Heidi Splete

WASHINGTON – Long-term data from a registry of civilians with traumatic brain injury may yield information that is relevant to the care of injured veterans returning from Iraq and Afghanistan, said Jean A. Langlois, Sc.D., at a meeting on traumatic brain injuries sponsored by the Institute of Medicine.

During her presentation, Dr. Langlois noted that there are relatively few long-term cohort studies of blast-induced TBI and the possible combined effects of these injuries and posttraumatic stress disorder (PTSD). The data she presented showed that civilian survivors of TBI often develop costly disabilities. More aggressive treatment might make a difference. “I think we will be seeing several directions for interventions, including electrical brain stimulation,” Dr. Langlois said.

Approximately 124,000 civilians in the United States are hospitalized each year with TBI, and about 40% of these patients will experience long-term disabilities, said Dr. Langlois, an epidemiologist at the Centers for Disease Control and Prevention.

Findings from previous studies have shown that even uninjured military personnel who return from combat are at increased risk of psychosocial and psychiatric problems, including PTSD, major depression, suicide, impaired social function, and limited ability to work, she noted.

She reviewed data from four population-based studies using the South Carolina Traumatic Brain Injury Follow-up Registry that included patients with TBI who required hospitalization. The TBI was severe in 45% of patients, moderate in 15%, and mild in 40%. Patients were aged 15 years or older, 60% were male, and 75% were white.

The first of the four studies evaluated psychosocial health in 2,118 patients 1 year after TBI. Based on the scores from a validated social function scale, 29% of the TBI patients reported poor psychosocial health 1 year after their injuries, which is more than one standard deviation below the population norms, Dr. Langlois said.

“We found almost double the rate of psychosocial health problems [compared with the rate in] the general population, but only 36% reported receiving any mental health care after TBI,” she said (Arch. Phys. Med. Rehabil. 2006;87:953–61).

Factors associated with poor psychosocial health 1 year after TBI included female gender, preinjury or postinjury psychiatric conditions, inadequate social support, physical limitations for activities of daily living, and preinjury drug or alcohol abuse problems.

Surprisingly, adults with TBI were less likely to report heavy alcohol consumption 1 year after injury, based on data from 1,606 patients.

The researchers used the CDC's Behavioral Risk Factor Surveillance summary questions to assess drinking habits. They found that 94% of the patients reported drinking the same amount or less alcohol 1 year after TBI than they did before TBI. And 50% of those who called themselves heavy drinkers reported drinking less. Heavy drinking was defined as an average of five or more drinks per occasion, or 22 or more drinking days within a month (J. Int. Neuropsychol. Soc. 2005;11:322–30).

But compared with the general population, the TBI population was more likely to binge drink (defined as five or more drinks on one occasion), and almost twice as likely to have five or more occasions to binge drink. Factors associated with heavy drinking were male gender, younger age, lack of support, diagnosis of depression since TBI, and self-reported fair to moderate (vs. excellent) mental health.

Also, research has shown that substance abuse problems may surface in later years after TBI, rather than immediately following the injury, said Dr. Langlois, citing a review of evidence that, on average, the quantities of alcohol consumed by TBI patients increased over time after their injuries (Arch. Phys. Med. Rehabil. 1995;76:302–9).

Clinical implications of heavy drinking include decreased recovery from TBI, increased impulsivity, exacerbation of cognitive problems, increased risk for seizures, and increased risk for additional brain injuries, Dr. Langlois added.

A third study focused on employment 1 year after TBI. These findings may have unique implications for returning military personnel who may not be able to redeploy and who will need to rejoin the civilian work force, Dr. Langlois said. The employment study included patients from the South Carolina database, plus data on people with TBI who were not in the South Carolina registry, for a total of 3,444 patients (2,487 men and 957 women).

At 1 year after TBI, a majority (41%) of the patients had stopped working, 36% had kept the same hours, 13% were working fewer hours, and 10% were working more hours, Dr. Langlois said.

Factors associated with not working included a longer hospital stay, nonwhite race, and having Medicaid or workers' compensation.

When the patients were divided by gender, men aged 20–24 years were the most likely to be working after 1 year, possibly because they tended to be the primary wage earners, whereas older men may have better disability or health benefits, Dr. Langlois noted. By contrast, women aged 18–24 years were most likely to be not working 1 year after TBI, possibly because they tend to be caring for children at home or because they may have complications if their injuries resulted from domestic violence, Dr. Langlois said.

Dr. Langlois concluded with a study of mortality within 1 year of TBI based on the South Carolina population data from 3,679 persons hospitalized with TBI (J. Head Trauma Rehab. 2005;20:257–69). Overall, the risk for all-cause mortality was seven times higher, compared with the U.S. death rate, and 80% of these deaths were reported as being related to the TBI, Dr. Langlois said.

Patients with severe TBI were significantly more likely to die within 15 months, compared with mild or moderate cases. Other factors associated with mortality from TBI included older age (75 years or older) and more comorbid conditions (three or more). The most common comorbidities were heart disease (48%), hypertension (29%), and fluid/electrolyte imbalance (21%).

WASHINGTON – Long-term data from a registry of civilians with traumatic brain injury may yield information that is relevant to the care of injured veterans returning from Iraq and Afghanistan, said Jean A. Langlois, Sc.D., at a meeting on traumatic brain injuries sponsored by the Institute of Medicine.

During her presentation, Dr. Langlois noted that there are relatively few long-term cohort studies of blast-induced TBI and the possible combined effects of these injuries and posttraumatic stress disorder (PTSD). The data she presented showed that civilian survivors of TBI often develop costly disabilities. More aggressive treatment might make a difference. “I think we will be seeing several directions for interventions, including electrical brain stimulation,” Dr. Langlois said.

Approximately 124,000 civilians in the United States are hospitalized each year with TBI, and about 40% of these patients will experience long-term disabilities, said Dr. Langlois, an epidemiologist at the Centers for Disease Control and Prevention.

Findings from previous studies have shown that even uninjured military personnel who return from combat are at increased risk of psychosocial and psychiatric problems, including PTSD, major depression, suicide, impaired social function, and limited ability to work, she noted.

She reviewed data from four population-based studies using the South Carolina Traumatic Brain Injury Follow-up Registry that included patients with TBI who required hospitalization. The TBI was severe in 45% of patients, moderate in 15%, and mild in 40%. Patients were aged 15 years or older, 60% were male, and 75% were white.

The first of the four studies evaluated psychosocial health in 2,118 patients 1 year after TBI. Based on the scores from a validated social function scale, 29% of the TBI patients reported poor psychosocial health 1 year after their injuries, which is more than one standard deviation below the population norms, Dr. Langlois said.

“We found almost double the rate of psychosocial health problems [compared with the rate in] the general population, but only 36% reported receiving any mental health care after TBI,” she said (Arch. Phys. Med. Rehabil. 2006;87:953–61).

Factors associated with poor psychosocial health 1 year after TBI included female gender, preinjury or postinjury psychiatric conditions, inadequate social support, physical limitations for activities of daily living, and preinjury drug or alcohol abuse problems.

Surprisingly, adults with TBI were less likely to report heavy alcohol consumption 1 year after injury, based on data from 1,606 patients.

The researchers used the CDC's Behavioral Risk Factor Surveillance summary questions to assess drinking habits. They found that 94% of the patients reported drinking the same amount or less alcohol 1 year after TBI than they did before TBI. And 50% of those who called themselves heavy drinkers reported drinking less. Heavy drinking was defined as an average of five or more drinks per occasion, or 22 or more drinking days within a month (J. Int. Neuropsychol. Soc. 2005;11:322–30).

But compared with the general population, the TBI population was more likely to binge drink (defined as five or more drinks on one occasion), and almost twice as likely to have five or more occasions to binge drink. Factors associated with heavy drinking were male gender, younger age, lack of support, diagnosis of depression since TBI, and self-reported fair to moderate (vs. excellent) mental health.

Also, research has shown that substance abuse problems may surface in later years after TBI, rather than immediately following the injury, said Dr. Langlois, citing a review of evidence that, on average, the quantities of alcohol consumed by TBI patients increased over time after their injuries (Arch. Phys. Med. Rehabil. 1995;76:302–9).

