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Foodborne illnesses of foreign, domestic origin: On the rise?
Are foodborne illness outbreaks more common now, or are we simply better at detection? Have the foods and sources associated with foodborne illness changed? Two recent Centers for Disease Control & Prevention reports provide insight.1,2 In 2016, the Foodborne Diseases Active Surveillance Network (FoodNet) detected 24,029 infections, 5,212 hospitalizations, and 98 fatalities.1 FoodNet has 10 sites serving 49 million people (15% of the U.S. population). These 2016 numbers changed only modestly from the 3 prior years.
The big two
, detected by traditional cultures or culture-independent diagnostic tests (CIDTs). (See table.) CIDTs are relatively new molecular-based, mostly multiplex assays that test for more than a dozen pathogens in one assay.
Overall, Salmonella originated from diverse sources (eggs, poultry, meat, unpasteurized milk/juice/cheese, or raw fruits/vegetables/spices/nuts). But, in 2016, U.S. Salmonella outbreaks were from eggs, alfalfa sprouts, poultry, pistachios, and organic shake/meal products.
The runners-up
Most of the remainder of the 2016 foodborne illnesses were caused by Shigella, with nearly 3,000 cases; shigatoxin-producing Escherichia coli (STEC), with nearly 2,000 cases; and Cryptosporidium, also with nearly 2,000 cases. (See table.)
Hemolytic uremic syndrome (HUS)
HUS rates, mostly resulting from E. coli 0157 H7 in meat, did not vary from 2013 to 2016, with a total 62 pediatric HUS cases in FoodNet (0.56 /100,000 population). Slightly over half (56%) occurred in children under 5 years old at 1.18 per 100,000 population.
Does CIDT increase detection rates?
Detection of the “big two” did not change from 2013 to 2016 or over the past 2 decades. That said, Campylobacter detection was actually down 11% if considering only culture-confirmed cases. That is, if we do not count detections made exclusively by CIDT.
This is important because CIDT – now supplanting culture in many laboratories – identifies pathogens not likely detected by standard culture because culture is generally selective and CIDT is more sensitive. CIDT can increase detection rates (solo and multiple pathogens), even if illnesses do not really increase. The CDC suggested that this contributed to increased STEC and Yersinia detection in 2016. Some would not have been detected if only culture had been utilized.
Viable bacterial/viral isolates are not available from CIDT. A replicating pathogen is needed to characterize shifting/emerging pathogen strains (for example, analysis for mutations or new pathogens via sequencing or antimicrobial susceptibility testing).
To compensate, some CIDT-using laboratories perform “reflex cultures.” CIDT positive specimens also are cultured to provide viable isolates. However, this adds cost to an already costly CIDT test.
The role of imported food
Surveillance systems, such as the Foodborne Disease Outbreak Surveillance System, also track imported foodborne illness. Despite an approximately 50% decrease in overall U.S. foodborne outbreaks since 2000, imported food-related outbreaks increased to 195 during 2006-2014 from 54 during 1996-2004, with 10,685 illnesses, 1,017 hospitalizations, and 19 deaths since 2009. Also, imported food-related outbreaks rose from a mean 3 per year pre-2000 to a mean 18 per year during 2009-2014. Most imported food outbreaks (86% of total) had three causes: scombroid toxin (42% of total), Salmonella (33%), and hepatitis A virus (11%).
Most imported food illnesses were from Salmonella (4,421 from 52 outbreaks), Cyclospora (2,533 from 33 outbreaks), hepatitis A virus (1,150 from 11 outbreaks), and Shigella (625 from 6 outbreaks). While eggs, ice cream, and poultry are notorious origins for Salmonella in domestic food, most imported Salmonella were from produce: fruits (26%), seeded vegetables (20%), sprouts (11%), nuts/seeds (10%), spices (7%), and herbs (2%).
Seafood/fish caused 55% of outbreaks but few illnesses per outbreak (median 3 illnesses/outbreak), so only 11% of total illnesses were caused by seafood/fish. In contrast, fresh produce caused only 33% of outbreaks but 84% of illnesses (median 40 illnesses/outbreak).
Geographic source, outbreak locations
The origin was known in 91% of outbreaks. Latin America and the Caribbean were most common, followed by Asia.3 Main contributing countries were Mexico (42 outbreaks), Indonesia (17) and Canada (11).
Contaminated fish/shellfish originated from all regions except Europe, most commonly from Asia (the majority of fish/shellfish outbreaks were from Indonesia, Vietnam, China, Philippines, Taiwan, and Thailand) with smaller contributions from the Bahamas and Ecuador.
Contaminated produce originated from all regions, mostly (64%) from Mexico and the Americas (Chile, Guatemala, and Honduras). All but one dairy outbreak originated in Latin America/the Caribbean.3 Outbreaks occurred in 31 states, most commonly California (30), Florida (25), and New York (16). Additionally, 43 (22%) were multistate outbreaks.
Conclusions
Outbreaks from domestic foods decreased, but those from imported foods increased. This makes sense given recent increases in outbreak-prone food imports, such as seafood/fish and produce.
To reduce overall foodborne illness outbreaks, governmental agencies need to:
- Develop/enforce regulations that promote proper growing, handling, and processing of foods.
- Strengthen surveillance networks and share standard culture and molecular detection/characterization protocols to identify outbreaks as close to real time as possible.
- Ensure rapid traceability not only to country of origin but to an exact farm or seafood/fish harvesting entity.
- Provide rapid public knowledge of outbreaks and origins, plus outbreak-specific recommendations to control/minimize resultant illnesses.
Individuals can help protect themselves by avoiding inadequately washed or incompletely cooked foods or foods of uncertain origin.
Dr. Harrison is professor of pediatrics and pediatric infectious diseases at Children’s Mercy Hospitals and Clinics, Kansas City, Mo. He said he had no relevant financial disclosures. Email him at [email protected].
References
1. MMWR. 2017 Apr 21;66(15):397-403.
2. Emerg Infect Dis. 2017 Mar;23(3):525-8.
3. Technical appendix in Emerg Infect Dis. 2017 Mar;23(3):525-8.
Are foodborne illness outbreaks more common now, or are we simply better at detection? Have the foods and sources associated with foodborne illness changed? Two recent Centers for Disease Control & Prevention reports provide insight.1,2 In 2016, the Foodborne Diseases Active Surveillance Network (FoodNet) detected 24,029 infections, 5,212 hospitalizations, and 98 fatalities.1 FoodNet has 10 sites serving 49 million people (15% of the U.S. population). These 2016 numbers changed only modestly from the 3 prior years.
The big two
, detected by traditional cultures or culture-independent diagnostic tests (CIDTs). (See table.) CIDTs are relatively new molecular-based, mostly multiplex assays that test for more than a dozen pathogens in one assay.
Overall, Salmonella originated from diverse sources (eggs, poultry, meat, unpasteurized milk/juice/cheese, or raw fruits/vegetables/spices/nuts). But, in 2016, U.S. Salmonella outbreaks were from eggs, alfalfa sprouts, poultry, pistachios, and organic shake/meal products.
The runners-up
Most of the remainder of the 2016 foodborne illnesses were caused by Shigella, with nearly 3,000 cases; shigatoxin-producing Escherichia coli (STEC), with nearly 2,000 cases; and Cryptosporidium, also with nearly 2,000 cases. (See table.)
Hemolytic uremic syndrome (HUS)
HUS rates, mostly resulting from E. coli 0157 H7 in meat, did not vary from 2013 to 2016, with a total 62 pediatric HUS cases in FoodNet (0.56 /100,000 population). Slightly over half (56%) occurred in children under 5 years old at 1.18 per 100,000 population.
Does CIDT increase detection rates?
Detection of the “big two” did not change from 2013 to 2016 or over the past 2 decades. That said, Campylobacter detection was actually down 11% if considering only culture-confirmed cases. That is, if we do not count detections made exclusively by CIDT.
This is important because CIDT – now supplanting culture in many laboratories – identifies pathogens not likely detected by standard culture because culture is generally selective and CIDT is more sensitive. CIDT can increase detection rates (solo and multiple pathogens), even if illnesses do not really increase. The CDC suggested that this contributed to increased STEC and Yersinia detection in 2016. Some would not have been detected if only culture had been utilized.
Viable bacterial/viral isolates are not available from CIDT. A replicating pathogen is needed to characterize shifting/emerging pathogen strains (for example, analysis for mutations or new pathogens via sequencing or antimicrobial susceptibility testing).
To compensate, some CIDT-using laboratories perform “reflex cultures.” CIDT positive specimens also are cultured to provide viable isolates. However, this adds cost to an already costly CIDT test.
The role of imported food
Surveillance systems, such as the Foodborne Disease Outbreak Surveillance System, also track imported foodborne illness. Despite an approximately 50% decrease in overall U.S. foodborne outbreaks since 2000, imported food-related outbreaks increased to 195 during 2006-2014 from 54 during 1996-2004, with 10,685 illnesses, 1,017 hospitalizations, and 19 deaths since 2009. Also, imported food-related outbreaks rose from a mean 3 per year pre-2000 to a mean 18 per year during 2009-2014. Most imported food outbreaks (86% of total) had three causes: scombroid toxin (42% of total), Salmonella (33%), and hepatitis A virus (11%).
Most imported food illnesses were from Salmonella (4,421 from 52 outbreaks), Cyclospora (2,533 from 33 outbreaks), hepatitis A virus (1,150 from 11 outbreaks), and Shigella (625 from 6 outbreaks). While eggs, ice cream, and poultry are notorious origins for Salmonella in domestic food, most imported Salmonella were from produce: fruits (26%), seeded vegetables (20%), sprouts (11%), nuts/seeds (10%), spices (7%), and herbs (2%).
