Diana Mahoney

CAMBRIDGE, MASS. – Certain cognitive factors are significant predictors of pain intensity and sexual impairment in women with vulvar vestibulitis syndrome, Geneviève Desrochers said in a poster presentation at the annual meeting of the Society for Sex Therapy and Research.

The findings of her study suggest that targeted cognitive-behavioral therapy might help mediate the severe pain associated with the chronic, persistent inflammatory condition.

Hierarchic regression analysis of data obtained from 67 women with vulvar vestibulitis syndrome showed that lower levels of pain self-efficacy (confidence in one's ability to perform a range of tasks despite pain) and higher levels of pain catastrophization (a negative cognitive response to, or anticipation of, pain) were both associated with more intense pain during intercourse, reported Ms. Desrochers, a Ph.D. candidate in psychology at the University of Quebec, Montreal.

All of the women enrolled in the study had a prior diagnosis of vulvar vestibulitis syndrome. As part of the investigation, the women underwent a gynecologic examination and completed a structured interview and standarized questionnaires focusing on pain self-efficacy, pain catastrophization, anxiety, and pain during intercourse.

The regression analysis also showed that catastrophization remained a strong predictor of the severity of pain symptoms after controlling for state-trait anxiety and self-efficacy. “Higher levels of catastrophization were still related to more severe pain,” Ms. Desrochers wrote. Of the variables, only self-efficacy was a good predictor of global sexual functioning after controlling for pain intensity and state-trait anxiety, with lower self-efficacy predicting increased sexual impairment.

“We did find that [lower levels of] state-trait anxiety mediated the role of catastrophizing in pain intensity,” Ms. Desrochers noted.

The findings of the study are consistent with a cognitive-behavioral model of chronic pain, “and they may be important components to consider for sex therapy with this population of women,” she suggested.

In a separate poster discussion at the meeting, which was also sponsored by the American College of Obstetricians and Gynecologists, Mélanie Jodoin, also a Ph.D. candidate in psychology at the university, presented additional data from the same investigation linking dyadic adjustment to psychological distress and sexual impairment in women with vulvar vestibulitis syndrome.

“The results of hierarchic regression analyses revealed that higher levels of dyadic adjustment were associated with better sexual functioning and lower psychological distress,” she reported.

The analyses also linked higher levels of state anxiety to increased dysfunctional dyadic adjustment, even after controlling for psychological distress and intensity of pain, suggesting that dyadic adjustment is a “powerful predictor of sexual impairment in women with vulvar vestibulitis syndrome, despite their pain intensity,” Ms. Jodoin wrote.

CAMBRIDGE, MASS. – Certain cognitive factors are significant predictors of pain intensity and sexual impairment in women with vulvar vestibulitis syndrome, Geneviève Desrochers said in a poster presentation at the annual meeting of the Society for Sex Therapy and Research.

The findings of her study suggest that targeted cognitive-behavioral therapy might help mediate the severe pain associated with the chronic, persistent inflammatory condition.

Hierarchic regression analysis of data obtained from 67 women with vulvar vestibulitis syndrome showed that lower levels of pain self-efficacy (confidence in one's ability to perform a range of tasks despite pain) and higher levels of pain catastrophization (a negative cognitive response to, or anticipation of, pain) were both associated with more intense pain during intercourse, reported Ms. Desrochers, a Ph.D. candidate in psychology at the University of Quebec, Montreal.

All of the women enrolled in the study had a prior diagnosis of vulvar vestibulitis syndrome. As part of the investigation, the women underwent a gynecologic examination and completed a structured interview and standarized questionnaires focusing on pain self-efficacy, pain catastrophization, anxiety, and pain during intercourse.

The regression analysis also showed that catastrophization remained a strong predictor of the severity of pain symptoms after controlling for state-trait anxiety and self-efficacy. “Higher levels of catastrophization were still related to more severe pain,” Ms. Desrochers wrote. Of the variables, only self-efficacy was a good predictor of global sexual functioning after controlling for pain intensity and state-trait anxiety, with lower self-efficacy predicting increased sexual impairment.

“We did find that [lower levels of] state-trait anxiety mediated the role of catastrophizing in pain intensity,” Ms. Desrochers noted.

The findings of the study are consistent with a cognitive-behavioral model of chronic pain, “and they may be important components to consider for sex therapy with this population of women,” she suggested.

In a separate poster discussion at the meeting, which was also sponsored by the American College of Obstetricians and Gynecologists, Mélanie Jodoin, also a Ph.D. candidate in psychology at the university, presented additional data from the same investigation linking dyadic adjustment to psychological distress and sexual impairment in women with vulvar vestibulitis syndrome.

“The results of hierarchic regression analyses revealed that higher levels of dyadic adjustment were associated with better sexual functioning and lower psychological distress,” she reported.

The analyses also linked higher levels of state anxiety to increased dysfunctional dyadic adjustment, even after controlling for psychological distress and intensity of pain, suggesting that dyadic adjustment is a “powerful predictor of sexual impairment in women with vulvar vestibulitis syndrome, despite their pain intensity,” Ms. Jodoin wrote.

CAMBRIDGE, MASS. – Certain cognitive factors are significant predictors of pain intensity and sexual impairment in women with vulvar vestibulitis syndrome, Geneviève Desrochers said in a poster presentation at the annual meeting of the Society for Sex Therapy and Research.

The findings of her study suggest that targeted cognitive-behavioral therapy might help mediate the severe pain associated with the chronic, persistent inflammatory condition.

Hierarchic regression analysis of data obtained from 67 women with vulvar vestibulitis syndrome showed that lower levels of pain self-efficacy (confidence in one's ability to perform a range of tasks despite pain) and higher levels of pain catastrophization (a negative cognitive response to, or anticipation of, pain) were both associated with more intense pain during intercourse, reported Ms. Desrochers, a Ph.D. candidate in psychology at the University of Quebec, Montreal.

All of the women enrolled in the study had a prior diagnosis of vulvar vestibulitis syndrome. As part of the investigation, the women underwent a gynecologic examination and completed a structured interview and standarized questionnaires focusing on pain self-efficacy, pain catastrophization, anxiety, and pain during intercourse.

The regression analysis also showed that catastrophization remained a strong predictor of the severity of pain symptoms after controlling for state-trait anxiety and self-efficacy. “Higher levels of catastrophization were still related to more severe pain,” Ms. Desrochers wrote. Of the variables, only self-efficacy was a good predictor of global sexual functioning after controlling for pain intensity and state-trait anxiety, with lower self-efficacy predicting increased sexual impairment.

“We did find that [lower levels of] state-trait anxiety mediated the role of catastrophizing in pain intensity,” Ms. Desrochers noted.

The findings of the study are consistent with a cognitive-behavioral model of chronic pain, “and they may be important components to consider for sex therapy with this population of women,” she suggested.

In a separate poster discussion at the meeting, which was also sponsored by the American College of Obstetricians and Gynecologists, Mélanie Jodoin, also a Ph.D. candidate in psychology at the university, presented additional data from the same investigation linking dyadic adjustment to psychological distress and sexual impairment in women with vulvar vestibulitis syndrome.

“The results of hierarchic regression analyses revealed that higher levels of dyadic adjustment were associated with better sexual functioning and lower psychological distress,” she reported.

The analyses also linked higher levels of state anxiety to increased dysfunctional dyadic adjustment, even after controlling for psychological distress and intensity of pain, suggesting that dyadic adjustment is a “powerful predictor of sexual impairment in women with vulvar vestibulitis syndrome, despite their pain intensity,” Ms. Jodoin wrote.

MONTREAL — Recombinant human activated protein C can be a lifesaver for some of the sickest patients with community-acquired pneumonia, Gary E. Garber, M.D., said at an international conference on community-acquired pneumonia.

Yet despite evidence that the coagulation inhibitor reduces mortality in patients with severe sepsis and community-acquired pneumonia (CAP) as their infection source, clinicians have been slow to embrace activated protein C—or drotrecogin alfa (Xigris)—as an adjunctive therapy for this well-defined patient population, said Dr. Garber, head of the division of infectious diseases at the University of Ottawa and the Ottawa Hospital.

In the landmark 2001 Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial, activated protein C (APC) reduced mortality from severe sepsis by nearly 20% among the 850 patients who received the drug, compared with the 840 patients given the placebo (N. Engl. J. Med. 2001;344:699–709).

The findings led to FDA approval of the drug for adult patients who have a high risk of death due to severe sepsis associated with acute organ dysfunction.

In a retrospective analysis of the investigation, Dr. Garber and his colleagues determined that more than 35% of the study participants had CAP as their infection source, and of these, 26% had Streptococcus pneumoniae identified as the pathogen (Crit. Care Med. 2005;33:952–61).

Those CAP patients treated with APC had a 28% relative reduction in mortality, compared with those who received placebo. In patients with confirmed S. pneumoniae infections, “mortality fell from an absolute mortality of 32.9% to 20% with APC treatment,” representing about a 40% relative reduction in mortality, he said.

The drug also had a significant effect on morbidity in the study population: Treated patients experienced faster resolution of cardiovascular and respiratory dysfunction and had more vasopressor- and ventilator-free days alive, compared with placebo patients, Dr. Garber said.

Because of its anticoagulant properties, APC is associated with an increased risk of serious bleeding, especially for patients with a preexisting risk for bleeding, such as those with central nervous system lesions or severe thrombocytopenia. This risk is one of the psychological barriers to wider usage of the drug, he noted.

