Heidi Splete

A tai chi exercise program was more effective than multimodal exercise or stretching at reducing falls among older adults in a 6-month study of 670 participants aged 70 years and older.

bloodstone/iStockphoto.com

Although exercise can be a safe way to reduce falls in older adults, “few comparative effectiveness data are available, especially for older adults with high fall risk,” wrote Fuzhong Li, PhD, of the Oregon Research Institute in Eugene, and his colleagues.

In a study published in JAMA Internal Medicine, the researchers randomized participants to a tailored tai chi program, Tai Ji Quan: Moving for Better Balance (TJQMBB), multimodal exercise, or a control intervention of basic stretching. Each intervention consisted of a twice-weekly 60-minute session for 24 weeks.

The study population included 670 community-dwelling adults aged 70 years and older at seven urban and suburban cities in Oregon. All participants had fallen within the past year or had impaired mobility that put them at increased fall risk. The average age of the participants was 78 years, 65% were women, and 92% were white.

A total of 152 falls occurred among 85 individuals in the TJQMBB group during the study period, compared with 218 falls among 112 individuals in the multimodal exercise group and 363 falls among 127 individuals in the stretching group. Overall, the tai chi group had a 58% reduced incidence of falls, compared with stretching, and a 31% reduced risk, compared with multimodal exercise.

The tai chi program used in the study included balance and stability training, described by the researchers as “unilateral weight-bearing and weight-shifting movements, trunk and pelvic rotation, ankle sway, and eye-head-hand movements.” The multimodal exercise program included aerobic conditioning, strength, balance, and flexibility activities, and the stretching intervention included stretching, breathing, and relaxation.

The results were limited by several factors, including the use of self-reports, low representation of African American participants, and collection of data from a single state, the researchers noted.

However, the findings support the potential of tai chi programs to reduce the risk of falls in older adults. “With increasing evidence of community adoption and implementation and information from cost-benefit and cost-effectiveness analyses, the intervention program represents a promising approach to low-cost and easily implementable fall prevention programs,” the researchers explained.

The study was supported in part by the National Institute on Aging. Dr. Li reported that he is the founder and owner of a consulting company, Exercise Alternatives, and that a licensing free for TJQMBB is paid directly to that company.

SOURCE: Li F et al. JAMA Intern Med. 2018 Sep 10. doi: 10.1001/jamainternmed.2018.3915.

A tai chi exercise program was more effective than multimodal exercise or stretching at reducing falls among older adults in a 6-month study of 670 participants aged 70 years and older.

bloodstone/iStockphoto.com

Although exercise can be a safe way to reduce falls in older adults, “few comparative effectiveness data are available, especially for older adults with high fall risk,” wrote Fuzhong Li, PhD, of the Oregon Research Institute in Eugene, and his colleagues.

In a study published in JAMA Internal Medicine, the researchers randomized participants to a tailored tai chi program, Tai Ji Quan: Moving for Better Balance (TJQMBB), multimodal exercise, or a control intervention of basic stretching. Each intervention consisted of a twice-weekly 60-minute session for 24 weeks.

The study population included 670 community-dwelling adults aged 70 years and older at seven urban and suburban cities in Oregon. All participants had fallen within the past year or had impaired mobility that put them at increased fall risk. The average age of the participants was 78 years, 65% were women, and 92% were white.

A total of 152 falls occurred among 85 individuals in the TJQMBB group during the study period, compared with 218 falls among 112 individuals in the multimodal exercise group and 363 falls among 127 individuals in the stretching group. Overall, the tai chi group had a 58% reduced incidence of falls, compared with stretching, and a 31% reduced risk, compared with multimodal exercise.

The tai chi program used in the study included balance and stability training, described by the researchers as “unilateral weight-bearing and weight-shifting movements, trunk and pelvic rotation, ankle sway, and eye-head-hand movements.” The multimodal exercise program included aerobic conditioning, strength, balance, and flexibility activities, and the stretching intervention included stretching, breathing, and relaxation.

The results were limited by several factors, including the use of self-reports, low representation of African American participants, and collection of data from a single state, the researchers noted.

However, the findings support the potential of tai chi programs to reduce the risk of falls in older adults. “With increasing evidence of community adoption and implementation and information from cost-benefit and cost-effectiveness analyses, the intervention program represents a promising approach to low-cost and easily implementable fall prevention programs,” the researchers explained.

The study was supported in part by the National Institute on Aging. Dr. Li reported that he is the founder and owner of a consulting company, Exercise Alternatives, and that a licensing free for TJQMBB is paid directly to that company.

SOURCE: Li F et al. JAMA Intern Med. 2018 Sep 10. doi: 10.1001/jamainternmed.2018.3915.

A tai chi exercise program was more effective than multimodal exercise or stretching at reducing falls among older adults in a 6-month study of 670 participants aged 70 years and older.

bloodstone/iStockphoto.com

Although exercise can be a safe way to reduce falls in older adults, “few comparative effectiveness data are available, especially for older adults with high fall risk,” wrote Fuzhong Li, PhD, of the Oregon Research Institute in Eugene, and his colleagues.

In a study published in JAMA Internal Medicine, the researchers randomized participants to a tailored tai chi program, Tai Ji Quan: Moving for Better Balance (TJQMBB), multimodal exercise, or a control intervention of basic stretching. Each intervention consisted of a twice-weekly 60-minute session for 24 weeks.

The study population included 670 community-dwelling adults aged 70 years and older at seven urban and suburban cities in Oregon. All participants had fallen within the past year or had impaired mobility that put them at increased fall risk. The average age of the participants was 78 years, 65% were women, and 92% were white.

A total of 152 falls occurred among 85 individuals in the TJQMBB group during the study period, compared with 218 falls among 112 individuals in the multimodal exercise group and 363 falls among 127 individuals in the stretching group. Overall, the tai chi group had a 58% reduced incidence of falls, compared with stretching, and a 31% reduced risk, compared with multimodal exercise.

The tai chi program used in the study included balance and stability training, described by the researchers as “unilateral weight-bearing and weight-shifting movements, trunk and pelvic rotation, ankle sway, and eye-head-hand movements.” The multimodal exercise program included aerobic conditioning, strength, balance, and flexibility activities, and the stretching intervention included stretching, breathing, and relaxation.

The results were limited by several factors, including the use of self-reports, low representation of African American participants, and collection of data from a single state, the researchers noted.

However, the findings support the potential of tai chi programs to reduce the risk of falls in older adults. “With increasing evidence of community adoption and implementation and information from cost-benefit and cost-effectiveness analyses, the intervention program represents a promising approach to low-cost and easily implementable fall prevention programs,” the researchers explained.

The study was supported in part by the National Institute on Aging. Dr. Li reported that he is the founder and owner of a consulting company, Exercise Alternatives, and that a licensing free for TJQMBB is paid directly to that company.

SOURCE: Li F et al. JAMA Intern Med. 2018 Sep 10. doi: 10.1001/jamainternmed.2018.3915.

More dermatologists in the United States practice in urban areas than in nonurban or rural areas, and this trend is likely to continue, according to data from a longitudinal study published online Sept. 5 in JAMA Dermatology.

Data from previous studies suggest that the demand for dermatologists continues to outpace the supply, thus dermatologists have their choice of locations and prefer urban areas because of greater professional opportunities, desire to live near family, and lack of financial incentives to relocate to underserved areas, wrote Hao Feng, MD, of the department of dermatology, New York University, and his colleagues.

To evaluate the latest longitudinal trends in dermatology and factors affecting geographic distribution, the researchers used the Area Health Resources File from 1995 to 2013 to examine the geographic densities of dermatologists and other physicians, as well as the age distribution of dermatologists. The counties were classified as rural, nonmetropolitan, and metropolitan.

Although the percentage changes in dermatologist density at the county level showed a greater increase during the study period in rural counties (30%) and nonmetropolitan counties (25%), compared with metropolitan counties (18%), the differences in actual density of dermatologists per 100,000 people were highest in urban areas.

Overall, dermatologist density in metropolitan areas increased from 3.47 to 4.11 per 100,000 people between 1995 and 2013. Dermatologist density in nonmetropolitan areas during this time increased from 0.84 in 1995 to 1.05 per 100,000 people in 2013, and from 0.065 to 0.085 per 100,000 people in rural areas during that time.

The researchers also evaluated dermatologist trends by age, and found that the number of dermatologists younger than 55 years increased by 21% in metropolitan areas and by 7% in nonmetropolitan and rural areas combined between 1995 and 2013.

The study findings were strengthened by the long time period, but limited by factors including inability to differentiate among full-time and part-time dermatologists, and among medical or cosmetic dermatologists and dermatologic surgeons, the researchers said. However, the results suggest that geographic disparities for dermatologists in the United States continue to increase, and strategies to correct it are important to maintain patient care, they wrote. “Careful workforce planning will be needed to consider alternative health care delivery models, dermatologist recruitment strategies, and the role of nonphysician practitioners and telemedicine, especially in nonmetropolitan or rural areas,” they noted.

