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Excessive masculinity linked to high suicide risk
Excessive masculinity is linked to a significantly increased risk for death by suicide in men, new research suggests.
In the first study to show this association, investigators found that men with high traditional masculinity (HTM) – a set of norms that includes competitiveness, emotional restriction, and aggression – were about two and half times more likely to die by suicide than their counterparts without HTM. The finding underscores the “central role” of gender in suicide death.
“We found that high-traditional-masculinity men were 2.4 times more likely to die by suicide than those who were not [of] high traditional masculinity. We feel this is a significant finding, and one that’s very rare to have evidence for,” study investigator Daniel Coleman, PhD, said in an interview.
“Our other findings are also important and interesting,” added Dr. Coleman, associate professor of social service at Fordham University, New York. “One was that high traditional masculinity was associated with a host of other significant risk factors for suicide death. So not only does high traditional masculinity add to the risk of suicide death, it also may have indirect effects through other variables, such as acting-out behavior.”
The study was published online Feb. 12 in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2019.4702).
First look
In the United States, death by suicide is 3.5 times more common in men than in women. Several potential drivers may explain this phenomenon; one plausible factor may be high levels of what the investigators describe as “traditional masculinity.”
Interestingly, previous studies suggest that HTM men experience suicidal thoughts to a greater degree than do other persons (Soc Psychiatry Psychiatr Epidemiol. 2017 Mar;52[3]:319-27). Nevertheless, the potential influence of HTM and suicide mortality has not been examined before now.
The study is a secondary analysis of the longitudinal Add Health (the National Longitudinal Study of Adolescent to Adult Health) study, which began in 1995 and followed 20,745 adolescents through young adulthood. Not only did that study show a direct association between measures of HTM and death by suicide, but it also corroborated the connection between HTM and other risk factors for suicide revealed in earlier research (Suicide Life Threat Behav. 2016 Apr;46[2]:191-205).
To tease out this relationship, Dr. Coleman and colleagues used data from the nationally representative Add Health study. That earlier research concluded that nine Add Health variables were associated with suicide; these included suicide by a family member, being expelled from school, running away from home, using a weapon, being of white race, a past history of smoking, being in a serious fight in the past year, delinquency, and fighting.
In the current study, the researchers hypothesized that HTM would be associated with these nine variables, in addition to suicide, depression, and gun access.
In the Add Health study, the adolescents were followed over time. In the current analysis, the researchers matched data from that study with death records from the National Death Index from 2014. Death by suicide was defined using National Death Index procedures.
The investigators then used an established procedure for scoring gender-typed attitudes and behaviors. As part of this, a single latent probability variable for identifying oneself as male was generated from 16 gender-discriminating variables.
Participants who were found to score at least a 73% probability of identifying as male (greater than 1 standard deviation above the mean) were classified as HTM.
“There’s been a lot of speculating about masculinity as a risk factor for male suicides,” Dr. Coleman said. “But it’s very difficult to study suicide death and something psychosocial like masculinity. So this was an attempt to fill that gap and test the hypothesis that’s being discussed quite a bit.”
A relevant risk factor
Twenty-two deaths occurred among the Add Health participants. Of those participants, 21 were men (odds ratio, 21.7; 95% confidence interval, 2.9-161; P less than .001).
The analysis showed that all nine risks for suicide that were highlighted in previous research were positively associated with HTM, with small to medium effect sizes. Of these, the most pronounced was family member suicide, with an OR of 1.89 (95% CI, 1.3-2.7).
Most tellingly, HTM men were 2.4 times more likely to end their lives by suicide than were men not defined as such (95% CI, 0.99-6.0; P less than .046). Nevertheless, HTM men were also 1.45 times less likely to report suicidal ideation (OR, 0.69; 95% CI, 0.60-0.81; P less than .001). There was no association between HTM and nonfatal suicide attempts.
Interestingly, HTM men were slightly more likely to report easy access to guns (OR, 1.1; 95% CI, 1.01-1.20; P less than .04), but they had lower levels of depression (Cohen’s d, 0.17; P less than .001).
HTM not only has a direct association with suicide but also with a web of indirect effects as well, thanks to its association with all the other risks identified in the previous study by another group of investigators.
HTM may be an underlying influence in male suicide that increases the probability of externalizing such behavioral risk factors as anger, violence, gun access, and school problems.
The finding that almost all of the people who died by suicide were men underscores the central role that gender plays in these tragedies. As such, the investigators hope that the study prompts more research, as well as intervention efforts aimed at the role of masculinity in suicide.
“There are already things going on around the world to try to address the risk factors of masculinity for suicide death,” Dr. Coleman said. “So even though we haven’t had the evidence that it’s a risk factor, people have been operating under that assumption anyway.
“Hopefully our research contributes to raising the profile that high traditional masculinity is a relevant risk factor that we can organize prevention and treatment around.”
An important contribution
Mark S. Kaplan, DrPH, commenting on the findings in an interview, said the study makes an important contribution to suicide research.
“Any study that tries to link a living sample with death data, as they did here, is important,” said Dr. Kaplan, professor of social welfare at the Luskin School of Public Affairs of the University of California, Los Angeles.
“It’s also important because it begins to scratch the surface of more proximal or distal factors that are associated with suicide, and masculinity is one of those factors,” Dr. Kaplan added.
“In an incremental way, it begins to add to the puzzle of why men have a higher mortality rate than their female counterparts. Because when it comes to suicide, men and women really are apples and oranges.”
Dr. Kaplan believes HTM is one of several traits that may lead men to take their own lives.
“There are all sorts of other issues. For example, masculinity might be interacting with some of the harsh socioeconomic conditions that many men face. I think all of this points to the real need to understand why men die from suicide,” he said.
The Add Health study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from the grant for the current study. Dr. Coleman and Dr. Kaplan have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Excessive masculinity is linked to a significantly increased risk for death by suicide in men, new research suggests.
In the first study to show this association, investigators found that men with high traditional masculinity (HTM) – a set of norms that includes competitiveness, emotional restriction, and aggression – were about two and half times more likely to die by suicide than their counterparts without HTM. The finding underscores the “central role” of gender in suicide death.
“We found that high-traditional-masculinity men were 2.4 times more likely to die by suicide than those who were not [of] high traditional masculinity. We feel this is a significant finding, and one that’s very rare to have evidence for,” study investigator Daniel Coleman, PhD, said in an interview.
“Our other findings are also important and interesting,” added Dr. Coleman, associate professor of social service at Fordham University, New York. “One was that high traditional masculinity was associated with a host of other significant risk factors for suicide death. So not only does high traditional masculinity add to the risk of suicide death, it also may have indirect effects through other variables, such as acting-out behavior.”
The study was published online Feb. 12 in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2019.4702).
First look
In the United States, death by suicide is 3.5 times more common in men than in women. Several potential drivers may explain this phenomenon; one plausible factor may be high levels of what the investigators describe as “traditional masculinity.”
Interestingly, previous studies suggest that HTM men experience suicidal thoughts to a greater degree than do other persons (Soc Psychiatry Psychiatr Epidemiol. 2017 Mar;52[3]:319-27). Nevertheless, the potential influence of HTM and suicide mortality has not been examined before now.
The study is a secondary analysis of the longitudinal Add Health (the National Longitudinal Study of Adolescent to Adult Health) study, which began in 1995 and followed 20,745 adolescents through young adulthood. Not only did that study show a direct association between measures of HTM and death by suicide, but it also corroborated the connection between HTM and other risk factors for suicide revealed in earlier research (Suicide Life Threat Behav. 2016 Apr;46[2]:191-205).
To tease out this relationship, Dr. Coleman and colleagues used data from the nationally representative Add Health study. That earlier research concluded that nine Add Health variables were associated with suicide; these included suicide by a family member, being expelled from school, running away from home, using a weapon, being of white race, a past history of smoking, being in a serious fight in the past year, delinquency, and fighting.
In the current study, the researchers hypothesized that HTM would be associated with these nine variables, in addition to suicide, depression, and gun access.
In the Add Health study, the adolescents were followed over time. In the current analysis, the researchers matched data from that study with death records from the National Death Index from 2014. Death by suicide was defined using National Death Index procedures.
The investigators then used an established procedure for scoring gender-typed attitudes and behaviors. As part of this, a single latent probability variable for identifying oneself as male was generated from 16 gender-discriminating variables.
Participants who were found to score at least a 73% probability of identifying as male (greater than 1 standard deviation above the mean) were classified as HTM.
“There’s been a lot of speculating about masculinity as a risk factor for male suicides,” Dr. Coleman said. “But it’s very difficult to study suicide death and something psychosocial like masculinity. So this was an attempt to fill that gap and test the hypothesis that’s being discussed quite a bit.”
A relevant risk factor
Twenty-two deaths occurred among the Add Health participants. Of those participants, 21 were men (odds ratio, 21.7; 95% confidence interval, 2.9-161; P less than .001).
The analysis showed that all nine risks for suicide that were highlighted in previous research were positively associated with HTM, with small to medium effect sizes. Of these, the most pronounced was family member suicide, with an OR of 1.89 (95% CI, 1.3-2.7).
Most tellingly, HTM men were 2.4 times more likely to end their lives by suicide than were men not defined as such (95% CI, 0.99-6.0; P less than .046). Nevertheless, HTM men were also 1.45 times less likely to report suicidal ideation (OR, 0.69; 95% CI, 0.60-0.81; P less than .001). There was no association between HTM and nonfatal suicide attempts.
Interestingly, HTM men were slightly more likely to report easy access to guns (OR, 1.1; 95% CI, 1.01-1.20; P less than .04), but they had lower levels of depression (Cohen’s d, 0.17; P less than .001).
HTM not only has a direct association with suicide but also with a web of indirect effects as well, thanks to its association with all the other risks identified in the previous study by another group of investigators.
HTM may be an underlying influence in male suicide that increases the probability of externalizing such behavioral risk factors as anger, violence, gun access, and school problems.
The finding that almost all of the people who died by suicide were men underscores the central role that gender plays in these tragedies. As such, the investigators hope that the study prompts more research, as well as intervention efforts aimed at the role of masculinity in suicide.
“There are already things going on around the world to try to address the risk factors of masculinity for suicide death,” Dr. Coleman said. “So even though we haven’t had the evidence that it’s a risk factor, people have been operating under that assumption anyway.
“Hopefully our research contributes to raising the profile that high traditional masculinity is a relevant risk factor that we can organize prevention and treatment around.”
An important contribution
Mark S. Kaplan, DrPH, commenting on the findings in an interview, said the study makes an important contribution to suicide research.
“Any study that tries to link a living sample with death data, as they did here, is important,” said Dr. Kaplan, professor of social welfare at the Luskin School of Public Affairs of the University of California, Los Angeles.
“It’s also important because it begins to scratch the surface of more proximal or distal factors that are associated with suicide, and masculinity is one of those factors,” Dr. Kaplan added.
