Jan Dyer

According to the Centers for Disease Control and Prevention’s (CDC) study, 1 in 4 germ samples sent to the AR Lab Network for testing had special genes that allow them to spread their resistance to other germs. Further investigation in facilities with unusual resistance revealed that about 1 in 10 screening tests from patients without symptoms identified a hard-to-treat germ that spreads easily, meaning the germ could have spread undetected in that health care facility, the CDC said.

The CDC containment strategy includes continued infection control assessments until spread is stopped, which takes a coordinated response among facilities, labs, health departments, and CDC through the AR Lab Network. Health departments using the approach have conducted infection control assessments and colonization screenings within 48 hours of finding unusual resistance and have reported no further transmission during follow-up over several weeks. Estimates show that for carbapenem-resistant Enterobacteriaceae alone, the containment strategy would prevent as many as 1,600 new infections in 3 years in a single state—a 76% reduction.

Health care practitioners can help by using contact precautions, asking patients about recent travel or health care, and communicating about status when patients are transferred.

According to the Centers for Disease Control and Prevention’s (CDC) study, 1 in 4 germ samples sent to the AR Lab Network for testing had special genes that allow them to spread their resistance to other germs. Further investigation in facilities with unusual resistance revealed that about 1 in 10 screening tests from patients without symptoms identified a hard-to-treat germ that spreads easily, meaning the germ could have spread undetected in that health care facility, the CDC said.

The CDC containment strategy includes continued infection control assessments until spread is stopped, which takes a coordinated response among facilities, labs, health departments, and CDC through the AR Lab Network. Health departments using the approach have conducted infection control assessments and colonization screenings within 48 hours of finding unusual resistance and have reported no further transmission during follow-up over several weeks. Estimates show that for carbapenem-resistant Enterobacteriaceae alone, the containment strategy would prevent as many as 1,600 new infections in 3 years in a single state—a 76% reduction.

Health care practitioners can help by using contact precautions, asking patients about recent travel or health care, and communicating about status when patients are transferred.

According to the Centers for Disease Control and Prevention’s (CDC) study, 1 in 4 germ samples sent to the AR Lab Network for testing had special genes that allow them to spread their resistance to other germs. Further investigation in facilities with unusual resistance revealed that about 1 in 10 screening tests from patients without symptoms identified a hard-to-treat germ that spreads easily, meaning the germ could have spread undetected in that health care facility, the CDC said.

The CDC containment strategy includes continued infection control assessments until spread is stopped, which takes a coordinated response among facilities, labs, health departments, and CDC through the AR Lab Network. Health departments using the approach have conducted infection control assessments and colonization screenings within 48 hours of finding unusual resistance and have reported no further transmission during follow-up over several weeks. Estimates show that for carbapenem-resistant Enterobacteriaceae alone, the containment strategy would prevent as many as 1,600 new infections in 3 years in a single state—a 76% reduction.

Health care practitioners can help by using contact precautions, asking patients about recent travel or health care, and communicating about status when patients are transferred.

A 53-year-old man presented to the hospital after gaining weight for 6 months and had developed peripheral edema and abdominal distension. He also had HIV for 32 years, had undergone a renal cadaveric transplant 2 years earlier, and had type 2 diabetes, coronary artery disease, and dyslipidemia. The patient was taking > 10 medications, including immunosuppressants and antiretrovirals.

Based on the physical examination and abdominal ultrasonography, the clinicians diagnosed the patient with ascites but could not confirm the cause. Although nonhepatic causes account for only about 15% of all ascites cases, the differential diagnosis includes malignant disease, lymphatic obstruction, and infections. But samples of ascitic fluid were negative for malignant disease and mycobacteria, and there was no evidence of lymphadenopathy. Lacking a definitive diagnosis, the clinicians decided on watchful waiting, with large-volume paracentesis every 2 to 3 weeks.

However, the patient returned to the hospital 1 week later with shortness of breath, nonproductive cough, and fever. Computed tomography (CT) scan showed small pleural effusions and consolidation in the lower lung. This time, a mycobacterial culture was positive for Mycobacterium avium (M avium ) complex.

Antimycobacterial drugs were added to his regimen, and his symptoms rapidly resolved. A CT scan confirmed improvement. Six months later, he was doing well, without recurrence.

The clinicians note that their patient was at increased risk because of the double toll HIV infection and the transplant had taken on his immune system. But the diagnosis was challenging because contrary to the school of thought that M avium complex infections are usually seen with CD4 count < 50 cells/µL, their patient’s count was 141 cells/µL at diagnosis.

When mycobacterial infections are suspected, patients may need extensive testing and close monitoring before the diagnosis can be made, the clinicians say. They suggest counseling patients about the potential need for invasive testing and the risks of possible diagnostic delay. Wherever possible, the clinicians add, patients with M avium complex should be overseen by infectious disease specialists and pharmacists to reduce the risk of harmful drug-drug interactions.

Source:
Auguste BL, Patel AD, Siemieniuk RA. CMAJ. 2018;190:E394-E387.
doi: 10.1503/cmaj.170823.

A 53-year-old man presented to the hospital after gaining weight for 6 months and had developed peripheral edema and abdominal distension. He also had HIV for 32 years, had undergone a renal cadaveric transplant 2 years earlier, and had type 2 diabetes, coronary artery disease, and dyslipidemia. The patient was taking > 10 medications, including immunosuppressants and antiretrovirals.

