Patrice Wendling

The genetic influence on fracture susceptibility depends on the type of fracture and age at the time of the event, results from a large Swedish twin study suggest.

In addition, the heritability of osteoporotic fractures is stronger than has been previously estimated, especially for early-occurring osteoporotic fractures, according to the study's lead author, Karl Michaëlsson, M.D., Ph.D., of the Uppsala (Sweden) University Hospital and associates.

The investigators identified 33,432 twins born from 1896 to 1944 included in the Swedish Twin Registry, currently the largest twin registry in the world.

Among them, 24,598 agreed to take part in the study.

Computer-assisted telephone interviews and the Swedish Inpatient Registry were used to identify 6,021 twins with any fracture, 3,599 with osteoporotic fractures, and 1,055 with a hip fracture after the age of 50 years.

Just 16% of the overall age-adjusted fracture variance and 27% of the osteoporotic age-adjusted fracture variance were explained by genetic variation (Arch. Intern. Med. 2005;165:1825–30).

The strongest genetic influence was evident for hip fractures. Nearly half (48%) of the variance in liability to these fractures was attributable to genetic factors.

There was a tendency toward lower heritability estimates of fractures among the men, but it was not statistically significant.

If the first hip fracture within a twin pair occurred before age 69 years, 68% of the variance of liability was explained by genetic factors. If the first hip fracture happened between ages 69 and 79 years, 47% of the variance was attributable to genetic variation. After age 79 years, that figure fell to 3%.

The same pattern of attenuated heredity estimates with increasing age also was evident for the other fracture categories.

“A search for genes and gene-environment interactions that affect early osteoporotic fracture risk is likely to be fruitful, but fracture-prevention efforts at older ages should be focused on lifestyle habits,” the authors report.

Finally, they suggest that an assessment of osteoporotic fracture risk by clinical examination may be recommended for relatives of patients with hip fractures before age 80 years.

The genetic influence on fracture susceptibility depends on the type of fracture and age at the time of the event, results from a large Swedish twin study suggest.

In addition, the heritability of osteoporotic fractures is stronger than has been previously estimated, especially for early-occurring osteoporotic fractures, according to the study's lead author, Karl Michaëlsson, M.D., Ph.D., of the Uppsala (Sweden) University Hospital and associates.

The investigators identified 33,432 twins born from 1896 to 1944 included in the Swedish Twin Registry, currently the largest twin registry in the world.

Among them, 24,598 agreed to take part in the study.

Computer-assisted telephone interviews and the Swedish Inpatient Registry were used to identify 6,021 twins with any fracture, 3,599 with osteoporotic fractures, and 1,055 with a hip fracture after the age of 50 years.

Just 16% of the overall age-adjusted fracture variance and 27% of the osteoporotic age-adjusted fracture variance were explained by genetic variation (Arch. Intern. Med. 2005;165:1825–30).

The strongest genetic influence was evident for hip fractures. Nearly half (48%) of the variance in liability to these fractures was attributable to genetic factors.

There was a tendency toward lower heritability estimates of fractures among the men, but it was not statistically significant.

If the first hip fracture within a twin pair occurred before age 69 years, 68% of the variance of liability was explained by genetic factors. If the first hip fracture happened between ages 69 and 79 years, 47% of the variance was attributable to genetic variation. After age 79 years, that figure fell to 3%.

The same pattern of attenuated heredity estimates with increasing age also was evident for the other fracture categories.

“A search for genes and gene-environment interactions that affect early osteoporotic fracture risk is likely to be fruitful, but fracture-prevention efforts at older ages should be focused on lifestyle habits,” the authors report.

Finally, they suggest that an assessment of osteoporotic fracture risk by clinical examination may be recommended for relatives of patients with hip fractures before age 80 years.

The genetic influence on fracture susceptibility depends on the type of fracture and age at the time of the event, results from a large Swedish twin study suggest.

In addition, the heritability of osteoporotic fractures is stronger than has been previously estimated, especially for early-occurring osteoporotic fractures, according to the study's lead author, Karl Michaëlsson, M.D., Ph.D., of the Uppsala (Sweden) University Hospital and associates.

The investigators identified 33,432 twins born from 1896 to 1944 included in the Swedish Twin Registry, currently the largest twin registry in the world.

Among them, 24,598 agreed to take part in the study.

Computer-assisted telephone interviews and the Swedish Inpatient Registry were used to identify 6,021 twins with any fracture, 3,599 with osteoporotic fractures, and 1,055 with a hip fracture after the age of 50 years.

Just 16% of the overall age-adjusted fracture variance and 27% of the osteoporotic age-adjusted fracture variance were explained by genetic variation (Arch. Intern. Med. 2005;165:1825–30).

The strongest genetic influence was evident for hip fractures. Nearly half (48%) of the variance in liability to these fractures was attributable to genetic factors.

There was a tendency toward lower heritability estimates of fractures among the men, but it was not statistically significant.

If the first hip fracture within a twin pair occurred before age 69 years, 68% of the variance of liability was explained by genetic factors. If the first hip fracture happened between ages 69 and 79 years, 47% of the variance was attributable to genetic variation. After age 79 years, that figure fell to 3%.

The same pattern of attenuated heredity estimates with increasing age also was evident for the other fracture categories.

“A search for genes and gene-environment interactions that affect early osteoporotic fracture risk is likely to be fruitful, but fracture-prevention efforts at older ages should be focused on lifestyle habits,” the authors report.

Finally, they suggest that an assessment of osteoporotic fracture risk by clinical examination may be recommended for relatives of patients with hip fractures before age 80 years.

Anti-tumor necrosis factor-α therapy may not always prevent the new onset or exacerbation of psoriatic skin lesions, according to a case series report involving patients taking the biologics for rheumatoid arthritis.

Infections, β-adrenergic blockers, or lithium were not present in any of the nine patients before the psoriasis erupted, reported Dr. Sonja Kary of Charité University Medicine Berlin, and associates (Arch. Rheum. Dis. [Epub ahead of print], Sept. 8, 2005). The diagnosis of rheumatoid arthritis was definite in all.

HLA typing revealed that one patient had HLA-Cw6, which is linked with psoriasis. Two patients had preexisting, but inactive, psoriasis. Nine patients were treated with adalimumab, etanercept, and infliximab at varying dosages for 4 days to 14 months prior to either new onset (five) or exacerbation (four). Some patients had previously received antimalarials that did not induce psoriasis.

Psoriasis vulgaris was diagnosed in six patients and pustulosis palmoplantaris in three, although pustular symptoms were present in five patients.

Withdrawing or reducing the dose of TNF-α-blocking agents led to improvement in some patients, but this approach was generally limited by the activity of the underlying rheumatoid arthritis. The severity of psoriatic symptoms was reduced when alternative anti-TNF-α agents were used.

Anti-tumor necrosis factor-α therapy may not always prevent the new onset or exacerbation of psoriatic skin lesions, according to a case series report involving patients taking the biologics for rheumatoid arthritis.

