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WHO guidance for caring for pregnant women in Zika virus areas
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
Study: 2.6% of patients discharged from U.S. hospital used probiotics
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
FROM AMERICAN JOURNAL OF INFECTION CONTROL
Ebola continues to impact survivors as epidemic wanes
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
FROM EMERGING INFECTIOUS DISEASES
Drug targeting Huntington’s disease–causing protein undergoing clinical trial
A drug that was found to have no dose-limiting side effects in nonhuman primates is being evaluated in a clinical trial for its ability to reduce production of the protein that causes Huntington’s disease (HD).
The new drug, which is an antisense oligonucleotide, was formerly known as ISIS-HTTRx and was renamed IONIS-HTTRx, because its developer changed its name in December 2015 to Ionis Pharmaceuticals from Isis Pharmaceuticals. IONIS-HTTRx acts as a gene silencer to inhibit the production of huntington protein in people with HD. The clinical trial now underway is a randomized, double-blind, placebo-controlled study aimed at evaluating the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple ascending doses of IONIS-HTTRx in up to 36 patients with early manifest HD. If the trial is successful, IONIS-HTTRx would be the first drug to modify HD progression in patients, according to an abstract to be presented at the annual meeting of the American Academy of Neurology in Vancouver in April.
Ionis found the drug to be well tolerated in rodents and nonhuman primates in investigational new drug-enabling toxicology studies, with nonhuman primates having received doses up to 20 mg of the drug intrathecally, according to the trial’s principal investigator Dr. Blair R. Leavitt of the University of British Columbia, Vancouver, and colleagues.
“It is very exciting to have the possibility of a treatment that could alter the course of this devastating disease. Right now we only have treatments that work on the symptoms of the disease.” Dr. Leavitt said in a written statement.
The study is supported by Ionis Pharmaceuticals and is part of Ionis’ collaboration with Roche to develop antisense drugs to treat HD, according to the investigators.
A drug that was found to have no dose-limiting side effects in nonhuman primates is being evaluated in a clinical trial for its ability to reduce production of the protein that causes Huntington’s disease (HD).
The new drug, which is an antisense oligonucleotide, was formerly known as ISIS-HTTRx and was renamed IONIS-HTTRx, because its developer changed its name in December 2015 to Ionis Pharmaceuticals from Isis Pharmaceuticals. IONIS-HTTRx acts as a gene silencer to inhibit the production of huntington protein in people with HD. The clinical trial now underway is a randomized, double-blind, placebo-controlled study aimed at evaluating the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple ascending doses of IONIS-HTTRx in up to 36 patients with early manifest HD. If the trial is successful, IONIS-HTTRx would be the first drug to modify HD progression in patients, according to an abstract to be presented at the annual meeting of the American Academy of Neurology in Vancouver in April.
Ionis found the drug to be well tolerated in rodents and nonhuman primates in investigational new drug-enabling toxicology studies, with nonhuman primates having received doses up to 20 mg of the drug intrathecally, according to the trial’s principal investigator Dr. Blair R. Leavitt of the University of British Columbia, Vancouver, and colleagues.
“It is very exciting to have the possibility of a treatment that could alter the course of this devastating disease. Right now we only have treatments that work on the symptoms of the disease.” Dr. Leavitt said in a written statement.
The study is supported by Ionis Pharmaceuticals and is part of Ionis’ collaboration with Roche to develop antisense drugs to treat HD, according to the investigators.
A drug that was found to have no dose-limiting side effects in nonhuman primates is being evaluated in a clinical trial for its ability to reduce production of the protein that causes Huntington’s disease (HD).
The new drug, which is an antisense oligonucleotide, was formerly known as ISIS-HTTRx and was renamed IONIS-HTTRx, because its developer changed its name in December 2015 to Ionis Pharmaceuticals from Isis Pharmaceuticals. IONIS-HTTRx acts as a gene silencer to inhibit the production of huntington protein in people with HD. The clinical trial now underway is a randomized, double-blind, placebo-controlled study aimed at evaluating the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple ascending doses of IONIS-HTTRx in up to 36 patients with early manifest HD. If the trial is successful, IONIS-HTTRx would be the first drug to modify HD progression in patients, according to an abstract to be presented at the annual meeting of the American Academy of Neurology in Vancouver in April.
