Sherry Boschert

SAN FRANCISCO — Give e-mail correspondence with patients the same care and attention you'd give to paper records, faxes, or phone calls in order to minimize medicolegal liability, advises Dr. Jeffrey L. Brown of the Cornell University Medical School in New York.

Physicians should be reasonably certain that the person requesting information by e-mail is authorized to receive it, just as would be done with phone calls, Dr. Brown said at the annual meeting of the American Academy of Pediatrics.

At a minimum, your e-mail system should include an automated response to any e-mails received from patients, acknowledging that an e-mail message has been received and saying that you will respond within a set period of time, such as 24 or 48 hours, said Dr. Brown, who is also in private practice in Rye Brook, N.Y. He has no association with companies that market e-mail systems or services.

The automated response should alert patients that confidentiality cannot always be ensured in e-mail correspondence, and that you cannot respond to urgent questions posed by e-mail. Patients should contact your office by phone for urgent matters.

The response also should inform patients that if they do not get a reply from you to any e-mail message within a reasonable period of time—“usually 48 hours,” Dr. Brown said—the patient should call your office, because you may not have received the e-mail. If you are away from the office when patients e-mail, the automated response should let them know that, and give the date of your return.

In the other direction, e-mails sent by physicians must be compliant with the Health Insurance Portability and Accountability Act (HIPAA). As with faxes, conventional e-mails must protect the confidentiality of sensitive information such as Social Security numbers, medical identification numbers, laboratory results, diagnoses, medications, and more.

To ensure confidentiality in e-mails, use an encrypted message system, Dr. Brown advised. Solo practitioners or small practices may want to do an Internet search for the term “encrypting e-mail systems” to find a list of encryption providers, he said. Typically, an outgoing e-mail would be sent to the provider, encrypted, and returned to the physician's system before going out to a patient.

Or, physicians may want to look into the AAP's partnership with Medem (www.medem.com

Confidential e-mail from physicians should contain a warning disclaimer similar to those used on fax transmissions, Dr. Brown suggested.

Treat e-mail messages like other patient correspondence, and file them appropriately, he added. Before erasing e-mail, save the patient's original e-mail and your response as hard copies in the patient's chart or electronically if you use electronic charts.

Take precautions to protect confidential information on laptop computers and hard drives, as you would for other medical records.

Use encryption software or change passwords frequently to prevent unauthorized access.

Erase all confidential information from hard drives before disposing of them.

“Even if you do all the right things, there is still a possibility that you will be subject to suits,” Dr. Brown said. “In the end, the best defense against legal action is practicing good medicine.”

E-Mail Don'ts

▸ Do not use your personal e-mail address to answer patient e-mails.

▸ Do not answer a new patient's e-mailed medical questions without first establishing a formal relationship. You have no idea who they are and what their problems are.

▸ Do not forward a patient's e-mail correspondence or address to a third party without first getting the patient's consent.

▸ Do not use an indiscreet topic in the heading of your response. Don't write, “Your pregnancy test is positive” in the subject line. Instead, use the same strategies you'd use when leaving a voice mail on a patient's answering machine. Say, “I have your lab work,” or something like that.

▸ Do not leave e-mail messages on a computer screen where they can be read by others.

Source: Dr. Brown

SAN FRANCISCO — Give e-mail correspondence with patients the same care and attention you'd give to paper records, faxes, or phone calls in order to minimize medicolegal liability, advises Dr. Jeffrey L. Brown of the Cornell University Medical School in New York.

Physicians should be reasonably certain that the person requesting information by e-mail is authorized to receive it, just as would be done with phone calls, Dr. Brown said at the annual meeting of the American Academy of Pediatrics.

At a minimum, your e-mail system should include an automated response to any e-mails received from patients, acknowledging that an e-mail message has been received and saying that you will respond within a set period of time, such as 24 or 48 hours, said Dr. Brown, who is also in private practice in Rye Brook, N.Y. He has no association with companies that market e-mail systems or services.

The automated response should alert patients that confidentiality cannot always be ensured in e-mail correspondence, and that you cannot respond to urgent questions posed by e-mail. Patients should contact your office by phone for urgent matters.

The response also should inform patients that if they do not get a reply from you to any e-mail message within a reasonable period of time—“usually 48 hours,” Dr. Brown said—the patient should call your office, because you may not have received the e-mail. If you are away from the office when patients e-mail, the automated response should let them know that, and give the date of your return.

In the other direction, e-mails sent by physicians must be compliant with the Health Insurance Portability and Accountability Act (HIPAA). As with faxes, conventional e-mails must protect the confidentiality of sensitive information such as Social Security numbers, medical identification numbers, laboratory results, diagnoses, medications, and more.

To ensure confidentiality in e-mails, use an encrypted message system, Dr. Brown advised. Solo practitioners or small practices may want to do an Internet search for the term “encrypting e-mail systems” to find a list of encryption providers, he said. Typically, an outgoing e-mail would be sent to the provider, encrypted, and returned to the physician's system before going out to a patient.

Or, physicians may want to look into the AAP's partnership with Medem (www.medem.com

Confidential e-mail from physicians should contain a warning disclaimer similar to those used on fax transmissions, Dr. Brown suggested.

Treat e-mail messages like other patient correspondence, and file them appropriately, he added. Before erasing e-mail, save the patient's original e-mail and your response as hard copies in the patient's chart or electronically if you use electronic charts.

Take precautions to protect confidential information on laptop computers and hard drives, as you would for other medical records.

Use encryption software or change passwords frequently to prevent unauthorized access.

Erase all confidential information from hard drives before disposing of them.

“Even if you do all the right things, there is still a possibility that you will be subject to suits,” Dr. Brown said. “In the end, the best defense against legal action is practicing good medicine.”

E-Mail Don'ts

▸ Do not use your personal e-mail address to answer patient e-mails.

▸ Do not answer a new patient's e-mailed medical questions without first establishing a formal relationship. You have no idea who they are and what their problems are.

▸ Do not forward a patient's e-mail correspondence or address to a third party without first getting the patient's consent.

▸ Do not use an indiscreet topic in the heading of your response. Don't write, “Your pregnancy test is positive” in the subject line. Instead, use the same strategies you'd use when leaving a voice mail on a patient's answering machine. Say, “I have your lab work,” or something like that.

▸ Do not leave e-mail messages on a computer screen where they can be read by others.

Source: Dr. Brown

SAN FRANCISCO — Give e-mail correspondence with patients the same care and attention you'd give to paper records, faxes, or phone calls in order to minimize medicolegal liability, advises Dr. Jeffrey L. Brown of the Cornell University Medical School in New York.

Physicians should be reasonably certain that the person requesting information by e-mail is authorized to receive it, just as would be done with phone calls, Dr. Brown said at the annual meeting of the American Academy of Pediatrics.

At a minimum, your e-mail system should include an automated response to any e-mails received from patients, acknowledging that an e-mail message has been received and saying that you will respond within a set period of time, such as 24 or 48 hours, said Dr. Brown, who is also in private practice in Rye Brook, N.Y. He has no association with companies that market e-mail systems or services.

The automated response should alert patients that confidentiality cannot always be ensured in e-mail correspondence, and that you cannot respond to urgent questions posed by e-mail. Patients should contact your office by phone for urgent matters.

The response also should inform patients that if they do not get a reply from you to any e-mail message within a reasonable period of time—“usually 48 hours,” Dr. Brown said—the patient should call your office, because you may not have received the e-mail. If you are away from the office when patients e-mail, the automated response should let them know that, and give the date of your return.

In the other direction, e-mails sent by physicians must be compliant with the Health Insurance Portability and Accountability Act (HIPAA). As with faxes, conventional e-mails must protect the confidentiality of sensitive information such as Social Security numbers, medical identification numbers, laboratory results, diagnoses, medications, and more.

To ensure confidentiality in e-mails, use an encrypted message system, Dr. Brown advised. Solo practitioners or small practices may want to do an Internet search for the term “encrypting e-mail systems” to find a list of encryption providers, he said. Typically, an outgoing e-mail would be sent to the provider, encrypted, and returned to the physician's system before going out to a patient.

Or, physicians may want to look into the AAP's partnership with Medem (www.medem.com

Confidential e-mail from physicians should contain a warning disclaimer similar to those used on fax transmissions, Dr. Brown suggested.

Treat e-mail messages like other patient correspondence, and file them appropriately, he added. Before erasing e-mail, save the patient's original e-mail and your response as hard copies in the patient's chart or electronically if you use electronic charts.

Take precautions to protect confidential information on laptop computers and hard drives, as you would for other medical records.

Use encryption software or change passwords frequently to prevent unauthorized access.

Erase all confidential information from hard drives before disposing of them.

“Even if you do all the right things, there is still a possibility that you will be subject to suits,” Dr. Brown said. “In the end, the best defense against legal action is practicing good medicine.”

E-Mail Don'ts

▸ Do not use your personal e-mail address to answer patient e-mails.

▸ Do not answer a new patient's e-mailed medical questions without first establishing a formal relationship. You have no idea who they are and what their problems are.

▸ Do not forward a patient's e-mail correspondence or address to a third party without first getting the patient's consent.

▸ Do not use an indiscreet topic in the heading of your response. Don't write, “Your pregnancy test is positive” in the subject line. Instead, use the same strategies you'd use when leaving a voice mail on a patient's answering machine. Say, “I have your lab work,” or something like that.

▸ Do not leave e-mail messages on a computer screen where they can be read by others.

Source: Dr. Brown

SAN FRANCISCO — A waterborne mycobacterium that infects humans through breaks in the skin causes lesions that easily are mistaken for staphylococcal infection, Dr. Peggy Weintrub said at the annual meeting of the American Academy of Pediatrics.

Mycobacterium marinum infection causes what's commonly known as “fish tank granuloma,” said Dr. Weintrub, chief of pediatric infectious diseases at the University of California, San Francisco. Lesions typically appear 1–4 weeks after exposure and start out as little papules and nodules that can be misdiagnosed as a staph infection. Later, however, they become verrucous, plaquelike lesions that start spreading up the skin along lymphatic tracts.

She described a case in a 3-year-old boy who presented with mild eczema and some other longstanding crusting lesions on his hand and arm that were spreading up the arm lymphocutaneously. The lesions had not responded to previous treatment with cephalexin. A previous culture from the lesions did grow some staphylococcal organisms, but two additional courses of antibiotics did not affect the lesions.