Infections, β-adrenergic blockers, or lithium were not present in any of the nine patients before the psoriasis erupted, reported Dr. Sonja Kary of Charité University Medicine Berlin, and associates (Arch. Rheum. Dis. [Epub ahead of print], Sept. 8, 2005). The diagnosis of rheumatoid arthritis was definite in all.

HLA typing revealed that one patient had HLA-Cw6, which is linked with psoriasis. Two patients had preexisting, but inactive, psoriasis. Nine patients were treated with adalimumab, etanercept, and infliximab at varying dosages for 4 days to 14 months prior to either new onset (five) or exacerbation (four). Some patients had previously received antimalarials that did not induce psoriasis.

Psoriasis vulgaris was diagnosed in six patients and pustulosis palmoplantaris in three, although pustular symptoms were present in five patients.

Withdrawing or reducing the dose of TNF-α-blocking agents led to improvement in some patients, but this approach was generally limited by the activity of the underlying rheumatoid arthritis. The severity of psoriatic symptoms was reduced when alternative anti-TNF-α agents were used.

Anti-tumor necrosis factor-α therapy may not always prevent the new onset or exacerbation of psoriatic skin lesions, according to a case series report involving patients taking the biologics for rheumatoid arthritis.

Infections, β-adrenergic blockers, or lithium were not present in any of the nine patients before the psoriasis erupted, reported Dr. Sonja Kary of Charité University Medicine Berlin, and associates (Arch. Rheum. Dis. [Epub ahead of print], Sept. 8, 2005). The diagnosis of rheumatoid arthritis was definite in all.

HLA typing revealed that one patient had HLA-Cw6, which is linked with psoriasis. Two patients had preexisting, but inactive, psoriasis. Nine patients were treated with adalimumab, etanercept, and infliximab at varying dosages for 4 days to 14 months prior to either new onset (five) or exacerbation (four). Some patients had previously received antimalarials that did not induce psoriasis.

Psoriasis vulgaris was diagnosed in six patients and pustulosis palmoplantaris in three, although pustular symptoms were present in five patients.

Withdrawing or reducing the dose of TNF-α-blocking agents led to improvement in some patients, but this approach was generally limited by the activity of the underlying rheumatoid arthritis. The severity of psoriatic symptoms was reduced when alternative anti-TNF-α agents were used.

CHICAGO — A single 10 minimal erythema dose from an excimer laser can safely and effectively treat moderate to severe plaque psoriasis, Kevin D. Cooper, M.D., said at the 11th International Psoriasis Symposium sponsored by the Skin Disease Education Foundation.

The 308-nm XTRAC excimer laser treatment system (PhotoMedex, Montgomeryville, Pa.) is the first laser treatment approved for psoriasis.

It offers an obvious advantage over conventional phototherapy because it can target lesional skin with a higher initial dose of ultraviolet radiation, he said.

What hasn't been known is the optimal dose needed to treat moderate to severe psoriasis.

A minimal erythema dose (MED) of 4–16 has been used. But crusting of the involved skin can occur if the dose exceeds 10 MED, said Dr. Cooper, professor and chair of dermatology at Case Western Reserve University, Cleveland.

In a study that was led by his former colleague Mark Kagen, M.D., 15 patients with a mean Psoriasis Area and Severity Index (PASI) score of 18.9 and a lesional thickness of 168 μm were treated on the trunk and extremities with a single dose of 10 MED from the XTRAC excimer laser.

Patients responded rapidly at 2 and 4 weeks post treatment. On average, PASI scores were reduced from 18.9 at baseline to 8 by week 8.

"What's remarkable is that this is a single dose," Dr. Cooper said.

The response was limited to the area treated, but improvement was noted in patients of all skin types, including Fitzpatrick skin type V.

Biopsies were performed on lesions in eight patients. Lesion thickness decreased, and depletion of epidermal and dermal T cells also was observed. T-cell counts decreased from 50–55 at baseline to 15 at 8 weeks post treatment.

Dr. Cooper and Dr. Kagen, now in private practice in Orlando, do not have a relevant conflict of interest.

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

CHICAGO — A single 10 minimal erythema dose from an excimer laser can safely and effectively treat moderate to severe plaque psoriasis, Kevin D. Cooper, M.D., said at the 11th International Psoriasis Symposium sponsored by the Skin Disease Education Foundation.

The 308-nm XTRAC excimer laser treatment system (PhotoMedex, Montgomeryville, Pa.) is the first laser treatment approved for psoriasis.

It offers an obvious advantage over conventional phototherapy because it can target lesional skin with a higher initial dose of ultraviolet radiation, he said.

What hasn't been known is the optimal dose needed to treat moderate to severe psoriasis.

A minimal erythema dose (MED) of 4–16 has been used. But crusting of the involved skin can occur if the dose exceeds 10 MED, said Dr. Cooper, professor and chair of dermatology at Case Western Reserve University, Cleveland.

In a study that was led by his former colleague Mark Kagen, M.D., 15 patients with a mean Psoriasis Area and Severity Index (PASI) score of 18.9 and a lesional thickness of 168 μm were treated on the trunk and extremities with a single dose of 10 MED from the XTRAC excimer laser.

Patients responded rapidly at 2 and 4 weeks post treatment. On average, PASI scores were reduced from 18.9 at baseline to 8 by week 8.

"What's remarkable is that this is a single dose," Dr. Cooper said.

The response was limited to the area treated, but improvement was noted in patients of all skin types, including Fitzpatrick skin type V.

Biopsies were performed on lesions in eight patients. Lesion thickness decreased, and depletion of epidermal and dermal T cells also was observed. T-cell counts decreased from 50–55 at baseline to 15 at 8 weeks post treatment.

Dr. Cooper and Dr. Kagen, now in private practice in Orlando, do not have a relevant conflict of interest.

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

CHICAGO — A single 10 minimal erythema dose from an excimer laser can safely and effectively treat moderate to severe plaque psoriasis, Kevin D. Cooper, M.D., said at the 11th International Psoriasis Symposium sponsored by the Skin Disease Education Foundation.

The 308-nm XTRAC excimer laser treatment system (PhotoMedex, Montgomeryville, Pa.) is the first laser treatment approved for psoriasis.

It offers an obvious advantage over conventional phototherapy because it can target lesional skin with a higher initial dose of ultraviolet radiation, he said.

What hasn't been known is the optimal dose needed to treat moderate to severe psoriasis.

A minimal erythema dose (MED) of 4–16 has been used. But crusting of the involved skin can occur if the dose exceeds 10 MED, said Dr. Cooper, professor and chair of dermatology at Case Western Reserve University, Cleveland.

In a study that was led by his former colleague Mark Kagen, M.D., 15 patients with a mean Psoriasis Area and Severity Index (PASI) score of 18.9 and a lesional thickness of 168 μm were treated on the trunk and extremities with a single dose of 10 MED from the XTRAC excimer laser.

Patients responded rapidly at 2 and 4 weeks post treatment. On average, PASI scores were reduced from 18.9 at baseline to 8 by week 8.

