Patrice Wendling

TUCSON, ARIZ. — Home blood pressure monitoring may have a role in changing diet and exercise habits in adults with type 2 diabetes mellitus, according to results from a small analysis presented at the annual meeting of the North American Primary Care Research Group.

Daily blood pressure monitoring was considered helpful in increasing awareness of blood pressure (BP) and making lifestyle changes in 21 of 24 patients. Overall, 77% of the patients reported making changes in their diet, and 50% exercised more as a result of daily blood pressure monitoring. Of the total, 54% of patients reported that their health status was “much better” or “somewhat better” after 6 months of home monitoring, reported Dr. Lauren DeAlleaume and colleagues at the University of Colorado Health Sciences Center, in Denver.

At baseline, 17 patients (71%) had hypertension, 4 (17%) had a history of myocardial infarction, 2 (8%) had suffered transient ischemic attacks, and 19 (79%) had increased cholesterol, 13 of whom were on cholesterol-lowering medication.

The self-reported finding of improved health status was unexpected, given that the average age was 62 years in patients with diabetes and other health problems, Dr. DeAlleaume noted in an interview. “We think it's a matter of empowerment, but there need to be more studies.”

When asked, 92% of patients said they felt they could make lifestyle changes to control their blood pressure. However, 21% reported that checking their blood pressure makes them feel anxious and that day-to-day BP variations worried them.

“Variations are not uncommon in practice, but patients tend to think their BP should be rock steady, whereas variability is normal and healthier,” said Dr. DeAlleaume of the department of family medicine at the university.

The analysis was part of the Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease (Freedom) trial, an ongoing trial examining cardiovascular risk factors in 34 patients with type 2 diabetes. Of these patients, 75% are female, 64% white, 32% Hispanic, and 71% have prescription coverage.

Overall, 24 patients agreed to monitor their BP daily with an automatic wrist cuff validated by the German Hypertension Society and to report their readings monthly via phone, mail, or the Internet. Feedback was provided to both the patients and their physicians. The target BP was a goal of less than 125 mm Hg/75 mm Hg.

The patients submitted an average of six reports; the average interval between reports was 40 days; and the preferred method of reporting was by mail.

There is evidence to suggest that home BP monitoring correlates better with ambulatory BP monitoring and target-organ damage than does office BP monitoring. Although the data are consistent, the number of studies is limited, Dr. DeAlleaume said.

“The reason everyone hasn't jumped on this bandwagon is that there aren't any major [home] blood pressure studies, but I think home monitoring is going to be the wave of the future,” she said.

TUCSON, ARIZ. — Home blood pressure monitoring may have a role in changing diet and exercise habits in adults with type 2 diabetes mellitus, according to results from a small analysis presented at the annual meeting of the North American Primary Care Research Group.

Daily blood pressure monitoring was considered helpful in increasing awareness of blood pressure (BP) and making lifestyle changes in 21 of 24 patients. Overall, 77% of the patients reported making changes in their diet, and 50% exercised more as a result of daily blood pressure monitoring. Of the total, 54% of patients reported that their health status was “much better” or “somewhat better” after 6 months of home monitoring, reported Dr. Lauren DeAlleaume and colleagues at the University of Colorado Health Sciences Center, in Denver.

At baseline, 17 patients (71%) had hypertension, 4 (17%) had a history of myocardial infarction, 2 (8%) had suffered transient ischemic attacks, and 19 (79%) had increased cholesterol, 13 of whom were on cholesterol-lowering medication.

The self-reported finding of improved health status was unexpected, given that the average age was 62 years in patients with diabetes and other health problems, Dr. DeAlleaume noted in an interview. “We think it's a matter of empowerment, but there need to be more studies.”

When asked, 92% of patients said they felt they could make lifestyle changes to control their blood pressure. However, 21% reported that checking their blood pressure makes them feel anxious and that day-to-day BP variations worried them.

“Variations are not uncommon in practice, but patients tend to think their BP should be rock steady, whereas variability is normal and healthier,” said Dr. DeAlleaume of the department of family medicine at the university.

The analysis was part of the Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease (Freedom) trial, an ongoing trial examining cardiovascular risk factors in 34 patients with type 2 diabetes. Of these patients, 75% are female, 64% white, 32% Hispanic, and 71% have prescription coverage.

Overall, 24 patients agreed to monitor their BP daily with an automatic wrist cuff validated by the German Hypertension Society and to report their readings monthly via phone, mail, or the Internet. Feedback was provided to both the patients and their physicians. The target BP was a goal of less than 125 mm Hg/75 mm Hg.

The patients submitted an average of six reports; the average interval between reports was 40 days; and the preferred method of reporting was by mail.

There is evidence to suggest that home BP monitoring correlates better with ambulatory BP monitoring and target-organ damage than does office BP monitoring. Although the data are consistent, the number of studies is limited, Dr. DeAlleaume said.

“The reason everyone hasn't jumped on this bandwagon is that there aren't any major [home] blood pressure studies, but I think home monitoring is going to be the wave of the future,” she said.

TUCSON, ARIZ. — Home blood pressure monitoring may have a role in changing diet and exercise habits in adults with type 2 diabetes mellitus, according to results from a small analysis presented at the annual meeting of the North American Primary Care Research Group.

Daily blood pressure monitoring was considered helpful in increasing awareness of blood pressure (BP) and making lifestyle changes in 21 of 24 patients. Overall, 77% of the patients reported making changes in their diet, and 50% exercised more as a result of daily blood pressure monitoring. Of the total, 54% of patients reported that their health status was “much better” or “somewhat better” after 6 months of home monitoring, reported Dr. Lauren DeAlleaume and colleagues at the University of Colorado Health Sciences Center, in Denver.

At baseline, 17 patients (71%) had hypertension, 4 (17%) had a history of myocardial infarction, 2 (8%) had suffered transient ischemic attacks, and 19 (79%) had increased cholesterol, 13 of whom were on cholesterol-lowering medication.

The self-reported finding of improved health status was unexpected, given that the average age was 62 years in patients with diabetes and other health problems, Dr. DeAlleaume noted in an interview. “We think it's a matter of empowerment, but there need to be more studies.”

When asked, 92% of patients said they felt they could make lifestyle changes to control their blood pressure. However, 21% reported that checking their blood pressure makes them feel anxious and that day-to-day BP variations worried them.

“Variations are not uncommon in practice, but patients tend to think their BP should be rock steady, whereas variability is normal and healthier,” said Dr. DeAlleaume of the department of family medicine at the university.

The analysis was part of the Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease (Freedom) trial, an ongoing trial examining cardiovascular risk factors in 34 patients with type 2 diabetes. Of these patients, 75% are female, 64% white, 32% Hispanic, and 71% have prescription coverage.

Overall, 24 patients agreed to monitor their BP daily with an automatic wrist cuff validated by the German Hypertension Society and to report their readings monthly via phone, mail, or the Internet. Feedback was provided to both the patients and their physicians. The target BP was a goal of less than 125 mm Hg/75 mm Hg.

The patients submitted an average of six reports; the average interval between reports was 40 days; and the preferred method of reporting was by mail.

There is evidence to suggest that home BP monitoring correlates better with ambulatory BP monitoring and target-organ damage than does office BP monitoring. Although the data are consistent, the number of studies is limited, Dr. DeAlleaume said.

“The reason everyone hasn't jumped on this bandwagon is that there aren't any major [home] blood pressure studies, but I think home monitoring is going to be the wave of the future,” she said.

VERONA, ITALY — Vitamin D₃ deficiency was found to be highly prevalent in adults with type 2 diabetes and was strongly and independently associated with early signs of atherosclerosis in a study conducted in Italy.

The results add to a growing body of evidence suggesting that serum concentrations of 25-hydroxyvitamin D₃ may be inversely associated with cardiovascular disease, as well as with some cancers and metabolic syndrome.

Further follow-up and interventional studies are needed to determine whether hypovitaminosis D₃ predicts the development of atherosclerosis in people with type 2 diabetes, and whether vitamin D₃ supplementation would be protective against atherosclerosis, Dr. Giovanni Targher and colleagues reported in a poster presentation at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Using a chemiluminescence immunoassay, the investigators compared winter serum levels of 25-hydroxyvitamin D (25[OH]D₃) in 390 consecutive patients with type 2 diabetes and 390 nondiabetic age- and gender-matched controls. Hypovitaminosis D₃ was defined as a 25(OH)D₃ level of 37.5 nmol/L or lower. Common carotid intimal medial thickening was measured using ultrasonography only in patients with diabetes by a single operator who was blinded to patient details.

Significantly more patients with diabetes had hypovitaminosis D₃, compared with controls (33.3% vs. 16.4%, respectively), reported the authors, who are with the division of internal medicine, Sacro Cuore Hospital of Negrar (Italy). In addition, the 130 patients with diabetes and hypovitaminosis D₃ had a significant increase in carotid intimal medial thickening, compared with the 260 vitamin D-sufficient diabetics (1.10 mm vs. 0.87 mm, respectively).

Compared with their vitamin D-sufficient counterparts, the diabetic patients with hypovitaminosis D₃ were also slightly older (59 years vs. 57 years) and had significantly higher hemoglobin A_1c (7.5% vs. 7.2%), fibrinogen (4.7 g/L vs. 4.3 g/L), and high-sensitivity C-reactive protein (5.0 mg/L vs. 4.3 mg/L) concentrations.

