Miriam E. Tucker

WASHINGTON — Even without evidence of coronary calcium on CT, a large proportion of diabetic patients are still at risk for atherosclerosis, Liviu Klein, M.D., said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

“Diabetics are clearly at risk for atherosclerosis. Some people believe that CAC [coronary artery calcium] is a perfect tool for discrimination, but it's not. … My concern is that the absence of CAC will be used as a reason not to treat,” Dr. Klein, a fellow in cardiovascular epidemiology and prevention at Northwestern University, Chicago, said in an interview.

About 30% of diabetic adults aged 45 and older without clinically manifest coronary heart disease have no coronary artery calcium (CAC score of 0) on CT. No previous study compared other markers of atherosclerosis in that subgroup with those of nondiabetics without CAC. The first-ever study to do so is a part of the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort of 6,814 African American, white, Chinese, and Hispanic adults aged 45–84 without symptoms or history of cardiovascular disease.

A total of 350 (34%) of the diabetic participants and 2,825 (49%) of the nondiabetic participants had CAC scores of 0 on coronary CT. Diabetic subjects were older than nondiabetics (61 vs. 57 years) and were more likely to be African American (44% vs. 28%) or Hispanic (34% vs. 23%). Average body mass index (BMI), waist circumference, and triglyceride and LDL-cholesterol levels were also higher in the diabetics than in the nondiabetics, Dr. Klein reported.

On B-mode carotid ultrasound, the diabetic patients had significantly higher common and internal carotid intimal medial thickness (IMT) than did nondiabetics, both before and after adjustment for age, gender, ethnicity, and traditional risk factors for atherosclerosis, including blood pressure, cholesterol level, BMI, smoking, socioeconomic status, and use of statins and aspirin.

After adjustment, common carotid IMTs were 0.84 mm for the diabetics and 0.81 for the nondiabetics; internal carotid IMTs were 0.98 mm and 0.86 mm, respectively. Levels of intercellular adhesion molecule-1 (ICAM-1), E-selectin, interleukin-6, and C-reactive protein (CRP) were all significantly greater in the diabetic group, indicating a greater burden of atherosclerosis, Dr. Klein said.

Mean ankle-brachial index did not differ significantly between the two groups either before or after the same adjustments, nor were there differences in levels of the plaque instability markers matrix metalloproteinase (MMP)-3, MMP-9, or soluble CD40 ligand (CD40-L).

Whether diabetic patients without a history of myocardial infarction have the same risk of CHD events as nondiabetic patients with a history of MI remains controversial, despite two sets of evidence-based guidelines issued by the National Heart, Lung, and Blood Institute categorizing diabetes as a “risk equivalent” for coronary heart disease and advising that all individuals with diabetes receive intensive CHD risk factor management (JAMA 2001;285:2486–97, JAMA 2003;289:2560–72).

However, conflicting data have appeared both before and since the dissemination of those two documents (the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure).

One recent study, for example, found that diabetic patients without MI had a lower risk of CHD events and mortality from cardiovascular disease than did nondiabetic patients with MI, but stroke risk was similar between the two groups (Circulation 2004;109:855–60), while another suggested that 5-year survival among diabetics without CAC is similar to that of nondiabetic subjects without CAC (J. Am. Coll. Cardiol. 2004;43:1663–9).

But, according to Dr. Klein, there are multiple problems with these and similar studies. They have not accounted for the fact that mean CAC differs among individuals of different races. In particular, African Americans and Hispanics have lower mean CAC values than do whites, despite having higher MI rates. “We don't really know what the calcium score means,” he said.

Moreover, these new data from MESA show that even if someone with diabetes has a CAC of 0 now, that person is likely to have a significantly higher atherosclerotic burden, compared with a nondiabetic. “If you wait until a diabetic has CAC, you will have missed the chance to prevent diabetes complications. … It's not so much an issue of mortality as it is of morbidity,” Dr. Klein said at the meeting, also sponsored by NHLBI.

As it is, fewer than 25% of diabetics receive appropriate treatment for cholesterol, hypertension, and glucose. That number could drop significantly if physicians use a CAC score of 0 on CT as a threshold for intensive treatment, he noted. “The problem is the more tools you have, the easier it is to just get the test rather than committing yourself to lifestyle modification. … But in diabetics, who clearly have atherosclerosis, you have to treat them.”

WASHINGTON — Even without evidence of coronary calcium on CT, a large proportion of diabetic patients are still at risk for atherosclerosis, Liviu Klein, M.D., said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

“Diabetics are clearly at risk for atherosclerosis. Some people believe that CAC [coronary artery calcium] is a perfect tool for discrimination, but it's not. … My concern is that the absence of CAC will be used as a reason not to treat,” Dr. Klein, a fellow in cardiovascular epidemiology and prevention at Northwestern University, Chicago, said in an interview.

About 30% of diabetic adults aged 45 and older without clinically manifest coronary heart disease have no coronary artery calcium (CAC score of 0) on CT. No previous study compared other markers of atherosclerosis in that subgroup with those of nondiabetics without CAC. The first-ever study to do so is a part of the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort of 6,814 African American, white, Chinese, and Hispanic adults aged 45–84 without symptoms or history of cardiovascular disease.

A total of 350 (34%) of the diabetic participants and 2,825 (49%) of the nondiabetic participants had CAC scores of 0 on coronary CT. Diabetic subjects were older than nondiabetics (61 vs. 57 years) and were more likely to be African American (44% vs. 28%) or Hispanic (34% vs. 23%). Average body mass index (BMI), waist circumference, and triglyceride and LDL-cholesterol levels were also higher in the diabetics than in the nondiabetics, Dr. Klein reported.

On B-mode carotid ultrasound, the diabetic patients had significantly higher common and internal carotid intimal medial thickness (IMT) than did nondiabetics, both before and after adjustment for age, gender, ethnicity, and traditional risk factors for atherosclerosis, including blood pressure, cholesterol level, BMI, smoking, socioeconomic status, and use of statins and aspirin.

After adjustment, common carotid IMTs were 0.84 mm for the diabetics and 0.81 for the nondiabetics; internal carotid IMTs were 0.98 mm and 0.86 mm, respectively. Levels of intercellular adhesion molecule-1 (ICAM-1), E-selectin, interleukin-6, and C-reactive protein (CRP) were all significantly greater in the diabetic group, indicating a greater burden of atherosclerosis, Dr. Klein said.

Mean ankle-brachial index did not differ significantly between the two groups either before or after the same adjustments, nor were there differences in levels of the plaque instability markers matrix metalloproteinase (MMP)-3, MMP-9, or soluble CD40 ligand (CD40-L).

Whether diabetic patients without a history of myocardial infarction have the same risk of CHD events as nondiabetic patients with a history of MI remains controversial, despite two sets of evidence-based guidelines issued by the National Heart, Lung, and Blood Institute categorizing diabetes as a “risk equivalent” for coronary heart disease and advising that all individuals with diabetes receive intensive CHD risk factor management (JAMA 2001;285:2486–97, JAMA 2003;289:2560–72).

However, conflicting data have appeared both before and since the dissemination of those two documents (the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure).

One recent study, for example, found that diabetic patients without MI had a lower risk of CHD events and mortality from cardiovascular disease than did nondiabetic patients with MI, but stroke risk was similar between the two groups (Circulation 2004;109:855–60), while another suggested that 5-year survival among diabetics without CAC is similar to that of nondiabetic subjects without CAC (J. Am. Coll. Cardiol. 2004;43:1663–9).

But, according to Dr. Klein, there are multiple problems with these and similar studies. They have not accounted for the fact that mean CAC differs among individuals of different races. In particular, African Americans and Hispanics have lower mean CAC values than do whites, despite having higher MI rates. “We don't really know what the calcium score means,” he said.

Moreover, these new data from MESA show that even if someone with diabetes has a CAC of 0 now, that person is likely to have a significantly higher atherosclerotic burden, compared with a nondiabetic. “If you wait until a diabetic has CAC, you will have missed the chance to prevent diabetes complications. … It's not so much an issue of mortality as it is of morbidity,” Dr. Klein said at the meeting, also sponsored by NHLBI.

As it is, fewer than 25% of diabetics receive appropriate treatment for cholesterol, hypertension, and glucose. That number could drop significantly if physicians use a CAC score of 0 on CT as a threshold for intensive treatment, he noted. “The problem is the more tools you have, the easier it is to just get the test rather than committing yourself to lifestyle modification. … But in diabetics, who clearly have atherosclerosis, you have to treat them.”

WASHINGTON — Even without evidence of coronary calcium on CT, a large proportion of diabetic patients are still at risk for atherosclerosis, Liviu Klein, M.D., said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

“Diabetics are clearly at risk for atherosclerosis. Some people believe that CAC [coronary artery calcium] is a perfect tool for discrimination, but it's not. … My concern is that the absence of CAC will be used as a reason not to treat,” Dr. Klein, a fellow in cardiovascular epidemiology and prevention at Northwestern University, Chicago, said in an interview.

About 30% of diabetic adults aged 45 and older without clinically manifest coronary heart disease have no coronary artery calcium (CAC score of 0) on CT. No previous study compared other markers of atherosclerosis in that subgroup with those of nondiabetics without CAC. The first-ever study to do so is a part of the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort of 6,814 African American, white, Chinese, and Hispanic adults aged 45–84 without symptoms or history of cardiovascular disease.

A total of 350 (34%) of the diabetic participants and 2,825 (49%) of the nondiabetic participants had CAC scores of 0 on coronary CT. Diabetic subjects were older than nondiabetics (61 vs. 57 years) and were more likely to be African American (44% vs. 28%) or Hispanic (34% vs. 23%). Average body mass index (BMI), waist circumference, and triglyceride and LDL-cholesterol levels were also higher in the diabetics than in the nondiabetics, Dr. Klein reported.

