Esther French

WASHINGTON – Substance abuse is a bigger problem for adolescents who daily spend time on social networking sites such as Facebook and Myspace, as 70% of American adolescents say they do, according to a survey released Aug. 24 by the National Center on Addiction and Substance Abuse at Columbia University.

Of those adolescents, 26% reported drinking alcohol, 10% reported using tobacco, and 13% reported using marijuana. The numbers are much lower for adolescents who do not frequent these sites: 9% for alcohol, 2% for tobacco, and 7% for marijuana.

Photo credit: ©DWP/Fotolia.com

In addition, adolescents who had seen photos on social networking sites of children and adolescents who were drunk, passed out, or using drugs had a greater likelihood of substance abuse and were more likely to have easy access to alcohol, marijuana, and prescription drugs without a prescription.

CASA Columbia randomly selected households and surveyed more than 2,000 adolescents aged 12-17 years – and about 500 of their parents – over the telephone and the Internet. CASA conducted this 16th annual national survey during March-May 2011, not to determine the percentage of teens who smoke, drink, and use drugs, but rather to identify factors that affect the likelihood of substance abuse.

"We’re not talking about causation here. We’re talking about association," the center’s founder and chairman, Joseph A. Califano, Jr. said at a press conference in Washington announcing the results. "We think it would be an important healthy factor for these pictures not to be on social networking sites."

The CASA report also included several findings about cyber bullying, which often occurs through social networking:

• Nineteen percent of adolescents said they had been the target of "mean or embarrassing" posts online;

• Twenty-five percent of girls have been "cyberbullied," compared with 14% of boys;

• Adolescents who have been cyberbullied are more than twice as likely to have used tobacco, alcohol, and marijuana as are those who have not been cyberbullied, and they are almost twice as likely to say that they are likely to try drugs in the future.

The CASA survey results also showed that almost one-third of adolescents watch "suggestive teen programming," such as "Gossip Girl," or "16 and Pregnant," or "Skins," and they were twice as likely to have used tobacco and almost twice as likely to have used alcohol as were teens who did not watch these shows. Easier access to these substances also was associated with watching these shows.

Dr. John R. Knight, a pediatrician who directs the Center for Adolescent Substance Abuse Research at Children’s Hospital Boston, said in an interview that he was not surprised by the survey results. "The only thing that’s surprising to me is that the media companies haven’t done anything about it," he said.

On MTV’s "Jersey Shore," a reality show mentioned in the survey, young adults regularly consume excessive amounts of alcohol. Dr. Knight said he turned on the show one time and was "appalled."

Multiple studies have confirmed that the likelihood of substance abuse by teenagers increases when they are exposed to mass media that show tobacco, alcohol, and illegal drugs in a positive or glamorous light. And in the 1990s, the medical community fought to oust the cartoon character Joe Camel from cigarette advertisements, because it appeared to target children.

But online social networking is a relatively new phenomenon – and one that has helped teens overcome addictions by connecting them with online support groups.

"Social networking is a two-edged sword," said Dr. Knight, who was not affiliated with the CASA report. "It can be destructive, but it also helps young people in recovery from substance abuse."

Of parents surveyed, 89% did not think social networking sites increased the likelihood of drug use for teens, and 87% thought the same about alcohol.

Lisa J. Merlo, Ph.D., a clinical psychologist with expertise in this area, said in an interview that it is important to ask adolescents about the amount of time they spend on social networking sites. Dr. Merlo of the University of Florida, Gainesville, who was not affiliated with the CASA report, also advised talking to parents about the importance of monitoring teens’ online activity – which 64% of parents in the survey said they do.

The report noted that teens who eat dinner with their families five to seven times a week do not have as high a risk for substance abuse as do those teens who have infrequent family dinners.

Mr. Califano reprimanded social networking sites for allowing the display of pictures of children and teens drunk, passed out, or using drugs. "We think it would be an important healthy factor for these pictures not to be on social networking sites. ... Continuing to provide the electronic vehicle for transmitting such images constitutes electronic child abuse," he said in a statement accompanying the survey report.

Advances in neuroscience and longitudinal studies show that exposure to alcohol, tobacco, and drugs at a young age leads to greater chances for permanent neurotoxic damage and psychological disorders later in life, Dr. Knight said.

"The data are shouting at us," he said. "We must protect these young people."

Knowledge Networks administered the Internet component of the survey, which 546 male teens and 491 female teens, along with 528 of their parents, completed. QEV Analytics conducted the telephone component, which 478 male teens and 528 female teens completed. CASA required parental or guardian consent for interviewing the adolescents, which was refused in 13.6% of eligible households.

Both components of the survey asked teens whether anyone could see or overhear their responses, but this did not appear to have an inhibiting impact on their answers. The findings note that confidentiality agreements, self-reporting, and the parental permission requirement might contribute to underreporting of substance abuse.

WASHINGTON – Substance abuse is a bigger problem for adolescents who daily spend time on social networking sites such as Facebook and Myspace, as 70% of American adolescents say they do, according to a survey released Aug. 24 by the National Center on Addiction and Substance Abuse at Columbia University.

Of those adolescents, 26% reported drinking alcohol, 10% reported using tobacco, and 13% reported using marijuana. The numbers are much lower for adolescents who do not frequent these sites: 9% for alcohol, 2% for tobacco, and 7% for marijuana.

Photo credit: ©DWP/Fotolia.com

In addition, adolescents who had seen photos on social networking sites of children and adolescents who were drunk, passed out, or using drugs had a greater likelihood of substance abuse and were more likely to have easy access to alcohol, marijuana, and prescription drugs without a prescription.

CASA Columbia randomly selected households and surveyed more than 2,000 adolescents aged 12-17 years – and about 500 of their parents – over the telephone and the Internet. CASA conducted this 16th annual national survey during March-May 2011, not to determine the percentage of teens who smoke, drink, and use drugs, but rather to identify factors that affect the likelihood of substance abuse.

"We’re not talking about causation here. We’re talking about association," the center’s founder and chairman, Joseph A. Califano, Jr. said at a press conference in Washington announcing the results. "We think it would be an important healthy factor for these pictures not to be on social networking sites."

The CASA report also included several findings about cyber bullying, which often occurs through social networking:

• Nineteen percent of adolescents said they had been the target of "mean or embarrassing" posts online;

• Twenty-five percent of girls have been "cyberbullied," compared with 14% of boys;

• Adolescents who have been cyberbullied are more than twice as likely to have used tobacco, alcohol, and marijuana as are those who have not been cyberbullied, and they are almost twice as likely to say that they are likely to try drugs in the future.

The CASA survey results also showed that almost one-third of adolescents watch "suggestive teen programming," such as "Gossip Girl," or "16 and Pregnant," or "Skins," and they were twice as likely to have used tobacco and almost twice as likely to have used alcohol as were teens who did not watch these shows. Easier access to these substances also was associated with watching these shows.

Dr. John R. Knight, a pediatrician who directs the Center for Adolescent Substance Abuse Research at Children’s Hospital Boston, said in an interview that he was not surprised by the survey results. "The only thing that’s surprising to me is that the media companies haven’t done anything about it," he said.

On MTV’s "Jersey Shore," a reality show mentioned in the survey, young adults regularly consume excessive amounts of alcohol. Dr. Knight said he turned on the show one time and was "appalled."

Multiple studies have confirmed that the likelihood of substance abuse by teenagers increases when they are exposed to mass media that show tobacco, alcohol, and illegal drugs in a positive or glamorous light. And in the 1990s, the medical community fought to oust the cartoon character Joe Camel from cigarette advertisements, because it appeared to target children.

But online social networking is a relatively new phenomenon – and one that has helped teens overcome addictions by connecting them with online support groups.

"Social networking is a two-edged sword," said Dr. Knight, who was not affiliated with the CASA report. "It can be destructive, but it also helps young people in recovery from substance abuse."

Of parents surveyed, 89% did not think social networking sites increased the likelihood of drug use for teens, and 87% thought the same about alcohol.

