Robert Finn

Major Finding: A single end-of-day pain score correlated with multiple pain scores measured during the day by a coefficient of 0.88 on weekdays and 0.86 on weekend days.

Data Source: Visual analog scale scores recorded on weekdays and weekend days by 157 patients with osteoarthritis.

Disclosures: Study supported by American College of Rheumatology Research and Education Foundation. The investigators reported no other conflicts of interest.

Patients with osteoarthritis who are asked just before bedtime to estimate their average pain during the day are able to produce accurate estimates, meaning that clinicians can rely on these end-of-day estimates without having to worry that the patient's recall may be biased.

These findings differ from those in other studies that have suggested that end-of-day recall might be affected by more recent pain readings, by whether it was a weekday or a weekend, or by other patient characteristics.

The patients in the current study all had osteoarthritis (OA) of the hand, hip, or knee. Their mean age was 62 years, and women accounted for 52% of the study cohort, wrote by Kelli D. Allen, Ph.D., and colleagues at Duke University, Durham, N.C. (J. Pain 2009 Jan. 22 [doi:10.1016/j.jpain.2009.09.007]).

They were each given a handheld computer that reminded them approximately every 2 hours to record their current level of pain on a visual-analog scale. At the end of the day, the computer also prompted the patients to estimate their average pain over the entire day. Each patient recorded pain estimates on 2 days, once on a weekday and once on a weekend day.

On average, pain scores recorded throughout the day on the 1-100 visual-analog scale were 35 on weekdays and 33 on weekends.

Patients' average end-of-day recalled pain scores were 37 on weekdays and 34 on weekends. None of the differences were statistically significant.

The overall correlation coefficient between end-of-day estimates and the average of the seven estimates during the day was 0.88 on weekdays and 0.86 on weekend days, indicating a high–and statistically significant–degree of correlation.

The investigators were able to eliminate the possibility that the patients may have been biased by their most recent pain reading when recalling their average pain. They did this by calculating the patient's average pain after deleting the final reading of the day and repeating the correlation analysis. If that reading affected the patient's recall significantly, the investigators would have seen a substantial change in the correlation coefficients. In fact, the correlation coefficients were almost identical–0.87 on weekdays and 0.85 on weekends.

In addition, the investigators found that none of the patient characteristics they tested had a significant correlation with the accuracy of the end-of-day estimates. In particular, they found that age, gender, race, joint site, and the tendency of the patient to catastrophize pain (measured by the Coping Strategies Questionnaire) had no significant interactions with accuracy.

The investigators acknowledged that pain recall over a 1-week period may be less accurate than 1-day recall. And they pointed out that they demonstrated the accuracy of patient recall only for the chronic pain of OA, which may account for the far lower degree of recall accuracy than other investigators saw in a study of acute pain in postsurgical patients.

Major Finding: A single end-of-day pain score correlated with multiple pain scores measured during the day by a coefficient of 0.88 on weekdays and 0.86 on weekend days.

Data Source: Visual analog scale scores recorded on weekdays and weekend days by 157 patients with osteoarthritis.

Disclosures: Study supported by American College of Rheumatology Research and Education Foundation. The investigators reported no other conflicts of interest.

Patients with osteoarthritis who are asked just before bedtime to estimate their average pain during the day are able to produce accurate estimates, meaning that clinicians can rely on these end-of-day estimates without having to worry that the patient's recall may be biased.

These findings differ from those in other studies that have suggested that end-of-day recall might be affected by more recent pain readings, by whether it was a weekday or a weekend, or by other patient characteristics.

The patients in the current study all had osteoarthritis (OA) of the hand, hip, or knee. Their mean age was 62 years, and women accounted for 52% of the study cohort, wrote by Kelli D. Allen, Ph.D., and colleagues at Duke University, Durham, N.C. (J. Pain 2009 Jan. 22 [doi:10.1016/j.jpain.2009.09.007]).

They were each given a handheld computer that reminded them approximately every 2 hours to record their current level of pain on a visual-analog scale. At the end of the day, the computer also prompted the patients to estimate their average pain over the entire day. Each patient recorded pain estimates on 2 days, once on a weekday and once on a weekend day.

On average, pain scores recorded throughout the day on the 1-100 visual-analog scale were 35 on weekdays and 33 on weekends.

Patients' average end-of-day recalled pain scores were 37 on weekdays and 34 on weekends. None of the differences were statistically significant.

The overall correlation coefficient between end-of-day estimates and the average of the seven estimates during the day was 0.88 on weekdays and 0.86 on weekend days, indicating a high–and statistically significant–degree of correlation.

The investigators were able to eliminate the possibility that the patients may have been biased by their most recent pain reading when recalling their average pain. They did this by calculating the patient's average pain after deleting the final reading of the day and repeating the correlation analysis. If that reading affected the patient's recall significantly, the investigators would have seen a substantial change in the correlation coefficients. In fact, the correlation coefficients were almost identical–0.87 on weekdays and 0.85 on weekends.

In addition, the investigators found that none of the patient characteristics they tested had a significant correlation with the accuracy of the end-of-day estimates. In particular, they found that age, gender, race, joint site, and the tendency of the patient to catastrophize pain (measured by the Coping Strategies Questionnaire) had no significant interactions with accuracy.

The investigators acknowledged that pain recall over a 1-week period may be less accurate than 1-day recall. And they pointed out that they demonstrated the accuracy of patient recall only for the chronic pain of OA, which may account for the far lower degree of recall accuracy than other investigators saw in a study of acute pain in postsurgical patients.

Major Finding: A single end-of-day pain score correlated with multiple pain scores measured during the day by a coefficient of 0.88 on weekdays and 0.86 on weekend days.

Data Source: Visual analog scale scores recorded on weekdays and weekend days by 157 patients with osteoarthritis.

Disclosures: Study supported by American College of Rheumatology Research and Education Foundation. The investigators reported no other conflicts of interest.

Patients with osteoarthritis who are asked just before bedtime to estimate their average pain during the day are able to produce accurate estimates, meaning that clinicians can rely on these end-of-day estimates without having to worry that the patient's recall may be biased.

These findings differ from those in other studies that have suggested that end-of-day recall might be affected by more recent pain readings, by whether it was a weekday or a weekend, or by other patient characteristics.

The patients in the current study all had osteoarthritis (OA) of the hand, hip, or knee. Their mean age was 62 years, and women accounted for 52% of the study cohort, wrote by Kelli D. Allen, Ph.D., and colleagues at Duke University, Durham, N.C. (J. Pain 2009 Jan. 22 [doi:10.1016/j.jpain.2009.09.007]).

They were each given a handheld computer that reminded them approximately every 2 hours to record their current level of pain on a visual-analog scale. At the end of the day, the computer also prompted the patients to estimate their average pain over the entire day. Each patient recorded pain estimates on 2 days, once on a weekday and once on a weekend day.

On average, pain scores recorded throughout the day on the 1-100 visual-analog scale were 35 on weekdays and 33 on weekends.

Patients' average end-of-day recalled pain scores were 37 on weekdays and 34 on weekends. None of the differences were statistically significant.

The overall correlation coefficient between end-of-day estimates and the average of the seven estimates during the day was 0.88 on weekdays and 0.86 on weekend days, indicating a high–and statistically significant–degree of correlation.

The investigators were able to eliminate the possibility that the patients may have been biased by their most recent pain reading when recalling their average pain. They did this by calculating the patient's average pain after deleting the final reading of the day and repeating the correlation analysis. If that reading affected the patient's recall significantly, the investigators would have seen a substantial change in the correlation coefficients. In fact, the correlation coefficients were almost identical–0.87 on weekdays and 0.85 on weekends.

In addition, the investigators found that none of the patient characteristics they tested had a significant correlation with the accuracy of the end-of-day estimates. In particular, they found that age, gender, race, joint site, and the tendency of the patient to catastrophize pain (measured by the Coping Strategies Questionnaire) had no significant interactions with accuracy.

The investigators acknowledged that pain recall over a 1-week period may be less accurate than 1-day recall. And they pointed out that they demonstrated the accuracy of patient recall only for the chronic pain of OA, which may account for the far lower degree of recall accuracy than other investigators saw in a study of acute pain in postsurgical patients.

Glatiramer acetate significantly delayed the conversion of clinically isolated syndrome to clinically definite multiple sclerosis, according to a randomized, double-blind, placebo-controlled trial published in the Lancet.

The drug reduced the risk of developing clinically definite multiple sclerosis (MS) by 45% compared with placebo, wrote Dr. Giancarlo Comi of the University Vita-Salute, Milan, and his coinvestigators from the PreCISe study (Lancet 2009[doi:10.1016/S0140-6736(09)61259-9]). In addition, the time it took for 25% of patients to convert to clinically definite disease more than doubled, from 336 days for placebo to 722 days for glatiramer acetate.

Glatiramer acetate previously has been shown to reduce relapses in patients with the relapsing-remitting form of MS.

In 85% of patients who are eventually diagnosed with MS, the first clinical event is an acute episode that goes away on its own. This is known as a clinically isolated syndrome. Not everyone who experiences a clinically isolated syndrome goes on to develop MS. After 15-20 years, about half of these patients will have major locomotor disabilities, but about a third will have little or no disability, Dr. David H. Miller of University College London, and Dr. Siobhan M. Leary of the National Hospital for Neurology and Neurosurgery, London, noted in a commentary (Lancet 2009 [doi:10.1016/S0140-6736(09)61453-7]).

Beta interferon also has been shown in placebo-controlled trials to delay the conversion of the clinically isolated syndrome to clinically definite disease, Dr. Miller and Dr. Leary wrote.

The PreCISe (Presenting With a Clinically Isolated Syndrome) study was funded by Teva Pharmaceutical Industries, which markets glatiramer acetate under the brand name Copaxone. Dr. Comi, along with several of his co-authors, acknowledged relationships with Teva. He served on company advisory boards, he served as a consultant, and he received honoraria for speaking activities. In addition, Dr. Comi disclosed relationships with Novartis, Sanofi-Aventis, Merck-Serono, Biogen-Dompe, and Bayer Schering.

The trial involved 481 patients at 80 sites in 16 countries. They were randomized to receive either 20 mg per day of subcutaneous glatiramer acetate or placebo for up to 36 months.

Patients were 18-45 years old at trial entry. All had a single unifocal neurologic event less than 90 days earlier along with a brain MRI showing at least two cerebral lesions at least 6 mm in diameter. Patients were excluded if they had a multifocal clinical presentation, diseases other than MS responsible for the clinical or MRI presentation, or had used beta interferon, chronic corticosteroids, or any experimental or investigational drugs within 6 months of screening.

The most common adverse events among patients taking glatiramer acetate were injection-site reactions (56% vs. 24% for those taking placebo) and immediate postinjection reactions (19% vs. 5%).

Dr. Miller and Dr. Leary wrote that some neurologists are likely to recommend beta interferon or glatiramer acetate to most patients with a clinically isolated syndrome. Others, however, will choose to take a wait and see approach, reasoning that many of these patients will never progress and that others will remain well for a long time.

Dr. Miller reported that he has received research grants through his institution for companies that manufacture drugs for MS, and has also received honoraria and travel expenses from them. Dr. Leary also reported receiving travel grants for meetings from such companies, including Teva.

Glatiramer acetate significantly delayed the conversion of clinically isolated syndrome to clinically definite multiple sclerosis, according to a randomized, double-blind, placebo-controlled trial published in the Lancet.