The researchers had no financial conflicts to disclose.

SOURCE: Feng H et al. JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.3022.

More dermatologists in the United States practice in urban areas than in nonurban or rural areas, and this trend is likely to continue, according to data from a longitudinal study published online Sept. 5 in JAMA Dermatology.

Data from previous studies suggest that the demand for dermatologists continues to outpace the supply, thus dermatologists have their choice of locations and prefer urban areas because of greater professional opportunities, desire to live near family, and lack of financial incentives to relocate to underserved areas, wrote Hao Feng, MD, of the department of dermatology, New York University, and his colleagues.

To evaluate the latest longitudinal trends in dermatology and factors affecting geographic distribution, the researchers used the Area Health Resources File from 1995 to 2013 to examine the geographic densities of dermatologists and other physicians, as well as the age distribution of dermatologists. The counties were classified as rural, nonmetropolitan, and metropolitan.

Although the percentage changes in dermatologist density at the county level showed a greater increase during the study period in rural counties (30%) and nonmetropolitan counties (25%), compared with metropolitan counties (18%), the differences in actual density of dermatologists per 100,000 people were highest in urban areas.

Overall, dermatologist density in metropolitan areas increased from 3.47 to 4.11 per 100,000 people between 1995 and 2013. Dermatologist density in nonmetropolitan areas during this time increased from 0.84 in 1995 to 1.05 per 100,000 people in 2013, and from 0.065 to 0.085 per 100,000 people in rural areas during that time.

The researchers also evaluated dermatologist trends by age, and found that the number of dermatologists younger than 55 years increased by 21% in metropolitan areas and by 7% in nonmetropolitan and rural areas combined between 1995 and 2013.

The study findings were strengthened by the long time period, but limited by factors including inability to differentiate among full-time and part-time dermatologists, and among medical or cosmetic dermatologists and dermatologic surgeons, the researchers said. However, the results suggest that geographic disparities for dermatologists in the United States continue to increase, and strategies to correct it are important to maintain patient care, they wrote. “Careful workforce planning will be needed to consider alternative health care delivery models, dermatologist recruitment strategies, and the role of nonphysician practitioners and telemedicine, especially in nonmetropolitan or rural areas,” they noted.

The researchers had no financial conflicts to disclose.

SOURCE: Feng H et al. JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.3022.

More dermatologists in the United States practice in urban areas than in nonurban or rural areas, and this trend is likely to continue, according to data from a longitudinal study published online Sept. 5 in JAMA Dermatology.

Data from previous studies suggest that the demand for dermatologists continues to outpace the supply, thus dermatologists have their choice of locations and prefer urban areas because of greater professional opportunities, desire to live near family, and lack of financial incentives to relocate to underserved areas, wrote Hao Feng, MD, of the department of dermatology, New York University, and his colleagues.

To evaluate the latest longitudinal trends in dermatology and factors affecting geographic distribution, the researchers used the Area Health Resources File from 1995 to 2013 to examine the geographic densities of dermatologists and other physicians, as well as the age distribution of dermatologists. The counties were classified as rural, nonmetropolitan, and metropolitan.

Although the percentage changes in dermatologist density at the county level showed a greater increase during the study period in rural counties (30%) and nonmetropolitan counties (25%), compared with metropolitan counties (18%), the differences in actual density of dermatologists per 100,000 people were highest in urban areas.

Overall, dermatologist density in metropolitan areas increased from 3.47 to 4.11 per 100,000 people between 1995 and 2013. Dermatologist density in nonmetropolitan areas during this time increased from 0.84 in 1995 to 1.05 per 100,000 people in 2013, and from 0.065 to 0.085 per 100,000 people in rural areas during that time.

The researchers also evaluated dermatologist trends by age, and found that the number of dermatologists younger than 55 years increased by 21% in metropolitan areas and by 7% in nonmetropolitan and rural areas combined between 1995 and 2013.

The study findings were strengthened by the long time period, but limited by factors including inability to differentiate among full-time and part-time dermatologists, and among medical or cosmetic dermatologists and dermatologic surgeons, the researchers said. However, the results suggest that geographic disparities for dermatologists in the United States continue to increase, and strategies to correct it are important to maintain patient care, they wrote. “Careful workforce planning will be needed to consider alternative health care delivery models, dermatologist recruitment strategies, and the role of nonphysician practitioners and telemedicine, especially in nonmetropolitan or rural areas,” they noted.

The researchers had no financial conflicts to disclose.

SOURCE: Feng H et al. JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.3022.

Adults with obstructive sleep apnea are approximately twice as likely as are those without it to develop gout, according to data from a large, retrospective study with a median 5-year follow-up.

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Data from previous studies have shown an increased risk in developing gout within the first year of an obstructive sleep apnea (OSA) diagnosis, wrote Milica Blagojevic-Bucknall, PhD, of Keele (England) University, and her colleagues.

In a study published in Arthritis & Rheumatology, the researchers compared 15,879 patients with OSA and 63,296 without.

Overall, 4.9% of OSA patients and 2.6% non‐OSA controls developed gout over a median follow‐up period of 5.8 years. The incidence rate for gout per 1,000 person‐years was 7.83 among patients with OSA and 4.03 for controls (adjusted hazard ratio, 1.42). The greatest risk for gout in the OSA patients occurred approximately 1-2 years after their diagnosis.

The researchers also found significant associations between body mass index and gout risk in sleep apnea across all BMI categories, but the strongest association occurred in the normal BMI group (HR 2.02) at 2-5 years after the index date of OSA.

“The novelty of this study lies in assessing both the short- and long-term association of OSA with incident gout in a large primary care-based population,” the researchers said. They proposed that the most likely explanation for the events was that “intermittent hypoxia increases nucleotide turnover which enhances endogenous uric acid production.”

The study findings were limited by several factors including potential misclassification of OSA and the impact of confounding variables such as genetics and diet, they noted.

However, the results support the association between sleep apnea and gout, but also serve to highlight that clinicians should “consider the possibility of gout in patients with sleep apnea regardless of obesity,” the researchers wrote.

The National Institute for Health Research funded the study. The authors have no conflicts of interest to declare.

SOURCE: Blagojevic-Bucknall M et al. Arthritis Rheumatol. 2018 Aug 30. doi: 10.1002/art.40662.

Adults with obstructive sleep apnea are approximately twice as likely as are those without it to develop gout, according to data from a large, retrospective study with a median 5-year follow-up.

copyright designer491/Thinkstock

Data from previous studies have shown an increased risk in developing gout within the first year of an obstructive sleep apnea (OSA) diagnosis, wrote Milica Blagojevic-Bucknall, PhD, of Keele (England) University, and her colleagues.

In a study published in Arthritis & Rheumatology, the researchers compared 15,879 patients with OSA and 63,296 without.

Overall, 4.9% of OSA patients and 2.6% non‐OSA controls developed gout over a median follow‐up period of 5.8 years. The incidence rate for gout per 1,000 person‐years was 7.83 among patients with OSA and 4.03 for controls (adjusted hazard ratio, 1.42). The greatest risk for gout in the OSA patients occurred approximately 1-2 years after their diagnosis.

The researchers also found significant associations between body mass index and gout risk in sleep apnea across all BMI categories, but the strongest association occurred in the normal BMI group (HR 2.02) at 2-5 years after the index date of OSA.

“The novelty of this study lies in assessing both the short- and long-term association of OSA with incident gout in a large primary care-based population,” the researchers said. They proposed that the most likely explanation for the events was that “intermittent hypoxia increases nucleotide turnover which enhances endogenous uric acid production.”

The study findings were limited by several factors including potential misclassification of OSA and the impact of confounding variables such as genetics and diet, they noted.

However, the results support the association between sleep apnea and gout, but also serve to highlight that clinicians should “consider the possibility of gout in patients with sleep apnea regardless of obesity,” the researchers wrote.

The National Institute for Health Research funded the study. The authors have no conflicts of interest to declare.

SOURCE: Blagojevic-Bucknall M et al. Arthritis Rheumatol. 2018 Aug 30. doi: 10.1002/art.40662.

Adults with obstructive sleep apnea are approximately twice as likely as are those without it to develop gout, according to data from a large, retrospective study with a median 5-year follow-up.

copyright designer491/Thinkstock

Data from previous studies have shown an increased risk in developing gout within the first year of an obstructive sleep apnea (OSA) diagnosis, wrote Milica Blagojevic-Bucknall, PhD, of Keele (England) University, and her colleagues.

In a study published in Arthritis & Rheumatology, the researchers compared 15,879 patients with OSA and 63,296 without.

Overall, 4.9% of OSA patients and 2.6% non‐OSA controls developed gout over a median follow‐up period of 5.8 years. The incidence rate for gout per 1,000 person‐years was 7.83 among patients with OSA and 4.03 for controls (adjusted hazard ratio, 1.42). The greatest risk for gout in the OSA patients occurred approximately 1-2 years after their diagnosis.

The researchers also found significant associations between body mass index and gout risk in sleep apnea across all BMI categories, but the strongest association occurred in the normal BMI group (HR 2.02) at 2-5 years after the index date of OSA.

