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Meditation affects genes, inflammation; art prescribed as medicine
As an adolescent, says James R. Doty, MD, he was heading down a road toward delinquency. He says his family was poor, and he was often hungry.
His father was an alcoholic, his mother had debilitating depression, and he was so reflexive that, after a nun at his Roman Catholic school slapped him, he slapped her back. But a random decision to browse a magic shop changed the way Dr. Doty was able to imagine his life.
The magic shop owner’s mother, Ruth, taught him about focusing on the present moment – rather than dwelling on past traumas. “What she taught me truly rewired my brain,” he says in an interview with Krista Tippett. “When I met her, I had little to no possibilities. Yet, my own personal circumstances did not change at all.”
“There was a study that was done that showed that the average person, almost 80% of the time, they’re not focused on the present, they’re focused on exactly that: regret about the past or anxiety about the future. When your attention is in those places, you can’t give your full attention to even what’s happening to you at that moment,” Dr. Doty says in the interview with Ms. Tippett for “On Being,” a radio conversation and podcast available online and in some NPR markets. [Distracted attention] “limits what you can accomplish in that moment. Unfortunately, it’s a horrible distraction, and it, again, limits us to the connections we are able to make and actually even who we are.”
Dr. Doty’s life so far has taught him that pain can be harnessed to enrich life.
“Most of us have a tendency to desire pleasure rather than pain. ... I think anyone who has lived a life, which means you have had pain and suffering – is that And it’s part of a meaningful life. When you’re able to take that pain and suffering and use it to not hide from the world, to use it not to be afraid of every interaction, but to use it to say, yes, it is hard sometimes, but I have learned so many lessons and have become more appreciative and have more gratitude and see in so many examples how in the face of the greatest adversity, people have shown their greatest humanity,” he says.
An important part of his journey of discovery has been the beneficial role that meditation can have on the body.
“In fact, even after brief periods of meditation, we actually can study the epigenetic effect of how our genes are changing their expression, even with brief periods of meditation, in the context of inflammation markers,” says Dr. Doty, a clinical professor of neurosurgery at Stanford (Calif.) University, and the founder and director of the Center for Compassion and Altruism Research and Education. “It’s extraordinary, because even with people who have meditated in this manner for as little as 2 weeks, you can see effects in regard to their blood pressure, in regard to the release of stress hormones and effects on the immune system.”
Dr. Doty is author of “Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart,” (New York: Penguin, 2016), and senior editor of the Oxford Handbook of Compassion Science.
Rx: Go visit an art exhibit
An innovative medical initiative has some Montreal physicians writing prescriptions for patients that, instead of leading them to the pharmacy, takes them to a local art museum.
Médecins francophones du Canada, a doctors’ organization based mainly in the province of Quebec, has partnered with the Montreal Museum of Fine Arts (MMFA) in providing free museum passes to patients.
Physician members of Médecins francophones du Canada can be approved to issue up to 50 prescriptions for a visit to MMFA collections and exhibitions. This is meant to complement existing and more traditional treatment.
The intent, according to the museum’s chief curator and director general, Nathalie Bondil, is to provide a “relaxing, revitalizing experience, a moment of respite” for those burdened physically or mentally by illness. “We can open new doors, not just for the patients, but also for the doctors,” she remarks in an interview with BBC News.
Patients also can avail themselves of the museum’s art therapy programs. “The neutral, beautiful, inspiring space” of museums like MMFA helps improve a patient’s mood and well-being,” Ms. Bondil says. Contemplating a painting or other artwork can, at least temporarily, take the patient to a mental space not dominated by illness-related worry, fear, anger, and sadness.
The idea of art as medicine is echoed elsewhere. A 2017 report in the United Kingdom recognized the vital contribution of the arts to health and well-being.
Lady Gaga describes health crisis
From a distance, the life of Lady Gaga might seem exotic and desirable. But the musician and actress recently revealed her own “mental health crisis” – and urged Hollywood to make better mental health care available to those in the entertainment business.
Her work also features multiple deadlines, and the pressure can prove overwhelming. “I began to notice that I would stare off into space and black out for seconds or minutes. I would see flashes of things I was tormented by, experiences that were filed away in my brain with ‘I’ll deal with you later’ for many years because my brain was protecting me, as science teaches us. These were also symptoms of disassociation and PTSD and I did not have a team that included mental health support,” according to an article in Variety reporting a speech by the entertainer, whose birth name is Stefani Joanne Angelina Germanotta.
The anguish she felt morphed into physical chronic pain, fibromyalgia, panic attacks, acute trauma responses, and debilitating declines in her mental health – including thoughts of suicide. One root of the trauma might have been a sexual assault that she says she experienced during childhood.
“I wish there had been a system in place to protect and guide me, a system in place to empower me to say no to things I felt I had to do, a system in place to empower me to stay away from toxic work environments or working with people who were of seriously questionable character,” she says. “There were days that I struggled or couldn’t make it to work, and I don’t want that for other artists or anyone.”
Fostering engagement over the phone
After retirement, some people find it difficult to get out into the community and engage with other people. But, for 94-year-old Frances Utpadel, human connection has proven to be a phone call away.
In a service that is provided by the acting industry in Hollywood, the retired film lab technician from Los Angeles has availed herself of the Daily Call Sheet program. The program, run by the Motion Picture and Television Fund and the AARP Foundation, pairs up folks like Ms. Utpadel with a fellow film industry member for phone chats several times each week.
“I was having the downtime because all my friends were moving away and dying,” Ms. Utpadel explains in an interview with People magazine. Now, she and her chat-buddy Norma talk two or three times a week. Conversations range from things going on in their daily lives to world issues.
The content of the conversations can be stimulating, as is sharing her thoughts with a kind voice. “This is something I’m very much for – don’t isolate yourself. I don’t have any friends to be texting or emailing,” she says. “I hear so many people are doing texting and email, and one of the big stores now, they won’t have any cashiers. And, I say, ‘What are they doing to the people? You’re isolating people. And the world is made of people.’”
The connection is even more important for Ms. Utpadel, who for decades, has taken care of her son, Terry – who suffered debilitating injuries in a car crash. She is the sole caregiver for Terry, who is aged 75 years.
Ms. Utpadel is adamant about the value of human interaction in a digital world in which life can be lived in isolation. “I’m used to the generation where you took pictures and had them developed. You don’t have those now. Everybody’s got them on their cell phone. It’s just a whole different world. But, I think, in a way, my world is richer than the other one. I don’t feel deprived about it or anything. I feel I’m better off.”
Communication ‘central’ in palliative care
Being a palliative care surgeon means delivering really bad news. It also means helping a patients deal with the realities of impending death. In this emotionally charged atmosphere, the surgeons’ words can be comforting or devastating.
“One of my mentors once told me that words are somewhat like a palliative care physician’s scalpel,” Toronto palliative care physician Evan Schneider, MD, says in an interview with the Canadian Broadcasting Corporation.
“We’re dealing with very intense, emotionally charged conversations. I think communication is probably the most central tenet of what we do. … There’s no one-size-fits-all approach to sharing bad news,” said Dr. Schneider says. The bad news may be anticipated or can come as total blind-side to the patient. In some cases, other treatment options may be available. In other cases, palliative care is the only option.
Clarity in communication is an absolute must. That means providing the information in a form that is understandable and relevant to the patients, and not to the physician. Dr. Schneider says his approach involves “trying to use as little overly jargony or medicalized words as necessary.”
Compounding the challenge, Dr. Schneider’s patients exemplify the linguistic stew that is Toronto, where some 140 different languages are spoken. As an English speaker, Dr. Schneider relies on medical interpreters to talk with patients and for their sensitivity to cultural nuances concerning death and dying that escape him.
“Sometimes there are family members who may [want] to protect their loved one from receiving bad news about their diagnosis or prognosis,” he says. “When we bring an interpreter into those scenarios, it can be very hard for family members, because information can be shared through interpretation that were trying to shield their loved one. That’s always a risk or a possibility when we are dealing with information that has to be translated to someone else.”
As an adolescent, says James R. Doty, MD, he was heading down a road toward delinquency. He says his family was poor, and he was often hungry.
His father was an alcoholic, his mother had debilitating depression, and he was so reflexive that, after a nun at his Roman Catholic school slapped him, he slapped her back. But a random decision to browse a magic shop changed the way Dr. Doty was able to imagine his life.
The magic shop owner’s mother, Ruth, taught him about focusing on the present moment – rather than dwelling on past traumas. “What she taught me truly rewired my brain,” he says in an interview with Krista Tippett. “When I met her, I had little to no possibilities. Yet, my own personal circumstances did not change at all.”
“There was a study that was done that showed that the average person, almost 80% of the time, they’re not focused on the present, they’re focused on exactly that: regret about the past or anxiety about the future. When your attention is in those places, you can’t give your full attention to even what’s happening to you at that moment,” Dr. Doty says in the interview with Ms. Tippett for “On Being,” a radio conversation and podcast available online and in some NPR markets. [Distracted attention] “limits what you can accomplish in that moment. Unfortunately, it’s a horrible distraction, and it, again, limits us to the connections we are able to make and actually even who we are.”
Dr. Doty’s life so far has taught him that pain can be harnessed to enrich life.
“Most of us have a tendency to desire pleasure rather than pain. ... I think anyone who has lived a life, which means you have had pain and suffering – is that And it’s part of a meaningful life. When you’re able to take that pain and suffering and use it to not hide from the world, to use it not to be afraid of every interaction, but to use it to say, yes, it is hard sometimes, but I have learned so many lessons and have become more appreciative and have more gratitude and see in so many examples how in the face of the greatest adversity, people have shown their greatest humanity,” he says.
An important part of his journey of discovery has been the beneficial role that meditation can have on the body.
“In fact, even after brief periods of meditation, we actually can study the epigenetic effect of how our genes are changing their expression, even with brief periods of meditation, in the context of inflammation markers,” says Dr. Doty, a clinical professor of neurosurgery at Stanford (Calif.) University, and the founder and director of the Center for Compassion and Altruism Research and Education. “It’s extraordinary, because even with people who have meditated in this manner for as little as 2 weeks, you can see effects in regard to their blood pressure, in regard to the release of stress hormones and effects on the immune system.”
Dr. Doty is author of “Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart,” (New York: Penguin, 2016), and senior editor of the Oxford Handbook of Compassion Science.
Rx: Go visit an art exhibit
An innovative medical initiative has some Montreal physicians writing prescriptions for patients that, instead of leading them to the pharmacy, takes them to a local art museum.
Médecins francophones du Canada, a doctors’ organization based mainly in the province of Quebec, has partnered with the Montreal Museum of Fine Arts (MMFA) in providing free museum passes to patients.
Physician members of Médecins francophones du Canada can be approved to issue up to 50 prescriptions for a visit to MMFA collections and exhibitions. This is meant to complement existing and more traditional treatment.
The intent, according to the museum’s chief curator and director general, Nathalie Bondil, is to provide a “relaxing, revitalizing experience, a moment of respite” for those burdened physically or mentally by illness. “We can open new doors, not just for the patients, but also for the doctors,” she remarks in an interview with BBC News.
Patients also can avail themselves of the museum’s art therapy programs. “The neutral, beautiful, inspiring space” of museums like MMFA helps improve a patient’s mood and well-being,” Ms. Bondil says. Contemplating a painting or other artwork can, at least temporarily, take the patient to a mental space not dominated by illness-related worry, fear, anger, and sadness.
The idea of art as medicine is echoed elsewhere. A 2017 report in the United Kingdom recognized the vital contribution of the arts to health and well-being.
Lady Gaga describes health crisis
From a distance, the life of Lady Gaga might seem exotic and desirable. But the musician and actress recently revealed her own “mental health crisis” – and urged Hollywood to make better mental health care available to those in the entertainment business.
Her work also features multiple deadlines, and the pressure can prove overwhelming. “I began to notice that I would stare off into space and black out for seconds or minutes. I would see flashes of things I was tormented by, experiences that were filed away in my brain with ‘I’ll deal with you later’ for many years because my brain was protecting me, as science teaches us. These were also symptoms of disassociation and PTSD and I did not have a team that included mental health support,” according to an article in Variety reporting a speech by the entertainer, whose birth name is Stefani Joanne Angelina Germanotta.
The anguish she felt morphed into physical chronic pain, fibromyalgia, panic attacks, acute trauma responses, and debilitating declines in her mental health – including thoughts of suicide. One root of the trauma might have been a sexual assault that she says she experienced during childhood.
“I wish there had been a system in place to protect and guide me, a system in place to empower me to say no to things I felt I had to do, a system in place to empower me to stay away from toxic work environments or working with people who were of seriously questionable character,” she says. “There were days that I struggled or couldn’t make it to work, and I don’t want that for other artists or anyone.”
