Heidi Splete

Knees with joint space narrowing lost more cartilage over a year than did knees without joint space narrowing, based on imaging results from a study of 80 adults with knee osteoarthritis.

Previous research has shown that radiography can identify structural osteoarthritis changes in the knee. But whether knees with joint space narrowing (JSN) lose more cartilage than those without JSN over the long term remains unclear.

To evaluate the impact of JSN on cartilage loss, Dr. Felix Eckstein of Paracelsus Medical University in Salzburg, Austria, and colleagues reviewed imaging data from 32 men and 48 women with pain in both knees, medial JSN in one knee, and no (or less) JSN in the other knee (the “less-affected knee”). The patients were selected from the Osteoarthritis Initiative cohort; their average age was 61 years, and their average body mass index was 31 kg/m

The results of the study were presented in September at OARSI's 2008 World Congress on Osteoarthritis in Rome.

Overall, the less-affected knees (with little or no JSN) showed little progression. In the medial tibia, there was little change for knees with no JSN (-1.0%) and a −3.9% change in the less-affected knees with JSN grade 1.

The average change in the tibia in the more-affected knees was −1.6% for the knees with a JSN grade of 1, −2.9% for the knees with a JSN grade of 2, and −6.9% for the knees with a JSN of 3.

When the medial femoral condyle measurements were separated into two parts—weight bearing and posterior—the rate of cartilage loss was greater in the weight bearing than in the posterior part; the tibia increased significantly with worse grades of JSN in the more severely affected knee. The standardized response mean (a measure of change) was significantly greater for JSN grades 3 and 2, compared with 1 for the weight-bearing femoral condyles.

Dr. Eckstein said that he was surprised by the results. “It was thought that subjects with no JSN or small grades of JSN have 'more' cartilage to lose than those at later stages, and would thus progress more rapidly,” he said in an interview. “However, the results showed that the more JSN is present, the faster the cartilage loss occurs.”

The take-home message for physicians is that the cartilage loss is very small in osteoarthritic knees without JSN. “When JSN starts, a vicious cycle of increasing cartilage loss is initiated,” Dr. Eckstein said. The results also suggest that MRI-based measures of cartilage morphometry are particularly responsive at the later disease stages.

The findings should be confirmed in larger cohort studies, which will be possible in the future because the National Institutes of Health-sponsored Osteoarthritis Initiative has recruited almost 5,000 patients, Dr. Eckstein noted.

Dr. Eckstein is co-owner and CEO of Chondrometrics GmbH, a company that provides MR imaging analysis to the pharmaceutical industry and to other researchers.

He also provides consulting services to Merck Serono, Novo Nordisk, Wyeth, and Pfizer Inc., and has received funding from Eli Lilly & Co., Merck Serono, GlaxoSmithKline, Wyeth, and Pfizer.

The image analysis in this study was sponsored by Eli Lilly & Co., and the image acquisition was sponsored by the Osteoarthritis Initiative.

MRI shows full-thickness lesion in cartilage of the medial femoral condyle (yellow). Courtesy Dr. Felix Eckstein

Knees with joint space narrowing lost more cartilage over a year than did knees without joint space narrowing, based on imaging results from a study of 80 adults with knee osteoarthritis.

Previous research has shown that radiography can identify structural osteoarthritis changes in the knee. But whether knees with joint space narrowing (JSN) lose more cartilage than those without JSN over the long term remains unclear.

To evaluate the impact of JSN on cartilage loss, Dr. Felix Eckstein of Paracelsus Medical University in Salzburg, Austria, and colleagues reviewed imaging data from 32 men and 48 women with pain in both knees, medial JSN in one knee, and no (or less) JSN in the other knee (the “less-affected knee”). The patients were selected from the Osteoarthritis Initiative cohort; their average age was 61 years, and their average body mass index was 31 kg/m

The results of the study were presented in September at OARSI's 2008 World Congress on Osteoarthritis in Rome.

Overall, the less-affected knees (with little or no JSN) showed little progression. In the medial tibia, there was little change for knees with no JSN (-1.0%) and a −3.9% change in the less-affected knees with JSN grade 1.

The average change in the tibia in the more-affected knees was −1.6% for the knees with a JSN grade of 1, −2.9% for the knees with a JSN grade of 2, and −6.9% for the knees with a JSN of 3.

When the medial femoral condyle measurements were separated into two parts—weight bearing and posterior—the rate of cartilage loss was greater in the weight bearing than in the posterior part; the tibia increased significantly with worse grades of JSN in the more severely affected knee. The standardized response mean (a measure of change) was significantly greater for JSN grades 3 and 2, compared with 1 for the weight-bearing femoral condyles.

Dr. Eckstein said that he was surprised by the results. “It was thought that subjects with no JSN or small grades of JSN have 'more' cartilage to lose than those at later stages, and would thus progress more rapidly,” he said in an interview. “However, the results showed that the more JSN is present, the faster the cartilage loss occurs.”

The take-home message for physicians is that the cartilage loss is very small in osteoarthritic knees without JSN. “When JSN starts, a vicious cycle of increasing cartilage loss is initiated,” Dr. Eckstein said. The results also suggest that MRI-based measures of cartilage morphometry are particularly responsive at the later disease stages.

The findings should be confirmed in larger cohort studies, which will be possible in the future because the National Institutes of Health-sponsored Osteoarthritis Initiative has recruited almost 5,000 patients, Dr. Eckstein noted.

Dr. Eckstein is co-owner and CEO of Chondrometrics GmbH, a company that provides MR imaging analysis to the pharmaceutical industry and to other researchers.

He also provides consulting services to Merck Serono, Novo Nordisk, Wyeth, and Pfizer Inc., and has received funding from Eli Lilly & Co., Merck Serono, GlaxoSmithKline, Wyeth, and Pfizer.

The image analysis in this study was sponsored by Eli Lilly & Co., and the image acquisition was sponsored by the Osteoarthritis Initiative.

MRI shows full-thickness lesion in cartilage of the medial femoral condyle (yellow). Courtesy Dr. Felix Eckstein

Knees with joint space narrowing lost more cartilage over a year than did knees without joint space narrowing, based on imaging results from a study of 80 adults with knee osteoarthritis.

Previous research has shown that radiography can identify structural osteoarthritis changes in the knee. But whether knees with joint space narrowing (JSN) lose more cartilage than those without JSN over the long term remains unclear.

To evaluate the impact of JSN on cartilage loss, Dr. Felix Eckstein of Paracelsus Medical University in Salzburg, Austria, and colleagues reviewed imaging data from 32 men and 48 women with pain in both knees, medial JSN in one knee, and no (or less) JSN in the other knee (the “less-affected knee”). The patients were selected from the Osteoarthritis Initiative cohort; their average age was 61 years, and their average body mass index was 31 kg/m

The results of the study were presented in September at OARSI's 2008 World Congress on Osteoarthritis in Rome.

Overall, the less-affected knees (with little or no JSN) showed little progression. In the medial tibia, there was little change for knees with no JSN (-1.0%) and a −3.9% change in the less-affected knees with JSN grade 1.

The average change in the tibia in the more-affected knees was −1.6% for the knees with a JSN grade of 1, −2.9% for the knees with a JSN grade of 2, and −6.9% for the knees with a JSN of 3.

When the medial femoral condyle measurements were separated into two parts—weight bearing and posterior—the rate of cartilage loss was greater in the weight bearing than in the posterior part; the tibia increased significantly with worse grades of JSN in the more severely affected knee. The standardized response mean (a measure of change) was significantly greater for JSN grades 3 and 2, compared with 1 for the weight-bearing femoral condyles.

Dr. Eckstein said that he was surprised by the results. “It was thought that subjects with no JSN or small grades of JSN have 'more' cartilage to lose than those at later stages, and would thus progress more rapidly,” he said in an interview. “However, the results showed that the more JSN is present, the faster the cartilage loss occurs.”

The take-home message for physicians is that the cartilage loss is very small in osteoarthritic knees without JSN. “When JSN starts, a vicious cycle of increasing cartilage loss is initiated,” Dr. Eckstein said. The results also suggest that MRI-based measures of cartilage morphometry are particularly responsive at the later disease stages.

The findings should be confirmed in larger cohort studies, which will be possible in the future because the National Institutes of Health-sponsored Osteoarthritis Initiative has recruited almost 5,000 patients, Dr. Eckstein noted.

Dr. Eckstein is co-owner and CEO of Chondrometrics GmbH, a company that provides MR imaging analysis to the pharmaceutical industry and to other researchers.

He also provides consulting services to Merck Serono, Novo Nordisk, Wyeth, and Pfizer Inc., and has received funding from Eli Lilly & Co., Merck Serono, GlaxoSmithKline, Wyeth, and Pfizer.

The image analysis in this study was sponsored by Eli Lilly & Co., and the image acquisition was sponsored by the Osteoarthritis Initiative.

