User login
Spotting Sepsis Sooner
More than 1.5 million Americans develop sepsis each year, and at least 250,000 die of it. “Detecting sepsis early and starting immediate treatment is often the difference between life and death. It starts with preventing the infections that lead to sepsis,” said CDC Director Brenda Fitzgerald, MD, introducing the CDC’s Get Ahead of Sepsis campaign, which launched in August. “We created Get Ahead of Sepsis to give people the resources they need to help stop this medical emergency in its tracks.”
The campaign is an educational initiative for both the public and health care professionals in hospitals, home care, long-term care, and urgent care. For many patients, the CDC says, sepsis develops from an infection that begins outside the hospital. Health care professionals are not only in prime positions to monitor for signs and symptoms of sepsis in the health care setting—they can also help educate patients about things they can do to prevent sepsis. For instance, people with chronic conditions can take good care to avoid infections that could lead to sepsis.
The campaign website, www.cdc.gov/sepsis, provides fact sheets, infographics, brochures, and other materials to help spread the word.
More than 1.5 million Americans develop sepsis each year, and at least 250,000 die of it. “Detecting sepsis early and starting immediate treatment is often the difference between life and death. It starts with preventing the infections that lead to sepsis,” said CDC Director Brenda Fitzgerald, MD, introducing the CDC’s Get Ahead of Sepsis campaign, which launched in August. “We created Get Ahead of Sepsis to give people the resources they need to help stop this medical emergency in its tracks.”
The campaign is an educational initiative for both the public and health care professionals in hospitals, home care, long-term care, and urgent care. For many patients, the CDC says, sepsis develops from an infection that begins outside the hospital. Health care professionals are not only in prime positions to monitor for signs and symptoms of sepsis in the health care setting—they can also help educate patients about things they can do to prevent sepsis. For instance, people with chronic conditions can take good care to avoid infections that could lead to sepsis.
The campaign website, www.cdc.gov/sepsis, provides fact sheets, infographics, brochures, and other materials to help spread the word.
More than 1.5 million Americans develop sepsis each year, and at least 250,000 die of it. “Detecting sepsis early and starting immediate treatment is often the difference between life and death. It starts with preventing the infections that lead to sepsis,” said CDC Director Brenda Fitzgerald, MD, introducing the CDC’s Get Ahead of Sepsis campaign, which launched in August. “We created Get Ahead of Sepsis to give people the resources they need to help stop this medical emergency in its tracks.”
The campaign is an educational initiative for both the public and health care professionals in hospitals, home care, long-term care, and urgent care. For many patients, the CDC says, sepsis develops from an infection that begins outside the hospital. Health care professionals are not only in prime positions to monitor for signs and symptoms of sepsis in the health care setting—they can also help educate patients about things they can do to prevent sepsis. For instance, people with chronic conditions can take good care to avoid infections that could lead to sepsis.
The campaign website, www.cdc.gov/sepsis, provides fact sheets, infographics, brochures, and other materials to help spread the word.
Nutrition Index Helps Identify High-Risk Elderly Heart Patients
A “wealth of evidence” suggests that nutrition and immunologic status on admission is closely associated with the outcome of patients with cardiovascular disease—especially high-risk elderly patients, say researchers from Chinese People’s Liberation Army General Hospital, Beijing. The researchers note that malnutrition is an independent factor influencing post myocardial infarction complications and mortality in geriatric patients with coronary artery disease (CAD). According to their study of 336 hospitalized patients with hypertension, the Controlling Nutritional Status (CONUT) score can help predict who is at highest risk.
Nutrition indexes are widely used. CONUT scores, which are calculated based on serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration, have been found useful in a variety of areas, including cancer. The Geriatric Nutritional Risk Index (GNRI), although a relatively new index for nutrition assessment in the elderly, is the most-used tool to evaluate patients with chronic kidney disease, the researchers say. Both indexes are “widely applied” in evaluation of patients with tumors who are also undergoing dialysis. Some studies also have reported on GNRI as a prognostic factor in cardiovascular diseases.
The researchers conducted their study to assess the effect of nutrition status on survival in patients aged ≥ 80 years, with hypertension, measuring outcomes at 90 days postadmission. All patients had a history of CAD, 167 had type 2 diabetes, and 124 had anemia. Of the enrolled patients, 192 were admitted for respiratory tract infection, with a significantly high proportion of poor nutrition status. Five patients scored > 9 on the CONUT scale. A score of ≥ 5 indicated moderate to severe malnutrition.
During the 90-day follow-up, 27 patients died. No differences in systolic blood pressure were found. The surviving patients, however, showed increased body mass index, hemoglobin, and albumin levels, as well as lower diastolic blood pressure and fasting blood glucose. Surviving patients had improved GRNI scores and reduced CONUT scores, both of which indicated improved nutrition status. Respiratory tract infection, CONUT, and albumin were independent predictors of all-cause mortality.
However, only CONUT accurately predicted all-cause mortality among patients with hypertension during the 90-day follow-up. A CONUT score above 3.0 at admission predicted all-cause mortality with a sensitivity of 77.8% and specificity of 64.7%.
Source:
Sun X, Luo L, Zhao X, Ye P. BMJ Open. 2017;7(9):e015649.
doi: 10.1136/bmjopen-2016-015649.
A “wealth of evidence” suggests that nutrition and immunologic status on admission is closely associated with the outcome of patients with cardiovascular disease—especially high-risk elderly patients, say researchers from Chinese People’s Liberation Army General Hospital, Beijing. The researchers note that malnutrition is an independent factor influencing post myocardial infarction complications and mortality in geriatric patients with coronary artery disease (CAD). According to their study of 336 hospitalized patients with hypertension, the Controlling Nutritional Status (CONUT) score can help predict who is at highest risk.
Nutrition indexes are widely used. CONUT scores, which are calculated based on serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration, have been found useful in a variety of areas, including cancer. The Geriatric Nutritional Risk Index (GNRI), although a relatively new index for nutrition assessment in the elderly, is the most-used tool to evaluate patients with chronic kidney disease, the researchers say. Both indexes are “widely applied” in evaluation of patients with tumors who are also undergoing dialysis. Some studies also have reported on GNRI as a prognostic factor in cardiovascular diseases.
The researchers conducted their study to assess the effect of nutrition status on survival in patients aged ≥ 80 years, with hypertension, measuring outcomes at 90 days postadmission. All patients had a history of CAD, 167 had type 2 diabetes, and 124 had anemia. Of the enrolled patients, 192 were admitted for respiratory tract infection, with a significantly high proportion of poor nutrition status. Five patients scored > 9 on the CONUT scale. A score of ≥ 5 indicated moderate to severe malnutrition.
During the 90-day follow-up, 27 patients died. No differences in systolic blood pressure were found. The surviving patients, however, showed increased body mass index, hemoglobin, and albumin levels, as well as lower diastolic blood pressure and fasting blood glucose. Surviving patients had improved GRNI scores and reduced CONUT scores, both of which indicated improved nutrition status. Respiratory tract infection, CONUT, and albumin were independent predictors of all-cause mortality.
However, only CONUT accurately predicted all-cause mortality among patients with hypertension during the 90-day follow-up. A CONUT score above 3.0 at admission predicted all-cause mortality with a sensitivity of 77.8% and specificity of 64.7%.
Source:
Sun X, Luo L, Zhao X, Ye P. BMJ Open. 2017;7(9):e015649.
doi: 10.1136/bmjopen-2016-015649.
A “wealth of evidence” suggests that nutrition and immunologic status on admission is closely associated with the outcome of patients with cardiovascular disease—especially high-risk elderly patients, say researchers from Chinese People’s Liberation Army General Hospital, Beijing. The researchers note that malnutrition is an independent factor influencing post myocardial infarction complications and mortality in geriatric patients with coronary artery disease (CAD). According to their study of 336 hospitalized patients with hypertension, the Controlling Nutritional Status (CONUT) score can help predict who is at highest risk.
