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Updated embryo transfer recommendations promote singletons
Transferring fewer embryos in appropriate clinical conditions reduces the rate of multiple gestations without impacting live birth rates, according to new recommendations from the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology.
The recommendations are the first update since 2013.
Dr. Penzias and fellow committee members reviewed national data from 2013 that showed similar pregnancy rates for women aged 42 years and younger who received a single euploid blastocyst or two untested blastocysts. But the risk of twins was significantly reduced with single embryo transfers (Fertil Steril. 2017 Apr;107[4]:901-3).
The recommendations state that euploid embryo transfer should be limited to one for women of any age with a favorable prognosis, and for women younger than 35 years regardless of the embryo stage.
Patients aged 35-37 years should first consider single-embryo transfer, and patients aged 38-40 years should receive single-blastocyst embryo transfers if euploid embryos are available, but no more than three cleavage-stage embryos or two blastocysts.
Patients aged 41-42 years should receive single blastocyst transfer if euploid embryos are available, or no more than four cleavage-stage embryos or three blastocysts.
For patients in each age group without a favorable prognosis, the recommendations support transfer of an additional embryo based on individual circumstances and with the condition of patient counseling about the risk of multiples. Additional embryo transfers also may be considered for women who fail to conceive after multiple cycles.
However, “patients with a coexisting medical condition for which a multiple pregnancy may increase the risk of significant morbidity should not have more than one embryo transferred,” the committee members wrote.
The recommendations also call for single-embryo transfer in donor cases where the oocyte donor is younger than 35 years. For patients using frozen embryos, transfers should not exceed the recommended numbers for each age group, and decisions should be based in part on the patient’s age when the embryos were frozen.
The new recommendations will impact clinical practice by providing clinicians with the data they need when counseling patients, said Dr. Penzias, a reproductive endocrinologist in Waltham, Mass., and a clinical professor at Harvard Medical School.
Patients should receive the take-home message that “placing more embryos at once isn’t the best way to achieve their goals,” he said. The recommendations “will help to continue the trend toward single-embryo transfer in an ever-widening group of patients,” he noted.
Looking ahead to research that might inform future recommendations, Dr. Penzias noted, “noninvasive assessment of embryo potential is actively being pursued. [Plus], better understanding of the endometrium and issues around implantation,” he said.
The committee members who developed the recommendations reported having no relevant financial conflicts.
Transferring fewer embryos in appropriate clinical conditions reduces the rate of multiple gestations without impacting live birth rates, according to new recommendations from the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology.
The recommendations are the first update since 2013.
Dr. Penzias and fellow committee members reviewed national data from 2013 that showed similar pregnancy rates for women aged 42 years and younger who received a single euploid blastocyst or two untested blastocysts. But the risk of twins was significantly reduced with single embryo transfers (Fertil Steril. 2017 Apr;107[4]:901-3).
The recommendations state that euploid embryo transfer should be limited to one for women of any age with a favorable prognosis, and for women younger than 35 years regardless of the embryo stage.
Patients aged 35-37 years should first consider single-embryo transfer, and patients aged 38-40 years should receive single-blastocyst embryo transfers if euploid embryos are available, but no more than three cleavage-stage embryos or two blastocysts.
Patients aged 41-42 years should receive single blastocyst transfer if euploid embryos are available, or no more than four cleavage-stage embryos or three blastocysts.
For patients in each age group without a favorable prognosis, the recommendations support transfer of an additional embryo based on individual circumstances and with the condition of patient counseling about the risk of multiples. Additional embryo transfers also may be considered for women who fail to conceive after multiple cycles.
However, “patients with a coexisting medical condition for which a multiple pregnancy may increase the risk of significant morbidity should not have more than one embryo transferred,” the committee members wrote.
The recommendations also call for single-embryo transfer in donor cases where the oocyte donor is younger than 35 years. For patients using frozen embryos, transfers should not exceed the recommended numbers for each age group, and decisions should be based in part on the patient’s age when the embryos were frozen.
The new recommendations will impact clinical practice by providing clinicians with the data they need when counseling patients, said Dr. Penzias, a reproductive endocrinologist in Waltham, Mass., and a clinical professor at Harvard Medical School.
Patients should receive the take-home message that “placing more embryos at once isn’t the best way to achieve their goals,” he said. The recommendations “will help to continue the trend toward single-embryo transfer in an ever-widening group of patients,” he noted.
Looking ahead to research that might inform future recommendations, Dr. Penzias noted, “noninvasive assessment of embryo potential is actively being pursued. [Plus], better understanding of the endometrium and issues around implantation,” he said.
The committee members who developed the recommendations reported having no relevant financial conflicts.
Transferring fewer embryos in appropriate clinical conditions reduces the rate of multiple gestations without impacting live birth rates, according to new recommendations from the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology.
The recommendations are the first update since 2013.
Dr. Penzias and fellow committee members reviewed national data from 2013 that showed similar pregnancy rates for women aged 42 years and younger who received a single euploid blastocyst or two untested blastocysts. But the risk of twins was significantly reduced with single embryo transfers (Fertil Steril. 2017 Apr;107[4]:901-3).
The recommendations state that euploid embryo transfer should be limited to one for women of any age with a favorable prognosis, and for women younger than 35 years regardless of the embryo stage.
Patients aged 35-37 years should first consider single-embryo transfer, and patients aged 38-40 years should receive single-blastocyst embryo transfers if euploid embryos are available, but no more than three cleavage-stage embryos or two blastocysts.
Patients aged 41-42 years should receive single blastocyst transfer if euploid embryos are available, or no more than four cleavage-stage embryos or three blastocysts.
For patients in each age group without a favorable prognosis, the recommendations support transfer of an additional embryo based on individual circumstances and with the condition of patient counseling about the risk of multiples. Additional embryo transfers also may be considered for women who fail to conceive after multiple cycles.
However, “patients with a coexisting medical condition for which a multiple pregnancy may increase the risk of significant morbidity should not have more than one embryo transferred,” the committee members wrote.
The recommendations also call for single-embryo transfer in donor cases where the oocyte donor is younger than 35 years. For patients using frozen embryos, transfers should not exceed the recommended numbers for each age group, and decisions should be based in part on the patient’s age when the embryos were frozen.
The new recommendations will impact clinical practice by providing clinicians with the data they need when counseling patients, said Dr. Penzias, a reproductive endocrinologist in Waltham, Mass., and a clinical professor at Harvard Medical School.
Patients should receive the take-home message that “placing more embryos at once isn’t the best way to achieve their goals,” he said. The recommendations “will help to continue the trend toward single-embryo transfer in an ever-widening group of patients,” he noted.
Looking ahead to research that might inform future recommendations, Dr. Penzias noted, “noninvasive assessment of embryo potential is actively being pursued. [Plus], better understanding of the endometrium and issues around implantation,” he said.
The committee members who developed the recommendations reported having no relevant financial conflicts.
FROM FERTILITY AND STERILITY
Perfluorodecalin-spiked patch improves tattoo removal results
Laser tattoo removal with use of a perfluorodecalin (PFD)-infused patch allowed significantly more passes during a 5-minute treatment session, in a randomized trial of 30 adults.
In the study, published online in Lasers in Surgery and Medicine, an average of 3.7 laser treatment passes (range 2-4) were used when the laser was combined with a PFD-infused patch during a 5-minute session, compared with an average of 1.4 passes (range 1-3) with the laser alone (P less than .0001).
“Laser-assisted tattoo removal is generally regarded as safe and effective, but the procedure is subject to several important limitations,” wrote Brian S. Biesman, MD, and Cara Costner, RN, FNP, who practice in Nashville, Tenn. These limitations include the need to wait for epidermal whitening to dissipate between laser passes, but “one strategy for improving the efficiency of laser-assisted tattoo removal involves the topical use of an optical clearing agent to reduce the epidermal whitening effect,” they explained.
“Topical use of PFD reduces optical scattering at the skin surface, which helps to improve energy delivery to the tattoo ink in deeper layers of the skin and may reduce the potential of epidermal injury and treatment-related AEs,” they added (Lasers Surg Med. 2017 March 20. doi: 10.1002/lsm.22659).
They enrolled 16 women and 14 men seeking tattoo removal in the randomized, split-area study. The mean age of the subjects was 37 years; most were Fitzpatrick skin type II or III. One side of each tattoo was treated with the 755-nm Q-Switched Alexandrite nanosecond laser alone, and the other half was treated with the same laser through the PFD patch.
