Amy Karon

SAN DIEGO – Screening preschoolers with an evidence-based eye chart is essential for detecting amblyopia in time to treat it successfully, said Dr. Geoffrey E. Bradford.

“School-age vision screening is really too late to effectively start treating amblyopia,” he said at the annual meeting of the American Academy of Pediatrics.

Amblyopia affects about 4.5 million children in the United States, causing one or both eyes to transmit blurred images to the developing visual cortex. The condition begins to resist treatment by age 5 years and causes permanent vision loss by age 7 years, noted Dr. Bradford, professor of ophthalmology at West Virginia University in Morgantown.

For this reason, the AAP and the American Association for Pediatric Opthalmology and Strabismus (AAPOS) recommend visual acuity screening for children beginning at 36-47 months of age, Dr. Bradford said.

Pediatricians should use the Lea symbols or HOTV charts, make sure the eye that is not being tested is adequately covered, and refer patients aged 36 to 47 months who cannot correctly identify most optotypes on the 20/50 line of the chart. The same criteria apply to the 20/40 line of the chart when testing children aged 48 to 57 months, he said. While still used in some practices, the “sailboat” chart lacks scientific evidence and is not recommended, and the tumbling E chart is not reliable in young children. “Testing should be done at 10 feet, not at 20 feet,” he added. “There are eye charts calibrated for 10 feet, and that’s really more accurate because the screener is better able to engage the child at 10 feet away.”

A kit with evidence-based, age-appropriate visual acuity charts, adhesive occlusion patches, and other useful items is available from AAPOS, Dr. Bradford noted. He reported no conflicts of interest.

SAN DIEGO – Screening preschoolers with an evidence-based eye chart is essential for detecting amblyopia in time to treat it successfully, said Dr. Geoffrey E. Bradford.

“School-age vision screening is really too late to effectively start treating amblyopia,” he said at the annual meeting of the American Academy of Pediatrics.

Amblyopia affects about 4.5 million children in the United States, causing one or both eyes to transmit blurred images to the developing visual cortex. The condition begins to resist treatment by age 5 years and causes permanent vision loss by age 7 years, noted Dr. Bradford, professor of ophthalmology at West Virginia University in Morgantown.

For this reason, the AAP and the American Association for Pediatric Opthalmology and Strabismus (AAPOS) recommend visual acuity screening for children beginning at 36-47 months of age, Dr. Bradford said.

Pediatricians should use the Lea symbols or HOTV charts, make sure the eye that is not being tested is adequately covered, and refer patients aged 36 to 47 months who cannot correctly identify most optotypes on the 20/50 line of the chart. The same criteria apply to the 20/40 line of the chart when testing children aged 48 to 57 months, he said. While still used in some practices, the “sailboat” chart lacks scientific evidence and is not recommended, and the tumbling E chart is not reliable in young children. “Testing should be done at 10 feet, not at 20 feet,” he added. “There are eye charts calibrated for 10 feet, and that’s really more accurate because the screener is better able to engage the child at 10 feet away.”

A kit with evidence-based, age-appropriate visual acuity charts, adhesive occlusion patches, and other useful items is available from AAPOS, Dr. Bradford noted. He reported no conflicts of interest.

SAN DIEGO – Screening preschoolers with an evidence-based eye chart is essential for detecting amblyopia in time to treat it successfully, said Dr. Geoffrey E. Bradford.

“School-age vision screening is really too late to effectively start treating amblyopia,” he said at the annual meeting of the American Academy of Pediatrics.

Amblyopia affects about 4.5 million children in the United States, causing one or both eyes to transmit blurred images to the developing visual cortex. The condition begins to resist treatment by age 5 years and causes permanent vision loss by age 7 years, noted Dr. Bradford, professor of ophthalmology at West Virginia University in Morgantown.

For this reason, the AAP and the American Association for Pediatric Opthalmology and Strabismus (AAPOS) recommend visual acuity screening for children beginning at 36-47 months of age, Dr. Bradford said.

Pediatricians should use the Lea symbols or HOTV charts, make sure the eye that is not being tested is adequately covered, and refer patients aged 36 to 47 months who cannot correctly identify most optotypes on the 20/50 line of the chart. The same criteria apply to the 20/40 line of the chart when testing children aged 48 to 57 months, he said. While still used in some practices, the “sailboat” chart lacks scientific evidence and is not recommended, and the tumbling E chart is not reliable in young children. “Testing should be done at 10 feet, not at 20 feet,” he added. “There are eye charts calibrated for 10 feet, and that’s really more accurate because the screener is better able to engage the child at 10 feet away.”

A kit with evidence-based, age-appropriate visual acuity charts, adhesive occlusion patches, and other useful items is available from AAPOS, Dr. Bradford noted. He reported no conflicts of interest.

SAN DIEGO – Screening preschoolers with an evidence-based eye chart is essential for detecting amblyopia in time to treat it successfully, said Dr. Geoffrey E. Bradford.

“School-age vision screening is really too late to effectively start treating amblyopia,” he said at the annual meeting of the American Academy of Pediatrics.

© Laikwunfai / thinkstockphotos.com

Amblyopia affects about 4.5 million children in the United States, causing one or both eyes to transmit blurred images to the developing visual cortex. The condition begins to resist treatment by age 5 years and causes permanent vision loss by age 7 years, noted Dr. Bradford, professor of ophthalmology at West Virginia University in Morgantown.

For this reason, the AAP and the American Association for Pediatric Opthalmology and Strabismus (AAPOS) recommend visual acuity screening for children beginning at 36-47 months of age, Dr. Bradford said.

Pediatricians should use the Lea symbols or HOTV charts, make sure the eye that is not being tested is adequately covered, and refer patients aged 36 to 47 months who cannot correctly identify most optotypes on the 20/50 line of the chart. The same criteria apply to the 20/40 line of the chart when testing children aged 48 to 57 months, he said. While still used in some practices, the “sailboat” chart lacks scientific evidence and is not recommended, and the tumbling E chart is not reliable in young children. “Testing should be done at 10 feet, not at 20 feet,” he added. “There are eye charts calibrated for 10 feet, and that’s really more accurate because the screener is better able to engage the child at 10 feet away.”

A kit with evidence-based, age-appropriate visual acuity charts, adhesive occlusion patches, and other useful items is available from AAPOS, Dr. Bradford noted. He reported no conflicts of interest.

SAN DIEGO – Screening preschoolers with an evidence-based eye chart is essential for detecting amblyopia in time to treat it successfully, said Dr. Geoffrey E. Bradford.

“School-age vision screening is really too late to effectively start treating amblyopia,” he said at the annual meeting of the American Academy of Pediatrics.

© Laikwunfai / thinkstockphotos.com

Amblyopia affects about 4.5 million children in the United States, causing one or both eyes to transmit blurred images to the developing visual cortex. The condition begins to resist treatment by age 5 years and causes permanent vision loss by age 7 years, noted Dr. Bradford, professor of ophthalmology at West Virginia University in Morgantown.