The drug reduced the risk of developing clinically definite multiple sclerosis (MS) by 45% compared with placebo, wrote Dr. Giancarlo Comi of the University Vita-Salute, Milan, and his coinvestigators from the PreCISe study (Lancet 2009[doi:10.1016/S0140-6736(09)61259-9]). In addition, the time it took for 25% of patients to convert to clinically definite disease more than doubled, from 336 days for placebo to 722 days for glatiramer acetate.

Glatiramer acetate previously has been shown to reduce relapses in patients with the relapsing-remitting form of MS.

In 85% of patients who are eventually diagnosed with MS, the first clinical event is an acute episode that goes away on its own. This is known as a clinically isolated syndrome. Not everyone who experiences a clinically isolated syndrome goes on to develop MS. After 15-20 years, about half of these patients will have major locomotor disabilities, but about a third will have little or no disability, Dr. David H. Miller of University College London, and Dr. Siobhan M. Leary of the National Hospital for Neurology and Neurosurgery, London, noted in a commentary (Lancet 2009 [doi:10.1016/S0140-6736(09)61453-7]).

Beta interferon also has been shown in placebo-controlled trials to delay the conversion of the clinically isolated syndrome to clinically definite disease, Dr. Miller and Dr. Leary wrote.

The PreCISe (Presenting With a Clinically Isolated Syndrome) study was funded by Teva Pharmaceutical Industries, which markets glatiramer acetate under the brand name Copaxone. Dr. Comi, along with several of his co-authors, acknowledged relationships with Teva. He served on company advisory boards, he served as a consultant, and he received honoraria for speaking activities. In addition, Dr. Comi disclosed relationships with Novartis, Sanofi-Aventis, Merck-Serono, Biogen-Dompe, and Bayer Schering.

The trial involved 481 patients at 80 sites in 16 countries. They were randomized to receive either 20 mg per day of subcutaneous glatiramer acetate or placebo for up to 36 months.

Patients were 18-45 years old at trial entry. All had a single unifocal neurologic event less than 90 days earlier along with a brain MRI showing at least two cerebral lesions at least 6 mm in diameter. Patients were excluded if they had a multifocal clinical presentation, diseases other than MS responsible for the clinical or MRI presentation, or had used beta interferon, chronic corticosteroids, or any experimental or investigational drugs within 6 months of screening.

The most common adverse events among patients taking glatiramer acetate were injection-site reactions (56% vs. 24% for those taking placebo) and immediate postinjection reactions (19% vs. 5%).

Dr. Miller and Dr. Leary wrote that some neurologists are likely to recommend beta interferon or glatiramer acetate to most patients with a clinically isolated syndrome. Others, however, will choose to take a wait and see approach, reasoning that many of these patients will never progress and that others will remain well for a long time.

Dr. Miller reported that he has received research grants through his institution for companies that manufacture drugs for MS, and has also received honoraria and travel expenses from them. Dr. Leary also reported receiving travel grants for meetings from such companies, including Teva.

Glatiramer acetate significantly delayed the conversion of clinically isolated syndrome to clinically definite multiple sclerosis, according to a randomized, double-blind, placebo-controlled trial published in the Lancet.

The drug reduced the risk of developing clinically definite multiple sclerosis (MS) by 45% compared with placebo, wrote Dr. Giancarlo Comi of the University Vita-Salute, Milan, and his coinvestigators from the PreCISe study (Lancet 2009[doi:10.1016/S0140-6736(09)61259-9]). In addition, the time it took for 25% of patients to convert to clinically definite disease more than doubled, from 336 days for placebo to 722 days for glatiramer acetate.

Glatiramer acetate previously has been shown to reduce relapses in patients with the relapsing-remitting form of MS.

In 85% of patients who are eventually diagnosed with MS, the first clinical event is an acute episode that goes away on its own. This is known as a clinically isolated syndrome. Not everyone who experiences a clinically isolated syndrome goes on to develop MS. After 15-20 years, about half of these patients will have major locomotor disabilities, but about a third will have little or no disability, Dr. David H. Miller of University College London, and Dr. Siobhan M. Leary of the National Hospital for Neurology and Neurosurgery, London, noted in a commentary (Lancet 2009 [doi:10.1016/S0140-6736(09)61453-7]).

Beta interferon also has been shown in placebo-controlled trials to delay the conversion of the clinically isolated syndrome to clinically definite disease, Dr. Miller and Dr. Leary wrote.

The PreCISe (Presenting With a Clinically Isolated Syndrome) study was funded by Teva Pharmaceutical Industries, which markets glatiramer acetate under the brand name Copaxone. Dr. Comi, along with several of his co-authors, acknowledged relationships with Teva. He served on company advisory boards, he served as a consultant, and he received honoraria for speaking activities. In addition, Dr. Comi disclosed relationships with Novartis, Sanofi-Aventis, Merck-Serono, Biogen-Dompe, and Bayer Schering.

The trial involved 481 patients at 80 sites in 16 countries. They were randomized to receive either 20 mg per day of subcutaneous glatiramer acetate or placebo for up to 36 months.

Patients were 18-45 years old at trial entry. All had a single unifocal neurologic event less than 90 days earlier along with a brain MRI showing at least two cerebral lesions at least 6 mm in diameter. Patients were excluded if they had a multifocal clinical presentation, diseases other than MS responsible for the clinical or MRI presentation, or had used beta interferon, chronic corticosteroids, or any experimental or investigational drugs within 6 months of screening.

The most common adverse events among patients taking glatiramer acetate were injection-site reactions (56% vs. 24% for those taking placebo) and immediate postinjection reactions (19% vs. 5%).

Dr. Miller and Dr. Leary wrote that some neurologists are likely to recommend beta interferon or glatiramer acetate to most patients with a clinically isolated syndrome. Others, however, will choose to take a wait and see approach, reasoning that many of these patients will never progress and that others will remain well for a long time.

Dr. Miller reported that he has received research grants through his institution for companies that manufacture drugs for MS, and has also received honoraria and travel expenses from them. Dr. Leary also reported receiving travel grants for meetings from such companies, including Teva.

Between 39 million and 80 million people in the United States contracted influenza A(H1N1) between April 2009 and Dec. 12, 2009, according to data collected by the Centers for Disease Control and Prevention.

The midlevel of the estimated range is 55 million individuals. Of those infected with H1N1 influenza, an estimated 173,000-362,000 here hospitalized, and between 7,880 and 16,460 died, the CDC reported.

Adults 18-64 years of age accounted for another 32 million cases, and about 18 million children 0-17 years of age contracted the virus. There were 5 million cases among individuals 65 years of age and older.

According to two surveys (the National 2009 H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System), an estimated 61 million persons (20% of the U.S. population) had received the monovalent H1N1 vaccine by Jan. 2, 2010, including 29% of children and 22% of health care personnel (MMWR 2010;59:1-5).

About 28% of people in the initial target groups and 38% of those in the limited vaccine subset received at least one dose. The initial target groups included pregnant women, persons who live with or care for infants less than 6 months of age, young adults aged 6 months to 24 years, and persons aged 25-64 years with certain medical conditions. The limited vaccine subset included pregnant women, persons who live with or care for infants less than 6 months of age, health care and emergency services personnel, children aged 6 months to 4 years, and children aged 5-18 years with certain medical conditions.

At an estimated 33%, the vaccination rate was highest among children 6 months to 4 years of age. The lowest rate, 11%, was among adults 65 years of age and older.

“Nearly 90% of adults aged [less than] 65 years with medical conditions that increase their risk for influenza-related complications remain unvaccinated,” wrote J.A. Singleton and colleagues at the CDC.

Verbatim

'The adherence in this study was absolutely off the charts.'

Dr. Marc L. Benton, on using continuous positive airway pressure to help golfers prevent obstructive sleep apnea—and improve their golf scores,

Between 39 million and 80 million people in the United States contracted influenza A(H1N1) between April 2009 and Dec. 12, 2009, according to data collected by the Centers for Disease Control and Prevention.

The midlevel of the estimated range is 55 million individuals. Of those infected with H1N1 influenza, an estimated 173,000-362,000 here hospitalized, and between 7,880 and 16,460 died, the CDC reported.

Adults 18-64 years of age accounted for another 32 million cases, and about 18 million children 0-17 years of age contracted the virus. There were 5 million cases among individuals 65 years of age and older.

According to two surveys (the National 2009 H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System), an estimated 61 million persons (20% of the U.S. population) had received the monovalent H1N1 vaccine by Jan. 2, 2010, including 29% of children and 22% of health care personnel (MMWR 2010;59:1-5).

About 28% of people in the initial target groups and 38% of those in the limited vaccine subset received at least one dose. The initial target groups included pregnant women, persons who live with or care for infants less than 6 months of age, young adults aged 6 months to 24 years, and persons aged 25-64 years with certain medical conditions. The limited vaccine subset included pregnant women, persons who live with or care for infants less than 6 months of age, health care and emergency services personnel, children aged 6 months to 4 years, and children aged 5-18 years with certain medical conditions.

At an estimated 33%, the vaccination rate was highest among children 6 months to 4 years of age. The lowest rate, 11%, was among adults 65 years of age and older.

“Nearly 90% of adults aged [less than] 65 years with medical conditions that increase their risk for influenza-related complications remain unvaccinated,” wrote J.A. Singleton and colleagues at the CDC.

Verbatim

'The adherence in this study was absolutely off the charts.'

Dr. Marc L. Benton, on using continuous positive airway pressure to help golfers prevent obstructive sleep apnea—and improve their golf scores,

Between 39 million and 80 million people in the United States contracted influenza A(H1N1) between April 2009 and Dec. 12, 2009, according to data collected by the Centers for Disease Control and Prevention.

The midlevel of the estimated range is 55 million individuals. Of those infected with H1N1 influenza, an estimated 173,000-362,000 here hospitalized, and between 7,880 and 16,460 died, the CDC reported.

Adults 18-64 years of age accounted for another 32 million cases, and about 18 million children 0-17 years of age contracted the virus. There were 5 million cases among individuals 65 years of age and older.

According to two surveys (the National 2009 H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System), an estimated 61 million persons (20% of the U.S. population) had received the monovalent H1N1 vaccine by Jan. 2, 2010, including 29% of children and 22% of health care personnel (MMWR 2010;59:1-5).

About 28% of people in the initial target groups and 38% of those in the limited vaccine subset received at least one dose. The initial target groups included pregnant women, persons who live with or care for infants less than 6 months of age, young adults aged 6 months to 24 years, and persons aged 25-64 years with certain medical conditions. The limited vaccine subset included pregnant women, persons who live with or care for infants less than 6 months of age, health care and emergency services personnel, children aged 6 months to 4 years, and children aged 5-18 years with certain medical conditions.

At an estimated 33%, the vaccination rate was highest among children 6 months to 4 years of age. The lowest rate, 11%, was among adults 65 years of age and older.

“Nearly 90% of adults aged [less than] 65 years with medical conditions that increase their risk for influenza-related complications remain unvaccinated,” wrote J.A. Singleton and colleagues at the CDC.

Verbatim

'The adherence in this study was absolutely off the charts.'

Dr. Marc L. Benton, on using continuous positive airway pressure to help golfers prevent obstructive sleep apnea—and improve their golf scores,

Cosmeceuticals - substances that exert both cosmetic and therapeutic benefits - will be a $16 billion business in 2010, according to Dr. Michael H. Gold.

While consumers can purchase hundreds of cosmeceutical products over the counter, many have never been subject to safety and efficacy testing, he said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

As a result, dermatologists have an important role to play in advising their patients, said Dr. Gold, of Vanderbilt University, Nashville. More and more, reputable cosmeceutical companies are subjecting their products to independent testing, with the results appearing in peer-reviewed scientific literature.

