Melinda Tanzola

Smoking seems to contribute to the development of knee cartilage loss and defects in those with a family history of knee osteoarthritis (OA), according to results reported by Dr. Changhai Ding and associates of the University of Tasmania in Australia.

In this study, 345 relatively young individuals (average age, 45 years) were measured at baseline and again 2.3 years later. Of the 162 persons with at least one parent with severe primary knee OA, 40 current smokers had greater loss in medial and lateral tibial cartilage volumes (beta = −2.20% and −1.45%. respectively) than did 47 former smokers and 75 never-smokers, after adjusting for confounding factors in a logistic regression analysis. Pack-years of smoking were also significantly associated with changes in cartilage volume (Arthritis Rheum. 2007;56:1521-8).

The authors did not find a similar relationship between smoking status and knee OA measures in 163 individuals with no family history of knee OA. The only factor significantly associated with smoking status in control individuals was change in lateral tibiofemoral cartilage volume, providing evidence for a “gene-environment interaction in the etiology of knee OA.”

Among those with a family history of knee OA, being a current smoker increased the risk of developing medial tibiofemoral cartilage defects by nearly fivefold during the study period and increased the risk of lateral tibiofemoral cartilage defects by threefold. The risk increases in heavy smokers (at least 20 pack-years) versus never-smokers were 10-fold and 13-fold, respectively.

The interaction in smoking status, family history of knee OA, and cartilage effects remained significant in regards to change in medial tibial cartilage volume and increases in cartilage defects, both medial and lateral, after adjusting for confounding factors. In the overall group, the prevalence of knee pain was higher in current smokers (41%) than in former smokers or never-smokers (33%), regardless of family history. However, there was no overall association between smoking status and baseline tibial cartilage volume or prevalent tibiofemoral cartilage defects.

Smoking seems to contribute to the development of knee cartilage loss and defects in those with a family history of knee osteoarthritis (OA), according to results reported by Dr. Changhai Ding and associates of the University of Tasmania in Australia.

In this study, 345 relatively young individuals (average age, 45 years) were measured at baseline and again 2.3 years later. Of the 162 persons with at least one parent with severe primary knee OA, 40 current smokers had greater loss in medial and lateral tibial cartilage volumes (beta = −2.20% and −1.45%. respectively) than did 47 former smokers and 75 never-smokers, after adjusting for confounding factors in a logistic regression analysis. Pack-years of smoking were also significantly associated with changes in cartilage volume (Arthritis Rheum. 2007;56:1521-8).

The authors did not find a similar relationship between smoking status and knee OA measures in 163 individuals with no family history of knee OA. The only factor significantly associated with smoking status in control individuals was change in lateral tibiofemoral cartilage volume, providing evidence for a “gene-environment interaction in the etiology of knee OA.”

Among those with a family history of knee OA, being a current smoker increased the risk of developing medial tibiofemoral cartilage defects by nearly fivefold during the study period and increased the risk of lateral tibiofemoral cartilage defects by threefold. The risk increases in heavy smokers (at least 20 pack-years) versus never-smokers were 10-fold and 13-fold, respectively.

The interaction in smoking status, family history of knee OA, and cartilage effects remained significant in regards to change in medial tibial cartilage volume and increases in cartilage defects, both medial and lateral, after adjusting for confounding factors. In the overall group, the prevalence of knee pain was higher in current smokers (41%) than in former smokers or never-smokers (33%), regardless of family history. However, there was no overall association between smoking status and baseline tibial cartilage volume or prevalent tibiofemoral cartilage defects.

Smoking seems to contribute to the development of knee cartilage loss and defects in those with a family history of knee osteoarthritis (OA), according to results reported by Dr. Changhai Ding and associates of the University of Tasmania in Australia.

In this study, 345 relatively young individuals (average age, 45 years) were measured at baseline and again 2.3 years later. Of the 162 persons with at least one parent with severe primary knee OA, 40 current smokers had greater loss in medial and lateral tibial cartilage volumes (beta = −2.20% and −1.45%. respectively) than did 47 former smokers and 75 never-smokers, after adjusting for confounding factors in a logistic regression analysis. Pack-years of smoking were also significantly associated with changes in cartilage volume (Arthritis Rheum. 2007;56:1521-8).

The authors did not find a similar relationship between smoking status and knee OA measures in 163 individuals with no family history of knee OA. The only factor significantly associated with smoking status in control individuals was change in lateral tibiofemoral cartilage volume, providing evidence for a “gene-environment interaction in the etiology of knee OA.”

