Heidi Splete

Major Finding: Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds).

Data Source: An analysis of 65 systematic reviews, 266 randomized, controlled trials, and 21 economic evaluations.

Disclosures: Lead author Dr. Zhang had no financial conflicts to disclose. Several of the co-authors have received consulting fees, honoraria, and research support from multiple drug and device manufacturers. No conflict of interest was identified that would prevent any OARSI Ethics Committee members from participating in the review.

Some osteoarthritis treatments are less effective than previously thought, judging from findings from a review of research conducted since 2006.

The goal of the update of published evidence is to determine whether the current Osteoarthritis Research Society International's (OARSI) recommendations for the treatment of OA, published in 2008, need to be modified. After reviewing this update and collecting feedback, the OARSI Treatment Guidelines Committee will determine whether changes are needed in 2010.

Acetaminophen use and surgical lavage and debridement were among the therapies that may be falling out of favor to treat knee and hip OA, but evidence supporting weight reduction is on the upswing, said Dr. Weiya Zhang, a rheumatologist at the University of Nottingham (England), and colleagues.

The researchers identified 64 systematic reviews, 266 randomized controlled trials, and 21 economic evaluations related to hip and knee OA that were published between January 2006 and January 2009.

“Of the 51 modalities of treatment addressed in the OARSI recommendations, 35 have now been systematically reviewed with 16 new or updated systematic reviews in the last 3 years,” the researchers wrote (Osteoarthritis Cartilage 2010 Feb. [Epub 10.1016/j.joca.2010.01.013

The reviewers assessed the best available evidence for effect size (ES) with 95% confidence intervals for improving function and relieving pain and stiffness associated with OA.

The new evidence for nonpharmacological therapies included several studies supporting weight reduction. Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds). The ES for pain relief for hip and knee OA were not significantly changed for acupuncture, education, exercise, and self-management.

New research on electromagnetic therapy showed a relatively small improvement in function (ES, 0.33) and no significant effect on pain reduction (ES, 0.16), in contrast to data from a 2002 Cochrane review showing an ES of 0.77 that almost led to electromagnetic therapy's inclusion in the 2008 OARSI guidelines (it was not included).

The review also yielded changes in evidence for pharmacological treatments for OA, notably for acetaminophen.

A review of five new studies of acetaminophen for knee OA showed no significant reductions in effect size for pain relief (pooled ES, 0.14).

Other recent studies showed an increased risk of hospitalization due to perforation, peptic ulceration, and bleeding when acetaminophen doses of more than 3 grams per day were used to treat OA (hazard ratio 1.20). No data from recent studies identified significant changes in the risks and benefits of oral or topical nonsteroidal anti-inflammatory agents, diacerhein, or interarticular corticosteroid injections for treating OA.

For surgical treatments, pooled results showed no benefit for lavage, debridement, or a combination of the two for treating OA compared with placebo. Effect sizes for pain relief, improvement in function, and reduction in stiffness were 0.21, 0.11, and 0.05, respectively.

For alternative medicine treatments, recent studies showed a reduced effect size for pain relief of OA with treatments including glucosamine sulphate, chondroitin sulphate, intra-articular hyaluronic acid injections, and avocado soybean unsponifiables. Recent studies of these treatments also showed increased evidence of publication bias and heterogeneous outcomes.

The results of the review were limited by many factors, including the inability to make comparisons across treatments when meta-analyses and systematic reviews had different inclusion and exclusion criteria than randomized controlled trials.

The researchers noted that there is a need for “a continuously updated, comprehensive, and coherent database of well-characterized trials of all modalities of treatment of OA.”

But they emphasized that treatment guidelines must be based on the best evidence, not simply on updated cumulative evidence.

Major Finding: Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds).

Data Source: An analysis of 65 systematic reviews, 266 randomized, controlled trials, and 21 economic evaluations.

Disclosures: Lead author Dr. Zhang had no financial conflicts to disclose. Several of the co-authors have received consulting fees, honoraria, and research support from multiple drug and device manufacturers. No conflict of interest was identified that would prevent any OARSI Ethics Committee members from participating in the review.

Some osteoarthritis treatments are less effective than previously thought, judging from findings from a review of research conducted since 2006.

The goal of the update of published evidence is to determine whether the current Osteoarthritis Research Society International's (OARSI) recommendations for the treatment of OA, published in 2008, need to be modified. After reviewing this update and collecting feedback, the OARSI Treatment Guidelines Committee will determine whether changes are needed in 2010.

Acetaminophen use and surgical lavage and debridement were among the therapies that may be falling out of favor to treat knee and hip OA, but evidence supporting weight reduction is on the upswing, said Dr. Weiya Zhang, a rheumatologist at the University of Nottingham (England), and colleagues.

The researchers identified 64 systematic reviews, 266 randomized controlled trials, and 21 economic evaluations related to hip and knee OA that were published between January 2006 and January 2009.

“Of the 51 modalities of treatment addressed in the OARSI recommendations, 35 have now been systematically reviewed with 16 new or updated systematic reviews in the last 3 years,” the researchers wrote (Osteoarthritis Cartilage 2010 Feb. [Epub 10.1016/j.joca.2010.01.013

The reviewers assessed the best available evidence for effect size (ES) with 95% confidence intervals for improving function and relieving pain and stiffness associated with OA.

The new evidence for nonpharmacological therapies included several studies supporting weight reduction. Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds). The ES for pain relief for hip and knee OA were not significantly changed for acupuncture, education, exercise, and self-management.

New research on electromagnetic therapy showed a relatively small improvement in function (ES, 0.33) and no significant effect on pain reduction (ES, 0.16), in contrast to data from a 2002 Cochrane review showing an ES of 0.77 that almost led to electromagnetic therapy's inclusion in the 2008 OARSI guidelines (it was not included).

The review also yielded changes in evidence for pharmacological treatments for OA, notably for acetaminophen.

A review of five new studies of acetaminophen for knee OA showed no significant reductions in effect size for pain relief (pooled ES, 0.14).

Other recent studies showed an increased risk of hospitalization due to perforation, peptic ulceration, and bleeding when acetaminophen doses of more than 3 grams per day were used to treat OA (hazard ratio 1.20). No data from recent studies identified significant changes in the risks and benefits of oral or topical nonsteroidal anti-inflammatory agents, diacerhein, or interarticular corticosteroid injections for treating OA.

For surgical treatments, pooled results showed no benefit for lavage, debridement, or a combination of the two for treating OA compared with placebo. Effect sizes for pain relief, improvement in function, and reduction in stiffness were 0.21, 0.11, and 0.05, respectively.

For alternative medicine treatments, recent studies showed a reduced effect size for pain relief of OA with treatments including glucosamine sulphate, chondroitin sulphate, intra-articular hyaluronic acid injections, and avocado soybean unsponifiables. Recent studies of these treatments also showed increased evidence of publication bias and heterogeneous outcomes.

The results of the review were limited by many factors, including the inability to make comparisons across treatments when meta-analyses and systematic reviews had different inclusion and exclusion criteria than randomized controlled trials.

The researchers noted that there is a need for “a continuously updated, comprehensive, and coherent database of well-characterized trials of all modalities of treatment of OA.”

But they emphasized that treatment guidelines must be based on the best evidence, not simply on updated cumulative evidence.

Major Finding: Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds).

Data Source: An analysis of 65 systematic reviews, 266 randomized, controlled trials, and 21 economic evaluations.

Disclosures: Lead author Dr. Zhang had no financial conflicts to disclose. Several of the co-authors have received consulting fees, honoraria, and research support from multiple drug and device manufacturers. No conflict of interest was identified that would prevent any OARSI Ethics Committee members from participating in the review.