Based on the physical examination and abdominal ultrasonography, the clinicians diagnosed the patient with ascites but could not confirm the cause. Although nonhepatic causes account for only about 15% of all ascites cases, the differential diagnosis includes malignant disease, lymphatic obstruction, and infections. But samples of ascitic fluid were negative for malignant disease and mycobacteria, and there was no evidence of lymphadenopathy. Lacking a definitive diagnosis, the clinicians decided on watchful waiting, with large-volume paracentesis every 2 to 3 weeks.

However, the patient returned to the hospital 1 week later with shortness of breath, nonproductive cough, and fever. Computed tomography (CT) scan showed small pleural effusions and consolidation in the lower lung. This time, a mycobacterial culture was positive for Mycobacterium avium (M avium ) complex.

Antimycobacterial drugs were added to his regimen, and his symptoms rapidly resolved. A CT scan confirmed improvement. Six months later, he was doing well, without recurrence.

The clinicians note that their patient was at increased risk because of the double toll HIV infection and the transplant had taken on his immune system. But the diagnosis was challenging because contrary to the school of thought that M avium complex infections are usually seen with CD4 count < 50 cells/µL, their patient’s count was 141 cells/µL at diagnosis.

When mycobacterial infections are suspected, patients may need extensive testing and close monitoring before the diagnosis can be made, the clinicians say. They suggest counseling patients about the potential need for invasive testing and the risks of possible diagnostic delay. Wherever possible, the clinicians add, patients with M avium complex should be overseen by infectious disease specialists and pharmacists to reduce the risk of harmful drug-drug interactions.

Source:
Auguste BL, Patel AD, Siemieniuk RA. CMAJ. 2018;190:E394-E387.
doi: 10.1503/cmaj.170823.

A 53-year-old man presented to the hospital after gaining weight for 6 months and had developed peripheral edema and abdominal distension. He also had HIV for 32 years, had undergone a renal cadaveric transplant 2 years earlier, and had type 2 diabetes, coronary artery disease, and dyslipidemia. The patient was taking > 10 medications, including immunosuppressants and antiretrovirals.

Based on the physical examination and abdominal ultrasonography, the clinicians diagnosed the patient with ascites but could not confirm the cause. Although nonhepatic causes account for only about 15% of all ascites cases, the differential diagnosis includes malignant disease, lymphatic obstruction, and infections. But samples of ascitic fluid were negative for malignant disease and mycobacteria, and there was no evidence of lymphadenopathy. Lacking a definitive diagnosis, the clinicians decided on watchful waiting, with large-volume paracentesis every 2 to 3 weeks.

However, the patient returned to the hospital 1 week later with shortness of breath, nonproductive cough, and fever. Computed tomography (CT) scan showed small pleural effusions and consolidation in the lower lung. This time, a mycobacterial culture was positive for Mycobacterium avium (M avium ) complex.

Antimycobacterial drugs were added to his regimen, and his symptoms rapidly resolved. A CT scan confirmed improvement. Six months later, he was doing well, without recurrence.

The clinicians note that their patient was at increased risk because of the double toll HIV infection and the transplant had taken on his immune system. But the diagnosis was challenging because contrary to the school of thought that M avium complex infections are usually seen with CD4 count < 50 cells/µL, their patient’s count was 141 cells/µL at diagnosis.

When mycobacterial infections are suspected, patients may need extensive testing and close monitoring before the diagnosis can be made, the clinicians say. They suggest counseling patients about the potential need for invasive testing and the risks of possible diagnostic delay. Wherever possible, the clinicians add, patients with M avium complex should be overseen by infectious disease specialists and pharmacists to reduce the risk of harmful drug-drug interactions.

Source:
Auguste BL, Patel AD, Siemieniuk RA. CMAJ. 2018;190:E394-E387.
doi: 10.1503/cmaj.170823.

Promising results from a phase 3 trial could represent a paradigm shift in treatment of patients with desmoid tumors, say National Cancer Institute (NCI) researchers. Sorafenib tosylate extended progression-free survival (PFS) compared with that of placebo in 87 patients with desmoid tumors or aggressive fibromatosis (DT/DF).  

Desmoid tumors or aggressive fibromatosis are rare sarcomas, usually found in the extremities or the abdomen and occasionally associated with familial adenomatous polyposis or Gardner syndrome. Effectiveness of current treatments—surgery, radiation, chemotherapy—is generally limited, says Jeff Abrams, MD, clinical director of NCI’s Division of Cancer Treatment and Diagnosis.

Sorafenib is a targeted treatment that interferes with the growth of cancer cells and new blood vessels that feed the tumors. It is approved for some patients with advanced kidney, liver, and thyroid cancers. It was chosen for the NCI trial because in earlier studies DT shrank in patients on sorafenib, and patients had fewer symptoms, including less pain.

Patients were assigned to receive sorafenib 400 mg/d or placebo. The trial was designed to assess improvement in PFS from 6 months for placebo to 15 months for sorafenib. Based on an interim analysis of the first 75 patients enrolled, the observed improvement in PFS exceeded the target. Patients on sorafenib were more likely to experience drug-related adverse effects, but those were generally not severe.

Treatment assignments have been disclosed to patients still receiving treatment and their physicians. Those who were receiving sorafenib can continue therapy, and those on placebo can switch to sorafenib.

Promising results from a phase 3 trial could represent a paradigm shift in treatment of patients with desmoid tumors, say National Cancer Institute (NCI) researchers. Sorafenib tosylate extended progression-free survival (PFS) compared with that of placebo in 87 patients with desmoid tumors or aggressive fibromatosis (DT/DF).  