Seafood/fish caused 55% of outbreaks but few illnesses per outbreak (median 3 illnesses/outbreak), so only 11% of total illnesses were caused by seafood/fish. In contrast, fresh produce caused only 33% of outbreaks but 84% of illnesses (median 40 illnesses/outbreak).
Geographic source, outbreak locations
The origin was known in 91% of outbreaks. Latin America and the Caribbean were most common, followed by Asia.3 Main contributing countries were Mexico (42 outbreaks), Indonesia (17) and Canada (11).
Contaminated fish/shellfish originated from all regions except Europe, most commonly from Asia (the majority of fish/shellfish outbreaks were from Indonesia, Vietnam, China, Philippines, Taiwan, and Thailand) with smaller contributions from the Bahamas and Ecuador.
Contaminated produce originated from all regions, mostly (64%) from Mexico and the Americas (Chile, Guatemala, and Honduras). All but one dairy outbreak originated in Latin America/the Caribbean.3 Outbreaks occurred in 31 states, most commonly California (30), Florida (25), and New York (16). Additionally, 43 (22%) were multistate outbreaks.
Conclusions
Outbreaks from domestic foods decreased, but those from imported foods increased. This makes sense given recent increases in outbreak-prone food imports, such as seafood/fish and produce.
To reduce overall foodborne illness outbreaks, governmental agencies need to:
- Develop/enforce regulations that promote proper growing, handling, and processing of foods.
- Strengthen surveillance networks and share standard culture and molecular detection/characterization protocols to identify outbreaks as close to real time as possible.
- Ensure rapid traceability not only to country of origin but to an exact farm or seafood/fish harvesting entity.
- Provide rapid public knowledge of outbreaks and origins, plus outbreak-specific recommendations to control/minimize resultant illnesses.
Individuals can help protect themselves by avoiding inadequately washed or incompletely cooked foods or foods of uncertain origin.
Dr. Harrison is professor of pediatrics and pediatric infectious diseases at Children’s Mercy Hospitals and Clinics, Kansas City, Mo. He said he had no relevant financial disclosures. Email him at [email protected].
References
1. MMWR. 2017 Apr 21;66(15):397-403.
2. Emerg Infect Dis. 2017 Mar;23(3):525-8.
3. Technical appendix in Emerg Infect Dis. 2017 Mar;23(3):525-8.
Are foodborne illness outbreaks more common now, or are we simply better at detection? Have the foods and sources associated with foodborne illness changed? Two recent Centers for Disease Control & Prevention reports provide insight.1,2 In 2016, the Foodborne Diseases Active Surveillance Network (FoodNet) detected 24,029 infections, 5,212 hospitalizations, and 98 fatalities.1 FoodNet has 10 sites serving 49 million people (15% of the U.S. population). These 2016 numbers changed only modestly from the 3 prior years.
The big two
, detected by traditional cultures or culture-independent diagnostic tests (CIDTs). (See table.) CIDTs are relatively new molecular-based, mostly multiplex assays that test for more than a dozen pathogens in one assay.
Overall, Salmonella originated from diverse sources (eggs, poultry, meat, unpasteurized milk/juice/cheese, or raw fruits/vegetables/spices/nuts). But, in 2016, U.S. Salmonella outbreaks were from eggs, alfalfa sprouts, poultry, pistachios, and organic shake/meal products.
The runners-up
Most of the remainder of the 2016 foodborne illnesses were caused by Shigella, with nearly 3,000 cases; shigatoxin-producing Escherichia coli (STEC), with nearly 2,000 cases; and Cryptosporidium, also with nearly 2,000 cases. (See table.)
Hemolytic uremic syndrome (HUS)
HUS rates, mostly resulting from E. coli 0157 H7 in meat, did not vary from 2013 to 2016, with a total 62 pediatric HUS cases in FoodNet (0.56 /100,000 population). Slightly over half (56%) occurred in children under 5 years old at 1.18 per 100,000 population.
Does CIDT increase detection rates?
Detection of the “big two” did not change from 2013 to 2016 or over the past 2 decades. That said, Campylobacter detection was actually down 11% if considering only culture-confirmed cases. That is, if we do not count detections made exclusively by CIDT.
This is important because CIDT – now supplanting culture in many laboratories – identifies pathogens not likely detected by standard culture because culture is generally selective and CIDT is more sensitive. CIDT can increase detection rates (solo and multiple pathogens), even if illnesses do not really increase. The CDC suggested that this contributed to increased STEC and Yersinia detection in 2016. Some would not have been detected if only culture had been utilized.
Viable bacterial/viral isolates are not available from CIDT. A replicating pathogen is needed to characterize shifting/emerging pathogen strains (for example, analysis for mutations or new pathogens via sequencing or antimicrobial susceptibility testing).
To compensate, some CIDT-using laboratories perform “reflex cultures.” CIDT positive specimens also are cultured to provide viable isolates. However, this adds cost to an already costly CIDT test.
The role of imported food
Surveillance systems, such as the Foodborne Disease Outbreak Surveillance System, also track imported foodborne illness. Despite an approximately 50% decrease in overall U.S. foodborne outbreaks since 2000, imported food-related outbreaks increased to 195 during 2006-2014 from 54 during 1996-2004, with 10,685 illnesses, 1,017 hospitalizations, and 19 deaths since 2009. Also, imported food-related outbreaks rose from a mean 3 per year pre-2000 to a mean 18 per year during 2009-2014. Most imported food outbreaks (86% of total) had three causes: scombroid toxin (42% of total), Salmonella (33%), and hepatitis A virus (11%).
Most imported food illnesses were from Salmonella (4,421 from 52 outbreaks), Cyclospora (2,533 from 33 outbreaks), hepatitis A virus (1,150 from 11 outbreaks), and Shigella (625 from 6 outbreaks). While eggs, ice cream, and poultry are notorious origins for Salmonella in domestic food, most imported Salmonella were from produce: fruits (26%), seeded vegetables (20%), sprouts (11%), nuts/seeds (10%), spices (7%), and herbs (2%).
Seafood/fish caused 55% of outbreaks but few illnesses per outbreak (median 3 illnesses/outbreak), so only 11% of total illnesses were caused by seafood/fish. In contrast, fresh produce caused only 33% of outbreaks but 84% of illnesses (median 40 illnesses/outbreak).
Geographic source, outbreak locations
The origin was known in 91% of outbreaks. Latin America and the Caribbean were most common, followed by Asia.3 Main contributing countries were Mexico (42 outbreaks), Indonesia (17) and Canada (11).
Contaminated fish/shellfish originated from all regions except Europe, most commonly from Asia (the majority of fish/shellfish outbreaks were from Indonesia, Vietnam, China, Philippines, Taiwan, and Thailand) with smaller contributions from the Bahamas and Ecuador.
Contaminated produce originated from all regions, mostly (64%) from Mexico and the Americas (Chile, Guatemala, and Honduras). All but one dairy outbreak originated in Latin America/the Caribbean.3 Outbreaks occurred in 31 states, most commonly California (30), Florida (25), and New York (16). Additionally, 43 (22%) were multistate outbreaks.
Conclusions
Outbreaks from domestic foods decreased, but those from imported foods increased. This makes sense given recent increases in outbreak-prone food imports, such as seafood/fish and produce.
To reduce overall foodborne illness outbreaks, governmental agencies need to:
- Develop/enforce regulations that promote proper growing, handling, and processing of foods.
- Strengthen surveillance networks and share standard culture and molecular detection/characterization protocols to identify outbreaks as close to real time as possible.
- Ensure rapid traceability not only to country of origin but to an exact farm or seafood/fish harvesting entity.
- Provide rapid public knowledge of outbreaks and origins, plus outbreak-specific recommendations to control/minimize resultant illnesses.
Individuals can help protect themselves by avoiding inadequately washed or incompletely cooked foods or foods of uncertain origin.
Dr. Harrison is professor of pediatrics and pediatric infectious diseases at Children’s Mercy Hospitals and Clinics, Kansas City, Mo. He said he had no relevant financial disclosures. Email him at [email protected].
References
1. MMWR. 2017 Apr 21;66(15):397-403.
2. Emerg Infect Dis. 2017 Mar;23(3):525-8.
3. Technical appendix in Emerg Infect Dis. 2017 Mar;23(3):525-8.
VIDEO: Lack of heart teams impact prevalence of PCI
BOSTON – Data show a marked bias in referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team.
More patients underwent percutaneous coronary intervention (PCI) in hospitals without on-site cardiac surgery than patients at hospitals with on-site cardiac surgery, according to the analysis presented at the annual meeting of the American Association for Thoracic Surgery. The multivariate logistic regression analysis showed that the absence of on-site cardiac surgery and a heart team was an independent predictor for PCI.
In this video, Ehud Raanani, MD, of Tel Aviv University in Israel discusses referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team and how this phenomenon could affect patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
BOSTON – Data show a marked bias in referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team.
More patients underwent percutaneous coronary intervention (PCI) in hospitals without on-site cardiac surgery than patients at hospitals with on-site cardiac surgery, according to the analysis presented at the annual meeting of the American Association for Thoracic Surgery. The multivariate logistic regression analysis showed that the absence of on-site cardiac surgery and a heart team was an independent predictor for PCI.
In this video, Ehud Raanani, MD, of Tel Aviv University in Israel discusses referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team and how this phenomenon could affect patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
BOSTON – Data show a marked bias in referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team.
More patients underwent percutaneous coronary intervention (PCI) in hospitals without on-site cardiac surgery than patients at hospitals with on-site cardiac surgery, according to the analysis presented at the annual meeting of the American Association for Thoracic Surgery. The multivariate logistic regression analysis showed that the absence of on-site cardiac surgery and a heart team was an independent predictor for PCI.
