Robert Finn

Major Finding: In the work-up of a patient with a recent transient ischemic attack or minor ischemic stroke, the most cost-effective strategy is duplex ultrasonography as the initial test, followed by CT angiography if the results are positive. Patients with 70%-99% stenosis should then undergo carotid endarterectomy. For the average 60-year-old man, this strategy had the lowest cost ($51,730) and yielded the largest number of quality-adjusted life years (14.38).

Data Sources: Meta-analysis of 41 studies, review of the literature, and a prospective diagnostic cohort study involving 351 patients.

Disclosures: The study was supported by the National Healthcare Insurance Board of the Netherlands and the Revolving Fund of Erasmus University Medical Center. The investigators stated that they had no financial relationships to disclose.

The most cost-effective strategy to diagnose carotid artery stenosis for most patients with recent transient ischemic attacks or minor strokes is duplex ultrasound, followed (if the results are positive) by CT angiography.

Patients with 70%-99% stenosis should then undergo carotid endarterectomy, according to a study based on a meta-analysis, a review of the literature, and a prospective diagnostic cohort study.

This strategy yields the lowest costs and the largest number of quality-adjusted life-years (QALY) for the average patient, according to analysis by Aletta T.R. Tholen, M.Sc., and colleagues from Erasmus University Medical Center, Rotterdam, the Netherlands (Radiology 2010;256:585-97).

For the typical 60-year-old man, this strategy would cost 39,826 euros (roughly US $51,730 at current exchange rates) and would yield 14.38 QALY. For the typical 60-year-old woman, it would cost 45,911 euros (US $59,634) and would yield 16.46 QALY.

The optimum strategy would differ somewhat for patients with higher risk profiles or a high probability of carotid artery stenosis, or for those who can undergo surgery without delay. In those cases, the duplex ultrasonography can be dispensed with in favor of CT angiography and surgery for 50%-99% stenosis.

For both men and women, the least cost-effective diagnostic strategy was duplex ultrasonography performed as a solo test. Duplex ultrasonography followed by contrast-enhanced MR angiography was intermediate in cost effectiveness, but was clearly dominated by duplex ultrasound followed by CT angiography.

The investigators used a decision-tree model to assess all feasible strategies in normal practice. They based their estimates of the prior probability of carotid artery stenosis on the results of a cross-sectional prospective diagnostic cohort study of 351 patients with a transient ischemic attack or minor stroke who were admitted to Erasmus University Medical Center between November 2002 and January 2005.

Of those patients, 9.8% of the males and 2.2% of the females had 70%-99% stenosis. Another 2.1% of the male patients and 1.4% of the female patients had 50%-69% stenosis.

In estimating the performances of the diagnostic tests, investigators relied on a meta-analysis that included 2,541 patients in a total of 41 studies published between January 1987 and April 2004. They based their information of the disadvantages of the various tests on their diagnostic cohort study and from a review of the literature.

“Our results suggest that if the patient cannot undergo surgery in a timely fashion, an initial duplex US examination and a 70%-99% stenosis criterion for surgery is indicated. On the other hand, if the patient can undergo surgery in a timely fashion, immediate CT-angiography and the use of a lenient criterion (50%-99% stenosis) as the surgery indication is beneficial,” the researchers concluded.

Major Finding: In the work-up of a patient with a recent transient ischemic attack or minor ischemic stroke, the most cost-effective strategy is duplex ultrasonography as the initial test, followed by CT angiography if the results are positive. Patients with 70%-99% stenosis should then undergo carotid endarterectomy. For the average 60-year-old man, this strategy had the lowest cost ($51,730) and yielded the largest number of quality-adjusted life years (14.38).

Data Sources: Meta-analysis of 41 studies, review of the literature, and a prospective diagnostic cohort study involving 351 patients.

Disclosures: The study was supported by the National Healthcare Insurance Board of the Netherlands and the Revolving Fund of Erasmus University Medical Center. The investigators stated that they had no financial relationships to disclose.

The most cost-effective strategy to diagnose carotid artery stenosis for most patients with recent transient ischemic attacks or minor strokes is duplex ultrasound, followed (if the results are positive) by CT angiography.

Patients with 70%-99% stenosis should then undergo carotid endarterectomy, according to a study based on a meta-analysis, a review of the literature, and a prospective diagnostic cohort study.

This strategy yields the lowest costs and the largest number of quality-adjusted life-years (QALY) for the average patient, according to analysis by Aletta T.R. Tholen, M.Sc., and colleagues from Erasmus University Medical Center, Rotterdam, the Netherlands (Radiology 2010;256:585-97).

For the typical 60-year-old man, this strategy would cost 39,826 euros (roughly US $51,730 at current exchange rates) and would yield 14.38 QALY. For the typical 60-year-old woman, it would cost 45,911 euros (US $59,634) and would yield 16.46 QALY.

The optimum strategy would differ somewhat for patients with higher risk profiles or a high probability of carotid artery stenosis, or for those who can undergo surgery without delay. In those cases, the duplex ultrasonography can be dispensed with in favor of CT angiography and surgery for 50%-99% stenosis.

For both men and women, the least cost-effective diagnostic strategy was duplex ultrasonography performed as a solo test. Duplex ultrasonography followed by contrast-enhanced MR angiography was intermediate in cost effectiveness, but was clearly dominated by duplex ultrasound followed by CT angiography.

The investigators used a decision-tree model to assess all feasible strategies in normal practice. They based their estimates of the prior probability of carotid artery stenosis on the results of a cross-sectional prospective diagnostic cohort study of 351 patients with a transient ischemic attack or minor stroke who were admitted to Erasmus University Medical Center between November 2002 and January 2005.

Of those patients, 9.8% of the males and 2.2% of the females had 70%-99% stenosis. Another 2.1% of the male patients and 1.4% of the female patients had 50%-69% stenosis.

In estimating the performances of the diagnostic tests, investigators relied on a meta-analysis that included 2,541 patients in a total of 41 studies published between January 1987 and April 2004. They based their information of the disadvantages of the various tests on their diagnostic cohort study and from a review of the literature.

