Renée Matthews

BETHESDA, MD. – Younger Hispanics born in the United States were more likely to report nonmedical use of prescription drugs than were their foreign-born counterparts, according to findings from a study of more than 2,000 people.

No significant differences in nonmedical prescription-drug use were found between immigrants who had been in the United States for fewer than 5 years and those who had lived there for 5 or more years, suggesting that duration of residency did not change the rates of nonmedical use, noted Yehuda Neumark, Ph.D., who presented the data at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The conference was sponsored by Brown Medical School, Providence, R.I.

Minority groups, including Hispanics, “tend to face greater medical and social adverse consequences of substance use.

“Therefore, understanding the factors that determine the origin and course of substance use disorders within these minority groups is essential for the development of primary and secondary prevention services,” he said.

Dr. Neumark, of Hebrew University-Hadassah Braun School of Public Health, Jerusalem, and his colleagues used data from the 2002–2003 National Latino and Asian American Study of 2,554 noninstitutionalized individuals aged 18 years and older who lived in the United States.

The study gathered information on the prevalence of psychiatric disorders and use of mental health services, but participants also were asked about lifetime and past-year use of prescription drugs with or without a recommendation from a provider.

The lifetime and past-year prevalence of nonmedical use of prescription drugs among Hispanics in the United States was 8.1% and 1.6%, respectively, and both of these prevalences were higher in U.S.-born Hispanics (14.4% and 2.7%) than in immigrant Hispanics (4.3% and 0.9%). Hispanic men were more likely than were women to report nonmedical use of these drugs, as were all individuals aged 18–29 and 30–44 years. Income and region of residence were not associated with use.

After controlling for relevant confounding factors, both groups–U.S.-born and immigrant–were more likely to report nonmedical prescription-drug use if they had been diagnosed with a depressive disorder (adjusted odds ratio, 1.9), chronic pain (AOR, 2.9), or alcohol dependence (AOR, 3.4). The association between nonmedical use and an anxiety disorder diagnosis was not significant (AOR, 1.5).

The researchers said it was important to understand the mechanisms driving the factors that affect the prevalence of nonmedical use of prescription drugs in immigrant and U.S.-born Hispanics to be able to develop and better target preventive and treatment programs.

Among those factors were migration patterns, country of origin, values that reinforce substance use, acculturation gaps, maladaptation, and lack of social capital.

Dr. Neumark noted that this was particularly important given that the Hispanic population in the United States is projected to reach 30% of the American population in 2050 and that this trend is being driven “primarily by a large influx of socially vulnerable” Hispanic immigrants and their U.S.-born children.

None of the researchers reported any financial disclosures.

BETHESDA, MD. – Younger Hispanics born in the United States were more likely to report nonmedical use of prescription drugs than were their foreign-born counterparts, according to findings from a study of more than 2,000 people.

No significant differences in nonmedical prescription-drug use were found between immigrants who had been in the United States for fewer than 5 years and those who had lived there for 5 or more years, suggesting that duration of residency did not change the rates of nonmedical use, noted Yehuda Neumark, Ph.D., who presented the data at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The conference was sponsored by Brown Medical School, Providence, R.I.

Minority groups, including Hispanics, “tend to face greater medical and social adverse consequences of substance use.

“Therefore, understanding the factors that determine the origin and course of substance use disorders within these minority groups is essential for the development of primary and secondary prevention services,” he said.

Dr. Neumark, of Hebrew University-Hadassah Braun School of Public Health, Jerusalem, and his colleagues used data from the 2002–2003 National Latino and Asian American Study of 2,554 noninstitutionalized individuals aged 18 years and older who lived in the United States.

The study gathered information on the prevalence of psychiatric disorders and use of mental health services, but participants also were asked about lifetime and past-year use of prescription drugs with or without a recommendation from a provider.

The lifetime and past-year prevalence of nonmedical use of prescription drugs among Hispanics in the United States was 8.1% and 1.6%, respectively, and both of these prevalences were higher in U.S.-born Hispanics (14.4% and 2.7%) than in immigrant Hispanics (4.3% and 0.9%). Hispanic men were more likely than were women to report nonmedical use of these drugs, as were all individuals aged 18–29 and 30–44 years. Income and region of residence were not associated with use.

After controlling for relevant confounding factors, both groups–U.S.-born and immigrant–were more likely to report nonmedical prescription-drug use if they had been diagnosed with a depressive disorder (adjusted odds ratio, 1.9), chronic pain (AOR, 2.9), or alcohol dependence (AOR, 3.4). The association between nonmedical use and an anxiety disorder diagnosis was not significant (AOR, 1.5).

The researchers said it was important to understand the mechanisms driving the factors that affect the prevalence of nonmedical use of prescription drugs in immigrant and U.S.-born Hispanics to be able to develop and better target preventive and treatment programs.

Among those factors were migration patterns, country of origin, values that reinforce substance use, acculturation gaps, maladaptation, and lack of social capital.

Dr. Neumark noted that this was particularly important given that the Hispanic population in the United States is projected to reach 30% of the American population in 2050 and that this trend is being driven “primarily by a large influx of socially vulnerable” Hispanic immigrants and their U.S.-born children.

None of the researchers reported any financial disclosures.

BETHESDA, MD. – Younger Hispanics born in the United States were more likely to report nonmedical use of prescription drugs than were their foreign-born counterparts, according to findings from a study of more than 2,000 people.

No significant differences in nonmedical prescription-drug use were found between immigrants who had been in the United States for fewer than 5 years and those who had lived there for 5 or more years, suggesting that duration of residency did not change the rates of nonmedical use, noted Yehuda Neumark, Ph.D., who presented the data at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The conference was sponsored by Brown Medical School, Providence, R.I.

Minority groups, including Hispanics, “tend to face greater medical and social adverse consequences of substance use.

“Therefore, understanding the factors that determine the origin and course of substance use disorders within these minority groups is essential for the development of primary and secondary prevention services,” he said.

Dr. Neumark, of Hebrew University-Hadassah Braun School of Public Health, Jerusalem, and his colleagues used data from the 2002–2003 National Latino and Asian American Study of 2,554 noninstitutionalized individuals aged 18 years and older who lived in the United States.

The study gathered information on the prevalence of psychiatric disorders and use of mental health services, but participants also were asked about lifetime and past-year use of prescription drugs with or without a recommendation from a provider.

The lifetime and past-year prevalence of nonmedical use of prescription drugs among Hispanics in the United States was 8.1% and 1.6%, respectively, and both of these prevalences were higher in U.S.-born Hispanics (14.4% and 2.7%) than in immigrant Hispanics (4.3% and 0.9%). Hispanic men were more likely than were women to report nonmedical use of these drugs, as were all individuals aged 18–29 and 30–44 years. Income and region of residence were not associated with use.

After controlling for relevant confounding factors, both groups–U.S.-born and immigrant–were more likely to report nonmedical prescription-drug use if they had been diagnosed with a depressive disorder (adjusted odds ratio, 1.9), chronic pain (AOR, 2.9), or alcohol dependence (AOR, 3.4). The association between nonmedical use and an anxiety disorder diagnosis was not significant (AOR, 1.5).

The researchers said it was important to understand the mechanisms driving the factors that affect the prevalence of nonmedical use of prescription drugs in immigrant and U.S.-born Hispanics to be able to develop and better target preventive and treatment programs.

Among those factors were migration patterns, country of origin, values that reinforce substance use, acculturation gaps, maladaptation, and lack of social capital.

Dr. Neumark noted that this was particularly important given that the Hispanic population in the United States is projected to reach 30% of the American population in 2050 and that this trend is being driven “primarily by a large influx of socially vulnerable” Hispanic immigrants and their U.S.-born children.

None of the researchers reported any financial disclosures.

WASHINGTON — Methamphetamine use has declined by almost half since 2006, and misuse of prescription drugs decreased significantly between 2007 and 2008.

The prevalence of past-month methamphetamine use dipped from 529,000 in 2007 to 314,000 in 2008 in people aged 12 years and older, according to data from the 2008 National Survey on Drug Use and Health. That represents a decline of past-month meth use by almost half since 2006, when that number was 731,000.

One possible reason for the decrease could be effect of the Combat Methamphetamine Epidemic Act (CMEA), which was enacted in 2006 to regulate sales of over-the-counter medications that could be used in manufacturing methamphetamine, said Dr. Carl C. Bell, director of public and community psychiatry at the University of Illinois at Chicago.

Under the CMEA, the medications were taken off the shelf, limits were placed on their purchase, customer ID was required, and sales were tracked, making it easier to find meth labs and close them down, Dr. Bell said.

Lloyd Johnston, Ph.D., principal investigator of the Monitoring the Future study, which tracks drug use among 8th, 10th, and 12th graders, said in an interview that he and his colleagues have seen a steady drop in methamphetamine use in that population since they started monitoring it in 1999 when past-year use was 4.1%, compared with 1.3% in 2008.

“The drop in meth use among teens and young adults has been occurring since the turn of the decade,” said Dr. Johnston, who is also a professor at the University of Michigan's Institute for Social Research in Ann Arbor.

“We don't have the relevant perceived risk measure for meth, but I think that the tremendous amount of bad publicity that meth use and local meth production received in earlier years led young people to see it as more dangerous and less glamorous than they had previously.”

The NSDUH study found that the misuse of prescription drugs also decreased significantly between 2007 and 2008 among individuals aged 12 years and over, and that there has been progress in containing other types of illicit drug use, though the data showed that the overall national past-month users of illicit drugs has remained level at about 20 million (8%) since 2002. (Illicit drugs include marijuana/hashish, cocaine/crack, heroin, hallucinogens, inhalants, and prescription psychotropics that are used nonmedically.)

“We are seeing the benefits of a public effort that accepts that addiction is treatable and therapy works,” said Eric B. Broderick, D.D.S., the acting administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), which sponsored the study and presented the report at a press conference. “It's important to get [our] message out.”

Marijuana was the most commonly used illicit drug, though 2008 levels of use remained steady compared with the previous year. The drug was used by 15.2 million or just under 75.7% of current illicit drug users, and 57.3% of all users used only marijuana.

In the 12- to 17-year-old group, 9.3% used illicit drugs, of whom 6.7% used marijuana (8% in 2007) and 2.9% used nonmedical prescription drugs. The remainder used inhalants and hallucinogens (1% each) and cocaine (0.4%).

Within this group, types of drugs used in the previous month varied by age: In the 12- to 13-year group, 1.5% had used prescription drugs nonmedically and 1% had used marijuana; in the 14- to 15-year group, almost 5.7% had used marijuana and 3.0% nonmedical prescription drugs; and among 16- to 17-year-olds, 12.7% had used marijuana and 4.0% hallucinogens.

