Heidi Splete

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.

Sepsis patients with diabetes are significantly less likely to experience acute respiratory failure than are patients without diabetes, according to data from a review of 930 million hospitalizations over 25 years.

Previous studies have shown that sepsis is common in people with diabetes, and that those patients are less likely to develop acute lung injuries as a result of sepsis. But those studies did not compare organ dysfunction in sepsis patients with and without diabetes.

Dr. Annette Esper of Emory University in Atlanta and her colleagues reviewed National Hospital Discharge Survey data from 1979-2003. The researchers identified 12.5 million cases of sepsis, and 17% of the patients had diabetes. Among those with diabetes and sepsis, 57% were women and 64% were white. The average age was 68 years.

Overall, patients with diabetes and sepsis were significantly more likely to develop acute renal failure than were patients without diabetes (13% vs. 7%), but were significantly less likely (9% vs. 14%) to develop acute respiratory failure (Crit. Care 2009 Feb. 12 [doi:10.1186/cc7717]).

The difference in acute respiratory failure persisted regardless of the infection source. Among patients with a respiratory source of sepsis, those with diabetes were significantly less likely to develop acute respiratory failure than were those without diabetes (16% vs. 23%). The difference in acute respiratory failure rates was also significant for patients with and without diabetes (6% vs. 10%) who had nonpulmonary sources of infection.

Although the overall fatality rate for sepsis patients with diabetes was significantly lower than for those without diabetes (19% vs. 21%), the fatality rates between patients with and without diabetes who developed acute respiratory failure were not significantly different (52% vs. 48%).

Theories as to why respiratory failure rates differ between patients with and without diabetes include blunted inflammatory response to organ dysfunction in people with diabetes, and the possibility that diabetes patients may be hospitalized for sepsis sooner because they are more alert to signs of infection. Diabetes medications may play a role, too. “Many medications administered to patients with [diabetes], including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose,” they noted.

The researchers had no financial conflicts to disclose.

Sepsis patients with diabetes are significantly less likely to experience acute respiratory failure than are patients without diabetes, according to data from a review of 930 million hospitalizations over 25 years.

Previous studies have shown that sepsis is common in people with diabetes, and that those patients are less likely to develop acute lung injuries as a result of sepsis. But those studies did not compare organ dysfunction in sepsis patients with and without diabetes.

Dr. Annette Esper of Emory University in Atlanta and her colleagues reviewed National Hospital Discharge Survey data from 1979-2003. The researchers identified 12.5 million cases of sepsis, and 17% of the patients had diabetes. Among those with diabetes and sepsis, 57% were women and 64% were white. The average age was 68 years.

Overall, patients with diabetes and sepsis were significantly more likely to develop acute renal failure than were patients without diabetes (13% vs. 7%), but were significantly less likely (9% vs. 14%) to develop acute respiratory failure (Crit. Care 2009 Feb. 12 [doi:10.1186/cc7717]).

The difference in acute respiratory failure persisted regardless of the infection source. Among patients with a respiratory source of sepsis, those with diabetes were significantly less likely to develop acute respiratory failure than were those without diabetes (16% vs. 23%). The difference in acute respiratory failure rates was also significant for patients with and without diabetes (6% vs. 10%) who had nonpulmonary sources of infection.

Although the overall fatality rate for sepsis patients with diabetes was significantly lower than for those without diabetes (19% vs. 21%), the fatality rates between patients with and without diabetes who developed acute respiratory failure were not significantly different (52% vs. 48%).

Theories as to why respiratory failure rates differ between patients with and without diabetes include blunted inflammatory response to organ dysfunction in people with diabetes, and the possibility that diabetes patients may be hospitalized for sepsis sooner because they are more alert to signs of infection. Diabetes medications may play a role, too. “Many medications administered to patients with [diabetes], including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose,” they noted.

The researchers had no financial conflicts to disclose.

Sepsis patients with diabetes are significantly less likely to experience acute respiratory failure than are patients without diabetes, according to data from a review of 930 million hospitalizations over 25 years.

Previous studies have shown that sepsis is common in people with diabetes, and that those patients are less likely to develop acute lung injuries as a result of sepsis. But those studies did not compare organ dysfunction in sepsis patients with and without diabetes.

Dr. Annette Esper of Emory University in Atlanta and her colleagues reviewed National Hospital Discharge Survey data from 1979-2003. The researchers identified 12.5 million cases of sepsis, and 17% of the patients had diabetes. Among those with diabetes and sepsis, 57% were women and 64% were white. The average age was 68 years.

