of socioeconomic determinants of health, to account for differences in clinically relevant outcomes,” they wrote.
Dr. Gelber is affiliated with the division of rheumatology at Johns Hopkins University, Baltimore. Dr. Morgan, who was also with Johns Hopkins, died before publication of the editorial. They made no conflict of interest disclosures.
“Not only do patients who manifest the diffuse cutaneous subset of disease experience a more severe course, but so do affected persons of African American race,” Nadia D. Morgan, MBBS, and Allan C. Gelber, MD, wrote in an accompanying editorial. The effects of socioeconomic status should not be overlooked based on the current study, in which the inclusion of socioeconomic factors eliminated the significance of association between race and mortality among scleroderma patients, they wrote.
“Overall, and in the context of these published reports which underscore the disproportionate and adverse impact of scleroderma among African Americans, and in light of the ongoing efforts of the GRASP study, the current paper by Moore et al. emphasizes the importance of socioeconomic status, and of socioeconomic determinants of health, to account for differences in clinically relevant outcomes,” they wrote.
Dr. Gelber is affiliated with the division of rheumatology at Johns Hopkins University, Baltimore. Dr. Morgan, who was also with Johns Hopkins, died before publication of the editorial. They made no conflict of interest disclosures.
according to findings from an analysis of single-center cohort data over a 10-year period.
Indeed, among patients in the cohort of 402 scleroderma patients at MedStar Georgetown University Hospital in Washington, lower household income was predictive of higher mortality during follow-up, independent of race, according to first author Duncan F. Moore, MD, and his colleagues at the hospital.
Previous studies have demonstrated increased risk for scleroderma in African American patients, who also are more likely than non–African Americans to be diagnosed at a younger age and to have conditions including more diffuse cutaneous disease, more severe restrictive lung disease, more cardiac and renal involvement, and increased mortality, the authors wrote in Arthritis Care & Research.
“We did clearly show that African Americans have worse outcomes and severe pulmonary involvement, but I was surprised that there still was a major contribution of socioeconomic status affecting outcomes for all patients, even though only 10% of our patients were indigent and on medical assistance,” Virginia Steen, MD, senior author of the study and professor of rheumatology at Georgetown University, said in an interview. “I still feel strongly that there are likely genetic issues as to why African Americans have such severe disease. We are eager to learn more from the GRASP [Genome Research in African American Scleroderma Patients] study, which is specifically looking at the genetic issues in African American scleroderma patients,” she said.
Of the 402 scleroderma patients at MedStar Georgetown who were seen during 2006-2016, 202 were African American. A total of 186 African American and 184 non–African American patients in the study met the 2013 American College of Rheumatology/European League Against Rheumatism criteria for systemic sclerosis (SSc). Demographics including gender (87% female) and age (mean of 48 years) were similar between the groups.
Overall, the African American patients showed more severe lung disease, more pulmonary hypertension, and more severe cardiac involvement than did non–African American patients, and autoantibodies were significantly different between the groups.
During follow-up, mortality proved much higher among African Americans at 21%, compared with 11% in non–African Americans (P = .005). However, the unadjusted hazard ratio for death declined from 2.061 (P = .006) to a nonsignificant 1.256 after adjustment for socioeconomic variables.
All socioeconomic measures showed significant differences between the groups. African Americans were more likely to be single and disabled at the initial study visit and to have Medicaid, but they were less likely to be a homemaker, have private insurance, or have a college degree. African Americans’ $74,000 median household income (based on ZIP code) was also a statistically significant $23,000 less than non–African American patients. But the researchers noted that “for every additional $10,000 of household income, independent of race, the hazard of death during follow-up declined by 15.5%.”
Notable differences in antibodies appeared between the groups, with more African American patients having isolated nucleolar ANA, anti-U1RNP antibody, or other positive antinuclear antibodies without SSc-specific antibodies. African American patients also were less likely to have anticentromere or anti-RNA polymerase III antibodies.
The study findings were limited by several factors, including possible bias in the matching process and the use of only index values for socioeconomic variables, the researchers noted.
Regardless of relative socioeconomic and genetic influences, “it is clear that African Americans with scleroderma merit more intensive efforts to facilitate timely diagnosis and access to continued evaluation and suppressive treatment, particularly with respect to cardiopulmonary involvement,” they wrote.
Next steps for research, according to Dr. Steen, include studying clinical subsets of African American patients to try to identify factors to predict outcomes, including the nucleolar pattern ANA, overlap with lupus, history of hypertension, and the relationship with renal crisis.
“We are also looking at whether the African American patients are less responsive to mycophenolate than the non–African American patients. We definitely need to find ways to be more aggressive at identifying and treating African American patients early in their disease,” she added.
The researchers had no financial conflicts to disclose. Dr. Steen serves on the MDedge Rheumatology Editorial Advisory Board.
SOURCE: Moore DF et al. Arthritis Care Res. 2019 March 1. doi: 10.1002/acr.23861.
according to findings from an analysis of single-center cohort data over a 10-year period.
Indeed, among patients in the cohort of 402 scleroderma patients at MedStar Georgetown University Hospital in Washington, lower household income was predictive of higher mortality during follow-up, independent of race, according to first author Duncan F. Moore, MD, and his colleagues at the hospital.
Previous studies have demonstrated increased risk for scleroderma in African American patients, who also are more likely than non–African Americans to be diagnosed at a younger age and to have conditions including more diffuse cutaneous disease, more severe restrictive lung disease, more cardiac and renal involvement, and increased mortality, the authors wrote in Arthritis Care & Research.
