Sharon Worcester

RHODES, GREECE — Adalimumab does not appear to increase the risk of serious infection in patients with rheumatoid arthritis, Dr. J. Kent reported at the 15th Congress of the European Academy of Dermatology and Venereology.

There was concern that rheumatoid arthritis (RA) patients, who are more prone to infection than are their healthy peers, would develop more infections while on anti-tumor necrosis factor (anti-TNF) agents like adalimumab (Humira) because of the role these agents play in host defense, Dr. Kent explained in a poster at the meeting.

However, in a study of more than 2,500 patients who participated in North American and European trials of adalimumab—which is also approved for the treatment of psoriatic arthritis and ankylosing spondylitis—there was no increased incidence of serious infections in RA patients, compared with the reported incidence of such infections in RA patients naive to anti-TNF therapy.

A total of 378 serious infections—most commonly pneumonia (70 patients), septic arthritis (37 patients), urinary tract infection (34 patients), and cellulitis (30 patients)—occurred in 305 patients (4.3 infections per 100 patient-years). The rates were similar to those reported in RA patients prior to availability of anti-TNF agents (3.1–9.6 infections per 100 patient-years), according to Dr. Kent of Abbott Laboratories (the maker of Humira).

The rate of serious infections also was not affected by diabetes status; a total of 23 serious infections occurred in the 146 patients with RA who had diabetes (4.9 infections per 100 patient-years), compared with 355 of 2,358 patients without diabetes (4.3 infections per 100 patient-years). Of note is a finding that 73% of patients with serious infections were using steroids at the time of the infection.

RHODES, GREECE — Adalimumab does not appear to increase the risk of serious infection in patients with rheumatoid arthritis, Dr. J. Kent reported at the 15th Congress of the European Academy of Dermatology and Venereology.

There was concern that rheumatoid arthritis (RA) patients, who are more prone to infection than are their healthy peers, would develop more infections while on anti-tumor necrosis factor (anti-TNF) agents like adalimumab (Humira) because of the role these agents play in host defense, Dr. Kent explained in a poster at the meeting.

However, in a study of more than 2,500 patients who participated in North American and European trials of adalimumab—which is also approved for the treatment of psoriatic arthritis and ankylosing spondylitis—there was no increased incidence of serious infections in RA patients, compared with the reported incidence of such infections in RA patients naive to anti-TNF therapy.

A total of 378 serious infections—most commonly pneumonia (70 patients), septic arthritis (37 patients), urinary tract infection (34 patients), and cellulitis (30 patients)—occurred in 305 patients (4.3 infections per 100 patient-years). The rates were similar to those reported in RA patients prior to availability of anti-TNF agents (3.1–9.6 infections per 100 patient-years), according to Dr. Kent of Abbott Laboratories (the maker of Humira).

The rate of serious infections also was not affected by diabetes status; a total of 23 serious infections occurred in the 146 patients with RA who had diabetes (4.9 infections per 100 patient-years), compared with 355 of 2,358 patients without diabetes (4.3 infections per 100 patient-years). Of note is a finding that 73% of patients with serious infections were using steroids at the time of the infection.

RHODES, GREECE — Adalimumab does not appear to increase the risk of serious infection in patients with rheumatoid arthritis, Dr. J. Kent reported at the 15th Congress of the European Academy of Dermatology and Venereology.

There was concern that rheumatoid arthritis (RA) patients, who are more prone to infection than are their healthy peers, would develop more infections while on anti-tumor necrosis factor (anti-TNF) agents like adalimumab (Humira) because of the role these agents play in host defense, Dr. Kent explained in a poster at the meeting.

However, in a study of more than 2,500 patients who participated in North American and European trials of adalimumab—which is also approved for the treatment of psoriatic arthritis and ankylosing spondylitis—there was no increased incidence of serious infections in RA patients, compared with the reported incidence of such infections in RA patients naive to anti-TNF therapy.

A total of 378 serious infections—most commonly pneumonia (70 patients), septic arthritis (37 patients), urinary tract infection (34 patients), and cellulitis (30 patients)—occurred in 305 patients (4.3 infections per 100 patient-years). The rates were similar to those reported in RA patients prior to availability of anti-TNF agents (3.1–9.6 infections per 100 patient-years), according to Dr. Kent of Abbott Laboratories (the maker of Humira).

The rate of serious infections also was not affected by diabetes status; a total of 23 serious infections occurred in the 146 patients with RA who had diabetes (4.9 infections per 100 patient-years), compared with 355 of 2,358 patients without diabetes (4.3 infections per 100 patient-years). Of note is a finding that 73% of patients with serious infections were using steroids at the time of the infection.

RHODES, GREECE — Lactamide monoethanolamine, a lactic acid-derived humectant commonly found in over-the-counter lotions and bath gels, appears to be beneficial for the treatment of cradle cap, Virginie Ribet, Ph.D., said at the 15th Congress of the European Academy of Dermatology and Venereology.

A lactamide monoethanolamine-based gel was safe, effective, and well tolerated in a randomized, controlled, open-label phase III study of 124 infants with mild to moderate seborrheic dermatitis of the scalp, Dr. Ribet of Pierre Fabre Research Institute in Ramonville Saint Agne, France, reported in a poster presentation.

Lesional scores, which were based on the area of involvement and intensity of scaling on four zones of the scalp, decreased significantly more in the 63 infants in the treatment group, compared with the 61 infants in the control group, at day 7 (55% vs. 42%), day 21 (81% vs. 70%), and day 42 (96% vs. 86%).

A lesional score of 0 was noted in 73% of infants in the treatment group at the end of the study, compared with 50% of those in the control group, said Dr. Ribet who did not disclose interest in the gel.

Parents of the 63 infants in the treatment group were asked to apply the gel, followed by a soft shampoo, daily for the first week, then two to three times per week thereafter for the course of the study. Only soft shampoo was applied to the 61 infants in the control group.

The gel was safe and well tolerated in both groups. Erythema was significantly improved from baseline to study end in both groups.

Both the investigators and the parents reported satisfaction on overall assessment; the product led to recovery or definite improvement in all treated infants, she noted.

RHODES, GREECE — Lactamide monoethanolamine, a lactic acid-derived humectant commonly found in over-the-counter lotions and bath gels, appears to be beneficial for the treatment of cradle cap, Virginie Ribet, Ph.D., said at the 15th Congress of the European Academy of Dermatology and Venereology.

A lactamide monoethanolamine-based gel was safe, effective, and well tolerated in a randomized, controlled, open-label phase III study of 124 infants with mild to moderate seborrheic dermatitis of the scalp, Dr. Ribet of Pierre Fabre Research Institute in Ramonville Saint Agne, France, reported in a poster presentation.

Lesional scores, which were based on the area of involvement and intensity of scaling on four zones of the scalp, decreased significantly more in the 63 infants in the treatment group, compared with the 61 infants in the control group, at day 7 (55% vs. 42%), day 21 (81% vs. 70%), and day 42 (96% vs. 86%).

A lesional score of 0 was noted in 73% of infants in the treatment group at the end of the study, compared with 50% of those in the control group, said Dr. Ribet who did not disclose interest in the gel.

Parents of the 63 infants in the treatment group were asked to apply the gel, followed by a soft shampoo, daily for the first week, then two to three times per week thereafter for the course of the study. Only soft shampoo was applied to the 61 infants in the control group.

The gel was safe and well tolerated in both groups. Erythema was significantly improved from baseline to study end in both groups.

Both the investigators and the parents reported satisfaction on overall assessment; the product led to recovery or definite improvement in all treated infants, she noted.