Some osteoarthritis treatments are less effective than previously thought, judging from findings from a review of research conducted since 2006.

The goal of the update of published evidence is to determine whether the current Osteoarthritis Research Society International's (OARSI) recommendations for the treatment of OA, published in 2008, need to be modified. After reviewing this update and collecting feedback, the OARSI Treatment Guidelines Committee will determine whether changes are needed in 2010.

Acetaminophen use and surgical lavage and debridement were among the therapies that may be falling out of favor to treat knee and hip OA, but evidence supporting weight reduction is on the upswing, said Dr. Weiya Zhang, a rheumatologist at the University of Nottingham (England), and colleagues.

The researchers identified 64 systematic reviews, 266 randomized controlled trials, and 21 economic evaluations related to hip and knee OA that were published between January 2006 and January 2009.

“Of the 51 modalities of treatment addressed in the OARSI recommendations, 35 have now been systematically reviewed with 16 new or updated systematic reviews in the last 3 years,” the researchers wrote (Osteoarthritis Cartilage 2010 Feb. [Epub 10.1016/j.joca.2010.01.013

The reviewers assessed the best available evidence for effect size (ES) with 95% confidence intervals for improving function and relieving pain and stiffness associated with OA.

The new evidence for nonpharmacological therapies included several studies supporting weight reduction. Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds). The ES for pain relief for hip and knee OA were not significantly changed for acupuncture, education, exercise, and self-management.

New research on electromagnetic therapy showed a relatively small improvement in function (ES, 0.33) and no significant effect on pain reduction (ES, 0.16), in contrast to data from a 2002 Cochrane review showing an ES of 0.77 that almost led to electromagnetic therapy's inclusion in the 2008 OARSI guidelines (it was not included).

The review also yielded changes in evidence for pharmacological treatments for OA, notably for acetaminophen.

A review of five new studies of acetaminophen for knee OA showed no significant reductions in effect size for pain relief (pooled ES, 0.14).

Other recent studies showed an increased risk of hospitalization due to perforation, peptic ulceration, and bleeding when acetaminophen doses of more than 3 grams per day were used to treat OA (hazard ratio 1.20). No data from recent studies identified significant changes in the risks and benefits of oral or topical nonsteroidal anti-inflammatory agents, diacerhein, or interarticular corticosteroid injections for treating OA.

For surgical treatments, pooled results showed no benefit for lavage, debridement, or a combination of the two for treating OA compared with placebo. Effect sizes for pain relief, improvement in function, and reduction in stiffness were 0.21, 0.11, and 0.05, respectively.

For alternative medicine treatments, recent studies showed a reduced effect size for pain relief of OA with treatments including glucosamine sulphate, chondroitin sulphate, intra-articular hyaluronic acid injections, and avocado soybean unsponifiables. Recent studies of these treatments also showed increased evidence of publication bias and heterogeneous outcomes.

The results of the review were limited by many factors, including the inability to make comparisons across treatments when meta-analyses and systematic reviews had different inclusion and exclusion criteria than randomized controlled trials.

The researchers noted that there is a need for “a continuously updated, comprehensive, and coherent database of well-characterized trials of all modalities of treatment of OA.”

But they emphasized that treatment guidelines must be based on the best evidence, not simply on updated cumulative evidence.

New Orleans — Approximately half of children with asthma were deficient in vitamin D in a study of 99 children aged 18 and younger. The findings were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Previous studies have indicated that vitamin D insufficiency contributes to the pathophysiology of allergic disease, but data on vitamin D’s impact on children with allergies and asthma are limited, said Dr. Daniel Searing of National Jewish Health in Denver, Colo.

In this study, Dr. Searing and colleagues identified 99 children who had asthma, atopic dermatitis, and/or a food allergy. The researchers assessed vitamin D by measuring serum 25-hydroxyvitamin D levels.

Overall, 47% of the patients had insufficient levels of vitamin D (less than 30 ng/mL). The median vitamin D level was 31 ng/mL.

To assess the impact of vitamin D on inflammation, the researchers cultured peripheral blood mononuclear cells (PBMC) from 11 patients using either 10 nM vitamin D or a placebo medium for 24 hours, and supplemented them with either 10 or 100 nM of dexamethasone for the last 3 hours of culturing. Next, they measured mitogen-activated protein kinase phosphatase-1 (MKP-1) and interleukin-10 (IL-10.)

“Vitamin D enhances glucocorticoid induction of MKP-1 and IL-10 in asthmatic PBMC in vitro,” the researchers wrote. Vitamin D addition can enhance the activity of dexamethasone more than 10-fold, they added.

“The relationship between vitamin D and corticosteroid pathways, as well as its effect on the inflammatory response, is not fully understood,” the researchers emphasized. But the results suggest that vitamin D supplementation may enhance the anti-inflammatory function of corticosteroids in asthma patients, they noted.

Median vitamin D levels were significantly lower in children taking inhaled corticosteroids (29 ng/mL), oral corticosteroids (25 ng/mL) and long-acting beta-agonists (25 ng/mL), compared with children who were not taking inhaled corticosteroids, oral corticosteroids, or long-acting beta-agonists (35 ng/mL, 32 ng/mL, and 34 ng/mL, respectively)

In addition, median vitamin D levels were significantly lower in children with positive vs. negative aeroallergen sensitivity to dog dander (29 ng/mL vs. 35 ng/mL) and house dust mites (27 ng/mL vs. 31 ng/mL).

Dr. Searing had no financial conflicts to disclose. The study was supported in part by a grant from the National Institutes of Health.

New Orleans — Approximately half of children with asthma were deficient in vitamin D in a study of 99 children aged 18 and younger. The findings were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Previous studies have indicated that vitamin D insufficiency contributes to the pathophysiology of allergic disease, but data on vitamin D’s impact on children with allergies and asthma are limited, said Dr. Daniel Searing of National Jewish Health in Denver, Colo.

In this study, Dr. Searing and colleagues identified 99 children who had asthma, atopic dermatitis, and/or a food allergy. The researchers assessed vitamin D by measuring serum 25-hydroxyvitamin D levels.

Overall, 47% of the patients had insufficient levels of vitamin D (less than 30 ng/mL). The median vitamin D level was 31 ng/mL.

To assess the impact of vitamin D on inflammation, the researchers cultured peripheral blood mononuclear cells (PBMC) from 11 patients using either 10 nM vitamin D or a placebo medium for 24 hours, and supplemented them with either 10 or 100 nM of dexamethasone for the last 3 hours of culturing. Next, they measured mitogen-activated protein kinase phosphatase-1 (MKP-1) and interleukin-10 (IL-10.)

“Vitamin D enhances glucocorticoid induction of MKP-1 and IL-10 in asthmatic PBMC in vitro,” the researchers wrote. Vitamin D addition can enhance the activity of dexamethasone more than 10-fold, they added.

“The relationship between vitamin D and corticosteroid pathways, as well as its effect on the inflammatory response, is not fully understood,” the researchers emphasized. But the results suggest that vitamin D supplementation may enhance the anti-inflammatory function of corticosteroids in asthma patients, they noted.

Median vitamin D levels were significantly lower in children taking inhaled corticosteroids (29 ng/mL), oral corticosteroids (25 ng/mL) and long-acting beta-agonists (25 ng/mL), compared with children who were not taking inhaled corticosteroids, oral corticosteroids, or long-acting beta-agonists (35 ng/mL, 32 ng/mL, and 34 ng/mL, respectively)

In addition, median vitamin D levels were significantly lower in children with positive vs. negative aeroallergen sensitivity to dog dander (29 ng/mL vs. 35 ng/mL) and house dust mites (27 ng/mL vs. 31 ng/mL).