Nutrition indexes are widely used. CONUT scores, which are calculated based on serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration, have been found useful in a variety of areas, including cancer. The Geriatric Nutritional Risk Index (GNRI), although a relatively new index for nutrition assessment in the elderly, is the most-used tool to evaluate patients with chronic kidney disease, the researchers say. Both indexes are “widely applied” in evaluation of patients with tumors who are also undergoing dialysis. Some studies also have reported on GNRI as a prognostic factor in cardiovascular diseases.
The researchers conducted their study to assess the effect of nutrition status on survival in patients aged ≥ 80 years, with hypertension, measuring outcomes at 90 days postadmission. All patients had a history of CAD, 167 had type 2 diabetes, and 124 had anemia. Of the enrolled patients, 192 were admitted for respiratory tract infection, with a significantly high proportion of poor nutrition status. Five patients scored > 9 on the CONUT scale. A score of ≥ 5 indicated moderate to severe malnutrition.
During the 90-day follow-up, 27 patients died. No differences in systolic blood pressure were found. The surviving patients, however, showed increased body mass index, hemoglobin, and albumin levels, as well as lower diastolic blood pressure and fasting blood glucose. Surviving patients had improved GRNI scores and reduced CONUT scores, both of which indicated improved nutrition status. Respiratory tract infection, CONUT, and albumin were independent predictors of all-cause mortality.
However, only CONUT accurately predicted all-cause mortality among patients with hypertension during the 90-day follow-up. A CONUT score above 3.0 at admission predicted all-cause mortality with a sensitivity of 77.8% and specificity of 64.7%.
Source:
Sun X, Luo L, Zhao X, Ye P. BMJ Open. 2017;7(9):e015649.
doi: 10.1136/bmjopen-2016-015649.
Obinutuzumab edges out rituximab for PFS in follicular lymphoma
In a head-to-head trial of anti-CD20 monoclonal antibodies in first-line therapy for follicular lymphoma, obinutuzumab-based chemotherapy was associated with slightly but significantly better progression-free survival than rituximab-based therapy, but at the cost of higher toxicities, including severe adverse events.
Among 1,202 patients with follicular lymphoma followed for a median of 34.5 months, the estimated 3-year rate of progression-free survival (PFS) for patients randomized to obinutuzumab-based chemotherapy and maintenance was 80%, compared with 73.3% for patients randomized to rituximab chemotherapy and maintenance. Response rates and overall survival were similar between the treatment groups, Robert Marcus, MB, BS, of King’s College Hospital, London, and his coinvestigators reported in the GALLIUM trial.
They acknowledged, however, that there were substantial differences between the treatment groups in the cumulative doses of obinutuzumab (Gazyva) and rituximab (Rituxan and others), which could have affected the relative efficacy of each regimen.
In addition, while patients were randomly assigned to one monoclonal antibody or the other, the choice of chemotherapy regimens, while standardized, was left to the discretion of investigators at each treatment site, another factor that might have influenced outcomes.
The investigators reported the results of a preplanned interim efficacy analysis. They compared obinutuzumab or rituximab plus chemotherapy in patients with indolent non-Hodgkin lymphoma, but the trial was powered to detect a PFS difference only in patients with follicular lymphoma. Patients who had a clinical response to induction therapy went on to maintenance therapy with the same monoclonal antibody.
In all, 1,202 patients with follicular lymphoma were enrolled and randomized, 601 in each arm, to receive induction with either intravenous obinutuzumab 1,000 mg on days 1, 8, and 15 of cycle 1 and on day 1 of subsequent cycles, or rituximab 375 mg/m2 on day 1 of each cycle for six or eight cycles, depending on the accompanying chemotherapy regimen. The regimens used were either CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), CVP (cyclophosphamide, vincristine, and prednisone), or bendamustine.
Patients with partial or complete responses were then maintained on the same monoclonal antibody they had received during induction, either obinutuzumab 1,000 mg or rituximab 375 mg/m2 every 2 months for 2 years, or until disease progression. Patients were not allowed to be crossed over to the other maintenance therapy.
Patients with stable disease after induction continued to be followed, but did not receive maintenance therapy.
The interim analysis was performed after 245 of 370 anticipated events (disease progression, relapse, or death) had occurred. At that time, the independent data and safety monitoring committee recommended full analysis of the trial data, and the sponsor agreed.
After a median follow-up of 34.5 months, an intention-to-treat analysis showed that the investigator-assessed, estimated 3-year rate of PFS was 80.0% in the obinutuzumab arm, compared with 73.3%; in the rituximab arm. This translated into a hazard ratio (HR) for progression, relapse, or death of 0.66 (P = .001). An independent review committee calculated a HR favoring obinutuzumab of 0.71 (P = .01).
Estimated 3-year overall survival rates were not significantly different at 94% and 92.1%, respectively.
Overall response rates were similar between the groups, at 88.5% with obinutuzumab group and 86.9% with rituximab, a difference that was not significant.
Obinutuzumab was associated with a higher rate of prespecified events of special interest, including infections, cardiac events, second neoplasms, infusion-related events, neutropenia, and thrombocytopenia.
Adverse events deemed to be related to the antibodies occurred in 59.3% of patients on obinutuzumab, and 48.9% of patients on rituximab.
There were more frequent grade 3 or 4 adverse events and deaths with obinutuzumab, occurring in 74.6% of patients vs. 67.8% on rituximab. Fatal adverse events occurred in 4% and 3.4% of patients, respectively.
A total of 81 patients died during the trial, including 35 in the obinutuzumab group and 46 in the rituximab group.
F. Hoffmann–La Roche supported the trial. Dr. Marcus disclosed consulting fees and lecture fees from Takeda Pharmaceuticals and travel support, consulting fees, and lecture fees from Roche. The majority of coauthors disclosed similar relationships.
Should obinutuzumab replace rituximab as the standard antibody in the treatment of patients receiving chemoimmunotherapy regimens for follicular lymphoma? Results from this trial would suggest that there might be no advantage for an obinutuzumab-containing chemoimmunotherapy regimen if maintenance treatment was not planned. Even with maintenance therapy, there is no evidence from this trial of an overall survival benefit with obinutuzumab. These findings, combined with the higher rate of toxic effects and, presumably, the higher cost of obinutuzumab, raise important questions regarding the advantage of its use. This issue is complicated further because it is possible that giving rituximab at a dose of 1,000 mg might reduce or eliminate any difference in progression-free survival – that is, if the difference is primarily a dose effect.
When the data on minimal residual disease are made available, the case in favor of obinutuzumab may appear to be more compelling if indeed a higher proportion of patients who received obinutuzumab have minimal residual disease status at some point in treatment and remain in remission longer than those who received rituximab. At the moment, the competition between these agents looks too close to call.
These comments are excerpted from an editorial (N Engl J Med. 2017 Oct 5;377;14:1389-90) by James O. Armitage, MD, University of Nebraska, Omaha, and Dan L. Longo, MD, Dana-Farber Cancer Institute, Boston. Dr. Armitage reported personal fees from Conatus, Samus Therapeutics, and Tesaro. Dr. Longo reported no relevant disclosures. He is deputy editor of The New England Journal of Medicine.
Should obinutuzumab replace rituximab as the standard antibody in the treatment of patients receiving chemoimmunotherapy regimens for follicular lymphoma? Results from this trial would suggest that there might be no advantage for an obinutuzumab-containing chemoimmunotherapy regimen if maintenance treatment was not planned. Even with maintenance therapy, there is no evidence from this trial of an overall survival benefit with obinutuzumab. These findings, combined with the higher rate of toxic effects and, presumably, the higher cost of obinutuzumab, raise important questions regarding the advantage of its use. This issue is complicated further because it is possible that giving rituximab at a dose of 1,000 mg might reduce or eliminate any difference in progression-free survival – that is, if the difference is primarily a dose effect.
When the data on minimal residual disease are made available, the case in favor of obinutuzumab may appear to be more compelling if indeed a higher proportion of patients who received obinutuzumab have minimal residual disease status at some point in treatment and remain in remission longer than those who received rituximab. At the moment, the competition between these agents looks too close to call.