VERONA, ITALY — Vitamin D₃ deficiency was found to be highly prevalent in adults with type 2 diabetes and was strongly and independently associated with early signs of atherosclerosis in a study conducted in Italy.

The results add to a growing body of evidence suggesting that serum concentrations of 25-hydroxyvitamin D₃ may be inversely associated with cardiovascular disease, as well as with some cancers and metabolic syndrome.

Further follow-up and interventional studies are needed to determine whether hypovitaminosis D₃ predicts the development of atherosclerosis in people with type 2 diabetes, and whether vitamin D₃ supplementation would be protective against atherosclerosis, Dr. Giovanni Targher and colleagues reported in a poster presentation at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Using a chemiluminescence immunoassay, the investigators compared winter serum levels of 25-hydroxyvitamin D (25[OH]D₃) in 390 consecutive patients with type 2 diabetes and 390 nondiabetic age- and gender-matched controls. Hypovitaminosis D₃ was defined as a 25(OH)D₃ level of 37.5 nmol/L or lower. Common carotid intimal medial thickening was measured using ultrasonography only in patients with diabetes by a single operator who was blinded to patient details.

Significantly more patients with diabetes had hypovitaminosis D₃, compared with controls (33.3% vs. 16.4%, respectively), reported the authors, who are with the division of internal medicine, Sacro Cuore Hospital of Negrar (Italy). In addition, the 130 patients with diabetes and hypovitaminosis D₃ had a significant increase in carotid intimal medial thickening, compared with the 260 vitamin D-sufficient diabetics (1.10 mm vs. 0.87 mm, respectively).

Compared with their vitamin D-sufficient counterparts, the diabetic patients with hypovitaminosis D₃ were also slightly older (59 years vs. 57 years) and had significantly higher hemoglobin A_1c (7.5% vs. 7.2%), fibrinogen (4.7 g/L vs. 4.3 g/L), and high-sensitivity C-reactive protein (5.0 mg/L vs. 4.3 mg/L) concentrations.

VERONA, ITALY — Vitamin D₃ deficiency was found to be highly prevalent in adults with type 2 diabetes and was strongly and independently associated with early signs of atherosclerosis in a study conducted in Italy.

The results add to a growing body of evidence suggesting that serum concentrations of 25-hydroxyvitamin D₃ may be inversely associated with cardiovascular disease, as well as with some cancers and metabolic syndrome.

Further follow-up and interventional studies are needed to determine whether hypovitaminosis D₃ predicts the development of atherosclerosis in people with type 2 diabetes, and whether vitamin D₃ supplementation would be protective against atherosclerosis, Dr. Giovanni Targher and colleagues reported in a poster presentation at a joint meeting of the Italian Association of Clinical Endocrinologists and the American Association of Clinical Endocrinologists.

Using a chemiluminescence immunoassay, the investigators compared winter serum levels of 25-hydroxyvitamin D (25[OH]D₃) in 390 consecutive patients with type 2 diabetes and 390 nondiabetic age- and gender-matched controls. Hypovitaminosis D₃ was defined as a 25(OH)D₃ level of 37.5 nmol/L or lower. Common carotid intimal medial thickening was measured using ultrasonography only in patients with diabetes by a single operator who was blinded to patient details.

Significantly more patients with diabetes had hypovitaminosis D₃, compared with controls (33.3% vs. 16.4%, respectively), reported the authors, who are with the division of internal medicine, Sacro Cuore Hospital of Negrar (Italy). In addition, the 130 patients with diabetes and hypovitaminosis D₃ had a significant increase in carotid intimal medial thickening, compared with the 260 vitamin D-sufficient diabetics (1.10 mm vs. 0.87 mm, respectively).

Compared with their vitamin D-sufficient counterparts, the diabetic patients with hypovitaminosis D₃ were also slightly older (59 years vs. 57 years) and had significantly higher hemoglobin A_1c (7.5% vs. 7.2%), fibrinogen (4.7 g/L vs. 4.3 g/L), and high-sensitivity C-reactive protein (5.0 mg/L vs. 4.3 mg/L) concentrations.

MONTREAL — Adenosine stress testing with supplemental arm pumping exercise had the same diagnostic accuracy as exercise stress testing in detecting coronary artery disease in a study of 302 patients.

The results validate a long-standing practice at Massachusetts General Hospital, Boston, where supplemental arm exercise with light weights—not arm exercise with squeeze balls and not a treadmill walk—has been used for a decade to prevent adenosine-related side effects during myocardial perfusion imaging.

Arm-pumping exercise is utilized in all patients who are unable to safely negotiate a treadmill, which includes many inpatients as well as elderly and arthritic patients and those with increased risk of falling because of seizure or balance disorders, Dr. Arash Kardan, of the hospital, said in an interview at the annual meeting of the American Society of Nuclear Cardiology. Though not well studied or understood, supplemental exercise is thought to mitigate adenosine-related bradycardia and hypotension via a neurocirculatory response, he said.

The study was presented in a poster at the meeting, and included 302 patients referred for clinically indicated rest-stress myocardial perfusion imaging (MPI) with technetium 99m sestamibi. Patients underwent either exercise stress testing using the standard Bruce protocol achieving 85% of maximum predicted heart rate, or received an adenosine infusion of 0.14 mg/kg per minute for 4–5 minutes in one arm and pumped a 2.5-pound weight with their opposite arm.

All of the patients underwent coronary angiography within 2 months of MPI. Positive MPI was defined as demonstrating a reversible defect, whereas positive angiography was defined as the presence of any lesion with greater than 50% stenosis. Patients with a history of myocardial infarction or coronary bypass surgery were included for analysis. Overall, one-third of the patients had previously reported coronary artery disease.

There were 158 patients in the exercise stress group, with a mean age of 63 years. The sensitivity was 91% and specificity 100%. There were 144 patients in the arm exercise group, with a mean age of 68 years. Sensitivity was 84% and specificity 81%; the differences from the exercise stress group were nonsignificant. No adenosine arm tests required termination because of side effects. All exercise treadmill tests were completed as well, he said.

MONTREAL — Adenosine stress testing with supplemental arm pumping exercise had the same diagnostic accuracy as exercise stress testing in detecting coronary artery disease in a study of 302 patients.

The results validate a long-standing practice at Massachusetts General Hospital, Boston, where supplemental arm exercise with light weights—not arm exercise with squeeze balls and not a treadmill walk—has been used for a decade to prevent adenosine-related side effects during myocardial perfusion imaging.

Arm-pumping exercise is utilized in all patients who are unable to safely negotiate a treadmill, which includes many inpatients as well as elderly and arthritic patients and those with increased risk of falling because of seizure or balance disorders, Dr. Arash Kardan, of the hospital, said in an interview at the annual meeting of the American Society of Nuclear Cardiology. Though not well studied or understood, supplemental exercise is thought to mitigate adenosine-related bradycardia and hypotension via a neurocirculatory response, he said.

The study was presented in a poster at the meeting, and included 302 patients referred for clinically indicated rest-stress myocardial perfusion imaging (MPI) with technetium 99m sestamibi. Patients underwent either exercise stress testing using the standard Bruce protocol achieving 85% of maximum predicted heart rate, or received an adenosine infusion of 0.14 mg/kg per minute for 4–5 minutes in one arm and pumped a 2.5-pound weight with their opposite arm.

All of the patients underwent coronary angiography within 2 months of MPI. Positive MPI was defined as demonstrating a reversible defect, whereas positive angiography was defined as the presence of any lesion with greater than 50% stenosis. Patients with a history of myocardial infarction or coronary bypass surgery were included for analysis. Overall, one-third of the patients had previously reported coronary artery disease.

There were 158 patients in the exercise stress group, with a mean age of 63 years. The sensitivity was 91% and specificity 100%. There were 144 patients in the arm exercise group, with a mean age of 68 years. Sensitivity was 84% and specificity 81%; the differences from the exercise stress group were nonsignificant. No adenosine arm tests required termination because of side effects. All exercise treadmill tests were completed as well, he said.

MONTREAL — Adenosine stress testing with supplemental arm pumping exercise had the same diagnostic accuracy as exercise stress testing in detecting coronary artery disease in a study of 302 patients.

The results validate a long-standing practice at Massachusetts General Hospital, Boston, where supplemental arm exercise with light weights—not arm exercise with squeeze balls and not a treadmill walk—has been used for a decade to prevent adenosine-related side effects during myocardial perfusion imaging.

Arm-pumping exercise is utilized in all patients who are unable to safely negotiate a treadmill, which includes many inpatients as well as elderly and arthritic patients and those with increased risk of falling because of seizure or balance disorders, Dr. Arash Kardan, of the hospital, said in an interview at the annual meeting of the American Society of Nuclear Cardiology. Though not well studied or understood, supplemental exercise is thought to mitigate adenosine-related bradycardia and hypotension via a neurocirculatory response, he said.

The study was presented in a poster at the meeting, and included 302 patients referred for clinically indicated rest-stress myocardial perfusion imaging (MPI) with technetium 99m sestamibi. Patients underwent either exercise stress testing using the standard Bruce protocol achieving 85% of maximum predicted heart rate, or received an adenosine infusion of 0.14 mg/kg per minute for 4–5 minutes in one arm and pumped a 2.5-pound weight with their opposite arm.

All of the patients underwent coronary angiography within 2 months of MPI. Positive MPI was defined as demonstrating a reversible defect, whereas positive angiography was defined as the presence of any lesion with greater than 50% stenosis. Patients with a history of myocardial infarction or coronary bypass surgery were included for analysis. Overall, one-third of the patients had previously reported coronary artery disease.

