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Quitting smoking plus low-dose helical CT reduces lung cancer death risk
Smoking abstinence for 7 years results in a 20% reduction in death from lung cancer – a benefit that is comparable to three rounds of annual screening with low-dose helical computed tomography (LDCT) – in asymptomatic individuals with at least a 30–pack-year smoking history, based on a secondary analysis of 50,263 participants in the National Lung Screening Trial (NLST).
Not smoking for 7 years plus screening for lung cancer with LDCT conferred an additional 10% reduction in lung cancer mortality. Similar patterns for smoking cessation benefits were noted for overall mortality, as well.
“This study is the first to quantify the benefit of smoking cessation coupled with lung cancer screening in a cohort that is asymptomatic,” wrote Dr. Nichole T. Tanner of the Medical University of South Carolina, Charleston, and her colleagues (Am J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201507-1420OC). “[Its] findings highlight the importance of integrating smoking cessation efforts into lung cancer screening programs.”
The NLST subset study included 47,902 participants who self-identified as non-Hispanic white and 2,361 who self-identified as non-Hispanic black; 24,190 were current smokers and 26,073 were former smokers who had quit within the 15 years prior to entering the study. Participants ranged in age from 55 to 74 years at the time of randomization and had a 30–pack-year or more history of cigarette smoking.
All participants were screened for lung cancer with either LDCT or a chest radiograph examination. A 20% reduction in death from lung cancer was seen in those who had abstained from smoking for 7 years and were screened for lung cancer with a chest radiograph and in those who had undergone three rounds of annual screening for lung cancer with LDCT and continued to smoke.
For former smokers screened with LDCT, the risk of dying of lung cancer decreased at a faster rate than it did for those screened with chest radiographs. For each additional year an individual abstained from smoking and had an LDCT screen, the risk of dying of lung cancer decreased by 9%. For those individuals who abstained from smoking and had been screened with a chest x-ray, the risk of dying of lung cancer decreased by 3%.
In contrast, there was a 10% increase in lung cancer mortality for each additional 10 pack-years smoked for those screened with LDCT (HR, 1.10; 95% CI, 1.08-1.13). This “did not vary significantly in the chest radiograph group,” according to the researchers.
In both screening groups, “an additional 6% risk of death from all causes (was seen) for each additional 10 pack-years smoked.”
In addition, black study participants who had quit smoking at trial entry had “a more pronounced benefit” from having done so, compared with the white study participants (HR, 0.53, 95% CI, 0.28-1.0).
The NLST was sponsored by the National Cancer Institute. Dr. Nichole T. Tanner, one of this secondary analysis’s authors reported receiving grants from ACCP OneBreath Foundation for her work on this project and grants from Olympus America, Cook, and the American Cancer Society for other work. Disclosures for all investigators are available at atsjournals.org.
This secondary analysis was limited by the fact that the National Lung Screening Trial “does not have information about smoking cessation or persistence during the trial.”
The finding of black former smokers having a hazard rate for lung cancer mortality of 0.53, compared with white former smokers, was reassuring, because “there is evidence that African Americans are at higher risk for lung cancer at lower smoking intensities than whites.”
While this secondary analysis suggests that screening for lung cancer can reduce lung cancer death risk, lung cancer screening alone is not adequate for preventing the disease. Screening must be “linked to smoking cessation efforts in those who are current smokers” and may need to follow criteria that are different from those used in the NLST.
“Implementation of lung cancer screening will be a serious challenge that must be linked to smoking cessation efforts in those who are current smokers at the time they enter a screening program, both for Centers for Medicare & Medicaid Services reimbursement and for medical appropriateness.”
Dr. Christine D. Berg is with Johns Hopkins Medicine, Baltimore, and the division of cancer epidemiology and prevention at the National Cancer Institute, Bethesda, Md. She made these remarks in an editorial accompanying Dr. Tanner’s report (J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201511-2270ED). She reported receiving personal fees from Medial CS, and she was the study director of the NLST.
This secondary analysis was limited by the fact that the National Lung Screening Trial “does not have information about smoking cessation or persistence during the trial.”
The finding of black former smokers having a hazard rate for lung cancer mortality of 0.53, compared with white former smokers, was reassuring, because “there is evidence that African Americans are at higher risk for lung cancer at lower smoking intensities than whites.”
While this secondary analysis suggests that screening for lung cancer can reduce lung cancer death risk, lung cancer screening alone is not adequate for preventing the disease. Screening must be “linked to smoking cessation efforts in those who are current smokers” and may need to follow criteria that are different from those used in the NLST.
“Implementation of lung cancer screening will be a serious challenge that must be linked to smoking cessation efforts in those who are current smokers at the time they enter a screening program, both for Centers for Medicare & Medicaid Services reimbursement and for medical appropriateness.”
Dr. Christine D. Berg is with Johns Hopkins Medicine, Baltimore, and the division of cancer epidemiology and prevention at the National Cancer Institute, Bethesda, Md. She made these remarks in an editorial accompanying Dr. Tanner’s report (J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201511-2270ED). She reported receiving personal fees from Medial CS, and she was the study director of the NLST.
This secondary analysis was limited by the fact that the National Lung Screening Trial “does not have information about smoking cessation or persistence during the trial.”
The finding of black former smokers having a hazard rate for lung cancer mortality of 0.53, compared with white former smokers, was reassuring, because “there is evidence that African Americans are at higher risk for lung cancer at lower smoking intensities than whites.”
While this secondary analysis suggests that screening for lung cancer can reduce lung cancer death risk, lung cancer screening alone is not adequate for preventing the disease. Screening must be “linked to smoking cessation efforts in those who are current smokers” and may need to follow criteria that are different from those used in the NLST.
“Implementation of lung cancer screening will be a serious challenge that must be linked to smoking cessation efforts in those who are current smokers at the time they enter a screening program, both for Centers for Medicare & Medicaid Services reimbursement and for medical appropriateness.”