Among those with a family history of knee OA, being a current smoker increased the risk of developing medial tibiofemoral cartilage defects by nearly fivefold during the study period and increased the risk of lateral tibiofemoral cartilage defects by threefold. The risk increases in heavy smokers (at least 20 pack-years) versus never-smokers were 10-fold and 13-fold, respectively.

The interaction in smoking status, family history of knee OA, and cartilage effects remained significant in regards to change in medial tibial cartilage volume and increases in cartilage defects, both medial and lateral, after adjusting for confounding factors. In the overall group, the prevalence of knee pain was higher in current smokers (41%) than in former smokers or never-smokers (33%), regardless of family history. However, there was no overall association between smoking status and baseline tibial cartilage volume or prevalent tibiofemoral cartilage defects.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years, the authors said. “We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases.” They also noted the importance of these findings for the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years, the authors said. “We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases.” They also noted the importance of these findings for the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years, the authors said. “We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases.” They also noted the importance of these findings for the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

Smoking appears to contribute to the development of knee cartilage loss and defects in individuals with a family history of knee osteoarthritis (OA), according to the results reported by Dr. Changhai Ding and associates of the University of Tasmania in Australia.

In this study the knee cartilage of 345 relatively young individuals (the average age was 45 years) were measured at baseline and again 2.3 years later, and their risk factors were assessed.

Of the 162 persons with at least one parent with severe primary knee OA, 40 current smokers had greater loss in medial and lateral tibial cartilage volumes (beta = −2.20% and −1.45%. respectively) than did 47 former smokers and 75 never-smokers, after adjusting for confounding factors in a logistic regression analysis. Pack-years of smoking were also significantly associated with changes in cartilage volume (Arthritis Rheum. 2007;56:1521–8).

Dr. Ding and associates did not find a similar relationship between smoking status and knee OA measures in 163 individuals with no family history of knee OA.

The only factor significantly associated with smoking status in control individuals was change in lateral tibiofemoral cartilage volume.

“This provides evidence for a gene-environment interaction in the etiology of knee OA,” the investigators wrote.

Among those with a family history of knee OA, being a current smoker increased the risk of developing medial tibiofemoral cartilage defects by nearly fivefold during the study period. Similarly, a positive family history increased the risk of lateral tibiofemoral cartilage defects threefold.

The risk increases among heavy smokers (at least 20 pack-years) versus never-smokers were 10-fold and 13-fold, respectively.

The interaction among smoking status, family history of knee OA, and cartilage effects remained significant in regards to change in medial tibial cartilage volume and increases in cartilage defects, both medial and lateral, even after adjusting for potentially confounding factors.

In the overall group, the prevalence of knee pain was higher among current smokers (41%) than it was among former smokers or never-smokers (33%), regardless of family history.

There was no overall association between smoking status and baseline tibial cartilage volume or prevalent tibiofemoral cartilage defects.

Smoking appears to contribute to the development of knee cartilage loss and defects in individuals with a family history of knee osteoarthritis (OA), according to the results reported by Dr. Changhai Ding and associates of the University of Tasmania in Australia.

In this study the knee cartilage of 345 relatively young individuals (the average age was 45 years) were measured at baseline and again 2.3 years later, and their risk factors were assessed.

Of the 162 persons with at least one parent with severe primary knee OA, 40 current smokers had greater loss in medial and lateral tibial cartilage volumes (beta = −2.20% and −1.45%. respectively) than did 47 former smokers and 75 never-smokers, after adjusting for confounding factors in a logistic regression analysis. Pack-years of smoking were also significantly associated with changes in cartilage volume (Arthritis Rheum. 2007;56:1521–8).

Dr. Ding and associates did not find a similar relationship between smoking status and knee OA measures in 163 individuals with no family history of knee OA.

The only factor significantly associated with smoking status in control individuals was change in lateral tibiofemoral cartilage volume.

“This provides evidence for a gene-environment interaction in the etiology of knee OA,” the investigators wrote.

Among those with a family history of knee OA, being a current smoker increased the risk of developing medial tibiofemoral cartilage defects by nearly fivefold during the study period. Similarly, a positive family history increased the risk of lateral tibiofemoral cartilage defects threefold.

The risk increases among heavy smokers (at least 20 pack-years) versus never-smokers were 10-fold and 13-fold, respectively.

The interaction among smoking status, family history of knee OA, and cartilage effects remained significant in regards to change in medial tibial cartilage volume and increases in cartilage defects, both medial and lateral, even after adjusting for potentially confounding factors.