Overall, patients with diabetes and sepsis were significantly more likely to develop acute renal failure than were patients without diabetes (13% vs. 7%), but were significantly less likely (9% vs. 14%) to develop acute respiratory failure (Crit. Care 2009 Feb. 12 [doi:10.1186/cc7717]).

The difference in acute respiratory failure persisted regardless of the infection source. Among patients with a respiratory source of sepsis, those with diabetes were significantly less likely to develop acute respiratory failure than were those without diabetes (16% vs. 23%). The difference in acute respiratory failure rates was also significant for patients with and without diabetes (6% vs. 10%) who had nonpulmonary sources of infection.

Although the overall fatality rate for sepsis patients with diabetes was significantly lower than for those without diabetes (19% vs. 21%), the fatality rates between patients with and without diabetes who developed acute respiratory failure were not significantly different (52% vs. 48%).

Theories as to why respiratory failure rates differ between patients with and without diabetes include blunted inflammatory response to organ dysfunction in people with diabetes, and the possibility that diabetes patients may be hospitalized for sepsis sooner because they are more alert to signs of infection. Diabetes medications may play a role, too. “Many medications administered to patients with [diabetes], including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose,” they noted.

The researchers 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 total 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 approximately 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 total 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, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The researchers 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 total 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 approximately 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 total 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, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The researchers 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 total 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 approximately 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 total 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, including its myriad of complications and costs both to individuals and to society,” the researchers wrote.

The researchers had no financial conflicts to disclose.

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 examine the effect of diabetes on dementia 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 study 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 years and 753 developed diabetes at age 65 years or older.

Overall, diabetes was significantly associated with an increased risk of dementia (increased risk of 63%), and patients whose diabetes was diagnosed at midlife were more than twice as likely to develop dementia as those diagnosed with diabetes later in life (increased risk of 176%), even after controlling for diabetes duration and twin factors.

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.

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 examine the effect of diabetes on dementia 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 study 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 years and 753 developed diabetes at age 65 years or older.

Overall, diabetes was significantly associated with an increased risk of dementia (increased risk of 63%), and patients whose diabetes was diagnosed at midlife were more than twice as likely to develop dementia as those diagnosed with diabetes later in life (increased risk of 176%), even after controlling for diabetes duration and twin factors.

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.

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 examine the effect of diabetes on dementia 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 study 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 years and 753 developed diabetes at age 65 years or older.

Overall, diabetes was significantly associated with an increased risk of dementia (increased risk of 63%), and patients whose diabetes was diagnosed at midlife were more than twice as likely to develop dementia as those diagnosed with diabetes later in life (increased risk of 176%), even after controlling for diabetes duration and twin factors.

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.

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.

RIO GRANDE, P.R. — Exercise does not increase foot ulcer rates in adults with diabetic peripheral neuropathy, based on data from 79 adults aged 50 years and older.

The American Diabetes Association recommends moderate physical activity for people with diabetes, but the organization also recommends that people with diabetes and neuropathy limit weight-bearing activity to reduce the risk of foot ulcers.

“This was based on a long-standing assumption that repetitive mechanical stimulation, which the feet endure during walking, would lead to foot ulcers in those with neuropathy, an assumption that has remained untested since rat foot pad studies in the 1970s,” said Dr. Joseph LeMaster of the University of Missouri-Columbia.

Previous studies have shown that people with diabetes who walk regularly can reduce their risk of developing complications such as cardiovascular disease, Dr. LeMaster said.

To determine whether regular walking increased the risk of foot ulcers, Dr. LeMaster and his colleagues conducted a randomized, controlled trial known as Feet First, in which 41 adults received an intervention that included leg strengthening and balance exercises, directions for a self-guided walking program, and telephone support every 2 weeks. Dr. LeMaster presented the results at the annual meeting of the North American Primary Care Research Group.

Both the intervention group and a control group of 38 adults received foot care education, regular foot checks, and eight sessions with a physical therapist, but the control group received no additional exercise intervention. The average age of the patients was 66 years, and 51% were women (Phys. Ther. 2008;88:1385–98).

After 6 months, the average number of total daily steps taken was not significantly different between the two groups, although the total steps decreased by 13% in the control group. But participants in the intervention group increased the steps taken during a 30-minute exercise session by 14% from baseline, compared with a 6% decrease in the control group.

Although the activity level was less than the researchers hoped for, the results suggest that the intervention helped prevent a decrease in activity, Dr. LeMaster said.