On B-mode carotid ultrasound, the diabetic patients had significantly higher common and internal carotid intimal medial thickness (IMT) than did nondiabetics, both before and after adjustment for age, gender, ethnicity, and traditional risk factors for atherosclerosis, including blood pressure, cholesterol level, BMI, smoking, socioeconomic status, and use of statins and aspirin.

After adjustment, common carotid IMTs were 0.84 mm for the diabetics and 0.81 for the nondiabetics; internal carotid IMTs were 0.98 mm and 0.86 mm, respectively. Levels of intercellular adhesion molecule-1 (ICAM-1), E-selectin, interleukin-6, and C-reactive protein (CRP) were all significantly greater in the diabetic group, indicating a greater burden of atherosclerosis, Dr. Klein said.

Mean ankle-brachial index did not differ significantly between the two groups either before or after the same adjustments, nor were there differences in levels of the plaque instability markers matrix metalloproteinase (MMP)-3, MMP-9, or soluble CD40 ligand (CD40-L).

Whether diabetic patients without a history of myocardial infarction have the same risk of CHD events as nondiabetic patients with a history of MI remains controversial, despite two sets of evidence-based guidelines issued by the National Heart, Lung, and Blood Institute categorizing diabetes as a “risk equivalent” for coronary heart disease and advising that all individuals with diabetes receive intensive CHD risk factor management (JAMA 2001;285:2486–97, JAMA 2003;289:2560–72).

However, conflicting data have appeared both before and since the dissemination of those two documents (the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure).

One recent study, for example, found that diabetic patients without MI had a lower risk of CHD events and mortality from cardiovascular disease than did nondiabetic patients with MI, but stroke risk was similar between the two groups (Circulation 2004;109:855–60), while another suggested that 5-year survival among diabetics without CAC is similar to that of nondiabetic subjects without CAC (J. Am. Coll. Cardiol. 2004;43:1663–9).

But, according to Dr. Klein, there are multiple problems with these and similar studies. They have not accounted for the fact that mean CAC differs among individuals of different races. In particular, African Americans and Hispanics have lower mean CAC values than do whites, despite having higher MI rates. “We don't really know what the calcium score means,” he said.

Moreover, these new data from MESA show that even if someone with diabetes has a CAC of 0 now, that person is likely to have a significantly higher atherosclerotic burden, compared with a nondiabetic. “If you wait until a diabetic has CAC, you will have missed the chance to prevent diabetes complications. … It's not so much an issue of mortality as it is of morbidity,” Dr. Klein said at the meeting, also sponsored by NHLBI.

As it is, fewer than 25% of diabetics receive appropriate treatment for cholesterol, hypertension, and glucose. That number could drop significantly if physicians use a CAC score of 0 on CT as a threshold for intensive treatment, he noted. “The problem is the more tools you have, the easier it is to just get the test rather than committing yourself to lifestyle modification. … But in diabetics, who clearly have atherosclerosis, you have to treat them.”

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project.

Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%–1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005;54:380–3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents (just 3 of 16 were detected), and of bleeding associated with anticoagulants such as warfarin and heparin (1 of 9 were detected).

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project.

Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%–1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005;54:380–3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents (just 3 of 16 were detected), and of bleeding associated with anticoagulants such as warfarin and heparin (1 of 9 were detected).

A new national active surveillance system designed to detect adverse drug events is very good at picking up true cases, but not particularly sensitive—especially when it comes to detecting hypoglycemia due to diabetes medications and bleeding associated with anticoagulants, the Centers for Disease Control and Prevention reported.

In 2003, the CDC collaborated with the Consumer Product Safety Commission and the Food and Drug Administration in developing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project.

Because adverse drug events (ADEs) are often more difficult to identify than other injuries, the CDC conducted an independent chart review in a sample of six NEISS-CADES hospitals, representing a range of sizes and of ADE reporting rates (0.2%–1.7% of emergency department visits).

Of 4,561 ED visit charts reviewed, a total of 68 ADE cases were identified. The patients had a median age of 57 years and 53% were female. Of the 29 ADE cases that had been reported to NEISS-CADES prior to the chart review, 25 were among the 68 cases detected by the reviewers. The remaining four were false-positives in which an injury attributed to a drug in the chief complaint section of the chart was not confirmed elsewhere in the chart, the CDC explained (MMWR 2005;54:380–3).

The estimated sensitivity of the NEISS-CADES for ascertaining ADEs was 0.33, while the estimated positive predictive value of a reported ADE to the system was 0.92. The relatively low sensitivity of the system was attributed to the difficulty in detecting hypoglycemia associated with diabetes agents (just 3 of 16 were detected), and of bleeding associated with anticoagulants such as warfarin and heparin (1 of 9 were detected).

WASHINGTON — Even without evidence of coronary calcium on CT, a large proportion of diabetic patients are still at risk for atherosclerosis, Liviu Klein, M.D., said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

“Diabetics are clearly at risk for atherosclerosis. Some people believe that CAC [coronary artery calcium] is a perfect tool for discrimination, but it's not. … My concern is that the absence of CAC will be used as a reason not to treat,” Dr. Klein, a fellow in cardiovascular epidemiology and prevention at Northwestern University, Chicago, said in an interview.

About 30% of diabetic adults aged 45 and older without clinically manifest coronary heart disease have no CAC (score of 0) on CT. No previous study compared other markers of atherosclerosis in that subgroup with those of nondiabetics without CAC. The first-ever study to do so is a part of the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort of 6,814 African American, white, Chinese, and Hispanic adults aged 45–84 without symptoms or history of cardiovascular disease.

A total of 350 (34%) of the diabetic participants and 2,825 (49%) of the nondiabetic participants had CAC scores of 0 on coronary CT. Diabetic subjects were older than nondiabetics (61 vs. 57 years) and were more likely to be African American (44% vs. 28%) or Hispanic (34% vs. 23%). Average body mass index (BMI), waist circumference, and triglyceride and LDL-cholesterol levels were also higher in the diabetics than in the nondiabetics, Dr. Klein reported.

On B-mode carotid ultrasound, the diabetic patients had significantly higher common and internal carotid intimal medial thickness (IMT) than did nondiabetics, both before and after adjustment for age, gender, ethnicity, and traditional risk factors for atherosclerosis, including blood pressure, cholesterol level, BMI, smoking, socioeconomic status, and use of statins and aspirin.

After adjustment, common carotid IMTs were 0.84 mm for the diabetics and 0.81 mm for the nondiabetics; internal carotid IMTs were 0.98 mm and 0.86 mm, respectively. Levels of intercellular adhesion molecule-1, E-selectin, interleukin-6, and C-reactive protein were all significantly greater in the diabetic group, indicating a greater burden of atherosclerosis, Dr. Klein said.

Mean ankle-brachial index did not differ significantly between the two groups either before or after the same adjustments, nor were there differences in levels of the plaque instability markers matrix metalloproteinase (MMP)-3, MMP-9, or soluble CD40 ligand.

Whether diabetic patients without a history of myocardial infarction have the same risk of CHD events as nondiabetic patients with a history of MI remains controversial, despite two sets of evidence-based guidelines issued by the National Heart, Lung, and Blood Institute categorizing diabetes as a “risk equivalent” for coronary heart disease and advising that all individuals with diabetes receive intensive CHD risk factor management (JAMA 2001;285:2486–97 JAMA 2003;289:2560–72).

However, conflicting data have appeared both before and since the dissemination of those two documents (the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure).

One recent study, for example, found that diabetic patients without MI had a lower risk of CHD events and mortality from cardiovascular disease than did nondiabetic patients with MI, but stroke risk was similar between the two groups (Circulation 2004;109:855–60), while another suggested that 5-year survival among diabetics without CAC is similar to that of nondiabetic subjects without CAC (J. Am. Coll. Cardiol. 2004;43:1663–9).

But, according to Dr. Klein, there are multiple problems with these and similar studies.

First, they have not accounted for the fact that mean CAC differs among individuals of different races. In particular, African Americans and Hispanics have lower mean CAC values than do whites, despite having higher MI rates. “We don't really know what the calcium score means,” he said.

Moreover, these new data from MESA show that even if someone with diabetes has a CAC of 0 now, that person is likely to have a significantly higher atherosclerotic burden, compared with a nondiabetic. “If you wait until a diabetic has CAC, you will have missed the chance to prevent diabetes complications. … It's not so much an issue of mortality as it is of morbidity,” Dr. Klein said at the meeting, also sponsored by NHLBI.

As it is, fewer than 25% of diabetics receive appropriate treatment for cholesterol, hypertension, and glucose. That number could drop significantly if physicians use a CAC score of 0 on CT as a threshold for intensive treatment, he noted. “The problem is the more tools you have, the easier it is to just get the test rather than committing yourself to lifestyle modification. … But in diabetics, who clearly have atherosclerosis, you have to treat them.”

WASHINGTON — Even without evidence of coronary calcium on CT, a large proportion of diabetic patients are still at risk for atherosclerosis, Liviu Klein, M.D., said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

“Diabetics are clearly at risk for atherosclerosis. Some people believe that CAC [coronary artery calcium] is a perfect tool for discrimination, but it's not. … My concern is that the absence of CAC will be used as a reason not to treat,” Dr. Klein, a fellow in cardiovascular epidemiology and prevention at Northwestern University, Chicago, said in an interview.

About 30% of diabetic adults aged 45 and older without clinically manifest coronary heart disease have no CAC (score of 0) on CT. No previous study compared other markers of atherosclerosis in that subgroup with those of nondiabetics without CAC. The first-ever study to do so is a part of the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort of 6,814 African American, white, Chinese, and Hispanic adults aged 45–84 without symptoms or history of cardiovascular disease.

A total of 350 (34%) of the diabetic participants and 2,825 (49%) of the nondiabetic participants had CAC scores of 0 on coronary CT. Diabetic subjects were older than nondiabetics (61 vs. 57 years) and were more likely to be African American (44% vs. 28%) or Hispanic (34% vs. 23%). Average body mass index (BMI), waist circumference, and triglyceride and LDL-cholesterol levels were also higher in the diabetics than in the nondiabetics, Dr. Klein reported.