Patients’ reports of pain based on the Visual Analog Scale were approximately one point lower on the areas treated with the laser and the patch compared with the laser alone. Compared with the laser-only areas, a lower proportion of the areas treated with the patch were affected by edema (36.7% vs. 63.3%) or erythema (33.3% vs. 70%). None of the patients had hypopigmentation or hyperpigmentation. “All AEs [adverse events] were transient and had resolved by the 1-month follow-up visit,” at which time all 30 patients said they preferred to continue their tattoo removal using the PFD patch, the investigators wrote.
The findings were limited by several factors, including the use of a single laser and the predominance of black or dark blue tattoos, as well as the lack of patients with darker skin types. However, “incorporation of the PFD patch into laser tattoo removal procedures may afford multiple benefits to the patient and provider, including increased efficiency, improved patient safety, fewer AEs associated with epidermal injury, and protection of the patient and provider from tissue splatter and laser plume,” the authors concluded.
Dr. Biesman disclosed grant support, honoraria, or consulting fees from Allergan, Cutera, Cytrellis, Evolus Galderma, Intraderm, Merz, ON Light Sciences, Revance, Sienna, Suneva, Syneron-Candela, Valeant, and Zeltiq. The study was sponsored by ON Light Sciences.
Laser tattoo removal with use of a perfluorodecalin (PFD)-infused patch allowed significantly more passes during a 5-minute treatment session, in a randomized trial of 30 adults.
In the study, published online in Lasers in Surgery and Medicine, an average of 3.7 laser treatment passes (range 2-4) were used when the laser was combined with a PFD-infused patch during a 5-minute session, compared with an average of 1.4 passes (range 1-3) with the laser alone (P less than .0001).
“Laser-assisted tattoo removal is generally regarded as safe and effective, but the procedure is subject to several important limitations,” wrote Brian S. Biesman, MD, and Cara Costner, RN, FNP, who practice in Nashville, Tenn. These limitations include the need to wait for epidermal whitening to dissipate between laser passes, but “one strategy for improving the efficiency of laser-assisted tattoo removal involves the topical use of an optical clearing agent to reduce the epidermal whitening effect,” they explained.
“Topical use of PFD reduces optical scattering at the skin surface, which helps to improve energy delivery to the tattoo ink in deeper layers of the skin and may reduce the potential of epidermal injury and treatment-related AEs,” they added (Lasers Surg Med. 2017 March 20. doi: 10.1002/lsm.22659).
They enrolled 16 women and 14 men seeking tattoo removal in the randomized, split-area study. The mean age of the subjects was 37 years; most were Fitzpatrick skin type II or III. One side of each tattoo was treated with the 755-nm Q-Switched Alexandrite nanosecond laser alone, and the other half was treated with the same laser through the PFD patch.
Patients’ reports of pain based on the Visual Analog Scale were approximately one point lower on the areas treated with the laser and the patch compared with the laser alone. Compared with the laser-only areas, a lower proportion of the areas treated with the patch were affected by edema (36.7% vs. 63.3%) or erythema (33.3% vs. 70%). None of the patients had hypopigmentation or hyperpigmentation. “All AEs [adverse events] were transient and had resolved by the 1-month follow-up visit,” at which time all 30 patients said they preferred to continue their tattoo removal using the PFD patch, the investigators wrote.
The findings were limited by several factors, including the use of a single laser and the predominance of black or dark blue tattoos, as well as the lack of patients with darker skin types. However, “incorporation of the PFD patch into laser tattoo removal procedures may afford multiple benefits to the patient and provider, including increased efficiency, improved patient safety, fewer AEs associated with epidermal injury, and protection of the patient and provider from tissue splatter and laser plume,” the authors concluded.
Dr. Biesman disclosed grant support, honoraria, or consulting fees from Allergan, Cutera, Cytrellis, Evolus Galderma, Intraderm, Merz, ON Light Sciences, Revance, Sienna, Suneva, Syneron-Candela, Valeant, and Zeltiq. The study was sponsored by ON Light Sciences.
Laser tattoo removal with use of a perfluorodecalin (PFD)-infused patch allowed significantly more passes during a 5-minute treatment session, in a randomized trial of 30 adults.
In the study, published online in Lasers in Surgery and Medicine, an average of 3.7 laser treatment passes (range 2-4) were used when the laser was combined with a PFD-infused patch during a 5-minute session, compared with an average of 1.4 passes (range 1-3) with the laser alone (P less than .0001).
“Laser-assisted tattoo removal is generally regarded as safe and effective, but the procedure is subject to several important limitations,” wrote Brian S. Biesman, MD, and Cara Costner, RN, FNP, who practice in Nashville, Tenn. These limitations include the need to wait for epidermal whitening to dissipate between laser passes, but “one strategy for improving the efficiency of laser-assisted tattoo removal involves the topical use of an optical clearing agent to reduce the epidermal whitening effect,” they explained.
“Topical use of PFD reduces optical scattering at the skin surface, which helps to improve energy delivery to the tattoo ink in deeper layers of the skin and may reduce the potential of epidermal injury and treatment-related AEs,” they added (Lasers Surg Med. 2017 March 20. doi: 10.1002/lsm.22659).
They enrolled 16 women and 14 men seeking tattoo removal in the randomized, split-area study. The mean age of the subjects was 37 years; most were Fitzpatrick skin type II or III. One side of each tattoo was treated with the 755-nm Q-Switched Alexandrite nanosecond laser alone, and the other half was treated with the same laser through the PFD patch.
Patients’ reports of pain based on the Visual Analog Scale were approximately one point lower on the areas treated with the laser and the patch compared with the laser alone. Compared with the laser-only areas, a lower proportion of the areas treated with the patch were affected by edema (36.7% vs. 63.3%) or erythema (33.3% vs. 70%). None of the patients had hypopigmentation or hyperpigmentation. “All AEs [adverse events] were transient and had resolved by the 1-month follow-up visit,” at which time all 30 patients said they preferred to continue their tattoo removal using the PFD patch, the investigators wrote.
The findings were limited by several factors, including the use of a single laser and the predominance of black or dark blue tattoos, as well as the lack of patients with darker skin types. However, “incorporation of the PFD patch into laser tattoo removal procedures may afford multiple benefits to the patient and provider, including increased efficiency, improved patient safety, fewer AEs associated with epidermal injury, and protection of the patient and provider from tissue splatter and laser plume,” the authors concluded.
Dr. Biesman disclosed grant support, honoraria, or consulting fees from Allergan, Cutera, Cytrellis, Evolus Galderma, Intraderm, Merz, ON Light Sciences, Revance, Sienna, Suneva, Syneron-Candela, Valeant, and Zeltiq. The study was sponsored by ON Light Sciences.
Key clinical point: Addition of a perfluorodecalin-infused patch to a laser treatment protocol allowed significantly more laser passes with no difference in adverse events.
Major finding: More laser treatment passes for tattoo removal were possible when the laser was combined with a perfluorodecalin patch vs. laser alone (an average of 3.7 vs. 1.4 passes in a 5-minute session, a significant difference).
Data source: A prospective, randomized study of 30 adults seeking removal of tattoos.
Disclosures: Dr. Biesman disclosed grant support, honoraria, or consulting fees from Allergan, Cutera, Cytrellis, Evolus Galderma, Intraderm, Merz, ON Light Sciences, Revance, Sienna, Suneva, Syneron-Candela, Valeant, and Zeltiq. The study was sponsored by ON Light Sciences.
Spousal suicide linked to higher risk of mental, physical disorders
The spouses of people who died by suicide are at increased risk of mental health disorders, physical problems, and social health problems within 5 years of their partner’s death, based on data from a cohort study of about 7 million adults in Denmark. The findings were published online March 22.
“To our knowledge, this is the largest and most comprehensive study of spouses bereaved by a partner’s suicide,” wrote Annette Erlangsen, PhD, of Mental Health Centre Copenhagen, Hellerup, Denmark, and her colleagues. Although bereavement by any means is associated with increased risk of mental disorders in a surviving spouse, “whether any aspects of loss by suicide are worse than bereavement in general remains unexamined,” they wrote.
The researchers identified suicides since 1970 using a cause of death registry. The study population included 4,814 men (mean age 54 years) and 10,793 women (mean age 50 years) whose spouses committed suicide (JAMA Psychiatry. 2017 Mar 22. doi: 10.1001/jamapsychiatry.2017.0226).
Overall, both male and female spouses of people who took their own lives were more likely than was the general population to develop mental disorders within 5 years, with an incidence rate ratio (IRR) of 1.8 and 1.7, respectively, reported Dr. Erlangsen and her colleagues.
