Kate Johnson

MONTREAL — Despite postmarketing concerns about the psychiatric side effects of varenicline for smoking cessation, the medication appears to be safe in patients who are depressed or at risk for depression, Jennifer B. McClure, Ph.D., reported at the annual meeting of the Society of Behavioral Medicine.

In a subanalysis of the Chronicle Offers Management to Patients With Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) trial, 661 smokers with a baseline history of depression, or a risk of depression, were monitored for mood changes and compared with 516 nondepressed smokers during their 12-week course of varenicline (Chantix) combined with behavioral smoking-cessation counseling (J. Gen. Intern. Med. 2009;24:563-9).

“We think that physicians should continue to closely monitor patients who are using varenicline, particularly if they have a psychiatric history,” she said.

Although people with a history of depression were more likely than nondepressed people to report side effects with the medication, “we didn't find an overall difference in their qualitative symptom experience or treatment outcomes,” said Dr. McClure, who is affiliated with Group Health Center for Health Studies, Seattle.

The study, funded by the National Cancer Institute, was a collaborative effort between Group Health; Free & Clear Inc., Seattle; and SRI International, an independent, nonprofit, research and development organization in Menlo Park, Calif. Medication was provided by Pfizer Inc., manufacturer of varenicline.

Varenicline was approved by the Food and Drug Administration about 3 years ago. It works by blocking nicotinic receptors and thus the rewarding effects of nicotine, while stimulating some dopamine release in order to provide relief from craving and withdrawal, Dr. McClure said.

Shortly after its release to market, the FDA raised concerns that varenicline might be associated with increased neuropsychiatric symptoms, including depressed mood, agitation, suicidal ideation, and behavior—particularly in people with a psychiatric history, she said.

“Unfortunately, due to the nature of the reports to the FDA, we are not able to determine if varenicline itself was the cause of the symptoms reported—it's possible they were due to nicotine withdrawal, substance use, the psychiatric conditions themselves, or some other factors. Unfortunately, subjects with a psychiatric history were excluded from the original efficacy trials.”

Research shows that between one- and two-thirds of smokers have a history of depression, and that smokers with a history of depression report more symptoms of nicotine withdrawal, have more negative affect after they quit, and have higher relapse rates, compared with nondepressed smokers, she added.

“But because varenicline does stimulate some release of dopamine, it's possible that it might ameliorate some of this negative effect and other side effects, and so prevent relapse.”

At baseline, the subjects in the study were screened briefly for symptoms of depression. “We didn't do an in-depth clinical interview. We just looked for the hallmark symptoms by asking: 'Have you ever, for a 2-week period or more, felt down, depressed, or hopeless, or had little interest or pleasure in doing things?'” she said.

Depressed and nondepressed subjects had similar nonsmoking rates at 21 days (49% vs. 47%, respectively) and 3 months (45% vs. 43%, respectively). However, depressed patients were more likely to report depression, anxiety, tension, agitation, difficulty concentrating and sleeping, and confusion. Depressed patients also were more likely to report other known side effects of the medication. However, despite this, negative affect actually declined in both groups, Dr. McClure said. One case of suicidal ideation was reported in a subject with undisclosed, untreated bipolar disorder.

Additional research is necessary in order to more fully tease out the safety and effectiveness of varenicline among psychologically vulnerable populations, she concluded.

Dr. McClure said she had no conflicts to disclose in connection with this study.

MONTREAL — Despite postmarketing concerns about the psychiatric side effects of varenicline for smoking cessation, the medication appears to be safe in patients who are depressed or at risk for depression, Jennifer B. McClure, Ph.D., reported at the annual meeting of the Society of Behavioral Medicine.

In a subanalysis of the Chronicle Offers Management to Patients With Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) trial, 661 smokers with a baseline history of depression, or a risk of depression, were monitored for mood changes and compared with 516 nondepressed smokers during their 12-week course of varenicline (Chantix) combined with behavioral smoking-cessation counseling (J. Gen. Intern. Med. 2009;24:563-9).

“We think that physicians should continue to closely monitor patients who are using varenicline, particularly if they have a psychiatric history,” she said.

Although people with a history of depression were more likely than nondepressed people to report side effects with the medication, “we didn't find an overall difference in their qualitative symptom experience or treatment outcomes,” said Dr. McClure, who is affiliated with Group Health Center for Health Studies, Seattle.

The study, funded by the National Cancer Institute, was a collaborative effort between Group Health; Free & Clear Inc., Seattle; and SRI International, an independent, nonprofit, research and development organization in Menlo Park, Calif. Medication was provided by Pfizer Inc., manufacturer of varenicline.

Varenicline was approved by the Food and Drug Administration about 3 years ago. It works by blocking nicotinic receptors and thus the rewarding effects of nicotine, while stimulating some dopamine release in order to provide relief from craving and withdrawal, Dr. McClure said.

Shortly after its release to market, the FDA raised concerns that varenicline might be associated with increased neuropsychiatric symptoms, including depressed mood, agitation, suicidal ideation, and behavior—particularly in people with a psychiatric history, she said.

“Unfortunately, due to the nature of the reports to the FDA, we are not able to determine if varenicline itself was the cause of the symptoms reported—it's possible they were due to nicotine withdrawal, substance use, the psychiatric conditions themselves, or some other factors. Unfortunately, subjects with a psychiatric history were excluded from the original efficacy trials.”

Research shows that between one- and two-thirds of smokers have a history of depression, and that smokers with a history of depression report more symptoms of nicotine withdrawal, have more negative affect after they quit, and have higher relapse rates, compared with nondepressed smokers, she added.

“But because varenicline does stimulate some release of dopamine, it's possible that it might ameliorate some of this negative effect and other side effects, and so prevent relapse.”

At baseline, the subjects in the study were screened briefly for symptoms of depression. “We didn't do an in-depth clinical interview. We just looked for the hallmark symptoms by asking: 'Have you ever, for a 2-week period or more, felt down, depressed, or hopeless, or had little interest or pleasure in doing things?'” she said.

Depressed and nondepressed subjects had similar nonsmoking rates at 21 days (49% vs. 47%, respectively) and 3 months (45% vs. 43%, respectively). However, depressed patients were more likely to report depression, anxiety, tension, agitation, difficulty concentrating and sleeping, and confusion. Depressed patients also were more likely to report other known side effects of the medication. However, despite this, negative affect actually declined in both groups, Dr. McClure said. One case of suicidal ideation was reported in a subject with undisclosed, untreated bipolar disorder.

Additional research is necessary in order to more fully tease out the safety and effectiveness of varenicline among psychologically vulnerable populations, she concluded.

Dr. McClure said she had no conflicts to disclose in connection with this study.

MONTREAL — Despite postmarketing concerns about the psychiatric side effects of varenicline for smoking cessation, the medication appears to be safe in patients who are depressed or at risk for depression, Jennifer B. McClure, Ph.D., reported at the annual meeting of the Society of Behavioral Medicine.

In a subanalysis of the Chronicle Offers Management to Patients With Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) trial, 661 smokers with a baseline history of depression, or a risk of depression, were monitored for mood changes and compared with 516 nondepressed smokers during their 12-week course of varenicline (Chantix) combined with behavioral smoking-cessation counseling (J. Gen. Intern. Med. 2009;24:563-9).

“We think that physicians should continue to closely monitor patients who are using varenicline, particularly if they have a psychiatric history,” she said.