In the PROWESS investigation, 3.5% of the treated patients experienced bleeding-related complications, compared with 2% of patients on placebo. In both the treatment and placebo groups, the bleeding was usually related to an invasive procedure. However, Dr. Garber pointed out that “bleeding is a major risk associated with severe sepsis. If monitored, it is easily managed and is not a contraindication to using APC.”

The drug is contraindicated in situations in which bleeding cannot be easily monitored; in patients with intracranial trauma or increased intracranial pressure; and in those who have had a recent epidural catheter, he said.

“In reality, when weighed against the benefit of keeping these patients alive, the slightly increased bleeding risk becomes less relevant,” Dr. Garber said at the conference, which was sponsored by the International Society of Chemotherapy.

Uncertainties about patient selection and drug cost are also barriers to clinician acceptance of APC, although neither concern is scientifically supported, he said.

“It is not that difficult to determine which patients should be treated with APC. Patients with pneumonia and systemic inflammation clearly benefit,” Dr. Garber noted, alluding to the retrospective PROWESS analysis; these data indicated that levels of interleukin-6—which is a strong negative prognostic marker in sepsis—dropped rapidly following APC treatment in septic CAP patients.

Specifically, “patients admitted to the [intensive care unit] with community-acquired pneumonia who require ventilatory and inotropic support will likely benefit from adjunctive treatment,” Dr. Garber said. “These patients are at high risk of death, and experience tells us that the relative benefit of APC increases with increased mortality [risk] and severity of underlying coagulopathy and inflammation.”

In terms of cost, a therapeutic course of APC in prototypic CAP patients with severe sepsis is more than twice that of tissue plasminogen activator (TPA), but it can save 6 out of every 100 lives, compared with 1 in 1,000 for TPA. “Instead of debating the role of APC in severe sepsis, we should be asking why TPA is the standard of care,” he said.

Other obstacles to acceptance of APC include a poor understanding of and lack of standardized treatment protocols for sepsis, particularly severe sepsis, the condition for which the drug is approved, Dr. Garber hypothesized. He has served as an advisor for the drug's manufacturer, Eli Lilly.

Perceived barriers notwithstanding, “in well-defined patient populations like CAP in the intensive care unit, APC should, without question, become a regular part of our treatment strategies,” he said.

MONTREAL — Recombinant human activated protein C can be a lifesaver for some of the sickest patients with community-acquired pneumonia, Gary E. Garber, M.D., said at an international conference on community-acquired pneumonia.

Yet despite evidence that the coagulation inhibitor reduces mortality in patients with severe sepsis and community-acquired pneumonia (CAP) as their infection source, clinicians have been slow to embrace activated protein C—or drotrecogin alfa (Xigris)—as an adjunctive therapy for this well-defined patient population, said Dr. Garber, head of the division of infectious diseases at the University of Ottawa and the Ottawa Hospital.

In the landmark 2001 Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial, activated protein C (APC) reduced mortality from severe sepsis by nearly 20% among the 850 patients who received the drug, compared with the 840 patients given the placebo (N. Engl. J. Med. 2001;344:699–709).

The findings led to FDA approval of the drug for adult patients who have a high risk of death due to severe sepsis associated with acute organ dysfunction.

In a retrospective analysis of the investigation, Dr. Garber and his colleagues determined that more than 35% of the study participants had CAP as their infection source, and of these, 26% had Streptococcus pneumoniae identified as the pathogen (Crit. Care Med. 2005;33:952–61).

Those CAP patients treated with APC had a 28% relative reduction in mortality, compared with those who received placebo. In patients with confirmed S. pneumoniae infections, “mortality fell from an absolute mortality of 32.9% to 20% with APC treatment,” representing about a 40% relative reduction in mortality, he said.

The drug also had a significant effect on morbidity in the study population: Treated patients experienced faster resolution of cardiovascular and respiratory dysfunction and had more vasopressor- and ventilator-free days alive, compared with placebo patients, Dr. Garber said.

Because of its anticoagulant properties, APC is associated with an increased risk of serious bleeding, especially for patients with a preexisting risk for bleeding, such as those with central nervous system lesions or severe thrombocytopenia. This risk is one of the psychological barriers to wider usage of the drug, he noted.

In the PROWESS investigation, 3.5% of the treated patients experienced bleeding-related complications, compared with 2% of patients on placebo. In both the treatment and placebo groups, the bleeding was usually related to an invasive procedure. However, Dr. Garber pointed out that “bleeding is a major risk associated with severe sepsis. If monitored, it is easily managed and is not a contraindication to using APC.”

The drug is contraindicated in situations in which bleeding cannot be easily monitored; in patients with intracranial trauma or increased intracranial pressure; and in those who have had a recent epidural catheter, he said.

“In reality, when weighed against the benefit of keeping these patients alive, the slightly increased bleeding risk becomes less relevant,” Dr. Garber said at the conference, which was sponsored by the International Society of Chemotherapy.

Uncertainties about patient selection and drug cost are also barriers to clinician acceptance of APC, although neither concern is scientifically supported, he said.

“It is not that difficult to determine which patients should be treated with APC. Patients with pneumonia and systemic inflammation clearly benefit,” Dr. Garber noted, alluding to the retrospective PROWESS analysis; these data indicated that levels of interleukin-6—which is a strong negative prognostic marker in sepsis—dropped rapidly following APC treatment in septic CAP patients.

Specifically, “patients admitted to the [intensive care unit] with community-acquired pneumonia who require ventilatory and inotropic support will likely benefit from adjunctive treatment,” Dr. Garber said. “These patients are at high risk of death, and experience tells us that the relative benefit of APC increases with increased mortality [risk] and severity of underlying coagulopathy and inflammation.”

In terms of cost, a therapeutic course of APC in prototypic CAP patients with severe sepsis is more than twice that of tissue plasminogen activator (TPA), but it can save 6 out of every 100 lives, compared with 1 in 1,000 for TPA. “Instead of debating the role of APC in severe sepsis, we should be asking why TPA is the standard of care,” he said.

Other obstacles to acceptance of APC include a poor understanding of and lack of standardized treatment protocols for sepsis, particularly severe sepsis, the condition for which the drug is approved, Dr. Garber hypothesized. He has served as an advisor for the drug's manufacturer, Eli Lilly.

Perceived barriers notwithstanding, “in well-defined patient populations like CAP in the intensive care unit, APC should, without question, become a regular part of our treatment strategies,” he said.

MONTREAL — Recombinant human activated protein C can be a lifesaver for some of the sickest patients with community-acquired pneumonia, Gary E. Garber, M.D., said at an international conference on community-acquired pneumonia.

Yet despite evidence that the coagulation inhibitor reduces mortality in patients with severe sepsis and community-acquired pneumonia (CAP) as their infection source, clinicians have been slow to embrace activated protein C—or drotrecogin alfa (Xigris)—as an adjunctive therapy for this well-defined patient population, said Dr. Garber, head of the division of infectious diseases at the University of Ottawa and the Ottawa Hospital.

In the landmark 2001 Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial, activated protein C (APC) reduced mortality from severe sepsis by nearly 20% among the 850 patients who received the drug, compared with the 840 patients given the placebo (N. Engl. J. Med. 2001;344:699–709).

The findings led to FDA approval of the drug for adult patients who have a high risk of death due to severe sepsis associated with acute organ dysfunction.

In a retrospective analysis of the investigation, Dr. Garber and his colleagues determined that more than 35% of the study participants had CAP as their infection source, and of these, 26% had Streptococcus pneumoniae identified as the pathogen (Crit. Care Med. 2005;33:952–61).

Those CAP patients treated with APC had a 28% relative reduction in mortality, compared with those who received placebo. In patients with confirmed S. pneumoniae infections, “mortality fell from an absolute mortality of 32.9% to 20% with APC treatment,” representing about a 40% relative reduction in mortality, he said.

The drug also had a significant effect on morbidity in the study population: Treated patients experienced faster resolution of cardiovascular and respiratory dysfunction and had more vasopressor- and ventilator-free days alive, compared with placebo patients, Dr. Garber said.

Because of its anticoagulant properties, APC is associated with an increased risk of serious bleeding, especially for patients with a preexisting risk for bleeding, such as those with central nervous system lesions or severe thrombocytopenia. This risk is one of the psychological barriers to wider usage of the drug, he noted.

In the PROWESS investigation, 3.5% of the treated patients experienced bleeding-related complications, compared with 2% of patients on placebo. In both the treatment and placebo groups, the bleeding was usually related to an invasive procedure. However, Dr. Garber pointed out that “bleeding is a major risk associated with severe sepsis. If monitored, it is easily managed and is not a contraindication to using APC.”

The drug is contraindicated in situations in which bleeding cannot be easily monitored; in patients with intracranial trauma or increased intracranial pressure; and in those who have had a recent epidural catheter, he said.

“In reality, when weighed against the benefit of keeping these patients alive, the slightly increased bleeding risk becomes less relevant,” Dr. Garber said at the conference, which was sponsored by the International Society of Chemotherapy.

Uncertainties about patient selection and drug cost are also barriers to clinician acceptance of APC, although neither concern is scientifically supported, he said.

“It is not that difficult to determine which patients should be treated with APC. Patients with pneumonia and systemic inflammation clearly benefit,” Dr. Garber noted, alluding to the retrospective PROWESS analysis; these data indicated that levels of interleukin-6—which is a strong negative prognostic marker in sepsis—dropped rapidly following APC treatment in septic CAP patients.

