Sharon Worcester

Neonates who are delivered at 36-38 weeks' gestation after fetal lung maturity is confirmed have nearly double the risk of adverse outcomes, compared with neonates delivered at 39 or 40 weeks, a large retrospective cohort study has shown.

The mean birth weight in 459 neonates with confirmed lung maturity who were delivered at 36-38 weeks' gestation was 3,017 g, compared with 3,362 g in 13,339 neonates delivered at 39-40 weeks. The risk of a composite outcome including death, adverse respiratory outcomes, hypoglycemia, treated hyperbilirubinemia, generalized seizures, necrotizing enterocolitis, hypoxic ischemic encephalopathy, periventricular leukomalacia, and suspected or proven sepsis was 6.1% in those in the 36- to 38-week group, compared with 2.5% in the 39- to 40-week group, Dr. Elizabeth Bates of the University of Alabama at Birmingham and her colleagues reported.

Early delivery remained a significant risk factor for the composite outcome after investigators adjusted for maternal age, ethnicity, parity, neonatal sex, intended mode of delivery, and any medical complication – including diabetes and hypertension. Early delivery was also a significant risk factor for several individual outcomes, including respiratory distress syndrome (adjusted odds ratio, 7.6); treated hyperbilirubinemia (AOR, 11.2); and hypoglycemia (AOR, 5.8), the investigators found (Obstet. Gynecol. 2010; 116:1288-95).

The incidence of the primary composite outcome generally decreased with increasing gestational age, they noted (9.2% incidence at 36 weeks, 3.2% at 37 weeks, 5.2% at 38 weeks, and 2.5% at 39-40 weeks).

Patients included in the study were women with a singleton pregnancy receiving prenatal care and giving birth at a single center from January 1999 to December 2008. Among those who were delivered at 36-38 weeks following documentation of fetal lung maturity, 42.5% had completed 36 weeks, 40.7% had completed 37 weeks, and only 16.8% had completed 38 weeks. Of those who were delivered at 38-40 weeks, 56.2% had completed 39 weeks, and 43.8% had completed 40 weeks. The mean gestational age was 37.1 weeks in those delivered at 36-38 weeks and was 39.8 weeks in those who delivered at 38-40 weeks.

The study findings are concerning, because fetal lung maturity is known to reduce the risk of respiratory morbidity, and confirmation of fetal lung maturity is “a recognized exception to longstanding recommendations against elective delivery before 39 weeks' gestation,” Dr. Bates and her associates noted.

Also, despite existing recommendations to the contrary, one-third of elective cesarean deliveries in one large study were performed before 39 weeks, they said.

Taken together, the findings in the current study “are consistent with relative immaturity at 36-38 weeks (regardless of lung maturity), compared with 39-40 weeks, and lower threshold for admission to the NICU and for invasive sepsis work-ups (suspected sepsis),” the investigators wrote.

They added that the findings should be considered in light of the study's limitations – including the retrospective study design and the related possibility of confounding, and the fact that the study does not fully address the risk of stillbirth associated with either delivery strategy studied. Nonetheless, they concluded that the findings suggest that “in the absence of ongoing concern about fetal death or maternal well-being if the pregnancy continued, delivery should be delayed until 39 weeks.”

The findings also suggest that purely elective fetal lung maturity testing and early delivery should be avoided, Dr. Bates and her associates noted.

One of the study authors, Dr. Alan T. N. Tita, was a Women's Reproductive Health Research Advanced Scholar at the University of Alabama at Birmingham at the time of the study and received funding from the National Institute of Child Health and Human Development. No relevant financial disclosures were reported by the other authors.

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Reconsider What Constitutes Term Birth

“This paper further advances our understanding of the optimal conditions for delivering a baby free of major health complications. Specifically, it confirms findings from a number of previous studies suggesting that babies born before 39 weeks' gestation have a significantly increased risk of complications, including respiratory distress syndrome, even if their lungs appear to be fully mature via biomarker testing,” Dr. E. Albert Reece said in an interview.

More importantly, he said, the study suggests that current definitions of what constitute a term birth may need to be reconsidered.

“Indeed, currently babies born between 37 and 42 completed weeks of pregnancy are considered full term, whereas babies born before 37 weeks of pregnancy are completed are considered preterm. However, if the results of this study are to be believed, they suggest that babies born before 39 weeks of gestation might be considered preterm as well.”

This may mean that the definition for term needs to be revised upward to 39-42 weeks, he added.

“It also means that physicians should try to do everything possible to keep from delivering women until they've reached 39 weeks of gestation, unless there are valid reasons for delivery to protect the health of the mother,” he said.

Vitals

DR. REECE is the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine, Baltimore. He is also professor in the departments of obstetrics and gynecology, medicine, and biochemistry and molecular biology. Dr. Reece said he had no relevant financial disclosures.

Neonates who are delivered at 36-38 weeks' gestation after fetal lung maturity is confirmed have nearly double the risk of adverse outcomes, compared with neonates delivered at 39 or 40 weeks, a large retrospective cohort study has shown.

The mean birth weight in 459 neonates with confirmed lung maturity who were delivered at 36-38 weeks' gestation was 3,017 g, compared with 3,362 g in 13,339 neonates delivered at 39-40 weeks. The risk of a composite outcome including death, adverse respiratory outcomes, hypoglycemia, treated hyperbilirubinemia, generalized seizures, necrotizing enterocolitis, hypoxic ischemic encephalopathy, periventricular leukomalacia, and suspected or proven sepsis was 6.1% in those in the 36- to 38-week group, compared with 2.5% in the 39- to 40-week group, Dr. Elizabeth Bates of the University of Alabama at Birmingham and her colleagues reported.

Early delivery remained a significant risk factor for the composite outcome after investigators adjusted for maternal age, ethnicity, parity, neonatal sex, intended mode of delivery, and any medical complication – including diabetes and hypertension. Early delivery was also a significant risk factor for several individual outcomes, including respiratory distress syndrome (adjusted odds ratio, 7.6); treated hyperbilirubinemia (AOR, 11.2); and hypoglycemia (AOR, 5.8), the investigators found (Obstet. Gynecol. 2010; 116:1288-95).

The incidence of the primary composite outcome generally decreased with increasing gestational age, they noted (9.2% incidence at 36 weeks, 3.2% at 37 weeks, 5.2% at 38 weeks, and 2.5% at 39-40 weeks).

Patients included in the study were women with a singleton pregnancy receiving prenatal care and giving birth at a single center from January 1999 to December 2008. Among those who were delivered at 36-38 weeks following documentation of fetal lung maturity, 42.5% had completed 36 weeks, 40.7% had completed 37 weeks, and only 16.8% had completed 38 weeks. Of those who were delivered at 38-40 weeks, 56.2% had completed 39 weeks, and 43.8% had completed 40 weeks. The mean gestational age was 37.1 weeks in those delivered at 36-38 weeks and was 39.8 weeks in those who delivered at 38-40 weeks.

The study findings are concerning, because fetal lung maturity is known to reduce the risk of respiratory morbidity, and confirmation of fetal lung maturity is “a recognized exception to longstanding recommendations against elective delivery before 39 weeks' gestation,” Dr. Bates and her associates noted.

Also, despite existing recommendations to the contrary, one-third of elective cesarean deliveries in one large study were performed before 39 weeks, they said.

Taken together, the findings in the current study “are consistent with relative immaturity at 36-38 weeks (regardless of lung maturity), compared with 39-40 weeks, and lower threshold for admission to the NICU and for invasive sepsis work-ups (suspected sepsis),” the investigators wrote.

They added that the findings should be considered in light of the study's limitations – including the retrospective study design and the related possibility of confounding, and the fact that the study does not fully address the risk of stillbirth associated with either delivery strategy studied. Nonetheless, they concluded that the findings suggest that “in the absence of ongoing concern about fetal death or maternal well-being if the pregnancy continued, delivery should be delayed until 39 weeks.”

The findings also suggest that purely elective fetal lung maturity testing and early delivery should be avoided, Dr. Bates and her associates noted.

One of the study authors, Dr. Alan T. N. Tita, was a Women's Reproductive Health Research Advanced Scholar at the University of Alabama at Birmingham at the time of the study and received funding from the National Institute of Child Health and Human Development. No relevant financial disclosures were reported by the other authors.

View on The News

Reconsider What Constitutes Term Birth

“This paper further advances our understanding of the optimal conditions for delivering a baby free of major health complications. Specifically, it confirms findings from a number of previous studies suggesting that babies born before 39 weeks' gestation have a significantly increased risk of complications, including respiratory distress syndrome, even if their lungs appear to be fully mature via biomarker testing,” Dr. E. Albert Reece said in an interview.

More importantly, he said, the study suggests that current definitions of what constitute a term birth may need to be reconsidered.

“Indeed, currently babies born between 37 and 42 completed weeks of pregnancy are considered full term, whereas babies born before 37 weeks of pregnancy are completed are considered preterm. However, if the results of this study are to be believed, they suggest that babies born before 39 weeks of gestation might be considered preterm as well.”

This may mean that the definition for term needs to be revised upward to 39-42 weeks, he added.

“It also means that physicians should try to do everything possible to keep from delivering women until they've reached 39 weeks of gestation, unless there are valid reasons for delivery to protect the health of the mother,” he said.

Vitals

DR. REECE is the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine, Baltimore. He is also professor in the departments of obstetrics and gynecology, medicine, and biochemistry and molecular biology. Dr. Reece said he had no relevant financial disclosures.

Neonates who are delivered at 36-38 weeks' gestation after fetal lung maturity is confirmed have nearly double the risk of adverse outcomes, compared with neonates delivered at 39 or 40 weeks, a large retrospective cohort study has shown.