In the overall group, the prevalence of knee pain was higher among current smokers (41%) than it was among former smokers or never-smokers (33%), regardless of family history.

There was no overall association between smoking status and baseline tibial cartilage volume or prevalent tibiofemoral cartilage defects.

Smoking appears to contribute to the development of knee cartilage loss and defects in individuals with a family history of knee osteoarthritis (OA), according to the results reported by Dr. Changhai Ding and associates of the University of Tasmania in Australia.

In this study the knee cartilage of 345 relatively young individuals (the average age was 45 years) were measured at baseline and again 2.3 years later, and their risk factors were assessed.

Of the 162 persons with at least one parent with severe primary knee OA, 40 current smokers had greater loss in medial and lateral tibial cartilage volumes (beta = −2.20% and −1.45%. respectively) than did 47 former smokers and 75 never-smokers, after adjusting for confounding factors in a logistic regression analysis. Pack-years of smoking were also significantly associated with changes in cartilage volume (Arthritis Rheum. 2007;56:1521–8).

Dr. Ding and associates did not find a similar relationship between smoking status and knee OA measures in 163 individuals with no family history of knee OA.

The only factor significantly associated with smoking status in control individuals was change in lateral tibiofemoral cartilage volume.

“This provides evidence for a gene-environment interaction in the etiology of knee OA,” the investigators wrote.

Among those with a family history of knee OA, being a current smoker increased the risk of developing medial tibiofemoral cartilage defects by nearly fivefold during the study period. Similarly, a positive family history increased the risk of lateral tibiofemoral cartilage defects threefold.

The risk increases among heavy smokers (at least 20 pack-years) versus never-smokers were 10-fold and 13-fold, respectively.

The interaction among smoking status, family history of knee OA, and cartilage effects remained significant in regards to change in medial tibial cartilage volume and increases in cartilage defects, both medial and lateral, even after adjusting for potentially confounding factors.

In the overall group, the prevalence of knee pain was higher among current smokers (41%) than it was among former smokers or never-smokers (33%), regardless of family history.

There was no overall association between smoking status and baseline tibial cartilage volume or prevalent tibiofemoral cartilage defects.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years.

“We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases,” wrote Dr. Miles and Ms. Takahashi.

They also emphasized the importance of these findings in terms of the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

The investigators also failed to identify an association between thimerosal-containing Rh immunoglobulin and various autism characteristics, including clinical diagnosis, IQ, gender, dysmorphology status, head size, and regressive versus early-onset autism spectrum disorder.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years.

“We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases,” wrote Dr. Miles and Ms. Takahashi.

They also emphasized the importance of these findings in terms of the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

The investigators also failed to identify an association between thimerosal-containing Rh immunoglobulin and various autism characteristics, including clinical diagnosis, IQ, gender, dysmorphology status, head size, and regressive versus early-onset autism spectrum disorder.

Exposure to thimerosal-containing Rh immunoglobulin during pregnancy is not associated with an increased risk of having a child with an autism spectrum disorder, said Dr. Judith H. Miles and T. Nicole Takahashi.

Overall, 214 mothers of 230 children receiving treatment for an autism spectrum disorder at the autism clinic at the University of Missouri-Columbia were not more likely to be Rh-negative than were 65 mothers of children receiving other medical genetic treatment there (15.4% vs. 15.4%), said Dr. Miles and Ms. Takahashi of the university (Am. J. Med. Genet. A 2007;doi:10.1002/ajmg.a.31846).

The proportion of Rh-negative women was similar among other controls, including 15.2% among all patients at the university hospital whose blood was typed between April 1, 2005, and March 31, 2006, and 17.7% among blood donors at the Missouri Illinois Regional Red Cross in calendar year 2005, they reported.

Mothers of children with an autism spectrum disorder were also not more likely than the control patients receiving other medical genetic treatment to have been exposed to antepartum thimerosal-containing Rh immunoglobulin (13.9% vs. 14.8% of those pregnant prior to 2002) or to have an Rh-incompatible pregnancy (61% vs. 50%).

These findings provide further evidence that exposure to ethylmercury in thimerosal does not explain the increased prevalence of autism in recent years.

“We hope this report … will offset some of the decreased compliance with immunization recommendations which is known to increase morbidity and mortality from childhood infectious diseases,” wrote Dr. Miles and Ms. Takahashi.

They also emphasized the importance of these findings in terms of the international use of thimerosal-containing vaccines, which are more affordable because they allow the preservation of multidose vials.

