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Adult vaccine coverage called 'unacceptably low'
Far too few U.S. adults are getting vaccinated against diseases other than flu, according to data from the Centers for Disease Control and Prevention’s National Health Interview Survey.
Although there is a heightened awareness about childhood and flu vaccinations, "we want adults to be aware that there are other vaccines that can prevent other serious diseases, such as whooping cough and shingles," Dr. Howard Koh, assistant secretary for health at the Department of Health and Human Services, said during a press briefing on the report.
The survey data showed that vaccination rates for tetanus-toxoid containing vaccines (Tdap and/or Td) and human papillomavirus (HPV) improved slightly between 2010 and 2011, but that, overall, rates of adult immunizations were still well below targets set by Healthy People 2020.
Describing the low vaccination rates as a "broad public health challenge," Dr. Koh called on doctors to regularly review vaccine schedules with their patients.
The report also highlights racial disparities in vaccination rates. While whites had the highest rates of vaccination, Hispanics, Asians, and blacks fell behind. The disparities could be caused by lack of access and cultural and linguistic barriers, officials said.
Dr. Koh said that the Affordable Care Act, which will extend health coverage to millions more Americans when its state health insurance exchanges start up in 2014, "is critically important ... because it makes preventive care more affordable."
Dr. Koh also unveiled the new HealthMap Vaccine Finder, where patients can find vaccine providers by zip code; he encouraged physicians to register on the site.
The report analyzed data from the 2011 NHIS for pneumococcal vaccine, tetanus toxoid–containing vaccines, hepatitis A, hepatitis B, herpes zoster, and HPV vaccines.
The highest vaccination rate increase was seen in HPV vaccination among women 19-26 years old (9%). In 2011, 30% of women in this age group reported having received the vaccine, compared with roughly 21% in 2010 (MMWR 2013;62[Early Release]:1-7).
In 2011, 13% of adults 19-64 years were vaccinated with Tdap, a 4.3% increase from 2010. However, the proportion of adults in all age groups receiving any tetanus toxoid–containing vaccines (Td or Tdap) has not changed over the past decade.
Pneumococcal vaccination coverage among adults aged 19-64 years was roughly 20%, a 1.6% increase from 2010. Among adults 65 years or older, the coverage was 62%, reflecting a 2.6% increase from 2010.
Between 2010 and 2011, overall hepatitis A vaccination coverage increased among adults between 19-49 years by 1.8% but was still low (13%), according to the report.
Herpes zoster vaccination rates remained similar to 2010, at roughly 16%.
"Vaccination coverage levels among adults are unacceptably low. Substantial improvement in adult vaccination is needed to reduce the health consequences of vaccine-preventable diseases among adults," the authors wrote.
They suggested education, increased access to vaccination services, and efforts to remove administrative and financial barriers to vaccination as potential solutions.
The report has several limitations, the authors noted. The NHIS sample excludes individuals in the military or in institutions, leading to possible under- or overestimation of vaccination rates. Also, the survey response rate was 66%, which could lead to sampling bias. The vaccination status wasn’t validated by medical records, and self-report is subject to recall bias. The authors added that the Tdap estimate is subject to considerable uncertainty.
On Twitter @naseemsmiller
Far too few U.S. adults are getting vaccinated against diseases other than flu, according to data from the Centers for Disease Control and Prevention’s National Health Interview Survey.
Although there is a heightened awareness about childhood and flu vaccinations, "we want adults to be aware that there are other vaccines that can prevent other serious diseases, such as whooping cough and shingles," Dr. Howard Koh, assistant secretary for health at the Department of Health and Human Services, said during a press briefing on the report.
The survey data showed that vaccination rates for tetanus-toxoid containing vaccines (Tdap and/or Td) and human papillomavirus (HPV) improved slightly between 2010 and 2011, but that, overall, rates of adult immunizations were still well below targets set by Healthy People 2020.
Describing the low vaccination rates as a "broad public health challenge," Dr. Koh called on doctors to regularly review vaccine schedules with their patients.
The report also highlights racial disparities in vaccination rates. While whites had the highest rates of vaccination, Hispanics, Asians, and blacks fell behind. The disparities could be caused by lack of access and cultural and linguistic barriers, officials said.
Dr. Koh said that the Affordable Care Act, which will extend health coverage to millions more Americans when its state health insurance exchanges start up in 2014, "is critically important ... because it makes preventive care more affordable."
Dr. Koh also unveiled the new HealthMap Vaccine Finder, where patients can find vaccine providers by zip code; he encouraged physicians to register on the site.
The report analyzed data from the 2011 NHIS for pneumococcal vaccine, tetanus toxoid–containing vaccines, hepatitis A, hepatitis B, herpes zoster, and HPV vaccines.
The highest vaccination rate increase was seen in HPV vaccination among women 19-26 years old (9%). In 2011, 30% of women in this age group reported having received the vaccine, compared with roughly 21% in 2010 (MMWR 2013;62[Early Release]:1-7).
In 2011, 13% of adults 19-64 years were vaccinated with Tdap, a 4.3% increase from 2010. However, the proportion of adults in all age groups receiving any tetanus toxoid–containing vaccines (Td or Tdap) has not changed over the past decade.
Pneumococcal vaccination coverage among adults aged 19-64 years was roughly 20%, a 1.6% increase from 2010. Among adults 65 years or older, the coverage was 62%, reflecting a 2.6% increase from 2010.
Between 2010 and 2011, overall hepatitis A vaccination coverage increased among adults between 19-49 years by 1.8% but was still low (13%), according to the report.
Herpes zoster vaccination rates remained similar to 2010, at roughly 16%.
"Vaccination coverage levels among adults are unacceptably low. Substantial improvement in adult vaccination is needed to reduce the health consequences of vaccine-preventable diseases among adults," the authors wrote.
They suggested education, increased access to vaccination services, and efforts to remove administrative and financial barriers to vaccination as potential solutions.
The report has several limitations, the authors noted. The NHIS sample excludes individuals in the military or in institutions, leading to possible under- or overestimation of vaccination rates. Also, the survey response rate was 66%, which could lead to sampling bias. The vaccination status wasn’t validated by medical records, and self-report is subject to recall bias. The authors added that the Tdap estimate is subject to considerable uncertainty.
On Twitter @naseemsmiller
Far too few U.S. adults are getting vaccinated against diseases other than flu, according to data from the Centers for Disease Control and Prevention’s National Health Interview Survey.
Although there is a heightened awareness about childhood and flu vaccinations, "we want adults to be aware that there are other vaccines that can prevent other serious diseases, such as whooping cough and shingles," Dr. Howard Koh, assistant secretary for health at the Department of Health and Human Services, said during a press briefing on the report.
The survey data showed that vaccination rates for tetanus-toxoid containing vaccines (Tdap and/or Td) and human papillomavirus (HPV) improved slightly between 2010 and 2011, but that, overall, rates of adult immunizations were still well below targets set by Healthy People 2020.
Describing the low vaccination rates as a "broad public health challenge," Dr. Koh called on doctors to regularly review vaccine schedules with their patients.
The report also highlights racial disparities in vaccination rates. While whites had the highest rates of vaccination, Hispanics, Asians, and blacks fell behind. The disparities could be caused by lack of access and cultural and linguistic barriers, officials said.
Dr. Koh said that the Affordable Care Act, which will extend health coverage to millions more Americans when its state health insurance exchanges start up in 2014, "is critically important ... because it makes preventive care more affordable."
Dr. Koh also unveiled the new HealthMap Vaccine Finder, where patients can find vaccine providers by zip code; he encouraged physicians to register on the site.
The report analyzed data from the 2011 NHIS for pneumococcal vaccine, tetanus toxoid–containing vaccines, hepatitis A, hepatitis B, herpes zoster, and HPV vaccines.
The highest vaccination rate increase was seen in HPV vaccination among women 19-26 years old (9%). In 2011, 30% of women in this age group reported having received the vaccine, compared with roughly 21% in 2010 (MMWR 2013;62[Early Release]:1-7).
In 2011, 13% of adults 19-64 years were vaccinated with Tdap, a 4.3% increase from 2010. However, the proportion of adults in all age groups receiving any tetanus toxoid–containing vaccines (Td or Tdap) has not changed over the past decade.
Pneumococcal vaccination coverage among adults aged 19-64 years was roughly 20%, a 1.6% increase from 2010. Among adults 65 years or older, the coverage was 62%, reflecting a 2.6% increase from 2010.
Between 2010 and 2011, overall hepatitis A vaccination coverage increased among adults between 19-49 years by 1.8% but was still low (13%), according to the report.
Herpes zoster vaccination rates remained similar to 2010, at roughly 16%.
"Vaccination coverage levels among adults are unacceptably low. Substantial improvement in adult vaccination is needed to reduce the health consequences of vaccine-preventable diseases among adults," the authors wrote.
They suggested education, increased access to vaccination services, and efforts to remove administrative and financial barriers to vaccination as potential solutions.
