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Running-Related Injuries Rising in School-Age Youths
DENVER – The annual number of emergency department visits for treatment of running-related injuries in 6- to 18-year-olds climbed by more than one-third from 1994 to 2007, according to a large national study.
More than one-half of these injuries occurred while the affected children and adolescents were at school, Lara Beth McKenzie, Ph.D., reported at the annual meeting of the American Public Health Association.
A particularly interesting finding in this study, believed to be the first-ever analysis of pediatric running-related injuries treated in U.S. emergency departments, was that one in three such injuries involved a running-related fall. This intriguing observation warrants further study with the aim of developing scientific evidence-based guidelines for pediatric running to replace the expert opinion–based recommendations now in place, according to Dr. McKenzie of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.
She presented an analysis of data from the National Electronic Injury Surveillance System for 1994-2007. The surveillance system, operated by the U.S. Consumer Products Safety Commission, collects data from a representative national sample comprising 100 U.S. hospitals.
Extrapolating from the weighted sample, an estimated 225,344 school-age youths were treated for running-related injuries in emergency departments during 1994-2007. The annual rate climbed from 24.2 injuries per 100,000 population in 1994 to 29.3/100,000 in 2007, a 21% increase in incidence. These figures undoubtedly underestimate the true number of running-related injuries, because they don’t include running mishaps treated in the offices of pediatricians, family physicians, or in urgent care clinics, Dr. McKenzie noted. On the other hand, it’s likely that patients with the most severe injuries found their way to the emergency department.
Many running injuries involved the lower extremities. Ankle injuries accounted for 31% of all running injuries, knee injuries 15%, and foot injuries 9%.
Fifty-two percent of all running-related injuries consisted of sprains and strains. Fractures occurred in 16% of patients and were most common when the injury involved an upper extremity.
Focusing on the issue of running-related falls, Dr. McKenzie observed that essentially no literature exists on this important topic. Forty-four percent of children aged 6-11 years had a fall-related injury; indeed, children in this age group were 81% more likely to sustain a fall-related injury than were 12- to 18-year-olds, a group in which overuse injuries were more common than were acute running-related trauma.
Falls tended to result in more serious injuries; they were significantly more likely to involve fractures, lacerations, and/or soft tissue injuries and they led to hospitalization more often than did running injuries not involving a fall.
Three-quarters of all running-related injuries incurred at school were in children aged 6-14 years. Older teens were most likely to get hurt while running in the street or at a sports facility or park.
Dr. McKenzie stressed that she’s by no means anti-running for children. It’s a form of physical activity that effectively fights the pediatric obesity epidemic, and it’s a practical tool for parents and gym teachers because it requires minimal equipment and is available to kids of all skill levels. But scientifically informed guidelines specifically for young runners are needed.
Dr. McKenzie declared no potential conflicts of interest.
DENVER – The annual number of emergency department visits for treatment of running-related injuries in 6- to 18-year-olds climbed by more than one-third from 1994 to 2007, according to a large national study.
More than one-half of these injuries occurred while the affected children and adolescents were at school, Lara Beth McKenzie, Ph.D., reported at the annual meeting of the American Public Health Association.
A particularly interesting finding in this study, believed to be the first-ever analysis of pediatric running-related injuries treated in U.S. emergency departments, was that one in three such injuries involved a running-related fall. This intriguing observation warrants further study with the aim of developing scientific evidence-based guidelines for pediatric running to replace the expert opinion–based recommendations now in place, according to Dr. McKenzie of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.
She presented an analysis of data from the National Electronic Injury Surveillance System for 1994-2007. The surveillance system, operated by the U.S. Consumer Products Safety Commission, collects data from a representative national sample comprising 100 U.S. hospitals.
Extrapolating from the weighted sample, an estimated 225,344 school-age youths were treated for running-related injuries in emergency departments during 1994-2007. The annual rate climbed from 24.2 injuries per 100,000 population in 1994 to 29.3/100,000 in 2007, a 21% increase in incidence. These figures undoubtedly underestimate the true number of running-related injuries, because they don’t include running mishaps treated in the offices of pediatricians, family physicians, or in urgent care clinics, Dr. McKenzie noted. On the other hand, it’s likely that patients with the most severe injuries found their way to the emergency department.
Many running injuries involved the lower extremities. Ankle injuries accounted for 31% of all running injuries, knee injuries 15%, and foot injuries 9%.
Fifty-two percent of all running-related injuries consisted of sprains and strains. Fractures occurred in 16% of patients and were most common when the injury involved an upper extremity.
Focusing on the issue of running-related falls, Dr. McKenzie observed that essentially no literature exists on this important topic. Forty-four percent of children aged 6-11 years had a fall-related injury; indeed, children in this age group were 81% more likely to sustain a fall-related injury than were 12- to 18-year-olds, a group in which overuse injuries were more common than were acute running-related trauma.
Falls tended to result in more serious injuries; they were significantly more likely to involve fractures, lacerations, and/or soft tissue injuries and they led to hospitalization more often than did running injuries not involving a fall.
Three-quarters of all running-related injuries incurred at school were in children aged 6-14 years. Older teens were most likely to get hurt while running in the street or at a sports facility or park.
Dr. McKenzie stressed that she’s by no means anti-running for children. It’s a form of physical activity that effectively fights the pediatric obesity epidemic, and it’s a practical tool for parents and gym teachers because it requires minimal equipment and is available to kids of all skill levels. But scientifically informed guidelines specifically for young runners are needed.
Dr. McKenzie declared no potential conflicts of interest.
DENVER – The annual number of emergency department visits for treatment of running-related injuries in 6- to 18-year-olds climbed by more than one-third from 1994 to 2007, according to a large national study.
More than one-half of these injuries occurred while the affected children and adolescents were at school, Lara Beth McKenzie, Ph.D., reported at the annual meeting of the American Public Health Association.
A particularly interesting finding in this study, believed to be the first-ever analysis of pediatric running-related injuries treated in U.S. emergency departments, was that one in three such injuries involved a running-related fall. This intriguing observation warrants further study with the aim of developing scientific evidence-based guidelines for pediatric running to replace the expert opinion–based recommendations now in place, according to Dr. McKenzie of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.
She presented an analysis of data from the National Electronic Injury Surveillance System for 1994-2007. The surveillance system, operated by the U.S. Consumer Products Safety Commission, collects data from a representative national sample comprising 100 U.S. hospitals.
Extrapolating from the weighted sample, an estimated 225,344 school-age youths were treated for running-related injuries in emergency departments during 1994-2007. The annual rate climbed from 24.2 injuries per 100,000 population in 1994 to 29.3/100,000 in 2007, a 21% increase in incidence. These figures undoubtedly underestimate the true number of running-related injuries, because they don’t include running mishaps treated in the offices of pediatricians, family physicians, or in urgent care clinics, Dr. McKenzie noted. On the other hand, it’s likely that patients with the most severe injuries found their way to the emergency department.
Many running injuries involved the lower extremities. Ankle injuries accounted for 31% of all running injuries, knee injuries 15%, and foot injuries 9%.
Fifty-two percent of all running-related injuries consisted of sprains and strains. Fractures occurred in 16% of patients and were most common when the injury involved an upper extremity.
Focusing on the issue of running-related falls, Dr. McKenzie observed that essentially no literature exists on this important topic. Forty-four percent of children aged 6-11 years had a fall-related injury; indeed, children in this age group were 81% more likely to sustain a fall-related injury than were 12- to 18-year-olds, a group in which overuse injuries were more common than were acute running-related trauma.
Falls tended to result in more serious injuries; they were significantly more likely to involve fractures, lacerations, and/or soft tissue injuries and they led to hospitalization more often than did running injuries not involving a fall.
Three-quarters of all running-related injuries incurred at school were in children aged 6-14 years. Older teens were most likely to get hurt while running in the street or at a sports facility or park.
Dr. McKenzie stressed that she’s by no means anti-running for children. It’s a form of physical activity that effectively fights the pediatric obesity epidemic, and it’s a practical tool for parents and gym teachers because it requires minimal equipment and is available to kids of all skill levels. But scientifically informed guidelines specifically for young runners are needed.
Dr. McKenzie declared no potential conflicts of interest.
FROM THE ANNUAL MEETING OF THE AMERICAN PUBLIC HEALTH ASSOCIATION
Running-Related Injuries Rising in School-Age Youths
DENVER – The annual number of emergency department visits for treatment of running-related injuries in 6- to 18-year-olds climbed by more than one-third from 1994 to 2007, according to a large national study.
More than one-half of these injuries occurred while the affected children and adolescents were at school, Lara Beth McKenzie, Ph.D., reported at the annual meeting of the American Public Health Association.
A particularly interesting finding in this study, believed to be the first-ever analysis of pediatric running-related injuries treated in U.S. emergency departments, was that one in three such injuries involved a running-related fall. This intriguing observation warrants further study with the aim of developing scientific evidence-based guidelines for pediatric running to replace the expert opinion–based recommendations now in place, according to Dr. McKenzie of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.
She presented an analysis of data from the National Electronic Injury Surveillance System for 1994-2007. The surveillance system, operated by the U.S. Consumer Products Safety Commission, collects data from a representative national sample comprising 100 U.S. hospitals.
Extrapolating from the weighted sample, an estimated 225,344 school-age youths were treated for running-related injuries in emergency departments during 1994-2007. The annual rate climbed from 24.2 injuries per 100,000 population in 1994 to 29.3/100,000 in 2007, a 21% increase in incidence. These figures undoubtedly underestimate the true number of running-related injuries, because they don’t include running mishaps treated in the offices of pediatricians, family physicians, or in urgent care clinics, Dr. McKenzie noted. On the other hand, it’s likely that patients with the most severe injuries found their way to the emergency department.
Many running injuries involved the lower extremities. Ankle injuries accounted for 31% of all running injuries, knee injuries 15%, and foot injuries 9%.
Fifty-two percent of all running-related injuries consisted of sprains and strains. Fractures occurred in 16% of patients and were most common when the injury involved an upper extremity.
Focusing on the issue of running-related falls, Dr. McKenzie observed that essentially no literature exists on this important topic. Forty-four percent of children aged 6-11 years had a fall-related injury; indeed, children in this age group were 81% more likely to sustain a fall-related injury than were 12- to 18-year-olds, a group in which overuse injuries were more common than were acute running-related trauma.
Falls tended to result in more serious injuries; they were significantly more likely to involve fractures, lacerations, and/or soft tissue injuries and they led to hospitalization more often than did running injuries not involving a fall.
Three-quarters of all running-related injuries incurred at school were in children aged 6-14 years. Older teens were most likely to get hurt while running in the street or at a sports facility or park.
Dr. McKenzie stressed that she’s by no means anti-running for children. It’s a form of physical activity that effectively fights the pediatric obesity epidemic, and it’s a practical tool for parents and gym teachers because it requires minimal equipment and is available to kids of all skill levels. But scientifically informed guidelines specifically for young runners are needed.
Dr. McKenzie declared no potential conflicts of interest.
DENVER – The annual number of emergency department visits for treatment of running-related injuries in 6- to 18-year-olds climbed by more than one-third from 1994 to 2007, according to a large national study.
More than one-half of these injuries occurred while the affected children and adolescents were at school, Lara Beth McKenzie, Ph.D., reported at the annual meeting of the American Public Health Association.
A particularly interesting finding in this study, believed to be the first-ever analysis of pediatric running-related injuries treated in U.S. emergency departments, was that one in three such injuries involved a running-related fall. This intriguing observation warrants further study with the aim of developing scientific evidence-based guidelines for pediatric running to replace the expert opinion–based recommendations now in place, according to Dr. McKenzie of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.
She presented an analysis of data from the National Electronic Injury Surveillance System for 1994-2007. The surveillance system, operated by the U.S. Consumer Products Safety Commission, collects data from a representative national sample comprising 100 U.S. hospitals.
Extrapolating from the weighted sample, an estimated 225,344 school-age youths were treated for running-related injuries in emergency departments during 1994-2007. The annual rate climbed from 24.2 injuries per 100,000 population in 1994 to 29.3/100,000 in 2007, a 21% increase in incidence. These figures undoubtedly underestimate the true number of running-related injuries, because they don’t include running mishaps treated in the offices of pediatricians, family physicians, or in urgent care clinics, Dr. McKenzie noted. On the other hand, it’s likely that patients with the most severe injuries found their way to the emergency department.
Many running injuries involved the lower extremities. Ankle injuries accounted for 31% of all running injuries, knee injuries 15%, and foot injuries 9%.
Fifty-two percent of all running-related injuries consisted of sprains and strains. Fractures occurred in 16% of patients and were most common when the injury involved an upper extremity.