In addition, both male and female spouses of bereaved by a spouse’s suicide had increased risk for mental disorders, compared with spouses bereaved by other causes of death, with IRRs of 1.7 and 2.0, respectively. Specifically, the investigators found an excess risk after bereavement tied to a spouse’s suicide of mood disorders (men: IRR, 1.7; 95% confidence interval, 1.4-2.1; women: IRR, 1.3; 95% CI, 1.2-1.5), posttraumatic stress disorder (men: IRR, 5.6; 95% CI, 2.7-11.4; women: IRR, 3.6, 95% CI, 2.3-5.5), anxiety (men: IRR, 1.4; 95% CI, 1.0-1.9; women: IRR, 1.1; 95% CI, 0.9-1.3), drug use disorders (men: IRR, 1.4; 95% CI, 1.0-2.1; women: IRR, 1.0; 95% CI, 0.8-1.3), and deliberate self-harm (men: IRR, 1.3; 95% CI, 1.0-1.8; women: IRR, 1.5, 95% CI, 1.2-1.8).
The spouses of people who died by suicide also were more likely to use municipal family support, sick leave, unemployment, disability, and mental health care services, compared with the general population.
From a physical standpoint, spouses of people who died by suicide were at increased risk for cirrhosis and sleep disorders, and the risk of dying from any cause was higher in both men and women (IRR, 1.2 and 1.4, respectively). The risk of the spouse committing suicide was higher than in the general population for men (IRR, 3.5) and women (IRR, 4.2).
Women whose spouses committed suicide also were at significantly increased risk of becoming homicide victims (IRR, 33.8).
The data were limited by several factors, including the inclusion only of adults in formal unions, and the possibility that the hospital diagnoses might underestimate the actual incidence of health problems, the researchers noted.
“Bereavement following suicide constitutes a psychological stressor and remains a public health burden,” Dr. Erlangsen and her colleagues wrote. “More proactive outreach and linkage to support mechanisms is needed for people bereaved by spousal suicide to help them navigate their grief.”
The researchers had no financial conflicts to disclose. The American Foundation for Suicide Prevention and the Danish Health Insurance Foundation supported the study.
The findings by Annette Erlangsen, PhD, and her associates do not establish causation between spousal suicide and the health risks for their surviving spouses, Eric D. Caine, MD, wrote in an editorial (JAMA Psychiatry. 2017 March 22. doi: 10.1001/jamapsychiatry.2017.0218). Issues tied to assortative mating, for example, cannot be ruled out. Still, the data inspire confidence in light of their “consistency across multiple outcome domains, and they build on many real-world observations as well as past research.”
“Right now we know that those who remain behind following a spouse’s suicide carry as a group increased risk for greater disease burdens and for premature mortality when compared with peers,” Dr. Caine wrote. “Thus, they deserve sustained attention beyond support during their time of acute grieving to promote health and to stave off potentially predictable, longer-term adverse consequences.”
Dr. Caine is affiliated with the Injury Control Research Center for Suicide Prevention at the University of Rochester (N.Y.). He reported no financial conflicts.
The findings by Annette Erlangsen, PhD, and her associates do not establish causation between spousal suicide and the health risks for their surviving spouses, Eric D. Caine, MD, wrote in an editorial (JAMA Psychiatry. 2017 March 22. doi: 10.1001/jamapsychiatry.2017.0218). Issues tied to assortative mating, for example, cannot be ruled out. Still, the data inspire confidence in light of their “consistency across multiple outcome domains, and they build on many real-world observations as well as past research.”
“Right now we know that those who remain behind following a spouse’s suicide carry as a group increased risk for greater disease burdens and for premature mortality when compared with peers,” Dr. Caine wrote. “Thus, they deserve sustained attention beyond support during their time of acute grieving to promote health and to stave off potentially predictable, longer-term adverse consequences.”
Dr. Caine is affiliated with the Injury Control Research Center for Suicide Prevention at the University of Rochester (N.Y.). He reported no financial conflicts.
The findings by Annette Erlangsen, PhD, and her associates do not establish causation between spousal suicide and the health risks for their surviving spouses, Eric D. Caine, MD, wrote in an editorial (JAMA Psychiatry. 2017 March 22. doi: 10.1001/jamapsychiatry.2017.0218). Issues tied to assortative mating, for example, cannot be ruled out. Still, the data inspire confidence in light of their “consistency across multiple outcome domains, and they build on many real-world observations as well as past research.”
“Right now we know that those who remain behind following a spouse’s suicide carry as a group increased risk for greater disease burdens and for premature mortality when compared with peers,” Dr. Caine wrote. “Thus, they deserve sustained attention beyond support during their time of acute grieving to promote health and to stave off potentially predictable, longer-term adverse consequences.”
Dr. Caine is affiliated with the Injury Control Research Center for Suicide Prevention at the University of Rochester (N.Y.). He reported no financial conflicts.
The spouses of people who died by suicide are at increased risk of mental health disorders, physical problems, and social health problems within 5 years of their partner’s death, based on data from a cohort study of about 7 million adults in Denmark. The findings were published online March 22.
“To our knowledge, this is the largest and most comprehensive study of spouses bereaved by a partner’s suicide,” wrote Annette Erlangsen, PhD, of Mental Health Centre Copenhagen, Hellerup, Denmark, and her colleagues. Although bereavement by any means is associated with increased risk of mental disorders in a surviving spouse, “whether any aspects of loss by suicide are worse than bereavement in general remains unexamined,” they wrote.
The researchers identified suicides since 1970 using a cause of death registry. The study population included 4,814 men (mean age 54 years) and 10,793 women (mean age 50 years) whose spouses committed suicide (JAMA Psychiatry. 2017 Mar 22. doi: 10.1001/jamapsychiatry.2017.0226).
Overall, both male and female spouses of people who took their own lives were more likely than was the general population to develop mental disorders within 5 years, with an incidence rate ratio (IRR) of 1.8 and 1.7, respectively, reported Dr. Erlangsen and her colleagues.
In addition, both male and female spouses of bereaved by a spouse’s suicide had increased risk for mental disorders, compared with spouses bereaved by other causes of death, with IRRs of 1.7 and 2.0, respectively. Specifically, the investigators found an excess risk after bereavement tied to a spouse’s suicide of mood disorders (men: IRR, 1.7; 95% confidence interval, 1.4-2.1; women: IRR, 1.3; 95% CI, 1.2-1.5), posttraumatic stress disorder (men: IRR, 5.6; 95% CI, 2.7-11.4; women: IRR, 3.6, 95% CI, 2.3-5.5), anxiety (men: IRR, 1.4; 95% CI, 1.0-1.9; women: IRR, 1.1; 95% CI, 0.9-1.3), drug use disorders (men: IRR, 1.4; 95% CI, 1.0-2.1; women: IRR, 1.0; 95% CI, 0.8-1.3), and deliberate self-harm (men: IRR, 1.3; 95% CI, 1.0-1.8; women: IRR, 1.5, 95% CI, 1.2-1.8).
The spouses of people who died by suicide also were more likely to use municipal family support, sick leave, unemployment, disability, and mental health care services, compared with the general population.
From a physical standpoint, spouses of people who died by suicide were at increased risk for cirrhosis and sleep disorders, and the risk of dying from any cause was higher in both men and women (IRR, 1.2 and 1.4, respectively). The risk of the spouse committing suicide was higher than in the general population for men (IRR, 3.5) and women (IRR, 4.2).
Women whose spouses committed suicide also were at significantly increased risk of becoming homicide victims (IRR, 33.8).
The data were limited by several factors, including the inclusion only of adults in formal unions, and the possibility that the hospital diagnoses might underestimate the actual incidence of health problems, the researchers noted.
“Bereavement following suicide constitutes a psychological stressor and remains a public health burden,” Dr. Erlangsen and her colleagues wrote. “More proactive outreach and linkage to support mechanisms is needed for people bereaved by spousal suicide to help them navigate their grief.”
The researchers had no financial conflicts to disclose. The American Foundation for Suicide Prevention and the Danish Health Insurance Foundation supported the study.
The spouses of people who died by suicide are at increased risk of mental health disorders, physical problems, and social health problems within 5 years of their partner’s death, based on data from a cohort study of about 7 million adults in Denmark. The findings were published online March 22.
“To our knowledge, this is the largest and most comprehensive study of spouses bereaved by a partner’s suicide,” wrote Annette Erlangsen, PhD, of Mental Health Centre Copenhagen, Hellerup, Denmark, and her colleagues. Although bereavement by any means is associated with increased risk of mental disorders in a surviving spouse, “whether any aspects of loss by suicide are worse than bereavement in general remains unexamined,” they wrote.