The mean birth weight in 459 neonates with confirmed lung maturity who were delivered at 36-38 weeks' gestation was 3,017 g, compared with 3,362 g in 13,339 neonates delivered at 39-40 weeks. The risk of a composite outcome including death, adverse respiratory outcomes, hypoglycemia, treated hyperbilirubinemia, generalized seizures, necrotizing enterocolitis, hypoxic ischemic encephalopathy, periventricular leukomalacia, and suspected or proven sepsis was 6.1% in those in the 36- to 38-week group, compared with 2.5% in the 39- to 40-week group, Dr. Elizabeth Bates of the University of Alabama at Birmingham and her colleagues reported.

Early delivery remained a significant risk factor for the composite outcome after investigators adjusted for maternal age, ethnicity, parity, neonatal sex, intended mode of delivery, and any medical complication – including diabetes and hypertension. Early delivery was also a significant risk factor for several individual outcomes, including respiratory distress syndrome (adjusted odds ratio, 7.6); treated hyperbilirubinemia (AOR, 11.2); and hypoglycemia (AOR, 5.8), the investigators found (Obstet. Gynecol. 2010; 116:1288-95).

The incidence of the primary composite outcome generally decreased with increasing gestational age, they noted (9.2% incidence at 36 weeks, 3.2% at 37 weeks, 5.2% at 38 weeks, and 2.5% at 39-40 weeks).

Patients included in the study were women with a singleton pregnancy receiving prenatal care and giving birth at a single center from January 1999 to December 2008. Among those who were delivered at 36-38 weeks following documentation of fetal lung maturity, 42.5% had completed 36 weeks, 40.7% had completed 37 weeks, and only 16.8% had completed 38 weeks. Of those who were delivered at 38-40 weeks, 56.2% had completed 39 weeks, and 43.8% had completed 40 weeks. The mean gestational age was 37.1 weeks in those delivered at 36-38 weeks and was 39.8 weeks in those who delivered at 38-40 weeks.

The study findings are concerning, because fetal lung maturity is known to reduce the risk of respiratory morbidity, and confirmation of fetal lung maturity is “a recognized exception to longstanding recommendations against elective delivery before 39 weeks' gestation,” Dr. Bates and her associates noted.

Also, despite existing recommendations to the contrary, one-third of elective cesarean deliveries in one large study were performed before 39 weeks, they said.

Taken together, the findings in the current study “are consistent with relative immaturity at 36-38 weeks (regardless of lung maturity), compared with 39-40 weeks, and lower threshold for admission to the NICU and for invasive sepsis work-ups (suspected sepsis),” the investigators wrote.

They added that the findings should be considered in light of the study's limitations – including the retrospective study design and the related possibility of confounding, and the fact that the study does not fully address the risk of stillbirth associated with either delivery strategy studied. Nonetheless, they concluded that the findings suggest that “in the absence of ongoing concern about fetal death or maternal well-being if the pregnancy continued, delivery should be delayed until 39 weeks.”

The findings also suggest that purely elective fetal lung maturity testing and early delivery should be avoided, Dr. Bates and her associates noted.

One of the study authors, Dr. Alan T. N. Tita, was a Women's Reproductive Health Research Advanced Scholar at the University of Alabama at Birmingham at the time of the study and received funding from the National Institute of Child Health and Human Development. No relevant financial disclosures were reported by the other authors.

View on The News

Reconsider What Constitutes Term Birth

“This paper further advances our understanding of the optimal conditions for delivering a baby free of major health complications. Specifically, it confirms findings from a number of previous studies suggesting that babies born before 39 weeks' gestation have a significantly increased risk of complications, including respiratory distress syndrome, even if their lungs appear to be fully mature via biomarker testing,” Dr. E. Albert Reece said in an interview.

More importantly, he said, the study suggests that current definitions of what constitute a term birth may need to be reconsidered.

“Indeed, currently babies born between 37 and 42 completed weeks of pregnancy are considered full term, whereas babies born before 37 weeks of pregnancy are completed are considered preterm. However, if the results of this study are to be believed, they suggest that babies born before 39 weeks of gestation might be considered preterm as well.”

This may mean that the definition for term needs to be revised upward to 39-42 weeks, he added.

“It also means that physicians should try to do everything possible to keep from delivering women until they've reached 39 weeks of gestation, unless there are valid reasons for delivery to protect the health of the mother,” he said.

Vitals

DR. REECE is the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine, Baltimore. He is also professor in the departments of obstetrics and gynecology, medicine, and biochemistry and molecular biology. Dr. Reece said he had no relevant financial disclosures.

ATLANTA — Neuropsychiatric manifestations are common in systemic lupus erythematosus, and although they are rarely directly attributable to SLE, they need to be addressed within the context of SLE management, according to Dr. John G. Hanly.

Data from the Systemic Lupus International Collaborating Clinics inception cohort indicate that nearly a third of SLE patients have neuropsychiatric manifestations, even very early in the course of disease. A study of the first 572 patients from that cohort showed that 172 had at least 1 of 19 neuropsychiatric syndromes, with nearly half having more than 1. The data from the cohort – which now includes more than 1,600 patients – have remained consistent over the years, and show that the most common neuropsychiatric manifestations were headache, mood disorder, and cognitive dysfunction.

“So the central nervous system is impacted in more than a single way for many of our patients,” said Dr. Hanly of Dalhousie University in Halifax, N.S.

Patients from the cohort had a mean age of 35 years and mean disease duration of fewer than 6 months. When models developed to assess symptom attribution were applied, they showed that only 46-93 (depending on the model) of 242 neuropsychiatric events were attributable to SLE, and that those attributable to the disease were mainly seizures and cerebrovascular events (Arthritis Rheum. 2007;561:265-73).

However, regardless of attribution, the conditions consistently had an adverse effect on health-related quality of life, Dr. Hanly said.

The management of neuropsychiatric manifestations in SLE patients first requires establishment of diagnosis of neuropsychiatric SLE as robustly as possible. “For me, that means you first have to establish a robust diagnosis of SLE,” he said.

Even if lupus is considered the primary reason for the neuropsychiatric event, it's still very important to look at non-SLE factors, including hypertension, infection, and metabolic abnormalities.

Indeed, the etiology of neuropsychiatric symptoms in SLE is multifactorial, and includes autoantibodies and anti-inflammatory mediators. Therefore, treatment options include symptom control, which works just as well in SLE patients as in non-SLE patients (particularly for seizures, mood disorders, and anxiety) and also anticoagulation or immunosuppression, Dr. Hanly said.

Unfortunately, a paucity of data exists in regard to these latter treatments in SLE, and to a certain extent it is necessary (at least in regard to antiphospholipid antibodies) to draw on data from studies in antiphospholipid syndrome.

When it comes to secondary prevention of thrombotic events, those studies – which are mostly retrospective – show that aspirin is not helpful, and that standard antithrombotic treatment with warfarin is as good as high-intensity treatment with warfarin.

The warfarin findings remain somewhat controversial, as one meta-analysis showed some benefit of higher-intensity anticoagulation therapy, but with a higher degree of associated risks such as hemorrhagic complications.

When it comes to immunosuppression, there are several uncontrolled studies supporting the use of either oral corticosteroids at a high dosage (1 mg/kg per day), or pulse corticosteroids (250-1,000 mg/day) for nervous system disease. There is comparable evidence for pulse IV cyclophosphamide at either 0.75-1 g/m

An open study in 13 patients showed that oral cyclophosphamide at 1-2 mg/kg per day for 6 months, followed by azathioprine at 1-2 mg/kg per day indefinitely, was useful in patients with lupus psychosis. Complete resolution was seen in all patients after a mean of 44 days. Patients in that study also received prednisone at 1 mg/kg per day for the first 8 weeks, followed by a tapering of the dose. Four patients required pulse methylprednisone at 750 mg/day for other organ disease (Am. J. Med. 2003;115:59-62).

Another study showed that IV cyclophosphamide was superior to methylprednisolone alone in 32 patients with severe neurological disease (response rates, 95% vs. 46%). Mean response time was 5 months in both groups, and toxicity was comparable in both groups (Ann. Rheum. Dis. 2005;64:620-5).

Rituximab also has been studied, and in a Japanese study of 10 SLE patients with varied refractory CNS-related symptoms, treatment was associated with remission in 4 patients (Ann. Rheum. Dis. 2007;66:470-5).

Dr. Hanly has received grants from the Canadian Institutes of Health Research, Abbott, Roche, Schering, and UCB. He has also worked on clinical trials for Abbott and UCB and is on advisory boards for UCB, Roche, Genentech, and GlaxoSmithKline.

ATLANTA — Neuropsychiatric manifestations are common in systemic lupus erythematosus, and although they are rarely directly attributable to SLE, they need to be addressed within the context of SLE management, according to Dr. John G. Hanly.

Data from the Systemic Lupus International Collaborating Clinics inception cohort indicate that nearly a third of SLE patients have neuropsychiatric manifestations, even very early in the course of disease. A study of the first 572 patients from that cohort showed that 172 had at least 1 of 19 neuropsychiatric syndromes, with nearly half having more than 1. The data from the cohort – which now includes more than 1,600 patients – have remained consistent over the years, and show that the most common neuropsychiatric manifestations were headache, mood disorder, and cognitive dysfunction.

“So the central nervous system is impacted in more than a single way for many of our patients,” said Dr. Hanly of Dalhousie University in Halifax, N.S.

Patients from the cohort had a mean age of 35 years and mean disease duration of fewer than 6 months. When models developed to assess symptom attribution were applied, they showed that only 46-93 (depending on the model) of 242 neuropsychiatric events were attributable to SLE, and that those attributable to the disease were mainly seizures and cerebrovascular events (Arthritis Rheum. 2007;561:265-73).