There were 158 patients in the exercise stress group, with a mean age of 63 years. The sensitivity was 91% and specificity 100%. There were 144 patients in the arm exercise group, with a mean age of 68 years. Sensitivity was 84% and specificity 81%; the differences from the exercise stress group were nonsignificant. No adenosine arm tests required termination because of side effects. All exercise treadmill tests were completed as well, he said.

TUCSON, ARIZ. – Canadian researchers have developed and validated a user-friendly six-question index that can be used in the office to elicit suspicion of elder abuse in seniors who are cognitively intact.

The goal of the Elder Abuse Suspicion Index (EASI) is not necessarily to diagnose abuse but to quantify a level of suspicion sufficient to justify referral to an appropriate community expert in elder abuse, Dr. Mark Yaffe said at the annual meeting of the North American Primary Care Research Group.

“Where we see the value of this tool is that it's easy enough to use that you can use it on repeated episodes with your patients or clients and see whether the responses you get [change],” said Dr. Yaffe, professor of family medicine at McGill University, Montreal.

Use of the index may also educate and sensitize physicians to elder abuse, which is associated with reduced survival in older adults, even after adjustment for other mortality risk factors. Prevalence rates in select developed countries vary widely, from 4% to 18%.

Dr. Yaffe and colleagues at McGill performed a literature review, categorizing items from known inventories into six themes. For each theme, they created one or two questions that were critiqued by focus groups of physicians, nurses, social workers, individual targeted seniors, and an international expert e-mail panel.

The six themes are risk; neglect; verbal, psychological, and emotional [abuse]; financial [exploitation]; physical and sexual [abuse]; and observational. To assess risk, the physician would ask the patient, “Over the last 12 months, have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?” For observational, the physician would consider the question: “Elder abuse may be associated with findings such as poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you [the physician] notice any of these today? In the last 12 months?”

The investigators approached 2,133 patients who spoke English or French, who were aged 65 years or older, and who were seeing their family physicians for any reason, of whom 906 met inclusion criteria, consented, and had EASI administered by 1 of 104 family physicians. A total of 875 patients answered at least five questions, and 663 underwent a structured 90-minute interview with trained social workers. The patients' mean age was 75 years, 76% spoke English, and 43% reported that their health was good.

Among the 663 interview patients, 105 (16%) answered “yes” to at least one of the six questions, including the risk factor question; and 13% answered “yes” to one of the five questions associated with signs and symptoms of abuse. Social workers believed that 79 patients (12%) had been abused in the previous year.

Positive responses were elicited from 110 patients (17%) for risk; 7 (1%) for neglect; 77 (12%) for verbal, psychological, or emotional abuse; 11 (2%) for financial; 14 (2%) for physical or sexual abuse; and 19 (3%) for observational.

Specificity for the index was 77%, and sensitivity, 44%, which Dr. Yaffe acknowledged was low. But this represents a first attempt to develop a suspicion index for elder abuse, he said, and it's unclear what sensitivity should be expected, because it's difficult to have accurate sensitivity and specificity data for a condition that is not well defined. Physicians' reactions to EASI were generally positive. Among 72 of the 104 physicians surveyed, 96% reported that EASI was “somewhat or very easy” to use, 68% said it took less than 2 minutes to use, and 97% said it had “some” or “a big impact” on their practice.

The World Health Organization's Aging and Life Course unit has applied EASI in Australia, Brazil, Chile, Costa Rica, Kenya, Singapore, and Switzerland, and the index has cross-cultural content validity.

TUCSON, ARIZ. – Canadian researchers have developed and validated a user-friendly six-question index that can be used in the office to elicit suspicion of elder abuse in seniors who are cognitively intact.

The goal of the Elder Abuse Suspicion Index (EASI) is not necessarily to diagnose abuse but to quantify a level of suspicion sufficient to justify referral to an appropriate community expert in elder abuse, Dr. Mark Yaffe said at the annual meeting of the North American Primary Care Research Group.

“Where we see the value of this tool is that it's easy enough to use that you can use it on repeated episodes with your patients or clients and see whether the responses you get [change],” said Dr. Yaffe, professor of family medicine at McGill University, Montreal.

Use of the index may also educate and sensitize physicians to elder abuse, which is associated with reduced survival in older adults, even after adjustment for other mortality risk factors. Prevalence rates in select developed countries vary widely, from 4% to 18%.

Dr. Yaffe and colleagues at McGill performed a literature review, categorizing items from known inventories into six themes. For each theme, they created one or two questions that were critiqued by focus groups of physicians, nurses, social workers, individual targeted seniors, and an international expert e-mail panel.

The six themes are risk; neglect; verbal, psychological, and emotional [abuse]; financial [exploitation]; physical and sexual [abuse]; and observational. To assess risk, the physician would ask the patient, “Over the last 12 months, have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?” For observational, the physician would consider the question: “Elder abuse may be associated with findings such as poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you [the physician] notice any of these today? In the last 12 months?”

The investigators approached 2,133 patients who spoke English or French, who were aged 65 years or older, and who were seeing their family physicians for any reason, of whom 906 met inclusion criteria, consented, and had EASI administered by 1 of 104 family physicians. A total of 875 patients answered at least five questions, and 663 underwent a structured 90-minute interview with trained social workers. The patients' mean age was 75 years, 76% spoke English, and 43% reported that their health was good.

Among the 663 interview patients, 105 (16%) answered “yes” to at least one of the six questions, including the risk factor question; and 13% answered “yes” to one of the five questions associated with signs and symptoms of abuse. Social workers believed that 79 patients (12%) had been abused in the previous year.

Positive responses were elicited from 110 patients (17%) for risk; 7 (1%) for neglect; 77 (12%) for verbal, psychological, or emotional abuse; 11 (2%) for financial; 14 (2%) for physical or sexual abuse; and 19 (3%) for observational.

Specificity for the index was 77%, and sensitivity, 44%, which Dr. Yaffe acknowledged was low. But this represents a first attempt to develop a suspicion index for elder abuse, he said, and it's unclear what sensitivity should be expected, because it's difficult to have accurate sensitivity and specificity data for a condition that is not well defined. Physicians' reactions to EASI were generally positive. Among 72 of the 104 physicians surveyed, 96% reported that EASI was “somewhat or very easy” to use, 68% said it took less than 2 minutes to use, and 97% said it had “some” or “a big impact” on their practice.

The World Health Organization's Aging and Life Course unit has applied EASI in Australia, Brazil, Chile, Costa Rica, Kenya, Singapore, and Switzerland, and the index has cross-cultural content validity.

TUCSON, ARIZ. – Canadian researchers have developed and validated a user-friendly six-question index that can be used in the office to elicit suspicion of elder abuse in seniors who are cognitively intact.

The goal of the Elder Abuse Suspicion Index (EASI) is not necessarily to diagnose abuse but to quantify a level of suspicion sufficient to justify referral to an appropriate community expert in elder abuse, Dr. Mark Yaffe said at the annual meeting of the North American Primary Care Research Group.

“Where we see the value of this tool is that it's easy enough to use that you can use it on repeated episodes with your patients or clients and see whether the responses you get [change],” said Dr. Yaffe, professor of family medicine at McGill University, Montreal.

Use of the index may also educate and sensitize physicians to elder abuse, which is associated with reduced survival in older adults, even after adjustment for other mortality risk factors. Prevalence rates in select developed countries vary widely, from 4% to 18%.

Dr. Yaffe and colleagues at McGill performed a literature review, categorizing items from known inventories into six themes. For each theme, they created one or two questions that were critiqued by focus groups of physicians, nurses, social workers, individual targeted seniors, and an international expert e-mail panel.

The six themes are risk; neglect; verbal, psychological, and emotional [abuse]; financial [exploitation]; physical and sexual [abuse]; and observational. To assess risk, the physician would ask the patient, “Over the last 12 months, have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?” For observational, the physician would consider the question: “Elder abuse may be associated with findings such as poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you [the physician] notice any of these today? In the last 12 months?”

The investigators approached 2,133 patients who spoke English or French, who were aged 65 years or older, and who were seeing their family physicians for any reason, of whom 906 met inclusion criteria, consented, and had EASI administered by 1 of 104 family physicians. A total of 875 patients answered at least five questions, and 663 underwent a structured 90-minute interview with trained social workers. The patients' mean age was 75 years, 76% spoke English, and 43% reported that their health was good.

Among the 663 interview patients, 105 (16%) answered “yes” to at least one of the six questions, including the risk factor question; and 13% answered “yes” to one of the five questions associated with signs and symptoms of abuse. Social workers believed that 79 patients (12%) had been abused in the previous year.

Positive responses were elicited from 110 patients (17%) for risk; 7 (1%) for neglect; 77 (12%) for verbal, psychological, or emotional abuse; 11 (2%) for financial; 14 (2%) for physical or sexual abuse; and 19 (3%) for observational.

Specificity for the index was 77%, and sensitivity, 44%, which Dr. Yaffe acknowledged was low. But this represents a first attempt to develop a suspicion index for elder abuse, he said, and it's unclear what sensitivity should be expected, because it's difficult to have accurate sensitivity and specificity data for a condition that is not well defined. Physicians' reactions to EASI were generally positive. Among 72 of the 104 physicians surveyed, 96% reported that EASI was “somewhat or very easy” to use, 68% said it took less than 2 minutes to use, and 97% said it had “some” or “a big impact” on their practice.