Lisa J. Merlo, Ph.D., a clinical psychologist with expertise in this area, said in an interview that it is important to ask adolescents about the amount of time they spend on social networking sites. Dr. Merlo of the University of Florida, Gainesville, who was not affiliated with the CASA report, also advised talking to parents about the importance of monitoring teens’ online activity – which 64% of parents in the survey said they do.

The report noted that teens who eat dinner with their families five to seven times a week do not have as high a risk for substance abuse as do those teens who have infrequent family dinners.

Mr. Califano reprimanded social networking sites for allowing the display of pictures of children and teens drunk, passed out, or using drugs. "We think it would be an important healthy factor for these pictures not to be on social networking sites. ... Continuing to provide the electronic vehicle for transmitting such images constitutes electronic child abuse," he said in a statement accompanying the survey report.

Advances in neuroscience and longitudinal studies show that exposure to alcohol, tobacco, and drugs at a young age leads to greater chances for permanent neurotoxic damage and psychological disorders later in life, Dr. Knight said.

"The data are shouting at us," he said. "We must protect these young people."

Knowledge Networks administered the Internet component of the survey, which 546 male teens and 491 female teens, along with 528 of their parents, completed. QEV Analytics conducted the telephone component, which 478 male teens and 528 female teens completed. CASA required parental or guardian consent for interviewing the adolescents, which was refused in 13.6% of eligible households.

Both components of the survey asked teens whether anyone could see or overhear their responses, but this did not appear to have an inhibiting impact on their answers. The findings note that confidentiality agreements, self-reporting, and the parental permission requirement might contribute to underreporting of substance abuse.

WASHINGTON – Substance abuse is a bigger problem for adolescents who daily spend time on social networking sites such as Facebook and Myspace, as 70% of American adolescents say they do, according to a survey released Aug. 24 by the National Center on Addiction and Substance Abuse at Columbia University.

Of those adolescents, 26% reported drinking alcohol, 10% reported using tobacco, and 13% reported using marijuana. The numbers are much lower for adolescents who do not frequent these sites: 9% for alcohol, 2% for tobacco, and 7% for marijuana.

Photo credit: ©DWP/Fotolia.com

In addition, adolescents who had seen photos on social networking sites of children and adolescents who were drunk, passed out, or using drugs had a greater likelihood of substance abuse and were more likely to have easy access to alcohol, marijuana, and prescription drugs without a prescription.

CASA Columbia randomly selected households and surveyed more than 2,000 adolescents aged 12-17 years – and about 500 of their parents – over the telephone and the Internet. CASA conducted this 16th annual national survey during March-May 2011, not to determine the percentage of teens who smoke, drink, and use drugs, but rather to identify factors that affect the likelihood of substance abuse.

"We’re not talking about causation here. We’re talking about association," the center’s founder and chairman, Joseph A. Califano, Jr. said at a press conference in Washington announcing the results. "We think it would be an important healthy factor for these pictures not to be on social networking sites."

The CASA report also included several findings about cyber bullying, which often occurs through social networking:

• Nineteen percent of adolescents said they had been the target of "mean or embarrassing" posts online;

• Twenty-five percent of girls have been "cyberbullied," compared with 14% of boys;

• Adolescents who have been cyberbullied are more than twice as likely to have used tobacco, alcohol, and marijuana as are those who have not been cyberbullied, and they are almost twice as likely to say that they are likely to try drugs in the future.

The CASA survey results also showed that almost one-third of adolescents watch "suggestive teen programming," such as "Gossip Girl," or "16 and Pregnant," or "Skins," and they were twice as likely to have used tobacco and almost twice as likely to have used alcohol as were teens who did not watch these shows. Easier access to these substances also was associated with watching these shows.

Dr. John R. Knight, a pediatrician who directs the Center for Adolescent Substance Abuse Research at Children’s Hospital Boston, said in an interview that he was not surprised by the survey results. "The only thing that’s surprising to me is that the media companies haven’t done anything about it," he said.

On MTV’s "Jersey Shore," a reality show mentioned in the survey, young adults regularly consume excessive amounts of alcohol. Dr. Knight said he turned on the show one time and was "appalled."

Multiple studies have confirmed that the likelihood of substance abuse by teenagers increases when they are exposed to mass media that show tobacco, alcohol, and illegal drugs in a positive or glamorous light. And in the 1990s, the medical community fought to oust the cartoon character Joe Camel from cigarette advertisements, because it appeared to target children.

But online social networking is a relatively new phenomenon – and one that has helped teens overcome addictions by connecting them with online support groups.

"Social networking is a two-edged sword," said Dr. Knight, who was not affiliated with the CASA report. "It can be destructive, but it also helps young people in recovery from substance abuse."

Of parents surveyed, 89% did not think social networking sites increased the likelihood of drug use for teens, and 87% thought the same about alcohol.

Lisa J. Merlo, Ph.D., a clinical psychologist with expertise in this area, said in an interview that it is important to ask adolescents about the amount of time they spend on social networking sites. Dr. Merlo of the University of Florida, Gainesville, who was not affiliated with the CASA report, also advised talking to parents about the importance of monitoring teens’ online activity – which 64% of parents in the survey said they do.

The report noted that teens who eat dinner with their families five to seven times a week do not have as high a risk for substance abuse as do those teens who have infrequent family dinners.

Mr. Califano reprimanded social networking sites for allowing the display of pictures of children and teens drunk, passed out, or using drugs. "We think it would be an important healthy factor for these pictures not to be on social networking sites. ... Continuing to provide the electronic vehicle for transmitting such images constitutes electronic child abuse," he said in a statement accompanying the survey report.

Advances in neuroscience and longitudinal studies show that exposure to alcohol, tobacco, and drugs at a young age leads to greater chances for permanent neurotoxic damage and psychological disorders later in life, Dr. Knight said.

"The data are shouting at us," he said. "We must protect these young people."

Knowledge Networks administered the Internet component of the survey, which 546 male teens and 491 female teens, along with 528 of their parents, completed. QEV Analytics conducted the telephone component, which 478 male teens and 528 female teens completed. CASA required parental or guardian consent for interviewing the adolescents, which was refused in 13.6% of eligible households.

Both components of the survey asked teens whether anyone could see or overhear their responses, but this did not appear to have an inhibiting impact on their answers. The findings note that confidentiality agreements, self-reporting, and the parental permission requirement might contribute to underreporting of substance abuse.

Major Finding: Nonadherence rates for antiepileptic medication reached 58% in the first 6 months after epilepsy diagnosis.

Data Source: A 6-month, single-center study of 124 children with newly diagnosed epilepsy.

Disclosures: The study was funded by a grant from the National Institutes of Health. Dr. Modi disclosed that she has been a consultant for Novartis Pharmaceuticals. Another study author disclosed speaker and adviser relationships with companies that manufacture antiepileptic drugs.

Some level of nonadherence to antiepileptic drug monotherapy was apparent in four of five adherence trajectories described in a single-center study of 124 children with newly diagnosed epilepsy.

Based on these findings, “clinicians should consider routinely assessing adherence to antiepileptic drug therapy in all children with epilepsy. Self-report measures of adherence have recently been developed for children with epilepsy and could be used in routine clinical care,” wrote Avani C. Modi, Ph.D., and her co-authors at Cincinnati Children's Hospital Medical Center.

They reported that the five trajectories included “severe early nonadherence” for 13% of patients, “severe delayed nonadherence” for 7% of patients, “moderate nonadherence” for 13%, “mild nonadherence” for 26%, and “near-perfect adherence” for 42%. The authors described the study as the first to examine adherence trajectories for children with epilepsy.

According to this group-based trajectory modeling, almost 60% of the patients were nonadherent for the first 6 months of treatment. This was a “surprising” figure, given the results of the investigators' previous study, which found a nonadherence rate of 20% in the first month of treatment, they wrote (JAMA 2011;305:1669–76).

Prior cross-sectional studies of children with epilepsy have described self-reported nonadherence rates of 12%-35%, but they had “major methodological problems,” according to the authors.

