Doug Brunk

SAN DIEGO — About one-third of patients referred to an asthma specialty clinic who were believed to have difficult to control asthma actually had vocal cord dysfunction, results from a single-center study showed.

“If patients have been on many different medicines––they've been on oral or inhaled steroids and they're not responding––it's worth checking to see if they actually have asthma or not,” study coauthor Catherine Vitari, R.N., said in an interview during a poster session at an international conference of the American Thoracic Society.

In a study led by her associate, Dr. Sally E. Wenzel, a pulmonologist and the director of the Asthma Institute at the University of Pittsburgh Medical Center, the researchers reviewed the charts of 152 new patients evaluated at the institute between December 2006 and September 2008 in an effort to verify the diagnosis of severe asthma.

Of the 152 patients, 119 (78%) had a presenting diagnosis of asthma while 33 had another diagnosis such as dyspnea, cough, and emphysema.

Ms. Vitari, a clinical research nurse at the Asthma Institute, reported that 40 of the 119 patients who presented with an asthma diagnosis underwent methacholine challenges with laryngoscopy because their history and physical suggested asthma may not be the primary diagnosis. Of these 40 patients, 39 had a negative test, which precluded the diagnosis of asthma in 33% of the 119 patients. “We didn't expect to see this,” she commented. “That's a pretty high percentage of people referred for asthma who didn't actually have asthma.”

Dr. Wenzel performs a laryngoscopy at the time of the methacholine challenge “to see if the vocal cords are closing or spasming, indicating vocal cord dysfunction, or if it's truly asthma,” Ms. Vitari explained. “If you send the patient to ENT instead to do a laryngoscopy and they don't see anything, it could be that the vocal cord dysfunction isn't acting up at that time since the spasms can be episodic and/or related to triggering events, or stimuli.”

She acknowledged certain limitations of the study, including its single-center design and the fact that only one physician did the assessments. The researchers had no conflicts to disclose.

SAN DIEGO — About one-third of patients referred to an asthma specialty clinic who were believed to have difficult to control asthma actually had vocal cord dysfunction, results from a single-center study showed.

“If patients have been on many different medicines––they've been on oral or inhaled steroids and they're not responding––it's worth checking to see if they actually have asthma or not,” study coauthor Catherine Vitari, R.N., said in an interview during a poster session at an international conference of the American Thoracic Society.

In a study led by her associate, Dr. Sally E. Wenzel, a pulmonologist and the director of the Asthma Institute at the University of Pittsburgh Medical Center, the researchers reviewed the charts of 152 new patients evaluated at the institute between December 2006 and September 2008 in an effort to verify the diagnosis of severe asthma.

Of the 152 patients, 119 (78%) had a presenting diagnosis of asthma while 33 had another diagnosis such as dyspnea, cough, and emphysema.

Ms. Vitari, a clinical research nurse at the Asthma Institute, reported that 40 of the 119 patients who presented with an asthma diagnosis underwent methacholine challenges with laryngoscopy because their history and physical suggested asthma may not be the primary diagnosis. Of these 40 patients, 39 had a negative test, which precluded the diagnosis of asthma in 33% of the 119 patients. “We didn't expect to see this,” she commented. “That's a pretty high percentage of people referred for asthma who didn't actually have asthma.”

Dr. Wenzel performs a laryngoscopy at the time of the methacholine challenge “to see if the vocal cords are closing or spasming, indicating vocal cord dysfunction, or if it's truly asthma,” Ms. Vitari explained. “If you send the patient to ENT instead to do a laryngoscopy and they don't see anything, it could be that the vocal cord dysfunction isn't acting up at that time since the spasms can be episodic and/or related to triggering events, or stimuli.”

She acknowledged certain limitations of the study, including its single-center design and the fact that only one physician did the assessments. The researchers had no conflicts to disclose.

SAN DIEGO — About one-third of patients referred to an asthma specialty clinic who were believed to have difficult to control asthma actually had vocal cord dysfunction, results from a single-center study showed.

“If patients have been on many different medicines––they've been on oral or inhaled steroids and they're not responding––it's worth checking to see if they actually have asthma or not,” study coauthor Catherine Vitari, R.N., said in an interview during a poster session at an international conference of the American Thoracic Society.

In a study led by her associate, Dr. Sally E. Wenzel, a pulmonologist and the director of the Asthma Institute at the University of Pittsburgh Medical Center, the researchers reviewed the charts of 152 new patients evaluated at the institute between December 2006 and September 2008 in an effort to verify the diagnosis of severe asthma.

Of the 152 patients, 119 (78%) had a presenting diagnosis of asthma while 33 had another diagnosis such as dyspnea, cough, and emphysema.

Ms. Vitari, a clinical research nurse at the Asthma Institute, reported that 40 of the 119 patients who presented with an asthma diagnosis underwent methacholine challenges with laryngoscopy because their history and physical suggested asthma may not be the primary diagnosis. Of these 40 patients, 39 had a negative test, which precluded the diagnosis of asthma in 33% of the 119 patients. “We didn't expect to see this,” she commented. “That's a pretty high percentage of people referred for asthma who didn't actually have asthma.”

Dr. Wenzel performs a laryngoscopy at the time of the methacholine challenge “to see if the vocal cords are closing or spasming, indicating vocal cord dysfunction, or if it's truly asthma,” Ms. Vitari explained. “If you send the patient to ENT instead to do a laryngoscopy and they don't see anything, it could be that the vocal cord dysfunction isn't acting up at that time since the spasms can be episodic and/or related to triggering events, or stimuli.”

She acknowledged certain limitations of the study, including its single-center design and the fact that only one physician did the assessments. The researchers had no conflicts to disclose.

As a child growing up in Toledo, Ohio, Dr. Stanford T. Shulman became fascinated with collecting postage stamps because they combined his interests in history and geography.

“One of the best ways to learn history and geography is from stamps from around the world,” said Dr. Shulman, chief of the division of infectious diseases at Children's Memorial Hospital, Chicago. Postage stamps “are colorful, they all tell a story, and you can learn a whole lot from them, whether you want to have a butterfly stamp collection, an elephant stamp collection, or a medicine stamp collection.”

During medical school and early in his career, he kept his stamp collection “kind of stashed in the closet.” But 35 years ago, as his infectious diseases career started to blossom at the University of Florida in Gainesville, his interest in his childhood hobby revived and he began collecting stamps with medical themes.

Today, he boasts a collection of about 3,000 medically themed stamps, and he writes a stamp column in Pediatric Annals to match whatever theme the journal tackles in a particular month, be it cardiology or infectious diseases. “If we have an issue devoted to psychiatric problems that kids can have, the hardest thing is to find psychiatric-themed stamps,” said Dr. Shulman, who is also a professor of pediatric infectious diseases at Northwestern University in Chicago. “There are two or three stamps that depict Sigmund Freud, but not much else. I'm always on the lookout for more stamps of that kind.”

His collection includes stamps of all shapes and sizes from all corners of the globe. The first medically themed stamps date back to about 1860, he said. More than 150 stamps have been issued by various countries to honor Louis Pasteur, the French chemist who is considered to be one of the founders of microbiology.

About 100 stamps have honored Sir Alexander Fleming, who discovered penicillin, including a souvenir sheet that shows three images: a Petri dish, a child receiving a penicillin shot, and soldiers being carried off the battlefield during World War I. Before penicillin was introduced, “many of these soldiers would die of the infectious complications in their wounds, such as gas gangrene,” Dr. Shulman said.

Other stamps have honored medical luminaries such as nursing pioneer Florence Nightingale; Dr. Virginia Apgar, who developed the Apgar score; and Dr. Edward L. Trudeau, who devoted his career to researching and treating tuberculosis. “The full spectrum of topics is pretty broad,” Dr. Shulman said.

Part of his collection includes stamps issued by the Kingdom of Hawaii in the 1800s, and he used some of them to mark the impact of measles on that region in a medical journal article (Pediatr. Infect. Dis. J. 2009;28:728–33).

“In 1824, the king and queen of Hawaii, who were both in their 20s, traveled to London to meet with the king in an effort to forge an alliance,” Dr. Shulman said. “About 10 days after they arrived in London, they came down with measles and died of the disease there. While these are not in and of themselves medical stamps, they portray individuals—mostly from the royal family in Hawaii—who also were sick or died from the measles. I've used these stamps to illustrate this medical history example.”

Other stamps in his collection highlight drug abuse prevention, physical fitness, and AIDS. “Dozens of countries have issued AIDS stamps,” he said. “Some of them show what the virus looks like under the electron microscope. There are some from developing countries that use stamps to get the message out as to how one can prevent the spread of AIDS. Some depict condoms and blood transfusions. The AIDS stamps almost never actually portray individuals, but they portray something important about the disease.”

To keep up with new stamp releases, Dr. Shulman subscribes to newspapers and magazines for philatelists and attends shows. He also is a member of the American Topical Association, a group of stamp collectors who have a specific area of interest. “Within that association, there's a medical subjects group,” he said. “It's mostly people from America, but there are people from all over the world. A publication related to medical-themed stamps comes out once every 2 months.”

A sense of the chase keeps Dr. Shulman engaged in his avocation. “If you're a stamp collector, you always have something you're chasing down, trying to locate a nice-looking copy of a particular stamp, and trying to find someone who has it and will sell it to you at a reasonable price,” he said. “There's a calming aspect associated with examining your stamp collection, studying the stamps, and putting them into an album properly.”

Intrigued by U.S. Coins

Like many of his fellow seventh graders who grew up in the Brownsville section of Brooklyn, N.Y., in the early 1960s, Dr. Lawrence Brown was active in sports but he also grew intrigued with collecting U.S. coins after being exposed to the hobby by a classmate.

“My mother seems to think that part of it had to do with that fact that I was among the more frugal of her children; I could keep the coin in my pocket, No. 1,” recalled Dr. Brown, who practices in public health at Cornell University, New York. “No. 2, the art of collecting early [in life] is probably what motivated me. I learned that there were different years of different coins, and I learned that different mints made different coins: Philadelphia, Denver, and San Francisco.”

If he obtained paper money, he would convert it into coins at the grocery store or the bank.

“At that time, you would commonly see a buffalo nickel or a Mercury dime,” said Dr. Brown, who is also senior vice president at the Addiction Research and Treatment Corporation in Brooklyn. “It amazed me that there were so many different topical reasons for our coinage, unlike now, when all of our coins are [represent] deceased presidents, which I think is a major mistake. I don't disagree with history; I'm a history buff. But we lose some of our artistic display when we focus just on people and not on other artistic subjects.”

Early on, one of the favorite coins he obtained was a 1909 penny designed by New York sculptor Victor D. Brenner under consent of President Theodore Roosevelt. Known as the VDB Lincoln, the coin has the head of Lincoln on the front and the back features a coat of arms. “I was overwhelmed, because that was like a needle in a haystack,” Dr. Brown said. “It wasn't in the best condition but to find it was amazing.”

In the early 1970s, he purchased a subscription to a U.S. Mint publication, which enabled him to buy proof sets and mint sets each year. His devotion to collecting waned during medical school and during a military tour of service in Vietnam, but it was rekindled in 2000 when he learned that the American Numismatic Association was staging its annual meeting nearby, and he decided to attend.

The goal of his current collection, known as the Erasmus Hall Collection in a nod to the Brooklyn high school he graduated from in 1969, is to assemble complete sets of modern coins by year and by mint mark. Modern is defined as any coin minted after 1960. “I focus on getting at least one type of a coin and add to the full completeness of a set,” said Dr. Brown, who spends about 1 hour each evening on his hobby.