The report has several limitations, the authors noted. The NHIS sample excludes individuals in the military or in institutions, leading to possible under- or overestimation of vaccination rates. Also, the survey response rate was 66%, which could lead to sampling bias. The vaccination status wasn’t validated by medical records, and self-report is subject to recall bias. The authors added that the Tdap estimate is subject to considerable uncertainty.
On Twitter @naseemsmiller
FROM MORBIDITY AND MORTALITY WEEKLY REPORT
Pneumococcal vaccine changes key in 2013 adult immunization schedule
Recommended use of several vaccines, including pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23), and Tdap vaccine, are updated in the 2013 adult immunization schedule, issued by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. The schedule was published online Jan. 28 in Morbidity and Mortality Weekly Report.
PCV13 is now recommended for adults 19 years and older who have immunocompromising conditions such as chronic renal failure, functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants.
Two doses of PPSV23 given before age 65 now are recommended for patients with certain conditions. For those who have received two doses before age 65, the vaccine is still recommended, as long as it has been 5 years since the most recent dose (MMWR 2013;62:1-19).
Individuals not vaccinated with PCV13 or PPSV23 should receive a single dose of PCV13, followed by a dose of PPSV23 at least 8 weeks apart. If already vaccinated with PPSV23, they should receive PCV13 vaccination 1 year or more later.
The tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is now recommended as routine for adults 65 years and older (one dose), and for pregnant women during 27 to 36 weeks’ gestation, regardless of the interval since prior Td/Tdap vaccination.
The zoster vaccine is now recommended for adults starting at age 60 years, with or without underlying health conditions, as long the vaccines is not contraindicated for them.
The complete schedule and footnotes can be found here.
Recommended use of several vaccines, including pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23), and Tdap vaccine, are updated in the 2013 adult immunization schedule, issued by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. The schedule was published online Jan. 28 in Morbidity and Mortality Weekly Report.
PCV13 is now recommended for adults 19 years and older who have immunocompromising conditions such as chronic renal failure, functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants.
Two doses of PPSV23 given before age 65 now are recommended for patients with certain conditions. For those who have received two doses before age 65, the vaccine is still recommended, as long as it has been 5 years since the most recent dose (MMWR 2013;62:1-19).
Individuals not vaccinated with PCV13 or PPSV23 should receive a single dose of PCV13, followed by a dose of PPSV23 at least 8 weeks apart. If already vaccinated with PPSV23, they should receive PCV13 vaccination 1 year or more later.
The tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is now recommended as routine for adults 65 years and older (one dose), and for pregnant women during 27 to 36 weeks’ gestation, regardless of the interval since prior Td/Tdap vaccination.
The zoster vaccine is now recommended for adults starting at age 60 years, with or without underlying health conditions, as long the vaccines is not contraindicated for them.
The complete schedule and footnotes can be found here.
Recommended use of several vaccines, including pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23), and Tdap vaccine, are updated in the 2013 adult immunization schedule, issued by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. The schedule was published online Jan. 28 in Morbidity and Mortality Weekly Report.
PCV13 is now recommended for adults 19 years and older who have immunocompromising conditions such as chronic renal failure, functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants.
Two doses of PPSV23 given before age 65 now are recommended for patients with certain conditions. For those who have received two doses before age 65, the vaccine is still recommended, as long as it has been 5 years since the most recent dose (MMWR 2013;62:1-19).
Individuals not vaccinated with PCV13 or PPSV23 should receive a single dose of PCV13, followed by a dose of PPSV23 at least 8 weeks apart. If already vaccinated with PPSV23, they should receive PCV13 vaccination 1 year or more later.
The tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is now recommended as routine for adults 65 years and older (one dose), and for pregnant women during 27 to 36 weeks’ gestation, regardless of the interval since prior Td/Tdap vaccination.
The zoster vaccine is now recommended for adults starting at age 60 years, with or without underlying health conditions, as long the vaccines is not contraindicated for them.
The complete schedule and footnotes can be found here.
First OTC drug approved for overactive bladder
Women with overactive bladder have access to an over-the-counter treatment for the first time, thanks to the Food and Drug Administration’s approval of Merck’s Oxytrol for Women Jan. 25.
This is a partial switch for the drug from prescription to over-the-counter, as men with overactive bladder still need a prescription for Oxytrol.
Although overactive bladder affects an estimated 33 million women, some studies suggest that many don’t seek treatment for it, and those who do seek treatment continue to have daily leakage (J. Urol. 2007;177:680-4).
"This effective, over-the-counter treatment offers women an option to independently manage their condition and achieve a newfound sense of control," Dr. Eman Elkadry of Harvard Medical School in Boston said in a statement issued by Merck. "The approval also provides recognition that this is a real medical disorder that can be addressed."
Each Oxytrol for Women patch is applied to the skin for 4 continuous days and nights, and delivers 3.9 mg of oxybutynin daily. Oxybutynin is an antispasmodic agent and is available in the United States under other prescription brand names, including Ditropan XL, Gelnique 3%, and Gelnique.
The safety and efficacy of the Oxytrol for Women patch were established in nine studies that included 5,000 participants, according to the FDA. "Overall, results from these studies showed that consumers can understand the information on the label, properly select whether the product is right for them, and use the drug appropriately," the agency noted.
The drug is not without side effects, although the ones reported in the studies were mild, including skin irritation at the site of the patch, dry mouth, and constipation, according to the FDA statement.
The announcement comes a week after the FDA approved Botox (onabotulinumtoxinA) for treatment of adults who don’t respond to a class of medications known as anticholinergics, which includes Oxytrol.
On Twitter @NaseemSMiller
Women with overactive bladder have access to an over-the-counter treatment for the first time, thanks to the Food and Drug Administration’s approval of Merck’s Oxytrol for Women Jan. 25.
This is a partial switch for the drug from prescription to over-the-counter, as men with overactive bladder still need a prescription for Oxytrol.
Although overactive bladder affects an estimated 33 million women, some studies suggest that many don’t seek treatment for it, and those who do seek treatment continue to have daily leakage (J. Urol. 2007;177:680-4).
"This effective, over-the-counter treatment offers women an option to independently manage their condition and achieve a newfound sense of control," Dr. Eman Elkadry of Harvard Medical School in Boston said in a statement issued by Merck. "The approval also provides recognition that this is a real medical disorder that can be addressed."
Each Oxytrol for Women patch is applied to the skin for 4 continuous days and nights, and delivers 3.9 mg of oxybutynin daily. Oxybutynin is an antispasmodic agent and is available in the United States under other prescription brand names, including Ditropan XL, Gelnique 3%, and Gelnique.
The safety and efficacy of the Oxytrol for Women patch were established in nine studies that included 5,000 participants, according to the FDA. "Overall, results from these studies showed that consumers can understand the information on the label, properly select whether the product is right for them, and use the drug appropriately," the agency noted.
The drug is not without side effects, although the ones reported in the studies were mild, including skin irritation at the site of the patch, dry mouth, and constipation, according to the FDA statement.
The announcement comes a week after the FDA approved Botox (onabotulinumtoxinA) for treatment of adults who don’t respond to a class of medications known as anticholinergics, which includes Oxytrol.
On Twitter @NaseemSMiller
Women with overactive bladder have access to an over-the-counter treatment for the first time, thanks to the Food and Drug Administration’s approval of Merck’s Oxytrol for Women Jan. 25.
This is a partial switch for the drug from prescription to over-the-counter, as men with overactive bladder still need a prescription for Oxytrol.
Although overactive bladder affects an estimated 33 million women, some studies suggest that many don’t seek treatment for it, and those who do seek treatment continue to have daily leakage (J. Urol. 2007;177:680-4).
"This effective, over-the-counter treatment offers women an option to independently manage their condition and achieve a newfound sense of control," Dr. Eman Elkadry of Harvard Medical School in Boston said in a statement issued by Merck. "The approval also provides recognition that this is a real medical disorder that can be addressed."
Each Oxytrol for Women patch is applied to the skin for 4 continuous days and nights, and delivers 3.9 mg of oxybutynin daily. Oxybutynin is an antispasmodic agent and is available in the United States under other prescription brand names, including Ditropan XL, Gelnique 3%, and Gelnique.
The safety and efficacy of the Oxytrol for Women patch were established in nine studies that included 5,000 participants, according to the FDA. "Overall, results from these studies showed that consumers can understand the information on the label, properly select whether the product is right for them, and use the drug appropriately," the agency noted.
The drug is not without side effects, although the ones reported in the studies were mild, including skin irritation at the site of the patch, dry mouth, and constipation, according to the FDA statement.
The announcement comes a week after the FDA approved Botox (onabotulinumtoxinA) for treatment of adults who don’t respond to a class of medications known as anticholinergics, which includes Oxytrol.
On Twitter @NaseemSMiller
RF positivity may predict response to some biologics in RA
A majority of studies of patients with rheumatoid arthritis that have collected data on rheumatoid factor status and response to treatment indicate that positivity for the autoantibody predicts response to rituximab and tocilizumab but not abatacept, according to a systematic review and meta-analysis.
