Doug Brunk

SAN DIEGO – The RNS System, an investigational device that delivers responsive stimulation to the brain of patients with uncontrolled seizures, shows promise in clinical trials, but the technical learning curve is currently steep, Dr. Ryder Gwinn said at the annual meeting of the Congress of Neurological Surgeons.

“Programming experience is growing but it's still not where we need to be,” said Dr. Gwinn, director of surgical epilepsy at the Swedish Neuroscience Institute, Seattle. “It's still very complex. I am very frequently changing parameters in order to reach seizure freedom. However, I believe that the system will become much easier to use as a result of the clinical trials currently underway.”

Dr. Ryder disclosed that he is a steering committee member for the devices' manufacturer, NeuroPace Inc., but he has not received consulting fees outside of the study budget. He also has no personal financial interest in the company.

The RNS System is a fully implanted, microprocessor-controlled device that uses up to nine contacts for stimulation. About the size of an iPod, it detects electrographic patterns from intracranial electrodes and delivers up to five separate programmable therapies. It stores up to 32 minutes of electrocorticogram data that can be downloaded to a laptop at any time.

Benefits of the device include focal treatment that leaves functional neuronal circuits intact, Dr. Gwinn said. In addition, a decision to treat “can be made without significant concern for functional consequences, and it doesn't preclude later alternative treatments.”

Concerns about the use of such technology include the fact that localization of focus could be critical to success. “Early seizure detection is important for contingent stimulation, and potentially abnormal tissue or aberrantly organized circuits would be left intact,” he noted.

In a recent feasibility study, Dr. Gwinn and his associates at 11 centers used the RNS System in 65 patients aged 18–65 years who had simple or complex partial seizures.

Patients were eligible for the trial if they had failed treatment with a minimum of two antiepileptic drugs; had a minimum of four seizures per month for 3 months; and had an established region of epileptiform activity. The primary end point was safety and preliminary evidence of efficacy. Response rate was defined as a greater than 50% reduction in seizures.

Of the 65 patients implanted with the RNS System, 50 received stimulation, one patient had a device that was never turned on, and 14 patients were in a sham-stimulation group (therapy off).

After a mean 847 days of follow-up, the researchers observed a responder rate of 32% in patients with complex partial seizures, 63% in patients with generalized tonic-clonic seizures, and 26% in those with total, disabling seizures (simple partial motor seizures, complex partial seizures, and generalized tonic-clonic seizures combined).

As of June 5, 2007, there were 15 serious adverse events, including one case of focal status epilepticus, one case of erosion from the leads, and one case of tissue infection, all of which resolved. Other adverse events included one case each of increase in seizure severity, confusion, sensitivity to visual stimuli, and sudden unexplained death in epilepsy (SUDEP). None of these adverse events were thought to be definitively related to the use of the device.

The researchers concluded that contingent stimulation appears to benefit patients with uncontrolled seizures. “More stimulation seems to be better, but early stimulation is often not enough to have an impact,” Dr. Gwinn pointed out. “No parameters so far can reliably eradicate seizures altogether.”

He and his associates at 28 centers are currently enrolling patients aged 18–70 years in a similar but larger pivotal study. The recruitment goal is 240 patients.

For now, the therapy appears to be safe. “Stimulation has been applied to all lobes, including the medial temporal lobe,” Dr. Gwinn said.

The RNS System delivers up to five separate programmable therapies. Courtesy Dr. Ryder Gwinn

SAN DIEGO – The RNS System, an investigational device that delivers responsive stimulation to the brain of patients with uncontrolled seizures, shows promise in clinical trials, but the technical learning curve is currently steep, Dr. Ryder Gwinn said at the annual meeting of the Congress of Neurological Surgeons.

“Programming experience is growing but it's still not where we need to be,” said Dr. Gwinn, director of surgical epilepsy at the Swedish Neuroscience Institute, Seattle. “It's still very complex. I am very frequently changing parameters in order to reach seizure freedom. However, I believe that the system will become much easier to use as a result of the clinical trials currently underway.”

Dr. Ryder disclosed that he is a steering committee member for the devices' manufacturer, NeuroPace Inc., but he has not received consulting fees outside of the study budget. He also has no personal financial interest in the company.

The RNS System is a fully implanted, microprocessor-controlled device that uses up to nine contacts for stimulation. About the size of an iPod, it detects electrographic patterns from intracranial electrodes and delivers up to five separate programmable therapies. It stores up to 32 minutes of electrocorticogram data that can be downloaded to a laptop at any time.

Benefits of the device include focal treatment that leaves functional neuronal circuits intact, Dr. Gwinn said. In addition, a decision to treat “can be made without significant concern for functional consequences, and it doesn't preclude later alternative treatments.”

Concerns about the use of such technology include the fact that localization of focus could be critical to success. “Early seizure detection is important for contingent stimulation, and potentially abnormal tissue or aberrantly organized circuits would be left intact,” he noted.

In a recent feasibility study, Dr. Gwinn and his associates at 11 centers used the RNS System in 65 patients aged 18–65 years who had simple or complex partial seizures.

Patients were eligible for the trial if they had failed treatment with a minimum of two antiepileptic drugs; had a minimum of four seizures per month for 3 months; and had an established region of epileptiform activity. The primary end point was safety and preliminary evidence of efficacy. Response rate was defined as a greater than 50% reduction in seizures.

Of the 65 patients implanted with the RNS System, 50 received stimulation, one patient had a device that was never turned on, and 14 patients were in a sham-stimulation group (therapy off).

After a mean 847 days of follow-up, the researchers observed a responder rate of 32% in patients with complex partial seizures, 63% in patients with generalized tonic-clonic seizures, and 26% in those with total, disabling seizures (simple partial motor seizures, complex partial seizures, and generalized tonic-clonic seizures combined).

As of June 5, 2007, there were 15 serious adverse events, including one case of focal status epilepticus, one case of erosion from the leads, and one case of tissue infection, all of which resolved. Other adverse events included one case each of increase in seizure severity, confusion, sensitivity to visual stimuli, and sudden unexplained death in epilepsy (SUDEP). None of these adverse events were thought to be definitively related to the use of the device.

The researchers concluded that contingent stimulation appears to benefit patients with uncontrolled seizures. “More stimulation seems to be better, but early stimulation is often not enough to have an impact,” Dr. Gwinn pointed out. “No parameters so far can reliably eradicate seizures altogether.”

He and his associates at 28 centers are currently enrolling patients aged 18–70 years in a similar but larger pivotal study. The recruitment goal is 240 patients.

For now, the therapy appears to be safe. “Stimulation has been applied to all lobes, including the medial temporal lobe,” Dr. Gwinn said.

The RNS System delivers up to five separate programmable therapies. Courtesy Dr. Ryder Gwinn

SAN DIEGO – The RNS System, an investigational device that delivers responsive stimulation to the brain of patients with uncontrolled seizures, shows promise in clinical trials, but the technical learning curve is currently steep, Dr. Ryder Gwinn said at the annual meeting of the Congress of Neurological Surgeons.

“Programming experience is growing but it's still not where we need to be,” said Dr. Gwinn, director of surgical epilepsy at the Swedish Neuroscience Institute, Seattle. “It's still very complex. I am very frequently changing parameters in order to reach seizure freedom. However, I believe that the system will become much easier to use as a result of the clinical trials currently underway.”

Dr. Ryder disclosed that he is a steering committee member for the devices' manufacturer, NeuroPace Inc., but he has not received consulting fees outside of the study budget. He also has no personal financial interest in the company.

The RNS System is a fully implanted, microprocessor-controlled device that uses up to nine contacts for stimulation. About the size of an iPod, it detects electrographic patterns from intracranial electrodes and delivers up to five separate programmable therapies. It stores up to 32 minutes of electrocorticogram data that can be downloaded to a laptop at any time.

Benefits of the device include focal treatment that leaves functional neuronal circuits intact, Dr. Gwinn said. In addition, a decision to treat “can be made without significant concern for functional consequences, and it doesn't preclude later alternative treatments.”

Concerns about the use of such technology include the fact that localization of focus could be critical to success. “Early seizure detection is important for contingent stimulation, and potentially abnormal tissue or aberrantly organized circuits would be left intact,” he noted.

In a recent feasibility study, Dr. Gwinn and his associates at 11 centers used the RNS System in 65 patients aged 18–65 years who had simple or complex partial seizures.

Patients were eligible for the trial if they had failed treatment with a minimum of two antiepileptic drugs; had a minimum of four seizures per month for 3 months; and had an established region of epileptiform activity. The primary end point was safety and preliminary evidence of efficacy. Response rate was defined as a greater than 50% reduction in seizures.

Of the 65 patients implanted with the RNS System, 50 received stimulation, one patient had a device that was never turned on, and 14 patients were in a sham-stimulation group (therapy off).

After a mean 847 days of follow-up, the researchers observed a responder rate of 32% in patients with complex partial seizures, 63% in patients with generalized tonic-clonic seizures, and 26% in those with total, disabling seizures (simple partial motor seizures, complex partial seizures, and generalized tonic-clonic seizures combined).

As of June 5, 2007, there were 15 serious adverse events, including one case of focal status epilepticus, one case of erosion from the leads, and one case of tissue infection, all of which resolved. Other adverse events included one case each of increase in seizure severity, confusion, sensitivity to visual stimuli, and sudden unexplained death in epilepsy (SUDEP). None of these adverse events were thought to be definitively related to the use of the device.

The researchers concluded that contingent stimulation appears to benefit patients with uncontrolled seizures. “More stimulation seems to be better, but early stimulation is often not enough to have an impact,” Dr. Gwinn pointed out. “No parameters so far can reliably eradicate seizures altogether.”

He and his associates at 28 centers are currently enrolling patients aged 18–70 years in a similar but larger pivotal study. The recruitment goal is 240 patients.

For now, the therapy appears to be safe. “Stimulation has been applied to all lobes, including the medial temporal lobe,” Dr. Gwinn said.

The RNS System delivers up to five separate programmable therapies. Courtesy Dr. Ryder Gwinn

CORONADO, CALIF. – Mounting evidence suggests that behavioral and psychosocial interventions proven successful for cocaine dependence–such as cognitive-behavioral therapy and contingency management–may work equally well for methamphetamine dependence.

“We haven't looked at community reinforcement or 12-step facilitation with methamphetamine users, but I would argue that the treatments that we have evidence for cocaine efficacy should be considered very promising if not effective for the treatment of methamphetamine dependence,” Richard Rawson, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry. “I don't think we need to redo all the studies we did during the 1980s and 1990s with cocaine treatment again for methamphetamine.”

In a 16-week study led by Dr. Rawson, a psychologist who is associate director of the integrated substance abuse programs at the University of California, Los Angeles, 171 stimulant-dependent patients were randomized to received either contingency management, cognitive-behavioral therapy (CBT), or combined contingency management and CBT. Contingency management condition participants received vouchers for stimulant-free urine samples, while CBT condition participants attended three 90-minute group sessions each week (Addiction 2006;101:267–74).

Self-reported stimulant use was reduced from baseline levels at all follow-up points for all groups, and urinalysis data did not differ between groups at follow-up. Contingency management produced better retention and urinalysis results; CBT produced comparable longer-term outcomes. No evidence was found of an additive effect when the two treatments were combined.

“This study suggests that contingency management is an efficacious treatment for reducing stimulant use and is superior during treatment to a CBT approach,” Dr. Rawson said. “Contingency management is useful in engaging substance abusers, retaining them in treatment, and helping them achieve abstinence from stimulant use. CBT also reduces drug use from baseline levels and produces comparable outcomes on all measures at follow-up.”

In the 1980s, Dr. Rawson and his associates developed a 16-week, nonresidential drug dependence treatment method known as the Matrix Model. This method incorporates several psychosocial elements, including individual counseling, CBT, motivational interviewing, positive reinforcement for behavior change, family education groups, urine testing, and participation in 12-step programs.

