Heidi Splete

Most of the way through a doctorate in medical anthropology, Dr. Brandon Kohrt felt a void: "I was doing research on cross-cultural mental health, and I realized that just doing research – especially in areas where there are no services – wasn’t enough." That’s when he decided to get some more hands-on clinical training. Now in his second year of residency in general psychiatry at Emory University in Atlanta, Dr. Kohrt also is working with the Carter Center, a not-for-profit organization founded by former President Jimmy Carter and Rosalynn Carter that works in collaboration with the government of Liberia to improve mental health care.

He spent a month in Liberia last fall and recently returned in March from his second trip.

What were your goals during your first visit?

The Carter Center’s goal is to develop mental health services throughout the entire country, in coordination with the government, with the aim that the government would own the system. I was brought on to help figure out the best way to make this a culturally competent mental health program.

I focused on what the local beliefs were regarding mental health and mental illness, what types of mental illnesses were present, what the ideas were about causation of mental illness, what services were or were not available to treat them, and ways to shore up existing capacity to address mental health needs.

How would you describe the mental health challenges in Liberia?

There are at least three major issues. One is a lack of trained mental health workers. In the current curricula for nurses and doctors, there is almost no exposure to mental health care. One of our goals is to help educate doctors, nurses, and other health professionals about what mental illness is and how to treat it.

The second is the need to improve psychotherapeutic services and access to medication. Many local health centers have no psychiatric medications available, nothing to treat psychosis, depression, or epilepsy. We saw information provided by the Clinton Foundation that assessed approximately 500 health care facilities in Liberia, and fewer than 5% of them had appropriate mental health medication.

The third problem is a lack of understanding among family members and the general public about what mental illness is, how to best support their loved ones, and what treatments are available. A goal of the Carter Center’s project, in addition to training clinicians and improving mental health care infrastructure, is to raise awareness in the community about mental illness and improve opportunities for families to seek support.

Here’s a case that illustrates these challenges: We interviewed a woman in the countryside who was worried about her daughter. As she described her daughter’s condition, I realized that the daughter was suffering from postpartum psychosis. She was acutely psychotic and unable to care for her baby. She finally brought her baby to a local hospital, but the infant was already in a state of severe malnutrition. The woman’s family did not know what was wrong with her. They had been unable to help her. They did not realize that she has a mental illness. Even if they realized their daughter had a psychiatric condition, there was not a mental health service provider within a day’s drive. They had spent a great deal of money taking her to traditional healers in Guinea who were unable to treat her condition.

This dire situation could have been prevented. Had there been more training of local health care professionals and medications available, this new mother could have been treated in an affordable fashion that could have improved her mental health and also the well-being of her baby.

Have people in Liberia been receptive to mental health care?

In my experience, I think that people would be very open to obtaining more mental health care. In the capital city of Monrovia, there is one psychiatric hospital, and people do go there for treatment and medications.

I think that culturally, people are able to understand the biological and medical aspects of mental illness. With the right education and public awareness, people could incorporate biomedical understandings of mental illness into their existing ideas of what constitutes a healthy person. If appropriate treatment were available, families would take their loved ones for mental health care.

The problem arises when there aren’t mental health professionals and appropriate medications available. As long as there are no alternatives, people will continue to rely solely on traditional and religious healers. These healers can be useful in many cases, but the best care will require access to psychiatric services as well other traditional psychosocial practices. The woman with postpartum psychosis needed psychiatric care; traditional healers, alone, were not enough. Ultimately, it is not the belief system but rather a services gap that keeps people from getting appropriate care.

What did you observe regarding compliance with mental health treatment?

The main barrier to compliance was the availability of the needed medicine. For example, family members would come to a clinic or hospital for epilepsy medication. They would get medicine to treat the patient for a few months. When they ran out of medication, they would come back for more, but the pharmacy and hospital would have run out. Also, a number of medications are sold on the black market, and patients who buy them can end up with medications that are expired or of the incorrect dosage.

What can be done to make more medications available?

The solutions include advocacy and raising awareness. There is a dearth of data about mental illness prevalence. The Liberian Ministry of Health and Social Welfare faces serious challenges when it makes decisions about allocating scarce resources, and these decisions are complicated by the lack of data on disease burden. If you don’t know the prevalence of epilepsy, it is difficult to determine how much medication needs to be ordered for the country. If clinicians don’t know how to recognize depression, they can’t estimate the number of patients needing treatment.

Better epidemiologic data are crucial to ensuring evidence-based decisions. Some helpful data exist; for example, multiple studies of PTSD (posttraumatic stress disorder) have been conducted that involve thousands of participants in Liberia. However, for other conditions such as epilepsy and schizophrenia, very little epidemiologic information is available. We hope to work with other organizations to determine the prevalence of the most debilitating mental illnesses and then raise awareness about the numbers of individuals affected. Through this process, we can work with the government to get treatment to the people who need it.

What are some of the conditions that people had in the places you visited?

Of approximately 20,000 clinic and hospital visits related to neuropsychiatric conditions in 2010, 45% were for epilepsy or seizure disorders, 15% were for schizophrenia, 14% for anxiety and psychosomatic disorders, and 9% were for depression and bipolar disorder. These numbers are just the tip of the iceberg. The actual burden of depression is likely much greater, as most people with depression don’t seek help. And most clinicians don’t know how to screen for it.

Substance abuse is a key concern, and the Carter Center plans to work with the Liberian government to put tools and resources in place to help address this problem.

The Ministry of Health and Social Welfare in Liberia intends to address five major conditions through a national mental health policy: epilepsy, psychosis, schizophrenia, substance abuse, and PTSD. A major issue with PTSD is the difference between the amount of attention it gets on an international scale and the attention that is given to other conditions. The majority of research in Liberia has focused on PTSD, but epilepsy, depression, psychosis, and substance abuse individually all contribute to a much greater portion of neuropsychiatric disability.

Why do you think there was so much epilepsy?

That is a good question. During my visit, we went to a remote area in the center of the country where roads are impassable for most of the year. In that area, we found a high prevalence of epilepsy and many cases in multiple family members. More research is needed to identify why this large burden of epilepsy affects parts of the country. This will help us find the best way to treat it. Is it a genetic condition, does it result from environmental exposure – or a combination? Many of the patients with epilepsy had cerebral malaria as children. Improving infectious disease treatment may be key to reducing later neuropsychiatric sequelae.

We were interested in the local understandings of epilepsy. We found that many people thought it was contagious. This led to health care workers’ stigmatizing patients and refusing them treatment. One belief is that people can transmit epilepsy from one person to another through saliva during a seizure. They compared it with the way rabies is transmitted from one animal to another.

We saw many persons with epilepsy who had significant burns, scars, and poorly healing sores. We found out that if someone with epilepsy falls into a fire, people do not pull them out because they are afraid of contracting epilepsy. Similarly, there are cases of persons drowning during seizures because people are afraid to pull them out of the water. I would argue that none of these is an unchangeable cultural belief. They represent fundamental human attempts to understand experience. These behaviors and stigmatization can be changed through education, combined with improved access to neuropsychiatric care.

What can be done to raise awareness?

The next step is creating antistigma messages in partnership with the Ministry of Health and other local groups. The Carter Center will work to raise awareness and educate people about epilepsy, psychosis, and depression. The campaigns will be in the form of radio dramas and street performances, which are ideal ways to get people engaged in the issue and get them to ask questions. Interactive narrative approaches are crucial to teach basic lessons about mental health care and support for individuals with mental illness

The Carter Center also is developing a mental health training module for family psychoeducation and support. This will complement the government’s ongoing work in standardizing psychosocial care in the country. This summer, the center will be piloting the module to see how it can improve quality of life for persons with mental illness and their families.

Do you have any tips about mental health care for clinicians who are working overseas?

Any clinician – regardless of specialty – who is working in underserved communities can have a dramatic impact in mental health care. There are two powerful things you can do: First, providing general health care for a person with mental illness sets an important example. In Liberia, as in most low- and high-income countries, mental health care often is a lower priority than are other kinds of medical care. In Liberia, persons with mental illness were often not given the same access to hospital care as were other patients because health care workers were uninformed about mental illnesses, thought that mental illnesses were contagious, and were afraid of psychiatric patients. As a clinical provider working overseas, you have the opportunity to demonstrate equality of care.

Second, clinicians in any specialty can take time to provide basic teaching on neuropsychiatric conditions. Any health care worker – from an ophthalmologist to a pediatric nurse – can use such opportunities to teach the basics about epilepsy, depression, or substance abuse.

Even the most basic lessons in mental health would be a tremendous benefit to local health professionals and people in areas with little exposure to information. To promote mental health around the globe, we need to communicate only three basic messages: Mental illness is treatable, it is not contagious, and it is just as important to people’s well-being as treating physical illnesses.

For more information about the Carter Center’s mental health program, visit http://www.cartercenter.org/health/mental_health/index.html.

Most of the way through a doctorate in medical anthropology, Dr. Brandon Kohrt felt a void: "I was doing research on cross-cultural mental health, and I realized that just doing research – especially in areas where there are no services – wasn’t enough." That’s when he decided to get some more hands-on clinical training. Now in his second year of residency in general psychiatry at Emory University in Atlanta, Dr. Kohrt also is working with the Carter Center, a not-for-profit organization founded by former President Jimmy Carter and Rosalynn Carter that works in collaboration with the government of Liberia to improve mental health care.