In this video, Ehud Raanani, MD, of Tel Aviv University in Israel discusses referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team and how this phenomenon could affect patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
AT THE AATS ANNUAL MEETING
Interdisciplinary care reduces deep dyspareunia in endometriosis
VANCOUVER – Interdisciplinary care for women with deep dyspareunia led to a reduction in severe cases, but had no effect on superficial dyspareunia, a study showed.
The findings were measured after 1 year in a treatment program that included laparoscopic surgery, hormonal suppression, biofeedback, pelvic floor physiotherapy, cognitive-behavioral therapy, and mindfulness-based therapy.
About half of women with endometriosis experience deep dyspareunia, which can have a strong, negative impact on quality of life and relationships, Paul Yong, MD, PhD, reported at the World Congress on Endometriosis. For women who do not respond to surgical or medical interventions, interdisciplinary approaches that address the biopsychosocial aspect of pain in endometriosis could be of benefit, he said.
He said the researchers didn’t expect the superficial dyspareunia to respond to the treatments, since it is likely tied to nerve issues. But as a secondary measure, superficial dyspareunia acted as a sort of built-in control to show that the interventions were not having a broad placebo or nonspecific effect on pain.
The study included 296 women who came to the BC Women’s Hospital Centre for Pelvic Pain and Endometriosis with complaints of deep dyspareunia between December 2013 and December 2014. In total, 58% had a confirmed diagnosis of endometriosis, 24% had suspected endometriosis, and 18% had no endometriosis. More than half of the women had irritable bowel syndrome, 42% had painful bladder syndrome, and 30% had pelvic floor dysfunction.
About 55% of patients underwent surgery, while 13% were on hormonal treatment at both baseline and 1 year, 11% were on a pain adjuvant, 30% were on opioids, and 17% were enrolled in a pain program.
At baseline, half of the women reported severe symptoms of deep dyspareunia, but that percentage dropped to 30.4% at 1 year. Moderate cases increased from 17.7% at baseline to 25.0% at 1 year, and mild cases increased from 27.3% to 44.6% (P less than .0001).
A secondary analysis of patients with superficial dyspareunia showed no statistically significant changes in category frequencies. Severe cases represented 22.4% of the population at baseline and 20.2% at 1 year, and similarities were also seen in proportions of moderate (20.2% vs. 19.8%) and mild cases (57.4% vs. 60.1%, P = .65).
“This really suggests that the treatment program has some specificity for deep dyspareunia,” Dr. Yong said.
Depressive symptoms at baseline, as assessed by the Patient Health Questionnaire–9 scale, predicted deep dyspareunia at 1 year (odds ratio, 1.07; 95% confidence interval, 1.03-1.11).
The efficacy against deep dyspareunia is encouraging, but superficial dyspareunia is also a key concern.
“The study suggests that the typical treatments for endometriosis may not impact at all this really prevalent issue of superficial pain, so there’s more for us to do there because that can be a cause of long-term suffering and decreased quality of life,” said Lori Brotto, PhD, director of the sexual health laboratory at the University of British Columbia, who moderated the session during which the research was presented.
Dr. Yong called for more research, specifically a trial targeting treatment of depressive symptoms to determine any effect on endometriosis-related sexual pain or function.
“I think there needs to be more work in the role of depression – not only screening for depression in women with endometriosis, but trying to understand what role it plays in endometriosis symptoms,” Dr. Yong said.
The study was funded by the Canadian Institutes of Health Research. Dr. Yong and Dr. Brotto reported having no relevant financial disclosures.
VANCOUVER – Interdisciplinary care for women with deep dyspareunia led to a reduction in severe cases, but had no effect on superficial dyspareunia, a study showed.
The findings were measured after 1 year in a treatment program that included laparoscopic surgery, hormonal suppression, biofeedback, pelvic floor physiotherapy, cognitive-behavioral therapy, and mindfulness-based therapy.
About half of women with endometriosis experience deep dyspareunia, which can have a strong, negative impact on quality of life and relationships, Paul Yong, MD, PhD, reported at the World Congress on Endometriosis. For women who do not respond to surgical or medical interventions, interdisciplinary approaches that address the biopsychosocial aspect of pain in endometriosis could be of benefit, he said.
He said the researchers didn’t expect the superficial dyspareunia to respond to the treatments, since it is likely tied to nerve issues. But as a secondary measure, superficial dyspareunia acted as a sort of built-in control to show that the interventions were not having a broad placebo or nonspecific effect on pain.
The study included 296 women who came to the BC Women’s Hospital Centre for Pelvic Pain and Endometriosis with complaints of deep dyspareunia between December 2013 and December 2014. In total, 58% had a confirmed diagnosis of endometriosis, 24% had suspected endometriosis, and 18% had no endometriosis. More than half of the women had irritable bowel syndrome, 42% had painful bladder syndrome, and 30% had pelvic floor dysfunction.
About 55% of patients underwent surgery, while 13% were on hormonal treatment at both baseline and 1 year, 11% were on a pain adjuvant, 30% were on opioids, and 17% were enrolled in a pain program.
At baseline, half of the women reported severe symptoms of deep dyspareunia, but that percentage dropped to 30.4% at 1 year. Moderate cases increased from 17.7% at baseline to 25.0% at 1 year, and mild cases increased from 27.3% to 44.6% (P less than .0001).
A secondary analysis of patients with superficial dyspareunia showed no statistically significant changes in category frequencies. Severe cases represented 22.4% of the population at baseline and 20.2% at 1 year, and similarities were also seen in proportions of moderate (20.2% vs. 19.8%) and mild cases (57.4% vs. 60.1%, P = .65).
“This really suggests that the treatment program has some specificity for deep dyspareunia,” Dr. Yong said.
Depressive symptoms at baseline, as assessed by the Patient Health Questionnaire–9 scale, predicted deep dyspareunia at 1 year (odds ratio, 1.07; 95% confidence interval, 1.03-1.11).
The efficacy against deep dyspareunia is encouraging, but superficial dyspareunia is also a key concern.
“The study suggests that the typical treatments for endometriosis may not impact at all this really prevalent issue of superficial pain, so there’s more for us to do there because that can be a cause of long-term suffering and decreased quality of life,” said Lori Brotto, PhD, director of the sexual health laboratory at the University of British Columbia, who moderated the session during which the research was presented.
Dr. Yong called for more research, specifically a trial targeting treatment of depressive symptoms to determine any effect on endometriosis-related sexual pain or function.
“I think there needs to be more work in the role of depression – not only screening for depression in women with endometriosis, but trying to understand what role it plays in endometriosis symptoms,” Dr. Yong said.
The study was funded by the Canadian Institutes of Health Research. Dr. Yong and Dr. Brotto reported having no relevant financial disclosures.
VANCOUVER – Interdisciplinary care for women with deep dyspareunia led to a reduction in severe cases, but had no effect on superficial dyspareunia, a study showed.
The findings were measured after 1 year in a treatment program that included laparoscopic surgery, hormonal suppression, biofeedback, pelvic floor physiotherapy, cognitive-behavioral therapy, and mindfulness-based therapy.
About half of women with endometriosis experience deep dyspareunia, which can have a strong, negative impact on quality of life and relationships, Paul Yong, MD, PhD, reported at the World Congress on Endometriosis. For women who do not respond to surgical or medical interventions, interdisciplinary approaches that address the biopsychosocial aspect of pain in endometriosis could be of benefit, he said.
He said the researchers didn’t expect the superficial dyspareunia to respond to the treatments, since it is likely tied to nerve issues. But as a secondary measure, superficial dyspareunia acted as a sort of built-in control to show that the interventions were not having a broad placebo or nonspecific effect on pain.
The study included 296 women who came to the BC Women’s Hospital Centre for Pelvic Pain and Endometriosis with complaints of deep dyspareunia between December 2013 and December 2014. In total, 58% had a confirmed diagnosis of endometriosis, 24% had suspected endometriosis, and 18% had no endometriosis. More than half of the women had irritable bowel syndrome, 42% had painful bladder syndrome, and 30% had pelvic floor dysfunction.
About 55% of patients underwent surgery, while 13% were on hormonal treatment at both baseline and 1 year, 11% were on a pain adjuvant, 30% were on opioids, and 17% were enrolled in a pain program.
At baseline, half of the women reported severe symptoms of deep dyspareunia, but that percentage dropped to 30.4% at 1 year. Moderate cases increased from 17.7% at baseline to 25.0% at 1 year, and mild cases increased from 27.3% to 44.6% (P less than .0001).
A secondary analysis of patients with superficial dyspareunia showed no statistically significant changes in category frequencies. Severe cases represented 22.4% of the population at baseline and 20.2% at 1 year, and similarities were also seen in proportions of moderate (20.2% vs. 19.8%) and mild cases (57.4% vs. 60.1%, P = .65).
“This really suggests that the treatment program has some specificity for deep dyspareunia,” Dr. Yong said.
Depressive symptoms at baseline, as assessed by the Patient Health Questionnaire–9 scale, predicted deep dyspareunia at 1 year (odds ratio, 1.07; 95% confidence interval, 1.03-1.11).
The efficacy against deep dyspareunia is encouraging, but superficial dyspareunia is also a key concern.
“The study suggests that the typical treatments for endometriosis may not impact at all this really prevalent issue of superficial pain, so there’s more for us to do there because that can be a cause of long-term suffering and decreased quality of life,” said Lori Brotto, PhD, director of the sexual health laboratory at the University of British Columbia, who moderated the session during which the research was presented.
Dr. Yong called for more research, specifically a trial targeting treatment of depressive symptoms to determine any effect on endometriosis-related sexual pain or function.
“I think there needs to be more work in the role of depression – not only screening for depression in women with endometriosis, but trying to understand what role it plays in endometriosis symptoms,” Dr. Yong said.
