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Number of TB-caused deaths fall, but disease still kills 1 million-plus
Tuberculosis (TB) mortality has fallen 47% since 1990, and the reporting on incidences of the disease has improved, says a global report by the World Health Organization (WHO). News about this disease is not all positive, however; TB continues to be one of the world’s deadliest diseases and many cases of TB went unreported last year, according to the WHO report.
Most improvements in mortality rate for TB patients occurred at the beginning of the 21st century, when the United Nations established the Millennium Development Goals, says the report. Such goals included halting and reversing TB incidence on a worldwide basis, in each of the 6 WHO regions, and in 16 of the 22 high-burden countries that collectively account for 80% of TB cases.
“In all, effective diagnosis and treatment of TB saved an estimated 43 million lives between 2000 and 2014,” says the report.
Better reporting on TB’s prevalence led to the first increase in the number of TB cases reported since 2007.
“The annual total of new TB cases, which had been about 5.7 million until 2013, rose to slightly more than 6 million in 2014 (an increase of 6%). This was mostly due to a 29% increase in notification in India, which followed the introduction of a policy of mandatory notification in May 2012, creation of a national Web-based reporting system in June 2012, and intensified efforts to engage the private health sector,” according to the report.
Despite these improvements in data collection of TB incidents, 37% of new TB cases were undiagnosed or not reported last year, with 9.6 million people having fallen sick to TB during a year when just 6 million new cases were reported, according to estimates. Regarding multidrug-resistant TB cases specifically, only 123,000 of an estimated 480,000 cases were detected and reported.
As for the deadliness of the disease, TB killed 1.5 million people in 2014.
Read the full report on the WHO website.
Tuberculosis (TB) mortality has fallen 47% since 1990, and the reporting on incidences of the disease has improved, says a global report by the World Health Organization (WHO). News about this disease is not all positive, however; TB continues to be one of the world’s deadliest diseases and many cases of TB went unreported last year, according to the WHO report.
Most improvements in mortality rate for TB patients occurred at the beginning of the 21st century, when the United Nations established the Millennium Development Goals, says the report. Such goals included halting and reversing TB incidence on a worldwide basis, in each of the 6 WHO regions, and in 16 of the 22 high-burden countries that collectively account for 80% of TB cases.
“In all, effective diagnosis and treatment of TB saved an estimated 43 million lives between 2000 and 2014,” says the report.
Better reporting on TB’s prevalence led to the first increase in the number of TB cases reported since 2007.
“The annual total of new TB cases, which had been about 5.7 million until 2013, rose to slightly more than 6 million in 2014 (an increase of 6%). This was mostly due to a 29% increase in notification in India, which followed the introduction of a policy of mandatory notification in May 2012, creation of a national Web-based reporting system in June 2012, and intensified efforts to engage the private health sector,” according to the report.
Despite these improvements in data collection of TB incidents, 37% of new TB cases were undiagnosed or not reported last year, with 9.6 million people having fallen sick to TB during a year when just 6 million new cases were reported, according to estimates. Regarding multidrug-resistant TB cases specifically, only 123,000 of an estimated 480,000 cases were detected and reported.
As for the deadliness of the disease, TB killed 1.5 million people in 2014.
Read the full report on the WHO website.
Tuberculosis (TB) mortality has fallen 47% since 1990, and the reporting on incidences of the disease has improved, says a global report by the World Health Organization (WHO). News about this disease is not all positive, however; TB continues to be one of the world’s deadliest diseases and many cases of TB went unreported last year, according to the WHO report.
Most improvements in mortality rate for TB patients occurred at the beginning of the 21st century, when the United Nations established the Millennium Development Goals, says the report. Such goals included halting and reversing TB incidence on a worldwide basis, in each of the 6 WHO regions, and in 16 of the 22 high-burden countries that collectively account for 80% of TB cases.
“In all, effective diagnosis and treatment of TB saved an estimated 43 million lives between 2000 and 2014,” says the report.
Better reporting on TB’s prevalence led to the first increase in the number of TB cases reported since 2007.
“The annual total of new TB cases, which had been about 5.7 million until 2013, rose to slightly more than 6 million in 2014 (an increase of 6%). This was mostly due to a 29% increase in notification in India, which followed the introduction of a policy of mandatory notification in May 2012, creation of a national Web-based reporting system in June 2012, and intensified efforts to engage the private health sector,” according to the report.
Despite these improvements in data collection of TB incidents, 37% of new TB cases were undiagnosed or not reported last year, with 9.6 million people having fallen sick to TB during a year when just 6 million new cases were reported, according to estimates. Regarding multidrug-resistant TB cases specifically, only 123,000 of an estimated 480,000 cases were detected and reported.
As for the deadliness of the disease, TB killed 1.5 million people in 2014.
Read the full report on the WHO website.
Raloxifene ineffective for treating AD patients
Treatment with the estrogen-receptor modulator raloxifene does not significantly improve cognitive function in women with Alzheimer’s disease (AD), results of a U.S. randomized, double-blind, placebo-controlled trial suggest.
The study’s researchers gave (120 mg) oral raloxifene or an identical placebo once daily to 42 postmenopausal women with dementia and probable AD of mild to moderate severity. Of those women, 39 continued to take the drug for the study’s full treatment period of 12 months.
At 12 months, the mean Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog) scores for both the treatment group and the placebo group were modestly lower than mean baseline scores. Dementia rating, function, and behavior also declined by similar amounts in both treatment groups.
Even caregivers’ responses to surveys suggested that both groups of patients had similar outcomes; caregiver burden and caregiver distress increased modestly over time for both groups.
Three of the study’s participants experienced serious adverse events, including one death of a woman who had taken raloxifene. This woman’s death was preceded by her developing pneumonia and heart failure, and an ischemic stroke, which may have been related to her use of the drug, according to Dr. Victor W. Henderson and his colleagues. Also in the experimental group was a women diagnosed with colon cancer. One woman in the placebo group was hospitalized for hallucinations and agitation.
“These results provide information to guide consideration and design of future trials. The essentially null effect of raloxifene on the primary outcomes implies a low likelihood of positive results but does not exclude the possibility of modest cognitive benefit or harm,” according to the researchers.
Read the full study in Neurology.
Treatment with the estrogen-receptor modulator raloxifene does not significantly improve cognitive function in women with Alzheimer’s disease (AD), results of a U.S. randomized, double-blind, placebo-controlled trial suggest.
The study’s researchers gave (120 mg) oral raloxifene or an identical placebo once daily to 42 postmenopausal women with dementia and probable AD of mild to moderate severity. Of those women, 39 continued to take the drug for the study’s full treatment period of 12 months.
At 12 months, the mean Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog) scores for both the treatment group and the placebo group were modestly lower than mean baseline scores. Dementia rating, function, and behavior also declined by similar amounts in both treatment groups.
Even caregivers’ responses to surveys suggested that both groups of patients had similar outcomes; caregiver burden and caregiver distress increased modestly over time for both groups.
