Heidi Splete

Approximately 1% of 8-year-old children in the United States meet criteria for an autism spectrum disorder, based on results of a nationwide study of 8-year-olds conducted in 2006.

“No single factor explains the change in prevalence,” said Catherine Rice, Ph.D., of the National Center on Birth Defects and Developmental Disabilities. Dr. Rice presented the study results in a telebriefing.

The study included health and education records from 11 communities throughout the United States participating in the Autism and Developmental Disabilities Network (ADDM). The project was funded by the Centers for Disease Control and Prevention. Dr. Rice and her colleagues at the CDC focused on 8-year-olds because most children with autism spectrum disorder (ASD) have been identified by this age. A team of clinicians reviewed the records to confirm ASD diagnoses and identified 2,757 children who met criteria for ASD (MMWR 2009;58[SS-10]:1–24).

The prevalence of ASD among 8-year-olds increased by an average of 57% between 2002 and 2006, based on data from 10 reporting communities that participated in the study in both years. This increase might be attributable to improved diagnostic techniques, but “a true increase in the risk for children to develop ASD symptoms cannot be ruled out,” the researchers said.

Increases in ASD occurred across sex, ethnicity, and cognitive function, but the most consistent pattern was the increase in ASD among boys, Dr. Rice said. Overall, the prevalence of ASD was 1 in 70 boys and 1 in 315 girls, which amounts to a four to five times higher prevalence in boys, compared with girls.

Dr. Rice advised all primary care physicians who suspect ASD in a child to refer the child for further diagnostic evaluation or intervention.

The researchers did not conduct in-person evaluations of each child, and the results were limited by variations in record keeping. The study was not designed to evaluate causes of ASD, but the findings suggest that more research is needed to determine how genetic and environmental factors interact to cause ASD spectrum symptoms, the researchers wrote.

Approximately 1% of 8-year-old children in the United States meet criteria for an autism spectrum disorder, based on results of a nationwide study of 8-year-olds conducted in 2006.

“No single factor explains the change in prevalence,” said Catherine Rice, Ph.D., of the National Center on Birth Defects and Developmental Disabilities. Dr. Rice presented the study results in a telebriefing.

The study included health and education records from 11 communities throughout the United States participating in the Autism and Developmental Disabilities Network (ADDM). The project was funded by the Centers for Disease Control and Prevention. Dr. Rice and her colleagues at the CDC focused on 8-year-olds because most children with autism spectrum disorder (ASD) have been identified by this age. A team of clinicians reviewed the records to confirm ASD diagnoses and identified 2,757 children who met criteria for ASD (MMWR 2009;58[SS-10]:1–24).

The prevalence of ASD among 8-year-olds increased by an average of 57% between 2002 and 2006, based on data from 10 reporting communities that participated in the study in both years. This increase might be attributable to improved diagnostic techniques, but “a true increase in the risk for children to develop ASD symptoms cannot be ruled out,” the researchers said.

Increases in ASD occurred across sex, ethnicity, and cognitive function, but the most consistent pattern was the increase in ASD among boys, Dr. Rice said. Overall, the prevalence of ASD was 1 in 70 boys and 1 in 315 girls, which amounts to a four to five times higher prevalence in boys, compared with girls.

Dr. Rice advised all primary care physicians who suspect ASD in a child to refer the child for further diagnostic evaluation or intervention.

The researchers did not conduct in-person evaluations of each child, and the results were limited by variations in record keeping. The study was not designed to evaluate causes of ASD, but the findings suggest that more research is needed to determine how genetic and environmental factors interact to cause ASD spectrum symptoms, the researchers wrote.

Approximately 1% of 8-year-old children in the United States meet criteria for an autism spectrum disorder, based on results of a nationwide study of 8-year-olds conducted in 2006.

“No single factor explains the change in prevalence,” said Catherine Rice, Ph.D., of the National Center on Birth Defects and Developmental Disabilities. Dr. Rice presented the study results in a telebriefing.

The study included health and education records from 11 communities throughout the United States participating in the Autism and Developmental Disabilities Network (ADDM). The project was funded by the Centers for Disease Control and Prevention. Dr. Rice and her colleagues at the CDC focused on 8-year-olds because most children with autism spectrum disorder (ASD) have been identified by this age. A team of clinicians reviewed the records to confirm ASD diagnoses and identified 2,757 children who met criteria for ASD (MMWR 2009;58[SS-10]:1–24).

The prevalence of ASD among 8-year-olds increased by an average of 57% between 2002 and 2006, based on data from 10 reporting communities that participated in the study in both years. This increase might be attributable to improved diagnostic techniques, but “a true increase in the risk for children to develop ASD symptoms cannot be ruled out,” the researchers said.

Increases in ASD occurred across sex, ethnicity, and cognitive function, but the most consistent pattern was the increase in ASD among boys, Dr. Rice said. Overall, the prevalence of ASD was 1 in 70 boys and 1 in 315 girls, which amounts to a four to five times higher prevalence in boys, compared with girls.

Dr. Rice advised all primary care physicians who suspect ASD in a child to refer the child for further diagnostic evaluation or intervention.

The researchers did not conduct in-person evaluations of each child, and the results were limited by variations in record keeping. The study was not designed to evaluate causes of ASD, but the findings suggest that more research is needed to determine how genetic and environmental factors interact to cause ASD spectrum symptoms, the researchers wrote.

The pandemic influenza A(H1N1) virus does not appear to spread among an infected person's household contacts as easily as viruses in past pandemics, according to an analysis of data collected in the United States.

Simon Cauchemez, Ph.D., of Imperial College, London, and colleagues reviewed information on the H1N1 infection in 216 households; in total, the virus was transmitted from 216 index patients to 600 household contacts. The median age of the index patient was 15 years, and each household had two to six members. Data were collected by the Centers for Disease Control and Prevention.

Overall, 78 (13%) of the 600 household contacts developed acute respiratory illness and 60 (10%) developed an influenzalike illness.

In 156 households (72%), no household contacts developed acute respiratory illness. In 46 households (21%), one household contact developed acute respiratory illness, and in 14 households (6%), more than one contact developed acute respiratory illness. These secondary cases were not systematically confirmed as H1N1 illness (N. Engl. J. Med. 2009;361:2619–27).

