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June 2007
Compiled by Suparna Dutta, MD, MPH
Resident, Pfizer Practicum Rotation in Health Policy and
Preventive Medicine
ACPM periodically compiles and abstracts journal articles
of interest to preventive medicine physicians. The latest
entries include articles on alcohol use and dementia; fish
oil supplements; multivitamin use and prostrate cancer;
inoculations of hospital staff; accidental death rates in
elderly; chronic disease; HIV testing; cardiac death;
folic acid; acute myocardial infarction; smoking; STIs;
and breast cancer.
MODERATE ALCOHOL USE MAY SLOW PROGRESSION TO DEMENTIA
FISH OIL SUPPLEMENTS PLUS REGULAR
EXERCISE BENEFIT OVERWEIGHT PATIENTS
MULTIVITAMIN USE ON PROSTRATE CANCER
INOCULATING HOSPITAL STAFF IN PANDEMIC OUTBREAK
ELDERLY FALLS, DRUG OVERDOES,
DRIVE INCREASE IN ACCIDENTAL DEATH RATE
IMPROVING MANAGEMENT
OF CHRONIC DISEASE AT COMMUNITY HEALTH CENTERS
WHO and UNAIDS RECOMMEND OPT-OUT
HIV-TESTING
BETTER TREATMENT, LOWER RISK FACTORS CAUSED DROP IN
CARDIAC DEATHS
FOLIC ACID DOESN’T DECREASE COLORECTAL ADENOMA RISK
SECONDHAND SMOKE CAUSES
ENDOTHELIAL DYSFUNCTION IN CHILDREN
LONG TERM SMOKING MAY
INCREASE RISK OF DEPRESSION
NEW SEXUALLY TRANSMITTED INFECTION
PASSES GONORRHEA IN PREVALENCE
BREAST CANCER SCREENING WITH MRI
MODERATE ALCOHOL USE MAY SLOW PROGRESSION TO DEMENTIA
The
May 22, 2007 issue of Neurology suggests a single
alcoholic drink every day or less may significantly delay
progression to dementia in individuals with mild cognitive
impairment.
Investigators at the
University
of
Bari
in Italy found patients with mild cognitive impairment who
had up to one drink per day developed dementia at a rate
85% slower than the control group, who abstained from
alcohol usage. The alcohol used in the study was mostly
wine.
Study
subjects were participants in the Italian Longitudinal
Study on Aging which was composed of 1445 individuals from
ages 65-84 who were healthy at the start of the study and
evaluated for risk factors for cognitive impairment. Out
of this group, 121 who developed mild cognitive impairment
were evaluated further for progression to dementia.
Statistical analyses indicated at a median follow up of
3.5 years, light drinking (0.1-1 drink/day) was associated
with a significantly lower rate of progression to dementia
compared with no alcohol consumption, with a HR of 0.15,
95% CI (0.03-0.77). There was no significant association
between higher levels of drinking (more than 1 drink/day)
and the rate of progression to dementia as compared to
nondrinkers. Analyses also indicated that compared with
alcohol from other sources, alcohol from wine was also
significantly associated with a lower rate of progression
to dementia.
The
mechanism by which low to moderate alcohol consumption is
able to slow the progression of dementia is not clear. It
may be through the effects of alcohol consumption on the
cerebral vasculature, as it has been shown moderate
alcohol consumption may be protective against ischemic
stroke and vascular dementia.
V. Solfrizzi, A.
D’Introno, A. M. Colacicco, C. Capurso, A. Del Parigi, G.
Baldassarre, P. Scapicchio, E. Scafato, M. Amodio, A.
Capurso, F. Panza For the Italian Longitudinal Study on
Aging Working Group. Alcohol consumption,
mild cognitive impairment, and progression to dementia;
Neurology, May
2007;
68:
1790 -
1799
Table of Contents
FISH OIL SUPPLEMENTS PLUS REGULAR
AEROBIC EXERCISE BENEFIT OVERWEIGHT PATIENTS
In the
May issue of the American Journal of Clinical Nutrition,
investigators published results of a study which found
fish oil supplements and regular aerobic exercise reduced
body fat and improved cardiovascular and metabolic
health.
