Diana Mahoney

BOSTON — Many parents of children who are overwieght or those at risk for becoming overweight don't perceive their children's weight accurately, Patricia A. Cluss, Ph.D., and colleagues said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

These findings “have significant implications for public health and clinical interventions aimed at decreasing the pediatric obesity epidemic,” wrote Dr. Cluss and her associates.

Parental awareness of and concern that their child's weight is above the normal range is “intrinsic to the success” of physicians' efforts to identify and target children for prevention or intervention, she said in an oral presentation.

To determine the accuracy of parental weight perceptions, the parents of 616 children aged 3–12 years seen at two community pediatric practices completed eight-item, self-administered questionnaires. Medical assistants weighed, measured, and calculated the children's body mass index (BMI).

The study included 281 girls and 335 boys. Of the girls, 15% were at risk for being overweight, with BMIs in the 85th to 94th percentiles, and 25% were overweight, with BMIs above the 94th percentile. Using the same criteria, 15% of the boys were at risk for being overweight, and 22% were overweight.

Only 49% of parents surveyed accurately recognized their overweight children as being overweight, reported Dr. Cluss of the University of Pittsburgh.

“The parents of overweight girls were more likely to accurately perceive their child as being overweight, compared [with] the parents of boys, particularly preadolescents,” said Dr. Cluss. While 63% of overweight girls' parents recognized their children's weight status, only 29% of overweight boys' parents had accurate perceptions.

The results also showed that parental perceptions were more often correct for children aged 6–12 years than for children younger than 6 years old.

Only 8% of the parents whose children were at risk for becoming overweight were aware of it.

The findings add to a growing body of data indicating that many parents do not correctly perceive their child's weight status—a fact that may hinder parents' readiness to engage with the pediatrician in tracking and intervention strategies, said Dr. Cluss.

As such, physicians “have an important role to play in identifying at-risk children and communicating early concern to parents,” she said.

In addition, special attention should be given to communicating with parents of younger children who may be overweight or at risk of becoming so and with parents of overweight boys, considering both groups had low accuracy rates, Dr. Cluss said.

BOSTON — Many parents of children who are overwieght or those at risk for becoming overweight don't perceive their children's weight accurately, Patricia A. Cluss, Ph.D., and colleagues said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

These findings “have significant implications for public health and clinical interventions aimed at decreasing the pediatric obesity epidemic,” wrote Dr. Cluss and her associates.

Parental awareness of and concern that their child's weight is above the normal range is “intrinsic to the success” of physicians' efforts to identify and target children for prevention or intervention, she said in an oral presentation.

To determine the accuracy of parental weight perceptions, the parents of 616 children aged 3–12 years seen at two community pediatric practices completed eight-item, self-administered questionnaires. Medical assistants weighed, measured, and calculated the children's body mass index (BMI).

The study included 281 girls and 335 boys. Of the girls, 15% were at risk for being overweight, with BMIs in the 85th to 94th percentiles, and 25% were overweight, with BMIs above the 94th percentile. Using the same criteria, 15% of the boys were at risk for being overweight, and 22% were overweight.

Only 49% of parents surveyed accurately recognized their overweight children as being overweight, reported Dr. Cluss of the University of Pittsburgh.

“The parents of overweight girls were more likely to accurately perceive their child as being overweight, compared [with] the parents of boys, particularly preadolescents,” said Dr. Cluss. While 63% of overweight girls' parents recognized their children's weight status, only 29% of overweight boys' parents had accurate perceptions.

The results also showed that parental perceptions were more often correct for children aged 6–12 years than for children younger than 6 years old.

Only 8% of the parents whose children were at risk for becoming overweight were aware of it.

The findings add to a growing body of data indicating that many parents do not correctly perceive their child's weight status—a fact that may hinder parents' readiness to engage with the pediatrician in tracking and intervention strategies, said Dr. Cluss.

As such, physicians “have an important role to play in identifying at-risk children and communicating early concern to parents,” she said.

In addition, special attention should be given to communicating with parents of younger children who may be overweight or at risk of becoming so and with parents of overweight boys, considering both groups had low accuracy rates, Dr. Cluss said.

BOSTON — Many parents of children who are overwieght or those at risk for becoming overweight don't perceive their children's weight accurately, Patricia A. Cluss, Ph.D., and colleagues said in a poster presentation at the annual meeting of the Society of Behavioral Medicine.

These findings “have significant implications for public health and clinical interventions aimed at decreasing the pediatric obesity epidemic,” wrote Dr. Cluss and her associates.

Parental awareness of and concern that their child's weight is above the normal range is “intrinsic to the success” of physicians' efforts to identify and target children for prevention or intervention, she said in an oral presentation.

To determine the accuracy of parental weight perceptions, the parents of 616 children aged 3–12 years seen at two community pediatric practices completed eight-item, self-administered questionnaires. Medical assistants weighed, measured, and calculated the children's body mass index (BMI).

The study included 281 girls and 335 boys. Of the girls, 15% were at risk for being overweight, with BMIs in the 85th to 94th percentiles, and 25% were overweight, with BMIs above the 94th percentile. Using the same criteria, 15% of the boys were at risk for being overweight, and 22% were overweight.

Only 49% of parents surveyed accurately recognized their overweight children as being overweight, reported Dr. Cluss of the University of Pittsburgh.

“The parents of overweight girls were more likely to accurately perceive their child as being overweight, compared [with] the parents of boys, particularly preadolescents,” said Dr. Cluss. While 63% of overweight girls' parents recognized their children's weight status, only 29% of overweight boys' parents had accurate perceptions.

The results also showed that parental perceptions were more often correct for children aged 6–12 years than for children younger than 6 years old.

Only 8% of the parents whose children were at risk for becoming overweight were aware of it.

The findings add to a growing body of data indicating that many parents do not correctly perceive their child's weight status—a fact that may hinder parents' readiness to engage with the pediatrician in tracking and intervention strategies, said Dr. Cluss.

As such, physicians “have an important role to play in identifying at-risk children and communicating early concern to parents,” she said.

In addition, special attention should be given to communicating with parents of younger children who may be overweight or at risk of becoming so and with parents of overweight boys, considering both groups had low accuracy rates, Dr. Cluss said.

NEW ORLEANS — Counseling about the health benefits of exercise is reaching fewer than one in three women over age 50, a national survey has shown.

Studies have shown that exercise can reduce a woman's risk of hip fracture, depression, arthritis pain, diabetes, and coronary artery disease, and that it can improve longevity and cognitive function. Yet a survey of 6,385 women over age 50 showed that only 31% of those aged 50–64 years had been counseled by their physicians to begin or continue any type of physical activity, reported Mara A. Schonberg, M.D.

The older the woman—regardless of functional status or comorbid illness—the less likely she was to have received exercise counseling. Only 29% of those aged 65–74 years received exercise counseling from their physicians, and only 22% of those aged 75–84 years and 14% of those aged 85 and older got such advice, Dr. Schonberg reported at the annual meeting of the Society of General Internal Medicine.

Dr. Schonberg and colleagues at Beth Israel Deaconess Medical Center in Boston used data from the National Center for Health Statistics' 2000 National Health Interview Survey to identify women aged 50 or older who had seen a health care provider during the previous year.

The investigators compared clinician counseling about exercise across the four age categories noted above, using multivariable logistic regression to adjust for demographic factors, body mass index, physical activity, smoking status, having a usual source of care, and number of doctor visits within the previous year. They used additional models to assess the influence of illness burden and functional status on exercise counseling habits.