The World Health Organization's Aging and Life Course unit has applied EASI in Australia, Brazil, Chile, Costa Rica, Kenya, Singapore, and Switzerland, and the index has cross-cultural content validity.

WASHINGTON — Allergen-specific immunoglobulin E testing is an effective tool for accurately diagnosing atopic triggers in patients with asthma, but it is underused in the United States, Dr. Leonard Fromer said at the annual meeting of the American Academy of Family Physicians.

Only 1 in 20 (5%) asthmatics in the U.S. is tested for triggers, he added.

Primary care physicians manage the majority of patients with mild to moderate asthma. In about 70%–90% of children and 60% of adults with asthma, the disease is atopic. But too often, the emphasis is on what medications to prescribe and not on identifying allergen exposures, said Dr. Fromer, professor of family medicine at the University of California, Los Angeles.

The shortcomings of skin-prick testing do not apply to blood-based IgE testing, because the test is looking only for the presence of the IgE antibody. Newer generation IgE tests such as Phadia's ImmunoCAP system allow for accurate testing in children as young as 6 months old, he said.

Some study findings have shown IgE testing to have sensitivity and specificity similar to that of skin-prick testing (J. Allergy Clin. Immunol. 1999;103:773–9). Moreover, there is a significant degree of variability in the way skin tests are performed, interpreted, and documented (Ann. Allergy Asthma Immunol. 2006;96:19–23), Dr. Fromer said.

There are more than 300 available reagents when ordering an IgE test. The respiratory panel is most important in young children and adults because by 3 years of age, respiratory allergens start to dominate, Dr. Fromer said.

The United States is divided into 19 regions, depending on the climate and prominent triggers, and these divisions are used by reference laboratories to create region-specific respiratory panels with the most common molds, dust mites, and pollens in the area where your patient lives or works.

Testing requires 2 mL of blood for children and 4 mL for adults, with results typically available in 48 hours. Negative results can occur even when symptoms suggest an allergic response. When this occurs, one should go with the patient history, Dr. Fromer said, emphasizing the importance of clinical history in driving the diagnosis.

Evidence also suggests that knowing a patient's psychosocial situation could help primary care physicians treat patients with asthma (Intl. Prim. Care Respir. J. 2006;15:278–85).

Too often, the emphasis is on what medications to prescribe and not on identifying allergen exposures. DR. FROMER

WASHINGTON — Allergen-specific immunoglobulin E testing is an effective tool for accurately diagnosing atopic triggers in patients with asthma, but it is underused in the United States, Dr. Leonard Fromer said at the annual meeting of the American Academy of Family Physicians.

Only 1 in 20 (5%) asthmatics in the U.S. is tested for triggers, he added.

Primary care physicians manage the majority of patients with mild to moderate asthma. In about 70%–90% of children and 60% of adults with asthma, the disease is atopic. But too often, the emphasis is on what medications to prescribe and not on identifying allergen exposures, said Dr. Fromer, professor of family medicine at the University of California, Los Angeles.

The shortcomings of skin-prick testing do not apply to blood-based IgE testing, because the test is looking only for the presence of the IgE antibody. Newer generation IgE tests such as Phadia's ImmunoCAP system allow for accurate testing in children as young as 6 months old, he said.

Some study findings have shown IgE testing to have sensitivity and specificity similar to that of skin-prick testing (J. Allergy Clin. Immunol. 1999;103:773–9). Moreover, there is a significant degree of variability in the way skin tests are performed, interpreted, and documented (Ann. Allergy Asthma Immunol. 2006;96:19–23), Dr. Fromer said.

There are more than 300 available reagents when ordering an IgE test. The respiratory panel is most important in young children and adults because by 3 years of age, respiratory allergens start to dominate, Dr. Fromer said.

The United States is divided into 19 regions, depending on the climate and prominent triggers, and these divisions are used by reference laboratories to create region-specific respiratory panels with the most common molds, dust mites, and pollens in the area where your patient lives or works.

Testing requires 2 mL of blood for children and 4 mL for adults, with results typically available in 48 hours. Negative results can occur even when symptoms suggest an allergic response. When this occurs, one should go with the patient history, Dr. Fromer said, emphasizing the importance of clinical history in driving the diagnosis.

Evidence also suggests that knowing a patient's psychosocial situation could help primary care physicians treat patients with asthma (Intl. Prim. Care Respir. J. 2006;15:278–85).

Too often, the emphasis is on what medications to prescribe and not on identifying allergen exposures. DR. FROMER

WASHINGTON — Allergen-specific immunoglobulin E testing is an effective tool for accurately diagnosing atopic triggers in patients with asthma, but it is underused in the United States, Dr. Leonard Fromer said at the annual meeting of the American Academy of Family Physicians.

Only 1 in 20 (5%) asthmatics in the U.S. is tested for triggers, he added.

Primary care physicians manage the majority of patients with mild to moderate asthma. In about 70%–90% of children and 60% of adults with asthma, the disease is atopic. But too often, the emphasis is on what medications to prescribe and not on identifying allergen exposures, said Dr. Fromer, professor of family medicine at the University of California, Los Angeles.

The shortcomings of skin-prick testing do not apply to blood-based IgE testing, because the test is looking only for the presence of the IgE antibody. Newer generation IgE tests such as Phadia's ImmunoCAP system allow for accurate testing in children as young as 6 months old, he said.

Some study findings have shown IgE testing to have sensitivity and specificity similar to that of skin-prick testing (J. Allergy Clin. Immunol. 1999;103:773–9). Moreover, there is a significant degree of variability in the way skin tests are performed, interpreted, and documented (Ann. Allergy Asthma Immunol. 2006;96:19–23), Dr. Fromer said.

There are more than 300 available reagents when ordering an IgE test. The respiratory panel is most important in young children and adults because by 3 years of age, respiratory allergens start to dominate, Dr. Fromer said.

The United States is divided into 19 regions, depending on the climate and prominent triggers, and these divisions are used by reference laboratories to create region-specific respiratory panels with the most common molds, dust mites, and pollens in the area where your patient lives or works.

Testing requires 2 mL of blood for children and 4 mL for adults, with results typically available in 48 hours. Negative results can occur even when symptoms suggest an allergic response. When this occurs, one should go with the patient history, Dr. Fromer said, emphasizing the importance of clinical history in driving the diagnosis.

Evidence also suggests that knowing a patient's psychosocial situation could help primary care physicians treat patients with asthma (Intl. Prim. Care Respir. J. 2006;15:278–85).

Too often, the emphasis is on what medications to prescribe and not on identifying allergen exposures. DR. FROMER

WASHINGTON — Physicians should consider using B-type natriuretic peptide to screen for hypertrophic obstructive cardiomyopathy in patients who present for a preparticipation physical examination.

The test is cheaper than an echocardiogram and could prevent sudden cardiac death in otherwise healthy young athletes, Dr. Suraj Achar said at the annual meeting of the American Academy of Family Physicians.

B-type natriuretic peptide (BNP) is one of four known natriuretic peptides released from the ventricles during pressure or volume overload. It has been used primarily in patients with chronic heart failure to assess their risk of death or other complications.

A level of less than 100 pg/mL is considered normal; 500 pg/mL is the goal for heart failure patients at hospital discharge; and 700 pg/mL or more is indicative of decompensated congested heart failure.

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic condition that affects 1 in 500 people, most of whom are asymptomatic. In about 70% of patients, the condition goes undetected until it is pathologic.

The prognostic value of a BNP test to screen for the condition is based on heart failure data that show that BNP levels are elevated when there is a stretch on the myocardium, said Dr. Achar, a professor at the University of California, San Diego. “That's the same thing in a way that happens with HOCM: You get hypertrophy of the myocardium that we believe will show up with an elevated BNP, even if the patients are clinically asymptomatic or normal on physical exam,” he said in an interview.

Dr. Achar and the study's principal investigator, Dr. Alan Maisel, a cardiologist at the university, have screened 500 high school and college athletes for HOCM using a BNP assay as part of a preparticipation physical exam conducted by the university's sports medicine program. Of those, five patients had elevated BNP levels, with the highest being 100 pg/ml. All of the patients had negative echocardiograms and are being followed.

One of the motivations for the study was a young man who was identified with HOCM but who didn't heed the advice of his physicians and died of sudden cardiac arrest after a pick-up game of basketball.

Echocardiogram would provide a definitive diagnosis of HOCM, but it is not cost effective when used as a screening tool in all U.S. athletes, he said.

The Heart Failure Society of America's latest guidelines on the evaluation and management of heart failure suggest using echocardiogram only when heart failure is suspected but diagnosis is uncertain.

Dr. Achar also advocates using BNP to screen for hypertrophic cardiomyopathy in patients who present with exertional dizziness.

WASHINGTON — Physicians should consider using B-type natriuretic peptide to screen for hypertrophic obstructive cardiomyopathy in patients who present for a preparticipation physical examination.

The test is cheaper than an echocardiogram and could prevent sudden cardiac death in otherwise healthy young athletes, Dr. Suraj Achar said at the annual meeting of the American Academy of Family Physicians.

B-type natriuretic peptide (BNP) is one of four known natriuretic peptides released from the ventricles during pressure or volume overload. It has been used primarily in patients with chronic heart failure to assess their risk of death or other complications.

A level of less than 100 pg/mL is considered normal; 500 pg/mL is the goal for heart failure patients at hospital discharge; and 700 pg/mL or more is indicative of decompensated congested heart failure.