For this reason, the AAP and the American Association for Pediatric Opthalmology and Strabismus (AAPOS) recommend visual acuity screening for children beginning at 36-47 months of age, Dr. Bradford said.

Pediatricians should use the Lea symbols or HOTV charts, make sure the eye that is not being tested is adequately covered, and refer patients aged 36 to 47 months who cannot correctly identify most optotypes on the 20/50 line of the chart. The same criteria apply to the 20/40 line of the chart when testing children aged 48 to 57 months, he said. While still used in some practices, the “sailboat” chart lacks scientific evidence and is not recommended, and the tumbling E chart is not reliable in young children. “Testing should be done at 10 feet, not at 20 feet,” he added. “There are eye charts calibrated for 10 feet, and that’s really more accurate because the screener is better able to engage the child at 10 feet away.”

A kit with evidence-based, age-appropriate visual acuity charts, adhesive occlusion patches, and other useful items is available from AAPOS, Dr. Bradford noted. He reported no conflicts of interest.

SAN DIEGO – Screening preschoolers with an evidence-based eye chart is essential for detecting amblyopia in time to treat it successfully, said Dr. Geoffrey E. Bradford.

“School-age vision screening is really too late to effectively start treating amblyopia,” he said at the annual meeting of the American Academy of Pediatrics.

© Laikwunfai / thinkstockphotos.com

Amblyopia affects about 4.5 million children in the United States, causing one or both eyes to transmit blurred images to the developing visual cortex. The condition begins to resist treatment by age 5 years and causes permanent vision loss by age 7 years, noted Dr. Bradford, professor of ophthalmology at West Virginia University in Morgantown.

For this reason, the AAP and the American Association for Pediatric Opthalmology and Strabismus (AAPOS) recommend visual acuity screening for children beginning at 36-47 months of age, Dr. Bradford said.

Pediatricians should use the Lea symbols or HOTV charts, make sure the eye that is not being tested is adequately covered, and refer patients aged 36 to 47 months who cannot correctly identify most optotypes on the 20/50 line of the chart. The same criteria apply to the 20/40 line of the chart when testing children aged 48 to 57 months, he said. While still used in some practices, the “sailboat” chart lacks scientific evidence and is not recommended, and the tumbling E chart is not reliable in young children. “Testing should be done at 10 feet, not at 20 feet,” he added. “There are eye charts calibrated for 10 feet, and that’s really more accurate because the screener is better able to engage the child at 10 feet away.”

A kit with evidence-based, age-appropriate visual acuity charts, adhesive occlusion patches, and other useful items is available from AAPOS, Dr. Bradford noted. He reported no conflicts of interest.

Cigarette smoking caused at least 14 million cases of major medical conditions among U.S. adults in 2009, investigators reported online Oct. 13 in JAMA Internal Medicine.

The statistic substantially exceeds a 2000 estimate by the Centers for Disease Control and Prevention of 12.7 million smoking-related conditions among 8.6 million individuals, said Brian L. Rostron, Ph.D., at the U.S. Food and Drug Administration, Silver Spring, Md., and his associates.

©ricky_68fr/fotolia.com

The discrepancy most likely stems from the fact that respondents in national health surveys tend to underreport chronic obstructive pulmonary disease (COPD), the leading medical consequence of smoking, the researchers said. Using spirometry data, they estimated more than 7.4 million cases of COPD attributable to smoking in 2009, which was 70% higher than past statistics based on self-reported data, they said (JAMA Intern. Med. 2014 Oct. 13 [doi:10.1001/ jamainternmed.2014.5219]). For the study, the researchers used data from the 2009 U.S. Census Bureau, the 2006-2012 National Health Interview Survey, and the National Health and Nutrition Examination Survey to calculate the population-attributable risk of major smoking-related conditions among U.S. adults aged 35 years and older. Besides COPD, these conditions included diabetes mellitus, heart attacks, cancer, and stroke.

This approach yielded an estimate of 6.9 million adults in the United States with at least one major medical condition secondary to smoking (95% confidence interval, 6.5-7.4 million), with a total of 10.9 million conditions identified (95% CI, 10.3-11.5 million), the researchers said.

To better estimate the burden of COPD secondary to smoking, the investigators then used self-reported and spirometry data from the National Health and Nutrition Examination Survey. This analysis identified 14 million smoking-attributable conditions overall (95% CI, 12.9 to 15.1 million), including more than 7.4 million cases of COPD, they said. Notably, COPD was 3.78 times more common among current female smokers than never smokers (95% CI, 3.46-4.12), and four times more common among male smokers than never smokers (95% CI, 3.54-4.52), they said.

The results are “generally conservative, owing to the existence of other diseases and medical events that were not included in these estimates,” the researchers wrote, adding that “the International Agency for Research on Cancer has concluded, for example, that ovarian cancer, specifically mucinous tumors, is caused by smoking.” Current estimates also do not capture the prevalence of cardiovascular surgeries, congestive heart failure, peripheral arterial disease, rheumatoid arthritis, and macular degeneration attributable to smoking, said the investigators.

Descriptions of medical diagnoses were self-reported and therefore might not always be accurate, Dr. Rostron and associates noted. They reported no funding sources or conflicts of interest.

Cigarette smoking caused at least 14 million cases of major medical conditions among U.S. adults in 2009, investigators reported online Oct. 13 in JAMA Internal Medicine.

The statistic substantially exceeds a 2000 estimate by the Centers for Disease Control and Prevention of 12.7 million smoking-related conditions among 8.6 million individuals, said Brian L. Rostron, Ph.D., at the U.S. Food and Drug Administration, Silver Spring, Md., and his associates.

©ricky_68fr/fotolia.com

The discrepancy most likely stems from the fact that respondents in national health surveys tend to underreport chronic obstructive pulmonary disease (COPD), the leading medical consequence of smoking, the researchers said. Using spirometry data, they estimated more than 7.4 million cases of COPD attributable to smoking in 2009, which was 70% higher than past statistics based on self-reported data, they said (JAMA Intern. Med. 2014 Oct. 13 [doi:10.1001/ jamainternmed.2014.5219]). For the study, the researchers used data from the 2009 U.S. Census Bureau, the 2006-2012 National Health Interview Survey, and the National Health and Nutrition Examination Survey to calculate the population-attributable risk of major smoking-related conditions among U.S. adults aged 35 years and older. Besides COPD, these conditions included diabetes mellitus, heart attacks, cancer, and stroke.

This approach yielded an estimate of 6.9 million adults in the United States with at least one major medical condition secondary to smoking (95% confidence interval, 6.5-7.4 million), with a total of 10.9 million conditions identified (95% CI, 10.3-11.5 million), the researchers said.

To better estimate the burden of COPD secondary to smoking, the investigators then used self-reported and spirometry data from the National Health and Nutrition Examination Survey. This analysis identified 14 million smoking-attributable conditions overall (95% CI, 12.9 to 15.1 million), including more than 7.4 million cases of COPD, they said. Notably, COPD was 3.78 times more common among current female smokers than never smokers (95% CI, 3.46-4.12), and four times more common among male smokers than never smokers (95% CI, 3.54-4.52), they said.