The children in the current study had a mean age of 7.2 years (range of 2–12 years) and 64% of them were male. The cohort was 76% white, 17% black, 7% biracial or multiracial, and 1% Asian; 3% were Hispanic. Nearly half of the cohort had idiopathic localization-related epilepsy (48%), and others had idiopathic generalized epilepsy (19%), idiopathic unclassified epilepsy (15%), cryptogenic localization-related epilepsy (8%), cryptogenic generalized epilepsy (5%), symptomatic localization-related epilepsy (5%), or symptomatic generalized epilepsy (1%).

A majority of the patients (60%) received carbamazepine, and others received valproic acid.

An electronic monitoring system measured adherence rates by recording when the medicine bottle was opened or closed. During follow-up appointments at 1 month post diagnosis and every 3 months thereafter, a pediatric epileptologist or pediatric epilepsy nurse practitioner recorded seizure frequency, adverse events, and any change in medication for controlling seizures or reducing intolerable adverse events.

Dr. Modi and her associates found no effect on adherence rates by other variables such as age, sex, caregiver marital status, seizure type and frequency, initial and total number of antiepileptic medications, frequency of adverse events, and who first observed the child's seizure.

The five adherence groups exhibited significant intra- and interpatient variability, according to the investigators. Children who had severe early nonadherence “took between one-quarter and one-half of their antiepileptic drug doses in the first month of therapy and then became completely nonadherent over time, suggesting 'volitional' nonadherence, wherein parents may have actively decided that their children should not take antiepileptic drugs based on reasoned decisions.”

Children in the severe delayed nonadherence group initially had about 90% adherence, but that gradually declined to about 20% after 6 months. This decline “may reflect caregivers who occasionally missed giving antiepileptic drug doses with no major health consequence (e.g., seizure) and, thus, made decisions to discontinue antiepileptic drugs.”

Dr. Modi and her coauthors said that those two groups are the children and families in greatest need of “adherence interventions focused on discussing the family's beliefs regarding epilepsy and antiepileptic drugs and providing education about treatment misconceptions.”

Children in the moderate nonadherence group, which averaged taking about 70% of their doses, may have missed taking their medication in blocked periods of time such as on vacations and during weekend sports, and “would benefit from problem-solving regarding barriers to adherence and instituting general behavioral and organizational strategies.”

The investigators wrote that the “often intrinsic link between socioeconomic status and education” makes it plausible that the limited financial resources of many of the families of children that fell into groups with mild or worse rates of nonadherence affect tangible aspects of poor adherence, such as the inability to pay for medications, as well as the intangible aspects, such as parental supervision.

Major Finding: Nonadherence rates for antiepileptic medication reached 58% in the first 6 months after epilepsy diagnosis.

Data Source: A 6-month, single-center study of 124 children with newly diagnosed epilepsy.

Disclosures: The study was funded by a grant from the National Institutes of Health. Dr. Modi disclosed that she has been a consultant for Novartis Pharmaceuticals. Another study author disclosed speaker and adviser relationships with companies that manufacture antiepileptic drugs.

Some level of nonadherence to antiepileptic drug monotherapy was apparent in four of five adherence trajectories described in a single-center study of 124 children with newly diagnosed epilepsy.

Based on these findings, “clinicians should consider routinely assessing adherence to antiepileptic drug therapy in all children with epilepsy. Self-report measures of adherence have recently been developed for children with epilepsy and could be used in routine clinical care,” wrote Avani C. Modi, Ph.D., and her co-authors at Cincinnati Children's Hospital Medical Center.

They reported that the five trajectories included “severe early nonadherence” for 13% of patients, “severe delayed nonadherence” for 7% of patients, “moderate nonadherence” for 13%, “mild nonadherence” for 26%, and “near-perfect adherence” for 42%. The authors described the study as the first to examine adherence trajectories for children with epilepsy.

According to this group-based trajectory modeling, almost 60% of the patients were nonadherent for the first 6 months of treatment. This was a “surprising” figure, given the results of the investigators' previous study, which found a nonadherence rate of 20% in the first month of treatment, they wrote (JAMA 2011;305:1669–76).

Prior cross-sectional studies of children with epilepsy have described self-reported nonadherence rates of 12%-35%, but they had “major methodological problems,” according to the authors.

The children in the current study had a mean age of 7.2 years (range of 2–12 years) and 64% of them were male. The cohort was 76% white, 17% black, 7% biracial or multiracial, and 1% Asian; 3% were Hispanic. Nearly half of the cohort had idiopathic localization-related epilepsy (48%), and others had idiopathic generalized epilepsy (19%), idiopathic unclassified epilepsy (15%), cryptogenic localization-related epilepsy (8%), cryptogenic generalized epilepsy (5%), symptomatic localization-related epilepsy (5%), or symptomatic generalized epilepsy (1%).

A majority of the patients (60%) received carbamazepine, and others received valproic acid.

An electronic monitoring system measured adherence rates by recording when the medicine bottle was opened or closed. During follow-up appointments at 1 month post diagnosis and every 3 months thereafter, a pediatric epileptologist or pediatric epilepsy nurse practitioner recorded seizure frequency, adverse events, and any change in medication for controlling seizures or reducing intolerable adverse events.

Dr. Modi and her associates found no effect on adherence rates by other variables such as age, sex, caregiver marital status, seizure type and frequency, initial and total number of antiepileptic medications, frequency of adverse events, and who first observed the child's seizure.

The five adherence groups exhibited significant intra- and interpatient variability, according to the investigators. Children who had severe early nonadherence “took between one-quarter and one-half of their antiepileptic drug doses in the first month of therapy and then became completely nonadherent over time, suggesting 'volitional' nonadherence, wherein parents may have actively decided that their children should not take antiepileptic drugs based on reasoned decisions.”

Children in the severe delayed nonadherence group initially had about 90% adherence, but that gradually declined to about 20% after 6 months. This decline “may reflect caregivers who occasionally missed giving antiepileptic drug doses with no major health consequence (e.g., seizure) and, thus, made decisions to discontinue antiepileptic drugs.”

Dr. Modi and her coauthors said that those two groups are the children and families in greatest need of “adherence interventions focused on discussing the family's beliefs regarding epilepsy and antiepileptic drugs and providing education about treatment misconceptions.”

Children in the moderate nonadherence group, which averaged taking about 70% of their doses, may have missed taking their medication in blocked periods of time such as on vacations and during weekend sports, and “would benefit from problem-solving regarding barriers to adherence and instituting general behavioral and organizational strategies.”

The investigators wrote that the “often intrinsic link between socioeconomic status and education” makes it plausible that the limited financial resources of many of the families of children that fell into groups with mild or worse rates of nonadherence affect tangible aspects of poor adherence, such as the inability to pay for medications, as well as the intangible aspects, such as parental supervision.

Major Finding: Nonadherence rates for antiepileptic medication reached 58% in the first 6 months after epilepsy diagnosis.

Data Source: A 6-month, single-center study of 124 children with newly diagnosed epilepsy.

Disclosures: The study was funded by a grant from the National Institutes of Health. Dr. Modi disclosed that she has been a consultant for Novartis Pharmaceuticals. Another study author disclosed speaker and adviser relationships with companies that manufacture antiepileptic drugs.

Some level of nonadherence to antiepileptic drug monotherapy was apparent in four of five adherence trajectories described in a single-center study of 124 children with newly diagnosed epilepsy.

Based on these findings, “clinicians should consider routinely assessing adherence to antiepileptic drug therapy in all children with epilepsy. Self-report measures of adherence have recently been developed for children with epilepsy and could be used in routine clinical care,” wrote Avani C. Modi, Ph.D., and her co-authors at Cincinnati Children's Hospital Medical Center.

They reported that the five trajectories included “severe early nonadherence” for 13% of patients, “severe delayed nonadherence” for 7% of patients, “moderate nonadherence” for 13%, “mild nonadherence” for 26%, and “near-perfect adherence” for 42%. The authors described the study as the first to examine adherence trajectories for children with epilepsy.