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic condition that affects 1 in 500 people, most of whom are asymptomatic. In about 70% of patients, the condition goes undetected until it is pathologic.

The prognostic value of a BNP test to screen for the condition is based on heart failure data that show that BNP levels are elevated when there is a stretch on the myocardium, said Dr. Achar, a professor at the University of California, San Diego. “That's the same thing in a way that happens with HOCM: You get hypertrophy of the myocardium that we believe will show up with an elevated BNP, even if the patients are clinically asymptomatic or normal on physical exam,” he said in an interview.

Dr. Achar and the study's principal investigator, Dr. Alan Maisel, a cardiologist at the university, have screened 500 high school and college athletes for HOCM using a BNP assay as part of a preparticipation physical exam conducted by the university's sports medicine program. Of those, five patients had elevated BNP levels, with the highest being 100 pg/ml. All of the patients had negative echocardiograms and are being followed.

One of the motivations for the study was a young man who was identified with HOCM but who didn't heed the advice of his physicians and died of sudden cardiac arrest after a pick-up game of basketball.

Echocardiogram would provide a definitive diagnosis of HOCM, but it is not cost effective when used as a screening tool in all U.S. athletes, he said.

The Heart Failure Society of America's latest guidelines on the evaluation and management of heart failure suggest using echocardiogram only when heart failure is suspected but diagnosis is uncertain.

Dr. Achar also advocates using BNP to screen for hypertrophic cardiomyopathy in patients who present with exertional dizziness.

WASHINGTON — Physicians should consider using B-type natriuretic peptide to screen for hypertrophic obstructive cardiomyopathy in patients who present for a preparticipation physical examination.

The test is cheaper than an echocardiogram and could prevent sudden cardiac death in otherwise healthy young athletes, Dr. Suraj Achar said at the annual meeting of the American Academy of Family Physicians.

B-type natriuretic peptide (BNP) is one of four known natriuretic peptides released from the ventricles during pressure or volume overload. It has been used primarily in patients with chronic heart failure to assess their risk of death or other complications.

A level of less than 100 pg/mL is considered normal; 500 pg/mL is the goal for heart failure patients at hospital discharge; and 700 pg/mL or more is indicative of decompensated congested heart failure.

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic condition that affects 1 in 500 people, most of whom are asymptomatic. In about 70% of patients, the condition goes undetected until it is pathologic.

The prognostic value of a BNP test to screen for the condition is based on heart failure data that show that BNP levels are elevated when there is a stretch on the myocardium, said Dr. Achar, a professor at the University of California, San Diego. “That's the same thing in a way that happens with HOCM: You get hypertrophy of the myocardium that we believe will show up with an elevated BNP, even if the patients are clinically asymptomatic or normal on physical exam,” he said in an interview.

Dr. Achar and the study's principal investigator, Dr. Alan Maisel, a cardiologist at the university, have screened 500 high school and college athletes for HOCM using a BNP assay as part of a preparticipation physical exam conducted by the university's sports medicine program. Of those, five patients had elevated BNP levels, with the highest being 100 pg/ml. All of the patients had negative echocardiograms and are being followed.

One of the motivations for the study was a young man who was identified with HOCM but who didn't heed the advice of his physicians and died of sudden cardiac arrest after a pick-up game of basketball.

Echocardiogram would provide a definitive diagnosis of HOCM, but it is not cost effective when used as a screening tool in all U.S. athletes, he said.

The Heart Failure Society of America's latest guidelines on the evaluation and management of heart failure suggest using echocardiogram only when heart failure is suspected but diagnosis is uncertain.

Dr. Achar also advocates using BNP to screen for hypertrophic cardiomyopathy in patients who present with exertional dizziness.

MONTREAL — Suboptimal glycemic control, elevated plasma osteoprotegerin, and presence of serum interleukin-6 were risk factors for progression of coronary artery calcification in a prospective study of asymptomatic patients with type 2 diabetes.

Despite having no known coronary artery disease, a significant proportion (30%) of the 398 patients followed in the study had atherosclerosis progression, Dr. Avijit Lahiri said at the annual meeting of the American Society of Nuclear Cardiology.

The study provides insight into the risk factors for progression of coronary calcification and establishes the role of combining cardiac CT for coronary artery calcium (CAC) imaging with simultaneous single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in uncomplicated, stable, asymptomatic patients with type 2 diabetes, Dr. Lahiri said.

CAC can be used to identify patients with increased atherosclerotic burden, but it does not identify obstructive coronary artery disease, explained Dr. Lahiri, director of cardiac imaging and research at Wellington Hospital in London. Therefore, there is a need to use combined MPI to detect silent ischemia. “Interestingly, these tests had a synergistic value on prognosis,” he said in an interview. “Thus, it would be cost effective to exclude those without CAC for further testing.”

The original study included 510 patients, of whom 20 went on to have cardiac events, and 402 were willing to participate in the current follow-up study. Four scans were technically inadequate, resulting in a cohort of 398 patients. Their mean age was 53 years; 61% were male; and their average serum glycosylated hemoglobin (HbA_1c) was 8%.

All patients underwent CAC imaging, as well as a clinical evaluation—at baseline and about 2.5 years later—that measured HbA_1c; serum interleukin-6 and C-reactive protein; and plasma osteoprotegerin. Those with a CAC score of more than 100 Agatston units at baseline also underwent MPI using a 2-day stress-rest protocol with technetium-99m sestamibi and dipyridamole and maximum treadmill exercise. Progression/regression of coronary calcification was defined as a change in the square root-transformed volumetric CAC score of 2.5 mm

At baseline, 211 (53%) of the 398 patients had coronary artery calcification. At follow-up, atherosclerosis progression was observed in 118 (30%) patients, including 22 (5.5%) who had no calcification at baseline, Dr. Lahiri said. Regression was noted in 3 (0.8%), and there was no change in 277 (70%).

At baseline, 24 patients had an abnormal perfusion scan. Progression of ischemia was seen in 14 patients, regression in 8, and no change in 2.

In a univariate analysis, age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. There was no significant association between calcium scores and serum levels of C-reactive protein or IL-6. Surprisingly, statin use was a negative predictor, Dr. Lahiri said.

In a multivariate logistic regression model, serum HbA_1c was one of the most important factors influencing progression. Poor glycemic control raised the risk of progression 10.5-fold, whereas the risk increased 2.5-fold for elevated plasma osteoprotegerin and 2.1-fold for IL-6.

SPECT images show progression of atherosclerosis in the right coronary and left circumflex arteries (arrows) of a patient with diabetes over a period of 1.7 years. Photos courtesy Dr. Avijit Lahiri

The tests were synergistic on prognosis. It would be cost effective to exclude those without CAC for further testing. DR. LAHIRI

MONTREAL — Suboptimal glycemic control, elevated plasma osteoprotegerin, and presence of serum interleukin-6 were risk factors for progression of coronary artery calcification in a prospective study of asymptomatic patients with type 2 diabetes.

Despite having no known coronary artery disease, a significant proportion (30%) of the 398 patients followed in the study had atherosclerosis progression, Dr. Avijit Lahiri said at the annual meeting of the American Society of Nuclear Cardiology.

The study provides insight into the risk factors for progression of coronary calcification and establishes the role of combining cardiac CT for coronary artery calcium (CAC) imaging with simultaneous single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in uncomplicated, stable, asymptomatic patients with type 2 diabetes, Dr. Lahiri said.

CAC can be used to identify patients with increased atherosclerotic burden, but it does not identify obstructive coronary artery disease, explained Dr. Lahiri, director of cardiac imaging and research at Wellington Hospital in London. Therefore, there is a need to use combined MPI to detect silent ischemia. “Interestingly, these tests had a synergistic value on prognosis,” he said in an interview. “Thus, it would be cost effective to exclude those without CAC for further testing.”

The original study included 510 patients, of whom 20 went on to have cardiac events, and 402 were willing to participate in the current follow-up study. Four scans were technically inadequate, resulting in a cohort of 398 patients. Their mean age was 53 years; 61% were male; and their average serum glycosylated hemoglobin (HbA_1c) was 8%.

All patients underwent CAC imaging, as well as a clinical evaluation—at baseline and about 2.5 years later—that measured HbA_1c; serum interleukin-6 and C-reactive protein; and plasma osteoprotegerin. Those with a CAC score of more than 100 Agatston units at baseline also underwent MPI using a 2-day stress-rest protocol with technetium-99m sestamibi and dipyridamole and maximum treadmill exercise. Progression/regression of coronary calcification was defined as a change in the square root-transformed volumetric CAC score of 2.5 mm

At baseline, 211 (53%) of the 398 patients had coronary artery calcification. At follow-up, atherosclerosis progression was observed in 118 (30%) patients, including 22 (5.5%) who had no calcification at baseline, Dr. Lahiri said. Regression was noted in 3 (0.8%), and there was no change in 277 (70%).

At baseline, 24 patients had an abnormal perfusion scan. Progression of ischemia was seen in 14 patients, regression in 8, and no change in 2.

In a univariate analysis, age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. There was no significant association between calcium scores and serum levels of C-reactive protein or IL-6. Surprisingly, statin use was a negative predictor, Dr. Lahiri said.

In a multivariate logistic regression model, serum HbA_1c was one of the most important factors influencing progression. Poor glycemic control raised the risk of progression 10.5-fold, whereas the risk increased 2.5-fold for elevated plasma osteoprotegerin and 2.1-fold for IL-6.