These comments are excerpted from an editorial (N Engl J Med. 2017 Oct 5;377;14:1389-90) by James O. Armitage, MD, University of Nebraska, Omaha, and Dan L. Longo, MD, Dana-Farber Cancer Institute, Boston. Dr. Armitage reported personal fees from Conatus, Samus Therapeutics, and Tesaro. Dr. Longo reported no relevant disclosures. He is deputy editor of The New England Journal of Medicine.
Should obinutuzumab replace rituximab as the standard antibody in the treatment of patients receiving chemoimmunotherapy regimens for follicular lymphoma? Results from this trial would suggest that there might be no advantage for an obinutuzumab-containing chemoimmunotherapy regimen if maintenance treatment was not planned. Even with maintenance therapy, there is no evidence from this trial of an overall survival benefit with obinutuzumab. These findings, combined with the higher rate of toxic effects and, presumably, the higher cost of obinutuzumab, raise important questions regarding the advantage of its use. This issue is complicated further because it is possible that giving rituximab at a dose of 1,000 mg might reduce or eliminate any difference in progression-free survival – that is, if the difference is primarily a dose effect.
When the data on minimal residual disease are made available, the case in favor of obinutuzumab may appear to be more compelling if indeed a higher proportion of patients who received obinutuzumab have minimal residual disease status at some point in treatment and remain in remission longer than those who received rituximab. At the moment, the competition between these agents looks too close to call.
These comments are excerpted from an editorial (N Engl J Med. 2017 Oct 5;377;14:1389-90) by James O. Armitage, MD, University of Nebraska, Omaha, and Dan L. Longo, MD, Dana-Farber Cancer Institute, Boston. Dr. Armitage reported personal fees from Conatus, Samus Therapeutics, and Tesaro. Dr. Longo reported no relevant disclosures. He is deputy editor of The New England Journal of Medicine.
In a head-to-head trial of anti-CD20 monoclonal antibodies in first-line therapy for follicular lymphoma, obinutuzumab-based chemotherapy was associated with slightly but significantly better progression-free survival than rituximab-based therapy, but at the cost of higher toxicities, including severe adverse events.
Among 1,202 patients with follicular lymphoma followed for a median of 34.5 months, the estimated 3-year rate of progression-free survival (PFS) for patients randomized to obinutuzumab-based chemotherapy and maintenance was 80%, compared with 73.3% for patients randomized to rituximab chemotherapy and maintenance. Response rates and overall survival were similar between the treatment groups, Robert Marcus, MB, BS, of King’s College Hospital, London, and his coinvestigators reported in the GALLIUM trial.
They acknowledged, however, that there were substantial differences between the treatment groups in the cumulative doses of obinutuzumab (Gazyva) and rituximab (Rituxan and others), which could have affected the relative efficacy of each regimen.
In addition, while patients were randomly assigned to one monoclonal antibody or the other, the choice of chemotherapy regimens, while standardized, was left to the discretion of investigators at each treatment site, another factor that might have influenced outcomes.
The investigators reported the results of a preplanned interim efficacy analysis. They compared obinutuzumab or rituximab plus chemotherapy in patients with indolent non-Hodgkin lymphoma, but the trial was powered to detect a PFS difference only in patients with follicular lymphoma. Patients who had a clinical response to induction therapy went on to maintenance therapy with the same monoclonal antibody.
In all, 1,202 patients with follicular lymphoma were enrolled and randomized, 601 in each arm, to receive induction with either intravenous obinutuzumab 1,000 mg on days 1, 8, and 15 of cycle 1 and on day 1 of subsequent cycles, or rituximab 375 mg/m2 on day 1 of each cycle for six or eight cycles, depending on the accompanying chemotherapy regimen. The regimens used were either CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), CVP (cyclophosphamide, vincristine, and prednisone), or bendamustine.
Patients with partial or complete responses were then maintained on the same monoclonal antibody they had received during induction, either obinutuzumab 1,000 mg or rituximab 375 mg/m2 every 2 months for 2 years, or until disease progression. Patients were not allowed to be crossed over to the other maintenance therapy.
Patients with stable disease after induction continued to be followed, but did not receive maintenance therapy.
The interim analysis was performed after 245 of 370 anticipated events (disease progression, relapse, or death) had occurred. At that time, the independent data and safety monitoring committee recommended full analysis of the trial data, and the sponsor agreed.
After a median follow-up of 34.5 months, an intention-to-treat analysis showed that the investigator-assessed, estimated 3-year rate of PFS was 80.0% in the obinutuzumab arm, compared with 73.3%; in the rituximab arm. This translated into a hazard ratio (HR) for progression, relapse, or death of 0.66 (P = .001). An independent review committee calculated a HR favoring obinutuzumab of 0.71 (P = .01).
Estimated 3-year overall survival rates were not significantly different at 94% and 92.1%, respectively.
Overall response rates were similar between the groups, at 88.5% with obinutuzumab group and 86.9% with rituximab, a difference that was not significant.
Obinutuzumab was associated with a higher rate of prespecified events of special interest, including infections, cardiac events, second neoplasms, infusion-related events, neutropenia, and thrombocytopenia.
Adverse events deemed to be related to the antibodies occurred in 59.3% of patients on obinutuzumab, and 48.9% of patients on rituximab.
There were more frequent grade 3 or 4 adverse events and deaths with obinutuzumab, occurring in 74.6% of patients vs. 67.8% on rituximab. Fatal adverse events occurred in 4% and 3.4% of patients, respectively.
A total of 81 patients died during the trial, including 35 in the obinutuzumab group and 46 in the rituximab group.
F. Hoffmann–La Roche supported the trial. Dr. Marcus disclosed consulting fees and lecture fees from Takeda Pharmaceuticals and travel support, consulting fees, and lecture fees from Roche. The majority of coauthors disclosed similar relationships.
In a head-to-head trial of anti-CD20 monoclonal antibodies in first-line therapy for follicular lymphoma, obinutuzumab-based chemotherapy was associated with slightly but significantly better progression-free survival than rituximab-based therapy, but at the cost of higher toxicities, including severe adverse events.
Among 1,202 patients with follicular lymphoma followed for a median of 34.5 months, the estimated 3-year rate of progression-free survival (PFS) for patients randomized to obinutuzumab-based chemotherapy and maintenance was 80%, compared with 73.3% for patients randomized to rituximab chemotherapy and maintenance. Response rates and overall survival were similar between the treatment groups, Robert Marcus, MB, BS, of King’s College Hospital, London, and his coinvestigators reported in the GALLIUM trial.
They acknowledged, however, that there were substantial differences between the treatment groups in the cumulative doses of obinutuzumab (Gazyva) and rituximab (Rituxan and others), which could have affected the relative efficacy of each regimen.
In addition, while patients were randomly assigned to one monoclonal antibody or the other, the choice of chemotherapy regimens, while standardized, was left to the discretion of investigators at each treatment site, another factor that might have influenced outcomes.
The investigators reported the results of a preplanned interim efficacy analysis. They compared obinutuzumab or rituximab plus chemotherapy in patients with indolent non-Hodgkin lymphoma, but the trial was powered to detect a PFS difference only in patients with follicular lymphoma. Patients who had a clinical response to induction therapy went on to maintenance therapy with the same monoclonal antibody.
In all, 1,202 patients with follicular lymphoma were enrolled and randomized, 601 in each arm, to receive induction with either intravenous obinutuzumab 1,000 mg on days 1, 8, and 15 of cycle 1 and on day 1 of subsequent cycles, or rituximab 375 mg/m2 on day 1 of each cycle for six or eight cycles, depending on the accompanying chemotherapy regimen. The regimens used were either CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), CVP (cyclophosphamide, vincristine, and prednisone), or bendamustine.
Patients with partial or complete responses were then maintained on the same monoclonal antibody they had received during induction, either obinutuzumab 1,000 mg or rituximab 375 mg/m2 every 2 months for 2 years, or until disease progression. Patients were not allowed to be crossed over to the other maintenance therapy.
Patients with stable disease after induction continued to be followed, but did not receive maintenance therapy.
The interim analysis was performed after 245 of 370 anticipated events (disease progression, relapse, or death) had occurred. At that time, the independent data and safety monitoring committee recommended full analysis of the trial data, and the sponsor agreed.
