Kate Johnson

MONTREAL — Prenatal care providers need to take a frontline attitude about novel influenza A (H1N1) because pregnant women are among those at highest risk for infection and serious complications.

“We need to get the message out to the practitioners in the field that they've really got to be thinking about this. They need to recognize that influenza in pregnancy is not trivial, and they should consider early treatment,” said Dr. Deborah Money, president-elect of the Infectious Diseases Society for Obstetrics and Gynecology.

Speaking after chairing an urgent update session on novel H1N1 influenza at the society's annual meeting, Dr. Money said the latest figures on the infection in pregnancy, published in Lancet (doi:10.1016/S0140-6736[09]61304-0) paint a worrisome picture of practitioner's reaction time.

Of 34 pregnant women who contracted the virus, only 50% were treated with oseltamivir, and just 8 (24%) received treatment within 48 hours of symptom onset.

“Antivirals have the best impact within the first 48 hours of treatment and the latest deaths in this population had late starts with oseltamivir treatment,” she said in an interview. Among the six women who died, the earliest initiation of oseltamivir was 6 days after symptom onset, and the latest was 15 days.

The most common presentation was a febrile, influenzalike illness (94% of the patients), which included fever plus cough or sore throat. Vomiting and diarrhea occurred in only 18% and 12% of pregnant patients. Pregnant women were more likely to report shortness of breath (41%) than patients in the general population (15%). Rhinorrhea occurred in 59% of pregnant patients.

Patient awareness also may be an issue, since many pregnant women might not think to call their obstetricians when they come down with the sniffles, she acknowledged.

Dr. Money, an associate professor of obstetrics and gynecology at the University of British Columbia, Vancouver, said prenatal care providers must now make new plans, not only to include influenza patients in their daily schedules, but to ensure that these patients do not put their other patients at risk.

“If the woman really needs to be seen, [providers] need to orchestrate this in a way that is safe for their other patients—either at the end of the day, or in a place with a negative pressure room, or by getting them to wear a mask on entry.”

The drug of choice is oseltamivir, at a dosage of 75 mg twice per day for 5 days (www.cdc.gov/h1n1flu/

“We already have a poor track record with the seasonal influenza. U.S. guidelines have recommended the seasonal influenza vaccine for pregnant women for some time, but despite those recommendations the uptake in studies has been in the 14% range. So given that poor track record, how are we going to manage immunizing women against both seasonal and H1N1 influenza?”

In the Lancet study, 56% of the pregnant women with novel H1N1 influenza had not received the seasonal influenza vaccine, 9% had been vaccinated, and vaccination status was unknown for the remaining 35%.

“The H1N1 vaccine might turn out to be two doses, although that is still to be determined. So, with the addition of the seasonal vaccine we're looking potentially at three doses through the fall and winter of all pregnant women going to care providers, and the logistics start to boggle the mind.”

Discussion at the meeting explored the possibility of setting up influenza vaccination clinics at teaching hospitals to relieve small clinics and private practitioners. However, this plan would still rely on vaccination recommendations from private practitioners.

“Our experience anecdotally is that care providers have been advising against vaccination in pregnancy because they misunderstand which ones you can give in pregnancy and which ones you can't. Our anxiety is that they won't give oseltamivir, and they won't give the vaccine because they are in that mind set. But generally speaking, those of us in academic centers that see complications, end up seeing more complications related to under-treatment rather than overtreatment,” Dr. Money said.

Among the six women who died, the earliest initiation of oseltamivir was 6 days after symptom onset.

Source DR. MONEY

MONTREAL — Prenatal care providers need to take a frontline attitude about novel influenza A (H1N1) because pregnant women are among those at highest risk for infection and serious complications.

“We need to get the message out to the practitioners in the field that they've really got to be thinking about this. They need to recognize that influenza in pregnancy is not trivial, and they should consider early treatment,” said Dr. Deborah Money, president-elect of the Infectious Diseases Society for Obstetrics and Gynecology.

Speaking after chairing an urgent update session on novel H1N1 influenza at the society's annual meeting, Dr. Money said the latest figures on the infection in pregnancy, published in Lancet (doi:10.1016/S0140-6736[09]61304-0) paint a worrisome picture of practitioner's reaction time.

Of 34 pregnant women who contracted the virus, only 50% were treated with oseltamivir, and just 8 (24%) received treatment within 48 hours of symptom onset.

“Antivirals have the best impact within the first 48 hours of treatment and the latest deaths in this population had late starts with oseltamivir treatment,” she said in an interview. Among the six women who died, the earliest initiation of oseltamivir was 6 days after symptom onset, and the latest was 15 days.

The most common presentation was a febrile, influenzalike illness (94% of the patients), which included fever plus cough or sore throat. Vomiting and diarrhea occurred in only 18% and 12% of pregnant patients. Pregnant women were more likely to report shortness of breath (41%) than patients in the general population (15%). Rhinorrhea occurred in 59% of pregnant patients.

Patient awareness also may be an issue, since many pregnant women might not think to call their obstetricians when they come down with the sniffles, she acknowledged.

Dr. Money, an associate professor of obstetrics and gynecology at the University of British Columbia, Vancouver, said prenatal care providers must now make new plans, not only to include influenza patients in their daily schedules, but to ensure that these patients do not put their other patients at risk.

“If the woman really needs to be seen, [providers] need to orchestrate this in a way that is safe for their other patients—either at the end of the day, or in a place with a negative pressure room, or by getting them to wear a mask on entry.”

The drug of choice is oseltamivir, at a dosage of 75 mg twice per day for 5 days (www.cdc.gov/h1n1flu/

“We already have a poor track record with the seasonal influenza. U.S. guidelines have recommended the seasonal influenza vaccine for pregnant women for some time, but despite those recommendations the uptake in studies has been in the 14% range. So given that poor track record, how are we going to manage immunizing women against both seasonal and H1N1 influenza?”

In the Lancet study, 56% of the pregnant women with novel H1N1 influenza had not received the seasonal influenza vaccine, 9% had been vaccinated, and vaccination status was unknown for the remaining 35%.

“The H1N1 vaccine might turn out to be two doses, although that is still to be determined. So, with the addition of the seasonal vaccine we're looking potentially at three doses through the fall and winter of all pregnant women going to care providers, and the logistics start to boggle the mind.”

Discussion at the meeting explored the possibility of setting up influenza vaccination clinics at teaching hospitals to relieve small clinics and private practitioners. However, this plan would still rely on vaccination recommendations from private practitioners.

“Our experience anecdotally is that care providers have been advising against vaccination in pregnancy because they misunderstand which ones you can give in pregnancy and which ones you can't. Our anxiety is that they won't give oseltamivir, and they won't give the vaccine because they are in that mind set. But generally speaking, those of us in academic centers that see complications, end up seeing more complications related to under-treatment rather than overtreatment,” Dr. Money said.

Among the six women who died, the earliest initiation of oseltamivir was 6 days after symptom onset.

Source DR. MONEY

MONTREAL — Prenatal care providers need to take a frontline attitude about novel influenza A (H1N1) because pregnant women are among those at highest risk for infection and serious complications.