Fostering engagement over the phone
After retirement, some people find it difficult to get out into the community and engage with other people. But, for 94-year-old Frances Utpadel, human connection has proven to be a phone call away.
In a service that is provided by the acting industry in Hollywood, the retired film lab technician from Los Angeles has availed herself of the Daily Call Sheet program. The program, run by the Motion Picture and Television Fund and the AARP Foundation, pairs up folks like Ms. Utpadel with a fellow film industry member for phone chats several times each week.
“I was having the downtime because all my friends were moving away and dying,” Ms. Utpadel explains in an interview with People magazine. Now, she and her chat-buddy Norma talk two or three times a week. Conversations range from things going on in their daily lives to world issues.
The content of the conversations can be stimulating, as is sharing her thoughts with a kind voice. “This is something I’m very much for – don’t isolate yourself. I don’t have any friends to be texting or emailing,” she says. “I hear so many people are doing texting and email, and one of the big stores now, they won’t have any cashiers. And, I say, ‘What are they doing to the people? You’re isolating people. And the world is made of people.’”
The connection is even more important for Ms. Utpadel, who for decades, has taken care of her son, Terry – who suffered debilitating injuries in a car crash. She is the sole caregiver for Terry, who is aged 75 years.
Ms. Utpadel is adamant about the value of human interaction in a digital world in which life can be lived in isolation. “I’m used to the generation where you took pictures and had them developed. You don’t have those now. Everybody’s got them on their cell phone. It’s just a whole different world. But, I think, in a way, my world is richer than the other one. I don’t feel deprived about it or anything. I feel I’m better off.”
Communication ‘central’ in palliative care
Being a palliative care surgeon means delivering really bad news. It also means helping a patients deal with the realities of impending death. In this emotionally charged atmosphere, the surgeons’ words can be comforting or devastating.
“One of my mentors once told me that words are somewhat like a palliative care physician’s scalpel,” Toronto palliative care physician Evan Schneider, MD, says in an interview with the Canadian Broadcasting Corporation.
“We’re dealing with very intense, emotionally charged conversations. I think communication is probably the most central tenet of what we do. … There’s no one-size-fits-all approach to sharing bad news,” said Dr. Schneider says. The bad news may be anticipated or can come as total blind-side to the patient. In some cases, other treatment options may be available. In other cases, palliative care is the only option.
Clarity in communication is an absolute must. That means providing the information in a form that is understandable and relevant to the patients, and not to the physician. Dr. Schneider says his approach involves “trying to use as little overly jargony or medicalized words as necessary.”
Compounding the challenge, Dr. Schneider’s patients exemplify the linguistic stew that is Toronto, where some 140 different languages are spoken. As an English speaker, Dr. Schneider relies on medical interpreters to talk with patients and for their sensitivity to cultural nuances concerning death and dying that escape him.
“Sometimes there are family members who may [want] to protect their loved one from receiving bad news about their diagnosis or prognosis,” he says. “When we bring an interpreter into those scenarios, it can be very hard for family members, because information can be shared through interpretation that were trying to shield their loved one. That’s always a risk or a possibility when we are dealing with information that has to be translated to someone else.”
As an adolescent, says James R. Doty, MD, he was heading down a road toward delinquency. He says his family was poor, and he was often hungry.
His father was an alcoholic, his mother had debilitating depression, and he was so reflexive that, after a nun at his Roman Catholic school slapped him, he slapped her back. But a random decision to browse a magic shop changed the way Dr. Doty was able to imagine his life.
The magic shop owner’s mother, Ruth, taught him about focusing on the present moment – rather than dwelling on past traumas. “What she taught me truly rewired my brain,” he says in an interview with Krista Tippett. “When I met her, I had little to no possibilities. Yet, my own personal circumstances did not change at all.”
“There was a study that was done that showed that the average person, almost 80% of the time, they’re not focused on the present, they’re focused on exactly that: regret about the past or anxiety about the future. When your attention is in those places, you can’t give your full attention to even what’s happening to you at that moment,” Dr. Doty says in the interview with Ms. Tippett for “On Being,” a radio conversation and podcast available online and in some NPR markets. [Distracted attention] “limits what you can accomplish in that moment. Unfortunately, it’s a horrible distraction, and it, again, limits us to the connections we are able to make and actually even who we are.”
Dr. Doty’s life so far has taught him that pain can be harnessed to enrich life.
“Most of us have a tendency to desire pleasure rather than pain. ... I think anyone who has lived a life, which means you have had pain and suffering – is that And it’s part of a meaningful life. When you’re able to take that pain and suffering and use it to not hide from the world, to use it not to be afraid of every interaction, but to use it to say, yes, it is hard sometimes, but I have learned so many lessons and have become more appreciative and have more gratitude and see in so many examples how in the face of the greatest adversity, people have shown their greatest humanity,” he says.
An important part of his journey of discovery has been the beneficial role that meditation can have on the body.
“In fact, even after brief periods of meditation, we actually can study the epigenetic effect of how our genes are changing their expression, even with brief periods of meditation, in the context of inflammation markers,” says Dr. Doty, a clinical professor of neurosurgery at Stanford (Calif.) University, and the founder and director of the Center for Compassion and Altruism Research and Education. “It’s extraordinary, because even with people who have meditated in this manner for as little as 2 weeks, you can see effects in regard to their blood pressure, in regard to the release of stress hormones and effects on the immune system.”
Dr. Doty is author of “Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart,” (New York: Penguin, 2016), and senior editor of the Oxford Handbook of Compassion Science.
Rx: Go visit an art exhibit
An innovative medical initiative has some Montreal physicians writing prescriptions for patients that, instead of leading them to the pharmacy, takes them to a local art museum.
Médecins francophones du Canada, a doctors’ organization based mainly in the province of Quebec, has partnered with the Montreal Museum of Fine Arts (MMFA) in providing free museum passes to patients.
Physician members of Médecins francophones du Canada can be approved to issue up to 50 prescriptions for a visit to MMFA collections and exhibitions. This is meant to complement existing and more traditional treatment.
The intent, according to the museum’s chief curator and director general, Nathalie Bondil, is to provide a “relaxing, revitalizing experience, a moment of respite” for those burdened physically or mentally by illness. “We can open new doors, not just for the patients, but also for the doctors,” she remarks in an interview with BBC News.
Patients also can avail themselves of the museum’s art therapy programs. “The neutral, beautiful, inspiring space” of museums like MMFA helps improve a patient’s mood and well-being,” Ms. Bondil says. Contemplating a painting or other artwork can, at least temporarily, take the patient to a mental space not dominated by illness-related worry, fear, anger, and sadness.
The idea of art as medicine is echoed elsewhere. A 2017 report in the United Kingdom recognized the vital contribution of the arts to health and well-being.
Lady Gaga describes health crisis
From a distance, the life of Lady Gaga might seem exotic and desirable. But the musician and actress recently revealed her own “mental health crisis” – and urged Hollywood to make better mental health care available to those in the entertainment business.
Her work also features multiple deadlines, and the pressure can prove overwhelming. “I began to notice that I would stare off into space and black out for seconds or minutes. I would see flashes of things I was tormented by, experiences that were filed away in my brain with ‘I’ll deal with you later’ for many years because my brain was protecting me, as science teaches us. These were also symptoms of disassociation and PTSD and I did not have a team that included mental health support,” according to an article in Variety reporting a speech by the entertainer, whose birth name is Stefani Joanne Angelina Germanotta.
The anguish she felt morphed into physical chronic pain, fibromyalgia, panic attacks, acute trauma responses, and debilitating declines in her mental health – including thoughts of suicide. One root of the trauma might have been a sexual assault that she says she experienced during childhood.
“I wish there had been a system in place to protect and guide me, a system in place to empower me to say no to things I felt I had to do, a system in place to empower me to stay away from toxic work environments or working with people who were of seriously questionable character,” she says. “There were days that I struggled or couldn’t make it to work, and I don’t want that for other artists or anyone.”
Fostering engagement over the phone
After retirement, some people find it difficult to get out into the community and engage with other people. But, for 94-year-old Frances Utpadel, human connection has proven to be a phone call away.
In a service that is provided by the acting industry in Hollywood, the retired film lab technician from Los Angeles has availed herself of the Daily Call Sheet program. The program, run by the Motion Picture and Television Fund and the AARP Foundation, pairs up folks like Ms. Utpadel with a fellow film industry member for phone chats several times each week.
“I was having the downtime because all my friends were moving away and dying,” Ms. Utpadel explains in an interview with People magazine. Now, she and her chat-buddy Norma talk two or three times a week. Conversations range from things going on in their daily lives to world issues.
The content of the conversations can be stimulating, as is sharing her thoughts with a kind voice. “This is something I’m very much for – don’t isolate yourself. I don’t have any friends to be texting or emailing,” she says. “I hear so many people are doing texting and email, and one of the big stores now, they won’t have any cashiers. And, I say, ‘What are they doing to the people? You’re isolating people. And the world is made of people.’”
The connection is even more important for Ms. Utpadel, who for decades, has taken care of her son, Terry – who suffered debilitating injuries in a car crash. She is the sole caregiver for Terry, who is aged 75 years.
Ms. Utpadel is adamant about the value of human interaction in a digital world in which life can be lived in isolation. “I’m used to the generation where you took pictures and had them developed. You don’t have those now. Everybody’s got them on their cell phone. It’s just a whole different world. But, I think, in a way, my world is richer than the other one. I don’t feel deprived about it or anything. I feel I’m better off.”
Communication ‘central’ in palliative care
Being a palliative care surgeon means delivering really bad news. It also means helping a patients deal with the realities of impending death. In this emotionally charged atmosphere, the surgeons’ words can be comforting or devastating.
“One of my mentors once told me that words are somewhat like a palliative care physician’s scalpel,” Toronto palliative care physician Evan Schneider, MD, says in an interview with the Canadian Broadcasting Corporation.
“We’re dealing with very intense, emotionally charged conversations. I think communication is probably the most central tenet of what we do. … There’s no one-size-fits-all approach to sharing bad news,” said Dr. Schneider says. The bad news may be anticipated or can come as total blind-side to the patient. In some cases, other treatment options may be available. In other cases, palliative care is the only option.
Clarity in communication is an absolute must. That means providing the information in a form that is understandable and relevant to the patients, and not to the physician. Dr. Schneider says his approach involves “trying to use as little overly jargony or medicalized words as necessary.”
Compounding the challenge, Dr. Schneider’s patients exemplify the linguistic stew that is Toronto, where some 140 different languages are spoken. As an English speaker, Dr. Schneider relies on medical interpreters to talk with patients and for their sensitivity to cultural nuances concerning death and dying that escape him.
“Sometimes there are family members who may [want] to protect their loved one from receiving bad news about their diagnosis or prognosis,” he says. “When we bring an interpreter into those scenarios, it can be very hard for family members, because information can be shared through interpretation that were trying to shield their loved one. That’s always a risk or a possibility when we are dealing with information that has to be translated to someone else.”
CAC scores in type 1 diabetes no higher than general population
CHICAGO – Roughly 70% of some 1,200 adult patients with type 1 diabetes screened for coronary artery calcium had a score of zero, about the same prevalence as in the general, U.S. adult population, suggesting the unexpected conclusion that a majority of middle-aged patients with type 1 diabetes do not have an elevated risk for coronary artery disease, in contrast to patients with type 2 diabetes.
Among 1,205 asymptomatic people with type 1 diabetes who underwent coronary artery calcium (CAC) measurement and were followed for an average of about 11 years, 71% had a CAC score of zero at baseline followed by a cardiovascular disease event rate of 5.6 events/1,000 patient years of follow-up, a “very low” event rate that made these patients no more likely to have an event than any adult of similar age and sex in the general U.S. population, Matthew J. Budoff, MD, said at the American Heart Association scientific sessions.
In prior reports, about half of patients with type 2 diabetes had a CAC score of zero, noted Dr. Budoff, professor of medicine and a specialist in cardiac CT imaging and preventive cardiology at the University of California, Los Angeles. In a general adult population that’s about 45 years old roughly three-quarters would have a CAC score of zero, he noted.
Until now, little has been known about CAC scores in asymptomatic, middle-aged adults with type 1 diabetes. The findings reported by Dr. Budoff raise questions about the 2018 revision of the cholesterol guideline from the American College of Cardiology and American Heart Association, released during the meeting (J Am Coll Cardiol. 2018. doi: 10.1016/j.jacc.2018.11.003), which lumps type 1 and type 2 diabetes together as a special high-risk category for cholesterol management.