MRI shows full-thickness lesion in cartilage of the medial femoral condyle (yellow). Courtesy Dr. Felix Eckstein

RIO GRANDE, P.R. — Primary care physicians don't appear to treat depression any more aggressively in patients who have medical comorbidities, compared with other patients, despite mounting evidence showing that depression may lead to worse medical outcomes.

The conclusions were based on a database review of more than 20,000 adult records. “There is good evidence that the rate of depression is higher in persons with certain medical comorbidities,” Dr. James Gill said at the annual meeting of the North American Primary Care Research Group. “You could make the argument that persons with depression should be treated more aggressively if they have comorbid conditions,” he added.

In a previous study, Dr. Gill, president of Delaware Valley Outcomes Research LLC, reviewed a large database of patients treated by a range of medical specialists and found no significant differences among the specialists in terms of their use of antidepressant medications to treat depressed patients with and without medical comorbidities (Int. J. Psychiatry 2008;38:203-15).

In order to focus on primary care physicians specifically, Dr. Gill conducted a secondary analysis of 209 family medicine and general internal medicine physicians and 24,876 of their patients, aged 18 years and older, who had diagnoses of depression.

The study population included 1,849 patients with incident depression diagnosed during the 1-year period from October 2006 through October 2007. Study participants had at least one office visit during the year and an active diagnosis of depression as of the end of the year. Data were collected from electronic medical records via the Medical Quality Improvement Consortium.

Approximately 75% of the patients were on any type of antidepressant medication at the study's end. A total of 92% were taking at least the minimum dosage of their prescribed medications, and almost half (49%) were taking the full dosage.

In addition, about one-quarter of the patients in the study had at least one of the six medical comorbidities included in the review: coronary heart disease, heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, cancer, and diabetes. The most common comorbidity was diabetes, affecting 13%.

After the researchers controlled for age, gender, and additional comorbidities, none of the six comorbidities were a significant predictor of any antidepressant medication use or of the dosage. Nor did the researchers find any significant differences in medication use by comorbidity in a subanalysis for the patients with incident depression during the observation year.

Patients with comorbid conditions were slightly more likely to be taking the maximum dosage of an antidepressant, and patients with medical comorbidities in the incident group were slightly less likely to be on medications, Dr. Gill noted.

“It does not look like primary care providers treat depression more aggressively in people with comorbidities,” he said. Possible reasons include concerns about medication side effects and the cost of additional medications. The study was limited by a lack of information about the severity of the patients' depression, Dr. Gill said.

But the question remains as to whether treating depression more aggressively can improve the comorbidities, he added, and more research is needed to explore this topic.

Dr. Gill had no financial conflicts to disclose.

RIO GRANDE, P.R. — Primary care physicians don't appear to treat depression any more aggressively in patients who have medical comorbidities, compared with other patients, despite mounting evidence showing that depression may lead to worse medical outcomes.

The conclusions were based on a database review of more than 20,000 adult records. “There is good evidence that the rate of depression is higher in persons with certain medical comorbidities,” Dr. James Gill said at the annual meeting of the North American Primary Care Research Group. “You could make the argument that persons with depression should be treated more aggressively if they have comorbid conditions,” he added.

In a previous study, Dr. Gill, president of Delaware Valley Outcomes Research LLC, reviewed a large database of patients treated by a range of medical specialists and found no significant differences among the specialists in terms of their use of antidepressant medications to treat depressed patients with and without medical comorbidities (Int. J. Psychiatry 2008;38:203-15).

In order to focus on primary care physicians specifically, Dr. Gill conducted a secondary analysis of 209 family medicine and general internal medicine physicians and 24,876 of their patients, aged 18 years and older, who had diagnoses of depression.

The study population included 1,849 patients with incident depression diagnosed during the 1-year period from October 2006 through October 2007. Study participants had at least one office visit during the year and an active diagnosis of depression as of the end of the year. Data were collected from electronic medical records via the Medical Quality Improvement Consortium.

Approximately 75% of the patients were on any type of antidepressant medication at the study's end. A total of 92% were taking at least the minimum dosage of their prescribed medications, and almost half (49%) were taking the full dosage.

In addition, about one-quarter of the patients in the study had at least one of the six medical comorbidities included in the review: coronary heart disease, heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, cancer, and diabetes. The most common comorbidity was diabetes, affecting 13%.

After the researchers controlled for age, gender, and additional comorbidities, none of the six comorbidities were a significant predictor of any antidepressant medication use or of the dosage. Nor did the researchers find any significant differences in medication use by comorbidity in a subanalysis for the patients with incident depression during the observation year.

Patients with comorbid conditions were slightly more likely to be taking the maximum dosage of an antidepressant, and patients with medical comorbidities in the incident group were slightly less likely to be on medications, Dr. Gill noted.

“It does not look like primary care providers treat depression more aggressively in people with comorbidities,” he said. Possible reasons include concerns about medication side effects and the cost of additional medications. The study was limited by a lack of information about the severity of the patients' depression, Dr. Gill said.

But the question remains as to whether treating depression more aggressively can improve the comorbidities, he added, and more research is needed to explore this topic.

Dr. Gill had no financial conflicts to disclose.

RIO GRANDE, P.R. — Primary care physicians don't appear to treat depression any more aggressively in patients who have medical comorbidities, compared with other patients, despite mounting evidence showing that depression may lead to worse medical outcomes.

The conclusions were based on a database review of more than 20,000 adult records. “There is good evidence that the rate of depression is higher in persons with certain medical comorbidities,” Dr. James Gill said at the annual meeting of the North American Primary Care Research Group. “You could make the argument that persons with depression should be treated more aggressively if they have comorbid conditions,” he added.

In a previous study, Dr. Gill, president of Delaware Valley Outcomes Research LLC, reviewed a large database of patients treated by a range of medical specialists and found no significant differences among the specialists in terms of their use of antidepressant medications to treat depressed patients with and without medical comorbidities (Int. J. Psychiatry 2008;38:203-15).

In order to focus on primary care physicians specifically, Dr. Gill conducted a secondary analysis of 209 family medicine and general internal medicine physicians and 24,876 of their patients, aged 18 years and older, who had diagnoses of depression.

The study population included 1,849 patients with incident depression diagnosed during the 1-year period from October 2006 through October 2007. Study participants had at least one office visit during the year and an active diagnosis of depression as of the end of the year. Data were collected from electronic medical records via the Medical Quality Improvement Consortium.

Approximately 75% of the patients were on any type of antidepressant medication at the study's end. A total of 92% were taking at least the minimum dosage of their prescribed medications, and almost half (49%) were taking the full dosage.

In addition, about one-quarter of the patients in the study had at least one of the six medical comorbidities included in the review: coronary heart disease, heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, cancer, and diabetes. The most common comorbidity was diabetes, affecting 13%.

After the researchers controlled for age, gender, and additional comorbidities, none of the six comorbidities were a significant predictor of any antidepressant medication use or of the dosage. Nor did the researchers find any significant differences in medication use by comorbidity in a subanalysis for the patients with incident depression during the observation year.

Patients with comorbid conditions were slightly more likely to be taking the maximum dosage of an antidepressant, and patients with medical comorbidities in the incident group were slightly less likely to be on medications, Dr. Gill noted.

“It does not look like primary care providers treat depression more aggressively in people with comorbidities,” he said. Possible reasons include concerns about medication side effects and the cost of additional medications. The study was limited by a lack of information about the severity of the patients' depression, Dr. Gill said.

But the question remains as to whether treating depression more aggressively can improve the comorbidities, he added, and more research is needed to explore this topic.

Dr. Gill had no financial conflicts to disclose.

A revised high-tech tool from the Department of Health and Human Services may make filling out a pre-exam checklist in the doctor's office obsolete, if doctors and patients will use it.

“We know that a large percentage of our risk for developing certain diseases is related to genetics and related to our family histories,” acting Surgeon General Steven Galson said in an interview.

In the future, clinicians will predict risk and plan therapy based on information obtained from a drop of blood, but that future is still far off, Dr. Galson said.

“We know that today, by using family history, we can get a lot of information that can help clinicians,” he emphasized. The online tool, called My Family Health Portrait, collects information in a standard way that's easy for family members to share and for clinicians to use, he said.

“We'd like to see every single American have the opportunity to input their data into this tool and enable their physicians to treat them with a better understanding of family history,” he added.

“Family history can provide important insights into future risk of developing a wide variety of serious medical conditions like cardiovascular disease, diabetes, and many types of cancers,” Dr. Greg Feero, a senior adviser for genomic medicine at the National Institutes of Health, said in an interview.

But many time-strapped clinicians fail to collect family history during an office visit.

“The tool offers doctors and patients a convenient way to collect and organize an expanded range of family history information outside of the time constraints and pressures of the office visit,” Dr. Feero said.

My Family Health Portrait was introduced in 2004 as a form that patients could print and take to their medical appointments. But the revised version (available at https://familyhistory.hhs.gov

For example, if you create a file with your own history, you are prompted to note the dates when you had certain diseases (if any) or to add diseases not on the default list. You can also add health information about your immediate family members (siblings, parents, children, aunts, and uncles) with options to add more family members. If you give your brother the file, it asks him whether he is a family member and reorients the data around him. This prevents the duplication of data; your brother would only need to input health data that are unique to him.