In the secondary cases of possible H1N1 influenza, household contacts who were aged 18 years and younger were about twice as likely to develop either acute respiratory illness or flulike illness, compared with household contacts aged 19 years and older. The median age of the household contacts was 26 years, but the median age of contacts with acute respiratory illness was 16.5 years and the median age of contacts with flulike illness was 14.5 years.

The average time between the onset of illness in an index patient and the onset of illness in one of his or her household contacts was 2.6 days.

The estimates of transmissibility in households were lower than those seen in previous pandemics, but they were similar to transmissibility data from the early phase of the H1N1 pandemic in Mexico. No specific symptom was associated with increased transmission of illness, and the findings showed no link between increased transmission of illness and the index patient's age, the researchers noted.

The findings were limited by several factors, including a lack of data about antiviral therapy in household contacts.

Dr. Cauchemez has received consulting fees from Sanofi Pasteur. The study was supported in part by grants from several organizations including the Medical Research Council and the Bill and Melinda Gates Foundation.

The pandemic influenza A(H1N1) virus does not appear to spread among an infected person's household contacts as easily as viruses in past pandemics, according to an analysis of data collected in the United States.

Simon Cauchemez, Ph.D., of Imperial College, London, and colleagues reviewed information on the H1N1 infection in 216 households; in total, the virus was transmitted from 216 index patients to 600 household contacts. The median age of the index patient was 15 years, and each household had two to six members. Data were collected by the Centers for Disease Control and Prevention.

Overall, 78 (13%) of the 600 household contacts developed acute respiratory illness and 60 (10%) developed an influenzalike illness.

In 156 households (72%), no household contacts developed acute respiratory illness. In 46 households (21%), one household contact developed acute respiratory illness, and in 14 households (6%), more than one contact developed acute respiratory illness. These secondary cases were not systematically confirmed as H1N1 illness (N. Engl. J. Med. 2009;361:2619–27).

In the secondary cases of possible H1N1 influenza, household contacts who were aged 18 years and younger were about twice as likely to develop either acute respiratory illness or flulike illness, compared with household contacts aged 19 years and older. The median age of the household contacts was 26 years, but the median age of contacts with acute respiratory illness was 16.5 years and the median age of contacts with flulike illness was 14.5 years.

The average time between the onset of illness in an index patient and the onset of illness in one of his or her household contacts was 2.6 days.

The estimates of transmissibility in households were lower than those seen in previous pandemics, but they were similar to transmissibility data from the early phase of the H1N1 pandemic in Mexico. No specific symptom was associated with increased transmission of illness, and the findings showed no link between increased transmission of illness and the index patient's age, the researchers noted.

The findings were limited by several factors, including a lack of data about antiviral therapy in household contacts.

Dr. Cauchemez has received consulting fees from Sanofi Pasteur. The study was supported in part by grants from several organizations including the Medical Research Council and the Bill and Melinda Gates Foundation.

The pandemic influenza A(H1N1) virus does not appear to spread among an infected person's household contacts as easily as viruses in past pandemics, according to an analysis of data collected in the United States.

Simon Cauchemez, Ph.D., of Imperial College, London, and colleagues reviewed information on the H1N1 infection in 216 households; in total, the virus was transmitted from 216 index patients to 600 household contacts. The median age of the index patient was 15 years, and each household had two to six members. Data were collected by the Centers for Disease Control and Prevention.

Overall, 78 (13%) of the 600 household contacts developed acute respiratory illness and 60 (10%) developed an influenzalike illness.

In 156 households (72%), no household contacts developed acute respiratory illness. In 46 households (21%), one household contact developed acute respiratory illness, and in 14 households (6%), more than one contact developed acute respiratory illness. These secondary cases were not systematically confirmed as H1N1 illness (N. Engl. J. Med. 2009;361:2619–27).

In the secondary cases of possible H1N1 influenza, household contacts who were aged 18 years and younger were about twice as likely to develop either acute respiratory illness or flulike illness, compared with household contacts aged 19 years and older. The median age of the household contacts was 26 years, but the median age of contacts with acute respiratory illness was 16.5 years and the median age of contacts with flulike illness was 14.5 years.

The average time between the onset of illness in an index patient and the onset of illness in one of his or her household contacts was 2.6 days.

The estimates of transmissibility in households were lower than those seen in previous pandemics, but they were similar to transmissibility data from the early phase of the H1N1 pandemic in Mexico. No specific symptom was associated with increased transmission of illness, and the findings showed no link between increased transmission of illness and the index patient's age, the researchers noted.

The findings were limited by several factors, including a lack of data about antiviral therapy in household contacts.

Dr. Cauchemez has received consulting fees from Sanofi Pasteur. The study was supported in part by grants from several organizations including the Medical Research Council and the Bill and Melinda Gates Foundation.

BOSTON — Initial serum lactate measurements are not reliable predictors of major injuries in children with severe blunt trauma, based on data from a prospective study of 200 children in a university pediatric emergency department.

Serum lactate levels are often used to measure tissue hypoperfusion in adult sepsis patients and in trauma patients who don't show signs of shock. “Elevated blood lactate reflects anaerobic metabolism due to hypoperfusion,” Dr. Antonio E. Muniz said at the annual meeting of the American Academy of Emergency Physicians.

Dr. Muniz of the University of Texas Health Sciences Center at Houston reviewed serum lactate levels in children aged 2–18 who had suffered blunt trauma. Serum lactate levels were elevated in 56 (28%) of the children. For predicting the 102 major injuries, the sensitivity of elevated lactate was 47% and the specificity was 86%, suggesting that initial levels of serum lactate are not helpful, he noted. The positive predictive value was 71%, and the negative predictive value was 68%.

Extremity fractures accounted for about 25% of the major injuries. Other types of major injuries included facial fracture, pelvic fracture, liver laceration, and spleen laceration. Most of the blunt trauma injuries were caused by motor vehicle accidents (152 children), followed by being hit by a car (24 children), falls (12 children), bicycle accidents (8 children), and gunshot wounds (4 children).

Data from other studies suggest that measuring serum lactate at later intervals after blunt trauma might be useful for assessing injuries, Dr. Muniz noted. He had no financial conflicts to disclose.

