Lorinda Bullock

Dermatologic surgery has come a long way since the 1950s. This look at some of the highlights – from phenol peels and hair transplants to tumescent liposuction and botulinum toxin injections – covers the subspecialty's evolution and influence.

Dermatologic surgery has come a long way since the 1950s. This look at some of the highlights – from phenol peels and hair transplants to tumescent liposuction and botulinum toxin injections – covers the subspecialty's evolution and influence.

Dermatologic surgery has come a long way since the 1950s. This look at some of the highlights – from phenol peels and hair transplants to tumescent liposuction and botulinum toxin injections – covers the subspecialty's evolution and influence.

The Food and Drug Administration on May 4 issued a final guidance to manufacturers and distributors of over-the-counter liquid drugs, addressing an ongoing concern over unclear directions on dosing delivery devices such as spoons, cups, and syringes.

Photo credit: © Larry Allen/Fotolia.com

According to a written statement, the FDA issued the guidance titled "Dosage Delivery Devices for Orally Ingested OTC Liquid Drug Products" to combat accidental drug overdoses, particularly in children. The guidance "describes how easy-to-use dosage delivery devices and devices that minimize the risk of unintentional overdose can be provided for OTC medicines such as liquid pain relievers, cold medicine, cough syrups, and digestion aids."

The key recommendations include:

• All oral OTC liquid drug products should have dosage delivery devices included in their packaging.
• All devices should be marked with calibrated units of liquid measurement (e.g., teaspoon, tablespoon, or mL) that are the same as the units of liquid measure specified in the directions for the product, and there should not be any unnecessary markings.
• Manufacturers should ensure that dosage delivery devices are used only with the products with which they are packaged.
• Liquid measure markings on dosage delivery devices should be clearly visible and not obscured when the liquid product is added to the device.

The FDA also offered information resources highlighting its Safe Use Initiative, as well as a brochure for parents and caregivers titled "Kids Aren’t Just Small Adults," and a 10-item tip sheet on how to prevent an accidental overdose.

The Food and Drug Administration on May 4 issued a final guidance to manufacturers and distributors of over-the-counter liquid drugs, addressing an ongoing concern over unclear directions on dosing delivery devices such as spoons, cups, and syringes.

Photo credit: © Larry Allen/Fotolia.com

According to a written statement, the FDA issued the guidance titled "Dosage Delivery Devices for Orally Ingested OTC Liquid Drug Products" to combat accidental drug overdoses, particularly in children. The guidance "describes how easy-to-use dosage delivery devices and devices that minimize the risk of unintentional overdose can be provided for OTC medicines such as liquid pain relievers, cold medicine, cough syrups, and digestion aids."

The key recommendations include:

• All oral OTC liquid drug products should have dosage delivery devices included in their packaging.
• All devices should be marked with calibrated units of liquid measurement (e.g., teaspoon, tablespoon, or mL) that are the same as the units of liquid measure specified in the directions for the product, and there should not be any unnecessary markings.
• Manufacturers should ensure that dosage delivery devices are used only with the products with which they are packaged.
• Liquid measure markings on dosage delivery devices should be clearly visible and not obscured when the liquid product is added to the device.

The FDA also offered information resources highlighting its Safe Use Initiative, as well as a brochure for parents and caregivers titled "Kids Aren’t Just Small Adults," and a 10-item tip sheet on how to prevent an accidental overdose.

The Food and Drug Administration on May 4 issued a final guidance to manufacturers and distributors of over-the-counter liquid drugs, addressing an ongoing concern over unclear directions on dosing delivery devices such as spoons, cups, and syringes.

Photo credit: © Larry Allen/Fotolia.com

According to a written statement, the FDA issued the guidance titled "Dosage Delivery Devices for Orally Ingested OTC Liquid Drug Products" to combat accidental drug overdoses, particularly in children. The guidance "describes how easy-to-use dosage delivery devices and devices that minimize the risk of unintentional overdose can be provided for OTC medicines such as liquid pain relievers, cold medicine, cough syrups, and digestion aids."

The key recommendations include:

• All oral OTC liquid drug products should have dosage delivery devices included in their packaging.
• All devices should be marked with calibrated units of liquid measurement (e.g., teaspoon, tablespoon, or mL) that are the same as the units of liquid measure specified in the directions for the product, and there should not be any unnecessary markings.
• Manufacturers should ensure that dosage delivery devices are used only with the products with which they are packaged.
• Liquid measure markings on dosage delivery devices should be clearly visible and not obscured when the liquid product is added to the device.

The FDA also offered information resources highlighting its Safe Use Initiative, as well as a brochure for parents and caregivers titled "Kids Aren’t Just Small Adults," and a 10-item tip sheet on how to prevent an accidental overdose.

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market because of an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care providers were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

“The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart's electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling,” said Dr. John Jenkins, director of the Office of New Drugs at the FDA's Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. “What is unique here is the new heart data show that adverse effects occur in regular doses in normal volunteers and not just in overdose.”

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart's electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency's assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

“Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case,” Dr. Jenkins said.

At the agency's request, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

In 2009, an estimated 10 million people were taking some form of propoxyphene – usually in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA's Office of Surveillance and Epidemiology at CDER. Patients taking the drug are advised not to stop treatment immediately. Instead, they should discuss with their physicians safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said, withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies have already banned propoxyphene. The FDA's original approval of propoxyphene in 1957 was based on older safety standards and did not include “the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today,” Dr. Jenkins said.

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market because of an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care providers were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

“The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart's electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling,” said Dr. John Jenkins, director of the Office of New Drugs at the FDA's Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. “What is unique here is the new heart data show that adverse effects occur in regular doses in normal volunteers and not just in overdose.”

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart's electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency's assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

“Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case,” Dr. Jenkins said.

At the agency's request, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

In 2009, an estimated 10 million people were taking some form of propoxyphene – usually in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA's Office of Surveillance and Epidemiology at CDER. Patients taking the drug are advised not to stop treatment immediately. Instead, they should discuss with their physicians safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said, withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies have already banned propoxyphene. The FDA's original approval of propoxyphene in 1957 was based on older safety standards and did not include “the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today,” Dr. Jenkins said.

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market because of an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care providers were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

“The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart's electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling,” said Dr. John Jenkins, director of the Office of New Drugs at the FDA's Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. “What is unique here is the new heart data show that adverse effects occur in regular doses in normal volunteers and not just in overdose.”

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart's electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency's assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

“Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case,” Dr. Jenkins said.

At the agency's request, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

In 2009, an estimated 10 million people were taking some form of propoxyphene – usually in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA's Office of Surveillance and Epidemiology at CDER. Patients taking the drug are advised not to stop treatment immediately. Instead, they should discuss with their physicians safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said, withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies have already banned propoxyphene. The FDA's original approval of propoxyphene in 1957 was based on older safety standards and did not include “the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today,” Dr. Jenkins said.

In recent years, dermatologists have been almost exclusively using fractional ablative and nonablative lasers to treat acne scars, while other effective treatments are being underused, according to Dr. Douglas Fife.

During the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF), Dr. Fife explained alternative therapies such as skin needling, the CROSS (chemical reconstruction of skin scars) technique, and subcision. These techniques are not only easy to learn, but “are effective in treating certain scars that are unlikely to improve with laser treatment alone,” he said in an interview.

“While lasers are an exciting new technology that has an important role in treating acne scars, only a few patients will respond to laser treatment by itself. In addition, both ablative and nonablative fractional lasers carry a high risk of postinflammatory hyperpigmentation in type III skin and above,” he said.

Proper preparation and setting appropriate expectations are essential to treating all acne scars, from grade 1 macular scars (erythematous, hyperpigmented, or hypopigmented marks) to severe grade 4 scars, noted Dr. Fife, a dermatologist in private practice in Las Vegas.

For scars that require resurfacing, Dr. Fife suggested chemical peels and dermabrasion. Other scar types may require lifting procedures such as subcision, fillers, and punch elevation, or excisional techniques such as punch excision and grafting and elliptical and en bloc excisions.

He discussed some of the techniques in detail during his presentation at the seminar.

Dermabrasion

Dr. Fife described dermabrasion as a “tried and true” method against boxcar, varicella, and rolling scars. To blend trouble areas into normal skin, he suggested applying a 10%-30% trichloroacetic acid peel to surrounding skin and using silica carbide sandpaper to bridge the treated areas.

