Sharon Worcester

Major Finding: The overall rate of pediatric hospitalizations due to C. difficile infections increased from 7.24 to 12.80 per 10,000 hospitalizations, with the highest rates occurring in children aged 1-4 years (rate of 44.87/10,000), 5-9 years (35.27/10,000), and less than 1 year, except newborns (32.01/10,000).

Data Source: Data from 3,739 hospitals from the Health Care Cost and Utilization Project and the National Hospital Discharge Survey.

Disclosures: Dr. Zilberberg reported receiving grant support for this study from ViroPharma.

Pediatric hospitalizations associated with Clostridium difficile infections increased dramatically from 1997 through 2006, according to data from the Health Care Cost and Utilization Project and the National Hospital Discharge Survey.

The overall rate of such hospitalizations increased from 7.24 to 12.80 per 10,000 hospitalizations, with the highest rates occurring in children aged 1-4 years (rate of 44.87/10,000), 5-9 years (35.27/10,000), and less than 1 year, except newborns (32.01/10,000). The lowest rates were seen in newborns, defined as infants whose related hospitalizations originated at their birth (0.5/10,000), Dr. Marya D. Zilberberg of the University of Massachusetts, Amherst, and her colleagues reported.

Most of the increase in C. difficile infection (CDI)–related hospitalizations identified in this study occurred between 2000 and 2006, and this may reflect the spread of a new hypervirulent bacterial strain of C. difficile known as BI/NAP1/027. An increase in detection of the strain has coincided with reports of increasing CDI-related hospitalizations, the authors noted (Emerg. Infect. Dis. 2010;16:604-9).

Evidence suggests that CDI is an increasingly prevalent diarrheal pathogen in children, and that a large proportion of pediatric CDI cases are community acquired. Many cases appear to be occurring without the exposure to antimicrobial drugs that has typically been a risk factor for CDI, they said, noting that the BI/NAP1/027 strain likely is related to these changes in pediatric CDI epidemiology; at least two reports show it has a prevalence of up to 38% in pediatric CDI populations, and it is associated with a fourfold increase in complication rates, compared with other strains.

To better characterize the epidemiology, the investigators performed a time-series analysis using information from the Kids' Inpatient Database (KID) of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, which includes data from more than 3,700 hospitals in 38 states, and from the Centers for Disease Control and Prevention's National Hospital Discharge Survey, which includes information from about 500 noninstitutional, nonfederal, short-stay hospitals in the United States.

The findings are consistent with those from other recent studies, which also showed increases in CDI-related hospitalizations and community-onset infections. In one study of children who presented to an emergency department with diarrheal illnesses, stool specimens were positive for C. difficile in 6.7%, but were positive for viral pathogens in 33% of cases.

Additional study is urgently needed to help better define the epidemiology of CDI, the investigators said, noting a particular need for more information about its role in the pathogenesis of disease in those under age 1 year who are not newborns. Laboratory testing for CDI is not routinely performed in those under age 1 year, because of their typically low rate of clinical disease and high rate of C. difficile carriage, and it remains unclear whether the relatively high rate of CDI-related hospitalizations in this group is a reflection of true disease or colonization, Dr. Zilberberg and her associates said.

“The detection of [C. difficile] free toxins A, B, or both in the stool of a symptomatic infant does not ensure a pathogenic role for C. difficile, especially if another cause for diarrhea can be identified,” they wrote, adding that non-CDI causes of diarrhea may have led to a reporting bias. This would explain the observed increase in CDI rates and, as shown in this study, an increasing cause of pediatric hospitalizations.

Major Finding: The overall rate of pediatric hospitalizations due to C. difficile infections increased from 7.24 to 12.80 per 10,000 hospitalizations, with the highest rates occurring in children aged 1-4 years (rate of 44.87/10,000), 5-9 years (35.27/10,000), and less than 1 year, except newborns (32.01/10,000).

Data Source: Data from 3,739 hospitals from the Health Care Cost and Utilization Project and the National Hospital Discharge Survey.

Disclosures: Dr. Zilberberg reported receiving grant support for this study from ViroPharma.

Pediatric hospitalizations associated with Clostridium difficile infections increased dramatically from 1997 through 2006, according to data from the Health Care Cost and Utilization Project and the National Hospital Discharge Survey.

The overall rate of such hospitalizations increased from 7.24 to 12.80 per 10,000 hospitalizations, with the highest rates occurring in children aged 1-4 years (rate of 44.87/10,000), 5-9 years (35.27/10,000), and less than 1 year, except newborns (32.01/10,000). The lowest rates were seen in newborns, defined as infants whose related hospitalizations originated at their birth (0.5/10,000), Dr. Marya D. Zilberberg of the University of Massachusetts, Amherst, and her colleagues reported.

Most of the increase in C. difficile infection (CDI)–related hospitalizations identified in this study occurred between 2000 and 2006, and this may reflect the spread of a new hypervirulent bacterial strain of C. difficile known as BI/NAP1/027. An increase in detection of the strain has coincided with reports of increasing CDI-related hospitalizations, the authors noted (Emerg. Infect. Dis. 2010;16:604-9).

Evidence suggests that CDI is an increasingly prevalent diarrheal pathogen in children, and that a large proportion of pediatric CDI cases are community acquired. Many cases appear to be occurring without the exposure to antimicrobial drugs that has typically been a risk factor for CDI, they said, noting that the BI/NAP1/027 strain likely is related to these changes in pediatric CDI epidemiology; at least two reports show it has a prevalence of up to 38% in pediatric CDI populations, and it is associated with a fourfold increase in complication rates, compared with other strains.

To better characterize the epidemiology, the investigators performed a time-series analysis using information from the Kids' Inpatient Database (KID) of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, which includes data from more than 3,700 hospitals in 38 states, and from the Centers for Disease Control and Prevention's National Hospital Discharge Survey, which includes information from about 500 noninstitutional, nonfederal, short-stay hospitals in the United States.

The findings are consistent with those from other recent studies, which also showed increases in CDI-related hospitalizations and community-onset infections. In one study of children who presented to an emergency department with diarrheal illnesses, stool specimens were positive for C. difficile in 6.7%, but were positive for viral pathogens in 33% of cases.

Additional study is urgently needed to help better define the epidemiology of CDI, the investigators said, noting a particular need for more information about its role in the pathogenesis of disease in those under age 1 year who are not newborns. Laboratory testing for CDI is not routinely performed in those under age 1 year, because of their typically low rate of clinical disease and high rate of C. difficile carriage, and it remains unclear whether the relatively high rate of CDI-related hospitalizations in this group is a reflection of true disease or colonization, Dr. Zilberberg and her associates said.

“The detection of [C. difficile] free toxins A, B, or both in the stool of a symptomatic infant does not ensure a pathogenic role for C. difficile, especially if another cause for diarrhea can be identified,” they wrote, adding that non-CDI causes of diarrhea may have led to a reporting bias. This would explain the observed increase in CDI rates and, as shown in this study, an increasing cause of pediatric hospitalizations.

Major Finding: The overall rate of pediatric hospitalizations due to C. difficile infections increased from 7.24 to 12.80 per 10,000 hospitalizations, with the highest rates occurring in children aged 1-4 years (rate of 44.87/10,000), 5-9 years (35.27/10,000), and less than 1 year, except newborns (32.01/10,000).

Data Source: Data from 3,739 hospitals from the Health Care Cost and Utilization Project and the National Hospital Discharge Survey.

Disclosures: Dr. Zilberberg reported receiving grant support for this study from ViroPharma.

Pediatric hospitalizations associated with Clostridium difficile infections increased dramatically from 1997 through 2006, according to data from the Health Care Cost and Utilization Project and the National Hospital Discharge Survey.

The overall rate of such hospitalizations increased from 7.24 to 12.80 per 10,000 hospitalizations, with the highest rates occurring in children aged 1-4 years (rate of 44.87/10,000), 5-9 years (35.27/10,000), and less than 1 year, except newborns (32.01/10,000). The lowest rates were seen in newborns, defined as infants whose related hospitalizations originated at their birth (0.5/10,000), Dr. Marya D. Zilberberg of the University of Massachusetts, Amherst, and her colleagues reported.

