Heidi Splete

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.

WASHINGTON — Children with asthma who used 6 or more canisters of short-acting beta₂-agonists in a year had twice the risk of asthma exacerbation, compared with children who used fewer than 6 canisters, based on results of a database review of more than 33,000 children aged 6-17 years.

Studies have shown an association between increased use of short-acting beta₂-agonists (SABAs) and asthma exacerbation in children, but a threshold for high SABA use has not been established, said Christopher M. Blanchette, Ph.D., of Lovelace Respiratory Research Institute in Kannapolis, N.C.

Dr. Blanchette and his colleagues reviewed data from 33,951 children with asthma who were continuously enrolled for 2 years in the PharMetrics Patient-Centric Database (a pool of more than 70 commercial health insurance plans) between July 1, 2003, and June 30, 2007. The researchers excluded children with chronic obstructive pulmonary disease, bronchitis, cystic fibrosis, and other conditions that required oral cortico-steroids. Average age was 11 years.

Asthma exacerbation was determined by any or all of the following: oral corticosteroid prescriptions, urgent care or emergency department visits for asthma, and hospitalizations for asthma.

Overall, most (70%) children used 0-2 canisters per year. A total of 24% of the children used no canisters, 46% used 0.5-2 canisters, 23% used 2.5-6 canisters, 5% used 6.5-12 canisters, and 2% used more than 12 canisters, according to the results presented at annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A total of 3,147 children (9%) used 6 or more SABA canisters, which was significantly associated with asthma exacerbation. In addition to a doubled risk of asthma exacerbation, children who used 6 or more canisters per year were more than three times as likely to be hospitalized or to have emergency department or urgent care visits, compared with children who used 0-5 canisters.

The study was limited by a lack of control for all potentially confounding factors, including the use of inhaled corticosteroids, the researchers wrote. The most common comorbidities were allergies or allergic rhinitis (35%), acute pharyngitis (25%), and acute upper respiratory infections (22%).

Although most of the children in the study did not meet the threshold associated with increased risk, the findings highlight the need for physicians to watch for the overuse of SABAs as a sign of uncontrolled asthma and adjust treatment accordingly to reduce the risk of exacerbation. The study was sponsored by AstraZeneca PLC.

To watch a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON — Children with asthma who used 6 or more canisters of short-acting beta₂-agonists in a year had twice the risk of asthma exacerbation, compared with children who used fewer than 6 canisters, based on results of a database review of more than 33,000 children aged 6-17 years.

Studies have shown an association between increased use of short-acting beta₂-agonists (SABAs) and asthma exacerbation in children, but a threshold for high SABA use has not been established, said Christopher M. Blanchette, Ph.D., of Lovelace Respiratory Research Institute in Kannapolis, N.C.

Dr. Blanchette and his colleagues reviewed data from 33,951 children with asthma who were continuously enrolled for 2 years in the PharMetrics Patient-Centric Database (a pool of more than 70 commercial health insurance plans) between July 1, 2003, and June 30, 2007. The researchers excluded children with chronic obstructive pulmonary disease, bronchitis, cystic fibrosis, and other conditions that required oral cortico-steroids. Average age was 11 years.

Asthma exacerbation was determined by any or all of the following: oral corticosteroid prescriptions, urgent care or emergency department visits for asthma, and hospitalizations for asthma.

Overall, most (70%) children used 0-2 canisters per year. A total of 24% of the children used no canisters, 46% used 0.5-2 canisters, 23% used 2.5-6 canisters, 5% used 6.5-12 canisters, and 2% used more than 12 canisters, according to the results presented at annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A total of 3,147 children (9%) used 6 or more SABA canisters, which was significantly associated with asthma exacerbation. In addition to a doubled risk of asthma exacerbation, children who used 6 or more canisters per year were more than three times as likely to be hospitalized or to have emergency department or urgent care visits, compared with children who used 0-5 canisters.

The study was limited by a lack of control for all potentially confounding factors, including the use of inhaled corticosteroids, the researchers wrote. The most common comorbidities were allergies or allergic rhinitis (35%), acute pharyngitis (25%), and acute upper respiratory infections (22%).

Although most of the children in the study did not meet the threshold associated with increased risk, the findings highlight the need for physicians to watch for the overuse of SABAs as a sign of uncontrolled asthma and adjust treatment accordingly to reduce the risk of exacerbation. The study was sponsored by AstraZeneca PLC.

To watch a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON — Children with asthma who used 6 or more canisters of short-acting beta₂-agonists in a year had twice the risk of asthma exacerbation, compared with children who used fewer than 6 canisters, based on results of a database review of more than 33,000 children aged 6-17 years.

Studies have shown an association between increased use of short-acting beta₂-agonists (SABAs) and asthma exacerbation in children, but a threshold for high SABA use has not been established, said Christopher M. Blanchette, Ph.D., of Lovelace Respiratory Research Institute in Kannapolis, N.C.