“The novelty of this study lies in assessing both the short- and long-term association of OSA with incident gout in a large primary care-based population,” the researchers said. They proposed that the most likely explanation for the events was that “intermittent hypoxia increases nucleotide turnover which enhances endogenous uric acid production.”

The study findings were limited by several factors including potential misclassification of OSA and the impact of confounding variables such as genetics and diet, they noted.

However, the results support the association between sleep apnea and gout, but also serve to highlight that clinicians should “consider the possibility of gout in patients with sleep apnea regardless of obesity,” the researchers wrote.

The National Institute for Health Research funded the study. The authors have no conflicts of interest to declare.

SOURCE: Blagojevic-Bucknall M et al. Arthritis Rheumatol. 2018 Aug 30. doi: 10.1002/art.40662.

Approximately one-third of children seen for head trauma visits in EDs underwent CT scans over a 9-year period in the United States, despite quality improvement initiatives to reduce unnecessary scans, based on a data from a cross-sectional survey published in Pediatrics.

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“Computed tomography (CT) is the reference standard to provide a rapid and definitive diagnosis of intracranial pathology but must be balanced against the risks of radiation-induced malignancy,” wrote Brett Burstein, MD, PhD, of Harvard T.H. Chan School of Public Health, Cambridge, Mass., and his colleagues.

The researchers reviewed data from National Hospital Ambulatory Care Medical Survey database of nationally representative ED visits by children younger than 18 years for head trauma from 2007 to 2015. The median age of the patients was 6 years; 61% were boys. Approximately 88% were seen in nonteaching or nonpediatric hospitals.

During the 9-year period, 32% of 3,054 children underwent head CT scans; the 3,054 represented an estimated 14.3 million children making pediatric ED visits for head trauma. No significant differences were noted from year to year after the researchers controlled for confounding patient and ED factors.

Overall, use of CT was associated with patient’s age 2 years and older (adjusted odds ratio 1.51), white race (aOR 1.43), highest level of triage (aOR 8.24), and treatment at a nonteaching or nonpediatric hospital (aOR 1.47 and 1.53, respectively).

No significant differences in CT use were observed when the researchers compared the periods before (2007-2009) and after (2010-2015) the introduction of the Pediatric Emergency Care Applied Research Network (PECARN) rules – a clinical prediction protocol to assess head injuries in children in an ED setting. The unadjusted proportion of children who underwent CTs during the before PECARN and after PECARN periods was 33% and 31%, respectively.

“The finding of no decrease in CT neuroimaging during the 9-year study period, and particularly after the publication of the PECARN rules in 2009, was counter to the a priori hypothesis of this study,” Dr. Burstein and his associates noted.

The findings were limited by several factors including the lack of data on the severity of the head injuries, data on repeat visits, and potential misclassification of hospitals, they said. However, the results highlight the need for targeted interventions to disseminate the latest clinical decisions into practice.

Dr. Burstein and his associates had no financial conflicts to disclose.

SOURCE: Burstein B al. Pediatrics. 2018 Sept 4. doi: 10.1542/peds.2018-0814.

Approximately one-third of children seen for head trauma visits in EDs underwent CT scans over a 9-year period in the United States, despite quality improvement initiatives to reduce unnecessary scans, based on a data from a cross-sectional survey published in Pediatrics.

©Thinkstock.com

“Computed tomography (CT) is the reference standard to provide a rapid and definitive diagnosis of intracranial pathology but must be balanced against the risks of radiation-induced malignancy,” wrote Brett Burstein, MD, PhD, of Harvard T.H. Chan School of Public Health, Cambridge, Mass., and his colleagues.

The researchers reviewed data from National Hospital Ambulatory Care Medical Survey database of nationally representative ED visits by children younger than 18 years for head trauma from 2007 to 2015. The median age of the patients was 6 years; 61% were boys. Approximately 88% were seen in nonteaching or nonpediatric hospitals.

During the 9-year period, 32% of 3,054 children underwent head CT scans; the 3,054 represented an estimated 14.3 million children making pediatric ED visits for head trauma. No significant differences were noted from year to year after the researchers controlled for confounding patient and ED factors.

Overall, use of CT was associated with patient’s age 2 years and older (adjusted odds ratio 1.51), white race (aOR 1.43), highest level of triage (aOR 8.24), and treatment at a nonteaching or nonpediatric hospital (aOR 1.47 and 1.53, respectively).

No significant differences in CT use were observed when the researchers compared the periods before (2007-2009) and after (2010-2015) the introduction of the Pediatric Emergency Care Applied Research Network (PECARN) rules – a clinical prediction protocol to assess head injuries in children in an ED setting. The unadjusted proportion of children who underwent CTs during the before PECARN and after PECARN periods was 33% and 31%, respectively.

“The finding of no decrease in CT neuroimaging during the 9-year study period, and particularly after the publication of the PECARN rules in 2009, was counter to the a priori hypothesis of this study,” Dr. Burstein and his associates noted.

The findings were limited by several factors including the lack of data on the severity of the head injuries, data on repeat visits, and potential misclassification of hospitals, they said. However, the results highlight the need for targeted interventions to disseminate the latest clinical decisions into practice.

Dr. Burstein and his associates had no financial conflicts to disclose.

SOURCE: Burstein B al. Pediatrics. 2018 Sept 4. doi: 10.1542/peds.2018-0814.

Approximately one-third of children seen for head trauma visits in EDs underwent CT scans over a 9-year period in the United States, despite quality improvement initiatives to reduce unnecessary scans, based on a data from a cross-sectional survey published in Pediatrics.

©Thinkstock.com

“Computed tomography (CT) is the reference standard to provide a rapid and definitive diagnosis of intracranial pathology but must be balanced against the risks of radiation-induced malignancy,” wrote Brett Burstein, MD, PhD, of Harvard T.H. Chan School of Public Health, Cambridge, Mass., and his colleagues.

The researchers reviewed data from National Hospital Ambulatory Care Medical Survey database of nationally representative ED visits by children younger than 18 years for head trauma from 2007 to 2015. The median age of the patients was 6 years; 61% were boys. Approximately 88% were seen in nonteaching or nonpediatric hospitals.

During the 9-year period, 32% of 3,054 children underwent head CT scans; the 3,054 represented an estimated 14.3 million children making pediatric ED visits for head trauma. No significant differences were noted from year to year after the researchers controlled for confounding patient and ED factors.

Overall, use of CT was associated with patient’s age 2 years and older (adjusted odds ratio 1.51), white race (aOR 1.43), highest level of triage (aOR 8.24), and treatment at a nonteaching or nonpediatric hospital (aOR 1.47 and 1.53, respectively).

No significant differences in CT use were observed when the researchers compared the periods before (2007-2009) and after (2010-2015) the introduction of the Pediatric Emergency Care Applied Research Network (PECARN) rules – a clinical prediction protocol to assess head injuries in children in an ED setting. The unadjusted proportion of children who underwent CTs during the before PECARN and after PECARN periods was 33% and 31%, respectively.

“The finding of no decrease in CT neuroimaging during the 9-year study period, and particularly after the publication of the PECARN rules in 2009, was counter to the a priori hypothesis of this study,” Dr. Burstein and his associates noted.

The findings were limited by several factors including the lack of data on the severity of the head injuries, data on repeat visits, and potential misclassification of hospitals, they said. However, the results highlight the need for targeted interventions to disseminate the latest clinical decisions into practice.

Dr. Burstein and his associates had no financial conflicts to disclose.

SOURCE: Burstein B al. Pediatrics. 2018 Sept 4. doi: 10.1542/peds.2018-0814.

Use of a smartphone application that provided daily reminders about topical treatment significantly improved adherence for patients with psoriasis, compared with those who did not use the app.

Milan_Zokic/thinkstockphotos.com

Treatment adherence remains a challenge in psoriasis, and although the field of electronic health interventions is growing, data on the effectiveness of such interventions are limited, wrote Mathias T. Svendsen, MD, of Odense University Hospital in Denmark, and his colleagues.

In a study published in the British Journal of Dermatology, 134 adults with psoriasis were randomized to use a smartphone app (68) or not (66) that provided daily medication reminders and daily information about the amount of treatment and number of product applications.

The primary outcome measure of treatment adherence was defined as once-daily application of topical medication – calcipotriol/betamethasone dipropionate cutaneous foam – for at least 80% of the days during the treatment period. A computer chip on the medication dispenser tracked patient use of the product and sent usage information to the patient’s smartphone via Bluetooth.

At 4 weeks, 65% of patients who used the app were adherent to treatment, versus 38% of those who didn’t use the app (P = .004).

In addition, patients who used the app showed significant improvement in disease severity, based on the secondary outcome measure of the Lattice System Physician’s Global Assessment (LS-PGA) at 4 weeks, with a mean change in score from baseline of 1.86 in the app group and 1.46 in the non-app group (P = .047). The LS-PGA and the Dermatology Life Quality Index (DLQI) were measured at all visits. No significant differences on the DLQI appeared between the groups.