Dr. Searing had no financial conflicts to disclose. The study was supported in part by a grant from the National Institutes of Health.

New Orleans — Approximately half of children with asthma were deficient in vitamin D in a study of 99 children aged 18 and younger. The findings were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Previous studies have indicated that vitamin D insufficiency contributes to the pathophysiology of allergic disease, but data on vitamin D’s impact on children with allergies and asthma are limited, said Dr. Daniel Searing of National Jewish Health in Denver, Colo.

In this study, Dr. Searing and colleagues identified 99 children who had asthma, atopic dermatitis, and/or a food allergy. The researchers assessed vitamin D by measuring serum 25-hydroxyvitamin D levels.

Overall, 47% of the patients had insufficient levels of vitamin D (less than 30 ng/mL). The median vitamin D level was 31 ng/mL.

To assess the impact of vitamin D on inflammation, the researchers cultured peripheral blood mononuclear cells (PBMC) from 11 patients using either 10 nM vitamin D or a placebo medium for 24 hours, and supplemented them with either 10 or 100 nM of dexamethasone for the last 3 hours of culturing. Next, they measured mitogen-activated protein kinase phosphatase-1 (MKP-1) and interleukin-10 (IL-10.)

“Vitamin D enhances glucocorticoid induction of MKP-1 and IL-10 in asthmatic PBMC in vitro,” the researchers wrote. Vitamin D addition can enhance the activity of dexamethasone more than 10-fold, they added.

“The relationship between vitamin D and corticosteroid pathways, as well as its effect on the inflammatory response, is not fully understood,” the researchers emphasized. But the results suggest that vitamin D supplementation may enhance the anti-inflammatory function of corticosteroids in asthma patients, they noted.

Median vitamin D levels were significantly lower in children taking inhaled corticosteroids (29 ng/mL), oral corticosteroids (25 ng/mL) and long-acting beta-agonists (25 ng/mL), compared with children who were not taking inhaled corticosteroids, oral corticosteroids, or long-acting beta-agonists (35 ng/mL, 32 ng/mL, and 34 ng/mL, respectively)

In addition, median vitamin D levels were significantly lower in children with positive vs. negative aeroallergen sensitivity to dog dander (29 ng/mL vs. 35 ng/mL) and house dust mites (27 ng/mL vs. 31 ng/mL).

Dr. Searing had no financial conflicts to disclose. The study was supported in part by a grant from the National Institutes of Health.

BOSTON — The prevalence of genital injuries was significantly higher among white patients than black patients, based on a review of 2,234 women aged 13 years and older who were examined after being raped.

This may be misleading, though, because methods of recognizing these injuries can be ineffectual in black women, said Linda Rossman, M.S.N., of Michigan State University, East Lansing, and her colleagues.

Data from previous studies have shown that direct visualization, contrast media, and colposcopy may be less effective at identifying genital injuries in darker-skinned patients, she said.

“Color awareness may be an important component of the sexual assault forensic examination,” she said in a poster presented at the annual meeting of the American College of Emergency Physicians. The researchers reviewed data from 2,234 consecutive female patients who were referred to a community-based Sexual Assault Nurse Examiner program (SANE) from four urban emergency departments during a 10-year period. In this study, genital injury was defined as any visible tissue trauma that could be categorized using the TEARS classification system (tears, ecchymoses, abrasions, redness, and swelling).

In this community, 83% of the women were white and 17% were black, with similar demographic characteristics, and the details of the assault cases also were similar. Overall, the prevalence of documented anogenital injuries was significantly higher in whites, compared with blacks (64% vs. 54%). The pattern of anogenital injuries was similar in both groups. The injuries typically involved the fossa navicularis, followed by the posterior fourchette, labia, and hymen, the researchers said. In addition, the prevalence of documented nongenital injuries was significantly higher in whites, compared with blacks (39% vs. 26%).

Lacerations were the most common injuries in all patients, but whites had a significantly greater incidence of documented erythema, compared with blacks, the researchers noted.

Disclosures: None was reported.

BOSTON — The prevalence of genital injuries was significantly higher among white patients than black patients, based on a review of 2,234 women aged 13 years and older who were examined after being raped.

This may be misleading, though, because methods of recognizing these injuries can be ineffectual in black women, said Linda Rossman, M.S.N., of Michigan State University, East Lansing, and her colleagues.

Data from previous studies have shown that direct visualization, contrast media, and colposcopy may be less effective at identifying genital injuries in darker-skinned patients, she said.

“Color awareness may be an important component of the sexual assault forensic examination,” she said in a poster presented at the annual meeting of the American College of Emergency Physicians. The researchers reviewed data from 2,234 consecutive female patients who were referred to a community-based Sexual Assault Nurse Examiner program (SANE) from four urban emergency departments during a 10-year period. In this study, genital injury was defined as any visible tissue trauma that could be categorized using the TEARS classification system (tears, ecchymoses, abrasions, redness, and swelling).

In this community, 83% of the women were white and 17% were black, with similar demographic characteristics, and the details of the assault cases also were similar. Overall, the prevalence of documented anogenital injuries was significantly higher in whites, compared with blacks (64% vs. 54%). The pattern of anogenital injuries was similar in both groups. The injuries typically involved the fossa navicularis, followed by the posterior fourchette, labia, and hymen, the researchers said. In addition, the prevalence of documented nongenital injuries was significantly higher in whites, compared with blacks (39% vs. 26%).

Lacerations were the most common injuries in all patients, but whites had a significantly greater incidence of documented erythema, compared with blacks, the researchers noted.

Disclosures: None was reported.

BOSTON — The prevalence of genital injuries was significantly higher among white patients than black patients, based on a review of 2,234 women aged 13 years and older who were examined after being raped.

This may be misleading, though, because methods of recognizing these injuries can be ineffectual in black women, said Linda Rossman, M.S.N., of Michigan State University, East Lansing, and her colleagues.

Data from previous studies have shown that direct visualization, contrast media, and colposcopy may be less effective at identifying genital injuries in darker-skinned patients, she said.

“Color awareness may be an important component of the sexual assault forensic examination,” she said in a poster presented at the annual meeting of the American College of Emergency Physicians. The researchers reviewed data from 2,234 consecutive female patients who were referred to a community-based Sexual Assault Nurse Examiner program (SANE) from four urban emergency departments during a 10-year period. In this study, genital injury was defined as any visible tissue trauma that could be categorized using the TEARS classification system (tears, ecchymoses, abrasions, redness, and swelling).

In this community, 83% of the women were white and 17% were black, with similar demographic characteristics, and the details of the assault cases also were similar. Overall, the prevalence of documented anogenital injuries was significantly higher in whites, compared with blacks (64% vs. 54%). The pattern of anogenital injuries was similar in both groups. The injuries typically involved the fossa navicularis, followed by the posterior fourchette, labia, and hymen, the researchers said. In addition, the prevalence of documented nongenital injuries was significantly higher in whites, compared with blacks (39% vs. 26%).

Lacerations were the most common injuries in all patients, but whites had a significantly greater incidence of documented erythema, compared with blacks, the researchers noted.

Disclosures: None was reported.

Major Finding: Experts will review new evidence to determine whether changes are needed to the OARSI guidelines for the treatment of hip and knee OA.

Data Source: An analysis of 65 systematic reviews, 266 randomized, controlled trials, and 21 economic evaluations.

Disclosures: Dr. Zhang had no financial conflicts to disclose. Several coauthors have received consulting fees, honoraria, and research support from multiple pharmaceutical and device-manufacturing companies. No potential conflict of interest was identified that would prevent any OARSI Ethics Committee members from participating in the review.