Dr. Blanchette and his colleagues reviewed data from 33,951 children with asthma who were continuously enrolled for 2 years in the PharMetrics Patient-Centric Database (a pool of more than 70 commercial health insurance plans) between July 1, 2003, and June 30, 2007. The researchers excluded children with chronic obstructive pulmonary disease, bronchitis, cystic fibrosis, and other conditions that required oral cortico-steroids. Average age was 11 years.

Asthma exacerbation was determined by any or all of the following: oral corticosteroid prescriptions, urgent care or emergency department visits for asthma, and hospitalizations for asthma.

Overall, most (70%) children used 0-2 canisters per year. A total of 24% of the children used no canisters, 46% used 0.5-2 canisters, 23% used 2.5-6 canisters, 5% used 6.5-12 canisters, and 2% used more than 12 canisters, according to the results presented at annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A total of 3,147 children (9%) used 6 or more SABA canisters, which was significantly associated with asthma exacerbation. In addition to a doubled risk of asthma exacerbation, children who used 6 or more canisters per year were more than three times as likely to be hospitalized or to have emergency department or urgent care visits, compared with children who used 0-5 canisters.

The study was limited by a lack of control for all potentially confounding factors, including the use of inhaled corticosteroids, the researchers wrote. The most common comorbidities were allergies or allergic rhinitis (35%), acute pharyngitis (25%), and acute upper respiratory infections (22%).

Although most of the children in the study did not meet the threshold associated with increased risk, the findings highlight the need for physicians to watch for the overuse of SABAs as a sign of uncontrolled asthma and adjust treatment accordingly to reduce the risk of exacerbation. The study was sponsored by AstraZeneca PLC.

To watch a related video, go to www.youtube.com/FamilyPracticeNews

ARLINGTON, VA. — The first international guidelines for the prevention and treatment of pressure ulcers are available for public comment, and a final version will be released in May, according to presenters at the National Pressure Ulcer Advisory Panel.

The international collaboration adds a new dimension to the guidelines, NPUAP President Laura Edsberg, Ph.D., said in an interview. “We have expanded the level of evidence that we are sharing,” she said. The draft guidelines result from the joint effort between the NPUAP and the European Pressure Ulcer Advisory Panel, based in England.

The treatment and prevention of pressure ulcers has become a hot topic in wound care, because pressure ulcers are among the conditions that Medicare considers preventable and soon will not reimburse hospitals for, if the wounds arise there.

The draft guidelines cover both prevention and treatment. The prevention section details what makes patients vulnerable to pressure ulcers, such as long-term contact with devices including nasal cannulae and tracheostomy plates. But the guidelines also emphasize preventive strategies, such as managing patient nourishment and hydration.

Additional guidelines compare different types of wound dressings, including foam, alginate, and hydrogel. Protocols for cleaning and supporting pressure ulcers, and alternative healing strategies including hydrotherapy, ultrasound, and maggot therapy are addressed.

More information on the draft guidelines and how to comment on them is at the NPUAP Web site, www.npuap.org

ARLINGTON, VA. — The first international guidelines for the prevention and treatment of pressure ulcers are available for public comment, and a final version will be released in May, according to presenters at the National Pressure Ulcer Advisory Panel.

The international collaboration adds a new dimension to the guidelines, NPUAP President Laura Edsberg, Ph.D., said in an interview. “We have expanded the level of evidence that we are sharing,” she said. The draft guidelines result from the joint effort between the NPUAP and the European Pressure Ulcer Advisory Panel, based in England.

The treatment and prevention of pressure ulcers has become a hot topic in wound care, because pressure ulcers are among the conditions that Medicare considers preventable and soon will not reimburse hospitals for, if the wounds arise there.

The draft guidelines cover both prevention and treatment. The prevention section details what makes patients vulnerable to pressure ulcers, such as long-term contact with devices including nasal cannulae and tracheostomy plates. But the guidelines also emphasize preventive strategies, such as managing patient nourishment and hydration.

Additional guidelines compare different types of wound dressings, including foam, alginate, and hydrogel. Protocols for cleaning and supporting pressure ulcers, and alternative healing strategies including hydrotherapy, ultrasound, and maggot therapy are addressed.

More information on the draft guidelines and how to comment on them is at the NPUAP Web site, www.npuap.org

ARLINGTON, VA. — The first international guidelines for the prevention and treatment of pressure ulcers are available for public comment, and a final version will be released in May, according to presenters at the National Pressure Ulcer Advisory Panel.

The international collaboration adds a new dimension to the guidelines, NPUAP President Laura Edsberg, Ph.D., said in an interview. “We have expanded the level of evidence that we are sharing,” she said. The draft guidelines result from the joint effort between the NPUAP and the European Pressure Ulcer Advisory Panel, based in England.

The treatment and prevention of pressure ulcers has become a hot topic in wound care, because pressure ulcers are among the conditions that Medicare considers preventable and soon will not reimburse hospitals for, if the wounds arise there.

The draft guidelines cover both prevention and treatment. The prevention section details what makes patients vulnerable to pressure ulcers, such as long-term contact with devices including nasal cannulae and tracheostomy plates. But the guidelines also emphasize preventive strategies, such as managing patient nourishment and hydration.