Desmoid tumors or aggressive fibromatosis are rare sarcomas, usually found in the extremities or the abdomen and occasionally associated with familial adenomatous polyposis or Gardner syndrome. Effectiveness of current treatments—surgery, radiation, chemotherapy—is generally limited, says Jeff Abrams, MD, clinical director of NCI’s Division of Cancer Treatment and Diagnosis.

Sorafenib is a targeted treatment that interferes with the growth of cancer cells and new blood vessels that feed the tumors. It is approved for some patients with advanced kidney, liver, and thyroid cancers. It was chosen for the NCI trial because in earlier studies DT shrank in patients on sorafenib, and patients had fewer symptoms, including less pain.

Patients were assigned to receive sorafenib 400 mg/d or placebo. The trial was designed to assess improvement in PFS from 6 months for placebo to 15 months for sorafenib. Based on an interim analysis of the first 75 patients enrolled, the observed improvement in PFS exceeded the target. Patients on sorafenib were more likely to experience drug-related adverse effects, but those were generally not severe.

Treatment assignments have been disclosed to patients still receiving treatment and their physicians. Those who were receiving sorafenib can continue therapy, and those on placebo can switch to sorafenib.

Promising results from a phase 3 trial could represent a paradigm shift in treatment of patients with desmoid tumors, say National Cancer Institute (NCI) researchers. Sorafenib tosylate extended progression-free survival (PFS) compared with that of placebo in 87 patients with desmoid tumors or aggressive fibromatosis (DT/DF).  

Desmoid tumors or aggressive fibromatosis are rare sarcomas, usually found in the extremities or the abdomen and occasionally associated with familial adenomatous polyposis or Gardner syndrome. Effectiveness of current treatments—surgery, radiation, chemotherapy—is generally limited, says Jeff Abrams, MD, clinical director of NCI’s Division of Cancer Treatment and Diagnosis.

Sorafenib is a targeted treatment that interferes with the growth of cancer cells and new blood vessels that feed the tumors. It is approved for some patients with advanced kidney, liver, and thyroid cancers. It was chosen for the NCI trial because in earlier studies DT shrank in patients on sorafenib, and patients had fewer symptoms, including less pain.

Patients were assigned to receive sorafenib 400 mg/d or placebo. The trial was designed to assess improvement in PFS from 6 months for placebo to 15 months for sorafenib. Based on an interim analysis of the first 75 patients enrolled, the observed improvement in PFS exceeded the target. Patients on sorafenib were more likely to experience drug-related adverse effects, but those were generally not severe.

Treatment assignments have been disclosed to patients still receiving treatment and their physicians. Those who were receiving sorafenib can continue therapy, and those on placebo can switch to sorafenib.

Loud noise is one of the most common workplace hazards in the US. One-quarter of US workers (an estimated 41 million people) report a history of noise exposure at work—and that may put them at risk for heart disease. According to a Centers for Disease Control and Prevention (CDC) study, high blood pressure and high cholesterol are more common among workers exposed to loud noise at work.

The National Institute for Occupational Safety and Health (NIOSH) researchers analyzed data from the 2014 National Health Interview Survey to estimate the prevalence of occupational noise exposure, hearing difficulty, and heart conditions within US industries and occupations. They also looked at the association between workplace noise exposure and heart disease. Their analysis showed:

• 25% of current workers had a history of work-related noise exposure, 14% were exposed in the last year;
• 12% of current workers had hearing difficulty, 24% had high blood pressure, 28% had high cholesterol; and
• Of those cases 58%, 14%, and 9%, respectively, can be attributed to occupational noise exposure.

Study coauthor Liz Masterson, PhD, says, “If noise could be reduced to safer levels in the workplace, more than 5 million cases of hearing difficulty among noise-exposed workers could potentially be prevented.”

Loud noise is one of the most common workplace hazards in the US. One-quarter of US workers (an estimated 41 million people) report a history of noise exposure at work—and that may put them at risk for heart disease. According to a Centers for Disease Control and Prevention (CDC) study, high blood pressure and high cholesterol are more common among workers exposed to loud noise at work.

The National Institute for Occupational Safety and Health (NIOSH) researchers analyzed data from the 2014 National Health Interview Survey to estimate the prevalence of occupational noise exposure, hearing difficulty, and heart conditions within US industries and occupations. They also looked at the association between workplace noise exposure and heart disease. Their analysis showed:

• 25% of current workers had a history of work-related noise exposure, 14% were exposed in the last year;
• 12% of current workers had hearing difficulty, 24% had high blood pressure, 28% had high cholesterol; and
• Of those cases 58%, 14%, and 9%, respectively, can be attributed to occupational noise exposure.

Study coauthor Liz Masterson, PhD, says, “If noise could be reduced to safer levels in the workplace, more than 5 million cases of hearing difficulty among noise-exposed workers could potentially be prevented.”

Loud noise is one of the most common workplace hazards in the US. One-quarter of US workers (an estimated 41 million people) report a history of noise exposure at work—and that may put them at risk for heart disease. According to a Centers for Disease Control and Prevention (CDC) study, high blood pressure and high cholesterol are more common among workers exposed to loud noise at work.

The National Institute for Occupational Safety and Health (NIOSH) researchers analyzed data from the 2014 National Health Interview Survey to estimate the prevalence of occupational noise exposure, hearing difficulty, and heart conditions within US industries and occupations. They also looked at the association between workplace noise exposure and heart disease. Their analysis showed:

• 25% of current workers had a history of work-related noise exposure, 14% were exposed in the last year;
• 12% of current workers had hearing difficulty, 24% had high blood pressure, 28% had high cholesterol; and
• Of those cases 58%, 14%, and 9%, respectively, can be attributed to occupational noise exposure.