Three of the study’s participants experienced serious adverse events, including one death of a woman who had taken raloxifene. This woman’s death was preceded by her developing pneumonia and heart failure, and an ischemic stroke, which may have been related to her use of the drug, according to Dr. Victor W. Henderson and his colleagues. Also in the experimental group was a women diagnosed with colon cancer. One woman in the placebo group was hospitalized for hallucinations and agitation.
“These results provide information to guide consideration and design of future trials. The essentially null effect of raloxifene on the primary outcomes implies a low likelihood of positive results but does not exclude the possibility of modest cognitive benefit or harm,” according to the researchers.
Read the full study in Neurology.
Treatment with the estrogen-receptor modulator raloxifene does not significantly improve cognitive function in women with Alzheimer’s disease (AD), results of a U.S. randomized, double-blind, placebo-controlled trial suggest.
The study’s researchers gave (120 mg) oral raloxifene or an identical placebo once daily to 42 postmenopausal women with dementia and probable AD of mild to moderate severity. Of those women, 39 continued to take the drug for the study’s full treatment period of 12 months.
At 12 months, the mean Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog) scores for both the treatment group and the placebo group were modestly lower than mean baseline scores. Dementia rating, function, and behavior also declined by similar amounts in both treatment groups.
Even caregivers’ responses to surveys suggested that both groups of patients had similar outcomes; caregiver burden and caregiver distress increased modestly over time for both groups.
Three of the study’s participants experienced serious adverse events, including one death of a woman who had taken raloxifene. This woman’s death was preceded by her developing pneumonia and heart failure, and an ischemic stroke, which may have been related to her use of the drug, according to Dr. Victor W. Henderson and his colleagues. Also in the experimental group was a women diagnosed with colon cancer. One woman in the placebo group was hospitalized for hallucinations and agitation.
“These results provide information to guide consideration and design of future trials. The essentially null effect of raloxifene on the primary outcomes implies a low likelihood of positive results but does not exclude the possibility of modest cognitive benefit or harm,” according to the researchers.
Read the full study in Neurology.
FROM NEUROLOGY
Case reports: Ingestion of aripiprazole precedes false positives for amphetamine use
Two children who had ingested aripiprazole but not amphetamines tested positive for amphetamine use in urine drug screens (UDSs) performed within 24 hours of their drug use, according to two case reports by Justin Kaplan, Pharm.D., of Hackensack (N.J.) University Medical Center and his colleagues.
In both cases, aripiprazole had been prescribed to the father of the child and had been taken by the child without the knowledge or auspices of a parent. Both of the children were admitted to hospitals where their urine was screened for drugs.
“To our knowledge this case series is the first to document potential false-positive UDSs after accidental ingestion of aripiprazole,” said the researchers. “In both cases, the presentation of drowsiness, lethargy, and ataxia were more consistent with ingestion of an atypical antipsychotic than with amphetamines.”
In one of the cases, a 2-year-old girl was found holding an open bottle of aripiprazole 15-mg tablets by her parents. The parents’ report of the incident suggested that the child had ingested three such tablets. The child’s urine was screened for amphetamines twice, in the hospital where she was admitted; the first screen, which was performed the morning after the child had been taken to a hospital, revealed an amphetamine concentration of 1,048 ng/mL. The child’s second UDS, which was performed the following day, indicated a 949 ng/mL concentration of amphetamines. Outside of the hospital, laboratory tests were performed on the child’s blood and urine samples from the day following her admittance to the hospital. Both of these additional tests were negative for amphetamines, suggesting that the results of the in-hospital UDSs had been false positives.
The other case involved a 20-month-old girl, whose father found her with pills scattered around her crib. The drugs were part of a 1-week supply of drugs of the father. The medications included alprazolam 2.5 mg, fluvoxamine 2,100 mg, clonazepam 17.5 mg, buspirone 420 mg, and aripiprazole 35 mg. This child’s urine was also screened for drugs twice at the hospital where she was admitted; this child only tested positive for amphetamine in the first assessment, with a 311 ng/mL concentration of amphetamines having been found in that UDS. As with the first case, this child’s urine and blood samples were subjected to off-site laboratory tests, which found no presence of amphetamines.
“There are several limitations to UDS immunoassays. Most important, poor specificity is associated with a risk of false-positive testing. A negative result does not exclude the possibility that the substance is present if it is below the lower threshold of detection. Additionally, there is no way to quantitatively correlate a positive result with the extent of immunoassays. Therefore immunoassays are the first step in a two-step system, in which all positive results must be confirmed by more reliable methods such as [gas chromatography mass spectrometry],” the researchers said.
Read the full study in Pediatrics. doi: 10:1542/peds.2014-3333.
Two children who had ingested aripiprazole but not amphetamines tested positive for amphetamine use in urine drug screens (UDSs) performed within 24 hours of their drug use, according to two case reports by Justin Kaplan, Pharm.D., of Hackensack (N.J.) University Medical Center and his colleagues.
In both cases, aripiprazole had been prescribed to the father of the child and had been taken by the child without the knowledge or auspices of a parent. Both of the children were admitted to hospitals where their urine was screened for drugs.
“To our knowledge this case series is the first to document potential false-positive UDSs after accidental ingestion of aripiprazole,” said the researchers. “In both cases, the presentation of drowsiness, lethargy, and ataxia were more consistent with ingestion of an atypical antipsychotic than with amphetamines.”
In one of the cases, a 2-year-old girl was found holding an open bottle of aripiprazole 15-mg tablets by her parents. The parents’ report of the incident suggested that the child had ingested three such tablets. The child’s urine was screened for amphetamines twice, in the hospital where she was admitted; the first screen, which was performed the morning after the child had been taken to a hospital, revealed an amphetamine concentration of 1,048 ng/mL. The child’s second UDS, which was performed the following day, indicated a 949 ng/mL concentration of amphetamines. Outside of the hospital, laboratory tests were performed on the child’s blood and urine samples from the day following her admittance to the hospital. Both of these additional tests were negative for amphetamines, suggesting that the results of the in-hospital UDSs had been false positives.
The other case involved a 20-month-old girl, whose father found her with pills scattered around her crib. The drugs were part of a 1-week supply of drugs of the father. The medications included alprazolam 2.5 mg, fluvoxamine 2,100 mg, clonazepam 17.5 mg, buspirone 420 mg, and aripiprazole 35 mg. This child’s urine was also screened for drugs twice at the hospital where she was admitted; this child only tested positive for amphetamine in the first assessment, with a 311 ng/mL concentration of amphetamines having been found in that UDS. As with the first case, this child’s urine and blood samples were subjected to off-site laboratory tests, which found no presence of amphetamines.
“There are several limitations to UDS immunoassays. Most important, poor specificity is associated with a risk of false-positive testing. A negative result does not exclude the possibility that the substance is present if it is below the lower threshold of detection. Additionally, there is no way to quantitatively correlate a positive result with the extent of immunoassays. Therefore immunoassays are the first step in a two-step system, in which all positive results must be confirmed by more reliable methods such as [gas chromatography mass spectrometry],” the researchers said.
Read the full study in Pediatrics. doi: 10:1542/peds.2014-3333.