After a median follow-up of 34.5 months, an intention-to-treat analysis showed that the investigator-assessed, estimated 3-year rate of PFS was 80.0% in the obinutuzumab arm, compared with 73.3%; in the rituximab arm. This translated into a hazard ratio (HR) for progression, relapse, or death of 0.66 (P = .001). An independent review committee calculated a HR favoring obinutuzumab of 0.71 (P = .01).
Estimated 3-year overall survival rates were not significantly different at 94% and 92.1%, respectively.
Overall response rates were similar between the groups, at 88.5% with obinutuzumab group and 86.9% with rituximab, a difference that was not significant.
Obinutuzumab was associated with a higher rate of prespecified events of special interest, including infections, cardiac events, second neoplasms, infusion-related events, neutropenia, and thrombocytopenia.
Adverse events deemed to be related to the antibodies occurred in 59.3% of patients on obinutuzumab, and 48.9% of patients on rituximab.
There were more frequent grade 3 or 4 adverse events and deaths with obinutuzumab, occurring in 74.6% of patients vs. 67.8% on rituximab. Fatal adverse events occurred in 4% and 3.4% of patients, respectively.
A total of 81 patients died during the trial, including 35 in the obinutuzumab group and 46 in the rituximab group.
F. Hoffmann–La Roche supported the trial. Dr. Marcus disclosed consulting fees and lecture fees from Takeda Pharmaceuticals and travel support, consulting fees, and lecture fees from Roche. The majority of coauthors disclosed similar relationships.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: Obinutuzumab-based chemotherapy and maintenance was associated with better progression-free survival, but not overall survival, compared with rituximab-based chemotherapy and maintenance.
Major finding: Three-year progression-free survival was 80% with obinutuzumab, vs. 73.3% with rituximab.
Data source: Interim analysis of a randomized phase 3, open-label trial of 1,202 patients with follicular lymphoma.
Disclosures: F. Hoffmann–La Roche supported the trial. Dr. Marcus disclosed consulting fees and lecture fees from Takeda Pharmaceuticals and travel support, consulting fees, and lecture fees from Roche. The majority of coauthors disclosed similar relationships.
VCR regimen showed efficacy in mantle cell and indolent lymphomas
The combination of bortezomib, cladribine, and rituximab (VCR) was an effective treatment regimen for patients with CD20-positive mantle cell lymphoma (MCL) and indolent non-Hodgkin’s lymphoma (iNHL), based on results of a recent phase 2, open-label study.
The overall response rate was 92% in the single-center, 24-patient study. The 2-year progression-free survival (PFS) was 82% and 54%, respectively, for MCL and iNHL patients; PFS was 80% for treatment-naive patients and 57% for those with refractory/recalcitrant disease, according to Soham D. Puvvada, MD, of the University of Arizona Cancer Center in Tucson, and her associates.
Two-year overall survival was 91% for MCL and 69% for iNHL patients. Median time to progression was 34.5 months, and median PFS had not been reached at 2 years, according to the researchers.
While the study (NCT00980395) was small and limited by its single-center design, the VCR combination “has encouraging activity in both MCL and iNHL and could be compared to standard therapies in future studies,” the researchers wrote. “For MCL in particular, we believe a noninferiority comparison to standard therapies would be justified by our results.”
Adverse events were most commonly hematologic, and three patients experienced febrile neutropenia, data show.
“Although hematological toxicity can be an issue, the regimen provides an alternative option in transplant ineligible relapsed/refractory MCL and iNHL,” wrote Dr. Puvvada and her colleagues. The study was published in Clinical Lymphoma, Myeloma & Leukemia (doi: 10.1016/j.clml.2017.09.001).
The researchers studied the combination of bortezomib, the proteasome inhibitor initially approved for relapsed/refractory MCL, cladribine, which has shown activity and promising response rates in patients with indolent lymphomas, and rituximab in patients with CD20-positive mantle cell or indolent lymphoma.
Patients with follicular lymphomas were eligible to be included in the study if they had received at least one previous line of therapy. All other participants could be treatment naive or have relapsed after previous treatment.
Of the 24 patients enrolled, 11 had MCL, 5 had follicular lymphoma, 4 had marginal zone lymphoma, 3 had lymphoplasmacytic lymphoma, and 1 had small lymphocytic lymphoma.
The VCR regimen, given every 28 days for no more than six cycles, included rituximab at 375 mg/m2 given intravenously on day 1 of each cycle, cladribine 4 mg/m2 given intravenously over 2 hours on days 1 through 5, and bortezomib 1.3 mg/m2 given intravenously on days 1 and 4. Patients received a median of five cycles of therapy.
Adverse events of grade 3 or greater occurred in 14 patients (58%); 8 patients had leukopenia, 6 had thrombocytopenia, 5 had fatigue, and 5 had neutropenia, which included febrile neutropenia in 3 patients.
With a median follow-up of 38.5 months, overall response rate for VCR was 96%. Complete responses occurred in 8 of 23 evaluable patients (35%) and partial responses in 14 more patients (61%).
The combination of bortezomib, cladribine, and rituximab (VCR) was an effective treatment regimen for patients with CD20-positive mantle cell lymphoma (MCL) and indolent non-Hodgkin’s lymphoma (iNHL), based on results of a recent phase 2, open-label study.
The overall response rate was 92% in the single-center, 24-patient study. The 2-year progression-free survival (PFS) was 82% and 54%, respectively, for MCL and iNHL patients; PFS was 80% for treatment-naive patients and 57% for those with refractory/recalcitrant disease, according to Soham D. Puvvada, MD, of the University of Arizona Cancer Center in Tucson, and her associates.
Two-year overall survival was 91% for MCL and 69% for iNHL patients. Median time to progression was 34.5 months, and median PFS had not been reached at 2 years, according to the researchers.
While the study (NCT00980395) was small and limited by its single-center design, the VCR combination “has encouraging activity in both MCL and iNHL and could be compared to standard therapies in future studies,” the researchers wrote. “For MCL in particular, we believe a noninferiority comparison to standard therapies would be justified by our results.”
Adverse events were most commonly hematologic, and three patients experienced febrile neutropenia, data show.
“Although hematological toxicity can be an issue, the regimen provides an alternative option in transplant ineligible relapsed/refractory MCL and iNHL,” wrote Dr. Puvvada and her colleagues. The study was published in Clinical Lymphoma, Myeloma & Leukemia (doi: 10.1016/j.clml.2017.09.001).
The researchers studied the combination of bortezomib, the proteasome inhibitor initially approved for relapsed/refractory MCL, cladribine, which has shown activity and promising response rates in patients with indolent lymphomas, and rituximab in patients with CD20-positive mantle cell or indolent lymphoma.
Patients with follicular lymphomas were eligible to be included in the study if they had received at least one previous line of therapy. All other participants could be treatment naive or have relapsed after previous treatment.
Of the 24 patients enrolled, 11 had MCL, 5 had follicular lymphoma, 4 had marginal zone lymphoma, 3 had lymphoplasmacytic lymphoma, and 1 had small lymphocytic lymphoma.
The VCR regimen, given every 28 days for no more than six cycles, included rituximab at 375 mg/m2 given intravenously on day 1 of each cycle, cladribine 4 mg/m2 given intravenously over 2 hours on days 1 through 5, and bortezomib 1.3 mg/m2 given intravenously on days 1 and 4. Patients received a median of five cycles of therapy.
Adverse events of grade 3 or greater occurred in 14 patients (58%); 8 patients had leukopenia, 6 had thrombocytopenia, 5 had fatigue, and 5 had neutropenia, which included febrile neutropenia in 3 patients.
With a median follow-up of 38.5 months, overall response rate for VCR was 96%. Complete responses occurred in 8 of 23 evaluable patients (35%) and partial responses in 14 more patients (61%).
The combination of bortezomib, cladribine, and rituximab (VCR) was an effective treatment regimen for patients with CD20-positive mantle cell lymphoma (MCL) and indolent non-Hodgkin’s lymphoma (iNHL), based on results of a recent phase 2, open-label study.