Although people with a history of depression were more likely than nondepressed people to report side effects with the medication, “we didn't find an overall difference in their qualitative symptom experience or treatment outcomes,” said Dr. McClure, who is affiliated with Group Health Center for Health Studies, Seattle.

The study, funded by the National Cancer Institute, was a collaborative effort between Group Health; Free & Clear Inc., Seattle; and SRI International, an independent, nonprofit, research and development organization in Menlo Park, Calif. Medication was provided by Pfizer Inc., manufacturer of varenicline.

Varenicline was approved by the Food and Drug Administration about 3 years ago. It works by blocking nicotinic receptors and thus the rewarding effects of nicotine, while stimulating some dopamine release in order to provide relief from craving and withdrawal, Dr. McClure said.

Shortly after its release to market, the FDA raised concerns that varenicline might be associated with increased neuropsychiatric symptoms, including depressed mood, agitation, suicidal ideation, and behavior—particularly in people with a psychiatric history, she said.

“Unfortunately, due to the nature of the reports to the FDA, we are not able to determine if varenicline itself was the cause of the symptoms reported—it's possible they were due to nicotine withdrawal, substance use, the psychiatric conditions themselves, or some other factors. Unfortunately, subjects with a psychiatric history were excluded from the original efficacy trials.”

Research shows that between one- and two-thirds of smokers have a history of depression, and that smokers with a history of depression report more symptoms of nicotine withdrawal, have more negative affect after they quit, and have higher relapse rates, compared with nondepressed smokers, she added.

“But because varenicline does stimulate some release of dopamine, it's possible that it might ameliorate some of this negative effect and other side effects, and so prevent relapse.”

At baseline, the subjects in the study were screened briefly for symptoms of depression. “We didn't do an in-depth clinical interview. We just looked for the hallmark symptoms by asking: 'Have you ever, for a 2-week period or more, felt down, depressed, or hopeless, or had little interest or pleasure in doing things?'” she said.

Depressed and nondepressed subjects had similar nonsmoking rates at 21 days (49% vs. 47%, respectively) and 3 months (45% vs. 43%, respectively). However, depressed patients were more likely to report depression, anxiety, tension, agitation, difficulty concentrating and sleeping, and confusion. Depressed patients also were more likely to report other known side effects of the medication. However, despite this, negative affect actually declined in both groups, Dr. McClure said. One case of suicidal ideation was reported in a subject with undisclosed, untreated bipolar disorder.

Additional research is necessary in order to more fully tease out the safety and effectiveness of varenicline among psychologically vulnerable populations, she concluded.

Dr. McClure said she had no conflicts to disclose in connection with this study.

MONTREAL — A twice-daily dose of celecoxib given over a period of 9 months was associated with a 60% reduction in the incidence of nonmelanoma skin cancer, according to the results of a new study.

“Inhibition of COX-2 is an effective means of limiting the development of cutaneous squamous and basal cell carcinomas in humans,” said Dr. Craig Elmets at the annual meeting of the Society for Investigative Dermatology.

The findings suggest that pharmaceutical agents such as celecoxib may offer greater protection against skin cancer than do sunscreens, which are only “modestly effective,” 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. “There's only about a 35% reduction in squamous cell carcinomas when sunscreens are used on a regular basis over a 5-year period of time, and there's no reduction in basal cell carcinomas.”

The multicenter, randomized, placebo-controlled study was funded by the National Cancer Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, with additional funding from Pfizer through a contractual agreement with the National Institutes of Health, he said. Dr. Elmets did not disclose any personal conflicts of interest.

The study enrolled 238 patients with nonmelanoma skin cancers from eight U.S. centers. The mean age of the patients was 65 years, most were male, and virtually all were white.

“The study was terminated somewhat early because of concerns of cardiovascular effects due to another COX-2 inhibitor,” he noted.

Subjects in the study had Fitzpatrick skin types I-III, extensive actinic damage with 10-40 actinic keratoses (AKs), and a prior histologic diagnosis of either AK or nonmelanoma skin cancer. Subjects were excluded if they required treatment with NSAIDs, although cardioprotective doses of aspirin were allowed.

At entry, patients had a mean number of 22 AKs, and between 2.1 and 2.5 nonmelanoma skin cancers, he said.

Patients were randomized to either placebo or celecoxib 200 mg twice daily, which is the approved dosage for arthritis, Dr. Elmets said. “We were concerned about cardiovascular abnormalities and GI abnormalities, and if anything there was a bias towards patients in the celecoxib group having a prior history of that.”

A comparison of the number of AKs at baseline and completion showed a lack of effect of celecoxib, compared with placebo, he noted. However, the development of new cutaneous basal and squamous cell carcinomas was much reduced. “We were delighted to find that celecoxib was quite effective, with a 58% reduction compared to placebo-treated controls,” he said.

If the two types of lesions are considered separately, celecoxib treatment led to a 58% reduction in squamous cell carcinoma (SCC), and a 62% reduction in basal cell carcinoma (BCC).

“The difference between the [placebo and treated] groups started to become apparent quite rapidly, at 3 months, and persisted throughout the study. We were concerned that there might be one or two outliers that were skewing the results, so rather than looking at the total number of skin cancers, we also looked at the number of individuals who developed BCC or SCC or both. Again we found that patients with celecoxib had fewer BCCs and SCCs than the placebo group.”

There were no differences in adverse events including cardiovascular adverse events between the two groups, Dr. Elmets reported. During the question period, he acknowledged that there were higher blood pressures reported in the treatment group.

The data are “very compelling,” commented Dr. Maryam Asgari of Kaiser Permanente in Oakland, Calif., in an interview. But she suggested perhaps the study was too short to have such dramatic conclusions. “I know that typically for most cancers you would need a study to last 2-5 years before you would expect to measure an effect,” she said. Similarly, adverse events from COX-2 inhibitors would likely need longer to develop.

Dr. Asgari said her research in the same field has produced the opposite results. Her study found no protective effect for all NSAIDs—both selective and nonselective COX inhibitors—on the incidence of squamous cell carcinoma. A previous paper published by her group also found no protective effect of these drugs on melanomas (J. Natl. Cancer Inst. 2008;100:967-71).

Celecoxib's lack of effect on AKs is a puzzling result, she added. “You would think that if COX-2 inhibitors are working to prevent new cancers from arising that they would also have a pretty dramatic effect on actinic keratoses because they both share the same pathway.”

Finally, patients in the COX-2 study were allowed to take cardioprotective doses of aspirin—an important factor that the analysis did not adjust for, she pointed out. “Even low-dose aspirin inhibits COX, and it could just be that the people in the treatment arm were much more likely to be on aspirin as well.”

MONTREAL — A twice-daily dose of celecoxib given over a period of 9 months was associated with a 60% reduction in the incidence of nonmelanoma skin cancer, according to the results of a new study.

“Inhibition of COX-2 is an effective means of limiting the development of cutaneous squamous and basal cell carcinomas in humans,” said Dr. Craig Elmets at the annual meeting of the Society for Investigative Dermatology.

The findings suggest that pharmaceutical agents such as celecoxib may offer greater protection against skin cancer than do sunscreens, which are only “modestly effective,” 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. “There's only about a 35% reduction in squamous cell carcinomas when sunscreens are used on a regular basis over a 5-year period of time, and there's no reduction in basal cell carcinomas.”

The multicenter, randomized, placebo-controlled study was funded by the National Cancer Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, with additional funding from Pfizer through a contractual agreement with the National Institutes of Health, he said. Dr. Elmets did not disclose any personal conflicts of interest.