In a
study done at the
University
of
South
Australia
in Adelaide, investigators found regular exercise and
consumption of long chain n-3 fatty acids from fish or
fish oil independently improved cardiovascular and
metabolic health, and combining the two lifestyle
modifications was possibly more effective than either
treatment alone.
In the
study, 75 participants with BMI > 25 , hypertension,
hyperlipidemia, or triglyceride levels were randomized to
either fish oil daily, fish oil plus exercise, a control
group of sunflower oil consumption daily, and sunflower
oil plus exercise. The exercise consisted of walking 3
days per week for 45 minutes at 75% of age predicted
maximal heart rate.
Compared with control, the fish oil group had lower
triglyceride levels, higher HDL levels, and improved
endothelium dependent vasodilatation, a monitor of
cardiovascular status. In groups exposed to exercise
versus those with the no exercise intervention, the
exercise group had better cardiovascular function. Both
fish oil and exercise independently reduced body fat, as
well.
The
compliance level was 85%, indicating this moderate level
of exercise and dietary supplementation may be well
tolerated by the general public.
A. Hill, J. Buckley, K. Murphy,
and P. Howe. Combining fish-oil supplements with
regular aerobic exercise improves body composition and
cardiovascular disease risk factors; Am. J.
Clinical Nutrition, May
2007;
85:
1267 -
1274.
Table of Contents
NO EFFECT ON REGULAR MULTIVITAMIN
USE ON PROSTATE CANCER, BUT HIGH INTAKE INCREASES RISK
A
large prospective study in the May 15 issue of the
Journal of the National Cancer Institute, found
regular multivitamin use has no effect on risk for
prostate cancer, but men with high intake of multivitamins
(> 7 times/week) are at more than two times the risk for
advanced and fatal prostate cancer, compared with those
who do not use multivitamins.
While
study authors cautioned against changing practice from an
observational study, where no conclusions could be drawn
regarding cause and effect, it does appear regular, daily
use of multivitamins in men does not increase their risk
for prostate cancer, while increased use may be a cause
for concern.
The
study looked at data from 295,344 men participating in the
NIH-AARP Diet and Health Study. All were cancer free at
the beginning of the study and after 5 years of follow up,
10,241 were diagnosed with prostate cancer, with 8,765
localized cancer, and 1,576 advanced cancers. Information
on multivitamin use was obtained from self-reported
questionnaires obtained when the men started the study. No
data is available on whether the men continued to use
multivitamins or for how long they continued.
Analyzing the data, the study authors found there was no
association between the use of multivitamins and risk for
localized prostate cancer. However, in the group of men
with high intake of vitamins, there was an increased risk
for advanced prostate cancer, with a RR of 1.32, 95% CI
(1.04-1.67). There was also an increase in risk for fatal
prostate cancer, RR = 1.98, 95% CI (1.07-3.66).
The
strongest association with increased multivitamin use was
found in men with a positive family history of prostate
cancer and also in men who reported additional use of
supplements, such as selenium, beta carotene and zinc. Men
taking supplements and high levels of multivitamins had
also an increased risk for localized prostate cancer.
This
study is not the first to suggest an increased risk with
multivitamin use for prostate cancer. Two previous reports
from the Cancer Prevention Study-II also suggested the
same. However, last years’ Supplementation en Vitamines et
Mineraux Antioxydants trial indicated decreased risk with
supplementation in men with normal PSA levels, and no
effect in men with elevated PSA levels.
The
study authors hypothesize multivitamin use may initially
protect against initiation of carcinogenesis, but may be
associated with rapid progression of cancer once it
occurs.
K. Lawson, M. Wright, A. Subar, T. Mouw, A. Hollenbeck,
A. Schatzkin, and M. Leitzmann. Multivitamin Use
and Risk of Prostate Cancer in the National Institutes of
Health–AARP Diet and Health Study; J. Natl.