Ionis found the drug to be well tolerated in rodents and nonhuman primates in investigational new drug-enabling toxicology studies, with nonhuman primates having received doses up to 20 mg of the drug intrathecally, according to the trial’s principal investigator Dr. Blair R. Leavitt of the University of British Columbia, Vancouver, and colleagues.
“It is very exciting to have the possibility of a treatment that could alter the course of this devastating disease. Right now we only have treatments that work on the symptoms of the disease.” Dr. Leavitt said in a written statement.
The study is supported by Ionis Pharmaceuticals and is part of Ionis’ collaboration with Roche to develop antisense drugs to treat HD, according to the investigators.
Donor human milk availability to VLBW infants associated with decreased NEC
For very low birth weight infants, the availability of donor human milk to newborns was associated with a decreased incidence of necrotizing enterocolitis and an increased rate of breastfeeding at discharge from a neonatal intensive care unit.
The researchers based their findings on data obtained from the California Perinatal Quality Care Collaborative, which gathers information on the care of greater than 90% of California’s neonatal intensive care unit (NICU) admissions of very low birth weight (VLBW) infants (defined as weighing less than or equal to 1.5 kg at birth), and the Mother’s Milk Bank of San Jose, a human milk bank serving 94 hospitals across several states, including California. All of the data was collected between 2007 and 2013 in over 42,000 VLBW babies. Babies were classified as breastfeeding at discharge, if they were feeding with human milk or human milk with fortifier or formula, but not if they were only feeding with formula.
Agata Kantorowska, a medical student at the University of Rochester (N.Y.) School of Medicine and Dentistry, and her colleagues noted that they did not know if donor human milk (DHM) was used primarily as a back-up feeding if mother’s milk was unavailable, in another way, or in conjunction with human milk-derived fortifiers; the proportion of VLBW infants within each NICU that received DHM; or the length of time that an individual received DHM.
Among the 22 hospitals studied that went from not having DHM available to making it available, on average, the rate of breastfeeding at discharge increased by 10% after DHM became available (P less than .0001). Among these same hospitals, the mean change in necrotizing enterocolitis (NEC) prevalence, following the introduction of DHM, was a 2.6% decrease (P = .0006). Before DHM became available in the 22 hospitals, 52.8% of VLBW infants were breastfeeding at discharge, compared with 61.7% after DHM became available. The rate of NEC was 6.6% among VLBW infants prior to DHM having becoming available at a hospital, versus 4.3% following the introduction of DHM to a hospital.
Following risk adjustment, not having DHM available in a hospital was a negative predictor for breastfeeding at discharge (odds ratio, 0.70) and a positive predictor of NEC (odds ratio, 1.15).
Ms. Kantorowska and her associates said while they found “a significant association between a hospital’s DHM status and increased breastfeeding and decreased NEC rates among VLBW infants,” factors other than the availability of DHM contributed to changes in breastfeeding and NEC rates that occurred. They also noted that they saw an increased rate of breastfeeding and a similar decreasing rate of NEC in hospitals that did not transition to using DHM.
“Societal attitudes toward breastfeeding are likely influencing mothers’ attempts to provide breast milk to their VLBW infants. ... The NICU battle against NEC is ongoing, and other advances in care that occurred from 2007 to 2013 could be contributing to the observed decrease in NEC rate in hospitals that acquired DHM,” the researchers said.
Read the full study in Pediatrics (doi: 10.1542/peds.2015-3123).
For very low birth weight infants, the availability of donor human milk to newborns was associated with a decreased incidence of necrotizing enterocolitis and an increased rate of breastfeeding at discharge from a neonatal intensive care unit.
