Heidi Splete

ARLINGTON, VA.–Approximately 40 million Americans are affected by sleep disorders, and more than 100,000 motor vehicle accidents per year are sleep related, Teodor Postolache, M.D., said at the annual conference of the Academy of Organizational and Occupational Psychiatry.

An understanding of the biologic rhythms that are associated with disruptive sleep gives psychiatrists additional perspectives on occupational problems.

Inadequate sleep, for example, could trigger a manic episode in a bipolar disorder patient, which could lead to a confrontation at work and the loss of a job, said Dr. Postolache of the University of Maryland, Baltimore.

Biologic rhythms are based on the movement of the earth and sun. They are internally generated–they occur in anticipation of environmental conditions–and circadian rhythms are the biologic rhythms based on a 24-hour cycle, explained Dr. Postolache, who specializes in consulting with travelers and athletes about aligning circadian rhythms to maximize physical and mental performance on arrival.

“One of the major roles of the circadian system is to consolidate periods of wakefulness and sleep,” as opposed to sleeping and waking several times during the day, he said. As people become sleepier, the circadian system sends signals to maintain alertness.

The circadian system raises the threshold for sleep in the evening, when sleepiness is at a maximum, and lowers that threshold in the early morning hours.

However, biologic rhythms vary with the individual, and laboratory research has shown that individual biologic rhythms impact cognitive performance. Psychiatrists–especially occupational psychiatrists–should keep this in mind.

Some people are “short sleepers” whose cognition does not improve if they sleep more than 7 or 8 hours, while others are “long sleepers” who truly need 10 hours of sleep to function at their best, Dr. Postolache said. Strategies that are aimed at helping sleep-disturbed patients get in tune with their biologic rhythms include taking naps and using light boxes and melatonin.

Naps

A 1-hour nap has been shown to pay back as much as 4 hours of sleep debt. As a result, naps should be seen as a drug-free intervention for sleepiness, and certain conditions make them more effective.

Silence and darkness are key for quality naps, as is elevation of the feet, and the hands and feet should be comfortably warm. For some people, soothing music facilitates a nap, according to Dr. Postolache.

One caveat, however, is a “terrible drop in vigilance” immediately following a nap, he said. Known as sleep inertia, this period lasts an average of 15–20 minutes, but can last up to 2 hours in rare cases.

In fact, studies have shown that hospital residents are prone to making major mistakes during the first 15–20 minutes after a nap.

From an occupational standpoint, those people who take naps at work should be given simple tasks to do when they first awaken.

“Those 20 minutes after waking up should not be a time when someone should be required to make major life or business decisions,” Dr. Postolache said.

Light boxes

Available in various forms and sizes, they help travelers shift their biologic rhythms to function at their best. Light boxes also may ease the discomfort of shift workers who are changing from a night shift to a day shift.

Melatonin

It is secreted in the dark, promotes sleepiness, and has been used to measure circadian rhythms. An onset of melatonin secretion occurs in the evening, followed by a rapid rise and then a plateau during the night.

The duration of melatonin secretion lengthens when the nights are long and shrinks when nights are short, he said.

Evidence for melatonin as a sleep agent is weak, but some evidence supports its use to reduce jet lag. A Cochrane Review (Cochrane Database Syst. Rev. 2002;2:CD001520) suggested that melatonin can relieve jet lag in people with a history of jet lag who are flying east (CLINICAL PSYCHIATRY NEWS, October 2004, p. 63).

Side effects of melatonin include drowsiness, decreased attention, GI symptoms, and possible antigonadal steroid effects, and it should be used on an as-needed basis, Dr. Postolache noted.

ARLINGTON, VA.–Approximately 40 million Americans are affected by sleep disorders, and more than 100,000 motor vehicle accidents per year are sleep related, Teodor Postolache, M.D., said at the annual conference of the Academy of Organizational and Occupational Psychiatry.

An understanding of the biologic rhythms that are associated with disruptive sleep gives psychiatrists additional perspectives on occupational problems.

Inadequate sleep, for example, could trigger a manic episode in a bipolar disorder patient, which could lead to a confrontation at work and the loss of a job, said Dr. Postolache of the University of Maryland, Baltimore.

Biologic rhythms are based on the movement of the earth and sun. They are internally generated–they occur in anticipation of environmental conditions–and circadian rhythms are the biologic rhythms based on a 24-hour cycle, explained Dr. Postolache, who specializes in consulting with travelers and athletes about aligning circadian rhythms to maximize physical and mental performance on arrival.

“One of the major roles of the circadian system is to consolidate periods of wakefulness and sleep,” as opposed to sleeping and waking several times during the day, he said. As people become sleepier, the circadian system sends signals to maintain alertness.

The circadian system raises the threshold for sleep in the evening, when sleepiness is at a maximum, and lowers that threshold in the early morning hours.

However, biologic rhythms vary with the individual, and laboratory research has shown that individual biologic rhythms impact cognitive performance. Psychiatrists–especially occupational psychiatrists–should keep this in mind.

Some people are “short sleepers” whose cognition does not improve if they sleep more than 7 or 8 hours, while others are “long sleepers” who truly need 10 hours of sleep to function at their best, Dr. Postolache said. Strategies that are aimed at helping sleep-disturbed patients get in tune with their biologic rhythms include taking naps and using light boxes and melatonin.

Naps

A 1-hour nap has been shown to pay back as much as 4 hours of sleep debt. As a result, naps should be seen as a drug-free intervention for sleepiness, and certain conditions make them more effective.

Silence and darkness are key for quality naps, as is elevation of the feet, and the hands and feet should be comfortably warm. For some people, soothing music facilitates a nap, according to Dr. Postolache.

One caveat, however, is a “terrible drop in vigilance” immediately following a nap, he said. Known as sleep inertia, this period lasts an average of 15–20 minutes, but can last up to 2 hours in rare cases.

In fact, studies have shown that hospital residents are prone to making major mistakes during the first 15–20 minutes after a nap.

From an occupational standpoint, those people who take naps at work should be given simple tasks to do when they first awaken.

“Those 20 minutes after waking up should not be a time when someone should be required to make major life or business decisions,” Dr. Postolache said.

Light boxes

Available in various forms and sizes, they help travelers shift their biologic rhythms to function at their best. Light boxes also may ease the discomfort of shift workers who are changing from a night shift to a day shift.

Melatonin

It is secreted in the dark, promotes sleepiness, and has been used to measure circadian rhythms. An onset of melatonin secretion occurs in the evening, followed by a rapid rise and then a plateau during the night.

The duration of melatonin secretion lengthens when the nights are long and shrinks when nights are short, he said.

Evidence for melatonin as a sleep agent is weak, but some evidence supports its use to reduce jet lag. A Cochrane Review (Cochrane Database Syst. Rev. 2002;2:CD001520) suggested that melatonin can relieve jet lag in people with a history of jet lag who are flying east (CLINICAL PSYCHIATRY NEWS, October 2004, p. 63).

Side effects of melatonin include drowsiness, decreased attention, GI symptoms, and possible antigonadal steroid effects, and it should be used on an as-needed basis, Dr. Postolache noted.

ARLINGTON, VA.–Approximately 40 million Americans are affected by sleep disorders, and more than 100,000 motor vehicle accidents per year are sleep related, Teodor Postolache, M.D., said at the annual conference of the Academy of Organizational and Occupational Psychiatry.

An understanding of the biologic rhythms that are associated with disruptive sleep gives psychiatrists additional perspectives on occupational problems.

Inadequate sleep, for example, could trigger a manic episode in a bipolar disorder patient, which could lead to a confrontation at work and the loss of a job, said Dr. Postolache of the University of Maryland, Baltimore.

Biologic rhythms are based on the movement of the earth and sun. They are internally generated–they occur in anticipation of environmental conditions–and circadian rhythms are the biologic rhythms based on a 24-hour cycle, explained Dr. Postolache, who specializes in consulting with travelers and athletes about aligning circadian rhythms to maximize physical and mental performance on arrival.