Most of the increase in C. difficile infection (CDI)–related hospitalizations identified in this study occurred between 2000 and 2006, and this may reflect the spread of a new hypervirulent bacterial strain of C. difficile known as BI/NAP1/027. An increase in detection of the strain has coincided with reports of increasing CDI-related hospitalizations, the authors noted (Emerg. Infect. Dis. 2010;16:604-9).

Evidence suggests that CDI is an increasingly prevalent diarrheal pathogen in children, and that a large proportion of pediatric CDI cases are community acquired. Many cases appear to be occurring without the exposure to antimicrobial drugs that has typically been a risk factor for CDI, they said, noting that the BI/NAP1/027 strain likely is related to these changes in pediatric CDI epidemiology; at least two reports show it has a prevalence of up to 38% in pediatric CDI populations, and it is associated with a fourfold increase in complication rates, compared with other strains.

To better characterize the epidemiology, the investigators performed a time-series analysis using information from the Kids' Inpatient Database (KID) of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, which includes data from more than 3,700 hospitals in 38 states, and from the Centers for Disease Control and Prevention's National Hospital Discharge Survey, which includes information from about 500 noninstitutional, nonfederal, short-stay hospitals in the United States.

The findings are consistent with those from other recent studies, which also showed increases in CDI-related hospitalizations and community-onset infections. In one study of children who presented to an emergency department with diarrheal illnesses, stool specimens were positive for C. difficile in 6.7%, but were positive for viral pathogens in 33% of cases.

Additional study is urgently needed to help better define the epidemiology of CDI, the investigators said, noting a particular need for more information about its role in the pathogenesis of disease in those under age 1 year who are not newborns. Laboratory testing for CDI is not routinely performed in those under age 1 year, because of their typically low rate of clinical disease and high rate of C. difficile carriage, and it remains unclear whether the relatively high rate of CDI-related hospitalizations in this group is a reflection of true disease or colonization, Dr. Zilberberg and her associates said.

“The detection of [C. difficile] free toxins A, B, or both in the stool of a symptomatic infant does not ensure a pathogenic role for C. difficile, especially if another cause for diarrhea can be identified,” they wrote, adding that non-CDI causes of diarrhea may have led to a reporting bias. This would explain the observed increase in CDI rates and, as shown in this study, an increasing cause of pediatric hospitalizations.

Although nearly a third of U.S. adults were at high risk for developing type 2 diabetes in 2005–2006, about 7% knew of their risk status, and only about half of those said they adopted risk reduction behaviors, data from the 2005–2006 National Health and Nutrition Examination Survey suggest.

Furthermore, of those who were aware of their risk status and who received health care in the year prior to the survey, only 35% said they were advised by their physician to try to control or lose weight, 37% said they were advised to reduce fat or calorie intake, and 39% said they were advised to increase physical activity, Linda S. Geiss of the Centers for Disease Control and Prevention, Atlanta, and her colleagues reported.

The data—from 1,391 adults aged 20 years and older without diabetes who participated in the survey—showed that reports of physician advice was strongly associated with reports of engaging in risk-reduction behaviors during the past year. Of those who received physician advice about weight loss or control, diet, and physical activity, 75%, 82%, and 71%, respectively, reported following the advice, the investigators said (Am. J. Prev. Med. 2010 April [doi:10.1016/j.amepre.2009.12.029]).

The multivariate adjusted prevalence of trying to control or lose weight, reduce fat or calorie intake, and increase physical activity for those who received advice vs. those who did not was 71.0 vs. 44.2, 81.2 vs. 42.3, and 67.9 vs. 38.4 for each behavior, respectively, the researchers found.

The findings are important because prevention trials consistently show that diabetes risk can be reduced substantially through modest weight loss and increased physical activity. However, improved efforts on the part of physicians to advise patients about lifestyle modifications are likely to be insufficient, as it has not been shown to be associated with maintaining the changes, they explained.

“Prevention promotion by physicians and other health professionals may be more effective if part of a larger process within healthcare systems and communities to promote behavior change,” they wrote. They went on to say that prospective studies of interventions and policies to promote and maintain healthy lifestyles with more objective measures of behaviors and outcomes are needed, as are studies on why and when people are screened for diabetes and counseled about behavior modification, and studies on what types of counseling are effective.

“Reversing the national trends in diabetes incidence is likely to require multiple tiers of interventions,” they wrote, noting a need for increased promotion of risk reduction behaviors, increased availability of evidence-based programs for those at risk, and more efficient identification and awareness of risk on the part of patients, providers, health care systems, and health payers.

Disclosures: The authors reported no financial disclosures.

Although nearly a third of U.S. adults were at high risk for developing type 2 diabetes in 2005–2006, about 7% knew of their risk status, and only about half of those said they adopted risk reduction behaviors, data from the 2005–2006 National Health and Nutrition Examination Survey suggest.

Furthermore, of those who were aware of their risk status and who received health care in the year prior to the survey, only 35% said they were advised by their physician to try to control or lose weight, 37% said they were advised to reduce fat or calorie intake, and 39% said they were advised to increase physical activity, Linda S. Geiss of the Centers for Disease Control and Prevention, Atlanta, and her colleagues reported.

The data—from 1,391 adults aged 20 years and older without diabetes who participated in the survey—showed that reports of physician advice was strongly associated with reports of engaging in risk-reduction behaviors during the past year. Of those who received physician advice about weight loss or control, diet, and physical activity, 75%, 82%, and 71%, respectively, reported following the advice, the investigators said (Am. J. Prev. Med. 2010 April [doi:10.1016/j.amepre.2009.12.029]).

The multivariate adjusted prevalence of trying to control or lose weight, reduce fat or calorie intake, and increase physical activity for those who received advice vs. those who did not was 71.0 vs. 44.2, 81.2 vs. 42.3, and 67.9 vs. 38.4 for each behavior, respectively, the researchers found.

The findings are important because prevention trials consistently show that diabetes risk can be reduced substantially through modest weight loss and increased physical activity. However, improved efforts on the part of physicians to advise patients about lifestyle modifications are likely to be insufficient, as it has not been shown to be associated with maintaining the changes, they explained.

“Prevention promotion by physicians and other health professionals may be more effective if part of a larger process within healthcare systems and communities to promote behavior change,” they wrote. They went on to say that prospective studies of interventions and policies to promote and maintain healthy lifestyles with more objective measures of behaviors and outcomes are needed, as are studies on why and when people are screened for diabetes and counseled about behavior modification, and studies on what types of counseling are effective.

“Reversing the national trends in diabetes incidence is likely to require multiple tiers of interventions,” they wrote, noting a need for increased promotion of risk reduction behaviors, increased availability of evidence-based programs for those at risk, and more efficient identification and awareness of risk on the part of patients, providers, health care systems, and health payers.

Disclosures: The authors reported no financial disclosures.

Although nearly a third of U.S. adults were at high risk for developing type 2 diabetes in 2005–2006, about 7% knew of their risk status, and only about half of those said they adopted risk reduction behaviors, data from the 2005–2006 National Health and Nutrition Examination Survey suggest.

Furthermore, of those who were aware of their risk status and who received health care in the year prior to the survey, only 35% said they were advised by their physician to try to control or lose weight, 37% said they were advised to reduce fat or calorie intake, and 39% said they were advised to increase physical activity, Linda S. Geiss of the Centers for Disease Control and Prevention, Atlanta, and her colleagues reported.

The data—from 1,391 adults aged 20 years and older without diabetes who participated in the survey—showed that reports of physician advice was strongly associated with reports of engaging in risk-reduction behaviors during the past year. Of those who received physician advice about weight loss or control, diet, and physical activity, 75%, 82%, and 71%, respectively, reported following the advice, the investigators said (Am. J. Prev. Med. 2010 April [doi:10.1016/j.amepre.2009.12.029]).