Clinical implications of heavy drinking include decreased recovery from TBI, increased impulsivity, exacerbation of cognitive problems, increased risk for seizures, and increased risk for additional brain injuries, Dr. Langlois added.

A third study focused on employment 1 year after TBI. These findings may have unique implications for returning military personnel who may not be able to redeploy and who will need to rejoin the civilian work force, Dr. Langlois said. The employment study included patients from the South Carolina database, plus data on people with TBI who were not in the South Carolina registry, for a total of 3,444 patients (2,487 men and 957 women).

At 1 year after TBI, a majority (41%) of the patients had stopped working, 36% had kept the same hours, 13% were working fewer hours, and 10% were working more hours, Dr. Langlois said.

Factors associated with not working included a longer hospital stay, nonwhite race, and having Medicaid or workers' compensation.

When the patients were divided by gender, men aged 20–24 years were the most likely to be working after 1 year, possibly because they tended to be the primary wage earners, whereas older men may have better disability or health benefits, Dr. Langlois noted. By contrast, women aged 18–24 years were most likely to be not working 1 year after TBI, possibly because they tend to be caring for children at home or because they may have complications if their injuries resulted from domestic violence, Dr. Langlois said.

Dr. Langlois concluded with a study of mortality within 1 year of TBI based on the South Carolina population data from 3,679 persons hospitalized with TBI (J. Head Trauma Rehab. 2005;20:257–69). Overall, the risk for all-cause mortality was seven times higher, compared with the U.S. death rate, and 80% of these deaths were reported as being related to the TBI, Dr. Langlois said.

Patients with severe TBI were significantly more likely to die within 15 months, compared with mild or moderate cases. Other factors associated with mortality from TBI included older age (75 years or older) and more comorbid conditions (three or more). The most common comorbidities were heart disease (48%), hypertension (29%), and fluid/electrolyte imbalance (21%).

WASHINGTON – Long-term data from a registry of civilians with traumatic brain injury may yield information that is relevant to the care of injured veterans returning from Iraq and Afghanistan, said Jean A. Langlois, Sc.D., at a meeting on traumatic brain injuries sponsored by the Institute of Medicine.

During her presentation, Dr. Langlois noted that there are relatively few long-term cohort studies of blast-induced TBI and the possible combined effects of these injuries and posttraumatic stress disorder (PTSD). The data she presented showed that civilian survivors of TBI often develop costly disabilities. More aggressive treatment might make a difference. “I think we will be seeing several directions for interventions, including electrical brain stimulation,” Dr. Langlois said.

Approximately 124,000 civilians in the United States are hospitalized each year with TBI, and about 40% of these patients will experience long-term disabilities, said Dr. Langlois, an epidemiologist at the Centers for Disease Control and Prevention.

Findings from previous studies have shown that even uninjured military personnel who return from combat are at increased risk of psychosocial and psychiatric problems, including PTSD, major depression, suicide, impaired social function, and limited ability to work, she noted.

She reviewed data from four population-based studies using the South Carolina Traumatic Brain Injury Follow-up Registry that included patients with TBI who required hospitalization. The TBI was severe in 45% of patients, moderate in 15%, and mild in 40%. Patients were aged 15 years or older, 60% were male, and 75% were white.

The first of the four studies evaluated psychosocial health in 2,118 patients 1 year after TBI. Based on the scores from a validated social function scale, 29% of the TBI patients reported poor psychosocial health 1 year after their injuries, which is more than one standard deviation below the population norms, Dr. Langlois said.

“We found almost double the rate of psychosocial health problems [compared with the rate in] the general population, but only 36% reported receiving any mental health care after TBI,” she said (Arch. Phys. Med. Rehabil. 2006;87:953–61).

Factors associated with poor psychosocial health 1 year after TBI included female gender, preinjury or postinjury psychiatric conditions, inadequate social support, physical limitations for activities of daily living, and preinjury drug or alcohol abuse problems.

Surprisingly, adults with TBI were less likely to report heavy alcohol consumption 1 year after injury, based on data from 1,606 patients.

The researchers used the CDC's Behavioral Risk Factor Surveillance summary questions to assess drinking habits. They found that 94% of the patients reported drinking the same amount or less alcohol 1 year after TBI than they did before TBI. And 50% of those who called themselves heavy drinkers reported drinking less. Heavy drinking was defined as an average of five or more drinks per occasion, or 22 or more drinking days within a month (J. Int. Neuropsychol. Soc. 2005;11:322–30).

But compared with the general population, the TBI population was more likely to binge drink (defined as five or more drinks on one occasion), and almost twice as likely to have five or more occasions to binge drink. Factors associated with heavy drinking were male gender, younger age, lack of support, diagnosis of depression since TBI, and self-reported fair to moderate (vs. excellent) mental health.

Also, research has shown that substance abuse problems may surface in later years after TBI, rather than immediately following the injury, said Dr. Langlois, citing a review of evidence that, on average, the quantities of alcohol consumed by TBI patients increased over time after their injuries (Arch. Phys. Med. Rehabil. 1995;76:302–9).

Clinical implications of heavy drinking include decreased recovery from TBI, increased impulsivity, exacerbation of cognitive problems, increased risk for seizures, and increased risk for additional brain injuries, Dr. Langlois added.

A third study focused on employment 1 year after TBI. These findings may have unique implications for returning military personnel who may not be able to redeploy and who will need to rejoin the civilian work force, Dr. Langlois said. The employment study included patients from the South Carolina database, plus data on people with TBI who were not in the South Carolina registry, for a total of 3,444 patients (2,487 men and 957 women).

At 1 year after TBI, a majority (41%) of the patients had stopped working, 36% had kept the same hours, 13% were working fewer hours, and 10% were working more hours, Dr. Langlois said.

Factors associated with not working included a longer hospital stay, nonwhite race, and having Medicaid or workers' compensation.

When the patients were divided by gender, men aged 20–24 years were the most likely to be working after 1 year, possibly because they tended to be the primary wage earners, whereas older men may have better disability or health benefits, Dr. Langlois noted. By contrast, women aged 18–24 years were most likely to be not working 1 year after TBI, possibly because they tend to be caring for children at home or because they may have complications if their injuries resulted from domestic violence, Dr. Langlois said.

Dr. Langlois concluded with a study of mortality within 1 year of TBI based on the South Carolina population data from 3,679 persons hospitalized with TBI (J. Head Trauma Rehab. 2005;20:257–69). Overall, the risk for all-cause mortality was seven times higher, compared with the U.S. death rate, and 80% of these deaths were reported as being related to the TBI, Dr. Langlois said.

Patients with severe TBI were significantly more likely to die within 15 months, compared with mild or moderate cases. Other factors associated with mortality from TBI included older age (75 years or older) and more comorbid conditions (three or more). The most common comorbidities were heart disease (48%), hypertension (29%), and fluid/electrolyte imbalance (21%).

Adolescents who first drank alcohol before 13 years of age were significantly more likely to exhibit suicidal behavior than their peers who didn't drink alcohol, based on results from the 2005 Youth Risk Behavior Survey of 13,639 U.S. students in grades 9–12.

About a quarter (25%) of the survey respondents reported drinking alcohol when they were younger than 13 years. Adolescents who reported preteen alcohol use were more than twice as likely to attempt suicide and nearly twice as likely to report suicidal thoughts, compared with nondrinking peers, reported Monica H. Swahn, Ph.D., and Robert M. Bossarte, Ph.D., of the Centers for Disease Control and Prevention, Atlanta.

Alcohol use is a known risk factor for suicidal behavior in adolescents, but the researchers sought specific links between suicidal behavior and preteen alcohol use after controlling for multiple factors such as age, gender, race, history of sadness, history of physical abuse, and history of carrying a weapon, they said (J. Adolesc. Health 2007;41:175–81).

Further analysis showed that, among girls, preteen alcohol use initiation was significantly associated with increased risk of suicidal thoughts–but not suicide attempts–relative to first consuming alcohol after age 13. Among boys, preteen alcohol use initiation was significantly associated with an increased risk of both suicidal thoughts and suicide attempts, compared with nondrinking teens, but not when compared with boys who first consumed alcohol at age 13 years or older.