“We did clearly show that African Americans have worse outcomes and severe pulmonary involvement, but I was surprised that there still was a major contribution of socioeconomic status affecting outcomes for all patients, even though only 10% of our patients were indigent and on medical assistance,” Virginia Steen, MD, senior author of the study and professor of rheumatology at Georgetown University, said in an interview. “I still feel strongly that there are likely genetic issues as to why African Americans have such severe disease. We are eager to learn more from the GRASP [Genome Research in African American Scleroderma Patients] study, which is specifically looking at the genetic issues in African American scleroderma patients,” she said.
Of the 402 scleroderma patients at MedStar Georgetown who were seen during 2006-2016, 202 were African American. A total of 186 African American and 184 non–African American patients in the study met the 2013 American College of Rheumatology/European League Against Rheumatism criteria for systemic sclerosis (SSc). Demographics including gender (87% female) and age (mean of 48 years) were similar between the groups.
Overall, the African American patients showed more severe lung disease, more pulmonary hypertension, and more severe cardiac involvement than did non–African American patients, and autoantibodies were significantly different between the groups.
During follow-up, mortality proved much higher among African Americans at 21%, compared with 11% in non–African Americans (P = .005). However, the unadjusted hazard ratio for death declined from 2.061 (P = .006) to a nonsignificant 1.256 after adjustment for socioeconomic variables.
All socioeconomic measures showed significant differences between the groups. African Americans were more likely to be single and disabled at the initial study visit and to have Medicaid, but they were less likely to be a homemaker, have private insurance, or have a college degree. African Americans’ $74,000 median household income (based on ZIP code) was also a statistically significant $23,000 less than non–African American patients. But the researchers noted that “for every additional $10,000 of household income, independent of race, the hazard of death during follow-up declined by 15.5%.”
Notable differences in antibodies appeared between the groups, with more African American patients having isolated nucleolar ANA, anti-U1RNP antibody, or other positive antinuclear antibodies without SSc-specific antibodies. African American patients also were less likely to have anticentromere or anti-RNA polymerase III antibodies.
The study findings were limited by several factors, including possible bias in the matching process and the use of only index values for socioeconomic variables, the researchers noted.
Regardless of relative socioeconomic and genetic influences, “it is clear that African Americans with scleroderma merit more intensive efforts to facilitate timely diagnosis and access to continued evaluation and suppressive treatment, particularly with respect to cardiopulmonary involvement,” they wrote.
Next steps for research, according to Dr. Steen, include studying clinical subsets of African American patients to try to identify factors to predict outcomes, including the nucleolar pattern ANA, overlap with lupus, history of hypertension, and the relationship with renal crisis.
“We are also looking at whether the African American patients are less responsive to mycophenolate than the non–African American patients. We definitely need to find ways to be more aggressive at identifying and treating African American patients early in their disease,” she added.
The researchers had no financial conflicts to disclose. Dr. Steen serves on the MDedge Rheumatology Editorial Advisory Board.
SOURCE: Moore DF et al. Arthritis Care Res. 2019 March 1. doi: 10.1002/acr.23861.
FROM ARTHRITIS CARE & RESEARCH
CDC exhorts more testing and treatment of HIV
Approximately 80% of HIV infections in the United States in 2016 were spread by almost 40% of infected individuals who did not know their status or were not receiving care, according to data from the Centers for Disease Control and Prevention.
However, leadership at the Department of Health & Human Services has developed a “bold but completely achievable” plan to reduce HIV infections within the next decade, Vice Adm. Jerome M. Adams, MD, the U.S. surgeon general, said in a teleconference to announce the results of a new Vital Signs report on the impact of undiagnosed and untreated HIV.
In the early release Vital Signs from Morbidity and Mortality Weekly Report, Li Zihao, PhD, and his colleagues at the CDC used a model to estimate rates of HIV transmission in 2016 based on data from the National HIV Behavioral Surveillance on needle-sharing behavior and sexual behaviors. The overall transmission rate was 3.5/100,000 person-years. Of these transmissions, 73.0% were from men who have sex with men, 9.7% from intravenous drug users, and 12% from heterosexuals.
The percentages of transmissions for those who were acutely ill with HIV but unaware, not acutely ill but unaware, aware of HIV infection but not treated, receiving care but not virally suppressed, and receiving care and virally suppressed were 4.0%, 33.6%, 42.6%, 19.8%, and 0%, respectively, the researchers said.
The study “emphasizes the impact that HIV resources could have,” by showing the importance of identifying infected individuals early and using the tools now available to treat them before they can transmit the disease, Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said during the conference.
“Today’s treatment regimens are simpler than those prescribed in the past, sometimes requiring only single-tablet formulations, with fewer side effects; most persons with HIV infection can achieve viral suppression within 6 months of initiating treatment,” the researchers wrote.
In the wake of the findings and at the start of the CDC’s 2019 National HIV Prevention Conference, the CDC proposed a federal initiative, “Ending the HIV Epidemic: A Plan for America.”
The goal is to reduce the incidence of new HIV infections by at least 90% over the next decade, starting with a focus on parts of the country with the highest disease burden, according to the CDC.
“Today’s Vital Signs report illustrates how a goal that once seemed impossible is now within our reach.” Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention, said during the conference. “If we increase access to testing and treatment for people with HIV, we could prevent a lion’s share of infections,” he said.
The plan involves working to identify individuals at risk, treating those who test positive as quickly as possible, and keeping them in care. Updated information on the CDC website provides more details for clinicians on how to have conversations about HIV with patients, the latest information about antiretroviral therapy, and details about prevention for partners including post- and pre-exposure prophylaxis (PEP and PreP), and condoms.