“In an incremental way, it begins to add to the puzzle of why men have a higher mortality rate than their female counterparts. Because when it comes to suicide, men and women really are apples and oranges.”
Dr. Kaplan believes HTM is one of several traits that may lead men to take their own lives.
“There are all sorts of other issues. For example, masculinity might be interacting with some of the harsh socioeconomic conditions that many men face. I think all of this points to the real need to understand why men die from suicide,” he said.
The Add Health study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from the grant for the current study. Dr. Coleman and Dr. Kaplan have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Excessive masculinity is linked to a significantly increased risk for death by suicide in men, new research suggests.
In the first study to show this association, investigators found that men with high traditional masculinity (HTM) – a set of norms that includes competitiveness, emotional restriction, and aggression – were about two and half times more likely to die by suicide than their counterparts without HTM. The finding underscores the “central role” of gender in suicide death.
“We found that high-traditional-masculinity men were 2.4 times more likely to die by suicide than those who were not [of] high traditional masculinity. We feel this is a significant finding, and one that’s very rare to have evidence for,” study investigator Daniel Coleman, PhD, said in an interview.
“Our other findings are also important and interesting,” added Dr. Coleman, associate professor of social service at Fordham University, New York. “One was that high traditional masculinity was associated with a host of other significant risk factors for suicide death. So not only does high traditional masculinity add to the risk of suicide death, it also may have indirect effects through other variables, such as acting-out behavior.”
The study was published online Feb. 12 in JAMA Psychiatry (doi: 10.1001/jamapsychiatry.2019.4702).
First look
In the United States, death by suicide is 3.5 times more common in men than in women. Several potential drivers may explain this phenomenon; one plausible factor may be high levels of what the investigators describe as “traditional masculinity.”
Interestingly, previous studies suggest that HTM men experience suicidal thoughts to a greater degree than do other persons (Soc Psychiatry Psychiatr Epidemiol. 2017 Mar;52[3]:319-27). Nevertheless, the potential influence of HTM and suicide mortality has not been examined before now.
The study is a secondary analysis of the longitudinal Add Health (the National Longitudinal Study of Adolescent to Adult Health) study, which began in 1995 and followed 20,745 adolescents through young adulthood. Not only did that study show a direct association between measures of HTM and death by suicide, but it also corroborated the connection between HTM and other risk factors for suicide revealed in earlier research (Suicide Life Threat Behav. 2016 Apr;46[2]:191-205).
To tease out this relationship, Dr. Coleman and colleagues used data from the nationally representative Add Health study. That earlier research concluded that nine Add Health variables were associated with suicide; these included suicide by a family member, being expelled from school, running away from home, using a weapon, being of white race, a past history of smoking, being in a serious fight in the past year, delinquency, and fighting.
In the current study, the researchers hypothesized that HTM would be associated with these nine variables, in addition to suicide, depression, and gun access.
In the Add Health study, the adolescents were followed over time. In the current analysis, the researchers matched data from that study with death records from the National Death Index from 2014. Death by suicide was defined using National Death Index procedures.
The investigators then used an established procedure for scoring gender-typed attitudes and behaviors. As part of this, a single latent probability variable for identifying oneself as male was generated from 16 gender-discriminating variables.
Participants who were found to score at least a 73% probability of identifying as male (greater than 1 standard deviation above the mean) were classified as HTM.
“There’s been a lot of speculating about masculinity as a risk factor for male suicides,” Dr. Coleman said. “But it’s very difficult to study suicide death and something psychosocial like masculinity. So this was an attempt to fill that gap and test the hypothesis that’s being discussed quite a bit.”
A relevant risk factor
Twenty-two deaths occurred among the Add Health participants. Of those participants, 21 were men (odds ratio, 21.7; 95% confidence interval, 2.9-161; P less than .001).
The analysis showed that all nine risks for suicide that were highlighted in previous research were positively associated with HTM, with small to medium effect sizes. Of these, the most pronounced was family member suicide, with an OR of 1.89 (95% CI, 1.3-2.7).
Most tellingly, HTM men were 2.4 times more likely to end their lives by suicide than were men not defined as such (95% CI, 0.99-6.0; P less than .046). Nevertheless, HTM men were also 1.45 times less likely to report suicidal ideation (OR, 0.69; 95% CI, 0.60-0.81; P less than .001). There was no association between HTM and nonfatal suicide attempts.
Interestingly, HTM men were slightly more likely to report easy access to guns (OR, 1.1; 95% CI, 1.01-1.20; P less than .04), but they had lower levels of depression (Cohen’s d, 0.17; P less than .001).
HTM not only has a direct association with suicide but also with a web of indirect effects as well, thanks to its association with all the other risks identified in the previous study by another group of investigators.
HTM may be an underlying influence in male suicide that increases the probability of externalizing such behavioral risk factors as anger, violence, gun access, and school problems.
The finding that almost all of the people who died by suicide were men underscores the central role that gender plays in these tragedies. As such, the investigators hope that the study prompts more research, as well as intervention efforts aimed at the role of masculinity in suicide.
“There are already things going on around the world to try to address the risk factors of masculinity for suicide death,” Dr. Coleman said. “So even though we haven’t had the evidence that it’s a risk factor, people have been operating under that assumption anyway.
“Hopefully our research contributes to raising the profile that high traditional masculinity is a relevant risk factor that we can organize prevention and treatment around.”
An important contribution
Mark S. Kaplan, DrPH, commenting on the findings in an interview, said the study makes an important contribution to suicide research.
“Any study that tries to link a living sample with death data, as they did here, is important,” said Dr. Kaplan, professor of social welfare at the Luskin School of Public Affairs of the University of California, Los Angeles.
“It’s also important because it begins to scratch the surface of more proximal or distal factors that are associated with suicide, and masculinity is one of those factors,” Dr. Kaplan added.
“In an incremental way, it begins to add to the puzzle of why men have a higher mortality rate than their female counterparts. Because when it comes to suicide, men and women really are apples and oranges.”
Dr. Kaplan believes HTM is one of several traits that may lead men to take their own lives.
“There are all sorts of other issues. For example, masculinity might be interacting with some of the harsh socioeconomic conditions that many men face. I think all of this points to the real need to understand why men die from suicide,” he said.
The Add Health study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from the grant for the current study. Dr. Coleman and Dr. Kaplan have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Cannabis for sleep: Short-term benefit, long-term disruption?
, new research shows.
Investigators found whole-plant medical cannabis use was associated with fewer problems with respect to waking up at night, but they also found that frequent medical cannabis use was associated with more problems initiating and maintaining sleep.
“Cannabis may improve overall sleep in the short term,” study investigator Sharon Sznitman, PhD, University of Haifa (Israel) Faculty of Social Welfare and Health Sciences, said in an interview. “But it’s also very interesting that when we looked at frequency of use in the group that used medical cannabis, individuals who had more frequent use also had poorer sleep in the long term.
“This suggests that while cannabis may improve overall sleep, it’s also possible that there is a tolerance that develops with either very frequent or long-term use,” she added.
The study was published online Jan. 20 in BMJ Supportive and Palliative Care.
A common problem
Estimates suggest chronic pain affects up to 37% of adults in the developed world. Individuals who suffer chronic pain often experience comorbid insomnia, which includes difficulty initiating sleep, sleep disruption, and early morning wakening.
For its part, medical cannabis to treat chronic pain symptoms and manage sleep problems has been widely reported as a prime motivation for medical cannabis use. Indeed, previous studies have concluded that the endocannabinoid system plays a role in sleep regulation, including sleep promotion and maintenance.
In recent years, investigators have reported the beneficial effects of medical cannabis for sleep. Nevertheless, some preclinical research has also concluded that chronic administration of tetrahydrocannabinol may result in tolerance to the sleep-enhancing effects of cannabis.
With that in mind, the researchers set out to examine the potential impact of whole-plant medicinal cannabis on sleep problems experienced by middle-aged patients suffering from chronic pain.
“People are self-reporting that they’re using cannabis for sleep and that it helps, but as we know, just because people are reporting that it works doesn’t mean that it will hold up in research,” Dr. Sznitman said.
The study included 128 individuals (mean age, 61±6 years; 51% females) with chronic neuropathic pain: 66 were medical cannabis users and 62 were not.
Three indicators of insomnia were measured using the 7-point Likert scale to assess issues with sleep initiation and maintenance.
In addition, investigators collected sociodemographic information, as well as data on daily consumption of tobacco, frequency of alcohol use, and pain severity. Finally, they collected patient data on the use of sleep-aid medications during the past month as well as tricyclic antidepressant use.
Frequent use, more sleep problems?
On average, medical cannabis users were 3 years younger than their nonusing counterparts (mean age, 60±6 vs. 63±6 years, respectively, P = .003) and more likely to be male (58% vs 40%, respectively, P = .038). Otherwise, the two groups were comparable.
Medical cannabis users reported taking the drug for an average of 4 years, at an average quantity of 31 g per month. The primary mode of administration was smoking (68.6%), followed by oil extracts (21.4%) and vaporization (20%).
Results showed that, of the total sample, 24.1% reported always waking up early and not falling back to sleep, 20.2% reported always having difficulty falling asleep, and 27.2% reported always waking up during the night.
After adjusting for patient age, sex, pain level, and use of sleep medications and antidepressants, medical cannabis use was associated with fewer problems with waking up at night, compared with nonmedical cannabis use. No differences were found between groups with respect to problems falling asleep or waking up early without being able to fall back to sleep, Dr. Sznitman and associates reported.
The final analysis of a subsample of patients that only included medical cannabis users showed frequency of medical cannabis use was associated with sleep problems, they said.
Specifically, more frequent cannabis use was associated with more problems related to waking up at night, as well as problems falling asleep.
Sleep problems associated with frequent medical cannabis use may signal the development of tolerance to the agent. However, frequent users of medical cannabis also maybsuffer pain or other comorbidities, which, in turn, may be linked to more sleep problems.
Either way, Dr. Sznitman said the study might open the door to another treatment option for patients suffering from chronic pain who struggle with sleep.
“If future research shows that the effect of medical cannabis on sleep is a consistent one, then we may be adding a new therapy for sleep problems, which are huge in society and especially in chronic pain patients,” she said.
Early days
Commenting on the findings in an interview, Ryan G. Vandrey, PhD, who was not involved in the study, said the findings are in line with previous research.
“I think the results make sense with respect to the data I’ve collected and from what I’ve seen,” said Dr. Vandrey, associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore.
“We typically only want to use sleep medications for short periods of time,” he continued. “When you think about recommended prescribing practices for any hypnotic medication, it’s usually short term, 2 weeks or less. Longer-term use often leads to tolerance, dependence, and withdrawal symptoms when the medication is stopped, which leads to an exacerbation of disordered sleep,” Dr. Vandrey said.
Nevertheless, he urged caution when interpreting the results.