The association of rheumatoid factor (RF) and response to certain biologics is disputed, and the findings have been contradictory. Meanwhile, there’s considerable heterogeneity in patient response to biologics: While some don’t benefit from a certain biologic, they do well on a different one, Dr. Jose Ramon Maneiro of Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain, and his colleagues wrote in their report.
The investigators set out to summarize the available evidence for how well RF positivity predicts response to rituximab, tocilizumab, and abatacept. They searched Medline, Embase, and the Cochrane Library for studies published between 2000 and 2011 in English, Spanish, French, Italian, or Portuguese, as well as online abstracts from the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) congresses from the same time period. The search resulted in more than 3,600 references and abstracts, from which they carefully selected 23 studies representing data from more than 5,800 patients (Semin. Arthritis Rheum. 2013 Jan. 3 [doi: 10.1016/j.semarthrit.2012.11.007]).
The researchers identified 14 studies on rituximab involving about 2,100 patients. In 11 studies that analyzed IgM RF status, 6 reported a significant association between IgM RF positivity and clinical response, including 1 that found a significant association with a titer greater than 30 IU/L but not greater than 20 IU/L. IgA RF status was significantly associated with clinical response in one study, while two other studies reported that IgG RF and IgA RF titers were significantly associated with clinical response. In six studies that used EULAR response criteria, patients with IgM RF positivity had significantly greater odds for meeting the response criteria than did those who were IgM RF negative (odds ratio, 3.52). Assessments of ACR response criteria found that RF positivity resulted in greater odds for an ACR20 response to rituximab in three studies (OR, 1.95) and an ACR50 response in three studies (OR, 5.38).
In four studies on tocilizumab, two indicated no relationship between RF status and response to the drug, whereas one report that analyzed data from three clinical trials found a significant association between RF status and ACR20 response. Another study found that the titer of IgM RF could predict Clinical Disease Activity Index. Overall, a meta-analysis of three studies found that RF positivity was significantly associated with greater odds for an ACR20 response (OR, 1.51).
A post hoc analysis of efficacy data from three clinical trials of abatacept showed no association between RF positivity and response to the drug. However, one observational study reported an association.
The review had several limitations, the authors noted. The meta-analysis aggregated results from clinical trials and observational studies, but none of the clinical trials was designed to test the studied association. Also, in observational studies there is a potential for bias from unmeasured confounding factors. In addition, the quality of the studies was low, the authors reported.
The study was partially supported by the Instituto de Salud Carlos III. The currently available version of the report, a corrected proof, did not note any financial disclosures for the authors.
On Twitter @NaseemSMiller
A majority of studies of patients with rheumatoid arthritis that have collected data on rheumatoid factor status and response to treatment indicate that positivity for the autoantibody predicts response to rituximab and tocilizumab but not abatacept, according to a systematic review and meta-analysis.
The association of rheumatoid factor (RF) and response to certain biologics is disputed, and the findings have been contradictory. Meanwhile, there’s considerable heterogeneity in patient response to biologics: While some don’t benefit from a certain biologic, they do well on a different one, Dr. Jose Ramon Maneiro of Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain, and his colleagues wrote in their report.
The investigators set out to summarize the available evidence for how well RF positivity predicts response to rituximab, tocilizumab, and abatacept. They searched Medline, Embase, and the Cochrane Library for studies published between 2000 and 2011 in English, Spanish, French, Italian, or Portuguese, as well as online abstracts from the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) congresses from the same time period. The search resulted in more than 3,600 references and abstracts, from which they carefully selected 23 studies representing data from more than 5,800 patients (Semin. Arthritis Rheum. 2013 Jan. 3 [doi: 10.1016/j.semarthrit.2012.11.007]).
The researchers identified 14 studies on rituximab involving about 2,100 patients. In 11 studies that analyzed IgM RF status, 6 reported a significant association between IgM RF positivity and clinical response, including 1 that found a significant association with a titer greater than 30 IU/L but not greater than 20 IU/L. IgA RF status was significantly associated with clinical response in one study, while two other studies reported that IgG RF and IgA RF titers were significantly associated with clinical response. In six studies that used EULAR response criteria, patients with IgM RF positivity had significantly greater odds for meeting the response criteria than did those who were IgM RF negative (odds ratio, 3.52). Assessments of ACR response criteria found that RF positivity resulted in greater odds for an ACR20 response to rituximab in three studies (OR, 1.95) and an ACR50 response in three studies (OR, 5.38).
In four studies on tocilizumab, two indicated no relationship between RF status and response to the drug, whereas one report that analyzed data from three clinical trials found a significant association between RF status and ACR20 response. Another study found that the titer of IgM RF could predict Clinical Disease Activity Index. Overall, a meta-analysis of three studies found that RF positivity was significantly associated with greater odds for an ACR20 response (OR, 1.51).
A post hoc analysis of efficacy data from three clinical trials of abatacept showed no association between RF positivity and response to the drug. However, one observational study reported an association.
The review had several limitations, the authors noted. The meta-analysis aggregated results from clinical trials and observational studies, but none of the clinical trials was designed to test the studied association. Also, in observational studies there is a potential for bias from unmeasured confounding factors. In addition, the quality of the studies was low, the authors reported.
The study was partially supported by the Instituto de Salud Carlos III. The currently available version of the report, a corrected proof, did not note any financial disclosures for the authors.
On Twitter @NaseemSMiller
A majority of studies of patients with rheumatoid arthritis that have collected data on rheumatoid factor status and response to treatment indicate that positivity for the autoantibody predicts response to rituximab and tocilizumab but not abatacept, according to a systematic review and meta-analysis.
The association of rheumatoid factor (RF) and response to certain biologics is disputed, and the findings have been contradictory. Meanwhile, there’s considerable heterogeneity in patient response to biologics: While some don’t benefit from a certain biologic, they do well on a different one, Dr. Jose Ramon Maneiro of Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain, and his colleagues wrote in their report.
The investigators set out to summarize the available evidence for how well RF positivity predicts response to rituximab, tocilizumab, and abatacept. They searched Medline, Embase, and the Cochrane Library for studies published between 2000 and 2011 in English, Spanish, French, Italian, or Portuguese, as well as online abstracts from the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) congresses from the same time period. The search resulted in more than 3,600 references and abstracts, from which they carefully selected 23 studies representing data from more than 5,800 patients (Semin. Arthritis Rheum. 2013 Jan. 3 [doi: 10.1016/j.semarthrit.2012.11.007]).
The researchers identified 14 studies on rituximab involving about 2,100 patients. In 11 studies that analyzed IgM RF status, 6 reported a significant association between IgM RF positivity and clinical response, including 1 that found a significant association with a titer greater than 30 IU/L but not greater than 20 IU/L. IgA RF status was significantly associated with clinical response in one study, while two other studies reported that IgG RF and IgA RF titers were significantly associated with clinical response. In six studies that used EULAR response criteria, patients with IgM RF positivity had significantly greater odds for meeting the response criteria than did those who were IgM RF negative (odds ratio, 3.52). Assessments of ACR response criteria found that RF positivity resulted in greater odds for an ACR20 response to rituximab in three studies (OR, 1.95) and an ACR50 response in three studies (OR, 5.38).
In four studies on tocilizumab, two indicated no relationship between RF status and response to the drug, whereas one report that analyzed data from three clinical trials found a significant association between RF status and ACR20 response. Another study found that the titer of IgM RF could predict Clinical Disease Activity Index. Overall, a meta-analysis of three studies found that RF positivity was significantly associated with greater odds for an ACR20 response (OR, 1.51).
A post hoc analysis of efficacy data from three clinical trials of abatacept showed no association between RF positivity and response to the drug. However, one observational study reported an association.
The review had several limitations, the authors noted. The meta-analysis aggregated results from clinical trials and observational studies, but none of the clinical trials was designed to test the studied association. Also, in observational studies there is a potential for bias from unmeasured confounding factors. In addition, the quality of the studies was low, the authors reported.
The study was partially supported by the Instituto de Salud Carlos III. The currently available version of the report, a corrected proof, did not note any financial disclosures for the authors.
On Twitter @NaseemSMiller
FROM SEMINARS IN ARTHRITIS AND RHEUMATISM
Major Finding: In six studies of rituximab that used EULAR response criteria, patients with IgM RF positivity had significantly greater odds for meeting the response criteria than did those who were IgM RF negative (OR, 3.52).
Data Source: A systematic review and meta-analysis of 23 studies, representing more than 5,800 patients.
Disclosures: The study was partially supported by the Instituto de Salud Carlos III. The currently available version of the report, a corrected proof, did not note any financial disclosures for the authors.
States failing at tobacco control
When it comes to tobacco control, state and the federal governments are falling far short of what is needed to oversee and enact tobacco prevention policies and programs, for the third year in a row, according to the American Lung Association’s 11th annual State of Tobacco Control report.