“Our results suggest that if the patient cannot undergo surgery in a timely fashion, an initial duplex US examination and a 70%-99% stenosis criterion for surgery is indicated. On the other hand, if the patient can undergo surgery in a timely fashion, immediate CT-angiography and the use of a lenient criterion (50%-99% stenosis) as the surgery indication is beneficial,” the researchers concluded.

Major Finding: In the work-up of a patient with a recent transient ischemic attack or minor ischemic stroke, the most cost-effective strategy is duplex ultrasonography as the initial test, followed by CT angiography if the results are positive. Patients with 70%-99% stenosis should then undergo carotid endarterectomy. For the average 60-year-old man, this strategy had the lowest cost ($51,730) and yielded the largest number of quality-adjusted life years (14.38).

Data Sources: Meta-analysis of 41 studies, review of the literature, and a prospective diagnostic cohort study involving 351 patients.

Disclosures: The study was supported by the National Healthcare Insurance Board of the Netherlands and the Revolving Fund of Erasmus University Medical Center. The investigators stated that they had no financial relationships to disclose.

The most cost-effective strategy to diagnose carotid artery stenosis for most patients with recent transient ischemic attacks or minor strokes is duplex ultrasound, followed (if the results are positive) by CT angiography.

Patients with 70%-99% stenosis should then undergo carotid endarterectomy, according to a study based on a meta-analysis, a review of the literature, and a prospective diagnostic cohort study.

This strategy yields the lowest costs and the largest number of quality-adjusted life-years (QALY) for the average patient, according to analysis by Aletta T.R. Tholen, M.Sc., and colleagues from Erasmus University Medical Center, Rotterdam, the Netherlands (Radiology 2010;256:585-97).

For the typical 60-year-old man, this strategy would cost 39,826 euros (roughly US $51,730 at current exchange rates) and would yield 14.38 QALY. For the typical 60-year-old woman, it would cost 45,911 euros (US $59,634) and would yield 16.46 QALY.

The optimum strategy would differ somewhat for patients with higher risk profiles or a high probability of carotid artery stenosis, or for those who can undergo surgery without delay. In those cases, the duplex ultrasonography can be dispensed with in favor of CT angiography and surgery for 50%-99% stenosis.

For both men and women, the least cost-effective diagnostic strategy was duplex ultrasonography performed as a solo test. Duplex ultrasonography followed by contrast-enhanced MR angiography was intermediate in cost effectiveness, but was clearly dominated by duplex ultrasound followed by CT angiography.

The investigators used a decision-tree model to assess all feasible strategies in normal practice. They based their estimates of the prior probability of carotid artery stenosis on the results of a cross-sectional prospective diagnostic cohort study of 351 patients with a transient ischemic attack or minor stroke who were admitted to Erasmus University Medical Center between November 2002 and January 2005.

Of those patients, 9.8% of the males and 2.2% of the females had 70%-99% stenosis. Another 2.1% of the male patients and 1.4% of the female patients had 50%-69% stenosis.

In estimating the performances of the diagnostic tests, investigators relied on a meta-analysis that included 2,541 patients in a total of 41 studies published between January 1987 and April 2004. They based their information of the disadvantages of the various tests on their diagnostic cohort study and from a review of the literature.

“Our results suggest that if the patient cannot undergo surgery in a timely fashion, an initial duplex US examination and a 70%-99% stenosis criterion for surgery is indicated. On the other hand, if the patient can undergo surgery in a timely fashion, immediate CT-angiography and the use of a lenient criterion (50%-99% stenosis) as the surgery indication is beneficial,” the researchers concluded.

Major Finding: One study found that men on active surveillance after a prostate cancer diagnosis are almost 19 times as likely to die from other causes as from prostate cancer over 10 years. Another study found that over 5 years, not a single man diagnosed with prostate cancer died of the disease while under active surveillance, and only 3% died of other causes.

Data Source: Two prospective cohort studies of men with low-grade prostate cancer, one with 452 men followed for 10 years, and the other with 532 men followed for 5 years.

Disclosures: Both investigators said that they had no conflicts of interest. Dr. Whitson's study was supported by the University of California, San Francisco; Dr. Klotz's study was supported by the Prostate Cancer Research Foundation of Canada.

SAN FRANCISCO — Men who were diagnosed with low-grade prostate cancer have little to fear from a strategy of “watchful waiting,” also called “active surveillance,” according to two longitudinal studies

In one study, Dr. Laurence Klotz, chief of urology at the University of Toronto, followed a prospective cohort of 452 men for 10 years. During that time there were only five deaths from prostate cancer. The men in the study were 18.6 times more likely to die from other causes than from prostate cancer.

Among the original cohort, 315 men (70%) had stable disease. “In this group none have metastasized, none have been upgraded, and none have been treated,” Dr. Klotz said during a press briefing.

“So we took these 315 patients and [asked], 'If we apply various PSA [prostate-specific antigen] triggers to this stable cohort, how does it perform?'” Dr. Klotz said. “And the remarkable thing is that these patients very frequently have a trigger for intervention.”

This suggests that none of these triggers for intervention based on PSA values is very reliable. For example, 84% of the men with stable disease had two or more successive PSA tests during the study indicating a PSA velocity greater than 2 ng/mL per year.

Other commonly used measures of PSA kinetics also yielded false-positive signals in these men with stable disease. Among those unreliable measures were PSA linear regression, differences between first and last PSA, and PSA threshold greater than 10 ng/mL.

“The bottom line is, these commonly used PSA triggers give what we consider to be a false signal for intervention very, very frequently,” Dr. Klotz said. “You have to interpret these values with caution.”

In the other study, Dr. Jared Whitson of the University of California, San Francisco, followed 532 men with low-grade prostate cancer for a mean of 55 months. The overall survival was 97%, and not a single man died from prostate cancer.

The men received prostate biopsies every 12-18 months, and 69% were still in active surveillance at the end of the study.