The initial, unadjusted model showed that for women aged 75–84 years and those aged 85 and older, the odds ratios for receiving exercise counseling were 0.8 and 0.6, respectively, compared with younger women. When the illness burden was taken into account, the odds ratios dropped to 0.7 and 0.5 for women aged 75–84 years and those aged 85 and older, respectively.

One “surprise” finding was that “the differences in exercise counseling across the age groups were more pronounced for women with less comorbidity than those with greater comorbidity,” Dr. Schonberg said. For example, the odds ratio for exercise counseling was 0.4 for women aged 85 or older with fewer than two comorbidities, compared with women aged 50–64 years with the same comorbidity, while it was 0.7 for women older than 85 with two or more comorbidities. This trend was consistent across all age groups.

These findings suggest that age is a conceptual barrier to clinicians discussing exercise with patients, despite awareness of the benefits of physical activity. “The greatest disparity is among older women with less illness burden,” said Dr. Schonberg, noting that efforts should be made to increase provider exercise counseling for such patients.

NEW ORLEANS — Counseling about the health benefits of exercise is reaching fewer than one in three women over age 50, a national survey has shown.

Studies have shown that exercise can reduce a woman's risk of hip fracture, depression, arthritis pain, diabetes, and coronary artery disease, and that it can improve longevity and cognitive function. Yet a survey of 6,385 women over age 50 showed that only 31% of those aged 50–64 years had been counseled by their physicians to begin or continue any type of physical activity, reported Mara A. Schonberg, M.D.

The older the woman—regardless of functional status or comorbid illness—the less likely she was to have received exercise counseling. Only 29% of those aged 65–74 years received exercise counseling from their physicians, and only 22% of those aged 75–84 years and 14% of those aged 85 and older got such advice, Dr. Schonberg reported at the annual meeting of the Society of General Internal Medicine.

Dr. Schonberg and colleagues at Beth Israel Deaconess Medical Center in Boston used data from the National Center for Health Statistics' 2000 National Health Interview Survey to identify women aged 50 or older who had seen a health care provider during the previous year.

The investigators compared clinician counseling about exercise across the four age categories noted above, using multivariable logistic regression to adjust for demographic factors, body mass index, physical activity, smoking status, having a usual source of care, and number of doctor visits within the previous year. They used additional models to assess the influence of illness burden and functional status on exercise counseling habits.

The initial, unadjusted model showed that for women aged 75–84 years and those aged 85 and older, the odds ratios for receiving exercise counseling were 0.8 and 0.6, respectively, compared with younger women. When the illness burden was taken into account, the odds ratios dropped to 0.7 and 0.5 for women aged 75–84 years and those aged 85 and older, respectively.

One “surprise” finding was that “the differences in exercise counseling across the age groups were more pronounced for women with less comorbidity than those with greater comorbidity,” Dr. Schonberg said. For example, the odds ratio for exercise counseling was 0.4 for women aged 85 or older with fewer than two comorbidities, compared with women aged 50–64 years with the same comorbidity, while it was 0.7 for women older than 85 with two or more comorbidities. This trend was consistent across all age groups.

These findings suggest that age is a conceptual barrier to clinicians discussing exercise with patients, despite awareness of the benefits of physical activity. “The greatest disparity is among older women with less illness burden,” said Dr. Schonberg, noting that efforts should be made to increase provider exercise counseling for such patients.

NEW ORLEANS — Counseling about the health benefits of exercise is reaching fewer than one in three women over age 50, a national survey has shown.

Studies have shown that exercise can reduce a woman's risk of hip fracture, depression, arthritis pain, diabetes, and coronary artery disease, and that it can improve longevity and cognitive function. Yet a survey of 6,385 women over age 50 showed that only 31% of those aged 50–64 years had been counseled by their physicians to begin or continue any type of physical activity, reported Mara A. Schonberg, M.D.

The older the woman—regardless of functional status or comorbid illness—the less likely she was to have received exercise counseling. Only 29% of those aged 65–74 years received exercise counseling from their physicians, and only 22% of those aged 75–84 years and 14% of those aged 85 and older got such advice, Dr. Schonberg reported at the annual meeting of the Society of General Internal Medicine.

Dr. Schonberg and colleagues at Beth Israel Deaconess Medical Center in Boston used data from the National Center for Health Statistics' 2000 National Health Interview Survey to identify women aged 50 or older who had seen a health care provider during the previous year.

The investigators compared clinician counseling about exercise across the four age categories noted above, using multivariable logistic regression to adjust for demographic factors, body mass index, physical activity, smoking status, having a usual source of care, and number of doctor visits within the previous year. They used additional models to assess the influence of illness burden and functional status on exercise counseling habits.

The initial, unadjusted model showed that for women aged 75–84 years and those aged 85 and older, the odds ratios for receiving exercise counseling were 0.8 and 0.6, respectively, compared with younger women. When the illness burden was taken into account, the odds ratios dropped to 0.7 and 0.5 for women aged 75–84 years and those aged 85 and older, respectively.

One “surprise” finding was that “the differences in exercise counseling across the age groups were more pronounced for women with less comorbidity than those with greater comorbidity,” Dr. Schonberg said. For example, the odds ratio for exercise counseling was 0.4 for women aged 85 or older with fewer than two comorbidities, compared with women aged 50–64 years with the same comorbidity, while it was 0.7 for women older than 85 with two or more comorbidities. This trend was consistent across all age groups.

These findings suggest that age is a conceptual barrier to clinicians discussing exercise with patients, despite awareness of the benefits of physical activity. “The greatest disparity is among older women with less illness burden,” said Dr. Schonberg, noting that efforts should be made to increase provider exercise counseling for such patients.

BOSTON — The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress will vary depending on both the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines published in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Clarify and ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said. “Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adults with cancer or their partners to help them address the needs of their children during cancer treatment, Dr. Schapira explained. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clinicians should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

BOSTON — The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress will vary depending on both the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines published in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Clarify and ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said. “Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adults with cancer or their partners to help them address the needs of their children during cancer treatment, Dr. Schapira explained. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clinicians should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

BOSTON — The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress will vary depending on both the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines published in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Clarify and ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said. “Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adults with cancer or their partners to help them address the needs of their children during cancer treatment, Dr. Schapira explained. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clinicians should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

ATLANTA— Medical personnel returning from combat deployment experience rates of posttraumatic stress disorder only slightly below those of returning soldiers, a study has shown.

Nearly 16% of medical personnel from one U.S. military hospital who had been deployed to the setting of large-scale, ongoing, armed conflict reported symptoms consistent with posttraumatic stress disorder (PTSD) in a voluntary, anonymous survey, said Tonya T. Kolkow, M.D., of Naval Medical Center San Diego. Whether a consequence of their exposure to battle scenes and wounded soldiers or a concern for their own safety and potential injury, “these individuals experience rates of PTSD somewhat comparable with that of returning soldiers who have engaged in battle,” she said. Previous studies have estimated that 15%–20% of combat troops returning from war experience PTSD.

“Medical personnel who provide care in the field and in field hospitals comprise a unique group of individuals with their own distinct trauma exposure,” Dr. Kolkow said in a poster presentation at the annual meeting of the American Psychiatric Association.

“Their training and experience with combat situations is likely to be more limited than that of military operational personnel, while their experience with exposure to illness, trauma, and death may be more extensive,” she noted.