"We are faced with a deep-pocketed, ever-evolving tobacco industry that’s determined to maintain its market share at the expense of our kids and current smokers," according to Paul G. Billings, American Lung Association senior vice president for advocacy and education. "State and federal policymakers must battle a changing Big Tobacco and step up to fund programs and enact policies proven to reduce tobacco use," according to the 158-page report, which is presented on an interactive Web page, with infographics and easy to browse drop-down menus.
The report, which tracks annual progress on tobacco control policies at the federal and state level, criticizes the Food and Drug Administration for not exercising its authority, and for not regulating various tobacco products, allowing for proliferation of a new generation of tobacco products aimed at youth.
The states’ inaction includes failure to invest the money from taxes and tobacco settlement payments into tobacco prevention programs, according to the report. The payments totaled close to $26 billion in 2012. The Centers for Disease Control and Prevention recommends that states spend a total of $3.7 billion to control tobacco use each year, but the states spent only $460 million, according to the American Lung Association analysis. Delaware, North Dakota, and Wyoming were the only states that did not receive a D or F (D for spending 50-59% of the CDC level, and F for less than 50%).
The only major tobacco prevention effort in 2012, according to the report, was the CDC’s "Tips From Former Smokers" advertising campaign, which cost $54 million. "We need more campaigns like this from the federal government," said Mr. Billings.
The report also followed the money, showing that during the 2011-2012 election cycle, candidates for state offices accepted $53.4 million from the tobacco industry. The industry also contributed more than $3.7 million to congressional and presidential candidates.
"It’s no wonder we’re losing ground in the fight to end tobacco-caused death and disease," said Mr. Billings. "Elected officials are getting cozy with Big Tobacco."
Smoking costs Americans $200 billion each year in health care costs and lost productivity.
On Twitter @NaseemSMiller
When it comes to tobacco control, state and the federal governments are falling far short of what is needed to oversee and enact tobacco prevention policies and programs, for the third year in a row, according to the American Lung Association’s 11th annual State of Tobacco Control report.
"We are faced with a deep-pocketed, ever-evolving tobacco industry that’s determined to maintain its market share at the expense of our kids and current smokers," according to Paul G. Billings, American Lung Association senior vice president for advocacy and education. "State and federal policymakers must battle a changing Big Tobacco and step up to fund programs and enact policies proven to reduce tobacco use," according to the 158-page report, which is presented on an interactive Web page, with infographics and easy to browse drop-down menus.
The report, which tracks annual progress on tobacco control policies at the federal and state level, criticizes the Food and Drug Administration for not exercising its authority, and for not regulating various tobacco products, allowing for proliferation of a new generation of tobacco products aimed at youth.
The states’ inaction includes failure to invest the money from taxes and tobacco settlement payments into tobacco prevention programs, according to the report. The payments totaled close to $26 billion in 2012. The Centers for Disease Control and Prevention recommends that states spend a total of $3.7 billion to control tobacco use each year, but the states spent only $460 million, according to the American Lung Association analysis. Delaware, North Dakota, and Wyoming were the only states that did not receive a D or F (D for spending 50-59% of the CDC level, and F for less than 50%).
The only major tobacco prevention effort in 2012, according to the report, was the CDC’s "Tips From Former Smokers" advertising campaign, which cost $54 million. "We need more campaigns like this from the federal government," said Mr. Billings.
The report also followed the money, showing that during the 2011-2012 election cycle, candidates for state offices accepted $53.4 million from the tobacco industry. The industry also contributed more than $3.7 million to congressional and presidential candidates.
"It’s no wonder we’re losing ground in the fight to end tobacco-caused death and disease," said Mr. Billings. "Elected officials are getting cozy with Big Tobacco."
Smoking costs Americans $200 billion each year in health care costs and lost productivity.
On Twitter @NaseemSMiller
When it comes to tobacco control, state and the federal governments are falling far short of what is needed to oversee and enact tobacco prevention policies and programs, for the third year in a row, according to the American Lung Association’s 11th annual State of Tobacco Control report.
"We are faced with a deep-pocketed, ever-evolving tobacco industry that’s determined to maintain its market share at the expense of our kids and current smokers," according to Paul G. Billings, American Lung Association senior vice president for advocacy and education. "State and federal policymakers must battle a changing Big Tobacco and step up to fund programs and enact policies proven to reduce tobacco use," according to the 158-page report, which is presented on an interactive Web page, with infographics and easy to browse drop-down menus.
The report, which tracks annual progress on tobacco control policies at the federal and state level, criticizes the Food and Drug Administration for not exercising its authority, and for not regulating various tobacco products, allowing for proliferation of a new generation of tobacco products aimed at youth.
The states’ inaction includes failure to invest the money from taxes and tobacco settlement payments into tobacco prevention programs, according to the report. The payments totaled close to $26 billion in 2012. The Centers for Disease Control and Prevention recommends that states spend a total of $3.7 billion to control tobacco use each year, but the states spent only $460 million, according to the American Lung Association analysis. Delaware, North Dakota, and Wyoming were the only states that did not receive a D or F (D for spending 50-59% of the CDC level, and F for less than 50%).
The only major tobacco prevention effort in 2012, according to the report, was the CDC’s "Tips From Former Smokers" advertising campaign, which cost $54 million. "We need more campaigns like this from the federal government," said Mr. Billings.
The report also followed the money, showing that during the 2011-2012 election cycle, candidates for state offices accepted $53.4 million from the tobacco industry. The industry also contributed more than $3.7 million to congressional and presidential candidates.
"It’s no wonder we’re losing ground in the fight to end tobacco-caused death and disease," said Mr. Billings. "Elected officials are getting cozy with Big Tobacco."
Smoking costs Americans $200 billion each year in health care costs and lost productivity.
On Twitter @NaseemSMiller
Cyclosporine no more effective than infliximab for ulcerative colitis
Cyclosporine was no more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids, according to an open-label, randomized controlled trial of 115 patients.
However, the authors, led by Dr. David Laharie of the hepatology and gastroenterology service at Bordeaux (France) Hospital Center, said that their findings should be interpreted with caution because of the sample size. They added that treatment choice should be guided by physician and center experience.
As many as 40% of patients with acute severe ulcerative colitis who are admitted to the hospital are resistant to intravenous corticosteroids. For these patients, two drugs, cyclosporine or infliximab, have been used as rescue drugs to avoid colectomy.
Meanwhile, there haven’t been many studies comparing the two drugs. A 2012 systematic review of studies on cyclosporine and infliximab showed that the two were comparable, but randomized trials were needed, the review authors noted (Int. J. Colorectal. Dis. 2012 Nov. 1 [Epub ahead of print]). The current study, according to Dr. Laharie and his colleagues, is the first randomized trial to address the issue (Lancet 2012;380:1909-15).
For the 98-day open-label study, researchers randomized 115 patients to cyclosporine (58 patients) or infliximab (57). The patients were admitted for acute severe flare of ulcerative colitis (Lichtiger score greater than 10 points) to one of the 27 European centers participating in the study between June 1, 2007, and Aug. 31, 2010. They were 18 years or older (mean, 37.5 years), and had never received cyclosporine or infliximab. Contraception during the trial and for 3 months after was mandatory for patients of childbearing age.
The primary endpoint was treatment failure at any time, including absence of clinical response on day 7, relapse between day 7 and day 98, absence of steroid-free remission at day 98, or a severe adverse event leading to interruption of treatment, colectomy, or death. The secondary endpoints included clinical response at day 7, time to clinical response, mucosal healing at day 98, colectomy-free survival, and safety.
Treatment failed in 35 patients (60%) who were receiving cyclosporine, and in 31 patients (54%) who were given infliximab (absolute risk difference of 6%, P = .52). There were no significant differences between the two groups’ suboutcomes, such as responses at day 7 and colectomy rates at day 98. Both drugs were well tolerated, and there were no serious infections or deaths during the trial period.
The authors noted several limitations of the study. Treatment assignments were open label. The use of composite criteria as a primary outcome, rather than colectomy alone, "probably restricted the effect of unmasking on therapeutic decisions," they wrote. Also, the study was powered to detect a large difference between the effect of the two drugs. In addition, they said that because of the sample size, the study’s findings needed to be interpreted with caution.
The authors listed disclosures with several companies, including Merck Sharp & Dohme, Abbott, and Ferring, but they said that no commercial entity had any role in the study, and that the funding sources had no role in the study design, data collection, analysis, or interpretation.
On Twitter @naseemsmiller
Cyclosporine was no more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids, according to an open-label, randomized controlled trial of 115 patients.
However, the authors, led by Dr. David Laharie of the hepatology and gastroenterology service at Bordeaux (France) Hospital Center, said that their findings should be interpreted with caution because of the sample size. They added that treatment choice should be guided by physician and center experience.