The researchers based their findings on data obtained from the California Perinatal Quality Care Collaborative, which gathers information on the care of greater than 90% of California’s neonatal intensive care unit (NICU) admissions of very low birth weight (VLBW) infants (defined as weighing less than or equal to 1.5 kg at birth), and the Mother’s Milk Bank of San Jose, a human milk bank serving 94 hospitals across several states, including California. All of the data was collected between 2007 and 2013 in over 42,000 VLBW babies. Babies were classified as breastfeeding at discharge, if they were feeding with human milk or human milk with fortifier or formula, but not if they were only feeding with formula.
Agata Kantorowska, a medical student at the University of Rochester (N.Y.) School of Medicine and Dentistry, and her colleagues noted that they did not know if donor human milk (DHM) was used primarily as a back-up feeding if mother’s milk was unavailable, in another way, or in conjunction with human milk-derived fortifiers; the proportion of VLBW infants within each NICU that received DHM; or the length of time that an individual received DHM.
Among the 22 hospitals studied that went from not having DHM available to making it available, on average, the rate of breastfeeding at discharge increased by 10% after DHM became available (P less than .0001). Among these same hospitals, the mean change in necrotizing enterocolitis (NEC) prevalence, following the introduction of DHM, was a 2.6% decrease (P = .0006). Before DHM became available in the 22 hospitals, 52.8% of VLBW infants were breastfeeding at discharge, compared with 61.7% after DHM became available. The rate of NEC was 6.6% among VLBW infants prior to DHM having becoming available at a hospital, versus 4.3% following the introduction of DHM to a hospital.
Following risk adjustment, not having DHM available in a hospital was a negative predictor for breastfeeding at discharge (odds ratio, 0.70) and a positive predictor of NEC (odds ratio, 1.15).
Ms. Kantorowska and her associates said while they found “a significant association between a hospital’s DHM status and increased breastfeeding and decreased NEC rates among VLBW infants,” factors other than the availability of DHM contributed to changes in breastfeeding and NEC rates that occurred. They also noted that they saw an increased rate of breastfeeding and a similar decreasing rate of NEC in hospitals that did not transition to using DHM.
“Societal attitudes toward breastfeeding are likely influencing mothers’ attempts to provide breast milk to their VLBW infants. ... The NICU battle against NEC is ongoing, and other advances in care that occurred from 2007 to 2013 could be contributing to the observed decrease in NEC rate in hospitals that acquired DHM,” the researchers said.
Read the full study in Pediatrics (doi: 10.1542/peds.2015-3123).
For very low birth weight infants, the availability of donor human milk to newborns was associated with a decreased incidence of necrotizing enterocolitis and an increased rate of breastfeeding at discharge from a neonatal intensive care unit.
The researchers based their findings on data obtained from the California Perinatal Quality Care Collaborative, which gathers information on the care of greater than 90% of California’s neonatal intensive care unit (NICU) admissions of very low birth weight (VLBW) infants (defined as weighing less than or equal to 1.5 kg at birth), and the Mother’s Milk Bank of San Jose, a human milk bank serving 94 hospitals across several states, including California. All of the data was collected between 2007 and 2013 in over 42,000 VLBW babies. Babies were classified as breastfeeding at discharge, if they were feeding with human milk or human milk with fortifier or formula, but not if they were only feeding with formula.
Agata Kantorowska, a medical student at the University of Rochester (N.Y.) School of Medicine and Dentistry, and her colleagues noted that they did not know if donor human milk (DHM) was used primarily as a back-up feeding if mother’s milk was unavailable, in another way, or in conjunction with human milk-derived fortifiers; the proportion of VLBW infants within each NICU that received DHM; or the length of time that an individual received DHM.
Among the 22 hospitals studied that went from not having DHM available to making it available, on average, the rate of breastfeeding at discharge increased by 10% after DHM became available (P less than .0001). Among these same hospitals, the mean change in necrotizing enterocolitis (NEC) prevalence, following the introduction of DHM, was a 2.6% decrease (P = .0006). Before DHM became available in the 22 hospitals, 52.8% of VLBW infants were breastfeeding at discharge, compared with 61.7% after DHM became available. The rate of NEC was 6.6% among VLBW infants prior to DHM having becoming available at a hospital, versus 4.3% following the introduction of DHM to a hospital.