"What's remarkable is that this is a single dose," Dr. Cooper said.

The response was limited to the area treated, but improvement was noted in patients of all skin types, including Fitzpatrick skin type V.

Biopsies were performed on lesions in eight patients. Lesion thickness decreased, and depletion of epidermal and dermal T cells also was observed. T-cell counts decreased from 50–55 at baseline to 15 at 8 weeks post treatment.

Dr. Cooper and Dr. Kagen, now in private practice in Orlando, do not have a relevant conflict of interest.

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

The Adiana transcervical sterilization system appears to be easy to use, safe, and effective, according to phase III data, Alan Johns, M.D., reported at the annual meeting of the AAGL.

The Adiana Complete system is available only for experimental use, but U.S. Food and Drug Administration submission is anticipated in mid-2006, said Dr. Johns, one of the clinical investigators in the trial.

The FDA approved Essure, currently the only nonincisional approach to female sterilization, in November 2002. The Adiana system “is the next step in the evolution of hysteroscopic devices,” Dr. Johns said in an interview. It may be better than the Essure simply because it doesn't require as much manipulation and the whole device is altogether shorter and easier to put in and cannulate, he said. “More importantly, in contrast to the Essure system, after the Adiana matrix has been deployed, nothing remains in the endometrial cavity.”

This may be important in women who later choose to undergo in vitro fertilization or endometrial ablation, because these options can be limited by the presence of a portion of a device in the endometrial cavity, he said.

The Adiana system also differs from Essure in that it uses radio frequency energy before placement of the polymer matrix in the fallopian tubes. This process is designed to stimulate vascularized tissue ingrowth into the matrix material, said Dr. Johns of Fort Worth, Tex. He accepted payment to enroll and treat patients in the trial but said he has no financial interest in Adiana Inc.

As of Sept. 30, 2005, the Evaluation of the Adiana System for Transcervical Sterilization Using Electrothermal Energy in Women (EASE) study had enrolled 770 women at 16 sites. Almost half (47%) were aged 28–33 years. A total of 655 patients were taken for hysteroscopy, and 10 were excluded for hysteroscopic findings. The remaining 115 patients either withdrew from the study or were excluded from the study protocol.

Treatment was attempted in 645 patients and bilateral placement was achieved in 614 (95%).

This placement rate is comparable with that attained by Essure in its clinical trials, he said. Lateral location of the ostia is the most common reason for failure of placement of hysteroscopic sterilization devices.

The average procedure time from insertion to removal of the hysteroscope was 12 minutes. Local and oral anesthesia was used in 35% of patients, local anesthesia plus intravenous sedation in 48%, and local plus intravenous analgesia in 17%. Nine patients were lost to follow-up or are awaiting 3-month hysterosalpingogram (HSG).

Failure of tubal occlusion occurred in 26 (4.29%) women, and there were two pregnancies. One occurred after proper placement of the device and HSG confirmation of occlusion. The second occurred when a physician misinterpreted the HSG and retreated the patient but placed the device in the occluded tube instead of the patent tube. There were no device-related significant adverse events. One procedure-related incident of hyponatremia was reported. All other events were minor and included spotting, cramping, and headache.

Radiofrequency energy is used before the Adiana implantable matrix is placed in the fallopian tubes. Adiana, Inc.

After the Adiana polymer matrix has been deployed, nothing remains in the endometrial cavity. Adiana, Inc.

The Adiana transcervical sterilization system appears to be easy to use, safe, and effective, according to phase III data, Alan Johns, M.D., reported at the annual meeting of the AAGL.

The Adiana Complete system is available only for experimental use, but U.S. Food and Drug Administration submission is anticipated in mid-2006, said Dr. Johns, one of the clinical investigators in the trial.

The FDA approved Essure, currently the only nonincisional approach to female sterilization, in November 2002. The Adiana system “is the next step in the evolution of hysteroscopic devices,” Dr. Johns said in an interview. It may be better than the Essure simply because it doesn't require as much manipulation and the whole device is altogether shorter and easier to put in and cannulate, he said. “More importantly, in contrast to the Essure system, after the Adiana matrix has been deployed, nothing remains in the endometrial cavity.”

This may be important in women who later choose to undergo in vitro fertilization or endometrial ablation, because these options can be limited by the presence of a portion of a device in the endometrial cavity, he said.

The Adiana system also differs from Essure in that it uses radio frequency energy before placement of the polymer matrix in the fallopian tubes. This process is designed to stimulate vascularized tissue ingrowth into the matrix material, said Dr. Johns of Fort Worth, Tex. He accepted payment to enroll and treat patients in the trial but said he has no financial interest in Adiana Inc.

As of Sept. 30, 2005, the Evaluation of the Adiana System for Transcervical Sterilization Using Electrothermal Energy in Women (EASE) study had enrolled 770 women at 16 sites. Almost half (47%) were aged 28–33 years. A total of 655 patients were taken for hysteroscopy, and 10 were excluded for hysteroscopic findings. The remaining 115 patients either withdrew from the study or were excluded from the study protocol.

Treatment was attempted in 645 patients and bilateral placement was achieved in 614 (95%).

This placement rate is comparable with that attained by Essure in its clinical trials, he said. Lateral location of the ostia is the most common reason for failure of placement of hysteroscopic sterilization devices.

The average procedure time from insertion to removal of the hysteroscope was 12 minutes. Local and oral anesthesia was used in 35% of patients, local anesthesia plus intravenous sedation in 48%, and local plus intravenous analgesia in 17%. Nine patients were lost to follow-up or are awaiting 3-month hysterosalpingogram (HSG).

Failure of tubal occlusion occurred in 26 (4.29%) women, and there were two pregnancies. One occurred after proper placement of the device and HSG confirmation of occlusion. The second occurred when a physician misinterpreted the HSG and retreated the patient but placed the device in the occluded tube instead of the patent tube. There were no device-related significant adverse events. One procedure-related incident of hyponatremia was reported. All other events were minor and included spotting, cramping, and headache.

Radiofrequency energy is used before the Adiana implantable matrix is placed in the fallopian tubes. Adiana, Inc.

After the Adiana polymer matrix has been deployed, nothing remains in the endometrial cavity. Adiana, Inc.

The Adiana transcervical sterilization system appears to be easy to use, safe, and effective, according to phase III data, Alan Johns, M.D., reported at the annual meeting of the AAGL.

The Adiana Complete system is available only for experimental use, but U.S. Food and Drug Administration submission is anticipated in mid-2006, said Dr. Johns, one of the clinical investigators in the trial.

The FDA approved Essure, currently the only nonincisional approach to female sterilization, in November 2002. The Adiana system “is the next step in the evolution of hysteroscopic devices,” Dr. Johns said in an interview. It may be better than the Essure simply because it doesn't require as much manipulation and the whole device is altogether shorter and easier to put in and cannulate, he said. “More importantly, in contrast to the Essure system, after the Adiana matrix has been deployed, nothing remains in the endometrial cavity.”