Focusing on the issue of running-related falls, Dr. McKenzie observed that essentially no literature exists on this important topic. Forty-four percent of children aged 6-11 years had a fall-related injury; indeed, children in this age group were 81% more likely to sustain a fall-related injury than were 12- to 18-year-olds, a group in which overuse injuries were more common than were acute running-related trauma.
Falls tended to result in more serious injuries; they were significantly more likely to involve fractures, lacerations, and/or soft tissue injuries and they led to hospitalization more often than did running injuries not involving a fall.
Three-quarters of all running-related injuries incurred at school were in children aged 6-14 years. Older teens were most likely to get hurt while running in the street or at a sports facility or park.
Dr. McKenzie stressed that she’s by no means anti-running for children. It’s a form of physical activity that effectively fights the pediatric obesity epidemic, and it’s a practical tool for parents and gym teachers because it requires minimal equipment and is available to kids of all skill levels. But scientifically informed guidelines specifically for young runners are needed.
Dr. McKenzie declared no potential conflicts of interest.
DENVER – The annual number of emergency department visits for treatment of running-related injuries in 6- to 18-year-olds climbed by more than one-third from 1994 to 2007, according to a large national study.
More than one-half of these injuries occurred while the affected children and adolescents were at school, Lara Beth McKenzie, Ph.D., reported at the annual meeting of the American Public Health Association.
A particularly interesting finding in this study, believed to be the first-ever analysis of pediatric running-related injuries treated in U.S. emergency departments, was that one in three such injuries involved a running-related fall. This intriguing observation warrants further study with the aim of developing scientific evidence-based guidelines for pediatric running to replace the expert opinion–based recommendations now in place, according to Dr. McKenzie of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.
She presented an analysis of data from the National Electronic Injury Surveillance System for 1994-2007. The surveillance system, operated by the U.S. Consumer Products Safety Commission, collects data from a representative national sample comprising 100 U.S. hospitals.
Extrapolating from the weighted sample, an estimated 225,344 school-age youths were treated for running-related injuries in emergency departments during 1994-2007. The annual rate climbed from 24.2 injuries per 100,000 population in 1994 to 29.3/100,000 in 2007, a 21% increase in incidence. These figures undoubtedly underestimate the true number of running-related injuries, because they don’t include running mishaps treated in the offices of pediatricians, family physicians, or in urgent care clinics, Dr. McKenzie noted. On the other hand, it’s likely that patients with the most severe injuries found their way to the emergency department.
Many running injuries involved the lower extremities. Ankle injuries accounted for 31% of all running injuries, knee injuries 15%, and foot injuries 9%.
Fifty-two percent of all running-related injuries consisted of sprains and strains. Fractures occurred in 16% of patients and were most common when the injury involved an upper extremity.
Focusing on the issue of running-related falls, Dr. McKenzie observed that essentially no literature exists on this important topic. Forty-four percent of children aged 6-11 years had a fall-related injury; indeed, children in this age group were 81% more likely to sustain a fall-related injury than were 12- to 18-year-olds, a group in which overuse injuries were more common than were acute running-related trauma.
Falls tended to result in more serious injuries; they were significantly more likely to involve fractures, lacerations, and/or soft tissue injuries and they led to hospitalization more often than did running injuries not involving a fall.
Three-quarters of all running-related injuries incurred at school were in children aged 6-14 years. Older teens were most likely to get hurt while running in the street or at a sports facility or park.
Dr. McKenzie stressed that she’s by no means anti-running for children. It’s a form of physical activity that effectively fights the pediatric obesity epidemic, and it’s a practical tool for parents and gym teachers because it requires minimal equipment and is available to kids of all skill levels. But scientifically informed guidelines specifically for young runners are needed.
Dr. McKenzie declared no potential conflicts of interest.
FROM THE ANNUAL MEETING OF THE AMERICAN PUBLIC HEALTH ASSOCIATION
Acetylcysteine Nixed for Prevention of Contrast-Induced Nephropathy
CHICAGO – Acetylcysteine does not prevent contrast-induced nephropathy in patients undergoing angiography, according to a large randomized trial.
The Acetylcysteine for the Prevention of Contrast-Induced Nephropathy (ACT) trial was a double-blind study in which 2,308 patients with one or more risk factors for contrast-induced nephropathy (CIN) undergoing coronary or vascular angiography at 46 Brazilian medical centers were randomized to high-dose acetylcysteine or placebo.
The primary end point in ACT, incidence of CIN in the first 48 hours after the procedure, was identical, at 12.7%, in both study arms. A 0.5-mg/dL or greater increase in serum creatinine occurred in 3.9% of the acetylcysteine group and 3.8% of the placebo group. The composite end point of 30-day all-cause mortality or need for dialysis occurred in 2.2% of those who got acetylcysteine and 2.3% of controls, Dr. Otavio Berwanger reported at the annual scientific sessions of the American Heart Association.
This is by far the largest of the 47 trials of acetylcysteine for prevention of CIN conducted to date. ACT was undertaken because the efficacy of acetylcysteine remained unclear since most prior studies were small and/or inadequately designed. The ACT findings are, however, in close accord with those from the handful of prior high-quality trials featuring double-blind randomization and intent-to-treat analysis, said Dr. Berwanger, chair of the ACT steering committee and director of the research institute at the Heart Hospital in Sao Paulo.
Three-quarters of ACT participants had diabetes or a history of renal failure, the two main risk factors for CIN.
The dosing of acetylcysteine in ACT was 1,200 mg given orally twice on the day prior to the procedure and two doses given after the procedure.
Discussant Dr. Brahmajee K. Nallamathu of the University of Michigan, Ann Arbor, said ACT is a high-quality study that’s quickly going to change clinical practice. Acetylcysteine is widely utilized – it’s a class IIB recommendation for patients with chronic renal insufficiency in the latest European Society of Cardiology guidelines. Ten percent of all patients undergoing percutaneous coronary intervention in Michigan in 2009 received acetylcysteine, as did 30% of those with chronic renal insufficiency.
"The argument has consistently been made that, ‘We’re not sure about acetylcysteine, but it’s safe and cheap.’ But it’s important to understand that it could increase length of stay, particularly if it’s started the day before, and it obviously adds to the cost and inconvenience for patients," Dr. Nallamathu said.
He noted that 15 meta-analyses have been conducted since the first small favorable study of acetylcysteine for prevention of CIN generated great excitement among cardiologists upon publication in the New England Journal of Medicine 10 years ago.
"I think this is a great lesson for all of us," Dr. Nallamathu said. "Meta-analysis may exacerbate uncertainty and publication bias, leading to further confusion."
Dr. Mariell Jessup, chair of the AHA scientific sessions program committee, said she was particularly impressed by the excellent design of ACT and the fact that the Brazilian Ministry of Health saw fit to fund a large trial addressing an important clinical question.
Dr. Berwanger promised more good things to come: Already being planned for next year is the ACT II trial, which will compare sodium bicarbonate to normal saline for hydration, as well as several different types of contrast, he said.
Dr. Berwanger and Dr. Nallamathu reported having no relevant financial disclosures.
CHICAGO – Acetylcysteine does not prevent contrast-induced nephropathy in patients undergoing angiography, according to a large randomized trial.
The Acetylcysteine for the Prevention of Contrast-Induced Nephropathy (ACT) trial was a double-blind study in which 2,308 patients with one or more risk factors for contrast-induced nephropathy (CIN) undergoing coronary or vascular angiography at 46 Brazilian medical centers were randomized to high-dose acetylcysteine or placebo.
The primary end point in ACT, incidence of CIN in the first 48 hours after the procedure, was identical, at 12.7%, in both study arms. A 0.5-mg/dL or greater increase in serum creatinine occurred in 3.9% of the acetylcysteine group and 3.8% of the placebo group. The composite end point of 30-day all-cause mortality or need for dialysis occurred in 2.2% of those who got acetylcysteine and 2.3% of controls, Dr. Otavio Berwanger reported at the annual scientific sessions of the American Heart Association.
This is by far the largest of the 47 trials of acetylcysteine for prevention of CIN conducted to date. ACT was undertaken because the efficacy of acetylcysteine remained unclear since most prior studies were small and/or inadequately designed. The ACT findings are, however, in close accord with those from the handful of prior high-quality trials featuring double-blind randomization and intent-to-treat analysis, said Dr. Berwanger, chair of the ACT steering committee and director of the research institute at the Heart Hospital in Sao Paulo.
Three-quarters of ACT participants had diabetes or a history of renal failure, the two main risk factors for CIN.
The dosing of acetylcysteine in ACT was 1,200 mg given orally twice on the day prior to the procedure and two doses given after the procedure.
Discussant Dr. Brahmajee K. Nallamathu of the University of Michigan, Ann Arbor, said ACT is a high-quality study that’s quickly going to change clinical practice. Acetylcysteine is widely utilized – it’s a class IIB recommendation for patients with chronic renal insufficiency in the latest European Society of Cardiology guidelines. Ten percent of all patients undergoing percutaneous coronary intervention in Michigan in 2009 received acetylcysteine, as did 30% of those with chronic renal insufficiency.
"The argument has consistently been made that, ‘We’re not sure about acetylcysteine, but it’s safe and cheap.’ But it’s important to understand that it could increase length of stay, particularly if it’s started the day before, and it obviously adds to the cost and inconvenience for patients," Dr. Nallamathu said.
He noted that 15 meta-analyses have been conducted since the first small favorable study of acetylcysteine for prevention of CIN generated great excitement among cardiologists upon publication in the New England Journal of Medicine 10 years ago.
"I think this is a great lesson for all of us," Dr. Nallamathu said. "Meta-analysis may exacerbate uncertainty and publication bias, leading to further confusion."
Dr. Mariell Jessup, chair of the AHA scientific sessions program committee, said she was particularly impressed by the excellent design of ACT and the fact that the Brazilian Ministry of Health saw fit to fund a large trial addressing an important clinical question.
Dr. Berwanger promised more good things to come: Already being planned for next year is the ACT II trial, which will compare sodium bicarbonate to normal saline for hydration, as well as several different types of contrast, he said.
Dr. Berwanger and Dr. Nallamathu reported having no relevant financial disclosures.
CHICAGO – Acetylcysteine does not prevent contrast-induced nephropathy in patients undergoing angiography, according to a large randomized trial.
The Acetylcysteine for the Prevention of Contrast-Induced Nephropathy (ACT) trial was a double-blind study in which 2,308 patients with one or more risk factors for contrast-induced nephropathy (CIN) undergoing coronary or vascular angiography at 46 Brazilian medical centers were randomized to high-dose acetylcysteine or placebo.
The primary end point in ACT, incidence of CIN in the first 48 hours after the procedure, was identical, at 12.7%, in both study arms. A 0.5-mg/dL or greater increase in serum creatinine occurred in 3.9% of the acetylcysteine group and 3.8% of the placebo group. The composite end point of 30-day all-cause mortality or need for dialysis occurred in 2.2% of those who got acetylcysteine and 2.3% of controls, Dr. Otavio Berwanger reported at the annual scientific sessions of the American Heart Association.
This is by far the largest of the 47 trials of acetylcysteine for prevention of CIN conducted to date. ACT was undertaken because the efficacy of acetylcysteine remained unclear since most prior studies were small and/or inadequately designed. The ACT findings are, however, in close accord with those from the handful of prior high-quality trials featuring double-blind randomization and intent-to-treat analysis, said Dr. Berwanger, chair of the ACT steering committee and director of the research institute at the Heart Hospital in Sao Paulo.
Three-quarters of ACT participants had diabetes or a history of renal failure, the two main risk factors for CIN.
The dosing of acetylcysteine in ACT was 1,200 mg given orally twice on the day prior to the procedure and two doses given after the procedure.
Discussant Dr. Brahmajee K. Nallamathu of the University of Michigan, Ann Arbor, said ACT is a high-quality study that’s quickly going to change clinical practice. Acetylcysteine is widely utilized – it’s a class IIB recommendation for patients with chronic renal insufficiency in the latest European Society of Cardiology guidelines. Ten percent of all patients undergoing percutaneous coronary intervention in Michigan in 2009 received acetylcysteine, as did 30% of those with chronic renal insufficiency.
"The argument has consistently been made that, ‘We’re not sure about acetylcysteine, but it’s safe and cheap.’ But it’s important to understand that it could increase length of stay, particularly if it’s started the day before, and it obviously adds to the cost and inconvenience for patients," Dr. Nallamathu said.
He noted that 15 meta-analyses have been conducted since the first small favorable study of acetylcysteine for prevention of CIN generated great excitement among cardiologists upon publication in the New England Journal of Medicine 10 years ago.
"I think this is a great lesson for all of us," Dr. Nallamathu said. "Meta-analysis may exacerbate uncertainty and publication bias, leading to further confusion."