RHODES, GREECE — Lactamide monoethanolamine, a lactic acid-derived humectant commonly found in over-the-counter lotions and bath gels, appears to be beneficial for the treatment of cradle cap, Virginie Ribet, Ph.D., said at the 15th Congress of the European Academy of Dermatology and Venereology.

A lactamide monoethanolamine-based gel was safe, effective, and well tolerated in a randomized, controlled, open-label phase III study of 124 infants with mild to moderate seborrheic dermatitis of the scalp, Dr. Ribet of Pierre Fabre Research Institute in Ramonville Saint Agne, France, reported in a poster presentation.

Lesional scores, which were based on the area of involvement and intensity of scaling on four zones of the scalp, decreased significantly more in the 63 infants in the treatment group, compared with the 61 infants in the control group, at day 7 (55% vs. 42%), day 21 (81% vs. 70%), and day 42 (96% vs. 86%).

A lesional score of 0 was noted in 73% of infants in the treatment group at the end of the study, compared with 50% of those in the control group, said Dr. Ribet who did not disclose interest in the gel.

Parents of the 63 infants in the treatment group were asked to apply the gel, followed by a soft shampoo, daily for the first week, then two to three times per week thereafter for the course of the study. Only soft shampoo was applied to the 61 infants in the control group.

The gel was safe and well tolerated in both groups. Erythema was significantly improved from baseline to study end in both groups.

Both the investigators and the parents reported satisfaction on overall assessment; the product led to recovery or definite improvement in all treated infants, she noted.

RHODES, GREECE — Combining topical immunomodulatory therapy or topical chemotherapy with cryosurgery provides an excellent alternative to excisional treatment for many skin malignancies, Dr. Paola Pasquali said at the 15th Congress of the European Academy of Dermatology and Venereology.

Cryosurgery itself represents an excellent option for many skin malignancies, including most basal cell carcinomas. Exceptions include morpheaform, metatypical, and neurotropic basal cell carcinomas, for which Mohs surgery is preferable. Cryosurgery is also beneficial for well-differentiated squamous cell carcinomas and lentigo maligna, she said.

The use of the immune response modifier imiquimod before any surgical intervention can improve local immune response and reduce treatment areas. Cryosurgery can then be used to treat areas that failed to respond, said Dr. Pasquali, a dermatologist in private practice in Caracas, Venezuela.

This approach is particularly useful in patients with severe sun damage with multiple actinic keratoses or superficial basal cell carcinomas, she said, noting that she has her patients use imiquimod 5 days a week for 6 weeks, followed by cryotherapy for remaining lesions.

This reduces the need for surgical treatment and provides a better cosmetic outcome, she said.

For nodular basal cell carcinomas, biopsy and curettage is performed, and the lesion is allowed to heal before imiquimod treatment is initiated and cryosurgery is used to treat remaining lesions.

Topical chemotherapy with the antimetabolite 5-fluorouracil can also be used along with cryosurgery in some patients, such as those with actinic keratoses or Bowen's disease.

As with imiquimod, the topical treatment is used to reduce the number and size of lesions and the remaining lesions are treated with cryosurgery.

These combinations also are useful for palliation in patients with large tumors, Dr. Pasquali noted.

This female patient had a hypertrophic actinic keratosis that was associated with a squamous cell carcinoma and severe actinic damage.

Improvement was evident after cryosurgery of the nodular lesion and treatment with imiquimod on the rest of the patient's damaged skin. Photos Courtesy Dr. Paola Pasquali

RHODES, GREECE — Combining topical immunomodulatory therapy or topical chemotherapy with cryosurgery provides an excellent alternative to excisional treatment for many skin malignancies, Dr. Paola Pasquali said at the 15th Congress of the European Academy of Dermatology and Venereology.

Cryosurgery itself represents an excellent option for many skin malignancies, including most basal cell carcinomas. Exceptions include morpheaform, metatypical, and neurotropic basal cell carcinomas, for which Mohs surgery is preferable. Cryosurgery is also beneficial for well-differentiated squamous cell carcinomas and lentigo maligna, she said.

The use of the immune response modifier imiquimod before any surgical intervention can improve local immune response and reduce treatment areas. Cryosurgery can then be used to treat areas that failed to respond, said Dr. Pasquali, a dermatologist in private practice in Caracas, Venezuela.

This approach is particularly useful in patients with severe sun damage with multiple actinic keratoses or superficial basal cell carcinomas, she said, noting that she has her patients use imiquimod 5 days a week for 6 weeks, followed by cryotherapy for remaining lesions.

This reduces the need for surgical treatment and provides a better cosmetic outcome, she said.

For nodular basal cell carcinomas, biopsy and curettage is performed, and the lesion is allowed to heal before imiquimod treatment is initiated and cryosurgery is used to treat remaining lesions.

Topical chemotherapy with the antimetabolite 5-fluorouracil can also be used along with cryosurgery in some patients, such as those with actinic keratoses or Bowen's disease.

As with imiquimod, the topical treatment is used to reduce the number and size of lesions and the remaining lesions are treated with cryosurgery.

These combinations also are useful for palliation in patients with large tumors, Dr. Pasquali noted.

This female patient had a hypertrophic actinic keratosis that was associated with a squamous cell carcinoma and severe actinic damage.

Improvement was evident after cryosurgery of the nodular lesion and treatment with imiquimod on the rest of the patient's damaged skin. Photos Courtesy Dr. Paola Pasquali

RHODES, GREECE — Combining topical immunomodulatory therapy or topical chemotherapy with cryosurgery provides an excellent alternative to excisional treatment for many skin malignancies, Dr. Paola Pasquali said at the 15th Congress of the European Academy of Dermatology and Venereology.

Cryosurgery itself represents an excellent option for many skin malignancies, including most basal cell carcinomas. Exceptions include morpheaform, metatypical, and neurotropic basal cell carcinomas, for which Mohs surgery is preferable. Cryosurgery is also beneficial for well-differentiated squamous cell carcinomas and lentigo maligna, she said.

The use of the immune response modifier imiquimod before any surgical intervention can improve local immune response and reduce treatment areas. Cryosurgery can then be used to treat areas that failed to respond, said Dr. Pasquali, a dermatologist in private practice in Caracas, Venezuela.

This approach is particularly useful in patients with severe sun damage with multiple actinic keratoses or superficial basal cell carcinomas, she said, noting that she has her patients use imiquimod 5 days a week for 6 weeks, followed by cryotherapy for remaining lesions.

This reduces the need for surgical treatment and provides a better cosmetic outcome, she said.

For nodular basal cell carcinomas, biopsy and curettage is performed, and the lesion is allowed to heal before imiquimod treatment is initiated and cryosurgery is used to treat remaining lesions.

Topical chemotherapy with the antimetabolite 5-fluorouracil can also be used along with cryosurgery in some patients, such as those with actinic keratoses or Bowen's disease.

As with imiquimod, the topical treatment is used to reduce the number and size of lesions and the remaining lesions are treated with cryosurgery.

These combinations also are useful for palliation in patients with large tumors, Dr. Pasquali noted.

This female patient had a hypertrophic actinic keratosis that was associated with a squamous cell carcinoma and severe actinic damage.

Improvement was evident after cryosurgery of the nodular lesion and treatment with imiquimod on the rest of the patient's damaged skin. Photos Courtesy Dr. Paola Pasquali

RHODES, GREECE — A new intralesional cryosurgery technique for targeting dermal skin lesions is safe and effective for the treatment of keloids and hypertrophic scars, Dr. Christos Zouboulis reported at the 15th Congress of the European Academy of Dermatology and Venereology.