“We need to get the message out to the practitioners in the field that they've really got to be thinking about this. They need to recognize that influenza in pregnancy is not trivial, and they should consider early treatment,” said Dr. Deborah Money, president-elect of the Infectious Diseases Society for Obstetrics and Gynecology.

Speaking after chairing an urgent update session on novel H1N1 influenza at the society's annual meeting, Dr. Money said the latest figures on the infection in pregnancy, published in Lancet (doi:10.1016/S0140-6736[09]61304-0) paint a worrisome picture of practitioner's reaction time.

Of 34 pregnant women who contracted the virus, only 50% were treated with oseltamivir, and just 8 (24%) received treatment within 48 hours of symptom onset.

“Antivirals have the best impact within the first 48 hours of treatment and the latest deaths in this population had late starts with oseltamivir treatment,” she said in an interview. Among the six women who died, the earliest initiation of oseltamivir was 6 days after symptom onset, and the latest was 15 days.

The most common presentation was a febrile, influenzalike illness (94% of the patients), which included fever plus cough or sore throat. Vomiting and diarrhea occurred in only 18% and 12% of pregnant patients. Pregnant women were more likely to report shortness of breath (41%) than patients in the general population (15%). Rhinorrhea occurred in 59% of pregnant patients.

Patient awareness also may be an issue, since many pregnant women might not think to call their obstetricians when they come down with the sniffles, she acknowledged.

Dr. Money, an associate professor of obstetrics and gynecology at the University of British Columbia, Vancouver, said prenatal care providers must now make new plans, not only to include influenza patients in their daily schedules, but to ensure that these patients do not put their other patients at risk.

“If the woman really needs to be seen, [providers] need to orchestrate this in a way that is safe for their other patients—either at the end of the day, or in a place with a negative pressure room, or by getting them to wear a mask on entry.”

The drug of choice is oseltamivir, at a dosage of 75 mg twice per day for 5 days (www.cdc.gov/h1n1flu/

“We already have a poor track record with the seasonal influenza. U.S. guidelines have recommended the seasonal influenza vaccine for pregnant women for some time, but despite those recommendations the uptake in studies has been in the 14% range. So given that poor track record, how are we going to manage immunizing women against both seasonal and H1N1 influenza?”

In the Lancet study, 56% of the pregnant women with novel H1N1 influenza had not received the seasonal influenza vaccine, 9% had been vaccinated, and vaccination status was unknown for the remaining 35%.

“The H1N1 vaccine might turn out to be two doses, although that is still to be determined. So, with the addition of the seasonal vaccine we're looking potentially at three doses through the fall and winter of all pregnant women going to care providers, and the logistics start to boggle the mind.”

Discussion at the meeting explored the possibility of setting up influenza vaccination clinics at teaching hospitals to relieve small clinics and private practitioners. However, this plan would still rely on vaccination recommendations from private practitioners.

“Our experience anecdotally is that care providers have been advising against vaccination in pregnancy because they misunderstand which ones you can give in pregnancy and which ones you can't. Our anxiety is that they won't give oseltamivir, and they won't give the vaccine because they are in that mind set. But generally speaking, those of us in academic centers that see complications, end up seeing more complications related to under-treatment rather than overtreatment,” Dr. Money said.

Among the six women who died, the earliest initiation of oseltamivir was 6 days after symptom onset.

Source DR. MONEY

MONTREAL — Women who have not yet established prenatal care have a significantly higher rate of acute pyelonephritis before 12 weeks of gestation compared with women who already have an obstetric provider by 12 weeks, according to a new study.

“Many providers do not see patients early in the first trimester, because they often like to ensure there is an established pregnancy. But we would encourage them to have patients present as early as possible, at least for labs and urine screening,” said Dr. Mollie Ann McDonnold, who presented her findings at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Her retrospective study examined 254 consecutive hospital admissions for acute pyelonephritis in pregnancy between January 2004 and June 2007. Overall, there were 29 cases (11%) occurring before 12 weeks' gestation, and 60 cases (24%) before 16 weeks' gestation.

Among women who had already established prenatal care (219), most infections occurred later in pregnancy, with only 5% of cases occurring before 12 weeks, and 16% occurring prior to 16 weeks of gestation.

Among women without prenatal care (35), however, 51% of cases presented prior to 12 weeks and 74% occurred prior to 16 weeks of gestation.

“These results were expected as it is not common to establish prenatal care prior to 12 weeks,” said Dr. McDonnold of the Warren Alpert Medical School of Brown University, Providence, R.I.

There were no differences in age, ethnicity, parity, length of hospital stay, presence or degree of fever, or heart rate at admission between women with or without established prenatal care.

However, there was a statistically significant difference in insurance status between the groups. While 57% of women with no prenatal care had no insurance, only 1.6% of women with prenatal care were in this situation. And 24% of women with prenatal care had private insurance, compared to just 2.4% of women without prenatal care.

“I think this is an extremely important observation,” commented Dr. Michael Gravett, president of IDSOG and professor of obstetrics and gynecology at the University of Washington in Seattle.

“The trend in prenatal care is that since we now do a lot of prenatal diagnosis we frequently defer initiation of care and labs until about 12 or 13 weeks. This is a reminder that common things occur more commonly and we tend to overlook them. This is a caution to see women earlier at least for urinalysis,” Dr. Gravett said.

MONTREAL — Women who have not yet established prenatal care have a significantly higher rate of acute pyelonephritis before 12 weeks of gestation compared with women who already have an obstetric provider by 12 weeks, according to a new study.

“Many providers do not see patients early in the first trimester, because they often like to ensure there is an established pregnancy. But we would encourage them to have patients present as early as possible, at least for labs and urine screening,” said Dr. Mollie Ann McDonnold, who presented her findings at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Her retrospective study examined 254 consecutive hospital admissions for acute pyelonephritis in pregnancy between January 2004 and June 2007. Overall, there were 29 cases (11%) occurring before 12 weeks' gestation, and 60 cases (24%) before 16 weeks' gestation.

Among women who had already established prenatal care (219), most infections occurred later in pregnancy, with only 5% of cases occurring before 12 weeks, and 16% occurring prior to 16 weeks of gestation.

Among women without prenatal care (35), however, 51% of cases presented prior to 12 weeks and 74% occurred prior to 16 weeks of gestation.

“These results were expected as it is not common to establish prenatal care prior to 12 weeks,” said Dr. McDonnold of the Warren Alpert Medical School of Brown University, Providence, R.I.

There were no differences in age, ethnicity, parity, length of hospital stay, presence or degree of fever, or heart rate at admission between women with or without established prenatal care.

However, there was a statistically significant difference in insurance status between the groups. While 57% of women with no prenatal care had no insurance, only 1.6% of women with prenatal care were in this situation. And 24% of women with prenatal care had private insurance, compared to just 2.4% of women without prenatal care.

“I think this is an extremely important observation,” commented Dr. Michael Gravett, president of IDSOG and professor of obstetrics and gynecology at the University of Washington in Seattle.