This may be important in women who later choose to undergo in vitro fertilization or endometrial ablation, because these options can be limited by the presence of a portion of a device in the endometrial cavity, he said.

The Adiana system also differs from Essure in that it uses radio frequency energy before placement of the polymer matrix in the fallopian tubes. This process is designed to stimulate vascularized tissue ingrowth into the matrix material, said Dr. Johns of Fort Worth, Tex. He accepted payment to enroll and treat patients in the trial but said he has no financial interest in Adiana Inc.

As of Sept. 30, 2005, the Evaluation of the Adiana System for Transcervical Sterilization Using Electrothermal Energy in Women (EASE) study had enrolled 770 women at 16 sites. Almost half (47%) were aged 28–33 years. A total of 655 patients were taken for hysteroscopy, and 10 were excluded for hysteroscopic findings. The remaining 115 patients either withdrew from the study or were excluded from the study protocol.

Treatment was attempted in 645 patients and bilateral placement was achieved in 614 (95%).

This placement rate is comparable with that attained by Essure in its clinical trials, he said. Lateral location of the ostia is the most common reason for failure of placement of hysteroscopic sterilization devices.

The average procedure time from insertion to removal of the hysteroscope was 12 minutes. Local and oral anesthesia was used in 35% of patients, local anesthesia plus intravenous sedation in 48%, and local plus intravenous analgesia in 17%. Nine patients were lost to follow-up or are awaiting 3-month hysterosalpingogram (HSG).

Failure of tubal occlusion occurred in 26 (4.29%) women, and there were two pregnancies. One occurred after proper placement of the device and HSG confirmation of occlusion. The second occurred when a physician misinterpreted the HSG and retreated the patient but placed the device in the occluded tube instead of the patent tube. There were no device-related significant adverse events. One procedure-related incident of hyponatremia was reported. All other events were minor and included spotting, cramping, and headache.

Radiofrequency energy is used before the Adiana implantable matrix is placed in the fallopian tubes. Adiana, Inc.

After the Adiana polymer matrix has been deployed, nothing remains in the endometrial cavity. Adiana, Inc.

QUEBEC CITY — Women who have had a low-trauma fracture are not getting the follow-up they need for osteoporosis, Sonia Singh, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

History of a low-trauma fracture is associated with a 40% increased risk of hip fracture, Dr. Singh said.

A retrospective chart review identified 100 women, 40 years or older, who presented with a low-trauma fracture to a community hospital emergency department. A questionnaire was sent to them 6–9 months after a fracture to determine whether they had been given a diagnosis of osteoporosis or received any treatment.

Preliminary results from 42 women showed that 22 (52%) had received no follow-up, 12 (29%) had received an ultrasound or bone mineral density scan, and 8 (19%) had follow-up without testing.

Of the 20 patients with follow-up, 7 (35%) had been prescribed medications.

Interviews with the women revealed only seven (17%) thought they were at an increased risk for another fracture.

Surprisingly, a history of two or three fractures did little to change that perception or to improve medication rates, said Dr. Singh, clinical research associate, Peace Arch Hospital, White Rock, B.C., Canada.

A previous study found similar follow-up and treatment rates, with fewer than 20% of 108 men and women who presented with fragility-type fractures at three Ontario hospitals receiving follow-up 1 year later (CMAJ 2000;163:819–22). “Despite the fact there has been a heightened profile for osteoporosis, that … has not improved the management,” she said.

QUEBEC CITY — Women who have had a low-trauma fracture are not getting the follow-up they need for osteoporosis, Sonia Singh, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

History of a low-trauma fracture is associated with a 40% increased risk of hip fracture, Dr. Singh said.

A retrospective chart review identified 100 women, 40 years or older, who presented with a low-trauma fracture to a community hospital emergency department. A questionnaire was sent to them 6–9 months after a fracture to determine whether they had been given a diagnosis of osteoporosis or received any treatment.

Preliminary results from 42 women showed that 22 (52%) had received no follow-up, 12 (29%) had received an ultrasound or bone mineral density scan, and 8 (19%) had follow-up without testing.

Of the 20 patients with follow-up, 7 (35%) had been prescribed medications.

Interviews with the women revealed only seven (17%) thought they were at an increased risk for another fracture.

Surprisingly, a history of two or three fractures did little to change that perception or to improve medication rates, said Dr. Singh, clinical research associate, Peace Arch Hospital, White Rock, B.C., Canada.

A previous study found similar follow-up and treatment rates, with fewer than 20% of 108 men and women who presented with fragility-type fractures at three Ontario hospitals receiving follow-up 1 year later (CMAJ 2000;163:819–22). “Despite the fact there has been a heightened profile for osteoporosis, that … has not improved the management,” she said.

QUEBEC CITY — Women who have had a low-trauma fracture are not getting the follow-up they need for osteoporosis, Sonia Singh, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

History of a low-trauma fracture is associated with a 40% increased risk of hip fracture, Dr. Singh said.

A retrospective chart review identified 100 women, 40 years or older, who presented with a low-trauma fracture to a community hospital emergency department. A questionnaire was sent to them 6–9 months after a fracture to determine whether they had been given a diagnosis of osteoporosis or received any treatment.

Preliminary results from 42 women showed that 22 (52%) had received no follow-up, 12 (29%) had received an ultrasound or bone mineral density scan, and 8 (19%) had follow-up without testing.

Of the 20 patients with follow-up, 7 (35%) had been prescribed medications.

Interviews with the women revealed only seven (17%) thought they were at an increased risk for another fracture.

Surprisingly, a history of two or three fractures did little to change that perception or to improve medication rates, said Dr. Singh, clinical research associate, Peace Arch Hospital, White Rock, B.C., Canada.

A previous study found similar follow-up and treatment rates, with fewer than 20% of 108 men and women who presented with fragility-type fractures at three Ontario hospitals receiving follow-up 1 year later (CMAJ 2000;163:819–22). “Despite the fact there has been a heightened profile for osteoporosis, that … has not improved the management,” she said.

QUEBEC CITY — Women who have had a low-trauma fracture are not getting the follow-up they need for osteoporosis, Sonia Singh, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

History of a previous low-trauma fracture is associated with a 40% increased risk of hip fracture, Dr. Singh reported.

A retrospective chart review identified 100 women aged 40 years or older who presented with a low-trauma fracture to a community hospital emergency department.

A questionnaire was sent to the women 6–9 months after the fracture to determine if they had been given a diagnosis of osteoporosis or had received any treatment, even just calcium supplementation.

Preliminary results from 42 women showed that 22 (52%) had no follow-up, 12 (29%) had received an ultrasound or bone mineral density scan, and 8 (19%) had follow-up without testing.

Of the 20 patients with follow-up, 7 (35%) had been prescribed medications.

Interviews with the women revealed that only 7 (17%) thought they were at an increased risk for another fracture.

Surprisingly, having had two or three previous fractures did little to change that perception or to improve medication rates, said Dr. Singh, clinical research associate, Peace Arch Hospital, White Rock, B.C., Canada.