The technique is a modified version of one first reported in 1993 and is performed using a novel intralesional cryoprobe (Etgar Group International Ltd., Israel) invented by Dr. Yaron Har-Shai of Berlin, Germany, and his associates. The probe, which is approved by the U.S. Food and Drug Administration, has an elongated, double-lumen, uninsulated needle with a safety cryogen vent and a sharp-cutting, sealed, distal tip designed to easily penetrate hard and dense dermal lesions such as keloids and hypertrophic scars.

In a pilot study of nine patients with recalcitrant auricular keloids, the proximal end of the probe was attached to an adaptor, which was connected to a standard "cryogun" cryogen source. The cryogun was filled with liquid nitrogen about 15 minutes before the procedure to allow adequate pressure to build up.

The patients were placed in the supine position, and the keloid surface was cleaned, disinfected, and draped. The area to be penetrated with the cryoprobe was intralesionally anesthetized with 1% lidocaine, and the sterile cryoprobe was forced into the long axis of the scar, with the sharp tip of the needle penetrating the distal edge of the scar.

Upon activation of the cryogun, the cryogen froze the keloids within 5–30 minutes, depending on scar volume, as iceballs appeared at each penetrating point of the cryoneedle and gradually spread toward one another. When the iceballs met, indicating complete freezing of the keloid, the cryogun was disengaged, and the cryoprobe was allowed to defrost for 1–2 minutes before being carefully withdrawn.

Treatment resulted in an average 67% reduction in scar volume at 6 months, which was maintained for up to 18 months after a single treatment. The average pretreatment scar volume was 2.89 cm

Patients also had significant reductions in scar hardness, scar elevation, and redness (average pre- and posttreatment scores of 2.9 vs. 0.50, 3.0 vs. 1.0, and 2.9 vs. 0.8, respectively). Subjective complaints were also reduced following treatment, with reductions seen in itching, pain, and tenderness (average pre- and posttreatment scores of 2.5 vs. 1.19, 2.0 vs. 0.3, and 2.3 vs. 0.4, respectively). There were no scar recurrences at 18 months' follow-up.

The treatment was generally well tolerated, Dr. Zouboulis said.

Any mild pain or discomfort that occurred during or after the procedure was easily managed. No active bleeding, infection, or adverse reactions such as hypopigmentation occurred, he noted.

The patients, seven women and two men aged 18–55 years, had a total of 10 keloids of 6 months' to 6 years' duration. The keloids, which resulted from piercings in 9 of 10 cases, and from a laceration in 1 case, had failed to respond to excision, laser surgery, surface cryosurgery, intralesional corticosteroid injections, and/or silicone ointment. The findings were reported earlier this year by Dr. Har-Shai, Dr. Zouboulis, and their associates (Wound Rep. Regen. 2006;14:18–27).

Histologic evaluation and studies of swine tissue following ex vivo intralesional cryosurgery—conducted as part of the same study in an effort to explain the mechanism of action of the cryoprobe—showed that the technique destroys the core of the scar with only small effects on surface cells, including melanocytes. The cryodamage caused by the technique is self-limited, and complete cell death is identified in the central cryolesions immediately following treatment; this suggests that direct cryothermic injury is the primary mechanism of action, the investigators explained.

The lack of hypopigmentation in this study—which might be explained by the minimal histologic changes in superficial adjacent areas of the central cryolesion, revealing a limited, demarcated, irreversible cell injury—suggests this technique might be particularly useful in patients with black or pigmented skin, who have a high prevalence of keloids, Dr. Zouboulis noted, adding that this technique and technology can be applied to scars of various shapes and contours at the ear helix and lobule, as well as in other areas of the body, as demonstrated in this and other studies.

In fact, the technology was developed for and will be studied for other indications involving deep skin lesions; keloids served as a "nondangerous proving principle" for efficacy, he explained.

"The major advantage of the intralesional cryoprobe to destroy the deeply localized target tissue with minimal effect on the superficial skin layers may have a significant importance in the future in the clinical application of cryosurgery not only in the treatment of keloids but also of other deeply localized skin lesions and tumors," he concluded.

Auricular keloids are shown at baseline (left) and after the intralesional cryosurgery technique. Photos courtesy Dr. Yaron Har-Shai

RHODES, GREECE — A new intralesional cryosurgery technique for targeting dermal skin lesions is safe and effective for the treatment of keloids and hypertrophic scars, Dr. Christos Zouboulis reported at the 15th Congress of the European Academy of Dermatology and Venereology.

The technique is a modified version of one first reported in 1993 and is performed using a novel intralesional cryoprobe (Etgar Group International Ltd., Israel) invented by Dr. Yaron Har-Shai of Berlin, Germany, and his associates. The probe, which is approved by the U.S. Food and Drug Administration, has an elongated, double-lumen, uninsulated needle with a safety cryogen vent and a sharp-cutting, sealed, distal tip designed to easily penetrate hard and dense dermal lesions such as keloids and hypertrophic scars.

In a pilot study of nine patients with recalcitrant auricular keloids, the proximal end of the probe was attached to an adaptor, which was connected to a standard "cryogun" cryogen source. The cryogun was filled with liquid nitrogen about 15 minutes before the procedure to allow adequate pressure to build up.

The patients were placed in the supine position, and the keloid surface was cleaned, disinfected, and draped. The area to be penetrated with the cryoprobe was intralesionally anesthetized with 1% lidocaine, and the sterile cryoprobe was forced into the long axis of the scar, with the sharp tip of the needle penetrating the distal edge of the scar.

Upon activation of the cryogun, the cryogen froze the keloids within 5–30 minutes, depending on scar volume, as iceballs appeared at each penetrating point of the cryoneedle and gradually spread toward one another. When the iceballs met, indicating complete freezing of the keloid, the cryogun was disengaged, and the cryoprobe was allowed to defrost for 1–2 minutes before being carefully withdrawn.

Treatment resulted in an average 67% reduction in scar volume at 6 months, which was maintained for up to 18 months after a single treatment. The average pretreatment scar volume was 2.89 cm

Patients also had significant reductions in scar hardness, scar elevation, and redness (average pre- and posttreatment scores of 2.9 vs. 0.50, 3.0 vs. 1.0, and 2.9 vs. 0.8, respectively). Subjective complaints were also reduced following treatment, with reductions seen in itching, pain, and tenderness (average pre- and posttreatment scores of 2.5 vs. 1.19, 2.0 vs. 0.3, and 2.3 vs. 0.4, respectively). There were no scar recurrences at 18 months' follow-up.

The treatment was generally well tolerated, Dr. Zouboulis said.

Any mild pain or discomfort that occurred during or after the procedure was easily managed. No active bleeding, infection, or adverse reactions such as hypopigmentation occurred, he noted.

The patients, seven women and two men aged 18–55 years, had a total of 10 keloids of 6 months' to 6 years' duration. The keloids, which resulted from piercings in 9 of 10 cases, and from a laceration in 1 case, had failed to respond to excision, laser surgery, surface cryosurgery, intralesional corticosteroid injections, and/or silicone ointment. The findings were reported earlier this year by Dr. Har-Shai, Dr. Zouboulis, and their associates (Wound Rep. Regen. 2006;14:18–27).

Histologic evaluation and studies of swine tissue following ex vivo intralesional cryosurgery—conducted as part of the same study in an effort to explain the mechanism of action of the cryoprobe—showed that the technique destroys the core of the scar with only small effects on surface cells, including melanocytes. The cryodamage caused by the technique is self-limited, and complete cell death is identified in the central cryolesions immediately following treatment; this suggests that direct cryothermic injury is the primary mechanism of action, the investigators explained.