Study coauthor Liz Masterson, PhD, says, “If noise could be reduced to safer levels in the workplace, more than 5 million cases of hearing difficulty among noise-exposed workers could potentially be prevented.”

About 10% to 15% of women in the US have postpartum depression (PPD)—but that estimate is based mostly on women of European ancestry. In black women the rates are doubled, and among Latinas the prevalence is 30% to 43%. But those 2 groups have been inadequately studied, say researchers from University of North Carolina. To help remedy the lack of information, they conducted a study with the largest and “most robustly phenotyped” cohort of minority women with PPD. Their study also is the first to examine genetic ancestry as it contributes to PPD risk.

The researchers recruited 549 women with PPD and 968 without PPD who were within 6 weeks of having given birth. Of those, 67.4% were black, 14.4% were Latina, and 18.2% were white. The median age was 26.7; nearly half of the participants were married. Only 3.6% had given birth for the first time.

The women completed a battery of tests, including the Abuse and Trauma Inventory, Everyday Stressors Index (ESI), Edinburgh Postnatal Depression Scale (EPDS), and Postpartum Bonding Questionnaire. The researchers also assessed estradiol, progesterone, brain-derived neurotrophic factor, oxytocin, and allopregnanolone.

The women with PPD had significantly higher rates of previous psychiatric diagnoses, significantly higher EPDS total scores, and higher rates of family history of PPD. They also had significantly higher rates of previous diagnoses of major depressive disorder (MDD) (53% vs 15%), although 47% were experiencing their first episode of MDD. Dramatically higher numbers of women with PPD vs without PPD had suicidal thoughts in the month prior to assessment: 36% vs 2%, respectively.

Genetic ancestry was not predictive of case status, nor were hormonal influences any different between the 2 groups. Instead, psychiatric history and exposure to adverse life events were significant predictors. Nearly half of all the women with PPD had a lifetime anxiety disorder diagnosis compared with 7% of the controls. And although 67% of all participants reported a history of ≥ 1 traumatic event, women with PPD had double the proportion of multiple events of abuse and trauma. Women who had experienced multiple adverse life events were 3 times more likely to have PPD. Childhood and adult sexual abuse and life-threatening attack were among the most predictive.

The women with PPD had an ESI score > 3 times higher than that of the controls (19% vs 6%, respectively). The researchers note that cumulative lifetime stress may lead to epigenetic modification, and thus to PPD. Women with PPD also had a significantly higher proportion of dysfunctional mother-infant relationships, although the numbers were low in both groups (7% vs 0.35%, respectively).

The researchers say that although genetic ancestry did not play a role in determining case status, there are important ethnic and cultural differences that do play a role in treatment. For instance, Latinas and black women may be less likely to accept antidepressants as therapy. And because socioeconomic status is a determinant of health care access, they also face major barriers to mental health care. However, neither insurance nor education status (markers of socioeconomic status) distinguished cases from controls, even when the researchers controlled for genetic ancestry.

Their data provide a set of risk factors that can be used in screening new mothers, the researchers say. A brief, single assessment for previous psychiatric and abuse/trauma history during the perinatal period, along with regular mood monitoring, could increase a clinician’s ability to predict the onset of PPD.

Source:
Guintivano J, Sullivan PF, Stuebe AM. Psychol Med. 2018;48(7):1190-1200.
doi: 10.1017/S0033291717002641.

About 10% to 15% of women in the US have postpartum depression (PPD)—but that estimate is based mostly on women of European ancestry. In black women the rates are doubled, and among Latinas the prevalence is 30% to 43%. But those 2 groups have been inadequately studied, say researchers from University of North Carolina. To help remedy the lack of information, they conducted a study with the largest and “most robustly phenotyped” cohort of minority women with PPD. Their study also is the first to examine genetic ancestry as it contributes to PPD risk.

The researchers recruited 549 women with PPD and 968 without PPD who were within 6 weeks of having given birth. Of those, 67.4% were black, 14.4% were Latina, and 18.2% were white. The median age was 26.7; nearly half of the participants were married. Only 3.6% had given birth for the first time.

The women completed a battery of tests, including the Abuse and Trauma Inventory, Everyday Stressors Index (ESI), Edinburgh Postnatal Depression Scale (EPDS), and Postpartum Bonding Questionnaire. The researchers also assessed estradiol, progesterone, brain-derived neurotrophic factor, oxytocin, and allopregnanolone.

The women with PPD had significantly higher rates of previous psychiatric diagnoses, significantly higher EPDS total scores, and higher rates of family history of PPD. They also had significantly higher rates of previous diagnoses of major depressive disorder (MDD) (53% vs 15%), although 47% were experiencing their first episode of MDD. Dramatically higher numbers of women with PPD vs without PPD had suicidal thoughts in the month prior to assessment: 36% vs 2%, respectively.

Genetic ancestry was not predictive of case status, nor were hormonal influences any different between the 2 groups. Instead, psychiatric history and exposure to adverse life events were significant predictors. Nearly half of all the women with PPD had a lifetime anxiety disorder diagnosis compared with 7% of the controls. And although 67% of all participants reported a history of ≥ 1 traumatic event, women with PPD had double the proportion of multiple events of abuse and trauma. Women who had experienced multiple adverse life events were 3 times more likely to have PPD. Childhood and adult sexual abuse and life-threatening attack were among the most predictive.

The women with PPD had an ESI score > 3 times higher than that of the controls (19% vs 6%, respectively). The researchers note that cumulative lifetime stress may lead to epigenetic modification, and thus to PPD. Women with PPD also had a significantly higher proportion of dysfunctional mother-infant relationships, although the numbers were low in both groups (7% vs 0.35%, respectively).