According to this group-based trajectory modeling, almost 60% of the patients were nonadherent for the first 6 months of treatment. This was a “surprising” figure, given the results of the investigators' previous study, which found a nonadherence rate of 20% in the first month of treatment, they wrote (JAMA 2011;305:1669–76).

Prior cross-sectional studies of children with epilepsy have described self-reported nonadherence rates of 12%-35%, but they had “major methodological problems,” according to the authors.

The children in the current study had a mean age of 7.2 years (range of 2–12 years) and 64% of them were male. The cohort was 76% white, 17% black, 7% biracial or multiracial, and 1% Asian; 3% were Hispanic. Nearly half of the cohort had idiopathic localization-related epilepsy (48%), and others had idiopathic generalized epilepsy (19%), idiopathic unclassified epilepsy (15%), cryptogenic localization-related epilepsy (8%), cryptogenic generalized epilepsy (5%), symptomatic localization-related epilepsy (5%), or symptomatic generalized epilepsy (1%).

A majority of the patients (60%) received carbamazepine, and others received valproic acid.

An electronic monitoring system measured adherence rates by recording when the medicine bottle was opened or closed. During follow-up appointments at 1 month post diagnosis and every 3 months thereafter, a pediatric epileptologist or pediatric epilepsy nurse practitioner recorded seizure frequency, adverse events, and any change in medication for controlling seizures or reducing intolerable adverse events.

Dr. Modi and her associates found no effect on adherence rates by other variables such as age, sex, caregiver marital status, seizure type and frequency, initial and total number of antiepileptic medications, frequency of adverse events, and who first observed the child's seizure.

The five adherence groups exhibited significant intra- and interpatient variability, according to the investigators. Children who had severe early nonadherence “took between one-quarter and one-half of their antiepileptic drug doses in the first month of therapy and then became completely nonadherent over time, suggesting 'volitional' nonadherence, wherein parents may have actively decided that their children should not take antiepileptic drugs based on reasoned decisions.”

Children in the severe delayed nonadherence group initially had about 90% adherence, but that gradually declined to about 20% after 6 months. This decline “may reflect caregivers who occasionally missed giving antiepileptic drug doses with no major health consequence (e.g., seizure) and, thus, made decisions to discontinue antiepileptic drugs.”

Dr. Modi and her coauthors said that those two groups are the children and families in greatest need of “adherence interventions focused on discussing the family's beliefs regarding epilepsy and antiepileptic drugs and providing education about treatment misconceptions.”

Children in the moderate nonadherence group, which averaged taking about 70% of their doses, may have missed taking their medication in blocked periods of time such as on vacations and during weekend sports, and “would benefit from problem-solving regarding barriers to adherence and instituting general behavioral and organizational strategies.”

The investigators wrote that the “often intrinsic link between socioeconomic status and education” makes it plausible that the limited financial resources of many of the families of children that fell into groups with mild or worse rates of nonadherence affect tangible aspects of poor adherence, such as the inability to pay for medications, as well as the intangible aspects, such as parental supervision.

Nearly half of children aged 4-10 years with autism spectrum disorders elope or wander away from safe spaces, and a relatively small percentage of families are receiving advice about the problem from a physician.

Those are the preliminary results from a national survey of 856 parents of children with an autism spectrum disorder (ASD). To reduce bias, the elopement frequency analysis included responses from a preselected group of 490 parents.

The ongoing survey, published April 20 and created by the Interactive Autism Network and other autism awareness and research groups, defines elopement as "the tendency to try to leave safe spaces or a responsible person’s care at age 4 years or older, beyond the toddler years when it is considered normal for a child to bolt from caregivers on a beach or in a store, or to leave the front yard and enter the street."

Among children with autism aged 7-10 years, the rate of elopement was almost 30%, which was eight times higher than for the child’s siblings without an ASD, the survey’s early results show. The elopement rate among children appeared to hit a low during the teen years and then began to rise again.

Nearly half of these wandering attempts succeeded, and in almost a third of these occurrences, the worried parents called the police. Two out of three families reported "close calls" with traffic dangers, and almost a third reported "close calls" with drowning. In addition, 35% of families with children who elope say their children are almost always unable to give their name, address, or phone number.

Fear of elopement restricted family activities for 62% of parents and led to lack of sleep for 40%. Also, 57% found elopement one of the most stressful behaviors for their child. The child’s state of mind during elopement was "playful or happy and focused," according to the parents’ reports. Less than 20% reported that the child felt "anxious" or "sad," and less than 10% said their child was "confused" or "in a fog."

Why do some children with an ASD have a tendency to elope? When offered a list of potential reasons, parents chose the child’s top motivations as a desire to run or explore, an attempt to go somewhere enjoyable, an attempt to escape an "anxious situation," pursuit of a special interest, and an attempt "to escape uncomfortable sensory stimuli." Children who eloped seldom did so to reach a favorite person.

Most of the parents did not see a relationship between the season and the child’s elopement frequency, although 25% did say that their child eloped most often during the summer.

In their efforts to cope with these behaviors, 19% of the parents received advice from a mental health professional, and 14% turned to a pediatrician or other physician. "Clearly, it is crucial that we develop supports and interventions for families coping with elopement behaviors in a child with ASD, and provide information to those community professionals who may receive appeals for help," the report said.

Funding for the survey came from the Autism Research Institute, the Autism Science Foundation, Autism Speaks, and the Global Autism Collaboration. The Interactive Autism Network Project, which is part of the Kennedy Krieger Institute in Baltimore, receives support from the Simons Foundation, Autism Speaks, and the National Institutes of Health.

Nearly half of children aged 4-10 years with autism spectrum disorders elope or wander away from safe spaces, and a relatively small percentage of families are receiving advice about the problem from a physician.

Those are the preliminary results from a national survey of 856 parents of children with an autism spectrum disorder (ASD). To reduce bias, the elopement frequency analysis included responses from a preselected group of 490 parents.

The ongoing survey, published April 20 and created by the Interactive Autism Network and other autism awareness and research groups, defines elopement as "the tendency to try to leave safe spaces or a responsible person’s care at age 4 years or older, beyond the toddler years when it is considered normal for a child to bolt from caregivers on a beach or in a store, or to leave the front yard and enter the street."

Among children with autism aged 7-10 years, the rate of elopement was almost 30%, which was eight times higher than for the child’s siblings without an ASD, the survey’s early results show. The elopement rate among children appeared to hit a low during the teen years and then began to rise again.

Nearly half of these wandering attempts succeeded, and in almost a third of these occurrences, the worried parents called the police. Two out of three families reported "close calls" with traffic dangers, and almost a third reported "close calls" with drowning. In addition, 35% of families with children who elope say their children are almost always unable to give their name, address, or phone number.

Fear of elopement restricted family activities for 62% of parents and led to lack of sleep for 40%. Also, 57% found elopement one of the most stressful behaviors for their child. The child’s state of mind during elopement was "playful or happy and focused," according to the parents’ reports. Less than 20% reported that the child felt "anxious" or "sad," and less than 10% said their child was "confused" or "in a fog."

Why do some children with an ASD have a tendency to elope? When offered a list of potential reasons, parents chose the child’s top motivations as a desire to run or explore, an attempt to go somewhere enjoyable, an attempt to escape an "anxious situation," pursuit of a special interest, and an attempt "to escape uncomfortable sensory stimuli." Children who eloped seldom did so to reach a favorite person.

Most of the parents did not see a relationship between the season and the child’s elopement frequency, although 25% did say that their child eloped most often during the summer.

In their efforts to cope with these behaviors, 19% of the parents received advice from a mental health professional, and 14% turned to a pediatrician or other physician. "Clearly, it is crucial that we develop supports and interventions for families coping with elopement behaviors in a child with ASD, and provide information to those community professionals who may receive appeals for help," the report said.

Funding for the survey came from the Autism Research Institute, the Autism Science Foundation, Autism Speaks, and the Global Autism Collaboration. The Interactive Autism Network Project, which is part of the Kennedy Krieger Institute in Baltimore, receives support from the Simons Foundation, Autism Speaks, and the National Institutes of Health.