Eugene McCray, MD, director of the CDC’s Division of HIV/AIDS Prevention, emphasized that the CDC recommends HIV testing for all individuals aged 13-64 years at least once in their lives. He added that everyone who tests positive should seek medical care, that everyone with HIV deserves support to combat stigma, and that those at risk should be empowered to take advantage of proven effective prevention strategies.
Clinicians can access the updated CDC page on caring for HIV patients here.
SOURCE: Li Z et al. MMWR Morb Mortal Wkly Rep. 2019 March 18. doi: org/10.15585/mmwr.mm6811e1.
Approximately 80% of HIV infections in the United States in 2016 were spread by almost 40% of infected individuals who did not know their status or were not receiving care, according to data from the Centers for Disease Control and Prevention.
However, leadership at the Department of Health & Human Services has developed a “bold but completely achievable” plan to reduce HIV infections within the next decade, Vice Adm. Jerome M. Adams, MD, the U.S. surgeon general, said in a teleconference to announce the results of a new Vital Signs report on the impact of undiagnosed and untreated HIV.
In the early release Vital Signs from Morbidity and Mortality Weekly Report, Li Zihao, PhD, and his colleagues at the CDC used a model to estimate rates of HIV transmission in 2016 based on data from the National HIV Behavioral Surveillance on needle-sharing behavior and sexual behaviors. The overall transmission rate was 3.5/100,000 person-years. Of these transmissions, 73.0% were from men who have sex with men, 9.7% from intravenous drug users, and 12% from heterosexuals.
The percentages of transmissions for those who were acutely ill with HIV but unaware, not acutely ill but unaware, aware of HIV infection but not treated, receiving care but not virally suppressed, and receiving care and virally suppressed were 4.0%, 33.6%, 42.6%, 19.8%, and 0%, respectively, the researchers said.
The study “emphasizes the impact that HIV resources could have,” by showing the importance of identifying infected individuals early and using the tools now available to treat them before they can transmit the disease, Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said during the conference.
“Today’s treatment regimens are simpler than those prescribed in the past, sometimes requiring only single-tablet formulations, with fewer side effects; most persons with HIV infection can achieve viral suppression within 6 months of initiating treatment,” the researchers wrote.
In the wake of the findings and at the start of the CDC’s 2019 National HIV Prevention Conference, the CDC proposed a federal initiative, “Ending the HIV Epidemic: A Plan for America.”
The goal is to reduce the incidence of new HIV infections by at least 90% over the next decade, starting with a focus on parts of the country with the highest disease burden, according to the CDC.
“Today’s Vital Signs report illustrates how a goal that once seemed impossible is now within our reach.” Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention, said during the conference. “If we increase access to testing and treatment for people with HIV, we could prevent a lion’s share of infections,” he said.
The plan involves working to identify individuals at risk, treating those who test positive as quickly as possible, and keeping them in care. Updated information on the CDC website provides more details for clinicians on how to have conversations about HIV with patients, the latest information about antiretroviral therapy, and details about prevention for partners including post- and pre-exposure prophylaxis (PEP and PreP), and condoms.
Eugene McCray, MD, director of the CDC’s Division of HIV/AIDS Prevention, emphasized that the CDC recommends HIV testing for all individuals aged 13-64 years at least once in their lives. He added that everyone who tests positive should seek medical care, that everyone with HIV deserves support to combat stigma, and that those at risk should be empowered to take advantage of proven effective prevention strategies.
Clinicians can access the updated CDC page on caring for HIV patients here.
SOURCE: Li Z et al. MMWR Morb Mortal Wkly Rep. 2019 March 18. doi: org/10.15585/mmwr.mm6811e1.
Approximately 80% of HIV infections in the United States in 2016 were spread by almost 40% of infected individuals who did not know their status or were not receiving care, according to data from the Centers for Disease Control and Prevention.
However, leadership at the Department of Health & Human Services has developed a “bold but completely achievable” plan to reduce HIV infections within the next decade, Vice Adm. Jerome M. Adams, MD, the U.S. surgeon general, said in a teleconference to announce the results of a new Vital Signs report on the impact of undiagnosed and untreated HIV.
In the early release Vital Signs from Morbidity and Mortality Weekly Report, Li Zihao, PhD, and his colleagues at the CDC used a model to estimate rates of HIV transmission in 2016 based on data from the National HIV Behavioral Surveillance on needle-sharing behavior and sexual behaviors. The overall transmission rate was 3.5/100,000 person-years. Of these transmissions, 73.0% were from men who have sex with men, 9.7% from intravenous drug users, and 12% from heterosexuals.
The percentages of transmissions for those who were acutely ill with HIV but unaware, not acutely ill but unaware, aware of HIV infection but not treated, receiving care but not virally suppressed, and receiving care and virally suppressed were 4.0%, 33.6%, 42.6%, 19.8%, and 0%, respectively, the researchers said.
The study “emphasizes the impact that HIV resources could have,” by showing the importance of identifying infected individuals early and using the tools now available to treat them before they can transmit the disease, Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said during the conference.
“Today’s treatment regimens are simpler than those prescribed in the past, sometimes requiring only single-tablet formulations, with fewer side effects; most persons with HIV infection can achieve viral suppression within 6 months of initiating treatment,” the researchers wrote.
In the wake of the findings and at the start of the CDC’s 2019 National HIV Prevention Conference, the CDC proposed a federal initiative, “Ending the HIV Epidemic: A Plan for America.”
The goal is to reduce the incidence of new HIV infections by at least 90% over the next decade, starting with a focus on parts of the country with the highest disease burden, according to the CDC.