“One of the major roles of the circadian system is to consolidate periods of wakefulness and sleep,” as opposed to sleeping and waking several times during the day, he said. As people become sleepier, the circadian system sends signals to maintain alertness.

The circadian system raises the threshold for sleep in the evening, when sleepiness is at a maximum, and lowers that threshold in the early morning hours.

However, biologic rhythms vary with the individual, and laboratory research has shown that individual biologic rhythms impact cognitive performance. Psychiatrists–especially occupational psychiatrists–should keep this in mind.

Some people are “short sleepers” whose cognition does not improve if they sleep more than 7 or 8 hours, while others are “long sleepers” who truly need 10 hours of sleep to function at their best, Dr. Postolache said. Strategies that are aimed at helping sleep-disturbed patients get in tune with their biologic rhythms include taking naps and using light boxes and melatonin.

Naps

A 1-hour nap has been shown to pay back as much as 4 hours of sleep debt. As a result, naps should be seen as a drug-free intervention for sleepiness, and certain conditions make them more effective.

Silence and darkness are key for quality naps, as is elevation of the feet, and the hands and feet should be comfortably warm. For some people, soothing music facilitates a nap, according to Dr. Postolache.

One caveat, however, is a “terrible drop in vigilance” immediately following a nap, he said. Known as sleep inertia, this period lasts an average of 15–20 minutes, but can last up to 2 hours in rare cases.

In fact, studies have shown that hospital residents are prone to making major mistakes during the first 15–20 minutes after a nap.

From an occupational standpoint, those people who take naps at work should be given simple tasks to do when they first awaken.

“Those 20 minutes after waking up should not be a time when someone should be required to make major life or business decisions,” Dr. Postolache said.

Light boxes

Available in various forms and sizes, they help travelers shift their biologic rhythms to function at their best. Light boxes also may ease the discomfort of shift workers who are changing from a night shift to a day shift.

Melatonin

It is secreted in the dark, promotes sleepiness, and has been used to measure circadian rhythms. An onset of melatonin secretion occurs in the evening, followed by a rapid rise and then a plateau during the night.

The duration of melatonin secretion lengthens when the nights are long and shrinks when nights are short, he said.

Evidence for melatonin as a sleep agent is weak, but some evidence supports its use to reduce jet lag. A Cochrane Review (Cochrane Database Syst. Rev. 2002;2:CD001520) suggested that melatonin can relieve jet lag in people with a history of jet lag who are flying east (CLINICAL PSYCHIATRY NEWS, October 2004, p. 63).

Side effects of melatonin include drowsiness, decreased attention, GI symptoms, and possible antigonadal steroid effects, and it should be used on an as-needed basis, Dr. Postolache noted.

WASHINGTON – Patients with severe opioid use immediately prior to treatment may not adhere to buprenorphine in an office-based setting, said Michael Pantalon, Ph.D.

In an ongoing randomized clinical trial, 91 opioid-dependent patients took daily buprenorphine/naloxone maintenance doses in a primary care clinic. After 24 weeks, the investigators classified the patients as “high-stable” adherence (52), “fluctuating-deteriorating” adherence (23) and “poor-flat” adherence (16). Baseline evaluations included motivation for treatment, severity of psychiatric and addictive symptoms, and urinalysis.

Overall, the 52 “high-stable” patients had spent significantly less money on drugs prior to treatment, and reported significantly fewer days of heroin use prior to treatment compared with those in both the “fluctuating-deteriorating” and “poor-flat” groups, Dr. Pantalon and his colleagues at Yale University, New Haven, reported in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The “high-stable” patients also were significantly less likely to name heroin as their major problem, compared with oxycodone (OxyContin) or other opiates, and they were significantly less likely to test positive for opioids before starting buprenorphine treatment. These data suggest that office-based treatment alone may not be sufficient for severe addicts, the investigators noted.

The conference was sponsored by Brown Medical School.

WASHINGTON – Patients with severe opioid use immediately prior to treatment may not adhere to buprenorphine in an office-based setting, said Michael Pantalon, Ph.D.

In an ongoing randomized clinical trial, 91 opioid-dependent patients took daily buprenorphine/naloxone maintenance doses in a primary care clinic. After 24 weeks, the investigators classified the patients as “high-stable” adherence (52), “fluctuating-deteriorating” adherence (23) and “poor-flat” adherence (16). Baseline evaluations included motivation for treatment, severity of psychiatric and addictive symptoms, and urinalysis.

Overall, the 52 “high-stable” patients had spent significantly less money on drugs prior to treatment, and reported significantly fewer days of heroin use prior to treatment compared with those in both the “fluctuating-deteriorating” and “poor-flat” groups, Dr. Pantalon and his colleagues at Yale University, New Haven, reported in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The “high-stable” patients also were significantly less likely to name heroin as their major problem, compared with oxycodone (OxyContin) or other opiates, and they were significantly less likely to test positive for opioids before starting buprenorphine treatment. These data suggest that office-based treatment alone may not be sufficient for severe addicts, the investigators noted.

The conference was sponsored by Brown Medical School.

WASHINGTON – Patients with severe opioid use immediately prior to treatment may not adhere to buprenorphine in an office-based setting, said Michael Pantalon, Ph.D.

In an ongoing randomized clinical trial, 91 opioid-dependent patients took daily buprenorphine/naloxone maintenance doses in a primary care clinic. After 24 weeks, the investigators classified the patients as “high-stable” adherence (52), “fluctuating-deteriorating” adherence (23) and “poor-flat” adherence (16). Baseline evaluations included motivation for treatment, severity of psychiatric and addictive symptoms, and urinalysis.

Overall, the 52 “high-stable” patients had spent significantly less money on drugs prior to treatment, and reported significantly fewer days of heroin use prior to treatment compared with those in both the “fluctuating-deteriorating” and “poor-flat” groups, Dr. Pantalon and his colleagues at Yale University, New Haven, reported in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

The “high-stable” patients also were significantly less likely to name heroin as their major problem, compared with oxycodone (OxyContin) or other opiates, and they were significantly less likely to test positive for opioids before starting buprenorphine treatment. These data suggest that office-based treatment alone may not be sufficient for severe addicts, the investigators noted.

The conference was sponsored by Brown Medical School.

WASHINGTON – Screening and intervention for alcohol problems can enhance the quality of a primary care visit, at least from a hazardous drinker's perspective.

Perceived quality of care, however, was not associated with the odds of hazardous drinking 6 months after the office visit, reported Richard Saitz, M.D., in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

In a regression analysis, Dr. Saitz of Boston University and his colleagues assessed the responses of 288 adult hazardous drinkers who saw 40 physicians for a general office visit. The patients' mean age was 43 years, 57% were black, 61% were men, and 71% saw a physician that they had seen on a prior occasion. They averaged six drinks per drinking day.

After the office visits, the patients were asked whether they had received alcohol counseling, such as advice on safe drinking limits or advice to cut down on or abstain from drinking.

After adjusting for variables, such as sex, race, education, comorbidity, level of physician training, previous visits to the same physician, and current alcohol problems, the mean scores in three areas of the Primary Care Assessment Survey–communication, comprehensiveness, and trust–were significantly higher among the 132 patients who said they had received alcohol counseling, compared with the 156 who said they had not received counseling, said Dr. Saitz at the conference, also sponsored by Brown Medical School.

Average quality scores (on a scale of 1–100) were significantly higher among the patients who received counseling, compared with scores of those who did not, in the areas of communication (85 vs. 76) and comprehensiveness (67 vs. 59). The average trust score was slightly higher among patients who received counseling than among those who didn't (79 vs. 77), but the difference was not statistically significant.

WASHINGTON – Screening and intervention for alcohol problems can enhance the quality of a primary care visit, at least from a hazardous drinker's perspective.

Perceived quality of care, however, was not associated with the odds of hazardous drinking 6 months after the office visit, reported Richard Saitz, M.D., in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

In a regression analysis, Dr. Saitz of Boston University and his colleagues assessed the responses of 288 adult hazardous drinkers who saw 40 physicians for a general office visit. The patients' mean age was 43 years, 57% were black, 61% were men, and 71% saw a physician that they had seen on a prior occasion. They averaged six drinks per drinking day.