Nearly half of children aged 4-10 years with autism spectrum disorders elope or wander away from safe spaces, and a relatively small percentage of families are receiving advice about the problem from a physician.

Those are the preliminary results from a national survey of 856 parents of children with an autism spectrum disorder (ASD). To reduce bias, the elopement frequency analysis included responses from a preselected group of 490 parents.

The ongoing survey, published April 20 and created by the Interactive Autism Network and other autism awareness and research groups, defines elopement as "the tendency to try to leave safe spaces or a responsible person’s care at age 4 years or older, beyond the toddler years when it is considered normal for a child to bolt from caregivers on a beach or in a store, or to leave the front yard and enter the street."

Among children with autism aged 7-10 years, the rate of elopement was almost 30%, which was eight times higher than for the child’s siblings without an ASD, the survey’s early results show. The elopement rate among children appeared to hit a low during the teen years and then began to rise again.

Nearly half of these wandering attempts succeeded, and in almost a third of these occurrences, the worried parents called the police. Two out of three families reported "close calls" with traffic dangers, and almost a third reported "close calls" with drowning. In addition, 35% of families with children who elope say their children are almost always unable to give their name, address, or phone number.

Fear of elopement restricted family activities for 62% of parents and led to lack of sleep for 40%. Also, 57% found elopement one of the most stressful behaviors for their child. The child’s state of mind during elopement was "playful or happy and focused," according to the parents’ reports. Less than 20% reported that the child felt "anxious" or "sad," and less than 10% said their child was "confused" or "in a fog."

Why do some children with an ASD have a tendency to elope? When offered a list of potential reasons, parents chose the child’s top motivations as a desire to run or explore, an attempt to go somewhere enjoyable, an attempt to escape an "anxious situation," pursuit of a special interest, and an attempt "to escape uncomfortable sensory stimuli." Children who eloped seldom did so to reach a favorite person.

Most of the parents did not see a relationship between the season and the child’s elopement frequency, although 25% did say that their child eloped most often during the summer.

In their efforts to cope with these behaviors, 19% of the parents received advice from a mental health professional, and 14% turned to a pediatrician or other physician. "Clearly, it is crucial that we develop supports and interventions for families coping with elopement behaviors in a child with ASD, and provide information to those community professionals who may receive appeals for help," the report said.

Funding for the survey came from the Autism Research Institute, the Autism Science Foundation, Autism Speaks, and the Global Autism Collaboration. The Interactive Autism Network Project, which is part of the Kennedy Krieger Institute in Baltimore, receives support from the Simons Foundation, Autism Speaks, and the National Institutes of Health.

Nearly half of children aged 4-10 years with autism spectrum disorders elope or wander away from safe spaces, and a relatively small percentage of families are receiving advice about the problem from a physician.

Those are the preliminary results from a national survey of 856 parents of children with an autism spectrum disorder (ASD). To reduce bias, the elopement frequency analysis included responses from a preselected group of 490 parents.

The ongoing survey, published April 20 and created by the Interactive Autism Network and other autism awareness and research groups, defines elopement as "the tendency to try to leave safe spaces or a responsible person’s care at age 4 years or older, beyond the toddler years when it is considered normal for a child to bolt from caregivers on a beach or in a store, or to leave the front yard and enter the street."

Among children with autism aged 7-10 years, the rate of elopement was almost 30%, which was eight times higher than for the child’s siblings without an ASD, the survey’s early results show. The elopement rate among children appeared to hit a low during the teen years and then began to rise again.

Nearly half of these wandering attempts succeeded, and in almost a third of these occurrences, the worried parents called the police. Two out of three families reported "close calls" with traffic dangers, and almost a third reported "close calls" with drowning. In addition, 35% of families with children who elope say their children are almost always unable to give their name, address, or phone number.

Fear of elopement restricted family activities for 62% of parents and led to lack of sleep for 40%. Also, 57% found elopement one of the most stressful behaviors for their child. The child’s state of mind during elopement was "playful or happy and focused," according to the parents’ reports. Less than 20% reported that the child felt "anxious" or "sad," and less than 10% said their child was "confused" or "in a fog."

Why do some children with an ASD have a tendency to elope? When offered a list of potential reasons, parents chose the child’s top motivations as a desire to run or explore, an attempt to go somewhere enjoyable, an attempt to escape an "anxious situation," pursuit of a special interest, and an attempt "to escape uncomfortable sensory stimuli." Children who eloped seldom did so to reach a favorite person.

Most of the parents did not see a relationship between the season and the child’s elopement frequency, although 25% did say that their child eloped most often during the summer.

In their efforts to cope with these behaviors, 19% of the parents received advice from a mental health professional, and 14% turned to a pediatrician or other physician. "Clearly, it is crucial that we develop supports and interventions for families coping with elopement behaviors in a child with ASD, and provide information to those community professionals who may receive appeals for help," the report said.

Funding for the survey came from the Autism Research Institute, the Autism Science Foundation, Autism Speaks, and the Global Autism Collaboration. The Interactive Autism Network Project, which is part of the Kennedy Krieger Institute in Baltimore, receives support from the Simons Foundation, Autism Speaks, and the National Institutes of Health.

Nearly half of children aged 4-10 years with autism spectrum disorders elope or wander away from safe spaces, and a relatively small percentage of families are receiving advice about the problem from a physician.

Those are the preliminary results from a national survey of 856 parents of children with an autism spectrum disorder (ASD). To reduce bias, the elopement frequency analysis included responses from a preselected group of 490 parents.

The ongoing survey, published April 20 and created by the Interactive Autism Network and other autism awareness and research groups, defines elopement as "the tendency to try to leave safe spaces or a responsible person’s care at age 4 years or older, beyond the toddler years when it is considered normal for a child to bolt from caregivers on a beach or in a store, or to leave the front yard and enter the street."

Among children with autism aged 7-10 years, the rate of elopement was almost 30%, which was eight times higher than for the child’s siblings without an ASD, the survey’s early results show. The elopement rate among children appeared to hit a low during the teen years and then began to rise again.

Nearly half of these wandering attempts succeeded, and in almost a third of these occurrences, the worried parents called the police. Two out of three families reported "close calls" with traffic dangers, and almost a third reported "close calls" with drowning. In addition, 35% of families with children who elope say their children are almost always unable to give their name, address, or phone number.

Fear of elopement restricted family activities for 62% of parents and led to lack of sleep for 40%. Also, 57% found elopement one of the most stressful behaviors for their child. The child’s state of mind during elopement was "playful or happy and focused," according to the parents’ reports. Less than 20% reported that the child felt "anxious" or "sad," and less than 10% said their child was "confused" or "in a fog."

Why do some children with an ASD have a tendency to elope? When offered a list of potential reasons, parents chose the child’s top motivations as a desire to run or explore, an attempt to go somewhere enjoyable, an attempt to escape an "anxious situation," pursuit of a special interest, and an attempt "to escape uncomfortable sensory stimuli." Children who eloped seldom did so to reach a favorite person.

Most of the parents did not see a relationship between the season and the child’s elopement frequency, although 25% did say that their child eloped most often during the summer.

In their efforts to cope with these behaviors, 19% of the parents received advice from a mental health professional, and 14% turned to a pediatrician or other physician. "Clearly, it is crucial that we develop supports and interventions for families coping with elopement behaviors in a child with ASD, and provide information to those community professionals who may receive appeals for help," the report said.

Funding for the survey came from the Autism Research Institute, the Autism Science Foundation, Autism Speaks, and the Global Autism Collaboration. The Interactive Autism Network Project, which is part of the Kennedy Krieger Institute in Baltimore, receives support from the Simons Foundation, Autism Speaks, and the National Institutes of Health.

Nearly half of children aged 4-10 years with autism spectrum disorders elope or wander away from safe spaces, and a relatively small percentage of families are receiving advice about the problem from a physician.

Those are the preliminary results from a national survey of 856 parents of children with an autism spectrum disorder (ASD). To reduce bias, the elopement frequency analysis included responses from a preselected group of 490 parents.