The low cost of equipment, no disposables, the “excellent” results, and the device's ability to be reused for other applications (like resurfacing surgical scars) are among the advantages, Dr. Fife reported.

As for the down side of dermabrasion, he noted that the learning curve is steep, and there is a high risk for infection due to aerosolized particles. In addition, dermabrasion can be “messy” (because of spatter), and is an aggressive procedure with high risks for hyper- and hypopigmentation, hypertrophic scarring, and temporary milia formation.

Excisional Techniques

The goal of excision is to “replace a prominent scar by a less conspicuous linear, superficial scar,” Dr. Fife noted. Not only can excision techniques like elliptical excision/rhytidectomy, punch excision, punch elevation, and subtotal/staged excision provide “dramatic” improvement to ice pick and deep boxcar scars, these treatments can “hide the new scars along relaxed skin tension lines.” However, the disadvantages may include “creation of a secondary scar” and abnormal healing in some patients.

The ideal candidates for treatments involving excisions include patients who have few scars; well-demarcated scars (ice pick, boxcar, acne excoriée); or deep, fibrotic, or hypopigmented scars, and those who have realistic expectations. Patients with a history of keloids or who have active or recently resolved acne are not recommended candidates.

Surgical skill is required to perform these techniques, Dr. Fife said. For scars greater than 3 mm, or scars with cutaneous bridges or persistent cysts and tunnels, he recommended elliptical excision. For scars less than 3 mm, and ice pick or deep boxcar scars, he suggested punch excision. For a punch excision, he explained that a 1.5-, 2-, 2.5-, or 3-mm punch biopsy tool is needed.

“While focal dermabrasion and excisional techniques require more training, they also are very effective for certain prominent scars,” he said.

Skin Needling

Skin needling goes by several names including dermarolling, percutaneous collagen induction, collagen induction therapy, dry tattooing, and intradermabrasion.

“Skin needling can penetrate deeper than some fractional laser treatments and does not carry the risk of hyperpigmentation,” Dr. Fife said. Compared with fractional lasers, skin needling has a more favorable safety profile and less down time (2-3 days) for the patient.

In addition, he said that the equipment required for skin needling is inexpensive, and it is a low-stress treatment option. The device can be reused on the patient multiple times. He did warn that skin needling is a bloody procedure that can be painful even with topical anesthetic. Also, there is no thermal effect.

The best candidates for skin needling are patients who have pigmented skin, want little down time, and have less money to spend, he said.

In most cases, Dr. Fife said patients who have significant scarring will need a combination of techniques for the best results and will require repeated procedures over a period of time to maintain the results.

“Combining the CROSS technique, filler injections, or subcision with fractional laser resurfacing in patients with moderate to severe scarring can improve the final outcome, as the different procedures target scars at different depths,” he said.

Dr. Fife said he had no relevant disclosures. SDEF and this news organization are owned by Elsevier.

A grade 4 acne scar is shown here. Use of a combination of techniques can improve the final outcome.

Source Courtesy Dr. Douglas Fife

In recent years, dermatologists have been almost exclusively using fractional ablative and nonablative lasers to treat acne scars, while other effective treatments are being underused, according to Dr. Douglas Fife.

During the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF), Dr. Fife explained alternative therapies such as skin needling, the CROSS (chemical reconstruction of skin scars) technique, and subcision. These techniques are not only easy to learn, but “are effective in treating certain scars that are unlikely to improve with laser treatment alone,” he said in an interview.

“While lasers are an exciting new technology that has an important role in treating acne scars, only a few patients will respond to laser treatment by itself. In addition, both ablative and nonablative fractional lasers carry a high risk of postinflammatory hyperpigmentation in type III skin and above,” he said.

Proper preparation and setting appropriate expectations are essential to treating all acne scars, from grade 1 macular scars (erythematous, hyperpigmented, or hypopigmented marks) to severe grade 4 scars, noted Dr. Fife, a dermatologist in private practice in Las Vegas.

For scars that require resurfacing, Dr. Fife suggested chemical peels and dermabrasion. Other scar types may require lifting procedures such as subcision, fillers, and punch elevation, or excisional techniques such as punch excision and grafting and elliptical and en bloc excisions.

He discussed some of the techniques in detail during his presentation at the seminar.

Dermabrasion

Dr. Fife described dermabrasion as a “tried and true” method against boxcar, varicella, and rolling scars. To blend trouble areas into normal skin, he suggested applying a 10%-30% trichloroacetic acid peel to surrounding skin and using silica carbide sandpaper to bridge the treated areas.

The low cost of equipment, no disposables, the “excellent” results, and the device's ability to be reused for other applications (like resurfacing surgical scars) are among the advantages, Dr. Fife reported.

As for the down side of dermabrasion, he noted that the learning curve is steep, and there is a high risk for infection due to aerosolized particles. In addition, dermabrasion can be “messy” (because of spatter), and is an aggressive procedure with high risks for hyper- and hypopigmentation, hypertrophic scarring, and temporary milia formation.

Excisional Techniques

The goal of excision is to “replace a prominent scar by a less conspicuous linear, superficial scar,” Dr. Fife noted. Not only can excision techniques like elliptical excision/rhytidectomy, punch excision, punch elevation, and subtotal/staged excision provide “dramatic” improvement to ice pick and deep boxcar scars, these treatments can “hide the new scars along relaxed skin tension lines.” However, the disadvantages may include “creation of a secondary scar” and abnormal healing in some patients.

The ideal candidates for treatments involving excisions include patients who have few scars; well-demarcated scars (ice pick, boxcar, acne excoriée); or deep, fibrotic, or hypopigmented scars, and those who have realistic expectations. Patients with a history of keloids or who have active or recently resolved acne are not recommended candidates.

Surgical skill is required to perform these techniques, Dr. Fife said. For scars greater than 3 mm, or scars with cutaneous bridges or persistent cysts and tunnels, he recommended elliptical excision. For scars less than 3 mm, and ice pick or deep boxcar scars, he suggested punch excision. For a punch excision, he explained that a 1.5-, 2-, 2.5-, or 3-mm punch biopsy tool is needed.

“While focal dermabrasion and excisional techniques require more training, they also are very effective for certain prominent scars,” he said.

Skin Needling

Skin needling goes by several names including dermarolling, percutaneous collagen induction, collagen induction therapy, dry tattooing, and intradermabrasion.

“Skin needling can penetrate deeper than some fractional laser treatments and does not carry the risk of hyperpigmentation,” Dr. Fife said. Compared with fractional lasers, skin needling has a more favorable safety profile and less down time (2-3 days) for the patient.

In addition, he said that the equipment required for skin needling is inexpensive, and it is a low-stress treatment option. The device can be reused on the patient multiple times. He did warn that skin needling is a bloody procedure that can be painful even with topical anesthetic. Also, there is no thermal effect.

The best candidates for skin needling are patients who have pigmented skin, want little down time, and have less money to spend, he said.

In most cases, Dr. Fife said patients who have significant scarring will need a combination of techniques for the best results and will require repeated procedures over a period of time to maintain the results.

“Combining the CROSS technique, filler injections, or subcision with fractional laser resurfacing in patients with moderate to severe scarring can improve the final outcome, as the different procedures target scars at different depths,” he said.

Dr. Fife said he had no relevant disclosures. SDEF and this news organization are owned by Elsevier.

A grade 4 acne scar is shown here. Use of a combination of techniques can improve the final outcome.

Source Courtesy Dr. Douglas Fife

In recent years, dermatologists have been almost exclusively using fractional ablative and nonablative lasers to treat acne scars, while other effective treatments are being underused, according to Dr. Douglas Fife.

During the Las Vegas Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF), Dr. Fife explained alternative therapies such as skin needling, the CROSS (chemical reconstruction of skin scars) technique, and subcision. These techniques are not only easy to learn, but “are effective in treating certain scars that are unlikely to improve with laser treatment alone,” he said in an interview.

“While lasers are an exciting new technology that has an important role in treating acne scars, only a few patients will respond to laser treatment by itself. In addition, both ablative and nonablative fractional lasers carry a high risk of postinflammatory hyperpigmentation in type III skin and above,” he said.

Proper preparation and setting appropriate expectations are essential to treating all acne scars, from grade 1 macular scars (erythematous, hyperpigmented, or hypopigmented marks) to severe grade 4 scars, noted Dr. Fife, a dermatologist in private practice in Las Vegas.