Of the 83 men who opted for radical prostatectomy, only 26 (31%) reached stage pT3, and only 22 (27%) had an extracapsular extension.

“Even among men who had not been upgraded, about 20% over 5 years will decide to be treated despite no change,” Dr. Whitson said at the press briefing.

“What we are doing now is using the PSA not as a trigger for intervention, but as a trigger for further diagnostic tests,” Dr. Klotz said.

'What we are doing now is using the PSA not as a trigger for intervention,' but as a trigger for diagnostic tests.

Source DR. KLOTZ

My Take

Active Surveillance Not Yet Standard

The studies by Dr. Klotz and Dr. Whitson both suggest that active surveillance is a reasonable strategy in men with low-grade prostate cancer. But I think it's still too soon to say that this strategy is the standard of care. In all fairness, I think we need to be a bit careful in saying that this is something we ought to be offering everyone. We just don't know enough about it yet.

What we really need from studies of active surveillance is longer-term follow-up. We need to know how many of these men we might have saved by active treatment vs. how many went on to never have to worry about prostate cancer. There are many adjuvant therapies that we can offer if they fail: radiation therapy, hormonal therapy, chemotherapy, and now immunotherapy. So I think the critical question is, what do we give up with active surveillance? We don't know that yet.

Most of these active surveillance protocols have a significant amount of fallout, some of it due to the treating physicians and some of it driven by the patients. One of the problems is that most of our patients concentrate on the PSA level. But a PSA level obtained today and one obtained tomorrow may be very different. Often patients get very anxious about active surveillance. PSA could stand for “patient-stimulated anxiety.”

J. BRANTLEY THRASHER, M.D., is a professor and the William L. Valk chair of urology at the University of Kansas Medical Center, Kansas City. The text is an edited version of remarks Dr. Thrasher made at a press briefing announcing the two studies at the AUA meeting.

Major Finding: One study found that men on active surveillance after a prostate cancer diagnosis are almost 19 times as likely to die from other causes as from prostate cancer over 10 years. Another study found that over 5 years, not a single man diagnosed with prostate cancer died of the disease while under active surveillance, and only 3% died of other causes.

Data Source: Two prospective cohort studies of men with low-grade prostate cancer, one with 452 men followed for 10 years, and the other with 532 men followed for 5 years.

Disclosures: Both investigators said that they had no conflicts of interest. Dr. Whitson's study was supported by the University of California, San Francisco; Dr. Klotz's study was supported by the Prostate Cancer Research Foundation of Canada.

SAN FRANCISCO — Men who were diagnosed with low-grade prostate cancer have little to fear from a strategy of “watchful waiting,” also called “active surveillance,” according to two longitudinal studies

In one study, Dr. Laurence Klotz, chief of urology at the University of Toronto, followed a prospective cohort of 452 men for 10 years. During that time there were only five deaths from prostate cancer. The men in the study were 18.6 times more likely to die from other causes than from prostate cancer.

Among the original cohort, 315 men (70%) had stable disease. “In this group none have metastasized, none have been upgraded, and none have been treated,” Dr. Klotz said during a press briefing.

“So we took these 315 patients and [asked], 'If we apply various PSA [prostate-specific antigen] triggers to this stable cohort, how does it perform?'” Dr. Klotz said. “And the remarkable thing is that these patients very frequently have a trigger for intervention.”

This suggests that none of these triggers for intervention based on PSA values is very reliable. For example, 84% of the men with stable disease had two or more successive PSA tests during the study indicating a PSA velocity greater than 2 ng/mL per year.

Other commonly used measures of PSA kinetics also yielded false-positive signals in these men with stable disease. Among those unreliable measures were PSA linear regression, differences between first and last PSA, and PSA threshold greater than 10 ng/mL.

“The bottom line is, these commonly used PSA triggers give what we consider to be a false signal for intervention very, very frequently,” Dr. Klotz said. “You have to interpret these values with caution.”

In the other study, Dr. Jared Whitson of the University of California, San Francisco, followed 532 men with low-grade prostate cancer for a mean of 55 months. The overall survival was 97%, and not a single man died from prostate cancer.

The men received prostate biopsies every 12-18 months, and 69% were still in active surveillance at the end of the study.

Of the 83 men who opted for radical prostatectomy, only 26 (31%) reached stage pT3, and only 22 (27%) had an extracapsular extension.

“Even among men who had not been upgraded, about 20% over 5 years will decide to be treated despite no change,” Dr. Whitson said at the press briefing.

“What we are doing now is using the PSA not as a trigger for intervention, but as a trigger for further diagnostic tests,” Dr. Klotz said.

'What we are doing now is using the PSA not as a trigger for intervention,' but as a trigger for diagnostic tests.

Source DR. KLOTZ

My Take

Active Surveillance Not Yet Standard

The studies by Dr. Klotz and Dr. Whitson both suggest that active surveillance is a reasonable strategy in men with low-grade prostate cancer. But I think it's still too soon to say that this strategy is the standard of care. In all fairness, I think we need to be a bit careful in saying that this is something we ought to be offering everyone. We just don't know enough about it yet.

What we really need from studies of active surveillance is longer-term follow-up. We need to know how many of these men we might have saved by active treatment vs. how many went on to never have to worry about prostate cancer. There are many adjuvant therapies that we can offer if they fail: radiation therapy, hormonal therapy, chemotherapy, and now immunotherapy. So I think the critical question is, what do we give up with active surveillance? We don't know that yet.

Most of these active surveillance protocols have a significant amount of fallout, some of it due to the treating physicians and some of it driven by the patients. One of the problems is that most of our patients concentrate on the PSA level. But a PSA level obtained today and one obtained tomorrow may be very different. Often patients get very anxious about active surveillance. PSA could stand for “patient-stimulated anxiety.”

J. BRANTLEY THRASHER, M.D., is a professor and the William L. Valk chair of urology at the University of Kansas Medical Center, Kansas City. The text is an edited version of remarks Dr. Thrasher made at a press briefing announcing the two studies at the AUA meeting.