“Then, I will work to improve the quality of the coin. In coin collecting, that's called a grade: How robust is the strike by the U.S. mint, how much wear is on the coin, and a number of other factors such as luster.”

Proof coins from the U.S. Mint are struck twice whereas circulated coins are struck once.

Dr. Brown displayed the Erasmus Hall proof set (1968-present) at the 2007 American United Numismatists convention. At the time, the proof set comprised 361 coins, but it has since grown to 382 coins.

Overall, Dr. Brown estimates that he owns more than 1,000 coins.

Dr. Stanford T. Shulman has about 3,000 stamps with a medical theme.

Source Courtesy Audio Visual Dept., Children's Memorial Hospital

This is one of the several stamps in Dr. Shulman's collection that highlights AIDS prevention.

Source Images Courtesy Dr. Stanford T. Shulman

Above is 1 of the more than 150 stamps that have been issued to honor French microbiologist Louis Pasteur.

As a child growing up in Toledo, Ohio, Dr. Stanford T. Shulman became fascinated with collecting postage stamps because they combined his interests in history and geography.

“One of the best ways to learn history and geography is from stamps from around the world,” said Dr. Shulman, chief of the division of infectious diseases at Children's Memorial Hospital, Chicago. Postage stamps “are colorful, they all tell a story, and you can learn a whole lot from them, whether you want to have a butterfly stamp collection, an elephant stamp collection, or a medicine stamp collection.”

During medical school and early in his career, he kept his stamp collection “kind of stashed in the closet.” But 35 years ago, as his infectious diseases career started to blossom at the University of Florida in Gainesville, his interest in his childhood hobby revived and he began collecting stamps with medical themes.

Today, he boasts a collection of about 3,000 medically themed stamps, and he writes a stamp column in Pediatric Annals to match whatever theme the journal tackles in a particular month, be it cardiology or infectious diseases. “If we have an issue devoted to psychiatric problems that kids can have, the hardest thing is to find psychiatric-themed stamps,” said Dr. Shulman, who is also a professor of pediatric infectious diseases at Northwestern University in Chicago. “There are two or three stamps that depict Sigmund Freud, but not much else. I'm always on the lookout for more stamps of that kind.”

His collection includes stamps of all shapes and sizes from all corners of the globe. The first medically themed stamps date back to about 1860, he said. More than 150 stamps have been issued by various countries to honor Louis Pasteur, the French chemist who is considered to be one of the founders of microbiology.

About 100 stamps have honored Sir Alexander Fleming, who discovered penicillin, including a souvenir sheet that shows three images: a Petri dish, a child receiving a penicillin shot, and soldiers being carried off the battlefield during World War I. Before penicillin was introduced, “many of these soldiers would die of the infectious complications in their wounds, such as gas gangrene,” Dr. Shulman said.

Other stamps have honored medical luminaries such as nursing pioneer Florence Nightingale; Dr. Virginia Apgar, who developed the Apgar score; and Dr. Edward L. Trudeau, who devoted his career to researching and treating tuberculosis. “The full spectrum of topics is pretty broad,” Dr. Shulman said.

Part of his collection includes stamps issued by the Kingdom of Hawaii in the 1800s, and he used some of them to mark the impact of measles on that region in a medical journal article (Pediatr. Infect. Dis. J. 2009;28:728–33).

“In 1824, the king and queen of Hawaii, who were both in their 20s, traveled to London to meet with the king in an effort to forge an alliance,” Dr. Shulman said. “About 10 days after they arrived in London, they came down with measles and died of the disease there. While these are not in and of themselves medical stamps, they portray individuals—mostly from the royal family in Hawaii—who also were sick or died from the measles. I've used these stamps to illustrate this medical history example.”

Other stamps in his collection highlight drug abuse prevention, physical fitness, and AIDS. “Dozens of countries have issued AIDS stamps,” he said. “Some of them show what the virus looks like under the electron microscope. There are some from developing countries that use stamps to get the message out as to how one can prevent the spread of AIDS. Some depict condoms and blood transfusions. The AIDS stamps almost never actually portray individuals, but they portray something important about the disease.”

To keep up with new stamp releases, Dr. Shulman subscribes to newspapers and magazines for philatelists and attends shows. He also is a member of the American Topical Association, a group of stamp collectors who have a specific area of interest. “Within that association, there's a medical subjects group,” he said. “It's mostly people from America, but there are people from all over the world. A publication related to medical-themed stamps comes out once every 2 months.”

A sense of the chase keeps Dr. Shulman engaged in his avocation. “If you're a stamp collector, you always have something you're chasing down, trying to locate a nice-looking copy of a particular stamp, and trying to find someone who has it and will sell it to you at a reasonable price,” he said. “There's a calming aspect associated with examining your stamp collection, studying the stamps, and putting them into an album properly.”

Intrigued by U.S. Coins

Like many of his fellow seventh graders who grew up in the Brownsville section of Brooklyn, N.Y., in the early 1960s, Dr. Lawrence Brown was active in sports but he also grew intrigued with collecting U.S. coins after being exposed to the hobby by a classmate.

“My mother seems to think that part of it had to do with that fact that I was among the more frugal of her children; I could keep the coin in my pocket, No. 1,” recalled Dr. Brown, who practices in public health at Cornell University, New York. “No. 2, the art of collecting early [in life] is probably what motivated me. I learned that there were different years of different coins, and I learned that different mints made different coins: Philadelphia, Denver, and San Francisco.”

If he obtained paper money, he would convert it into coins at the grocery store or the bank.

“At that time, you would commonly see a buffalo nickel or a Mercury dime,” said Dr. Brown, who is also senior vice president at the Addiction Research and Treatment Corporation in Brooklyn. “It amazed me that there were so many different topical reasons for our coinage, unlike now, when all of our coins are [represent] deceased presidents, which I think is a major mistake. I don't disagree with history; I'm a history buff. But we lose some of our artistic display when we focus just on people and not on other artistic subjects.”

Early on, one of the favorite coins he obtained was a 1909 penny designed by New York sculptor Victor D. Brenner under consent of President Theodore Roosevelt. Known as the VDB Lincoln, the coin has the head of Lincoln on the front and the back features a coat of arms. “I was overwhelmed, because that was like a needle in a haystack,” Dr. Brown said. “It wasn't in the best condition but to find it was amazing.”

In the early 1970s, he purchased a subscription to a U.S. Mint publication, which enabled him to buy proof sets and mint sets each year. His devotion to collecting waned during medical school and during a military tour of service in Vietnam, but it was rekindled in 2000 when he learned that the American Numismatic Association was staging its annual meeting nearby, and he decided to attend.

The goal of his current collection, known as the Erasmus Hall Collection in a nod to the Brooklyn high school he graduated from in 1969, is to assemble complete sets of modern coins by year and by mint mark. Modern is defined as any coin minted after 1960. “I focus on getting at least one type of a coin and add to the full completeness of a set,” said Dr. Brown, who spends about 1 hour each evening on his hobby.

“Then, I will work to improve the quality of the coin. In coin collecting, that's called a grade: How robust is the strike by the U.S. mint, how much wear is on the coin, and a number of other factors such as luster.”

Proof coins from the U.S. Mint are struck twice whereas circulated coins are struck once.

Dr. Brown displayed the Erasmus Hall proof set (1968-present) at the 2007 American United Numismatists convention. At the time, the proof set comprised 361 coins, but it has since grown to 382 coins.

Overall, Dr. Brown estimates that he owns more than 1,000 coins.

Dr. Stanford T. Shulman has about 3,000 stamps with a medical theme.

Source Courtesy Audio Visual Dept., Children's Memorial Hospital

This is one of the several stamps in Dr. Shulman's collection that highlights AIDS prevention.

Source Images Courtesy Dr. Stanford T. Shulman

Above is 1 of the more than 150 stamps that have been issued to honor French microbiologist Louis Pasteur.

As a child growing up in Toledo, Ohio, Dr. Stanford T. Shulman became fascinated with collecting postage stamps because they combined his interests in history and geography.

“One of the best ways to learn history and geography is from stamps from around the world,” said Dr. Shulman, chief of the division of infectious diseases at Children's Memorial Hospital, Chicago. Postage stamps “are colorful, they all tell a story, and you can learn a whole lot from them, whether you want to have a butterfly stamp collection, an elephant stamp collection, or a medicine stamp collection.”

During medical school and early in his career, he kept his stamp collection “kind of stashed in the closet.” But 35 years ago, as his infectious diseases career started to blossom at the University of Florida in Gainesville, his interest in his childhood hobby revived and he began collecting stamps with medical themes.

Today, he boasts a collection of about 3,000 medically themed stamps, and he writes a stamp column in Pediatric Annals to match whatever theme the journal tackles in a particular month, be it cardiology or infectious diseases. “If we have an issue devoted to psychiatric problems that kids can have, the hardest thing is to find psychiatric-themed stamps,” said Dr. Shulman, who is also a professor of pediatric infectious diseases at Northwestern University in Chicago. “There are two or three stamps that depict Sigmund Freud, but not much else. I'm always on the lookout for more stamps of that kind.”

His collection includes stamps of all shapes and sizes from all corners of the globe. The first medically themed stamps date back to about 1860, he said. More than 150 stamps have been issued by various countries to honor Louis Pasteur, the French chemist who is considered to be one of the founders of microbiology.

About 100 stamps have honored Sir Alexander Fleming, who discovered penicillin, including a souvenir sheet that shows three images: a Petri dish, a child receiving a penicillin shot, and soldiers being carried off the battlefield during World War I. Before penicillin was introduced, “many of these soldiers would die of the infectious complications in their wounds, such as gas gangrene,” Dr. Shulman said.

Other stamps have honored medical luminaries such as nursing pioneer Florence Nightingale; Dr. Virginia Apgar, who developed the Apgar score; and Dr. Edward L. Trudeau, who devoted his career to researching and treating tuberculosis. “The full spectrum of topics is pretty broad,” Dr. Shulman said.

Part of his collection includes stamps issued by the Kingdom of Hawaii in the 1800s, and he used some of them to mark the impact of measles on that region in a medical journal article (Pediatr. Infect. Dis. J. 2009;28:728–33).

“In 1824, the king and queen of Hawaii, who were both in their 20s, traveled to London to meet with the king in an effort to forge an alliance,” Dr. Shulman said. “About 10 days after they arrived in London, they came down with measles and died of the disease there. While these are not in and of themselves medical stamps, they portray individuals—mostly from the royal family in Hawaii—who also were sick or died from the measles. I've used these stamps to illustrate this medical history example.”

Other stamps in his collection highlight drug abuse prevention, physical fitness, and AIDS. “Dozens of countries have issued AIDS stamps,” he said. “Some of them show what the virus looks like under the electron microscope. There are some from developing countries that use stamps to get the message out as to how one can prevent the spread of AIDS. Some depict condoms and blood transfusions. The AIDS stamps almost never actually portray individuals, but they portray something important about the disease.”

To keep up with new stamp releases, Dr. Shulman subscribes to newspapers and magazines for philatelists and attends shows. He also is a member of the American Topical Association, a group of stamp collectors who have a specific area of interest. “Within that association, there's a medical subjects group,” he said. “It's mostly people from America, but there are people from all over the world. A publication related to medical-themed stamps comes out once every 2 months.”

A sense of the chase keeps Dr. Shulman engaged in his avocation. “If you're a stamp collector, you always have something you're chasing down, trying to locate a nice-looking copy of a particular stamp, and trying to find someone who has it and will sell it to you at a reasonable price,” he said. “There's a calming aspect associated with examining your stamp collection, studying the stamps, and putting them into an album properly.”