“The trend in prenatal care is that since we now do a lot of prenatal diagnosis we frequently defer initiation of care and labs until about 12 or 13 weeks. This is a reminder that common things occur more commonly and we tend to overlook them. This is a caution to see women earlier at least for urinalysis,” Dr. Gravett said.

MONTREAL — Women who have not yet established prenatal care have a significantly higher rate of acute pyelonephritis before 12 weeks of gestation compared with women who already have an obstetric provider by 12 weeks, according to a new study.

“Many providers do not see patients early in the first trimester, because they often like to ensure there is an established pregnancy. But we would encourage them to have patients present as early as possible, at least for labs and urine screening,” said Dr. Mollie Ann McDonnold, who presented her findings at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Her retrospective study examined 254 consecutive hospital admissions for acute pyelonephritis in pregnancy between January 2004 and June 2007. Overall, there were 29 cases (11%) occurring before 12 weeks' gestation, and 60 cases (24%) before 16 weeks' gestation.

Among women who had already established prenatal care (219), most infections occurred later in pregnancy, with only 5% of cases occurring before 12 weeks, and 16% occurring prior to 16 weeks of gestation.

Among women without prenatal care (35), however, 51% of cases presented prior to 12 weeks and 74% occurred prior to 16 weeks of gestation.

“These results were expected as it is not common to establish prenatal care prior to 12 weeks,” said Dr. McDonnold of the Warren Alpert Medical School of Brown University, Providence, R.I.

There were no differences in age, ethnicity, parity, length of hospital stay, presence or degree of fever, or heart rate at admission between women with or without established prenatal care.

However, there was a statistically significant difference in insurance status between the groups. While 57% of women with no prenatal care had no insurance, only 1.6% of women with prenatal care were in this situation. And 24% of women with prenatal care had private insurance, compared to just 2.4% of women without prenatal care.

“I think this is an extremely important observation,” commented Dr. Michael Gravett, president of IDSOG and professor of obstetrics and gynecology at the University of Washington in Seattle.

“The trend in prenatal care is that since we now do a lot of prenatal diagnosis we frequently defer initiation of care and labs until about 12 or 13 weeks. This is a reminder that common things occur more commonly and we tend to overlook them. This is a caution to see women earlier at least for urinalysis,” Dr. Gravett said.

MONTREAL — HIV screening of pregnant women falls well short of national guidelines, particularly among patients seen in private practice, according to a study presented at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“We have to really reinforce with all providers the importance of universal screening,” said Dr. Harold Wiesenfeld, senior investigator of the study, which found that patients were 17.5 times less likely to undergo screening in private practice than were those seen in a clinic setting.

The study of 300 women revealed that 61% had no HIV screening results in their medical record at the time of parturition.

Guidelines that were adopted in 1999 by the Institute of Medicine, the Centers for Disease Control, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommend routine, universal HIV screening in pregnancy to avoid vertical transmission, noted study presenter Margaret Kennedy, who is a medical student at the University of Pittsburgh.

But among the study's subjects, all of whom were questioned up to 72 hours before delivery, only 65% reported undergoing HIV screening during pregnancy, while 25% reported no screening, and 10% were not sure if they had been tested.

A multivariate analysis revealed that being white and married were each independently associated with a threefold greater risk of not being screened.

The provider's influence was the most important factor in screening, said Ms. Kennedy.

Women whose provider did not consider screening important were 14 times more likely to be unscreened; those whose providers considered screening optional were 2.9 times more likely to be unscreened. On the other hand, women whose providers encouraged screening were 3.7 times more likely to have undergone screening.

“My personal opinion is the importance of HIV screening is not stressed in many patient/provider encounters,” said Dr. Wiesenfeld, who is also with the university. “Some providers don't think HIV is relevant to their population because they have an affluent, white population. It mirrors chlamydia screening. They don't think their patients are at risk.”

A comparison of medical records with subjects' responses revealed some recall bias: Two percent of those who reported having been tested had actually declined testing. Of those who reporting no screening, 11% had actually been screened (35% said they had not been offered screening, and 65% said they had declined). In addition, 17% of those who were unsure had been screened.

“Universal offering of HIV screening as an opt-out, in conjunction with encouragement from providers, may greatly increase prenatal HIV screening rates,” she said.

“Universal HIV screening is not at the rates we would like across the country,” concluded Dr. Wiesenfeld.

“The take-home message is that it's low—but what's more important is who is not being screened. Women who are white, and affluent, and in a private practice center … are less likely to be screened, as are those who don't feel their provider is encouraging it,” he added.

The investigators said they had no conflicts of interest.

MONTREAL — HIV screening of pregnant women falls well short of national guidelines, particularly among patients seen in private practice, according to a study presented at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“We have to really reinforce with all providers the importance of universal screening,” said Dr. Harold Wiesenfeld, senior investigator of the study, which found that patients were 17.5 times less likely to undergo screening in private practice than were those seen in a clinic setting.

The study of 300 women revealed that 61% had no HIV screening results in their medical record at the time of parturition.

Guidelines that were adopted in 1999 by the Institute of Medicine, the Centers for Disease Control, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommend routine, universal HIV screening in pregnancy to avoid vertical transmission, noted study presenter Margaret Kennedy, who is a medical student at the University of Pittsburgh.

But among the study's subjects, all of whom were questioned up to 72 hours before delivery, only 65% reported undergoing HIV screening during pregnancy, while 25% reported no screening, and 10% were not sure if they had been tested.

A multivariate analysis revealed that being white and married were each independently associated with a threefold greater risk of not being screened.

The provider's influence was the most important factor in screening, said Ms. Kennedy.

Women whose provider did not consider screening important were 14 times more likely to be unscreened; those whose providers considered screening optional were 2.9 times more likely to be unscreened. On the other hand, women whose providers encouraged screening were 3.7 times more likely to have undergone screening.

“My personal opinion is the importance of HIV screening is not stressed in many patient/provider encounters,” said Dr. Wiesenfeld, who is also with the university. “Some providers don't think HIV is relevant to their population because they have an affluent, white population. It mirrors chlamydia screening. They don't think their patients are at risk.”

A comparison of medical records with subjects' responses revealed some recall bias: Two percent of those who reported having been tested had actually declined testing. Of those who reporting no screening, 11% had actually been screened (35% said they had not been offered screening, and 65% said they had declined). In addition, 17% of those who were unsure had been screened.

“Universal offering of HIV screening as an opt-out, in conjunction with encouragement from providers, may greatly increase prenatal HIV screening rates,” she said.

“Universal HIV screening is not at the rates we would like across the country,” concluded Dr. Wiesenfeld.

“The take-home message is that it's low—but what's more important is who is not being screened. Women who are white, and affluent, and in a private practice center … are less likely to be screened, as are those who don't feel their provider is encouraging it,” he added.

The investigators said they had no conflicts of interest.

MONTREAL — HIV screening of pregnant women falls well short of national guidelines, particularly among patients seen in private practice, according to a study presented at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

“We have to really reinforce with all providers the importance of universal screening,” said Dr. Harold Wiesenfeld, senior investigator of the study, which found that patients were 17.5 times less likely to undergo screening in private practice than were those seen in a clinic setting.