The study was funded by the Canadian Institutes of Health Research. Dr. Yong and Dr. Brotto reported having no relevant financial disclosures.
AT WCE 2017
Key clinical point:
Major finding: Severe cases of deep dyspareunia dropped from 50.0% to 30.4% at 1 year.
Data source: A retrospective analysis of 296 patients at a single center.
Disclosures: The study was funded by the Canadian Institutes of Health Research. Dr. Yong and Dr. Brotto reported having no relevant financial disclosures.
Mole count predicted melanoma death, especially among men
PORTLAND, ORE. – Among white men, the presence of at least one cutaneous nevus measuring 3 mm or more significantly predicted death from melanoma, in an adjusted analysis of a large prospective cohort study.
Mole count also predicted melanoma death among white women, but the association reached statistical significance only when women had at least three cutaneous nevi measuring 3 mm or more, Eunyoung Cho, ScD, said at the annual meeting of the Society for Investigative Dermatology. The reasons why these associations varied by sex is unclear, although previous studies have documented higher rates of melanoma death among men than among women, and even male physicians tend to seek health care less frequently than their female counterparts, Dr. Cho said in her poster presentation.
In the Nurses’ Health Study, white women with at least three moles measuring at least 3 mm in diameter were at significantly increased risk of dying of melanoma, compared with those with no moles that size (hazard ratio, 2.5; 95% confidence interval, 1.5-4.1), even after the investigators controlled for many other potential confounders, including sunburn history, skin reaction to sun during childhood, tanning ability, family history of melanoma, personal history of nonmelanoma skin cancer, age, activity level, smoking, body mass index, alcohol intake, and hair color. Women with one or two moles also showed a trend toward increased risk of melanoma death (HR, 1.4), but the 95% confidence interval for the hazard ratio did not reach statistical significance (0.9-2.3).
The investigators estimated that among white women, each additional mole measuring 3 mm or more conferred about a 12% increase in the melanoma death rate, even after confounders were controlled for.
In the Health Professionals Follow-Up Study, men with one or two moles of at least 3 mm had about twice the melanoma death rate as men without moles of this size (HR, 2.0; 95% CI, 1.3-3.3), even after investigators controlled for potential confounders. The risk of melanoma death was even greater among men with at least three moles (HR, 4.0; 95% CI, 2.5-6.2), and the difference in rates was statistically significant (P less than .0001). After confounders were accounted for, each additional mole measuring at least 3 mm conferred a 20% increase in the rate of melanoma death.
A different picture emerged after narrowing the adjusted analyses to include only people diagnosed with melanoma: In this group, mole count did not predict melanoma death among women, but continued to do so among men with melanoma who had at least three moles at baseline (HR, 1.8; 95% CI, 1.1-3.0), Dr. Cho reported. Among men, higher mole count also predicted melanoma of at least 1-mm Breslow thickness, an important prognostic factor, she added. Hazard ratios for these “thicker melanomas” were 1.9 (95% CI, 1.1-3.3) among men with one or two moles, and 2.5 (95% CI, 1.5-4.4) among men with three or more moles. Among women with melanoma, mole count did not predict Breslow thickness.
The extent to which sex affected trends in this analysis highlights the need for more studies of sex and other phenotypic risk factors for melanoma death, Dr. Cho concluded. She presented on behalf of lead author Wen-Qing Li, PhD, also of Brown University.
The National Institutes of Health and the Dermatology Foundation provided funding. Dr. Cho and Dr. Li had no relevant financial disclosures.
PORTLAND, ORE. – Among white men, the presence of at least one cutaneous nevus measuring 3 mm or more significantly predicted death from melanoma, in an adjusted analysis of a large prospective cohort study.
Mole count also predicted melanoma death among white women, but the association reached statistical significance only when women had at least three cutaneous nevi measuring 3 mm or more, Eunyoung Cho, ScD, said at the annual meeting of the Society for Investigative Dermatology. The reasons why these associations varied by sex is unclear, although previous studies have documented higher rates of melanoma death among men than among women, and even male physicians tend to seek health care less frequently than their female counterparts, Dr. Cho said in her poster presentation.
In the Nurses’ Health Study, white women with at least three moles measuring at least 3 mm in diameter were at significantly increased risk of dying of melanoma, compared with those with no moles that size (hazard ratio, 2.5; 95% confidence interval, 1.5-4.1), even after the investigators controlled for many other potential confounders, including sunburn history, skin reaction to sun during childhood, tanning ability, family history of melanoma, personal history of nonmelanoma skin cancer, age, activity level, smoking, body mass index, alcohol intake, and hair color. Women with one or two moles also showed a trend toward increased risk of melanoma death (HR, 1.4), but the 95% confidence interval for the hazard ratio did not reach statistical significance (0.9-2.3).
The investigators estimated that among white women, each additional mole measuring 3 mm or more conferred about a 12% increase in the melanoma death rate, even after confounders were controlled for.
In the Health Professionals Follow-Up Study, men with one or two moles of at least 3 mm had about twice the melanoma death rate as men without moles of this size (HR, 2.0; 95% CI, 1.3-3.3), even after investigators controlled for potential confounders. The risk of melanoma death was even greater among men with at least three moles (HR, 4.0; 95% CI, 2.5-6.2), and the difference in rates was statistically significant (P less than .0001). After confounders were accounted for, each additional mole measuring at least 3 mm conferred a 20% increase in the rate of melanoma death.
A different picture emerged after narrowing the adjusted analyses to include only people diagnosed with melanoma: In this group, mole count did not predict melanoma death among women, but continued to do so among men with melanoma who had at least three moles at baseline (HR, 1.8; 95% CI, 1.1-3.0), Dr. Cho reported. Among men, higher mole count also predicted melanoma of at least 1-mm Breslow thickness, an important prognostic factor, she added. Hazard ratios for these “thicker melanomas” were 1.9 (95% CI, 1.1-3.3) among men with one or two moles, and 2.5 (95% CI, 1.5-4.4) among men with three or more moles. Among women with melanoma, mole count did not predict Breslow thickness.
The extent to which sex affected trends in this analysis highlights the need for more studies of sex and other phenotypic risk factors for melanoma death, Dr. Cho concluded. She presented on behalf of lead author Wen-Qing Li, PhD, also of Brown University.
The National Institutes of Health and the Dermatology Foundation provided funding. Dr. Cho and Dr. Li had no relevant financial disclosures.
PORTLAND, ORE. – Among white men, the presence of at least one cutaneous nevus measuring 3 mm or more significantly predicted death from melanoma, in an adjusted analysis of a large prospective cohort study.
Mole count also predicted melanoma death among white women, but the association reached statistical significance only when women had at least three cutaneous nevi measuring 3 mm or more, Eunyoung Cho, ScD, said at the annual meeting of the Society for Investigative Dermatology. The reasons why these associations varied by sex is unclear, although previous studies have documented higher rates of melanoma death among men than among women, and even male physicians tend to seek health care less frequently than their female counterparts, Dr. Cho said in her poster presentation.
In the Nurses’ Health Study, white women with at least three moles measuring at least 3 mm in diameter were at significantly increased risk of dying of melanoma, compared with those with no moles that size (hazard ratio, 2.5; 95% confidence interval, 1.5-4.1), even after the investigators controlled for many other potential confounders, including sunburn history, skin reaction to sun during childhood, tanning ability, family history of melanoma, personal history of nonmelanoma skin cancer, age, activity level, smoking, body mass index, alcohol intake, and hair color. Women with one or two moles also showed a trend toward increased risk of melanoma death (HR, 1.4), but the 95% confidence interval for the hazard ratio did not reach statistical significance (0.9-2.3).
The investigators estimated that among white women, each additional mole measuring 3 mm or more conferred about a 12% increase in the melanoma death rate, even after confounders were controlled for.
In the Health Professionals Follow-Up Study, men with one or two moles of at least 3 mm had about twice the melanoma death rate as men without moles of this size (HR, 2.0; 95% CI, 1.3-3.3), even after investigators controlled for potential confounders. The risk of melanoma death was even greater among men with at least three moles (HR, 4.0; 95% CI, 2.5-6.2), and the difference in rates was statistically significant (P less than .0001). After confounders were accounted for, each additional mole measuring at least 3 mm conferred a 20% increase in the rate of melanoma death.
A different picture emerged after narrowing the adjusted analyses to include only people diagnosed with melanoma: In this group, mole count did not predict melanoma death among women, but continued to do so among men with melanoma who had at least three moles at baseline (HR, 1.8; 95% CI, 1.1-3.0), Dr. Cho reported. Among men, higher mole count also predicted melanoma of at least 1-mm Breslow thickness, an important prognostic factor, she added. Hazard ratios for these “thicker melanomas” were 1.9 (95% CI, 1.1-3.3) among men with one or two moles, and 2.5 (95% CI, 1.5-4.4) among men with three or more moles. Among women with melanoma, mole count did not predict Breslow thickness.
The extent to which sex affected trends in this analysis highlights the need for more studies of sex and other phenotypic risk factors for melanoma death, Dr. Cho concluded. She presented on behalf of lead author Wen-Qing Li, PhD, also of Brown University.
The National Institutes of Health and the Dermatology Foundation provided funding. Dr. Cho and Dr. Li had no relevant financial disclosures.
AT SID 2017
Key clinical point: Mole count was an independent risk factor for melanoma death among men and, to a lesser extent, among women.
Major finding: Adjusted hazard ratios were 2.0 among white men with one or two moles at least 3 mm in diameter and 4.0 among those with at least three moles, but among white women, the association was not significant unless they had at least three moles (HR, 2.5).
Data source: Adjusted analyses of 77,288 white women from the Nurses’ Health Study and 32,455 white men from the Health Professionals Follow-Up Study for 1986 through 2012.
