Heidi Splete

A pilot program on how to better counsel patients and families about childhood obesity is underway in five California-based residency programs.

Pediatric and family medicine residents are trained in strategies to help patients make behavioral changes proven to reduce and prevent obesity. For example, the program provides tips for helping individuals decrease their consumption of sugary beverages. Residents are armed with handouts on healthy beverage options and a visual aid that shows how much sugar is in a soda or sports drink.

The hope is that preparing future primary care physicians to effectively motivate lifestyle changes will help stem the prevalence rates of pediatric obesity, type 2 diabetes, and heart disease, Dr. Lydia Tinajero-Deck, the project's principal investigator, said in an interview.

The pilot, dubbed Fit for Residents, was developed by the University of California, Los Angeles, in collaboration with the American Academy of Pediatrics and American Academy of Family Physicians, said Dr. Tinajero-Deck, a pediatrician at Children's Hospital & Research Center in Oakland, Calif.

“The actual pilot program for our residents is 1 year, with the goal of sustainability and integration” into the residency program as a permanent education piece, she said. To expand it nationwide, “We need to collect data on how the curriculum was taught within these pilot programs” to identify and promote the best practices, she added.

A pilot program on how to better counsel patients and families about childhood obesity is underway in five California-based residency programs.

Pediatric and family medicine residents are trained in strategies to help patients make behavioral changes proven to reduce and prevent obesity. For example, the program provides tips for helping individuals decrease their consumption of sugary beverages. Residents are armed with handouts on healthy beverage options and a visual aid that shows how much sugar is in a soda or sports drink.

The hope is that preparing future primary care physicians to effectively motivate lifestyle changes will help stem the prevalence rates of pediatric obesity, type 2 diabetes, and heart disease, Dr. Lydia Tinajero-Deck, the project's principal investigator, said in an interview.

The pilot, dubbed Fit for Residents, was developed by the University of California, Los Angeles, in collaboration with the American Academy of Pediatrics and American Academy of Family Physicians, said Dr. Tinajero-Deck, a pediatrician at Children's Hospital & Research Center in Oakland, Calif.

“The actual pilot program for our residents is 1 year, with the goal of sustainability and integration” into the residency program as a permanent education piece, she said. To expand it nationwide, “We need to collect data on how the curriculum was taught within these pilot programs” to identify and promote the best practices, she added.

A pilot program on how to better counsel patients and families about childhood obesity is underway in five California-based residency programs.

Pediatric and family medicine residents are trained in strategies to help patients make behavioral changes proven to reduce and prevent obesity. For example, the program provides tips for helping individuals decrease their consumption of sugary beverages. Residents are armed with handouts on healthy beverage options and a visual aid that shows how much sugar is in a soda or sports drink.

The hope is that preparing future primary care physicians to effectively motivate lifestyle changes will help stem the prevalence rates of pediatric obesity, type 2 diabetes, and heart disease, Dr. Lydia Tinajero-Deck, the project's principal investigator, said in an interview.

The pilot, dubbed Fit for Residents, was developed by the University of California, Los Angeles, in collaboration with the American Academy of Pediatrics and American Academy of Family Physicians, said Dr. Tinajero-Deck, a pediatrician at Children's Hospital & Research Center in Oakland, Calif.

“The actual pilot program for our residents is 1 year, with the goal of sustainability and integration” into the residency program as a permanent education piece, she said. To expand it nationwide, “We need to collect data on how the curriculum was taught within these pilot programs” to identify and promote the best practices, she added.

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey.

Researchers reviewed interviews with 23,393 adults aged 18 and older that were included in the National Health Interview Survey (NHIS). The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the division of extramural research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral natural products. Another $4.1 billion were spent on classes such as yoga and tai chi; $2.9 billion, on homeopathic medicine; and $200 million, on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted.

The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

Although the overall number of visits to CAM providers (except for acupuncturists) decreased in 2007, compared with a decade earlier, “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

But the NHIS data show that U.S. adults make more than 300 million visits to CAM providers and spend billions of dollars on CAM annually.

“These expenditures, although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report online at the CDC's Web site at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey.

Researchers reviewed interviews with 23,393 adults aged 18 and older that were included in the National Health Interview Survey (NHIS). The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the division of extramural research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral natural products. Another $4.1 billion were spent on classes such as yoga and tai chi; $2.9 billion, on homeopathic medicine; and $200 million, on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted.

The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

Although the overall number of visits to CAM providers (except for acupuncturists) decreased in 2007, compared with a decade earlier, “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

But the NHIS data show that U.S. adults make more than 300 million visits to CAM providers and spend billions of dollars on CAM annually.

“These expenditures, although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report online at the CDC's Web site at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey.

Researchers reviewed interviews with 23,393 adults aged 18 and older that were included in the National Health Interview Survey (NHIS). The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the division of extramural research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral natural products. Another $4.1 billion were spent on classes such as yoga and tai chi; $2.9 billion, on homeopathic medicine; and $200 million, on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted.

The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

Although the overall number of visits to CAM providers (except for acupuncturists) decreased in 2007, compared with a decade earlier, “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

But the NHIS data show that U.S. adults make more than 300 million visits to CAM providers and spend billions of dollars on CAM annually.

“These expenditures, although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report online at the CDC's Web site at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

The Centers for Disease Control and Prevention has updated its guidelines for using antiviral medications to treat the seasonal and pandemic influenza A(H1N1) viruses, according to the CDC Web site.

The updated recommendations include guidance for clinicians about the following:

▸ Treating children younger than age 1 year. Oseltamivir (Tamiflu) is not approved by the Food and Drug Administration for use in children younger than 1 year of age. But given this age group's increased risk for complications from the H1N1 virus, the CDC recommends a 5-day antiviral treatment dose with oseltamivir of 25 mg twice daily for children aged 6–11 months, 20 mg twice daily for children aged 3–5 months, and 12 mg twice daily for children younger than 3 months.