Intrigued by U.S. Coins

Like many of his fellow seventh graders who grew up in the Brownsville section of Brooklyn, N.Y., in the early 1960s, Dr. Lawrence Brown was active in sports but he also grew intrigued with collecting U.S. coins after being exposed to the hobby by a classmate.

“My mother seems to think that part of it had to do with that fact that I was among the more frugal of her children; I could keep the coin in my pocket, No. 1,” recalled Dr. Brown, who practices in public health at Cornell University, New York. “No. 2, the art of collecting early [in life] is probably what motivated me. I learned that there were different years of different coins, and I learned that different mints made different coins: Philadelphia, Denver, and San Francisco.”

If he obtained paper money, he would convert it into coins at the grocery store or the bank.

“At that time, you would commonly see a buffalo nickel or a Mercury dime,” said Dr. Brown, who is also senior vice president at the Addiction Research and Treatment Corporation in Brooklyn. “It amazed me that there were so many different topical reasons for our coinage, unlike now, when all of our coins are [represent] deceased presidents, which I think is a major mistake. I don't disagree with history; I'm a history buff. But we lose some of our artistic display when we focus just on people and not on other artistic subjects.”

Early on, one of the favorite coins he obtained was a 1909 penny designed by New York sculptor Victor D. Brenner under consent of President Theodore Roosevelt. Known as the VDB Lincoln, the coin has the head of Lincoln on the front and the back features a coat of arms. “I was overwhelmed, because that was like a needle in a haystack,” Dr. Brown said. “It wasn't in the best condition but to find it was amazing.”

In the early 1970s, he purchased a subscription to a U.S. Mint publication, which enabled him to buy proof sets and mint sets each year. His devotion to collecting waned during medical school and during a military tour of service in Vietnam, but it was rekindled in 2000 when he learned that the American Numismatic Association was staging its annual meeting nearby, and he decided to attend.

The goal of his current collection, known as the Erasmus Hall Collection in a nod to the Brooklyn high school he graduated from in 1969, is to assemble complete sets of modern coins by year and by mint mark. Modern is defined as any coin minted after 1960. “I focus on getting at least one type of a coin and add to the full completeness of a set,” said Dr. Brown, who spends about 1 hour each evening on his hobby.

“Then, I will work to improve the quality of the coin. In coin collecting, that's called a grade: How robust is the strike by the U.S. mint, how much wear is on the coin, and a number of other factors such as luster.”

Proof coins from the U.S. Mint are struck twice whereas circulated coins are struck once.

Dr. Brown displayed the Erasmus Hall proof set (1968-present) at the 2007 American United Numismatists convention. At the time, the proof set comprised 361 coins, but it has since grown to 382 coins.

Overall, Dr. Brown estimates that he owns more than 1,000 coins.

Dr. Stanford T. Shulman has about 3,000 stamps with a medical theme.

Source Courtesy Audio Visual Dept., Children's Memorial Hospital

This is one of the several stamps in Dr. Shulman's collection that highlights AIDS prevention.

Source Images Courtesy Dr. Stanford T. Shulman

Above is 1 of the more than 150 stamps that have been issued to honor French microbiologist Louis Pasteur.

Dr. James Barron never took physical fitness seriously until age 30, when he served as the physician for a Marine battalion, but he'd always been intrigued by watching Ironman competitions on television—grueling events that consist of a 2.4-mile swim, a 112-mile bike ride, and a 26-mile run.

“In my mind I would think 'boy, wouldn't it be great to do that some day?'” said Dr. Barron, a 44-year-old internist from Grand Rapids, Mich.

The motivator for his will to ultimately become an Ironman-level triathlete came from a painful life event: the September 2001 death of his 5-year-old niece, Allie Cibulas, from inoperable brain cancer.

“She had a horrible course,” Dr. Barron recalled. “I remember visiting her, being so frustrated. I had so much pent-up energy and I wanted to do something to try to make a difference in the lives of other people affected by children with any type of illness.”

So in 2003 he registered for an Ironman competition in Madison, Wis., and asked friends, family, and perfect strangers to champion him by donating money to Allie's Angels—a charity serving terminally ill children and research on pediatric brain cancer that was launched in honor of his niece (www.alliesangels.com

“I thought, 'I'm going to push myself to my limit and do what I can to try to help out,'” he said. “When little children go through chemotherapy, they're not prepared for it. I had never done a triathlon in my life, so it was symbolic that I was going to go do something I'd never done before and fight my own personal battle to complete it. It pales in comparison to what Allie went through, but the symbolism is that I was going to fight my hardest battle in honor of her, without having prior experience.”

After nearly a year of training, when race day arrived he completed the event and helped to raise several thousand dollars for Allie's Angels. “It wasn't a lot of money,” he said. “But for me it was more [about] creating awareness and putting my own sweat and tears into it.”

Dr. Barron described feeling like an “imposter” in a crowd of highly trained triathletes during the race. “I remember when I crossed the finish line many hours after the winner, still seeing the winner of the race there to cheer me on and welcome me to the club,” he said. “It's a feeling of acceptance. It was very emotional, thinking about my niece as I went through the race. That kind of kept me going the whole time.”

With his first Ironman behind him, Dr. Barron went on to improve his completion times in subsequent Ironman competitions in Lake Placid, N.Y., and in Louisville, Ky., keying in on specific charities to support for each event. In August, he returned to Louisville to compete in the Ford Ironman Lousiville event and help raise money for the National Alliance on Mental Illness Michigan (www.namimi.org

Dr. Barron's ultimate Ironman goal is to compete in Kona, Hawaii, the premier competition in this event.

In addition to his full-time role as a hospitalist for Michigan Medical, P.C. at Spectrum Butterworth in Grand Rapids, Dr. Barron is an essential caretaker of his wife, Dr. Denise Barron-Kraus, and their two teenage sons.

Dr. Barron-Kraus left medical practice in 2000 because she suffers from mental health issues and fibromyalgia that affects her ability to perform activities of daily living. That leaves Dr. Barron precious little time for training, but he manages.

“My husband's ability to dedicate so much time and energy to exercise, in addition to his demanding work schedule at the hospital and home, is amazing to me,” Dr. Barron-Kraus said.

“His choice of hobby is a great one for him as he has a significant family cardiac history. He is in better shape than the 19-year-old I met in college. In addition to the physical benefits of exercise, it serves as his main stress-reliever, improving all areas of his life,” she continued.

He noted that participating in Ironman competitions have helped him achieve a “can-do mindset” for whatever challenges come his way.

“Being able to do an Ironman shows that I can accomplish just about anything I put my mind to,” he said. “I believe it positively affects my work attitude and my attitude at home. The biggest thing for me is, as a physician I always want to make a difference in the lives of people.”

By doing Ironman competitions, “I'm able to do that. While I haven't raised a ton of money, I've been able to add meaning to my personal life while raising money and awareness for important causes,” Dr. Barron said.

Dr. Barron started training for the Ironman after the death of his niece.

Source Courtesy Kyle Barron-Kraus

Dr. James Barron never took physical fitness seriously until age 30, when he served as the physician for a Marine battalion, but he'd always been intrigued by watching Ironman competitions on television—grueling events that consist of a 2.4-mile swim, a 112-mile bike ride, and a 26-mile run.

“In my mind I would think 'boy, wouldn't it be great to do that some day?'” said Dr. Barron, a 44-year-old internist from Grand Rapids, Mich.

The motivator for his will to ultimately become an Ironman-level triathlete came from a painful life event: the September 2001 death of his 5-year-old niece, Allie Cibulas, from inoperable brain cancer.

“She had a horrible course,” Dr. Barron recalled. “I remember visiting her, being so frustrated. I had so much pent-up energy and I wanted to do something to try to make a difference in the lives of other people affected by children with any type of illness.”

So in 2003 he registered for an Ironman competition in Madison, Wis., and asked friends, family, and perfect strangers to champion him by donating money to Allie's Angels—a charity serving terminally ill children and research on pediatric brain cancer that was launched in honor of his niece (www.alliesangels.com

“I thought, 'I'm going to push myself to my limit and do what I can to try to help out,'” he said. “When little children go through chemotherapy, they're not prepared for it. I had never done a triathlon in my life, so it was symbolic that I was going to go do something I'd never done before and fight my own personal battle to complete it. It pales in comparison to what Allie went through, but the symbolism is that I was going to fight my hardest battle in honor of her, without having prior experience.”

After nearly a year of training, when race day arrived he completed the event and helped to raise several thousand dollars for Allie's Angels. “It wasn't a lot of money,” he said. “But for me it was more [about] creating awareness and putting my own sweat and tears into it.”

Dr. Barron described feeling like an “imposter” in a crowd of highly trained triathletes during the race. “I remember when I crossed the finish line many hours after the winner, still seeing the winner of the race there to cheer me on and welcome me to the club,” he said. “It's a feeling of acceptance. It was very emotional, thinking about my niece as I went through the race. That kind of kept me going the whole time.”

With his first Ironman behind him, Dr. Barron went on to improve his completion times in subsequent Ironman competitions in Lake Placid, N.Y., and in Louisville, Ky., keying in on specific charities to support for each event. In August, he returned to Louisville to compete in the Ford Ironman Lousiville event and help raise money for the National Alliance on Mental Illness Michigan (www.namimi.org

Dr. Barron's ultimate Ironman goal is to compete in Kona, Hawaii, the premier competition in this event.

In addition to his full-time role as a hospitalist for Michigan Medical, P.C. at Spectrum Butterworth in Grand Rapids, Dr. Barron is an essential caretaker of his wife, Dr. Denise Barron-Kraus, and their two teenage sons.

Dr. Barron-Kraus left medical practice in 2000 because she suffers from mental health issues and fibromyalgia that affects her ability to perform activities of daily living. That leaves Dr. Barron precious little time for training, but he manages.

“My husband's ability to dedicate so much time and energy to exercise, in addition to his demanding work schedule at the hospital and home, is amazing to me,” Dr. Barron-Kraus said.

“His choice of hobby is a great one for him as he has a significant family cardiac history. He is in better shape than the 19-year-old I met in college. In addition to the physical benefits of exercise, it serves as his main stress-reliever, improving all areas of his life,” she continued.

He noted that participating in Ironman competitions have helped him achieve a “can-do mindset” for whatever challenges come his way.

“Being able to do an Ironman shows that I can accomplish just about anything I put my mind to,” he said. “I believe it positively affects my work attitude and my attitude at home. The biggest thing for me is, as a physician I always want to make a difference in the lives of people.”

By doing Ironman competitions, “I'm able to do that. While I haven't raised a ton of money, I've been able to add meaning to my personal life while raising money and awareness for important causes,” Dr. Barron said.

Dr. Barron started training for the Ironman after the death of his niece.

Source Courtesy Kyle Barron-Kraus

Dr. James Barron never took physical fitness seriously until age 30, when he served as the physician for a Marine battalion, but he'd always been intrigued by watching Ironman competitions on television—grueling events that consist of a 2.4-mile swim, a 112-mile bike ride, and a 26-mile run.

“In my mind I would think 'boy, wouldn't it be great to do that some day?'” said Dr. Barron, a 44-year-old internist from Grand Rapids, Mich.

The motivator for his will to ultimately become an Ironman-level triathlete came from a painful life event: the September 2001 death of his 5-year-old niece, Allie Cibulas, from inoperable brain cancer.

“She had a horrible course,” Dr. Barron recalled. “I remember visiting her, being so frustrated. I had so much pent-up energy and I wanted to do something to try to make a difference in the lives of other people affected by children with any type of illness.”