The boy was afebrile and systemically well, and had an infant sibling at home with no lesions.

The patient's history helped point clinicians toward M. marinum. The boy liked to be helpful, assisting his mother with the baby and helping his father with anything and everything, including gardening and cleaning the family's fish tank.

“I was imagining trying to get a 3-year-old to clean a fish tank,” said Dr. Weintrub. “Apparently, this was his favorite job, so he had done it multiple times in the weeks before he broke out in these lesions,” giving M. marinum an inoculation pathway through the boy's eczematous lesions.

M. marinum infects fish and amphibians. “You can sometimes get a history of a fish tank, but you also can get this infection from swimming in pools and in natural bodies of water—any kind of significant water exposure,” she said.

In rare cases, immunocompetent patients can develop disseminated M. marinum infection, affecting bones or joint tendon sheaths. “Particularly on the hand, it's a very worrisome diagnosis,” Dr. Weintrub said.

If a lesion is oozing, the secretions can be cultured for M. marinum. A skin biopsy from the boy grew the organism. Histopathology will show granulomas.

Patient history also can help sort through the differential diagnoses. A history of gardening raises the possibility of Sporothrix schenckii infection, which produces lesions that look very similar to M. marinum lesions, with a lymphocutaneous spread. S. schenckii resides in decaying vegetation, moss, soil, wood, and hay. It is more a disease of adults (typically farmers, gardeners, and forestry workers) than of children, with a history of skin trauma in 10%–60% of cases. A history of travel may suggest Leishmania, a parasite.

Clinicians also should consider Staphylococcus aureus infection, which most commonly causes pustular, draining lesions but rarely can cause granulomatous disease that looks like M. marinum, Dr. Weintrub said.

Usually two or three drugs are used to treat M. marinum infection, although no controlled studies back these strategies. “There aren't really good guidelines” on which drugs to use or for how long, she noted. Regimens may include clarithromycin or azithromycin, ethambutol, rifampin, and/or minocycline or doxycycline (for older patients). In general, 1–2 months of treatment may suffice, but 3 months of therapy was needed for the boy's lesions to clear completely. Localized infection is more likely to clear up than is deep infection. In rare cases, surgery may be needed to remove infected tissue.

This Mycobacterium marinum culture shows a rough colony of granular growth. CDC/Dr. CHARLES C. SHEPARD

SAN FRANCISCO — A waterborne mycobacterium that infects humans through breaks in the skin causes lesions that easily are mistaken for staphylococcal infection, Dr. Peggy Weintrub said at the annual meeting of the American Academy of Pediatrics.

Mycobacterium marinum infection causes what's commonly known as “fish tank granuloma,” said Dr. Weintrub, chief of pediatric infectious diseases at the University of California, San Francisco. Lesions typically appear 1–4 weeks after exposure and start out as little papules and nodules that can be misdiagnosed as a staph infection. Later, however, they become verrucous, plaquelike lesions that start spreading up the skin along lymphatic tracts.

She described a case in a 3-year-old boy who presented with mild eczema and some other longstanding crusting lesions on his hand and arm that were spreading up the arm lymphocutaneously. The lesions had not responded to previous treatment with cephalexin. A previous culture from the lesions did grow some staphylococcal organisms, but two additional courses of antibiotics did not affect the lesions.

The boy was afebrile and systemically well, and had an infant sibling at home with no lesions.

The patient's history helped point clinicians toward M. marinum. The boy liked to be helpful, assisting his mother with the baby and helping his father with anything and everything, including gardening and cleaning the family's fish tank.

“I was imagining trying to get a 3-year-old to clean a fish tank,” said Dr. Weintrub. “Apparently, this was his favorite job, so he had done it multiple times in the weeks before he broke out in these lesions,” giving M. marinum an inoculation pathway through the boy's eczematous lesions.

M. marinum infects fish and amphibians. “You can sometimes get a history of a fish tank, but you also can get this infection from swimming in pools and in natural bodies of water—any kind of significant water exposure,” she said.

In rare cases, immunocompetent patients can develop disseminated M. marinum infection, affecting bones or joint tendon sheaths. “Particularly on the hand, it's a very worrisome diagnosis,” Dr. Weintrub said.

If a lesion is oozing, the secretions can be cultured for M. marinum. A skin biopsy from the boy grew the organism. Histopathology will show granulomas.

Patient history also can help sort through the differential diagnoses. A history of gardening raises the possibility of Sporothrix schenckii infection, which produces lesions that look very similar to M. marinum lesions, with a lymphocutaneous spread. S. schenckii resides in decaying vegetation, moss, soil, wood, and hay. It is more a disease of adults (typically farmers, gardeners, and forestry workers) than of children, with a history of skin trauma in 10%–60% of cases. A history of travel may suggest Leishmania, a parasite.

Clinicians also should consider Staphylococcus aureus infection, which most commonly causes pustular, draining lesions but rarely can cause granulomatous disease that looks like M. marinum, Dr. Weintrub said.

Usually two or three drugs are used to treat M. marinum infection, although no controlled studies back these strategies. “There aren't really good guidelines” on which drugs to use or for how long, she noted. Regimens may include clarithromycin or azithromycin, ethambutol, rifampin, and/or minocycline or doxycycline (for older patients). In general, 1–2 months of treatment may suffice, but 3 months of therapy was needed for the boy's lesions to clear completely. Localized infection is more likely to clear up than is deep infection. In rare cases, surgery may be needed to remove infected tissue.

This Mycobacterium marinum culture shows a rough colony of granular growth. CDC/Dr. CHARLES C. SHEPARD

SAN FRANCISCO — A waterborne mycobacterium that infects humans through breaks in the skin causes lesions that easily are mistaken for staphylococcal infection, Dr. Peggy Weintrub said at the annual meeting of the American Academy of Pediatrics.

Mycobacterium marinum infection causes what's commonly known as “fish tank granuloma,” said Dr. Weintrub, chief of pediatric infectious diseases at the University of California, San Francisco. Lesions typically appear 1–4 weeks after exposure and start out as little papules and nodules that can be misdiagnosed as a staph infection. Later, however, they become verrucous, plaquelike lesions that start spreading up the skin along lymphatic tracts.

She described a case in a 3-year-old boy who presented with mild eczema and some other longstanding crusting lesions on his hand and arm that were spreading up the arm lymphocutaneously. The lesions had not responded to previous treatment with cephalexin. A previous culture from the lesions did grow some staphylococcal organisms, but two additional courses of antibiotics did not affect the lesions.

The boy was afebrile and systemically well, and had an infant sibling at home with no lesions.

The patient's history helped point clinicians toward M. marinum. The boy liked to be helpful, assisting his mother with the baby and helping his father with anything and everything, including gardening and cleaning the family's fish tank.

“I was imagining trying to get a 3-year-old to clean a fish tank,” said Dr. Weintrub. “Apparently, this was his favorite job, so he had done it multiple times in the weeks before he broke out in these lesions,” giving M. marinum an inoculation pathway through the boy's eczematous lesions.

M. marinum infects fish and amphibians. “You can sometimes get a history of a fish tank, but you also can get this infection from swimming in pools and in natural bodies of water—any kind of significant water exposure,” she said.

In rare cases, immunocompetent patients can develop disseminated M. marinum infection, affecting bones or joint tendon sheaths. “Particularly on the hand, it's a very worrisome diagnosis,” Dr. Weintrub said.

If a lesion is oozing, the secretions can be cultured for M. marinum. A skin biopsy from the boy grew the organism. Histopathology will show granulomas.

Patient history also can help sort through the differential diagnoses. A history of gardening raises the possibility of Sporothrix schenckii infection, which produces lesions that look very similar to M. marinum lesions, with a lymphocutaneous spread. S. schenckii resides in decaying vegetation, moss, soil, wood, and hay. It is more a disease of adults (typically farmers, gardeners, and forestry workers) than of children, with a history of skin trauma in 10%–60% of cases. A history of travel may suggest Leishmania, a parasite.

Clinicians also should consider Staphylococcus aureus infection, which most commonly causes pustular, draining lesions but rarely can cause granulomatous disease that looks like M. marinum, Dr. Weintrub said.

Usually two or three drugs are used to treat M. marinum infection, although no controlled studies back these strategies. “There aren't really good guidelines” on which drugs to use or for how long, she noted. Regimens may include clarithromycin or azithromycin, ethambutol, rifampin, and/or minocycline or doxycycline (for older patients). In general, 1–2 months of treatment may suffice, but 3 months of therapy was needed for the boy's lesions to clear completely. Localized infection is more likely to clear up than is deep infection. In rare cases, surgery may be needed to remove infected tissue.

This Mycobacterium marinum culture shows a rough colony of granular growth. CDC/Dr. CHARLES C. SHEPARD

SAN FRANCISCO — Community-onset Clostridium difficile infection that is not antibiotic related has emerged as a multinational problem that can be life threatening, said Dr. Sarah S. Long, chief of infectious diseases at St. Christopher's Hospital for Children, Philadelphia.

The conventional way of thinking about C. difficile infection considered it to be usually associated with antibiotic use, to mainly affect adults, not to be life threatening, and to seldom produce severe diarrheal illness when seen in children.

“Throw that [way of thinking] away. You have to start thinking and worrying about C. difficile as community onset without antibiotic exposure,” Dr. Long said at the annual meeting of the American Academy of Pediatrics.

The more modern C. difficile shows antibiotic resistance—probably caused by widespread use of fluoroquinolones—and has mutated to lose a regulatory gene that normally suppresses production of toxin by the organism. The mutated C. difficile produces 16–20 times the amount of toxin as that of the organism without the gene deletion. Four healthy people died recently in Philadelphia from C. difficile infection after failing treatment with multiple antibiotics followed by colectomies. Two of the infections were in postpartum women. “C. difficile in pregnant ladies and post partum can be a very severe disease,” Dr. Long cautioned.

Clinicians should consider C. difficile infection in otherwise healthy patients with diarrhea persisting beyond 3 days, whether or not the patient has been exposed to antibiotics, especially if there's blood in the stool or the patient is feverish or toxic appearing. “You have to put that on your list of things to worry about alongside Salmonella, Shigella, Campylobacter, and toxin-producing Escherichia coli,” she said. Culture isn't helpful for diagnosis. A good diagnostic test is an enzyme immunoassay test, which can give a result in 2 hours. Specialists also may order a cytotoxin assay.

