Heidi Splete

Nearly half of Americans’ sodium consumption can be traced to 10 types of foods, according to data from the Centers for Disease Control and Prevention published Feb. 7 in the CDC’s Morbidity and Mortality Weekly Report.

The top 10 sources, which account for 44% of sodium consumption in Americans over age 2 years, are white bread and rolls; lunch meats, including deli turkey and ham; pizza (frozen or restaurant); poultry; soups; sandwiches; cheese; meat dishes; pasta dishes: and salty snack foods such as potato chips, pretzels, and popcorn.

Photo David Sone/National Cancer Institute

Some 90% of Americans eat too much sodium, which increases their risk for developing high blood pressure, which in turn can increase the risk for heart disease and stroke, CDC Director Dr. Thomas R. Frieden said in a media telebriefing.

"One of the things that is driving our blood pressure up is that most of the adults in this country eat or drink twice the amount of sodium that is recommended," Dr. Frieden said. Most of that comes from sodium already present in food, not what is added at the table, he noted.

According to the CDC report, the average American older than 2 years consumes 3,300 mg of sodium daily from food alone, not including any salt added at the table. The U.S. Dietary Guidelines recommendation is less than 2,300 mg/day, and only 1,500 mg/day for individuals at increased risk for heart disease and stroke: adults aged 51 years and older; individuals with high blood pressure, diabetes, or chronic kidney disease; and African Americans.

Foods that seem nutritious may have high levels of sodium, such as cottage cheese or turkey breast from a deli.

"Potato chips, pretzels, and popcorn only account for about 3% of sodium consumption," Dr. Frieden said.

Overall, 65% of Americans’ sodium intake comes from food sold in grocery stores and 25% comes from restaurant foods, he said.

Cutting back on sodium is a challenge because it is present in so many processed foods and restaurant foods, said Dr. Frieden. However, the sodium content of processed foods can vary widely by brand, so simply reading the labels and comparing products is an easy way to cut down on sodium. The sodium in a single piece of pizza can vary as much as two or three times, depending on the brand, he said. Eating more fresh or frozen fruits and vegetables (without sauces) can curb sodium consumption, as can preparing more food at home instead of eating out or eating processed foods, he said.

Physicians can play an important role in helping everyone reduce their sodium intake, especially those at increased risk for heart disease and stroke.

"Physicians can work with nutritionists and other health professionals to help patients understand what the sources of sodium are in their own diets," Dr. Frieden explained. "They may be surprised to find that their breakfast cereal contains the equivalent of 8-10 shakes of salt," he said.

Individuals may find options for cereals, meals, and snacks that contain much less sodium and taste just as good, said Dr. Frieden. "We encourage salting to taste," by adding minimal salt at the table rather than consuming products that are already high in salt, and by using alternatives to salt to flavor food, he said. "There are plenty of spices other than sodium that can make food taste great," he added.

Some companies are already working to gradually reduce the salt in processed foods. A report issued last year by the Institute of Medicine recommended that food manufacturers gradually reduce the amount of sodium in their products.

This process will take time, but the goal is to improve consumer choices, said Dr. Frieden.

"The bottom line is that heart disease and stroke are leading causes of health care spending in this country, and it is possible to reduce that by reducing the sodium in our diets," Dr. Frieden emphasized.

"We can substantially reduce sodium intake, save lives, and save money," he said.

The data were taken from "What We Eat in America," part of the national Health and Nutrition Examination Survey, 2007-2008.

For guidance on a low-sodium eating plan, visit the National Institutes of Health’s website for the DASH diet.

Nearly half of Americans’ sodium consumption can be traced to 10 types of foods, according to data from the Centers for Disease Control and Prevention published Feb. 7 in the CDC’s Morbidity and Mortality Weekly Report.

The top 10 sources, which account for 44% of sodium consumption in Americans over age 2 years, are white bread and rolls; lunch meats, including deli turkey and ham; pizza (frozen or restaurant); poultry; soups; sandwiches; cheese; meat dishes; pasta dishes: and salty snack foods such as potato chips, pretzels, and popcorn.

Photo David Sone/National Cancer Institute

Some 90% of Americans eat too much sodium, which increases their risk for developing high blood pressure, which in turn can increase the risk for heart disease and stroke, CDC Director Dr. Thomas R. Frieden said in a media telebriefing.

"One of the things that is driving our blood pressure up is that most of the adults in this country eat or drink twice the amount of sodium that is recommended," Dr. Frieden said. Most of that comes from sodium already present in food, not what is added at the table, he noted.

According to the CDC report, the average American older than 2 years consumes 3,300 mg of sodium daily from food alone, not including any salt added at the table. The U.S. Dietary Guidelines recommendation is less than 2,300 mg/day, and only 1,500 mg/day for individuals at increased risk for heart disease and stroke: adults aged 51 years and older; individuals with high blood pressure, diabetes, or chronic kidney disease; and African Americans.

Foods that seem nutritious may have high levels of sodium, such as cottage cheese or turkey breast from a deli.

"Potato chips, pretzels, and popcorn only account for about 3% of sodium consumption," Dr. Frieden said.

Overall, 65% of Americans’ sodium intake comes from food sold in grocery stores and 25% comes from restaurant foods, he said.

Cutting back on sodium is a challenge because it is present in so many processed foods and restaurant foods, said Dr. Frieden. However, the sodium content of processed foods can vary widely by brand, so simply reading the labels and comparing products is an easy way to cut down on sodium. The sodium in a single piece of pizza can vary as much as two or three times, depending on the brand, he said. Eating more fresh or frozen fruits and vegetables (without sauces) can curb sodium consumption, as can preparing more food at home instead of eating out or eating processed foods, he said.

Physicians can play an important role in helping everyone reduce their sodium intake, especially those at increased risk for heart disease and stroke.

"Physicians can work with nutritionists and other health professionals to help patients understand what the sources of sodium are in their own diets," Dr. Frieden explained. "They may be surprised to find that their breakfast cereal contains the equivalent of 8-10 shakes of salt," he said.

Individuals may find options for cereals, meals, and snacks that contain much less sodium and taste just as good, said Dr. Frieden. "We encourage salting to taste," by adding minimal salt at the table rather than consuming products that are already high in salt, and by using alternatives to salt to flavor food, he said. "There are plenty of spices other than sodium that can make food taste great," he added.

Some companies are already working to gradually reduce the salt in processed foods. A report issued last year by the Institute of Medicine recommended that food manufacturers gradually reduce the amount of sodium in their products.

This process will take time, but the goal is to improve consumer choices, said Dr. Frieden.

"The bottom line is that heart disease and stroke are leading causes of health care spending in this country, and it is possible to reduce that by reducing the sodium in our diets," Dr. Frieden emphasized.

"We can substantially reduce sodium intake, save lives, and save money," he said.

The data were taken from "What We Eat in America," part of the national Health and Nutrition Examination Survey, 2007-2008.

For guidance on a low-sodium eating plan, visit the National Institutes of Health’s website for the DASH diet.

Nearly half of Americans’ sodium consumption can be traced to 10 types of foods, according to data from the Centers for Disease Control and Prevention published Feb. 7 in the CDC’s Morbidity and Mortality Weekly Report.

The top 10 sources, which account for 44% of sodium consumption in Americans over age 2 years, are white bread and rolls; lunch meats, including deli turkey and ham; pizza (frozen or restaurant); poultry; soups; sandwiches; cheese; meat dishes; pasta dishes: and salty snack foods such as potato chips, pretzels, and popcorn.

Photo David Sone/National Cancer Institute

Some 90% of Americans eat too much sodium, which increases their risk for developing high blood pressure, which in turn can increase the risk for heart disease and stroke, CDC Director Dr. Thomas R. Frieden said in a media telebriefing.

"One of the things that is driving our blood pressure up is that most of the adults in this country eat or drink twice the amount of sodium that is recommended," Dr. Frieden said. Most of that comes from sodium already present in food, not what is added at the table, he noted.

According to the CDC report, the average American older than 2 years consumes 3,300 mg of sodium daily from food alone, not including any salt added at the table. The U.S. Dietary Guidelines recommendation is less than 2,300 mg/day, and only 1,500 mg/day for individuals at increased risk for heart disease and stroke: adults aged 51 years and older; individuals with high blood pressure, diabetes, or chronic kidney disease; and African Americans.

Foods that seem nutritious may have high levels of sodium, such as cottage cheese or turkey breast from a deli.

"Potato chips, pretzels, and popcorn only account for about 3% of sodium consumption," Dr. Frieden said.

Overall, 65% of Americans’ sodium intake comes from food sold in grocery stores and 25% comes from restaurant foods, he said.

Cutting back on sodium is a challenge because it is present in so many processed foods and restaurant foods, said Dr. Frieden. However, the sodium content of processed foods can vary widely by brand, so simply reading the labels and comparing products is an easy way to cut down on sodium. The sodium in a single piece of pizza can vary as much as two or three times, depending on the brand, he said. Eating more fresh or frozen fruits and vegetables (without sauces) can curb sodium consumption, as can preparing more food at home instead of eating out or eating processed foods, he said.

Physicians can play an important role in helping everyone reduce their sodium intake, especially those at increased risk for heart disease and stroke.

"Physicians can work with nutritionists and other health professionals to help patients understand what the sources of sodium are in their own diets," Dr. Frieden explained. "They may be surprised to find that their breakfast cereal contains the equivalent of 8-10 shakes of salt," he said.

Individuals may find options for cereals, meals, and snacks that contain much less sodium and taste just as good, said Dr. Frieden. "We encourage salting to taste," by adding minimal salt at the table rather than consuming products that are already high in salt, and by using alternatives to salt to flavor food, he said. "There are plenty of spices other than sodium that can make food taste great," he added.

Some companies are already working to gradually reduce the salt in processed foods. A report issued last year by the Institute of Medicine recommended that food manufacturers gradually reduce the amount of sodium in their products.

This process will take time, but the goal is to improve consumer choices, said Dr. Frieden.

"The bottom line is that heart disease and stroke are leading causes of health care spending in this country, and it is possible to reduce that by reducing the sodium in our diets," Dr. Frieden emphasized.

"We can substantially reduce sodium intake, save lives, and save money," he said.

The data were taken from "What We Eat in America," part of the national Health and Nutrition Examination Survey, 2007-2008.

For guidance on a low-sodium eating plan, visit the National Institutes of Health’s website for the DASH diet.

RIO GRANDE, P.R. – When it comes to treating psoriasis patients with topical products, the location of the psoriasis helps determine the best vehicle for delivery, according to Dr. Eric W. Baum.

Some topical therapies work well when used alone, while others are more effective in combination with other products, Dr. Baum said at the annual Caribbean Dermatology Symposium. But the success of any topical psoriasis therapy depends on the vehicle, and the right vehicle varies for each patient.

"The vehicle can greatly influence percutaneous absorption and therefore increase therapeutic efficacy," said Dr. Baum of the University of Alabama at Birmingham.