The results are “generally conservative, owing to the existence of other diseases and medical events that were not included in these estimates,” the researchers wrote, adding that “the International Agency for Research on Cancer has concluded, for example, that ovarian cancer, specifically mucinous tumors, is caused by smoking.” Current estimates also do not capture the prevalence of cardiovascular surgeries, congestive heart failure, peripheral arterial disease, rheumatoid arthritis, and macular degeneration attributable to smoking, said the investigators.

Descriptions of medical diagnoses were self-reported and therefore might not always be accurate, Dr. Rostron and associates noted. They reported no funding sources or conflicts of interest.

Cigarette smoking caused at least 14 million cases of major medical conditions among U.S. adults in 2009, investigators reported online Oct. 13 in JAMA Internal Medicine.

The statistic substantially exceeds a 2000 estimate by the Centers for Disease Control and Prevention of 12.7 million smoking-related conditions among 8.6 million individuals, said Brian L. Rostron, Ph.D., at the U.S. Food and Drug Administration, Silver Spring, Md., and his associates.

©ricky_68fr/fotolia.com

The discrepancy most likely stems from the fact that respondents in national health surveys tend to underreport chronic obstructive pulmonary disease (COPD), the leading medical consequence of smoking, the researchers said. Using spirometry data, they estimated more than 7.4 million cases of COPD attributable to smoking in 2009, which was 70% higher than past statistics based on self-reported data, they said (JAMA Intern. Med. 2014 Oct. 13 [doi:10.1001/ jamainternmed.2014.5219]). For the study, the researchers used data from the 2009 U.S. Census Bureau, the 2006-2012 National Health Interview Survey, and the National Health and Nutrition Examination Survey to calculate the population-attributable risk of major smoking-related conditions among U.S. adults aged 35 years and older. Besides COPD, these conditions included diabetes mellitus, heart attacks, cancer, and stroke.

This approach yielded an estimate of 6.9 million adults in the United States with at least one major medical condition secondary to smoking (95% confidence interval, 6.5-7.4 million), with a total of 10.9 million conditions identified (95% CI, 10.3-11.5 million), the researchers said.

To better estimate the burden of COPD secondary to smoking, the investigators then used self-reported and spirometry data from the National Health and Nutrition Examination Survey. This analysis identified 14 million smoking-attributable conditions overall (95% CI, 12.9 to 15.1 million), including more than 7.4 million cases of COPD, they said. Notably, COPD was 3.78 times more common among current female smokers than never smokers (95% CI, 3.46-4.12), and four times more common among male smokers than never smokers (95% CI, 3.54-4.52), they said.

The results are “generally conservative, owing to the existence of other diseases and medical events that were not included in these estimates,” the researchers wrote, adding that “the International Agency for Research on Cancer has concluded, for example, that ovarian cancer, specifically mucinous tumors, is caused by smoking.” Current estimates also do not capture the prevalence of cardiovascular surgeries, congestive heart failure, peripheral arterial disease, rheumatoid arthritis, and macular degeneration attributable to smoking, said the investigators.

Descriptions of medical diagnoses were self-reported and therefore might not always be accurate, Dr. Rostron and associates noted. They reported no funding sources or conflicts of interest.

Physical therapy before joint replacement surgery cut the predicted use of postoperative care by 29%, saving an estimated $1,215 in health care costs per patient, according to a Medicare claims analysis.

“These data are clinically relevant and can be used in the development of cost-effective and value-based total joint replacement programs,” said Dr. Richard Snow at OhioHealth in Columbus and his associates. The study is the first to evaluate the real-world link between preoperative physical therapy and use of postoperative care, the researchers said.

© iStock / ThinkStockPhotos.com

Numbers of total hip and knee replacements are projected to increase by 1.7 and 6.7 times, respectively, in the United States between 2005 and 2030, Dr. Snow and his coauthors noted. And while average length of hospital stay after these surgeries has dropped by more than 50%, there has been a substantial rise in per-patient costs of skilled nursing facilities, home health agencies, and inpatient rehabilitation, they said (J. Bone Joint Surg. 2014 Oct. 1 [doi:10.2106/JBJS.M.01285]).

The researchers analyzed 4,733 hip and knee replacement cases within a 39-county cluster of Medicare referral hospitals, and looked at the association between preoperative physical therapy (or “prehabilitation”) and use of postoperative care services in the 90 days after hospital discharge. Because of the skewed distribution of payments, the investigators looked only at cases that fell below the 95th percentile (or $41,113) for cost of care, they said.

In all, 79.7% of patients who did not undergo prehabilitation used acute care services after surgery, compared with 54.2% of patients who did (P < .0001). After controlling for comorbidities and demographic variables, prehabilitation was linked to an absolute reduction of 29% from the predicted to the observed rate of post-acute care use, saving an estimated average of $1,215 per patient, they said. Reductions in use of skilled nursing facilities, home health care services, and inpatient rehabilitation were the main drivers of the cost reduction, the researchers reported.

The findings support prior work indicating that prehabilitation can improve the value of care for patients undergoing total joint replacements, said Dr. Snow and his associates. “As the volume of arthroplasties expands within the framework of increasing health care costs, providers are under mounting pressure to identify the most cost-effective method of delivering high-quality, value-based health care,” they said.

Future studies should look at optimal ways to balance preoperative and postoperative care in specific populations of patients, the investigators said.

The research was partially supported by OhioHealth Research Institute. One or more authors reported financial relationships with biomedical entities deemed to possibly influence the research.

Physical therapy before joint replacement surgery cut the predicted use of postoperative care by 29%, saving an estimated $1,215 in health care costs per patient, according to a Medicare claims analysis.

“These data are clinically relevant and can be used in the development of cost-effective and value-based total joint replacement programs,” said Dr. Richard Snow at OhioHealth in Columbus and his associates. The study is the first to evaluate the real-world link between preoperative physical therapy and use of postoperative care, the researchers said.

© iStock / ThinkStockPhotos.com

Numbers of total hip and knee replacements are projected to increase by 1.7 and 6.7 times, respectively, in the United States between 2005 and 2030, Dr. Snow and his coauthors noted. And while average length of hospital stay after these surgeries has dropped by more than 50%, there has been a substantial rise in per-patient costs of skilled nursing facilities, home health agencies, and inpatient rehabilitation, they said (J. Bone Joint Surg. 2014 Oct. 1 [doi:10.2106/JBJS.M.01285]).

The researchers analyzed 4,733 hip and knee replacement cases within a 39-county cluster of Medicare referral hospitals, and looked at the association between preoperative physical therapy (or “prehabilitation”) and use of postoperative care services in the 90 days after hospital discharge. Because of the skewed distribution of payments, the investigators looked only at cases that fell below the 95th percentile (or $41,113) for cost of care, they said.