The guideline should instead “advocate for more therapy with a CAC score of more than 100 and less therapy with a CAC score of zero in patients with type 1 diabetes,” Dr. Budoff suggested. “A statin for someone with a CAC score of zero probably won’t result in event reduction. The 70% of patients with type 1 diabetes who have a CAC score of zero potentially may not benefit from a statin,” he said in a video interview.
Dr. Budoff and his associates used CAC scores and outcomes data collected on 1,205 asymptomatic people with type 1 diabetes enrolled in the EDIC (Epidemiology of Diabetes Interventions and Complications) trial who underwent CAC scoring as part of the study protocol when they averaged 43 years of age. Follow-up tracked the incidence of cardiovascular disease events in 1,156 of these patients for an average of about 11 years. During follow-up, 105 patients had a cardiovascular disease event, an overall rate of 8.5 events/1,000 patient years of follow-up.
The results also confirmed the prognostic power of the CAC score in these patients. Compared with the very low event rate among those with a zero score, patients with a score of 1-100 had 71% more events, patients with a CAC score of 101-300 had a 5.4-fold higher event rate as those with no coronary calcium, and patients with a CAC score of greater than 300 had a 6.9-fold higher event rate than those with no coronary calcium, Dr. Budoff reported.
Coronary calcium deposits, a direct reflection of atheroma load, can change over time, but somewhat slowly. A CAC score of zero is very reliable for predicting a very low rate of cardiovascular disease events over the subsequent 5 years, and in many people it can reliably predict for as long as 10 years, Dr. Budoff said. Beyond that, follow-up CAC scoring is necessary to check for changes in coronary status, “especially in patients with type 1 diabetes,”
SOURCE: Budoff M et al. Abstract 13133.
CHICAGO – Roughly 70% of some 1,200 adult patients with type 1 diabetes screened for coronary artery calcium had a score of zero, about the same prevalence as in the general, U.S. adult population, suggesting the unexpected conclusion that a majority of middle-aged patients with type 1 diabetes do not have an elevated risk for coronary artery disease, in contrast to patients with type 2 diabetes.
Among 1,205 asymptomatic people with type 1 diabetes who underwent coronary artery calcium (CAC) measurement and were followed for an average of about 11 years, 71% had a CAC score of zero at baseline followed by a cardiovascular disease event rate of 5.6 events/1,000 patient years of follow-up, a “very low” event rate that made these patients no more likely to have an event than any adult of similar age and sex in the general U.S. population, Matthew J. Budoff, MD, said at the American Heart Association scientific sessions.
In prior reports, about half of patients with type 2 diabetes had a CAC score of zero, noted Dr. Budoff, professor of medicine and a specialist in cardiac CT imaging and preventive cardiology at the University of California, Los Angeles. In a general adult population that’s about 45 years old roughly three-quarters would have a CAC score of zero, he noted.
Until now, little has been known about CAC scores in asymptomatic, middle-aged adults with type 1 diabetes. The findings reported by Dr. Budoff raise questions about the 2018 revision of the cholesterol guideline from the American College of Cardiology and American Heart Association, released during the meeting (J Am Coll Cardiol. 2018. doi: 10.1016/j.jacc.2018.11.003), which lumps type 1 and type 2 diabetes together as a special high-risk category for cholesterol management.
The guideline should instead “advocate for more therapy with a CAC score of more than 100 and less therapy with a CAC score of zero in patients with type 1 diabetes,” Dr. Budoff suggested. “A statin for someone with a CAC score of zero probably won’t result in event reduction. The 70% of patients with type 1 diabetes who have a CAC score of zero potentially may not benefit from a statin,” he said in a video interview.
Dr. Budoff and his associates used CAC scores and outcomes data collected on 1,205 asymptomatic people with type 1 diabetes enrolled in the EDIC (Epidemiology of Diabetes Interventions and Complications) trial who underwent CAC scoring as part of the study protocol when they averaged 43 years of age. Follow-up tracked the incidence of cardiovascular disease events in 1,156 of these patients for an average of about 11 years. During follow-up, 105 patients had a cardiovascular disease event, an overall rate of 8.5 events/1,000 patient years of follow-up.
The results also confirmed the prognostic power of the CAC score in these patients. Compared with the very low event rate among those with a zero score, patients with a score of 1-100 had 71% more events, patients with a CAC score of 101-300 had a 5.4-fold higher event rate as those with no coronary calcium, and patients with a CAC score of greater than 300 had a 6.9-fold higher event rate than those with no coronary calcium, Dr. Budoff reported.
Coronary calcium deposits, a direct reflection of atheroma load, can change over time, but somewhat slowly. A CAC score of zero is very reliable for predicting a very low rate of cardiovascular disease events over the subsequent 5 years, and in many people it can reliably predict for as long as 10 years, Dr. Budoff said. Beyond that, follow-up CAC scoring is necessary to check for changes in coronary status, “especially in patients with type 1 diabetes,”
SOURCE: Budoff M et al. Abstract 13133.
CHICAGO – Roughly 70% of some 1,200 adult patients with type 1 diabetes screened for coronary artery calcium had a score of zero, about the same prevalence as in the general, U.S. adult population, suggesting the unexpected conclusion that a majority of middle-aged patients with type 1 diabetes do not have an elevated risk for coronary artery disease, in contrast to patients with type 2 diabetes.
Among 1,205 asymptomatic people with type 1 diabetes who underwent coronary artery calcium (CAC) measurement and were followed for an average of about 11 years, 71% had a CAC score of zero at baseline followed by a cardiovascular disease event rate of 5.6 events/1,000 patient years of follow-up, a “very low” event rate that made these patients no more likely to have an event than any adult of similar age and sex in the general U.S. population, Matthew J. Budoff, MD, said at the American Heart Association scientific sessions.
In prior reports, about half of patients with type 2 diabetes had a CAC score of zero, noted Dr. Budoff, professor of medicine and a specialist in cardiac CT imaging and preventive cardiology at the University of California, Los Angeles. In a general adult population that’s about 45 years old roughly three-quarters would have a CAC score of zero, he noted.
Until now, little has been known about CAC scores in asymptomatic, middle-aged adults with type 1 diabetes. The findings reported by Dr. Budoff raise questions about the 2018 revision of the cholesterol guideline from the American College of Cardiology and American Heart Association, released during the meeting (J Am Coll Cardiol. 2018. doi: 10.1016/j.jacc.2018.11.003), which lumps type 1 and type 2 diabetes together as a special high-risk category for cholesterol management.
The guideline should instead “advocate for more therapy with a CAC score of more than 100 and less therapy with a CAC score of zero in patients with type 1 diabetes,” Dr. Budoff suggested. “A statin for someone with a CAC score of zero probably won’t result in event reduction. The 70% of patients with type 1 diabetes who have a CAC score of zero potentially may not benefit from a statin,” he said in a video interview.
Dr. Budoff and his associates used CAC scores and outcomes data collected on 1,205 asymptomatic people with type 1 diabetes enrolled in the EDIC (Epidemiology of Diabetes Interventions and Complications) trial who underwent CAC scoring as part of the study protocol when they averaged 43 years of age. Follow-up tracked the incidence of cardiovascular disease events in 1,156 of these patients for an average of about 11 years. During follow-up, 105 patients had a cardiovascular disease event, an overall rate of 8.5 events/1,000 patient years of follow-up.
The results also confirmed the prognostic power of the CAC score in these patients. Compared with the very low event rate among those with a zero score, patients with a score of 1-100 had 71% more events, patients with a CAC score of 101-300 had a 5.4-fold higher event rate as those with no coronary calcium, and patients with a CAC score of greater than 300 had a 6.9-fold higher event rate than those with no coronary calcium, Dr. Budoff reported.
Coronary calcium deposits, a direct reflection of atheroma load, can change over time, but somewhat slowly. A CAC score of zero is very reliable for predicting a very low rate of cardiovascular disease events over the subsequent 5 years, and in many people it can reliably predict for as long as 10 years, Dr. Budoff said. Beyond that, follow-up CAC scoring is necessary to check for changes in coronary status, “especially in patients with type 1 diabetes,”
SOURCE: Budoff M et al. Abstract 13133.
REPORTING FROM THE AHA SCIENTIFIC SESSIONS
Key clinical point: .
Major finding: Seventy-one percent of patients with type 1 diabetes had a coronary artery calcium score of zero.
Study details: Review of data collected from 1,205 patients in the EDIC trial.
Disclosures: The EDIC trial had no commercial funding. Dr. Budoff has received research funding from General Electric.
Source: Budoff M et al. AHA 2018, Abstract 13133.
Prolonged DAPT doesn’t help left main CAD
SAN DIEGO – Among patients who receive a drug-eluting stent (DES) in their left main coronary artery (LMCA), continuation of dual antiplatelet therapy (DAPT) past 1 year appears to provide no benefit.
The results come from a subanalysis of the EXCEL trial, which compared the Xience DES to coronary artery bypass graft (CABG) surgery in LMCA lesions.
The LMCA is worrisome to a lot of physicians because of the large amount of myocardial tissue it contains, and they often prescribe DAPT past the generally recommended 1 year. “It’s this magic thing, that ‘Well, it’s left main stenting, and you’d better protect the patient.’ But it turns out that it doesn’t,” said Sorin Brener, MD, director of the catheterization lab at New York Methodist Hospital, who presented the results of the study at the Transcatheter Cardiovascular Therapeutics annual meeting.
The researchers compared patients in both groups who opted to stop DAPT after 1 year versus those who continued therapy out to 3 years, and the news was not favorable for continuation. A composite of death, myocardial infarction, or stroke was higher among patients who continued DAPT, though the results did not reach statistical significance.
It’s possible that patients who continued DAPT were more ill on average. “Obviously, there could be cases where the doctor decided they deserved more prolonged therapy, but it’s not measurable, so I don’t think they were sicker,” said Dr. Brener.
The study was also underpowered. Those worse trends probably don’t represent a real signal, according to Dr. Brener. Rather, they suggest that there is no significant difference between the approaches. “The signal just tells you that there is no difference, and that prolonging DAPT probably just induces some minor bleeding, but it doesn’t protect you. So the message would be that you should treat all your patients the same way regardless of where you put the stent,” said Dr. Brener.
The researchers compared data from 497 patients in the EXCEL trial who continued DAPT out to 3 years with that from 136 who stopped DAPT early (115 stopped in year 1-2; 21 stopped in year 2-3). The baseline characteristics of the two groups were similar except for a higher incidence of recent MI in the group that stopped DAPT early (21.3% vs. 13.7%; P = .03).
At 3 years, death, MI, or stroke occurred in 7.8% of the continuation group and in 5.2% of the patients who stopped DAPT. All-cause mortality was 5.8% in the continuation group compared with 2.3% of those who stopped. When the researchers restricted the analysis to patients who presented with acute coronary syndrome, 7.6% and 3.6%, respectively, met the primary endpoint. None of these differences reached statistical significance.
The study was limited by a high dropout rate from DAPT in the first year: 152 patients stopped taking the medication even though they experienced no events, and they were excluded from the analysis.
The EXCEL trial was funded by Abbott. Dr. Brener has been a consultant or received honoraria or speaker’s fees for AstraZeneca.
SOURCE: Brener S. TCT 2018, Abstract TCT-1.
SAN DIEGO – Among patients who receive a drug-eluting stent (DES) in their left main coronary artery (LMCA), continuation of dual antiplatelet therapy (DAPT) past 1 year appears to provide no benefit.
The results come from a subanalysis of the EXCEL trial, which compared the Xience DES to coronary artery bypass graft (CABG) surgery in LMCA lesions.
The LMCA is worrisome to a lot of physicians because of the large amount of myocardial tissue it contains, and they often prescribe DAPT past the generally recommended 1 year. “It’s this magic thing, that ‘Well, it’s left main stenting, and you’d better protect the patient.’ But it turns out that it doesn’t,” said Sorin Brener, MD, director of the catheterization lab at New York Methodist Hospital, who presented the results of the study at the Transcatheter Cardiovascular Therapeutics annual meeting.
The researchers compared patients in both groups who opted to stop DAPT after 1 year versus those who continued therapy out to 3 years, and the news was not favorable for continuation. A composite of death, myocardial infarction, or stroke was higher among patients who continued DAPT, though the results did not reach statistical significance.
It’s possible that patients who continued DAPT were more ill on average. “Obviously, there could be cases where the doctor decided they deserved more prolonged therapy, but it’s not measurable, so I don’t think they were sicker,” said Dr. Brener.
The study was also underpowered. Those worse trends probably don’t represent a real signal, according to Dr. Brener. Rather, they suggest that there is no significant difference between the approaches. “The signal just tells you that there is no difference, and that prolonging DAPT probably just induces some minor bleeding, but it doesn’t protect you. So the message would be that you should treat all your patients the same way regardless of where you put the stent,” said Dr. Brener.