Antioxidants are the most commonly used active ingredients in most cosmeceuticals. "We're doing anything we can to use natural-based ingredients, plant derivatives, fruits, and vegetables, to reverse free-radical damage and to prevent skin aging," he said in an interview. "But I think we need to understand that not every fruit, vegetable, and plant has got something in it that's good for your skin."

The list of proven antioxidants is long, but it is important to remember that while antioxidants can slow the progression of wrinkles and other signs of skin aging, they cannot reverse the progression alone.

There is one exception, according to Dr. Gold. While Vitamin C is an antioxidant with the proven ability to prevent aging and ultraviolet-induced skin damage, it has another property. Through a separate mechanism, topically applied vitamin C induces collagen formation, and, thus, can be used to treat wrinkles.

Many other products claim to improve wrinkles, but this ability is almost always due to swelling or hydrating effects. Wrinkles return in full force once the product has worn off.

Because of its unique properties, vitamin C is a component of many cosmeceuticals, but it is important to consider how each product is packaged before recommending it, he said. Vitamin C, like many other antioxidants, is quite unstable, and can easily become oxidized and inactivated long before reaching the skin.

Vitamin C is rapidly inactivated by light or UV radiation. If the product is not in a dark container, the Vitamin C will quickly degrade.

Dr. Gold also noted that many antioxidants work synergistically. Cosmeceuticals that include more than one active ingredient are likely to be better than those based on a single antioxidant.

He is particularly interested in a line of cosmeceuticals manufactured by Neocutis. (Dr. Gold acknowledged serving as a consultant to that company, and his clinic sells their products.) In addition to antioxidants, many Neocutis products are based on growth factors that have shown synergy in improving skin.

Dr. Gold has conducted studies for the Neocutis product, Bio-restorative Skin Cream. One such study found the product to be effective in treating adverse events associated with photodynamic therapy (J. Drugs Dermatol. 2006;5:796-8). Another study demonstrated that the product is effective for facial skin rejuvenation as assessed by 3D in vivo optical skin imaging (J. Drugs Dermatol. 2007;6:1018-23). And a third study, presented at the annual meeting of the American Academy of Dermatology in 2006, showed that the product was effective in treating facial elastosis.

Although the Food and Drug Administration does not regulate cosmeceuticals, and they can be sold freely over the counter, Neocutis makes its products available only through physicians. Other companies do the same, and these products tend to be stronger and more efficacious than those sold in a local pharmacy.

Dr. Gold reserved particular scorn for cosmeceuticals that are sold through multilevel marketing schemes. "There are products out there that are snake oils," he said. "If you purchase anything in a pyramid scheme or a multilevel marketing company, you're just throwing good money away. We try to buy products from reputable companies, products that have had skin testing and appropriate clinical work done on them."

^{Photo Courtesy Dr. Michael H. Gold}

Dr. Gold also disclosed being a consultant for Obagi Medical and Steifel, and being a consultant, researcher, and speaker for numerous other pharmaceutical and medical device companies.

SDEF and this news organization are owned by Elsevier.

Cosmeceuticals - substances that exert both cosmetic and therapeutic benefits - will be a $16 billion business in 2010, according to Dr. Michael H. Gold.

While consumers can purchase hundreds of cosmeceutical products over the counter, many have never been subject to safety and efficacy testing, he said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

As a result, dermatologists have an important role to play in advising their patients, said Dr. Gold, of Vanderbilt University, Nashville. More and more, reputable cosmeceutical companies are subjecting their products to independent testing, with the results appearing in peer-reviewed scientific literature.

Antioxidants are the most commonly used active ingredients in most cosmeceuticals. "We're doing anything we can to use natural-based ingredients, plant derivatives, fruits, and vegetables, to reverse free-radical damage and to prevent skin aging," he said in an interview. "But I think we need to understand that not every fruit, vegetable, and plant has got something in it that's good for your skin."

The list of proven antioxidants is long, but it is important to remember that while antioxidants can slow the progression of wrinkles and other signs of skin aging, they cannot reverse the progression alone.

There is one exception, according to Dr. Gold. While Vitamin C is an antioxidant with the proven ability to prevent aging and ultraviolet-induced skin damage, it has another property. Through a separate mechanism, topically applied vitamin C induces collagen formation, and, thus, can be used to treat wrinkles.

Many other products claim to improve wrinkles, but this ability is almost always due to swelling or hydrating effects. Wrinkles return in full force once the product has worn off.

Because of its unique properties, vitamin C is a component of many cosmeceuticals, but it is important to consider how each product is packaged before recommending it, he said. Vitamin C, like many other antioxidants, is quite unstable, and can easily become oxidized and inactivated long before reaching the skin.

Vitamin C is rapidly inactivated by light or UV radiation. If the product is not in a dark container, the Vitamin C will quickly degrade.

Dr. Gold also noted that many antioxidants work synergistically. Cosmeceuticals that include more than one active ingredient are likely to be better than those based on a single antioxidant.

He is particularly interested in a line of cosmeceuticals manufactured by Neocutis. (Dr. Gold acknowledged serving as a consultant to that company, and his clinic sells their products.) In addition to antioxidants, many Neocutis products are based on growth factors that have shown synergy in improving skin.

Dr. Gold has conducted studies for the Neocutis product, Bio-restorative Skin Cream. One such study found the product to be effective in treating adverse events associated with photodynamic therapy (J. Drugs Dermatol. 2006;5:796-8). Another study demonstrated that the product is effective for facial skin rejuvenation as assessed by 3D in vivo optical skin imaging (J. Drugs Dermatol. 2007;6:1018-23). And a third study, presented at the annual meeting of the American Academy of Dermatology in 2006, showed that the product was effective in treating facial elastosis.

Although the Food and Drug Administration does not regulate cosmeceuticals, and they can be sold freely over the counter, Neocutis makes its products available only through physicians. Other companies do the same, and these products tend to be stronger and more efficacious than those sold in a local pharmacy.

Dr. Gold reserved particular scorn for cosmeceuticals that are sold through multilevel marketing schemes. "There are products out there that are snake oils," he said. "If you purchase anything in a pyramid scheme or a multilevel marketing company, you're just throwing good money away. We try to buy products from reputable companies, products that have had skin testing and appropriate clinical work done on them."

^{Photo Courtesy Dr. Michael H. Gold}

Dr. Gold also disclosed being a consultant for Obagi Medical and Steifel, and being a consultant, researcher, and speaker for numerous other pharmaceutical and medical device companies.

SDEF and this news organization are owned by Elsevier.

Cosmeceuticals - substances that exert both cosmetic and therapeutic benefits - will be a $16 billion business in 2010, according to Dr. Michael H. Gold.

While consumers can purchase hundreds of cosmeceutical products over the counter, many have never been subject to safety and efficacy testing, he said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

As a result, dermatologists have an important role to play in advising their patients, said Dr. Gold, of Vanderbilt University, Nashville. More and more, reputable cosmeceutical companies are subjecting their products to independent testing, with the results appearing in peer-reviewed scientific literature.

Antioxidants are the most commonly used active ingredients in most cosmeceuticals. "We're doing anything we can to use natural-based ingredients, plant derivatives, fruits, and vegetables, to reverse free-radical damage and to prevent skin aging," he said in an interview. "But I think we need to understand that not every fruit, vegetable, and plant has got something in it that's good for your skin."

The list of proven antioxidants is long, but it is important to remember that while antioxidants can slow the progression of wrinkles and other signs of skin aging, they cannot reverse the progression alone.

There is one exception, according to Dr. Gold. While Vitamin C is an antioxidant with the proven ability to prevent aging and ultraviolet-induced skin damage, it has another property. Through a separate mechanism, topically applied vitamin C induces collagen formation, and, thus, can be used to treat wrinkles.

Many other products claim to improve wrinkles, but this ability is almost always due to swelling or hydrating effects. Wrinkles return in full force once the product has worn off.

Because of its unique properties, vitamin C is a component of many cosmeceuticals, but it is important to consider how each product is packaged before recommending it, he said. Vitamin C, like many other antioxidants, is quite unstable, and can easily become oxidized and inactivated long before reaching the skin.

Vitamin C is rapidly inactivated by light or UV radiation. If the product is not in a dark container, the Vitamin C will quickly degrade.

Dr. Gold also noted that many antioxidants work synergistically. Cosmeceuticals that include more than one active ingredient are likely to be better than those based on a single antioxidant.

He is particularly interested in a line of cosmeceuticals manufactured by Neocutis. (Dr. Gold acknowledged serving as a consultant to that company, and his clinic sells their products.) In addition to antioxidants, many Neocutis products are based on growth factors that have shown synergy in improving skin.

Dr. Gold has conducted studies for the Neocutis product, Bio-restorative Skin Cream. One such study found the product to be effective in treating adverse events associated with photodynamic therapy (J. Drugs Dermatol. 2006;5:796-8). Another study demonstrated that the product is effective for facial skin rejuvenation as assessed by 3D in vivo optical skin imaging (J. Drugs Dermatol. 2007;6:1018-23). And a third study, presented at the annual meeting of the American Academy of Dermatology in 2006, showed that the product was effective in treating facial elastosis.

Although the Food and Drug Administration does not regulate cosmeceuticals, and they can be sold freely over the counter, Neocutis makes its products available only through physicians. Other companies do the same, and these products tend to be stronger and more efficacious than those sold in a local pharmacy.

Dr. Gold reserved particular scorn for cosmeceuticals that are sold through multilevel marketing schemes. "There are products out there that are snake oils," he said. "If you purchase anything in a pyramid scheme or a multilevel marketing company, you're just throwing good money away. We try to buy products from reputable companies, products that have had skin testing and appropriate clinical work done on them."

^{Photo Courtesy Dr. Michael H. Gold}

Dr. Gold also disclosed being a consultant for Obagi Medical and Steifel, and being a consultant, researcher, and speaker for numerous other pharmaceutical and medical device companies.

SDEF and this news organization are owned by Elsevier.

Major Finding: Children with autism spectrum disorders need careful GI evaluations, but there's no good evidence that they have unique gastrointestinal problems or benefit from restricted diets.

Data Source: Literature review and the consensus of an interdisciplinary expert panel

Disclosures: The Autism Forum convened the panel and provided honoraria to its 14 members. One panel member reported relationships with a number of pharmaceutical companies. Another chairs an academic department that derives revenue from genetic laboratory testing.

There's no good evidence that children with autism have unique gastrointestinal disorders, nor is there convincing evidence that gluten-free or casein-free diets help these children, according to an expert panel.

The panel, convened by the Autism Forum, reached consensus on 23 statements regarding the evaluation, diagnosis, and treatment of gastrointestinal disorders in children with autism spectrum disorders (ASDs) (Pediatrics 2010;125:S1-S18).

One key recommendation was that children with ASDs need to be evaluated carefully for GI problems because many such children are nonverbal, and even those who are verbal may have difficulty describing their symptoms, such as abdominal pain.

In particular, the panel noted that children with ASDs often respond to GI symptoms by exhibiting problem behaviors such as agitation, aggression, and sleep disturbances.

The panel included experts in child psychiatry, developmental pediatrics, epidemiology, medical genetics, immunology, nursing, pediatric allergy, pediatric gastroenterology, pediatric pain, pediatric neurology, pediatric nutrition, and psychology. Dr. Timothy Buie of Harvard Medical School, Boston, was the paper's lead author.

The recommendations were based on a literature review, but without a formal meta-analysis. “Because of the absence, in general, of high-quality clinical research data, evidence-based recommendations are not possible at the present time,” the panelists wrote. “However, the panel agreed on a number of statements based on expert opinion that arose from a review of existing evidence. It is acknowledged that, in many areas, evidence is generally confined to case reports, observational or descriptive studies, and poorly controlled or uncontrolled studies.”