The investigators also failed to identify an association between thimerosal-containing Rh immunoglobulin and various autism characteristics, including clinical diagnosis, IQ, gender, dysmorphology status, head size, and regressive versus early-onset autism spectrum disorder.

For individuals with chronic tennis elbow, rehabilitation based on isokinetic eccentric exercises appears to produce better results than conventional rehabilitation after about 9 weeks, according to a recent study.

Dr. Jean-Louis Croisier and his colleagues at the University of Liege (Belgium) treated 92 patients with unilateral chronic lateral epicondylar tendinopathy who had symptoms for an average of 8 months that did not respond to conservative nonstrengthening treatments.

The 46 individuals who received strengthening-based isokinetic eccentric training with a dynamometer had significantly greater reductions in pain and reported disability than did 46 matched individuals who resumed conventional nonstrengthening rehabilitation measures (Br. J. Sports Med. 2007;41:269–75).

At the end of treatment, average pain scores with eccentric training and control rehabilitation were 1.2 ± 0.9 and 4.3 ± 1.6, respectively (0 = no pain, 10 = most severe pain). Average values on the disability questionnaire were 14.4 ± 4.6 and 10.2 ± 3.8, respectively (0 = most disability, 20 = no disability).

The patients receiving eccentric training also achieved average peak torques that were similar on the affected and unaffected sides, whereas peak torque was significantly reduced in the injured side in the control group.

Outcomes as measured by ultrasonography were also significantly better with eccentric training. By the end of treatment, 48% of patients treated with eccentric training had normalization of the tendon diameter, compared with 28% of those in the control group. Moreover, patients in the control group were more than three times as likely to have no improvement in their echographic image.

For individuals with chronic tennis elbow, rehabilitation based on isokinetic eccentric exercises appears to produce better results than conventional rehabilitation after about 9 weeks, according to a recent study.

Dr. Jean-Louis Croisier and his colleagues at the University of Liege (Belgium) treated 92 patients with unilateral chronic lateral epicondylar tendinopathy who had symptoms for an average of 8 months that did not respond to conservative nonstrengthening treatments.

The 46 individuals who received strengthening-based isokinetic eccentric training with a dynamometer had significantly greater reductions in pain and reported disability than did 46 matched individuals who resumed conventional nonstrengthening rehabilitation measures (Br. J. Sports Med. 2007;41:269–75).

At the end of treatment, average pain scores with eccentric training and control rehabilitation were 1.2 ± 0.9 and 4.3 ± 1.6, respectively (0 = no pain, 10 = most severe pain). Average values on the disability questionnaire were 14.4 ± 4.6 and 10.2 ± 3.8, respectively (0 = most disability, 20 = no disability).

The patients receiving eccentric training also achieved average peak torques that were similar on the affected and unaffected sides, whereas peak torque was significantly reduced in the injured side in the control group.

Outcomes as measured by ultrasonography were also significantly better with eccentric training. By the end of treatment, 48% of patients treated with eccentric training had normalization of the tendon diameter, compared with 28% of those in the control group. Moreover, patients in the control group were more than three times as likely to have no improvement in their echographic image.

For individuals with chronic tennis elbow, rehabilitation based on isokinetic eccentric exercises appears to produce better results than conventional rehabilitation after about 9 weeks, according to a recent study.

Dr. Jean-Louis Croisier and his colleagues at the University of Liege (Belgium) treated 92 patients with unilateral chronic lateral epicondylar tendinopathy who had symptoms for an average of 8 months that did not respond to conservative nonstrengthening treatments.

The 46 individuals who received strengthening-based isokinetic eccentric training with a dynamometer had significantly greater reductions in pain and reported disability than did 46 matched individuals who resumed conventional nonstrengthening rehabilitation measures (Br. J. Sports Med. 2007;41:269–75).

At the end of treatment, average pain scores with eccentric training and control rehabilitation were 1.2 ± 0.9 and 4.3 ± 1.6, respectively (0 = no pain, 10 = most severe pain). Average values on the disability questionnaire were 14.4 ± 4.6 and 10.2 ± 3.8, respectively (0 = most disability, 20 = no disability).

The patients receiving eccentric training also achieved average peak torques that were similar on the affected and unaffected sides, whereas peak torque was significantly reduced in the injured side in the control group.

Outcomes as measured by ultrasonography were also significantly better with eccentric training. By the end of treatment, 48% of patients treated with eccentric training had normalization of the tendon diameter, compared with 28% of those in the control group. Moreover, patients in the control group were more than three times as likely to have no improvement in their echographic image.