According to the Department of Health and Human Services, building the basics of a family health history should take about 15–20 minutes. Beyond that, the more family members someone includes, the longer it takes. The history may be downloaded onto a patient's own computer, and it is not automatically accessible by the government or by any health care provider without the patient's permission.

Doctors who start an exam with an accurate family history at hand can spend their time reviewing and interpreting the information, rather than collecting it, Dr. Feero said.

“Importantly, the new tool is designed using accepted data standards, so that the data file it creates has the potential to be shared electronically with electronic health record and personalized health record systems,” Dr. Feero noted. “Ultimately, this same standards-based design should allow the development of automated tools to help clinicians interpret the information the patients provide them.”

But how easy is it for clinicians to promote the tool to patients, and use it in practice? “If the clinician currently uses a paper-based patient family history intake form for new patients, or for yearly physicals, the provider could simply ask patients to complete the new tool online and supply them either with the data file or a paper version,” Dr. Feero explained. “If secure e-mail systems are available to the patient and provider, this might be another option for transferring the information.”

Alternatively, the entire program is available for downloading and customizing at no charge. Providers can install the My Family Health Portrait software as part of their health information technology system. Patients could complete the information at a kiosk or laptop in the waiting room, and have the electronic file sent directly to their physicians for review.

An electronic family history is potentially useful, Dr. Charles Scott, a pediatrician in private practice in Medford, N.J., said in an interview. But it would have to be reviewed and incorporated carefully, so that patients would not be able to access medical files other than their own if they completed the history in a doctor's office, he said. Software compatibility could be a problem in some practices, he added.

And it's important to remember the personal touch, no matter how much electronic media become part of medical practice. “My fear is that we may get so involved with our data entry in the e-chart that we will forget to warmly interact face to face with our patients,” Dr. Scott said.

Dr. Scott had no financial conflicts to disclose. Dr. Feero is an employee of the National Institutes of Health, which is part of the Department of Health and Human Services.

A revised high-tech tool from the Department of Health and Human Services may make filling out a pre-exam checklist in the doctor's office obsolete, if doctors and patients will use it.

“We know that a large percentage of our risk for developing certain diseases is related to genetics and related to our family histories,” acting Surgeon General Steven Galson said in an interview.

In the future, clinicians will predict risk and plan therapy based on information obtained from a drop of blood, but that future is still far off, Dr. Galson said.

“We know that today, by using family history, we can get a lot of information that can help clinicians,” he emphasized. The online tool, called My Family Health Portrait, collects information in a standard way that's easy for family members to share and for clinicians to use, he said.

“We'd like to see every single American have the opportunity to input their data into this tool and enable their physicians to treat them with a better understanding of family history,” he added.

“Family history can provide important insights into future risk of developing a wide variety of serious medical conditions like cardiovascular disease, diabetes, and many types of cancers,” Dr. Greg Feero, a senior adviser for genomic medicine at the National Institutes of Health, said in an interview.

But many time-strapped clinicians fail to collect family history during an office visit.

“The tool offers doctors and patients a convenient way to collect and organize an expanded range of family history information outside of the time constraints and pressures of the office visit,” Dr. Feero said.

My Family Health Portrait was introduced in 2004 as a form that patients could print and take to their medical appointments. But the revised version (available at https://familyhistory.hhs.gov

For example, if you create a file with your own history, you are prompted to note the dates when you had certain diseases (if any) or to add diseases not on the default list. You can also add health information about your immediate family members (siblings, parents, children, aunts, and uncles) with options to add more family members. If you give your brother the file, it asks him whether he is a family member and reorients the data around him. This prevents the duplication of data; your brother would only need to input health data that are unique to him.

According to the Department of Health and Human Services, building the basics of a family health history should take about 15–20 minutes. Beyond that, the more family members someone includes, the longer it takes. The history may be downloaded onto a patient's own computer, and it is not automatically accessible by the government or by any health care provider without the patient's permission.

Doctors who start an exam with an accurate family history at hand can spend their time reviewing and interpreting the information, rather than collecting it, Dr. Feero said.

“Importantly, the new tool is designed using accepted data standards, so that the data file it creates has the potential to be shared electronically with electronic health record and personalized health record systems,” Dr. Feero noted. “Ultimately, this same standards-based design should allow the development of automated tools to help clinicians interpret the information the patients provide them.”

But how easy is it for clinicians to promote the tool to patients, and use it in practice? “If the clinician currently uses a paper-based patient family history intake form for new patients, or for yearly physicals, the provider could simply ask patients to complete the new tool online and supply them either with the data file or a paper version,” Dr. Feero explained. “If secure e-mail systems are available to the patient and provider, this might be another option for transferring the information.”

Alternatively, the entire program is available for downloading and customizing at no charge. Providers can install the My Family Health Portrait software as part of their health information technology system. Patients could complete the information at a kiosk or laptop in the waiting room, and have the electronic file sent directly to their physicians for review.

An electronic family history is potentially useful, Dr. Charles Scott, a pediatrician in private practice in Medford, N.J., said in an interview. But it would have to be reviewed and incorporated carefully, so that patients would not be able to access medical files other than their own if they completed the history in a doctor's office, he said. Software compatibility could be a problem in some practices, he added.

And it's important to remember the personal touch, no matter how much electronic media become part of medical practice. “My fear is that we may get so involved with our data entry in the e-chart that we will forget to warmly interact face to face with our patients,” Dr. Scott said.

Dr. Scott had no financial conflicts to disclose. Dr. Feero is an employee of the National Institutes of Health, which is part of the Department of Health and Human Services.

A revised high-tech tool from the Department of Health and Human Services may make filling out a pre-exam checklist in the doctor's office obsolete, if doctors and patients will use it.

“We know that a large percentage of our risk for developing certain diseases is related to genetics and related to our family histories,” acting Surgeon General Steven Galson said in an interview.

In the future, clinicians will predict risk and plan therapy based on information obtained from a drop of blood, but that future is still far off, Dr. Galson said.

“We know that today, by using family history, we can get a lot of information that can help clinicians,” he emphasized. The online tool, called My Family Health Portrait, collects information in a standard way that's easy for family members to share and for clinicians to use, he said.

“We'd like to see every single American have the opportunity to input their data into this tool and enable their physicians to treat them with a better understanding of family history,” he added.

“Family history can provide important insights into future risk of developing a wide variety of serious medical conditions like cardiovascular disease, diabetes, and many types of cancers,” Dr. Greg Feero, a senior adviser for genomic medicine at the National Institutes of Health, said in an interview.

But many time-strapped clinicians fail to collect family history during an office visit.

“The tool offers doctors and patients a convenient way to collect and organize an expanded range of family history information outside of the time constraints and pressures of the office visit,” Dr. Feero said.

My Family Health Portrait was introduced in 2004 as a form that patients could print and take to their medical appointments. But the revised version (available at https://familyhistory.hhs.gov

For example, if you create a file with your own history, you are prompted to note the dates when you had certain diseases (if any) or to add diseases not on the default list. You can also add health information about your immediate family members (siblings, parents, children, aunts, and uncles) with options to add more family members. If you give your brother the file, it asks him whether he is a family member and reorients the data around him. This prevents the duplication of data; your brother would only need to input health data that are unique to him.

According to the Department of Health and Human Services, building the basics of a family health history should take about 15–20 minutes. Beyond that, the more family members someone includes, the longer it takes. The history may be downloaded onto a patient's own computer, and it is not automatically accessible by the government or by any health care provider without the patient's permission.

Doctors who start an exam with an accurate family history at hand can spend their time reviewing and interpreting the information, rather than collecting it, Dr. Feero said.

“Importantly, the new tool is designed using accepted data standards, so that the data file it creates has the potential to be shared electronically with electronic health record and personalized health record systems,” Dr. Feero noted. “Ultimately, this same standards-based design should allow the development of automated tools to help clinicians interpret the information the patients provide them.”

But how easy is it for clinicians to promote the tool to patients, and use it in practice? “If the clinician currently uses a paper-based patient family history intake form for new patients, or for yearly physicals, the provider could simply ask patients to complete the new tool online and supply them either with the data file or a paper version,” Dr. Feero explained. “If secure e-mail systems are available to the patient and provider, this might be another option for transferring the information.”

Alternatively, the entire program is available for downloading and customizing at no charge. Providers can install the My Family Health Portrait software as part of their health information technology system. Patients could complete the information at a kiosk or laptop in the waiting room, and have the electronic file sent directly to their physicians for review.

An electronic family history is potentially useful, Dr. Charles Scott, a pediatrician in private practice in Medford, N.J., said in an interview. But it would have to be reviewed and incorporated carefully, so that patients would not be able to access medical files other than their own if they completed the history in a doctor's office, he said. Software compatibility could be a problem in some practices, he added.