In all, 79.7% of patients who did not undergo prehabilitation used acute care services after surgery, compared with 54.2% of patients who did (P < .0001). After controlling for comorbidities and demographic variables, prehabilitation was linked to an absolute reduction of 29% from the predicted to the observed rate of post-acute care use, saving an estimated average of $1,215 per patient, they said. Reductions in use of skilled nursing facilities, home health care services, and inpatient rehabilitation were the main drivers of the cost reduction, the researchers reported.

The findings support prior work indicating that prehabilitation can improve the value of care for patients undergoing total joint replacements, said Dr. Snow and his associates. “As the volume of arthroplasties expands within the framework of increasing health care costs, providers are under mounting pressure to identify the most cost-effective method of delivering high-quality, value-based health care,” they said.

Future studies should look at optimal ways to balance preoperative and postoperative care in specific populations of patients, the investigators said.

The research was partially supported by OhioHealth Research Institute. One or more authors reported financial relationships with biomedical entities deemed to possibly influence the research.

Physical therapy before joint replacement surgery cut the predicted use of postoperative care by 29%, saving an estimated $1,215 in health care costs per patient, according to a Medicare claims analysis.

“These data are clinically relevant and can be used in the development of cost-effective and value-based total joint replacement programs,” said Dr. Richard Snow at OhioHealth in Columbus and his associates. The study is the first to evaluate the real-world link between preoperative physical therapy and use of postoperative care, the researchers said.

© iStock / ThinkStockPhotos.com

Numbers of total hip and knee replacements are projected to increase by 1.7 and 6.7 times, respectively, in the United States between 2005 and 2030, Dr. Snow and his coauthors noted. And while average length of hospital stay after these surgeries has dropped by more than 50%, there has been a substantial rise in per-patient costs of skilled nursing facilities, home health agencies, and inpatient rehabilitation, they said (J. Bone Joint Surg. 2014 Oct. 1 [doi:10.2106/JBJS.M.01285]).

The researchers analyzed 4,733 hip and knee replacement cases within a 39-county cluster of Medicare referral hospitals, and looked at the association between preoperative physical therapy (or “prehabilitation”) and use of postoperative care services in the 90 days after hospital discharge. Because of the skewed distribution of payments, the investigators looked only at cases that fell below the 95th percentile (or $41,113) for cost of care, they said.

In all, 79.7% of patients who did not undergo prehabilitation used acute care services after surgery, compared with 54.2% of patients who did (P < .0001). After controlling for comorbidities and demographic variables, prehabilitation was linked to an absolute reduction of 29% from the predicted to the observed rate of post-acute care use, saving an estimated average of $1,215 per patient, they said. Reductions in use of skilled nursing facilities, home health care services, and inpatient rehabilitation were the main drivers of the cost reduction, the researchers reported.

The findings support prior work indicating that prehabilitation can improve the value of care for patients undergoing total joint replacements, said Dr. Snow and his associates. “As the volume of arthroplasties expands within the framework of increasing health care costs, providers are under mounting pressure to identify the most cost-effective method of delivering high-quality, value-based health care,” they said.

Future studies should look at optimal ways to balance preoperative and postoperative care in specific populations of patients, the investigators said.

The research was partially supported by OhioHealth Research Institute. One or more authors reported financial relationships with biomedical entities deemed to possibly influence the research.

Psoriatic dactylitis might be caused by inflammation of the small enthesis pulleys of flexor tendons of affected fingers and toes, according a study using high-resolution MRI.

The findings help explain the association between flexor tenosynovitis and dactylitis in patients with psoriatic arthritis (PsA), said Dr. Ai Lyn Tan of the National Institute for Health Research’s musculoskeletal biomedical research unit at Leeds (England) University.

Dactylitis, also known as sausage digits, affects about 40% of patients with PsA. Past studies have suggested that enthesitis might be the cause but also have found a link between dactylitis and flexor tenosynovitis, the researchers said. Using high-resolution MRI (hr-MRI), they obtained T1- and T2-weighted images and contrast-enhanced MRI of the digits of 12 patients, including 22 dactylic joints. The investigators also imaged 13 finger and toe joints from 10 healthy controls (Ann. Rheum. Dis. 2014 Sept. 26 [doi:10.1136/annrheumdis-2014-205839].

The hr-MRI studies showed that 75% of patients with dactylitis had enthesitis of the collateral ligament insertions of fingers or toes and 50% had enthesitis of the extensor tendon insertions. Three patients – two of whom had received intramuscular steroid injections within 6 weeks of the scan – did not have ligament enthesitis. Patients who had received steroid injections also lacked evidence of extensor tendon enthesitis. Furthermore, flexor tenosynovitis was seen in 75% of patients with dactylitis, the investigators reported.

Abnormalities were less frequent and milder among the healthy controls. None had signal changes in the tendon pulleys or fibrous sheaths, and only one had evidence of mild flexor tenosynovitis (P = .004), they said.

Limitations of the study included its small size, the researchers noted. In addition, nine patients were male and only three were female.

The study was funded by the Medical Research Council and Arthritis Research UK. The authors reported no conflicts of interest.

Psoriatic dactylitis might be caused by inflammation of the small enthesis pulleys of flexor tendons of affected fingers and toes, according a study using high-resolution MRI.

The findings help explain the association between flexor tenosynovitis and dactylitis in patients with psoriatic arthritis (PsA), said Dr. Ai Lyn Tan of the National Institute for Health Research’s musculoskeletal biomedical research unit at Leeds (England) University.

Dactylitis, also known as sausage digits, affects about 40% of patients with PsA. Past studies have suggested that enthesitis might be the cause but also have found a link between dactylitis and flexor tenosynovitis, the researchers said. Using high-resolution MRI (hr-MRI), they obtained T1- and T2-weighted images and contrast-enhanced MRI of the digits of 12 patients, including 22 dactylic joints. The investigators also imaged 13 finger and toe joints from 10 healthy controls (Ann. Rheum. Dis. 2014 Sept. 26 [doi:10.1136/annrheumdis-2014-205839].

The hr-MRI studies showed that 75% of patients with dactylitis had enthesitis of the collateral ligament insertions of fingers or toes and 50% had enthesitis of the extensor tendon insertions. Three patients – two of whom had received intramuscular steroid injections within 6 weeks of the scan – did not have ligament enthesitis. Patients who had received steroid injections also lacked evidence of extensor tendon enthesitis. Furthermore, flexor tenosynovitis was seen in 75% of patients with dactylitis, the investigators reported.

Abnormalities were less frequent and milder among the healthy controls. None had signal changes in the tendon pulleys or fibrous sheaths, and only one had evidence of mild flexor tenosynovitis (P = .004), they said.

Limitations of the study included its small size, the researchers noted. In addition, nine patients were male and only three were female.

The study was funded by the Medical Research Council and Arthritis Research UK. The authors reported no conflicts of interest.

Psoriatic dactylitis might be caused by inflammation of the small enthesis pulleys of flexor tendons of affected fingers and toes, according a study using high-resolution MRI.