The researchers identified suicides since 1970 using a cause of death registry. The study population included 4,814 men (mean age 54 years) and 10,793 women (mean age 50 years) whose spouses committed suicide (JAMA Psychiatry. 2017 Mar 22. doi: 10.1001/jamapsychiatry.2017.0226).
Overall, both male and female spouses of people who took their own lives were more likely than was the general population to develop mental disorders within 5 years, with an incidence rate ratio (IRR) of 1.8 and 1.7, respectively, reported Dr. Erlangsen and her colleagues.
In addition, both male and female spouses of bereaved by a spouse’s suicide had increased risk for mental disorders, compared with spouses bereaved by other causes of death, with IRRs of 1.7 and 2.0, respectively. Specifically, the investigators found an excess risk after bereavement tied to a spouse’s suicide of mood disorders (men: IRR, 1.7; 95% confidence interval, 1.4-2.1; women: IRR, 1.3; 95% CI, 1.2-1.5), posttraumatic stress disorder (men: IRR, 5.6; 95% CI, 2.7-11.4; women: IRR, 3.6, 95% CI, 2.3-5.5), anxiety (men: IRR, 1.4; 95% CI, 1.0-1.9; women: IRR, 1.1; 95% CI, 0.9-1.3), drug use disorders (men: IRR, 1.4; 95% CI, 1.0-2.1; women: IRR, 1.0; 95% CI, 0.8-1.3), and deliberate self-harm (men: IRR, 1.3; 95% CI, 1.0-1.8; women: IRR, 1.5, 95% CI, 1.2-1.8).
The spouses of people who died by suicide also were more likely to use municipal family support, sick leave, unemployment, disability, and mental health care services, compared with the general population.
From a physical standpoint, spouses of people who died by suicide were at increased risk for cirrhosis and sleep disorders, and the risk of dying from any cause was higher in both men and women (IRR, 1.2 and 1.4, respectively). The risk of the spouse committing suicide was higher than in the general population for men (IRR, 3.5) and women (IRR, 4.2).
Women whose spouses committed suicide also were at significantly increased risk of becoming homicide victims (IRR, 33.8).
The data were limited by several factors, including the inclusion only of adults in formal unions, and the possibility that the hospital diagnoses might underestimate the actual incidence of health problems, the researchers noted.
“Bereavement following suicide constitutes a psychological stressor and remains a public health burden,” Dr. Erlangsen and her colleagues wrote. “More proactive outreach and linkage to support mechanisms is needed for people bereaved by spousal suicide to help them navigate their grief.”
The researchers had no financial conflicts to disclose. The American Foundation for Suicide Prevention and the Danish Health Insurance Foundation supported the study.
FROM JAMA PSYCHIATRY
Key clinical point: The spouses of people who died by suicide are at increased risk for mental, physical, and social problems.
Major finding: Mental disorders, especially mood disorders, were more likely among adults whose spouse had committed suicide within the past 5 years (incidence rate ratio, 1.8).
Data source: A nationwide cohort study of 6.7 million people aged 18 and older in Denmark.
Disclosures: The researchers had no financial conflicts to disclose. The American Foundation for Suicide Prevention and the Danish Health Insurance Foundation supported the study.
Psychological factors drive Crohn’s symptom reports
Psychological factors, rather than disease activity, were significantly associated with symptoms in children and teens with Crohn’s disease, based on data from 127 children aged 8-18 years.
Patients completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs, and coping. Disease activity was measured by the Pediatric Crohn’s Disease Activity Index.
The researchers used a model to assess how psychology factors and disease activity impacted symptoms and disability.
The disability model showed significant associations with both psychological factors (P less than .001) and disease activity (P less than .05). However, the symptoms model showed a significant association only with psychological factors (P less than .001).
“One possible explanation for our findings is that many patients with Crohn’s disease report elevated levels of psychological distress,” wrote Miranda A. L. van Tilburg, PhD, of the University of North Carolina at Chapel Hill and colleagues.
Although the study was limited by the use of self-reports, “this finding is an important one because symptom presentation often plays an important role in treatment decisions, which could lead to unnecessary exposure to tests and treatments, with potential negative side effects,” the researchers wrote. “When confronted with a pediatric patient with Crohn’s disease who has high levels of psychological distress, independent of his or her inflammatory status, the clinician should consider incorporating behavioral techniques such as education, reassurance, and cognitive behavior therapy into the management plan,” they said.
The researchers had no financial conflicts to disclose.
Read the full study here: doi: 10.1016/j.jpeds.2017.01.058.
Psychological factors, rather than disease activity, were significantly associated with symptoms in children and teens with Crohn’s disease, based on data from 127 children aged 8-18 years.
Patients completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs, and coping. Disease activity was measured by the Pediatric Crohn’s Disease Activity Index.
The researchers used a model to assess how psychology factors and disease activity impacted symptoms and disability.
The disability model showed significant associations with both psychological factors (P less than .001) and disease activity (P less than .05). However, the symptoms model showed a significant association only with psychological factors (P less than .001).
“One possible explanation for our findings is that many patients with Crohn’s disease report elevated levels of psychological distress,” wrote Miranda A. L. van Tilburg, PhD, of the University of North Carolina at Chapel Hill and colleagues.
Although the study was limited by the use of self-reports, “this finding is an important one because symptom presentation often plays an important role in treatment decisions, which could lead to unnecessary exposure to tests and treatments, with potential negative side effects,” the researchers wrote. “When confronted with a pediatric patient with Crohn’s disease who has high levels of psychological distress, independent of his or her inflammatory status, the clinician should consider incorporating behavioral techniques such as education, reassurance, and cognitive behavior therapy into the management plan,” they said.
The researchers had no financial conflicts to disclose.
Read the full study here: doi: 10.1016/j.jpeds.2017.01.058.
Psychological factors, rather than disease activity, were significantly associated with symptoms in children and teens with Crohn’s disease, based on data from 127 children aged 8-18 years.
Patients completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs, and coping. Disease activity was measured by the Pediatric Crohn’s Disease Activity Index.
The researchers used a model to assess how psychology factors and disease activity impacted symptoms and disability.
The disability model showed significant associations with both psychological factors (P less than .001) and disease activity (P less than .05). However, the symptoms model showed a significant association only with psychological factors (P less than .001).
“One possible explanation for our findings is that many patients with Crohn’s disease report elevated levels of psychological distress,” wrote Miranda A. L. van Tilburg, PhD, of the University of North Carolina at Chapel Hill and colleagues.
Although the study was limited by the use of self-reports, “this finding is an important one because symptom presentation often plays an important role in treatment decisions, which could lead to unnecessary exposure to tests and treatments, with potential negative side effects,” the researchers wrote. “When confronted with a pediatric patient with Crohn’s disease who has high levels of psychological distress, independent of his or her inflammatory status, the clinician should consider incorporating behavioral techniques such as education, reassurance, and cognitive behavior therapy into the management plan,” they said.
The researchers had no financial conflicts to disclose.
Read the full study here: doi: 10.1016/j.jpeds.2017.01.058.
FROM JOURNAL OF PEDIATRICS
Influenza vaccine is underused in children with heart disease
The influenza vaccine is underused in children with heart disease; approximately one-third were vaccinated in a prospective study of 186 children in September and October 2012.
“Annual influenza vaccination is the most effective and safe means of preventing the disease,” and children with chronic diseases including heart conditions are at increased risk for complications that would require hospitalization, wrote Gilat Livni, MD, of Tel Aviv University and colleagues.
Overall, 59% of parents reported that their primary pediatrician recommended flu vaccination, and 53% of these parents complied. By contrast, only 13% of children whose pediatricians had not recommended vaccination received it.
“The failure of parents to receive information or advice from a physician regarding vaccination was strongly inversely related to vaccination of the child,” the researchers wrote. Parents’ misconceptions included the belief that the vaccine would cause flu (66%, of whom 30% had their child vaccinated); the belief that the vaccine would cause severe side effects (55%, of whom 26% had their child vaccinated), and the belief that the vaccine was unsafe (47%, 21% of whom had their child vaccinated).
“Our results emphasize the need to raise awareness among physicians and other medical health care personnel dealing with children with heart disease of the importance of properly counseling parents regarding influenza vaccination,” the researchers said. “Recommending the vaccine should be made part of routine patient visits in fall and winter.”
The researchers had no financial conflicts to disclose. The findings were published online ahead of print in the Pediatric Infectious Disease Journal (Ped Infect Dis J. 2017. doi: 10.1097/INF.0000000000001579).
The influenza vaccine is underused in children with heart disease; approximately one-third were vaccinated in a prospective study of 186 children in September and October 2012.