Among the panel's other conclusions were:

▸ Children with ASDs are subject to the same common GI disorders as neurotypical children and should be evaluated thoroughly. In particular, clinicians should be sure that these children receive a complete medical evaluation for GI disorders when they present with problem behaviors. Behavioral treatment may complement medical treatment in children with both ASDs and GI disorders, but behavioral treatment alone is not enough.

▸ The existence of “autistic enterocolitis” or other gastrointestinal disturbances unique to children with ASDs has not been established, and the evidence for abnormal gastrointestinal permeability (“leaky gut”) is limited. More research is needed in these areas, the panel said.

▸ Pediatricians and other primary care providers should be alert to nutritional problems in children with ASDs. Some of these children have narrow food preferences, and some parents may put their children on highly restrictive diets that are intended to be therapeutic but result in malnutrition.

Major Finding: Children with autism spectrum disorders need careful GI evaluations, but there's no good evidence that they have unique gastrointestinal problems or benefit from restricted diets.

Data Source: Literature review and the consensus of an interdisciplinary expert panel

Disclosures: The Autism Forum convened the panel and provided honoraria to its 14 members. One panel member reported relationships with a number of pharmaceutical companies. Another chairs an academic department that derives revenue from genetic laboratory testing.

There's no good evidence that children with autism have unique gastrointestinal disorders, nor is there convincing evidence that gluten-free or casein-free diets help these children, according to an expert panel.

The panel, convened by the Autism Forum, reached consensus on 23 statements regarding the evaluation, diagnosis, and treatment of gastrointestinal disorders in children with autism spectrum disorders (ASDs) (Pediatrics 2010;125:S1-S18).

One key recommendation was that children with ASDs need to be evaluated carefully for GI problems because many such children are nonverbal, and even those who are verbal may have difficulty describing their symptoms, such as abdominal pain.

In particular, the panel noted that children with ASDs often respond to GI symptoms by exhibiting problem behaviors such as agitation, aggression, and sleep disturbances.

The panel included experts in child psychiatry, developmental pediatrics, epidemiology, medical genetics, immunology, nursing, pediatric allergy, pediatric gastroenterology, pediatric pain, pediatric neurology, pediatric nutrition, and psychology. Dr. Timothy Buie of Harvard Medical School, Boston, was the paper's lead author.

The recommendations were based on a literature review, but without a formal meta-analysis. “Because of the absence, in general, of high-quality clinical research data, evidence-based recommendations are not possible at the present time,” the panelists wrote. “However, the panel agreed on a number of statements based on expert opinion that arose from a review of existing evidence. It is acknowledged that, in many areas, evidence is generally confined to case reports, observational or descriptive studies, and poorly controlled or uncontrolled studies.”

Among the panel's other conclusions were:

▸ Children with ASDs are subject to the same common GI disorders as neurotypical children and should be evaluated thoroughly. In particular, clinicians should be sure that these children receive a complete medical evaluation for GI disorders when they present with problem behaviors. Behavioral treatment may complement medical treatment in children with both ASDs and GI disorders, but behavioral treatment alone is not enough.

▸ The existence of “autistic enterocolitis” or other gastrointestinal disturbances unique to children with ASDs has not been established, and the evidence for abnormal gastrointestinal permeability (“leaky gut”) is limited. More research is needed in these areas, the panel said.

▸ Pediatricians and other primary care providers should be alert to nutritional problems in children with ASDs. Some of these children have narrow food preferences, and some parents may put their children on highly restrictive diets that are intended to be therapeutic but result in malnutrition.

Major Finding: Children with autism spectrum disorders need careful GI evaluations, but there's no good evidence that they have unique gastrointestinal problems or benefit from restricted diets.

Data Source: Literature review and the consensus of an interdisciplinary expert panel

Disclosures: The Autism Forum convened the panel and provided honoraria to its 14 members. One panel member reported relationships with a number of pharmaceutical companies. Another chairs an academic department that derives revenue from genetic laboratory testing.

There's no good evidence that children with autism have unique gastrointestinal disorders, nor is there convincing evidence that gluten-free or casein-free diets help these children, according to an expert panel.

The panel, convened by the Autism Forum, reached consensus on 23 statements regarding the evaluation, diagnosis, and treatment of gastrointestinal disorders in children with autism spectrum disorders (ASDs) (Pediatrics 2010;125:S1-S18).

One key recommendation was that children with ASDs need to be evaluated carefully for GI problems because many such children are nonverbal, and even those who are verbal may have difficulty describing their symptoms, such as abdominal pain.

In particular, the panel noted that children with ASDs often respond to GI symptoms by exhibiting problem behaviors such as agitation, aggression, and sleep disturbances.

The panel included experts in child psychiatry, developmental pediatrics, epidemiology, medical genetics, immunology, nursing, pediatric allergy, pediatric gastroenterology, pediatric pain, pediatric neurology, pediatric nutrition, and psychology. Dr. Timothy Buie of Harvard Medical School, Boston, was the paper's lead author.

The recommendations were based on a literature review, but without a formal meta-analysis. “Because of the absence, in general, of high-quality clinical research data, evidence-based recommendations are not possible at the present time,” the panelists wrote. “However, the panel agreed on a number of statements based on expert opinion that arose from a review of existing evidence. It is acknowledged that, in many areas, evidence is generally confined to case reports, observational or descriptive studies, and poorly controlled or uncontrolled studies.”

Among the panel's other conclusions were:

▸ Children with ASDs are subject to the same common GI disorders as neurotypical children and should be evaluated thoroughly. In particular, clinicians should be sure that these children receive a complete medical evaluation for GI disorders when they present with problem behaviors. Behavioral treatment may complement medical treatment in children with both ASDs and GI disorders, but behavioral treatment alone is not enough.

▸ The existence of “autistic enterocolitis” or other gastrointestinal disturbances unique to children with ASDs has not been established, and the evidence for abnormal gastrointestinal permeability (“leaky gut”) is limited. More research is needed in these areas, the panel said.

▸ Pediatricians and other primary care providers should be alert to nutritional problems in children with ASDs. Some of these children have narrow food preferences, and some parents may put their children on highly restrictive diets that are intended to be therapeutic but result in malnutrition.

Major Finding: Obesity, whether measured by BMI, waist circumference, or waist-to-hips ratio, is an independent predictor of stroke risk regardless of sex or race.

Data Source: A median of 17 years of follow-up with 13,549 participants in the Atherosclerosis Risk in Communities (ARIC) Study.

Disclosures: The study was funded by the National Heart, Lung, and Blood Institute. The authors stated that they had no other conflicts of interest.

Obesity was a significant risk factor for ischemic stroke, regardless of sex or race, in a longitudinal study of black and white adults.

While earlier studies have demonstrated associations between stroke and hypertension, diabetes, and smoking, data regarding an association with obesity were conflicting, Dr. Hiroshi Yatsuya of the University of Minnesota, Minneapolis, and colleagues reported.

Investigators followed 13,549 individuals for a median of 16.9 years in the most thorough demonstration yet of a significant association between obesity and stroke.

The incidence of stroke ranged from 1.2 cases per 1,000 person-years in the lowest quintile of obesity among white women to 8.0 cases per 1,000 person-years in the highest quintile of obesity among black men.

Compared with people in the lowest quintile of obesity, those in the highest quintile had an increase in the relative risk of stroke of 38% if they were black women, 89% if they were black men, 70% if they were white women, and 51% if they were white men. All these differences were statistically significant.

Those relative risks were adjusted only for age. But they changed only slightly after additional adjustments for education, smoking status, pack-years, usual alcohol consumption, and physical activity.

The statistical relationship between stroke and obesity disappeared when the investigators also controlled for systolic blood pressure, hypertension medication, and diabetes, and blood levels of HDL cholesterol, von Willebrand factor, and albumin. This suggests that one or more of those factors accounted for the relationship between stroke and obesity.

“In fact, either blood pressure or diabetes mellitus alone … could have eliminated significant associations between obesity measure quintiles and ischemic stroke incidence,” the investigators wrote (Stroke 2010;41: doi:10.1161/STROKEAHA.109.566299

Participants in the study were aged 45-64 years when they enrolled in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 to 1989.

They came from four communities: Forsyth County, N.C., Jackson, Miss., Minneapolis, Minn., and Washington County, Md.

Investigators contacted the participants by phone annually, and they also saw them during four clinic visits.

It has long been recognized that blacks have a higher risk of stroke than whites, and that men have a higher risk than women. This study confirmed that relationship and extended it across the obesity range.

The investigators found few differences in the relationship between stroke and obesity no matter how obesity was measured. Increasing body mass index, waist circumference, and waist-to-hip ratio were all significantly associated with an increased risk of stroke.

Investigators excluded ARIC participants from the stroke study if, at the time they enrolled, they had already suffered a stroke, coronary heart disease, or cancer, since those conditions and their treatment could have confounded the association between stroke and obesity. During the period of follow-up investigators tabulated 598 incident strokes.

The authors noted their findings have limited generalizability to other cultural or socioeconomic situations because the blacks in the study were primarily from one field center while the whites were from the other three.

Major Finding: Obesity, whether measured by BMI, waist circumference, or waist-to-hips ratio, is an independent predictor of stroke risk regardless of sex or race.

Data Source: A median of 17 years of follow-up with 13,549 participants in the Atherosclerosis Risk in Communities (ARIC) Study.

Disclosures: The study was funded by the National Heart, Lung, and Blood Institute. The authors stated that they had no other conflicts of interest.

Obesity was a significant risk factor for ischemic stroke, regardless of sex or race, in a longitudinal study of black and white adults.

While earlier studies have demonstrated associations between stroke and hypertension, diabetes, and smoking, data regarding an association with obesity were conflicting, Dr. Hiroshi Yatsuya of the University of Minnesota, Minneapolis, and colleagues reported.

Investigators followed 13,549 individuals for a median of 16.9 years in the most thorough demonstration yet of a significant association between obesity and stroke.

The incidence of stroke ranged from 1.2 cases per 1,000 person-years in the lowest quintile of obesity among white women to 8.0 cases per 1,000 person-years in the highest quintile of obesity among black men.

Compared with people in the lowest quintile of obesity, those in the highest quintile had an increase in the relative risk of stroke of 38% if they were black women, 89% if they were black men, 70% if they were white women, and 51% if they were white men. All these differences were statistically significant.

Those relative risks were adjusted only for age. But they changed only slightly after additional adjustments for education, smoking status, pack-years, usual alcohol consumption, and physical activity.

The statistical relationship between stroke and obesity disappeared when the investigators also controlled for systolic blood pressure, hypertension medication, and diabetes, and blood levels of HDL cholesterol, von Willebrand factor, and albumin. This suggests that one or more of those factors accounted for the relationship between stroke and obesity.

“In fact, either blood pressure or diabetes mellitus alone … could have eliminated significant associations between obesity measure quintiles and ischemic stroke incidence,” the investigators wrote (Stroke 2010;41: doi:10.1161/STROKEAHA.109.566299

Participants in the study were aged 45-64 years when they enrolled in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 to 1989.

They came from four communities: Forsyth County, N.C., Jackson, Miss., Minneapolis, Minn., and Washington County, Md.

Investigators contacted the participants by phone annually, and they also saw them during four clinic visits.

It has long been recognized that blacks have a higher risk of stroke than whites, and that men have a higher risk than women. This study confirmed that relationship and extended it across the obesity range.