The ongoing survey, published April 20 and created by the Interactive Autism Network and other autism awareness and research groups, defines elopement as "the tendency to try to leave safe spaces or a responsible person’s care at age 4 years or older, beyond the toddler years when it is considered normal for a child to bolt from caregivers on a beach or in a store, or to leave the front yard and enter the street."

Among children with autism aged 7-10 years, the rate of elopement was almost 30%, which was eight times higher than for the child’s siblings without an ASD, the survey’s early results show. The elopement rate among children appeared to hit a low during the teen years and then began to rise again.

Nearly half of these wandering attempts succeeded, and in almost a third of these occurrences, the worried parents called the police. Two out of three families reported "close calls" with traffic dangers, and almost a third reported "close calls" with drowning. In addition, 35% of families with children who elope say their children are almost always unable to give their name, address, or phone number.

Fear of elopement restricted family activities for 62% of parents and led to lack of sleep for 40%. Also, 57% found elopement one of the most stressful behaviors for their child. The child’s state of mind during elopement was "playful or happy and focused," according to the parents’ reports. Less than 20% reported that the child felt "anxious" or "sad," and less than 10% said their child was "confused" or "in a fog."

Why do some children with an ASD have a tendency to elope? When offered a list of potential reasons, parents chose the child’s top motivations as a desire to run or explore, an attempt to go somewhere enjoyable, an attempt to escape an "anxious situation," pursuit of a special interest, and an attempt "to escape uncomfortable sensory stimuli." Children who eloped seldom did so to reach a favorite person.

Most of the parents did not see a relationship between the season and the child’s elopement frequency, although 25% did say that their child eloped most often during the summer.

In their efforts to cope with these behaviors, 19% of the parents received advice from a mental health professional, and 14% turned to a pediatrician or other physician. "Clearly, it is crucial that we develop supports and interventions for families coping with elopement behaviors in a child with ASD, and provide information to those community professionals who may receive appeals for help," the report said.

Funding for the survey came from the Autism Research Institute, the Autism Science Foundation, Autism Speaks, and the Global Autism Collaboration. The Interactive Autism Network Project, which is part of the Kennedy Krieger Institute in Baltimore, receives support from the Simons Foundation, Autism Speaks, and the National Institutes of Health.

Younger age, obesity, more recent health plan membership, and lower family income all reduce the likelihood that a woman will complete a mammogram, reported Dr. Adrianne C. Feldstein and her associates at Kaiser Permanente Northwest in Portland, Ore.

Younger age increased the likelihood that a woman would report being “too busy” to get a mammogram and that she would have more doubts about its usefulness or accuracy. Family income was a more significant variable than was race in mammogram completion, which is “consistent with findings from other studies,” they noted (J. Womens Health 2011 [doi:10.1089/jwh.2010.2195

In a study of 4,708 women aged 50–69 years, investigators first evaluated a patient's likelihood of completing a mammogram during a 10-month follow-up period after patients received multiple reminders over 3–4 months. Variables included age, visits to an ob.gyn. or primary care physician, race, family income, length of health plan membership, and body mass index.

In the study's second phase, a subgroup of 340 women completed a mail-in survey that identified barriers to and facilitators for mammograms by answering yes or no to provided statements such as “I'm embarrassed about having mammo-gram.” Their replies showed that although repeated reminders are effective, significant obstacles still remain.

Pain emerged as one of the major barriers for patients. The study cited 25% of the patients as reporting that a mammogram “causes too much pain,” and in obese patients the percentage rose to 31%. The relationship between pain and obesity remains unclear and could be the subject of further investigation, Dr. Feldstein said in an interview.

Meanwhile, she recommended that mammography providers explore ways to reduce pain for all patients.

“If you have the technician do the initial compression, and then the patient verbally controls the pressure from that point on, that seems to reduce the patient's pain and still preserve the quality of the x-ray image,” Dr. Feldstein said.

The study was funded by the National Cancer Institute. Dr. Feldstein and her associates said they had no relevant financial disclosures.

Younger age, obesity, more recent health plan membership, and lower family income all reduce the likelihood that a woman will complete a mammogram, reported Dr. Adrianne C. Feldstein and her associates at Kaiser Permanente Northwest in Portland, Ore.

Younger age increased the likelihood that a woman would report being “too busy” to get a mammogram and that she would have more doubts about its usefulness or accuracy. Family income was a more significant variable than was race in mammogram completion, which is “consistent with findings from other studies,” they noted (J. Womens Health 2011 [doi:10.1089/jwh.2010.2195

In a study of 4,708 women aged 50–69 years, investigators first evaluated a patient's likelihood of completing a mammogram during a 10-month follow-up period after patients received multiple reminders over 3–4 months. Variables included age, visits to an ob.gyn. or primary care physician, race, family income, length of health plan membership, and body mass index.

In the study's second phase, a subgroup of 340 women completed a mail-in survey that identified barriers to and facilitators for mammograms by answering yes or no to provided statements such as “I'm embarrassed about having mammo-gram.” Their replies showed that although repeated reminders are effective, significant obstacles still remain.

Pain emerged as one of the major barriers for patients. The study cited 25% of the patients as reporting that a mammogram “causes too much pain,” and in obese patients the percentage rose to 31%. The relationship between pain and obesity remains unclear and could be the subject of further investigation, Dr. Feldstein said in an interview.

Meanwhile, she recommended that mammography providers explore ways to reduce pain for all patients.

“If you have the technician do the initial compression, and then the patient verbally controls the pressure from that point on, that seems to reduce the patient's pain and still preserve the quality of the x-ray image,” Dr. Feldstein said.

The study was funded by the National Cancer Institute. Dr. Feldstein and her associates said they had no relevant financial disclosures.

Younger age, obesity, more recent health plan membership, and lower family income all reduce the likelihood that a woman will complete a mammogram, reported Dr. Adrianne C. Feldstein and her associates at Kaiser Permanente Northwest in Portland, Ore.

Younger age increased the likelihood that a woman would report being “too busy” to get a mammogram and that she would have more doubts about its usefulness or accuracy. Family income was a more significant variable than was race in mammogram completion, which is “consistent with findings from other studies,” they noted (J. Womens Health 2011 [doi:10.1089/jwh.2010.2195

In a study of 4,708 women aged 50–69 years, investigators first evaluated a patient's likelihood of completing a mammogram during a 10-month follow-up period after patients received multiple reminders over 3–4 months. Variables included age, visits to an ob.gyn. or primary care physician, race, family income, length of health plan membership, and body mass index.

In the study's second phase, a subgroup of 340 women completed a mail-in survey that identified barriers to and facilitators for mammograms by answering yes or no to provided statements such as “I'm embarrassed about having mammo-gram.” Their replies showed that although repeated reminders are effective, significant obstacles still remain.

Pain emerged as one of the major barriers for patients. The study cited 25% of the patients as reporting that a mammogram “causes too much pain,” and in obese patients the percentage rose to 31%. The relationship between pain and obesity remains unclear and could be the subject of further investigation, Dr. Feldstein said in an interview.

Meanwhile, she recommended that mammography providers explore ways to reduce pain for all patients.

“If you have the technician do the initial compression, and then the patient verbally controls the pressure from that point on, that seems to reduce the patient's pain and still preserve the quality of the x-ray image,” Dr. Feldstein said.

The study was funded by the National Cancer Institute. Dr. Feldstein and her associates said they had no relevant financial disclosures.

A panel of 18 experts from 10 European countries had some difficulty in defining when the benefits sufficiently outweighed the potential adverse effects of various NSAIDs – with and without a proton pump inhibitor – for 144 profiles of patients with chronic rheumatic diseases.

Panelists generally gave patients with low gastrointestinal or cardiovascular risks the full range of NSAID options. Approximately one-third of the patient-drug matches labeled “inappropriate” by panelists applied to the use of a nonselective NSAID without a PPI (Ann. Rheum. Dis. 2011;70:818–22).