So in 2003 he registered for an Ironman competition in Madison, Wis., and asked friends, family, and perfect strangers to champion him by donating money to Allie's Angels—a charity serving terminally ill children and research on pediatric brain cancer that was launched in honor of his niece (www.alliesangels.com

“I thought, 'I'm going to push myself to my limit and do what I can to try to help out,'” he said. “When little children go through chemotherapy, they're not prepared for it. I had never done a triathlon in my life, so it was symbolic that I was going to go do something I'd never done before and fight my own personal battle to complete it. It pales in comparison to what Allie went through, but the symbolism is that I was going to fight my hardest battle in honor of her, without having prior experience.”

After nearly a year of training, when race day arrived he completed the event and helped to raise several thousand dollars for Allie's Angels. “It wasn't a lot of money,” he said. “But for me it was more [about] creating awareness and putting my own sweat and tears into it.”

Dr. Barron described feeling like an “imposter” in a crowd of highly trained triathletes during the race. “I remember when I crossed the finish line many hours after the winner, still seeing the winner of the race there to cheer me on and welcome me to the club,” he said. “It's a feeling of acceptance. It was very emotional, thinking about my niece as I went through the race. That kind of kept me going the whole time.”

With his first Ironman behind him, Dr. Barron went on to improve his completion times in subsequent Ironman competitions in Lake Placid, N.Y., and in Louisville, Ky., keying in on specific charities to support for each event. In August, he returned to Louisville to compete in the Ford Ironman Lousiville event and help raise money for the National Alliance on Mental Illness Michigan (www.namimi.org

Dr. Barron's ultimate Ironman goal is to compete in Kona, Hawaii, the premier competition in this event.

In addition to his full-time role as a hospitalist for Michigan Medical, P.C. at Spectrum Butterworth in Grand Rapids, Dr. Barron is an essential caretaker of his wife, Dr. Denise Barron-Kraus, and their two teenage sons.

Dr. Barron-Kraus left medical practice in 2000 because she suffers from mental health issues and fibromyalgia that affects her ability to perform activities of daily living. That leaves Dr. Barron precious little time for training, but he manages.

“My husband's ability to dedicate so much time and energy to exercise, in addition to his demanding work schedule at the hospital and home, is amazing to me,” Dr. Barron-Kraus said.

“His choice of hobby is a great one for him as he has a significant family cardiac history. He is in better shape than the 19-year-old I met in college. In addition to the physical benefits of exercise, it serves as his main stress-reliever, improving all areas of his life,” she continued.

He noted that participating in Ironman competitions have helped him achieve a “can-do mindset” for whatever challenges come his way.

“Being able to do an Ironman shows that I can accomplish just about anything I put my mind to,” he said. “I believe it positively affects my work attitude and my attitude at home. The biggest thing for me is, as a physician I always want to make a difference in the lives of people.”

By doing Ironman competitions, “I'm able to do that. While I haven't raised a ton of money, I've been able to add meaning to my personal life while raising money and awareness for important causes,” Dr. Barron said.

Dr. Barron started training for the Ironman after the death of his niece.

Source Courtesy Kyle Barron-Kraus

SAN DIEGO — The prevalence of dyspareunia in menopausal women ranges from 11% to 45%, according to the best estimates in the medical literature.

However, “the literature [on this topic] is terribly flawed,” Dr. Andrew T. Goldstein said at the annual meeting of the North American Menopause Society.

“Age alone is often used instead of menstrual status, there's a failure to indicate surgical versus natural menopause, and there's a failure to indicate if women are on hormone replacement therapy, and if so, what types. Also, the use of validated questionnaires is sorely lacking,” said Dr. Goldstein, an ob.gyn. practicing in Annapolis, Md., who specializes in the treatment of vulvovaginal disorders.

If anything, the prevalence of dyspareunia in menopausal women seems to be increasing because of a variety of factors, including the fact that fewer women are taking hormone therapy; 22%-45% of women not on hormone therapy have dyspareunia. In addition, “changing attitudes of postmenopausal women and their sexuality [are factors]. They expect to have sex later in life,” he said.

Another contributing factor is the proliferation of phosphodiesterase type 5 inhibitors in recent years, which allow the partners of these women to remain sexually active, resume sexual activity, or increase sexual activity.

Dr. Goldstein cautioned clinicians not to assume that the cause of dyspareunia in menopausal women is always atrophic vaginitis. “There are many different causes of postmenopausal dyspareunia,” he said.

Many premenopausal women have dyspareunia that is never adequately treated, Dr. Goldstein added. A study by other researchers showed that 40% of women with vulvar pain never sought primary treatment (J. Am. Med. Womens Assoc. 2003;58:82-8). “In addition, at best, only 75% of women given adequate estradiol treatment are cured of their pain,” Dr. Goldstein said.

However, with a thorough history, physical, and differential diagnosis, “the specific disease process can be determined, and this will determine the correct diagnosis and treatment,” he noted.

Evaluations should include an assessment of when the dyspareunia started, the location of the pain, and the nature of the symptoms. “Different symptoms point us in different directions,” Dr. Goldstein said. “A throbbing, dull, or stabbing pain can often suggest a pelvic floor dysfunction, whereas dryness or tearing can suggest an estrogen deficiency or vulvar dermatoses. Symptoms such as hesitancy, urgency, frequency, or incomplete emptying, constipation, and rectal fissures can also suggest hypertonus pelvic floor muscles.”

He recommended that the physical exam include a careful inspection of the vulva, as at least 75% of dyspareunia cases are vulvar in origin. Special attention should be paid to the vulvar vestibule, “but we have to look at all of the structures,” he said.

The exam also should include vulvoscopy to look for areas of erythema, lichenification, fissures, erosions, ulcerations, scarring and architectural changes, evidence of atrophy, hypopigmentation and hyperpigmentation, and evidence of vulvar intraepithelial neoplasm, he said.

Another component of his exam is the “Q-tip test.” Begin by touching a moistened swab lateral to Hart's line, Dr. Goldstein said, and then just medial to Hart's line. Touch the vestibule at 1 o'clock and 11 o'clock adjacent to the urethra at the ostia of the Skene's glands. Then touch the vestibule at 4 o'clock and 8 o'clock at the ostia of the Bartholin's gland.

“Frequently there will just be pain posteriorly and not anteriorly,” Dr. Goldstein said. “I believe that if you just have posterior pain and not anterior pain, that's almost always a sign of hypertonus of the pelvic floor musculature, and that's often the cause of the dyspareunia. If you have diffuse pain at the entire vestibule, that [points to] an intrinsic problem within the vestibular tissue.”

Dr. Goldstein disclosed that he serves on the advisory boards of Boehringer Ingelheim and Wyeth. He has also received research funding from Novartis.

SAN DIEGO — The prevalence of dyspareunia in menopausal women ranges from 11% to 45%, according to the best estimates in the medical literature.

However, “the literature [on this topic] is terribly flawed,” Dr. Andrew T. Goldstein said at the annual meeting of the North American Menopause Society.

“Age alone is often used instead of menstrual status, there's a failure to indicate surgical versus natural menopause, and there's a failure to indicate if women are on hormone replacement therapy, and if so, what types. Also, the use of validated questionnaires is sorely lacking,” said Dr. Goldstein, an ob.gyn. practicing in Annapolis, Md., who specializes in the treatment of vulvovaginal disorders.

If anything, the prevalence of dyspareunia in menopausal women seems to be increasing because of a variety of factors, including the fact that fewer women are taking hormone therapy; 22%-45% of women not on hormone therapy have dyspareunia. In addition, “changing attitudes of postmenopausal women and their sexuality [are factors]. They expect to have sex later in life,” he said.

Another contributing factor is the proliferation of phosphodiesterase type 5 inhibitors in recent years, which allow the partners of these women to remain sexually active, resume sexual activity, or increase sexual activity.

Dr. Goldstein cautioned clinicians not to assume that the cause of dyspareunia in menopausal women is always atrophic vaginitis. “There are many different causes of postmenopausal dyspareunia,” he said.

Many premenopausal women have dyspareunia that is never adequately treated, Dr. Goldstein added. A study by other researchers showed that 40% of women with vulvar pain never sought primary treatment (J. Am. Med. Womens Assoc. 2003;58:82-8). “In addition, at best, only 75% of women given adequate estradiol treatment are cured of their pain,” Dr. Goldstein said.

However, with a thorough history, physical, and differential diagnosis, “the specific disease process can be determined, and this will determine the correct diagnosis and treatment,” he noted.

Evaluations should include an assessment of when the dyspareunia started, the location of the pain, and the nature of the symptoms. “Different symptoms point us in different directions,” Dr. Goldstein said. “A throbbing, dull, or stabbing pain can often suggest a pelvic floor dysfunction, whereas dryness or tearing can suggest an estrogen deficiency or vulvar dermatoses. Symptoms such as hesitancy, urgency, frequency, or incomplete emptying, constipation, and rectal fissures can also suggest hypertonus pelvic floor muscles.”

He recommended that the physical exam include a careful inspection of the vulva, as at least 75% of dyspareunia cases are vulvar in origin. Special attention should be paid to the vulvar vestibule, “but we have to look at all of the structures,” he said.

The exam also should include vulvoscopy to look for areas of erythema, lichenification, fissures, erosions, ulcerations, scarring and architectural changes, evidence of atrophy, hypopigmentation and hyperpigmentation, and evidence of vulvar intraepithelial neoplasm, he said.

Another component of his exam is the “Q-tip test.” Begin by touching a moistened swab lateral to Hart's line, Dr. Goldstein said, and then just medial to Hart's line. Touch the vestibule at 1 o'clock and 11 o'clock adjacent to the urethra at the ostia of the Skene's glands. Then touch the vestibule at 4 o'clock and 8 o'clock at the ostia of the Bartholin's gland.

“Frequently there will just be pain posteriorly and not anteriorly,” Dr. Goldstein said. “I believe that if you just have posterior pain and not anterior pain, that's almost always a sign of hypertonus of the pelvic floor musculature, and that's often the cause of the dyspareunia. If you have diffuse pain at the entire vestibule, that [points to] an intrinsic problem within the vestibular tissue.”

Dr. Goldstein disclosed that he serves on the advisory boards of Boehringer Ingelheim and Wyeth. He has also received research funding from Novartis.

SAN DIEGO — The prevalence of dyspareunia in menopausal women ranges from 11% to 45%, according to the best estimates in the medical literature.

However, “the literature [on this topic] is terribly flawed,” Dr. Andrew T. Goldstein said at the annual meeting of the North American Menopause Society.

“Age alone is often used instead of menstrual status, there's a failure to indicate surgical versus natural menopause, and there's a failure to indicate if women are on hormone replacement therapy, and if so, what types. Also, the use of validated questionnaires is sorely lacking,” said Dr. Goldstein, an ob.gyn. practicing in Annapolis, Md., who specializes in the treatment of vulvovaginal disorders.

If anything, the prevalence of dyspareunia in menopausal women seems to be increasing because of a variety of factors, including the fact that fewer women are taking hormone therapy; 22%-45% of women not on hormone therapy have dyspareunia. In addition, “changing attitudes of postmenopausal women and their sexuality [are factors]. They expect to have sex later in life,” he said.

Another contributing factor is the proliferation of phosphodiesterase type 5 inhibitors in recent years, which allow the partners of these women to remain sexually active, resume sexual activity, or increase sexual activity.

Dr. Goldstein cautioned clinicians not to assume that the cause of dyspareunia in menopausal women is always atrophic vaginitis. “There are many different causes of postmenopausal dyspareunia,” he said.

Many premenopausal women have dyspareunia that is never adequately treated, Dr. Goldstein added. A study by other researchers showed that 40% of women with vulvar pain never sought primary treatment (J. Am. Med. Womens Assoc. 2003;58:82-8). “In addition, at best, only 75% of women given adequate estradiol treatment are cured of their pain,” Dr. Goldstein said.