The investigators found few differences in the relationship between stroke and obesity no matter how obesity was measured. Increasing body mass index, waist circumference, and waist-to-hip ratio were all significantly associated with an increased risk of stroke.

Investigators excluded ARIC participants from the stroke study if, at the time they enrolled, they had already suffered a stroke, coronary heart disease, or cancer, since those conditions and their treatment could have confounded the association between stroke and obesity. During the period of follow-up investigators tabulated 598 incident strokes.

The authors noted their findings have limited generalizability to other cultural or socioeconomic situations because the blacks in the study were primarily from one field center while the whites were from the other three.

Major Finding: Obesity, whether measured by BMI, waist circumference, or waist-to-hips ratio, is an independent predictor of stroke risk regardless of sex or race.

Data Source: A median of 17 years of follow-up with 13,549 participants in the Atherosclerosis Risk in Communities (ARIC) Study.

Disclosures: The study was funded by the National Heart, Lung, and Blood Institute. The authors stated that they had no other conflicts of interest.

Obesity was a significant risk factor for ischemic stroke, regardless of sex or race, in a longitudinal study of black and white adults.

While earlier studies have demonstrated associations between stroke and hypertension, diabetes, and smoking, data regarding an association with obesity were conflicting, Dr. Hiroshi Yatsuya of the University of Minnesota, Minneapolis, and colleagues reported.

Investigators followed 13,549 individuals for a median of 16.9 years in the most thorough demonstration yet of a significant association between obesity and stroke.

The incidence of stroke ranged from 1.2 cases per 1,000 person-years in the lowest quintile of obesity among white women to 8.0 cases per 1,000 person-years in the highest quintile of obesity among black men.

Compared with people in the lowest quintile of obesity, those in the highest quintile had an increase in the relative risk of stroke of 38% if they were black women, 89% if they were black men, 70% if they were white women, and 51% if they were white men. All these differences were statistically significant.

Those relative risks were adjusted only for age. But they changed only slightly after additional adjustments for education, smoking status, pack-years, usual alcohol consumption, and physical activity.

The statistical relationship between stroke and obesity disappeared when the investigators also controlled for systolic blood pressure, hypertension medication, and diabetes, and blood levels of HDL cholesterol, von Willebrand factor, and albumin. This suggests that one or more of those factors accounted for the relationship between stroke and obesity.

“In fact, either blood pressure or diabetes mellitus alone … could have eliminated significant associations between obesity measure quintiles and ischemic stroke incidence,” the investigators wrote (Stroke 2010;41: doi:10.1161/STROKEAHA.109.566299

Participants in the study were aged 45-64 years when they enrolled in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 to 1989.

They came from four communities: Forsyth County, N.C., Jackson, Miss., Minneapolis, Minn., and Washington County, Md.

Investigators contacted the participants by phone annually, and they also saw them during four clinic visits.

It has long been recognized that blacks have a higher risk of stroke than whites, and that men have a higher risk than women. This study confirmed that relationship and extended it across the obesity range.

The investigators found few differences in the relationship between stroke and obesity no matter how obesity was measured. Increasing body mass index, waist circumference, and waist-to-hip ratio were all significantly associated with an increased risk of stroke.

Investigators excluded ARIC participants from the stroke study if, at the time they enrolled, they had already suffered a stroke, coronary heart disease, or cancer, since those conditions and their treatment could have confounded the association between stroke and obesity. During the period of follow-up investigators tabulated 598 incident strokes.

The authors noted their findings have limited generalizability to other cultural or socioeconomic situations because the blacks in the study were primarily from one field center while the whites were from the other three.

Major Finding: The rates of teen pregnancy, birth, and abortion increased in 2006 after declining every year since 1990.

Data Source: Data compiled from national-level and state-level sources.

Disclosures: Preparation of the report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

Teen pregnancy rates increased 3% in the United States in 2006 after declining every year since 1990, according to the Guttmacher Institute.

In addition, teen births rose 4% and teen abortions rose 1% between 2005 and 2006, according to the report compiled from a variety of national and state-level sources.

The teen pregnancy rate hit its peak in 1990, with 117 pregnancies per 1,000 women aged 15-19 years. By 2005 it had declined 40%, to 70/1,000. But in 2006, the rate increased to 72/1,000.

“After more than a decade of progress, this reversal is deeply troubling,” Heather Boonstra of the Guttmacher Institute said in a statement. “It coincides with an increase in rigid abstinence-only-until-marriage programs, which received major funding boosts under the Bush administration.”

Two experts interviewed by this newspaper weren't so sure that the increase could be attributed to abstinence-only sex education.

“The temporal association between the increase in abstinence-only programs and the increase in the pregnancy rate definitely deserves closer attention,” said Dr. Lee Savio Beers of Children's National Medical Center, Washington, D.C. “It's such a multifactorial issue that we may never have an answer.”

Dr. Melissa Kottke, of the department of obstetrics and gynecology at Emory University and director of the Jane Fonda Center for Adolescent Reproductive Health, both in Atlanta, said, “I think there's going to be a lot of things contributing to [increases in teen pregnancy rates], and I don't think we're going to know what all of those are.”

Among those contributors according to Dr. Kottke: teenage sexual activity, poverty, the media, parenting, funding for care, and funding for family planning services.

“All of those things are going to contribute,” she said, “and I don't think we're going to be able to point our finger at one thing or the other.”

About the Guttmacher Institute, Dr. Beers said, “They're a well-respected organization. Their policy views tend to be on the liberal side. But I think everyone pretty much agrees that their facts are good, and their numbers are good, and for pregnancy numbers, they're better than pretty much anyone.”

Although the long decline and recent uptick in teen pregnancy rates were seen in blacks, Hispanics, and non-Hispanic whites, there were some substantial racial and ethic differences. (See chart.) Among black teens, the pregnancy rate increased 2.4%, to 126/1,000, in 2006.

Among Hispanic teens, the pregnancy rate increased 1% to 127/1,000 in 2006. Among non-Hispanic whites, the rate increased 2% to 44/1,000 in 2006.

Dr. Kottke said there's evidence the 1-year uptick is not a statistical fluke. She's seen preliminary data for 2007 indicating that teen pregnancy, birth, and abortion rates increased for a second year.

Vitals

Source Elsevier Global Medical News

Major Finding: The rates of teen pregnancy, birth, and abortion increased in 2006 after declining every year since 1990.

Data Source: Data compiled from national-level and state-level sources.

Disclosures: Preparation of the report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

Teen pregnancy rates increased 3% in the United States in 2006 after declining every year since 1990, according to the Guttmacher Institute.

In addition, teen births rose 4% and teen abortions rose 1% between 2005 and 2006, according to the report compiled from a variety of national and state-level sources.

The teen pregnancy rate hit its peak in 1990, with 117 pregnancies per 1,000 women aged 15-19 years. By 2005 it had declined 40%, to 70/1,000. But in 2006, the rate increased to 72/1,000.

“After more than a decade of progress, this reversal is deeply troubling,” Heather Boonstra of the Guttmacher Institute said in a statement. “It coincides with an increase in rigid abstinence-only-until-marriage programs, which received major funding boosts under the Bush administration.”

Two experts interviewed by this newspaper weren't so sure that the increase could be attributed to abstinence-only sex education.

“The temporal association between the increase in abstinence-only programs and the increase in the pregnancy rate definitely deserves closer attention,” said Dr. Lee Savio Beers of Children's National Medical Center, Washington, D.C. “It's such a multifactorial issue that we may never have an answer.”

Dr. Melissa Kottke, of the department of obstetrics and gynecology at Emory University and director of the Jane Fonda Center for Adolescent Reproductive Health, both in Atlanta, said, “I think there's going to be a lot of things contributing to [increases in teen pregnancy rates], and I don't think we're going to know what all of those are.”

Among those contributors according to Dr. Kottke: teenage sexual activity, poverty, the media, parenting, funding for care, and funding for family planning services.

“All of those things are going to contribute,” she said, “and I don't think we're going to be able to point our finger at one thing or the other.”

About the Guttmacher Institute, Dr. Beers said, “They're a well-respected organization. Their policy views tend to be on the liberal side. But I think everyone pretty much agrees that their facts are good, and their numbers are good, and for pregnancy numbers, they're better than pretty much anyone.”

Although the long decline and recent uptick in teen pregnancy rates were seen in blacks, Hispanics, and non-Hispanic whites, there were some substantial racial and ethic differences. (See chart.) Among black teens, the pregnancy rate increased 2.4%, to 126/1,000, in 2006.

Among Hispanic teens, the pregnancy rate increased 1% to 127/1,000 in 2006. Among non-Hispanic whites, the rate increased 2% to 44/1,000 in 2006.

Dr. Kottke said there's evidence the 1-year uptick is not a statistical fluke. She's seen preliminary data for 2007 indicating that teen pregnancy, birth, and abortion rates increased for a second year.

Vitals

Source Elsevier Global Medical News

Major Finding: The rates of teen pregnancy, birth, and abortion increased in 2006 after declining every year since 1990.

Data Source: Data compiled from national-level and state-level sources.

Disclosures: Preparation of the report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

Teen pregnancy rates increased 3% in the United States in 2006 after declining every year since 1990, according to the Guttmacher Institute.

In addition, teen births rose 4% and teen abortions rose 1% between 2005 and 2006, according to the report compiled from a variety of national and state-level sources.

The teen pregnancy rate hit its peak in 1990, with 117 pregnancies per 1,000 women aged 15-19 years. By 2005 it had declined 40%, to 70/1,000. But in 2006, the rate increased to 72/1,000.

“After more than a decade of progress, this reversal is deeply troubling,” Heather Boonstra of the Guttmacher Institute said in a statement. “It coincides with an increase in rigid abstinence-only-until-marriage programs, which received major funding boosts under the Bush administration.”

Two experts interviewed by this newspaper weren't so sure that the increase could be attributed to abstinence-only sex education.

“The temporal association between the increase in abstinence-only programs and the increase in the pregnancy rate definitely deserves closer attention,” said Dr. Lee Savio Beers of Children's National Medical Center, Washington, D.C. “It's such a multifactorial issue that we may never have an answer.”

Dr. Melissa Kottke, of the department of obstetrics and gynecology at Emory University and director of the Jane Fonda Center for Adolescent Reproductive Health, both in Atlanta, said, “I think there's going to be a lot of things contributing to [increases in teen pregnancy rates], and I don't think we're going to know what all of those are.”

Among those contributors according to Dr. Kottke: teenage sexual activity, poverty, the media, parenting, funding for care, and funding for family planning services.

“All of those things are going to contribute,” she said, “and I don't think we're going to be able to point our finger at one thing or the other.”

About the Guttmacher Institute, Dr. Beers said, “They're a well-respected organization. Their policy views tend to be on the liberal side. But I think everyone pretty much agrees that their facts are good, and their numbers are good, and for pregnancy numbers, they're better than pretty much anyone.”

Although the long decline and recent uptick in teen pregnancy rates were seen in blacks, Hispanics, and non-Hispanic whites, there were some substantial racial and ethic differences. (See chart.) Among black teens, the pregnancy rate increased 2.4%, to 126/1,000, in 2006.

Among Hispanic teens, the pregnancy rate increased 1% to 127/1,000 in 2006. Among non-Hispanic whites, the rate increased 2% to 44/1,000 in 2006.

Dr. Kottke said there's evidence the 1-year uptick is not a statistical fluke. She's seen preliminary data for 2007 indicating that teen pregnancy, birth, and abortion rates increased for a second year.