The study enrolled 238 patients with nonmelanoma skin cancers from eight U.S. centers. The mean age of the patients was 65 years, most were male, and virtually all were white.

“The study was terminated somewhat early because of concerns of cardiovascular effects due to another COX-2 inhibitor,” he noted.

Subjects in the study had Fitzpatrick skin types I-III, extensive actinic damage with 10-40 actinic keratoses (AKs), and a prior histologic diagnosis of either AK or nonmelanoma skin cancer. Subjects were excluded if they required treatment with NSAIDs, although cardioprotective doses of aspirin were allowed.

At entry, patients had a mean number of 22 AKs, and between 2.1 and 2.5 nonmelanoma skin cancers, he said.

Patients were randomized to either placebo or celecoxib 200 mg twice daily, which is the approved dosage for arthritis, Dr. Elmets said. “We were concerned about cardiovascular abnormalities and GI abnormalities, and if anything there was a bias towards patients in the celecoxib group having a prior history of that.”

A comparison of the number of AKs at baseline and completion showed a lack of effect of celecoxib, compared with placebo, he noted. However, the development of new cutaneous basal and squamous cell carcinomas was much reduced. “We were delighted to find that celecoxib was quite effective, with a 58% reduction compared to placebo-treated controls,” he said.

If the two types of lesions are considered separately, celecoxib treatment led to a 58% reduction in squamous cell carcinoma (SCC), and a 62% reduction in basal cell carcinoma (BCC).

“The difference between the [placebo and treated] groups started to become apparent quite rapidly, at 3 months, and persisted throughout the study. We were concerned that there might be one or two outliers that were skewing the results, so rather than looking at the total number of skin cancers, we also looked at the number of individuals who developed BCC or SCC or both. Again we found that patients with celecoxib had fewer BCCs and SCCs than the placebo group.”

There were no differences in adverse events including cardiovascular adverse events between the two groups, Dr. Elmets reported. During the question period, he acknowledged that there were higher blood pressures reported in the treatment group.

The data are “very compelling,” commented Dr. Maryam Asgari of Kaiser Permanente in Oakland, Calif., in an interview. But she suggested perhaps the study was too short to have such dramatic conclusions. “I know that typically for most cancers you would need a study to last 2-5 years before you would expect to measure an effect,” she said. Similarly, adverse events from COX-2 inhibitors would likely need longer to develop.

Dr. Asgari said her research in the same field has produced the opposite results. Her study found no protective effect for all NSAIDs—both selective and nonselective COX inhibitors—on the incidence of squamous cell carcinoma. A previous paper published by her group also found no protective effect of these drugs on melanomas (J. Natl. Cancer Inst. 2008;100:967-71).

Celecoxib's lack of effect on AKs is a puzzling result, she added. “You would think that if COX-2 inhibitors are working to prevent new cancers from arising that they would also have a pretty dramatic effect on actinic keratoses because they both share the same pathway.”

Finally, patients in the COX-2 study were allowed to take cardioprotective doses of aspirin—an important factor that the analysis did not adjust for, she pointed out. “Even low-dose aspirin inhibits COX, and it could just be that the people in the treatment arm were much more likely to be on aspirin as well.”

MONTREAL — A twice-daily dose of celecoxib given over a period of 9 months was associated with a 60% reduction in the incidence of nonmelanoma skin cancer, according to the results of a new study.

“Inhibition of COX-2 is an effective means of limiting the development of cutaneous squamous and basal cell carcinomas in humans,” said Dr. Craig Elmets at the annual meeting of the Society for Investigative Dermatology.

The findings suggest that pharmaceutical agents such as celecoxib may offer greater protection against skin cancer than do sunscreens, which are only “modestly effective,” 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. “There's only about a 35% reduction in squamous cell carcinomas when sunscreens are used on a regular basis over a 5-year period of time, and there's no reduction in basal cell carcinomas.”

The multicenter, randomized, placebo-controlled study was funded by the National Cancer Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, with additional funding from Pfizer through a contractual agreement with the National Institutes of Health, he said. Dr. Elmets did not disclose any personal conflicts of interest.

The study enrolled 238 patients with nonmelanoma skin cancers from eight U.S. centers. The mean age of the patients was 65 years, most were male, and virtually all were white.

“The study was terminated somewhat early because of concerns of cardiovascular effects due to another COX-2 inhibitor,” he noted.

Subjects in the study had Fitzpatrick skin types I-III, extensive actinic damage with 10-40 actinic keratoses (AKs), and a prior histologic diagnosis of either AK or nonmelanoma skin cancer. Subjects were excluded if they required treatment with NSAIDs, although cardioprotective doses of aspirin were allowed.

At entry, patients had a mean number of 22 AKs, and between 2.1 and 2.5 nonmelanoma skin cancers, he said.

Patients were randomized to either placebo or celecoxib 200 mg twice daily, which is the approved dosage for arthritis, Dr. Elmets said. “We were concerned about cardiovascular abnormalities and GI abnormalities, and if anything there was a bias towards patients in the celecoxib group having a prior history of that.”

A comparison of the number of AKs at baseline and completion showed a lack of effect of celecoxib, compared with placebo, he noted. However, the development of new cutaneous basal and squamous cell carcinomas was much reduced. “We were delighted to find that celecoxib was quite effective, with a 58% reduction compared to placebo-treated controls,” he said.

If the two types of lesions are considered separately, celecoxib treatment led to a 58% reduction in squamous cell carcinoma (SCC), and a 62% reduction in basal cell carcinoma (BCC).

“The difference between the [placebo and treated] groups started to become apparent quite rapidly, at 3 months, and persisted throughout the study. We were concerned that there might be one or two outliers that were skewing the results, so rather than looking at the total number of skin cancers, we also looked at the number of individuals who developed BCC or SCC or both. Again we found that patients with celecoxib had fewer BCCs and SCCs than the placebo group.”

There were no differences in adverse events including cardiovascular adverse events between the two groups, Dr. Elmets reported. During the question period, he acknowledged that there were higher blood pressures reported in the treatment group.

The data are “very compelling,” commented Dr. Maryam Asgari of Kaiser Permanente in Oakland, Calif., in an interview. But she suggested perhaps the study was too short to have such dramatic conclusions. “I know that typically for most cancers you would need a study to last 2-5 years before you would expect to measure an effect,” she said. Similarly, adverse events from COX-2 inhibitors would likely need longer to develop.

Dr. Asgari said her research in the same field has produced the opposite results. Her study found no protective effect for all NSAIDs—both selective and nonselective COX inhibitors—on the incidence of squamous cell carcinoma. A previous paper published by her group also found no protective effect of these drugs on melanomas (J. Natl. Cancer Inst. 2008;100:967-71).

Celecoxib's lack of effect on AKs is a puzzling result, she added. “You would think that if COX-2 inhibitors are working to prevent new cancers from arising that they would also have a pretty dramatic effect on actinic keratoses because they both share the same pathway.”

Finally, patients in the COX-2 study were allowed to take cardioprotective doses of aspirin—an important factor that the analysis did not adjust for, she pointed out. “Even low-dose aspirin inhibits COX, and it could just be that the people in the treatment arm were much more likely to be on aspirin as well.”

MONTREAL — Although the prevalence of human papillomavirus is similar among females and males, physicians will need to be careful about promoting a vaccine that specifically targets men, according to a survey of male college students.