The findings support results from previous studies that link alcohol use to suicidal behavior in teens, but the data differ from previous studies by not supporting gender differences in the increased risk of suicidal behavior in preteen drinkers. Future research should address risk factors, protective factors, and motivation for alcohol use in younger adolescents to develop prevention and intervention plans, Dr. Swahn and Dr. Bossarte said.

Adolescents who first drank alcohol before 13 years of age were significantly more likely to exhibit suicidal behavior than their peers who didn't drink alcohol, based on results from the 2005 Youth Risk Behavior Survey of 13,639 U.S. students in grades 9–12.

About a quarter (25%) of the survey respondents reported drinking alcohol when they were younger than 13 years. Adolescents who reported preteen alcohol use were more than twice as likely to attempt suicide and nearly twice as likely to report suicidal thoughts, compared with nondrinking peers, reported Monica H. Swahn, Ph.D., and Robert M. Bossarte, Ph.D., of the Centers for Disease Control and Prevention, Atlanta.

Alcohol use is a known risk factor for suicidal behavior in adolescents, but the researchers sought specific links between suicidal behavior and preteen alcohol use after controlling for multiple factors such as age, gender, race, history of sadness, history of physical abuse, and history of carrying a weapon, they said (J. Adolesc. Health 2007;41:175–81).

Further analysis showed that, among girls, preteen alcohol use initiation was significantly associated with increased risk of suicidal thoughts–but not suicide attempts–relative to first consuming alcohol after age 13. Among boys, preteen alcohol use initiation was significantly associated with an increased risk of both suicidal thoughts and suicide attempts, compared with nondrinking teens, but not when compared with boys who first consumed alcohol at age 13 years or older.

The findings support results from previous studies that link alcohol use to suicidal behavior in teens, but the data differ from previous studies by not supporting gender differences in the increased risk of suicidal behavior in preteen drinkers. Future research should address risk factors, protective factors, and motivation for alcohol use in younger adolescents to develop prevention and intervention plans, Dr. Swahn and Dr. Bossarte said.

Adolescents who first drank alcohol before 13 years of age were significantly more likely to exhibit suicidal behavior than their peers who didn't drink alcohol, based on results from the 2005 Youth Risk Behavior Survey of 13,639 U.S. students in grades 9–12.

About a quarter (25%) of the survey respondents reported drinking alcohol when they were younger than 13 years. Adolescents who reported preteen alcohol use were more than twice as likely to attempt suicide and nearly twice as likely to report suicidal thoughts, compared with nondrinking peers, reported Monica H. Swahn, Ph.D., and Robert M. Bossarte, Ph.D., of the Centers for Disease Control and Prevention, Atlanta.

Alcohol use is a known risk factor for suicidal behavior in adolescents, but the researchers sought specific links between suicidal behavior and preteen alcohol use after controlling for multiple factors such as age, gender, race, history of sadness, history of physical abuse, and history of carrying a weapon, they said (J. Adolesc. Health 2007;41:175–81).

Further analysis showed that, among girls, preteen alcohol use initiation was significantly associated with increased risk of suicidal thoughts–but not suicide attempts–relative to first consuming alcohol after age 13. Among boys, preteen alcohol use initiation was significantly associated with an increased risk of both suicidal thoughts and suicide attempts, compared with nondrinking teens, but not when compared with boys who first consumed alcohol at age 13 years or older.

The findings support results from previous studies that link alcohol use to suicidal behavior in teens, but the data differ from previous studies by not supporting gender differences in the increased risk of suicidal behavior in preteen drinkers. Future research should address risk factors, protective factors, and motivation for alcohol use in younger adolescents to develop prevention and intervention plans, Dr. Swahn and Dr. Bossarte said.

WASHINGTON — Adding a smoking cessation component to electronic medical record systems improves the likelihood that hospitalized individuals with a history of smoking will receive cessation counseling, according to study results presented at a conference sponsored by the National Patient Safety Foundation.

Because hospitalization forces patients to temporarily abstain from smoking, identifying smokers when they are hospitalized with other illnesses may help them quit, Dr. Vikram Verma wrote in a poster.

Dr. Verma and colleagues at Kings County Hospital Center in Brooklyn, N.Y., reviewed 420 patient charts during the 6-month period prior to adding a smoking cessation component to the electronic medical record (EMR). The researchers identified 62 smokers (15%). Of these, 24 (39%) received nicotine replacement therapy and 29 patients refused NRT. For the other nine, the smoking cessation issue remained unaddressed.

The EMR included a mandatory “tobacco evaluation” field to guarantee that the smoking status was assessed in all patients. In addition, an electronic reminder to prescribe transdermal NRT appears in the records of all patients who smoke, and any patients who are “positive” in the smoking history field are automatically referred to a smoking cessation counselor.

During the 6-month period after adding the smoking cessation field to the EMR, the researchers identified 85 smokers when they reviewed another 420 patient charts. The issue of smoking cessation was addressed in 100% of those patients, although 65 (76%) refused NRT.

“The program facilitated our efforts in providing smoking cessation counseling,” the researchers said. Also, adding smoking status to the EMR may help with long-term studies of patients' smoking status.

WASHINGTON — Adding a smoking cessation component to electronic medical record systems improves the likelihood that hospitalized individuals with a history of smoking will receive cessation counseling, according to study results presented at a conference sponsored by the National Patient Safety Foundation.

Because hospitalization forces patients to temporarily abstain from smoking, identifying smokers when they are hospitalized with other illnesses may help them quit, Dr. Vikram Verma wrote in a poster.

Dr. Verma and colleagues at Kings County Hospital Center in Brooklyn, N.Y., reviewed 420 patient charts during the 6-month period prior to adding a smoking cessation component to the electronic medical record (EMR). The researchers identified 62 smokers (15%). Of these, 24 (39%) received nicotine replacement therapy and 29 patients refused NRT. For the other nine, the smoking cessation issue remained unaddressed.

The EMR included a mandatory “tobacco evaluation” field to guarantee that the smoking status was assessed in all patients. In addition, an electronic reminder to prescribe transdermal NRT appears in the records of all patients who smoke, and any patients who are “positive” in the smoking history field are automatically referred to a smoking cessation counselor.

During the 6-month period after adding the smoking cessation field to the EMR, the researchers identified 85 smokers when they reviewed another 420 patient charts. The issue of smoking cessation was addressed in 100% of those patients, although 65 (76%) refused NRT.

“The program facilitated our efforts in providing smoking cessation counseling,” the researchers said. Also, adding smoking status to the EMR may help with long-term studies of patients' smoking status.

WASHINGTON — Adding a smoking cessation component to electronic medical record systems improves the likelihood that hospitalized individuals with a history of smoking will receive cessation counseling, according to study results presented at a conference sponsored by the National Patient Safety Foundation.

Because hospitalization forces patients to temporarily abstain from smoking, identifying smokers when they are hospitalized with other illnesses may help them quit, Dr. Vikram Verma wrote in a poster.

Dr. Verma and colleagues at Kings County Hospital Center in Brooklyn, N.Y., reviewed 420 patient charts during the 6-month period prior to adding a smoking cessation component to the electronic medical record (EMR). The researchers identified 62 smokers (15%). Of these, 24 (39%) received nicotine replacement therapy and 29 patients refused NRT. For the other nine, the smoking cessation issue remained unaddressed.

The EMR included a mandatory “tobacco evaluation” field to guarantee that the smoking status was assessed in all patients. In addition, an electronic reminder to prescribe transdermal NRT appears in the records of all patients who smoke, and any patients who are “positive” in the smoking history field are automatically referred to a smoking cessation counselor.

During the 6-month period after adding the smoking cessation field to the EMR, the researchers identified 85 smokers when they reviewed another 420 patient charts. The issue of smoking cessation was addressed in 100% of those patients, although 65 (76%) refused NRT.

“The program facilitated our efforts in providing smoking cessation counseling,” the researchers said. Also, adding smoking status to the EMR may help with long-term studies of patients' smoking status.

CHICAGO — When facing a child with localized scleroderma, be wary if the scleroderma is linear, especially if it is on the face or on a limb where it crosses a joint, Dr. Amy Gilliam said at the annual meeting of the Society for Pediatric Dermatology.