A previous study found similar follow-up and treatment rates, with fewer than 20% of 108 men and women who presented with fragility-type fractures at three Ontario hospitals receiving follow-up 1 year later (CMAJ 2000;163:819–22).

“Despite the fact there has been a heightened profile for osteoporosis, that in itself has not improved the management,” she said. “Our follow-up and treatment [findings] were a little better than the previous studies, but it's still not acceptable.”

QUEBEC CITY — Women who have had a low-trauma fracture are not getting the follow-up they need for osteoporosis, Sonia Singh, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

History of a previous low-trauma fracture is associated with a 40% increased risk of hip fracture, Dr. Singh reported.

A retrospective chart review identified 100 women aged 40 years or older who presented with a low-trauma fracture to a community hospital emergency department.

A questionnaire was sent to the women 6–9 months after the fracture to determine if they had been given a diagnosis of osteoporosis or had received any treatment, even just calcium supplementation.

Preliminary results from 42 women showed that 22 (52%) had no follow-up, 12 (29%) had received an ultrasound or bone mineral density scan, and 8 (19%) had follow-up without testing.

Of the 20 patients with follow-up, 7 (35%) had been prescribed medications.

Interviews with the women revealed that only 7 (17%) thought they were at an increased risk for another fracture.

Surprisingly, having had two or three previous fractures did little to change that perception or to improve medication rates, said Dr. Singh, clinical research associate, Peace Arch Hospital, White Rock, B.C., Canada.

A previous study found similar follow-up and treatment rates, with fewer than 20% of 108 men and women who presented with fragility-type fractures at three Ontario hospitals receiving follow-up 1 year later (CMAJ 2000;163:819–22).

“Despite the fact there has been a heightened profile for osteoporosis, that in itself has not improved the management,” she said. “Our follow-up and treatment [findings] were a little better than the previous studies, but it's still not acceptable.”

QUEBEC CITY — Women who have had a low-trauma fracture are not getting the follow-up they need for osteoporosis, Sonia Singh, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

History of a previous low-trauma fracture is associated with a 40% increased risk of hip fracture, Dr. Singh reported.

A retrospective chart review identified 100 women aged 40 years or older who presented with a low-trauma fracture to a community hospital emergency department.

A questionnaire was sent to the women 6–9 months after the fracture to determine if they had been given a diagnosis of osteoporosis or had received any treatment, even just calcium supplementation.

Preliminary results from 42 women showed that 22 (52%) had no follow-up, 12 (29%) had received an ultrasound or bone mineral density scan, and 8 (19%) had follow-up without testing.

Of the 20 patients with follow-up, 7 (35%) had been prescribed medications.

Interviews with the women revealed that only 7 (17%) thought they were at an increased risk for another fracture.

Surprisingly, having had two or three previous fractures did little to change that perception or to improve medication rates, said Dr. Singh, clinical research associate, Peace Arch Hospital, White Rock, B.C., Canada.

A previous study found similar follow-up and treatment rates, with fewer than 20% of 108 men and women who presented with fragility-type fractures at three Ontario hospitals receiving follow-up 1 year later (CMAJ 2000;163:819–22).

“Despite the fact there has been a heightened profile for osteoporosis, that in itself has not improved the management,” she said. “Our follow-up and treatment [findings] were a little better than the previous studies, but it's still not acceptable.”

Women of all ethnicities face the same increased risk for breast cancer related to postmenopausal hormone therapy, a study suggests.

The study also found that leaner women taking hormone therapy (HT) had a relatively greater increase in breast cancer risk than did heavier women.

The study, led by Sulggi Lee, M.D., of the Keck School of Medicine at the University of Southern California, Los Angeles, provides some of the first data comparing breast cancer risk among different ethnic groups in relation to HT use.

The cohort study was conducted among 55,371 African-American, Native Hawaiian, Japanese-American, Hispanic, and white postmenopausal women, aged 45–75 years, in the Hawaii-Los Angeles Multiethnic Cohort study.

A total of 1,615 incident invasive breast cancer cases were identified over an average of 7.3 years (Int. J. Cancer [Epub ahead of print] 2005;doi: 10.1002/ijc.21481 www.interscience.wiley.com

Current estrogen-progestin therapy (EPT) use was associated with a 29% increased risk of breast cancer after 5 years of use. Current use of unopposed estrogen therapy (ET) was associated with a 10% increase in risk after 5 years. These results assume that women using hormones at baseline continued to do so.

The increase in risk with EPT use was clearly seen in all ethnic groups, whereas the increase with ET use was seen in all groups except African Americans.

Relative risks for current EPT and ET use were greater for women with a body mass index of less than 25 kg/m

“Data on this aspect of the relationship between EPT use and risk are scarce, and it is too early to draw a firm conclusion,” the authors wrote.

Current EPT use was significantly associated only with estrogen receptor-positive (ER+)/ progesterone receptor-positive (PR+) tumors (relative risk 1.34), but risk also was increased for both ER+/progesterone receptor-negative (PR−) tumors (RR 1.15) and estrogen receptor-negative (ER−)/PR+ tumors (RR 1.18).

Estrogen therapy was associated with both ER+/PR+ and ER+/PR− tumors. These findings are generally consistent with earlier studies.

There was little difference in risk by stage of disease or histological subtype.

The authors noted the possibility that their results may have been influenced by the fact that HT users are more likely to be screened for breast cancer.

Women of all ethnicities face the same increased risk for breast cancer related to postmenopausal hormone therapy, a study suggests.

The study also found that leaner women taking hormone therapy (HT) had a relatively greater increase in breast cancer risk than did heavier women.

The study, led by Sulggi Lee, M.D., of the Keck School of Medicine at the University of Southern California, Los Angeles, provides some of the first data comparing breast cancer risk among different ethnic groups in relation to HT use.

The cohort study was conducted among 55,371 African-American, Native Hawaiian, Japanese-American, Hispanic, and white postmenopausal women, aged 45–75 years, in the Hawaii-Los Angeles Multiethnic Cohort study.

A total of 1,615 incident invasive breast cancer cases were identified over an average of 7.3 years (Int. J. Cancer [Epub ahead of print] 2005;doi: 10.1002/ijc.21481 www.interscience.wiley.com

Current estrogen-progestin therapy (EPT) use was associated with a 29% increased risk of breast cancer after 5 years of use. Current use of unopposed estrogen therapy (ET) was associated with a 10% increase in risk after 5 years. These results assume that women using hormones at baseline continued to do so.

The increase in risk with EPT use was clearly seen in all ethnic groups, whereas the increase with ET use was seen in all groups except African Americans.

Relative risks for current EPT and ET use were greater for women with a body mass index of less than 25 kg/m

“Data on this aspect of the relationship between EPT use and risk are scarce, and it is too early to draw a firm conclusion,” the authors wrote.

Current EPT use was significantly associated only with estrogen receptor-positive (ER+)/ progesterone receptor-positive (PR+) tumors (relative risk 1.34), but risk also was increased for both ER+/progesterone receptor-negative (PR−) tumors (RR 1.15) and estrogen receptor-negative (ER−)/PR+ tumors (RR 1.18).