Some osteoarthritis treatments are less effective than previously thought, judging from findings from a review of research conducted since 2006.

The goal of the update of published evidence is to determine whether the current Osteoarthritis Research Society International's (OARSI) recommendations for the treatment of OA, published in 2008, need to be modified. After reviewing this update and collecting feedback, the OARSI Treatment Guidelines Committee will determine whether changes are needed in 2010.

Acetaminophen use and surgical lavage and debridement were among the therapies that may be falling out of favor to treat knee and hip OA, but evidence supporting weight reduction is on the upswing, said Dr. Weiya Zhang, a rheumatologist at the University of Nottingham (England), and colleagues.

The researchers identified 64 systematic reviews, 266 randomized controlled trials, and 21 economic evaluations related to hip and knee OA that were published between January 2006 and January 2009. “Of the 51 modalities of treatment addressed in the OARSI recommendations, 35 have now been systematically reviewed with 16 new or updated systematic reviews in the last 3 years,” the researchers wrote (Osteoarthritis Cartilage 2010 Feb. [Epub doi:10.1016/j.joca.2010.01.013]). They assessed the best available evidence for effect size (ES) with 95% confidence intervals for improving function and relieving pain and stiffness associated with OA.

The new evidence for nonpharmacologic therapies included several studies supporting weight reduction. Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds). The ES for pain relief for hip and knee OA were not significantly changed for acupuncture, education, exercise, and self-management. New research on electromagnetic therapy showed a relatively small improvement in function (ES, 0.33) and no significant effect on pain reduction (ES, 0.16).

The review also yielded some changes in evidence for pharmacologic OA treatments, notably acetaminophen. A review of five new studies of acetaminophen for knee OA showed no significant reductions in effect size for pain relief (pooled ES, 0.14). Other recent studies showed an increased risk of hospitalization because of perforation, peptic ulceration, and bleeding when acetaminophen doses of more than 3 g/day were used to treat OA (hazard ratio, 1.20). No data from recent studies identified significant changes in the risks and benefits of oral or topical NSAIDs, diacerhein, or interarticular corticosteroid injections for treating OA.

For surgical treatments, pooled results showed no benefit for lavage, debridement, or a combination of the two for treating OA, compared with placebo. Effect sizes for pain relief, function improvement, and stiffness reduction were 0.21, 0.11, and 0.05, respectively.

The researchers noted that there is a need for “a continuously updated, comprehensive, and coherent database of well-characterized trials of all modalities of treatment of OA.” But they emphasized that treatment guidelines must be based on the best evidence, not simply on updated cumulative evidence.

Major Finding: Experts will review new evidence to determine whether changes are needed to the OARSI guidelines for the treatment of hip and knee OA.

Data Source: An analysis of 65 systematic reviews, 266 randomized, controlled trials, and 21 economic evaluations.

Disclosures: Dr. Zhang had no financial conflicts to disclose. Several coauthors have received consulting fees, honoraria, and research support from multiple pharmaceutical and device-manufacturing companies. No potential conflict of interest was identified that would prevent any OARSI Ethics Committee members from participating in the review.

Some osteoarthritis treatments are less effective than previously thought, judging from findings from a review of research conducted since 2006.

The goal of the update of published evidence is to determine whether the current Osteoarthritis Research Society International's (OARSI) recommendations for the treatment of OA, published in 2008, need to be modified. After reviewing this update and collecting feedback, the OARSI Treatment Guidelines Committee will determine whether changes are needed in 2010.

Acetaminophen use and surgical lavage and debridement were among the therapies that may be falling out of favor to treat knee and hip OA, but evidence supporting weight reduction is on the upswing, said Dr. Weiya Zhang, a rheumatologist at the University of Nottingham (England), and colleagues.

The researchers identified 64 systematic reviews, 266 randomized controlled trials, and 21 economic evaluations related to hip and knee OA that were published between January 2006 and January 2009. “Of the 51 modalities of treatment addressed in the OARSI recommendations, 35 have now been systematically reviewed with 16 new or updated systematic reviews in the last 3 years,” the researchers wrote (Osteoarthritis Cartilage 2010 Feb. [Epub doi:10.1016/j.joca.2010.01.013]). They assessed the best available evidence for effect size (ES) with 95% confidence intervals for improving function and relieving pain and stiffness associated with OA.

The new evidence for nonpharmacologic therapies included several studies supporting weight reduction. Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds). The ES for pain relief for hip and knee OA were not significantly changed for acupuncture, education, exercise, and self-management. New research on electromagnetic therapy showed a relatively small improvement in function (ES, 0.33) and no significant effect on pain reduction (ES, 0.16).

The review also yielded some changes in evidence for pharmacologic OA treatments, notably acetaminophen. A review of five new studies of acetaminophen for knee OA showed no significant reductions in effect size for pain relief (pooled ES, 0.14). Other recent studies showed an increased risk of hospitalization because of perforation, peptic ulceration, and bleeding when acetaminophen doses of more than 3 g/day were used to treat OA (hazard ratio, 1.20). No data from recent studies identified significant changes in the risks and benefits of oral or topical NSAIDs, diacerhein, or interarticular corticosteroid injections for treating OA.

For surgical treatments, pooled results showed no benefit for lavage, debridement, or a combination of the two for treating OA, compared with placebo. Effect sizes for pain relief, function improvement, and stiffness reduction were 0.21, 0.11, and 0.05, respectively.

The researchers noted that there is a need for “a continuously updated, comprehensive, and coherent database of well-characterized trials of all modalities of treatment of OA.” But they emphasized that treatment guidelines must be based on the best evidence, not simply on updated cumulative evidence.

Major Finding: Experts will review new evidence to determine whether changes are needed to the OARSI guidelines for the treatment of hip and knee OA.

Data Source: An analysis of 65 systematic reviews, 266 randomized, controlled trials, and 21 economic evaluations.

Disclosures: Dr. Zhang had no financial conflicts to disclose. Several coauthors have received consulting fees, honoraria, and research support from multiple pharmaceutical and device-manufacturing companies. No potential conflict of interest was identified that would prevent any OARSI Ethics Committee members from participating in the review.

Some osteoarthritis treatments are less effective than previously thought, judging from findings from a review of research conducted since 2006.

The goal of the update of published evidence is to determine whether the current Osteoarthritis Research Society International's (OARSI) recommendations for the treatment of OA, published in 2008, need to be modified. After reviewing this update and collecting feedback, the OARSI Treatment Guidelines Committee will determine whether changes are needed in 2010.

Acetaminophen use and surgical lavage and debridement were among the therapies that may be falling out of favor to treat knee and hip OA, but evidence supporting weight reduction is on the upswing, said Dr. Weiya Zhang, a rheumatologist at the University of Nottingham (England), and colleagues.

The researchers identified 64 systematic reviews, 266 randomized controlled trials, and 21 economic evaluations related to hip and knee OA that were published between January 2006 and January 2009. “Of the 51 modalities of treatment addressed in the OARSI recommendations, 35 have now been systematically reviewed with 16 new or updated systematic reviews in the last 3 years,” the researchers wrote (Osteoarthritis Cartilage 2010 Feb. [Epub doi:10.1016/j.joca.2010.01.013]). They assessed the best available evidence for effect size (ES) with 95% confidence intervals for improving function and relieving pain and stiffness associated with OA.