“Today’s Vital Signs report illustrates how a goal that once seemed impossible is now within our reach.” Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention, said during the conference. “If we increase access to testing and treatment for people with HIV, we could prevent a lion’s share of infections,” he said.
The plan involves working to identify individuals at risk, treating those who test positive as quickly as possible, and keeping them in care. Updated information on the CDC website provides more details for clinicians on how to have conversations about HIV with patients, the latest information about antiretroviral therapy, and details about prevention for partners including post- and pre-exposure prophylaxis (PEP and PreP), and condoms.
Eugene McCray, MD, director of the CDC’s Division of HIV/AIDS Prevention, emphasized that the CDC recommends HIV testing for all individuals aged 13-64 years at least once in their lives. He added that everyone who tests positive should seek medical care, that everyone with HIV deserves support to combat stigma, and that those at risk should be empowered to take advantage of proven effective prevention strategies.
Clinicians can access the updated CDC page on caring for HIV patients here.
SOURCE: Li Z et al. MMWR Morb Mortal Wkly Rep. 2019 March 18. doi: org/10.15585/mmwr.mm6811e1.
FROM THE CDC
Heart failure remains a common, costly concern
Heart failure remains one of the deadliest chronic medical conditions, with 5-year mortality rates approaching 50%, and is the most common diagnosis for adults aged 65 years and older who are admitted to the hospital, according to Albert J. Hicks III, MD.
Dr. Hicks, a cardiologist at Baylor Scott & White Health in Temple, Tex., will discuss the latest challenges and hottest topics surrounding heart failure in the “Updates in Heart Failure” session on Monday, at HM19.
The growth of an aging population in the United States further emphasizes the importance of heart failure as a topic of interest to clinicians, Dr. Hicks said in an interview. He noted that heart failure is the highest medical expenditure for Medicare, and estimates suggest the condition will cost the U.S. health care system $30 billion by the year 2030, he said. With these numbers in mind, the timing of referring patients to an advanced heart failure team is a key issue.
But the timing of referral for advanced care is just one of the hot topics on the agenda for the “Updates in Heart Failure” session, Dr. Hicks said. Other topics include heart failure epidemiology (incidence, prevalence, morbidity, mortality, and disparities); economics of heart failure (burden of care on the U.S. health care system); heart failure hospitalizations and readmissions (risk factors, comorbidities, patient compliance issues); pathophysiology (why heart failure is so deadly); signs and symptoms of heart failure (how to recognize them); treatment of stage C heart failure, with a review of old and new drugs and devices; and treatment of stage D heart failure, including palliative care, mechanical circulatory support, and heart transplantation.
Dr. Hicks’ primary goal for the session is to “increase awareness of the high mortality associated with a heart failure diagnosis,” he said. He also hopes to educate hospitalists about the latest medications, devices, and resources for heart failure patients and to give them the tools and knowledge to help reduce morbidity and mortality in their heart failure patients.
Session attendees also will benefit from Dr. Hicks’ practical advice on identifying warning signs that indicate a heart failure patient may need a medical assist device or a heart transplant and on encouraging early referral of heart failure patients to advanced heart failure specialists before irreversible end-organ damage occurs.
Dr. Hicks hypothesized that the high mortality associated with a heart failure diagnosis, hospital readmission, and late referral will generate the liveliest discussion because issues of costs and resources continue to evolve.
His take-home message: “Early recognition and referral of heart failure patients to a heart failure cardiologist can improve patient costs, morbidity, and survival.
Dr. Hicks had no relevant financial conflicts to disclose.
Updates in Heart Failure
Monday, 2:00-2:40 p.m.
Woodrow Wilson
Heart failure remains one of the deadliest chronic medical conditions, with 5-year mortality rates approaching 50%, and is the most common diagnosis for adults aged 65 years and older who are admitted to the hospital, according to Albert J. Hicks III, MD.
Dr. Hicks, a cardiologist at Baylor Scott & White Health in Temple, Tex., will discuss the latest challenges and hottest topics surrounding heart failure in the “Updates in Heart Failure” session on Monday, at HM19.
The growth of an aging population in the United States further emphasizes the importance of heart failure as a topic of interest to clinicians, Dr. Hicks said in an interview. He noted that heart failure is the highest medical expenditure for Medicare, and estimates suggest the condition will cost the U.S. health care system $30 billion by the year 2030, he said. With these numbers in mind, the timing of referring patients to an advanced heart failure team is a key issue.
But the timing of referral for advanced care is just one of the hot topics on the agenda for the “Updates in Heart Failure” session, Dr. Hicks said. Other topics include heart failure epidemiology (incidence, prevalence, morbidity, mortality, and disparities); economics of heart failure (burden of care on the U.S. health care system); heart failure hospitalizations and readmissions (risk factors, comorbidities, patient compliance issues); pathophysiology (why heart failure is so deadly); signs and symptoms of heart failure (how to recognize them); treatment of stage C heart failure, with a review of old and new drugs and devices; and treatment of stage D heart failure, including palliative care, mechanical circulatory support, and heart transplantation.
Dr. Hicks’ primary goal for the session is to “increase awareness of the high mortality associated with a heart failure diagnosis,” he said. He also hopes to educate hospitalists about the latest medications, devices, and resources for heart failure patients and to give them the tools and knowledge to help reduce morbidity and mortality in their heart failure patients.
Session attendees also will benefit from Dr. Hicks’ practical advice on identifying warning signs that indicate a heart failure patient may need a medical assist device or a heart transplant and on encouraging early referral of heart failure patients to advanced heart failure specialists before irreversible end-organ damage occurs.
Dr. Hicks hypothesized that the high mortality associated with a heart failure diagnosis, hospital readmission, and late referral will generate the liveliest discussion because issues of costs and resources continue to evolve.