The multivariate adjusted prevalence of trying to control or lose weight, reduce fat or calorie intake, and increase physical activity for those who received advice vs. those who did not was 71.0 vs. 44.2, 81.2 vs. 42.3, and 67.9 vs. 38.4 for each behavior, respectively, the researchers found.

The findings are important because prevention trials consistently show that diabetes risk can be reduced substantially through modest weight loss and increased physical activity. However, improved efforts on the part of physicians to advise patients about lifestyle modifications are likely to be insufficient, as it has not been shown to be associated with maintaining the changes, they explained.

“Prevention promotion by physicians and other health professionals may be more effective if part of a larger process within healthcare systems and communities to promote behavior change,” they wrote. They went on to say that prospective studies of interventions and policies to promote and maintain healthy lifestyles with more objective measures of behaviors and outcomes are needed, as are studies on why and when people are screened for diabetes and counseled about behavior modification, and studies on what types of counseling are effective.

“Reversing the national trends in diabetes incidence is likely to require multiple tiers of interventions,” they wrote, noting a need for increased promotion of risk reduction behaviors, increased availability of evidence-based programs for those at risk, and more efficient identification and awareness of risk on the part of patients, providers, health care systems, and health payers.

Disclosures: The authors reported no financial disclosures.

MIAMI - Patients, particularly those with pigmented skin, should be counseled about the importance of vitamin D intake through supplementation, diet, and sun exposure, according to Dr. Pearl E. Grimes.

Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.

African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.

Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.

In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.

More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.

Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.

In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.

Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.

The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.

Patients should be advised about the best sources of dietary vitamin D, including  fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.

"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.

"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.

Dr. Grimes reported she had no disclosures related to her presentation.

MIAMI - Patients, particularly those with pigmented skin, should be counseled about the importance of vitamin D intake through supplementation, diet, and sun exposure, according to Dr. Pearl E. Grimes.

Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.

African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.

Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.

In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.

More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.

Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.

In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.

Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.

The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.

Patients should be advised about the best sources of dietary vitamin D, including  fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.

"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.

"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.

Dr. Grimes reported she had no disclosures related to her presentation.

MIAMI - Patients, particularly those with pigmented skin, should be counseled about the importance of vitamin D intake through supplementation, diet, and sun exposure, according to Dr. Pearl E. Grimes.

Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.

African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.

Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.

In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.

More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.

Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.

In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.

Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.

The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.

Patients should be advised about the best sources of dietary vitamin D, including  fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.

"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.

"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.

Dr. Grimes reported she had no disclosures related to her presentation.

MIAMI – Long-term use of tacrolimus ointment in children with atopic dermatitis is associated with a low rate of serious adverse events, according to interim data from a prospective study.

The safety profile shown thus far is consistent with the established profile for tacrolimus ointment (Protopic), and it is hoped that these findings will encourage dermatologists to continue enrolling pediatric patients in this ongoing phase IV safety study, Dr. Joyce Rico said in a poster presentation at the annual meeting of the American Academy of Dermatology.

The interim report focused on 4,800 patients enrolled in APPLES (A Prospective Pediatric Longitudinal Evaluation Study) between May 2005 and September 2009. The investigators seek to enroll 8,000 children in the multinational, observational cohort study, said Dr. Rico, vice president of medical science at Astellas Pharma Inc., Chicago.

That is the number needed to accurately identify an increase in the risk of malignancy associated with tacrolimus treatment over the course of the 10-year study, but the investigators are also evaluating other serious adverse events.

Such events occurred in about 5% of the participants, who had a median age of 6 years at enrollment. Most of the serious events were asthma, occurring in 1% of patients, and infectionsincluding pneumonia, bronchitis, cellulitis, gastroenteritis, and tonsillitis – occurring in nearly 2% of patients. There was one report of a malignancy – a peripheral glioneuronal tumor – not typically associated with immunosuppression, Dr. Rico noted.

The malignancy rate in APPLES is half that seen in the general U.S. population, based on data from the Surveillance, Epidemiology, and End Results database, she said.

About 40% of children in APPLES had mild disease at baseline and about 60% reported moderate or severe disease. Treatment is either 0.03% ointment (the dosage approved for children) or off-label 0.1% ointment (the dosage approved for adults); most are being treated with 0.1% ointment. The median cumulative duration of time since initial treatment application is 2.8 years per patient.

“The serious adverse events profile we’re seeing is consistent with what was observed during the clinical development program,” Dr. Rico said, noting that, although the results are encouraging, enrollment of the full 8,000 patients is needed to adequately address the long-term safety of tacrolimus treatment in children.

“I encourage you and your colleagues to continue to enroll patients ... It’s going to take the dermatology community continuing to help us to reach that goal,” she concluded.

Dr. Rico is employed by Astellas, the maker of Protopic and sponsor of the study.

MIAMI – Long-term use of tacrolimus ointment in children with atopic dermatitis is associated with a low rate of serious adverse events, according to interim data from a prospective study.

The safety profile shown thus far is consistent with the established profile for tacrolimus ointment (Protopic), and it is hoped that these findings will encourage dermatologists to continue enrolling pediatric patients in this ongoing phase IV safety study, Dr. Joyce Rico said in a poster presentation at the annual meeting of the American Academy of Dermatology.

The interim report focused on 4,800 patients enrolled in APPLES (A Prospective Pediatric Longitudinal Evaluation Study) between May 2005 and September 2009. The investigators seek to enroll 8,000 children in the multinational, observational cohort study, said Dr. Rico, vice president of medical science at Astellas Pharma Inc., Chicago.

That is the number needed to accurately identify an increase in the risk of malignancy associated with tacrolimus treatment over the course of the 10-year study, but the investigators are also evaluating other serious adverse events.

Such events occurred in about 5% of the participants, who had a median age of 6 years at enrollment. Most of the serious events were asthma, occurring in 1% of patients, and infectionsincluding pneumonia, bronchitis, cellulitis, gastroenteritis, and tonsillitis – occurring in nearly 2% of patients. There was one report of a malignancy – a peripheral glioneuronal tumor – not typically associated with immunosuppression, Dr. Rico noted.

The malignancy rate in APPLES is half that seen in the general U.S. population, based on data from the Surveillance, Epidemiology, and End Results database, she said.

About 40% of children in APPLES had mild disease at baseline and about 60% reported moderate or severe disease. Treatment is either 0.03% ointment (the dosage approved for children) or off-label 0.1% ointment (the dosage approved for adults); most are being treated with 0.1% ointment. The median cumulative duration of time since initial treatment application is 2.8 years per patient.

“The serious adverse events profile we’re seeing is consistent with what was observed during the clinical development program,” Dr. Rico said, noting that, although the results are encouraging, enrollment of the full 8,000 patients is needed to adequately address the long-term safety of tacrolimus treatment in children.

“I encourage you and your colleagues to continue to enroll patients ... It’s going to take the dermatology community continuing to help us to reach that goal,” she concluded.

Dr. Rico is employed by Astellas, the maker of Protopic and sponsor of the study.

MIAMI – Long-term use of tacrolimus ointment in children with atopic dermatitis is associated with a low rate of serious adverse events, according to interim data from a prospective study.

The safety profile shown thus far is consistent with the established profile for tacrolimus ointment (Protopic), and it is hoped that these findings will encourage dermatologists to continue enrolling pediatric patients in this ongoing phase IV safety study, Dr. Joyce Rico said in a poster presentation at the annual meeting of the American Academy of Dermatology.

The interim report focused on 4,800 patients enrolled in APPLES (A Prospective Pediatric Longitudinal Evaluation Study) between May 2005 and September 2009. The investigators seek to enroll 8,000 children in the multinational, observational cohort study, said Dr. Rico, vice president of medical science at Astellas Pharma Inc., Chicago.

That is the number needed to accurately identify an increase in the risk of malignancy associated with tacrolimus treatment over the course of the 10-year study, but the investigators are also evaluating other serious adverse events.

Such events occurred in about 5% of the participants, who had a median age of 6 years at enrollment. Most of the serious events were asthma, occurring in 1% of patients, and infectionsincluding pneumonia, bronchitis, cellulitis, gastroenteritis, and tonsillitis – occurring in nearly 2% of patients. There was one report of a malignancy – a peripheral glioneuronal tumor – not typically associated with immunosuppression, Dr. Rico noted.

