Targeted therapies for pediatric psoriasis.

Children who are recalcitrant to topical therapy for their moderate to severe plaque psoriasis and/or highly visible lesions may be candidates for systemic therapy. Methotrexate has been the most commonly used systemic agent in children. However, at least 25% of patients are now treated with biologics, especially tumor necrosis factor-α inhibitors, and their use is expanding as their availability, demonstrated safety and efficacy, and practitioner experience are increasing. In the United States, etanercept is Food and Drug Administration approved for ages 6 years and older and ustekinumab for 12 years of age and older. In Europe, adalimumab is also approved for pediatric psoriasis for 4 years of age and older. While biologics have the advantage of less frequent administration, greater and more rapid efficacy than methotrexate, fewer side effects, and a less rigorous need for monitoring, their cost is much higher than that of methotrexate and other systemic medications, concerns about the development of neutralizing antibodies necessitate continuous treatment, and their long-term safety profile remains to be determined.

The influence of context on antimicrobial prescribing for febrile respiratory illness: a cohort study.

BACKGROUND: Little is known about the influence of contextual factors on a physician's likelihood to prescribe antimicrobials for febrile respiratory illness (FRI). Context includes epidemiologic context (for example, a pandemic period) and personal context (for example, recent exposure to other patients with FRI). OBJECTIVE: To examine the association between contextual factors and antimicrobial prescribing for FRI. DESIGN: 5.5-year retrospective cohort study. SETTING: A network of Midwestern primary care providers. PATIENTS: All patients presenting with FRI during influenza seasons between 2006 and 2011. MEASUREMENTS: Antimicrobial prescribing for FRI during pandemic and seasonal influenza periods. RESULTS: 28 301 unique patient encounters for FRI with 69 physicians in 26 practices were included. An antibiotic was prescribed in 12 795 (45.2%) cases. The range of prescribing among physicians was 17.9% to 83.7%. Antibiotics were prescribed in 47.5% of encounters during the seasonal period and 39.2% during the pandemic period (P < 0.001). After multivariable adjustment for patient and physician characteristics, antibiotic prescribing was lower in the pandemic period (odds ratio [OR], 0.72 [95% CI, 0.68 to 0.77]) than in the seasonal period. The likelihood of prescribing an antibiotic decreased as the number of FRI cases that a physician had seen in the previous week increased (OR, 0.93 [CI, 0.86 to 1.01] for 2 to 3 patients with FRI seen in the previous week; OR, 0.84 [CI, 0.77 to 0.91] for 4 to 6 patients; OR, 0.71 [CI, 0.64 to 0.78] for 7 to 11 patients; and OR, 0.57 [CI, 0.51 to 0.63] for ≥12 patients compared with the reference range of 0 to 1 patients). Pandemic season and recent personal context were also associated with antiviral prescribing. LIMITATION: Retrospective study in a single geographic area. CONCLUSION: Epidemiologic context and the number of cases of FRI that a physician had recently seen were associated with his or her likelihood to prescribe antimicrobials for FRI. Interventions that enhance a physician's contextual awareness may improve antimicrobial use. PRIMARY FUNDING SOURCE: NorthShore University HealthSystem.

Biodemographic and physical correlates of sexual orientation in men.

To better understand sexual orientation from an evolutionary perspective, we investigated whether, compared to heterosexual men, the fewer direct descendants of homosexual men could be counterbalanced by a larger number of other close biological relatives. We also investigated the extent to which three patterns generally studied separately--handedness, number of biological older brothers, and hair-whorl rotation pattern--correlated with each other, and for evidence of replication of previous findings on how each pattern related to sexual orientation. We surveyed at Gay Pride and general community festivals, analyzing data for 894 heterosexual men and 694 homosexual men, both groups predominantly (~80%) white/non-Hispanic. The Kinsey distribution of sexual orientation for men recruited from the general community festivals approximated previous population-based surveys. Compared to heterosexual men, homosexual men had both more relatives, especially paternal relatives, and more homosexual male relatives. We found that the familiality for male sexual orientation decreased with relatedness, i.e., when moving from first-degree to second-degree relatives. We also replicated the fraternal birth order effect. However, we found no significant correlations among handedness, hair whorl rotation pattern, and sexual orientation, and, contrary to some previous research, no evidence that male sexual orientation is transmitted predominantly through the maternal line.

Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders.

The consequences of atopic dermatitis reach beyond the skin and past childhood. Patients with atopic dermatitis are at risk of developing allergic comorbidities, but less is known about the associations between atopic dermatitis and non-allergic conditions. Understanding these non-allergic comorbidities has the potential to improve patient outcomes and to help mitigate the cost and burdens associated with these conditions. Atopic dermatitis is associated with cutaneous bacterial infections, more severe forms/courses of cutaneous viral infections, and extra-cutaneous infections. Atopic dermatitis is also associated with several mental health comorbidities particularly attention-deficit hyperactivity disorder, anxiety, and depression. Data are largely inconsistent for specific cancers, but atopic dermatitis appears to protect against malignancy overall; severe long-term atopic dermatitis is associated with adult lymphomas. Atopic dermatitis may also be associated with obesity, cardiovascular disease, and autoimmune disease, particularly alopecia areata and gastrointestinal immune-mediated disorders. Although the causative mechanisms underlying these associations are poorly understood, treating physicians should be aware of associations in seeking to alleviate the burden for patients with atopic dermatitis.

Allergic Rhinitis: Mechanisms and Treatment.

The prevalence of allergic rhinitis (AR) has been estimated at 10% to 40%, and its economic burden is substantial. AR patients develop specific immunoglobulin E (IgE) antibody responses to indoor and outdoor environmental allergens with exposure over time. These specific IgE antibodies bind to high-affinity IgE receptors on mast cells and basophils. Key outcome measures of therapeutic interventions include rhinitis symptom control, rescue medication requirements, and quality-of-life measures. A comprehensive multiple modality treatment plan customized to the individual patient can optimize outcomes.