Specifically, “patients admitted to the [intensive care unit] with community-acquired pneumonia who require ventilatory and inotropic support will likely benefit from adjunctive treatment,” Dr. Garber said. “These patients are at high risk of death, and experience tells us that the relative benefit of APC increases with increased mortality [risk] and severity of underlying coagulopathy and inflammation.”

In terms of cost, a therapeutic course of APC in prototypic CAP patients with severe sepsis is more than twice that of tissue plasminogen activator (TPA), but it can save 6 out of every 100 lives, compared with 1 in 1,000 for TPA. “Instead of debating the role of APC in severe sepsis, we should be asking why TPA is the standard of care,” he said.

Other obstacles to acceptance of APC include a poor understanding of and lack of standardized treatment protocols for sepsis, particularly severe sepsis, the condition for which the drug is approved, Dr. Garber hypothesized. He has served as an advisor for the drug's manufacturer, Eli Lilly.

Perceived barriers notwithstanding, “in well-defined patient populations like CAP in the intensive care unit, APC should, without question, become a regular part of our treatment strategies,” he said.

MONTREAL — Respiratory fluoroquinolones for the treatment of community-acquired pneumonia should generally be restricted to hospitalized patients to minimize the development of resistance to the drugs among respiratory pathogens as well as colonization by other pathogens, said Thomas M. File Jr., M.D.

“Outpatient studies have shown that many [community-acquired pneumonia] patients who are given quinolones could have been given other agents as preferred first-line therapy, and investigators have identified incorrect dosing and duration patterns that could lead to the development of antibiotic resistance to quinolones,” Dr. File said at an international conference on community-acquired pneumonia.

Outpatient fluoroquinolone therapy should be considered only for patients at increased risk for drug-resistant Streptococcus pneumoniae, including those with comorbid conditions such as diabetes, chronic inflammatory lung disease, liver or renal insufficiency, malignancy, or congestive heart failure, and for patients who have been treated recently with antibacterial agents, said Dr. File, chief of the infectious disease service with Summa Health System in Akron, Ohio.

Since their introduction in the mid-1980s, fluoroquinolones have gained popularity because of their broad-spectrum coverage and high serum levels attained with oral administration—as well as increasing antibiotic resistance among pathogens. The approved agents, including gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin, are especially valuable for treating lower respiratory tract infections, given the growing prevalence of multiresistant pneumococci, Dr. File noted at the conference, sponsored by the International Society of Chemotherapy.

“The respiratory fluoroquinolones make excellent choices for therapy of community-acquired pneumonia because of their intrinsic activity against the key pathogens, including drug-resistant S. pneumoniae and the atypical organisms, and because of their excellent bioavailability and ability to penetrate well into pulmonary sites of infection,” he added. Another advantage is that the serum half-life is longer than that of other agents, including ciprofloxacin, allowing for once-daily dosing.

Numerous randomized trials have favored fluoroquinolones over standard therapy in terms of efficacy, and several have suggested that initial treatment with the respiratory fluoroquinolones can lead to a rapid clinical response, thus justifying shorter-course therapy for many patients and minimizing the possibility for noncompliance, Dr. File said.

For previously healthy outpatients with community-acquired pneumonia who have not received antimicrobial drugs within the prior 3 months, updated recommendations for empiric antimicrobial therapy suggest treatment with an extended-spectrum macrolide or doxycycline. For patients with comorbidities or who have received recent antimicrobial therapy, therapeutic options include a respiratory fluoroquinolone, a ketolide alone in the absence of enteric gram-negative bacteria, or a combination of a β-lactam plus a macrolide, Dr. File said.

“Another possible option for outpatients with modifying factors is the use of parenteral intramuscular or intravenous ceftriaxone plus an oral macrolide or doxycycline,” he noted.

For inpatient therapy in the general hospital ward, recommended initial therapy includes monotherapy with one of the respiratory fluoroquinolones or a β-lactam plus a macrolide or doxycycline.

“In some patients who don't have severe disease and have no risk factors for drug resistant S. pneumoniae or gram-negative pathogens, parenteral azithromycin monotherapy may be considered,” Dr. File said.

Initial treatment for patients in the intensive care unit “who are more likely to be very ill and to have multiple risk factors for more resistant pathogens” should be more aggressive, covering for both atypical organisms and traditional bacterial pathogens. Combination therapy with a potent antipneumococcal β-lactam and an advanced macrolide or a respiratory fluoroquinolone is recommended when Pseudomonas infection is not a consideration, he noted.

“The role of the respiratory fluoroquinolones for severe community-acquired pneumonia patients in the intensive care unit has not been established. Thus, fluoroquinolone monotherapy is not recommended in these patients,” Dr. File added.

In the presence of risk factors for Pseudomonas infection, as with severe structural lung diseases, “therapy should include drugs that are effective against pneumococcus, Pseudomonas, and Legionella,” he said.

Such therapies include an antipneumococcal, antipseudomonal β-lactam plus ciprofloxacin or levofloxacin; an antipneumococcal, antipseudomonal β-lactam plus an aminoglycoside and intravenous macrolide or intravenous macrolide or intravenous antipneumococcal quinolone; or, for patients with penicillin allergy, aztreonam plus levofloxacin or aztreonam plus moxifloxacin or gatifloxacin, with or without aminoglycoside.

MONTREAL — Respiratory fluoroquinolones for the treatment of community-acquired pneumonia should generally be restricted to hospitalized patients to minimize the development of resistance to the drugs among respiratory pathogens as well as colonization by other pathogens, said Thomas M. File Jr., M.D.

“Outpatient studies have shown that many [community-acquired pneumonia] patients who are given quinolones could have been given other agents as preferred first-line therapy, and investigators have identified incorrect dosing and duration patterns that could lead to the development of antibiotic resistance to quinolones,” Dr. File said at an international conference on community-acquired pneumonia.

Outpatient fluoroquinolone therapy should be considered only for patients at increased risk for drug-resistant Streptococcus pneumoniae, including those with comorbid conditions such as diabetes, chronic inflammatory lung disease, liver or renal insufficiency, malignancy, or congestive heart failure, and for patients who have been treated recently with antibacterial agents, said Dr. File, chief of the infectious disease service with Summa Health System in Akron, Ohio.

Since their introduction in the mid-1980s, fluoroquinolones have gained popularity because of their broad-spectrum coverage and high serum levels attained with oral administration—as well as increasing antibiotic resistance among pathogens. The approved agents, including gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin, are especially valuable for treating lower respiratory tract infections, given the growing prevalence of multiresistant pneumococci, Dr. File noted at the conference, sponsored by the International Society of Chemotherapy.

“The respiratory fluoroquinolones make excellent choices for therapy of community-acquired pneumonia because of their intrinsic activity against the key pathogens, including drug-resistant S. pneumoniae and the atypical organisms, and because of their excellent bioavailability and ability to penetrate well into pulmonary sites of infection,” he added. Another advantage is that the serum half-life is longer than that of other agents, including ciprofloxacin, allowing for once-daily dosing.

Numerous randomized trials have favored fluoroquinolones over standard therapy in terms of efficacy, and several have suggested that initial treatment with the respiratory fluoroquinolones can lead to a rapid clinical response, thus justifying shorter-course therapy for many patients and minimizing the possibility for noncompliance, Dr. File said.

For previously healthy outpatients with community-acquired pneumonia who have not received antimicrobial drugs within the prior 3 months, updated recommendations for empiric antimicrobial therapy suggest treatment with an extended-spectrum macrolide or doxycycline. For patients with comorbidities or who have received recent antimicrobial therapy, therapeutic options include a respiratory fluoroquinolone, a ketolide alone in the absence of enteric gram-negative bacteria, or a combination of a β-lactam plus a macrolide, Dr. File said.

“Another possible option for outpatients with modifying factors is the use of parenteral intramuscular or intravenous ceftriaxone plus an oral macrolide or doxycycline,” he noted.

For inpatient therapy in the general hospital ward, recommended initial therapy includes monotherapy with one of the respiratory fluoroquinolones or a β-lactam plus a macrolide or doxycycline.

“In some patients who don't have severe disease and have no risk factors for drug resistant S. pneumoniae or gram-negative pathogens, parenteral azithromycin monotherapy may be considered,” Dr. File said.

Initial treatment for patients in the intensive care unit “who are more likely to be very ill and to have multiple risk factors for more resistant pathogens” should be more aggressive, covering for both atypical organisms and traditional bacterial pathogens. Combination therapy with a potent antipneumococcal β-lactam and an advanced macrolide or a respiratory fluoroquinolone is recommended when Pseudomonas infection is not a consideration, he noted.

“The role of the respiratory fluoroquinolones for severe community-acquired pneumonia patients in the intensive care unit has not been established. Thus, fluoroquinolone monotherapy is not recommended in these patients,” Dr. File added.

In the presence of risk factors for Pseudomonas infection, as with severe structural lung diseases, “therapy should include drugs that are effective against pneumococcus, Pseudomonas, and Legionella,” he said.

Such therapies include an antipneumococcal, antipseudomonal β-lactam plus ciprofloxacin or levofloxacin; an antipneumococcal, antipseudomonal β-lactam plus an aminoglycoside and intravenous macrolide or intravenous macrolide or intravenous antipneumococcal quinolone; or, for patients with penicillin allergy, aztreonam plus levofloxacin or aztreonam plus moxifloxacin or gatifloxacin, with or without aminoglycoside.

MONTREAL — Respiratory fluoroquinolones for the treatment of community-acquired pneumonia should generally be restricted to hospitalized patients to minimize the development of resistance to the drugs among respiratory pathogens as well as colonization by other pathogens, said Thomas M. File Jr., M.D.