He spent a month in Liberia last fall and recently returned in March from his second trip.

What were your goals during your first visit?

The Carter Center’s goal is to develop mental health services throughout the entire country, in coordination with the government, with the aim that the government would own the system. I was brought on to help figure out the best way to make this a culturally competent mental health program.

I focused on what the local beliefs were regarding mental health and mental illness, what types of mental illnesses were present, what the ideas were about causation of mental illness, what services were or were not available to treat them, and ways to shore up existing capacity to address mental health needs.

How would you describe the mental health challenges in Liberia?

There are at least three major issues. One is a lack of trained mental health workers. In the current curricula for nurses and doctors, there is almost no exposure to mental health care. One of our goals is to help educate doctors, nurses, and other health professionals about what mental illness is and how to treat it.

The second is the need to improve psychotherapeutic services and access to medication. Many local health centers have no psychiatric medications available, nothing to treat psychosis, depression, or epilepsy. We saw information provided by the Clinton Foundation that assessed approximately 500 health care facilities in Liberia, and fewer than 5% of them had appropriate mental health medication.

The third problem is a lack of understanding among family members and the general public about what mental illness is, how to best support their loved ones, and what treatments are available. A goal of the Carter Center’s project, in addition to training clinicians and improving mental health care infrastructure, is to raise awareness in the community about mental illness and improve opportunities for families to seek support.

Here’s a case that illustrates these challenges: We interviewed a woman in the countryside who was worried about her daughter. As she described her daughter’s condition, I realized that the daughter was suffering from postpartum psychosis. She was acutely psychotic and unable to care for her baby. She finally brought her baby to a local hospital, but the infant was already in a state of severe malnutrition. The woman’s family did not know what was wrong with her. They had been unable to help her. They did not realize that she has a mental illness. Even if they realized their daughter had a psychiatric condition, there was not a mental health service provider within a day’s drive. They had spent a great deal of money taking her to traditional healers in Guinea who were unable to treat her condition.

This dire situation could have been prevented. Had there been more training of local health care professionals and medications available, this new mother could have been treated in an affordable fashion that could have improved her mental health and also the well-being of her baby.

Have people in Liberia been receptive to mental health care?

In my experience, I think that people would be very open to obtaining more mental health care. In the capital city of Monrovia, there is one psychiatric hospital, and people do go there for treatment and medications.

I think that culturally, people are able to understand the biological and medical aspects of mental illness. With the right education and public awareness, people could incorporate biomedical understandings of mental illness into their existing ideas of what constitutes a healthy person. If appropriate treatment were available, families would take their loved ones for mental health care.

The problem arises when there aren’t mental health professionals and appropriate medications available. As long as there are no alternatives, people will continue to rely solely on traditional and religious healers. These healers can be useful in many cases, but the best care will require access to psychiatric services as well other traditional psychosocial practices. The woman with postpartum psychosis needed psychiatric care; traditional healers, alone, were not enough. Ultimately, it is not the belief system but rather a services gap that keeps people from getting appropriate care.

What did you observe regarding compliance with mental health treatment?

The main barrier to compliance was the availability of the needed medicine. For example, family members would come to a clinic or hospital for epilepsy medication. They would get medicine to treat the patient for a few months. When they ran out of medication, they would come back for more, but the pharmacy and hospital would have run out. Also, a number of medications are sold on the black market, and patients who buy them can end up with medications that are expired or of the incorrect dosage.

What can be done to make more medications available?

The solutions include advocacy and raising awareness. There is a dearth of data about mental illness prevalence. The Liberian Ministry of Health and Social Welfare faces serious challenges when it makes decisions about allocating scarce resources, and these decisions are complicated by the lack of data on disease burden. If you don’t know the prevalence of epilepsy, it is difficult to determine how much medication needs to be ordered for the country. If clinicians don’t know how to recognize depression, they can’t estimate the number of patients needing treatment.

Better epidemiologic data are crucial to ensuring evidence-based decisions. Some helpful data exist; for example, multiple studies of PTSD (posttraumatic stress disorder) have been conducted that involve thousands of participants in Liberia. However, for other conditions such as epilepsy and schizophrenia, very little epidemiologic information is available. We hope to work with other organizations to determine the prevalence of the most debilitating mental illnesses and then raise awareness about the numbers of individuals affected. Through this process, we can work with the government to get treatment to the people who need it.

What are some of the conditions that people had in the places you visited?

Of approximately 20,000 clinic and hospital visits related to neuropsychiatric conditions in 2010, 45% were for epilepsy or seizure disorders, 15% were for schizophrenia, 14% for anxiety and psychosomatic disorders, and 9% were for depression and bipolar disorder. These numbers are just the tip of the iceberg. The actual burden of depression is likely much greater, as most people with depression don’t seek help. And most clinicians don’t know how to screen for it.

Substance abuse is a key concern, and the Carter Center plans to work with the Liberian government to put tools and resources in place to help address this problem.

The Ministry of Health and Social Welfare in Liberia intends to address five major conditions through a national mental health policy: epilepsy, psychosis, schizophrenia, substance abuse, and PTSD. A major issue with PTSD is the difference between the amount of attention it gets on an international scale and the attention that is given to other conditions. The majority of research in Liberia has focused on PTSD, but epilepsy, depression, psychosis, and substance abuse individually all contribute to a much greater portion of neuropsychiatric disability.

Why do you think there was so much epilepsy?

That is a good question. During my visit, we went to a remote area in the center of the country where roads are impassable for most of the year. In that area, we found a high prevalence of epilepsy and many cases in multiple family members. More research is needed to identify why this large burden of epilepsy affects parts of the country. This will help us find the best way to treat it. Is it a genetic condition, does it result from environmental exposure – or a combination? Many of the patients with epilepsy had cerebral malaria as children. Improving infectious disease treatment may be key to reducing later neuropsychiatric sequelae.

We were interested in the local understandings of epilepsy. We found that many people thought it was contagious. This led to health care workers’ stigmatizing patients and refusing them treatment. One belief is that people can transmit epilepsy from one person to another through saliva during a seizure. They compared it with the way rabies is transmitted from one animal to another.

We saw many persons with epilepsy who had significant burns, scars, and poorly healing sores. We found out that if someone with epilepsy falls into a fire, people do not pull them out because they are afraid of contracting epilepsy. Similarly, there are cases of persons drowning during seizures because people are afraid to pull them out of the water. I would argue that none of these is an unchangeable cultural belief. They represent fundamental human attempts to understand experience. These behaviors and stigmatization can be changed through education, combined with improved access to neuropsychiatric care.

What can be done to raise awareness?

The next step is creating antistigma messages in partnership with the Ministry of Health and other local groups. The Carter Center will work to raise awareness and educate people about epilepsy, psychosis, and depression. The campaigns will be in the form of radio dramas and street performances, which are ideal ways to get people engaged in the issue and get them to ask questions. Interactive narrative approaches are crucial to teach basic lessons about mental health care and support for individuals with mental illness

The Carter Center also is developing a mental health training module for family psychoeducation and support. This will complement the government’s ongoing work in standardizing psychosocial care in the country. This summer, the center will be piloting the module to see how it can improve quality of life for persons with mental illness and their families.

Do you have any tips about mental health care for clinicians who are working overseas?

Any clinician – regardless of specialty – who is working in underserved communities can have a dramatic impact in mental health care. There are two powerful things you can do: First, providing general health care for a person with mental illness sets an important example. In Liberia, as in most low- and high-income countries, mental health care often is a lower priority than are other kinds of medical care. In Liberia, persons with mental illness were often not given the same access to hospital care as were other patients because health care workers were uninformed about mental illnesses, thought that mental illnesses were contagious, and were afraid of psychiatric patients. As a clinical provider working overseas, you have the opportunity to demonstrate equality of care.

Second, clinicians in any specialty can take time to provide basic teaching on neuropsychiatric conditions. Any health care worker – from an ophthalmologist to a pediatric nurse – can use such opportunities to teach the basics about epilepsy, depression, or substance abuse.

Even the most basic lessons in mental health would be a tremendous benefit to local health professionals and people in areas with little exposure to information. To promote mental health around the globe, we need to communicate only three basic messages: Mental illness is treatable, it is not contagious, and it is just as important to people’s well-being as treating physical illnesses.

For more information about the Carter Center’s mental health program, visit http://www.cartercenter.org/health/mental_health/index.html.

Most of the way through a doctorate in medical anthropology, Dr. Brandon Kohrt felt a void: "I was doing research on cross-cultural mental health, and I realized that just doing research – especially in areas where there are no services – wasn’t enough." That’s when he decided to get some more hands-on clinical training. Now in his second year of residency in general psychiatry at Emory University in Atlanta, Dr. Kohrt also is working with the Carter Center, a not-for-profit organization founded by former President Jimmy Carter and Rosalynn Carter that works in collaboration with the government of Liberia to improve mental health care.

He spent a month in Liberia last fall and recently returned in March from his second trip.

What were your goals during your first visit?