Overall illicit drug use and use of specific drugs in this group held steady between 2007 and 2008, though there was an increase in the past-month rate of hallucinogen use (1.0% in 2008 vs. 0.7% in 2007) because of an increase in Ecstasy use (0.3% in 2007 vs. 0.4% in 2008), and a decline in the nonmedical use of prescription drugs (2.9% in 2008 vs. 3.3% in 2007) that was driven by a slowdown in nonmedical pain reliever use.

Past-year use of Ecstasy was 1.4% for 2008, which was significantly lower than 2002's level of 2.2%, but higher than the lowest level of 1.0% in 2005. The use of LSD also showed an upward trend to 0.7% last year, compared with 0.4% in 2006.

Dr. Johnston said that data from the Monitoring the Future study had shown that “Ecstasy use had dropped dramatically after 2001 as teens came to see it as more dangerous. [But] more recent cohorts of teens are now seeing Ecstasy use as considerably less dangerous than teens did just 3-5 years ago, making them more vulnerable to a rebound in use.”

He said that he and his colleagues had found that lower LSD use in teens was probably the result of a drop in availability rather than an increase in perceived risk of the drug. There is concern is that the decline in perceived risk and disapproval of the drug might make this group vulnerable to LSD use if supply increases, he noted.

“This erosion in perceived risk is something that we believe happens as new cohorts of young people enter adolescence and don't know what their predecessors learned about the drug. We call it 'generational forgetting,'” Dr. Johnston said.

The NSDUH study showed that current illicit drug use was higher among young adults aged 18-25 years (20%) than it was in youths aged 12-17 (9%) and those aged over 26 (6%). However, the 2007 and 2008 rates remained steady.

Among those aged 50-59 years—the baby boomers—past-month use increased from 2.7% in 2002 to 4.6% in 2008. In the 50- to 54-year-old group, that rate went from 3.4% in 2002, to 6.0% in 2006 and 4.3% in 2008; and in the 55- to 59-year-old group, the levels were 1.9% in 2002 and 5.0% in 2008. The investigators suggest this increase might be a result of the aging boomers' higher lifetime rates of illicit drug use.

Among the continuing concerns is that of the 23.1 million people who need treatment for illicit drug use, only 2.3 million (about 10%) receive treatment. Gil Kerlikowske, director of the office of National Drug Control Policy, emphasized the importance of addressing these treatment disparities, adding that “treatment is half the cost of incarceration.”

Mr. Kerlikowske's contention that he had “ended the war with drug users” and that the new focus should be on “prevention, treatment, and recovery in a holistic way” drew praise from Dr. Bell and Dr. Johnston.

“Thank God someone with sense is in the national drug control policy area. This is a shift we have been pushing in the Institute of Medicine's 2009 report,” Dr. Bell said.

Dr. Johnston said he had long been a proponent of demand-side action in dealing with drug use. “There is good evidence from our studies that demand-side factors have reduced drug use substantially at times,” he said.

The NSDUH interviews about 67,500 individuals in the general U.S. population aged 12 years and older. Each respondent who completes the interview receives $30. Military personnel, inmates, inpatients, and homeless persons who do not live in a shelter are excluded.

Source Elsevier Global Medical News

Illicit Drug Use, Suicide, Depression Closely Related

Mental illness appears to raise the stakes when it comes to illicit drug use and cigarette use, the 2008 NSDUH data show.

For example, the incidence of past-year illicit drug and cigarette use in mentally ill persons aged 18 years and older was almost double that in those without mental illness. The rates of alcohol use, however, were closer between the groups.

Regarding suicide consideration, planning, and attempts, there were notable differences between the two groups: Past-year substance users were more than three times more likely to have considered suicide than were nonusers (11.0% vs. 3.0%, respectively), more than four times more likely to have planned a suicide (3.4% vs. 0.8%, and nearly seven times more likely to have attempted suicide (2.0% vs. 0.3%), the SAMHSA noted in a press release based on data from the survey.

The survey asked all adult respondents (those aged 18 and over) about suicidal thoughts and behavior, whereas data on mental illness were collected both in youths aged 12-17 years and in adults. Until now, suicidality data had been collected only within the major depressive episode module.

The data showed that in the general U.S. public, nearly 8.3 million adults (3.7%) seriously considered committing suicide in the previous year, 2.3 million had made a suicide plan, and 1.1 million had attempted suicide. Young adults aged 18-25 years were at greatest risk for suicidal thoughts (6.7%), compared with those aged 26-49 (3.9%) and the 50 or older age group (2.3%). The trends for planning and attempting were similar in the three age groups.

The findings showed “just how pervasive the risk of suicide is in our nation. … The magnitude of the public health crisis revealed by this study should motivate us to do everything possible to reach those at risk,” Dr. Broderick said.

Among youths, rates of substance, alcohol, and cigarette use in those with major depressive episode were more than double those of nonusers. Of those with past-year episode, 37.4% had used illicit drugs, compared with 17.2% of nonusers; 3.6% vs. 1.8%, respectively, reported daily cigarette use; and 3.4% vs. 1.8% reported heavy alcohol use.

WASHINGTON — Methamphetamine use has declined by almost half since 2006, and misuse of prescription drugs decreased significantly between 2007 and 2008.

The prevalence of past-month methamphetamine use dipped from 529,000 in 2007 to 314,000 in 2008 in people aged 12 years and older, according to data from the 2008 National Survey on Drug Use and Health. That represents a decline of past-month meth use by almost half since 2006, when that number was 731,000.

One possible reason for the decrease could be effect of the Combat Methamphetamine Epidemic Act (CMEA), which was enacted in 2006 to regulate sales of over-the-counter medications that could be used in manufacturing methamphetamine, said Dr. Carl C. Bell, director of public and community psychiatry at the University of Illinois at Chicago.

Under the CMEA, the medications were taken off the shelf, limits were placed on their purchase, customer ID was required, and sales were tracked, making it easier to find meth labs and close them down, Dr. Bell said.

Lloyd Johnston, Ph.D., principal investigator of the Monitoring the Future study, which tracks drug use among 8th, 10th, and 12th graders, said in an interview that he and his colleagues have seen a steady drop in methamphetamine use in that population since they started monitoring it in 1999 when past-year use was 4.1%, compared with 1.3% in 2008.

“The drop in meth use among teens and young adults has been occurring since the turn of the decade,” said Dr. Johnston, who is also a professor at the University of Michigan's Institute for Social Research in Ann Arbor.

“We don't have the relevant perceived risk measure for meth, but I think that the tremendous amount of bad publicity that meth use and local meth production received in earlier years led young people to see it as more dangerous and less glamorous than they had previously.”

The NSDUH study found that the misuse of prescription drugs also decreased significantly between 2007 and 2008 among individuals aged 12 years and over, and that there has been progress in containing other types of illicit drug use, though the data showed that the overall national past-month users of illicit drugs has remained level at about 20 million (8%) since 2002. (Illicit drugs include marijuana/hashish, cocaine/crack, heroin, hallucinogens, inhalants, and prescription psychotropics that are used nonmedically.)

“We are seeing the benefits of a public effort that accepts that addiction is treatable and therapy works,” said Eric B. Broderick, D.D.S., the acting administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), which sponsored the study and presented the report at a press conference. “It's important to get [our] message out.”

Marijuana was the most commonly used illicit drug, though 2008 levels of use remained steady compared with the previous year. The drug was used by 15.2 million or just under 75.7% of current illicit drug users, and 57.3% of all users used only marijuana.

In the 12- to 17-year-old group, 9.3% used illicit drugs, of whom 6.7% used marijuana (8% in 2007) and 2.9% used nonmedical prescription drugs. The remainder used inhalants and hallucinogens (1% each) and cocaine (0.4%).

Within this group, types of drugs used in the previous month varied by age: In the 12- to 13-year group, 1.5% had used prescription drugs nonmedically and 1% had used marijuana; in the 14- to 15-year group, almost 5.7% had used marijuana and 3.0% nonmedical prescription drugs; and among 16- to 17-year-olds, 12.7% had used marijuana and 4.0% hallucinogens.

Overall illicit drug use and use of specific drugs in this group held steady between 2007 and 2008, though there was an increase in the past-month rate of hallucinogen use (1.0% in 2008 vs. 0.7% in 2007) because of an increase in Ecstasy use (0.3% in 2007 vs. 0.4% in 2008), and a decline in the nonmedical use of prescription drugs (2.9% in 2008 vs. 3.3% in 2007) that was driven by a slowdown in nonmedical pain reliever use.

Past-year use of Ecstasy was 1.4% for 2008, which was significantly lower than 2002's level of 2.2%, but higher than the lowest level of 1.0% in 2005. The use of LSD also showed an upward trend to 0.7% last year, compared with 0.4% in 2006.

Dr. Johnston said that data from the Monitoring the Future study had shown that “Ecstasy use had dropped dramatically after 2001 as teens came to see it as more dangerous. [But] more recent cohorts of teens are now seeing Ecstasy use as considerably less dangerous than teens did just 3-5 years ago, making them more vulnerable to a rebound in use.”

He said that he and his colleagues had found that lower LSD use in teens was probably the result of a drop in availability rather than an increase in perceived risk of the drug. There is concern is that the decline in perceived risk and disapproval of the drug might make this group vulnerable to LSD use if supply increases, he noted.

“This erosion in perceived risk is something that we believe happens as new cohorts of young people enter adolescence and don't know what their predecessors learned about the drug. We call it 'generational forgetting,'” Dr. Johnston said.

The NSDUH study showed that current illicit drug use was higher among young adults aged 18-25 years (20%) than it was in youths aged 12-17 (9%) and those aged over 26 (6%). However, the 2007 and 2008 rates remained steady.

Among those aged 50-59 years—the baby boomers—past-month use increased from 2.7% in 2002 to 4.6% in 2008. In the 50- to 54-year-old group, that rate went from 3.4% in 2002, to 6.0% in 2006 and 4.3% in 2008; and in the 55- to 59-year-old group, the levels were 1.9% in 2002 and 5.0% in 2008. The investigators suggest this increase might be a result of the aging boomers' higher lifetime rates of illicit drug use.

Among the continuing concerns is that of the 23.1 million people who need treatment for illicit drug use, only 2.3 million (about 10%) receive treatment. Gil Kerlikowske, director of the office of National Drug Control Policy, emphasized the importance of addressing these treatment disparities, adding that “treatment is half the cost of incarceration.”

Mr. Kerlikowske's contention that he had “ended the war with drug users” and that the new focus should be on “prevention, treatment, and recovery in a holistic way” drew praise from Dr. Bell and Dr. Johnston.

“Thank God someone with sense is in the national drug control policy area. This is a shift we have been pushing in the Institute of Medicine's 2009 report,” Dr. Bell said.

Dr. Johnston said he had long been a proponent of demand-side action in dealing with drug use. “There is good evidence from our studies that demand-side factors have reduced drug use substantially at times,” he said.

The NSDUH interviews about 67,500 individuals in the general U.S. population aged 12 years and older. Each respondent who completes the interview receives $30. Military personnel, inmates, inpatients, and homeless persons who do not live in a shelter are excluded.