The CDC's recommendations for 10-day prophylaxis with oseltamivir are 25 mg once daily for children aged 6–11 months, and 20 mg once daily for children aged 3–5 months, but oseltamivir is not currently recommended for prophylaxis for children younger than 3 months unless the situation is deemed critical.

The FDA issued an Emergency Use Authorization in April 2009 for the emergency use of oseltamivir in children younger than 1 year old.

▸ Dispenser measurements. Clinicians and pharmacists are cautioned that an oral dosing dispenser that comes with Tamiflu for oral suspension shows dose measurements in 30-mg, 45-mg, and 60-mg increments. These measurements use mg and match those currently recommended by the CDC for treatment or chemoprophylaxis against H1N1 infection, but the prescription instructions may be listed in mL or tsp, which can lead to dosing errors.

▸ Patients with neuromuscular or neurocognitive disorders. The revised recommendations for individuals who might benefit most from early treatment with antiviral therapy include patients with disorders that can increase the risk for aspiration, such as spinal cord injuries, seizure disorders, cognitive dysfunction, and other neuromuscular disorders, plus any disorders that “can compromise respiratory function or the handling or respiratory secretions.”

The CDC stated that its guidance will be updated as needed. For the latest information on the CDC's flu recommendations, visit cdc.govflu.gov

The Centers for Disease Control and Prevention has updated its guidelines for using antiviral medications to treat the seasonal and pandemic influenza A(H1N1) viruses, according to the CDC Web site.

The updated recommendations include guidance for clinicians about the following:

▸ Treating children younger than age 1 year. Oseltamivir (Tamiflu) is not approved by the Food and Drug Administration for use in children younger than 1 year of age. But given this age group's increased risk for complications from the H1N1 virus, the CDC recommends a 5-day antiviral treatment dose with oseltamivir of 25 mg twice daily for children aged 6–11 months, 20 mg twice daily for children aged 3–5 months, and 12 mg twice daily for children younger than 3 months.

The CDC's recommendations for 10-day prophylaxis with oseltamivir are 25 mg once daily for children aged 6–11 months, and 20 mg once daily for children aged 3–5 months, but oseltamivir is not currently recommended for prophylaxis for children younger than 3 months unless the situation is deemed critical.

The FDA issued an Emergency Use Authorization in April 2009 for the emergency use of oseltamivir in children younger than 1 year old.

▸ Dispenser measurements. Clinicians and pharmacists are cautioned that an oral dosing dispenser that comes with Tamiflu for oral suspension shows dose measurements in 30-mg, 45-mg, and 60-mg increments. These measurements use mg and match those currently recommended by the CDC for treatment or chemoprophylaxis against H1N1 infection, but the prescription instructions may be listed in mL or tsp, which can lead to dosing errors.

▸ Patients with neuromuscular or neurocognitive disorders. The revised recommendations for individuals who might benefit most from early treatment with antiviral therapy include patients with disorders that can increase the risk for aspiration, such as spinal cord injuries, seizure disorders, cognitive dysfunction, and other neuromuscular disorders, plus any disorders that “can compromise respiratory function or the handling or respiratory secretions.”

The CDC stated that its guidance will be updated as needed. For the latest information on the CDC's flu recommendations, visit cdc.govflu.gov

The Centers for Disease Control and Prevention has updated its guidelines for using antiviral medications to treat the seasonal and pandemic influenza A(H1N1) viruses, according to the CDC Web site.

The updated recommendations include guidance for clinicians about the following:

▸ Treating children younger than age 1 year. Oseltamivir (Tamiflu) is not approved by the Food and Drug Administration for use in children younger than 1 year of age. But given this age group's increased risk for complications from the H1N1 virus, the CDC recommends a 5-day antiviral treatment dose with oseltamivir of 25 mg twice daily for children aged 6–11 months, 20 mg twice daily for children aged 3–5 months, and 12 mg twice daily for children younger than 3 months.

The CDC's recommendations for 10-day prophylaxis with oseltamivir are 25 mg once daily for children aged 6–11 months, and 20 mg once daily for children aged 3–5 months, but oseltamivir is not currently recommended for prophylaxis for children younger than 3 months unless the situation is deemed critical.

The FDA issued an Emergency Use Authorization in April 2009 for the emergency use of oseltamivir in children younger than 1 year old.

▸ Dispenser measurements. Clinicians and pharmacists are cautioned that an oral dosing dispenser that comes with Tamiflu for oral suspension shows dose measurements in 30-mg, 45-mg, and 60-mg increments. These measurements use mg and match those currently recommended by the CDC for treatment or chemoprophylaxis against H1N1 infection, but the prescription instructions may be listed in mL or tsp, which can lead to dosing errors.

▸ Patients with neuromuscular or neurocognitive disorders. The revised recommendations for individuals who might benefit most from early treatment with antiviral therapy include patients with disorders that can increase the risk for aspiration, such as spinal cord injuries, seizure disorders, cognitive dysfunction, and other neuromuscular disorders, plus any disorders that “can compromise respiratory function or the handling or respiratory secretions.”

The CDC stated that its guidance will be updated as needed. For the latest information on the CDC's flu recommendations, visit cdc.govflu.gov

More than two-thirds of patients who were treated with stents for unprotected left main coronary artery disease were alive 10 years later, and patients who received drug-eluting stents had significantly fewer adverse events than did those who had bare metal stents, on the basis of data from 252 adults.

“Unprotected left main coronary artery disease (ULMCA) occurs in 3%-5% of coronary artery disease patients and is the subject of intense investigation,” wrote Dr. Pawel E. Buszman of the Medical University of Silesia in Katowice, Poland.