For scars that require resurfacing, Dr. Fife suggested chemical peels and dermabrasion. Other scar types may require lifting procedures such as subcision, fillers, and punch elevation, or excisional techniques such as punch excision and grafting and elliptical and en bloc excisions.

He discussed some of the techniques in detail during his presentation at the seminar.

Dermabrasion

Dr. Fife described dermabrasion as a “tried and true” method against boxcar, varicella, and rolling scars. To blend trouble areas into normal skin, he suggested applying a 10%-30% trichloroacetic acid peel to surrounding skin and using silica carbide sandpaper to bridge the treated areas.

The low cost of equipment, no disposables, the “excellent” results, and the device's ability to be reused for other applications (like resurfacing surgical scars) are among the advantages, Dr. Fife reported.

As for the down side of dermabrasion, he noted that the learning curve is steep, and there is a high risk for infection due to aerosolized particles. In addition, dermabrasion can be “messy” (because of spatter), and is an aggressive procedure with high risks for hyper- and hypopigmentation, hypertrophic scarring, and temporary milia formation.

Excisional Techniques

The goal of excision is to “replace a prominent scar by a less conspicuous linear, superficial scar,” Dr. Fife noted. Not only can excision techniques like elliptical excision/rhytidectomy, punch excision, punch elevation, and subtotal/staged excision provide “dramatic” improvement to ice pick and deep boxcar scars, these treatments can “hide the new scars along relaxed skin tension lines.” However, the disadvantages may include “creation of a secondary scar” and abnormal healing in some patients.

The ideal candidates for treatments involving excisions include patients who have few scars; well-demarcated scars (ice pick, boxcar, acne excoriée); or deep, fibrotic, or hypopigmented scars, and those who have realistic expectations. Patients with a history of keloids or who have active or recently resolved acne are not recommended candidates.

Surgical skill is required to perform these techniques, Dr. Fife said. For scars greater than 3 mm, or scars with cutaneous bridges or persistent cysts and tunnels, he recommended elliptical excision. For scars less than 3 mm, and ice pick or deep boxcar scars, he suggested punch excision. For a punch excision, he explained that a 1.5-, 2-, 2.5-, or 3-mm punch biopsy tool is needed.

“While focal dermabrasion and excisional techniques require more training, they also are very effective for certain prominent scars,” he said.

Skin Needling

Skin needling goes by several names including dermarolling, percutaneous collagen induction, collagen induction therapy, dry tattooing, and intradermabrasion.

“Skin needling can penetrate deeper than some fractional laser treatments and does not carry the risk of hyperpigmentation,” Dr. Fife said. Compared with fractional lasers, skin needling has a more favorable safety profile and less down time (2-3 days) for the patient.

In addition, he said that the equipment required for skin needling is inexpensive, and it is a low-stress treatment option. The device can be reused on the patient multiple times. He did warn that skin needling is a bloody procedure that can be painful even with topical anesthetic. Also, there is no thermal effect.

The best candidates for skin needling are patients who have pigmented skin, want little down time, and have less money to spend, he said.

In most cases, Dr. Fife said patients who have significant scarring will need a combination of techniques for the best results and will require repeated procedures over a period of time to maintain the results.

“Combining the CROSS technique, filler injections, or subcision with fractional laser resurfacing in patients with moderate to severe scarring can improve the final outcome, as the different procedures target scars at different depths,” he said.

Dr. Fife said he had no relevant disclosures. SDEF and this news organization are owned by Elsevier.

A grade 4 acne scar is shown here. Use of a combination of techniques can improve the final outcome.

Source Courtesy Dr. Douglas Fife

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market due to an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care professionals were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

"The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart’s electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling," said Dr. John Jenkins, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. "What is unique here is the new heart data shows that adverse effects occur in regular doses in normal volunteers and not just in overdose."

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart’s electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency’s assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

"Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case."

At the request of the agency, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

As of 2009, an estimated 10 million people were taking some form of propoxyphene – most commonly in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA’s Office of Surveillance and Epidemiology at CDER. Patients currently taking the drug are advised not to stop treatment immediately. Instead, they should see their physician to discuss safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies such as the Medicines and Healthcare products Regulatory Agency in the United Kingdom and the European Medicines Agency have already banned propoxyphene.

The FDA’s original approval of propoxyphene in 1957 was based on older safety standards and did not include "the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today," Dr. Jenkins said.

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market due to an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care professionals were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

"The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart’s electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling," said Dr. John Jenkins, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. "What is unique here is the new heart data shows that adverse effects occur in regular doses in normal volunteers and not just in overdose."

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart’s electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency’s assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

"Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case."

At the request of the agency, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

As of 2009, an estimated 10 million people were taking some form of propoxyphene – most commonly in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA’s Office of Surveillance and Epidemiology at CDER. Patients currently taking the drug are advised not to stop treatment immediately. Instead, they should see their physician to discuss safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies such as the Medicines and Healthcare products Regulatory Agency in the United Kingdom and the European Medicines Agency have already banned propoxyphene.

The FDA’s original approval of propoxyphene in 1957 was based on older safety standards and did not include "the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today," Dr. Jenkins said.

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market due to an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care professionals were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

"The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart’s electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling," said Dr. John Jenkins, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. "What is unique here is the new heart data shows that adverse effects occur in regular doses in normal volunteers and not just in overdose."

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart’s electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency’s assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

"Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case."

At the request of the agency, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

As of 2009, an estimated 10 million people were taking some form of propoxyphene – most commonly in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA’s Office of Surveillance and Epidemiology at CDER. Patients currently taking the drug are advised not to stop treatment immediately. Instead, they should see their physician to discuss safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies such as the Medicines and Healthcare products Regulatory Agency in the United Kingdom and the European Medicines Agency have already banned propoxyphene.

The FDA’s original approval of propoxyphene in 1957 was based on older safety standards and did not include "the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today," Dr. Jenkins said.

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market due to an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care professionals were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

"The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart’s electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling," said Dr. John Jenkins, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. "What is unique here is the new heart data shows that adverse effects occur in regular doses in normal volunteers and not just in overdose."

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart’s electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency’s assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

"Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case."

At the request of the agency, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

As of 2009, an estimated 10 million people were taking some form of propoxyphene – most commonly in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA’s Office of Surveillance and Epidemiology at CDER. Patients currently taking the drug are advised not to stop treatment immediately. Instead, they should see their physician to discuss safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies such as the Medicines and Healthcare products Regulatory Agency in the United Kingdom and the European Medicines Agency have already banned propoxyphene.

The FDA’s original approval of propoxyphene in 1957 was based on older safety standards and did not include "the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today," Dr. Jenkins said.

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market due to an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care professionals were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

"The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart’s electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling," said Dr. John Jenkins, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. "What is unique here is the new heart data shows that adverse effects occur in regular doses in normal volunteers and not just in overdose."

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart’s electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency’s assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

"Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case."

At the request of the agency, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

As of 2009, an estimated 10 million people were taking some form of propoxyphene – most commonly in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA’s Office of Surveillance and Epidemiology at CDER. Patients currently taking the drug are advised not to stop treatment immediately. Instead, they should see their physician to discuss safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies such as the Medicines and Healthcare products Regulatory Agency in the United Kingdom and the European Medicines Agency have already banned propoxyphene.

The FDA’s original approval of propoxyphene in 1957 was based on older safety standards and did not include "the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today," Dr. Jenkins said.

Propoxyphene, a widely used treatment for mild to moderate pain, has been removed from the U.S. market due to an increased risk of serious fatal heart rhythm abnormalities in people taking the drug, Food and Drug Administration officials said Nov. 19.

During a teleconference, health care professionals were advised to stop prescribing the drugs known by the brand names Darvon and Darvocet immediately.

"The trial showed that propoxyphene significantly increased the QT interval, which is one measure of the heart’s electrical activity. This effect was seen in normal volunteers at propoxyphene doses at or slightly above the maximum recommended doses in the approved labeling," said Dr. John Jenkins, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research (CDER).

Dr. Jenkins said that an increase in the QT interval of the magnitude seen with propoxyphene is known to increase the risk that patients may suffer potentially serious or even fatal heart rhythm abnormalities. "What is unique here is the new heart data shows that adverse effects occur in regular doses in normal volunteers and not just in overdose."

The new data from the clinical trial also showed that propoxyphene increased the duration of two other measures of the heart’s electrical activity – the PR interval and the QRS complex. Increases in these measures also are known to lead to abnormalities in heart rhythm, Dr. Jenkins said.