Cancer Inst. 2007; 99: 754-764.
Table of Contents
COMPUTER MODEL DETERMINES EFFICIENT STRATEGIES FOR
INOCULATING HOSPTIAL STAFF IN PANDEMIC OUTBREAK
Using
discrete-event simulation, a new study has found a
computer model can determine efficient strategies to
inoculate all hospital staff during a pandemic outbreak,
as reported in the May issue of Infection Control and
Hospital Epidemiology.
The
authors state it is important during an outbreak for
hospitals to remain fully functional. With that goal in
mind, this study conducted at the Weill Medical College of
Cornell University in New York, used discrete-event
simulation to compare strategies between two specific
methods of staff inoculation, and one in which an
unmanaged, nonrandom scenario was simulated.
Both
structured approaches tested had significant advantages
over the unmanaged, “first come, first serve” scenario.
The objective of the two specific management methods
involved distribution of services and work shifts as
evenly as possible.
The
best strategy was found to be the “ticket strategy”, where
each staff member was assigned a time for inoculation,
based on badge number or hospital ID. The other managed
strategy involved allowing staff members to pick their
time of inoculation, but only when the line for receiving
prophylaxis had less than a set number of people. One
disadvantage of this strategy is many return trips were
needed by staff members when the line maximum was met.
While
many individual hospitals have differing levels of
emergency preparedness planning, there is very little
evidence based/best practice examples of this aspect of
hospital protection, the study authors concluded. Thus,
this study is the start of an effort from academic
research to aid public health officials and emergency
management planners with their decision making.
W. Xiong, E. Hollingsworth, J.
Muckstadt, J. Van Lieu Vorenkamp, E. Lazar, N. Cagliuso,
Sr., and N. Hupert. Hospital "Self-Prophylaxis":
Strategies for Efficient Protection of the Workforce in
the Face of Infectious Disease Threats; Infect Control
Hosp Epidemiol. 2007;28:618-621.
Table of Contents
ELDERLY FALLS, DRUG OVERDOESES,
DRIVE INCREASE IN ACCIDENTAL DEATH RATE
Recent
data from the National Safety Council report indicate
accidental deaths in the US rose by 21% between 1995 and
2005, with many of those deaths caused by drug overdoses
and falls among the elderly.
Deaths
from falls of people over the age of 65 rose 31% between
1999 and 2003, with the report defining death from fall as
a death within one year of a fall. In addition, accidental
poisoning deaths, usually from illegal, prescription, or
over the counter drug overdoses, rose 11% between 2002 and
2003. Poisoning is now the fastest rising cause of
accidental death. The rates were increasing at the highest
levels among white women, with a rate of increase of more
than 300% over 10 years.
Overall, motor vehicle crashes are the top cause of
accidental deaths, but that number has decreased by 16%
since 1992. Workplace accidents have also decreased as a
cause of death by 17% since 1992. There was a 1% increase
in accidental deaths from 2004.
NSC:
http://www.nsc.org/news/injury_data.htm
Table of Contents
IMPROVING THE
MANAGEMENT OF CHRONIC DISEASE AT COMMUNITY HEALTH
CENTERS
In the
March 1st edition of the New England Journal
of Medicine, a controlled trial was done to study
community health centers participating in quality
improvement collaboratives (the Health Disparities
Collaboratives, as sponsored by HRSA) for the care of
patients with diabetes, asthma, or hypertension.
The
Health Disparities Collaborative of the Health Resources
and Services Administration (HRSA) were designed to
improve care in community health centers, where many
patients who are uninsured, or are from ethnic or racial
minority groups receive treatment.
In
this study, 9,658 patients at 44 intervention centers who
participated in the collaboratives and 20 centers had not
participated were enrolled (called external controls).
Each intervention center also served as an internal
control for another condition. Equality measures were
abstracted from medical records at each health center, and
overall quality scores were created by standardizing and
averaging the scores from all of the applicable measures.