The findings help explain the association between flexor tenosynovitis and dactylitis in patients with psoriatic arthritis (PsA), said Dr. Ai Lyn Tan of the National Institute for Health Research’s musculoskeletal biomedical research unit at Leeds (England) University.

Dactylitis, also known as sausage digits, affects about 40% of patients with PsA. Past studies have suggested that enthesitis might be the cause but also have found a link between dactylitis and flexor tenosynovitis, the researchers said. Using high-resolution MRI (hr-MRI), they obtained T1- and T2-weighted images and contrast-enhanced MRI of the digits of 12 patients, including 22 dactylic joints. The investigators also imaged 13 finger and toe joints from 10 healthy controls (Ann. Rheum. Dis. 2014 Sept. 26 [doi:10.1136/annrheumdis-2014-205839].

The hr-MRI studies showed that 75% of patients with dactylitis had enthesitis of the collateral ligament insertions of fingers or toes and 50% had enthesitis of the extensor tendon insertions. Three patients – two of whom had received intramuscular steroid injections within 6 weeks of the scan – did not have ligament enthesitis. Patients who had received steroid injections also lacked evidence of extensor tendon enthesitis. Furthermore, flexor tenosynovitis was seen in 75% of patients with dactylitis, the investigators reported.

Abnormalities were less frequent and milder among the healthy controls. None had signal changes in the tendon pulleys or fibrous sheaths, and only one had evidence of mild flexor tenosynovitis (P = .004), they said.

Limitations of the study included its small size, the researchers noted. In addition, nine patients were male and only three were female.

The study was funded by the Medical Research Council and Arthritis Research UK. The authors reported no conflicts of interest.

Combining tumor necrosis factor-alpha inhibitors with conventional disease-modifying antirheumatic drugs more than doubled the risk of shingles in patients with psoriatic arthritis, according to a retrospective cohort study.

Patients who took drugs from only one class or the other, however, were no more likely to develop herpes zoster than were untreated patients, said Dr. Devy Zisman of Carmel Medical Center in Haifa, Israel, and his associates.

Biological therapies for inflammatory arthritis have been linked to an increased risk of herpes zoster in some analyses. To investigate the issue, Dr. Zisman and associates studied 3,128 patients with psoriatic arthritis from a national Israeli health care database. The patients averaged 50 years of age, and 46% were male (Ann. Rheum. Dis. 2014 Sept. 26 [doi:10.1136/ annrheumdis-2013-205148]).

© clsgraphics/iStockphoto.com

A total of 182 herpes zoster cases occurred during 20,096 person-years of observation, the researchers said. After controlling for sex, age, comorbidities, steroid treatment, and past treatment with conventional DMARDs, the hazard ratio for herpes zoster with coadministration of tumor necrosis factor-alpha (TNF-alpha) inhibitors and conventional DMARDs was 2.37 (95% confidence interval, 1.32-4.22; P = .004), compared with 1.28 for TNF-alpha inhibitors alone (95% CI, 0.69-2.4) and 1.11 for conventional DMARDs alone (95% CI, 0.76-1.62). The anti–TNF-alpha agents studied included infliximab, adalimumab, and etanercept, while DMARDs included salazopyrine, methotrexate, leflunomide, cyclosporine A, azathioprine, and hydroxychloroquine.

The incidence of herpes zoster in patients prescribed combination regimens was 17.86 cases per 1,000 person-years (95% CI, 10.91-27.58), far higher than for patients who took neither DMARDs nor anti–TNF-alpha agents (7.36), took only conventional DMARDs (9.21), or took only TNF-alpha inhibitors (8.64), the investigators reported.

Older age and treatment with steroids were linked to a slight rise in the risk of herpes zoster (HRs, 1.01 and 1.08, respectively), confirming prior findings, Dr. Zisman and his associates said.

The authors reported no funding sources or conflicts of interest.

Combining tumor necrosis factor-alpha inhibitors with conventional disease-modifying antirheumatic drugs more than doubled the risk of shingles in patients with psoriatic arthritis, according to a retrospective cohort study.

Patients who took drugs from only one class or the other, however, were no more likely to develop herpes zoster than were untreated patients, said Dr. Devy Zisman of Carmel Medical Center in Haifa, Israel, and his associates.

Biological therapies for inflammatory arthritis have been linked to an increased risk of herpes zoster in some analyses. To investigate the issue, Dr. Zisman and associates studied 3,128 patients with psoriatic arthritis from a national Israeli health care database. The patients averaged 50 years of age, and 46% were male (Ann. Rheum. Dis. 2014 Sept. 26 [doi:10.1136/ annrheumdis-2013-205148]).

© clsgraphics/iStockphoto.com

A total of 182 herpes zoster cases occurred during 20,096 person-years of observation, the researchers said. After controlling for sex, age, comorbidities, steroid treatment, and past treatment with conventional DMARDs, the hazard ratio for herpes zoster with coadministration of tumor necrosis factor-alpha (TNF-alpha) inhibitors and conventional DMARDs was 2.37 (95% confidence interval, 1.32-4.22; P = .004), compared with 1.28 for TNF-alpha inhibitors alone (95% CI, 0.69-2.4) and 1.11 for conventional DMARDs alone (95% CI, 0.76-1.62). The anti–TNF-alpha agents studied included infliximab, adalimumab, and etanercept, while DMARDs included salazopyrine, methotrexate, leflunomide, cyclosporine A, azathioprine, and hydroxychloroquine.

The incidence of herpes zoster in patients prescribed combination regimens was 17.86 cases per 1,000 person-years (95% CI, 10.91-27.58), far higher than for patients who took neither DMARDs nor anti–TNF-alpha agents (7.36), took only conventional DMARDs (9.21), or took only TNF-alpha inhibitors (8.64), the investigators reported.

Older age and treatment with steroids were linked to a slight rise in the risk of herpes zoster (HRs, 1.01 and 1.08, respectively), confirming prior findings, Dr. Zisman and his associates said.

The authors reported no funding sources or conflicts of interest.

Combining tumor necrosis factor-alpha inhibitors with conventional disease-modifying antirheumatic drugs more than doubled the risk of shingles in patients with psoriatic arthritis, according to a retrospective cohort study.

Patients who took drugs from only one class or the other, however, were no more likely to develop herpes zoster than were untreated patients, said Dr. Devy Zisman of Carmel Medical Center in Haifa, Israel, and his associates.

Biological therapies for inflammatory arthritis have been linked to an increased risk of herpes zoster in some analyses. To investigate the issue, Dr. Zisman and associates studied 3,128 patients with psoriatic arthritis from a national Israeli health care database. The patients averaged 50 years of age, and 46% were male (Ann. Rheum. Dis. 2014 Sept. 26 [doi:10.1136/ annrheumdis-2013-205148]).