Major Finding: One study found that men on active surveillance after a prostate cancer diagnosis are almost 19 times as likely to die from other causes as from prostate cancer over 10 years. Another study found that over 5 years, not a single man diagnosed with prostate cancer died of the disease while under active surveillance, and only 3% died of other causes.

Data Source: Two prospective cohort studies of men with low-grade prostate cancer, one with 452 men followed for 10 years, and the other with 532 men followed for 5 years.

Disclosures: Both investigators said that they had no conflicts of interest. Dr. Whitson's study was supported by the University of California, San Francisco; Dr. Klotz's study was supported by the Prostate Cancer Research Foundation of Canada.

SAN FRANCISCO — Men who were diagnosed with low-grade prostate cancer have little to fear from a strategy of “watchful waiting,” also called “active surveillance,” according to two longitudinal studies

In one study, Dr. Laurence Klotz, chief of urology at the University of Toronto, followed a prospective cohort of 452 men for 10 years. During that time there were only five deaths from prostate cancer. The men in the study were 18.6 times more likely to die from other causes than from prostate cancer.

Among the original cohort, 315 men (70%) had stable disease. “In this group none have metastasized, none have been upgraded, and none have been treated,” Dr. Klotz said during a press briefing.

“So we took these 315 patients and [asked], 'If we apply various PSA [prostate-specific antigen] triggers to this stable cohort, how does it perform?'” Dr. Klotz said. “And the remarkable thing is that these patients very frequently have a trigger for intervention.”

This suggests that none of these triggers for intervention based on PSA values is very reliable. For example, 84% of the men with stable disease had two or more successive PSA tests during the study indicating a PSA velocity greater than 2 ng/mL per year.

Other commonly used measures of PSA kinetics also yielded false-positive signals in these men with stable disease. Among those unreliable measures were PSA linear regression, differences between first and last PSA, and PSA threshold greater than 10 ng/mL.

“The bottom line is, these commonly used PSA triggers give what we consider to be a false signal for intervention very, very frequently,” Dr. Klotz said. “You have to interpret these values with caution.”

In the other study, Dr. Jared Whitson of the University of California, San Francisco, followed 532 men with low-grade prostate cancer for a mean of 55 months. The overall survival was 97%, and not a single man died from prostate cancer.

The men received prostate biopsies every 12-18 months, and 69% were still in active surveillance at the end of the study.

Of the 83 men who opted for radical prostatectomy, only 26 (31%) reached stage pT3, and only 22 (27%) had an extracapsular extension.

“Even among men who had not been upgraded, about 20% over 5 years will decide to be treated despite no change,” Dr. Whitson said at the press briefing.

“What we are doing now is using the PSA not as a trigger for intervention, but as a trigger for further diagnostic tests,” Dr. Klotz said.

'What we are doing now is using the PSA not as a trigger for intervention,' but as a trigger for diagnostic tests.

Source DR. KLOTZ

My Take

Active Surveillance Not Yet Standard

The studies by Dr. Klotz and Dr. Whitson both suggest that active surveillance is a reasonable strategy in men with low-grade prostate cancer. But I think it's still too soon to say that this strategy is the standard of care. In all fairness, I think we need to be a bit careful in saying that this is something we ought to be offering everyone. We just don't know enough about it yet.

What we really need from studies of active surveillance is longer-term follow-up. We need to know how many of these men we might have saved by active treatment vs. how many went on to never have to worry about prostate cancer. There are many adjuvant therapies that we can offer if they fail: radiation therapy, hormonal therapy, chemotherapy, and now immunotherapy. So I think the critical question is, what do we give up with active surveillance? We don't know that yet.

Most of these active surveillance protocols have a significant amount of fallout, some of it due to the treating physicians and some of it driven by the patients. One of the problems is that most of our patients concentrate on the PSA level. But a PSA level obtained today and one obtained tomorrow may be very different. Often patients get very anxious about active surveillance. PSA could stand for “patient-stimulated anxiety.”

J. BRANTLEY THRASHER, M.D., is a professor and the William L. Valk chair of urology at the University of Kansas Medical Center, Kansas City. The text is an edited version of remarks Dr. Thrasher made at a press briefing announcing the two studies at the AUA meeting.

Major Finding: Fifty percent of American youths have no parks, community centers, and sidewalks in their neighborhoods. Only 17% of high school students are physically active.

Data Source: Data from a variety of behavioral surveys administered between 2006 and 2009.

Disclosures: None was reported.

Only 20% of census blocks nationwide have parks within a half-mile of their boundary, according to a report issued by the Centers for Disease Control and Prevention. Furthermore, 50% of U.S. youths say they lack access to parks, community centers, and sidewalks in their neighborhoods.

The State Indicator Report on Physical Activity, 2010 also documented that only 17% of high school students report getting the recommended 1 hour of exercise per day. Only 65% of adults reported being physically active, which the report defined as 150 minutes per week of moderate physical exercise, 75 minutes per week of vigorous physical exercise, or a combination of the two.

In a prepared statement, First Lady Michelle Obama tied the lack of physical activity to this lack of access. “Today's report shows that too many kids are spending too much time in front of the computer or TV or a video game or have limited access to physical activity, because they live in neighborhoods that aren't safe, go to schools where PE classes have been cut, or live in communities where there are no sports leagues or after-school activity programs,” she said. “We need parents and teachers, business and community leaders, and the public and private sectors to come together to create more opportunities for kids to be active so they can lead happy, healthy lives.”

In preparing the report, the CDC compiled data from a variety of behavioral surveys administered between 2006 and 2009.

Other findings from the report include:

▸ Nationwide, only 30% of high school students take daily physical education classes.

▸ A total of 25% of adults say they engage in no leisure-time physical activity whatsoever.

▸ Only 20 states require or recommend that elementary schools provide scheduled recess.

▸ Fewer than half (46%) of middle schools and high schools support walking or biking to and from school.