After the office visits, the patients were asked whether they had received alcohol counseling, such as advice on safe drinking limits or advice to cut down on or abstain from drinking.

After adjusting for variables, such as sex, race, education, comorbidity, level of physician training, previous visits to the same physician, and current alcohol problems, the mean scores in three areas of the Primary Care Assessment Survey–communication, comprehensiveness, and trust–were significantly higher among the 132 patients who said they had received alcohol counseling, compared with the 156 who said they had not received counseling, said Dr. Saitz at the conference, also sponsored by Brown Medical School.

Average quality scores (on a scale of 1–100) were significantly higher among the patients who received counseling, compared with scores of those who did not, in the areas of communication (85 vs. 76) and comprehensiveness (67 vs. 59). The average trust score was slightly higher among patients who received counseling than among those who didn't (79 vs. 77), but the difference was not statistically significant.

WASHINGTON – Screening and intervention for alcohol problems can enhance the quality of a primary care visit, at least from a hazardous drinker's perspective.

Perceived quality of care, however, was not associated with the odds of hazardous drinking 6 months after the office visit, reported Richard Saitz, M.D., in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

In a regression analysis, Dr. Saitz of Boston University and his colleagues assessed the responses of 288 adult hazardous drinkers who saw 40 physicians for a general office visit. The patients' mean age was 43 years, 57% were black, 61% were men, and 71% saw a physician that they had seen on a prior occasion. They averaged six drinks per drinking day.

After the office visits, the patients were asked whether they had received alcohol counseling, such as advice on safe drinking limits or advice to cut down on or abstain from drinking.

After adjusting for variables, such as sex, race, education, comorbidity, level of physician training, previous visits to the same physician, and current alcohol problems, the mean scores in three areas of the Primary Care Assessment Survey–communication, comprehensiveness, and trust–were significantly higher among the 132 patients who said they had received alcohol counseling, compared with the 156 who said they had not received counseling, said Dr. Saitz at the conference, also sponsored by Brown Medical School.

Average quality scores (on a scale of 1–100) were significantly higher among the patients who received counseling, compared with scores of those who did not, in the areas of communication (85 vs. 76) and comprehensiveness (67 vs. 59). The average trust score was slightly higher among patients who received counseling than among those who didn't (79 vs. 77), but the difference was not statistically significant.

WASHINGTON – When doctors talk about exercise, older adults listen, Shaun Nelson said at the annual meeting of the Gerontological Society of America.

A caring, empathetic physician who counsels patients aged 60 and older about exercise will probably make an impression, even if the doctor is not a paragon of fitness, said Mr. Nelson, an MPH candidate at the University of Illinois, Chicago, who conducted focus group interviews of 28 adults aged 60–74 years. As one woman noted during the interviews, “You like a doctor that seems to be worried about your welfare. … I guess if they were [role models] it might be better. But to me, that really wouldn't be a factor.”

Older adults are receptive to exercise counseling as a way to manage chronic pain and to avoid medication, Mr. Nelson said. One white male patient reported, “My cholesterol was up. And [the doctor] told me about it, and we set up a plan, again, to exercise more and to diet. Didn't even think of any type of drug–that wasn't even a consideration.”

In general, women were more likely to view a doctor's persistence in exercise counseling as caring rather than nagging, were more likely to fit in exercise when they could, and were more encouraged by qualitative benefits, such as better-fitting clothes. Men were more likely to view a doctor's persistent exercise counseling as nagging, were more likely to have a fixed schedule for exercise, and were encouraged by quantitative benefits, such as a lower blood pressure.

Black patients were less likely to have a long visit with their doctors and were less likely to consider water exercise because of fear of water and not knowing how to swim; white patients were more likely to express concerns about repeated dressing and undressing, and having to find a place to park at a gym.

Mr. Nelson's work was part of a grant from the Robert Wood Johnson Foundation to study physicians' and older adults' experiences with exercise counseling during an office visit. The grant also supported studies of the physician perspective conducted by Daphne Schneider, M.D., of Cornell University, New York, and Karen Peters, Dr.P.H., of the University of Illinois, Rockford.

Dr. Schneider interviewed a convenience sample of 37 public and private sector physicians in urban and suburban areas about discussing exercise with older patients. Sixty-two percent of the physicians specialized in family medicine, 33% specialized in internal medicine, and 35% were board certified in geriatrics. Their mean age was 46 years, and they had completed medical studies between 1963 and 2003. Most of the doctors were white (70%), and 51% were women.

All the physicians reported that they counseled some older patients about exercise, and nearly a third of them said that they counseled all patients about exercise. However, the physicians' perceptions varied as to their roles as exercise advocates. While most saw themselves as coaches/teachers, some saw themselves as authority figures whose words carried real weight with patients, and others said that the implementation of exercise recommendations would be better handled by a nurse-practitioner or trainer.

Physicians cited discussion of a patient's chronic condition, diagnosis of a chronic illness, or the possible need to start a new medication, as the best opportunities for exercise counseling. One physician told a diabetic woman that she might not need to use insulin if she could watch her diet and motivate herself to exercise. “She came back 3 months later and her hemoglobin A_1C was less than 7. She had been swimming every day, sometimes she rode a bicycle, and she was saying how she felt much better, and her sugars were better, and she was happy,” the physician said.

Barriers to exercise counseling during an office visit included lack of training, lack of time, and lack of a reimbursement mechanism. As one physician noted, the complicated medical histories of geriatric patients often push exercise counseling to the bottom of a list of issues to be addressed in an office visit. From a financial perspective, “taking more time and doing exercise counseling looks like an unaffordable luxury,” the physician recounted.

Physicians who treat older patients in rural areas have issues similar to their suburban counterparts regarding exercise counseling for seniors. Dr. Peters analyzed results of a mail-in survey returned by 11 family physicians and one nurse-practitioner aged 31–54 years from her ongoing study of exercise counseling in rural Illinois counties. All the physicians in the rural study said that exercise was relevant to their older patients, and 75% said they recommended exercise in the context of chronic disease management; 58% said they recommended exercise in the context of weight loss and in the context of a routine health and physical exam.

Half of the rural physicians viewed their roles as educational in terms of exercise counseling. In addition, 42% saw themselves in a support/advocate role. The physicians noted that 75% of their older patients cited lack of time as a perceived barrier to exercise, and 42% cited joint pain as a barrier.

Physicians should know that older adults are receptive to exercise counseling if it is presented in a caring and empathetic way, with attention to racial and gender preferences, according to the presenters.

WASHINGTON – When doctors talk about exercise, older adults listen, Shaun Nelson said at the annual meeting of the Gerontological Society of America.

A caring, empathetic physician who counsels patients aged 60 and older about exercise will probably make an impression, even if the doctor is not a paragon of fitness, said Mr. Nelson, an MPH candidate at the University of Illinois, Chicago, who conducted focus group interviews of 28 adults aged 60–74 years. As one woman noted during the interviews, “You like a doctor that seems to be worried about your welfare. … I guess if they were [role models] it might be better. But to me, that really wouldn't be a factor.”

Older adults are receptive to exercise counseling as a way to manage chronic pain and to avoid medication, Mr. Nelson said. One white male patient reported, “My cholesterol was up. And [the doctor] told me about it, and we set up a plan, again, to exercise more and to diet. Didn't even think of any type of drug–that wasn't even a consideration.”

In general, women were more likely to view a doctor's persistence in exercise counseling as caring rather than nagging, were more likely to fit in exercise when they could, and were more encouraged by qualitative benefits, such as better-fitting clothes. Men were more likely to view a doctor's persistent exercise counseling as nagging, were more likely to have a fixed schedule for exercise, and were encouraged by quantitative benefits, such as a lower blood pressure.

Black patients were less likely to have a long visit with their doctors and were less likely to consider water exercise because of fear of water and not knowing how to swim; white patients were more likely to express concerns about repeated dressing and undressing, and having to find a place to park at a gym.