The lack of hypopigmentation in this study—which might be explained by the minimal histologic changes in superficial adjacent areas of the central cryolesion, revealing a limited, demarcated, irreversible cell injury—suggests this technique might be particularly useful in patients with black or pigmented skin, who have a high prevalence of keloids, Dr. Zouboulis noted, adding that this technique and technology can be applied to scars of various shapes and contours at the ear helix and lobule, as well as in other areas of the body, as demonstrated in this and other studies.

In fact, the technology was developed for and will be studied for other indications involving deep skin lesions; keloids served as a "nondangerous proving principle" for efficacy, he explained.

"The major advantage of the intralesional cryoprobe to destroy the deeply localized target tissue with minimal effect on the superficial skin layers may have a significant importance in the future in the clinical application of cryosurgery not only in the treatment of keloids but also of other deeply localized skin lesions and tumors," he concluded.

Auricular keloids are shown at baseline (left) and after the intralesional cryosurgery technique. Photos courtesy Dr. Yaron Har-Shai

RHODES, GREECE — A new intralesional cryosurgery technique for targeting dermal skin lesions is safe and effective for the treatment of keloids and hypertrophic scars, Dr. Christos Zouboulis reported at the 15th Congress of the European Academy of Dermatology and Venereology.

The technique is a modified version of one first reported in 1993 and is performed using a novel intralesional cryoprobe (Etgar Group International Ltd., Israel) invented by Dr. Yaron Har-Shai of Berlin, Germany, and his associates. The probe, which is approved by the U.S. Food and Drug Administration, has an elongated, double-lumen, uninsulated needle with a safety cryogen vent and a sharp-cutting, sealed, distal tip designed to easily penetrate hard and dense dermal lesions such as keloids and hypertrophic scars.

In a pilot study of nine patients with recalcitrant auricular keloids, the proximal end of the probe was attached to an adaptor, which was connected to a standard "cryogun" cryogen source. The cryogun was filled with liquid nitrogen about 15 minutes before the procedure to allow adequate pressure to build up.

The patients were placed in the supine position, and the keloid surface was cleaned, disinfected, and draped. The area to be penetrated with the cryoprobe was intralesionally anesthetized with 1% lidocaine, and the sterile cryoprobe was forced into the long axis of the scar, with the sharp tip of the needle penetrating the distal edge of the scar.

Upon activation of the cryogun, the cryogen froze the keloids within 5–30 minutes, depending on scar volume, as iceballs appeared at each penetrating point of the cryoneedle and gradually spread toward one another. When the iceballs met, indicating complete freezing of the keloid, the cryogun was disengaged, and the cryoprobe was allowed to defrost for 1–2 minutes before being carefully withdrawn.

Treatment resulted in an average 67% reduction in scar volume at 6 months, which was maintained for up to 18 months after a single treatment. The average pretreatment scar volume was 2.89 cm

Patients also had significant reductions in scar hardness, scar elevation, and redness (average pre- and posttreatment scores of 2.9 vs. 0.50, 3.0 vs. 1.0, and 2.9 vs. 0.8, respectively). Subjective complaints were also reduced following treatment, with reductions seen in itching, pain, and tenderness (average pre- and posttreatment scores of 2.5 vs. 1.19, 2.0 vs. 0.3, and 2.3 vs. 0.4, respectively). There were no scar recurrences at 18 months' follow-up.

The treatment was generally well tolerated, Dr. Zouboulis said.

Any mild pain or discomfort that occurred during or after the procedure was easily managed. No active bleeding, infection, or adverse reactions such as hypopigmentation occurred, he noted.

The patients, seven women and two men aged 18–55 years, had a total of 10 keloids of 6 months' to 6 years' duration. The keloids, which resulted from piercings in 9 of 10 cases, and from a laceration in 1 case, had failed to respond to excision, laser surgery, surface cryosurgery, intralesional corticosteroid injections, and/or silicone ointment. The findings were reported earlier this year by Dr. Har-Shai, Dr. Zouboulis, and their associates (Wound Rep. Regen. 2006;14:18–27).

Histologic evaluation and studies of swine tissue following ex vivo intralesional cryosurgery—conducted as part of the same study in an effort to explain the mechanism of action of the cryoprobe—showed that the technique destroys the core of the scar with only small effects on surface cells, including melanocytes. The cryodamage caused by the technique is self-limited, and complete cell death is identified in the central cryolesions immediately following treatment; this suggests that direct cryothermic injury is the primary mechanism of action, the investigators explained.

The lack of hypopigmentation in this study—which might be explained by the minimal histologic changes in superficial adjacent areas of the central cryolesion, revealing a limited, demarcated, irreversible cell injury—suggests this technique might be particularly useful in patients with black or pigmented skin, who have a high prevalence of keloids, Dr. Zouboulis noted, adding that this technique and technology can be applied to scars of various shapes and contours at the ear helix and lobule, as well as in other areas of the body, as demonstrated in this and other studies.

In fact, the technology was developed for and will be studied for other indications involving deep skin lesions; keloids served as a "nondangerous proving principle" for efficacy, he explained.

"The major advantage of the intralesional cryoprobe to destroy the deeply localized target tissue with minimal effect on the superficial skin layers may have a significant importance in the future in the clinical application of cryosurgery not only in the treatment of keloids but also of other deeply localized skin lesions and tumors," he concluded.

Auricular keloids are shown at baseline (left) and after the intralesional cryosurgery technique. Photos courtesy Dr. Yaron Har-Shai

SALT LAKE CITY — Automatically titrated continuous positive airway pressure appears to be an effective option for the management of obstructive sleep apnea in patients who fail to adhere to the standard of manually titrated CPAP.

Of 57 patients who were poorly compliant (defined in this study as using CPAP for 2–4 hours during a study night) or noncompliant (defined as using CPAP for less than 2 hours during a study night), 72% were compliant with auto-CPAP, Vincenza E. Castronovo, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.

The patients were a subgroup of 509 consecutive patients with severe obstructive sleep apnea who underwent one full night of polysomnography with manual CPAP titration, and who were noncompliant during that night. These patients received the auto-CPAP treatment one night after receiving the manual titration CPAP, and used it for a mean of 6.7 hours with an average pressure of 8.4 cm H₂O and a 90th centile pressure of 10.2 cm H₂O, said Dr. Castronovo of the University Vita-Salute San Raffaele, Milan.

SALT LAKE CITY — Automatically titrated continuous positive airway pressure appears to be an effective option for the management of obstructive sleep apnea in patients who fail to adhere to the standard of manually titrated CPAP.

Of 57 patients who were poorly compliant (defined in this study as using CPAP for 2–4 hours during a study night) or noncompliant (defined as using CPAP for less than 2 hours during a study night), 72% were compliant with auto-CPAP, Vincenza E. Castronovo, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.

The patients were a subgroup of 509 consecutive patients with severe obstructive sleep apnea who underwent one full night of polysomnography with manual CPAP titration, and who were noncompliant during that night. These patients received the auto-CPAP treatment one night after receiving the manual titration CPAP, and used it for a mean of 6.7 hours with an average pressure of 8.4 cm H₂O and a 90th centile pressure of 10.2 cm H₂O, said Dr. Castronovo of the University Vita-Salute San Raffaele, Milan.

SALT LAKE CITY — Automatically titrated continuous positive airway pressure appears to be an effective option for the management of obstructive sleep apnea in patients who fail to adhere to the standard of manually titrated CPAP.

Of 57 patients who were poorly compliant (defined in this study as using CPAP for 2–4 hours during a study night) or noncompliant (defined as using CPAP for less than 2 hours during a study night), 72% were compliant with auto-CPAP, Vincenza E. Castronovo, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.