The full report is available at http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2009.pdf

Major Finding: Fifty percent of American youths have no parks, community centers, and sidewalks in their neighborhoods. Only 17% of high school students are physically active.

Data Source: Data from a variety of behavioral surveys administered between 2006 and 2009.

Disclosures: None was reported.

Only 20% of census blocks nationwide have parks within a half-mile of their boundary, according to a report issued by the Centers for Disease Control and Prevention. Furthermore, 50% of U.S. youths say they lack access to parks, community centers, and sidewalks in their neighborhoods.

The State Indicator Report on Physical Activity, 2010 also documented that only 17% of high school students report getting the recommended 1 hour of exercise per day. Only 65% of adults reported being physically active, which the report defined as 150 minutes per week of moderate physical exercise, 75 minutes per week of vigorous physical exercise, or a combination of the two.

In a prepared statement, First Lady Michelle Obama tied the lack of physical activity to this lack of access. “Today's report shows that too many kids are spending too much time in front of the computer or TV or a video game or have limited access to physical activity, because they live in neighborhoods that aren't safe, go to schools where PE classes have been cut, or live in communities where there are no sports leagues or after-school activity programs,” she said. “We need parents and teachers, business and community leaders, and the public and private sectors to come together to create more opportunities for kids to be active so they can lead happy, healthy lives.”

In preparing the report, the CDC compiled data from a variety of behavioral surveys administered between 2006 and 2009.

Other findings from the report include:

▸ Nationwide, only 30% of high school students take daily physical education classes.

▸ A total of 25% of adults say they engage in no leisure-time physical activity whatsoever.

▸ Only 20 states require or recommend that elementary schools provide scheduled recess.

▸ Fewer than half (46%) of middle schools and high schools support walking or biking to and from school.

The full report is available at http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2009.pdf

Major Finding: Fifty percent of American youths have no parks, community centers, and sidewalks in their neighborhoods. Only 17% of high school students are physically active.

Data Source: Data from a variety of behavioral surveys administered between 2006 and 2009.

Disclosures: None was reported.

Only 20% of census blocks nationwide have parks within a half-mile of their boundary, according to a report issued by the Centers for Disease Control and Prevention. Furthermore, 50% of U.S. youths say they lack access to parks, community centers, and sidewalks in their neighborhoods.

The State Indicator Report on Physical Activity, 2010 also documented that only 17% of high school students report getting the recommended 1 hour of exercise per day. Only 65% of adults reported being physically active, which the report defined as 150 minutes per week of moderate physical exercise, 75 minutes per week of vigorous physical exercise, or a combination of the two.

In a prepared statement, First Lady Michelle Obama tied the lack of physical activity to this lack of access. “Today's report shows that too many kids are spending too much time in front of the computer or TV or a video game or have limited access to physical activity, because they live in neighborhoods that aren't safe, go to schools where PE classes have been cut, or live in communities where there are no sports leagues or after-school activity programs,” she said. “We need parents and teachers, business and community leaders, and the public and private sectors to come together to create more opportunities for kids to be active so they can lead happy, healthy lives.”

In preparing the report, the CDC compiled data from a variety of behavioral surveys administered between 2006 and 2009.

Other findings from the report include:

▸ Nationwide, only 30% of high school students take daily physical education classes.

▸ A total of 25% of adults say they engage in no leisure-time physical activity whatsoever.

▸ Only 20 states require or recommend that elementary schools provide scheduled recess.

▸ Fewer than half (46%) of middle schools and high schools support walking or biking to and from school.

The full report is available at http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2009.pdf

Major Finding: In a substudy of 15 adolescent girls with significant bone loss while using depot medroxyprogesterone acetate, only 1 participant had a “sufficient” serum vitamin D level of greater than 30 ng/mL.

Data Source: Subset of a prospective study of 181 adolescent girls on depot medroxyprogesterone acetate.

Disclosures: The study was sponsored by Pfizer/Pharmacia, and one of the investigators was employed by that company. Dr. Harel disclosed financial relationships with Merck, Teva/Duramed, Ortho-McNeil, GlaxoSmithKline, Novartis, and Warner Chilcott.

LAS VEGAS — Abnormally low levels of vitamin D were seen in a subset of 15 adolescent girls who had substantial losses in bone mineral density while using depot medroxyprogesterone acetate for contraception, according to preliminary results from a prospective study.

The girls were among 181 teens using depot medroxyprogesterone acetate (Depo-Provera, Pfizer) in a prospective study. Bone mineral density (BMD) losses of 5% or more were seen at the lumbar spine in 25% and at the hip in 50% of the study participants.

The relative estrogen deficiency associated with depot medroxyprogesterone acetate (DMPA) did not correlate with the size of the BMD loss, said Dr. Zeev Harel of Brown University, Providence, R.I.

Moreover, serum estradiol remained above 40-50 pg/mL in almost all participants, Dr. Harel said. This level is considered to be sufficient to conserve bone in elderly women.

He and his colleagues looked at 15 young women who lost at least 5% of BMD from baseline. Their mean age was 17 years, and they were an average of 61 months post menarche. Their BMIs were within the normal range, and none was obese. Their ethnicity was diverse, and they resided in various U.S. locations.

The investigators noted BMD losses in the majority of the 15 girls after two or three DMPA injections, but some participants did not exhibit BMD losses until after their 10th or 13th injection.

Serum 25-hydroxyvitamin D (25[OH]D) levels were available for 14 of the 15 girls, and all but 1 had low levels of vitamin D. Levels above 30 ng/mL are considered sufficient, levels between 20 and 30 ng/mL are referred to as “insufficient,” and levels below 20 ng/mL are referred to as “deficient.” Seven of the 14 participants (50%) were vitamin D insufficient, 6 (43%) were vitamin D deficient, and 1 (7%) had normal levels of vitamin D. The mean serum 25(OH)D level among the participants was about 25 ng/mL, in the insufficient range. Mean levels of parathyroid hormone, on the other hand, were in the normal range.