“Outpatient studies have shown that many [community-acquired pneumonia] patients who are given quinolones could have been given other agents as preferred first-line therapy, and investigators have identified incorrect dosing and duration patterns that could lead to the development of antibiotic resistance to quinolones,” Dr. File said at an international conference on community-acquired pneumonia.

Outpatient fluoroquinolone therapy should be considered only for patients at increased risk for drug-resistant Streptococcus pneumoniae, including those with comorbid conditions such as diabetes, chronic inflammatory lung disease, liver or renal insufficiency, malignancy, or congestive heart failure, and for patients who have been treated recently with antibacterial agents, said Dr. File, chief of the infectious disease service with Summa Health System in Akron, Ohio.

Since their introduction in the mid-1980s, fluoroquinolones have gained popularity because of their broad-spectrum coverage and high serum levels attained with oral administration—as well as increasing antibiotic resistance among pathogens. The approved agents, including gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin, are especially valuable for treating lower respiratory tract infections, given the growing prevalence of multiresistant pneumococci, Dr. File noted at the conference, sponsored by the International Society of Chemotherapy.

“The respiratory fluoroquinolones make excellent choices for therapy of community-acquired pneumonia because of their intrinsic activity against the key pathogens, including drug-resistant S. pneumoniae and the atypical organisms, and because of their excellent bioavailability and ability to penetrate well into pulmonary sites of infection,” he added. Another advantage is that the serum half-life is longer than that of other agents, including ciprofloxacin, allowing for once-daily dosing.

Numerous randomized trials have favored fluoroquinolones over standard therapy in terms of efficacy, and several have suggested that initial treatment with the respiratory fluoroquinolones can lead to a rapid clinical response, thus justifying shorter-course therapy for many patients and minimizing the possibility for noncompliance, Dr. File said.

For previously healthy outpatients with community-acquired pneumonia who have not received antimicrobial drugs within the prior 3 months, updated recommendations for empiric antimicrobial therapy suggest treatment with an extended-spectrum macrolide or doxycycline. For patients with comorbidities or who have received recent antimicrobial therapy, therapeutic options include a respiratory fluoroquinolone, a ketolide alone in the absence of enteric gram-negative bacteria, or a combination of a β-lactam plus a macrolide, Dr. File said.

“Another possible option for outpatients with modifying factors is the use of parenteral intramuscular or intravenous ceftriaxone plus an oral macrolide or doxycycline,” he noted.

For inpatient therapy in the general hospital ward, recommended initial therapy includes monotherapy with one of the respiratory fluoroquinolones or a β-lactam plus a macrolide or doxycycline.

“In some patients who don't have severe disease and have no risk factors for drug resistant S. pneumoniae or gram-negative pathogens, parenteral azithromycin monotherapy may be considered,” Dr. File said.

Initial treatment for patients in the intensive care unit “who are more likely to be very ill and to have multiple risk factors for more resistant pathogens” should be more aggressive, covering for both atypical organisms and traditional bacterial pathogens. Combination therapy with a potent antipneumococcal β-lactam and an advanced macrolide or a respiratory fluoroquinolone is recommended when Pseudomonas infection is not a consideration, he noted.

“The role of the respiratory fluoroquinolones for severe community-acquired pneumonia patients in the intensive care unit has not been established. Thus, fluoroquinolone monotherapy is not recommended in these patients,” Dr. File added.

In the presence of risk factors for Pseudomonas infection, as with severe structural lung diseases, “therapy should include drugs that are effective against pneumococcus, Pseudomonas, and Legionella,” he said.

Such therapies include an antipneumococcal, antipseudomonal β-lactam plus ciprofloxacin or levofloxacin; an antipneumococcal, antipseudomonal β-lactam plus an aminoglycoside and intravenous macrolide or intravenous macrolide or intravenous antipneumococcal quinolone; or, for patients with penicillin allergy, aztreonam plus levofloxacin or aztreonam plus moxifloxacin or gatifloxacin, with or without aminoglycoside.

NEW ORLEANS — A brief, two-question screening instrument is sensitive for identifying depression in patients with coronary heart disease, a study has shown.

Because major depression is associated with adverse outcomes in this patient population, the availability of a quick, effective tool for improving detection and referral rates could improve patient outcomes substantially, David D. McManus, M.D., reported at the annual meeting of the Society of General Internal Medicine.

Using data from the Heart and Soul Study out of the University of California, San Francisco, Dr. McManus and his colleagues compared the test characteristics of four depression case-finding instruments with those of the Diagnostic Interview for Depression in 1,024 adults with stable coronary heart disease (CHD) recruited from San Francisco-area outpatient clinics.

The instruments selected for comparison were the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), and a brief screen that asks patients about depressed mood and anhedonia.

Specifically, the brief screen asks patients, “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by little interest or pleasure in doing things?” Dr. McManus said. An answer of “yes” to either of these questions was considered a positive screen.

Of the 1,024 study participants, 224 had major depression by standard measure (Diagnostic Interview for Depression). The brief, two-question screen was, at 90%, the most sensitive of the four test measures.

The sensitivity of the CES-D, the PHQ-9, and the PHQ-2 was 76%, 54%, and 39%, respectively. The specificity of the brief screen was 69%, compared with 79%, 90%, and 92% for the CES-D, the PHQ-9, and the PHQ-2.

“The two-question instrument was a sensitive tool for identifying depression in CHD patients from diverse outpatient care settings,” Dr. McManus said.

The instrument can be easily integrated into outpatient visits, “even in the busiest cardiology practices,” he said. “A negative response to both questions effectively rules out depression, and a positive response to either suggests the patient might benefit from referral or treatment.”

The Heart and Soul Study is an ongoing, prospective cohort study designed to determine how psychosocial factors influence disease progression in patients with CHD. Study participants have a mean age of 67 years.

NEW ORLEANS — A brief, two-question screening instrument is sensitive for identifying depression in patients with coronary heart disease, a study has shown.

Because major depression is associated with adverse outcomes in this patient population, the availability of a quick, effective tool for improving detection and referral rates could improve patient outcomes substantially, David D. McManus, M.D., reported at the annual meeting of the Society of General Internal Medicine.

Using data from the Heart and Soul Study out of the University of California, San Francisco, Dr. McManus and his colleagues compared the test characteristics of four depression case-finding instruments with those of the Diagnostic Interview for Depression in 1,024 adults with stable coronary heart disease (CHD) recruited from San Francisco-area outpatient clinics.

The instruments selected for comparison were the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), and a brief screen that asks patients about depressed mood and anhedonia.

Specifically, the brief screen asks patients, “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by little interest or pleasure in doing things?” Dr. McManus said. An answer of “yes” to either of these questions was considered a positive screen.

Of the 1,024 study participants, 224 had major depression by standard measure (Diagnostic Interview for Depression). The brief, two-question screen was, at 90%, the most sensitive of the four test measures.

The sensitivity of the CES-D, the PHQ-9, and the PHQ-2 was 76%, 54%, and 39%, respectively. The specificity of the brief screen was 69%, compared with 79%, 90%, and 92% for the CES-D, the PHQ-9, and the PHQ-2.

“The two-question instrument was a sensitive tool for identifying depression in CHD patients from diverse outpatient care settings,” Dr. McManus said.

The instrument can be easily integrated into outpatient visits, “even in the busiest cardiology practices,” he said. “A negative response to both questions effectively rules out depression, and a positive response to either suggests the patient might benefit from referral or treatment.”

The Heart and Soul Study is an ongoing, prospective cohort study designed to determine how psychosocial factors influence disease progression in patients with CHD. Study participants have a mean age of 67 years.

NEW ORLEANS — A brief, two-question screening instrument is sensitive for identifying depression in patients with coronary heart disease, a study has shown.

Because major depression is associated with adverse outcomes in this patient population, the availability of a quick, effective tool for improving detection and referral rates could improve patient outcomes substantially, David D. McManus, M.D., reported at the annual meeting of the Society of General Internal Medicine.

Using data from the Heart and Soul Study out of the University of California, San Francisco, Dr. McManus and his colleagues compared the test characteristics of four depression case-finding instruments with those of the Diagnostic Interview for Depression in 1,024 adults with stable coronary heart disease (CHD) recruited from San Francisco-area outpatient clinics.

The instruments selected for comparison were the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), and a brief screen that asks patients about depressed mood and anhedonia.

Specifically, the brief screen asks patients, “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by little interest or pleasure in doing things?” Dr. McManus said. An answer of “yes” to either of these questions was considered a positive screen.

Of the 1,024 study participants, 224 had major depression by standard measure (Diagnostic Interview for Depression). The brief, two-question screen was, at 90%, the most sensitive of the four test measures.

The sensitivity of the CES-D, the PHQ-9, and the PHQ-2 was 76%, 54%, and 39%, respectively. The specificity of the brief screen was 69%, compared with 79%, 90%, and 92% for the CES-D, the PHQ-9, and the PHQ-2.

“The two-question instrument was a sensitive tool for identifying depression in CHD patients from diverse outpatient care settings,” Dr. McManus said.

The instrument can be easily integrated into outpatient visits, “even in the busiest cardiology practices,” he said. “A negative response to both questions effectively rules out depression, and a positive response to either suggests the patient might benefit from referral or treatment.”

The Heart and Soul Study is an ongoing, prospective cohort study designed to determine how psychosocial factors influence disease progression in patients with CHD. Study participants have a mean age of 67 years.