In a study the researchers conducted at eight sites nationwide, 978 methamphetamine-dependent patients were randomly assigned to receive either treatment as usual or the Matrix Model and were followed for 12 months (Addiction 2004;99:708–17). In six of the eight sites, patients who were assigned to the Matrix study attended more clinical sessions, compared with those who received treatment as usual (27 vs. 13, respectively), had a higher treatment completion rate (40% vs. 34%, respectively), provided significantly more methamphetamine-free urine samples during the treatment period (a mean of 6.25 weeks vs. 3.12 weeks, respectively), and had longer periods of methamphetamine-free abstinence (3.8 weeks vs. 2.6 weeks, respectively).

Dr. Rawson went on to note that a key predictor of no methamphetamine use at treatment discharge and at the 6- and 12-month study follow-up was methamphetamine use for 15 days or fewer at baseline. “That's been the single most important predictor of treatment outcome,” he said. “We've seen that in about eight different studies. If you have to ask people one question to figure out what kind of treatment they need, that's the most important one. People who use more have more difficulty.”

Other predictors of success include lifetime meth use of less than 2 years, no previous drug abuse treatment, and providing three consecutive methamphetamine-free urinalyses during treatment.

In a yet-to-be-published trial that assessed the treatment impact on HIV risk behavior among methamphetamine users in the aforementioned Matrix study, the mean number of people who injected in the past 30 days fell from 13.1% at baseline to 5.4% at treatment end. According to repeated measures on 193 people who injected over the past 30 days, changes in injection practices also improved. The mean number of times they injected fell from 19.7 at baseline to 7.8 at treatment end, and the mean number of times they used dirty needles fell from 3.9 to 0.91.

In addition, Matrix program enrollment had a positive effect on most risky sexual practices. For example, the mean number of times Matrix program enrollees had sex without a condom with a methamphetamine user in the past 30 days user fell from 6.5 at baseline to 1.4 at treatment end.

“Methamphetamine treatment is associated with substantial reductions in HIV risk behaviors,” Dr. Rawson concluded. “Retention and treatment play a critical role in preventing the escalation of HIV risk behaviors.”

The symposium was sponsored by the National Institute on Drug Abuse.

A manual about the Matrix Model program can be downloaded for free at the Substance Abuse and Mental Health Services Administration Web site, www.samhsa.gov

CORONADO, CALIF. – Mounting evidence suggests that behavioral and psychosocial interventions proven successful for cocaine dependence–such as cognitive-behavioral therapy and contingency management–may work equally well for methamphetamine dependence.

“We haven't looked at community reinforcement or 12-step facilitation with methamphetamine users, but I would argue that the treatments that we have evidence for cocaine efficacy should be considered very promising if not effective for the treatment of methamphetamine dependence,” Richard Rawson, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry. “I don't think we need to redo all the studies we did during the 1980s and 1990s with cocaine treatment again for methamphetamine.”

In a 16-week study led by Dr. Rawson, a psychologist who is associate director of the integrated substance abuse programs at the University of California, Los Angeles, 171 stimulant-dependent patients were randomized to received either contingency management, cognitive-behavioral therapy (CBT), or combined contingency management and CBT. Contingency management condition participants received vouchers for stimulant-free urine samples, while CBT condition participants attended three 90-minute group sessions each week (Addiction 2006;101:267–74).

Self-reported stimulant use was reduced from baseline levels at all follow-up points for all groups, and urinalysis data did not differ between groups at follow-up. Contingency management produced better retention and urinalysis results; CBT produced comparable longer-term outcomes. No evidence was found of an additive effect when the two treatments were combined.

“This study suggests that contingency management is an efficacious treatment for reducing stimulant use and is superior during treatment to a CBT approach,” Dr. Rawson said. “Contingency management is useful in engaging substance abusers, retaining them in treatment, and helping them achieve abstinence from stimulant use. CBT also reduces drug use from baseline levels and produces comparable outcomes on all measures at follow-up.”

In the 1980s, Dr. Rawson and his associates developed a 16-week, nonresidential drug dependence treatment method known as the Matrix Model. This method incorporates several psychosocial elements, including individual counseling, CBT, motivational interviewing, positive reinforcement for behavior change, family education groups, urine testing, and participation in 12-step programs.

In a study the researchers conducted at eight sites nationwide, 978 methamphetamine-dependent patients were randomly assigned to receive either treatment as usual or the Matrix Model and were followed for 12 months (Addiction 2004;99:708–17). In six of the eight sites, patients who were assigned to the Matrix study attended more clinical sessions, compared with those who received treatment as usual (27 vs. 13, respectively), had a higher treatment completion rate (40% vs. 34%, respectively), provided significantly more methamphetamine-free urine samples during the treatment period (a mean of 6.25 weeks vs. 3.12 weeks, respectively), and had longer periods of methamphetamine-free abstinence (3.8 weeks vs. 2.6 weeks, respectively).

Dr. Rawson went on to note that a key predictor of no methamphetamine use at treatment discharge and at the 6- and 12-month study follow-up was methamphetamine use for 15 days or fewer at baseline. “That's been the single most important predictor of treatment outcome,” he said. “We've seen that in about eight different studies. If you have to ask people one question to figure out what kind of treatment they need, that's the most important one. People who use more have more difficulty.”

Other predictors of success include lifetime meth use of less than 2 years, no previous drug abuse treatment, and providing three consecutive methamphetamine-free urinalyses during treatment.

In a yet-to-be-published trial that assessed the treatment impact on HIV risk behavior among methamphetamine users in the aforementioned Matrix study, the mean number of people who injected in the past 30 days fell from 13.1% at baseline to 5.4% at treatment end. According to repeated measures on 193 people who injected over the past 30 days, changes in injection practices also improved. The mean number of times they injected fell from 19.7 at baseline to 7.8 at treatment end, and the mean number of times they used dirty needles fell from 3.9 to 0.91.

In addition, Matrix program enrollment had a positive effect on most risky sexual practices. For example, the mean number of times Matrix program enrollees had sex without a condom with a methamphetamine user in the past 30 days user fell from 6.5 at baseline to 1.4 at treatment end.

“Methamphetamine treatment is associated with substantial reductions in HIV risk behaviors,” Dr. Rawson concluded. “Retention and treatment play a critical role in preventing the escalation of HIV risk behaviors.”

The symposium was sponsored by the National Institute on Drug Abuse.

A manual about the Matrix Model program can be downloaded for free at the Substance Abuse and Mental Health Services Administration Web site, www.samhsa.gov

CORONADO, CALIF. – Mounting evidence suggests that behavioral and psychosocial interventions proven successful for cocaine dependence–such as cognitive-behavioral therapy and contingency management–may work equally well for methamphetamine dependence.

“We haven't looked at community reinforcement or 12-step facilitation with methamphetamine users, but I would argue that the treatments that we have evidence for cocaine efficacy should be considered very promising if not effective for the treatment of methamphetamine dependence,” Richard Rawson, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry. “I don't think we need to redo all the studies we did during the 1980s and 1990s with cocaine treatment again for methamphetamine.”

In a 16-week study led by Dr. Rawson, a psychologist who is associate director of the integrated substance abuse programs at the University of California, Los Angeles, 171 stimulant-dependent patients were randomized to received either contingency management, cognitive-behavioral therapy (CBT), or combined contingency management and CBT. Contingency management condition participants received vouchers for stimulant-free urine samples, while CBT condition participants attended three 90-minute group sessions each week (Addiction 2006;101:267–74).

Self-reported stimulant use was reduced from baseline levels at all follow-up points for all groups, and urinalysis data did not differ between groups at follow-up. Contingency management produced better retention and urinalysis results; CBT produced comparable longer-term outcomes. No evidence was found of an additive effect when the two treatments were combined.

“This study suggests that contingency management is an efficacious treatment for reducing stimulant use and is superior during treatment to a CBT approach,” Dr. Rawson said. “Contingency management is useful in engaging substance abusers, retaining them in treatment, and helping them achieve abstinence from stimulant use. CBT also reduces drug use from baseline levels and produces comparable outcomes on all measures at follow-up.”

In the 1980s, Dr. Rawson and his associates developed a 16-week, nonresidential drug dependence treatment method known as the Matrix Model. This method incorporates several psychosocial elements, including individual counseling, CBT, motivational interviewing, positive reinforcement for behavior change, family education groups, urine testing, and participation in 12-step programs.

In a study the researchers conducted at eight sites nationwide, 978 methamphetamine-dependent patients were randomly assigned to receive either treatment as usual or the Matrix Model and were followed for 12 months (Addiction 2004;99:708–17). In six of the eight sites, patients who were assigned to the Matrix study attended more clinical sessions, compared with those who received treatment as usual (27 vs. 13, respectively), had a higher treatment completion rate (40% vs. 34%, respectively), provided significantly more methamphetamine-free urine samples during the treatment period (a mean of 6.25 weeks vs. 3.12 weeks, respectively), and had longer periods of methamphetamine-free abstinence (3.8 weeks vs. 2.6 weeks, respectively).

Dr. Rawson went on to note that a key predictor of no methamphetamine use at treatment discharge and at the 6- and 12-month study follow-up was methamphetamine use for 15 days or fewer at baseline. “That's been the single most important predictor of treatment outcome,” he said. “We've seen that in about eight different studies. If you have to ask people one question to figure out what kind of treatment they need, that's the most important one. People who use more have more difficulty.”

Other predictors of success include lifetime meth use of less than 2 years, no previous drug abuse treatment, and providing three consecutive methamphetamine-free urinalyses during treatment.

In a yet-to-be-published trial that assessed the treatment impact on HIV risk behavior among methamphetamine users in the aforementioned Matrix study, the mean number of people who injected in the past 30 days fell from 13.1% at baseline to 5.4% at treatment end. According to repeated measures on 193 people who injected over the past 30 days, changes in injection practices also improved. The mean number of times they injected fell from 19.7 at baseline to 7.8 at treatment end, and the mean number of times they used dirty needles fell from 3.9 to 0.91.

In addition, Matrix program enrollment had a positive effect on most risky sexual practices. For example, the mean number of times Matrix program enrollees had sex without a condom with a methamphetamine user in the past 30 days user fell from 6.5 at baseline to 1.4 at treatment end.

“Methamphetamine treatment is associated with substantial reductions in HIV risk behaviors,” Dr. Rawson concluded. “Retention and treatment play a critical role in preventing the escalation of HIV risk behaviors.”

The symposium was sponsored by the National Institute on Drug Abuse.

A manual about the Matrix Model program can be downloaded for free at the Substance Abuse and Mental Health Services Administration Web site, www.samhsa.gov

CORONADO, CALIF. – One out of six medical students at a private Midwestern medical school reported prior use of at least one club drug, results from a survey found.

“Therefore, physicians should be cognizant, when treating medical students, physicians, or other health care workers, that we are not excluded from substance abuse,” Dr. Alex Horowitz said in an interview after presenting the study as a poster at the meeting

“The same principles should be applied when assessing health care workers for substance use as when assessing the rest of the population,” he asserted.

In what he said is the first study of its kind, Dr. Horowitz and his associates asked 340 students at a private Midwestern medical school to complete an anonymous survey about their use of and attitudes about club drugs. Generation I club drugs were defined as cocaine and LSD; generation II club drugs included methylenedioxymethamphetamine (also known as ecstasy), methamphetamine, gamma hydroxybutyrate (GHB), Rohypnol, ketamine, and dextromethorphan. Nearly half (46%) of the respondents were first-year medical students; 34% were in their second year; and 20% were third-year students.

The overall prevalence of lifetime club drug use was 17%, with ecstasy and cocaine as the most popular agents of choice (12% and 6%, respectively), reported Dr. Horowitz, psychiatric unit chief of the methadone treatment program at Bellevue Hospital Center, New York.

The prevalence of medical students' lifetime ecstasy use was similar to that of their peers in the general population, as reported in the National Institute on Drug Abuse's 2004 “Monitoring the Future” survey. However, the use of generation I club drugs by medical students was lower than that of their peers in the general population, an association that remains unclear.

Compared with students aged 21–25 years, those aged 26 and older were more likely to have used the generation I drugs (cocaine, 16% vs. 4%, respectively; LSD, 14% vs. 2%). However, no relationship was found between age and use of generation II club drugs in general.