The study of 300 women revealed that 61% had no HIV screening results in their medical record at the time of parturition.

Guidelines that were adopted in 1999 by the Institute of Medicine, the Centers for Disease Control, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommend routine, universal HIV screening in pregnancy to avoid vertical transmission, noted study presenter Margaret Kennedy, who is a medical student at the University of Pittsburgh.

But among the study's subjects, all of whom were questioned up to 72 hours before delivery, only 65% reported undergoing HIV screening during pregnancy, while 25% reported no screening, and 10% were not sure if they had been tested.

A multivariate analysis revealed that being white and married were each independently associated with a threefold greater risk of not being screened.

The provider's influence was the most important factor in screening, said Ms. Kennedy.

Women whose provider did not consider screening important were 14 times more likely to be unscreened; those whose providers considered screening optional were 2.9 times more likely to be unscreened. On the other hand, women whose providers encouraged screening were 3.7 times more likely to have undergone screening.

“My personal opinion is the importance of HIV screening is not stressed in many patient/provider encounters,” said Dr. Wiesenfeld, who is also with the university. “Some providers don't think HIV is relevant to their population because they have an affluent, white population. It mirrors chlamydia screening. They don't think their patients are at risk.”

A comparison of medical records with subjects' responses revealed some recall bias: Two percent of those who reported having been tested had actually declined testing. Of those who reporting no screening, 11% had actually been screened (35% said they had not been offered screening, and 65% said they had declined). In addition, 17% of those who were unsure had been screened.

“Universal offering of HIV screening as an opt-out, in conjunction with encouragement from providers, may greatly increase prenatal HIV screening rates,” she said.

“Universal HIV screening is not at the rates we would like across the country,” concluded Dr. Wiesenfeld.

“The take-home message is that it's low—but what's more important is who is not being screened. Women who are white, and affluent, and in a private practice center … are less likely to be screened, as are those who don't feel their provider is encouraging it,” he added.

The investigators said they had no conflicts of interest.

MONTREAL – A simple saliva test to assess a smoker's degree of nicotine dependence could become the first step of a smoking cessation treatment, a study has shown.

Light or heavy nicotine dependence can predict a person's success in quitting or risk of relapse, Caryn Lerman, Ph.D., said at the annual meeting of the Society of Behavioral Medicine. Clinicians could use this information to guide treatment choices for their patients.

“We could decide whether someone needs smoking cessation counseling only, or whether they would do better with a patch, or if they need a medication such as bupropion or varenicline,” said Dr. Lerman of the Transdisciplinary Tobacco Use Research Center at the University of Pennsylvania, Philadelphia.

The saliva test measures the ratio of two nicotine metabolites, 3′-hydroxycotinine and cotinine, to determine a person's rate of nicotine clearance or metabolism, Dr. Lerman said.

A new study by her group has validated that smokers with the slowest nicotine metabolism are about twice as likely to quit as are smokers with faster nicotine metabolism (Pharmacol. Biochem. Behav. 2009;92:6-11). The study enrolled 568 smokers who were given counseling and 8 weeks of a 21-mg nicotine patch. The saliva test measured the metabolite ratio pretreatment to distinguish fast from slow nicotine metabolizers. Eight weeks after the quit date, fast metabolizers were approximately 50% less likely to be abstinent, compared with slow metabolizers (28% vs. 42%).

The findings support the value of the saliva test as a biomarker to predict success with transdermal nicotine for smoking cessation, the authors concluded. “We are developing a treatment algorithm which suggests that slow metabolizers may need nothing more than counseling or nicotine patch, but fast metabolizers are candidates for more nonnicotine medications which may be more costly and have more side effects than the patch,” they wrote (Clin. Pharmacol. Ther. 2008;84:320-5).

MONTREAL – A simple saliva test to assess a smoker's degree of nicotine dependence could become the first step of a smoking cessation treatment, a study has shown.

Light or heavy nicotine dependence can predict a person's success in quitting or risk of relapse, Caryn Lerman, Ph.D., said at the annual meeting of the Society of Behavioral Medicine. Clinicians could use this information to guide treatment choices for their patients.

“We could decide whether someone needs smoking cessation counseling only, or whether they would do better with a patch, or if they need a medication such as bupropion or varenicline,” said Dr. Lerman of the Transdisciplinary Tobacco Use Research Center at the University of Pennsylvania, Philadelphia.

The saliva test measures the ratio of two nicotine metabolites, 3′-hydroxycotinine and cotinine, to determine a person's rate of nicotine clearance or metabolism, Dr. Lerman said.

A new study by her group has validated that smokers with the slowest nicotine metabolism are about twice as likely to quit as are smokers with faster nicotine metabolism (Pharmacol. Biochem. Behav. 2009;92:6-11). The study enrolled 568 smokers who were given counseling and 8 weeks of a 21-mg nicotine patch. The saliva test measured the metabolite ratio pretreatment to distinguish fast from slow nicotine metabolizers. Eight weeks after the quit date, fast metabolizers were approximately 50% less likely to be abstinent, compared with slow metabolizers (28% vs. 42%).

The findings support the value of the saliva test as a biomarker to predict success with transdermal nicotine for smoking cessation, the authors concluded. “We are developing a treatment algorithm which suggests that slow metabolizers may need nothing more than counseling or nicotine patch, but fast metabolizers are candidates for more nonnicotine medications which may be more costly and have more side effects than the patch,” they wrote (Clin. Pharmacol. Ther. 2008;84:320-5).

MONTREAL – A simple saliva test to assess a smoker's degree of nicotine dependence could become the first step of a smoking cessation treatment, a study has shown.

Light or heavy nicotine dependence can predict a person's success in quitting or risk of relapse, Caryn Lerman, Ph.D., said at the annual meeting of the Society of Behavioral Medicine. Clinicians could use this information to guide treatment choices for their patients.

“We could decide whether someone needs smoking cessation counseling only, or whether they would do better with a patch, or if they need a medication such as bupropion or varenicline,” said Dr. Lerman of the Transdisciplinary Tobacco Use Research Center at the University of Pennsylvania, Philadelphia.

The saliva test measures the ratio of two nicotine metabolites, 3′-hydroxycotinine and cotinine, to determine a person's rate of nicotine clearance or metabolism, Dr. Lerman said.

A new study by her group has validated that smokers with the slowest nicotine metabolism are about twice as likely to quit as are smokers with faster nicotine metabolism (Pharmacol. Biochem. Behav. 2009;92:6-11). The study enrolled 568 smokers who were given counseling and 8 weeks of a 21-mg nicotine patch. The saliva test measured the metabolite ratio pretreatment to distinguish fast from slow nicotine metabolizers. Eight weeks after the quit date, fast metabolizers were approximately 50% less likely to be abstinent, compared with slow metabolizers (28% vs. 42%).

The findings support the value of the saliva test as a biomarker to predict success with transdermal nicotine for smoking cessation, the authors concluded. “We are developing a treatment algorithm which suggests that slow metabolizers may need nothing more than counseling or nicotine patch, but fast metabolizers are candidates for more nonnicotine medications which may be more costly and have more side effects than the patch,” they wrote (Clin. Pharmacol. Ther. 2008;84:320-5).