Dr. Mariell Jessup, chair of the AHA scientific sessions program committee, said she was particularly impressed by the excellent design of ACT and the fact that the Brazilian Ministry of Health saw fit to fund a large trial addressing an important clinical question.
Dr. Berwanger promised more good things to come: Already being planned for next year is the ACT II trial, which will compare sodium bicarbonate to normal saline for hydration, as well as several different types of contrast, he said.
Dr. Berwanger and Dr. Nallamathu reported having no relevant financial disclosures.
Acetylcysteine Nixed for Prevention of Contrast-Induced Nephropathy
CHICAGO – Acetylcysteine does not prevent contrast-induced nephropathy in patients undergoing angiography, according to a large randomized trial.
The Acetylcysteine for the Prevention of Contrast-Induced Nephropathy (ACT) trial was a double-blind study in which 2,308 patients with one or more risk factors for contrast-induced nephropathy (CIN) undergoing coronary or vascular angiography at 46 Brazilian medical centers were randomized to high-dose acetylcysteine or placebo.
The primary end point in ACT, incidence of CIN in the first 48 hours after the procedure, was identical, at 12.7%, in both study arms. A 0.5-mg/dL or greater increase in serum creatinine occurred in 3.9% of the acetylcysteine group and 3.8% of the placebo group. The composite end point of 30-day all-cause mortality or need for dialysis occurred in 2.2% of those who got acetylcysteine and 2.3% of controls, Dr. Otavio Berwanger reported at the annual scientific sessions of the American Heart Association.
This is by far the largest of the 47 trials of acetylcysteine for prevention of CIN conducted to date. ACT was undertaken because the efficacy of acetylcysteine remained unclear since most prior studies were small and/or inadequately designed. The ACT findings are, however, in close accord with those from the handful of prior high-quality trials featuring double-blind randomization and intent-to-treat analysis, said Dr. Berwanger, chair of the ACT steering committee and director of the research institute at the Heart Hospital in Sao Paulo.
Three-quarters of ACT participants had diabetes or a history of renal failure, the two main risk factors for CIN.
The dosing of acetylcysteine in ACT was 1,200 mg given orally twice on the day prior to the procedure and two doses given after the procedure.
Discussant Dr. Brahmajee K. Nallamathu of the University of Michigan, Ann Arbor, said ACT is a high-quality study that’s quickly going to change clinical practice. Acetylcysteine is widely utilized – it’s a class IIB recommendation for patients with chronic renal insufficiency in the latest European Society of Cardiology guidelines. Ten percent of all patients undergoing percutaneous coronary intervention in Michigan in 2009 received acetylcysteine, as did 30% of those with chronic renal insufficiency.
"The argument has consistently been made that, ‘We’re not sure about acetylcysteine, but it’s safe and cheap.’ But it’s important to understand that it could increase length of stay, particularly if it’s started the day before, and it obviously adds to the cost and inconvenience for patients," Dr. Nallamathu said.
He noted that 15 meta-analyses have been conducted since the first small favorable study of acetylcysteine for prevention of CIN generated great excitement among cardiologists upon publication in the New England Journal of Medicine 10 years ago.
"I think this is a great lesson for all of us," Dr. Nallamathu said. "Meta-analysis may exacerbate uncertainty and publication bias, leading to further confusion."
Dr. Mariell Jessup, chair of the AHA scientific sessions program committee, said she was particularly impressed by the excellent design of ACT and the fact that the Brazilian Ministry of Health saw fit to fund a large trial addressing an important clinical question.
Dr. Berwanger promised more good things to come: Already being planned for next year is the ACT II trial, which will compare sodium bicarbonate to normal saline for hydration, as well as several different types of contrast, he said.
Dr. Berwanger and Dr. Nallamathu reported having no relevant financial disclosures.
CHICAGO – Acetylcysteine does not prevent contrast-induced nephropathy in patients undergoing angiography, according to a large randomized trial.
The Acetylcysteine for the Prevention of Contrast-Induced Nephropathy (ACT) trial was a double-blind study in which 2,308 patients with one or more risk factors for contrast-induced nephropathy (CIN) undergoing coronary or vascular angiography at 46 Brazilian medical centers were randomized to high-dose acetylcysteine or placebo.
The primary end point in ACT, incidence of CIN in the first 48 hours after the procedure, was identical, at 12.7%, in both study arms. A 0.5-mg/dL or greater increase in serum creatinine occurred in 3.9% of the acetylcysteine group and 3.8% of the placebo group. The composite end point of 30-day all-cause mortality or need for dialysis occurred in 2.2% of those who got acetylcysteine and 2.3% of controls, Dr. Otavio Berwanger reported at the annual scientific sessions of the American Heart Association.
This is by far the largest of the 47 trials of acetylcysteine for prevention of CIN conducted to date. ACT was undertaken because the efficacy of acetylcysteine remained unclear since most prior studies were small and/or inadequately designed. The ACT findings are, however, in close accord with those from the handful of prior high-quality trials featuring double-blind randomization and intent-to-treat analysis, said Dr. Berwanger, chair of the ACT steering committee and director of the research institute at the Heart Hospital in Sao Paulo.
Three-quarters of ACT participants had diabetes or a history of renal failure, the two main risk factors for CIN.
The dosing of acetylcysteine in ACT was 1,200 mg given orally twice on the day prior to the procedure and two doses given after the procedure.
Discussant Dr. Brahmajee K. Nallamathu of the University of Michigan, Ann Arbor, said ACT is a high-quality study that’s quickly going to change clinical practice. Acetylcysteine is widely utilized – it’s a class IIB recommendation for patients with chronic renal insufficiency in the latest European Society of Cardiology guidelines. Ten percent of all patients undergoing percutaneous coronary intervention in Michigan in 2009 received acetylcysteine, as did 30% of those with chronic renal insufficiency.
"The argument has consistently been made that, ‘We’re not sure about acetylcysteine, but it’s safe and cheap.’ But it’s important to understand that it could increase length of stay, particularly if it’s started the day before, and it obviously adds to the cost and inconvenience for patients," Dr. Nallamathu said.
He noted that 15 meta-analyses have been conducted since the first small favorable study of acetylcysteine for prevention of CIN generated great excitement among cardiologists upon publication in the New England Journal of Medicine 10 years ago.
"I think this is a great lesson for all of us," Dr. Nallamathu said. "Meta-analysis may exacerbate uncertainty and publication bias, leading to further confusion."
Dr. Mariell Jessup, chair of the AHA scientific sessions program committee, said she was particularly impressed by the excellent design of ACT and the fact that the Brazilian Ministry of Health saw fit to fund a large trial addressing an important clinical question.
Dr. Berwanger promised more good things to come: Already being planned for next year is the ACT II trial, which will compare sodium bicarbonate to normal saline for hydration, as well as several different types of contrast, he said.
Dr. Berwanger and Dr. Nallamathu reported having no relevant financial disclosures.
CHICAGO – Acetylcysteine does not prevent contrast-induced nephropathy in patients undergoing angiography, according to a large randomized trial.
The Acetylcysteine for the Prevention of Contrast-Induced Nephropathy (ACT) trial was a double-blind study in which 2,308 patients with one or more risk factors for contrast-induced nephropathy (CIN) undergoing coronary or vascular angiography at 46 Brazilian medical centers were randomized to high-dose acetylcysteine or placebo.
The primary end point in ACT, incidence of CIN in the first 48 hours after the procedure, was identical, at 12.7%, in both study arms. A 0.5-mg/dL or greater increase in serum creatinine occurred in 3.9% of the acetylcysteine group and 3.8% of the placebo group. The composite end point of 30-day all-cause mortality or need for dialysis occurred in 2.2% of those who got acetylcysteine and 2.3% of controls, Dr. Otavio Berwanger reported at the annual scientific sessions of the American Heart Association.
This is by far the largest of the 47 trials of acetylcysteine for prevention of CIN conducted to date. ACT was undertaken because the efficacy of acetylcysteine remained unclear since most prior studies were small and/or inadequately designed. The ACT findings are, however, in close accord with those from the handful of prior high-quality trials featuring double-blind randomization and intent-to-treat analysis, said Dr. Berwanger, chair of the ACT steering committee and director of the research institute at the Heart Hospital in Sao Paulo.
Three-quarters of ACT participants had diabetes or a history of renal failure, the two main risk factors for CIN.
The dosing of acetylcysteine in ACT was 1,200 mg given orally twice on the day prior to the procedure and two doses given after the procedure.
Discussant Dr. Brahmajee K. Nallamathu of the University of Michigan, Ann Arbor, said ACT is a high-quality study that’s quickly going to change clinical practice. Acetylcysteine is widely utilized – it’s a class IIB recommendation for patients with chronic renal insufficiency in the latest European Society of Cardiology guidelines. Ten percent of all patients undergoing percutaneous coronary intervention in Michigan in 2009 received acetylcysteine, as did 30% of those with chronic renal insufficiency.
"The argument has consistently been made that, ‘We’re not sure about acetylcysteine, but it’s safe and cheap.’ But it’s important to understand that it could increase length of stay, particularly if it’s started the day before, and it obviously adds to the cost and inconvenience for patients," Dr. Nallamathu said.
He noted that 15 meta-analyses have been conducted since the first small favorable study of acetylcysteine for prevention of CIN generated great excitement among cardiologists upon publication in the New England Journal of Medicine 10 years ago.
"I think this is a great lesson for all of us," Dr. Nallamathu said. "Meta-analysis may exacerbate uncertainty and publication bias, leading to further confusion."
Dr. Mariell Jessup, chair of the AHA scientific sessions program committee, said she was particularly impressed by the excellent design of ACT and the fact that the Brazilian Ministry of Health saw fit to fund a large trial addressing an important clinical question.
Dr. Berwanger promised more good things to come: Already being planned for next year is the ACT II trial, which will compare sodium bicarbonate to normal saline for hydration, as well as several different types of contrast, he said.
Dr. Berwanger and Dr. Nallamathu reported having no relevant financial disclosures.
Telemonitoring Nixed for Improving Heart Failure Outcomes
CHICAGO – Two major new clinical trials have failed to show improved outcomes for home telemonitoring of patients with heart failure, prompting a critical reappraisal of this once-promising disease management strategy.
"I think this is an important moment in our understanding of the contribution of this novel intervention in the overall management of heart failure – and I think the weight of evidence demonstrates that it is noncontributory," Dr. Clyde W. Yancy said following presentation of the two randomized trials at the annual scientific sessions of the American Heart Association.
"Evidence-based, guideline-driven therapy is the standard of care and should always be our first priority in the treatment of heart failure. The benefit of telemonitoring that has been demonstrated to be present has always been less in the few randomized controlled trials than the cohort studies, and we’ve allowed hyperbole and excitement to guide our judgment, rather than evidence," added Dr. Yancy, medical director of the Baylor Heart and Vascular Institute and chief of cardiothoracic transplantation at Baylor University Medical Center in Dallas.
One of the studies presented at the AHA meeting was the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, a National Heart, Lung, and Blood Institute–funded study involving 1,653 U.S. patients enrolled less than a month after discharge for acute decompensated heart failure.
After 6 months of daily remote telemonitoring using the commercially popular Tel-Assurance system marketed by Pharos Innovations, death and rehospitalization rates in patients using the automated telephone monitoring system were similar to those in controls receiving usual care, reported Dr. Sarwat I. Chaudhry of Yale University, New Haven, Conn.
Similarly, the 2-year Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial, which enrolled 710 German patients with mild-to-moderate heart failure, failed to show that 24/7 access to remote telemonitoring improves all-cause mortality or heart failure hospitalization rates compared to usual care, according to Dr. Stefan D. Anker, professor of cardiology at Charite University Hospital, Berlin.
"There’s no need to parse the data any further," commented Dr. Yancy, a former AHA president. "There was no benefit seen in either of these well-designed clinical trials on outcomes that are important to patients with heart failure."
The findings in these two definitive randomized trials underscore the limitations of meta-analyses based upon small studies with heterogeneous results, including a Cochrane Collaboration review published just a few months ago, he added. The Cochrane report, based upon 11 studies involving 2,710 patients, concluded that telemonitoring programs for patients with chronic heart failure reduced the risk of all-cause mortality by one-third and all-cause hospitalization by 21% (Cochrane Database Syst.Rev. Aug. 4,2010; CD007228.Review).
Health systems are under mounting pressure to reduce hospital readmissions, pressure that will intensify under the Patient Protection and Affordable Care Act. In this regard, Dr. Yancy noted that his recent Google search of the terms ‘telemonitoring and heart failure’ brought up 87,000 entries. The entire first page consisted of commercial advertisements for available systems.
"Every commercial application I opened had an implicit promise, almost a guarantee, of reduced costs and better outcomes for your patients with heart failure. We need to retard this kind of unbridled rush to a technology which, even though seemingly benign, is one that comes at a cost and is not proven to benefit our patients with heart failure," he concluded.