The researchers say that although genetic ancestry did not play a role in determining case status, there are important ethnic and cultural differences that do play a role in treatment. For instance, Latinas and black women may be less likely to accept antidepressants as therapy. And because socioeconomic status is a determinant of health care access, they also face major barriers to mental health care. However, neither insurance nor education status (markers of socioeconomic status) distinguished cases from controls, even when the researchers controlled for genetic ancestry.

Their data provide a set of risk factors that can be used in screening new mothers, the researchers say. A brief, single assessment for previous psychiatric and abuse/trauma history during the perinatal period, along with regular mood monitoring, could increase a clinician’s ability to predict the onset of PPD.

Source:
Guintivano J, Sullivan PF, Stuebe AM. Psychol Med. 2018;48(7):1190-1200.
doi: 10.1017/S0033291717002641.

About 10% to 15% of women in the US have postpartum depression (PPD)—but that estimate is based mostly on women of European ancestry. In black women the rates are doubled, and among Latinas the prevalence is 30% to 43%. But those 2 groups have been inadequately studied, say researchers from University of North Carolina. To help remedy the lack of information, they conducted a study with the largest and “most robustly phenotyped” cohort of minority women with PPD. Their study also is the first to examine genetic ancestry as it contributes to PPD risk.

The researchers recruited 549 women with PPD and 968 without PPD who were within 6 weeks of having given birth. Of those, 67.4% were black, 14.4% were Latina, and 18.2% were white. The median age was 26.7; nearly half of the participants were married. Only 3.6% had given birth for the first time.

The women completed a battery of tests, including the Abuse and Trauma Inventory, Everyday Stressors Index (ESI), Edinburgh Postnatal Depression Scale (EPDS), and Postpartum Bonding Questionnaire. The researchers also assessed estradiol, progesterone, brain-derived neurotrophic factor, oxytocin, and allopregnanolone.

The women with PPD had significantly higher rates of previous psychiatric diagnoses, significantly higher EPDS total scores, and higher rates of family history of PPD. They also had significantly higher rates of previous diagnoses of major depressive disorder (MDD) (53% vs 15%), although 47% were experiencing their first episode of MDD. Dramatically higher numbers of women with PPD vs without PPD had suicidal thoughts in the month prior to assessment: 36% vs 2%, respectively.

Genetic ancestry was not predictive of case status, nor were hormonal influences any different between the 2 groups. Instead, psychiatric history and exposure to adverse life events were significant predictors. Nearly half of all the women with PPD had a lifetime anxiety disorder diagnosis compared with 7% of the controls. And although 67% of all participants reported a history of ≥ 1 traumatic event, women with PPD had double the proportion of multiple events of abuse and trauma. Women who had experienced multiple adverse life events were 3 times more likely to have PPD. Childhood and adult sexual abuse and life-threatening attack were among the most predictive.

The women with PPD had an ESI score > 3 times higher than that of the controls (19% vs 6%, respectively). The researchers note that cumulative lifetime stress may lead to epigenetic modification, and thus to PPD. Women with PPD also had a significantly higher proportion of dysfunctional mother-infant relationships, although the numbers were low in both groups (7% vs 0.35%, respectively).

The researchers say that although genetic ancestry did not play a role in determining case status, there are important ethnic and cultural differences that do play a role in treatment. For instance, Latinas and black women may be less likely to accept antidepressants as therapy. And because socioeconomic status is a determinant of health care access, they also face major barriers to mental health care. However, neither insurance nor education status (markers of socioeconomic status) distinguished cases from controls, even when the researchers controlled for genetic ancestry.

Their data provide a set of risk factors that can be used in screening new mothers, the researchers say. A brief, single assessment for previous psychiatric and abuse/trauma history during the perinatal period, along with regular mood monitoring, could increase a clinician’s ability to predict the onset of PPD.

Source:
Guintivano J, Sullivan PF, Stuebe AM. Psychol Med. 2018;48(7):1190-1200.
doi: 10.1017/S0033291717002641.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has launched a new Resource Center, aiming to give communities, clinicians, policy makers, and others the tools they need to put evidence-based information into practice.

The Evidence-Based Resource Center (www.samhsa.gov/ebp-resource-center) provides new or updated Treatment Improvement Protocols, tool kits, resource guides, clinical practice guidelines , and other science-based resources. The website has an easy-to-use point-and-click system. Users can search by topic, resource, target population, and target audience. The site also includes an opioid-specific resources section.

The center is part of a new comprehensive approach that allows rapid development and dissemination of the latest expert consensus on prevention, treatment, and recovery, SAMHSA says. It also provides communities and practitioners with tools to facilitate comprehensive needs assessment, match interventions to those needs, support implementation, and evaluate and incorporate continuous quality improvement as they translate science into action.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has launched a new Resource Center, aiming to give communities, clinicians, policy makers, and others the tools they need to put evidence-based information into practice.

The Evidence-Based Resource Center (www.samhsa.gov/ebp-resource-center) provides new or updated Treatment Improvement Protocols, tool kits, resource guides, clinical practice guidelines , and other science-based resources. The website has an easy-to-use point-and-click system. Users can search by topic, resource, target population, and target audience. The site also includes an opioid-specific resources section.

The center is part of a new comprehensive approach that allows rapid development and dissemination of the latest expert consensus on prevention, treatment, and recovery, SAMHSA says. It also provides communities and practitioners with tools to facilitate comprehensive needs assessment, match interventions to those needs, support implementation, and evaluate and incorporate continuous quality improvement as they translate science into action.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has launched a new Resource Center, aiming to give communities, clinicians, policy makers, and others the tools they need to put evidence-based information into practice.