Disclosures: The National Institutes of Health and the Dermatology Foundation provided funding for the study. Dr. Cho and Dr. Li had no relevant financial disclosures.
Trump administration loosens up HealthCare.gov
Patients buying health insurance through an Affordable Care Act health insurance exchange will no longer have to complete the transaction via HealthCare.gov.
The move is intended to help bring stability to the health insurance market, Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said in a statement.
“It is common sense to make it as simple and easy as possible for consumers to shop for and access health coverage,” she said. “It is time to get the federal government out of the way and give patients the best tools to make their own health care decision.”
The change will take effect with the open enrollment period for the 2018 coverage year.
Since the beginning of the health insurance exchanges, patients were required to complete their coverage applications via HealthCare.gov. Feedback from users indicated that “the process was confusing and made it harder to complete the application,” Ms. Verma said in a statement.
The move comes as the Republican-led Congress and the Trump Administration seek to repeal and replace the ACA. This move would deemphasize the government’s role in providing coverage as consumers could potentially avoid contact with HealthCare.gov altogether if they are using a third party to purchase coverage.
Patients buying health insurance through an Affordable Care Act health insurance exchange will no longer have to complete the transaction via HealthCare.gov.
The move is intended to help bring stability to the health insurance market, Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said in a statement.
“It is common sense to make it as simple and easy as possible for consumers to shop for and access health coverage,” she said. “It is time to get the federal government out of the way and give patients the best tools to make their own health care decision.”
The change will take effect with the open enrollment period for the 2018 coverage year.
Since the beginning of the health insurance exchanges, patients were required to complete their coverage applications via HealthCare.gov. Feedback from users indicated that “the process was confusing and made it harder to complete the application,” Ms. Verma said in a statement.
The move comes as the Republican-led Congress and the Trump Administration seek to repeal and replace the ACA. This move would deemphasize the government’s role in providing coverage as consumers could potentially avoid contact with HealthCare.gov altogether if they are using a third party to purchase coverage.
Patients buying health insurance through an Affordable Care Act health insurance exchange will no longer have to complete the transaction via HealthCare.gov.
The move is intended to help bring stability to the health insurance market, Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said in a statement.
“It is common sense to make it as simple and easy as possible for consumers to shop for and access health coverage,” she said. “It is time to get the federal government out of the way and give patients the best tools to make their own health care decision.”
The change will take effect with the open enrollment period for the 2018 coverage year.
Since the beginning of the health insurance exchanges, patients were required to complete their coverage applications via HealthCare.gov. Feedback from users indicated that “the process was confusing and made it harder to complete the application,” Ms. Verma said in a statement.
The move comes as the Republican-led Congress and the Trump Administration seek to repeal and replace the ACA. This move would deemphasize the government’s role in providing coverage as consumers could potentially avoid contact with HealthCare.gov altogether if they are using a third party to purchase coverage.
More telemedicine shifts to system-wide models
As telemedicine gains momentum, more health providers are moving from stand-alone programs to system-wide approaches.
In a survey of 436 U.S. health care executives, physicians, nurses, hospitals, and other health professionals, 25% of respondents with a telemedicine program began with a departmental approach but are now shifting to an enterprise system, 39% had an established enterprise system, and 36% remain with a departmental basis.
The survey of health care professionals’ priorities, objectives, challenges, and telemedicine models of care was conducted between December 2016 and January 2017 for REACH Health, a telemedicine software company.
Fifty-one percent of respondents reported that telemedicine is a top priority or high priority, a decrease from last year’s survey in which 66% of respondents said so. This shift could be linked to a continuing evolution and maturation of telemedicine as more programs move from ad-hoc project status to mainstream service, according to the report.
The telemedicine features most valuable to health providers were clinical documentation, the ability to send documentation to/from the electronic medical record, and the ability to analyze consult data. For the second year, health providers rated their top three telemedicine objectives as: improving patient outcomes, improving patient convenience, and increasing patient engagement.
Overall, health providers responded that the possible repeal and replacement of the Affordable Care Act would be positive for telemedicine. Forty-one percent of respondents said that patient adoption and the use of telemedicine would increase with ACA repeal/replace and 40% of health providers said that internal adoption and use of telemedicine would rise with replacement of the health law.
Just under half (47%) said they were uncertain how health care law changes would impact telemedicine parity laws, and 45% were unsure how repeal and replace would affect Medicare and Medicaid reimbursement for telemedicine services.
[email protected]
On Twitter @legal_med
As telemedicine gains momentum, more health providers are moving from stand-alone programs to system-wide approaches.
In a survey of 436 U.S. health care executives, physicians, nurses, hospitals, and other health professionals, 25% of respondents with a telemedicine program began with a departmental approach but are now shifting to an enterprise system, 39% had an established enterprise system, and 36% remain with a departmental basis.
The survey of health care professionals’ priorities, objectives, challenges, and telemedicine models of care was conducted between December 2016 and January 2017 for REACH Health, a telemedicine software company.
Fifty-one percent of respondents reported that telemedicine is a top priority or high priority, a decrease from last year’s survey in which 66% of respondents said so. This shift could be linked to a continuing evolution and maturation of telemedicine as more programs move from ad-hoc project status to mainstream service, according to the report.
The telemedicine features most valuable to health providers were clinical documentation, the ability to send documentation to/from the electronic medical record, and the ability to analyze consult data. For the second year, health providers rated their top three telemedicine objectives as: improving patient outcomes, improving patient convenience, and increasing patient engagement.
Overall, health providers responded that the possible repeal and replacement of the Affordable Care Act would be positive for telemedicine. Forty-one percent of respondents said that patient adoption and the use of telemedicine would increase with ACA repeal/replace and 40% of health providers said that internal adoption and use of telemedicine would rise with replacement of the health law.
Just under half (47%) said they were uncertain how health care law changes would impact telemedicine parity laws, and 45% were unsure how repeal and replace would affect Medicare and Medicaid reimbursement for telemedicine services.
[email protected]
On Twitter @legal_med
As telemedicine gains momentum, more health providers are moving from stand-alone programs to system-wide approaches.
In a survey of 436 U.S. health care executives, physicians, nurses, hospitals, and other health professionals, 25% of respondents with a telemedicine program began with a departmental approach but are now shifting to an enterprise system, 39% had an established enterprise system, and 36% remain with a departmental basis.
The survey of health care professionals’ priorities, objectives, challenges, and telemedicine models of care was conducted between December 2016 and January 2017 for REACH Health, a telemedicine software company.
Fifty-one percent of respondents reported that telemedicine is a top priority or high priority, a decrease from last year’s survey in which 66% of respondents said so. This shift could be linked to a continuing evolution and maturation of telemedicine as more programs move from ad-hoc project status to mainstream service, according to the report.
The telemedicine features most valuable to health providers were clinical documentation, the ability to send documentation to/from the electronic medical record, and the ability to analyze consult data. For the second year, health providers rated their top three telemedicine objectives as: improving patient outcomes, improving patient convenience, and increasing patient engagement.
Overall, health providers responded that the possible repeal and replacement of the Affordable Care Act would be positive for telemedicine. Forty-one percent of respondents said that patient adoption and the use of telemedicine would increase with ACA repeal/replace and 40% of health providers said that internal adoption and use of telemedicine would rise with replacement of the health law.
Just under half (47%) said they were uncertain how health care law changes would impact telemedicine parity laws, and 45% were unsure how repeal and replace would affect Medicare and Medicaid reimbursement for telemedicine services.
[email protected]
On Twitter @legal_med
Teletriage cut dermatology wait times ninefold for patients at a free clinic
PORTLAND – For uninsured patients with limited health care access, a teledermatology triage protocol cut average appointment wait times by ninefold, and usually provided adequate dermatologic care without the need for in-person follow-up, Peter B. Chansky reported at the annual meeting of the Society for Investigative Dermatology.
“In our study, teledermatology was sufficient to triage 70% of cases, which significantly reduced time to evaluation, increased the availability of in-person appointments, and provided a new chance for volunteer dermatologists to serve disadvantaged populations that do not have access to specialty providers,” Mr. Chansky, a medical student at the University of Pennsylvania, Philadelphia, said during an oral presentation of his poster.
Puentes de Salud is a nonprofit, multidisciplinary health care clinic that serves uninsured Latino immigrants in southern Philadelphia, explained Mr. Chansky, who conducted the study under the mentorship of Jules B. Lipoff, MD, of the department of dermatology, at the University of Pennsylvania. Volunteer dermatologists hold a clinic at Puentes de Salud once per month, but patients’ need substantially outpaces supply, which has fueled long wait times and delays in care.
To test an alternative, the volunteer dermatologists created a “teletriage” system for primary care providers to turn to first, before attempting to schedule in-person dermatology appointments at Puentes de Salud. The results were striking: Teledermatology cut average wait times by a factor of 9.3, and patients who typically had gone months with unevaluated skin lesions waited an average of 1.4 days (standard deviation, 3.1 days) for a teledermatology consult, instead of 13.4 days (SD, 1.9 days) for an in-person appointment (P less than .0001).
Just as notably, teledermatologists changed or expanded on 70% of primary care providers’ diagnoses and altered their treatment plans 95% of the time. “Teledermatology also reclaimed 18% of monthly in-person clinic appointments for patients who needed face-to-face consultation,” Mr. Chansky said. “Access to dermatologic care is especially limited among uninsured patients, and using teledermatology to triage patients in a volunteer free clinic has never been evaluated,” he noted.
The analysis included 60 teletriage referrals from nurses and physicians over 2.5 years. Patients were usually male, averaged 32 years in age, and reported an average symptom duration of 15 months. Most lesions had not previously been treated. Cases were usually inflammatory in nature (45%), while 18% were neoplastic, 17% were infectious, and 8% were pigmented lesions. Lesions were usually located on visible areas of skin, including the face, hands, and arms.