Two children who had ingested aripiprazole but not amphetamines tested positive for amphetamine use in urine drug screens (UDSs) performed within 24 hours of their drug use, according to two case reports by Justin Kaplan, Pharm.D., of Hackensack (N.J.) University Medical Center and his colleagues.
In both cases, aripiprazole had been prescribed to the father of the child and had been taken by the child without the knowledge or auspices of a parent. Both of the children were admitted to hospitals where their urine was screened for drugs.
“To our knowledge this case series is the first to document potential false-positive UDSs after accidental ingestion of aripiprazole,” said the researchers. “In both cases, the presentation of drowsiness, lethargy, and ataxia were more consistent with ingestion of an atypical antipsychotic than with amphetamines.”
In one of the cases, a 2-year-old girl was found holding an open bottle of aripiprazole 15-mg tablets by her parents. The parents’ report of the incident suggested that the child had ingested three such tablets. The child’s urine was screened for amphetamines twice, in the hospital where she was admitted; the first screen, which was performed the morning after the child had been taken to a hospital, revealed an amphetamine concentration of 1,048 ng/mL. The child’s second UDS, which was performed the following day, indicated a 949 ng/mL concentration of amphetamines. Outside of the hospital, laboratory tests were performed on the child’s blood and urine samples from the day following her admittance to the hospital. Both of these additional tests were negative for amphetamines, suggesting that the results of the in-hospital UDSs had been false positives.
The other case involved a 20-month-old girl, whose father found her with pills scattered around her crib. The drugs were part of a 1-week supply of drugs of the father. The medications included alprazolam 2.5 mg, fluvoxamine 2,100 mg, clonazepam 17.5 mg, buspirone 420 mg, and aripiprazole 35 mg. This child’s urine was also screened for drugs twice at the hospital where she was admitted; this child only tested positive for amphetamine in the first assessment, with a 311 ng/mL concentration of amphetamines having been found in that UDS. As with the first case, this child’s urine and blood samples were subjected to off-site laboratory tests, which found no presence of amphetamines.
“There are several limitations to UDS immunoassays. Most important, poor specificity is associated with a risk of false-positive testing. A negative result does not exclude the possibility that the substance is present if it is below the lower threshold of detection. Additionally, there is no way to quantitatively correlate a positive result with the extent of immunoassays. Therefore immunoassays are the first step in a two-step system, in which all positive results must be confirmed by more reliable methods such as [gas chromatography mass spectrometry],” the researchers said.
Read the full study in Pediatrics. doi: 10:1542/peds.2014-3333.
FROM PEDIATRICS
ILDS establishes guidelines for treating AK patients
The International Leagues of Dermatological Societies (ILDS) in cooperation with the European Dermatology Forum has developed consensus-based guidelines for the treatment of actinic keratosis (AK), which are published in the Journal of the European Academy of Dermatology and Venereology.
“The guidelines were elaborated along adapted recommendations by the WHO guidelines review committee and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group,” say R. N. Werner and colleagues of the Medical University of Berlin. The guidelines include recommendations for treatment of different subgroups of AK patients, how to make an AK diagnosis, how to assess AK patients, and how to define AK.
The ILDS recommends or suggests the following interventions for treating patients who have single AK lesions:
• Cryotherapy
• Curettage (discrete, hyperkeratotic lesions)
• 0.5% 5-fluorouracil (5-FU)
• 5% 5-FU
• 0.5% 5-FU + 10% salicylic acid (discrete, hyperkeratotic lesions)
• 3.75% imiquimod
• 5% imiquimod
• Ingenol mebutate 0.015% (lesions on the face or scalp) and ingenol mebutate 0.05% (lesions on the trunk or extremities)
• 5-aminolevulinic acid-photodynamic therapy (ALA-PDT)
• methylaminolevulinate-photodynamic therapy (MAL-PDT)
For patients with multiple AK lesions/field cancerization, the ILDS recommends* or suggests that patients use the following therapies:
• 0.5% 5-FU*
• 3.75% imiquimod*
• Ingenol mebutate 0.015% (lesions on the face or scalp) and ingenol mebutate 0.05% (lesions on the trunk or extremities)*
• ALA-PDT*
• MAL-PDT*
• Cryotherapy (patients with multiple lesions, especially for multiple discrete lesions; not suitable for the treatment of field cancerization)
• 3% diclofenac in 2.5% hyaluronic acid gel
• 5% 5-FU
• 0.5% 5-FU + 10% salicylic acid (discrete, hyperkeratotic lesions)
• 5% imiquimod
• 2.5% imiquimod
• CO2 laser and Er:YAG laser
For immunosuppressed AK patients, the ILDS suggests the following treatments:
• Cryotherapy (especially for single lesions or multiple discrete lesions; not suitable for the treatment of field cancerization);
• Curettage (discrete, hyperkeratotic lesions)
• 5% 5-FU
• 5% imiquimod
• ALA-PDT
• MAL-PDT
The ILDS additionally recommends that immunosuppressed AK patients not use CO2 laser and Er:YAG laser.
“Deviation from the recommendations may be justified or inevitable in specific situations. The ultimate judgment regarding patient care must be individualized and must be made by the physician and patient in light of all presenting circumstances,” the authors said. “International guidelines are intended to be adapted to national or regional circumstances” (J Eur Acad Dermatol Venereol. 2015;29:2069-79).
The “long version of the guidelines” is available as an online supplement. Additionally, a methods report, results report, and declarations of interest of the guidelines development have been published at doi: 10.1111/jdv.13179 in the Journal of the European Academy of Dermatology and Venereology (2015).
The International Leagues of Dermatological Societies (ILDS) in cooperation with the European Dermatology Forum has developed consensus-based guidelines for the treatment of actinic keratosis (AK), which are published in the Journal of the European Academy of Dermatology and Venereology.
“The guidelines were elaborated along adapted recommendations by the WHO guidelines review committee and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group,” say R. N. Werner and colleagues of the Medical University of Berlin. The guidelines include recommendations for treatment of different subgroups of AK patients, how to make an AK diagnosis, how to assess AK patients, and how to define AK.
The ILDS recommends or suggests the following interventions for treating patients who have single AK lesions:
• Cryotherapy
• Curettage (discrete, hyperkeratotic lesions)
• 0.5% 5-fluorouracil (5-FU)
• 5% 5-FU
• 0.5% 5-FU + 10% salicylic acid (discrete, hyperkeratotic lesions)
• 3.75% imiquimod
• 5% imiquimod
• Ingenol mebutate 0.015% (lesions on the face or scalp) and ingenol mebutate 0.05% (lesions on the trunk or extremities)
• 5-aminolevulinic acid-photodynamic therapy (ALA-PDT)
• methylaminolevulinate-photodynamic therapy (MAL-PDT)
For patients with multiple AK lesions/field cancerization, the ILDS recommends* or suggests that patients use the following therapies:
• 0.5% 5-FU*
• 3.75% imiquimod*
• Ingenol mebutate 0.015% (lesions on the face or scalp) and ingenol mebutate 0.05% (lesions on the trunk or extremities)*
• ALA-PDT*
• MAL-PDT*
• Cryotherapy (patients with multiple lesions, especially for multiple discrete lesions; not suitable for the treatment of field cancerization)
• 3% diclofenac in 2.5% hyaluronic acid gel
• 5% 5-FU
• 0.5% 5-FU + 10% salicylic acid (discrete, hyperkeratotic lesions)
• 5% imiquimod
• 2.5% imiquimod
• CO2 laser and Er:YAG laser
For immunosuppressed AK patients, the ILDS suggests the following treatments:
• Cryotherapy (especially for single lesions or multiple discrete lesions; not suitable for the treatment of field cancerization);
• Curettage (discrete, hyperkeratotic lesions)
• 5% 5-FU
• 5% imiquimod
• ALA-PDT
• MAL-PDT
The ILDS additionally recommends that immunosuppressed AK patients not use CO2 laser and Er:YAG laser.