The researchers compared data from 497 patients in the EXCEL trial who continued DAPT out to 3 years with that from 136 who stopped DAPT early (115 stopped in year 1-2; 21 stopped in year 2-3). The baseline characteristics of the two groups were similar except for a higher incidence of recent MI in the group that stopped DAPT early (21.3% vs. 13.7%; P = .03).
At 3 years, death, MI, or stroke occurred in 7.8% of the continuation group and in 5.2% of the patients who stopped DAPT. All-cause mortality was 5.8% in the continuation group compared with 2.3% of those who stopped. When the researchers restricted the analysis to patients who presented with acute coronary syndrome, 7.6% and 3.6%, respectively, met the primary endpoint. None of these differences reached statistical significance.
The study was limited by a high dropout rate from DAPT in the first year: 152 patients stopped taking the medication even though they experienced no events, and they were excluded from the analysis.
The EXCEL trial was funded by Abbott. Dr. Brener has been a consultant or received honoraria or speaker’s fees for AstraZeneca.
SOURCE: Brener S. TCT 2018, Abstract TCT-1.
SAN DIEGO – Among patients who receive a drug-eluting stent (DES) in their left main coronary artery (LMCA), continuation of dual antiplatelet therapy (DAPT) past 1 year appears to provide no benefit.
The results come from a subanalysis of the EXCEL trial, which compared the Xience DES to coronary artery bypass graft (CABG) surgery in LMCA lesions.
The LMCA is worrisome to a lot of physicians because of the large amount of myocardial tissue it contains, and they often prescribe DAPT past the generally recommended 1 year. “It’s this magic thing, that ‘Well, it’s left main stenting, and you’d better protect the patient.’ But it turns out that it doesn’t,” said Sorin Brener, MD, director of the catheterization lab at New York Methodist Hospital, who presented the results of the study at the Transcatheter Cardiovascular Therapeutics annual meeting.
The researchers compared patients in both groups who opted to stop DAPT after 1 year versus those who continued therapy out to 3 years, and the news was not favorable for continuation. A composite of death, myocardial infarction, or stroke was higher among patients who continued DAPT, though the results did not reach statistical significance.
It’s possible that patients who continued DAPT were more ill on average. “Obviously, there could be cases where the doctor decided they deserved more prolonged therapy, but it’s not measurable, so I don’t think they were sicker,” said Dr. Brener.
The study was also underpowered. Those worse trends probably don’t represent a real signal, according to Dr. Brener. Rather, they suggest that there is no significant difference between the approaches. “The signal just tells you that there is no difference, and that prolonging DAPT probably just induces some minor bleeding, but it doesn’t protect you. So the message would be that you should treat all your patients the same way regardless of where you put the stent,” said Dr. Brener.
The researchers compared data from 497 patients in the EXCEL trial who continued DAPT out to 3 years with that from 136 who stopped DAPT early (115 stopped in year 1-2; 21 stopped in year 2-3). The baseline characteristics of the two groups were similar except for a higher incidence of recent MI in the group that stopped DAPT early (21.3% vs. 13.7%; P = .03).
At 3 years, death, MI, or stroke occurred in 7.8% of the continuation group and in 5.2% of the patients who stopped DAPT. All-cause mortality was 5.8% in the continuation group compared with 2.3% of those who stopped. When the researchers restricted the analysis to patients who presented with acute coronary syndrome, 7.6% and 3.6%, respectively, met the primary endpoint. None of these differences reached statistical significance.
The study was limited by a high dropout rate from DAPT in the first year: 152 patients stopped taking the medication even though they experienced no events, and they were excluded from the analysis.
The EXCEL trial was funded by Abbott. Dr. Brener has been a consultant or received honoraria or speaker’s fees for AstraZeneca.
SOURCE: Brener S. TCT 2018, Abstract TCT-1.
REPORTING FROM TCT 2018
Key clinical point: Prolonged DAPT was not associated with better outcomes.
Major finding: Composite death, myocardial infarction, and stroke was similar between the two groups.
Study details: A post hoc analysis of 633 patients in the EXCEL trial.
Disclosures: The EXCEL trial was funded by Abbott. Dr. Brener has been a consultant or received honoraria or speaker’s fees for AstraZeneca.
Source: Brener S. TCT 2018, Abstract TCT-1.
Experts advise risk stratification for newborn early-onset sepsis
according to a pair of clinical reports published in Pediatrics.
Early-onset sepsis usually begins during labor in term infants, but in preterm infants, “the pathogenesis of preterm EOS likely begins before the onset of labor in many cases of preterm labor and/or PROM [premature rupture of membranes],” wrote Karen M. Puopolo, MD, of the University of Pennsylvania, Philadelphia, and her colleagues.
In the report on preterm infants, the researchers noted that EOS risk assessment using gestational age can be useful for term infants, but not for preterm infants. Instead, they advised categorizing preterm infants as low risk based on birth circumstances. Low-risk preterm infants were defined as those born by cesarean delivery because of maternal noninfectious illness or placental insufficiency in the absence of labor, attempts to induce labor, or rupture of membranes before delivery. Consider the risk/benefit balance of performing an EOS laboratory evaluation and empirical antibiotics, depending on the neonate’s clinical condition, the researchers said.
Preterm infants at high risk for EOS are those born preterm because of maternal cervical incompetence, preterm labor, premature rupture of membranes, clinical concerns for intra-amniotic infection, or acute onset of “unexplained nonreassuring fetal status,” Dr. Puopolo and her associates said. These infants should be managed with a blood culture and empirical antibiotics.
“The combination of ampicillin and gentamicin is the most appropriate empirical antibiotic regimen for infants at risk for EOS,” they noted. “Empirical administration of additional broad-spectrum antibiotics may be indicated in preterm infants who are severely ill and at a high risk for EOS, particularly after prolonged antepartum maternal antibiotic treatment,” they said. Antibiotics should be discontinued by 36-48 hours of incubation unless the infant shows signs of site-specific infection.
In the second report, again with Dr. Puopolo as the primary author, management of EOS was addressed for full-term infants, defined as those born at 35 weeks’ gestation or later.
Infants born at 35 weeks’ gestation or later can be stratified for EOS risk based on algorithms for intrapartum risk factors as well as risk assessments based on these risk factors and infant examinations, the researchers said.
There are a variety of acceptable approaches to risk stratification: categorical algorithms with threshold values for intrapartum risk factors; multivariate risk assessment based on both intrapartum risk factors (such as maternal chorioamnionitis, group B streptococcus colonization, adequacy of intrapartum antibiotic prophylaxis, and duration of ROM); and serial infant examination to detect clinical signs of illness after birth, Dr. Puopolo and her associates wrote.
They recommended that birth centers choose which type of EOS risk assessment to use and tailor it to their own situation. Once local guidelines are developed, ongoing surveillance is suggested.
The same recommendations apply to term infants as preterm infants regarding first-choice use of ampicillin and gentamicin when necessary, to be discontinued when blood cultures are sterile at 36-48 hours of incubation in the absence of site-specific infection, they said.
The reports do “not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate,” Dr. Puopolo and her associates noted.
The researchers had no financial conflicts to disclose, and there was no external funding.
SOURCE: Puopolo KM et al. Pediatrics. 2018 Nov. doi: 10.1542/peds.2018-2896; Puopolo KM et al. Pediatrics. 2018 Nov. doi: 10.1542/peds.2018-2894.
according to a pair of clinical reports published in Pediatrics.
Early-onset sepsis usually begins during labor in term infants, but in preterm infants, “the pathogenesis of preterm EOS likely begins before the onset of labor in many cases of preterm labor and/or PROM [premature rupture of membranes],” wrote Karen M. Puopolo, MD, of the University of Pennsylvania, Philadelphia, and her colleagues.
In the report on preterm infants, the researchers noted that EOS risk assessment using gestational age can be useful for term infants, but not for preterm infants. Instead, they advised categorizing preterm infants as low risk based on birth circumstances. Low-risk preterm infants were defined as those born by cesarean delivery because of maternal noninfectious illness or placental insufficiency in the absence of labor, attempts to induce labor, or rupture of membranes before delivery. Consider the risk/benefit balance of performing an EOS laboratory evaluation and empirical antibiotics, depending on the neonate’s clinical condition, the researchers said.
Preterm infants at high risk for EOS are those born preterm because of maternal cervical incompetence, preterm labor, premature rupture of membranes, clinical concerns for intra-amniotic infection, or acute onset of “unexplained nonreassuring fetal status,” Dr. Puopolo and her associates said. These infants should be managed with a blood culture and empirical antibiotics.
“The combination of ampicillin and gentamicin is the most appropriate empirical antibiotic regimen for infants at risk for EOS,” they noted. “Empirical administration of additional broad-spectrum antibiotics may be indicated in preterm infants who are severely ill and at a high risk for EOS, particularly after prolonged antepartum maternal antibiotic treatment,” they said. Antibiotics should be discontinued by 36-48 hours of incubation unless the infant shows signs of site-specific infection.
In the second report, again with Dr. Puopolo as the primary author, management of EOS was addressed for full-term infants, defined as those born at 35 weeks’ gestation or later.
Infants born at 35 weeks’ gestation or later can be stratified for EOS risk based on algorithms for intrapartum risk factors as well as risk assessments based on these risk factors and infant examinations, the researchers said.
There are a variety of acceptable approaches to risk stratification: categorical algorithms with threshold values for intrapartum risk factors; multivariate risk assessment based on both intrapartum risk factors (such as maternal chorioamnionitis, group B streptococcus colonization, adequacy of intrapartum antibiotic prophylaxis, and duration of ROM); and serial infant examination to detect clinical signs of illness after birth, Dr. Puopolo and her associates wrote.
They recommended that birth centers choose which type of EOS risk assessment to use and tailor it to their own situation. Once local guidelines are developed, ongoing surveillance is suggested.
The same recommendations apply to term infants as preterm infants regarding first-choice use of ampicillin and gentamicin when necessary, to be discontinued when blood cultures are sterile at 36-48 hours of incubation in the absence of site-specific infection, they said.
The reports do “not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate,” Dr. Puopolo and her associates noted.
The researchers had no financial conflicts to disclose, and there was no external funding.
SOURCE: Puopolo KM et al. Pediatrics. 2018 Nov. doi: 10.1542/peds.2018-2896; Puopolo KM et al. Pediatrics. 2018 Nov. doi: 10.1542/peds.2018-2894.
according to a pair of clinical reports published in Pediatrics.
Early-onset sepsis usually begins during labor in term infants, but in preterm infants, “the pathogenesis of preterm EOS likely begins before the onset of labor in many cases of preterm labor and/or PROM [premature rupture of membranes],” wrote Karen M. Puopolo, MD, of the University of Pennsylvania, Philadelphia, and her colleagues.
In the report on preterm infants, the researchers noted that EOS risk assessment using gestational age can be useful for term infants, but not for preterm infants. Instead, they advised categorizing preterm infants as low risk based on birth circumstances. Low-risk preterm infants were defined as those born by cesarean delivery because of maternal noninfectious illness or placental insufficiency in the absence of labor, attempts to induce labor, or rupture of membranes before delivery. Consider the risk/benefit balance of performing an EOS laboratory evaluation and empirical antibiotics, depending on the neonate’s clinical condition, the researchers said.
Preterm infants at high risk for EOS are those born preterm because of maternal cervical incompetence, preterm labor, premature rupture of membranes, clinical concerns for intra-amniotic infection, or acute onset of “unexplained nonreassuring fetal status,” Dr. Puopolo and her associates said. These infants should be managed with a blood culture and empirical antibiotics.
“The combination of ampicillin and gentamicin is the most appropriate empirical antibiotic regimen for infants at risk for EOS,” they noted. “Empirical administration of additional broad-spectrum antibiotics may be indicated in preterm infants who are severely ill and at a high risk for EOS, particularly after prolonged antepartum maternal antibiotic treatment,” they said. Antibiotics should be discontinued by 36-48 hours of incubation unless the infant shows signs of site-specific infection.
In the second report, again with Dr. Puopolo as the primary author, management of EOS was addressed for full-term infants, defined as those born at 35 weeks’ gestation or later.
Infants born at 35 weeks’ gestation or later can be stratified for EOS risk based on algorithms for intrapartum risk factors as well as risk assessments based on these risk factors and infant examinations, the researchers said.
There are a variety of acceptable approaches to risk stratification: categorical algorithms with threshold values for intrapartum risk factors; multivariate risk assessment based on both intrapartum risk factors (such as maternal chorioamnionitis, group B streptococcus colonization, adequacy of intrapartum antibiotic prophylaxis, and duration of ROM); and serial infant examination to detect clinical signs of illness after birth, Dr. Puopolo and her associates wrote.