Another discussant of the trials, Dr. Lynne Warner Stevenson, stressed that telemonitoring for heart failure isn’t dead, but for it to be effective the right physiologic variables related to fluid balance need to be monitored. What’s being monitored now – changes in body weight and symptoms – are inadequate as harbingers of decompensation. They often occur too late for out-of-hospital correction. Ambulatory hemodynamic monitoring via implanted devices, now under study, holds more promise.
With more responsive physiologic measures and improved electronic technology, it should be possible for heart failure patients to monitor their disease status and adjust their own diuretic therapy without the labor-intense daily remote involvement of physicians and nurses required by today’s telemonitoring systems, predicted Dr. Stevenson, professor of medicine at Harvard Medical School and director of the cardiomyopathy and heart failure program at Brigham and Women’s Hospital, both in Boston.
"It has certainly been achieved for diabetic management. We never thought this would be possible, but most of our diabetic patients actually adjust their own medications several times a day according to their glucose readings," she noted.
Dr. Chaudhry, Dr. Yancy, and Dr. Stevenson declared having no relevant financial interests. The TIM-HF trial was funded by the German Federal Ministry of Economics and Technology in partnership with several technology companies. Dr. Anker disclosed that he serves as a consultant to one of those companies, Robert Bosch Healthcare.
CHICAGO – Two major new clinical trials have failed to show improved outcomes for home telemonitoring of patients with heart failure, prompting a critical reappraisal of this once-promising disease management strategy.
"I think this is an important moment in our understanding of the contribution of this novel intervention in the overall management of heart failure – and I think the weight of evidence demonstrates that it is noncontributory," Dr. Clyde W. Yancy said following presentation of the two randomized trials at the annual scientific sessions of the American Heart Association.
"Evidence-based, guideline-driven therapy is the standard of care and should always be our first priority in the treatment of heart failure. The benefit of telemonitoring that has been demonstrated to be present has always been less in the few randomized controlled trials than the cohort studies, and we’ve allowed hyperbole and excitement to guide our judgment, rather than evidence," added Dr. Yancy, medical director of the Baylor Heart and Vascular Institute and chief of cardiothoracic transplantation at Baylor University Medical Center in Dallas.
One of the studies presented at the AHA meeting was the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, a National Heart, Lung, and Blood Institute–funded study involving 1,653 U.S. patients enrolled less than a month after discharge for acute decompensated heart failure.
After 6 months of daily remote telemonitoring using the commercially popular Tel-Assurance system marketed by Pharos Innovations, death and rehospitalization rates in patients using the automated telephone monitoring system were similar to those in controls receiving usual care, reported Dr. Sarwat I. Chaudhry of Yale University, New Haven, Conn.
Similarly, the 2-year Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial, which enrolled 710 German patients with mild-to-moderate heart failure, failed to show that 24/7 access to remote telemonitoring improves all-cause mortality or heart failure hospitalization rates compared to usual care, according to Dr. Stefan D. Anker, professor of cardiology at Charite University Hospital, Berlin.
"There’s no need to parse the data any further," commented Dr. Yancy, a former AHA president. "There was no benefit seen in either of these well-designed clinical trials on outcomes that are important to patients with heart failure."
The findings in these two definitive randomized trials underscore the limitations of meta-analyses based upon small studies with heterogeneous results, including a Cochrane Collaboration review published just a few months ago, he added. The Cochrane report, based upon 11 studies involving 2,710 patients, concluded that telemonitoring programs for patients with chronic heart failure reduced the risk of all-cause mortality by one-third and all-cause hospitalization by 21% (Cochrane Database Syst.Rev. Aug. 4,2010; CD007228.Review).
Health systems are under mounting pressure to reduce hospital readmissions, pressure that will intensify under the Patient Protection and Affordable Care Act. In this regard, Dr. Yancy noted that his recent Google search of the terms ‘telemonitoring and heart failure’ brought up 87,000 entries. The entire first page consisted of commercial advertisements for available systems.
"Every commercial application I opened had an implicit promise, almost a guarantee, of reduced costs and better outcomes for your patients with heart failure. We need to retard this kind of unbridled rush to a technology which, even though seemingly benign, is one that comes at a cost and is not proven to benefit our patients with heart failure," he concluded.
Another discussant of the trials, Dr. Lynne Warner Stevenson, stressed that telemonitoring for heart failure isn’t dead, but for it to be effective the right physiologic variables related to fluid balance need to be monitored. What’s being monitored now – changes in body weight and symptoms – are inadequate as harbingers of decompensation. They often occur too late for out-of-hospital correction. Ambulatory hemodynamic monitoring via implanted devices, now under study, holds more promise.
With more responsive physiologic measures and improved electronic technology, it should be possible for heart failure patients to monitor their disease status and adjust their own diuretic therapy without the labor-intense daily remote involvement of physicians and nurses required by today’s telemonitoring systems, predicted Dr. Stevenson, professor of medicine at Harvard Medical School and director of the cardiomyopathy and heart failure program at Brigham and Women’s Hospital, both in Boston.
"It has certainly been achieved for diabetic management. We never thought this would be possible, but most of our diabetic patients actually adjust their own medications several times a day according to their glucose readings," she noted.
Dr. Chaudhry, Dr. Yancy, and Dr. Stevenson declared having no relevant financial interests. The TIM-HF trial was funded by the German Federal Ministry of Economics and Technology in partnership with several technology companies. Dr. Anker disclosed that he serves as a consultant to one of those companies, Robert Bosch Healthcare.
CHICAGO – Two major new clinical trials have failed to show improved outcomes for home telemonitoring of patients with heart failure, prompting a critical reappraisal of this once-promising disease management strategy.
"I think this is an important moment in our understanding of the contribution of this novel intervention in the overall management of heart failure – and I think the weight of evidence demonstrates that it is noncontributory," Dr. Clyde W. Yancy said following presentation of the two randomized trials at the annual scientific sessions of the American Heart Association.
"Evidence-based, guideline-driven therapy is the standard of care and should always be our first priority in the treatment of heart failure. The benefit of telemonitoring that has been demonstrated to be present has always been less in the few randomized controlled trials than the cohort studies, and we’ve allowed hyperbole and excitement to guide our judgment, rather than evidence," added Dr. Yancy, medical director of the Baylor Heart and Vascular Institute and chief of cardiothoracic transplantation at Baylor University Medical Center in Dallas.
One of the studies presented at the AHA meeting was the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, a National Heart, Lung, and Blood Institute–funded study involving 1,653 U.S. patients enrolled less than a month after discharge for acute decompensated heart failure.
After 6 months of daily remote telemonitoring using the commercially popular Tel-Assurance system marketed by Pharos Innovations, death and rehospitalization rates in patients using the automated telephone monitoring system were similar to those in controls receiving usual care, reported Dr. Sarwat I. Chaudhry of Yale University, New Haven, Conn.
Similarly, the 2-year Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial, which enrolled 710 German patients with mild-to-moderate heart failure, failed to show that 24/7 access to remote telemonitoring improves all-cause mortality or heart failure hospitalization rates compared to usual care, according to Dr. Stefan D. Anker, professor of cardiology at Charite University Hospital, Berlin.
"There’s no need to parse the data any further," commented Dr. Yancy, a former AHA president. "There was no benefit seen in either of these well-designed clinical trials on outcomes that are important to patients with heart failure."
The findings in these two definitive randomized trials underscore the limitations of meta-analyses based upon small studies with heterogeneous results, including a Cochrane Collaboration review published just a few months ago, he added. The Cochrane report, based upon 11 studies involving 2,710 patients, concluded that telemonitoring programs for patients with chronic heart failure reduced the risk of all-cause mortality by one-third and all-cause hospitalization by 21% (Cochrane Database Syst.Rev. Aug. 4,2010; CD007228.Review).
Health systems are under mounting pressure to reduce hospital readmissions, pressure that will intensify under the Patient Protection and Affordable Care Act. In this regard, Dr. Yancy noted that his recent Google search of the terms ‘telemonitoring and heart failure’ brought up 87,000 entries. The entire first page consisted of commercial advertisements for available systems.
"Every commercial application I opened had an implicit promise, almost a guarantee, of reduced costs and better outcomes for your patients with heart failure. We need to retard this kind of unbridled rush to a technology which, even though seemingly benign, is one that comes at a cost and is not proven to benefit our patients with heart failure," he concluded.
Another discussant of the trials, Dr. Lynne Warner Stevenson, stressed that telemonitoring for heart failure isn’t dead, but for it to be effective the right physiologic variables related to fluid balance need to be monitored. What’s being monitored now – changes in body weight and symptoms – are inadequate as harbingers of decompensation. They often occur too late for out-of-hospital correction. Ambulatory hemodynamic monitoring via implanted devices, now under study, holds more promise.
With more responsive physiologic measures and improved electronic technology, it should be possible for heart failure patients to monitor their disease status and adjust their own diuretic therapy without the labor-intense daily remote involvement of physicians and nurses required by today’s telemonitoring systems, predicted Dr. Stevenson, professor of medicine at Harvard Medical School and director of the cardiomyopathy and heart failure program at Brigham and Women’s Hospital, both in Boston.
"It has certainly been achieved for diabetic management. We never thought this would be possible, but most of our diabetic patients actually adjust their own medications several times a day according to their glucose readings," she noted.
Dr. Chaudhry, Dr. Yancy, and Dr. Stevenson declared having no relevant financial interests. The TIM-HF trial was funded by the German Federal Ministry of Economics and Technology in partnership with several technology companies. Dr. Anker disclosed that he serves as a consultant to one of those companies, Robert Bosch Healthcare.
FROM THE ANNUAL SCIENTIFIC SESSIONS OF THE AMERICAN HEART ASSOCIATION
Telemonitoring Nixed for Improving Heart Failure Outcomes
CHICAGO – Two major new clinical trials have failed to show improved outcomes for home telemonitoring of patients with heart failure, prompting a critical reappraisal of this once-promising disease management strategy.
"I think this is an important moment in our understanding of the contribution of this novel intervention in the overall management of heart failure – and I think the weight of evidence demonstrates that it is noncontributory," Dr. Clyde W. Yancy said following presentation of the two randomized trials at the annual scientific sessions of the American Heart Association.
"Evidence-based, guideline-driven therapy is the standard of care and should always be our first priority in the treatment of heart failure. The benefit of telemonitoring that has been demonstrated to be present has always been less in the few randomized controlled trials than the cohort studies, and we’ve allowed hyperbole and excitement to guide our judgment, rather than evidence," added Dr. Yancy, medical director of the Baylor Heart and Vascular Institute and chief of cardiothoracic transplantation at Baylor University Medical Center in Dallas.
One of the studies presented at the AHA meeting was the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, a National Heart, Lung, and Blood Institute–funded study involving 1,653 U.S. patients enrolled less than a month after discharge for acute decompensated heart failure.
After 6 months of daily remote telemonitoring using the commercially popular Tel-Assurance system marketed by Pharos Innovations, death and rehospitalization rates in patients using the automated telephone monitoring system were similar to those in controls receiving usual care, reported Dr. Sarwat I. Chaudhry of Yale University, New Haven, Conn.
Similarly, the 2-year Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial, which enrolled 710 German patients with mild-to-moderate heart failure, failed to show that 24/7 access to remote telemonitoring improves all-cause mortality or heart failure hospitalization rates compared to usual care, according to Dr. Stefan D. Anker, professor of cardiology at Charite University Hospital, Berlin.
"There’s no need to parse the data any further," commented Dr. Yancy, a former AHA president. "There was no benefit seen in either of these well-designed clinical trials on outcomes that are important to patients with heart failure."
The findings in these two definitive randomized trials underscore the limitations of meta-analyses based upon small studies with heterogeneous results, including a Cochrane Collaboration review published just a few months ago, he added. The Cochrane report, based upon 11 studies involving 2,710 patients, concluded that telemonitoring programs for patients with chronic heart failure reduced the risk of all-cause mortality by one-third and all-cause hospitalization by 21% (Cochrane Database Syst.Rev. Aug. 4,2010; CD007228.Review).
Health systems are under mounting pressure to reduce hospital readmissions, pressure that will intensify under the Patient Protection and Affordable Care Act. In this regard, Dr. Yancy noted that his recent Google search of the terms ‘telemonitoring and heart failure’ brought up 87,000 entries. The entire first page consisted of commercial advertisements for available systems.
"Every commercial application I opened had an implicit promise, almost a guarantee, of reduced costs and better outcomes for your patients with heart failure. We need to retard this kind of unbridled rush to a technology which, even though seemingly benign, is one that comes at a cost and is not proven to benefit our patients with heart failure," he concluded.