Students who reported never using club drugs perceived regular cocaine use as posing the greatest risk to health (89%), followed by ecstasy (72%). For students who reported lifetime use of at least one club drug, the perceived risk of using cocaine and ecstasy regularly was significantly lower (75% and 58%, respectively). The use of club drugs did not differ between men and women, but women found them to be generally more harmful than men did.

“There appears to be a correlation between knowledge/perceived harmfulness of each drug and drug use,” said Dr. Horowitz, of the department of psychiatry at New York University, also in New York. “Therefore, increasing formal medical student education on club drugs would help them be aware of dangers of club drug use, and also would help them know how to then assess and treat their patients who use club drugs.”

A greater number of students thought it would be necessary to revoke the license of physicians who were currently using generation I club drugs than those who were using generation II club drugs (27% vs. 20%, respectively). Women were more likely than men to endorse license revocation for physicians currently using generation I club drugs (33% vs. 22%, respectively) and for those currently using generation II club drugs (26% vs. 15%, respectively).

Dr. Horowitz acknowledged that the self-reported nature of the study is a limitation. “Some medical students may underreport their drug use for fear of having anyone find out, despite the anonymity of the survey,” he said.

Another limitation is that the data were collected in a classroom setting, which means that participants were limited to students more likely to attend class. However, the survey was administered in a class that was considered mandatory.

CORONADO, CALIF. – One out of six medical students at a private Midwestern medical school reported prior use of at least one club drug, results from a survey found.

“Therefore, physicians should be cognizant, when treating medical students, physicians, or other health care workers, that we are not excluded from substance abuse,” Dr. Alex Horowitz said in an interview after presenting the study as a poster at the meeting

“The same principles should be applied when assessing health care workers for substance use as when assessing the rest of the population,” he asserted.

In what he said is the first study of its kind, Dr. Horowitz and his associates asked 340 students at a private Midwestern medical school to complete an anonymous survey about their use of and attitudes about club drugs. Generation I club drugs were defined as cocaine and LSD; generation II club drugs included methylenedioxymethamphetamine (also known as ecstasy), methamphetamine, gamma hydroxybutyrate (GHB), Rohypnol, ketamine, and dextromethorphan. Nearly half (46%) of the respondents were first-year medical students; 34% were in their second year; and 20% were third-year students.

The overall prevalence of lifetime club drug use was 17%, with ecstasy and cocaine as the most popular agents of choice (12% and 6%, respectively), reported Dr. Horowitz, psychiatric unit chief of the methadone treatment program at Bellevue Hospital Center, New York.

The prevalence of medical students' lifetime ecstasy use was similar to that of their peers in the general population, as reported in the National Institute on Drug Abuse's 2004 “Monitoring the Future” survey. However, the use of generation I club drugs by medical students was lower than that of their peers in the general population, an association that remains unclear.

Compared with students aged 21–25 years, those aged 26 and older were more likely to have used the generation I drugs (cocaine, 16% vs. 4%, respectively; LSD, 14% vs. 2%). However, no relationship was found between age and use of generation II club drugs in general.

Students who reported never using club drugs perceived regular cocaine use as posing the greatest risk to health (89%), followed by ecstasy (72%). For students who reported lifetime use of at least one club drug, the perceived risk of using cocaine and ecstasy regularly was significantly lower (75% and 58%, respectively). The use of club drugs did not differ between men and women, but women found them to be generally more harmful than men did.

“There appears to be a correlation between knowledge/perceived harmfulness of each drug and drug use,” said Dr. Horowitz, of the department of psychiatry at New York University, also in New York. “Therefore, increasing formal medical student education on club drugs would help them be aware of dangers of club drug use, and also would help them know how to then assess and treat their patients who use club drugs.”

A greater number of students thought it would be necessary to revoke the license of physicians who were currently using generation I club drugs than those who were using generation II club drugs (27% vs. 20%, respectively). Women were more likely than men to endorse license revocation for physicians currently using generation I club drugs (33% vs. 22%, respectively) and for those currently using generation II club drugs (26% vs. 15%, respectively).

Dr. Horowitz acknowledged that the self-reported nature of the study is a limitation. “Some medical students may underreport their drug use for fear of having anyone find out, despite the anonymity of the survey,” he said.

Another limitation is that the data were collected in a classroom setting, which means that participants were limited to students more likely to attend class. However, the survey was administered in a class that was considered mandatory.

CORONADO, CALIF. – One out of six medical students at a private Midwestern medical school reported prior use of at least one club drug, results from a survey found.

“Therefore, physicians should be cognizant, when treating medical students, physicians, or other health care workers, that we are not excluded from substance abuse,” Dr. Alex Horowitz said in an interview after presenting the study as a poster at the meeting

“The same principles should be applied when assessing health care workers for substance use as when assessing the rest of the population,” he asserted.

In what he said is the first study of its kind, Dr. Horowitz and his associates asked 340 students at a private Midwestern medical school to complete an anonymous survey about their use of and attitudes about club drugs. Generation I club drugs were defined as cocaine and LSD; generation II club drugs included methylenedioxymethamphetamine (also known as ecstasy), methamphetamine, gamma hydroxybutyrate (GHB), Rohypnol, ketamine, and dextromethorphan. Nearly half (46%) of the respondents were first-year medical students; 34% were in their second year; and 20% were third-year students.

The overall prevalence of lifetime club drug use was 17%, with ecstasy and cocaine as the most popular agents of choice (12% and 6%, respectively), reported Dr. Horowitz, psychiatric unit chief of the methadone treatment program at Bellevue Hospital Center, New York.

The prevalence of medical students' lifetime ecstasy use was similar to that of their peers in the general population, as reported in the National Institute on Drug Abuse's 2004 “Monitoring the Future” survey. However, the use of generation I club drugs by medical students was lower than that of their peers in the general population, an association that remains unclear.

Compared with students aged 21–25 years, those aged 26 and older were more likely to have used the generation I drugs (cocaine, 16% vs. 4%, respectively; LSD, 14% vs. 2%). However, no relationship was found between age and use of generation II club drugs in general.

Students who reported never using club drugs perceived regular cocaine use as posing the greatest risk to health (89%), followed by ecstasy (72%). For students who reported lifetime use of at least one club drug, the perceived risk of using cocaine and ecstasy regularly was significantly lower (75% and 58%, respectively). The use of club drugs did not differ between men and women, but women found them to be generally more harmful than men did.

“There appears to be a correlation between knowledge/perceived harmfulness of each drug and drug use,” said Dr. Horowitz, of the department of psychiatry at New York University, also in New York. “Therefore, increasing formal medical student education on club drugs would help them be aware of dangers of club drug use, and also would help them know how to then assess and treat their patients who use club drugs.”

A greater number of students thought it would be necessary to revoke the license of physicians who were currently using generation I club drugs than those who were using generation II club drugs (27% vs. 20%, respectively). Women were more likely than men to endorse license revocation for physicians currently using generation I club drugs (33% vs. 22%, respectively) and for those currently using generation II club drugs (26% vs. 15%, respectively).

Dr. Horowitz acknowledged that the self-reported nature of the study is a limitation. “Some medical students may underreport their drug use for fear of having anyone find out, despite the anonymity of the survey,” he said.

Another limitation is that the data were collected in a classroom setting, which means that participants were limited to students more likely to attend class. However, the survey was administered in a class that was considered mandatory.

SAN DIEGO — Consider expanding subclinical cardiovascular disease testing to include asymptomatic high-risk patient populations, Leslee J. Shaw, Ph.D., advised attendees at the annual meeting of the American Society of Nuclear Cardiology.

Primary care physicians considering which patients to refer for evaluation should ask themselves in which of their appropriate patients they can identify risk of cardiovascular disease, suggested Dr. Shaw, professor of medicine at Emory University, Atlanta. “The goal is to expand cardiovascular testing to improve the detection gap. But we have to do it appropriately, without excessive cost.”

One ideal population to target with subclinical testing is the high-risk elderly. A recent study found that 1 in 5 people aged 65 years and older has an ankle brachial index of less than 0.9, yet only 1 in 10 peripheral artery disease patients will have classical symptoms of intermittent claudication (Atherosclerosis 2004;172:95–105). “If one relies solely on classical symptoms of intermittent claudication, you will underappreciate the prevalence of peripheral artery disease,” said Dr. Shaw, who is also an outcomes research scientist for the Emory Program in Cardiovascular Outcomes Research and Epidemiology. “So in this population of patients, perhaps ankle brachial index or some other modality may be good at identifying asymptomatic patients who are at risk of worsening outcome.”

Other populations to target include:

▸ High-risk functionally impaired patients. Patients who can't achieve 5 METs on the treadmill test “are functionally impaired and have a high risk for cardiovascular events,” she said. “We need to do a better job of not only identifying the degrees of comorbidity, but treating their comorbidities, perhaps getting them to improve their exercise abilities to lessen that risk. There [are] a lot of data showing that these patients can improve their exercise tolerance and can have an improved outcome following cardiac rehabilitation.”

▸ High-risk smokers. Smoking is a leading cause of acute coronary thrombosis. Dr. Shaw and her associates showed in a recent study that patients who smoke and have coronary calcification have a worsening mortality, compared with nonsmokers (Eur. Heart J. 2006;27:968–75). “Young smokers with a lot of coronary calcification have an anticipated loss in life expectancy of 4–5 years,” she said. “This is a good message for young smokers, especially patients in their 40s who have children. Five years is a lot to lose of your life.”

▸ Asymptomatic diabetics. Diabetes patients who are candidates for subclinical cardiovascular disease testing include those with poorly controlled diabetes, those who have not achieved their LDL cholesterol goal, those with multiple cardiac risk factors, and those who have had diabetes for more than 5 years.

In this population of patients “you might want to think about assessing the baseline cardiovascular risk, consider ischemia testing in those with a high-risk scan, and look for disease progression downstream,” Dr. Shaw said.

She called coronary calcification “an amazing prognostic test.” The overall rate of perfusion abnormalities is high in diabetic patients with a calcium score of 100 or higher.

▸ Patients with metabolic syndrome. The National Cholesterol Education Panel Adult Treatment Panel III defines the criteria for metabolic syndrome as three or more of the following: abdominal obesity (a waistline greater than 102 cm in men and greater than 88 cm in women); triglyceride levels of 150 mg/dL or greater; HDL cholesterol levels of less than 40 mg/dL in men and less than 50 mg/dL in women; a systolic blood pressure of 130 mm Hg or greater or a diastolic blood pressure of 85 mm Hg or greater; and a fasting glucose level of 110 mg/dL or greater.

A recent study showed that the prevalence of inducible ischemia is increased among patients with metabolic syndrome who do not have diabetes, as well as in those who have diabetes, when their calcium scores exceed 100 (Diabetes Care 2005;28:1445–50).

In these patients, “think about retesting with perfusion imaging,” Dr. Shaw advised.

▸ High-risk women. This includes those with early menopause, those with autoimmune disease, and those with polycystic ovary syndrome. All conditions confer an increased risk of coronary artery disease.

Dr. Shaw emphasized that by targeting high-risk patient populations, you are not screening, you are testing. “So in discussions with payers, tell them that you are trying to identify appropriate testing candidates and minimize inappropriate testing in your testing practice,” she explained. “The goal is to identify patients who require more intensive management and thereby decrease the detection gap of high-risk patients with a resulting … improvement in cardiovascular mortality.”

SAN DIEGO — Consider expanding subclinical cardiovascular disease testing to include asymptomatic high-risk patient populations, Leslee J. Shaw, Ph.D., advised attendees at the annual meeting of the American Society of Nuclear Cardiology.

Primary care physicians considering which patients to refer for evaluation should ask themselves in which of their appropriate patients they can identify risk of cardiovascular disease, suggested Dr. Shaw, professor of medicine at Emory University, Atlanta. “The goal is to expand cardiovascular testing to improve the detection gap. But we have to do it appropriately, without excessive cost.”

One ideal population to target with subclinical testing is the high-risk elderly. A recent study found that 1 in 5 people aged 65 years and older has an ankle brachial index of less than 0.9, yet only 1 in 10 peripheral artery disease patients will have classical symptoms of intermittent claudication (Atherosclerosis 2004;172:95–105). “If one relies solely on classical symptoms of intermittent claudication, you will underappreciate the prevalence of peripheral artery disease,” said Dr. Shaw, who is also an outcomes research scientist for the Emory Program in Cardiovascular Outcomes Research and Epidemiology. “So in this population of patients, perhaps ankle brachial index or some other modality may be good at identifying asymptomatic patients who are at risk of worsening outcome.”