Estrogen therapy was associated with both ER+/PR+ and ER+/PR− tumors. These findings are generally consistent with earlier studies.

There was little difference in risk by stage of disease or histological subtype.

The authors noted the possibility that their results may have been influenced by the fact that HT users are more likely to be screened for breast cancer.

Women of all ethnicities face the same increased risk for breast cancer related to postmenopausal hormone therapy, a study suggests.

The study also found that leaner women taking hormone therapy (HT) had a relatively greater increase in breast cancer risk than did heavier women.

The study, led by Sulggi Lee, M.D., of the Keck School of Medicine at the University of Southern California, Los Angeles, provides some of the first data comparing breast cancer risk among different ethnic groups in relation to HT use.

The cohort study was conducted among 55,371 African-American, Native Hawaiian, Japanese-American, Hispanic, and white postmenopausal women, aged 45–75 years, in the Hawaii-Los Angeles Multiethnic Cohort study.

A total of 1,615 incident invasive breast cancer cases were identified over an average of 7.3 years (Int. J. Cancer [Epub ahead of print] 2005;doi: 10.1002/ijc.21481 www.interscience.wiley.com

Current estrogen-progestin therapy (EPT) use was associated with a 29% increased risk of breast cancer after 5 years of use. Current use of unopposed estrogen therapy (ET) was associated with a 10% increase in risk after 5 years. These results assume that women using hormones at baseline continued to do so.

The increase in risk with EPT use was clearly seen in all ethnic groups, whereas the increase with ET use was seen in all groups except African Americans.

Relative risks for current EPT and ET use were greater for women with a body mass index of less than 25 kg/m

“Data on this aspect of the relationship between EPT use and risk are scarce, and it is too early to draw a firm conclusion,” the authors wrote.

Current EPT use was significantly associated only with estrogen receptor-positive (ER+)/ progesterone receptor-positive (PR+) tumors (relative risk 1.34), but risk also was increased for both ER+/progesterone receptor-negative (PR−) tumors (RR 1.15) and estrogen receptor-negative (ER−)/PR+ tumors (RR 1.18).

Estrogen therapy was associated with both ER+/PR+ and ER+/PR− tumors. These findings are generally consistent with earlier studies.

There was little difference in risk by stage of disease or histological subtype.

The authors noted the possibility that their results may have been influenced by the fact that HT users are more likely to be screened for breast cancer.

QUEBEC CITY — A series of telephone calls can significantly improve cancer screening rates among low-income women, a randomized controlled trial suggests.

Not all practices have the resources to implement such an intervention, Allen J. Dietrich, M.D., said at the annual meeting of the North American Primary Care Research Group. But the model is compatible with telephone support systems available in many health care groups.

He presented a study in which 1,390 women aged 50–69 years were recruited from 11 community and migrant health centers in New York City that are part of a practice-based research network. Most women were overdue for two or all three of the following cancer screenings: Pap, mammography, and colorectal.

Patients were randomized to usual care or to an intervention that included a series of telephone calls to assess patient barriers to screening, provide any needed education, and assist with access to services.

Many of the women were foreign born, and Spanish was the primary language for 445 (64%) of the 696 women in the intervention group. An average of four 15-minute telephone calls were made to the women by master's degree students, who followed a bilingual script. Education materials and clinician recommendation letters were mailed also.

An analysis showed that 37% of patients received education alone, 9% education plus an appointment reminder, 7% education plus access assistance, 2% access assistance alone, and 18% received a phone call but did not receive any of the three types of support.

Despite a large media campaign on colon cancer led by television anchor Katie Couric at the time of the study, the largest barriers were to colorectal screening, said Dr. Dietrich, associate director for population science at the Norris Cotton Cancer Center in Lebanon and Dartmouth Medical School, Hanover, both in N.H. Women had no information, disinformation, or had not received a clinical recommendation for this particular service.

When the subject of home fecal occult blood testing was broached, the response from many of the women was, “You want me to do what?” The response became so common that staff referred to it by initials alone.

Between baseline and follow-up at 18 months, all three screening services increased significantly more for the intervention group, compared with the usual care group.

Colorectal cancer screening increased the most, with more than a 60% increase observed for the intervention group.

There was a 17% increase in mammography and a 10% increase in Pap testing.

In the usual care group, mammography and Pap testing rates remained about the same as at baseline and colorectal screenings increase slightly.

The next step for the researchers is to replicate the findings in Medicare or managed care organizations in New York City. They plan to use billing data rather than chart records to identify women in need and perhaps to combine the telephone interventions with existing outreach efforts such as child immunization reminders.

“This is centralized telephone resources as an intervention, but clearly there are other things that are needed to address these health care disparities,” Dr. Dietrich said. “This isn't the answer to everything anymore than office systems are the answer to everything. We need more intervention research that increases the options to address prevention care services and their disparities in primary care.”

QUEBEC CITY — A series of telephone calls can significantly improve cancer screening rates among low-income women, a randomized controlled trial suggests.

Not all practices have the resources to implement such an intervention, Allen J. Dietrich, M.D., said at the annual meeting of the North American Primary Care Research Group. But the model is compatible with telephone support systems available in many health care groups.

He presented a study in which 1,390 women aged 50–69 years were recruited from 11 community and migrant health centers in New York City that are part of a practice-based research network. Most women were overdue for two or all three of the following cancer screenings: Pap, mammography, and colorectal.

Patients were randomized to usual care or to an intervention that included a series of telephone calls to assess patient barriers to screening, provide any needed education, and assist with access to services.

Many of the women were foreign born, and Spanish was the primary language for 445 (64%) of the 696 women in the intervention group. An average of four 15-minute telephone calls were made to the women by master's degree students, who followed a bilingual script. Education materials and clinician recommendation letters were mailed also.

An analysis showed that 37% of patients received education alone, 9% education plus an appointment reminder, 7% education plus access assistance, 2% access assistance alone, and 18% received a phone call but did not receive any of the three types of support.

Despite a large media campaign on colon cancer led by television anchor Katie Couric at the time of the study, the largest barriers were to colorectal screening, said Dr. Dietrich, associate director for population science at the Norris Cotton Cancer Center in Lebanon and Dartmouth Medical School, Hanover, both in N.H. Women had no information, disinformation, or had not received a clinical recommendation for this particular service.

When the subject of home fecal occult blood testing was broached, the response from many of the women was, “You want me to do what?” The response became so common that staff referred to it by initials alone.

Between baseline and follow-up at 18 months, all three screening services increased significantly more for the intervention group, compared with the usual care group.

Colorectal cancer screening increased the most, with more than a 60% increase observed for the intervention group.

There was a 17% increase in mammography and a 10% increase in Pap testing.

In the usual care group, mammography and Pap testing rates remained about the same as at baseline and colorectal screenings increase slightly.

The next step for the researchers is to replicate the findings in Medicare or managed care organizations in New York City. They plan to use billing data rather than chart records to identify women in need and perhaps to combine the telephone interventions with existing outreach efforts such as child immunization reminders.