As many as 40% of patients with acute severe ulcerative colitis who are admitted to the hospital are resistant to intravenous corticosteroids. For these patients, two drugs, cyclosporine or infliximab, have been used as rescue drugs to avoid colectomy.
Meanwhile, there haven’t been many studies comparing the two drugs. A 2012 systematic review of studies on cyclosporine and infliximab showed that the two were comparable, but randomized trials were needed, the review authors noted (Int. J. Colorectal. Dis. 2012 Nov. 1 [Epub ahead of print]). The current study, according to Dr. Laharie and his colleagues, is the first randomized trial to address the issue (Lancet 2012;380:1909-15).
For the 98-day open-label study, researchers randomized 115 patients to cyclosporine (58 patients) or infliximab (57). The patients were admitted for acute severe flare of ulcerative colitis (Lichtiger score greater than 10 points) to one of the 27 European centers participating in the study between June 1, 2007, and Aug. 31, 2010. They were 18 years or older (mean, 37.5 years), and had never received cyclosporine or infliximab. Contraception during the trial and for 3 months after was mandatory for patients of childbearing age.
The primary endpoint was treatment failure at any time, including absence of clinical response on day 7, relapse between day 7 and day 98, absence of steroid-free remission at day 98, or a severe adverse event leading to interruption of treatment, colectomy, or death. The secondary endpoints included clinical response at day 7, time to clinical response, mucosal healing at day 98, colectomy-free survival, and safety.
Treatment failed in 35 patients (60%) who were receiving cyclosporine, and in 31 patients (54%) who were given infliximab (absolute risk difference of 6%, P = .52). There were no significant differences between the two groups’ suboutcomes, such as responses at day 7 and colectomy rates at day 98. Both drugs were well tolerated, and there were no serious infections or deaths during the trial period.
The authors noted several limitations of the study. Treatment assignments were open label. The use of composite criteria as a primary outcome, rather than colectomy alone, "probably restricted the effect of unmasking on therapeutic decisions," they wrote. Also, the study was powered to detect a large difference between the effect of the two drugs. In addition, they said that because of the sample size, the study’s findings needed to be interpreted with caution.
The authors listed disclosures with several companies, including Merck Sharp & Dohme, Abbott, and Ferring, but they said that no commercial entity had any role in the study, and that the funding sources had no role in the study design, data collection, analysis, or interpretation.
On Twitter @naseemsmiller
Cyclosporine was no more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids, according to an open-label, randomized controlled trial of 115 patients.
However, the authors, led by Dr. David Laharie of the hepatology and gastroenterology service at Bordeaux (France) Hospital Center, said that their findings should be interpreted with caution because of the sample size. They added that treatment choice should be guided by physician and center experience.
As many as 40% of patients with acute severe ulcerative colitis who are admitted to the hospital are resistant to intravenous corticosteroids. For these patients, two drugs, cyclosporine or infliximab, have been used as rescue drugs to avoid colectomy.
Meanwhile, there haven’t been many studies comparing the two drugs. A 2012 systematic review of studies on cyclosporine and infliximab showed that the two were comparable, but randomized trials were needed, the review authors noted (Int. J. Colorectal. Dis. 2012 Nov. 1 [Epub ahead of print]). The current study, according to Dr. Laharie and his colleagues, is the first randomized trial to address the issue (Lancet 2012;380:1909-15).
For the 98-day open-label study, researchers randomized 115 patients to cyclosporine (58 patients) or infliximab (57). The patients were admitted for acute severe flare of ulcerative colitis (Lichtiger score greater than 10 points) to one of the 27 European centers participating in the study between June 1, 2007, and Aug. 31, 2010. They were 18 years or older (mean, 37.5 years), and had never received cyclosporine or infliximab. Contraception during the trial and for 3 months after was mandatory for patients of childbearing age.
The primary endpoint was treatment failure at any time, including absence of clinical response on day 7, relapse between day 7 and day 98, absence of steroid-free remission at day 98, or a severe adverse event leading to interruption of treatment, colectomy, or death. The secondary endpoints included clinical response at day 7, time to clinical response, mucosal healing at day 98, colectomy-free survival, and safety.
Treatment failed in 35 patients (60%) who were receiving cyclosporine, and in 31 patients (54%) who were given infliximab (absolute risk difference of 6%, P = .52). There were no significant differences between the two groups’ suboutcomes, such as responses at day 7 and colectomy rates at day 98. Both drugs were well tolerated, and there were no serious infections or deaths during the trial period.
The authors noted several limitations of the study. Treatment assignments were open label. The use of composite criteria as a primary outcome, rather than colectomy alone, "probably restricted the effect of unmasking on therapeutic decisions," they wrote. Also, the study was powered to detect a large difference between the effect of the two drugs. In addition, they said that because of the sample size, the study’s findings needed to be interpreted with caution.
The authors listed disclosures with several companies, including Merck Sharp & Dohme, Abbott, and Ferring, but they said that no commercial entity had any role in the study, and that the funding sources had no role in the study design, data collection, analysis, or interpretation.
On Twitter @naseemsmiller
FROM THE LANCET
Major Finding: Treatment failed in 60%, or 35 patients who were receiving cyclosporine, and 54%, or 31 patients who were given infliximab (absolute risk difference of 6%, P = 0.52).
Data Source: A 98-day open-label study of 115 patients randomly assigned to cyclosporine (58 patients) or infliximab (57), admitted to one of the 27 European centers participating in the study between June 1, 2007, and Aug. 31, 2010.
Disclosures: The authors listed disclosures with several companies, including Merck Sharp & Dohme, Abbott, and Ferring, but they said that no commercial entity had any role in the study, and that the funding sources had no role in the study design, data collection, analysis, or interpretation.
CDC: Binge drinking in women, girls under-recognized
Binge drinking, which is the most dangerous form of alcohol consumption, is a serious, yet under-recognized health risk for women, according to a federal report that showed one in eight U.S. adult women and one in five high school girls binge drank in 2011.
The issue is not new, officials said, but they expressed concern with the statistics, saying that the rates of binge drinking among high school girls is now almost equal to that of boys, and the rates have remained almost the same among U.S. adult women for more than a decade.
In 2011, nearly 13% of U.S. adult women binge drank more than three times a month and with roughly six drinks during each occasion. Meanwhile, close to 20% of high school girls reported binge drinking, according to the analysis of two national databases, which was published in the Centers for Disease Control and Prevention’s Vital Signs (MMWR 2013 Jan. 3;62:1-5).
CDC director Thomas R. Frieden said that there were no data showing whether women are aware of the dangers of binge drinking, and he stressed the importance of raising awareness.
"Health-care providers have an important role to play in reducing binge drinking," Dr. Frieden said during a news conference. "They can talk to all patients, including pregnant women about their alcohol consumption, and advise those who drink too much, to do so less."
The report, which analyzed data from the 2011 Behavioral Risk Factor Surveillance System (278,000 women) and the national Youth Risk Behavior Survey (7,500 girls), also showed:
• During each year, between 2001 and 2005, alcohol use accounted for nearly 23,000 deaths and 633,000 years of potential life lost among U.S. girls and adult women. Binge drinking accounted for half of these statistics.
• Binge drinking was most prevalent among women aged 18- to 24-years-old (24%) and 25- to 34-years-old (20%), and then gradually decreased with increasing age.
• Binge drinking was most prevalent among women whose annual household income was $75,000 or more (16%).
• Although non-Hispanic white women had the highest rate of binge drinking (13%), compared with 11% among Hispanic women, and 10% among black women, the frequency and intensity of binge drinking was similar across the racial and ethnic groups.
• Women without a high school degree had the lowest prevalence of binge drinking (8.5%), yet the ones who binge drank reported the highest frequency (more than four times a month), and intensity (more than six drinks per occasion), compared with women who had higher levels of education.
• Roughly 38% of high school girls consumed alcohol, more than half of whom said that they binge drank.
• The prevalence of binge drinking among Hispanic (22.4%) and non-Hispanic white (21.7%) high school girls was nearly twice as much as that of non-Hispanic black girls (10.3%).
Binge drinking was defined as consumption of four or more drinks in a row for women, and five or more drinks in a row for high school girls. Officials said that the rates would have been higher by one-third or more if the number of drinks for girls was reduced from 5 to 4 in the survey.
Federal officials said that binge drinking is a risk factor for many health and social problems among women, because their bodies respond to alcohol differently from men. Women generally reach higher blood alcohol levels than do men at the same consumption level, even after adjustment for body size, food eaten, and other factors. Binge drinking has been associated with heart disease, breast cancer, behaviors that could lead to contracting sexually transmitted diseases, and unintended pregnancy, in addition to fetal alcohol spectrum disorders and sudden infant death syndrome.
Officials urged physicians, states, and communities to implement evidence-based interventions, such as recommendations by the Guide to Community Preventive Services, and the U.S. Preventive Services Task Force.
On Twitter @naseemsmiller
Binge drinking, which is the most dangerous form of alcohol consumption, is a serious, yet under-recognized health risk for women, according to a federal report that showed one in eight U.S. adult women and one in five high school girls binge drank in 2011.