The Carter Center’s goal is to develop mental health services throughout the entire country, in coordination with the government, with the aim that the government would own the system. I was brought on to help figure out the best way to make this a culturally competent mental health program.

I focused on what the local beliefs were regarding mental health and mental illness, what types of mental illnesses were present, what the ideas were about causation of mental illness, what services were or were not available to treat them, and ways to shore up existing capacity to address mental health needs.

How would you describe the mental health challenges in Liberia?

There are at least three major issues. One is a lack of trained mental health workers. In the current curricula for nurses and doctors, there is almost no exposure to mental health care. One of our goals is to help educate doctors, nurses, and other health professionals about what mental illness is and how to treat it.

The second is the need to improve psychotherapeutic services and access to medication. Many local health centers have no psychiatric medications available, nothing to treat psychosis, depression, or epilepsy. We saw information provided by the Clinton Foundation that assessed approximately 500 health care facilities in Liberia, and fewer than 5% of them had appropriate mental health medication.

The third problem is a lack of understanding among family members and the general public about what mental illness is, how to best support their loved ones, and what treatments are available. A goal of the Carter Center’s project, in addition to training clinicians and improving mental health care infrastructure, is to raise awareness in the community about mental illness and improve opportunities for families to seek support.

Here’s a case that illustrates these challenges: We interviewed a woman in the countryside who was worried about her daughter. As she described her daughter’s condition, I realized that the daughter was suffering from postpartum psychosis. She was acutely psychotic and unable to care for her baby. She finally brought her baby to a local hospital, but the infant was already in a state of severe malnutrition. The woman’s family did not know what was wrong with her. They had been unable to help her. They did not realize that she has a mental illness. Even if they realized their daughter had a psychiatric condition, there was not a mental health service provider within a day’s drive. They had spent a great deal of money taking her to traditional healers in Guinea who were unable to treat her condition.

This dire situation could have been prevented. Had there been more training of local health care professionals and medications available, this new mother could have been treated in an affordable fashion that could have improved her mental health and also the well-being of her baby.

Have people in Liberia been receptive to mental health care?

In my experience, I think that people would be very open to obtaining more mental health care. In the capital city of Monrovia, there is one psychiatric hospital, and people do go there for treatment and medications.

I think that culturally, people are able to understand the biological and medical aspects of mental illness. With the right education and public awareness, people could incorporate biomedical understandings of mental illness into their existing ideas of what constitutes a healthy person. If appropriate treatment were available, families would take their loved ones for mental health care.

The problem arises when there aren’t mental health professionals and appropriate medications available. As long as there are no alternatives, people will continue to rely solely on traditional and religious healers. These healers can be useful in many cases, but the best care will require access to psychiatric services as well other traditional psychosocial practices. The woman with postpartum psychosis needed psychiatric care; traditional healers, alone, were not enough. Ultimately, it is not the belief system but rather a services gap that keeps people from getting appropriate care.

What did you observe regarding compliance with mental health treatment?

The main barrier to compliance was the availability of the needed medicine. For example, family members would come to a clinic or hospital for epilepsy medication. They would get medicine to treat the patient for a few months. When they ran out of medication, they would come back for more, but the pharmacy and hospital would have run out. Also, a number of medications are sold on the black market, and patients who buy them can end up with medications that are expired or of the incorrect dosage.

What can be done to make more medications available?

The solutions include advocacy and raising awareness. There is a dearth of data about mental illness prevalence. The Liberian Ministry of Health and Social Welfare faces serious challenges when it makes decisions about allocating scarce resources, and these decisions are complicated by the lack of data on disease burden. If you don’t know the prevalence of epilepsy, it is difficult to determine how much medication needs to be ordered for the country. If clinicians don’t know how to recognize depression, they can’t estimate the number of patients needing treatment.

Better epidemiologic data are crucial to ensuring evidence-based decisions. Some helpful data exist; for example, multiple studies of PTSD (posttraumatic stress disorder) have been conducted that involve thousands of participants in Liberia. However, for other conditions such as epilepsy and schizophrenia, very little epidemiologic information is available. We hope to work with other organizations to determine the prevalence of the most debilitating mental illnesses and then raise awareness about the numbers of individuals affected. Through this process, we can work with the government to get treatment to the people who need it.

What are some of the conditions that people had in the places you visited?

Of approximately 20,000 clinic and hospital visits related to neuropsychiatric conditions in 2010, 45% were for epilepsy or seizure disorders, 15% were for schizophrenia, 14% for anxiety and psychosomatic disorders, and 9% were for depression and bipolar disorder. These numbers are just the tip of the iceberg. The actual burden of depression is likely much greater, as most people with depression don’t seek help. And most clinicians don’t know how to screen for it.

Substance abuse is a key concern, and the Carter Center plans to work with the Liberian government to put tools and resources in place to help address this problem.

The Ministry of Health and Social Welfare in Liberia intends to address five major conditions through a national mental health policy: epilepsy, psychosis, schizophrenia, substance abuse, and PTSD. A major issue with PTSD is the difference between the amount of attention it gets on an international scale and the attention that is given to other conditions. The majority of research in Liberia has focused on PTSD, but epilepsy, depression, psychosis, and substance abuse individually all contribute to a much greater portion of neuropsychiatric disability.

Why do you think there was so much epilepsy?

That is a good question. During my visit, we went to a remote area in the center of the country where roads are impassable for most of the year. In that area, we found a high prevalence of epilepsy and many cases in multiple family members. More research is needed to identify why this large burden of epilepsy affects parts of the country. This will help us find the best way to treat it. Is it a genetic condition, does it result from environmental exposure – or a combination? Many of the patients with epilepsy had cerebral malaria as children. Improving infectious disease treatment may be key to reducing later neuropsychiatric sequelae.

We were interested in the local understandings of epilepsy. We found that many people thought it was contagious. This led to health care workers’ stigmatizing patients and refusing them treatment. One belief is that people can transmit epilepsy from one person to another through saliva during a seizure. They compared it with the way rabies is transmitted from one animal to another.

We saw many persons with epilepsy who had significant burns, scars, and poorly healing sores. We found out that if someone with epilepsy falls into a fire, people do not pull them out because they are afraid of contracting epilepsy. Similarly, there are cases of persons drowning during seizures because people are afraid to pull them out of the water. I would argue that none of these is an unchangeable cultural belief. They represent fundamental human attempts to understand experience. These behaviors and stigmatization can be changed through education, combined with improved access to neuropsychiatric care.

What can be done to raise awareness?

The next step is creating antistigma messages in partnership with the Ministry of Health and other local groups. The Carter Center will work to raise awareness and educate people about epilepsy, psychosis, and depression. The campaigns will be in the form of radio dramas and street performances, which are ideal ways to get people engaged in the issue and get them to ask questions. Interactive narrative approaches are crucial to teach basic lessons about mental health care and support for individuals with mental illness

The Carter Center also is developing a mental health training module for family psychoeducation and support. This will complement the government’s ongoing work in standardizing psychosocial care in the country. This summer, the center will be piloting the module to see how it can improve quality of life for persons with mental illness and their families.

Do you have any tips about mental health care for clinicians who are working overseas?

Any clinician – regardless of specialty – who is working in underserved communities can have a dramatic impact in mental health care. There are two powerful things you can do: First, providing general health care for a person with mental illness sets an important example. In Liberia, as in most low- and high-income countries, mental health care often is a lower priority than are other kinds of medical care. In Liberia, persons with mental illness were often not given the same access to hospital care as were other patients because health care workers were uninformed about mental illnesses, thought that mental illnesses were contagious, and were afraid of psychiatric patients. As a clinical provider working overseas, you have the opportunity to demonstrate equality of care.

Second, clinicians in any specialty can take time to provide basic teaching on neuropsychiatric conditions. Any health care worker – from an ophthalmologist to a pediatric nurse – can use such opportunities to teach the basics about epilepsy, depression, or substance abuse.

Even the most basic lessons in mental health would be a tremendous benefit to local health professionals and people in areas with little exposure to information. To promote mental health around the globe, we need to communicate only three basic messages: Mental illness is treatable, it is not contagious, and it is just as important to people’s well-being as treating physical illnesses.

For more information about the Carter Center’s mental health program, visit http://www.cartercenter.org/health/mental_health/index.html.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN DIEGO – Type 2 diabetes patients achieved greater blood sugar control with once-daily liraglutide injections than with other standard type 2 diabetes medications, according to the findings from a meta-analysis of seven phase III studies. The findings were presented April 14 at the annual meeting of the American Association of Clinical Endocrinologists.

"The progressive nature of type 2 diabetes makes it difficult for any single therapy to be effective long-term," said Dr. Robert Henry of the University of California, San Diego.

Liraglutide (Victoza) was approved by the Food and Drug Administration in January 2010 to treat type 2 diabetes in adults as an adjunct therapy to a healthy diet and exercise.

To further evaluate the impact of liraglutide on blood sugar control, Dr. Henry and his colleagues consolidated data from seven phase III clinical trials and divided the patients into five categories based on their baseline hemoglobin A_1c level: 7.5% or less (651 patients), 7.6%-8.0% (601 patients), 8.1%-8.5% (538 patients), 8.6%-9.0% (432 patients), and greater than 9.0% (607 patients).