However, with a thorough history, physical, and differential diagnosis, “the specific disease process can be determined, and this will determine the correct diagnosis and treatment,” he noted.

Evaluations should include an assessment of when the dyspareunia started, the location of the pain, and the nature of the symptoms. “Different symptoms point us in different directions,” Dr. Goldstein said. “A throbbing, dull, or stabbing pain can often suggest a pelvic floor dysfunction, whereas dryness or tearing can suggest an estrogen deficiency or vulvar dermatoses. Symptoms such as hesitancy, urgency, frequency, or incomplete emptying, constipation, and rectal fissures can also suggest hypertonus pelvic floor muscles.”

He recommended that the physical exam include a careful inspection of the vulva, as at least 75% of dyspareunia cases are vulvar in origin. Special attention should be paid to the vulvar vestibule, “but we have to look at all of the structures,” he said.

The exam also should include vulvoscopy to look for areas of erythema, lichenification, fissures, erosions, ulcerations, scarring and architectural changes, evidence of atrophy, hypopigmentation and hyperpigmentation, and evidence of vulvar intraepithelial neoplasm, he said.

Another component of his exam is the “Q-tip test.” Begin by touching a moistened swab lateral to Hart's line, Dr. Goldstein said, and then just medial to Hart's line. Touch the vestibule at 1 o'clock and 11 o'clock adjacent to the urethra at the ostia of the Skene's glands. Then touch the vestibule at 4 o'clock and 8 o'clock at the ostia of the Bartholin's gland.

“Frequently there will just be pain posteriorly and not anteriorly,” Dr. Goldstein said. “I believe that if you just have posterior pain and not anterior pain, that's almost always a sign of hypertonus of the pelvic floor musculature, and that's often the cause of the dyspareunia. If you have diffuse pain at the entire vestibule, that [points to] an intrinsic problem within the vestibular tissue.”

Dr. Goldstein disclosed that he serves on the advisory boards of Boehringer Ingelheim and Wyeth. He has also received research funding from Novartis.

SAN DIEGO — The presence of an estimated glomerular filtration rate less than 60 mL/min per 1.73 m

“Don't just settle for measuring a patient's serum creatinine level. Know what the estimated GFR is,” lead study investigator Dr. David G. Warnock advised in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“If it's less than 60 [mL/min per 1.73 m

Dr. Warnock and his colleagues evaluated the association between all-cause mortality and the three components of chronic kidney disease in 19,125 men and women who participated in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort investigation of incident stroke in whites and blacks aged 45 years and older in the United States.

In addition to the low glomerular filtration rate, albuminuria was defined as an albumin/creatinine ratio of 30 mg/g or greater and anemia was defined as a hemoglobin level less than 13.5 g/dL for men and less than 12.0 g/dL for women.

Study participants had single measurements of serum creatinine, urinary creatinine and albumin, and other baseline assessments. The researchers ascertained vital status based on telephone interviews every 6 months. Prevalent coronary heart disease included self-reported previous myocardial infarction, stroke, cardiovascular procedures, or evidence of previous myocardial infarction by electrocardiogram.

Of the 19,125 people in the cohort, 14,361 had no coronary heart disease or stroke over a mean follow-up of 3.6 years and 4,764 did. Study participants with prevalent coronary heart disease were slightly older than their unaffected counterparts (mean age of 67 years vs. 63 years, respectively).

Dr. Warnock, professor of medicine in the division of nephrology at the University of Alabama, Birmingham, reported that there were 650 deaths among study participants, evenly divided between those who had coronary heart disease or stroke and those who did not.

In both groups, significant hazard ratios for all-cause mortality were independently associated with an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m

Dr. Warnock acknowledged certain limitations of the study, including the potential for ascertainment bias and the fact that only blacks and whites were enrolled, “so we can't say anything about Asians or Hispanics. There's no reason to suspect different results [in those populations], but we don't know.”

The study was supported by a grant from the National Institute of Neurological Disorders and Stroke and by a grant from Amgen to Dr. Warnock.

'Don't just settle for measuring a patient's serum creatinine level. Know what the estimated GFR is.'

Source DR. WARNOCK

SAN DIEGO — The presence of an estimated glomerular filtration rate less than 60 mL/min per 1.73 m

“Don't just settle for measuring a patient's serum creatinine level. Know what the estimated GFR is,” lead study investigator Dr. David G. Warnock advised in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“If it's less than 60 [mL/min per 1.73 m

Dr. Warnock and his colleagues evaluated the association between all-cause mortality and the three components of chronic kidney disease in 19,125 men and women who participated in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort investigation of incident stroke in whites and blacks aged 45 years and older in the United States.

In addition to the low glomerular filtration rate, albuminuria was defined as an albumin/creatinine ratio of 30 mg/g or greater and anemia was defined as a hemoglobin level less than 13.5 g/dL for men and less than 12.0 g/dL for women.

Study participants had single measurements of serum creatinine, urinary creatinine and albumin, and other baseline assessments. The researchers ascertained vital status based on telephone interviews every 6 months. Prevalent coronary heart disease included self-reported previous myocardial infarction, stroke, cardiovascular procedures, or evidence of previous myocardial infarction by electrocardiogram.

Of the 19,125 people in the cohort, 14,361 had no coronary heart disease or stroke over a mean follow-up of 3.6 years and 4,764 did. Study participants with prevalent coronary heart disease were slightly older than their unaffected counterparts (mean age of 67 years vs. 63 years, respectively).

Dr. Warnock, professor of medicine in the division of nephrology at the University of Alabama, Birmingham, reported that there were 650 deaths among study participants, evenly divided between those who had coronary heart disease or stroke and those who did not.

In both groups, significant hazard ratios for all-cause mortality were independently associated with an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m

Dr. Warnock acknowledged certain limitations of the study, including the potential for ascertainment bias and the fact that only blacks and whites were enrolled, “so we can't say anything about Asians or Hispanics. There's no reason to suspect different results [in those populations], but we don't know.”

The study was supported by a grant from the National Institute of Neurological Disorders and Stroke and by a grant from Amgen to Dr. Warnock.

'Don't just settle for measuring a patient's serum creatinine level. Know what the estimated GFR is.'

Source DR. WARNOCK

SAN DIEGO — The presence of an estimated glomerular filtration rate less than 60 mL/min per 1.73 m

“Don't just settle for measuring a patient's serum creatinine level. Know what the estimated GFR is,” lead study investigator Dr. David G. Warnock advised in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“If it's less than 60 [mL/min per 1.73 m

Dr. Warnock and his colleagues evaluated the association between all-cause mortality and the three components of chronic kidney disease in 19,125 men and women who participated in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort investigation of incident stroke in whites and blacks aged 45 years and older in the United States.

In addition to the low glomerular filtration rate, albuminuria was defined as an albumin/creatinine ratio of 30 mg/g or greater and anemia was defined as a hemoglobin level less than 13.5 g/dL for men and less than 12.0 g/dL for women.

Study participants had single measurements of serum creatinine, urinary creatinine and albumin, and other baseline assessments. The researchers ascertained vital status based on telephone interviews every 6 months. Prevalent coronary heart disease included self-reported previous myocardial infarction, stroke, cardiovascular procedures, or evidence of previous myocardial infarction by electrocardiogram.

Of the 19,125 people in the cohort, 14,361 had no coronary heart disease or stroke over a mean follow-up of 3.6 years and 4,764 did. Study participants with prevalent coronary heart disease were slightly older than their unaffected counterparts (mean age of 67 years vs. 63 years, respectively).

Dr. Warnock, professor of medicine in the division of nephrology at the University of Alabama, Birmingham, reported that there were 650 deaths among study participants, evenly divided between those who had coronary heart disease or stroke and those who did not.

In both groups, significant hazard ratios for all-cause mortality were independently associated with an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m

Dr. Warnock acknowledged certain limitations of the study, including the potential for ascertainment bias and the fact that only blacks and whites were enrolled, “so we can't say anything about Asians or Hispanics. There's no reason to suspect different results [in those populations], but we don't know.”

The study was supported by a grant from the National Institute of Neurological Disorders and Stroke and by a grant from Amgen to Dr. Warnock.

'Don't just settle for measuring a patient's serum creatinine level. Know what the estimated GFR is.'

Source DR. WARNOCK

SAN DIEGO — Olmesartan reduced the risk of microalbuminuria by 23% in normoalbuminuric patients with type 2 diabetes and at least one additional cardiovascular disease risk factor, results from a large European trial showed.

The angiotensin receptor blocker also yielded unprecedented blood pressure control for this population of patients.

Those are the first key findings from the Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study, which were unveiled during a press briefing at the annual meeting of the American Society of Nephrology.

“Despite all of our efforts, we still have problems effectively treating diabetic nephropathy,” said the study's steering committee chair, Dr. Hermann G. Haller of the department of nephrology at Hannover (Germany) Medical School. “The problem for prevention is that we have to diagnose and treat it early. Microalbuminuria is the first sign of the pathogenesis of diabetic nephropathy. It is also an important marker of early development of cardiovascular disease and can indicate microvascular disease.”

The primary end point of the study was the occurrence of microalbuminuria based on two or more positive morning spot urine measurements. Secondary end points were cardiovascular events, renal function, and microvascular morbidity.

With support from Daiichi Sankyo, which markets olmesartan, researchers in 19 countries enrolled 4,449 patients, aged 18-75 years, with well-controlled type 2 diabetes. All patients were normoalbuminuric (defined as a level of 25 mg/g or less for men and 35 mg/g or less for women) and had at lease one additional cardiovascular risk factor, such as high triglyceride levels or hypertension. None of the participants had received an ACE inhibitor or an angiotensin receptor blocker within 6 months of participation.

The patients were randomized to receive either 40 mg olmesartan per day or placebo (conventional antihypertensive treatment without blockade of the renin-angiotensin system). The urine albumin- creatinine ratio was determined every 6 months. Patients were followed for an average of 3.2 years.

At their discretion, study investigators could add calcium channel blockers, diuretics, or beta-blockers to the regimen to help patients achieve the target blood pressure goal of 130/80 mm Hg.

The patients' mean age was 58 years, mean duration of diabetes was 6 years, mean hemoglobin A_1c level was 7.6%, and mean body mass index was 31 kg/m

Dr. Haller reported that nearly 80% of patients in the olmesartan group reached the target BP of 130/80 mm Hg at 42 months, compared with about 75% of patients in the placebo group. “The percentage of patients reaching the blood pressure goal was very high,” he said. “ROADMAP will need further analysis to find out what this high percentage of control actually means.”

Over the study period, microalbuminuria occurred in about 8% of the patients in the olmesartan group and 10% of the patients in the placebo group, a statistically significant difference (hazard ratio 0.77). This translated into a risk reduction of 23% for the olmesartan group, compared with the placebo group.

After 1 year, the first incidence of microalbuminuria occurred in about 3% of patients in both groups. For the remainder of the study, fewer patients in the olmesartan group experienced microalbuminuria, compared with patients in the placebo group. “The divergence after 1 year indicates that the specific effects of olmesartan are not due to early hemodynamic changes that would have happened in the first couple of months,” Dr. Haller said in an interview. “We think that olmesartan has a specific, perhaps structural effect on the kidney, either in the glomeruli or in the basal membrane, in the microcirculation.”

Dr. Haller disclosed that he has received honoraria and is a paid consultant for several pharmaceutical companies, including Daiichi Sankyo.

SAN DIEGO — Olmesartan reduced the risk of microalbuminuria by 23% in normoalbuminuric patients with type 2 diabetes and at least one additional cardiovascular disease risk factor, results from a large European trial showed.

The angiotensin receptor blocker also yielded unprecedented blood pressure control for this population of patients.