However, regardless of attribution, the conditions consistently had an adverse effect on health-related quality of life, Dr. Hanly said.

The management of neuropsychiatric manifestations in SLE patients first requires establishment of diagnosis of neuropsychiatric SLE as robustly as possible. “For me, that means you first have to establish a robust diagnosis of SLE,” he said.

Even if lupus is considered the primary reason for the neuropsychiatric event, it's still very important to look at non-SLE factors, including hypertension, infection, and metabolic abnormalities.

Indeed, the etiology of neuropsychiatric symptoms in SLE is multifactorial, and includes autoantibodies and anti-inflammatory mediators. Therefore, treatment options include symptom control, which works just as well in SLE patients as in non-SLE patients (particularly for seizures, mood disorders, and anxiety) and also anticoagulation or immunosuppression, Dr. Hanly said.

Unfortunately, a paucity of data exists in regard to these latter treatments in SLE, and to a certain extent it is necessary (at least in regard to antiphospholipid antibodies) to draw on data from studies in antiphospholipid syndrome.

When it comes to secondary prevention of thrombotic events, those studies – which are mostly retrospective – show that aspirin is not helpful, and that standard antithrombotic treatment with warfarin is as good as high-intensity treatment with warfarin.

The warfarin findings remain somewhat controversial, as one meta-analysis showed some benefit of higher-intensity anticoagulation therapy, but with a higher degree of associated risks such as hemorrhagic complications.

When it comes to immunosuppression, there are several uncontrolled studies supporting the use of either oral corticosteroids at a high dosage (1 mg/kg per day), or pulse corticosteroids (250-1,000 mg/day) for nervous system disease. There is comparable evidence for pulse IV cyclophosphamide at either 0.75-1 g/m

An open study in 13 patients showed that oral cyclophosphamide at 1-2 mg/kg per day for 6 months, followed by azathioprine at 1-2 mg/kg per day indefinitely, was useful in patients with lupus psychosis. Complete resolution was seen in all patients after a mean of 44 days. Patients in that study also received prednisone at 1 mg/kg per day for the first 8 weeks, followed by a tapering of the dose. Four patients required pulse methylprednisone at 750 mg/day for other organ disease (Am. J. Med. 2003;115:59-62).

Another study showed that IV cyclophosphamide was superior to methylprednisolone alone in 32 patients with severe neurological disease (response rates, 95% vs. 46%). Mean response time was 5 months in both groups, and toxicity was comparable in both groups (Ann. Rheum. Dis. 2005;64:620-5).

Rituximab also has been studied, and in a Japanese study of 10 SLE patients with varied refractory CNS-related symptoms, treatment was associated with remission in 4 patients (Ann. Rheum. Dis. 2007;66:470-5).

Dr. Hanly has received grants from the Canadian Institutes of Health Research, Abbott, Roche, Schering, and UCB. He has also worked on clinical trials for Abbott and UCB and is on advisory boards for UCB, Roche, Genentech, and GlaxoSmithKline.

ATLANTA — Neuropsychiatric manifestations are common in systemic lupus erythematosus, and although they are rarely directly attributable to SLE, they need to be addressed within the context of SLE management, according to Dr. John G. Hanly.

Data from the Systemic Lupus International Collaborating Clinics inception cohort indicate that nearly a third of SLE patients have neuropsychiatric manifestations, even very early in the course of disease. A study of the first 572 patients from that cohort showed that 172 had at least 1 of 19 neuropsychiatric syndromes, with nearly half having more than 1. The data from the cohort – which now includes more than 1,600 patients – have remained consistent over the years, and show that the most common neuropsychiatric manifestations were headache, mood disorder, and cognitive dysfunction.

“So the central nervous system is impacted in more than a single way for many of our patients,” said Dr. Hanly of Dalhousie University in Halifax, N.S.

Patients from the cohort had a mean age of 35 years and mean disease duration of fewer than 6 months. When models developed to assess symptom attribution were applied, they showed that only 46-93 (depending on the model) of 242 neuropsychiatric events were attributable to SLE, and that those attributable to the disease were mainly seizures and cerebrovascular events (Arthritis Rheum. 2007;561:265-73).

However, regardless of attribution, the conditions consistently had an adverse effect on health-related quality of life, Dr. Hanly said.

The management of neuropsychiatric manifestations in SLE patients first requires establishment of diagnosis of neuropsychiatric SLE as robustly as possible. “For me, that means you first have to establish a robust diagnosis of SLE,” he said.

Even if lupus is considered the primary reason for the neuropsychiatric event, it's still very important to look at non-SLE factors, including hypertension, infection, and metabolic abnormalities.

Indeed, the etiology of neuropsychiatric symptoms in SLE is multifactorial, and includes autoantibodies and anti-inflammatory mediators. Therefore, treatment options include symptom control, which works just as well in SLE patients as in non-SLE patients (particularly for seizures, mood disorders, and anxiety) and also anticoagulation or immunosuppression, Dr. Hanly said.

Unfortunately, a paucity of data exists in regard to these latter treatments in SLE, and to a certain extent it is necessary (at least in regard to antiphospholipid antibodies) to draw on data from studies in antiphospholipid syndrome.

When it comes to secondary prevention of thrombotic events, those studies – which are mostly retrospective – show that aspirin is not helpful, and that standard antithrombotic treatment with warfarin is as good as high-intensity treatment with warfarin.

The warfarin findings remain somewhat controversial, as one meta-analysis showed some benefit of higher-intensity anticoagulation therapy, but with a higher degree of associated risks such as hemorrhagic complications.

When it comes to immunosuppression, there are several uncontrolled studies supporting the use of either oral corticosteroids at a high dosage (1 mg/kg per day), or pulse corticosteroids (250-1,000 mg/day) for nervous system disease. There is comparable evidence for pulse IV cyclophosphamide at either 0.75-1 g/m

An open study in 13 patients showed that oral cyclophosphamide at 1-2 mg/kg per day for 6 months, followed by azathioprine at 1-2 mg/kg per day indefinitely, was useful in patients with lupus psychosis. Complete resolution was seen in all patients after a mean of 44 days. Patients in that study also received prednisone at 1 mg/kg per day for the first 8 weeks, followed by a tapering of the dose. Four patients required pulse methylprednisone at 750 mg/day for other organ disease (Am. J. Med. 2003;115:59-62).

Another study showed that IV cyclophosphamide was superior to methylprednisolone alone in 32 patients with severe neurological disease (response rates, 95% vs. 46%). Mean response time was 5 months in both groups, and toxicity was comparable in both groups (Ann. Rheum. Dis. 2005;64:620-5).

Rituximab also has been studied, and in a Japanese study of 10 SLE patients with varied refractory CNS-related symptoms, treatment was associated with remission in 4 patients (Ann. Rheum. Dis. 2007;66:470-5).

Dr. Hanly has received grants from the Canadian Institutes of Health Research, Abbott, Roche, Schering, and UCB. He has also worked on clinical trials for Abbott and UCB and is on advisory boards for UCB, Roche, Genentech, and GlaxoSmithKline.

Major Finding: After investigators controlled for age and sex, Spearman's correlation coefficients showed a significant relationship between all measures of physical functioning and CRP level in early RA, but no correlation between those measures and modified Total Sharp Score (mTSS). In longstanding RA, the measures of physical functioning were significantly correlated with mTSS and with CRP.

Data Source: From a pooled analysis of data from two trials of RA patients.

Disclosures: Dr. Bergman disclosed that he has received research grants and consulting fees or other remuneration, and/or served on the speakers bureau for Abbott Laboratories, Bristol-Meyers Squibb, Roche, and UCB.

ATLANTA — Physical functioning in rheumatoid arthritis patients is affected more by inflammation early in the disease process, and more by structural damage as the disease progresses, according to an analysis of pooled data from two large clinical trials.

“We feel that this study confirms that deterioration of physical functioning as a result of RA may be driven predominantly by inflammation earlier in the course of disease, but over time it is driven more by structural damage than it is by inflammation. It also suggests that earlier treatment of these patients with appropriate therapy prior to development of significant structural damage should dramatically improve the long-term physical function and disability outcomes of our patients with rheumatoid arthritis,” reported Dr. Martin J. Bergman.

Dr. Bergman and his colleagues studied 1,415 patients from the two trials, each of which assessed the effects of adalimumab in RA: The PREMIER (Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery) trial was a double-blind, placebo-controlled phase III trial in patients with early RA, and the DE019 trial was a randomized, placebo-controlled trial of patients with established RA. A total of 908 patients from these trials had a disease duration of 3 years or less, and 507 had a disease duration of greater than 3 years.

“We pooled data to assess the relationship between structural damage as measured by the modified Total Sharp Score, joint space narrowing, and joint erosions. We also looked at inflammation as measured by C-reactive protein,” said Dr. Bergman, who is both on the staff of the division of rheumatology at Drexel University in Philadelphia, and chief of the division of rheumatology at Taylor Hospital of Arthritis and Rheumatology in Ridley Park, Pa.

Physical functioning was assessed using the Health Assessment Questionnaire (HAQ), and the Physical Component Score and Physical Functioning domain of the Short Form (SF)-36 Questionnaire, which assesses quality of life, he said.

Spearman's correlation coefficients showed a significant relationship between all three measures of physical function and C-reactive protein in early RA, but no correlation between those measures and a modified Total Sharp Score (mTSS).

In patients with longstanding RA, the measures of function were significantly correlated with mTSS and with CRP – although the latter associations were weaker than those seen in early disease, Dr. Bergman concluded.