His take-home message: “Early recognition and referral of heart failure patients to a heart failure cardiologist can improve patient costs, morbidity, and survival.
Dr. Hicks had no relevant financial conflicts to disclose.
Updates in Heart Failure
Monday, 2:00-2:40 p.m.
Woodrow Wilson
Heart failure remains one of the deadliest chronic medical conditions, with 5-year mortality rates approaching 50%, and is the most common diagnosis for adults aged 65 years and older who are admitted to the hospital, according to Albert J. Hicks III, MD.
Dr. Hicks, a cardiologist at Baylor Scott & White Health in Temple, Tex., will discuss the latest challenges and hottest topics surrounding heart failure in the “Updates in Heart Failure” session on Monday, at HM19.
The growth of an aging population in the United States further emphasizes the importance of heart failure as a topic of interest to clinicians, Dr. Hicks said in an interview. He noted that heart failure is the highest medical expenditure for Medicare, and estimates suggest the condition will cost the U.S. health care system $30 billion by the year 2030, he said. With these numbers in mind, the timing of referring patients to an advanced heart failure team is a key issue.
But the timing of referral for advanced care is just one of the hot topics on the agenda for the “Updates in Heart Failure” session, Dr. Hicks said. Other topics include heart failure epidemiology (incidence, prevalence, morbidity, mortality, and disparities); economics of heart failure (burden of care on the U.S. health care system); heart failure hospitalizations and readmissions (risk factors, comorbidities, patient compliance issues); pathophysiology (why heart failure is so deadly); signs and symptoms of heart failure (how to recognize them); treatment of stage C heart failure, with a review of old and new drugs and devices; and treatment of stage D heart failure, including palliative care, mechanical circulatory support, and heart transplantation.
Dr. Hicks’ primary goal for the session is to “increase awareness of the high mortality associated with a heart failure diagnosis,” he said. He also hopes to educate hospitalists about the latest medications, devices, and resources for heart failure patients and to give them the tools and knowledge to help reduce morbidity and mortality in their heart failure patients.
Session attendees also will benefit from Dr. Hicks’ practical advice on identifying warning signs that indicate a heart failure patient may need a medical assist device or a heart transplant and on encouraging early referral of heart failure patients to advanced heart failure specialists before irreversible end-organ damage occurs.
Dr. Hicks hypothesized that the high mortality associated with a heart failure diagnosis, hospital readmission, and late referral will generate the liveliest discussion because issues of costs and resources continue to evolve.
His take-home message: “Early recognition and referral of heart failure patients to a heart failure cardiologist can improve patient costs, morbidity, and survival.
Dr. Hicks had no relevant financial conflicts to disclose.
Updates in Heart Failure
Monday, 2:00-2:40 p.m.
Woodrow Wilson
International lounge promotes global networking and perspective
At the 2019 Annual Conference, the Society of Hospital Medicine is building on its commitment to develop global relationships and serve as a resource for hospital-based medicine programs around the world. The International Lounge at HM19 complements a busy day of sessions and offers attendees a chance to unwind and expand their perspective on international hospital medicine.
“Once again SHM will provide a special place for our international attendees at HM 2019 to network and meet with SHM board members, hospitalist leaders, and fellow attendees,” Laurence Wellikson, MD, MHM, CEO of SHM, said in an interview. The International Lounge will be held in National Harbor 3 and will be open on March 26 from 10:00 a.m. until 3:00 p.m.
While no formal presentations are scheduled for the International Lounge, the goal is to provide an informal place to gather and communicate, said Dr. Wellikson.
However, some programs and special events related to international hospital medicine are scheduled for other points during the annual conference. A panel discussion on March 25 from 12:45 to 1:30 p.m. will focus on hospital medicine in Brazil, Holland, and the United Arab Emirates and will include information on the growth of hospital medicine internationally. In addition, an International Special Interest Forum will be held on March 25 from 4:30 until 5:30 p.m. in Magnolia 1.
“If you are from outside the U.S. or if you are interested in networking with or learning more about the growth of hospital medicine around the world, then consider visiting the International Lounge on March 26 or attending the Special Interest Forum or the panel discussion on March 25,” Dr. Wellikson said.
Hospitalist medicine is the fastest growing specialty in the United States, and the field continues to expand beyond the United States, according to a report published in 2018 in the International Journal of General Medicine.
Reasons for the growth of international hospital medicine remain similar to those in the United States despite differences in cultural norms, regulations, and health care systems, according to the report. Drivers of hospitalist programs abroad include interest in optimizing hospital operations, containing costs, and improving quality and safety of patient care. The report cited lack of training, care transitions, low compensation, and stigma as barriers to the development of hospitalist programs internationally. However, continued support from the United States to support international hospitalist groups as they organize will help support the growth of hospitalist medicine worldwide, the authors noted.
Throughout the year, SHM supports the growth of international chapters under the staff support of Lisa Kroll, and any attendees with questions about international hospital medicine programs can contact her at [email protected]. Ongoing SHM goals in support of international hospital medicine include an Internet-based regional community on the society’s HMX platform, as well as helping international chapters get organized and develop their own meetings.
International Hospital Medicine in U.A.E., Brazil and Holland
Monday, 12:45 – 1:30 p.m.
Potomac ABCD
International Special Interest Forum
Monday, 4:30 – 5:30 p.m.
Magnolia 1
At the 2019 Annual Conference, the Society of Hospital Medicine is building on its commitment to develop global relationships and serve as a resource for hospital-based medicine programs around the world. The International Lounge at HM19 complements a busy day of sessions and offers attendees a chance to unwind and expand their perspective on international hospital medicine.