The malignancy rate in APPLES is half that seen in the general U.S. population, based on data from the Surveillance, Epidemiology, and End Results database, she said.

About 40% of children in APPLES had mild disease at baseline and about 60% reported moderate or severe disease. Treatment is either 0.03% ointment (the dosage approved for children) or off-label 0.1% ointment (the dosage approved for adults); most are being treated with 0.1% ointment. The median cumulative duration of time since initial treatment application is 2.8 years per patient.

“The serious adverse events profile we’re seeing is consistent with what was observed during the clinical development program,” Dr. Rico said, noting that, although the results are encouraging, enrollment of the full 8,000 patients is needed to adequately address the long-term safety of tacrolimus treatment in children.

“I encourage you and your colleagues to continue to enroll patients ... It’s going to take the dermatology community continuing to help us to reach that goal,” she concluded.

Dr. Rico is employed by Astellas, the maker of Protopic and sponsor of the study.

MIAMI - The cost of treating dermatologic toxicities associated with targeted anticancer therapies contributes significantly to the overall financial burden of cancer care, cost analysis data from 131 affected patients suggest.

The overall cost of caring for treatment-related dermatologic toxicities in the 30-month study was more than $337,409, or $2,576 per patient, Dr. Judy H. Borovicka reported at the annual meeting of the American Academy of Dermatology.

The analysis included the cost of clinic visits, laboratory tests, diagnostic and therapeutic procedures, medications, and supplies, said Dr. Borovicka, a clinical trial investigator at Northwestern University, Chicago.

Patients had a total of 481 visits (for an average of 3.7 per person) to a subspecialty clinic developed to treat skin and eye reactions to inhibitors of epidermal growth-factor receptor and kinases (the SERIES Clinic in Chicago) between November 2005 and April 2008, for a mean cost per visit of $701. All were diagnosed with 1 of 15 primary cancer types, and were treated with rituximab, erlotinib, imatinib, lapatinib, panitumumab, sorafenib, or sunitinib.

The more common dermatologic toxicities associated with these drugs included papulopustular rash, periungual inflammation, xerosis, alopecia, and ocular changes. Papulopustular rash was the most common toxicity, occurring in 45%-100% of patients.

Sorafenib induced the most costly dermatologic toxicities, with a mean overall patient cost of $2,974; lapatinib and imatinib were associated with the least costly toxicities, with mean overall costs of $1,275 and $1,490, respectively, Dr. Borovicka said, noting that the differences in cost between sorafenib and lapatinib/imatinib were statistically significant.

Toxicity severity was predictive of increased patient cost; however, age, gender, race/ethnicity, cancer type, and cancer severity were not predictors of patient cost, Dr. Borovicka said.

"Toxicities impact the quality of life of patients undergoing treatment with targeted anticancer therapies, and they carry significant financial implications... management of untoward effects is paramount to minimizing the disruption of therapy," she concluded.

Dr. Borovicka stated that she has no relevant financial or other disclosures related to this study.

MIAMI - The cost of treating dermatologic toxicities associated with targeted anticancer therapies contributes significantly to the overall financial burden of cancer care, cost analysis data from 131 affected patients suggest.

The overall cost of caring for treatment-related dermatologic toxicities in the 30-month study was more than $337,409, or $2,576 per patient, Dr. Judy H. Borovicka reported at the annual meeting of the American Academy of Dermatology.

The analysis included the cost of clinic visits, laboratory tests, diagnostic and therapeutic procedures, medications, and supplies, said Dr. Borovicka, a clinical trial investigator at Northwestern University, Chicago.

Patients had a total of 481 visits (for an average of 3.7 per person) to a subspecialty clinic developed to treat skin and eye reactions to inhibitors of epidermal growth-factor receptor and kinases (the SERIES Clinic in Chicago) between November 2005 and April 2008, for a mean cost per visit of $701. All were diagnosed with 1 of 15 primary cancer types, and were treated with rituximab, erlotinib, imatinib, lapatinib, panitumumab, sorafenib, or sunitinib.

The more common dermatologic toxicities associated with these drugs included papulopustular rash, periungual inflammation, xerosis, alopecia, and ocular changes. Papulopustular rash was the most common toxicity, occurring in 45%-100% of patients.

Sorafenib induced the most costly dermatologic toxicities, with a mean overall patient cost of $2,974; lapatinib and imatinib were associated with the least costly toxicities, with mean overall costs of $1,275 and $1,490, respectively, Dr. Borovicka said, noting that the differences in cost between sorafenib and lapatinib/imatinib were statistically significant.

Toxicity severity was predictive of increased patient cost; however, age, gender, race/ethnicity, cancer type, and cancer severity were not predictors of patient cost, Dr. Borovicka said.

"Toxicities impact the quality of life of patients undergoing treatment with targeted anticancer therapies, and they carry significant financial implications... management of untoward effects is paramount to minimizing the disruption of therapy," she concluded.

Dr. Borovicka stated that she has no relevant financial or other disclosures related to this study.

MIAMI - The cost of treating dermatologic toxicities associated with targeted anticancer therapies contributes significantly to the overall financial burden of cancer care, cost analysis data from 131 affected patients suggest.

The overall cost of caring for treatment-related dermatologic toxicities in the 30-month study was more than $337,409, or $2,576 per patient, Dr. Judy H. Borovicka reported at the annual meeting of the American Academy of Dermatology.

The analysis included the cost of clinic visits, laboratory tests, diagnostic and therapeutic procedures, medications, and supplies, said Dr. Borovicka, a clinical trial investigator at Northwestern University, Chicago.

Patients had a total of 481 visits (for an average of 3.7 per person) to a subspecialty clinic developed to treat skin and eye reactions to inhibitors of epidermal growth-factor receptor and kinases (the SERIES Clinic in Chicago) between November 2005 and April 2008, for a mean cost per visit of $701. All were diagnosed with 1 of 15 primary cancer types, and were treated with rituximab, erlotinib, imatinib, lapatinib, panitumumab, sorafenib, or sunitinib.

The more common dermatologic toxicities associated with these drugs included papulopustular rash, periungual inflammation, xerosis, alopecia, and ocular changes. Papulopustular rash was the most common toxicity, occurring in 45%-100% of patients.

Sorafenib induced the most costly dermatologic toxicities, with a mean overall patient cost of $2,974; lapatinib and imatinib were associated with the least costly toxicities, with mean overall costs of $1,275 and $1,490, respectively, Dr. Borovicka said, noting that the differences in cost between sorafenib and lapatinib/imatinib were statistically significant.

Toxicity severity was predictive of increased patient cost; however, age, gender, race/ethnicity, cancer type, and cancer severity were not predictors of patient cost, Dr. Borovicka said.

"Toxicities impact the quality of life of patients undergoing treatment with targeted anticancer therapies, and they carry significant financial implications... management of untoward effects is paramount to minimizing the disruption of therapy," she concluded.

Dr. Borovicka stated that she has no relevant financial or other disclosures related to this study.

MIAMI – Children with psoriasis have a significantly greater risk of developing a psychiatric disorder than those without psoriasis, according to findings from a large, retrospective, case-control study.

Nationally representative health plan data for 7,404 children with psoriasis under age 18 years found that 5.1% were diagnosed with or treated for a psychiatric disorder after health plan enrollment, compared with 4.1% of 37,020 controls. Psoriasis patients were particularly more likely to be diagnosed with depression (3%) or anxiety (1.8%), compared with controls (2.4% and 1.4%, respectively), Carol Bao, Ph.D., reported during a poster discussion session at the annual meeting of the American Academy of Dermatology.

For children with psoriasis, the estimated hazard ratio for developing any psychiatric disorder was 1.25, for developing depression was 1.23, and for developing anxiety was 1.32, said Dr. Bao, a senior manager at Abbott Laboratories, Chicago.