“Annual influenza vaccination is the most effective and safe means of preventing the disease,” and children with chronic diseases including heart conditions are at increased risk for complications that would require hospitalization, wrote Gilat Livni, MD, of Tel Aviv University and colleagues.
Overall, 59% of parents reported that their primary pediatrician recommended flu vaccination, and 53% of these parents complied. By contrast, only 13% of children whose pediatricians had not recommended vaccination received it.
“The failure of parents to receive information or advice from a physician regarding vaccination was strongly inversely related to vaccination of the child,” the researchers wrote. Parents’ misconceptions included the belief that the vaccine would cause flu (66%, of whom 30% had their child vaccinated); the belief that the vaccine would cause severe side effects (55%, of whom 26% had their child vaccinated), and the belief that the vaccine was unsafe (47%, 21% of whom had their child vaccinated).
“Our results emphasize the need to raise awareness among physicians and other medical health care personnel dealing with children with heart disease of the importance of properly counseling parents regarding influenza vaccination,” the researchers said. “Recommending the vaccine should be made part of routine patient visits in fall and winter.”
The researchers had no financial conflicts to disclose. The findings were published online ahead of print in the Pediatric Infectious Disease Journal (Ped Infect Dis J. 2017. doi: 10.1097/INF.0000000000001579).
The influenza vaccine is underused in children with heart disease; approximately one-third were vaccinated in a prospective study of 186 children in September and October 2012.
“Annual influenza vaccination is the most effective and safe means of preventing the disease,” and children with chronic diseases including heart conditions are at increased risk for complications that would require hospitalization, wrote Gilat Livni, MD, of Tel Aviv University and colleagues.
Overall, 59% of parents reported that their primary pediatrician recommended flu vaccination, and 53% of these parents complied. By contrast, only 13% of children whose pediatricians had not recommended vaccination received it.
“The failure of parents to receive information or advice from a physician regarding vaccination was strongly inversely related to vaccination of the child,” the researchers wrote. Parents’ misconceptions included the belief that the vaccine would cause flu (66%, of whom 30% had their child vaccinated); the belief that the vaccine would cause severe side effects (55%, of whom 26% had their child vaccinated), and the belief that the vaccine was unsafe (47%, 21% of whom had their child vaccinated).
“Our results emphasize the need to raise awareness among physicians and other medical health care personnel dealing with children with heart disease of the importance of properly counseling parents regarding influenza vaccination,” the researchers said. “Recommending the vaccine should be made part of routine patient visits in fall and winter.”
The researchers had no financial conflicts to disclose. The findings were published online ahead of print in the Pediatric Infectious Disease Journal (Ped Infect Dis J. 2017. doi: 10.1097/INF.0000000000001579).
FROM THE JOURNAL OF PEDIATRICS
Aspirin or rivaroxaban plus P2Y12 inhibitor equals 5% bleeding risk
Clinically significant bleeding in acute coronary patients was approximately 5% when their P2Y12 inhibitor treatment was combined with either rivaroxaban or with aspirin, based on data from a randomized, multicenter study of 3,037 adults.
The findings support the use of low-dose rivaroxaban as a safe strategy and an alternative to aspirin for postacute care of coronary syndromes, wrote E. Magnus Ohman, MD, of Duke University in Durham, N.C., and his colleagues.
The study was presented at the annual meeting of the American College of Cardiology and published simultaneously in the Lancet (2017. Mar 18. doi: org/10.1016/S0140-6736[17]30751-1).
The GEMINI ACS 1 trial included patients older than 18 years, who were randomized to P2Y12 with rivaroxaban or P2Y12 with aspirin within 10 days of admission for acute coronary syndrome events, from 371 clinical centers in 21 countries. The patients received 2.5 mg of low-dose rivaroxaban twice daily plus a P2Y12 inhibitor (clopidogrel or ticagrelor, based on national availability) or 100 mg of aspirin daily plus a P2Y12 inhibitor. Patients were assessed at 30, 90, 180, and 270 days.
Overall, 154 patients (5%) met the primary endpoint of thrombolysis in myocardial infarction (TIMI) of clinically significant bleeding – 80 patients (5%) in the rivaroxaban group and 74 (5%) in the aspirin group. Baseline demographics were not significantly different between the groups, and clinically significant bleeding was not significantly different among subgroups.
TIMI bleeding that required medical attention was the most common, occurring in 4% of each group. Both groups had a low frequency of severe or major bleeding based on the TIMI bleeding definitions, the researchers noted.
The composite ischemic endpoint of cardiovascular death, myocardial infarction, stroke, or definite stent thrombosis was 5% in both groups, and both groups had a similar frequency of all-cause mortality and of each of the composite ischemic elements. Rivaroxaban was associated with a higher occurrence of the ischemic composite endpoint in the first 30 days (hazard ratio, 1.48), but this difference was not statistically significant.
“Additionally, no significant interaction was noted for the risk of clinically significant bleeding by P2Y12 inhibitor strata (ticagrelor vs. clopidogrel), but these stratified bleeding analyses were exploratory and hypothesis generating,” the researchers wrote.
The findings were limited by several factors, including a delay in randomization from the patients’ index events, a homogeneous population, and exclusion of patients treated with prasugrel, the researchers noted. However, “based upon these findings and the unmet need for improved treatments in the postacute coronary syndromes setting, further testing of the efficacy and safety of this novel dual pathway antithrombotic regimen in an adequately powered trial should be considered,” they said.
The study was funded by Janssen Research & Development and Bayer. Lead author Dr. Ohman has received research grants from Janssen and other companies. Several coauthors disclosed relationships with multiple companies, including Janssen.
“The antithrombotic effect of aspirin is largely explained by inhibition of COX [cyclo-oxygenase] 1, a central enzyme mediating platelet activation,” wrote Paul A. Gurbel, MD, and Udaya S. Tantry, PhD, in an accompanying comment. “This and pleiotropic cardioprotective properties should be considered before forsaking or replacing aspirin, particularly early in the highly prothrombotic state of a new acute coronary syndrome (panel),” they said.
The major downside of aspirin is gastrointestinal bleeding, the commenters wrote. “But, almost all bleeding metrics were nonsignificantly lower with aspirin, and a 50% increased bleed rate with rivaroxaban cannot be excluded,” they said. Also, although the frequency of major bleeding was similar between the groups, “numerically, the lowest composite ischaemic endpoint rate was noted with aspirin plus ticagrelor therapy (ticagrelor plus aspirin = 3.9%; ticagrelor plus rivaroxaban = 4.7%; clopidogrel plus rivaroxaban = 5.4%; and clopidogrel plus aspirin = 5.9%),” they said. “Thus, it might be premature to believe that a low-dose Xa inhibitor on top of a P2Y12 inhibitor can be [an] effective and safe therapy for most stabilized patients with acute coronary syndromes” (Lancet. 2017 Mar 18. doi: org/10.1016/S0140-6736[17]30760-2).
Dr. Gurbel and Dr. Tantry are affiliated with the Inova Heart and Vascular Institute, Falls Church, VA. Dr. Gurbel disclosed relationships with multiple companies including study sponsor Janssen.
“The antithrombotic effect of aspirin is largely explained by inhibition of COX [cyclo-oxygenase] 1, a central enzyme mediating platelet activation,” wrote Paul A. Gurbel, MD, and Udaya S. Tantry, PhD, in an accompanying comment. “This and pleiotropic cardioprotective properties should be considered before forsaking or replacing aspirin, particularly early in the highly prothrombotic state of a new acute coronary syndrome (panel),” they said.
The major downside of aspirin is gastrointestinal bleeding, the commenters wrote. “But, almost all bleeding metrics were nonsignificantly lower with aspirin, and a 50% increased bleed rate with rivaroxaban cannot be excluded,” they said. Also, although the frequency of major bleeding was similar between the groups, “numerically, the lowest composite ischaemic endpoint rate was noted with aspirin plus ticagrelor therapy (ticagrelor plus aspirin = 3.9%; ticagrelor plus rivaroxaban = 4.7%; clopidogrel plus rivaroxaban = 5.4%; and clopidogrel plus aspirin = 5.9%),” they said. “Thus, it might be premature to believe that a low-dose Xa inhibitor on top of a P2Y12 inhibitor can be [an] effective and safe therapy for most stabilized patients with acute coronary syndromes” (Lancet. 2017 Mar 18. doi: org/10.1016/S0140-6736[17]30760-2).
Dr. Gurbel and Dr. Tantry are affiliated with the Inova Heart and Vascular Institute, Falls Church, VA. Dr. Gurbel disclosed relationships with multiple companies including study sponsor Janssen.
