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Benralizumab approved for eosinophilic asthma
This is the only respiratory biologic to provide fast and “near-complete depletion of eosinophils within 24 hours,” according to the statement from AstraZeneca.
Similar adverse events were seen in patients who took benralizumab and the placebo. AstraZeneca will market benralizumab under the trade name Fasenra.
“This is an important day for severe, eosinophilic asthma patients who have had limited treatment options for far too long,” said Eugene Bleecker, MD, professor and codirector of genetics, genomics, and precision medicine at the University of Arizona in Tucson, in the statement.
This is the only respiratory biologic to provide fast and “near-complete depletion of eosinophils within 24 hours,” according to the statement from AstraZeneca.
Similar adverse events were seen in patients who took benralizumab and the placebo. AstraZeneca will market benralizumab under the trade name Fasenra.
“This is an important day for severe, eosinophilic asthma patients who have had limited treatment options for far too long,” said Eugene Bleecker, MD, professor and codirector of genetics, genomics, and precision medicine at the University of Arizona in Tucson, in the statement.
This is the only respiratory biologic to provide fast and “near-complete depletion of eosinophils within 24 hours,” according to the statement from AstraZeneca.
Similar adverse events were seen in patients who took benralizumab and the placebo. AstraZeneca will market benralizumab under the trade name Fasenra.
“This is an important day for severe, eosinophilic asthma patients who have had limited treatment options for far too long,” said Eugene Bleecker, MD, professor and codirector of genetics, genomics, and precision medicine at the University of Arizona in Tucson, in the statement.
Pilot study finds a more diverse microbiome in preadolescents with acne, compared with controls
The skin microbiome in preadolescents with acne was more diverse than that of controls, and showed some differences from what is known about the microbiome in adults with acne, in a prospective pilot study.
The results have possible treatment implications, suggesting that preadolescents may require a different treatment approach than adults, although additional, larger studies are needed, according to Carrie C. Coughlin, MD, of the division of dermatology in the departments of medicine and pediatrics at Washington University in St. Louis, and her coauthors (Pediatr Dermatol. 2017 Oct 11. doi: 10.1111/pde.13261).
The study enrolled 13 children aged 7-10 years: 5 with acne (3 randomized to treatment with benzoyl peroxide 5% gel or cream and 2 to treatment with tretinoin 0.025% cream), treated for 7-10 weeks; and 8 controls, matched for sex and age.
At baseline, microbiome samples of facial and retroauricular skin among the controls with no acne showed that Streptococcus “was the genus present in highest relative abundance, followed by Propionibacterium,” the authors wrote. In addition to high levels of Streptococcus, those with acne also “had more Staphylococcus and Propionibacterium than controls at all sites before treatment.”
Among those with acne, average Comprehensive Acne Severity Scale values at baseline were 1.3-1.4, among those with acne, dropping to an average of 1 with treatment, which was not statistically significant at follow-up.
But among those with acne, the diversity of cutaneous bacteria decreased with both treatments, down to levels similar to controls, which was a significant effect (P less than .001). This was a “notable” finding, they wrote, “because benzoyl peroxide and tretinoin are known as comedolytic, but tretinoin is not typically thought of as having antibacterial properties like benzoyl peroxide.”
This observation “suggests that topical retinoids may have an effect on the local microbiome through alterations in the cutaneous microenvironment rather than having direct effects on resident microorganisms,” they added.
The authors also pointed out that in the microbiome of adults with acne, Propionibacterium has been found to be more prevalent, indicating that different treatments may be indicated in preadolescents.
The study was funded with a clinical research grant from the American Acne and Rosacea Society.
Recent work has highlighted distinct differences in the cutaneous microbiota of acne sufferers versus those who tend not to “break out,” specifically, decreased bacterial diversity, increased Propionibacterium acnes and Staphylococcus aureus, and importantly, specific ribotypes of P. acnes (not all P. acnes is created equal in the eyes of acne vulgaris). There are also emerging data highlighting the impact of both topical and systemic acne medications on this altered bacterial community, though the significance of such changes has yet to be determined. However, these findings are predominantly derived from the adult population, and just as pediatric skin is not just little adult skin, acne can be morphologically different in this population. And no question, the microbiota here is different from adults.
In their pilot study, Coughlin et al. set out to evaluate the alterations in cutaneous microbiota in adolescents with acne versus healthy controls. Interestingly, as opposed to adults, adolescent acne sufferers have greater bacterial diversity, with a high predominance of streptococcus in addition to P. acnes and S. aureus. No surprise, benzoyl peroxide brought diversity down as it is “-cidal” to everything (even our cells).
While a small sample size, two big questions emerge from this study: Why does bacterial diversity increase in pediatric acne patients but decreases in adults with acne? And what is the significance of streptococcus in pediatric acne? Certainly, the clinical morphology of pediatric acne (more comedonal as per the authors) is different than that of adult female acne (cystic and clinically inflamed nodules), for example. Do specific alterations in the skin microbiome directly impact lesion type? We shall see.
Adam Friedman, MD, is residency program director, and director of translational research, in the department of dermatology, George Washington University, Washington. He had no relevant disclosures. Dr. Friedman is a member of the Dermatology News editorial board.
Recent work has highlighted distinct differences in the cutaneous microbiota of acne sufferers versus those who tend not to “break out,” specifically, decreased bacterial diversity, increased Propionibacterium acnes and Staphylococcus aureus, and importantly, specific ribotypes of P. acnes (not all P. acnes is created equal in the eyes of acne vulgaris). There are also emerging data highlighting the impact of both topical and systemic acne medications on this altered bacterial community, though the significance of such changes has yet to be determined. However, these findings are predominantly derived from the adult population, and just as pediatric skin is not just little adult skin, acne can be morphologically different in this population. And no question, the microbiota here is different from adults.
In their pilot study, Coughlin et al. set out to evaluate the alterations in cutaneous microbiota in adolescents with acne versus healthy controls. Interestingly, as opposed to adults, adolescent acne sufferers have greater bacterial diversity, with a high predominance of streptococcus in addition to P. acnes and S. aureus. No surprise, benzoyl peroxide brought diversity down as it is “-cidal” to everything (even our cells).
While a small sample size, two big questions emerge from this study: Why does bacterial diversity increase in pediatric acne patients but decreases in adults with acne? And what is the significance of streptococcus in pediatric acne? Certainly, the clinical morphology of pediatric acne (more comedonal as per the authors) is different than that of adult female acne (cystic and clinically inflamed nodules), for example. Do specific alterations in the skin microbiome directly impact lesion type? We shall see.
Adam Friedman, MD, is residency program director, and director of translational research, in the department of dermatology, George Washington University, Washington. He had no relevant disclosures. Dr. Friedman is a member of the Dermatology News editorial board.
Recent work has highlighted distinct differences in the cutaneous microbiota of acne sufferers versus those who tend not to “break out,” specifically, decreased bacterial diversity, increased Propionibacterium acnes and Staphylococcus aureus, and importantly, specific ribotypes of P. acnes (not all P. acnes is created equal in the eyes of acne vulgaris). There are also emerging data highlighting the impact of both topical and systemic acne medications on this altered bacterial community, though the significance of such changes has yet to be determined. However, these findings are predominantly derived from the adult population, and just as pediatric skin is not just little adult skin, acne can be morphologically different in this population. And no question, the microbiota here is different from adults.
In their pilot study, Coughlin et al. set out to evaluate the alterations in cutaneous microbiota in adolescents with acne versus healthy controls. Interestingly, as opposed to adults, adolescent acne sufferers have greater bacterial diversity, with a high predominance of streptococcus in addition to P. acnes and S. aureus. No surprise, benzoyl peroxide brought diversity down as it is “-cidal” to everything (even our cells).
While a small sample size, two big questions emerge from this study: Why does bacterial diversity increase in pediatric acne patients but decreases in adults with acne? And what is the significance of streptococcus in pediatric acne? Certainly, the clinical morphology of pediatric acne (more comedonal as per the authors) is different than that of adult female acne (cystic and clinically inflamed nodules), for example. Do specific alterations in the skin microbiome directly impact lesion type? We shall see.
Adam Friedman, MD, is residency program director, and director of translational research, in the department of dermatology, George Washington University, Washington. He had no relevant disclosures. Dr. Friedman is a member of the Dermatology News editorial board.
The skin microbiome in preadolescents with acne was more diverse than that of controls, and showed some differences from what is known about the microbiome in adults with acne, in a prospective pilot study.
The results have possible treatment implications, suggesting that preadolescents may require a different treatment approach than adults, although additional, larger studies are needed, according to Carrie C. Coughlin, MD, of the division of dermatology in the departments of medicine and pediatrics at Washington University in St. Louis, and her coauthors (Pediatr Dermatol. 2017 Oct 11. doi: 10.1111/pde.13261).
The study enrolled 13 children aged 7-10 years: 5 with acne (3 randomized to treatment with benzoyl peroxide 5% gel or cream and 2 to treatment with tretinoin 0.025% cream), treated for 7-10 weeks; and 8 controls, matched for sex and age.
At baseline, microbiome samples of facial and retroauricular skin among the controls with no acne showed that Streptococcus “was the genus present in highest relative abundance, followed by Propionibacterium,” the authors wrote. In addition to high levels of Streptococcus, those with acne also “had more Staphylococcus and Propionibacterium than controls at all sites before treatment.”
Among those with acne, average Comprehensive Acne Severity Scale values at baseline were 1.3-1.4, among those with acne, dropping to an average of 1 with treatment, which was not statistically significant at follow-up.