MONTREAL — A single application of a vaginal microbicide gel resulted in persistently protective levels 24 hours later, with no significant side effects, reported Dr. Katherine Bunge of Magee-Womens Hospital in Pittsburgh.

This preliminary safety and persistence information "justifies daily dosing," she said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

The phase I, single-center trial of the nonnucleoside reverse transcription inhibitor UC-781 randomized 60 healthy women at a ratio of 2:1 to either treatment or placebo, explained Dr. Bunge, who had no disclosures to declare.

The women (mean age 26 years) also were randomized to product exposure durations of either 2, 4, or 8 hours. They received a physician-administered dose of vaginal gel and were then required to stay in the research facility for their assigned time period, after which specimens were collected by cervicovaginal lavage (CVL) and vaginal swabs. The subjects then returned 1 day, 1 week, and 1 month later for follow-up.

Urogenital irritation was assessed by pelvic exam and symptoms, microscopic genital changes were assessed by colposcopy, systemic safety was assessed by history and laboratory parameters, vaginal flora was quantified, and cervical cytokines were measured.

"These are fairly typical safety measures in any phase I trial of a microbicide, but what we attempted to do that hadn't really been looked at before was to figure out a way to determine the persistence of this vaginally applied drug that we didn't really expect to be absorbed," she said.

To that end, plasma drug levels were measured both immediately after the patients' timed exposure and then again a day later; drug levels were measured in CVL and vaginal swab specimens, which also were collected at those two time points, Dr. Bunge explained.

At 24 hours post exposure, two patients had detectable levels of UC-781 in their plasma, but in both cases the levels were considered below the limits of quantification, she said.

In contrast, "the most important and interesting data" showed persistence of the drug in the vagina, she said. Eight hours after treatment, 100% of the women had detectable drug levels in CVL specimens and 90% had detectable levels in vaginal swab specimens. At 24 hours post exposure, 93% had detectable levels after a second CVL, and 42% showed detectable levels after a second vaginal swab.

Dr. Bunge pointed out that even after 24 hours, the median concentration of UC-781 in CVL specimens was 4,965 pmol/mL. "The inhibitory concentration of UC-781 is 2 pmol/mL, so in fact at 24 hours after washout, the median concentration of detectable drug in CVL samples was a thousand times the inhibitory concentration."

Among the 197 adverse events (121 in the treatment group and 76 in the placebo group), 85% were classified as mild. There were four severe events but all were deemed not related or probably not related to treatment, said Dr. Bunge.

"There was no difference between groups in terms of concentration of microorganisms at every time point, or proinflammatory cytokines—and most importantly in the treatment group, there was no shift in these concentrations," she said. A total of 18 patients had new colposcopic findings on follow-up, but all were considered superficial.

MONTREAL — A single application of a vaginal microbicide gel resulted in persistently protective levels 24 hours later, with no significant side effects, reported Dr. Katherine Bunge of Magee-Womens Hospital in Pittsburgh.

This preliminary safety and persistence information "justifies daily dosing," she said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

The phase I, single-center trial of the nonnucleoside reverse transcription inhibitor UC-781 randomized 60 healthy women at a ratio of 2:1 to either treatment or placebo, explained Dr. Bunge, who had no disclosures to declare.

The women (mean age 26 years) also were randomized to product exposure durations of either 2, 4, or 8 hours. They received a physician-administered dose of vaginal gel and were then required to stay in the research facility for their assigned time period, after which specimens were collected by cervicovaginal lavage (CVL) and vaginal swabs. The subjects then returned 1 day, 1 week, and 1 month later for follow-up.

Urogenital irritation was assessed by pelvic exam and symptoms, microscopic genital changes were assessed by colposcopy, systemic safety was assessed by history and laboratory parameters, vaginal flora was quantified, and cervical cytokines were measured.

"These are fairly typical safety measures in any phase I trial of a microbicide, but what we attempted to do that hadn't really been looked at before was to figure out a way to determine the persistence of this vaginally applied drug that we didn't really expect to be absorbed," she said.

To that end, plasma drug levels were measured both immediately after the patients' timed exposure and then again a day later; drug levels were measured in CVL and vaginal swab specimens, which also were collected at those two time points, Dr. Bunge explained.

At 24 hours post exposure, two patients had detectable levels of UC-781 in their plasma, but in both cases the levels were considered below the limits of quantification, she said.

In contrast, "the most important and interesting data" showed persistence of the drug in the vagina, she said. Eight hours after treatment, 100% of the women had detectable drug levels in CVL specimens and 90% had detectable levels in vaginal swab specimens. At 24 hours post exposure, 93% had detectable levels after a second CVL, and 42% showed detectable levels after a second vaginal swab.

Dr. Bunge pointed out that even after 24 hours, the median concentration of UC-781 in CVL specimens was 4,965 pmol/mL. "The inhibitory concentration of UC-781 is 2 pmol/mL, so in fact at 24 hours after washout, the median concentration of detectable drug in CVL samples was a thousand times the inhibitory concentration."

Among the 197 adverse events (121 in the treatment group and 76 in the placebo group), 85% were classified as mild. There were four severe events but all were deemed not related or probably not related to treatment, said Dr. Bunge.

"There was no difference between groups in terms of concentration of microorganisms at every time point, or proinflammatory cytokines—and most importantly in the treatment group, there was no shift in these concentrations," she said. A total of 18 patients had new colposcopic findings on follow-up, but all were considered superficial.

MONTREAL — A single application of a vaginal microbicide gel resulted in persistently protective levels 24 hours later, with no significant side effects, reported Dr. Katherine Bunge of Magee-Womens Hospital in Pittsburgh.

This preliminary safety and persistence information "justifies daily dosing," she said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

The phase I, single-center trial of the nonnucleoside reverse transcription inhibitor UC-781 randomized 60 healthy women at a ratio of 2:1 to either treatment or placebo, explained Dr. Bunge, who had no disclosures to declare.

The women (mean age 26 years) also were randomized to product exposure durations of either 2, 4, or 8 hours. They received a physician-administered dose of vaginal gel and were then required to stay in the research facility for their assigned time period, after which specimens were collected by cervicovaginal lavage (CVL) and vaginal swabs. The subjects then returned 1 day, 1 week, and 1 month later for follow-up.

Urogenital irritation was assessed by pelvic exam and symptoms, microscopic genital changes were assessed by colposcopy, systemic safety was assessed by history and laboratory parameters, vaginal flora was quantified, and cervical cytokines were measured.

"These are fairly typical safety measures in any phase I trial of a microbicide, but what we attempted to do that hadn't really been looked at before was to figure out a way to determine the persistence of this vaginally applied drug that we didn't really expect to be absorbed," she said.

To that end, plasma drug levels were measured both immediately after the patients' timed exposure and then again a day later; drug levels were measured in CVL and vaginal swab specimens, which also were collected at those two time points, Dr. Bunge explained.