Other populations to target include:

▸ High-risk functionally impaired patients. Patients who can't achieve 5 METs on the treadmill test “are functionally impaired and have a high risk for cardiovascular events,” she said. “We need to do a better job of not only identifying the degrees of comorbidity, but treating their comorbidities, perhaps getting them to improve their exercise abilities to lessen that risk. There [are] a lot of data showing that these patients can improve their exercise tolerance and can have an improved outcome following cardiac rehabilitation.”

▸ High-risk smokers. Smoking is a leading cause of acute coronary thrombosis. Dr. Shaw and her associates showed in a recent study that patients who smoke and have coronary calcification have a worsening mortality, compared with nonsmokers (Eur. Heart J. 2006;27:968–75). “Young smokers with a lot of coronary calcification have an anticipated loss in life expectancy of 4–5 years,” she said. “This is a good message for young smokers, especially patients in their 40s who have children. Five years is a lot to lose of your life.”

▸ Asymptomatic diabetics. Diabetes patients who are candidates for subclinical cardiovascular disease testing include those with poorly controlled diabetes, those who have not achieved their LDL cholesterol goal, those with multiple cardiac risk factors, and those who have had diabetes for more than 5 years.

In this population of patients “you might want to think about assessing the baseline cardiovascular risk, consider ischemia testing in those with a high-risk scan, and look for disease progression downstream,” Dr. Shaw said.

She called coronary calcification “an amazing prognostic test.” The overall rate of perfusion abnormalities is high in diabetic patients with a calcium score of 100 or higher.

▸ Patients with metabolic syndrome. The National Cholesterol Education Panel Adult Treatment Panel III defines the criteria for metabolic syndrome as three or more of the following: abdominal obesity (a waistline greater than 102 cm in men and greater than 88 cm in women); triglyceride levels of 150 mg/dL or greater; HDL cholesterol levels of less than 40 mg/dL in men and less than 50 mg/dL in women; a systolic blood pressure of 130 mm Hg or greater or a diastolic blood pressure of 85 mm Hg or greater; and a fasting glucose level of 110 mg/dL or greater.

A recent study showed that the prevalence of inducible ischemia is increased among patients with metabolic syndrome who do not have diabetes, as well as in those who have diabetes, when their calcium scores exceed 100 (Diabetes Care 2005;28:1445–50).

In these patients, “think about retesting with perfusion imaging,” Dr. Shaw advised.

▸ High-risk women. This includes those with early menopause, those with autoimmune disease, and those with polycystic ovary syndrome. All conditions confer an increased risk of coronary artery disease.

Dr. Shaw emphasized that by targeting high-risk patient populations, you are not screening, you are testing. “So in discussions with payers, tell them that you are trying to identify appropriate testing candidates and minimize inappropriate testing in your testing practice,” she explained. “The goal is to identify patients who require more intensive management and thereby decrease the detection gap of high-risk patients with a resulting … improvement in cardiovascular mortality.”

SAN DIEGO — Consider expanding subclinical cardiovascular disease testing to include asymptomatic high-risk patient populations, Leslee J. Shaw, Ph.D., advised attendees at the annual meeting of the American Society of Nuclear Cardiology.

Primary care physicians considering which patients to refer for evaluation should ask themselves in which of their appropriate patients they can identify risk of cardiovascular disease, suggested Dr. Shaw, professor of medicine at Emory University, Atlanta. “The goal is to expand cardiovascular testing to improve the detection gap. But we have to do it appropriately, without excessive cost.”

One ideal population to target with subclinical testing is the high-risk elderly. A recent study found that 1 in 5 people aged 65 years and older has an ankle brachial index of less than 0.9, yet only 1 in 10 peripheral artery disease patients will have classical symptoms of intermittent claudication (Atherosclerosis 2004;172:95–105). “If one relies solely on classical symptoms of intermittent claudication, you will underappreciate the prevalence of peripheral artery disease,” said Dr. Shaw, who is also an outcomes research scientist for the Emory Program in Cardiovascular Outcomes Research and Epidemiology. “So in this population of patients, perhaps ankle brachial index or some other modality may be good at identifying asymptomatic patients who are at risk of worsening outcome.”

Other populations to target include:

▸ High-risk functionally impaired patients. Patients who can't achieve 5 METs on the treadmill test “are functionally impaired and have a high risk for cardiovascular events,” she said. “We need to do a better job of not only identifying the degrees of comorbidity, but treating their comorbidities, perhaps getting them to improve their exercise abilities to lessen that risk. There [are] a lot of data showing that these patients can improve their exercise tolerance and can have an improved outcome following cardiac rehabilitation.”

▸ High-risk smokers. Smoking is a leading cause of acute coronary thrombosis. Dr. Shaw and her associates showed in a recent study that patients who smoke and have coronary calcification have a worsening mortality, compared with nonsmokers (Eur. Heart J. 2006;27:968–75). “Young smokers with a lot of coronary calcification have an anticipated loss in life expectancy of 4–5 years,” she said. “This is a good message for young smokers, especially patients in their 40s who have children. Five years is a lot to lose of your life.”

▸ Asymptomatic diabetics. Diabetes patients who are candidates for subclinical cardiovascular disease testing include those with poorly controlled diabetes, those who have not achieved their LDL cholesterol goal, those with multiple cardiac risk factors, and those who have had diabetes for more than 5 years.

In this population of patients “you might want to think about assessing the baseline cardiovascular risk, consider ischemia testing in those with a high-risk scan, and look for disease progression downstream,” Dr. Shaw said.

She called coronary calcification “an amazing prognostic test.” The overall rate of perfusion abnormalities is high in diabetic patients with a calcium score of 100 or higher.

▸ Patients with metabolic syndrome. The National Cholesterol Education Panel Adult Treatment Panel III defines the criteria for metabolic syndrome as three or more of the following: abdominal obesity (a waistline greater than 102 cm in men and greater than 88 cm in women); triglyceride levels of 150 mg/dL or greater; HDL cholesterol levels of less than 40 mg/dL in men and less than 50 mg/dL in women; a systolic blood pressure of 130 mm Hg or greater or a diastolic blood pressure of 85 mm Hg or greater; and a fasting glucose level of 110 mg/dL or greater.

A recent study showed that the prevalence of inducible ischemia is increased among patients with metabolic syndrome who do not have diabetes, as well as in those who have diabetes, when their calcium scores exceed 100 (Diabetes Care 2005;28:1445–50).

In these patients, “think about retesting with perfusion imaging,” Dr. Shaw advised.

▸ High-risk women. This includes those with early menopause, those with autoimmune disease, and those with polycystic ovary syndrome. All conditions confer an increased risk of coronary artery disease.

Dr. Shaw emphasized that by targeting high-risk patient populations, you are not screening, you are testing. “So in discussions with payers, tell them that you are trying to identify appropriate testing candidates and minimize inappropriate testing in your testing practice,” she explained. “The goal is to identify patients who require more intensive management and thereby decrease the detection gap of high-risk patients with a resulting … improvement in cardiovascular mortality.”

Women who followed the Dietary Approaches to Stop Hypertension diet had significant risk reductions of coronary heart disease and stroke, results from a cohort of participants in the ongoing Nurses Health Study showed.

Previous studies have shown that the diet—heavy in fruits and vegetables—lowers blood pressure and blood lipids, but this marks the first time benefit on a disease state has been demonstrated.

“It's one thing if your blood pressure or cholesterol goes down, but it does not automatically translate to a reduction of disease risk,” lead study author Teresa Fung, Sc.D., said in an interview after the work was presented at the annual scientific sessions of the American Heart Association. “In this study I wanted to see if the diet is related to reducing the disease.”

Developed by researchers funded by the National Heart, Lung, and Blood Institute in the 1990s, the Dietary Approaches to Stop Hypertension (DASH) diet is low in cholesterol and sodium and contains no more than 30% of calories from fat. It emphasizes fruits, vegetables, and fat-free or low-fat dairy products.

Dr. Fung and her associates evaluated 88,415 women from the Nurses Health Study who were aged 34–59 years in 1980 and had no history of cardiovascular disease or diabetes. The researchers used a questionnaire to assess the women's diet seven times over 24 years of follow-up and used medical records to tabulate their incidence of cardiovascular disease and stroke.

In an effort to measure the women's adherence to the DASH diet, the researchers created a DASH score based on their consumption of eight foods and nutrients: fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed meat, sweetened beverages, and sodium.

Patients were divided into quintiles on the basis of how closely they followed the diet, with quintile 1 being poorly followed (the bottom 20%) and quintile 5 being well followed (the top 20%). Cox proportional hazard analysis was used to adjust for potential confounders such as age, smoking, family history of coronary heart disease (CHD) and stroke, and level of physical activity.

Over the 24-year follow-up, there were 1,876 cases of nonfatal myocardial infarction, 883 deaths due to coronary heart disease, and 2,317 strokes. The researchers observed significantly lower risks of CHD and stroke when they compared quintile 5 with quintile 1. (See box.)

“This is more evidence to promote this diet,” said Dr. Fung, associate professor of nutrition at Simmons College, Boston. She said she was surprised that the magnitude of effect was greater for CHD than for stroke.

The researchers also observed that the risk reduction for stroke was much stronger in women who had a history of hypertension at baseline, compared with those who did not. “The message in that is, even if someone is hypertensive, it's not the end of the world,” Dr. Fung said. “Controlling hypertension by medication or other means is extremely important. You can gain risk reduction if you follow the [DASH] diet. A typical adult should be eating 9 servings of fruits and vegetables combined per day, which is a lot, because the average American consumes between 3.5–4 servings per day. That is not so easy.”

The study was funded by the National Institutes of Health.

ELSEVIER GLOBAL MEDICAL NEWS

Women who followed the Dietary Approaches to Stop Hypertension diet had significant risk reductions of coronary heart disease and stroke, results from a cohort of participants in the ongoing Nurses Health Study showed.

Previous studies have shown that the diet—heavy in fruits and vegetables—lowers blood pressure and blood lipids, but this marks the first time benefit on a disease state has been demonstrated.

“It's one thing if your blood pressure or cholesterol goes down, but it does not automatically translate to a reduction of disease risk,” lead study author Teresa Fung, Sc.D., said in an interview after the work was presented at the annual scientific sessions of the American Heart Association. “In this study I wanted to see if the diet is related to reducing the disease.”

Developed by researchers funded by the National Heart, Lung, and Blood Institute in the 1990s, the Dietary Approaches to Stop Hypertension (DASH) diet is low in cholesterol and sodium and contains no more than 30% of calories from fat. It emphasizes fruits, vegetables, and fat-free or low-fat dairy products.

Dr. Fung and her associates evaluated 88,415 women from the Nurses Health Study who were aged 34–59 years in 1980 and had no history of cardiovascular disease or diabetes. The researchers used a questionnaire to assess the women's diet seven times over 24 years of follow-up and used medical records to tabulate their incidence of cardiovascular disease and stroke.

In an effort to measure the women's adherence to the DASH diet, the researchers created a DASH score based on their consumption of eight foods and nutrients: fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed meat, sweetened beverages, and sodium.

Patients were divided into quintiles on the basis of how closely they followed the diet, with quintile 1 being poorly followed (the bottom 20%) and quintile 5 being well followed (the top 20%). Cox proportional hazard analysis was used to adjust for potential confounders such as age, smoking, family history of coronary heart disease (CHD) and stroke, and level of physical activity.

Over the 24-year follow-up, there were 1,876 cases of nonfatal myocardial infarction, 883 deaths due to coronary heart disease, and 2,317 strokes. The researchers observed significantly lower risks of CHD and stroke when they compared quintile 5 with quintile 1. (See box.)

“This is more evidence to promote this diet,” said Dr. Fung, associate professor of nutrition at Simmons College, Boston. She said she was surprised that the magnitude of effect was greater for CHD than for stroke.

The researchers also observed that the risk reduction for stroke was much stronger in women who had a history of hypertension at baseline, compared with those who did not. “The message in that is, even if someone is hypertensive, it's not the end of the world,” Dr. Fung said. “Controlling hypertension by medication or other means is extremely important. You can gain risk reduction if you follow the [DASH] diet. A typical adult should be eating 9 servings of fruits and vegetables combined per day, which is a lot, because the average American consumes between 3.5–4 servings per day. That is not so easy.”

The study was funded by the National Institutes of Health.

ELSEVIER GLOBAL MEDICAL NEWS

Women who followed the Dietary Approaches to Stop Hypertension diet had significant risk reductions of coronary heart disease and stroke, results from a cohort of participants in the ongoing Nurses Health Study showed.

Previous studies have shown that the diet—heavy in fruits and vegetables—lowers blood pressure and blood lipids, but this marks the first time benefit on a disease state has been demonstrated.

“It's one thing if your blood pressure or cholesterol goes down, but it does not automatically translate to a reduction of disease risk,” lead study author Teresa Fung, Sc.D., said in an interview after the work was presented at the annual scientific sessions of the American Heart Association. “In this study I wanted to see if the diet is related to reducing the disease.”

Developed by researchers funded by the National Heart, Lung, and Blood Institute in the 1990s, the Dietary Approaches to Stop Hypertension (DASH) diet is low in cholesterol and sodium and contains no more than 30% of calories from fat. It emphasizes fruits, vegetables, and fat-free or low-fat dairy products.

Dr. Fung and her associates evaluated 88,415 women from the Nurses Health Study who were aged 34–59 years in 1980 and had no history of cardiovascular disease or diabetes. The researchers used a questionnaire to assess the women's diet seven times over 24 years of follow-up and used medical records to tabulate their incidence of cardiovascular disease and stroke.

In an effort to measure the women's adherence to the DASH diet, the researchers created a DASH score based on their consumption of eight foods and nutrients: fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed meat, sweetened beverages, and sodium.

Patients were divided into quintiles on the basis of how closely they followed the diet, with quintile 1 being poorly followed (the bottom 20%) and quintile 5 being well followed (the top 20%). Cox proportional hazard analysis was used to adjust for potential confounders such as age, smoking, family history of coronary heart disease (CHD) and stroke, and level of physical activity.

Over the 24-year follow-up, there were 1,876 cases of nonfatal myocardial infarction, 883 deaths due to coronary heart disease, and 2,317 strokes. The researchers observed significantly lower risks of CHD and stroke when they compared quintile 5 with quintile 1. (See box.)

“This is more evidence to promote this diet,” said Dr. Fung, associate professor of nutrition at Simmons College, Boston. She said she was surprised that the magnitude of effect was greater for CHD than for stroke.

The researchers also observed that the risk reduction for stroke was much stronger in women who had a history of hypertension at baseline, compared with those who did not. “The message in that is, even if someone is hypertensive, it's not the end of the world,” Dr. Fung said. “Controlling hypertension by medication or other means is extremely important. You can gain risk reduction if you follow the [DASH] diet. A typical adult should be eating 9 servings of fruits and vegetables combined per day, which is a lot, because the average American consumes between 3.5–4 servings per day. That is not so easy.”

The study was funded by the National Institutes of Health.

ELSEVIER GLOBAL MEDICAL NEWS

Women with a so-called empty calorie diet—high in sweetened beverages, red meat, and desserts—had significantly elevated intima-media thickness, compared with women who followed other dietary patterns, including diets high in fat.

The finding comes from an analysis of the Framingham Heart Offspring/Spouse Study that was presented during a poster session at the annual scientific sessions of the American Heart Association.

“Any diet that consists of regular intake of a lot of fatty food, a lot of sugary food including sugary drinks, and not a lot of low-fat dairy, fruits, or vegetables is probably setting a woman up for cardiovascular problems,” lead study author Lisa S. Brown said in an interview.

Ms. Brown and her associates analyzed data from 1,278 women with a mean age of 58 years who participated in the Framingham Offspring/Spouse Study and who completed the Framingham food frequency questionnaire during 1984–1988, underwent intima-media thickness measurement via ultrasound at exam 6 (1996–1998), and were free of cardiovascular disease at exam 6.

“A lot of intima-media thickness and diet work has looked at specific nutrients—especially antioxidants and different types of fats,” noted Ms. Brown, a registered dietitian who is a doctoral candidate in medical nutrition sciences at Boston University. “None have looked at diet in such a comprehensive manner.”

Based on how the women responded to a validated Framingham food frequency questionnaire, the researchers placed them into one of five dietary patterns:

▸ Heart healthy. The 250 women in this group eat more fruits and vegetables than women in the other groups. “We think this is a group that changed their diet some time in their adult life and that they make an effort to be health conscious,” she said.

▸ Light eating. The 612 women in this group are chronic dieters who consume the least amount of sweets and take in the least amount of calories. “But they tend to be a little heavier than we would expect them to be based on their dietary intake,” she said.

▸ Wine and moderate eating. The 45 women in this group consume about two alcoholic drinks per day. Their diet also is highest in cholesterol and lowest in calcium consumption.

▸ High fat. The 266 women in this group “get a lot of their calories from refined grains and vegetable fats both hard and soft, so they get a lot of margarine and oils,” Ms. Brown said. “Their saturated fat is the highest [among] all the groups but for some reason they are also the least likely to be overweight or obese. We don't know why, and we are still trying to figure out what makes this group different from what we expect.”

▸ Empty calorie. The 105 women in this group consume seven to eight times more soda and other sweetened beverages, compared with their counterparts. They also consume more red meat and desserts and eat fewer fruits, vegetables, and micronutrients than women in the other groups. In addition, empty calorie dieters are likely to smoke and have a higher body mass index than women in the other groups.

Women in the empty calorie group had maximum carotid intima-media thickness of 1.46 mm, which was significantly higher than that of women in the heart healthy group (1.18 mm), light eating group (1.22 mm), wine and moderate eating group (1.27 mm), and high fat group (1.17 mm). This relationship remained significant even after controlling for smoking, systolic blood pressure, cholesterol, body mass index, and other risk factors.

“We suspect that the intima-media thickness of the empty calorie group is so high because intima-media thickness is a really good indicator of lifetime exposure to all the things that cause heart disease risk including poor diet, high blood pressure, high cholesterol, smoking, and physical inactivity,” Ms. Brown said.

Women with a so-called empty calorie diet—high in sweetened beverages, red meat, and desserts—had significantly elevated intima-media thickness, compared with women who followed other dietary patterns, including diets high in fat.

The finding comes from an analysis of the Framingham Heart Offspring/Spouse Study that was presented during a poster session at the annual scientific sessions of the American Heart Association.

“Any diet that consists of regular intake of a lot of fatty food, a lot of sugary food including sugary drinks, and not a lot of low-fat dairy, fruits, or vegetables is probably setting a woman up for cardiovascular problems,” lead study author Lisa S. Brown said in an interview.

Ms. Brown and her associates analyzed data from 1,278 women with a mean age of 58 years who participated in the Framingham Offspring/Spouse Study and who completed the Framingham food frequency questionnaire during 1984–1988, underwent intima-media thickness measurement via ultrasound at exam 6 (1996–1998), and were free of cardiovascular disease at exam 6.

“A lot of intima-media thickness and diet work has looked at specific nutrients—especially antioxidants and different types of fats,” noted Ms. Brown, a registered dietitian who is a doctoral candidate in medical nutrition sciences at Boston University. “None have looked at diet in such a comprehensive manner.”

Based on how the women responded to a validated Framingham food frequency questionnaire, the researchers placed them into one of five dietary patterns:

▸ Heart healthy. The 250 women in this group eat more fruits and vegetables than women in the other groups. “We think this is a group that changed their diet some time in their adult life and that they make an effort to be health conscious,” she said.

▸ Light eating. The 612 women in this group are chronic dieters who consume the least amount of sweets and take in the least amount of calories. “But they tend to be a little heavier than we would expect them to be based on their dietary intake,” she said.

▸ Wine and moderate eating. The 45 women in this group consume about two alcoholic drinks per day. Their diet also is highest in cholesterol and lowest in calcium consumption.

▸ High fat. The 266 women in this group “get a lot of their calories from refined grains and vegetable fats both hard and soft, so they get a lot of margarine and oils,” Ms. Brown said. “Their saturated fat is the highest [among] all the groups but for some reason they are also the least likely to be overweight or obese. We don't know why, and we are still trying to figure out what makes this group different from what we expect.”

▸ Empty calorie. The 105 women in this group consume seven to eight times more soda and other sweetened beverages, compared with their counterparts. They also consume more red meat and desserts and eat fewer fruits, vegetables, and micronutrients than women in the other groups. In addition, empty calorie dieters are likely to smoke and have a higher body mass index than women in the other groups.

Women in the empty calorie group had maximum carotid intima-media thickness of 1.46 mm, which was significantly higher than that of women in the heart healthy group (1.18 mm), light eating group (1.22 mm), wine and moderate eating group (1.27 mm), and high fat group (1.17 mm). This relationship remained significant even after controlling for smoking, systolic blood pressure, cholesterol, body mass index, and other risk factors.

“We suspect that the intima-media thickness of the empty calorie group is so high because intima-media thickness is a really good indicator of lifetime exposure to all the things that cause heart disease risk including poor diet, high blood pressure, high cholesterol, smoking, and physical inactivity,” Ms. Brown said.

Women with a so-called empty calorie diet—high in sweetened beverages, red meat, and desserts—had significantly elevated intima-media thickness, compared with women who followed other dietary patterns, including diets high in fat.

The finding comes from an analysis of the Framingham Heart Offspring/Spouse Study that was presented during a poster session at the annual scientific sessions of the American Heart Association.

“Any diet that consists of regular intake of a lot of fatty food, a lot of sugary food including sugary drinks, and not a lot of low-fat dairy, fruits, or vegetables is probably setting a woman up for cardiovascular problems,” lead study author Lisa S. Brown said in an interview.

Ms. Brown and her associates analyzed data from 1,278 women with a mean age of 58 years who participated in the Framingham Offspring/Spouse Study and who completed the Framingham food frequency questionnaire during 1984–1988, underwent intima-media thickness measurement via ultrasound at exam 6 (1996–1998), and were free of cardiovascular disease at exam 6.

“A lot of intima-media thickness and diet work has looked at specific nutrients—especially antioxidants and different types of fats,” noted Ms. Brown, a registered dietitian who is a doctoral candidate in medical nutrition sciences at Boston University. “None have looked at diet in such a comprehensive manner.”

Based on how the women responded to a validated Framingham food frequency questionnaire, the researchers placed them into one of five dietary patterns:

▸ Heart healthy. The 250 women in this group eat more fruits and vegetables than women in the other groups. “We think this is a group that changed their diet some time in their adult life and that they make an effort to be health conscious,” she said.

▸ Light eating. The 612 women in this group are chronic dieters who consume the least amount of sweets and take in the least amount of calories. “But they tend to be a little heavier than we would expect them to be based on their dietary intake,” she said.

▸ Wine and moderate eating. The 45 women in this group consume about two alcoholic drinks per day. Their diet also is highest in cholesterol and lowest in calcium consumption.

▸ High fat. The 266 women in this group “get a lot of their calories from refined grains and vegetable fats both hard and soft, so they get a lot of margarine and oils,” Ms. Brown said. “Their saturated fat is the highest [among] all the groups but for some reason they are also the least likely to be overweight or obese. We don't know why, and we are still trying to figure out what makes this group different from what we expect.”

▸ Empty calorie. The 105 women in this group consume seven to eight times more soda and other sweetened beverages, compared with their counterparts. They also consume more red meat and desserts and eat fewer fruits, vegetables, and micronutrients than women in the other groups. In addition, empty calorie dieters are likely to smoke and have a higher body mass index than women in the other groups.

Women in the empty calorie group had maximum carotid intima-media thickness of 1.46 mm, which was significantly higher than that of women in the heart healthy group (1.18 mm), light eating group (1.22 mm), wine and moderate eating group (1.27 mm), and high fat group (1.17 mm). This relationship remained significant even after controlling for smoking, systolic blood pressure, cholesterol, body mass index, and other risk factors.

“We suspect that the intima-media thickness of the empty calorie group is so high because intima-media thickness is a really good indicator of lifetime exposure to all the things that cause heart disease risk including poor diet, high blood pressure, high cholesterol, smoking, and physical inactivity,” Ms. Brown said.

SAN DIEGO — During the winter of 2006 and the spring of 2007, adenovirus 14 caused a community outbreak of respiratory disease in Oregon, with a fatality rate of 19%, Dr. Paul Lewis reported at the annual meeting of the Infectious Diseases Society of America.

“This seemed to come out of nowhere,” Dr. Lewis, a public health physician with the state of Oregon and a pediatric infectious disease physician with Oregon Health and Science University, Portland, said of the outbreak. “In patients with serious respiratory illness without an identified etiology, clinicians should think about viruses.”

The cluster was first identified in the spring of 2007 by his associate, Dr. David Gilbert, who was making rounds in the intensive care unit at Providence Portland Medical Center and thought it was odd that 4 of 13 patients had adenovirus infections, which are typically mild and self-limited.

“When we called other hospitals in the Portland area, we almost fell out of our chairs because they all had seen recent severe and fatal cases of adenovirus,” Dr. Lewis said.

The researchers studied 45 cases of adenovirus that were detected in Oregon medical laboratories between November 2006 and April 2007. The adenovirus isolates were typed by hexon gene sequencing or by a novel adenovirus 14-specific real-time polymerase chain reaction assay.

More than 75% of all adenovirus cases were in male patients. Of the 45 cases, 31 (69%) were adenovirus 14, a serotype first identified in 1953 but seen infrequently and never in outbreaks since that time.

Patients infected with adenovirus 14 were significantly older than patients infected with other adenovirus isolates (a mean of 59 years vs. 1 year, respectively). They also had significantly higher rates of hospitalization (71% vs. 14%, respectively).

Clinical features of patients with adenovirus 14 included fever (84%), tachypnea (77%), hypoxia (48%), and hypotension (43%). Of the 24 chest x-rays obtained, 21 (88%) had abnormal findings. Lobar consolidation was the most common pattern seen.

Dr. Lewis reported that 22 (71%) of the adenovirus 14 patients required hospitalization, and 6 (19%) died. Of the hospitalized patients, 16 (73%) required ICU care, 13 (59%) required mechanical ventilation, and 8 (36%) required blood pressure support with vasopressors.

“Infection control was a great concern to hospitals that saw multiple cases,” Dr. Lewis said. “Many patients were isolated with [severe acute respiratory syndrome]-like precaution. There was a health care worker at an ICU taking care of one of these patients who was subsequently admitted to that ICU with adenovirus 14,” he added. “That's our only known possible case of transmission, but we cannot be sure it was not acquired in the community.”

Treatment included “lots of empiric antibiotics.” Cidofovir was used in six patients, two of whom died.

Dr. Lewis said that there are 51 known adenovirus serotypes. Types 1, 2, and 5 are nearly universal in children, whereas types 3, 4, and 7 are common in adults. No adenovirus vaccine is currently available in the United States, and previous vaccines developed for the military do not cover adenovirus 14.

He acknowledged certain limitations of the study, including its retrospective design and the potential for testing bias.

Lobar consolidation is shown in a patient on day 1 of hospitalization.

The same patient is shown above on day 4 of hospitalization. Photos courtesy Dr. Paul Lewis

SAN DIEGO — During the winter of 2006 and the spring of 2007, adenovirus 14 caused a community outbreak of respiratory disease in Oregon, with a fatality rate of 19%, Dr. Paul Lewis reported at the annual meeting of the Infectious Diseases Society of America.

“This seemed to come out of nowhere,” Dr. Lewis, a public health physician with the state of Oregon and a pediatric infectious disease physician with Oregon Health and Science University, Portland, said of the outbreak. “In patients with serious respiratory illness without an identified etiology, clinicians should think about viruses.”

The cluster was first identified in the spring of 2007 by his associate, Dr. David Gilbert, who was making rounds in the intensive care unit at Providence Portland Medical Center and thought it was odd that 4 of 13 patients had adenovirus infections, which are typically mild and self-limited.

“When we called other hospitals in the Portland area, we almost fell out of our chairs because they all had seen recent severe and fatal cases of adenovirus,” Dr. Lewis said.

The researchers studied 45 cases of adenovirus that were detected in Oregon medical laboratories between November 2006 and April 2007. The adenovirus isolates were typed by hexon gene sequencing or by a novel adenovirus 14-specific real-time polymerase chain reaction assay.

More than 75% of all adenovirus cases were in male patients. Of the 45 cases, 31 (69%) were adenovirus 14, a serotype first identified in 1953 but seen infrequently and never in outbreaks since that time.

Patients infected with adenovirus 14 were significantly older than patients infected with other adenovirus isolates (a mean of 59 years vs. 1 year, respectively). They also had significantly higher rates of hospitalization (71% vs. 14%, respectively).

Clinical features of patients with adenovirus 14 included fever (84%), tachypnea (77%), hypoxia (48%), and hypotension (43%). Of the 24 chest x-rays obtained, 21 (88%) had abnormal findings. Lobar consolidation was the most common pattern seen.

Dr. Lewis reported that 22 (71%) of the adenovirus 14 patients required hospitalization, and 6 (19%) died. Of the hospitalized patients, 16 (73%) required ICU care, 13 (59%) required mechanical ventilation, and 8 (36%) required blood pressure support with vasopressors.

“Infection control was a great concern to hospitals that saw multiple cases,” Dr. Lewis said. “Many patients were isolated with [severe acute respiratory syndrome]-like precaution. There was a health care worker at an ICU taking care of one of these patients who was subsequently admitted to that ICU with adenovirus 14,” he added. “That's our only known possible case of transmission, but we cannot be sure it was not acquired in the community.”

Treatment included “lots of empiric antibiotics.” Cidofovir was used in six patients, two of whom died.

Dr. Lewis said that there are 51 known adenovirus serotypes. Types 1, 2, and 5 are nearly universal in children, whereas types 3, 4, and 7 are common in adults. No adenovirus vaccine is currently available in the United States, and previous vaccines developed for the military do not cover adenovirus 14.

He acknowledged certain limitations of the study, including its retrospective design and the potential for testing bias.

Lobar consolidation is shown in a patient on day 1 of hospitalization.

The same patient is shown above on day 4 of hospitalization. Photos courtesy Dr. Paul Lewis

SAN DIEGO — During the winter of 2006 and the spring of 2007, adenovirus 14 caused a community outbreak of respiratory disease in Oregon, with a fatality rate of 19%, Dr. Paul Lewis reported at the annual meeting of the Infectious Diseases Society of America.

“This seemed to come out of nowhere,” Dr. Lewis, a public health physician with the state of Oregon and a pediatric infectious disease physician with Oregon Health and Science University, Portland, said of the outbreak. “In patients with serious respiratory illness without an identified etiology, clinicians should think about viruses.”

The cluster was first identified in the spring of 2007 by his associate, Dr. David Gilbert, who was making rounds in the intensive care unit at Providence Portland Medical Center and thought it was odd that 4 of 13 patients had adenovirus infections, which are typically mild and self-limited.

“When we called other hospitals in the Portland area, we almost fell out of our chairs because they all had seen recent severe and fatal cases of adenovirus,” Dr. Lewis said.

The researchers studied 45 cases of adenovirus that were detected in Oregon medical laboratories between November 2006 and April 2007. The adenovirus isolates were typed by hexon gene sequencing or by a novel adenovirus 14-specific real-time polymerase chain reaction assay.

More than 75% of all adenovirus cases were in male patients. Of the 45 cases, 31 (69%) were adenovirus 14, a serotype first identified in 1953 but seen infrequently and never in outbreaks since that time.

Patients infected with adenovirus 14 were significantly older than patients infected with other adenovirus isolates (a mean of 59 years vs. 1 year, respectively). They also had significantly higher rates of hospitalization (71% vs. 14%, respectively).

Clinical features of patients with adenovirus 14 included fever (84%), tachypnea (77%), hypoxia (48%), and hypotension (43%). Of the 24 chest x-rays obtained, 21 (88%) had abnormal findings. Lobar consolidation was the most common pattern seen.

Dr. Lewis reported that 22 (71%) of the adenovirus 14 patients required hospitalization, and 6 (19%) died. Of the hospitalized patients, 16 (73%) required ICU care, 13 (59%) required mechanical ventilation, and 8 (36%) required blood pressure support with vasopressors.

“Infection control was a great concern to hospitals that saw multiple cases,” Dr. Lewis said. “Many patients were isolated with [severe acute respiratory syndrome]-like precaution. There was a health care worker at an ICU taking care of one of these patients who was subsequently admitted to that ICU with adenovirus 14,” he added. “That's our only known possible case of transmission, but we cannot be sure it was not acquired in the community.”

Treatment included “lots of empiric antibiotics.” Cidofovir was used in six patients, two of whom died.

Dr. Lewis said that there are 51 known adenovirus serotypes. Types 1, 2, and 5 are nearly universal in children, whereas types 3, 4, and 7 are common in adults. No adenovirus vaccine is currently available in the United States, and previous vaccines developed for the military do not cover adenovirus 14.

He acknowledged certain limitations of the study, including its retrospective design and the potential for testing bias.

Lobar consolidation is shown in a patient on day 1 of hospitalization.

The same patient is shown above on day 4 of hospitalization. Photos courtesy Dr. Paul Lewis

SAN DIEGO — In the 1980s, patients with HIV/AIDS commonly lost an excessive amount of weight, a process known as wasting.

But today, these patients are becoming just as overweight and obese as the general population of the U.S., Dr. Nancy F. Crum-Cianflone reported at the annual meeting of the Infectious Diseases Society of America. A study of 663 HIV-positive patients treated at two U.S. Navy clinics revealed that 63% were overweight or obese.

According to the Centers for Disease Control and Prevention, 66% of the general population in the U.S. is overweight or obese.

In 2005, she and her associates collected data from 663 HIV patients at Naval Medical Center in San Diego and National Naval Medical Center in Bethesda, Md., including duration of HIV infection, CD4 count, viral load, antiretroviral therapy, diabetes, and hypertension. They defined wasting as a body mass index of less than 20 kg/m2, overweight as a BMI of 25-29.9, and obesity as a BMI of 30 or greater, said lead author Dr. Crum-Cianflone, an HIV research physician with the TriService AIDS Clinical Consortium in San Diego.

The mean age of patients was 41 years, and 50% were white, 26% had hypertension, and 8% had diabetes. Some had been followed in the clinics since 1986.

Of the 663 patients, 46% were overweight, 17% were obese, and 3% met the definition of wasting. None of the study participants met the strictest criteria for wasting, which is a BMI of 18.5 or less.

At the time of diagnosis, 46% were overweight or obese. Over the course of their infection, 72% gained weight.

Multivariate analysis revealed two significant predictors of increasing BMI: younger age at HIV diagnosis and longer duration of HIV infection. "We also learned that people who gained weight were more likely to have high blood pressure," Dr. Crum-Cianflone said during a press briefing.

Patients with high CD4 counts also were more likely to be overweight than were those with lower CD4 counts.

No association was observed between the use of highly active antiretroviral treatment (HAART) and weight gain.

Specific reasons for the rise in obesity among HIV patients are unclear. Dr. Crum-Cianflone said it may partly have to do with the fact that with improved HAART, HIV has essentially become a chronic condition with a longer expected life span.

In another study presented at the meeting, researchers at Washington University in St. Louis found that HIV-positive patients aged 50 and older were no more likely to have heart disease or diabetes than a group of age-matched HIV-negative controls from the general population.

"Although our study was small, we can probably begin to reassure people living with HIV who are over the age of 50 and clinicians looking after them that comorbidities and toxicities to medications, such as dyslipidemia, diabetes mellitus, and osteoporosis, may not be increased compared to the general U. S. population as it ages," lead study author Dr. Nur Onen said in an interview at the meeting.

She and her associates compared the incidence of heart disease, diabetes, high blood pressure, osteoporosis, and other conditions between a group of 70 HIV-positive patients aged 50 and older on HAART and a group of HIV-negative controls from the National Health and Nutrition Examination Survey matched by age, gender, race, smoking status, and BMI. The mean age of patients was 56 years, 86% were male, and 66% were white. Their mean BMI was 25, and 90% were on HAART (a mean duration of 7 years, 91% with full viral suppression).

Dr. Onen, an infectious diseases fellow at the university, reported that while hypertension was significantly more prevalent in HIV-positive patients than in controls (51% vs. 31%, respectively), there were no differences in the prevalence of heart disease (10% vs. 14%), diabetes (13% vs. 11%), or osteoporosis (2% in each group).

At diagnosis, 46% of HIV patients were overweight or obese. Over the course of their infection, 72% gained weight. DR. CRUM-CIANFLONE

SAN DIEGO — In the 1980s, patients with HIV/AIDS commonly lost an excessive amount of weight, a process known as wasting.

But today, these patients are becoming just as overweight and obese as the general population of the U.S., Dr. Nancy F. Crum-Cianflone reported at the annual meeting of the Infectious Diseases Society of America. A study of 663 HIV-positive patients treated at two U.S. Navy clinics revealed that 63% were overweight or obese.

According to the Centers for Disease Control and Prevention, 66% of the general population in the U.S. is overweight or obese.

In 2005, she and her associates collected data from 663 HIV patients at Naval Medical Center in San Diego and National Naval Medical Center in Bethesda, Md., including duration of HIV infection, CD4 count, viral load, antiretroviral therapy, diabetes, and hypertension. They defined wasting as a body mass index of less than 20 kg/m2, overweight as a BMI of 25-29.9, and obesity as a BMI of 30 or greater, said lead author Dr. Crum-Cianflone, an HIV research physician with the TriService AIDS Clinical Consortium in San Diego.

The mean age of patients was 41 years, and 50% were white, 26% had hypertension, and 8% had diabetes. Some had been followed in the clinics since 1986.

Of the 663 patients, 46% were overweight, 17% were obese, and 3% met the definition of wasting. None of the study participants met the strictest criteria for wasting, which is a BMI of 18.5 or less.

At the time of diagnosis, 46% were overweight or obese. Over the course of their infection, 72% gained weight.

Multivariate analysis revealed two significant predictors of increasing BMI: younger age at HIV diagnosis and longer duration of HIV infection. "We also learned that people who gained weight were more likely to have high blood pressure," Dr. Crum-Cianflone said during a press briefing.

Patients with high CD4 counts also were more likely to be overweight than were those with lower CD4 counts.

No association was observed between the use of highly active antiretroviral treatment (HAART) and weight gain.

Specific reasons for the rise in obesity among HIV patients are unclear. Dr. Crum-Cianflone said it may partly have to do with the fact that with improved HAART, HIV has essentially become a chronic condition with a longer expected life span.

In another study presented at the meeting, researchers at Washington University in St. Louis found that HIV-positive patients aged 50 and older were no more likely to have heart disease or diabetes than a group of age-matched HIV-negative controls from the general population.

"Although our study was small, we can probably begin to reassure people living with HIV who are over the age of 50 and clinicians looking after them that comorbidities and toxicities to medications, such as dyslipidemia, diabetes mellitus, and osteoporosis, may not be increased compared to the general U. S. population as it ages," lead study author Dr. Nur Onen said in an interview at the meeting.

She and her associates compared the incidence of heart disease, diabetes, high blood pressure, osteoporosis, and other conditions between a group of 70 HIV-positive patients aged 50 and older on HAART and a group of HIV-negative controls from the National Health and Nutrition Examination Survey matched by age, gender, race, smoking status, and BMI. The mean age of patients was 56 years, 86% were male, and 66% were white. Their mean BMI was 25, and 90% were on HAART (a mean duration of 7 years, 91% with full viral suppression).

Dr. Onen, an infectious diseases fellow at the university, reported that while hypertension was significantly more prevalent in HIV-positive patients than in controls (51% vs. 31%, respectively), there were no differences in the prevalence of heart disease (10% vs. 14%), diabetes (13% vs. 11%), or osteoporosis (2% in each group).

At diagnosis, 46% of HIV patients were overweight or obese. Over the course of their infection, 72% gained weight. DR. CRUM-CIANFLONE

SAN DIEGO — In the 1980s, patients with HIV/AIDS commonly lost an excessive amount of weight, a process known as wasting.

But today, these patients are becoming just as overweight and obese as the general population of the U.S., Dr. Nancy F. Crum-Cianflone reported at the annual meeting of the Infectious Diseases Society of America. A study of 663 HIV-positive patients treated at two U.S. Navy clinics revealed that 63% were overweight or obese.

According to the Centers for Disease Control and Prevention, 66% of the general population in the U.S. is overweight or obese.

In 2005, she and her associates collected data from 663 HIV patients at Naval Medical Center in San Diego and National Naval Medical Center in Bethesda, Md., including duration of HIV infection, CD4 count, viral load, antiretroviral therapy, diabetes, and hypertension. They defined wasting as a body mass index of less than 20 kg/m2, overweight as a BMI of 25-29.9, and obesity as a BMI of 30 or greater, said lead author Dr. Crum-Cianflone, an HIV research physician with the TriService AIDS Clinical Consortium in San Diego.

The mean age of patients was 41 years, and 50% were white, 26% had hypertension, and 8% had diabetes. Some had been followed in the clinics since 1986.

Of the 663 patients, 46% were overweight, 17% were obese, and 3% met the definition of wasting. None of the study participants met the strictest criteria for wasting, which is a BMI of 18.5 or less.

At the time of diagnosis, 46% were overweight or obese. Over the course of their infection, 72% gained weight.

Multivariate analysis revealed two significant predictors of increasing BMI: younger age at HIV diagnosis and longer duration of HIV infection. "We also learned that people who gained weight were more likely to have high blood pressure," Dr. Crum-Cianflone said during a press briefing.

Patients with high CD4 counts also were more likely to be overweight than were those with lower CD4 counts.

No association was observed between the use of highly active antiretroviral treatment (HAART) and weight gain.

Specific reasons for the rise in obesity among HIV patients are unclear. Dr. Crum-Cianflone said it may partly have to do with the fact that with improved HAART, HIV has essentially become a chronic condition with a longer expected life span.

In another study presented at the meeting, researchers at Washington University in St. Louis found that HIV-positive patients aged 50 and older were no more likely to have heart disease or diabetes than a group of age-matched HIV-negative controls from the general population.

"Although our study was small, we can probably begin to reassure people living with HIV who are over the age of 50 and clinicians looking after them that comorbidities and toxicities to medications, such as dyslipidemia, diabetes mellitus, and osteoporosis, may not be increased compared to the general U. S. population as it ages," lead study author Dr. Nur Onen said in an interview at the meeting.

She and her associates compared the incidence of heart disease, diabetes, high blood pressure, osteoporosis, and other conditions between a group of 70 HIV-positive patients aged 50 and older on HAART and a group of HIV-negative controls from the National Health and Nutrition Examination Survey matched by age, gender, race, smoking status, and BMI. The mean age of patients was 56 years, 86% were male, and 66% were white. Their mean BMI was 25, and 90% were on HAART (a mean duration of 7 years, 91% with full viral suppression).

Dr. Onen, an infectious diseases fellow at the university, reported that while hypertension was significantly more prevalent in HIV-positive patients than in controls (51% vs. 31%, respectively), there were no differences in the prevalence of heart disease (10% vs. 14%), diabetes (13% vs. 11%), or osteoporosis (2% in each group).

At diagnosis, 46% of HIV patients were overweight or obese. Over the course of their infection, 72% gained weight. DR. CRUM-CIANFLONE

SAN DIEGO — The overall rates of resistance of pediatric Staphylococcus aureus isolates to clindamycin remained stable at around 11% in Southern California between 2004 and the first half of 2007, results from a large study of patients from that area demonstrated.

At the same time, overall resistance to both a ?-lactam and clindamycin remained stable at 2.8%, Dr. Mark B. Salzman reported at the annual meeting of the Infectious Diseases Society of America.

"We need to continue to monitor resistance rates of clindamycin and other antimicrobials," said Dr. Salzman, a pediatrician at Kaiser Permanente West Los Angeles Medical Center.

He and his associate, Susan M. Novak-Weekley, Ph.D., identified all S. aureus isolates from Kaiser Permanente Southern California patients under the age of 18 years between January 2004 and June 2007.

Kaiser Permanente Southern California is a large HMO system with 11 hospitals, 110 medical offices, and 839,000 patients under the age of 18. The researchers categorized the S. aureus isolates by year and by methicillin-resistant S. aureus (MRSA) status, methicillin-susceptible S. aureus (MSSA) status, and clindamycin susceptibility.

"Only one isolate per patient per year was counted, unless it was different in susceptibility to either clindamycin or oxacillin or if it was from a different source cultured more than 6 months later," Dr. Salzman said.

In 2004, there were 2,095 S. aureus isolates in patients under the age of 18 years, compared with 3,406 in 2005, 4,801 in 2006, and 2,329 in the first 6 months of 2007. MRSA accounted for 33% of isolates in 2004, 43% of isolates in 2005, 45% of isolates in 2006, and 46% of isolates in the first 6 months of 2007. "Since 2005 the pediatric MRSA rates seemed to have reached a plateau," he said.

The number of clindamycin suspension prescriptions nearly tripled over the time period, from 1,276 in 2004 to a projected 3,300 in 2007 based on data extrapolated from the first 6 months of 2007.

The number of prescriptions for clindamycin capsules rose from 41,427 to 70,000 in 2007 based on data extrapolated from the first 6 months of 2007.

Clindamycin resistance rates to MRSA isolates were 8% in 2004, 7% in 2005, 6% in 2006, and 7% in the first 6 months of 2007, while the rates of resistance to MSSA isolates were 13%, 17%, 15%, and 15%, respectively. The rates of clindamycin resistance to S. aureus, including both MRSA and MSSA, were 11.2% in 2004, 12.3% in 2005, 10.9% in 2006, and 11.2% in 2007. The percentage of isolates that were resistant to both ?-lactams and clindamycin were 2.7% in 2004, 2.9% in 2005, 2.7% in 2006, and 3.1% in the first 6 months of 2007, for an overall rate of 2.8%.

"All presumed S. aureus infections should be cultured if possible," said Dr. Salzman. "Clindamycin can still be used as empiric therapy for most nonserious S. aureus infections, but I think that combining a ?-lactam with clindamycin should be considered for empiric therapy of more serious S. aureus infections."

He advised that vancomycin be reserved "for life-threatening infections or very serious infections or empiric therapy when other therapies fail in the absence of culture and susceptibility confirmation."

Dr. Salzman disclosed that he is on the speakers' bureau for Sanofi Pasteur.

SAN DIEGO — The overall rates of resistance of pediatric Staphylococcus aureus isolates to clindamycin remained stable at around 11% in Southern California between 2004 and the first half of 2007, results from a large study of patients from that area demonstrated.

At the same time, overall resistance to both a ?-lactam and clindamycin remained stable at 2.8%, Dr. Mark B. Salzman reported at the annual meeting of the Infectious Diseases Society of America.

"We need to continue to monitor resistance rates of clindamycin and other antimicrobials," said Dr. Salzman, a pediatrician at Kaiser Permanente West Los Angeles Medical Center.

He and his associate, Susan M. Novak-Weekley, Ph.D., identified all S. aureus isolates from Kaiser Permanente Southern California patients under the age of 18 years between January 2004 and June 2007.

Kaiser Permanente Southern California is a large HMO system with 11 hospitals, 110 medical offices, and 839,000 patients under the age of 18. The researchers categorized the S. aureus isolates by year and by methicillin-resistant S. aureus (MRSA) status, methicillin-susceptible S. aureus (MSSA) status, and clindamycin susceptibility.

"Only one isolate per patient per year was counted, unless it was different in susceptibility to either clindamycin or oxacillin or if it was from a different source cultured more than 6 months later," Dr. Salzman said.