Current guidelines recommend that patients with ULMCA be revascularized with coronary artery bypass surgery. To evaluate the outcomes of stenting in this subset of patients, Dr. Buszman and his colleagues reviewed data from patients who underwent percutaneous coronary intervention to treat left main artery stenosis between January 1997 and March 2008. PCI was performed in these patients rather than surgery because of anatomical suitability, high surgical risk, or patient preference. The average age of the patients was 69 years (J. Am. Coll. Cardiol. 2009 Aug. 19 [doi:10.1016/j.jacc.2009.07.007

A total of 158 patients received bare metal stents (BMS) and 94 received drug-eluting stents (DES). Overall, angiographic success was achieved in 98% of the patients.

Angiographic success was defined as less than 30% residual stenosis of the left main artery, a minimal lumen diameter of at least 3 mm, a thrombolysis in myocardial infarction flow grade of 3, and no dissection.

During a short-term follow-up period of 30 days, major adverse cardiovascular and cerebral events (MACCE) occurred in 12 patients (5%) and 4 patients died (2%).

The long-term follow-up period ranged from 1 to 11 years, with an average follow-up period of 3.8 years. Based on a Kaplan-Meier analysis, the 5-year and 10-year survival rates were 78% and 69%, respectively.

During long-term follow-up, MACCE occurred in 64 patients (25%), including 25 MIs, 21 target lesion revascularizations, and 3 strokes. Of the 35 patients who died (14%), 28 were considered cardiac deaths. “There was significantly better long-term survival in patients with isolated left main coronary artery disease (LM) or LM with 1- and 2-vessel disease when compared with LM with 3-vessel disease,” the researchers said.

The patients in the DES group were significantly more likely to have a higher surgical risk and a higher incidence of left main artery stenosis than were the patients in the BMS group. But the unadjusted occurrence of major adverse cardiovascular and cerebral events was significantly lower in the DES group compared with the BMS group (15% vs. 26%), the researchers noted. “Further propensity score matching and data adjustment confirmed and strengthened those findings,” they said.

There were no significant differences between the stent groups in terms of death, myocardial infarction, stroke, or target lesion revascularizations.

The study was limited by the low rate of angiographic follow-up and an inconsistent use of intravascular ultrasound to evaluate the result of the stenting, the authors wrote.

But the favorable feasibility and outcome results supported data from previous studies, the researchers said. In contrast to previous studies, there was no significant difference in survival or major adverse event rates in patients with distal left main coronary artery compared with the proximal/medial left main coronary artery.

The findings are the first prospective data on long-term results of left main coronary artery stenting, using patients in the Left Main Coronary Artery Stenting (LE MANS) registry. The high procedural success rate and low rates of periprocedural mortality (1.3%) and major adverse events suggest that the stents are safe and feasible for ULMCA, the researchers noted. “Based upon the mounting evidence, there can be little dispute at this juncture that PCI can be offered as a safe alternative to CABG for a significant number of patients with left main disease, particularly nondiabetics without extensive concomitant artery disease,” Dr. Jeffrey Moses of Columbia University, New York, and his colleagues wrote in an accompanying editorial (doi:10.1016/j.jacc.2009.07.016

Neither Dr. Buszman nor Dr. Moses disclosed financial conflicts of interest. Previously, Dr. Moses disclosed that he was on the speakers bureau for and received honoraria from Cordis, Johnson & Johnson, Boston Scientific, and Sanofi, and was an adviser to Cordis and Johnson & Johnson. Dr. Buszman previously disclosed that he had no financial conflicts of interest.

More than two-thirds of patients who were treated with stents for unprotected left main coronary artery disease were alive 10 years later, and patients who received drug-eluting stents had significantly fewer adverse events than did those who had bare metal stents, on the basis of data from 252 adults.

“Unprotected left main coronary artery disease (ULMCA) occurs in 3%-5% of coronary artery disease patients and is the subject of intense investigation,” wrote Dr. Pawel E. Buszman of the Medical University of Silesia in Katowice, Poland.

Current guidelines recommend that patients with ULMCA be revascularized with coronary artery bypass surgery. To evaluate the outcomes of stenting in this subset of patients, Dr. Buszman and his colleagues reviewed data from patients who underwent percutaneous coronary intervention to treat left main artery stenosis between January 1997 and March 2008. PCI was performed in these patients rather than surgery because of anatomical suitability, high surgical risk, or patient preference. The average age of the patients was 69 years (J. Am. Coll. Cardiol. 2009 Aug. 19 [doi:10.1016/j.jacc.2009.07.007

A total of 158 patients received bare metal stents (BMS) and 94 received drug-eluting stents (DES). Overall, angiographic success was achieved in 98% of the patients.

Angiographic success was defined as less than 30% residual stenosis of the left main artery, a minimal lumen diameter of at least 3 mm, a thrombolysis in myocardial infarction flow grade of 3, and no dissection.

During a short-term follow-up period of 30 days, major adverse cardiovascular and cerebral events (MACCE) occurred in 12 patients (5%) and 4 patients died (2%).

The long-term follow-up period ranged from 1 to 11 years, with an average follow-up period of 3.8 years. Based on a Kaplan-Meier analysis, the 5-year and 10-year survival rates were 78% and 69%, respectively.

During long-term follow-up, MACCE occurred in 64 patients (25%), including 25 MIs, 21 target lesion revascularizations, and 3 strokes. Of the 35 patients who died (14%), 28 were considered cardiac deaths. “There was significantly better long-term survival in patients with isolated left main coronary artery disease (LM) or LM with 1- and 2-vessel disease when compared with LM with 3-vessel disease,” the researchers said.

The patients in the DES group were significantly more likely to have a higher surgical risk and a higher incidence of left main artery stenosis than were the patients in the BMS group. But the unadjusted occurrence of major adverse cardiovascular and cerebral events was significantly lower in the DES group compared with the BMS group (15% vs. 26%), the researchers noted. “Further propensity score matching and data adjustment confirmed and strengthened those findings,” they said.