To better understand the effects of war on medical personnel, including physicians, nurses, enlisted medical technicians, and other health care workers, who are assigned within the combat theater, Dr. Kolkow and her colleagues provided a voluntary, anonymous, Internet-based questionnaire to the medical staff of a major U.S. military hospital that has deployed a high number of personnel to support U.S. military efforts in Iraq and Afghanistan. Staff members were asked to participate regardless of whether they had been deployed to a combat zone.

The survey included questions about demographics, prior trauma experience, traumatic exposure, and emotional reactions during deployment, and rates of mental health care use before and after deployment. A total of 310 surveys were completed, including 102 from individuals who were deployed the previous year.

The investigators used the 17-item National Center for PTSD Checklist of the Department of Veterans Affairs (PCL-17) to detect PTSD symptoms and the depression scale of the Patient Health Questionnaire-9 to assess the presence of depressive symptoms.

In their PTSD assessments, “we used two case definitions—a broad screening definition in which respondents were scored as positive for PTSD if they endorsed DSM-IV criteria and a strict screening definition that required the same distribution of symptoms along with a PCL-17 symptom severity score of 50 or higher, indicating a significant level of distress,” Dr. Kolkow noted.

Of those who had been deployed to combat areas within the previous year, 15.7% met the broad PTSD criteria, 8.8% met the more conservative criteria, and 4.9% met criteria for probable depression.

While there was no association between combat deployment and presence of depression, deployment to a combat zone was significantly associated with the presence of both the broad and strict PTSD criteria after controlling for demographic variables,” Dr. Kolkow said.

Individuals at greatest risk for developing PTSD included those who were directly exposed to combat; those who were fired upon by opposition forces; and those who reported experiencing significant fear for their own safety, anxiety, and helplessness during deployment, Dr. Kolkow said.

In the sample as a whole, ages younger than 35 years and the absence of a college degree were significant risk factors for the presence of PTSD. Those findings probably are likely reflective of the fact that the younger, less educated health care providers typically had more combat exposure, she said.

More research is needed to evaluate the psychological impact of combat deployment on medical personnel and to provide direction in addressing their mental health needs, Dr. Kolkow said.

ATLANTA— Medical personnel returning from combat deployment experience rates of posttraumatic stress disorder only slightly below those of returning soldiers, a study has shown.

Nearly 16% of medical personnel from one U.S. military hospital who had been deployed to the setting of large-scale, ongoing, armed conflict reported symptoms consistent with posttraumatic stress disorder (PTSD) in a voluntary, anonymous survey, said Tonya T. Kolkow, M.D., of Naval Medical Center San Diego. Whether a consequence of their exposure to battle scenes and wounded soldiers or a concern for their own safety and potential injury, “these individuals experience rates of PTSD somewhat comparable with that of returning soldiers who have engaged in battle,” she said. Previous studies have estimated that 15%–20% of combat troops returning from war experience PTSD.

“Medical personnel who provide care in the field and in field hospitals comprise a unique group of individuals with their own distinct trauma exposure,” Dr. Kolkow said in a poster presentation at the annual meeting of the American Psychiatric Association.

“Their training and experience with combat situations is likely to be more limited than that of military operational personnel, while their experience with exposure to illness, trauma, and death may be more extensive,” she noted.

To better understand the effects of war on medical personnel, including physicians, nurses, enlisted medical technicians, and other health care workers, who are assigned within the combat theater, Dr. Kolkow and her colleagues provided a voluntary, anonymous, Internet-based questionnaire to the medical staff of a major U.S. military hospital that has deployed a high number of personnel to support U.S. military efforts in Iraq and Afghanistan. Staff members were asked to participate regardless of whether they had been deployed to a combat zone.

The survey included questions about demographics, prior trauma experience, traumatic exposure, and emotional reactions during deployment, and rates of mental health care use before and after deployment. A total of 310 surveys were completed, including 102 from individuals who were deployed the previous year.

The investigators used the 17-item National Center for PTSD Checklist of the Department of Veterans Affairs (PCL-17) to detect PTSD symptoms and the depression scale of the Patient Health Questionnaire-9 to assess the presence of depressive symptoms.

In their PTSD assessments, “we used two case definitions—a broad screening definition in which respondents were scored as positive for PTSD if they endorsed DSM-IV criteria and a strict screening definition that required the same distribution of symptoms along with a PCL-17 symptom severity score of 50 or higher, indicating a significant level of distress,” Dr. Kolkow noted.

Of those who had been deployed to combat areas within the previous year, 15.7% met the broad PTSD criteria, 8.8% met the more conservative criteria, and 4.9% met criteria for probable depression.

While there was no association between combat deployment and presence of depression, deployment to a combat zone was significantly associated with the presence of both the broad and strict PTSD criteria after controlling for demographic variables,” Dr. Kolkow said.

Individuals at greatest risk for developing PTSD included those who were directly exposed to combat; those who were fired upon by opposition forces; and those who reported experiencing significant fear for their own safety, anxiety, and helplessness during deployment, Dr. Kolkow said.

In the sample as a whole, ages younger than 35 years and the absence of a college degree were significant risk factors for the presence of PTSD. Those findings probably are likely reflective of the fact that the younger, less educated health care providers typically had more combat exposure, she said.

More research is needed to evaluate the psychological impact of combat deployment on medical personnel and to provide direction in addressing their mental health needs, Dr. Kolkow said.

ATLANTA— Medical personnel returning from combat deployment experience rates of posttraumatic stress disorder only slightly below those of returning soldiers, a study has shown.

Nearly 16% of medical personnel from one U.S. military hospital who had been deployed to the setting of large-scale, ongoing, armed conflict reported symptoms consistent with posttraumatic stress disorder (PTSD) in a voluntary, anonymous survey, said Tonya T. Kolkow, M.D., of Naval Medical Center San Diego. Whether a consequence of their exposure to battle scenes and wounded soldiers or a concern for their own safety and potential injury, “these individuals experience rates of PTSD somewhat comparable with that of returning soldiers who have engaged in battle,” she said. Previous studies have estimated that 15%–20% of combat troops returning from war experience PTSD.

“Medical personnel who provide care in the field and in field hospitals comprise a unique group of individuals with their own distinct trauma exposure,” Dr. Kolkow said in a poster presentation at the annual meeting of the American Psychiatric Association.

“Their training and experience with combat situations is likely to be more limited than that of military operational personnel, while their experience with exposure to illness, trauma, and death may be more extensive,” she noted.

To better understand the effects of war on medical personnel, including physicians, nurses, enlisted medical technicians, and other health care workers, who are assigned within the combat theater, Dr. Kolkow and her colleagues provided a voluntary, anonymous, Internet-based questionnaire to the medical staff of a major U.S. military hospital that has deployed a high number of personnel to support U.S. military efforts in Iraq and Afghanistan. Staff members were asked to participate regardless of whether they had been deployed to a combat zone.

The survey included questions about demographics, prior trauma experience, traumatic exposure, and emotional reactions during deployment, and rates of mental health care use before and after deployment. A total of 310 surveys were completed, including 102 from individuals who were deployed the previous year.

The investigators used the 17-item National Center for PTSD Checklist of the Department of Veterans Affairs (PCL-17) to detect PTSD symptoms and the depression scale of the Patient Health Questionnaire-9 to assess the presence of depressive symptoms.

In their PTSD assessments, “we used two case definitions—a broad screening definition in which respondents were scored as positive for PTSD if they endorsed DSM-IV criteria and a strict screening definition that required the same distribution of symptoms along with a PCL-17 symptom severity score of 50 or higher, indicating a significant level of distress,” Dr. Kolkow noted.