Additional guidelines compare different types of wound dressings, including foam, alginate, and hydrogel. Protocols for cleaning and supporting pressure ulcers, and alternative healing strategies including hydrotherapy, ultrasound, and maggot therapy are addressed.

More information on the draft guidelines and how to comment on them is at the NPUAP Web site, www.npuap.org

WASHINGTON — A 100-mcg dose of the inhaled corticosteroid mometasone furoate, given either once or twice daily, significantly reduced the need for rescue medications in 296 children aged 4–11 years with mild to moderate persistent asthma.

Overall, children in both the once- and twice-daily mometasone furoate (MF) groups averaged significantly fewer puffs of rescue medication after 12 weeks, compared with a placebo group. The average baseline rescue medication use was 1.3 puffs per day in all three groups. Children in the once-daily and twice-daily treatment groups reported average reductions in rescue medication use of 19.5% and 13.4%, respectively. By contrast, rescue medication use increased by an average of 22% in the placebo group during the study period.

“Rescue medication use was reduced quickly and showed a trend for progressive reduction over the entire 12-week treatment period,” Dr. William E. Berger, who is in private practice in Mission Viejo, Calif., and his colleagues, reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

MF recently was approved to treat asthma in children aged 4–11 years. The current study was part of a larger trial that contributed to the drug's approval, Dr. Berger said in an interview.

The children were randomized to receive a 100-mcg dose of MF (via a dry powder inhaler) once daily (98 children) or twice daily (99 children), or a placebo (99 children). The researchers calculated changes in the number of rescue medication puffs per day and measured peak morning and evening expiratory flow.

The average age of the children was 9 years in the treatment groups and 8 years in the placebo group. The demographics and baseline uses of rescue medication and peak flow measurements were not significantly different among the three groups.

Significant improvements in peak expiratory flow were observed in both treatment groups compared with placebo during each week of the study.

Both doses of MF were well tolerated; the incidence of adverse events was similar in the once-daily, twice-daily, and placebo groups (55%, 60%, and 52%, respectively).

Adverse events included headache and upper respiratory tract infection.

The study population included children aged 4–11 years who had been diagnosed with asthma for at least 6 months. Children who used nebulizers or other long-acting beta2-agonists, had been hospitalized during the 3 months before the study, or who used systemic corticosteroids for at least 15 days during the 6 months before the study were excluded.

These findings parallel the results from the larger drug approval study, which showed that inhaled MF given either once or twice daily was significantly more effective than was placebo at improving pulmonary function in children with mild to moderate asthma, the researchers wrote.

The study was sponsored by Schering-Plough Corp.

WASHINGTON — A 100-mcg dose of the inhaled corticosteroid mometasone furoate, given either once or twice daily, significantly reduced the need for rescue medications in 296 children aged 4–11 years with mild to moderate persistent asthma.

Overall, children in both the once- and twice-daily mometasone furoate (MF) groups averaged significantly fewer puffs of rescue medication after 12 weeks, compared with a placebo group. The average baseline rescue medication use was 1.3 puffs per day in all three groups. Children in the once-daily and twice-daily treatment groups reported average reductions in rescue medication use of 19.5% and 13.4%, respectively. By contrast, rescue medication use increased by an average of 22% in the placebo group during the study period.

“Rescue medication use was reduced quickly and showed a trend for progressive reduction over the entire 12-week treatment period,” Dr. William E. Berger, who is in private practice in Mission Viejo, Calif., and his colleagues, reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

MF recently was approved to treat asthma in children aged 4–11 years. The current study was part of a larger trial that contributed to the drug's approval, Dr. Berger said in an interview.

The children were randomized to receive a 100-mcg dose of MF (via a dry powder inhaler) once daily (98 children) or twice daily (99 children), or a placebo (99 children). The researchers calculated changes in the number of rescue medication puffs per day and measured peak morning and evening expiratory flow.

The average age of the children was 9 years in the treatment groups and 8 years in the placebo group. The demographics and baseline uses of rescue medication and peak flow measurements were not significantly different among the three groups.

Significant improvements in peak expiratory flow were observed in both treatment groups compared with placebo during each week of the study.

Both doses of MF were well tolerated; the incidence of adverse events was similar in the once-daily, twice-daily, and placebo groups (55%, 60%, and 52%, respectively).

Adverse events included headache and upper respiratory tract infection.

The study population included children aged 4–11 years who had been diagnosed with asthma for at least 6 months. Children who used nebulizers or other long-acting beta2-agonists, had been hospitalized during the 3 months before the study, or who used systemic corticosteroids for at least 15 days during the 6 months before the study were excluded.

These findings parallel the results from the larger drug approval study, which showed that inhaled MF given either once or twice daily was significantly more effective than was placebo at improving pulmonary function in children with mild to moderate asthma, the researchers wrote.

The study was sponsored by Schering-Plough Corp.

WASHINGTON — A 100-mcg dose of the inhaled corticosteroid mometasone furoate, given either once or twice daily, significantly reduced the need for rescue medications in 296 children aged 4–11 years with mild to moderate persistent asthma.