In an interview, Dr. Harel expressed surprise at these results. “I was expecting probably less than 30% [of the participants would have low levels of vitamin D],” he said “We were surprised specifically because when we drew the blood we did it at the end of the summer. Typically we absorb vitamin D from the sun. Also, most of the patients were Caucasian. We know that vitamin D deficiency is common in African Americans and Hispanics. Also, they were not extremely obese. We know we can find vitamin D deficiency in obesity. And we also had representatives from states that were really sunny, California for example.”

Dr. Harel said the results were worrisome enough for him to recommend measuring total 25(OH)D in adolescent girls using depot medroxyprogesterone acetate. “And if it's low—deficient or insufficient—treat it accordingly.”

The mean serum 25(OH)D level among the participants was about 25 ng/mL, in the insufficient range.

Source DR. HAREL

Major Finding: In a substudy of 15 adolescent girls with significant bone loss while using depot medroxyprogesterone acetate, only 1 participant had a “sufficient” serum vitamin D level of greater than 30 ng/mL.

Data Source: Subset of a prospective study of 181 adolescent girls on depot medroxyprogesterone acetate.

Disclosures: The study was sponsored by Pfizer/Pharmacia, and one of the investigators was employed by that company. Dr. Harel disclosed financial relationships with Merck, Teva/Duramed, Ortho-McNeil, GlaxoSmithKline, Novartis, and Warner Chilcott.

LAS VEGAS — Abnormally low levels of vitamin D were seen in a subset of 15 adolescent girls who had substantial losses in bone mineral density while using depot medroxyprogesterone acetate for contraception, according to preliminary results from a prospective study.

The girls were among 181 teens using depot medroxyprogesterone acetate (Depo-Provera, Pfizer) in a prospective study. Bone mineral density (BMD) losses of 5% or more were seen at the lumbar spine in 25% and at the hip in 50% of the study participants.

The relative estrogen deficiency associated with depot medroxyprogesterone acetate (DMPA) did not correlate with the size of the BMD loss, said Dr. Zeev Harel of Brown University, Providence, R.I.

Moreover, serum estradiol remained above 40-50 pg/mL in almost all participants, Dr. Harel said. This level is considered to be sufficient to conserve bone in elderly women.

He and his colleagues looked at 15 young women who lost at least 5% of BMD from baseline. Their mean age was 17 years, and they were an average of 61 months post menarche. Their BMIs were within the normal range, and none was obese. Their ethnicity was diverse, and they resided in various U.S. locations.

The investigators noted BMD losses in the majority of the 15 girls after two or three DMPA injections, but some participants did not exhibit BMD losses until after their 10th or 13th injection.

Serum 25-hydroxyvitamin D (25[OH]D) levels were available for 14 of the 15 girls, and all but 1 had low levels of vitamin D. Levels above 30 ng/mL are considered sufficient, levels between 20 and 30 ng/mL are referred to as “insufficient,” and levels below 20 ng/mL are referred to as “deficient.” Seven of the 14 participants (50%) were vitamin D insufficient, 6 (43%) were vitamin D deficient, and 1 (7%) had normal levels of vitamin D. The mean serum 25(OH)D level among the participants was about 25 ng/mL, in the insufficient range. Mean levels of parathyroid hormone, on the other hand, were in the normal range.

In an interview, Dr. Harel expressed surprise at these results. “I was expecting probably less than 30% [of the participants would have low levels of vitamin D],” he said “We were surprised specifically because when we drew the blood we did it at the end of the summer. Typically we absorb vitamin D from the sun. Also, most of the patients were Caucasian. We know that vitamin D deficiency is common in African Americans and Hispanics. Also, they were not extremely obese. We know we can find vitamin D deficiency in obesity. And we also had representatives from states that were really sunny, California for example.”

Dr. Harel said the results were worrisome enough for him to recommend measuring total 25(OH)D in adolescent girls using depot medroxyprogesterone acetate. “And if it's low—deficient or insufficient—treat it accordingly.”

The mean serum 25(OH)D level among the participants was about 25 ng/mL, in the insufficient range.

Source DR. HAREL

Major Finding: In a substudy of 15 adolescent girls with significant bone loss while using depot medroxyprogesterone acetate, only 1 participant had a “sufficient” serum vitamin D level of greater than 30 ng/mL.

Data Source: Subset of a prospective study of 181 adolescent girls on depot medroxyprogesterone acetate.

Disclosures: The study was sponsored by Pfizer/Pharmacia, and one of the investigators was employed by that company. Dr. Harel disclosed financial relationships with Merck, Teva/Duramed, Ortho-McNeil, GlaxoSmithKline, Novartis, and Warner Chilcott.

LAS VEGAS — Abnormally low levels of vitamin D were seen in a subset of 15 adolescent girls who had substantial losses in bone mineral density while using depot medroxyprogesterone acetate for contraception, according to preliminary results from a prospective study.

The girls were among 181 teens using depot medroxyprogesterone acetate (Depo-Provera, Pfizer) in a prospective study. Bone mineral density (BMD) losses of 5% or more were seen at the lumbar spine in 25% and at the hip in 50% of the study participants.

The relative estrogen deficiency associated with depot medroxyprogesterone acetate (DMPA) did not correlate with the size of the BMD loss, said Dr. Zeev Harel of Brown University, Providence, R.I.

Moreover, serum estradiol remained above 40-50 pg/mL in almost all participants, Dr. Harel said. This level is considered to be sufficient to conserve bone in elderly women.

He and his colleagues looked at 15 young women who lost at least 5% of BMD from baseline. Their mean age was 17 years, and they were an average of 61 months post menarche. Their BMIs were within the normal range, and none was obese. Their ethnicity was diverse, and they resided in various U.S. locations.

The investigators noted BMD losses in the majority of the 15 girls after two or three DMPA injections, but some participants did not exhibit BMD losses until after their 10th or 13th injection.