Another discussant of the trials, Dr. Lynne Warner Stevenson, stressed that telemonitoring for heart failure isn’t dead, but for it to be effective the right physiologic variables related to fluid balance need to be monitored. What’s being monitored now – changes in body weight and symptoms – are inadequate as harbingers of decompensation. They often occur too late for out-of-hospital correction. Ambulatory hemodynamic monitoring via implanted devices, now under study, holds more promise.
With more responsive physiologic measures and improved electronic technology, it should be possible for heart failure patients to monitor their disease status and adjust their own diuretic therapy without the labor-intense daily remote involvement of physicians and nurses required by today’s telemonitoring systems, predicted Dr. Stevenson, professor of medicine at Harvard Medical School and director of the cardiomyopathy and heart failure program at Brigham and Women’s Hospital, both in Boston.
"It has certainly been achieved for diabetic management. We never thought this would be possible, but most of our diabetic patients actually adjust their own medications several times a day according to their glucose readings," she noted.
Dr. Chaudhry, Dr. Yancy, and Dr. Stevenson declared having no relevant financial interests. The TIM-HF trial was funded by the German Federal Ministry of Economics and Technology in partnership with several technology companies. Dr. Anker disclosed that he serves as a consultant to one of those companies, Robert Bosch Healthcare.
CHICAGO – Two major new clinical trials have failed to show improved outcomes for home telemonitoring of patients with heart failure, prompting a critical reappraisal of this once-promising disease management strategy.
"I think this is an important moment in our understanding of the contribution of this novel intervention in the overall management of heart failure – and I think the weight of evidence demonstrates that it is noncontributory," Dr. Clyde W. Yancy said following presentation of the two randomized trials at the annual scientific sessions of the American Heart Association.
"Evidence-based, guideline-driven therapy is the standard of care and should always be our first priority in the treatment of heart failure. The benefit of telemonitoring that has been demonstrated to be present has always been less in the few randomized controlled trials than the cohort studies, and we’ve allowed hyperbole and excitement to guide our judgment, rather than evidence," added Dr. Yancy, medical director of the Baylor Heart and Vascular Institute and chief of cardiothoracic transplantation at Baylor University Medical Center in Dallas.
One of the studies presented at the AHA meeting was the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, a National Heart, Lung, and Blood Institute–funded study involving 1,653 U.S. patients enrolled less than a month after discharge for acute decompensated heart failure.
After 6 months of daily remote telemonitoring using the commercially popular Tel-Assurance system marketed by Pharos Innovations, death and rehospitalization rates in patients using the automated telephone monitoring system were similar to those in controls receiving usual care, reported Dr. Sarwat I. Chaudhry of Yale University, New Haven, Conn.
Similarly, the 2-year Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial, which enrolled 710 German patients with mild-to-moderate heart failure, failed to show that 24/7 access to remote telemonitoring improves all-cause mortality or heart failure hospitalization rates compared to usual care, according to Dr. Stefan D. Anker, professor of cardiology at Charite University Hospital, Berlin.
"There’s no need to parse the data any further," commented Dr. Yancy, a former AHA president. "There was no benefit seen in either of these well-designed clinical trials on outcomes that are important to patients with heart failure."
The findings in these two definitive randomized trials underscore the limitations of meta-analyses based upon small studies with heterogeneous results, including a Cochrane Collaboration review published just a few months ago, he added. The Cochrane report, based upon 11 studies involving 2,710 patients, concluded that telemonitoring programs for patients with chronic heart failure reduced the risk of all-cause mortality by one-third and all-cause hospitalization by 21% (Cochrane Database Syst.Rev. Aug. 4,2010; CD007228.Review).
Health systems are under mounting pressure to reduce hospital readmissions, pressure that will intensify under the Patient Protection and Affordable Care Act. In this regard, Dr. Yancy noted that his recent Google search of the terms ‘telemonitoring and heart failure’ brought up 87,000 entries. The entire first page consisted of commercial advertisements for available systems.
"Every commercial application I opened had an implicit promise, almost a guarantee, of reduced costs and better outcomes for your patients with heart failure. We need to retard this kind of unbridled rush to a technology which, even though seemingly benign, is one that comes at a cost and is not proven to benefit our patients with heart failure," he concluded.
Another discussant of the trials, Dr. Lynne Warner Stevenson, stressed that telemonitoring for heart failure isn’t dead, but for it to be effective the right physiologic variables related to fluid balance need to be monitored. What’s being monitored now – changes in body weight and symptoms – are inadequate as harbingers of decompensation. They often occur too late for out-of-hospital correction. Ambulatory hemodynamic monitoring via implanted devices, now under study, holds more promise.
With more responsive physiologic measures and improved electronic technology, it should be possible for heart failure patients to monitor their disease status and adjust their own diuretic therapy without the labor-intense daily remote involvement of physicians and nurses required by today’s telemonitoring systems, predicted Dr. Stevenson, professor of medicine at Harvard Medical School and director of the cardiomyopathy and heart failure program at Brigham and Women’s Hospital, both in Boston.
"It has certainly been achieved for diabetic management. We never thought this would be possible, but most of our diabetic patients actually adjust their own medications several times a day according to their glucose readings," she noted.
Dr. Chaudhry, Dr. Yancy, and Dr. Stevenson declared having no relevant financial interests. The TIM-HF trial was funded by the German Federal Ministry of Economics and Technology in partnership with several technology companies. Dr. Anker disclosed that he serves as a consultant to one of those companies, Robert Bosch Healthcare.
CHICAGO – Two major new clinical trials have failed to show improved outcomes for home telemonitoring of patients with heart failure, prompting a critical reappraisal of this once-promising disease management strategy.
"I think this is an important moment in our understanding of the contribution of this novel intervention in the overall management of heart failure – and I think the weight of evidence demonstrates that it is noncontributory," Dr. Clyde W. Yancy said following presentation of the two randomized trials at the annual scientific sessions of the American Heart Association.
"Evidence-based, guideline-driven therapy is the standard of care and should always be our first priority in the treatment of heart failure. The benefit of telemonitoring that has been demonstrated to be present has always been less in the few randomized controlled trials than the cohort studies, and we’ve allowed hyperbole and excitement to guide our judgment, rather than evidence," added Dr. Yancy, medical director of the Baylor Heart and Vascular Institute and chief of cardiothoracic transplantation at Baylor University Medical Center in Dallas.
One of the studies presented at the AHA meeting was the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, a National Heart, Lung, and Blood Institute–funded study involving 1,653 U.S. patients enrolled less than a month after discharge for acute decompensated heart failure.
After 6 months of daily remote telemonitoring using the commercially popular Tel-Assurance system marketed by Pharos Innovations, death and rehospitalization rates in patients using the automated telephone monitoring system were similar to those in controls receiving usual care, reported Dr. Sarwat I. Chaudhry of Yale University, New Haven, Conn.
Similarly, the 2-year Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial, which enrolled 710 German patients with mild-to-moderate heart failure, failed to show that 24/7 access to remote telemonitoring improves all-cause mortality or heart failure hospitalization rates compared to usual care, according to Dr. Stefan D. Anker, professor of cardiology at Charite University Hospital, Berlin.
"There’s no need to parse the data any further," commented Dr. Yancy, a former AHA president. "There was no benefit seen in either of these well-designed clinical trials on outcomes that are important to patients with heart failure."
The findings in these two definitive randomized trials underscore the limitations of meta-analyses based upon small studies with heterogeneous results, including a Cochrane Collaboration review published just a few months ago, he added. The Cochrane report, based upon 11 studies involving 2,710 patients, concluded that telemonitoring programs for patients with chronic heart failure reduced the risk of all-cause mortality by one-third and all-cause hospitalization by 21% (Cochrane Database Syst.Rev. Aug. 4,2010; CD007228.Review).
Health systems are under mounting pressure to reduce hospital readmissions, pressure that will intensify under the Patient Protection and Affordable Care Act. In this regard, Dr. Yancy noted that his recent Google search of the terms ‘telemonitoring and heart failure’ brought up 87,000 entries. The entire first page consisted of commercial advertisements for available systems.
"Every commercial application I opened had an implicit promise, almost a guarantee, of reduced costs and better outcomes for your patients with heart failure. We need to retard this kind of unbridled rush to a technology which, even though seemingly benign, is one that comes at a cost and is not proven to benefit our patients with heart failure," he concluded.
Another discussant of the trials, Dr. Lynne Warner Stevenson, stressed that telemonitoring for heart failure isn’t dead, but for it to be effective the right physiologic variables related to fluid balance need to be monitored. What’s being monitored now – changes in body weight and symptoms – are inadequate as harbingers of decompensation. They often occur too late for out-of-hospital correction. Ambulatory hemodynamic monitoring via implanted devices, now under study, holds more promise.
With more responsive physiologic measures and improved electronic technology, it should be possible for heart failure patients to monitor their disease status and adjust their own diuretic therapy without the labor-intense daily remote involvement of physicians and nurses required by today’s telemonitoring systems, predicted Dr. Stevenson, professor of medicine at Harvard Medical School and director of the cardiomyopathy and heart failure program at Brigham and Women’s Hospital, both in Boston.
"It has certainly been achieved for diabetic management. We never thought this would be possible, but most of our diabetic patients actually adjust their own medications several times a day according to their glucose readings," she noted.
Dr. Chaudhry, Dr. Yancy, and Dr. Stevenson declared having no relevant financial interests. The TIM-HF trial was funded by the German Federal Ministry of Economics and Technology in partnership with several technology companies. Dr. Anker disclosed that he serves as a consultant to one of those companies, Robert Bosch Healthcare.
FROM THE ANNUAL SCIENTIFIC SESSIONS OF THE AMERICAN HEART ASSOCIATION
Girls' Soccer Second to Football for High School Sports Concussion
DENVER – High school girls have twice the concussion rate of boys playing similar sports, according to an 11-year study conducted in a large public school district.
Not surprisingly, football accounted for the most concussions among participants in the six boys’ and six girls’ sports examined in the long-term study. But the sport with the second-highest concussion rate was girls’ soccer, classified as an incidental contact sport rather than a collision sport, Andrew E. Lincoln, ScD, said at the annual meeting of the American Public Health Association.
He presented a retrospective study of all concussions occurring in athletes participating in 12 sports at 25 high schools in Fairfax County, Va., during 1997-2008. This suburban Washington school district was the ideal location for such a study because as a matter of district policy a certified athletic trainer was on site for all games and practices, and all injuries – big or small – had to be logged electronically on a daily basis, explained Dr. Lincoln of the sports medicine research center at Union Memorial Hospital, Baltimore.
During the study period, there were 2,479 observed concussions during nearly 11 million athletic exposures. An athletic exposure was defined as a game or practice. Football led the way, accounting for 53% of all concussions. The other boys’ sports included in the study were lacrosse, soccer, wrestling, basketball, and baseball. The girls’ sports were soccer, which accounted for 7% of all concussions among high school athletes, along with lacrosse, basketball, softball, field hockey, and cheerleading. Another 15 sports are offered in the school district, but they account for relatively few concussions.
Seventy-five percent of all concussions occurred in boys’ sports, which accounted for 53% of athletic exposures. "In terms of who walks in the door to the athletic trainer’s room with a concussion, it’s a 3-to-1 ratio of boys to girls," Dr. Lincoln observed.
Football had a concussion incidence of 0.6 cases per 1,000 athletic exposures. This was followed by girls’ soccer, at 0.35 per 1,000 athletic exposures, and boys’ lacrosse, at 0.30 per 1,000. Baseball and cheerleading had the lowest rates at 0.06 per 1,000. That means the incidence of concussion was 10.9-fold greater in football than in baseball, and 6-fold more in girls’ soccer than in cheerleading.
Although cheerleading had the lowest concussion incidence among girls’ sports, it accounted for 5% of all athletic concussions, putting it in a fourth-place tie with wrestling for that dubious distinction.
In the three sports that are closely similar for boys and girls – basketball, soccer, and baseball/softball – the concussion rate was consistently twice as great for girls. This gender disparity has previously been described at the collegiate level, but this is the first study to demonstrate the same phenomenon at the high school level, according to the researcher.
While both boys and girls play high school lacrosse, these are two very different sports. In boys’ lacrosse, it’s a full-on collision sport, helmets and pads required. For girls it’s an incidental contact sport requiring only protective eye wear.
The concussion rate in the school district increased by an average of 16.5% annually during the study period for a 4.6-fold jump between 1997 and 2008. The increase was seen in all 12 sports. Football had the smallest annual increase rate, at 8%, while concussions in cheerleaders jumped by 26% per year and in wrestlers by 27% annually.
"The major concerns are football, girls’ soccer, and boys’ lacrosse. However, the increasing incidence across all sports suggests the focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk," according to Dr. Lincoln.