On B-mode carotid ultrasound, the diabetic patients had significantly higher common and internal carotid intimal medial thickness (IMT) than did nondiabetics, both before and after adjustment for age, gender, ethnicity, and traditional risk factors for atherosclerosis, including blood pressure, cholesterol level, BMI, smoking, socioeconomic status, and use of statins and aspirin.

After adjustment, common carotid IMTs were 0.84 mm for the diabetics and 0.81 mm for the nondiabetics; internal carotid IMTs were 0.98 mm and 0.86 mm, respectively. Levels of intercellular adhesion molecule-1, E-selectin, interleukin-6, and C-reactive protein were all significantly greater in the diabetic group, indicating a greater burden of atherosclerosis, Dr. Klein said.

Mean ankle-brachial index did not differ significantly between the two groups either before or after the same adjustments, nor were there differences in levels of the plaque instability markers matrix metalloproteinase (MMP)-3, MMP-9, or soluble CD40 ligand.

Whether diabetic patients without a history of myocardial infarction have the same risk of CHD events as nondiabetic patients with a history of MI remains controversial, despite two sets of evidence-based guidelines issued by the National Heart, Lung, and Blood Institute categorizing diabetes as a “risk equivalent” for coronary heart disease and advising that all individuals with diabetes receive intensive CHD risk factor management (JAMA 2001;285:2486–97 JAMA 2003;289:2560–72).

However, conflicting data have appeared both before and since the dissemination of those two documents (the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure).

One recent study, for example, found that diabetic patients without MI had a lower risk of CHD events and mortality from cardiovascular disease than did nondiabetic patients with MI, but stroke risk was similar between the two groups (Circulation 2004;109:855–60), while another suggested that 5-year survival among diabetics without CAC is similar to that of nondiabetic subjects without CAC (J. Am. Coll. Cardiol. 2004;43:1663–9).

But, according to Dr. Klein, there are multiple problems with these and similar studies.

First, they have not accounted for the fact that mean CAC differs among individuals of different races. In particular, African Americans and Hispanics have lower mean CAC values than do whites, despite having higher MI rates. “We don't really know what the calcium score means,” he said.

Moreover, these new data from MESA show that even if someone with diabetes has a CAC of 0 now, that person is likely to have a significantly higher atherosclerotic burden, compared with a nondiabetic. “If you wait until a diabetic has CAC, you will have missed the chance to prevent diabetes complications. … It's not so much an issue of mortality as it is of morbidity,” Dr. Klein said at the meeting, also sponsored by NHLBI.

As it is, fewer than 25% of diabetics receive appropriate treatment for cholesterol, hypertension, and glucose. That number could drop significantly if physicians use a CAC score of 0 on CT as a threshold for intensive treatment, he noted. “The problem is the more tools you have, the easier it is to just get the test rather than committing yourself to lifestyle modification. … But in diabetics, who clearly have atherosclerosis, you have to treat them.”

WASHINGTON — Even without evidence of coronary calcium on CT, a large proportion of diabetic patients are still at risk for atherosclerosis, Liviu Klein, M.D., said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

“Diabetics are clearly at risk for atherosclerosis. Some people believe that CAC [coronary artery calcium] is a perfect tool for discrimination, but it's not. … My concern is that the absence of CAC will be used as a reason not to treat,” Dr. Klein, a fellow in cardiovascular epidemiology and prevention at Northwestern University, Chicago, said in an interview.

About 30% of diabetic adults aged 45 and older without clinically manifest coronary heart disease have no CAC (score of 0) on CT. No previous study compared other markers of atherosclerosis in that subgroup with those of nondiabetics without CAC. The first-ever study to do so is a part of the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort of 6,814 African American, white, Chinese, and Hispanic adults aged 45–84 without symptoms or history of cardiovascular disease.

A total of 350 (34%) of the diabetic participants and 2,825 (49%) of the nondiabetic participants had CAC scores of 0 on coronary CT. Diabetic subjects were older than nondiabetics (61 vs. 57 years) and were more likely to be African American (44% vs. 28%) or Hispanic (34% vs. 23%). Average body mass index (BMI), waist circumference, and triglyceride and LDL-cholesterol levels were also higher in the diabetics than in the nondiabetics, Dr. Klein reported.

On B-mode carotid ultrasound, the diabetic patients had significantly higher common and internal carotid intimal medial thickness (IMT) than did nondiabetics, both before and after adjustment for age, gender, ethnicity, and traditional risk factors for atherosclerosis, including blood pressure, cholesterol level, BMI, smoking, socioeconomic status, and use of statins and aspirin.

After adjustment, common carotid IMTs were 0.84 mm for the diabetics and 0.81 mm for the nondiabetics; internal carotid IMTs were 0.98 mm and 0.86 mm, respectively. Levels of intercellular adhesion molecule-1, E-selectin, interleukin-6, and C-reactive protein were all significantly greater in the diabetic group, indicating a greater burden of atherosclerosis, Dr. Klein said.

Mean ankle-brachial index did not differ significantly between the two groups either before or after the same adjustments, nor were there differences in levels of the plaque instability markers matrix metalloproteinase (MMP)-3, MMP-9, or soluble CD40 ligand.

Whether diabetic patients without a history of myocardial infarction have the same risk of CHD events as nondiabetic patients with a history of MI remains controversial, despite two sets of evidence-based guidelines issued by the National Heart, Lung, and Blood Institute categorizing diabetes as a “risk equivalent” for coronary heart disease and advising that all individuals with diabetes receive intensive CHD risk factor management (JAMA 2001;285:2486–97 JAMA 2003;289:2560–72).

However, conflicting data have appeared both before and since the dissemination of those two documents (the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure).

One recent study, for example, found that diabetic patients without MI had a lower risk of CHD events and mortality from cardiovascular disease than did nondiabetic patients with MI, but stroke risk was similar between the two groups (Circulation 2004;109:855–60), while another suggested that 5-year survival among diabetics without CAC is similar to that of nondiabetic subjects without CAC (J. Am. Coll. Cardiol. 2004;43:1663–9).

But, according to Dr. Klein, there are multiple problems with these and similar studies.

First, they have not accounted for the fact that mean CAC differs among individuals of different races. In particular, African Americans and Hispanics have lower mean CAC values than do whites, despite having higher MI rates. “We don't really know what the calcium score means,” he said.

Moreover, these new data from MESA show that even if someone with diabetes has a CAC of 0 now, that person is likely to have a significantly higher atherosclerotic burden, compared with a nondiabetic. “If you wait until a diabetic has CAC, you will have missed the chance to prevent diabetes complications. … It's not so much an issue of mortality as it is of morbidity,” Dr. Klein said at the meeting, also sponsored by NHLBI.

As it is, fewer than 25% of diabetics receive appropriate treatment for cholesterol, hypertension, and glucose. That number could drop significantly if physicians use a CAC score of 0 on CT as a threshold for intensive treatment, he noted. “The problem is the more tools you have, the easier it is to just get the test rather than committing yourself to lifestyle modification. … But in diabetics, who clearly have atherosclerosis, you have to treat them.”

The incidence of several major food-borne infections declined markedly between 1996 and 2004, preliminary data from the Centers for Disease Control and Prevention suggest.

For the first time in 2004, the national incidence of Shiga-toxin-producing Escherichia coli (STEC) O157 infections fell below the Healthy People 2010 goal of 1 case per 100,000 population. In addition, rates of Campylobacter infection are approaching the target of less than 12.3 cases per 100,000, while the 2004 rate of Listeria, 2.7 per 1 million population, is nearly down to the goal of 2.5 cases per million, to be reached by the end of 2005.

But although most of the news from the CDC's 10-site Food-Borne Diseases Active Surveillance Network (FoodNet) was good, there were increases in the incidence of both Vibrio and two Salmonella serotypes from baseline in 1996–1998 to 2004, according to the CDC (MMWR 2005;54:352–6).

In 2004, a total of 15,806 laboratory-confirmed cases of infections were identified in the FoodNet surveillance area, which included 44.1 million individuals, or 15.2% of the U.S. population. The three most frequent were Salmonella (6,464 cases), Campylobacter (5,665), and Shigella (2,231), followed by Cryptosporidium (613), STEC O157 (401), Yersinia (173), Vibrio (124), Listeria (120), and Cyclospora (15).

FoodNet cases were part of 239 nationally reported food-borne disease outbreaks, of which 58% were associated with restaurants. Of the 152 outbreaks in which an etiology was reported, the most common were norovirus (57%) and Salmonella (18%).

In 2003, FoodNet collected data on 52 cases of hemolytic-uremic syndrome in children less than 15 years of age (rate 0.6 per 100,000). Of those, 36 (69%) were among those younger than 5 years, the CDC said.

In comparing the preliminary 2004 numbers with those from 1996 to 1998, the CDC adjusted for the difference in FoodNet's population, which was just 14.2 million during the earlier time period. The estimated incidence of infections with Campylobacter decreased by 31%, Cryptosporidium by 40%, STEC O157 by 42%, Listeria by 40%, Yersinia by 45%, and overall Salmonella infections by 8%. The estimated incidence of Shigella infections in 2004 wasn't significantly different from the baseline period, while overall Vibrio infections increased by 47%, to 2.8 per 100,000 population in 2004, the CDC reported.

Although the incidence of Salmonella decreased overall, only one of the five most common serotypes, S. typhimurium, actually dropped significantly (by 41%). Two of the others—S. enteritidis and S. heidelberg—didn't change, while both S. newport and S. javiana rose by 41% and 167%, respectively. The substantial increase in S. javiana was due in part to a multistate outbreak in 2004 that was associated with Roma tomatoes, they noted.

The substantial decline in STEC O157, first seen in 2003, coincides with several important food safety initiatives and educational efforts, and is consistent with reports from the U.S. Department of Agriculture of declines in contamination of ground beef following industry responses to governmental food safety initiatives.