Efficacy trials suggest that the Gardasil HPV vaccine, which is currently approved for females only, is efficacious in males, and it could be approved for this population as early as the fall, said Mary Gerend, Ph.D., of Florida State University, Tallahassee.

However, her study of 221 young males suggests that their attitudes about the acceptability of the vaccine are only slightly positive, and depend partly on what it is called. On a scale of 1 (unlikely) to 6 (very likely) they indicated a 3.6 level of interest in receiving the vaccine, she reported.

"Marketing it as 'the cervical cancer' vaccine may not be the most effective strategy for this group," she said at the annual meeting of the Society of Behavioral Medicine.

The men in her group were aged 18–26 years, and 96% of them were heterosexual. Although only 47% had a current partner, 81% indicated that they had had sexual intercourse. The group reported a mean of 4.8 lifetime partners (range 0–34).

"Younger men were more interested, as were gay and bisexual men," Dr. Gerend said, adding that other predictors of interest were having already had sex, having a current partner, and ever being tested for a sexually transmitted infection.

Regarding a potential name for the vaccine, most of the group (76%) said they preferred "Gardasil" or "the HPV vaccine."

In a separate study of 356 heterosexual male college students, Dr. Gerend found that emphasizing the benefits of vaccination for a man's partner versus the personal benefits did not boost interest in vaccination (Sex. Transm. Dis. 2009;36:58-62).

Dr. Gerend did not disclose any conflicts of interest.

MONTREAL — Although the prevalence of human papillomavirus is similar among females and males, physicians will need to be careful about promoting a vaccine that specifically targets men, according to a survey of male college students.

Efficacy trials suggest that the Gardasil HPV vaccine, which is currently approved for females only, is efficacious in males, and it could be approved for this population as early as the fall, said Mary Gerend, Ph.D., of Florida State University, Tallahassee.

However, her study of 221 young males suggests that their attitudes about the acceptability of the vaccine are only slightly positive, and depend partly on what it is called. On a scale of 1 (unlikely) to 6 (very likely) they indicated a 3.6 level of interest in receiving the vaccine, she reported.

"Marketing it as 'the cervical cancer' vaccine may not be the most effective strategy for this group," she said at the annual meeting of the Society of Behavioral Medicine.

The men in her group were aged 18–26 years, and 96% of them were heterosexual. Although only 47% had a current partner, 81% indicated that they had had sexual intercourse. The group reported a mean of 4.8 lifetime partners (range 0–34).

"Younger men were more interested, as were gay and bisexual men," Dr. Gerend said, adding that other predictors of interest were having already had sex, having a current partner, and ever being tested for a sexually transmitted infection.

Regarding a potential name for the vaccine, most of the group (76%) said they preferred "Gardasil" or "the HPV vaccine."

In a separate study of 356 heterosexual male college students, Dr. Gerend found that emphasizing the benefits of vaccination for a man's partner versus the personal benefits did not boost interest in vaccination (Sex. Transm. Dis. 2009;36:58-62).

Dr. Gerend did not disclose any conflicts of interest.

MONTREAL — Although the prevalence of human papillomavirus is similar among females and males, physicians will need to be careful about promoting a vaccine that specifically targets men, according to a survey of male college students.

Efficacy trials suggest that the Gardasil HPV vaccine, which is currently approved for females only, is efficacious in males, and it could be approved for this population as early as the fall, said Mary Gerend, Ph.D., of Florida State University, Tallahassee.

However, her study of 221 young males suggests that their attitudes about the acceptability of the vaccine are only slightly positive, and depend partly on what it is called. On a scale of 1 (unlikely) to 6 (very likely) they indicated a 3.6 level of interest in receiving the vaccine, she reported.

"Marketing it as 'the cervical cancer' vaccine may not be the most effective strategy for this group," she said at the annual meeting of the Society of Behavioral Medicine.

The men in her group were aged 18–26 years, and 96% of them were heterosexual. Although only 47% had a current partner, 81% indicated that they had had sexual intercourse. The group reported a mean of 4.8 lifetime partners (range 0–34).

"Younger men were more interested, as were gay and bisexual men," Dr. Gerend said, adding that other predictors of interest were having already had sex, having a current partner, and ever being tested for a sexually transmitted infection.

Regarding a potential name for the vaccine, most of the group (76%) said they preferred "Gardasil" or "the HPV vaccine."

In a separate study of 356 heterosexual male college students, Dr. Gerend found that emphasizing the benefits of vaccination for a man's partner versus the personal benefits did not boost interest in vaccination (Sex. Transm. Dis. 2009;36:58-62).

Dr. Gerend did not disclose any conflicts of interest.

A new report from the National Survey on Drug Use and Health provides data on the prevalence of past-year depression among veterans aged 21–39.

An estimated 25%-30% of veterans of the wars in Iraq and Afghanistan have reported symptoms of a mental disorder or cognitive condition. The report is at www.oas.samhsa.gov/2k8/veteransDepressed/veteransDepressed.htm

A new report from the National Survey on Drug Use and Health provides data on the prevalence of past-year depression among veterans aged 21–39.

An estimated 25%-30% of veterans of the wars in Iraq and Afghanistan have reported symptoms of a mental disorder or cognitive condition. The report is at www.oas.samhsa.gov/2k8/veteransDepressed/veteransDepressed.htm

A new report from the National Survey on Drug Use and Health provides data on the prevalence of past-year depression among veterans aged 21–39.

An estimated 25%-30% of veterans of the wars in Iraq and Afghanistan have reported symptoms of a mental disorder or cognitive condition. The report is at www.oas.samhsa.gov/2k8/veteransDepressed/veteransDepressed.htm

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., of the Veterans Affairs Medical Center in Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, posttraumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggests that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within 1 month of their suicide; 20% had seen a mental health specialist. Older individuals had higher rates of contact with a primary care provider, compared with younger people (Am. J. Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous 2 weeks.

At intake, nursing staff ask one simple question: “In the past 2 weeks, have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital. “We assess risk factors, social/demographic factors, current life stressors, and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or posttraumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized. Among the 118 referred for specialty treatment, 63% had never been offered help before, Dr. Shabana said.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it,” he said. The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple handoff from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to [receiving care from] a mental health expert.

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., of the Veterans Affairs Medical Center in Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, posttraumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggests that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within 1 month of their suicide; 20% had seen a mental health specialist. Older individuals had higher rates of contact with a primary care provider, compared with younger people (Am. J. Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous 2 weeks.

At intake, nursing staff ask one simple question: “In the past 2 weeks, have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital. “We assess risk factors, social/demographic factors, current life stressors, and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or posttraumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized. Among the 118 referred for specialty treatment, 63% had never been offered help before, Dr. Shabana said.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it,” he said. The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple handoff from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to [receiving care from] a mental health expert.

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., of the Veterans Affairs Medical Center in Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, posttraumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggests that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within 1 month of their suicide; 20% had seen a mental health specialist. Older individuals had higher rates of contact with a primary care provider, compared with younger people (Am. J. Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous 2 weeks.

At intake, nursing staff ask one simple question: “In the past 2 weeks, have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital. “We assess risk factors, social/demographic factors, current life stressors, and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or posttraumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized. Among the 118 referred for specialty treatment, 63% had never been offered help before, Dr. Shabana said.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it,” he said. The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple handoff from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to [receiving care from] a mental health expert.