And it's important to remember the personal touch, no matter how much electronic media become part of medical practice. “My fear is that we may get so involved with our data entry in the e-chart that we will forget to warmly interact face to face with our patients,” Dr. Scott said.

Dr. Scott had no financial conflicts to disclose. Dr. Feero is an employee of the National Institutes of Health, which is part of the Department of Health and Human Services.

A midlife diagnosis of diabetes increases the risk of developing Alzheimer's disease and vascular dementia, based on results of a twin study including more than 13,000 individuals.

Previous studies have shown that people with diabetes are at increased risk for dementia, but little is known about the mechanism of action, wrote Dr. Weili Xu of the Karolinska Institutet, Stockholm, and the Stockholm Gerontology Research Center.

Dr. Xu and colleagues conducted this twin study to verify the effect of diabetes on dementia, examine whether this effect varied based on the age of diabetes onset, and assess the possible role of genetics (Diabetes 2009;58:71-7). Data were taken from a national registry of Swedish twins who were at least 65 years old when they entered the study between 1998 and 2001.

Of 13,693 participants, 13,056 had no dementia, 467 had dementia, and 170 had questionable dementia, based on DSM-IV criteria. Midlife diabetes was defined as the onset of type 2 diabetes before age 65 years.

A total of 1,396 individuals had type 2 diabetes; 643 developed diabetes before age 65, and 753 developed diabetes at age 65 or older.

Overall, diabetes was significantly associated with a higher risk of dementia, and patients whose diabetes was diagnosed at midlife were more than twice as likely to develop dementia as those diagnosed later in life, even after controlling for diabetes duration and twin factors. In an analysis using a generalized estimating equation model (to measure all subjects at a common set of times) midlife and late-life diabetes diagnoses were significantly associated with increased dementia risks of 176% and 63%, respectively.

In addition, data from co-twin matched case-control analyses showed that the effect of midlife diabetes on dementia remained significant while the effect of later-life diabetes diagnosis on dementia did not.

These data suggest that adult lifestyle traits such as diet, exercise, smoking, and diabetes control may have a substantial impact on the link between midlife diabetes and dementia.

But “unmeasured familial factors” including genetic factors and environmental influences in early life might contribute to the association between late-life diabetes diagnosis and dementia, the researchers noted.

The study's limitations include the prevalence of dementia cases, the use of self-reports, and the lack of information about genes and environmental factors.

However, the findings “add to the growing evidence of a link between diabetes, vascular damage, and neurodegenerative changes in the brain,” they wrote, adding more studies are needed to identify environmental factors and genetic influences.

The study was supported in part by research grants from sources including the National Institute on Aging and the American Alzheimer's Association. The researchers disclosed no financial conflicts of interest.

A midlife diagnosis of diabetes increases the risk of developing Alzheimer's disease and vascular dementia, based on results of a twin study including more than 13,000 individuals.

Previous studies have shown that people with diabetes are at increased risk for dementia, but little is known about the mechanism of action, wrote Dr. Weili Xu of the Karolinska Institutet, Stockholm, and the Stockholm Gerontology Research Center.

Dr. Xu and colleagues conducted this twin study to verify the effect of diabetes on dementia, examine whether this effect varied based on the age of diabetes onset, and assess the possible role of genetics (Diabetes 2009;58:71-7). Data were taken from a national registry of Swedish twins who were at least 65 years old when they entered the study between 1998 and 2001.

Of 13,693 participants, 13,056 had no dementia, 467 had dementia, and 170 had questionable dementia, based on DSM-IV criteria. Midlife diabetes was defined as the onset of type 2 diabetes before age 65 years.

A total of 1,396 individuals had type 2 diabetes; 643 developed diabetes before age 65, and 753 developed diabetes at age 65 or older.

Overall, diabetes was significantly associated with a higher risk of dementia, and patients whose diabetes was diagnosed at midlife were more than twice as likely to develop dementia as those diagnosed later in life, even after controlling for diabetes duration and twin factors. In an analysis using a generalized estimating equation model (to measure all subjects at a common set of times) midlife and late-life diabetes diagnoses were significantly associated with increased dementia risks of 176% and 63%, respectively.

In addition, data from co-twin matched case-control analyses showed that the effect of midlife diabetes on dementia remained significant while the effect of later-life diabetes diagnosis on dementia did not.

These data suggest that adult lifestyle traits such as diet, exercise, smoking, and diabetes control may have a substantial impact on the link between midlife diabetes and dementia.

But “unmeasured familial factors” including genetic factors and environmental influences in early life might contribute to the association between late-life diabetes diagnosis and dementia, the researchers noted.

The study's limitations include the prevalence of dementia cases, the use of self-reports, and the lack of information about genes and environmental factors.

However, the findings “add to the growing evidence of a link between diabetes, vascular damage, and neurodegenerative changes in the brain,” they wrote, adding more studies are needed to identify environmental factors and genetic influences.

The study was supported in part by research grants from sources including the National Institute on Aging and the American Alzheimer's Association. The researchers disclosed no financial conflicts of interest.

A midlife diagnosis of diabetes increases the risk of developing Alzheimer's disease and vascular dementia, based on results of a twin study including more than 13,000 individuals.

Previous studies have shown that people with diabetes are at increased risk for dementia, but little is known about the mechanism of action, wrote Dr. Weili Xu of the Karolinska Institutet, Stockholm, and the Stockholm Gerontology Research Center.

Dr. Xu and colleagues conducted this twin study to verify the effect of diabetes on dementia, examine whether this effect varied based on the age of diabetes onset, and assess the possible role of genetics (Diabetes 2009;58:71-7). Data were taken from a national registry of Swedish twins who were at least 65 years old when they entered the study between 1998 and 2001.

Of 13,693 participants, 13,056 had no dementia, 467 had dementia, and 170 had questionable dementia, based on DSM-IV criteria. Midlife diabetes was defined as the onset of type 2 diabetes before age 65 years.

A total of 1,396 individuals had type 2 diabetes; 643 developed diabetes before age 65, and 753 developed diabetes at age 65 or older.

Overall, diabetes was significantly associated with a higher risk of dementia, and patients whose diabetes was diagnosed at midlife were more than twice as likely to develop dementia as those diagnosed later in life, even after controlling for diabetes duration and twin factors. In an analysis using a generalized estimating equation model (to measure all subjects at a common set of times) midlife and late-life diabetes diagnoses were significantly associated with increased dementia risks of 176% and 63%, respectively.

In addition, data from co-twin matched case-control analyses showed that the effect of midlife diabetes on dementia remained significant while the effect of later-life diabetes diagnosis on dementia did not.

These data suggest that adult lifestyle traits such as diet, exercise, smoking, and diabetes control may have a substantial impact on the link between midlife diabetes and dementia.

But “unmeasured familial factors” including genetic factors and environmental influences in early life might contribute to the association between late-life diabetes diagnosis and dementia, the researchers noted.

The study's limitations include the prevalence of dementia cases, the use of self-reports, and the lack of information about genes and environmental factors.

However, the findings “add to the growing evidence of a link between diabetes, vascular damage, and neurodegenerative changes in the brain,” they wrote, adding more studies are needed to identify environmental factors and genetic influences.

The study was supported in part by research grants from sources including the National Institute on Aging and the American Alzheimer's Association. The researchers disclosed no financial conflicts of interest.

WASHINGTON — A majority of new mothers at high risk for pertussis were receptive to a postpartum pertussis vaccine before leaving the hospital, based on data from more than 1,000 women after implementation of a new hospital protocol.

“Most pertussis deaths occur in infants less than 6 months,” who are too young to have completed their primary vaccination series, Dr. C. Mary Healy said at the jointly held Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Pertussis rates in Texas have risen in recent years, especially among Hispanic infants, said Dr. Healy of Baylor College of Medicine, Houston. Hispanic infants have a 74% higher incidence of pertussis compared with infants of other ethnicities, for reasons that are poorly understood. In 2007, approximately 70% of pertussis-related deaths in the United States occurred among Hispanic infants.

In more than 75% of infant pertussis cases, the infants are infected by someone in the household. In 2006, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a targeted immunization strategy called “cocooning.” This plan calls for a booster dose of the tetanus, diphtheria, acellular pertussis (Tdap) vaccine for postpartum women, contacts of infants younger than 1 year, and health care providers who treat infants aged younger than 1 year.

But cocooning poses challenges, Dr. Healy said. “The cornerstone to the success of cocooning is immunizing postpartum women. This puts the onus on obstetricians to both recommend and potentially administer vaccine.”

To improve protection against pertussis in a high-risk, medically underserved and uninsured Hispanic population, Dr. Healy and her colleagues implemented a protocol of postpartum Tdap vaccination at a hospital in Houston and presented preliminary results at the meeting.

The investigators instructed hospital personnel through grand rounds, small group in-service programs, and educational materials. They initiated a standing order for postpartum Tdap immunization (barring medical contraindications) and provided information about the vaccine to all postpartum women.