There were no significant differences between the stent groups in terms of death, myocardial infarction, stroke, or target lesion revascularizations.

The study was limited by the low rate of angiographic follow-up and an inconsistent use of intravascular ultrasound to evaluate the result of the stenting, the authors wrote.

But the favorable feasibility and outcome results supported data from previous studies, the researchers said. In contrast to previous studies, there was no significant difference in survival or major adverse event rates in patients with distal left main coronary artery compared with the proximal/medial left main coronary artery.

The findings are the first prospective data on long-term results of left main coronary artery stenting, using patients in the Left Main Coronary Artery Stenting (LE MANS) registry. The high procedural success rate and low rates of periprocedural mortality (1.3%) and major adverse events suggest that the stents are safe and feasible for ULMCA, the researchers noted. “Based upon the mounting evidence, there can be little dispute at this juncture that PCI can be offered as a safe alternative to CABG for a significant number of patients with left main disease, particularly nondiabetics without extensive concomitant artery disease,” Dr. Jeffrey Moses of Columbia University, New York, and his colleagues wrote in an accompanying editorial (doi:10.1016/j.jacc.2009.07.016

Neither Dr. Buszman nor Dr. Moses disclosed financial conflicts of interest. Previously, Dr. Moses disclosed that he was on the speakers bureau for and received honoraria from Cordis, Johnson & Johnson, Boston Scientific, and Sanofi, and was an adviser to Cordis and Johnson & Johnson. Dr. Buszman previously disclosed that he had no financial conflicts of interest.

More than two-thirds of patients who were treated with stents for unprotected left main coronary artery disease were alive 10 years later, and patients who received drug-eluting stents had significantly fewer adverse events than did those who had bare metal stents, on the basis of data from 252 adults.

“Unprotected left main coronary artery disease (ULMCA) occurs in 3%-5% of coronary artery disease patients and is the subject of intense investigation,” wrote Dr. Pawel E. Buszman of the Medical University of Silesia in Katowice, Poland.

Current guidelines recommend that patients with ULMCA be revascularized with coronary artery bypass surgery. To evaluate the outcomes of stenting in this subset of patients, Dr. Buszman and his colleagues reviewed data from patients who underwent percutaneous coronary intervention to treat left main artery stenosis between January 1997 and March 2008. PCI was performed in these patients rather than surgery because of anatomical suitability, high surgical risk, or patient preference. The average age of the patients was 69 years (J. Am. Coll. Cardiol. 2009 Aug. 19 [doi:10.1016/j.jacc.2009.07.007

A total of 158 patients received bare metal stents (BMS) and 94 received drug-eluting stents (DES). Overall, angiographic success was achieved in 98% of the patients.

Angiographic success was defined as less than 30% residual stenosis of the left main artery, a minimal lumen diameter of at least 3 mm, a thrombolysis in myocardial infarction flow grade of 3, and no dissection.

During a short-term follow-up period of 30 days, major adverse cardiovascular and cerebral events (MACCE) occurred in 12 patients (5%) and 4 patients died (2%).

The long-term follow-up period ranged from 1 to 11 years, with an average follow-up period of 3.8 years. Based on a Kaplan-Meier analysis, the 5-year and 10-year survival rates were 78% and 69%, respectively.

During long-term follow-up, MACCE occurred in 64 patients (25%), including 25 MIs, 21 target lesion revascularizations, and 3 strokes. Of the 35 patients who died (14%), 28 were considered cardiac deaths. “There was significantly better long-term survival in patients with isolated left main coronary artery disease (LM) or LM with 1- and 2-vessel disease when compared with LM with 3-vessel disease,” the researchers said.

The patients in the DES group were significantly more likely to have a higher surgical risk and a higher incidence of left main artery stenosis than were the patients in the BMS group. But the unadjusted occurrence of major adverse cardiovascular and cerebral events was significantly lower in the DES group compared with the BMS group (15% vs. 26%), the researchers noted. “Further propensity score matching and data adjustment confirmed and strengthened those findings,” they said.

There were no significant differences between the stent groups in terms of death, myocardial infarction, stroke, or target lesion revascularizations.

The study was limited by the low rate of angiographic follow-up and an inconsistent use of intravascular ultrasound to evaluate the result of the stenting, the authors wrote.

But the favorable feasibility and outcome results supported data from previous studies, the researchers said. In contrast to previous studies, there was no significant difference in survival or major adverse event rates in patients with distal left main coronary artery compared with the proximal/medial left main coronary artery.

The findings are the first prospective data on long-term results of left main coronary artery stenting, using patients in the Left Main Coronary Artery Stenting (LE MANS) registry. The high procedural success rate and low rates of periprocedural mortality (1.3%) and major adverse events suggest that the stents are safe and feasible for ULMCA, the researchers noted. “Based upon the mounting evidence, there can be little dispute at this juncture that PCI can be offered as a safe alternative to CABG for a significant number of patients with left main disease, particularly nondiabetics without extensive concomitant artery disease,” Dr. Jeffrey Moses of Columbia University, New York, and his colleagues wrote in an accompanying editorial (doi:10.1016/j.jacc.2009.07.016

Neither Dr. Buszman nor Dr. Moses disclosed financial conflicts of interest. Previously, Dr. Moses disclosed that he was on the speakers bureau for and received honoraria from Cordis, Johnson & Johnson, Boston Scientific, and Sanofi, and was an adviser to Cordis and Johnson & Johnson. Dr. Buszman previously disclosed that he had no financial conflicts of interest.

The Centers for Disease Control and Prevention has updated its guidelines for using antiviral medications to treat the seasonal and pandemic influenza A(H1N1) viruses, according to the CDC Web site.