Mr. Nelson's work was part of a grant from the Robert Wood Johnson Foundation to study physicians' and older adults' experiences with exercise counseling during an office visit. The grant also supported studies of the physician perspective conducted by Daphne Schneider, M.D., of Cornell University, New York, and Karen Peters, Dr.P.H., of the University of Illinois, Rockford.

Dr. Schneider interviewed a convenience sample of 37 public and private sector physicians in urban and suburban areas about discussing exercise with older patients. Sixty-two percent of the physicians specialized in family medicine, 33% specialized in internal medicine, and 35% were board certified in geriatrics. Their mean age was 46 years, and they had completed medical studies between 1963 and 2003. Most of the doctors were white (70%), and 51% were women.

All the physicians reported that they counseled some older patients about exercise, and nearly a third of them said that they counseled all patients about exercise. However, the physicians' perceptions varied as to their roles as exercise advocates. While most saw themselves as coaches/teachers, some saw themselves as authority figures whose words carried real weight with patients, and others said that the implementation of exercise recommendations would be better handled by a nurse-practitioner or trainer.

Physicians cited discussion of a patient's chronic condition, diagnosis of a chronic illness, or the possible need to start a new medication, as the best opportunities for exercise counseling. One physician told a diabetic woman that she might not need to use insulin if she could watch her diet and motivate herself to exercise. “She came back 3 months later and her hemoglobin A_1C was less than 7. She had been swimming every day, sometimes she rode a bicycle, and she was saying how she felt much better, and her sugars were better, and she was happy,” the physician said.

Barriers to exercise counseling during an office visit included lack of training, lack of time, and lack of a reimbursement mechanism. As one physician noted, the complicated medical histories of geriatric patients often push exercise counseling to the bottom of a list of issues to be addressed in an office visit. From a financial perspective, “taking more time and doing exercise counseling looks like an unaffordable luxury,” the physician recounted.

Physicians who treat older patients in rural areas have issues similar to their suburban counterparts regarding exercise counseling for seniors. Dr. Peters analyzed results of a mail-in survey returned by 11 family physicians and one nurse-practitioner aged 31–54 years from her ongoing study of exercise counseling in rural Illinois counties. All the physicians in the rural study said that exercise was relevant to their older patients, and 75% said they recommended exercise in the context of chronic disease management; 58% said they recommended exercise in the context of weight loss and in the context of a routine health and physical exam.

Half of the rural physicians viewed their roles as educational in terms of exercise counseling. In addition, 42% saw themselves in a support/advocate role. The physicians noted that 75% of their older patients cited lack of time as a perceived barrier to exercise, and 42% cited joint pain as a barrier.

Physicians should know that older adults are receptive to exercise counseling if it is presented in a caring and empathetic way, with attention to racial and gender preferences, according to the presenters.

WASHINGTON – When doctors talk about exercise, older adults listen, Shaun Nelson said at the annual meeting of the Gerontological Society of America.

A caring, empathetic physician who counsels patients aged 60 and older about exercise will probably make an impression, even if the doctor is not a paragon of fitness, said Mr. Nelson, an MPH candidate at the University of Illinois, Chicago, who conducted focus group interviews of 28 adults aged 60–74 years. As one woman noted during the interviews, “You like a doctor that seems to be worried about your welfare. … I guess if they were [role models] it might be better. But to me, that really wouldn't be a factor.”

Older adults are receptive to exercise counseling as a way to manage chronic pain and to avoid medication, Mr. Nelson said. One white male patient reported, “My cholesterol was up. And [the doctor] told me about it, and we set up a plan, again, to exercise more and to diet. Didn't even think of any type of drug–that wasn't even a consideration.”

In general, women were more likely to view a doctor's persistence in exercise counseling as caring rather than nagging, were more likely to fit in exercise when they could, and were more encouraged by qualitative benefits, such as better-fitting clothes. Men were more likely to view a doctor's persistent exercise counseling as nagging, were more likely to have a fixed schedule for exercise, and were encouraged by quantitative benefits, such as a lower blood pressure.

Black patients were less likely to have a long visit with their doctors and were less likely to consider water exercise because of fear of water and not knowing how to swim; white patients were more likely to express concerns about repeated dressing and undressing, and having to find a place to park at a gym.

Mr. Nelson's work was part of a grant from the Robert Wood Johnson Foundation to study physicians' and older adults' experiences with exercise counseling during an office visit. The grant also supported studies of the physician perspective conducted by Daphne Schneider, M.D., of Cornell University, New York, and Karen Peters, Dr.P.H., of the University of Illinois, Rockford.

Dr. Schneider interviewed a convenience sample of 37 public and private sector physicians in urban and suburban areas about discussing exercise with older patients. Sixty-two percent of the physicians specialized in family medicine, 33% specialized in internal medicine, and 35% were board certified in geriatrics. Their mean age was 46 years, and they had completed medical studies between 1963 and 2003. Most of the doctors were white (70%), and 51% were women.

All the physicians reported that they counseled some older patients about exercise, and nearly a third of them said that they counseled all patients about exercise. However, the physicians' perceptions varied as to their roles as exercise advocates. While most saw themselves as coaches/teachers, some saw themselves as authority figures whose words carried real weight with patients, and others said that the implementation of exercise recommendations would be better handled by a nurse-practitioner or trainer.

Physicians cited discussion of a patient's chronic condition, diagnosis of a chronic illness, or the possible need to start a new medication, as the best opportunities for exercise counseling. One physician told a diabetic woman that she might not need to use insulin if she could watch her diet and motivate herself to exercise. “She came back 3 months later and her hemoglobin A_1C was less than 7. She had been swimming every day, sometimes she rode a bicycle, and she was saying how she felt much better, and her sugars were better, and she was happy,” the physician said.

Barriers to exercise counseling during an office visit included lack of training, lack of time, and lack of a reimbursement mechanism. As one physician noted, the complicated medical histories of geriatric patients often push exercise counseling to the bottom of a list of issues to be addressed in an office visit. From a financial perspective, “taking more time and doing exercise counseling looks like an unaffordable luxury,” the physician recounted.

Physicians who treat older patients in rural areas have issues similar to their suburban counterparts regarding exercise counseling for seniors. Dr. Peters analyzed results of a mail-in survey returned by 11 family physicians and one nurse-practitioner aged 31–54 years from her ongoing study of exercise counseling in rural Illinois counties. All the physicians in the rural study said that exercise was relevant to their older patients, and 75% said they recommended exercise in the context of chronic disease management; 58% said they recommended exercise in the context of weight loss and in the context of a routine health and physical exam.

Half of the rural physicians viewed their roles as educational in terms of exercise counseling. In addition, 42% saw themselves in a support/advocate role. The physicians noted that 75% of their older patients cited lack of time as a perceived barrier to exercise, and 42% cited joint pain as a barrier.

Physicians should know that older adults are receptive to exercise counseling if it is presented in a caring and empathetic way, with attention to racial and gender preferences, according to the presenters.

The live, attenuated, cold-adapted influenza vaccine, also known as CAIV-T (FluMist) was safe and effective in children aged 60 months to 17 years in the second year of its use for prevention of flu.

The CAIV-T vaccine was first available for use during the 2003–2004 season and was designed to contain three flu strains that matched those recommended by the FDA for the annual trivalent inactivated vaccine. Robert B. Belshe, M.D., of St. Louis University and colleagues reviewed a safety trial that included 6,657 children aged 5–17 years and an efficacy trial including 312 children aged 60–71 months. (Clin. Infect. Dis. 2004;39;920–7).

The safety trial evaluated medically attended events within 42 days of vaccine administration. Overall, the frequency of events in four categories—acute respiratory events, acute gastrointestinal events, systemic bacterial infections, and rare events possibly associated with wild-type influenza—was not significantly different between the 4,452 children in the vaccine group and the 2,205 children in a placebo group.

Results from the efficacy study showed an efficacy rate of 87% for children aged 60 months and older and no significant increase in the frequency of fevers greater than 37.8° C. In addition, no significant increase in frequencies of runny nose, nasal congestion, vomiting, or muscle aches was noted among the vaccine recipients compared with the placebo group.