Source Elsevier Global Medical News

Illicit Drug Use, Suicide, Depression Closely Related

Mental illness appears to raise the stakes when it comes to illicit drug use and cigarette use, the 2008 NSDUH data show.

For example, the incidence of past-year illicit drug and cigarette use in mentally ill persons aged 18 years and older was almost double that in those without mental illness. The rates of alcohol use, however, were closer between the groups.

Regarding suicide consideration, planning, and attempts, there were notable differences between the two groups: Past-year substance users were more than three times more likely to have considered suicide than were nonusers (11.0% vs. 3.0%, respectively), more than four times more likely to have planned a suicide (3.4% vs. 0.8%, and nearly seven times more likely to have attempted suicide (2.0% vs. 0.3%), the SAMHSA noted in a press release based on data from the survey.

The survey asked all adult respondents (those aged 18 and over) about suicidal thoughts and behavior, whereas data on mental illness were collected both in youths aged 12-17 years and in adults. Until now, suicidality data had been collected only within the major depressive episode module.

The data showed that in the general U.S. public, nearly 8.3 million adults (3.7%) seriously considered committing suicide in the previous year, 2.3 million had made a suicide plan, and 1.1 million had attempted suicide. Young adults aged 18-25 years were at greatest risk for suicidal thoughts (6.7%), compared with those aged 26-49 (3.9%) and the 50 or older age group (2.3%). The trends for planning and attempting were similar in the three age groups.

The findings showed “just how pervasive the risk of suicide is in our nation. … The magnitude of the public health crisis revealed by this study should motivate us to do everything possible to reach those at risk,” Dr. Broderick said.

Among youths, rates of substance, alcohol, and cigarette use in those with major depressive episode were more than double those of nonusers. Of those with past-year episode, 37.4% had used illicit drugs, compared with 17.2% of nonusers; 3.6% vs. 1.8%, respectively, reported daily cigarette use; and 3.4% vs. 1.8% reported heavy alcohol use.

WASHINGTON — Methamphetamine use has declined by almost half since 2006, and misuse of prescription drugs decreased significantly between 2007 and 2008.

The prevalence of past-month methamphetamine use dipped from 529,000 in 2007 to 314,000 in 2008 in people aged 12 years and older, according to data from the 2008 National Survey on Drug Use and Health. That represents a decline of past-month meth use by almost half since 2006, when that number was 731,000.

One possible reason for the decrease could be effect of the Combat Methamphetamine Epidemic Act (CMEA), which was enacted in 2006 to regulate sales of over-the-counter medications that could be used in manufacturing methamphetamine, said Dr. Carl C. Bell, director of public and community psychiatry at the University of Illinois at Chicago.

Under the CMEA, the medications were taken off the shelf, limits were placed on their purchase, customer ID was required, and sales were tracked, making it easier to find meth labs and close them down, Dr. Bell said.

Lloyd Johnston, Ph.D., principal investigator of the Monitoring the Future study, which tracks drug use among 8th, 10th, and 12th graders, said in an interview that he and his colleagues have seen a steady drop in methamphetamine use in that population since they started monitoring it in 1999 when past-year use was 4.1%, compared with 1.3% in 2008.

“The drop in meth use among teens and young adults has been occurring since the turn of the decade,” said Dr. Johnston, who is also a professor at the University of Michigan's Institute for Social Research in Ann Arbor.

“We don't have the relevant perceived risk measure for meth, but I think that the tremendous amount of bad publicity that meth use and local meth production received in earlier years led young people to see it as more dangerous and less glamorous than they had previously.”

The NSDUH study found that the misuse of prescription drugs also decreased significantly between 2007 and 2008 among individuals aged 12 years and over, and that there has been progress in containing other types of illicit drug use, though the data showed that the overall national past-month users of illicit drugs has remained level at about 20 million (8%) since 2002. (Illicit drugs include marijuana/hashish, cocaine/crack, heroin, hallucinogens, inhalants, and prescription psychotropics that are used nonmedically.)

“We are seeing the benefits of a public effort that accepts that addiction is treatable and therapy works,” said Eric B. Broderick, D.D.S., the acting administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), which sponsored the study and presented the report at a press conference. “It's important to get [our] message out.”

Marijuana was the most commonly used illicit drug, though 2008 levels of use remained steady compared with the previous year. The drug was used by 15.2 million or just under 75.7% of current illicit drug users, and 57.3% of all users used only marijuana.

In the 12- to 17-year-old group, 9.3% used illicit drugs, of whom 6.7% used marijuana (8% in 2007) and 2.9% used nonmedical prescription drugs. The remainder used inhalants and hallucinogens (1% each) and cocaine (0.4%).

Within this group, types of drugs used in the previous month varied by age: In the 12- to 13-year group, 1.5% had used prescription drugs nonmedically and 1% had used marijuana; in the 14- to 15-year group, almost 5.7% had used marijuana and 3.0% nonmedical prescription drugs; and among 16- to 17-year-olds, 12.7% had used marijuana and 4.0% hallucinogens.

Overall illicit drug use and use of specific drugs in this group held steady between 2007 and 2008, though there was an increase in the past-month rate of hallucinogen use (1.0% in 2008 vs. 0.7% in 2007) because of an increase in Ecstasy use (0.3% in 2007 vs. 0.4% in 2008), and a decline in the nonmedical use of prescription drugs (2.9% in 2008 vs. 3.3% in 2007) that was driven by a slowdown in nonmedical pain reliever use.

Past-year use of Ecstasy was 1.4% for 2008, which was significantly lower than 2002's level of 2.2%, but higher than the lowest level of 1.0% in 2005. The use of LSD also showed an upward trend to 0.7% last year, compared with 0.4% in 2006.

Dr. Johnston said that data from the Monitoring the Future study had shown that “Ecstasy use had dropped dramatically after 2001 as teens came to see it as more dangerous. [But] more recent cohorts of teens are now seeing Ecstasy use as considerably less dangerous than teens did just 3-5 years ago, making them more vulnerable to a rebound in use.”

He said that he and his colleagues had found that lower LSD use in teens was probably the result of a drop in availability rather than an increase in perceived risk of the drug. There is concern is that the decline in perceived risk and disapproval of the drug might make this group vulnerable to LSD use if supply increases, he noted.

“This erosion in perceived risk is something that we believe happens as new cohorts of young people enter adolescence and don't know what their predecessors learned about the drug. We call it 'generational forgetting,'” Dr. Johnston said.

The NSDUH study showed that current illicit drug use was higher among young adults aged 18-25 years (20%) than it was in youths aged 12-17 (9%) and those aged over 26 (6%). However, the 2007 and 2008 rates remained steady.

Among those aged 50-59 years—the baby boomers—past-month use increased from 2.7% in 2002 to 4.6% in 2008. In the 50- to 54-year-old group, that rate went from 3.4% in 2002, to 6.0% in 2006 and 4.3% in 2008; and in the 55- to 59-year-old group, the levels were 1.9% in 2002 and 5.0% in 2008. The investigators suggest this increase might be a result of the aging boomers' higher lifetime rates of illicit drug use.

Among the continuing concerns is that of the 23.1 million people who need treatment for illicit drug use, only 2.3 million (about 10%) receive treatment. Gil Kerlikowske, director of the office of National Drug Control Policy, emphasized the importance of addressing these treatment disparities, adding that “treatment is half the cost of incarceration.”

Mr. Kerlikowske's contention that he had “ended the war with drug users” and that the new focus should be on “prevention, treatment, and recovery in a holistic way” drew praise from Dr. Bell and Dr. Johnston.

“Thank God someone with sense is in the national drug control policy area. This is a shift we have been pushing in the Institute of Medicine's 2009 report,” Dr. Bell said.

Dr. Johnston said he had long been a proponent of demand-side action in dealing with drug use. “There is good evidence from our studies that demand-side factors have reduced drug use substantially at times,” he said.

The NSDUH interviews about 67,500 individuals in the general U.S. population aged 12 years and older. Each respondent who completes the interview receives $30. Military personnel, inmates, inpatients, and homeless persons who do not live in a shelter are excluded.

Source Elsevier Global Medical News

Illicit Drug Use, Suicide, Depression Closely Related

Mental illness appears to raise the stakes when it comes to illicit drug use and cigarette use, the 2008 NSDUH data show.

For example, the incidence of past-year illicit drug and cigarette use in mentally ill persons aged 18 years and older was almost double that in those without mental illness. The rates of alcohol use, however, were closer between the groups.

Regarding suicide consideration, planning, and attempts, there were notable differences between the two groups: Past-year substance users were more than three times more likely to have considered suicide than were nonusers (11.0% vs. 3.0%, respectively), more than four times more likely to have planned a suicide (3.4% vs. 0.8%, and nearly seven times more likely to have attempted suicide (2.0% vs. 0.3%), the SAMHSA noted in a press release based on data from the survey.

The survey asked all adult respondents (those aged 18 and over) about suicidal thoughts and behavior, whereas data on mental illness were collected both in youths aged 12-17 years and in adults. Until now, suicidality data had been collected only within the major depressive episode module.

The data showed that in the general U.S. public, nearly 8.3 million adults (3.7%) seriously considered committing suicide in the previous year, 2.3 million had made a suicide plan, and 1.1 million had attempted suicide. Young adults aged 18-25 years were at greatest risk for suicidal thoughts (6.7%), compared with those aged 26-49 (3.9%) and the 50 or older age group (2.3%). The trends for planning and attempting were similar in the three age groups.

The findings showed “just how pervasive the risk of suicide is in our nation. … The magnitude of the public health crisis revealed by this study should motivate us to do everything possible to reach those at risk,” Dr. Broderick said.

Among youths, rates of substance, alcohol, and cigarette use in those with major depressive episode were more than double those of nonusers. Of those with past-year episode, 37.4% had used illicit drugs, compared with 17.2% of nonusers; 3.6% vs. 1.8%, respectively, reported daily cigarette use; and 3.4% vs. 1.8% reported heavy alcohol use.

Children treated with medication for attention-deficit/hyperactivity disorder during their elementary school years score higher on standardized tests for mathematics and reading, compared with their ADHD peers who are not medicated, data from a longitudinal study of 594 children show.

However, the gains did not close the test-score gap between children with and without the condition, Richard M. Scheffler, Ph.D., of the University of California, Berkeley, and his colleagues reported.

They also noted that children who were medicated for a longer time had reading scores of just over 5 points higher than those of their unmedicated peers. And although they did not find a significant interaction with gender, they did find that the medication-reading association was lower in children with an individualized education program than it was for those with no such program.

ADHD affects about 8% of school-aged children in the United States, of whom about 56% are treated with a prescription medication. The condition is marked by inattention and impulsivity, and by atypical levels of physical activity. This population often also grapples with lower academic achievement, compared with non-ADHD peers, as well as higher grade retention, special education placement, and dropout rates. However, the association between medication use and academic achievement is “largely unknown,” the authors wrote (Pediatrics 2009;123:1272-9).