“The antithrombotic effect of aspirin is largely explained by inhibition of COX [cyclo-oxygenase] 1, a central enzyme mediating platelet activation,” wrote Paul A. Gurbel, MD, and Udaya S. Tantry, PhD, in an accompanying comment. “This and pleiotropic cardioprotective properties should be considered before forsaking or replacing aspirin, particularly early in the highly prothrombotic state of a new acute coronary syndrome (panel),” they said.
The major downside of aspirin is gastrointestinal bleeding, the commenters wrote. “But, almost all bleeding metrics were nonsignificantly lower with aspirin, and a 50% increased bleed rate with rivaroxaban cannot be excluded,” they said. Also, although the frequency of major bleeding was similar between the groups, “numerically, the lowest composite ischaemic endpoint rate was noted with aspirin plus ticagrelor therapy (ticagrelor plus aspirin = 3.9%; ticagrelor plus rivaroxaban = 4.7%; clopidogrel plus rivaroxaban = 5.4%; and clopidogrel plus aspirin = 5.9%),” they said. “Thus, it might be premature to believe that a low-dose Xa inhibitor on top of a P2Y12 inhibitor can be [an] effective and safe therapy for most stabilized patients with acute coronary syndromes” (Lancet. 2017 Mar 18. doi: org/10.1016/S0140-6736[17]30760-2).
Dr. Gurbel and Dr. Tantry are affiliated with the Inova Heart and Vascular Institute, Falls Church, VA. Dr. Gurbel disclosed relationships with multiple companies including study sponsor Janssen.
Clinically significant bleeding in acute coronary patients was approximately 5% when their P2Y12 inhibitor treatment was combined with either rivaroxaban or with aspirin, based on data from a randomized, multicenter study of 3,037 adults.
The findings support the use of low-dose rivaroxaban as a safe strategy and an alternative to aspirin for postacute care of coronary syndromes, wrote E. Magnus Ohman, MD, of Duke University in Durham, N.C., and his colleagues.
The study was presented at the annual meeting of the American College of Cardiology and published simultaneously in the Lancet (2017. Mar 18. doi: org/10.1016/S0140-6736[17]30751-1).
The GEMINI ACS 1 trial included patients older than 18 years, who were randomized to P2Y12 with rivaroxaban or P2Y12 with aspirin within 10 days of admission for acute coronary syndrome events, from 371 clinical centers in 21 countries. The patients received 2.5 mg of low-dose rivaroxaban twice daily plus a P2Y12 inhibitor (clopidogrel or ticagrelor, based on national availability) or 100 mg of aspirin daily plus a P2Y12 inhibitor. Patients were assessed at 30, 90, 180, and 270 days.
Overall, 154 patients (5%) met the primary endpoint of thrombolysis in myocardial infarction (TIMI) of clinically significant bleeding – 80 patients (5%) in the rivaroxaban group and 74 (5%) in the aspirin group. Baseline demographics were not significantly different between the groups, and clinically significant bleeding was not significantly different among subgroups.
TIMI bleeding that required medical attention was the most common, occurring in 4% of each group. Both groups had a low frequency of severe or major bleeding based on the TIMI bleeding definitions, the researchers noted.
The composite ischemic endpoint of cardiovascular death, myocardial infarction, stroke, or definite stent thrombosis was 5% in both groups, and both groups had a similar frequency of all-cause mortality and of each of the composite ischemic elements. Rivaroxaban was associated with a higher occurrence of the ischemic composite endpoint in the first 30 days (hazard ratio, 1.48), but this difference was not statistically significant.
“Additionally, no significant interaction was noted for the risk of clinically significant bleeding by P2Y12 inhibitor strata (ticagrelor vs. clopidogrel), but these stratified bleeding analyses were exploratory and hypothesis generating,” the researchers wrote.
The findings were limited by several factors, including a delay in randomization from the patients’ index events, a homogeneous population, and exclusion of patients treated with prasugrel, the researchers noted. However, “based upon these findings and the unmet need for improved treatments in the postacute coronary syndromes setting, further testing of the efficacy and safety of this novel dual pathway antithrombotic regimen in an adequately powered trial should be considered,” they said.
The study was funded by Janssen Research & Development and Bayer. Lead author Dr. Ohman has received research grants from Janssen and other companies. Several coauthors disclosed relationships with multiple companies, including Janssen.
Clinically significant bleeding in acute coronary patients was approximately 5% when their P2Y12 inhibitor treatment was combined with either rivaroxaban or with aspirin, based on data from a randomized, multicenter study of 3,037 adults.
The findings support the use of low-dose rivaroxaban as a safe strategy and an alternative to aspirin for postacute care of coronary syndromes, wrote E. Magnus Ohman, MD, of Duke University in Durham, N.C., and his colleagues.
The study was presented at the annual meeting of the American College of Cardiology and published simultaneously in the Lancet (2017. Mar 18. doi: org/10.1016/S0140-6736[17]30751-1).
The GEMINI ACS 1 trial included patients older than 18 years, who were randomized to P2Y12 with rivaroxaban or P2Y12 with aspirin within 10 days of admission for acute coronary syndrome events, from 371 clinical centers in 21 countries. The patients received 2.5 mg of low-dose rivaroxaban twice daily plus a P2Y12 inhibitor (clopidogrel or ticagrelor, based on national availability) or 100 mg of aspirin daily plus a P2Y12 inhibitor. Patients were assessed at 30, 90, 180, and 270 days.
Overall, 154 patients (5%) met the primary endpoint of thrombolysis in myocardial infarction (TIMI) of clinically significant bleeding – 80 patients (5%) in the rivaroxaban group and 74 (5%) in the aspirin group. Baseline demographics were not significantly different between the groups, and clinically significant bleeding was not significantly different among subgroups.
TIMI bleeding that required medical attention was the most common, occurring in 4% of each group. Both groups had a low frequency of severe or major bleeding based on the TIMI bleeding definitions, the researchers noted.
The composite ischemic endpoint of cardiovascular death, myocardial infarction, stroke, or definite stent thrombosis was 5% in both groups, and both groups had a similar frequency of all-cause mortality and of each of the composite ischemic elements. Rivaroxaban was associated with a higher occurrence of the ischemic composite endpoint in the first 30 days (hazard ratio, 1.48), but this difference was not statistically significant.
“Additionally, no significant interaction was noted for the risk of clinically significant bleeding by P2Y12 inhibitor strata (ticagrelor vs. clopidogrel), but these stratified bleeding analyses were exploratory and hypothesis generating,” the researchers wrote.
The findings were limited by several factors, including a delay in randomization from the patients’ index events, a homogeneous population, and exclusion of patients treated with prasugrel, the researchers noted. However, “based upon these findings and the unmet need for improved treatments in the postacute coronary syndromes setting, further testing of the efficacy and safety of this novel dual pathway antithrombotic regimen in an adequately powered trial should be considered,” they said.
The study was funded by Janssen Research & Development and Bayer. Lead author Dr. Ohman has received research grants from Janssen and other companies. Several coauthors disclosed relationships with multiple companies, including Janssen.
FROM ACC 17
Key clinical point: The risk of major bleeding was similar between acute coronary syndrome patients treated with a combination of low-dose rivaroxaban and P2Y12 inhibitor and those treated with aspirin and P2Y12 inhibitor.
Major finding: Clinically significant bleeding occurred in 5% of patients in each treatment group (HR, 1.09).
Data source: A double-blind, multicenter, randomized trial (GEMINI ACS 1) including 3,037 adults.
Disclosures: The study was funded by Janssen Research & Development and Bayer. Lead author Dr. Ohman has received research grants from Janssen and other companies. Several coauthors disclosed relationships with multiple companies, including Janssen.
Infant hepatitis B vaccine protection lingers into adolescence
Adolescents who received hepatitis B virus (HBV) vaccinations as infants still showed protection despite little evidence of residual antibodies, a study showed.
This finding was based on data from a prospective study of 137 children, aged 10-11 years, and 213 children, aged 15-16 years, with no history of HBV infection who were vaccinated at 2, 4, and 6 months of age. Michelle Pinto, MD, of the Vaccine Evaluation Center in Vancouver and her colleagues measured residual immunity to determine whether HBV boosters might be needed in adolescents vaccinated as infants to prolong immunity and reduce disease transmission in adulthood.
Overall, 97% of the younger age group and 91% of the older age group showed reactions to an HBV vaccine challenge. An additional 3 (2%) younger children and 12 (6%) older children responded to a second vaccine challenge after failing to respond to the first.
Limitations of the study included a “limited ability of the challenge vaccine procedure to accurately identify immune memory and anamnestic responses” and the differences between the findings and those from long-term outcome data in similar studies in other countries, Dr. Pinto and her associates wrote.