The researchers reviewed the mean changes in HbA_1c from baseline to 26 weeks of treatment. Overall, mean hemoglobin A_1c reductions with a once-daily, 1.8-mg dose of liraglutide were greater than the reductions achieved with standard regimens involving exenatide, insulin glargine, glimepiride, rosiglitazone, or sitagliptin.

In particular, HbA_1c levels were significantly reduced in patients with a baseline HbA_1c of 7.5% or less in the liraglutide group compared with all other groups. The mean reductions in HbA_1c for patients on liraglutide ranged from 0.7% in the 7.5% or less category to 1.8% in the greater than 9.0% category. The next best mean reduction in HbA_1c was seen among patients taking two other injectable therapies: insulin glargine and exenatide. Reductions in HbA_1c in patients taking insulin glargine ranged from 0.3% to 1.5%, and HbA_1c reductions in those taking exenatide ranged from 0.4% to 1.3%.

Patients taking sulfonylureas, sitagliptin, or thiazolidinediones showed less improvement from baseline than did patients taking the injectables. The average reduction in patients taking sitagliptin ranged from 0.0% to 1.1%. The average reduction with sulfonylureas ranged from 0.4% to 1.4%, and the average reduction with thiazolidinediones ranged from 0.4% to 0.8%.

Among 348 patients in the liraglutide group with baseline HbA_1c levels of 7.5% or less, 216 (63%) reached the AACE-recommended HbA_1c target of 6.5% or less, compared with less than half (20%-49%) of patients with a baseline HbA_1c of 7.5% or less in the other groups, Dr. Henry noted.

Among 333 patients in the liraglutide group with HbA_1c levels greater than 9.0%, 33 (10%) reached the 6.5% or less target, compared with 4 (12%) of 34 patients in the insulin glargine group and 0%-5% of patients in the other groups.

The study was limited by the use of mean data, which does not account for individual variability, but the results suggest that liraglutide was effective at reducing HbA_1c throughout the baseline HbA_1c spectrum, Dr. Henry said.

The study was sponsored by Novo Nordisk, which manufactures liraglutide. Dr. Henry has received research support from multiple pharmaceutical companies, including Amylin Pharmaceuticals, AstraZeneca, and Novartis. He has served as an adviser or consultant for, and has received consulting fees from, several companies, including Amylin, Eli Lilly, and Novo Nordisk.

SAN FRANCISCO – Children with recurrent, severe virus-induced wheezing during their first 3 years of life had significantly reduced prebronchodilator lung function at school age, compared with children with no history of wheezing, but no differences were seen on tests of postbronchodilator lung function, based on data from 215 children.

Previous studies have shown that early childhood is a vulnerable time for the development of lung function, and recurrent wheezing can be a major risk factor for reduced lung function when children reach school age, said Dr. Daniel Jackson of the University of Wisconsin, Madison, and his colleagues.

"This is particularly important because loss of lung function is associated with morbidity and limitation due to asthma," Dr. Jackson said in an interview.

The researchers reviewed data from the Childhood Origins of Asthma (COAST) study, a prospective study of children at increased risk for allergies or asthma. They divided the children into four groups according to their wheezing history. The groups consisted of 101 children with no wheezing, 69 children with wheezing who received no oral corticosteroids, 23 children who received corticosteroids with one episode of wheezing, and 22 children who received corticosteroids with two or more episodes of wheezing. Pre- and postbronchodilator spirometry was performed each year to check lung function and compare lung volume among the groups, according to the researchers’ poster, which was presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, prebronchodilator forced expiratory volume in 0.5- and 1-second (FEV_0.5 and FEV₁) measures obtained at age 5-8 years were significantly lower in children with histories of multiple wheezing episodes treated with oral corticosteroids, compared with each of the other groups, after the investigators controlled for factors including asthma, age, sex, height, weight, race, and smoke exposure. The children with two or more wheezing episodes treated with oral corticosteroids had an average FEV₁ of 1.26 L, compared with 1.37 L in children with no episodes of wheezing, 1.34 L in children who had wheezing without oral corticosteroid treatment, and 1.38 L in children who had wheezing with one oral corticosteroid treatment.

However, postbronchodilator measures taken at 6-8 years were not significantly different in children with repeated wheezing episodes, compared with children with fewer or no wheezing episodes.

The findings suggest that reduced lung function in school-aged children at high risk for asthma is at least partially reversible, the researchers noted. "Whether these severe wheezing episodes caused progressive lung function or were due to low baseline lung function is not known," they wrote. But the results also suggest that preventing severe wheezing in early childhood could reduce later problems caused by a loss of lung function, and new therapeutic strategies are needed to prevent virus-induced wheezing in high-risk children, they added.

The study was supported by grants from the National Institutes of Health. Dr. Jackson said he had no relevant financial disclosures.

SAN FRANCISCO – Children with recurrent, severe virus-induced wheezing during their first 3 years of life had significantly reduced prebronchodilator lung function at school age, compared with children with no history of wheezing, but no differences were seen on tests of postbronchodilator lung function, based on data from 215 children.

Previous studies have shown that early childhood is a vulnerable time for the development of lung function, and recurrent wheezing can be a major risk factor for reduced lung function when children reach school age, said Dr. Daniel Jackson of the University of Wisconsin, Madison, and his colleagues.

"This is particularly important because loss of lung function is associated with morbidity and limitation due to asthma," Dr. Jackson said in an interview.

The researchers reviewed data from the Childhood Origins of Asthma (COAST) study, a prospective study of children at increased risk for allergies or asthma. They divided the children into four groups according to their wheezing history. The groups consisted of 101 children with no wheezing, 69 children with wheezing who received no oral corticosteroids, 23 children who received corticosteroids with one episode of wheezing, and 22 children who received corticosteroids with two or more episodes of wheezing. Pre- and postbronchodilator spirometry was performed each year to check lung function and compare lung volume among the groups, according to the researchers’ poster, which was presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, prebronchodilator forced expiratory volume in 0.5- and 1-second (FEV_0.5 and FEV₁) measures obtained at age 5-8 years were significantly lower in children with histories of multiple wheezing episodes treated with oral corticosteroids, compared with each of the other groups, after the investigators controlled for factors including asthma, age, sex, height, weight, race, and smoke exposure. The children with two or more wheezing episodes treated with oral corticosteroids had an average FEV₁ of 1.26 L, compared with 1.37 L in children with no episodes of wheezing, 1.34 L in children who had wheezing without oral corticosteroid treatment, and 1.38 L in children who had wheezing with one oral corticosteroid treatment.

However, postbronchodilator measures taken at 6-8 years were not significantly different in children with repeated wheezing episodes, compared with children with fewer or no wheezing episodes.

The findings suggest that reduced lung function in school-aged children at high risk for asthma is at least partially reversible, the researchers noted. "Whether these severe wheezing episodes caused progressive lung function or were due to low baseline lung function is not known," they wrote. But the results also suggest that preventing severe wheezing in early childhood could reduce later problems caused by a loss of lung function, and new therapeutic strategies are needed to prevent virus-induced wheezing in high-risk children, they added.

The study was supported by grants from the National Institutes of Health. Dr. Jackson said he had no relevant financial disclosures.

SAN FRANCISCO – Children with recurrent, severe virus-induced wheezing during their first 3 years of life had significantly reduced prebronchodilator lung function at school age, compared with children with no history of wheezing, but no differences were seen on tests of postbronchodilator lung function, based on data from 215 children.

Previous studies have shown that early childhood is a vulnerable time for the development of lung function, and recurrent wheezing can be a major risk factor for reduced lung function when children reach school age, said Dr. Daniel Jackson of the University of Wisconsin, Madison, and his colleagues.

"This is particularly important because loss of lung function is associated with morbidity and limitation due to asthma," Dr. Jackson said in an interview.

The researchers reviewed data from the Childhood Origins of Asthma (COAST) study, a prospective study of children at increased risk for allergies or asthma. They divided the children into four groups according to their wheezing history. The groups consisted of 101 children with no wheezing, 69 children with wheezing who received no oral corticosteroids, 23 children who received corticosteroids with one episode of wheezing, and 22 children who received corticosteroids with two or more episodes of wheezing. Pre- and postbronchodilator spirometry was performed each year to check lung function and compare lung volume among the groups, according to the researchers’ poster, which was presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, prebronchodilator forced expiratory volume in 0.5- and 1-second (FEV_0.5 and FEV₁) measures obtained at age 5-8 years were significantly lower in children with histories of multiple wheezing episodes treated with oral corticosteroids, compared with each of the other groups, after the investigators controlled for factors including asthma, age, sex, height, weight, race, and smoke exposure. The children with two or more wheezing episodes treated with oral corticosteroids had an average FEV₁ of 1.26 L, compared with 1.37 L in children with no episodes of wheezing, 1.34 L in children who had wheezing without oral corticosteroid treatment, and 1.38 L in children who had wheezing with one oral corticosteroid treatment.

However, postbronchodilator measures taken at 6-8 years were not significantly different in children with repeated wheezing episodes, compared with children with fewer or no wheezing episodes.