From Jan. 7 to April 30, 2008, 1,127 (73%) of 1,553 postpartum women received Tdap before leaving the hospital. The median age of the mothers was 26 years, and approximately 55% were aged 20–30 years.

“But let me draw your attention to the group aged 10–19 years,” Dr. Healy said. “Not only are they at particularly high risk for transmitting pertussis to their infants, but they are eligible for free vaccines under the Vaccines for Children Program, so cost should not be a barrier.” Approximately 11% of the mothers in the study were aged 10–19 years.

A total of 93% of the study group was Hispanic, 4% were black, and the rest were white or another ethnicity.

“In general, Tdap vaccine was well, and even enthusiastically, accepted by mothers and health care providers alike,” Dr. Healy said. “Wherever possible, Td [tetanus-diphtheria toxoids vaccine] during pregnancy is now deferred in favor of postpartum Tdap,” she added.

The investigators reviewed data from 426 mothers who were not immunized, and found that they were more likely to be black and older, compared with the immunized women. In a subset of 117 women who refused Tdap, more than 80% claimed that they had received Td during pregnancy. But a review of patient records found that 32% of women who reported receiving Td had received another medication, usually a flu vaccine.

In this study, postpartum immunization was successfully implemented through a standing order protocol that may be a model for protecting infants against pertussis and other vaccine-preventable diseases, said Dr. Healy. Education of health care providers was critical in ensuring the success of the program.

The Tdap vaccine for the study was donated by Sanofi Pasteur. Dr. Healy stated that she had no personal financial conflicts to disclose.

WASHINGTON — A majority of new mothers at high risk for pertussis were receptive to a postpartum pertussis vaccine before leaving the hospital, based on data from more than 1,000 women after implementation of a new hospital protocol.

“Most pertussis deaths occur in infants less than 6 months,” who are too young to have completed their primary vaccination series, Dr. C. Mary Healy said at the jointly held Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Pertussis rates in Texas have risen in recent years, especially among Hispanic infants, said Dr. Healy of Baylor College of Medicine, Houston. Hispanic infants have a 74% higher incidence of pertussis compared with infants of other ethnicities, for reasons that are poorly understood. In 2007, approximately 70% of pertussis-related deaths in the United States occurred among Hispanic infants.

In more than 75% of infant pertussis cases, the infants are infected by someone in the household. In 2006, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a targeted immunization strategy called “cocooning.” This plan calls for a booster dose of the tetanus, diphtheria, acellular pertussis (Tdap) vaccine for postpartum women, contacts of infants younger than 1 year, and health care providers who treat infants aged younger than 1 year.

But cocooning poses challenges, Dr. Healy said. “The cornerstone to the success of cocooning is immunizing postpartum women. This puts the onus on obstetricians to both recommend and potentially administer vaccine.”

To improve protection against pertussis in a high-risk, medically underserved and uninsured Hispanic population, Dr. Healy and her colleagues implemented a protocol of postpartum Tdap vaccination at a hospital in Houston and presented preliminary results at the meeting.

The investigators instructed hospital personnel through grand rounds, small group in-service programs, and educational materials. They initiated a standing order for postpartum Tdap immunization (barring medical contraindications) and provided information about the vaccine to all postpartum women.

From Jan. 7 to April 30, 2008, 1,127 (73%) of 1,553 postpartum women received Tdap before leaving the hospital. The median age of the mothers was 26 years, and approximately 55% were aged 20–30 years.

“But let me draw your attention to the group aged 10–19 years,” Dr. Healy said. “Not only are they at particularly high risk for transmitting pertussis to their infants, but they are eligible for free vaccines under the Vaccines for Children Program, so cost should not be a barrier.” Approximately 11% of the mothers in the study were aged 10–19 years.

A total of 93% of the study group was Hispanic, 4% were black, and the rest were white or another ethnicity.

“In general, Tdap vaccine was well, and even enthusiastically, accepted by mothers and health care providers alike,” Dr. Healy said. “Wherever possible, Td [tetanus-diphtheria toxoids vaccine] during pregnancy is now deferred in favor of postpartum Tdap,” she added.

The investigators reviewed data from 426 mothers who were not immunized, and found that they were more likely to be black and older, compared with the immunized women. In a subset of 117 women who refused Tdap, more than 80% claimed that they had received Td during pregnancy. But a review of patient records found that 32% of women who reported receiving Td had received another medication, usually a flu vaccine.

In this study, postpartum immunization was successfully implemented through a standing order protocol that may be a model for protecting infants against pertussis and other vaccine-preventable diseases, said Dr. Healy. Education of health care providers was critical in ensuring the success of the program.

The Tdap vaccine for the study was donated by Sanofi Pasteur. Dr. Healy stated that she had no personal financial conflicts to disclose.

WASHINGTON — A majority of new mothers at high risk for pertussis were receptive to a postpartum pertussis vaccine before leaving the hospital, based on data from more than 1,000 women after implementation of a new hospital protocol.

“Most pertussis deaths occur in infants less than 6 months,” who are too young to have completed their primary vaccination series, Dr. C. Mary Healy said at the jointly held Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Pertussis rates in Texas have risen in recent years, especially among Hispanic infants, said Dr. Healy of Baylor College of Medicine, Houston. Hispanic infants have a 74% higher incidence of pertussis compared with infants of other ethnicities, for reasons that are poorly understood. In 2007, approximately 70% of pertussis-related deaths in the United States occurred among Hispanic infants.

In more than 75% of infant pertussis cases, the infants are infected by someone in the household. In 2006, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a targeted immunization strategy called “cocooning.” This plan calls for a booster dose of the tetanus, diphtheria, acellular pertussis (Tdap) vaccine for postpartum women, contacts of infants younger than 1 year, and health care providers who treat infants aged younger than 1 year.

But cocooning poses challenges, Dr. Healy said. “The cornerstone to the success of cocooning is immunizing postpartum women. This puts the onus on obstetricians to both recommend and potentially administer vaccine.”

To improve protection against pertussis in a high-risk, medically underserved and uninsured Hispanic population, Dr. Healy and her colleagues implemented a protocol of postpartum Tdap vaccination at a hospital in Houston and presented preliminary results at the meeting.

The investigators instructed hospital personnel through grand rounds, small group in-service programs, and educational materials. They initiated a standing order for postpartum Tdap immunization (barring medical contraindications) and provided information about the vaccine to all postpartum women.

From Jan. 7 to April 30, 2008, 1,127 (73%) of 1,553 postpartum women received Tdap before leaving the hospital. The median age of the mothers was 26 years, and approximately 55% were aged 20–30 years.

“But let me draw your attention to the group aged 10–19 years,” Dr. Healy said. “Not only are they at particularly high risk for transmitting pertussis to their infants, but they are eligible for free vaccines under the Vaccines for Children Program, so cost should not be a barrier.” Approximately 11% of the mothers in the study were aged 10–19 years.

A total of 93% of the study group was Hispanic, 4% were black, and the rest were white or another ethnicity.

“In general, Tdap vaccine was well, and even enthusiastically, accepted by mothers and health care providers alike,” Dr. Healy said. “Wherever possible, Td [tetanus-diphtheria toxoids vaccine] during pregnancy is now deferred in favor of postpartum Tdap,” she added.

The investigators reviewed data from 426 mothers who were not immunized, and found that they were more likely to be black and older, compared with the immunized women. In a subset of 117 women who refused Tdap, more than 80% claimed that they had received Td during pregnancy. But a review of patient records found that 32% of women who reported receiving Td had received another medication, usually a flu vaccine.

In this study, postpartum immunization was successfully implemented through a standing order protocol that may be a model for protecting infants against pertussis and other vaccine-preventable diseases, said Dr. Healy. Education of health care providers was critical in ensuring the success of the program.

The Tdap vaccine for the study was donated by Sanofi Pasteur. Dr. Healy stated that she had no personal financial conflicts to disclose.

WASHINGTON — Herpes simplex virus type 2 infected approximately one-third of the young women in a study of 127 adolescents, but behavioral and demographic factors were more predictive of disease than were clinical symptoms.

Data from population-based studies have shown that herpes simplex virus type 2 (HSV-2) most often is acquired by women between the ages of 20 and 29 years, but many of them have no clinical symptoms, said Dr. Kenneth Fife of Indiana University in Indianapolis.

To determine the demographic and behavioral factors associated with HSV-2 infection in young women, Dr. Fife and his colleagues collected data for 4–6 years from 127 adolescents aged 14–18 years at baseline. The researchers presented their results in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

Of the study population, 92% were black and 7% were white; 33% were antibody positive for HSV-2 at baseline. Only three participants had a history of clinically diagnosed herpes when they entered the study, and the participants underwent quarterly screening for incident STDs.

Each participant kept a detailed behavioral diary for two 12-week periods each year and collected weekly vaginal swab samples during these 12-week periods. At the conclusion of the study, the average age of the participants was 21 years.