Major Finding: After investigators controlled for age and sex, Spearman's correlation coefficients showed a significant relationship between all measures of physical functioning and CRP level in early RA, but no correlation between those measures and modified Total Sharp Score (mTSS). In longstanding RA, the measures of physical functioning were significantly correlated with mTSS and with CRP.

Data Source: From a pooled analysis of data from two trials of RA patients.

Disclosures: Dr. Bergman disclosed that he has received research grants and consulting fees or other remuneration, and/or served on the speakers bureau for Abbott Laboratories, Bristol-Meyers Squibb, Roche, and UCB.

ATLANTA — Physical functioning in rheumatoid arthritis patients is affected more by inflammation early in the disease process, and more by structural damage as the disease progresses, according to an analysis of pooled data from two large clinical trials.

“We feel that this study confirms that deterioration of physical functioning as a result of RA may be driven predominantly by inflammation earlier in the course of disease, but over time it is driven more by structural damage than it is by inflammation. It also suggests that earlier treatment of these patients with appropriate therapy prior to development of significant structural damage should dramatically improve the long-term physical function and disability outcomes of our patients with rheumatoid arthritis,” reported Dr. Martin J. Bergman.

Dr. Bergman and his colleagues studied 1,415 patients from the two trials, each of which assessed the effects of adalimumab in RA: The PREMIER (Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery) trial was a double-blind, placebo-controlled phase III trial in patients with early RA, and the DE019 trial was a randomized, placebo-controlled trial of patients with established RA. A total of 908 patients from these trials had a disease duration of 3 years or less, and 507 had a disease duration of greater than 3 years.

“We pooled data to assess the relationship between structural damage as measured by the modified Total Sharp Score, joint space narrowing, and joint erosions. We also looked at inflammation as measured by C-reactive protein,” said Dr. Bergman, who is both on the staff of the division of rheumatology at Drexel University in Philadelphia, and chief of the division of rheumatology at Taylor Hospital of Arthritis and Rheumatology in Ridley Park, Pa.

Physical functioning was assessed using the Health Assessment Questionnaire (HAQ), and the Physical Component Score and Physical Functioning domain of the Short Form (SF)-36 Questionnaire, which assesses quality of life, he said.

Spearman's correlation coefficients showed a significant relationship between all three measures of physical function and C-reactive protein in early RA, but no correlation between those measures and a modified Total Sharp Score (mTSS).

In patients with longstanding RA, the measures of function were significantly correlated with mTSS and with CRP – although the latter associations were weaker than those seen in early disease, Dr. Bergman concluded.

Major Finding: After investigators controlled for age and sex, Spearman's correlation coefficients showed a significant relationship between all measures of physical functioning and CRP level in early RA, but no correlation between those measures and modified Total Sharp Score (mTSS). In longstanding RA, the measures of physical functioning were significantly correlated with mTSS and with CRP.

Data Source: From a pooled analysis of data from two trials of RA patients.

Disclosures: Dr. Bergman disclosed that he has received research grants and consulting fees or other remuneration, and/or served on the speakers bureau for Abbott Laboratories, Bristol-Meyers Squibb, Roche, and UCB.

ATLANTA — Physical functioning in rheumatoid arthritis patients is affected more by inflammation early in the disease process, and more by structural damage as the disease progresses, according to an analysis of pooled data from two large clinical trials.

“We feel that this study confirms that deterioration of physical functioning as a result of RA may be driven predominantly by inflammation earlier in the course of disease, but over time it is driven more by structural damage than it is by inflammation. It also suggests that earlier treatment of these patients with appropriate therapy prior to development of significant structural damage should dramatically improve the long-term physical function and disability outcomes of our patients with rheumatoid arthritis,” reported Dr. Martin J. Bergman.

Dr. Bergman and his colleagues studied 1,415 patients from the two trials, each of which assessed the effects of adalimumab in RA: The PREMIER (Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery) trial was a double-blind, placebo-controlled phase III trial in patients with early RA, and the DE019 trial was a randomized, placebo-controlled trial of patients with established RA. A total of 908 patients from these trials had a disease duration of 3 years or less, and 507 had a disease duration of greater than 3 years.

“We pooled data to assess the relationship between structural damage as measured by the modified Total Sharp Score, joint space narrowing, and joint erosions. We also looked at inflammation as measured by C-reactive protein,” said Dr. Bergman, who is both on the staff of the division of rheumatology at Drexel University in Philadelphia, and chief of the division of rheumatology at Taylor Hospital of Arthritis and Rheumatology in Ridley Park, Pa.

Physical functioning was assessed using the Health Assessment Questionnaire (HAQ), and the Physical Component Score and Physical Functioning domain of the Short Form (SF)-36 Questionnaire, which assesses quality of life, he said.

Spearman's correlation coefficients showed a significant relationship between all three measures of physical function and C-reactive protein in early RA, but no correlation between those measures and a modified Total Sharp Score (mTSS).

In patients with longstanding RA, the measures of function were significantly correlated with mTSS and with CRP – although the latter associations were weaker than those seen in early disease, Dr. Bergman concluded.

ATLANTA — Use of tumor necrosis factor inhibitors was associated with a lower rate of Alzheimer's disease in patients with rheumatoid arthritis.

The finding was seen in a nested case-control study. TNF blockers were associated with a 55% reduction in the risk of incident Alzheimer's dementia after adjustment for the presence of known potential risk factors for vascular dementia, including hypertension, hyperlipidemia, diabetes, peripheral vascular disease, and coronary artery disease, said Dr. Richard C. Chou of Dartmouth-Hitchcock Medical Center in Milton, Mass.

Dr. Chou and his colleagues identified 41,109 patients with RA in a commercially insured cohort of 8.5 million adults. Among the RA patients, 458 also had a diagnosis of Alzheimer's disease.

The overall prevalence of dementia in RA patients was 1.11%; the overall prevalence in the cohort without RA was 0.14%.

Exposure to three specific anti-TNF drugs – infliximab, etanercept, and adalimumab – was examined, as was exposure to sulfasalazine, prednisone, and rituximab.

Use of the anti-TNF agents as a group was significantly associated with a reduced risk of Alzheimer's dementia, Dr. Chou said. When the anti-TNF agents were analyzed individually, only etanercept was significantly associated with reduced risk. Etanercept was associated with about a 70% reduction in the risk of Alzheimer's dementia.

Dr. Chou said he had no relevant financial disclosures.

ATLANTA — Use of tumor necrosis factor inhibitors was associated with a lower rate of Alzheimer's disease in patients with rheumatoid arthritis.

The finding was seen in a nested case-control study. TNF blockers were associated with a 55% reduction in the risk of incident Alzheimer's dementia after adjustment for the presence of known potential risk factors for vascular dementia, including hypertension, hyperlipidemia, diabetes, peripheral vascular disease, and coronary artery disease, said Dr. Richard C. Chou of Dartmouth-Hitchcock Medical Center in Milton, Mass.

Dr. Chou and his colleagues identified 41,109 patients with RA in a commercially insured cohort of 8.5 million adults. Among the RA patients, 458 also had a diagnosis of Alzheimer's disease.

The overall prevalence of dementia in RA patients was 1.11%; the overall prevalence in the cohort without RA was 0.14%.

Exposure to three specific anti-TNF drugs – infliximab, etanercept, and adalimumab – was examined, as was exposure to sulfasalazine, prednisone, and rituximab.

Use of the anti-TNF agents as a group was significantly associated with a reduced risk of Alzheimer's dementia, Dr. Chou said. When the anti-TNF agents were analyzed individually, only etanercept was significantly associated with reduced risk. Etanercept was associated with about a 70% reduction in the risk of Alzheimer's dementia.

Dr. Chou said he had no relevant financial disclosures.

ATLANTA — Use of tumor necrosis factor inhibitors was associated with a lower rate of Alzheimer's disease in patients with rheumatoid arthritis.

The finding was seen in a nested case-control study. TNF blockers were associated with a 55% reduction in the risk of incident Alzheimer's dementia after adjustment for the presence of known potential risk factors for vascular dementia, including hypertension, hyperlipidemia, diabetes, peripheral vascular disease, and coronary artery disease, said Dr. Richard C. Chou of Dartmouth-Hitchcock Medical Center in Milton, Mass.

Dr. Chou and his colleagues identified 41,109 patients with RA in a commercially insured cohort of 8.5 million adults. Among the RA patients, 458 also had a diagnosis of Alzheimer's disease.

The overall prevalence of dementia in RA patients was 1.11%; the overall prevalence in the cohort without RA was 0.14%.

Exposure to three specific anti-TNF drugs – infliximab, etanercept, and adalimumab – was examined, as was exposure to sulfasalazine, prednisone, and rituximab.

Use of the anti-TNF agents as a group was significantly associated with a reduced risk of Alzheimer's dementia, Dr. Chou said. When the anti-TNF agents were analyzed individually, only etanercept was significantly associated with reduced risk. Etanercept was associated with about a 70% reduction in the risk of Alzheimer's dementia.

Dr. Chou said he had no relevant financial disclosures.

ATLANTA — Rheumatoid arthritis patients who switch from one tumor necrosis factor inhibitor to another during the course of their disease are not at increased risk for serious infections, according to an analysis of data from a large health claims database.

The unadjusted rates of first serious infection in 13,752 RA patients who received only one tumor necrosis factor (TNF) inhibitor between Jan. 1, 2001, and Dec. 21, 2007, and in 2,293 RA patients who switched at least once from one TNF inhibitor to another during that time period did not differ significantly in either a model that analyzed infection rates within 90 days of any health insurance claim for a TNF inhibitor (the index date), or in a model that analyzed infection rates at any time after the index date, reported Bao-Anh Nguyen-Khoa, D.Pharm.