Following risk adjustment, not having DHM available in a hospital was a negative predictor for breastfeeding at discharge (odds ratio, 0.70) and a positive predictor of NEC (odds ratio, 1.15).
Ms. Kantorowska and her associates said while they found “a significant association between a hospital’s DHM status and increased breastfeeding and decreased NEC rates among VLBW infants,” factors other than the availability of DHM contributed to changes in breastfeeding and NEC rates that occurred. They also noted that they saw an increased rate of breastfeeding and a similar decreasing rate of NEC in hospitals that did not transition to using DHM.
“Societal attitudes toward breastfeeding are likely influencing mothers’ attempts to provide breast milk to their VLBW infants. ... The NICU battle against NEC is ongoing, and other advances in care that occurred from 2007 to 2013 could be contributing to the observed decrease in NEC rate in hospitals that acquired DHM,” the researchers said.
Read the full study in Pediatrics (doi: 10.1542/peds.2015-3123).
FROM PEDIATRICS
Gender identity disorders in males associated with MS
An association between gender identity disorders (GIDs) and subsequent multiple sclerosis (MS) in males was found in an analysis of linked English Hospital Episode Statistics and mortality data from January 1999 to March 2012.
The findings “suggest that low testosterone levels and/or feminising gonadal hormones might influence MS risk in some men and highlight a need for further work to explore any potential role for gonadal hormones in management and/or prevention strategies,” wrote Dr. Julia Pakpoor of the Unit of Health-Care Epidemiology, Nuffield Department of Population Health, at University of Oxford (England).
She and her colleagues used the patient data to construct male and female cohorts (1,157 patients and 2,390 patients, respectively) of patients with GIDs. A patient was included in one of the two GID cohorts if he or she had an episode of care or hospital admission in which a GID or sexual transformation procedure was coded in any diagnostic position.
For males with GIDs transitioning to females, the most studied treatment regimen involves using feminizing hormones and anti-androgens, which reduce testosterone secretion or neutralize testosterone activity, the researchers noted.
They also used the database to construct male and female cohorts (4.6 million patients and 3.4 million patients, respectively) to serve as two control groups. For patients to be included in the control groups, they needed to have been first admitted to a hospital for a minor condition and to never have been admitted to a hospital for MS. Patients who had been admitted to a hospital for MS either before or at the same time they were admitted for GIDs were excluded from the GID cohorts. A patient stopped being followed upon diagnosis with MS.
“Our study design cannot give insights into mechanisms that might explain the association [between males with GIDs and MS]. However, there is evidence suggesting an association between gonadal hormones and MS, including animal models suggesting anti-inflammatory and/or neuroprotective actions of testosterone, studies indicating a high prevalence of hypogonadism in male MS patients, and improved cognitive function and slowed brain atrophy in a small pilot trial of testosterone,” the researchers noted.
The adjusted rate ratio of MS following GID in males was 6.63 (P = .0002), compared with 1.44 in females (P = .58). The adjusted rate ratios were based on 4 observed cases and 0.6 expected cases of MS in males and 5 observed cases and 3.5 expected cases of MS in females.
The authors reported no conflicts of interest.
Read the study in Multiple Sclerosis Journal (doi: 10.1177/1352458515627205).
An association between gender identity disorders (GIDs) and subsequent multiple sclerosis (MS) in males was found in an analysis of linked English Hospital Episode Statistics and mortality data from January 1999 to March 2012.
The findings “suggest that low testosterone levels and/or feminising gonadal hormones might influence MS risk in some men and highlight a need for further work to explore any potential role for gonadal hormones in management and/or prevention strategies,” wrote Dr. Julia Pakpoor of the Unit of Health-Care Epidemiology, Nuffield Department of Population Health, at University of Oxford (England).
She and her colleagues used the patient data to construct male and female cohorts (1,157 patients and 2,390 patients, respectively) of patients with GIDs. A patient was included in one of the two GID cohorts if he or she had an episode of care or hospital admission in which a GID or sexual transformation procedure was coded in any diagnostic position.