When scoring patient profiles, panelists took into account seven clinical variables: age of 65 years or older, history of upper gastrointestinal problems, use of anticoagulants, use of systemic corticosteroids, intermittent or continuous treatment pattern, cardiovascular risk, and the use of low-dose aspirin (for those patients with cardiovascular risk). Against these variables, panelists considered 10 treatment options: ibuprofen, diclofenac, naproxen, celecoxib, etoricoxib, and each of these drugs plus a PPI. They did not consider costs when making their treatment recommendations, according to Dr. G.R. Burmester of the department of rheumatology and clinical immunology, Charité Medical University Berlin, and his coauthors.

For patients with the lowest gastrointestinal and cardiovascular risks, a nonselective NSAID (ibuprofen, diclofenac, or naproxen) was deemed appropriate. As gastrointestinal risks increased, the cyclooxygenase-2 (COX-2) inhibitors celecoxib and etoricoxib alone or a nonselective NSAID plus PPI were considered appropriate. In cases of high gastrointestinal risk and low to average cardiovascular risk, panelists rated ibuprofen/diclofenac plus PPI, or a COX-2 inhibitor plus PPI, as the most appropriate options. For patients with both high gastrointestinal and cardiovascular risks, avoidance of all NSAIDs was recommended, with the use of diclofenac, naproxen, celecoxib, or etoricoxib plus PPI deemed acceptable if necessary.

In January 2008, the panel established the appropriateness rating of treatment options on a 1–9 scale, with 1 as “inappropriate” and 9 as “appropriate.” As defined by the RAND/UCLA appropriateness method, a “treatment had to be considered appropriate if the expected benefits exceeded the potential negative consequences by a sufficient margin.” However, the panel did not define “sufficient,” which led to most of the disagreement on scoring.

All panelists disclosed receiving honoraria from Pfizer, which supported the study with an unrestricted educational grant. Eleven panelists disclosed other relationships with pharmaceutical companies, including Pfizer.

A panel of 18 experts from 10 European countries had some difficulty in defining when the benefits sufficiently outweighed the potential adverse effects of various NSAIDs – with and without a proton pump inhibitor – for 144 profiles of patients with chronic rheumatic diseases.

Panelists generally gave patients with low gastrointestinal or cardiovascular risks the full range of NSAID options. Approximately one-third of the patient-drug matches labeled “inappropriate” by panelists applied to the use of a nonselective NSAID without a PPI (Ann. Rheum. Dis. 2011;70:818–22).

When scoring patient profiles, panelists took into account seven clinical variables: age of 65 years or older, history of upper gastrointestinal problems, use of anticoagulants, use of systemic corticosteroids, intermittent or continuous treatment pattern, cardiovascular risk, and the use of low-dose aspirin (for those patients with cardiovascular risk). Against these variables, panelists considered 10 treatment options: ibuprofen, diclofenac, naproxen, celecoxib, etoricoxib, and each of these drugs plus a PPI. They did not consider costs when making their treatment recommendations, according to Dr. G.R. Burmester of the department of rheumatology and clinical immunology, Charité Medical University Berlin, and his coauthors.

For patients with the lowest gastrointestinal and cardiovascular risks, a nonselective NSAID (ibuprofen, diclofenac, or naproxen) was deemed appropriate. As gastrointestinal risks increased, the cyclooxygenase-2 (COX-2) inhibitors celecoxib and etoricoxib alone or a nonselective NSAID plus PPI were considered appropriate. In cases of high gastrointestinal risk and low to average cardiovascular risk, panelists rated ibuprofen/diclofenac plus PPI, or a COX-2 inhibitor plus PPI, as the most appropriate options. For patients with both high gastrointestinal and cardiovascular risks, avoidance of all NSAIDs was recommended, with the use of diclofenac, naproxen, celecoxib, or etoricoxib plus PPI deemed acceptable if necessary.

In January 2008, the panel established the appropriateness rating of treatment options on a 1–9 scale, with 1 as “inappropriate” and 9 as “appropriate.” As defined by the RAND/UCLA appropriateness method, a “treatment had to be considered appropriate if the expected benefits exceeded the potential negative consequences by a sufficient margin.” However, the panel did not define “sufficient,” which led to most of the disagreement on scoring.

All panelists disclosed receiving honoraria from Pfizer, which supported the study with an unrestricted educational grant. Eleven panelists disclosed other relationships with pharmaceutical companies, including Pfizer.

A panel of 18 experts from 10 European countries had some difficulty in defining when the benefits sufficiently outweighed the potential adverse effects of various NSAIDs – with and without a proton pump inhibitor – for 144 profiles of patients with chronic rheumatic diseases.

Panelists generally gave patients with low gastrointestinal or cardiovascular risks the full range of NSAID options. Approximately one-third of the patient-drug matches labeled “inappropriate” by panelists applied to the use of a nonselective NSAID without a PPI (Ann. Rheum. Dis. 2011;70:818–22).

When scoring patient profiles, panelists took into account seven clinical variables: age of 65 years or older, history of upper gastrointestinal problems, use of anticoagulants, use of systemic corticosteroids, intermittent or continuous treatment pattern, cardiovascular risk, and the use of low-dose aspirin (for those patients with cardiovascular risk). Against these variables, panelists considered 10 treatment options: ibuprofen, diclofenac, naproxen, celecoxib, etoricoxib, and each of these drugs plus a PPI. They did not consider costs when making their treatment recommendations, according to Dr. G.R. Burmester of the department of rheumatology and clinical immunology, Charité Medical University Berlin, and his coauthors.

For patients with the lowest gastrointestinal and cardiovascular risks, a nonselective NSAID (ibuprofen, diclofenac, or naproxen) was deemed appropriate. As gastrointestinal risks increased, the cyclooxygenase-2 (COX-2) inhibitors celecoxib and etoricoxib alone or a nonselective NSAID plus PPI were considered appropriate. In cases of high gastrointestinal risk and low to average cardiovascular risk, panelists rated ibuprofen/diclofenac plus PPI, or a COX-2 inhibitor plus PPI, as the most appropriate options. For patients with both high gastrointestinal and cardiovascular risks, avoidance of all NSAIDs was recommended, with the use of diclofenac, naproxen, celecoxib, or etoricoxib plus PPI deemed acceptable if necessary.

In January 2008, the panel established the appropriateness rating of treatment options on a 1–9 scale, with 1 as “inappropriate” and 9 as “appropriate.” As defined by the RAND/UCLA appropriateness method, a “treatment had to be considered appropriate if the expected benefits exceeded the potential negative consequences by a sufficient margin.” However, the panel did not define “sufficient,” which led to most of the disagreement on scoring.

All panelists disclosed receiving honoraria from Pfizer, which supported the study with an unrestricted educational grant. Eleven panelists disclosed other relationships with pharmaceutical companies, including Pfizer.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

A panel of 18 experts from 10 European countries had some difficulty in defining when the benefits sufficiently outweighed the potential adverse effects of various nonsteroidal anti-inflammatory drugs – with and without a proton pump inhibitor – for 144 profiles of patients with chronic rheumatic diseases.

Panelists generally gave patients with low gastrointestinal or cardiovascular risks the full range of NSAID options. Approximately one-third of the patient-drug matches labeled "inappropriate" by panelists applied to the use of a nonselective NSAID without a PPI, the panelists wrote in Annals of the Rheumatic Diseases (Ann. Rheum. Dis. 2011;70:818-22).

When scoring patient profiles, panelists took into account seven clinical variables: age of 65 years or older, history of upper gastrointestinal problems, use of anticoagulants, use of systemic corticosteroids, intermittent or continuous treatment pattern, cardiovascular risk, and the use of low-dose aspirin (for those patients with cardiovascular risk). Against these variables, panelists considered 10 treatment options: ibuprofen, diclofenac, naproxen, celecoxib, etoricoxib, and each of these drugs plus a PPI. They did not consider costs when making their treatment recommendations, according to Dr. G.R. Burmester of the department of rheumatology and clinical immunology, Charité Medical University Berlin, and his coauthors.