Nearly 90% of patients will respond to treatment with metronidazole for 10 days, but 20%–25% will relapse. Of those patients that relapse, half will relapse again after retreatment. There is no standard therapy for chronic recurrences, but a number of antibiotic regimens or fecal transplants have been tried.

SAN FRANCISCO — Community-onset Clostridium difficile infection that is not antibiotic related has emerged as a multinational problem that can be life threatening, said Dr. Sarah S. Long, chief of infectious diseases at St. Christopher's Hospital for Children, Philadelphia.

The conventional way of thinking about C. difficile infection considered it to be usually associated with antibiotic use, to mainly affect adults, not to be life threatening, and to seldom produce severe diarrheal illness when seen in children.

“Throw that [way of thinking] away. You have to start thinking and worrying about C. difficile as community onset without antibiotic exposure,” Dr. Long said at the annual meeting of the American Academy of Pediatrics.

The more modern C. difficile shows antibiotic resistance—probably caused by widespread use of fluoroquinolones—and has mutated to lose a regulatory gene that normally suppresses production of toxin by the organism. The mutated C. difficile produces 16–20 times the amount of toxin as that of the organism without the gene deletion. Four healthy people died recently in Philadelphia from C. difficile infection after failing treatment with multiple antibiotics followed by colectomies. Two of the infections were in postpartum women. “C. difficile in pregnant ladies and post partum can be a very severe disease,” Dr. Long cautioned.

Clinicians should consider C. difficile infection in otherwise healthy patients with diarrhea persisting beyond 3 days, whether or not the patient has been exposed to antibiotics, especially if there's blood in the stool or the patient is feverish or toxic appearing. “You have to put that on your list of things to worry about alongside Salmonella, Shigella, Campylobacter, and toxin-producing Escherichia coli,” she said. Culture isn't helpful for diagnosis. A good diagnostic test is an enzyme immunoassay test, which can give a result in 2 hours. Specialists also may order a cytotoxin assay.

Nearly 90% of patients will respond to treatment with metronidazole for 10 days, but 20%–25% will relapse. Of those patients that relapse, half will relapse again after retreatment. There is no standard therapy for chronic recurrences, but a number of antibiotic regimens or fecal transplants have been tried.

SAN FRANCISCO — Community-onset Clostridium difficile infection that is not antibiotic related has emerged as a multinational problem that can be life threatening, said Dr. Sarah S. Long, chief of infectious diseases at St. Christopher's Hospital for Children, Philadelphia.

The conventional way of thinking about C. difficile infection considered it to be usually associated with antibiotic use, to mainly affect adults, not to be life threatening, and to seldom produce severe diarrheal illness when seen in children.

“Throw that [way of thinking] away. You have to start thinking and worrying about C. difficile as community onset without antibiotic exposure,” Dr. Long said at the annual meeting of the American Academy of Pediatrics.

The more modern C. difficile shows antibiotic resistance—probably caused by widespread use of fluoroquinolones—and has mutated to lose a regulatory gene that normally suppresses production of toxin by the organism. The mutated C. difficile produces 16–20 times the amount of toxin as that of the organism without the gene deletion. Four healthy people died recently in Philadelphia from C. difficile infection after failing treatment with multiple antibiotics followed by colectomies. Two of the infections were in postpartum women. “C. difficile in pregnant ladies and post partum can be a very severe disease,” Dr. Long cautioned.

Clinicians should consider C. difficile infection in otherwise healthy patients with diarrhea persisting beyond 3 days, whether or not the patient has been exposed to antibiotics, especially if there's blood in the stool or the patient is feverish or toxic appearing. “You have to put that on your list of things to worry about alongside Salmonella, Shigella, Campylobacter, and toxin-producing Escherichia coli,” she said. Culture isn't helpful for diagnosis. A good diagnostic test is an enzyme immunoassay test, which can give a result in 2 hours. Specialists also may order a cytotoxin assay.

Nearly 90% of patients will respond to treatment with metronidazole for 10 days, but 20%–25% will relapse. Of those patients that relapse, half will relapse again after retreatment. There is no standard therapy for chronic recurrences, but a number of antibiotic regimens or fecal transplants have been tried.

SAN FRANCISCO — Go beyond the usual questions about travel to other countries or the keeping of nontraditional pets, when asking parents about potential environmental exposures to diarrhea-causing agents, Dr. Sarah S. Long advised.

Ask about two increasingly recognized sources of infection—petting zoos and swimming pools, said Dr. Long, chief of infectious diseases at St. Christopher's Hospital for Children, Philadelphia.

Agricultural fairs, petting zoos, and their equivalents are prime grounds for enteropathogens that can cause acute and often bloody diarrhea, especially in children younger than age 3 years who carry pacifiers, bottles, toys, or food in the vicinity of animals.

“I don't think we spend enough time asking about whether they've traveled to places where there are animals,” Dr. Long said at the annual meeting of the American Academy of Pediatrics.

Whether someone brings animals to a day care center or a family visits a local 4-H fair, the transient nature of most petting zoo environments usually results in poor hygiene. They often feature high-risk animals such as baby chicks, which harbor Salmonella species, or neonatal calves, which can transmit Escherichia coli. Children under age 5 years should not touch these animals, she said.

Advise parents that when they take children to these environments, bring nothing that a child might put in his or her mouth, and avoid eating food prepared there if possible. Most importantly, everyone should use hand sanitizer when leaving, whether they touched anything or not.

The summer of 2007 saw 400 cases of Cryptosporidium-associated vomiting and diarrhea from an outbreak of infections around swimming pools in Philadelphia. Cryptosporidium species also can be transmitted in day care centers and from farm animal contacts.

This protozoan is very chlorine resistant and remains in the stool of infected people for about 2 weeks after the diarrhea stops, unlike other agents that cause acute diarrhea. “We did anticipatory treatment of an awful lot of children” this past summer, Dr. Long said.

Routine lab tests for ova and parasites will not detect Cryptosporidium. “You want to ask about swimming pools,” and order specific antigen detection on stool specimens if you suspect Cryptosporidium. Treatment with 3 days of nitazoxanide is approved for children aged 1 year or older.

To prevent this infection, advise parents of all young children not to change diapers at poolside. A child with diapers in the pool should be checked frequently and taken to the bathroom to clean their diapers and wash up. Anyone with a diarrheal illness in the very recent past should stay out of the pool. A pool associated with Cryptosporidium infection should be shut for 2 weeks and hyperchlorinated.

Advise parents that when they take children to these environments, bring nothing that a child might put in his or her mouth. Everyone should use hand sanitizer when leaving, whether they touched anything or not. LOUISE A. KOENIG/ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Go beyond the usual questions about travel to other countries or the keeping of nontraditional pets, when asking parents about potential environmental exposures to diarrhea-causing agents, Dr. Sarah S. Long advised.

Ask about two increasingly recognized sources of infection—petting zoos and swimming pools, said Dr. Long, chief of infectious diseases at St. Christopher's Hospital for Children, Philadelphia.

Agricultural fairs, petting zoos, and their equivalents are prime grounds for enteropathogens that can cause acute and often bloody diarrhea, especially in children younger than age 3 years who carry pacifiers, bottles, toys, or food in the vicinity of animals.

“I don't think we spend enough time asking about whether they've traveled to places where there are animals,” Dr. Long said at the annual meeting of the American Academy of Pediatrics.

Whether someone brings animals to a day care center or a family visits a local 4-H fair, the transient nature of most petting zoo environments usually results in poor hygiene. They often feature high-risk animals such as baby chicks, which harbor Salmonella species, or neonatal calves, which can transmit Escherichia coli. Children under age 5 years should not touch these animals, she said.

Advise parents that when they take children to these environments, bring nothing that a child might put in his or her mouth, and avoid eating food prepared there if possible. Most importantly, everyone should use hand sanitizer when leaving, whether they touched anything or not.

The summer of 2007 saw 400 cases of Cryptosporidium-associated vomiting and diarrhea from an outbreak of infections around swimming pools in Philadelphia. Cryptosporidium species also can be transmitted in day care centers and from farm animal contacts.

This protozoan is very chlorine resistant and remains in the stool of infected people for about 2 weeks after the diarrhea stops, unlike other agents that cause acute diarrhea. “We did anticipatory treatment of an awful lot of children” this past summer, Dr. Long said.

Routine lab tests for ova and parasites will not detect Cryptosporidium. “You want to ask about swimming pools,” and order specific antigen detection on stool specimens if you suspect Cryptosporidium. Treatment with 3 days of nitazoxanide is approved for children aged 1 year or older.

To prevent this infection, advise parents of all young children not to change diapers at poolside. A child with diapers in the pool should be checked frequently and taken to the bathroom to clean their diapers and wash up. Anyone with a diarrheal illness in the very recent past should stay out of the pool. A pool associated with Cryptosporidium infection should be shut for 2 weeks and hyperchlorinated.

Advise parents that when they take children to these environments, bring nothing that a child might put in his or her mouth. Everyone should use hand sanitizer when leaving, whether they touched anything or not. LOUISE A. KOENIG/ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Go beyond the usual questions about travel to other countries or the keeping of nontraditional pets, when asking parents about potential environmental exposures to diarrhea-causing agents, Dr. Sarah S. Long advised.

Ask about two increasingly recognized sources of infection—petting zoos and swimming pools, said Dr. Long, chief of infectious diseases at St. Christopher's Hospital for Children, Philadelphia.

Agricultural fairs, petting zoos, and their equivalents are prime grounds for enteropathogens that can cause acute and often bloody diarrhea, especially in children younger than age 3 years who carry pacifiers, bottles, toys, or food in the vicinity of animals.

“I don't think we spend enough time asking about whether they've traveled to places where there are animals,” Dr. Long said at the annual meeting of the American Academy of Pediatrics.

Whether someone brings animals to a day care center or a family visits a local 4-H fair, the transient nature of most petting zoo environments usually results in poor hygiene. They often feature high-risk animals such as baby chicks, which harbor Salmonella species, or neonatal calves, which can transmit Escherichia coli. Children under age 5 years should not touch these animals, she said.