It’s unclear whether the explanation for the marked rise in concussion incidence over time is that sports have gotten more aggressive, or coding and diagnosis have improved. Most likely the answer lies in a combination of both, he said.
Why the markedly higher concussion risk in girls compared with boys playing the same sports? Dr. Lincoln said other investigators have put forth three hypotheses. One is that boys’ greater muscle mass can absorb more of the impact energy that would otherwise be transferred to the brain. Another possibility is that girls might be culturally more willing to report injuries and seek care. And perhaps hormonal differences are at work as well; studies have shown that girls take longer to recover from concussions.
Governing bodies for professional and amateur sports are now taking concussions and their potential long-term sequelae far more seriously than even a few years ago, Dr. Lincoln said
"I think if we look at this in terms of any other public health issue we would all be pretty outraged, so I’m kind of glad to see the outrage in society right now, and the movement on policy issues as well," he said.
His study was financially supported by the U.S. Lacrosse Sports Science and Safety Committee. Dr. Lincoln declared having no relevant financial interests.
DENVER – High school girls have twice the concussion rate of boys playing similar sports, according to an 11-year study conducted in a large public school district.
Not surprisingly, football accounted for the most concussions among participants in the six boys’ and six girls’ sports examined in the long-term study. But the sport with the second-highest concussion rate was girls’ soccer, classified as an incidental contact sport rather than a collision sport, Andrew E. Lincoln, ScD, said at the annual meeting of the American Public Health Association.
He presented a retrospective study of all concussions occurring in athletes participating in 12 sports at 25 high schools in Fairfax County, Va., during 1997-2008. This suburban Washington school district was the ideal location for such a study because as a matter of district policy a certified athletic trainer was on site for all games and practices, and all injuries – big or small – had to be logged electronically on a daily basis, explained Dr. Lincoln of the sports medicine research center at Union Memorial Hospital, Baltimore.
During the study period, there were 2,479 observed concussions during nearly 11 million athletic exposures. An athletic exposure was defined as a game or practice. Football led the way, accounting for 53% of all concussions. The other boys’ sports included in the study were lacrosse, soccer, wrestling, basketball, and baseball. The girls’ sports were soccer, which accounted for 7% of all concussions among high school athletes, along with lacrosse, basketball, softball, field hockey, and cheerleading. Another 15 sports are offered in the school district, but they account for relatively few concussions.
Seventy-five percent of all concussions occurred in boys’ sports, which accounted for 53% of athletic exposures. "In terms of who walks in the door to the athletic trainer’s room with a concussion, it’s a 3-to-1 ratio of boys to girls," Dr. Lincoln observed.
Football had a concussion incidence of 0.6 cases per 1,000 athletic exposures. This was followed by girls’ soccer, at 0.35 per 1,000 athletic exposures, and boys’ lacrosse, at 0.30 per 1,000. Baseball and cheerleading had the lowest rates at 0.06 per 1,000. That means the incidence of concussion was 10.9-fold greater in football than in baseball, and 6-fold more in girls’ soccer than in cheerleading.
Although cheerleading had the lowest concussion incidence among girls’ sports, it accounted for 5% of all athletic concussions, putting it in a fourth-place tie with wrestling for that dubious distinction.
In the three sports that are closely similar for boys and girls – basketball, soccer, and baseball/softball – the concussion rate was consistently twice as great for girls. This gender disparity has previously been described at the collegiate level, but this is the first study to demonstrate the same phenomenon at the high school level, according to the researcher.
While both boys and girls play high school lacrosse, these are two very different sports. In boys’ lacrosse, it’s a full-on collision sport, helmets and pads required. For girls it’s an incidental contact sport requiring only protective eye wear.
The concussion rate in the school district increased by an average of 16.5% annually during the study period for a 4.6-fold jump between 1997 and 2008. The increase was seen in all 12 sports. Football had the smallest annual increase rate, at 8%, while concussions in cheerleaders jumped by 26% per year and in wrestlers by 27% annually.
"The major concerns are football, girls’ soccer, and boys’ lacrosse. However, the increasing incidence across all sports suggests the focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk," according to Dr. Lincoln.
It’s unclear whether the explanation for the marked rise in concussion incidence over time is that sports have gotten more aggressive, or coding and diagnosis have improved. Most likely the answer lies in a combination of both, he said.
Why the markedly higher concussion risk in girls compared with boys playing the same sports? Dr. Lincoln said other investigators have put forth three hypotheses. One is that boys’ greater muscle mass can absorb more of the impact energy that would otherwise be transferred to the brain. Another possibility is that girls might be culturally more willing to report injuries and seek care. And perhaps hormonal differences are at work as well; studies have shown that girls take longer to recover from concussions.
Governing bodies for professional and amateur sports are now taking concussions and their potential long-term sequelae far more seriously than even a few years ago, Dr. Lincoln said
"I think if we look at this in terms of any other public health issue we would all be pretty outraged, so I’m kind of glad to see the outrage in society right now, and the movement on policy issues as well," he said.
His study was financially supported by the U.S. Lacrosse Sports Science and Safety Committee. Dr. Lincoln declared having no relevant financial interests.
DENVER – High school girls have twice the concussion rate of boys playing similar sports, according to an 11-year study conducted in a large public school district.
Not surprisingly, football accounted for the most concussions among participants in the six boys’ and six girls’ sports examined in the long-term study. But the sport with the second-highest concussion rate was girls’ soccer, classified as an incidental contact sport rather than a collision sport, Andrew E. Lincoln, ScD, said at the annual meeting of the American Public Health Association.
He presented a retrospective study of all concussions occurring in athletes participating in 12 sports at 25 high schools in Fairfax County, Va., during 1997-2008. This suburban Washington school district was the ideal location for such a study because as a matter of district policy a certified athletic trainer was on site for all games and practices, and all injuries – big or small – had to be logged electronically on a daily basis, explained Dr. Lincoln of the sports medicine research center at Union Memorial Hospital, Baltimore.
During the study period, there were 2,479 observed concussions during nearly 11 million athletic exposures. An athletic exposure was defined as a game or practice. Football led the way, accounting for 53% of all concussions. The other boys’ sports included in the study were lacrosse, soccer, wrestling, basketball, and baseball. The girls’ sports were soccer, which accounted for 7% of all concussions among high school athletes, along with lacrosse, basketball, softball, field hockey, and cheerleading. Another 15 sports are offered in the school district, but they account for relatively few concussions.
Seventy-five percent of all concussions occurred in boys’ sports, which accounted for 53% of athletic exposures. "In terms of who walks in the door to the athletic trainer’s room with a concussion, it’s a 3-to-1 ratio of boys to girls," Dr. Lincoln observed.
Football had a concussion incidence of 0.6 cases per 1,000 athletic exposures. This was followed by girls’ soccer, at 0.35 per 1,000 athletic exposures, and boys’ lacrosse, at 0.30 per 1,000. Baseball and cheerleading had the lowest rates at 0.06 per 1,000. That means the incidence of concussion was 10.9-fold greater in football than in baseball, and 6-fold more in girls’ soccer than in cheerleading.
Although cheerleading had the lowest concussion incidence among girls’ sports, it accounted for 5% of all athletic concussions, putting it in a fourth-place tie with wrestling for that dubious distinction.
In the three sports that are closely similar for boys and girls – basketball, soccer, and baseball/softball – the concussion rate was consistently twice as great for girls. This gender disparity has previously been described at the collegiate level, but this is the first study to demonstrate the same phenomenon at the high school level, according to the researcher.
While both boys and girls play high school lacrosse, these are two very different sports. In boys’ lacrosse, it’s a full-on collision sport, helmets and pads required. For girls it’s an incidental contact sport requiring only protective eye wear.
The concussion rate in the school district increased by an average of 16.5% annually during the study period for a 4.6-fold jump between 1997 and 2008. The increase was seen in all 12 sports. Football had the smallest annual increase rate, at 8%, while concussions in cheerleaders jumped by 26% per year and in wrestlers by 27% annually.
"The major concerns are football, girls’ soccer, and boys’ lacrosse. However, the increasing incidence across all sports suggests the focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk," according to Dr. Lincoln.
It’s unclear whether the explanation for the marked rise in concussion incidence over time is that sports have gotten more aggressive, or coding and diagnosis have improved. Most likely the answer lies in a combination of both, he said.
Why the markedly higher concussion risk in girls compared with boys playing the same sports? Dr. Lincoln said other investigators have put forth three hypotheses. One is that boys’ greater muscle mass can absorb more of the impact energy that would otherwise be transferred to the brain. Another possibility is that girls might be culturally more willing to report injuries and seek care. And perhaps hormonal differences are at work as well; studies have shown that girls take longer to recover from concussions.
Governing bodies for professional and amateur sports are now taking concussions and their potential long-term sequelae far more seriously than even a few years ago, Dr. Lincoln said
"I think if we look at this in terms of any other public health issue we would all be pretty outraged, so I’m kind of glad to see the outrage in society right now, and the movement on policy issues as well," he said.
His study was financially supported by the U.S. Lacrosse Sports Science and Safety Committee. Dr. Lincoln declared having no relevant financial interests.
FROM THE ANNUAL MEETING OF THE AMERICAN PUBLIC HEALTH ASSOCIATION
Major Finding: Football had a concussion incidence of 0.6 cases per 1,000 athletic games or practices. The sport with the second highest incidence was girls’ soccer, at 0.35 per 1,000 athletic exposures.
Data Source: A retrospective analysis of all 2,479 observed concussions during nearly 11 million athletic games or practices in 12 sports at 25 high schools in Fairfax County, Va., during 1997-2008.
Disclosures: The study was financially supported by the U.S. Lacrosse Sports Science and Safety Committee. Dr. Lincoln declared having no relevant financial interests.
Hypertexting by Teens Linked to Increased Health Risks
DENVER – Teens who overuse cell phone texting or social networking Web sites have disturbingly high rates of a wide range of health risk behaviors, a large cross-sectional study showed.
"The startling results of this study suggest that, when left unchecked, texting and other widely popular methods of staying connected can have dangerous health effects on teenagers," possibly associated with a general lack of adult supervision, Dr. Scott Frank said at the annual meeting of the American Public Health Association.
He presented the results of a survey completed anonymously by 4,257 teens at 20 schools in Cuyahoga County, Ohio. Of the responders, 20% were what Dr. Frank classified as "hypertexters," based upon their self-reported texting an average of 120 or more times per day on school days.
Based upon their responses on the Youth Risk Behavior Survey, completed as part of the anonymous survey, these hypertexters were an adjusted twofold more likely to have ever tried alcohol, 43% more likely to be binge drinkers, 32% more likely to be current users of marijuana, and 40% more likely to have tried cigarettes than kids who texted less or, as was true for 22% of students, not at all.
They were also 42% more likely to report feeling depressive sadness, 55% more likely to have been in a physical fight during the past year, 3.4-fold more likely to have ever had sex, and 88% more likely to have had four or more sexual partners. In addition, they were 39% more likely to report skipping class, 63% more likely to average less than 7 hours of sleep, 60% more likely to get poor grades, 39% more likely to watch television for 3 hours or more daily, and 67% more likely to have been a victim of cyberbullying.
They were also 2.7-fold more likely to rarely or never wear a bike helmet and 39% more likely to rarely or never wear a seat belt, reported Dr. Frank of Case Western Reserve University, Cleveland.
The relative risks were adjusted for age, sex, race, parental education, and household structure. This was necessary because hypertexters were more likely to be minority females of low socioeconomic status with no father in the home.
Hypernetworking was defined as spending an average of more than 3 hours per school day on Facebook or other social networking Web sites. This threshold was met by 11.5% of students; another 22% reported having no involvement at all with such Web sites. Hypernetworkers were an adjusted 79% more likely to have tried alcohol, 69% more likely to be current binge drinkers, and 32% more likely to be current users of marijuana. They were also twice as likely to have had sex before age 13, and 60% more likely to have had four or more sexual partners.
Like the hypertexters, the hypernetworkers were more likely to get poor grades, watch a lot of television, get too little sleep, have been in a physical fight during the past 12 months, and experience cyberbullying. They were also 2.5 times more likely to report rarely or never using a bike helmet or seat belt.
A particularly notable finding was the overall poor emotional health of the hypernetworkers, Dr. Frank continued. They were 2.5 times more likely to indicate they had made a suicide attempt, 92% more likely to report feeling depressive sadness, 2.5-fold more likely to have engaged in deliberate self-harm without suicidal intent, 2.2-fold more likely to report feeling a high level of stress, and 3.4-fold more likely to characterize themselves as having an eating disorder.
The highest levels of health risk behaviors were reported by the 3.8% of teens who were both hypertexters and hypernetworkers, according to Dr. Frank.