The new evidence for nonpharmacologic therapies included several studies supporting weight reduction. Pooled data from two new systemic reviews showed improvements in pain (ES, 0.20) and physical function (ES, 0.23) after an average weight loss of 6.1 kg (approximately 13 pounds). The ES for pain relief for hip and knee OA were not significantly changed for acupuncture, education, exercise, and self-management. New research on electromagnetic therapy showed a relatively small improvement in function (ES, 0.33) and no significant effect on pain reduction (ES, 0.16).

The review also yielded some changes in evidence for pharmacologic OA treatments, notably acetaminophen. A review of five new studies of acetaminophen for knee OA showed no significant reductions in effect size for pain relief (pooled ES, 0.14). Other recent studies showed an increased risk of hospitalization because of perforation, peptic ulceration, and bleeding when acetaminophen doses of more than 3 g/day were used to treat OA (hazard ratio, 1.20). No data from recent studies identified significant changes in the risks and benefits of oral or topical NSAIDs, diacerhein, or interarticular corticosteroid injections for treating OA.

For surgical treatments, pooled results showed no benefit for lavage, debridement, or a combination of the two for treating OA, compared with placebo. Effect sizes for pain relief, function improvement, and stiffness reduction were 0.21, 0.11, and 0.05, respectively.

The researchers noted that there is a need for “a continuously updated, comprehensive, and coherent database of well-characterized trials of all modalities of treatment of OA.” But they emphasized that treatment guidelines must be based on the best evidence, not simply on updated cumulative evidence.

WASHINGTON — Obese women are less likely to be screened for osteoporosis than are normal- or overweight women, according to findings from a study of more than 140,000 women included in an integrated health care plan database.

Previous studies have shown mixed results on the disparity in preventive health care for obese patients, compared with normal-weight patients, said Kristi Reynolds, Ph.D., of Kaiser Permanente in Pasadena, Calif., and her colleagues.

“It is largely unknown whether obesity is associated with the quality of care for osteoporosis, which is both preventable and treatable but is often undiagnosed and untreated,” the researchers said. Physicians may be less inclined to screen obese women for osteoporosis because body weight is associated with higher bone density, they suggested.

Data from 146,975 health care provider visits in 2007 and 2008 were reviewed.

The average age of the women was 73 years; 35% were normal weight; 35% were overweight; and 19%, 7%, and 4% fell into obesity categories I, II, and III, respectively. Normal weight body mass index (BMI) was defined as 18.5-24.9 kg/m

About 67% of the women had undergone bone mineral density testing within 4 years of the study, which was the criteria by which participants could be considered “screened.” Only 52% of women with a BMI of 40 kg/m

After controlling for age, race, and income, the odds ratio of osteoporosis screening for overweight women was 0.99, while the odds ratios for women in obese classes I, II, and III groups were 0.90, 0.77, and 0.60, respectively. The findings were presented in a poster at the the annual meeting of the Obesity Society.

The researchers are employees of Kaiser Permanente. They reported having no financial conflicts of interest.

—Heidi Splete

WASHINGTON — Obese women are less likely to be screened for osteoporosis than are normal- or overweight women, according to findings from a study of more than 140,000 women included in an integrated health care plan database.

Previous studies have shown mixed results on the disparity in preventive health care for obese patients, compared with normal-weight patients, said Kristi Reynolds, Ph.D., of Kaiser Permanente in Pasadena, Calif., and her colleagues.

“It is largely unknown whether obesity is associated with the quality of care for osteoporosis, which is both preventable and treatable but is often undiagnosed and untreated,” the researchers said. Physicians may be less inclined to screen obese women for osteoporosis because body weight is associated with higher bone density, they suggested.

Data from 146,975 health care provider visits in 2007 and 2008 were reviewed.

The average age of the women was 73 years; 35% were normal weight; 35% were overweight; and 19%, 7%, and 4% fell into obesity categories I, II, and III, respectively. Normal weight body mass index (BMI) was defined as 18.5-24.9 kg/m

About 67% of the women had undergone bone mineral density testing within 4 years of the study, which was the criteria by which participants could be considered “screened.” Only 52% of women with a BMI of 40 kg/m

After controlling for age, race, and income, the odds ratio of osteoporosis screening for overweight women was 0.99, while the odds ratios for women in obese classes I, II, and III groups were 0.90, 0.77, and 0.60, respectively. The findings were presented in a poster at the the annual meeting of the Obesity Society.

The researchers are employees of Kaiser Permanente. They reported having no financial conflicts of interest.

—Heidi Splete

WASHINGTON — Obese women are less likely to be screened for osteoporosis than are normal- or overweight women, according to findings from a study of more than 140,000 women included in an integrated health care plan database.

Previous studies have shown mixed results on the disparity in preventive health care for obese patients, compared with normal-weight patients, said Kristi Reynolds, Ph.D., of Kaiser Permanente in Pasadena, Calif., and her colleagues.

“It is largely unknown whether obesity is associated with the quality of care for osteoporosis, which is both preventable and treatable but is often undiagnosed and untreated,” the researchers said. Physicians may be less inclined to screen obese women for osteoporosis because body weight is associated with higher bone density, they suggested.

Data from 146,975 health care provider visits in 2007 and 2008 were reviewed.

The average age of the women was 73 years; 35% were normal weight; 35% were overweight; and 19%, 7%, and 4% fell into obesity categories I, II, and III, respectively. Normal weight body mass index (BMI) was defined as 18.5-24.9 kg/m

About 67% of the women had undergone bone mineral density testing within 4 years of the study, which was the criteria by which participants could be considered “screened.” Only 52% of women with a BMI of 40 kg/m

After controlling for age, race, and income, the odds ratio of osteoporosis screening for overweight women was 0.99, while the odds ratios for women in obese classes I, II, and III groups were 0.90, 0.77, and 0.60, respectively. The findings were presented in a poster at the the annual meeting of the Obesity Society.

The researchers are employees of Kaiser Permanente. They reported having no financial conflicts of interest.

—Heidi Splete

ORLANDO — Both the indication and the incidence of adenotonsillar procedures in children have changed, according to Dr. Laura Orvidas.

“We seem to do more adenotonsillectomies for sleep-disordered breathing than we have in the past,” she said at the combined sections meeting of the Triological Society.

To evaluate changes in the incidence and indications for tonsillectomy and adenotonsillectomy, Dr. Orvidas of the Mayo Clinic in Rochester, Minn., reviewed data from the Mayo Clinic's database for a 35-year period between 1970 and 2005. The study population included 8,106 tonsillectomy and/or adenotonsillectomy patients aged 6 months to 29 years (mean age, 10.5 years).

The most interesting finding was the change in surgical indications for all procedures, said Dr. Orvidas: “Early on we were treating mostly for infection, and now it seems to be mostly for upper airway obstruction.” In 1970, treatment of infection accounted for approximately 90% of either adenotonsillectomies or tonsillectomies, while upper airway obstruction accounted for about 10%. In 2005, upper airway obstruction accounted for more than half of the indications for both procedures, while infection accounted for about 25% and a combination of both upper airway obstruction and infection accounted for approximately 20%.

The incidence of tonsillectomy or adenotonsillectomy was 369/100,000 person-years during the period from 1970 to 1974, compared with 642/100,000 person-years from 2001 to 2005, Dr. Orvidas said. Sixty-five percent of the tonsillectomy patients, 48% of the adenotonsillectomy patients, and 55% of the patients for both conditions were female.

“Neither the indication nor the incidence for adenotonsillar surgery has been static,” Dr. Orvidas noted at the meeting, jointly sponsored by the Triological Society and the American College of Surgeons.

Adenotonsillectomy incidence increased more than tonsillectomy incidence overall, although there was a high density of tonsillectomies in adolescent females, she said. For tonsillectomy alone, the mean age across the entire study period was 16 years vs. a mean of 7 years for adenotonsillectomy.