Since 1978, two citizen petitions have asked the agency to either ban the drug or reschedule it from Schedule IV to Schedule II. The agency did not act on the petitions until July 2009, when it required the manufacturer of Darvon and Darvocet, Xanodyne Pharmaceuticals Inc., to conduct a new safety study of the drug in healthy volunteers.

The new data altered the agency’s assessment of the risk-benefit profile of the drug by showing that the heart risk of propoxyphene could apply to all users and not just those who took excessive doses or those with medical conditions that might reduce their ability to clear propoxyphene from the body, Dr. Jenkins said.

"Since it is not possible to accurately predict what patients might be at risk or to monitor patients while on the drug for signs of an increased risk, we concluded that a risk evaluation and mitigation strategy or REMS would not be appropriate in this case."

At the request of the agency, Xanodyne voluntarily removed its drugs from store shelves Nov. 18. The FDA has requested that manufacturers of the approved generic versions of propoxyphene do the same.

As of 2009, an estimated 10 million people were taking some form of propoxyphene – most commonly in a formulation that also contains acetaminophen (such as Darvocet), said Dr. Gerald Dal Pan, director of the FDA’s Office of Surveillance and Epidemiology at CDER. Patients currently taking the drug are advised not to stop treatment immediately. Instead, they should see their physician to discuss safely switching to another treatment. If propoxyphene is stopped suddenly, Dr. Dal Pan said withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur. Once the drug is cleared from the body, the heart risks go away, so longtime users should not fear that they are more vulnerable to heart arrhythmias, he said.

Internationally, regulatory agencies such as the Medicines and Healthcare products Regulatory Agency in the United Kingdom and the European Medicines Agency have already banned propoxyphene.

The FDA’s original approval of propoxyphene in 1957 was based on older safety standards and did not include "the careful assessment of the possible effects on the electroactivity of the heart that is required for all new drugs today," Dr. Jenkins said.

Lung cancer is the second leading cancer diagnosis and the leading cause of cancer deaths in the United States, yet new data show black Americans and southerners are diagnosed at an even more alarming rate.

The Centers for Disease and Control reported in its weekly Morbidity and Mortality Weekly Report, dated Nov. 12, that annual incidence of lung cancer among blacks is 76.1 per 100,000, which is higher than the national incidence of 69.3 per 100,000. Whites were the second leading group with an incidence of 69.7 per 100,000, followed by American Indian/Alaska Natives (48.4). Hispanics fared better than did non-Hispanics, however, with an incidence of 37.3 per 100,000 vs. 71.9 among non-Hispanics.

In the South, the incidence of lung cancer was 76.0 per 100,000, also surpassing national numbers. Not only did white southerners have the highest incidence of lung cancer in the South (76.3), but among all whites in the United States as well (67.7).

According to the CDC, geographic location played a role in lung cancer incidence, and the agency noted that this report is the first to analyze lung cancer incidence among racial/ethnic groups by U.S. census region. The highest lung cancer incidences for blacks, Hispanics, and Asian/Pacific Islanders in the entire country were reported in the Midwest. There, blacks had a lung cancer incidence of 88.9 per 100,000, while Midwest Hispanics and Asian/Pacific Islanders had incidences of 40.6 and 64.2, respectively. People living in western states had the lowest lung cancer incidence in the nation with 58.8 per 100,000. Among Asian/Pacific Islanders, the highest lung cancer incidence was in the West with 42.5 per 100,000. All the incidence data reported were statistically significant, the CDC said.

The data came from a number of sources including the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program for the period 1998-2006. These combined data reflected new lung cancer cases "representing approximately 80% of the U.S. population," the report said.

The analysis included only cancer cases with the primary site of lung or bronchus, according to the World Health Organization’s International Classification of Diseases for Oncology, Third Edition.

Gender and age also were factors in incidence rates. Lung cancer incidence was higher in men than in women (88.2 vs. 55.4). Among persons aged 70-79 years, the incidence of lung cancer "peaked" at 426.7 per 100,000 and gradually declined with younger age. A similar age pattern persisted within racial and ethnic categories, the CDC said. In the 70-79 age group, a flip occurred – whites surpassed blacks with an incidence of 432.9 per 100,000, compared with blacks in the same age group (422.7). In every other younger age group, blacks had a higher lung cancer incidence.

"Racial/ethnic disparities in lung cancer incidence are associated with multiple factors, including differences in smoking prevalence, metabolism of tobacco smoke products, susceptibility to tobacco-induced lung cancer, and socioeconomic status. Blacks are more susceptible to smoking-induced lung cancer and have less access to health care services compared with whites. These factors might contribute to the higher lung cancer incidence in the black population," the report said.

The CDC noted that lung cancer also is caused by environmental exposures. "Radon, for example, is a naturally occurring, colorless, odorless gas that can become trapped in buildings; it is the second leading cause of lung cancer overall, and the leading cause of lung cancer in nonsmokers."

Four limitations were included in the report:

United States Cancer Statistics data only included 80% of the entire U.S. population and "might not accurately represent the whole U.S. population." Also, the national estimates of lung cancer incidence might be underreported because "many of the states that did not meet data-quality standards are in the South, the region with the highest smoking prevalence," the CDC said.

Information about smoking status is not available in the cancer registry data.

Racial/ethnic data in registries generally are of varying quality for American Indians/Alaska Natives and Hispanics.

The distribution of lung cancer histologic types was not considered in this analysis. "Although racial differences in histology have been shown in previous studies, unpublished analyses by CDC show little variation in lung cancer histology by region or race/ethnicity," the CDC said.

"Antismoking initiatives and efforts to reduce exposure to environmental carcinogens (e.g., radon and secondhand smoke) should be implemented to reduce the toll of lung cancer among all populations, especially targeting those at risk," the CDC concluded.

Lung cancer is the second leading cancer diagnosis and the leading cause of cancer deaths in the United States, yet new data show black Americans and southerners are diagnosed at an even more alarming rate.

The Centers for Disease and Control reported in its weekly Morbidity and Mortality Weekly Report, dated Nov. 12, that annual incidence of lung cancer among blacks is 76.1 per 100,000, which is higher than the national incidence of 69.3 per 100,000. Whites were the second leading group with an incidence of 69.7 per 100,000, followed by American Indian/Alaska Natives (48.4). Hispanics fared better than did non-Hispanics, however, with an incidence of 37.3 per 100,000 vs. 71.9 among non-Hispanics.

In the South, the incidence of lung cancer was 76.0 per 100,000, also surpassing national numbers. Not only did white southerners have the highest incidence of lung cancer in the South (76.3), but among all whites in the United States as well (67.7).

According to the CDC, geographic location played a role in lung cancer incidence, and the agency noted that this report is the first to analyze lung cancer incidence among racial/ethnic groups by U.S. census region. The highest lung cancer incidences for blacks, Hispanics, and Asian/Pacific Islanders in the entire country were reported in the Midwest. There, blacks had a lung cancer incidence of 88.9 per 100,000, while Midwest Hispanics and Asian/Pacific Islanders had incidences of 40.6 and 64.2, respectively. People living in western states had the lowest lung cancer incidence in the nation with 58.8 per 100,000. Among Asian/Pacific Islanders, the highest lung cancer incidence was in the West with 42.5 per 100,000. All the incidence data reported were statistically significant, the CDC said.

The data came from a number of sources including the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program for the period 1998-2006. These combined data reflected new lung cancer cases "representing approximately 80% of the U.S. population," the report said.

The analysis included only cancer cases with the primary site of lung or bronchus, according to the World Health Organization’s International Classification of Diseases for Oncology, Third Edition.

Gender and age also were factors in incidence rates. Lung cancer incidence was higher in men than in women (88.2 vs. 55.4). Among persons aged 70-79 years, the incidence of lung cancer "peaked" at 426.7 per 100,000 and gradually declined with younger age. A similar age pattern persisted within racial and ethnic categories, the CDC said. In the 70-79 age group, a flip occurred – whites surpassed blacks with an incidence of 432.9 per 100,000, compared with blacks in the same age group (422.7). In every other younger age group, blacks had a higher lung cancer incidence.

"Racial/ethnic disparities in lung cancer incidence are associated with multiple factors, including differences in smoking prevalence, metabolism of tobacco smoke products, susceptibility to tobacco-induced lung cancer, and socioeconomic status. Blacks are more susceptible to smoking-induced lung cancer and have less access to health care services compared with whites. These factors might contribute to the higher lung cancer incidence in the black population," the report said.