Advise parents that when they take children to these environments, bring nothing that a child might put in his or her mouth, and avoid eating food prepared there if possible. Most importantly, everyone should use hand sanitizer when leaving, whether they touched anything or not.

The summer of 2007 saw 400 cases of Cryptosporidium-associated vomiting and diarrhea from an outbreak of infections around swimming pools in Philadelphia. Cryptosporidium species also can be transmitted in day care centers and from farm animal contacts.

This protozoan is very chlorine resistant and remains in the stool of infected people for about 2 weeks after the diarrhea stops, unlike other agents that cause acute diarrhea. “We did anticipatory treatment of an awful lot of children” this past summer, Dr. Long said.

Routine lab tests for ova and parasites will not detect Cryptosporidium. “You want to ask about swimming pools,” and order specific antigen detection on stool specimens if you suspect Cryptosporidium. Treatment with 3 days of nitazoxanide is approved for children aged 1 year or older.

To prevent this infection, advise parents of all young children not to change diapers at poolside. A child with diapers in the pool should be checked frequently and taken to the bathroom to clean their diapers and wash up. Anyone with a diarrheal illness in the very recent past should stay out of the pool. A pool associated with Cryptosporidium infection should be shut for 2 weeks and hyperchlorinated.

Advise parents that when they take children to these environments, bring nothing that a child might put in his or her mouth. Everyone should use hand sanitizer when leaving, whether they touched anything or not. LOUISE A. KOENIG/ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Communication skills are key when talking to parents who are reluctant to immunize their children, judging by results of one of the first observational studies of these encounters in private practice.

A pilot study recruited seven pediatricians and two family physicians in Louisville, Ky., for a “field test” of using “standardized patients” in primary care practice settings, Dr. Kristina Bryant said at the annual meeting of the American Academy of Pediatrics. Standardized patients are actors or actresses who are trained to portray patients and are commonly used in medical schools to help teach and test students.

The physicians were told that a standardized patient would visit their office within 6 months, but were not told what the standardized patient would do or say, explained Dr. Bryant of the University of Louisville (Ky.). Dr. Bryant is associated with several companies that make vaccines. She is on the speakers' bureaus of Sanofi Pasteur and Abbott Laboratories, and she has received research funds from Merck & Co., MedImmune, Wyeth Pharmaceuticals, and GlaxoSmithKline.

The actresses in the study pretended to be pregnant women who had just moved to the area and were looking for a pediatrician. They portrayed 24- to 30-year-old married women who were “pregnant” for the first time; they simulated pregnancy with a padded belly kit. “We actually had pediatricians patting the mother's tummy,” Dr. Bryant said. “It was very believable.”

The standardized patients presented themselves as upper middle class, college educated, and Internet savvy women. They paid for the visit out of pocket, claiming that their insurance was pending and they didn't have insurance cards yet.

Each woman told the physicians that she didn't want to immunize her child because she believed the MMR vaccine causes autism and the varicella vaccine causes neurologic damage. In addition, she said that too many vaccines overload the immune system, that the AAP and the Centers for Disease Control and Prevention are not truthful, and that she did not believe her child was at risk for getting measles, diphtheria, or other diseases anyway.

The standardized patients graded physicians on a survey after each encounter, and recordings of four encounters were transcribed and analyzed by the investigators.

Physicians scored very well in listening to the mother's concerns about vaccines, maintaining eye contact, spending adequate time with the mother (a median of 19 minutes per visit), using understandable terms, and behaving in a nonpaternalistic manner, reported Dr. Bryant and her associates. They also scored well in eliciting the mother's agenda for the visit, avoiding interrupting, and being warm, compassionate, and nonjudgmental.

Physicians did not score as well on “characteristics that are important not just in vaccination risk/benefit communications, but in communications with families in general,” she said. These included introducing themselves and welcoming the mother, expressing interest in the mother, asking open-ended questions, and encouraging questions from the mother. Scores also were lower in checking for the mother's understanding, validating the importance of her concerns, assessing the mother's knowledge about vaccines, and summarizing at the end of the visit.

Among the four physicians who were recorded, only three discussed the risks and benefits of vaccines, and only two presented scientific evidence to refute the mother's claims that MMR causes autism or that thimerosal is dangerous.

Two referred mothers to the AAP and CDC Web sites for more information, and two offered to delay some vaccines—a strategy recommended by the AAP when dealing with reluctant parents. None explored cost as a potential barrier to immunization.

Two gave the mothers inaccurate information. One said he would have to contact Child Protective Services if the mother refused to vaccinate her child. The other said that the child could not attend public school unless immunized, but Kentucky allows religious exemptions.

“The plus side is that none of these physicians refused to care for this family if the mother refused immunizations, and [all] talked about [vaccine refusal] being addressed at future visits,” Dr. Bryant said.

SAN FRANCISCO — Communication skills are key when talking to parents who are reluctant to immunize their children, judging by results of one of the first observational studies of these encounters in private practice.

A pilot study recruited seven pediatricians and two family physicians in Louisville, Ky., for a “field test” of using “standardized patients” in primary care practice settings, Dr. Kristina Bryant said at the annual meeting of the American Academy of Pediatrics. Standardized patients are actors or actresses who are trained to portray patients and are commonly used in medical schools to help teach and test students.

The physicians were told that a standardized patient would visit their office within 6 months, but were not told what the standardized patient would do or say, explained Dr. Bryant of the University of Louisville (Ky.). Dr. Bryant is associated with several companies that make vaccines. She is on the speakers' bureaus of Sanofi Pasteur and Abbott Laboratories, and she has received research funds from Merck & Co., MedImmune, Wyeth Pharmaceuticals, and GlaxoSmithKline.

The actresses in the study pretended to be pregnant women who had just moved to the area and were looking for a pediatrician. They portrayed 24- to 30-year-old married women who were “pregnant” for the first time; they simulated pregnancy with a padded belly kit. “We actually had pediatricians patting the mother's tummy,” Dr. Bryant said. “It was very believable.”

The standardized patients presented themselves as upper middle class, college educated, and Internet savvy women. They paid for the visit out of pocket, claiming that their insurance was pending and they didn't have insurance cards yet.

Each woman told the physicians that she didn't want to immunize her child because she believed the MMR vaccine causes autism and the varicella vaccine causes neurologic damage. In addition, she said that too many vaccines overload the immune system, that the AAP and the Centers for Disease Control and Prevention are not truthful, and that she did not believe her child was at risk for getting measles, diphtheria, or other diseases anyway.

The standardized patients graded physicians on a survey after each encounter, and recordings of four encounters were transcribed and analyzed by the investigators.

Physicians scored very well in listening to the mother's concerns about vaccines, maintaining eye contact, spending adequate time with the mother (a median of 19 minutes per visit), using understandable terms, and behaving in a nonpaternalistic manner, reported Dr. Bryant and her associates. They also scored well in eliciting the mother's agenda for the visit, avoiding interrupting, and being warm, compassionate, and nonjudgmental.

Physicians did not score as well on “characteristics that are important not just in vaccination risk/benefit communications, but in communications with families in general,” she said. These included introducing themselves and welcoming the mother, expressing interest in the mother, asking open-ended questions, and encouraging questions from the mother. Scores also were lower in checking for the mother's understanding, validating the importance of her concerns, assessing the mother's knowledge about vaccines, and summarizing at the end of the visit.

Among the four physicians who were recorded, only three discussed the risks and benefits of vaccines, and only two presented scientific evidence to refute the mother's claims that MMR causes autism or that thimerosal is dangerous.

Two referred mothers to the AAP and CDC Web sites for more information, and two offered to delay some vaccines—a strategy recommended by the AAP when dealing with reluctant parents. None explored cost as a potential barrier to immunization.

Two gave the mothers inaccurate information. One said he would have to contact Child Protective Services if the mother refused to vaccinate her child. The other said that the child could not attend public school unless immunized, but Kentucky allows religious exemptions.

“The plus side is that none of these physicians refused to care for this family if the mother refused immunizations, and [all] talked about [vaccine refusal] being addressed at future visits,” Dr. Bryant said.

SAN FRANCISCO — Communication skills are key when talking to parents who are reluctant to immunize their children, judging by results of one of the first observational studies of these encounters in private practice.

A pilot study recruited seven pediatricians and two family physicians in Louisville, Ky., for a “field test” of using “standardized patients” in primary care practice settings, Dr. Kristina Bryant said at the annual meeting of the American Academy of Pediatrics. Standardized patients are actors or actresses who are trained to portray patients and are commonly used in medical schools to help teach and test students.

The physicians were told that a standardized patient would visit their office within 6 months, but were not told what the standardized patient would do or say, explained Dr. Bryant of the University of Louisville (Ky.). Dr. Bryant is associated with several companies that make vaccines. She is on the speakers' bureaus of Sanofi Pasteur and Abbott Laboratories, and she has received research funds from Merck & Co., MedImmune, Wyeth Pharmaceuticals, and GlaxoSmithKline.

The actresses in the study pretended to be pregnant women who had just moved to the area and were looking for a pediatrician. They portrayed 24- to 30-year-old married women who were “pregnant” for the first time; they simulated pregnancy with a padded belly kit. “We actually had pediatricians patting the mother's tummy,” Dr. Bryant said. “It was very believable.”

The standardized patients presented themselves as upper middle class, college educated, and Internet savvy women. They paid for the visit out of pocket, claiming that their insurance was pending and they didn't have insurance cards yet.

Each woman told the physicians that she didn't want to immunize her child because she believed the MMR vaccine causes autism and the varicella vaccine causes neurologic damage. In addition, she said that too many vaccines overload the immune system, that the AAP and the Centers for Disease Control and Prevention are not truthful, and that she did not believe her child was at risk for getting measles, diphtheria, or other diseases anyway.

The standardized patients graded physicians on a survey after each encounter, and recordings of four encounters were transcribed and analyzed by the investigators.

Physicians scored very well in listening to the mother's concerns about vaccines, maintaining eye contact, spending adequate time with the mother (a median of 19 minutes per visit), using understandable terms, and behaving in a nonpaternalistic manner, reported Dr. Bryant and her associates. They also scored well in eliciting the mother's agenda for the visit, avoiding interrupting, and being warm, compassionate, and nonjudgmental.