Vitals

Source Elsevier Global Medical News

Major Finding: African Americans were 60% less likely to receive pharmacotherapy and 40% less likely to receive psychotherapy than were non-Latino whites with depression. The results for receiving “any depression therapy” were 30% for Caribbean blacks vs. 54% for non-Latino whites

Data Source: Nationally representative sample of 15,762 adults in the Collaborative Psychiatric Epidemiology Surveys. Nationally representative sample of 6,504 adolescents in the National Longitudinal Study of Adolescent Health.

Disclosures: None of the investigators in either study reported relevant conflicts.

Two recent studies highlight some surprising racial and ethnic disparities in the origin of depression and its treatment among adults and adolescents in the United States.

For example, in one of the studies, the investigators identified a large gap between the percentage of Caribbean blacks and non-Latino whites who met 12-month major depressive episode criteria and received “any depression therapy.”

In another study, researchers were able to identify a variety of risk factors for depression in European American adolescents. However, a single demographic variable emerged as a dominant predictor of depression in African Americans.

In the first study, investigators analyzed survey data from three nationally representative samples of Americans aged 18 years and older, totaling 15,762 individuals. Hector M. González, Ph.D., of Wayne State University, Detroit, and his colleagues, determined that 8.3% of those surveyed met DSM-IV criteria for major depression during the previous 12 months. After controlling for sex, sample sizes, and other factors, no significant differences were found among African Americans, Mexican Americans, Puerto Ricans, Caribbean blacks, and non-Latino whites in the rate of depression (Arch. Gen. Psychiatry 2010;67:37-46).

After correcting for age, sex, education, health insurance, and household income, African Americans were 60% less likely to receive pharmacotherapy and 40% less likely to receive psychotherapy than were non-Latino whites. The other groups did not differ significantly on that measure.

But receiving some therapy does not imply that a patient receives adequate therapy. The survey data allowed investigators to estimate how many of people with depression were receiving adequate therapy, that is, therapy concordant with published treatment guidelines. Overall, only 11% of the depressed individuals received guideline-concordant pharmacotherapy, and only 19% received guideline-concordant psychotherapy.

Caribbean blacks fared worst on this measure, being 95% less likely to receive guideline-concordant pharmacotherapy than were non-Latino whites. Whether an individual had health insurance was another significant independent predictor of depression treatment.

In the other study, Dr. Benjamin W. Van Voorhees of the University of Chicago and his colleagues analyzed data from a survey conducted in the mid 1990s of a national representative sample of 6,504 adolescents in grades 7-12. As judged by a five-item version of the Centers for Epidemiological Study-Depréssion (CES-D) scale, the investigators determined that African Americans had a slightly higher incidence of depressive episodes than did European Americans (11.5% vs. 8.6%) (J. Natl. Med. Assoc. 2009;101:1255-67).

In a multiple exposure model that corrected for a large number of variables, the demographic variable “neither parent finished high school” emerged as overwhelmingly associated with depression in African Americans, conferring a 21-fold increase in relative risk. Other significant factors for African Americans were “rates survival until age 35 unlikely,” (relative risk 2.62), “got headaches over the previous year,” (relative risk 3.34), and “reports trouble getting along with your teachers,” (relative risk 2.69).

For European Americans, seven factors emerged as significant in the multiple exposure model. The one with the highest relative risk was “friend attempted suicide,” (relative risk 5.16).

The investigators concluded that “the typical framework for risk that focuses heavily on affect and cognition may have been heavily influenced by the predominance of European American youth in previous studies,” and that African Americans might have “unmeasured resiliency factors that protect them in the face of factors [that] increase the risk of episodes among European Americans.

My Take

Low Treatment Rates Dismaying

Both of these studies underscore the importance of making care accessible in different communities, perhaps using different strategies. They also may help us identify factors that can be targeted in treatment for various populations.

The article by Dr. Gonzalez and colleagues was intriguing—and dismaying. The definitions they used for pharmacotherapy gave a tremendous amount of latitude for calling a treatment “guideline-concordant.” It suggests that things are bad now, but they're probably even worse than they appear to be.

Although we've known for decades that depression is often not treated, and even when it is treated, even in academic centers, it's not treated well, these results show just how staggeringly low treatment rates are.

Dr. Van Voorhees and colleagues report that risk factors for depression vary depending on the ethnicity of the respondent. It's surprising that for African American youths, demographic features were predictive. It suggests that African Americans may have a resilience to environmental stressors. On the other hand, that risk factors for depression in African Americans are mostly demographic is disappointing, since those are factors we can't change.

Major Finding: African Americans were 60% less likely to receive pharmacotherapy and 40% less likely to receive psychotherapy than were non-Latino whites with depression. The results for receiving “any depression therapy” were 30% for Caribbean blacks vs. 54% for non-Latino whites

Data Source: Nationally representative sample of 15,762 adults in the Collaborative Psychiatric Epidemiology Surveys. Nationally representative sample of 6,504 adolescents in the National Longitudinal Study of Adolescent Health.

Disclosures: None of the investigators in either study reported relevant conflicts.

Two recent studies highlight some surprising racial and ethnic disparities in the origin of depression and its treatment among adults and adolescents in the United States.

For example, in one of the studies, the investigators identified a large gap between the percentage of Caribbean blacks and non-Latino whites who met 12-month major depressive episode criteria and received “any depression therapy.”

In another study, researchers were able to identify a variety of risk factors for depression in European American adolescents. However, a single demographic variable emerged as a dominant predictor of depression in African Americans.

In the first study, investigators analyzed survey data from three nationally representative samples of Americans aged 18 years and older, totaling 15,762 individuals. Hector M. González, Ph.D., of Wayne State University, Detroit, and his colleagues, determined that 8.3% of those surveyed met DSM-IV criteria for major depression during the previous 12 months. After controlling for sex, sample sizes, and other factors, no significant differences were found among African Americans, Mexican Americans, Puerto Ricans, Caribbean blacks, and non-Latino whites in the rate of depression (Arch. Gen. Psychiatry 2010;67:37-46).

After correcting for age, sex, education, health insurance, and household income, African Americans were 60% less likely to receive pharmacotherapy and 40% less likely to receive psychotherapy than were non-Latino whites. The other groups did not differ significantly on that measure.

But receiving some therapy does not imply that a patient receives adequate therapy. The survey data allowed investigators to estimate how many of people with depression were receiving adequate therapy, that is, therapy concordant with published treatment guidelines. Overall, only 11% of the depressed individuals received guideline-concordant pharmacotherapy, and only 19% received guideline-concordant psychotherapy.

Caribbean blacks fared worst on this measure, being 95% less likely to receive guideline-concordant pharmacotherapy than were non-Latino whites. Whether an individual had health insurance was another significant independent predictor of depression treatment.

In the other study, Dr. Benjamin W. Van Voorhees of the University of Chicago and his colleagues analyzed data from a survey conducted in the mid 1990s of a national representative sample of 6,504 adolescents in grades 7-12. As judged by a five-item version of the Centers for Epidemiological Study-Depréssion (CES-D) scale, the investigators determined that African Americans had a slightly higher incidence of depressive episodes than did European Americans (11.5% vs. 8.6%) (J. Natl. Med. Assoc. 2009;101:1255-67).

In a multiple exposure model that corrected for a large number of variables, the demographic variable “neither parent finished high school” emerged as overwhelmingly associated with depression in African Americans, conferring a 21-fold increase in relative risk. Other significant factors for African Americans were “rates survival until age 35 unlikely,” (relative risk 2.62), “got headaches over the previous year,” (relative risk 3.34), and “reports trouble getting along with your teachers,” (relative risk 2.69).

For European Americans, seven factors emerged as significant in the multiple exposure model. The one with the highest relative risk was “friend attempted suicide,” (relative risk 5.16).

The investigators concluded that “the typical framework for risk that focuses heavily on affect and cognition may have been heavily influenced by the predominance of European American youth in previous studies,” and that African Americans might have “unmeasured resiliency factors that protect them in the face of factors [that] increase the risk of episodes among European Americans.

My Take

Low Treatment Rates Dismaying

Both of these studies underscore the importance of making care accessible in different communities, perhaps using different strategies. They also may help us identify factors that can be targeted in treatment for various populations.

The article by Dr. Gonzalez and colleagues was intriguing—and dismaying. The definitions they used for pharmacotherapy gave a tremendous amount of latitude for calling a treatment “guideline-concordant.” It suggests that things are bad now, but they're probably even worse than they appear to be.

Although we've known for decades that depression is often not treated, and even when it is treated, even in academic centers, it's not treated well, these results show just how staggeringly low treatment rates are.

Dr. Van Voorhees and colleagues report that risk factors for depression vary depending on the ethnicity of the respondent. It's surprising that for African American youths, demographic features were predictive. It suggests that African Americans may have a resilience to environmental stressors. On the other hand, that risk factors for depression in African Americans are mostly demographic is disappointing, since those are factors we can't change.

Major Finding: African Americans were 60% less likely to receive pharmacotherapy and 40% less likely to receive psychotherapy than were non-Latino whites with depression. The results for receiving “any depression therapy” were 30% for Caribbean blacks vs. 54% for non-Latino whites

Data Source: Nationally representative sample of 15,762 adults in the Collaborative Psychiatric Epidemiology Surveys. Nationally representative sample of 6,504 adolescents in the National Longitudinal Study of Adolescent Health.

Disclosures: None of the investigators in either study reported relevant conflicts.

Two recent studies highlight some surprising racial and ethnic disparities in the origin of depression and its treatment among adults and adolescents in the United States.

For example, in one of the studies, the investigators identified a large gap between the percentage of Caribbean blacks and non-Latino whites who met 12-month major depressive episode criteria and received “any depression therapy.”

In another study, researchers were able to identify a variety of risk factors for depression in European American adolescents. However, a single demographic variable emerged as a dominant predictor of depression in African Americans.

In the first study, investigators analyzed survey data from three nationally representative samples of Americans aged 18 years and older, totaling 15,762 individuals. Hector M. González, Ph.D., of Wayne State University, Detroit, and his colleagues, determined that 8.3% of those surveyed met DSM-IV criteria for major depression during the previous 12 months. After controlling for sex, sample sizes, and other factors, no significant differences were found among African Americans, Mexican Americans, Puerto Ricans, Caribbean blacks, and non-Latino whites in the rate of depression (Arch. Gen. Psychiatry 2010;67:37-46).

After correcting for age, sex, education, health insurance, and household income, African Americans were 60% less likely to receive pharmacotherapy and 40% less likely to receive psychotherapy than were non-Latino whites. The other groups did not differ significantly on that measure.

But receiving some therapy does not imply that a patient receives adequate therapy. The survey data allowed investigators to estimate how many of people with depression were receiving adequate therapy, that is, therapy concordant with published treatment guidelines. Overall, only 11% of the depressed individuals received guideline-concordant pharmacotherapy, and only 19% received guideline-concordant psychotherapy.

Caribbean blacks fared worst on this measure, being 95% less likely to receive guideline-concordant pharmacotherapy than were non-Latino whites. Whether an individual had health insurance was another significant independent predictor of depression treatment.

In the other study, Dr. Benjamin W. Van Voorhees of the University of Chicago and his colleagues analyzed data from a survey conducted in the mid 1990s of a national representative sample of 6,504 adolescents in grades 7-12. As judged by a five-item version of the Centers for Epidemiological Study-Depréssion (CES-D) scale, the investigators determined that African Americans had a slightly higher incidence of depressive episodes than did European Americans (11.5% vs. 8.6%) (J. Natl. Med. Assoc. 2009;101:1255-67).