However, “the fact that substantial differences exist in measures of residual protection among teenagers after infant or adolescent HBV vaccinations warrants close ongoing scrutiny of whether important differences will emerge in long-term protection, with or without booster vaccination,” they said (Pediatr Infect Dis J. 2017. doi: 10.1097/INF.0000000000001543).
Adolescents who received hepatitis B virus (HBV) vaccinations as infants still showed protection despite little evidence of residual antibodies, a study showed.
This finding was based on data from a prospective study of 137 children, aged 10-11 years, and 213 children, aged 15-16 years, with no history of HBV infection who were vaccinated at 2, 4, and 6 months of age. Michelle Pinto, MD, of the Vaccine Evaluation Center in Vancouver and her colleagues measured residual immunity to determine whether HBV boosters might be needed in adolescents vaccinated as infants to prolong immunity and reduce disease transmission in adulthood.
Overall, 97% of the younger age group and 91% of the older age group showed reactions to an HBV vaccine challenge. An additional 3 (2%) younger children and 12 (6%) older children responded to a second vaccine challenge after failing to respond to the first.
Limitations of the study included a “limited ability of the challenge vaccine procedure to accurately identify immune memory and anamnestic responses” and the differences between the findings and those from long-term outcome data in similar studies in other countries, Dr. Pinto and her associates wrote.
However, “the fact that substantial differences exist in measures of residual protection among teenagers after infant or adolescent HBV vaccinations warrants close ongoing scrutiny of whether important differences will emerge in long-term protection, with or without booster vaccination,” they said (Pediatr Infect Dis J. 2017. doi: 10.1097/INF.0000000000001543).
Adolescents who received hepatitis B virus (HBV) vaccinations as infants still showed protection despite little evidence of residual antibodies, a study showed.
This finding was based on data from a prospective study of 137 children, aged 10-11 years, and 213 children, aged 15-16 years, with no history of HBV infection who were vaccinated at 2, 4, and 6 months of age. Michelle Pinto, MD, of the Vaccine Evaluation Center in Vancouver and her colleagues measured residual immunity to determine whether HBV boosters might be needed in adolescents vaccinated as infants to prolong immunity and reduce disease transmission in adulthood.
Overall, 97% of the younger age group and 91% of the older age group showed reactions to an HBV vaccine challenge. An additional 3 (2%) younger children and 12 (6%) older children responded to a second vaccine challenge after failing to respond to the first.
Limitations of the study included a “limited ability of the challenge vaccine procedure to accurately identify immune memory and anamnestic responses” and the differences between the findings and those from long-term outcome data in similar studies in other countries, Dr. Pinto and her associates wrote.
However, “the fact that substantial differences exist in measures of residual protection among teenagers after infant or adolescent HBV vaccinations warrants close ongoing scrutiny of whether important differences will emerge in long-term protection, with or without booster vaccination,” they said (Pediatr Infect Dis J. 2017. doi: 10.1097/INF.0000000000001543).
FROM THE PEDIATRIC INFECTIOUS DISEASE JOURNAL
More time in aftercare improves abstinence
Patients treated for addiction for longer than 30 days showed a significantly higher abstinence success rate of 84%, compared with 55% for patients whose treatment stopped at 30 days, a study of 72 adults shows.
The findings were not significantly different among different kinds of addictions, such as alcohol and amphetamine addiction or opioid and benzodiazepine dependency (Open J Psychiatr. Jan 2017;7:51-60).
“Recovery is an ongoing process once a client leaves treatment,” wrote Akikur R. Mohammad, MD, CEO/founder of the Inspire Malibu drug and alcohol treatment center in Southern California, and his colleagues. “Clients who adhere to their discharge plan and immerse themselves in recovery-related activities and lifestyle are likely to achieve sobriety for longer periods of time, if not indefinitely.”
To assess the efficacy of treatment and the predictors of relapse, the researchers enrolled 32 men and 40 women who were undergoing clinical treatment for various types of addiction. The average age was 30 years for the men and 30.7 years for the women.
In addition, the researchers developed models of treatment outcomes. They found a relative risk of substance abuse relapse of 18.1 for patients who failed to answer the phone at least three times during a 12-month follow-up period, compared with patients who only failed to answer the phone either zero, one, or two times.
Although the results were limited by the use of self reports, the findings support the role of aftercare follow-up in identifying addiction patients at risk for relapse, noted Dr. Mohammad of the University of California, Los Angeles, and his colleagues.
The researchers had no financial conflicts to disclose.
Patients treated for addiction for longer than 30 days showed a significantly higher abstinence success rate of 84%, compared with 55% for patients whose treatment stopped at 30 days, a study of 72 adults shows.
The findings were not significantly different among different kinds of addictions, such as alcohol and amphetamine addiction or opioid and benzodiazepine dependency (Open J Psychiatr. Jan 2017;7:51-60).
“Recovery is an ongoing process once a client leaves treatment,” wrote Akikur R. Mohammad, MD, CEO/founder of the Inspire Malibu drug and alcohol treatment center in Southern California, and his colleagues. “Clients who adhere to their discharge plan and immerse themselves in recovery-related activities and lifestyle are likely to achieve sobriety for longer periods of time, if not indefinitely.”
To assess the efficacy of treatment and the predictors of relapse, the researchers enrolled 32 men and 40 women who were undergoing clinical treatment for various types of addiction. The average age was 30 years for the men and 30.7 years for the women.
In addition, the researchers developed models of treatment outcomes. They found a relative risk of substance abuse relapse of 18.1 for patients who failed to answer the phone at least three times during a 12-month follow-up period, compared with patients who only failed to answer the phone either zero, one, or two times.
Although the results were limited by the use of self reports, the findings support the role of aftercare follow-up in identifying addiction patients at risk for relapse, noted Dr. Mohammad of the University of California, Los Angeles, and his colleagues.
The researchers had no financial conflicts to disclose.
Patients treated for addiction for longer than 30 days showed a significantly higher abstinence success rate of 84%, compared with 55% for patients whose treatment stopped at 30 days, a study of 72 adults shows.
The findings were not significantly different among different kinds of addictions, such as alcohol and amphetamine addiction or opioid and benzodiazepine dependency (Open J Psychiatr. Jan 2017;7:51-60).
“Recovery is an ongoing process once a client leaves treatment,” wrote Akikur R. Mohammad, MD, CEO/founder of the Inspire Malibu drug and alcohol treatment center in Southern California, and his colleagues. “Clients who adhere to their discharge plan and immerse themselves in recovery-related activities and lifestyle are likely to achieve sobriety for longer periods of time, if not indefinitely.”
To assess the efficacy of treatment and the predictors of relapse, the researchers enrolled 32 men and 40 women who were undergoing clinical treatment for various types of addiction. The average age was 30 years for the men and 30.7 years for the women.
In addition, the researchers developed models of treatment outcomes. They found a relative risk of substance abuse relapse of 18.1 for patients who failed to answer the phone at least three times during a 12-month follow-up period, compared with patients who only failed to answer the phone either zero, one, or two times.
Although the results were limited by the use of self reports, the findings support the role of aftercare follow-up in identifying addiction patients at risk for relapse, noted Dr. Mohammad of the University of California, Los Angeles, and his colleagues.
The researchers had no financial conflicts to disclose.
FROM THE OPEN JOURNAL OF PSYCHIATRY
Pneumococcal conjugate vaccine beats Streptococcus pneumoniae bacteremia
Routine use of the 13-valent pneumococcal conjugate vaccine (PCV13) reduced the incidence of Streptococcus pneumoniae bacteremia by 95% from a time period before to a time period after the vaccine was implemented, based on a review of more than 57,000 blood cultures from children aged 3-36 months.
Kaiser Permanente implemented universal immunization with PCV13 in June 2010. “Initial trends through 2012 demonstrated continued decline in pneumococcal infections, with the biggest impact in children less than 5 years old,” wrote Tara Greenhow, MD, of Kaiser Permanente Northern California, San Francisco, and her colleagues.
Overall, the incidence of S. pneumoniae bacteremia declined from 74.5 per 100,000 children during the period before PCV7 (1998-1999) to 3.5 per 100,000 children during a period after routine use of PCV13 (2013-2014). The annual number of bacteremia cases from any cause dropped by 78% between these two time periods.
As bacteremia caused by pneumococci decreased, 77% of cases in the post-PCV13 time period were caused by Escherichia coli, Salmonella spp., and Staphylococcus aureus. “A total of 76% of bacteremia occurred with a source, including 34% urinary tract infections, 17% gastroenteritis, 8% pneumonias, 8% osteomyelitis, 6% skin and soft tissue infections, and 3% other,” Dr. Greenhow and her associates reported.