The CDC noted that lung cancer also is caused by environmental exposures. "Radon, for example, is a naturally occurring, colorless, odorless gas that can become trapped in buildings; it is the second leading cause of lung cancer overall, and the leading cause of lung cancer in nonsmokers."

Four limitations were included in the report:

United States Cancer Statistics data only included 80% of the entire U.S. population and "might not accurately represent the whole U.S. population." Also, the national estimates of lung cancer incidence might be underreported because "many of the states that did not meet data-quality standards are in the South, the region with the highest smoking prevalence," the CDC said.

Information about smoking status is not available in the cancer registry data.

Racial/ethnic data in registries generally are of varying quality for American Indians/Alaska Natives and Hispanics.

The distribution of lung cancer histologic types was not considered in this analysis. "Although racial differences in histology have been shown in previous studies, unpublished analyses by CDC show little variation in lung cancer histology by region or race/ethnicity," the CDC said.

"Antismoking initiatives and efforts to reduce exposure to environmental carcinogens (e.g., radon and secondhand smoke) should be implemented to reduce the toll of lung cancer among all populations, especially targeting those at risk," the CDC concluded.

Lung cancer is the second leading cancer diagnosis and the leading cause of cancer deaths in the United States, yet new data show black Americans and southerners are diagnosed at an even more alarming rate.

The Centers for Disease and Control reported in its weekly Morbidity and Mortality Weekly Report, dated Nov. 12, that annual incidence of lung cancer among blacks is 76.1 per 100,000, which is higher than the national incidence of 69.3 per 100,000. Whites were the second leading group with an incidence of 69.7 per 100,000, followed by American Indian/Alaska Natives (48.4). Hispanics fared better than did non-Hispanics, however, with an incidence of 37.3 per 100,000 vs. 71.9 among non-Hispanics.

In the South, the incidence of lung cancer was 76.0 per 100,000, also surpassing national numbers. Not only did white southerners have the highest incidence of lung cancer in the South (76.3), but among all whites in the United States as well (67.7).

According to the CDC, geographic location played a role in lung cancer incidence, and the agency noted that this report is the first to analyze lung cancer incidence among racial/ethnic groups by U.S. census region. The highest lung cancer incidences for blacks, Hispanics, and Asian/Pacific Islanders in the entire country were reported in the Midwest. There, blacks had a lung cancer incidence of 88.9 per 100,000, while Midwest Hispanics and Asian/Pacific Islanders had incidences of 40.6 and 64.2, respectively. People living in western states had the lowest lung cancer incidence in the nation with 58.8 per 100,000. Among Asian/Pacific Islanders, the highest lung cancer incidence was in the West with 42.5 per 100,000. All the incidence data reported were statistically significant, the CDC said.

The data came from a number of sources including the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program for the period 1998-2006. These combined data reflected new lung cancer cases "representing approximately 80% of the U.S. population," the report said.

The analysis included only cancer cases with the primary site of lung or bronchus, according to the World Health Organization’s International Classification of Diseases for Oncology, Third Edition.

Gender and age also were factors in incidence rates. Lung cancer incidence was higher in men than in women (88.2 vs. 55.4). Among persons aged 70-79 years, the incidence of lung cancer "peaked" at 426.7 per 100,000 and gradually declined with younger age. A similar age pattern persisted within racial and ethnic categories, the CDC said. In the 70-79 age group, a flip occurred – whites surpassed blacks with an incidence of 432.9 per 100,000, compared with blacks in the same age group (422.7). In every other younger age group, blacks had a higher lung cancer incidence.

"Racial/ethnic disparities in lung cancer incidence are associated with multiple factors, including differences in smoking prevalence, metabolism of tobacco smoke products, susceptibility to tobacco-induced lung cancer, and socioeconomic status. Blacks are more susceptible to smoking-induced lung cancer and have less access to health care services compared with whites. These factors might contribute to the higher lung cancer incidence in the black population," the report said.

The CDC noted that lung cancer also is caused by environmental exposures. "Radon, for example, is a naturally occurring, colorless, odorless gas that can become trapped in buildings; it is the second leading cause of lung cancer overall, and the leading cause of lung cancer in nonsmokers."

Four limitations were included in the report:

United States Cancer Statistics data only included 80% of the entire U.S. population and "might not accurately represent the whole U.S. population." Also, the national estimates of lung cancer incidence might be underreported because "many of the states that did not meet data-quality standards are in the South, the region with the highest smoking prevalence," the CDC said.

Information about smoking status is not available in the cancer registry data.

Racial/ethnic data in registries generally are of varying quality for American Indians/Alaska Natives and Hispanics.

The distribution of lung cancer histologic types was not considered in this analysis. "Although racial differences in histology have been shown in previous studies, unpublished analyses by CDC show little variation in lung cancer histology by region or race/ethnicity," the CDC said.

"Antismoking initiatives and efforts to reduce exposure to environmental carcinogens (e.g., radon and secondhand smoke) should be implemented to reduce the toll of lung cancer among all populations, especially targeting those at risk," the CDC concluded.

Older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – but vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same, according to a report by the Centers for Disease Control and Prevention.

According to the CDC's Morbidity and Mortality Weekly Report, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010.

The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years no later than the 2009-2010 season were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – from 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-2009 season to 55.7% in 2009-2010.

Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13 through Sept. 25, 2010), with the majority of it seasonal influenza.

Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.”

The last CDC update on influenza activity was July 30, 2010.

Seasonal influenza vaccination rates among children aged 6 months to 18 years improved overall in 2009-2010.

Source ©Jaimie Duplass/Fotolia.com

Older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – but vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same, according to a report by the Centers for Disease Control and Prevention.

According to the CDC's Morbidity and Mortality Weekly Report, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010.

The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years no later than the 2009-2010 season were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – from 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-2009 season to 55.7% in 2009-2010.

Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13 through Sept. 25, 2010), with the majority of it seasonal influenza.

Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.”

The last CDC update on influenza activity was July 30, 2010.

Seasonal influenza vaccination rates among children aged 6 months to 18 years improved overall in 2009-2010.

Source ©Jaimie Duplass/Fotolia.com

Older children are getting seasonal influenza vaccinations in greater numbers compared with the previous flu season – mostly due to H1N1 concerns – but vaccination coverage rates for the youngest, most vulnerable age group – infants – have remained the same, according to a report by the Centers for Disease Control and Prevention.

According to the CDC's Morbidity and Mortality Weekly Report, seasonal flu vaccination rates among children across all age groups (6 months to 18 years) improved overall in 2009-2010.

The average vaccination coverage with one or more seasonal influenza doses increased to 26.3%, compared with 20.8% of all children for the 2008-2009 season. The researchers also determined that full vaccination coverage was low during the 2009-2010 season, ranging from 34.7% among children aged 6-23 months to 15.3% among children aged 13-18 years (MMWR 2010;59:1266-9).

These data are also helping the agency find out if efforts by the CDC Advisory Committee on Immunization Practices (ACIP) to expand its seasonal influenza vaccination recommendations to include all children aged 5-18 years no later than the 2009-2010 season were fruitful.

The researchers used state data from the National H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System (BRFSS) and from eight sentinel geographic regions (subsets of Arizona, Colorado, Michigan, Minnesota, Oregon, and Wisconsin; the entire state of North Dakota; and all of New York City). Vaccination with the influenza A(H1N1) 2009 monovalent vaccine was not included in this report, the researchers wrote.

Children aged 5-12 years showed the largest increase in vaccination coverage – from 19.0% to 27.1% over the last two flu seasons – while coverage among children 6-23 months only increased from 55.2% in the 2008-2009 season to 55.7% in 2009-2010.

Seasonal flu vaccination coverage among children aged 2-4 years and 13-18 years increased at similar rates: 38.4% (from 33.0% in 2008-2009) and 15.3% (from 10.9%), respectively.

“The increase in coverage from the 2008-09 season to the 2009-10 season among older children and adolescents could reflect the usually observed increase in vaccination coverage with newly recommended vaccines, increased awareness of influenza vaccination because of the 2009 H1N1 pandemic, or other reasons,” the report said.

“These findings highlight the need to identify varied strategies and venues for delivering influenza vaccine to different age groups of children to increase vaccination coverage,” the researchers added.

The CDC recommended new strategies and continued implementation of proven existing strategies that may include “vaccinating later in the season (January-March), standing orders, reminder/recall notifications, parental education about vaccination, and use of school-located vaccination programs.”