The investigators drew on data from the Early Childhood Longitudinal Study–Kindergarten Class of 1998-1999 (ECLS-K), which tracks the academic progress of a nationally representative sample of children who attended kindergarten in the United States during that period. The full ECLS-K sample was 8,370, of whom 594 were diagnosed with ADHD. Of those with ADHD, 75% were boys, 71.6% were white, 12.2% black, 11.0% Hispanic, and 1.4% Asian/Pacific islander.

The data were collected at five waves between kindergarten and fifth grade–in the fall and spring of kindergarten and in the spring of the first, third, and fifth grades, over a 6-year period.

Dr. David Fassler, who was not involved with the study, said in an interview that the results are consistent with general clinical experience. However, because of the methodology used, he said, the results should be “interpreted with caution. For example, the authors rely on the parents' reports of both diagnosis and medication,” said Dr. Fassler, a child and adolescent psychiatrist, and clinical professor of psychiatry at the University of Vermont, Burlington. “Nonetheless, I expect the findings will prove somewhat reassuring to parents and physicians evaluating treatment options for children with ADHD.”

The authors reported that they had no relevant disclosures. The study was funded by a grant from the National Institute of Mental Health.

Children treated with medication for attention-deficit/hyperactivity disorder during their elementary school years score higher on standardized tests for mathematics and reading, compared with their ADHD peers who are not medicated, data from a longitudinal study of 594 children show.

However, the gains did not close the test-score gap between children with and without the condition, Richard M. Scheffler, Ph.D., of the University of California, Berkeley, and his colleagues reported.

They also noted that children who were medicated for a longer time had reading scores of just over 5 points higher than those of their unmedicated peers. And although they did not find a significant interaction with gender, they did find that the medication-reading association was lower in children with an individualized education program than it was for those with no such program.

ADHD affects about 8% of school-aged children in the United States, of whom about 56% are treated with a prescription medication. The condition is marked by inattention and impulsivity, and by atypical levels of physical activity. This population often also grapples with lower academic achievement, compared with non-ADHD peers, as well as higher grade retention, special education placement, and dropout rates. However, the association between medication use and academic achievement is “largely unknown,” the authors wrote (Pediatrics 2009;123:1272-9).

The investigators drew on data from the Early Childhood Longitudinal Study–Kindergarten Class of 1998-1999 (ECLS-K), which tracks the academic progress of a nationally representative sample of children who attended kindergarten in the United States during that period. The full ECLS-K sample was 8,370, of whom 594 were diagnosed with ADHD. Of those with ADHD, 75% were boys, 71.6% were white, 12.2% black, 11.0% Hispanic, and 1.4% Asian/Pacific islander.

The data were collected at five waves between kindergarten and fifth grade–in the fall and spring of kindergarten and in the spring of the first, third, and fifth grades, over a 6-year period.

Dr. David Fassler, who was not involved with the study, said in an interview that the results are consistent with general clinical experience. However, because of the methodology used, he said, the results should be “interpreted with caution. For example, the authors rely on the parents' reports of both diagnosis and medication,” said Dr. Fassler, a child and adolescent psychiatrist, and clinical professor of psychiatry at the University of Vermont, Burlington. “Nonetheless, I expect the findings will prove somewhat reassuring to parents and physicians evaluating treatment options for children with ADHD.”

The authors reported that they had no relevant disclosures. The study was funded by a grant from the National Institute of Mental Health.

Children treated with medication for attention-deficit/hyperactivity disorder during their elementary school years score higher on standardized tests for mathematics and reading, compared with their ADHD peers who are not medicated, data from a longitudinal study of 594 children show.

However, the gains did not close the test-score gap between children with and without the condition, Richard M. Scheffler, Ph.D., of the University of California, Berkeley, and his colleagues reported.

They also noted that children who were medicated for a longer time had reading scores of just over 5 points higher than those of their unmedicated peers. And although they did not find a significant interaction with gender, they did find that the medication-reading association was lower in children with an individualized education program than it was for those with no such program.

ADHD affects about 8% of school-aged children in the United States, of whom about 56% are treated with a prescription medication. The condition is marked by inattention and impulsivity, and by atypical levels of physical activity. This population often also grapples with lower academic achievement, compared with non-ADHD peers, as well as higher grade retention, special education placement, and dropout rates. However, the association between medication use and academic achievement is “largely unknown,” the authors wrote (Pediatrics 2009;123:1272-9).

The investigators drew on data from the Early Childhood Longitudinal Study–Kindergarten Class of 1998-1999 (ECLS-K), which tracks the academic progress of a nationally representative sample of children who attended kindergarten in the United States during that period. The full ECLS-K sample was 8,370, of whom 594 were diagnosed with ADHD. Of those with ADHD, 75% were boys, 71.6% were white, 12.2% black, 11.0% Hispanic, and 1.4% Asian/Pacific islander.

The data were collected at five waves between kindergarten and fifth grade–in the fall and spring of kindergarten and in the spring of the first, third, and fifth grades, over a 6-year period.

Dr. David Fassler, who was not involved with the study, said in an interview that the results are consistent with general clinical experience. However, because of the methodology used, he said, the results should be “interpreted with caution. For example, the authors rely on the parents' reports of both diagnosis and medication,” said Dr. Fassler, a child and adolescent psychiatrist, and clinical professor of psychiatry at the University of Vermont, Burlington. “Nonetheless, I expect the findings will prove somewhat reassuring to parents and physicians evaluating treatment options for children with ADHD.”

The authors reported that they had no relevant disclosures. The study was funded by a grant from the National Institute of Mental Health.

Patients with diabetes often experience periods of sustained hyperglycemia that are not addressed by intensified or appropriate treatment.

Of 5,070 patients at a Michigan multispecialty practice who began oral monotherapy (sulfonylurea or metformin) for diabetes, 1,386 incurred a period of sustained hyperglycemia—defined as two hemoglobin A_1c levels above 8% within 90 days—during follow-up (Diabetes Care 2009;32:1447-52).

Patients' average age was just over 60 years, 48% were female, and 37% were African American.

Most (60%) had employer-sponsored health insurance; 52% were on a sulfonylurea, 45% took metformin, and 4% were on other therapies.

The researchers looked at mean number of days to sustained hyperglycemia and the factors associated with it in the monotherapy group, as well as factors associated with getting appropriate care for these patients. Appropriate care was defined as either HbA_1c of 7% or less or therapy intensification such as increasing the dose of the original oral agent, adding another oral agent, changing the oral agent class, or adding insulin.

The findings showed that 8% of the patients incurred sustained hyperglycemia in the first year and that by 5 years, 38% had done so. Increasing age and HbA_1c levels, and, for African Americans, starting on sulfonylurea rather than metformin, increased the risk of sustained hyperglycemia, whereas medication adherence and greater income reduced the risk, wrote the authors, led by Jennifer E. Lafata, Ph.D., of the Center for Health Services Research in Detroit.

Of those with sustained hyperglycemia, there was a median lapse of 3.9 months before they received appropriate care, with 59% receiving such care within 6 months. However, by 1 year, 25% had not received appropriate care, and at the end of 2 years, 11% still had not received it. Without medication intensification, fewer than 5% of patients returned to glycemic control.

Time to receiving appropriate care was related to income (higher salary, less delay). Patient adherence, a recent hospital admission, and visits to a primary care physician or an endocrinologist also bolstered access to care. In addition, patients with higher HbA_1c levels tended to received appropriate care sooner.

The research was funded by Sanofi-Aventis. Dr. Lafata disclosed that she is a member of the Abbott Health Policy Advisory Board and receives research funding from Teva Neuroscience.

Patients with diabetes often experience periods of sustained hyperglycemia that are not addressed by intensified or appropriate treatment.

Of 5,070 patients at a Michigan multispecialty practice who began oral monotherapy (sulfonylurea or metformin) for diabetes, 1,386 incurred a period of sustained hyperglycemia—defined as two hemoglobin A_1c levels above 8% within 90 days—during follow-up (Diabetes Care 2009;32:1447-52).

Patients' average age was just over 60 years, 48% were female, and 37% were African American.

Most (60%) had employer-sponsored health insurance; 52% were on a sulfonylurea, 45% took metformin, and 4% were on other therapies.

The researchers looked at mean number of days to sustained hyperglycemia and the factors associated with it in the monotherapy group, as well as factors associated with getting appropriate care for these patients. Appropriate care was defined as either HbA_1c of 7% or less or therapy intensification such as increasing the dose of the original oral agent, adding another oral agent, changing the oral agent class, or adding insulin.

The findings showed that 8% of the patients incurred sustained hyperglycemia in the first year and that by 5 years, 38% had done so. Increasing age and HbA_1c levels, and, for African Americans, starting on sulfonylurea rather than metformin, increased the risk of sustained hyperglycemia, whereas medication adherence and greater income reduced the risk, wrote the authors, led by Jennifer E. Lafata, Ph.D., of the Center for Health Services Research in Detroit.

Of those with sustained hyperglycemia, there was a median lapse of 3.9 months before they received appropriate care, with 59% receiving such care within 6 months. However, by 1 year, 25% had not received appropriate care, and at the end of 2 years, 11% still had not received it. Without medication intensification, fewer than 5% of patients returned to glycemic control.

Time to receiving appropriate care was related to income (higher salary, less delay). Patient adherence, a recent hospital admission, and visits to a primary care physician or an endocrinologist also bolstered access to care. In addition, patients with higher HbA_1c levels tended to received appropriate care sooner.

The research was funded by Sanofi-Aventis. Dr. Lafata disclosed that she is a member of the Abbott Health Policy Advisory Board and receives research funding from Teva Neuroscience.

Patients with diabetes often experience periods of sustained hyperglycemia that are not addressed by intensified or appropriate treatment.

Of 5,070 patients at a Michigan multispecialty practice who began oral monotherapy (sulfonylurea or metformin) for diabetes, 1,386 incurred a period of sustained hyperglycemia—defined as two hemoglobin A_1c levels above 8% within 90 days—during follow-up (Diabetes Care 2009;32:1447-52).

Patients' average age was just over 60 years, 48% were female, and 37% were African American.

Most (60%) had employer-sponsored health insurance; 52% were on a sulfonylurea, 45% took metformin, and 4% were on other therapies.

The researchers looked at mean number of days to sustained hyperglycemia and the factors associated with it in the monotherapy group, as well as factors associated with getting appropriate care for these patients. Appropriate care was defined as either HbA_1c of 7% or less or therapy intensification such as increasing the dose of the original oral agent, adding another oral agent, changing the oral agent class, or adding insulin.