The overall response rate was 92% in the single-center, 24-patient study. The 2-year progression-free survival (PFS) was 82% and 54%, respectively, for MCL and iNHL patients; PFS was 80% for treatment-naive patients and 57% for those with refractory/recalcitrant disease, according to Soham D. Puvvada, MD, of the University of Arizona Cancer Center in Tucson, and her associates.
Two-year overall survival was 91% for MCL and 69% for iNHL patients. Median time to progression was 34.5 months, and median PFS had not been reached at 2 years, according to the researchers.
While the study (NCT00980395) was small and limited by its single-center design, the VCR combination “has encouraging activity in both MCL and iNHL and could be compared to standard therapies in future studies,” the researchers wrote. “For MCL in particular, we believe a noninferiority comparison to standard therapies would be justified by our results.”
Adverse events were most commonly hematologic, and three patients experienced febrile neutropenia, data show.
“Although hematological toxicity can be an issue, the regimen provides an alternative option in transplant ineligible relapsed/refractory MCL and iNHL,” wrote Dr. Puvvada and her colleagues. The study was published in Clinical Lymphoma, Myeloma & Leukemia (doi: 10.1016/j.clml.2017.09.001).
The researchers studied the combination of bortezomib, the proteasome inhibitor initially approved for relapsed/refractory MCL, cladribine, which has shown activity and promising response rates in patients with indolent lymphomas, and rituximab in patients with CD20-positive mantle cell or indolent lymphoma.
Patients with follicular lymphomas were eligible to be included in the study if they had received at least one previous line of therapy. All other participants could be treatment naive or have relapsed after previous treatment.
Of the 24 patients enrolled, 11 had MCL, 5 had follicular lymphoma, 4 had marginal zone lymphoma, 3 had lymphoplasmacytic lymphoma, and 1 had small lymphocytic lymphoma.
The VCR regimen, given every 28 days for no more than six cycles, included rituximab at 375 mg/m2 given intravenously on day 1 of each cycle, cladribine 4 mg/m2 given intravenously over 2 hours on days 1 through 5, and bortezomib 1.3 mg/m2 given intravenously on days 1 and 4. Patients received a median of five cycles of therapy.
Adverse events of grade 3 or greater occurred in 14 patients (58%); 8 patients had leukopenia, 6 had thrombocytopenia, 5 had fatigue, and 5 had neutropenia, which included febrile neutropenia in 3 patients.
With a median follow-up of 38.5 months, overall response rate for VCR was 96%. Complete responses occurred in 8 of 23 evaluable patients (35%) and partial responses in 14 more patients (61%).
FROM LYMPHOMA, MYELOMA & LEUKEMIA
Key clinical point:
Major finding: The overall response rate was 92%, with a 2-year PFS of 82% and 54% for patients with mantle cell lymphoma (MCL) and indolent non-Hodgkin’s lymphoma (iNHL), respectively. Adverse events were most commonly hematologic, and three patients experienced febrile neutropenia.
Data source: A phase 2, open-label study including 24 patients with mantle cell or indolent lymphomas.
Disclosures: No disclosures were reported in the accepted manuscript.
Healing Diabetic Foot Ulcers With Exercise
Foot ulcers are a common complication of diabetes, due to macro- and microvascular changes that lead to neuropathy. But despite treatment with standard interventions such as debridement and pressure relief, many diabetic foot ulcers persist as nonhealing wounds, say researchers from Nnamdi Azidiwe University and University of Nigeria.
Oxygenation is key to keep the tissues healthy, the researchers say. We already know that exercise enhances blood circulation and improves vascular blood perfusion and capillary oxygen tension. However, little research has associated increased vascular blood perfusion with wound healing in diabetic foot ulcers, the researchers say. They reanalyzed results from 1 of their earlier studies to find out whether aerobic exercise would lead to healing.
In a 12-week program, 61 patients with type 1 or 2 diabetes mellitus were randomly assigned to an intervention or control group. Each patient had had a persistent ulcer of at least 1 cm2. The intervention group rode a bicycle ergometer at 60% of their maximum heart rate and progressed to 85%. The researchers tested them for oxygen percentage saturation and ankle brachial index (ABI) at baseline every 2 weeks.
At the end of the program, the researchers found a “sharp contrast” between the 2 groups, including a significant difference in the oxygen percentage saturation (99.00 vs 97.20) and the ABI. The reduction in wound size was also significant for the exercise group.
There is evidence, the researchers say, that exercise enhances blood circulation by lowering plasma glucose concentration. Normally, endothelial cells metabolize the circulating blood glucose—unless they are overwhelmed by glucose molecules during hyperglycemia. Previously, the researchers also noted that plasma glucose dropped significantly, mostly at the end of the fourth week of the exercise program.
In this study, increases in ABIs, the researchers say, imply enhanced oxygen supply to the extremities. During the fourth week, they found greater wound size reductions and the ABI significantly correlated with oxygen percentage saturation. The ankle brachial index may be a useful tool, the researchers suggest, for predicting improvement in oxygen percentage saturation.
The researchers’ findings lead them to recommend that nonweight bearing exercise be made a “cornerstone” of management for people with diabetic foot ulcers.
Source:
Nwankwo MJ, Okoye GC, Victor EA, Obinna EA. Int J Diabetes Res. 2014;3(3):41-48.
doi:10.5923/j.diabetes.20140303.03
Foot ulcers are a common complication of diabetes, due to macro- and microvascular changes that lead to neuropathy. But despite treatment with standard interventions such as debridement and pressure relief, many diabetic foot ulcers persist as nonhealing wounds, say researchers from Nnamdi Azidiwe University and University of Nigeria.
Oxygenation is key to keep the tissues healthy, the researchers say. We already know that exercise enhances blood circulation and improves vascular blood perfusion and capillary oxygen tension. However, little research has associated increased vascular blood perfusion with wound healing in diabetic foot ulcers, the researchers say. They reanalyzed results from 1 of their earlier studies to find out whether aerobic exercise would lead to healing.
In a 12-week program, 61 patients with type 1 or 2 diabetes mellitus were randomly assigned to an intervention or control group. Each patient had had a persistent ulcer of at least 1 cm2. The intervention group rode a bicycle ergometer at 60% of their maximum heart rate and progressed to 85%. The researchers tested them for oxygen percentage saturation and ankle brachial index (ABI) at baseline every 2 weeks.
At the end of the program, the researchers found a “sharp contrast” between the 2 groups, including a significant difference in the oxygen percentage saturation (99.00 vs 97.20) and the ABI. The reduction in wound size was also significant for the exercise group.
There is evidence, the researchers say, that exercise enhances blood circulation by lowering plasma glucose concentration. Normally, endothelial cells metabolize the circulating blood glucose—unless they are overwhelmed by glucose molecules during hyperglycemia. Previously, the researchers also noted that plasma glucose dropped significantly, mostly at the end of the fourth week of the exercise program.
In this study, increases in ABIs, the researchers say, imply enhanced oxygen supply to the extremities. During the fourth week, they found greater wound size reductions and the ABI significantly correlated with oxygen percentage saturation. The ankle brachial index may be a useful tool, the researchers suggest, for predicting improvement in oxygen percentage saturation.
The researchers’ findings lead them to recommend that nonweight bearing exercise be made a “cornerstone” of management for people with diabetic foot ulcers.
Source:
Nwankwo MJ, Okoye GC, Victor EA, Obinna EA. Int J Diabetes Res. 2014;3(3):41-48.
doi:10.5923/j.diabetes.20140303.03
Foot ulcers are a common complication of diabetes, due to macro- and microvascular changes that lead to neuropathy. But despite treatment with standard interventions such as debridement and pressure relief, many diabetic foot ulcers persist as nonhealing wounds, say researchers from Nnamdi Azidiwe University and University of Nigeria.
Oxygenation is key to keep the tissues healthy, the researchers say. We already know that exercise enhances blood circulation and improves vascular blood perfusion and capillary oxygen tension. However, little research has associated increased vascular blood perfusion with wound healing in diabetic foot ulcers, the researchers say. They reanalyzed results from 1 of their earlier studies to find out whether aerobic exercise would lead to healing.