For males with GIDs transitioning to females, the most studied treatment regimen involves using feminizing hormones and anti-androgens, which reduce testosterone secretion or neutralize testosterone activity, the researchers noted.
They also used the database to construct male and female cohorts (4.6 million patients and 3.4 million patients, respectively) to serve as two control groups. For patients to be included in the control groups, they needed to have been first admitted to a hospital for a minor condition and to never have been admitted to a hospital for MS. Patients who had been admitted to a hospital for MS either before or at the same time they were admitted for GIDs were excluded from the GID cohorts. A patient stopped being followed upon diagnosis with MS.
“Our study design cannot give insights into mechanisms that might explain the association [between males with GIDs and MS]. However, there is evidence suggesting an association between gonadal hormones and MS, including animal models suggesting anti-inflammatory and/or neuroprotective actions of testosterone, studies indicating a high prevalence of hypogonadism in male MS patients, and improved cognitive function and slowed brain atrophy in a small pilot trial of testosterone,” the researchers noted.
The adjusted rate ratio of MS following GID in males was 6.63 (P = .0002), compared with 1.44 in females (P = .58). The adjusted rate ratios were based on 4 observed cases and 0.6 expected cases of MS in males and 5 observed cases and 3.5 expected cases of MS in females.
The authors reported no conflicts of interest.
Read the study in Multiple Sclerosis Journal (doi: 10.1177/1352458515627205).
An association between gender identity disorders (GIDs) and subsequent multiple sclerosis (MS) in males was found in an analysis of linked English Hospital Episode Statistics and mortality data from January 1999 to March 2012.
The findings “suggest that low testosterone levels and/or feminising gonadal hormones might influence MS risk in some men and highlight a need for further work to explore any potential role for gonadal hormones in management and/or prevention strategies,” wrote Dr. Julia Pakpoor of the Unit of Health-Care Epidemiology, Nuffield Department of Population Health, at University of Oxford (England).
She and her colleagues used the patient data to construct male and female cohorts (1,157 patients and 2,390 patients, respectively) of patients with GIDs. A patient was included in one of the two GID cohorts if he or she had an episode of care or hospital admission in which a GID or sexual transformation procedure was coded in any diagnostic position.
For males with GIDs transitioning to females, the most studied treatment regimen involves using feminizing hormones and anti-androgens, which reduce testosterone secretion or neutralize testosterone activity, the researchers noted.
They also used the database to construct male and female cohorts (4.6 million patients and 3.4 million patients, respectively) to serve as two control groups. For patients to be included in the control groups, they needed to have been first admitted to a hospital for a minor condition and to never have been admitted to a hospital for MS. Patients who had been admitted to a hospital for MS either before or at the same time they were admitted for GIDs were excluded from the GID cohorts. A patient stopped being followed upon diagnosis with MS.
“Our study design cannot give insights into mechanisms that might explain the association [between males with GIDs and MS]. However, there is evidence suggesting an association between gonadal hormones and MS, including animal models suggesting anti-inflammatory and/or neuroprotective actions of testosterone, studies indicating a high prevalence of hypogonadism in male MS patients, and improved cognitive function and slowed brain atrophy in a small pilot trial of testosterone,” the researchers noted.
The adjusted rate ratio of MS following GID in males was 6.63 (P = .0002), compared with 1.44 in females (P = .58). The adjusted rate ratios were based on 4 observed cases and 0.6 expected cases of MS in males and 5 observed cases and 3.5 expected cases of MS in females.
The authors reported no conflicts of interest.
Read the study in Multiple Sclerosis Journal (doi: 10.1177/1352458515627205).
FROM MULTIPLE SCLEROSIS JOURNAL
Use preventive strategies to lower cardiovascular risks in bipolar I
The significantly increased risk of myocardial infarction or stroke in patients with bipolar I disorder appears to be tied more to preventive factors than to cardiovascular risk factors. However, bipolar I patients with a history of psychosis have an marginally increased risk of MI or stroke, a population-based cohort study showed.