He noted that a recent national study by the Kaiser Family Foundation concluded that 69% of 11- to -14-year olds and 85% of 15- to 18-year-olds owned a cell phone in 2009. Nearly half of students in grades 7-12 reported texting daily, averaging 57 texts and devoting 1 hour and 35 minutes per day to the activity. Of the texters, 84% indicated their parents had no rules regarding text messaging.
The lack of parental oversight regarding this explosively popular activity is a key point, in Dr. Frank’s view. It’s not that hypertexting directly leads to sex, drugs, and vehicular recklessness; rather, it’s that hypertexting bespeaks a lack of parental control having broad ramifications.
"This study should be a wake-up call for parents to not only help their children stay safe by not texting and driving, but [also] by discouraging excessive use of the cell phone or social Web sites in general," he concluded.
His study was funded by the Cuyahoga County Board of Health and other governmental agencies. Dr. Frank reported having no relevant financial conflicts of interest.
DENVER – Teens who overuse cell phone texting or social networking Web sites have disturbingly high rates of a wide range of health risk behaviors, a large cross-sectional study showed.
"The startling results of this study suggest that, when left unchecked, texting and other widely popular methods of staying connected can have dangerous health effects on teenagers," possibly associated with a general lack of adult supervision, Dr. Scott Frank said at the annual meeting of the American Public Health Association.
He presented the results of a survey completed anonymously by 4,257 teens at 20 schools in Cuyahoga County, Ohio. Of the responders, 20% were what Dr. Frank classified as "hypertexters," based upon their self-reported texting an average of 120 or more times per day on school days.
Based upon their responses on the Youth Risk Behavior Survey, completed as part of the anonymous survey, these hypertexters were an adjusted twofold more likely to have ever tried alcohol, 43% more likely to be binge drinkers, 32% more likely to be current users of marijuana, and 40% more likely to have tried cigarettes than kids who texted less or, as was true for 22% of students, not at all.
They were also 42% more likely to report feeling depressive sadness, 55% more likely to have been in a physical fight during the past year, 3.4-fold more likely to have ever had sex, and 88% more likely to have had four or more sexual partners. In addition, they were 39% more likely to report skipping class, 63% more likely to average less than 7 hours of sleep, 60% more likely to get poor grades, 39% more likely to watch television for 3 hours or more daily, and 67% more likely to have been a victim of cyberbullying.
They were also 2.7-fold more likely to rarely or never wear a bike helmet and 39% more likely to rarely or never wear a seat belt, reported Dr. Frank of Case Western Reserve University, Cleveland.
The relative risks were adjusted for age, sex, race, parental education, and household structure. This was necessary because hypertexters were more likely to be minority females of low socioeconomic status with no father in the home.
Hypernetworking was defined as spending an average of more than 3 hours per school day on Facebook or other social networking Web sites. This threshold was met by 11.5% of students; another 22% reported having no involvement at all with such Web sites. Hypernetworkers were an adjusted 79% more likely to have tried alcohol, 69% more likely to be current binge drinkers, and 32% more likely to be current users of marijuana. They were also twice as likely to have had sex before age 13, and 60% more likely to have had four or more sexual partners.
Like the hypertexters, the hypernetworkers were more likely to get poor grades, watch a lot of television, get too little sleep, have been in a physical fight during the past 12 months, and experience cyberbullying. They were also 2.5 times more likely to report rarely or never using a bike helmet or seat belt.
A particularly notable finding was the overall poor emotional health of the hypernetworkers, Dr. Frank continued. They were 2.5 times more likely to indicate they had made a suicide attempt, 92% more likely to report feeling depressive sadness, 2.5-fold more likely to have engaged in deliberate self-harm without suicidal intent, 2.2-fold more likely to report feeling a high level of stress, and 3.4-fold more likely to characterize themselves as having an eating disorder.
The highest levels of health risk behaviors were reported by the 3.8% of teens who were both hypertexters and hypernetworkers, according to Dr. Frank.
He noted that a recent national study by the Kaiser Family Foundation concluded that 69% of 11- to -14-year olds and 85% of 15- to 18-year-olds owned a cell phone in 2009. Nearly half of students in grades 7-12 reported texting daily, averaging 57 texts and devoting 1 hour and 35 minutes per day to the activity. Of the texters, 84% indicated their parents had no rules regarding text messaging.
The lack of parental oversight regarding this explosively popular activity is a key point, in Dr. Frank’s view. It’s not that hypertexting directly leads to sex, drugs, and vehicular recklessness; rather, it’s that hypertexting bespeaks a lack of parental control having broad ramifications.
"This study should be a wake-up call for parents to not only help their children stay safe by not texting and driving, but [also] by discouraging excessive use of the cell phone or social Web sites in general," he concluded.
His study was funded by the Cuyahoga County Board of Health and other governmental agencies. Dr. Frank reported having no relevant financial conflicts of interest.
DENVER – Teens who overuse cell phone texting or social networking Web sites have disturbingly high rates of a wide range of health risk behaviors, a large cross-sectional study showed.
"The startling results of this study suggest that, when left unchecked, texting and other widely popular methods of staying connected can have dangerous health effects on teenagers," possibly associated with a general lack of adult supervision, Dr. Scott Frank said at the annual meeting of the American Public Health Association.
He presented the results of a survey completed anonymously by 4,257 teens at 20 schools in Cuyahoga County, Ohio. Of the responders, 20% were what Dr. Frank classified as "hypertexters," based upon their self-reported texting an average of 120 or more times per day on school days.
Based upon their responses on the Youth Risk Behavior Survey, completed as part of the anonymous survey, these hypertexters were an adjusted twofold more likely to have ever tried alcohol, 43% more likely to be binge drinkers, 32% more likely to be current users of marijuana, and 40% more likely to have tried cigarettes than kids who texted less or, as was true for 22% of students, not at all.
They were also 42% more likely to report feeling depressive sadness, 55% more likely to have been in a physical fight during the past year, 3.4-fold more likely to have ever had sex, and 88% more likely to have had four or more sexual partners. In addition, they were 39% more likely to report skipping class, 63% more likely to average less than 7 hours of sleep, 60% more likely to get poor grades, 39% more likely to watch television for 3 hours or more daily, and 67% more likely to have been a victim of cyberbullying.
They were also 2.7-fold more likely to rarely or never wear a bike helmet and 39% more likely to rarely or never wear a seat belt, reported Dr. Frank of Case Western Reserve University, Cleveland.
The relative risks were adjusted for age, sex, race, parental education, and household structure. This was necessary because hypertexters were more likely to be minority females of low socioeconomic status with no father in the home.
Hypernetworking was defined as spending an average of more than 3 hours per school day on Facebook or other social networking Web sites. This threshold was met by 11.5% of students; another 22% reported having no involvement at all with such Web sites. Hypernetworkers were an adjusted 79% more likely to have tried alcohol, 69% more likely to be current binge drinkers, and 32% more likely to be current users of marijuana. They were also twice as likely to have had sex before age 13, and 60% more likely to have had four or more sexual partners.
Like the hypertexters, the hypernetworkers were more likely to get poor grades, watch a lot of television, get too little sleep, have been in a physical fight during the past 12 months, and experience cyberbullying. They were also 2.5 times more likely to report rarely or never using a bike helmet or seat belt.
A particularly notable finding was the overall poor emotional health of the hypernetworkers, Dr. Frank continued. They were 2.5 times more likely to indicate they had made a suicide attempt, 92% more likely to report feeling depressive sadness, 2.5-fold more likely to have engaged in deliberate self-harm without suicidal intent, 2.2-fold more likely to report feeling a high level of stress, and 3.4-fold more likely to characterize themselves as having an eating disorder.
The highest levels of health risk behaviors were reported by the 3.8% of teens who were both hypertexters and hypernetworkers, according to Dr. Frank.
He noted that a recent national study by the Kaiser Family Foundation concluded that 69% of 11- to -14-year olds and 85% of 15- to 18-year-olds owned a cell phone in 2009. Nearly half of students in grades 7-12 reported texting daily, averaging 57 texts and devoting 1 hour and 35 minutes per day to the activity. Of the texters, 84% indicated their parents had no rules regarding text messaging.
The lack of parental oversight regarding this explosively popular activity is a key point, in Dr. Frank’s view. It’s not that hypertexting directly leads to sex, drugs, and vehicular recklessness; rather, it’s that hypertexting bespeaks a lack of parental control having broad ramifications.
"This study should be a wake-up call for parents to not only help their children stay safe by not texting and driving, but [also] by discouraging excessive use of the cell phone or social Web sites in general," he concluded.
His study was funded by the Cuyahoga County Board of Health and other governmental agencies. Dr. Frank reported having no relevant financial conflicts of interest.
FROM THE ANNUAL MEETING OF THE AMERICAN PUBLIC HEALTH ASSOCIATION
Hypertexting by Teens Linked to Increased Health Risks
DENVER – Teens who overuse cell phone texting or social networking Web sites have disturbingly high rates of a wide range of health risk behaviors, a large cross-sectional study showed.
"The startling results of this study suggest that, when left unchecked, texting and other widely popular methods of staying connected can have dangerous health effects on teenagers," possibly associated with a general lack of adult supervision, Dr. Scott Frank said at the annual meeting of the American Public Health Association.
He presented the results of a survey completed anonymously by 4,257 teens at 20 schools in Cuyahoga County, Ohio. Of the responders, 20% were what Dr. Frank classified as "hypertexters," based upon their self-reported texting an average of 120 or more times per day on school days.
Based upon their responses on the Youth Risk Behavior Survey, completed as part of the anonymous survey, these hypertexters were an adjusted twofold more likely to have ever tried alcohol, 43% more likely to be binge drinkers, 32% more likely to be current users of marijuana, and 40% more likely to have tried cigarettes than kids who texted less or, as was true for 22% of students, not at all.
They were also 42% more likely to report feeling depressive sadness, 55% more likely to have been in a physical fight during the past year, 3.4-fold more likely to have ever had sex, and 88% more likely to have had four or more sexual partners. In addition, they were 39% more likely to report skipping class, 63% more likely to average less than 7 hours of sleep, 60% more likely to get poor grades, 39% more likely to watch television for 3 hours or more daily, and 67% more likely to have been a victim of cyberbullying.
They were also 2.7-fold more likely to rarely or never wear a bike helmet and 39% more likely to rarely or never wear a seat belt, reported Dr. Frank of Case Western Reserve University, Cleveland.
The relative risks were adjusted for age, sex, race, parental education, and household structure. This was necessary because hypertexters were more likely to be minority females of low socioeconomic status with no father in the home.
Hypernetworking was defined as spending an average of more than 3 hours per school day on Facebook or other social networking Web sites. This threshold was met by 11.5% of students; another 22% reported having no involvement at all with such Web sites. Hypernetworkers were an adjusted 79% more likely to have tried alcohol, 69% more likely to be current binge drinkers, and 32% more likely to be current users of marijuana. They were also twice as likely to have had sex before age 13, and 60% more likely to have had four or more sexual partners.
Like the hypertexters, the hypernetworkers were more likely to get poor grades, watch a lot of television, get too little sleep, have been in a physical fight during the past 12 months, and experience cyberbullying. They were also 2.5 times more likely to report rarely or never using a bike helmet or seat belt.
A particularly notable finding was the overall poor emotional health of the hypernetworkers, Dr. Frank continued. They were 2.5 times more likely to indicate they had made a suicide attempt, 92% more likely to report feeling depressive sadness, 2.5-fold more likely to have engaged in deliberate self-harm without suicidal intent, 2.2-fold more likely to report feeling a high level of stress, and 3.4-fold more likely to characterize themselves as having an eating disorder.
The highest levels of health risk behaviors were reported by the 3.8% of teens who were both hypertexters and hypernetworkers, according to Dr. Frank.
He noted that a recent national study by the Kaiser Family Foundation concluded that 69% of 11- to -14-year olds and 85% of 15- to 18-year-olds owned a cell phone in 2009. Nearly half of students in grades 7-12 reported texting daily, averaging 57 texts and devoting 1 hour and 35 minutes per day to the activity. Of the texters, 84% indicated their parents had no rules regarding text messaging.
The lack of parental oversight regarding this explosively popular activity is a key point, in Dr. Frank’s view. It’s not that hypertexting directly leads to sex, drugs, and vehicular recklessness; rather, it’s that hypertexting bespeaks a lack of parental control having broad ramifications.
"This study should be a wake-up call for parents to not only help their children stay safe by not texting and driving, but [also] by discouraging excessive use of the cell phone or social Web sites in general," he concluded.
His study was funded by the Cuyahoga County Board of Health and other governmental agencies. Dr. Frank reported having no relevant financial conflicts of interest.
DENVER – Teens who overuse cell phone texting or social networking Web sites have disturbingly high rates of a wide range of health risk behaviors, a large cross-sectional study showed.