“I think the study warrants caution about long-term daily use of cannabinoids with respect to sleep,” he said. “But we need more detailed evaluations, as the trial wasn’t testing a defined product, specific dose, or dose regimen.
“In addition, this was all done in the context of people with chronic pain and not treating disordered sleep or insomnia, but the study highlights the importance of recognizing that long-term chronic use of cannabis is not likely to fully resolve sleep problems.”
Dr. Sznitman agreed that the research is still in its very early stages.
“We’re still far from saying we have the evidence to support the use of medical cannabis for sleep,” she said. “For in the end it was just a cross-sectional, observational study, so we cannot say anything about cause and effect. But if these results pan out, they could be far-reaching and exciting.”
The study was funded by the University of Haifa and Rambam Hospital in Israel, and by the Evelyn Lipper Foundation. Dr. Sznitman and Dr. Vandrey have disclosed no relevant financial relationships.
This article first appeared on Medscape.com.
, new research shows.
Investigators found whole-plant medical cannabis use was associated with fewer problems with respect to waking up at night, but they also found that frequent medical cannabis use was associated with more problems initiating and maintaining sleep.
“Cannabis may improve overall sleep in the short term,” study investigator Sharon Sznitman, PhD, University of Haifa (Israel) Faculty of Social Welfare and Health Sciences, said in an interview. “But it’s also very interesting that when we looked at frequency of use in the group that used medical cannabis, individuals who had more frequent use also had poorer sleep in the long term.
“This suggests that while cannabis may improve overall sleep, it’s also possible that there is a tolerance that develops with either very frequent or long-term use,” she added.
The study was published online Jan. 20 in BMJ Supportive and Palliative Care.
A common problem
Estimates suggest chronic pain affects up to 37% of adults in the developed world. Individuals who suffer chronic pain often experience comorbid insomnia, which includes difficulty initiating sleep, sleep disruption, and early morning wakening.
For its part, medical cannabis to treat chronic pain symptoms and manage sleep problems has been widely reported as a prime motivation for medical cannabis use. Indeed, previous studies have concluded that the endocannabinoid system plays a role in sleep regulation, including sleep promotion and maintenance.
In recent years, investigators have reported the beneficial effects of medical cannabis for sleep. Nevertheless, some preclinical research has also concluded that chronic administration of tetrahydrocannabinol may result in tolerance to the sleep-enhancing effects of cannabis.
With that in mind, the researchers set out to examine the potential impact of whole-plant medicinal cannabis on sleep problems experienced by middle-aged patients suffering from chronic pain.
“People are self-reporting that they’re using cannabis for sleep and that it helps, but as we know, just because people are reporting that it works doesn’t mean that it will hold up in research,” Dr. Sznitman said.
The study included 128 individuals (mean age, 61±6 years; 51% females) with chronic neuropathic pain: 66 were medical cannabis users and 62 were not.
Three indicators of insomnia were measured using the 7-point Likert scale to assess issues with sleep initiation and maintenance.
In addition, investigators collected sociodemographic information, as well as data on daily consumption of tobacco, frequency of alcohol use, and pain severity. Finally, they collected patient data on the use of sleep-aid medications during the past month as well as tricyclic antidepressant use.
Frequent use, more sleep problems?
On average, medical cannabis users were 3 years younger than their nonusing counterparts (mean age, 60±6 vs. 63±6 years, respectively, P = .003) and more likely to be male (58% vs 40%, respectively, P = .038). Otherwise, the two groups were comparable.
Medical cannabis users reported taking the drug for an average of 4 years, at an average quantity of 31 g per month. The primary mode of administration was smoking (68.6%), followed by oil extracts (21.4%) and vaporization (20%).
Results showed that, of the total sample, 24.1% reported always waking up early and not falling back to sleep, 20.2% reported always having difficulty falling asleep, and 27.2% reported always waking up during the night.
After adjusting for patient age, sex, pain level, and use of sleep medications and antidepressants, medical cannabis use was associated with fewer problems with waking up at night, compared with nonmedical cannabis use. No differences were found between groups with respect to problems falling asleep or waking up early without being able to fall back to sleep, Dr. Sznitman and associates reported.
The final analysis of a subsample of patients that only included medical cannabis users showed frequency of medical cannabis use was associated with sleep problems, they said.
Specifically, more frequent cannabis use was associated with more problems related to waking up at night, as well as problems falling asleep.
Sleep problems associated with frequent medical cannabis use may signal the development of tolerance to the agent. However, frequent users of medical cannabis also maybsuffer pain or other comorbidities, which, in turn, may be linked to more sleep problems.
Either way, Dr. Sznitman said the study might open the door to another treatment option for patients suffering from chronic pain who struggle with sleep.
“If future research shows that the effect of medical cannabis on sleep is a consistent one, then we may be adding a new therapy for sleep problems, which are huge in society and especially in chronic pain patients,” she said.
Early days
Commenting on the findings in an interview, Ryan G. Vandrey, PhD, who was not involved in the study, said the findings are in line with previous research.
“I think the results make sense with respect to the data I’ve collected and from what I’ve seen,” said Dr. Vandrey, associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore.
“We typically only want to use sleep medications for short periods of time,” he continued. “When you think about recommended prescribing practices for any hypnotic medication, it’s usually short term, 2 weeks or less. Longer-term use often leads to tolerance, dependence, and withdrawal symptoms when the medication is stopped, which leads to an exacerbation of disordered sleep,” Dr. Vandrey said.
Nevertheless, he urged caution when interpreting the results.
“I think the study warrants caution about long-term daily use of cannabinoids with respect to sleep,” he said. “But we need more detailed evaluations, as the trial wasn’t testing a defined product, specific dose, or dose regimen.
“In addition, this was all done in the context of people with chronic pain and not treating disordered sleep or insomnia, but the study highlights the importance of recognizing that long-term chronic use of cannabis is not likely to fully resolve sleep problems.”
Dr. Sznitman agreed that the research is still in its very early stages.
“We’re still far from saying we have the evidence to support the use of medical cannabis for sleep,” she said. “For in the end it was just a cross-sectional, observational study, so we cannot say anything about cause and effect. But if these results pan out, they could be far-reaching and exciting.”
The study was funded by the University of Haifa and Rambam Hospital in Israel, and by the Evelyn Lipper Foundation. Dr. Sznitman and Dr. Vandrey have disclosed no relevant financial relationships.
This article first appeared on Medscape.com.
, new research shows.
Investigators found whole-plant medical cannabis use was associated with fewer problems with respect to waking up at night, but they also found that frequent medical cannabis use was associated with more problems initiating and maintaining sleep.
“Cannabis may improve overall sleep in the short term,” study investigator Sharon Sznitman, PhD, University of Haifa (Israel) Faculty of Social Welfare and Health Sciences, said in an interview. “But it’s also very interesting that when we looked at frequency of use in the group that used medical cannabis, individuals who had more frequent use also had poorer sleep in the long term.
“This suggests that while cannabis may improve overall sleep, it’s also possible that there is a tolerance that develops with either very frequent or long-term use,” she added.
The study was published online Jan. 20 in BMJ Supportive and Palliative Care.
A common problem
Estimates suggest chronic pain affects up to 37% of adults in the developed world. Individuals who suffer chronic pain often experience comorbid insomnia, which includes difficulty initiating sleep, sleep disruption, and early morning wakening.
For its part, medical cannabis to treat chronic pain symptoms and manage sleep problems has been widely reported as a prime motivation for medical cannabis use. Indeed, previous studies have concluded that the endocannabinoid system plays a role in sleep regulation, including sleep promotion and maintenance.
In recent years, investigators have reported the beneficial effects of medical cannabis for sleep. Nevertheless, some preclinical research has also concluded that chronic administration of tetrahydrocannabinol may result in tolerance to the sleep-enhancing effects of cannabis.
With that in mind, the researchers set out to examine the potential impact of whole-plant medicinal cannabis on sleep problems experienced by middle-aged patients suffering from chronic pain.
“People are self-reporting that they’re using cannabis for sleep and that it helps, but as we know, just because people are reporting that it works doesn’t mean that it will hold up in research,” Dr. Sznitman said.
The study included 128 individuals (mean age, 61±6 years; 51% females) with chronic neuropathic pain: 66 were medical cannabis users and 62 were not.
Three indicators of insomnia were measured using the 7-point Likert scale to assess issues with sleep initiation and maintenance.
In addition, investigators collected sociodemographic information, as well as data on daily consumption of tobacco, frequency of alcohol use, and pain severity. Finally, they collected patient data on the use of sleep-aid medications during the past month as well as tricyclic antidepressant use.
Frequent use, more sleep problems?
On average, medical cannabis users were 3 years younger than their nonusing counterparts (mean age, 60±6 vs. 63±6 years, respectively, P = .003) and more likely to be male (58% vs 40%, respectively, P = .038). Otherwise, the two groups were comparable.
Medical cannabis users reported taking the drug for an average of 4 years, at an average quantity of 31 g per month. The primary mode of administration was smoking (68.6%), followed by oil extracts (21.4%) and vaporization (20%).
Results showed that, of the total sample, 24.1% reported always waking up early and not falling back to sleep, 20.2% reported always having difficulty falling asleep, and 27.2% reported always waking up during the night.
After adjusting for patient age, sex, pain level, and use of sleep medications and antidepressants, medical cannabis use was associated with fewer problems with waking up at night, compared with nonmedical cannabis use. No differences were found between groups with respect to problems falling asleep or waking up early without being able to fall back to sleep, Dr. Sznitman and associates reported.
The final analysis of a subsample of patients that only included medical cannabis users showed frequency of medical cannabis use was associated with sleep problems, they said.
Specifically, more frequent cannabis use was associated with more problems related to waking up at night, as well as problems falling asleep.
Sleep problems associated with frequent medical cannabis use may signal the development of tolerance to the agent. However, frequent users of medical cannabis also maybsuffer pain or other comorbidities, which, in turn, may be linked to more sleep problems.
Either way, Dr. Sznitman said the study might open the door to another treatment option for patients suffering from chronic pain who struggle with sleep.
“If future research shows that the effect of medical cannabis on sleep is a consistent one, then we may be adding a new therapy for sleep problems, which are huge in society and especially in chronic pain patients,” she said.
Early days
Commenting on the findings in an interview, Ryan G. Vandrey, PhD, who was not involved in the study, said the findings are in line with previous research.
“I think the results make sense with respect to the data I’ve collected and from what I’ve seen,” said Dr. Vandrey, associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore.
“We typically only want to use sleep medications for short periods of time,” he continued. “When you think about recommended prescribing practices for any hypnotic medication, it’s usually short term, 2 weeks or less. Longer-term use often leads to tolerance, dependence, and withdrawal symptoms when the medication is stopped, which leads to an exacerbation of disordered sleep,” Dr. Vandrey said.
Nevertheless, he urged caution when interpreting the results.