The researchers came to those conclusions after analyzing residents’ health records and death certificates in Olmsted County, Minn., which were contained within the Rochester Epidemiology Project database. The study’s participants included 334 patients with bipolar I disorder and 334 people without bipolar disorder, although one of the patients who did not have bipolar I at the beginning of the study was later diagnosed with the disorder. All participants had been residents of Olmsted County from Jan. 1, 1966, through Dec. 31,1996.
Patients continued to be followed until Dec. 31, 2013, unless one of the following events occurred before that date: the patient had an MI or stroke, was lost to follow-up, or died before the end of the study. A patient experiencing an MI, stroke, or death or a patient disappearing from the database triggered an end to that patient’s participation in the study.
When an individual having an MI or a stroke was treated as a composite outcome, bipolar I disorder patients had a significantly increased risk of experiencing a fatal or non-fatal MI or stroke, compared with the individuals in the control group (P = .04). The risk was no longer significant after the researchers adjusted for the following potential baseline confounders of the association between bipolar disorder and cardiovascular disease: alcohol use disorder, diabetes, hypertension, and smoking (P = .46).
Meanwhile, a secondary analysis of the data showed that history of psychosis was indeed tied to a marginally increased risk of MI or stroke (P =.06).
“It will be fundamental to improve current preventive strategies to decrease the prevalence of smoking, alcohol use, hypertension, and diabetes among patients with bipolar disorder,” said Dr. Miguel L. Prieto of the department of psychiatry and psychology at the Mayo Medical School, Rochester, Minn., and his colleagues. “Moreover, we detected a possible higher risk of MI/stroke in the subgroup of patients with history of psychosis that certainly warrants replication.”
Future research also should seek to determine early biomarkers of atherosclerosis, the researchers said.
Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2016.01.015).
The significantly increased risk of myocardial infarction or stroke in patients with bipolar I disorder appears to be tied more to preventive factors than to cardiovascular risk factors. However, bipolar I patients with a history of psychosis have an marginally increased risk of MI or stroke, a population-based cohort study showed.
The researchers came to those conclusions after analyzing residents’ health records and death certificates in Olmsted County, Minn., which were contained within the Rochester Epidemiology Project database. The study’s participants included 334 patients with bipolar I disorder and 334 people without bipolar disorder, although one of the patients who did not have bipolar I at the beginning of the study was later diagnosed with the disorder. All participants had been residents of Olmsted County from Jan. 1, 1966, through Dec. 31,1996.
Patients continued to be followed until Dec. 31, 2013, unless one of the following events occurred before that date: the patient had an MI or stroke, was lost to follow-up, or died before the end of the study. A patient experiencing an MI, stroke, or death or a patient disappearing from the database triggered an end to that patient’s participation in the study.
When an individual having an MI or a stroke was treated as a composite outcome, bipolar I disorder patients had a significantly increased risk of experiencing a fatal or non-fatal MI or stroke, compared with the individuals in the control group (P = .04). The risk was no longer significant after the researchers adjusted for the following potential baseline confounders of the association between bipolar disorder and cardiovascular disease: alcohol use disorder, diabetes, hypertension, and smoking (P = .46).
Meanwhile, a secondary analysis of the data showed that history of psychosis was indeed tied to a marginally increased risk of MI or stroke (P =.06).
“It will be fundamental to improve current preventive strategies to decrease the prevalence of smoking, alcohol use, hypertension, and diabetes among patients with bipolar disorder,” said Dr. Miguel L. Prieto of the department of psychiatry and psychology at the Mayo Medical School, Rochester, Minn., and his colleagues. “Moreover, we detected a possible higher risk of MI/stroke in the subgroup of patients with history of psychosis that certainly warrants replication.”
Future research also should seek to determine early biomarkers of atherosclerosis, the researchers said.
Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2016.01.015).
The significantly increased risk of myocardial infarction or stroke in patients with bipolar I disorder appears to be tied more to preventive factors than to cardiovascular risk factors. However, bipolar I patients with a history of psychosis have an marginally increased risk of MI or stroke, a population-based cohort study showed.