But among those with acne, the diversity of cutaneous bacteria decreased with both treatments, down to levels similar to controls, which was a significant effect (P less than .001). This was a “notable” finding, they wrote, “because benzoyl peroxide and tretinoin are known as comedolytic, but tretinoin is not typically thought of as having antibacterial properties like benzoyl peroxide.”
This observation “suggests that topical retinoids may have an effect on the local microbiome through alterations in the cutaneous microenvironment rather than having direct effects on resident microorganisms,” they added.
The authors also pointed out that in the microbiome of adults with acne, Propionibacterium has been found to be more prevalent, indicating that different treatments may be indicated in preadolescents.
The study was funded with a clinical research grant from the American Acne and Rosacea Society.
The skin microbiome in preadolescents with acne was more diverse than that of controls, and showed some differences from what is known about the microbiome in adults with acne, in a prospective pilot study.
The results have possible treatment implications, suggesting that preadolescents may require a different treatment approach than adults, although additional, larger studies are needed, according to Carrie C. Coughlin, MD, of the division of dermatology in the departments of medicine and pediatrics at Washington University in St. Louis, and her coauthors (Pediatr Dermatol. 2017 Oct 11. doi: 10.1111/pde.13261).
The study enrolled 13 children aged 7-10 years: 5 with acne (3 randomized to treatment with benzoyl peroxide 5% gel or cream and 2 to treatment with tretinoin 0.025% cream), treated for 7-10 weeks; and 8 controls, matched for sex and age.
At baseline, microbiome samples of facial and retroauricular skin among the controls with no acne showed that Streptococcus “was the genus present in highest relative abundance, followed by Propionibacterium,” the authors wrote. In addition to high levels of Streptococcus, those with acne also “had more Staphylococcus and Propionibacterium than controls at all sites before treatment.”
Among those with acne, average Comprehensive Acne Severity Scale values at baseline were 1.3-1.4, among those with acne, dropping to an average of 1 with treatment, which was not statistically significant at follow-up.
But among those with acne, the diversity of cutaneous bacteria decreased with both treatments, down to levels similar to controls, which was a significant effect (P less than .001). This was a “notable” finding, they wrote, “because benzoyl peroxide and tretinoin are known as comedolytic, but tretinoin is not typically thought of as having antibacterial properties like benzoyl peroxide.”
This observation “suggests that topical retinoids may have an effect on the local microbiome through alterations in the cutaneous microenvironment rather than having direct effects on resident microorganisms,” they added.
The authors also pointed out that in the microbiome of adults with acne, Propionibacterium has been found to be more prevalent, indicating that different treatments may be indicated in preadolescents.
The study was funded with a clinical research grant from the American Acne and Rosacea Society.
FROM PEDIATRIC DERMATOLOGY
Key clinical point:
Major finding: The skin microbiome was more diverse among preadolescents with acne, compared with age-matched controls without acne, and Streptococcus was the predominant bacterium.
Data source: A prospective randomized pilot study that evaluated the skin microbiome of five preadolescents with acne, before and after treatment, and eight without acne.
Disclosures: The study was supported with a grant from the American Acne and Rosacea Society.
Early referral recommended for high-risk port-wine stain cases
In high-risk port-wine stain phenotypes – forehead, hemifacial, and median – early referral to a pediatric neurologist is the best way to enable early symptom recognition of Sturge-Weber syndrome (SWS), according to results of a literature review.
If imaging is desired, electroencephalography (EEG) is cheaper and more minimally invasive than MRI (Pediatr Dermatol. 2017 Oct 16. doi: 10.1111/pde.13304).
Of the 34 studies analyzed, none examined the correlation between early detection of presymptomatic SWS and earlier seizure detection. There were also no data to verify improved outcomes with early detection, Michaela Zallmann, MD, of the department of dermatology at Eastern Health, Monash University, Box Hill, Australia, and her coauthors reported. While this indicates a need for further studies, it also shows a need for improved education and clinical monitoring as standard practice.
Additionally, negative imaging results do not obviate the possibility of SWS diagnosis, the investigators reported. In the studies that recorded false negatives, MRI was negative in 3%-6% of infants who later became symptomatic. Of the seven infants with false-negative results, four were less than 6 months old when the initial imaging was conducted. The investigators noted that it is not known at what age a negative MRI can reliably exclude SWS.
When imaging was used for early detection, EEG was shown to be safer and less expensive than MRI, according to the review. Of children who were not anesthetized for MRI, 30%-50% showed considerable distress, while EEG was shown to be minimally invasive. Findings from a retrospective chart review show that 14 MRIs were performed to detect one asymptomatic case of SWS, costing $11,768. In comparison, EEG costs $87 for a routine outpatient study.
“Demonstrating brain involvement on MRI in infants with high-risk PWS may facilitate more stringent counseling and monitoring, but … a negative MRI does not obviate the need for neurologic counseling and monitoring,” the investigators wrote. “Allaying anxiety about diagnostic uncertainty is not achieved using a scan but through detailed education, appropriate clinical monitoring, and nuanced reassurance.”
The investigators did not report any financial disclosures.
In high-risk port-wine stain phenotypes – forehead, hemifacial, and median – early referral to a pediatric neurologist is the best way to enable early symptom recognition of Sturge-Weber syndrome (SWS), according to results of a literature review.
If imaging is desired, electroencephalography (EEG) is cheaper and more minimally invasive than MRI (Pediatr Dermatol. 2017 Oct 16. doi: 10.1111/pde.13304).
Of the 34 studies analyzed, none examined the correlation between early detection of presymptomatic SWS and earlier seizure detection. There were also no data to verify improved outcomes with early detection, Michaela Zallmann, MD, of the department of dermatology at Eastern Health, Monash University, Box Hill, Australia, and her coauthors reported. While this indicates a need for further studies, it also shows a need for improved education and clinical monitoring as standard practice.
Additionally, negative imaging results do not obviate the possibility of SWS diagnosis, the investigators reported. In the studies that recorded false negatives, MRI was negative in 3%-6% of infants who later became symptomatic. Of the seven infants with false-negative results, four were less than 6 months old when the initial imaging was conducted. The investigators noted that it is not known at what age a negative MRI can reliably exclude SWS.
When imaging was used for early detection, EEG was shown to be safer and less expensive than MRI, according to the review. Of children who were not anesthetized for MRI, 30%-50% showed considerable distress, while EEG was shown to be minimally invasive. Findings from a retrospective chart review show that 14 MRIs were performed to detect one asymptomatic case of SWS, costing $11,768. In comparison, EEG costs $87 for a routine outpatient study.
“Demonstrating brain involvement on MRI in infants with high-risk PWS may facilitate more stringent counseling and monitoring, but … a negative MRI does not obviate the need for neurologic counseling and monitoring,” the investigators wrote. “Allaying anxiety about diagnostic uncertainty is not achieved using a scan but through detailed education, appropriate clinical monitoring, and nuanced reassurance.”
The investigators did not report any financial disclosures.
In high-risk port-wine stain phenotypes – forehead, hemifacial, and median – early referral to a pediatric neurologist is the best way to enable early symptom recognition of Sturge-Weber syndrome (SWS), according to results of a literature review.
If imaging is desired, electroencephalography (EEG) is cheaper and more minimally invasive than MRI (Pediatr Dermatol. 2017 Oct 16. doi: 10.1111/pde.13304).
Of the 34 studies analyzed, none examined the correlation between early detection of presymptomatic SWS and earlier seizure detection. There were also no data to verify improved outcomes with early detection, Michaela Zallmann, MD, of the department of dermatology at Eastern Health, Monash University, Box Hill, Australia, and her coauthors reported. While this indicates a need for further studies, it also shows a need for improved education and clinical monitoring as standard practice.
Additionally, negative imaging results do not obviate the possibility of SWS diagnosis, the investigators reported. In the studies that recorded false negatives, MRI was negative in 3%-6% of infants who later became symptomatic. Of the seven infants with false-negative results, four were less than 6 months old when the initial imaging was conducted. The investigators noted that it is not known at what age a negative MRI can reliably exclude SWS.
When imaging was used for early detection, EEG was shown to be safer and less expensive than MRI, according to the review. Of children who were not anesthetized for MRI, 30%-50% showed considerable distress, while EEG was shown to be minimally invasive. Findings from a retrospective chart review show that 14 MRIs were performed to detect one asymptomatic case of SWS, costing $11,768. In comparison, EEG costs $87 for a routine outpatient study.
“Demonstrating brain involvement on MRI in infants with high-risk PWS may facilitate more stringent counseling and monitoring, but … a negative MRI does not obviate the need for neurologic counseling and monitoring,” the investigators wrote. “Allaying anxiety about diagnostic uncertainty is not achieved using a scan but through detailed education, appropriate clinical monitoring, and nuanced reassurance.”
The investigators did not report any financial disclosures.
Key clinical point:
Major finding: To identify one case of Sturge-Weber syndrome, MRI cost $11,768, compared with $87 for a routine outpatient EEG.
Data source: A literature review of 34 articles.
Disclosures: The investigators did not report any financial disclosures.
Novel picosecond laser improves acne scarring
Novel picosecond-domain 1,064 nm and 532 nm neodymium: yttrium aluminum garnet (Nd:YAG) lasers used with a new holographic beam splitter safely and effectively treated facial acne scars in a prospective study.
Among the 27 participants who completed the study, the mean improvement in acne scarring was 1.4 on a 10-point global aesthetic scale (range –4 to 6 points; 95% confidence interval, 0.85-1.9); these assessments were performed by three blinded physician reviewers 12 weeks after the last treatment. In addition, 23 (85%) of the participants reported that they were satisfied or very satisfied with their treatment, Eric F. Bernstein, MD, who is in private practice in Ardmore, Pa., and his coauthors reported (Lasers Surg Med. 2017 Nov;49[9]:796-802).