MONTREAL — Major depression is associated with a twofold increase in the risk of incident diabetic foot ulcers, according to the results of a large, prospective, population-based cohort study.

The findings suggest strong benefits in screening for and treating depression to prevent this complication, said Dr. Lisa Williams, of the department of dermatology at the University of Washington, Seattle.

“Depression is twice as common in patients with diabetes,” she said at the annual meeting of the Society for Investigative Dermatology. “At any one time, 11%-12% of patients with diabetes have major depression, and 31% have significant depressive symptoms.”

Until now, it has not been known whether depression increases the incidence of diabetic foot ulcers. However, it is known that “depression is associated with more severe and larger diabetic foot ulcers, and poor healing and recurrence. Depression is also associated with a threefold increase in mortality rate among patients with their first foot ulcer,” she said.

Her study, funded by the National Institute of Mental Health, included 3,474 patients from the Pathways Epidemiologic Study, a prospective cohort of primary care diabetes patients from nine clinics in western Washington State.

Major and minor depression were assessed using the Patient Health Questionnaire (PHQ-9), and there was a mean follow-up of about 4 years. New-onset foot ulcers were assessed during the course of the study, using ICD-9 codes.

There were 401 diagnoses of major and 290 diagnoses of minor depression in the cohort, and 121 incident foot ulcers, said Dr. Williams, who reported no conflicts of interest.

Compared with patients with no depression, Dr. Williams and her coinvestigators found a significant increase in the risk of foot ulcers in patients with major, but not minor, depression (hazard ratios, 2.0 and 1.3, respectively).

There was no difference between depressed and nondepressed patients in foot self-care. However, previous research has shown that depression in patients with diabetes is associated with poor self-care, as well as hyperglycemia, smoking, and obesity, she said. “In our study, we found that compared with nondepressed patients, depressed patients were older, unmarried, had [a higher BMI], were more likely to smoke, and had more diabetes complications.

MONTREAL — Major depression is associated with a twofold increase in the risk of incident diabetic foot ulcers, according to the results of a large, prospective, population-based cohort study.

The findings suggest strong benefits in screening for and treating depression to prevent this complication, said Dr. Lisa Williams, of the department of dermatology at the University of Washington, Seattle.

“Depression is twice as common in patients with diabetes,” she said at the annual meeting of the Society for Investigative Dermatology. “At any one time, 11%-12% of patients with diabetes have major depression, and 31% have significant depressive symptoms.”

Until now, it has not been known whether depression increases the incidence of diabetic foot ulcers. However, it is known that “depression is associated with more severe and larger diabetic foot ulcers, and poor healing and recurrence. Depression is also associated with a threefold increase in mortality rate among patients with their first foot ulcer,” she said.

Her study, funded by the National Institute of Mental Health, included 3,474 patients from the Pathways Epidemiologic Study, a prospective cohort of primary care diabetes patients from nine clinics in western Washington State.

Major and minor depression were assessed using the Patient Health Questionnaire (PHQ-9), and there was a mean follow-up of about 4 years. New-onset foot ulcers were assessed during the course of the study, using ICD-9 codes.

There were 401 diagnoses of major and 290 diagnoses of minor depression in the cohort, and 121 incident foot ulcers, said Dr. Williams, who reported no conflicts of interest.

Compared with patients with no depression, Dr. Williams and her coinvestigators found a significant increase in the risk of foot ulcers in patients with major, but not minor, depression (hazard ratios, 2.0 and 1.3, respectively).

There was no difference between depressed and nondepressed patients in foot self-care. However, previous research has shown that depression in patients with diabetes is associated with poor self-care, as well as hyperglycemia, smoking, and obesity, she said. “In our study, we found that compared with nondepressed patients, depressed patients were older, unmarried, had [a higher BMI], were more likely to smoke, and had more diabetes complications.

MONTREAL — Major depression is associated with a twofold increase in the risk of incident diabetic foot ulcers, according to the results of a large, prospective, population-based cohort study.

The findings suggest strong benefits in screening for and treating depression to prevent this complication, said Dr. Lisa Williams, of the department of dermatology at the University of Washington, Seattle.

“Depression is twice as common in patients with diabetes,” she said at the annual meeting of the Society for Investigative Dermatology. “At any one time, 11%-12% of patients with diabetes have major depression, and 31% have significant depressive symptoms.”

Until now, it has not been known whether depression increases the incidence of diabetic foot ulcers. However, it is known that “depression is associated with more severe and larger diabetic foot ulcers, and poor healing and recurrence. Depression is also associated with a threefold increase in mortality rate among patients with their first foot ulcer,” she said.

Her study, funded by the National Institute of Mental Health, included 3,474 patients from the Pathways Epidemiologic Study, a prospective cohort of primary care diabetes patients from nine clinics in western Washington State.

Major and minor depression were assessed using the Patient Health Questionnaire (PHQ-9), and there was a mean follow-up of about 4 years. New-onset foot ulcers were assessed during the course of the study, using ICD-9 codes.

There were 401 diagnoses of major and 290 diagnoses of minor depression in the cohort, and 121 incident foot ulcers, said Dr. Williams, who reported no conflicts of interest.

Compared with patients with no depression, Dr. Williams and her coinvestigators found a significant increase in the risk of foot ulcers in patients with major, but not minor, depression (hazard ratios, 2.0 and 1.3, respectively).

There was no difference between depressed and nondepressed patients in foot self-care. However, previous research has shown that depression in patients with diabetes is associated with poor self-care, as well as hyperglycemia, smoking, and obesity, she said. “In our study, we found that compared with nondepressed patients, depressed patients were older, unmarried, had [a higher BMI], were more likely to smoke, and had more diabetes complications.

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., from the Veterans Affairs Medical Center, Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, post-traumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggest that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within one month of their suicide; 20% had seen a mental health specialist.

Older individuals had higher rates of contact with a primary care provider than younger people (Am. J Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous two weeks.

At intake, nursing staff ask one simple question: “In the past two weeks have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital.

“We assess risk factors, social/demographic factors, current life stressors and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were currently already being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or post-traumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized.

Among the 118 referred for specialty treatment, 63% had never been offered help before, said Dr. Shabana.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it.”

The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple hand-off from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to a mental health expert.”

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., from the Veterans Affairs Medical Center, Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, post-traumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggest that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within one month of their suicide; 20% had seen a mental health specialist.

Older individuals had higher rates of contact with a primary care provider than younger people (Am. J Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous two weeks.

At intake, nursing staff ask one simple question: “In the past two weeks have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital.

“We assess risk factors, social/demographic factors, current life stressors and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were currently already being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or post-traumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized.

Among the 118 referred for specialty treatment, 63% had never been offered help before, said Dr. Shabana.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it.”

The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple hand-off from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to a mental health expert.”

MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., from the Veterans Affairs Medical Center, Salem, Va.

“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.

“Many veterans are prone to things like chronic pain, post-traumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.

Evidence from the Centers for Disease Control and Prevention suggest that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.

A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within one month of their suicide; 20% had seen a mental health specialist.

Older individuals had higher rates of contact with a primary care provider than younger people (Am. J Psychiatry 2002;159:909–16).

An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous two weeks.

At intake, nursing staff ask one simple question: “In the past two weeks have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital.

“We assess risk factors, social/demographic factors, current life stressors and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.

Among a group of veterans who screened positive for the initial intake question, 177 were currently already being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.

Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or post-traumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized.