SPECT images show progression of atherosclerosis in the right coronary and left circumflex arteries (arrows) of a patient with diabetes over a period of 1.7 years. Photos courtesy Dr. Avijit Lahiri

The tests were synergistic on prognosis. It would be cost effective to exclude those without CAC for further testing. DR. LAHIRI

MONTREAL — Suboptimal glycemic control, elevated plasma osteoprotegerin, and presence of serum interleukin-6 were risk factors for progression of coronary artery calcification in a prospective study of asymptomatic patients with type 2 diabetes.

Despite having no known coronary artery disease, a significant proportion (30%) of the 398 patients followed in the study had atherosclerosis progression, Dr. Avijit Lahiri said at the annual meeting of the American Society of Nuclear Cardiology.

The study provides insight into the risk factors for progression of coronary calcification and establishes the role of combining cardiac CT for coronary artery calcium (CAC) imaging with simultaneous single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in uncomplicated, stable, asymptomatic patients with type 2 diabetes, Dr. Lahiri said.

CAC can be used to identify patients with increased atherosclerotic burden, but it does not identify obstructive coronary artery disease, explained Dr. Lahiri, director of cardiac imaging and research at Wellington Hospital in London. Therefore, there is a need to use combined MPI to detect silent ischemia. “Interestingly, these tests had a synergistic value on prognosis,” he said in an interview. “Thus, it would be cost effective to exclude those without CAC for further testing.”

The original study included 510 patients, of whom 20 went on to have cardiac events, and 402 were willing to participate in the current follow-up study. Four scans were technically inadequate, resulting in a cohort of 398 patients. Their mean age was 53 years; 61% were male; and their average serum glycosylated hemoglobin (HbA_1c) was 8%.

All patients underwent CAC imaging, as well as a clinical evaluation—at baseline and about 2.5 years later—that measured HbA_1c; serum interleukin-6 and C-reactive protein; and plasma osteoprotegerin. Those with a CAC score of more than 100 Agatston units at baseline also underwent MPI using a 2-day stress-rest protocol with technetium-99m sestamibi and dipyridamole and maximum treadmill exercise. Progression/regression of coronary calcification was defined as a change in the square root-transformed volumetric CAC score of 2.5 mm

At baseline, 211 (53%) of the 398 patients had coronary artery calcification. At follow-up, atherosclerosis progression was observed in 118 (30%) patients, including 22 (5.5%) who had no calcification at baseline, Dr. Lahiri said. Regression was noted in 3 (0.8%), and there was no change in 277 (70%).

At baseline, 24 patients had an abnormal perfusion scan. Progression of ischemia was seen in 14 patients, regression in 8, and no change in 2.

In a univariate analysis, age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. There was no significant association between calcium scores and serum levels of C-reactive protein or IL-6. Surprisingly, statin use was a negative predictor, Dr. Lahiri said.

In a multivariate logistic regression model, serum HbA_1c was one of the most important factors influencing progression. Poor glycemic control raised the risk of progression 10.5-fold, whereas the risk increased 2.5-fold for elevated plasma osteoprotegerin and 2.1-fold for IL-6.

SPECT images show progression of atherosclerosis in the right coronary and left circumflex arteries (arrows) of a patient with diabetes over a period of 1.7 years. Photos courtesy Dr. Avijit Lahiri

The tests were synergistic on prognosis. It would be cost effective to exclude those without CAC for further testing. DR. LAHIRI

MONTREAL — Suboptimal glycemic control, elevated plasma osteoprotegerin, and presence of serum interleukin-6 were risk factors for progression of coronary artery calcification in a prospective study of asymptomatic patients with type 2 diabetes.

Despite having no known coronary artery disease, a significant proportion (30%) of the 398 patients followed in the study had atherosclerosis progression, Dr. Avijit Lahiri said at the annual meeting of the American Society of Nuclear Cardiology.

The study provides insight into the risk factors for progression of coronary calcification and establishes the role of combining cardiac CT for coronary artery calcium (CAC) imaging with simultaneous single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in uncomplicated, stable, asymptomatic patients with type 2 diabetes, Dr. Lahiri said.

CAC can be used to identify patients with increased atherosclerotic burden, but it does not identify obstructive coronary artery disease, explained Dr. Lahiri, director of cardiac imaging and research at Wellington Hospital in London. Therefore, there is a need to use combined MPI to detect silent ischemia. “Interestingly, these tests had a synergistic value on prognosis,” he said in an interview. “Thus, it would be cost effective to exclude those without CAC for further testing.”

The original study included 510 patients, of whom 20 went on to have cardiac events, and 402 were willing to participate in the follow-up study. Four scans were technically inadequate, resulting in a cohort of 398 patients. Their mean age was 53 years; 61% were male; and their average serum glycosylated hemoglobin (HbA_1c) was 8%.

All patients underwent CAC imaging, as well as a clinical evaluation—at baseline and about 2.5 years later—that measured HbA_1c; serum interleukin-6 and C-reactive protein; and plasma osteoprotegerin. Those with a CAC score of more than 100 Agatston units at baseline also underwent MPI using a 2-day stress-rest protocol with technetium-99m sestamibi and dipyridamole and maximum treadmill exercise.

At baseline, 211 (53%) of the 398 patients had coronary artery calcification. At follow-up, atherosclerosis progression was observed in 118 (30%) patients, including 22 (5.5%) who had no calcification at baseline, Dr. Lahiri said. Regression was noted in 3 (0.8%), and there was no change in 277 (70%).

At baseline, 24 patients had an abnormal perfusion scan. Progression of ischemia was seen in 14 patients, regression in 8, and no change in 2.

In a univariate analysis, age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. There was no significant association between calcium scores and serum levels of C-reactive protein or IL-6. Surprisingly, statin use was a negative predictor, Dr. Lahiri said.

In a multivariate logistic regression model, serum HbA_1c was a most important factor influencing progression. Poor glycemic control raised the risk of progression 10.5-fold; the risk increased 2.5-fold for elevated plasma osteoprotegerin and 2.1-fold for IL-6.

Age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. DR. LAHIRI

SPECT images show progression of atherosclerosis in the right coronary and left circumflex arteries (arrows) of a diabetic patient over 1.7 years. Photos courtesy Dr. Avijit Lahiri

MONTREAL — Suboptimal glycemic control, elevated plasma osteoprotegerin, and presence of serum interleukin-6 were risk factors for progression of coronary artery calcification in a prospective study of asymptomatic patients with type 2 diabetes.

Despite having no known coronary artery disease, a significant proportion (30%) of the 398 patients followed in the study had atherosclerosis progression, Dr. Avijit Lahiri said at the annual meeting of the American Society of Nuclear Cardiology.

The study provides insight into the risk factors for progression of coronary calcification and establishes the role of combining cardiac CT for coronary artery calcium (CAC) imaging with simultaneous single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in uncomplicated, stable, asymptomatic patients with type 2 diabetes, Dr. Lahiri said.

CAC can be used to identify patients with increased atherosclerotic burden, but it does not identify obstructive coronary artery disease, explained Dr. Lahiri, director of cardiac imaging and research at Wellington Hospital in London. Therefore, there is a need to use combined MPI to detect silent ischemia. “Interestingly, these tests had a synergistic value on prognosis,” he said in an interview. “Thus, it would be cost effective to exclude those without CAC for further testing.”

The original study included 510 patients, of whom 20 went on to have cardiac events, and 402 were willing to participate in the follow-up study. Four scans were technically inadequate, resulting in a cohort of 398 patients. Their mean age was 53 years; 61% were male; and their average serum glycosylated hemoglobin (HbA_1c) was 8%.

All patients underwent CAC imaging, as well as a clinical evaluation—at baseline and about 2.5 years later—that measured HbA_1c; serum interleukin-6 and C-reactive protein; and plasma osteoprotegerin. Those with a CAC score of more than 100 Agatston units at baseline also underwent MPI using a 2-day stress-rest protocol with technetium-99m sestamibi and dipyridamole and maximum treadmill exercise.

At baseline, 211 (53%) of the 398 patients had coronary artery calcification. At follow-up, atherosclerosis progression was observed in 118 (30%) patients, including 22 (5.5%) who had no calcification at baseline, Dr. Lahiri said. Regression was noted in 3 (0.8%), and there was no change in 277 (70%).

At baseline, 24 patients had an abnormal perfusion scan. Progression of ischemia was seen in 14 patients, regression in 8, and no change in 2.

In a univariate analysis, age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. There was no significant association between calcium scores and serum levels of C-reactive protein or IL-6. Surprisingly, statin use was a negative predictor, Dr. Lahiri said.

In a multivariate logistic regression model, serum HbA_1c was a most important factor influencing progression. Poor glycemic control raised the risk of progression 10.5-fold; the risk increased 2.5-fold for elevated plasma osteoprotegerin and 2.1-fold for IL-6.

Age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. DR. LAHIRI

SPECT images show progression of atherosclerosis in the right coronary and left circumflex arteries (arrows) of a diabetic patient over 1.7 years. Photos courtesy Dr. Avijit Lahiri

MONTREAL — Suboptimal glycemic control, elevated plasma osteoprotegerin, and presence of serum interleukin-6 were risk factors for progression of coronary artery calcification in a prospective study of asymptomatic patients with type 2 diabetes.

Despite having no known coronary artery disease, a significant proportion (30%) of the 398 patients followed in the study had atherosclerosis progression, Dr. Avijit Lahiri said at the annual meeting of the American Society of Nuclear Cardiology.