Serum 25-hydroxyvitamin D (25[OH]D) levels were available for 14 of the 15 girls, and all but 1 had low levels of vitamin D. Levels above 30 ng/mL are considered sufficient, levels between 20 and 30 ng/mL are referred to as “insufficient,” and levels below 20 ng/mL are referred to as “deficient.” Seven of the 14 participants (50%) were vitamin D insufficient, 6 (43%) were vitamin D deficient, and 1 (7%) had normal levels of vitamin D. The mean serum 25(OH)D level among the participants was about 25 ng/mL, in the insufficient range. Mean levels of parathyroid hormone, on the other hand, were in the normal range.

In an interview, Dr. Harel expressed surprise at these results. “I was expecting probably less than 30% [of the participants would have low levels of vitamin D],” he said “We were surprised specifically because when we drew the blood we did it at the end of the summer. Typically we absorb vitamin D from the sun. Also, most of the patients were Caucasian. We know that vitamin D deficiency is common in African Americans and Hispanics. Also, they were not extremely obese. We know we can find vitamin D deficiency in obesity. And we also had representatives from states that were really sunny, California for example.”

Dr. Harel said the results were worrisome enough for him to recommend measuring total 25(OH)D in adolescent girls using depot medroxyprogesterone acetate. “And if it's low—deficient or insufficient—treat it accordingly.”

The mean serum 25(OH)D level among the participants was about 25 ng/mL, in the insufficient range.

Source DR. HAREL

Major Finding: Fifty percent of American youths have no parks, community centers, or sidewalks in their neighborhoods. Only 17% of high school students are physically active.

Data Source: Data from a variety of behavioral surveys administered between 2006 and 2009.

Disclosures: None

Only 20% of census blocks nationwide have parks within a half-mile of their boundary, according to a report issued by the Centers for Disease Control and Prevention. Furthermore, 50% of U.S. youths say they lack access to parks, community centers, and sidewalks in their neighborhoods.

The State Indicator Report on Physical Activity, 2010, also documented that only 17% of high school students report getting the recommended 1 hour of exercise per day. Only 65% of adults reported being physically active, which the report defined as 150 minutes per week of moderate physical exercise, 75 minutes per week of vigorous physical exercise, or a combination of the two.

In a prepared statement, First Lady Michelle Obama tied the lack of physical activity to this lack of access. “Today's report shows that too many kids are spending too much time in front of the computer or TV or a video game or have limited access to physical activity, because they live in neighborhoods that aren't safe, go to schools where PE classes have been cut, or live in communities where there are no sports leagues or after-school activity programs,” she said. “We need parents and teachers, business and community leaders, and the public and private sectors to come together to create more opportunities for kids to be active so they can lead happy, healthy lives.”

In preparing the report, the CDC compiled data from various behavioral surveys administered during 2006-2009. The report also included data on state-level efforts to promote physical activity between 2001 and 2009.

Other findings from the report include:

▸ Nationwide, only 30% of high school students take daily physical education classes.

▸ A total of 25% of adults say they engage in no leisure-time physical activity whatsoever.

▸ Only 20 states require or recommend that elementary schools provide scheduled recess.

The full report is available at http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2009.pdf

Major Finding: Fifty percent of American youths have no parks, community centers, or sidewalks in their neighborhoods. Only 17% of high school students are physically active.

Data Source: Data from a variety of behavioral surveys administered between 2006 and 2009.

Disclosures: None

Only 20% of census blocks nationwide have parks within a half-mile of their boundary, according to a report issued by the Centers for Disease Control and Prevention. Furthermore, 50% of U.S. youths say they lack access to parks, community centers, and sidewalks in their neighborhoods.

The State Indicator Report on Physical Activity, 2010, also documented that only 17% of high school students report getting the recommended 1 hour of exercise per day. Only 65% of adults reported being physically active, which the report defined as 150 minutes per week of moderate physical exercise, 75 minutes per week of vigorous physical exercise, or a combination of the two.

In a prepared statement, First Lady Michelle Obama tied the lack of physical activity to this lack of access. “Today's report shows that too many kids are spending too much time in front of the computer or TV or a video game or have limited access to physical activity, because they live in neighborhoods that aren't safe, go to schools where PE classes have been cut, or live in communities where there are no sports leagues or after-school activity programs,” she said. “We need parents and teachers, business and community leaders, and the public and private sectors to come together to create more opportunities for kids to be active so they can lead happy, healthy lives.”

In preparing the report, the CDC compiled data from various behavioral surveys administered during 2006-2009. The report also included data on state-level efforts to promote physical activity between 2001 and 2009.

Other findings from the report include:

▸ Nationwide, only 30% of high school students take daily physical education classes.

▸ A total of 25% of adults say they engage in no leisure-time physical activity whatsoever.

▸ Only 20 states require or recommend that elementary schools provide scheduled recess.

The full report is available at http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2009.pdf

Major Finding: Fifty percent of American youths have no parks, community centers, or sidewalks in their neighborhoods. Only 17% of high school students are physically active.

Data Source: Data from a variety of behavioral surveys administered between 2006 and 2009.

Disclosures: None

Only 20% of census blocks nationwide have parks within a half-mile of their boundary, according to a report issued by the Centers for Disease Control and Prevention. Furthermore, 50% of U.S. youths say they lack access to parks, community centers, and sidewalks in their neighborhoods.

The State Indicator Report on Physical Activity, 2010, also documented that only 17% of high school students report getting the recommended 1 hour of exercise per day. Only 65% of adults reported being physically active, which the report defined as 150 minutes per week of moderate physical exercise, 75 minutes per week of vigorous physical exercise, or a combination of the two.

In a prepared statement, First Lady Michelle Obama tied the lack of physical activity to this lack of access. “Today's report shows that too many kids are spending too much time in front of the computer or TV or a video game or have limited access to physical activity, because they live in neighborhoods that aren't safe, go to schools where PE classes have been cut, or live in communities where there are no sports leagues or after-school activity programs,” she said. “We need parents and teachers, business and community leaders, and the public and private sectors to come together to create more opportunities for kids to be active so they can lead happy, healthy lives.”