The patients were a subgroup of 509 consecutive patients with severe obstructive sleep apnea who underwent one full night of polysomnography with manual CPAP titration, and who were noncompliant during that night. These patients received the auto-CPAP treatment one night after receiving the manual titration CPAP, and used it for a mean of 6.7 hours with an average pressure of 8.4 cm H₂O and a 90th centile pressure of 10.2 cm H₂O, said Dr. Castronovo of the University Vita-Salute San Raffaele, Milan.

BOSTON — Treadmill training appears to benefit children with cerebral palsy, according to the findings of three studies presented at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

In one study—a matched pairs, clinical, controlled trial that took place in a specialized school setting—6 weeks of partial-body-weight treadmill training improved walking speed over short distances. In some children, the training also improved endurance, Karen Janine Dodd, Ph.D., reported.

A total of seven children aged 5–14 years (mean of 8 years 9 months) were recruited for the experimental group, and seven others matched for gender, age, type of cerebral palsy (CP), and Gross Motor Function Classification System (GMFCS) level served as controls. Those in the experimental group walked on the treadmill using partial-body-weight support (using a harness support apparatus under physical therapist supervision) twice weekly for a maximum of 30 minutes per session for the 6-week study period. Control patients continued normal activities, which could include therapy but not treadmill training.

Compared with controls, those in the experimental group showed significant improvements in walking speed, with a mean increase of 4.21 m/min (a 68% increase over baseline) in the experimental group, and no change in the control group. Results on a 10-minute walk test showed a “definite trend” that fell short of statistical significance toward improvement in the experimental group, with a mean increase of 19.81 m (57% over baseline), said Dr. Dodd of La Trobe University, Melbourne. Children in this study had GMFCS level III (4 patients) or IV (10 patients) disease, indicating a moderate to severe walking disability. Six had athetoid quadriplegia, six had spastic quadriplegia, and two had spastic diplegia.

In another study, a more intensive program of body-weight supported treadmill training improved walking speed and efficiency, and in some cases functional gait, balance, and endurance in school-age children with CP and GMFCS level 1 who were able to ambulate independently without assistive devices.

Six children aged 6–14 years participated in 30-minute treadmill training sessions twice daily, 6 days per week for 6 weeks. A harness system was used to support 30% of body weight at the start of the study, and support was decreased to almost 0% by the end of the study, Patricia Burtner, Ph.D., reported.

Pre- and post-training tests showed significant improvements on 10-m walking velocity (mean 1.47 m/sec vs. 1.66 m/sec) and on energy expenditure index (mean 0.68 vs. 0.39, calculated as ambulation heart rate minus resting heart rate divided by ambulation velocity), said Dr. Burtner of the University of New Mexico, Albuquerque. Individual results on the 10-m velocity test showed that five of six participants improved by at least 13% and as much as 23% following training, while one had a decrease of about 8%. Three of six participants had 3%–30% improvement on the 6-minute endurance walk test.

Furthermore, three of the subjects showed improvement of 50%–300% on a single-leg balance test, and four of six showed improvement of 1%–9% on a gross motor function measure score, although the overall improvements on these tests were not statistically significant.

In a third study, an 8-week, home-based treadmill training program in ambulatory children with hemiplegic CP failed to show significant improvement in a number of outcome measures, including a 6-minute walk test, gross motor function measure, and gait symmetry and endurance, but participants and/or their families reported the training was beneficial.

“It is interesting to note that seven of eight families stated that treadmill training was beneficial, and that all reported improved gait and/or function,” said Amy Winter Bodkin, Ph.D., of the Center for Gait and Movement Analysis at the University of Colorado at Denver.

This randomized, controlled trial included eight children, aged 6–12 years, with GMFCS level I or II CP who trained three times per week (without body-weight support) for 20 minutes per session, and seven controls.

The findings are inconsistent with previous studies, and this may be a result of the relatively high level of ability in the study population. The participants felt the training promoted smoother gait and the ability to walk farther, Dr. Bodkin noted. Treadmill training should continue to be studied, she said.

A child with cerebral palsy is doing the treadmill training program in the home. Courtesy Dr. Amy Winter Bodkin

BOSTON — Treadmill training appears to benefit children with cerebral palsy, according to the findings of three studies presented at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

In one study—a matched pairs, clinical, controlled trial that took place in a specialized school setting—6 weeks of partial-body-weight treadmill training improved walking speed over short distances. In some children, the training also improved endurance, Karen Janine Dodd, Ph.D., reported.

A total of seven children aged 5–14 years (mean of 8 years 9 months) were recruited for the experimental group, and seven others matched for gender, age, type of cerebral palsy (CP), and Gross Motor Function Classification System (GMFCS) level served as controls. Those in the experimental group walked on the treadmill using partial-body-weight support (using a harness support apparatus under physical therapist supervision) twice weekly for a maximum of 30 minutes per session for the 6-week study period. Control patients continued normal activities, which could include therapy but not treadmill training.

Compared with controls, those in the experimental group showed significant improvements in walking speed, with a mean increase of 4.21 m/min (a 68% increase over baseline) in the experimental group, and no change in the control group. Results on a 10-minute walk test showed a “definite trend” that fell short of statistical significance toward improvement in the experimental group, with a mean increase of 19.81 m (57% over baseline), said Dr. Dodd of La Trobe University, Melbourne. Children in this study had GMFCS level III (4 patients) or IV (10 patients) disease, indicating a moderate to severe walking disability. Six had athetoid quadriplegia, six had spastic quadriplegia, and two had spastic diplegia.

In another study, a more intensive program of body-weight supported treadmill training improved walking speed and efficiency, and in some cases functional gait, balance, and endurance in school-age children with CP and GMFCS level 1 who were able to ambulate independently without assistive devices.

Six children aged 6–14 years participated in 30-minute treadmill training sessions twice daily, 6 days per week for 6 weeks. A harness system was used to support 30% of body weight at the start of the study, and support was decreased to almost 0% by the end of the study, Patricia Burtner, Ph.D., reported.

Pre- and post-training tests showed significant improvements on 10-m walking velocity (mean 1.47 m/sec vs. 1.66 m/sec) and on energy expenditure index (mean 0.68 vs. 0.39, calculated as ambulation heart rate minus resting heart rate divided by ambulation velocity), said Dr. Burtner of the University of New Mexico, Albuquerque. Individual results on the 10-m velocity test showed that five of six participants improved by at least 13% and as much as 23% following training, while one had a decrease of about 8%. Three of six participants had 3%–30% improvement on the 6-minute endurance walk test.

Furthermore, three of the subjects showed improvement of 50%–300% on a single-leg balance test, and four of six showed improvement of 1%–9% on a gross motor function measure score, although the overall improvements on these tests were not statistically significant.

In a third study, an 8-week, home-based treadmill training program in ambulatory children with hemiplegic CP failed to show significant improvement in a number of outcome measures, including a 6-minute walk test, gross motor function measure, and gait symmetry and endurance, but participants and/or their families reported the training was beneficial.

“It is interesting to note that seven of eight families stated that treadmill training was beneficial, and that all reported improved gait and/or function,” said Amy Winter Bodkin, Ph.D., of the Center for Gait and Movement Analysis at the University of Colorado at Denver.

This randomized, controlled trial included eight children, aged 6–12 years, with GMFCS level I or II CP who trained three times per week (without body-weight support) for 20 minutes per session, and seven controls.

The findings are inconsistent with previous studies, and this may be a result of the relatively high level of ability in the study population. The participants felt the training promoted smoother gait and the ability to walk farther, Dr. Bodkin noted. Treadmill training should continue to be studied, she said.