Women from families with hereditary breast cancer who do not carry the BRCA1 or BRCA2 genetic mutations are not at increased risk for ovarian cancer, a prospective study has shown.

If validated by additional studies, the findings by Noah D. Kauff, M.D., and colleagues at New York's Memorial Sloan-Kettering Cancer Center may allow physicians to better tailor ovarian cancer risk-reduction strategies.

Using records from the Sloan-Kettering clinical genetics service, investigators identified more than 1,700 patients who underwent genetic testing for BRCA mutations from August 1996 through July 2002 and who had consented to participate in follow-up studies. Those kindred with site-specific breast cancer who were BRCA mutation-negative and who had a living female proband received detailed questionnaires to provide clinical follow-up information and information on new cancers in themselves and their first- and second-degree relatives.

For the study, probands were defined as the youngest living BRCA mutation-negative women with breast cancer whose lineage included at least three cases of breast cancer—at least one of which must have been diagnosed before age 50—and no ovarian cancer, the investigators said (J. Natl. Cancer Inst. 2005;97:1382–4).

Probands whose heritage was exclusively Ashkenazi Jewish were included if they tested negative for the three Ashkenazi founder mutations because such testing has been shown to identify approximately 95% of detectable BRCA mutations, Dr. Kauff and associates stated.

Of 207 living female probands identified, 165 completed the study questionnaires. During a mean follow-up of 40.6 months, 19 new cases of breast cancer were diagnosed in the families, which included the 165 probands and 583 first- or second-degree female relatives. The disease incidence was more than three times greater than expected in age-matched women from the general population.

During the same follow-up period, one case of ovarian cancer was diagnosed, which is consistent with expectations for an average-risk population.

Dr. Kauff and associates advised caution with respect to revising ovarian cancer risk-reduction strategies for women from families with site-specific hereditary breast cancer kindred and mutation-negative status until the findings can be confirmed through additional studies.

The authors wrote that “two-thirds of the women in the cohort were Ashkenazi Jewish, and it is possible that BRCA mutation testing in this group more effectively excludes the possibility of a deleterious mutation than in non-Ashkenazi populations.”

Also, the study was powered to detect a 3.5- to 4-fold increase in ovarian cancer risk, compared with the general population, but detection of a 2.5- to 3-fold increase would require 3,800–7,600 women-years of follow-up, compared with the 2,534 women-years of follow-up represented by the current study.

Women from families with hereditary breast cancer who do not carry the BRCA1 or BRCA2 genetic mutations are not at increased risk for ovarian cancer, a prospective study has shown.

If validated by additional studies, the findings by Noah D. Kauff, M.D., and colleagues at New York's Memorial Sloan-Kettering Cancer Center may allow physicians to better tailor ovarian cancer risk-reduction strategies.

Using records from the Sloan-Kettering clinical genetics service, investigators identified more than 1,700 patients who underwent genetic testing for BRCA mutations from August 1996 through July 2002 and who had consented to participate in follow-up studies. Those kindred with site-specific breast cancer who were BRCA mutation-negative and who had a living female proband received detailed questionnaires to provide clinical follow-up information and information on new cancers in themselves and their first- and second-degree relatives.

For the study, probands were defined as the youngest living BRCA mutation-negative women with breast cancer whose lineage included at least three cases of breast cancer—at least one of which must have been diagnosed before age 50—and no ovarian cancer, the investigators said (J. Natl. Cancer Inst. 2005;97:1382–4).

Probands whose heritage was exclusively Ashkenazi Jewish were included if they tested negative for the three Ashkenazi founder mutations because such testing has been shown to identify approximately 95% of detectable BRCA mutations, Dr. Kauff and associates stated.

Of 207 living female probands identified, 165 completed the study questionnaires. During a mean follow-up of 40.6 months, 19 new cases of breast cancer were diagnosed in the families, which included the 165 probands and 583 first- or second-degree female relatives. The disease incidence was more than three times greater than expected in age-matched women from the general population.

During the same follow-up period, one case of ovarian cancer was diagnosed, which is consistent with expectations for an average-risk population.

Dr. Kauff and associates advised caution with respect to revising ovarian cancer risk-reduction strategies for women from families with site-specific hereditary breast cancer kindred and mutation-negative status until the findings can be confirmed through additional studies.

The authors wrote that “two-thirds of the women in the cohort were Ashkenazi Jewish, and it is possible that BRCA mutation testing in this group more effectively excludes the possibility of a deleterious mutation than in non-Ashkenazi populations.”

Also, the study was powered to detect a 3.5- to 4-fold increase in ovarian cancer risk, compared with the general population, but detection of a 2.5- to 3-fold increase would require 3,800–7,600 women-years of follow-up, compared with the 2,534 women-years of follow-up represented by the current study.

Women from families with hereditary breast cancer who do not carry the BRCA1 or BRCA2 genetic mutations are not at increased risk for ovarian cancer, a prospective study has shown.

If validated by additional studies, the findings by Noah D. Kauff, M.D., and colleagues at New York's Memorial Sloan-Kettering Cancer Center may allow physicians to better tailor ovarian cancer risk-reduction strategies.

Using records from the Sloan-Kettering clinical genetics service, investigators identified more than 1,700 patients who underwent genetic testing for BRCA mutations from August 1996 through July 2002 and who had consented to participate in follow-up studies. Those kindred with site-specific breast cancer who were BRCA mutation-negative and who had a living female proband received detailed questionnaires to provide clinical follow-up information and information on new cancers in themselves and their first- and second-degree relatives.

For the study, probands were defined as the youngest living BRCA mutation-negative women with breast cancer whose lineage included at least three cases of breast cancer—at least one of which must have been diagnosed before age 50—and no ovarian cancer, the investigators said (J. Natl. Cancer Inst. 2005;97:1382–4).

Probands whose heritage was exclusively Ashkenazi Jewish were included if they tested negative for the three Ashkenazi founder mutations because such testing has been shown to identify approximately 95% of detectable BRCA mutations, Dr. Kauff and associates stated.

Of 207 living female probands identified, 165 completed the study questionnaires. During a mean follow-up of 40.6 months, 19 new cases of breast cancer were diagnosed in the families, which included the 165 probands and 583 first- or second-degree female relatives. The disease incidence was more than three times greater than expected in age-matched women from the general population.

During the same follow-up period, one case of ovarian cancer was diagnosed, which is consistent with expectations for an average-risk population.

Dr. Kauff and associates advised caution with respect to revising ovarian cancer risk-reduction strategies for women from families with site-specific hereditary breast cancer kindred and mutation-negative status until the findings can be confirmed through additional studies.

The authors wrote that “two-thirds of the women in the cohort were Ashkenazi Jewish, and it is possible that BRCA mutation testing in this group more effectively excludes the possibility of a deleterious mutation than in non-Ashkenazi populations.”

Also, the study was powered to detect a 3.5- to 4-fold increase in ovarian cancer risk, compared with the general population, but detection of a 2.5- to 3-fold increase would require 3,800–7,600 women-years of follow-up, compared with the 2,534 women-years of follow-up represented by the current study.

BOSTON — Prenatal care providers are bypassing a “golden opportunity” to improve the long-term health of families by not addressing the health-risk behaviors of expectant fathers, according to Kevin Everett, Ph.D., of the University of Missouri-Columbia.

Pregnancy often is viewed as a “teachable moment” because women become receptive to and are more likely to follow health advice that could positively impact their children, and men's health-risk behaviors are rarely considered during this time, Dr. Everett said at the annual meeting of the Society of Behavioral Medicine.

To better understand paternal health-risk behaviors and determine whether the inclusion of a prenatal care component focusing on reducing them would be favorably received, Dr. Everett and his colleagues conducted a telephone survey of 138 expectant fathers from rural, low-income families who were at least 18 years old and had consent from their pregnant partners.

The participants answered questions about their health behaviors, including tobacco use, problem drinking, physical activity, body mass index, and nutrition. Sociodemographic variables and ratings of health beliefs also were recorded.

The median age of the men surveyed was 27. They were predominantly white (87%), and more than half (66%) were high school graduates. Approximately 86% of the men were employed at the time of the survey, and nearly 62% were married to their partners. More than half of the study population (61%) reported being in “excellent” or “very good” health.

With respect to health-risk behaviors, nearly half of the men (49%) were smokers and almost one-third (30%) engaged in hazardous drinking. Most of the men (94%) were deemed to have poor nutritional habits, and approximately one-quarter were obese.

Ironically, Dr. Everett said, “many of the [respondents'] reported health beliefs are incongruent with these behaviors.” Nearly 95% of the men acknowledged the importance of a healthful diet. More than 98% knew smoking around children or babies was unhealthy, and nearly 90% reported that they thought it was not okay to drink alcohol around children.

Of particular interest was the respondents' receptiveness both to learning about potential health changes and implementing them, he said. Nearly 98% of the men expressed a willingness to change their own behaviors to help their partners change their potentially harmful behaviors. About 93% of the men were confident in their ability to make these changes, and 83% expressed a desire for getting information about making changes.

By not considering the health behaviors and attitudes of expectant fathers, “providers are missing an important window,” Dr. Everett said. “Health behavior changes made by men may be the critical factors for determining early and long-term family health by enhancing partner health behavior change.”

BOSTON — Prenatal care providers are bypassing a “golden opportunity” to improve the long-term health of families by not addressing the health-risk behaviors of expectant fathers, according to Kevin Everett, Ph.D., of the University of Missouri-Columbia.