At 24 hours post exposure, two patients had detectable levels of UC-781 in their plasma, but in both cases the levels were considered below the limits of quantification, she said.

In contrast, "the most important and interesting data" showed persistence of the drug in the vagina, she said. Eight hours after treatment, 100% of the women had detectable drug levels in CVL specimens and 90% had detectable levels in vaginal swab specimens. At 24 hours post exposure, 93% had detectable levels after a second CVL, and 42% showed detectable levels after a second vaginal swab.

Dr. Bunge pointed out that even after 24 hours, the median concentration of UC-781 in CVL specimens was 4,965 pmol/mL. "The inhibitory concentration of UC-781 is 2 pmol/mL, so in fact at 24 hours after washout, the median concentration of detectable drug in CVL samples was a thousand times the inhibitory concentration."

Among the 197 adverse events (121 in the treatment group and 76 in the placebo group), 85% were classified as mild. There were four severe events but all were deemed not related or probably not related to treatment, said Dr. Bunge.

"There was no difference between groups in terms of concentration of microorganisms at every time point, or proinflammatory cytokines—and most importantly in the treatment group, there was no shift in these concentrations," she said. A total of 18 patients had new colposcopic findings on follow-up, but all were considered superficial.

MONTREAL — Increased vitamin D intake is not protective against melanoma, according to the results of the largest prospective cohort study presented by Dr. Maryam M. Asgari of Kaiser Permanente in Oakland, Calif.

Her study, presented at the annual meeting of the Society for Investigative Dermatology, suggests a trend toward a greater risk of melanoma with high dietary intake of vitamin D.

“When we looked at diet alone there was a slightly increased risk, but when we combined diet and supplement use, the risk washed out,” she said in an interview.

The cohort comprised 68,611 participants in the Vitamins and Cohort Lifestyle study. The average age was 62 years; 52% were female.

The researchers studied dietary intake of vitamin D and other nutrients in the preceding year, and supplement use over the past 10 years.

There was no evidence of an association between supplement use and an increased or decreased risk of melanoma, reported Dr. Asgari.

However, there was a nonsignificant trend toward a protective effect at the higher supplement doses.

When supplement use was examined in combination with dietary intake, there was no association with melanoma risk. However, high dietary intake alone was significantly associated with a slightly increased risk of melanoma.

MONTREAL — Increased vitamin D intake is not protective against melanoma, according to the results of the largest prospective cohort study presented by Dr. Maryam M. Asgari of Kaiser Permanente in Oakland, Calif.

Her study, presented at the annual meeting of the Society for Investigative Dermatology, suggests a trend toward a greater risk of melanoma with high dietary intake of vitamin D.

“When we looked at diet alone there was a slightly increased risk, but when we combined diet and supplement use, the risk washed out,” she said in an interview.

The cohort comprised 68,611 participants in the Vitamins and Cohort Lifestyle study. The average age was 62 years; 52% were female.

The researchers studied dietary intake of vitamin D and other nutrients in the preceding year, and supplement use over the past 10 years.

There was no evidence of an association between supplement use and an increased or decreased risk of melanoma, reported Dr. Asgari.

However, there was a nonsignificant trend toward a protective effect at the higher supplement doses.

When supplement use was examined in combination with dietary intake, there was no association with melanoma risk. However, high dietary intake alone was significantly associated with a slightly increased risk of melanoma.

MONTREAL — Increased vitamin D intake is not protective against melanoma, according to the results of the largest prospective cohort study presented by Dr. Maryam M. Asgari of Kaiser Permanente in Oakland, Calif.

Her study, presented at the annual meeting of the Society for Investigative Dermatology, suggests a trend toward a greater risk of melanoma with high dietary intake of vitamin D.

“When we looked at diet alone there was a slightly increased risk, but when we combined diet and supplement use, the risk washed out,” she said in an interview.

The cohort comprised 68,611 participants in the Vitamins and Cohort Lifestyle study. The average age was 62 years; 52% were female.

The researchers studied dietary intake of vitamin D and other nutrients in the preceding year, and supplement use over the past 10 years.

There was no evidence of an association between supplement use and an increased or decreased risk of melanoma, reported Dr. Asgari.

However, there was a nonsignificant trend toward a protective effect at the higher supplement doses.

When supplement use was examined in combination with dietary intake, there was no association with melanoma risk. However, high dietary intake alone was significantly associated with a slightly increased risk of melanoma.

AMSTERDAM — A new genetic screen of zygotes performed a few hours after in vitro fertilization has advantages over conventional preimplantation genetic screening, particularly in patients with a very poor prognosis, based on results of the first clinical application of the procedure.

Although preimplantation genetic screening (PGS) allows examination of only about half of the chromosomes in a 3-day embryo, the new technique, known as comparative genomic hybridization (CGH), can evaluate all chromosomes in newly fertilized oocytes (zygotes), Elpida Fragouli, Ph.D., reported at the annual meeting of the European Society of Human Reproduction and Embryology.

Her study of CGH in 82 women with a very poor prognosis shows an ongoing pregnancy rate of 20%, including three deliveries.

“This is exceptional considering the extremely poor prognosis of the women involved,” said Dr. Fragouli of the University of Oxford (England). “This represents a doubling of the usual pregnancy rate for people who fall into this category, which is otherwise, at best, under 10%, and at worst, 0.”

The women were an average of 41 years old, with histories of implantation failures and multiple unexplained spontaneous abortions, she said.

Using CGH, Dr. Fragouli and her associates found chromosomal abnormalities in 64% of 473 screened zygotes, including abnormalities in chromosomes that are not examined in conventional PGS. “With standard screening, 39% of these abnormalities would not have been detected, and 16% of abnormalities would have been incorrectly diagnosed as normal.”

Only healthy zygotes were allowed to mature, resulting in 73 embryos, which were transferred to 35 patients.

The CGH technique is considered less invasive than regular PGS, because it does not require a day 3 biopsy of embryonic cells, which some experts consider damaging to the embryo. Instead, CGH involves the removal and examination of polar bodies, which are by-products of fertilization and not necessary for embryo development.

Dr. Fragouli did not declare any conflicts of interest.

AMSTERDAM — A new genetic screen of zygotes performed a few hours after in vitro fertilization has advantages over conventional preimplantation genetic screening, particularly in patients with a very poor prognosis, based on results of the first clinical application of the procedure.

Although preimplantation genetic screening (PGS) allows examination of only about half of the chromosomes in a 3-day embryo, the new technique, known as comparative genomic hybridization (CGH), can evaluate all chromosomes in newly fertilized oocytes (zygotes), Elpida Fragouli, Ph.D., reported at the annual meeting of the European Society of Human Reproduction and Embryology.

Her study of CGH in 82 women with a very poor prognosis shows an ongoing pregnancy rate of 20%, including three deliveries.

“This is exceptional considering the extremely poor prognosis of the women involved,” said Dr. Fragouli of the University of Oxford (England). “This represents a doubling of the usual pregnancy rate for people who fall into this category, which is otherwise, at best, under 10%, and at worst, 0.”

The women were an average of 41 years old, with histories of implantation failures and multiple unexplained spontaneous abortions, she said.