The updated recommendations include guidance for clinicians about antiviral treatment for very young children and information about correct dosing using the oseltamivir (Tamiflu) dosing dispenser:

▸ Treating children younger than age 1 year. Oseltamivir is not approved by the Food and Drug Administration for use in children younger than 1 year of age. But given this age group's increased risk for complications from the H1N1 virus, the CDC recommends a 5-day antiviral treatment dose with oseltamivir of 25 mg twice daily for children aged 6-11 months, 20 mg twice daily for children aged 3-5 months, and 12 mg twice daily for children younger than 3 months.

The CDC's recommendations for 10-day prophylaxis with oseltamivir are 25 mg once daily for children aged 6-11 months, and 20 mg once daily for children aged 3-5 months, but oseltamivir is not currently recommended for prophylaxis for children younger than 3 months unless the situation is deemed critical. The FDA issued an Emergency Use Authorization in April 2009 for the emergency use of oseltamivir in children younger than 1 year old.

▸ Dispenser measurements. The updated CDC antiviral recommendations caution clinicians and pharmacists that an oral dosing dispenser that comes with Tamiflu for oral suspension shows dose measurements in 30-mg, 45-mg, and 60-mg increments. These measurements use “mg” and match those currently recommended by the CDC for treatment of or chemoprophylaxis against H1N1 infection (see table), but the prescription instructions may be listed in “mL” or “tsp,” which can lead to dosing errors.

The CDC Web site states that the recommendations should be considered an interim document, which will be updated as needed. For the latest information on the CDC's flu guidance and recommendations, visit www.cdc.govwww.flu.gov

Source ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention has updated its guidelines for using antiviral medications to treat the seasonal and pandemic influenza A(H1N1) viruses, according to the CDC Web site.

The updated recommendations include guidance for clinicians about antiviral treatment for very young children and information about correct dosing using the oseltamivir (Tamiflu) dosing dispenser:

▸ Treating children younger than age 1 year. Oseltamivir is not approved by the Food and Drug Administration for use in children younger than 1 year of age. But given this age group's increased risk for complications from the H1N1 virus, the CDC recommends a 5-day antiviral treatment dose with oseltamivir of 25 mg twice daily for children aged 6-11 months, 20 mg twice daily for children aged 3-5 months, and 12 mg twice daily for children younger than 3 months.

The CDC's recommendations for 10-day prophylaxis with oseltamivir are 25 mg once daily for children aged 6-11 months, and 20 mg once daily for children aged 3-5 months, but oseltamivir is not currently recommended for prophylaxis for children younger than 3 months unless the situation is deemed critical. The FDA issued an Emergency Use Authorization in April 2009 for the emergency use of oseltamivir in children younger than 1 year old.

▸ Dispenser measurements. The updated CDC antiviral recommendations caution clinicians and pharmacists that an oral dosing dispenser that comes with Tamiflu for oral suspension shows dose measurements in 30-mg, 45-mg, and 60-mg increments. These measurements use “mg” and match those currently recommended by the CDC for treatment of or chemoprophylaxis against H1N1 infection (see table), but the prescription instructions may be listed in “mL” or “tsp,” which can lead to dosing errors.

The CDC Web site states that the recommendations should be considered an interim document, which will be updated as needed. For the latest information on the CDC's flu guidance and recommendations, visit www.cdc.govwww.flu.gov

Source ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention has updated its guidelines for using antiviral medications to treat the seasonal and pandemic influenza A(H1N1) viruses, according to the CDC Web site.

The updated recommendations include guidance for clinicians about antiviral treatment for very young children and information about correct dosing using the oseltamivir (Tamiflu) dosing dispenser:

▸ Treating children younger than age 1 year. Oseltamivir is not approved by the Food and Drug Administration for use in children younger than 1 year of age. But given this age group's increased risk for complications from the H1N1 virus, the CDC recommends a 5-day antiviral treatment dose with oseltamivir of 25 mg twice daily for children aged 6-11 months, 20 mg twice daily for children aged 3-5 months, and 12 mg twice daily for children younger than 3 months.

The CDC's recommendations for 10-day prophylaxis with oseltamivir are 25 mg once daily for children aged 6-11 months, and 20 mg once daily for children aged 3-5 months, but oseltamivir is not currently recommended for prophylaxis for children younger than 3 months unless the situation is deemed critical. The FDA issued an Emergency Use Authorization in April 2009 for the emergency use of oseltamivir in children younger than 1 year old.

▸ Dispenser measurements. The updated CDC antiviral recommendations caution clinicians and pharmacists that an oral dosing dispenser that comes with Tamiflu for oral suspension shows dose measurements in 30-mg, 45-mg, and 60-mg increments. These measurements use “mg” and match those currently recommended by the CDC for treatment of or chemoprophylaxis against H1N1 infection (see table), but the prescription instructions may be listed in “mL” or “tsp,” which can lead to dosing errors.

The CDC Web site states that the recommendations should be considered an interim document, which will be updated as needed. For the latest information on the CDC's flu guidance and recommendations, visit www.cdc.govwww.flu.gov

Source ELSEVIER GLOBAL MEDICAL NEWS

A pilot program aimed at teaching residents how to better counsel patients and families about childhood obesity is underway in five California-based residency programs.

The idea is to train pediatric and family medicine residents in strategies that can help patients make behavioral changes proven to reduce and prevent obesity. For example, the program gives the residents tips for helping individuals decrease their consumption of sugary beverages. Residents are armed with handouts on healthy beverage options and a visual aid that shows patients how much sugar is in a soda or sports drink.

The hope is that preparing future primary care physicians to effectively motivate lifestyle changes will help stem the prevalence rates of pediatric obesity, type 2 diabetes, and heart disease, Dr. Lydia Tinajero-Deck, the project's principal investigator, said in an interview.