Those are the first key findings from the Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study, which were unveiled during a press briefing at the annual meeting of the American Society of Nephrology.

“Despite all of our efforts, we still have problems effectively treating diabetic nephropathy,” said the study's steering committee chair, Dr. Hermann G. Haller of the department of nephrology at Hannover (Germany) Medical School. “The problem for prevention is that we have to diagnose and treat it early. Microalbuminuria is the first sign of the pathogenesis of diabetic nephropathy. It is also an important marker of early development of cardiovascular disease and can indicate microvascular disease.”

The primary end point of the study was the occurrence of microalbuminuria based on two or more positive morning spot urine measurements. Secondary end points were cardiovascular events, renal function, and microvascular morbidity.

With support from Daiichi Sankyo, which markets olmesartan, researchers in 19 countries enrolled 4,449 patients, aged 18-75 years, with well-controlled type 2 diabetes. All patients were normoalbuminuric (defined as a level of 25 mg/g or less for men and 35 mg/g or less for women) and had at lease one additional cardiovascular risk factor, such as high triglyceride levels or hypertension. None of the participants had received an ACE inhibitor or an angiotensin receptor blocker within 6 months of participation.

The patients were randomized to receive either 40 mg olmesartan per day or placebo (conventional antihypertensive treatment without blockade of the renin-angiotensin system). The urine albumin- creatinine ratio was determined every 6 months. Patients were followed for an average of 3.2 years.

At their discretion, study investigators could add calcium channel blockers, diuretics, or beta-blockers to the regimen to help patients achieve the target blood pressure goal of 130/80 mm Hg.

The patients' mean age was 58 years, mean duration of diabetes was 6 years, mean hemoglobin A_1c level was 7.6%, and mean body mass index was 31 kg/m

Dr. Haller reported that nearly 80% of patients in the olmesartan group reached the target BP of 130/80 mm Hg at 42 months, compared with about 75% of patients in the placebo group. “The percentage of patients reaching the blood pressure goal was very high,” he said. “ROADMAP will need further analysis to find out what this high percentage of control actually means.”

Over the study period, microalbuminuria occurred in about 8% of the patients in the olmesartan group and 10% of the patients in the placebo group, a statistically significant difference (hazard ratio 0.77). This translated into a risk reduction of 23% for the olmesartan group, compared with the placebo group.

After 1 year, the first incidence of microalbuminuria occurred in about 3% of patients in both groups. For the remainder of the study, fewer patients in the olmesartan group experienced microalbuminuria, compared with patients in the placebo group. “The divergence after 1 year indicates that the specific effects of olmesartan are not due to early hemodynamic changes that would have happened in the first couple of months,” Dr. Haller said in an interview. “We think that olmesartan has a specific, perhaps structural effect on the kidney, either in the glomeruli or in the basal membrane, in the microcirculation.”

Dr. Haller disclosed that he has received honoraria and is a paid consultant for several pharmaceutical companies, including Daiichi Sankyo.

SAN DIEGO — Olmesartan reduced the risk of microalbuminuria by 23% in normoalbuminuric patients with type 2 diabetes and at least one additional cardiovascular disease risk factor, results from a large European trial showed.

The angiotensin receptor blocker also yielded unprecedented blood pressure control for this population of patients.

Those are the first key findings from the Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study, which were unveiled during a press briefing at the annual meeting of the American Society of Nephrology.

“Despite all of our efforts, we still have problems effectively treating diabetic nephropathy,” said the study's steering committee chair, Dr. Hermann G. Haller of the department of nephrology at Hannover (Germany) Medical School. “The problem for prevention is that we have to diagnose and treat it early. Microalbuminuria is the first sign of the pathogenesis of diabetic nephropathy. It is also an important marker of early development of cardiovascular disease and can indicate microvascular disease.”

The primary end point of the study was the occurrence of microalbuminuria based on two or more positive morning spot urine measurements. Secondary end points were cardiovascular events, renal function, and microvascular morbidity.

With support from Daiichi Sankyo, which markets olmesartan, researchers in 19 countries enrolled 4,449 patients, aged 18-75 years, with well-controlled type 2 diabetes. All patients were normoalbuminuric (defined as a level of 25 mg/g or less for men and 35 mg/g or less for women) and had at lease one additional cardiovascular risk factor, such as high triglyceride levels or hypertension. None of the participants had received an ACE inhibitor or an angiotensin receptor blocker within 6 months of participation.

The patients were randomized to receive either 40 mg olmesartan per day or placebo (conventional antihypertensive treatment without blockade of the renin-angiotensin system). The urine albumin- creatinine ratio was determined every 6 months. Patients were followed for an average of 3.2 years.

At their discretion, study investigators could add calcium channel blockers, diuretics, or beta-blockers to the regimen to help patients achieve the target blood pressure goal of 130/80 mm Hg.

The patients' mean age was 58 years, mean duration of diabetes was 6 years, mean hemoglobin A_1c level was 7.6%, and mean body mass index was 31 kg/m

Dr. Haller reported that nearly 80% of patients in the olmesartan group reached the target BP of 130/80 mm Hg at 42 months, compared with about 75% of patients in the placebo group. “The percentage of patients reaching the blood pressure goal was very high,” he said. “ROADMAP will need further analysis to find out what this high percentage of control actually means.”

Over the study period, microalbuminuria occurred in about 8% of the patients in the olmesartan group and 10% of the patients in the placebo group, a statistically significant difference (hazard ratio 0.77). This translated into a risk reduction of 23% for the olmesartan group, compared with the placebo group.

After 1 year, the first incidence of microalbuminuria occurred in about 3% of patients in both groups. For the remainder of the study, fewer patients in the olmesartan group experienced microalbuminuria, compared with patients in the placebo group. “The divergence after 1 year indicates that the specific effects of olmesartan are not due to early hemodynamic changes that would have happened in the first couple of months,” Dr. Haller said in an interview. “We think that olmesartan has a specific, perhaps structural effect on the kidney, either in the glomeruli or in the basal membrane, in the microcirculation.”

Dr. Haller disclosed that he has received honoraria and is a paid consultant for several pharmaceutical companies, including Daiichi Sankyo.

SAN DIEGO — The risk of a major depressive episode more than doubles for women during and after the menopausal transition, compared with when they were premenopausal, results from a 9-year follow-up study showed.

The finding suggests that clinicians “need to pay attention to depressive symptoms during this time in a woman's life, and perhaps do a more extensive assessment both in terms of the current presentation and a history of depression, so they have a better understanding of what the overall risk is for a major depressive episode and how they might intervene to prevent it,” the study's principal investigator, Joyce T. Bromberger, Ph.D., said in an interview at the annual meeting of the North American Menopause Society.

She and her associates analyzed 9 years of follow-up data from 221 premenopausal women enrolled at the Pittsburgh site of the Study of Women's Health Across the Nation, a multisite epidemiologic study designed to examine the health of women during midlife. The researchers used the Nonpatient Structured Clinical Interview for DSM-IV Axis I Disorders at baseline to determine lifetime history of major depression and annually to assess current and past-year major depression. They classified the women's status according to self-reported bleeding criteria as premenopausal, perimenopausal, postmenopausal, and postmenopausal on hormones.

Covariates included race, history of major depression at baseline, time-varying age, stressful life events such as the loss of a spouse or a job, use of psychotropic medications, and hot flashes/night sweats. Women who reported a bilateral oophorectomy or hysterectomy were not included in the analyses after the procedure.

At baseline the women were between the ages of 42 and 52, reported Dr. Bromberger, associate professor of epidemiology and psychiatry at the University of Pittsburgh. Of the 221 women, 129 (58%) transitioned to postmenopause over the 9 years and 69 (31%) experienced at least one major depressive episode. Nearly half of women with a history of a major depression at baseline (47%) met criteria for current or past-year major depression, compared with 23% of women without a history of major depression at baseline.

Univariate analyses demonstrated that the greatest risk for having a major depressive episode occurred when women were postmenopausal (odds ratio 3.52) or when they were perimenopausal (OR 2.13), compared with when they were premenopausal.

In the fully adjusted multivariate analyses, women remained significantly more likely to have a major depressive episode when they were postmenopausal (OR 3.79) or perimenopausal (OR 2.05). Odd ratios were also significantly greater for African American women (OR 2.10), women with a history of depression (OR 2.97), and women who reported stressful life events (OR 2.90).

“I was surprised by the increased risk during the postmenopause, because the majority of the literature on depressive symptoms has suggested that the increased risk is during the [menopausal] transition, and not after it,” Dr. Bromberger said.

The study was funded by the National Institute on Aging, the National Institute of Mental Health, and the National Institute of Nursing Research.

Odd ratios were also greater for African American women, and women who reported stressful life events.

Source Dr. Bromberger

SAN DIEGO — The risk of a major depressive episode more than doubles for women during and after the menopausal transition, compared with when they were premenopausal, results from a 9-year follow-up study showed.

The finding suggests that clinicians “need to pay attention to depressive symptoms during this time in a woman's life, and perhaps do a more extensive assessment both in terms of the current presentation and a history of depression, so they have a better understanding of what the overall risk is for a major depressive episode and how they might intervene to prevent it,” the study's principal investigator, Joyce T. Bromberger, Ph.D., said in an interview at the annual meeting of the North American Menopause Society.

She and her associates analyzed 9 years of follow-up data from 221 premenopausal women enrolled at the Pittsburgh site of the Study of Women's Health Across the Nation, a multisite epidemiologic study designed to examine the health of women during midlife. The researchers used the Nonpatient Structured Clinical Interview for DSM-IV Axis I Disorders at baseline to determine lifetime history of major depression and annually to assess current and past-year major depression. They classified the women's status according to self-reported bleeding criteria as premenopausal, perimenopausal, postmenopausal, and postmenopausal on hormones.

Covariates included race, history of major depression at baseline, time-varying age, stressful life events such as the loss of a spouse or a job, use of psychotropic medications, and hot flashes/night sweats. Women who reported a bilateral oophorectomy or hysterectomy were not included in the analyses after the procedure.

At baseline the women were between the ages of 42 and 52, reported Dr. Bromberger, associate professor of epidemiology and psychiatry at the University of Pittsburgh. Of the 221 women, 129 (58%) transitioned to postmenopause over the 9 years and 69 (31%) experienced at least one major depressive episode. Nearly half of women with a history of a major depression at baseline (47%) met criteria for current or past-year major depression, compared with 23% of women without a history of major depression at baseline.

Univariate analyses demonstrated that the greatest risk for having a major depressive episode occurred when women were postmenopausal (odds ratio 3.52) or when they were perimenopausal (OR 2.13), compared with when they were premenopausal.

In the fully adjusted multivariate analyses, women remained significantly more likely to have a major depressive episode when they were postmenopausal (OR 3.79) or perimenopausal (OR 2.05). Odd ratios were also significantly greater for African American women (OR 2.10), women with a history of depression (OR 2.97), and women who reported stressful life events (OR 2.90).

“I was surprised by the increased risk during the postmenopause, because the majority of the literature on depressive symptoms has suggested that the increased risk is during the [menopausal] transition, and not after it,” Dr. Bromberger said.

The study was funded by the National Institute on Aging, the National Institute of Mental Health, and the National Institute of Nursing Research.

Odd ratios were also greater for African American women, and women who reported stressful life events.

Source Dr. Bromberger

SAN DIEGO — The risk of a major depressive episode more than doubles for women during and after the menopausal transition, compared with when they were premenopausal, results from a 9-year follow-up study showed.