“Deviation from the recommendations may be justified or inevitable in specific situations. The ultimate judgment regarding patient care must be individualized and must be made by the physician and patient in light of all presenting circumstances,” the authors said. “International guidelines are intended to be adapted to national or regional circumstances” (J Eur Acad Dermatol Venereol. 2015;29:2069-79).
The “long version of the guidelines” is available as an online supplement. Additionally, a methods report, results report, and declarations of interest of the guidelines development have been published at doi: 10.1111/jdv.13179 in the Journal of the European Academy of Dermatology and Venereology (2015).
The International Leagues of Dermatological Societies (ILDS) in cooperation with the European Dermatology Forum has developed consensus-based guidelines for the treatment of actinic keratosis (AK), which are published in the Journal of the European Academy of Dermatology and Venereology.
“The guidelines were elaborated along adapted recommendations by the WHO guidelines review committee and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group,” say R. N. Werner and colleagues of the Medical University of Berlin. The guidelines include recommendations for treatment of different subgroups of AK patients, how to make an AK diagnosis, how to assess AK patients, and how to define AK.
The ILDS recommends or suggests the following interventions for treating patients who have single AK lesions:
• Cryotherapy
• Curettage (discrete, hyperkeratotic lesions)
• 0.5% 5-fluorouracil (5-FU)
• 5% 5-FU
• 0.5% 5-FU + 10% salicylic acid (discrete, hyperkeratotic lesions)
• 3.75% imiquimod
• 5% imiquimod
• Ingenol mebutate 0.015% (lesions on the face or scalp) and ingenol mebutate 0.05% (lesions on the trunk or extremities)
• 5-aminolevulinic acid-photodynamic therapy (ALA-PDT)
• methylaminolevulinate-photodynamic therapy (MAL-PDT)
For patients with multiple AK lesions/field cancerization, the ILDS recommends* or suggests that patients use the following therapies:
• 0.5% 5-FU*
• 3.75% imiquimod*
• Ingenol mebutate 0.015% (lesions on the face or scalp) and ingenol mebutate 0.05% (lesions on the trunk or extremities)*
• ALA-PDT*
• MAL-PDT*
• Cryotherapy (patients with multiple lesions, especially for multiple discrete lesions; not suitable for the treatment of field cancerization)
• 3% diclofenac in 2.5% hyaluronic acid gel
• 5% 5-FU
• 0.5% 5-FU + 10% salicylic acid (discrete, hyperkeratotic lesions)
• 5% imiquimod
• 2.5% imiquimod
• CO2 laser and Er:YAG laser
For immunosuppressed AK patients, the ILDS suggests the following treatments:
• Cryotherapy (especially for single lesions or multiple discrete lesions; not suitable for the treatment of field cancerization);
• Curettage (discrete, hyperkeratotic lesions)
• 5% 5-FU
• 5% imiquimod
• ALA-PDT
• MAL-PDT
The ILDS additionally recommends that immunosuppressed AK patients not use CO2 laser and Er:YAG laser.
“Deviation from the recommendations may be justified or inevitable in specific situations. The ultimate judgment regarding patient care must be individualized and must be made by the physician and patient in light of all presenting circumstances,” the authors said. “International guidelines are intended to be adapted to national or regional circumstances” (J Eur Acad Dermatol Venereol. 2015;29:2069-79).
The “long version of the guidelines” is available as an online supplement. Additionally, a methods report, results report, and declarations of interest of the guidelines development have been published at doi: 10.1111/jdv.13179 in the Journal of the European Academy of Dermatology and Venereology (2015).
FROM JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY
Availability of flavored tobacco products drives tobacco use in youths
The availability of flavored tobacco products appears to be a major driver of tobacco use in youths, suggests an analysis of a nationally representative longitudinal cohort study from 2013 to 2014.
The 13,651 youth participants (aged 12-17 years) in the U.S. Population Assessment of Tobacco and Health (PATH) study responded to questions about ever and past 30-day use of various tobacco products. For each product ever used, youths indicated whether the first product they used was flavored. Users of noncigarette tobacco products, including e-cigarettes, reported past 30-day use of a flavored product or products; of those individuals, the ones that had used a tobacco product (including e-cigarettes) other than a cigarette within the past 30 days reported their reasons for engaging in such activities.
The majority of tobacco products users said that their inaugural taste of tobacco was in the form of a flavored product, including 88.7% of ever hookah users, 81.0% of ever e-cigarette users, 65.4% of ever users of any cigar type, and 50.1% of ever cigarette smokers. Among study participants who had used tobacco within the past 30 days, 79.8% had used a flavored tobacco product.
Furthermore, well over 50% of individuals who had used noncigarette tobacco products within the past 30 days reported the availability of flavored versions of such products as having been among their leading reasons for using them. Specifically, 81.5% of e-cigarette users, 78.9% of hookah users, 73.8% of cigar users, 69.3% of smokeless tobacco users, and 67.2% of snus pouch users said they liked their respective tobacco products “because they come in flavors.”
“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users,” said Bridget K. Ambrose, Ph.D., of the Center for Tobacco Products, Food and Drug Administration, Silver Spring, Md., and her colleagues.
“Data from future PATH study waves can provide information on tobacco use trajectories following experimentation with flavored, compared with nonflavored products,” according to the researchers.
Read the full study in JAMA (doi: 10.1001/jama.2015.13802).
The availability of flavored tobacco products appears to be a major driver of tobacco use in youths, suggests an analysis of a nationally representative longitudinal cohort study from 2013 to 2014.
The 13,651 youth participants (aged 12-17 years) in the U.S. Population Assessment of Tobacco and Health (PATH) study responded to questions about ever and past 30-day use of various tobacco products. For each product ever used, youths indicated whether the first product they used was flavored. Users of noncigarette tobacco products, including e-cigarettes, reported past 30-day use of a flavored product or products; of those individuals, the ones that had used a tobacco product (including e-cigarettes) other than a cigarette within the past 30 days reported their reasons for engaging in such activities.
The majority of tobacco products users said that their inaugural taste of tobacco was in the form of a flavored product, including 88.7% of ever hookah users, 81.0% of ever e-cigarette users, 65.4% of ever users of any cigar type, and 50.1% of ever cigarette smokers. Among study participants who had used tobacco within the past 30 days, 79.8% had used a flavored tobacco product.