Using CGH, Dr. Fragouli and her associates found chromosomal abnormalities in 64% of 473 screened zygotes, including abnormalities in chromosomes that are not examined in conventional PGS. “With standard screening, 39% of these abnormalities would not have been detected, and 16% of abnormalities would have been incorrectly diagnosed as normal.”

Only healthy zygotes were allowed to mature, resulting in 73 embryos, which were transferred to 35 patients.

The CGH technique is considered less invasive than regular PGS, because it does not require a day 3 biopsy of embryonic cells, which some experts consider damaging to the embryo. Instead, CGH involves the removal and examination of polar bodies, which are by-products of fertilization and not necessary for embryo development.

Dr. Fragouli did not declare any conflicts of interest.

AMSTERDAM — A new genetic screen of zygotes performed a few hours after in vitro fertilization has advantages over conventional preimplantation genetic screening, particularly in patients with a very poor prognosis, based on results of the first clinical application of the procedure.

Although preimplantation genetic screening (PGS) allows examination of only about half of the chromosomes in a 3-day embryo, the new technique, known as comparative genomic hybridization (CGH), can evaluate all chromosomes in newly fertilized oocytes (zygotes), Elpida Fragouli, Ph.D., reported at the annual meeting of the European Society of Human Reproduction and Embryology.

Her study of CGH in 82 women with a very poor prognosis shows an ongoing pregnancy rate of 20%, including three deliveries.

“This is exceptional considering the extremely poor prognosis of the women involved,” said Dr. Fragouli of the University of Oxford (England). “This represents a doubling of the usual pregnancy rate for people who fall into this category, which is otherwise, at best, under 10%, and at worst, 0.”

The women were an average of 41 years old, with histories of implantation failures and multiple unexplained spontaneous abortions, she said.

Using CGH, Dr. Fragouli and her associates found chromosomal abnormalities in 64% of 473 screened zygotes, including abnormalities in chromosomes that are not examined in conventional PGS. “With standard screening, 39% of these abnormalities would not have been detected, and 16% of abnormalities would have been incorrectly diagnosed as normal.”

Only healthy zygotes were allowed to mature, resulting in 73 embryos, which were transferred to 35 patients.

The CGH technique is considered less invasive than regular PGS, because it does not require a day 3 biopsy of embryonic cells, which some experts consider damaging to the embryo. Instead, CGH involves the removal and examination of polar bodies, which are by-products of fertilization and not necessary for embryo development.

Dr. Fragouli did not declare any conflicts of interest.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those without, or in remission from, depression, according to a study of 161 patients.

“This suggests that any change in depressive symptomatology over time can affect medication adherence and may be clinically important,” Sara Gallagher said at the annual meeting of the Society of Behavioral Medicine.

Her study was embedded in a randomized, controlled trial that tested the effect of a motivational interviewing on medication adherence. It involved hypertensive African Americans (mean age 54; 87% women) who were followed in primary care practice.

Depressive symptomatology was assessed at baseline and at 6 and 12 months with the Center for Epidemiologic Studies-Depression Scale. Forty-four percent were classified as nondepressed, and 19% were considered depressed. Thirty-seven percent were classified as remittent, having progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher of New York (N.Y.) University.

Medication adherence was assessed at baseline and at 12 months with the self-reported Morisky scale. At baseline, 64% reported nonadherence. This dropped to 48% by study's end.

A multivariate analysis showed that depressive symptoms were associated with medication nonadherence, Ms. Gallagher said. Among the depressed patients, 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of symptoms can result in improved adherence suggests a benefit to addressing patient depression in this context, Ms. Gallagher said.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those without, or in remission from, depression, according to a study of 161 patients.

“This suggests that any change in depressive symptomatology over time can affect medication adherence and may be clinically important,” Sara Gallagher said at the annual meeting of the Society of Behavioral Medicine.

Her study was embedded in a randomized, controlled trial that tested the effect of a motivational interviewing on medication adherence. It involved hypertensive African Americans (mean age 54; 87% women) who were followed in primary care practice.

Depressive symptomatology was assessed at baseline and at 6 and 12 months with the Center for Epidemiologic Studies-Depression Scale. Forty-four percent were classified as nondepressed, and 19% were considered depressed. Thirty-seven percent were classified as remittent, having progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher of New York (N.Y.) University.

Medication adherence was assessed at baseline and at 12 months with the self-reported Morisky scale. At baseline, 64% reported nonadherence. This dropped to 48% by study's end.

A multivariate analysis showed that depressive symptoms were associated with medication nonadherence, Ms. Gallagher said. Among the depressed patients, 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of symptoms can result in improved adherence suggests a benefit to addressing patient depression in this context, Ms. Gallagher said.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those without, or in remission from, depression, according to a study of 161 patients.

“This suggests that any change in depressive symptomatology over time can affect medication adherence and may be clinically important,” Sara Gallagher said at the annual meeting of the Society of Behavioral Medicine.

Her study was embedded in a randomized, controlled trial that tested the effect of a motivational interviewing on medication adherence. It involved hypertensive African Americans (mean age 54; 87% women) who were followed in primary care practice.

Depressive symptomatology was assessed at baseline and at 6 and 12 months with the Center for Epidemiologic Studies-Depression Scale. Forty-four percent were classified as nondepressed, and 19% were considered depressed. Thirty-seven percent were classified as remittent, having progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher of New York (N.Y.) University.

Medication adherence was assessed at baseline and at 12 months with the self-reported Morisky scale. At baseline, 64% reported nonadherence. This dropped to 48% by study's end.

A multivariate analysis showed that depressive symptoms were associated with medication nonadherence, Ms. Gallagher said. Among the depressed patients, 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of symptoms can result in improved adherence suggests a benefit to addressing patient depression in this context, Ms. Gallagher said.

MONTREAL — Actinic keratoses are dynamic lesions and their expression varies over time, based on an 11-month study of the natural course of the lesions in people with extensive actinic damage.

“At any one time, less than half of the lesions are evident clinically,” said Dr. Craig Elmets, who reported his findings on at the annual meeting of the Society for Investigative Dermatology.

The pattern of regression and recurrence of actinic keratoses (AK) has implications for the treatment of the lesions, said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham.

“If one is going to treat individual lesions, then they need to be treated aggressively because at any one time only a minority of the [visible] AK are present,” he said. “In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions.”

Dr. Elmets did not disclose any conflictst in regard to this study, but he serves on the advisory boards of several pharmaceutical companies.

The study followed AK lesions for 11 months in 26 individuals with extensive actinic damage. At baseline, the subjects had 10-40 actinic lesions and at least one prior histological diagnosis of an AK or a nonmelanoma skin cancer.

The subjects' AKs were mapped at baseline and at 3, 6, 9, and 11 months. The lesions also were biopsied at baseline and the end of the study. “If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,” Dr. Elmets explained.

At baseline, there were a total of 610 AKs in the study group (mean 23.5 per individual). At the end of the study, this number was not significantly different despite the development of 973 new lesions over the 11-month period.

About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, he said. “A total of 51 of the lesions regressed twice.”