A child with cerebral palsy is doing the treadmill training program in the home. Courtesy Dr. Amy Winter Bodkin

BOSTON — Treadmill training appears to benefit children with cerebral palsy, according to the findings of three studies presented at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

In one study—a matched pairs, clinical, controlled trial that took place in a specialized school setting—6 weeks of partial-body-weight treadmill training improved walking speed over short distances. In some children, the training also improved endurance, Karen Janine Dodd, Ph.D., reported.

A total of seven children aged 5–14 years (mean of 8 years 9 months) were recruited for the experimental group, and seven others matched for gender, age, type of cerebral palsy (CP), and Gross Motor Function Classification System (GMFCS) level served as controls. Those in the experimental group walked on the treadmill using partial-body-weight support (using a harness support apparatus under physical therapist supervision) twice weekly for a maximum of 30 minutes per session for the 6-week study period. Control patients continued normal activities, which could include therapy but not treadmill training.

Compared with controls, those in the experimental group showed significant improvements in walking speed, with a mean increase of 4.21 m/min (a 68% increase over baseline) in the experimental group, and no change in the control group. Results on a 10-minute walk test showed a “definite trend” that fell short of statistical significance toward improvement in the experimental group, with a mean increase of 19.81 m (57% over baseline), said Dr. Dodd of La Trobe University, Melbourne. Children in this study had GMFCS level III (4 patients) or IV (10 patients) disease, indicating a moderate to severe walking disability. Six had athetoid quadriplegia, six had spastic quadriplegia, and two had spastic diplegia.

In another study, a more intensive program of body-weight supported treadmill training improved walking speed and efficiency, and in some cases functional gait, balance, and endurance in school-age children with CP and GMFCS level 1 who were able to ambulate independently without assistive devices.

Six children aged 6–14 years participated in 30-minute treadmill training sessions twice daily, 6 days per week for 6 weeks. A harness system was used to support 30% of body weight at the start of the study, and support was decreased to almost 0% by the end of the study, Patricia Burtner, Ph.D., reported.

Pre- and post-training tests showed significant improvements on 10-m walking velocity (mean 1.47 m/sec vs. 1.66 m/sec) and on energy expenditure index (mean 0.68 vs. 0.39, calculated as ambulation heart rate minus resting heart rate divided by ambulation velocity), said Dr. Burtner of the University of New Mexico, Albuquerque. Individual results on the 10-m velocity test showed that five of six participants improved by at least 13% and as much as 23% following training, while one had a decrease of about 8%. Three of six participants had 3%–30% improvement on the 6-minute endurance walk test.

Furthermore, three of the subjects showed improvement of 50%–300% on a single-leg balance test, and four of six showed improvement of 1%–9% on a gross motor function measure score, although the overall improvements on these tests were not statistically significant.

In a third study, an 8-week, home-based treadmill training program in ambulatory children with hemiplegic CP failed to show significant improvement in a number of outcome measures, including a 6-minute walk test, gross motor function measure, and gait symmetry and endurance, but participants and/or their families reported the training was beneficial.

“It is interesting to note that seven of eight families stated that treadmill training was beneficial, and that all reported improved gait and/or function,” said Amy Winter Bodkin, Ph.D., of the Center for Gait and Movement Analysis at the University of Colorado at Denver.

This randomized, controlled trial included eight children, aged 6–12 years, with GMFCS level I or II CP who trained three times per week (without body-weight support) for 20 minutes per session, and seven controls.

The findings are inconsistent with previous studies, and this may be a result of the relatively high level of ability in the study population. The participants felt the training promoted smoother gait and the ability to walk farther, Dr. Bodkin noted. Treadmill training should continue to be studied, she said.

A child with cerebral palsy is doing the treadmill training program in the home. Courtesy Dr. Amy Winter Bodkin

BOSTON — If those practicing in Rhode Island are any indication, primary care pediatricians have some work to do when it comes to incorporating guidelines provided by the American Academy of Pediatrics for the transition and transfer of adolescents with special needs to adult health care.

A survey of 103 pediatricians, representing 80% of pediatric primary care practices in the state, showed that 87% have no formal policy for transferring adolescent patients with special needs to adult health care. This suggests the specialty is in the early stages of adopting the guidelines, according to Dr. Robert T. Burke, who presented the findings in a poster at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

A consensus statement published jointly in 2002 by the AAP, the American Academy of Family Physicians, and the American College of Physicians-American Society of Internal Medicine (now the American College of Physicians) on such transition and transfer of care was approved as policy by the boards of these organizations.

The statement aimed to “ensure that by the year 2010 all physicians who provide primary or subspecialty care to young people with special health care needs (1) understand the rational for transition from child-oriented to adult-oriented health care; (2) have the knowledge and skills to facilitate that process; and (3) know if, how, and when transfer of care is indicated” (Pediatrics 2002;110:1304–6).

Adults with special health care needs deserve an adult-focused primary care physician, according to the statement.

Among the “first steps” for ensuring a successful transition, as outlined in the statement, are preparing and maintaining an up-to-date medical summary that is portable and accessible, and creating a written health care transition plan by age 14 along with the patient and patient's family. However, in addition to a lack of formal policies for transferring patients, the survey showed that a third of respondents had patients over age 22 years in their practice.

About half (47%) of these patients had special needs, and all of the patients over age 24 years had special needs, Dr. Burke of Brown University, Providence, R.I., reported.

Categories of transfer that emerged from the survey included “age out,” “drop out,” “forced out,” “hang out,” “move out,” and “transfer out.” (See box.)

About 19% of adolescents in the practices dropped out overall, but only 7% of those with special needs dropped out. Furthermore, only 7% of adolescent overall “hung out” after age 22 years, while 28% of those with special needs “hung out” after age 22 years,” Dr. Burke noted.

The respondents completed a 13-item questionnaire about office policies, procedures, and processes for transferring adolescents with and without special health care needs.

Responses indicated that less than 3% of physicians believe transition should begin in early adolescence, 64% thought transition should begin 1 year before transfer, and 28% said transition should occur at the time of transfer.

About a third (30%) reported difficulty with transferring adolescents to adult care overall, and half had difficulty transferring those with special health care needs.

Also, only 31% provided written transfer summaries to accepting adult providers and only 18% had direct contact with those providers.

The findings suggest that additional efforts to educate physicians and promote the guidelines are needed.

“We are at the beginning of a process that will have challenges for both pediatric and adult care providers,” Dr. Burke said in an interview, noting that a number of initiatives are underway to promote the use of the guidelines in Rhode Island.

A similar study of physicians who will be accepting adolescent patients (including internists and family physicians) is underway, and a guidebook on the subject of transfer of care for both pediatric and adult health care providers is in development, Dr. Burke said.

Models for transition and transfer to adult health care also are being developed in a collaborative effort that includes both pediatric and adult care providers, the Rhode Island Department of Health, and health care plans, he noted.

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — If those practicing in Rhode Island are any indication, primary care pediatricians have some work to do when it comes to incorporating guidelines provided by the American Academy of Pediatrics for the transition and transfer of adolescents with special needs to adult health care.

A survey of 103 pediatricians, representing 80% of pediatric primary care practices in the state, showed that 87% have no formal policy for transferring adolescent patients with special needs to adult health care. This suggests the specialty is in the early stages of adopting the guidelines, according to Dr. Robert T. Burke, who presented the findings in a poster at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

A consensus statement published jointly in 2002 by the AAP, the American Academy of Family Physicians, and the American College of Physicians-American Society of Internal Medicine (now the American College of Physicians) on such transition and transfer of care was approved as policy by the boards of these organizations.