The study provides insight into the risk factors for progression of coronary calcification and establishes the role of combining cardiac CT for coronary artery calcium (CAC) imaging with simultaneous single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in uncomplicated, stable, asymptomatic patients with type 2 diabetes, Dr. Lahiri said.

CAC can be used to identify patients with increased atherosclerotic burden, but it does not identify obstructive coronary artery disease, explained Dr. Lahiri, director of cardiac imaging and research at Wellington Hospital in London. Therefore, there is a need to use combined MPI to detect silent ischemia. “Interestingly, these tests had a synergistic value on prognosis,” he said in an interview. “Thus, it would be cost effective to exclude those without CAC for further testing.”

The original study included 510 patients, of whom 20 went on to have cardiac events, and 402 were willing to participate in the follow-up study. Four scans were technically inadequate, resulting in a cohort of 398 patients. Their mean age was 53 years; 61% were male; and their average serum glycosylated hemoglobin (HbA_1c) was 8%.

All patients underwent CAC imaging, as well as a clinical evaluation—at baseline and about 2.5 years later—that measured HbA_1c; serum interleukin-6 and C-reactive protein; and plasma osteoprotegerin. Those with a CAC score of more than 100 Agatston units at baseline also underwent MPI using a 2-day stress-rest protocol with technetium-99m sestamibi and dipyridamole and maximum treadmill exercise.

At baseline, 211 (53%) of the 398 patients had coronary artery calcification. At follow-up, atherosclerosis progression was observed in 118 (30%) patients, including 22 (5.5%) who had no calcification at baseline, Dr. Lahiri said. Regression was noted in 3 (0.8%), and there was no change in 277 (70%).

At baseline, 24 patients had an abnormal perfusion scan. Progression of ischemia was seen in 14 patients, regression in 8, and no change in 2.

In a univariate analysis, age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. There was no significant association between calcium scores and serum levels of C-reactive protein or IL-6. Surprisingly, statin use was a negative predictor, Dr. Lahiri said.

In a multivariate logistic regression model, serum HbA_1c was a most important factor influencing progression. Poor glycemic control raised the risk of progression 10.5-fold; the risk increased 2.5-fold for elevated plasma osteoprotegerin and 2.1-fold for IL-6.

Age, male gender, presence of hypertension, and baseline HbA_1c were predictors of atherosclerosis progression. DR. LAHIRI

SPECT images show progression of atherosclerosis in the right coronary and left circumflex arteries (arrows) of a diabetic patient over 1.7 years. Photos courtesy Dr. Avijit Lahiri

PITTSBURGH — Pregnant women with anxiety or depression have higher levels of α-amylase, a measure of adrenergic system activity, and lower morning cortisol levels, preliminary results from a longitudinal study demonstrated.

The findings suggest the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis may be affected in opposite directions by stress during pregnancy, Alison Shea, Ph.D. candidate, and her associates reported in a poster at the International Congress of Neuroendocrinology.

The analysis included 60 women who were among the first of 250 pregnant women to be recruited as part of the multicenter Maternal Adversity, Vulnerability, and Neurodevelopment (MAVAN) study led by Dr. Meir Steiner, of McMaster University, Hamilton, Ont. The women were divided into three groups: those presenting with symptoms of depression or anxiety who chose psychotherapy only, those with symptoms who chose antidepressants, and a control group with no current or past psychiatric illness.

A battery of psychological tests was performed at baseline (gestational age 14–24 weeks), and morning salivary samples were collected daily to measure stress indicators such as cortisol, dehydroepiandrosterone (DHEA), and α-amylase. A follow-up assessment was performed at 24–30 weeks and included psychological testing, salivary samples, and a 24-hour Holter ECG. Infants are being followed during the postpartum period until 3 years of age.

The results indicate that depression and anxiety scores during pregnancy are positively correlated with α-amylase levels and negatively correlated with morning cortisol levels. Both associations were statistically significant, reported Ms. Shea, of the Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton.

Compared with controls, both the cortisol response to awakening and the 24-hour heart rate variability were lower for mothers with anxiety and depression, particularly among those not taking antidepressants. Reduced heart rate variability indicates the body's inability to respond to stress in a changing environment, and is thought to improve with the use of antidepressants, Ms. Shea said in an interview. The study found that the greater the mother's heart rate variability, the longer the gestation. “It makes sense, but it's never been looked at in pregnant women,” she said.

Head circumference at birth was strongly correlated with maternal 24-hour mean heart rate during pregnancy, even after controlling for birth weight and gestational age. Among women with depression and anxiety, the higher the heart rate during pregnancy, the smaller the head circumference. Head circumference is purported to be a measure of brain volume and has been found to be smaller among babies born to women with posttraumatic stress disorder, she said.

Birth length was significantly smaller for babies born to women with anxiety or depression (49.64 cm), compared with those born to women treated with antidepressants (50.91 cm) and controls (53.01 cm).

Ponderal index, which is an indicator of infant body mass index, also was significantly higher among babies of women suffering from anxiety and depression (2.65 g/cm

PITTSBURGH — Pregnant women with anxiety or depression have higher levels of α-amylase, a measure of adrenergic system activity, and lower morning cortisol levels, preliminary results from a longitudinal study demonstrated.

The findings suggest the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis may be affected in opposite directions by stress during pregnancy, Alison Shea, Ph.D. candidate, and her associates reported in a poster at the International Congress of Neuroendocrinology.

The analysis included 60 women who were among the first of 250 pregnant women to be recruited as part of the multicenter Maternal Adversity, Vulnerability, and Neurodevelopment (MAVAN) study led by Dr. Meir Steiner, of McMaster University, Hamilton, Ont. The women were divided into three groups: those presenting with symptoms of depression or anxiety who chose psychotherapy only, those with symptoms who chose antidepressants, and a control group with no current or past psychiatric illness.

A battery of psychological tests was performed at baseline (gestational age 14–24 weeks), and morning salivary samples were collected daily to measure stress indicators such as cortisol, dehydroepiandrosterone (DHEA), and α-amylase. A follow-up assessment was performed at 24–30 weeks and included psychological testing, salivary samples, and a 24-hour Holter ECG. Infants are being followed during the postpartum period until 3 years of age.

The results indicate that depression and anxiety scores during pregnancy are positively correlated with α-amylase levels and negatively correlated with morning cortisol levels. Both associations were statistically significant, reported Ms. Shea, of the Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton.

Compared with controls, both the cortisol response to awakening and the 24-hour heart rate variability were lower for mothers with anxiety and depression, particularly among those not taking antidepressants. Reduced heart rate variability indicates the body's inability to respond to stress in a changing environment, and is thought to improve with the use of antidepressants, Ms. Shea said in an interview. The study found that the greater the mother's heart rate variability, the longer the gestation. “It makes sense, but it's never been looked at in pregnant women,” she said.

Head circumference at birth was strongly correlated with maternal 24-hour mean heart rate during pregnancy, even after controlling for birth weight and gestational age. Among women with depression and anxiety, the higher the heart rate during pregnancy, the smaller the head circumference. Head circumference is purported to be a measure of brain volume and has been found to be smaller among babies born to women with posttraumatic stress disorder, she said.

Birth length was significantly smaller for babies born to women with anxiety or depression (49.64 cm), compared with those born to women treated with antidepressants (50.91 cm) and controls (53.01 cm).

Ponderal index, which is an indicator of infant body mass index, also was significantly higher among babies of women suffering from anxiety and depression (2.65 g/cm

PITTSBURGH — Pregnant women with anxiety or depression have higher levels of α-amylase, a measure of adrenergic system activity, and lower morning cortisol levels, preliminary results from a longitudinal study demonstrated.

The findings suggest the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis may be affected in opposite directions by stress during pregnancy, Alison Shea, Ph.D. candidate, and her associates reported in a poster at the International Congress of Neuroendocrinology.

The analysis included 60 women who were among the first of 250 pregnant women to be recruited as part of the multicenter Maternal Adversity, Vulnerability, and Neurodevelopment (MAVAN) study led by Dr. Meir Steiner, of McMaster University, Hamilton, Ont. The women were divided into three groups: those presenting with symptoms of depression or anxiety who chose psychotherapy only, those with symptoms who chose antidepressants, and a control group with no current or past psychiatric illness.

A battery of psychological tests was performed at baseline (gestational age 14–24 weeks), and morning salivary samples were collected daily to measure stress indicators such as cortisol, dehydroepiandrosterone (DHEA), and α-amylase. A follow-up assessment was performed at 24–30 weeks and included psychological testing, salivary samples, and a 24-hour Holter ECG. Infants are being followed during the postpartum period until 3 years of age.

The results indicate that depression and anxiety scores during pregnancy are positively correlated with α-amylase levels and negatively correlated with morning cortisol levels. Both associations were statistically significant, reported Ms. Shea, of the Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton.

Compared with controls, both the cortisol response to awakening and the 24-hour heart rate variability were lower for mothers with anxiety and depression, particularly among those not taking antidepressants. Reduced heart rate variability indicates the body's inability to respond to stress in a changing environment, and is thought to improve with the use of antidepressants, Ms. Shea said in an interview. The study found that the greater the mother's heart rate variability, the longer the gestation. “It makes sense, but it's never been looked at in pregnant women,” she said.

Head circumference at birth was strongly correlated with maternal 24-hour mean heart rate during pregnancy, even after controlling for birth weight and gestational age. Among women with depression and anxiety, the higher the heart rate during pregnancy, the smaller the head circumference. Head circumference is purported to be a measure of brain volume and has been found to be smaller among babies born to women with posttraumatic stress disorder, she said.