“I think the study warrants caution about long-term daily use of cannabinoids with respect to sleep,” he said. “But we need more detailed evaluations, as the trial wasn’t testing a defined product, specific dose, or dose regimen.
“In addition, this was all done in the context of people with chronic pain and not treating disordered sleep or insomnia, but the study highlights the importance of recognizing that long-term chronic use of cannabis is not likely to fully resolve sleep problems.”
Dr. Sznitman agreed that the research is still in its very early stages.
“We’re still far from saying we have the evidence to support the use of medical cannabis for sleep,” she said. “For in the end it was just a cross-sectional, observational study, so we cannot say anything about cause and effect. But if these results pan out, they could be far-reaching and exciting.”
The study was funded by the University of Haifa and Rambam Hospital in Israel, and by the Evelyn Lipper Foundation. Dr. Sznitman and Dr. Vandrey have disclosed no relevant financial relationships.
This article first appeared on Medscape.com.
FROM BMJ SUPPORTIVE AND PALLIATIVE CARE
Depression Not Well Managed in Fibromyalgia
KANANASKIS, ALTA. — A significant proportion of all fibromyalgia patients with depression are not receiving adequate treatment for the disorder, if the experience of a multidisciplinary Canadian tertiary-care pain clinic is any indication.
A full 80% of 137 consecutive patients with fibromyalgia at the pain center of McGill University Health Centre, Montreal, suffered from important depression, Dr. Mary-Ann Fitzcharles reported.
Of these, only 48% were being treated with any type of antidepressant and only 3% were seeing a psychologist.
Moreover, only 19% of the depressed fibromyalgia patients were taking tricyclic antidepressants.
Important depression was defined as that seen in a patient scoring 4 or higher on a scale of 1–10 on the depression component of the fibromylagia impact questionnaire.
Depression was also assessed using an anxiety and depression scale. In addition, patients were seen by a psychologist and were evaluated for depression according to DSM criteria, Dr. Fitzcharles said in an interview.
“If we don't address the mood disorder, I believe we're not going to be successful in pain management” for fibromyalgia, said Dr. Fitzcharles, a rheumatologist and professor of medicine at McGill.
Dr. Fitzcharles reported the group's findings at the annual meeting of the Canadian Rheumatology Association.
The depressed and nondepressed patients were similar in terms of age, employment status, disability status, and reported pain intensity on a visual analog scale.
However, the depressed patients were found to have longer disease duration (12 vs. 7 years; P = .03).
They also scored higher on the pain catastrophizing scale (30 vs. 22; P = .002), the arthritis impact measurement scale for anxiety (6.6 vs. 5.5; P = .05), and the total fibromyalgia impact questionnaire (65 vs. 57; P = .048).
After adjustment for other covariates, duration of pain was the only factor associated with depression in multivariate analysis (adjusted odds ratio, 1.11; P = .004).
Dr. Fitzcharles noted that many fibromyalgia patients commonly receive antidepressants—particularly tricyclic antidepressants—but said this largely reflects treatment patterns for fibromyalgia pain and sleep, rather than use for mood effect.
“Even though they're on antidepressants, they're still significantly depressed. So the antidepressant they're taking may be not the best one,” she said in an interview.
“So rather than hammering these poor patients with pain-relieving treatments, maybe we should be addressing the multiplicity of important symptoms. Because it's more than just pain. There's also a sleep disorder, fatigue, and a mood disorder. Because if we don't address everything, we're not going to be successful in anything,” she said.
With this in mind, Dr. Fitzcharles now tries to ensure that her fibromyalgia patients receive treatment specifically tailored to their complete range of symptoms.
The next step in the research chain will be to determine how these individualized treatment regimens affect depression rates.
As this type of approach ultimately becomes more popular with physicians, there may be a curbing of rheumatology referrals, which she said are often unnecessary.
“The patients are typically perceived as difficult fibromyalgia patients and are being referred to us by the [general practitioners],” she said.
“But the GPs are really very good at managing this. So if you've got a fibromyalgia patient who is really not responding, think of treating the mood disorder.”
Dr. Fitzcharles disclosed that she is a consultant speaker for Pfizer Inc., Eli Lilly & Co., Boehringer Ingelheim, Valeant Pharmaceuticals International, and Jannsen-Ortho Inc.
KANANASKIS, ALTA. — A significant proportion of all fibromyalgia patients with depression are not receiving adequate treatment for the disorder, if the experience of a multidisciplinary Canadian tertiary-care pain clinic is any indication.
A full 80% of 137 consecutive patients with fibromyalgia at the pain center of McGill University Health Centre, Montreal, suffered from important depression, Dr. Mary-Ann Fitzcharles reported.
Of these, only 48% were being treated with any type of antidepressant and only 3% were seeing a psychologist.
Moreover, only 19% of the depressed fibromyalgia patients were taking tricyclic antidepressants.
Important depression was defined as that seen in a patient scoring 4 or higher on a scale of 1–10 on the depression component of the fibromylagia impact questionnaire.
Depression was also assessed using an anxiety and depression scale. In addition, patients were seen by a psychologist and were evaluated for depression according to DSM criteria, Dr. Fitzcharles said in an interview.
“If we don't address the mood disorder, I believe we're not going to be successful in pain management” for fibromyalgia, said Dr. Fitzcharles, a rheumatologist and professor of medicine at McGill.
Dr. Fitzcharles reported the group's findings at the annual meeting of the Canadian Rheumatology Association.
The depressed and nondepressed patients were similar in terms of age, employment status, disability status, and reported pain intensity on a visual analog scale.
However, the depressed patients were found to have longer disease duration (12 vs. 7 years; P = .03).
They also scored higher on the pain catastrophizing scale (30 vs. 22; P = .002), the arthritis impact measurement scale for anxiety (6.6 vs. 5.5; P = .05), and the total fibromyalgia impact questionnaire (65 vs. 57; P = .048).
After adjustment for other covariates, duration of pain was the only factor associated with depression in multivariate analysis (adjusted odds ratio, 1.11; P = .004).
Dr. Fitzcharles noted that many fibromyalgia patients commonly receive antidepressants—particularly tricyclic antidepressants—but said this largely reflects treatment patterns for fibromyalgia pain and sleep, rather than use for mood effect.
“Even though they're on antidepressants, they're still significantly depressed. So the antidepressant they're taking may be not the best one,” she said in an interview.
“So rather than hammering these poor patients with pain-relieving treatments, maybe we should be addressing the multiplicity of important symptoms. Because it's more than just pain. There's also a sleep disorder, fatigue, and a mood disorder. Because if we don't address everything, we're not going to be successful in anything,” she said.
With this in mind, Dr. Fitzcharles now tries to ensure that her fibromyalgia patients receive treatment specifically tailored to their complete range of symptoms.
The next step in the research chain will be to determine how these individualized treatment regimens affect depression rates.
As this type of approach ultimately becomes more popular with physicians, there may be a curbing of rheumatology referrals, which she said are often unnecessary.
“The patients are typically perceived as difficult fibromyalgia patients and are being referred to us by the [general practitioners],” she said.
“But the GPs are really very good at managing this. So if you've got a fibromyalgia patient who is really not responding, think of treating the mood disorder.”
Dr. Fitzcharles disclosed that she is a consultant speaker for Pfizer Inc., Eli Lilly & Co., Boehringer Ingelheim, Valeant Pharmaceuticals International, and Jannsen-Ortho Inc.
KANANASKIS, ALTA. — A significant proportion of all fibromyalgia patients with depression are not receiving adequate treatment for the disorder, if the experience of a multidisciplinary Canadian tertiary-care pain clinic is any indication.
A full 80% of 137 consecutive patients with fibromyalgia at the pain center of McGill University Health Centre, Montreal, suffered from important depression, Dr. Mary-Ann Fitzcharles reported.
Of these, only 48% were being treated with any type of antidepressant and only 3% were seeing a psychologist.
Moreover, only 19% of the depressed fibromyalgia patients were taking tricyclic antidepressants.
Important depression was defined as that seen in a patient scoring 4 or higher on a scale of 1–10 on the depression component of the fibromylagia impact questionnaire.
Depression was also assessed using an anxiety and depression scale. In addition, patients were seen by a psychologist and were evaluated for depression according to DSM criteria, Dr. Fitzcharles said in an interview.
“If we don't address the mood disorder, I believe we're not going to be successful in pain management” for fibromyalgia, said Dr. Fitzcharles, a rheumatologist and professor of medicine at McGill.
Dr. Fitzcharles reported the group's findings at the annual meeting of the Canadian Rheumatology Association.
The depressed and nondepressed patients were similar in terms of age, employment status, disability status, and reported pain intensity on a visual analog scale.
However, the depressed patients were found to have longer disease duration (12 vs. 7 years; P = .03).
They also scored higher on the pain catastrophizing scale (30 vs. 22; P = .002), the arthritis impact measurement scale for anxiety (6.6 vs. 5.5; P = .05), and the total fibromyalgia impact questionnaire (65 vs. 57; P = .048).
After adjustment for other covariates, duration of pain was the only factor associated with depression in multivariate analysis (adjusted odds ratio, 1.11; P = .004).
Dr. Fitzcharles noted that many fibromyalgia patients commonly receive antidepressants—particularly tricyclic antidepressants—but said this largely reflects treatment patterns for fibromyalgia pain and sleep, rather than use for mood effect.
“Even though they're on antidepressants, they're still significantly depressed. So the antidepressant they're taking may be not the best one,” she said in an interview.
“So rather than hammering these poor patients with pain-relieving treatments, maybe we should be addressing the multiplicity of important symptoms. Because it's more than just pain. There's also a sleep disorder, fatigue, and a mood disorder. Because if we don't address everything, we're not going to be successful in anything,” she said.
With this in mind, Dr. Fitzcharles now tries to ensure that her fibromyalgia patients receive treatment specifically tailored to their complete range of symptoms.
The next step in the research chain will be to determine how these individualized treatment regimens affect depression rates.
As this type of approach ultimately becomes more popular with physicians, there may be a curbing of rheumatology referrals, which she said are often unnecessary.
“The patients are typically perceived as difficult fibromyalgia patients and are being referred to us by the [general practitioners],” she said.
“But the GPs are really very good at managing this. So if you've got a fibromyalgia patient who is really not responding, think of treating the mood disorder.”
Dr. Fitzcharles disclosed that she is a consultant speaker for Pfizer Inc., Eli Lilly & Co., Boehringer Ingelheim, Valeant Pharmaceuticals International, and Jannsen-Ortho Inc.
Errors Hinder Utility of Data-Capture Software
KANANASKIS, ALTA. — A new technology involving automatic data capture from incoming faxes may not function as well as originally anticipated, and seems fraught with a variety of front-end user problems.
The fax system may prove to be a valuable tool in a practice audit, assuming that the errors found by his study are corrected, said Dr. Steven Edworthy of the University of Calgary, Alta.