The researchers came to those conclusions after analyzing residents’ health records and death certificates in Olmsted County, Minn., which were contained within the Rochester Epidemiology Project database. The study’s participants included 334 patients with bipolar I disorder and 334 people without bipolar disorder, although one of the patients who did not have bipolar I at the beginning of the study was later diagnosed with the disorder. All participants had been residents of Olmsted County from Jan. 1, 1966, through Dec. 31,1996.
Patients continued to be followed until Dec. 31, 2013, unless one of the following events occurred before that date: the patient had an MI or stroke, was lost to follow-up, or died before the end of the study. A patient experiencing an MI, stroke, or death or a patient disappearing from the database triggered an end to that patient’s participation in the study.
When an individual having an MI or a stroke was treated as a composite outcome, bipolar I disorder patients had a significantly increased risk of experiencing a fatal or non-fatal MI or stroke, compared with the individuals in the control group (P = .04). The risk was no longer significant after the researchers adjusted for the following potential baseline confounders of the association between bipolar disorder and cardiovascular disease: alcohol use disorder, diabetes, hypertension, and smoking (P = .46).
Meanwhile, a secondary analysis of the data showed that history of psychosis was indeed tied to a marginally increased risk of MI or stroke (P =.06).
“It will be fundamental to improve current preventive strategies to decrease the prevalence of smoking, alcohol use, hypertension, and diabetes among patients with bipolar disorder,” said Dr. Miguel L. Prieto of the department of psychiatry and psychology at the Mayo Medical School, Rochester, Minn., and his colleagues. “Moreover, we detected a possible higher risk of MI/stroke in the subgroup of patients with history of psychosis that certainly warrants replication.”
Future research also should seek to determine early biomarkers of atherosclerosis, the researchers said.
Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2016.01.015).
FROM JOURNAL OF AFFECTIVE DISORDERS
NIDA releases strategic plan to prevent, treat substance use disorders
The National Institute on Drug Abuse (NIDA) has developed a 5-year strategic plan aimed at gaining new information about the basic science of the brain as it relates to the causes and consequences of drug use and addiction. Part of the plan is to use novel findings about the brain to create more effective interventions for preventing and treating substance use disorders, according to a written statement by NIDA.
The plan for 2016-2020, which NIDA has named “Advancing Addiction Science,” calls for the achievement of the following four strategic goals:
• Identify the biological, environmental, behavioral, and social causes and consequences of drug use and addiction across the lifespan.
• Develop improved strategies to prevent drug use and its consequences.
• Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery.
• Increase the public health impact of NIDA research and programs.
“Developing this plan was a collaborative effort incorporating guidance from the National Advisory Council on Drug Abuse, scientific and clinical experts, stakeholder organizations, and the public,” NIDA Director Nora Volkow said in a written statement.
“This plan outlines our broad goals across basic science, prevention, treatment, and public health; identifies four priority focus areas that we believe present unique opportunities to be leveraged over the next 5 years; and reflects a flexible, dynamic approach that will allow us to adapt to new scientific and technological advances and changing public health needs, and to take advantage of scientific opportunities as they arise,” she said.
More information about the plan is available here.
The National Institute on Drug Abuse (NIDA) has developed a 5-year strategic plan aimed at gaining new information about the basic science of the brain as it relates to the causes and consequences of drug use and addiction. Part of the plan is to use novel findings about the brain to create more effective interventions for preventing and treating substance use disorders, according to a written statement by NIDA.
The plan for 2016-2020, which NIDA has named “Advancing Addiction Science,” calls for the achievement of the following four strategic goals:
• Identify the biological, environmental, behavioral, and social causes and consequences of drug use and addiction across the lifespan.
• Develop improved strategies to prevent drug use and its consequences.
• Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery.
• Increase the public health impact of NIDA research and programs.
“Developing this plan was a collaborative effort incorporating guidance from the National Advisory Council on Drug Abuse, scientific and clinical experts, stakeholder organizations, and the public,” NIDA Director Nora Volkow said in a written statement.