The pilot, dubbed Fit for Residents, was developed by the University of California, Los Angeles, in collaboration with the American Academy of Pediatrics and American Academy of Family Physicians, said Dr. Tinajero-Deck, a pediatrician in the primary care department at Children's Hospital & Research Center in Oakland, Calif.

A pilot program aimed at teaching residents how to better counsel patients and families about childhood obesity is underway in five California-based residency programs.

The idea is to train pediatric and family medicine residents in strategies that can help patients make behavioral changes proven to reduce and prevent obesity. For example, the program gives the residents tips for helping individuals decrease their consumption of sugary beverages. Residents are armed with handouts on healthy beverage options and a visual aid that shows patients how much sugar is in a soda or sports drink.

The hope is that preparing future primary care physicians to effectively motivate lifestyle changes will help stem the prevalence rates of pediatric obesity, type 2 diabetes, and heart disease, Dr. Lydia Tinajero-Deck, the project's principal investigator, said in an interview.

The pilot, dubbed Fit for Residents, was developed by the University of California, Los Angeles, in collaboration with the American Academy of Pediatrics and American Academy of Family Physicians, said Dr. Tinajero-Deck, a pediatrician in the primary care department at Children's Hospital & Research Center in Oakland, Calif.

A pilot program aimed at teaching residents how to better counsel patients and families about childhood obesity is underway in five California-based residency programs.

The idea is to train pediatric and family medicine residents in strategies that can help patients make behavioral changes proven to reduce and prevent obesity. For example, the program gives the residents tips for helping individuals decrease their consumption of sugary beverages. Residents are armed with handouts on healthy beverage options and a visual aid that shows patients how much sugar is in a soda or sports drink.

The hope is that preparing future primary care physicians to effectively motivate lifestyle changes will help stem the prevalence rates of pediatric obesity, type 2 diabetes, and heart disease, Dr. Lydia Tinajero-Deck, the project's principal investigator, said in an interview.

The pilot, dubbed Fit for Residents, was developed by the University of California, Los Angeles, in collaboration with the American Academy of Pediatrics and American Academy of Family Physicians, said Dr. Tinajero-Deck, a pediatrician in the primary care department at Children's Hospital & Research Center in Oakland, Calif.

WASHINGTON — The health cost of obesity in the United States jumped over the past decade, from $74 billion in 1998 to approximately $147 billion today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity may involve community intervention rather than clinical intervention. But physicians have a responsibility to encourage patients' weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

To watch a video interview of Dr. Finkelstein, go to: http://www.youtube.com/watch?v=TwyTYVrnJjw

WASHINGTON — The health cost of obesity in the United States jumped over the past decade, from $74 billion in 1998 to approximately $147 billion today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity may involve community intervention rather than clinical intervention. But physicians have a responsibility to encourage patients' weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

To watch a video interview of Dr. Finkelstein, go to: http://www.youtube.com/watch?v=TwyTYVrnJjw

WASHINGTON — The health cost of obesity in the United States jumped over the past decade, from $74 billion in 1998 to approximately $147 billion today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity may involve community intervention rather than clinical intervention. But physicians have a responsibility to encourage patients' weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

To watch a video interview of Dr. Finkelstein, go to: http://www.youtube.com/watch?v=TwyTYVrnJjw

Bacterial coinfections likely played a role in almost one-third of fatal cases of 2009 pandemic influenza A(H1N1) in the United States, based on data from 77 patients published online in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

“These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 H1N1 and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza,” the investigators wrote (MMWR 2009;58:1–4).

The investigators found evidence of concurrent bacterial infection in lung specimens from 22 of 77 patients (29%) with fatal cases of 2009 H1N1 infection. The specimens were submitted to the CDC by medical examiners and local health departments between May 1 and Aug. 20, 2009.

A total of 10 fatal cases were coinfections with Streptococcus pneumoniae, 6 were Streptococcus pyogenes, 7 were Staphylococcus aureus, 2 were Streptococcus mitis, and 1 was Haemophilus influenzae. Four of the fatal cases involved multiple pathogens. The age of the patients ranged from 2 months to 56 years, with an average age of 31 years. The 22 patients were divided evenly by sex. The average duration of illness was 6 days, based on data from 17 of the 22 coinfection cases for whom this information was available.

Medical history was available for 21 of the coinfection patients, and 16 of these had underlying medical conditions “that were known to increase the risk for influenza-related complications,” the investigators wrote. And 15 patients had conditions that were indications for vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23), the investigators added. Data were not available on the vaccination status of any of the 22 bacterial coinfection cases.

Although two early reviews of severe 2009 H1N1 cases this year showed no evidence of coinfection with bacterial pneumonia, the current results support findings from autopsy studies in previous pandemics, in which bacterial coinfections were found in the majority of the deaths attributed to influenza A infections, the investigators wrote.

The results were limited by incomplete patient information, a lack of specimens from unaffected lung tissue, and a limited evaluation of potential bacterial pathogens, they noted.

For the complete MMWR report, visit www.cdc.gov/mmwr

Bacterial coinfections likely played a role in almost one-third of fatal cases of 2009 pandemic influenza A(H1N1) in the United States, based on data from 77 patients published online in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

“These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 H1N1 and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza,” the investigators wrote (MMWR 2009;58:1–4).

The investigators found evidence of concurrent bacterial infection in lung specimens from 22 of 77 patients (29%) with fatal cases of 2009 H1N1 infection. The specimens were submitted to the CDC by medical examiners and local health departments between May 1 and Aug. 20, 2009.

A total of 10 fatal cases were coinfections with Streptococcus pneumoniae, 6 were Streptococcus pyogenes, 7 were Staphylococcus aureus, 2 were Streptococcus mitis, and 1 was Haemophilus influenzae. Four of the fatal cases involved multiple pathogens. The age of the patients ranged from 2 months to 56 years, with an average age of 31 years. The 22 patients were divided evenly by sex. The average duration of illness was 6 days, based on data from 17 of the 22 coinfection cases for whom this information was available.