BOSTON — Initial serum lactate measurements are not reliable predictors of major injuries in children with severe blunt trauma, based on data from a prospective study of 200 children in a university pediatric emergency department.

Serum lactate levels are often used to measure tissue hypoperfusion in adult sepsis patients and in trauma patients who don't show signs of shock. “Elevated blood lactate reflects anaerobic metabolism due to hypoperfusion,” Dr. Antonio E. Muniz said at the annual meeting of the American Academy of Emergency Physicians.

Dr. Muniz of the University of Texas Health Sciences Center at Houston reviewed serum lactate levels in children aged 2–18 who had suffered blunt trauma. Serum lactate levels were elevated in 56 (28%) of the children. For predicting the 102 major injuries, the sensitivity of elevated lactate was 47% and the specificity was 86%, suggesting that initial levels of serum lactate are not helpful, he noted. The positive predictive value was 71%, and the negative predictive value was 68%.

Extremity fractures accounted for about 25% of the major injuries. Other types of major injuries included facial fracture, pelvic fracture, liver laceration, and spleen laceration. Most of the blunt trauma injuries were caused by motor vehicle accidents (152 children), followed by being hit by a car (24 children), falls (12 children), bicycle accidents (8 children), and gunshot wounds (4 children).

Data from other studies suggest that measuring serum lactate at later intervals after blunt trauma might be useful for assessing injuries, Dr. Muniz noted. He had no financial conflicts to disclose.

BOSTON — Initial serum lactate measurements are not reliable predictors of major injuries in children with severe blunt trauma, based on data from a prospective study of 200 children in a university pediatric emergency department.

Serum lactate levels are often used to measure tissue hypoperfusion in adult sepsis patients and in trauma patients who don't show signs of shock. “Elevated blood lactate reflects anaerobic metabolism due to hypoperfusion,” Dr. Antonio E. Muniz said at the annual meeting of the American Academy of Emergency Physicians.

Dr. Muniz of the University of Texas Health Sciences Center at Houston reviewed serum lactate levels in children aged 2–18 who had suffered blunt trauma. Serum lactate levels were elevated in 56 (28%) of the children. For predicting the 102 major injuries, the sensitivity of elevated lactate was 47% and the specificity was 86%, suggesting that initial levels of serum lactate are not helpful, he noted. The positive predictive value was 71%, and the negative predictive value was 68%.

Extremity fractures accounted for about 25% of the major injuries. Other types of major injuries included facial fracture, pelvic fracture, liver laceration, and spleen laceration. Most of the blunt trauma injuries were caused by motor vehicle accidents (152 children), followed by being hit by a car (24 children), falls (12 children), bicycle accidents (8 children), and gunshot wounds (4 children).

Data from other studies suggest that measuring serum lactate at later intervals after blunt trauma might be useful for assessing injuries, Dr. Muniz noted. He had no financial conflicts to disclose.

WASHINGTON — Two novel weight loss drugs led to significant losses in overweight and obese adults, according to the findings from two phase III, placebo-controlled trials that were presented at the annual meeting of the Obesity Society.

The drugs are not yet approved by the Food and Drug Administration. If approved, they will provide additional options for the treatment of obesity.

In one study, Dr. Caroline Apovian of Boston University Medical Center presented results of the Contrave Obesity Research II (COR-II) study, a phase III, double-blind trial of 1,496 adults with an average age of 44 years and an average body mass index of 36 kg/m

The study involved Orexigen Therapeutics Inc.'s combination naltrexone SR/bupropion SR combination therapy (Contrave).

Participants were randomized to a single daily oral dose of the combination drug NB32 (32 mg naltrexone/360 mg bupropion) or a placebo.

After 28 weeks, 56% of the treatment group participants achieved at least a 5% weight loss—the study's primary outcome measure—compared with 18% of the placebo group. A 10% weight loss was achieved by 27% of the treatment group and 7% of the placebo group; 15% loss was achieved by 10% and 2% of the groups, respectively. Baseline demographics were similar between the treatment and placebo groups.

After 28 weeks, participants were rerandomized to a combination drug including 48 mg naltrexone and 360 mg bupropion (NB48).

“This was a chance to see if there was a higher dose needed,” Dr. Apovian said, but at 56 weeks, there was no significant change in weight loss with NB48 compared with NB32.

Patients in the treatment group reported significant decreases in food cravings compared with baseline, she said.

Approximately half of the patients in the drug and placebo groups discontinued the study, but discontinuation because of adverse events was low. Nausea, the most common adverse event, was mild or moderate in most cases, “and occurred mostly in the first 4 weeks,” Dr. Apovian said.

The combination drug seemed to be well tolerated, and the safety profile was consistent with previous data on the two drugs when used separately, she added.

Dr. Apovian is on the advisory board of Orexigen and has received financial support from other pharmaceutical companies, including Eli Lilly & Co. and Amgen. Orexigen intends to submit the drug for FDA approval in the first half of 2010, according to a company statement.

Dr. Lee Kaplan of Harvard University in Cambridge, Mass., presented results of a study of lorcaserin, a selective 5HT2C agonist designed to promote weight loss without the cardiovascular side effects that are associated with nonspecific 5HT agonists.

The randomized, double-blind, placebo-controlled phase III study enrolled 4,008 patients aged 18-65 years for 52 weeks. The study involved patients with a BMI of 27-45 kg/m

Overall, the intent-to-treat analysis showed that a 5% weight loss was achieved by 47% of participants who took 10 mg lorcaserin twice daily, by 40% of those who took 10 mg lorcaserin once daily, and by 25% of those who took a placebo, said Dr. Kaplan, who is also director of the Massachusetts General Hospital weight center in Boston.

Patients in the twice-daily, once-daily, and placebo groups who completed the study according to the protocol lost an average of 7.7 kg, 6.5 kg, and 3.9 kg, respectively.

The most common adverse events were headache, fatigue, dizziness, and nausea, each of which occurred in less than 5% of patients.

Patients with FDA-defined valvulopathy were included in the study, and the lorcaserin was not associated with increased valvulopathy during the study, Dr. Kaplan added.

Dr. Kaplan has received financial support from lorcaserin's manufacturer, Arena Pharmaceuticals, among other pharmaceutical companies.

Lorcaserin has not yet been approved by the FDA.