Among the 118 referred for specialty treatment, 63% had never been offered help before, said Dr. Shabana.

“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it.”

The beauty of the screening model is that it is simple and effective, he explained.

There are reduced barriers to access because of the simple hand-off from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.

“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to a mental health expert.”

MONTREAL — Women who drank alcohol, especially those who consumed at least five beers per week, were at increased risk of developing psoriasis, based on an analysis of the Nurses' Health Study.

Compared with abstainers, women who drank alcohol (defined as consumption of at least 30 g, or roughly two drinks, per week) had a significantly increased risk of developing psoriasis, with a relative risk (RR) of 1.59, said Dr. Patrick Dominguez, who presented his findings at the annual meeting of the Society for Investigative Dermatology.

When type of alcohol was examined, however, only regular beer consumption of more than five drinks per week was a significant predictor (RR 1.83) for the development of psoriasis. “For any amount of light beer, wine, or liquor consumed, the relative risks were not significant.”

At study entry in 1989, women in the Nurses' Health Study were asked about their level of alcohol consumption in grams per week. According to the Centers for Disease Control and Prevention, a standard drink contains 13.7 g of alcohol and is defined as 12 ounces of regular beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Over a 14-year period, biennial questionnaires were used to monitor both the amount as well as the type of alcohol consumed (regular beer, light beer, wine, or liquor), said Dr. Dominguez, who is a research fellow in the department of dermatology at Brigham and Women's Hospital in Boston.

In 2005, participants were asked if they had psoriasis. A total of 2,169 reported a diagnosis of psoriasis; 1,162 were prevalent cases and the remaining 1,007 were incident cases, said Dr. Dominguez, who declared no conflicts of interest. After excluding incident cases for which there was incomplete information on alcohol consumption, 955 participants with new onset psoriasis were included for analysis.

The abstainers and women who drank alcohol did not differ significantly in age. Abstainers had slightly higher body mass indices. Drinkers were more physically active, and a higher percentage of drinkers also reported current or past smoking.

“We also measured dietary folate, which may be a modifier for alcohol's effect in psoriasis, and folate intake was higher in the drinkers, but not significantly higher,” Dr. Dominguez said.

One possible explanation for the study's findings is that gluten, a nonalcoholic ingredient found in beer, might trigger the onset of psoriasis, he speculated.

“There are multiple case series in which patients with gluten sensitivity, or celiac disease, and psoriasis go on a gluten-free diet, and their psoriasis clears up,” he said in an interview. “Beer is the only alcoholic drink that contains gluten. Light beer has some gluten but much less.”

MONTREAL — Women who drank alcohol, especially those who consumed at least five beers per week, were at increased risk of developing psoriasis, based on an analysis of the Nurses' Health Study.

Compared with abstainers, women who drank alcohol (defined as consumption of at least 30 g, or roughly two drinks, per week) had a significantly increased risk of developing psoriasis, with a relative risk (RR) of 1.59, said Dr. Patrick Dominguez, who presented his findings at the annual meeting of the Society for Investigative Dermatology.

When type of alcohol was examined, however, only regular beer consumption of more than five drinks per week was a significant predictor (RR 1.83) for the development of psoriasis. “For any amount of light beer, wine, or liquor consumed, the relative risks were not significant.”

At study entry in 1989, women in the Nurses' Health Study were asked about their level of alcohol consumption in grams per week. According to the Centers for Disease Control and Prevention, a standard drink contains 13.7 g of alcohol and is defined as 12 ounces of regular beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Over a 14-year period, biennial questionnaires were used to monitor both the amount as well as the type of alcohol consumed (regular beer, light beer, wine, or liquor), said Dr. Dominguez, who is a research fellow in the department of dermatology at Brigham and Women's Hospital in Boston.

In 2005, participants were asked if they had psoriasis. A total of 2,169 reported a diagnosis of psoriasis; 1,162 were prevalent cases and the remaining 1,007 were incident cases, said Dr. Dominguez, who declared no conflicts of interest. After excluding incident cases for which there was incomplete information on alcohol consumption, 955 participants with new onset psoriasis were included for analysis.

The abstainers and women who drank alcohol did not differ significantly in age. Abstainers had slightly higher body mass indices. Drinkers were more physically active, and a higher percentage of drinkers also reported current or past smoking.

“We also measured dietary folate, which may be a modifier for alcohol's effect in psoriasis, and folate intake was higher in the drinkers, but not significantly higher,” Dr. Dominguez said.

One possible explanation for the study's findings is that gluten, a nonalcoholic ingredient found in beer, might trigger the onset of psoriasis, he speculated.

“There are multiple case series in which patients with gluten sensitivity, or celiac disease, and psoriasis go on a gluten-free diet, and their psoriasis clears up,” he said in an interview. “Beer is the only alcoholic drink that contains gluten. Light beer has some gluten but much less.”

MONTREAL — Women who drank alcohol, especially those who consumed at least five beers per week, were at increased risk of developing psoriasis, based on an analysis of the Nurses' Health Study.

Compared with abstainers, women who drank alcohol (defined as consumption of at least 30 g, or roughly two drinks, per week) had a significantly increased risk of developing psoriasis, with a relative risk (RR) of 1.59, said Dr. Patrick Dominguez, who presented his findings at the annual meeting of the Society for Investigative Dermatology.

When type of alcohol was examined, however, only regular beer consumption of more than five drinks per week was a significant predictor (RR 1.83) for the development of psoriasis. “For any amount of light beer, wine, or liquor consumed, the relative risks were not significant.”

At study entry in 1989, women in the Nurses' Health Study were asked about their level of alcohol consumption in grams per week. According to the Centers for Disease Control and Prevention, a standard drink contains 13.7 g of alcohol and is defined as 12 ounces of regular beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Over a 14-year period, biennial questionnaires were used to monitor both the amount as well as the type of alcohol consumed (regular beer, light beer, wine, or liquor), said Dr. Dominguez, who is a research fellow in the department of dermatology at Brigham and Women's Hospital in Boston.

In 2005, participants were asked if they had psoriasis. A total of 2,169 reported a diagnosis of psoriasis; 1,162 were prevalent cases and the remaining 1,007 were incident cases, said Dr. Dominguez, who declared no conflicts of interest. After excluding incident cases for which there was incomplete information on alcohol consumption, 955 participants with new onset psoriasis were included for analysis.

The abstainers and women who drank alcohol did not differ significantly in age. Abstainers had slightly higher body mass indices. Drinkers were more physically active, and a higher percentage of drinkers also reported current or past smoking.

“We also measured dietary folate, which may be a modifier for alcohol's effect in psoriasis, and folate intake was higher in the drinkers, but not significantly higher,” Dr. Dominguez said.

One possible explanation for the study's findings is that gluten, a nonalcoholic ingredient found in beer, might trigger the onset of psoriasis, he speculated.

“There are multiple case series in which patients with gluten sensitivity, or celiac disease, and psoriasis go on a gluten-free diet, and their psoriasis clears up,” he said in an interview. “Beer is the only alcoholic drink that contains gluten. Light beer has some gluten but much less.”

MONTREAL — Mortality rates are significantly increased in patients with severe psoriasis compared with the general population, according to two new studies.

But the studies have conflicting results regarding cause of death, researchers reported at the annual meeting of the Society for Investigative Dermatology. A study by Dr. Rahat Azfar showed an age-dependent, significantly increased risk of cardiovascular death with severe psoriasis, compared with patients without it.