"Topical psoriasis treatment is quite interesting, because there are so many different choices," said Dr. Baum. "I might use a foam on the hands because it is less sticky; I’ll use sprays with different types of nozzles to penetrate areas that are hard to reach."

Vehicle options for topical psoriasis therapy include cream, ointment, tape, gel, lotion, aerosol spray, foam, solution, shampoo, powder, and oil.

There is no silver bullet when it comes to psoriasis, but topical therapy remains many dermatologists’ first choice for initial treatment, noted Dr. Baum, who shared recent data on three products.

Foam

In a phase III study, clobetasol propionate 0.05% foam (Olux-E, Stiefel) significantly improved erythema, scaling, and plaque thickness in patients with mild to moderate plaque psoriasis after 2 weeks of use, compared with control foam. Based on these findings, the foam is considered to be safe for use in mild to moderate psoriasis patients aged 12 years and older, said Dr. Baum.

In a previous unpublished, company-funded study of Olux-E for moderate to severe atopic dermatitis, patients rated several cosmetic qualities of the foam higher than for other vehicles, including the ability to be easily spread, ease of application, quick absorption, lack of fragrance, and lack of residue, he noted.

Spray

Sprays can be an excellent choice for the scalp or other hairy areas, said Dr. Baum.

In an open-label noncomparator study of triamcinolone acetonide 0.2% spray (Kenalog, Bristol-Myers Squibb) for steroid-responsive dermatoses, 85% of 39 patients reported improvement after 7 days of use. In addition, 95% of patients said they preferred the spray over creams and ointments, 92% said they would request the spray for future use, and more than half reported satisfaction with the cooling effects of the spray (J. Clin. Aesthet. Dermatol. 2010;3:27-31).

The study also found that patients who applied the spray twice daily for scalp or leg psoriasis showed visible improvements after 1 week, suggesting that the long nozzle associated with the spray vehicle allowed for better penetration, said Dr. Baum.

Cream

For large areas of dermatoses, a biphasic cream may be particularly effective, according to Dr. Baum. He and his colleagues studied the effectiveness and patient acceptance of halcinonide 0.1% (Halog, Ranbaxy) for treating large, steroid-responsive dermatoses (J. Clin. Aesthet. Dermatol. 2011;4:29-33).

At baseline, 40 patients aged 23-85 years were diagnosed with moderate to severe dermatoses, and 83% had psoriasis (2 patients were lost to follow-up). After 28 days of treatment with halcinonide cream, 47% of patients were clear or almost clear, said Dr. Baum. And of equal importance, the vehicle was popular with patients; 95% said they "liked the way the product spread on the skin," Dr. Baum said. In addition, 87% said they would ask for the same cream again for another skin problem.

"Halog cream has been around for many years" but physicians may not realize that it is a biphasic cream, said Dr. Baum. "The biphasic cream allows penetration of the medication immediately, and then a delayed response."

When treating psoriasis topically, don’t forget to consider the potency of the product. "If you use a high-potency product in certain areas, you will have a greater risk of some of the adverse side effects of topical corticosteroids that none of us want," said Dr. Baum. It is important to consider these different factors when choosing a topical psoriasis product for a particular location.

Dr. Baum has served as an advisory board member, speaker, investigator, or consultant for Amgen, DUSA, Galderma, GlaxoSmithKline (Stiefel), Intendis (Bayer), Merz, and Ranbaxy.

RIO GRANDE, P.R. – When it comes to treating psoriasis patients with topical products, the location of the psoriasis helps determine the best vehicle for delivery, according to Dr. Eric W. Baum.

Some topical therapies work well when used alone, while others are more effective in combination with other products, Dr. Baum said at the annual Caribbean Dermatology Symposium. But the success of any topical psoriasis therapy depends on the vehicle, and the right vehicle varies for each patient.

"The vehicle can greatly influence percutaneous absorption and therefore increase therapeutic efficacy," said Dr. Baum of the University of Alabama at Birmingham.

"Topical psoriasis treatment is quite interesting, because there are so many different choices," said Dr. Baum. "I might use a foam on the hands because it is less sticky; I’ll use sprays with different types of nozzles to penetrate areas that are hard to reach."

Vehicle options for topical psoriasis therapy include cream, ointment, tape, gel, lotion, aerosol spray, foam, solution, shampoo, powder, and oil.

There is no silver bullet when it comes to psoriasis, but topical therapy remains many dermatologists’ first choice for initial treatment, noted Dr. Baum, who shared recent data on three products.

Foam

In a phase III study, clobetasol propionate 0.05% foam (Olux-E, Stiefel) significantly improved erythema, scaling, and plaque thickness in patients with mild to moderate plaque psoriasis after 2 weeks of use, compared with control foam. Based on these findings, the foam is considered to be safe for use in mild to moderate psoriasis patients aged 12 years and older, said Dr. Baum.

In a previous unpublished, company-funded study of Olux-E for moderate to severe atopic dermatitis, patients rated several cosmetic qualities of the foam higher than for other vehicles, including the ability to be easily spread, ease of application, quick absorption, lack of fragrance, and lack of residue, he noted.

Spray

Sprays can be an excellent choice for the scalp or other hairy areas, said Dr. Baum.

In an open-label noncomparator study of triamcinolone acetonide 0.2% spray (Kenalog, Bristol-Myers Squibb) for steroid-responsive dermatoses, 85% of 39 patients reported improvement after 7 days of use. In addition, 95% of patients said they preferred the spray over creams and ointments, 92% said they would request the spray for future use, and more than half reported satisfaction with the cooling effects of the spray (J. Clin. Aesthet. Dermatol. 2010;3:27-31).

The study also found that patients who applied the spray twice daily for scalp or leg psoriasis showed visible improvements after 1 week, suggesting that the long nozzle associated with the spray vehicle allowed for better penetration, said Dr. Baum.

Cream

For large areas of dermatoses, a biphasic cream may be particularly effective, according to Dr. Baum. He and his colleagues studied the effectiveness and patient acceptance of halcinonide 0.1% (Halog, Ranbaxy) for treating large, steroid-responsive dermatoses (J. Clin. Aesthet. Dermatol. 2011;4:29-33).

At baseline, 40 patients aged 23-85 years were diagnosed with moderate to severe dermatoses, and 83% had psoriasis (2 patients were lost to follow-up). After 28 days of treatment with halcinonide cream, 47% of patients were clear or almost clear, said Dr. Baum. And of equal importance, the vehicle was popular with patients; 95% said they "liked the way the product spread on the skin," Dr. Baum said. In addition, 87% said they would ask for the same cream again for another skin problem.

"Halog cream has been around for many years" but physicians may not realize that it is a biphasic cream, said Dr. Baum. "The biphasic cream allows penetration of the medication immediately, and then a delayed response."

When treating psoriasis topically, don’t forget to consider the potency of the product. "If you use a high-potency product in certain areas, you will have a greater risk of some of the adverse side effects of topical corticosteroids that none of us want," said Dr. Baum. It is important to consider these different factors when choosing a topical psoriasis product for a particular location.

Dr. Baum has served as an advisory board member, speaker, investigator, or consultant for Amgen, DUSA, Galderma, GlaxoSmithKline (Stiefel), Intendis (Bayer), Merz, and Ranbaxy.

RIO GRANDE, P.R. – When it comes to treating psoriasis patients with topical products, the location of the psoriasis helps determine the best vehicle for delivery, according to Dr. Eric W. Baum.

Some topical therapies work well when used alone, while others are more effective in combination with other products, Dr. Baum said at the annual Caribbean Dermatology Symposium. But the success of any topical psoriasis therapy depends on the vehicle, and the right vehicle varies for each patient.

"The vehicle can greatly influence percutaneous absorption and therefore increase therapeutic efficacy," said Dr. Baum of the University of Alabama at Birmingham.

"Topical psoriasis treatment is quite interesting, because there are so many different choices," said Dr. Baum. "I might use a foam on the hands because it is less sticky; I’ll use sprays with different types of nozzles to penetrate areas that are hard to reach."

Vehicle options for topical psoriasis therapy include cream, ointment, tape, gel, lotion, aerosol spray, foam, solution, shampoo, powder, and oil.

There is no silver bullet when it comes to psoriasis, but topical therapy remains many dermatologists’ first choice for initial treatment, noted Dr. Baum, who shared recent data on three products.

Foam

In a phase III study, clobetasol propionate 0.05% foam (Olux-E, Stiefel) significantly improved erythema, scaling, and plaque thickness in patients with mild to moderate plaque psoriasis after 2 weeks of use, compared with control foam. Based on these findings, the foam is considered to be safe for use in mild to moderate psoriasis patients aged 12 years and older, said Dr. Baum.

In a previous unpublished, company-funded study of Olux-E for moderate to severe atopic dermatitis, patients rated several cosmetic qualities of the foam higher than for other vehicles, including the ability to be easily spread, ease of application, quick absorption, lack of fragrance, and lack of residue, he noted.

Spray

Sprays can be an excellent choice for the scalp or other hairy areas, said Dr. Baum.

In an open-label noncomparator study of triamcinolone acetonide 0.2% spray (Kenalog, Bristol-Myers Squibb) for steroid-responsive dermatoses, 85% of 39 patients reported improvement after 7 days of use. In addition, 95% of patients said they preferred the spray over creams and ointments, 92% said they would request the spray for future use, and more than half reported satisfaction with the cooling effects of the spray (J. Clin. Aesthet. Dermatol. 2010;3:27-31).

The study also found that patients who applied the spray twice daily for scalp or leg psoriasis showed visible improvements after 1 week, suggesting that the long nozzle associated with the spray vehicle allowed for better penetration, said Dr. Baum.

Cream

For large areas of dermatoses, a biphasic cream may be particularly effective, according to Dr. Baum. He and his colleagues studied the effectiveness and patient acceptance of halcinonide 0.1% (Halog, Ranbaxy) for treating large, steroid-responsive dermatoses (J. Clin. Aesthet. Dermatol. 2011;4:29-33).

At baseline, 40 patients aged 23-85 years were diagnosed with moderate to severe dermatoses, and 83% had psoriasis (2 patients were lost to follow-up). After 28 days of treatment with halcinonide cream, 47% of patients were clear or almost clear, said Dr. Baum. And of equal importance, the vehicle was popular with patients; 95% said they "liked the way the product spread on the skin," Dr. Baum said. In addition, 87% said they would ask for the same cream again for another skin problem.

"Halog cream has been around for many years" but physicians may not realize that it is a biphasic cream, said Dr. Baum. "The biphasic cream allows penetration of the medication immediately, and then a delayed response."

When treating psoriasis topically, don’t forget to consider the potency of the product. "If you use a high-potency product in certain areas, you will have a greater risk of some of the adverse side effects of topical corticosteroids that none of us want," said Dr. Baum. It is important to consider these different factors when choosing a topical psoriasis product for a particular location.