Overall, children in both the once- and twice-daily mometasone furoate (MF) groups averaged significantly fewer puffs of rescue medication after 12 weeks, compared with a placebo group. The average baseline rescue medication use was 1.3 puffs per day in all three groups. Children in the once-daily and twice-daily treatment groups reported average reductions in rescue medication use of 19.5% and 13.4%, respectively. By contrast, rescue medication use increased by an average of 22% in the placebo group during the study period.

“Rescue medication use was reduced quickly and showed a trend for progressive reduction over the entire 12-week treatment period,” Dr. William E. Berger, who is in private practice in Mission Viejo, Calif., and his colleagues, reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

MF recently was approved to treat asthma in children aged 4–11 years. The current study was part of a larger trial that contributed to the drug's approval, Dr. Berger said in an interview.

The children were randomized to receive a 100-mcg dose of MF (via a dry powder inhaler) once daily (98 children) or twice daily (99 children), or a placebo (99 children). The researchers calculated changes in the number of rescue medication puffs per day and measured peak morning and evening expiratory flow.

The average age of the children was 9 years in the treatment groups and 8 years in the placebo group. The demographics and baseline uses of rescue medication and peak flow measurements were not significantly different among the three groups.

Significant improvements in peak expiratory flow were observed in both treatment groups compared with placebo during each week of the study.

Both doses of MF were well tolerated; the incidence of adverse events was similar in the once-daily, twice-daily, and placebo groups (55%, 60%, and 52%, respectively).

Adverse events included headache and upper respiratory tract infection.

The study population included children aged 4–11 years who had been diagnosed with asthma for at least 6 months. Children who used nebulizers or other long-acting beta2-agonists, had been hospitalized during the 3 months before the study, or who used systemic corticosteroids for at least 15 days during the 6 months before the study were excluded.

These findings parallel the results from the larger drug approval study, which showed that inhaled MF given either once or twice daily was significantly more effective than was placebo at improving pulmonary function in children with mild to moderate asthma, the researchers wrote.

The study was sponsored by Schering-Plough Corp.

Paying people to quit smoking significantly increased smoking-cessation rates, compared with a control strategy that had no financial incentives, according to a workplace-based study.

Previous studies of workplace-based financial incentives to help people quit smoking have used small sample sizes and small payments, wrote Dr. Kevin G. Volpp of the University of Pennsylvania in Philadelphia, and colleagues.

The researchers randomized 442 adult smokers to receive information about smoking-cessation programs and 436 to receive information about smoking-cessation programs plus a financial incentive. The participants volunteered for the study after being identified through a survey about smoking habits. Those who used tobacco products other than cigarettes were excluded.

The financial incentive was $100 to complete a smoking-cessation program, plus $250 for confirmed cessation of smoking at 3 or 6 months after entering the study. In addition, participants received $400 for smoking cessation 6 months after the previous date of confirmed smoking cessation (9 months or 12 months). They were also assessed for smoking status (but were not paid) after another 6 months (15 or 18 months after study enrollment). The smoking-cessation program was not based at the workplace; instead, participants were advised to use existing programs in the community.

The study population included adults aged 18 years and older who reported smoking at least five cigarettes daily. Demographic traits were similar between the two groups. The participants were followed for at least 12 months, and the study's primary end point was smoking cessation 9 or 12 months after study enrollment.

Overall, the rate of confirmed smoking cessation (based on a cotinine test) at 9 months or 12 months was about 3 times greater in the financial incentive group, compared with the control group (15% vs. 5%). The smoking-cessation rate within 6 months of starting the study was significantly higher in the financial incentive group, compared with the control group (21% vs. 12%). And the cessation rate remained significantly higher in the financial incentive group, compared with the control group at 15 or 18 months (9% vs. 4%).

Significantly more individuals in the financial incentive group than in the control group enrolled in (15% vs. 5%) and completed (11% vs. 3%) a smoking-cessation education program. Those in the financial incentive group who took part in the smoking-cessation program had higher smoking-cessation rates, compared with controls who took part in the program (46% vs. 21%).

“Targeted payments for smoking cessation have the advantage of being unbundled from health insurance premiums and thus may be more salient to people, thereby having a greater influence on behavior,” the researchers said (N. Engl. J. Med. 2009;360:699–709).

The relapse rates between the 9- or 12-month follow-up and the 15- or 18-month follow-up were 36% in the financial incentive group and 27% in the control group. Although those results were higher than those found in other studies, the difference may be negligible compared with other studies, the researchers noted, because so few participants in the current study quit smoking.

The study was limited by its majority of white adults (90%) with high levels of income and education, the researchers noted. More research is needed to assess the effect of financial incentives on employees with lower socioeconomic status and on those of different ethnicities, they added.

The study was supported in part by grants from the Centers for Disease Control and Prevention and the Pennsylvania Department of Health. Dr. Volpp has received lecture fees from Aetna Inc. and grant support from Aetna and Pfizer Inc.

Payments are unbundled from health insurance premiums and thus may have a greater influence on behavior. DR. VOLPP

Paying people to quit smoking significantly increased smoking-cessation rates, compared with a control strategy that had no financial incentives, according to a workplace-based study.