The Evidence-Based Resource Center (www.samhsa.gov/ebp-resource-center) provides new or updated Treatment Improvement Protocols, tool kits, resource guides, clinical practice guidelines , and other science-based resources. The website has an easy-to-use point-and-click system. Users can search by topic, resource, target population, and target audience. The site also includes an opioid-specific resources section.

The center is part of a new comprehensive approach that allows rapid development and dissemination of the latest expert consensus on prevention, treatment, and recovery, SAMHSA says. It also provides communities and practitioners with tools to facilitate comprehensive needs assessment, match interventions to those needs, support implementation, and evaluate and incorporate continuous quality improvement as they translate science into action.

Squamous cell carcinomas (SCCs) associated with smoking and human papillomavirus (HPV) have distinct genomic signatures, say researchers from a National Institutes of Health-supported study. That is one of the findings that may help distinguish SCCs from other cancers and point the way to new research and treatment.

The researchers used new analytic tools and data from the recently completed PanCancer Atlas to investigate similarities and differences among SCCs in the head and neck, lung, esophagus, cervix, and bladder. The PanCancer Atlas is a detailed analysis from a dataset containing molecular and clinical information on more than 10,000 tumors from 33 forms of cancer.

The researchers combined multiple platforms of genomic data from 1,400 SCC samples into integrated analyses, creating visual clusters of tumors based on genomic characteristics.

Squamous cell carcinomas had genomic features that set them apart from other cancers, the researchers found. The most common were gains or losses of the sections of certain chromosomes, making it likely that those regions harbor genes important to the development of SCCs.

The current study expands on research reported in 2014 and 2015, which compared genomic features of SCCs in head and neck cancer associated with smoking (a risk factor for head and neck cancer [HNC]) and HPV (a risk factor for cervical and some HNCs). Certain features were present in tumors associated with both, whereas others were exclusive to only 1 of the 2. The researchers also found similarities in the genomic characteristics of HNCs with lung cancers, some bladder cancers, and cervical cancer.

Squamous cell carcinomas (SCCs) associated with smoking and human papillomavirus (HPV) have distinct genomic signatures, say researchers from a National Institutes of Health-supported study. That is one of the findings that may help distinguish SCCs from other cancers and point the way to new research and treatment.

The researchers used new analytic tools and data from the recently completed PanCancer Atlas to investigate similarities and differences among SCCs in the head and neck, lung, esophagus, cervix, and bladder. The PanCancer Atlas is a detailed analysis from a dataset containing molecular and clinical information on more than 10,000 tumors from 33 forms of cancer.

The researchers combined multiple platforms of genomic data from 1,400 SCC samples into integrated analyses, creating visual clusters of tumors based on genomic characteristics.

Squamous cell carcinomas had genomic features that set them apart from other cancers, the researchers found. The most common were gains or losses of the sections of certain chromosomes, making it likely that those regions harbor genes important to the development of SCCs.

The current study expands on research reported in 2014 and 2015, which compared genomic features of SCCs in head and neck cancer associated with smoking (a risk factor for head and neck cancer [HNC]) and HPV (a risk factor for cervical and some HNCs). Certain features were present in tumors associated with both, whereas others were exclusive to only 1 of the 2. The researchers also found similarities in the genomic characteristics of HNCs with lung cancers, some bladder cancers, and cervical cancer.

Squamous cell carcinomas (SCCs) associated with smoking and human papillomavirus (HPV) have distinct genomic signatures, say researchers from a National Institutes of Health-supported study. That is one of the findings that may help distinguish SCCs from other cancers and point the way to new research and treatment.

The researchers used new analytic tools and data from the recently completed PanCancer Atlas to investigate similarities and differences among SCCs in the head and neck, lung, esophagus, cervix, and bladder. The PanCancer Atlas is a detailed analysis from a dataset containing molecular and clinical information on more than 10,000 tumors from 33 forms of cancer.

The researchers combined multiple platforms of genomic data from 1,400 SCC samples into integrated analyses, creating visual clusters of tumors based on genomic characteristics.

Squamous cell carcinomas had genomic features that set them apart from other cancers, the researchers found. The most common were gains or losses of the sections of certain chromosomes, making it likely that those regions harbor genes important to the development of SCCs.

The current study expands on research reported in 2014 and 2015, which compared genomic features of SCCs in head and neck cancer associated with smoking (a risk factor for head and neck cancer [HNC]) and HPV (a risk factor for cervical and some HNCs). Certain features were present in tumors associated with both, whereas others were exclusive to only 1 of the 2. The researchers also found similarities in the genomic characteristics of HNCs with lung cancers, some bladder cancers, and cervical cancer.

Participants reported the greatest improvements in diabetes-related quality of life (QOL) and better overall health status even though they would need lifelong immune-suppressing drugs to prevent transplant rejection.

The study, conducted by the Clinical Islet Transplantation Consortium, involved 48 people with hypoglycemia unawareness who experienced frequent episodes of severe hypoglycemia despite receiving expert care. Each participant received at least 1 islet transplant.

One year after the first transplant, 42 participants (88%) were free of severe hypoglycemic events, had near-normal blood glucose control, and had restored awareness of hypoglycemia. About half of the recipients needed to continue on insulin to control blood glucose, but the reported improvements in QOL were similar between those who did and those who did not. The researchers say the elimination of severe hypoglycemia and the associated fears outweighed concerns about the need for continued insulin treatment.