The issue is not new, officials said, but they expressed concern with the statistics, saying that the rates of binge drinking among high school girls is now almost equal to that of boys, and the rates have remained almost the same among U.S. adult women for more than a decade.
In 2011, nearly 13% of U.S. adult women binge drank more than three times a month and with roughly six drinks during each occasion. Meanwhile, close to 20% of high school girls reported binge drinking, according to the analysis of two national databases, which was published in the Centers for Disease Control and Prevention’s Vital Signs (MMWR 2013 Jan. 3;62:1-5).
CDC director Thomas R. Frieden said that there were no data showing whether women are aware of the dangers of binge drinking, and he stressed the importance of raising awareness.
"Health-care providers have an important role to play in reducing binge drinking," Dr. Frieden said during a news conference. "They can talk to all patients, including pregnant women about their alcohol consumption, and advise those who drink too much, to do so less."
The report, which analyzed data from the 2011 Behavioral Risk Factor Surveillance System (278,000 women) and the national Youth Risk Behavior Survey (7,500 girls), also showed:
• During each year, between 2001 and 2005, alcohol use accounted for nearly 23,000 deaths and 633,000 years of potential life lost among U.S. girls and adult women. Binge drinking accounted for half of these statistics.
• Binge drinking was most prevalent among women aged 18- to 24-years-old (24%) and 25- to 34-years-old (20%), and then gradually decreased with increasing age.
• Binge drinking was most prevalent among women whose annual household income was $75,000 or more (16%).
• Although non-Hispanic white women had the highest rate of binge drinking (13%), compared with 11% among Hispanic women, and 10% among black women, the frequency and intensity of binge drinking was similar across the racial and ethnic groups.
• Women without a high school degree had the lowest prevalence of binge drinking (8.5%), yet the ones who binge drank reported the highest frequency (more than four times a month), and intensity (more than six drinks per occasion), compared with women who had higher levels of education.
• Roughly 38% of high school girls consumed alcohol, more than half of whom said that they binge drank.
• The prevalence of binge drinking among Hispanic (22.4%) and non-Hispanic white (21.7%) high school girls was nearly twice as much as that of non-Hispanic black girls (10.3%).
Binge drinking was defined as consumption of four or more drinks in a row for women, and five or more drinks in a row for high school girls. Officials said that the rates would have been higher by one-third or more if the number of drinks for girls was reduced from 5 to 4 in the survey.
Federal officials said that binge drinking is a risk factor for many health and social problems among women, because their bodies respond to alcohol differently from men. Women generally reach higher blood alcohol levels than do men at the same consumption level, even after adjustment for body size, food eaten, and other factors. Binge drinking has been associated with heart disease, breast cancer, behaviors that could lead to contracting sexually transmitted diseases, and unintended pregnancy, in addition to fetal alcohol spectrum disorders and sudden infant death syndrome.
Officials urged physicians, states, and communities to implement evidence-based interventions, such as recommendations by the Guide to Community Preventive Services, and the U.S. Preventive Services Task Force.
On Twitter @naseemsmiller
Binge drinking, which is the most dangerous form of alcohol consumption, is a serious, yet under-recognized health risk for women, according to a federal report that showed one in eight U.S. adult women and one in five high school girls binge drank in 2011.
The issue is not new, officials said, but they expressed concern with the statistics, saying that the rates of binge drinking among high school girls is now almost equal to that of boys, and the rates have remained almost the same among U.S. adult women for more than a decade.
In 2011, nearly 13% of U.S. adult women binge drank more than three times a month and with roughly six drinks during each occasion. Meanwhile, close to 20% of high school girls reported binge drinking, according to the analysis of two national databases, which was published in the Centers for Disease Control and Prevention’s Vital Signs (MMWR 2013 Jan. 3;62:1-5).
CDC director Thomas R. Frieden said that there were no data showing whether women are aware of the dangers of binge drinking, and he stressed the importance of raising awareness.
"Health-care providers have an important role to play in reducing binge drinking," Dr. Frieden said during a news conference. "They can talk to all patients, including pregnant women about their alcohol consumption, and advise those who drink too much, to do so less."
The report, which analyzed data from the 2011 Behavioral Risk Factor Surveillance System (278,000 women) and the national Youth Risk Behavior Survey (7,500 girls), also showed:
• During each year, between 2001 and 2005, alcohol use accounted for nearly 23,000 deaths and 633,000 years of potential life lost among U.S. girls and adult women. Binge drinking accounted for half of these statistics.
• Binge drinking was most prevalent among women aged 18- to 24-years-old (24%) and 25- to 34-years-old (20%), and then gradually decreased with increasing age.
• Binge drinking was most prevalent among women whose annual household income was $75,000 or more (16%).
• Although non-Hispanic white women had the highest rate of binge drinking (13%), compared with 11% among Hispanic women, and 10% among black women, the frequency and intensity of binge drinking was similar across the racial and ethnic groups.
• Women without a high school degree had the lowest prevalence of binge drinking (8.5%), yet the ones who binge drank reported the highest frequency (more than four times a month), and intensity (more than six drinks per occasion), compared with women who had higher levels of education.
• Roughly 38% of high school girls consumed alcohol, more than half of whom said that they binge drank.
• The prevalence of binge drinking among Hispanic (22.4%) and non-Hispanic white (21.7%) high school girls was nearly twice as much as that of non-Hispanic black girls (10.3%).
Binge drinking was defined as consumption of four or more drinks in a row for women, and five or more drinks in a row for high school girls. Officials said that the rates would have been higher by one-third or more if the number of drinks for girls was reduced from 5 to 4 in the survey.
Federal officials said that binge drinking is a risk factor for many health and social problems among women, because their bodies respond to alcohol differently from men. Women generally reach higher blood alcohol levels than do men at the same consumption level, even after adjustment for body size, food eaten, and other factors. Binge drinking has been associated with heart disease, breast cancer, behaviors that could lead to contracting sexually transmitted diseases, and unintended pregnancy, in addition to fetal alcohol spectrum disorders and sudden infant death syndrome.
Officials urged physicians, states, and communities to implement evidence-based interventions, such as recommendations by the Guide to Community Preventive Services, and the U.S. Preventive Services Task Force.
On Twitter @naseemsmiller
FROM MMWR
Major Finding: One in eight U.S. adult women and one in five high school girls binge drank in 2011.
Data Source: Analysis of data from the 2011 Behavioral Risk Factor Surveillance System (278,000 women) and the national Youth Risk Behavior Survey (7,500 high school girls).
Disclosures: The authors had no relevant disclosures.
Flu activity continues to increase
This year’s flu season, which started a month earlier than usual, continues to show increased activity across the nation.
In week 50 (Dec. 9-15), 30% of the 9,500 respiratory specimens tested in national laboratories were positive for influenza. Among outpatient visits reported to the U.S. Outpatient Influenza-Like Illness Surveillance Network, 3.2% were positive for influenza-like illness, compared to the expected national baseline of 2.2%.
Over the last several weeks, the number of states reporting high flu activity grew from 5 to 12. Those states include Alabama, Georgia, Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, Texas, Utah, and Virginia. Meanwhile, 22 states are still reporting minimal flu activity.
"It’s too early to tell how severe our season might be," CDC Director Dr. Thomas Frieden said in a statement. "However, we know that thousands die and hundreds of thousands of people are hospitalized with flu each year."
The proportion of deaths (6.7%) attributed to pneumonia and influenza are still below the epidemic threshold (7.0%) in week 50. Two pediatric deaths related to influenza were reported in week 50.
The dominant strain this year is influenza A(H3N2), which has been associated with more severe flu seasons. This year’s flu vaccine is a 90% match for the specimens that have been sent to the CDC, according to an agency update on Dec. 21.
"Vaccination is the single most important step we can take to protect ourselves and our families against infection. It’s not too late to get vaccinated before the flu season peaks," Dr. Frieden said.
Roughly 123 million doses of influenza vaccine have been distributed so far, and nearly 112 million Americans have been vaccinated so far this flu season, the CDC reported.
Also on Dec. 21, the Food and Drug Administration expanded approval of oseltamivir (Tamiflu) to children as young as 2 weeks old who have shown flu symptoms for 2 days or less. The agency stressed that oseltamivir is not approved to prevent flu in this population and that the drug’s safety and efficacy has not been established in those younger than 2 weeks old.
This year’s flu season, which started a month earlier than usual, continues to show increased activity across the nation.
In week 50 (Dec. 9-15), 30% of the 9,500 respiratory specimens tested in national laboratories were positive for influenza. Among outpatient visits reported to the U.S. Outpatient Influenza-Like Illness Surveillance Network, 3.2% were positive for influenza-like illness, compared to the expected national baseline of 2.2%.
Over the last several weeks, the number of states reporting high flu activity grew from 5 to 12. Those states include Alabama, Georgia, Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, Texas, Utah, and Virginia. Meanwhile, 22 states are still reporting minimal flu activity.