Previous studies of workplace-based financial incentives to help people quit smoking have used small sample sizes and small payments, wrote Dr. Kevin G. Volpp of the University of Pennsylvania in Philadelphia, and colleagues.

The researchers randomized 442 adult smokers to receive information about smoking-cessation programs and 436 to receive information about smoking-cessation programs plus a financial incentive. The participants volunteered for the study after being identified through a survey about smoking habits. Those who used tobacco products other than cigarettes were excluded.

The financial incentive was $100 to complete a smoking-cessation program, plus $250 for confirmed cessation of smoking at 3 or 6 months after entering the study. In addition, participants received $400 for smoking cessation 6 months after the previous date of confirmed smoking cessation (9 months or 12 months). They were also assessed for smoking status (but were not paid) after another 6 months (15 or 18 months after study enrollment). The smoking-cessation program was not based at the workplace; instead, participants were advised to use existing programs in the community.

The study population included adults aged 18 years and older who reported smoking at least five cigarettes daily. Demographic traits were similar between the two groups. The participants were followed for at least 12 months, and the study's primary end point was smoking cessation 9 or 12 months after study enrollment.

Overall, the rate of confirmed smoking cessation (based on a cotinine test) at 9 months or 12 months was about 3 times greater in the financial incentive group, compared with the control group (15% vs. 5%). The smoking-cessation rate within 6 months of starting the study was significantly higher in the financial incentive group, compared with the control group (21% vs. 12%). And the cessation rate remained significantly higher in the financial incentive group, compared with the control group at 15 or 18 months (9% vs. 4%).

Significantly more individuals in the financial incentive group than in the control group enrolled in (15% vs. 5%) and completed (11% vs. 3%) a smoking-cessation education program. Those in the financial incentive group who took part in the smoking-cessation program had higher smoking-cessation rates, compared with controls who took part in the program (46% vs. 21%).

“Targeted payments for smoking cessation have the advantage of being unbundled from health insurance premiums and thus may be more salient to people, thereby having a greater influence on behavior,” the researchers said (N. Engl. J. Med. 2009;360:699–709).

The relapse rates between the 9- or 12-month follow-up and the 15- or 18-month follow-up were 36% in the financial incentive group and 27% in the control group. Although those results were higher than those found in other studies, the difference may be negligible compared with other studies, the researchers noted, because so few participants in the current study quit smoking.

The study was limited by its majority of white adults (90%) with high levels of income and education, the researchers noted. More research is needed to assess the effect of financial incentives on employees with lower socioeconomic status and on those of different ethnicities, they added.

The study was supported in part by grants from the Centers for Disease Control and Prevention and the Pennsylvania Department of Health. Dr. Volpp has received lecture fees from Aetna Inc. and grant support from Aetna and Pfizer Inc.

Payments are unbundled from health insurance premiums and thus may have a greater influence on behavior. DR. VOLPP

Paying people to quit smoking significantly increased smoking-cessation rates, compared with a control strategy that had no financial incentives, according to a workplace-based study.

Previous studies of workplace-based financial incentives to help people quit smoking have used small sample sizes and small payments, wrote Dr. Kevin G. Volpp of the University of Pennsylvania in Philadelphia, and colleagues.

The researchers randomized 442 adult smokers to receive information about smoking-cessation programs and 436 to receive information about smoking-cessation programs plus a financial incentive. The participants volunteered for the study after being identified through a survey about smoking habits. Those who used tobacco products other than cigarettes were excluded.

The financial incentive was $100 to complete a smoking-cessation program, plus $250 for confirmed cessation of smoking at 3 or 6 months after entering the study. In addition, participants received $400 for smoking cessation 6 months after the previous date of confirmed smoking cessation (9 months or 12 months). They were also assessed for smoking status (but were not paid) after another 6 months (15 or 18 months after study enrollment). The smoking-cessation program was not based at the workplace; instead, participants were advised to use existing programs in the community.

The study population included adults aged 18 years and older who reported smoking at least five cigarettes daily. Demographic traits were similar between the two groups. The participants were followed for at least 12 months, and the study's primary end point was smoking cessation 9 or 12 months after study enrollment.

Overall, the rate of confirmed smoking cessation (based on a cotinine test) at 9 months or 12 months was about 3 times greater in the financial incentive group, compared with the control group (15% vs. 5%). The smoking-cessation rate within 6 months of starting the study was significantly higher in the financial incentive group, compared with the control group (21% vs. 12%). And the cessation rate remained significantly higher in the financial incentive group, compared with the control group at 15 or 18 months (9% vs. 4%).

Significantly more individuals in the financial incentive group than in the control group enrolled in (15% vs. 5%) and completed (11% vs. 3%) a smoking-cessation education program. Those in the financial incentive group who took part in the smoking-cessation program had higher smoking-cessation rates, compared with controls who took part in the program (46% vs. 21%).

“Targeted payments for smoking cessation have the advantage of being unbundled from health insurance premiums and thus may be more salient to people, thereby having a greater influence on behavior,” the researchers said (N. Engl. J. Med. 2009;360:699–709).