The study comprised 27 men and women with Fitzpatrick skin types II-V whose mean age was 45 years. They were treated with four monthly treatments. Of the participants, 19 were treated with the 1,064 nm laser and 8 with the 532 nm laser; both treatments employed a novel holographic hand piece to deliver precise beams of focused laser energy. Blinded physician reviewers evaluated digital images taken both before treatment and 12 weeks after the final treatment.
Based on the averages of scores from the reviewers, 81% of the participants showed some degree of improvement, 48% had a mean improvement of at least 2 points, and 26% had a mean improvement score of at least 3 points.
Participants experienced some side effects immediately after treatment, including mild to moderate erythema (100% of patients for both lasers), mild to moderate edema (95% for 1,064 nm, 97% for 532 nm), mild to moderate petechiae (50%, 38%), and mild purpura (17%, 0%). All these responses cleared within a few hours or a few days after treatments, according to patient reports.
None of the patients experienced pigmentary changes, based on before and after treatment photos. In contrast, the most commonly used laser for treating acne scarring – the nonfractionated CO2 laser – causes significant hyperpigmentation and even permanent hypopigmentation, the authors pointed out.
No significant difference was seen when comparing mean improvement scores between participants treated with the 1,064 nm lasers and those treated with the 532 nm lasers.
“The use of picosecond-domain pulses delivers clinical benefits at lower fluences and energies than would be required at longer pulse durations and may offer qualitatively different tissue effects than earlier-generation lasers,” Dr. Bernstein and his coauthors wrote. “Future studies investigating combinations of the 1,064 and 532 nm picosecond-domain fractionated wavelengths, as well as larger trials with skin types V and VI, should increase the ways the device is used and the conditions it is used to treat,” they added.
Limitations of the study included the short 3-month follow-up, they noted.
The study was funded by Syneron Candela, the manufacturer of the laser and the holographic beam-splitting optic used in the study; the company loaned the equipment for the study. Dr. Bernstein is a consultant for Syneron Candela. Two of the five authors were employees of Syneron Candela at the time the study was conducted. No other financial disclosures were reported.
Novel picosecond-domain 1,064 nm and 532 nm neodymium: yttrium aluminum garnet (Nd:YAG) lasers used with a new holographic beam splitter safely and effectively treated facial acne scars in a prospective study.
Among the 27 participants who completed the study, the mean improvement in acne scarring was 1.4 on a 10-point global aesthetic scale (range –4 to 6 points; 95% confidence interval, 0.85-1.9); these assessments were performed by three blinded physician reviewers 12 weeks after the last treatment. In addition, 23 (85%) of the participants reported that they were satisfied or very satisfied with their treatment, Eric F. Bernstein, MD, who is in private practice in Ardmore, Pa., and his coauthors reported (Lasers Surg Med. 2017 Nov;49[9]:796-802).
The study comprised 27 men and women with Fitzpatrick skin types II-V whose mean age was 45 years. They were treated with four monthly treatments. Of the participants, 19 were treated with the 1,064 nm laser and 8 with the 532 nm laser; both treatments employed a novel holographic hand piece to deliver precise beams of focused laser energy. Blinded physician reviewers evaluated digital images taken both before treatment and 12 weeks after the final treatment.
Based on the averages of scores from the reviewers, 81% of the participants showed some degree of improvement, 48% had a mean improvement of at least 2 points, and 26% had a mean improvement score of at least 3 points.
Participants experienced some side effects immediately after treatment, including mild to moderate erythema (100% of patients for both lasers), mild to moderate edema (95% for 1,064 nm, 97% for 532 nm), mild to moderate petechiae (50%, 38%), and mild purpura (17%, 0%). All these responses cleared within a few hours or a few days after treatments, according to patient reports.
None of the patients experienced pigmentary changes, based on before and after treatment photos. In contrast, the most commonly used laser for treating acne scarring – the nonfractionated CO2 laser – causes significant hyperpigmentation and even permanent hypopigmentation, the authors pointed out.
No significant difference was seen when comparing mean improvement scores between participants treated with the 1,064 nm lasers and those treated with the 532 nm lasers.
“The use of picosecond-domain pulses delivers clinical benefits at lower fluences and energies than would be required at longer pulse durations and may offer qualitatively different tissue effects than earlier-generation lasers,” Dr. Bernstein and his coauthors wrote. “Future studies investigating combinations of the 1,064 and 532 nm picosecond-domain fractionated wavelengths, as well as larger trials with skin types V and VI, should increase the ways the device is used and the conditions it is used to treat,” they added.
Limitations of the study included the short 3-month follow-up, they noted.
The study was funded by Syneron Candela, the manufacturer of the laser and the holographic beam-splitting optic used in the study; the company loaned the equipment for the study. Dr. Bernstein is a consultant for Syneron Candela. Two of the five authors were employees of Syneron Candela at the time the study was conducted. No other financial disclosures were reported.
Novel picosecond-domain 1,064 nm and 532 nm neodymium: yttrium aluminum garnet (Nd:YAG) lasers used with a new holographic beam splitter safely and effectively treated facial acne scars in a prospective study.
Among the 27 participants who completed the study, the mean improvement in acne scarring was 1.4 on a 10-point global aesthetic scale (range –4 to 6 points; 95% confidence interval, 0.85-1.9); these assessments were performed by three blinded physician reviewers 12 weeks after the last treatment. In addition, 23 (85%) of the participants reported that they were satisfied or very satisfied with their treatment, Eric F. Bernstein, MD, who is in private practice in Ardmore, Pa., and his coauthors reported (Lasers Surg Med. 2017 Nov;49[9]:796-802).
The study comprised 27 men and women with Fitzpatrick skin types II-V whose mean age was 45 years. They were treated with four monthly treatments. Of the participants, 19 were treated with the 1,064 nm laser and 8 with the 532 nm laser; both treatments employed a novel holographic hand piece to deliver precise beams of focused laser energy. Blinded physician reviewers evaluated digital images taken both before treatment and 12 weeks after the final treatment.
Based on the averages of scores from the reviewers, 81% of the participants showed some degree of improvement, 48% had a mean improvement of at least 2 points, and 26% had a mean improvement score of at least 3 points.
Participants experienced some side effects immediately after treatment, including mild to moderate erythema (100% of patients for both lasers), mild to moderate edema (95% for 1,064 nm, 97% for 532 nm), mild to moderate petechiae (50%, 38%), and mild purpura (17%, 0%). All these responses cleared within a few hours or a few days after treatments, according to patient reports.
None of the patients experienced pigmentary changes, based on before and after treatment photos. In contrast, the most commonly used laser for treating acne scarring – the nonfractionated CO2 laser – causes significant hyperpigmentation and even permanent hypopigmentation, the authors pointed out.
No significant difference was seen when comparing mean improvement scores between participants treated with the 1,064 nm lasers and those treated with the 532 nm lasers.
“The use of picosecond-domain pulses delivers clinical benefits at lower fluences and energies than would be required at longer pulse durations and may offer qualitatively different tissue effects than earlier-generation lasers,” Dr. Bernstein and his coauthors wrote. “Future studies investigating combinations of the 1,064 and 532 nm picosecond-domain fractionated wavelengths, as well as larger trials with skin types V and VI, should increase the ways the device is used and the conditions it is used to treat,” they added.
Limitations of the study included the short 3-month follow-up, they noted.
The study was funded by Syneron Candela, the manufacturer of the laser and the holographic beam-splitting optic used in the study; the company loaned the equipment for the study. Dr. Bernstein is a consultant for Syneron Candela. Two of the five authors were employees of Syneron Candela at the time the study was conducted. No other financial disclosures were reported.
FROM LASERS IN SURGERY AND MEDICINE
Key clinical point: A new picosecond-domain 1,064 nm and 532 nm Nd:YAG laser combined with a novel holographic beam splitter can treat facial acne scars safely and effectively.
Major finding: All 27 participants who completed the study saw a mean improvement in acne scarring of 1.4 on a 10-point scale, with improvement ranging up to 60%.
Data source: A prospective study of participants with facial acne scars who were treated with four monthly laser treatments.
Disclosures: The study was funded by Syneron Candela, the manufacturer of the laser and the holographic beam-splitting optic used in the study; the company loaned the equipment for the study. Dr. Bernstein is a consultant for Syneron Candela. Two of the five authors were employees of Syneron Candela at the time the study was conducted. No other financial disclosures were reported.
Intellectual impairment seems not a risk of asymptomatic cCMV
Infants with congenital cytomegalovirus (cCMV) who were asymptomatic at birth with normal hearing by age 2 years were not at higher risk of intellectual impairment or low academic achievement, compared with controls, but patients with sensorineural hearing loss may experience more difficulty, according to a longitudinal study.
Full-scale intelligence, language, and academic achievement was evaluated in 78 adolescents with cCMV and normal hearing, 11 with cCMV and sensorineural hearing loss (SNHL) by age 2 years, and 40 controls. Mean full-scale intelligence scores did not vary among the patients with normal hearing and the controls, said Adriana S. Lopez of the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, and her coauthors. Each group scored a mean 108 (95% confidence interval, 105-110 and 104-111, respectively) at age 5 years and 111 (95% CI, 108-114 and 107-104, respectively) at age 18 years (P = .96). The scores of the patients with SNHL, however, were 7 points lower at both times (P less than .05).
In the other categories (expressive vocabulary and academic achievement in math and reading), the differences between the three groups were not statistically significant (P less than .05 for all three categories), suggesting that the other scores may underestimate the full intellectual potential of cCMV patients with SNHL, according to the researchers (Pediatrics. 2017. doi: 10.1542/peds.2017-1517).