“Once again SHM will provide a special place for our international attendees at HM 2019 to network and meet with SHM board members, hospitalist leaders, and fellow attendees,” Laurence Wellikson, MD, MHM, CEO of SHM, said in an interview. The International Lounge will be held in National Harbor 3 and will be open on March 26 from 10:00 a.m. until 3:00 p.m.
While no formal presentations are scheduled for the International Lounge, the goal is to provide an informal place to gather and communicate, said Dr. Wellikson.
However, some programs and special events related to international hospital medicine are scheduled for other points during the annual conference. A panel discussion on March 25 from 12:45 to 1:30 p.m. will focus on hospital medicine in Brazil, Holland, and the United Arab Emirates and will include information on the growth of hospital medicine internationally. In addition, an International Special Interest Forum will be held on March 25 from 4:30 until 5:30 p.m. in Magnolia 1.
“If you are from outside the U.S. or if you are interested in networking with or learning more about the growth of hospital medicine around the world, then consider visiting the International Lounge on March 26 or attending the Special Interest Forum or the panel discussion on March 25,” Dr. Wellikson said.
Hospitalist medicine is the fastest growing specialty in the United States, and the field continues to expand beyond the United States, according to a report published in 2018 in the International Journal of General Medicine.
Reasons for the growth of international hospital medicine remain similar to those in the United States despite differences in cultural norms, regulations, and health care systems, according to the report. Drivers of hospitalist programs abroad include interest in optimizing hospital operations, containing costs, and improving quality and safety of patient care. The report cited lack of training, care transitions, low compensation, and stigma as barriers to the development of hospitalist programs internationally. However, continued support from the United States to support international hospitalist groups as they organize will help support the growth of hospitalist medicine worldwide, the authors noted.
Throughout the year, SHM supports the growth of international chapters under the staff support of Lisa Kroll, and any attendees with questions about international hospital medicine programs can contact her at [email protected]. Ongoing SHM goals in support of international hospital medicine include an Internet-based regional community on the society’s HMX platform, as well as helping international chapters get organized and develop their own meetings.
International Hospital Medicine in U.A.E., Brazil and Holland
Monday, 12:45 – 1:30 p.m.
Potomac ABCD
International Special Interest Forum
Monday, 4:30 – 5:30 p.m.
Magnolia 1
At the 2019 Annual Conference, the Society of Hospital Medicine is building on its commitment to develop global relationships and serve as a resource for hospital-based medicine programs around the world. The International Lounge at HM19 complements a busy day of sessions and offers attendees a chance to unwind and expand their perspective on international hospital medicine.
“Once again SHM will provide a special place for our international attendees at HM 2019 to network and meet with SHM board members, hospitalist leaders, and fellow attendees,” Laurence Wellikson, MD, MHM, CEO of SHM, said in an interview. The International Lounge will be held in National Harbor 3 and will be open on March 26 from 10:00 a.m. until 3:00 p.m.
While no formal presentations are scheduled for the International Lounge, the goal is to provide an informal place to gather and communicate, said Dr. Wellikson.
However, some programs and special events related to international hospital medicine are scheduled for other points during the annual conference. A panel discussion on March 25 from 12:45 to 1:30 p.m. will focus on hospital medicine in Brazil, Holland, and the United Arab Emirates and will include information on the growth of hospital medicine internationally. In addition, an International Special Interest Forum will be held on March 25 from 4:30 until 5:30 p.m. in Magnolia 1.
“If you are from outside the U.S. or if you are interested in networking with or learning more about the growth of hospital medicine around the world, then consider visiting the International Lounge on March 26 or attending the Special Interest Forum or the panel discussion on March 25,” Dr. Wellikson said.
Hospitalist medicine is the fastest growing specialty in the United States, and the field continues to expand beyond the United States, according to a report published in 2018 in the International Journal of General Medicine.
Reasons for the growth of international hospital medicine remain similar to those in the United States despite differences in cultural norms, regulations, and health care systems, according to the report. Drivers of hospitalist programs abroad include interest in optimizing hospital operations, containing costs, and improving quality and safety of patient care. The report cited lack of training, care transitions, low compensation, and stigma as barriers to the development of hospitalist programs internationally. However, continued support from the United States to support international hospitalist groups as they organize will help support the growth of hospitalist medicine worldwide, the authors noted.
Throughout the year, SHM supports the growth of international chapters under the staff support of Lisa Kroll, and any attendees with questions about international hospital medicine programs can contact her at [email protected]. Ongoing SHM goals in support of international hospital medicine include an Internet-based regional community on the society’s HMX platform, as well as helping international chapters get organized and develop their own meetings.
International Hospital Medicine in U.A.E., Brazil and Holland
Monday, 12:45 – 1:30 p.m.
Potomac ABCD
International Special Interest Forum
Monday, 4:30 – 5:30 p.m.
Magnolia 1
Destress dermatologic procedures with honesty, distraction, relaxation
according to a report published in Pediatric Dermatology.
For many children, the anticipation of pain and the anxiety about a procedure results in a more painful experience, wrote Andrew M. Armenta of the University of Texas, Galveston, and his colleagues. Preparing children in advance and using cognitive behavioral therapy (CBT) strategies in the moment can help reduce their anxiety.
“CBT is a skill‐based approach that focuses on the present and aims to teach efficient ways of identifying distorted thinking, modifying beliefs, and changing behaviors for a more favorable outcome of real‐life situations,” they wrote.
First, Dr. Armenta and his associates advised, be honest with children about what to expect from a procedure. Evidence does not support phrases such as, “It won’t hurt,” or “It will be over soon,” to reduce anxiety.