Pregnancy often is viewed as a “teachable moment” because women become receptive to and are more likely to follow health advice that could positively impact their children, and men's health-risk behaviors are rarely considered during this time, Dr. Everett said at the annual meeting of the Society of Behavioral Medicine.

To better understand paternal health-risk behaviors and determine whether the inclusion of a prenatal care component focusing on reducing them would be favorably received, Dr. Everett and his colleagues conducted a telephone survey of 138 expectant fathers from rural, low-income families who were at least 18 years old and had consent from their pregnant partners.

The participants answered questions about their health behaviors, including tobacco use, problem drinking, physical activity, body mass index, and nutrition. Sociodemographic variables and ratings of health beliefs also were recorded.

The median age of the men surveyed was 27. They were predominantly white (87%), and more than half (66%) were high school graduates. Approximately 86% of the men were employed at the time of the survey, and nearly 62% were married to their partners. More than half of the study population (61%) reported being in “excellent” or “very good” health.

With respect to health-risk behaviors, nearly half of the men (49%) were smokers and almost one-third (30%) engaged in hazardous drinking. Most of the men (94%) were deemed to have poor nutritional habits, and approximately one-quarter were obese.

Ironically, Dr. Everett said, “many of the [respondents'] reported health beliefs are incongruent with these behaviors.” Nearly 95% of the men acknowledged the importance of a healthful diet. More than 98% knew smoking around children or babies was unhealthy, and nearly 90% reported that they thought it was not okay to drink alcohol around children.

Of particular interest was the respondents' receptiveness both to learning about potential health changes and implementing them, he said. Nearly 98% of the men expressed a willingness to change their own behaviors to help their partners change their potentially harmful behaviors. About 93% of the men were confident in their ability to make these changes, and 83% expressed a desire for getting information about making changes.

By not considering the health behaviors and attitudes of expectant fathers, “providers are missing an important window,” Dr. Everett said. “Health behavior changes made by men may be the critical factors for determining early and long-term family health by enhancing partner health behavior change.”

BOSTON — Prenatal care providers are bypassing a “golden opportunity” to improve the long-term health of families by not addressing the health-risk behaviors of expectant fathers, according to Kevin Everett, Ph.D., of the University of Missouri-Columbia.

Pregnancy often is viewed as a “teachable moment” because women become receptive to and are more likely to follow health advice that could positively impact their children, and men's health-risk behaviors are rarely considered during this time, Dr. Everett said at the annual meeting of the Society of Behavioral Medicine.

To better understand paternal health-risk behaviors and determine whether the inclusion of a prenatal care component focusing on reducing them would be favorably received, Dr. Everett and his colleagues conducted a telephone survey of 138 expectant fathers from rural, low-income families who were at least 18 years old and had consent from their pregnant partners.

The participants answered questions about their health behaviors, including tobacco use, problem drinking, physical activity, body mass index, and nutrition. Sociodemographic variables and ratings of health beliefs also were recorded.

The median age of the men surveyed was 27. They were predominantly white (87%), and more than half (66%) were high school graduates. Approximately 86% of the men were employed at the time of the survey, and nearly 62% were married to their partners. More than half of the study population (61%) reported being in “excellent” or “very good” health.

With respect to health-risk behaviors, nearly half of the men (49%) were smokers and almost one-third (30%) engaged in hazardous drinking. Most of the men (94%) were deemed to have poor nutritional habits, and approximately one-quarter were obese.

Ironically, Dr. Everett said, “many of the [respondents'] reported health beliefs are incongruent with these behaviors.” Nearly 95% of the men acknowledged the importance of a healthful diet. More than 98% knew smoking around children or babies was unhealthy, and nearly 90% reported that they thought it was not okay to drink alcohol around children.

Of particular interest was the respondents' receptiveness both to learning about potential health changes and implementing them, he said. Nearly 98% of the men expressed a willingness to change their own behaviors to help their partners change their potentially harmful behaviors. About 93% of the men were confident in their ability to make these changes, and 83% expressed a desire for getting information about making changes.

By not considering the health behaviors and attitudes of expectant fathers, “providers are missing an important window,” Dr. Everett said. “Health behavior changes made by men may be the critical factors for determining early and long-term family health by enhancing partner health behavior change.”

BOSTON— Contrast stress echocardiography is significantly more specific and no less sensitive than nuclear stress testing for evaluating chest pain in women who have a low to medium probability of coronary disease, a study has shown.

The findings suggest the ultrasound technique should be the preferred diagnostic test in this population, particularly because nuclear stress testing in women is complicated by a higher false positive rate than in men, Kenneth Ford, M.D., reported in a poster presentation at the annual meeting of the American Society of Echocardiography.

In comparing the accuracy of the two imaging modalities, Dr. Ford and his colleagues at Western Baptist Hospital in Paducah, Ky., enrolled 250 women with chest pain who were considered to be at low to intermediate risk for coronary artery disease (CAD). Women's average age was 53 years, and the average follow-up time was 543 days. Coronary disease risk-prediction factors included hypertension, diabetes, smoking, vascular disease, and family history.

Each woman underwent gated single-photon emission computed tomography (SPECT) with attenuation correction and contrast echocardiography, both at rest and immediately after a standard treadmill test, and each was injected with a weight-adjusted dose of sestamibi at peak stress followed by a 0.5-cc bolus of echo contrast. A single radiologist who was blinded to the stress echo results read all of the nuclear images.

“Patients with a reversible nuclear perfusion defect or a stress-induced wall motion abnormality on echocardiogram were urged to undergo a cardiac catheterization,” Dr. Ford noted.

Of the 250 women, 16 had significant CAD defined as more than 60% stenosis in the “culprit” vessel prompting major cardiac events during the study follow-up period, said Dr. Ford.

Major cardiac events included the need for percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), myocardial infarction (MI), and death. Of the 16 patients with significant disease, 13 underwent PCI, 2 required CABG, and 1 suffered MI.

The sestamibi test correctly identified 8 of the 16 true positive conditions; the ultrasound test correctly identified 12 of them. Because of the small numbers, the difference in the sensitivity rates was not statistically significant, said Dr. Ford.

The difference between the specificity achieved by each of the diagnostic imaging techniques was significant, Dr. Ford said. Among the 234 women without significant coronary disease, the sestamibi tests produced 15 false positives, for a specificity of 94%, compared with 2 false positives—specificity of 99%—from the ultrasound images.

The lower false positive rate of stress echo tests results in fewer unnecessary heart catheterizations in younger women with intermediate to low risk for heart disease, Dr. Ford noted.

BOSTON— Contrast stress echocardiography is significantly more specific and no less sensitive than nuclear stress testing for evaluating chest pain in women who have a low to medium probability of coronary disease, a study has shown.

The findings suggest the ultrasound technique should be the preferred diagnostic test in this population, particularly because nuclear stress testing in women is complicated by a higher false positive rate than in men, Kenneth Ford, M.D., reported in a poster presentation at the annual meeting of the American Society of Echocardiography.

In comparing the accuracy of the two imaging modalities, Dr. Ford and his colleagues at Western Baptist Hospital in Paducah, Ky., enrolled 250 women with chest pain who were considered to be at low to intermediate risk for coronary artery disease (CAD). Women's average age was 53 years, and the average follow-up time was 543 days. Coronary disease risk-prediction factors included hypertension, diabetes, smoking, vascular disease, and family history.

Each woman underwent gated single-photon emission computed tomography (SPECT) with attenuation correction and contrast echocardiography, both at rest and immediately after a standard treadmill test, and each was injected with a weight-adjusted dose of sestamibi at peak stress followed by a 0.5-cc bolus of echo contrast. A single radiologist who was blinded to the stress echo results read all of the nuclear images.

“Patients with a reversible nuclear perfusion defect or a stress-induced wall motion abnormality on echocardiogram were urged to undergo a cardiac catheterization,” Dr. Ford noted.

Of the 250 women, 16 had significant CAD defined as more than 60% stenosis in the “culprit” vessel prompting major cardiac events during the study follow-up period, said Dr. Ford.

Major cardiac events included the need for percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), myocardial infarction (MI), and death. Of the 16 patients with significant disease, 13 underwent PCI, 2 required CABG, and 1 suffered MI.

The sestamibi test correctly identified 8 of the 16 true positive conditions; the ultrasound test correctly identified 12 of them. Because of the small numbers, the difference in the sensitivity rates was not statistically significant, said Dr. Ford.

The difference between the specificity achieved by each of the diagnostic imaging techniques was significant, Dr. Ford said. Among the 234 women without significant coronary disease, the sestamibi tests produced 15 false positives, for a specificity of 94%, compared with 2 false positives—specificity of 99%—from the ultrasound images.

The lower false positive rate of stress echo tests results in fewer unnecessary heart catheterizations in younger women with intermediate to low risk for heart disease, Dr. Ford noted.

BOSTON— Contrast stress echocardiography is significantly more specific and no less sensitive than nuclear stress testing for evaluating chest pain in women who have a low to medium probability of coronary disease, a study has shown.

The findings suggest the ultrasound technique should be the preferred diagnostic test in this population, particularly because nuclear stress testing in women is complicated by a higher false positive rate than in men, Kenneth Ford, M.D., reported in a poster presentation at the annual meeting of the American Society of Echocardiography.

In comparing the accuracy of the two imaging modalities, Dr. Ford and his colleagues at Western Baptist Hospital in Paducah, Ky., enrolled 250 women with chest pain who were considered to be at low to intermediate risk for coronary artery disease (CAD). Women's average age was 53 years, and the average follow-up time was 543 days. Coronary disease risk-prediction factors included hypertension, diabetes, smoking, vascular disease, and family history.