The drop in Campylobacter, on the other hand, likely reflects efforts to reduce contamination of poultry and to educate consumers about safe food handling, the CDC said.

Rises in some salmonella strains reflect a lack of understanding about the epidemiology of the organism and the methods by which it contaminates produce. Multidrug resistance is also a problem with Salmonella, particularly the newport strain.

The reasons for the increase in Vibrio, which is typically associated with seafood, are not clear. The Food and Drug Administration is currently conducting an assessment.

The incidence of several major food-borne infections declined markedly between 1996 and 2004, preliminary data from the Centers for Disease Control and Prevention suggest.

For the first time in 2004, the national incidence of Shiga-toxin-producing Escherichia coli (STEC) O157 infections fell below the Healthy People 2010 goal of 1 case per 100,000 population. In addition, rates of Campylobacter infection are approaching the target of less than 12.3 cases per 100,000, while the 2004 rate of Listeria, 2.7 per 1 million population, is nearly down to the goal of 2.5 cases per million, to be reached by the end of 2005.

But although most of the news from the CDC's 10-site Food-Borne Diseases Active Surveillance Network (FoodNet) was good, there were increases in the incidence of both Vibrio and two Salmonella serotypes from baseline in 1996–1998 to 2004, according to the CDC (MMWR 2005;54:352–6).

In 2004, a total of 15,806 laboratory-confirmed cases of infections were identified in the FoodNet surveillance area, which included 44.1 million individuals, or 15.2% of the U.S. population. The three most frequent were Salmonella (6,464 cases), Campylobacter (5,665), and Shigella (2,231), followed by Cryptosporidium (613), STEC O157 (401), Yersinia (173), Vibrio (124), Listeria (120), and Cyclospora (15).

FoodNet cases were part of 239 nationally reported food-borne disease outbreaks, of which 58% were associated with restaurants. Of the 152 outbreaks in which an etiology was reported, the most common were norovirus (57%) and Salmonella (18%).

In 2003, FoodNet collected data on 52 cases of hemolytic-uremic syndrome in children less than 15 years of age (rate 0.6 per 100,000). Of those, 36 (69%) were among those younger than 5 years, the CDC said.

In comparing the preliminary 2004 numbers with those from 1996 to 1998, the CDC adjusted for the difference in FoodNet's population, which was just 14.2 million during the earlier time period. The estimated incidence of infections with Campylobacter decreased by 31%, Cryptosporidium by 40%, STEC O157 by 42%, Listeria by 40%, Yersinia by 45%, and overall Salmonella infections by 8%. The estimated incidence of Shigella infections in 2004 wasn't significantly different from the baseline period, while overall Vibrio infections increased by 47%, to 2.8 per 100,000 population in 2004, the CDC reported.

Although the incidence of Salmonella decreased overall, only one of the five most common serotypes, S. typhimurium, actually dropped significantly (by 41%). Two of the others—S. enteritidis and S. heidelberg—didn't change, while both S. newport and S. javiana rose by 41% and 167%, respectively. The substantial increase in S. javiana was due in part to a multistate outbreak in 2004 that was associated with Roma tomatoes, they noted.

The substantial decline in STEC O157, first seen in 2003, coincides with several important food safety initiatives and educational efforts, and is consistent with reports from the U.S. Department of Agriculture of declines in contamination of ground beef following industry responses to governmental food safety initiatives.

The drop in Campylobacter, on the other hand, likely reflects efforts to reduce contamination of poultry and to educate consumers about safe food handling, the CDC said.

Rises in some salmonella strains reflect a lack of understanding about the epidemiology of the organism and the methods by which it contaminates produce. Multidrug resistance is also a problem with Salmonella, particularly the newport strain.

The reasons for the increase in Vibrio, which is typically associated with seafood, are not clear. The Food and Drug Administration is currently conducting an assessment.

The incidence of several major food-borne infections declined markedly between 1996 and 2004, preliminary data from the Centers for Disease Control and Prevention suggest.

For the first time in 2004, the national incidence of Shiga-toxin-producing Escherichia coli (STEC) O157 infections fell below the Healthy People 2010 goal of 1 case per 100,000 population. In addition, rates of Campylobacter infection are approaching the target of less than 12.3 cases per 100,000, while the 2004 rate of Listeria, 2.7 per 1 million population, is nearly down to the goal of 2.5 cases per million, to be reached by the end of 2005.

But although most of the news from the CDC's 10-site Food-Borne Diseases Active Surveillance Network (FoodNet) was good, there were increases in the incidence of both Vibrio and two Salmonella serotypes from baseline in 1996–1998 to 2004, according to the CDC (MMWR 2005;54:352–6).

In 2004, a total of 15,806 laboratory-confirmed cases of infections were identified in the FoodNet surveillance area, which included 44.1 million individuals, or 15.2% of the U.S. population. The three most frequent were Salmonella (6,464 cases), Campylobacter (5,665), and Shigella (2,231), followed by Cryptosporidium (613), STEC O157 (401), Yersinia (173), Vibrio (124), Listeria (120), and Cyclospora (15).

FoodNet cases were part of 239 nationally reported food-borne disease outbreaks, of which 58% were associated with restaurants. Of the 152 outbreaks in which an etiology was reported, the most common were norovirus (57%) and Salmonella (18%).

In 2003, FoodNet collected data on 52 cases of hemolytic-uremic syndrome in children less than 15 years of age (rate 0.6 per 100,000). Of those, 36 (69%) were among those younger than 5 years, the CDC said.

In comparing the preliminary 2004 numbers with those from 1996 to 1998, the CDC adjusted for the difference in FoodNet's population, which was just 14.2 million during the earlier time period. The estimated incidence of infections with Campylobacter decreased by 31%, Cryptosporidium by 40%, STEC O157 by 42%, Listeria by 40%, Yersinia by 45%, and overall Salmonella infections by 8%. The estimated incidence of Shigella infections in 2004 wasn't significantly different from the baseline period, while overall Vibrio infections increased by 47%, to 2.8 per 100,000 population in 2004, the CDC reported.

Although the incidence of Salmonella decreased overall, only one of the five most common serotypes, S. typhimurium, actually dropped significantly (by 41%). Two of the others—S. enteritidis and S. heidelberg—didn't change, while both S. newport and S. javiana rose by 41% and 167%, respectively. The substantial increase in S. javiana was due in part to a multistate outbreak in 2004 that was associated with Roma tomatoes, they noted.

The substantial decline in STEC O157, first seen in 2003, coincides with several important food safety initiatives and educational efforts, and is consistent with reports from the U.S. Department of Agriculture of declines in contamination of ground beef following industry responses to governmental food safety initiatives.

The drop in Campylobacter, on the other hand, likely reflects efforts to reduce contamination of poultry and to educate consumers about safe food handling, the CDC said.

Rises in some salmonella strains reflect a lack of understanding about the epidemiology of the organism and the methods by which it contaminates produce. Multidrug resistance is also a problem with Salmonella, particularly the newport strain.

The reasons for the increase in Vibrio, which is typically associated with seafood, are not clear. The Food and Drug Administration is currently conducting an assessment.

VANCOUVER, B.C. — Panic symptoms affect many patients with diabetes and are linked to depression and diabetes-related disability, Evette Ludman, Ph.D., and her associates reported in a poster presentation at the annual meeting of the American Psychosomatic Society.

Like other forms of anxiety, panic symptoms in diabetic patients are often associated with depression as well as poor diabetes-related functional and clinical indicators. “Clinicians treating diabetic patients should be alert for panic symptoms as well as depressive symptoms. Panic episodes may be mistaken for hypoglycemia,” said Dr. Ludman, senior research associate at the Center for Health Studies, Group Health Cooperative (GHC), Seattle.

In a National Institute of Mental Health-supported study—the first to look specifically at panic symptoms in diabetic patients—surveys were sent to 9,063 individuals in a population-based diabetes registry from nine primary care clinics of GHC, a large HMO in western Washington.

Complete data were available for 4,385, of whom 4.4% met criteria for panic disorder, defined as answering “yes” both when asked if they'd had “spells of panic or fear” during the past 2 weeks, and when asked if these feelings “forced you to change what you were doing at the time.”

Respondents who answered yes to both questions were significantly more likely to be female than were those who reported no panic symptoms (63.7% vs. 48.1%), to be employed (53.3% vs. 41.9%), and to also have a diagnosis of major depression (54.9% vs. 10.0%); they were also significantly younger (55.4 years vs. 63.7 years). Overall, 2.0% of the patients had panic but no major depression, 2.4% had both panic and major depression, and 9.5% had major depression without panic symptoms, Dr. Ludman reported.

Independent of depression, symptoms of panic were associated with higher hemoglobin A_1c values, a greater number of diabetes complications, higher levels of disability (using World Health Organization criteria), and lower social functioning. Unlike depression, panic was not associated with smoking or body mass index.

“Treatment for panic episodes is likely to positively impact diabetes symptoms, self-care, and quality of life among patients with diabetes,” Dr. Ludman and her associates said.

VANCOUVER, B.C. — Panic symptoms affect many patients with diabetes and are linked to depression and diabetes-related disability, Evette Ludman, Ph.D., and her associates reported in a poster presentation at the annual meeting of the American Psychosomatic Society.

Like other forms of anxiety, panic symptoms in diabetic patients are often associated with depression as well as poor diabetes-related functional and clinical indicators. “Clinicians treating diabetic patients should be alert for panic symptoms as well as depressive symptoms. Panic episodes may be mistaken for hypoglycemia,” said Dr. Ludman, senior research associate at the Center for Health Studies, Group Health Cooperative (GHC), Seattle.

In a National Institute of Mental Health-supported study—the first to look specifically at panic symptoms in diabetic patients—surveys were sent to 9,063 individuals in a population-based diabetes registry from nine primary care clinics of GHC, a large HMO in western Washington.