The findings suggest that reduced lung function in school-aged children at high risk for asthma is at least partially reversible, the researchers noted. "Whether these severe wheezing episodes caused progressive lung function or were due to low baseline lung function is not known," they wrote. But the results also suggest that preventing severe wheezing in early childhood could reduce later problems caused by a loss of lung function, and new therapeutic strategies are needed to prevent virus-induced wheezing in high-risk children, they added.

The study was supported by grants from the National Institutes of Health. Dr. Jackson said he had no relevant financial disclosures.

SAN FRANCISCO – Children with recurrent, severe virus-induced wheezing during their first 3 years of life had significantly reduced prebronchodilator lung function at school age, compared with children with no history of wheezing, but no differences were seen on tests of postbronchodilator lung function, based on data from 215 children.

Previous studies have shown that early childhood is a vulnerable time for the development of lung function, and recurrent wheezing can be a major risk factor for reduced lung function when children reach school age, said Dr. Daniel Jackson of the University of Wisconsin, Madison, and his colleagues.

"This is particularly important because loss of lung function is associated with morbidity and limitation due to asthma," Dr. Jackson said in an interview.

The researchers reviewed data from the Childhood Origins of Asthma (COAST) study, a prospective study of children at increased risk for allergies or asthma. They divided the children into four groups according to their wheezing history. The groups consisted of 101 children with no wheezing, 69 children with wheezing who received no oral corticosteroids, 23 children who received corticosteroids with one episode of wheezing, and 22 children who received corticosteroids with two or more episodes of wheezing. Pre- and postbronchodilator spirometry was performed each year to check lung function and compare lung volume among the groups, according to the researchers’ poster, which was presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, prebronchodilator forced expiratory volume in 0.5- and 1-second (FEV_0.5 and FEV₁) measures obtained at age 5-8 years were significantly lower in children with histories of multiple wheezing episodes treated with oral corticosteroids, compared with each of the other groups, after the investigators controlled for factors including asthma, age, sex, height, weight, race, and smoke exposure. The children with two or more wheezing episodes treated with oral corticosteroids had an average FEV₁ of 1.26 L, compared with 1.37 L in children with no episodes of wheezing, 1.34 L in children who had wheezing without oral corticosteroid treatment, and 1.38 L in children who had wheezing with one oral corticosteroid treatment.

However, postbronchodilator measures taken at 6-8 years were not significantly different in children with repeated wheezing episodes, compared with children with fewer or no wheezing episodes.

The findings suggest that reduced lung function in school-aged children at high risk for asthma is at least partially reversible, the researchers noted. "Whether these severe wheezing episodes caused progressive lung function or were due to low baseline lung function is not known," they wrote. But the results also suggest that preventing severe wheezing in early childhood could reduce later problems caused by a loss of lung function, and new therapeutic strategies are needed to prevent virus-induced wheezing in high-risk children, they added.

The study was supported by grants from the National Institutes of Health. Dr. Jackson said he had no relevant financial disclosures.

SAN FRANCISCO – Children with recurrent, severe virus-induced wheezing during their first 3 years of life had significantly reduced prebronchodilator lung function at school age, compared with children with no history of wheezing, but no differences were seen on tests of postbronchodilator lung function, based on data from 215 children.

Previous studies have shown that early childhood is a vulnerable time for the development of lung function, and recurrent wheezing can be a major risk factor for reduced lung function when children reach school age, said Dr. Daniel Jackson of the University of Wisconsin, Madison, and his colleagues.

"This is particularly important because loss of lung function is associated with morbidity and limitation due to asthma," Dr. Jackson said in an interview.

The researchers reviewed data from the Childhood Origins of Asthma (COAST) study, a prospective study of children at increased risk for allergies or asthma. They divided the children into four groups according to their wheezing history. The groups consisted of 101 children with no wheezing, 69 children with wheezing who received no oral corticosteroids, 23 children who received corticosteroids with one episode of wheezing, and 22 children who received corticosteroids with two or more episodes of wheezing. Pre- and postbronchodilator spirometry was performed each year to check lung function and compare lung volume among the groups, according to the researchers’ poster, which was presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, prebronchodilator forced expiratory volume in 0.5- and 1-second (FEV_0.5 and FEV₁) measures obtained at age 5-8 years were significantly lower in children with histories of multiple wheezing episodes treated with oral corticosteroids, compared with each of the other groups, after the investigators controlled for factors including asthma, age, sex, height, weight, race, and smoke exposure. The children with two or more wheezing episodes treated with oral corticosteroids had an average FEV₁ of 1.26 L, compared with 1.37 L in children with no episodes of wheezing, 1.34 L in children who had wheezing without oral corticosteroid treatment, and 1.38 L in children who had wheezing with one oral corticosteroid treatment.

However, postbronchodilator measures taken at 6-8 years were not significantly different in children with repeated wheezing episodes, compared with children with fewer or no wheezing episodes.

The findings suggest that reduced lung function in school-aged children at high risk for asthma is at least partially reversible, the researchers noted. "Whether these severe wheezing episodes caused progressive lung function or were due to low baseline lung function is not known," they wrote. But the results also suggest that preventing severe wheezing in early childhood could reduce later problems caused by a loss of lung function, and new therapeutic strategies are needed to prevent virus-induced wheezing in high-risk children, they added.

The study was supported by grants from the National Institutes of Health. Dr. Jackson said he had no relevant financial disclosures.

SAN FRANCISCO – Children with recurrent, severe virus-induced wheezing during their first 3 years of life had significantly reduced prebronchodilator lung function at school age, compared with children with no history of wheezing, but no differences were seen on tests of postbronchodilator lung function, based on data from 215 children.

Previous studies have shown that early childhood is a vulnerable time for the development of lung function, and recurrent wheezing can be a major risk factor for reduced lung function when children reach school age, said Dr. Daniel Jackson of the University of Wisconsin, Madison, and his colleagues.

"This is particularly important because loss of lung function is associated with morbidity and limitation due to asthma," Dr. Jackson said in an interview.

The researchers reviewed data from the Childhood Origins of Asthma (COAST) study, a prospective study of children at increased risk for allergies or asthma. They divided the children into four groups according to their wheezing history. The groups consisted of 101 children with no wheezing, 69 children with wheezing who received no oral corticosteroids, 23 children who received corticosteroids with one episode of wheezing, and 22 children who received corticosteroids with two or more episodes of wheezing. Pre- and postbronchodilator spirometry was performed each year to check lung function and compare lung volume among the groups, according to the researchers’ poster, which was presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, prebronchodilator forced expiratory volume in 0.5- and 1-second (FEV_0.5 and FEV₁) measures obtained at age 5-8 years were significantly lower in children with histories of multiple wheezing episodes treated with oral corticosteroids, compared with each of the other groups, after the investigators controlled for factors including asthma, age, sex, height, weight, race, and smoke exposure. The children with two or more wheezing episodes treated with oral corticosteroids had an average FEV₁ of 1.26 L, compared with 1.37 L in children with no episodes of wheezing, 1.34 L in children who had wheezing without oral corticosteroid treatment, and 1.38 L in children who had wheezing with one oral corticosteroid treatment.

However, postbronchodilator measures taken at 6-8 years were not significantly different in children with repeated wheezing episodes, compared with children with fewer or no wheezing episodes.

The findings suggest that reduced lung function in school-aged children at high risk for asthma is at least partially reversible, the researchers noted. "Whether these severe wheezing episodes caused progressive lung function or were due to low baseline lung function is not known," they wrote. But the results also suggest that preventing severe wheezing in early childhood could reduce later problems caused by a loss of lung function, and new therapeutic strategies are needed to prevent virus-induced wheezing in high-risk children, they added.

The study was supported by grants from the National Institutes of Health. Dr. Jackson said he had no relevant financial disclosures.

NATIONAL HARBOR, MD. – Topical diclofenac sodium 1% gel was as well tolerated as placebo, based on data from 1,426 patients with knee osteoarthritis and 783 patients with hand osteoarthritis.

Findings from previous studies have shown that diclofenac sodium 1% gel (DSG) is effective in treating knee and hand osteoarthritis (OA), but safety data were limited, said Dr. John H. Peniston of Feasterville (Pa.) Family Health Clinic.

In this pooled analysis, the researchers reviewed data from patients aged 35 years and older with knee OA and aged 40 years and older with hand OA. The findings were presented in a poster at the annual meeting of the American Academy of Pain Medicine.

In the group with knee OA, 721 patients were randomized to DSG and 705 to a placebo gel. The most common adverse events were application site related; these occurred in 406 (56.3%) of the DSG patients and 340 (48.2%) of the placebo patients. The incidence of gastrointestinal, cardiovascular, hepatic, or renal adverse events (AEs) was similar between the two groups. The only serious AE potentially related to treatment was a deep-vein thrombosis and pulmonary embolism that developed in an 80-year-old woman with multiple cardiovascular–risk factors, the researchers noted. The most common treatment-emergent AE was headache, reported in approximately 15% of patients in each group.

In the group with hand OA, 400 patients were randomized to DSG and 383 to a placebo gel. Application site events were the most common AEs, occurring in 163 (40.8%) of the DSG patients and 139 (36.3%) of the placebo patients. Rates of cardiovascular, gastrointestinal, renal, and hepatic AEs were similar between the groups. Treatment-related gastrointestinal events occurred in two patients in the DSG group and one in the placebo group. None of the cardiovascular or serious AEs in either group were considered treatment-related, the researchers wrote. However, two patients with hand OA in both the active treatment and placebo groups experienced liver-enzyme elevation to three times the upper limit of normal. The most common treatment-emergent AE was headache, reported by 9% of patients in the DSG group and 10% of the placebo group.