For patients with the lowest gastrointestinal and cardiovascular risks, a nonselective NSAID (ibuprofen, diclofenac, or naproxen) was deemed appropriate. As gastrointestinal risks increased, the cyclooxygenase-2 (COX-2) inhibitors celecoxib and etoricoxib alone or a nonselective NSAID plus PPI were considered appropriate. In cases of high gastrointestinal risk and low to average cardiovascular risk, panelists rated ibuprofen/diclofenac plus PPI, or a COX-2 inhibitor plus PPI, as the most appropriate options. For patients with both high gastrointestinal and cardiovascular risks, avoidance of all NSAIDs was recommended, with the use of diclofenac, naproxen, celecoxib, or etoricoxib plus PPI deemed acceptable if necessary.

In January 2008, the panel established the appropriateness rating of treatment options on a 1-9 scale, with 1 as "inappropriate" and 9 as "appropriate." As defined by the RAND/UCLA appropriateness method, a "treatment had to be considered appropriate if the expected benefits exceeded the potential negative consequences by a sufficient margin." However, the panel did not define "sufficient," which led to most of the disagreement on scoring.

In June 2008, after the panel evaluated the first-round practice ratings and revised the evaluation measures, the second round of rating began with the 144 patient profiles and 10 treatment choices. A treatment with a median score of 7-9 was categorized as appropriate, whereas treatments with a median score of 1-3 were labeled inappropriate and those scoring 4-6 were categorized as uncertain.

An online tool (www.e-hims.com/Sensar) shows the corresponding panel treatment recommendation for various patient data.

Panelists were experts in the fields of rheumatology, orthopedics, cardiology, clinical pharmacology, gastroenterology, family medicine, and geriatrics.

All panelists disclosed receiving honoraria from Pfizer, which supported the study with an unrestricted educational grant. Eleven panelists disclosed other relationships with pharmaceutical companies, including Pfizer.

A panel of 18 experts from 10 European countries had some difficulty in defining when the benefits sufficiently outweighed the potential adverse effects of various nonsteroidal anti-inflammatory drugs – with and without a proton pump inhibitor – for 144 profiles of patients with chronic rheumatic diseases.

Panelists generally gave patients with low gastrointestinal or cardiovascular risks the full range of NSAID options. Approximately one-third of the patient-drug matches labeled "inappropriate" by panelists applied to the use of a nonselective NSAID without a PPI, the panelists wrote in Annals of the Rheumatic Diseases (Ann. Rheum. Dis. 2011;70:818-22).

When scoring patient profiles, panelists took into account seven clinical variables: age of 65 years or older, history of upper gastrointestinal problems, use of anticoagulants, use of systemic corticosteroids, intermittent or continuous treatment pattern, cardiovascular risk, and the use of low-dose aspirin (for those patients with cardiovascular risk). Against these variables, panelists considered 10 treatment options: ibuprofen, diclofenac, naproxen, celecoxib, etoricoxib, and each of these drugs plus a PPI. They did not consider costs when making their treatment recommendations, according to Dr. G.R. Burmester of the department of rheumatology and clinical immunology, Charité Medical University Berlin, and his coauthors.

For patients with the lowest gastrointestinal and cardiovascular risks, a nonselective NSAID (ibuprofen, diclofenac, or naproxen) was deemed appropriate. As gastrointestinal risks increased, the cyclooxygenase-2 (COX-2) inhibitors celecoxib and etoricoxib alone or a nonselective NSAID plus PPI were considered appropriate. In cases of high gastrointestinal risk and low to average cardiovascular risk, panelists rated ibuprofen/diclofenac plus PPI, or a COX-2 inhibitor plus PPI, as the most appropriate options. For patients with both high gastrointestinal and cardiovascular risks, avoidance of all NSAIDs was recommended, with the use of diclofenac, naproxen, celecoxib, or etoricoxib plus PPI deemed acceptable if necessary.

In January 2008, the panel established the appropriateness rating of treatment options on a 1-9 scale, with 1 as "inappropriate" and 9 as "appropriate." As defined by the RAND/UCLA appropriateness method, a "treatment had to be considered appropriate if the expected benefits exceeded the potential negative consequences by a sufficient margin." However, the panel did not define "sufficient," which led to most of the disagreement on scoring.

In June 2008, after the panel evaluated the first-round practice ratings and revised the evaluation measures, the second round of rating began with the 144 patient profiles and 10 treatment choices. A treatment with a median score of 7-9 was categorized as appropriate, whereas treatments with a median score of 1-3 were labeled inappropriate and those scoring 4-6 were categorized as uncertain.

An online tool (www.e-hims.com/Sensar) shows the corresponding panel treatment recommendation for various patient data.

Panelists were experts in the fields of rheumatology, orthopedics, cardiology, clinical pharmacology, gastroenterology, family medicine, and geriatrics.

All panelists disclosed receiving honoraria from Pfizer, which supported the study with an unrestricted educational grant. Eleven panelists disclosed other relationships with pharmaceutical companies, including Pfizer.

A panel of 18 experts from 10 European countries had some difficulty in defining when the benefits sufficiently outweighed the potential adverse effects of various nonsteroidal anti-inflammatory drugs – with and without a proton pump inhibitor – for 144 profiles of patients with chronic rheumatic diseases.

Panelists generally gave patients with low gastrointestinal or cardiovascular risks the full range of NSAID options. Approximately one-third of the patient-drug matches labeled "inappropriate" by panelists applied to the use of a nonselective NSAID without a PPI, the panelists wrote in Annals of the Rheumatic Diseases (Ann. Rheum. Dis. 2011;70:818-22).

When scoring patient profiles, panelists took into account seven clinical variables: age of 65 years or older, history of upper gastrointestinal problems, use of anticoagulants, use of systemic corticosteroids, intermittent or continuous treatment pattern, cardiovascular risk, and the use of low-dose aspirin (for those patients with cardiovascular risk). Against these variables, panelists considered 10 treatment options: ibuprofen, diclofenac, naproxen, celecoxib, etoricoxib, and each of these drugs plus a PPI. They did not consider costs when making their treatment recommendations, according to Dr. G.R. Burmester of the department of rheumatology and clinical immunology, Charité Medical University Berlin, and his coauthors.

For patients with the lowest gastrointestinal and cardiovascular risks, a nonselective NSAID (ibuprofen, diclofenac, or naproxen) was deemed appropriate. As gastrointestinal risks increased, the cyclooxygenase-2 (COX-2) inhibitors celecoxib and etoricoxib alone or a nonselective NSAID plus PPI were considered appropriate. In cases of high gastrointestinal risk and low to average cardiovascular risk, panelists rated ibuprofen/diclofenac plus PPI, or a COX-2 inhibitor plus PPI, as the most appropriate options. For patients with both high gastrointestinal and cardiovascular risks, avoidance of all NSAIDs was recommended, with the use of diclofenac, naproxen, celecoxib, or etoricoxib plus PPI deemed acceptable if necessary.

In January 2008, the panel established the appropriateness rating of treatment options on a 1-9 scale, with 1 as "inappropriate" and 9 as "appropriate." As defined by the RAND/UCLA appropriateness method, a "treatment had to be considered appropriate if the expected benefits exceeded the potential negative consequences by a sufficient margin." However, the panel did not define "sufficient," which led to most of the disagreement on scoring.

In June 2008, after the panel evaluated the first-round practice ratings and revised the evaluation measures, the second round of rating began with the 144 patient profiles and 10 treatment choices. A treatment with a median score of 7-9 was categorized as appropriate, whereas treatments with a median score of 1-3 were labeled inappropriate and those scoring 4-6 were categorized as uncertain.

An online tool (www.e-hims.com/Sensar) shows the corresponding panel treatment recommendation for various patient data.

Panelists were experts in the fields of rheumatology, orthopedics, cardiology, clinical pharmacology, gastroenterology, family medicine, and geriatrics.

All panelists disclosed receiving honoraria from Pfizer, which supported the study with an unrestricted educational grant. Eleven panelists disclosed other relationships with pharmaceutical companies, including Pfizer.