Overall, 22 lesions occurred in the intervention group and 14 in the control group after 6 months, but this difference was not significant. This number increased to 27 lesions in the intervention group and 21 in the control group after 12 months. The total of 48 lesions excluded 9 lesions that resulted from trauma during self-care (such as cutting a toe while trimming a toenail).

The overall ulcer rates were similar between the groups at 6 months, but by 12 months the rate of weight-bearing full-thickness plantar lesions was higher in the control group, compared with the intervention group (five lesions vs. one).

“We conclude that intervention achieved a modest increase in daily ambulatory activity,” Dr. LeMaster said. “Prescribing these patients a carefully monitored program in which they gradually increase walking over several months is probably safe,” he said. But he noted that careful attention to footwear and regular foot checks are important.

The study was limited by wide confidence intervals, “so we can only draw preliminary conclusions about the effect of the intervention on foot ulcers,” he said.

But gradually increasing activity is the key to success for diabetic neuropathy patients, he said during a question-and-answer session. When asked what clinicians can tell diabetic neuropathy patients about increasing activity, he emphasized using a pedometer to ensure a gradual increase in activity. Ulcers are more likely to occur when someone has been inactive and tries to increase activity too quickly, he said.

The Feet First study was sponsored by the Robert Wood Johnson Foundation. Dr. LeMaster and his colleagues have received funding from the National Institutes of Health for a follow-up study that will involve working more closely with patients to increase activity.

RIO GRANDE, P.R. — Exercise does not increase foot ulcer rates in adults with diabetic peripheral neuropathy, based on data from 79 adults aged 50 years and older.

The American Diabetes Association recommends moderate physical activity for people with diabetes, but the organization also recommends that people with diabetes and neuropathy limit weight-bearing activity to reduce the risk of foot ulcers.

“This was based on a long-standing assumption that repetitive mechanical stimulation, which the feet endure during walking, would lead to foot ulcers in those with neuropathy, an assumption that has remained untested since rat foot pad studies in the 1970s,” said Dr. Joseph LeMaster of the University of Missouri-Columbia.

Previous studies have shown that people with diabetes who walk regularly can reduce their risk of developing complications such as cardiovascular disease, Dr. LeMaster said.

To determine whether regular walking increased the risk of foot ulcers, Dr. LeMaster and his colleagues conducted a randomized, controlled trial known as Feet First, in which 41 adults received an intervention that included leg strengthening and balance exercises, directions for a self-guided walking program, and telephone support every 2 weeks. Dr. LeMaster presented the results at the annual meeting of the North American Primary Care Research Group.

Both the intervention group and a control group of 38 adults received foot care education, regular foot checks, and eight sessions with a physical therapist, but the control group received no additional exercise intervention. The average age of the patients was 66 years, and 51% were women (Phys. Ther. 2008;88:1385–98).

After 6 months, the average number of total daily steps taken was not significantly different between the two groups, although the total steps decreased by 13% in the control group. But participants in the intervention group increased the steps taken during a 30-minute exercise session by 14% from baseline, compared with a 6% decrease in the control group.

Although the activity level was less than the researchers hoped for, the results suggest that the intervention helped prevent a decrease in activity, Dr. LeMaster said.

Overall, 22 lesions occurred in the intervention group and 14 in the control group after 6 months, but this difference was not significant. This number increased to 27 lesions in the intervention group and 21 in the control group after 12 months. The total of 48 lesions excluded 9 lesions that resulted from trauma during self-care (such as cutting a toe while trimming a toenail).

The overall ulcer rates were similar between the groups at 6 months, but by 12 months the rate of weight-bearing full-thickness plantar lesions was higher in the control group, compared with the intervention group (five lesions vs. one).

“We conclude that intervention achieved a modest increase in daily ambulatory activity,” Dr. LeMaster said. “Prescribing these patients a carefully monitored program in which they gradually increase walking over several months is probably safe,” he said. But he noted that careful attention to footwear and regular foot checks are important.

The study was limited by wide confidence intervals, “so we can only draw preliminary conclusions about the effect of the intervention on foot ulcers,” he said.

But gradually increasing activity is the key to success for diabetic neuropathy patients, he said during a question-and-answer session. When asked what clinicians can tell diabetic neuropathy patients about increasing activity, he emphasized using a pedometer to ensure a gradual increase in activity. Ulcers are more likely to occur when someone has been inactive and tries to increase activity too quickly, he said.