WASHINGTON — Two novel weight loss drugs led to significant losses in overweight and obese adults, according to the findings from two phase III, placebo-controlled trials that were presented at the annual meeting of the Obesity Society.

The drugs are not yet approved by the Food and Drug Administration. If approved, they will provide additional options for the treatment of obesity.

In one study, Dr. Caroline Apovian of Boston University Medical Center presented results of the Contrave Obesity Research II (COR-II) study, a phase III, double-blind trial of 1,496 adults with an average age of 44 years and an average body mass index of 36 kg/m

The study involved Orexigen Therapeutics Inc.'s combination naltrexone SR/bupropion SR combination therapy (Contrave).

Participants were randomized to a single daily oral dose of the combination drug NB32 (32 mg naltrexone/360 mg bupropion) or a placebo.

After 28 weeks, 56% of the treatment group participants achieved at least a 5% weight loss—the study's primary outcome measure—compared with 18% of the placebo group. A 10% weight loss was achieved by 27% of the treatment group and 7% of the placebo group; 15% loss was achieved by 10% and 2% of the groups, respectively. Baseline demographics were similar between the treatment and placebo groups.

After 28 weeks, participants were rerandomized to a combination drug including 48 mg naltrexone and 360 mg bupropion (NB48).

“This was a chance to see if there was a higher dose needed,” Dr. Apovian said, but at 56 weeks, there was no significant change in weight loss with NB48 compared with NB32.

Patients in the treatment group reported significant decreases in food cravings compared with baseline, she said.

Approximately half of the patients in the drug and placebo groups discontinued the study, but discontinuation because of adverse events was low. Nausea, the most common adverse event, was mild or moderate in most cases, “and occurred mostly in the first 4 weeks,” Dr. Apovian said.

The combination drug seemed to be well tolerated, and the safety profile was consistent with previous data on the two drugs when used separately, she added.

Dr. Apovian is on the advisory board of Orexigen and has received financial support from other pharmaceutical companies, including Eli Lilly & Co. and Amgen. Orexigen intends to submit the drug for FDA approval in the first half of 2010, according to a company statement.

Dr. Lee Kaplan of Harvard University in Cambridge, Mass., presented results of a study of lorcaserin, a selective 5HT2C agonist designed to promote weight loss without the cardiovascular side effects that are associated with nonspecific 5HT agonists.

The randomized, double-blind, placebo-controlled phase III study enrolled 4,008 patients aged 18-65 years for 52 weeks. The study involved patients with a BMI of 27-45 kg/m

Overall, the intent-to-treat analysis showed that a 5% weight loss was achieved by 47% of participants who took 10 mg lorcaserin twice daily, by 40% of those who took 10 mg lorcaserin once daily, and by 25% of those who took a placebo, said Dr. Kaplan, who is also director of the Massachusetts General Hospital weight center in Boston.

Patients in the twice-daily, once-daily, and placebo groups who completed the study according to the protocol lost an average of 7.7 kg, 6.5 kg, and 3.9 kg, respectively.

The most common adverse events were headache, fatigue, dizziness, and nausea, each of which occurred in less than 5% of patients.

Patients with FDA-defined valvulopathy were included in the study, and the lorcaserin was not associated with increased valvulopathy during the study, Dr. Kaplan added.

Dr. Kaplan has received financial support from lorcaserin's manufacturer, Arena Pharmaceuticals, among other pharmaceutical companies.

Lorcaserin has not yet been approved by the FDA.

WASHINGTON — Two novel weight loss drugs led to significant losses in overweight and obese adults, according to the findings from two phase III, placebo-controlled trials that were presented at the annual meeting of the Obesity Society.

The drugs are not yet approved by the Food and Drug Administration. If approved, they will provide additional options for the treatment of obesity.

In one study, Dr. Caroline Apovian of Boston University Medical Center presented results of the Contrave Obesity Research II (COR-II) study, a phase III, double-blind trial of 1,496 adults with an average age of 44 years and an average body mass index of 36 kg/m

The study involved Orexigen Therapeutics Inc.'s combination naltrexone SR/bupropion SR combination therapy (Contrave).

Participants were randomized to a single daily oral dose of the combination drug NB32 (32 mg naltrexone/360 mg bupropion) or a placebo.

After 28 weeks, 56% of the treatment group participants achieved at least a 5% weight loss—the study's primary outcome measure—compared with 18% of the placebo group. A 10% weight loss was achieved by 27% of the treatment group and 7% of the placebo group; 15% loss was achieved by 10% and 2% of the groups, respectively. Baseline demographics were similar between the treatment and placebo groups.

After 28 weeks, participants were rerandomized to a combination drug including 48 mg naltrexone and 360 mg bupropion (NB48).

“This was a chance to see if there was a higher dose needed,” Dr. Apovian said, but at 56 weeks, there was no significant change in weight loss with NB48 compared with NB32.

Patients in the treatment group reported significant decreases in food cravings compared with baseline, she said.

Approximately half of the patients in the drug and placebo groups discontinued the study, but discontinuation because of adverse events was low. Nausea, the most common adverse event, was mild or moderate in most cases, “and occurred mostly in the first 4 weeks,” Dr. Apovian said.

The combination drug seemed to be well tolerated, and the safety profile was consistent with previous data on the two drugs when used separately, she added.

Dr. Apovian is on the advisory board of Orexigen and has received financial support from other pharmaceutical companies, including Eli Lilly & Co. and Amgen. Orexigen intends to submit the drug for FDA approval in the first half of 2010, according to a company statement.

Dr. Lee Kaplan of Harvard University in Cambridge, Mass., presented results of a study of lorcaserin, a selective 5HT2C agonist designed to promote weight loss without the cardiovascular side effects that are associated with nonspecific 5HT agonists.

The randomized, double-blind, placebo-controlled phase III study enrolled 4,008 patients aged 18-65 years for 52 weeks. The study involved patients with a BMI of 27-45 kg/m

Overall, the intent-to-treat analysis showed that a 5% weight loss was achieved by 47% of participants who took 10 mg lorcaserin twice daily, by 40% of those who took 10 mg lorcaserin once daily, and by 25% of those who took a placebo, said Dr. Kaplan, who is also director of the Massachusetts General Hospital weight center in Boston.