In a 12-week program, 61 patients with type 1 or 2 diabetes mellitus were randomly assigned to an intervention or control group. Each patient had had a persistent ulcer of at least 1 cm2. The intervention group rode a bicycle ergometer at 60% of their maximum heart rate and progressed to 85%. The researchers tested them for oxygen percentage saturation and ankle brachial index (ABI) at baseline every 2 weeks.
At the end of the program, the researchers found a “sharp contrast” between the 2 groups, including a significant difference in the oxygen percentage saturation (99.00 vs 97.20) and the ABI. The reduction in wound size was also significant for the exercise group.
There is evidence, the researchers say, that exercise enhances blood circulation by lowering plasma glucose concentration. Normally, endothelial cells metabolize the circulating blood glucose—unless they are overwhelmed by glucose molecules during hyperglycemia. Previously, the researchers also noted that plasma glucose dropped significantly, mostly at the end of the fourth week of the exercise program.
In this study, increases in ABIs, the researchers say, imply enhanced oxygen supply to the extremities. During the fourth week, they found greater wound size reductions and the ABI significantly correlated with oxygen percentage saturation. The ankle brachial index may be a useful tool, the researchers suggest, for predicting improvement in oxygen percentage saturation.
The researchers’ findings lead them to recommend that nonweight bearing exercise be made a “cornerstone” of management for people with diabetic foot ulcers.
Source:
Nwankwo MJ, Okoye GC, Victor EA, Obinna EA. Int J Diabetes Res. 2014;3(3):41-48.
doi:10.5923/j.diabetes.20140303.03
Lifesaving future seen for electronic cigarettes
A switch from cigarettes to e-cigarettes has the potential to prevent almost 90,000 premature deaths in the United States in the year 2026, according to a study examining e-cigarette substitution scenarios.
The investigators’ “optimistic scenario” – in which new smokers use e-cigarettes instead of cigarettes, smoking prevalence falls to 5% over a 10-year period, and e-cigarettes have a 5% excess risk over regular cigarettes – projects 380,832 premature deaths from smoking in the year 2026. Under a “status quo scenario,” which projected current cigarette initiation and cessation rates and did not include e-cigarettes or other tobacco products, there would be 470,743 deaths, reported David T. Levy, PhD, and his associates (Tob Control. 2017 Oct 2. doi: 10.1136/tobaccocontrol-2017-053759).
Further projections suggest that the optimistic scenario could result in almost 6.6 million fewer premature deaths and 86.7 million years of life gained by the year 2100, compared with the status quo scenario, while the pessimistic scenario would prevent 1.6 million deaths and add an extra 20.8 million years of life, they noted.
Since “a strategy of replacing cigarette by e-cigarette use can yield substantial gains, even with conservative assumptions about related risks … an endgame scenario for cigarettes might well be within reach, if new technologies for delivering nicotine with substantially less harm, but sufficient satisfaction, are harnessed with sufficient passion and political will to aggressively phase out tobacco cigarettes,” Dr. Levy and his associates wrote.
The study was funded by grants from the National Institute on Drug Abuse and the National Cancer Institute. One investigator received a research grant from Pfizer and served as an advisory board member to Johnson & Johnson, which manufactures smoking cessation medications. No other conflicts of interest were declared.
A switch from cigarettes to e-cigarettes has the potential to prevent almost 90,000 premature deaths in the United States in the year 2026, according to a study examining e-cigarette substitution scenarios.
The investigators’ “optimistic scenario” – in which new smokers use e-cigarettes instead of cigarettes, smoking prevalence falls to 5% over a 10-year period, and e-cigarettes have a 5% excess risk over regular cigarettes – projects 380,832 premature deaths from smoking in the year 2026. Under a “status quo scenario,” which projected current cigarette initiation and cessation rates and did not include e-cigarettes or other tobacco products, there would be 470,743 deaths, reported David T. Levy, PhD, and his associates (Tob Control. 2017 Oct 2. doi: 10.1136/tobaccocontrol-2017-053759).
Further projections suggest that the optimistic scenario could result in almost 6.6 million fewer premature deaths and 86.7 million years of life gained by the year 2100, compared with the status quo scenario, while the pessimistic scenario would prevent 1.6 million deaths and add an extra 20.8 million years of life, they noted.
Since “a strategy of replacing cigarette by e-cigarette use can yield substantial gains, even with conservative assumptions about related risks … an endgame scenario for cigarettes might well be within reach, if new technologies for delivering nicotine with substantially less harm, but sufficient satisfaction, are harnessed with sufficient passion and political will to aggressively phase out tobacco cigarettes,” Dr. Levy and his associates wrote.
The study was funded by grants from the National Institute on Drug Abuse and the National Cancer Institute. One investigator received a research grant from Pfizer and served as an advisory board member to Johnson & Johnson, which manufactures smoking cessation medications. No other conflicts of interest were declared.
A switch from cigarettes to e-cigarettes has the potential to prevent almost 90,000 premature deaths in the United States in the year 2026, according to a study examining e-cigarette substitution scenarios.
The investigators’ “optimistic scenario” – in which new smokers use e-cigarettes instead of cigarettes, smoking prevalence falls to 5% over a 10-year period, and e-cigarettes have a 5% excess risk over regular cigarettes – projects 380,832 premature deaths from smoking in the year 2026. Under a “status quo scenario,” which projected current cigarette initiation and cessation rates and did not include e-cigarettes or other tobacco products, there would be 470,743 deaths, reported David T. Levy, PhD, and his associates (Tob Control. 2017 Oct 2. doi: 10.1136/tobaccocontrol-2017-053759).
Further projections suggest that the optimistic scenario could result in almost 6.6 million fewer premature deaths and 86.7 million years of life gained by the year 2100, compared with the status quo scenario, while the pessimistic scenario would prevent 1.6 million deaths and add an extra 20.8 million years of life, they noted.
Since “a strategy of replacing cigarette by e-cigarette use can yield substantial gains, even with conservative assumptions about related risks … an endgame scenario for cigarettes might well be within reach, if new technologies for delivering nicotine with substantially less harm, but sufficient satisfaction, are harnessed with sufficient passion and political will to aggressively phase out tobacco cigarettes,” Dr. Levy and his associates wrote.
The study was funded by grants from the National Institute on Drug Abuse and the National Cancer Institute. One investigator received a research grant from Pfizer and served as an advisory board member to Johnson & Johnson, which manufactures smoking cessation medications. No other conflicts of interest were declared.
FROM TOBACCO CONTROL
Increase in Kids Who Are Getting the HPV Vaccine
The HPV vaccine has led to “dramatic declines” in HPV infections, according to the CDC. Since the first HPV vaccine was introduced 10 years ago, the percentage of infections that cause cancers and genital warts has dropped by 71% among teenage girls and 61% among young women. According to the annual National Immunization Survey-Teen report, 60% of teens aged 13 to 17 years received ≥ 1 doses of HPV vaccine in 2016, up 4 percentage points from 2015.
More boys are getting the vaccine, too. About 56% of boys received their first dose (although that is still less than the 65% seen in girls)—representing a 6% increase from 2015; rates for girls remained stable.
As encouraging as those numbers are, there is more work to do, the CDC says. Although most adolescents have received the first dose, only 43% are up-to-date on all the recommended doses. The CDC recommends that 11- to 12-year-olds get 2 doses of HPV vaccine at least 6 months apart. The CDC updated its HPV vaccine recommendations in 2016 when new evidence showed that 2 doses of the vaccine provided levels of protection similar to those seen for 3 doses in older adolescents and young adults.
Parents can get the vaccine for their child during any doctor’s visit, but the CDC recommends that adolescents get the HPV vaccine during the same visit that they get whooping cough and meningitis vaccine.
The HPV vaccine has led to “dramatic declines” in HPV infections, according to the CDC. Since the first HPV vaccine was introduced 10 years ago, the percentage of infections that cause cancers and genital warts has dropped by 71% among teenage girls and 61% among young women. According to the annual National Immunization Survey-Teen report, 60% of teens aged 13 to 17 years received ≥ 1 doses of HPV vaccine in 2016, up 4 percentage points from 2015.