The study used special templates developed for Gravic Inc.'s Remark software, which interprets and processes data from incoming fax questionnaires, Dr. Edworthy reported at the annual meeting of the Canadian Rheumatology Association.
Bar codes were used to identify the name of the practice, and respondents used printed “bubbles” (like those on answer sheets for standardized tests) for their answers on two questionnaires on practice characteristics and treatment choices for rheumatoid arthritis.
“The beauty of it was that it would come straight into our server and be read,” he said in an interview.
“We automated the entire process at a very fundamental level for the rheumatologists. Even somebody who didn't have a computer could participate in this program,” he added.
In all, 27 rheumatologists sent 457 faxes, 17% of which could not be read by the software. The majority of these had missing, angled, or upside-down pages, or other significant defects such as blurred text, a small font, or multiple pages printed on a single sheet of paper.
The questionnaires considered by the software to be valid were then subjected to a quality control examination. A small percentage of them contained misread fields, but questionnaires with such errors “were generally coming from people who didn't have good technology in their office,” Dr. Edworthy said. “Their fax machines were old or hadn't been cleaned.”
The refinement of this type of program may ultimately prove to be a boon in the everyday practice of rheumatologists who are not ready to make the transition to electronic medical record (EMR) systems, he noted.
Rheumatologists could use bar-coded forms to receive faxed referrals that are automatically processed by the technology, thereby streamlining business processes.
Although utilizing EMR systems or handheld computers may be the eventual goal of most medical practices, not all rheumatologists are comfortable using such devices. Going “paperlite” before “paperless” will be a more comfortable evolution for most rheumatologists, he added.
“By and large, rheumatologists are very comfortable doing a lot of things on paper,” Dr. Edworthy said.
“Most like to sit [across from] the patient and make their notes, and then do their dictation into a recorder or [send the notes] to a transcriptionist's office afterward,” he added.
Developers of EMR technology have not addressed that issue fully, Dr. Edworthy said.
Taking notes on a PDA may seem like a similar process, but it can be distracting for the physician, particularly if he or she is not comfortable using a keyboard.
The fax system could be a “potential bridge in terms of where rheumatologists are today and where they will be a few years from now,” he said.
Dr. Edworthy disclosed no financial conflicts of interest.
KANANASKIS, ALTA. — A new technology involving automatic data capture from incoming faxes may not function as well as originally anticipated, and seems fraught with a variety of front-end user problems.
The fax system may prove to be a valuable tool in a practice audit, assuming that the errors found by his study are corrected, said Dr. Steven Edworthy of the University of Calgary, Alta.
The study used special templates developed for Gravic Inc.'s Remark software, which interprets and processes data from incoming fax questionnaires, Dr. Edworthy reported at the annual meeting of the Canadian Rheumatology Association.
Bar codes were used to identify the name of the practice, and respondents used printed “bubbles” (like those on answer sheets for standardized tests) for their answers on two questionnaires on practice characteristics and treatment choices for rheumatoid arthritis.
“The beauty of it was that it would come straight into our server and be read,” he said in an interview.
“We automated the entire process at a very fundamental level for the rheumatologists. Even somebody who didn't have a computer could participate in this program,” he added.
In all, 27 rheumatologists sent 457 faxes, 17% of which could not be read by the software. The majority of these had missing, angled, or upside-down pages, or other significant defects such as blurred text, a small font, or multiple pages printed on a single sheet of paper.
The questionnaires considered by the software to be valid were then subjected to a quality control examination. A small percentage of them contained misread fields, but questionnaires with such errors “were generally coming from people who didn't have good technology in their office,” Dr. Edworthy said. “Their fax machines were old or hadn't been cleaned.”
The refinement of this type of program may ultimately prove to be a boon in the everyday practice of rheumatologists who are not ready to make the transition to electronic medical record (EMR) systems, he noted.
Rheumatologists could use bar-coded forms to receive faxed referrals that are automatically processed by the technology, thereby streamlining business processes.
Although utilizing EMR systems or handheld computers may be the eventual goal of most medical practices, not all rheumatologists are comfortable using such devices. Going “paperlite” before “paperless” will be a more comfortable evolution for most rheumatologists, he added.
“By and large, rheumatologists are very comfortable doing a lot of things on paper,” Dr. Edworthy said.
“Most like to sit [across from] the patient and make their notes, and then do their dictation into a recorder or [send the notes] to a transcriptionist's office afterward,” he added.
Developers of EMR technology have not addressed that issue fully, Dr. Edworthy said.
Taking notes on a PDA may seem like a similar process, but it can be distracting for the physician, particularly if he or she is not comfortable using a keyboard.
The fax system could be a “potential bridge in terms of where rheumatologists are today and where they will be a few years from now,” he said.
Dr. Edworthy disclosed no financial conflicts of interest.
KANANASKIS, ALTA. — A new technology involving automatic data capture from incoming faxes may not function as well as originally anticipated, and seems fraught with a variety of front-end user problems.
The fax system may prove to be a valuable tool in a practice audit, assuming that the errors found by his study are corrected, said Dr. Steven Edworthy of the University of Calgary, Alta.
The study used special templates developed for Gravic Inc.'s Remark software, which interprets and processes data from incoming fax questionnaires, Dr. Edworthy reported at the annual meeting of the Canadian Rheumatology Association.
Bar codes were used to identify the name of the practice, and respondents used printed “bubbles” (like those on answer sheets for standardized tests) for their answers on two questionnaires on practice characteristics and treatment choices for rheumatoid arthritis.
“The beauty of it was that it would come straight into our server and be read,” he said in an interview.
“We automated the entire process at a very fundamental level for the rheumatologists. Even somebody who didn't have a computer could participate in this program,” he added.
In all, 27 rheumatologists sent 457 faxes, 17% of which could not be read by the software. The majority of these had missing, angled, or upside-down pages, or other significant defects such as blurred text, a small font, or multiple pages printed on a single sheet of paper.
The questionnaires considered by the software to be valid were then subjected to a quality control examination. A small percentage of them contained misread fields, but questionnaires with such errors “were generally coming from people who didn't have good technology in their office,” Dr. Edworthy said. “Their fax machines were old or hadn't been cleaned.”
The refinement of this type of program may ultimately prove to be a boon in the everyday practice of rheumatologists who are not ready to make the transition to electronic medical record (EMR) systems, he noted.
Rheumatologists could use bar-coded forms to receive faxed referrals that are automatically processed by the technology, thereby streamlining business processes.
Although utilizing EMR systems or handheld computers may be the eventual goal of most medical practices, not all rheumatologists are comfortable using such devices. Going “paperlite” before “paperless” will be a more comfortable evolution for most rheumatologists, he added.
“By and large, rheumatologists are very comfortable doing a lot of things on paper,” Dr. Edworthy said.
“Most like to sit [across from] the patient and make their notes, and then do their dictation into a recorder or [send the notes] to a transcriptionist's office afterward,” he added.
Developers of EMR technology have not addressed that issue fully, Dr. Edworthy said.
Taking notes on a PDA may seem like a similar process, but it can be distracting for the physician, particularly if he or she is not comfortable using a keyboard.
The fax system could be a “potential bridge in terms of where rheumatologists are today and where they will be a few years from now,” he said.
Dr. Edworthy disclosed no financial conflicts of interest.
Occult Blood Test Useful in Ca Screening
BANFF, ALTA. — A screening program in Ontario was successful in detecting high-risk adenomas and colorectal cancer in patients referred because of positive fecal occult blood test results or a family history of colorectal cancer.
Dr. William G. Paterson and his colleagues reviewed the charts of 764 patients referred to the program; 122 were referred because of positive fecal occult blood tests (FOBTs). Of those, 14 patients were found to have cancer (11.4% diagnostic yield) and 30 had high-risk adenomas (24.6% diagnostic yield).
The remaining 642 patients screened through the program had a family history of colorectal cancer. Eleven cases of cancer (1.7% diagnostic yield) and 37 high-risk adenomas (5.8% diagnostic yield) were found. The yield for this cohort was not statistically different between patients whose first-degree relative was diagnosed at age 60 years or younger, or at older than 60 years of age.
A separate group of 2,011 patients underwent screening colonoscopy outside the newly developed program; 135 of them were considered to be of average risk, Dr. Paterson reported at the Canadian Digestive Diseases Week.
Among average-risk patients, one was found to have cancer (0.7% diagnostic yield); five others had high-risk adenoma (3.7% diagnostic yield).
“So the yield for those who came with a positive FOBT was significantly higher than all the other routes,” said Dr. Paterson, chief of gastroenterology at Queen's University in Kingston, Ontario.
Dr. Paterson disclosed that he has no relevant financial interests to disclose regarding this topic. CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
BANFF, ALTA. — A screening program in Ontario was successful in detecting high-risk adenomas and colorectal cancer in patients referred because of positive fecal occult blood test results or a family history of colorectal cancer.
Dr. William G. Paterson and his colleagues reviewed the charts of 764 patients referred to the program; 122 were referred because of positive fecal occult blood tests (FOBTs). Of those, 14 patients were found to have cancer (11.4% diagnostic yield) and 30 had high-risk adenomas (24.6% diagnostic yield).
The remaining 642 patients screened through the program had a family history of colorectal cancer. Eleven cases of cancer (1.7% diagnostic yield) and 37 high-risk adenomas (5.8% diagnostic yield) were found. The yield for this cohort was not statistically different between patients whose first-degree relative was diagnosed at age 60 years or younger, or at older than 60 years of age.
A separate group of 2,011 patients underwent screening colonoscopy outside the newly developed program; 135 of them were considered to be of average risk, Dr. Paterson reported at the Canadian Digestive Diseases Week.
Among average-risk patients, one was found to have cancer (0.7% diagnostic yield); five others had high-risk adenoma (3.7% diagnostic yield).
“So the yield for those who came with a positive FOBT was significantly higher than all the other routes,” said Dr. Paterson, chief of gastroenterology at Queen's University in Kingston, Ontario.
Dr. Paterson disclosed that he has no relevant financial interests to disclose regarding this topic. CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
BANFF, ALTA. — A screening program in Ontario was successful in detecting high-risk adenomas and colorectal cancer in patients referred because of positive fecal occult blood test results or a family history of colorectal cancer.
Dr. William G. Paterson and his colleagues reviewed the charts of 764 patients referred to the program; 122 were referred because of positive fecal occult blood tests (FOBTs). Of those, 14 patients were found to have cancer (11.4% diagnostic yield) and 30 had high-risk adenomas (24.6% diagnostic yield).
The remaining 642 patients screened through the program had a family history of colorectal cancer. Eleven cases of cancer (1.7% diagnostic yield) and 37 high-risk adenomas (5.8% diagnostic yield) were found. The yield for this cohort was not statistically different between patients whose first-degree relative was diagnosed at age 60 years or younger, or at older than 60 years of age.