Dr. Christine D. Berg is with Johns Hopkins Medicine, Baltimore, and the division of cancer epidemiology and prevention at the National Cancer Institute, Bethesda, Md. She made these remarks in an editorial accompanying Dr. Tanner’s report (J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201511-2270ED). She reported receiving personal fees from Medial CS, and she was the study director of the NLST.
Smoking abstinence for 7 years results in a 20% reduction in death from lung cancer – a benefit that is comparable to three rounds of annual screening with low-dose helical computed tomography (LDCT) – in asymptomatic individuals with at least a 30–pack-year smoking history, based on a secondary analysis of 50,263 participants in the National Lung Screening Trial (NLST).
Not smoking for 7 years plus screening for lung cancer with LDCT conferred an additional 10% reduction in lung cancer mortality. Similar patterns for smoking cessation benefits were noted for overall mortality, as well.
“This study is the first to quantify the benefit of smoking cessation coupled with lung cancer screening in a cohort that is asymptomatic,” wrote Dr. Nichole T. Tanner of the Medical University of South Carolina, Charleston, and her colleagues (Am J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201507-1420OC). “[Its] findings highlight the importance of integrating smoking cessation efforts into lung cancer screening programs.”
The NLST subset study included 47,902 participants who self-identified as non-Hispanic white and 2,361 who self-identified as non-Hispanic black; 24,190 were current smokers and 26,073 were former smokers who had quit within the 15 years prior to entering the study. Participants ranged in age from 55 to 74 years at the time of randomization and had a 30–pack-year or more history of cigarette smoking.
All participants were screened for lung cancer with either LDCT or a chest radiograph examination. A 20% reduction in death from lung cancer was seen in those who had abstained from smoking for 7 years and were screened for lung cancer with a chest radiograph and in those who had undergone three rounds of annual screening for lung cancer with LDCT and continued to smoke.
For former smokers screened with LDCT, the risk of dying of lung cancer decreased at a faster rate than it did for those screened with chest radiographs. For each additional year an individual abstained from smoking and had an LDCT screen, the risk of dying of lung cancer decreased by 9%. For those individuals who abstained from smoking and had been screened with a chest x-ray, the risk of dying of lung cancer decreased by 3%.
In contrast, there was a 10% increase in lung cancer mortality for each additional 10 pack-years smoked for those screened with LDCT (HR, 1.10; 95% CI, 1.08-1.13). This “did not vary significantly in the chest radiograph group,” according to the researchers.
In both screening groups, “an additional 6% risk of death from all causes (was seen) for each additional 10 pack-years smoked.”
In addition, black study participants who had quit smoking at trial entry had “a more pronounced benefit” from having done so, compared with the white study participants (HR, 0.53, 95% CI, 0.28-1.0).
The NLST was sponsored by the National Cancer Institute. Dr. Nichole T. Tanner, one of this secondary analysis’s authors reported receiving grants from ACCP OneBreath Foundation for her work on this project and grants from Olympus America, Cook, and the American Cancer Society for other work. Disclosures for all investigators are available at atsjournals.org.
Smoking abstinence for 7 years results in a 20% reduction in death from lung cancer – a benefit that is comparable to three rounds of annual screening with low-dose helical computed tomography (LDCT) – in asymptomatic individuals with at least a 30–pack-year smoking history, based on a secondary analysis of 50,263 participants in the National Lung Screening Trial (NLST).
Not smoking for 7 years plus screening for lung cancer with LDCT conferred an additional 10% reduction in lung cancer mortality. Similar patterns for smoking cessation benefits were noted for overall mortality, as well.
“This study is the first to quantify the benefit of smoking cessation coupled with lung cancer screening in a cohort that is asymptomatic,” wrote Dr. Nichole T. Tanner of the Medical University of South Carolina, Charleston, and her colleagues (Am J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201507-1420OC). “[Its] findings highlight the importance of integrating smoking cessation efforts into lung cancer screening programs.”
The NLST subset study included 47,902 participants who self-identified as non-Hispanic white and 2,361 who self-identified as non-Hispanic black; 24,190 were current smokers and 26,073 were former smokers who had quit within the 15 years prior to entering the study. Participants ranged in age from 55 to 74 years at the time of randomization and had a 30–pack-year or more history of cigarette smoking.
All participants were screened for lung cancer with either LDCT or a chest radiograph examination. A 20% reduction in death from lung cancer was seen in those who had abstained from smoking for 7 years and were screened for lung cancer with a chest radiograph and in those who had undergone three rounds of annual screening for lung cancer with LDCT and continued to smoke.
For former smokers screened with LDCT, the risk of dying of lung cancer decreased at a faster rate than it did for those screened with chest radiographs. For each additional year an individual abstained from smoking and had an LDCT screen, the risk of dying of lung cancer decreased by 9%. For those individuals who abstained from smoking and had been screened with a chest x-ray, the risk of dying of lung cancer decreased by 3%.
In contrast, there was a 10% increase in lung cancer mortality for each additional 10 pack-years smoked for those screened with LDCT (HR, 1.10; 95% CI, 1.08-1.13). This “did not vary significantly in the chest radiograph group,” according to the researchers.
In both screening groups, “an additional 6% risk of death from all causes (was seen) for each additional 10 pack-years smoked.”
In addition, black study participants who had quit smoking at trial entry had “a more pronounced benefit” from having done so, compared with the white study participants (HR, 0.53, 95% CI, 0.28-1.0).
The NLST was sponsored by the National Cancer Institute. Dr. Nichole T. Tanner, one of this secondary analysis’s authors reported receiving grants from ACCP OneBreath Foundation for her work on this project and grants from Olympus America, Cook, and the American Cancer Society for other work. Disclosures for all investigators are available at atsjournals.org.
FROM AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Key clinical point: Smoking cessation and lung cancer screening with low-dose helical computed tomography reduces lung cancer mortality.
Major finding: Combining 15 years of smoking cessation with LDCT screening for lung cancer resulted in a 38% risk reduction in lung cancer death.
Data source: A secondary analysis of a 50,263-person subset of the randomized, controlled National Lung Screening Trial.
Disclosures: The NLST was sponsored by the National Cancer Institute. Dr. Nichole T. Tanner, one of this secondary analysis’s authors reported receiving grants from ACCP OneBreath Foundation for her work on this project and grants from Olympus America, Cook, and the American Cancer Society for other work. Disclosures for all investigators are available at atsjournals.org.
Publicizing benefits of HPV vaccine may drive uptick in its use
Increased publicizing of the human papillomavirus (HPV) vaccine’s benefits could drive growth in patients’ usage of the vaccine, researchers said in a letter to the editors of the Pediatric Infectious Disease Journal.
Dr. Harry Pellman, clinical professor of pediatrics at the University of California, Irvine, and Brandon Brown, Ph.D., of the division of clinical sciences at the Center for Health Communities at the University of California, Riverside, cited having observed higher rates of HPV vaccinations in their practice, where doctors recommend the vaccine, than were found by a Centers for Disease Control and Prevention study (42% males, 60% females) as an explanation for their hypothesis. In Dr. Pellman’s and Dr. Brown’s study, which included 101 patients, 90% of male and 67% of female patients (P less than .01) received an HPV vaccination.
In an anonymous survey of these patients’ parents, the researchers learned that “strength of the provider recommendation” (85%) and “publicity around the importance of vaccinating against HPV disease” (69%) were the most common reasons parents chose to accept the HPV vaccination for their child. The pediatricians also noted that 89% of the parents surveyed who had a family member or friend diagnosed with cervical or female organ cancer agreed to have their child vaccinated.
Dr. Pellman and Dr. Brown also found that “wanting to learn more about the vaccine” (60%) was the reason given by most parents who opted not to have their child vaccinated to prevent HPV. “This also suggests that publicizing the role of HPV vaccination in preventing HPV disease and its consequences might be an important public health strategy,” they said.
To read the letter, go to (Pediatr Infect Dis J. 2016 Jan;35[1]:119-20 doi: 10.1097/INF.0000000000000941).
Increased publicizing of the human papillomavirus (HPV) vaccine’s benefits could drive growth in patients’ usage of the vaccine, researchers said in a letter to the editors of the Pediatric Infectious Disease Journal.
Dr. Harry Pellman, clinical professor of pediatrics at the University of California, Irvine, and Brandon Brown, Ph.D., of the division of clinical sciences at the Center for Health Communities at the University of California, Riverside, cited having observed higher rates of HPV vaccinations in their practice, where doctors recommend the vaccine, than were found by a Centers for Disease Control and Prevention study (42% males, 60% females) as an explanation for their hypothesis. In Dr. Pellman’s and Dr. Brown’s study, which included 101 patients, 90% of male and 67% of female patients (P less than .01) received an HPV vaccination.
In an anonymous survey of these patients’ parents, the researchers learned that “strength of the provider recommendation” (85%) and “publicity around the importance of vaccinating against HPV disease” (69%) were the most common reasons parents chose to accept the HPV vaccination for their child. The pediatricians also noted that 89% of the parents surveyed who had a family member or friend diagnosed with cervical or female organ cancer agreed to have their child vaccinated.
Dr. Pellman and Dr. Brown also found that “wanting to learn more about the vaccine” (60%) was the reason given by most parents who opted not to have their child vaccinated to prevent HPV. “This also suggests that publicizing the role of HPV vaccination in preventing HPV disease and its consequences might be an important public health strategy,” they said.
To read the letter, go to (Pediatr Infect Dis J. 2016 Jan;35[1]:119-20 doi: 10.1097/INF.0000000000000941).
Increased publicizing of the human papillomavirus (HPV) vaccine’s benefits could drive growth in patients’ usage of the vaccine, researchers said in a letter to the editors of the Pediatric Infectious Disease Journal.
Dr. Harry Pellman, clinical professor of pediatrics at the University of California, Irvine, and Brandon Brown, Ph.D., of the division of clinical sciences at the Center for Health Communities at the University of California, Riverside, cited having observed higher rates of HPV vaccinations in their practice, where doctors recommend the vaccine, than were found by a Centers for Disease Control and Prevention study (42% males, 60% females) as an explanation for their hypothesis. In Dr. Pellman’s and Dr. Brown’s study, which included 101 patients, 90% of male and 67% of female patients (P less than .01) received an HPV vaccination.
In an anonymous survey of these patients’ parents, the researchers learned that “strength of the provider recommendation” (85%) and “publicity around the importance of vaccinating against HPV disease” (69%) were the most common reasons parents chose to accept the HPV vaccination for their child. The pediatricians also noted that 89% of the parents surveyed who had a family member or friend diagnosed with cervical or female organ cancer agreed to have their child vaccinated.
Dr. Pellman and Dr. Brown also found that “wanting to learn more about the vaccine” (60%) was the reason given by most parents who opted not to have their child vaccinated to prevent HPV. “This also suggests that publicizing the role of HPV vaccination in preventing HPV disease and its consequences might be an important public health strategy,” they said.
To read the letter, go to (Pediatr Infect Dis J. 2016 Jan;35[1]:119-20 doi: 10.1097/INF.0000000000000941).
FROM THE PEDIATRIC INFECTIOUS DISEASE JOURNAL
WHO guidance for caring for pregnant women in Zika virus areas
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
Study: 2.6% of patients discharged from U.S. hospital used probiotics
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
FROM AMERICAN JOURNAL OF INFECTION CONTROL
Ebola continues to impact survivors as epidemic wanes
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
FROM EMERGING INFECTIOUS DISEASES
Drug targeting Huntington’s disease–causing protein undergoing clinical trial
A drug that was found to have no dose-limiting side effects in nonhuman primates is being evaluated in a clinical trial for its ability to reduce production of the protein that causes Huntington’s disease (HD).
The new drug, which is an antisense oligonucleotide, was formerly known as ISIS-HTTRx and was renamed IONIS-HTTRx, because its developer changed its name in December 2015 to Ionis Pharmaceuticals from Isis Pharmaceuticals. IONIS-HTTRx acts as a gene silencer to inhibit the production of huntington protein in people with HD. The clinical trial now underway is a randomized, double-blind, placebo-controlled study aimed at evaluating the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple ascending doses of IONIS-HTTRx in up to 36 patients with early manifest HD. If the trial is successful, IONIS-HTTRx would be the first drug to modify HD progression in patients, according to an abstract to be presented at the annual meeting of the American Academy of Neurology in Vancouver in April.
Ionis found the drug to be well tolerated in rodents and nonhuman primates in investigational new drug-enabling toxicology studies, with nonhuman primates having received doses up to 20 mg of the drug intrathecally, according to the trial’s principal investigator Dr. Blair R. Leavitt of the University of British Columbia, Vancouver, and colleagues.
“It is very exciting to have the possibility of a treatment that could alter the course of this devastating disease. Right now we only have treatments that work on the symptoms of the disease.” Dr. Leavitt said in a written statement.
The study is supported by Ionis Pharmaceuticals and is part of Ionis’ collaboration with Roche to develop antisense drugs to treat HD, according to the investigators.
A drug that was found to have no dose-limiting side effects in nonhuman primates is being evaluated in a clinical trial for its ability to reduce production of the protein that causes Huntington’s disease (HD).
The new drug, which is an antisense oligonucleotide, was formerly known as ISIS-HTTRx and was renamed IONIS-HTTRx, because its developer changed its name in December 2015 to Ionis Pharmaceuticals from Isis Pharmaceuticals. IONIS-HTTRx acts as a gene silencer to inhibit the production of huntington protein in people with HD. The clinical trial now underway is a randomized, double-blind, placebo-controlled study aimed at evaluating the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple ascending doses of IONIS-HTTRx in up to 36 patients with early manifest HD. If the trial is successful, IONIS-HTTRx would be the first drug to modify HD progression in patients, according to an abstract to be presented at the annual meeting of the American Academy of Neurology in Vancouver in April.
Ionis found the drug to be well tolerated in rodents and nonhuman primates in investigational new drug-enabling toxicology studies, with nonhuman primates having received doses up to 20 mg of the drug intrathecally, according to the trial’s principal investigator Dr. Blair R. Leavitt of the University of British Columbia, Vancouver, and colleagues.
“It is very exciting to have the possibility of a treatment that could alter the course of this devastating disease. Right now we only have treatments that work on the symptoms of the disease.” Dr. Leavitt said in a written statement.
The study is supported by Ionis Pharmaceuticals and is part of Ionis’ collaboration with Roche to develop antisense drugs to treat HD, according to the investigators.
A drug that was found to have no dose-limiting side effects in nonhuman primates is being evaluated in a clinical trial for its ability to reduce production of the protein that causes Huntington’s disease (HD).
The new drug, which is an antisense oligonucleotide, was formerly known as ISIS-HTTRx and was renamed IONIS-HTTRx, because its developer changed its name in December 2015 to Ionis Pharmaceuticals from Isis Pharmaceuticals. IONIS-HTTRx acts as a gene silencer to inhibit the production of huntington protein in people with HD. The clinical trial now underway is a randomized, double-blind, placebo-controlled study aimed at evaluating the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple ascending doses of IONIS-HTTRx in up to 36 patients with early manifest HD. If the trial is successful, IONIS-HTTRx would be the first drug to modify HD progression in patients, according to an abstract to be presented at the annual meeting of the American Academy of Neurology in Vancouver in April.
Ionis found the drug to be well tolerated in rodents and nonhuman primates in investigational new drug-enabling toxicology studies, with nonhuman primates having received doses up to 20 mg of the drug intrathecally, according to the trial’s principal investigator Dr. Blair R. Leavitt of the University of British Columbia, Vancouver, and colleagues.
“It is very exciting to have the possibility of a treatment that could alter the course of this devastating disease. Right now we only have treatments that work on the symptoms of the disease.” Dr. Leavitt said in a written statement.
The study is supported by Ionis Pharmaceuticals and is part of Ionis’ collaboration with Roche to develop antisense drugs to treat HD, according to the investigators.
Donor human milk availability to VLBW infants associated with decreased NEC
For very low birth weight infants, the availability of donor human milk to newborns was associated with a decreased incidence of necrotizing enterocolitis and an increased rate of breastfeeding at discharge from a neonatal intensive care unit.
The researchers based their findings on data obtained from the California Perinatal Quality Care Collaborative, which gathers information on the care of greater than 90% of California’s neonatal intensive care unit (NICU) admissions of very low birth weight (VLBW) infants (defined as weighing less than or equal to 1.5 kg at birth), and the Mother’s Milk Bank of San Jose, a human milk bank serving 94 hospitals across several states, including California. All of the data was collected between 2007 and 2013 in over 42,000 VLBW babies. Babies were classified as breastfeeding at discharge, if they were feeding with human milk or human milk with fortifier or formula, but not if they were only feeding with formula.
Agata Kantorowska, a medical student at the University of Rochester (N.Y.) School of Medicine and Dentistry, and her colleagues noted that they did not know if donor human milk (DHM) was used primarily as a back-up feeding if mother’s milk was unavailable, in another way, or in conjunction with human milk-derived fortifiers; the proportion of VLBW infants within each NICU that received DHM; or the length of time that an individual received DHM.
Among the 22 hospitals studied that went from not having DHM available to making it available, on average, the rate of breastfeeding at discharge increased by 10% after DHM became available (P less than .0001). Among these same hospitals, the mean change in necrotizing enterocolitis (NEC) prevalence, following the introduction of DHM, was a 2.6% decrease (P = .0006). Before DHM became available in the 22 hospitals, 52.8% of VLBW infants were breastfeeding at discharge, compared with 61.7% after DHM became available. The rate of NEC was 6.6% among VLBW infants prior to DHM having becoming available at a hospital, versus 4.3% following the introduction of DHM to a hospital.
Following risk adjustment, not having DHM available in a hospital was a negative predictor for breastfeeding at discharge (odds ratio, 0.70) and a positive predictor of NEC (odds ratio, 1.15).
Ms. Kantorowska and her associates said while they found “a significant association between a hospital’s DHM status and increased breastfeeding and decreased NEC rates among VLBW infants,” factors other than the availability of DHM contributed to changes in breastfeeding and NEC rates that occurred. They also noted that they saw an increased rate of breastfeeding and a similar decreasing rate of NEC in hospitals that did not transition to using DHM.
“Societal attitudes toward breastfeeding are likely influencing mothers’ attempts to provide breast milk to their VLBW infants. ... The NICU battle against NEC is ongoing, and other advances in care that occurred from 2007 to 2013 could be contributing to the observed decrease in NEC rate in hospitals that acquired DHM,” the researchers said.
Read the full study in Pediatrics (doi: 10.1542/peds.2015-3123).
For very low birth weight infants, the availability of donor human milk to newborns was associated with a decreased incidence of necrotizing enterocolitis and an increased rate of breastfeeding at discharge from a neonatal intensive care unit.
The researchers based their findings on data obtained from the California Perinatal Quality Care Collaborative, which gathers information on the care of greater than 90% of California’s neonatal intensive care unit (NICU) admissions of very low birth weight (VLBW) infants (defined as weighing less than or equal to 1.5 kg at birth), and the Mother’s Milk Bank of San Jose, a human milk bank serving 94 hospitals across several states, including California. All of the data was collected between 2007 and 2013 in over 42,000 VLBW babies. Babies were classified as breastfeeding at discharge, if they were feeding with human milk or human milk with fortifier or formula, but not if they were only feeding with formula.
Agata Kantorowska, a medical student at the University of Rochester (N.Y.) School of Medicine and Dentistry, and her colleagues noted that they did not know if donor human milk (DHM) was used primarily as a back-up feeding if mother’s milk was unavailable, in another way, or in conjunction with human milk-derived fortifiers; the proportion of VLBW infants within each NICU that received DHM; or the length of time that an individual received DHM.
Among the 22 hospitals studied that went from not having DHM available to making it available, on average, the rate of breastfeeding at discharge increased by 10% after DHM became available (P less than .0001). Among these same hospitals, the mean change in necrotizing enterocolitis (NEC) prevalence, following the introduction of DHM, was a 2.6% decrease (P = .0006). Before DHM became available in the 22 hospitals, 52.8% of VLBW infants were breastfeeding at discharge, compared with 61.7% after DHM became available. The rate of NEC was 6.6% among VLBW infants prior to DHM having becoming available at a hospital, versus 4.3% following the introduction of DHM to a hospital.
Following risk adjustment, not having DHM available in a hospital was a negative predictor for breastfeeding at discharge (odds ratio, 0.70) and a positive predictor of NEC (odds ratio, 1.15).
Ms. Kantorowska and her associates said while they found “a significant association between a hospital’s DHM status and increased breastfeeding and decreased NEC rates among VLBW infants,” factors other than the availability of DHM contributed to changes in breastfeeding and NEC rates that occurred. They also noted that they saw an increased rate of breastfeeding and a similar decreasing rate of NEC in hospitals that did not transition to using DHM.
“Societal attitudes toward breastfeeding are likely influencing mothers’ attempts to provide breast milk to their VLBW infants. ... The NICU battle against NEC is ongoing, and other advances in care that occurred from 2007 to 2013 could be contributing to the observed decrease in NEC rate in hospitals that acquired DHM,” the researchers said.
Read the full study in Pediatrics (doi: 10.1542/peds.2015-3123).
For very low birth weight infants, the availability of donor human milk to newborns was associated with a decreased incidence of necrotizing enterocolitis and an increased rate of breastfeeding at discharge from a neonatal intensive care unit.
The researchers based their findings on data obtained from the California Perinatal Quality Care Collaborative, which gathers information on the care of greater than 90% of California’s neonatal intensive care unit (NICU) admissions of very low birth weight (VLBW) infants (defined as weighing less than or equal to 1.5 kg at birth), and the Mother’s Milk Bank of San Jose, a human milk bank serving 94 hospitals across several states, including California. All of the data was collected between 2007 and 2013 in over 42,000 VLBW babies. Babies were classified as breastfeeding at discharge, if they were feeding with human milk or human milk with fortifier or formula, but not if they were only feeding with formula.
Agata Kantorowska, a medical student at the University of Rochester (N.Y.) School of Medicine and Dentistry, and her colleagues noted that they did not know if donor human milk (DHM) was used primarily as a back-up feeding if mother’s milk was unavailable, in another way, or in conjunction with human milk-derived fortifiers; the proportion of VLBW infants within each NICU that received DHM; or the length of time that an individual received DHM.
Among the 22 hospitals studied that went from not having DHM available to making it available, on average, the rate of breastfeeding at discharge increased by 10% after DHM became available (P less than .0001). Among these same hospitals, the mean change in necrotizing enterocolitis (NEC) prevalence, following the introduction of DHM, was a 2.6% decrease (P = .0006). Before DHM became available in the 22 hospitals, 52.8% of VLBW infants were breastfeeding at discharge, compared with 61.7% after DHM became available. The rate of NEC was 6.6% among VLBW infants prior to DHM having becoming available at a hospital, versus 4.3% following the introduction of DHM to a hospital.
Following risk adjustment, not having DHM available in a hospital was a negative predictor for breastfeeding at discharge (odds ratio, 0.70) and a positive predictor of NEC (odds ratio, 1.15).
Ms. Kantorowska and her associates said while they found “a significant association between a hospital’s DHM status and increased breastfeeding and decreased NEC rates among VLBW infants,” factors other than the availability of DHM contributed to changes in breastfeeding and NEC rates that occurred. They also noted that they saw an increased rate of breastfeeding and a similar decreasing rate of NEC in hospitals that did not transition to using DHM.
“Societal attitudes toward breastfeeding are likely influencing mothers’ attempts to provide breast milk to their VLBW infants. ... The NICU battle against NEC is ongoing, and other advances in care that occurred from 2007 to 2013 could be contributing to the observed decrease in NEC rate in hospitals that acquired DHM,” the researchers said.
Read the full study in Pediatrics (doi: 10.1542/peds.2015-3123).
FROM PEDIATRICS
Gender identity disorders in males associated with MS
An association between gender identity disorders (GIDs) and subsequent multiple sclerosis (MS) in males was found in an analysis of linked English Hospital Episode Statistics and mortality data from January 1999 to March 2012.
The findings “suggest that low testosterone levels and/or feminising gonadal hormones might influence MS risk in some men and highlight a need for further work to explore any potential role for gonadal hormones in management and/or prevention strategies,” wrote Dr. Julia Pakpoor of the Unit of Health-Care Epidemiology, Nuffield Department of Population Health, at University of Oxford (England).
She and her colleagues used the patient data to construct male and female cohorts (1,157 patients and 2,390 patients, respectively) of patients with GIDs. A patient was included in one of the two GID cohorts if he or she had an episode of care or hospital admission in which a GID or sexual transformation procedure was coded in any diagnostic position.
For males with GIDs transitioning to females, the most studied treatment regimen involves using feminizing hormones and anti-androgens, which reduce testosterone secretion or neutralize testosterone activity, the researchers noted.
They also used the database to construct male and female cohorts (4.6 million patients and 3.4 million patients, respectively) to serve as two control groups. For patients to be included in the control groups, they needed to have been first admitted to a hospital for a minor condition and to never have been admitted to a hospital for MS. Patients who had been admitted to a hospital for MS either before or at the same time they were admitted for GIDs were excluded from the GID cohorts. A patient stopped being followed upon diagnosis with MS.
“Our study design cannot give insights into mechanisms that might explain the association [between males with GIDs and MS]. However, there is evidence suggesting an association between gonadal hormones and MS, including animal models suggesting anti-inflammatory and/or neuroprotective actions of testosterone, studies indicating a high prevalence of hypogonadism in male MS patients, and improved cognitive function and slowed brain atrophy in a small pilot trial of testosterone,” the researchers noted.
The adjusted rate ratio of MS following GID in males was 6.63 (P = .0002), compared with 1.44 in females (P = .58). The adjusted rate ratios were based on 4 observed cases and 0.6 expected cases of MS in males and 5 observed cases and 3.5 expected cases of MS in females.
The authors reported no conflicts of interest.
Read the study in Multiple Sclerosis Journal (doi: 10.1177/1352458515627205).
An association between gender identity disorders (GIDs) and subsequent multiple sclerosis (MS) in males was found in an analysis of linked English Hospital Episode Statistics and mortality data from January 1999 to March 2012.
The findings “suggest that low testosterone levels and/or feminising gonadal hormones might influence MS risk in some men and highlight a need for further work to explore any potential role for gonadal hormones in management and/or prevention strategies,” wrote Dr. Julia Pakpoor of the Unit of Health-Care Epidemiology, Nuffield Department of Population Health, at University of Oxford (England).
She and her colleagues used the patient data to construct male and female cohorts (1,157 patients and 2,390 patients, respectively) of patients with GIDs. A patient was included in one of the two GID cohorts if he or she had an episode of care or hospital admission in which a GID or sexual transformation procedure was coded in any diagnostic position.
For males with GIDs transitioning to females, the most studied treatment regimen involves using feminizing hormones and anti-androgens, which reduce testosterone secretion or neutralize testosterone activity, the researchers noted.
They also used the database to construct male and female cohorts (4.6 million patients and 3.4 million patients, respectively) to serve as two control groups. For patients to be included in the control groups, they needed to have been first admitted to a hospital for a minor condition and to never have been admitted to a hospital for MS. Patients who had been admitted to a hospital for MS either before or at the same time they were admitted for GIDs were excluded from the GID cohorts. A patient stopped being followed upon diagnosis with MS.
“Our study design cannot give insights into mechanisms that might explain the association [between males with GIDs and MS]. However, there is evidence suggesting an association between gonadal hormones and MS, including animal models suggesting anti-inflammatory and/or neuroprotective actions of testosterone, studies indicating a high prevalence of hypogonadism in male MS patients, and improved cognitive function and slowed brain atrophy in a small pilot trial of testosterone,” the researchers noted.
The adjusted rate ratio of MS following GID in males was 6.63 (P = .0002), compared with 1.44 in females (P = .58). The adjusted rate ratios were based on 4 observed cases and 0.6 expected cases of MS in males and 5 observed cases and 3.5 expected cases of MS in females.
The authors reported no conflicts of interest.
Read the study in Multiple Sclerosis Journal (doi: 10.1177/1352458515627205).
An association between gender identity disorders (GIDs) and subsequent multiple sclerosis (MS) in males was found in an analysis of linked English Hospital Episode Statistics and mortality data from January 1999 to March 2012.
The findings “suggest that low testosterone levels and/or feminising gonadal hormones might influence MS risk in some men and highlight a need for further work to explore any potential role for gonadal hormones in management and/or prevention strategies,” wrote Dr. Julia Pakpoor of the Unit of Health-Care Epidemiology, Nuffield Department of Population Health, at University of Oxford (England).
She and her colleagues used the patient data to construct male and female cohorts (1,157 patients and 2,390 patients, respectively) of patients with GIDs. A patient was included in one of the two GID cohorts if he or she had an episode of care or hospital admission in which a GID or sexual transformation procedure was coded in any diagnostic position.
For males with GIDs transitioning to females, the most studied treatment regimen involves using feminizing hormones and anti-androgens, which reduce testosterone secretion or neutralize testosterone activity, the researchers noted.
They also used the database to construct male and female cohorts (4.6 million patients and 3.4 million patients, respectively) to serve as two control groups. For patients to be included in the control groups, they needed to have been first admitted to a hospital for a minor condition and to never have been admitted to a hospital for MS. Patients who had been admitted to a hospital for MS either before or at the same time they were admitted for GIDs were excluded from the GID cohorts. A patient stopped being followed upon diagnosis with MS.
“Our study design cannot give insights into mechanisms that might explain the association [between males with GIDs and MS]. However, there is evidence suggesting an association between gonadal hormones and MS, including animal models suggesting anti-inflammatory and/or neuroprotective actions of testosterone, studies indicating a high prevalence of hypogonadism in male MS patients, and improved cognitive function and slowed brain atrophy in a small pilot trial of testosterone,” the researchers noted.
The adjusted rate ratio of MS following GID in males was 6.63 (P = .0002), compared with 1.44 in females (P = .58). The adjusted rate ratios were based on 4 observed cases and 0.6 expected cases of MS in males and 5 observed cases and 3.5 expected cases of MS in females.
The authors reported no conflicts of interest.
Read the study in Multiple Sclerosis Journal (doi: 10.1177/1352458515627205).
FROM MULTIPLE SCLEROSIS JOURNAL
Use preventive strategies to lower cardiovascular risks in bipolar I
The significantly increased risk of myocardial infarction or stroke in patients with bipolar I disorder appears to be tied more to preventive factors than to cardiovascular risk factors. However, bipolar I patients with a history of psychosis have an marginally increased risk of MI or stroke, a population-based cohort study showed.
The researchers came to those conclusions after analyzing residents’ health records and death certificates in Olmsted County, Minn., which were contained within the Rochester Epidemiology Project database. The study’s participants included 334 patients with bipolar I disorder and 334 people without bipolar disorder, although one of the patients who did not have bipolar I at the beginning of the study was later diagnosed with the disorder. All participants had been residents of Olmsted County from Jan. 1, 1966, through Dec. 31,1996.
Patients continued to be followed until Dec. 31, 2013, unless one of the following events occurred before that date: the patient had an MI or stroke, was lost to follow-up, or died before the end of the study. A patient experiencing an MI, stroke, or death or a patient disappearing from the database triggered an end to that patient’s participation in the study.
When an individual having an MI or a stroke was treated as a composite outcome, bipolar I disorder patients had a significantly increased risk of experiencing a fatal or non-fatal MI or stroke, compared with the individuals in the control group (P = .04). The risk was no longer significant after the researchers adjusted for the following potential baseline confounders of the association between bipolar disorder and cardiovascular disease: alcohol use disorder, diabetes, hypertension, and smoking (P = .46).
Meanwhile, a secondary analysis of the data showed that history of psychosis was indeed tied to a marginally increased risk of MI or stroke (P =.06).
“It will be fundamental to improve current preventive strategies to decrease the prevalence of smoking, alcohol use, hypertension, and diabetes among patients with bipolar disorder,” said Dr. Miguel L. Prieto of the department of psychiatry and psychology at the Mayo Medical School, Rochester, Minn., and his colleagues. “Moreover, we detected a possible higher risk of MI/stroke in the subgroup of patients with history of psychosis that certainly warrants replication.”
Future research also should seek to determine early biomarkers of atherosclerosis, the researchers said.
Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2016.01.015).
The significantly increased risk of myocardial infarction or stroke in patients with bipolar I disorder appears to be tied more to preventive factors than to cardiovascular risk factors. However, bipolar I patients with a history of psychosis have an marginally increased risk of MI or stroke, a population-based cohort study showed.
The researchers came to those conclusions after analyzing residents’ health records and death certificates in Olmsted County, Minn., which were contained within the Rochester Epidemiology Project database. The study’s participants included 334 patients with bipolar I disorder and 334 people without bipolar disorder, although one of the patients who did not have bipolar I at the beginning of the study was later diagnosed with the disorder. All participants had been residents of Olmsted County from Jan. 1, 1966, through Dec. 31,1996.
Patients continued to be followed until Dec. 31, 2013, unless one of the following events occurred before that date: the patient had an MI or stroke, was lost to follow-up, or died before the end of the study. A patient experiencing an MI, stroke, or death or a patient disappearing from the database triggered an end to that patient’s participation in the study.
When an individual having an MI or a stroke was treated as a composite outcome, bipolar I disorder patients had a significantly increased risk of experiencing a fatal or non-fatal MI or stroke, compared with the individuals in the control group (P = .04). The risk was no longer significant after the researchers adjusted for the following potential baseline confounders of the association between bipolar disorder and cardiovascular disease: alcohol use disorder, diabetes, hypertension, and smoking (P = .46).
Meanwhile, a secondary analysis of the data showed that history of psychosis was indeed tied to a marginally increased risk of MI or stroke (P =.06).
“It will be fundamental to improve current preventive strategies to decrease the prevalence of smoking, alcohol use, hypertension, and diabetes among patients with bipolar disorder,” said Dr. Miguel L. Prieto of the department of psychiatry and psychology at the Mayo Medical School, Rochester, Minn., and his colleagues. “Moreover, we detected a possible higher risk of MI/stroke in the subgroup of patients with history of psychosis that certainly warrants replication.”
Future research also should seek to determine early biomarkers of atherosclerosis, the researchers said.
Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2016.01.015).