Complete data were available for 4,385, of whom 4.4% met criteria for panic disorder, defined as answering “yes” both when asked if they'd had “spells of panic or fear” during the past 2 weeks, and when asked if these feelings “forced you to change what you were doing at the time.”

Respondents who answered yes to both questions were significantly more likely to be female than were those who reported no panic symptoms (63.7% vs. 48.1%), to be employed (53.3% vs. 41.9%), and to also have a diagnosis of major depression (54.9% vs. 10.0%); they were also significantly younger (55.4 years vs. 63.7 years). Overall, 2.0% of the patients had panic but no major depression, 2.4% had both panic and major depression, and 9.5% had major depression without panic symptoms, Dr. Ludman reported.

Independent of depression, symptoms of panic were associated with higher hemoglobin A_1c values, a greater number of diabetes complications, higher levels of disability (using World Health Organization criteria), and lower social functioning. Unlike depression, panic was not associated with smoking or body mass index.

“Treatment for panic episodes is likely to positively impact diabetes symptoms, self-care, and quality of life among patients with diabetes,” Dr. Ludman and her associates said.

VANCOUVER, B.C. — Panic symptoms affect many patients with diabetes and are linked to depression and diabetes-related disability, Evette Ludman, Ph.D., and her associates reported in a poster presentation at the annual meeting of the American Psychosomatic Society.

Like other forms of anxiety, panic symptoms in diabetic patients are often associated with depression as well as poor diabetes-related functional and clinical indicators. “Clinicians treating diabetic patients should be alert for panic symptoms as well as depressive symptoms. Panic episodes may be mistaken for hypoglycemia,” said Dr. Ludman, senior research associate at the Center for Health Studies, Group Health Cooperative (GHC), Seattle.

In a National Institute of Mental Health-supported study—the first to look specifically at panic symptoms in diabetic patients—surveys were sent to 9,063 individuals in a population-based diabetes registry from nine primary care clinics of GHC, a large HMO in western Washington.

Complete data were available for 4,385, of whom 4.4% met criteria for panic disorder, defined as answering “yes” both when asked if they'd had “spells of panic or fear” during the past 2 weeks, and when asked if these feelings “forced you to change what you were doing at the time.”

Respondents who answered yes to both questions were significantly more likely to be female than were those who reported no panic symptoms (63.7% vs. 48.1%), to be employed (53.3% vs. 41.9%), and to also have a diagnosis of major depression (54.9% vs. 10.0%); they were also significantly younger (55.4 years vs. 63.7 years). Overall, 2.0% of the patients had panic but no major depression, 2.4% had both panic and major depression, and 9.5% had major depression without panic symptoms, Dr. Ludman reported.

Independent of depression, symptoms of panic were associated with higher hemoglobin A_1c values, a greater number of diabetes complications, higher levels of disability (using World Health Organization criteria), and lower social functioning. Unlike depression, panic was not associated with smoking or body mass index.

“Treatment for panic episodes is likely to positively impact diabetes symptoms, self-care, and quality of life among patients with diabetes,” Dr. Ludman and her associates said.

WASHINGTON — Using ancillary staff to obtain patient immunization and medication histories before the patient sees the physician could go a long way toward improving immunization rates among high-risk adults, Linda Hill, M.D., said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Despite long-standing recommendations for annual influenza vaccine and one-time pneumococcal vaccination for adults aged 18–49 with chronic lung, cardiovascular, metabolic, and immunosuppressive conditions, overall coverage levels are only 20% for influenza vaccine and 8% for Pneumovax. Rates are just slightly better for diabetic patients, at 27% and 15%.

The Healthy People 2010 goal is 60% for both vaccines, said Dr. Hill of the department of preventive and family medicine at the University of California, San Diego.

In an effort to determine what types of preventive health issues are addressed during a typical office visit, Dr. Hill and her associates audiotaped 37 visits of patients aged 20–50 years old with chronic conditions.

Patients were seen at three community health centers and one private practice between September 2003 and January 2005.

The average visit lasted about 13 minutes. About 5 minutes were spent taking the patient's history, half a minute on providing generic health information, another 1–2 minutes on evaluations such as explaining test results, and about a half minute on the physical exam. Only fractions of minutes each were spent offering health recommendations, such as “you should get more exercise”; discussing preventive services other than immunizations, such as mammograms; and discussing and/or planning immunizations.

Of the 24 visits in which immunizations were discussed, the discussion took a little over a minute. But when immunizations were discussed and the patient actually got a shot, less than half a minute was spent on the discussion. And during those 24 visits, no other preventive health issues were discussed, noted Dr. Hill, who is also associate director of the Center for Behavioral Epidemiology and Community Health at San Diego State University.

Of interest, on average more than half of the visit (8 of the 13 minutes) was spent discussing the history, mostly the patient's medications.

Although this isn't surprising, the actual discussion tended to be more about trying to figure out what the patient was taking and in what dose than about assessing the appropriateness of the dose or explaining to the patient what it was for.

Previous data have shown that, more than any patient characteristic, physician advice is the greatest predictor of receipt of immunizations. Moreover, physician immunization advice is more likely to occur when the physician to staff ratio is at least 1:4 and when the time spent with the physician is at least half of the total visit time.

It would make sense to have ancillary staff members obtain and document immunization and medication histories prior to seeing the physician, thereby leaving the physician more time for more complex decisions and for talking with the patient about important preventive health measures such as immunization, Dr. Hill said.

WASHINGTON — Using ancillary staff to obtain patient immunization and medication histories before the patient sees the physician could go a long way toward improving immunization rates among high-risk adults, Linda Hill, M.D., said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Despite long-standing recommendations for annual influenza vaccine and one-time pneumococcal vaccination for adults aged 18–49 with chronic lung, cardiovascular, metabolic, and immunosuppressive conditions, overall coverage levels are only 20% for influenza vaccine and 8% for Pneumovax. Rates are just slightly better for diabetic patients, at 27% and 15%.

The Healthy People 2010 goal is 60% for both vaccines, said Dr. Hill of the department of preventive and family medicine at the University of California, San Diego.

In an effort to determine what types of preventive health issues are addressed during a typical office visit, Dr. Hill and her associates audiotaped 37 visits of patients aged 20–50 years old with chronic conditions.

Patients were seen at three community health centers and one private practice between September 2003 and January 2005.

The average visit lasted about 13 minutes. About 5 minutes were spent taking the patient's history, half a minute on providing generic health information, another 1–2 minutes on evaluations such as explaining test results, and about a half minute on the physical exam. Only fractions of minutes each were spent offering health recommendations, such as “you should get more exercise”; discussing preventive services other than immunizations, such as mammograms; and discussing and/or planning immunizations.

Of the 24 visits in which immunizations were discussed, the discussion took a little over a minute. But when immunizations were discussed and the patient actually got a shot, less than half a minute was spent on the discussion. And during those 24 visits, no other preventive health issues were discussed, noted Dr. Hill, who is also associate director of the Center for Behavioral Epidemiology and Community Health at San Diego State University.

Of interest, on average more than half of the visit (8 of the 13 minutes) was spent discussing the history, mostly the patient's medications.

Although this isn't surprising, the actual discussion tended to be more about trying to figure out what the patient was taking and in what dose than about assessing the appropriateness of the dose or explaining to the patient what it was for.

Previous data have shown that, more than any patient characteristic, physician advice is the greatest predictor of receipt of immunizations. Moreover, physician immunization advice is more likely to occur when the physician to staff ratio is at least 1:4 and when the time spent with the physician is at least half of the total visit time.

It would make sense to have ancillary staff members obtain and document immunization and medication histories prior to seeing the physician, thereby leaving the physician more time for more complex decisions and for talking with the patient about important preventive health measures such as immunization, Dr. Hill said.

WASHINGTON — Using ancillary staff to obtain patient immunization and medication histories before the patient sees the physician could go a long way toward improving immunization rates among high-risk adults, Linda Hill, M.D., said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Despite long-standing recommendations for annual influenza vaccine and one-time pneumococcal vaccination for adults aged 18–49 with chronic lung, cardiovascular, metabolic, and immunosuppressive conditions, overall coverage levels are only 20% for influenza vaccine and 8% for Pneumovax. Rates are just slightly better for diabetic patients, at 27% and 15%.

The Healthy People 2010 goal is 60% for both vaccines, said Dr. Hill of the department of preventive and family medicine at the University of California, San Diego.

In an effort to determine what types of preventive health issues are addressed during a typical office visit, Dr. Hill and her associates audiotaped 37 visits of patients aged 20–50 years old with chronic conditions.

Patients were seen at three community health centers and one private practice between September 2003 and January 2005.

The average visit lasted about 13 minutes. About 5 minutes were spent taking the patient's history, half a minute on providing generic health information, another 1–2 minutes on evaluations such as explaining test results, and about a half minute on the physical exam. Only fractions of minutes each were spent offering health recommendations, such as “you should get more exercise”; discussing preventive services other than immunizations, such as mammograms; and discussing and/or planning immunizations.

Of the 24 visits in which immunizations were discussed, the discussion took a little over a minute. But when immunizations were discussed and the patient actually got a shot, less than half a minute was spent on the discussion. And during those 24 visits, no other preventive health issues were discussed, noted Dr. Hill, who is also associate director of the Center for Behavioral Epidemiology and Community Health at San Diego State University.

Of interest, on average more than half of the visit (8 of the 13 minutes) was spent discussing the history, mostly the patient's medications.

Although this isn't surprising, the actual discussion tended to be more about trying to figure out what the patient was taking and in what dose than about assessing the appropriateness of the dose or explaining to the patient what it was for.

Previous data have shown that, more than any patient characteristic, physician advice is the greatest predictor of receipt of immunizations. Moreover, physician immunization advice is more likely to occur when the physician to staff ratio is at least 1:4 and when the time spent with the physician is at least half of the total visit time.

It would make sense to have ancillary staff members obtain and document immunization and medication histories prior to seeing the physician, thereby leaving the physician more time for more complex decisions and for talking with the patient about important preventive health measures such as immunization, Dr. Hill said.