Each woman underwent gated single-photon emission computed tomography (SPECT) with attenuation correction and contrast echocardiography, both at rest and immediately after a standard treadmill test, and each was injected with a weight-adjusted dose of sestamibi at peak stress followed by a 0.5-cc bolus of echo contrast. A single radiologist who was blinded to the stress echo results read all of the nuclear images.

“Patients with a reversible nuclear perfusion defect or a stress-induced wall motion abnormality on echocardiogram were urged to undergo a cardiac catheterization,” Dr. Ford noted.

Of the 250 women, 16 had significant CAD defined as more than 60% stenosis in the “culprit” vessel prompting major cardiac events during the study follow-up period, said Dr. Ford.

Major cardiac events included the need for percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), myocardial infarction (MI), and death. Of the 16 patients with significant disease, 13 underwent PCI, 2 required CABG, and 1 suffered MI.

The sestamibi test correctly identified 8 of the 16 true positive conditions; the ultrasound test correctly identified 12 of them. Because of the small numbers, the difference in the sensitivity rates was not statistically significant, said Dr. Ford.

The difference between the specificity achieved by each of the diagnostic imaging techniques was significant, Dr. Ford said. Among the 234 women without significant coronary disease, the sestamibi tests produced 15 false positives, for a specificity of 94%, compared with 2 false positives—specificity of 99%—from the ultrasound images.

The lower false positive rate of stress echo tests results in fewer unnecessary heart catheterizations in younger women with intermediate to low risk for heart disease, Dr. Ford noted.

CAMBRIDGE, MASS. — Certain cognitive factors are significant predictors of pain intensity and sexual impairment in women with vulvar vestibulitis syndrome, Geneviève Desrochers said in a poster presentation at the annual meeting of the Society for Sex Therapy and Research.

The findings of her study suggest that targeted cognitive-behavioral therapy might help mediate the severe pain associated with the chronic, persistent inflammatory condition.

Hierarchic regression analysis of data obtained from 67 women with vulvar vestibulitis syndrome showed that lower levels of pain self-efficacy (confidence in one's ability to perform a range of tasks despite pain) and higher levels of pain catastrophization (a negative cognitive response to, or anticipation of, pain) were both associated with more intense pain during intercourse, reported Ms. Desrochers, who is a Ph.D. candidate in psychology at the University of Quebec, Montreal.

All study participants had a prior diagnosis of vulvar vestibulitis syndrome. As part of the investigation, the women underwent a gynecologic examination and completed a structured interview and standarized questionnaires focusing on pain self-efficacy, pain catastrophization, anxiety, and pain during intercourse.

The regression analysis also showed that catastrophization remained a strong predictor of the severity of pain symptoms after controlling for state-trait anxiety and self-efficacy.

“Higher levels of catastrophization were still related to more severe pain,” Ms. Desrochers wrote.

Of the variables, only self-efficacy was a good predictor of global sexual functioning after controlling for pain intensity and state-trait anxiety, with lower self-efficacy predicting increased sexual impairment.

“We did find that [lower levels of] state-trait anxiety mediated the role of catastrophizing in pain intensity,” Ms. Desrochers noted.

The findings of the study are consistent with a cognitive-behavioral model of chronic pain, “and they may be important components to consider for sex therapy with this population of women,” Ms. Desrochers suggested during the meeting, which was also sponsored by the American College of Obstetricians and Gynecologists.

CAMBRIDGE, MASS. — Certain cognitive factors are significant predictors of pain intensity and sexual impairment in women with vulvar vestibulitis syndrome, Geneviève Desrochers said in a poster presentation at the annual meeting of the Society for Sex Therapy and Research.

The findings of her study suggest that targeted cognitive-behavioral therapy might help mediate the severe pain associated with the chronic, persistent inflammatory condition.

Hierarchic regression analysis of data obtained from 67 women with vulvar vestibulitis syndrome showed that lower levels of pain self-efficacy (confidence in one's ability to perform a range of tasks despite pain) and higher levels of pain catastrophization (a negative cognitive response to, or anticipation of, pain) were both associated with more intense pain during intercourse, reported Ms. Desrochers, who is a Ph.D. candidate in psychology at the University of Quebec, Montreal.

All study participants had a prior diagnosis of vulvar vestibulitis syndrome. As part of the investigation, the women underwent a gynecologic examination and completed a structured interview and standarized questionnaires focusing on pain self-efficacy, pain catastrophization, anxiety, and pain during intercourse.

The regression analysis also showed that catastrophization remained a strong predictor of the severity of pain symptoms after controlling for state-trait anxiety and self-efficacy.

“Higher levels of catastrophization were still related to more severe pain,” Ms. Desrochers wrote.

Of the variables, only self-efficacy was a good predictor of global sexual functioning after controlling for pain intensity and state-trait anxiety, with lower self-efficacy predicting increased sexual impairment.

“We did find that [lower levels of] state-trait anxiety mediated the role of catastrophizing in pain intensity,” Ms. Desrochers noted.

The findings of the study are consistent with a cognitive-behavioral model of chronic pain, “and they may be important components to consider for sex therapy with this population of women,” Ms. Desrochers suggested during the meeting, which was also sponsored by the American College of Obstetricians and Gynecologists.

CAMBRIDGE, MASS. — Certain cognitive factors are significant predictors of pain intensity and sexual impairment in women with vulvar vestibulitis syndrome, Geneviève Desrochers said in a poster presentation at the annual meeting of the Society for Sex Therapy and Research.

The findings of her study suggest that targeted cognitive-behavioral therapy might help mediate the severe pain associated with the chronic, persistent inflammatory condition.

Hierarchic regression analysis of data obtained from 67 women with vulvar vestibulitis syndrome showed that lower levels of pain self-efficacy (confidence in one's ability to perform a range of tasks despite pain) and higher levels of pain catastrophization (a negative cognitive response to, or anticipation of, pain) were both associated with more intense pain during intercourse, reported Ms. Desrochers, who is a Ph.D. candidate in psychology at the University of Quebec, Montreal.

All study participants had a prior diagnosis of vulvar vestibulitis syndrome. As part of the investigation, the women underwent a gynecologic examination and completed a structured interview and standarized questionnaires focusing on pain self-efficacy, pain catastrophization, anxiety, and pain during intercourse.

The regression analysis also showed that catastrophization remained a strong predictor of the severity of pain symptoms after controlling for state-trait anxiety and self-efficacy.

“Higher levels of catastrophization were still related to more severe pain,” Ms. Desrochers wrote.

Of the variables, only self-efficacy was a good predictor of global sexual functioning after controlling for pain intensity and state-trait anxiety, with lower self-efficacy predicting increased sexual impairment.

“We did find that [lower levels of] state-trait anxiety mediated the role of catastrophizing in pain intensity,” Ms. Desrochers noted.

The findings of the study are consistent with a cognitive-behavioral model of chronic pain, “and they may be important components to consider for sex therapy with this population of women,” Ms. Desrochers suggested during the meeting, which was also sponsored by the American College of Obstetricians and Gynecologists.

NEW ORLEANS — Giving primary care physicians quantitative information about fracture risk can help them make more judicious use of preventive drug therapy for postmenopausal women at below-average risk for osteoporosis, Joan M. Neuner, M.D., said at the annual meeting of the Society of General Internal Medicine.

In a national survey targeting a random sample of primary care physicians, those who received lifetime and 5-year quantitative fracture risk estimates along with bone mineral density (BMD) reports were less likely than those given standard BMD reports to recommend preventive prescription drugs for a 70-year-old, average-weight woman with a T score of −1.01, Dr. Neuner reported.

The survey included nationally representative proportions of general internists, family physicians, general practitioners, and ob.gyns. The physicians were asked to respond to four clinical vignettes that varied with regard to patient age, weight, and hip BMD. The survey also included Likert-scaled items to measure osteoporosis knowledge, attitudes, and screening preferences.

Of the respondents, 141 randomly received standard hip BMD measures for each vignette (reported as g/cm

Dr. Neuner and her colleagues at the Medical College of Wisconsin in Milwaukee developed a logistic regression model to adjust the results for physician specialty, physician demographics, and physician estimates of relative fracture risk for a patient with below-average risk.

“In the unadjusted analysis, physicians who received augmented BMD reports were no more or less likely to recommend prescription medications for any of the vignettes,” Dr. Neuner said. In the adjusted model, however, 25% of the physicians who received the augmented BMD would have prescribed drug therapy for the below-average-risk 70-year-old, compared with 36% of the physicians who received the standard BMD report only—a statistically significant difference, she said.

Physicians in the standard BMD group who correctly identified the woman as having a below-average risk of hip fracture based on age, weight, and hip BMD also were less likely to recommend drug therapy, she added.

The findings suggest that adding quantitative fracture risk estimates to BMD reports “has the potential to change physician prescribing behavior” for women at low risk for osteoporosis. Similarly, educating primary care providers about risk classification could change their perceptions about who should get preventive drug therapy, Dr. Neuner said.

NEW ORLEANS — Giving primary care physicians quantitative information about fracture risk can help them make more judicious use of preventive drug therapy for postmenopausal women at below-average risk for osteoporosis, Joan M. Neuner, M.D., said at the annual meeting of the Society of General Internal Medicine.