“Only increasing age, increased time since sexual debut, and an increased number of lifetime sexual partners were significantly correlated with a positive HSV-2 test,” Dr. Fife noted. The odds ratios for these factors were 1.36, 1.17, and 1.09, respectively.

The researchers found no significant association between a positive test result and recorded clinical symptoms of genital pain or discharge.

Of 121 participants for whom complete behavioral data were available, 67 had previous sera available for HSV-2 antibody testing, and 17 (25%) of these women seroconverted from negative to positive during the course of the study.

The DNA testing for HSV-2 in the study population is ongoing, but preliminary results from 13 women with positive results on polymerase chain reaction tests showed that most of the participants shed virus from the genital tract and most had several positive DNA tests over a single 12-week period.

The study was limited by the use of self-reports, but the results suggest that HSV-2 control programs should include young women because they shed virus frequently despite a lack of clinical symptoms, and early signs of infection may go unrecognized, Dr. Fife said.

The study was supported by a grant to Dr. Fife from GlaxoSmithKline and funding from the National Institutes of Health.

WASHINGTON — Herpes simplex virus type 2 infected approximately one-third of the young women in a study of 127 adolescents, but behavioral and demographic factors were more predictive of disease than were clinical symptoms.

Data from population-based studies have shown that herpes simplex virus type 2 (HSV-2) most often is acquired by women between the ages of 20 and 29 years, but many of them have no clinical symptoms, said Dr. Kenneth Fife of Indiana University in Indianapolis.

To determine the demographic and behavioral factors associated with HSV-2 infection in young women, Dr. Fife and his colleagues collected data for 4–6 years from 127 adolescents aged 14–18 years at baseline. The researchers presented their results in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

Of the study population, 92% were black and 7% were white; 33% were antibody positive for HSV-2 at baseline. Only three participants had a history of clinically diagnosed herpes when they entered the study, and the participants underwent quarterly screening for incident STDs.

Each participant kept a detailed behavioral diary for two 12-week periods each year and collected weekly vaginal swab samples during these 12-week periods. At the conclusion of the study, the average age of the participants was 21 years.

“Only increasing age, increased time since sexual debut, and an increased number of lifetime sexual partners were significantly correlated with a positive HSV-2 test,” Dr. Fife noted. The odds ratios for these factors were 1.36, 1.17, and 1.09, respectively.

The researchers found no significant association between a positive test result and recorded clinical symptoms of genital pain or discharge.

Of 121 participants for whom complete behavioral data were available, 67 had previous sera available for HSV-2 antibody testing, and 17 (25%) of these women seroconverted from negative to positive during the course of the study.

The DNA testing for HSV-2 in the study population is ongoing, but preliminary results from 13 women with positive results on polymerase chain reaction tests showed that most of the participants shed virus from the genital tract and most had several positive DNA tests over a single 12-week period.

The study was limited by the use of self-reports, but the results suggest that HSV-2 control programs should include young women because they shed virus frequently despite a lack of clinical symptoms, and early signs of infection may go unrecognized, Dr. Fife said.

The study was supported by a grant to Dr. Fife from GlaxoSmithKline and funding from the National Institutes of Health.

WASHINGTON — Herpes simplex virus type 2 infected approximately one-third of the young women in a study of 127 adolescents, but behavioral and demographic factors were more predictive of disease than were clinical symptoms.

Data from population-based studies have shown that herpes simplex virus type 2 (HSV-2) most often is acquired by women between the ages of 20 and 29 years, but many of them have no clinical symptoms, said Dr. Kenneth Fife of Indiana University in Indianapolis.

To determine the demographic and behavioral factors associated with HSV-2 infection in young women, Dr. Fife and his colleagues collected data for 4–6 years from 127 adolescents aged 14–18 years at baseline. The researchers presented their results in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

Of the study population, 92% were black and 7% were white; 33% were antibody positive for HSV-2 at baseline. Only three participants had a history of clinically diagnosed herpes when they entered the study, and the participants underwent quarterly screening for incident STDs.

Each participant kept a detailed behavioral diary for two 12-week periods each year and collected weekly vaginal swab samples during these 12-week periods. At the conclusion of the study, the average age of the participants was 21 years.

“Only increasing age, increased time since sexual debut, and an increased number of lifetime sexual partners were significantly correlated with a positive HSV-2 test,” Dr. Fife noted. The odds ratios for these factors were 1.36, 1.17, and 1.09, respectively.

The researchers found no significant association between a positive test result and recorded clinical symptoms of genital pain or discharge.

Of 121 participants for whom complete behavioral data were available, 67 had previous sera available for HSV-2 antibody testing, and 17 (25%) of these women seroconverted from negative to positive during the course of the study.

The DNA testing for HSV-2 in the study population is ongoing, but preliminary results from 13 women with positive results on polymerase chain reaction tests showed that most of the participants shed virus from the genital tract and most had several positive DNA tests over a single 12-week period.

The study was limited by the use of self-reports, but the results suggest that HSV-2 control programs should include young women because they shed virus frequently despite a lack of clinical symptoms, and early signs of infection may go unrecognized, Dr. Fife said.

The study was supported by a grant to Dr. Fife from GlaxoSmithKline and funding from the National Institutes of Health.

Escitalopram and sertraline were the most effective of a dozen second-generation antidepressants for treating major depression in adults, results of a review of randomized controlled trials that included more than 25,000 patients show.

Previous studies of the effectiveness of second-generation antidepressants have been inconsistent, said Dr. Andrea Cipriani of the University of Verona (Italy). Dr. Cipriani and his colleagues reviewed 117 randomized, controlled trials using a multiple-treatment meta-analysis, so they could compare treatments within and between trials.

The average length of treatment was 8 weeks, and the average sample size was 110 patients. The studies included a total of 25,928 adults (65% women) who participated in studies for the treatment of acute unipolar major depression between 1991 and 2007.

The review included the following drugs: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine (Lancet 2009 [doi: 10.1016/S0140-6736(09)60046-5]).

Overall, some of the medications were significantly and clinically different in their effectiveness and acceptability. The four medications that were best tolerated were escitalopram, sertraline, citalopram, and bupropion. But the four drugs that were the most effective were mirtazapine, escitalopram, venlafaxine, and sertraline. Reboxetine was significantly less effective than any of the other 11 medications.

“The results indicate the two of the most efficacious treatments (mirtazapine and venlafaxine) might not be the best for overall acceptability,” they said.

“Our findings might help to choose among new generation antidepressants for acute treatment of major depression,” they noted.

The study results were limited to 8-week acute-phase treatment of depression and did not include a formal cost-effectiveness analysis, but the researchers suggested that sertraline may be the first choice financially in many countries.

Dr. Cipriani had no financial conflicts to disclose.

Escitalopram and sertraline were the most effective of a dozen second-generation antidepressants for treating major depression in adults, results of a review of randomized controlled trials that included more than 25,000 patients show.

Previous studies of the effectiveness of second-generation antidepressants have been inconsistent, said Dr. Andrea Cipriani of the University of Verona (Italy). Dr. Cipriani and his colleagues reviewed 117 randomized, controlled trials using a multiple-treatment meta-analysis, so they could compare treatments within and between trials.

The average length of treatment was 8 weeks, and the average sample size was 110 patients. The studies included a total of 25,928 adults (65% women) who participated in studies for the treatment of acute unipolar major depression between 1991 and 2007.

The review included the following drugs: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine (Lancet 2009 [doi: 10.1016/S0140-6736(09)60046-5]).

Overall, some of the medications were significantly and clinically different in their effectiveness and acceptability. The four medications that were best tolerated were escitalopram, sertraline, citalopram, and bupropion. But the four drugs that were the most effective were mirtazapine, escitalopram, venlafaxine, and sertraline. Reboxetine was significantly less effective than any of the other 11 medications.

“The results indicate the two of the most efficacious treatments (mirtazapine and venlafaxine) might not be the best for overall acceptability,” they said.

“Our findings might help to choose among new generation antidepressants for acute treatment of major depression,” they noted.

The study results were limited to 8-week acute-phase treatment of depression and did not include a formal cost-effectiveness analysis, but the researchers suggested that sertraline may be the first choice financially in many countries.

Dr. Cipriani had no financial conflicts to disclose.

Escitalopram and sertraline were the most effective of a dozen second-generation antidepressants for treating major depression in adults, results of a review of randomized controlled trials that included more than 25,000 patients show.

Previous studies of the effectiveness of second-generation antidepressants have been inconsistent, said Dr. Andrea Cipriani of the University of Verona (Italy). Dr. Cipriani and his colleagues reviewed 117 randomized, controlled trials using a multiple-treatment meta-analysis, so they could compare treatments within and between trials.

The average length of treatment was 8 weeks, and the average sample size was 110 patients. The studies included a total of 25,928 adults (65% women) who participated in studies for the treatment of acute unipolar major depression between 1991 and 2007.

The review included the following drugs: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine (Lancet 2009 [doi: 10.1016/S0140-6736(09)60046-5]).