"In general, adverse events with diclofenac sodium were mild and resolved without the need for additional treatment, consistent with a favorable tolerability profile," the researchers said.

The clinical trials for DSG were funded by Novartis, and this post hoc analysis was funded by Endo Pharmaceuticals. Dr. Peniston said he had no financial conflicts to disclose, but several study coauthors were employed by either Novartis or Endo.

NATIONAL HARBOR, MD. – Topical diclofenac sodium 1% gel was as well tolerated as placebo, based on data from 1,426 patients with knee osteoarthritis and 783 patients with hand osteoarthritis.

Findings from previous studies have shown that diclofenac sodium 1% gel (DSG) is effective in treating knee and hand osteoarthritis (OA), but safety data were limited, said Dr. John H. Peniston of Feasterville (Pa.) Family Health Clinic.

In this pooled analysis, the researchers reviewed data from patients aged 35 years and older with knee OA and aged 40 years and older with hand OA. The findings were presented in a poster at the annual meeting of the American Academy of Pain Medicine.

In the group with knee OA, 721 patients were randomized to DSG and 705 to a placebo gel. The most common adverse events were application site related; these occurred in 406 (56.3%) of the DSG patients and 340 (48.2%) of the placebo patients. The incidence of gastrointestinal, cardiovascular, hepatic, or renal adverse events (AEs) was similar between the two groups. The only serious AE potentially related to treatment was a deep-vein thrombosis and pulmonary embolism that developed in an 80-year-old woman with multiple cardiovascular–risk factors, the researchers noted. The most common treatment-emergent AE was headache, reported in approximately 15% of patients in each group.

In the group with hand OA, 400 patients were randomized to DSG and 383 to a placebo gel. Application site events were the most common AEs, occurring in 163 (40.8%) of the DSG patients and 139 (36.3%) of the placebo patients. Rates of cardiovascular, gastrointestinal, renal, and hepatic AEs were similar between the groups. Treatment-related gastrointestinal events occurred in two patients in the DSG group and one in the placebo group. None of the cardiovascular or serious AEs in either group were considered treatment-related, the researchers wrote. However, two patients with hand OA in both the active treatment and placebo groups experienced liver-enzyme elevation to three times the upper limit of normal. The most common treatment-emergent AE was headache, reported by 9% of patients in the DSG group and 10% of the placebo group.

"In general, adverse events with diclofenac sodium were mild and resolved without the need for additional treatment, consistent with a favorable tolerability profile," the researchers said.

The clinical trials for DSG were funded by Novartis, and this post hoc analysis was funded by Endo Pharmaceuticals. Dr. Peniston said he had no financial conflicts to disclose, but several study coauthors were employed by either Novartis or Endo.

NATIONAL HARBOR, MD. – Topical diclofenac sodium 1% gel was as well tolerated as placebo, based on data from 1,426 patients with knee osteoarthritis and 783 patients with hand osteoarthritis.

Findings from previous studies have shown that diclofenac sodium 1% gel (DSG) is effective in treating knee and hand osteoarthritis (OA), but safety data were limited, said Dr. John H. Peniston of Feasterville (Pa.) Family Health Clinic.

In this pooled analysis, the researchers reviewed data from patients aged 35 years and older with knee OA and aged 40 years and older with hand OA. The findings were presented in a poster at the annual meeting of the American Academy of Pain Medicine.

In the group with knee OA, 721 patients were randomized to DSG and 705 to a placebo gel. The most common adverse events were application site related; these occurred in 406 (56.3%) of the DSG patients and 340 (48.2%) of the placebo patients. The incidence of gastrointestinal, cardiovascular, hepatic, or renal adverse events (AEs) was similar between the two groups. The only serious AE potentially related to treatment was a deep-vein thrombosis and pulmonary embolism that developed in an 80-year-old woman with multiple cardiovascular–risk factors, the researchers noted. The most common treatment-emergent AE was headache, reported in approximately 15% of patients in each group.

In the group with hand OA, 400 patients were randomized to DSG and 383 to a placebo gel. Application site events were the most common AEs, occurring in 163 (40.8%) of the DSG patients and 139 (36.3%) of the placebo patients. Rates of cardiovascular, gastrointestinal, renal, and hepatic AEs were similar between the groups. Treatment-related gastrointestinal events occurred in two patients in the DSG group and one in the placebo group. None of the cardiovascular or serious AEs in either group were considered treatment-related, the researchers wrote. However, two patients with hand OA in both the active treatment and placebo groups experienced liver-enzyme elevation to three times the upper limit of normal. The most common treatment-emergent AE was headache, reported by 9% of patients in the DSG group and 10% of the placebo group.

"In general, adverse events with diclofenac sodium were mild and resolved without the need for additional treatment, consistent with a favorable tolerability profile," the researchers said.

The clinical trials for DSG were funded by Novartis, and this post hoc analysis was funded by Endo Pharmaceuticals. Dr. Peniston said he had no financial conflicts to disclose, but several study coauthors were employed by either Novartis or Endo.

NATIONAL HARBOR, MD. – Topical diclofenac sodium 1% gel was as well tolerated as placebo, based on data from 1,426 patients with knee osteoarthritis and 783 patients with hand osteoarthritis.

Findings from previous studies have shown that diclofenac sodium 1% gel (DSG) is effective in treating knee and hand osteoarthritis (OA), but safety data were limited, said Dr. John H. Peniston of Feasterville (Pa.) Family Health Clinic.

In this pooled analysis, the researchers reviewed data from patients aged 35 years and older with knee OA and aged 40 years and older with hand OA. The findings were presented in a poster at the annual meeting of the American Academy of Pain Medicine.

In the group with knee OA, 721 patients were randomized to DSG and 705 to a placebo gel. The most common adverse events were application site related; these occurred in 406 (56.3%) of the DSG patients and 340 (48.2%) of the placebo patients. The incidence of gastrointestinal, cardiovascular, hepatic, or renal adverse events (AEs) was similar between the two groups. The only serious AE potentially related to treatment was a deep-vein thrombosis and pulmonary embolism that developed in an 80-year-old woman with multiple cardiovascular–risk factors, the researchers noted. The most common treatment-emergent AE was headache, reported in approximately 15% of patients in each group.

In the group with hand OA, 400 patients were randomized to DSG and 383 to a placebo gel. Application site events were the most common AEs, occurring in 163 (40.8%) of the DSG patients and 139 (36.3%) of the placebo patients. Rates of cardiovascular, gastrointestinal, renal, and hepatic AEs were similar between the groups. Treatment-related gastrointestinal events occurred in two patients in the DSG group and one in the placebo group. None of the cardiovascular or serious AEs in either group were considered treatment-related, the researchers wrote. However, two patients with hand OA in both the active treatment and placebo groups experienced liver-enzyme elevation to three times the upper limit of normal. The most common treatment-emergent AE was headache, reported by 9% of patients in the DSG group and 10% of the placebo group.

"In general, adverse events with diclofenac sodium were mild and resolved without the need for additional treatment, consistent with a favorable tolerability profile," the researchers said.

The clinical trials for DSG were funded by Novartis, and this post hoc analysis was funded by Endo Pharmaceuticals. Dr. Peniston said he had no financial conflicts to disclose, but several study coauthors were employed by either Novartis or Endo.

NATIONAL HARBOR, MD. – Topical diclofenac sodium 1% gel was as well tolerated as placebo, based on data from 1,426 patients with knee osteoarthritis and 783 patients with hand osteoarthritis.

Findings from previous studies have shown that diclofenac sodium 1% gel (DSG) is effective in treating knee and hand osteoarthritis (OA), but safety data were limited, said Dr. John H. Peniston of Feasterville (Pa.) Family Health Clinic.

In this pooled analysis, the researchers reviewed data from patients aged 35 years and older with knee OA and aged 40 years and older with hand OA. The findings were presented in a poster at the annual meeting of the American Academy of Pain Medicine.

In the group with knee OA, 721 patients were randomized to DSG and 705 to a placebo gel. The most common adverse events were application site related; these occurred in 406 (56.3%) of the DSG patients and 340 (48.2%) of the placebo patients. The incidence of gastrointestinal, cardiovascular, hepatic, or renal adverse events (AEs) was similar between the two groups. The only serious AE potentially related to treatment was a deep-vein thrombosis and pulmonary embolism that developed in an 80-year-old woman with multiple cardiovascular–risk factors, the researchers noted. The most common treatment-emergent AE was headache, reported in approximately 15% of patients in each group.

In the group with hand OA, 400 patients were randomized to DSG and 383 to a placebo gel. Application site events were the most common AEs, occurring in 163 (40.8%) of the DSG patients and 139 (36.3%) of the placebo patients. Rates of cardiovascular, gastrointestinal, renal, and hepatic AEs were similar between the groups. Treatment-related gastrointestinal events occurred in two patients in the DSG group and one in the placebo group. None of the cardiovascular or serious AEs in either group were considered treatment-related, the researchers wrote. However, two patients with hand OA in both the active treatment and placebo groups experienced liver-enzyme elevation to three times the upper limit of normal. The most common treatment-emergent AE was headache, reported by 9% of patients in the DSG group and 10% of the placebo group.