“This is centralized telephone resources as an intervention, but clearly there are other things that are needed to address these health care disparities,” Dr. Dietrich said. “This isn't the answer to everything anymore than office systems are the answer to everything. We need more intervention research that increases the options to address prevention care services and their disparities in primary care.”

QUEBEC CITY — A series of telephone calls can significantly improve cancer screening rates among low-income women, a randomized controlled trial suggests.

Not all practices have the resources to implement such an intervention, Allen J. Dietrich, M.D., said at the annual meeting of the North American Primary Care Research Group. But the model is compatible with telephone support systems available in many health care groups.

He presented a study in which 1,390 women aged 50–69 years were recruited from 11 community and migrant health centers in New York City that are part of a practice-based research network. Most women were overdue for two or all three of the following cancer screenings: Pap, mammography, and colorectal.

Patients were randomized to usual care or to an intervention that included a series of telephone calls to assess patient barriers to screening, provide any needed education, and assist with access to services.

Many of the women were foreign born, and Spanish was the primary language for 445 (64%) of the 696 women in the intervention group. An average of four 15-minute telephone calls were made to the women by master's degree students, who followed a bilingual script. Education materials and clinician recommendation letters were mailed also.

An analysis showed that 37% of patients received education alone, 9% education plus an appointment reminder, 7% education plus access assistance, 2% access assistance alone, and 18% received a phone call but did not receive any of the three types of support.

Despite a large media campaign on colon cancer led by television anchor Katie Couric at the time of the study, the largest barriers were to colorectal screening, said Dr. Dietrich, associate director for population science at the Norris Cotton Cancer Center in Lebanon and Dartmouth Medical School, Hanover, both in N.H. Women had no information, disinformation, or had not received a clinical recommendation for this particular service.

When the subject of home fecal occult blood testing was broached, the response from many of the women was, “You want me to do what?” The response became so common that staff referred to it by initials alone.

Between baseline and follow-up at 18 months, all three screening services increased significantly more for the intervention group, compared with the usual care group.

Colorectal cancer screening increased the most, with more than a 60% increase observed for the intervention group.

There was a 17% increase in mammography and a 10% increase in Pap testing.

In the usual care group, mammography and Pap testing rates remained about the same as at baseline and colorectal screenings increase slightly.

The next step for the researchers is to replicate the findings in Medicare or managed care organizations in New York City. They plan to use billing data rather than chart records to identify women in need and perhaps to combine the telephone interventions with existing outreach efforts such as child immunization reminders.

“This is centralized telephone resources as an intervention, but clearly there are other things that are needed to address these health care disparities,” Dr. Dietrich said. “This isn't the answer to everything anymore than office systems are the answer to everything. We need more intervention research that increases the options to address prevention care services and their disparities in primary care.”

QUEBEC CITY — The use of rapid human immunodeficiency virus testing has had a profound impact on primary care settings in New Jersey, Denise Young, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

Because the test doesn't require a second visit to receive results, more HIV-positive patients are learning of their HIV status and receiving counseling.

New Jersey, which is fifth in the United States in cumulative reported AIDS cases and first in the proportion of women living with AIDS, introduced rapid HIV testing at publicly funded testing and counseling clinics in November 2003. It is now used in 90 sites throughout the state.

Testing has been done with the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, Pa.), which is approved by the Food and Drug Administration for use with whole blood. It is not approved for serum testing or stored samples.

A whole-blood specimen is obtained via fingerstick or venipuncture and inserted into the testing device, which resembles a home pregnancy test kit. Results are ready in 20 minutes.

This compares with 1–2 weeks for the most commonly used initial HIV test, the enzyme immune assay, confirmed with Western blot or immunofluorescence assay.

Prior to rapid testing, only 65% of patients in New Jersey returned for their results.

In contrast, 99.7% of 25,264 patients screened with rapid HIV testing got their results and received counseling, according to an analysis of state databases through July 21, 2005.

A total of 510 (2%) patients were HIV positive. Of these, 327 (64%) were newly diagnosed, reported Dr. Young, Robert Wood Johnson Medical School, New Brunswick, N.J., and her associates. Further analysis will determine if the seroprevalence at rapid test sites is the same as at traditional testing sites, or if newly diagnosed patients are getting into treatment services in a timely manner, she said.

It is hoped that by providing the opportunity to engage patients more quickly, the test will help decrease the mortality and morbidity associated with HIV infection.

Rapid testing is also being looked at as a way to lessen racial disparities that exist in New Jersey, which has one of the highest HIV infection rates in the nation, she said.

One in every 66 African Americans and 1 in every 171 Hispanics in New Jersey is living with HIV/AIDS, according the New Jersey Department of Health and Senior Services.

The state health department encourages the use of rapid testing for occupational exposures and in pregnant women to cut the risk of mother-to-child transmission, according to statements from the department. But there are trade-offs. More HIV-positive people will get their results, but some people will receive a false-positive result.

Postmarketing surveillance on the OraQuick test initiated by the Centers for Disease Control and Prevention in September 2003 has identified at least five HIV-infected patients who were incorrectly informed their rapid HIV test results were positive, according to the CDC's Web site.

Publicly funded sites in New Jersey follow CDC protocol, which recommends all preliminary positive results with rapid HIV testing be confirmed by Western blot or immunofluorescence assay, Dr. Young said.

QUEBEC CITY — The use of rapid human immunodeficiency virus testing has had a profound impact on primary care settings in New Jersey, Denise Young, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

Because the test doesn't require a second visit to receive results, more HIV-positive patients are learning of their HIV status and receiving counseling.

New Jersey, which is fifth in the United States in cumulative reported AIDS cases and first in the proportion of women living with AIDS, introduced rapid HIV testing at publicly funded testing and counseling clinics in November 2003. It is now used in 90 sites throughout the state.

Testing has been done with the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, Pa.), which is approved by the Food and Drug Administration for use with whole blood. It is not approved for serum testing or stored samples.

A whole-blood specimen is obtained via fingerstick or venipuncture and inserted into the testing device, which resembles a home pregnancy test kit. Results are ready in 20 minutes.

This compares with 1–2 weeks for the most commonly used initial HIV test, the enzyme immune assay, confirmed with Western blot or immunofluorescence assay.

Prior to rapid testing, only 65% of patients in New Jersey returned for their results.

In contrast, 99.7% of 25,264 patients screened with rapid HIV testing got their results and received counseling, according to an analysis of state databases through July 21, 2005.

A total of 510 (2%) patients were HIV positive. Of these, 327 (64%) were newly diagnosed, reported Dr. Young, Robert Wood Johnson Medical School, New Brunswick, N.J., and her associates. Further analysis will determine if the seroprevalence at rapid test sites is the same as at traditional testing sites, or if newly diagnosed patients are getting into treatment services in a timely manner, she said.

It is hoped that by providing the opportunity to engage patients more quickly, the test will help decrease the mortality and morbidity associated with HIV infection.