“Findings from our study suggest that and, therefore, may not need long-term monitoring for cognitive impairment and/or disabilities,” Dr. Lopez and her coauthors wrote. “This information could provide reassurance to parents.”
“Further studies are needed to better understand the impact of asymptomatic congenital CMV infection on behavior and specific cognitive domains such as attention, perception, and memory,” they concluded.
The study was funded by the National Institutes of Health and was supported in other ways by a number of other organizations. Dr. Lopez and her coauthors reported no financial disclosures.
Congenital cytomegalovirus (cCMV) infection is a leading nongenetic cause of hearing loss and neurodevelopmental disability, with the number of infants experiencing these symptoms approaching that of those with Down Syndrome and exceeding that of those with fetal alcohol syndrome, spina bifida, and childhood infections such as HIV. Most infected infants are asymptomatic, and the majority are not recognized at birth.
Yet little is known about intellectual outcomes and academic performance in these children. Lopez et al. provide encouraging findings and new insights that begin to bridge this gap in knowledge about children with asymptomatic cCMV up into adolescence.
There were some challenges in this study, including the large percentage of children whose mothers have medium to high socioeconomic status and the selection of appropriate controls. Although the controls were born within 6 days of the infants with cCMV, they were not matched for other demographic factors. It will be important to confirm these findings in children with families of lower socioeconomic status.
That said, this study is helpful in defining the disease burden from this common prenatal infection and in reassuring patients and doctors that these infants are not at increased risk for disabilities in terms of intellectual attainment and academic performance.
Suresh B. Boppana, MD, is a professor of pediatrics and microbiology, and Karen B. Fowler, DrPH, is a professor of epidemiology. Both practice at the University of Alabama in Birmingham. These remarks accompanied the Lopez et al. article (Pediatrics. 2017. doi: 10.1542/peds.2017-2526). Neither author reported any financial disclosures.
Congenital cytomegalovirus (cCMV) infection is a leading nongenetic cause of hearing loss and neurodevelopmental disability, with the number of infants experiencing these symptoms approaching that of those with Down Syndrome and exceeding that of those with fetal alcohol syndrome, spina bifida, and childhood infections such as HIV. Most infected infants are asymptomatic, and the majority are not recognized at birth.
Yet little is known about intellectual outcomes and academic performance in these children. Lopez et al. provide encouraging findings and new insights that begin to bridge this gap in knowledge about children with asymptomatic cCMV up into adolescence.
There were some challenges in this study, including the large percentage of children whose mothers have medium to high socioeconomic status and the selection of appropriate controls. Although the controls were born within 6 days of the infants with cCMV, they were not matched for other demographic factors. It will be important to confirm these findings in children with families of lower socioeconomic status.
That said, this study is helpful in defining the disease burden from this common prenatal infection and in reassuring patients and doctors that these infants are not at increased risk for disabilities in terms of intellectual attainment and academic performance.
Suresh B. Boppana, MD, is a professor of pediatrics and microbiology, and Karen B. Fowler, DrPH, is a professor of epidemiology. Both practice at the University of Alabama in Birmingham. These remarks accompanied the Lopez et al. article (Pediatrics. 2017. doi: 10.1542/peds.2017-2526). Neither author reported any financial disclosures.
Congenital cytomegalovirus (cCMV) infection is a leading nongenetic cause of hearing loss and neurodevelopmental disability, with the number of infants experiencing these symptoms approaching that of those with Down Syndrome and exceeding that of those with fetal alcohol syndrome, spina bifida, and childhood infections such as HIV. Most infected infants are asymptomatic, and the majority are not recognized at birth.
Yet little is known about intellectual outcomes and academic performance in these children. Lopez et al. provide encouraging findings and new insights that begin to bridge this gap in knowledge about children with asymptomatic cCMV up into adolescence.
There were some challenges in this study, including the large percentage of children whose mothers have medium to high socioeconomic status and the selection of appropriate controls. Although the controls were born within 6 days of the infants with cCMV, they were not matched for other demographic factors. It will be important to confirm these findings in children with families of lower socioeconomic status.
That said, this study is helpful in defining the disease burden from this common prenatal infection and in reassuring patients and doctors that these infants are not at increased risk for disabilities in terms of intellectual attainment and academic performance.
Suresh B. Boppana, MD, is a professor of pediatrics and microbiology, and Karen B. Fowler, DrPH, is a professor of epidemiology. Both practice at the University of Alabama in Birmingham. These remarks accompanied the Lopez et al. article (Pediatrics. 2017. doi: 10.1542/peds.2017-2526). Neither author reported any financial disclosures.
Infants with congenital cytomegalovirus (cCMV) who were asymptomatic at birth with normal hearing by age 2 years were not at higher risk of intellectual impairment or low academic achievement, compared with controls, but patients with sensorineural hearing loss may experience more difficulty, according to a longitudinal study.
Full-scale intelligence, language, and academic achievement was evaluated in 78 adolescents with cCMV and normal hearing, 11 with cCMV and sensorineural hearing loss (SNHL) by age 2 years, and 40 controls. Mean full-scale intelligence scores did not vary among the patients with normal hearing and the controls, said Adriana S. Lopez of the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, and her coauthors. Each group scored a mean 108 (95% confidence interval, 105-110 and 104-111, respectively) at age 5 years and 111 (95% CI, 108-114 and 107-104, respectively) at age 18 years (P = .96). The scores of the patients with SNHL, however, were 7 points lower at both times (P less than .05).
In the other categories (expressive vocabulary and academic achievement in math and reading), the differences between the three groups were not statistically significant (P less than .05 for all three categories), suggesting that the other scores may underestimate the full intellectual potential of cCMV patients with SNHL, according to the researchers (Pediatrics. 2017. doi: 10.1542/peds.2017-1517).
“Findings from our study suggest that and, therefore, may not need long-term monitoring for cognitive impairment and/or disabilities,” Dr. Lopez and her coauthors wrote. “This information could provide reassurance to parents.”
“Further studies are needed to better understand the impact of asymptomatic congenital CMV infection on behavior and specific cognitive domains such as attention, perception, and memory,” they concluded.
The study was funded by the National Institutes of Health and was supported in other ways by a number of other organizations. Dr. Lopez and her coauthors reported no financial disclosures.
Infants with congenital cytomegalovirus (cCMV) who were asymptomatic at birth with normal hearing by age 2 years were not at higher risk of intellectual impairment or low academic achievement, compared with controls, but patients with sensorineural hearing loss may experience more difficulty, according to a longitudinal study.
Full-scale intelligence, language, and academic achievement was evaluated in 78 adolescents with cCMV and normal hearing, 11 with cCMV and sensorineural hearing loss (SNHL) by age 2 years, and 40 controls. Mean full-scale intelligence scores did not vary among the patients with normal hearing and the controls, said Adriana S. Lopez of the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, and her coauthors. Each group scored a mean 108 (95% confidence interval, 105-110 and 104-111, respectively) at age 5 years and 111 (95% CI, 108-114 and 107-104, respectively) at age 18 years (P = .96). The scores of the patients with SNHL, however, were 7 points lower at both times (P less than .05).
In the other categories (expressive vocabulary and academic achievement in math and reading), the differences between the three groups were not statistically significant (P less than .05 for all three categories), suggesting that the other scores may underestimate the full intellectual potential of cCMV patients with SNHL, according to the researchers (Pediatrics. 2017. doi: 10.1542/peds.2017-1517).
“Findings from our study suggest that and, therefore, may not need long-term monitoring for cognitive impairment and/or disabilities,” Dr. Lopez and her coauthors wrote. “This information could provide reassurance to parents.”
“Further studies are needed to better understand the impact of asymptomatic congenital CMV infection on behavior and specific cognitive domains such as attention, perception, and memory,” they concluded.
The study was funded by the National Institutes of Health and was supported in other ways by a number of other organizations. Dr. Lopez and her coauthors reported no financial disclosures.
FROM PEDIATRICS
Key clinical point: Infants with cCMV who were asymptomatic at birth with normal hearing by age 2 years were not at higher risk of intellectual impairment or low academic achievement, compared with controls, but patients with sensorineural hearing loss may experience more difficulty.
Major finding: The infants with cCMV with normal hearing at 2 years and the controls both scored a mean 108 at age 5 years and 111 at age 18 years (P = .96). The scores of the patients with SNHL, however, were 7 points lower (P less than .05).
Data source: A longitudinal study of 78 adolescents with cCMV and normal hearing, 11 with cCMV and SNHL by age 2 years, and 40 controls.
Disclosures: The study was funded by the National Institutes of Health and was supported in other ways by a number of other organizations. Dr. Lopez and her coauthors reported no financial disclosures.
Further evidence supports link between Zika and GBS
Newly identified risk factors add to the growing evidence of a causal association between Zika virus and Guillain-Barré Syndrome (GBS), according to a case-control study.
In a study conducted in Puerto Rico, GBS diagnosis was confirmed in 39 of 47 (83%) patients with clinical suspicion of the syndrome from nine hospitals from April 2016 to December 2016. They were compared with 78 control patients to identify GBS risk factors. Three risk factors were identified, Emilio Dirlikov, PhD, of the division of scientific education and professional development for the Centers for Disease Control and Prevention in San Juan, Puerto Rico, and his coauthors said in a research letter to JAMA (2017;318[15]:1498).
“During Zika virus outbreaks, clinical suspicion should be elevated to improve GBS patient prognosis through prompt diagnosis and treatment,” Dr. Dirlikov and his coauthors wrote. This was a small study. “The pathophysiology of Zika virus infection and risk factors for developing GBS require further investigation. Clinical trials of the Zika virus vaccine should monitor for GBS,” they said.