Physicians did not score as well on “characteristics that are important not just in vaccination risk/benefit communications, but in communications with families in general,” she said. These included introducing themselves and welcoming the mother, expressing interest in the mother, asking open-ended questions, and encouraging questions from the mother. Scores also were lower in checking for the mother's understanding, validating the importance of her concerns, assessing the mother's knowledge about vaccines, and summarizing at the end of the visit.

Among the four physicians who were recorded, only three discussed the risks and benefits of vaccines, and only two presented scientific evidence to refute the mother's claims that MMR causes autism or that thimerosal is dangerous.

Two referred mothers to the AAP and CDC Web sites for more information, and two offered to delay some vaccines—a strategy recommended by the AAP when dealing with reluctant parents. None explored cost as a potential barrier to immunization.

Two gave the mothers inaccurate information. One said he would have to contact Child Protective Services if the mother refused to vaccinate her child. The other said that the child could not attend public school unless immunized, but Kentucky allows religious exemptions.

“The plus side is that none of these physicians refused to care for this family if the mother refused immunizations, and [all] talked about [vaccine refusal] being addressed at future visits,” Dr. Bryant said.

SAN FRANCISCO — A surprisingly high 85% of older adults with hypertension, hyperglycemia, or hyperlipidemia reported engaging in lifestyle modifications, such as diet change or exercise, in a longitudinal study of 666 people, Eleanor M. Simonsick, Ph.D., said at the annual meeting of the Gerontological Society of America.

Patients who reported voluntary lifestyle modification generally weighed less, had less obesity, and exercised more than patients who denied lifestyle modification. The two groups did not differ, however, in measures of disease such as blood pressure, fasting glucose measurements, hemoglobin A_1c values, and cholesterol levels, with the possible exception of triglyceride levels, reported Dr. Simonsick, an epidemiologist at the National Institute on Aging, Baltimore, and her associates.

“In terms of their specific conditions, it would appear that additional guidance is required” for voluntary lifestyle modification to improve health, she added.

On the plus side, the results refute the common notion that patients aren't interested in lifestyle modification, a misconception that dissuades many physicians from bringing up the subject, some surveys suggest. “I think that we should have more confidence in the patient population, that they may actually be receptive to lifestyle modification,” Dr. Simonsick said.

The study analyzed data from the Baltimore Longitudinal Study of Aging (BLSA), which performs 3-day examinations and surveys of participants every 1–4 years, depending on their age. Participants make the trip to Baltimore for these visits, so the study is skewed toward healthier, more highly educated adults, she acknowledged. The study's results are not representative of the general population, and probably represent the most positive outcomes one might expect to see in terms of adoption rates and effects from lifestyle modification, she said.

Patients in this analysis of coding visits during 2004 to 2007 had a mean age of 68 years. Half were women, 29% were black, and a majority had more than a college education. Overall, 47% of participants reported being diagnosed with hypertension, 19% said they had been told they had either diabetes or high glucose levels, 56% said they had been diagnosed with hyperglycemia, and 23% had none of the above.

Among those with hypertension, 83% reported voluntary lifestyle modification, “which is a much higher number than we had expected,” Dr. Simonsick said. Of those who made lifestyle modifications, 90% were taking antihypertensive medication, compared with 91% who did not change their lifestyle.

The obesity rate in hypertensive patients was 31% with lifestyle modification and 65% without, a significant difference. There were no major differences between these groups in systolic or diastolic blood pressures—126/67 mm Hg in the lifestyle modification group, compared with 127/69 mm Hg in the others.

Among those with hyperglycemia, 85% reported lifestyle modification, and these patients were significantly more likely to be on medication (48% vs. 22% of non-lifestyle modifiers). Fasting glucose levels were slightly higher in the lifestyle modification group than in other patients, but hemoglobin A_1c values were 6% in both groups.

The higher medication use and higher fasting glucose levels in the lifestyle modification group may be caused by a higher rate of diabetes rather than just hyperglycemia, compared with the non-lifestyle modification group, but the data couldn't show that explicitly, she said.

Among those with hyperlipidemia, 85% reported lifestyle modification, and 62% of these people were taking medication, compared with 54% of non-lifestyle modifiers (a nonsignificant difference).

Obesity rates were 26% in the lifestyle modifiers and 50% in non-lifestyle. Triglyceride levels also were significantly different between groups, measuring 116 mg/dL in patients who pursued lifestyle modification, compared with 133 mg/dL in those who didn't.

SAN FRANCISCO — A surprisingly high 85% of older adults with hypertension, hyperglycemia, or hyperlipidemia reported engaging in lifestyle modifications, such as diet change or exercise, in a longitudinal study of 666 people, Eleanor M. Simonsick, Ph.D., said at the annual meeting of the Gerontological Society of America.

Patients who reported voluntary lifestyle modification generally weighed less, had less obesity, and exercised more than patients who denied lifestyle modification. The two groups did not differ, however, in measures of disease such as blood pressure, fasting glucose measurements, hemoglobin A_1c values, and cholesterol levels, with the possible exception of triglyceride levels, reported Dr. Simonsick, an epidemiologist at the National Institute on Aging, Baltimore, and her associates.

“In terms of their specific conditions, it would appear that additional guidance is required” for voluntary lifestyle modification to improve health, she added.

On the plus side, the results refute the common notion that patients aren't interested in lifestyle modification, a misconception that dissuades many physicians from bringing up the subject, some surveys suggest. “I think that we should have more confidence in the patient population, that they may actually be receptive to lifestyle modification,” Dr. Simonsick said.

The study analyzed data from the Baltimore Longitudinal Study of Aging (BLSA), which performs 3-day examinations and surveys of participants every 1–4 years, depending on their age. Participants make the trip to Baltimore for these visits, so the study is skewed toward healthier, more highly educated adults, she acknowledged. The study's results are not representative of the general population, and probably represent the most positive outcomes one might expect to see in terms of adoption rates and effects from lifestyle modification, she said.

Patients in this analysis of coding visits during 2004 to 2007 had a mean age of 68 years. Half were women, 29% were black, and a majority had more than a college education. Overall, 47% of participants reported being diagnosed with hypertension, 19% said they had been told they had either diabetes or high glucose levels, 56% said they had been diagnosed with hyperglycemia, and 23% had none of the above.

Among those with hypertension, 83% reported voluntary lifestyle modification, “which is a much higher number than we had expected,” Dr. Simonsick said. Of those who made lifestyle modifications, 90% were taking antihypertensive medication, compared with 91% who did not change their lifestyle.

The obesity rate in hypertensive patients was 31% with lifestyle modification and 65% without, a significant difference. There were no major differences between these groups in systolic or diastolic blood pressures—126/67 mm Hg in the lifestyle modification group, compared with 127/69 mm Hg in the others.

Among those with hyperglycemia, 85% reported lifestyle modification, and these patients were significantly more likely to be on medication (48% vs. 22% of non-lifestyle modifiers). Fasting glucose levels were slightly higher in the lifestyle modification group than in other patients, but hemoglobin A_1c values were 6% in both groups.

The higher medication use and higher fasting glucose levels in the lifestyle modification group may be caused by a higher rate of diabetes rather than just hyperglycemia, compared with the non-lifestyle modification group, but the data couldn't show that explicitly, she said.

Among those with hyperlipidemia, 85% reported lifestyle modification, and 62% of these people were taking medication, compared with 54% of non-lifestyle modifiers (a nonsignificant difference).

Obesity rates were 26% in the lifestyle modifiers and 50% in non-lifestyle. Triglyceride levels also were significantly different between groups, measuring 116 mg/dL in patients who pursued lifestyle modification, compared with 133 mg/dL in those who didn't.

SAN FRANCISCO — A surprisingly high 85% of older adults with hypertension, hyperglycemia, or hyperlipidemia reported engaging in lifestyle modifications, such as diet change or exercise, in a longitudinal study of 666 people, Eleanor M. Simonsick, Ph.D., said at the annual meeting of the Gerontological Society of America.

Patients who reported voluntary lifestyle modification generally weighed less, had less obesity, and exercised more than patients who denied lifestyle modification. The two groups did not differ, however, in measures of disease such as blood pressure, fasting glucose measurements, hemoglobin A_1c values, and cholesterol levels, with the possible exception of triglyceride levels, reported Dr. Simonsick, an epidemiologist at the National Institute on Aging, Baltimore, and her associates.

“In terms of their specific conditions, it would appear that additional guidance is required” for voluntary lifestyle modification to improve health, she added.

On the plus side, the results refute the common notion that patients aren't interested in lifestyle modification, a misconception that dissuades many physicians from bringing up the subject, some surveys suggest. “I think that we should have more confidence in the patient population, that they may actually be receptive to lifestyle modification,” Dr. Simonsick said.

The study analyzed data from the Baltimore Longitudinal Study of Aging (BLSA), which performs 3-day examinations and surveys of participants every 1–4 years, depending on their age. Participants make the trip to Baltimore for these visits, so the study is skewed toward healthier, more highly educated adults, she acknowledged. The study's results are not representative of the general population, and probably represent the most positive outcomes one might expect to see in terms of adoption rates and effects from lifestyle modification, she said.

Patients in this analysis of coding visits during 2004 to 2007 had a mean age of 68 years. Half were women, 29% were black, and a majority had more than a college education. Overall, 47% of participants reported being diagnosed with hypertension, 19% said they had been told they had either diabetes or high glucose levels, 56% said they had been diagnosed with hyperglycemia, and 23% had none of the above.

Among those with hypertension, 83% reported voluntary lifestyle modification, “which is a much higher number than we had expected,” Dr. Simonsick said. Of those who made lifestyle modifications, 90% were taking antihypertensive medication, compared with 91% who did not change their lifestyle.

The obesity rate in hypertensive patients was 31% with lifestyle modification and 65% without, a significant difference. There were no major differences between these groups in systolic or diastolic blood pressures—126/67 mm Hg in the lifestyle modification group, compared with 127/69 mm Hg in the others.

Among those with hyperglycemia, 85% reported lifestyle modification, and these patients were significantly more likely to be on medication (48% vs. 22% of non-lifestyle modifiers). Fasting glucose levels were slightly higher in the lifestyle modification group than in other patients, but hemoglobin A_1c values were 6% in both groups.