They recommended that birth centers choose which type of EOS risk assessment to use and tailor it to their own situation. Once local guidelines are developed, ongoing surveillance is suggested.
The same recommendations apply to term infants as preterm infants regarding first-choice use of ampicillin and gentamicin when necessary, to be discontinued when blood cultures are sterile at 36-48 hours of incubation in the absence of site-specific infection, they said.
The reports do “not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate,” Dr. Puopolo and her associates noted.
The researchers had no financial conflicts to disclose, and there was no external funding.
SOURCE: Puopolo KM et al. Pediatrics. 2018 Nov. doi: 10.1542/peds.2018-2896; Puopolo KM et al. Pediatrics. 2018 Nov. doi: 10.1542/peds.2018-2894.
FROM PEDIATRICS
Dementia linked to increased mortality risk in adults with Down syndrome
Adults with Down syndrome and dementia had a risk of death five times higher than those without dementia, according to results of a recent prospective study.
More than 70% of the individuals with Down syndrome who died over the course of follow-up had a clinical diagnosis of dementia in this longitudinal study of community dwelling participants, many of whom had factors associated with dementia such as the apolipoprotein E (APOE) genotype.
The findings of this study support an “urgent need” for clinical trials of treatment that might delay or prevent dementia in individuals with Down syndrome, said the investigators, led by Rosalyn Hithersay, MSc, of the department of forensic and neurodevelopmental sciences in the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London (United Kingdom).
“We hope that our findings can improve clinical care by identifying factors associated with increased risk for dementia and mortality risk in this population, suggesting the potentially beneficial effects of existing medication options and helping clinicians provide prognostic information for their patients,” the authors wrote in JAMA Neurology.
The risk of dementia in individuals with Down syndrome has grown to “exceptional” levels, alongside a dramatic increase in life expectancy in these patients, from just 10 years of age some 50 years ago, to nearly 64 years today, investigators said.
Although other research has confirmed that dementia is frequently recorded as a contributory factor in Down syndrome deaths in recent years, this latest study provides crude mortality rates and exploratory analyses of factors that may modify mortality and dementia risk, according to the researchers.
Their study included 211 individuals with Down syndrome who were aged at least 36 years at study entry and followed for a total of 503.92 person-years, the investigators reported.
A total of 27 individuals died during follow-up, with a median age at death of 57 years; of those individuals, 19 (70.37%) had a clinical diagnosis of dementia, according to the report.
The crude mortality rate for individuals with dementia was nearly 1,192 deaths per 10,000 person-years, compared with 232 deaths per 10,000 person-years for those with no dementia diagnosis, the investigators found.
Further analysis showed that factors independently associated with mortality in those with a dementia diagnosis included APOE genotype, dementia medication status, early-onset epilepsy, and presence of two or more comorbid conditions.
In a combined model, APOE genotype was significantly associated with mortality risk, they added.
Among the eight individuals with Down syndrome who died without a dementia diagnosis, one reportedly had early signs of cognitive decline, and two had late-onset epilepsy.
Late-onset epilepsy, identified in seven individuals (4.8%) with no dementia diagnosis in this study, was the only factor associated with mortality in individuals without dementia, conferring a 10-fold increase in risk of that outcome, according to the analysis.
“This raises the question of whether seizures can begin in the absence of other features of dementia in individuals with Down syndrome or whether these seven individuals had significant AD pathology and neurological symptoms but had yet to receive a formal dementia diagnosis,” the researchers wrote in a discussion of results.
The authors reported no conflict of interest disclosures related to the study. Their research was supported by UK National Institute for Health Research networks and participating National Health Services trusts, as well as a Wellcome Trust Strategic Award to the London Down Syndrome Consortium.
SOURCE: Hithersay R et al. JAMA Neurol. 2018 Nov 19. doi: 10.1001/jamaneurol.2018.3616
Although this prospective longitudinal study has a limited sample size and short follow-up, the finding that dementia is the proximate cause of death in approximately 70% of individuals with Down syndrome was “astonishing,” Michael S. Rafii, MD, PhD, and Stephanie L. Santoro, MD, wrote in an editorial.
Mortality rates among individuals with Down syndrome were five times higher in those with dementia as compared with those without dementia in this study, with a median age at death of 57 years (see article).
“By comparison, in the general population, dementia of any subtype is listed in only 18% of death certificates for those older than 65 years, with mortality rates being slightly less than twofold higher in those with dementia than those without,” Dr. Rafiii and Dr. Santoro wrote in their editorial.
Results of the study imply that most older individuals with Down syndrome will have dementia at the time of death, which suggests that these individuals and their families have a “greater need” to plan for a life stage that includes dementia, the authors said.
Physicians and health care systems could consider screening for dementia and epilepsy as part of their standard care practices for older adults with Down syndrome based on these study results, they added.
“Although consensus guidelines and screening tools have been published for the evaluation and management of dementia in Down syndrome, it remains unclear if there has been widespread implementation of these,” the authors said.
Dr. Rafii is with the Alzheimer’s Therapeutic Research Institute at the University of Southern California, San Diego. Coauthor Dr. Santoro is with the Down Syndrome Program at Massachusetts General Hospital and with Harvard Medical School, both in Boston. The authors reported no conflict of interest disclosures related to their editorial, which appears in JAMA Neurology .
Although this prospective longitudinal study has a limited sample size and short follow-up, the finding that dementia is the proximate cause of death in approximately 70% of individuals with Down syndrome was “astonishing,” Michael S. Rafii, MD, PhD, and Stephanie L. Santoro, MD, wrote in an editorial.
Mortality rates among individuals with Down syndrome were five times higher in those with dementia as compared with those without dementia in this study, with a median age at death of 57 years (see article).
“By comparison, in the general population, dementia of any subtype is listed in only 18% of death certificates for those older than 65 years, with mortality rates being slightly less than twofold higher in those with dementia than those without,” Dr. Rafiii and Dr. Santoro wrote in their editorial.
Results of the study imply that most older individuals with Down syndrome will have dementia at the time of death, which suggests that these individuals and their families have a “greater need” to plan for a life stage that includes dementia, the authors said.
Physicians and health care systems could consider screening for dementia and epilepsy as part of their standard care practices for older adults with Down syndrome based on these study results, they added.
“Although consensus guidelines and screening tools have been published for the evaluation and management of dementia in Down syndrome, it remains unclear if there has been widespread implementation of these,” the authors said.
Dr. Rafii is with the Alzheimer’s Therapeutic Research Institute at the University of Southern California, San Diego. Coauthor Dr. Santoro is with the Down Syndrome Program at Massachusetts General Hospital and with Harvard Medical School, both in Boston. The authors reported no conflict of interest disclosures related to their editorial, which appears in JAMA Neurology .
Although this prospective longitudinal study has a limited sample size and short follow-up, the finding that dementia is the proximate cause of death in approximately 70% of individuals with Down syndrome was “astonishing,” Michael S. Rafii, MD, PhD, and Stephanie L. Santoro, MD, wrote in an editorial.
Mortality rates among individuals with Down syndrome were five times higher in those with dementia as compared with those without dementia in this study, with a median age at death of 57 years (see article).
“By comparison, in the general population, dementia of any subtype is listed in only 18% of death certificates for those older than 65 years, with mortality rates being slightly less than twofold higher in those with dementia than those without,” Dr. Rafiii and Dr. Santoro wrote in their editorial.
Results of the study imply that most older individuals with Down syndrome will have dementia at the time of death, which suggests that these individuals and their families have a “greater need” to plan for a life stage that includes dementia, the authors said.
Physicians and health care systems could consider screening for dementia and epilepsy as part of their standard care practices for older adults with Down syndrome based on these study results, they added.
“Although consensus guidelines and screening tools have been published for the evaluation and management of dementia in Down syndrome, it remains unclear if there has been widespread implementation of these,” the authors said.
Dr. Rafii is with the Alzheimer’s Therapeutic Research Institute at the University of Southern California, San Diego. Coauthor Dr. Santoro is with the Down Syndrome Program at Massachusetts General Hospital and with Harvard Medical School, both in Boston. The authors reported no conflict of interest disclosures related to their editorial, which appears in JAMA Neurology .
Adults with Down syndrome and dementia had a risk of death five times higher than those without dementia, according to results of a recent prospective study.
More than 70% of the individuals with Down syndrome who died over the course of follow-up had a clinical diagnosis of dementia in this longitudinal study of community dwelling participants, many of whom had factors associated with dementia such as the apolipoprotein E (APOE) genotype.
The findings of this study support an “urgent need” for clinical trials of treatment that might delay or prevent dementia in individuals with Down syndrome, said the investigators, led by Rosalyn Hithersay, MSc, of the department of forensic and neurodevelopmental sciences in the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London (United Kingdom).
“We hope that our findings can improve clinical care by identifying factors associated with increased risk for dementia and mortality risk in this population, suggesting the potentially beneficial effects of existing medication options and helping clinicians provide prognostic information for their patients,” the authors wrote in JAMA Neurology.
The risk of dementia in individuals with Down syndrome has grown to “exceptional” levels, alongside a dramatic increase in life expectancy in these patients, from just 10 years of age some 50 years ago, to nearly 64 years today, investigators said.
Although other research has confirmed that dementia is frequently recorded as a contributory factor in Down syndrome deaths in recent years, this latest study provides crude mortality rates and exploratory analyses of factors that may modify mortality and dementia risk, according to the researchers.
Their study included 211 individuals with Down syndrome who were aged at least 36 years at study entry and followed for a total of 503.92 person-years, the investigators reported.
A total of 27 individuals died during follow-up, with a median age at death of 57 years; of those individuals, 19 (70.37%) had a clinical diagnosis of dementia, according to the report.
The crude mortality rate for individuals with dementia was nearly 1,192 deaths per 10,000 person-years, compared with 232 deaths per 10,000 person-years for those with no dementia diagnosis, the investigators found.
Further analysis showed that factors independently associated with mortality in those with a dementia diagnosis included APOE genotype, dementia medication status, early-onset epilepsy, and presence of two or more comorbid conditions.
In a combined model, APOE genotype was significantly associated with mortality risk, they added.
Among the eight individuals with Down syndrome who died without a dementia diagnosis, one reportedly had early signs of cognitive decline, and two had late-onset epilepsy.
Late-onset epilepsy, identified in seven individuals (4.8%) with no dementia diagnosis in this study, was the only factor associated with mortality in individuals without dementia, conferring a 10-fold increase in risk of that outcome, according to the analysis.
“This raises the question of whether seizures can begin in the absence of other features of dementia in individuals with Down syndrome or whether these seven individuals had significant AD pathology and neurological symptoms but had yet to receive a formal dementia diagnosis,” the researchers wrote in a discussion of results.
The authors reported no conflict of interest disclosures related to the study. Their research was supported by UK National Institute for Health Research networks and participating National Health Services trusts, as well as a Wellcome Trust Strategic Award to the London Down Syndrome Consortium.
SOURCE: Hithersay R et al. JAMA Neurol. 2018 Nov 19. doi: 10.1001/jamaneurol.2018.3616
Adults with Down syndrome and dementia had a risk of death five times higher than those without dementia, according to results of a recent prospective study.
More than 70% of the individuals with Down syndrome who died over the course of follow-up had a clinical diagnosis of dementia in this longitudinal study of community dwelling participants, many of whom had factors associated with dementia such as the apolipoprotein E (APOE) genotype.
The findings of this study support an “urgent need” for clinical trials of treatment that might delay or prevent dementia in individuals with Down syndrome, said the investigators, led by Rosalyn Hithersay, MSc, of the department of forensic and neurodevelopmental sciences in the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London (United Kingdom).
“We hope that our findings can improve clinical care by identifying factors associated with increased risk for dementia and mortality risk in this population, suggesting the potentially beneficial effects of existing medication options and helping clinicians provide prognostic information for their patients,” the authors wrote in JAMA Neurology.
The risk of dementia in individuals with Down syndrome has grown to “exceptional” levels, alongside a dramatic increase in life expectancy in these patients, from just 10 years of age some 50 years ago, to nearly 64 years today, investigators said.
Although other research has confirmed that dementia is frequently recorded as a contributory factor in Down syndrome deaths in recent years, this latest study provides crude mortality rates and exploratory analyses of factors that may modify mortality and dementia risk, according to the researchers.
Their study included 211 individuals with Down syndrome who were aged at least 36 years at study entry and followed for a total of 503.92 person-years, the investigators reported.
A total of 27 individuals died during follow-up, with a median age at death of 57 years; of those individuals, 19 (70.37%) had a clinical diagnosis of dementia, according to the report.