The findings showed that 8% of the patients incurred sustained hyperglycemia in the first year and that by 5 years, 38% had done so. Increasing age and HbA_1c levels, and, for African Americans, starting on sulfonylurea rather than metformin, increased the risk of sustained hyperglycemia, whereas medication adherence and greater income reduced the risk, wrote the authors, led by Jennifer E. Lafata, Ph.D., of the Center for Health Services Research in Detroit.

Of those with sustained hyperglycemia, there was a median lapse of 3.9 months before they received appropriate care, with 59% receiving such care within 6 months. However, by 1 year, 25% had not received appropriate care, and at the end of 2 years, 11% still had not received it. Without medication intensification, fewer than 5% of patients returned to glycemic control.

Time to receiving appropriate care was related to income (higher salary, less delay). Patient adherence, a recent hospital admission, and visits to a primary care physician or an endocrinologist also bolstered access to care. In addition, patients with higher HbA_1c levels tended to received appropriate care sooner.

The research was funded by Sanofi-Aventis. Dr. Lafata disclosed that she is a member of the Abbott Health Policy Advisory Board and receives research funding from Teva Neuroscience.

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

“The most striking differences in melanoma incidence and mortality occur in the elderly,” wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed.

The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color. In the physical examination, the investigators recorded the number of melanocytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

“Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population,” wrote the authors, who also put the number of lifetime severe sunburns in this category. “On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients [aged 60 or older].”

None of the authors disclosed any conflicts of interest.

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

“The most striking differences in melanoma incidence and mortality occur in the elderly,” wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed.

The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color. In the physical examination, the investigators recorded the number of melanocytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

“Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population,” wrote the authors, who also put the number of lifetime severe sunburns in this category. “On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients [aged 60 or older].”

None of the authors disclosed any conflicts of interest.

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

“The most striking differences in melanoma incidence and mortality occur in the elderly,” wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed.

The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color. In the physical examination, the investigators recorded the number of melanocytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

“Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population,” wrote the authors, who also put the number of lifetime severe sunburns in this category. “On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients [aged 60 or older].”

None of the authors disclosed any conflicts of interest.

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

"The most striking differences in melanoma incidence and mortality occur in the elderly," wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed. The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color.

In the physical examination, the investigators recorded number of melano-cytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

"Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population," wrote the authors, who also put the number of lifetime severe sunburns in this category. "On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients" aged 60 or older.

In addition to chronic sun exposure and smoking, lifetime severe sunburns, blond or red hair, the number of melanocytic nevi, and personal history were statistically significant in the multivariate analyses, whereas solar lentigines and actinic keratoses and intermittent sun exposure were not.

The authors emphasized the importance of these findings in the context of a progressively aging population. However, they cited their use of self-reported data, selection bias, and small sample size as limitations of the study and said that further studies are needed.

None of the authors disclosed any conflicts of interest.

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

"The most striking differences in melanoma incidence and mortality occur in the elderly," wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed. The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color.

In the physical examination, the investigators recorded number of melano-cytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

"Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population," wrote the authors, who also put the number of lifetime severe sunburns in this category. "On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients" aged 60 or older.

In addition to chronic sun exposure and smoking, lifetime severe sunburns, blond or red hair, the number of melanocytic nevi, and personal history were statistically significant in the multivariate analyses, whereas solar lentigines and actinic keratoses and intermittent sun exposure were not.

The authors emphasized the importance of these findings in the context of a progressively aging population. However, they cited their use of self-reported data, selection bias, and small sample size as limitations of the study and said that further studies are needed.

None of the authors disclosed any conflicts of interest.

Environmental factors, such as smoking and severe sunburn, were more important than genetic factors in establishing risk for melanoma in older patients, according to the findings of an observational case-control study.

The study also found that melanoma risk factors in older patients (aged 60 and older) were different than those already established for a younger population. Other risk factors cited included prolonged occupational sun exposure, blond or red hair, and a personal (but not family) history of nonmelanoma skin cancer, noncutaneous neoplasia, or melanocytic nevi.

"The most striking differences in melanoma incidence and mortality occur in the elderly," wrote Dr. Eduardo Nagore of the department of dermatology at the Instituto Valenciano de Oncología, Valenica, Spain, and his colleagues. In the United States, for example, the melanoma mortality rate in older patients increased 157% from 1969 to 1999, with a nearly fivefold increase in incidence in older men.

Thicker melanomas were found to be associated with aging—bearing in mind that Breslow thickness is the most accurate prognostic tool in cutaneous melanoma; lentigo malignant melanomas and acral lentiginous melanomas are more prevalent in this age group; and aging itself, independent of Breslow thickness, ulceration, and node metastases, is an independent prognostic factor.

For the current study, the investigators selected consecutive melanoma patients who visited the institute in Valenica for the first time or for a control visit. To be included, they had to be aged 60 years or older and have a diagnosis of melanoma that had been histopathologically confirmed. The final sample after deaths and loss to follow-up was 160 patients (54% men, median age 68 years). There were 318 controls—two age- and sex-matched controls for each melanoma case, except for one, a 96-year-old man (J. Eur. Acad. Dermatol. Venereol. 2009 June 26 [doi:10.1111/j.1468-3083.2009.03353.x]).

The data for both cases and controls were derived from an interview and a physical examination by two dermatologists. Details of the following were obtained: intermittent sun exposure, such as during sunbathing or sports; occupational sun exposure—chronic exposure from an outdoor job such as gardening, farming, or sailing—and the duration in years; the lifetime number of episodes of severe and light sunburns; smoking history; personal history of noncutaneous neoplasias and nonmelanoma skin cancer; family history; phototype; and hair and eye color.

In the physical examination, the investigators recorded number of melano-cytic nevi of more than 2 mm in diameter and the presence of solar lentigines and actinic keratoses.

The results of univariate comparisons between the cases and the controls showed that a higher proportion of melanoma patients had blue or green eyes, blond or red hair and a low phototype, and a history of sunburns. A higher percentage of melanoma patients also reported having had many years of occupational sun exposure and having smoked, and there was a higher prevalence of solar lentigines, actinic keratoses, and melanocytic nevi, and of a personal history of nonmelanoma skin cancer and other noncancerous neoplasias, the authors reported. However, not all of these factors showed significance in multivariate analyses.

"Chronic sun exposure and smoking seem to be a risk factor of developing melanoma in the elderly in contrast to the entire population," wrote the authors, who also put the number of lifetime severe sunburns in this category. "On the other hand, broadly demonstrated melanoma risk factors such as low phototype, fair eye color, and family history of melanoma have not shown significance in patients" aged 60 or older.

In addition to chronic sun exposure and smoking, lifetime severe sunburns, blond or red hair, the number of melanocytic nevi, and personal history were statistically significant in the multivariate analyses, whereas solar lentigines and actinic keratoses and intermittent sun exposure were not.

The authors emphasized the importance of these findings in the context of a progressively aging population. However, they cited their use of self-reported data, selection bias, and small sample size as limitations of the study and said that further studies are needed.

None of the authors disclosed any conflicts of interest.

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

According to the abstract, patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

Televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) also were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to show that telemedicine would help expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (which ranges from 1 to 5) and a mean motor UPDRS of 34.7 (which is measured from 1 to 108, with a higher score indicating greater disability).

The community participants were randomized to telemedicine care (6 patients) or standard care (4 patients). All four nursing home patients received telemedicine care. Participants in the telemedicine group received three one-on-one visits over 6 months (month 1, month 2, and month 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

All of the Web-based televideo assessments were conducted at the nursing home. These assessments mirrored an in-person evaluation, during which participants were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All of the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration).

The four nursing home participants completed 94% of their telemedicine visits. They showed trends toward improvement in satisfaction with care, quality of life, and depressive symptoms.

All of the motor UPDRS items were able to be completed at each visit, establishing the feasibility of performing the assessment by televideo. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

“The participant was actually traveling a far distance [for] the telemedicine encounter. Certainly one wonders if providing care in the home or at a closer location would have allowed this individual to continue receiving their care via telemedicine,” Dr. Biglan said in an interview.

In focus group follow-up, both participants and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” he said.

“They were adamant that telemedicine was convenient and made communicating easy, and despite occasional technological glitches and trouble hearing the doctor, they remained positive.” Nevertheless, “travel remained an issue for some [and] participants had mixed feelings about the possibility of completing telemedicine visits at home without medical and technical support staff.”

The study was funded through the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

According to the abstract, patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

Televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) also were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to show that telemedicine would help expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (which ranges from 1 to 5) and a mean motor UPDRS of 34.7 (which is measured from 1 to 108, with a higher score indicating greater disability).

The community participants were randomized to telemedicine care (6 patients) or standard care (4 patients). All four nursing home patients received telemedicine care. Participants in the telemedicine group received three one-on-one visits over 6 months (month 1, month 2, and month 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

All of the Web-based televideo assessments were conducted at the nursing home. These assessments mirrored an in-person evaluation, during which participants were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All of the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration).

The four nursing home participants completed 94% of their telemedicine visits. They showed trends toward improvement in satisfaction with care, quality of life, and depressive symptoms.

All of the motor UPDRS items were able to be completed at each visit, establishing the feasibility of performing the assessment by televideo. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

“The participant was actually traveling a far distance [for] the telemedicine encounter. Certainly one wonders if providing care in the home or at a closer location would have allowed this individual to continue receiving their care via telemedicine,” Dr. Biglan said in an interview.

In focus group follow-up, both participants and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” he said.

“They were adamant that telemedicine was convenient and made communicating easy, and despite occasional technological glitches and trouble hearing the doctor, they remained positive.” Nevertheless, “travel remained an issue for some [and] participants had mixed feelings about the possibility of completing telemedicine visits at home without medical and technical support staff.”

The study was funded through the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

According to the abstract, patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

Televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) also were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to show that telemedicine would help expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (which ranges from 1 to 5) and a mean motor UPDRS of 34.7 (which is measured from 1 to 108, with a higher score indicating greater disability).

The community participants were randomized to telemedicine care (6 patients) or standard care (4 patients). All four nursing home patients received telemedicine care. Participants in the telemedicine group received three one-on-one visits over 6 months (month 1, month 2, and month 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

All of the Web-based televideo assessments were conducted at the nursing home. These assessments mirrored an in-person evaluation, during which participants were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All of the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration).

The four nursing home participants completed 94% of their telemedicine visits. They showed trends toward improvement in satisfaction with care, quality of life, and depressive symptoms.

All of the motor UPDRS items were able to be completed at each visit, establishing the feasibility of performing the assessment by televideo. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

“The participant was actually traveling a far distance [for] the telemedicine encounter. Certainly one wonders if providing care in the home or at a closer location would have allowed this individual to continue receiving their care via telemedicine,” Dr. Biglan said in an interview.

In focus group follow-up, both participants and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” he said.

“They were adamant that telemedicine was convenient and made communicating easy, and despite occasional technological glitches and trouble hearing the doctor, they remained positive.” Nevertheless, “travel remained an issue for some [and] participants had mixed feelings about the possibility of completing telemedicine visits at home without medical and technical support staff.”