The relapse rates between the 9- or 12-month follow-up and the 15- or 18-month follow-up were 36% in the financial incentive group and 27% in the control group. Although those results were higher than those found in other studies, the difference may be negligible compared with other studies, the researchers noted, because so few participants in the current study quit smoking.

The study was limited by its majority of white adults (90%) with high levels of income and education, the researchers noted. More research is needed to assess the effect of financial incentives on employees with lower socioeconomic status and on those of different ethnicities, they added.

The study was supported in part by grants from the Centers for Disease Control and Prevention and the Pennsylvania Department of Health. Dr. Volpp has received lecture fees from Aetna Inc. and grant support from Aetna and Pfizer Inc.

Payments are unbundled from health insurance premiums and thus may have a greater influence on behavior. DR. VOLPP

W eight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults.

Obesity is a risk factor for obstructive sleep apnea (OSA), but no randomized trials have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, they randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to lifestyle counseling.

The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

“Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variable, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

W eight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults.

Obesity is a risk factor for obstructive sleep apnea (OSA), but no randomized trials have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, they randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to lifestyle counseling.

The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

“Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variable, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

W eight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults.

Obesity is a risk factor for obstructive sleep apnea (OSA), but no randomized trials have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, they randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to lifestyle counseling.

The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

“Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variable, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

A program for healthy weight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults aged 18-65 years.

Obesity is a known risk factor for obstructive sleep apnea (OSA), but no randomized studies have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, the researchers randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to a program of routine lifestyle counseling. The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year follow-up, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

“Changes in AHI during the 12-month follow-up were strongly associated with changes in weight and waist circumference,” the researchers wrote. A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

In addition, the intervention was associated with improvements in other obesity-related cardiovascular disease risk factors.

During follow-up, two of four patients in the intervention group who were taking oral diabetes medications were able to discontinue the medications, while two of the controls started taking diabetes medications. In all, 5 of 18 intervention patients were able to discontinue their antihypertensive medications, compared with 2 of 15 patients in the control group. And 6 of 12 patients in the intervention group who were taking cholesterol medications were able to discontinue them, compared with 3 of 18 controls.

Patients in the intervention group also reported improvements in quality of life, with scores nearly twice as high as the controls at the 1-year follow-up point. Patients in the intervention group also reported greater improvement in symptoms of OSA, including snoring and daytime sleepiness, compared with controls.

Long-term lifestyle changes can improve OSA, the researchers said. “Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variables, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

A program for healthy weight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults aged 18-65 years.

Obesity is a known risk factor for obstructive sleep apnea (OSA), but no randomized studies have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, the researchers randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to a program of routine lifestyle counseling. The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year follow-up, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

“Changes in AHI during the 12-month follow-up were strongly associated with changes in weight and waist circumference,” the researchers wrote. A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

In addition, the intervention was associated with improvements in other obesity-related cardiovascular disease risk factors.

During follow-up, two of four patients in the intervention group who were taking oral diabetes medications were able to discontinue the medications, while two of the controls started taking diabetes medications. In all, 5 of 18 intervention patients were able to discontinue their antihypertensive medications, compared with 2 of 15 patients in the control group. And 6 of 12 patients in the intervention group who were taking cholesterol medications were able to discontinue them, compared with 3 of 18 controls.

Patients in the intervention group also reported improvements in quality of life, with scores nearly twice as high as the controls at the 1-year follow-up point. Patients in the intervention group also reported greater improvement in symptoms of OSA, including snoring and daytime sleepiness, compared with controls.

Long-term lifestyle changes can improve OSA, the researchers said. “Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variables, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

A program for healthy weight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults aged 18-65 years.

Obesity is a known risk factor for obstructive sleep apnea (OSA), but no randomized studies have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, the researchers randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to a program of routine lifestyle counseling. The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year follow-up, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

“Changes in AHI during the 12-month follow-up were strongly associated with changes in weight and waist circumference,” the researchers wrote. A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

In addition, the intervention was associated with improvements in other obesity-related cardiovascular disease risk factors.

During follow-up, two of four patients in the intervention group who were taking oral diabetes medications were able to discontinue the medications, while two of the controls started taking diabetes medications. In all, 5 of 18 intervention patients were able to discontinue their antihypertensive medications, compared with 2 of 15 patients in the control group. And 6 of 12 patients in the intervention group who were taking cholesterol medications were able to discontinue them, compared with 3 of 18 controls.

Patients in the intervention group also reported improvements in quality of life, with scores nearly twice as high as the controls at the 1-year follow-up point. Patients in the intervention group also reported greater improvement in symptoms of OSA, including snoring and daytime sleepiness, compared with controls.

Long-term lifestyle changes can improve OSA, the researchers said. “Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variables, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

Long-term lipid abnormalities were significantly associated with higher albumin excretion in a study of 895 adolescents aged 10-16 years with type 1 diabetes.