The data confirm that the efficacy of CAIV-T extends to the youngest children in the age range for which it is currently recommended, Peter F. Wright, M.D., of Vanderbilt University, Nashville, Tenn., said in an editorial (Clin. Infect. Dis. 2004;39:928–9).

The live, attenuated, cold-adapted influenza vaccine, also known as CAIV-T (FluMist) was safe and effective in children aged 60 months to 17 years in the second year of its use for prevention of flu.

The CAIV-T vaccine was first available for use during the 2003–2004 season and was designed to contain three flu strains that matched those recommended by the FDA for the annual trivalent inactivated vaccine. Robert B. Belshe, M.D., of St. Louis University and colleagues reviewed a safety trial that included 6,657 children aged 5–17 years and an efficacy trial including 312 children aged 60–71 months. (Clin. Infect. Dis. 2004;39;920–7).

The safety trial evaluated medically attended events within 42 days of vaccine administration. Overall, the frequency of events in four categories—acute respiratory events, acute gastrointestinal events, systemic bacterial infections, and rare events possibly associated with wild-type influenza—was not significantly different between the 4,452 children in the vaccine group and the 2,205 children in a placebo group.

Results from the efficacy study showed an efficacy rate of 87% for children aged 60 months and older and no significant increase in the frequency of fevers greater than 37.8° C. In addition, no significant increase in frequencies of runny nose, nasal congestion, vomiting, or muscle aches was noted among the vaccine recipients compared with the placebo group.

The data confirm that the efficacy of CAIV-T extends to the youngest children in the age range for which it is currently recommended, Peter F. Wright, M.D., of Vanderbilt University, Nashville, Tenn., said in an editorial (Clin. Infect. Dis. 2004;39:928–9).

The live, attenuated, cold-adapted influenza vaccine, also known as CAIV-T (FluMist) was safe and effective in children aged 60 months to 17 years in the second year of its use for prevention of flu.

The CAIV-T vaccine was first available for use during the 2003–2004 season and was designed to contain three flu strains that matched those recommended by the FDA for the annual trivalent inactivated vaccine. Robert B. Belshe, M.D., of St. Louis University and colleagues reviewed a safety trial that included 6,657 children aged 5–17 years and an efficacy trial including 312 children aged 60–71 months. (Clin. Infect. Dis. 2004;39;920–7).

The safety trial evaluated medically attended events within 42 days of vaccine administration. Overall, the frequency of events in four categories—acute respiratory events, acute gastrointestinal events, systemic bacterial infections, and rare events possibly associated with wild-type influenza—was not significantly different between the 4,452 children in the vaccine group and the 2,205 children in a placebo group.

Results from the efficacy study showed an efficacy rate of 87% for children aged 60 months and older and no significant increase in the frequency of fevers greater than 37.8° C. In addition, no significant increase in frequencies of runny nose, nasal congestion, vomiting, or muscle aches was noted among the vaccine recipients compared with the placebo group.

The data confirm that the efficacy of CAIV-T extends to the youngest children in the age range for which it is currently recommended, Peter F. Wright, M.D., of Vanderbilt University, Nashville, Tenn., said in an editorial (Clin. Infect. Dis. 2004;39:928–9).

A teenaged girl who contracted rabies from a bat and received experimental therapy recovered and was discharged from the Children's Hospital of Wisconsin (Wauwatosa).

The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl on Sept. 12, 2004. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine.

She presented to Children's Hospital on Oct. 18 with symptoms of rabies, including slurred speech and fluctuating consciousness. The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment were being kept under wraps while the doctors prepared to publish their account of the case.

The girl was discharged in early January, according to a hospital press statement. Although her physicians declared her medically sound, she will continue therapy to refine her speech and regain strength.

A rabies vaccine prevent the disease if given within days of exposure, but is useless in saving the patient's life in advanced cases.

A teenaged girl who contracted rabies from a bat and received experimental therapy recovered and was discharged from the Children's Hospital of Wisconsin (Wauwatosa).

The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl on Sept. 12, 2004. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine.

She presented to Children's Hospital on Oct. 18 with symptoms of rabies, including slurred speech and fluctuating consciousness. The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment were being kept under wraps while the doctors prepared to publish their account of the case.

The girl was discharged in early January, according to a hospital press statement. Although her physicians declared her medically sound, she will continue therapy to refine her speech and regain strength.

A rabies vaccine prevent the disease if given within days of exposure, but is useless in saving the patient's life in advanced cases.

A teenaged girl who contracted rabies from a bat and received experimental therapy recovered and was discharged from the Children's Hospital of Wisconsin (Wauwatosa).

The girl is the first known person to survive rabies without receiving a vaccine. The bat bit the girl on Sept. 12, 2004. She reportedly thought that the bite was just a scratch, and she and those with her assumed, incorrectly, that only healthy bats could fly, so she did not see a doctor for a vaccine.

She presented to Children's Hospital on Oct. 18 with symptoms of rabies, including slurred speech and fluctuating consciousness. The doctors induced a temporary coma and treated her with antiviral drugs to boost her immune system and allow her natural immunity to fight the virus. The details of the treatment were being kept under wraps while the doctors prepared to publish their account of the case.

The girl was discharged in early January, according to a hospital press statement. Although her physicians declared her medically sound, she will continue therapy to refine her speech and regain strength.

A rabies vaccine prevent the disease if given within days of exposure, but is useless in saving the patient's life in advanced cases.

WASHINGTON — When doctors talk about exercise, older adults listen, Shaun Nelson said at the annual meeting of the Gerontological Society of America.

A caring, empathetic physician who counsels patients aged 60 and older about exercise will probably make an impression, even if the doctor is not a paragon of fitness, said Mr. Nelson, an MPH candidate at the University of Illinois, Chicago, who conducted focus group interviews of 28 adults aged 60–74 years. As one woman noted during the interviews, “You like a doctor that seems to be worried about your welfare. … I guess if they were [role models] it might be better. But to me, that really wouldn't be a factor.”

Older adults are receptive to exercise counseling as a way to manage chronic pain and to avoid medication, Mr. Nelson said. One white male patient reported, “My cholesterol was up. And [the doctor] told me about it, and we set up a plan, again, to exercise more and to diet. Didn't even think of any type of drug—that wasn't even a consideration.”

In general, women were more likely to view a doctor's persistence in exercise counseling as caring rather than nagging, were more likely to fit in exercise when they could, and were more encouraged by qualitative benefits, such as better-fitting clothes. Men were more likely to view a doctor's persistent exercise counseling as nagging; were more likely to have a fixed schedule for exercise; and were encouraged by quantitative benefits, such as a lower blood pressure. Black patients were less likely to have a long visit with their doctors and were less likely to consider water exercise because of fear of water and not knowing how to swim; white patients were more likely to express concerns about repeated dressing and undressing, and having to find a place to park at a gym.

Mr. Nelson's work was part of a grant from the Robert Wood Johnson Foundation The grant also supported studies of the physician perspective conducted by Daphne Schneider, M.D., of Cornell University, New York, and Karen Peters, Dr.P.H., of the University of Illinois, Rockford.

Dr. Schneider interviewed a convenience sample of 37 public and private sector physicians in urban and suburban areas about whether they discussed exercise with older patients. Sixty-two percent were family physicians; 35% specialized in geriatrics, and 33% were internists. Most of the doctors were white (70%), and 51% were women and the mean age was 46 years.

All the physicians reported that they counseled some older patients about exercise, and nearly a third of them said that they counseled all patients about exercise. However, the physicians' perceptions varied as to their roles as exercise advocates. Although most saw themselves as coaches/teachers, some saw themselves as authority figures whose words carried real weight with patients, and others said that the implementation of exercise recommendations would be better handled by a nurse-practitioner or trainer.

Physicians cited discussion of a patient's chronic condition, diagnosis of a chronic illness, or the possible need to start a new medication, as the best opportunities for exercise counseling. One physician told a diabetic woman that she might not need to use insulin if she could watch her diet and motivate herself to exercise.