However, not all young people initially present with the skin hardening and atrophy that characterizes scleroderma, explained Dr. Gilliam, a dermatologist at the University of California, San Francisco. Instead, these patients are often misdiagnosed with vitiligo for months or years before the correct diagnosis of juvenile localized scleroderma is made.

To better characterize localized scleroderma in children, Dr. Gilliam and her colleagues reviewed data from 127 patients younger than 21 years who were evaluated at UCSF. Dr. Gilliam's research was supported in part by a grant from the Society for Pediatric Dermatology and the Dermatology Foundation, but she had no other financial disclosures.

"Something unique in our study is that we collected information on body surface area of involvement," Dr. Gilliam said. "And we had a dermatology perspective rather than a rheumatology perspective.

"One of the interesting things that came out of our data was that the presenting sign in about 50% of the patients was some type of dyspigmentation, either hyper-, hypo- or depigmentation," she said. Add the 19 patients who had what they called a "bruise," and dyspigmentation was a presenting symptom in nearly two-thirds of the cases.

Another key finding was that patients whose scleroderma involved 5% or more of their total body surface area were significantly more likely to have extracutaneous symptoms—including arthralgias and orthopedic, pulmonary, and gastrointestinal problems—than were patients whose scleroderma involved less than 5% of their total body surface area. The significance was true in separate analyses of the 89 patients whose charts were reviewed retrospectively and the 38 patients who were studied prospectively and followed.

But neurologic problems were the notable exception in the patient population. "That sticks out like a sore thumb," said Dr. Gilliam. Localized scleroderma on less than 5% of the body surface area was significantly associated with neurologic problems, and neurologic problems were significantly more common in patients with facial linear scleroderma.

This finding "makes complete sense to me, because when we are talking about neurologic problems in the setting of localized scleroderma, we are usually talking about the face, which has at most 6% of the surface area, so these patients with neurologic problems are likely to have lower total body surface area involvement," she said.

Apart from the relationship with body surface area, Dr. Gilliam was able to prove that neurologic problems were more common in patients with facial linear scleroderma compared with those who had other forms of localized scleroderma (33% vs. 8%). Her data also showed that orthopedic problems were significantly more common in patients with nonfacial linear scleroderma, compared with those who had other forms of localized scleroderma (22% vs. 2%).

But body surface area alone is not enough to assess localized scleroderma, Dr. Gilliam emphasized. The patients to worry about are those with segmental or linear presentations and those with the characteristic pinkish-purple macules that indicate generalized morphea.

It's important to think about location in cases of localized scleroderma, Dr. Gilliam added. In her study, gastrointestinal problems were significantly more common in patients with generalized morphea and in patients who had scleroderma on the trunk, compared with those who had scleroderma in other locations (21% vs. 5%). But location isn't everything: Pulmonary problems were significantly more common among patients with generalized morphea, but the presence or absence of localized scleroderma on the trunk was not significant.

Lastly, Dr. Gilliam did not find a significant association between positive levels of antinuclear antibodies and extracutaneous conditions, although she cited a separate study of 750 patients that did show a significant association (Arthritis Rheum. 2005;52:2873–81).

CHICAGO — When facing a child with localized scleroderma, be wary if the scleroderma is linear, especially if it is on the face or on a limb where it crosses a joint, Dr. Amy Gilliam said at the annual meeting of the Society for Pediatric Dermatology.

However, not all young people initially present with the skin hardening and atrophy that characterizes scleroderma, explained Dr. Gilliam, a dermatologist at the University of California, San Francisco. Instead, these patients are often misdiagnosed with vitiligo for months or years before the correct diagnosis of juvenile localized scleroderma is made.

To better characterize localized scleroderma in children, Dr. Gilliam and her colleagues reviewed data from 127 patients younger than 21 years who were evaluated at UCSF. Dr. Gilliam's research was supported in part by a grant from the Society for Pediatric Dermatology and the Dermatology Foundation, but she had no other financial disclosures.

"Something unique in our study is that we collected information on body surface area of involvement," Dr. Gilliam said. "And we had a dermatology perspective rather than a rheumatology perspective.

"One of the interesting things that came out of our data was that the presenting sign in about 50% of the patients was some type of dyspigmentation, either hyper-, hypo- or depigmentation," she said. Add the 19 patients who had what they called a "bruise," and dyspigmentation was a presenting symptom in nearly two-thirds of the cases.

Another key finding was that patients whose scleroderma involved 5% or more of their total body surface area were significantly more likely to have extracutaneous symptoms—including arthralgias and orthopedic, pulmonary, and gastrointestinal problems—than were patients whose scleroderma involved less than 5% of their total body surface area. The significance was true in separate analyses of the 89 patients whose charts were reviewed retrospectively and the 38 patients who were studied prospectively and followed.

But neurologic problems were the notable exception in the patient population. "That sticks out like a sore thumb," said Dr. Gilliam. Localized scleroderma on less than 5% of the body surface area was significantly associated with neurologic problems, and neurologic problems were significantly more common in patients with facial linear scleroderma.

This finding "makes complete sense to me, because when we are talking about neurologic problems in the setting of localized scleroderma, we are usually talking about the face, which has at most 6% of the surface area, so these patients with neurologic problems are likely to have lower total body surface area involvement," she said.

Apart from the relationship with body surface area, Dr. Gilliam was able to prove that neurologic problems were more common in patients with facial linear scleroderma compared with those who had other forms of localized scleroderma (33% vs. 8%). Her data also showed that orthopedic problems were significantly more common in patients with nonfacial linear scleroderma, compared with those who had other forms of localized scleroderma (22% vs. 2%).

But body surface area alone is not enough to assess localized scleroderma, Dr. Gilliam emphasized. The patients to worry about are those with segmental or linear presentations and those with the characteristic pinkish-purple macules that indicate generalized morphea.

It's important to think about location in cases of localized scleroderma, Dr. Gilliam added. In her study, gastrointestinal problems were significantly more common in patients with generalized morphea and in patients who had scleroderma on the trunk, compared with those who had scleroderma in other locations (21% vs. 5%). But location isn't everything: Pulmonary problems were significantly more common among patients with generalized morphea, but the presence or absence of localized scleroderma on the trunk was not significant.

Lastly, Dr. Gilliam did not find a significant association between positive levels of antinuclear antibodies and extracutaneous conditions, although she cited a separate study of 750 patients that did show a significant association (Arthritis Rheum. 2005;52:2873–81).

CHICAGO — When facing a child with localized scleroderma, be wary if the scleroderma is linear, especially if it is on the face or on a limb where it crosses a joint, Dr. Amy Gilliam said at the annual meeting of the Society for Pediatric Dermatology.

However, not all young people initially present with the skin hardening and atrophy that characterizes scleroderma, explained Dr. Gilliam, a dermatologist at the University of California, San Francisco. Instead, these patients are often misdiagnosed with vitiligo for months or years before the correct diagnosis of juvenile localized scleroderma is made.

To better characterize localized scleroderma in children, Dr. Gilliam and her colleagues reviewed data from 127 patients younger than 21 years who were evaluated at UCSF. Dr. Gilliam's research was supported in part by a grant from the Society for Pediatric Dermatology and the Dermatology Foundation, but she had no other financial disclosures.

"Something unique in our study is that we collected information on body surface area of involvement," Dr. Gilliam said. "And we had a dermatology perspective rather than a rheumatology perspective.

"One of the interesting things that came out of our data was that the presenting sign in about 50% of the patients was some type of dyspigmentation, either hyper-, hypo- or depigmentation," she said. Add the 19 patients who had what they called a "bruise," and dyspigmentation was a presenting symptom in nearly two-thirds of the cases.

Another key finding was that patients whose scleroderma involved 5% or more of their total body surface area were significantly more likely to have extracutaneous symptoms—including arthralgias and orthopedic, pulmonary, and gastrointestinal problems—than were patients whose scleroderma involved less than 5% of their total body surface area. The significance was true in separate analyses of the 89 patients whose charts were reviewed retrospectively and the 38 patients who were studied prospectively and followed.