Data on lipid levels and the possible association between lipids and albumin excretion in teens with type 1 diabetes are limited. But previous studies suggest that the relationship between these values can help clinicians predict the risk of diabetic neuropathy in these patients, wrote Dr. Maria Loredana Marcovecchio of the University of Cambridge (England) and her colleagues.

The researchers reviewed data from 490 boys and 405 girls, whose mean age at baseline was 14.5 years, with type 1 diabetes who were enrolled in an ongoing juvenile diabetes study in the United Kingdom. The data included three consecutive early morning urine samples to determine albumin-creatinine ratios, collected each year for an average of 2.3 years. Nonfasting blood samples were taken to assess lipids. They defined microalbuminuria (MA) as an albumin-creatinine ratio in the 3.5-35 mg/mmol range for boys and in the 4.0-40 mg/mmol range for girls in two of three consecutive urine samples at an annual collection (Diabetes Care 2009 [Epub ahead of print: http://care.diabetesjournals.org

During the follow-up period, 115 teens developed MA. The average concentrations of total cholesterol and non-HDL cholesterol were significantly higher in the teens with MA, compared with teens with normal albumin levels (4.7 mmol/L vs. 4.5 mmol/L and 3.2 mmol/L vs. 2.9 mmol/L, respectively).

Age-related changes in total cholesterol and non-HDL cholesterol in teens older than age 15 or 16 years were higher in the 28 teens with persistent MA compared with the 87 teens with transient MA and compared with teens without MA, the researchers noted. The average age of onset for MA was 15 years, which supports the link between lipids and MA, but the worse glycemic control in teens with MA could be a factor, they added.

During the follow-up period, an average of 19% of the teens had abnormal total cholesterol, 20% had abnormal triglycerides, 26% had abnormal HDL cholesterol, and 10% had abnormal LDL cholesterol. In addition, an average of 2.5% had low HDL cholesterol, 35% had borderline triglycerides, and 13% had borderline LDL cholesterol.

Overall, the association between average lipid levels and average hemoglobin A1c levels was significant (with the exception of HDL cholesterol). The associations were significantly stronger in girls compared with boys. Older age and longer duration of diabetes were significant predictors of all types of lipid abnormalities, and higher body mass index was significantly associated with all lipid abnormalities, except total cholesterol.

The researchers had no financial conflicts to disclose.

Long-term lipid abnormalities were significantly associated with higher albumin excretion in a study of 895 adolescents aged 10-16 years with type 1 diabetes.

Data on lipid levels and the possible association between lipids and albumin excretion in teens with type 1 diabetes are limited. But previous studies suggest that the relationship between these values can help clinicians predict the risk of diabetic neuropathy in these patients, wrote Dr. Maria Loredana Marcovecchio of the University of Cambridge (England) and her colleagues.

The researchers reviewed data from 490 boys and 405 girls, whose mean age at baseline was 14.5 years, with type 1 diabetes who were enrolled in an ongoing juvenile diabetes study in the United Kingdom. The data included three consecutive early morning urine samples to determine albumin-creatinine ratios, collected each year for an average of 2.3 years. Nonfasting blood samples were taken to assess lipids. They defined microalbuminuria (MA) as an albumin-creatinine ratio in the 3.5-35 mg/mmol range for boys and in the 4.0-40 mg/mmol range for girls in two of three consecutive urine samples at an annual collection (Diabetes Care 2009 [Epub ahead of print: http://care.diabetesjournals.org

During the follow-up period, 115 teens developed MA. The average concentrations of total cholesterol and non-HDL cholesterol were significantly higher in the teens with MA, compared with teens with normal albumin levels (4.7 mmol/L vs. 4.5 mmol/L and 3.2 mmol/L vs. 2.9 mmol/L, respectively).

Age-related changes in total cholesterol and non-HDL cholesterol in teens older than age 15 or 16 years were higher in the 28 teens with persistent MA compared with the 87 teens with transient MA and compared with teens without MA, the researchers noted. The average age of onset for MA was 15 years, which supports the link between lipids and MA, but the worse glycemic control in teens with MA could be a factor, they added.

During the follow-up period, an average of 19% of the teens had abnormal total cholesterol, 20% had abnormal triglycerides, 26% had abnormal HDL cholesterol, and 10% had abnormal LDL cholesterol. In addition, an average of 2.5% had low HDL cholesterol, 35% had borderline triglycerides, and 13% had borderline LDL cholesterol.

Overall, the association between average lipid levels and average hemoglobin A1c levels was significant (with the exception of HDL cholesterol). The associations were significantly stronger in girls compared with boys. Older age and longer duration of diabetes were significant predictors of all types of lipid abnormalities, and higher body mass index was significantly associated with all lipid abnormalities, except total cholesterol.

The researchers had no financial conflicts to disclose.

Long-term lipid abnormalities were significantly associated with higher albumin excretion in a study of 895 adolescents aged 10-16 years with type 1 diabetes.

Data on lipid levels and the possible association between lipids and albumin excretion in teens with type 1 diabetes are limited. But previous studies suggest that the relationship between these values can help clinicians predict the risk of diabetic neuropathy in these patients, wrote Dr. Maria Loredana Marcovecchio of the University of Cambridge (England) and her colleagues.