A separate group of 2,011 patients underwent screening colonoscopy outside the newly developed program; 135 of them were considered to be of average risk, Dr. Paterson reported at the Canadian Digestive Diseases Week.
Among average-risk patients, one was found to have cancer (0.7% diagnostic yield); five others had high-risk adenoma (3.7% diagnostic yield).
“So the yield for those who came with a positive FOBT was significantly higher than all the other routes,” said Dr. Paterson, chief of gastroenterology at Queen's University in Kingston, Ontario.
Dr. Paterson disclosed that he has no relevant financial interests to disclose regarding this topic. CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
Risk of Colonic Polyps High in Diabetic Patients
BANFF, ALTA. — Patients with diabetes appear to be at higher risk of developing colon polyps than are nondiabetics, according to the results of a case control study.
In the chart review of 305 people who had received a colonoscopy, those in whom adenomas and/or carcinomas were detected had seven times the odds of being diabetic, compared with patients without those lesions.
On the basis of these findings, Dr. Nitasha Anand recommended that diabetic patients undergo earlier or more frequent colon screening than patients without diabetes. However, she pointed out that the study's several confounders made it difficult to draw definite conclusions.
“Insulin is a growth factor for epithelium in the colon,” Dr. Anand said at the Canadian Digestive Diseases Week. “So we were wondering whether people with higher insulin levels in the blood would have more polyps in the colon than the average person.” Previous studies have found a slightly increased risk of colon polyps in diabetic patients, with odds ratios from 1.2 to 1.3, said Dr. Anand of St. Michael's Hospital in Toronto.
Of the 305 charts eligible for analysis, 40 were from patients with diabetes. Controls comprised the first 265 consecutive patients without diabetes.
Three diabetic patients had neoplasms, as did three controls. The odds ratio for patients with diabetes having adenomas and/or carcinomas was 7.4, compared with nondiabetic patients.
“There are several of limitations to this study,” Dr. Anand said in an interview. “It's retrospective, which comes with its own host of issues. In addition, if it's not charted, we had no way of knowing if a patient was diabetic or not.” In addition, the diabetic patients were older than their counterparts in the control group (mean age 64 vs. 58 years, respectively), she said.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver. Dr. Anand had no financial interests to disclose regarding the study.
BANFF, ALTA. — Patients with diabetes appear to be at higher risk of developing colon polyps than are nondiabetics, according to the results of a case control study.
In the chart review of 305 people who had received a colonoscopy, those in whom adenomas and/or carcinomas were detected had seven times the odds of being diabetic, compared with patients without those lesions.
On the basis of these findings, Dr. Nitasha Anand recommended that diabetic patients undergo earlier or more frequent colon screening than patients without diabetes. However, she pointed out that the study's several confounders made it difficult to draw definite conclusions.
“Insulin is a growth factor for epithelium in the colon,” Dr. Anand said at the Canadian Digestive Diseases Week. “So we were wondering whether people with higher insulin levels in the blood would have more polyps in the colon than the average person.” Previous studies have found a slightly increased risk of colon polyps in diabetic patients, with odds ratios from 1.2 to 1.3, said Dr. Anand of St. Michael's Hospital in Toronto.
Of the 305 charts eligible for analysis, 40 were from patients with diabetes. Controls comprised the first 265 consecutive patients without diabetes.
Three diabetic patients had neoplasms, as did three controls. The odds ratio for patients with diabetes having adenomas and/or carcinomas was 7.4, compared with nondiabetic patients.
“There are several of limitations to this study,” Dr. Anand said in an interview. “It's retrospective, which comes with its own host of issues. In addition, if it's not charted, we had no way of knowing if a patient was diabetic or not.” In addition, the diabetic patients were older than their counterparts in the control group (mean age 64 vs. 58 years, respectively), she said.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver. Dr. Anand had no financial interests to disclose regarding the study.
BANFF, ALTA. — Patients with diabetes appear to be at higher risk of developing colon polyps than are nondiabetics, according to the results of a case control study.
In the chart review of 305 people who had received a colonoscopy, those in whom adenomas and/or carcinomas were detected had seven times the odds of being diabetic, compared with patients without those lesions.
On the basis of these findings, Dr. Nitasha Anand recommended that diabetic patients undergo earlier or more frequent colon screening than patients without diabetes. However, she pointed out that the study's several confounders made it difficult to draw definite conclusions.
“Insulin is a growth factor for epithelium in the colon,” Dr. Anand said at the Canadian Digestive Diseases Week. “So we were wondering whether people with higher insulin levels in the blood would have more polyps in the colon than the average person.” Previous studies have found a slightly increased risk of colon polyps in diabetic patients, with odds ratios from 1.2 to 1.3, said Dr. Anand of St. Michael's Hospital in Toronto.
Of the 305 charts eligible for analysis, 40 were from patients with diabetes. Controls comprised the first 265 consecutive patients without diabetes.
Three diabetic patients had neoplasms, as did three controls. The odds ratio for patients with diabetes having adenomas and/or carcinomas was 7.4, compared with nondiabetic patients.
“There are several of limitations to this study,” Dr. Anand said in an interview. “It's retrospective, which comes with its own host of issues. In addition, if it's not charted, we had no way of knowing if a patient was diabetic or not.” In addition, the diabetic patients were older than their counterparts in the control group (mean age 64 vs. 58 years, respectively), she said.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver. Dr. Anand had no financial interests to disclose regarding the study.
Occult HBV May Be Common in HIV Patients
BANFF, ALTA. — Occult hepatitis B coinfection appears to be common in HIV-positive individuals, based on the first study of its kind to test for hepatitis B in peripheral blood mononuclear cells, reported Dr. Carla S. Coffin at the Canadian Digestive Diseases Week.
Of the 46 HIV-infected patients included in the study, 12 (26%) tested positive for hepatitis B virus (HBV) genomes in peripheral blood mononuclear cells (PBMCs). Interestingly, all of the study's participants tested negative for HBV genomes in plasma, indicating that the lymphoid system may be an important site for maintenance of HBV replication, even when the serum or plasma is apparently HBV nonreactive.
Dr. Coffin reported that, to her knowledge, this is the first study to undertake parallel analysis for occult HBV in both plasma and PBMC samples from HIV-infected individuals. “All of the previous studies that I was able to find looked for the virus only within plasma or serum.”
The findings suggest that “the lymphoid system is of vital importance in determining the presence of occult HBV infection,” Dr. Coffin explained.
Further testing of the coinfected patients revealed that their mean alanine aminotransferase (ALT) level was higher than that of their counterparts who tested negative for occult HBV, indicating possible ongoing hepatic necroinflammatory activity.
Dr. Coffin and her colleagues at the University of Calgary (Alta.) and Memorial University in St. John's, Nfld., also found that coinfected patients had lower median CD4+ T-cell counts (203 vs. 251 cells/mm
Preliminary sequence analysis revealed that coinfected patients had HBV and HIV viral diversity. This suggests a possible synergistic effect of coinfection on viral molecular evolution.
These data suggest the potential for serious pathogenic ramifications in HIV infection, said Dr. Coffin, a clinical scholar in the department of medicine. “In chronic HIV infection, HBV coinfection increases the risk of end-stage liver disease.”
“Case reports have reported an association with chronic transaminitis, HAART [highly active antiretroviral treatment]-related flares, and hepatotoxicity in coinfected patients,” she added.
“Moreover, in the pre-HAART area, there was one report [in which] antigen-negative patients with antibodies to HBV were found to have a more rapid progression to AIDS. Finally, the risk of reactivation of occult HBV and possible severe clinical consequences have been described.”
Dr. Coffin said that she had no relevant financial interests regarding this topic.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
BANFF, ALTA. — Occult hepatitis B coinfection appears to be common in HIV-positive individuals, based on the first study of its kind to test for hepatitis B in peripheral blood mononuclear cells, reported Dr. Carla S. Coffin at the Canadian Digestive Diseases Week.
Of the 46 HIV-infected patients included in the study, 12 (26%) tested positive for hepatitis B virus (HBV) genomes in peripheral blood mononuclear cells (PBMCs). Interestingly, all of the study's participants tested negative for HBV genomes in plasma, indicating that the lymphoid system may be an important site for maintenance of HBV replication, even when the serum or plasma is apparently HBV nonreactive.
Dr. Coffin reported that, to her knowledge, this is the first study to undertake parallel analysis for occult HBV in both plasma and PBMC samples from HIV-infected individuals. “All of the previous studies that I was able to find looked for the virus only within plasma or serum.”
The findings suggest that “the lymphoid system is of vital importance in determining the presence of occult HBV infection,” Dr. Coffin explained.
Further testing of the coinfected patients revealed that their mean alanine aminotransferase (ALT) level was higher than that of their counterparts who tested negative for occult HBV, indicating possible ongoing hepatic necroinflammatory activity.
Dr. Coffin and her colleagues at the University of Calgary (Alta.) and Memorial University in St. John's, Nfld., also found that coinfected patients had lower median CD4+ T-cell counts (203 vs. 251 cells/mm
Preliminary sequence analysis revealed that coinfected patients had HBV and HIV viral diversity. This suggests a possible synergistic effect of coinfection on viral molecular evolution.
These data suggest the potential for serious pathogenic ramifications in HIV infection, said Dr. Coffin, a clinical scholar in the department of medicine. “In chronic HIV infection, HBV coinfection increases the risk of end-stage liver disease.”
“Case reports have reported an association with chronic transaminitis, HAART [highly active antiretroviral treatment]-related flares, and hepatotoxicity in coinfected patients,” she added.
“Moreover, in the pre-HAART area, there was one report [in which] antigen-negative patients with antibodies to HBV were found to have a more rapid progression to AIDS. Finally, the risk of reactivation of occult HBV and possible severe clinical consequences have been described.”
Dr. Coffin said that she had no relevant financial interests regarding this topic.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
BANFF, ALTA. — Occult hepatitis B coinfection appears to be common in HIV-positive individuals, based on the first study of its kind to test for hepatitis B in peripheral blood mononuclear cells, reported Dr. Carla S. Coffin at the Canadian Digestive Diseases Week.
Of the 46 HIV-infected patients included in the study, 12 (26%) tested positive for hepatitis B virus (HBV) genomes in peripheral blood mononuclear cells (PBMCs). Interestingly, all of the study's participants tested negative for HBV genomes in plasma, indicating that the lymphoid system may be an important site for maintenance of HBV replication, even when the serum or plasma is apparently HBV nonreactive.
Dr. Coffin reported that, to her knowledge, this is the first study to undertake parallel analysis for occult HBV in both plasma and PBMC samples from HIV-infected individuals. “All of the previous studies that I was able to find looked for the virus only within plasma or serum.”
The findings suggest that “the lymphoid system is of vital importance in determining the presence of occult HBV infection,” Dr. Coffin explained.