Dr. Baum has served as an advisory board member, speaker, investigator, or consultant for Amgen, DUSA, Galderma, GlaxoSmithKline (Stiefel), Intendis (Bayer), Merz, and Ranbaxy.

RIO GRANDE, P.R. – Treating psoriasis patients earlier in life could help prevent later physical and psychological problems, according to Dr. Alexa B. Kimball.

"We used to think that we should save our therapies until our patients really needed them, because we were afraid that toxicity might accumulate," Dr. Kimball said at the annual Caribbean Dermatology Symposium. However, that thinking has changed, thanks in part to the availability of safer treatment options.

But of equal importance, "treating patients early in their disease may have an impact that affects the rest of their lives," including jobs, education, socioeconomic status, and curbing the development of health problems like obesity, cardiovascular disease, and psychiatric disorders, she said.

The quality of life issues associated with psoriasis are well known, but recent data confirm that physical and mental comorbidities start in childhood.

According to recent data from the National Psoriasis Foundation, 38% of children with psoriasis reported being bullied because of their condition, noted Dr. Kimball of Massachusetts General Hospital and Harvard Medical School, both in Boston.

Another study found that approximately one-third of children aged 4-17 years with psoriasis had a body mass index greater than the 95th percentile (N. Engl. J. Med. 2008;358:241-51). Conditions such as childhood obesity are not easily managed, and have significant implications for future health, she said.

In a retrospective study of 7,404 psoriasis patients younger than 18 years and 37,020 healthy controls, children with psoriasis were significantly more likely than controls to develop any psychiatric disorder (5% vs. 4%), depression (3% vs. 2%), and anxiety (2% vs. 1%), Dr. Kimball and her colleagues found (J. Am. Acad. Dermatol. 2012 Jan. 16 [doi:10.1016/j.jaad.2011.11.948]).

And the likelihood of comorbidities in psoriasis patients continues as they grow up, she said. "Chronic disease interacts with psychosocial and health events in a complex and ongoing manner throughout a person’s life."

Comorbidities in psoriasis patients appear to accumulate over time. Dr. Kimball cited data from the Nurses’ Health Study II, a cohort including more than 100,000 women who were aged 27-44 years in 1991. In a subset of 1,813 women with psoriasis, the risk of diabetes was approximately 60% higher, and the risk of hypertension was almost 20% higher, compared with women without psoriasis (Arch. Dermatol. 2009;145:379-82).

In a case-control study conducted by Dr. Kimball and her colleagues, cardiovascular disease, diabetes, depression, hyperlipidemia, hypertension, and obesity all increased significantly in psoriasis patients, compared with healthy controls, over a 4-year follow-up period (J. Am. Acad. Dermatol. 2010;62[suppl. 1]:AB3).

These findings suggest that medical comorbidities associated with psoriasis accumulate over time; therefore, aggressive treatment of psoriasis in younger patients could improve their psychological and physical quality of life, Dr. Kimball said. Although there are no recommendations for additional health screening for psoriasis patients beyond the age-recommended preventive health measures, "younger patients especially need to be monitored for psychiatric issues," she said. And these patients should be kept up to date on vaccinations, particularly the annual flu vaccine and the human papillomavirus vaccine.

Dr. Kimball reported receiving grants, honoraria, consulting fees, and other support from Abbott, Amgen, and Janssen Pharmaceuticals.

RIO GRANDE, P.R. – Treating psoriasis patients earlier in life could help prevent later physical and psychological problems, according to Dr. Alexa B. Kimball.

"We used to think that we should save our therapies until our patients really needed them, because we were afraid that toxicity might accumulate," Dr. Kimball said at the annual Caribbean Dermatology Symposium. However, that thinking has changed, thanks in part to the availability of safer treatment options.

But of equal importance, "treating patients early in their disease may have an impact that affects the rest of their lives," including jobs, education, socioeconomic status, and curbing the development of health problems like obesity, cardiovascular disease, and psychiatric disorders, she said.

The quality of life issues associated with psoriasis are well known, but recent data confirm that physical and mental comorbidities start in childhood.

According to recent data from the National Psoriasis Foundation, 38% of children with psoriasis reported being bullied because of their condition, noted Dr. Kimball of Massachusetts General Hospital and Harvard Medical School, both in Boston.

Another study found that approximately one-third of children aged 4-17 years with psoriasis had a body mass index greater than the 95th percentile (N. Engl. J. Med. 2008;358:241-51). Conditions such as childhood obesity are not easily managed, and have significant implications for future health, she said.

In a retrospective study of 7,404 psoriasis patients younger than 18 years and 37,020 healthy controls, children with psoriasis were significantly more likely than controls to develop any psychiatric disorder (5% vs. 4%), depression (3% vs. 2%), and anxiety (2% vs. 1%), Dr. Kimball and her colleagues found (J. Am. Acad. Dermatol. 2012 Jan. 16 [doi:10.1016/j.jaad.2011.11.948]).

And the likelihood of comorbidities in psoriasis patients continues as they grow up, she said. "Chronic disease interacts with psychosocial and health events in a complex and ongoing manner throughout a person’s life."

Comorbidities in psoriasis patients appear to accumulate over time. Dr. Kimball cited data from the Nurses’ Health Study II, a cohort including more than 100,000 women who were aged 27-44 years in 1991. In a subset of 1,813 women with psoriasis, the risk of diabetes was approximately 60% higher, and the risk of hypertension was almost 20% higher, compared with women without psoriasis (Arch. Dermatol. 2009;145:379-82).

In a case-control study conducted by Dr. Kimball and her colleagues, cardiovascular disease, diabetes, depression, hyperlipidemia, hypertension, and obesity all increased significantly in psoriasis patients, compared with healthy controls, over a 4-year follow-up period (J. Am. Acad. Dermatol. 2010;62[suppl. 1]:AB3).

These findings suggest that medical comorbidities associated with psoriasis accumulate over time; therefore, aggressive treatment of psoriasis in younger patients could improve their psychological and physical quality of life, Dr. Kimball said. Although there are no recommendations for additional health screening for psoriasis patients beyond the age-recommended preventive health measures, "younger patients especially need to be monitored for psychiatric issues," she said. And these patients should be kept up to date on vaccinations, particularly the annual flu vaccine and the human papillomavirus vaccine.

Dr. Kimball reported receiving grants, honoraria, consulting fees, and other support from Abbott, Amgen, and Janssen Pharmaceuticals.

RIO GRANDE, P.R. – Treating psoriasis patients earlier in life could help prevent later physical and psychological problems, according to Dr. Alexa B. Kimball.

"We used to think that we should save our therapies until our patients really needed them, because we were afraid that toxicity might accumulate," Dr. Kimball said at the annual Caribbean Dermatology Symposium. However, that thinking has changed, thanks in part to the availability of safer treatment options.

But of equal importance, "treating patients early in their disease may have an impact that affects the rest of their lives," including jobs, education, socioeconomic status, and curbing the development of health problems like obesity, cardiovascular disease, and psychiatric disorders, she said.

The quality of life issues associated with psoriasis are well known, but recent data confirm that physical and mental comorbidities start in childhood.

According to recent data from the National Psoriasis Foundation, 38% of children with psoriasis reported being bullied because of their condition, noted Dr. Kimball of Massachusetts General Hospital and Harvard Medical School, both in Boston.

Another study found that approximately one-third of children aged 4-17 years with psoriasis had a body mass index greater than the 95th percentile (N. Engl. J. Med. 2008;358:241-51). Conditions such as childhood obesity are not easily managed, and have significant implications for future health, she said.

In a retrospective study of 7,404 psoriasis patients younger than 18 years and 37,020 healthy controls, children with psoriasis were significantly more likely than controls to develop any psychiatric disorder (5% vs. 4%), depression (3% vs. 2%), and anxiety (2% vs. 1%), Dr. Kimball and her colleagues found (J. Am. Acad. Dermatol. 2012 Jan. 16 [doi:10.1016/j.jaad.2011.11.948]).

And the likelihood of comorbidities in psoriasis patients continues as they grow up, she said. "Chronic disease interacts with psychosocial and health events in a complex and ongoing manner throughout a person’s life."

Comorbidities in psoriasis patients appear to accumulate over time. Dr. Kimball cited data from the Nurses’ Health Study II, a cohort including more than 100,000 women who were aged 27-44 years in 1991. In a subset of 1,813 women with psoriasis, the risk of diabetes was approximately 60% higher, and the risk of hypertension was almost 20% higher, compared with women without psoriasis (Arch. Dermatol. 2009;145:379-82).

In a case-control study conducted by Dr. Kimball and her colleagues, cardiovascular disease, diabetes, depression, hyperlipidemia, hypertension, and obesity all increased significantly in psoriasis patients, compared with healthy controls, over a 4-year follow-up period (J. Am. Acad. Dermatol. 2010;62[suppl. 1]:AB3).

These findings suggest that medical comorbidities associated with psoriasis accumulate over time; therefore, aggressive treatment of psoriasis in younger patients could improve their psychological and physical quality of life, Dr. Kimball said. Although there are no recommendations for additional health screening for psoriasis patients beyond the age-recommended preventive health measures, "younger patients especially need to be monitored for psychiatric issues," she said. And these patients should be kept up to date on vaccinations, particularly the annual flu vaccine and the human papillomavirus vaccine.

Dr. Kimball reported receiving grants, honoraria, consulting fees, and other support from Abbott, Amgen, and Janssen Pharmaceuticals.

RIO GRANDE, P.R. – Malignancy rates in psoriasis patients treated with ustekinumab did not increase significantly over 4 years of follow-up, based on pooled data from 3,117 patients enrolled in ustekinumab clinical trials.

Ustekinumab has shown effectiveness for treating moderate to severe psoriasis, but due to the potential of increased risk for cancer associated with its use, patients from several clinical trials (including PHOENIX I, PHOENIX II, and ACCEPT) are still being followed, said Dr. Kim A. Papp, director of research at Probity Medical Research, Waterloo, Ont., and colleagues.

Photo Courtesy CDC/Dr. N.J. Fiumara

The cumulative rates for nonmelanoma skin cancer in patients treated with ustekinumab for psoriasis remained low and stable throughout the follow-up period. A total of 0.57 cancer events per 100 person-years were reported in 2009 and 0.62 cancer events per 100 person-years were reported in 2010. The findings were presented at the annual Caribbean Dermatology Symposium.

In the complete analysis that included 6,791 patient-years of follow-up, 41 patients treated with any dose of ustekinumab developed at least one nonmelanoma skin cancer, and 3 patients developed both basal cell carcinoma and squamous cell carcinoma.

Another 42 patients developed at least one other malignancy, including 4 patients with melanoma in situ. However, no cases of invasive melanoma were observed during the study period. The other most common malignancies were prostate cancer (12 patients), colorectal cancer (4 patients) and breast cancer (3 patients).

By comparison, 39 individuals in the general population (based on the National Cancer Institute’s Surveillance, Epidemiology, and End Results database) developed at least one malignancy.