The large population of the Kaiser Permanente system supports the accuracy of the now rare incidence of bacteremia in young children, the researchers noted. However, “because bacteremia in the post-PCV13 era is more likely to occur with a source, a focused examination should be performed and appropriate studies should be obtained at the time of a blood culture collection,” they said.
Routine use of the 13-valent pneumococcal conjugate vaccine (PCV13) reduced the incidence of Streptococcus pneumoniae bacteremia by 95% from a time period before to a time period after the vaccine was implemented, based on a review of more than 57,000 blood cultures from children aged 3-36 months.
Kaiser Permanente implemented universal immunization with PCV13 in June 2010. “Initial trends through 2012 demonstrated continued decline in pneumococcal infections, with the biggest impact in children less than 5 years old,” wrote Tara Greenhow, MD, of Kaiser Permanente Northern California, San Francisco, and her colleagues.
Overall, the incidence of S. pneumoniae bacteremia declined from 74.5 per 100,000 children during the period before PCV7 (1998-1999) to 3.5 per 100,000 children during a period after routine use of PCV13 (2013-2014). The annual number of bacteremia cases from any cause dropped by 78% between these two time periods.
As bacteremia caused by pneumococci decreased, 77% of cases in the post-PCV13 time period were caused by Escherichia coli, Salmonella spp., and Staphylococcus aureus. “A total of 76% of bacteremia occurred with a source, including 34% urinary tract infections, 17% gastroenteritis, 8% pneumonias, 8% osteomyelitis, 6% skin and soft tissue infections, and 3% other,” Dr. Greenhow and her associates reported.
The large population of the Kaiser Permanente system supports the accuracy of the now rare incidence of bacteremia in young children, the researchers noted. However, “because bacteremia in the post-PCV13 era is more likely to occur with a source, a focused examination should be performed and appropriate studies should be obtained at the time of a blood culture collection,” they said.
Routine use of the 13-valent pneumococcal conjugate vaccine (PCV13) reduced the incidence of Streptococcus pneumoniae bacteremia by 95% from a time period before to a time period after the vaccine was implemented, based on a review of more than 57,000 blood cultures from children aged 3-36 months.
Kaiser Permanente implemented universal immunization with PCV13 in June 2010. “Initial trends through 2012 demonstrated continued decline in pneumococcal infections, with the biggest impact in children less than 5 years old,” wrote Tara Greenhow, MD, of Kaiser Permanente Northern California, San Francisco, and her colleagues.
Overall, the incidence of S. pneumoniae bacteremia declined from 74.5 per 100,000 children during the period before PCV7 (1998-1999) to 3.5 per 100,000 children during a period after routine use of PCV13 (2013-2014). The annual number of bacteremia cases from any cause dropped by 78% between these two time periods.
As bacteremia caused by pneumococci decreased, 77% of cases in the post-PCV13 time period were caused by Escherichia coli, Salmonella spp., and Staphylococcus aureus. “A total of 76% of bacteremia occurred with a source, including 34% urinary tract infections, 17% gastroenteritis, 8% pneumonias, 8% osteomyelitis, 6% skin and soft tissue infections, and 3% other,” Dr. Greenhow and her associates reported.
The large population of the Kaiser Permanente system supports the accuracy of the now rare incidence of bacteremia in young children, the researchers noted. However, “because bacteremia in the post-PCV13 era is more likely to occur with a source, a focused examination should be performed and appropriate studies should be obtained at the time of a blood culture collection,” they said.
FROM PEDIATRICS
Esophageal variceal bleeding, portal hypertension tied to recurrent pediatric GI bleeds
Readmission to the hospital after acute GI bleeding in children is most often associated with an initial diagnosis of portal hypertension or esophageal variceal hemorrhage, based on data from a retrospective study of 9,902 patients.
Rebleeding in adults may be predicted by endoscopic characteristics of the bleeding source in some cases, but “there is still a considerable subgroup of children admitted with acute gastrointestinal bleeding and not endoscoped but in whom we do not have any measure to predict rebleeding including after discharge,” Thomas M. Attard, MD, Children’s Mercy Hospital, Kansas City, Mo., and his colleagues said.
The study included children aged 1-21 years with upper or indeterminate GI bleeding who were discharged from 49 pediatric hospitals between January 1, 2007 and September 30, 2015. Overall, 1,460 children (16%) were readmitted at least once within 30 days, with 72 readmitted twice and an average of 10 days’ time to readmission.
Readmission for recurrent bleeding was most frequently associated with an initial diagnosis of portal hypertension (20%) or esophageal variceal hemorrhage (20%). Children who had undergone endoscopy (odds ratio, 0.77) or Meckel’s scan (OR, 0.51) on initial admission were least likely to require readmission.
Children with one or two complex chronic conditions were almost twice as likely to be readmitted than were those with no complex chronic conditions, and a longer initial hospital stay and early treatment with proton pump inhibitors were associated with increased likelihood of readmission. “These may be indicative of more medically frail patients and greater severity of initial illness, respectively,” the researchers said. They found no association between increased risk of readmission and demographic factors including age, sex, race, and urban vs. rural residence (J Pediatr. 2017 Feb. doi: 10.1016/j.jpeds.2017.01.044).
Readmission to the hospital after acute GI bleeding in children is most often associated with an initial diagnosis of portal hypertension or esophageal variceal hemorrhage, based on data from a retrospective study of 9,902 patients.
Rebleeding in adults may be predicted by endoscopic characteristics of the bleeding source in some cases, but “there is still a considerable subgroup of children admitted with acute gastrointestinal bleeding and not endoscoped but in whom we do not have any measure to predict rebleeding including after discharge,” Thomas M. Attard, MD, Children’s Mercy Hospital, Kansas City, Mo., and his colleagues said.
The study included children aged 1-21 years with upper or indeterminate GI bleeding who were discharged from 49 pediatric hospitals between January 1, 2007 and September 30, 2015. Overall, 1,460 children (16%) were readmitted at least once within 30 days, with 72 readmitted twice and an average of 10 days’ time to readmission.
Readmission for recurrent bleeding was most frequently associated with an initial diagnosis of portal hypertension (20%) or esophageal variceal hemorrhage (20%). Children who had undergone endoscopy (odds ratio, 0.77) or Meckel’s scan (OR, 0.51) on initial admission were least likely to require readmission.
Children with one or two complex chronic conditions were almost twice as likely to be readmitted than were those with no complex chronic conditions, and a longer initial hospital stay and early treatment with proton pump inhibitors were associated with increased likelihood of readmission. “These may be indicative of more medically frail patients and greater severity of initial illness, respectively,” the researchers said. They found no association between increased risk of readmission and demographic factors including age, sex, race, and urban vs. rural residence (J Pediatr. 2017 Feb. doi: 10.1016/j.jpeds.2017.01.044).
Readmission to the hospital after acute GI bleeding in children is most often associated with an initial diagnosis of portal hypertension or esophageal variceal hemorrhage, based on data from a retrospective study of 9,902 patients.
Rebleeding in adults may be predicted by endoscopic characteristics of the bleeding source in some cases, but “there is still a considerable subgroup of children admitted with acute gastrointestinal bleeding and not endoscoped but in whom we do not have any measure to predict rebleeding including after discharge,” Thomas M. Attard, MD, Children’s Mercy Hospital, Kansas City, Mo., and his colleagues said.
The study included children aged 1-21 years with upper or indeterminate GI bleeding who were discharged from 49 pediatric hospitals between January 1, 2007 and September 30, 2015. Overall, 1,460 children (16%) were readmitted at least once within 30 days, with 72 readmitted twice and an average of 10 days’ time to readmission.
Readmission for recurrent bleeding was most frequently associated with an initial diagnosis of portal hypertension (20%) or esophageal variceal hemorrhage (20%). Children who had undergone endoscopy (odds ratio, 0.77) or Meckel’s scan (OR, 0.51) on initial admission were least likely to require readmission.
Children with one or two complex chronic conditions were almost twice as likely to be readmitted than were those with no complex chronic conditions, and a longer initial hospital stay and early treatment with proton pump inhibitors were associated with increased likelihood of readmission. “These may be indicative of more medically frail patients and greater severity of initial illness, respectively,” the researchers said. They found no association between increased risk of readmission and demographic factors including age, sex, race, and urban vs. rural residence (J Pediatr. 2017 Feb. doi: 10.1016/j.jpeds.2017.01.044).
FROM THE JOURNAL OF PEDIATRICS