Rates of first serious infection in the 90-day model were 6.31 and 6.78/100 patient-years in the nonswitchers and switchers; rates in the ever-treated model were 8.45 and. 9.10/100 patient-years in the nonswitchers and switchers.

Rates of first serious infection in both models declined significantly from the first year after the index date, to the second year after the index date and beyond. In the 90-day model, those rates declined from 8.59 to 2.66/100 patient-years in the nonswitchers, and from 8.72 to 2.64/100 patient-years in the switchers. In the ever-treated model, the rates declined from 10.15 to 4.18/100 patient-years in the nonswitchers, and from 10.11 to 4.44/100 patient-years in the switchers, said Dr. Nguyen-Khoa, a pharmacoepidemiology consultant in Arlington, Va.

After adjustment for age, sex, selected comorbidities, Charlson comorbidity score, hospitalizations, and other RA treatments, there still was no significant difference between the nonswitchers and switchers in the risk of serious infection for either attribution model (hazard ratio, 0.93 in the 90-day model, and 0.94 in the ever-treated model).

Patients in the health insurance claims database used for this study were included if they had not been treated with other biologic agents, and if baseline data were available for at least 365 days of enrollment prior to the index date. Serious infections were defined as infections requiring intravenous antibiotic treatment or hospitalization.

Prior studies have documented an increased risk of serious infections in patients using TNF inhibitors, with incident rates of 3.6-10.5 cases/100 patient-years, and with similar findings to the current study in regard to differences in infection rates in the first year compared with the second year. However, although switching anti-TNF agents is a common strategy in RA patients who experience adverse events or lack of efficacy, infection rates in patients who switch drugs have not been widely studied, Dr. Nguyen-Khoa said.

In the current study, he and his colleagues demonstrated that switching TNF inhibitors does not increase risk, and they also reported a reduced rate of serious infections in patients who survived into the second year – a finding that corresponded with the results of those earlier studies, he said.

This study was supported by Genentech and Biogen IDEC. Dr. Nguyen-Khoa said he had no conflicts of interest.

ATLANTA — Rheumatoid arthritis patients who switch from one tumor necrosis factor inhibitor to another during the course of their disease are not at increased risk for serious infections, according to an analysis of data from a large health claims database.

The unadjusted rates of first serious infection in 13,752 RA patients who received only one tumor necrosis factor (TNF) inhibitor between Jan. 1, 2001, and Dec. 21, 2007, and in 2,293 RA patients who switched at least once from one TNF inhibitor to another during that time period did not differ significantly in either a model that analyzed infection rates within 90 days of any health insurance claim for a TNF inhibitor (the index date), or in a model that analyzed infection rates at any time after the index date, reported Bao-Anh Nguyen-Khoa, D.Pharm.

Rates of first serious infection in the 90-day model were 6.31 and 6.78/100 patient-years in the nonswitchers and switchers; rates in the ever-treated model were 8.45 and. 9.10/100 patient-years in the nonswitchers and switchers.

Rates of first serious infection in both models declined significantly from the first year after the index date, to the second year after the index date and beyond. In the 90-day model, those rates declined from 8.59 to 2.66/100 patient-years in the nonswitchers, and from 8.72 to 2.64/100 patient-years in the switchers. In the ever-treated model, the rates declined from 10.15 to 4.18/100 patient-years in the nonswitchers, and from 10.11 to 4.44/100 patient-years in the switchers, said Dr. Nguyen-Khoa, a pharmacoepidemiology consultant in Arlington, Va.

After adjustment for age, sex, selected comorbidities, Charlson comorbidity score, hospitalizations, and other RA treatments, there still was no significant difference between the nonswitchers and switchers in the risk of serious infection for either attribution model (hazard ratio, 0.93 in the 90-day model, and 0.94 in the ever-treated model).

Patients in the health insurance claims database used for this study were included if they had not been treated with other biologic agents, and if baseline data were available for at least 365 days of enrollment prior to the index date. Serious infections were defined as infections requiring intravenous antibiotic treatment or hospitalization.

Prior studies have documented an increased risk of serious infections in patients using TNF inhibitors, with incident rates of 3.6-10.5 cases/100 patient-years, and with similar findings to the current study in regard to differences in infection rates in the first year compared with the second year. However, although switching anti-TNF agents is a common strategy in RA patients who experience adverse events or lack of efficacy, infection rates in patients who switch drugs have not been widely studied, Dr. Nguyen-Khoa said.

In the current study, he and his colleagues demonstrated that switching TNF inhibitors does not increase risk, and they also reported a reduced rate of serious infections in patients who survived into the second year – a finding that corresponded with the results of those earlier studies, he said.

This study was supported by Genentech and Biogen IDEC. Dr. Nguyen-Khoa said he had no conflicts of interest.

ATLANTA — Rheumatoid arthritis patients who switch from one tumor necrosis factor inhibitor to another during the course of their disease are not at increased risk for serious infections, according to an analysis of data from a large health claims database.

The unadjusted rates of first serious infection in 13,752 RA patients who received only one tumor necrosis factor (TNF) inhibitor between Jan. 1, 2001, and Dec. 21, 2007, and in 2,293 RA patients who switched at least once from one TNF inhibitor to another during that time period did not differ significantly in either a model that analyzed infection rates within 90 days of any health insurance claim for a TNF inhibitor (the index date), or in a model that analyzed infection rates at any time after the index date, reported Bao-Anh Nguyen-Khoa, D.Pharm.

Rates of first serious infection in the 90-day model were 6.31 and 6.78/100 patient-years in the nonswitchers and switchers; rates in the ever-treated model were 8.45 and. 9.10/100 patient-years in the nonswitchers and switchers.

Rates of first serious infection in both models declined significantly from the first year after the index date, to the second year after the index date and beyond. In the 90-day model, those rates declined from 8.59 to 2.66/100 patient-years in the nonswitchers, and from 8.72 to 2.64/100 patient-years in the switchers. In the ever-treated model, the rates declined from 10.15 to 4.18/100 patient-years in the nonswitchers, and from 10.11 to 4.44/100 patient-years in the switchers, said Dr. Nguyen-Khoa, a pharmacoepidemiology consultant in Arlington, Va.

After adjustment for age, sex, selected comorbidities, Charlson comorbidity score, hospitalizations, and other RA treatments, there still was no significant difference between the nonswitchers and switchers in the risk of serious infection for either attribution model (hazard ratio, 0.93 in the 90-day model, and 0.94 in the ever-treated model).

Patients in the health insurance claims database used for this study were included if they had not been treated with other biologic agents, and if baseline data were available for at least 365 days of enrollment prior to the index date. Serious infections were defined as infections requiring intravenous antibiotic treatment or hospitalization.

Prior studies have documented an increased risk of serious infections in patients using TNF inhibitors, with incident rates of 3.6-10.5 cases/100 patient-years, and with similar findings to the current study in regard to differences in infection rates in the first year compared with the second year. However, although switching anti-TNF agents is a common strategy in RA patients who experience adverse events or lack of efficacy, infection rates in patients who switch drugs have not been widely studied, Dr. Nguyen-Khoa said.

In the current study, he and his colleagues demonstrated that switching TNF inhibitors does not increase risk, and they also reported a reduced rate of serious infections in patients who survived into the second year – a finding that corresponded with the results of those earlier studies, he said.

This study was supported by Genentech and Biogen IDEC. Dr. Nguyen-Khoa said he had no conflicts of interest.

Part of the mission of the Women's Dermatologic Society is to help women in dermatology "realize and fulfill their greatest potential" by promoting research, patient care, and patient and public education.

A list of recent accomplishments suggests that this part of its mission – and more – was fulfilled in 2010.

The Society's "Play Safe in the Sun" campaign, for example, garnered strong support from members this past year – 400 volunteer hours, for starters – and skin cancer screenings, sun safe educational activities, and public service announcements were achieved as part of the campaign.

"Most of the work done through the 'Play Safe in the Sun' program was done through Ladies Professional Golf Association events," said Dr. Lisa A. Garner, president of the Women's Dermatologic Society (WDS), which has been a partner in the campaign.

Events are also now being held in conjunction with professional tennis events.

Volunteers, including 31 dermatologists, provided the 400 hours of service at events across the country, where they screened participants, from players, to audience members, to members of the media. The efforts paid off in healthy ways; the referral rate for suspicious lesions requiring follow-up was 35%, said Dr. Garner.

The series of public service announcements promoting sun safe practices produced as part of the campaign aired frequently on the Golf Channel. The WDS also provided assistance to members who wanted to conduct "Play Safe in the Sun" events in their own communities, she added.

The program was launched in 2004, and for the past 3 years has been supported by a grant from L’Oréal. A commitment for funding for the next 3 years was recently made by La Roche-Posay, Dr. Garner said.

In addition to the "Play Safe in the Sun" program, WDS provided 42 mentorship, 6 academic, and 3 career and community advancement awards in 2010.

These awards also serve to fulfill the Society's mission, she said.

Mentorship is a cornerstone of WDS, which was founded to provide women in dermatology with educational and networking opportunities, as well as leadership training. The Mentorship Awards are designed to help promote mentoring relationships that might otherwise be impossible because of distance or lack of funding, and they help promote leadership potential in residents or junior faculty members who demonstrate exceptional promise, Dr. Garner said.

The Academic Research Awards are provided to resident or early-career dermatologists who are conducting basic science or clinical research in dermatology. The awards of up to $10,000 each are granted largely on the basis of scientific merit and anticipated impact on the field of dermatology. And the Career and Community Advancement Awards provide grant money to practicing dermatologists who are working to advance their career through educational or community service pursuits that also advance the practice of dermatology.