The findings were limited by the inclusion of several studies of varying lengths and by the inclusion criteria that can make comparison with the general population difficult, the researchers noted. The results suggest that rates of nonmelanoma skin cancer and other malignancies in psoriasis patients taking ustekinumab do not increase over time.

However, "additional long term data from clinical trials, observational registries, and postmarketing reporting databases will continue to define the ustekinumab malignancy risk profile," they wrote.

The study was sponsored by Centocor, which manufactures ustekinmab.

RIO GRANDE, P.R. – Malignancy rates in psoriasis patients treated with ustekinumab did not increase significantly over 4 years of follow-up, based on pooled data from 3,117 patients enrolled in ustekinumab clinical trials.

Ustekinumab has shown effectiveness for treating moderate to severe psoriasis, but due to the potential of increased risk for cancer associated with its use, patients from several clinical trials (including PHOENIX I, PHOENIX II, and ACCEPT) are still being followed, said Dr. Kim A. Papp, director of research at Probity Medical Research, Waterloo, Ont., and colleagues.

Photo Courtesy CDC/Dr. N.J. Fiumara

The cumulative rates for nonmelanoma skin cancer in patients treated with ustekinumab for psoriasis remained low and stable throughout the follow-up period. A total of 0.57 cancer events per 100 person-years were reported in 2009 and 0.62 cancer events per 100 person-years were reported in 2010. The findings were presented at the annual Caribbean Dermatology Symposium.

In the complete analysis that included 6,791 patient-years of follow-up, 41 patients treated with any dose of ustekinumab developed at least one nonmelanoma skin cancer, and 3 patients developed both basal cell carcinoma and squamous cell carcinoma.

Another 42 patients developed at least one other malignancy, including 4 patients with melanoma in situ. However, no cases of invasive melanoma were observed during the study period. The other most common malignancies were prostate cancer (12 patients), colorectal cancer (4 patients) and breast cancer (3 patients).

By comparison, 39 individuals in the general population (based on the National Cancer Institute’s Surveillance, Epidemiology, and End Results database) developed at least one malignancy.

The findings were limited by the inclusion of several studies of varying lengths and by the inclusion criteria that can make comparison with the general population difficult, the researchers noted. The results suggest that rates of nonmelanoma skin cancer and other malignancies in psoriasis patients taking ustekinumab do not increase over time.

However, "additional long term data from clinical trials, observational registries, and postmarketing reporting databases will continue to define the ustekinumab malignancy risk profile," they wrote.

The study was sponsored by Centocor, which manufactures ustekinmab.

RIO GRANDE, P.R. – Malignancy rates in psoriasis patients treated with ustekinumab did not increase significantly over 4 years of follow-up, based on pooled data from 3,117 patients enrolled in ustekinumab clinical trials.

Ustekinumab has shown effectiveness for treating moderate to severe psoriasis, but due to the potential of increased risk for cancer associated with its use, patients from several clinical trials (including PHOENIX I, PHOENIX II, and ACCEPT) are still being followed, said Dr. Kim A. Papp, director of research at Probity Medical Research, Waterloo, Ont., and colleagues.

Photo Courtesy CDC/Dr. N.J. Fiumara

The cumulative rates for nonmelanoma skin cancer in patients treated with ustekinumab for psoriasis remained low and stable throughout the follow-up period. A total of 0.57 cancer events per 100 person-years were reported in 2009 and 0.62 cancer events per 100 person-years were reported in 2010. The findings were presented at the annual Caribbean Dermatology Symposium.

In the complete analysis that included 6,791 patient-years of follow-up, 41 patients treated with any dose of ustekinumab developed at least one nonmelanoma skin cancer, and 3 patients developed both basal cell carcinoma and squamous cell carcinoma.

Another 42 patients developed at least one other malignancy, including 4 patients with melanoma in situ. However, no cases of invasive melanoma were observed during the study period. The other most common malignancies were prostate cancer (12 patients), colorectal cancer (4 patients) and breast cancer (3 patients).

By comparison, 39 individuals in the general population (based on the National Cancer Institute’s Surveillance, Epidemiology, and End Results database) developed at least one malignancy.

The findings were limited by the inclusion of several studies of varying lengths and by the inclusion criteria that can make comparison with the general population difficult, the researchers noted. The results suggest that rates of nonmelanoma skin cancer and other malignancies in psoriasis patients taking ustekinumab do not increase over time.

However, "additional long term data from clinical trials, observational registries, and postmarketing reporting databases will continue to define the ustekinumab malignancy risk profile," they wrote.

The study was sponsored by Centocor, which manufactures ustekinmab.

The prevalence of oral human papillomavirus is nearly three times higher in men than in women, according to data from more than 5,000 individuals in the United States.

The findings were simultaneously published online in JAMA and presented at the Multidisciplinary Head and Neck Cancer Symposium in Phoenix on Jan. 26 (JAMA 2012;307: [doi: 10.1001/jama.2012/101]).

Oral HPV infection causes a subset of oropharyngeal squamous cell carcinoma (OSCC) that has increased in several countries, including the United States, over the past 3 decades, said Dr. Maura L. Gillison of the Ohio State University, Columbus, and her colleagues. "HPV has been directly implicated as the underlying cause," they noted. However, the epidemiology of OSCC has not been well studied.

The researchers conducted a cross-sectional study of HPV infection as part the National Health and Nutrition Examination Survey (NHANES) for 2009-2010. The study population included 5,579 men and women aged 14-69 years who were tested for HPV at mobile centers.

Overall, the prevalence of any HPV infection was 6.9%, and the prevalence of HPV type 16 (the type associated with OSCC) was 1%. The prevalence of any HPV infection was significantly higher in men than in women (10.1% vs. 3.6%, P less than .001). The peak prevalence of oral HPV occurred in people aged 30-34 years (7.3%) and 60-64 years (11.4%).

Infection in either gender was significantly more common in those with a history of any sexual contact (7.5%), compared with those who had no history of sexual contact (0.9%). The risk of infection also increased significantly as the number of sex partners for any type of sex increased. "One in five individuals with more than 20 lifetime sexual partners was infected," the researchers said.

Univariate associations between risk of oral HPV infection and alcohol and marijuana use did not remain significant in a multivariate analysis. However, cigarette smoking remained independently associated with an increased risk of oral HPV infection. The risk significantly increased with the number of cigarettes smoked daily for both men and women, but this trend was stronger in women.

In a multivariate analysis, age, gender, number of sexual partners, and number of cigarettes smoked daily remained independently associated with an increased risk of oral HPV infection.

"Our data provide evidence that oral HPV infection is predominantly sexually transmitted," the researchers said. Although HPV-positive OSCC has been associated with oral sex in particular, this study could not associate infection with a particular sexual behavior, they added.

The findings were limited by the emphasis on Alpha-papillomaviruses only, which likely underestimates the prevalence of oral HPV infection, the researchers said. But the findings suggest that vaccine trials to test the efficacy of the current HPV vaccine against oral HPV may be warranted. "Such trials could inform ongoing discussions regarding the benefits of HPV vaccination for males, given the higher prevalence of oral HPV infection demonstrated here as well as higher incidence of HPV-positive OSCC among men," they said.

The Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society for Radiation Oncology.

Study sponsors included the Ohio State University Comprehensive Cancer Center and the National Cancer Institute. Dr. Gillison has served as a consultant to study sponsor Merck and to GlaxoSmithKline.

The incidence of HPV-positive oropharyngeal cancers increased 225% – from 0.8/100,000 to 2.8/100,000 – between 1988 and 2004, according to a presentation by Dr. Gillison at the annual meeting of the American Society of Clinical Oncology in June 2011. Click here for a report on the earlier findings.

The prevalence of oral human papillomavirus is nearly three times higher in men than in women, according to data from more than 5,000 individuals in the United States.

The findings were simultaneously published online in JAMA and presented at the Multidisciplinary Head and Neck Cancer Symposium in Phoenix on Jan. 26 (JAMA 2012;307: [doi: 10.1001/jama.2012/101]).

Oral HPV infection causes a subset of oropharyngeal squamous cell carcinoma (OSCC) that has increased in several countries, including the United States, over the past 3 decades, said Dr. Maura L. Gillison of the Ohio State University, Columbus, and her colleagues. "HPV has been directly implicated as the underlying cause," they noted. However, the epidemiology of OSCC has not been well studied.

The researchers conducted a cross-sectional study of HPV infection as part the National Health and Nutrition Examination Survey (NHANES) for 2009-2010. The study population included 5,579 men and women aged 14-69 years who were tested for HPV at mobile centers.

Overall, the prevalence of any HPV infection was 6.9%, and the prevalence of HPV type 16 (the type associated with OSCC) was 1%. The prevalence of any HPV infection was significantly higher in men than in women (10.1% vs. 3.6%, P less than .001). The peak prevalence of oral HPV occurred in people aged 30-34 years (7.3%) and 60-64 years (11.4%).

Infection in either gender was significantly more common in those with a history of any sexual contact (7.5%), compared with those who had no history of sexual contact (0.9%). The risk of infection also increased significantly as the number of sex partners for any type of sex increased. "One in five individuals with more than 20 lifetime sexual partners was infected," the researchers said.

Univariate associations between risk of oral HPV infection and alcohol and marijuana use did not remain significant in a multivariate analysis. However, cigarette smoking remained independently associated with an increased risk of oral HPV infection. The risk significantly increased with the number of cigarettes smoked daily for both men and women, but this trend was stronger in women.

In a multivariate analysis, age, gender, number of sexual partners, and number of cigarettes smoked daily remained independently associated with an increased risk of oral HPV infection.

"Our data provide evidence that oral HPV infection is predominantly sexually transmitted," the researchers said. Although HPV-positive OSCC has been associated with oral sex in particular, this study could not associate infection with a particular sexual behavior, they added.

The findings were limited by the emphasis on Alpha-papillomaviruses only, which likely underestimates the prevalence of oral HPV infection, the researchers said. But the findings suggest that vaccine trials to test the efficacy of the current HPV vaccine against oral HPV may be warranted. "Such trials could inform ongoing discussions regarding the benefits of HPV vaccination for males, given the higher prevalence of oral HPV infection demonstrated here as well as higher incidence of HPV-positive OSCC among men," they said.

The Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society for Radiation Oncology.

Study sponsors included the Ohio State University Comprehensive Cancer Center and the National Cancer Institute. Dr. Gillison has served as a consultant to study sponsor Merck and to GlaxoSmithKline.

The incidence of HPV-positive oropharyngeal cancers increased 225% – from 0.8/100,000 to 2.8/100,000 – between 1988 and 2004, according to a presentation by Dr. Gillison at the annual meeting of the American Society of Clinical Oncology in June 2011. Click here for a report on the earlier findings.

The prevalence of oral human papillomavirus is nearly three times higher in men than in women, according to data from more than 5,000 individuals in the United States.