"It’s too early to tell how severe our season might be," CDC Director Dr. Thomas Frieden said in a statement. "However, we know that thousands die and hundreds of thousands of people are hospitalized with flu each year."
The proportion of deaths (6.7%) attributed to pneumonia and influenza are still below the epidemic threshold (7.0%) in week 50. Two pediatric deaths related to influenza were reported in week 50.
The dominant strain this year is influenza A(H3N2), which has been associated with more severe flu seasons. This year’s flu vaccine is a 90% match for the specimens that have been sent to the CDC, according to an agency update on Dec. 21.
"Vaccination is the single most important step we can take to protect ourselves and our families against infection. It’s not too late to get vaccinated before the flu season peaks," Dr. Frieden said.
Roughly 123 million doses of influenza vaccine have been distributed so far, and nearly 112 million Americans have been vaccinated so far this flu season, the CDC reported.
Also on Dec. 21, the Food and Drug Administration expanded approval of oseltamivir (Tamiflu) to children as young as 2 weeks old who have shown flu symptoms for 2 days or less. The agency stressed that oseltamivir is not approved to prevent flu in this population and that the drug’s safety and efficacy has not been established in those younger than 2 weeks old.
This year’s flu season, which started a month earlier than usual, continues to show increased activity across the nation.
In week 50 (Dec. 9-15), 30% of the 9,500 respiratory specimens tested in national laboratories were positive for influenza. Among outpatient visits reported to the U.S. Outpatient Influenza-Like Illness Surveillance Network, 3.2% were positive for influenza-like illness, compared to the expected national baseline of 2.2%.
Over the last several weeks, the number of states reporting high flu activity grew from 5 to 12. Those states include Alabama, Georgia, Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, Texas, Utah, and Virginia. Meanwhile, 22 states are still reporting minimal flu activity.
"It’s too early to tell how severe our season might be," CDC Director Dr. Thomas Frieden said in a statement. "However, we know that thousands die and hundreds of thousands of people are hospitalized with flu each year."
The proportion of deaths (6.7%) attributed to pneumonia and influenza are still below the epidemic threshold (7.0%) in week 50. Two pediatric deaths related to influenza were reported in week 50.
The dominant strain this year is influenza A(H3N2), which has been associated with more severe flu seasons. This year’s flu vaccine is a 90% match for the specimens that have been sent to the CDC, according to an agency update on Dec. 21.
"Vaccination is the single most important step we can take to protect ourselves and our families against infection. It’s not too late to get vaccinated before the flu season peaks," Dr. Frieden said.
Roughly 123 million doses of influenza vaccine have been distributed so far, and nearly 112 million Americans have been vaccinated so far this flu season, the CDC reported.
Also on Dec. 21, the Food and Drug Administration expanded approval of oseltamivir (Tamiflu) to children as young as 2 weeks old who have shown flu symptoms for 2 days or less. The agency stressed that oseltamivir is not approved to prevent flu in this population and that the drug’s safety and efficacy has not been established in those younger than 2 weeks old.
Researchers at ASH express concern with fiscal cliff
ATLANTA – Like many of their fellow physicians, oncologists and hematologists are concerned about the across-the-board federal budget cuts looming on the other side of the fiscal cliff.
At its recently concluded annual meeting, the American Society of Hematology surveyed abstract presenters and found that two-thirds are reliant on the National Institutes of Health for some or all of their research funding.
Should sequestration go into effect in January, the NIH budget is expected to be cut by about $2.5 billion. The agency "would have to halt or curtail scientific research, including needed research into cancer and childhood diseases," according to a report from the federal Office of Management and Budget.
Such cuts, according to ASH leaders, will discourage young scientists from pursuing a career in research, and if left in place would eventually dismantle the teaching support structure.
A total of 86% of U.S.-based survey respondents reported that they had referenced NIH-funded studies in their research. Three-quarters said they were "extremely concerned" about the threat of NIH budget cuts and the impact on their careers.
"We could lose a generation of scientists," Dr. Janis L. Abkowitz, president of ASH, said in an interview. The research field may not look any different for a few years, but "eventually, we will lose the competitive edge in research. It’s as if we’re giving up on science."
In 2011, roughly 18% of projects received R01 grant funding, the major funding mechanism for individual projects. That’s compared with 22% in 2010, 25%-32% in 1993-2003, and 45%-58% in 1962-1966, according to an article coauthored by Dr. Abkowitz (JAMA 2012;308:2343-4).
The article also challenges other professional societies to bring the issue to the forefront and create programs such as the ASH bridge grant program to help fund researchers caught in sequestration’s grip that otherwise would lose their funding.
Dr. Abkowitz, head of the division of hematology at the University of Washington, Seattle, said that funding from pharmaceutical companies doesn’t fill the gap for cuts in NIH funding, because drug companies invest in ideas that are developed and that have commercial possibilities, she said.
NIH grants, on the other hand, "invest in individuals who have great ideas. Some ideas work out, some fail, and some take 10 years to come to fruition," she said. "But it’s the idea that’s the revolutionary piece that eventually could lead to a discovery that could cure a disease or find a new test, and is the economic driver. That’s why we have prominence economically and in health care. It\'s because of these novel ideas."
If the country goes over the fiscal cliff in January, 2,300 new grants won’t receive funding. Some 33,000 jobs depend on those grants, Dr. Robert Hromas, chair of ASH’s Committee on Scientific Affairs, said in an interview (see video). "It’s as if we’re turning off the spigot for future grants."
NIH issued a statement this month, proposing a "critical initiative" to help sustain the future of U.S. biomedical research.
ATLANTA – Like many of their fellow physicians, oncologists and hematologists are concerned about the across-the-board federal budget cuts looming on the other side of the fiscal cliff.
At its recently concluded annual meeting, the American Society of Hematology surveyed abstract presenters and found that two-thirds are reliant on the National Institutes of Health for some or all of their research funding.
Should sequestration go into effect in January, the NIH budget is expected to be cut by about $2.5 billion. The agency "would have to halt or curtail scientific research, including needed research into cancer and childhood diseases," according to a report from the federal Office of Management and Budget.
Such cuts, according to ASH leaders, will discourage young scientists from pursuing a career in research, and if left in place would eventually dismantle the teaching support structure.
A total of 86% of U.S.-based survey respondents reported that they had referenced NIH-funded studies in their research. Three-quarters said they were "extremely concerned" about the threat of NIH budget cuts and the impact on their careers.
"We could lose a generation of scientists," Dr. Janis L. Abkowitz, president of ASH, said in an interview. The research field may not look any different for a few years, but "eventually, we will lose the competitive edge in research. It’s as if we’re giving up on science."
In 2011, roughly 18% of projects received R01 grant funding, the major funding mechanism for individual projects. That’s compared with 22% in 2010, 25%-32% in 1993-2003, and 45%-58% in 1962-1966, according to an article coauthored by Dr. Abkowitz (JAMA 2012;308:2343-4).
The article also challenges other professional societies to bring the issue to the forefront and create programs such as the ASH bridge grant program to help fund researchers caught in sequestration’s grip that otherwise would lose their funding.
Dr. Abkowitz, head of the division of hematology at the University of Washington, Seattle, said that funding from pharmaceutical companies doesn’t fill the gap for cuts in NIH funding, because drug companies invest in ideas that are developed and that have commercial possibilities, she said.
NIH grants, on the other hand, "invest in individuals who have great ideas. Some ideas work out, some fail, and some take 10 years to come to fruition," she said. "But it’s the idea that’s the revolutionary piece that eventually could lead to a discovery that could cure a disease or find a new test, and is the economic driver. That’s why we have prominence economically and in health care. It\'s because of these novel ideas."
If the country goes over the fiscal cliff in January, 2,300 new grants won’t receive funding. Some 33,000 jobs depend on those grants, Dr. Robert Hromas, chair of ASH’s Committee on Scientific Affairs, said in an interview (see video). "It’s as if we’re turning off the spigot for future grants."
NIH issued a statement this month, proposing a "critical initiative" to help sustain the future of U.S. biomedical research.
ATLANTA – Like many of their fellow physicians, oncologists and hematologists are concerned about the across-the-board federal budget cuts looming on the other side of the fiscal cliff.
At its recently concluded annual meeting, the American Society of Hematology surveyed abstract presenters and found that two-thirds are reliant on the National Institutes of Health for some or all of their research funding.
Should sequestration go into effect in January, the NIH budget is expected to be cut by about $2.5 billion. The agency "would have to halt or curtail scientific research, including needed research into cancer and childhood diseases," according to a report from the federal Office of Management and Budget.
Such cuts, according to ASH leaders, will discourage young scientists from pursuing a career in research, and if left in place would eventually dismantle the teaching support structure.
A total of 86% of U.S.-based survey respondents reported that they had referenced NIH-funded studies in their research. Three-quarters said they were "extremely concerned" about the threat of NIH budget cuts and the impact on their careers.