The incidence of several major food-borne infections declined markedly between 1996 and 2004, preliminary data from the Centers for Disease Control and Prevention suggest.

For the first time in 2004, the national incidence of Shiga-toxin-producing Escherichia coli (STEC) O157 infections fell below the Healthy People 2010 goal of 1 case per 100,000 population. In addition, rates of Campylobacter are approaching the target of below 12.3 cases per 100,000, while the 2004 rate of Listeria, 2.7 per 1 million population, is nearly down to the goal of 2.5 cases per million by the end of 2005.

But although most of the news from the CDC's 10-site Food-Borne Diseases Active Surveillance Network (FoodNet) was good, there were increases in the incidence of both Vibrio and of two Salmonella serotypes from baseline in 1996–1998 to 2004, according to the CDC (MMWR 2005;54:352–6).

In 2004, a total of 15,806 laboratory-confirmed cases of infections were identified in the FoodNet surveillance area, which included 44.1 million individuals, or 15.2% of the U.S. population.

The three most frequent were Salmonella (6,464 cases), Campylobacter (5,665), and Shigella (2,231), followed by Cryptosporidium (613), STEC O157 (401), Yersinia (173), Vibrio (124), Listeria (120), and Cyclospora (15).

FoodNet cases were part of 239 nationally reported food-borne disease outbreaks, of which 58% were associated with restaurants. Of the 152 outbreaks in which an etiology was reported, the most common were norovirus (57%) and Salmonella (18%).

In 2003, FoodNet collected data on 52 cases of hemolytic-uremic syndrome in children less than 15 years of age (rate 0.6 per 100,000). Of those, 36 (69%) were among those younger than 5 years, the CDC said.

In comparing the preliminary 2004 numbers with those from 1996 to 1998, the CDC adjusted for the difference in FoodNet's population, which was just 14.2 million during the earlier time period. The estimated incidence of infections with Campylobacter decreased 31%, Cryptosporidium by 40%, STEC O157 by 42%, Listeria by 40%, Yersinia by 45%, and overall Salmonella infections by 8%. The estimated incidence of Shigella infections in 2004 wasn't significantly different from the baseline period, while overall Vibrio infections increased by 47%, to 2.8 per 100,000 population in 2004, the CDC reported.

Although the incidence of Salmonella decreased overall, only one of the five most common serotypes, S. typhimurium, actually dropped significantly (by 41%). Two of the others—S. enteritidis and S. heidelberg—didn't change, while both S. newport and S. javiana rose by 41% and 167%, respectively.

The substantial increase in S. javiana was due in part to a multistate outbreak in 2004 that was associated with Roma tomatoes, they noted.

The substantial decline in STEC O157, first seen in 2003, coincides with several important food safety initiatives and educational efforts, and is consistent with reports from the U.S. Department of Agriculture of declines in contamination of ground beef following industry responses to governmental food safety initiatives.

The drop in Campylobacter, on the other hand, likely reflects efforts to reduce contamination of poultry and to educate consumers about safe food handling, the CDC said.

Rises in some Salmonella strains reflect a lack of understanding about the epidemiology of the organism and the methods by which it contaminates produce. Multidrug resistance is also a problem with Salmonella, particularly the newport strain.

The reasons for the increase in Vibrio, typically associated with seafood, are not clear. The Food and Drug Administration is currently conducting an assessment.

The incidence of several major food-borne infections declined markedly between 1996 and 2004, preliminary data from the Centers for Disease Control and Prevention suggest.

For the first time in 2004, the national incidence of Shiga-toxin-producing Escherichia coli (STEC) O157 infections fell below the Healthy People 2010 goal of 1 case per 100,000 population. In addition, rates of Campylobacter are approaching the target of below 12.3 cases per 100,000, while the 2004 rate of Listeria, 2.7 per 1 million population, is nearly down to the goal of 2.5 cases per million by the end of 2005.

But although most of the news from the CDC's 10-site Food-Borne Diseases Active Surveillance Network (FoodNet) was good, there were increases in the incidence of both Vibrio and of two Salmonella serotypes from baseline in 1996–1998 to 2004, according to the CDC (MMWR 2005;54:352–6).

In 2004, a total of 15,806 laboratory-confirmed cases of infections were identified in the FoodNet surveillance area, which included 44.1 million individuals, or 15.2% of the U.S. population.

The three most frequent were Salmonella (6,464 cases), Campylobacter (5,665), and Shigella (2,231), followed by Cryptosporidium (613), STEC O157 (401), Yersinia (173), Vibrio (124), Listeria (120), and Cyclospora (15).

FoodNet cases were part of 239 nationally reported food-borne disease outbreaks, of which 58% were associated with restaurants. Of the 152 outbreaks in which an etiology was reported, the most common were norovirus (57%) and Salmonella (18%).

In 2003, FoodNet collected data on 52 cases of hemolytic-uremic syndrome in children less than 15 years of age (rate 0.6 per 100,000). Of those, 36 (69%) were among those younger than 5 years, the CDC said.

In comparing the preliminary 2004 numbers with those from 1996 to 1998, the CDC adjusted for the difference in FoodNet's population, which was just 14.2 million during the earlier time period. The estimated incidence of infections with Campylobacter decreased 31%, Cryptosporidium by 40%, STEC O157 by 42%, Listeria by 40%, Yersinia by 45%, and overall Salmonella infections by 8%. The estimated incidence of Shigella infections in 2004 wasn't significantly different from the baseline period, while overall Vibrio infections increased by 47%, to 2.8 per 100,000 population in 2004, the CDC reported.

Although the incidence of Salmonella decreased overall, only one of the five most common serotypes, S. typhimurium, actually dropped significantly (by 41%). Two of the others—S. enteritidis and S. heidelberg—didn't change, while both S. newport and S. javiana rose by 41% and 167%, respectively.

The substantial increase in S. javiana was due in part to a multistate outbreak in 2004 that was associated with Roma tomatoes, they noted.

The substantial decline in STEC O157, first seen in 2003, coincides with several important food safety initiatives and educational efforts, and is consistent with reports from the U.S. Department of Agriculture of declines in contamination of ground beef following industry responses to governmental food safety initiatives.

The drop in Campylobacter, on the other hand, likely reflects efforts to reduce contamination of poultry and to educate consumers about safe food handling, the CDC said.

Rises in some Salmonella strains reflect a lack of understanding about the epidemiology of the organism and the methods by which it contaminates produce. Multidrug resistance is also a problem with Salmonella, particularly the newport strain.

The reasons for the increase in Vibrio, typically associated with seafood, are not clear. The Food and Drug Administration is currently conducting an assessment.

The incidence of several major food-borne infections declined markedly between 1996 and 2004, preliminary data from the Centers for Disease Control and Prevention suggest.

For the first time in 2004, the national incidence of Shiga-toxin-producing Escherichia coli (STEC) O157 infections fell below the Healthy People 2010 goal of 1 case per 100,000 population. In addition, rates of Campylobacter are approaching the target of below 12.3 cases per 100,000, while the 2004 rate of Listeria, 2.7 per 1 million population, is nearly down to the goal of 2.5 cases per million by the end of 2005.

But although most of the news from the CDC's 10-site Food-Borne Diseases Active Surveillance Network (FoodNet) was good, there were increases in the incidence of both Vibrio and of two Salmonella serotypes from baseline in 1996–1998 to 2004, according to the CDC (MMWR 2005;54:352–6).

In 2004, a total of 15,806 laboratory-confirmed cases of infections were identified in the FoodNet surveillance area, which included 44.1 million individuals, or 15.2% of the U.S. population.

The three most frequent were Salmonella (6,464 cases), Campylobacter (5,665), and Shigella (2,231), followed by Cryptosporidium (613), STEC O157 (401), Yersinia (173), Vibrio (124), Listeria (120), and Cyclospora (15).

FoodNet cases were part of 239 nationally reported food-borne disease outbreaks, of which 58% were associated with restaurants. Of the 152 outbreaks in which an etiology was reported, the most common were norovirus (57%) and Salmonella (18%).

In 2003, FoodNet collected data on 52 cases of hemolytic-uremic syndrome in children less than 15 years of age (rate 0.6 per 100,000). Of those, 36 (69%) were among those younger than 5 years, the CDC said.

In comparing the preliminary 2004 numbers with those from 1996 to 1998, the CDC adjusted for the difference in FoodNet's population, which was just 14.2 million during the earlier time period. The estimated incidence of infections with Campylobacter decreased 31%, Cryptosporidium by 40%, STEC O157 by 42%, Listeria by 40%, Yersinia by 45%, and overall Salmonella infections by 8%. The estimated incidence of Shigella infections in 2004 wasn't significantly different from the baseline period, while overall Vibrio infections increased by 47%, to 2.8 per 100,000 population in 2004, the CDC reported.

Although the incidence of Salmonella decreased overall, only one of the five most common serotypes, S. typhimurium, actually dropped significantly (by 41%). Two of the others—S. enteritidis and S. heidelberg—didn't change, while both S. newport and S. javiana rose by 41% and 167%, respectively.

The substantial increase in S. javiana was due in part to a multistate outbreak in 2004 that was associated with Roma tomatoes, they noted.

The substantial decline in STEC O157, first seen in 2003, coincides with several important food safety initiatives and educational efforts, and is consistent with reports from the U.S. Department of Agriculture of declines in contamination of ground beef following industry responses to governmental food safety initiatives.

The drop in Campylobacter, on the other hand, likely reflects efforts to reduce contamination of poultry and to educate consumers about safe food handling, the CDC said.

Rises in some Salmonella strains reflect a lack of understanding about the epidemiology of the organism and the methods by which it contaminates produce. Multidrug resistance is also a problem with Salmonella, particularly the newport strain.

The reasons for the increase in Vibrio, typically associated with seafood, are not clear. The Food and Drug Administration is currently conducting an assessment.