The investigators also looked at prescriptions for psychotropic medications in assessing risk for development of psychiatric disorders. Prescriptions can be a marker for a diagnosis in cases where the prescribing physician may be hesitant to refer the patient or make a diagnosis, Dr. Bao explained, noting that this helped correct for possible underestimation of the development of psychiatric disorders and provided a risk estimate range.

When both diagnoses and prescriptions were considered, psoriasis patients had 25%-47% greater risk of developing a psychiatric disorder, 23%-62% greater risk of developing depression, and 32%-250% greater risk of developing anxiety, compared with controls, she said.

Patients included in the study had a mean age of 11.4 years. They were selected from a database of health plan participants who were enrolled in a plan at least 6 months before and after the first psoriasis diagnosis date (the index date), and who were followed from the index date until they were first diagnosed with any psychiatric disorder or were prescribed a drug used for the treatment of a psychiatric disorder. Any plan participant with a pre-enrollment psychiatric diagnosis or prescription was excluded.

Controls were matched to patients based on age, sex, and index date.

The findings of an increased risk of developing psychiatric disorders in case patients remained significant after controlling for age, sex, health plan, region of residence, and comorbidities, Dr. Bao noted.

The study is limited by the potential for coding and reporting errors in the data used and by lack of information on the severity of the psychiatric disorders. However, the findings do suggest that the psychiatric impact of psoriasis on children must be addressed because of the potential for both short-and long-term adverse effects.

"If we put these data in perspective, the development of psychiatric disorders at a young age can have a great impact in future adult life," she said.

Abbott Laboratories sponsored the study.

MIAMI – Children with psoriasis have a significantly greater risk of developing a psychiatric disorder than those without psoriasis, according to findings from a large, retrospective, case-control study.

Nationally representative health plan data for 7,404 children with psoriasis under age 18 years found that 5.1% were diagnosed with or treated for a psychiatric disorder after health plan enrollment, compared with 4.1% of 37,020 controls. Psoriasis patients were particularly more likely to be diagnosed with depression (3%) or anxiety (1.8%), compared with controls (2.4% and 1.4%, respectively), Carol Bao, Ph.D., reported during a poster discussion session at the annual meeting of the American Academy of Dermatology.

For children with psoriasis, the estimated hazard ratio for developing any psychiatric disorder was 1.25, for developing depression was 1.23, and for developing anxiety was 1.32, said Dr. Bao, a senior manager at Abbott Laboratories, Chicago.

The investigators also looked at prescriptions for psychotropic medications in assessing risk for development of psychiatric disorders. Prescriptions can be a marker for a diagnosis in cases where the prescribing physician may be hesitant to refer the patient or make a diagnosis, Dr. Bao explained, noting that this helped correct for possible underestimation of the development of psychiatric disorders and provided a risk estimate range.

When both diagnoses and prescriptions were considered, psoriasis patients had 25%-47% greater risk of developing a psychiatric disorder, 23%-62% greater risk of developing depression, and 32%-250% greater risk of developing anxiety, compared with controls, she said.

Patients included in the study had a mean age of 11.4 years. They were selected from a database of health plan participants who were enrolled in a plan at least 6 months before and after the first psoriasis diagnosis date (the index date), and who were followed from the index date until they were first diagnosed with any psychiatric disorder or were prescribed a drug used for the treatment of a psychiatric disorder. Any plan participant with a pre-enrollment psychiatric diagnosis or prescription was excluded.

Controls were matched to patients based on age, sex, and index date.

The findings of an increased risk of developing psychiatric disorders in case patients remained significant after controlling for age, sex, health plan, region of residence, and comorbidities, Dr. Bao noted.

The study is limited by the potential for coding and reporting errors in the data used and by lack of information on the severity of the psychiatric disorders. However, the findings do suggest that the psychiatric impact of psoriasis on children must be addressed because of the potential for both short-and long-term adverse effects.

"If we put these data in perspective, the development of psychiatric disorders at a young age can have a great impact in future adult life," she said.

Abbott Laboratories sponsored the study.

MIAMI – Children with psoriasis have a significantly greater risk of developing a psychiatric disorder than those without psoriasis, according to findings from a large, retrospective, case-control study.

Nationally representative health plan data for 7,404 children with psoriasis under age 18 years found that 5.1% were diagnosed with or treated for a psychiatric disorder after health plan enrollment, compared with 4.1% of 37,020 controls. Psoriasis patients were particularly more likely to be diagnosed with depression (3%) or anxiety (1.8%), compared with controls (2.4% and 1.4%, respectively), Carol Bao, Ph.D., reported during a poster discussion session at the annual meeting of the American Academy of Dermatology.

For children with psoriasis, the estimated hazard ratio for developing any psychiatric disorder was 1.25, for developing depression was 1.23, and for developing anxiety was 1.32, said Dr. Bao, a senior manager at Abbott Laboratories, Chicago.

The investigators also looked at prescriptions for psychotropic medications in assessing risk for development of psychiatric disorders. Prescriptions can be a marker for a diagnosis in cases where the prescribing physician may be hesitant to refer the patient or make a diagnosis, Dr. Bao explained, noting that this helped correct for possible underestimation of the development of psychiatric disorders and provided a risk estimate range.

When both diagnoses and prescriptions were considered, psoriasis patients had 25%-47% greater risk of developing a psychiatric disorder, 23%-62% greater risk of developing depression, and 32%-250% greater risk of developing anxiety, compared with controls, she said.

Patients included in the study had a mean age of 11.4 years. They were selected from a database of health plan participants who were enrolled in a plan at least 6 months before and after the first psoriasis diagnosis date (the index date), and who were followed from the index date until they were first diagnosed with any psychiatric disorder or were prescribed a drug used for the treatment of a psychiatric disorder. Any plan participant with a pre-enrollment psychiatric diagnosis or prescription was excluded.

Controls were matched to patients based on age, sex, and index date.

The findings of an increased risk of developing psychiatric disorders in case patients remained significant after controlling for age, sex, health plan, region of residence, and comorbidities, Dr. Bao noted.

The study is limited by the potential for coding and reporting errors in the data used and by lack of information on the severity of the psychiatric disorders. However, the findings do suggest that the psychiatric impact of psoriasis on children must be addressed because of the potential for both short-and long-term adverse effects.

"If we put these data in perspective, the development of psychiatric disorders at a young age can have a great impact in future adult life," she said.

Abbott Laboratories sponsored the study.

Although nearly a third of U.S. adults were at high risk for developing type 2 diabetes in 2005–2006, about 7% knew of their risk status, and only about half of those said they adopted risk-reduction behaviors, data from the 2005–2006 National Health and Nutrition Examination Survey suggest.

Furthermore, of those who were aware of their risk status and who received health care in the year prior to the survey, only 35% said they were advised by their physician to try to control or lose weight, 37% said they were advised to reduce fat or calorie intake, and 39% said they were advised to increase physical activity, Linda S. Geiss of the Centers for Disease Control and Prevention, Atlanta, and her colleagues reported.

The data—from 1,391 adults aged 20 years and older without diabetes who participated in the survey—showed that reports of physician advice were strongly associated with reports of engaging in risk-reduction behaviors in the past year. Of those receiving physician advice about weight loss or control, diet, and physical activity, 75%, 82%, and 71%, respectively, reported following the advice, the investigators said (Am. J. Prev. Med. 2010 April [10.1016/j.amepre.2009.12.029

The multivariate adjusted prevalence of trying to control or lose weight, reduce fat or calorie intake, and increase physical activity for those who received advice vs. those who did not was 71.0 vs. 44.2, 81.2 vs. 42.3, and 67.9 v. 38.4 for each behavior, respectively, they found.

The findings are important because prevention trials consistently show that diabetes risk can be reduced substantially through modest weight loss and increased physical activity. However, improved efforts on the part of physicians to advise patients about lifestyle modifications are likely to be insufficient for addressing the problem of suboptimal adoption of risk-reduction behaviors, the investigators argue.

Although physician advice has been shown to help initiate changes in health behaviors, it has not been shown to be associated with maintaining the changes, they explained.

“Prevention promotion by physicians and other health professionals may be more effective if part of a larger process within healthcare systems and communities to promote behavior change, and pragmatic approaches for linking primary care with effective community-based approaches are needed,” they wrote.

They went on to say that prospective studies of interventions and policies to promote and maintain healthy lifestyles with more objective measures of behaviors and outcomes are needed.

The investigators reported no financial disclosures.

Although nearly a third of U.S. adults were at high risk for developing type 2 diabetes in 2005–2006, about 7% knew of their risk status, and only about half of those said they adopted risk-reduction behaviors, data from the 2005–2006 National Health and Nutrition Examination Survey suggest.

Furthermore, of those who were aware of their risk status and who received health care in the year prior to the survey, only 35% said they were advised by their physician to try to control or lose weight, 37% said they were advised to reduce fat or calorie intake, and 39% said they were advised to increase physical activity, Linda S. Geiss of the Centers for Disease Control and Prevention, Atlanta, and her colleagues reported.

The data—from 1,391 adults aged 20 years and older without diabetes who participated in the survey—showed that reports of physician advice were strongly associated with reports of engaging in risk-reduction behaviors in the past year. Of those receiving physician advice about weight loss or control, diet, and physical activity, 75%, 82%, and 71%, respectively, reported following the advice, the investigators said (Am. J. Prev. Med. 2010 April [10.1016/j.amepre.2009.12.029

The multivariate adjusted prevalence of trying to control or lose weight, reduce fat or calorie intake, and increase physical activity for those who received advice vs. those who did not was 71.0 vs. 44.2, 81.2 vs. 42.3, and 67.9 v. 38.4 for each behavior, respectively, they found.

The findings are important because prevention trials consistently show that diabetes risk can be reduced substantially through modest weight loss and increased physical activity. However, improved efforts on the part of physicians to advise patients about lifestyle modifications are likely to be insufficient for addressing the problem of suboptimal adoption of risk-reduction behaviors, the investigators argue.

Although physician advice has been shown to help initiate changes in health behaviors, it has not been shown to be associated with maintaining the changes, they explained.

“Prevention promotion by physicians and other health professionals may be more effective if part of a larger process within healthcare systems and communities to promote behavior change, and pragmatic approaches for linking primary care with effective community-based approaches are needed,” they wrote.

They went on to say that prospective studies of interventions and policies to promote and maintain healthy lifestyles with more objective measures of behaviors and outcomes are needed.

The investigators reported no financial disclosures.

Although nearly a third of U.S. adults were at high risk for developing type 2 diabetes in 2005–2006, about 7% knew of their risk status, and only about half of those said they adopted risk-reduction behaviors, data from the 2005–2006 National Health and Nutrition Examination Survey suggest.

Furthermore, of those who were aware of their risk status and who received health care in the year prior to the survey, only 35% said they were advised by their physician to try to control or lose weight, 37% said they were advised to reduce fat or calorie intake, and 39% said they were advised to increase physical activity, Linda S. Geiss of the Centers for Disease Control and Prevention, Atlanta, and her colleagues reported.

The data—from 1,391 adults aged 20 years and older without diabetes who participated in the survey—showed that reports of physician advice were strongly associated with reports of engaging in risk-reduction behaviors in the past year. Of those receiving physician advice about weight loss or control, diet, and physical activity, 75%, 82%, and 71%, respectively, reported following the advice, the investigators said (Am. J. Prev. Med. 2010 April [10.1016/j.amepre.2009.12.029

The multivariate adjusted prevalence of trying to control or lose weight, reduce fat or calorie intake, and increase physical activity for those who received advice vs. those who did not was 71.0 vs. 44.2, 81.2 vs. 42.3, and 67.9 v. 38.4 for each behavior, respectively, they found.

The findings are important because prevention trials consistently show that diabetes risk can be reduced substantially through modest weight loss and increased physical activity. However, improved efforts on the part of physicians to advise patients about lifestyle modifications are likely to be insufficient for addressing the problem of suboptimal adoption of risk-reduction behaviors, the investigators argue.

Although physician advice has been shown to help initiate changes in health behaviors, it has not been shown to be associated with maintaining the changes, they explained.

“Prevention promotion by physicians and other health professionals may be more effective if part of a larger process within healthcare systems and communities to promote behavior change, and pragmatic approaches for linking primary care with effective community-based approaches are needed,” they wrote.

They went on to say that prospective studies of interventions and policies to promote and maintain healthy lifestyles with more objective measures of behaviors and outcomes are needed.

The investigators reported no financial disclosures.

Drinking 12 or more cups of coffee daily was associated with a significant reduction in the incidence of type 2 diabetes over nearly 8 years, compared with consuming no coffee, according to the findings of a study published online.

The study looked at self-reported coffee intake among men and women aged 45-74 years who had participated in the 4,579-person Strong Heart Study, an investigation of cardiovascular disease among 13 American Indian tribes/communities. Participants in that study had baseline data collected during 1989-1992 and were followed for an average of 7.6 years.

Participants in the current analysis were the 1,141 men and women who had normal fasting glucose at baseline, wrote Dr. Ying Zhang of the Oklahoma University Health Sciences Center, Oklahoma City, and associates (Nutr. Metab. Cardiovasc. Dis. 2010 Feb. 18 [doi: 10.1016/j.numecd.2009.10.020

The 92 (8.1%) participants who reported drinking at least 12 cups of coffee daily had a 67% lower risk (hazard ratio, 0.33) of developing type 2 diabetes during the follow-up period than non–coffee drinkers, even after adjustment for age, gender, smoking, alcohol use, family history of diabetes, physical activity, and body mass index.

In fact, coffee consumption was significantly related to diabetes risk only among those people who drank 12 or more cups daily, they noted.

Hazard ratios for developing diabetes were 0.93, 0.87, 0.72, and 0.78 for those with daily intake of 1-2 cups, 3-4 cups, 5-7 cups, and 8-11 cups, respectively, the investigators found.

The findings support those from several other studies showing a link between caffeine intake and diabetes development, but this is one of the few investigations that focused on a population known to have a high incidence of diabetes and that had normal glucose tolerance at baseline.

Additional studies are needed on the various elements in coffee, such as antioxidants, phenol chlorogenic acid, magnesium, and caffeine, that may be involved in the biologic mechanisms linking coffee consumption and diabetes risk reduction, they said.

The investigation was limited by a lack of available dietary data on the participants. High coffee consumption may be a marker for dietary patterns and factors related to diabetes risk but not measured in this study, Dr. Zhang and associates noted.

Further study is needed to determine if the association between coffee consumption and diabetes development found in this study is causal or the result of such unmeasured confounders. Also, the potential benefits of consuming 12 or more cups of coffee daily should be weighed against potential detrimental effects on blood pressure levels and sleep patterns, the investigators said.

The study was supported by grants from the National Heart, Lung, and Blood Institute.

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70286_fx1.sml

Coffee consumption was significantly related to diabetes risk only among those people who drank 12 or more cups daily.

Source ©Robert Brown/Fotolia.com

Drinking 12 or more cups of coffee daily was associated with a significant reduction in the incidence of type 2 diabetes over nearly 8 years, compared with consuming no coffee, according to the findings of a study published online.

The study looked at self-reported coffee intake among men and women aged 45-74 years who had participated in the 4,579-person Strong Heart Study, an investigation of cardiovascular disease among 13 American Indian tribes/communities. Participants in that study had baseline data collected during 1989-1992 and were followed for an average of 7.6 years.

Participants in the current analysis were the 1,141 men and women who had normal fasting glucose at baseline, wrote Dr. Ying Zhang of the Oklahoma University Health Sciences Center, Oklahoma City, and associates (Nutr. Metab. Cardiovasc. Dis. 2010 Feb. 18 [doi: 10.1016/j.numecd.2009.10.020

The 92 (8.1%) participants who reported drinking at least 12 cups of coffee daily had a 67% lower risk (hazard ratio, 0.33) of developing type 2 diabetes during the follow-up period than non–coffee drinkers, even after adjustment for age, gender, smoking, alcohol use, family history of diabetes, physical activity, and body mass index.

In fact, coffee consumption was significantly related to diabetes risk only among those people who drank 12 or more cups daily, they noted.

Hazard ratios for developing diabetes were 0.93, 0.87, 0.72, and 0.78 for those with daily intake of 1-2 cups, 3-4 cups, 5-7 cups, and 8-11 cups, respectively, the investigators found.

The findings support those from several other studies showing a link between caffeine intake and diabetes development, but this is one of the few investigations that focused on a population known to have a high incidence of diabetes and that had normal glucose tolerance at baseline.

Additional studies are needed on the various elements in coffee, such as antioxidants, phenol chlorogenic acid, magnesium, and caffeine, that may be involved in the biologic mechanisms linking coffee consumption and diabetes risk reduction, they said.

The investigation was limited by a lack of available dietary data on the participants. High coffee consumption may be a marker for dietary patterns and factors related to diabetes risk but not measured in this study, Dr. Zhang and associates noted.

Further study is needed to determine if the association between coffee consumption and diabetes development found in this study is causal or the result of such unmeasured confounders. Also, the potential benefits of consuming 12 or more cups of coffee daily should be weighed against potential detrimental effects on blood pressure levels and sleep patterns, the investigators said.

The study was supported by grants from the National Heart, Lung, and Blood Institute.

Document

70286_fx1.sml

Coffee consumption was significantly related to diabetes risk only among those people who drank 12 or more cups daily.

Source ©Robert Brown/Fotolia.com

Drinking 12 or more cups of coffee daily was associated with a significant reduction in the incidence of type 2 diabetes over nearly 8 years, compared with consuming no coffee, according to the findings of a study published online.

The study looked at self-reported coffee intake among men and women aged 45-74 years who had participated in the 4,579-person Strong Heart Study, an investigation of cardiovascular disease among 13 American Indian tribes/communities. Participants in that study had baseline data collected during 1989-1992 and were followed for an average of 7.6 years.

Participants in the current analysis were the 1,141 men and women who had normal fasting glucose at baseline, wrote Dr. Ying Zhang of the Oklahoma University Health Sciences Center, Oklahoma City, and associates (Nutr. Metab. Cardiovasc. Dis. 2010 Feb. 18 [doi: 10.1016/j.numecd.2009.10.020

The 92 (8.1%) participants who reported drinking at least 12 cups of coffee daily had a 67% lower risk (hazard ratio, 0.33) of developing type 2 diabetes during the follow-up period than non–coffee drinkers, even after adjustment for age, gender, smoking, alcohol use, family history of diabetes, physical activity, and body mass index.

In fact, coffee consumption was significantly related to diabetes risk only among those people who drank 12 or more cups daily, they noted.

Hazard ratios for developing diabetes were 0.93, 0.87, 0.72, and 0.78 for those with daily intake of 1-2 cups, 3-4 cups, 5-7 cups, and 8-11 cups, respectively, the investigators found.

The findings support those from several other studies showing a link between caffeine intake and diabetes development, but this is one of the few investigations that focused on a population known to have a high incidence of diabetes and that had normal glucose tolerance at baseline.

Additional studies are needed on the various elements in coffee, such as antioxidants, phenol chlorogenic acid, magnesium, and caffeine, that may be involved in the biologic mechanisms linking coffee consumption and diabetes risk reduction, they said.

The investigation was limited by a lack of available dietary data on the participants. High coffee consumption may be a marker for dietary patterns and factors related to diabetes risk but not measured in this study, Dr. Zhang and associates noted.

Further study is needed to determine if the association between coffee consumption and diabetes development found in this study is causal or the result of such unmeasured confounders. Also, the potential benefits of consuming 12 or more cups of coffee daily should be weighed against potential detrimental effects on blood pressure levels and sleep patterns, the investigators said.

The study was supported by grants from the National Heart, Lung, and Blood Institute.

Document

70286_fx1.sml

Coffee consumption was significantly related to diabetes risk only among those people who drank 12 or more cups daily.

Source ©Robert Brown/Fotolia.com

MIAMI — A substituted trans-stilbene derivative known as WBI-1001, which showed promise for the topical treatment of atopic dermatitis in preclinical studies, was safe and effective for mild to moderate disease in a small double-blind, randomized, vehicle-controlled study.

A total of 36 patients aged 18-65 years with chronic mild to moderate atopic dermatitis were randomized to apply either 0.5% WBI-1001 cream, 1.0% cream, or vehicle cream twice daily for 4 weeks.

At 1-week follow-up, the two treatment groups had significant reductions in Eczema Area and Severity Index (EASI) scores, compared with the vehicle group, with score reductions of 59.3% and 54.9% in the 0.5% and 1.0% groups, respectively, versus a 7.1% reduction in the vehicle group, Dr. Youwen Zhou reported during a poster discussion session at the annual meeting of the American Academy of Dermatology.

Similar improvements were seen in Severity Scoring of Atopic Dermatitis Severity Index (SCORAD) scores, Investigator Global Assessment (IGA) scores, body surface area (BSA) affected, and pruritis; in the 0.5% and 1.0% treatment groups vs. the vehicle group, respectively, SCORAD scores decreased 56.2% and 50.1% vs. 18.4%; IGA scores decreased by 38.9% and 45.8% vs. 5.6%; body surface area affected decreased by 64.4% and 57.7% vs. 1.08%; and pruritis scores decreased by 74% and 56% vs. 25%.

At 4-week follow-up, half of the patients in the treatment groups were clear or almost clear, compared with only 16.7% of those in the vehicle group, said Dr. Zhou of the University of British Columbia, Vancouver.

No treatment-related adverse events were seen in this study, no drug accumulation was reported, and no detectable drug was found in 76% of plasma samples, indicating that there was only minimal absorption into the blood system, Dr. Zhou said.

This is an early-stage clinical trial, but the findings suggest that the novel nonsteroidal anti-inflammatory WBI-1001 compound has promise for the treatment of mild to moderate atopic dermatitis, he concluded.

He noted that, except for pruritis, which occurred less often in the 0.5% treatment group, the 0.5% and 1.0% doses had similar outcomes that were significantly better than those seen in the vehicle arm.

The study was supported by Welichem Biotech Inc. Dr. Zhou is a paid consultant for Welichem Biotech.

MIAMI — A substituted trans-stilbene derivative known as WBI-1001, which showed promise for the topical treatment of atopic dermatitis in preclinical studies, was safe and effective for mild to moderate disease in a small double-blind, randomized, vehicle-controlled study.

A total of 36 patients aged 18-65 years with chronic mild to moderate atopic dermatitis were randomized to apply either 0.5% WBI-1001 cream, 1.0% cream, or vehicle cream twice daily for 4 weeks.

At 1-week follow-up, the two treatment groups had significant reductions in Eczema Area and Severity Index (EASI) scores, compared with the vehicle group, with score reductions of 59.3% and 54.9% in the 0.5% and 1.0% groups, respectively, versus a 7.1% reduction in the vehicle group, Dr. Youwen Zhou reported during a poster discussion session at the annual meeting of the American Academy of Dermatology.

Similar improvements were seen in Severity Scoring of Atopic Dermatitis Severity Index (SCORAD) scores, Investigator Global Assessment (IGA) scores, body surface area (BSA) affected, and pruritis; in the 0.5% and 1.0% treatment groups vs. the vehicle group, respectively, SCORAD scores decreased 56.2% and 50.1% vs. 18.4%; IGA scores decreased by 38.9% and 45.8% vs. 5.6%; body surface area affected decreased by 64.4% and 57.7% vs. 1.08%; and pruritis scores decreased by 74% and 56% vs. 25%.

At 4-week follow-up, half of the patients in the treatment groups were clear or almost clear, compared with only 16.7% of those in the vehicle group, said Dr. Zhou of the University of British Columbia, Vancouver.

No treatment-related adverse events were seen in this study, no drug accumulation was reported, and no detectable drug was found in 76% of plasma samples, indicating that there was only minimal absorption into the blood system, Dr. Zhou said.

This is an early-stage clinical trial, but the findings suggest that the novel nonsteroidal anti-inflammatory WBI-1001 compound has promise for the treatment of mild to moderate atopic dermatitis, he concluded.

He noted that, except for pruritis, which occurred less often in the 0.5% treatment group, the 0.5% and 1.0% doses had similar outcomes that were significantly better than those seen in the vehicle arm.

The study was supported by Welichem Biotech Inc. Dr. Zhou is a paid consultant for Welichem Biotech.

MIAMI — A substituted trans-stilbene derivative known as WBI-1001, which showed promise for the topical treatment of atopic dermatitis in preclinical studies, was safe and effective for mild to moderate disease in a small double-blind, randomized, vehicle-controlled study.

A total of 36 patients aged 18-65 years with chronic mild to moderate atopic dermatitis were randomized to apply either 0.5% WBI-1001 cream, 1.0% cream, or vehicle cream twice daily for 4 weeks.

At 1-week follow-up, the two treatment groups had significant reductions in Eczema Area and Severity Index (EASI) scores, compared with the vehicle group, with score reductions of 59.3% and 54.9% in the 0.5% and 1.0% groups, respectively, versus a 7.1% reduction in the vehicle group, Dr. Youwen Zhou reported during a poster discussion session at the annual meeting of the American Academy of Dermatology.

Similar improvements were seen in Severity Scoring of Atopic Dermatitis Severity Index (SCORAD) scores, Investigator Global Assessment (IGA) scores, body surface area (BSA) affected, and pruritis; in the 0.5% and 1.0% treatment groups vs. the vehicle group, respectively, SCORAD scores decreased 56.2% and 50.1% vs. 18.4%; IGA scores decreased by 38.9% and 45.8% vs. 5.6%; body surface area affected decreased by 64.4% and 57.7% vs. 1.08%; and pruritis scores decreased by 74% and 56% vs. 25%.

At 4-week follow-up, half of the patients in the treatment groups were clear or almost clear, compared with only 16.7% of those in the vehicle group, said Dr. Zhou of the University of British Columbia, Vancouver.

No treatment-related adverse events were seen in this study, no drug accumulation was reported, and no detectable drug was found in 76% of plasma samples, indicating that there was only minimal absorption into the blood system, Dr. Zhou said.

This is an early-stage clinical trial, but the findings suggest that the novel nonsteroidal anti-inflammatory WBI-1001 compound has promise for the treatment of mild to moderate atopic dermatitis, he concluded.

He noted that, except for pruritis, which occurred less often in the 0.5% treatment group, the 0.5% and 1.0% doses had similar outcomes that were significantly better than those seen in the vehicle arm.

The study was supported by Welichem Biotech Inc. Dr. Zhou is a paid consultant for Welichem Biotech.

Miami — Text daily educational and treatment reminder messages to patients with atopic dermatitis and you just might get a big “TY” message back.

That’s a “Thank You.”'

Reminder text messages were associated with improved treatment adherence, health maintenance behaviors, and possibly disease severity in a study of 20 patients aged 14 years and older, Venessa Pena-Robichaux reported in a poster at the annual meeting of the American Academy of Dermatology.

The patients, who had a mean age of 29.6 years, received daily texts for 6 weeks, which alternated between reminders (such as, “Please remember to use the medication or product you use to treat your atopic dermatitis today!”) and educational messages (such as, “People with atopic dermatitis have a lifelong tendency to develop skin infections.”). Eighty-five percent of participants said they found the medication reminder messages helpful, 90% said they found the educational messages helpful, 80% said they would like to keep receiving the messages, and 85% said they would recommend the texting program to a friend, said Ms. Pena-Robichaux, a fourth-year medical student at Harvard Medical School, Boston.

The texts were not only welcomed by the participants, they appeared to improve medication use: 80% of patients reported an increase in the number days each week that they were adherent to their medical treatment. The number of days of medication use increased from a prestudy mean of 3.7 days per week to a poststudy mean of 6.1 days. Additionally, 95% of patients reported an improvement in at least one health maintenance behavior during the study period, and the SCORing Atopic Dermatitis (SCORAD) index decreased in 70% of patients from pre- to post study by a mean of 7.3 points on the 100-point scale.

Given the popularity of cell phones and text messaging – and in particular the tech-savvy nature of younger patients these days (about half of the participants in this study were college students), the potential of this simple and cost-effective intervention for improving positive health behaviors deserves a second look, Ms. Pena-Robichaux said, noting that a larger randomized controlled study of the texting program is in the works and could be underway B 4 2 long.

Miami — Text daily educational and treatment reminder messages to patients with atopic dermatitis and you just might get a big “TY” message back.

That’s a “Thank You.”'

Reminder text messages were associated with improved treatment adherence, health maintenance behaviors, and possibly disease severity in a study of 20 patients aged 14 years and older, Venessa Pena-Robichaux reported in a poster at the annual meeting of the American Academy of Dermatology.

The patients, who had a mean age of 29.6 years, received daily texts for 6 weeks, which alternated between reminders (such as, “Please remember to use the medication or product you use to treat your atopic dermatitis today!”) and educational messages (such as, “People with atopic dermatitis have a lifelong tendency to develop skin infections.”). Eighty-five percent of participants said they found the medication reminder messages helpful, 90% said they found the educational messages helpful, 80% said they would like to keep receiving the messages, and 85% said they would recommend the texting program to a friend, said Ms. Pena-Robichaux, a fourth-year medical student at Harvard Medical School, Boston.

The texts were not only welcomed by the participants, they appeared to improve medication use: 80% of patients reported an increase in the number days each week that they were adherent to their medical treatment. The number of days of medication use increased from a prestudy mean of 3.7 days per week to a poststudy mean of 6.1 days. Additionally, 95% of patients reported an improvement in at least one health maintenance behavior during the study period, and the SCORing Atopic Dermatitis (SCORAD) index decreased in 70% of patients from pre- to post study by a mean of 7.3 points on the 100-point scale.

Given the popularity of cell phones and text messaging – and in particular the tech-savvy nature of younger patients these days (about half of the participants in this study were college students), the potential of this simple and cost-effective intervention for improving positive health behaviors deserves a second look, Ms. Pena-Robichaux said, noting that a larger randomized controlled study of the texting program is in the works and could be underway B 4 2 long.

Miami — Text daily educational and treatment reminder messages to patients with atopic dermatitis and you just might get a big “TY” message back.

That’s a “Thank You.”'

Reminder text messages were associated with improved treatment adherence, health maintenance behaviors, and possibly disease severity in a study of 20 patients aged 14 years and older, Venessa Pena-Robichaux reported in a poster at the annual meeting of the American Academy of Dermatology.

The patients, who had a mean age of 29.6 years, received daily texts for 6 weeks, which alternated between reminders (such as, “Please remember to use the medication or product you use to treat your atopic dermatitis today!”) and educational messages (such as, “People with atopic dermatitis have a lifelong tendency to develop skin infections.”). Eighty-five percent of participants said they found the medication reminder messages helpful, 90% said they found the educational messages helpful, 80% said they would like to keep receiving the messages, and 85% said they would recommend the texting program to a friend, said Ms. Pena-Robichaux, a fourth-year medical student at Harvard Medical School, Boston.

The texts were not only welcomed by the participants, they appeared to improve medication use: 80% of patients reported an increase in the number days each week that they were adherent to their medical treatment. The number of days of medication use increased from a prestudy mean of 3.7 days per week to a poststudy mean of 6.1 days. Additionally, 95% of patients reported an improvement in at least one health maintenance behavior during the study period, and the SCORing Atopic Dermatitis (SCORAD) index decreased in 70% of patients from pre- to post study by a mean of 7.3 points on the 100-point scale.

Given the popularity of cell phones and text messaging – and in particular the tech-savvy nature of younger patients these days (about half of the participants in this study were college students), the potential of this simple and cost-effective intervention for improving positive health behaviors deserves a second look, Ms. Pena-Robichaux said, noting that a larger randomized controlled study of the texting program is in the works and could be underway B 4 2 long.