Overall, some of the medications were significantly and clinically different in their effectiveness and acceptability. The four medications that were best tolerated were escitalopram, sertraline, citalopram, and bupropion. But the four drugs that were the most effective were mirtazapine, escitalopram, venlafaxine, and sertraline. Reboxetine was significantly less effective than any of the other 11 medications.

“The results indicate the two of the most efficacious treatments (mirtazapine and venlafaxine) might not be the best for overall acceptability,” they said.

“Our findings might help to choose among new generation antidepressants for acute treatment of major depression,” they noted.

The study results were limited to 8-week acute-phase treatment of depression and did not include a formal cost-effectiveness analysis, but the researchers suggested that sertraline may be the first choice financially in many countries.

Dr. Cipriani had no financial conflicts to disclose.

WASHINGTON — Using hormonal contraceptives might weaken a woman's natural immunity to the herpesvirus, according to findings from a pilot study of healthy women aged 18-35 years.

Findings from previous epidemiologic studies suggest that women who use hormonal contraception are at increased risk for sexually transmitted infections and herpes simplex virus (HSV) shedding. Yet clinical studies have shown that "cervicovaginal lavage fluid protects against HSV, HIV, and bacteria," lead author Dr. Gail F. Shust said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the annual meeting of the Infectious Diseases Society of America (IDSA).

Dr. Shust and colleagues from Albert Einstein College of Medicine, New York, measured anti-HSV activity and levels of immunity associated with hormonal contraception use by collecting samples of cervicovaginal lavage (CVL) fluid from 16 women once a week for 3-8 weeks. Nine women had normal ovulatory cycles and served as controls, and seven women used hormonal contraception.

When average values from the repeat CVL samples from each woman were compared, in the follicular phase, women using hormonal contraception showed significantly less anti-HSV activity compared with the controls. In the luteal phase, the difference did not reach statistical significance.

When individual fluid samples were compared (for a total of 94 samples), the anti-HSV activity in women using hormonal contraception was significantly lower, compared with the controls, in both the follicular and luteal phases.

Correlations between anti-HSV activity and specific mucosal mediators that can inhibit herpes infection were measured through a Spearman's rank correlation coefficient analysis. Based on this measure, anti-HSV activity was positively correlated with levels of human neutrophil peptides (HNPs) 1, 2, and 3 (Spearman's rho = 0.45), lactoferrin (rs = 0.52), lysozyme (rs = 0.58), and IgA (rs = 0.44).

In addition, anti-HSV activity was negatively correlated with interferon-alpha 2 (rs = −0.36). Each of these correlations was statistically significant.

The study was limited by its small size and intrasubject and intersubject variability in anti-HSV activity.

These findings may provide a biologic explanation for the epidemiologic findings of increased risk for acquisition of sexually transmitted infections, and for HSV shedding, in the setting of hormonal contraception, the researchers said. Studies of the factors that modify anti-HSV activity are ongoing, and larger, prospective studies are needed to support the results, they noted.

Dr. Shust reported no financial conflicts of interest.

WASHINGTON — Using hormonal contraceptives might weaken a woman's natural immunity to the herpesvirus, according to findings from a pilot study of healthy women aged 18-35 years.

Findings from previous epidemiologic studies suggest that women who use hormonal contraception are at increased risk for sexually transmitted infections and herpes simplex virus (HSV) shedding. Yet clinical studies have shown that "cervicovaginal lavage fluid protects against HSV, HIV, and bacteria," lead author Dr. Gail F. Shust said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the annual meeting of the Infectious Diseases Society of America (IDSA).

Dr. Shust and colleagues from Albert Einstein College of Medicine, New York, measured anti-HSV activity and levels of immunity associated with hormonal contraception use by collecting samples of cervicovaginal lavage (CVL) fluid from 16 women once a week for 3-8 weeks. Nine women had normal ovulatory cycles and served as controls, and seven women used hormonal contraception.

When average values from the repeat CVL samples from each woman were compared, in the follicular phase, women using hormonal contraception showed significantly less anti-HSV activity compared with the controls. In the luteal phase, the difference did not reach statistical significance.

When individual fluid samples were compared (for a total of 94 samples), the anti-HSV activity in women using hormonal contraception was significantly lower, compared with the controls, in both the follicular and luteal phases.

Correlations between anti-HSV activity and specific mucosal mediators that can inhibit herpes infection were measured through a Spearman's rank correlation coefficient analysis. Based on this measure, anti-HSV activity was positively correlated with levels of human neutrophil peptides (HNPs) 1, 2, and 3 (Spearman's rho = 0.45), lactoferrin (rs = 0.52), lysozyme (rs = 0.58), and IgA (rs = 0.44).

In addition, anti-HSV activity was negatively correlated with interferon-alpha 2 (rs = −0.36). Each of these correlations was statistically significant.

The study was limited by its small size and intrasubject and intersubject variability in anti-HSV activity.

These findings may provide a biologic explanation for the epidemiologic findings of increased risk for acquisition of sexually transmitted infections, and for HSV shedding, in the setting of hormonal contraception, the researchers said. Studies of the factors that modify anti-HSV activity are ongoing, and larger, prospective studies are needed to support the results, they noted.

Dr. Shust reported no financial conflicts of interest.

WASHINGTON — Using hormonal contraceptives might weaken a woman's natural immunity to the herpesvirus, according to findings from a pilot study of healthy women aged 18-35 years.

Findings from previous epidemiologic studies suggest that women who use hormonal contraception are at increased risk for sexually transmitted infections and herpes simplex virus (HSV) shedding. Yet clinical studies have shown that "cervicovaginal lavage fluid protects against HSV, HIV, and bacteria," lead author Dr. Gail F. Shust said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the annual meeting of the Infectious Diseases Society of America (IDSA).

Dr. Shust and colleagues from Albert Einstein College of Medicine, New York, measured anti-HSV activity and levels of immunity associated with hormonal contraception use by collecting samples of cervicovaginal lavage (CVL) fluid from 16 women once a week for 3-8 weeks. Nine women had normal ovulatory cycles and served as controls, and seven women used hormonal contraception.

When average values from the repeat CVL samples from each woman were compared, in the follicular phase, women using hormonal contraception showed significantly less anti-HSV activity compared with the controls. In the luteal phase, the difference did not reach statistical significance.

When individual fluid samples were compared (for a total of 94 samples), the anti-HSV activity in women using hormonal contraception was significantly lower, compared with the controls, in both the follicular and luteal phases.

Correlations between anti-HSV activity and specific mucosal mediators that can inhibit herpes infection were measured through a Spearman's rank correlation coefficient analysis. Based on this measure, anti-HSV activity was positively correlated with levels of human neutrophil peptides (HNPs) 1, 2, and 3 (Spearman's rho = 0.45), lactoferrin (rs = 0.52), lysozyme (rs = 0.58), and IgA (rs = 0.44).

In addition, anti-HSV activity was negatively correlated with interferon-alpha 2 (rs = −0.36). Each of these correlations was statistically significant.

The study was limited by its small size and intrasubject and intersubject variability in anti-HSV activity.

These findings may provide a biologic explanation for the epidemiologic findings of increased risk for acquisition of sexually transmitted infections, and for HSV shedding, in the setting of hormonal contraception, the researchers said. Studies of the factors that modify anti-HSV activity are ongoing, and larger, prospective studies are needed to support the results, they noted.

Dr. Shust reported no financial conflicts of interest.

RIO GRANDE, P.R. — Primary care physicians can successfully perform screening colonoscopies and identify patients at increased risk for developing colorectal cancer, according to a review of 559 colonoscopies.

Colonoscopy is the preferred screening method for patients who are at increased risk for developing colorectal cancer, while flexible sigmoidoscopy is considered adequate for average risk individuals, said Dr. Khalid Jaboori of Madigan Army Medical Center in Fort Lewis, Washington.

There aren't enough gastroenterologists to perform screening colonoscopies on all the patients who need them, whether they are at high risk or not, said Dr. Jaboori. Colonoscopy is a safe, cost-effective procedure that allows a full view of the colon and management of the findings, he added.

The researchers reviewed outpatient colonoscopies performed by a family physician between September 2003 and October 2007 on patients aged 26–87 years. The study population included 324 patients at average risk and 235 at high risk. The researchers recorded the location of all neoplasias and calculated the diagnostic yield of a flexible sigmoidoscopy for how many neoplasias would have been found with flexible sigmoidoscopy alone. The neoplasias that would have been detected by flexible sigmoidoscopy alone were defined as those in the left colon or in the distal part of the right colon. Dr. Jaboori presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, the presence of colonic neoplasia was 23% in the average-risk group and 33% in the high-risk group. There was no significant difference in the prevalence of proximal colonic neoplasia that would have been found by colonoscopy between average-risk (10%) and high-risk patients (15%). Also, isolated advanced lesions on the right side of the colon were identified in four patients (1.2%) in the average-risk group and one patient (0.4%) in the high-risk group, which was not a significant difference.