The findings were simultaneously published online in JAMA and presented at the Multidisciplinary Head and Neck Cancer Symposium in Phoenix on Jan. 26 (JAMA 2012;307: [doi: 10.1001/jama.2012/101]).

Oral HPV infection causes a subset of oropharyngeal squamous cell carcinoma (OSCC) that has increased in several countries, including the United States, over the past 3 decades, said Dr. Maura L. Gillison of the Ohio State University, Columbus, and her colleagues. "HPV has been directly implicated as the underlying cause," they noted. However, the epidemiology of OSCC has not been well studied.

The researchers conducted a cross-sectional study of HPV infection as part the National Health and Nutrition Examination Survey (NHANES) for 2009-2010. The study population included 5,579 men and women aged 14-69 years who were tested for HPV at mobile centers.

Overall, the prevalence of any HPV infection was 6.9%, and the prevalence of HPV type 16 (the type associated with OSCC) was 1%. The prevalence of any HPV infection was significantly higher in men than in women (10.1% vs. 3.6%, P less than .001). The peak prevalence of oral HPV occurred in people aged 30-34 years (7.3%) and 60-64 years (11.4%).

Infection in either gender was significantly more common in those with a history of any sexual contact (7.5%), compared with those who had no history of sexual contact (0.9%). The risk of infection also increased significantly as the number of sex partners for any type of sex increased. "One in five individuals with more than 20 lifetime sexual partners was infected," the researchers said.

Univariate associations between risk of oral HPV infection and alcohol and marijuana use did not remain significant in a multivariate analysis. However, cigarette smoking remained independently associated with an increased risk of oral HPV infection. The risk significantly increased with the number of cigarettes smoked daily for both men and women, but this trend was stronger in women.

In a multivariate analysis, age, gender, number of sexual partners, and number of cigarettes smoked daily remained independently associated with an increased risk of oral HPV infection.

"Our data provide evidence that oral HPV infection is predominantly sexually transmitted," the researchers said. Although HPV-positive OSCC has been associated with oral sex in particular, this study could not associate infection with a particular sexual behavior, they added.

The findings were limited by the emphasis on Alpha-papillomaviruses only, which likely underestimates the prevalence of oral HPV infection, the researchers said. But the findings suggest that vaccine trials to test the efficacy of the current HPV vaccine against oral HPV may be warranted. "Such trials could inform ongoing discussions regarding the benefits of HPV vaccination for males, given the higher prevalence of oral HPV infection demonstrated here as well as higher incidence of HPV-positive OSCC among men," they said.

The Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society for Radiation Oncology.

Study sponsors included the Ohio State University Comprehensive Cancer Center and the National Cancer Institute. Dr. Gillison has served as a consultant to study sponsor Merck and to GlaxoSmithKline.

The incidence of HPV-positive oropharyngeal cancers increased 225% – from 0.8/100,000 to 2.8/100,000 – between 1988 and 2004, according to a presentation by Dr. Gillison at the annual meeting of the American Society of Clinical Oncology in June 2011. Click here for a report on the earlier findings.

Twenty-four percent of 525 pediatricians surveyed agreed that children with attention-deficit/hyperactivity disorder should undergo cardiac screening before taking stimulants, according to a study published online Jan. 16 in Pediatrics.

Although postmarketing reports during the past decade have shown cases of sudden cardiac death (SCD) in children with attention-deficit/hyperactivity disorder (ADHD) who were taking stimulants, findings from studies specifically addressing the topic have been inconsistent, said Dr. Laurel K. Leslie of Tufts Medical Center, Boston, and colleagues.

These studies have been undertaken in the wake of various recommendations for evaluation of cardiac status prior to starting stimulant treatment. In 2008, the American Heart Association "released a policy statement widely interpreted as recommending the routine use of electrocardiograms (ECGs) to evaluate children" prior to starting treatment with stimulant medication (Circulation 2008;117:2407-23).

As a clarification of that policy statement, the American Academy of Pediatrics (AAP) and the American Heart Association subsequently published a joint statement, which was endorsed by the American Academy of Child and Adolescent Psychiatry, that revised the American Heart Association’s original recommendation of the ECG. The joint statement stated that physicians should perform in-depth cardiac history and physicals (H&P) prior to starting stimulant treatment and get ECGs for children with positive findings. It noted that getting an ECG was a Class IIa recommendation so it is reasonable for a physician to consider an ECG, but not mandatory.

Then, the AAP stated in a 2008 policy statement that medications used to treat ADHD had not been shown to cause SCD, and there was not sufficient evidence to justify obtaining routine ECGs before starting treatment with stimulants. The AAP concluded that "until these questions are answered, a recommendation to obtain routine ECGs for children receiving ADHD medications is not warranted" (Pediatrics 2008;122:451-3).

In Dr. Leslie’s current study, 75% of the survey respondents agreed that physicians have a responsibility to inform families about the possible risk of SCD before children begin treatment with stimulants. However, only 30% agreed that the risk of a potential lawsuit was high enough to warrant cardiac screening (Pediatrics 2012;129:222-30).

In addition, 36% of the respondents agreed that informing families about a possible SCD risk might deter them from giving the stimulants to their children.

As part of the survey, each of the respondents reported the cardiac screening practices for his or her most recent patient with ADHD. Nearly all respondents (93%) completed a routine history and physical, and 71% collected an in-depth cardiac history, while 48% completed an in-depth cardiac history and physical.

Less than half (46%) of the physicians discussed cardiac risks with families of a recent patient with ADHD, although most (93%) of the respondents discussed weight loss or appetite suppression as a side effect of stimulants, 87% discussed sleep disturbance, and 75% discussed affective symptoms such as moodiness, irritability, and suicidality.

A total of 77 respondents (15%) reported ordering an ECG for their most recent patient; 42 of these did so because it was standard in their practices. Only 16 (21%) of the physicians who ordered ECGs reviewed the results themselves.

There was a general lack of comfort with cardiac screening procedures. A total of 71% of respondents said that their ability to interpret a pediatric ECG was a barrier to screening, and 18% said that their ability to perform an in-depth cardiac history and physical was a barrier. The respondents reported other barriers including lack of local specialists (18%), a long wait to see a specialist (37%), and patients’ inability to pay for care (52%).

In a multivariate analysis, certain associations emerged among attitudes, barriers, and physician practices, the researchers wrote. "Legal liability and physician responsibility to inform families of SCD risk were positively associated with an in-depth cardiac H&P, whereas barriers in ability to perform an in-depth cardiac H&P were negatively associated," they noted.

The findings suggest that balancing the potential benefits of stimulants for ADHD children with the obligation to inform families of a possible SCD risk remains a challenge for pediatricians, the researchers said.

"Shared decision-making extends informed consent by not only exchanging information about treatment options, risks, and benefits, but also by sharing viewpoints so that patients, families, and physicians become aware of each other’s perspectives with the goal of achieving a mutually agreed on treatment plan," Dr. Leslie and colleagues wrote.

The survey was mailed to 1,600 randomly selected AAP members who provide direct patient care to children aged 5-17 years with ADHD. Pediatricians who were retired, trainees, or not based in the United States were excluded. Most who responded were female, non-Hispanic/white, and practicing for an average of 18 years.

The study was limited by the lower-than-expected response rate, the lack of information about the resources available in each practice, and the lack of perspective from families. But the study is the first to ask pediatricians about this topic specifically, and the findings reinforce the ongoing controversy over the potential cardiac risks associated with stimulant use by children with ADHD, Dr. Leslie and colleagues noted.

Dr. Leslie and colleagues reported having no relevant financial disclosures. The study was funded by the National Institutes of Health.

Twenty-four percent of 525 pediatricians surveyed agreed that children with attention-deficit/hyperactivity disorder should undergo cardiac screening before taking stimulants, according to a study published online Jan. 16 in Pediatrics.

Although postmarketing reports during the past decade have shown cases of sudden cardiac death (SCD) in children with attention-deficit/hyperactivity disorder (ADHD) who were taking stimulants, findings from studies specifically addressing the topic have been inconsistent, said Dr. Laurel K. Leslie of Tufts Medical Center, Boston, and colleagues.

These studies have been undertaken in the wake of various recommendations for evaluation of cardiac status prior to starting stimulant treatment. In 2008, the American Heart Association "released a policy statement widely interpreted as recommending the routine use of electrocardiograms (ECGs) to evaluate children" prior to starting treatment with stimulant medication (Circulation 2008;117:2407-23).

As a clarification of that policy statement, the American Academy of Pediatrics (AAP) and the American Heart Association subsequently published a joint statement, which was endorsed by the American Academy of Child and Adolescent Psychiatry, that revised the American Heart Association’s original recommendation of the ECG. The joint statement stated that physicians should perform in-depth cardiac history and physicals (H&P) prior to starting stimulant treatment and get ECGs for children with positive findings. It noted that getting an ECG was a Class IIa recommendation so it is reasonable for a physician to consider an ECG, but not mandatory.

Then, the AAP stated in a 2008 policy statement that medications used to treat ADHD had not been shown to cause SCD, and there was not sufficient evidence to justify obtaining routine ECGs before starting treatment with stimulants. The AAP concluded that "until these questions are answered, a recommendation to obtain routine ECGs for children receiving ADHD medications is not warranted" (Pediatrics 2008;122:451-3).

In Dr. Leslie’s current study, 75% of the survey respondents agreed that physicians have a responsibility to inform families about the possible risk of SCD before children begin treatment with stimulants. However, only 30% agreed that the risk of a potential lawsuit was high enough to warrant cardiac screening (Pediatrics 2012;129:222-30).

In addition, 36% of the respondents agreed that informing families about a possible SCD risk might deter them from giving the stimulants to their children.

As part of the survey, each of the respondents reported the cardiac screening practices for his or her most recent patient with ADHD. Nearly all respondents (93%) completed a routine history and physical, and 71% collected an in-depth cardiac history, while 48% completed an in-depth cardiac history and physical.

Less than half (46%) of the physicians discussed cardiac risks with families of a recent patient with ADHD, although most (93%) of the respondents discussed weight loss or appetite suppression as a side effect of stimulants, 87% discussed sleep disturbance, and 75% discussed affective symptoms such as moodiness, irritability, and suicidality.

A total of 77 respondents (15%) reported ordering an ECG for their most recent patient; 42 of these did so because it was standard in their practices. Only 16 (21%) of the physicians who ordered ECGs reviewed the results themselves.

There was a general lack of comfort with cardiac screening procedures. A total of 71% of respondents said that their ability to interpret a pediatric ECG was a barrier to screening, and 18% said that their ability to perform an in-depth cardiac history and physical was a barrier. The respondents reported other barriers including lack of local specialists (18%), a long wait to see a specialist (37%), and patients’ inability to pay for care (52%).

In a multivariate analysis, certain associations emerged among attitudes, barriers, and physician practices, the researchers wrote. "Legal liability and physician responsibility to inform families of SCD risk were positively associated with an in-depth cardiac H&P, whereas barriers in ability to perform an in-depth cardiac H&P were negatively associated," they noted.