Another accomplishment of the WDS in 2010 was the development of a 1-day International Leadership Development Forum to be held in conjunction with the World Congress of Dermatology in Seoul, South Korea this year. Many U.S. and international WDS members will be speaking at the event, which is being spearheaded by an international member and will take place just prior to the Congress, she noted.

Dr. Garner said that during her term as WDS president in 2010-2011, she has been in awe of the willingness of WDS members to volunteer their time and efforts, whether to mentor fellow dermatologists, to assist at screening events, or to speak at an educational forum.

"We have so many members ready and willing to volunteer at the drop of a hat," she said, noting that at a "Play Safe in the Sun" event last year, volunteers had to be turned away thanks to the outpouring of support from members.

"We continue to be a very strong and vibrant organization in the community, with dedicated and energetic members who love to mentor, who love to service, and who serve the profession of dermatology in ways that go beyond just taking good care of our patients," she said.

Dr. Garner's term as president ends Feb. 6 at the WDS annual meeting and luncheon when president-elect Dr. Diane Berson of New York will take the reins.

Part of the mission of the Women's Dermatologic Society is to help women in dermatology "realize and fulfill their greatest potential" by promoting research, patient care, and patient and public education.

A list of recent accomplishments suggests that this part of its mission – and more – was fulfilled in 2010.

The Society's "Play Safe in the Sun" campaign, for example, garnered strong support from members this past year – 400 volunteer hours, for starters – and skin cancer screenings, sun safe educational activities, and public service announcements were achieved as part of the campaign.

"Most of the work done through the 'Play Safe in the Sun' program was done through Ladies Professional Golf Association events," said Dr. Lisa A. Garner, president of the Women's Dermatologic Society (WDS), which has been a partner in the campaign.

Events are also now being held in conjunction with professional tennis events.

Volunteers, including 31 dermatologists, provided the 400 hours of service at events across the country, where they screened participants, from players, to audience members, to members of the media. The efforts paid off in healthy ways; the referral rate for suspicious lesions requiring follow-up was 35%, said Dr. Garner.

The series of public service announcements promoting sun safe practices produced as part of the campaign aired frequently on the Golf Channel. The WDS also provided assistance to members who wanted to conduct "Play Safe in the Sun" events in their own communities, she added.

The program was launched in 2004, and for the past 3 years has been supported by a grant from L’Oréal. A commitment for funding for the next 3 years was recently made by La Roche-Posay, Dr. Garner said.

In addition to the "Play Safe in the Sun" program, WDS provided 42 mentorship, 6 academic, and 3 career and community advancement awards in 2010.

These awards also serve to fulfill the Society's mission, she said.

Mentorship is a cornerstone of WDS, which was founded to provide women in dermatology with educational and networking opportunities, as well as leadership training. The Mentorship Awards are designed to help promote mentoring relationships that might otherwise be impossible because of distance or lack of funding, and they help promote leadership potential in residents or junior faculty members who demonstrate exceptional promise, Dr. Garner said.

The Academic Research Awards are provided to resident or early-career dermatologists who are conducting basic science or clinical research in dermatology. The awards of up to $10,000 each are granted largely on the basis of scientific merit and anticipated impact on the field of dermatology. And the Career and Community Advancement Awards provide grant money to practicing dermatologists who are working to advance their career through educational or community service pursuits that also advance the practice of dermatology.

Another accomplishment of the WDS in 2010 was the development of a 1-day International Leadership Development Forum to be held in conjunction with the World Congress of Dermatology in Seoul, South Korea this year. Many U.S. and international WDS members will be speaking at the event, which is being spearheaded by an international member and will take place just prior to the Congress, she noted.

Dr. Garner said that during her term as WDS president in 2010-2011, she has been in awe of the willingness of WDS members to volunteer their time and efforts, whether to mentor fellow dermatologists, to assist at screening events, or to speak at an educational forum.

"We have so many members ready and willing to volunteer at the drop of a hat," she said, noting that at a "Play Safe in the Sun" event last year, volunteers had to be turned away thanks to the outpouring of support from members.

"We continue to be a very strong and vibrant organization in the community, with dedicated and energetic members who love to mentor, who love to service, and who serve the profession of dermatology in ways that go beyond just taking good care of our patients," she said.

Dr. Garner's term as president ends Feb. 6 at the WDS annual meeting and luncheon when president-elect Dr. Diane Berson of New York will take the reins.

Part of the mission of the Women's Dermatologic Society is to help women in dermatology "realize and fulfill their greatest potential" by promoting research, patient care, and patient and public education.

A list of recent accomplishments suggests that this part of its mission – and more – was fulfilled in 2010.

The Society's "Play Safe in the Sun" campaign, for example, garnered strong support from members this past year – 400 volunteer hours, for starters – and skin cancer screenings, sun safe educational activities, and public service announcements were achieved as part of the campaign.

"Most of the work done through the 'Play Safe in the Sun' program was done through Ladies Professional Golf Association events," said Dr. Lisa A. Garner, president of the Women's Dermatologic Society (WDS), which has been a partner in the campaign.

Events are also now being held in conjunction with professional tennis events.

Volunteers, including 31 dermatologists, provided the 400 hours of service at events across the country, where they screened participants, from players, to audience members, to members of the media. The efforts paid off in healthy ways; the referral rate for suspicious lesions requiring follow-up was 35%, said Dr. Garner.

The series of public service announcements promoting sun safe practices produced as part of the campaign aired frequently on the Golf Channel. The WDS also provided assistance to members who wanted to conduct "Play Safe in the Sun" events in their own communities, she added.

The program was launched in 2004, and for the past 3 years has been supported by a grant from L’Oréal. A commitment for funding for the next 3 years was recently made by La Roche-Posay, Dr. Garner said.

In addition to the "Play Safe in the Sun" program, WDS provided 42 mentorship, 6 academic, and 3 career and community advancement awards in 2010.

These awards also serve to fulfill the Society's mission, she said.

Mentorship is a cornerstone of WDS, which was founded to provide women in dermatology with educational and networking opportunities, as well as leadership training. The Mentorship Awards are designed to help promote mentoring relationships that might otherwise be impossible because of distance or lack of funding, and they help promote leadership potential in residents or junior faculty members who demonstrate exceptional promise, Dr. Garner said.

The Academic Research Awards are provided to resident or early-career dermatologists who are conducting basic science or clinical research in dermatology. The awards of up to $10,000 each are granted largely on the basis of scientific merit and anticipated impact on the field of dermatology. And the Career and Community Advancement Awards provide grant money to practicing dermatologists who are working to advance their career through educational or community service pursuits that also advance the practice of dermatology.

Another accomplishment of the WDS in 2010 was the development of a 1-day International Leadership Development Forum to be held in conjunction with the World Congress of Dermatology in Seoul, South Korea this year. Many U.S. and international WDS members will be speaking at the event, which is being spearheaded by an international member and will take place just prior to the Congress, she noted.

Dr. Garner said that during her term as WDS president in 2010-2011, she has been in awe of the willingness of WDS members to volunteer their time and efforts, whether to mentor fellow dermatologists, to assist at screening events, or to speak at an educational forum.

"We have so many members ready and willing to volunteer at the drop of a hat," she said, noting that at a "Play Safe in the Sun" event last year, volunteers had to be turned away thanks to the outpouring of support from members.

"We continue to be a very strong and vibrant organization in the community, with dedicated and energetic members who love to mentor, who love to service, and who serve the profession of dermatology in ways that go beyond just taking good care of our patients," she said.

Dr. Garner's term as president ends Feb. 6 at the WDS annual meeting and luncheon when president-elect Dr. Diane Berson of New York will take the reins.

Neonates who are delivered at 36-38 weeks’ gestation after fetal lung maturity is confirmed have nearly double the risk of adverse outcomes, compared with neonates delivered at 39 or 40 weeks, a large retrospective cohort study has shown.

The mean birth weight in 459 neonates with confirmed lung maturity who were delivered at 36-38 weeks’ gestation was 3,017 g, compared with 3,362 g in 13,339 neonates delivered at 39-40 weeks. The risk of a composite outcome including death, adverse respiratory outcomes, hypoglycemia, treated hyperbilirubinemia, generalized seizures, necrotizing enterocolitis, hypoxic ischemic encephalopathy, periventricular leukomalacia, and suspected or proven sepsis was 6.1% in those in the 36- to 38-week group, compared with 2.5% in the 39- to 40-week group, Dr. Elizabeth Bates of the University of Alabama at Birmingham and her colleagues reported.

Early delivery remained a significant risk factor for the composite outcome after investigators adjusted for maternal age, ethnicity, parity, neonatal sex, intended mode of delivery, and any medical complication – including diabetes and hypertension. Early delivery was also a significant risk factor for several individual outcomes, including respiratory distress syndrome (adjusted odds ratio, 7.6); treated hyperbilirubinemia (AOR, 11.2); and hypoglycemia (AOR, 5.8), the investigators found (Obstet. Gynecol. 2010;116:1288-95).

The incidence of the primary composite outcome generally decreased with increasing gestational age, they noted (9.2% incidence at 36 weeks, 3.2% at 37 weeks, 5.2% at 38 weeks, and 2.5% at 39-40 weeks).

Patients included in the study were women with a singleton pregnancy receiving prenatal care and giving birth at a single center from January 1999 to December 2008. Among those who were delivered at 36-38 weeks following documentation of fetal lung maturity, 42.5% had completed 36 weeks, 40.7% had completed 37 weeks, and only 16.8% had completed 38 weeks. Of those who were delivered at 38-40 weeks, 56.2% had completed 39 weeks, and 43.8% had completed 40 weeks. The mean gestational age was 37.1 weeks in those delivered at 36-38 weeks and was 39.8 weeks in those who gave birth at 38-40 weeks.