Dr. Orvidas also noted an increase in both adenotonsillectomy and tonsillectomy procedures for younger males. The possible reasons for these two trends were not addressed in the Mayo Clinic study.

Disclosures: Dr. Orvidas said she had no financial conflicts to disclose.

ORLANDO — Both the indication and the incidence of adenotonsillar procedures in children have changed, according to Dr. Laura Orvidas.

“We seem to do more adenotonsillectomies for sleep-disordered breathing than we have in the past,” she said at the combined sections meeting of the Triological Society.

To evaluate changes in the incidence and indications for tonsillectomy and adenotonsillectomy, Dr. Orvidas of the Mayo Clinic in Rochester, Minn., reviewed data from the Mayo Clinic's database for a 35-year period between 1970 and 2005. The study population included 8,106 tonsillectomy and/or adenotonsillectomy patients aged 6 months to 29 years (mean age, 10.5 years).

The most interesting finding was the change in surgical indications for all procedures, said Dr. Orvidas: “Early on we were treating mostly for infection, and now it seems to be mostly for upper airway obstruction.” In 1970, treatment of infection accounted for approximately 90% of either adenotonsillectomies or tonsillectomies, while upper airway obstruction accounted for about 10%. In 2005, upper airway obstruction accounted for more than half of the indications for both procedures, while infection accounted for about 25% and a combination of both upper airway obstruction and infection accounted for approximately 20%.

The incidence of tonsillectomy or adenotonsillectomy was 369/100,000 person-years during the period from 1970 to 1974, compared with 642/100,000 person-years from 2001 to 2005, Dr. Orvidas said. Sixty-five percent of the tonsillectomy patients, 48% of the adenotonsillectomy patients, and 55% of the patients for both conditions were female.

“Neither the indication nor the incidence for adenotonsillar surgery has been static,” Dr. Orvidas noted at the meeting, jointly sponsored by the Triological Society and the American College of Surgeons.

Adenotonsillectomy incidence increased more than tonsillectomy incidence overall, although there was a high density of tonsillectomies in adolescent females, she said. For tonsillectomy alone, the mean age across the entire study period was 16 years vs. a mean of 7 years for adenotonsillectomy.

Dr. Orvidas also noted an increase in both adenotonsillectomy and tonsillectomy procedures for younger males. The possible reasons for these two trends were not addressed in the Mayo Clinic study.

Disclosures: Dr. Orvidas said she had no financial conflicts to disclose.

ORLANDO — Both the indication and the incidence of adenotonsillar procedures in children have changed, according to Dr. Laura Orvidas.

“We seem to do more adenotonsillectomies for sleep-disordered breathing than we have in the past,” she said at the combined sections meeting of the Triological Society.

To evaluate changes in the incidence and indications for tonsillectomy and adenotonsillectomy, Dr. Orvidas of the Mayo Clinic in Rochester, Minn., reviewed data from the Mayo Clinic's database for a 35-year period between 1970 and 2005. The study population included 8,106 tonsillectomy and/or adenotonsillectomy patients aged 6 months to 29 years (mean age, 10.5 years).

The most interesting finding was the change in surgical indications for all procedures, said Dr. Orvidas: “Early on we were treating mostly for infection, and now it seems to be mostly for upper airway obstruction.” In 1970, treatment of infection accounted for approximately 90% of either adenotonsillectomies or tonsillectomies, while upper airway obstruction accounted for about 10%. In 2005, upper airway obstruction accounted for more than half of the indications for both procedures, while infection accounted for about 25% and a combination of both upper airway obstruction and infection accounted for approximately 20%.

The incidence of tonsillectomy or adenotonsillectomy was 369/100,000 person-years during the period from 1970 to 1974, compared with 642/100,000 person-years from 2001 to 2005, Dr. Orvidas said. Sixty-five percent of the tonsillectomy patients, 48% of the adenotonsillectomy patients, and 55% of the patients for both conditions were female.

“Neither the indication nor the incidence for adenotonsillar surgery has been static,” Dr. Orvidas noted at the meeting, jointly sponsored by the Triological Society and the American College of Surgeons.

Adenotonsillectomy incidence increased more than tonsillectomy incidence overall, although there was a high density of tonsillectomies in adolescent females, she said. For tonsillectomy alone, the mean age across the entire study period was 16 years vs. a mean of 7 years for adenotonsillectomy.

Dr. Orvidas also noted an increase in both adenotonsillectomy and tonsillectomy procedures for younger males. The possible reasons for these two trends were not addressed in the Mayo Clinic study.

Disclosures: Dr. Orvidas said she had no financial conflicts to disclose.

Major Finding: Children with asthma who underwent adenotonsillectomies required significantly less asthma medication and had fewer hospitalizations, compared with presurgical utilization.

Data Source: A retrospective review of 465 consecutive children with and without asthma who underwent adenotonsillectomy at a single institution. Symptoms of asthma were compared 12 months pre- and post surgery.

Disclosures: Dr. Busino had no financial conflicts to disclose.

ORLANDO — Children with asthma who underwent adenotonsillectomies showed significant improvement in their asthma symptoms, compared with presurgical levels, according to findings from a retrospective review of 93 children with asthma.

Children with asthma are at greater risk for sleep-disordered breathing than their peers without asthma, said Dr. Rowley S. Busino of the University of Medicine and Dentistry of New Jersey, Newark. Consequently, asthma is a common comorbidity in children undergoing adenotonsillectomy.

Parents of children with asthma often report that their children's asthmatic symptoms improve after an adenotonsillectomy, but that observation has not been well studied, Dr. Busino observed.

Dr. Busino and her colleagues reviewed data from all children who underwent adenotonsillectomy at a single institution between 2002 and 2007. The study population included 93 children with asthma and 372 children without asthma. The children were aged 3-14 years, with an average age of 6 years. Children younger than 3 years and those with comorbid medical conditions including Down syndrome, heart disease, subglottic stenosis, prematurity, and neurological disorders were excluded.

Both groups were similar in terms of age and gender distribution, and the most common reason for surgery in both groups was obstructive sleep apnea/adenotonsillar hypertrophy. Asthma symptoms were assessed 12 months before and 12 months after surgery, according to a poster presented at the Triological Society's Combined Sections Meeting.

After surgery, the children with asthma had significantly fewer hospital visits (1.6 vs. 0.1), and used significantly fewer daily medications (2.6 vs. 2.3) and systemic steroids (2.0 vs. 0.5), compared with presurgery levels.

Scores on the Asthma Control Test also improved significantly after surgery, compared with presurgery scores, from 18.5 to 20.5.

Because of the small number of respiratory complications in each group, the researchers were not able to assess whether children with asthma had a higher postoperative respiratory complication rate, compared with children without asthma. The average length of postoperative hospital stay was not significantly different between the asthma and control groups.

“This study suggests that adenotonsillectomy, which provides improvement in the upper airways of children, may in turn lead to improvement of their lower airways,” Dr. Busino said at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

Prospective studies to clarify the relationship between asthma, adenotonsillectomy, and obstructive sleep apnea are needed to improve clinical care, she said.

Major Finding: Children with asthma who underwent adenotonsillectomies required significantly less asthma medication and had fewer hospitalizations, compared with presurgical utilization.

Data Source: A retrospective review of 465 consecutive children with and without asthma who underwent adenotonsillectomy at a single institution. Symptoms of asthma were compared 12 months pre- and post surgery.

Disclosures: Dr. Busino had no financial conflicts to disclose.

ORLANDO — Children with asthma who underwent adenotonsillectomies showed significant improvement in their asthma symptoms, compared with presurgical levels, according to findings from a retrospective review of 93 children with asthma.