The findings suggest that balancing the potential benefits of stimulants for ADHD children with the obligation to inform families of a possible SCD risk remains a challenge for pediatricians, the researchers said.

"Shared decision-making extends informed consent by not only exchanging information about treatment options, risks, and benefits, but also by sharing viewpoints so that patients, families, and physicians become aware of each other’s perspectives with the goal of achieving a mutually agreed on treatment plan," Dr. Leslie and colleagues wrote.

The survey was mailed to 1,600 randomly selected AAP members who provide direct patient care to children aged 5-17 years with ADHD. Pediatricians who were retired, trainees, or not based in the United States were excluded. Most who responded were female, non-Hispanic/white, and practicing for an average of 18 years.

The study was limited by the lower-than-expected response rate, the lack of information about the resources available in each practice, and the lack of perspective from families. But the study is the first to ask pediatricians about this topic specifically, and the findings reinforce the ongoing controversy over the potential cardiac risks associated with stimulant use by children with ADHD, Dr. Leslie and colleagues noted.

Dr. Leslie and colleagues reported having no relevant financial disclosures. The study was funded by the National Institutes of Health.

Twenty-four percent of 525 pediatricians surveyed agreed that children with attention-deficit/hyperactivity disorder should undergo cardiac screening before taking stimulants, according to a study published online Jan. 16 in Pediatrics.

Although postmarketing reports during the past decade have shown cases of sudden cardiac death (SCD) in children with attention-deficit/hyperactivity disorder (ADHD) who were taking stimulants, findings from studies specifically addressing the topic have been inconsistent, said Dr. Laurel K. Leslie of Tufts Medical Center, Boston, and colleagues.

These studies have been undertaken in the wake of various recommendations for evaluation of cardiac status prior to starting stimulant treatment. In 2008, the American Heart Association "released a policy statement widely interpreted as recommending the routine use of electrocardiograms (ECGs) to evaluate children" prior to starting treatment with stimulant medication (Circulation 2008;117:2407-23).

As a clarification of that policy statement, the American Academy of Pediatrics (AAP) and the American Heart Association subsequently published a joint statement, which was endorsed by the American Academy of Child and Adolescent Psychiatry, that revised the American Heart Association’s original recommendation of the ECG. The joint statement stated that physicians should perform in-depth cardiac history and physicals (H&P) prior to starting stimulant treatment and get ECGs for children with positive findings. It noted that getting an ECG was a Class IIa recommendation so it is reasonable for a physician to consider an ECG, but not mandatory.

Then, the AAP stated in a 2008 policy statement that medications used to treat ADHD had not been shown to cause SCD, and there was not sufficient evidence to justify obtaining routine ECGs before starting treatment with stimulants. The AAP concluded that "until these questions are answered, a recommendation to obtain routine ECGs for children receiving ADHD medications is not warranted" (Pediatrics 2008;122:451-3).

In Dr. Leslie’s current study, 75% of the survey respondents agreed that physicians have a responsibility to inform families about the possible risk of SCD before children begin treatment with stimulants. However, only 30% agreed that the risk of a potential lawsuit was high enough to warrant cardiac screening (Pediatrics 2012;129:222-30).

In addition, 36% of the respondents agreed that informing families about a possible SCD risk might deter them from giving the stimulants to their children.

As part of the survey, each of the respondents reported the cardiac screening practices for his or her most recent patient with ADHD. Nearly all respondents (93%) completed a routine history and physical, and 71% collected an in-depth cardiac history, while 48% completed an in-depth cardiac history and physical.

Less than half (46%) of the physicians discussed cardiac risks with families of a recent patient with ADHD, although most (93%) of the respondents discussed weight loss or appetite suppression as a side effect of stimulants, 87% discussed sleep disturbance, and 75% discussed affective symptoms such as moodiness, irritability, and suicidality.

A total of 77 respondents (15%) reported ordering an ECG for their most recent patient; 42 of these did so because it was standard in their practices. Only 16 (21%) of the physicians who ordered ECGs reviewed the results themselves.

There was a general lack of comfort with cardiac screening procedures. A total of 71% of respondents said that their ability to interpret a pediatric ECG was a barrier to screening, and 18% said that their ability to perform an in-depth cardiac history and physical was a barrier. The respondents reported other barriers including lack of local specialists (18%), a long wait to see a specialist (37%), and patients’ inability to pay for care (52%).

In a multivariate analysis, certain associations emerged among attitudes, barriers, and physician practices, the researchers wrote. "Legal liability and physician responsibility to inform families of SCD risk were positively associated with an in-depth cardiac H&P, whereas barriers in ability to perform an in-depth cardiac H&P were negatively associated," they noted.

The findings suggest that balancing the potential benefits of stimulants for ADHD children with the obligation to inform families of a possible SCD risk remains a challenge for pediatricians, the researchers said.

"Shared decision-making extends informed consent by not only exchanging information about treatment options, risks, and benefits, but also by sharing viewpoints so that patients, families, and physicians become aware of each other’s perspectives with the goal of achieving a mutually agreed on treatment plan," Dr. Leslie and colleagues wrote.

The survey was mailed to 1,600 randomly selected AAP members who provide direct patient care to children aged 5-17 years with ADHD. Pediatricians who were retired, trainees, or not based in the United States were excluded. Most who responded were female, non-Hispanic/white, and practicing for an average of 18 years.

The study was limited by the lower-than-expected response rate, the lack of information about the resources available in each practice, and the lack of perspective from families. But the study is the first to ask pediatricians about this topic specifically, and the findings reinforce the ongoing controversy over the potential cardiac risks associated with stimulant use by children with ADHD, Dr. Leslie and colleagues noted.

Dr. Leslie and colleagues reported having no relevant financial disclosures. The study was funded by the National Institutes of Health.

WASHINGTON – The American College of Physicians Foundation* has created pharmaceutical company–sponsored physician and patient education materials aimed at preventing strokes among the estimated 2.6 million Americans with atrial fibrillation.

Providers who manage patients with atrial fibrillation have tended to underestimate the risk of stroke and overestimate the risk of bleeding from anticoagulants, which has contributed the undertreatment of patients who could benefit from anticoagulation therapy, according to Dr. Samuel Z. Goldhaber. The side effects associated with warfarin made it an unappealing choice. But new oral medications, such as dabigatran, are providing more options, said the cardiologist at Harvard University and Brigham and Women’s Hospital in Boston.

The effort, spearheaded by the ACP Foundation's Initiative on Atrial Fibrillation and Stroke Prevention, shores up the role of primary care in atrial fibrillation management at a time when newly approved alternatives to warfarin have dramatically expanded treatment options. "You don’t need to be a specialist to prevent a stroke from atrial fibrillation," said Dr. Goldhaber, a member the initiative’s panel.

The materials are aimed at helping the internal medicine physician, family physician, or nurse practitioner play a role in preventing stroke by looking for atrial fibrillation, and, when appropriate, selecting a treatment agent, which in the future is more likely to be an oral anticoagulant, he said at a Jan. 10 press conference.

Janssen Pharmaceuticals, manufacturer of rivaroxaban, sponsored the development of the concise, one-page clinician work sheet that can be used at the bedside, a patient and caregiver booklet, and three patient videos to help patients understand whether they are candidates for anticoagulation medication.

In addition, the initiative produced a compendium addressing quality of care issues at the hospital level for the purposes of educating staff about atrial fibrillation management.

In evaluating whether patients are candidates for anticoagulation therapy, the clinician tool advises the use the CHADS₂scoring system to assess stroke risk, the outpatient bleeding risk index (OBRI), and doing an assessment of the individual’s risk for falling.

The patient booklet, in large print, features tips from atrial fibrillation patients.

The videos feature a physician’s explanation of anticoagulation therapy, including a discussion of treatment options with an actual patient

When patients are more empowered and educated, they are more likely to adhere to any decisions they make with their clinicians, said Dr. Barbara Schuster of Georgia Health Sciences University in Augusta, and cochair of the ACP’s initiative panel.

"It is the conversation between the patient and clinician that helps them take hold of their own health care," she said.

But the tools aren’t only about medication, Dr. Goldhaber noted. As patients review the materials, they will get an overview of stroke risk, which is designed to reinforce the importance of heart-healthy living; maintaining a healthy blood pressure, taking antihypertensive medications, and eating sensibly, he said.

The new materials are expected to be available at the ACP website, and they are scheduled to be presented and distributed at the ACP annual meeting this spring.

Dr. Goldhaber has received research support from Bristol-Myers Squibb, Boehringer Ingelheim, Eisai, EKOS, Johnson & Johnson, and Sanofi-Aventis. He has served as a consultant to Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi, Eisai, Merck, Pfizer, Portola, and Sanofi-Aventis.

* Correction: An earlier version of this story did not accurately identify the role of the ACP Foundation. The error has been corrected.

WASHINGTON – The American College of Physicians Foundation* has created pharmaceutical company–sponsored physician and patient education materials aimed at preventing strokes among the estimated 2.6 million Americans with atrial fibrillation.

Providers who manage patients with atrial fibrillation have tended to underestimate the risk of stroke and overestimate the risk of bleeding from anticoagulants, which has contributed the undertreatment of patients who could benefit from anticoagulation therapy, according to Dr. Samuel Z. Goldhaber. The side effects associated with warfarin made it an unappealing choice. But new oral medications, such as dabigatran, are providing more options, said the cardiologist at Harvard University and Brigham and Women’s Hospital in Boston.

The effort, spearheaded by the ACP Foundation's Initiative on Atrial Fibrillation and Stroke Prevention, shores up the role of primary care in atrial fibrillation management at a time when newly approved alternatives to warfarin have dramatically expanded treatment options. "You don’t need to be a specialist to prevent a stroke from atrial fibrillation," said Dr. Goldhaber, a member the initiative’s panel.

The materials are aimed at helping the internal medicine physician, family physician, or nurse practitioner play a role in preventing stroke by looking for atrial fibrillation, and, when appropriate, selecting a treatment agent, which in the future is more likely to be an oral anticoagulant, he said at a Jan. 10 press conference.

Janssen Pharmaceuticals, manufacturer of rivaroxaban, sponsored the development of the concise, one-page clinician work sheet that can be used at the bedside, a patient and caregiver booklet, and three patient videos to help patients understand whether they are candidates for anticoagulation medication.

In addition, the initiative produced a compendium addressing quality of care issues at the hospital level for the purposes of educating staff about atrial fibrillation management.

In evaluating whether patients are candidates for anticoagulation therapy, the clinician tool advises the use the CHADS₂scoring system to assess stroke risk, the outpatient bleeding risk index (OBRI), and doing an assessment of the individual’s risk for falling.

The patient booklet, in large print, features tips from atrial fibrillation patients.

The videos feature a physician’s explanation of anticoagulation therapy, including a discussion of treatment options with an actual patient

When patients are more empowered and educated, they are more likely to adhere to any decisions they make with their clinicians, said Dr. Barbara Schuster of Georgia Health Sciences University in Augusta, and cochair of the ACP’s initiative panel.