Timing the disclosure of a procedure and creating the appropriate setting also can help reduce anxiety. For very young children, short notice of a procedure is often best, with the promise of a small reward or outing afterward. Older children may want some advance notice so they can feel prepared, but their specific concerns should be addressed.
CBT-based techniques include deep breathing and positive coping statements such as “I can do this” for older children, or encouraging them to talk about a family pet or listen to music. Younger children may be distracted with pinwheels, rattles, or songs. “Additionally, in recent years, virtual reality headsets have even proved to be effective distractors, resulting in an overall reduction in both pain and fear,” Dr. Armenta and his associates noted.
Other useful strategies include allowing children to choose their position and location for an injection or procedure when possible. Small children may be able to sit on the lap of an adult, and older children may prefer sitting up to lying down. Avoid physical restraint unless it is absolutely necessary for safety, the researchers emphasized.
Incorporating CBT-based strategies of breathing and distraction with honesty and respectful disclosure of what is being done and why “not only makes practicing pediatric dermatology easier, but also can improve patient adherence to painful procedures,” they said.
No disclosure information was given.
SOURCE: Armenta AM et al. Pediatr Dermatol. 2019. doi: 10.1111/pde.13739.
according to a report published in Pediatric Dermatology.
For many children, the anticipation of pain and the anxiety about a procedure results in a more painful experience, wrote Andrew M. Armenta of the University of Texas, Galveston, and his colleagues. Preparing children in advance and using cognitive behavioral therapy (CBT) strategies in the moment can help reduce their anxiety.
“CBT is a skill‐based approach that focuses on the present and aims to teach efficient ways of identifying distorted thinking, modifying beliefs, and changing behaviors for a more favorable outcome of real‐life situations,” they wrote.
First, Dr. Armenta and his associates advised, be honest with children about what to expect from a procedure. Evidence does not support phrases such as, “It won’t hurt,” or “It will be over soon,” to reduce anxiety.
Timing the disclosure of a procedure and creating the appropriate setting also can help reduce anxiety. For very young children, short notice of a procedure is often best, with the promise of a small reward or outing afterward. Older children may want some advance notice so they can feel prepared, but their specific concerns should be addressed.
CBT-based techniques include deep breathing and positive coping statements such as “I can do this” for older children, or encouraging them to talk about a family pet or listen to music. Younger children may be distracted with pinwheels, rattles, or songs. “Additionally, in recent years, virtual reality headsets have even proved to be effective distractors, resulting in an overall reduction in both pain and fear,” Dr. Armenta and his associates noted.
Other useful strategies include allowing children to choose their position and location for an injection or procedure when possible. Small children may be able to sit on the lap of an adult, and older children may prefer sitting up to lying down. Avoid physical restraint unless it is absolutely necessary for safety, the researchers emphasized.
Incorporating CBT-based strategies of breathing and distraction with honesty and respectful disclosure of what is being done and why “not only makes practicing pediatric dermatology easier, but also can improve patient adherence to painful procedures,” they said.
No disclosure information was given.
SOURCE: Armenta AM et al. Pediatr Dermatol. 2019. doi: 10.1111/pde.13739.
according to a report published in Pediatric Dermatology.
For many children, the anticipation of pain and the anxiety about a procedure results in a more painful experience, wrote Andrew M. Armenta of the University of Texas, Galveston, and his colleagues. Preparing children in advance and using cognitive behavioral therapy (CBT) strategies in the moment can help reduce their anxiety.
“CBT is a skill‐based approach that focuses on the present and aims to teach efficient ways of identifying distorted thinking, modifying beliefs, and changing behaviors for a more favorable outcome of real‐life situations,” they wrote.
First, Dr. Armenta and his associates advised, be honest with children about what to expect from a procedure. Evidence does not support phrases such as, “It won’t hurt,” or “It will be over soon,” to reduce anxiety.
Timing the disclosure of a procedure and creating the appropriate setting also can help reduce anxiety. For very young children, short notice of a procedure is often best, with the promise of a small reward or outing afterward. Older children may want some advance notice so they can feel prepared, but their specific concerns should be addressed.
CBT-based techniques include deep breathing and positive coping statements such as “I can do this” for older children, or encouraging them to talk about a family pet or listen to music. Younger children may be distracted with pinwheels, rattles, or songs. “Additionally, in recent years, virtual reality headsets have even proved to be effective distractors, resulting in an overall reduction in both pain and fear,” Dr. Armenta and his associates noted.
Other useful strategies include allowing children to choose their position and location for an injection or procedure when possible. Small children may be able to sit on the lap of an adult, and older children may prefer sitting up to lying down. Avoid physical restraint unless it is absolutely necessary for safety, the researchers emphasized.
Incorporating CBT-based strategies of breathing and distraction with honesty and respectful disclosure of what is being done and why “not only makes practicing pediatric dermatology easier, but also can improve patient adherence to painful procedures,” they said.
No disclosure information was given.
SOURCE: Armenta AM et al. Pediatr Dermatol. 2019. doi: 10.1111/pde.13739.
FROM PEDIATRIC DERMATOLOGY
In utero infections raise risk for autism
Children whose mothers experienced any type of infection during pregnancy were nearly 80 times more likely to be diagnosed with autism than those whose mothers did not have infections, based on data from more than one million children in Sweden.
Although previous studies have shown associations between specific infections in utero and specific conditions, such as schizophrenia, “Whether maternal infection and inflammation can alter fetal neurodevelopment to a degree that imparts risk for a broad spectrum of psychopathologic conditions across the child’s lifetime is unknown,” wrote Benjamin J. S. al-Haddad, MD, formerly of Seattle Children’s Hospital, Washington, currently with Doctors without Borders,Katiola, Côte d’Ivoire, and his colleagues.