Patients in the twice-daily, once-daily, and placebo groups who completed the study according to the protocol lost an average of 7.7 kg, 6.5 kg, and 3.9 kg, respectively.

The most common adverse events were headache, fatigue, dizziness, and nausea, each of which occurred in less than 5% of patients.

Patients with FDA-defined valvulopathy were included in the study, and the lorcaserin was not associated with increased valvulopathy during the study, Dr. Kaplan added.

Dr. Kaplan has received financial support from lorcaserin's manufacturer, Arena Pharmaceuticals, among other pharmaceutical companies.

Lorcaserin has not yet been approved by the FDA.

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

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

“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 noted.

Data from 146,975 health care provider visits between July 1, 2007, and June 30, 2008, were reviewed.

Average age 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 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, the criteria by which participants were considered “screened.” Only 52% of women with a BMI of 40 kg/m

After adjustment for age, race, and income, the odds ratio of osteoporosis screening for overweight women was 0.99, while the ratios for women in obese classes I, II, and III 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 results suggest that many overweight and obese women aren't screened for osteoporosis, said the researchers, who reported having no conflicts of interest.

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

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

“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 noted.

Data from 146,975 health care provider visits between July 1, 2007, and June 30, 2008, were reviewed.

Average age 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 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, the criteria by which participants were considered “screened.” Only 52% of women with a BMI of 40 kg/m

After adjustment for age, race, and income, the odds ratio of osteoporosis screening for overweight women was 0.99, while the ratios for women in obese classes I, II, and III 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 results suggest that many overweight and obese women aren't screened for osteoporosis, said the researchers, who reported having no conflicts of interest.

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

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

“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 noted.

Data from 146,975 health care provider visits between July 1, 2007, and June 30, 2008, were reviewed.

Average age 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 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, the criteria by which participants were considered “screened.” Only 52% of women with a BMI of 40 kg/m

After adjustment for age, race, and income, the odds ratio of osteoporosis screening for overweight women was 0.99, while the ratios for women in obese classes I, II, and III 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 results suggest that many overweight and obese women aren't screened for osteoporosis, said the researchers, who reported having no conflicts of interest.

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9-26 years. ACIP made the recommendation at its annual fall meeting

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18. But unlike the quadrivalent vaccine (Merck & Co.'s Gardasil), the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate. Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable. The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11-12 years and recommended second and third doses at 1-2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses.

Unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC.

Source Parker Smith/Elsevier Global Medical News

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9-26 years. ACIP made the recommendation at its annual fall meeting

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18. But unlike the quadrivalent vaccine (Merck & Co.'s Gardasil), the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate. Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable. The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11-12 years and recommended second and third doses at 1-2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses.

Unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC.

Source Parker Smith/Elsevier Global Medical News

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9-26 years. ACIP made the recommendation at its annual fall meeting

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18. But unlike the quadrivalent vaccine (Merck & Co.'s Gardasil), the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate. Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable. The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11-12 years and recommended second and third doses at 1-2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses.

Unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC.

Source Parker Smith/Elsevier Global Medical News

BOSTON — Delayed examinations following sexual assaults significantly reduced the frequency of documented anogenital injuries in the victims, based on data from 2,799 cases.

Data on the nature and documentation of anogenital injuries beyond 24-48 hours after a sexual assault are limited, and 72 hours generally is suggested as the maximum time after the assault to document anogenital injuries, Catherine Burger, a medical student at Michigan State University, Grand Rapids, and her colleagues said at the annual meeting of the American College of Emergency Physicians.

The researchers reviewed data from consecutive female patients aged 13 years and older who presented to the community-based Sexual Assault Nurse Examiner program—funded by the Michigan Department of Community Health—during a 10-year period. Their goal was to analyze how the types, location, and frequency of anogenital injuries related to both the victim's age and the time from assault to examination. The researchers also looked for demographic factors that might be linked to the delay in seeking care. A total of 1,192 patients were 19 years or younger (adolescents) and 1,607 were older than 19 years (adults). The results were presented in a poster at the meeting.

A total of 776 victims (26%) delayed seeking medical care for at least 24 hours after an assault. Those who delayed care were significantly younger (20.7 vs. 23.6 years), significantly more likely to have been victimized by a family member or acquaintance (86% vs. 79%), and significantly less likely to report the assault to the police (64% vs. 84%), compared with those who sought care within 24 hours. Adolescents who delayed care were significantly more likely to report alcohol or drug use before the assault, compared with adults who delayed seeking care (58% vs. 47%).

Overall, “the frequency of anogenital lacerations and abrasions decreased from 71% at less than 24 hours to 28% at greater than 96 hours,” the researchers wrote.

In both adolescents and adults, the frequency of documented anogenital injuries dropped by about 8% each day after the assault. But at the 72-hour mark, 50% of adolescents and 38% of adults had documented anogenital injuries. Adolescents had a greater frequency of genital injuries, compared with adults across all time periods.

The results suggest that anogenital injuries can still be documented in medicolegal examinations, even at 72 hours after the assault, the researchers said.

The researchers had no financial conflicts to disclose.

BOSTON — Delayed examinations following sexual assaults significantly reduced the frequency of documented anogenital injuries in the victims, based on data from 2,799 cases.

Data on the nature and documentation of anogenital injuries beyond 24-48 hours after a sexual assault are limited, and 72 hours generally is suggested as the maximum time after the assault to document anogenital injuries, Catherine Burger, a medical student at Michigan State University, Grand Rapids, and her colleagues said at the annual meeting of the American College of Emergency Physicians.

The researchers reviewed data from consecutive female patients aged 13 years and older who presented to the community-based Sexual Assault Nurse Examiner program—funded by the Michigan Department of Community Health—during a 10-year period. Their goal was to analyze how the types, location, and frequency of anogenital injuries related to both the victim's age and the time from assault to examination. The researchers also looked for demographic factors that might be linked to the delay in seeking care. A total of 1,192 patients were 19 years or younger (adolescents) and 1,607 were older than 19 years (adults). The results were presented in a poster at the meeting.

A total of 776 victims (26%) delayed seeking medical care for at least 24 hours after an assault. Those who delayed care were significantly younger (20.7 vs. 23.6 years), significantly more likely to have been victimized by a family member or acquaintance (86% vs. 79%), and significantly less likely to report the assault to the police (64% vs. 84%), compared with those who sought care within 24 hours. Adolescents who delayed care were significantly more likely to report alcohol or drug use before the assault, compared with adults who delayed seeking care (58% vs. 47%).