In other influenza news announced in the same weekly report (MMWR 2010;59:1270-3), the CDC said that, for this time of year, low levels of influenza activity are currently being reported in the United States (July 13 through Sept. 25, 2010), with the majority of it seasonal influenza.

Meanwhile, there has been typical seasonal influenza activity in the southern hemisphere, as well as influenza activity in tropical areas, “with a mix of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B viruses cocirculating.”

The last CDC update on influenza activity was July 30, 2010.

Seasonal influenza vaccination rates among children aged 6 months to 18 years improved overall in 2009-2010.

Source ©Jaimie Duplass/Fotolia.com

WASHINGTON – Like the United States and other countries around the world, Iraq suffers from a shortage of psychiatrists. But in Iraq, the situation is particularly dire: The country has only about 100 psychiatrists to serve a population of 30 million people, experts say.

That sobering statistic compelled psychiatrists such as Dr. Rebwar Ghareeb Hama of the General Hospital of Sulaimani, Kurdistan, to participate in the Iraq-SAMHSA Partnership on Behavioral Health program. The Substance Abuse and Mental Health Services Administration and the Iraqi government were part of the initiative developed in 2004 to help Iraq reestablish its behavioral health service system.

“We are only a few psychiatrists serving about 2 million people inside Sulaimani,” said Dr. Hama, who was part of the team focused on integrating trauma services into primary health care centers. “We have no clinical psychologists, no clinical social workers, so with these short limits, we want to teach or to train nonexperts inside the health centers like general practitioners [and] nurses to identify those people inside the community … and when they find difficulties in managing them, refer them to our centers inside the psychiatry department in the general hospital.”

After 6 weeks of observing how various mental health care services are provided in the United States, Dr. Hama and 23 other psychiatrists from Iraq were headed home, armed with new strategies and ready to implement local programs they have designed with the help of their American colleagues.

This group is the second set of psychiatrists and other health professionals from Iraq selected to participate in the program. Their time of intensive training and conferences culminated in a closing session Oct. 21 at the Iraqi Cultural Center, where they presented action plans for their war-weary population, ranging from the implementation of an Iraqi Mental Health Act, to ramping up efforts to improve substance-abuse treatment programs for adults and posttraumatic stress disorder treatment (PTSD) programs for children. The first group participated in the program in 2008.

In the plan developed by Dr. Hama's team (which included three other doctors from Kurdistan), they want to create small, multidisciplinary teams of three people – a general practitioner, a nurse, and “medical staff” – and teach them how to identify patients with PTSD. These teams will be trained in 12 health centers in Sulaimani, he said.

Dr. Hama added that his team wants to train both religious leaders because of their influence in the community and teachers, who will often be the first to notice children suffering from PTSD or other problems. “The people will listen to them. Training those teachers will be very helpful to share all of these programs with a huge number of the population.”

In addition to Dr. Hama's team, the other five concentrated on school-based mental health services; forensic, trauma, and substance abuse treatment services; and services for mothers and children with chronic psychiatric disabilities. The projects represented areas across Iraq that included Maysan, Baghdad, Baqubah, Mosul, and Kurdistan.

Each group had a specific area of interest and visited host sites, which included the Johns Hopkins University, Baltimore; the Maryland Department of Health and Mental Hygiene; the National Center on Trauma-Informed Care, Alexandria, Va.; Children's National Medical Center, Washington; INOVA Fairfax (Va.) Comprehensive Addictions Treatment Services; and University of California, Los Angeles, Integrated Substance Abuse Program.

Planning group leaders Dr. Allen R. Dyer, chair of the department of psychiatry at East Tennessee State University, Johnson City, and Dr. Anita S. Everett were each assigned to work with one of the groups. They both felt that the program was more about sharing ideas than forcing the American way of practicing medicine onto the Iraqis.

“We don't feel like we've been exactly teaching them how to do certain things based on the way we do, but rather, exposing them to the way we do things here so they can take that back,” said Dr. Everett of the department of community and general psychiatry at Johns Hopkins.

Dr. Everett, who was a planning group leader for the forensic services team, explained that she was able to share insight on such issues as patient confidentiality, documentation, and medical records, as well as on performance improvement projects and child-abuse reporting. “There's a whole variety of things you can't really teach about so much as have an immersion experience,” she said.

As a planning group leader, Dr. Dyer, also of the International Medical Corps, said his aim was to help the psychiatrists from Iraq “develop the skills they need to move forward.” For his part, Dr. Hama remains optimistic – despite the difficulties he is sure to face when he returns home. “We must try our best, working hard to serve our people,” he said. “They are our people, and they are suffering. We must help them.”

'The people will listen to [teachers and religious leaders]. Training those teachers will be very helpful.'

Source DR. HAMA

Several Iraqi mental health professionals spent 6 weeks visiting facilities in the United States.

Source Lorinda Bullock/Elsevier Global Medical News

WASHINGTON – Like the United States and other countries around the world, Iraq suffers from a shortage of psychiatrists. But in Iraq, the situation is particularly dire: The country has only about 100 psychiatrists to serve a population of 30 million people, experts say.

That sobering statistic compelled psychiatrists such as Dr. Rebwar Ghareeb Hama of the General Hospital of Sulaimani, Kurdistan, to participate in the Iraq-SAMHSA Partnership on Behavioral Health program. The Substance Abuse and Mental Health Services Administration and the Iraqi government were part of the initiative developed in 2004 to help Iraq reestablish its behavioral health service system.

“We are only a few psychiatrists serving about 2 million people inside Sulaimani,” said Dr. Hama, who was part of the team focused on integrating trauma services into primary health care centers. “We have no clinical psychologists, no clinical social workers, so with these short limits, we want to teach or to train nonexperts inside the health centers like general practitioners [and] nurses to identify those people inside the community … and when they find difficulties in managing them, refer them to our centers inside the psychiatry department in the general hospital.”

After 6 weeks of observing how various mental health care services are provided in the United States, Dr. Hama and 23 other psychiatrists from Iraq were headed home, armed with new strategies and ready to implement local programs they have designed with the help of their American colleagues.

This group is the second set of psychiatrists and other health professionals from Iraq selected to participate in the program. Their time of intensive training and conferences culminated in a closing session Oct. 21 at the Iraqi Cultural Center, where they presented action plans for their war-weary population, ranging from the implementation of an Iraqi Mental Health Act, to ramping up efforts to improve substance-abuse treatment programs for adults and posttraumatic stress disorder treatment (PTSD) programs for children. The first group participated in the program in 2008.

In the plan developed by Dr. Hama's team (which included three other doctors from Kurdistan), they want to create small, multidisciplinary teams of three people – a general practitioner, a nurse, and “medical staff” – and teach them how to identify patients with PTSD. These teams will be trained in 12 health centers in Sulaimani, he said.

Dr. Hama added that his team wants to train both religious leaders because of their influence in the community and teachers, who will often be the first to notice children suffering from PTSD or other problems. “The people will listen to them. Training those teachers will be very helpful to share all of these programs with a huge number of the population.”

In addition to Dr. Hama's team, the other five concentrated on school-based mental health services; forensic, trauma, and substance abuse treatment services; and services for mothers and children with chronic psychiatric disabilities. The projects represented areas across Iraq that included Maysan, Baghdad, Baqubah, Mosul, and Kurdistan.

Each group had a specific area of interest and visited host sites, which included the Johns Hopkins University, Baltimore; the Maryland Department of Health and Mental Hygiene; the National Center on Trauma-Informed Care, Alexandria, Va.; Children's National Medical Center, Washington; INOVA Fairfax (Va.) Comprehensive Addictions Treatment Services; and University of California, Los Angeles, Integrated Substance Abuse Program.

Planning group leaders Dr. Allen R. Dyer, chair of the department of psychiatry at East Tennessee State University, Johnson City, and Dr. Anita S. Everett were each assigned to work with one of the groups. They both felt that the program was more about sharing ideas than forcing the American way of practicing medicine onto the Iraqis.

“We don't feel like we've been exactly teaching them how to do certain things based on the way we do, but rather, exposing them to the way we do things here so they can take that back,” said Dr. Everett of the department of community and general psychiatry at Johns Hopkins.

Dr. Everett, who was a planning group leader for the forensic services team, explained that she was able to share insight on such issues as patient confidentiality, documentation, and medical records, as well as on performance improvement projects and child-abuse reporting. “There's a whole variety of things you can't really teach about so much as have an immersion experience,” she said.