In a national survey targeting a random sample of primary care physicians, those who received lifetime and 5-year quantitative fracture risk estimates along with bone mineral density (BMD) reports were less likely than those given standard BMD reports to recommend preventive prescription drugs for a 70-year-old, average-weight woman with a T score of −1.01, Dr. Neuner reported.

The survey included nationally representative proportions of general internists, family physicians, general practitioners, and ob.gyns. The physicians were asked to respond to four clinical vignettes that varied with regard to patient age, weight, and hip BMD. The survey also included Likert-scaled items to measure osteoporosis knowledge, attitudes, and screening preferences.

Of the respondents, 141 randomly received standard hip BMD measures for each vignette (reported as g/cm

Dr. Neuner and her colleagues at the Medical College of Wisconsin in Milwaukee developed a logistic regression model to adjust the results for physician specialty, physician demographics, and physician estimates of relative fracture risk for a patient with below-average risk.

“In the unadjusted analysis, physicians who received augmented BMD reports were no more or less likely to recommend prescription medications for any of the vignettes,” Dr. Neuner said. In the adjusted model, however, 25% of the physicians who received the augmented BMD would have prescribed drug therapy for the below-average-risk 70-year-old, compared with 36% of the physicians who received the standard BMD report only—a statistically significant difference, she said.

Physicians in the standard BMD group who correctly identified the woman as having a below-average risk of hip fracture based on age, weight, and hip BMD also were less likely to recommend drug therapy, she added.

The findings suggest that adding quantitative fracture risk estimates to BMD reports “has the potential to change physician prescribing behavior” for women at low risk for osteoporosis. Similarly, educating primary care providers about risk classification could change their perceptions about who should get preventive drug therapy, Dr. Neuner said.

NEW ORLEANS — Giving primary care physicians quantitative information about fracture risk can help them make more judicious use of preventive drug therapy for postmenopausal women at below-average risk for osteoporosis, Joan M. Neuner, M.D., said at the annual meeting of the Society of General Internal Medicine.

In a national survey targeting a random sample of primary care physicians, those who received lifetime and 5-year quantitative fracture risk estimates along with bone mineral density (BMD) reports were less likely than those given standard BMD reports to recommend preventive prescription drugs for a 70-year-old, average-weight woman with a T score of −1.01, Dr. Neuner reported.

The survey included nationally representative proportions of general internists, family physicians, general practitioners, and ob.gyns. The physicians were asked to respond to four clinical vignettes that varied with regard to patient age, weight, and hip BMD. The survey also included Likert-scaled items to measure osteoporosis knowledge, attitudes, and screening preferences.

Of the respondents, 141 randomly received standard hip BMD measures for each vignette (reported as g/cm

Dr. Neuner and her colleagues at the Medical College of Wisconsin in Milwaukee developed a logistic regression model to adjust the results for physician specialty, physician demographics, and physician estimates of relative fracture risk for a patient with below-average risk.

“In the unadjusted analysis, physicians who received augmented BMD reports were no more or less likely to recommend prescription medications for any of the vignettes,” Dr. Neuner said. In the adjusted model, however, 25% of the physicians who received the augmented BMD would have prescribed drug therapy for the below-average-risk 70-year-old, compared with 36% of the physicians who received the standard BMD report only—a statistically significant difference, she said.

Physicians in the standard BMD group who correctly identified the woman as having a below-average risk of hip fracture based on age, weight, and hip BMD also were less likely to recommend drug therapy, she added.

The findings suggest that adding quantitative fracture risk estimates to BMD reports “has the potential to change physician prescribing behavior” for women at low risk for osteoporosis. Similarly, educating primary care providers about risk classification could change their perceptions about who should get preventive drug therapy, Dr. Neuner said.

NEW ORLEANS — Giving primary care physicians quantitative information about fracture risk can help them make more judicious use of preventive drug therapy for postmenopausal women at below-average risk for osteoporosis, Joan M. Neuner, M.D., said at the annual meeting of the Society of General Internal Medicine.

In a national survey targeting a random sample of primary care physicians, those who received lifetime and 5-year quantitative fracture risk estimates along with bone mineral density (BMD) reports were less likely than those given standard BMD reports to recommend preventive prescription drugs for a 70-year-old, average-weight woman with a T score of −1.01, Dr. Neuner reported.

The survey included nationally representative proportions of general internists, family physicians, general practitioners, and ob.gyns. The physicians were asked to respond to four clinical vignettes that varied with regard to patient age, weight, and hip BMD. The survey also included Likert-scaled items to measure osteoporosis knowledge, attitudes, and screening preferences.

Of the respondents, 141 randomly received standard hip BMD measures for each vignette (reported as g/cm

Dr. Neuner and her colleagues at the Medical College of Wisconsin in Milwaukee developed a logistic regression model to adjust the results for physician specialty, physician demographics, and physician estimates of relative fracture risk for a patient with below-average risk.

“In the unadjusted analysis, physicians who received augmented BMD reports were no more or less likely to recommend prescription medications for any of the vignettes,” Dr. Neuner said. In the adjusted model, however, 25% of the physicians who received the augmented BMD would have prescribed drug therapy for the below-average-risk 70-year-old, compared with 36% of the physicians who received the standard BMD report only—a statistically significant difference, she said.

Physicians in the standard BMD group who correctly identified the woman as having a below-average risk of hip fracture based on age, weight, and hip BMD also were less likely to recommend drug therapy, she added.

The findings suggest that adding quantitative fracture risk estimates to BMD reports “has the potential to change physician prescribing behavior” for women at low risk for osteoporosis. Similarly, educating primary care providers about risk classification could change their perceptions about who should get preventive drug therapy, Dr. Neuner said.

NEW ORLEANS — Giving primary care physicians quantitative information about fracture risk can help them make more judicious use of preventive drug therapy for postmenopausal women at below-average risk for osteoporosis, Joan M. Neuner, M.D., said at the annual meeting of the Society of General Internal Medicine.

In a national survey targeting a random sample of primary care physicians, those who received lifetime and 5-year quantitative fracture risk estimates along with bone mineral density (BMD) reports were less likely than those given standard BMD reports to recommend preventive prescription drugs for a 70-year-old, average-weight woman with a T score of −1.01, Dr. Neuner reported.

The survey included nationally representative proportions of general internists, family physicians, general practitioners, and ob.gyns. The physicians were asked to respond to four clinical vignettes that varied with regard to patient age, weight, and hip BMD. The survey also included Likert-scaled items to measure osteoporosis knowledge, attitudes, and screening preferences.

Of the respondents, 141 randomly received standard hip BMD measures for each vignette (reported as g/cm

Dr. Neuner and her colleagues at the Medical College of Wisconsin in Milwaukee developed a logistic regression model to adjust the results for physician specialty, physician demographics, and physician estimates of relative fracture risk for a patient with below-average risk.

“In the unadjusted analysis, physicians who received augmented BMD reports were no more or less likely to recommend prescription medications for any of the vignettes,” Dr. Neuner said. In the adjusted model, however, 25% of the physicians who received the augmented BMD would have prescribed drug therapy for the below-average-risk 70-year-old, compared with 36% of the physicians who received the standard BMD report only—a statistically significant difference, she said.

Physicians in the standard BMD group who correctly identified the woman as having a below-average risk of hip fracture based on age, weight, and hip BMD also were less likely to recommend drug therapy, she added.

The findings suggest that adding quantitative fracture risk estimates to BMD reports “has the potential to change physician prescribing behavior” for women at low risk for osteoporosis. Similarly, educating primary care providers about risk classification could change their perceptions about who should get preventive drug therapy, Dr. Neuner said.

NEW ORLEANS — Giving primary care physicians quantitative information about fracture risk can help them make more judicious use of preventive drug therapy for postmenopausal women at below-average risk for osteoporosis, Joan M. Neuner, M.D., said at the annual meeting of the Society of General Internal Medicine.

In a national survey targeting a random sample of primary care physicians, those who received lifetime and 5-year quantitative fracture risk estimates along with bone mineral density (BMD) reports were less likely than those given standard BMD reports to recommend preventive prescription drugs for a 70-year-old, average-weight woman with a T score of −1.01, Dr. Neuner reported.

The survey included nationally representative proportions of general internists, family physicians, general practitioners, and ob.gyns. The physicians were asked to respond to four clinical vignettes that varied with regard to patient age, weight, and hip BMD. The survey also included Likert-scaled items to measure osteoporosis knowledge, attitudes, and screening preferences.

Of the respondents, 141 randomly received standard hip BMD measures for each vignette (reported as g/cm

Dr. Neuner and her colleagues at the Medical College of Wisconsin in Milwaukee developed a logistic regression model to adjust the results for physician specialty, physician demographics, and physician estimates of relative fracture risk for a patient with below-average risk.

“In the unadjusted analysis, physicians who received augmented BMD reports were no more or less likely to recommend prescription medications for any of the vignettes,” Dr. Neuner said. In the adjusted model, however, 25% of the physicians who received the augmented BMD would have prescribed drug therapy for the below-average-risk 70-year-old, compared with 36% of the physicians who received the standard BMD report only—a statistically significant difference, she said.

Physicians in the standard BMD group who correctly identified the woman as having a below-average risk of hip fracture based on age, weight, and hip BMD also were less likely to recommend drug therapy, she added.

The findings suggest that adding quantitative fracture risk estimates to BMD reports “has the potential to change physician prescribing behavior” for women at low risk for osteoporosis. Similarly, educating primary care providers about risk classification could change their perceptions about who should get preventive drug therapy, Dr. Neuner said.