Of those who had been deployed to combat areas within the previous year, 15.7% met the broad PTSD criteria, 8.8% met the more conservative criteria, and 4.9% met criteria for probable depression.

While there was no association between combat deployment and presence of depression, deployment to a combat zone was significantly associated with the presence of both the broad and strict PTSD criteria after controlling for demographic variables,” Dr. Kolkow said.

Individuals at greatest risk for developing PTSD included those who were directly exposed to combat; those who were fired upon by opposition forces; and those who reported experiencing significant fear for their own safety, anxiety, and helplessness during deployment, Dr. Kolkow said.

In the sample as a whole, ages younger than 35 years and the absence of a college degree were significant risk factors for the presence of PTSD. Those findings probably are likely reflective of the fact that the younger, less educated health care providers typically had more combat exposure, she said.

More research is needed to evaluate the psychological impact of combat deployment on medical personnel and to provide direction in addressing their mental health needs, Dr. Kolkow said.

NEW ORLEANS — Measuring non-HDL cholesterol level may be a better primary screen for risk of first nonfatal myocardial infarction in women than measuring the level of LDL cholesterol, reported Wildon R. Farwell, M.D.

LDL cholesterol has long been considered the most atherogenic lipoprotein, but recent studies have implicated other types of cholesterol, including triglyceride-rich very low-density-lipoprotein cholesterol and intermediate-density-lipoprotein cholesterol—both of which are included in the non-HDL measure, Dr. Farwell said at the annual meeting of the Society of General Internal Medicine.

He and his colleagues at Brigham and Women's Hospital, Boston, analyzed data from a cohort of nearly 19,000 women from the Women's Health Study who neither had a diagnosis of hyperlipidemia nor took cholesterol medication. They performed direct-measurement assays for lipid parameters and collected baseline self-reported risk factors at enrollment. They confirmed 118 self-reported cases of first nonfatal MI and used Cox proportional hazards models to compare the independent associations of non-HDL cholesterol and LDL cholesterol with MI risk, adjusting for cardiovascular risk factors.

The mean values of LDL and non-HDL cholesterol in the 118 MI patients were 116.3 mg/dL and 147.5 mg/dL, respectively. Non-HDL cholesterol level was a more significant predictor of risk than LDL cholesterol level. “The hazard ratio for the highest tertile [of non-HDL cholesterol] was 2.91, compared with 1.51 for LDL,” Dr. Farwell said. Similarly, the hazard ratios for the middle non-HDL and LDL tertiles were 1.81 and 0.92, he reported.

The non-HDL tertile measures were defined as less than 130.1 mg/dL, from 130.1 to 159.4 mg/dL, and greater than 159.4 mg/dL. For LDL cholesterol, the tertile measures were defined as less than 102.1 mg/dL, from 102.1 to 126.6 mg/dL, and greater than 126.6 mg/dL.

“While LDL cholesterol is important, non-HDL cholesterol may be the more important predictor, at least in some groups of people,” Dr. Farwell said.

NEW ORLEANS — Measuring non-HDL cholesterol level may be a better primary screen for risk of first nonfatal myocardial infarction in women than measuring the level of LDL cholesterol, reported Wildon R. Farwell, M.D.

LDL cholesterol has long been considered the most atherogenic lipoprotein, but recent studies have implicated other types of cholesterol, including triglyceride-rich very low-density-lipoprotein cholesterol and intermediate-density-lipoprotein cholesterol—both of which are included in the non-HDL measure, Dr. Farwell said at the annual meeting of the Society of General Internal Medicine.

He and his colleagues at Brigham and Women's Hospital, Boston, analyzed data from a cohort of nearly 19,000 women from the Women's Health Study who neither had a diagnosis of hyperlipidemia nor took cholesterol medication. They performed direct-measurement assays for lipid parameters and collected baseline self-reported risk factors at enrollment. They confirmed 118 self-reported cases of first nonfatal MI and used Cox proportional hazards models to compare the independent associations of non-HDL cholesterol and LDL cholesterol with MI risk, adjusting for cardiovascular risk factors.

The mean values of LDL and non-HDL cholesterol in the 118 MI patients were 116.3 mg/dL and 147.5 mg/dL, respectively. Non-HDL cholesterol level was a more significant predictor of risk than LDL cholesterol level. “The hazard ratio for the highest tertile [of non-HDL cholesterol] was 2.91, compared with 1.51 for LDL,” Dr. Farwell said. Similarly, the hazard ratios for the middle non-HDL and LDL tertiles were 1.81 and 0.92, he reported.

The non-HDL tertile measures were defined as less than 130.1 mg/dL, from 130.1 to 159.4 mg/dL, and greater than 159.4 mg/dL. For LDL cholesterol, the tertile measures were defined as less than 102.1 mg/dL, from 102.1 to 126.6 mg/dL, and greater than 126.6 mg/dL.

“While LDL cholesterol is important, non-HDL cholesterol may be the more important predictor, at least in some groups of people,” Dr. Farwell said.

NEW ORLEANS — Measuring non-HDL cholesterol level may be a better primary screen for risk of first nonfatal myocardial infarction in women than measuring the level of LDL cholesterol, reported Wildon R. Farwell, M.D.

LDL cholesterol has long been considered the most atherogenic lipoprotein, but recent studies have implicated other types of cholesterol, including triglyceride-rich very low-density-lipoprotein cholesterol and intermediate-density-lipoprotein cholesterol—both of which are included in the non-HDL measure, Dr. Farwell said at the annual meeting of the Society of General Internal Medicine.

He and his colleagues at Brigham and Women's Hospital, Boston, analyzed data from a cohort of nearly 19,000 women from the Women's Health Study who neither had a diagnosis of hyperlipidemia nor took cholesterol medication. They performed direct-measurement assays for lipid parameters and collected baseline self-reported risk factors at enrollment. They confirmed 118 self-reported cases of first nonfatal MI and used Cox proportional hazards models to compare the independent associations of non-HDL cholesterol and LDL cholesterol with MI risk, adjusting for cardiovascular risk factors.

The mean values of LDL and non-HDL cholesterol in the 118 MI patients were 116.3 mg/dL and 147.5 mg/dL, respectively. Non-HDL cholesterol level was a more significant predictor of risk than LDL cholesterol level. “The hazard ratio for the highest tertile [of non-HDL cholesterol] was 2.91, compared with 1.51 for LDL,” Dr. Farwell said. Similarly, the hazard ratios for the middle non-HDL and LDL tertiles were 1.81 and 0.92, he reported.

The non-HDL tertile measures were defined as less than 130.1 mg/dL, from 130.1 to 159.4 mg/dL, and greater than 159.4 mg/dL. For LDL cholesterol, the tertile measures were defined as less than 102.1 mg/dL, from 102.1 to 126.6 mg/dL, and greater than 126.6 mg/dL.

“While LDL cholesterol is important, non-HDL cholesterol may be the more important predictor, at least in some groups of people,” Dr. Farwell said.

NEW ORLEANS — Spanish-language users of a bilingual interactive computer program in an urgent care clinic reaped the most educational benefit from the system, a study has shown.

The findings suggest that computerized educational modules may be an important tool to help reduce health care disparities among medically underserved populations, Bonnie Leeman-Castillo said in a presen-tation at the annual meeting of the Society of General Internal Medicine.