Changes in quality were evaluated using hierarchical
regression models controlled for patient characteristics.
Results indicated intervention centers had greater
improvement than the external and internal control centers
in the composite measures of quality for the care of
patients with asthma and diabetes, but not hypertension.
Compared with the external control centers, the
intervention centers had significant improvements in the
measures of prevention and screening, including 21%
increase in diabetic foot examination and in disease
treatment and monitoring. There was no improvement in any
of the intermediate outcomes assessed, such as urgent care
or hospitalization for asthma, control of HbA1C levels for
diabetes, and control of blood pressure for hypertension.
The
authors concluded the Health Disparities Collaborative
significantly improved the processes of care for diabetes
and asthma. There was however, no improvement in the
clinical outcomes studied.
B. Landon, L. Hicks, A. O'Malley,
T. Lieu, T. Keegan, B. McNeil, and E. Guadagnoli.
Improving the Management of Chronic Disease at
Community Health Centers; N Eng J Med
2007;356;921-934.
Table of Contents
WHO and UNAIDS RECOMMEND
OPT-OUT HIV TESTING
On May
30, 2007, the WHO and UNAIDS issued new guidelines
regarding HIV testing and counseling in healthcare
facilities. In previous guidelines, it was up to the
patient to actively seek out HIV testing. In the current
guidelines, the provider initiates the HIV testing. The
guidelines consisted of the following:
Worldwide, HIV testing and counseling should be
recommended to all patients who present with any
suspicious signs or symptoms of HIV or AIDS.
Where
the prevalence of HIV exceeds 1% in the general
population, HIV testing and counseling should be
recommended to all patients in all healthcare settings.
Where
the country-wide prevalence of HIV is less than 1% in the
general population, clinicians should consider
recommending HIV testing and counseling to patients in
facilities such as those offering antenatal, tuberculosis,
and sexual-health services and those whose patient
populations include those at highest risk for HIV.
World Health Organization.
Guidance on provider-initiated HIV testing and counseling
in health facilities. May 2007. Available at:
http://www.who.int/hiv/who_pitc_guidelines.pdf.
Accessed June 11, 2007.
Table of Contents
BETTER TREATMENT, LOWER RISK FACTORS CAUSED DROP IN
CARDIAC DEATHS
A
study published in the June 7th issue of the
New England Journal of Medicine has found the decline
in deaths in the
United
States
from coronary heart disease from 1980-2000 can be
attributed to both better treatments and a reduction of
risk factors.
The
study looked at how the death rate from coronary heart
disease had been cut by almost a half over the course of
20 years. Using the IMPACT statistical model, risk factors
such as smoking, diet, and exercise status, and
hypertension were analyzed. IMPACT was also applied to
data on the use and effectiveness of specific cardiac
treatments between 1980 and 2000 among
U.S. adults 25 to 84 years old. Researchers found medical
treatments accounted for 47% of the drop while decreased
risk factors accounted for 44% of the change.
However, the risk factor recutions were partially offset
by an increase in deaths due to increased BMI and
diabetes. Together, diabetes and obesity caused an
additional 60,000 cardiac deaths. The authors of the study
warned if these increases continue, the two conditions
could eradicate the improvements made over the past 20
years in combating coronary heart disease. The authors
recommend future strategies for preventing and treating
coronary heart disease should therefore be
comprehensive, maximizing the coverage of
effective treatments and actively promoting
population-based prevention by reducing risk factors.
E.
Ford, U. Ajani, J. Croft, J. Critchley, D. Labarthe, T.
Kottke, W. Giles, and S. Capewell. Explaining
the Decrease in U.S. Deaths from Coronary Disease,
1980–2000; N Eng J Med 2007; 356:2388-2398.