"In general, adverse events with diclofenac sodium were mild and resolved without the need for additional treatment, consistent with a favorable tolerability profile," the researchers said.

The clinical trials for DSG were funded by Novartis, and this post hoc analysis was funded by Endo Pharmaceuticals. Dr. Peniston said he had no financial conflicts to disclose, but several study coauthors were employed by either Novartis or Endo.

NATIONAL HARBOR, MD. – Topical diclofenac sodium 1% gel was as well tolerated as placebo, based on data from 1,426 patients with knee osteoarthritis and 783 patients with hand osteoarthritis.

Findings from previous studies have shown that diclofenac sodium 1% gel (DSG) is effective in treating knee and hand osteoarthritis (OA), but safety data were limited, said Dr. John H. Peniston of Feasterville (Pa.) Family Health Clinic.

In this pooled analysis, the researchers reviewed data from patients aged 35 years and older with knee OA and aged 40 years and older with hand OA. The findings were presented in a poster at the annual meeting of the American Academy of Pain Medicine.

In the group with knee OA, 721 patients were randomized to DSG and 705 to a placebo gel. The most common adverse events were application site related; these occurred in 406 (56.3%) of the DSG patients and 340 (48.2%) of the placebo patients. The incidence of gastrointestinal, cardiovascular, hepatic, or renal adverse events (AEs) was similar between the two groups. The only serious AE potentially related to treatment was a deep-vein thrombosis and pulmonary embolism that developed in an 80-year-old woman with multiple cardiovascular–risk factors, the researchers noted. The most common treatment-emergent AE was headache, reported in approximately 15% of patients in each group.

In the group with hand OA, 400 patients were randomized to DSG and 383 to a placebo gel. Application site events were the most common AEs, occurring in 163 (40.8%) of the DSG patients and 139 (36.3%) of the placebo patients. Rates of cardiovascular, gastrointestinal, renal, and hepatic AEs were similar between the groups. Treatment-related gastrointestinal events occurred in two patients in the DSG group and one in the placebo group. None of the cardiovascular or serious AEs in either group were considered treatment-related, the researchers wrote. However, two patients with hand OA in both the active treatment and placebo groups experienced liver-enzyme elevation to three times the upper limit of normal. The most common treatment-emergent AE was headache, reported by 9% of patients in the DSG group and 10% of the placebo group.

"In general, adverse events with diclofenac sodium were mild and resolved without the need for additional treatment, consistent with a favorable tolerability profile," the researchers said.

The clinical trials for DSG were funded by Novartis, and this post hoc analysis was funded by Endo Pharmaceuticals. Dr. Peniston said he had no financial conflicts to disclose, but several study coauthors were employed by either Novartis or Endo.

Teen birth rates in the United States fell by 37% over the past two decades, reaching the lowest rate ever recorded, according to data from the Centers for Disease Control and Prevention.

Despite those promising data, "we still have a ways to go to improve our teen birth rate to reflect what is seen in other parts of the world," said Ursula Bauer, Ph.D., director of the National Center for Chronic Disease Prevention and Health Promotion, and Dr. Wanda Barfield, director of the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, in a teleconference.

The birth rate for girls aged 15-19 years in 2008 and 2009 was 39 per 1,000 girls in the United States, according to the report, which was published online April 5 in Morbidity and Mortality Weekly Report (MMWR 2011;60:1-8).

However, teen birth rates in the United States are as much as nine times higher than in many other developed countries. Teen birth rates for 2008-2009 were 27 per 1,000 in Great Britain, 10 per 1,000 in Germany and France, and 6 per 1,000 in Sweden and Denmark.

The researchers, from the Centers for Disease Control and Prevention (CDC), reviewed National Vital Statistics System data from 1991 to 2009 on teen birth rates, as well as National Youth Risk Behavior Survey data on sexual activity and contraceptive use. They also reviewed data on sex education and the use of reproductive health services for teens aged 15-19 years from the 2006-2008 National Survey of Family Growth.

In 2009, teen birth rates were lowest in the Northeastern and upper Midwestern states and highest in the Southern states. The states with the lowest birth rates – Connecticut, Massachusetts, New Hampshire, New Jersey, and Vermont – posted rates ranging from 16 to 23 births per 1,000 girls aged 15-19 years. The states with the highest rates – Arkansas, Mississippi, New Mexico, Oklahoma, and Texas – had rates ranging from 59 to 64 births per 1,000 girls aged 15-19 years.

The number of teens having sex declined across white, black, and Hispanic ethnicities for both boys and girls, but black and Hispanic girls remained at least twice as likely as white girls to become teen mothers.

Approximately 46% of teens in the United States have had sexual intercourse – down from 54% in 1991 – and 12% of those teens used no contraception, down from 16% in 1991, according to the report. In addition, approximately half of teens had spoken with parents about abstinence or birth control.

"Health care providers have a key role to play in bringing down teen birth rates and teen pregnancy rates," said Dr. Bauer. "Talking to teens, both boys and girls, about sexual health and reproductive health, and talking about available contraception, is very important for health care providers in their encounters with teens," she said.

According to a CDC fact sheet, health care providers can help reduce the teen birth rate in the United States by making more birth control options available to sexually active teens, including long-acting methods such as IUDs, and by educating teens about the proper use of birth control options, including condoms and oral contraceptives.

Teen birth rates in the United States fell by 37% over the past two decades, reaching the lowest rate ever recorded, according to data from the Centers for Disease Control and Prevention.

Despite those promising data, "we still have a ways to go to improve our teen birth rate to reflect what is seen in other parts of the world," said Ursula Bauer, Ph.D., director of the National Center for Chronic Disease Prevention and Health Promotion, and Dr. Wanda Barfield, director of the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, in a teleconference.

The birth rate for girls aged 15-19 years in 2008 and 2009 was 39 per 1,000 girls in the United States, according to the report, which was published online April 5 in Morbidity and Mortality Weekly Report (MMWR 2011;60:1-8).

However, teen birth rates in the United States are as much as nine times higher than in many other developed countries. Teen birth rates for 2008-2009 were 27 per 1,000 in Great Britain, 10 per 1,000 in Germany and France, and 6 per 1,000 in Sweden and Denmark.

The researchers, from the Centers for Disease Control and Prevention (CDC), reviewed National Vital Statistics System data from 1991 to 2009 on teen birth rates, as well as National Youth Risk Behavior Survey data on sexual activity and contraceptive use. They also reviewed data on sex education and the use of reproductive health services for teens aged 15-19 years from the 2006-2008 National Survey of Family Growth.

In 2009, teen birth rates were lowest in the Northeastern and upper Midwestern states and highest in the Southern states. The states with the lowest birth rates – Connecticut, Massachusetts, New Hampshire, New Jersey, and Vermont – posted rates ranging from 16 to 23 births per 1,000 girls aged 15-19 years. The states with the highest rates – Arkansas, Mississippi, New Mexico, Oklahoma, and Texas – had rates ranging from 59 to 64 births per 1,000 girls aged 15-19 years.

The number of teens having sex declined across white, black, and Hispanic ethnicities for both boys and girls, but black and Hispanic girls remained at least twice as likely as white girls to become teen mothers.

Approximately 46% of teens in the United States have had sexual intercourse – down from 54% in 1991 – and 12% of those teens used no contraception, down from 16% in 1991, according to the report. In addition, approximately half of teens had spoken with parents about abstinence or birth control.

"Health care providers have a key role to play in bringing down teen birth rates and teen pregnancy rates," said Dr. Bauer. "Talking to teens, both boys and girls, about sexual health and reproductive health, and talking about available contraception, is very important for health care providers in their encounters with teens," she said.

According to a CDC fact sheet, health care providers can help reduce the teen birth rate in the United States by making more birth control options available to sexually active teens, including long-acting methods such as IUDs, and by educating teens about the proper use of birth control options, including condoms and oral contraceptives.

Teen birth rates in the United States fell by 37% over the past two decades, reaching the lowest rate ever recorded, according to data from the Centers for Disease Control and Prevention.

Despite those promising data, "we still have a ways to go to improve our teen birth rate to reflect what is seen in other parts of the world," said Ursula Bauer, Ph.D., director of the National Center for Chronic Disease Prevention and Health Promotion, and Dr. Wanda Barfield, director of the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, in a teleconference.

The birth rate for girls aged 15-19 years in 2008 and 2009 was 39 per 1,000 girls in the United States, according to the report, which was published online April 5 in Morbidity and Mortality Weekly Report (MMWR 2011;60:1-8).

However, teen birth rates in the United States are as much as nine times higher than in many other developed countries. Teen birth rates for 2008-2009 were 27 per 1,000 in Great Britain, 10 per 1,000 in Germany and France, and 6 per 1,000 in Sweden and Denmark.

The researchers, from the Centers for Disease Control and Prevention (CDC), reviewed National Vital Statistics System data from 1991 to 2009 on teen birth rates, as well as National Youth Risk Behavior Survey data on sexual activity and contraceptive use. They also reviewed data on sex education and the use of reproductive health services for teens aged 15-19 years from the 2006-2008 National Survey of Family Growth.