Children with asthma are at greater risk for sleep-disordered breathing than their peers without asthma, said Dr. Rowley S. Busino of the University of Medicine and Dentistry of New Jersey, Newark. Consequently, asthma is a common comorbidity in children undergoing adenotonsillectomy.

Parents of children with asthma often report that their children's asthmatic symptoms improve after an adenotonsillectomy, but that observation has not been well studied, Dr. Busino observed.

Dr. Busino and her colleagues reviewed data from all children who underwent adenotonsillectomy at a single institution between 2002 and 2007. The study population included 93 children with asthma and 372 children without asthma. The children were aged 3-14 years, with an average age of 6 years. Children younger than 3 years and those with comorbid medical conditions including Down syndrome, heart disease, subglottic stenosis, prematurity, and neurological disorders were excluded.

Both groups were similar in terms of age and gender distribution, and the most common reason for surgery in both groups was obstructive sleep apnea/adenotonsillar hypertrophy. Asthma symptoms were assessed 12 months before and 12 months after surgery, according to a poster presented at the Triological Society's Combined Sections Meeting.

After surgery, the children with asthma had significantly fewer hospital visits (1.6 vs. 0.1), and used significantly fewer daily medications (2.6 vs. 2.3) and systemic steroids (2.0 vs. 0.5), compared with presurgery levels.

Scores on the Asthma Control Test also improved significantly after surgery, compared with presurgery scores, from 18.5 to 20.5.

Because of the small number of respiratory complications in each group, the researchers were not able to assess whether children with asthma had a higher postoperative respiratory complication rate, compared with children without asthma. The average length of postoperative hospital stay was not significantly different between the asthma and control groups.

“This study suggests that adenotonsillectomy, which provides improvement in the upper airways of children, may in turn lead to improvement of their lower airways,” Dr. Busino said at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

Prospective studies to clarify the relationship between asthma, adenotonsillectomy, and obstructive sleep apnea are needed to improve clinical care, she said.

Major Finding: Children with asthma who underwent adenotonsillectomies required significantly less asthma medication and had fewer hospitalizations, compared with presurgical utilization.

Data Source: A retrospective review of 465 consecutive children with and without asthma who underwent adenotonsillectomy at a single institution. Symptoms of asthma were compared 12 months pre- and post surgery.

Disclosures: Dr. Busino had no financial conflicts to disclose.

ORLANDO — Children with asthma who underwent adenotonsillectomies showed significant improvement in their asthma symptoms, compared with presurgical levels, according to findings from a retrospective review of 93 children with asthma.

Children with asthma are at greater risk for sleep-disordered breathing than their peers without asthma, said Dr. Rowley S. Busino of the University of Medicine and Dentistry of New Jersey, Newark. Consequently, asthma is a common comorbidity in children undergoing adenotonsillectomy.

Parents of children with asthma often report that their children's asthmatic symptoms improve after an adenotonsillectomy, but that observation has not been well studied, Dr. Busino observed.

Dr. Busino and her colleagues reviewed data from all children who underwent adenotonsillectomy at a single institution between 2002 and 2007. The study population included 93 children with asthma and 372 children without asthma. The children were aged 3-14 years, with an average age of 6 years. Children younger than 3 years and those with comorbid medical conditions including Down syndrome, heart disease, subglottic stenosis, prematurity, and neurological disorders were excluded.

Both groups were similar in terms of age and gender distribution, and the most common reason for surgery in both groups was obstructive sleep apnea/adenotonsillar hypertrophy. Asthma symptoms were assessed 12 months before and 12 months after surgery, according to a poster presented at the Triological Society's Combined Sections Meeting.

After surgery, the children with asthma had significantly fewer hospital visits (1.6 vs. 0.1), and used significantly fewer daily medications (2.6 vs. 2.3) and systemic steroids (2.0 vs. 0.5), compared with presurgery levels.

Scores on the Asthma Control Test also improved significantly after surgery, compared with presurgery scores, from 18.5 to 20.5.

Because of the small number of respiratory complications in each group, the researchers were not able to assess whether children with asthma had a higher postoperative respiratory complication rate, compared with children without asthma. The average length of postoperative hospital stay was not significantly different between the asthma and control groups.

“This study suggests that adenotonsillectomy, which provides improvement in the upper airways of children, may in turn lead to improvement of their lower airways,” Dr. Busino said at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

Prospective studies to clarify the relationship between asthma, adenotonsillectomy, and obstructive sleep apnea are needed to improve clinical care, she said.

Major Findings: Depressive symptoms were reported by 76% of adolescents seeking bariatric surgery.

Data Source: A review of baseline psychosocial characteristics of 82 teens undergoing bariatric surgery.

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

WASHINGTON – Almost one-third of adolescents who were approved for bariatric surgery reported using psychotropic medications, but the use of substances such as drugs and alcohol was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. However, 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues crossing physical, social, emotional, and body-esteem domains.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS).

Teen-LABS includes five clinical centers collaborating to facilitate clinical, behavioral, and epidemiologic studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the group's Web site, www.teen-LABS.org

Major Findings: Depressive symptoms were reported by 76% of adolescents seeking bariatric surgery.

Data Source: A review of baseline psychosocial characteristics of 82 teens undergoing bariatric surgery.

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

WASHINGTON – Almost one-third of adolescents who were approved for bariatric surgery reported using psychotropic medications, but the use of substances such as drugs and alcohol was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. However, 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues crossing physical, social, emotional, and body-esteem domains.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS).

Teen-LABS includes five clinical centers collaborating to facilitate clinical, behavioral, and epidemiologic studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the group's Web site, www.teen-LABS.org

Major Findings: Depressive symptoms were reported by 76% of adolescents seeking bariatric surgery.

Data Source: A review of baseline psychosocial characteristics of 82 teens undergoing bariatric surgery.

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

WASHINGTON – Almost one-third of adolescents who were approved for bariatric surgery reported using psychotropic medications, but the use of substances such as drugs and alcohol was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. However, 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues crossing physical, social, emotional, and body-esteem domains.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS).

Teen-LABS includes five clinical centers collaborating to facilitate clinical, behavioral, and epidemiologic studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the group's Web site, www.teen-LABS.org

"The benefits of sun protection clearly outweigh the risks," said Dr. Sheila Fallon Friedlander, but the debate continues over how to balance the benefits of outdoor activities for children with protection against skin cancer.

Some studies suggest outdoor activity is protective against melanoma, Dr. Friedlander said  She cited a case-control study of 583 cases of cutaneous malignant melanoma and 608 controls (Int. J. Epidemiol. 1999;28:418-27). Intermittent sun exposure, such as beach vacations during adolescence and the use of tanning beds and sunlamps, was associated with a significantly greater risk for melanoma, whereas chronic exposure, indicated by days of outdoor activity during adolescence and by outdoor jobs in adulthood, was associated with a significantly reduced risk for melanoma.

But sun protection and patient education does appear to play a role in reducing the number of nevi in children. Dr. Friedlander, clinical professor of pediatrics and medicine at the University of California, San Diego, cited another study in which 458 children in first to fourth grade in Canada were randomized to receive sunscreen and counseling about sun protection. Three years later, the sunscreen group had significantly fewer new nevi compared with the control group (JAMA 2000;283:2955-60).

What's a dermatologist to do? "Common sense prevails," Dr. Friedlander said. She advised dermatologists to counsel children and their parents to protect against sunburns by using sunscreens and sun-protective clothing. Also, "identify high-risk patients and follow them" so that any problems can be spotted early, she said.