More boys are getting the vaccine, too. About 56% of boys received their first dose (although that is still less than the 65% seen in girls)—representing a 6% increase from 2015; rates for girls remained stable.
As encouraging as those numbers are, there is more work to do, the CDC says. Although most adolescents have received the first dose, only 43% are up-to-date on all the recommended doses. The CDC recommends that 11- to 12-year-olds get 2 doses of HPV vaccine at least 6 months apart. The CDC updated its HPV vaccine recommendations in 2016 when new evidence showed that 2 doses of the vaccine provided levels of protection similar to those seen for 3 doses in older adolescents and young adults.
Parents can get the vaccine for their child during any doctor’s visit, but the CDC recommends that adolescents get the HPV vaccine during the same visit that they get whooping cough and meningitis vaccine.
The HPV vaccine has led to “dramatic declines” in HPV infections, according to the CDC. Since the first HPV vaccine was introduced 10 years ago, the percentage of infections that cause cancers and genital warts has dropped by 71% among teenage girls and 61% among young women. According to the annual National Immunization Survey-Teen report, 60% of teens aged 13 to 17 years received ≥ 1 doses of HPV vaccine in 2016, up 4 percentage points from 2015.
More boys are getting the vaccine, too. About 56% of boys received their first dose (although that is still less than the 65% seen in girls)—representing a 6% increase from 2015; rates for girls remained stable.
As encouraging as those numbers are, there is more work to do, the CDC says. Although most adolescents have received the first dose, only 43% are up-to-date on all the recommended doses. The CDC recommends that 11- to 12-year-olds get 2 doses of HPV vaccine at least 6 months apart. The CDC updated its HPV vaccine recommendations in 2016 when new evidence showed that 2 doses of the vaccine provided levels of protection similar to those seen for 3 doses in older adolescents and young adults.
Parents can get the vaccine for their child during any doctor’s visit, but the CDC recommends that adolescents get the HPV vaccine during the same visit that they get whooping cough and meningitis vaccine.
Smoking and Food Insecurity: How to Solve a Dual Challenge?
Smoking and poor nutrition—2 of the leading preventable causes of death—are reciprocally linked in many ways, multiplying the public health challenges. For instance, smokers are less likely to eat healthful foods and food insecurity is independently associated with smoking. Researchers from the University at Albany, State University of New York, who conducted both a health interview survey and a food environment assessment with 1,917 adults, found that each indicator of food distress was significantly associated with current smoking. Respondents who consumed ≤ 1 serving of fruits and vegetables per day had significantly higher odds of current smoking, compared with those who consumed ≥ 5 servings. Similarly, the odds of current smoking were significantly higher among respondents who were food insecure, used a food pantry, and received Supplemental Nutrition Assistance Program benefits. Living in a neighborhood with low access to healthful food doubled the prevalence of smoking.
Respondents shopped for food often at a corner store (convenience store), dollar store, or drug store. That highlights one of the challenges: All the convenience stores, drug stores, and about 63% of the dollar stores also were tobacco retailers, and nearly all of those had tobacco advertising.
The researchers note that research on the link between smoking and food distress is “limited.” A common explanation for it, they say, is the “opportunity cost” argument. Smokers spend up to 24% of their income on cigarettes—leaving less money for food. Other research also has found that smokers tend to have less appetite than do nonsmokers (smoking may alter hunger-satiety sensation). On the other hand, chronic hunger, imbalanced diet and not having enough money to buy adequate food naturally may cause stress and anxiety and can increase dependence on nicotine. Moreover, food-insecure people may smoke to suppress hunger.
The researchers suggest ways to help solve the problem. One would be to disseminate smoking-related educational materials in food pantries and other community nutrition assistance resources. Another would be to prioritize smoking-cessation interventions for stores in “food deserts.” Only a few policy-based interventions exist, the researchers say. They point to a California city that enacted a citywide “healthy corner store” policy that rewards local small business for offering healthful foods and imposes tobacco-control measures, such as eliminating visible tobacco displays at checkout counters.
Smoking and poor nutrition—2 of the leading preventable causes of death—are reciprocally linked in many ways, multiplying the public health challenges. For instance, smokers are less likely to eat healthful foods and food insecurity is independently associated with smoking. Researchers from the University at Albany, State University of New York, who conducted both a health interview survey and a food environment assessment with 1,917 adults, found that each indicator of food distress was significantly associated with current smoking. Respondents who consumed ≤ 1 serving of fruits and vegetables per day had significantly higher odds of current smoking, compared with those who consumed ≥ 5 servings. Similarly, the odds of current smoking were significantly higher among respondents who were food insecure, used a food pantry, and received Supplemental Nutrition Assistance Program benefits. Living in a neighborhood with low access to healthful food doubled the prevalence of smoking.
Respondents shopped for food often at a corner store (convenience store), dollar store, or drug store. That highlights one of the challenges: All the convenience stores, drug stores, and about 63% of the dollar stores also were tobacco retailers, and nearly all of those had tobacco advertising.
The researchers note that research on the link between smoking and food distress is “limited.” A common explanation for it, they say, is the “opportunity cost” argument. Smokers spend up to 24% of their income on cigarettes—leaving less money for food. Other research also has found that smokers tend to have less appetite than do nonsmokers (smoking may alter hunger-satiety sensation). On the other hand, chronic hunger, imbalanced diet and not having enough money to buy adequate food naturally may cause stress and anxiety and can increase dependence on nicotine. Moreover, food-insecure people may smoke to suppress hunger.
The researchers suggest ways to help solve the problem. One would be to disseminate smoking-related educational materials in food pantries and other community nutrition assistance resources. Another would be to prioritize smoking-cessation interventions for stores in “food deserts.” Only a few policy-based interventions exist, the researchers say. They point to a California city that enacted a citywide “healthy corner store” policy that rewards local small business for offering healthful foods and imposes tobacco-control measures, such as eliminating visible tobacco displays at checkout counters.
Smoking and poor nutrition—2 of the leading preventable causes of death—are reciprocally linked in many ways, multiplying the public health challenges. For instance, smokers are less likely to eat healthful foods and food insecurity is independently associated with smoking. Researchers from the University at Albany, State University of New York, who conducted both a health interview survey and a food environment assessment with 1,917 adults, found that each indicator of food distress was significantly associated with current smoking. Respondents who consumed ≤ 1 serving of fruits and vegetables per day had significantly higher odds of current smoking, compared with those who consumed ≥ 5 servings. Similarly, the odds of current smoking were significantly higher among respondents who were food insecure, used a food pantry, and received Supplemental Nutrition Assistance Program benefits. Living in a neighborhood with low access to healthful food doubled the prevalence of smoking.
Respondents shopped for food often at a corner store (convenience store), dollar store, or drug store. That highlights one of the challenges: All the convenience stores, drug stores, and about 63% of the dollar stores also were tobacco retailers, and nearly all of those had tobacco advertising.
The researchers note that research on the link between smoking and food distress is “limited.” A common explanation for it, they say, is the “opportunity cost” argument. Smokers spend up to 24% of their income on cigarettes—leaving less money for food. Other research also has found that smokers tend to have less appetite than do nonsmokers (smoking may alter hunger-satiety sensation). On the other hand, chronic hunger, imbalanced diet and not having enough money to buy adequate food naturally may cause stress and anxiety and can increase dependence on nicotine. Moreover, food-insecure people may smoke to suppress hunger.
The researchers suggest ways to help solve the problem. One would be to disseminate smoking-related educational materials in food pantries and other community nutrition assistance resources. Another would be to prioritize smoking-cessation interventions for stores in “food deserts.” Only a few policy-based interventions exist, the researchers say. They point to a California city that enacted a citywide “healthy corner store” policy that rewards local small business for offering healthful foods and imposes tobacco-control measures, such as eliminating visible tobacco displays at checkout counters.
Just over half of pregnant women got flu vaccine in 2016-2017
Influenza vaccination among pregnant women during the 2016-2017 flu season was slightly higher than during the 2015-2016 season, according to the Centers for Disease Control and Prevention.