Islet transplantation is investigational in the US. Although the results are promising, the National Institutes of Health cautions that the process is not appropriate for all patients with type 1 diabetes mellitus due to risks and adverse effects.

Participants reported the greatest improvements in diabetes-related quality of life (QOL) and better overall health status even though they would need lifelong immune-suppressing drugs to prevent transplant rejection.

The study, conducted by the Clinical Islet Transplantation Consortium, involved 48 people with hypoglycemia unawareness who experienced frequent episodes of severe hypoglycemia despite receiving expert care. Each participant received at least 1 islet transplant.

One year after the first transplant, 42 participants (88%) were free of severe hypoglycemic events, had near-normal blood glucose control, and had restored awareness of hypoglycemia. About half of the recipients needed to continue on insulin to control blood glucose, but the reported improvements in QOL were similar between those who did and those who did not. The researchers say the elimination of severe hypoglycemia and the associated fears outweighed concerns about the need for continued insulin treatment.

Islet transplantation is investigational in the US. Although the results are promising, the National Institutes of Health cautions that the process is not appropriate for all patients with type 1 diabetes mellitus due to risks and adverse effects.

Participants reported the greatest improvements in diabetes-related quality of life (QOL) and better overall health status even though they would need lifelong immune-suppressing drugs to prevent transplant rejection.

The study, conducted by the Clinical Islet Transplantation Consortium, involved 48 people with hypoglycemia unawareness who experienced frequent episodes of severe hypoglycemia despite receiving expert care. Each participant received at least 1 islet transplant.

One year after the first transplant, 42 participants (88%) were free of severe hypoglycemic events, had near-normal blood glucose control, and had restored awareness of hypoglycemia. About half of the recipients needed to continue on insulin to control blood glucose, but the reported improvements in QOL were similar between those who did and those who did not. The researchers say the elimination of severe hypoglycemia and the associated fears outweighed concerns about the need for continued insulin treatment.

Islet transplantation is investigational in the US. Although the results are promising, the National Institutes of Health cautions that the process is not appropriate for all patients with type 1 diabetes mellitus due to risks and adverse effects.

In 2015, young people aged 13- 24 years accounted for > 1 in 5 new HIV diagnoses in the US. Young people aged 15-24 years also account for half of all new sexually transmitted disease infections. Many of those high-risk youth are caught in the juvenile justice system, where they experience more mental illness, substance abuse, and STDs than their peers in the general population.

It is a challenge to identify and implement effective prevention strategies for these young people, but a study at the University of Illinois shows potential. PHAT Life: Preventing HIV/AIDS Among Teens uses role-playing, videos, games, and skill-building exercises to promote knowledge about HIV/AIDS, positive coping, and problem-solving skills.

The study was conducted with 310 urban teens, mostly African American boys, on probation in Chicago’s Cook County, the second-largest county justice system in the US. The participants were assigned to PHAT Life or an equally intensive health information program. Both 2-week programs consisted of 8 90- to 120-minute sessions, delivered at detention-alternative after-school programs.

The study measured the degree of condom use and number of sexual partners in the 6 months before and after the intervention. Among participants who reported the highest-risk sexual behavior at baseline, those assigned to PHAT Life were over 4 times more likely than those in the control group to report a reduction in number of sexual partners and more consistent condom use. Of those who reported having had sex before age 12, the PHAT Life participants reported significantly fewer sexual partners after the intervention.

“Uniquely tailored interventions like PHAT Life … are essential to mitigate young offenders’ poor long-term trajectories,” says Geri Donenberg, PhD, study leader.

The next step, the researchers say, is to identify how best to disseminate PHAT Life resources to ensure it’s self-sustaining in the juvenile justice system.

In 2015, young people aged 13- 24 years accounted for > 1 in 5 new HIV diagnoses in the US. Young people aged 15-24 years also account for half of all new sexually transmitted disease infections. Many of those high-risk youth are caught in the juvenile justice system, where they experience more mental illness, substance abuse, and STDs than their peers in the general population.

It is a challenge to identify and implement effective prevention strategies for these young people, but a study at the University of Illinois shows potential. PHAT Life: Preventing HIV/AIDS Among Teens uses role-playing, videos, games, and skill-building exercises to promote knowledge about HIV/AIDS, positive coping, and problem-solving skills.

The study was conducted with 310 urban teens, mostly African American boys, on probation in Chicago’s Cook County, the second-largest county justice system in the US. The participants were assigned to PHAT Life or an equally intensive health information program. Both 2-week programs consisted of 8 90- to 120-minute sessions, delivered at detention-alternative after-school programs.

The study measured the degree of condom use and number of sexual partners in the 6 months before and after the intervention. Among participants who reported the highest-risk sexual behavior at baseline, those assigned to PHAT Life were over 4 times more likely than those in the control group to report a reduction in number of sexual partners and more consistent condom use. Of those who reported having had sex before age 12, the PHAT Life participants reported significantly fewer sexual partners after the intervention.

“Uniquely tailored interventions like PHAT Life … are essential to mitigate young offenders’ poor long-term trajectories,” says Geri Donenberg, PhD, study leader.

The next step, the researchers say, is to identify how best to disseminate PHAT Life resources to ensure it’s self-sustaining in the juvenile justice system.

In 2015, young people aged 13- 24 years accounted for > 1 in 5 new HIV diagnoses in the US. Young people aged 15-24 years also account for half of all new sexually transmitted disease infections. Many of those high-risk youth are caught in the juvenile justice system, where they experience more mental illness, substance abuse, and STDs than their peers in the general population.