During a 22-week follow-up completed by 122 patients, the effects were similar, but the differences were not statistically significant at weeks 8 and 26.

The study findings were limited by several factors, including the lack of knowledge of the correct amount of medication needed for the full benefit of the topical treatment and a lack of data on patient satisfaction with the app, the researchers noted. However, the results suggest that a medication reminder app improved disease severity as well as patient adherence rates in the short term, and that “there is potential for implementing patient-supporting apps in the dermatology clinic.”

The study was supported by LEO Pharma and by the Kirsten and Volmer Rask Nielsen’s Foundation; part of Dr. Svendsen’s salary during the study was paid by LEO Pharma, and several coauthors reported relationships with LEO Pharma.

SOURCE: Svendsen MT et al. Br J Dermatol. 2018 Apr 14. doi: 10.1111/bjd.16667.

Use of a smartphone application that provided daily reminders about topical treatment significantly improved adherence for patients with psoriasis, compared with those who did not use the app.

Milan_Zokic/thinkstockphotos.com

Treatment adherence remains a challenge in psoriasis, and although the field of electronic health interventions is growing, data on the effectiveness of such interventions are limited, wrote Mathias T. Svendsen, MD, of Odense University Hospital in Denmark, and his colleagues.

In a study published in the British Journal of Dermatology, 134 adults with psoriasis were randomized to use a smartphone app (68) or not (66) that provided daily medication reminders and daily information about the amount of treatment and number of product applications.

The primary outcome measure of treatment adherence was defined as once-daily application of topical medication – calcipotriol/betamethasone dipropionate cutaneous foam – for at least 80% of the days during the treatment period. A computer chip on the medication dispenser tracked patient use of the product and sent usage information to the patient’s smartphone via Bluetooth.

At 4 weeks, 65% of patients who used the app were adherent to treatment, versus 38% of those who didn’t use the app (P = .004).

In addition, patients who used the app showed significant improvement in disease severity, based on the secondary outcome measure of the Lattice System Physician’s Global Assessment (LS-PGA) at 4 weeks, with a mean change in score from baseline of 1.86 in the app group and 1.46 in the non-app group (P = .047). The LS-PGA and the Dermatology Life Quality Index (DLQI) were measured at all visits. No significant differences on the DLQI appeared between the groups.

During a 22-week follow-up completed by 122 patients, the effects were similar, but the differences were not statistically significant at weeks 8 and 26.

The study findings were limited by several factors, including the lack of knowledge of the correct amount of medication needed for the full benefit of the topical treatment and a lack of data on patient satisfaction with the app, the researchers noted. However, the results suggest that a medication reminder app improved disease severity as well as patient adherence rates in the short term, and that “there is potential for implementing patient-supporting apps in the dermatology clinic.”

The study was supported by LEO Pharma and by the Kirsten and Volmer Rask Nielsen’s Foundation; part of Dr. Svendsen’s salary during the study was paid by LEO Pharma, and several coauthors reported relationships with LEO Pharma.

SOURCE: Svendsen MT et al. Br J Dermatol. 2018 Apr 14. doi: 10.1111/bjd.16667.

Use of a smartphone application that provided daily reminders about topical treatment significantly improved adherence for patients with psoriasis, compared with those who did not use the app.

Milan_Zokic/thinkstockphotos.com

Treatment adherence remains a challenge in psoriasis, and although the field of electronic health interventions is growing, data on the effectiveness of such interventions are limited, wrote Mathias T. Svendsen, MD, of Odense University Hospital in Denmark, and his colleagues.

In a study published in the British Journal of Dermatology, 134 adults with psoriasis were randomized to use a smartphone app (68) or not (66) that provided daily medication reminders and daily information about the amount of treatment and number of product applications.

The primary outcome measure of treatment adherence was defined as once-daily application of topical medication – calcipotriol/betamethasone dipropionate cutaneous foam – for at least 80% of the days during the treatment period. A computer chip on the medication dispenser tracked patient use of the product and sent usage information to the patient’s smartphone via Bluetooth.

At 4 weeks, 65% of patients who used the app were adherent to treatment, versus 38% of those who didn’t use the app (P = .004).

In addition, patients who used the app showed significant improvement in disease severity, based on the secondary outcome measure of the Lattice System Physician’s Global Assessment (LS-PGA) at 4 weeks, with a mean change in score from baseline of 1.86 in the app group and 1.46 in the non-app group (P = .047). The LS-PGA and the Dermatology Life Quality Index (DLQI) were measured at all visits. No significant differences on the DLQI appeared between the groups.

During a 22-week follow-up completed by 122 patients, the effects were similar, but the differences were not statistically significant at weeks 8 and 26.

The study findings were limited by several factors, including the lack of knowledge of the correct amount of medication needed for the full benefit of the topical treatment and a lack of data on patient satisfaction with the app, the researchers noted. However, the results suggest that a medication reminder app improved disease severity as well as patient adherence rates in the short term, and that “there is potential for implementing patient-supporting apps in the dermatology clinic.”

The study was supported by LEO Pharma and by the Kirsten and Volmer Rask Nielsen’s Foundation; part of Dr. Svendsen’s salary during the study was paid by LEO Pharma, and several coauthors reported relationships with LEO Pharma.

SOURCE: Svendsen MT et al. Br J Dermatol. 2018 Apr 14. doi: 10.1111/bjd.16667.

Higher pretreatment drug concentrations close to a resistance breakpoint for susceptibility were associated with greater relapse risk in TB, based on data from 54 patients who relapsed and 63 who were treated and cured.

iLexx/Thinkstock

“We postulated that drug-susceptible Mycobacterium tuberculosis might have a graded spectrum of susceptibilities that could be used to determine the risk of relapse,” wrote Roberto Colangeli, PhD, of Rutgers University, Newark, N.J., and his colleagues.

In a study published in the New England Journal of Medicine, the researchers examined pretreatment bacterial isolates from adults with TB who had experienced relapse and those who were cured. Using these isolates, they identified the minimum inhibitory concentration (MIC) – the lowest concentration of the drug that prevents visible bacterial growth in culture – for isoniazid and rifampin.

Overall, after controlling for other potential relapse risk factors, higher pretreatment MIC values for both isoniazid and rifampin were associated with an increased relapse risk. For isoniazid, the average MIC below the breakpoint was 0.0334 mcg/mL for relapsed patients and 0.0286 mcg/mL for cured patients. For rifampin, the average MIC below the breakpoint was 0.0695 mcg/mL for relapsed patients and 0.0453 mcg/mL for cured patients. The higher values for the relapsed versus cured patients were represented by factors of 1.17 and 1.53 for isoniazid and rifampin, respectively.

The average age of the patients was 41 years; 83% were men, and 35% were non-Hispanic white.

The study findings were limited by several factors, including the small sample size, retrospective design, and inability to test MIC values from primary cultures versus subcultures, the researchers wrote. However, the results suggest an impact of MIC values on treatment outcomes, and “additional studies that are performed in larger, well-defined prospective cohorts and that include MIC testing of pretreatment culture isolates will be useful to better validate these findings,”

The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Colangeli reported no financial conflicts. Dr. Alland disclosed funding from Cepheid and several current and pending patents in the United States and Europe, with some royalties paid to Cepheid.

SOURCE: Colangeli R et al. N Engl J Med. 2018;379:823-33.

Higher pretreatment drug concentrations close to a resistance breakpoint for susceptibility were associated with greater relapse risk in TB, based on data from 54 patients who relapsed and 63 who were treated and cured.

iLexx/Thinkstock

“We postulated that drug-susceptible Mycobacterium tuberculosis might have a graded spectrum of susceptibilities that could be used to determine the risk of relapse,” wrote Roberto Colangeli, PhD, of Rutgers University, Newark, N.J., and his colleagues.

In a study published in the New England Journal of Medicine, the researchers examined pretreatment bacterial isolates from adults with TB who had experienced relapse and those who were cured. Using these isolates, they identified the minimum inhibitory concentration (MIC) – the lowest concentration of the drug that prevents visible bacterial growth in culture – for isoniazid and rifampin.

Overall, after controlling for other potential relapse risk factors, higher pretreatment MIC values for both isoniazid and rifampin were associated with an increased relapse risk. For isoniazid, the average MIC below the breakpoint was 0.0334 mcg/mL for relapsed patients and 0.0286 mcg/mL for cured patients. For rifampin, the average MIC below the breakpoint was 0.0695 mcg/mL for relapsed patients and 0.0453 mcg/mL for cured patients. The higher values for the relapsed versus cured patients were represented by factors of 1.17 and 1.53 for isoniazid and rifampin, respectively.

The average age of the patients was 41 years; 83% were men, and 35% were non-Hispanic white.

The study findings were limited by several factors, including the small sample size, retrospective design, and inability to test MIC values from primary cultures versus subcultures, the researchers wrote. However, the results suggest an impact of MIC values on treatment outcomes, and “additional studies that are performed in larger, well-defined prospective cohorts and that include MIC testing of pretreatment culture isolates will be useful to better validate these findings,”

The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Colangeli reported no financial conflicts. Dr. Alland disclosed funding from Cepheid and several current and pending patents in the United States and Europe, with some royalties paid to Cepheid.

SOURCE: Colangeli R et al. N Engl J Med. 2018;379:823-33.

Higher pretreatment drug concentrations close to a resistance breakpoint for susceptibility were associated with greater relapse risk in TB, based on data from 54 patients who relapsed and 63 who were treated and cured.

iLexx/Thinkstock

“We postulated that drug-susceptible Mycobacterium tuberculosis might have a graded spectrum of susceptibilities that could be used to determine the risk of relapse,” wrote Roberto Colangeli, PhD, of Rutgers University, Newark, N.J., and his colleagues.

In a study published in the New England Journal of Medicine, the researchers examined pretreatment bacterial isolates from adults with TB who had experienced relapse and those who were cured. Using these isolates, they identified the minimum inhibitory concentration (MIC) – the lowest concentration of the drug that prevents visible bacterial growth in culture – for isoniazid and rifampin.

Overall, after controlling for other potential relapse risk factors, higher pretreatment MIC values for both isoniazid and rifampin were associated with an increased relapse risk. For isoniazid, the average MIC below the breakpoint was 0.0334 mcg/mL for relapsed patients and 0.0286 mcg/mL for cured patients. For rifampin, the average MIC below the breakpoint was 0.0695 mcg/mL for relapsed patients and 0.0453 mcg/mL for cured patients. The higher values for the relapsed versus cured patients were represented by factors of 1.17 and 1.53 for isoniazid and rifampin, respectively.

The average age of the patients was 41 years; 83% were men, and 35% were non-Hispanic white.

The study findings were limited by several factors, including the small sample size, retrospective design, and inability to test MIC values from primary cultures versus subcultures, the researchers wrote. However, the results suggest an impact of MIC values on treatment outcomes, and “additional studies that are performed in larger, well-defined prospective cohorts and that include MIC testing of pretreatment culture isolates will be useful to better validate these findings,”

The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Colangeli reported no financial conflicts. Dr. Alland disclosed funding from Cepheid and several current and pending patents in the United States and Europe, with some royalties paid to Cepheid.

SOURCE: Colangeli R et al. N Engl J Med. 2018;379:823-33.

Epilepsy occurred in approximately two-thirds of infants with congenital Zika virus infection in a study of 141 children.

copyright Devonyu/Thinkstock

“When ZIKV [Zika virus] infection is acquired in utero, it may be associated with epilepsy, and we characterized aspects of this complication in a study performed at our referral center,” wrote Hélio van der Linden Jr., MD, of Dr. Henrique Santillo Rehabilitation and Readaptation Center in Goiânia, Brazil, and colleagues in a letter to the editor published in the New England Journal of Medicine.

The researchers reviewed data from 141 infants aged 1-14 months with a median age of 9 months and Zika virus infection confirmed by laboratory analysis; 55% were girls.

The prevalence of epilepsy was 67%, with a mean age at onset of 4.9 months. Based on data provided by parents, 74% of the children experienced seizures at 6 months of age or younger.

Overall, 77% of the infants experienced a single type of seizure. Epileptic spasms, the most common type, occurred in 72% of infants, followed by focal motor seizure (21%) and tonic seizures (4%).

All 95 epileptic infants were treated with antiepileptic medications and 62 (65%) achieved remission. Of those in remission, 24 (39%) received monotherapy and 38 (61%) received polytherapy. The drugs most associated with seizure control were vigabatrin, levetiracetam, valproate, and phenobarbital.

The prevalence of epilepsy in this study was higher than that seen in previous studies, and most patients had early-onset, drug-resistant epilepsy, the researchers noted. However, burst-suppression patterns and hypsarrhythmia on EEG predicted more severe disease and suggest that epilepsy might complicate cases of congenital Zika infection, they said.

The researchers had no financial conflicts to disclose.

SOURCE: van der Linden H et al. N Engl J Med. 2018 Aug 30. doi: 10.1056/NEJMc1716070.

Epilepsy occurred in approximately two-thirds of infants with congenital Zika virus infection in a study of 141 children.

copyright Devonyu/Thinkstock

“When ZIKV [Zika virus] infection is acquired in utero, it may be associated with epilepsy, and we characterized aspects of this complication in a study performed at our referral center,” wrote Hélio van der Linden Jr., MD, of Dr. Henrique Santillo Rehabilitation and Readaptation Center in Goiânia, Brazil, and colleagues in a letter to the editor published in the New England Journal of Medicine.

The researchers reviewed data from 141 infants aged 1-14 months with a median age of 9 months and Zika virus infection confirmed by laboratory analysis; 55% were girls.

The prevalence of epilepsy was 67%, with a mean age at onset of 4.9 months. Based on data provided by parents, 74% of the children experienced seizures at 6 months of age or younger.

Overall, 77% of the infants experienced a single type of seizure. Epileptic spasms, the most common type, occurred in 72% of infants, followed by focal motor seizure (21%) and tonic seizures (4%).

All 95 epileptic infants were treated with antiepileptic medications and 62 (65%) achieved remission. Of those in remission, 24 (39%) received monotherapy and 38 (61%) received polytherapy. The drugs most associated with seizure control were vigabatrin, levetiracetam, valproate, and phenobarbital.

The prevalence of epilepsy in this study was higher than that seen in previous studies, and most patients had early-onset, drug-resistant epilepsy, the researchers noted. However, burst-suppression patterns and hypsarrhythmia on EEG predicted more severe disease and suggest that epilepsy might complicate cases of congenital Zika infection, they said.

The researchers had no financial conflicts to disclose.

SOURCE: van der Linden H et al. N Engl J Med. 2018 Aug 30. doi: 10.1056/NEJMc1716070.

Epilepsy occurred in approximately two-thirds of infants with congenital Zika virus infection in a study of 141 children.

copyright Devonyu/Thinkstock

“When ZIKV [Zika virus] infection is acquired in utero, it may be associated with epilepsy, and we characterized aspects of this complication in a study performed at our referral center,” wrote Hélio van der Linden Jr., MD, of Dr. Henrique Santillo Rehabilitation and Readaptation Center in Goiânia, Brazil, and colleagues in a letter to the editor published in the New England Journal of Medicine.

The researchers reviewed data from 141 infants aged 1-14 months with a median age of 9 months and Zika virus infection confirmed by laboratory analysis; 55% were girls.

The prevalence of epilepsy was 67%, with a mean age at onset of 4.9 months. Based on data provided by parents, 74% of the children experienced seizures at 6 months of age or younger.

Overall, 77% of the infants experienced a single type of seizure. Epileptic spasms, the most common type, occurred in 72% of infants, followed by focal motor seizure (21%) and tonic seizures (4%).

All 95 epileptic infants were treated with antiepileptic medications and 62 (65%) achieved remission. Of those in remission, 24 (39%) received monotherapy and 38 (61%) received polytherapy. The drugs most associated with seizure control were vigabatrin, levetiracetam, valproate, and phenobarbital.

The prevalence of epilepsy in this study was higher than that seen in previous studies, and most patients had early-onset, drug-resistant epilepsy, the researchers noted. However, burst-suppression patterns and hypsarrhythmia on EEG predicted more severe disease and suggest that epilepsy might complicate cases of congenital Zika infection, they said.

The researchers had no financial conflicts to disclose.

SOURCE: van der Linden H et al. N Engl J Med. 2018 Aug 30. doi: 10.1056/NEJMc1716070.

Children and adolescents who moved longer distances or more frequently before 16 years of age were significantly more likely to develop psychosis in early adulthood than were those with less residential mobility, according to data from about 1.4 million children and adolescents in Sweden.

Data from previous studies have supported a link between childhood residential mobility and subsequent nonaffective psychoses, but no research has addressed the effects in later adolescence and young adulthood until now, wrote Ceri Price of Cardiff (Wales) University and colleagues.

In a study published in JAMA Psychiatry, the researchers reviewed data from a population-based cohort of individuals who were born in Sweden between Jan. 1, 1982, and Dec. 31, 1995, and lived in Sweden at age 16 years. The participants were followed from their 16th birthdays until a diagnosis of a nonaffective psychotic disorder, death, censorship because of emigration, or Dec. 31, 2011 – whichever came first.

Overall, the most sensitive range for an association between moving and psychosis was ages 16-19 years; the adjusted hazard ratio for a nonaffective psychotic disorder was 1.99 for participants who moved each year between ages 16 and 19 years, compared with those who never moved. In addition, moving greater distances before 16 years of age was independently associated with an increased risk of nonaffective psychosis (HR, 1.11) and the data suggested a nonlinear threshold effect when the distance moved exceeded 30 km.

A total of 4,537 individuals had a nonaffective psychotic disorder at a median 21 years of age, and a dose-response relationship emerged between more frequent moves and increased risk of nonaffective psychosis after controlling for confounding variables.

By contrast, a single move in young adulthood was not associated with increased psychosis risk, but moving at least four times during young adulthood was associated with an increased risk (adjusted HR, 1.82).

The study findings were strengthened by the longitudinal design and large population, but they were limited by several factors, including an absence of data on other adverse childhood experiences, such as family discord; peer relationships, such as friendships and bullying; and information on school changes and the disruption of peer relationships, the researchers wrote.

However, the results support the theory that psychosis risk can be affected by the disruption of social networks, peer support, and identity formation that occurs when children and adolescents move, and these results have potential implications for child health services and social policy, they noted.

“It is important that health, social, and educational practitioners ensure that children and adolescents who are newly resident to their neighborhoods receive adequate support to minimize the risks of adverse outcomes during adulthood, and every effort should be made to ensure the effective transfer of care for highly mobile children who are already in contact with health and social services,” they said.

The researchers had no financial conflicts to disclose. The study was supported in part by the Wellcome Trust and the Royal Society.

SOURCE: Price C et al. JAMA Psychiatry. 2018 Aug 22. doi: 10.1001/jamapsychiatry.2018.2233.

Children and adolescents who moved longer distances or more frequently before 16 years of age were significantly more likely to develop psychosis in early adulthood than were those with less residential mobility, according to data from about 1.4 million children and adolescents in Sweden.

Data from previous studies have supported a link between childhood residential mobility and subsequent nonaffective psychoses, but no research has addressed the effects in later adolescence and young adulthood until now, wrote Ceri Price of Cardiff (Wales) University and colleagues.

In a study published in JAMA Psychiatry, the researchers reviewed data from a population-based cohort of individuals who were born in Sweden between Jan. 1, 1982, and Dec. 31, 1995, and lived in Sweden at age 16 years. The participants were followed from their 16th birthdays until a diagnosis of a nonaffective psychotic disorder, death, censorship because of emigration, or Dec. 31, 2011 – whichever came first.

Overall, the most sensitive range for an association between moving and psychosis was ages 16-19 years; the adjusted hazard ratio for a nonaffective psychotic disorder was 1.99 for participants who moved each year between ages 16 and 19 years, compared with those who never moved. In addition, moving greater distances before 16 years of age was independently associated with an increased risk of nonaffective psychosis (HR, 1.11) and the data suggested a nonlinear threshold effect when the distance moved exceeded 30 km.

A total of 4,537 individuals had a nonaffective psychotic disorder at a median 21 years of age, and a dose-response relationship emerged between more frequent moves and increased risk of nonaffective psychosis after controlling for confounding variables.

By contrast, a single move in young adulthood was not associated with increased psychosis risk, but moving at least four times during young adulthood was associated with an increased risk (adjusted HR, 1.82).

The study findings were strengthened by the longitudinal design and large population, but they were limited by several factors, including an absence of data on other adverse childhood experiences, such as family discord; peer relationships, such as friendships and bullying; and information on school changes and the disruption of peer relationships, the researchers wrote.

However, the results support the theory that psychosis risk can be affected by the disruption of social networks, peer support, and identity formation that occurs when children and adolescents move, and these results have potential implications for child health services and social policy, they noted.

“It is important that health, social, and educational practitioners ensure that children and adolescents who are newly resident to their neighborhoods receive adequate support to minimize the risks of adverse outcomes during adulthood, and every effort should be made to ensure the effective transfer of care for highly mobile children who are already in contact with health and social services,” they said.

The researchers had no financial conflicts to disclose. The study was supported in part by the Wellcome Trust and the Royal Society.

SOURCE: Price C et al. JAMA Psychiatry. 2018 Aug 22. doi: 10.1001/jamapsychiatry.2018.2233.

Children and adolescents who moved longer distances or more frequently before 16 years of age were significantly more likely to develop psychosis in early adulthood than were those with less residential mobility, according to data from about 1.4 million children and adolescents in Sweden.

Data from previous studies have supported a link between childhood residential mobility and subsequent nonaffective psychoses, but no research has addressed the effects in later adolescence and young adulthood until now, wrote Ceri Price of Cardiff (Wales) University and colleagues.

In a study published in JAMA Psychiatry, the researchers reviewed data from a population-based cohort of individuals who were born in Sweden between Jan. 1, 1982, and Dec. 31, 1995, and lived in Sweden at age 16 years. The participants were followed from their 16th birthdays until a diagnosis of a nonaffective psychotic disorder, death, censorship because of emigration, or Dec. 31, 2011 – whichever came first.

Overall, the most sensitive range for an association between moving and psychosis was ages 16-19 years; the adjusted hazard ratio for a nonaffective psychotic disorder was 1.99 for participants who moved each year between ages 16 and 19 years, compared with those who never moved. In addition, moving greater distances before 16 years of age was independently associated with an increased risk of nonaffective psychosis (HR, 1.11) and the data suggested a nonlinear threshold effect when the distance moved exceeded 30 km.

A total of 4,537 individuals had a nonaffective psychotic disorder at a median 21 years of age, and a dose-response relationship emerged between more frequent moves and increased risk of nonaffective psychosis after controlling for confounding variables.

By contrast, a single move in young adulthood was not associated with increased psychosis risk, but moving at least four times during young adulthood was associated with an increased risk (adjusted HR, 1.82).

The study findings were strengthened by the longitudinal design and large population, but they were limited by several factors, including an absence of data on other adverse childhood experiences, such as family discord; peer relationships, such as friendships and bullying; and information on school changes and the disruption of peer relationships, the researchers wrote.

However, the results support the theory that psychosis risk can be affected by the disruption of social networks, peer support, and identity formation that occurs when children and adolescents move, and these results have potential implications for child health services and social policy, they noted.

“It is important that health, social, and educational practitioners ensure that children and adolescents who are newly resident to their neighborhoods receive adequate support to minimize the risks of adverse outcomes during adulthood, and every effort should be made to ensure the effective transfer of care for highly mobile children who are already in contact with health and social services,” they said.

The researchers had no financial conflicts to disclose. The study was supported in part by the Wellcome Trust and the Royal Society.

SOURCE: Price C et al. JAMA Psychiatry. 2018 Aug 22. doi: 10.1001/jamapsychiatry.2018.2233.

Screen women for cervical cancer with basic cytology starting at age 21 years, and consider adding high-risk human papillomavirus (hrHPV) testing alone or with cytology for women aged 30 years and older, the U.S. Preventive Services Task Force recommended in an updated statement on cervical cancer screening .

The statement, accompanying evidence report, and a modeling study were published online in JAMA.

Cervical cancer deaths in the United States have declined from 2.8 deaths per 100,000 women in 2000 to 2.3 deaths per 100,000 women in 2015 because of the adoption of widespread screening, according to Susan J. Curry, PhD., of the University of Iowa, Iowa City, and her colleagues in the USPSTF (JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10897.

Based on the latest evidence and the modeling study, the USPSTF gives an A recommendation to screening women aged 21-29 years for cervical cancer every 3 years with cervical cytology alone. The task force also gives an A to screening women aged 30-65 years every 5 years with either hrHPV testing alone or in combination with cytology.

The task force recommends against screening (D recommendation) for women younger than 21 years, older than 65 years with a history of screening and low cervical cancer risk, and women who have had hysterectomies with removal of the cervix and no history of cervical cancer risk.

To update the previous recommendations issued in 2012, the task force reviewed the latest evidence and commissioned a modeling study to help determine the best screening strategies in terms of age, screening intervals, and risks vs. benefits.

In the model, researchers assessed 19 strategies for cervical cancer screening based on a hypothetical cohort of women who began screening at 21 years of age.

Overall, the different strategies were similar in effectiveness, but primary hrHPV testing and alternative cotesting were slightly more effective: Cervical cancer deaths ranged from 0.23 to 0.29 deaths per 1,000 women in strategies involving hrHPV testing or cotesting, vs. 0.30 to 0.76 deaths per 1,000 women for strategies based on the current guidelines.

In addition, switching the age of hrHPV testing from 25 years to 30 years and using a 5-year screening interval showed the most effectiveness in terms of risks vs. harms, wrote Jane K. Kim, PhD, of Harvard University, Boston, and her colleagues (JAMA. 2018 Aug 21. doi: 10.1001/jama.2017.19872). “Switching from cytology to 5-year primary hrHPV testing at age 30 years (strategy 14) was associated with a ratio of 640 colposcopies per cancer case averted; earlier switch ages required a greater number of colposcopies per cancer case averted.”

The recommendations also were supported by an evidence report including eight randomized, controlled trials of 410,556 women, five cohort studies of 402,615 women, and a meta-analysis of individual participant data including 176,464 women.

The evidence report sought to address the benefits and harms of cervical cancer screening using hrHPV screening alone as the primary screening method or paired with cytology (cotesting), compared with primary screening using cytology alone.

Overall, both hrHPV and hrHPV plus cytology were associated with higher rates of false-positives and colposcopy compared with cytology alone, “which could lead to more treatments with potential harms,” wrote Joy Melnikow, MD, of the University of California, Davis, and her colleagues (JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10400.

In addition, hrHPV testing yielded higher rates of positive cervical intraepithelial neoplasia, compared with cytology alone as initial screening.

However, further research is needed to address the impact of any cervical cancer screening strategies in populations with limited access to health care and screening, the researchers noted.

The updated USPSTF recommendations are largely in line with those issued by leading women’s health organizations including the American College of Obstetricians and Gynecologists, ASCCP, and the Society for Gynecologic Oncology, according to a joint statement.

“With a number of screening options now available, the new guidelines emphasize the importance of the patient-provider shared decision-making process to assist women in making an informed choice about which screening method is most suitable for them,” according to the statement, “However, more importantly, there needs to be a continued effort to ensure all women are adequately screened because a significant number of women in the country are not. It’s also essential for women to have access to all of the tests and that they are appropriately covered by insurance companies.

“We hope the USPSTF recommendations foster more discussions between patients and providers about cervical cancer screening, promote opportunities for patient education on the benefits and safety of HPV vaccination for cervical cancer prevention and encourage providers to offer HPV vaccines in their offices,” the statement noted.

The USPSTF research was funded by the Agency for Healthcare Research and Quality. The researchers for the modeling report were supported in part by a National Cancer Institute grant. The researchers had no relevant financial conflicts to disclose.

SOURCES: Kim J et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2017.19872; Melnikow J et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10400; Curry S et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10897.

Screen women for cervical cancer with basic cytology starting at age 21 years, and consider adding high-risk human papillomavirus (hrHPV) testing alone or with cytology for women aged 30 years and older, the U.S. Preventive Services Task Force recommended in an updated statement on cervical cancer screening .

The statement, accompanying evidence report, and a modeling study were published online in JAMA.

Cervical cancer deaths in the United States have declined from 2.8 deaths per 100,000 women in 2000 to 2.3 deaths per 100,000 women in 2015 because of the adoption of widespread screening, according to Susan J. Curry, PhD., of the University of Iowa, Iowa City, and her colleagues in the USPSTF (JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10897.

Based on the latest evidence and the modeling study, the USPSTF gives an A recommendation to screening women aged 21-29 years for cervical cancer every 3 years with cervical cytology alone. The task force also gives an A to screening women aged 30-65 years every 5 years with either hrHPV testing alone or in combination with cytology.

The task force recommends against screening (D recommendation) for women younger than 21 years, older than 65 years with a history of screening and low cervical cancer risk, and women who have had hysterectomies with removal of the cervix and no history of cervical cancer risk.

To update the previous recommendations issued in 2012, the task force reviewed the latest evidence and commissioned a modeling study to help determine the best screening strategies in terms of age, screening intervals, and risks vs. benefits.

In the model, researchers assessed 19 strategies for cervical cancer screening based on a hypothetical cohort of women who began screening at 21 years of age.

Overall, the different strategies were similar in effectiveness, but primary hrHPV testing and alternative cotesting were slightly more effective: Cervical cancer deaths ranged from 0.23 to 0.29 deaths per 1,000 women in strategies involving hrHPV testing or cotesting, vs. 0.30 to 0.76 deaths per 1,000 women for strategies based on the current guidelines.

In addition, switching the age of hrHPV testing from 25 years to 30 years and using a 5-year screening interval showed the most effectiveness in terms of risks vs. harms, wrote Jane K. Kim, PhD, of Harvard University, Boston, and her colleagues (JAMA. 2018 Aug 21. doi: 10.1001/jama.2017.19872). “Switching from cytology to 5-year primary hrHPV testing at age 30 years (strategy 14) was associated with a ratio of 640 colposcopies per cancer case averted; earlier switch ages required a greater number of colposcopies per cancer case averted.”

The recommendations also were supported by an evidence report including eight randomized, controlled trials of 410,556 women, five cohort studies of 402,615 women, and a meta-analysis of individual participant data including 176,464 women.

The evidence report sought to address the benefits and harms of cervical cancer screening using hrHPV screening alone as the primary screening method or paired with cytology (cotesting), compared with primary screening using cytology alone.

Overall, both hrHPV and hrHPV plus cytology were associated with higher rates of false-positives and colposcopy compared with cytology alone, “which could lead to more treatments with potential harms,” wrote Joy Melnikow, MD, of the University of California, Davis, and her colleagues (JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10400.

In addition, hrHPV testing yielded higher rates of positive cervical intraepithelial neoplasia, compared with cytology alone as initial screening.

However, further research is needed to address the impact of any cervical cancer screening strategies in populations with limited access to health care and screening, the researchers noted.

The updated USPSTF recommendations are largely in line with those issued by leading women’s health organizations including the American College of Obstetricians and Gynecologists, ASCCP, and the Society for Gynecologic Oncology, according to a joint statement.

“With a number of screening options now available, the new guidelines emphasize the importance of the patient-provider shared decision-making process to assist women in making an informed choice about which screening method is most suitable for them,” according to the statement, “However, more importantly, there needs to be a continued effort to ensure all women are adequately screened because a significant number of women in the country are not. It’s also essential for women to have access to all of the tests and that they are appropriately covered by insurance companies.

“We hope the USPSTF recommendations foster more discussions between patients and providers about cervical cancer screening, promote opportunities for patient education on the benefits and safety of HPV vaccination for cervical cancer prevention and encourage providers to offer HPV vaccines in their offices,” the statement noted.

The USPSTF research was funded by the Agency for Healthcare Research and Quality. The researchers for the modeling report were supported in part by a National Cancer Institute grant. The researchers had no relevant financial conflicts to disclose.

SOURCES: Kim J et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2017.19872; Melnikow J et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10400; Curry S et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10897.

Screen women for cervical cancer with basic cytology starting at age 21 years, and consider adding high-risk human papillomavirus (hrHPV) testing alone or with cytology for women aged 30 years and older, the U.S. Preventive Services Task Force recommended in an updated statement on cervical cancer screening .

The statement, accompanying evidence report, and a modeling study were published online in JAMA.

Cervical cancer deaths in the United States have declined from 2.8 deaths per 100,000 women in 2000 to 2.3 deaths per 100,000 women in 2015 because of the adoption of widespread screening, according to Susan J. Curry, PhD., of the University of Iowa, Iowa City, and her colleagues in the USPSTF (JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10897.

Based on the latest evidence and the modeling study, the USPSTF gives an A recommendation to screening women aged 21-29 years for cervical cancer every 3 years with cervical cytology alone. The task force also gives an A to screening women aged 30-65 years every 5 years with either hrHPV testing alone or in combination with cytology.

The task force recommends against screening (D recommendation) for women younger than 21 years, older than 65 years with a history of screening and low cervical cancer risk, and women who have had hysterectomies with removal of the cervix and no history of cervical cancer risk.

To update the previous recommendations issued in 2012, the task force reviewed the latest evidence and commissioned a modeling study to help determine the best screening strategies in terms of age, screening intervals, and risks vs. benefits.

In the model, researchers assessed 19 strategies for cervical cancer screening based on a hypothetical cohort of women who began screening at 21 years of age.

Overall, the different strategies were similar in effectiveness, but primary hrHPV testing and alternative cotesting were slightly more effective: Cervical cancer deaths ranged from 0.23 to 0.29 deaths per 1,000 women in strategies involving hrHPV testing or cotesting, vs. 0.30 to 0.76 deaths per 1,000 women for strategies based on the current guidelines.

In addition, switching the age of hrHPV testing from 25 years to 30 years and using a 5-year screening interval showed the most effectiveness in terms of risks vs. harms, wrote Jane K. Kim, PhD, of Harvard University, Boston, and her colleagues (JAMA. 2018 Aug 21. doi: 10.1001/jama.2017.19872). “Switching from cytology to 5-year primary hrHPV testing at age 30 years (strategy 14) was associated with a ratio of 640 colposcopies per cancer case averted; earlier switch ages required a greater number of colposcopies per cancer case averted.”

The recommendations also were supported by an evidence report including eight randomized, controlled trials of 410,556 women, five cohort studies of 402,615 women, and a meta-analysis of individual participant data including 176,464 women.

The evidence report sought to address the benefits and harms of cervical cancer screening using hrHPV screening alone as the primary screening method or paired with cytology (cotesting), compared with primary screening using cytology alone.

Overall, both hrHPV and hrHPV plus cytology were associated with higher rates of false-positives and colposcopy compared with cytology alone, “which could lead to more treatments with potential harms,” wrote Joy Melnikow, MD, of the University of California, Davis, and her colleagues (JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10400.

In addition, hrHPV testing yielded higher rates of positive cervical intraepithelial neoplasia, compared with cytology alone as initial screening.

However, further research is needed to address the impact of any cervical cancer screening strategies in populations with limited access to health care and screening, the researchers noted.

The updated USPSTF recommendations are largely in line with those issued by leading women’s health organizations including the American College of Obstetricians and Gynecologists, ASCCP, and the Society for Gynecologic Oncology, according to a joint statement.