Using a histologic grading scheme that was based on a cervical dysplasia model, Dr. Elmets noted little progression in the severity of lesions in terms of proliferation, atypia, or both features.

AKs have been thought to be precursors to squamous cell carcinomas in some cases. The presence of AKs is strongly predictive of individuals who are at increased risk for basal cell and squamous cell carcinomas.

MONTREAL — Actinic keratoses are dynamic lesions and their expression varies over time, based on an 11-month study of the natural course of the lesions in people with extensive actinic damage.

“At any one time, less than half of the lesions are evident clinically,” said Dr. Craig Elmets, who reported his findings on at the annual meeting of the Society for Investigative Dermatology.

The pattern of regression and recurrence of actinic keratoses (AK) has implications for the treatment of the lesions, said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham.

“If one is going to treat individual lesions, then they need to be treated aggressively because at any one time only a minority of the [visible] AK are present,” he said. “In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions.”

Dr. Elmets did not disclose any conflictst in regard to this study, but he serves on the advisory boards of several pharmaceutical companies.

The study followed AK lesions for 11 months in 26 individuals with extensive actinic damage. At baseline, the subjects had 10-40 actinic lesions and at least one prior histological diagnosis of an AK or a nonmelanoma skin cancer.

The subjects' AKs were mapped at baseline and at 3, 6, 9, and 11 months. The lesions also were biopsied at baseline and the end of the study. “If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,” Dr. Elmets explained.

At baseline, there were a total of 610 AKs in the study group (mean 23.5 per individual). At the end of the study, this number was not significantly different despite the development of 973 new lesions over the 11-month period.

About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, he said. “A total of 51 of the lesions regressed twice.”

Using a histologic grading scheme that was based on a cervical dysplasia model, Dr. Elmets noted little progression in the severity of lesions in terms of proliferation, atypia, or both features.

AKs have been thought to be precursors to squamous cell carcinomas in some cases. The presence of AKs is strongly predictive of individuals who are at increased risk for basal cell and squamous cell carcinomas.

MONTREAL — Actinic keratoses are dynamic lesions and their expression varies over time, based on an 11-month study of the natural course of the lesions in people with extensive actinic damage.

“At any one time, less than half of the lesions are evident clinically,” said Dr. Craig Elmets, who reported his findings on at the annual meeting of the Society for Investigative Dermatology.

The pattern of regression and recurrence of actinic keratoses (AK) has implications for the treatment of the lesions, said Dr. Elmets, professor and chair of the department of dermatology and director of the Skin Disease Research Center at the University of Alabama, Birmingham.

“If one is going to treat individual lesions, then they need to be treated aggressively because at any one time only a minority of the [visible] AK are present,” he said. “In patients with extensive actinic damage, peel treatment may be a very good approach to treating these lesions.”

Dr. Elmets did not disclose any conflictst in regard to this study, but he serves on the advisory boards of several pharmaceutical companies.

The study followed AK lesions for 11 months in 26 individuals with extensive actinic damage. At baseline, the subjects had 10-40 actinic lesions and at least one prior histological diagnosis of an AK or a nonmelanoma skin cancer.

The subjects' AKs were mapped at baseline and at 3, 6, 9, and 11 months. The lesions also were biopsied at baseline and the end of the study. “If a lesion that had been selected for biopsy was no longer present clinically, the site where it had been was still biopsied,” Dr. Elmets explained.

At baseline, there were a total of 610 AKs in the study group (mean 23.5 per individual). At the end of the study, this number was not significantly different despite the development of 973 new lesions over the 11-month period.

About 40% of the lesions present at baseline had regressed by month 11, and nearly 200 of the lesions that were present at baseline regressed and then recurred, he said. “A total of 51 of the lesions regressed twice.”

Using a histologic grading scheme that was based on a cervical dysplasia model, Dr. Elmets noted little progression in the severity of lesions in terms of proliferation, atypia, or both features.

AKs have been thought to be precursors to squamous cell carcinomas in some cases. The presence of AKs is strongly predictive of individuals who are at increased risk for basal cell and squamous cell carcinomas.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those who are not depressed or are in remission from depression, according to a study presented at the annual meeting of the Society of Behavioral Medicine.

Sara Gallagher of New York (N.Y.) University, studied 161 hypertensive African Americans who were followed in primary care practice. The patients had a mean age of 54 years, and 87% of them were women. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale.

A total of 44% of patients were classified as nondepressed, with a CES-D score of less than 16 at all time points, while 19% were considered depressed, with a score of 16 or above at all time points. A total of 37% of patients were classified as remittent, meaning that they progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher.

Medication adherence was assessed at baseline and at 12 months using the self-reported Morisky scale. At baseline, 64% of the study population reported nonadherence to their medication, and this dropped to 48% at the end of the study.

A multivariate analysis revealed that depressive symptoms were tied to drug nonadherence, Ms. Gallagher reported. Among the depressed patients, only 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of depressive symptoms can result in improved adherence suggests a benefit to addressing patient depression, she said.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those who are not depressed or are in remission from depression, according to a study presented at the annual meeting of the Society of Behavioral Medicine.

Sara Gallagher of New York (N.Y.) University, studied 161 hypertensive African Americans who were followed in primary care practice. The patients had a mean age of 54 years, and 87% of them were women. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale.

A total of 44% of patients were classified as nondepressed, with a CES-D score of less than 16 at all time points, while 19% were considered depressed, with a score of 16 or above at all time points. A total of 37% of patients were classified as remittent, meaning that they progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher.

Medication adherence was assessed at baseline and at 12 months using the self-reported Morisky scale. At baseline, 64% of the study population reported nonadherence to their medication, and this dropped to 48% at the end of the study.

A multivariate analysis revealed that depressive symptoms were tied to drug nonadherence, Ms. Gallagher reported. Among the depressed patients, only 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of depressive symptoms can result in improved adherence suggests a benefit to addressing patient depression, she said.

MONTREAL — Hypertensive patients who have depression are less likely to stick to their therapy regimen than are those who are not depressed or are in remission from depression, according to a study presented at the annual meeting of the Society of Behavioral Medicine.

Sara Gallagher of New York (N.Y.) University, studied 161 hypertensive African Americans who were followed in primary care practice. The patients had a mean age of 54 years, and 87% of them were women. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale.

A total of 44% of patients were classified as nondepressed, with a CES-D score of less than 16 at all time points, while 19% were considered depressed, with a score of 16 or above at all time points. A total of 37% of patients were classified as remittent, meaning that they progressed from depressed to nondepressed over the course of the study, said Ms. Gallagher.

Medication adherence was assessed at baseline and at 12 months using the self-reported Morisky scale. At baseline, 64% of the study population reported nonadherence to their medication, and this dropped to 48% at the end of the study.

A multivariate analysis revealed that depressive symptoms were tied to drug nonadherence, Ms. Gallagher reported. Among the depressed patients, only 34% reported adherence at 12 months, compared with 66% in the nondepressed group and 47% in the remittent group.

The finding that a remittence of depressive symptoms can result in improved adherence suggests a benefit to addressing patient depression, she said.