The crude mortality rate for individuals with dementia was nearly 1,192 deaths per 10,000 person-years, compared with 232 deaths per 10,000 person-years for those with no dementia diagnosis, the investigators found.
Further analysis showed that factors independently associated with mortality in those with a dementia diagnosis included APOE genotype, dementia medication status, early-onset epilepsy, and presence of two or more comorbid conditions.
In a combined model, APOE genotype was significantly associated with mortality risk, they added.
Among the eight individuals with Down syndrome who died without a dementia diagnosis, one reportedly had early signs of cognitive decline, and two had late-onset epilepsy.
Late-onset epilepsy, identified in seven individuals (4.8%) with no dementia diagnosis in this study, was the only factor associated with mortality in individuals without dementia, conferring a 10-fold increase in risk of that outcome, according to the analysis.
“This raises the question of whether seizures can begin in the absence of other features of dementia in individuals with Down syndrome or whether these seven individuals had significant AD pathology and neurological symptoms but had yet to receive a formal dementia diagnosis,” the researchers wrote in a discussion of results.
The authors reported no conflict of interest disclosures related to the study. Their research was supported by UK National Institute for Health Research networks and participating National Health Services trusts, as well as a Wellcome Trust Strategic Award to the London Down Syndrome Consortium.
SOURCE: Hithersay R et al. JAMA Neurol. 2018 Nov 19. doi: 10.1001/jamaneurol.2018.3616
FROM JAMA NEUROLOGY
Key clinical point: Adults with Down syndrome and dementia had a risk of death five times higher than those without dementia.
Major finding: The crude mortality rate for individuals with dementia versus those without dementia, respectively, was approximately 1,192 and 232 deaths per 10,000 person-years.
Study details: A prospective longitudinal study of 211 community-dwelling adults with Down syndrome in the United Kingdom.
Disclosures: Study authors reported no conflict of interest disclosures. The research was supported by National Institute for Health Research networks and participating National Health Services trusts, and a Wellcome Trust Strategic Award.
Source: Hithersay R et al. JAMA Neurol. 2018 Nov 19.
Second-melanoma risk higher with indoor tanning
than those who avoid indoor tanning, according to a retrospective study involving 434 melanoma patients.
The incidence of second melanomas over the entire 16-year course of the study was 25.2% among the tanning-bed users and 18.6% for nonusers. Among these study subjects – 27 with tanning-bed exposure and 61 without – median time to the second tumor was 225 days (0.62 years) for exposed patients and 1,280 days (3.50 years) for those with no exposure, the investigators reported.
This study, they wrote, is the first to show that “patients who had second primary melanoma diagnoses were more likely to have had” exposure to artificial UVR. The increased radiation intensity of tanning beds, “as opposed to UVR from ambient sunlight, in a physiologically vulnerable patient population [fair-skinned persons] at an early age contributes to our findings of decreased tumor lag time.”
SOURCE: Li Y et al. J Am Acad Dermatol. 2018;79(6):1101-8.
than those who avoid indoor tanning, according to a retrospective study involving 434 melanoma patients.
The incidence of second melanomas over the entire 16-year course of the study was 25.2% among the tanning-bed users and 18.6% for nonusers. Among these study subjects – 27 with tanning-bed exposure and 61 without – median time to the second tumor was 225 days (0.62 years) for exposed patients and 1,280 days (3.50 years) for those with no exposure, the investigators reported.
This study, they wrote, is the first to show that “patients who had second primary melanoma diagnoses were more likely to have had” exposure to artificial UVR. The increased radiation intensity of tanning beds, “as opposed to UVR from ambient sunlight, in a physiologically vulnerable patient population [fair-skinned persons] at an early age contributes to our findings of decreased tumor lag time.”
SOURCE: Li Y et al. J Am Acad Dermatol. 2018;79(6):1101-8.
than those who avoid indoor tanning, according to a retrospective study involving 434 melanoma patients.
The incidence of second melanomas over the entire 16-year course of the study was 25.2% among the tanning-bed users and 18.6% for nonusers. Among these study subjects – 27 with tanning-bed exposure and 61 without – median time to the second tumor was 225 days (0.62 years) for exposed patients and 1,280 days (3.50 years) for those with no exposure, the investigators reported.
This study, they wrote, is the first to show that “patients who had second primary melanoma diagnoses were more likely to have had” exposure to artificial UVR. The increased radiation intensity of tanning beds, “as opposed to UVR from ambient sunlight, in a physiologically vulnerable patient population [fair-skinned persons] at an early age contributes to our findings of decreased tumor lag time.”
SOURCE: Li Y et al. J Am Acad Dermatol. 2018;79(6):1101-8.
FROM THE JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Levonorgestrel implant right after delivery does not affect breastfeeding, infant growth
Researchers found no significant differences in infant growth, changes in breastfeeding initiation or breastfeeding continuation at 3-month and 6-month follow-up among women who received a levonorgestrel contraception implant very soon after delivery, compared with women who waited to receive the implant.
“These findings are consistent with the preponderance of literature supporting the hypothesis that progestin-containing contraceptives do not compromise a woman’s ability to initiate or sustain breastfeeding and do not adversely affect infant growth,” Sarah Averbach, MD, of the University of California, San Francisco, and her colleagues wrote in their study published in Contraception.
Dr. Averbach and her colleagues randomized 96 women to receive a two-rod levonorgestrel (LNG)–releasing subdermal contraceptive implant within 5 days of delivery (mean time, 36 hours post delivery) and 87 women to delay the implant to between 6 and 8 weeks at a postpartum follow-up visit (mean time, 68 days). The women were a minimum of 18 years old with a recent vaginal or cesarean section delivery at a Ugandan hospital; 55% of the women had at least three children, and 73% said they had prior experience breastfeeding. The researchers then examined infant weight change and infant head circumference change at 6 months from birth, time to lactogenesis, and whether mothers continued to breastfeed at 3 months and 6 months after birth.
Infant weight was similar in the immediate-implant group (4,632 g), compared with the delayed-implant group (4,407 g; P = .26); infant head circumference was similar between both groups (9.3 cm vs. 9.5 cm; P = .70) at 6 months as well. The time to lactogenesis was not significantly different in the immediate-implant (65 hours) and delayed-implant (63 hours; P = .84) groups. At 3 months, 74% of immediate-implant participants and 71% of delayed-implant participants said they were breastfeeding exclusively (P = .74); at 6 months, 48% of immediate implant participants and 52% of delayed implant participants reported exclusive breastfeeding (P equals .58).
Limitations of the study included follow-up to only 6 months and selection of participants with previous breastfeeding experience. Researchers also noted better measurements of infant and maternal breast milk intake also could be used and limit generalization of the results.
This study was funded by the Society of Family Planning Research Fund. Dr. Averbach is supported by an award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The other authors had no relevant financial disclosures.
SOURCE: Averbach S et al. Contraception. 2018. doi: 10.1016/j.contraception.2018.10.008.
Researchers found no significant differences in infant growth, changes in breastfeeding initiation or breastfeeding continuation at 3-month and 6-month follow-up among women who received a levonorgestrel contraception implant very soon after delivery, compared with women who waited to receive the implant.
“These findings are consistent with the preponderance of literature supporting the hypothesis that progestin-containing contraceptives do not compromise a woman’s ability to initiate or sustain breastfeeding and do not adversely affect infant growth,” Sarah Averbach, MD, of the University of California, San Francisco, and her colleagues wrote in their study published in Contraception.
Dr. Averbach and her colleagues randomized 96 women to receive a two-rod levonorgestrel (LNG)–releasing subdermal contraceptive implant within 5 days of delivery (mean time, 36 hours post delivery) and 87 women to delay the implant to between 6 and 8 weeks at a postpartum follow-up visit (mean time, 68 days). The women were a minimum of 18 years old with a recent vaginal or cesarean section delivery at a Ugandan hospital; 55% of the women had at least three children, and 73% said they had prior experience breastfeeding. The researchers then examined infant weight change and infant head circumference change at 6 months from birth, time to lactogenesis, and whether mothers continued to breastfeed at 3 months and 6 months after birth.
Infant weight was similar in the immediate-implant group (4,632 g), compared with the delayed-implant group (4,407 g; P = .26); infant head circumference was similar between both groups (9.3 cm vs. 9.5 cm; P = .70) at 6 months as well. The time to lactogenesis was not significantly different in the immediate-implant (65 hours) and delayed-implant (63 hours; P = .84) groups. At 3 months, 74% of immediate-implant participants and 71% of delayed-implant participants said they were breastfeeding exclusively (P = .74); at 6 months, 48% of immediate implant participants and 52% of delayed implant participants reported exclusive breastfeeding (P equals .58).
Limitations of the study included follow-up to only 6 months and selection of participants with previous breastfeeding experience. Researchers also noted better measurements of infant and maternal breast milk intake also could be used and limit generalization of the results.
This study was funded by the Society of Family Planning Research Fund. Dr. Averbach is supported by an award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The other authors had no relevant financial disclosures.
SOURCE: Averbach S et al. Contraception. 2018. doi: 10.1016/j.contraception.2018.10.008.
Researchers found no significant differences in infant growth, changes in breastfeeding initiation or breastfeeding continuation at 3-month and 6-month follow-up among women who received a levonorgestrel contraception implant very soon after delivery, compared with women who waited to receive the implant.
“These findings are consistent with the preponderance of literature supporting the hypothesis that progestin-containing contraceptives do not compromise a woman’s ability to initiate or sustain breastfeeding and do not adversely affect infant growth,” Sarah Averbach, MD, of the University of California, San Francisco, and her colleagues wrote in their study published in Contraception.
Dr. Averbach and her colleagues randomized 96 women to receive a two-rod levonorgestrel (LNG)–releasing subdermal contraceptive implant within 5 days of delivery (mean time, 36 hours post delivery) and 87 women to delay the implant to between 6 and 8 weeks at a postpartum follow-up visit (mean time, 68 days). The women were a minimum of 18 years old with a recent vaginal or cesarean section delivery at a Ugandan hospital; 55% of the women had at least three children, and 73% said they had prior experience breastfeeding. The researchers then examined infant weight change and infant head circumference change at 6 months from birth, time to lactogenesis, and whether mothers continued to breastfeed at 3 months and 6 months after birth.
Infant weight was similar in the immediate-implant group (4,632 g), compared with the delayed-implant group (4,407 g; P = .26); infant head circumference was similar between both groups (9.3 cm vs. 9.5 cm; P = .70) at 6 months as well. The time to lactogenesis was not significantly different in the immediate-implant (65 hours) and delayed-implant (63 hours; P = .84) groups. At 3 months, 74% of immediate-implant participants and 71% of delayed-implant participants said they were breastfeeding exclusively (P = .74); at 6 months, 48% of immediate implant participants and 52% of delayed implant participants reported exclusive breastfeeding (P equals .58).
Limitations of the study included follow-up to only 6 months and selection of participants with previous breastfeeding experience. Researchers also noted better measurements of infant and maternal breast milk intake also could be used and limit generalization of the results.
This study was funded by the Society of Family Planning Research Fund. Dr. Averbach is supported by an award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The other authors had no relevant financial disclosures.
SOURCE: Averbach S et al. Contraception. 2018. doi: 10.1016/j.contraception.2018.10.008.
FROM CONTRACEPTION
Key clinical point:
Major finding: Infant weight was similar in the immediate-implant group (4,632 g), compared with the delayed-implant group (4,407 g; P = .26); infant head circumference was similar between both groups (9.3 cm vs. 9.5 cm; P = .70) at 6 months as well.
Study details: A randomized trial of 96 women in Uganda who received a contraceptive implant less than 5 days after delivery and 86 women who received the implant between 6 and 8 weeks post partum.
Disclosures: This study was funded by the Society of Family Planning Research Fund. Dr. Averbach is supported by an award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The other authors had no relevant financial disclosures.
Source: Averbach S et al. Contraception. 2018. doi: 10.1016/j.contraception.2018.10.008.
Treating psoriasis with biologics: Recommendations from an expert
LAS VEGAS – If you’re considering adding biologics for psoriasis to your clinical practice, dermatologist Kristina C. Duffin, MD, has some advice: Don’t expect to just use one drug, focus on comorbidities, and embrace strategies to bypass the potential obstacle of prior-authorization approvals.
Here are some tips from Dr. Duffin, who spoke at the Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar:
- Don’t expect a one-size-fits-all medication. “There is no one, single go-to drug,” said Dr. Duffin, who is cochair of the department of dermatology at the University of Utah, Salt Lake City. “Maybe someday, we will have a biological personalized medicine marker to say this is the right drug, but for now we don’t.” More than 10 biologics are available to treat psoriasis, she said, and more are in the pipeline.