Overall, “the frequency of anogenital lacerations and abrasions decreased from 71% at less than 24 hours to 28% at greater than 96 hours,” the researchers wrote.

In both adolescents and adults, the frequency of documented anogenital injuries dropped by about 8% each day after the assault. But at the 72-hour mark, 50% of adolescents and 38% of adults had documented anogenital injuries. Adolescents had a greater frequency of genital injuries, compared with adults across all time periods.

The results suggest that anogenital injuries can still be documented in medicolegal examinations, even at 72 hours after the assault, the researchers said.

The researchers had no financial conflicts to disclose.

BOSTON — Delayed examinations following sexual assaults significantly reduced the frequency of documented anogenital injuries in the victims, based on data from 2,799 cases.

Data on the nature and documentation of anogenital injuries beyond 24-48 hours after a sexual assault are limited, and 72 hours generally is suggested as the maximum time after the assault to document anogenital injuries, Catherine Burger, a medical student at Michigan State University, Grand Rapids, and her colleagues said at the annual meeting of the American College of Emergency Physicians.

The researchers reviewed data from consecutive female patients aged 13 years and older who presented to the community-based Sexual Assault Nurse Examiner program—funded by the Michigan Department of Community Health—during a 10-year period. Their goal was to analyze how the types, location, and frequency of anogenital injuries related to both the victim's age and the time from assault to examination. The researchers also looked for demographic factors that might be linked to the delay in seeking care. A total of 1,192 patients were 19 years or younger (adolescents) and 1,607 were older than 19 years (adults). The results were presented in a poster at the meeting.

A total of 776 victims (26%) delayed seeking medical care for at least 24 hours after an assault. Those who delayed care were significantly younger (20.7 vs. 23.6 years), significantly more likely to have been victimized by a family member or acquaintance (86% vs. 79%), and significantly less likely to report the assault to the police (64% vs. 84%), compared with those who sought care within 24 hours. Adolescents who delayed care were significantly more likely to report alcohol or drug use before the assault, compared with adults who delayed seeking care (58% vs. 47%).

Overall, “the frequency of anogenital lacerations and abrasions decreased from 71% at less than 24 hours to 28% at greater than 96 hours,” the researchers wrote.

In both adolescents and adults, the frequency of documented anogenital injuries dropped by about 8% each day after the assault. But at the 72-hour mark, 50% of adolescents and 38% of adults had documented anogenital injuries. Adolescents had a greater frequency of genital injuries, compared with adults across all time periods.

The results suggest that anogenital injuries can still be documented in medicolegal examinations, even at 72 hours after the assault, the researchers said.

The researchers had no financial conflicts to disclose.

SAN FRANCISCO — Many women experience minor skin conditions such as pruritus, stretch marks, and melasma during pregnancy, but several serious skin diseases can emerge.

When it comes to treating skin conditions in pregnant women, it is important to remember that there is a great deal of variation in how these patients experience symptoms, Dr. Kristin M. Leiferman explained at a meeting sponsored by Skin Disease Education Foundation.

Many mothers-to-be will endure some degree of skin discomfort such as itching, rather than take medications, she said. “But pregnant women need to be monitored closely for secondary problems associated with skin disorders, including cutaneous infection, fluid balance problems, excessive blistering or erosion, and lack of sleep due to discomfort from itching.”

Dr. Kristin M. Leiferman of the University of Utah, Salt Lake City, reviewed several dermatoses of pregnancy, including:

▸ Polymorphic eruption of pregnancy/pruritic urticarial papules and plaques of pregnancy (PEP/PUPPP). The pathogenesis of PEP/PUPPP remains unknown but many theories persist, including those citing the role of hormones, fetal DNA, and placental factors, Dr. Leiferman said. The condition has a nonspecific inflammatory pattern, and there may be perivascular lymphocytic infiltration in the upper and middle dermis.

The differential diagnosis for PEP/PUPPP should start by ruling out scabies, Dr. Leiferman noted. Once scabies is ruled out, a dermatologist's differential should include pemphigoid gestationis, atopic eruption of pregnancy, contact dermatitis, drug eruption, erythema multiforme, and pityriasis rosea, she said.

▸ Pemphigoid gestationis. This condition is an autoimmune disorder that typically begins with urticaria or blistering around the umbilicus, Dr. Leiferman noted. Until or unless blistering occurs, this condition may be difficult to distinguish from PEP/PUPPP, she said, although PEP/PUPPP does not usually involve the area immediately around the umbilicus.

Pemphigoid gestationis may occur during or immediately after pregnancy, or it can occur with hormone use. The condition can present with urticarial, arch-shaped plaques in addition to dermatitis and blisters. The current evidence suggests that pemphigoid gestationis occurs when the protection of a fetus from the mother's immune response breaks down. When diagnosing pemphigoid gestationis, be sure to rule out varicella and pemphigus vulgaris, Dr. Leiferman emphasized.

▸ Cholestasis of pregnancy. This condition is characterized by a sudden onset of itching, first on the palms and soles, and then the itching becomes generalized. Cholestasis of pregnancy does not include primary skin lesions, but it can have serious effects for both mother and fetus. It may cause gallstones or jaundice in the mother, and increased levels of serum bile salts can enter the fetal circulation and cause a reduction in the level of oxygen in the placenta. The oxygen dip can lead to cardiac depression and increase the risk of prematurity, fetal distress, and stillbirth.

▸ Atopic eruption of pregnancy. This condition encompasses three previously recognized distinct skin conditions—prurigo of pregnancy, pruritic folliculitis of pregnancy, and eczema of pregnancy, Dr. Leiferman explained. Most patients have atopic dermatitis, from which the name derives. Studies suggest that approximately half of these patients have signs of eczema and approximately one-third have signs of papules and prurigo.

The histology of atopic eruption of pregnancy is nonspecific, and debate continues as to whether the condition should be considered a distinct dermatosis of pregnancy or an exacerbation of a skin disease with pregnancy, said Dr. Leiferman.