The higher medication use and higher fasting glucose levels in the lifestyle modification group may be caused by a higher rate of diabetes rather than just hyperglycemia, compared with the non-lifestyle modification group, but the data couldn't show that explicitly, she said.

Among those with hyperlipidemia, 85% reported lifestyle modification, and 62% of these people were taking medication, compared with 54% of non-lifestyle modifiers (a nonsignificant difference).

Obesity rates were 26% in the lifestyle modifiers and 50% in non-lifestyle. Triglyceride levels also were significantly different between groups, measuring 116 mg/dL in patients who pursued lifestyle modification, compared with 133 mg/dL in those who didn't.

SAN FRANCISCO — The Eastern exercise, tai chi, improved a measure of cognitive function in a year-long, randomized, controlled study of 132 healthy older adults.

This is the first study to document mental improvements resulting from tai chi, Ruth E. Taylor-Piliae, Ph.D., said in a poster presentation at the annual meeting of the Gerontological Society of America.

Compared with baseline, those who did Western-type exercise had greater improvement after 6 months in upper body flexibility, gaining 4 cm on the back-scratch test; the tai chi and control groups gained 1 cm. But those who did tai chi had greater improvement in balance, adding 7 seconds to a single-leg stance test, compared with baseline; the Western exercise group added 4 seconds, and the control group added 1 second.

The tai chi group also had greater improvement in one of three measures of cognitive function, reported Dr. Taylor-Piliae of the University of Arizona, Tucson, and her associates. Most of the improvements remained after an additional 6 months of doing the same exercise.

Cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall (forward and backward). Results on the digits-backward test, which is thought to assess attention, concentration, and mental tracking, improved in the tai chi group. The tai chi group's score went up an average of 0.6 points, while the average score in the Western exercise group went down by 0.7 and the control group's score went down by 0.1.

The study randomized sedentary adults with an average age of 69 years to a two-phase program of tai chi or Western exercise, or to a control group that received an attention-control intervention. For the first 6 months, participants in the two exercise groups exercised for 45 minutes five times per week, twice in a class and three times at home. During the second 6 months, they did one classroom-based and three home-based exercise sessions per week.

The tai chi group learned the Yang-style 24-posture short form of tai chi. The Western exercise group did a combination of exercises for aerobic endurance, flexibility, and strength.

The intention-to-treat analysis of results included all participants—37 in the tai chi group, 39 in the Western exercise group, and 56 in the control group. Six-month assessments were available for 28 people in the tai chi group, 36 in the Western exercise group, and 51 in the control group. The 1-year follow-up assessed 26 patients in the tai chi group and 34 in the Western exercise group.

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — The Eastern exercise, tai chi, improved a measure of cognitive function in a year-long, randomized, controlled study of 132 healthy older adults.

This is the first study to document mental improvements resulting from tai chi, Ruth E. Taylor-Piliae, Ph.D., said in a poster presentation at the annual meeting of the Gerontological Society of America.

Compared with baseline, those who did Western-type exercise had greater improvement after 6 months in upper body flexibility, gaining 4 cm on the back-scratch test; the tai chi and control groups gained 1 cm. But those who did tai chi had greater improvement in balance, adding 7 seconds to a single-leg stance test, compared with baseline; the Western exercise group added 4 seconds, and the control group added 1 second.

The tai chi group also had greater improvement in one of three measures of cognitive function, reported Dr. Taylor-Piliae of the University of Arizona, Tucson, and her associates. Most of the improvements remained after an additional 6 months of doing the same exercise.

Cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall (forward and backward). Results on the digits-backward test, which is thought to assess attention, concentration, and mental tracking, improved in the tai chi group. The tai chi group's score went up an average of 0.6 points, while the average score in the Western exercise group went down by 0.7 and the control group's score went down by 0.1.

The study randomized sedentary adults with an average age of 69 years to a two-phase program of tai chi or Western exercise, or to a control group that received an attention-control intervention. For the first 6 months, participants in the two exercise groups exercised for 45 minutes five times per week, twice in a class and three times at home. During the second 6 months, they did one classroom-based and three home-based exercise sessions per week.

The tai chi group learned the Yang-style 24-posture short form of tai chi. The Western exercise group did a combination of exercises for aerobic endurance, flexibility, and strength.

The intention-to-treat analysis of results included all participants—37 in the tai chi group, 39 in the Western exercise group, and 56 in the control group. Six-month assessments were available for 28 people in the tai chi group, 36 in the Western exercise group, and 51 in the control group. The 1-year follow-up assessed 26 patients in the tai chi group and 34 in the Western exercise group.

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — The Eastern exercise, tai chi, improved a measure of cognitive function in a year-long, randomized, controlled study of 132 healthy older adults.

This is the first study to document mental improvements resulting from tai chi, Ruth E. Taylor-Piliae, Ph.D., said in a poster presentation at the annual meeting of the Gerontological Society of America.

Compared with baseline, those who did Western-type exercise had greater improvement after 6 months in upper body flexibility, gaining 4 cm on the back-scratch test; the tai chi and control groups gained 1 cm. But those who did tai chi had greater improvement in balance, adding 7 seconds to a single-leg stance test, compared with baseline; the Western exercise group added 4 seconds, and the control group added 1 second.

The tai chi group also had greater improvement in one of three measures of cognitive function, reported Dr. Taylor-Piliae of the University of Arizona, Tucson, and her associates. Most of the improvements remained after an additional 6 months of doing the same exercise.

Cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall (forward and backward). Results on the digits-backward test, which is thought to assess attention, concentration, and mental tracking, improved in the tai chi group. The tai chi group's score went up an average of 0.6 points, while the average score in the Western exercise group went down by 0.7 and the control group's score went down by 0.1.

The study randomized sedentary adults with an average age of 69 years to a two-phase program of tai chi or Western exercise, or to a control group that received an attention-control intervention. For the first 6 months, participants in the two exercise groups exercised for 45 minutes five times per week, twice in a class and three times at home. During the second 6 months, they did one classroom-based and three home-based exercise sessions per week.

The tai chi group learned the Yang-style 24-posture short form of tai chi. The Western exercise group did a combination of exercises for aerobic endurance, flexibility, and strength.

The intention-to-treat analysis of results included all participants—37 in the tai chi group, 39 in the Western exercise group, and 56 in the control group. Six-month assessments were available for 28 people in the tai chi group, 36 in the Western exercise group, and 51 in the control group. The 1-year follow-up assessed 26 patients in the tai chi group and 34 in the Western exercise group.

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Cognitive-behavioral therapy for comorbid insomnia in patients with osteoarthritis not only improved sleep but also reduced self-reported pain in a randomized, controlled pilot study of 51 patients, reported Michael V. Vitiello, Ph.D.

The improvements in both sleep and pain levels persisted at 1-year follow-up. This is the first study to demonstrate such a duration of benefit from cognitive-behavioral therapy for insomnia in patients with comorbid chronic medical illness of any kind, Dr. Vitiello and his associates reported in a poster presentation at the annual meeting of the Gerontological Society of America.

This preliminary study suggests that improving sleep can be “analgesic” in patients with osteoarthritis, said Dr. Vitiello, professor of psychiatry and behavioral sciences at the University of Washington, Seattle. “Techniques to improve sleep should be considered for addition to treatment programs for pain management in osteoarthritis and possibly other pain states,” he added.

The study randomized 23 patients (18 women and 5 men) to cognitive-behavioral therapy for insomnia and 28 patients (27 women, 1 man) to a control group that received an intervention focused on attention control, stress management, and wellness. Neither group specifically addressed pain control. Each group met 2 hours per week for 8 weeks for the intervention.

Several measures of insomnia improved significantly in the treatment group but not in the control group. Sleep latency (the time it takes to fall asleep) decreased from a mean of 40 minutes before therapy to 24 minutes, and nighttime wakefulness decreased from 62 to 25 minutes. Sleep efficiency (the proportion of time in bed spent asleep) improved from 71% to 84%.

Self-reported pain on the Short Form-36 pain scale improved from a score of 56 before cognitive-behavioral therapy to 66 afterward (with a higher score indicating less pain), but did not change significantly in the control group. There was a nonsignificant trend toward reduced pain in the treatment group as measured by the McGill Pain Questionnaire.

After posttreatment results were assessed, 10 patients in the control group crossed over to receive cognitive-behavioral therapy for insomnia. Results of 1-year follow-up in 19 patients from the original cognitive-behavioral therapy group plus the 10 crossovers were nearly identical to the results of the after-treatment assessments, showing duration of the improvements over time, Dr. Vitiello said.

SAN FRANCISCO — Cognitive-behavioral therapy for comorbid insomnia in patients with osteoarthritis not only improved sleep but also reduced self-reported pain in a randomized, controlled pilot study of 51 patients, reported Michael V. Vitiello, Ph.D.

The improvements in both sleep and pain levels persisted at 1-year follow-up. This is the first study to demonstrate such a duration of benefit from cognitive-behavioral therapy for insomnia in patients with comorbid chronic medical illness of any kind, Dr. Vitiello and his associates reported in a poster presentation at the annual meeting of the Gerontological Society of America.

This preliminary study suggests that improving sleep can be “analgesic” in patients with osteoarthritis, said Dr. Vitiello, professor of psychiatry and behavioral sciences at the University of Washington, Seattle. “Techniques to improve sleep should be considered for addition to treatment programs for pain management in osteoarthritis and possibly other pain states,” he added.

The study randomized 23 patients (18 women and 5 men) to cognitive-behavioral therapy for insomnia and 28 patients (27 women, 1 man) to a control group that received an intervention focused on attention control, stress management, and wellness. Neither group specifically addressed pain control. Each group met 2 hours per week for 8 weeks for the intervention.

Several measures of insomnia improved significantly in the treatment group but not in the control group. Sleep latency (the time it takes to fall asleep) decreased from a mean of 40 minutes before therapy to 24 minutes, and nighttime wakefulness decreased from 62 to 25 minutes. Sleep efficiency (the proportion of time in bed spent asleep) improved from 71% to 84%.

Self-reported pain on the Short Form-36 pain scale improved from a score of 56 before cognitive-behavioral therapy to 66 afterward (with a higher score indicating less pain), but did not change significantly in the control group. There was a nonsignificant trend toward reduced pain in the treatment group as measured by the McGill Pain Questionnaire.