Table of Contents
FOLIC ACID DOESN’T DECREASE COLORECTAL ADENOMA RISK
A
study in the June 6th issue of the Journal
of the American Medical Association finds high doses
of folic acid do not decrease the risk of colorectal
adenomas in people who are at increased risk for
developing them. Folic acid may, in fact, increase their
risk for advanced lesions and multiple adenomas. Previous
laboratory and epidemiological data suggested folic acid
actually had an antineoplastic effect in the large
intestine.
The
study was a double blind, randomized control trial, which
consisted of 1, 012 patients who had a positive history of
colorectal adenoma. One group received 1 mg/day of folic
acid while the other group received placebo. Following the
two groups over the course of three years, the incidence
of at least one colorectal adenoma on follow up
colonoscopy screening was 41.9% for the folic acid group
and 37.2% for the placebo group (RR 1.13, 95% CI
0.92-1.37, p = 0.23). The incidence of at least one
advanced lesion found on colonoscopy was 11.6% for the
folic acid group and 6.9% for the placebo group (RR 1.67,
95% CI 1.00-2.80, p = 0.05). Folic acid also might be
associated with an increased risk of having three or more
adenomas and of developing prostate cancer, though the
authors warned those results may be spurious.
The
food supply has been fortified with folate since 1996, and
the authors contend this may have affected study results,
as the study began before fortification with folate began.
Further study is needed to ascertain whether
supplementation of the food supply with folic acid may be
increasing the population’s risk for colorectal adenomas.
B. Cole, J. Baron, R. Sandler, R.
Haile, D. Ahnen, R. Bresalier, G. McKeown-Eyssen, R.
Summers, and R. Rothstein et al. for the Polyp Prevention
Study Group. Folic Acid for the Prevention of
Colorectal Adenomas: A Randomized Clinical Trial;
JAMA. 2007;297:2351-2359.
Table of Contents
PAY FOR PERFORMANCE,
QUALITY OF CARE, AND OUTCOMES IN ACUTE MYOCARDIAL
INFARCTION
A recent study in JAMA analyzed the largest
pay-for-performance pilot project to date in the United
States, launched in 2003 by the Centers for Medicare and
Medicaid Services. Pay for performance has been promoted
by many as a tool for improving quality of care. This
study was undertaken to determine if pay for performance
was associated with either improved processes of care and
outcomes, or unintended consequences, looking at
indicators for acute myocardial infarction in hospitals
participating in the CMS pilot project.
The study was an
observational, patient-level analysis of
105,383 patients with acute non–ST-segment
elevation myocardial infarction who were enrolled in the
CRUSADE national quality-improvement
initiative. Patients were treated between
July 1, 2003,
and
June 30, 2006,
at 54 hospitals in the CMS program and 446
control hospitals. The main outcome measure for
the study was the differences in the use of ACC/AHA
class I guideline recommended therapies and
in-hospital mortality between the CMS pilot pay
for performance and control hospitals.
The study found
among treatments subject to financial incentives,
there was a slightly higher rate of improvement for
2 of 6 targeted therapies at
pay-for-performance vs control hospitals (odds
ratio [OR] comparing adherence scores from 2003 through
2006 at half-year intervals for aspirin at
discharge, 1.31; 95% confidence interval [CI],
1.18-1.46 vs OR, 1.17; 95% CI, 1.12-1.21; P = .04)
and for smoking cessation counseling (OR, 1.50; 95%
CI, 1.29-1.73 vs OR, 1.28; 95% CI, 1.22-1.35;
P = .05). There was no significant
difference in a composite measure of the 6 CMS
rewarded therapies between the 2 hospital groups (change
in odds per half-year period of receiving CMS
therapies: OR, 1.23; 95% CI, 1.15-1.30 vs OR,
1.17; 95% CI, 1.14-1.20; P = .16). For
composite measures of acute myocardial infarction
treatments not subject to incentives, rates of
improvement were not significantly different
(OR, 1.09; 95% CI, 1.05-1.14 vs OR, 1.08; 95% CI,
1.06-1.09; P = .49). Overall, there was no
evidence improvements in in-hospital mortality
were incrementally greater at
pay-for-performance sites (change in odds of in-hospital
death per half-year period, 0.91; 95% CI, 0.84-0.99
vs 0.97; 95% CI, 0.94-0.99; P = .21).