Medical history was available for 21 of the coinfection patients, and 16 of these had underlying medical conditions “that were known to increase the risk for influenza-related complications,” the investigators wrote. And 15 patients had conditions that were indications for vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23), the investigators added. Data were not available on the vaccination status of any of the 22 bacterial coinfection cases.

Although two early reviews of severe 2009 H1N1 cases this year showed no evidence of coinfection with bacterial pneumonia, the current results support findings from autopsy studies in previous pandemics, in which bacterial coinfections were found in the majority of the deaths attributed to influenza A infections, the investigators wrote.

The results were limited by incomplete patient information, a lack of specimens from unaffected lung tissue, and a limited evaluation of potential bacterial pathogens, they noted.

For the complete MMWR report, visit www.cdc.gov/mmwr

Bacterial coinfections likely played a role in almost one-third of fatal cases of 2009 pandemic influenza A(H1N1) in the United States, based on data from 77 patients published online in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

“These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 H1N1 and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza,” the investigators wrote (MMWR 2009;58:1–4).

The investigators found evidence of concurrent bacterial infection in lung specimens from 22 of 77 patients (29%) with fatal cases of 2009 H1N1 infection. The specimens were submitted to the CDC by medical examiners and local health departments between May 1 and Aug. 20, 2009.

A total of 10 fatal cases were coinfections with Streptococcus pneumoniae, 6 were Streptococcus pyogenes, 7 were Staphylococcus aureus, 2 were Streptococcus mitis, and 1 was Haemophilus influenzae. Four of the fatal cases involved multiple pathogens. The age of the patients ranged from 2 months to 56 years, with an average age of 31 years. The 22 patients were divided evenly by sex. The average duration of illness was 6 days, based on data from 17 of the 22 coinfection cases for whom this information was available.

Medical history was available for 21 of the coinfection patients, and 16 of these had underlying medical conditions “that were known to increase the risk for influenza-related complications,” the investigators wrote. And 15 patients had conditions that were indications for vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23), the investigators added. Data were not available on the vaccination status of any of the 22 bacterial coinfection cases.

Although two early reviews of severe 2009 H1N1 cases this year showed no evidence of coinfection with bacterial pneumonia, the current results support findings from autopsy studies in previous pandemics, in which bacterial coinfections were found in the majority of the deaths attributed to influenza A infections, the investigators wrote.

The results were limited by incomplete patient information, a lack of specimens from unaffected lung tissue, and a limited evaluation of potential bacterial pathogens, they noted.

For the complete MMWR report, visit www.cdc.gov/mmwr

BETHESDA, MD. — Family history continues to be an important tool for clinicians, but more research is needed before it can be declared an evidence-based strategy that improves outcomes for patients, according to a statement released after a conference on Family History and Improving Health sponsored by the National Institutes of Health.

“There's still a lot we don't know about how to collect and use family history effectively,” Dr. Alfred Berg of the University of Washington, Seattle, said at the start of the conference.

“The panel recognized that family history has an important role,” he added during a telebriefing after the conference. But it is unclear how this information can best be gathered and used to predict disease outcomes in primary care, he said.

The statement was compiled by an expert panel based on a review of the best available evidence on the role of family history in the diagnosis of common diseases seen by primary care clinicians. Dr. Berg served as chairperson of the panel.

Panelists heard from researchers who presented data on the usefulness of family history for risk assessment in clinical care settings, as well as in specific populations such as children and pregnant women.

In the statement, the panel acknowledged that “Family history was a core element of clinical care long before the evidence-based medicine paradigm was even proposed.” Consequently, the evidence to support the usefulness of family history for identifying common diseases is weak in several key areas, including defining the key elements of family history, linking results to clinical conditions, and evaluating potential benefits and harms.

Health care professionals in the United States have always asked patients about family history information, said Dr. Berg. The increase in the availability of genomic information and the shift toward electronic medical records provide interesting possibilities for ways to use family history more effectively to improve health outcomes, he added.

The statement includes a list of research questions that fall into three categories: structure or characteristics of a family history; the process of acquiring a family history; and outcomes of the acquisition, interpretation, and application of family history information.

One research question asks, “What are optimal ways to use family history in a primary care setting to identify individuals who can benefit from enhanced surveillance or referral to genetics services?”

The report is not designed to inform clinical practice, said Dr. Berg. But one of the goals of the conference is that the research agenda will generate the kind of information that eventually allows physicians to do a better job of collecting family history information, he said.

A State-of-the-Science statement is not an official policy or position statement of the National Institutes of Health or the federal government. The panel members had no relevant financial conflicts to disclose. The statement is available online at www.consensus.nih.gov

'There's still a lot we don't know about how to collect and use family history effectively.'

Source DR. BERG

BETHESDA, MD. — Family history continues to be an important tool for clinicians, but more research is needed before it can be declared an evidence-based strategy that improves outcomes for patients, according to a statement released after a conference on Family History and Improving Health sponsored by the National Institutes of Health.

“There's still a lot we don't know about how to collect and use family history effectively,” Dr. Alfred Berg of the University of Washington, Seattle, said at the start of the conference.

“The panel recognized that family history has an important role,” he added during a telebriefing after the conference. But it is unclear how this information can best be gathered and used to predict disease outcomes in primary care, he said.

The statement was compiled by an expert panel based on a review of the best available evidence on the role of family history in the diagnosis of common diseases seen by primary care clinicians. Dr. Berg served as chairperson of the panel.

Panelists heard from researchers who presented data on the usefulness of family history for risk assessment in clinical care settings, as well as in specific populations such as children and pregnant women.