The statement aimed to “ensure that by the year 2010 all physicians who provide primary or subspecialty care to young people with special health care needs (1) understand the rational for transition from child-oriented to adult-oriented health care; (2) have the knowledge and skills to facilitate that process; and (3) know if, how, and when transfer of care is indicated” (Pediatrics 2002;110:1304–6).

Adults with special health care needs deserve an adult-focused primary care physician, according to the statement.

Among the “first steps” for ensuring a successful transition, as outlined in the statement, are preparing and maintaining an up-to-date medical summary that is portable and accessible, and creating a written health care transition plan by age 14 along with the patient and patient's family. However, in addition to a lack of formal policies for transferring patients, the survey showed that a third of respondents had patients over age 22 years in their practice.

About half (47%) of these patients had special needs, and all of the patients over age 24 years had special needs, Dr. Burke of Brown University, Providence, R.I., reported.

Categories of transfer that emerged from the survey included “age out,” “drop out,” “forced out,” “hang out,” “move out,” and “transfer out.” (See box.)

About 19% of adolescents in the practices dropped out overall, but only 7% of those with special needs dropped out. Furthermore, only 7% of adolescent overall “hung out” after age 22 years, while 28% of those with special needs “hung out” after age 22 years,” Dr. Burke noted.

The respondents completed a 13-item questionnaire about office policies, procedures, and processes for transferring adolescents with and without special health care needs.

Responses indicated that less than 3% of physicians believe transition should begin in early adolescence, 64% thought transition should begin 1 year before transfer, and 28% said transition should occur at the time of transfer.

About a third (30%) reported difficulty with transferring adolescents to adult care overall, and half had difficulty transferring those with special health care needs.

Also, only 31% provided written transfer summaries to accepting adult providers and only 18% had direct contact with those providers.

The findings suggest that additional efforts to educate physicians and promote the guidelines are needed.

“We are at the beginning of a process that will have challenges for both pediatric and adult care providers,” Dr. Burke said in an interview, noting that a number of initiatives are underway to promote the use of the guidelines in Rhode Island.

A similar study of physicians who will be accepting adolescent patients (including internists and family physicians) is underway, and a guidebook on the subject of transfer of care for both pediatric and adult health care providers is in development, Dr. Burke said.

Models for transition and transfer to adult health care also are being developed in a collaborative effort that includes both pediatric and adult care providers, the Rhode Island Department of Health, and health care plans, he noted.

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — If those practicing in Rhode Island are any indication, primary care pediatricians have some work to do when it comes to incorporating guidelines provided by the American Academy of Pediatrics for the transition and transfer of adolescents with special needs to adult health care.

A survey of 103 pediatricians, representing 80% of pediatric primary care practices in the state, showed that 87% have no formal policy for transferring adolescent patients with special needs to adult health care. This suggests the specialty is in the early stages of adopting the guidelines, according to Dr. Robert T. Burke, who presented the findings in a poster at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.

A consensus statement published jointly in 2002 by the AAP, the American Academy of Family Physicians, and the American College of Physicians-American Society of Internal Medicine (now the American College of Physicians) on such transition and transfer of care was approved as policy by the boards of these organizations.

The statement aimed to “ensure that by the year 2010 all physicians who provide primary or subspecialty care to young people with special health care needs (1) understand the rational for transition from child-oriented to adult-oriented health care; (2) have the knowledge and skills to facilitate that process; and (3) know if, how, and when transfer of care is indicated” (Pediatrics 2002;110:1304–6).

Adults with special health care needs deserve an adult-focused primary care physician, according to the statement.

Among the “first steps” for ensuring a successful transition, as outlined in the statement, are preparing and maintaining an up-to-date medical summary that is portable and accessible, and creating a written health care transition plan by age 14 along with the patient and patient's family. However, in addition to a lack of formal policies for transferring patients, the survey showed that a third of respondents had patients over age 22 years in their practice.

About half (47%) of these patients had special needs, and all of the patients over age 24 years had special needs, Dr. Burke of Brown University, Providence, R.I., reported.

Categories of transfer that emerged from the survey included “age out,” “drop out,” “forced out,” “hang out,” “move out,” and “transfer out.” (See box.)

About 19% of adolescents in the practices dropped out overall, but only 7% of those with special needs dropped out. Furthermore, only 7% of adolescent overall “hung out” after age 22 years, while 28% of those with special needs “hung out” after age 22 years,” Dr. Burke noted.

The respondents completed a 13-item questionnaire about office policies, procedures, and processes for transferring adolescents with and without special health care needs.

Responses indicated that less than 3% of physicians believe transition should begin in early adolescence, 64% thought transition should begin 1 year before transfer, and 28% said transition should occur at the time of transfer.

About a third (30%) reported difficulty with transferring adolescents to adult care overall, and half had difficulty transferring those with special health care needs.

Also, only 31% provided written transfer summaries to accepting adult providers and only 18% had direct contact with those providers.

The findings suggest that additional efforts to educate physicians and promote the guidelines are needed.

“We are at the beginning of a process that will have challenges for both pediatric and adult care providers,” Dr. Burke said in an interview, noting that a number of initiatives are underway to promote the use of the guidelines in Rhode Island.

A similar study of physicians who will be accepting adolescent patients (including internists and family physicians) is underway, and a guidebook on the subject of transfer of care for both pediatric and adult health care providers is in development, Dr. Burke said.

Models for transition and transfer to adult health care also are being developed in a collaborative effort that includes both pediatric and adult care providers, the Rhode Island Department of Health, and health care plans, he noted.

ELSEVIER GLOBAL MEDICAL NEWS

SALT LAKE CITY – Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, findings from the Nurses' Health Study suggest.

Data from more than 68,000 women who participated in the study show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night.

The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel reported at the annual meeting of the Associated Professional Sleep Societies.

Furthermore, the relative risk for obesity (BMI over 30 kg/m

Study participants first responded to a questionnaire about sleep habits in 1986 and were followed for 16 years, with additional information about weight and important covariates obtained biannually.

Additional research is needed to elucidate the mechanisms for weight gain as it relates to sleep duration, Dr. Patel said.

SALT LAKE CITY – Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, findings from the Nurses' Health Study suggest.

Data from more than 68,000 women who participated in the study show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night.

The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel reported at the annual meeting of the Associated Professional Sleep Societies.

Furthermore, the relative risk for obesity (BMI over 30 kg/m

Study participants first responded to a questionnaire about sleep habits in 1986 and were followed for 16 years, with additional information about weight and important covariates obtained biannually.

Additional research is needed to elucidate the mechanisms for weight gain as it relates to sleep duration, Dr. Patel said.

SALT LAKE CITY – Sleep duration of less than 6 hours is an independent predictor of future weight gain and obesity in women, findings from the Nurses' Health Study suggest.

Data from more than 68,000 women who participated in the study show that after adjusting for age and body mass index, women sleeping for 5 or fewer hours/night gained 1.04 kg more over 16 years and those sleeping 6 hours/night gained 0.68 kg more than those sleeping 7 hours/night.

The relative risk for gaining 15 kg or more was 1.32 in those sleeping 5 hours/night and 1.12 for those sleeping 6 hours/night, compared with those sleeping 7 hours, Dr. Sanjay R. Patel reported at the annual meeting of the Associated Professional Sleep Societies.

Furthermore, the relative risk for obesity (BMI over 30 kg/m

Study participants first responded to a questionnaire about sleep habits in 1986 and were followed for 16 years, with additional information about weight and important covariates obtained biannually.

Additional research is needed to elucidate the mechanisms for weight gain as it relates to sleep duration, Dr. Patel said.

SALT LAKE CITY – A strong relationship exists between restless legs syndrome and major depressive disorder, a community-based study suggests.