Furthermore, well over 50% of individuals who had used noncigarette tobacco products within the past 30 days reported the availability of flavored versions of such products as having been among their leading reasons for using them. Specifically, 81.5% of e-cigarette users, 78.9% of hookah users, 73.8% of cigar users, 69.3% of smokeless tobacco users, and 67.2% of snus pouch users said they liked their respective tobacco products “because they come in flavors.”
“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users,” said Bridget K. Ambrose, Ph.D., of the Center for Tobacco Products, Food and Drug Administration, Silver Spring, Md., and her colleagues.
“Data from future PATH study waves can provide information on tobacco use trajectories following experimentation with flavored, compared with nonflavored products,” according to the researchers.
Read the full study in JAMA (doi: 10.1001/jama.2015.13802).
The availability of flavored tobacco products appears to be a major driver of tobacco use in youths, suggests an analysis of a nationally representative longitudinal cohort study from 2013 to 2014.
The 13,651 youth participants (aged 12-17 years) in the U.S. Population Assessment of Tobacco and Health (PATH) study responded to questions about ever and past 30-day use of various tobacco products. For each product ever used, youths indicated whether the first product they used was flavored. Users of noncigarette tobacco products, including e-cigarettes, reported past 30-day use of a flavored product or products; of those individuals, the ones that had used a tobacco product (including e-cigarettes) other than a cigarette within the past 30 days reported their reasons for engaging in such activities.
The majority of tobacco products users said that their inaugural taste of tobacco was in the form of a flavored product, including 88.7% of ever hookah users, 81.0% of ever e-cigarette users, 65.4% of ever users of any cigar type, and 50.1% of ever cigarette smokers. Among study participants who had used tobacco within the past 30 days, 79.8% had used a flavored tobacco product.
Furthermore, well over 50% of individuals who had used noncigarette tobacco products within the past 30 days reported the availability of flavored versions of such products as having been among their leading reasons for using them. Specifically, 81.5% of e-cigarette users, 78.9% of hookah users, 73.8% of cigar users, 69.3% of smokeless tobacco users, and 67.2% of snus pouch users said they liked their respective tobacco products “because they come in flavors.”
“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users,” said Bridget K. Ambrose, Ph.D., of the Center for Tobacco Products, Food and Drug Administration, Silver Spring, Md., and her colleagues.
“Data from future PATH study waves can provide information on tobacco use trajectories following experimentation with flavored, compared with nonflavored products,” according to the researchers.
Read the full study in JAMA (doi: 10.1001/jama.2015.13802).
FROM JAMA
Drug-resistant malaria parasite may spread to Africa
Forms of Plasmodium falciparum parasites successfully infected various species of mosquitoes, including the major African vector for malaria, a study revealed.
The parasites, which are resistant to the antimalarial drug artemisinin, have rapidly spread in Cambodia and other Greater Mekong Subregion countries.
In patients and in vitro, the researchers produced gametocytes from clinical isolates of Plasmodium falciparum, the deadliest species of malaria parasites. The researchers then infected Anopheles mosquito vectors from Southeast Asia and Africa with the gametocytes.
The parasite isolates developed and produced sporozoites in the Southeast Asian vectors, An. dirus and An. minimus, and the major African vector, An. coluzzii.
“Our finding that highly differentiated ART-resistant parasites infect highly diverse Anopheles species unveils a significant unanticipated challenge to the elimination of malaria in Southeast Asia and the prevention of [artemisinin-resistant] malaria in Africa,” said Dr. Brandyce St. Laurent of the National Institute of Allergy and Infectious Diseases and her coauthors.
“The researchers plan to investigate other potential genetic determinants of parasite infection of mosquitoes and further examine which Anopheles species from Cambodia are naturally transmitting artemisinin-resistant parasites in the wild,” according to a written statement from the NIH.
The authors declared no competing financial interests.
Read the full study in Nature Communications (2015;6:8614).
Forms of Plasmodium falciparum parasites successfully infected various species of mosquitoes, including the major African vector for malaria, a study revealed.
The parasites, which are resistant to the antimalarial drug artemisinin, have rapidly spread in Cambodia and other Greater Mekong Subregion countries.
In patients and in vitro, the researchers produced gametocytes from clinical isolates of Plasmodium falciparum, the deadliest species of malaria parasites. The researchers then infected Anopheles mosquito vectors from Southeast Asia and Africa with the gametocytes.
The parasite isolates developed and produced sporozoites in the Southeast Asian vectors, An. dirus and An. minimus, and the major African vector, An. coluzzii.
“Our finding that highly differentiated ART-resistant parasites infect highly diverse Anopheles species unveils a significant unanticipated challenge to the elimination of malaria in Southeast Asia and the prevention of [artemisinin-resistant] malaria in Africa,” said Dr. Brandyce St. Laurent of the National Institute of Allergy and Infectious Diseases and her coauthors.
“The researchers plan to investigate other potential genetic determinants of parasite infection of mosquitoes and further examine which Anopheles species from Cambodia are naturally transmitting artemisinin-resistant parasites in the wild,” according to a written statement from the NIH.
The authors declared no competing financial interests.
Read the full study in Nature Communications (2015;6:8614).
Forms of Plasmodium falciparum parasites successfully infected various species of mosquitoes, including the major African vector for malaria, a study revealed.
The parasites, which are resistant to the antimalarial drug artemisinin, have rapidly spread in Cambodia and other Greater Mekong Subregion countries.
In patients and in vitro, the researchers produced gametocytes from clinical isolates of Plasmodium falciparum, the deadliest species of malaria parasites. The researchers then infected Anopheles mosquito vectors from Southeast Asia and Africa with the gametocytes.
The parasite isolates developed and produced sporozoites in the Southeast Asian vectors, An. dirus and An. minimus, and the major African vector, An. coluzzii.
“Our finding that highly differentiated ART-resistant parasites infect highly diverse Anopheles species unveils a significant unanticipated challenge to the elimination of malaria in Southeast Asia and the prevention of [artemisinin-resistant] malaria in Africa,” said Dr. Brandyce St. Laurent of the National Institute of Allergy and Infectious Diseases and her coauthors.
“The researchers plan to investigate other potential genetic determinants of parasite infection of mosquitoes and further examine which Anopheles species from Cambodia are naturally transmitting artemisinin-resistant parasites in the wild,” according to a written statement from the NIH.
The authors declared no competing financial interests.
Read the full study in Nature Communications (2015;6:8614).
FROM NATURE COMMUNICATIONS
Residents, supervising physicians differ on when to communicate
Discordance exists between supervising physicians and residents regarding which scenarios require supervising physicians’ input, according to a study.
The study was based on responses to an anonymous online survey of pediatric residents, internal medicine/pediatric residents, and fellows and attending physicians of hospital medicine service, hematology/oncology, gastroenterology, and pulmonology at MassGeneral Hospital for Children (MGHfC) in Boston. Respondents included 62 of 67 eligible residents and 50 of 56 eligible supervising physicians, which included both the attendings and fellows. The survey presented 34 scenarios encountered by residents doing after-hours coverage on a general pediatric floor. The survey asked whether after-hours residents should contact supervising physicians immediately or delay communication to the next day, for each scenario.