During a 4-month period, 296 adults seeking care for acute respiratory tract infections at an urgent care facility in Denver were referred to a free-standing computer that housed an audiovisual education module that provided information in both English and Spanish. The module prompted the patients to provide information about demographics, knowledge and attitudes about antibiotics and acute respiratory infections, reasons for seeking care for their illness, and a symptom inventory.

“The computer then suggested a likely diagnosis based on the patients' symptoms and provided information about how to best treat the illness,” said Ms. Leeman-Castillo, a Ph.D. candidate in the Health and Behavioral Science Program at the University of Colorado at Denver.

After using the program, patients were asked to rate their experience with it in terms of complexity, understanding, and perceived usefulness. The main outcome measures, she said, “were whether the patient learned something new about colds and flu and whether they trusted the computer information.”

With respect to demographics, 81% of the users were aged 18–44, 59% were female, 54% were Hispanic, 50% had household incomes of less than $10,000, and 16% completed the Spanish-language version of the module.

Patients who answered questions in Spanish were significantly less likely to report prior computer experience and more likely to require help using the system. In terms of ease of use and understanding the computer messages, the differences between those who responded in English and Spanish were small but significant. About 84% of the English-speaking respondents, compared with 71% of those who responded in Spanish, rated the program as easy to use, and 87% of those who answered in English said they understood the information, compared with 81% of the Spanish-speaking group.

After adjustment for patient demographics and computer module qualities, Spanish-language users were significantly more likely to report learning something new from the program and trusting the information, Ms. Leeman-Castillo said.

“Interestingly, we found that prior computer experience was a strong negative predictor of learning something new and trusting the information,” suggesting that populations with the least exposure to and experience with interactive computer media may get the most out of such health learning tools, she said.

In general, the interactive module seemed to be well received by patients and effective at disseminating important health information, particularly to populations that may not otherwise be getting important public health information about such things as antibiotic overuse, she noted. However, “our finding that prior computer experience was associated with less learning and trust deserves further exploration,” she concluded.

Ms. Leeman-Castillo stated that she had no financial interests or other relationship with the manufacturers of the commercial products or suppliers of the commercial services relative to the health-information module.

NEW ORLEANS — Spanish-language users of a bilingual interactive computer program in an urgent care clinic reaped the most educational benefit from the system, a study has shown.

The findings suggest that computerized educational modules may be an important tool to help reduce health care disparities among medically underserved populations, Bonnie Leeman-Castillo said in a presen-tation at the annual meeting of the Society of General Internal Medicine.

During a 4-month period, 296 adults seeking care for acute respiratory tract infections at an urgent care facility in Denver were referred to a free-standing computer that housed an audiovisual education module that provided information in both English and Spanish. The module prompted the patients to provide information about demographics, knowledge and attitudes about antibiotics and acute respiratory infections, reasons for seeking care for their illness, and a symptom inventory.

“The computer then suggested a likely diagnosis based on the patients' symptoms and provided information about how to best treat the illness,” said Ms. Leeman-Castillo, a Ph.D. candidate in the Health and Behavioral Science Program at the University of Colorado at Denver.

After using the program, patients were asked to rate their experience with it in terms of complexity, understanding, and perceived usefulness. The main outcome measures, she said, “were whether the patient learned something new about colds and flu and whether they trusted the computer information.”

With respect to demographics, 81% of the users were aged 18–44, 59% were female, 54% were Hispanic, 50% had household incomes of less than $10,000, and 16% completed the Spanish-language version of the module.

Patients who answered questions in Spanish were significantly less likely to report prior computer experience and more likely to require help using the system. In terms of ease of use and understanding the computer messages, the differences between those who responded in English and Spanish were small but significant. About 84% of the English-speaking respondents, compared with 71% of those who responded in Spanish, rated the program as easy to use, and 87% of those who answered in English said they understood the information, compared with 81% of the Spanish-speaking group.

After adjustment for patient demographics and computer module qualities, Spanish-language users were significantly more likely to report learning something new from the program and trusting the information, Ms. Leeman-Castillo said.

“Interestingly, we found that prior computer experience was a strong negative predictor of learning something new and trusting the information,” suggesting that populations with the least exposure to and experience with interactive computer media may get the most out of such health learning tools, she said.

In general, the interactive module seemed to be well received by patients and effective at disseminating important health information, particularly to populations that may not otherwise be getting important public health information about such things as antibiotic overuse, she noted. However, “our finding that prior computer experience was associated with less learning and trust deserves further exploration,” she concluded.

Ms. Leeman-Castillo stated that she had no financial interests or other relationship with the manufacturers of the commercial products or suppliers of the commercial services relative to the health-information module.

NEW ORLEANS — Spanish-language users of a bilingual interactive computer program in an urgent care clinic reaped the most educational benefit from the system, a study has shown.

The findings suggest that computerized educational modules may be an important tool to help reduce health care disparities among medically underserved populations, Bonnie Leeman-Castillo said in a presen-tation at the annual meeting of the Society of General Internal Medicine.

During a 4-month period, 296 adults seeking care for acute respiratory tract infections at an urgent care facility in Denver were referred to a free-standing computer that housed an audiovisual education module that provided information in both English and Spanish. The module prompted the patients to provide information about demographics, knowledge and attitudes about antibiotics and acute respiratory infections, reasons for seeking care for their illness, and a symptom inventory.

“The computer then suggested a likely diagnosis based on the patients' symptoms and provided information about how to best treat the illness,” said Ms. Leeman-Castillo, a Ph.D. candidate in the Health and Behavioral Science Program at the University of Colorado at Denver.

After using the program, patients were asked to rate their experience with it in terms of complexity, understanding, and perceived usefulness. The main outcome measures, she said, “were whether the patient learned something new about colds and flu and whether they trusted the computer information.”

With respect to demographics, 81% of the users were aged 18–44, 59% were female, 54% were Hispanic, 50% had household incomes of less than $10,000, and 16% completed the Spanish-language version of the module.

Patients who answered questions in Spanish were significantly less likely to report prior computer experience and more likely to require help using the system. In terms of ease of use and understanding the computer messages, the differences between those who responded in English and Spanish were small but significant. About 84% of the English-speaking respondents, compared with 71% of those who responded in Spanish, rated the program as easy to use, and 87% of those who answered in English said they understood the information, compared with 81% of the Spanish-speaking group.

After adjustment for patient demographics and computer module qualities, Spanish-language users were significantly more likely to report learning something new from the program and trusting the information, Ms. Leeman-Castillo said.

“Interestingly, we found that prior computer experience was a strong negative predictor of learning something new and trusting the information,” suggesting that populations with the least exposure to and experience with interactive computer media may get the most out of such health learning tools, she said.

In general, the interactive module seemed to be well received by patients and effective at disseminating important health information, particularly to populations that may not otherwise be getting important public health information about such things as antibiotic overuse, she noted. However, “our finding that prior computer experience was associated with less learning and trust deserves further exploration,” she concluded.

Ms. Leeman-Castillo stated that she had no financial interests or other relationship with the manufacturers of the commercial products or suppliers of the commercial services relative to the health-information module.

BOSTON — Left atrial function is a sensitive predictor of cardiovascular outcome in patients with stable coronary heart disease, a prospective study has shown.

Of 989 patients with heart disease recruited for the ongoing Heart and Soul Study at the San Francisco Veterans' Affairs Medical Center and the University of California at San Francisco, 8.5% of the 247 patients whose left atrial function index was in the lowest quartile had a cardiac event during the 1-year follow-up period, compared with 4% of the 742 whose indices fell into the upper three quartiles, reported Pamela Y.F. Hsu, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

“The association between a low index and cardiovascular outcomes persisted after adjusting for smoking, congestive heart failure, other comorbid illnesses, medication use, and left ventricular ejection fraction,” said Dr. Hsu of the Mayo Clinic in Scottsdale, Ariz.