The Feet First study was sponsored by the Robert Wood Johnson Foundation. Dr. LeMaster and his colleagues have received funding from the National Institutes of Health for a follow-up study that will involve working more closely with patients to increase activity.

RIO GRANDE, P.R. — Exercise does not increase foot ulcer rates in adults with diabetic peripheral neuropathy, based on data from 79 adults aged 50 years and older.

The American Diabetes Association recommends moderate physical activity for people with diabetes, but the organization also recommends that people with diabetes and neuropathy limit weight-bearing activity to reduce the risk of foot ulcers.

“This was based on a long-standing assumption that repetitive mechanical stimulation, which the feet endure during walking, would lead to foot ulcers in those with neuropathy, an assumption that has remained untested since rat foot pad studies in the 1970s,” said Dr. Joseph LeMaster of the University of Missouri-Columbia.

Previous studies have shown that people with diabetes who walk regularly can reduce their risk of developing complications such as cardiovascular disease, Dr. LeMaster said.

To determine whether regular walking increased the risk of foot ulcers, Dr. LeMaster and his colleagues conducted a randomized, controlled trial known as Feet First, in which 41 adults received an intervention that included leg strengthening and balance exercises, directions for a self-guided walking program, and telephone support every 2 weeks. Dr. LeMaster presented the results at the annual meeting of the North American Primary Care Research Group.

Both the intervention group and a control group of 38 adults received foot care education, regular foot checks, and eight sessions with a physical therapist, but the control group received no additional exercise intervention. The average age of the patients was 66 years, and 51% were women (Phys. Ther. 2008;88:1385–98).

After 6 months, the average number of total daily steps taken was not significantly different between the two groups, although the total steps decreased by 13% in the control group. But participants in the intervention group increased the steps taken during a 30-minute exercise session by 14% from baseline, compared with a 6% decrease in the control group.

Although the activity level was less than the researchers hoped for, the results suggest that the intervention helped prevent a decrease in activity, Dr. LeMaster said.

Overall, 22 lesions occurred in the intervention group and 14 in the control group after 6 months, but this difference was not significant. This number increased to 27 lesions in the intervention group and 21 in the control group after 12 months. The total of 48 lesions excluded 9 lesions that resulted from trauma during self-care (such as cutting a toe while trimming a toenail).

The overall ulcer rates were similar between the groups at 6 months, but by 12 months the rate of weight-bearing full-thickness plantar lesions was higher in the control group, compared with the intervention group (five lesions vs. one).

“We conclude that intervention achieved a modest increase in daily ambulatory activity,” Dr. LeMaster said. “Prescribing these patients a carefully monitored program in which they gradually increase walking over several months is probably safe,” he said. But he noted that careful attention to footwear and regular foot checks are important.

The study was limited by wide confidence intervals, “so we can only draw preliminary conclusions about the effect of the intervention on foot ulcers,” he said.

But gradually increasing activity is the key to success for diabetic neuropathy patients, he said during a question-and-answer session. When asked what clinicians can tell diabetic neuropathy patients about increasing activity, he emphasized using a pedometer to ensure a gradual increase in activity. Ulcers are more likely to occur when someone has been inactive and tries to increase activity too quickly, he said.

The Feet First study was sponsored by the Robert Wood Johnson Foundation. Dr. LeMaster and his colleagues have received funding from the National Institutes of Health for a follow-up study that will involve working more closely with patients to increase activity.

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 and the annual meeting of the Infectious Diseases Society of America.

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. 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 and the annual meeting of the Infectious Diseases Society of America.

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. 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 and the annual meeting of the Infectious Diseases Society of America.

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. Dr. Shust reported no financial conflicts of interest.

RIO GRANDE, P.R. — A majority of health care providers said they would not insert an IUD before obtaining Pap test or colposcopy results in a recently postpartum woman with low-grade squamous epithelial lesions, according to results of a survey of nearly 300 participants.

Although evidence does not support a connection between IUDs and an increased risk of cervical dysplasia, many providers require screening tests before inserting IUDs, which may leave women vulnerable to unintended pregnancy, the researchers said.

To determine health care providers' attitudes about screening tests and IUDs, Dr. Tara Stein and Dr. Marji Gold of Albert Einstein College of Medicine, New York, surveyed 294 providers: 214 colposcopy providers and 80 providers who do not perform colposcopies. The average age of the participants was 44 years. Approximately half of the providers reported that they had inserted 1–20 IUDs during the past year. The participants were recruited for the survey while attending academic conferences, and the results were presented in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, 88% of colposcopy providers and 90% of noncolposcopy providers said that they would insert an IUD without Pap test or colposcopy results if the patient were a 30-year-old woman whose last normal Pap was 2 years ago.