“Responses were statistically significantly different between residents and supervising physicians in 17 of the 34 scenarios (50%). In all 17 of these scenarios without exception, more supervising physicians wanted immediate communication, compared with the residents,” wrote Dr. Deepak Palakshappa, chief pediatric resident at the time of the study and currently an instructor at Children’s Hospital of Philadelphia, and his colleagues.
The 17 scenarios under which discordance of opinions existed between the two groups fell under the categories of clinical, laboratory/radiology, and logistical/social. The clinical scenarios under which the greatest discrepancies between the two groups occurred were a new fever in an otherwise well patient (odds ratio, 11.49; P less than .001) and an increasing oxygen requirement in a patient already on oxygen (OR, 6.27; P less than .001).
The laboratory/radiology scenario with the largest discrepancy on whether a supervising physician should be immediately contacted was a new radiographic finding (OR, 7.72; P less than .001). One of the logistical/social scenarios over which members of the two groups most often disagreed on the timing of notifying a supervising physician was in the case of an angry parent or family member (OR, 15.67; P less than .001).
Among the study’s other findings was that 32% of all residents knew that the hospital had communication guidelines for addressing various work scenarios, at the time the researchers were conducting the study.
“Future studies should evaluate whether and how these communication preferences actually translate into changes in actual behaviors and subsequent patient care outcomes,” the researchers said.
Read the study in the Journal of Pediatrics (doi: 10.1016/j.peds.2015.08.052).
Discordance exists between supervising physicians and residents regarding which scenarios require supervising physicians’ input, according to a study.
The study was based on responses to an anonymous online survey of pediatric residents, internal medicine/pediatric residents, and fellows and attending physicians of hospital medicine service, hematology/oncology, gastroenterology, and pulmonology at MassGeneral Hospital for Children (MGHfC) in Boston. Respondents included 62 of 67 eligible residents and 50 of 56 eligible supervising physicians, which included both the attendings and fellows. The survey presented 34 scenarios encountered by residents doing after-hours coverage on a general pediatric floor. The survey asked whether after-hours residents should contact supervising physicians immediately or delay communication to the next day, for each scenario.
“Responses were statistically significantly different between residents and supervising physicians in 17 of the 34 scenarios (50%). In all 17 of these scenarios without exception, more supervising physicians wanted immediate communication, compared with the residents,” wrote Dr. Deepak Palakshappa, chief pediatric resident at the time of the study and currently an instructor at Children’s Hospital of Philadelphia, and his colleagues.
The 17 scenarios under which discordance of opinions existed between the two groups fell under the categories of clinical, laboratory/radiology, and logistical/social. The clinical scenarios under which the greatest discrepancies between the two groups occurred were a new fever in an otherwise well patient (odds ratio, 11.49; P less than .001) and an increasing oxygen requirement in a patient already on oxygen (OR, 6.27; P less than .001).
The laboratory/radiology scenario with the largest discrepancy on whether a supervising physician should be immediately contacted was a new radiographic finding (OR, 7.72; P less than .001). One of the logistical/social scenarios over which members of the two groups most often disagreed on the timing of notifying a supervising physician was in the case of an angry parent or family member (OR, 15.67; P less than .001).
Among the study’s other findings was that 32% of all residents knew that the hospital had communication guidelines for addressing various work scenarios, at the time the researchers were conducting the study.
“Future studies should evaluate whether and how these communication preferences actually translate into changes in actual behaviors and subsequent patient care outcomes,” the researchers said.
Read the study in the Journal of Pediatrics (doi: 10.1016/j.peds.2015.08.052).
Discordance exists between supervising physicians and residents regarding which scenarios require supervising physicians’ input, according to a study.
The study was based on responses to an anonymous online survey of pediatric residents, internal medicine/pediatric residents, and fellows and attending physicians of hospital medicine service, hematology/oncology, gastroenterology, and pulmonology at MassGeneral Hospital for Children (MGHfC) in Boston. Respondents included 62 of 67 eligible residents and 50 of 56 eligible supervising physicians, which included both the attendings and fellows. The survey presented 34 scenarios encountered by residents doing after-hours coverage on a general pediatric floor. The survey asked whether after-hours residents should contact supervising physicians immediately or delay communication to the next day, for each scenario.
“Responses were statistically significantly different between residents and supervising physicians in 17 of the 34 scenarios (50%). In all 17 of these scenarios without exception, more supervising physicians wanted immediate communication, compared with the residents,” wrote Dr. Deepak Palakshappa, chief pediatric resident at the time of the study and currently an instructor at Children’s Hospital of Philadelphia, and his colleagues.
The 17 scenarios under which discordance of opinions existed between the two groups fell under the categories of clinical, laboratory/radiology, and logistical/social. The clinical scenarios under which the greatest discrepancies between the two groups occurred were a new fever in an otherwise well patient (odds ratio, 11.49; P less than .001) and an increasing oxygen requirement in a patient already on oxygen (OR, 6.27; P less than .001).
The laboratory/radiology scenario with the largest discrepancy on whether a supervising physician should be immediately contacted was a new radiographic finding (OR, 7.72; P less than .001). One of the logistical/social scenarios over which members of the two groups most often disagreed on the timing of notifying a supervising physician was in the case of an angry parent or family member (OR, 15.67; P less than .001).
Among the study’s other findings was that 32% of all residents knew that the hospital had communication guidelines for addressing various work scenarios, at the time the researchers were conducting the study.
“Future studies should evaluate whether and how these communication preferences actually translate into changes in actual behaviors and subsequent patient care outcomes,” the researchers said.
Read the study in the Journal of Pediatrics (doi: 10.1016/j.peds.2015.08.052).
FROM THE JOURNAL OF PEDIATRICS
FDA approves new treatment for Factor X deficiency
The U.S. Food and Drug Administration has provided its first approval of a coagulation factor replacement drug specifically for patients with hereditary Factor X deficiency who are aged 12 years or older, the FDA said in a written statement. Typically, patients with this inherited disorder are treated with plasma-derived prothrombin complex concentrates.
Coagadex, the new coagulation factor replacement drug, was effective at controlling bleeding episodes in individuals with moderate to severe hereditary Factor X deficiency, in a 16-patient study. Prior to being treated with the purified Factor X concentrate, the study’s participants had the following types of bleeding episodes: spontaneous; traumatic; or heavy menstrual.
Researchers also conducted a smaller study of the drug’s effectiveness on patients who were undergoing surgery. In this research project, Coagadex was successful at controlling blood loss during and after surgery, in those patients with mild hereditary Factor X deficiency.
“The approval of Coagadex is a significant advancement for patients who suffer from this rare but serious disease,” said Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, in the release.
Bio Products Laboratory manufactured the new drug.
The U.S. Food and Drug Administration has provided its first approval of a coagulation factor replacement drug specifically for patients with hereditary Factor X deficiency who are aged 12 years or older, the FDA said in a written statement. Typically, patients with this inherited disorder are treated with plasma-derived prothrombin complex concentrates.