The authors concluded among hospitals participating in a
voluntary quality-improvement initiative, the
pay-for-performance program was not associated
with any significant incremental improvement in
quality of care or outcomes for acute myocardial
infarction. However, there was no evidence pay
for performance had an adverse association with
improvement in processes of care not subject to
financial incentives.
S. Glickman, F. Ou, E. DeLong, M. Roe, B. Lytle, J.
Mulgund, J. Rumsfeld, W. Gibler, E. Magnus Ohman, K.
Schulman, E. Peterson. Pay for Performance,
Quality of Care, and Outcomes in Acute Myocardial
Infarction; JAMA. 2007;297:2373-2380.
Table of Contents
SECONDHAND SMOKE CAUSES
ENDOTHELIAL DYSFUNCTION IN CHILDREN
A study from Finland published in the June 4th
issue of Circulation finds children as young as 12 may
develop endothelial dysfunction in response to secondhand
smoke, in a dose-dependent fashion, even with minimal
exposure. This study corroborates previous studies on the
harmful effects of passive smoking in teenagers and
adults.
The study used data from an ongoing Special Turku Coronary
Risk Factor Intervention Project for children, in which
serum cotinine concentration (a serum marker for recent
nicotine exposure), was measured annually in children ages
8-11. At age 11, endothelial function was measured using
brachial artery endothelium dependent flow mediated
vasodilatation and the values were assessed, comparing
with serum cotinine concentrations.
Eleven year olds with the highest cotinine levels had the
greatest attenuation in endothelial dilation, whereas
children with undetectable cotinine levels had the least
impairment of endothelial function. The trend was
unchanged, even after controlling for traditional risk
factors for atherosclerosis.
Cotinine levels even in the highest group were found to be
lower than in previous studies from Britain and America,
suggesting perhaps no level of exposure to smoking is
safe.
K. Kallio, E. Jokinen, O.
Raitakari, M. Hämäläinen, M. Siltala, I. Volanen, T.
Kaitosaari, J. Viikari, T. Rönnemaa, and O. Simell.
Tobacco Smoke Exposure Is Associated With
Attenuated Endothelial Function in 11-Year-Old Healthy
Children; Circulation, Jun
2007; 115:
3205 - 3212.
Table of Contents
LONG TERM SMOKING MAY
INCREASE RISK OF DEPRESSION
Smoking and depression are both highly prevalent
conditions with profound public health implications.
Persistent smoking may be a predictor of depression
symptoms, a longitudinal study of Finnish twins published
in the May issue of Psychological Medicine. This
association was not seen in individuals who had quit
smoking many years ago.
The study, from the University of Helsinki, was based on
records from 10,977 men and women. The cohort used was the
Finnish Twin Cohort, established to examine the genetic,
environmental, and psychosocial determinants of chronic
diseases and health behaviors. Smoking status was
determined by questionnaires conducted in 1975 and 1981.
Twins who responded to at least one of the surveys were
evaluated with the Beck Depression Inventory in 1990.
Using multiple logistic regression analyses, with
never-smoked as the reference category, the authors found
men were significantly more prone to depressive symptoms
if they had reported smoking at the time of both earlier
surveys (OR 1.42) or were smokers in 1971 who had quit by
1981 (OR 1.68). Genetic modeling suggested a modest
correlation between genetic components of smoking and
depression. Among women, only quitters had an increased
risk for depression. Only men and women who smoked
previously but had quit by the time of the first survey in
1975 were not at increased risk for depressive symptoms.
The investigators concluded the persistent smoking seemed
to be the strongest predictor of depressive symptoms.
While nicotine is thought of as a mood elevator, chronic
use of cigarettes may lead to depressive symptoms
secondary to the numerous other compounds contained in
cigarette smoke. There are over 4000 compounds in
cigarette smoke, many of them bioactive, cytotoxic,
carcinogenic, or mutagenic. In addition, as nicotine is
addiction, the mechanism of addiction may also increase
the risk for depression.