▸ Impetigo herpetiformis. Another disorder previously thought to be a dermatosis of pregnancy is impetigo herpetiformis, now generally regarded as a variant of pustular psoriasis, Dr. Leiferman stated. It rapidly resolves after delivery, but recurrences in subsequent pregnancies are common and are more severe with earlier onset. Neonatal death or stillbirth may result from placental insufficiency. Recurrences with menses can occur for years, she said.

With pregnancy-associated dermatoses, “treatment should be tailored to the symptoms and to the disease with the least amount [of] and least potentially toxic medications that will keep the mother comfortable and the baby safe,” Dr. Leiferman said in an interview.

“Certain pregnancy-associated dermatoses may respond to skin care that helps reduce itching, and to topical medications from which little is absorbed internally,” she explained. By contrast, when the skin is blistered or eroded, more aggressive treatments are needed.

Systemic glucocorticoids, such as prednisone, are the main therapy for pemphigoid gestationis and other severe pregnancy-related skin problems, said Dr. Leiferman. “Their use in pregnancy is well studied, and they generally are tolerated, but they may be associated with placental calcifications and low-birth-weight infants.”

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO — Many women experience minor skin conditions such as pruritus, stretch marks, and melasma during pregnancy, but several serious skin diseases can emerge.

When it comes to treating skin conditions in pregnant women, it is important to remember that there is a great deal of variation in how these patients experience symptoms, Dr. Kristin M. Leiferman explained at a meeting sponsored by Skin Disease Education Foundation.

Many mothers-to-be will endure some degree of skin discomfort such as itching, rather than take medications, she said. “But pregnant women need to be monitored closely for secondary problems associated with skin disorders, including cutaneous infection, fluid balance problems, excessive blistering or erosion, and lack of sleep due to discomfort from itching.”

Dr. Kristin M. Leiferman of the University of Utah, Salt Lake City, reviewed several dermatoses of pregnancy, including:

▸ Polymorphic eruption of pregnancy/pruritic urticarial papules and plaques of pregnancy (PEP/PUPPP). The pathogenesis of PEP/PUPPP remains unknown but many theories persist, including those citing the role of hormones, fetal DNA, and placental factors, Dr. Leiferman said. The condition has a nonspecific inflammatory pattern, and there may be perivascular lymphocytic infiltration in the upper and middle dermis.

The differential diagnosis for PEP/PUPPP should start by ruling out scabies, Dr. Leiferman noted. Once scabies is ruled out, a dermatologist's differential should include pemphigoid gestationis, atopic eruption of pregnancy, contact dermatitis, drug eruption, erythema multiforme, and pityriasis rosea, she said.

▸ Pemphigoid gestationis. This condition is an autoimmune disorder that typically begins with urticaria or blistering around the umbilicus, Dr. Leiferman noted. Until or unless blistering occurs, this condition may be difficult to distinguish from PEP/PUPPP, she said, although PEP/PUPPP does not usually involve the area immediately around the umbilicus.

Pemphigoid gestationis may occur during or immediately after pregnancy, or it can occur with hormone use. The condition can present with urticarial, arch-shaped plaques in addition to dermatitis and blisters. The current evidence suggests that pemphigoid gestationis occurs when the protection of a fetus from the mother's immune response breaks down. When diagnosing pemphigoid gestationis, be sure to rule out varicella and pemphigus vulgaris, Dr. Leiferman emphasized.

▸ Cholestasis of pregnancy. This condition is characterized by a sudden onset of itching, first on the palms and soles, and then the itching becomes generalized. Cholestasis of pregnancy does not include primary skin lesions, but it can have serious effects for both mother and fetus. It may cause gallstones or jaundice in the mother, and increased levels of serum bile salts can enter the fetal circulation and cause a reduction in the level of oxygen in the placenta. The oxygen dip can lead to cardiac depression and increase the risk of prematurity, fetal distress, and stillbirth.

▸ Atopic eruption of pregnancy. This condition encompasses three previously recognized distinct skin conditions—prurigo of pregnancy, pruritic folliculitis of pregnancy, and eczema of pregnancy, Dr. Leiferman explained. Most patients have atopic dermatitis, from which the name derives. Studies suggest that approximately half of these patients have signs of eczema and approximately one-third have signs of papules and prurigo.

The histology of atopic eruption of pregnancy is nonspecific, and debate continues as to whether the condition should be considered a distinct dermatosis of pregnancy or an exacerbation of a skin disease with pregnancy, said Dr. Leiferman.

▸ Impetigo herpetiformis. Another disorder previously thought to be a dermatosis of pregnancy is impetigo herpetiformis, now generally regarded as a variant of pustular psoriasis, Dr. Leiferman stated. It rapidly resolves after delivery, but recurrences in subsequent pregnancies are common and are more severe with earlier onset. Neonatal death or stillbirth may result from placental insufficiency. Recurrences with menses can occur for years, she said.

With pregnancy-associated dermatoses, “treatment should be tailored to the symptoms and to the disease with the least amount [of] and least potentially toxic medications that will keep the mother comfortable and the baby safe,” Dr. Leiferman said in an interview.

“Certain pregnancy-associated dermatoses may respond to skin care that helps reduce itching, and to topical medications from which little is absorbed internally,” she explained. By contrast, when the skin is blistered or eroded, more aggressive treatments are needed.

Systemic glucocorticoids, such as prednisone, are the main therapy for pemphigoid gestationis and other severe pregnancy-related skin problems, said Dr. Leiferman. “Their use in pregnancy is well studied, and they generally are tolerated, but they may be associated with placental calcifications and low-birth-weight infants.”

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO — Many women experience minor skin conditions such as pruritus, stretch marks, and melasma during pregnancy, but several serious skin diseases can emerge.

When it comes to treating skin conditions in pregnant women, it is important to remember that there is a great deal of variation in how these patients experience symptoms, Dr. Kristin M. Leiferman explained at a meeting sponsored by Skin Disease Education Foundation.

Many mothers-to-be will endure some degree of skin discomfort such as itching, rather than take medications, she said. “But pregnant women need to be monitored closely for secondary problems associated with skin disorders, including cutaneous infection, fluid balance problems, excessive blistering or erosion, and lack of sleep due to discomfort from itching.”