The study findings are concerning, because fetal lung maturity is known to reduce the risk of respiratory morbidity, and confirmation of fetal lung maturity is "a recognized exception to longstanding recommendations against elective delivery before 39 weeks’ gestation," Dr. Bates and her associates noted.

Also, despite existing recommendations to the contrary, one-third of elective cesarean deliveries in one large study were performed before 39 weeks, they said.

Taken together, the findings in the current study "are consistent with relative immaturity at 36-38 weeks (regardless of lung maturity), compared with 39-40 weeks, and lower threshold for admission to the NICU and for invasive sepsis work-ups (suspected sepsis)," the investigators wrote.

They added that the findings should be considered in light of the study’s limitations – including the retrospective study design and the related possibility of confounding, and the fact that the study does not fully address the risk of stillbirth associated with either delivery strategy studied. Nonetheless, they concluded that the findings suggest that "in the absence of ongoing concern about fetal death or maternal well-being if the pregnancy continued, delivery should be delayed until 39 weeks."

The findings also suggest that purely elective fetal lung maturity testing and early delivery should be avoided, Dr. Bates and her associates noted.

One of the study authors, Dr. Alan T. N. Tita, was a Women’s Reproductive Health Research Advanced Scholar at the University of Alabama at Birmingham at the time of the study and received funding from the National Institute of Child Health and Human Development. No relevant financial disclosures were reported by the other authors.

Neonates who are delivered at 36-38 weeks’ gestation after fetal lung maturity is confirmed have nearly double the risk of adverse outcomes, compared with neonates delivered at 39 or 40 weeks, a large retrospective cohort study has shown.

The mean birth weight in 459 neonates with confirmed lung maturity who were delivered at 36-38 weeks’ gestation was 3,017 g, compared with 3,362 g in 13,339 neonates delivered at 39-40 weeks. The risk of a composite outcome including death, adverse respiratory outcomes, hypoglycemia, treated hyperbilirubinemia, generalized seizures, necrotizing enterocolitis, hypoxic ischemic encephalopathy, periventricular leukomalacia, and suspected or proven sepsis was 6.1% in those in the 36- to 38-week group, compared with 2.5% in the 39- to 40-week group, Dr. Elizabeth Bates of the University of Alabama at Birmingham and her colleagues reported.

Early delivery remained a significant risk factor for the composite outcome after investigators adjusted for maternal age, ethnicity, parity, neonatal sex, intended mode of delivery, and any medical complication – including diabetes and hypertension. Early delivery was also a significant risk factor for several individual outcomes, including respiratory distress syndrome (adjusted odds ratio, 7.6); treated hyperbilirubinemia (AOR, 11.2); and hypoglycemia (AOR, 5.8), the investigators found (Obstet. Gynecol. 2010;116:1288-95).

The incidence of the primary composite outcome generally decreased with increasing gestational age, they noted (9.2% incidence at 36 weeks, 3.2% at 37 weeks, 5.2% at 38 weeks, and 2.5% at 39-40 weeks).

Patients included in the study were women with a singleton pregnancy receiving prenatal care and giving birth at a single center from January 1999 to December 2008. Among those who were delivered at 36-38 weeks following documentation of fetal lung maturity, 42.5% had completed 36 weeks, 40.7% had completed 37 weeks, and only 16.8% had completed 38 weeks. Of those who were delivered at 38-40 weeks, 56.2% had completed 39 weeks, and 43.8% had completed 40 weeks. The mean gestational age was 37.1 weeks in those delivered at 36-38 weeks and was 39.8 weeks in those who gave birth at 38-40 weeks.

The study findings are concerning, because fetal lung maturity is known to reduce the risk of respiratory morbidity, and confirmation of fetal lung maturity is "a recognized exception to longstanding recommendations against elective delivery before 39 weeks’ gestation," Dr. Bates and her associates noted.

Also, despite existing recommendations to the contrary, one-third of elective cesarean deliveries in one large study were performed before 39 weeks, they said.

Taken together, the findings in the current study "are consistent with relative immaturity at 36-38 weeks (regardless of lung maturity), compared with 39-40 weeks, and lower threshold for admission to the NICU and for invasive sepsis work-ups (suspected sepsis)," the investigators wrote.

They added that the findings should be considered in light of the study’s limitations – including the retrospective study design and the related possibility of confounding, and the fact that the study does not fully address the risk of stillbirth associated with either delivery strategy studied. Nonetheless, they concluded that the findings suggest that "in the absence of ongoing concern about fetal death or maternal well-being if the pregnancy continued, delivery should be delayed until 39 weeks."

The findings also suggest that purely elective fetal lung maturity testing and early delivery should be avoided, Dr. Bates and her associates noted.

One of the study authors, Dr. Alan T. N. Tita, was a Women’s Reproductive Health Research Advanced Scholar at the University of Alabama at Birmingham at the time of the study and received funding from the National Institute of Child Health and Human Development. No relevant financial disclosures were reported by the other authors.

Neonates who are delivered at 36-38 weeks’ gestation after fetal lung maturity is confirmed have nearly double the risk of adverse outcomes, compared with neonates delivered at 39 or 40 weeks, a large retrospective cohort study has shown.

The mean birth weight in 459 neonates with confirmed lung maturity who were delivered at 36-38 weeks’ gestation was 3,017 g, compared with 3,362 g in 13,339 neonates delivered at 39-40 weeks. The risk of a composite outcome including death, adverse respiratory outcomes, hypoglycemia, treated hyperbilirubinemia, generalized seizures, necrotizing enterocolitis, hypoxic ischemic encephalopathy, periventricular leukomalacia, and suspected or proven sepsis was 6.1% in those in the 36- to 38-week group, compared with 2.5% in the 39- to 40-week group, Dr. Elizabeth Bates of the University of Alabama at Birmingham and her colleagues reported.

Early delivery remained a significant risk factor for the composite outcome after investigators adjusted for maternal age, ethnicity, parity, neonatal sex, intended mode of delivery, and any medical complication – including diabetes and hypertension. Early delivery was also a significant risk factor for several individual outcomes, including respiratory distress syndrome (adjusted odds ratio, 7.6); treated hyperbilirubinemia (AOR, 11.2); and hypoglycemia (AOR, 5.8), the investigators found (Obstet. Gynecol. 2010;116:1288-95).

The incidence of the primary composite outcome generally decreased with increasing gestational age, they noted (9.2% incidence at 36 weeks, 3.2% at 37 weeks, 5.2% at 38 weeks, and 2.5% at 39-40 weeks).

Patients included in the study were women with a singleton pregnancy receiving prenatal care and giving birth at a single center from January 1999 to December 2008. Among those who were delivered at 36-38 weeks following documentation of fetal lung maturity, 42.5% had completed 36 weeks, 40.7% had completed 37 weeks, and only 16.8% had completed 38 weeks. Of those who were delivered at 38-40 weeks, 56.2% had completed 39 weeks, and 43.8% had completed 40 weeks. The mean gestational age was 37.1 weeks in those delivered at 36-38 weeks and was 39.8 weeks in those who gave birth at 38-40 weeks.

The study findings are concerning, because fetal lung maturity is known to reduce the risk of respiratory morbidity, and confirmation of fetal lung maturity is "a recognized exception to longstanding recommendations against elective delivery before 39 weeks’ gestation," Dr. Bates and her associates noted.

Also, despite existing recommendations to the contrary, one-third of elective cesarean deliveries in one large study were performed before 39 weeks, they said.

Taken together, the findings in the current study "are consistent with relative immaturity at 36-38 weeks (regardless of lung maturity), compared with 39-40 weeks, and lower threshold for admission to the NICU and for invasive sepsis work-ups (suspected sepsis)," the investigators wrote.

They added that the findings should be considered in light of the study’s limitations – including the retrospective study design and the related possibility of confounding, and the fact that the study does not fully address the risk of stillbirth associated with either delivery strategy studied. Nonetheless, they concluded that the findings suggest that "in the absence of ongoing concern about fetal death or maternal well-being if the pregnancy continued, delivery should be delayed until 39 weeks."

The findings also suggest that purely elective fetal lung maturity testing and early delivery should be avoided, Dr. Bates and her associates noted.

One of the study authors, Dr. Alan T. N. Tita, was a Women’s Reproductive Health Research Advanced Scholar at the University of Alabama at Birmingham at the time of the study and received funding from the National Institute of Child Health and Human Development. No relevant financial disclosures were reported by the other authors.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported in the February issue of the Journal of Investigative Dermatology.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported in the February issue of the Journal of Investigative Dermatology.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported in the February issue of the Journal of Investigative Dermatology.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

One in 15 neonates in a large, retrospective, observational study was delivered at 34-36 weeks’ gestation for potentially avoidable or elective precursors for late preterm delivery, and those deliveries were associated with greater risk of neonatal morbidity and mortality than were deliveries at or after 37 weeks for the same indications.

The findings suggest that nearly 7% of late preterm births – and possibly their associated morbidity and mortality – could be avoided, according to Dr. S. Katherine Laughon of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and her colleagues.

The investigators also found that different precursors for late preterm deliveries were associated with differing rates of neonatal morbidity in the study, a factor that has implications for counseling patients about the risks and benefits of late preterm delivery, they reported in November in Obstetrics & Gynecology.

Nearly 66% of preterm deliveries were late preterm deliveries in this study, which compared 15,136 singleton gestations delivered late preterm (between 34 weeks and 36 weeks 6 days) vs. 170,593 gestations delivered between 37 weeks and 41 weeks 6 days.