Rapid testing is also being looked at as a way to lessen racial disparities that exist in New Jersey, which has one of the highest HIV infection rates in the nation, she said.

One in every 66 African Americans and 1 in every 171 Hispanics in New Jersey is living with HIV/AIDS, according the New Jersey Department of Health and Senior Services.

The state health department encourages the use of rapid testing for occupational exposures and in pregnant women to cut the risk of mother-to-child transmission, according to statements from the department. But there are trade-offs. More HIV-positive people will get their results, but some people will receive a false-positive result.

Postmarketing surveillance on the OraQuick test initiated by the Centers for Disease Control and Prevention in September 2003 has identified at least five HIV-infected patients who were incorrectly informed their rapid HIV test results were positive, according to the CDC's Web site.

Publicly funded sites in New Jersey follow CDC protocol, which recommends all preliminary positive results with rapid HIV testing be confirmed by Western blot or immunofluorescence assay, Dr. Young said.

QUEBEC CITY — The use of rapid human immunodeficiency virus testing has had a profound impact on primary care settings in New Jersey, Denise Young, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.

Because the test doesn't require a second visit to receive results, more HIV-positive patients are learning of their HIV status and receiving counseling.

New Jersey, which is fifth in the United States in cumulative reported AIDS cases and first in the proportion of women living with AIDS, introduced rapid HIV testing at publicly funded testing and counseling clinics in November 2003. It is now used in 90 sites throughout the state.

Testing has been done with the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, Pa.), which is approved by the Food and Drug Administration for use with whole blood. It is not approved for serum testing or stored samples.

A whole-blood specimen is obtained via fingerstick or venipuncture and inserted into the testing device, which resembles a home pregnancy test kit. Results are ready in 20 minutes.

This compares with 1–2 weeks for the most commonly used initial HIV test, the enzyme immune assay, confirmed with Western blot or immunofluorescence assay.

Prior to rapid testing, only 65% of patients in New Jersey returned for their results.

In contrast, 99.7% of 25,264 patients screened with rapid HIV testing got their results and received counseling, according to an analysis of state databases through July 21, 2005.

A total of 510 (2%) patients were HIV positive. Of these, 327 (64%) were newly diagnosed, reported Dr. Young, Robert Wood Johnson Medical School, New Brunswick, N.J., and her associates. Further analysis will determine if the seroprevalence at rapid test sites is the same as at traditional testing sites, or if newly diagnosed patients are getting into treatment services in a timely manner, she said.

It is hoped that by providing the opportunity to engage patients more quickly, the test will help decrease the mortality and morbidity associated with HIV infection.

Rapid testing is also being looked at as a way to lessen racial disparities that exist in New Jersey, which has one of the highest HIV infection rates in the nation, she said.

One in every 66 African Americans and 1 in every 171 Hispanics in New Jersey is living with HIV/AIDS, according the New Jersey Department of Health and Senior Services.

The state health department encourages the use of rapid testing for occupational exposures and in pregnant women to cut the risk of mother-to-child transmission, according to statements from the department. But there are trade-offs. More HIV-positive people will get their results, but some people will receive a false-positive result.

Postmarketing surveillance on the OraQuick test initiated by the Centers for Disease Control and Prevention in September 2003 has identified at least five HIV-infected patients who were incorrectly informed their rapid HIV test results were positive, according to the CDC's Web site.

Publicly funded sites in New Jersey follow CDC protocol, which recommends all preliminary positive results with rapid HIV testing be confirmed by Western blot or immunofluorescence assay, Dr. Young said.

QUEBEC CITY — Society may be willing to label anyone who's not rail thin as being overweight, but a new study suggests that physicians are loath to do so, even with the obese.

Researchers randomly identified 486 obese or overweight patients aged 18–70 years in a family medicine clinic by calculating their body mass index (kg/m

“There's still some discomfort. How do we bring it up?” said Cassandra Arceneaux, M.D., of the University of Texas, Galveston. “There needs to be education for the physician on how to talk to patients about weight.”

Another problem may be the way obesity is documented in the chart.

“Some physicians said that it doesn't make sense to talk about obesity because you can't bill for it and get paid,” she said.

Only 3% of overweight (BMI 25–29.9) patients were diagnosed, compared with 7.8% of patients with stage 1 obesity (BMI 30–34.9), 28% of patients with stage 2 obesity (BMI 35–39.9), and 61% of patients with stage 3 obesity (BMI 40 or greater).

Of the total sample, these patients accounted for 37.5%, 26.9%, 16.6%, and 19%, respectively.

Of stage 3 obesity patients, 7% received education compared with 1% of overweight patients, 2.5% of stage 1 obesity patients, and 4% of stage 2 obesity patients.

QUEBEC CITY — Society may be willing to label anyone who's not rail thin as being overweight, but a new study suggests that physicians are loath to do so, even with the obese.

Researchers randomly identified 486 obese or overweight patients aged 18–70 years in a family medicine clinic by calculating their body mass index (kg/m

“There's still some discomfort. How do we bring it up?” said Cassandra Arceneaux, M.D., of the University of Texas, Galveston. “There needs to be education for the physician on how to talk to patients about weight.”

Another problem may be the way obesity is documented in the chart.

“Some physicians said that it doesn't make sense to talk about obesity because you can't bill for it and get paid,” she said.

Only 3% of overweight (BMI 25–29.9) patients were diagnosed, compared with 7.8% of patients with stage 1 obesity (BMI 30–34.9), 28% of patients with stage 2 obesity (BMI 35–39.9), and 61% of patients with stage 3 obesity (BMI 40 or greater).

Of the total sample, these patients accounted for 37.5%, 26.9%, 16.6%, and 19%, respectively.

Of stage 3 obesity patients, 7% received education compared with 1% of overweight patients, 2.5% of stage 1 obesity patients, and 4% of stage 2 obesity patients.

QUEBEC CITY — Society may be willing to label anyone who's not rail thin as being overweight, but a new study suggests that physicians are loath to do so, even with the obese.

Researchers randomly identified 486 obese or overweight patients aged 18–70 years in a family medicine clinic by calculating their body mass index (kg/m

“There's still some discomfort. How do we bring it up?” said Cassandra Arceneaux, M.D., of the University of Texas, Galveston. “There needs to be education for the physician on how to talk to patients about weight.”

Another problem may be the way obesity is documented in the chart.

“Some physicians said that it doesn't make sense to talk about obesity because you can't bill for it and get paid,” she said.

Only 3% of overweight (BMI 25–29.9) patients were diagnosed, compared with 7.8% of patients with stage 1 obesity (BMI 30–34.9), 28% of patients with stage 2 obesity (BMI 35–39.9), and 61% of patients with stage 3 obesity (BMI 40 or greater).

Of the total sample, these patients accounted for 37.5%, 26.9%, 16.6%, and 19%, respectively.

Of stage 3 obesity patients, 7% received education compared with 1% of overweight patients, 2.5% of stage 1 obesity patients, and 4% of stage 2 obesity patients.