The study was funded through the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.

Supplements of antioxidants and zinc plus higher dietary intakes of docosahexaenoic acid or eicosapentaenoic acid and a reduction in the dietary glycemic index protect against progression to advanced age-related macular degeneration, according to an analysis of 8 years of data from the Age-Related Eye Disease Study.

The same analysis also found that a diet rich in docosahexaenoic acid (DHA) was associated with a lower progression of early age-related macular degeneration (AMD), independent of the supplements.

Such benefits would come from the weekly consumption of two to three servings of fatty fish, such as salmon, tuna, mackerel, shellfish, and herring. That would achieve the recommended daily intake of omega-3 fatty acids, and substantially cut the risk of both early- and late-stage AMD, wrote Chung-Jung Chiu, D.D.S., Ph.D., of Tufts University, Boston, and his colleagues (Br. J. Ophthalmol. Online First 2009 [doi:10. 1136/bjo.2008.143412]).

There is no cure for AMD, making efforts to prevent it or delay its progression all the more pressing, especially with a rapidly aging world population.

Data from observational studies have suggested that a higher intake of antioxidants is associated with a reduced risk of AMD. Earlier data from the Age-Related Eye Disease Study (AREDS) have shown that high doses of antioxidants (vitamins C and E, and beta-carotene) and zinc benefit people at risk for advanced AMD. However, other data have suggested that DHA and eicosapentaenoic acid (EPA) may be protective against the disease, or that lowering the dietary glycemic index (dGI) reduces disease risk.

The new study is the first to examine a potential association between progression to advanced AMD and intake of the aforementioned nutrients plus dietary DHA and EPA and a reduced dGI.

Of 3,640 study participants, 2,924 individuals (2,523 eyes) in the early stages of the disease were selected after exclusions, and continued receiving placebo, antioxidants, zinc, or antioxidant plus zinc.

Their mean age was 69 years, 97% were white, and 58% were women. Fifty-six percent of the participants had ever smoked and 39% were hypertensive, and their mean dietary intakes, expressed as servings/week, were fruits and juices (16), vegetables (16), fish (2), meat (5), and dairy products (11). The researchers gathered data on possible risk factors from baseline physical and ophthalmic examinations and demographic and food-frequency questionnaires, and obtained and graded fundus photographs of the macula at baseline, 2 years, and then annually up to 8 years.

The eyes were originally classified into one of five groups based on increasing severity of drusen or AMD type, with groups 1-3 defined as early AMD and groups 4 and 5 as advanced AMD. Groups 1 and 2 (at risk of early AMD progression) and group 3 (at risk of advanced AMD progression) were used in the current study.

Progression for an eye was defined as a more advanced grade than the baseline grade. The AREDS supplementation formula contained 5, 6, and 18 times the recommended daily allowance of zinc, vitamin C, and vitamin E, respectively.

Independent of AREDS supplementation, increased intake of DHA and EPA and a lower dGI were associated with a lower risk of progression from early to advanced AMD. Participants who consumed the greatest amounts of DHA (64 mg/day or more) and EPA (42 mg/day or more) and had the greatest reduction in dGI were at the lowest risk.

The protective effect of the omega-3 fatty acids (DHA and EPA) against progression to advanced disease may have occurred because Western diets provide low levels of the fatty acids, the researchers said. Thus, any increase in their intakes would promote prevention.

In regard to dGI, the participants' diet was high in refined carbohydrates (high-GI foods). “These data show that a 6-unit reduction in dGI [roughly] equivalent to replacing five slices of white bread (GI = 100) with five slices of whole-grain bread (GI = 79) from the daily diet … might eliminate almost 8% of advanced AMD cases in a 5-year period,” they reported.

However, in participants at risk for early AMD progression, only those in the placebo group benefited from higher DHA intake, because of an antagonistic interaction between DHA and AREDS supplementation in the other groups.

That antagonistic interaction “was not observed in our analysis of progression to advanced AMD,” wrote the authors. “These results may imply that the protective effect of DHA may be through different mechanisms at different stages of AMD progression.”

Analysis of the global effect of low dGI showed a significant protection against progression to advanced AMD, independent of AREDS intervention, although an interaction test suggested that the extent of protection may vary by type of AREDS intervention. Further stratification analysis found a synergistic interaction between low dGI diets and AREDS supplementation, suggesting that a low-dGI diet is beneficial for those at risk of advanced disease, and that those taking the supplementation would benefit even more.

However, a higher dietary beta-carotene intake was associated with an increased risk of progression to advanced disease. Although that risk was independent of the type of supplementation, it was strongest in those receiving the antioxidants plus zinc.

The investigators noted that the AREDS supplementation was already not recommended for smokers because of the risk of lung cancer from beta-carotene.

The new finding linking beta-carotene and disease progression lends support to dropping beta-carotene from the supplement, they noted.

The project received financial support from the U.S. Department of Agriculture and the National Institutes of Health, and grants from the Johnson & Johnson Focused Giving Program, American Health Assistance Foundation, and the Ross Aging Initiative. None of the authors had any financial disclosures related to the study.

Weekly consumption of 2-3 servings of DHA-rich foods such as salmon, tuna, or mackerel cut progression of AMD. Lynda Banzi/Elsevier Global Medical News

Supplements of antioxidants and zinc plus higher dietary intakes of docosahexaenoic acid or eicosapentaenoic acid and a reduction in the dietary glycemic index protect against progression to advanced age-related macular degeneration, according to an analysis of 8 years of data from the Age-Related Eye Disease Study.

The same analysis also found that a diet rich in docosahexaenoic acid (DHA) was associated with a lower progression of early age-related macular degeneration (AMD), independent of the supplements.

Such benefits would come from the weekly consumption of two to three servings of fatty fish, such as salmon, tuna, mackerel, shellfish, and herring. That would achieve the recommended daily intake of omega-3 fatty acids, and substantially cut the risk of both early- and late-stage AMD, wrote Chung-Jung Chiu, D.D.S., Ph.D., of Tufts University, Boston, and his colleagues (Br. J. Ophthalmol. Online First 2009 [doi:10. 1136/bjo.2008.143412]).

There is no cure for AMD, making efforts to prevent it or delay its progression all the more pressing, especially with a rapidly aging world population.

Data from observational studies have suggested that a higher intake of antioxidants is associated with a reduced risk of AMD. Earlier data from the Age-Related Eye Disease Study (AREDS) have shown that high doses of antioxidants (vitamins C and E, and beta-carotene) and zinc benefit people at risk for advanced AMD. However, other data have suggested that DHA and eicosapentaenoic acid (EPA) may be protective against the disease, or that lowering the dietary glycemic index (dGI) reduces disease risk.

The new study is the first to examine a potential association between progression to advanced AMD and intake of the aforementioned nutrients plus dietary DHA and EPA and a reduced dGI.

Of 3,640 study participants, 2,924 individuals (2,523 eyes) in the early stages of the disease were selected after exclusions, and continued receiving placebo, antioxidants, zinc, or antioxidant plus zinc.

Their mean age was 69 years, 97% were white, and 58% were women. Fifty-six percent of the participants had ever smoked and 39% were hypertensive, and their mean dietary intakes, expressed as servings/week, were fruits and juices (16), vegetables (16), fish (2), meat (5), and dairy products (11). The researchers gathered data on possible risk factors from baseline physical and ophthalmic examinations and demographic and food-frequency questionnaires, and obtained and graded fundus photographs of the macula at baseline, 2 years, and then annually up to 8 years.

The eyes were originally classified into one of five groups based on increasing severity of drusen or AMD type, with groups 1-3 defined as early AMD and groups 4 and 5 as advanced AMD. Groups 1 and 2 (at risk of early AMD progression) and group 3 (at risk of advanced AMD progression) were used in the current study.

Progression for an eye was defined as a more advanced grade than the baseline grade. The AREDS supplementation formula contained 5, 6, and 18 times the recommended daily allowance of zinc, vitamin C, and vitamin E, respectively.

Independent of AREDS supplementation, increased intake of DHA and EPA and a lower dGI were associated with a lower risk of progression from early to advanced AMD. Participants who consumed the greatest amounts of DHA (64 mg/day or more) and EPA (42 mg/day or more) and had the greatest reduction in dGI were at the lowest risk.

The protective effect of the omega-3 fatty acids (DHA and EPA) against progression to advanced disease may have occurred because Western diets provide low levels of the fatty acids, the researchers said. Thus, any increase in their intakes would promote prevention.

In regard to dGI, the participants' diet was high in refined carbohydrates (high-GI foods). “These data show that a 6-unit reduction in dGI [roughly] equivalent to replacing five slices of white bread (GI = 100) with five slices of whole-grain bread (GI = 79) from the daily diet … might eliminate almost 8% of advanced AMD cases in a 5-year period,” they reported.

However, in participants at risk for early AMD progression, only those in the placebo group benefited from higher DHA intake, because of an antagonistic interaction between DHA and AREDS supplementation in the other groups.

That antagonistic interaction “was not observed in our analysis of progression to advanced AMD,” wrote the authors. “These results may imply that the protective effect of DHA may be through different mechanisms at different stages of AMD progression.”

Analysis of the global effect of low dGI showed a significant protection against progression to advanced AMD, independent of AREDS intervention, although an interaction test suggested that the extent of protection may vary by type of AREDS intervention. Further stratification analysis found a synergistic interaction between low dGI diets and AREDS supplementation, suggesting that a low-dGI diet is beneficial for those at risk of advanced disease, and that those taking the supplementation would benefit even more.

However, a higher dietary beta-carotene intake was associated with an increased risk of progression to advanced disease. Although that risk was independent of the type of supplementation, it was strongest in those receiving the antioxidants plus zinc.

The investigators noted that the AREDS supplementation was already not recommended for smokers because of the risk of lung cancer from beta-carotene.

The new finding linking beta-carotene and disease progression lends support to dropping beta-carotene from the supplement, they noted.

The project received financial support from the U.S. Department of Agriculture and the National Institutes of Health, and grants from the Johnson & Johnson Focused Giving Program, American Health Assistance Foundation, and the Ross Aging Initiative. None of the authors had any financial disclosures related to the study.

Weekly consumption of 2-3 servings of DHA-rich foods such as salmon, tuna, or mackerel cut progression of AMD. Lynda Banzi/Elsevier Global Medical News

Supplements of antioxidants and zinc plus higher dietary intakes of docosahexaenoic acid or eicosapentaenoic acid and a reduction in the dietary glycemic index protect against progression to advanced age-related macular degeneration, according to an analysis of 8 years of data from the Age-Related Eye Disease Study.

The same analysis also found that a diet rich in docosahexaenoic acid (DHA) was associated with a lower progression of early age-related macular degeneration (AMD), independent of the supplements.