Overall coverage for 2016-2017 was 53.6% among pregnant women, compared with 49.9% in 2015-2016, continuing the overall rise seen over the last several flu seasons. Among pregnant women who received a recommendation from a health care provider and were offered vaccination, coverage was 70.5% in 2016-2017, while coverage was 43.7% among women who received a recommendation but no offer and 14.8% among those who did not receive a recommendation, the CDC reported (MMWR. 2017 Sep 29;66[38]:1016-22).
Among other subgroups, coverage by age for the 2016-2017 flu season was 41.7% for those aged 18-24 years, 58.4% for those aged 25-34 years, and 58.5% for those 35-49 years old. There also was considerable variation by race/ethnicity, with coverage at 61.2% for Hispanics, 55.4% for whites, 42.3% for blacks, and 51.7% for others. Coverage for the subgroups corresponded with the rates at which vaccination was recommended: Younger women were less likely than older women to receive a recommendation, and Hispanic and white women more likely to receive recommendations than did blacks and other races/ethnicities, the CDC said.
The 2017 data include 1,893 responses to an Internet panel survey conducted from March 28 to April 7, 2017. The analysis of the 2016 panel survey, which was conducted from March 29 to April 7, 2016, included responses from 1,692 women.
Influenza vaccination among pregnant women during the 2016-2017 flu season was slightly higher than during the 2015-2016 season, according to the Centers for Disease Control and Prevention.
Overall coverage for 2016-2017 was 53.6% among pregnant women, compared with 49.9% in 2015-2016, continuing the overall rise seen over the last several flu seasons. Among pregnant women who received a recommendation from a health care provider and were offered vaccination, coverage was 70.5% in 2016-2017, while coverage was 43.7% among women who received a recommendation but no offer and 14.8% among those who did not receive a recommendation, the CDC reported (MMWR. 2017 Sep 29;66[38]:1016-22).
Among other subgroups, coverage by age for the 2016-2017 flu season was 41.7% for those aged 18-24 years, 58.4% for those aged 25-34 years, and 58.5% for those 35-49 years old. There also was considerable variation by race/ethnicity, with coverage at 61.2% for Hispanics, 55.4% for whites, 42.3% for blacks, and 51.7% for others. Coverage for the subgroups corresponded with the rates at which vaccination was recommended: Younger women were less likely than older women to receive a recommendation, and Hispanic and white women more likely to receive recommendations than did blacks and other races/ethnicities, the CDC said.
The 2017 data include 1,893 responses to an Internet panel survey conducted from March 28 to April 7, 2017. The analysis of the 2016 panel survey, which was conducted from March 29 to April 7, 2016, included responses from 1,692 women.
Influenza vaccination among pregnant women during the 2016-2017 flu season was slightly higher than during the 2015-2016 season, according to the Centers for Disease Control and Prevention.
Overall coverage for 2016-2017 was 53.6% among pregnant women, compared with 49.9% in 2015-2016, continuing the overall rise seen over the last several flu seasons. Among pregnant women who received a recommendation from a health care provider and were offered vaccination, coverage was 70.5% in 2016-2017, while coverage was 43.7% among women who received a recommendation but no offer and 14.8% among those who did not receive a recommendation, the CDC reported (MMWR. 2017 Sep 29;66[38]:1016-22).
Among other subgroups, coverage by age for the 2016-2017 flu season was 41.7% for those aged 18-24 years, 58.4% for those aged 25-34 years, and 58.5% for those 35-49 years old. There also was considerable variation by race/ethnicity, with coverage at 61.2% for Hispanics, 55.4% for whites, 42.3% for blacks, and 51.7% for others. Coverage for the subgroups corresponded with the rates at which vaccination was recommended: Younger women were less likely than older women to receive a recommendation, and Hispanic and white women more likely to receive recommendations than did blacks and other races/ethnicities, the CDC said.
The 2017 data include 1,893 responses to an Internet panel survey conducted from March 28 to April 7, 2017. The analysis of the 2016 panel survey, which was conducted from March 29 to April 7, 2016, included responses from 1,692 women.
FROM MMWR
Clinicians: Be clear about flu vaccine’s value
WASHINGTON – Flu vaccination rates remain below the 70% Healthy People 2020 goal for most of the U.S. population, but data show that a recommendation from a clinician can encourage individuals to get vaccinated and to vaccinate their children, according to a panel of experts who spoke at a press briefing sponsored by the National Foundation for Infectious Diseases.
“Annual vaccination is our first line of defense against the flu,” William Schaffner, MD, of Vanderbilt University, Nashville, Tenn., said at the briefing. The unpredictable nature of the flu makes annual vaccination even more important – and the earlier, the better, said Dr. Schaffner. “If you have seen one flu season, you have seen ... one flu season.”
In a video interview at the briefing, experts emphasized the safety and effectiveness of the flu vaccine for a range of populations, including children, pregnant women, and older adults. And they offered tips to convince patients of the importance of vaccination, as well as the need to make sure health care staff are protected.
Briefing participants included former Department of Health and Human Services Secretary Thomas A. Price, MD; Patricia A. Stinchfield, RN, MS, CPNP, CIC of Children’s Hospitals and Clinics of Minnesota, St. Paul; Kathleen M. Neuzil, MD, of the University of Maryland; and Daniel B. Jernigan, MD, of the Centers for Disease Control and Prevention.
The clinicians interviewed had no financial conflicts to disclose.
WASHINGTON – Flu vaccination rates remain below the 70% Healthy People 2020 goal for most of the U.S. population, but data show that a recommendation from a clinician can encourage individuals to get vaccinated and to vaccinate their children, according to a panel of experts who spoke at a press briefing sponsored by the National Foundation for Infectious Diseases.
“Annual vaccination is our first line of defense against the flu,” William Schaffner, MD, of Vanderbilt University, Nashville, Tenn., said at the briefing. The unpredictable nature of the flu makes annual vaccination even more important – and the earlier, the better, said Dr. Schaffner. “If you have seen one flu season, you have seen ... one flu season.”
In a video interview at the briefing, experts emphasized the safety and effectiveness of the flu vaccine for a range of populations, including children, pregnant women, and older adults. And they offered tips to convince patients of the importance of vaccination, as well as the need to make sure health care staff are protected.
Briefing participants included former Department of Health and Human Services Secretary Thomas A. Price, MD; Patricia A. Stinchfield, RN, MS, CPNP, CIC of Children’s Hospitals and Clinics of Minnesota, St. Paul; Kathleen M. Neuzil, MD, of the University of Maryland; and Daniel B. Jernigan, MD, of the Centers for Disease Control and Prevention.
The clinicians interviewed had no financial conflicts to disclose.
WASHINGTON – Flu vaccination rates remain below the 70% Healthy People 2020 goal for most of the U.S. population, but data show that a recommendation from a clinician can encourage individuals to get vaccinated and to vaccinate their children, according to a panel of experts who spoke at a press briefing sponsored by the National Foundation for Infectious Diseases.
“Annual vaccination is our first line of defense against the flu,” William Schaffner, MD, of Vanderbilt University, Nashville, Tenn., said at the briefing. The unpredictable nature of the flu makes annual vaccination even more important – and the earlier, the better, said Dr. Schaffner. “If you have seen one flu season, you have seen ... one flu season.”
In a video interview at the briefing, experts emphasized the safety and effectiveness of the flu vaccine for a range of populations, including children, pregnant women, and older adults. And they offered tips to convince patients of the importance of vaccination, as well as the need to make sure health care staff are protected.
Briefing participants included former Department of Health and Human Services Secretary Thomas A. Price, MD; Patricia A. Stinchfield, RN, MS, CPNP, CIC of Children’s Hospitals and Clinics of Minnesota, St. Paul; Kathleen M. Neuzil, MD, of the University of Maryland; and Daniel B. Jernigan, MD, of the Centers for Disease Control and Prevention.
The clinicians interviewed had no financial conflicts to disclose.
AT A PRESS BRIEFING BY THE NATIONAL FOUNDATION FOR INFECTIOUS DISEASES