After posttreatment results were assessed, 10 patients in the control group crossed over to receive cognitive-behavioral therapy for insomnia. Results of 1-year follow-up in 19 patients from the original cognitive-behavioral therapy group plus the 10 crossovers were nearly identical to the results of the after-treatment assessments, showing duration of the improvements over time, Dr. Vitiello said.

SAN FRANCISCO — Cognitive-behavioral therapy for comorbid insomnia in patients with osteoarthritis not only improved sleep but also reduced self-reported pain in a randomized, controlled pilot study of 51 patients, reported Michael V. Vitiello, Ph.D.

The improvements in both sleep and pain levels persisted at 1-year follow-up. This is the first study to demonstrate such a duration of benefit from cognitive-behavioral therapy for insomnia in patients with comorbid chronic medical illness of any kind, Dr. Vitiello and his associates reported in a poster presentation at the annual meeting of the Gerontological Society of America.

This preliminary study suggests that improving sleep can be “analgesic” in patients with osteoarthritis, said Dr. Vitiello, professor of psychiatry and behavioral sciences at the University of Washington, Seattle. “Techniques to improve sleep should be considered for addition to treatment programs for pain management in osteoarthritis and possibly other pain states,” he added.

The study randomized 23 patients (18 women and 5 men) to cognitive-behavioral therapy for insomnia and 28 patients (27 women, 1 man) to a control group that received an intervention focused on attention control, stress management, and wellness. Neither group specifically addressed pain control. Each group met 2 hours per week for 8 weeks for the intervention.

Several measures of insomnia improved significantly in the treatment group but not in the control group. Sleep latency (the time it takes to fall asleep) decreased from a mean of 40 minutes before therapy to 24 minutes, and nighttime wakefulness decreased from 62 to 25 minutes. Sleep efficiency (the proportion of time in bed spent asleep) improved from 71% to 84%.

Self-reported pain on the Short Form-36 pain scale improved from a score of 56 before cognitive-behavioral therapy to 66 afterward (with a higher score indicating less pain), but did not change significantly in the control group. There was a nonsignificant trend toward reduced pain in the treatment group as measured by the McGill Pain Questionnaire.

After posttreatment results were assessed, 10 patients in the control group crossed over to receive cognitive-behavioral therapy for insomnia. Results of 1-year follow-up in 19 patients from the original cognitive-behavioral therapy group plus the 10 crossovers were nearly identical to the results of the after-treatment assessments, showing duration of the improvements over time, Dr. Vitiello said.

SAN FRANCISCO — Children can get acne at any age, but what many parents think is acne might actually be something else, Dr. Rebecca L. Smith said at a meeting sponsored by Skin Disease Education Foundation.

A good example is “neonatal acne.” That's what this imposter used to be called, until it was recognized as a pustulosis process, not acne, said Dr. Smith, a dermatologist in Fort Mill, S.C.

The condition is now known as neonatal cephalic pustulosis, a common, transient eruption that occurs in the first weeks of life and that is localized to cheeks, chin, forehead, and eyelids. Lesions may also develop on the chest, neck, and scalp.

If a parent insists on treatment, a bit of topical 2% ketoconazole cream usually clears the skin quickly, she advised.

However, “infants can get acne, and it can be very bad,” she acknowledged. It is most common on the cheeks, and more likely in boys than in girls. “You can treat these children like [most] other acne patients, with topical and oral antibiotics and even topical tretinoin at times. Extreme cases can be treated with isotretinoin.”

The situation changes after the first year, however. Dr. Smith said she refers any child between 1 year of age and puberty who has bad acne to an endocrinologist because neonatal adrenal glands produce only minimal androgen after 1 year of life, so acne in early childhood raises concern about underlying disease and hyperandrogenism.

“We're seeing children younger and younger these days” with typically midfacial acne that's often the first sign of pubertal maturation, she said. These acne-prone children secrete sebum in the midfacial area earlier than do children without acne.

When it comes to management, Dr. Smith said she tries to translate the treatment strategy into terms children can understand, targeting as many age-appropriate factors as possible.

“We're going to treat your oil, treat your plugs, treat your bugs, and then treat your redness,” she tells them. “A teenager can get that.” That corresponds with treating sebum, faulty follicular keratinization, bacteria, and inflammation.

To avoid inducing drug resistance in Propionibacterium acnes, one should use the least aggressive treatment regimen that will provide a sustained response, she advised.

“I'm not worried about P. acnes resistance. [I'm] worried about P. acnes sharing that” resistance with other bacteria, she emphasized.

Dr. Smith said that she always adds benzoyl peroxide to antibiotic therapy for acne because it increases antibiotic penetration and creates a tough environment for P. acnes. Some combination products are on the market. Patients should be told that these products can bleach clothing, pillowcases, carpet, and hair, but not skin, she said.

Retinoids are the foundation of maintenance therapy for acne. “I want everyone on retinoids eventually,” she said. Many retinoid options are available. Get to know them, and choose the one that's right for each patient, she suggested.

Dr. Smith advised against instructing children to use a pea-sized amount for the entire face, because that may not mean much to vegetable-averse children. “Tell them to use a chocolate chip-sized amount,” and show them how to dot the face and rub the retinoid in, she said.

To increase children's ability to tolerate retinoid therapy, have them wash their faces with a gentle cleanser and apply an oil-free moisturizer before applying the retinoid.

This may slightly decrease the effect of the retinoid, but increased adherence to therapy can provide better results than applying the retinoid alone, she said. Another strategy is to titrate dosing by starting applications every second or third night for the first week, and increasing frequency as tolerated.

Dr. Smith said that she has been a speaker or adviser for, or has received funding from, companies that make retinoids, antibiotics, or tretinoin products for the treatment of acne. These companies include Allergan, CollaGenex, Dermik, Galderma, Medicis, SkinMedica, Stiefel, and Warner Chilcott.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SAN FRANCISCO — Children can get acne at any age, but what many parents think is acne might actually be something else, Dr. Rebecca L. Smith said at a meeting sponsored by Skin Disease Education Foundation.

A good example is “neonatal acne.” That's what this imposter used to be called, until it was recognized as a pustulosis process, not acne, said Dr. Smith, a dermatologist in Fort Mill, S.C.

The condition is now known as neonatal cephalic pustulosis, a common, transient eruption that occurs in the first weeks of life and that is localized to cheeks, chin, forehead, and eyelids. Lesions may also develop on the chest, neck, and scalp.

If a parent insists on treatment, a bit of topical 2% ketoconazole cream usually clears the skin quickly, she advised.

However, “infants can get acne, and it can be very bad,” she acknowledged. It is most common on the cheeks, and more likely in boys than in girls. “You can treat these children like [most] other acne patients, with topical and oral antibiotics and even topical tretinoin at times. Extreme cases can be treated with isotretinoin.”

The situation changes after the first year, however. Dr. Smith said she refers any child between 1 year of age and puberty who has bad acne to an endocrinologist because neonatal adrenal glands produce only minimal androgen after 1 year of life, so acne in early childhood raises concern about underlying disease and hyperandrogenism.

“We're seeing children younger and younger these days” with typically midfacial acne that's often the first sign of pubertal maturation, she said. These acne-prone children secrete sebum in the midfacial area earlier than do children without acne.

When it comes to management, Dr. Smith said she tries to translate the treatment strategy into terms children can understand, targeting as many age-appropriate factors as possible.

“We're going to treat your oil, treat your plugs, treat your bugs, and then treat your redness,” she tells them. “A teenager can get that.” That corresponds with treating sebum, faulty follicular keratinization, bacteria, and inflammation.

To avoid inducing drug resistance in Propionibacterium acnes, one should use the least aggressive treatment regimen that will provide a sustained response, she advised.

“I'm not worried about P. acnes resistance. [I'm] worried about P. acnes sharing that” resistance with other bacteria, she emphasized.

Dr. Smith said that she always adds benzoyl peroxide to antibiotic therapy for acne because it increases antibiotic penetration and creates a tough environment for P. acnes. Some combination products are on the market. Patients should be told that these products can bleach clothing, pillowcases, carpet, and hair, but not skin, she said.

Retinoids are the foundation of maintenance therapy for acne. “I want everyone on retinoids eventually,” she said. Many retinoid options are available. Get to know them, and choose the one that's right for each patient, she suggested.

Dr. Smith advised against instructing children to use a pea-sized amount for the entire face, because that may not mean much to vegetable-averse children. “Tell them to use a chocolate chip-sized amount,” and show them how to dot the face and rub the retinoid in, she said.

To increase children's ability to tolerate retinoid therapy, have them wash their faces with a gentle cleanser and apply an oil-free moisturizer before applying the retinoid.

This may slightly decrease the effect of the retinoid, but increased adherence to therapy can provide better results than applying the retinoid alone, she said. Another strategy is to titrate dosing by starting applications every second or third night for the first week, and increasing frequency as tolerated.

Dr. Smith said that she has been a speaker or adviser for, or has received funding from, companies that make retinoids, antibiotics, or tretinoin products for the treatment of acne. These companies include Allergan, CollaGenex, Dermik, Galderma, Medicis, SkinMedica, Stiefel, and Warner Chilcott.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SAN FRANCISCO — Children can get acne at any age, but what many parents think is acne might actually be something else, Dr. Rebecca L. Smith said at a meeting sponsored by Skin Disease Education Foundation.

A good example is “neonatal acne.” That's what this imposter used to be called, until it was recognized as a pustulosis process, not acne, said Dr. Smith, a dermatologist in Fort Mill, S.C.

The condition is now known as neonatal cephalic pustulosis, a common, transient eruption that occurs in the first weeks of life and that is localized to cheeks, chin, forehead, and eyelids. Lesions may also develop on the chest, neck, and scalp.

If a parent insists on treatment, a bit of topical 2% ketoconazole cream usually clears the skin quickly, she advised.

However, “infants can get acne, and it can be very bad,” she acknowledged. It is most common on the cheeks, and more likely in boys than in girls. “You can treat these children like [most] other acne patients, with topical and oral antibiotics and even topical tretinoin at times. Extreme cases can be treated with isotretinoin.”

The situation changes after the first year, however. Dr. Smith said she refers any child between 1 year of age and puberty who has bad acne to an endocrinologist because neonatal adrenal glands produce only minimal androgen after 1 year of life, so acne in early childhood raises concern about underlying disease and hyperandrogenism.