In the statement, the panel acknowledged that “Family history was a core element of clinical care long before the evidence-based medicine paradigm was even proposed.” Consequently, the evidence to support the usefulness of family history for identifying common diseases is weak in several key areas, including defining the key elements of family history, linking results to clinical conditions, and evaluating potential benefits and harms.

Health care professionals in the United States have always asked patients about family history information, said Dr. Berg. The increase in the availability of genomic information and the shift toward electronic medical records provide interesting possibilities for ways to use family history more effectively to improve health outcomes, he added.

The statement includes a list of research questions that fall into three categories: structure or characteristics of a family history; the process of acquiring a family history; and outcomes of the acquisition, interpretation, and application of family history information.

One research question asks, “What are optimal ways to use family history in a primary care setting to identify individuals who can benefit from enhanced surveillance or referral to genetics services?”

The report is not designed to inform clinical practice, said Dr. Berg. But one of the goals of the conference is that the research agenda will generate the kind of information that eventually allows physicians to do a better job of collecting family history information, he said.

A State-of-the-Science statement is not an official policy or position statement of the National Institutes of Health or the federal government. The panel members had no relevant financial conflicts to disclose. The statement is available online at www.consensus.nih.gov

'There's still a lot we don't know about how to collect and use family history effectively.'

Source DR. BERG

BETHESDA, MD. — Family history continues to be an important tool for clinicians, but more research is needed before it can be declared an evidence-based strategy that improves outcomes for patients, according to a statement released after a conference on Family History and Improving Health sponsored by the National Institutes of Health.

“There's still a lot we don't know about how to collect and use family history effectively,” Dr. Alfred Berg of the University of Washington, Seattle, said at the start of the conference.

“The panel recognized that family history has an important role,” he added during a telebriefing after the conference. But it is unclear how this information can best be gathered and used to predict disease outcomes in primary care, he said.

The statement was compiled by an expert panel based on a review of the best available evidence on the role of family history in the diagnosis of common diseases seen by primary care clinicians. Dr. Berg served as chairperson of the panel.

Panelists heard from researchers who presented data on the usefulness of family history for risk assessment in clinical care settings, as well as in specific populations such as children and pregnant women.

In the statement, the panel acknowledged that “Family history was a core element of clinical care long before the evidence-based medicine paradigm was even proposed.” Consequently, the evidence to support the usefulness of family history for identifying common diseases is weak in several key areas, including defining the key elements of family history, linking results to clinical conditions, and evaluating potential benefits and harms.

Health care professionals in the United States have always asked patients about family history information, said Dr. Berg. The increase in the availability of genomic information and the shift toward electronic medical records provide interesting possibilities for ways to use family history more effectively to improve health outcomes, he added.

The statement includes a list of research questions that fall into three categories: structure or characteristics of a family history; the process of acquiring a family history; and outcomes of the acquisition, interpretation, and application of family history information.

One research question asks, “What are optimal ways to use family history in a primary care setting to identify individuals who can benefit from enhanced surveillance or referral to genetics services?”

The report is not designed to inform clinical practice, said Dr. Berg. But one of the goals of the conference is that the research agenda will generate the kind of information that eventually allows physicians to do a better job of collecting family history information, he said.

A State-of-the-Science statement is not an official policy or position statement of the National Institutes of Health or the federal government. The panel members had no relevant financial conflicts to disclose. The statement is available online at www.consensus.nih.gov

'There's still a lot we don't know about how to collect and use family history effectively.'

Source DR. BERG

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, according to data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease (IBD) remains uncertain. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data, he said at the annual Digestive Disease Week.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, and 26,216 controls without a history of these infections.

During an average follow-up of 7.5 years, a first-time diagnosis of IBD was reported in 107 individuals with a history of Salmonella or Campylobacter infections, and in 73 controls. The risk of IBD was similar for both pathogens, and was independent of age and sex. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 when the first year after infection was excluded.

The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD, said Dr. Nielsen, who had no financial conflicts to disclose.

A related video is at www.youtube.com/Internal

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, according to data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease (IBD) remains uncertain. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data, he said at the annual Digestive Disease Week.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, and 26,216 controls without a history of these infections.

During an average follow-up of 7.5 years, a first-time diagnosis of IBD was reported in 107 individuals with a history of Salmonella or Campylobacter infections, and in 73 controls. The risk of IBD was similar for both pathogens, and was independent of age and sex. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 when the first year after infection was excluded.

The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD, said Dr. Nielsen, who had no financial conflicts to disclose.

A related video is at www.youtube.com/Internal

CHICAGO — A history of foodborne infections nearly triples the risk of inflammatory bowel disease, according to data from a population-based study of nearly 40,000 adults.

“We have seen increased incidence of both colitis and Crohn's disease in recent years,” said Dr. Henrik Nielsen of Aalborg (Denmark) Hospital. The pathogenesis of inflammatory bowel disease (IBD) remains uncertain. Previous studies have suggested a role for environmental factors, including infections, but few of these studies have included long-term follow-up data, he said at the annual Digestive Disease Week.

Dr. Nielsen and his colleagues used laboratory registries from 1991 to 2003 to identify 13,148 adults with a history of Salmonella or Campylobacter gastroenteritis, and 26,216 controls without a history of these infections.

During an average follow-up of 7.5 years, a first-time diagnosis of IBD was reported in 107 individuals with a history of Salmonella or Campylobacter infections, and in 73 controls. The risk of IBD was similar for both pathogens, and was independent of age and sex. In the group with the history of infections, the odds ratio for IBD was 2.9 during the entire follow-up period and 1.9 when the first year after infection was excluded.

The study could not prove causality because of its retrospective nature, but the results may contribute to a better understanding of the etiology of IBD, said Dr. Nielsen, who had no financial conflicts to disclose.

A related video is at www.youtube.com/Internal