“Severe psoriasis may be an independent risk factor for cardiovascular mortality,” noted Dr. Azfar of the University of Pennsylvania, Philadelphia, whose study showed a 50% increase in cardiovascular death.

Her findings are in direct contrast to another study presented in the same session and conflict with a growing body of evidence. Dr. Robert Stern presented results from the 30-year PUVA Follow-Up Study, which showed no increase in cardiovascular death risk in severe psoriasis patients, all of whom had undergone PUVA.

“In patients with extremely severe psoriasis, there is an increased risk of death from noncardiovascular, but not cardiovascular causes,” said Dr. Stern, professor of dermatology at Harvard Medical School and vice chair of dermatology at Beth Israel Deaconess Medical Center in Boston.

“Previous studies of cardiovascular mortality have not controlled for traditional CV risk factors, as our work has done,” commented Dr. Azfar, who declared no conflicts of interest.

Her study, which she presented at the meeting, was funded by the National Institutes of Health and a grant from Centocor. It examined more than 3,000 patients with severe psoriasis, matched to more than 14,000 controls.

Compared with controls, patients with severe psoriasis had a significantly increased risk of all-cause mortality (odds ratio [OR] 1.78), she said.

After researchers controlled for traditional cardiovascular risk factors, psoriasis patients had a clinically significant increased risk of cardiovascular death (hazard ratio [HR] 1.55). This risk was modified by age, with patients aged 40 and younger being at greater risk (HR 2.65) than patients aged 41–60 (HR 1.90). This translated to an excess of 5.78 cardiovascular deaths per 10,000 person-years at age 40 and 58.9 per 10,000 person-years at age 60, she said.

Dr. Stern, who declared no conflicts of interest, agreed that cardiovascular risk factors are important, but his data suggest they are no more important than other risk factors.

The data show “that liver disease and nonmelanoma skin cancer accounted for more than half the approximately 70 excess deaths we observed,” he said. His prospective study followed 1,376 patients from the PUVA Follow-Up for 28 years, from 1976 to 2004.

Comparing the observed and expected mortality rates among patients and controls, the researchers found an increased all-cause mortality rate among only those patients with the most severe psoriasis. When cause of death was examined in this group, noncardiovascular reasons explained the increased risk, and there was a nonsignificant increase in the rate of cardiovascular deaths, compared with controls, Dr. Stern said.

'Previous studies of cardiovascular mortality have not controlled for traditional CV risk factors, as our work has done.' DR. AZFAR

MONTREAL — Mortality rates are significantly increased in patients with severe psoriasis compared with the general population, according to two new studies.

But the studies have conflicting results regarding cause of death, researchers reported at the annual meeting of the Society for Investigative Dermatology. A study by Dr. Rahat Azfar showed an age-dependent, significantly increased risk of cardiovascular death with severe psoriasis, compared with patients without it.

“Severe psoriasis may be an independent risk factor for cardiovascular mortality,” noted Dr. Azfar of the University of Pennsylvania, Philadelphia, whose study showed a 50% increase in cardiovascular death.

Her findings are in direct contrast to another study presented in the same session and conflict with a growing body of evidence. Dr. Robert Stern presented results from the 30-year PUVA Follow-Up Study, which showed no increase in cardiovascular death risk in severe psoriasis patients, all of whom had undergone PUVA.

“In patients with extremely severe psoriasis, there is an increased risk of death from noncardiovascular, but not cardiovascular causes,” said Dr. Stern, professor of dermatology at Harvard Medical School and vice chair of dermatology at Beth Israel Deaconess Medical Center in Boston.

“Previous studies of cardiovascular mortality have not controlled for traditional CV risk factors, as our work has done,” commented Dr. Azfar, who declared no conflicts of interest.

Her study, which she presented at the meeting, was funded by the National Institutes of Health and a grant from Centocor. It examined more than 3,000 patients with severe psoriasis, matched to more than 14,000 controls.

Compared with controls, patients with severe psoriasis had a significantly increased risk of all-cause mortality (odds ratio [OR] 1.78), she said.

After researchers controlled for traditional cardiovascular risk factors, psoriasis patients had a clinically significant increased risk of cardiovascular death (hazard ratio [HR] 1.55). This risk was modified by age, with patients aged 40 and younger being at greater risk (HR 2.65) than patients aged 41–60 (HR 1.90). This translated to an excess of 5.78 cardiovascular deaths per 10,000 person-years at age 40 and 58.9 per 10,000 person-years at age 60, she said.

Dr. Stern, who declared no conflicts of interest, agreed that cardiovascular risk factors are important, but his data suggest they are no more important than other risk factors.

The data show “that liver disease and nonmelanoma skin cancer accounted for more than half the approximately 70 excess deaths we observed,” he said. His prospective study followed 1,376 patients from the PUVA Follow-Up for 28 years, from 1976 to 2004.

Comparing the observed and expected mortality rates among patients and controls, the researchers found an increased all-cause mortality rate among only those patients with the most severe psoriasis. When cause of death was examined in this group, noncardiovascular reasons explained the increased risk, and there was a nonsignificant increase in the rate of cardiovascular deaths, compared with controls, Dr. Stern said.

'Previous studies of cardiovascular mortality have not controlled for traditional CV risk factors, as our work has done.' DR. AZFAR

MONTREAL — Mortality rates are significantly increased in patients with severe psoriasis compared with the general population, according to two new studies.

But the studies have conflicting results regarding cause of death, researchers reported at the annual meeting of the Society for Investigative Dermatology. A study by Dr. Rahat Azfar showed an age-dependent, significantly increased risk of cardiovascular death with severe psoriasis, compared with patients without it.

“Severe psoriasis may be an independent risk factor for cardiovascular mortality,” noted Dr. Azfar of the University of Pennsylvania, Philadelphia, whose study showed a 50% increase in cardiovascular death.

Her findings are in direct contrast to another study presented in the same session and conflict with a growing body of evidence. Dr. Robert Stern presented results from the 30-year PUVA Follow-Up Study, which showed no increase in cardiovascular death risk in severe psoriasis patients, all of whom had undergone PUVA.

“In patients with extremely severe psoriasis, there is an increased risk of death from noncardiovascular, but not cardiovascular causes,” said Dr. Stern, professor of dermatology at Harvard Medical School and vice chair of dermatology at Beth Israel Deaconess Medical Center in Boston.

“Previous studies of cardiovascular mortality have not controlled for traditional CV risk factors, as our work has done,” commented Dr. Azfar, who declared no conflicts of interest.

Her study, which she presented at the meeting, was funded by the National Institutes of Health and a grant from Centocor. It examined more than 3,000 patients with severe psoriasis, matched to more than 14,000 controls.

Compared with controls, patients with severe psoriasis had a significantly increased risk of all-cause mortality (odds ratio [OR] 1.78), she said.

After researchers controlled for traditional cardiovascular risk factors, psoriasis patients had a clinically significant increased risk of cardiovascular death (hazard ratio [HR] 1.55). This risk was modified by age, with patients aged 40 and younger being at greater risk (HR 2.65) than patients aged 41–60 (HR 1.90). This translated to an excess of 5.78 cardiovascular deaths per 10,000 person-years at age 40 and 58.9 per 10,000 person-years at age 60, she said.

Dr. Stern, who declared no conflicts of interest, agreed that cardiovascular risk factors are important, but his data suggest they are no more important than other risk factors.