Such benefits would come from the weekly consumption of two to three servings of fatty fish, such as salmon, tuna, mackerel, shellfish, and herring. That would achieve the recommended daily intake of omega-3 fatty acids, and substantially cut the risk of both early- and late-stage AMD, wrote Chung-Jung Chiu, D.D.S., Ph.D., of Tufts University, Boston, and his colleagues (Br. J. Ophthalmol. Online First 2009 [doi:10. 1136/bjo.2008.143412]).

There is no cure for AMD, making efforts to prevent it or delay its progression all the more pressing, especially with a rapidly aging world population.

Data from observational studies have suggested that a higher intake of antioxidants is associated with a reduced risk of AMD. Earlier data from the Age-Related Eye Disease Study (AREDS) have shown that high doses of antioxidants (vitamins C and E, and beta-carotene) and zinc benefit people at risk for advanced AMD. However, other data have suggested that DHA and eicosapentaenoic acid (EPA) may be protective against the disease, or that lowering the dietary glycemic index (dGI) reduces disease risk.

The new study is the first to examine a potential association between progression to advanced AMD and intake of the aforementioned nutrients plus dietary DHA and EPA and a reduced dGI.

Of 3,640 study participants, 2,924 individuals (2,523 eyes) in the early stages of the disease were selected after exclusions, and continued receiving placebo, antioxidants, zinc, or antioxidant plus zinc.

Their mean age was 69 years, 97% were white, and 58% were women. Fifty-six percent of the participants had ever smoked and 39% were hypertensive, and their mean dietary intakes, expressed as servings/week, were fruits and juices (16), vegetables (16), fish (2), meat (5), and dairy products (11). The researchers gathered data on possible risk factors from baseline physical and ophthalmic examinations and demographic and food-frequency questionnaires, and obtained and graded fundus photographs of the macula at baseline, 2 years, and then annually up to 8 years.

The eyes were originally classified into one of five groups based on increasing severity of drusen or AMD type, with groups 1-3 defined as early AMD and groups 4 and 5 as advanced AMD. Groups 1 and 2 (at risk of early AMD progression) and group 3 (at risk of advanced AMD progression) were used in the current study.

Progression for an eye was defined as a more advanced grade than the baseline grade. The AREDS supplementation formula contained 5, 6, and 18 times the recommended daily allowance of zinc, vitamin C, and vitamin E, respectively.

Independent of AREDS supplementation, increased intake of DHA and EPA and a lower dGI were associated with a lower risk of progression from early to advanced AMD. Participants who consumed the greatest amounts of DHA (64 mg/day or more) and EPA (42 mg/day or more) and had the greatest reduction in dGI were at the lowest risk.

The protective effect of the omega-3 fatty acids (DHA and EPA) against progression to advanced disease may have occurred because Western diets provide low levels of the fatty acids, the researchers said. Thus, any increase in their intakes would promote prevention.

In regard to dGI, the participants' diet was high in refined carbohydrates (high-GI foods). “These data show that a 6-unit reduction in dGI [roughly] equivalent to replacing five slices of white bread (GI = 100) with five slices of whole-grain bread (GI = 79) from the daily diet … might eliminate almost 8% of advanced AMD cases in a 5-year period,” they reported.

However, in participants at risk for early AMD progression, only those in the placebo group benefited from higher DHA intake, because of an antagonistic interaction between DHA and AREDS supplementation in the other groups.

That antagonistic interaction “was not observed in our analysis of progression to advanced AMD,” wrote the authors. “These results may imply that the protective effect of DHA may be through different mechanisms at different stages of AMD progression.”

Analysis of the global effect of low dGI showed a significant protection against progression to advanced AMD, independent of AREDS intervention, although an interaction test suggested that the extent of protection may vary by type of AREDS intervention. Further stratification analysis found a synergistic interaction between low dGI diets and AREDS supplementation, suggesting that a low-dGI diet is beneficial for those at risk of advanced disease, and that those taking the supplementation would benefit even more.

However, a higher dietary beta-carotene intake was associated with an increased risk of progression to advanced disease. Although that risk was independent of the type of supplementation, it was strongest in those receiving the antioxidants plus zinc.

The investigators noted that the AREDS supplementation was already not recommended for smokers because of the risk of lung cancer from beta-carotene.

The new finding linking beta-carotene and disease progression lends support to dropping beta-carotene from the supplement, they noted.

The project received financial support from the U.S. Department of Agriculture and the National Institutes of Health, and grants from the Johnson & Johnson Focused Giving Program, American Health Assistance Foundation, and the Ross Aging Initiative. None of the authors had any financial disclosures related to the study.

Weekly consumption of 2-3 servings of DHA-rich foods such as salmon, tuna, or mackerel cut progression of AMD. Lynda Banzi/Elsevier Global Medical News

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

Patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

They also reported that televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to be able to use telemedicine to expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (range, 1-5) and a mean motor UPDRS of 34.7 (range, 1-108, with higher scores indicating greater disability).

The community participants were randomized to telemedicine care (six) or standard care (four). All four nursing home patients received telemedicine care. Those in the telemedicine group received three one-on-one visits over 6 months (month 1, 2, and 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

The Web-based televideo assessments were conducted at the nursing home. They mirrored an inperson evaluation, during which patients were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration). The four nursing home patients completed 94% of their telemedicine visits, showing trends toward improvement in care satisfaction, quality of life, and depressive symptoms.

The investigators also reported the motor UPDRS items were able to be completed at each visit. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

In focus group follow-up, both patients and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” Dr. Biglan said in an interview. “They were adamant that it was convenient and made communicating easy.” Nevertheless, “travel remained an issue for some, [and] others had mixed feelings about completing telemedicine visits at home without medical and technical support staff.”

Dr. Biglan said the study was limited by its focus on feasibility and a single disease. “While short-term feasibility was established, the long-tern feasibility and benefits of telemedicine [have yet] to be evaluated. The study's focus was PD, whose clinical evaluation is largely visual. The reliability and validity of telemedicine assessments for PD remains to be established, as does applicability to other conditions such as Alzheimer's disease, which are more common in nursing home populations.”

The researchers plan to expand the telemedicine initiatives to other sites and evaluate the use of remote assessments via telemedicine in clinical trials.

The study was funded by the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

Patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

They also reported that televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to be able to use telemedicine to expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (range, 1-5) and a mean motor UPDRS of 34.7 (range, 1-108, with higher scores indicating greater disability).

The community participants were randomized to telemedicine care (six) or standard care (four). All four nursing home patients received telemedicine care. Those in the telemedicine group received three one-on-one visits over 6 months (month 1, 2, and 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

The Web-based televideo assessments were conducted at the nursing home. They mirrored an inperson evaluation, during which patients were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration). The four nursing home patients completed 94% of their telemedicine visits, showing trends toward improvement in care satisfaction, quality of life, and depressive symptoms.

The investigators also reported the motor UPDRS items were able to be completed at each visit. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

In focus group follow-up, both patients and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” Dr. Biglan said in an interview. “They were adamant that it was convenient and made communicating easy.” Nevertheless, “travel remained an issue for some, [and] others had mixed feelings about completing telemedicine visits at home without medical and technical support staff.”

Dr. Biglan said the study was limited by its focus on feasibility and a single disease. “While short-term feasibility was established, the long-tern feasibility and benefits of telemedicine [have yet] to be evaluated. The study's focus was PD, whose clinical evaluation is largely visual. The reliability and validity of telemedicine assessments for PD remains to be established, as does applicability to other conditions such as Alzheimer's disease, which are more common in nursing home populations.”

The researchers plan to expand the telemedicine initiatives to other sites and evaluate the use of remote assessments via telemedicine in clinical trials.

The study was funded by the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.

Using telemedicine to evaluate patients with Parkinson's disease is reliable and feasible, according to data from a small, randomized, controlled pilot study of nursing home and community-dwelling patients.

Patients in the study with Parkinson's disease (PD) who received telemedicine care over the course of 6 months showed improvements in quality of life, mood, satisfaction with care, cognition, and motor function, compared with those who received standard care, Dr. Kevin M. Biglan and Dr. Ray Dorsey of the University of Rochester (N.Y.) and their colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders in Paris.

They also reported that televideo assessments of the motor Unified Parkinson's Disease Rating Scale (UPDRS) were reliable and valid, compared with the standard in-person assessment of these patients.

The researchers enrolled 14 patients who lived 150 miles from the university (4 in a nursing home and 10 who lived in the community nearby). By providing the patients with Web-based telemedicine, they sought to improve their access to specialized care. They also hoped to be able to use telemedicine to expand the pool of Parkinson's patients who could participate in clinical trials if the logistics and difficulties relating to travel and costs were eliminated.

At baseline, the participants were a mean age of 71 years, and half were women. They had a mean Hoehn & Yahr stage of 2.7 (range, 1-5) and a mean motor UPDRS of 34.7 (range, 1-108, with higher scores indicating greater disability).

The community participants were randomized to telemedicine care (six) or standard care (four). All four nursing home patients received telemedicine care. Those in the telemedicine group received three one-on-one visits over 6 months (month 1, 2, and 3) from one of two investigators who were movement disorder specialists. There was a fourth visit, at 6.5 months, to allow for the test-retest reliability comparison of the 6- and 6.5-month motor scores.

The Web-based televideo assessments were conducted at the nursing home. They mirrored an inperson evaluation, during which patients were asked about their PD, medications, function, and complications of therapy. The investigator performed a motor UPDRS examination at each visit, with a nurse available to assist in performing rigidity testing and pull testing.

Participants in the control group received their standard routine care from their primary physician and/or neurologist.

All the community-dwelling patients randomized to telemedicine completed all three telemedicine visits. Compared with their standard-care counterparts, they showed significant improvements in quality of life on the EQ-5D (6.3-point improvement vs. 17.2-point deterioration) and the motor UPDRS (0.33 improvement vs. 6.5 deterioration). The four nursing home patients completed 94% of their telemedicine visits, showing trends toward improvement in care satisfaction, quality of life, and depressive symptoms.

The investigators also reported the motor UPDRS items were able to be completed at each visit. All of the motor items were fair or better agreement between telemedicine and in-person, except for rigidity and leg agility, leading the researchers to conclude that the motor UPDRS is reliable and valid in the telemedicine setting.

One of the 10 telemedicine participants discontinued with telemedicine care after the study was completed.

In focus group follow-up, both patients and caregivers reported high satisfaction with telemedicine, “especially the decreased travel burden and access to higher quality, dedicated PD experts,” Dr. Biglan said in an interview. “They were adamant that it was convenient and made communicating easy.” Nevertheless, “travel remained an issue for some, [and] others had mixed feelings about completing telemedicine visits at home without medical and technical support staff.”

Dr. Biglan said the study was limited by its focus on feasibility and a single disease. “While short-term feasibility was established, the long-tern feasibility and benefits of telemedicine [have yet] to be evaluated. The study's focus was PD, whose clinical evaluation is largely visual. The reliability and validity of telemedicine assessments for PD remains to be established, as does applicability to other conditions such as Alzheimer's disease, which are more common in nursing home populations.”