“We're seeing children younger and younger these days” with typically midfacial acne that's often the first sign of pubertal maturation, she said. These acne-prone children secrete sebum in the midfacial area earlier than do children without acne.

When it comes to management, Dr. Smith said she tries to translate the treatment strategy into terms children can understand, targeting as many age-appropriate factors as possible.

“We're going to treat your oil, treat your plugs, treat your bugs, and then treat your redness,” she tells them. “A teenager can get that.” That corresponds with treating sebum, faulty follicular keratinization, bacteria, and inflammation.

To avoid inducing drug resistance in Propionibacterium acnes, one should use the least aggressive treatment regimen that will provide a sustained response, she advised.

“I'm not worried about P. acnes resistance. [I'm] worried about P. acnes sharing that” resistance with other bacteria, she emphasized.

Dr. Smith said that she always adds benzoyl peroxide to antibiotic therapy for acne because it increases antibiotic penetration and creates a tough environment for P. acnes. Some combination products are on the market. Patients should be told that these products can bleach clothing, pillowcases, carpet, and hair, but not skin, she said.

Retinoids are the foundation of maintenance therapy for acne. “I want everyone on retinoids eventually,” she said. Many retinoid options are available. Get to know them, and choose the one that's right for each patient, she suggested.

Dr. Smith advised against instructing children to use a pea-sized amount for the entire face, because that may not mean much to vegetable-averse children. “Tell them to use a chocolate chip-sized amount,” and show them how to dot the face and rub the retinoid in, she said.

To increase children's ability to tolerate retinoid therapy, have them wash their faces with a gentle cleanser and apply an oil-free moisturizer before applying the retinoid.

This may slightly decrease the effect of the retinoid, but increased adherence to therapy can provide better results than applying the retinoid alone, she said. Another strategy is to titrate dosing by starting applications every second or third night for the first week, and increasing frequency as tolerated.

Dr. Smith said that she has been a speaker or adviser for, or has received funding from, companies that make retinoids, antibiotics, or tretinoin products for the treatment of acne. These companies include Allergan, CollaGenex, Dermik, Galderma, Medicis, SkinMedica, Stiefel, and Warner Chilcott.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SAN FRANCISCO – Western and Eastern modes of exercise produced different improvements in physical functioning, and the Eastern exercise–tai chi–improved one measure of cognitive function in a year-long, randomized, controlled study of 132 healthy older adults.

This is the first study to document mental improvements resulting from tai chi, Ruth E. Taylor-Piliae, Ph.D., said in a poster presentation at the annual meeting of the Gerontological Society of America.

Compared with baseline, those who did Western-type exercise had greater improvement after 6 months in upper body flexibility, gaining 4 cm on the back-scratch test; the tai chi and control groups gained 1 cm.

But those who did tai chi had greater improvement in balance, adding 7 seconds to a single-leg stance test, compared with baseline; the Western exercise group added 4 seconds, and the control group added 1 second.

The tai chi group also had greater improvement in one of three measures of cognitive function studied, reported Dr. Taylor-Piliae of the University of Arizona, Tucson, and her associates.

Most of the improvements persisted after an additional 6 months of doing the same exercise, they reported.

Subjects' cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall (forward and backward).

Results on the digits-backward test, which is thought to assess attention, concentration, and mental tracking, improved in the tai chi group.

The tai chi group's score went up an average of 0.6 points, while the average score in the Western exercise group went down by 0.7 and the control group's score went down by 0.1.

“I'd love to see older adults out there exercising, and if they're not interested in going to the gym and doing traditional Western exercise, tai chi is an alternative that they could pursue that will bring health benefits,” she said.

The study randomized sedentary adults with an average age of 69 years to a two-phase program of tai chi or Western exercise, or to a control group that received an attention-control intervention.

For the first 6 months, participants in the two exercise groups exercised for 45 minutes five times per week, twice in a class and three times at home.

During the second 6 months of the study, the participants did one classroom-based and three home-based exercise sessions per week.

The tai chi group learned the Yang-style 24-posture short form of tai chi.

The Western exercise group did a combination of exercises for aerobic endurance, flexibility, and strength that included walking, lifting light hand weights, and stretching.

The intention-to-treat analysis of results included all participants–37 in the tai chi group, 39 in the Western exercise group, and 56 in the control group.

Six-month assessments were available for 28 people in the tai chi group, 36 in the Western exercise group, and 51 in the control group.

The 1-year follow-up assessed 26 patients in the tai chi group and 34 in the Western exercise group.

Previous studies have shown that tai chi also can significantly improve strength and flexibility.

The current study included well-educated, relatively affluent people who probably were in fairly good shape at baseline, making some changes more difficult to detect in a small study, Dr. Taylor-Piliae suggested. She is designing a new study aimed at looking at the effects of tai chi in patients with cardiovascular problems, particularly stroke.

Cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall. DR. TAYLOR-PILIAE

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO – Western and Eastern modes of exercise produced different improvements in physical functioning, and the Eastern exercise–tai chi–improved one measure of cognitive function in a year-long, randomized, controlled study of 132 healthy older adults.

This is the first study to document mental improvements resulting from tai chi, Ruth E. Taylor-Piliae, Ph.D., said in a poster presentation at the annual meeting of the Gerontological Society of America.

Compared with baseline, those who did Western-type exercise had greater improvement after 6 months in upper body flexibility, gaining 4 cm on the back-scratch test; the tai chi and control groups gained 1 cm.

But those who did tai chi had greater improvement in balance, adding 7 seconds to a single-leg stance test, compared with baseline; the Western exercise group added 4 seconds, and the control group added 1 second.

The tai chi group also had greater improvement in one of three measures of cognitive function studied, reported Dr. Taylor-Piliae of the University of Arizona, Tucson, and her associates.

Most of the improvements persisted after an additional 6 months of doing the same exercise, they reported.

Subjects' cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall (forward and backward).

Results on the digits-backward test, which is thought to assess attention, concentration, and mental tracking, improved in the tai chi group.

The tai chi group's score went up an average of 0.6 points, while the average score in the Western exercise group went down by 0.7 and the control group's score went down by 0.1.

“I'd love to see older adults out there exercising, and if they're not interested in going to the gym and doing traditional Western exercise, tai chi is an alternative that they could pursue that will bring health benefits,” she said.

The study randomized sedentary adults with an average age of 69 years to a two-phase program of tai chi or Western exercise, or to a control group that received an attention-control intervention.

For the first 6 months, participants in the two exercise groups exercised for 45 minutes five times per week, twice in a class and three times at home.

During the second 6 months of the study, the participants did one classroom-based and three home-based exercise sessions per week.

The tai chi group learned the Yang-style 24-posture short form of tai chi.

The Western exercise group did a combination of exercises for aerobic endurance, flexibility, and strength that included walking, lifting light hand weights, and stretching.

The intention-to-treat analysis of results included all participants–37 in the tai chi group, 39 in the Western exercise group, and 56 in the control group.

Six-month assessments were available for 28 people in the tai chi group, 36 in the Western exercise group, and 51 in the control group.

The 1-year follow-up assessed 26 patients in the tai chi group and 34 in the Western exercise group.

Previous studies have shown that tai chi also can significantly improve strength and flexibility.

The current study included well-educated, relatively affluent people who probably were in fairly good shape at baseline, making some changes more difficult to detect in a small study, Dr. Taylor-Piliae suggested. She is designing a new study aimed at looking at the effects of tai chi in patients with cardiovascular problems, particularly stroke.

Cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall. DR. TAYLOR-PILIAE

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO – Western and Eastern modes of exercise produced different improvements in physical functioning, and the Eastern exercise–tai chi–improved one measure of cognitive function in a year-long, randomized, controlled study of 132 healthy older adults.

This is the first study to document mental improvements resulting from tai chi, Ruth E. Taylor-Piliae, Ph.D., said in a poster presentation at the annual meeting of the Gerontological Society of America.

Compared with baseline, those who did Western-type exercise had greater improvement after 6 months in upper body flexibility, gaining 4 cm on the back-scratch test; the tai chi and control groups gained 1 cm.

But those who did tai chi had greater improvement in balance, adding 7 seconds to a single-leg stance test, compared with baseline; the Western exercise group added 4 seconds, and the control group added 1 second.

The tai chi group also had greater improvement in one of three measures of cognitive function studied, reported Dr. Taylor-Piliae of the University of Arizona, Tucson, and her associates.

Most of the improvements persisted after an additional 6 months of doing the same exercise, they reported.

Subjects' cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall (forward and backward).

Results on the digits-backward test, which is thought to assess attention, concentration, and mental tracking, improved in the tai chi group.

The tai chi group's score went up an average of 0.6 points, while the average score in the Western exercise group went down by 0.7 and the control group's score went down by 0.1.

“I'd love to see older adults out there exercising, and if they're not interested in going to the gym and doing traditional Western exercise, tai chi is an alternative that they could pursue that will bring health benefits,” she said.

The study randomized sedentary adults with an average age of 69 years to a two-phase program of tai chi or Western exercise, or to a control group that received an attention-control intervention.

For the first 6 months, participants in the two exercise groups exercised for 45 minutes five times per week, twice in a class and three times at home.

During the second 6 months of the study, the participants did one classroom-based and three home-based exercise sessions per week.

The tai chi group learned the Yang-style 24-posture short form of tai chi.

The Western exercise group did a combination of exercises for aerobic endurance, flexibility, and strength that included walking, lifting light hand weights, and stretching.

The intention-to-treat analysis of results included all participants–37 in the tai chi group, 39 in the Western exercise group, and 56 in the control group.

Six-month assessments were available for 28 people in the tai chi group, 36 in the Western exercise group, and 51 in the control group.

The 1-year follow-up assessed 26 patients in the tai chi group and 34 in the Western exercise group.

Previous studies have shown that tai chi also can significantly improve strength and flexibility.

The current study included well-educated, relatively affluent people who probably were in fairly good shape at baseline, making some changes more difficult to detect in a small study, Dr. Taylor-Piliae suggested. She is designing a new study aimed at looking at the effects of tai chi in patients with cardiovascular problems, particularly stroke.

Cognitive function was measured by tests of semantic fluency (animal naming) and digit span recall. DR. TAYLOR-PILIAE

ELSEVIER GLOBAL MEDICAL NEWS