The data show “that liver disease and nonmelanoma skin cancer accounted for more than half the approximately 70 excess deaths we observed,” he said. His prospective study followed 1,376 patients from the PUVA Follow-Up for 28 years, from 1976 to 2004.

Comparing the observed and expected mortality rates among patients and controls, the researchers found an increased all-cause mortality rate among only those patients with the most severe psoriasis. When cause of death was examined in this group, noncardiovascular reasons explained the increased risk, and there was a nonsignificant increase in the rate of cardiovascular deaths, compared with controls, Dr. Stern said.

'Previous studies of cardiovascular mortality have not controlled for traditional CV risk factors, as our work has done.' DR. AZFAR

MONTREAL — Women who drank alcohol, especially those consuming at least five beers per week, were at increased risk of developing psoriasis, based on an analysis of the Nurses' Health Study.

Compared to abstainers, women who drank alcohol (defined as consumption of at least 30 grams, or roughly two drinks, per week) had a significantly increased risk of developing psoriasis, with a relative risk (RR) of 1.6, said Dr. Patrick Dominguez, who presented his findings at the annual meeting of the Society for Investigative Dermatology

When type of alcohol was examined, however, only regular beer consumption of more than 5 drinks per week was a significant predictor (RR 1.8) for the development of psoriasis. “For any amount of light beer, wine, or liquor consumed, the relative risks were not significant.”

At study entry in 1989, women in the Nurses' Health Study were asked about their level of alcohol consumption in grams per week. According to the Centers for Disease Control and Prevention, a standard drink contains 13.7 grams of alcohol and is defined as 12 ounces of regular beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Over a 14-year period, biennial questionnaires were used to monitor both the amount as well as the type of alcohol consumed (regular beer, light beer, wine, or liquor), said Dr. Dominguez, who is a research fellow in the department of dermatology at Brigham and Women's Hospital in Boston.

In 2005, participants were asked if they had psoriasis. A total of 2,169 reported a diagnosis of psoriasis; 1,162 were prevalent cases and the remaining 1,007 were incident cases, said Dr. Dominguez, who declared no conflicts of interest. After excluding incident cases for which there was incomplete information on alcohol consumption, 955 participants with new onset psoriasis were included for analysis.

The abstainers and women who drank alcohol did not differ significantly in age. Abstainers had slightly higher body mass indices. Drinkers were more physically active, and a higher percentage of drinkers also reported current or past smoking.

One possible explanation for the study's findings is that gluten, a non-alcoholic ingredient found in beer, might trigger the onset of psoriasis, Dr. Dominguez speculated.

“There are multiple case series in which patients with gluten sensitivity, or celiac disease, and psoriasis go on a gluten-free diet, and their psoriasis clears up,” he said in an interview. “Beer is the only alcoholic drink that contains gluten. Light beer has some gluten but much less.”

Gluten, which is found in beer but not other forms of alcohol, may be a trigger. Courtesy Len Rizzi/National Cancer Institute

MONTREAL — Women who drank alcohol, especially those consuming at least five beers per week, were at increased risk of developing psoriasis, based on an analysis of the Nurses' Health Study.

Compared to abstainers, women who drank alcohol (defined as consumption of at least 30 grams, or roughly two drinks, per week) had a significantly increased risk of developing psoriasis, with a relative risk (RR) of 1.6, said Dr. Patrick Dominguez, who presented his findings at the annual meeting of the Society for Investigative Dermatology

When type of alcohol was examined, however, only regular beer consumption of more than 5 drinks per week was a significant predictor (RR 1.8) for the development of psoriasis. “For any amount of light beer, wine, or liquor consumed, the relative risks were not significant.”

At study entry in 1989, women in the Nurses' Health Study were asked about their level of alcohol consumption in grams per week. According to the Centers for Disease Control and Prevention, a standard drink contains 13.7 grams of alcohol and is defined as 12 ounces of regular beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Over a 14-year period, biennial questionnaires were used to monitor both the amount as well as the type of alcohol consumed (regular beer, light beer, wine, or liquor), said Dr. Dominguez, who is a research fellow in the department of dermatology at Brigham and Women's Hospital in Boston.

In 2005, participants were asked if they had psoriasis. A total of 2,169 reported a diagnosis of psoriasis; 1,162 were prevalent cases and the remaining 1,007 were incident cases, said Dr. Dominguez, who declared no conflicts of interest. After excluding incident cases for which there was incomplete information on alcohol consumption, 955 participants with new onset psoriasis were included for analysis.

The abstainers and women who drank alcohol did not differ significantly in age. Abstainers had slightly higher body mass indices. Drinkers were more physically active, and a higher percentage of drinkers also reported current or past smoking.

One possible explanation for the study's findings is that gluten, a non-alcoholic ingredient found in beer, might trigger the onset of psoriasis, Dr. Dominguez speculated.

“There are multiple case series in which patients with gluten sensitivity, or celiac disease, and psoriasis go on a gluten-free diet, and their psoriasis clears up,” he said in an interview. “Beer is the only alcoholic drink that contains gluten. Light beer has some gluten but much less.”

Gluten, which is found in beer but not other forms of alcohol, may be a trigger. Courtesy Len Rizzi/National Cancer Institute

MONTREAL — Women who drank alcohol, especially those consuming at least five beers per week, were at increased risk of developing psoriasis, based on an analysis of the Nurses' Health Study.

Compared to abstainers, women who drank alcohol (defined as consumption of at least 30 grams, or roughly two drinks, per week) had a significantly increased risk of developing psoriasis, with a relative risk (RR) of 1.6, said Dr. Patrick Dominguez, who presented his findings at the annual meeting of the Society for Investigative Dermatology

When type of alcohol was examined, however, only regular beer consumption of more than 5 drinks per week was a significant predictor (RR 1.8) for the development of psoriasis. “For any amount of light beer, wine, or liquor consumed, the relative risks were not significant.”

At study entry in 1989, women in the Nurses' Health Study were asked about their level of alcohol consumption in grams per week. According to the Centers for Disease Control and Prevention, a standard drink contains 13.7 grams of alcohol and is defined as 12 ounces of regular beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Over a 14-year period, biennial questionnaires were used to monitor both the amount as well as the type of alcohol consumed (regular beer, light beer, wine, or liquor), said Dr. Dominguez, who is a research fellow in the department of dermatology at Brigham and Women's Hospital in Boston.

In 2005, participants were asked if they had psoriasis. A total of 2,169 reported a diagnosis of psoriasis; 1,162 were prevalent cases and the remaining 1,007 were incident cases, said Dr. Dominguez, who declared no conflicts of interest. After excluding incident cases for which there was incomplete information on alcohol consumption, 955 participants with new onset psoriasis were included for analysis.

The abstainers and women who drank alcohol did not differ significantly in age. Abstainers had slightly higher body mass indices. Drinkers were more physically active, and a higher percentage of drinkers also reported current or past smoking.

One possible explanation for the study's findings is that gluten, a non-alcoholic ingredient found in beer, might trigger the onset of psoriasis, Dr. Dominguez speculated.

“There are multiple case series in which patients with gluten sensitivity, or celiac disease, and psoriasis go on a gluten-free diet, and their psoriasis clears up,” he said in an interview. “Beer is the only alcoholic drink that contains gluten. Light beer has some gluten but much less.”

Gluten, which is found in beer but not other forms of alcohol, may be a trigger. Courtesy Len Rizzi/National Cancer Institute