© clsgraphics/iStockphoto.com

A total of 182 herpes zoster cases occurred during 20,096 person-years of observation, the researchers said. After controlling for sex, age, comorbidities, steroid treatment, and past treatment with conventional DMARDs, the hazard ratio for herpes zoster with coadministration of tumor necrosis factor-alpha (TNF-alpha) inhibitors and conventional DMARDs was 2.37 (95% confidence interval, 1.32-4.22; P = .004), compared with 1.28 for TNF-alpha inhibitors alone (95% CI, 0.69-2.4) and 1.11 for conventional DMARDs alone (95% CI, 0.76-1.62). The anti–TNF-alpha agents studied included infliximab, adalimumab, and etanercept, while DMARDs included salazopyrine, methotrexate, leflunomide, cyclosporine A, azathioprine, and hydroxychloroquine.

The incidence of herpes zoster in patients prescribed combination regimens was 17.86 cases per 1,000 person-years (95% CI, 10.91-27.58), far higher than for patients who took neither DMARDs nor anti–TNF-alpha agents (7.36), took only conventional DMARDs (9.21), or took only TNF-alpha inhibitors (8.64), the investigators reported.

Older age and treatment with steroids were linked to a slight rise in the risk of herpes zoster (HRs, 1.01 and 1.08, respectively), confirming prior findings, Dr. Zisman and his associates said.

The authors reported no funding sources or conflicts of interest.

Early prenatal exposure to bisphenol A was linked to diminished lung function at age 4 years and to persistent childhood wheezing, according to a birth cohort analysis reported online Oct. 6 in JAMA Pediatrics.

“If future studies confirm that prenatal BPA exposure may be a risk factor for impaired respiratory health, it may offer another avenue to prevent the development of asthma,” said Dr. Adam J. Spanier of the University of Maryland in Baltimore and his associates.

In the study, which enrolled 398 pairs of English-speaking mothers and infants in the Cincinnati area, every 10-fold increase in maternal urinary concentration of BPA at 16 weeks’ gestation led to a 4.27-fold rise in the odds of persistent wheezing in offspring (adjusted odds ratio, 4.27; 95% confidence interval, 1.37 to 13.30), the researchers reported. The findings “confirm and extend” the results for parent-reported wheezing from the same cohort at age 3 years, they said (JAMA Pediatr. 2014 Oct. 6 [doi:10.1001/jamapediatrics.2014.1397]). There also was an association of increasing mean maternal urinary BPA level with decreasing percent predicted forced expiratory volume at age 4 years. However, the effect on lung function was not seen for children aged 5 years.

© suriyasilsaksom/Thinkstock

Another study reported a postnatal association of BPA exposure with asthma and wheezing in children, but did not find an association with prenatal BPA exposure. “Additional research is needed to clarify the contrasting findings in recent human studies,” Dr. Spanier and his associates wrote.

The study cohort did have worse lung function parameters than the reference sample of healthy children, the researchers said. Furthermore, minority, low-income families were more likely to drop out of the study than were higher-income white families.

The study was supported by a Flight Attendant Medical Research Foundation Young Clinical Scientist Award from the National Institute of Environmental Health Sciences. The authors reported having no relevant financial conflicts.

Early prenatal exposure to bisphenol A was linked to diminished lung function at age 4 years and to persistent childhood wheezing, according to a birth cohort analysis reported online Oct. 6 in JAMA Pediatrics.

“If future studies confirm that prenatal BPA exposure may be a risk factor for impaired respiratory health, it may offer another avenue to prevent the development of asthma,” said Dr. Adam J. Spanier of the University of Maryland in Baltimore and his associates.

In the study, which enrolled 398 pairs of English-speaking mothers and infants in the Cincinnati area, every 10-fold increase in maternal urinary concentration of BPA at 16 weeks’ gestation led to a 4.27-fold rise in the odds of persistent wheezing in offspring (adjusted odds ratio, 4.27; 95% confidence interval, 1.37 to 13.30), the researchers reported. The findings “confirm and extend” the results for parent-reported wheezing from the same cohort at age 3 years, they said (JAMA Pediatr. 2014 Oct. 6 [doi:10.1001/jamapediatrics.2014.1397]). There also was an association of increasing mean maternal urinary BPA level with decreasing percent predicted forced expiratory volume at age 4 years. However, the effect on lung function was not seen for children aged 5 years.

© suriyasilsaksom/Thinkstock

Another study reported a postnatal association of BPA exposure with asthma and wheezing in children, but did not find an association with prenatal BPA exposure. “Additional research is needed to clarify the contrasting findings in recent human studies,” Dr. Spanier and his associates wrote.

The study cohort did have worse lung function parameters than the reference sample of healthy children, the researchers said. Furthermore, minority, low-income families were more likely to drop out of the study than were higher-income white families.

The study was supported by a Flight Attendant Medical Research Foundation Young Clinical Scientist Award from the National Institute of Environmental Health Sciences. The authors reported having no relevant financial conflicts.

Early prenatal exposure to bisphenol A was linked to diminished lung function at age 4 years and to persistent childhood wheezing, according to a birth cohort analysis reported online Oct. 6 in JAMA Pediatrics.

“If future studies confirm that prenatal BPA exposure may be a risk factor for impaired respiratory health, it may offer another avenue to prevent the development of asthma,” said Dr. Adam J. Spanier of the University of Maryland in Baltimore and his associates.

In the study, which enrolled 398 pairs of English-speaking mothers and infants in the Cincinnati area, every 10-fold increase in maternal urinary concentration of BPA at 16 weeks’ gestation led to a 4.27-fold rise in the odds of persistent wheezing in offspring (adjusted odds ratio, 4.27; 95% confidence interval, 1.37 to 13.30), the researchers reported. The findings “confirm and extend” the results for parent-reported wheezing from the same cohort at age 3 years, they said (JAMA Pediatr. 2014 Oct. 6 [doi:10.1001/jamapediatrics.2014.1397]). There also was an association of increasing mean maternal urinary BPA level with decreasing percent predicted forced expiratory volume at age 4 years. However, the effect on lung function was not seen for children aged 5 years.

© suriyasilsaksom/Thinkstock

Another study reported a postnatal association of BPA exposure with asthma and wheezing in children, but did not find an association with prenatal BPA exposure. “Additional research is needed to clarify the contrasting findings in recent human studies,” Dr. Spanier and his associates wrote.

The study cohort did have worse lung function parameters than the reference sample of healthy children, the researchers said. Furthermore, minority, low-income families were more likely to drop out of the study than were higher-income white families.

The study was supported by a Flight Attendant Medical Research Foundation Young Clinical Scientist Award from the National Institute of Environmental Health Sciences. The authors reported having no relevant financial conflicts.

A beta-lactam alone was not inferior to combined macrolide plus beta-lactam treatment for moderately severe community-acquired pneumonia, investigators reported. The results were published Oct. 6 in JAMA Internal Medicine.

Combination therapy was superior in subgroups of patients who had more severe pneumonia or infections of atypical pathogens, said Dr. Nicolas Garin of Hospital Riviera-Chablais, Switzerland.