In 2009, teen birth rates were lowest in the Northeastern and upper Midwestern states and highest in the Southern states. The states with the lowest birth rates – Connecticut, Massachusetts, New Hampshire, New Jersey, and Vermont – posted rates ranging from 16 to 23 births per 1,000 girls aged 15-19 years. The states with the highest rates – Arkansas, Mississippi, New Mexico, Oklahoma, and Texas – had rates ranging from 59 to 64 births per 1,000 girls aged 15-19 years.

The number of teens having sex declined across white, black, and Hispanic ethnicities for both boys and girls, but black and Hispanic girls remained at least twice as likely as white girls to become teen mothers.

Approximately 46% of teens in the United States have had sexual intercourse – down from 54% in 1991 – and 12% of those teens used no contraception, down from 16% in 1991, according to the report. In addition, approximately half of teens had spoken with parents about abstinence or birth control.

"Health care providers have a key role to play in bringing down teen birth rates and teen pregnancy rates," said Dr. Bauer. "Talking to teens, both boys and girls, about sexual health and reproductive health, and talking about available contraception, is very important for health care providers in their encounters with teens," she said.

According to a CDC fact sheet, health care providers can help reduce the teen birth rate in the United States by making more birth control options available to sexually active teens, including long-acting methods such as IUDs, and by educating teens about the proper use of birth control options, including condoms and oral contraceptives.

Teen birth rates in the United States fell by 37% over the past two decades, reaching the lowest rate ever recorded, according to data from the Centers for Disease Control and Prevention.

Despite those promising data, "we still have a ways to go to improve our teen birth rate to reflect what is seen in other parts of the world," said Ursula Bauer, Ph.D., director of the National Center for Chronic Disease Prevention and Health Promotion, and Dr. Wanda Barfield, director of the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, in a teleconference.

The birth rate for girls aged 15-19 years in 2008 and 2009 was 39 per 1,000 girls in the United States, according to the report, which was published online April 5 in Morbidity and Mortality Weekly Report (MMWR 2011;60:1-8).

However, teen birth rates in the United States are as much as nine times higher than in many other developed countries. Teen birth rates for 2008-2009 were 27 per 1,000 in Great Britain, 10 per 1,000 in Germany and France, and 6 per 1,000 in Sweden and Denmark.

The researchers, from the Centers for Disease Control and Prevention (CDC), reviewed National Vital Statistics System data from 1991 to 2009 on teen birth rates, as well as National Youth Risk Behavior Survey data on sexual activity and contraceptive use. They also reviewed data on sex education and the use of reproductive health services for teens aged 15-19 years from the 2006-2008 National Survey of Family Growth.

In 2009, teen birth rates were lowest in the Northeastern and upper Midwestern states and highest in the Southern states. The states with the lowest birth rates – Connecticut, Massachusetts, New Hampshire, New Jersey, and Vermont – posted rates ranging from 16 to 23 births per 1,000 girls aged 15-19 years. The states with the highest rates – Arkansas, Mississippi, New Mexico, Oklahoma, and Texas – had rates ranging from 59 to 64 births per 1,000 girls aged 15-19 years.

The number of teens having sex declined across white, black, and Hispanic ethnicities for both boys and girls, but black and Hispanic girls remained at least twice as likely as white girls to become teen mothers.

Approximately 46% of teens in the United States have had sexual intercourse – down from 54% in 1991 – and 12% of those teens used no contraception, down from 16% in 1991, according to the report. In addition, approximately half of teens had spoken with parents about abstinence or birth control.

"Health care providers have a key role to play in bringing down teen birth rates and teen pregnancy rates," said Dr. Bauer. "Talking to teens, both boys and girls, about sexual health and reproductive health, and talking about available contraception, is very important for health care providers in their encounters with teens," she said.

According to a CDC fact sheet, health care providers can help reduce the teen birth rate in the United States by making more birth control options available to sexually active teens, including long-acting methods such as IUDs, and by educating teens about the proper use of birth control options, including condoms and oral contraceptives.

Teen birth rates in the United States fell by 37% over the past two decades, reaching the lowest rate ever recorded, according to data from the Centers for Disease Control and Prevention.

Despite those promising data, "we still have a ways to go to improve our teen birth rate to reflect what is seen in other parts of the world," said Ursula Bauer, Ph.D., director of the National Center for Chronic Disease Prevention and Health Promotion, and Dr. Wanda Barfield, director of the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, in a teleconference.

The birth rate for girls aged 15-19 years in 2008 and 2009 was 39 per 1,000 girls in the United States, according to the report, which was published online April 5 in Morbidity and Mortality Weekly Report (MMWR 2011;60:1-8).

However, teen birth rates in the United States are as much as nine times higher than in many other developed countries. Teen birth rates for 2008-2009 were 27 per 1,000 in Great Britain, 10 per 1,000 in Germany and France, and 6 per 1,000 in Sweden and Denmark.

The researchers, from the Centers for Disease Control and Prevention (CDC), reviewed National Vital Statistics System data from 1991 to 2009 on teen birth rates, as well as National Youth Risk Behavior Survey data on sexual activity and contraceptive use. They also reviewed data on sex education and the use of reproductive health services for teens aged 15-19 years from the 2006-2008 National Survey of Family Growth.

In 2009, teen birth rates were lowest in the Northeastern and upper Midwestern states and highest in the Southern states. The states with the lowest birth rates – Connecticut, Massachusetts, New Hampshire, New Jersey, and Vermont – posted rates ranging from 16 to 23 births per 1,000 girls aged 15-19 years. The states with the highest rates – Arkansas, Mississippi, New Mexico, Oklahoma, and Texas – had rates ranging from 59 to 64 births per 1,000 girls aged 15-19 years.

The number of teens having sex declined across white, black, and Hispanic ethnicities for both boys and girls, but black and Hispanic girls remained at least twice as likely as white girls to become teen mothers.

Approximately 46% of teens in the United States have had sexual intercourse – down from 54% in 1991 – and 12% of those teens used no contraception, down from 16% in 1991, according to the report. In addition, approximately half of teens had spoken with parents about abstinence or birth control.

"Health care providers have a key role to play in bringing down teen birth rates and teen pregnancy rates," said Dr. Bauer. "Talking to teens, both boys and girls, about sexual health and reproductive health, and talking about available contraception, is very important for health care providers in their encounters with teens," she said.

According to a CDC fact sheet, health care providers can help reduce the teen birth rate in the United States by making more birth control options available to sexually active teens, including long-acting methods such as IUDs, and by educating teens about the proper use of birth control options, including condoms and oral contraceptives.

Teen birth rates in the United States fell by 37% over the past two decades, reaching the lowest rate ever recorded, according to data from the Centers for Disease Control and Prevention.

Despite those promising data, "we still have a ways to go to improve our teen birth rate to reflect what is seen in other parts of the world," said Ursula Bauer, Ph.D., director of the National Center for Chronic Disease Prevention and Health Promotion, and Dr. Wanda Barfield, director of the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, in a teleconference.

The birth rate for girls aged 15-19 years in 2008 and 2009 was 39 per 1,000 girls in the United States, according to the report, which was published online April 5 in Morbidity and Mortality Weekly Report (MMWR 2011;60:1-8).

However, teen birth rates in the United States are as much as nine times higher than in many other developed countries. Teen birth rates for 2008-2009 were 27 per 1,000 in Great Britain, 10 per 1,000 in Germany and France, and 6 per 1,000 in Sweden and Denmark.

The researchers, from the Centers for Disease Control and Prevention (CDC), reviewed National Vital Statistics System data from 1991 to 2009 on teen birth rates, as well as National Youth Risk Behavior Survey data on sexual activity and contraceptive use. They also reviewed data on sex education and the use of reproductive health services for teens aged 15-19 years from the 2006-2008 National Survey of Family Growth.

In 2009, teen birth rates were lowest in the Northeastern and upper Midwestern states and highest in the Southern states. The states with the lowest birth rates – Connecticut, Massachusetts, New Hampshire, New Jersey, and Vermont – posted rates ranging from 16 to 23 births per 1,000 girls aged 15-19 years. The states with the highest rates – Arkansas, Mississippi, New Mexico, Oklahoma, and Texas – had rates ranging from 59 to 64 births per 1,000 girls aged 15-19 years.

The number of teens having sex declined across white, black, and Hispanic ethnicities for both boys and girls, but black and Hispanic girls remained at least twice as likely as white girls to become teen mothers.

Approximately 46% of teens in the United States have had sexual intercourse – down from 54% in 1991 – and 12% of those teens used no contraception, down from 16% in 1991, according to the report. In addition, approximately half of teens had spoken with parents about abstinence or birth control.

"Health care providers have a key role to play in bringing down teen birth rates and teen pregnancy rates," said Dr. Bauer. "Talking to teens, both boys and girls, about sexual health and reproductive health, and talking about available contraception, is very important for health care providers in their encounters with teens," she said.

According to a CDC fact sheet, health care providers can help reduce the teen birth rate in the United States by making more birth control options available to sexually active teens, including long-acting methods such as IUDs, and by educating teens about the proper use of birth control options, including condoms and oral contraceptives.