The significantly increased risk of myocardial infarction or stroke in patients with bipolar I disorder appears to be tied more to preventive factors than to cardiovascular risk factors. However, bipolar I patients with a history of psychosis have an marginally increased risk of MI or stroke, a population-based cohort study showed.
The researchers came to those conclusions after analyzing residents’ health records and death certificates in Olmsted County, Minn., which were contained within the Rochester Epidemiology Project database. The study’s participants included 334 patients with bipolar I disorder and 334 people without bipolar disorder, although one of the patients who did not have bipolar I at the beginning of the study was later diagnosed with the disorder. All participants had been residents of Olmsted County from Jan. 1, 1966, through Dec. 31,1996.
Patients continued to be followed until Dec. 31, 2013, unless one of the following events occurred before that date: the patient had an MI or stroke, was lost to follow-up, or died before the end of the study. A patient experiencing an MI, stroke, or death or a patient disappearing from the database triggered an end to that patient’s participation in the study.
When an individual having an MI or a stroke was treated as a composite outcome, bipolar I disorder patients had a significantly increased risk of experiencing a fatal or non-fatal MI or stroke, compared with the individuals in the control group (P = .04). The risk was no longer significant after the researchers adjusted for the following potential baseline confounders of the association between bipolar disorder and cardiovascular disease: alcohol use disorder, diabetes, hypertension, and smoking (P = .46).
Meanwhile, a secondary analysis of the data showed that history of psychosis was indeed tied to a marginally increased risk of MI or stroke (P =.06).
“It will be fundamental to improve current preventive strategies to decrease the prevalence of smoking, alcohol use, hypertension, and diabetes among patients with bipolar disorder,” said Dr. Miguel L. Prieto of the department of psychiatry and psychology at the Mayo Medical School, Rochester, Minn., and his colleagues. “Moreover, we detected a possible higher risk of MI/stroke in the subgroup of patients with history of psychosis that certainly warrants replication.”
Future research also should seek to determine early biomarkers of atherosclerosis, the researchers said.
Read the study in Journal of Affective Disorders (doi: 10.1016/j.jad.2016.01.015).
FROM JOURNAL OF AFFECTIVE DISORDERS
NIDA releases strategic plan to prevent, treat substance use disorders
The National Institute on Drug Abuse (NIDA) has developed a 5-year strategic plan aimed at gaining new information about the basic science of the brain as it relates to the causes and consequences of drug use and addiction. Part of the plan is to use novel findings about the brain to create more effective interventions for preventing and treating substance use disorders, according to a written statement by NIDA.
The plan for 2016-2020, which NIDA has named “Advancing Addiction Science,” calls for the achievement of the following four strategic goals:
• Identify the biological, environmental, behavioral, and social causes and consequences of drug use and addiction across the lifespan.
• Develop improved strategies to prevent drug use and its consequences.
• Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery.
• Increase the public health impact of NIDA research and programs.
“Developing this plan was a collaborative effort incorporating guidance from the National Advisory Council on Drug Abuse, scientific and clinical experts, stakeholder organizations, and the public,” NIDA Director Nora Volkow said in a written statement.
“This plan outlines our broad goals across basic science, prevention, treatment, and public health; identifies four priority focus areas that we believe present unique opportunities to be leveraged over the next 5 years; and reflects a flexible, dynamic approach that will allow us to adapt to new scientific and technological advances and changing public health needs, and to take advantage of scientific opportunities as they arise,” she said.
More information about the plan is available here.
The National Institute on Drug Abuse (NIDA) has developed a 5-year strategic plan aimed at gaining new information about the basic science of the brain as it relates to the causes and consequences of drug use and addiction. Part of the plan is to use novel findings about the brain to create more effective interventions for preventing and treating substance use disorders, according to a written statement by NIDA.
The plan for 2016-2020, which NIDA has named “Advancing Addiction Science,” calls for the achievement of the following four strategic goals:
• Identify the biological, environmental, behavioral, and social causes and consequences of drug use and addiction across the lifespan.
• Develop improved strategies to prevent drug use and its consequences.
• Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery.
• Increase the public health impact of NIDA research and programs.
“Developing this plan was a collaborative effort incorporating guidance from the National Advisory Council on Drug Abuse, scientific and clinical experts, stakeholder organizations, and the public,” NIDA Director Nora Volkow said in a written statement.
“This plan outlines our broad goals across basic science, prevention, treatment, and public health; identifies four priority focus areas that we believe present unique opportunities to be leveraged over the next 5 years; and reflects a flexible, dynamic approach that will allow us to adapt to new scientific and technological advances and changing public health needs, and to take advantage of scientific opportunities as they arise,” she said.
More information about the plan is available here.
The National Institute on Drug Abuse (NIDA) has developed a 5-year strategic plan aimed at gaining new information about the basic science of the brain as it relates to the causes and consequences of drug use and addiction. Part of the plan is to use novel findings about the brain to create more effective interventions for preventing and treating substance use disorders, according to a written statement by NIDA.
The plan for 2016-2020, which NIDA has named “Advancing Addiction Science,” calls for the achievement of the following four strategic goals:
• Identify the biological, environmental, behavioral, and social causes and consequences of drug use and addiction across the lifespan.
• Develop improved strategies to prevent drug use and its consequences.
• Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery.
• Increase the public health impact of NIDA research and programs.
“Developing this plan was a collaborative effort incorporating guidance from the National Advisory Council on Drug Abuse, scientific and clinical experts, stakeholder organizations, and the public,” NIDA Director Nora Volkow said in a written statement.
“This plan outlines our broad goals across basic science, prevention, treatment, and public health; identifies four priority focus areas that we believe present unique opportunities to be leveraged over the next 5 years; and reflects a flexible, dynamic approach that will allow us to adapt to new scientific and technological advances and changing public health needs, and to take advantage of scientific opportunities as they arise,” she said.
More information about the plan is available here.