T. Korhonen, U. Broms, J.
Varjonen, K. Romanov, M. Koskenvuo, T. Kinnunen, and K.
Kaprio. Smoking behaviour as a predictor of depression
among Finnish men and women: A Prospective Cohort Study of
Adult Twins. Psychol Med 2007;37:705-715.
Table of Contents
NEW SEXUALLY TRANSMITTED
INFECTION PASSES GONORRHEA IN PREVALENCE
A relatively new sexually transmitted infection has
surpassed Neiserria gonorrhea in prevalence among young
adults in the US, according to a new study published in
the June issue of the American Journal of Public Health.
Mycoplasma genitalium was first identified in the 1980s.
In the current study, researchers at the University of
Washington, Seattle, found a prevalence of M. genitalium
infection of 1%, in contrast to a prevalence of N.
gonorrhea of 0.4%. Prevalence of chlamydial infections was
4.2% and trichomonal infection prevalence was 2.3%.
The study examined 1,714 women and 1,218 men between the
ages of 18-27 years who participated in Wave III of the
National Longitudinal Study of Adolescent Health. M.
genitalium prevalence was 1.1% among women having vaginal
intercourse compared with 0.05% for those who did not.
Prevalence increased 10% with each additional sexual
partner. Prevalence was also 11 times higher among
individuals living with a sexual partner, seven times
higher among blacks and four times higher among those who
use condoms during sex.
Many M. genitalium infections are asymptomatic, like
chlamydial infections. However, it is likely too soon to
recommend widespread screening for Chlamydia, the authors
state. In men, M. genitalium is likely another cause for
non-gonococcal urethritis.
There is currently no data on the incidence of M.
genitalium in the US. Among Kenyan commercial sex workers,
M. genitalium incidence was 22.7 per 100 women years, as
compared to 14 per 100 woman years for C. trachomatis and
8 per 100 woman years for N. gonorrhea.
There are no official recommendations on treating M.
genitalium infections, but previous studies suggest
azithromycin may be more effective than doxycycline.
L. Manhart, K. Holmes, J. Hughes,
L. Houston, and P. Totten. Mycoplasma genitalium
Among Young Adults in the United States: An Emerging
Sexually Transmitted Infection; Am J Public
Health
2007;
97:
1118 -
1125.
Table of Contents
BREAST CANCER SCREENING WITH
MRI
The American Cancer Society has published new guidelines
for breast screening with contrast enhanced magnetic
resonance imaging as an adjunct to mammography. They
recommend the following:
Annual MRI screening for patients with BRCA mutations and
whose risk of developing breast cancer is at least 20%,
according to predictive models based on family history.
This recommendation is based on nonrandomized screening
studies.
Annual MRI screening is recommended for patients who
receive chest radiation between the ages 10-30 and for
patients with several unusual genetic syndromes. This is
based on expert opinion.
There is insufficient evidence to recommend for or against
MRI screening for women with personal histories of breast
cancer, atypical ductal hyperplasa, ductal carcinoma,
lobular hyperplasia, or lobular carcinoma in situ or women
with a lifetime risk of 15-30%.
MRI screening is not recommended for women with a lifetime
risk below 15%
Screening should begin at age 30 for most high risk women.
In studies of high risk patients, MIR is more sensitive,
but less specific than mammography.
D. Saslow, C. Boetes, W. Burke, S.
Harms, M. Leach, C. Lehman, E. Morris, E. Pisano, M.
Schnall, S. Sener, R. Smith, E. Warner, M. Yaffe, K.
Andrews, C. Russell for the American Cancer Society Breast
Cancer Advisory Group. American Cancer Society
Guidelines for Breast Screening with
MRI as an Adjunct to Mammography; CA
Cancer J Clin 2007 57: 75-89.
Table of Contents
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