The study was supported with a grant from the National Institutes of Health. Carlos A. Luciano, MD, also reported grant funding from the University of Puerto Rico Medical Sciences, San Juan. No other authors reported any financial disclosures.
Newly identified risk factors add to the growing evidence of a causal association between Zika virus and Guillain-Barré Syndrome (GBS), according to a case-control study.
In a study conducted in Puerto Rico, GBS diagnosis was confirmed in 39 of 47 (83%) patients with clinical suspicion of the syndrome from nine hospitals from April 2016 to December 2016. They were compared with 78 control patients to identify GBS risk factors. Three risk factors were identified, Emilio Dirlikov, PhD, of the division of scientific education and professional development for the Centers for Disease Control and Prevention in San Juan, Puerto Rico, and his coauthors said in a research letter to JAMA (2017;318[15]:1498).
“During Zika virus outbreaks, clinical suspicion should be elevated to improve GBS patient prognosis through prompt diagnosis and treatment,” Dr. Dirlikov and his coauthors wrote. This was a small study. “The pathophysiology of Zika virus infection and risk factors for developing GBS require further investigation. Clinical trials of the Zika virus vaccine should monitor for GBS,” they said.
The study was supported with a grant from the National Institutes of Health. Carlos A. Luciano, MD, also reported grant funding from the University of Puerto Rico Medical Sciences, San Juan. No other authors reported any financial disclosures.
Newly identified risk factors add to the growing evidence of a causal association between Zika virus and Guillain-Barré Syndrome (GBS), according to a case-control study.
In a study conducted in Puerto Rico, GBS diagnosis was confirmed in 39 of 47 (83%) patients with clinical suspicion of the syndrome from nine hospitals from April 2016 to December 2016. They were compared with 78 control patients to identify GBS risk factors. Three risk factors were identified, Emilio Dirlikov, PhD, of the division of scientific education and professional development for the Centers for Disease Control and Prevention in San Juan, Puerto Rico, and his coauthors said in a research letter to JAMA (2017;318[15]:1498).
“During Zika virus outbreaks, clinical suspicion should be elevated to improve GBS patient prognosis through prompt diagnosis and treatment,” Dr. Dirlikov and his coauthors wrote. This was a small study. “The pathophysiology of Zika virus infection and risk factors for developing GBS require further investigation. Clinical trials of the Zika virus vaccine should monitor for GBS,” they said.
The study was supported with a grant from the National Institutes of Health. Carlos A. Luciano, MD, also reported grant funding from the University of Puerto Rico Medical Sciences, San Juan. No other authors reported any financial disclosures.
FROM JAMA
Key clinical point:
Major finding: Case patients saw higher rates of acute illness within the previous 2 months (82%), acute Zika virus infection (23%), and any laboratory evidence of Zika virus infection (69%), compared with controls.
Data source: A case-control study of 39 patients with GBS and 78 controls.
Disclosures: The study was supported with a grant from the National Institutes of Health. Carlos A. Luciano, MD, also reported grant funding from the University of Puerto Rico Medical Sciences, San Juan. No other authors reported any financial disclosures.
Intensive exercise didn’t improve glycemic control for obese pregnant women
An intensive exercise intervention for obese pregnant women did not improve maternal glycemia, but did attenuate excessive gestational weight gain, according to the a single-center, randomized controlled trial published in Obstetrics & Gynecology.
The Healthy Eating, Exercise and Lifestyle Trial, conducted from November 2013 through April 2016 at the Coombe Women and Infants University Hospital in Dublin, randomized 88 pregnant women with a body mass index of 30 kg/m2 or greater at their first prenatal visit to either a medically supervised exercise program or to the control group. The intervention consisted of 50-60 minutes of exercise at least once per week, including resistance or weights and aerobic exercises (Obstet Gynecol. 2017;130:1001-10).
However, excessive gestational weight gain at 36 weeks’ gestation (greater than 9.1 kg) was lower in the exercise group at 22.2%, compared with 43.2% in the control group (P less than .05), Niamh Daly of Coombe Women and Infants University Hospital and her coauthors reported.
“Our study may have failed to improve maternal glycemia because the ideal time to begin such a program could be before pregnancy,” the researchers wrote. “Pregnant women who are obese, however, should be advised to exercise because it attenuates excessive gestational weight gain.”
The study was partially funded by Friends of the Coombe, a charity organization. The authors reported having no financial disclosures.
An intensive exercise intervention for obese pregnant women did not improve maternal glycemia, but did attenuate excessive gestational weight gain, according to the a single-center, randomized controlled trial published in Obstetrics & Gynecology.
The Healthy Eating, Exercise and Lifestyle Trial, conducted from November 2013 through April 2016 at the Coombe Women and Infants University Hospital in Dublin, randomized 88 pregnant women with a body mass index of 30 kg/m2 or greater at their first prenatal visit to either a medically supervised exercise program or to the control group. The intervention consisted of 50-60 minutes of exercise at least once per week, including resistance or weights and aerobic exercises (Obstet Gynecol. 2017;130:1001-10).
However, excessive gestational weight gain at 36 weeks’ gestation (greater than 9.1 kg) was lower in the exercise group at 22.2%, compared with 43.2% in the control group (P less than .05), Niamh Daly of Coombe Women and Infants University Hospital and her coauthors reported.
“Our study may have failed to improve maternal glycemia because the ideal time to begin such a program could be before pregnancy,” the researchers wrote. “Pregnant women who are obese, however, should be advised to exercise because it attenuates excessive gestational weight gain.”
The study was partially funded by Friends of the Coombe, a charity organization. The authors reported having no financial disclosures.
An intensive exercise intervention for obese pregnant women did not improve maternal glycemia, but did attenuate excessive gestational weight gain, according to the a single-center, randomized controlled trial published in Obstetrics & Gynecology.
The Healthy Eating, Exercise and Lifestyle Trial, conducted from November 2013 through April 2016 at the Coombe Women and Infants University Hospital in Dublin, randomized 88 pregnant women with a body mass index of 30 kg/m2 or greater at their first prenatal visit to either a medically supervised exercise program or to the control group. The intervention consisted of 50-60 minutes of exercise at least once per week, including resistance or weights and aerobic exercises (Obstet Gynecol. 2017;130:1001-10).
However, excessive gestational weight gain at 36 weeks’ gestation (greater than 9.1 kg) was lower in the exercise group at 22.2%, compared with 43.2% in the control group (P less than .05), Niamh Daly of Coombe Women and Infants University Hospital and her coauthors reported.
“Our study may have failed to improve maternal glycemia because the ideal time to begin such a program could be before pregnancy,” the researchers wrote. “Pregnant women who are obese, however, should be advised to exercise because it attenuates excessive gestational weight gain.”
The study was partially funded by Friends of the Coombe, a charity organization. The authors reported having no financial disclosures.
FROM OBSTETRICS & GYNECOLOGY
Key clinical point:
Major finding: There was no difference in mean fasting plasma glucose between the control group (90.0 plus or minus 9.0 mg/dL) and the exercise group (93.6 plus or minus 7.2 mg/dL) at 24-28 weeks’ gestation (P = .13).
Data source: A single-center, randomized controlled trial of 88 pregnant women with a BMI of 30 kg/m2 or greater.
Disclosures: The study was partially funded by Friends of the Coombe, a charity organization. The authors reported having no financial disclosures.
Herpes simplex type 2 infection markedly increases HIV risk
The risk of contracting HIV was almost three to five times higher among people infected with herpes simplex virus type 2 (HSV-2), in a systematic review and meta-analysis.
The analysis of 57 longitudinal studies found that the adjusted relative risk (RR) of HIV incidence after exposure to HSV-2 infection at baseline (“prevalent infection”) was 2.7 and was 4.7 after exposure to HSV-2 infection during follow-up (“incident infection”). The studies, mostly conducted in Africa, were found in PubMed, MEDLINE, and Embase publications from Jan. 1, 2003, to May 25, 2017; the analysis was published online on Aug. 23 (Lancet Infect Dis. 2017. pii: S1473-3099[17]30405-X. doi: 10.1016/S1473-3099[17]30405-X).
“The greater cofactor effect for incident HSV-2 infection than for prevalent HSV-2 infection might be because newly acquired HSV-2 infection is associated with an increased frequency and severity of genital ulceration, viral shedding, and inflammation in the genital tract, symptoms and manifestations that decrease with time after infection,” according to Katharine J. Looker, PhD, of the University of Bristol (England), and Jocelyn A.R. Elmes, PhD, of Imperial College London (England) and their coauthors.
Associations still were significant but lower in higher-risk populations, such as female sex workers and their clients, men who have sex with men, and serodiscordant couples, the researchers said. For those with prevalent HSV-2, the adjusted RR of contracting HIV was 1.7 (95% confidence interval, 1.4-2.1), compared with 2.9 for those with incident HSV-2 infection (95% CI, 1.7-5.0).
“Quantifying the effect of HSV-2 infection on HIV acquisition has important public health implications, particularly in high-prevalence settings where coinfection is common, because prevention of HSV-2 infection ... might indirectly prevent HIV infection,” the authors wrote. “Knowledge of this association informs the advice and information given to individuals diagnosed with genital herpes, who might be at increased risk of acquiring HIV.”
The study was funded by the World Health Organization. Dr. Looker reported personal fees from the WHO. Dr. Elmes reported grants from the National Institutes of Health and the Wellcome Trust outside of this study. Two authors reported financial support from Aquarius Population Health and other support from WHO and NIH; the three remaining authors had no disclosures.