The finding suggests that clinicians “need to pay attention to depressive symptoms during this time in a woman's life, and perhaps do a more extensive assessment both in terms of the current presentation and a history of depression, so they have a better understanding of what the overall risk is for a major depressive episode and how they might intervene to prevent it,” the study's principal investigator, Joyce T. Bromberger, Ph.D., said in an interview at the annual meeting of the North American Menopause Society.

She and her associates analyzed 9 years of follow-up data from 221 premenopausal women enrolled at the Pittsburgh site of the Study of Women's Health Across the Nation, a multisite epidemiologic study designed to examine the health of women during midlife. The researchers used the Nonpatient Structured Clinical Interview for DSM-IV Axis I Disorders at baseline to determine lifetime history of major depression and annually to assess current and past-year major depression. They classified the women's status according to self-reported bleeding criteria as premenopausal, perimenopausal, postmenopausal, and postmenopausal on hormones.

Covariates included race, history of major depression at baseline, time-varying age, stressful life events such as the loss of a spouse or a job, use of psychotropic medications, and hot flashes/night sweats. Women who reported a bilateral oophorectomy or hysterectomy were not included in the analyses after the procedure.

At baseline the women were between the ages of 42 and 52, reported Dr. Bromberger, associate professor of epidemiology and psychiatry at the University of Pittsburgh. Of the 221 women, 129 (58%) transitioned to postmenopause over the 9 years and 69 (31%) experienced at least one major depressive episode. Nearly half of women with a history of a major depression at baseline (47%) met criteria for current or past-year major depression, compared with 23% of women without a history of major depression at baseline.

Univariate analyses demonstrated that the greatest risk for having a major depressive episode occurred when women were postmenopausal (odds ratio 3.52) or when they were perimenopausal (OR 2.13), compared with when they were premenopausal.

In the fully adjusted multivariate analyses, women remained significantly more likely to have a major depressive episode when they were postmenopausal (OR 3.79) or perimenopausal (OR 2.05). Odd ratios were also significantly greater for African American women (OR 2.10), women with a history of depression (OR 2.97), and women who reported stressful life events (OR 2.90).

“I was surprised by the increased risk during the postmenopause, because the majority of the literature on depressive symptoms has suggested that the increased risk is during the [menopausal] transition, and not after it,” Dr. Bromberger said.

The study was funded by the National Institute on Aging, the National Institute of Mental Health, and the National Institute of Nursing Research.

Odd ratios were also greater for African American women, and women who reported stressful life events.

Source Dr. Bromberger

SAN DIEGO — The combination of breastfeeding and delaying pregnancy until the majority of bone mass has been acquired appears to have a protective effect on bones, according to study involving more than 600 women.

“Several studies have shown that people who have had many pregnancies have less bone loss than women with no pregnancies,” lead author Dr. Peter F. Schnatz said in an interview.

“Our study is the first to our knowledge looking at the effect of pregnancy during the time of peak bone mineral acquisition and its eventual and ultimate effect on the development of postmenopausal osteoporosis,” he said at a poster session at the annual meeting of the North American Menopause Society.

Dr. Schnatz, of the department of obstetrics and gynecology at Reading (Pa.) Hospital and Medical Center, and his associates analyzed data from 619 women aged older than 49 years who presented for bone density scanning in the Hartford, Conn., area. They assessed risk factors for osteoporosis, including a previous atraumatic fracture of the hip or spine, pregnancy information, and dual-energy x-ray absorptiometry results. Mean age of the study participants was 62 years; 50% were either current or past smokers.

Women who had breastfed had a significantly lower prevalence of osteoporosis (8%) than did those who did not breastfeed (19%), a finding that surprised the researchers. “It would seem that breastfeeding, which requires acquisition of calcium from the mother to nourish the baby, would cause bone loss,” Dr. Schnatz said. “We wonder if there may be a rebound anabolic phenomenon, hence resulting in overall benefit.”

Among those who had breastfed, women aged younger than 27 years at the first pregnancy had a significantly higher prevalence of osteoporosis than did those who were 27 and older at first pregnancy (11% vs. 5%, respectively).

Of those who were at least 27 years old at first pregnancy, there was a significantly increased prevalence of osteoporosis in those who did not breastfeed, compared with those who did (25% vs. 5%, respectively).

Women who were at least 27 years old at their first pregnancy and who breastfed had a statistically lower prevalence of osteoporosis, compared with their counterparts who had their first pregnancy younger than age 27 and no history of breastfeeding (5% vs. 16%, respectively).

Among women who did not breastfeed, there was little difference in the risk of postmenopausal osteoporosis if the first pregnancy occurred at or after age 22 or 27 years, Dr. Schnatz wrote.

“Women should be encouraged to wait until the postadolescent years for childbearing and should be encouraged to breastfeed,” he concluded.

The study was supported by a grant from the Alliance for Better Bone Health. Dr. Schnatz and his associates had no other financial conflicts to disclose.

SAN DIEGO — The combination of breastfeeding and delaying pregnancy until the majority of bone mass has been acquired appears to have a protective effect on bones, according to study involving more than 600 women.

“Several studies have shown that people who have had many pregnancies have less bone loss than women with no pregnancies,” lead author Dr. Peter F. Schnatz said in an interview.

“Our study is the first to our knowledge looking at the effect of pregnancy during the time of peak bone mineral acquisition and its eventual and ultimate effect on the development of postmenopausal osteoporosis,” he said at a poster session at the annual meeting of the North American Menopause Society.

Dr. Schnatz, of the department of obstetrics and gynecology at Reading (Pa.) Hospital and Medical Center, and his associates analyzed data from 619 women aged older than 49 years who presented for bone density scanning in the Hartford, Conn., area. They assessed risk factors for osteoporosis, including a previous atraumatic fracture of the hip or spine, pregnancy information, and dual-energy x-ray absorptiometry results. Mean age of the study participants was 62 years; 50% were either current or past smokers.

Women who had breastfed had a significantly lower prevalence of osteoporosis (8%) than did those who did not breastfeed (19%), a finding that surprised the researchers. “It would seem that breastfeeding, which requires acquisition of calcium from the mother to nourish the baby, would cause bone loss,” Dr. Schnatz said. “We wonder if there may be a rebound anabolic phenomenon, hence resulting in overall benefit.”

Among those who had breastfed, women aged younger than 27 years at the first pregnancy had a significantly higher prevalence of osteoporosis than did those who were 27 and older at first pregnancy (11% vs. 5%, respectively).

Of those who were at least 27 years old at first pregnancy, there was a significantly increased prevalence of osteoporosis in those who did not breastfeed, compared with those who did (25% vs. 5%, respectively).

Women who were at least 27 years old at their first pregnancy and who breastfed had a statistically lower prevalence of osteoporosis, compared with their counterparts who had their first pregnancy younger than age 27 and no history of breastfeeding (5% vs. 16%, respectively).

Among women who did not breastfeed, there was little difference in the risk of postmenopausal osteoporosis if the first pregnancy occurred at or after age 22 or 27 years, Dr. Schnatz wrote.

“Women should be encouraged to wait until the postadolescent years for childbearing and should be encouraged to breastfeed,” he concluded.

The study was supported by a grant from the Alliance for Better Bone Health. Dr. Schnatz and his associates had no other financial conflicts to disclose.

SAN DIEGO — The combination of breastfeeding and delaying pregnancy until the majority of bone mass has been acquired appears to have a protective effect on bones, according to study involving more than 600 women.

“Several studies have shown that people who have had many pregnancies have less bone loss than women with no pregnancies,” lead author Dr. Peter F. Schnatz said in an interview.

“Our study is the first to our knowledge looking at the effect of pregnancy during the time of peak bone mineral acquisition and its eventual and ultimate effect on the development of postmenopausal osteoporosis,” he said at a poster session at the annual meeting of the North American Menopause Society.

Dr. Schnatz, of the department of obstetrics and gynecology at Reading (Pa.) Hospital and Medical Center, and his associates analyzed data from 619 women aged older than 49 years who presented for bone density scanning in the Hartford, Conn., area. They assessed risk factors for osteoporosis, including a previous atraumatic fracture of the hip or spine, pregnancy information, and dual-energy x-ray absorptiometry results. Mean age of the study participants was 62 years; 50% were either current or past smokers.

Women who had breastfed had a significantly lower prevalence of osteoporosis (8%) than did those who did not breastfeed (19%), a finding that surprised the researchers. “It would seem that breastfeeding, which requires acquisition of calcium from the mother to nourish the baby, would cause bone loss,” Dr. Schnatz said. “We wonder if there may be a rebound anabolic phenomenon, hence resulting in overall benefit.”

Among those who had breastfed, women aged younger than 27 years at the first pregnancy had a significantly higher prevalence of osteoporosis than did those who were 27 and older at first pregnancy (11% vs. 5%, respectively).

Of those who were at least 27 years old at first pregnancy, there was a significantly increased prevalence of osteoporosis in those who did not breastfeed, compared with those who did (25% vs. 5%, respectively).

Women who were at least 27 years old at their first pregnancy and who breastfed had a statistically lower prevalence of osteoporosis, compared with their counterparts who had their first pregnancy younger than age 27 and no history of breastfeeding (5% vs. 16%, respectively).

Among women who did not breastfeed, there was little difference in the risk of postmenopausal osteoporosis if the first pregnancy occurred at or after age 22 or 27 years, Dr. Schnatz wrote.

“Women should be encouraged to wait until the postadolescent years for childbearing and should be encouraged to breastfeed,” he concluded.

The study was supported by a grant from the Alliance for Better Bone Health. Dr. Schnatz and his associates had no other financial conflicts to disclose.

SAN DIEGO — Postmenopausal women with severe vasomotor symptoms show a circadian rhythm of hot flashes that peaks in the late afternoon and early evening hours, results from a small study showed.

“A lot of women complain about frequency of hot flashes at night,” Lauren Drogos said in an interview after her poster presentation at the annual meeting of the North American Menopause Society. “But we found that women were having the least frequent amount of hot flashes at night.

For the study, Ms. Drogos and her associates evaluated baseline data from a trial of 29 postmenopausal women who had at least 35 hot flashes per week and were enrolled in a clinical trial comparing the efficacy of hormone therapy, black cohosh, and red clover for menopausal symptoms and cognition. The women wore ambulatory sternal skin conductance monitors, which recorded their hot flashes over a 24-hour period. Hot flashes were defined as a greater than 2-micromho increase in skin conductance within 30 seconds. The women also kept a diary of their perceived hot flashes.

In an effort to reduce the interindividual variability in the time of hot flashes for study participants on different sleep/wake schedules, the researchers normalized the data to each woman's wake time.

The mean age of the study participants was 53 years, 61% were African American, 36% were white, and the rest were Asian American.

The women had an average of 19 hot flashes during the 24-hour monitoring period, including 14 during waking hours and 5 during sleeping hours, reported Ms. Drogos, a graduate student in the department of psychology at the University of Illinois at Chicago. “There was a broad peak of hot flash frequency, extending from late afternoon to evening hours, and a nadir that roughly corresponded to the time of the sleep episode,” the researchers wrote in their poster.

From a clinical standpoint, Ms. Drogos said, “if you have a highly symptomatic postmenopausal woman, you might want to advise her that her symptoms may peak at this time. If she has something important going on, advise her to plan accordingly by dressing in layers or packing an extra T-shirt in her bag.”

The pattern matchest “other circadian rhythms that generally follow this rise, such as core body temperature and peaks of cortisol levels,” she added.

Ms. Drogos acknowledged certain limitations of the study, including its small sample size and the fact that it focused on highly symptomatic women. “We want to do some follow-up studies, possibly looking at women who have shifted circadian rhythm, such as night shift nurses,” she said.

She reported no financial conflicts of interest.

Hot flashes were least frequent at night, with the peak occurring from late afternoon to evening hours.