“She came back 3 months later and her hemoglobin A1C was less than 7. She had been swimming every day, sometimes she rode a bicycle, and she was saying how she felt much better, and her sugars were better, and she was happy,” the physician said.

Barriers to exercise counseling during an office visit included lack of training, lack of time, and lack of a reimbursement mechanism. One physician noted, the complicated medical histories of geriatric patients often push exercise counseling to the bottom of a list of issues to be addressed in an office visit. From a financial perspective, “taking more time and doing exercise counseling looks like an unaffordable luxury,” the physician recounted.

Physicians in rural areas have issues similar to their suburban counterparts regarding exercise counseling for seniors. Dr. Peters analyzed results of a mail-in survey returned by 11 family physicians and one nurse-practitioner aged 31–54 years from her ongoing study of exercise counseling in rural Illinois counties. All the physicians in the rural study said that exercise was relevant to their older patients, and 75% said they recommended exercise in the context of chronic disease management; 58% said they recommended exercise in the context of weight loss and in the context of a routine health and physical exam.

Half of the rural physicians viewed their roles as educational in terms of exercise counseling. In addition, 42% saw themselves in a support/advocate role. All the physicians said that they stress the frequency of exercise, and 83% said that they stress duration. The physicians noted that 75% of their older patients cited lack of time as a perceived barrier to exercise, and 42% cited joint pain as a barrier.

Rural patients also cited weather as a barrier—they didn't want to walk outside in winter due to icy walks and fear of falling, and any exercise facilities were far away and expensive.

Physicians should know that their senior patients take them seriously. Older adults are receptive to exercise counseling if it is presented in a caring and empathetic way, with attention to racial and gender preferences, according to the presenters.

WASHINGTON — When doctors talk about exercise, older adults listen, Shaun Nelson said at the annual meeting of the Gerontological Society of America.

A caring, empathetic physician who counsels patients aged 60 and older about exercise will probably make an impression, even if the doctor is not a paragon of fitness, said Mr. Nelson, an MPH candidate at the University of Illinois, Chicago, who conducted focus group interviews of 28 adults aged 60–74 years. As one woman noted during the interviews, “You like a doctor that seems to be worried about your welfare. … I guess if they were [role models] it might be better. But to me, that really wouldn't be a factor.”

Older adults are receptive to exercise counseling as a way to manage chronic pain and to avoid medication, Mr. Nelson said. One white male patient reported, “My cholesterol was up. And [the doctor] told me about it, and we set up a plan, again, to exercise more and to diet. Didn't even think of any type of drug—that wasn't even a consideration.”

In general, women were more likely to view a doctor's persistence in exercise counseling as caring rather than nagging, were more likely to fit in exercise when they could, and were more encouraged by qualitative benefits, such as better-fitting clothes. Men were more likely to view a doctor's persistent exercise counseling as nagging; were more likely to have a fixed schedule for exercise; and were encouraged by quantitative benefits, such as a lower blood pressure. Black patients were less likely to have a long visit with their doctors and were less likely to consider water exercise because of fear of water and not knowing how to swim; white patients were more likely to express concerns about repeated dressing and undressing, and having to find a place to park at a gym.

Mr. Nelson's work was part of a grant from the Robert Wood Johnson Foundation The grant also supported studies of the physician perspective conducted by Daphne Schneider, M.D., of Cornell University, New York, and Karen Peters, Dr.P.H., of the University of Illinois, Rockford.

Dr. Schneider interviewed a convenience sample of 37 public and private sector physicians in urban and suburban areas about whether they discussed exercise with older patients. Sixty-two percent were family physicians; 35% specialized in geriatrics, and 33% were internists. Most of the doctors were white (70%), and 51% were women and the mean age was 46 years.

All the physicians reported that they counseled some older patients about exercise, and nearly a third of them said that they counseled all patients about exercise. However, the physicians' perceptions varied as to their roles as exercise advocates. Although most saw themselves as coaches/teachers, some saw themselves as authority figures whose words carried real weight with patients, and others said that the implementation of exercise recommendations would be better handled by a nurse-practitioner or trainer.

Physicians cited discussion of a patient's chronic condition, diagnosis of a chronic illness, or the possible need to start a new medication, as the best opportunities for exercise counseling. One physician told a diabetic woman that she might not need to use insulin if she could watch her diet and motivate herself to exercise.

“She came back 3 months later and her hemoglobin A1C was less than 7. She had been swimming every day, sometimes she rode a bicycle, and she was saying how she felt much better, and her sugars were better, and she was happy,” the physician said.

Barriers to exercise counseling during an office visit included lack of training, lack of time, and lack of a reimbursement mechanism. One physician noted, the complicated medical histories of geriatric patients often push exercise counseling to the bottom of a list of issues to be addressed in an office visit. From a financial perspective, “taking more time and doing exercise counseling looks like an unaffordable luxury,” the physician recounted.

Physicians in rural areas have issues similar to their suburban counterparts regarding exercise counseling for seniors. Dr. Peters analyzed results of a mail-in survey returned by 11 family physicians and one nurse-practitioner aged 31–54 years from her ongoing study of exercise counseling in rural Illinois counties. All the physicians in the rural study said that exercise was relevant to their older patients, and 75% said they recommended exercise in the context of chronic disease management; 58% said they recommended exercise in the context of weight loss and in the context of a routine health and physical exam.

Half of the rural physicians viewed their roles as educational in terms of exercise counseling. In addition, 42% saw themselves in a support/advocate role. All the physicians said that they stress the frequency of exercise, and 83% said that they stress duration. The physicians noted that 75% of their older patients cited lack of time as a perceived barrier to exercise, and 42% cited joint pain as a barrier.

Rural patients also cited weather as a barrier—they didn't want to walk outside in winter due to icy walks and fear of falling, and any exercise facilities were far away and expensive.

Physicians should know that their senior patients take them seriously. Older adults are receptive to exercise counseling if it is presented in a caring and empathetic way, with attention to racial and gender preferences, according to the presenters.

WASHINGTON — When doctors talk about exercise, older adults listen, Shaun Nelson said at the annual meeting of the Gerontological Society of America.

A caring, empathetic physician who counsels patients aged 60 and older about exercise will probably make an impression, even if the doctor is not a paragon of fitness, said Mr. Nelson, an MPH candidate at the University of Illinois, Chicago, who conducted focus group interviews of 28 adults aged 60–74 years. As one woman noted during the interviews, “You like a doctor that seems to be worried about your welfare. … I guess if they were [role models] it might be better. But to me, that really wouldn't be a factor.”

Older adults are receptive to exercise counseling as a way to manage chronic pain and to avoid medication, Mr. Nelson said. One white male patient reported, “My cholesterol was up. And [the doctor] told me about it, and we set up a plan, again, to exercise more and to diet. Didn't even think of any type of drug—that wasn't even a consideration.”

In general, women were more likely to view a doctor's persistence in exercise counseling as caring rather than nagging, were more likely to fit in exercise when they could, and were more encouraged by qualitative benefits, such as better-fitting clothes. Men were more likely to view a doctor's persistent exercise counseling as nagging; were more likely to have a fixed schedule for exercise; and were encouraged by quantitative benefits, such as a lower blood pressure. Black patients were less likely to have a long visit with their doctors and were less likely to consider water exercise because of fear of water and not knowing how to swim; white patients were more likely to express concerns about repeated dressing and undressing, and having to find a place to park at a gym.

Mr. Nelson's work was part of a grant from the Robert Wood Johnson Foundation The grant also supported studies of the physician perspective conducted by Daphne Schneider, M.D., of Cornell University, New York, and Karen Peters, Dr.P.H., of the University of Illinois, Rockford.

Dr. Schneider interviewed a convenience sample of 37 public and private sector physicians in urban and suburban areas about whether they discussed exercise with older patients. Sixty-two percent were family physicians; 35% specialized in geriatrics, and 33% were internists. Most of the doctors were white (70%), and 51% were women and the mean age was 46 years.