By contrast, 27% of colposcopy providers and 17% of noncolposcopy providers said that they would insert an IUD without Pap or colposcopy results if the patient were a 28-year-old woman who was 6 weeks post partum with a history of low-grade squamous epithelial lesions (LSIL) during pregnancy.

Although the presence of LSIL increases the risk of cervical dysplasia, only 1% of the survey respondents said they believed that the copper T 380 and levonorgestrel intrauterine systems worsen cervical dysplasia.

The researchers had no financial conflicts to disclose.

RIO GRANDE, P.R. — A majority of health care providers said they would not insert an IUD before obtaining Pap test or colposcopy results in a recently postpartum woman with low-grade squamous epithelial lesions, according to results of a survey of nearly 300 participants.

Although evidence does not support a connection between IUDs and an increased risk of cervical dysplasia, many providers require screening tests before inserting IUDs, which may leave women vulnerable to unintended pregnancy, the researchers said.

To determine health care providers' attitudes about screening tests and IUDs, Dr. Tara Stein and Dr. Marji Gold of Albert Einstein College of Medicine, New York, surveyed 294 providers: 214 colposcopy providers and 80 providers who do not perform colposcopies. The average age of the participants was 44 years. Approximately half of the providers reported that they had inserted 1–20 IUDs during the past year. The participants were recruited for the survey while attending academic conferences, and the results were presented in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, 88% of colposcopy providers and 90% of noncolposcopy providers said that they would insert an IUD without Pap test or colposcopy results if the patient were a 30-year-old woman whose last normal Pap was 2 years ago.

By contrast, 27% of colposcopy providers and 17% of noncolposcopy providers said that they would insert an IUD without Pap or colposcopy results if the patient were a 28-year-old woman who was 6 weeks post partum with a history of low-grade squamous epithelial lesions (LSIL) during pregnancy.

Although the presence of LSIL increases the risk of cervical dysplasia, only 1% of the survey respondents said they believed that the copper T 380 and levonorgestrel intrauterine systems worsen cervical dysplasia.

The researchers had no financial conflicts to disclose.

RIO GRANDE, P.R. — A majority of health care providers said they would not insert an IUD before obtaining Pap test or colposcopy results in a recently postpartum woman with low-grade squamous epithelial lesions, according to results of a survey of nearly 300 participants.

Although evidence does not support a connection between IUDs and an increased risk of cervical dysplasia, many providers require screening tests before inserting IUDs, which may leave women vulnerable to unintended pregnancy, the researchers said.

To determine health care providers' attitudes about screening tests and IUDs, Dr. Tara Stein and Dr. Marji Gold of Albert Einstein College of Medicine, New York, surveyed 294 providers: 214 colposcopy providers and 80 providers who do not perform colposcopies. The average age of the participants was 44 years. Approximately half of the providers reported that they had inserted 1–20 IUDs during the past year. The participants were recruited for the survey while attending academic conferences, and the results were presented in a poster at the annual meeting of the North American Primary Care Research Group.

Overall, 88% of colposcopy providers and 90% of noncolposcopy providers said that they would insert an IUD without Pap test or colposcopy results if the patient were a 30-year-old woman whose last normal Pap was 2 years ago.

By contrast, 27% of colposcopy providers and 17% of noncolposcopy providers said that they would insert an IUD without Pap or colposcopy results if the patient were a 28-year-old woman who was 6 weeks post partum with a history of low-grade squamous epithelial lesions (LSIL) during pregnancy.

Although the presence of LSIL increases the risk of cervical dysplasia, only 1% of the survey respondents said they believed that the copper T 380 and levonorgestrel intrauterine systems worsen cervical dysplasia.

The researchers 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, providers 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 providers 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.

Clinicians can continue to remind patients to provide as much family history as possible, but it may take time to resolve technical and privacy issues before an electronic family health history becomes a seamless part of an electronic medical record, he 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, providers 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 providers 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.

Clinicians can continue to remind patients to provide as much family history as possible, but it may take time to resolve technical and privacy issues before an electronic family health history becomes a seamless part of an electronic medical record, he 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, providers 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 providers 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.

Clinicians can continue to remind patients to provide as much family history as possible, but it may take time to resolve technical and privacy issues before an electronic family health history becomes a seamless part of an electronic medical record, he 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.