As a planning group leader, Dr. Dyer, also of the International Medical Corps, said his aim was to help the psychiatrists from Iraq “develop the skills they need to move forward.” For his part, Dr. Hama remains optimistic – despite the difficulties he is sure to face when he returns home. “We must try our best, working hard to serve our people,” he said. “They are our people, and they are suffering. We must help them.”

'The people will listen to [teachers and religious leaders]. Training those teachers will be very helpful.'

Source DR. HAMA

Several Iraqi mental health professionals spent 6 weeks visiting facilities in the United States.

Source Lorinda Bullock/Elsevier Global Medical News

WASHINGTON – Like the United States and other countries around the world, Iraq suffers from a shortage of psychiatrists. But in Iraq, the situation is particularly dire: The country has only about 100 psychiatrists to serve a population of 30 million people, experts say.

That sobering statistic compelled psychiatrists such as Dr. Rebwar Ghareeb Hama of the General Hospital of Sulaimani, Kurdistan, to participate in the Iraq-SAMHSA Partnership on Behavioral Health program. The Substance Abuse and Mental Health Services Administration and the Iraqi government were part of the initiative developed in 2004 to help Iraq reestablish its behavioral health service system.

“We are only a few psychiatrists serving about 2 million people inside Sulaimani,” said Dr. Hama, who was part of the team focused on integrating trauma services into primary health care centers. “We have no clinical psychologists, no clinical social workers, so with these short limits, we want to teach or to train nonexperts inside the health centers like general practitioners [and] nurses to identify those people inside the community … and when they find difficulties in managing them, refer them to our centers inside the psychiatry department in the general hospital.”

After 6 weeks of observing how various mental health care services are provided in the United States, Dr. Hama and 23 other psychiatrists from Iraq were headed home, armed with new strategies and ready to implement local programs they have designed with the help of their American colleagues.

This group is the second set of psychiatrists and other health professionals from Iraq selected to participate in the program. Their time of intensive training and conferences culminated in a closing session Oct. 21 at the Iraqi Cultural Center, where they presented action plans for their war-weary population, ranging from the implementation of an Iraqi Mental Health Act, to ramping up efforts to improve substance-abuse treatment programs for adults and posttraumatic stress disorder treatment (PTSD) programs for children. The first group participated in the program in 2008.

In the plan developed by Dr. Hama's team (which included three other doctors from Kurdistan), they want to create small, multidisciplinary teams of three people – a general practitioner, a nurse, and “medical staff” – and teach them how to identify patients with PTSD. These teams will be trained in 12 health centers in Sulaimani, he said.

Dr. Hama added that his team wants to train both religious leaders because of their influence in the community and teachers, who will often be the first to notice children suffering from PTSD or other problems. “The people will listen to them. Training those teachers will be very helpful to share all of these programs with a huge number of the population.”

In addition to Dr. Hama's team, the other five concentrated on school-based mental health services; forensic, trauma, and substance abuse treatment services; and services for mothers and children with chronic psychiatric disabilities. The projects represented areas across Iraq that included Maysan, Baghdad, Baqubah, Mosul, and Kurdistan.

Each group had a specific area of interest and visited host sites, which included the Johns Hopkins University, Baltimore; the Maryland Department of Health and Mental Hygiene; the National Center on Trauma-Informed Care, Alexandria, Va.; Children's National Medical Center, Washington; INOVA Fairfax (Va.) Comprehensive Addictions Treatment Services; and University of California, Los Angeles, Integrated Substance Abuse Program.

Planning group leaders Dr. Allen R. Dyer, chair of the department of psychiatry at East Tennessee State University, Johnson City, and Dr. Anita S. Everett were each assigned to work with one of the groups. They both felt that the program was more about sharing ideas than forcing the American way of practicing medicine onto the Iraqis.

“We don't feel like we've been exactly teaching them how to do certain things based on the way we do, but rather, exposing them to the way we do things here so they can take that back,” said Dr. Everett of the department of community and general psychiatry at Johns Hopkins.

Dr. Everett, who was a planning group leader for the forensic services team, explained that she was able to share insight on such issues as patient confidentiality, documentation, and medical records, as well as on performance improvement projects and child-abuse reporting. “There's a whole variety of things you can't really teach about so much as have an immersion experience,” she said.

As a planning group leader, Dr. Dyer, also of the International Medical Corps, said his aim was to help the psychiatrists from Iraq “develop the skills they need to move forward.” For his part, Dr. Hama remains optimistic – despite the difficulties he is sure to face when he returns home. “We must try our best, working hard to serve our people,” he said. “They are our people, and they are suffering. We must help them.”

'The people will listen to [teachers and religious leaders]. Training those teachers will be very helpful.'

Source DR. HAMA

Several Iraqi mental health professionals spent 6 weeks visiting facilities in the United States.

Source Lorinda Bullock/Elsevier Global Medical News

WASHINGTON – Like the United States and other countries around the world, Iraq suffers from a shortage of psychiatrists. But in Iraq, the situation is particularly dire: The country has only about 100 psychiatrists to serve a population of 30 million people, experts say.

That sobering statistic compelled psychiatrists such as Dr. Rebwar Ghareeb Hama of the General Hospital of Sulaimani, Kurdistan, to participate in the Iraq-SAMHSA Partnership on Behavioral Health program. The Substance Abuse and Mental Health Services Administration and the Iraqi government were part of the initiative developed in 2004 to help Iraq reestablish its behavioral health service system.

“We are only a few psychiatrists serving about 2 million people inside Sulaimani,” said Dr. Hama, who was part of the team focused on integrating trauma services into primary health care centers. “We have no clinical psychologists, no clinical social workers, so with these short limits, we want to teach or to train nonexperts inside the health centers like general practitioners [and] nurses to identify those people inside the community ... and when they find difficulties in managing them, refer them to our centers inside the psychiatry department in the general hospital.”

After 6 weeks of observing how various mental health care services are provided in the United States, Dr. Hama and 23 other psychiatrists from Iraq were headed home, armed with new strategies and ready to implement local programs they have designed with the help of their American colleagues.

This group is the second set of psychiatrists and other health professionals from Iraq selected to participate in the program. Their time of intensive training and conferences culminated in a closing session Oct. 21 at the Iraqi Cultural Center, where they presented action plans for their war-weary population, ranging from the implementation of an Iraqi Mental Health Act, to ramping up efforts to improve substance-abuse treatment programs for adults and posttraumatic stress disorder treatment (PTSD) programs for children. The first group participated in the program in 2008.

In the plan developed by Dr. Hama’s team (which included three other doctors from Kurdistan), they want to create small, multidisciplinary teams of three people – a general practitioner, a nurse, and “medical staff” – and teach them how to identify patients with PTSD. These teams will be trained in 12 health centers in Sulaimani, he said.

Dr. Hama added that his team wants to train both religious leaders because of their influence in the community and teachers, who will often be the first to notice children suffering from PTSD or other problems. “The people will listen to them. Training those teachers will be very helpful to share all of these programs with a huge number of the population.”

In addition to Dr. Hama’s team, the other five concentrated on school-based mental health services, forensic, trauma, and substance abuse treatment services, services for mothers and children with chronic psychiatric disabilities. The projects represented areas across Iraq that included Maysan, Baghdad, Baqubah, Mosul, and Kurdistan.

Each group had a specific area of interest and visited host sites, which included the Johns Hopkins University, Baltimore; the Maryland Department of Health and Mental Hygiene; the National Center on Trauma-Informed Care, Alexandria, Va.; Children’s National Medical Center, Washington; INOVA Fairfax (Va.) Comprehensive Addictions Treatment Services; and University of California, Los Angeles, Integrated Substance Abuse Program.

Planning group leaders Dr. Allen R. Dyer, chair of the department of psychiatry at East Tennessee State University, Johnson City, and Dr. Anita S. Everett, were each assigned to work with one of the groups. They each felt that the program was more about sharing ideas than about the forcing the American way of practicing medicine onto the Iraqis.

“We don’t feel like we’ve been exactly teaching them how to do certain things based on the way we do, but rather, exposing them to the way we do things here so they can take that back,” said Dr. Everett of the department of community and general psychiatry at Johns Hopkins.

Dr. Everett, who was a planning group leader for the forensic services team, explained that she was able to share insight on such issues as patient confidentiality, documentation, and medical records, as well as on performance improvement projects and child-abuse reporting. “There’s a whole variety of things you can’t really teach about so much as have an immersion experience,” she said.