The investigators used data from the Consortium on Safe Labor, a study that included 228,668 deliveries from 12 clinical centers and 19 hospitals representing nine American College of Obstetricians and Gynecologists districts in 2002-2008.

Precursors for late preterm birth included spontaneous labor in 30% of cases, preterm premature rupture of membranes (PPROM) in 32% of cases, and medical indications for an obstetric, maternal, or fetal condition in 32% of cases. The cause of late preterm birth was unknown in 6% of cases, the investigators said (Obstet. Gynecol. 2010;116:1047-55).

Of the medical indications for late preterm delivery, hypertensive disease was most common (48% of indicated deliveries), followed by a maternal condition (32%), and a fetal condition (30%).

With advancing gestational age, the incidence of respiratory morbidity and neonatal sepsis decreased, as did neonatal intensive care unit admissions and median NICU length of stay, regardless of the reason for late preterm delivery, the investigators noted.

PPROM-related late preterm deliveries were associated with decreased severe respiratory morbidity, compared with those delivered for other reasons. Medically indicated late preterm deliveries were associated with a higher incidence of newborn sepsis and neonatal death at 35 and 36 weeks, compared with the other precursors. Indicated deliveries also were associated with a higher incidence of admission to the NICU at every gestational age, compared with the other categories.

The investigators found that among the "indicated" categories, 18% were for soft – or potentially avoidable – precursors. Additionally, in the "unknown" category there were 175 elective deliveries with no other maternal-fetal or obstetric complications, "and together these 1,044 soft or elective precursors made up 6.9%, or approximately 1 in 15, of all late preterm deliveries," they noted, adding that the "adjusted risk of oxygen use, transient tachypnea of the newborn, mechanical ventilation, respiratory distress syndrome, pneumonia or newborn sepsis, and admission to the NICU all were significantly decreased for neonates with soft or elective precursors delivered at 37, 38, 39, and 40 weeks of gestation compared with late preterm."

No increase in the risk of stillbirth or neonatal mortality was seen with expectant management of these soft precursors, suggesting that at least 1 in 15 of the deliveries with soft precursors could have been expectantly managed until 39 weeks’ gestation, Dr. Laughon and her associates said.

Furthermore, the differences in neonatal outcomes based on precursor type suggest that "the underlying pathology for precursors is an important determining factor in neonatal morbidity."

Based on these findings, the investigators recommended that elective deliveries be postponed until 39 weeks’ gestation. As for soft precursors, additional study is needed, they said. "More prospective data are needed and guidelines should be developed to help providers and women decide which soft precursors can be managed expectantly," Dr. Laughon and her associates concluded.

The authors said they had no relevant financial disclosures.

One in 15 neonates in a large, retrospective, observational study was delivered at 34-36 weeks’ gestation for potentially avoidable or elective precursors for late preterm delivery, and those deliveries were associated with greater risk of neonatal morbidity and mortality than were deliveries at or after 37 weeks for the same indications.

The findings suggest that nearly 7% of late preterm births – and possibly their associated morbidity and mortality – could be avoided, according to Dr. S. Katherine Laughon of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and her colleagues.

The investigators also found that different precursors for late preterm deliveries were associated with differing rates of neonatal morbidity in the study, a factor that has implications for counseling patients about the risks and benefits of late preterm delivery, they reported in November in Obstetrics & Gynecology.

Nearly 66% of preterm deliveries were late preterm deliveries in this study, which compared 15,136 singleton gestations delivered late preterm (between 34 weeks and 36 weeks 6 days) vs. 170,593 gestations delivered between 37 weeks and 41 weeks 6 days.

The investigators used data from the Consortium on Safe Labor, a study that included 228,668 deliveries from 12 clinical centers and 19 hospitals representing nine American College of Obstetricians and Gynecologists districts in 2002-2008.

Precursors for late preterm birth included spontaneous labor in 30% of cases, preterm premature rupture of membranes (PPROM) in 32% of cases, and medical indications for an obstetric, maternal, or fetal condition in 32% of cases. The cause of late preterm birth was unknown in 6% of cases, the investigators said (Obstet. Gynecol. 2010;116:1047-55).

Of the medical indications for late preterm delivery, hypertensive disease was most common (48% of indicated deliveries), followed by a maternal condition (32%), and a fetal condition (30%).

With advancing gestational age, the incidence of respiratory morbidity and neonatal sepsis decreased, as did neonatal intensive care unit admissions and median NICU length of stay, regardless of the reason for late preterm delivery, the investigators noted.

PPROM-related late preterm deliveries were associated with decreased severe respiratory morbidity, compared with those delivered for other reasons. Medically indicated late preterm deliveries were associated with a higher incidence of newborn sepsis and neonatal death at 35 and 36 weeks, compared with the other precursors. Indicated deliveries also were associated with a higher incidence of admission to the NICU at every gestational age, compared with the other categories.

The investigators found that among the "indicated" categories, 18% were for soft – or potentially avoidable – precursors. Additionally, in the "unknown" category there were 175 elective deliveries with no other maternal-fetal or obstetric complications, "and together these 1,044 soft or elective precursors made up 6.9%, or approximately 1 in 15, of all late preterm deliveries," they noted, adding that the "adjusted risk of oxygen use, transient tachypnea of the newborn, mechanical ventilation, respiratory distress syndrome, pneumonia or newborn sepsis, and admission to the NICU all were significantly decreased for neonates with soft or elective precursors delivered at 37, 38, 39, and 40 weeks of gestation compared with late preterm."

No increase in the risk of stillbirth or neonatal mortality was seen with expectant management of these soft precursors, suggesting that at least 1 in 15 of the deliveries with soft precursors could have been expectantly managed until 39 weeks’ gestation, Dr. Laughon and her associates said.

Furthermore, the differences in neonatal outcomes based on precursor type suggest that "the underlying pathology for precursors is an important determining factor in neonatal morbidity."

Based on these findings, the investigators recommended that elective deliveries be postponed until 39 weeks’ gestation. As for soft precursors, additional study is needed, they said. "More prospective data are needed and guidelines should be developed to help providers and women decide which soft precursors can be managed expectantly," Dr. Laughon and her associates concluded.

The authors said they had no relevant financial disclosures.

One in 15 neonates in a large, retrospective, observational study was delivered at 34-36 weeks’ gestation for potentially avoidable or elective precursors for late preterm delivery, and those deliveries were associated with greater risk of neonatal morbidity and mortality than were deliveries at or after 37 weeks for the same indications.

The findings suggest that nearly 7% of late preterm births – and possibly their associated morbidity and mortality – could be avoided, according to Dr. S. Katherine Laughon of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and her colleagues.

The investigators also found that different precursors for late preterm deliveries were associated with differing rates of neonatal morbidity in the study, a factor that has implications for counseling patients about the risks and benefits of late preterm delivery, they reported in November in Obstetrics & Gynecology.

Nearly 66% of preterm deliveries were late preterm deliveries in this study, which compared 15,136 singleton gestations delivered late preterm (between 34 weeks and 36 weeks 6 days) vs. 170,593 gestations delivered between 37 weeks and 41 weeks 6 days.

The investigators used data from the Consortium on Safe Labor, a study that included 228,668 deliveries from 12 clinical centers and 19 hospitals representing nine American College of Obstetricians and Gynecologists districts in 2002-2008.

Precursors for late preterm birth included spontaneous labor in 30% of cases, preterm premature rupture of membranes (PPROM) in 32% of cases, and medical indications for an obstetric, maternal, or fetal condition in 32% of cases. The cause of late preterm birth was unknown in 6% of cases, the investigators said (Obstet. Gynecol. 2010;116:1047-55).

Of the medical indications for late preterm delivery, hypertensive disease was most common (48% of indicated deliveries), followed by a maternal condition (32%), and a fetal condition (30%).

With advancing gestational age, the incidence of respiratory morbidity and neonatal sepsis decreased, as did neonatal intensive care unit admissions and median NICU length of stay, regardless of the reason for late preterm delivery, the investigators noted.

PPROM-related late preterm deliveries were associated with decreased severe respiratory morbidity, compared with those delivered for other reasons. Medically indicated late preterm deliveries were associated with a higher incidence of newborn sepsis and neonatal death at 35 and 36 weeks, compared with the other precursors. Indicated deliveries also were associated with a higher incidence of admission to the NICU at every gestational age, compared with the other categories.

The investigators found that among the "indicated" categories, 18% were for soft – or potentially avoidable – precursors. Additionally, in the "unknown" category there were 175 elective deliveries with no other maternal-fetal or obstetric complications, "and together these 1,044 soft or elective precursors made up 6.9%, or approximately 1 in 15, of all late preterm deliveries," they noted, adding that the "adjusted risk of oxygen use, transient tachypnea of the newborn, mechanical ventilation, respiratory distress syndrome, pneumonia or newborn sepsis, and admission to the NICU all were significantly decreased for neonates with soft or elective precursors delivered at 37, 38, 39, and 40 weeks of gestation compared with late preterm."

No increase in the risk of stillbirth or neonatal mortality was seen with expectant management of these soft precursors, suggesting that at least 1 in 15 of the deliveries with soft precursors could have been expectantly managed until 39 weeks’ gestation, Dr. Laughon and her associates said.

Furthermore, the differences in neonatal outcomes based on precursor type suggest that "the underlying pathology for precursors is an important determining factor in neonatal morbidity."

Based on these findings, the investigators recommended that elective deliveries be postponed until 39 weeks’ gestation. As for soft precursors, additional study is needed, they said. "More prospective data are needed and guidelines should be developed to help providers and women decide which soft precursors can be managed expectantly," Dr. Laughon and her associates concluded.

The authors said they had no relevant financial disclosures.