It is a challenge to identify and implement effective prevention strategies for these young people, but a study at the University of Illinois shows potential. PHAT Life: Preventing HIV/AIDS Among Teens uses role-playing, videos, games, and skill-building exercises to promote knowledge about HIV/AIDS, positive coping, and problem-solving skills.

The study was conducted with 310 urban teens, mostly African American boys, on probation in Chicago’s Cook County, the second-largest county justice system in the US. The participants were assigned to PHAT Life or an equally intensive health information program. Both 2-week programs consisted of 8 90- to 120-minute sessions, delivered at detention-alternative after-school programs.

The study measured the degree of condom use and number of sexual partners in the 6 months before and after the intervention. Among participants who reported the highest-risk sexual behavior at baseline, those assigned to PHAT Life were over 4 times more likely than those in the control group to report a reduction in number of sexual partners and more consistent condom use. Of those who reported having had sex before age 12, the PHAT Life participants reported significantly fewer sexual partners after the intervention.

“Uniquely tailored interventions like PHAT Life … are essential to mitigate young offenders’ poor long-term trajectories,” says Geri Donenberg, PhD, study leader.

The next step, the researchers say, is to identify how best to disseminate PHAT Life resources to ensure it’s self-sustaining in the juvenile justice system.

The research paradigm had been: examine a person’s traits or symptomsthen, then search for genes or gene variants that cause or contribute to them. But it was difficult for researchers to recontact people with genotypes of interest for “downstream” follow-up.

Now, the National Institute of Health (NIH) and Inova Health System are launching The Genomic Ascertainment Cohort (TGAC), a 2-year pilot project that will allow researchers to recall genotyped people and examine the influence of genes and gene variants on phenotypes. “This is essentially match-making between genes and gene variants and the researchers who study them,” says Richard Siegel, MD, PhD, TGAC co-organizer, and clinical director and chief of the Autoimmunity Branch at the National Institute of Arthritis and Musculoskeletal and Skin Diseases. For instance, a researcher might locate a genotype of interest in the database and ask participants with the genotype to come to the NIH Clinical Center in Bethesda.

Participating NIH institutes will contribute genome and exome sequences from existing research programs to the database. Another 1,000 patients will be recruited to have genome sequencing performed. Half of the new recruits will be from Hispanic backgrounds.

The researchers are aiming for 10,000 genomes and exomes to allow recruitment of people with both common and rarer gene variants.

“We’re trying to advance science in a new, creative, and slightly radical way,” says Leslie Biesecker, MD, TGAC co-organizer and chief of the Medical Genomics and Metabolic Genetics Branch at the National Human Genome Research Institute. “We’re especially interested in using this as a platform to test our ability to predict phenotype from genotype—one of the key underpinnings of predictive genomic medicine.”

The research paradigm had been: examine a person’s traits or symptomsthen, then search for genes or gene variants that cause or contribute to them. But it was difficult for researchers to recontact people with genotypes of interest for “downstream” follow-up.

Now, the National Institute of Health (NIH) and Inova Health System are launching The Genomic Ascertainment Cohort (TGAC), a 2-year pilot project that will allow researchers to recall genotyped people and examine the influence of genes and gene variants on phenotypes. “This is essentially match-making between genes and gene variants and the researchers who study them,” says Richard Siegel, MD, PhD, TGAC co-organizer, and clinical director and chief of the Autoimmunity Branch at the National Institute of Arthritis and Musculoskeletal and Skin Diseases. For instance, a researcher might locate a genotype of interest in the database and ask participants with the genotype to come to the NIH Clinical Center in Bethesda.

Participating NIH institutes will contribute genome and exome sequences from existing research programs to the database. Another 1,000 patients will be recruited to have genome sequencing performed. Half of the new recruits will be from Hispanic backgrounds.

The researchers are aiming for 10,000 genomes and exomes to allow recruitment of people with both common and rarer gene variants.

“We’re trying to advance science in a new, creative, and slightly radical way,” says Leslie Biesecker, MD, TGAC co-organizer and chief of the Medical Genomics and Metabolic Genetics Branch at the National Human Genome Research Institute. “We’re especially interested in using this as a platform to test our ability to predict phenotype from genotype—one of the key underpinnings of predictive genomic medicine.”

The research paradigm had been: examine a person’s traits or symptomsthen, then search for genes or gene variants that cause or contribute to them. But it was difficult for researchers to recontact people with genotypes of interest for “downstream” follow-up.

Now, the National Institute of Health (NIH) and Inova Health System are launching The Genomic Ascertainment Cohort (TGAC), a 2-year pilot project that will allow researchers to recall genotyped people and examine the influence of genes and gene variants on phenotypes. “This is essentially match-making between genes and gene variants and the researchers who study them,” says Richard Siegel, MD, PhD, TGAC co-organizer, and clinical director and chief of the Autoimmunity Branch at the National Institute of Arthritis and Musculoskeletal and Skin Diseases. For instance, a researcher might locate a genotype of interest in the database and ask participants with the genotype to come to the NIH Clinical Center in Bethesda.

Participating NIH institutes will contribute genome and exome sequences from existing research programs to the database. Another 1,000 patients will be recruited to have genome sequencing performed. Half of the new recruits will be from Hispanic backgrounds.

The researchers are aiming for 10,000 genomes and exomes to allow recruitment of people with both common and rarer gene variants.

“We’re trying to advance science in a new, creative, and slightly radical way,” says Leslie Biesecker, MD, TGAC co-organizer and chief of the Medical Genomics and Metabolic Genetics Branch at the National Human Genome Research Institute. “We’re especially interested in using this as a platform to test our ability to predict phenotype from genotype—one of the key underpinnings of predictive genomic medicine.”