"We could lose a generation of scientists," Dr. Janis L. Abkowitz, president of ASH, said in an interview. The research field may not look any different for a few years, but "eventually, we will lose the competitive edge in research. It’s as if we’re giving up on science."
In 2011, roughly 18% of projects received R01 grant funding, the major funding mechanism for individual projects. That’s compared with 22% in 2010, 25%-32% in 1993-2003, and 45%-58% in 1962-1966, according to an article coauthored by Dr. Abkowitz (JAMA 2012;308:2343-4).
The article also challenges other professional societies to bring the issue to the forefront and create programs such as the ASH bridge grant program to help fund researchers caught in sequestration’s grip that otherwise would lose their funding.
Dr. Abkowitz, head of the division of hematology at the University of Washington, Seattle, said that funding from pharmaceutical companies doesn’t fill the gap for cuts in NIH funding, because drug companies invest in ideas that are developed and that have commercial possibilities, she said.
NIH grants, on the other hand, "invest in individuals who have great ideas. Some ideas work out, some fail, and some take 10 years to come to fruition," she said. "But it’s the idea that’s the revolutionary piece that eventually could lead to a discovery that could cure a disease or find a new test, and is the economic driver. That’s why we have prominence economically and in health care. It\'s because of these novel ideas."
If the country goes over the fiscal cliff in January, 2,300 new grants won’t receive funding. Some 33,000 jobs depend on those grants, Dr. Robert Hromas, chair of ASH’s Committee on Scientific Affairs, said in an interview (see video). "It’s as if we’re turning off the spigot for future grants."
NIH issued a statement this month, proposing a "critical initiative" to help sustain the future of U.S. biomedical research.
AT THE ANNUAL MEETING OF THE AMERICAN SOCIETY OF HEMATOLOGY
Flu Season Starts a Month Early
Instead of waiting for the new year to ring in, the 2012-2013 flu season has gotten an early start by almost a month, breaking a decade-long trend, federal health officials announced Dec. 3.
Centers for Disease Control and Prevention (CDC) Director Thomas R. Frieden said that the influenza virus is unpredictable, but the early season and the dominant flu strains suggest that this could be a bad flu year. "We haven’t said that it’s going to be the worst flu season, but it’s the earliest season we’ve seen since 2003-2004," he said. The 2009-2010 flu pandemic remains an exception.
The dominant influenza strain this year is influenza A(H3N2), which has been associated with more severe flu seasons. But the good news is that this year’s flu vaccine is a 90% match for the specimens that have been sent to the CDC, according to an agency update.
Vaccine-makers have sent out roughly 123 million doses of the vaccine so far, and nearly 112 million Americans have been vaccinated so far this flu season, according to officials.
What’s hinting toward an early uptick of the flu season is a national baseline for the percentage of outpatient visits that were due to flulike illnesses. The percent of such visits reached the baseline (2.2%) this year during week 47 (Nov. 17-24). In the 2010-2011 season, such visits barely reached the baseline during the first week of 2011.
Alabama, Louisiana, Mississippi, Tennessee, and Texas reported the highest influenza-like illness activity during week 47. The lowest activity was reported in Ohio, Utah, and Virginia.
During this period, 6.3% of all reported deaths were due to pneumonia and influenza, which is below the epidemic threshold of 6.7%. Two influenza-related pediatric deaths have been reported so far this year.
Officials also said that they were encouraged by the vaccination rates among health care professionals. The early-season 2012-2013 flu vaccination rate among this group was at nearly 63%, similar to what was reported midseason the prior year. Pharmacists reported the highest vaccination rate (89%), followed by physicians (83%), nurses (82%), nurse practitioners and physician assistants (73%), and other clinical professionals (77%).
Also, nearly half of all pregnant women have been vaccinated so far this year, similar to numbers reported last year. The biggest trigger for this group’s vaccination, said Dr. Frieden, is whether their obstetricians offer vaccination in the office, as nearly three-quarters of those pregnant women get vaccinated.
The CDC encourages everyone over 6 months of age to get flu vaccination. "The vaccine remains the best tool that we have," said Dr. Frieden.
"When you get together with your friends and family, be sure that you spread good cheer and you give presents, and that you don’t share infections and spread the flu," he said.
Instead of waiting for the new year to ring in, the 2012-2013 flu season has gotten an early start by almost a month, breaking a decade-long trend, federal health officials announced Dec. 3.
Centers for Disease Control and Prevention (CDC) Director Thomas R. Frieden said that the influenza virus is unpredictable, but the early season and the dominant flu strains suggest that this could be a bad flu year. "We haven’t said that it’s going to be the worst flu season, but it’s the earliest season we’ve seen since 2003-2004," he said. The 2009-2010 flu pandemic remains an exception.
The dominant influenza strain this year is influenza A(H3N2), which has been associated with more severe flu seasons. But the good news is that this year’s flu vaccine is a 90% match for the specimens that have been sent to the CDC, according to an agency update.
Vaccine-makers have sent out roughly 123 million doses of the vaccine so far, and nearly 112 million Americans have been vaccinated so far this flu season, according to officials.
What’s hinting toward an early uptick of the flu season is a national baseline for the percentage of outpatient visits that were due to flulike illnesses. The percent of such visits reached the baseline (2.2%) this year during week 47 (Nov. 17-24). In the 2010-2011 season, such visits barely reached the baseline during the first week of 2011.
Alabama, Louisiana, Mississippi, Tennessee, and Texas reported the highest influenza-like illness activity during week 47. The lowest activity was reported in Ohio, Utah, and Virginia.
During this period, 6.3% of all reported deaths were due to pneumonia and influenza, which is below the epidemic threshold of 6.7%. Two influenza-related pediatric deaths have been reported so far this year.
Officials also said that they were encouraged by the vaccination rates among health care professionals. The early-season 2012-2013 flu vaccination rate among this group was at nearly 63%, similar to what was reported midseason the prior year. Pharmacists reported the highest vaccination rate (89%), followed by physicians (83%), nurses (82%), nurse practitioners and physician assistants (73%), and other clinical professionals (77%).
Also, nearly half of all pregnant women have been vaccinated so far this year, similar to numbers reported last year. The biggest trigger for this group’s vaccination, said Dr. Frieden, is whether their obstetricians offer vaccination in the office, as nearly three-quarters of those pregnant women get vaccinated.
The CDC encourages everyone over 6 months of age to get flu vaccination. "The vaccine remains the best tool that we have," said Dr. Frieden.
"When you get together with your friends and family, be sure that you spread good cheer and you give presents, and that you don’t share infections and spread the flu," he said.
Instead of waiting for the new year to ring in, the 2012-2013 flu season has gotten an early start by almost a month, breaking a decade-long trend, federal health officials announced Dec. 3.
Centers for Disease Control and Prevention (CDC) Director Thomas R. Frieden said that the influenza virus is unpredictable, but the early season and the dominant flu strains suggest that this could be a bad flu year. "We haven’t said that it’s going to be the worst flu season, but it’s the earliest season we’ve seen since 2003-2004," he said. The 2009-2010 flu pandemic remains an exception.
The dominant influenza strain this year is influenza A(H3N2), which has been associated with more severe flu seasons. But the good news is that this year’s flu vaccine is a 90% match for the specimens that have been sent to the CDC, according to an agency update.
Vaccine-makers have sent out roughly 123 million doses of the vaccine so far, and nearly 112 million Americans have been vaccinated so far this flu season, according to officials.
What’s hinting toward an early uptick of the flu season is a national baseline for the percentage of outpatient visits that were due to flulike illnesses. The percent of such visits reached the baseline (2.2%) this year during week 47 (Nov. 17-24). In the 2010-2011 season, such visits barely reached the baseline during the first week of 2011.
Alabama, Louisiana, Mississippi, Tennessee, and Texas reported the highest influenza-like illness activity during week 47. The lowest activity was reported in Ohio, Utah, and Virginia.
During this period, 6.3% of all reported deaths were due to pneumonia and influenza, which is below the epidemic threshold of 6.7%. Two influenza-related pediatric deaths have been reported so far this year.
Officials also said that they were encouraged by the vaccination rates among health care professionals. The early-season 2012-2013 flu vaccination rate among this group was at nearly 63%, similar to what was reported midseason the prior year. Pharmacists reported the highest vaccination rate (89%), followed by physicians (83%), nurses (82%), nurse practitioners and physician assistants (73%), and other clinical professionals (77%).
Also, nearly half of all pregnant women have been vaccinated so far this year, similar to numbers reported last year. The biggest trigger for this group’s vaccination, said Dr. Frieden, is whether their obstetricians offer vaccination in the office, as nearly three-quarters of those pregnant women get vaccinated.
The CDC encourages everyone over 6 months of age to get flu vaccination. "The vaccine remains the best tool that we have," said Dr. Frieden.
"When you get together with your friends and family, be sure that you spread good cheer and you give presents, and that you don’t share infections and spread the flu," he said.
FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION
