Heidi Splete

Paying people to quit smoking significantly increased smoking-cessation rates, compared with a control strategy that had no financial incentives, according to a workplace-based study.

Previous studies of workplace-based financial incentives to help people quit smoking have used small sample sizes and small payments, wrote Dr. Kevin G. Volpp of the University of Pennsylvania in Philadelphia, and colleagues.

The researchers randomized 442 adult smokers to receive information about smoking-cessation programs and 436 to receive information about smoking-cessation programs plus a financial incentive. The participants volunteered for the study after being identified through a survey about smoking habits. Those who used tobacco products other than cigarettes were excluded.

The financial incentive was $100 to complete a smoking-cessation program, plus $250 for confirmed cessation of smoking at 3 or 6 months after entering the study. In addition, participants received $400 for smoking cessation 6 months after the previous date of confirmed smoking cessation (9 months or 12 months). They were also assessed for smoking status (but were not paid) after another 6 months (15 or 18 months after study enrollment). The smoking-cessation program was not based at the workplace; instead, participants were advised to use existing programs in the community.

The study population included adults aged 18 years and older who reported smoking at least five cigarettes daily. Demographic traits were similar between the two groups. The participants were followed for at least 12 months, and the study's primary end point was smoking cessation 9 or 12 months after study enrollment.

Overall, the rate of confirmed smoking cessation (based on a cotinine test) at 9 months or 12 months was about 3 times greater in the financial incentive group, compared with the control group (15% vs. 5%). The smoking-cessation rate within 6 months of starting the study was significantly higher in the financial incentive group, compared with the control group (21% vs. 12%). And the cessation rate remained significantly higher in the financial incentive group, compared with the control group at 15 or 18 months (9% vs. 4%).

Significantly more individuals in the financial incentive group than in the control group enrolled in (15% vs. 5%) and completed (11% vs. 3%) a smoking-cessation education program. Those in the financial incentive group who took part in the smoking-cessation program had higher smoking-cessation rates, compared with controls who took part in the program (46% vs. 21%).

“Targeted payments for smoking cessation have the advantage of being unbundled from health insurance premiums and thus may be more salient to people, thereby having a greater influence on behavior,” the researchers said (N. Engl. J. Med. 2009;360:699–709).

The relapse rates between the 9- or 12-month follow-up and the 15- or 18-month follow-up were 36% in the financial incentive group and 27% in the control group. Although those results were higher than those found in other studies, the difference may be negligible compared with other studies, the researchers noted, because so few participants in the current study quit smoking.

The study was limited by its majority of white adults (90%) with high levels of income and education, the researchers noted. More research is needed to assess the effect of financial incentives on employees with lower socioeconomic status and on those of different ethnicities, they added.

The study was supported in part by grants from the Centers for Disease Control and Prevention and the Pennsylvania Department of Health. Dr. Volpp has received lecture fees from Aetna Inc. and grant support from Aetna and Pfizer Inc.

Payments are unbundled from health insurance premiums and thus may have a greater influence on behavior. DR. VOLPP

Paying people to quit smoking significantly increased smoking-cessation rates, compared with a control strategy that had no financial incentives, according to a workplace-based study.

Previous studies of workplace-based financial incentives to help people quit smoking have used small sample sizes and small payments, wrote Dr. Kevin G. Volpp of the University of Pennsylvania in Philadelphia, and colleagues.

The researchers randomized 442 adult smokers to receive information about smoking-cessation programs and 436 to receive information about smoking-cessation programs plus a financial incentive. The participants volunteered for the study after being identified through a survey about smoking habits. Those who used tobacco products other than cigarettes were excluded.

The financial incentive was $100 to complete a smoking-cessation program, plus $250 for confirmed cessation of smoking at 3 or 6 months after entering the study. In addition, participants received $400 for smoking cessation 6 months after the previous date of confirmed smoking cessation (9 months or 12 months). They were also assessed for smoking status (but were not paid) after another 6 months (15 or 18 months after study enrollment). The smoking-cessation program was not based at the workplace; instead, participants were advised to use existing programs in the community.

The study population included adults aged 18 years and older who reported smoking at least five cigarettes daily. Demographic traits were similar between the two groups. The participants were followed for at least 12 months, and the study's primary end point was smoking cessation 9 or 12 months after study enrollment.

Overall, the rate of confirmed smoking cessation (based on a cotinine test) at 9 months or 12 months was about 3 times greater in the financial incentive group, compared with the control group (15% vs. 5%). The smoking-cessation rate within 6 months of starting the study was significantly higher in the financial incentive group, compared with the control group (21% vs. 12%). And the cessation rate remained significantly higher in the financial incentive group, compared with the control group at 15 or 18 months (9% vs. 4%).

Significantly more individuals in the financial incentive group than in the control group enrolled in (15% vs. 5%) and completed (11% vs. 3%) a smoking-cessation education program. Those in the financial incentive group who took part in the smoking-cessation program had higher smoking-cessation rates, compared with controls who took part in the program (46% vs. 21%).

“Targeted payments for smoking cessation have the advantage of being unbundled from health insurance premiums and thus may be more salient to people, thereby having a greater influence on behavior,” the researchers said (N. Engl. J. Med. 2009;360:699–709).

The relapse rates between the 9- or 12-month follow-up and the 15- or 18-month follow-up were 36% in the financial incentive group and 27% in the control group. Although those results were higher than those found in other studies, the difference may be negligible compared with other studies, the researchers noted, because so few participants in the current study quit smoking.

The study was limited by its majority of white adults (90%) with high levels of income and education, the researchers noted. More research is needed to assess the effect of financial incentives on employees with lower socioeconomic status and on those of different ethnicities, they added.

The study was supported in part by grants from the Centers for Disease Control and Prevention and the Pennsylvania Department of Health. Dr. Volpp has received lecture fees from Aetna Inc. and grant support from Aetna and Pfizer Inc.

Payments are unbundled from health insurance premiums and thus may have a greater influence on behavior. DR. VOLPP

Paying people to quit smoking significantly increased smoking-cessation rates, compared with a control strategy that had no financial incentives, according to a workplace-based study.

Previous studies of workplace-based financial incentives to help people quit smoking have used small sample sizes and small payments, wrote Dr. Kevin G. Volpp of the University of Pennsylvania in Philadelphia, and colleagues.

The researchers randomized 442 adult smokers to receive information about smoking-cessation programs and 436 to receive information about smoking-cessation programs plus a financial incentive. The participants volunteered for the study after being identified through a survey about smoking habits. Those who used tobacco products other than cigarettes were excluded.

The financial incentive was $100 to complete a smoking-cessation program, plus $250 for confirmed cessation of smoking at 3 or 6 months after entering the study. In addition, participants received $400 for smoking cessation 6 months after the previous date of confirmed smoking cessation (9 months or 12 months). They were also assessed for smoking status (but were not paid) after another 6 months (15 or 18 months after study enrollment). The smoking-cessation program was not based at the workplace; instead, participants were advised to use existing programs in the community.

The study population included adults aged 18 years and older who reported smoking at least five cigarettes daily. Demographic traits were similar between the two groups. The participants were followed for at least 12 months, and the study's primary end point was smoking cessation 9 or 12 months after study enrollment.

Overall, the rate of confirmed smoking cessation (based on a cotinine test) at 9 months or 12 months was about 3 times greater in the financial incentive group, compared with the control group (15% vs. 5%). The smoking-cessation rate within 6 months of starting the study was significantly higher in the financial incentive group, compared with the control group (21% vs. 12%). And the cessation rate remained significantly higher in the financial incentive group, compared with the control group at 15 or 18 months (9% vs. 4%).

Significantly more individuals in the financial incentive group than in the control group enrolled in (15% vs. 5%) and completed (11% vs. 3%) a smoking-cessation education program. Those in the financial incentive group who took part in the smoking-cessation program had higher smoking-cessation rates, compared with controls who took part in the program (46% vs. 21%).

“Targeted payments for smoking cessation have the advantage of being unbundled from health insurance premiums and thus may be more salient to people, thereby having a greater influence on behavior,” the researchers said (N. Engl. J. Med. 2009;360:699–709).

The relapse rates between the 9- or 12-month follow-up and the 15- or 18-month follow-up were 36% in the financial incentive group and 27% in the control group. Although those results were higher than those found in other studies, the difference may be negligible compared with other studies, the researchers noted, because so few participants in the current study quit smoking.

The study was limited by its majority of white adults (90%) with high levels of income and education, the researchers noted. More research is needed to assess the effect of financial incentives on employees with lower socioeconomic status and on those of different ethnicities, they added.

The study was supported in part by grants from the Centers for Disease Control and Prevention and the Pennsylvania Department of Health. Dr. Volpp has received lecture fees from Aetna Inc. and grant support from Aetna and Pfizer Inc.

Payments are unbundled from health insurance premiums and thus may have a greater influence on behavior. DR. VOLPP

W eight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults.

Obesity is a risk factor for obstructive sleep apnea (OSA), but no randomized trials have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, they randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to lifestyle counseling.

The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

“Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variable, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

W eight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults.

Obesity is a risk factor for obstructive sleep apnea (OSA), but no randomized trials have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, they randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to lifestyle counseling.

The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

“Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variable, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

W eight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults.

Obesity is a risk factor for obstructive sleep apnea (OSA), but no randomized trials have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, they randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to lifestyle counseling.

The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

“Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variable, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

A program for healthy weight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults aged 18-65 years.

Obesity is a known risk factor for obstructive sleep apnea (OSA), but no randomized studies have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, the researchers randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to a program of routine lifestyle counseling. The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year follow-up, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

“Changes in AHI during the 12-month follow-up were strongly associated with changes in weight and waist circumference,” the researchers wrote. A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

In addition, the intervention was associated with improvements in other obesity-related cardiovascular disease risk factors.

During follow-up, two of four patients in the intervention group who were taking oral diabetes medications were able to discontinue the medications, while two of the controls started taking diabetes medications. In all, 5 of 18 intervention patients were able to discontinue their antihypertensive medications, compared with 2 of 15 patients in the control group. And 6 of 12 patients in the intervention group who were taking cholesterol medications were able to discontinue them, compared with 3 of 18 controls.

Patients in the intervention group also reported improvements in quality of life, with scores nearly twice as high as the controls at the 1-year follow-up point. Patients in the intervention group also reported greater improvement in symptoms of OSA, including snoring and daytime sleepiness, compared with controls.

Long-term lifestyle changes can improve OSA, the researchers said. “Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variables, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

A program for healthy weight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults aged 18-65 years.

Obesity is a known risk factor for obstructive sleep apnea (OSA), but no randomized studies have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, the researchers randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to a program of routine lifestyle counseling. The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year follow-up, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

“Changes in AHI during the 12-month follow-up were strongly associated with changes in weight and waist circumference,” the researchers wrote. A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

In addition, the intervention was associated with improvements in other obesity-related cardiovascular disease risk factors.

During follow-up, two of four patients in the intervention group who were taking oral diabetes medications were able to discontinue the medications, while two of the controls started taking diabetes medications. In all, 5 of 18 intervention patients were able to discontinue their antihypertensive medications, compared with 2 of 15 patients in the control group. And 6 of 12 patients in the intervention group who were taking cholesterol medications were able to discontinue them, compared with 3 of 18 controls.

Patients in the intervention group also reported improvements in quality of life, with scores nearly twice as high as the controls at the 1-year follow-up point. Patients in the intervention group also reported greater improvement in symptoms of OSA, including snoring and daytime sleepiness, compared with controls.

Long-term lifestyle changes can improve OSA, the researchers said. “Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variables, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

A program for healthy weight loss significantly improved mild obstructive sleep apnea, according to results of a study of overweight adults aged 18-65 years.

Obesity is a known risk factor for obstructive sleep apnea (OSA), but no randomized studies have addressed whether weight reduction improves the condition, noted Dr. Henri P.I. Tuomilehto of the University of Kuopio (Finland), and colleagues.

In the study, the researchers randomized 72 overweight adults with mild OSA to a program that included a very-low-calorie diet and supervised lifestyle modification, or to a program of routine lifestyle counseling. The intervention included instructions for a very-low-calorie diet and 14 visits with a nutritionist during a 1-year period (including face-to-face meetings and group sessions), as well as recommendations for increasing physical activity. No specific exercise program was included in the intervention.

Improvements in OSA were objectively measured using the apnea-hypopnea index (AHI), and subjectively measured using a quality of life scale and patient reports of symptom changes. All participants had a body mass index between 28 and 40 kg/m

At 1-year follow-up, the intervention group achieved significantly greater weight loss on average, compared with the controls (11 kg vs. 2 kg). The average total AHI in the intervention group was 6 events per hour, which was significantly less than the average of 9.6 events per hour in the control group (Am. J. Respir. Crit. Care Med. 2009;179:320-7).

“Changes in AHI during the 12-month follow-up were strongly associated with changes in weight and waist circumference,” the researchers wrote. A 5-kg weight loss from baseline body weight was associated with a 2.0-unit reduction in AHI, and a 5-cm reduction in waist circumference was associated with a 2.5-unit reduction in AHI.

In addition, the intervention was associated with improvements in other obesity-related cardiovascular disease risk factors.

During follow-up, two of four patients in the intervention group who were taking oral diabetes medications were able to discontinue the medications, while two of the controls started taking diabetes medications. In all, 5 of 18 intervention patients were able to discontinue their antihypertensive medications, compared with 2 of 15 patients in the control group. And 6 of 12 patients in the intervention group who were taking cholesterol medications were able to discontinue them, compared with 3 of 18 controls.

Patients in the intervention group also reported improvements in quality of life, with scores nearly twice as high as the controls at the 1-year follow-up point. Patients in the intervention group also reported greater improvement in symptoms of OSA, including snoring and daytime sleepiness, compared with controls.

Long-term lifestyle changes can improve OSA, the researchers said. “Significant improvements were also found in symptoms related to OSA, insulin resistance, lipids, and cardiorespiratory variables, such as arterial oxygen saturation, in patients belonging to the intervention group,” they wrote.

The researchers had no financial conflicts to disclose.

Long-term lipid abnormalities were significantly associated with higher albumin excretion in a study of 895 adolescents aged 10-16 years with type 1 diabetes.

Data on lipid levels and the possible association between lipids and albumin excretion in teens with type 1 diabetes are limited. But previous studies suggest that the relationship between these values can help clinicians predict the risk of diabetic neuropathy in these patients, wrote Dr. Maria Loredana Marcovecchio of the University of Cambridge (England) and her colleagues.

The researchers reviewed data from 490 boys and 405 girls, whose mean age at baseline was 14.5 years, with type 1 diabetes who were enrolled in an ongoing juvenile diabetes study in the United Kingdom. The data included three consecutive early morning urine samples to determine albumin-creatinine ratios, collected each year for an average of 2.3 years. Nonfasting blood samples were taken to assess lipids. They defined microalbuminuria (MA) as an albumin-creatinine ratio in the 3.5-35 mg/mmol range for boys and in the 4.0-40 mg/mmol range for girls in two of three consecutive urine samples at an annual collection (Diabetes Care 2009 [Epub ahead of print: http://care.diabetesjournals.org

During the follow-up period, 115 teens developed MA. The average concentrations of total cholesterol and non-HDL cholesterol were significantly higher in the teens with MA, compared with teens with normal albumin levels (4.7 mmol/L vs. 4.5 mmol/L and 3.2 mmol/L vs. 2.9 mmol/L, respectively).

Age-related changes in total cholesterol and non-HDL cholesterol in teens older than age 15 or 16 years were higher in the 28 teens with persistent MA compared with the 87 teens with transient MA and compared with teens without MA, the researchers noted. The average age of onset for MA was 15 years, which supports the link between lipids and MA, but the worse glycemic control in teens with MA could be a factor, they added.

During the follow-up period, an average of 19% of the teens had abnormal total cholesterol, 20% had abnormal triglycerides, 26% had abnormal HDL cholesterol, and 10% had abnormal LDL cholesterol. In addition, an average of 2.5% had low HDL cholesterol, 35% had borderline triglycerides, and 13% had borderline LDL cholesterol.

Overall, the association between average lipid levels and average hemoglobin A1c levels was significant (with the exception of HDL cholesterol). The associations were significantly stronger in girls compared with boys. Older age and longer duration of diabetes were significant predictors of all types of lipid abnormalities, and higher body mass index was significantly associated with all lipid abnormalities, except total cholesterol.

The researchers had no financial conflicts to disclose.

Long-term lipid abnormalities were significantly associated with higher albumin excretion in a study of 895 adolescents aged 10-16 years with type 1 diabetes.

Data on lipid levels and the possible association between lipids and albumin excretion in teens with type 1 diabetes are limited. But previous studies suggest that the relationship between these values can help clinicians predict the risk of diabetic neuropathy in these patients, wrote Dr. Maria Loredana Marcovecchio of the University of Cambridge (England) and her colleagues.

The researchers reviewed data from 490 boys and 405 girls, whose mean age at baseline was 14.5 years, with type 1 diabetes who were enrolled in an ongoing juvenile diabetes study in the United Kingdom. The data included three consecutive early morning urine samples to determine albumin-creatinine ratios, collected each year for an average of 2.3 years. Nonfasting blood samples were taken to assess lipids. They defined microalbuminuria (MA) as an albumin-creatinine ratio in the 3.5-35 mg/mmol range for boys and in the 4.0-40 mg/mmol range for girls in two of three consecutive urine samples at an annual collection (Diabetes Care 2009 [Epub ahead of print: http://care.diabetesjournals.org

During the follow-up period, 115 teens developed MA. The average concentrations of total cholesterol and non-HDL cholesterol were significantly higher in the teens with MA, compared with teens with normal albumin levels (4.7 mmol/L vs. 4.5 mmol/L and 3.2 mmol/L vs. 2.9 mmol/L, respectively).

Age-related changes in total cholesterol and non-HDL cholesterol in teens older than age 15 or 16 years were higher in the 28 teens with persistent MA compared with the 87 teens with transient MA and compared with teens without MA, the researchers noted. The average age of onset for MA was 15 years, which supports the link between lipids and MA, but the worse glycemic control in teens with MA could be a factor, they added.

During the follow-up period, an average of 19% of the teens had abnormal total cholesterol, 20% had abnormal triglycerides, 26% had abnormal HDL cholesterol, and 10% had abnormal LDL cholesterol. In addition, an average of 2.5% had low HDL cholesterol, 35% had borderline triglycerides, and 13% had borderline LDL cholesterol.

Overall, the association between average lipid levels and average hemoglobin A1c levels was significant (with the exception of HDL cholesterol). The associations were significantly stronger in girls compared with boys. Older age and longer duration of diabetes were significant predictors of all types of lipid abnormalities, and higher body mass index was significantly associated with all lipid abnormalities, except total cholesterol.

The researchers had no financial conflicts to disclose.

Long-term lipid abnormalities were significantly associated with higher albumin excretion in a study of 895 adolescents aged 10-16 years with type 1 diabetes.

Data on lipid levels and the possible association between lipids and albumin excretion in teens with type 1 diabetes are limited. But previous studies suggest that the relationship between these values can help clinicians predict the risk of diabetic neuropathy in these patients, wrote Dr. Maria Loredana Marcovecchio of the University of Cambridge (England) and her colleagues.

The researchers reviewed data from 490 boys and 405 girls, whose mean age at baseline was 14.5 years, with type 1 diabetes who were enrolled in an ongoing juvenile diabetes study in the United Kingdom. The data included three consecutive early morning urine samples to determine albumin-creatinine ratios, collected each year for an average of 2.3 years. Nonfasting blood samples were taken to assess lipids. They defined microalbuminuria (MA) as an albumin-creatinine ratio in the 3.5-35 mg/mmol range for boys and in the 4.0-40 mg/mmol range for girls in two of three consecutive urine samples at an annual collection (Diabetes Care 2009 [Epub ahead of print: http://care.diabetesjournals.org

During the follow-up period, 115 teens developed MA. The average concentrations of total cholesterol and non-HDL cholesterol were significantly higher in the teens with MA, compared with teens with normal albumin levels (4.7 mmol/L vs. 4.5 mmol/L and 3.2 mmol/L vs. 2.9 mmol/L, respectively).

Age-related changes in total cholesterol and non-HDL cholesterol in teens older than age 15 or 16 years were higher in the 28 teens with persistent MA compared with the 87 teens with transient MA and compared with teens without MA, the researchers noted. The average age of onset for MA was 15 years, which supports the link between lipids and MA, but the worse glycemic control in teens with MA could be a factor, they added.

During the follow-up period, an average of 19% of the teens had abnormal total cholesterol, 20% had abnormal triglycerides, 26% had abnormal HDL cholesterol, and 10% had abnormal LDL cholesterol. In addition, an average of 2.5% had low HDL cholesterol, 35% had borderline triglycerides, and 13% had borderline LDL cholesterol.

Overall, the association between average lipid levels and average hemoglobin A1c levels was significant (with the exception of HDL cholesterol). The associations were significantly stronger in girls compared with boys. Older age and longer duration of diabetes were significant predictors of all types of lipid abnormalities, and higher body mass index was significantly associated with all lipid abnormalities, except total cholesterol.

The researchers had no financial conflicts to disclose.

More than 40% of Americans aged at least 20 years have hyperglycemic conditions, according to review of the 2005-2006 National Health and Nutrition Examination Survey.

Catherine Cowie, Ph.D., of the National Institutes of Health, and her colleagues compared NHANES data from 1988-1994 to that of 2005-2006 (Diabetes Care 2009;32:287-94).

The total crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in those aged 20 and older. The total diabetes prevalence peaked at about 30% among those older than 60 years, and the prevalence of diabetes was about the same in men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests, was 30%. This rate was highest among those aged 75 and older, where it reached 47%.

The total prevalence of diabetes and prediabetes, diagnosed and undiagnosed, was significantly higher in men (48% vs. 34%) but this was due largely to the greater prevalence of prediabetes among men. The prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks vs. whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

A comparison of the 2005-2006 data with that of 1988-1994 showed a significant rise in the crude prevalence of diagnosed diabetes from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005-2006 portends all the consequences of diabetes, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, they noted.

The researchers had no financial conflicts to disclose.

More than 40% of Americans aged at least 20 years have hyperglycemic conditions, according to review of the 2005-2006 National Health and Nutrition Examination Survey.

Catherine Cowie, Ph.D., of the National Institutes of Health, and her colleagues compared NHANES data from 1988-1994 to that of 2005-2006 (Diabetes Care 2009;32:287-94).

The total crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in those aged 20 and older. The total diabetes prevalence peaked at about 30% among those older than 60 years, and the prevalence of diabetes was about the same in men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests, was 30%. This rate was highest among those aged 75 and older, where it reached 47%.

The total prevalence of diabetes and prediabetes, diagnosed and undiagnosed, was significantly higher in men (48% vs. 34%) but this was due largely to the greater prevalence of prediabetes among men. The prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks vs. whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

A comparison of the 2005-2006 data with that of 1988-1994 showed a significant rise in the crude prevalence of diagnosed diabetes from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005-2006 portends all the consequences of diabetes, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, they noted.

The researchers had no financial conflicts to disclose.

More than 40% of Americans aged at least 20 years have hyperglycemic conditions, according to review of the 2005-2006 National Health and Nutrition Examination Survey.

Catherine Cowie, Ph.D., of the National Institutes of Health, and her colleagues compared NHANES data from 1988-1994 to that of 2005-2006 (Diabetes Care 2009;32:287-94).

The total crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in those aged 20 and older. The total diabetes prevalence peaked at about 30% among those older than 60 years, and the prevalence of diabetes was about the same in men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests, was 30%. This rate was highest among those aged 75 and older, where it reached 47%.

The total prevalence of diabetes and prediabetes, diagnosed and undiagnosed, was significantly higher in men (48% vs. 34%) but this was due largely to the greater prevalence of prediabetes among men. The prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks vs. whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

A comparison of the 2005-2006 data with that of 1988-1994 showed a significant rise in the crude prevalence of diagnosed diabetes from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005-2006 portends all the consequences of diabetes, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, they noted.

The researchers had no financial conflicts to disclose.

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, research director of the McLennan County Medical Education and Research Foundation, Waco, Texas.

Previous studies of osteoporosis in women have focused mainly on white women because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded from the study.

About 50% of the study participants met the criteria for osteopenia and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine. Overall, the left femoral neck had the lowest regional BMD, with an average T score of −1.23. Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Dr. Weaver had no financial conflicts to disclose.

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, research director of the McLennan County Medical Education and Research Foundation, Waco, Texas.

Previous studies of osteoporosis in women have focused mainly on white women because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded from the study.

About 50% of the study participants met the criteria for osteopenia and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine. Overall, the left femoral neck had the lowest regional BMD, with an average T score of −1.23. Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Dr. Weaver had no financial conflicts to disclose.

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, research director of the McLennan County Medical Education and Research Foundation, Waco, Texas.

Previous studies of osteoporosis in women have focused mainly on white women because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded from the study.

About 50% of the study participants met the criteria for osteopenia and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine. Overall, the left femoral neck had the lowest regional BMD, with an average T score of −1.23. Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Dr. Weaver had no financial conflicts to disclose.

Persistent headaches occurred in nearly 98% of soldiers who suffered head trauma, blast exposure, or concussion while on duty in Iraq or Afghanistan, according to results of a survey of soldiers who returned from deployment between June and October 2008.

“Our goal was to try to determine the types, the duration, the frequency, and any occupational dysfunction caused by headaches in soldiers with a history of head trauma, concussion, or blasts,” Dr. Brett J. Theeler of the Madigan Army Medical Center in Tacoma, Wash., said in an interview.

Previous research has shown that about 15% of soldiers deployed to Iraq or Afghanistan experience mild traumatic brain injuries, but the prevalence and characteristics of the headaches associated with these injuries have not been well studied, he noted.

Dr. Theeler and his colleagues conducted a study based on a 13-item headache questionnaire. The study participants included 963 men and 15 women who returned from Iraq or Afghanistan within 3 months prior to enrolling in the study. The average age of the soldiers was 27 years.

The complete study results will be presented at the annual meeting of the American Academy of Neurology in April.

Overall, 351 of the 957 soldiers (37%) who reported headaches said that they started having headaches within a week of their injuries, and 20% reported that they started having headaches 1–4 weeks after their injuries.

Of those whose headaches began within 1 week of their injuries, 60% had headaches that met three or more criteria for migraines, and 40% said their headaches interfered with their normal activities. Of all of the soldiers who reported headaches, 30% said they had at least 15 days of headaches per month.

“We were very interested in the headache types,” Dr. Theeler said.

In an earlier study on headaches in soldiers, he and his colleagues found that more of these posttraumatic headaches had migraine features, compared with headaches in the general population (CLINICAL NEUROLOGY NEWS, Sept. 2006, p. 17). The current study had similar results.

“That doesn't mean that the head trauma or concussion is directly related to migraine, but we think head trauma is one of those important factors that lead these soldiers to have a higher frequency of migraines than people in the general population,” he said.

Identifying a specific type of headache might lead to a better diagnosis and possibly better treatments for the soldiers, Dr. Theeler said.

One of the take-home points for clinicians is that soldiers who have persistent migraine-type headaches might respond to migraine treatments, although the treatment of these soldiers has not been systematically studied, Dr. Theeler added.

Additional research is needed to determine the best acute medications and the best prophylactic treatments for soldiers who have headaches with migraine features after head trauma, and Dr. Theeler and his colleagues are currently conducting studies to address these issues.

Dr. Theeler said he had no financial conflicts to disclose.

Persistent headaches occurred in nearly 98% of soldiers who suffered head trauma, blast exposure, or concussion while on duty in Iraq or Afghanistan, according to results of a survey of soldiers who returned from deployment between June and October 2008.

“Our goal was to try to determine the types, the duration, the frequency, and any occupational dysfunction caused by headaches in soldiers with a history of head trauma, concussion, or blasts,” Dr. Brett J. Theeler of the Madigan Army Medical Center in Tacoma, Wash., said in an interview.

Previous research has shown that about 15% of soldiers deployed to Iraq or Afghanistan experience mild traumatic brain injuries, but the prevalence and characteristics of the headaches associated with these injuries have not been well studied, he noted.

Dr. Theeler and his colleagues conducted a study based on a 13-item headache questionnaire. The study participants included 963 men and 15 women who returned from Iraq or Afghanistan within 3 months prior to enrolling in the study. The average age of the soldiers was 27 years.

The complete study results will be presented at the annual meeting of the American Academy of Neurology in April.

Overall, 351 of the 957 soldiers (37%) who reported headaches said that they started having headaches within a week of their injuries, and 20% reported that they started having headaches 1–4 weeks after their injuries.

Of those whose headaches began within 1 week of their injuries, 60% had headaches that met three or more criteria for migraines, and 40% said their headaches interfered with their normal activities. Of all of the soldiers who reported headaches, 30% said they had at least 15 days of headaches per month.

“We were very interested in the headache types,” Dr. Theeler said.

In an earlier study on headaches in soldiers, he and his colleagues found that more of these posttraumatic headaches had migraine features, compared with headaches in the general population (CLINICAL NEUROLOGY NEWS, Sept. 2006, p. 17). The current study had similar results.

“That doesn't mean that the head trauma or concussion is directly related to migraine, but we think head trauma is one of those important factors that lead these soldiers to have a higher frequency of migraines than people in the general population,” he said.

Identifying a specific type of headache might lead to a better diagnosis and possibly better treatments for the soldiers, Dr. Theeler said.

One of the take-home points for clinicians is that soldiers who have persistent migraine-type headaches might respond to migraine treatments, although the treatment of these soldiers has not been systematically studied, Dr. Theeler added.

Additional research is needed to determine the best acute medications and the best prophylactic treatments for soldiers who have headaches with migraine features after head trauma, and Dr. Theeler and his colleagues are currently conducting studies to address these issues.

Dr. Theeler said he had no financial conflicts to disclose.

Persistent headaches occurred in nearly 98% of soldiers who suffered head trauma, blast exposure, or concussion while on duty in Iraq or Afghanistan, according to results of a survey of soldiers who returned from deployment between June and October 2008.

“Our goal was to try to determine the types, the duration, the frequency, and any occupational dysfunction caused by headaches in soldiers with a history of head trauma, concussion, or blasts,” Dr. Brett J. Theeler of the Madigan Army Medical Center in Tacoma, Wash., said in an interview.

Previous research has shown that about 15% of soldiers deployed to Iraq or Afghanistan experience mild traumatic brain injuries, but the prevalence and characteristics of the headaches associated with these injuries have not been well studied, he noted.

Dr. Theeler and his colleagues conducted a study based on a 13-item headache questionnaire. The study participants included 963 men and 15 women who returned from Iraq or Afghanistan within 3 months prior to enrolling in the study. The average age of the soldiers was 27 years.

The complete study results will be presented at the annual meeting of the American Academy of Neurology in April.

Overall, 351 of the 957 soldiers (37%) who reported headaches said that they started having headaches within a week of their injuries, and 20% reported that they started having headaches 1–4 weeks after their injuries.

Of those whose headaches began within 1 week of their injuries, 60% had headaches that met three or more criteria for migraines, and 40% said their headaches interfered with their normal activities. Of all of the soldiers who reported headaches, 30% said they had at least 15 days of headaches per month.

“We were very interested in the headache types,” Dr. Theeler said.

In an earlier study on headaches in soldiers, he and his colleagues found that more of these posttraumatic headaches had migraine features, compared with headaches in the general population (CLINICAL NEUROLOGY NEWS, Sept. 2006, p. 17). The current study had similar results.

“That doesn't mean that the head trauma or concussion is directly related to migraine, but we think head trauma is one of those important factors that lead these soldiers to have a higher frequency of migraines than people in the general population,” he said.

Identifying a specific type of headache might lead to a better diagnosis and possibly better treatments for the soldiers, Dr. Theeler said.

One of the take-home points for clinicians is that soldiers who have persistent migraine-type headaches might respond to migraine treatments, although the treatment of these soldiers has not been systematically studied, Dr. Theeler added.

Additional research is needed to determine the best acute medications and the best prophylactic treatments for soldiers who have headaches with migraine features after head trauma, and Dr. Theeler and his colleagues are currently conducting studies to address these issues.

Dr. Theeler said he had no financial conflicts to disclose.

Endurance athletes with left ventricular hypertrophy had deformation values within normal limits, based on echocardiographic findings from 182 adults who participated in a study.

Because hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death in athletes, it's important to distinguish between HCM and left ventricular hypertrophy (LVH), the changes in heart cavity size and wall thickness that often occur in endurance athletes, according to Dr. Arco J. Teske of the University Medical Center in Utrecht, the Netherlands.

Dr. Teske and colleagues compared imaging data from 120 athletes and 62 nonathletic controls aged 18–40 years who had a normal electrocardiogram and no history of cardiovascular disease, diabetes, or hypertension. The study population included 57 amateur athletes who trained at least 9 hours but not more than 18 hours each week, 63 Olympic-level athletes who trained more than 18 hours each week, and 62 healthy controls who exercised less than 3 hours each week. Overall, 62% of the athletes and 58% of the controls were men.

The athletes participated in endurance sports including rowing, triathlons, cycling, and running. The study did not include individuals with HCM or hypertension-induced LVH (doi:10.1136/bjsm.2008.054346).

The researchers performed a standard echocardiographic exam and measured left ventricular dimensions, and they identified LVH in 33 athletes (28%). LVH was defined as an LV mass greater than 132 g/m

Tissue Doppler imaging showed no differences in strain or strain-rate values among athletes with LVH, compared with controls and athletes who did not have LVH. In a regional deformation analysis, a barely significant correlation appeared between anteroseptal wall thickness and both strain and strain-rate in athletes with LVH, which suggested a slight reduction in septal longitudinal function when the septal wall was thicker. But the correlations remained similar to those of the entire study group, and no significant correlations appeared between posterior wall thickness and regional deformation values.

Previous studies have identified cutoff values of −10.6% for peak systolic strain and a septal/posterior ratio greater than 1.3 as signs of HCM, and none of the patients in this study met those criteria, despite the gradual reduction associated with the increased wall thickness, the researchers noted.

These findings indicate that a moderate reduction in regional septal deformation shouldn't be considered problematic in an endurance athlete with “echocardiographic LVH of unknown origin,” they concluded.

Dr. Teske and his colleagues had no financial conflicts to report.

Endurance athletes with left ventricular hypertrophy had deformation values within normal limits, based on echocardiographic findings from 182 adults who participated in a study.

Because hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death in athletes, it's important to distinguish between HCM and left ventricular hypertrophy (LVH), the changes in heart cavity size and wall thickness that often occur in endurance athletes, according to Dr. Arco J. Teske of the University Medical Center in Utrecht, the Netherlands.

Dr. Teske and colleagues compared imaging data from 120 athletes and 62 nonathletic controls aged 18–40 years who had a normal electrocardiogram and no history of cardiovascular disease, diabetes, or hypertension. The study population included 57 amateur athletes who trained at least 9 hours but not more than 18 hours each week, 63 Olympic-level athletes who trained more than 18 hours each week, and 62 healthy controls who exercised less than 3 hours each week. Overall, 62% of the athletes and 58% of the controls were men.

The athletes participated in endurance sports including rowing, triathlons, cycling, and running. The study did not include individuals with HCM or hypertension-induced LVH (doi:10.1136/bjsm.2008.054346).

The researchers performed a standard echocardiographic exam and measured left ventricular dimensions, and they identified LVH in 33 athletes (28%). LVH was defined as an LV mass greater than 132 g/m

Tissue Doppler imaging showed no differences in strain or strain-rate values among athletes with LVH, compared with controls and athletes who did not have LVH. In a regional deformation analysis, a barely significant correlation appeared between anteroseptal wall thickness and both strain and strain-rate in athletes with LVH, which suggested a slight reduction in septal longitudinal function when the septal wall was thicker. But the correlations remained similar to those of the entire study group, and no significant correlations appeared between posterior wall thickness and regional deformation values.

Previous studies have identified cutoff values of −10.6% for peak systolic strain and a septal/posterior ratio greater than 1.3 as signs of HCM, and none of the patients in this study met those criteria, despite the gradual reduction associated with the increased wall thickness, the researchers noted.

These findings indicate that a moderate reduction in regional septal deformation shouldn't be considered problematic in an endurance athlete with “echocardiographic LVH of unknown origin,” they concluded.

Dr. Teske and his colleagues had no financial conflicts to report.

Endurance athletes with left ventricular hypertrophy had deformation values within normal limits, based on echocardiographic findings from 182 adults who participated in a study.

Because hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death in athletes, it's important to distinguish between HCM and left ventricular hypertrophy (LVH), the changes in heart cavity size and wall thickness that often occur in endurance athletes, according to Dr. Arco J. Teske of the University Medical Center in Utrecht, the Netherlands.

Dr. Teske and colleagues compared imaging data from 120 athletes and 62 nonathletic controls aged 18–40 years who had a normal electrocardiogram and no history of cardiovascular disease, diabetes, or hypertension. The study population included 57 amateur athletes who trained at least 9 hours but not more than 18 hours each week, 63 Olympic-level athletes who trained more than 18 hours each week, and 62 healthy controls who exercised less than 3 hours each week. Overall, 62% of the athletes and 58% of the controls were men.

The athletes participated in endurance sports including rowing, triathlons, cycling, and running. The study did not include individuals with HCM or hypertension-induced LVH (doi:10.1136/bjsm.2008.054346).

The researchers performed a standard echocardiographic exam and measured left ventricular dimensions, and they identified LVH in 33 athletes (28%). LVH was defined as an LV mass greater than 132 g/m

Tissue Doppler imaging showed no differences in strain or strain-rate values among athletes with LVH, compared with controls and athletes who did not have LVH. In a regional deformation analysis, a barely significant correlation appeared between anteroseptal wall thickness and both strain and strain-rate in athletes with LVH, which suggested a slight reduction in septal longitudinal function when the septal wall was thicker. But the correlations remained similar to those of the entire study group, and no significant correlations appeared between posterior wall thickness and regional deformation values.

Previous studies have identified cutoff values of −10.6% for peak systolic strain and a septal/posterior ratio greater than 1.3 as signs of HCM, and none of the patients in this study met those criteria, despite the gradual reduction associated with the increased wall thickness, the researchers noted.

These findings indicate that a moderate reduction in regional septal deformation shouldn't be considered problematic in an endurance athlete with “echocardiographic LVH of unknown origin,” they concluded.

Dr. Teske and his colleagues had no financial conflicts to report.

RIO GRANDE, P.R. — Injury rates among recreational runners were significantly reduced after they adopted a running technique called ChiRunning, according to results of a survey of 2,500 runners.

Previous research has suggested that injuries among runners increase with age, but such injuries may be prevented with some simple modifications to running technique that can be self-taught from a book, Dr. Mark Cucuzzella of West Virginia University, Morgantown, said in an interview.

ChiRunning, described in a book of the same name by Danny Dreyer (New York: Fireside, 2004), involves leaning forward while running so that the midfoot, rather than the heel, strikes the ground.

Dr. Cucuzzella and his colleagues, including Mr. Dreyer, conducted an online survey of adult runners who had bought the ChiRunning book or had subscribed to the ChiRunning e-mail newsletter. The survey, conducted online over a 2-month period in the fall of 2007, is the first study to evaluate the impact of changing running technique on injury rates in moderate and recreational runners, said Dr. Cucuzzella, a family physician and experienced runner who has dealt with his share of injuries.

A total of 71% of the runners said that they were able to teach themselves the technique from the book; others learned it from clinics or other resources. Most (80%) of the respondents indicated that they ran fewer then 30 miles per week, and more than 70% were older than 40 years. Approximately 55% of the respondents were men, 45% were women, and about 50% overall had been injured before trying the technique.

More than 90% of the respondents said that they were able to change their running mechanics, and 60% of these reported improvements within a month. Just over half of the respondents said that they had tried ChiRunning to recover from an injury, and 88% of these runners believed that the technique “probably” or “definitely” aided their recovery.

Some individuals reported that they were able to avoid surgery, said Dr. Cucuzzella who presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, injury rates were significantly lower in the 6 months after learning the ChiRunning technique, compared with baseline rates. The number of respondents who reported missing more than 20 days of running because of injury dropped from 25% to 6%, and the number who reported missing 10–20 days of running because of injury dropped from 15% to 5%. More than 90% of the respondents said they thought that the ChiRunning technique had played a role in preventing injuries, and more than 90% of the respondents said that they would recommend ChiRunning to others.

The clinical implications are that physicians can introduce patients, especially those with nagging sports injuries, to an intervention that has been shown to reduce injury rates and keep people active.

Dr. Cucuzzella plans to conduct a prospective study to follow and compare injury rates in runners who have used the ChiRunning technique with control patients who have not.

Dr. Cucuzzella had no financial conflicts to disclose.

Watch related video at www.youtube.com/FamilyPracticeNews

When ChiRunning (left), the ankles, pelvis, and shoulders are in alignment, which is reported to increase efficiency and reduce the risk of injury. Lori Cheung

RIO GRANDE, P.R. — Injury rates among recreational runners were significantly reduced after they adopted a running technique called ChiRunning, according to results of a survey of 2,500 runners.

Previous research has suggested that injuries among runners increase with age, but such injuries may be prevented with some simple modifications to running technique that can be self-taught from a book, Dr. Mark Cucuzzella of West Virginia University, Morgantown, said in an interview.

ChiRunning, described in a book of the same name by Danny Dreyer (New York: Fireside, 2004), involves leaning forward while running so that the midfoot, rather than the heel, strikes the ground.

Dr. Cucuzzella and his colleagues, including Mr. Dreyer, conducted an online survey of adult runners who had bought the ChiRunning book or had subscribed to the ChiRunning e-mail newsletter. The survey, conducted online over a 2-month period in the fall of 2007, is the first study to evaluate the impact of changing running technique on injury rates in moderate and recreational runners, said Dr. Cucuzzella, a family physician and experienced runner who has dealt with his share of injuries.

A total of 71% of the runners said that they were able to teach themselves the technique from the book; others learned it from clinics or other resources. Most (80%) of the respondents indicated that they ran fewer then 30 miles per week, and more than 70% were older than 40 years. Approximately 55% of the respondents were men, 45% were women, and about 50% overall had been injured before trying the technique.

More than 90% of the respondents said that they were able to change their running mechanics, and 60% of these reported improvements within a month. Just over half of the respondents said that they had tried ChiRunning to recover from an injury, and 88% of these runners believed that the technique “probably” or “definitely” aided their recovery.

Some individuals reported that they were able to avoid surgery, said Dr. Cucuzzella who presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, injury rates were significantly lower in the 6 months after learning the ChiRunning technique, compared with baseline rates. The number of respondents who reported missing more than 20 days of running because of injury dropped from 25% to 6%, and the number who reported missing 10–20 days of running because of injury dropped from 15% to 5%. More than 90% of the respondents said they thought that the ChiRunning technique had played a role in preventing injuries, and more than 90% of the respondents said that they would recommend ChiRunning to others.

The clinical implications are that physicians can introduce patients, especially those with nagging sports injuries, to an intervention that has been shown to reduce injury rates and keep people active.

Dr. Cucuzzella plans to conduct a prospective study to follow and compare injury rates in runners who have used the ChiRunning technique with control patients who have not.

Dr. Cucuzzella had no financial conflicts to disclose.

Watch related video at www.youtube.com/FamilyPracticeNews

When ChiRunning (left), the ankles, pelvis, and shoulders are in alignment, which is reported to increase efficiency and reduce the risk of injury. Lori Cheung

RIO GRANDE, P.R. — Injury rates among recreational runners were significantly reduced after they adopted a running technique called ChiRunning, according to results of a survey of 2,500 runners.

Previous research has suggested that injuries among runners increase with age, but such injuries may be prevented with some simple modifications to running technique that can be self-taught from a book, Dr. Mark Cucuzzella of West Virginia University, Morgantown, said in an interview.

ChiRunning, described in a book of the same name by Danny Dreyer (New York: Fireside, 2004), involves leaning forward while running so that the midfoot, rather than the heel, strikes the ground.