In a study published In JAMA Psychiatry, the researchers followed 1,791,520 children (48.6% girls) born between Jan. 1, 1973, and Dec. 31, 2014, for up to 41 years using population-based registry data.
Overall, researchers found a 79% increased risk of an autism diagnosis (hazard ratio 1.79) and a 24% increased risk of a depression diagnosis (HR 1.24) for individuals exposed to any maternal infection in utero compared with those not exposed.
Similar increases in risk appeared when the data were broken down by type of infection. Hazard ratios for an autism diagnosis were 1.81 for exposure to a severe maternal infection and 1.89 for a maternal urinary tract infection; hazard ratios for depression were 1.24 and 1.30, respectively, for severe maternal infection and maternal urinary tract infection.
No increased risk in bipolar disorder, or other psychoses including schizophrenia were observed.
The findings were limited by several factors including the inclusion only of infections diagnosed in a hospital setting, and thus may not be generalizable to infections diagnosed in an outpatient setting, the researchers noted. However, the results “amplify the urgency to better understand the role of maternal infection during pregnancy on fetal brain development and suggest that prevention of infection (such as by influenza vaccination) or anti-inflammatory therapies may be important strategies for the primary prevention of some portion of autism and depression,” they said.
The researchers had no conflicts to disclose. The study was funded by grants from several organizations including the National Institutes of Health.
SOURCE: al-Haddad BJS et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.0029.
Children whose mothers experienced any type of infection during pregnancy were nearly 80 times more likely to be diagnosed with autism than those whose mothers did not have infections, based on data from more than one million children in Sweden.
Although previous studies have shown associations between specific infections in utero and specific conditions, such as schizophrenia, “Whether maternal infection and inflammation can alter fetal neurodevelopment to a degree that imparts risk for a broad spectrum of psychopathologic conditions across the child’s lifetime is unknown,” wrote Benjamin J. S. al-Haddad, MD, formerly of Seattle Children’s Hospital, Washington, currently with Doctors without Borders,Katiola, Côte d’Ivoire, and his colleagues.
In a study published In JAMA Psychiatry, the researchers followed 1,791,520 children (48.6% girls) born between Jan. 1, 1973, and Dec. 31, 2014, for up to 41 years using population-based registry data.
Overall, researchers found a 79% increased risk of an autism diagnosis (hazard ratio 1.79) and a 24% increased risk of a depression diagnosis (HR 1.24) for individuals exposed to any maternal infection in utero compared with those not exposed.
Similar increases in risk appeared when the data were broken down by type of infection. Hazard ratios for an autism diagnosis were 1.81 for exposure to a severe maternal infection and 1.89 for a maternal urinary tract infection; hazard ratios for depression were 1.24 and 1.30, respectively, for severe maternal infection and maternal urinary tract infection.
No increased risk in bipolar disorder, or other psychoses including schizophrenia were observed.
The findings were limited by several factors including the inclusion only of infections diagnosed in a hospital setting, and thus may not be generalizable to infections diagnosed in an outpatient setting, the researchers noted. However, the results “amplify the urgency to better understand the role of maternal infection during pregnancy on fetal brain development and suggest that prevention of infection (such as by influenza vaccination) or anti-inflammatory therapies may be important strategies for the primary prevention of some portion of autism and depression,” they said.
The researchers had no conflicts to disclose. The study was funded by grants from several organizations including the National Institutes of Health.
SOURCE: al-Haddad BJS et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.0029.
Children whose mothers experienced any type of infection during pregnancy were nearly 80 times more likely to be diagnosed with autism than those whose mothers did not have infections, based on data from more than one million children in Sweden.
Although previous studies have shown associations between specific infections in utero and specific conditions, such as schizophrenia, “Whether maternal infection and inflammation can alter fetal neurodevelopment to a degree that imparts risk for a broad spectrum of psychopathologic conditions across the child’s lifetime is unknown,” wrote Benjamin J. S. al-Haddad, MD, formerly of Seattle Children’s Hospital, Washington, currently with Doctors without Borders,Katiola, Côte d’Ivoire, and his colleagues.
In a study published In JAMA Psychiatry, the researchers followed 1,791,520 children (48.6% girls) born between Jan. 1, 1973, and Dec. 31, 2014, for up to 41 years using population-based registry data.
Overall, researchers found a 79% increased risk of an autism diagnosis (hazard ratio 1.79) and a 24% increased risk of a depression diagnosis (HR 1.24) for individuals exposed to any maternal infection in utero compared with those not exposed.
Similar increases in risk appeared when the data were broken down by type of infection. Hazard ratios for an autism diagnosis were 1.81 for exposure to a severe maternal infection and 1.89 for a maternal urinary tract infection; hazard ratios for depression were 1.24 and 1.30, respectively, for severe maternal infection and maternal urinary tract infection.
No increased risk in bipolar disorder, or other psychoses including schizophrenia were observed.
The findings were limited by several factors including the inclusion only of infections diagnosed in a hospital setting, and thus may not be generalizable to infections diagnosed in an outpatient setting, the researchers noted. However, the results “amplify the urgency to better understand the role of maternal infection during pregnancy on fetal brain development and suggest that prevention of infection (such as by influenza vaccination) or anti-inflammatory therapies may be important strategies for the primary prevention of some portion of autism and depression,” they said.
The researchers had no conflicts to disclose. The study was funded by grants from several organizations including the National Institutes of Health.
SOURCE: al-Haddad BJS et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.0029.
FROM JAMA PSYCHIATRY