Further testing of the coinfected patients revealed that their mean alanine aminotransferase (ALT) level was higher than that of their counterparts who tested negative for occult HBV, indicating possible ongoing hepatic necroinflammatory activity.
Dr. Coffin and her colleagues at the University of Calgary (Alta.) and Memorial University in St. John's, Nfld., also found that coinfected patients had lower median CD4+ T-cell counts (203 vs. 251 cells/mm
Preliminary sequence analysis revealed that coinfected patients had HBV and HIV viral diversity. This suggests a possible synergistic effect of coinfection on viral molecular evolution.
These data suggest the potential for serious pathogenic ramifications in HIV infection, said Dr. Coffin, a clinical scholar in the department of medicine. “In chronic HIV infection, HBV coinfection increases the risk of end-stage liver disease.”
“Case reports have reported an association with chronic transaminitis, HAART [highly active antiretroviral treatment]-related flares, and hepatotoxicity in coinfected patients,” she added.
“Moreover, in the pre-HAART area, there was one report [in which] antigen-negative patients with antibodies to HBV were found to have a more rapid progression to AIDS. Finally, the risk of reactivation of occult HBV and possible severe clinical consequences have been described.”
Dr. Coffin said that she had no relevant financial interests regarding this topic.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
FOB Tests Useful in Colon Ca Screening
BANFF, ALTA. — A colorectal screening program in Ontario has proven successful in detecting high-risk adenomas and colorectal cancer in patients referred because of positive fecal occult blood test results or a family history of colorectal cancer.
“About 2 years ago, the Ontario Ministry of Health announced this new colorectal screening program, which is based on fecal occult blood [FOB] testing for average-risk patients and colonoscopy for those with a first-degree relative with colorectal cancer,” said Dr. William G. Paterson at the Canadian Digestive Diseases Week. “And certainly amongst the GI community there was controversy as to whether a screening program based on FOB testing was the best approach,” he added.
To answer this question, Dr. Paterson and his colleagues reviewed the charts of 764 patients referred to the program; 122 were referred because of positive FOB tests. Of those, 14 patients were found to have cancer (11.4% diagnostic yield) and 30 had high-risk adenomas (24.6% diagnostic yield).
The remaining 642 patients screened through the program had a family history of colorectal cancer. Eleven cases of cancer (1.7% diagnostic yield) and 37 high-risk adenomas (5.8% diagnostic yield) were found. The yield for this cohort was not statistically different between patients whose first-degree relative was diagnosed at age 60 years or younger, or at older than 60 years of age.
Dr. Paterson reported that a separate group of 2,011 patients underwent screening colonoscopy outside the newly developed program; 135 of them were considered to be of average risk.
Among average-risk patients, one was found to have cancer (0.7% diagnostic yield); five others had high-risk adenoma (3.7% diagnostic yield).
“So the yield for those who came with a positive FOBT was significantly higher than all the other routes,” said Dr. Paterson, chief of gastroenterology at Queen's University in Kingston, Ontario.
Given the potential importance of positive FOB tests, the investigators also analyzed the data according to the number of positive tests a patient had; data were available for 107 patients with positive FOB test results.
Of the 50 patients who had one positive test, none was found to have cancer, and 10 had high-risk adenomas (20% diagnostic yield). By comparison, 9 of the 57 patients (15.8% diagnostic yield) who had two or more positive tests had cancer, and 20 (35.1% diagnostic yield) had high-risk adenomas.
“More than one positive fecal occult blood test is associated with a statistically significantly higher yield of colorectal cancer,” he added. “This suggests that these patients should be triaged for more rapid access to colonoscopy.”
Dr. Paterson disclosed that he has no relevant financial interests to disclose regarding this topic.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
BANFF, ALTA. — A colorectal screening program in Ontario has proven successful in detecting high-risk adenomas and colorectal cancer in patients referred because of positive fecal occult blood test results or a family history of colorectal cancer.
“About 2 years ago, the Ontario Ministry of Health announced this new colorectal screening program, which is based on fecal occult blood [FOB] testing for average-risk patients and colonoscopy for those with a first-degree relative with colorectal cancer,” said Dr. William G. Paterson at the Canadian Digestive Diseases Week. “And certainly amongst the GI community there was controversy as to whether a screening program based on FOB testing was the best approach,” he added.
To answer this question, Dr. Paterson and his colleagues reviewed the charts of 764 patients referred to the program; 122 were referred because of positive FOB tests. Of those, 14 patients were found to have cancer (11.4% diagnostic yield) and 30 had high-risk adenomas (24.6% diagnostic yield).
The remaining 642 patients screened through the program had a family history of colorectal cancer. Eleven cases of cancer (1.7% diagnostic yield) and 37 high-risk adenomas (5.8% diagnostic yield) were found. The yield for this cohort was not statistically different between patients whose first-degree relative was diagnosed at age 60 years or younger, or at older than 60 years of age.
Dr. Paterson reported that a separate group of 2,011 patients underwent screening colonoscopy outside the newly developed program; 135 of them were considered to be of average risk.
Among average-risk patients, one was found to have cancer (0.7% diagnostic yield); five others had high-risk adenoma (3.7% diagnostic yield).
“So the yield for those who came with a positive FOBT was significantly higher than all the other routes,” said Dr. Paterson, chief of gastroenterology at Queen's University in Kingston, Ontario.
Given the potential importance of positive FOB tests, the investigators also analyzed the data according to the number of positive tests a patient had; data were available for 107 patients with positive FOB test results.
Of the 50 patients who had one positive test, none was found to have cancer, and 10 had high-risk adenomas (20% diagnostic yield). By comparison, 9 of the 57 patients (15.8% diagnostic yield) who had two or more positive tests had cancer, and 20 (35.1% diagnostic yield) had high-risk adenomas.
“More than one positive fecal occult blood test is associated with a statistically significantly higher yield of colorectal cancer,” he added. “This suggests that these patients should be triaged for more rapid access to colonoscopy.”
Dr. Paterson disclosed that he has no relevant financial interests to disclose regarding this topic.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
BANFF, ALTA. — A colorectal screening program in Ontario has proven successful in detecting high-risk adenomas and colorectal cancer in patients referred because of positive fecal occult blood test results or a family history of colorectal cancer.
“About 2 years ago, the Ontario Ministry of Health announced this new colorectal screening program, which is based on fecal occult blood [FOB] testing for average-risk patients and colonoscopy for those with a first-degree relative with colorectal cancer,” said Dr. William G. Paterson at the Canadian Digestive Diseases Week. “And certainly amongst the GI community there was controversy as to whether a screening program based on FOB testing was the best approach,” he added.
To answer this question, Dr. Paterson and his colleagues reviewed the charts of 764 patients referred to the program; 122 were referred because of positive FOB tests. Of those, 14 patients were found to have cancer (11.4% diagnostic yield) and 30 had high-risk adenomas (24.6% diagnostic yield).
The remaining 642 patients screened through the program had a family history of colorectal cancer. Eleven cases of cancer (1.7% diagnostic yield) and 37 high-risk adenomas (5.8% diagnostic yield) were found. The yield for this cohort was not statistically different between patients whose first-degree relative was diagnosed at age 60 years or younger, or at older than 60 years of age.
Dr. Paterson reported that a separate group of 2,011 patients underwent screening colonoscopy outside the newly developed program; 135 of them were considered to be of average risk.
Among average-risk patients, one was found to have cancer (0.7% diagnostic yield); five others had high-risk adenoma (3.7% diagnostic yield).
“So the yield for those who came with a positive FOBT was significantly higher than all the other routes,” said Dr. Paterson, chief of gastroenterology at Queen's University in Kingston, Ontario.
Given the potential importance of positive FOB tests, the investigators also analyzed the data according to the number of positive tests a patient had; data were available for 107 patients with positive FOB test results.
Of the 50 patients who had one positive test, none was found to have cancer, and 10 had high-risk adenomas (20% diagnostic yield). By comparison, 9 of the 57 patients (15.8% diagnostic yield) who had two or more positive tests had cancer, and 20 (35.1% diagnostic yield) had high-risk adenomas.
“More than one positive fecal occult blood test is associated with a statistically significantly higher yield of colorectal cancer,” he added. “This suggests that these patients should be triaged for more rapid access to colonoscopy.”
Dr. Paterson disclosed that he has no relevant financial interests to disclose regarding this topic.
CDDW is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
New Program Helps Simplify Prediction of Fracture Risk
KANANASKIS, ALTA. — Physicians looking for a quick and easy way to predict fracture risk may need to look no further than a new computer program that considers more than just bone mineral density in making such determinations and summarizes its findings in a vivid, color-coded representation of the patient.
Developed by rheumatologist William Bensen, the Bone DESTINY software program predicts fractures more reliably than do bone mineral density (BMD) assessments alone. Use of the Bone DESTINY program achieves prediction accuracy comparable to that attained by following the guidelines developed by Osteoporosis Canada (Can. Assoc. Radiol. J. 2005;56:178–88).
Bone DESTINY is free to physicians and is currently being used in the Hamilton, Ont., area. It has not been released for general use yet, but there are plans to make it available throughout Canada, the United States, and Europe. It has been funded by Dr. Bensen and the division of rheumatology at McMaster University, Hamilton.
“Bone DESTINY begins with bone density, then adds a number of other important risk factors,” said Dr. Maggie Larché, a rheumatologist at McMaster University. “These include age, steroid use, propensity to fall, history of previous falls, body mass index, and previous fragility fractures.
“These data are plugged into a handheld computer, which then generates a neat graphic with a color-coded representation of the patient's risk.” The program's five color codes represent fracture risk; patients at high (red) or very high (purple) risk for fracture are recommended for treatment. The program also produces an accompanying text report.
In the first of two studies presented at the annual meeting of the Canadian Rheumatology Association, Dr. Larché and her colleagues at McMaster studied the predictive value of the Bone DESTINY program in 14,812 postmenopausal women at least 60 years old. For each patient, a set of treatment recommendations was produced based on BMD alone, on Osteoporosis Canada guidelines, or on Bone DESTINY results.
Among 7,049 patients aged 60–69 years, BMD analysis alone recommended treatment in 19%. By comparison, 20% were recommended for treatment according to OC guidelines, and 28% according to Bone DESTINY. In 5,252 patients aged 70–79 years, 29% were recommended for treatment based on BMD alone, 43% according to Bone DESTINY, and 51% according to OC guidelines. In 2,511 patients at least 80 years old, 47%, 72%, and 77% would be recommended for treatment according to BMD, OC guidelines, and Bone DESTINY results, respectively.
A second study compared predictive values of the three methods in 572 men and 3,914 women (50 years and older) who had suffered at least one previous fragility fracture.
For all age groups, both Bone DESTINY and OC guidelines recommended treatment in 80% of the women to prevent another fracture; 35% of the women would have received treatment based on BMD alone, Dr. Larché reported.
The most significant difference, however, was observed in men, in whom Bone DESTINY recommended treatment in 73%, compared with 26% by BMD alone and 41% by OC guidelines.