Guidelines differ on whether to use a beta-lactam alone or together with a macrolide when empirically treating moderately severe community-acquired pneumonia, noted Dr. Garin and his associates. They carried out a multicenter, open-label noninferiority trial of 580 patients who received either intravenous cefuroxime or amoxicillin and clavulanic acid alone, or a beta-lactam plus a macrolide in the form of intravenous or oral clarithromycin. Patients in the monotherapy group switched to dual treatment if their urine tested positive for the Legionella pneumophila antigen, said the investigators.

Median age of the patients was 76 years.

© CDC / Dr. Jim Feeley

After 7 days of treatment, 41.2% of patients in the monotherapy group had not reached clinical stability, compared with 33.6% of patients in the combination arm (P = .07), the researchers said. Kaplan-Meier curves showed that the difference between the two groups peaked on day 7 and persisted until day 30, but never reached statistical significance, they added.

At the same time, patients with atypical infections were less likely to stabilize with monotherapy compared with dual treatment (hazard ratio, 0.33; 95% CI, 0.13 to 0.85), the researchers said. The superiority of dual therapy in these patients “may be explained by failure to provide timely coverage of the Legionella infection,” the investigators said. Patients randomized to monotherapy whose urine tested positive went an average of almost 2 days before starting macrolides, they noted. “This long interval reflects real-life practice, with delays in collecting a urine sample for testing, receiving the results, and prescribing the appropriate antibiotic,” they said.

Patients with Pneumonia Severity Index) category IV pneumonia also were less likely to reach clinical stability on monotherapy (HR, 0.81; 95% CI, 0.59-1.10), the researchers noted. “Future work might test a strategy of tailoring the initial therapy on the severity of the pneumonia, with combination therapy reserved for patients with PSI category IV or higher pneumonia,” they wrote.

In addition, 7.9% of patients in the monotherapy group were readmitted within 30 days, compared with 3.1% of the dual therapy group (P = .01), the researchers reported (JAMA Intern. Med. 2014 Oct. 6 [doi: 10.1001/jamainternmed.2014.4887]).

Clinical stability was defined as a heart rate less than 100/min, systolic blood pressure of more than 90 mm Hg, tympanic temperature less than 38.0° C, respiratory rate less than 24/min, and oxygen saturation by pulse oximetry of more than 90% on room air, the authors wrote.

The study was supported by the Swiss National Science Foundation, the Clinical Trial Unit, and Geneva University Hospitals. The authors reported no conflicts of interest.

A beta-lactam alone was not inferior to combined macrolide plus beta-lactam treatment for moderately severe community-acquired pneumonia, investigators reported. The results were published Oct. 6 in JAMA Internal Medicine.

Combination therapy was superior in subgroups of patients who had more severe pneumonia or infections of atypical pathogens, said Dr. Nicolas Garin of Hospital Riviera-Chablais, Switzerland.

Guidelines differ on whether to use a beta-lactam alone or together with a macrolide when empirically treating moderately severe community-acquired pneumonia, noted Dr. Garin and his associates. They carried out a multicenter, open-label noninferiority trial of 580 patients who received either intravenous cefuroxime or amoxicillin and clavulanic acid alone, or a beta-lactam plus a macrolide in the form of intravenous or oral clarithromycin. Patients in the monotherapy group switched to dual treatment if their urine tested positive for the Legionella pneumophila antigen, said the investigators.

Median age of the patients was 76 years.

© CDC / Dr. Jim Feeley

After 7 days of treatment, 41.2% of patients in the monotherapy group had not reached clinical stability, compared with 33.6% of patients in the combination arm (P = .07), the researchers said. Kaplan-Meier curves showed that the difference between the two groups peaked on day 7 and persisted until day 30, but never reached statistical significance, they added.

At the same time, patients with atypical infections were less likely to stabilize with monotherapy compared with dual treatment (hazard ratio, 0.33; 95% CI, 0.13 to 0.85), the researchers said. The superiority of dual therapy in these patients “may be explained by failure to provide timely coverage of the Legionella infection,” the investigators said. Patients randomized to monotherapy whose urine tested positive went an average of almost 2 days before starting macrolides, they noted. “This long interval reflects real-life practice, with delays in collecting a urine sample for testing, receiving the results, and prescribing the appropriate antibiotic,” they said.

Patients with Pneumonia Severity Index) category IV pneumonia also were less likely to reach clinical stability on monotherapy (HR, 0.81; 95% CI, 0.59-1.10), the researchers noted. “Future work might test a strategy of tailoring the initial therapy on the severity of the pneumonia, with combination therapy reserved for patients with PSI category IV or higher pneumonia,” they wrote.

In addition, 7.9% of patients in the monotherapy group were readmitted within 30 days, compared with 3.1% of the dual therapy group (P = .01), the researchers reported (JAMA Intern. Med. 2014 Oct. 6 [doi: 10.1001/jamainternmed.2014.4887]).

Clinical stability was defined as a heart rate less than 100/min, systolic blood pressure of more than 90 mm Hg, tympanic temperature less than 38.0° C, respiratory rate less than 24/min, and oxygen saturation by pulse oximetry of more than 90% on room air, the authors wrote.

The study was supported by the Swiss National Science Foundation, the Clinical Trial Unit, and Geneva University Hospitals. The authors reported no conflicts of interest.

A beta-lactam alone was not inferior to combined macrolide plus beta-lactam treatment for moderately severe community-acquired pneumonia, investigators reported. The results were published Oct. 6 in JAMA Internal Medicine.

Combination therapy was superior in subgroups of patients who had more severe pneumonia or infections of atypical pathogens, said Dr. Nicolas Garin of Hospital Riviera-Chablais, Switzerland.

Guidelines differ on whether to use a beta-lactam alone or together with a macrolide when empirically treating moderately severe community-acquired pneumonia, noted Dr. Garin and his associates. They carried out a multicenter, open-label noninferiority trial of 580 patients who received either intravenous cefuroxime or amoxicillin and clavulanic acid alone, or a beta-lactam plus a macrolide in the form of intravenous or oral clarithromycin. Patients in the monotherapy group switched to dual treatment if their urine tested positive for the Legionella pneumophila antigen, said the investigators.

Median age of the patients was 76 years.

© CDC / Dr. Jim Feeley

After 7 days of treatment, 41.2% of patients in the monotherapy group had not reached clinical stability, compared with 33.6% of patients in the combination arm (P = .07), the researchers said. Kaplan-Meier curves showed that the difference between the two groups peaked on day 7 and persisted until day 30, but never reached statistical significance, they added.

At the same time, patients with atypical infections were less likely to stabilize with monotherapy compared with dual treatment (hazard ratio, 0.33; 95% CI, 0.13 to 0.85), the researchers said. The superiority of dual therapy in these patients “may be explained by failure to provide timely coverage of the Legionella infection,” the investigators said. Patients randomized to monotherapy whose urine tested positive went an average of almost 2 days before starting macrolides, they noted. “This long interval reflects real-life practice, with delays in collecting a urine sample for testing, receiving the results, and prescribing the appropriate antibiotic,” they said.