But neurologic problems were the notable exception in the patient population. "That sticks out like a sore thumb," said Dr. Gilliam. Localized scleroderma on less than 5% of the body surface area was significantly associated with neurologic problems, and neurologic problems were significantly more common in patients with facial linear scleroderma.

This finding "makes complete sense to me, because when we are talking about neurologic problems in the setting of localized scleroderma, we are usually talking about the face, which has at most 6% of the surface area, so these patients with neurologic problems are likely to have lower total body surface area involvement," she said.

Apart from the relationship with body surface area, Dr. Gilliam was able to prove that neurologic problems were more common in patients with facial linear scleroderma compared with those who had other forms of localized scleroderma (33% vs. 8%). Her data also showed that orthopedic problems were significantly more common in patients with nonfacial linear scleroderma, compared with those who had other forms of localized scleroderma (22% vs. 2%).

But body surface area alone is not enough to assess localized scleroderma, Dr. Gilliam emphasized. The patients to worry about are those with segmental or linear presentations and those with the characteristic pinkish-purple macules that indicate generalized morphea.

It's important to think about location in cases of localized scleroderma, Dr. Gilliam added. In her study, gastrointestinal problems were significantly more common in patients with generalized morphea and in patients who had scleroderma on the trunk, compared with those who had scleroderma in other locations (21% vs. 5%). But location isn't everything: Pulmonary problems were significantly more common among patients with generalized morphea, but the presence or absence of localized scleroderma on the trunk was not significant.

Lastly, Dr. Gilliam did not find a significant association between positive levels of antinuclear antibodies and extracutaneous conditions, although she cited a separate study of 750 patients that did show a significant association (Arthritis Rheum. 2005;52:2873–81).

CHICAGO — An aqueous gel formula that combines 0.025% tretinoin and 1.2% clindamycin phosphate significantly reduces both inflammatory and noninflammatory acne lesions, Dr. James Leyden said in a poster presented at the annual meeting of the Society for Pediatric Dermatology.

The combination gel, marketed as Ziana, has been approved by the Food and Drug Administration for once-daily topical treatment of acne vulgaris in children aged 12 years and older.

In a phase III study, 1,710 patients aged 12–18 years were randomized into four groups to receive the combination gel, a tretinoin-only gel, a clindamycin phosphate-only gel, or a placebo gel. The baseline acne conditions ranged from mild to severe; patients were required to have 20–100 noninflammatory lesions, 20–50 inflammatory lesions, and two nodules to enroll in the study.

Overall, the patients in the combination gel group showed significantly greater reductions in the number of inflammatory lesions, noninflammatory lesions, and total lesion counts after 12 weeks of daily treatment, compared with the other groups, wrote Dr. Leyden of Broomall, Pa. He has received financial support from several drug manufacturers, including Medicis Pharmaceutical Corp., which manufactures Ziana and sponsored the study.

The average reductions for inflammatory and noninflammatory lesions, respectively, were 46% and 35% for the combination group; 35% and 26% for the tretinoin group; 36% and 23% for the clindamycin phosphate group; and 16% and 9% for the placebo group. The average reduction in total lesion count was 39% for the combination group, 30% for the tretinoin group, 29% for the clindamycin phosphate group, and 12% for the placebo group.

In addition, tolerability data from a subset of 45 patients were presented in a separate poster at the meeting. The findings showed that the clindamycin phosphate/tretinoin combination gel was as well tolerated as 0.1% adapalene gel and significantly better tolerated than 0.1% tretinoin microsphere gel based on clinical evaluation of redness and scaling and patient reports of burning, stinging, and itching, Dr. Leyden reported.

CHICAGO — An aqueous gel formula that combines 0.025% tretinoin and 1.2% clindamycin phosphate significantly reduces both inflammatory and noninflammatory acne lesions, Dr. James Leyden said in a poster presented at the annual meeting of the Society for Pediatric Dermatology.

The combination gel, marketed as Ziana, has been approved by the Food and Drug Administration for once-daily topical treatment of acne vulgaris in children aged 12 years and older.

In a phase III study, 1,710 patients aged 12–18 years were randomized into four groups to receive the combination gel, a tretinoin-only gel, a clindamycin phosphate-only gel, or a placebo gel. The baseline acne conditions ranged from mild to severe; patients were required to have 20–100 noninflammatory lesions, 20–50 inflammatory lesions, and two nodules to enroll in the study.

Overall, the patients in the combination gel group showed significantly greater reductions in the number of inflammatory lesions, noninflammatory lesions, and total lesion counts after 12 weeks of daily treatment, compared with the other groups, wrote Dr. Leyden of Broomall, Pa. He has received financial support from several drug manufacturers, including Medicis Pharmaceutical Corp., which manufactures Ziana and sponsored the study.

The average reductions for inflammatory and noninflammatory lesions, respectively, were 46% and 35% for the combination group; 35% and 26% for the tretinoin group; 36% and 23% for the clindamycin phosphate group; and 16% and 9% for the placebo group. The average reduction in total lesion count was 39% for the combination group, 30% for the tretinoin group, 29% for the clindamycin phosphate group, and 12% for the placebo group.

In addition, tolerability data from a subset of 45 patients were presented in a separate poster at the meeting. The findings showed that the clindamycin phosphate/tretinoin combination gel was as well tolerated as 0.1% adapalene gel and significantly better tolerated than 0.1% tretinoin microsphere gel based on clinical evaluation of redness and scaling and patient reports of burning, stinging, and itching, Dr. Leyden reported.

CHICAGO — An aqueous gel formula that combines 0.025% tretinoin and 1.2% clindamycin phosphate significantly reduces both inflammatory and noninflammatory acne lesions, Dr. James Leyden said in a poster presented at the annual meeting of the Society for Pediatric Dermatology.

The combination gel, marketed as Ziana, has been approved by the Food and Drug Administration for once-daily topical treatment of acne vulgaris in children aged 12 years and older.

In a phase III study, 1,710 patients aged 12–18 years were randomized into four groups to receive the combination gel, a tretinoin-only gel, a clindamycin phosphate-only gel, or a placebo gel. The baseline acne conditions ranged from mild to severe; patients were required to have 20–100 noninflammatory lesions, 20–50 inflammatory lesions, and two nodules to enroll in the study.

Overall, the patients in the combination gel group showed significantly greater reductions in the number of inflammatory lesions, noninflammatory lesions, and total lesion counts after 12 weeks of daily treatment, compared with the other groups, wrote Dr. Leyden of Broomall, Pa. He has received financial support from several drug manufacturers, including Medicis Pharmaceutical Corp., which manufactures Ziana and sponsored the study.

The average reductions for inflammatory and noninflammatory lesions, respectively, were 46% and 35% for the combination group; 35% and 26% for the tretinoin group; 36% and 23% for the clindamycin phosphate group; and 16% and 9% for the placebo group. The average reduction in total lesion count was 39% for the combination group, 30% for the tretinoin group, 29% for the clindamycin phosphate group, and 12% for the placebo group.

In addition, tolerability data from a subset of 45 patients were presented in a separate poster at the meeting. The findings showed that the clindamycin phosphate/tretinoin combination gel was as well tolerated as 0.1% adapalene gel and significantly better tolerated than 0.1% tretinoin microsphere gel based on clinical evaluation of redness and scaling and patient reports of burning, stinging, and itching, Dr. Leyden reported.

WASHINGTON — High blood pressure remains a real and growing problem that, if left untreated, could increase in prevalence by 60% over the next 2 decades, Dr. Richard Roberts said at a press briefing.

“If action is not taken soon … there will be significant public health consequences,” said Dr. Roberts, a family physician and professor in the department of family medicine at the University of Wisconsin, Madison.

He spoke on behalf of a coalition of 14 medical groups and voluntary health organizations that commissioned a report to compile the latest information about high blood pressure and its impact on health care systems. The report, “High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next,” serves as a call to action for health policy makers and physicians.

Citing data from the National Health and Nutrition Examination Survey (NHANES), the report notes that the prevalence of high blood pressure in adults in the United States increased from 25% in 1988–1994 to 29% in 1999–2002. In addition, the growing problem of high blood pressure in children is expected to contribute to the overall increase in prevalence over the next 20 years.