Coagadex, the new coagulation factor replacement drug, was effective at controlling bleeding episodes in individuals with moderate to severe hereditary Factor X deficiency, in a 16-patient study. Prior to being treated with the purified Factor X concentrate, the study’s participants had the following types of bleeding episodes: spontaneous; traumatic; or heavy menstrual.
Researchers also conducted a smaller study of the drug’s effectiveness on patients who were undergoing surgery. In this research project, Coagadex was successful at controlling blood loss during and after surgery, in those patients with mild hereditary Factor X deficiency.
“The approval of Coagadex is a significant advancement for patients who suffer from this rare but serious disease,” said Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, in the release.
Bio Products Laboratory manufactured the new drug.
The U.S. Food and Drug Administration has provided its first approval of a coagulation factor replacement drug specifically for patients with hereditary Factor X deficiency who are aged 12 years or older, the FDA said in a written statement. Typically, patients with this inherited disorder are treated with plasma-derived prothrombin complex concentrates.
Coagadex, the new coagulation factor replacement drug, was effective at controlling bleeding episodes in individuals with moderate to severe hereditary Factor X deficiency, in a 16-patient study. Prior to being treated with the purified Factor X concentrate, the study’s participants had the following types of bleeding episodes: spontaneous; traumatic; or heavy menstrual.
Researchers also conducted a smaller study of the drug’s effectiveness on patients who were undergoing surgery. In this research project, Coagadex was successful at controlling blood loss during and after surgery, in those patients with mild hereditary Factor X deficiency.
“The approval of Coagadex is a significant advancement for patients who suffer from this rare but serious disease,” said Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, in the release.
Bio Products Laboratory manufactured the new drug.
Prevalence of marijuana use among U.S. adults climbs to 9.5%
The past-year prevalence of marijuana use among U.S. adults more than doubled in 2012-2013, compared with 2001-2002. Meanwhile, the prevalence of marijuana use disorder among users decreased significantly during those periods, a study suggests.
“While many in the United States think prohibition of recreational marijuana should be ended, this study and others suggest caution and the need for public education about the potential harms in marijuana use, including the risk for addiction,” wrote Deborah S. Hasin, Ph.D., of the department of psychiatry, Columbia University, New York, and her colleagues.
Their conclusions are based on responses to survey questions obtained through face-to-face interviews of 36,309 adults in 2012-2013 that were compared to those of 43,093 adults in 2001-2002. In the more recently conducted survey, past-year DSM-IV marijuana use was defined as any use, and researchers used National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule–5 (AUDADIS-5) to determine whether survey participants had marijuana use disorder. In the older study, the researchers used the AUDADIS-IV to evaluate whether a survey participant had a marijuana use disorder and was a marijuana user.
Past-year marijuana use significantly increased in 2012-2013, to 9.5%, compared with 4.1% in 2001-2002. Significant growth also occurred in the prevalence of DSM-IV marijuana use disorder; 2.9% of respondents to the 2012-2013 survey had the disorder, compared with 1.5% of respondents to the 2001-2002 survey.
However, the prevalence of past-year DSM-IV marijuana use disorder among marijuana users moved in the opposite direction. In 2012-2013, 30.6% of marijuana users manifested the disorder, compared with 35.6% of marijuana users in 2001-2002.
“Because no increase in the risk for marijuana use disorders was found among users (in fact, the risk decreased among users), the increase in prevalence of marijuana use disorders can be attributed to the increase in marijuana users between the two surveys,” Dr. Hasin wrote.
Future studies on marijuana use should address changes in past-year frequency of use, specific DSM-IV abuse or dependence criteria, severity of disorder, other aspects of use, and risk factors, the researchers said.
Read the study in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2015.1858).
The past-year prevalence of marijuana use among U.S. adults more than doubled in 2012-2013, compared with 2001-2002. Meanwhile, the prevalence of marijuana use disorder among users decreased significantly during those periods, a study suggests.
“While many in the United States think prohibition of recreational marijuana should be ended, this study and others suggest caution and the need for public education about the potential harms in marijuana use, including the risk for addiction,” wrote Deborah S. Hasin, Ph.D., of the department of psychiatry, Columbia University, New York, and her colleagues.
Their conclusions are based on responses to survey questions obtained through face-to-face interviews of 36,309 adults in 2012-2013 that were compared to those of 43,093 adults in 2001-2002. In the more recently conducted survey, past-year DSM-IV marijuana use was defined as any use, and researchers used National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule–5 (AUDADIS-5) to determine whether survey participants had marijuana use disorder. In the older study, the researchers used the AUDADIS-IV to evaluate whether a survey participant had a marijuana use disorder and was a marijuana user.
Past-year marijuana use significantly increased in 2012-2013, to 9.5%, compared with 4.1% in 2001-2002. Significant growth also occurred in the prevalence of DSM-IV marijuana use disorder; 2.9% of respondents to the 2012-2013 survey had the disorder, compared with 1.5% of respondents to the 2001-2002 survey.
However, the prevalence of past-year DSM-IV marijuana use disorder among marijuana users moved in the opposite direction. In 2012-2013, 30.6% of marijuana users manifested the disorder, compared with 35.6% of marijuana users in 2001-2002.
“Because no increase in the risk for marijuana use disorders was found among users (in fact, the risk decreased among users), the increase in prevalence of marijuana use disorders can be attributed to the increase in marijuana users between the two surveys,” Dr. Hasin wrote.
Future studies on marijuana use should address changes in past-year frequency of use, specific DSM-IV abuse or dependence criteria, severity of disorder, other aspects of use, and risk factors, the researchers said.
Read the study in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2015.1858).
The past-year prevalence of marijuana use among U.S. adults more than doubled in 2012-2013, compared with 2001-2002. Meanwhile, the prevalence of marijuana use disorder among users decreased significantly during those periods, a study suggests.
“While many in the United States think prohibition of recreational marijuana should be ended, this study and others suggest caution and the need for public education about the potential harms in marijuana use, including the risk for addiction,” wrote Deborah S. Hasin, Ph.D., of the department of psychiatry, Columbia University, New York, and her colleagues.
Their conclusions are based on responses to survey questions obtained through face-to-face interviews of 36,309 adults in 2012-2013 that were compared to those of 43,093 adults in 2001-2002. In the more recently conducted survey, past-year DSM-IV marijuana use was defined as any use, and researchers used National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule–5 (AUDADIS-5) to determine whether survey participants had marijuana use disorder. In the older study, the researchers used the AUDADIS-IV to evaluate whether a survey participant had a marijuana use disorder and was a marijuana user.
Past-year marijuana use significantly increased in 2012-2013, to 9.5%, compared with 4.1% in 2001-2002. Significant growth also occurred in the prevalence of DSM-IV marijuana use disorder; 2.9% of respondents to the 2012-2013 survey had the disorder, compared with 1.5% of respondents to the 2001-2002 survey.
However, the prevalence of past-year DSM-IV marijuana use disorder among marijuana users moved in the opposite direction. In 2012-2013, 30.6% of marijuana users manifested the disorder, compared with 35.6% of marijuana users in 2001-2002.
“Because no increase in the risk for marijuana use disorders was found among users (in fact, the risk decreased among users), the increase in prevalence of marijuana use disorders can be attributed to the increase in marijuana users between the two surveys,” Dr. Hasin wrote.