The incidence of HIV infection has not changed in a decade. Development of successful strategies to prevent HIV acquisition might require more creative approaches to meet the needs of the most susceptible populations, including exploration of the role of sexually transmitted infections, such as herpes simplex virus type 2 (HSV-2), in HIV infection.
This study provides the first systematic review and meta-analysis in more than a decade to assess the effect of HSV-2 infection on subsequent HIV acquisition. There are some preventative treatments available for HIV and HSV-2, but they have poor availability in low-income regions that have the highest risk of infection. Therefore, other multipurpose prevention technologies for HSV-2 and HIV are needed to give individuals a broad range of prevention options and to target the lifestyles and preferences of the most susceptible populations, including young women in Africa who have the highest incidence of HIV and HSV-2 worldwide.
Thomas M. Zydowsky, PhD , is the director of biomedical research and pharmaceutical development in the HIV and AIDS program at the Population Council’s Center for Biomedical Research in New York. His commentary accompanied the Looker et al. study ( Lancet Infect Dis. 2017 Aug 23. pii: S1473-3099[17]30493-0. doi: 10.1016/S1473-3099[17]30493-0 ). He reported no financial conflicts of interest.
The incidence of HIV infection has not changed in a decade. Development of successful strategies to prevent HIV acquisition might require more creative approaches to meet the needs of the most susceptible populations, including exploration of the role of sexually transmitted infections, such as herpes simplex virus type 2 (HSV-2), in HIV infection.
This study provides the first systematic review and meta-analysis in more than a decade to assess the effect of HSV-2 infection on subsequent HIV acquisition. There are some preventative treatments available for HIV and HSV-2, but they have poor availability in low-income regions that have the highest risk of infection. Therefore, other multipurpose prevention technologies for HSV-2 and HIV are needed to give individuals a broad range of prevention options and to target the lifestyles and preferences of the most susceptible populations, including young women in Africa who have the highest incidence of HIV and HSV-2 worldwide.
Thomas M. Zydowsky, PhD , is the director of biomedical research and pharmaceutical development in the HIV and AIDS program at the Population Council’s Center for Biomedical Research in New York. His commentary accompanied the Looker et al. study ( Lancet Infect Dis. 2017 Aug 23. pii: S1473-3099[17]30493-0. doi: 10.1016/S1473-3099[17]30493-0 ). He reported no financial conflicts of interest.
The incidence of HIV infection has not changed in a decade. Development of successful strategies to prevent HIV acquisition might require more creative approaches to meet the needs of the most susceptible populations, including exploration of the role of sexually transmitted infections, such as herpes simplex virus type 2 (HSV-2), in HIV infection.
This study provides the first systematic review and meta-analysis in more than a decade to assess the effect of HSV-2 infection on subsequent HIV acquisition. There are some preventative treatments available for HIV and HSV-2, but they have poor availability in low-income regions that have the highest risk of infection. Therefore, other multipurpose prevention technologies for HSV-2 and HIV are needed to give individuals a broad range of prevention options and to target the lifestyles and preferences of the most susceptible populations, including young women in Africa who have the highest incidence of HIV and HSV-2 worldwide.
Thomas M. Zydowsky, PhD , is the director of biomedical research and pharmaceutical development in the HIV and AIDS program at the Population Council’s Center for Biomedical Research in New York. His commentary accompanied the Looker et al. study ( Lancet Infect Dis. 2017 Aug 23. pii: S1473-3099[17]30493-0. doi: 10.1016/S1473-3099[17]30493-0 ). He reported no financial conflicts of interest.
The risk of contracting HIV was almost three to five times higher among people infected with herpes simplex virus type 2 (HSV-2), in a systematic review and meta-analysis.
The analysis of 57 longitudinal studies found that the adjusted relative risk (RR) of HIV incidence after exposure to HSV-2 infection at baseline (“prevalent infection”) was 2.7 and was 4.7 after exposure to HSV-2 infection during follow-up (“incident infection”). The studies, mostly conducted in Africa, were found in PubMed, MEDLINE, and Embase publications from Jan. 1, 2003, to May 25, 2017; the analysis was published online on Aug. 23 (Lancet Infect Dis. 2017. pii: S1473-3099[17]30405-X. doi: 10.1016/S1473-3099[17]30405-X).
“The greater cofactor effect for incident HSV-2 infection than for prevalent HSV-2 infection might be because newly acquired HSV-2 infection is associated with an increased frequency and severity of genital ulceration, viral shedding, and inflammation in the genital tract, symptoms and manifestations that decrease with time after infection,” according to Katharine J. Looker, PhD, of the University of Bristol (England), and Jocelyn A.R. Elmes, PhD, of Imperial College London (England) and their coauthors.
Associations still were significant but lower in higher-risk populations, such as female sex workers and their clients, men who have sex with men, and serodiscordant couples, the researchers said. For those with prevalent HSV-2, the adjusted RR of contracting HIV was 1.7 (95% confidence interval, 1.4-2.1), compared with 2.9 for those with incident HSV-2 infection (95% CI, 1.7-5.0).
“Quantifying the effect of HSV-2 infection on HIV acquisition has important public health implications, particularly in high-prevalence settings where coinfection is common, because prevention of HSV-2 infection ... might indirectly prevent HIV infection,” the authors wrote. “Knowledge of this association informs the advice and information given to individuals diagnosed with genital herpes, who might be at increased risk of acquiring HIV.”
The study was funded by the World Health Organization. Dr. Looker reported personal fees from the WHO. Dr. Elmes reported grants from the National Institutes of Health and the Wellcome Trust outside of this study. Two authors reported financial support from Aquarius Population Health and other support from WHO and NIH; the three remaining authors had no disclosures.
The risk of contracting HIV was almost three to five times higher among people infected with herpes simplex virus type 2 (HSV-2), in a systematic review and meta-analysis.
The analysis of 57 longitudinal studies found that the adjusted relative risk (RR) of HIV incidence after exposure to HSV-2 infection at baseline (“prevalent infection”) was 2.7 and was 4.7 after exposure to HSV-2 infection during follow-up (“incident infection”). The studies, mostly conducted in Africa, were found in PubMed, MEDLINE, and Embase publications from Jan. 1, 2003, to May 25, 2017; the analysis was published online on Aug. 23 (Lancet Infect Dis. 2017. pii: S1473-3099[17]30405-X. doi: 10.1016/S1473-3099[17]30405-X).
“The greater cofactor effect for incident HSV-2 infection than for prevalent HSV-2 infection might be because newly acquired HSV-2 infection is associated with an increased frequency and severity of genital ulceration, viral shedding, and inflammation in the genital tract, symptoms and manifestations that decrease with time after infection,” according to Katharine J. Looker, PhD, of the University of Bristol (England), and Jocelyn A.R. Elmes, PhD, of Imperial College London (England) and their coauthors.
Associations still were significant but lower in higher-risk populations, such as female sex workers and their clients, men who have sex with men, and serodiscordant couples, the researchers said. For those with prevalent HSV-2, the adjusted RR of contracting HIV was 1.7 (95% confidence interval, 1.4-2.1), compared with 2.9 for those with incident HSV-2 infection (95% CI, 1.7-5.0).
“Quantifying the effect of HSV-2 infection on HIV acquisition has important public health implications, particularly in high-prevalence settings where coinfection is common, because prevention of HSV-2 infection ... might indirectly prevent HIV infection,” the authors wrote. “Knowledge of this association informs the advice and information given to individuals diagnosed with genital herpes, who might be at increased risk of acquiring HIV.”
The study was funded by the World Health Organization. Dr. Looker reported personal fees from the WHO. Dr. Elmes reported grants from the National Institutes of Health and the Wellcome Trust outside of this study. Two authors reported financial support from Aquarius Population Health and other support from WHO and NIH; the three remaining authors had no disclosures.
FROM THE LANCET: INFECTIOUS DISEASES
Key clinical point:
Major finding: The adjusted relative risk of HIV incidence after exposure to prevalent HSV-2 was 2.7 (95% CI, 2.2-3.4) and was 4.7 after exposure to incident HSV-2 (95% CI, 2.2-10.1).
Data source: A systematic review and meta-analysis of 57 longitudinal studies on the risk of HIV acquisition associated with HSV-2 infection.
Disclosures: The study was funded by the World Health Organization. One lead author reported personal fees from the World Health Organization; the other reported grants from the National Institutes of Health and the Wellcome Trust outside of this study. Two authors reported financial support from Aquarius Population Health and other support from WHO and NIH; the three remaining authors had no disclosures.
TNF inhibitors associated with fewer side effects than methotrexate in children with psoriasis
Treatment with tumor necrosis factor (TNF) inhibitors was associated with fewer adverse events (AEs) than with methotrexate, in an international, retrospective study of children with psoriasis.
“Patients with pediatric psoriasis treated with methotrexate had a greater risk of having one or more AEs than those treated with TNF-I [tumor necrosis factor inhibitors], although fewer AEs occurred with methotrexate or TNF-I than with other drug classes,” Inge M.G.J. Bronckers, MD, of the department of dermatology at Radboud University, Nijmegen, the Netherlands, and his coauthors reported.
Among those treated with methotrexate, administration of folic acid six to seven times a week was more protective against methotrexate-associated gastrointestinal AEs, than when administered only once a week. The study was published on Sept. 13 in JAMA Dermatology (2017. doi: 10.1001/jamadermatol.2017.3029).