Of 42 patients with restless legs syndrome (RLS), approximately 21% had a lifetime diagnosis of major depressive disorder (MDD), compared with 8% of 982 control patients, for a 2.8 adjusted odds ratio for MDD risk. Patients participated in the Baltimore Epidemiologic Catchment Area study, Dr. Hochang B. Lee reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Participants completed a seven-item RLS questionnaire, and the National Institute of Mental Health Diagnostic Interview Schedule was administered by a trained lay interviewer. Results were adjusted for relevant sociodemographic and health-related variables, noted Dr. Lee of the department of psychiatry at Johns Hopkins University, Baltimore.

The findings support those from a number of other studies in clinical samples, which also have suggested a relationship between depression and RLS, according to the investigator. Few studies, however, have focused on the link between MDD and RLS.

Future studies should focus on possible pathophysiologic mechanisms for the link between these common conditions, Dr. Lee concluded.

SALT LAKE CITY – A strong relationship exists between restless legs syndrome and major depressive disorder, a community-based study suggests.

Of 42 patients with restless legs syndrome (RLS), approximately 21% had a lifetime diagnosis of major depressive disorder (MDD), compared with 8% of 982 control patients, for a 2.8 adjusted odds ratio for MDD risk. Patients participated in the Baltimore Epidemiologic Catchment Area study, Dr. Hochang B. Lee reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Participants completed a seven-item RLS questionnaire, and the National Institute of Mental Health Diagnostic Interview Schedule was administered by a trained lay interviewer. Results were adjusted for relevant sociodemographic and health-related variables, noted Dr. Lee of the department of psychiatry at Johns Hopkins University, Baltimore.

The findings support those from a number of other studies in clinical samples, which also have suggested a relationship between depression and RLS, according to the investigator. Few studies, however, have focused on the link between MDD and RLS.

Future studies should focus on possible pathophysiologic mechanisms for the link between these common conditions, Dr. Lee concluded.

SALT LAKE CITY – A strong relationship exists between restless legs syndrome and major depressive disorder, a community-based study suggests.

Of 42 patients with restless legs syndrome (RLS), approximately 21% had a lifetime diagnosis of major depressive disorder (MDD), compared with 8% of 982 control patients, for a 2.8 adjusted odds ratio for MDD risk. Patients participated in the Baltimore Epidemiologic Catchment Area study, Dr. Hochang B. Lee reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Participants completed a seven-item RLS questionnaire, and the National Institute of Mental Health Diagnostic Interview Schedule was administered by a trained lay interviewer. Results were adjusted for relevant sociodemographic and health-related variables, noted Dr. Lee of the department of psychiatry at Johns Hopkins University, Baltimore.

The findings support those from a number of other studies in clinical samples, which also have suggested a relationship between depression and RLS, according to the investigator. Few studies, however, have focused on the link between MDD and RLS.

Future studies should focus on possible pathophysiologic mechanisms for the link between these common conditions, Dr. Lee concluded.

SALT LAKE CITY – Adolescent insomnia is fairly common and appears to be a risk factor for psychological disorders in young adulthood, Brandy M. Roane reported at the annual meeting of the Associated Professional Sleep Societies.

Of 4,253 adolescents aged 12–18 years at baseline, more than 9% reported insomnia.

For the purposes of this study, insomnia was defined as a self-report of having difficulty falling asleep on all or most nights during the prior year, according to Ms. Roane, who is a doctoral student in psychology at the University of North Texas at Dallas.

Those participants who reported insomnia during adolescence were 1.7 times more likely to binge drink and smoke cigarettes, 1.6 times more likely to have smoked marijuana, 2.6 times more likely to have used other drugs, and 2.4 times more likely to have depression than did those who did not report insomnia, she said, noting that each of these findings was highly statistically significant.

Reevaluation by an in-home survey 7–8 years following the initial interview showed that during young adulthood, those who had insomnia during adolescence were 1.2 times more likely to smoke cigarettes, 2.8 times more likely to have been diagnosed with depression, 3.5 times more likely to use medications for depression and stress, compared with those who did not report insomnia during adolesence.

In addition, the investigators found that these young adults were 2.1 times more likely to have attempted suicide, and 2.1 times more likely to have suicidal ideation, compared with those adolescents who did not report insomnia during adolescence.

These findings also were statistically significant, Ms. Roane said.

Further analysis to control for gender and baseline levels of variables such as depression are planned.

But these preliminary findings suggest that insomnia during adolescence may have repercussions later in life and that exploration of preventive treatments in adolescence is warranted, she said.

SALT LAKE CITY – Adolescent insomnia is fairly common and appears to be a risk factor for psychological disorders in young adulthood, Brandy M. Roane reported at the annual meeting of the Associated Professional Sleep Societies.

Of 4,253 adolescents aged 12–18 years at baseline, more than 9% reported insomnia.

For the purposes of this study, insomnia was defined as a self-report of having difficulty falling asleep on all or most nights during the prior year, according to Ms. Roane, who is a doctoral student in psychology at the University of North Texas at Dallas.

Those participants who reported insomnia during adolescence were 1.7 times more likely to binge drink and smoke cigarettes, 1.6 times more likely to have smoked marijuana, 2.6 times more likely to have used other drugs, and 2.4 times more likely to have depression than did those who did not report insomnia, she said, noting that each of these findings was highly statistically significant.

Reevaluation by an in-home survey 7–8 years following the initial interview showed that during young adulthood, those who had insomnia during adolescence were 1.2 times more likely to smoke cigarettes, 2.8 times more likely to have been diagnosed with depression, 3.5 times more likely to use medications for depression and stress, compared with those who did not report insomnia during adolesence.

In addition, the investigators found that these young adults were 2.1 times more likely to have attempted suicide, and 2.1 times more likely to have suicidal ideation, compared with those adolescents who did not report insomnia during adolescence.

These findings also were statistically significant, Ms. Roane said.

Further analysis to control for gender and baseline levels of variables such as depression are planned.

But these preliminary findings suggest that insomnia during adolescence may have repercussions later in life and that exploration of preventive treatments in adolescence is warranted, she said.

SALT LAKE CITY – Adolescent insomnia is fairly common and appears to be a risk factor for psychological disorders in young adulthood, Brandy M. Roane reported at the annual meeting of the Associated Professional Sleep Societies.

Of 4,253 adolescents aged 12–18 years at baseline, more than 9% reported insomnia.

For the purposes of this study, insomnia was defined as a self-report of having difficulty falling asleep on all or most nights during the prior year, according to Ms. Roane, who is a doctoral student in psychology at the University of North Texas at Dallas.

Those participants who reported insomnia during adolescence were 1.7 times more likely to binge drink and smoke cigarettes, 1.6 times more likely to have smoked marijuana, 2.6 times more likely to have used other drugs, and 2.4 times more likely to have depression than did those who did not report insomnia, she said, noting that each of these findings was highly statistically significant.

Reevaluation by an in-home survey 7–8 years following the initial interview showed that during young adulthood, those who had insomnia during adolescence were 1.2 times more likely to smoke cigarettes, 2.8 times more likely to have been diagnosed with depression, 3.5 times more likely to use medications for depression and stress, compared with those who did not report insomnia during adolesence.

In addition, the investigators found that these young adults were 2.1 times more likely to have attempted suicide, and 2.1 times more likely to have suicidal ideation, compared with those adolescents who did not report insomnia during adolescence.

These findings also were statistically significant, Ms. Roane said.

Further analysis to control for gender and baseline levels of variables such as depression are planned.

But these preliminary findings suggest that insomnia during adolescence may have repercussions later in life and that exploration of preventive treatments in adolescence is warranted, she said.