Individuals with recent-onset rheumatoid arthritis treated according to disease activity score for 2 years appear to gain little benefit from conventional disease-modifying antirheumatic drugs after initial methotrexate failure, according to the results of a post hoc analysis of the randomized, multicenter, controlled BeSt study.

Overall, 162 of the 244 study patients (66%) failed 2 years of initial methotrexate (MTX) therapy. A subsequent addition of, or switch to, sulfasalazine (SSA), failed in 108 of 138 patients (78%). Subsequent leflunomide monotherapy failed in 47 of 54 patients (87%), while MTX plus SSA and hydroxychloroquine failed in 28 of 44 patients (64%), reported Dr. Sjoerd M. van der Kooij of the Leiden (the Netherlands) University Medical Center and colleagues. However, 34 of 48 patients (71%) who switched to MTX plus infliximab did have treatment success.

Overall, the median total Sharp/van der Heijde score progression was significantly greater among “MTX failures” than “MTX successes” (3 units vs. 1 unit, respectively), regardless of response to subsequent disease-modifying antirheumatic drugs (DMARDs) (Ann. Rheum. Dis. 2007 Feb. 9 [Epub doi:10.1136/ard.2006.066662]).

“This observation confirms earlier studies suggesting that adequate, early suppression of disease activity is paramount for the suppression of joint damage progression,” wrote Dr. van der Kooij and colleagues.

“MTX successes” included the 79 patients who achieved a disease activity score (DAS) of 2.4 after 2 years of methotrexate monotherapy. “MTX failures” included the 66% of patients in the study who initially received MTX 15–25 mg/wk but who discontinued the drug because of toxicity or failure to achieve a DAS of 2.4 or less after 2 years, according to the investigators. These patients were then randomized to receive either sequential monotherapy or a step-up combination therapy. A higher DAS at baseline and female sex were significantly and independently predictive of MTX failure.

Dr. van der Kooij and colleagues suggested that, following the failure of initial MTX therapy, treatment with an anti-tumor necrosis factor agent should not be delayed, given that “switching to or adding other conventional DMARDs offers little chance of clinical efficacy and allows progression of joint damage.”

BeST is supported by the Dutch government and the Dutch College of Health Insurance Companies.

Individuals with recent-onset rheumatoid arthritis treated according to disease activity score for 2 years appear to gain little benefit from conventional disease-modifying antirheumatic drugs after initial methotrexate failure, according to the results of a post hoc analysis of the randomized, multicenter, controlled BeSt study.

Overall, 162 of the 244 study patients (66%) failed 2 years of initial methotrexate (MTX) therapy. A subsequent addition of, or switch to, sulfasalazine (SSA), failed in 108 of 138 patients (78%). Subsequent leflunomide monotherapy failed in 47 of 54 patients (87%), while MTX plus SSA and hydroxychloroquine failed in 28 of 44 patients (64%), reported Dr. Sjoerd M. van der Kooij of the Leiden (the Netherlands) University Medical Center and colleagues. However, 34 of 48 patients (71%) who switched to MTX plus infliximab did have treatment success.

Overall, the median total Sharp/van der Heijde score progression was significantly greater among “MTX failures” than “MTX successes” (3 units vs. 1 unit, respectively), regardless of response to subsequent disease-modifying antirheumatic drugs (DMARDs) (Ann. Rheum. Dis. 2007 Feb. 9 [Epub doi:10.1136/ard.2006.066662]).

“This observation confirms earlier studies suggesting that adequate, early suppression of disease activity is paramount for the suppression of joint damage progression,” wrote Dr. van der Kooij and colleagues.

“MTX successes” included the 79 patients who achieved a disease activity score (DAS) of 2.4 after 2 years of methotrexate monotherapy. “MTX failures” included the 66% of patients in the study who initially received MTX 15–25 mg/wk but who discontinued the drug because of toxicity or failure to achieve a DAS of 2.4 or less after 2 years, according to the investigators. These patients were then randomized to receive either sequential monotherapy or a step-up combination therapy. A higher DAS at baseline and female sex were significantly and independently predictive of MTX failure.

Dr. van der Kooij and colleagues suggested that, following the failure of initial MTX therapy, treatment with an anti-tumor necrosis factor agent should not be delayed, given that “switching to or adding other conventional DMARDs offers little chance of clinical efficacy and allows progression of joint damage.”

BeST is supported by the Dutch government and the Dutch College of Health Insurance Companies.

Individuals with recent-onset rheumatoid arthritis treated according to disease activity score for 2 years appear to gain little benefit from conventional disease-modifying antirheumatic drugs after initial methotrexate failure, according to the results of a post hoc analysis of the randomized, multicenter, controlled BeSt study.