The study evaluated 390 children with moderate to severe psoriasis, treated with at least one systemic medication at 20 centers in Canada, Europe, and the United States, during December 1990-September 2014. They were diagnosed at a mean age of about 8 years, and started systemic therapy a mean of 3 years later. Of the 390 children treated for psoriasis, 270 were treated with methotrexate and 106 were treated with biologics, most often the TNF inhibitor etanercept. The remaining treatments were acitretin, cyclosporine, and fumaric acid esters; almost 19% were treated with more than one medication.
Of those treated with methotrexate, 130 (48.1%) experienced one or more treatment-related AEs, compared with 41 (38.7%) of those treated with a biologic agent (odds ratio, 1.76; P = .03). Almost 25% of those on methotrexate had GI-related AEs, the most common AE; other AEs included elevated transaminase levels and fatigue. Among those on biologics, injection site reactions were the most common (in 18.9%); 12 patients (11.3%) of those on biologics had infections, primarily airway infections.
Compared with those on a TNF inhibitor, patients on methotrexate were more likely to experience GI-related AEs (OR, 11.49; P less than .001) or to discontinue treatment (OR, 5.69; P = .02), the investigators said. But associated infections were more common with TNF inhibitors (OR, 0.36; P = .03), compared with methotrexate. There were no cases of malignancies or tuberculosis.
Folic acid was prescribed to 239 patients receiving methotrexate in one of three regimens: once weekly; six times weekly, avoiding the methotrexate day; and seven times weekly, according to the investigators. Compared with once-weekly treatment, administration six or seven times weekly was associated with a lower probability of developing a GI-related AE (OR, 0.16; P less than .001; OR, 0.21; P = .003, respectively).
“Data are sparse on the relative use of systemic agents and their toxic effects in the pediatric population,” Dr. Bronckers and his coauthors wrote, adding that standardized guidelines and more data concerning children are needed. “Our data suggest that a weekly administration of folic acid could be replaced with a daily or six times weekly administration to reduce GI AEs, although the potential efficacy of six vs. seven times weekly dosing deserves further investigation,” they concluded.
The study was supported by a grant from the International Psoriasis Council. Of the 23 authors, 11 had financial disclosures with various pharmaceutical manufacturers.
Treatment with tumor necrosis factor (TNF) inhibitors was associated with fewer adverse events (AEs) than with methotrexate, in an international, retrospective study of children with psoriasis.
“Patients with pediatric psoriasis treated with methotrexate had a greater risk of having one or more AEs than those treated with TNF-I [tumor necrosis factor inhibitors], although fewer AEs occurred with methotrexate or TNF-I than with other drug classes,” Inge M.G.J. Bronckers, MD, of the department of dermatology at Radboud University, Nijmegen, the Netherlands, and his coauthors reported.
Among those treated with methotrexate, administration of folic acid six to seven times a week was more protective against methotrexate-associated gastrointestinal AEs, than when administered only once a week. The study was published on Sept. 13 in JAMA Dermatology (2017. doi: 10.1001/jamadermatol.2017.3029).
The study evaluated 390 children with moderate to severe psoriasis, treated with at least one systemic medication at 20 centers in Canada, Europe, and the United States, during December 1990-September 2014. They were diagnosed at a mean age of about 8 years, and started systemic therapy a mean of 3 years later. Of the 390 children treated for psoriasis, 270 were treated with methotrexate and 106 were treated with biologics, most often the TNF inhibitor etanercept. The remaining treatments were acitretin, cyclosporine, and fumaric acid esters; almost 19% were treated with more than one medication.
Of those treated with methotrexate, 130 (48.1%) experienced one or more treatment-related AEs, compared with 41 (38.7%) of those treated with a biologic agent (odds ratio, 1.76; P = .03). Almost 25% of those on methotrexate had GI-related AEs, the most common AE; other AEs included elevated transaminase levels and fatigue. Among those on biologics, injection site reactions were the most common (in 18.9%); 12 patients (11.3%) of those on biologics had infections, primarily airway infections.
Compared with those on a TNF inhibitor, patients on methotrexate were more likely to experience GI-related AEs (OR, 11.49; P less than .001) or to discontinue treatment (OR, 5.69; P = .02), the investigators said. But associated infections were more common with TNF inhibitors (OR, 0.36; P = .03), compared with methotrexate. There were no cases of malignancies or tuberculosis.
Folic acid was prescribed to 239 patients receiving methotrexate in one of three regimens: once weekly; six times weekly, avoiding the methotrexate day; and seven times weekly, according to the investigators. Compared with once-weekly treatment, administration six or seven times weekly was associated with a lower probability of developing a GI-related AE (OR, 0.16; P less than .001; OR, 0.21; P = .003, respectively).
“Data are sparse on the relative use of systemic agents and their toxic effects in the pediatric population,” Dr. Bronckers and his coauthors wrote, adding that standardized guidelines and more data concerning children are needed. “Our data suggest that a weekly administration of folic acid could be replaced with a daily or six times weekly administration to reduce GI AEs, although the potential efficacy of six vs. seven times weekly dosing deserves further investigation,” they concluded.
The study was supported by a grant from the International Psoriasis Council. Of the 23 authors, 11 had financial disclosures with various pharmaceutical manufacturers.
Treatment with tumor necrosis factor (TNF) inhibitors was associated with fewer adverse events (AEs) than with methotrexate, in an international, retrospective study of children with psoriasis.
“Patients with pediatric psoriasis treated with methotrexate had a greater risk of having one or more AEs than those treated with TNF-I [tumor necrosis factor inhibitors], although fewer AEs occurred with methotrexate or TNF-I than with other drug classes,” Inge M.G.J. Bronckers, MD, of the department of dermatology at Radboud University, Nijmegen, the Netherlands, and his coauthors reported.
Among those treated with methotrexate, administration of folic acid six to seven times a week was more protective against methotrexate-associated gastrointestinal AEs, than when administered only once a week. The study was published on Sept. 13 in JAMA Dermatology (2017. doi: 10.1001/jamadermatol.2017.3029).
The study evaluated 390 children with moderate to severe psoriasis, treated with at least one systemic medication at 20 centers in Canada, Europe, and the United States, during December 1990-September 2014. They were diagnosed at a mean age of about 8 years, and started systemic therapy a mean of 3 years later. Of the 390 children treated for psoriasis, 270 were treated with methotrexate and 106 were treated with biologics, most often the TNF inhibitor etanercept. The remaining treatments were acitretin, cyclosporine, and fumaric acid esters; almost 19% were treated with more than one medication.
Of those treated with methotrexate, 130 (48.1%) experienced one or more treatment-related AEs, compared with 41 (38.7%) of those treated with a biologic agent (odds ratio, 1.76; P = .03). Almost 25% of those on methotrexate had GI-related AEs, the most common AE; other AEs included elevated transaminase levels and fatigue. Among those on biologics, injection site reactions were the most common (in 18.9%); 12 patients (11.3%) of those on biologics had infections, primarily airway infections.
Compared with those on a TNF inhibitor, patients on methotrexate were more likely to experience GI-related AEs (OR, 11.49; P less than .001) or to discontinue treatment (OR, 5.69; P = .02), the investigators said. But associated infections were more common with TNF inhibitors (OR, 0.36; P = .03), compared with methotrexate. There were no cases of malignancies or tuberculosis.
Folic acid was prescribed to 239 patients receiving methotrexate in one of three regimens: once weekly; six times weekly, avoiding the methotrexate day; and seven times weekly, according to the investigators. Compared with once-weekly treatment, administration six or seven times weekly was associated with a lower probability of developing a GI-related AE (OR, 0.16; P less than .001; OR, 0.21; P = .003, respectively).
“Data are sparse on the relative use of systemic agents and their toxic effects in the pediatric population,” Dr. Bronckers and his coauthors wrote, adding that standardized guidelines and more data concerning children are needed. “Our data suggest that a weekly administration of folic acid could be replaced with a daily or six times weekly administration to reduce GI AEs, although the potential efficacy of six vs. seven times weekly dosing deserves further investigation,” they concluded.
The study was supported by a grant from the International Psoriasis Council. Of the 23 authors, 11 had financial disclosures with various pharmaceutical manufacturers.
FROM JAMA DERMATOLOGY
Key clinical point:
Major finding: Almost half (48.1%) of the children treated with methotrexate experienced one or more treatment-related adverse events, compared with 41 (38.7%) of those treated with a biologic agent (OR, 1.76; P = .03).
Data source: An international, retrospective study of 390 children with moderate to severe psoriasis compared the adverse events associated with different systemic therapies.
Disclosures: The study was supported by a grant from the International Psoriasis Council.
Breastfeeding practices have improved, but some attitudes are concerning
Pediatricians’ recommendations and practices for breastfeeding have become more closely aligned with American Academy of Pediatrics policy since 1995, but attitudes toward breastfeeding show cause for concern, according to a study.
The percentage of surveyed pediatricians who advise exclusive breastfeeding during the first month rose from 66% in 1995 to 75% in 2014 (P less than .05), reported Lori Feldman-Winter, MD, MPH, of Rowan University, Camden, N.J., and her coauthors (Pediatrics. 2017. doi: 10.1542/peds.2017-1229).
Physicians also were less likely to recommend formula supplementation (12% in 1995; 4.5% in 2014; P less than .05).
In addition, pediatricians in 2014 were significantly more likely to report that their affiliated hospitals had applied to be a baby-friendly hospital (56%), compared with results for 1995 (12%) and 2004 (22%) (P less than .05), the investigators said. The physicians also were more likely to report that their practices were more in line with the “Ten Steps to Successful Breastfeeding” policy.