But once parents and children are on board with sun protection, what should they use? The Environmental Working Group (EWG), a nonprofit organization that reviews and disseminates information about contaminants in consumer products and the environment, has come down in favor of physical sunscreens, based on a review of 400 studies and 2,000 sunscreens, Dr. Friedlander said.

Some parents and children prefer organic sunscreens, which contain oxybenzones, but the EWG rates these products as more dangerous than physical sunscreens. Some research suggests that oxybenzones can be absorbed into the skin in a way that the nano-particles of zinc oxide and titanium dioxide in physical sunscreens cannot, Dr. Friedlander said.

Be aware of what sunscreen characteristics raise concerns in your patients and their parents, Dr. Friedlander said. Share information with them, refer them to the EWG Web (www.ewg.org) and come up with a reasonable plan for sun protection.

Dr. Friedlander has served as a clinical investigator for Johnson & Johnson, which manufactures sunscreen products. SDEF and this news organization are owned by Elsevier.

"The benefits of sun protection clearly outweigh the risks," said Dr. Sheila Fallon Friedlander, but the debate continues over how to balance the benefits of outdoor activities for children with protection against skin cancer.

Some studies suggest outdoor activity is protective against melanoma, Dr. Friedlander said  She cited a case-control study of 583 cases of cutaneous malignant melanoma and 608 controls (Int. J. Epidemiol. 1999;28:418-27). Intermittent sun exposure, such as beach vacations during adolescence and the use of tanning beds and sunlamps, was associated with a significantly greater risk for melanoma, whereas chronic exposure, indicated by days of outdoor activity during adolescence and by outdoor jobs in adulthood, was associated with a significantly reduced risk for melanoma.

But sun protection and patient education does appear to play a role in reducing the number of nevi in children. Dr. Friedlander, clinical professor of pediatrics and medicine at the University of California, San Diego, cited another study in which 458 children in first to fourth grade in Canada were randomized to receive sunscreen and counseling about sun protection. Three years later, the sunscreen group had significantly fewer new nevi compared with the control group (JAMA 2000;283:2955-60).

What's a dermatologist to do? "Common sense prevails," Dr. Friedlander said. She advised dermatologists to counsel children and their parents to protect against sunburns by using sunscreens and sun-protective clothing. Also, "identify high-risk patients and follow them" so that any problems can be spotted early, she said.

But once parents and children are on board with sun protection, what should they use? The Environmental Working Group (EWG), a nonprofit organization that reviews and disseminates information about contaminants in consumer products and the environment, has come down in favor of physical sunscreens, based on a review of 400 studies and 2,000 sunscreens, Dr. Friedlander said.

Some parents and children prefer organic sunscreens, which contain oxybenzones, but the EWG rates these products as more dangerous than physical sunscreens. Some research suggests that oxybenzones can be absorbed into the skin in a way that the nano-particles of zinc oxide and titanium dioxide in physical sunscreens cannot, Dr. Friedlander said.

Be aware of what sunscreen characteristics raise concerns in your patients and their parents, Dr. Friedlander said. Share information with them, refer them to the EWG Web (www.ewg.org) and come up with a reasonable plan for sun protection.

Dr. Friedlander has served as a clinical investigator for Johnson & Johnson, which manufactures sunscreen products. SDEF and this news organization are owned by Elsevier.

"The benefits of sun protection clearly outweigh the risks," said Dr. Sheila Fallon Friedlander, but the debate continues over how to balance the benefits of outdoor activities for children with protection against skin cancer.

Some studies suggest outdoor activity is protective against melanoma, Dr. Friedlander said  She cited a case-control study of 583 cases of cutaneous malignant melanoma and 608 controls (Int. J. Epidemiol. 1999;28:418-27). Intermittent sun exposure, such as beach vacations during adolescence and the use of tanning beds and sunlamps, was associated with a significantly greater risk for melanoma, whereas chronic exposure, indicated by days of outdoor activity during adolescence and by outdoor jobs in adulthood, was associated with a significantly reduced risk for melanoma.

But sun protection and patient education does appear to play a role in reducing the number of nevi in children. Dr. Friedlander, clinical professor of pediatrics and medicine at the University of California, San Diego, cited another study in which 458 children in first to fourth grade in Canada were randomized to receive sunscreen and counseling about sun protection. Three years later, the sunscreen group had significantly fewer new nevi compared with the control group (JAMA 2000;283:2955-60).

What's a dermatologist to do? "Common sense prevails," Dr. Friedlander said. She advised dermatologists to counsel children and their parents to protect against sunburns by using sunscreens and sun-protective clothing. Also, "identify high-risk patients and follow them" so that any problems can be spotted early, she said.

But once parents and children are on board with sun protection, what should they use? The Environmental Working Group (EWG), a nonprofit organization that reviews and disseminates information about contaminants in consumer products and the environment, has come down in favor of physical sunscreens, based on a review of 400 studies and 2,000 sunscreens, Dr. Friedlander said.

Some parents and children prefer organic sunscreens, which contain oxybenzones, but the EWG rates these products as more dangerous than physical sunscreens. Some research suggests that oxybenzones can be absorbed into the skin in a way that the nano-particles of zinc oxide and titanium dioxide in physical sunscreens cannot, Dr. Friedlander said.

Be aware of what sunscreen characteristics raise concerns in your patients and their parents, Dr. Friedlander said. Share information with them, refer them to the EWG Web (www.ewg.org) and come up with a reasonable plan for sun protection.

Dr. Friedlander has served as a clinical investigator for Johnson & Johnson, which manufactures sunscreen products. SDEF and this news organization are owned by Elsevier.

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, according to study findings.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of coronary heart disease per year by an estimated 60,000 to 120,000, according to the computer model. New cases of stroke would be reduced by 32,000 to 66,000, and new cases of myocardial infarction would be reduced by 54,000 to 99,000.

Cutting daily salt consumption would benefit adults of all ages, both genders, and all races, according to the model, but “the anticipated relative benefits among blacks would be greater than those among nonblacks across all age groups and both sexes,” the researchers noted.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent myocardial infarction and stroke.

In adults aged 35 to 64 years, the relative reduction in mortality would be approximately 7%–11% for blacks and 3%–6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000 to 392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but add that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and myocardial infarction with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMe0910352

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, according to study findings.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of coronary heart disease per year by an estimated 60,000 to 120,000, according to the computer model. New cases of stroke would be reduced by 32,000 to 66,000, and new cases of myocardial infarction would be reduced by 54,000 to 99,000.

Cutting daily salt consumption would benefit adults of all ages, both genders, and all races, according to the model, but “the anticipated relative benefits among blacks would be greater than those among nonblacks across all age groups and both sexes,” the researchers noted.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent myocardial infarction and stroke.

In adults aged 35 to 64 years, the relative reduction in mortality would be approximately 7%–11% for blacks and 3%–6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000 to 392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but add that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and myocardial infarction with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMe0910352

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, according to study findings.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of coronary heart disease per year by an estimated 60,000 to 120,000, according to the computer model. New cases of stroke would be reduced by 32,000 to 66,000, and new cases of myocardial infarction would be reduced by 54,000 to 99,000.

Cutting daily salt consumption would benefit adults of all ages, both genders, and all races, according to the model, but “the anticipated relative benefits among blacks would be greater than those among nonblacks across all age groups and both sexes,” the researchers noted.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent myocardial infarction and stroke.

In adults aged 35 to 64 years, the relative reduction in mortality would be approximately 7%–11% for blacks and 3%–6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000 to 392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but add that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and myocardial infarction with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (NEJM 2010 Jan. 20 [Epub doi: 10.1056/NEJMe0910352