Overall, 162 of the 244 study patients (66%) failed 2 years of initial methotrexate (MTX) therapy. A subsequent addition of, or switch to, sulfasalazine (SSA), failed in 108 of 138 patients (78%). Subsequent leflunomide monotherapy failed in 47 of 54 patients (87%), while MTX plus SSA and hydroxychloroquine failed in 28 of 44 patients (64%), reported Dr. Sjoerd M. van der Kooij of the Leiden (the Netherlands) University Medical Center and colleagues. However, 34 of 48 patients (71%) who switched to MTX plus infliximab did have treatment success.

Overall, the median total Sharp/van der Heijde score progression was significantly greater among “MTX failures” than “MTX successes” (3 units vs. 1 unit, respectively), regardless of response to subsequent disease-modifying antirheumatic drugs (DMARDs) (Ann. Rheum. Dis. 2007 Feb. 9 [Epub doi:10.1136/ard.2006.066662]).

“This observation confirms earlier studies suggesting that adequate, early suppression of disease activity is paramount for the suppression of joint damage progression,” wrote Dr. van der Kooij and colleagues.

“MTX successes” included the 79 patients who achieved a disease activity score (DAS) of 2.4 after 2 years of methotrexate monotherapy. “MTX failures” included the 66% of patients in the study who initially received MTX 15–25 mg/wk but who discontinued the drug because of toxicity or failure to achieve a DAS of 2.4 or less after 2 years, according to the investigators. These patients were then randomized to receive either sequential monotherapy or a step-up combination therapy. A higher DAS at baseline and female sex were significantly and independently predictive of MTX failure.

Dr. van der Kooij and colleagues suggested that, following the failure of initial MTX therapy, treatment with an anti-tumor necrosis factor agent should not be delayed, given that “switching to or adding other conventional DMARDs offers little chance of clinical efficacy and allows progression of joint damage.”

BeST is supported by the Dutch government and the Dutch College of Health Insurance Companies.

ATLANTA — Use of tests to screen for sexually transmitted diseases without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through 25 years of age. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to the findings of a large study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, recommended Dr. Policar, of the University of California, San Francisco.

Clinicians have choices for detecting sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regards to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. This test is indicated for immunocompetent women at least 30 years of age who have their cervix. Clinicians should tell women in advance that they will be screened for HPV so patients can expect the result.

ATLANTA — Use of tests to screen for sexually transmitted diseases without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through 25 years of age. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to the findings of a large study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, recommended Dr. Policar, of the University of California, San Francisco.

Clinicians have choices for detecting sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regards to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. This test is indicated for immunocompetent women at least 30 years of age who have their cervix. Clinicians should tell women in advance that they will be screened for HPV so patients can expect the result.

ATLANTA — Use of tests to screen for sexually transmitted diseases without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through 25 years of age. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to the findings of a large study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, recommended Dr. Policar, of the University of California, San Francisco.

Clinicians have choices for detecting sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regards to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. This test is indicated for immunocompetent women at least 30 years of age who have their cervix. Clinicians should tell women in advance that they will be screened for HPV so patients can expect the result.

ATLANTA — Many tests now are available for screening and diagnosing sexually transmitted diseases. However, screening without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through 25 years of age. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to the findings of a large study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, recommended Dr. Policar, of the University of California, San Francisco.

Clinicians now have multiple choices for screening sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regards to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. This test is indicated for women at least 30 years of age who are immunocompetent with their cervix in place. Clinicians using this test should tell women in advance that they will be screened for HPV so they can expect the result.

For the 92% of women who do test negative for both HPV and Pap on the combined test, Dr. Policar emphasized that “the guidelines are adamant that the woman does not need to be rescreened any earlier than 3 years. You don't want to test any earlier than that because there are too many false positives, yet no improvement in the detection of high-grade squamous epithelial lesions.”

ATLANTA — Many tests now are available for screening and diagnosing sexually transmitted diseases. However, screening without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through 25 years of age. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to the findings of a large study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, recommended Dr. Policar, of the University of California, San Francisco.

Clinicians now have multiple choices for screening sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regards to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. This test is indicated for women at least 30 years of age who are immunocompetent with their cervix in place. Clinicians using this test should tell women in advance that they will be screened for HPV so they can expect the result.

For the 92% of women who do test negative for both HPV and Pap on the combined test, Dr. Policar emphasized that “the guidelines are adamant that the woman does not need to be rescreened any earlier than 3 years. You don't want to test any earlier than that because there are too many false positives, yet no improvement in the detection of high-grade squamous epithelial lesions.”