"The startling results of this study suggest that, when left unchecked, texting and other widely popular methods of staying connected can have dangerous health effects on teenagers," possibly associated with a general lack of adult supervision, Dr. Scott Frank said at the annual meeting of the American Public Health Association.
He presented the results of a survey completed anonymously by 4,257 teens at 20 schools in Cuyahoga County, Ohio. Of the responders, 20% were what Dr. Frank classified as "hypertexters," based upon their self-reported texting an average of 120 or more times per day on school days.
Based upon their responses on the Youth Risk Behavior Survey, completed as part of the anonymous survey, these hypertexters were an adjusted twofold more likely to have ever tried alcohol, 43% more likely to be binge drinkers, 32% more likely to be current users of marijuana, and 40% more likely to have tried cigarettes than kids who texted less or, as was true for 22% of students, not at all.
They were also 42% more likely to report feeling depressive sadness, 55% more likely to have been in a physical fight during the past year, 3.4-fold more likely to have ever had sex, and 88% more likely to have had four or more sexual partners. In addition, they were 39% more likely to report skipping class, 63% more likely to average less than 7 hours of sleep, 60% more likely to get poor grades, 39% more likely to watch television for 3 hours or more daily, and 67% more likely to have been a victim of cyberbullying.
They were also 2.7-fold more likely to rarely or never wear a bike helmet and 39% more likely to rarely or never wear a seat belt, reported Dr. Frank of Case Western Reserve University, Cleveland.
The relative risks were adjusted for age, sex, race, parental education, and household structure. This was necessary because hypertexters were more likely to be minority females of low socioeconomic status with no father in the home.
Hypernetworking was defined as spending an average of more than 3 hours per school day on Facebook or other social networking Web sites. This threshold was met by 11.5% of students; another 22% reported having no involvement at all with such Web sites. Hypernetworkers were an adjusted 79% more likely to have tried alcohol, 69% more likely to be current binge drinkers, and 32% more likely to be current users of marijuana. They were also twice as likely to have had sex before age 13, and 60% more likely to have had four or more sexual partners.
Like the hypertexters, the hypernetworkers were more likely to get poor grades, watch a lot of television, get too little sleep, have been in a physical fight during the past 12 months, and experience cyberbullying. They were also 2.5 times more likely to report rarely or never using a bike helmet or seat belt.
A particularly notable finding was the overall poor emotional health of the hypernetworkers, Dr. Frank continued. They were 2.5 times more likely to indicate they had made a suicide attempt, 92% more likely to report feeling depressive sadness, 2.5-fold more likely to have engaged in deliberate self-harm without suicidal intent, 2.2-fold more likely to report feeling a high level of stress, and 3.4-fold more likely to characterize themselves as having an eating disorder.
The highest levels of health risk behaviors were reported by the 3.8% of teens who were both hypertexters and hypernetworkers, according to Dr. Frank.
He noted that a recent national study by the Kaiser Family Foundation concluded that 69% of 11- to -14-year olds and 85% of 15- to 18-year-olds owned a cell phone in 2009. Nearly half of students in grades 7-12 reported texting daily, averaging 57 texts and devoting 1 hour and 35 minutes per day to the activity. Of the texters, 84% indicated their parents had no rules regarding text messaging.
The lack of parental oversight regarding this explosively popular activity is a key point, in Dr. Frank’s view. It’s not that hypertexting directly leads to sex, drugs, and vehicular recklessness; rather, it’s that hypertexting bespeaks a lack of parental control having broad ramifications.
"This study should be a wake-up call for parents to not only help their children stay safe by not texting and driving, but [also] by discouraging excessive use of the cell phone or social Web sites in general," he concluded.
His study was funded by the Cuyahoga County Board of Health and other governmental agencies. Dr. Frank reported having no relevant financial conflicts of interest.
DENVER – Teens who overuse cell phone texting or social networking Web sites have disturbingly high rates of a wide range of health risk behaviors, a large cross-sectional study showed.
"The startling results of this study suggest that, when left unchecked, texting and other widely popular methods of staying connected can have dangerous health effects on teenagers," possibly associated with a general lack of adult supervision, Dr. Scott Frank said at the annual meeting of the American Public Health Association.
He presented the results of a survey completed anonymously by 4,257 teens at 20 schools in Cuyahoga County, Ohio. Of the responders, 20% were what Dr. Frank classified as "hypertexters," based upon their self-reported texting an average of 120 or more times per day on school days.
Based upon their responses on the Youth Risk Behavior Survey, completed as part of the anonymous survey, these hypertexters were an adjusted twofold more likely to have ever tried alcohol, 43% more likely to be binge drinkers, 32% more likely to be current users of marijuana, and 40% more likely to have tried cigarettes than kids who texted less or, as was true for 22% of students, not at all.
They were also 42% more likely to report feeling depressive sadness, 55% more likely to have been in a physical fight during the past year, 3.4-fold more likely to have ever had sex, and 88% more likely to have had four or more sexual partners. In addition, they were 39% more likely to report skipping class, 63% more likely to average less than 7 hours of sleep, 60% more likely to get poor grades, 39% more likely to watch television for 3 hours or more daily, and 67% more likely to have been a victim of cyberbullying.
They were also 2.7-fold more likely to rarely or never wear a bike helmet and 39% more likely to rarely or never wear a seat belt, reported Dr. Frank of Case Western Reserve University, Cleveland.
The relative risks were adjusted for age, sex, race, parental education, and household structure. This was necessary because hypertexters were more likely to be minority females of low socioeconomic status with no father in the home.
Hypernetworking was defined as spending an average of more than 3 hours per school day on Facebook or other social networking Web sites. This threshold was met by 11.5% of students; another 22% reported having no involvement at all with such Web sites. Hypernetworkers were an adjusted 79% more likely to have tried alcohol, 69% more likely to be current binge drinkers, and 32% more likely to be current users of marijuana. They were also twice as likely to have had sex before age 13, and 60% more likely to have had four or more sexual partners.
Like the hypertexters, the hypernetworkers were more likely to get poor grades, watch a lot of television, get too little sleep, have been in a physical fight during the past 12 months, and experience cyberbullying. They were also 2.5 times more likely to report rarely or never using a bike helmet or seat belt.
A particularly notable finding was the overall poor emotional health of the hypernetworkers, Dr. Frank continued. They were 2.5 times more likely to indicate they had made a suicide attempt, 92% more likely to report feeling depressive sadness, 2.5-fold more likely to have engaged in deliberate self-harm without suicidal intent, 2.2-fold more likely to report feeling a high level of stress, and 3.4-fold more likely to characterize themselves as having an eating disorder.
The highest levels of health risk behaviors were reported by the 3.8% of teens who were both hypertexters and hypernetworkers, according to Dr. Frank.
He noted that a recent national study by the Kaiser Family Foundation concluded that 69% of 11- to -14-year olds and 85% of 15- to 18-year-olds owned a cell phone in 2009. Nearly half of students in grades 7-12 reported texting daily, averaging 57 texts and devoting 1 hour and 35 minutes per day to the activity. Of the texters, 84% indicated their parents had no rules regarding text messaging.
The lack of parental oversight regarding this explosively popular activity is a key point, in Dr. Frank’s view. It’s not that hypertexting directly leads to sex, drugs, and vehicular recklessness; rather, it’s that hypertexting bespeaks a lack of parental control having broad ramifications.
"This study should be a wake-up call for parents to not only help their children stay safe by not texting and driving, but [also] by discouraging excessive use of the cell phone or social Web sites in general," he concluded.
His study was funded by the Cuyahoga County Board of Health and other governmental agencies. Dr. Frank reported having no relevant financial conflicts of interest.
FROM THE ANNUAL MEETING OF THE AMERICAN PUBLIC HEALTH ASSOCIATION
Meta-Analyses Indicate Asthma Boosts Lung Cancer Risk
DENVER — Asthma may be a risk factor for lung cancer, according to two new meta-analyses.
The public health implications of such an association would be enormous. Asthma affects at least 15 million Americans, 40% of them children. Its prevalence has been climbing steadily for decades in developed countries, more than doubling in the United States during a recent 20-year period. And lung cancer is the second most common noncutaneous malignancy in this country, with 10% of lung cancer deaths not attributable to smoking, Chanis Mercado said at the annual meeting of the American Public Health Association.
One of the two meta-analyses she performed as a Ph.D. candidate in public health at the Ponce (P.R.) School of Medicine involved 17 high-quality case-control studies with a total of 54,238 subjects. The conclusion was that individuals with asthma had 34% greater odds of having lung cancer, compared with matched controls without asthma.
A separate meta-analysis that included 16 high-quality cohort studies and 1,384,824 subjects showed that those with asthma were 46% more likely to develop lung cancer than were subjects without asthma.
These results were statistically robust. Eliminating any individual study didn’t substantially change the results. Tests for the existence of publication bias proved reassuringly negative.
One biologically plausible possible mechanism for the observed asthma–lung cancer link is that the persistent chronic inflammation that is a defining feature of asthma causes DNA damage to cells in the airway. Another possibility is that asthma patients have defective clearance of toxins in the bronchioalveolar epithelium, resulting in prolonged local exposure to carcinogens, she said.
The clinical implication of these two meta-analyses is that asthma patients ought to be screened earlier and more often for signs and symptoms of lung cancer, Ms. Mercado continued. This screening might take the form of chest x-rays, sputum cytology tests, and/or a low threshold for acting on symptoms of weight loss or hemoptysis.
Ms. Mercado declared having no relevant financial interests.
DENVER — Asthma may be a risk factor for lung cancer, according to two new meta-analyses.
The public health implications of such an association would be enormous. Asthma affects at least 15 million Americans, 40% of them children. Its prevalence has been climbing steadily for decades in developed countries, more than doubling in the United States during a recent 20-year period. And lung cancer is the second most common noncutaneous malignancy in this country, with 10% of lung cancer deaths not attributable to smoking, Chanis Mercado said at the annual meeting of the American Public Health Association.
One of the two meta-analyses she performed as a Ph.D. candidate in public health at the Ponce (P.R.) School of Medicine involved 17 high-quality case-control studies with a total of 54,238 subjects. The conclusion was that individuals with asthma had 34% greater odds of having lung cancer, compared with matched controls without asthma.
A separate meta-analysis that included 16 high-quality cohort studies and 1,384,824 subjects showed that those with asthma were 46% more likely to develop lung cancer than were subjects without asthma.
These results were statistically robust. Eliminating any individual study didn’t substantially change the results. Tests for the existence of publication bias proved reassuringly negative.
One biologically plausible possible mechanism for the observed asthma–lung cancer link is that the persistent chronic inflammation that is a defining feature of asthma causes DNA damage to cells in the airway. Another possibility is that asthma patients have defective clearance of toxins in the bronchioalveolar epithelium, resulting in prolonged local exposure to carcinogens, she said.
The clinical implication of these two meta-analyses is that asthma patients ought to be screened earlier and more often for signs and symptoms of lung cancer, Ms. Mercado continued. This screening might take the form of chest x-rays, sputum cytology tests, and/or a low threshold for acting on symptoms of weight loss or hemoptysis.
Ms. Mercado declared having no relevant financial interests.
DENVER — Asthma may be a risk factor for lung cancer, according to two new meta-analyses.
The public health implications of such an association would be enormous. Asthma affects at least 15 million Americans, 40% of them children. Its prevalence has been climbing steadily for decades in developed countries, more than doubling in the United States during a recent 20-year period. And lung cancer is the second most common noncutaneous malignancy in this country, with 10% of lung cancer deaths not attributable to smoking, Chanis Mercado said at the annual meeting of the American Public Health Association.
One of the two meta-analyses she performed as a Ph.D. candidate in public health at the Ponce (P.R.) School of Medicine involved 17 high-quality case-control studies with a total of 54,238 subjects. The conclusion was that individuals with asthma had 34% greater odds of having lung cancer, compared with matched controls without asthma.
A separate meta-analysis that included 16 high-quality cohort studies and 1,384,824 subjects showed that those with asthma were 46% more likely to develop lung cancer than were subjects without asthma.
These results were statistically robust. Eliminating any individual study didn’t substantially change the results. Tests for the existence of publication bias proved reassuringly negative.
One biologically plausible possible mechanism for the observed asthma–lung cancer link is that the persistent chronic inflammation that is a defining feature of asthma causes DNA damage to cells in the airway. Another possibility is that asthma patients have defective clearance of toxins in the bronchioalveolar epithelium, resulting in prolonged local exposure to carcinogens, she said.
The clinical implication of these two meta-analyses is that asthma patients ought to be screened earlier and more often for signs and symptoms of lung cancer, Ms. Mercado continued. This screening might take the form of chest x-rays, sputum cytology tests, and/or a low threshold for acting on symptoms of weight loss or hemoptysis.
Ms. Mercado declared having no relevant financial interests.