Source MS. DROGOS

SAN DIEGO — Postmenopausal women with severe vasomotor symptoms show a circadian rhythm of hot flashes that peaks in the late afternoon and early evening hours, results from a small study showed.

“A lot of women complain about frequency of hot flashes at night,” Lauren Drogos said in an interview after her poster presentation at the annual meeting of the North American Menopause Society. “But we found that women were having the least frequent amount of hot flashes at night.

For the study, Ms. Drogos and her associates evaluated baseline data from a trial of 29 postmenopausal women who had at least 35 hot flashes per week and were enrolled in a clinical trial comparing the efficacy of hormone therapy, black cohosh, and red clover for menopausal symptoms and cognition. The women wore ambulatory sternal skin conductance monitors, which recorded their hot flashes over a 24-hour period. Hot flashes were defined as a greater than 2-micromho increase in skin conductance within 30 seconds. The women also kept a diary of their perceived hot flashes.

In an effort to reduce the interindividual variability in the time of hot flashes for study participants on different sleep/wake schedules, the researchers normalized the data to each woman's wake time.

The mean age of the study participants was 53 years, 61% were African American, 36% were white, and the rest were Asian American.

The women had an average of 19 hot flashes during the 24-hour monitoring period, including 14 during waking hours and 5 during sleeping hours, reported Ms. Drogos, a graduate student in the department of psychology at the University of Illinois at Chicago. “There was a broad peak of hot flash frequency, extending from late afternoon to evening hours, and a nadir that roughly corresponded to the time of the sleep episode,” the researchers wrote in their poster.

From a clinical standpoint, Ms. Drogos said, “if you have a highly symptomatic postmenopausal woman, you might want to advise her that her symptoms may peak at this time. If she has something important going on, advise her to plan accordingly by dressing in layers or packing an extra T-shirt in her bag.”

The pattern matchest “other circadian rhythms that generally follow this rise, such as core body temperature and peaks of cortisol levels,” she added.

Ms. Drogos acknowledged certain limitations of the study, including its small sample size and the fact that it focused on highly symptomatic women. “We want to do some follow-up studies, possibly looking at women who have shifted circadian rhythm, such as night shift nurses,” she said.

She reported no financial conflicts of interest.

Hot flashes were least frequent at night, with the peak occurring from late afternoon to evening hours.

Source MS. DROGOS

SAN DIEGO — Postmenopausal women with severe vasomotor symptoms show a circadian rhythm of hot flashes that peaks in the late afternoon and early evening hours, results from a small study showed.

“A lot of women complain about frequency of hot flashes at night,” Lauren Drogos said in an interview after her poster presentation at the annual meeting of the North American Menopause Society. “But we found that women were having the least frequent amount of hot flashes at night.

For the study, Ms. Drogos and her associates evaluated baseline data from a trial of 29 postmenopausal women who had at least 35 hot flashes per week and were enrolled in a clinical trial comparing the efficacy of hormone therapy, black cohosh, and red clover for menopausal symptoms and cognition. The women wore ambulatory sternal skin conductance monitors, which recorded their hot flashes over a 24-hour period. Hot flashes were defined as a greater than 2-micromho increase in skin conductance within 30 seconds. The women also kept a diary of their perceived hot flashes.

In an effort to reduce the interindividual variability in the time of hot flashes for study participants on different sleep/wake schedules, the researchers normalized the data to each woman's wake time.

The mean age of the study participants was 53 years, 61% were African American, 36% were white, and the rest were Asian American.

The women had an average of 19 hot flashes during the 24-hour monitoring period, including 14 during waking hours and 5 during sleeping hours, reported Ms. Drogos, a graduate student in the department of psychology at the University of Illinois at Chicago. “There was a broad peak of hot flash frequency, extending from late afternoon to evening hours, and a nadir that roughly corresponded to the time of the sleep episode,” the researchers wrote in their poster.

From a clinical standpoint, Ms. Drogos said, “if you have a highly symptomatic postmenopausal woman, you might want to advise her that her symptoms may peak at this time. If she has something important going on, advise her to plan accordingly by dressing in layers or packing an extra T-shirt in her bag.”

The pattern matchest “other circadian rhythms that generally follow this rise, such as core body temperature and peaks of cortisol levels,” she added.

Ms. Drogos acknowledged certain limitations of the study, including its small sample size and the fact that it focused on highly symptomatic women. “We want to do some follow-up studies, possibly looking at women who have shifted circadian rhythm, such as night shift nurses,” she said.

She reported no financial conflicts of interest.

Hot flashes were least frequent at night, with the peak occurring from late afternoon to evening hours.

Source MS. DROGOS

SAN DIEGO — Breast cancer survivors are taking an average of eight medications or supplements, results from a survey of nearly 400 women showed.

“This study shows that there is a need to evaluate medications women are taking prior to the start of cancer treatment to promote discussion and education about drug-drug interactions that can impact treatment,” Julie L. Otte, Ph.D., said in an interview after her poster presentation at the annual meeting of the North American Menopause Society.

To date, the majority of research in the medical literature has focused on diseases and medications that are related to the prevalence of cancer, said Dr. Otte, a nurse who is a postdoctoral fellow focussing on behavioral oncology at Indiana University School of Nursing, Indianapolis. “However, there is little research in the field of pharmacogenetics regarding drug-drug interactions and cancer treatment and survivorship,” she said.

To investigate the association, she and her associates reviewed prescription, herbal, and over-the-counter medications reported in baseline questionnaire data from the COBRA (Consortium on Breast Cancer Pharmacogenomics) randomized clinical trial that evaluated the pharmacogenetics and toxicities of exemestane and letrozole for the treatment of breast cancer. The sample included 389 female breast cancer survivors with a mean age of 59 years and a mean body mass index of 37 kg/m

The top five noncancer comorbid conditions reported by the study participants were drug allergies (50%), high or low blood pressure (41%), high cholesterol (38%), a history of bone fracture (34%), and arthritis (29%).

The women reported that they were taking an average of eight medications or supplements per day. The five most common therapeutic categories represented were vitamins and herbal supplements (39%), cardiac drugs (16%), medications for pain and inflammation (13%), other (9%), and drugs for psychological conditions (6%).

“Although we expected the number of comorbid conditions to increase with age, requiring several prescription medications, it was interesting that the majority of medications reported were over-the-counter” herbals or supplements, and not prescriptions, Dr. Otte commented. Because these data were collected before the patients started a clinical trial, it is unclear whether patients would divulge the same information to their practitioners who prescribe routine medications. The extent of polypharmacy and the number of practitioners prescribing medications are also unclear.

“All of these questions prompt the need for further investigation and study to better educate patients on the possible harm of certain drug interactions,” Dr. Otte said. She said the study had certain limitations, including the potential for underreporting of prescription and over-the-counter medications by some participants. “In addition, it is unclear if these results can be generalized to a noncancer population of women or other cancer populations.” Dr. Otte reported that she had no conflicts of interest related to the study, which was funded by the National Cancer Institute.

SAN DIEGO — Breast cancer survivors are taking an average of eight medications or supplements, results from a survey of nearly 400 women showed.

“This study shows that there is a need to evaluate medications women are taking prior to the start of cancer treatment to promote discussion and education about drug-drug interactions that can impact treatment,” Julie L. Otte, Ph.D., said in an interview after her poster presentation at the annual meeting of the North American Menopause Society.

To date, the majority of research in the medical literature has focused on diseases and medications that are related to the prevalence of cancer, said Dr. Otte, a nurse who is a postdoctoral fellow focussing on behavioral oncology at Indiana University School of Nursing, Indianapolis. “However, there is little research in the field of pharmacogenetics regarding drug-drug interactions and cancer treatment and survivorship,” she said.

To investigate the association, she and her associates reviewed prescription, herbal, and over-the-counter medications reported in baseline questionnaire data from the COBRA (Consortium on Breast Cancer Pharmacogenomics) randomized clinical trial that evaluated the pharmacogenetics and toxicities of exemestane and letrozole for the treatment of breast cancer. The sample included 389 female breast cancer survivors with a mean age of 59 years and a mean body mass index of 37 kg/m

The top five noncancer comorbid conditions reported by the study participants were drug allergies (50%), high or low blood pressure (41%), high cholesterol (38%), a history of bone fracture (34%), and arthritis (29%).

The women reported that they were taking an average of eight medications or supplements per day. The five most common therapeutic categories represented were vitamins and herbal supplements (39%), cardiac drugs (16%), medications for pain and inflammation (13%), other (9%), and drugs for psychological conditions (6%).

“Although we expected the number of comorbid conditions to increase with age, requiring several prescription medications, it was interesting that the majority of medications reported were over-the-counter” herbals or supplements, and not prescriptions, Dr. Otte commented. Because these data were collected before the patients started a clinical trial, it is unclear whether patients would divulge the same information to their practitioners who prescribe routine medications. The extent of polypharmacy and the number of practitioners prescribing medications are also unclear.

“All of these questions prompt the need for further investigation and study to better educate patients on the possible harm of certain drug interactions,” Dr. Otte said. She said the study had certain limitations, including the potential for underreporting of prescription and over-the-counter medications by some participants. “In addition, it is unclear if these results can be generalized to a noncancer population of women or other cancer populations.” Dr. Otte reported that she had no conflicts of interest related to the study, which was funded by the National Cancer Institute.

SAN DIEGO — Breast cancer survivors are taking an average of eight medications or supplements, results from a survey of nearly 400 women showed.

“This study shows that there is a need to evaluate medications women are taking prior to the start of cancer treatment to promote discussion and education about drug-drug interactions that can impact treatment,” Julie L. Otte, Ph.D., said in an interview after her poster presentation at the annual meeting of the North American Menopause Society.

To date, the majority of research in the medical literature has focused on diseases and medications that are related to the prevalence of cancer, said Dr. Otte, a nurse who is a postdoctoral fellow focussing on behavioral oncology at Indiana University School of Nursing, Indianapolis. “However, there is little research in the field of pharmacogenetics regarding drug-drug interactions and cancer treatment and survivorship,” she said.

To investigate the association, she and her associates reviewed prescription, herbal, and over-the-counter medications reported in baseline questionnaire data from the COBRA (Consortium on Breast Cancer Pharmacogenomics) randomized clinical trial that evaluated the pharmacogenetics and toxicities of exemestane and letrozole for the treatment of breast cancer. The sample included 389 female breast cancer survivors with a mean age of 59 years and a mean body mass index of 37 kg/m

The top five noncancer comorbid conditions reported by the study participants were drug allergies (50%), high or low blood pressure (41%), high cholesterol (38%), a history of bone fracture (34%), and arthritis (29%).

The women reported that they were taking an average of eight medications or supplements per day. The five most common therapeutic categories represented were vitamins and herbal supplements (39%), cardiac drugs (16%), medications for pain and inflammation (13%), other (9%), and drugs for psychological conditions (6%).

“Although we expected the number of comorbid conditions to increase with age, requiring several prescription medications, it was interesting that the majority of medications reported were over-the-counter” herbals or supplements, and not prescriptions, Dr. Otte commented. Because these data were collected before the patients started a clinical trial, it is unclear whether patients would divulge the same information to their practitioners who prescribe routine medications. The extent of polypharmacy and the number of practitioners prescribing medications are also unclear.

“All of these questions prompt the need for further investigation and study to better educate patients on the possible harm of certain drug interactions,” Dr. Otte said. She said the study had certain limitations, including the potential for underreporting of prescription and over-the-counter medications by some participants. “In addition, it is unclear if these results can be generalized to a noncancer population of women or other cancer populations.” Dr. Otte reported that she had no conflicts of interest related to the study, which was funded by the National Cancer Institute.