All the physicians reported that they counseled some older patients about exercise, and nearly a third of them said that they counseled all patients about exercise. However, the physicians' perceptions varied as to their roles as exercise advocates. Although most saw themselves as coaches/teachers, some saw themselves as authority figures whose words carried real weight with patients, and others said that the implementation of exercise recommendations would be better handled by a nurse-practitioner or trainer.

Physicians cited discussion of a patient's chronic condition, diagnosis of a chronic illness, or the possible need to start a new medication, as the best opportunities for exercise counseling. One physician told a diabetic woman that she might not need to use insulin if she could watch her diet and motivate herself to exercise.

“She came back 3 months later and her hemoglobin A1C was less than 7. She had been swimming every day, sometimes she rode a bicycle, and she was saying how she felt much better, and her sugars were better, and she was happy,” the physician said.

Barriers to exercise counseling during an office visit included lack of training, lack of time, and lack of a reimbursement mechanism. One physician noted, the complicated medical histories of geriatric patients often push exercise counseling to the bottom of a list of issues to be addressed in an office visit. From a financial perspective, “taking more time and doing exercise counseling looks like an unaffordable luxury,” the physician recounted.

Physicians in rural areas have issues similar to their suburban counterparts regarding exercise counseling for seniors. Dr. Peters analyzed results of a mail-in survey returned by 11 family physicians and one nurse-practitioner aged 31–54 years from her ongoing study of exercise counseling in rural Illinois counties. All the physicians in the rural study said that exercise was relevant to their older patients, and 75% said they recommended exercise in the context of chronic disease management; 58% said they recommended exercise in the context of weight loss and in the context of a routine health and physical exam.

Half of the rural physicians viewed their roles as educational in terms of exercise counseling. In addition, 42% saw themselves in a support/advocate role. All the physicians said that they stress the frequency of exercise, and 83% said that they stress duration. The physicians noted that 75% of their older patients cited lack of time as a perceived barrier to exercise, and 42% cited joint pain as a barrier.

Rural patients also cited weather as a barrier—they didn't want to walk outside in winter due to icy walks and fear of falling, and any exercise facilities were far away and expensive.

Physicians should know that their senior patients take them seriously. Older adults are receptive to exercise counseling if it is presented in a caring and empathetic way, with attention to racial and gender preferences, according to the presenters.

WASHINGTON — Screening and intervention for alcohol problems can enhance the quality of a primary care visit, at least from a hazardous drinker's perspective.

Perceived quality of care, however, was not associated with the odds of hazardous drinking 6 months after the office visit, reported Richard Saitz, M.D., in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

In a regression analysis, Dr. Saitz of Boston University and his colleagues assessed the responses of 288 adult hazardous drinkers who saw 40 physicians for a general office visit. The patients' mean age was 43 years, 57% were black, 61% were men, and 71% saw a physician that they had seen on a prior occasion. They averaged six drinks per drinking day.

After the office visits, the patients were asked whether they had received alcohol counseling, such as advice on safe drinking limits or advice to cut down on or abstain from drinking.

After adjustment for variables, such as sex, race, education, comorbidity, level of physician training, previous visits to the same physician, and current alcohol problems, the mean scores in three areas of the Primary Care Assessment Survey—communication, comprehensiveness, and trust—were significantly higher among the 132 patients who said they had received alcohol counseling, compared with the 156 who said they had not received counseling, said Dr. Saitz at the conference, also sponsored by Brown Medical School.

Average quality scores (on a scale of 1–100) were significantly higher among the patients who received counseling, compared with scores of those who did not, in the areas of communication (85 vs. 76) and comprehensiveness (67 vs. 59). The average trust score was slightly higher among patients who received counseling than among those who didn't (79 vs. 77), but the difference was not statistically significant.

WASHINGTON — Screening and intervention for alcohol problems can enhance the quality of a primary care visit, at least from a hazardous drinker's perspective.

Perceived quality of care, however, was not associated with the odds of hazardous drinking 6 months after the office visit, reported Richard Saitz, M.D., in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

In a regression analysis, Dr. Saitz of Boston University and his colleagues assessed the responses of 288 adult hazardous drinkers who saw 40 physicians for a general office visit. The patients' mean age was 43 years, 57% were black, 61% were men, and 71% saw a physician that they had seen on a prior occasion. They averaged six drinks per drinking day.

After the office visits, the patients were asked whether they had received alcohol counseling, such as advice on safe drinking limits or advice to cut down on or abstain from drinking.

After adjustment for variables, such as sex, race, education, comorbidity, level of physician training, previous visits to the same physician, and current alcohol problems, the mean scores in three areas of the Primary Care Assessment Survey—communication, comprehensiveness, and trust—were significantly higher among the 132 patients who said they had received alcohol counseling, compared with the 156 who said they had not received counseling, said Dr. Saitz at the conference, also sponsored by Brown Medical School.

Average quality scores (on a scale of 1–100) were significantly higher among the patients who received counseling, compared with scores of those who did not, in the areas of communication (85 vs. 76) and comprehensiveness (67 vs. 59). The average trust score was slightly higher among patients who received counseling than among those who didn't (79 vs. 77), but the difference was not statistically significant.

WASHINGTON — Screening and intervention for alcohol problems can enhance the quality of a primary care visit, at least from a hazardous drinker's perspective.

Perceived quality of care, however, was not associated with the odds of hazardous drinking 6 months after the office visit, reported Richard Saitz, M.D., in a poster presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.

In a regression analysis, Dr. Saitz of Boston University and his colleagues assessed the responses of 288 adult hazardous drinkers who saw 40 physicians for a general office visit. The patients' mean age was 43 years, 57% were black, 61% were men, and 71% saw a physician that they had seen on a prior occasion. They averaged six drinks per drinking day.

After the office visits, the patients were asked whether they had received alcohol counseling, such as advice on safe drinking limits or advice to cut down on or abstain from drinking.

After adjustment for variables, such as sex, race, education, comorbidity, level of physician training, previous visits to the same physician, and current alcohol problems, the mean scores in three areas of the Primary Care Assessment Survey—communication, comprehensiveness, and trust—were significantly higher among the 132 patients who said they had received alcohol counseling, compared with the 156 who said they had not received counseling, said Dr. Saitz at the conference, also sponsored by Brown Medical School.

Average quality scores (on a scale of 1–100) were significantly higher among the patients who received counseling, compared with scores of those who did not, in the areas of communication (85 vs. 76) and comprehensiveness (67 vs. 59). The average trust score was slightly higher among patients who received counseling than among those who didn't (79 vs. 77), but the difference was not statistically significant.

WASHINGTON — More than half of patients undergoing percutaneous coronary interventions reported in a survey that they were “worried a little” about repeat revascularization, said Dan Greenberg, Ph.D., in a poster presented at a scientific forum sponsored by the American Heart Association.

Improved physician-patient communication may especially benefit patients with a history of revascularization, said Dr. Greenberg of the Harvard Clinical Research Institute, Boston, and colleagues, on the basis of the responses of 382 patients to a self-administered questionnaire.

Of the patients, 54% said they were “worried a little,” 17% said they were “worried a lot,” and 29% said they were “not worried at all” about the chance their blockages would return. In terms of risk perception, 49% rated their risk as the same as that of a typical patient, 32% perceived their risk as lower, and 20% perceived their risk as higher.

In a univariate analysis, patients with a history of myocardial infarction had a significantly higher perceived risk of repeat revascularization, compared with patients without history of MI. Patients with prior percutaneous coronary interventions or psychiatric conditions and those who were smokers at the time of the procedure were significantly more concerned about repeat surgery, compared with patients without those characteristics. Both increased concern and a greater perceived risk were significantly associated with younger age and worse health-related quality of life.

Most of the patients were white (94%), and male (75%), with an average age of 63 years. A fifth were past or current smokers, 24% had a previous coronary artery bypass graft, 38% had a previous acute MI, 41% had a previous angioplasty, and 17% had a psychiatric condition, he said.