The researchers reviewed data from 490 boys and 405 girls, whose mean age at baseline was 14.5 years, with type 1 diabetes who were enrolled in an ongoing juvenile diabetes study in the United Kingdom. The data included three consecutive early morning urine samples to determine albumin-creatinine ratios, collected each year for an average of 2.3 years. Nonfasting blood samples were taken to assess lipids. They defined microalbuminuria (MA) as an albumin-creatinine ratio in the 3.5-35 mg/mmol range for boys and in the 4.0-40 mg/mmol range for girls in two of three consecutive urine samples at an annual collection (Diabetes Care 2009 [Epub ahead of print: http://care.diabetesjournals.org

During the follow-up period, 115 teens developed MA. The average concentrations of total cholesterol and non-HDL cholesterol were significantly higher in the teens with MA, compared with teens with normal albumin levels (4.7 mmol/L vs. 4.5 mmol/L and 3.2 mmol/L vs. 2.9 mmol/L, respectively).

Age-related changes in total cholesterol and non-HDL cholesterol in teens older than age 15 or 16 years were higher in the 28 teens with persistent MA compared with the 87 teens with transient MA and compared with teens without MA, the researchers noted. The average age of onset for MA was 15 years, which supports the link between lipids and MA, but the worse glycemic control in teens with MA could be a factor, they added.

During the follow-up period, an average of 19% of the teens had abnormal total cholesterol, 20% had abnormal triglycerides, 26% had abnormal HDL cholesterol, and 10% had abnormal LDL cholesterol. In addition, an average of 2.5% had low HDL cholesterol, 35% had borderline triglycerides, and 13% had borderline LDL cholesterol.

Overall, the association between average lipid levels and average hemoglobin A1c levels was significant (with the exception of HDL cholesterol). The associations were significantly stronger in girls compared with boys. Older age and longer duration of diabetes were significant predictors of all types of lipid abnormalities, and higher body mass index was significantly associated with all lipid abnormalities, except total cholesterol.

The researchers had no financial conflicts to disclose.

More than 40% of Americans aged at least 20 years have hyperglycemic conditions, according to review of the 2005-2006 National Health and Nutrition Examination Survey.

Catherine Cowie, Ph.D., of the National Institutes of Health, and her colleagues compared NHANES data from 1988-1994 to that of 2005-2006 (Diabetes Care 2009;32:287-94).

The total crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in those aged 20 and older. The total diabetes prevalence peaked at about 30% among those older than 60 years, and the prevalence of diabetes was about the same in men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests, was 30%. This rate was highest among those aged 75 and older, where it reached 47%.

The total prevalence of diabetes and prediabetes, diagnosed and undiagnosed, was significantly higher in men (48% vs. 34%) but this was due largely to the greater prevalence of prediabetes among men. The prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks vs. whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

A comparison of the 2005-2006 data with that of 1988-1994 showed a significant rise in the crude prevalence of diagnosed diabetes from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005-2006 portends all the consequences of diabetes, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, they noted.

The researchers had no financial conflicts to disclose.

More than 40% of Americans aged at least 20 years have hyperglycemic conditions, according to review of the 2005-2006 National Health and Nutrition Examination Survey.

Catherine Cowie, Ph.D., of the National Institutes of Health, and her colleagues compared NHANES data from 1988-1994 to that of 2005-2006 (Diabetes Care 2009;32:287-94).

The total crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in those aged 20 and older. The total diabetes prevalence peaked at about 30% among those older than 60 years, and the prevalence of diabetes was about the same in men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests, was 30%. This rate was highest among those aged 75 and older, where it reached 47%.

The total prevalence of diabetes and prediabetes, diagnosed and undiagnosed, was significantly higher in men (48% vs. 34%) but this was due largely to the greater prevalence of prediabetes among men. The prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks vs. whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

A comparison of the 2005-2006 data with that of 1988-1994 showed a significant rise in the crude prevalence of diagnosed diabetes from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005-2006 portends all the consequences of diabetes, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, they noted.

The researchers had no financial conflicts to disclose.

More than 40% of Americans aged at least 20 years have hyperglycemic conditions, according to review of the 2005-2006 National Health and Nutrition Examination Survey.

Catherine Cowie, Ph.D., of the National Institutes of Health, and her colleagues compared NHANES data from 1988-1994 to that of 2005-2006 (Diabetes Care 2009;32:287-94).

The total crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in those aged 20 and older. The total diabetes prevalence peaked at about 30% among those older than 60 years, and the prevalence of diabetes was about the same in men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests, was 30%. This rate was highest among those aged 75 and older, where it reached 47%.

The total prevalence of diabetes and prediabetes, diagnosed and undiagnosed, was significantly higher in men (48% vs. 34%) but this was due largely to the greater prevalence of prediabetes among men. The prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks vs. whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

A comparison of the 2005-2006 data with that of 1988-1994 showed a significant rise in the crude prevalence of diagnosed diabetes from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005-2006 portends all the consequences of diabetes, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, they noted.

The researchers had no financial conflicts to disclose.