“With a number of screening options now available, the new guidelines emphasize the importance of the patient-provider shared decision-making process to assist women in making an informed choice about which screening method is most suitable for them,” according to the statement, “However, more importantly, there needs to be a continued effort to ensure all women are adequately screened because a significant number of women in the country are not. It’s also essential for women to have access to all of the tests and that they are appropriately covered by insurance companies.

“We hope the USPSTF recommendations foster more discussions between patients and providers about cervical cancer screening, promote opportunities for patient education on the benefits and safety of HPV vaccination for cervical cancer prevention and encourage providers to offer HPV vaccines in their offices,” the statement noted.

The USPSTF research was funded by the Agency for Healthcare Research and Quality. The researchers for the modeling report were supported in part by a National Cancer Institute grant. The researchers had no relevant financial conflicts to disclose.

SOURCES: Kim J et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2017.19872; Melnikow J et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10400; Curry S et al. JAMA. 2018 Aug 21. doi: 10.1001/jama.2018.10897.

Nighttime media use was associated with less sleep, as well as self-reported anxiety and depression, in teens with attention-deficit/hyperactivity disorder, based on data from 81 adolescents.

junpinzon/Thinkstock

“This is the first study to document an association between nighttime media use and more sleep problems and internalizing symptoms in adolescents diagnosed with ADHD,” wrote Stephen P. Becker, PhD, of the University of Cincinnati and colleagues.

Although previous research has addressed the impact of screen time on sleep, anxiety, and depression in children and teens, the impact on adolescents with conditions such as ADHD has not been well studied, the researchers noted.

In a study published in Sleep Medicine, the researchers conducted a study of 81 adolescents aged 13-17 years who met diagnostic criteria for ADHD. The School Sleep Habits Survey (SSHS) was used to measure sleep patterns based on self-reports, and parents reported on teens’ sleep using the Sleep Disturbance Scale for Children. In addition, several other tools that measured ADHD symptoms, daytime sleepiness, anxiety, and depression were administered to both the teens and their parents.

The researchers assessed the number of technologies in each participant’s bedroom and the total hours of electronic media use at night, defined as after 9:00 p.m.

Overall, approximately 60% of the teens in the sample reported more than 4 hours of nighttime media use; 63% reported less than 8 hours of sleep on school nights, but this figure reached 76% when parent reports of teens’ sleep was used. When the teens’ self-reports were used, media use was not significantly different between those who had less than 8 hours of sleep vs. those who had 8 hours or more (5.85 vs. 4.39 hours of nighttime media use). But their parents’ reports told another story. In the parent reports, media use was significantly higher in the short sleepers vs. long sleepers (6.12 vs. 2.65 hours of nighttime media use).

After controlling for factors including age, sex, pubertal stage, use of stimulant medication, and severity of ADHD symptoms, nighttime media use was significantly associated with shorter sleep duration, the researchers said.

Nighttime media use also was significantly associated with greater adolescent-reported depressive symptoms, total anxiety symptoms overall, and panic symptoms in particular, as well as with parent-reported generalized anxiety symptoms.

The study findings were limited by several factors including the cross-sectional design, the lack of an objective sleep measure, and the lack of non-ADHD controls, the researchers noted. Also, the researchers were unable to measure parental control over teen media use or to examine different types of media use, including media multitasking (such as texting while video gaming).

However, the findings “suggest that it is important for clinicians to consider nighttime media use when assessing and treating adolescent ADHD, specifically regarding sleep issues and co-occurring depression and anxiety,” they said.

The researchers had no financial conflicts to disclose. The study was funded by grants from the National Institutes of Mental Health.

SOURCE: Becker S et al. Sleep Med. 2018. doi: 10.1016/ j.sleep.2018.06.021.

Nighttime media use was associated with less sleep, as well as self-reported anxiety and depression, in teens with attention-deficit/hyperactivity disorder, based on data from 81 adolescents.

junpinzon/Thinkstock

“This is the first study to document an association between nighttime media use and more sleep problems and internalizing symptoms in adolescents diagnosed with ADHD,” wrote Stephen P. Becker, PhD, of the University of Cincinnati and colleagues.

Although previous research has addressed the impact of screen time on sleep, anxiety, and depression in children and teens, the impact on adolescents with conditions such as ADHD has not been well studied, the researchers noted.

In a study published in Sleep Medicine, the researchers conducted a study of 81 adolescents aged 13-17 years who met diagnostic criteria for ADHD. The School Sleep Habits Survey (SSHS) was used to measure sleep patterns based on self-reports, and parents reported on teens’ sleep using the Sleep Disturbance Scale for Children. In addition, several other tools that measured ADHD symptoms, daytime sleepiness, anxiety, and depression were administered to both the teens and their parents.

The researchers assessed the number of technologies in each participant’s bedroom and the total hours of electronic media use at night, defined as after 9:00 p.m.

Overall, approximately 60% of the teens in the sample reported more than 4 hours of nighttime media use; 63% reported less than 8 hours of sleep on school nights, but this figure reached 76% when parent reports of teens’ sleep was used. When the teens’ self-reports were used, media use was not significantly different between those who had less than 8 hours of sleep vs. those who had 8 hours or more (5.85 vs. 4.39 hours of nighttime media use). But their parents’ reports told another story. In the parent reports, media use was significantly higher in the short sleepers vs. long sleepers (6.12 vs. 2.65 hours of nighttime media use).

After controlling for factors including age, sex, pubertal stage, use of stimulant medication, and severity of ADHD symptoms, nighttime media use was significantly associated with shorter sleep duration, the researchers said.

Nighttime media use also was significantly associated with greater adolescent-reported depressive symptoms, total anxiety symptoms overall, and panic symptoms in particular, as well as with parent-reported generalized anxiety symptoms.

The study findings were limited by several factors including the cross-sectional design, the lack of an objective sleep measure, and the lack of non-ADHD controls, the researchers noted. Also, the researchers were unable to measure parental control over teen media use or to examine different types of media use, including media multitasking (such as texting while video gaming).

However, the findings “suggest that it is important for clinicians to consider nighttime media use when assessing and treating adolescent ADHD, specifically regarding sleep issues and co-occurring depression and anxiety,” they said.

The researchers had no financial conflicts to disclose. The study was funded by grants from the National Institutes of Mental Health.

SOURCE: Becker S et al. Sleep Med. 2018. doi: 10.1016/ j.sleep.2018.06.021.

Nighttime media use was associated with less sleep, as well as self-reported anxiety and depression, in teens with attention-deficit/hyperactivity disorder, based on data from 81 adolescents.

junpinzon/Thinkstock

“This is the first study to document an association between nighttime media use and more sleep problems and internalizing symptoms in adolescents diagnosed with ADHD,” wrote Stephen P. Becker, PhD, of the University of Cincinnati and colleagues.

Although previous research has addressed the impact of screen time on sleep, anxiety, and depression in children and teens, the impact on adolescents with conditions such as ADHD has not been well studied, the researchers noted.

In a study published in Sleep Medicine, the researchers conducted a study of 81 adolescents aged 13-17 years who met diagnostic criteria for ADHD. The School Sleep Habits Survey (SSHS) was used to measure sleep patterns based on self-reports, and parents reported on teens’ sleep using the Sleep Disturbance Scale for Children. In addition, several other tools that measured ADHD symptoms, daytime sleepiness, anxiety, and depression were administered to both the teens and their parents.

The researchers assessed the number of technologies in each participant’s bedroom and the total hours of electronic media use at night, defined as after 9:00 p.m.

Overall, approximately 60% of the teens in the sample reported more than 4 hours of nighttime media use; 63% reported less than 8 hours of sleep on school nights, but this figure reached 76% when parent reports of teens’ sleep was used. When the teens’ self-reports were used, media use was not significantly different between those who had less than 8 hours of sleep vs. those who had 8 hours or more (5.85 vs. 4.39 hours of nighttime media use). But their parents’ reports told another story. In the parent reports, media use was significantly higher in the short sleepers vs. long sleepers (6.12 vs. 2.65 hours of nighttime media use).

After controlling for factors including age, sex, pubertal stage, use of stimulant medication, and severity of ADHD symptoms, nighttime media use was significantly associated with shorter sleep duration, the researchers said.

Nighttime media use also was significantly associated with greater adolescent-reported depressive symptoms, total anxiety symptoms overall, and panic symptoms in particular, as well as with parent-reported generalized anxiety symptoms.

The study findings were limited by several factors including the cross-sectional design, the lack of an objective sleep measure, and the lack of non-ADHD controls, the researchers noted. Also, the researchers were unable to measure parental control over teen media use or to examine different types of media use, including media multitasking (such as texting while video gaming).

However, the findings “suggest that it is important for clinicians to consider nighttime media use when assessing and treating adolescent ADHD, specifically regarding sleep issues and co-occurring depression and anxiety,” they said.

The researchers had no financial conflicts to disclose. The study was funded by grants from the National Institutes of Mental Health.

SOURCE: Becker S et al. Sleep Med. 2018. doi: 10.1016/ j.sleep.2018.06.021.