To determine the left atrial function index (LAFI), the investigators calculated the time-velocity integral for the left ventricular outflow tract, the left atrial end systolic volume (LAESV) and end diastolic volume (LAEDV), and the LAESV index measurements by using transthoracic echocardiography.

They also measured biplane left atrial volumes and calculated the left atrial ejection fraction (LAESV/LAEDV). The LAFI represents the left ventricular outflow tract time-velocity integral multiplied by the left atrial ejection fraction over the LAESV index, with the whole multiplied by 10 log 4.

Using logistic regression, the investigators evaluated the association between the lowest LAFI quartile and cardiovascular outcomes—including myocardial infarction, hospitalization for congestive heart failure, and coronary disease death—and adjusted for potential confounding variables.

In the lowest quartile, the age-adjusted odds ratio for having any cardiac event within 1 year was 3.3, while the specific odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.3, 4.8, and 4.2, respectively.

In the multivariable adjusted model, the odds ratio for any cardiac event was 2.6 and the respective odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.0, 3.3, and 2.2. All of the associations were statistically significant, Dr. Hsu said.

The findings indicate that the LAFI “is a simple, powerful, and clinically useful tool” for predicting 1-year cardiovascular outcomes in coronary heart disease patients, Dr. Hsu said.

It also adds to a growing body of evidence supporting the importance of left atrial function in determining cardiovascular prognoses, she added.

BOSTON — Left atrial function is a sensitive predictor of cardiovascular outcome in patients with stable coronary heart disease, a prospective study has shown.

Of 989 patients with heart disease recruited for the ongoing Heart and Soul Study at the San Francisco Veterans' Affairs Medical Center and the University of California at San Francisco, 8.5% of the 247 patients whose left atrial function index was in the lowest quartile had a cardiac event during the 1-year follow-up period, compared with 4% of the 742 whose indices fell into the upper three quartiles, reported Pamela Y.F. Hsu, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

“The association between a low index and cardiovascular outcomes persisted after adjusting for smoking, congestive heart failure, other comorbid illnesses, medication use, and left ventricular ejection fraction,” said Dr. Hsu of the Mayo Clinic in Scottsdale, Ariz.

To determine the left atrial function index (LAFI), the investigators calculated the time-velocity integral for the left ventricular outflow tract, the left atrial end systolic volume (LAESV) and end diastolic volume (LAEDV), and the LAESV index measurements by using transthoracic echocardiography.

They also measured biplane left atrial volumes and calculated the left atrial ejection fraction (LAESV/LAEDV). The LAFI represents the left ventricular outflow tract time-velocity integral multiplied by the left atrial ejection fraction over the LAESV index, with the whole multiplied by 10 log 4.

Using logistic regression, the investigators evaluated the association between the lowest LAFI quartile and cardiovascular outcomes—including myocardial infarction, hospitalization for congestive heart failure, and coronary disease death—and adjusted for potential confounding variables.

In the lowest quartile, the age-adjusted odds ratio for having any cardiac event within 1 year was 3.3, while the specific odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.3, 4.8, and 4.2, respectively.

In the multivariable adjusted model, the odds ratio for any cardiac event was 2.6 and the respective odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.0, 3.3, and 2.2. All of the associations were statistically significant, Dr. Hsu said.

The findings indicate that the LAFI “is a simple, powerful, and clinically useful tool” for predicting 1-year cardiovascular outcomes in coronary heart disease patients, Dr. Hsu said.

It also adds to a growing body of evidence supporting the importance of left atrial function in determining cardiovascular prognoses, she added.

BOSTON — Left atrial function is a sensitive predictor of cardiovascular outcome in patients with stable coronary heart disease, a prospective study has shown.

Of 989 patients with heart disease recruited for the ongoing Heart and Soul Study at the San Francisco Veterans' Affairs Medical Center and the University of California at San Francisco, 8.5% of the 247 patients whose left atrial function index was in the lowest quartile had a cardiac event during the 1-year follow-up period, compared with 4% of the 742 whose indices fell into the upper three quartiles, reported Pamela Y.F. Hsu, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

“The association between a low index and cardiovascular outcomes persisted after adjusting for smoking, congestive heart failure, other comorbid illnesses, medication use, and left ventricular ejection fraction,” said Dr. Hsu of the Mayo Clinic in Scottsdale, Ariz.

To determine the left atrial function index (LAFI), the investigators calculated the time-velocity integral for the left ventricular outflow tract, the left atrial end systolic volume (LAESV) and end diastolic volume (LAEDV), and the LAESV index measurements by using transthoracic echocardiography.

They also measured biplane left atrial volumes and calculated the left atrial ejection fraction (LAESV/LAEDV). The LAFI represents the left ventricular outflow tract time-velocity integral multiplied by the left atrial ejection fraction over the LAESV index, with the whole multiplied by 10 log 4.

Using logistic regression, the investigators evaluated the association between the lowest LAFI quartile and cardiovascular outcomes—including myocardial infarction, hospitalization for congestive heart failure, and coronary disease death—and adjusted for potential confounding variables.

In the lowest quartile, the age-adjusted odds ratio for having any cardiac event within 1 year was 3.3, while the specific odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.3, 4.8, and 4.2, respectively.

In the multivariable adjusted model, the odds ratio for any cardiac event was 2.6 and the respective odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.0, 3.3, and 2.2. All of the associations were statistically significant, Dr. Hsu said.

The findings indicate that the LAFI “is a simple, powerful, and clinically useful tool” for predicting 1-year cardiovascular outcomes in coronary heart disease patients, Dr. Hsu said.

It also adds to a growing body of evidence supporting the importance of left atrial function in determining cardiovascular prognoses, she added.

NEW ORLEANS — Measuring non-HDL cholesterol level may be a better primary screen for risk of first nonfatal myocardial infarction in women than measuring the level of LDL cholesterol, reported Wildon R. Farwell, M.D.

Recent studies have implicated non-HDL cholesterol—including triglyceride-rich very low-density-lipoprotein cholesterol and intermediate-density-lipoprotein cholesterol—as atherogenic, Dr. Farwell said at the annual meeting of the Society of General Internal Medicine.

He and his colleagues at Brigham and Women's Hospital, Boston, analyzed data on nearly 19,000 women from the Women's Health Study who neither had a diagnosis of hyperlipidemia nor took cholesterol medication. They confirmed 118 self-reported cases of first nonfatal MI and used Cox proportional hazards models to control for cardiovascular risk factors.

The mean values of LDL and non-HDL cholesterol in the 118 MI patients were 116.3 mg/dL and 147.5 mg/dL, respectively. Non-HDL cholesterol level was a more significant predictor of risk than LDL cholesterol level. The hazard ratio for the highest tertile of non-HDL cholesterol was 2.91, compared with 1.51 for LDL. Similarly, the hazard ratios for the middle non-HDL and LDL tertiles were 1.81 and 0.92, Dr. Farwell said.

The non-HDL tertile measures were defined as less than 130.1 mg/dL, from 130.1 to 159.4 mg/dL, and greater than 159.4 mg/dL. For LDL cholesterol, the tertile measures were defined as less than 102.1 mg/dL, from 102.1 to 126.6 mg/dL, and greater than 126.6 mg/dL.