- Pay close attention to comorbidities. It’s important to “have a good grasp” of a patient’s comorbidities, which can help focus the choice of a biologic, Dr. Duffin said. She recommends starting with an anti–tumor necrosis factor (TNF) agents for patients with psoriatic arthritis. For patients with Crohn’s disease, she recommends anti-TNF (adalimumab, infliximab) and anti-interleukin–12/23 or anti-IL-23 agents (ustekinumab). Anti-TNF agents should be avoided in patients with multiple sclerosis, and anti-IL-17 agents shouldn’t be given to patients with recurrent candidiasis, she noted.
- Encourage patients to make prompt decisions. Dr. Duffin sits down with patients to discuss various biologic options, and she goes over information in handouts. She also focuses on their needs: “Are they interested in getting better fast? Do they want to be clear for their wedding in a month?” She prefers to not let patients go home to think about what they’d like to do. Instead, she advises patients to make choices while at the office visit.
- Order lab tests and be careful about vaccines. Dr. Duffin orders the following tests for all patients who are starting on biologics: CBC, comprehensive metabolic panel, hepatitis B and C, and tuberculosis. She orders HIV, Hba1c and lipid tests, if appropriate. She prefers that patients treated with biologics avoid live vaccines. She suggests other vaccines, if indicated, such as seasonal influenza and pneumonia vaccines, and for those aged 50 years and older, herpes zoster vaccine. She urges patients to call the office if they have an infection or need surgery because they may need to discuss putting a temporary hold on the biologics.
- Understand how to navigate formularies.“Getting drugs approved for patients with Medicare is a challenge,” Dr. Duffin said. It’s helpful to understand how insurers handle specific psoriasis drugs so you can choose one that’s likely to be covered if you’re unsure which one is best. The website www.covermymeds.com allows physicians to easily check insurer formularies, free of charge, she said.
- Documentation is crucial when you’re dealing with an insurer. Document body surface area, Psoriasis Area Severity Index scores, or physician global assessment measures, she advised. An app provided by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, is a helpful in determining these measurements, she said. Also include information about failed treatments and the rationale behind why you chose a specific treatment, she said. “If denial happens, get the details,” she said. This may turn up a clerical error on the insurer’s part that incorrectly led to a denial.
- Escalate challenges to drug denials. If the preferred treatment is denied, one option is to appeal the denial. As a resource, Dr. Duffin pointed to sample letters for appealing denials for physicians and patients on the websites for the American Academy of Dermatology and the National Psoriasis Foundation. Ask for a limited 6-month approval, she said, or have the patient write a letter to the insurer using one of the sample letter templates. Another option is to ask the insurer for a “peer-to-peer” review, she said. “Sometimes it’s really hard for insurance company folks to say no to you if you have a really good story,” she commented.
- Help your patients get financial assistance. Almost every biologic manufacturer has a patient assistance plan, which can also help with deductibles and copays, Dr. Duffin said.
Dr. Duffin discloses consulting for AbbVie, Amgen, Celgene, Janssen, Lilly, Novartis, Pfizer, and Sienna. She has received grant/contracted research support from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Sienna, Stiefel, and UCB.
SDEF and this news organization are owned by the same parent company.
LAS VEGAS – If you’re considering adding biologics for psoriasis to your clinical practice, dermatologist Kristina C. Duffin, MD, has some advice: Don’t expect to just use one drug, focus on comorbidities, and embrace strategies to bypass the potential obstacle of prior-authorization approvals.
Here are some tips from Dr. Duffin, who spoke at the Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar:
- Don’t expect a one-size-fits-all medication. “There is no one, single go-to drug,” said Dr. Duffin, who is cochair of the department of dermatology at the University of Utah, Salt Lake City. “Maybe someday, we will have a biological personalized medicine marker to say this is the right drug, but for now we don’t.” More than 10 biologics are available to treat psoriasis, she said, and more are in the pipeline.
- Pay close attention to comorbidities. It’s important to “have a good grasp” of a patient’s comorbidities, which can help focus the choice of a biologic, Dr. Duffin said. She recommends starting with an anti–tumor necrosis factor (TNF) agents for patients with psoriatic arthritis. For patients with Crohn’s disease, she recommends anti-TNF (adalimumab, infliximab) and anti-interleukin–12/23 or anti-IL-23 agents (ustekinumab). Anti-TNF agents should be avoided in patients with multiple sclerosis, and anti-IL-17 agents shouldn’t be given to patients with recurrent candidiasis, she noted.
- Encourage patients to make prompt decisions. Dr. Duffin sits down with patients to discuss various biologic options, and she goes over information in handouts. She also focuses on their needs: “Are they interested in getting better fast? Do they want to be clear for their wedding in a month?” She prefers to not let patients go home to think about what they’d like to do. Instead, she advises patients to make choices while at the office visit.
- Order lab tests and be careful about vaccines. Dr. Duffin orders the following tests for all patients who are starting on biologics: CBC, comprehensive metabolic panel, hepatitis B and C, and tuberculosis. She orders HIV, Hba1c and lipid tests, if appropriate. She prefers that patients treated with biologics avoid live vaccines. She suggests other vaccines, if indicated, such as seasonal influenza and pneumonia vaccines, and for those aged 50 years and older, herpes zoster vaccine. She urges patients to call the office if they have an infection or need surgery because they may need to discuss putting a temporary hold on the biologics.
- Understand how to navigate formularies.“Getting drugs approved for patients with Medicare is a challenge,” Dr. Duffin said. It’s helpful to understand how insurers handle specific psoriasis drugs so you can choose one that’s likely to be covered if you’re unsure which one is best. The website www.covermymeds.com allows physicians to easily check insurer formularies, free of charge, she said.
- Documentation is crucial when you’re dealing with an insurer. Document body surface area, Psoriasis Area Severity Index scores, or physician global assessment measures, she advised. An app provided by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, is a helpful in determining these measurements, she said. Also include information about failed treatments and the rationale behind why you chose a specific treatment, she said. “If denial happens, get the details,” she said. This may turn up a clerical error on the insurer’s part that incorrectly led to a denial.
- Escalate challenges to drug denials. If the preferred treatment is denied, one option is to appeal the denial. As a resource, Dr. Duffin pointed to sample letters for appealing denials for physicians and patients on the websites for the American Academy of Dermatology and the National Psoriasis Foundation. Ask for a limited 6-month approval, she said, or have the patient write a letter to the insurer using one of the sample letter templates. Another option is to ask the insurer for a “peer-to-peer” review, she said. “Sometimes it’s really hard for insurance company folks to say no to you if you have a really good story,” she commented.
- Help your patients get financial assistance. Almost every biologic manufacturer has a patient assistance plan, which can also help with deductibles and copays, Dr. Duffin said.
Dr. Duffin discloses consulting for AbbVie, Amgen, Celgene, Janssen, Lilly, Novartis, Pfizer, and Sienna. She has received grant/contracted research support from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Sienna, Stiefel, and UCB.
SDEF and this news organization are owned by the same parent company.
LAS VEGAS – If you’re considering adding biologics for psoriasis to your clinical practice, dermatologist Kristina C. Duffin, MD, has some advice: Don’t expect to just use one drug, focus on comorbidities, and embrace strategies to bypass the potential obstacle of prior-authorization approvals.
Here are some tips from Dr. Duffin, who spoke at the Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar:
- Don’t expect a one-size-fits-all medication. “There is no one, single go-to drug,” said Dr. Duffin, who is cochair of the department of dermatology at the University of Utah, Salt Lake City. “Maybe someday, we will have a biological personalized medicine marker to say this is the right drug, but for now we don’t.” More than 10 biologics are available to treat psoriasis, she said, and more are in the pipeline.
- Pay close attention to comorbidities. It’s important to “have a good grasp” of a patient’s comorbidities, which can help focus the choice of a biologic, Dr. Duffin said. She recommends starting with an anti–tumor necrosis factor (TNF) agents for patients with psoriatic arthritis. For patients with Crohn’s disease, she recommends anti-TNF (adalimumab, infliximab) and anti-interleukin–12/23 or anti-IL-23 agents (ustekinumab). Anti-TNF agents should be avoided in patients with multiple sclerosis, and anti-IL-17 agents shouldn’t be given to patients with recurrent candidiasis, she noted.
- Encourage patients to make prompt decisions. Dr. Duffin sits down with patients to discuss various biologic options, and she goes over information in handouts. She also focuses on their needs: “Are they interested in getting better fast? Do they want to be clear for their wedding in a month?” She prefers to not let patients go home to think about what they’d like to do. Instead, she advises patients to make choices while at the office visit.
- Order lab tests and be careful about vaccines. Dr. Duffin orders the following tests for all patients who are starting on biologics: CBC, comprehensive metabolic panel, hepatitis B and C, and tuberculosis. She orders HIV, Hba1c and lipid tests, if appropriate. She prefers that patients treated with biologics avoid live vaccines. She suggests other vaccines, if indicated, such as seasonal influenza and pneumonia vaccines, and for those aged 50 years and older, herpes zoster vaccine. She urges patients to call the office if they have an infection or need surgery because they may need to discuss putting a temporary hold on the biologics.
- Understand how to navigate formularies.“Getting drugs approved for patients with Medicare is a challenge,” Dr. Duffin said. It’s helpful to understand how insurers handle specific psoriasis drugs so you can choose one that’s likely to be covered if you’re unsure which one is best. The website www.covermymeds.com allows physicians to easily check insurer formularies, free of charge, she said.
- Documentation is crucial when you’re dealing with an insurer. Document body surface area, Psoriasis Area Severity Index scores, or physician global assessment measures, she advised. An app provided by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, is a helpful in determining these measurements, she said. Also include information about failed treatments and the rationale behind why you chose a specific treatment, she said. “If denial happens, get the details,” she said. This may turn up a clerical error on the insurer’s part that incorrectly led to a denial.
- Escalate challenges to drug denials. If the preferred treatment is denied, one option is to appeal the denial. As a resource, Dr. Duffin pointed to sample letters for appealing denials for physicians and patients on the websites for the American Academy of Dermatology and the National Psoriasis Foundation. Ask for a limited 6-month approval, she said, or have the patient write a letter to the insurer using one of the sample letter templates. Another option is to ask the insurer for a “peer-to-peer” review, she said. “Sometimes it’s really hard for insurance company folks to say no to you if you have a really good story,” she commented.
- Help your patients get financial assistance. Almost every biologic manufacturer has a patient assistance plan, which can also help with deductibles and copays, Dr. Duffin said.
Dr. Duffin discloses consulting for AbbVie, Amgen, Celgene, Janssen, Lilly, Novartis, Pfizer, and Sienna. She has received grant/contracted research support from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Sienna, Stiefel, and UCB.
SDEF and this news organization are owned by the same parent company.
EXPERT ANALYSIS FROM SDEF LAS VEGAS DERMATOLOGY SEMINAR
Intimate partner violence and PTSD increase menopausal symptom risk
Intimate partner violence or sexual assault may have a significant effect on menopausal symptoms in women, according to a cohort study published in JAMA Internal Medicine.
Researchers analyzed data from 2,016 women aged 40 years or older who were enrolled in the observational Reproductive Risks of Incontinence Study; 40% were non-Latina white, 21% were black, 20% were Latina or Hispanic, and 19% were Asian. Of this cohort, 21% had experienced emotional intimate partner violence (IPV) – 64 (3.2%) in the past 12 months – 16% had experienced physical IPV, 14% had experienced both, and 19% reported sexual assault. More than one in five women (23%) met the criteria for clinically significant PTSD.
Women who had experienced emotional domestic abuse were 36% more likely to report difficulty sleeping, 50% more like to experience night sweats, and 60% more likely to experience pain with intercourse, compared with women who had not experienced any abuse.
Physical abuse was associated with 33% higher odds of night sweats, and sexual assault was associated with 41% higher odds of vaginal dryness, 42% higher odds of vaginal irritation, and 44% higher odds of pain with intercourse.
Women with clinically significant PTSD symptoms were significantly more likely to experience all the symptoms of menopause, including twofold higher odds of pain with intercourse and threefold higher odds of difficulty sleeping. When authors accounted for the effect of PTSD symptoms in the cohort, they found that only the association between emotional abuse and night sweats or pain with intercourse, and between sexual assault and vaginal dryness, remained independently significant.
Carolyn J. Gibson, PhD, MPH, of the San Francisco Veterans Affairs Health Care System, and coauthors said that the biological and hormonal changes that underpin menopausal symptoms, as well as health risk behaviors, cardiometabolic risk factors, and other chronic health conditions associated with menopause, all are impacted by trauma and its psychological effects.
“Chronic hyperarousal and hypervigilance, common in individuals who have experienced trauma and characteristic symptoms of PTSD, may affect sleep and symptom sensitivity,” they wrote.