As a planning group leader, Dr. Dyer, also of the International Medical Corps, said his aim was to help the psychiatrists from Iraq “develop the skills they need to move forward.”

For his part, Dr. Hama remains optimistic – despite the difficulties he is sure to face when he returns home.

“We must try our best, working hard to serve our people,” he said. “They are our people, and they are suffering. We must help them.”

WASHINGTON – Like the United States and other countries around the world, Iraq suffers from a shortage of psychiatrists. But in Iraq, the situation is particularly dire: The country has only about 100 psychiatrists to serve a population of 30 million people, experts say.

That sobering statistic compelled psychiatrists such as Dr. Rebwar Ghareeb Hama of the General Hospital of Sulaimani, Kurdistan, to participate in the Iraq-SAMHSA Partnership on Behavioral Health program. The Substance Abuse and Mental Health Services Administration and the Iraqi government were part of the initiative developed in 2004 to help Iraq reestablish its behavioral health service system.

“We are only a few psychiatrists serving about 2 million people inside Sulaimani,” said Dr. Hama, who was part of the team focused on integrating trauma services into primary health care centers. “We have no clinical psychologists, no clinical social workers, so with these short limits, we want to teach or to train nonexperts inside the health centers like general practitioners [and] nurses to identify those people inside the community ... and when they find difficulties in managing them, refer them to our centers inside the psychiatry department in the general hospital.”

After 6 weeks of observing how various mental health care services are provided in the United States, Dr. Hama and 23 other psychiatrists from Iraq were headed home, armed with new strategies and ready to implement local programs they have designed with the help of their American colleagues.

This group is the second set of psychiatrists and other health professionals from Iraq selected to participate in the program. Their time of intensive training and conferences culminated in a closing session Oct. 21 at the Iraqi Cultural Center, where they presented action plans for their war-weary population, ranging from the implementation of an Iraqi Mental Health Act, to ramping up efforts to improve substance-abuse treatment programs for adults and posttraumatic stress disorder treatment (PTSD) programs for children. The first group participated in the program in 2008.

In the plan developed by Dr. Hama’s team (which included three other doctors from Kurdistan), they want to create small, multidisciplinary teams of three people – a general practitioner, a nurse, and “medical staff” – and teach them how to identify patients with PTSD. These teams will be trained in 12 health centers in Sulaimani, he said.

Dr. Hama added that his team wants to train both religious leaders because of their influence in the community and teachers, who will often be the first to notice children suffering from PTSD or other problems. “The people will listen to them. Training those teachers will be very helpful to share all of these programs with a huge number of the population.”

In addition to Dr. Hama’s team, the other five concentrated on school-based mental health services, forensic, trauma, and substance abuse treatment services, services for mothers and children with chronic psychiatric disabilities. The projects represented areas across Iraq that included Maysan, Baghdad, Baqubah, Mosul, and Kurdistan.

Each group had a specific area of interest and visited host sites, which included the Johns Hopkins University, Baltimore; the Maryland Department of Health and Mental Hygiene; the National Center on Trauma-Informed Care, Alexandria, Va.; Children’s National Medical Center, Washington; INOVA Fairfax (Va.) Comprehensive Addictions Treatment Services; and University of California, Los Angeles, Integrated Substance Abuse Program.

Planning group leaders Dr. Allen R. Dyer, chair of the department of psychiatry at East Tennessee State University, Johnson City, and Dr. Anita S. Everett, were each assigned to work with one of the groups. They each felt that the program was more about sharing ideas than about the forcing the American way of practicing medicine onto the Iraqis.

“We don’t feel like we’ve been exactly teaching them how to do certain things based on the way we do, but rather, exposing them to the way we do things here so they can take that back,” said Dr. Everett of the department of community and general psychiatry at Johns Hopkins.

Dr. Everett, who was a planning group leader for the forensic services team, explained that she was able to share insight on such issues as patient confidentiality, documentation, and medical records, as well as on performance improvement projects and child-abuse reporting. “There’s a whole variety of things you can’t really teach about so much as have an immersion experience,” she said.

As a planning group leader, Dr. Dyer, also of the International Medical Corps, said his aim was to help the psychiatrists from Iraq “develop the skills they need to move forward.”

For his part, Dr. Hama remains optimistic – despite the difficulties he is sure to face when he returns home.

“We must try our best, working hard to serve our people,” he said. “They are our people, and they are suffering. We must help them.”

WASHINGTON – Like the United States and other countries around the world, Iraq suffers from a shortage of psychiatrists. But in Iraq, the situation is particularly dire: The country has only about 100 psychiatrists to serve a population of 30 million people, experts say.

That sobering statistic compelled psychiatrists such as Dr. Rebwar Ghareeb Hama of the General Hospital of Sulaimani, Kurdistan, to participate in the Iraq-SAMHSA Partnership on Behavioral Health program. The Substance Abuse and Mental Health Services Administration and the Iraqi government were part of the initiative developed in 2004 to help Iraq reestablish its behavioral health service system.

“We are only a few psychiatrists serving about 2 million people inside Sulaimani,” said Dr. Hama, who was part of the team focused on integrating trauma services into primary health care centers. “We have no clinical psychologists, no clinical social workers, so with these short limits, we want to teach or to train nonexperts inside the health centers like general practitioners [and] nurses to identify those people inside the community ... and when they find difficulties in managing them, refer them to our centers inside the psychiatry department in the general hospital.”

After 6 weeks of observing how various mental health care services are provided in the United States, Dr. Hama and 23 other psychiatrists from Iraq were headed home, armed with new strategies and ready to implement local programs they have designed with the help of their American colleagues.

This group is the second set of psychiatrists and other health professionals from Iraq selected to participate in the program. Their time of intensive training and conferences culminated in a closing session Oct. 21 at the Iraqi Cultural Center, where they presented action plans for their war-weary population, ranging from the implementation of an Iraqi Mental Health Act, to ramping up efforts to improve substance-abuse treatment programs for adults and posttraumatic stress disorder treatment (PTSD) programs for children. The first group participated in the program in 2008.

In the plan developed by Dr. Hama’s team (which included three other doctors from Kurdistan), they want to create small, multidisciplinary teams of three people – a general practitioner, a nurse, and “medical staff” – and teach them how to identify patients with PTSD. These teams will be trained in 12 health centers in Sulaimani, he said.

Dr. Hama added that his team wants to train both religious leaders because of their influence in the community and teachers, who will often be the first to notice children suffering from PTSD or other problems. “The people will listen to them. Training those teachers will be very helpful to share all of these programs with a huge number of the population.”

In addition to Dr. Hama’s team, the other five concentrated on school-based mental health services, forensic, trauma, and substance abuse treatment services, services for mothers and children with chronic psychiatric disabilities. The projects represented areas across Iraq that included Maysan, Baghdad, Baqubah, Mosul, and Kurdistan.

Each group had a specific area of interest and visited host sites, which included the Johns Hopkins University, Baltimore; the Maryland Department of Health and Mental Hygiene; the National Center on Trauma-Informed Care, Alexandria, Va.; Children’s National Medical Center, Washington; INOVA Fairfax (Va.) Comprehensive Addictions Treatment Services; and University of California, Los Angeles, Integrated Substance Abuse Program.

Planning group leaders Dr. Allen R. Dyer, chair of the department of psychiatry at East Tennessee State University, Johnson City, and Dr. Anita S. Everett, were each assigned to work with one of the groups. They each felt that the program was more about sharing ideas than about the forcing the American way of practicing medicine onto the Iraqis.

“We don’t feel like we’ve been exactly teaching them how to do certain things based on the way we do, but rather, exposing them to the way we do things here so they can take that back,” said Dr. Everett of the department of community and general psychiatry at Johns Hopkins.

Dr. Everett, who was a planning group leader for the forensic services team, explained that she was able to share insight on such issues as patient confidentiality, documentation, and medical records, as well as on performance improvement projects and child-abuse reporting. “There’s a whole variety of things you can’t really teach about so much as have an immersion experience,” she said.

As a planning group leader, Dr. Dyer, also of the International Medical Corps, said his aim was to help the psychiatrists from Iraq “develop the skills they need to move forward.”

For his part, Dr. Hama remains optimistic – despite the difficulties he is sure to face when he returns home.

“We must try our best, working hard to serve our people,” he said. “They are our people, and they are suffering. We must help them.”