The report, which was sponsored by an unrestricted educational grant from Novartis AG, calls for an international effort to address five public policy goals:

▸ Recognize that high blood pressure is a global health priority.

▸ Achieve global consensus on standards for managing high blood pressure.

▸ Empower primary care physicians to be the first lines of defense against high blood pressure on a global level.

▸ Educate patients about treatment options and acknowledge the difficulties of adhering to lifestyle and medication regimens.

▸ Conduct long-term clinical and epidemiologic studies on the costs and benefits of treating high blood pressure based on emerging trends and scientific research.

Losing weight and becoming more active are among the best ways to prevent hypertension, especially for young people. But for many, regular medication may be necessary to keep their blood pressure at a healthy level, said Dr. Michael A. Weber, chair of the American Society of Hypertension's Specialist Program and one of the coauthors of the report, at the briefing. Patients also need to understand that the only way to know if they have high blood pressure is to have it measured, he said. “It is a totally asymptomatic condition.”

Treating high blood pressure could reduce the probability of heart attacks by 40%–50%, the incidence of stroke, and the number of patients requiring kidney dialysis, added Dr. Weber, professor of medicine at the State University of New York, Brooklyn. He is a consultant for several pharmaceutical companies, including Novartis.

WASHINGTON — High blood pressure remains a real and growing problem that, if left untreated, could increase in prevalence by 60% over the next 2 decades, Dr. Richard Roberts said at a press briefing.

“If action is not taken soon … there will be significant public health consequences,” said Dr. Roberts, a family physician and professor in the department of family medicine at the University of Wisconsin, Madison.

He spoke on behalf of a coalition of 14 medical groups and voluntary health organizations that commissioned a report to compile the latest information about high blood pressure and its impact on health care systems. The report, “High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next,” serves as a call to action for health policy makers and physicians.

Citing data from the National Health and Nutrition Examination Survey (NHANES), the report notes that the prevalence of high blood pressure in adults in the United States increased from 25% in 1988–1994 to 29% in 1999–2002. In addition, the growing problem of high blood pressure in children is expected to contribute to the overall increase in prevalence over the next 20 years.

The report, which was sponsored by an unrestricted educational grant from Novartis AG, calls for an international effort to address five public policy goals:

▸ Recognize that high blood pressure is a global health priority.

▸ Achieve global consensus on standards for managing high blood pressure.

▸ Empower primary care physicians to be the first lines of defense against high blood pressure on a global level.

▸ Educate patients about treatment options and acknowledge the difficulties of adhering to lifestyle and medication regimens.

▸ Conduct long-term clinical and epidemiologic studies on the costs and benefits of treating high blood pressure based on emerging trends and scientific research.

Losing weight and becoming more active are among the best ways to prevent hypertension, especially for young people. But for many, regular medication may be necessary to keep their blood pressure at a healthy level, said Dr. Michael A. Weber, chair of the American Society of Hypertension's Specialist Program and one of the coauthors of the report, at the briefing. Patients also need to understand that the only way to know if they have high blood pressure is to have it measured, he said. “It is a totally asymptomatic condition.”

Treating high blood pressure could reduce the probability of heart attacks by 40%–50%, the incidence of stroke, and the number of patients requiring kidney dialysis, added Dr. Weber, professor of medicine at the State University of New York, Brooklyn. He is a consultant for several pharmaceutical companies, including Novartis.

WASHINGTON — High blood pressure remains a real and growing problem that, if left untreated, could increase in prevalence by 60% over the next 2 decades, Dr. Richard Roberts said at a press briefing.

“If action is not taken soon … there will be significant public health consequences,” said Dr. Roberts, a family physician and professor in the department of family medicine at the University of Wisconsin, Madison.

He spoke on behalf of a coalition of 14 medical groups and voluntary health organizations that commissioned a report to compile the latest information about high blood pressure and its impact on health care systems. The report, “High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next,” serves as a call to action for health policy makers and physicians.

Citing data from the National Health and Nutrition Examination Survey (NHANES), the report notes that the prevalence of high blood pressure in adults in the United States increased from 25% in 1988–1994 to 29% in 1999–2002. In addition, the growing problem of high blood pressure in children is expected to contribute to the overall increase in prevalence over the next 20 years.

The report, which was sponsored by an unrestricted educational grant from Novartis AG, calls for an international effort to address five public policy goals:

▸ Recognize that high blood pressure is a global health priority.

▸ Achieve global consensus on standards for managing high blood pressure.

▸ Empower primary care physicians to be the first lines of defense against high blood pressure on a global level.

▸ Educate patients about treatment options and acknowledge the difficulties of adhering to lifestyle and medication regimens.

▸ Conduct long-term clinical and epidemiologic studies on the costs and benefits of treating high blood pressure based on emerging trends and scientific research.

Losing weight and becoming more active are among the best ways to prevent hypertension, especially for young people. But for many, regular medication may be necessary to keep their blood pressure at a healthy level, said Dr. Michael A. Weber, chair of the American Society of Hypertension's Specialist Program and one of the coauthors of the report, at the briefing. Patients also need to understand that the only way to know if they have high blood pressure is to have it measured, he said. “It is a totally asymptomatic condition.”

Treating high blood pressure could reduce the probability of heart attacks by 40%–50%, the incidence of stroke, and the number of patients requiring kidney dialysis, added Dr. Weber, professor of medicine at the State University of New York, Brooklyn. He is a consultant for several pharmaceutical companies, including Novartis.

MINNEAPOLIS — Children with frequent, loud snoring are significantly more likely to develop recurrent otitis media and to require tympanostomy tubes than are children who don't snore, based on data from more than 16,000 children aged 5–7 years.

Recurrent otitis media and habitual snoring share many risk factors. To assess the relationship between these conditions, Dr. David Gozal of the University of Louisville (Ky.) and his colleagues compared the frequency of recurrent otitis media (ROM) and the need for tympanostomy tube placement in school-aged children who snored versus those who did not snore.

The researchers presented their findings in a poster at the annual meeting of the Associated Professional Sleep Societies.

Parents of 16,321 children who attended public school in Jefferson County, Ky., completed questionnaires about their children's sleeping habits.

Overall, 1,844 children (11%) had a history of habitual snoring (defined as snoring more than 3 nights per week). More than half (53%) of the habitual snorers were boys, and 26% of the habitual snorers were black.

A total of 5,074 children had a history of ROM, and 2,604 children had tympanostomy tubes.

Nearly twice as many of the habitually snoring children had a history of ROM, compared with children who did not snore (16% vs. 9%), even after controlling for known otitis media risk factors such as asthma, chronic rhinitis, allergies, and exposure to cigarette smoke, they reported.

Similarly, children with a history of habitual snoring were almost three times more likely than children without a history of snoring to have had tympanostomy tubes placed (24% vs. 9%, respectively), after controlling for the same risk factors, the investigators found.

The findings support an association between habitual snoring and an increased risk of ROM and need for tympanostomy tubes.

Additional studies are needed to assess the prevalence of obstructive sleep apnea in children with ROM, the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

MINNEAPOLIS — Children with frequent, loud snoring are significantly more likely to develop recurrent otitis media and to require tympanostomy tubes than are children who don't snore, based on data from more than 16,000 children aged 5–7 years.

Recurrent otitis media and habitual snoring share many risk factors. To assess the relationship between these conditions, Dr. David Gozal of the University of Louisville (Ky.) and his colleagues compared the frequency of recurrent otitis media (ROM) and the need for tympanostomy tube placement in school-aged children who snored versus those who did not snore.

The researchers presented their findings in a poster at the annual meeting of the Associated Professional Sleep Societies.

Parents of 16,321 children who attended public school in Jefferson County, Ky., completed questionnaires about their children's sleeping habits.

Overall, 1,844 children (11%) had a history of habitual snoring (defined as snoring more than 3 nights per week). More than half (53%) of the habitual snorers were boys, and 26% of the habitual snorers were black.

A total of 5,074 children had a history of ROM, and 2,604 children had tympanostomy tubes.

Nearly twice as many of the habitually snoring children had a history of ROM, compared with children who did not snore (16% vs. 9%), even after controlling for known otitis media risk factors such as asthma, chronic rhinitis, allergies, and exposure to cigarette smoke, they reported.