The diagnostic ability of flexible sigmoidoscopy to detect any neoplasia was similar for the average-risk and high-risk groups (both 56%).

“Approximately 44% of the neoplasias would have been missed in both groups with flexible sigmoidoscopy alone,” Dr. Jaboori said.

The results suggest that primary care residents and physicians should be trained in colonoscopies. “Increasing the pool of competently trained endoscopists will allow more patients to benefit from screening colonoscopy as the standard of care,” the researchers noted.

Dr. Jaboori had no conflicts of interest to report. The views in the study are those of the authors and do not reflect the policy of the U.S. Army, the Department of Defense, or the U.S. government. To watch a video go to www.youtube.com/user/FamilyPracticeNews

RIO GRANDE, P.R. — Primary care physicians can successfully perform screening colonoscopies and identify patients at increased risk for developing colorectal cancer, according to a review of 559 colonoscopies.

Colonoscopy is the preferred screening method for patients who are at increased risk for developing colorectal cancer, while flexible sigmoidoscopy is considered adequate for average risk individuals, said Dr. Khalid Jaboori of Madigan Army Medical Center in Fort Lewis, Washington.

There aren't enough gastroenterologists to perform screening colonoscopies on all the patients who need them, whether they are at high risk or not, said Dr. Jaboori. Colonoscopy is a safe, cost-effective procedure that allows a full view of the colon and management of the findings, he added.

The researchers reviewed outpatient colonoscopies performed by a family physician between September 2003 and October 2007 on patients aged 26–87 years. The study population included 324 patients at average risk and 235 at high risk. The researchers recorded the location of all neoplasias and calculated the diagnostic yield of a flexible sigmoidoscopy for how many neoplasias would have been found with flexible sigmoidoscopy alone. The neoplasias that would have been detected by flexible sigmoidoscopy alone were defined as those in the left colon or in the distal part of the right colon. Dr. Jaboori presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, the presence of colonic neoplasia was 23% in the average-risk group and 33% in the high-risk group. There was no significant difference in the prevalence of proximal colonic neoplasia that would have been found by colonoscopy between average-risk (10%) and high-risk patients (15%). Also, isolated advanced lesions on the right side of the colon were identified in four patients (1.2%) in the average-risk group and one patient (0.4%) in the high-risk group, which was not a significant difference.

The diagnostic ability of flexible sigmoidoscopy to detect any neoplasia was similar for the average-risk and high-risk groups (both 56%).

“Approximately 44% of the neoplasias would have been missed in both groups with flexible sigmoidoscopy alone,” Dr. Jaboori said.

The results suggest that primary care residents and physicians should be trained in colonoscopies. “Increasing the pool of competently trained endoscopists will allow more patients to benefit from screening colonoscopy as the standard of care,” the researchers noted.

Dr. Jaboori had no conflicts of interest to report. The views in the study are those of the authors and do not reflect the policy of the U.S. Army, the Department of Defense, or the U.S. government. To watch a video go to www.youtube.com/user/FamilyPracticeNews

RIO GRANDE, P.R. — Primary care physicians can successfully perform screening colonoscopies and identify patients at increased risk for developing colorectal cancer, according to a review of 559 colonoscopies.

Colonoscopy is the preferred screening method for patients who are at increased risk for developing colorectal cancer, while flexible sigmoidoscopy is considered adequate for average risk individuals, said Dr. Khalid Jaboori of Madigan Army Medical Center in Fort Lewis, Washington.

There aren't enough gastroenterologists to perform screening colonoscopies on all the patients who need them, whether they are at high risk or not, said Dr. Jaboori. Colonoscopy is a safe, cost-effective procedure that allows a full view of the colon and management of the findings, he added.

The researchers reviewed outpatient colonoscopies performed by a family physician between September 2003 and October 2007 on patients aged 26–87 years. The study population included 324 patients at average risk and 235 at high risk. The researchers recorded the location of all neoplasias and calculated the diagnostic yield of a flexible sigmoidoscopy for how many neoplasias would have been found with flexible sigmoidoscopy alone. The neoplasias that would have been detected by flexible sigmoidoscopy alone were defined as those in the left colon or in the distal part of the right colon. Dr. Jaboori presented the results in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, the presence of colonic neoplasia was 23% in the average-risk group and 33% in the high-risk group. There was no significant difference in the prevalence of proximal colonic neoplasia that would have been found by colonoscopy between average-risk (10%) and high-risk patients (15%). Also, isolated advanced lesions on the right side of the colon were identified in four patients (1.2%) in the average-risk group and one patient (0.4%) in the high-risk group, which was not a significant difference.

The diagnostic ability of flexible sigmoidoscopy to detect any neoplasia was similar for the average-risk and high-risk groups (both 56%).

“Approximately 44% of the neoplasias would have been missed in both groups with flexible sigmoidoscopy alone,” Dr. Jaboori said.

The results suggest that primary care residents and physicians should be trained in colonoscopies. “Increasing the pool of competently trained endoscopists will allow more patients to benefit from screening colonoscopy as the standard of care,” the researchers noted.

Dr. Jaboori had no conflicts of interest to report. The views in the study are those of the authors and do not reflect the policy of the U.S. Army, the Department of Defense, or the U.S. government. To watch a video go to www.youtube.com/user/FamilyPracticeNews

ARLINGTON, VA. — Despite the lack of evidence that over-the-counter cold medicines cure the common cold, nearly two-thirds of American adults choose them to treat symptoms, according to survey results from 1,005 individuals aged 18 and older.

The findings suggest that physicians should continue to educate patients about the limits of nonproven OTC medications and natural remedies for cold prevention and treatment, wrote Dr. Mark Moyad and his colleagues in a poster presented at the annual meeting of the American College of Nutrition.

However, Americans appear to be getting the message about hand hygiene. Overall, 72% of the survey respondents reported frequent handwashing as a first line of defense against cold prevention. Other prevention methods included taking multivitamins (48%), getting plenty of rest (41%), and taking vitamin C supplements (36%).

Once they had developed a cold, 79% of the survey respondents reported drinking lots of fluids, 71% reported getting plenty of rest, and 68% reported using OTC medications.

Data for this study were culled from a nationwide sample of respondents to an online survey conducted as part of a larger research project on the common cold in America that was commissioned by U.S. Nutrition and conducted by Booth Research Services Inc. of Atlanta. Dr. Moyad, of the University of Michigan, Ann Arbor, is on the advisory board of Zila Pharmaceuticals, the manufacturer of the vitamin C supplement Ester-C.

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. — Despite the lack of evidence that over-the-counter cold medicines cure the common cold, nearly two-thirds of American adults choose them to treat symptoms, according to survey results from 1,005 individuals aged 18 and older.

The findings suggest that physicians should continue to educate patients about the limits of nonproven OTC medications and natural remedies for cold prevention and treatment, wrote Dr. Mark Moyad and his colleagues in a poster presented at the annual meeting of the American College of Nutrition.

However, Americans appear to be getting the message about hand hygiene. Overall, 72% of the survey respondents reported frequent handwashing as a first line of defense against cold prevention. Other prevention methods included taking multivitamins (48%), getting plenty of rest (41%), and taking vitamin C supplements (36%).

Once they had developed a cold, 79% of the survey respondents reported drinking lots of fluids, 71% reported getting plenty of rest, and 68% reported using OTC medications.

Data for this study were culled from a nationwide sample of respondents to an online survey conducted as part of a larger research project on the common cold in America that was commissioned by U.S. Nutrition and conducted by Booth Research Services Inc. of Atlanta. Dr. Moyad, of the University of Michigan, Ann Arbor, is on the advisory board of Zila Pharmaceuticals, the manufacturer of the vitamin C supplement Ester-C.

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. — Despite the lack of evidence that over-the-counter cold medicines cure the common cold, nearly two-thirds of American adults choose them to treat symptoms, according to survey results from 1,005 individuals aged 18 and older.

The findings suggest that physicians should continue to educate patients about the limits of nonproven OTC medications and natural remedies for cold prevention and treatment, wrote Dr. Mark Moyad and his colleagues in a poster presented at the annual meeting of the American College of Nutrition.

However, Americans appear to be getting the message about hand hygiene. Overall, 72% of the survey respondents reported frequent handwashing as a first line of defense against cold prevention. Other prevention methods included taking multivitamins (48%), getting plenty of rest (41%), and taking vitamin C supplements (36%).

Once they had developed a cold, 79% of the survey respondents reported drinking lots of fluids, 71% reported getting plenty of rest, and 68% reported using OTC medications.

Data for this study were culled from a nationwide sample of respondents to an online survey conducted as part of a larger research project on the common cold in America that was commissioned by U.S. Nutrition and conducted by Booth Research Services Inc. of Atlanta. Dr. Moyad, of the University of Michigan, Ann Arbor, is on the advisory board of Zila Pharmaceuticals, the manufacturer of the vitamin C supplement Ester-C.

ELSEVIER GLOBAL MEDICAL NEWS