Dr. Cucuzzella and his colleagues, including Mr. Dreyer, conducted an online survey of adult runners who had bought the ChiRunning book or had subscribed to the ChiRunning e-mail newsletter. The survey, conducted online over a 2-month period in the fall of 2007, is the first study to evaluate the impact of changing running technique on injury rates in moderate and recreational runners, said Dr. Cucuzzella, a family physician and experienced runner who has dealt with his share of injuries.

A total of 71% of the runners said that they were able to teach themselves the technique from the book; others learned it from clinics or other resources. Most (80%) of the respondents indicated that they ran fewer then 30 miles per week, and more than 70% were older than 40 years. Approximately 55% of the respondents were men, 45% were women, and about 50% overall had been injured before trying the technique.

More than 90% of the respondents said that they were able to change their running mechanics, and 60% of these reported improvements within a month. Just over half of the respondents said that they had tried ChiRunning to recover from an injury, and 88% of these runners believed that the technique “probably” or “definitely” aided their recovery.

Some individuals reported that they were able to avoid surgery, said Dr. Cucuzzella who presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, injury rates were significantly lower in the 6 months after learning the ChiRunning technique, compared with baseline rates. The number of respondents who reported missing more than 20 days of running because of injury dropped from 25% to 6%, and the number who reported missing 10–20 days of running because of injury dropped from 15% to 5%. More than 90% of the respondents said they thought that the ChiRunning technique had played a role in preventing injuries, and more than 90% of the respondents said that they would recommend ChiRunning to others.

The clinical implications are that physicians can introduce patients, especially those with nagging sports injuries, to an intervention that has been shown to reduce injury rates and keep people active.

Dr. Cucuzzella plans to conduct a prospective study to follow and compare injury rates in runners who have used the ChiRunning technique with control patients who have not.

Dr. Cucuzzella had no financial conflicts to disclose.

Watch related video at www.youtube.com/FamilyPracticeNews

When ChiRunning (left), the ankles, pelvis, and shoulders are in alignment, which is reported to increase efficiency and reduce the risk of injury. Lori Cheung

More than 40% of American adults aged 20 years and older have hyperglycemic conditions, according to review of data from the 2005–2006 National Health and Nutrition Examination Survey.

In this study, Catherine Cowie, Ph.D., of the National Institutes of Health and her colleagues compared NHANES data for 1988–1994 with data for 2005–2006 (Diabetes Care 2009;32:287–94).

The crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in individuals aged 20 years and older. The total diabetes prevalence peaked at about 30% among all age groups older than 60 years, and the prevalence of diabetes was approximately the same in both men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests was 30%, and this prevalence was highest among individuals aged 75 years and older, where it reached 47%.

The prevalence of diabetes and prediabetes, both diagnosed and undiagnosed, was significantly higher in men, compared with women (48% vs. 34%) but most of this difference was because of the greater prevalence of prediabetes among men. And the prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks, compared with whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

When the researchers compared the 2005–2006 data with the data for 1988–1994, they found that the crude prevalence of diagnosed diabetes rose significantly, from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005–2006 portends all the consequences of diabetes,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, the investigators reported.

But the findings illustrate the chronic problem of diabetes and prediabetes in the United States and support the need for lifestyle modification for individuals with diabetes or prediabetes, said the researchers, who had no financial conflicts to disclose.

More than 40% of American adults aged 20 years and older have hyperglycemic conditions, according to review of data from the 2005–2006 National Health and Nutrition Examination Survey.

In this study, Catherine Cowie, Ph.D., of the National Institutes of Health and her colleagues compared NHANES data for 1988–1994 with data for 2005–2006 (Diabetes Care 2009;32:287–94).

The crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in individuals aged 20 years and older. The total diabetes prevalence peaked at about 30% among all age groups older than 60 years, and the prevalence of diabetes was approximately the same in both men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests was 30%, and this prevalence was highest among individuals aged 75 years and older, where it reached 47%.

The prevalence of diabetes and prediabetes, both diagnosed and undiagnosed, was significantly higher in men, compared with women (48% vs. 34%) but most of this difference was because of the greater prevalence of prediabetes among men. And the prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks, compared with whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

When the researchers compared the 2005–2006 data with the data for 1988–1994, they found that the crude prevalence of diagnosed diabetes rose significantly, from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005–2006 portends all the consequences of diabetes,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, the investigators reported.

But the findings illustrate the chronic problem of diabetes and prediabetes in the United States and support the need for lifestyle modification for individuals with diabetes or prediabetes, said the researchers, who had no financial conflicts to disclose.

More than 40% of American adults aged 20 years and older have hyperglycemic conditions, according to review of data from the 2005–2006 National Health and Nutrition Examination Survey.

In this study, Catherine Cowie, Ph.D., of the National Institutes of Health and her colleagues compared NHANES data for 1988–1994 with data for 2005–2006 (Diabetes Care 2009;32:287–94).

The crude prevalence of diabetes, including diagnosed and undiagnosed cases based on fasting plasma glucose or 2-hour glucose tests, was 13% in individuals aged 20 years and older. The total diabetes prevalence peaked at about 30% among all age groups older than 60 years, and the prevalence of diabetes was approximately the same in both men and women.

After the researchers controlled for age and sex, the total diabetes prevalence was 70% higher in non-Hispanic blacks and 80% higher in Mexican Americans, compared with non-Hispanic whites.

The total crude prevalence of prediabetes, including both diagnosed and undiagnosed cases based on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) tests was 30%, and this prevalence was highest among individuals aged 75 years and older, where it reached 47%.

The prevalence of diabetes and prediabetes, both diagnosed and undiagnosed, was significantly higher in men, compared with women (48% vs. 34%) but most of this difference was because of the greater prevalence of prediabetes among men. And the prevalence of any hyperglycemic condition was significantly higher in non-Hispanic blacks, compared with whites (44% vs. 39%) and in Mexican Americans vs. non-Hispanic whites (52% vs. 39%).

When the researchers compared the 2005–2006 data with the data for 1988–1994, they found that the crude prevalence of diagnosed diabetes rose significantly, from 5% to 8%.

“The sheer magnitude of prevalence of hyperglycemic conditions found in 2005–2006 portends all the consequences of diabetes,” the researchers wrote.

The results were limited by the use of a single plasma glucose reading for some cases of undiagnosed diabetes and prediabetes, the investigators reported.

But the findings illustrate the chronic problem of diabetes and prediabetes in the United States and support the need for lifestyle modification for individuals with diabetes or prediabetes, said the researchers, who had no financial conflicts to disclose.