Similarly, children with a history of habitual snoring were almost three times more likely than children without a history of snoring to have had tympanostomy tubes placed (24% vs. 9%, respectively), after controlling for the same risk factors, the investigators found.

The findings support an association between habitual snoring and an increased risk of ROM and need for tympanostomy tubes.

Additional studies are needed to assess the prevalence of obstructive sleep apnea in children with ROM, the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

MINNEAPOLIS — Children with frequent, loud snoring are significantly more likely to develop recurrent otitis media and to require tympanostomy tubes than are children who don't snore, based on data from more than 16,000 children aged 5–7 years.

Recurrent otitis media and habitual snoring share many risk factors. To assess the relationship between these conditions, Dr. David Gozal of the University of Louisville (Ky.) and his colleagues compared the frequency of recurrent otitis media (ROM) and the need for tympanostomy tube placement in school-aged children who snored versus those who did not snore.

The researchers presented their findings in a poster at the annual meeting of the Associated Professional Sleep Societies.

Parents of 16,321 children who attended public school in Jefferson County, Ky., completed questionnaires about their children's sleeping habits.

Overall, 1,844 children (11%) had a history of habitual snoring (defined as snoring more than 3 nights per week). More than half (53%) of the habitual snorers were boys, and 26% of the habitual snorers were black.

A total of 5,074 children had a history of ROM, and 2,604 children had tympanostomy tubes.

Nearly twice as many of the habitually snoring children had a history of ROM, compared with children who did not snore (16% vs. 9%), even after controlling for known otitis media risk factors such as asthma, chronic rhinitis, allergies, and exposure to cigarette smoke, they reported.

Similarly, children with a history of habitual snoring were almost three times more likely than children without a history of snoring to have had tympanostomy tubes placed (24% vs. 9%, respectively), after controlling for the same risk factors, the investigators found.

The findings support an association between habitual snoring and an increased risk of ROM and need for tympanostomy tubes.

Additional studies are needed to assess the prevalence of obstructive sleep apnea in children with ROM, the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Using medication to treat children with attention-deficit/hyperactivity disorder offers no long-term advantage over other treatment methods, according to a follow-up study.

Dr. Peter S. Jensen and his colleagues at Columbia University, New York, found that children with ADHD who were treated with medication (including stimulants, bupropion, and tricyclics) showed greater improvements in symptoms, compared with children who had been treated with behavior therapy after 14 months of treatment. But those on the medication algorithm lost that advantage after 3 years, based on data from the Multimodal Treatment Study of Children With ADHD (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:989-1002).

The original study included 579 children aged 7–10 years who had been diagnosed with “ADHD combined type.” The children were randomized into one of four treatment groups—intensive multicomponent behavior therapy, intensive medication management, the combination, and routine community care—and they were followed for 14 months.

Of those, 485 children, now aged 10–13 years, took part in a long-term follow-up study. All of the children showed some ADHD and oppositional defiant disorder symptom (ODD) improvement, compared with baseline after 14 months, although the differences were significantly greater in the children in the medication and combination groups after 14 months and 24 months.

But none of the randomized treatment groups showed significant differences on any of five measures of clinical and functional outcomes by 36 months' follow-up. The clinical and functional outcomes were parent reports and teacher reports of ADHD and ODD symptoms, reading achievement scores, social skills, and functional impairment.

Intensive medication management of ADHD in children may have a long-term impact only if the intensity of the medication use is maintained over time, the researchers wrote.

The study was supported in part by the National Institute of Mental Health.

Using medication to treat children with attention-deficit/hyperactivity disorder offers no long-term advantage over other treatment methods, according to a follow-up study.

Dr. Peter S. Jensen and his colleagues at Columbia University, New York, found that children with ADHD who were treated with medication (including stimulants, bupropion, and tricyclics) showed greater improvements in symptoms, compared with children who had been treated with behavior therapy after 14 months of treatment. But those on the medication algorithm lost that advantage after 3 years, based on data from the Multimodal Treatment Study of Children With ADHD (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:989-1002).

The original study included 579 children aged 7–10 years who had been diagnosed with “ADHD combined type.” The children were randomized into one of four treatment groups—intensive multicomponent behavior therapy, intensive medication management, the combination, and routine community care—and they were followed for 14 months.

Of those, 485 children, now aged 10–13 years, took part in a long-term follow-up study. All of the children showed some ADHD and oppositional defiant disorder symptom (ODD) improvement, compared with baseline after 14 months, although the differences were significantly greater in the children in the medication and combination groups after 14 months and 24 months.

But none of the randomized treatment groups showed significant differences on any of five measures of clinical and functional outcomes by 36 months' follow-up. The clinical and functional outcomes were parent reports and teacher reports of ADHD and ODD symptoms, reading achievement scores, social skills, and functional impairment.

Intensive medication management of ADHD in children may have a long-term impact only if the intensity of the medication use is maintained over time, the researchers wrote.

The study was supported in part by the National Institute of Mental Health.

Using medication to treat children with attention-deficit/hyperactivity disorder offers no long-term advantage over other treatment methods, according to a follow-up study.

Dr. Peter S. Jensen and his colleagues at Columbia University, New York, found that children with ADHD who were treated with medication (including stimulants, bupropion, and tricyclics) showed greater improvements in symptoms, compared with children who had been treated with behavior therapy after 14 months of treatment. But those on the medication algorithm lost that advantage after 3 years, based on data from the Multimodal Treatment Study of Children With ADHD (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:989-1002).

The original study included 579 children aged 7–10 years who had been diagnosed with “ADHD combined type.” The children were randomized into one of four treatment groups—intensive multicomponent behavior therapy, intensive medication management, the combination, and routine community care—and they were followed for 14 months.

Of those, 485 children, now aged 10–13 years, took part in a long-term follow-up study. All of the children showed some ADHD and oppositional defiant disorder symptom (ODD) improvement, compared with baseline after 14 months, although the differences were significantly greater in the children in the medication and combination groups after 14 months and 24 months.

But none of the randomized treatment groups showed significant differences on any of five measures of clinical and functional outcomes by 36 months' follow-up. The clinical and functional outcomes were parent reports and teacher reports of ADHD and ODD symptoms, reading achievement scores, social skills, and functional impairment.

Intensive medication management of ADHD in children may have a long-term impact only if the intensity of the medication use is maintained over time, the researchers wrote.

The study was supported in part by the National Institute of Mental Health.

WASHINGTON – Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often computerized allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and his colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database in order to reduce the ambiguity of handwritten prescriptions. Once a prescription has been entered into the database, the system generates alerts about patient allergies and potential drug-drug interactions.

Clinicians overrode warnings about potential drug allergies in 56% of the orders, and changed the medication in 44% of the orders. When the data were broken down by provider type, physicians were the least likely to override warnings, although more than half of them did so. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included “not a true allergy,” “medical reason outweighed risk,” and “physician/pharmacist approved.”

CPOEs are not yet widely used, but they have the potential to improve patient safety. The results suggest a need for accurate and up-to-date information to make the CPOE allergy alerts more useful for clinicians

WASHINGTON – Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often computerized allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and his colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database in order to reduce the ambiguity of handwritten prescriptions. Once a prescription has been entered into the database, the system generates alerts about patient allergies and potential drug-drug interactions.

Clinicians overrode warnings about potential drug allergies in 56% of the orders, and changed the medication in 44% of the orders. When the data were broken down by provider type, physicians were the least likely to override warnings, although more than half of them did so. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included “not a true allergy,” “medical reason outweighed risk,” and “physician/pharmacist approved.”

CPOEs are not yet widely used, but they have the potential to improve patient safety. The results suggest a need for accurate and up-to-date information to make the CPOE allergy alerts more useful for clinicians

WASHINGTON – Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often computerized allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and his colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database in order to reduce the ambiguity of handwritten prescriptions. Once a prescription has been entered into the database, the system generates alerts about patient allergies and potential drug-drug interactions.

Clinicians overrode warnings about potential drug allergies in 56% of the orders, and changed the medication in 44% of the orders. When the data were broken down by provider type, physicians were the least likely to override warnings, although more than half of them did so. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included “not a true allergy,” “medical reason outweighed risk,” and “physician/pharmacist approved.”