Dr. Kristin M. Leiferman of the University of Utah, Salt Lake City, reviewed several dermatoses of pregnancy, including:

▸ Polymorphic eruption of pregnancy/pruritic urticarial papules and plaques of pregnancy (PEP/PUPPP). The pathogenesis of PEP/PUPPP remains unknown but many theories persist, including those citing the role of hormones, fetal DNA, and placental factors, Dr. Leiferman said. The condition has a nonspecific inflammatory pattern, and there may be perivascular lymphocytic infiltration in the upper and middle dermis.

The differential diagnosis for PEP/PUPPP should start by ruling out scabies, Dr. Leiferman noted. Once scabies is ruled out, a dermatologist's differential should include pemphigoid gestationis, atopic eruption of pregnancy, contact dermatitis, drug eruption, erythema multiforme, and pityriasis rosea, she said.

▸ Pemphigoid gestationis. This condition is an autoimmune disorder that typically begins with urticaria or blistering around the umbilicus, Dr. Leiferman noted. Until or unless blistering occurs, this condition may be difficult to distinguish from PEP/PUPPP, she said, although PEP/PUPPP does not usually involve the area immediately around the umbilicus.

Pemphigoid gestationis may occur during or immediately after pregnancy, or it can occur with hormone use. The condition can present with urticarial, arch-shaped plaques in addition to dermatitis and blisters. The current evidence suggests that pemphigoid gestationis occurs when the protection of a fetus from the mother's immune response breaks down. When diagnosing pemphigoid gestationis, be sure to rule out varicella and pemphigus vulgaris, Dr. Leiferman emphasized.

▸ Cholestasis of pregnancy. This condition is characterized by a sudden onset of itching, first on the palms and soles, and then the itching becomes generalized. Cholestasis of pregnancy does not include primary skin lesions, but it can have serious effects for both mother and fetus. It may cause gallstones or jaundice in the mother, and increased levels of serum bile salts can enter the fetal circulation and cause a reduction in the level of oxygen in the placenta. The oxygen dip can lead to cardiac depression and increase the risk of prematurity, fetal distress, and stillbirth.

▸ Atopic eruption of pregnancy. This condition encompasses three previously recognized distinct skin conditions—prurigo of pregnancy, pruritic folliculitis of pregnancy, and eczema of pregnancy, Dr. Leiferman explained. Most patients have atopic dermatitis, from which the name derives. Studies suggest that approximately half of these patients have signs of eczema and approximately one-third have signs of papules and prurigo.

The histology of atopic eruption of pregnancy is nonspecific, and debate continues as to whether the condition should be considered a distinct dermatosis of pregnancy or an exacerbation of a skin disease with pregnancy, said Dr. Leiferman.

▸ Impetigo herpetiformis. Another disorder previously thought to be a dermatosis of pregnancy is impetigo herpetiformis, now generally regarded as a variant of pustular psoriasis, Dr. Leiferman stated. It rapidly resolves after delivery, but recurrences in subsequent pregnancies are common and are more severe with earlier onset. Neonatal death or stillbirth may result from placental insufficiency. Recurrences with menses can occur for years, she said.

With pregnancy-associated dermatoses, “treatment should be tailored to the symptoms and to the disease with the least amount [of] and least potentially toxic medications that will keep the mother comfortable and the baby safe,” Dr. Leiferman said in an interview.

“Certain pregnancy-associated dermatoses may respond to skin care that helps reduce itching, and to topical medications from which little is absorbed internally,” she explained. By contrast, when the skin is blistered or eroded, more aggressive treatments are needed.

Systemic glucocorticoids, such as prednisone, are the main therapy for pemphigoid gestationis and other severe pregnancy-related skin problems, said Dr. Leiferman. “Their use in pregnancy is well studied, and they generally are tolerated, but they may be associated with placental calcifications and low-birth-weight infants.”

SDEF and this news organization are owned by Elsevier.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric banding surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single-center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' body mass indexes ranged from 36 kg/m

After 1 year, the average total weight loss was 16 kg, and the percentage of weight lost was 24%. Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

The number of adjustments to the band during the first year was not predictive of weight loss, according to the researchers. Patient age also had no apparent effect on weight loss, nor did comorbidities including type 2 diabetes, hypertension, obstructive sleep apnea, and asthma.

“Prospective trials are needed to define strategies to improve weight loss outcomes after gastric banding,” the investigators concluded.

Dr. Teixeira has served as an adviser to Allergan, which manufactures an adjustable gastric banding system.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric banding surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single-center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' body mass indexes ranged from 36 kg/m

After 1 year, the average total weight loss was 16 kg, and the percentage of weight lost was 24%. Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

The number of adjustments to the band during the first year was not predictive of weight loss, according to the researchers. Patient age also had no apparent effect on weight loss, nor did comorbidities including type 2 diabetes, hypertension, obstructive sleep apnea, and asthma.

“Prospective trials are needed to define strategies to improve weight loss outcomes after gastric banding,” the investigators concluded.

Dr. Teixeira has served as an adviser to Allergan, which manufactures an adjustable gastric banding system.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric banding surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single-center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' body mass indexes ranged from 36 kg/m

After 1 year, the average total weight loss was 16 kg, and the percentage of weight lost was 24%. Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

The number of adjustments to the band during the first year was not predictive of weight loss, according to the researchers. Patient age also had no apparent effect on weight loss, nor did comorbidities including type 2 diabetes, hypertension, obstructive sleep apnea, and asthma.

“Prospective trials are needed to define strategies to improve weight loss outcomes after gastric banding,” the investigators concluded.

Dr. Teixeira has served as an adviser to Allergan, which manufactures an adjustable gastric banding system.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed vaccine effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said.

In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, said Dr. Sanchez.

The results may help guide both seasonal and H1N1 vaccination in the military and Department of Defense dependents, he added.

Dr. Sanchez had no financial conflicts to disclose.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed vaccine effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said.

In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, said Dr. Sanchez.

The results may help guide both seasonal and H1N1 vaccination in the military and Department of Defense dependents, he added.

Dr. Sanchez had no financial conflicts to disclose.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed vaccine effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said.

In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, said Dr. Sanchez.

The results may help guide both seasonal and H1N1 vaccination in the military and Department of Defense dependents, he added.

Dr. Sanchez had no financial conflicts to disclose.