This protocol relied on volunteer dermatologists, but teletriage repeatedly has been shown to provide effective dermatologic care in a variety of health care settings, Mr. Chansky noted. “Teledermatology is an accurate, cost-effective, and efficient tool for improving access to dermatologic care,” he added.
Mr. Chansky did not acknowledge external funding sources and had no conflicts of interest.
PORTLAND – For uninsured patients with limited health care access, a teledermatology triage protocol cut average appointment wait times by ninefold, and usually provided adequate dermatologic care without the need for in-person follow-up, Peter B. Chansky reported at the annual meeting of the Society for Investigative Dermatology.
“In our study, teledermatology was sufficient to triage 70% of cases, which significantly reduced time to evaluation, increased the availability of in-person appointments, and provided a new chance for volunteer dermatologists to serve disadvantaged populations that do not have access to specialty providers,” Mr. Chansky, a medical student at the University of Pennsylvania, Philadelphia, said during an oral presentation of his poster.
Puentes de Salud is a nonprofit, multidisciplinary health care clinic that serves uninsured Latino immigrants in southern Philadelphia, explained Mr. Chansky, who conducted the study under the mentorship of Jules B. Lipoff, MD, of the department of dermatology, at the University of Pennsylvania. Volunteer dermatologists hold a clinic at Puentes de Salud once per month, but patients’ need substantially outpaces supply, which has fueled long wait times and delays in care.
To test an alternative, the volunteer dermatologists created a “teletriage” system for primary care providers to turn to first, before attempting to schedule in-person dermatology appointments at Puentes de Salud. The results were striking: Teledermatology cut average wait times by a factor of 9.3, and patients who typically had gone months with unevaluated skin lesions waited an average of 1.4 days (standard deviation, 3.1 days) for a teledermatology consult, instead of 13.4 days (SD, 1.9 days) for an in-person appointment (P less than .0001).
Just as notably, teledermatologists changed or expanded on 70% of primary care providers’ diagnoses and altered their treatment plans 95% of the time. “Teledermatology also reclaimed 18% of monthly in-person clinic appointments for patients who needed face-to-face consultation,” Mr. Chansky said. “Access to dermatologic care is especially limited among uninsured patients, and using teledermatology to triage patients in a volunteer free clinic has never been evaluated,” he noted.
The analysis included 60 teletriage referrals from nurses and physicians over 2.5 years. Patients were usually male, averaged 32 years in age, and reported an average symptom duration of 15 months. Most lesions had not previously been treated. Cases were usually inflammatory in nature (45%), while 18% were neoplastic, 17% were infectious, and 8% were pigmented lesions. Lesions were usually located on visible areas of skin, including the face, hands, and arms.
This protocol relied on volunteer dermatologists, but teletriage repeatedly has been shown to provide effective dermatologic care in a variety of health care settings, Mr. Chansky noted. “Teledermatology is an accurate, cost-effective, and efficient tool for improving access to dermatologic care,” he added.
Mr. Chansky did not acknowledge external funding sources and had no conflicts of interest.
PORTLAND – For uninsured patients with limited health care access, a teledermatology triage protocol cut average appointment wait times by ninefold, and usually provided adequate dermatologic care without the need for in-person follow-up, Peter B. Chansky reported at the annual meeting of the Society for Investigative Dermatology.
“In our study, teledermatology was sufficient to triage 70% of cases, which significantly reduced time to evaluation, increased the availability of in-person appointments, and provided a new chance for volunteer dermatologists to serve disadvantaged populations that do not have access to specialty providers,” Mr. Chansky, a medical student at the University of Pennsylvania, Philadelphia, said during an oral presentation of his poster.
Puentes de Salud is a nonprofit, multidisciplinary health care clinic that serves uninsured Latino immigrants in southern Philadelphia, explained Mr. Chansky, who conducted the study under the mentorship of Jules B. Lipoff, MD, of the department of dermatology, at the University of Pennsylvania. Volunteer dermatologists hold a clinic at Puentes de Salud once per month, but patients’ need substantially outpaces supply, which has fueled long wait times and delays in care.
To test an alternative, the volunteer dermatologists created a “teletriage” system for primary care providers to turn to first, before attempting to schedule in-person dermatology appointments at Puentes de Salud. The results were striking: Teledermatology cut average wait times by a factor of 9.3, and patients who typically had gone months with unevaluated skin lesions waited an average of 1.4 days (standard deviation, 3.1 days) for a teledermatology consult, instead of 13.4 days (SD, 1.9 days) for an in-person appointment (P less than .0001).
Just as notably, teledermatologists changed or expanded on 70% of primary care providers’ diagnoses and altered their treatment plans 95% of the time. “Teledermatology also reclaimed 18% of monthly in-person clinic appointments for patients who needed face-to-face consultation,” Mr. Chansky said. “Access to dermatologic care is especially limited among uninsured patients, and using teledermatology to triage patients in a volunteer free clinic has never been evaluated,” he noted.
The analysis included 60 teletriage referrals from nurses and physicians over 2.5 years. Patients were usually male, averaged 32 years in age, and reported an average symptom duration of 15 months. Most lesions had not previously been treated. Cases were usually inflammatory in nature (45%), while 18% were neoplastic, 17% were infectious, and 8% were pigmented lesions. Lesions were usually located on visible areas of skin, including the face, hands, and arms.
This protocol relied on volunteer dermatologists, but teletriage repeatedly has been shown to provide effective dermatologic care in a variety of health care settings, Mr. Chansky noted. “Teledermatology is an accurate, cost-effective, and efficient tool for improving access to dermatologic care,” he added.
Mr. Chansky did not acknowledge external funding sources and had no conflicts of interest.
AT SID 2017
Key clinical point: For uninsured patients with limited health care access, teledermatology triage protocol can significantly cut appointment wait times and usually obviates the need for in-person follow-up.
Major finding: Teledermatology triage cut average appointment wait times by a factor of 9.3, and 70% of patients did not need additional in-person care.
Data source: An analysis of 60 referrals to teletriage over 2.5 years, among patients seen at a free clinic in Philadelphia.
Disclosures: Mr. Chansky did not acknowledge external funding sources, and had no conflicts of interest.
6MWTs improved following online pulmonary rehab
WASHINGTON – An online pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD) was not inferior to an in-person program, according to study findings presented at an international conference of the American Thoracic Society, Tuesday.
In a walking test conducted after all patients completed a 7-week program, participants in the online program, on average, increased their 6MWT (6-minute walking test) score by 23.8 m (P = .098) from baseline; this amount of improvement is much greater than the noninferiority threshold for this study. COPD assessment, hospital anxiety, respiratory function, and modified medical research council dyspnea scores of patients who participated in the online program were also not inferior to the scores of patients who participated in the in-person program.
If found to be a viable option, online options for COPD patients could be useful for treatment in those who would otherwise not have access to in-person rehabilitation sessions, said Tom Wilkinson, MD, PhD, of the University of Southhampton (England), in his presentation.
“The challenges for patients with COPD are quite real; there are factors which are limiting the access of treatments ... in the way of geography of where our patients live,” said Dr. Wilkinson. “[Also] some patients may be housebound or have social anxiety but would benefit from using programs more regularly.”
The study’s 90 participants were assigned to participate either in an online program designed as an in-home guide for pulmonary rehabilitation or in pulmonary rehabilitation sessions at a local facility, after a baseline 6-minute walking test, according to Dr. Wilkinson.
The average age of patients participating in the face-to-face program was 71 years, while the average age for the online group was 69 years. Both groups were predominantly male and former smokers.
Investigators designed the online program to mimic face-to-face sessions by integrating advice on exercises, and information about a patient’s condition, into the program. While the online program included five sessions per week of either exercise or education, the program for patients in the control group involved two facility sessions per week.
Dr. Wilkinson said the online form of rehabilitation used in this study would not only benefit patients, but would help hospitals financially.
An online application could be a helpful supplement for facilities that do not have the resources to hire additional workers or do not have the proper facility to conduct these sessions, he added.
Attendees expressed concern that the learning curve of an online platform could make participating in the program difficult for COPD patients.
Dr. Wilkinson said he and his team had taken that potential learning curve into account when designing the program, by including digital literacy programs and a service hotline.
This study was funded by a grant awarded through the U.K. small business research initiative. The investigators reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
WASHINGTON – An online pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD) was not inferior to an in-person program, according to study findings presented at an international conference of the American Thoracic Society, Tuesday.
In a walking test conducted after all patients completed a 7-week program, participants in the online program, on average, increased their 6MWT (6-minute walking test) score by 23.8 m (P = .098) from baseline; this amount of improvement is much greater than the noninferiority threshold for this study. COPD assessment, hospital anxiety, respiratory function, and modified medical research council dyspnea scores of patients who participated in the online program were also not inferior to the scores of patients who participated in the in-person program.
If found to be a viable option, online options for COPD patients could be useful for treatment in those who would otherwise not have access to in-person rehabilitation sessions, said Tom Wilkinson, MD, PhD, of the University of Southhampton (England), in his presentation.
“The challenges for patients with COPD are quite real; there are factors which are limiting the access of treatments ... in the way of geography of where our patients live,” said Dr. Wilkinson. “[Also] some patients may be housebound or have social anxiety but would benefit from using programs more regularly.”
The study’s 90 participants were assigned to participate either in an online program designed as an in-home guide for pulmonary rehabilitation or in pulmonary rehabilitation sessions at a local facility, after a baseline 6-minute walking test, according to Dr. Wilkinson.
The average age of patients participating in the face-to-face program was 71 years, while the average age for the online group was 69 years. Both groups were predominantly male and former smokers.