ATLANTA — Many tests now are available for screening and diagnosing sexually transmitted diseases. However, screening without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through 25 years of age. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to the findings of a large study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, recommended Dr. Policar, of the University of California, San Francisco.

Clinicians now have multiple choices for screening sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regards to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. This test is indicated for women at least 30 years of age who are immunocompetent with their cervix in place. Clinicians using this test should tell women in advance that they will be screened for HPV so they can expect the result.

For the 92% of women who do test negative for both HPV and Pap on the combined test, Dr. Policar emphasized that “the guidelines are adamant that the woman does not need to be rescreened any earlier than 3 years. You don't want to test any earlier than that because there are too many false positives, yet no improvement in the detection of high-grade squamous epithelial lesions.”

Vitamin E supplementation does not appear to confer a benefit in cognitive decline in women after 10 years, results of a randomized, double-blind, placebo-controlled study show.

These results, based on an analysis of data from the Women's Health Study, found no significant cognitive differences in 6,377 women at least 65 years of age who alternated taking 600 IU vitamin E and 100 mg low-dose aspirin every other day or placebo. The subjects initially were evaluated 5.6 years after randomization and at a follow-up visit an average of 4 years later (Arch. Intern. Med. 2006;166:2462–8).

Verbal memory, Telephone Interview of Cognitive Status scores, and category fluency (which reflects executive retrieval functions) were also not significantly different between groups at the follow-up analysis, noted Dr. Jae Hee Kang of the Brigham and Women's Hospital in Boston, and colleagues in their report.

Changes in cognitive function over time also were similar with vitamin E and placebo, though vitamin E was associated with a 15% lower risk of substantial verbal memory decline that reached borderline statistical significance.

Women who exercised less than once a week did gain slightly more benefit from vitamin E in terms of cognitive decline. However, the investigators found that women who exercised at least once per week had no mean change in global cognitive score, and thus, no benefit from vitamin E could be detected.

Vitamin E also proved more beneficial in women without diabetes than in women with diabetes.

The investigators suggested that a longer duration might be needed to show a cognitive benefit with vitamin E, though they noted that other studies have failed to show such a benefit.

Vitamin E supplementation does not appear to confer a benefit in cognitive decline in women after 10 years, results of a randomized, double-blind, placebo-controlled study show.

These results, based on an analysis of data from the Women's Health Study, found no significant cognitive differences in 6,377 women at least 65 years of age who alternated taking 600 IU vitamin E and 100 mg low-dose aspirin every other day or placebo. The subjects initially were evaluated 5.6 years after randomization and at a follow-up visit an average of 4 years later (Arch. Intern. Med. 2006;166:2462–8).

Verbal memory, Telephone Interview of Cognitive Status scores, and category fluency (which reflects executive retrieval functions) were also not significantly different between groups at the follow-up analysis, noted Dr. Jae Hee Kang of the Brigham and Women's Hospital in Boston, and colleagues in their report.

Changes in cognitive function over time also were similar with vitamin E and placebo, though vitamin E was associated with a 15% lower risk of substantial verbal memory decline that reached borderline statistical significance.

Women who exercised less than once a week did gain slightly more benefit from vitamin E in terms of cognitive decline. However, the investigators found that women who exercised at least once per week had no mean change in global cognitive score, and thus, no benefit from vitamin E could be detected.

Vitamin E also proved more beneficial in women without diabetes than in women with diabetes.

The investigators suggested that a longer duration might be needed to show a cognitive benefit with vitamin E, though they noted that other studies have failed to show such a benefit.

Vitamin E supplementation does not appear to confer a benefit in cognitive decline in women after 10 years, results of a randomized, double-blind, placebo-controlled study show.

These results, based on an analysis of data from the Women's Health Study, found no significant cognitive differences in 6,377 women at least 65 years of age who alternated taking 600 IU vitamin E and 100 mg low-dose aspirin every other day or placebo. The subjects initially were evaluated 5.6 years after randomization and at a follow-up visit an average of 4 years later (Arch. Intern. Med. 2006;166:2462–8).

Verbal memory, Telephone Interview of Cognitive Status scores, and category fluency (which reflects executive retrieval functions) were also not significantly different between groups at the follow-up analysis, noted Dr. Jae Hee Kang of the Brigham and Women's Hospital in Boston, and colleagues in their report.

Changes in cognitive function over time also were similar with vitamin E and placebo, though vitamin E was associated with a 15% lower risk of substantial verbal memory decline that reached borderline statistical significance.