VANCOUVER, B.C. – Panic symptoms affect many patients with diabetes and are linked to depression and diabetes-related disability, Evette Ludman, Ph.D., and her associates reported in a poster presentation at the annual meeting of the American Psychosomatic Society.

Like other forms of anxiety, panic symptoms in diabetic patients are often associated with depression as well as poor diabetes-related functional and clinical indicators.

“Clinicians treating diabetic patients should be alert for panic symptoms as well as depressive symptoms. Panic episodes may be mistaken for hypoglycemia,” said Dr. Ludman, senior research associate at the Center for Health Studies, Group Health Cooperative (GHC), Seattle.

In a National Institute of Mental Health-supported study–the first to look specifically at panic symptoms in diabetic patients–surveys were sent to 9,063 individuals in a population-based diabetes registry from nine primary care clinics of GHC, a large HMO in western Washington. Complete data were available for 4,385, of whom 4.4% met criteria for panic disorder, defined as answering “yes” both when asked if they'd had “spells of panic or fear” during the past 2 weeks, and when asked if these feelings “forced you to change what you were doing at the time.”

Respondents who answered yes to both questions were significantly more likely to be female than were those who reported no panic symptoms (63.7% vs. 48.1%), to be employed (53.3% vs. 41.9%), and to also have a diagnosis of major depression (54.9% vs. 10.0%); they were also significantly younger (55.4 years vs. 63.7 years). Overall, 2.0% of the patients had panic but no major depression, 2.4% had both panic and major depression, and 9.5% had major depression without panic symptoms, Dr. Ludman and her associates reported.

Independent of depression, symptoms of panic were associated with higher hemoglobin A_1c values, a greater number of diabetes complications, higher levels of disability (using World Health Organization criteria), and lower social functioning. Unlike depression, panic was not associated with smoking or body mass index.

“Treatment for panic episodes is likely to positively impact diabetes symptoms, self-care, and quality of life among patients with diabetes,” Dr. Ludman said.

VANCOUVER, B.C. – Panic symptoms affect many patients with diabetes and are linked to depression and diabetes-related disability, Evette Ludman, Ph.D., and her associates reported in a poster presentation at the annual meeting of the American Psychosomatic Society.

Like other forms of anxiety, panic symptoms in diabetic patients are often associated with depression as well as poor diabetes-related functional and clinical indicators.

“Clinicians treating diabetic patients should be alert for panic symptoms as well as depressive symptoms. Panic episodes may be mistaken for hypoglycemia,” said Dr. Ludman, senior research associate at the Center for Health Studies, Group Health Cooperative (GHC), Seattle.

In a National Institute of Mental Health-supported study–the first to look specifically at panic symptoms in diabetic patients–surveys were sent to 9,063 individuals in a population-based diabetes registry from nine primary care clinics of GHC, a large HMO in western Washington. Complete data were available for 4,385, of whom 4.4% met criteria for panic disorder, defined as answering “yes” both when asked if they'd had “spells of panic or fear” during the past 2 weeks, and when asked if these feelings “forced you to change what you were doing at the time.”

Respondents who answered yes to both questions were significantly more likely to be female than were those who reported no panic symptoms (63.7% vs. 48.1%), to be employed (53.3% vs. 41.9%), and to also have a diagnosis of major depression (54.9% vs. 10.0%); they were also significantly younger (55.4 years vs. 63.7 years). Overall, 2.0% of the patients had panic but no major depression, 2.4% had both panic and major depression, and 9.5% had major depression without panic symptoms, Dr. Ludman and her associates reported.

Independent of depression, symptoms of panic were associated with higher hemoglobin A_1c values, a greater number of diabetes complications, higher levels of disability (using World Health Organization criteria), and lower social functioning. Unlike depression, panic was not associated with smoking or body mass index.

“Treatment for panic episodes is likely to positively impact diabetes symptoms, self-care, and quality of life among patients with diabetes,” Dr. Ludman said.

VANCOUVER, B.C. – Panic symptoms affect many patients with diabetes and are linked to depression and diabetes-related disability, Evette Ludman, Ph.D., and her associates reported in a poster presentation at the annual meeting of the American Psychosomatic Society.

Like other forms of anxiety, panic symptoms in diabetic patients are often associated with depression as well as poor diabetes-related functional and clinical indicators.

“Clinicians treating diabetic patients should be alert for panic symptoms as well as depressive symptoms. Panic episodes may be mistaken for hypoglycemia,” said Dr. Ludman, senior research associate at the Center for Health Studies, Group Health Cooperative (GHC), Seattle.

In a National Institute of Mental Health-supported study–the first to look specifically at panic symptoms in diabetic patients–surveys were sent to 9,063 individuals in a population-based diabetes registry from nine primary care clinics of GHC, a large HMO in western Washington. Complete data were available for 4,385, of whom 4.4% met criteria for panic disorder, defined as answering “yes” both when asked if they'd had “spells of panic or fear” during the past 2 weeks, and when asked if these feelings “forced you to change what you were doing at the time.”

Respondents who answered yes to both questions were significantly more likely to be female than were those who reported no panic symptoms (63.7% vs. 48.1%), to be employed (53.3% vs. 41.9%), and to also have a diagnosis of major depression (54.9% vs. 10.0%); they were also significantly younger (55.4 years vs. 63.7 years). Overall, 2.0% of the patients had panic but no major depression, 2.4% had both panic and major depression, and 9.5% had major depression without panic symptoms, Dr. Ludman and her associates reported.

Independent of depression, symptoms of panic were associated with higher hemoglobin A_1c values, a greater number of diabetes complications, higher levels of disability (using World Health Organization criteria), and lower social functioning. Unlike depression, panic was not associated with smoking or body mass index.

“Treatment for panic episodes is likely to positively impact diabetes symptoms, self-care, and quality of life among patients with diabetes,” Dr. Ludman said.

VANCOUVER, B.C. – Psychiatric disorders are common among people taking opioid medications, Mark D. Sullivan, M.D., reported at the annual meeting of the American Psychosomatic Society.

Data from the first population-based investigation of psychiatric comorbidity among patients receiving regularly prescribed opioid medication suggest that common depressive or anxiety disorders may pose a greater clinical problem among candidates for chronic opioid therapy than does substance abuse, said Dr. Sullivan of the department of psychiatry at the University of Washington, Seattle.

Moreover, the findings also point to unmet needs for mental health care among patients routinely receiving prescribed opioids. “We need to carefully assess and treat mood and anxiety disorders in patients who are candidates for chronic opioid therapy,” Dr. Sullivan said.

Among 9,279 respondents to a nationwide telephone survey conducted in 1997–1998, 2.7% (252) reported regular use of prescribed opioids “at least several times a week for a month or more.” All respondents were assessed for common psychiatric disorders with the World Health Organization's Composite International Diagnostic Interview (CIDI) and for substance abuse via an adaptation of the CIDI for drugs and Alcohol Use Disorders Identification Test (AUDIT) for alcohol.

Common psychiatric disorders were present in 45% of the opioid users, compared with just 12% of the nonusers. Most common was major depressive disorder, in 29% vs. 9%, followed by panic disorder, in 18% vs. 3%.

Problem drug use was also more common among the regular opioid users (7% vs. 2%), but the proportions reporting problem drinking did not differ (7% vs. 6.5%), Dr. Sullivan reported.

Prior to adjustment for various demographic factors, patients with a mood or anxiety disorder were six times more likely than those without to be regular opioid users. When looking at the effects of individual psychiatric disorders, those with panic disorder were seven times more likely to receive opioids, while patients with depression, dysthymia, or problem drug use were approximately four times more likely to receive opioids.

And even after adjusting for significant demographic and clinical predictors of regular opioid use–including age, education, income, work disability, self-rated health, and chronic back pain and headaches–patients with a common psychiatric disorder were still more than three times as likely as those without psychiatric diagnoses to receive regular opioids, Dr. Sullivan said.

VANCOUVER, B.C. – Psychiatric disorders are common among people taking opioid medications, Mark D. Sullivan, M.D., reported at the annual meeting of the American Psychosomatic Society.

Data from the first population-based investigation of psychiatric comorbidity among patients receiving regularly prescribed opioid medication suggest that common depressive or anxiety disorders may pose a greater clinical problem among candidates for chronic opioid therapy than does substance abuse, said Dr. Sullivan of the department of psychiatry at the University of Washington, Seattle.

Moreover, the findings also point to unmet needs for mental health care among patients routinely receiving prescribed opioids. “We need to carefully assess and treat mood and anxiety disorders in patients who are candidates for chronic opioid therapy,” Dr. Sullivan said.

Among 9,279 respondents to a nationwide telephone survey conducted in 1997–1998, 2.7% (252) reported regular use of prescribed opioids “at least several times a week for a month or more.” All respondents were assessed for common psychiatric disorders with the World Health Organization's Composite International Diagnostic Interview (CIDI) and for substance abuse via an adaptation of the CIDI for drugs and Alcohol Use Disorders Identification Test (AUDIT) for alcohol.

Common psychiatric disorders were present in 45% of the opioid users, compared with just 12% of the nonusers. Most common was major depressive disorder, in 29% vs. 9%, followed by panic disorder, in 18% vs. 3%.

Problem drug use was also more common among the regular opioid users (7% vs. 2%), but the proportions reporting problem drinking did not differ (7% vs. 6.5%), Dr. Sullivan reported.

Prior to adjustment for various demographic factors, patients with a mood or anxiety disorder were six times more likely than those without to be regular opioid users. When looking at the effects of individual psychiatric disorders, those with panic disorder were seven times more likely to receive opioids, while patients with depression, dysthymia, or problem drug use were approximately four times more likely to receive opioids.

And even after adjusting for significant demographic and clinical predictors of regular opioid use–including age, education, income, work disability, self-rated health, and chronic back pain and headaches–patients with a common psychiatric disorder were still more than three times as likely as those without psychiatric diagnoses to receive regular opioids, Dr. Sullivan said.