Investigators designed the online program to mimic face-to-face sessions by integrating advice on exercises, and information about a patient’s condition, into the program. While the online program included five sessions per week of either exercise or education, the program for patients in the control group involved two facility sessions per week.
Dr. Wilkinson said the online form of rehabilitation used in this study would not only benefit patients, but would help hospitals financially.
An online application could be a helpful supplement for facilities that do not have the resources to hire additional workers or do not have the proper facility to conduct these sessions, he added.
Attendees expressed concern that the learning curve of an online platform could make participating in the program difficult for COPD patients.
Dr. Wilkinson said he and his team had taken that potential learning curve into account when designing the program, by including digital literacy programs and a service hotline.
This study was funded by a grant awarded through the U.K. small business research initiative. The investigators reported no relevant financial disclosures.
[email protected]
On Twitter @eaztweets
WASHINGTON – An online pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD) was not inferior to an in-person program, according to study findings presented at an international conference of the American Thoracic Society, Tuesday.
In a walking test conducted after all patients completed a 7-week program, participants in the online program, on average, increased their 6MWT (6-minute walking test) score by 23.8 m (P = .098) from baseline; this amount of improvement is much greater than the noninferiority threshold for this study. COPD assessment, hospital anxiety, respiratory function, and modified medical research council dyspnea scores of patients who participated in the online program were also not inferior to the scores of patients who participated in the in-person program.
If found to be a viable option, online options for COPD patients could be useful for treatment in those who would otherwise not have access to in-person rehabilitation sessions, said Tom Wilkinson, MD, PhD, of the University of Southhampton (England), in his presentation.
“The challenges for patients with COPD are quite real; there are factors which are limiting the access of treatments ... in the way of geography of where our patients live,” said Dr. Wilkinson. “[Also] some patients may be housebound or have social anxiety but would benefit from using programs more regularly.”
The study’s 90 participants were assigned to participate either in an online program designed as an in-home guide for pulmonary rehabilitation or in pulmonary rehabilitation sessions at a local facility, after a baseline 6-minute walking test, according to Dr. Wilkinson.
The average age of patients participating in the face-to-face program was 71 years, while the average age for the online group was 69 years. Both groups were predominantly male and former smokers.
Investigators designed the online program to mimic face-to-face sessions by integrating advice on exercises, and information about a patient’s condition, into the program. While the online program included five sessions per week of either exercise or education, the program for patients in the control group involved two facility sessions per week.
Dr. Wilkinson said the online form of rehabilitation used in this study would not only benefit patients, but would help hospitals financially.
An online application could be a helpful supplement for facilities that do not have the resources to hire additional workers or do not have the proper facility to conduct these sessions, he added.
Attendees expressed concern that the learning curve of an online platform could make participating in the program difficult for COPD patients.
Dr. Wilkinson said he and his team had taken that potential learning curve into account when designing the program, by including digital literacy programs and a service hotline.
This study was funded by a grant awarded through the U.K. small business research initiative. The investigators reported no relevant financial disclosures.
[email protected]
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Key clinical point:
Major finding: The 6-minute walking test scores for patients participating in an online pulmonary rehabilitation program improved by 23.8 m, on average (P = .098).
Data source: A single-blind, randomized controlled trial of 90 patients conducted through the Portsmouth Hospital.
Disclosures: This study was funded by a grant awarded through the U.K. small business research initiative. Investigators reported no relevant financial disclosures.
Inpatient prenatal yoga found feasible for high-risk women
AT ACOG 2017
SAN DIEGO – Inpatient prenatal yoga is a feasible and acceptable intervention for high-risk women admitted to the hospital, results from a single-center study suggested.
“We know that outside of obstetrics, yoga is beneficial to stress relief, musculoskeletal pain, and sleep quality,” Veronica Demtchouk, MD, said in an interview at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists. “Inpatient high-risk obstetrics patients have very limited physical activity that they feel is safe to do.”
In an effort to investigate the feasibility of establishing an inpatient prenatal yoga program, the researchers recruited 40 women with anticipated admission to the antepartum service for at least 72 hours and who received medical clearance from their primary obstetrician. One of the medical center’s nurse practitioners, who is also a certified yoga instructor, taught a 30-minute prenatal yoga session once a week in a waiting room.
“It was a large enough space; we moved away the furniture and did the yoga sessions there,” Dr. Demtchouk said.
Study participants completed a questionnaire after each yoga session and at hospital discharge, while 14 nurses completed questionnaires regarding patient care and patient satisfaction. Of the 40 patients, 16 completed one or more yoga sessions; 24 did not participate because of scheduling conflicts with ultrasound or fetal testing, change in clinical status, lack of interest on the day of the session, and delivery or discharge prior to the yoga session.
Of the 16 study participants, 8 reported a decreased level of stress, 4 reported better sleep, 4 reported applying the yoga techniques outside of class, and 3 reported decreased pain/discomfort.
“Not a single woman complained or was displeased with the yoga sessions,” Dr. Demtchouk said. “The biggest challenge was the timing of the yoga session. It was just once a week, which limited the number of women who could attend.”
Of the 14 nurses who completed questionnaires, all viewed yoga as beneficial to their patients, none found it disruptive to providing patient care, and all indicated they would recommend an inpatient prenatal yoga program to other hospitals with an antepartum service.
“I think having several sessions throughout the week is essential for having adequate patient participation,” Dr. Demtchouk added. “It’s essential to have the nurses on board with it.”
She reported having no relevant financial disclosures.
AT ACOG 2017
SAN DIEGO – Inpatient prenatal yoga is a feasible and acceptable intervention for high-risk women admitted to the hospital, results from a single-center study suggested.
“We know that outside of obstetrics, yoga is beneficial to stress relief, musculoskeletal pain, and sleep quality,” Veronica Demtchouk, MD, said in an interview at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists. “Inpatient high-risk obstetrics patients have very limited physical activity that they feel is safe to do.”
In an effort to investigate the feasibility of establishing an inpatient prenatal yoga program, the researchers recruited 40 women with anticipated admission to the antepartum service for at least 72 hours and who received medical clearance from their primary obstetrician. One of the medical center’s nurse practitioners, who is also a certified yoga instructor, taught a 30-minute prenatal yoga session once a week in a waiting room.
“It was a large enough space; we moved away the furniture and did the yoga sessions there,” Dr. Demtchouk said.
Study participants completed a questionnaire after each yoga session and at hospital discharge, while 14 nurses completed questionnaires regarding patient care and patient satisfaction. Of the 40 patients, 16 completed one or more yoga sessions; 24 did not participate because of scheduling conflicts with ultrasound or fetal testing, change in clinical status, lack of interest on the day of the session, and delivery or discharge prior to the yoga session.
Of the 16 study participants, 8 reported a decreased level of stress, 4 reported better sleep, 4 reported applying the yoga techniques outside of class, and 3 reported decreased pain/discomfort.
“Not a single woman complained or was displeased with the yoga sessions,” Dr. Demtchouk said. “The biggest challenge was the timing of the yoga session. It was just once a week, which limited the number of women who could attend.”
Of the 14 nurses who completed questionnaires, all viewed yoga as beneficial to their patients, none found it disruptive to providing patient care, and all indicated they would recommend an inpatient prenatal yoga program to other hospitals with an antepartum service.
“I think having several sessions throughout the week is essential for having adequate patient participation,” Dr. Demtchouk added. “It’s essential to have the nurses on board with it.”
She reported having no relevant financial disclosures.
AT ACOG 2017
SAN DIEGO – Inpatient prenatal yoga is a feasible and acceptable intervention for high-risk women admitted to the hospital, results from a single-center study suggested.
“We know that outside of obstetrics, yoga is beneficial to stress relief, musculoskeletal pain, and sleep quality,” Veronica Demtchouk, MD, said in an interview at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists. “Inpatient high-risk obstetrics patients have very limited physical activity that they feel is safe to do.”
In an effort to investigate the feasibility of establishing an inpatient prenatal yoga program, the researchers recruited 40 women with anticipated admission to the antepartum service for at least 72 hours and who received medical clearance from their primary obstetrician. One of the medical center’s nurse practitioners, who is also a certified yoga instructor, taught a 30-minute prenatal yoga session once a week in a waiting room.
“It was a large enough space; we moved away the furniture and did the yoga sessions there,” Dr. Demtchouk said.
Study participants completed a questionnaire after each yoga session and at hospital discharge, while 14 nurses completed questionnaires regarding patient care and patient satisfaction. Of the 40 patients, 16 completed one or more yoga sessions; 24 did not participate because of scheduling conflicts with ultrasound or fetal testing, change in clinical status, lack of interest on the day of the session, and delivery or discharge prior to the yoga session.
Of the 16 study participants, 8 reported a decreased level of stress, 4 reported better sleep, 4 reported applying the yoga techniques outside of class, and 3 reported decreased pain/discomfort.
“Not a single woman complained or was displeased with the yoga sessions,” Dr. Demtchouk said. “The biggest challenge was the timing of the yoga session. It was just once a week, which limited the number of women who could attend.”
Of the 14 nurses who completed questionnaires, all viewed yoga as beneficial to their patients, none found it disruptive to providing patient care, and all indicated they would recommend an inpatient prenatal yoga program to other hospitals with an antepartum service.
“I think having several sessions throughout the week is essential for having adequate patient participation,” Dr. Demtchouk added. “It’s essential to have the nurses on board with it.”
She reported having no relevant financial disclosures.
Key clinical point:
Major finding: Of the 16 study participants, 8 reported a decreased level of stress, 4 reported better sleep, 4 reported applying the yoga techniques outside of class, and 3 reported decreased pain/discomfort.
Data source: A feasibility study of 16 hospitalized high-risk pregnant women.
Disclosures: Dr. Demtchouk reported having no relevant financial disclosures.