The researchers plan to expand the telemedicine initiatives to other sites and evaluate the use of remote assessments via telemedicine in clinical trials.

The study was funded by the Presbyterian Home for Central New York and the Central New York Parkinson's Disease Support Group. None of the researchers had any conflicts of interest.

Obituary

Dr. David C. Sabiston Jr., a cardiac surgeon who performed one of the early coronary bypass operations in a human, died of a stroke at his home in Chapel Hill, N.C. He was 84.

In that 1962 procedure, Dr. Sabiston and his team at Johns Hopkins University in Baltimore used the leg veins of a patient to graft a conduit between the aorta and blocked coronary arteries. Two years later, Dr. Michael E. DeBakey and Dr. H. Edward Garrett performed what is considered to be the first successful coronary bypass surgery, this time aided by advances and refinements in the heart-lung machine (CARDIOLOGY NEWS, August 2008, p. 23).

In addition to his recognition as a pioneer surgeon and researcher, Dr. Sabiston was acknowledged nationally and internationally for his substantial contribution to surgical education. He edited two of the leading textbooks in surgery—Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, now in its 16th edition; and Sabiston & Spencer Surgery of the Chest, now in its 7th edition.

After moving in 1964 from Hopkins to Duke University in Durham, N.C., as professor of surgery and chair of the department of surgery, Dr. Sabiston continued that department's philosophy of consolidating patient care, education, and research. Dr. Nancy Andrews, dean of medicine at Duke, recalled in a statement that Dr. Sabiston was a “hero in the eyes of the surgeons” who had taught her in medical school. In addition, against the political backdrop of the civil rights movement in the 1960s, Dr. Sabiston was instrumental in opening the Duke clinics to blacks, and he later advocated for greater representation of minorities on the faculty.

Dr. Sabiston completed his medical degree and a surgical residency at Johns Hopkins University School of Medicine. In 1953, he began a 2-year stint in the U.S. Army Medical Corps in the cardiovascular research department at Walter Reed Medical Center in Washington, after which he returned to Hopkins as an assistant professor of surgery and an investigator at the Howard Hughes Medical Institute in Chevy Chase, Md. He studied at the University of London and Oxford University on a Fulbright scholarship and again returned to Hopkins, where he became professor of surgery before leaving for Duke.

Cardiologists on the Move

Dr. Gordon Tomaselli, an expert on sudden cardiac death and heart rhythm disturbances, has been named director of the division of cardiology at the Johns Hopkins University School of Medicine and codirector of the school's Heart and Vascular Institute.

Dr. Tomaselli succeeds Dr. Eduardo Marbán, who had led the division since 2002 and moved to Los Angeles in 2007 as director of Cedars-Sinai Heart Institute (CARDIOLOGY NEWS, June 2007, p. 31). He will also succeed Dr. Marbán as the Michel Mirowski, M.D., Professor of Cardiology.

Most of Dr. Tomaselli's research has focused on arrhythmias, and especially new therapies for prevention of the condition. In addition, as codirector of the Donald W. Reynolds Cardiovascular Clinical Research Center, he has been studying the causes of sudden cardiac death. His future research is expected to explore the use of imaging and genetic screening in the early detection of arrhythmias and the use of stem cells to treat tissue damaged by heart attack or cardiac arrest.

Dr. Tomaselli, who has a degree in biochemistry and chemistry from the State University of New York at Buffalo, earned his medical degree from the Albert Einstein College of Medicine in New York, and completed his training and a residency in San Francisco at the University of California. He was a research fellow at the UCSF Cardiovascular Research Institute before moving to a fellowship program at Hopkins. He joined the faculty 3 years later.

Dr. David C. Sabiston Jr., a pioneer in coronary bypass surgery, was perhaps better known as he is shown here, as a teacher at Duke University. Duke University Medical Center Archives

Dr. Gordon Tomaselli

Obituary

Dr. David C. Sabiston Jr., a cardiac surgeon who performed one of the early coronary bypass operations in a human, died of a stroke at his home in Chapel Hill, N.C. He was 84.

In that 1962 procedure, Dr. Sabiston and his team at Johns Hopkins University in Baltimore used the leg veins of a patient to graft a conduit between the aorta and blocked coronary arteries. Two years later, Dr. Michael E. DeBakey and Dr. H. Edward Garrett performed what is considered to be the first successful coronary bypass surgery, this time aided by advances and refinements in the heart-lung machine (CARDIOLOGY NEWS, August 2008, p. 23).

In addition to his recognition as a pioneer surgeon and researcher, Dr. Sabiston was acknowledged nationally and internationally for his substantial contribution to surgical education. He edited two of the leading textbooks in surgery—Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, now in its 16th edition; and Sabiston & Spencer Surgery of the Chest, now in its 7th edition.

After moving in 1964 from Hopkins to Duke University in Durham, N.C., as professor of surgery and chair of the department of surgery, Dr. Sabiston continued that department's philosophy of consolidating patient care, education, and research. Dr. Nancy Andrews, dean of medicine at Duke, recalled in a statement that Dr. Sabiston was a “hero in the eyes of the surgeons” who had taught her in medical school. In addition, against the political backdrop of the civil rights movement in the 1960s, Dr. Sabiston was instrumental in opening the Duke clinics to blacks, and he later advocated for greater representation of minorities on the faculty.

Dr. Sabiston completed his medical degree and a surgical residency at Johns Hopkins University School of Medicine. In 1953, he began a 2-year stint in the U.S. Army Medical Corps in the cardiovascular research department at Walter Reed Medical Center in Washington, after which he returned to Hopkins as an assistant professor of surgery and an investigator at the Howard Hughes Medical Institute in Chevy Chase, Md. He studied at the University of London and Oxford University on a Fulbright scholarship and again returned to Hopkins, where he became professor of surgery before leaving for Duke.

Cardiologists on the Move

Dr. Gordon Tomaselli, an expert on sudden cardiac death and heart rhythm disturbances, has been named director of the division of cardiology at the Johns Hopkins University School of Medicine and codirector of the school's Heart and Vascular Institute.

Dr. Tomaselli succeeds Dr. Eduardo Marbán, who had led the division since 2002 and moved to Los Angeles in 2007 as director of Cedars-Sinai Heart Institute (CARDIOLOGY NEWS, June 2007, p. 31). He will also succeed Dr. Marbán as the Michel Mirowski, M.D., Professor of Cardiology.

Most of Dr. Tomaselli's research has focused on arrhythmias, and especially new therapies for prevention of the condition. In addition, as codirector of the Donald W. Reynolds Cardiovascular Clinical Research Center, he has been studying the causes of sudden cardiac death. His future research is expected to explore the use of imaging and genetic screening in the early detection of arrhythmias and the use of stem cells to treat tissue damaged by heart attack or cardiac arrest.

Dr. Tomaselli, who has a degree in biochemistry and chemistry from the State University of New York at Buffalo, earned his medical degree from the Albert Einstein College of Medicine in New York, and completed his training and a residency in San Francisco at the University of California. He was a research fellow at the UCSF Cardiovascular Research Institute before moving to a fellowship program at Hopkins. He joined the faculty 3 years later.

Dr. David C. Sabiston Jr., a pioneer in coronary bypass surgery, was perhaps better known as he is shown here, as a teacher at Duke University. Duke University Medical Center Archives

Dr. Gordon Tomaselli

Obituary

Dr. David C. Sabiston Jr., a cardiac surgeon who performed one of the early coronary bypass operations in a human, died of a stroke at his home in Chapel Hill, N.C. He was 84.

In that 1962 procedure, Dr. Sabiston and his team at Johns Hopkins University in Baltimore used the leg veins of a patient to graft a conduit between the aorta and blocked coronary arteries. Two years later, Dr. Michael E. DeBakey and Dr. H. Edward Garrett performed what is considered to be the first successful coronary bypass surgery, this time aided by advances and refinements in the heart-lung machine (CARDIOLOGY NEWS, August 2008, p. 23).

In addition to his recognition as a pioneer surgeon and researcher, Dr. Sabiston was acknowledged nationally and internationally for his substantial contribution to surgical education. He edited two of the leading textbooks in surgery—Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, now in its 16th edition; and Sabiston & Spencer Surgery of the Chest, now in its 7th edition.

After moving in 1964 from Hopkins to Duke University in Durham, N.C., as professor of surgery and chair of the department of surgery, Dr. Sabiston continued that department's philosophy of consolidating patient care, education, and research. Dr. Nancy Andrews, dean of medicine at Duke, recalled in a statement that Dr. Sabiston was a “hero in the eyes of the surgeons” who had taught her in medical school. In addition, against the political backdrop of the civil rights movement in the 1960s, Dr. Sabiston was instrumental in opening the Duke clinics to blacks, and he later advocated for greater representation of minorities on the faculty.

Dr. Sabiston completed his medical degree and a surgical residency at Johns Hopkins University School of Medicine. In 1953, he began a 2-year stint in the U.S. Army Medical Corps in the cardiovascular research department at Walter Reed Medical Center in Washington, after which he returned to Hopkins as an assistant professor of surgery and an investigator at the Howard Hughes Medical Institute in Chevy Chase, Md. He studied at the University of London and Oxford University on a Fulbright scholarship and again returned to Hopkins, where he became professor of surgery before leaving for Duke.

Cardiologists on the Move

Dr. Gordon Tomaselli, an expert on sudden cardiac death and heart rhythm disturbances, has been named director of the division of cardiology at the Johns Hopkins University School of Medicine and codirector of the school's Heart and Vascular Institute.

Dr. Tomaselli succeeds Dr. Eduardo Marbán, who had led the division since 2002 and moved to Los Angeles in 2007 as director of Cedars-Sinai Heart Institute (CARDIOLOGY NEWS, June 2007, p. 31). He will also succeed Dr. Marbán as the Michel Mirowski, M.D., Professor of Cardiology.

Most of Dr. Tomaselli's research has focused on arrhythmias, and especially new therapies for prevention of the condition. In addition, as codirector of the Donald W. Reynolds Cardiovascular Clinical Research Center, he has been studying the causes of sudden cardiac death. His future research is expected to explore the use of imaging and genetic screening in the early detection of arrhythmias and the use of stem cells to treat tissue damaged by heart attack or cardiac arrest.

Dr. Tomaselli, who has a degree in biochemistry and chemistry from the State University of New York at Buffalo, earned his medical degree from the Albert Einstein College of Medicine in New York, and completed his training and a residency in San Francisco at the University of California. He was a research fellow at the UCSF Cardiovascular Research Institute before moving to a fellowship program at Hopkins. He joined the faculty 3 years later.

Dr. David C. Sabiston Jr., a pioneer in coronary bypass surgery, was perhaps better known as he is shown here, as a teacher at Duke University. Duke University Medical Center Archives

Dr. Gordon Tomaselli