In an interview, Dr. Larché said these differences may be explained by the weighting of such risk factors as history of falls and propensity to fall, which the OC guidelines do not consider. “We feel they are underestimating rather than we are overestimating the fracture risk, but that's still to be determined.
“In the end, Bone DESTINY has a very similar outcome to OC guidelines, but has the advantage of being very user-friendly,” she added. “The primary care physicians absolutely adore it, as do we.”
Dr. Larché reported receiving honoraria and/or speakers fees from Amgen, Abbott, BMS, Pfizer, Schering, and GSK.
KANANASKIS, ALTA. — Physicians looking for a quick and easy way to predict fracture risk may need to look no further than a new computer program that considers more than just bone mineral density in making such determinations and summarizes its findings in a vivid, color-coded representation of the patient.
Developed by rheumatologist William Bensen, the Bone DESTINY software program predicts fractures more reliably than do bone mineral density (BMD) assessments alone. Use of the Bone DESTINY program achieves prediction accuracy comparable to that attained by following the guidelines developed by Osteoporosis Canada (Can. Assoc. Radiol. J. 2005;56:178–88).
Bone DESTINY is free to physicians and is currently being used in the Hamilton, Ont., area. It has not been released for general use yet, but there are plans to make it available throughout Canada, the United States, and Europe. It has been funded by Dr. Bensen and the division of rheumatology at McMaster University, Hamilton.
“Bone DESTINY begins with bone density, then adds a number of other important risk factors,” said Dr. Maggie Larché, a rheumatologist at McMaster University. “These include age, steroid use, propensity to fall, history of previous falls, body mass index, and previous fragility fractures.
“These data are plugged into a handheld computer, which then generates a neat graphic with a color-coded representation of the patient's risk.” The program's five color codes represent fracture risk; patients at high (red) or very high (purple) risk for fracture are recommended for treatment. The program also produces an accompanying text report.
In the first of two studies presented at the annual meeting of the Canadian Rheumatology Association, Dr. Larché and her colleagues at McMaster studied the predictive value of the Bone DESTINY program in 14,812 postmenopausal women at least 60 years old. For each patient, a set of treatment recommendations was produced based on BMD alone, on Osteoporosis Canada guidelines, or on Bone DESTINY results.
Among 7,049 patients aged 60–69 years, BMD analysis alone recommended treatment in 19%. By comparison, 20% were recommended for treatment according to OC guidelines, and 28% according to Bone DESTINY. In 5,252 patients aged 70–79 years, 29% were recommended for treatment based on BMD alone, 43% according to Bone DESTINY, and 51% according to OC guidelines. In 2,511 patients at least 80 years old, 47%, 72%, and 77% would be recommended for treatment according to BMD, OC guidelines, and Bone DESTINY results, respectively.
A second study compared predictive values of the three methods in 572 men and 3,914 women (50 years and older) who had suffered at least one previous fragility fracture.
For all age groups, both Bone DESTINY and OC guidelines recommended treatment in 80% of the women to prevent another fracture; 35% of the women would have received treatment based on BMD alone, Dr. Larché reported.
The most significant difference, however, was observed in men, in whom Bone DESTINY recommended treatment in 73%, compared with 26% by BMD alone and 41% by OC guidelines.
In an interview, Dr. Larché said these differences may be explained by the weighting of such risk factors as history of falls and propensity to fall, which the OC guidelines do not consider. “We feel they are underestimating rather than we are overestimating the fracture risk, but that's still to be determined.
“In the end, Bone DESTINY has a very similar outcome to OC guidelines, but has the advantage of being very user-friendly,” she added. “The primary care physicians absolutely adore it, as do we.”
Dr. Larché reported receiving honoraria and/or speakers fees from Amgen, Abbott, BMS, Pfizer, Schering, and GSK.
KANANASKIS, ALTA. — Physicians looking for a quick and easy way to predict fracture risk may need to look no further than a new computer program that considers more than just bone mineral density in making such determinations and summarizes its findings in a vivid, color-coded representation of the patient.
Developed by rheumatologist William Bensen, the Bone DESTINY software program predicts fractures more reliably than do bone mineral density (BMD) assessments alone. Use of the Bone DESTINY program achieves prediction accuracy comparable to that attained by following the guidelines developed by Osteoporosis Canada (Can. Assoc. Radiol. J. 2005;56:178–88).
Bone DESTINY is free to physicians and is currently being used in the Hamilton, Ont., area. It has not been released for general use yet, but there are plans to make it available throughout Canada, the United States, and Europe. It has been funded by Dr. Bensen and the division of rheumatology at McMaster University, Hamilton.
“Bone DESTINY begins with bone density, then adds a number of other important risk factors,” said Dr. Maggie Larché, a rheumatologist at McMaster University. “These include age, steroid use, propensity to fall, history of previous falls, body mass index, and previous fragility fractures.
“These data are plugged into a handheld computer, which then generates a neat graphic with a color-coded representation of the patient's risk.” The program's five color codes represent fracture risk; patients at high (red) or very high (purple) risk for fracture are recommended for treatment. The program also produces an accompanying text report.
In the first of two studies presented at the annual meeting of the Canadian Rheumatology Association, Dr. Larché and her colleagues at McMaster studied the predictive value of the Bone DESTINY program in 14,812 postmenopausal women at least 60 years old. For each patient, a set of treatment recommendations was produced based on BMD alone, on Osteoporosis Canada guidelines, or on Bone DESTINY results.
Among 7,049 patients aged 60–69 years, BMD analysis alone recommended treatment in 19%. By comparison, 20% were recommended for treatment according to OC guidelines, and 28% according to Bone DESTINY. In 5,252 patients aged 70–79 years, 29% were recommended for treatment based on BMD alone, 43% according to Bone DESTINY, and 51% according to OC guidelines. In 2,511 patients at least 80 years old, 47%, 72%, and 77% would be recommended for treatment according to BMD, OC guidelines, and Bone DESTINY results, respectively.
A second study compared predictive values of the three methods in 572 men and 3,914 women (50 years and older) who had suffered at least one previous fragility fracture.
For all age groups, both Bone DESTINY and OC guidelines recommended treatment in 80% of the women to prevent another fracture; 35% of the women would have received treatment based on BMD alone, Dr. Larché reported.
The most significant difference, however, was observed in men, in whom Bone DESTINY recommended treatment in 73%, compared with 26% by BMD alone and 41% by OC guidelines.
In an interview, Dr. Larché said these differences may be explained by the weighting of such risk factors as history of falls and propensity to fall, which the OC guidelines do not consider. “We feel they are underestimating rather than we are overestimating the fracture risk, but that's still to be determined.
“In the end, Bone DESTINY has a very similar outcome to OC guidelines, but has the advantage of being very user-friendly,” she added. “The primary care physicians absolutely adore it, as do we.”
Dr. Larché reported receiving honoraria and/or speakers fees from Amgen, Abbott, BMS, Pfizer, Schering, and GSK.
Risk of Colonic Polyps High in Diabetic Patients
BANFF, ALTA., CANADA — Patients with diabetes appear to be at higher risk of developing colon polyps than are nondiabetics, according to the results of a case-control study.
In the chart review of 305 people who had received a colonoscopy, those in whom adenomas and/or carcinomas were detected had seven times the odds of being diabetic than did patients without such lesions.
On the basis of these findings, the investigator recommended that diabetic patients undergo earlier or more frequent colon screening than patients without diabetes.
“Insulin is a growth factor for epithelium in the colon,” Dr. Nitasha Anand said at the Canadian Digestive Diseases Week.
Dr. Anand and her colleagues at St. Michael's Hospital in Toronto used ICD-10 codes to identify approximately 9,000 patients who underwent colonoscopy at the institution over a 3-year period. Of these, 305 charts were eligible for analysis, 40 of which were from patients with diabetes. Controls comprised the first 265 consecutive patients without diabetes, so there were 6.6 controls for each diabetic individual. The data showed that 3 of the 40 patients with diabetes had neoplasms, as did 3 of the 265 controls. The odds ratio for patients with diabetes having adenomas and/or carcinomas was 7.4, compared with nondiabetic patients.
The diabetic patients were older than the control patients (mean age 64 vs. 58 years). “Age makes a difference, because the older you are, the more likely you are to have polyps,” she added.
BANFF, ALTA., CANADA — Patients with diabetes appear to be at higher risk of developing colon polyps than are nondiabetics, according to the results of a case-control study.
In the chart review of 305 people who had received a colonoscopy, those in whom adenomas and/or carcinomas were detected had seven times the odds of being diabetic than did patients without such lesions.
On the basis of these findings, the investigator recommended that diabetic patients undergo earlier or more frequent colon screening than patients without diabetes.
“Insulin is a growth factor for epithelium in the colon,” Dr. Nitasha Anand said at the Canadian Digestive Diseases Week.
Dr. Anand and her colleagues at St. Michael's Hospital in Toronto used ICD-10 codes to identify approximately 9,000 patients who underwent colonoscopy at the institution over a 3-year period. Of these, 305 charts were eligible for analysis, 40 of which were from patients with diabetes. Controls comprised the first 265 consecutive patients without diabetes, so there were 6.6 controls for each diabetic individual. The data showed that 3 of the 40 patients with diabetes had neoplasms, as did 3 of the 265 controls. The odds ratio for patients with diabetes having adenomas and/or carcinomas was 7.4, compared with nondiabetic patients.
The diabetic patients were older than the control patients (mean age 64 vs. 58 years). “Age makes a difference, because the older you are, the more likely you are to have polyps,” she added.
BANFF, ALTA., CANADA — Patients with diabetes appear to be at higher risk of developing colon polyps than are nondiabetics, according to the results of a case-control study.
In the chart review of 305 people who had received a colonoscopy, those in whom adenomas and/or carcinomas were detected had seven times the odds of being diabetic than did patients without such lesions.
On the basis of these findings, the investigator recommended that diabetic patients undergo earlier or more frequent colon screening than patients without diabetes.
“Insulin is a growth factor for epithelium in the colon,” Dr. Nitasha Anand said at the Canadian Digestive Diseases Week.
Dr. Anand and her colleagues at St. Michael's Hospital in Toronto used ICD-10 codes to identify approximately 9,000 patients who underwent colonoscopy at the institution over a 3-year period. Of these, 305 charts were eligible for analysis, 40 of which were from patients with diabetes. Controls comprised the first 265 consecutive patients without diabetes, so there were 6.6 controls for each diabetic individual. The data showed that 3 of the 40 patients with diabetes had neoplasms, as did 3 of the 265 controls. The odds ratio for patients with diabetes having adenomas and/or carcinomas was 7.4, compared with nondiabetic patients.
The diabetic patients were older than the control patients (mean age 64 vs. 58 years). “Age makes a difference, because the older you are, the more likely you are to have polyps,” she added.