Birth length was significantly smaller for babies born to women with anxiety or depression (49.64 cm), compared with those born to women treated with antidepressants (50.91 cm) and controls (53.01 cm).

Ponderal index, which is an indicator of infant body mass index, also was significantly higher among babies of women suffering from anxiety and depression (2.65 g/cm

MONTREAL – There is a disconnect in communications between physicians and parents of children with asthma, according to an analysis of data from a new global asthma survey.

Parents and physicians disagree on the amount of time dedicated to asthma education in the office; who initiates discussion about medication side effects; and the level of treatment compliance with asthma medication.

The North American pediatric findings of the Global Asthma Physician and Patient (GAPP) study also confirm what most physicians already know: Asthma medication compliance is low; patients with poor compliance experience more symptoms; and side effects lead patients to switch or drop medications.

The authors conclude that patient compliance and outcomes could be enhanced through better physician-patient communications and asthma education, and the availability of new treatment options with lower side-effect profiles, Dr. Ronald Dahl of Aarhus (Denmark) University Hospital, and his associates on the GAPP Survey Working Group reported in a poster at the Seventh International Congress on Pediatric Pulmonology.

The GAPP survey is the first-ever global quantitative survey to uncover asthma attitudes and treatment practices among patients and physicians. The survey was conducted between May and August 2005 in 16 countries and included a total of 5,482 online and telephone interviews with 1,017 parents of children diagnosed with asthma, 1,006 physicians who treat children with asthma, 1,726 adults over 18 years of age with asthma, and 1,733 physicians who treat adults.

The study, which was supported by an educational grant from Altana Pharma and conducted in cooperation with the World Allergy Organization and American College of Allergy, Asthma, and Immunology, was sufficiently powered to ensure statistical significance globally and in each country.

The pediatric analysis presented here was based on 618 interviews conducted in North America among 314 parents and 304 physicians.

Among parents interviewed, 62% reported their children's asthma as mild; 33% as moderate; and 5% as severe. In the 12 months before the interview, parents reported several events demonstrating poor asthma control such as making an unscheduled visit to their doctor (34%), going to the emergency department (11%), and admission to the hospital (5%), the authors reported.

According to parents, physicians don't discuss specific asthma management issues such as the development of an individual management plan (66%); correct inhaler technique (69%); and keeping daily symptom/medication diaries (25%). In every case, physicians' perceptions of the incidence of these discussions were higher (90%, 97%, 53%, respectively).

Consistently, parents also perceive less time is spent on asthma education than do physicians. While 18% of parents reported that during a typical office visit, no time is spent on asthma education, about 84% of physicians report spending at least half of their office time on education.

Overall, 27% of parents answered “false” or “not sure” when asked whether mild asthma attacks could be fatal, which demonstrates a general lack of understanding about the disease, the authors reported. Global findings from the survey indicate that treatment compliance increased with the level of asthma education, a trend that also was seen in local results.

Of those patients with asthma who take or had taken asthma medication, 37% of parents reported never discussing short-term side effects such as fungal infection, sore throat, or hoarseness with their physicians; and 55% reported never discussing long-term effects including weight gain, weakening of the bones or changing bone density, cataracts, or glaucoma. This compares with physician reports of 1% and 6%.

A similar disparity was seen regarding lack of parental awareness of both short- and long-term side effects of inhaled corticosteroids.

More information on the GAPP study findings is available at www.gappsurvey.org

MONTREAL – There is a disconnect in communications between physicians and parents of children with asthma, according to an analysis of data from a new global asthma survey.

Parents and physicians disagree on the amount of time dedicated to asthma education in the office; who initiates discussion about medication side effects; and the level of treatment compliance with asthma medication.

The North American pediatric findings of the Global Asthma Physician and Patient (GAPP) study also confirm what most physicians already know: Asthma medication compliance is low; patients with poor compliance experience more symptoms; and side effects lead patients to switch or drop medications.

The authors conclude that patient compliance and outcomes could be enhanced through better physician-patient communications and asthma education, and the availability of new treatment options with lower side-effect profiles, Dr. Ronald Dahl of Aarhus (Denmark) University Hospital, and his associates on the GAPP Survey Working Group reported in a poster at the Seventh International Congress on Pediatric Pulmonology.

The GAPP survey is the first-ever global quantitative survey to uncover asthma attitudes and treatment practices among patients and physicians. The survey was conducted between May and August 2005 in 16 countries and included a total of 5,482 online and telephone interviews with 1,017 parents of children diagnosed with asthma, 1,006 physicians who treat children with asthma, 1,726 adults over 18 years of age with asthma, and 1,733 physicians who treat adults.

The study, which was supported by an educational grant from Altana Pharma and conducted in cooperation with the World Allergy Organization and American College of Allergy, Asthma, and Immunology, was sufficiently powered to ensure statistical significance globally and in each country.

The pediatric analysis presented here was based on 618 interviews conducted in North America among 314 parents and 304 physicians.

Among parents interviewed, 62% reported their children's asthma as mild; 33% as moderate; and 5% as severe. In the 12 months before the interview, parents reported several events demonstrating poor asthma control such as making an unscheduled visit to their doctor (34%), going to the emergency department (11%), and admission to the hospital (5%), the authors reported.

According to parents, physicians don't discuss specific asthma management issues such as the development of an individual management plan (66%); correct inhaler technique (69%); and keeping daily symptom/medication diaries (25%). In every case, physicians' perceptions of the incidence of these discussions were higher (90%, 97%, 53%, respectively).

Consistently, parents also perceive less time is spent on asthma education than do physicians. While 18% of parents reported that during a typical office visit, no time is spent on asthma education, about 84% of physicians report spending at least half of their office time on education.

Overall, 27% of parents answered “false” or “not sure” when asked whether mild asthma attacks could be fatal, which demonstrates a general lack of understanding about the disease, the authors reported. Global findings from the survey indicate that treatment compliance increased with the level of asthma education, a trend that also was seen in local results.

Of those patients with asthma who take or had taken asthma medication, 37% of parents reported never discussing short-term side effects such as fungal infection, sore throat, or hoarseness with their physicians; and 55% reported never discussing long-term effects including weight gain, weakening of the bones or changing bone density, cataracts, or glaucoma. This compares with physician reports of 1% and 6%.

A similar disparity was seen regarding lack of parental awareness of both short- and long-term side effects of inhaled corticosteroids.

More information on the GAPP study findings is available at www.gappsurvey.org

MONTREAL – There is a disconnect in communications between physicians and parents of children with asthma, according to an analysis of data from a new global asthma survey.

Parents and physicians disagree on the amount of time dedicated to asthma education in the office; who initiates discussion about medication side effects; and the level of treatment compliance with asthma medication.

The North American pediatric findings of the Global Asthma Physician and Patient (GAPP) study also confirm what most physicians already know: Asthma medication compliance is low; patients with poor compliance experience more symptoms; and side effects lead patients to switch or drop medications.

The authors conclude that patient compliance and outcomes could be enhanced through better physician-patient communications and asthma education, and the availability of new treatment options with lower side-effect profiles, Dr. Ronald Dahl of Aarhus (Denmark) University Hospital, and his associates on the GAPP Survey Working Group reported in a poster at the Seventh International Congress on Pediatric Pulmonology.

The GAPP survey is the first-ever global quantitative survey to uncover asthma attitudes and treatment practices among patients and physicians. The survey was conducted between May and August 2005 in 16 countries and included a total of 5,482 online and telephone interviews with 1,017 parents of children diagnosed with asthma, 1,006 physicians who treat children with asthma, 1,726 adults over 18 years of age with asthma, and 1,733 physicians who treat adults.

The study, which was supported by an educational grant from Altana Pharma and conducted in cooperation with the World Allergy Organization and American College of Allergy, Asthma, and Immunology, was sufficiently powered to ensure statistical significance globally and in each country.

The pediatric analysis presented here was based on 618 interviews conducted in North America among 314 parents and 304 physicians.

Among parents interviewed, 62% reported their children's asthma as mild; 33% as moderate; and 5% as severe. In the 12 months before the interview, parents reported several events demonstrating poor asthma control such as making an unscheduled visit to their doctor (34%), going to the emergency department (11%), and admission to the hospital (5%), the authors reported.

According to parents, physicians don't discuss specific asthma management issues such as the development of an individual management plan (66%); correct inhaler technique (69%); and keeping daily symptom/medication diaries (25%). In every case, physicians' perceptions of the incidence of these discussions were higher (90%, 97%, 53%, respectively).

Consistently, parents also perceive less time is spent on asthma education than do physicians. While 18% of parents reported that during a typical office visit, no time is spent on asthma education, about 84% of physicians report spending at least half of their office time on education.

Overall, 27% of parents answered “false” or “not sure” when asked whether mild asthma attacks could be fatal, which demonstrates a general lack of understanding about the disease, the authors reported. Global findings from the survey indicate that treatment compliance increased with the level of asthma education, a trend that also was seen in local results.

Of those patients with asthma who take or had taken asthma medication, 37% of parents reported never discussing short-term side effects such as fungal infection, sore throat, or hoarseness with their physicians; and 55% reported never discussing long-term effects including weight gain, weakening of the bones or changing bone density, cataracts, or glaucoma. This compares with physician reports of 1% and 6%.

A similar disparity was seen regarding lack of parental awareness of both short- and long-term side effects of inhaled corticosteroids.

More information on the GAPP study findings is available at www.gappsurvey.org