Future studies on marijuana use should address changes in past-year frequency of use, specific DSM-IV abuse or dependence criteria, severity of disorder, other aspects of use, and risk factors, the researchers said.
Read the study in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2015.1858).
FROM JAMA PSYCHIATRY
OnabotulinumtoxinA associated with reduced severity of PAH
The severity of primary axillary hyperhidrosis (PAH) decreased in more than half of patients who received onabotulinumtoxinA injections, in a nonrandomized, open-label study.
The researchers gave 144 adolescents with PAH up to six treatments with the drug, with retreatment occurring no sooner than 8 weeks after a prior treatment and no later than 44 weeks after the initial treatment.
Patients were retreated if they had 50 mg or more of spontaneous resting axillary sweat production in each axilla, following injections to each axilla. Fifty-six patients received one treatment, 59 patients received two treatments, 20 received three treatments, 6 received four treatments, and 3 received five treatments. Patients’ scores on the 4-point Hyperhidrosis Disease Severity Scale (HDSS) were among the measures used to evaluate responses to the onabotulinumtoxinA injections.
Results showed that 72.3% of patients experienced at least a 2-point improvement in their HDSS score at 4 weeks after their first treatment, and 56.6% of patients experienced a 2-point or greater improvement at 8 weeks following their second round of injections.
Mean sweat production declined by an average of 83.9% 4 weeks after treatment, and by an average of 78.1% 8 weeks after treatment. More than 50% of patients experienced at least a 90% reduction in sweat production at the 4th week following one of their injections (either the first, second, or third treatment).
Ninety-two patients (63.9%) reported experiencing adverse events (AEs), with upper respiratory tract infections having occurred the most frequently. While most of such adverse events “were mild or moderate in severity,” three patients experienced serious AEs and an additional three experienced severe AEs. Eight patients (5.6%) had 10 treatment-related AEs, including hyperhidrosis (back and palms), injection-site pain, lymphadenopathy, nausea, injection-site irritation, self-reported compensatory sweating (palms), dizziness, and pruritus.
“This study demonstrated that the efficacy and safety of onabotulinumtoxinA in treating PAH reported in previous registration clinical trials in adults can be extended to adolescents,” wrote Dr. Dee Anna Glaser of Saint Louis University and her colleagues.
Dr. Glaser is a paid consultant and investigator for Allergan, Dermira, and Miramar Labs. She has received research grants and honoraria from these companies and is an investigator for Ulthera. Her coauthors disclosed ties to Allergan.
Read the study in Pediatric Dermatology (doi: 10.1111/pde.12620).
The severity of primary axillary hyperhidrosis (PAH) decreased in more than half of patients who received onabotulinumtoxinA injections, in a nonrandomized, open-label study.
The researchers gave 144 adolescents with PAH up to six treatments with the drug, with retreatment occurring no sooner than 8 weeks after a prior treatment and no later than 44 weeks after the initial treatment.
Patients were retreated if they had 50 mg or more of spontaneous resting axillary sweat production in each axilla, following injections to each axilla. Fifty-six patients received one treatment, 59 patients received two treatments, 20 received three treatments, 6 received four treatments, and 3 received five treatments. Patients’ scores on the 4-point Hyperhidrosis Disease Severity Scale (HDSS) were among the measures used to evaluate responses to the onabotulinumtoxinA injections.
Results showed that 72.3% of patients experienced at least a 2-point improvement in their HDSS score at 4 weeks after their first treatment, and 56.6% of patients experienced a 2-point or greater improvement at 8 weeks following their second round of injections.
Mean sweat production declined by an average of 83.9% 4 weeks after treatment, and by an average of 78.1% 8 weeks after treatment. More than 50% of patients experienced at least a 90% reduction in sweat production at the 4th week following one of their injections (either the first, second, or third treatment).
Ninety-two patients (63.9%) reported experiencing adverse events (AEs), with upper respiratory tract infections having occurred the most frequently. While most of such adverse events “were mild or moderate in severity,” three patients experienced serious AEs and an additional three experienced severe AEs. Eight patients (5.6%) had 10 treatment-related AEs, including hyperhidrosis (back and palms), injection-site pain, lymphadenopathy, nausea, injection-site irritation, self-reported compensatory sweating (palms), dizziness, and pruritus.
“This study demonstrated that the efficacy and safety of onabotulinumtoxinA in treating PAH reported in previous registration clinical trials in adults can be extended to adolescents,” wrote Dr. Dee Anna Glaser of Saint Louis University and her colleagues.
Dr. Glaser is a paid consultant and investigator for Allergan, Dermira, and Miramar Labs. She has received research grants and honoraria from these companies and is an investigator for Ulthera. Her coauthors disclosed ties to Allergan.
Read the study in Pediatric Dermatology (doi: 10.1111/pde.12620).
The severity of primary axillary hyperhidrosis (PAH) decreased in more than half of patients who received onabotulinumtoxinA injections, in a nonrandomized, open-label study.
The researchers gave 144 adolescents with PAH up to six treatments with the drug, with retreatment occurring no sooner than 8 weeks after a prior treatment and no later than 44 weeks after the initial treatment.
Patients were retreated if they had 50 mg or more of spontaneous resting axillary sweat production in each axilla, following injections to each axilla. Fifty-six patients received one treatment, 59 patients received two treatments, 20 received three treatments, 6 received four treatments, and 3 received five treatments. Patients’ scores on the 4-point Hyperhidrosis Disease Severity Scale (HDSS) were among the measures used to evaluate responses to the onabotulinumtoxinA injections.
Results showed that 72.3% of patients experienced at least a 2-point improvement in their HDSS score at 4 weeks after their first treatment, and 56.6% of patients experienced a 2-point or greater improvement at 8 weeks following their second round of injections.
Mean sweat production declined by an average of 83.9% 4 weeks after treatment, and by an average of 78.1% 8 weeks after treatment. More than 50% of patients experienced at least a 90% reduction in sweat production at the 4th week following one of their injections (either the first, second, or third treatment).
Ninety-two patients (63.9%) reported experiencing adverse events (AEs), with upper respiratory tract infections having occurred the most frequently. While most of such adverse events “were mild or moderate in severity,” three patients experienced serious AEs and an additional three experienced severe AEs. Eight patients (5.6%) had 10 treatment-related AEs, including hyperhidrosis (back and palms), injection-site pain, lymphadenopathy, nausea, injection-site irritation, self-reported compensatory sweating (palms), dizziness, and pruritus.
“This study demonstrated that the efficacy and safety of onabotulinumtoxinA in treating PAH reported in previous registration clinical trials in adults can be extended to adolescents,” wrote Dr. Dee Anna Glaser of Saint Louis University and her colleagues.
Dr. Glaser is a paid consultant and investigator for Allergan, Dermira, and Miramar Labs. She has received research grants and honoraria from these companies and is an investigator for Ulthera. Her coauthors disclosed ties to Allergan.
Read the study in Pediatric Dermatology (doi: 10.1111/pde.12620).
FROM PEDIATRIC DERMATOLOGY