“This plan outlines our broad goals across basic science, prevention, treatment, and public health; identifies four priority focus areas that we believe present unique opportunities to be leveraged over the next 5 years; and reflects a flexible, dynamic approach that will allow us to adapt to new scientific and technological advances and changing public health needs, and to take advantage of scientific opportunities as they arise,” she said.
More information about the plan is available here.
The National Institute on Drug Abuse (NIDA) has developed a 5-year strategic plan aimed at gaining new information about the basic science of the brain as it relates to the causes and consequences of drug use and addiction. Part of the plan is to use novel findings about the brain to create more effective interventions for preventing and treating substance use disorders, according to a written statement by NIDA.
The plan for 2016-2020, which NIDA has named “Advancing Addiction Science,” calls for the achievement of the following four strategic goals:
• Identify the biological, environmental, behavioral, and social causes and consequences of drug use and addiction across the lifespan.
• Develop improved strategies to prevent drug use and its consequences.
• Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery.
• Increase the public health impact of NIDA research and programs.
“Developing this plan was a collaborative effort incorporating guidance from the National Advisory Council on Drug Abuse, scientific and clinical experts, stakeholder organizations, and the public,” NIDA Director Nora Volkow said in a written statement.
“This plan outlines our broad goals across basic science, prevention, treatment, and public health; identifies four priority focus areas that we believe present unique opportunities to be leveraged over the next 5 years; and reflects a flexible, dynamic approach that will allow us to adapt to new scientific and technological advances and changing public health needs, and to take advantage of scientific opportunities as they arise,” she said.
More information about the plan is available here.
Childhood Metabolic Syndrome Severity Declined Relative to HDL, Triglyceride Changes
The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.
The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.
The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.
Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.
The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.
“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”
The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”
Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).
The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.
The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.
The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.
Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.
The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.
“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”
The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”
Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).
The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.
The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.
The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.
Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.
The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.
“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”
The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”
Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).
FROM PEDIATRICS
Childhood metabolic syndrome severity declined relative to HDL, triglyceride changes
The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.
The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.
The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.
Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.
The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.
“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”
The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”
Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).
The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.
The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.
The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.
Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.
The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.
“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”
The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”
Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).
The severity of childhood metabolic syndrome declined in a study of U.S. adolescents relative to increases in high-density lipoproteins (HDL) and decreases in fasting triglyceride measurements among the individuals examined, reported Arthur M. Lee of the University of Virginia, Charlottesville, and his colleagues.
The metabolic syndrome (MetS) is characterized by central obesity, high fasting glucose, high fasting triglycerides, high blood pressure (BP), and low HDL.
The researchers used regression analysis of individual waves of data from 1999 to 2012 to analyze 5,117 individuals aged 12-19 years. The data came from the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES, 1999-2012), a cross-sectional, national, stratified, multistage probability survey conducted in 2-year waves. The severity of MetS was calculated using the Pediatric MetS z score. Patients who were pregnant, had an active hepatitis B infection, had physician-diagnosed diabetes, or were currently using antidiabetic or antihyperlipidemic medication were excluded from the study.
Overall, a linear trend of a decreasing MetS z score (P = .030) was found despite the body mass index z score having increased significantly. While fasting triglyceride measurements declined significantly, HDL levels rose significantly.
The researchers also found temporal trends of decreasing total calorie consumption, decreasing carbohydrate consumption, and increasing unsaturated fat consumption.
“The overall decreasing trend in the MetS z score is likely secondary to the increasing trend in HDL measurements and decreasing trend in fasting triglycerides measurements, ” wrote Mr. Lee and his associates. “The increasing trend in HDL and decreasing fasting triglyceride measurements could be attributable in part to trends of decreasing carbohydrate intake and increasing unsaturated fat intake.”
The researchers recommended future studies on individuals with MetS focus on determining, “the causality of lifestyle factors in improvements of MetS severity.”
Read the study in Pediatrics (doi: 10.1542/peds.2015-3177).
FROM PEDIATRICS