In 2004, there were 2,095 S. aureus isolates in patients under the age of 18 years, compared with 3,406 in 2005, 4,801 in 2006, and 2,329 in the first 6 months of 2007. MRSA accounted for 33% of isolates in 2004, 43% of isolates in 2005, 45% of isolates in 2006, and 46% of isolates in the first 6 months of 2007. "Since 2005 the pediatric MRSA rates seemed to have reached a plateau," he said.

The number of clindamycin suspension prescriptions nearly tripled over the time period, from 1,276 in 2004 to a projected 3,300 in 2007 based on data extrapolated from the first 6 months of 2007.

The number of prescriptions for clindamycin capsules rose from 41,427 to 70,000 in 2007 based on data extrapolated from the first 6 months of 2007.

Clindamycin resistance rates to MRSA isolates were 8% in 2004, 7% in 2005, 6% in 2006, and 7% in the first 6 months of 2007, while the rates of resistance to MSSA isolates were 13%, 17%, 15%, and 15%, respectively. The rates of clindamycin resistance to S. aureus, including both MRSA and MSSA, were 11.2% in 2004, 12.3% in 2005, 10.9% in 2006, and 11.2% in 2007. The percentage of isolates that were resistant to both ?-lactams and clindamycin were 2.7% in 2004, 2.9% in 2005, 2.7% in 2006, and 3.1% in the first 6 months of 2007, for an overall rate of 2.8%.

"All presumed S. aureus infections should be cultured if possible," said Dr. Salzman. "Clindamycin can still be used as empiric therapy for most nonserious S. aureus infections, but I think that combining a ?-lactam with clindamycin should be considered for empiric therapy of more serious S. aureus infections."

He advised that vancomycin be reserved "for life-threatening infections or very serious infections or empiric therapy when other therapies fail in the absence of culture and susceptibility confirmation."

Dr. Salzman disclosed that he is on the speakers' bureau for Sanofi Pasteur.

SAN DIEGO — The overall rates of resistance of pediatric Staphylococcus aureus isolates to clindamycin remained stable at around 11% in Southern California between 2004 and the first half of 2007, results from a large study of patients from that area demonstrated.

At the same time, overall resistance to both a ?-lactam and clindamycin remained stable at 2.8%, Dr. Mark B. Salzman reported at the annual meeting of the Infectious Diseases Society of America.

"We need to continue to monitor resistance rates of clindamycin and other antimicrobials," said Dr. Salzman, a pediatrician at Kaiser Permanente West Los Angeles Medical Center.

He and his associate, Susan M. Novak-Weekley, Ph.D., identified all S. aureus isolates from Kaiser Permanente Southern California patients under the age of 18 years between January 2004 and June 2007.

Kaiser Permanente Southern California is a large HMO system with 11 hospitals, 110 medical offices, and 839,000 patients under the age of 18. The researchers categorized the S. aureus isolates by year and by methicillin-resistant S. aureus (MRSA) status, methicillin-susceptible S. aureus (MSSA) status, and clindamycin susceptibility.

"Only one isolate per patient per year was counted, unless it was different in susceptibility to either clindamycin or oxacillin or if it was from a different source cultured more than 6 months later," Dr. Salzman said.

In 2004, there were 2,095 S. aureus isolates in patients under the age of 18 years, compared with 3,406 in 2005, 4,801 in 2006, and 2,329 in the first 6 months of 2007. MRSA accounted for 33% of isolates in 2004, 43% of isolates in 2005, 45% of isolates in 2006, and 46% of isolates in the first 6 months of 2007. "Since 2005 the pediatric MRSA rates seemed to have reached a plateau," he said.

The number of clindamycin suspension prescriptions nearly tripled over the time period, from 1,276 in 2004 to a projected 3,300 in 2007 based on data extrapolated from the first 6 months of 2007.

The number of prescriptions for clindamycin capsules rose from 41,427 to 70,000 in 2007 based on data extrapolated from the first 6 months of 2007.

Clindamycin resistance rates to MRSA isolates were 8% in 2004, 7% in 2005, 6% in 2006, and 7% in the first 6 months of 2007, while the rates of resistance to MSSA isolates were 13%, 17%, 15%, and 15%, respectively. The rates of clindamycin resistance to S. aureus, including both MRSA and MSSA, were 11.2% in 2004, 12.3% in 2005, 10.9% in 2006, and 11.2% in 2007. The percentage of isolates that were resistant to both ?-lactams and clindamycin were 2.7% in 2004, 2.9% in 2005, 2.7% in 2006, and 3.1% in the first 6 months of 2007, for an overall rate of 2.8%.

"All presumed S. aureus infections should be cultured if possible," said Dr. Salzman. "Clindamycin can still be used as empiric therapy for most nonserious S. aureus infections, but I think that combining a ?-lactam with clindamycin should be considered for empiric therapy of more serious S. aureus infections."

He advised that vancomycin be reserved "for life-threatening infections or very serious infections or empiric therapy when other therapies fail in the absence of culture and susceptibility confirmation."

Dr. Salzman disclosed that he is on the speakers' bureau for Sanofi Pasteur.

SAN DIEGO — Cases of Rocky Mountain spotted fever increased nearly threefold between 2001 and 2005, John Openshaw reported at the annual meeting of the Infectious Diseases Society of America.

An increase in the number of suburban homes that encroach on rural areas is one possible reason for the spike in reported cases, although “increased physician awareness and increased surveillance efforts are [also] involved,” Mr. Openshaw said during a press briefing. “The true explanation is likely a combination of many factors.”

Rocky Mountain spotted fever is caused by the Rickettsia rickettsii bacteria, which are typically spread through tick bites. Early signs of the fever include acute onset of fever and other flulike symptoms, followed by rash.

“The biggest problem is that people often don't remember being bitten by a tick, and by the time the classic rash appears, the disease has already progressed significantly, and it may be too late,” Dr. David Swerdlow, previous team leader for the rickettsial zoonoses branch of the Centers for Disease Control and Prevention, said in a prepared statement.

Researchers analyzed data from the National Electronic Telecommunications System for Surveillance and found that during 2001–2005, there were 6,598 cases of Rocky Mountain spotted fever reported in 45 states, said Mr. Openshaw, a medical student at the University of Pennsylvania, Philadelphia, who worked on the study during a CDC Applied Epidemiology Fellowship in 2006.

The disease resulted in death in 22 people (0.3%) in that period.

The number of cases in the United States increased nearly threefold over the period, from 695 cases in 2001 to 1,936 cases in 2005. The incidence was higher in suburban areas than it was in rural areas, and the largest increase was in the southern Atlantic states.

Despite the increase in the number of cases, the rates of hospitalization fell from 29% in 2001 to 18% in 2005, and the rates of complications from the disease fell from 8% to 4%.

Immunocompromised patients were most likely to be hospitalized with the disease (41%), followed by adults over the age of 70 years (40%) and children under the age of 5 (35%).

Mr. Openshaw also reported that 53 counties in the United States had a fivefold increase in the incidence of Rocky Mountain spotted fever. Moreover, about half of the 1,079 counties reporting disease were newly affected during the study period.

The disease was reported in every state, except Alaska, California, Hawaii, Maine, and Washington.

“Physicians should be aware of the increase in Rocky Mountain spotted fever,” he said, adding that they should also be aware of “the difficulty in diagnosing a lot of these patients and the importance of proper treatment.”

Physicians should be aware of the difficulty of diagnosing these patients and the importance of proper treatment. MR. OPENSHAW

SAN DIEGO — Cases of Rocky Mountain spotted fever increased nearly threefold between 2001 and 2005, John Openshaw reported at the annual meeting of the Infectious Diseases Society of America.

An increase in the number of suburban homes that encroach on rural areas is one possible reason for the spike in reported cases, although “increased physician awareness and increased surveillance efforts are [also] involved,” Mr. Openshaw said during a press briefing. “The true explanation is likely a combination of many factors.”

Rocky Mountain spotted fever is caused by the Rickettsia rickettsii bacteria, which are typically spread through tick bites. Early signs of the fever include acute onset of fever and other flulike symptoms, followed by rash.

“The biggest problem is that people often don't remember being bitten by a tick, and by the time the classic rash appears, the disease has already progressed significantly, and it may be too late,” Dr. David Swerdlow, previous team leader for the rickettsial zoonoses branch of the Centers for Disease Control and Prevention, said in a prepared statement.

Researchers analyzed data from the National Electronic Telecommunications System for Surveillance and found that during 2001–2005, there were 6,598 cases of Rocky Mountain spotted fever reported in 45 states, said Mr. Openshaw, a medical student at the University of Pennsylvania, Philadelphia, who worked on the study during a CDC Applied Epidemiology Fellowship in 2006.

The disease resulted in death in 22 people (0.3%) in that period.

The number of cases in the United States increased nearly threefold over the period, from 695 cases in 2001 to 1,936 cases in 2005. The incidence was higher in suburban areas than it was in rural areas, and the largest increase was in the southern Atlantic states.

Despite the increase in the number of cases, the rates of hospitalization fell from 29% in 2001 to 18% in 2005, and the rates of complications from the disease fell from 8% to 4%.

Immunocompromised patients were most likely to be hospitalized with the disease (41%), followed by adults over the age of 70 years (40%) and children under the age of 5 (35%).

Mr. Openshaw also reported that 53 counties in the United States had a fivefold increase in the incidence of Rocky Mountain spotted fever. Moreover, about half of the 1,079 counties reporting disease were newly affected during the study period.

The disease was reported in every state, except Alaska, California, Hawaii, Maine, and Washington.

“Physicians should be aware of the increase in Rocky Mountain spotted fever,” he said, adding that they should also be aware of “the difficulty in diagnosing a lot of these patients and the importance of proper treatment.”

Physicians should be aware of the difficulty of diagnosing these patients and the importance of proper treatment. MR. OPENSHAW

SAN DIEGO — Cases of Rocky Mountain spotted fever increased nearly threefold between 2001 and 2005, John Openshaw reported at the annual meeting of the Infectious Diseases Society of America.

An increase in the number of suburban homes that encroach on rural areas is one possible reason for the spike in reported cases, although “increased physician awareness and increased surveillance efforts are [also] involved,” Mr. Openshaw said during a press briefing. “The true explanation is likely a combination of many factors.”

Rocky Mountain spotted fever is caused by the Rickettsia rickettsii bacteria, which are typically spread through tick bites. Early signs of the fever include acute onset of fever and other flulike symptoms, followed by rash.

“The biggest problem is that people often don't remember being bitten by a tick, and by the time the classic rash appears, the disease has already progressed significantly, and it may be too late,” Dr. David Swerdlow, previous team leader for the rickettsial zoonoses branch of the Centers for Disease Control and Prevention, said in a prepared statement.

Researchers analyzed data from the National Electronic Telecommunications System for Surveillance and found that during 2001–2005, there were 6,598 cases of Rocky Mountain spotted fever reported in 45 states, said Mr. Openshaw, a medical student at the University of Pennsylvania, Philadelphia, who worked on the study during a CDC Applied Epidemiology Fellowship in 2006.

The disease resulted in death in 22 people (0.3%) in that period.

The number of cases in the United States increased nearly threefold over the period, from 695 cases in 2001 to 1,936 cases in 2005. The incidence was higher in suburban areas than it was in rural areas, and the largest increase was in the southern Atlantic states.

Despite the increase in the number of cases, the rates of hospitalization fell from 29% in 2001 to 18% in 2005, and the rates of complications from the disease fell from 8% to 4%.

Immunocompromised patients were most likely to be hospitalized with the disease (41%), followed by adults over the age of 70 years (40%) and children under the age of 5 (35%).

Mr. Openshaw also reported that 53 counties in the United States had a fivefold increase in the incidence of Rocky Mountain spotted fever. Moreover, about half of the 1,079 counties reporting disease were newly affected during the study period.

The disease was reported in every state, except Alaska, California, Hawaii, Maine, and Washington.

“Physicians should be aware of the increase in Rocky Mountain spotted fever,” he said, adding that they should also be aware of “the difficulty in diagnosing a lot of these patients and the importance of proper treatment.”

Physicians should be aware of the difficulty of diagnosing these patients and the importance of proper treatment. MR. OPENSHAW