In a multiple exposure model that corrected for a large number of variables, the demographic variable “neither parent finished high school” emerged as overwhelmingly associated with depression in African Americans, conferring a 21-fold increase in relative risk. Other significant factors for African Americans were “rates survival until age 35 unlikely,” (relative risk 2.62), “got headaches over the previous year,” (relative risk 3.34), and “reports trouble getting along with your teachers,” (relative risk 2.69).

For European Americans, seven factors emerged as significant in the multiple exposure model. The one with the highest relative risk was “friend attempted suicide,” (relative risk 5.16).

The investigators concluded that “the typical framework for risk that focuses heavily on affect and cognition may have been heavily influenced by the predominance of European American youth in previous studies,” and that African Americans might have “unmeasured resiliency factors that protect them in the face of factors [that] increase the risk of episodes among European Americans.

My Take

Low Treatment Rates Dismaying

Both of these studies underscore the importance of making care accessible in different communities, perhaps using different strategies. They also may help us identify factors that can be targeted in treatment for various populations.

The article by Dr. Gonzalez and colleagues was intriguing—and dismaying. The definitions they used for pharmacotherapy gave a tremendous amount of latitude for calling a treatment “guideline-concordant.” It suggests that things are bad now, but they're probably even worse than they appear to be.

Although we've known for decades that depression is often not treated, and even when it is treated, even in academic centers, it's not treated well, these results show just how staggeringly low treatment rates are.

Dr. Van Voorhees and colleagues report that risk factors for depression vary depending on the ethnicity of the respondent. It's surprising that for African American youths, demographic features were predictive. It suggests that African Americans may have a resilience to environmental stressors. On the other hand, that risk factors for depression in African Americans are mostly demographic is disappointing, since those are factors we can't change.

Major Finding: The rates of teen pregnancy, birth, and abortion increased in 2006 after declining every year since 1990.

Data Source: Data compiled from national-level and state-level sources.

Disclosures: Preparation of the report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

Teen pregnancy rates increased 3% in the United States in 2006 after declining every year since 1990, according to a report from the Guttmacher Institute.

In addition, teen births rose 4% and teen abortions rose 1% between 2005 and 2006, according to the report, which the institute compiled from a variety of national and state-level sources.

The teen pregnancy rate hit its peak in 1990, with 117 pregnancies per 1,000 women aged 15-19 years. By 2005 it had declined 40%, to 70/1,000. But in 2006, the rate increased to 72/1,000.

“After more than a decade of progress, this reversal is deeply troubling,” Heather Boonstra, a senior public policy associate at the Guttmacher Institute, said in a prepared statement. “It coincides with an increase in rigid abstinence-only-until-marriage programs, which received major funding boosts under the Bush administration. A strong body of research shows that these programs do not work. Fortunately, the heyday of this failed experiment has come to an end with the enactment of a new teen pregnancy prevention initiative that ensures that programs will be age appropriate, medically accurate, and, most importantly, based on research demonstrating their effectiveness.”

Two experts interviewed by this news organization weren't so sure that the increase in pregnancy rates could be attributed to abstinence-only sex education. “The temporal association between the increase in abstinence-only programs and the increase in the pregnancy rate definitely deserves closer attention,” said Dr. Lee Savio Beers, a pediatrician who is director of the healthy generations clinic at Children's National Medical Center, Washington, D.C. “I don't know that anyone knows for sure whether it's directly related, but the two kind of came together. It's such a multifactorial issue that we may never have an answer on that.”

Dr. Melissa Kottke, who is with the department of ob.gyn. at Emory University and is director of the Jane Fonda Center for Adolescent Reproductive Health, both in Atlanta, said, “I think there's going to be a lot of things contributing to [increases in teen pregnancy rates], and I don't think we're going to know what all of those are.”

Dr. Kottke listed some of the other possibilities: teenage sexual activity, poverty, the media, parenting, funding for care, and funding for family planning services. “All of those things are going to contribute,” she said, “and I don't think we're going to be able to point our finger at one thing or the other.”

About the Guttmacher Institute, Dr. Beers said, “They're a well-respected organization. Their policy views tend to be on the liberal side. But I think everyone pretty much agrees that their facts are good, and their numbers are good, and for pregnancy numbers, they're better than pretty much anyone.”

Although the long decline and recent uptick in teen pregnancy rates were seen in blacks, Hispanics, and non-Hispanic whites, there were some substantial racial and ethic differences. Among black teens, the pregnancy rate declined by 45%, from 224/1,000 in 1990 to 123/1,000 in 2005, and then increased 2.4%, to 126/1,000 in 2006.

Among Hispanic teens, the pregnancy rate declined by 26%, from 170/1,000 in 1992 to 125/1,000 in 2005, and then increased 1% to 127/1,000 in 2006.

And among non-Hispanic whites, the rate declined by 51%, from 87/1,000 in 1990 to 43/1,000 in 2005, and then increased 2% to 44/1,000 in 2006.

State-level data were not available for 2006, but in 2005 the highest teen pregnancy rates were in New Mexico (93/1,000), Nevada (90/1,000), and Arizona (89/1,000). The lowest rates were in New Hampshire (33/1,000), Vermont (49/1,000), and Maine (48/1,000).

Although there has been a long decline in the teen pregnancy rate in the United States, even at their low point in 2005, the U.S. teen pregnancy, birth, and abortion rates were still way above those for all other developed nations, Dr. Beers said.

And Dr. Kottke said that there's already evidence that the 1-year uptick is not a statistical fluke. She's seen preliminary data for 2007 indicating that the increase in teen pregnancy, birth, and abortion rates increased for a second year.

Physicians have a unique opportunity to help turn these numbers around, she said. “What we know is that young people still trust their physicians, and they look to their physicians for important education. Physicians who are serving young teens need to make sure they are an avenue for education, for care, and for confidentiality.”

The Guttmacher Institute's report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

The full report is available at www.guttmacher.org/pubs/USTPtrends.pdf

Vitals

Source Elsevier Global Medical News

Major Finding: The rates of teen pregnancy, birth, and abortion increased in 2006 after declining every year since 1990.

Data Source: Data compiled from national-level and state-level sources.

Disclosures: Preparation of the report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

Teen pregnancy rates increased 3% in the United States in 2006 after declining every year since 1990, according to a report from the Guttmacher Institute.

In addition, teen births rose 4% and teen abortions rose 1% between 2005 and 2006, according to the report, which the institute compiled from a variety of national and state-level sources.

The teen pregnancy rate hit its peak in 1990, with 117 pregnancies per 1,000 women aged 15-19 years. By 2005 it had declined 40%, to 70/1,000. But in 2006, the rate increased to 72/1,000.

“After more than a decade of progress, this reversal is deeply troubling,” Heather Boonstra, a senior public policy associate at the Guttmacher Institute, said in a prepared statement. “It coincides with an increase in rigid abstinence-only-until-marriage programs, which received major funding boosts under the Bush administration. A strong body of research shows that these programs do not work. Fortunately, the heyday of this failed experiment has come to an end with the enactment of a new teen pregnancy prevention initiative that ensures that programs will be age appropriate, medically accurate, and, most importantly, based on research demonstrating their effectiveness.”

Two experts interviewed by this news organization weren't so sure that the increase in pregnancy rates could be attributed to abstinence-only sex education. “The temporal association between the increase in abstinence-only programs and the increase in the pregnancy rate definitely deserves closer attention,” said Dr. Lee Savio Beers, a pediatrician who is director of the healthy generations clinic at Children's National Medical Center, Washington, D.C. “I don't know that anyone knows for sure whether it's directly related, but the two kind of came together. It's such a multifactorial issue that we may never have an answer on that.”

Dr. Melissa Kottke, who is with the department of ob.gyn. at Emory University and is director of the Jane Fonda Center for Adolescent Reproductive Health, both in Atlanta, said, “I think there's going to be a lot of things contributing to [increases in teen pregnancy rates], and I don't think we're going to know what all of those are.”

Dr. Kottke listed some of the other possibilities: teenage sexual activity, poverty, the media, parenting, funding for care, and funding for family planning services. “All of those things are going to contribute,” she said, “and I don't think we're going to be able to point our finger at one thing or the other.”

About the Guttmacher Institute, Dr. Beers said, “They're a well-respected organization. Their policy views tend to be on the liberal side. But I think everyone pretty much agrees that their facts are good, and their numbers are good, and for pregnancy numbers, they're better than pretty much anyone.”

Although the long decline and recent uptick in teen pregnancy rates were seen in blacks, Hispanics, and non-Hispanic whites, there were some substantial racial and ethic differences. Among black teens, the pregnancy rate declined by 45%, from 224/1,000 in 1990 to 123/1,000 in 2005, and then increased 2.4%, to 126/1,000 in 2006.

Among Hispanic teens, the pregnancy rate declined by 26%, from 170/1,000 in 1992 to 125/1,000 in 2005, and then increased 1% to 127/1,000 in 2006.

And among non-Hispanic whites, the rate declined by 51%, from 87/1,000 in 1990 to 43/1,000 in 2005, and then increased 2% to 44/1,000 in 2006.

State-level data were not available for 2006, but in 2005 the highest teen pregnancy rates were in New Mexico (93/1,000), Nevada (90/1,000), and Arizona (89/1,000). The lowest rates were in New Hampshire (33/1,000), Vermont (49/1,000), and Maine (48/1,000).

Although there has been a long decline in the teen pregnancy rate in the United States, even at their low point in 2005, the U.S. teen pregnancy, birth, and abortion rates were still way above those for all other developed nations, Dr. Beers said.

And Dr. Kottke said that there's already evidence that the 1-year uptick is not a statistical fluke. She's seen preliminary data for 2007 indicating that the increase in teen pregnancy, birth, and abortion rates increased for a second year.

Physicians have a unique opportunity to help turn these numbers around, she said. “What we know is that young people still trust their physicians, and they look to their physicians for important education. Physicians who are serving young teens need to make sure they are an avenue for education, for care, and for confidentiality.”

The Guttmacher Institute's report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

The full report is available at www.guttmacher.org/pubs/USTPtrends.pdf

Vitals

Source Elsevier Global Medical News

Major Finding: The rates of teen pregnancy, birth, and abortion increased in 2006 after declining every year since 1990.

Data Source: Data compiled from national-level and state-level sources.

Disclosures: Preparation of the report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

Teen pregnancy rates increased 3% in the United States in 2006 after declining every year since 1990, according to a report from the Guttmacher Institute.

In addition, teen births rose 4% and teen abortions rose 1% between 2005 and 2006, according to the report, which the institute compiled from a variety of national and state-level sources.

The teen pregnancy rate hit its peak in 1990, with 117 pregnancies per 1,000 women aged 15-19 years. By 2005 it had declined 40%, to 70/1,000. But in 2006, the rate increased to 72/1,000.

“After more than a decade of progress, this reversal is deeply troubling,” Heather Boonstra, a senior public policy associate at the Guttmacher Institute, said in a prepared statement. “It coincides with an increase in rigid abstinence-only-until-marriage programs, which received major funding boosts under the Bush administration. A strong body of research shows that these programs do not work. Fortunately, the heyday of this failed experiment has come to an end with the enactment of a new teen pregnancy prevention initiative that ensures that programs will be age appropriate, medically accurate, and, most importantly, based on research demonstrating their effectiveness.”

Two experts interviewed by this news organization weren't so sure that the increase in pregnancy rates could be attributed to abstinence-only sex education. “The temporal association between the increase in abstinence-only programs and the increase in the pregnancy rate definitely deserves closer attention,” said Dr. Lee Savio Beers, a pediatrician who is director of the healthy generations clinic at Children's National Medical Center, Washington, D.C. “I don't know that anyone knows for sure whether it's directly related, but the two kind of came together. It's such a multifactorial issue that we may never have an answer on that.”