"It is the conversation between the patient and clinician that helps them take hold of their own health care," she said.

But the tools aren’t only about medication, Dr. Goldhaber noted. As patients review the materials, they will get an overview of stroke risk, which is designed to reinforce the importance of heart-healthy living; maintaining a healthy blood pressure, taking antihypertensive medications, and eating sensibly, he said.

The new materials are expected to be available at the ACP website, and they are scheduled to be presented and distributed at the ACP annual meeting this spring.

Dr. Goldhaber has received research support from Bristol-Myers Squibb, Boehringer Ingelheim, Eisai, EKOS, Johnson & Johnson, and Sanofi-Aventis. He has served as a consultant to Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi, Eisai, Merck, Pfizer, Portola, and Sanofi-Aventis.

* Correction: An earlier version of this story did not accurately identify the role of the ACP Foundation. The error has been corrected.

WASHINGTON – The American College of Physicians Foundation* has created pharmaceutical company–sponsored physician and patient education materials aimed at preventing strokes among the estimated 2.6 million Americans with atrial fibrillation.

Providers who manage patients with atrial fibrillation have tended to underestimate the risk of stroke and overestimate the risk of bleeding from anticoagulants, which has contributed the undertreatment of patients who could benefit from anticoagulation therapy, according to Dr. Samuel Z. Goldhaber. The side effects associated with warfarin made it an unappealing choice. But new oral medications, such as dabigatran, are providing more options, said the cardiologist at Harvard University and Brigham and Women’s Hospital in Boston.

The effort, spearheaded by the ACP Foundation's Initiative on Atrial Fibrillation and Stroke Prevention, shores up the role of primary care in atrial fibrillation management at a time when newly approved alternatives to warfarin have dramatically expanded treatment options. "You don’t need to be a specialist to prevent a stroke from atrial fibrillation," said Dr. Goldhaber, a member the initiative’s panel.

The materials are aimed at helping the internal medicine physician, family physician, or nurse practitioner play a role in preventing stroke by looking for atrial fibrillation, and, when appropriate, selecting a treatment agent, which in the future is more likely to be an oral anticoagulant, he said at a Jan. 10 press conference.

Janssen Pharmaceuticals, manufacturer of rivaroxaban, sponsored the development of the concise, one-page clinician work sheet that can be used at the bedside, a patient and caregiver booklet, and three patient videos to help patients understand whether they are candidates for anticoagulation medication.

In addition, the initiative produced a compendium addressing quality of care issues at the hospital level for the purposes of educating staff about atrial fibrillation management.

In evaluating whether patients are candidates for anticoagulation therapy, the clinician tool advises the use the CHADS₂scoring system to assess stroke risk, the outpatient bleeding risk index (OBRI), and doing an assessment of the individual’s risk for falling.

The patient booklet, in large print, features tips from atrial fibrillation patients.

The videos feature a physician’s explanation of anticoagulation therapy, including a discussion of treatment options with an actual patient

When patients are more empowered and educated, they are more likely to adhere to any decisions they make with their clinicians, said Dr. Barbara Schuster of Georgia Health Sciences University in Augusta, and cochair of the ACP’s initiative panel.

"It is the conversation between the patient and clinician that helps them take hold of their own health care," she said.

But the tools aren’t only about medication, Dr. Goldhaber noted. As patients review the materials, they will get an overview of stroke risk, which is designed to reinforce the importance of heart-healthy living; maintaining a healthy blood pressure, taking antihypertensive medications, and eating sensibly, he said.

The new materials are expected to be available at the ACP website, and they are scheduled to be presented and distributed at the ACP annual meeting this spring.

Dr. Goldhaber has received research support from Bristol-Myers Squibb, Boehringer Ingelheim, Eisai, EKOS, Johnson & Johnson, and Sanofi-Aventis. He has served as a consultant to Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi, Eisai, Merck, Pfizer, Portola, and Sanofi-Aventis.

* Correction: An earlier version of this story did not accurately identify the role of the ACP Foundation. The error has been corrected.

Measurable cognitive decline may begin as early as 45 years of age, according to data from a 10-year study of more than 7,000 adults.

Previous studies have shown limited evidence of cognitive decline before age 60 years, "but the age at which cognitive decline becomes evident at the population level remains the subject of debate," Dr. Archana Singh-Manoux of the Institut National de la Santé et de la Recherche Médicale in Villejuif, France, and her colleagues wrote Jan. 5 in the British Medical Journal.

The scores in most areas (memory, reasoning, and phonemic and semantic fluency) – with the exception of vocabulary – significantly declined in all age groups for both men and women. Controlling for education had no significant impact on the findings.

Of note, reasoning declined by 3.6% in both men and women aged 45-49 years at baseline. By comparison, mental reasoning declined by 9.6% in men aged 65-70 years at baseline, and by 7.4% in women aged 65-70 years at baseline.

The study participants were part of the Whitehall II cohort, a population of British civil servants established in 1985. The study included 5,198 men and 2,192 women who were aged 45-70 years in 1997-1999, when they began cognitive testing (BMJ 2012 Jan. 5 [doi:10.1136/bmj.d7622]).

Cognitive testing consisted of three clinical examinations conducted over 10 years. Each examination included the Alice Heim 4-I (a test of verbal and mathematical reasoning); a test of short-term verbal memory (writing in a 2-minute period as many words as possible from a list of 20 that had been spoken to them); a test of phonemic fluency (writing as many words beginning with "S" as possible in 1 minute); semantic fluency (writing as many animal names as possible in 1 minute); and the Mill Hill vocabulary test.

Although the findings may not be generalizable because of the homogenous, white-collar study population, the results suggest that paying more attention to dementia risk factors such as obesity, hypertension, and high cholesterol in midlife may be more important than previously thought, the researchers noted. Further studies are needed to determine how and whether cognitive trajectories can be modified, and to identify the best age window for successful interventions, they said.

The researchers had no financial conflicts to disclose. The Whitehall II study is supported by a grant from the British Medical Research Council and the British Heart Foundation.

Measurable cognitive decline may begin as early as 45 years of age, according to data from a 10-year study of more than 7,000 adults.

Previous studies have shown limited evidence of cognitive decline before age 60 years, "but the age at which cognitive decline becomes evident at the population level remains the subject of debate," Dr. Archana Singh-Manoux of the Institut National de la Santé et de la Recherche Médicale in Villejuif, France, and her colleagues wrote Jan. 5 in the British Medical Journal.

The scores in most areas (memory, reasoning, and phonemic and semantic fluency) – with the exception of vocabulary – significantly declined in all age groups for both men and women. Controlling for education had no significant impact on the findings.

Of note, reasoning declined by 3.6% in both men and women aged 45-49 years at baseline. By comparison, mental reasoning declined by 9.6% in men aged 65-70 years at baseline, and by 7.4% in women aged 65-70 years at baseline.

The study participants were part of the Whitehall II cohort, a population of British civil servants established in 1985. The study included 5,198 men and 2,192 women who were aged 45-70 years in 1997-1999, when they began cognitive testing (BMJ 2012 Jan. 5 [doi:10.1136/bmj.d7622]).

Cognitive testing consisted of three clinical examinations conducted over 10 years. Each examination included the Alice Heim 4-I (a test of verbal and mathematical reasoning); a test of short-term verbal memory (writing in a 2-minute period as many words as possible from a list of 20 that had been spoken to them); a test of phonemic fluency (writing as many words beginning with "S" as possible in 1 minute); semantic fluency (writing as many animal names as possible in 1 minute); and the Mill Hill vocabulary test.

Although the findings may not be generalizable because of the homogenous, white-collar study population, the results suggest that paying more attention to dementia risk factors such as obesity, hypertension, and high cholesterol in midlife may be more important than previously thought, the researchers noted. Further studies are needed to determine how and whether cognitive trajectories can be modified, and to identify the best age window for successful interventions, they said.

The researchers had no financial conflicts to disclose. The Whitehall II study is supported by a grant from the British Medical Research Council and the British Heart Foundation.

Measurable cognitive decline may begin as early as 45 years of age, according to data from a 10-year study of more than 7,000 adults.

Previous studies have shown limited evidence of cognitive decline before age 60 years, "but the age at which cognitive decline becomes evident at the population level remains the subject of debate," Dr. Archana Singh-Manoux of the Institut National de la Santé et de la Recherche Médicale in Villejuif, France, and her colleagues wrote Jan. 5 in the British Medical Journal.

The scores in most areas (memory, reasoning, and phonemic and semantic fluency) – with the exception of vocabulary – significantly declined in all age groups for both men and women. Controlling for education had no significant impact on the findings.

Of note, reasoning declined by 3.6% in both men and women aged 45-49 years at baseline. By comparison, mental reasoning declined by 9.6% in men aged 65-70 years at baseline, and by 7.4% in women aged 65-70 years at baseline.

The study participants were part of the Whitehall II cohort, a population of British civil servants established in 1985. The study included 5,198 men and 2,192 women who were aged 45-70 years in 1997-1999, when they began cognitive testing (BMJ 2012 Jan. 5 [doi:10.1136/bmj.d7622]).

Cognitive testing consisted of three clinical examinations conducted over 10 years. Each examination included the Alice Heim 4-I (a test of verbal and mathematical reasoning); a test of short-term verbal memory (writing in a 2-minute period as many words as possible from a list of 20 that had been spoken to them); a test of phonemic fluency (writing as many words beginning with "S" as possible in 1 minute); semantic fluency (writing as many animal names as possible in 1 minute); and the Mill Hill vocabulary test.

Although the findings may not be generalizable because of the homogenous, white-collar study population, the results suggest that paying more attention to dementia risk factors such as obesity, hypertension, and high cholesterol in midlife may be more important than previously thought, the researchers noted. Further studies are needed to determine how and whether cognitive trajectories can be modified, and to identify the best age window for successful interventions, they said.

The researchers had no financial conflicts to disclose. The Whitehall II study is supported by a grant from the British Medical Research Council and the British Heart Foundation.

Many women with systemic sclerosis can have successful pregnancies, but the rates of preterm birth, low birth weight, and intrauterine growth restriction are approximately twice as high in these women compared to the general population of pregnant women, based on data from 109 pregnancies in 99 women with systemic sclerosis.

The findings were published in Arthritis & Rheumatism (Arthritis Rheum. 2011 Dec. 28 [doi:10.1002/art.34350]).

Data from previous studies have suggested negative outcomes for pregnancies in women with systemic sclerosis (SSc), but these have been small case series or large database reviews that did not allow for the identification of individual patients, said Dr. Mara Taraborelli of Spedali Civili and University, Brescia, Italy, and colleagues.

In this prospective study, the researchers followed 99 women with SSc who had 109 pregnancies between 2000 and 2011. The women attended one of 25 participating research centers in Italy.

The average age at conception was 32 years, and most of the women were white. A total of 107 pregnancies were spontaneous, and 2 were achieved with assisted reproductive techniques.