Despite this general trend toward AAP recommendation–compliant practices, many pediatricians doubt the likelihood of breastfeeding success. Although in 1995, 70% of pediatricians reported that almost any mother can be successful at breastfeeding if she keeps trying, only 56% reported the same in 2014 (P less than .05), Dr. Feldman-Winter and her coauthors said. Similarly, only 50% reported that the benefits of breastfeeding outweigh the difficulties in 2014, compared with 70% in 1995 (P less than .05). This may be in part because younger pediatricians reported less confidence in managing common breastfeeding problems and being able to adequately address parents’ questions about breastfeeding; there was a statistically significant difference between pediatricians younger than 45 years and those 45 years and older (P less than .01).
“Pediatricians have demonstrated a modest decline in attitudes about the potential for breastfeeding success,” the investigators wrote. “Lack of resident support for breastfeeding is apparent among many programs and may set the stage for attitudes about breastfeeding for years to come. There are continued opportunities to enhance training in breastfeeding and participate in breastfeeding management and support.”
The study was funded by the American Academy of Pediatrics and the Maternal and Child Health Bureau, Health Resources and Services Administration, and Department of Health and Human Services. None of the authors reported any financial disclosures.
Despite changes in breastfeeding recommendations and practices as well as numerous initiatives from organizations such as the Centers for Disease Control and Prevention and the Department of Health and Human Services, residency training for breastfeeding is not universal.
The study by Feldman et al. shows some concerning trends toward a lack of belief among pediatricians that the benefits of breastfeeding outweigh the difficulties or inconveniences and toward less confidence in managing breastfeeding. They also indicate that baby-friendly hospitals are providing the required breastfeeding education, but this is only a start.
As the trend toward staffing hospitals with pediatric hospitalists increases, it is essential to remember that ambulatory pediatricians also need breastfeeding education because they are responsible for ongoing follow-up care. Maintenance of certification should include breastfeeding as a “core competency” for general pediatricians as well.
Although this analysis shows progress, “the importance of routine integration of breastfeeding into all aspects of medical education cannot be overstated. Breastfeeding education should be as routine in the curriculum as other preventive health strategies, such as immunization.” Hopefully, future studies will show that pediatricians have the skills, attitudes, and confidence necessary to provide competent support to their patients.
Joan Younger Meek, MD, is the associate dean for graduate medical education and a professor at Florida State University in Tallahassee. Her comments were with the Feldman-Winter et al. article in Pediatrics (2017. doi: 10.1542/peds.2017-2509). She reported no relevant financial disclosures or external funding.
Despite changes in breastfeeding recommendations and practices as well as numerous initiatives from organizations such as the Centers for Disease Control and Prevention and the Department of Health and Human Services, residency training for breastfeeding is not universal.
The study by Feldman et al. shows some concerning trends toward a lack of belief among pediatricians that the benefits of breastfeeding outweigh the difficulties or inconveniences and toward less confidence in managing breastfeeding. They also indicate that baby-friendly hospitals are providing the required breastfeeding education, but this is only a start.
As the trend toward staffing hospitals with pediatric hospitalists increases, it is essential to remember that ambulatory pediatricians also need breastfeeding education because they are responsible for ongoing follow-up care. Maintenance of certification should include breastfeeding as a “core competency” for general pediatricians as well.
Although this analysis shows progress, “the importance of routine integration of breastfeeding into all aspects of medical education cannot be overstated. Breastfeeding education should be as routine in the curriculum as other preventive health strategies, such as immunization.” Hopefully, future studies will show that pediatricians have the skills, attitudes, and confidence necessary to provide competent support to their patients.
Joan Younger Meek, MD, is the associate dean for graduate medical education and a professor at Florida State University in Tallahassee. Her comments were with the Feldman-Winter et al. article in Pediatrics (2017. doi: 10.1542/peds.2017-2509). She reported no relevant financial disclosures or external funding.
Despite changes in breastfeeding recommendations and practices as well as numerous initiatives from organizations such as the Centers for Disease Control and Prevention and the Department of Health and Human Services, residency training for breastfeeding is not universal.
The study by Feldman et al. shows some concerning trends toward a lack of belief among pediatricians that the benefits of breastfeeding outweigh the difficulties or inconveniences and toward less confidence in managing breastfeeding. They also indicate that baby-friendly hospitals are providing the required breastfeeding education, but this is only a start.
As the trend toward staffing hospitals with pediatric hospitalists increases, it is essential to remember that ambulatory pediatricians also need breastfeeding education because they are responsible for ongoing follow-up care. Maintenance of certification should include breastfeeding as a “core competency” for general pediatricians as well.
Although this analysis shows progress, “the importance of routine integration of breastfeeding into all aspects of medical education cannot be overstated. Breastfeeding education should be as routine in the curriculum as other preventive health strategies, such as immunization.” Hopefully, future studies will show that pediatricians have the skills, attitudes, and confidence necessary to provide competent support to their patients.
Joan Younger Meek, MD, is the associate dean for graduate medical education and a professor at Florida State University in Tallahassee. Her comments were with the Feldman-Winter et al. article in Pediatrics (2017. doi: 10.1542/peds.2017-2509). She reported no relevant financial disclosures or external funding.
Pediatricians’ recommendations and practices for breastfeeding have become more closely aligned with American Academy of Pediatrics policy since 1995, but attitudes toward breastfeeding show cause for concern, according to a study.
The percentage of surveyed pediatricians who advise exclusive breastfeeding during the first month rose from 66% in 1995 to 75% in 2014 (P less than .05), reported Lori Feldman-Winter, MD, MPH, of Rowan University, Camden, N.J., and her coauthors (Pediatrics. 2017. doi: 10.1542/peds.2017-1229).
Physicians also were less likely to recommend formula supplementation (12% in 1995; 4.5% in 2014; P less than .05).
In addition, pediatricians in 2014 were significantly more likely to report that their affiliated hospitals had applied to be a baby-friendly hospital (56%), compared with results for 1995 (12%) and 2004 (22%) (P less than .05), the investigators said. The physicians also were more likely to report that their practices were more in line with the “Ten Steps to Successful Breastfeeding” policy.
Despite this general trend toward AAP recommendation–compliant practices, many pediatricians doubt the likelihood of breastfeeding success. Although in 1995, 70% of pediatricians reported that almost any mother can be successful at breastfeeding if she keeps trying, only 56% reported the same in 2014 (P less than .05), Dr. Feldman-Winter and her coauthors said. Similarly, only 50% reported that the benefits of breastfeeding outweigh the difficulties in 2014, compared with 70% in 1995 (P less than .05). This may be in part because younger pediatricians reported less confidence in managing common breastfeeding problems and being able to adequately address parents’ questions about breastfeeding; there was a statistically significant difference between pediatricians younger than 45 years and those 45 years and older (P less than .01).
“Pediatricians have demonstrated a modest decline in attitudes about the potential for breastfeeding success,” the investigators wrote. “Lack of resident support for breastfeeding is apparent among many programs and may set the stage for attitudes about breastfeeding for years to come. There are continued opportunities to enhance training in breastfeeding and participate in breastfeeding management and support.”
The study was funded by the American Academy of Pediatrics and the Maternal and Child Health Bureau, Health Resources and Services Administration, and Department of Health and Human Services. None of the authors reported any financial disclosures.
Pediatricians’ recommendations and practices for breastfeeding have become more closely aligned with American Academy of Pediatrics policy since 1995, but attitudes toward breastfeeding show cause for concern, according to a study.
The percentage of surveyed pediatricians who advise exclusive breastfeeding during the first month rose from 66% in 1995 to 75% in 2014 (P less than .05), reported Lori Feldman-Winter, MD, MPH, of Rowan University, Camden, N.J., and her coauthors (Pediatrics. 2017. doi: 10.1542/peds.2017-1229).
Physicians also were less likely to recommend formula supplementation (12% in 1995; 4.5% in 2014; P less than .05).
In addition, pediatricians in 2014 were significantly more likely to report that their affiliated hospitals had applied to be a baby-friendly hospital (56%), compared with results for 1995 (12%) and 2004 (22%) (P less than .05), the investigators said. The physicians also were more likely to report that their practices were more in line with the “Ten Steps to Successful Breastfeeding” policy.
Despite this general trend toward AAP recommendation–compliant practices, many pediatricians doubt the likelihood of breastfeeding success. Although in 1995, 70% of pediatricians reported that almost any mother can be successful at breastfeeding if she keeps trying, only 56% reported the same in 2014 (P less than .05), Dr. Feldman-Winter and her coauthors said. Similarly, only 50% reported that the benefits of breastfeeding outweigh the difficulties in 2014, compared with 70% in 1995 (P less than .05). This may be in part because younger pediatricians reported less confidence in managing common breastfeeding problems and being able to adequately address parents’ questions about breastfeeding; there was a statistically significant difference between pediatricians younger than 45 years and those 45 years and older (P less than .01).
“Pediatricians have demonstrated a modest decline in attitudes about the potential for breastfeeding success,” the investigators wrote. “Lack of resident support for breastfeeding is apparent among many programs and may set the stage for attitudes about breastfeeding for years to come. There are continued opportunities to enhance training in breastfeeding and participate in breastfeeding management and support.”
The study was funded by the American Academy of Pediatrics and the Maternal and Child Health Bureau, Health Resources and Services Administration, and Department of Health and Human Services. None of the authors reported any financial disclosures.
FROM PEDIATRICS
Key clinical point:
Major finding: The percentage of surveyed physicians who advise exclusive breastfeeding during the first month rose from 66% in 1995 to 75% in 2014 (P less than .05).
Data source: An analysis of data from three AAP Periodic Surveys of Fellows.
Disclosures: The study was funded by the American Academy of Pediatrics and the Maternal and Child Health Bureau, Health Resources and Services Administration, and Department of Health and Human Services. None of the authors reported any financial disclosures.