AAP advises against giving fruit juice to children under 1 year
according to a 2017 policy statement by the American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition and the Committee on Nutrition.
In addition, no more than 4 ounces of fruit juice per day should be given to toddlers aged 1-3 years, and no more than 4-6 ounces to children aged 4-6 years. For children aged 7-18 years, fruit juice intake should be limited to 8 ounces (Pediatrics. 2017 Jun;139[6]:e20170967).
In fact, the AAP recommends that human milk be the only nutrient for infants up to 6 months of age, or a prepared infant formula for mothers who cannot breastfeed or choose not to breastfeed their infants. In a study of 168 children aged either 2 years or 5 years, consumption of 12 fluid ounces or more per day of fruit juice was associated with short stature and with obesity (Pediatrics. 1997 Jan;99[1]:15-22).
If toddlers are given fruit juice, it should be in a cup rather that a bottle, sippy cup, or box of juice that they can carry around for long periods. Also, infants and toddlers should not be put to bed with a bottle of fruit juice, according to the statement. Prolonged exposure of the teeth to the sugars in juice can result in dental caries.
Fruit juice is sometime erroneously used instead of oral electrolyte solutions to rehydrate infants and young children with gastroenteritis or diarrhea, but the high carbohydrate content of fruit juice “may exceed the intestine’s ability to absorb carbohydrate, resulting in carbohydrate malabsorption. Carbohydrate malabsorption causes osmotic diarrhea, increasing the severity of the diarrhea already present,” according to the statement. Also, if fruit juice is used to replace fluid losses in infants, it may cause hyponatremia.
There are several medical conditions in which it is prudent to determine how much fruit juice is being consumed:
- Overnutrition or undernutrition.
- Chronic diarrhea, excessive flatulence, abdominal pain, and bloating.
- Dental caries.
- Poor or excessive weight gain.
Fruit juice is viewed by parents as nutritious, but toddlers and young children should be encouraged to eat whole fruit instead.
“We know that excessive fruit juice can lead to excessive weight gain and tooth decay,” coauthor Steven A. Abrams, MD, of the University of Texas, Austin, said in a press release. “Pediatricians have a lot of information to share with families on how to provide the proper balance of fresh fruit within their child’s diet.”
The authors said they had no relevant financial conflicts.
The AAP’s new policy statement regarding limiting juice consumption has potential to make a big difference in the prevention of two largely preventable diseases – obesity and dental caries. Recognizing that obesity and dental caries are silent epidemics in the United States, and that overconsumption of sugar is a common risk factor for both of these diseases, the AAP’s new policy statement is overdue. Fruit juice has as much sugar as soda drinks, yet parents feel it is a healthy drink alternative because juice comes from fruit. Parents often introduce juice to their children at a very young age and serve them more juice than is needed. Also, young children commonly consume juice in a sippy cup or bottle, which can lead to dental decay, because the frequent sipping of the juice fuels the acid-producing bacteria that contribute to enamel erosion.
As pediatricians, my colleagues and I are challenged to help children maintain a healthy weight and healthy mouths, and we have long battled the early introduction and overconsumption of juice. Medical and dental health care professionals, along with public health programs, can rally around this new policy statement.
Patricia Braun, MD, is a professor of pediatrics at the University of Colorado, Denver, and a practicing pediatrician at Denver Health. She had no conflicts of interest.
The AAP’s new policy statement regarding limiting juice consumption has potential to make a big difference in the prevention of two largely preventable diseases – obesity and dental caries. Recognizing that obesity and dental caries are silent epidemics in the United States, and that overconsumption of sugar is a common risk factor for both of these diseases, the AAP’s new policy statement is overdue. Fruit juice has as much sugar as soda drinks, yet parents feel it is a healthy drink alternative because juice comes from fruit. Parents often introduce juice to their children at a very young age and serve them more juice than is needed. Also, young children commonly consume juice in a sippy cup or bottle, which can lead to dental decay, because the frequent sipping of the juice fuels the acid-producing bacteria that contribute to enamel erosion.
As pediatricians, my colleagues and I are challenged to help children maintain a healthy weight and healthy mouths, and we have long battled the early introduction and overconsumption of juice. Medical and dental health care professionals, along with public health programs, can rally around this new policy statement.
Patricia Braun, MD, is a professor of pediatrics at the University of Colorado, Denver, and a practicing pediatrician at Denver Health. She had no conflicts of interest.
The AAP’s new policy statement regarding limiting juice consumption has potential to make a big difference in the prevention of two largely preventable diseases – obesity and dental caries. Recognizing that obesity and dental caries are silent epidemics in the United States, and that overconsumption of sugar is a common risk factor for both of these diseases, the AAP’s new policy statement is overdue. Fruit juice has as much sugar as soda drinks, yet parents feel it is a healthy drink alternative because juice comes from fruit. Parents often introduce juice to their children at a very young age and serve them more juice than is needed. Also, young children commonly consume juice in a sippy cup or bottle, which can lead to dental decay, because the frequent sipping of the juice fuels the acid-producing bacteria that contribute to enamel erosion.
As pediatricians, my colleagues and I are challenged to help children maintain a healthy weight and healthy mouths, and we have long battled the early introduction and overconsumption of juice. Medical and dental health care professionals, along with public health programs, can rally around this new policy statement.
Patricia Braun, MD, is a professor of pediatrics at the University of Colorado, Denver, and a practicing pediatrician at Denver Health. She had no conflicts of interest.
according to a 2017 policy statement by the American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition and the Committee on Nutrition.
In addition, no more than 4 ounces of fruit juice per day should be given to toddlers aged 1-3 years, and no more than 4-6 ounces to children aged 4-6 years. For children aged 7-18 years, fruit juice intake should be limited to 8 ounces (Pediatrics. 2017 Jun;139[6]:e20170967).
In fact, the AAP recommends that human milk be the only nutrient for infants up to 6 months of age, or a prepared infant formula for mothers who cannot breastfeed or choose not to breastfeed their infants. In a study of 168 children aged either 2 years or 5 years, consumption of 12 fluid ounces or more per day of fruit juice was associated with short stature and with obesity (Pediatrics. 1997 Jan;99[1]:15-22).
If toddlers are given fruit juice, it should be in a cup rather that a bottle, sippy cup, or box of juice that they can carry around for long periods. Also, infants and toddlers should not be put to bed with a bottle of fruit juice, according to the statement. Prolonged exposure of the teeth to the sugars in juice can result in dental caries.
Fruit juice is sometime erroneously used instead of oral electrolyte solutions to rehydrate infants and young children with gastroenteritis or diarrhea, but the high carbohydrate content of fruit juice “may exceed the intestine’s ability to absorb carbohydrate, resulting in carbohydrate malabsorption. Carbohydrate malabsorption causes osmotic diarrhea, increasing the severity of the diarrhea already present,” according to the statement. Also, if fruit juice is used to replace fluid losses in infants, it may cause hyponatremia.
There are several medical conditions in which it is prudent to determine how much fruit juice is being consumed:
- Overnutrition or undernutrition.
- Chronic diarrhea, excessive flatulence, abdominal pain, and bloating.
- Dental caries.
- Poor or excessive weight gain.
Fruit juice is viewed by parents as nutritious, but toddlers and young children should be encouraged to eat whole fruit instead.
“We know that excessive fruit juice can lead to excessive weight gain and tooth decay,” coauthor Steven A. Abrams, MD, of the University of Texas, Austin, said in a press release. “Pediatricians have a lot of information to share with families on how to provide the proper balance of fresh fruit within their child’s diet.”
The authors said they had no relevant financial conflicts.
according to a 2017 policy statement by the American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition and the Committee on Nutrition.
In addition, no more than 4 ounces of fruit juice per day should be given to toddlers aged 1-3 years, and no more than 4-6 ounces to children aged 4-6 years. For children aged 7-18 years, fruit juice intake should be limited to 8 ounces (Pediatrics. 2017 Jun;139[6]:e20170967).
In fact, the AAP recommends that human milk be the only nutrient for infants up to 6 months of age, or a prepared infant formula for mothers who cannot breastfeed or choose not to breastfeed their infants. In a study of 168 children aged either 2 years or 5 years, consumption of 12 fluid ounces or more per day of fruit juice was associated with short stature and with obesity (Pediatrics. 1997 Jan;99[1]:15-22).
If toddlers are given fruit juice, it should be in a cup rather that a bottle, sippy cup, or box of juice that they can carry around for long periods. Also, infants and toddlers should not be put to bed with a bottle of fruit juice, according to the statement. Prolonged exposure of the teeth to the sugars in juice can result in dental caries.
Fruit juice is sometime erroneously used instead of oral electrolyte solutions to rehydrate infants and young children with gastroenteritis or diarrhea, but the high carbohydrate content of fruit juice “may exceed the intestine’s ability to absorb carbohydrate, resulting in carbohydrate malabsorption. Carbohydrate malabsorption causes osmotic diarrhea, increasing the severity of the diarrhea already present,” according to the statement. Also, if fruit juice is used to replace fluid losses in infants, it may cause hyponatremia.
There are several medical conditions in which it is prudent to determine how much fruit juice is being consumed:
- Overnutrition or undernutrition.
- Chronic diarrhea, excessive flatulence, abdominal pain, and bloating.
- Dental caries.
- Poor or excessive weight gain.
Fruit juice is viewed by parents as nutritious, but toddlers and young children should be encouraged to eat whole fruit instead.
“We know that excessive fruit juice can lead to excessive weight gain and tooth decay,” coauthor Steven A. Abrams, MD, of the University of Texas, Austin, said in a press release. “Pediatricians have a lot of information to share with families on how to provide the proper balance of fresh fruit within their child’s diet.”
The authors said they had no relevant financial conflicts.