Dr. Melissa Kottke, who is with the department of ob.gyn. at Emory University and is director of the Jane Fonda Center for Adolescent Reproductive Health, both in Atlanta, said, “I think there's going to be a lot of things contributing to [increases in teen pregnancy rates], and I don't think we're going to know what all of those are.”

Dr. Kottke listed some of the other possibilities: teenage sexual activity, poverty, the media, parenting, funding for care, and funding for family planning services. “All of those things are going to contribute,” she said, “and I don't think we're going to be able to point our finger at one thing or the other.”

About the Guttmacher Institute, Dr. Beers said, “They're a well-respected organization. Their policy views tend to be on the liberal side. But I think everyone pretty much agrees that their facts are good, and their numbers are good, and for pregnancy numbers, they're better than pretty much anyone.”

Although the long decline and recent uptick in teen pregnancy rates were seen in blacks, Hispanics, and non-Hispanic whites, there were some substantial racial and ethic differences. Among black teens, the pregnancy rate declined by 45%, from 224/1,000 in 1990 to 123/1,000 in 2005, and then increased 2.4%, to 126/1,000 in 2006.

Among Hispanic teens, the pregnancy rate declined by 26%, from 170/1,000 in 1992 to 125/1,000 in 2005, and then increased 1% to 127/1,000 in 2006.

And among non-Hispanic whites, the rate declined by 51%, from 87/1,000 in 1990 to 43/1,000 in 2005, and then increased 2% to 44/1,000 in 2006.

State-level data were not available for 2006, but in 2005 the highest teen pregnancy rates were in New Mexico (93/1,000), Nevada (90/1,000), and Arizona (89/1,000). The lowest rates were in New Hampshire (33/1,000), Vermont (49/1,000), and Maine (48/1,000).

Although there has been a long decline in the teen pregnancy rate in the United States, even at their low point in 2005, the U.S. teen pregnancy, birth, and abortion rates were still way above those for all other developed nations, Dr. Beers said.

And Dr. Kottke said that there's already evidence that the 1-year uptick is not a statistical fluke. She's seen preliminary data for 2007 indicating that the increase in teen pregnancy, birth, and abortion rates increased for a second year.

Physicians have a unique opportunity to help turn these numbers around, she said. “What we know is that young people still trust their physicians, and they look to their physicians for important education. Physicians who are serving young teens need to make sure they are an avenue for education, for care, and for confidentiality.”

The Guttmacher Institute's report was funded by the Brush Foundation, the California Wellness Foundation, and the Annie E. Casey Foundation.

The full report is available at www.guttmacher.org/pubs/USTPtrends.pdf

Vitals

Source Elsevier Global Medical News

SAN FRANCISCO — A proper evaluation of a palpable breast mass is important not only for quality of care but also because a delayed cancer diagnosis due to a negative clinical exam or a negative mammogram is a primary cause of malpractice awards in this area, according to Dr. Leah Karliner.

Studies have shown that over a 10-year period, about 16% of women aged 40-69 years bring a concern about their breasts to primary care physicians.

While the majority of palpable breast masses turn out to be benign cysts or fibroadenomas, breast cancer is found in 11% of women complaining of a breast lump and 4% of women with any breast complaint, she said said at a meeting on women's health sponsored by the University of California, San Francisco.

The classic characteristics of a malignant mass are well known. Cancer is more likely if there is a single lesion, if it's hard and immovable, if it has irregular borders, and if it's 2 cm or more in diameter.

“Unfortunately, cancers are often soft and cystic, movable, regular, [and] small,” said Dr. Karliner of the division of general internal medicine at the university. Furthermore, “benign lesions can be single, like cancers are supposed to be.”

With the clinical characteristics so unreliable, Dr. Karliner recommended the following algorithm when evaluating a woman with a palpable mass. Decisions are fairly simple for older women, those above the age of 30-35 years. All such women who come in complaining of a mass should receive a diagnostic mammogram, both to evaluate the mass and to search for occult malignancies elsewhere in the same breast. According to one study of 41,000 women with self-reported breast lumps, diagnostic mammography alone has a sensitivity of 87.3% and a specificity of 84.5%.

But that means diagnostic mammography misses 10%-20% of breast cancers. The addition of ultrasound to the mammogram, however, increases the negative predictive value to 97%.

The so-called triple diagnosis, consisting of a physical exam, mammography, and skilled fine-needle aspiration (FNA) biopsy, misses very few cancers, Dr. Karliner said. If all three tests are negative, it's safe to schedule follow-up exams every 3-6 months for a year. If all three are positive, the patient should be referred for definitive treatment. And if any one test is suggestive of malignancy, the patient should have a core or excisional biopsy.

The algorithm for younger women presenting with a self-reported lump has a more complex decision tree, with the evaluation depending on whether the physician can feel the lump and whether the woman is at high risk.

If the physician can't feel a dominant mass on physical exam and the woman is of average risk, she should return in 2-3 months for a reexamination, and if the lump is then palpable she should undergo a further work-up.

If the physician can't feel a dominant mass and the woman is at high risk, with first-degree relatives who had cancer at a young age, she should be referred to a breast surgeon or clinic. The surgeon or clinic may choose to do a further work-up or simply to follow her closely.

If the physician can feel a palpable lump in a younger woman, and if she's at average risk and the exam is not concerning, she should return for a reexamination 3-10 days after her next menses.

If that younger woman with a palpable lump is at high risk, or if the exam is concerning, “you want an ultrasound first, if the mass doesn't feel cystic,” she said. “If the mass does feel cystic, it's an option to go ahead and FNA it first, and see if you can resolve the mass with that.

Disclosures: None was reported.

SAN FRANCISCO — A proper evaluation of a palpable breast mass is important not only for quality of care but also because a delayed cancer diagnosis due to a negative clinical exam or a negative mammogram is a primary cause of malpractice awards in this area, according to Dr. Leah Karliner.

Studies have shown that over a 10-year period, about 16% of women aged 40-69 years bring a concern about their breasts to primary care physicians.

While the majority of palpable breast masses turn out to be benign cysts or fibroadenomas, breast cancer is found in 11% of women complaining of a breast lump and 4% of women with any breast complaint, she said said at a meeting on women's health sponsored by the University of California, San Francisco.

The classic characteristics of a malignant mass are well known. Cancer is more likely if there is a single lesion, if it's hard and immovable, if it has irregular borders, and if it's 2 cm or more in diameter.

“Unfortunately, cancers are often soft and cystic, movable, regular, [and] small,” said Dr. Karliner of the division of general internal medicine at the university. Furthermore, “benign lesions can be single, like cancers are supposed to be.”

With the clinical characteristics so unreliable, Dr. Karliner recommended the following algorithm when evaluating a woman with a palpable mass. Decisions are fairly simple for older women, those above the age of 30-35 years. All such women who come in complaining of a mass should receive a diagnostic mammogram, both to evaluate the mass and to search for occult malignancies elsewhere in the same breast. According to one study of 41,000 women with self-reported breast lumps, diagnostic mammography alone has a sensitivity of 87.3% and a specificity of 84.5%.

But that means diagnostic mammography misses 10%-20% of breast cancers. The addition of ultrasound to the mammogram, however, increases the negative predictive value to 97%.

The so-called triple diagnosis, consisting of a physical exam, mammography, and skilled fine-needle aspiration (FNA) biopsy, misses very few cancers, Dr. Karliner said. If all three tests are negative, it's safe to schedule follow-up exams every 3-6 months for a year. If all three are positive, the patient should be referred for definitive treatment. And if any one test is suggestive of malignancy, the patient should have a core or excisional biopsy.

The algorithm for younger women presenting with a self-reported lump has a more complex decision tree, with the evaluation depending on whether the physician can feel the lump and whether the woman is at high risk.

If the physician can't feel a dominant mass on physical exam and the woman is of average risk, she should return in 2-3 months for a reexamination, and if the lump is then palpable she should undergo a further work-up.

If the physician can't feel a dominant mass and the woman is at high risk, with first-degree relatives who had cancer at a young age, she should be referred to a breast surgeon or clinic. The surgeon or clinic may choose to do a further work-up or simply to follow her closely.

If the physician can feel a palpable lump in a younger woman, and if she's at average risk and the exam is not concerning, she should return for a reexamination 3-10 days after her next menses.

If that younger woman with a palpable lump is at high risk, or if the exam is concerning, “you want an ultrasound first, if the mass doesn't feel cystic,” she said. “If the mass does feel cystic, it's an option to go ahead and FNA it first, and see if you can resolve the mass with that.

Disclosures: None was reported.

SAN FRANCISCO — A proper evaluation of a palpable breast mass is important not only for quality of care but also because a delayed cancer diagnosis due to a negative clinical exam or a negative mammogram is a primary cause of malpractice awards in this area, according to Dr. Leah Karliner.

Studies have shown that over a 10-year period, about 16% of women aged 40-69 years bring a concern about their breasts to primary care physicians.

While the majority of palpable breast masses turn out to be benign cysts or fibroadenomas, breast cancer is found in 11% of women complaining of a breast lump and 4% of women with any breast complaint, she said said at a meeting on women's health sponsored by the University of California, San Francisco.

The classic characteristics of a malignant mass are well known. Cancer is more likely if there is a single lesion, if it's hard and immovable, if it has irregular borders, and if it's 2 cm or more in diameter.

“Unfortunately, cancers are often soft and cystic, movable, regular, [and] small,” said Dr. Karliner of the division of general internal medicine at the university. Furthermore, “benign lesions can be single, like cancers are supposed to be.”

With the clinical characteristics so unreliable, Dr. Karliner recommended the following algorithm when evaluating a woman with a palpable mass. Decisions are fairly simple for older women, those above the age of 30-35 years. All such women who come in complaining of a mass should receive a diagnostic mammogram, both to evaluate the mass and to search for occult malignancies elsewhere in the same breast. According to one study of 41,000 women with self-reported breast lumps, diagnostic mammography alone has a sensitivity of 87.3% and a specificity of 84.5%.

But that means diagnostic mammography misses 10%-20% of breast cancers. The addition of ultrasound to the mammogram, however, increases the negative predictive value to 97%.

The so-called triple diagnosis, consisting of a physical exam, mammography, and skilled fine-needle aspiration (FNA) biopsy, misses very few cancers, Dr. Karliner said. If all three tests are negative, it's safe to schedule follow-up exams every 3-6 months for a year. If all three are positive, the patient should be referred for definitive treatment. And if any one test is suggestive of malignancy, the patient should have a core or excisional biopsy.

The algorithm for younger women presenting with a self-reported lump has a more complex decision tree, with the evaluation depending on whether the physician can feel the lump and whether the woman is at high risk.

If the physician can't feel a dominant mass on physical exam and the woman is of average risk, she should return in 2-3 months for a reexamination, and if the lump is then palpable she should undergo a further work-up.

If the physician can't feel a dominant mass and the woman is at high risk, with first-degree relatives who had cancer at a young age, she should be referred to a breast surgeon or clinic. The surgeon or clinic may choose to do a further work-up or simply to follow her closely.

If the physician can feel a palpable lump in a younger woman, and if she's at average risk and the exam is not concerning, she should return for a reexamination 3-10 days after her next menses.

If that younger woman with a palpable lump is at high risk, or if the exam is concerning, “you want an ultrasound first, if the mass doesn't feel cystic,” she said. “If the mass does feel cystic, it's an option to go ahead and FNA it first, and see if you can resolve the mass with that.

Disclosures: None was reported.