CPOEs are not yet widely used, but they have the potential to improve patient safety. The results suggest a need for accurate and up-to-date information to make the CPOE allergy alerts more useful for clinicians

MINNEAPOLIS – Treatment with both eszopiclone and escitalopram significantly improved the symptoms of insomnia and anxiety–compared with escitalopram alone, according to data from 595 adults presented at the annual meeting of the Associated Professional Sleep Societies.

Results from a pair of studies supported by Sepracor Inc. showed that the eszopiclone/escitalopram combination was well tolerated and significantly improved not only anxiety but also the length and quality of sleep. Because insomnia often coexists with generalized anxiety disorder, a double-duty treatment regimen would be helpful for patients who suffer from both conditions, the researchers noted.

All study participants met criteria for generalized anxiety disorder and insomnia. All of them received 10 mg escitalopram (Lexapro) daily for 10 weeks. At the same time, 294 were randomized to receive 3 mg eszopiclone (Lunesta), while 301 received placebo for 8 weeks, followed by a 2-week discontinuation period.

Overall, patients who took the combination therapy showed significant improvements in mood and anxiety symptoms based on their Clinical Global Impression scale and the Hamilton Anxiety scale scores after 1, 2, 4, 6, 8, and 10 weeks of treatment, Dr. Mark H. Pollack reported. Dr. Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital, Boston, conducted the study.

Similarly, scores on the 17-item Hamilton Rating Scale for Depression (HAM-D17) were significantly better in the combination therapy group at all evaluation points. Anxiety remission rates were higher in the combination therapy group, too, compared with the placebo group (42% vs. 36%), said Dr. Pollack, who serves on the advisory boards of and has received support for research from several pharmaceutical companies, including that of Sepracor.

In a second study of the same group of patients, presented by Dr. W. Vaughn McCall, professor and chairman of the department of psychiatry and behavioral medicine at Wake Forest University, Winston-Salem, N.C., significantly more patients who received combination therapy had no clinically meaningful insomnia at 8 weeks, compared with the escitalopram-only patients (47% vs. 33%).

In addition, combination therapy patients took significantly less time to fall asleep, slept longer, and scored significantly better on the insomnia severity index than did the escitalopram-only group, said Dr. McCall, who serves on Sepracor's speakers' bureau and its advisory board.

The adverse event rates were similar in both groups during the study period (78% for the combination group and 68% for the escitalopram-only group) and were identical (16%) during the 2-week discontinuation period. Overall the treatment was well tolerated, and no patients showed evidence of rebound insomnia as a result of the medications.

The most common adverse events reported in at least 10% of the combination therapy group were unpleasant taste (24%), headache (19%), dry mouth (16%), and sleepiness (11%); the most common adverse events reported in the escitalopram-only group were headache (15%) and nausea (15%).

ELSEVIER GLOBAL MEDICAL NEWS

MINNEAPOLIS – Treatment with both eszopiclone and escitalopram significantly improved the symptoms of insomnia and anxiety–compared with escitalopram alone, according to data from 595 adults presented at the annual meeting of the Associated Professional Sleep Societies.

Results from a pair of studies supported by Sepracor Inc. showed that the eszopiclone/escitalopram combination was well tolerated and significantly improved not only anxiety but also the length and quality of sleep. Because insomnia often coexists with generalized anxiety disorder, a double-duty treatment regimen would be helpful for patients who suffer from both conditions, the researchers noted.

All study participants met criteria for generalized anxiety disorder and insomnia. All of them received 10 mg escitalopram (Lexapro) daily for 10 weeks. At the same time, 294 were randomized to receive 3 mg eszopiclone (Lunesta), while 301 received placebo for 8 weeks, followed by a 2-week discontinuation period.

Overall, patients who took the combination therapy showed significant improvements in mood and anxiety symptoms based on their Clinical Global Impression scale and the Hamilton Anxiety scale scores after 1, 2, 4, 6, 8, and 10 weeks of treatment, Dr. Mark H. Pollack reported. Dr. Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital, Boston, conducted the study.

Similarly, scores on the 17-item Hamilton Rating Scale for Depression (HAM-D17) were significantly better in the combination therapy group at all evaluation points. Anxiety remission rates were higher in the combination therapy group, too, compared with the placebo group (42% vs. 36%), said Dr. Pollack, who serves on the advisory boards of and has received support for research from several pharmaceutical companies, including that of Sepracor.

In a second study of the same group of patients, presented by Dr. W. Vaughn McCall, professor and chairman of the department of psychiatry and behavioral medicine at Wake Forest University, Winston-Salem, N.C., significantly more patients who received combination therapy had no clinically meaningful insomnia at 8 weeks, compared with the escitalopram-only patients (47% vs. 33%).

In addition, combination therapy patients took significantly less time to fall asleep, slept longer, and scored significantly better on the insomnia severity index than did the escitalopram-only group, said Dr. McCall, who serves on Sepracor's speakers' bureau and its advisory board.

The adverse event rates were similar in both groups during the study period (78% for the combination group and 68% for the escitalopram-only group) and were identical (16%) during the 2-week discontinuation period. Overall the treatment was well tolerated, and no patients showed evidence of rebound insomnia as a result of the medications.

The most common adverse events reported in at least 10% of the combination therapy group were unpleasant taste (24%), headache (19%), dry mouth (16%), and sleepiness (11%); the most common adverse events reported in the escitalopram-only group were headache (15%) and nausea (15%).

ELSEVIER GLOBAL MEDICAL NEWS

MINNEAPOLIS – Treatment with both eszopiclone and escitalopram significantly improved the symptoms of insomnia and anxiety–compared with escitalopram alone, according to data from 595 adults presented at the annual meeting of the Associated Professional Sleep Societies.

Results from a pair of studies supported by Sepracor Inc. showed that the eszopiclone/escitalopram combination was well tolerated and significantly improved not only anxiety but also the length and quality of sleep. Because insomnia often coexists with generalized anxiety disorder, a double-duty treatment regimen would be helpful for patients who suffer from both conditions, the researchers noted.

All study participants met criteria for generalized anxiety disorder and insomnia. All of them received 10 mg escitalopram (Lexapro) daily for 10 weeks. At the same time, 294 were randomized to receive 3 mg eszopiclone (Lunesta), while 301 received placebo for 8 weeks, followed by a 2-week discontinuation period.

Overall, patients who took the combination therapy showed significant improvements in mood and anxiety symptoms based on their Clinical Global Impression scale and the Hamilton Anxiety scale scores after 1, 2, 4, 6, 8, and 10 weeks of treatment, Dr. Mark H. Pollack reported. Dr. Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital, Boston, conducted the study.

Similarly, scores on the 17-item Hamilton Rating Scale for Depression (HAM-D17) were significantly better in the combination therapy group at all evaluation points. Anxiety remission rates were higher in the combination therapy group, too, compared with the placebo group (42% vs. 36%), said Dr. Pollack, who serves on the advisory boards of and has received support for research from several pharmaceutical companies, including that of Sepracor.

In a second study of the same group of patients, presented by Dr. W. Vaughn McCall, professor and chairman of the department of psychiatry and behavioral medicine at Wake Forest University, Winston-Salem, N.C., significantly more patients who received combination therapy had no clinically meaningful insomnia at 8 weeks, compared with the escitalopram-only patients (47% vs. 33%).

In addition, combination therapy patients took significantly less time to fall asleep, slept longer, and scored significantly better on the insomnia severity index than did the escitalopram-only group, said Dr. McCall, who serves on Sepracor's speakers' bureau and its advisory board.

The adverse event rates were similar in both groups during the study period (78% for the combination group and 68% for the escitalopram-only group) and were identical (16%) during the 2-week discontinuation period. Overall the treatment was well tolerated, and no patients showed evidence of rebound insomnia as a result of the medications.

The most common adverse events reported in at least 10% of the combination therapy group were unpleasant taste (24%), headache (19%), dry mouth (16%), and sleepiness (11%); the most common adverse events reported in the escitalopram-only group were headache (15%) and nausea (15%).

ELSEVIER GLOBAL MEDICAL NEWS