The reverse is also true; that the symptoms of menopause can impact the symptoms of PTSD by affecting a woman’s sense of self-efficacy, interpersonal engagements, and heighten the stress associated with this period of transition.
“The clinical management of menopause symptoms may also be enhanced by trauma-informed care, including recognition of challenges that may impair efforts to address menopause-related concerns among women affected by trauma,” the authors wrote.
Clinicians also could help by providing education about the link between trauma and health, providing their patients with a safe and supportive treatment environment, and facilitating referrals for psychological or trauma-specific services when needed, they said.
The research was supported by the San Francisco Veterans Affairs Medical Center and Kaiser Permanente Northern California, and funded by the University of California San Francisco–Kaiser Permanente Grants Program for Delivery Science, the Office of Research on Women’s Health Specialized Center of Research, and grants from the National Institute of Diabetes and Digestive and Kidney Diseases.
SOURCE: Gibson C et al. JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5233.
An estimated 33% of women in the United States have been sexually assaulted, and an estimated 25% have experienced IPV, so be aware of how common this “wicked problem” is, the way it impacts health, and what role you can play in educating and helping patients by connecting them to available resources.
But that is not enough. Consider measures such as training yourself and staff in how to assess for IPV and sexual assault and use of EHR to integrate IPV assessment into routine clinical care, as well as developing protocols to be followed when a patient discloses IPV or sexual assault. A multidisciplinary approach also can help, including victim service advocates and behavioral health clinicians to provide care and support.
State requirements for reporting partner and sexual violence differ, so be aware of your state laws.
A strength of this study is that it included emotional as well as physical IPV, which often is left out although it has serious impacts.
Rebecca C. Thurston, PhD, is from the department of psychiatry at the University of Pittsburgh, and Elizabeth Miller, MD, PhD, is from the division of adolescent and young adult medicine at the UPMC Children’s Hospital of Pittsburgh. These comments were taken from an accompanying editorial (JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5242). Dr. Thurston declared research support from the National Institutes of Health and consultancies for Pfizer, Procter & Gamble, and MAS Innovations.
An estimated 33% of women in the United States have been sexually assaulted, and an estimated 25% have experienced IPV, so be aware of how common this “wicked problem” is, the way it impacts health, and what role you can play in educating and helping patients by connecting them to available resources.
But that is not enough. Consider measures such as training yourself and staff in how to assess for IPV and sexual assault and use of EHR to integrate IPV assessment into routine clinical care, as well as developing protocols to be followed when a patient discloses IPV or sexual assault. A multidisciplinary approach also can help, including victim service advocates and behavioral health clinicians to provide care and support.
State requirements for reporting partner and sexual violence differ, so be aware of your state laws.
A strength of this study is that it included emotional as well as physical IPV, which often is left out although it has serious impacts.
Rebecca C. Thurston, PhD, is from the department of psychiatry at the University of Pittsburgh, and Elizabeth Miller, MD, PhD, is from the division of adolescent and young adult medicine at the UPMC Children’s Hospital of Pittsburgh. These comments were taken from an accompanying editorial (JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5242). Dr. Thurston declared research support from the National Institutes of Health and consultancies for Pfizer, Procter & Gamble, and MAS Innovations.
An estimated 33% of women in the United States have been sexually assaulted, and an estimated 25% have experienced IPV, so be aware of how common this “wicked problem” is, the way it impacts health, and what role you can play in educating and helping patients by connecting them to available resources.
But that is not enough. Consider measures such as training yourself and staff in how to assess for IPV and sexual assault and use of EHR to integrate IPV assessment into routine clinical care, as well as developing protocols to be followed when a patient discloses IPV or sexual assault. A multidisciplinary approach also can help, including victim service advocates and behavioral health clinicians to provide care and support.
State requirements for reporting partner and sexual violence differ, so be aware of your state laws.
A strength of this study is that it included emotional as well as physical IPV, which often is left out although it has serious impacts.
Rebecca C. Thurston, PhD, is from the department of psychiatry at the University of Pittsburgh, and Elizabeth Miller, MD, PhD, is from the division of adolescent and young adult medicine at the UPMC Children’s Hospital of Pittsburgh. These comments were taken from an accompanying editorial (JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5242). Dr. Thurston declared research support from the National Institutes of Health and consultancies for Pfizer, Procter & Gamble, and MAS Innovations.
Intimate partner violence or sexual assault may have a significant effect on menopausal symptoms in women, according to a cohort study published in JAMA Internal Medicine.
Researchers analyzed data from 2,016 women aged 40 years or older who were enrolled in the observational Reproductive Risks of Incontinence Study; 40% were non-Latina white, 21% were black, 20% were Latina or Hispanic, and 19% were Asian. Of this cohort, 21% had experienced emotional intimate partner violence (IPV) – 64 (3.2%) in the past 12 months – 16% had experienced physical IPV, 14% had experienced both, and 19% reported sexual assault. More than one in five women (23%) met the criteria for clinically significant PTSD.
Women who had experienced emotional domestic abuse were 36% more likely to report difficulty sleeping, 50% more like to experience night sweats, and 60% more likely to experience pain with intercourse, compared with women who had not experienced any abuse.
Physical abuse was associated with 33% higher odds of night sweats, and sexual assault was associated with 41% higher odds of vaginal dryness, 42% higher odds of vaginal irritation, and 44% higher odds of pain with intercourse.
Women with clinically significant PTSD symptoms were significantly more likely to experience all the symptoms of menopause, including twofold higher odds of pain with intercourse and threefold higher odds of difficulty sleeping. When authors accounted for the effect of PTSD symptoms in the cohort, they found that only the association between emotional abuse and night sweats or pain with intercourse, and between sexual assault and vaginal dryness, remained independently significant.
Carolyn J. Gibson, PhD, MPH, of the San Francisco Veterans Affairs Health Care System, and coauthors said that the biological and hormonal changes that underpin menopausal symptoms, as well as health risk behaviors, cardiometabolic risk factors, and other chronic health conditions associated with menopause, all are impacted by trauma and its psychological effects.
“Chronic hyperarousal and hypervigilance, common in individuals who have experienced trauma and characteristic symptoms of PTSD, may affect sleep and symptom sensitivity,” they wrote.
The reverse is also true; that the symptoms of menopause can impact the symptoms of PTSD by affecting a woman’s sense of self-efficacy, interpersonal engagements, and heighten the stress associated with this period of transition.
“The clinical management of menopause symptoms may also be enhanced by trauma-informed care, including recognition of challenges that may impair efforts to address menopause-related concerns among women affected by trauma,” the authors wrote.
Clinicians also could help by providing education about the link between trauma and health, providing their patients with a safe and supportive treatment environment, and facilitating referrals for psychological or trauma-specific services when needed, they said.
The research was supported by the San Francisco Veterans Affairs Medical Center and Kaiser Permanente Northern California, and funded by the University of California San Francisco–Kaiser Permanente Grants Program for Delivery Science, the Office of Research on Women’s Health Specialized Center of Research, and grants from the National Institute of Diabetes and Digestive and Kidney Diseases.
SOURCE: Gibson C et al. JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5233.
Intimate partner violence or sexual assault may have a significant effect on menopausal symptoms in women, according to a cohort study published in JAMA Internal Medicine.
Researchers analyzed data from 2,016 women aged 40 years or older who were enrolled in the observational Reproductive Risks of Incontinence Study; 40% were non-Latina white, 21% were black, 20% were Latina or Hispanic, and 19% were Asian. Of this cohort, 21% had experienced emotional intimate partner violence (IPV) – 64 (3.2%) in the past 12 months – 16% had experienced physical IPV, 14% had experienced both, and 19% reported sexual assault. More than one in five women (23%) met the criteria for clinically significant PTSD.
Women who had experienced emotional domestic abuse were 36% more likely to report difficulty sleeping, 50% more like to experience night sweats, and 60% more likely to experience pain with intercourse, compared with women who had not experienced any abuse.
Physical abuse was associated with 33% higher odds of night sweats, and sexual assault was associated with 41% higher odds of vaginal dryness, 42% higher odds of vaginal irritation, and 44% higher odds of pain with intercourse.
Women with clinically significant PTSD symptoms were significantly more likely to experience all the symptoms of menopause, including twofold higher odds of pain with intercourse and threefold higher odds of difficulty sleeping. When authors accounted for the effect of PTSD symptoms in the cohort, they found that only the association between emotional abuse and night sweats or pain with intercourse, and between sexual assault and vaginal dryness, remained independently significant.
Carolyn J. Gibson, PhD, MPH, of the San Francisco Veterans Affairs Health Care System, and coauthors said that the biological and hormonal changes that underpin menopausal symptoms, as well as health risk behaviors, cardiometabolic risk factors, and other chronic health conditions associated with menopause, all are impacted by trauma and its psychological effects.
“Chronic hyperarousal and hypervigilance, common in individuals who have experienced trauma and characteristic symptoms of PTSD, may affect sleep and symptom sensitivity,” they wrote.
The reverse is also true; that the symptoms of menopause can impact the symptoms of PTSD by affecting a woman’s sense of self-efficacy, interpersonal engagements, and heighten the stress associated with this period of transition.
“The clinical management of menopause symptoms may also be enhanced by trauma-informed care, including recognition of challenges that may impair efforts to address menopause-related concerns among women affected by trauma,” the authors wrote.
Clinicians also could help by providing education about the link between trauma and health, providing their patients with a safe and supportive treatment environment, and facilitating referrals for psychological or trauma-specific services when needed, they said.
The research was supported by the San Francisco Veterans Affairs Medical Center and Kaiser Permanente Northern California, and funded by the University of California San Francisco–Kaiser Permanente Grants Program for Delivery Science, the Office of Research on Women’s Health Specialized Center of Research, and grants from the National Institute of Diabetes and Digestive and Kidney Diseases.
SOURCE: Gibson C et al. JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5233.
FROM JAMA INTERNAL MEDICINE
Key clinical point: Intimate partner violence increases the risk of menopausal symptoms.
Major finding:
Study details: A cohort study in 2,016 women aged 40 years and older.
Disclosures: The research was supported by the San Francisco Veterans Affairs Medical Center and Kaiser Permanente Northern California, and funded by the University of California San Francisco–Kaiser Permanente Grants Program for Delivery Science, the Office of Research on Women’s Health Specialized Center of Research, and grants from the National Institute of Diabetes and Digestive and Kidney Diseases.
Source: Gibson C et al. JAMA Intern Med. 2018 Nov 19. doi:10.1001/jamainternmed.2018.5233.
Advancements in the Delivery of Biologics for the Treatment of Diabetes
Diabetes medication administration often forces patients into uncomfortable situations. Those with complicated treatment or with a fear of needles might hesitate to adhere to their suggested regimen, placing themselves at risk. Over the years, several mechanisms have evolved to help make insulin delivery, and so, betting patient adherence.
This fifth eNewsletter in the series, entitled Advancements in the Delivery of Biologics for the Treatment of Diabetes was written by James Ruggles, PhD, and James Meehan, MSc. It covers the history of insulin delivery methods starting from 1922 and through present day.
Click here to read the supplement
About the Authors:
James Ruggles, PhD
AstraZeneca
Wilmington, DE, USA
James Meehan, MSc
AstraZeneca
Macclesfield, Cheshire, UK
Diabetes medication administration often forces patients into uncomfortable situations. Those with complicated treatment or with a fear of needles might hesitate to adhere to their suggested regimen, placing themselves at risk. Over the years, several mechanisms have evolved to help make insulin delivery, and so, betting patient adherence.
This fifth eNewsletter in the series, entitled Advancements in the Delivery of Biologics for the Treatment of Diabetes was written by James Ruggles, PhD, and James Meehan, MSc. It covers the history of insulin delivery methods starting from 1922 and through present day.
Click here to read the supplement
About the Authors:
James Ruggles, PhD
AstraZeneca
Wilmington, DE, USA
James Meehan, MSc
AstraZeneca
Macclesfield, Cheshire, UK
Diabetes medication administration often forces patients into uncomfortable situations. Those with complicated treatment or with a fear of needles might hesitate to adhere to their suggested regimen, placing themselves at risk. Over the years, several mechanisms have evolved to help make insulin delivery, and so, betting patient adherence.
This fifth eNewsletter in the series, entitled Advancements in the Delivery of Biologics for the Treatment of Diabetes was written by James Ruggles, PhD, and James Meehan, MSc. It covers the history of insulin delivery methods starting from 1922 and through present day.
Click here to read the supplement
About the Authors:
James Ruggles, PhD
AstraZeneca
Wilmington, DE, USA
James Meehan, MSc
AstraZeneca
Macclesfield, Cheshire, UK