Preterm deliveries were significantly more common in the SSc women, compared to the general obstetric population that served as a control group (25% vs. 12%, respectively). Severe preterm delivery (defined as delivery at less than 34 weeks) also was significantly more common in SSc women, compared to the controls (10% vs. 5%, respectively).

In addition, very low birth weight babies and cases of intrauterine growth restriction were significantly more common in the SSc women, compared to the controls (5% vs. 1%, respectively, and 6% vs. 1%, respectively).

The researchers found no increase in hypertensive disorders of pregnancy or spontaneous pregnancy losses in SSc women, compared to the general pregnant population.

"We observed a low rate of disease progression shortly after the end of pregnancy; this risk might be greater in aSCL-70 positive patients with recent-onset disease," the researchers noted. All four cases of internal organ disease evolution within 12 months after delivery occurred in women who were aSCL-70 positive, and 3 of 23 (13%) of women who were aSCL-70 positive whose disease had lasted less than 3 years had some disease progression after delivery.

A total of six newborns spent a median of 15 days in the intensive care unit. Of these, one was severely premature and died of multi-organ failure.

The study findings were limited by the use of retrospective analysis and the use of controls for only one year, but the results suggest that successful pregnancies are possible for SSc women despite the increased risks for poor maternal and fetal outcomes, with multidisciplinary management, the researchers said. However, pregnancy may not be advisable for patients with severe organ damage or recent onset of SSc, especially those who are antitopoisomerase positive, they added.

The researchers had no financial conflicts to disclose. The study was supported in part by three patients’ associations: the Gruppo Italiano Lotta alla Sclerodermia, Gruppo Lupus Eritematoso Sistemico Lombardia, and the Associazone Lombarda Malati Reumatici.

Many women with systemic sclerosis can have successful pregnancies, but the rates of preterm birth, low birth weight, and intrauterine growth restriction are approximately twice as high in these women compared to the general population of pregnant women, based on data from 109 pregnancies in 99 women with systemic sclerosis.

The findings were published in Arthritis & Rheumatism (Arthritis Rheum. 2011 Dec. 28 [doi:10.1002/art.34350]).

Data from previous studies have suggested negative outcomes for pregnancies in women with systemic sclerosis (SSc), but these have been small case series or large database reviews that did not allow for the identification of individual patients, said Dr. Mara Taraborelli of Spedali Civili and University, Brescia, Italy, and colleagues.

In this prospective study, the researchers followed 99 women with SSc who had 109 pregnancies between 2000 and 2011. The women attended one of 25 participating research centers in Italy.

The average age at conception was 32 years, and most of the women were white. A total of 107 pregnancies were spontaneous, and 2 were achieved with assisted reproductive techniques.

Preterm deliveries were significantly more common in the SSc women, compared to the general obstetric population that served as a control group (25% vs. 12%, respectively). Severe preterm delivery (defined as delivery at less than 34 weeks) also was significantly more common in SSc women, compared to the controls (10% vs. 5%, respectively).

In addition, very low birth weight babies and cases of intrauterine growth restriction were significantly more common in the SSc women, compared to the controls (5% vs. 1%, respectively, and 6% vs. 1%, respectively).

The researchers found no increase in hypertensive disorders of pregnancy or spontaneous pregnancy losses in SSc women, compared to the general pregnant population.

"We observed a low rate of disease progression shortly after the end of pregnancy; this risk might be greater in aSCL-70 positive patients with recent-onset disease," the researchers noted. All four cases of internal organ disease evolution within 12 months after delivery occurred in women who were aSCL-70 positive, and 3 of 23 (13%) of women who were aSCL-70 positive whose disease had lasted less than 3 years had some disease progression after delivery.

A total of six newborns spent a median of 15 days in the intensive care unit. Of these, one was severely premature and died of multi-organ failure.

The study findings were limited by the use of retrospective analysis and the use of controls for only one year, but the results suggest that successful pregnancies are possible for SSc women despite the increased risks for poor maternal and fetal outcomes, with multidisciplinary management, the researchers said. However, pregnancy may not be advisable for patients with severe organ damage or recent onset of SSc, especially those who are antitopoisomerase positive, they added.

The researchers had no financial conflicts to disclose. The study was supported in part by three patients’ associations: the Gruppo Italiano Lotta alla Sclerodermia, Gruppo Lupus Eritematoso Sistemico Lombardia, and the Associazone Lombarda Malati Reumatici.

Many women with systemic sclerosis can have successful pregnancies, but the rates of preterm birth, low birth weight, and intrauterine growth restriction are approximately twice as high in these women compared to the general population of pregnant women, based on data from 109 pregnancies in 99 women with systemic sclerosis.

The findings were published in Arthritis & Rheumatism (Arthritis Rheum. 2011 Dec. 28 [doi:10.1002/art.34350]).

Data from previous studies have suggested negative outcomes for pregnancies in women with systemic sclerosis (SSc), but these have been small case series or large database reviews that did not allow for the identification of individual patients, said Dr. Mara Taraborelli of Spedali Civili and University, Brescia, Italy, and colleagues.

In this prospective study, the researchers followed 99 women with SSc who had 109 pregnancies between 2000 and 2011. The women attended one of 25 participating research centers in Italy.

The average age at conception was 32 years, and most of the women were white. A total of 107 pregnancies were spontaneous, and 2 were achieved with assisted reproductive techniques.

Preterm deliveries were significantly more common in the SSc women, compared to the general obstetric population that served as a control group (25% vs. 12%, respectively). Severe preterm delivery (defined as delivery at less than 34 weeks) also was significantly more common in SSc women, compared to the controls (10% vs. 5%, respectively).

In addition, very low birth weight babies and cases of intrauterine growth restriction were significantly more common in the SSc women, compared to the controls (5% vs. 1%, respectively, and 6% vs. 1%, respectively).

The researchers found no increase in hypertensive disorders of pregnancy or spontaneous pregnancy losses in SSc women, compared to the general pregnant population.

"We observed a low rate of disease progression shortly after the end of pregnancy; this risk might be greater in aSCL-70 positive patients with recent-onset disease," the researchers noted. All four cases of internal organ disease evolution within 12 months after delivery occurred in women who were aSCL-70 positive, and 3 of 23 (13%) of women who were aSCL-70 positive whose disease had lasted less than 3 years had some disease progression after delivery.

A total of six newborns spent a median of 15 days in the intensive care unit. Of these, one was severely premature and died of multi-organ failure.

The study findings were limited by the use of retrospective analysis and the use of controls for only one year, but the results suggest that successful pregnancies are possible for SSc women despite the increased risks for poor maternal and fetal outcomes, with multidisciplinary management, the researchers said. However, pregnancy may not be advisable for patients with severe organ damage or recent onset of SSc, especially those who are antitopoisomerase positive, they added.

The researchers had no financial conflicts to disclose. The study was supported in part by three patients’ associations: the Gruppo Italiano Lotta alla Sclerodermia, Gruppo Lupus Eritematoso Sistemico Lombardia, and the Associazone Lombarda Malati Reumatici.

TORONTO – Low vitamin D levels were linked with more psychotic features in mentally ill adolescents, in a small study.

Studies have linked vitamin D deficiency with seasonal affective disorder, schizophrenia, and depression, Dr. Barbara L. Gracious of Ohio State University, Columbus, said at the meeting. She and her colleagues studied 104 consecutive teens seen for acute or partial hospital stays for psychiatric symptoms over an 18-month period. Patients' average age was 15, 27% were male, and 73% were white. Overall, 72% had low vitamin D levels (25-OHD levels less than 30 ng/mL), and 34% were vitamin D deficient (25-OHD levels less than 20 ng/mL). By comparison, 9% of a cohort of teens from the NHANES (National Health and Nutrition Survey) were vitamin D deficient, the researchers noted.

Psychotic features were seen in 40% of the teens with low vitamin D levels and 16% of those with normal levels, a statistically significant difference. Black ethnicity was linked with vitamin D deficiency, but vitamin D–deficient black teens were not significantly more likely than were vitamin D–deficient white teens to exhibit psychotic features.

No studies indicate that vitamin D deficiency is a causative factor in psychosis.

Dr. Gracious is a consultant for Johnson & Johnson. None of her coauthors reported conflicts. The study was supported by the National Institutes of Health, Ohio State University, and the University of Rochester (N.Y.).

TORONTO – Low vitamin D levels were linked with more psychotic features in mentally ill adolescents, in a small study.

Studies have linked vitamin D deficiency with seasonal affective disorder, schizophrenia, and depression, Dr. Barbara L. Gracious of Ohio State University, Columbus, said at the meeting. She and her colleagues studied 104 consecutive teens seen for acute or partial hospital stays for psychiatric symptoms over an 18-month period. Patients' average age was 15, 27% were male, and 73% were white. Overall, 72% had low vitamin D levels (25-OHD levels less than 30 ng/mL), and 34% were vitamin D deficient (25-OHD levels less than 20 ng/mL). By comparison, 9% of a cohort of teens from the NHANES (National Health and Nutrition Survey) were vitamin D deficient, the researchers noted.

Psychotic features were seen in 40% of the teens with low vitamin D levels and 16% of those with normal levels, a statistically significant difference. Black ethnicity was linked with vitamin D deficiency, but vitamin D–deficient black teens were not significantly more likely than were vitamin D–deficient white teens to exhibit psychotic features.

No studies indicate that vitamin D deficiency is a causative factor in psychosis.

Dr. Gracious is a consultant for Johnson & Johnson. None of her coauthors reported conflicts. The study was supported by the National Institutes of Health, Ohio State University, and the University of Rochester (N.Y.).

TORONTO – Low vitamin D levels were linked with more psychotic features in mentally ill adolescents, in a small study.

Studies have linked vitamin D deficiency with seasonal affective disorder, schizophrenia, and depression, Dr. Barbara L. Gracious of Ohio State University, Columbus, said at the meeting. She and her colleagues studied 104 consecutive teens seen for acute or partial hospital stays for psychiatric symptoms over an 18-month period. Patients' average age was 15, 27% were male, and 73% were white. Overall, 72% had low vitamin D levels (25-OHD levels less than 30 ng/mL), and 34% were vitamin D deficient (25-OHD levels less than 20 ng/mL). By comparison, 9% of a cohort of teens from the NHANES (National Health and Nutrition Survey) were vitamin D deficient, the researchers noted.

Psychotic features were seen in 40% of the teens with low vitamin D levels and 16% of those with normal levels, a statistically significant difference. Black ethnicity was linked with vitamin D deficiency, but vitamin D–deficient black teens were not significantly more likely than were vitamin D–deficient white teens to exhibit psychotic features.

No studies indicate that vitamin D deficiency is a causative factor in psychosis.

Dr. Gracious is a consultant for Johnson & Johnson. None of her coauthors reported conflicts. The study was supported by the National Institutes of Health, Ohio State University, and the University of Rochester (N.Y.).