WASHINGTON — More than half of patients undergoing percutaneous coronary interventions reported in a survey that they were “worried a little” about repeat revascularization, said Dan Greenberg, Ph.D., in a poster presented at a scientific forum sponsored by the American Heart Association.

Improved physician-patient communication may especially benefit patients with a history of revascularization, said Dr. Greenberg of the Harvard Clinical Research Institute, Boston, and colleagues, on the basis of the responses of 382 patients to a self-administered questionnaire.

Of the patients, 54% said they were “worried a little,” 17% said they were “worried a lot,” and 29% said they were “not worried at all” about the chance their blockages would return. In terms of risk perception, 49% rated their risk as the same as that of a typical patient, 32% perceived their risk as lower, and 20% perceived their risk as higher.

In a univariate analysis, patients with a history of myocardial infarction had a significantly higher perceived risk of repeat revascularization, compared with patients without history of MI. Patients with prior percutaneous coronary interventions or psychiatric conditions and those who were smokers at the time of the procedure were significantly more concerned about repeat surgery, compared with patients without those characteristics. Both increased concern and a greater perceived risk were significantly associated with younger age and worse health-related quality of life.

Most of the patients were white (94%), and male (75%), with an average age of 63 years. A fifth were past or current smokers, 24% had a previous coronary artery bypass graft, 38% had a previous acute MI, 41% had a previous angioplasty, and 17% had a psychiatric condition, he said.

WASHINGTON — More than half of patients undergoing percutaneous coronary interventions reported in a survey that they were “worried a little” about repeat revascularization, said Dan Greenberg, Ph.D., in a poster presented at a scientific forum sponsored by the American Heart Association.

Improved physician-patient communication may especially benefit patients with a history of revascularization, said Dr. Greenberg of the Harvard Clinical Research Institute, Boston, and colleagues, on the basis of the responses of 382 patients to a self-administered questionnaire.

Of the patients, 54% said they were “worried a little,” 17% said they were “worried a lot,” and 29% said they were “not worried at all” about the chance their blockages would return. In terms of risk perception, 49% rated their risk as the same as that of a typical patient, 32% perceived their risk as lower, and 20% perceived their risk as higher.

In a univariate analysis, patients with a history of myocardial infarction had a significantly higher perceived risk of repeat revascularization, compared with patients without history of MI. Patients with prior percutaneous coronary interventions or psychiatric conditions and those who were smokers at the time of the procedure were significantly more concerned about repeat surgery, compared with patients without those characteristics. Both increased concern and a greater perceived risk were significantly associated with younger age and worse health-related quality of life.

Most of the patients were white (94%), and male (75%), with an average age of 63 years. A fifth were past or current smokers, 24% had a previous coronary artery bypass graft, 38% had a previous acute MI, 41% had a previous angioplasty, and 17% had a psychiatric condition, he said.

The U.S. Food and Drug Administration has added a black box warning to Depo-Provera to emphasize the potential for bone mineral density loss with long-term use of the injectable contraceptive.

Depo-Provera has been used throughout the world for decades and remains a safe and effective method of birth control, the FDA said in a statement.

However, a recent review of the drug's long-term effects on bone mineral density (BMD) by the FDA and Pfizer Inc., which manufactures the drug, prompted the addition to the label.

The black box warning notes that women who use Depo-Provera may experience a significant decrease in BMD that might not be completely reversible after discontinuing use. Consequently, Depo-Provera should be used as a long-term birth control method (more than 2 years) only if other methods are inadequate.

The warning also states that it's not known whether Depo-Provera use during adolescence or early adulthood will reduce peak bone mass and increase the risk of osteoporotic fracture in later life.

Since the U.S. approval of Depo-Provera in 1992, the prescribing information has included a warning that use of the contraceptive may be considered among the risk factors for development of osteoporosis, Pfizer noted in a statement.

Additional clinical research was initiated in the 1990s to clarify the effects of Depo-Provera on BMD. Results of those studies were considered in the review and led to the labeling revisions.

One of the studies included 540 women aged 25-38 years who used Depo-Provera for 5 years and were then followed for 2 years.

The review also included data from an ongoing investigation of nearly 400 adolescents aged 12-18 years that will end in 2006 after 5 years of treatment and 2 years of follow-up, said Pfizer spokesperson Rebecca Hamm.

Physicians should encourage patients to consider other contraceptive options for long-term use, Ms. Hamm noted.

If women choose to continue using Depo-Provera long-term, physicians should consider periodic BMD tests and advise these patients to take calcium supplements, quit smoking, and engage in moderate exercise to help prevent BMD loss, Ms. Hamm advised.

The U.S. Food and Drug Administration has added a black box warning to Depo-Provera to emphasize the potential for bone mineral density loss with long-term use of the injectable contraceptive.

Depo-Provera has been used throughout the world for decades and remains a safe and effective method of birth control, the FDA said in a statement.

However, a recent review of the drug's long-term effects on bone mineral density (BMD) by the FDA and Pfizer Inc., which manufactures the drug, prompted the addition to the label.

The black box warning notes that women who use Depo-Provera may experience a significant decrease in BMD that might not be completely reversible after discontinuing use. Consequently, Depo-Provera should be used as a long-term birth control method (more than 2 years) only if other methods are inadequate.

The warning also states that it's not known whether Depo-Provera use during adolescence or early adulthood will reduce peak bone mass and increase the risk of osteoporotic fracture in later life.

Since the U.S. approval of Depo-Provera in 1992, the prescribing information has included a warning that use of the contraceptive may be considered among the risk factors for development of osteoporosis, Pfizer noted in a statement.

Additional clinical research was initiated in the 1990s to clarify the effects of Depo-Provera on BMD. Results of those studies were considered in the review and led to the labeling revisions.

One of the studies included 540 women aged 25-38 years who used Depo-Provera for 5 years and were then followed for 2 years.

The review also included data from an ongoing investigation of nearly 400 adolescents aged 12-18 years that will end in 2006 after 5 years of treatment and 2 years of follow-up, said Pfizer spokesperson Rebecca Hamm.

Physicians should encourage patients to consider other contraceptive options for long-term use, Ms. Hamm noted.

If women choose to continue using Depo-Provera long-term, physicians should consider periodic BMD tests and advise these patients to take calcium supplements, quit smoking, and engage in moderate exercise to help prevent BMD loss, Ms. Hamm advised.

The U.S. Food and Drug Administration has added a black box warning to Depo-Provera to emphasize the potential for bone mineral density loss with long-term use of the injectable contraceptive.

Depo-Provera has been used throughout the world for decades and remains a safe and effective method of birth control, the FDA said in a statement.

However, a recent review of the drug's long-term effects on bone mineral density (BMD) by the FDA and Pfizer Inc., which manufactures the drug, prompted the addition to the label.

The black box warning notes that women who use Depo-Provera may experience a significant decrease in BMD that might not be completely reversible after discontinuing use. Consequently, Depo-Provera should be used as a long-term birth control method (more than 2 years) only if other methods are inadequate.

The warning also states that it's not known whether Depo-Provera use during adolescence or early adulthood will reduce peak bone mass and increase the risk of osteoporotic fracture in later life.

Since the U.S. approval of Depo-Provera in 1992, the prescribing information has included a warning that use of the contraceptive may be considered among the risk factors for development of osteoporosis, Pfizer noted in a statement.

Additional clinical research was initiated in the 1990s to clarify the effects of Depo-Provera on BMD. Results of those studies were considered in the review and led to the labeling revisions.

One of the studies included 540 women aged 25-38 years who used Depo-Provera for 5 years and were then followed for 2 years.

The review also included data from an ongoing investigation of nearly 400 adolescents aged 12-18 years that will end in 2006 after 5 years of treatment and 2 years of follow-up, said Pfizer spokesperson Rebecca Hamm.

Physicians should encourage patients to consider other contraceptive options for long-term use, Ms. Hamm noted.

If women choose to continue using Depo-Provera long-term, physicians should consider periodic BMD tests and advise these patients to take calcium supplements, quit smoking, and engage in moderate exercise to help prevent BMD loss, Ms. Hamm advised.