Patients with Pneumonia Severity Index) category IV pneumonia also were less likely to reach clinical stability on monotherapy (HR, 0.81; 95% CI, 0.59-1.10), the researchers noted. “Future work might test a strategy of tailoring the initial therapy on the severity of the pneumonia, with combination therapy reserved for patients with PSI category IV or higher pneumonia,” they wrote.

In addition, 7.9% of patients in the monotherapy group were readmitted within 30 days, compared with 3.1% of the dual therapy group (P = .01), the researchers reported (JAMA Intern. Med. 2014 Oct. 6 [doi: 10.1001/jamainternmed.2014.4887]).

Clinical stability was defined as a heart rate less than 100/min, systolic blood pressure of more than 90 mm Hg, tympanic temperature less than 38.0° C, respiratory rate less than 24/min, and oxygen saturation by pulse oximetry of more than 90% on room air, the authors wrote.

The study was supported by the Swiss National Science Foundation, the Clinical Trial Unit, and Geneva University Hospitals. The authors reported no conflicts of interest.

About 70% of older adults with complicated grief improved with targeted exposure-based counseling, compared with 32% who underwent interpersonal therapy, according to a randomized trial.

Response rates were sustained 6 months later, reflecting positive results from an earlier study of complicated grief therapy (CGT) in middle-aged patients, reported Dr. Katherine Shear of Columbia University College of Physicians and Surgeons, New York, and her associates.

“Complicated grief is an underrecognized public health problem that likely affects millions of people in the United States, many of them elderly,” the investigators wrote. Symptoms often resemble depression but do not benefit from interpersonal therapy to the extent that depression does (JAMA Psychiatry 2014 Sept. 23 [doi: 10.1001/jamapsychiatry.2014.1242]).For the study, 151 bereaved adults with scores of at least 30 on the Inventory of Complicated Grief underwent 16 individual weekly sessions of either CGT or interpersonal therapy. About 81% of patients were women; average age was 66 years. The CGT intervention included work with grief-monitoring diaries, memories, and photographs, discussions of goals, and imaginary conversations with the deceased, while patients in interpersonal therapy discussed the death, positive and negative aspects of their relationships with the deceased, and how to develop satisfying relationships in the present.

Symptoms and measures of work and social impairment improved significantly faster with CGT than with interpersonal therapy, the researchers noted. The response rate for exposure-based therapy was 70.5%, compared with 32% for interpersonal therapy (relative risk, 2.20; 95% confidence interval, 1.51-3.22; P less than .001). Six months after baseline, 100% of CGT patients had maintained their improvement, compared with 86.4% of patients who underwent interpersonal therapy, they added.

“Complicated grief is a stress response syndrome, and CGT uses revisiting procedures derived from prolonged exposure for PTSD,” said Dr. Shear and associates. “Older adults appear to tolerate emotional activation reasonably well and respond to these procedures similarly to younger adults.”

The National Institute of Mental Health funded the study. Dr. Shear reported receiving a contract from Guilford Press to write a book on grief. The other authors reported no conflicts of interest.

About 70% of older adults with complicated grief improved with targeted exposure-based counseling, compared with 32% who underwent interpersonal therapy, according to a randomized trial.

Response rates were sustained 6 months later, reflecting positive results from an earlier study of complicated grief therapy (CGT) in middle-aged patients, reported Dr. Katherine Shear of Columbia University College of Physicians and Surgeons, New York, and her associates.

“Complicated grief is an underrecognized public health problem that likely affects millions of people in the United States, many of them elderly,” the investigators wrote. Symptoms often resemble depression but do not benefit from interpersonal therapy to the extent that depression does (JAMA Psychiatry 2014 Sept. 23 [doi: 10.1001/jamapsychiatry.2014.1242]).For the study, 151 bereaved adults with scores of at least 30 on the Inventory of Complicated Grief underwent 16 individual weekly sessions of either CGT or interpersonal therapy. About 81% of patients were women; average age was 66 years. The CGT intervention included work with grief-monitoring diaries, memories, and photographs, discussions of goals, and imaginary conversations with the deceased, while patients in interpersonal therapy discussed the death, positive and negative aspects of their relationships with the deceased, and how to develop satisfying relationships in the present.

Symptoms and measures of work and social impairment improved significantly faster with CGT than with interpersonal therapy, the researchers noted. The response rate for exposure-based therapy was 70.5%, compared with 32% for interpersonal therapy (relative risk, 2.20; 95% confidence interval, 1.51-3.22; P less than .001). Six months after baseline, 100% of CGT patients had maintained their improvement, compared with 86.4% of patients who underwent interpersonal therapy, they added.

“Complicated grief is a stress response syndrome, and CGT uses revisiting procedures derived from prolonged exposure for PTSD,” said Dr. Shear and associates. “Older adults appear to tolerate emotional activation reasonably well and respond to these procedures similarly to younger adults.”

The National Institute of Mental Health funded the study. Dr. Shear reported receiving a contract from Guilford Press to write a book on grief. The other authors reported no conflicts of interest.

About 70% of older adults with complicated grief improved with targeted exposure-based counseling, compared with 32% who underwent interpersonal therapy, according to a randomized trial.

Response rates were sustained 6 months later, reflecting positive results from an earlier study of complicated grief therapy (CGT) in middle-aged patients, reported Dr. Katherine Shear of Columbia University College of Physicians and Surgeons, New York, and her associates.

“Complicated grief is an underrecognized public health problem that likely affects millions of people in the United States, many of them elderly,” the investigators wrote. Symptoms often resemble depression but do not benefit from interpersonal therapy to the extent that depression does (JAMA Psychiatry 2014 Sept. 23 [doi: 10.1001/jamapsychiatry.2014.1242]).For the study, 151 bereaved adults with scores of at least 30 on the Inventory of Complicated Grief underwent 16 individual weekly sessions of either CGT or interpersonal therapy. About 81% of patients were women; average age was 66 years. The CGT intervention included work with grief-monitoring diaries, memories, and photographs, discussions of goals, and imaginary conversations with the deceased, while patients in interpersonal therapy discussed the death, positive and negative aspects of their relationships with the deceased, and how to develop satisfying relationships in the present.

Symptoms and measures of work and social impairment improved significantly faster with CGT than with interpersonal therapy, the researchers noted. The response rate for exposure-based therapy was 70.5%, compared with 32% for interpersonal therapy (relative risk, 2.20; 95% confidence interval, 1.51-3.22; P less than .001). Six months after baseline, 100% of CGT patients had maintained their improvement, compared with 86.4% of patients who underwent interpersonal therapy, they added.

“Complicated grief is a stress response syndrome, and CGT uses revisiting procedures derived from prolonged exposure for PTSD,” said Dr. Shear and associates. “Older adults appear to tolerate emotional activation reasonably well and respond to these procedures similarly to younger adults.”

The National Institute of Mental Health funded the study. Dr. Shear reported receiving a contract from Guilford Press to write a book on grief. The other authors reported no conflicts of interest.