“While LDL cholesterol is important, non-HDL cholesterol may be the more important predictor, at least in some groups of people,” Dr. Farwell said.

NEW ORLEANS — Measuring non-HDL cholesterol level may be a better primary screen for risk of first nonfatal myocardial infarction in women than measuring the level of LDL cholesterol, reported Wildon R. Farwell, M.D.

Recent studies have implicated non-HDL cholesterol—including triglyceride-rich very low-density-lipoprotein cholesterol and intermediate-density-lipoprotein cholesterol—as atherogenic, Dr. Farwell said at the annual meeting of the Society of General Internal Medicine.

He and his colleagues at Brigham and Women's Hospital, Boston, analyzed data on nearly 19,000 women from the Women's Health Study who neither had a diagnosis of hyperlipidemia nor took cholesterol medication. They confirmed 118 self-reported cases of first nonfatal MI and used Cox proportional hazards models to control for cardiovascular risk factors.

The mean values of LDL and non-HDL cholesterol in the 118 MI patients were 116.3 mg/dL and 147.5 mg/dL, respectively. Non-HDL cholesterol level was a more significant predictor of risk than LDL cholesterol level. The hazard ratio for the highest tertile of non-HDL cholesterol was 2.91, compared with 1.51 for LDL. Similarly, the hazard ratios for the middle non-HDL and LDL tertiles were 1.81 and 0.92, Dr. Farwell said.

The non-HDL tertile measures were defined as less than 130.1 mg/dL, from 130.1 to 159.4 mg/dL, and greater than 159.4 mg/dL. For LDL cholesterol, the tertile measures were defined as less than 102.1 mg/dL, from 102.1 to 126.6 mg/dL, and greater than 126.6 mg/dL.

“While LDL cholesterol is important, non-HDL cholesterol may be the more important predictor, at least in some groups of people,” Dr. Farwell said.

NEW ORLEANS — Measuring non-HDL cholesterol level may be a better primary screen for risk of first nonfatal myocardial infarction in women than measuring the level of LDL cholesterol, reported Wildon R. Farwell, M.D.

Recent studies have implicated non-HDL cholesterol—including triglyceride-rich very low-density-lipoprotein cholesterol and intermediate-density-lipoprotein cholesterol—as atherogenic, Dr. Farwell said at the annual meeting of the Society of General Internal Medicine.

He and his colleagues at Brigham and Women's Hospital, Boston, analyzed data on nearly 19,000 women from the Women's Health Study who neither had a diagnosis of hyperlipidemia nor took cholesterol medication. They confirmed 118 self-reported cases of first nonfatal MI and used Cox proportional hazards models to control for cardiovascular risk factors.

The mean values of LDL and non-HDL cholesterol in the 118 MI patients were 116.3 mg/dL and 147.5 mg/dL, respectively. Non-HDL cholesterol level was a more significant predictor of risk than LDL cholesterol level. The hazard ratio for the highest tertile of non-HDL cholesterol was 2.91, compared with 1.51 for LDL. Similarly, the hazard ratios for the middle non-HDL and LDL tertiles were 1.81 and 0.92, Dr. Farwell said.

The non-HDL tertile measures were defined as less than 130.1 mg/dL, from 130.1 to 159.4 mg/dL, and greater than 159.4 mg/dL. For LDL cholesterol, the tertile measures were defined as less than 102.1 mg/dL, from 102.1 to 126.6 mg/dL, and greater than 126.6 mg/dL.

“While LDL cholesterol is important, non-HDL cholesterol may be the more important predictor, at least in some groups of people,” Dr. Farwell said.

BOSTON — For acute heart failure patients with neither a history of coronary disease nor evidence of acute MI, myocardial contrast echocardiography can distinguish ischemic from nonischemic etiology, a study has shown.

The ability to identify underlying coronary artery disease in such patients has therapeutic as well as prognostic implications, reported Rajesh Janardhanan, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

A noninvasive bedside technique for evaluating acute coronary syndromes, myocardial contrast echocardiography (MCE) provides a simultaneous assessment of regional wall motion and myocardial perfusion using microbubble contrast agents.

To assess the sensitivity and specificity of the imaging tool in the evaluation of acute heart failure, Dr. Janardhanan of Brigham and Women's Hospital in Boston, and investigators at Northwick Park Hospital in Harrow, England, reviewed the imaging results from 52 consecutive patients with acute heart failure with no prior history of coronary artery disease (CAD) and no clinical evidence of acute MI on hospital admission.

All the patients in the study underwent echocardiography and MCE at rest and following dipyridamole stress. Additionally, all patients underwent coronary arteriography prior to hospital discharge. On coronary arteriography, 22 of the 52 patients had evidence of CAD, defined as more than 50% luminal diameter narrowing, Dr. Janardhanan said.

The sensitivity and specificity of MCE for detecting CAD in the 22 patients was 82% and 97%, respectively, with a positive predictive value of 95% and a negative predictive value of 88%.

Among the various markers of coronary artery disease, including MCE, clinical variables, ECG, biochemical measures, and resting echocardiographic results, MCE “was the only [statistically significant] independent predictor of CAD,” Dr. Janardhanan said.

Both myocardial blood flow reserve and myocardial blood velocity reserve decreased relative to increasing CAD severity, suggesting quantitative MCE data may be an effective tool for stratifying risk in patients with acute heart failure, Dr. Janardhanan concluded.

BOSTON — For acute heart failure patients with neither a history of coronary disease nor evidence of acute MI, myocardial contrast echocardiography can distinguish ischemic from nonischemic etiology, a study has shown.

The ability to identify underlying coronary artery disease in such patients has therapeutic as well as prognostic implications, reported Rajesh Janardhanan, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

A noninvasive bedside technique for evaluating acute coronary syndromes, myocardial contrast echocardiography (MCE) provides a simultaneous assessment of regional wall motion and myocardial perfusion using microbubble contrast agents.

To assess the sensitivity and specificity of the imaging tool in the evaluation of acute heart failure, Dr. Janardhanan of Brigham and Women's Hospital in Boston, and investigators at Northwick Park Hospital in Harrow, England, reviewed the imaging results from 52 consecutive patients with acute heart failure with no prior history of coronary artery disease (CAD) and no clinical evidence of acute MI on hospital admission.

All the patients in the study underwent echocardiography and MCE at rest and following dipyridamole stress. Additionally, all patients underwent coronary arteriography prior to hospital discharge. On coronary arteriography, 22 of the 52 patients had evidence of CAD, defined as more than 50% luminal diameter narrowing, Dr. Janardhanan said.

The sensitivity and specificity of MCE for detecting CAD in the 22 patients was 82% and 97%, respectively, with a positive predictive value of 95% and a negative predictive value of 88%.

Among the various markers of coronary artery disease, including MCE, clinical variables, ECG, biochemical measures, and resting echocardiographic results, MCE “was the only [statistically significant] independent predictor of CAD,” Dr. Janardhanan said.

Both myocardial blood flow reserve and myocardial blood velocity reserve decreased relative to increasing CAD severity, suggesting quantitative MCE data may be an effective tool for stratifying risk in patients with acute heart failure, Dr. Janardhanan concluded.

BOSTON — For acute heart failure patients with neither a history of coronary disease nor evidence of acute MI, myocardial contrast echocardiography can distinguish ischemic from nonischemic etiology, a study has shown.

The ability to identify underlying coronary artery disease in such patients has therapeutic as well as prognostic implications, reported Rajesh Janardhanan, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

A noninvasive bedside technique for evaluating acute coronary syndromes, myocardial contrast echocardiography (MCE) provides a simultaneous assessment of regional wall motion and myocardial perfusion using microbubble contrast agents.