VANCOUVER, B.C. – Psychiatric disorders are common among people taking opioid medications, Mark D. Sullivan, M.D., reported at the annual meeting of the American Psychosomatic Society.

Data from the first population-based investigation of psychiatric comorbidity among patients receiving regularly prescribed opioid medication suggest that common depressive or anxiety disorders may pose a greater clinical problem among candidates for chronic opioid therapy than does substance abuse, said Dr. Sullivan of the department of psychiatry at the University of Washington, Seattle.

Moreover, the findings also point to unmet needs for mental health care among patients routinely receiving prescribed opioids. “We need to carefully assess and treat mood and anxiety disorders in patients who are candidates for chronic opioid therapy,” Dr. Sullivan said.

Among 9,279 respondents to a nationwide telephone survey conducted in 1997–1998, 2.7% (252) reported regular use of prescribed opioids “at least several times a week for a month or more.” All respondents were assessed for common psychiatric disorders with the World Health Organization's Composite International Diagnostic Interview (CIDI) and for substance abuse via an adaptation of the CIDI for drugs and Alcohol Use Disorders Identification Test (AUDIT) for alcohol.

Common psychiatric disorders were present in 45% of the opioid users, compared with just 12% of the nonusers. Most common was major depressive disorder, in 29% vs. 9%, followed by panic disorder, in 18% vs. 3%.

Problem drug use was also more common among the regular opioid users (7% vs. 2%), but the proportions reporting problem drinking did not differ (7% vs. 6.5%), Dr. Sullivan reported.

Prior to adjustment for various demographic factors, patients with a mood or anxiety disorder were six times more likely than those without to be regular opioid users. When looking at the effects of individual psychiatric disorders, those with panic disorder were seven times more likely to receive opioids, while patients with depression, dysthymia, or problem drug use were approximately four times more likely to receive opioids.

And even after adjusting for significant demographic and clinical predictors of regular opioid use–including age, education, income, work disability, self-rated health, and chronic back pain and headaches–patients with a common psychiatric disorder were still more than three times as likely as those without psychiatric diagnoses to receive regular opioids, Dr. Sullivan said.

VANCOUVER, B.C. — Transcendental meditation may improve vascular function in African American teenagers with high-normal blood pressure, Vernon A. Barnes, Ph.D., said at the annual meeting of the American Psychosomatic Society.

Transcendental meditation (TM), a process by which “the mind is allowed to settle down to a state of least mental activity,” has been shown to decrease sympathetic nervous system tone, hypothalamic-pituitary-adrenocortical axis activation, and cortisol levels, which are associated with reductions in blood pressure.

In a study by Dr. Barnes and his associates at the Medical College of Georgia, Augusta, systolic and diastolic blood pressures were significantly reduced in 50 African American adolescents with high-normal blood pressures who practiced TM twice a day for 4 months (Am. J. Hypertens. 2004;17:366–9).

In that study, 57 African American adolescents (mean age 16.2 years) were randomized to practicing TM for 15 minutes, twice a day for 4 months. One session was held in school during homeroom, the other was practiced at home. Another 54 teens received 15-minute didactic health education sessions about weight management, healthy diet, and physical activity each day at school, and also were assigned to walk 15 minutes a day.

At-home compliance with the meditation—in which “the ordinary thinking process becomes quiescent and a distinctive wakeful but deeply restful state” is achieved—was 76%, including weekends and holidays, Dr. Barnes told this newspaper.

Echocardiographic-derived measures of the subjects' endothelium-dependent vasodilation to reactive hyperemia (EDAD)—a functional measure of vascular remodeling that is inversely correlated with cardiac structure and function—were collected before and after the interventions, and again at 4 months' follow-up.

The procedure involved scanning the subjects' right brachial artery prior to and for 2 minutes following 4 minutes of hyperemia, which was induced by inflating the cuff to 200 mm Hg. EDAD was calculated as the percentage change from baseline diameter to maximum post-cuff release diameter. The sonographer was blinded to which group the subject was in, Dr. Barnes said.

From pre- to 4 months post intervention, EDAD in the TM group increased by 21%, from 12.4% to 15%, compared with a 4% decrease of 12.3% to 11.8% in the health education group.

“If this improvement is replicated among other at-risk groups and in cohorts of cardiovascular disease patients, this will have important implications for inclusion of TM in the efforts to prevent and treat CVD and its clinical consequences,” he said.

Other benefits were seen as well. Anecdotes related by the students corroborated school records documenting improved behavior related to school, fewer rule violations, and fewer days suspended. Students also reported improvements in sleep, athletic and school performance, and personal relationships, Dr. Barnes said.

This study, which was funded by the National Heart, Lung, and Blood Institute, was singled out by the psychosomatic society as among those “having the highest potential to change clinical practice.”

VANCOUVER, B.C. — Transcendental meditation may improve vascular function in African American teenagers with high-normal blood pressure, Vernon A. Barnes, Ph.D., said at the annual meeting of the American Psychosomatic Society.

Transcendental meditation (TM), a process by which “the mind is allowed to settle down to a state of least mental activity,” has been shown to decrease sympathetic nervous system tone, hypothalamic-pituitary-adrenocortical axis activation, and cortisol levels, which are associated with reductions in blood pressure.

In a study by Dr. Barnes and his associates at the Medical College of Georgia, Augusta, systolic and diastolic blood pressures were significantly reduced in 50 African American adolescents with high-normal blood pressures who practiced TM twice a day for 4 months (Am. J. Hypertens. 2004;17:366–9).

In that study, 57 African American adolescents (mean age 16.2 years) were randomized to practicing TM for 15 minutes, twice a day for 4 months. One session was held in school during homeroom, the other was practiced at home. Another 54 teens received 15-minute didactic health education sessions about weight management, healthy diet, and physical activity each day at school, and also were assigned to walk 15 minutes a day.

At-home compliance with the meditation—in which “the ordinary thinking process becomes quiescent and a distinctive wakeful but deeply restful state” is achieved—was 76%, including weekends and holidays, Dr. Barnes told this newspaper.

Echocardiographic-derived measures of the subjects' endothelium-dependent vasodilation to reactive hyperemia (EDAD)—a functional measure of vascular remodeling that is inversely correlated with cardiac structure and function—were collected before and after the interventions, and again at 4 months' follow-up.

The procedure involved scanning the subjects' right brachial artery prior to and for 2 minutes following 4 minutes of hyperemia, which was induced by inflating the cuff to 200 mm Hg. EDAD was calculated as the percentage change from baseline diameter to maximum post-cuff release diameter. The sonographer was blinded to which group the subject was in, Dr. Barnes said.

From pre- to 4 months post intervention, EDAD in the TM group increased by 21%, from 12.4% to 15%, compared with a 4% decrease of 12.3% to 11.8% in the health education group.

“If this improvement is replicated among other at-risk groups and in cohorts of cardiovascular disease patients, this will have important implications for inclusion of TM in the efforts to prevent and treat CVD and its clinical consequences,” he said.

Other benefits were seen as well. Anecdotes related by the students corroborated school records documenting improved behavior related to school, fewer rule violations, and fewer days suspended. Students also reported improvements in sleep, athletic and school performance, and personal relationships, Dr. Barnes said.

This study, which was funded by the National Heart, Lung, and Blood Institute, was singled out by the psychosomatic society as among those “having the highest potential to change clinical practice.”

VANCOUVER, B.C. — Transcendental meditation may improve vascular function in African American teenagers with high-normal blood pressure, Vernon A. Barnes, Ph.D., said at the annual meeting of the American Psychosomatic Society.

Transcendental meditation (TM), a process by which “the mind is allowed to settle down to a state of least mental activity,” has been shown to decrease sympathetic nervous system tone, hypothalamic-pituitary-adrenocortical axis activation, and cortisol levels, which are associated with reductions in blood pressure.

In a study by Dr. Barnes and his associates at the Medical College of Georgia, Augusta, systolic and diastolic blood pressures were significantly reduced in 50 African American adolescents with high-normal blood pressures who practiced TM twice a day for 4 months (Am. J. Hypertens. 2004;17:366–9).

In that study, 57 African American adolescents (mean age 16.2 years) were randomized to practicing TM for 15 minutes, twice a day for 4 months. One session was held in school during homeroom, the other was practiced at home. Another 54 teens received 15-minute didactic health education sessions about weight management, healthy diet, and physical activity each day at school, and also were assigned to walk 15 minutes a day.

At-home compliance with the meditation—in which “the ordinary thinking process becomes quiescent and a distinctive wakeful but deeply restful state” is achieved—was 76%, including weekends and holidays, Dr. Barnes told this newspaper.

Echocardiographic-derived measures of the subjects' endothelium-dependent vasodilation to reactive hyperemia (EDAD)—a functional measure of vascular remodeling that is inversely correlated with cardiac structure and function—were collected before and after the interventions, and again at 4 months' follow-up.

The procedure involved scanning the subjects' right brachial artery prior to and for 2 minutes following 4 minutes of hyperemia, which was induced by inflating the cuff to 200 mm Hg. EDAD was calculated as the percentage change from baseline diameter to maximum post-cuff release diameter. The sonographer was blinded to which group the subject was in, Dr. Barnes said.

From pre- to 4 months post intervention, EDAD in the TM group increased by 21%, from 12.4% to 15%, compared with a 4% decrease of 12.3% to 11.8% in the health education group.

“If this improvement is replicated among other at-risk groups and in cohorts of cardiovascular disease patients, this will have important implications for inclusion of TM in the efforts to prevent and treat CVD and its clinical consequences,” he said.

Other benefits were seen as well. Anecdotes related by the students corroborated school records documenting improved behavior related to school, fewer rule violations, and fewer days suspended. Students also reported improvements in sleep, athletic and school performance, and personal relationships, Dr. Barnes said.

This study, which was funded by the National Heart, Lung, and Blood Institute, was singled out by the psychosomatic society as among those “having the highest potential to change clinical practice.”