Women who exercised less than once a week did gain slightly more benefit from vitamin E in terms of cognitive decline. However, the investigators found that women who exercised at least once per week had no mean change in global cognitive score, and thus, no benefit from vitamin E could be detected.

Vitamin E also proved more beneficial in women without diabetes than in women with diabetes.

The investigators suggested that a longer duration might be needed to show a cognitive benefit with vitamin E, though they noted that other studies have failed to show such a benefit.

ATLANTA — Many tests now are available for screening and diagnosing sexually transmitted diseases. However, screening without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through age 25. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to a study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, said Dr. Policar, of the University of California, San Francisco.

Clinicians now have multiple choices for screening sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regard to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. It is indicated for women at least 30 years of age who are immunocompetent with their cervix in place. Clinicians using this test should tell women in advance that they will be screened for HPV so they can expect the result.

ATLANTA — Many tests now are available for screening and diagnosing sexually transmitted diseases. However, screening without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through age 25. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to a study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, said Dr. Policar, of the University of California, San Francisco.

Clinicians now have multiple choices for screening sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regard to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. It is indicated for women at least 30 years of age who are immunocompetent with their cervix in place. Clinicians using this test should tell women in advance that they will be screened for HPV so they can expect the result.

ATLANTA — Many tests now are available for screening and diagnosing sexually transmitted diseases. However, screening without a clear indication may do more harm than good, Dr. Michael Policar said at a conference on contraceptive technology sponsored by Contemporary Forums.

“We're clearly overscreening women older than age 26 for chlamydia,” he explained, as data from the Centers for Disease Control and Prevention suggest that fewer than 2% of sexually active women in this age group are infected with chlamydia.

On the other hand, Dr. Policar recommended routine screening for chlamydia in women through age 25. The prevalence of chlamydia among sexually active teenagers is 5%–10%, and most of these patients are asymptomatic. Annual screening could lead to a 56% reduction in pelvic inflammatory disease in teenagers, according to a study done in Seattle (N. Engl. J. Med. 1996;334:1362–6).

Screening for cervical gonorrhea is appropriate in settings where the prevalence is at least 1%, particularly in urban settings. Routine testing in lower-prevalence areas can lead to a low positive predictive value, resulting in a larger proportion of false positives.

Patients who have had a high-risk sexual exposure should be screened for gonorrhea, chlamydia, syphilis, HIV, and, possibly, herpes simplex virus-2, said Dr. Policar, of the University of California, San Francisco.

Clinicians now have multiple choices for screening sexually transmitted diseases. Dr. Policar said that multiple pathogen tests performed with a single sample are preferred when clinicians would like to screen for all the pathogens included in a test. However, he cautioned against using multiple pathogen test panels that “include pathogens that do not need to be found,” both to reduce the likelihood of false positives and to avoid using resources for unnecessary tests.

Several molecular-based tests are now available for chlamydia and gonorrhea. The nucleic acid amplification tests (NAATs) can detect a small number of organisms and allow the use of urine rather than endocervical swabs. In fact, the new CDC guidelines suggest using urine unless a speculum already is being inserted for another reason.

Urine sampling for the NAATs has slightly different requirements than do other urine tests, to ensure that any organisms are present in sufficient quantity. Patients cannot have urinated in the past hour, they should not cleanse the perineum before sampling, they should collect the first part of the urinary stream, and they should collect only as much urine as the test requires.

Dr. Policar noted that nucleic acid probe tests are not as accurate as the NAATs, and clinicians using these tests should consider switching to a NAAT system. One caveat of the NAAT is that it cannot be used for a test of cure for at least 3 weeks, because it will detect the presence of dead pathogens. Only a culture test can be performed accurately within that time frame.

According to the 2006 CDC guidelines, a retest for chlamydia or gonorrhea should be performed in 3 months, as these infections are associated with a high likelihood of repeat infection and the retesting strategy focuses on higher-risk patients.

Tests for human papillomavirus (HPV) also are overperformed, said Dr. Policar, especially in regard to the low-risk HPV types for which there is no clinical relevance or treatment strategy. He therefore recommends using the high-risk HPV DNA test only in the context of cervical cancer screening and the management of abnormal Pap smear results, but not as a screening or diagnostic test for sexually transmitted infection.

The combined HPV/Pap test is growing in popularity as a cervical cancer screening tool. It is indicated for women at least 30 years of age who are immunocompetent with their cervix in place. Clinicians using this test should tell women in advance that they will be screened for HPV so they can expect the result.