To assess the sensitivity and specificity of the imaging tool in the evaluation of acute heart failure, Dr. Janardhanan of Brigham and Women's Hospital in Boston, and investigators at Northwick Park Hospital in Harrow, England, reviewed the imaging results from 52 consecutive patients with acute heart failure with no prior history of coronary artery disease (CAD) and no clinical evidence of acute MI on hospital admission.

All the patients in the study underwent echocardiography and MCE at rest and following dipyridamole stress. Additionally, all patients underwent coronary arteriography prior to hospital discharge. On coronary arteriography, 22 of the 52 patients had evidence of CAD, defined as more than 50% luminal diameter narrowing, Dr. Janardhanan said.

The sensitivity and specificity of MCE for detecting CAD in the 22 patients was 82% and 97%, respectively, with a positive predictive value of 95% and a negative predictive value of 88%.

Among the various markers of coronary artery disease, including MCE, clinical variables, ECG, biochemical measures, and resting echocardiographic results, MCE “was the only [statistically significant] independent predictor of CAD,” Dr. Janardhanan said.

Both myocardial blood flow reserve and myocardial blood velocity reserve decreased relative to increasing CAD severity, suggesting quantitative MCE data may be an effective tool for stratifying risk in patients with acute heart failure, Dr. Janardhanan concluded.

Maternal folate status is an important predictor of infant birth weight, a prospective study has shown.

In a cohort of nearly 1,000 expectant mothers, those with lower levels of erythrocyte red blood cell (RBC) folate in early pregnancy were significantly more likely to have low-birth-weight babies, according to Caroline Relton, M.D., and her associates at the University of Newcastle upon Tyne (England).

The researchers investigated the relationship between maternal and newborn RBC folate status, vitamin B₁₂ status, maternal smoking, age, parity, and infant birth rate in 998 pregnant mothers receiving prenatal care at a hospital in northwest England and their newborns. Blood samples were collected from mothers during their first routine prenatal appointment and from the newborns' umbilical cords at birth (Br. J. Nutr. 2005;93:593–9).

In a multivariate analysis, maternal folate status was the only significant determinant of birth weight. Each standard deviation increase in maternal folic acid level was associated with a 14% weight increase in birth weight z score.

Univariate linear regression analysis associated smoking with a significant decrease in birth weight; however, multivariate analysis showed a dramatically reduced, nonsignificant influence, suggesting that smoking and maternal folate status are not independent of each other. Folate levels were significantly lower in women who smoked than in nonsmokers, thus the effect of smoking on birth weight may be mediated in part by its association with maternal folate, according to the authors.

Maternal vitamin B₁₂ status was significantly associated with both maternal and neonatal folate but not with birth weight. However, the relationship between vitamin B₁₂ and maternal folate status suggests this micronutrient has an important role in maternal nutrition during pregnancy, the authors wrote.

Neonatal vitamin B₁₂ had a small but significant influence on infant birth weight when analyzed in a univariate model, but the effect was not significant when considered in a multivariate model, nor was there any association between neonatal folate and birth weight.

Folate is of fundamental importance to cell function, including the synthesis and repair of DNA and gene expression. Although the exact nature of the relationship between folate and birth weight is not known, reductions in folate are associated with increases in the amino acid homocysteine. Elevated homocysteine has been linked to many clinical conditions that affect fetal growth, the authors stated.

Maternal folate status is an important predictor of infant birth weight, a prospective study has shown.

In a cohort of nearly 1,000 expectant mothers, those with lower levels of erythrocyte red blood cell (RBC) folate in early pregnancy were significantly more likely to have low-birth-weight babies, according to Caroline Relton, M.D., and her associates at the University of Newcastle upon Tyne (England).

The researchers investigated the relationship between maternal and newborn RBC folate status, vitamin B₁₂ status, maternal smoking, age, parity, and infant birth rate in 998 pregnant mothers receiving prenatal care at a hospital in northwest England and their newborns. Blood samples were collected from mothers during their first routine prenatal appointment and from the newborns' umbilical cords at birth (Br. J. Nutr. 2005;93:593–9).

In a multivariate analysis, maternal folate status was the only significant determinant of birth weight. Each standard deviation increase in maternal folic acid level was associated with a 14% weight increase in birth weight z score.

Univariate linear regression analysis associated smoking with a significant decrease in birth weight; however, multivariate analysis showed a dramatically reduced, nonsignificant influence, suggesting that smoking and maternal folate status are not independent of each other. Folate levels were significantly lower in women who smoked than in nonsmokers, thus the effect of smoking on birth weight may be mediated in part by its association with maternal folate, according to the authors.

Maternal vitamin B₁₂ status was significantly associated with both maternal and neonatal folate but not with birth weight. However, the relationship between vitamin B₁₂ and maternal folate status suggests this micronutrient has an important role in maternal nutrition during pregnancy, the authors wrote.

Neonatal vitamin B₁₂ had a small but significant influence on infant birth weight when analyzed in a univariate model, but the effect was not significant when considered in a multivariate model, nor was there any association between neonatal folate and birth weight.

Folate is of fundamental importance to cell function, including the synthesis and repair of DNA and gene expression. Although the exact nature of the relationship between folate and birth weight is not known, reductions in folate are associated with increases in the amino acid homocysteine. Elevated homocysteine has been linked to many clinical conditions that affect fetal growth, the authors stated.

Maternal folate status is an important predictor of infant birth weight, a prospective study has shown.

In a cohort of nearly 1,000 expectant mothers, those with lower levels of erythrocyte red blood cell (RBC) folate in early pregnancy were significantly more likely to have low-birth-weight babies, according to Caroline Relton, M.D., and her associates at the University of Newcastle upon Tyne (England).

The researchers investigated the relationship between maternal and newborn RBC folate status, vitamin B₁₂ status, maternal smoking, age, parity, and infant birth rate in 998 pregnant mothers receiving prenatal care at a hospital in northwest England and their newborns. Blood samples were collected from mothers during their first routine prenatal appointment and from the newborns' umbilical cords at birth (Br. J. Nutr. 2005;93:593–9).

In a multivariate analysis, maternal folate status was the only significant determinant of birth weight. Each standard deviation increase in maternal folic acid level was associated with a 14% weight increase in birth weight z score.

Univariate linear regression analysis associated smoking with a significant decrease in birth weight; however, multivariate analysis showed a dramatically reduced, nonsignificant influence, suggesting that smoking and maternal folate status are not independent of each other. Folate levels were significantly lower in women who smoked than in nonsmokers, thus the effect of smoking on birth weight may be mediated in part by its association with maternal folate, according to the authors.

Maternal vitamin B₁₂ status was significantly associated with both maternal and neonatal folate but not with birth weight. However, the relationship between vitamin B₁₂ and maternal folate status suggests this micronutrient has an important role in maternal nutrition during pregnancy, the authors wrote.

Neonatal vitamin B₁₂ had a small but significant influence on infant birth weight when analyzed in a univariate model, but the effect was not significant when considered in a multivariate model, nor was there any association between neonatal folate and birth weight.

Folate is of fundamental importance to cell function, including the synthesis and repair of DNA and gene expression. Although the exact nature of the relationship between folate and birth weight is not known, reductions in folate are associated with increases in the amino acid homocysteine. Elevated homocysteine has been linked to many clinical conditions that affect fetal growth, the authors stated.