In preparing the report, the CDC compiled data from various behavioral surveys administered during 2006-2009. The report also included data on state-level efforts to promote physical activity between 2001 and 2009.

Other findings from the report include:

▸ Nationwide, only 30% of high school students take daily physical education classes.

▸ A total of 25% of adults say they engage in no leisure-time physical activity whatsoever.

▸ Only 20 states require or recommend that elementary schools provide scheduled recess.

The full report is available at http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2009.pdf

SAN FRANCISCO — Higher levels of exercise are associated with lower levels of sexual dysfunction, according to a study of 178 healthy men.

Men who reported exercise of at least 9 metabolic equivalents (METs) per week were 65% less likely to report sexual dysfunction. Brisk walking for 30 minutes a day for 4 days per week is equivalent to about 9 METs, according to Dr. Erin R. McNamara of Duke University Medical Center, Durham, N.C., who presented the results of her study at the meeting.

“If men won't exercise for the cardiovascular benefits, maybe they'll exercise to have better sex,” Dr. McNamara said at a news briefing.

The men in the study were all enrolled in a prospective case-control study at the Durham Veterans Affairs Medical Center. Their mean age was 62 years; mean body mass index was 30.7 kg/m

The sexual function survey consisted of six questions, including ability to have an erection, quality and frequency of erections, and overall sexual ability. The investigators converted scores on the survey to a 0-100 scale.

The men also were asked to assess their duration, intensity, and frequency of exercise. The investigators converted these estimates to MET hours per week. They classified men reporting fewer than 3 MET hours per week as sedentary (53% of the sample), 3–8 MET hours as active (14%), 9–17 MET hours as moderately active (9%), and 18 or more MET hours as highly active (24%).

Mean sexual function scores were 42 for sedentary men, 50 for active men, 72 for moderately active men, and 70 for highly active men. The trend was statistically significant.

In a multivariate analysis controlling for age, race, BMI, and other factors, men reporting moderate or high levels of physical activity were 65% less likely to have sexual dysfunction than sedentary men.

Men with moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

Source ©Willie B. Thomas/iStockphoto.com

SAN FRANCISCO — Higher levels of exercise are associated with lower levels of sexual dysfunction, according to a study of 178 healthy men.

Men who reported exercise of at least 9 metabolic equivalents (METs) per week were 65% less likely to report sexual dysfunction. Brisk walking for 30 minutes a day for 4 days per week is equivalent to about 9 METs, according to Dr. Erin R. McNamara of Duke University Medical Center, Durham, N.C., who presented the results of her study at the meeting.

“If men won't exercise for the cardiovascular benefits, maybe they'll exercise to have better sex,” Dr. McNamara said at a news briefing.

The men in the study were all enrolled in a prospective case-control study at the Durham Veterans Affairs Medical Center. Their mean age was 62 years; mean body mass index was 30.7 kg/m

The sexual function survey consisted of six questions, including ability to have an erection, quality and frequency of erections, and overall sexual ability. The investigators converted scores on the survey to a 0-100 scale.

The men also were asked to assess their duration, intensity, and frequency of exercise. The investigators converted these estimates to MET hours per week. They classified men reporting fewer than 3 MET hours per week as sedentary (53% of the sample), 3–8 MET hours as active (14%), 9–17 MET hours as moderately active (9%), and 18 or more MET hours as highly active (24%).

Mean sexual function scores were 42 for sedentary men, 50 for active men, 72 for moderately active men, and 70 for highly active men. The trend was statistically significant.

In a multivariate analysis controlling for age, race, BMI, and other factors, men reporting moderate or high levels of physical activity were 65% less likely to have sexual dysfunction than sedentary men.

Men with moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

Source ©Willie B. Thomas/iStockphoto.com

SAN FRANCISCO — Higher levels of exercise are associated with lower levels of sexual dysfunction, according to a study of 178 healthy men.

Men who reported exercise of at least 9 metabolic equivalents (METs) per week were 65% less likely to report sexual dysfunction. Brisk walking for 30 minutes a day for 4 days per week is equivalent to about 9 METs, according to Dr. Erin R. McNamara of Duke University Medical Center, Durham, N.C., who presented the results of her study at the meeting.

“If men won't exercise for the cardiovascular benefits, maybe they'll exercise to have better sex,” Dr. McNamara said at a news briefing.

The men in the study were all enrolled in a prospective case-control study at the Durham Veterans Affairs Medical Center. Their mean age was 62 years; mean body mass index was 30.7 kg/m

The sexual function survey consisted of six questions, including ability to have an erection, quality and frequency of erections, and overall sexual ability. The investigators converted scores on the survey to a 0-100 scale.

The men also were asked to assess their duration, intensity, and frequency of exercise. The investigators converted these estimates to MET hours per week. They classified men reporting fewer than 3 MET hours per week as sedentary (53% of the sample), 3–8 MET hours as active (14%), 9–17 MET hours as moderately active (9%), and 18 or more MET hours as highly active (24%).

Mean sexual function scores were 42 for sedentary men, 50 for active men, 72 for moderately active men, and 70 for highly active men. The trend was statistically significant.

In a multivariate analysis controlling for age, race, BMI, and other factors, men reporting moderate or high levels of physical activity were 65% less likely to have sexual dysfunction than sedentary men.

Men with moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

Source ©Willie B. Thomas/iStockphoto.com

Major Finding: Asymptomatic patients with elevated PSAs who were given 6 weeks of ciprofloxacin saw mean PSA levels decline 11%, compared with an increase of 4% in patients in a control group. The difference was not statistically significant.

Data Source: Randomized controlled trial of 120 men.

Disclosures: The investigators stated that they had no conflicts and that the study received no specific funding.

SAN FRANCISCO — Some physicians prescribe antibiotics to men with elevated prostate specific antigen to differentiate those who have infection or inflammation from those who have cancer, but a randomized controlled trial shows no significant change in mean PSA levels between 60 asymptomatic men given a 6-week regimen of a fluoroquinolone and another 60 men assigned to observation.

Those who took 500 mg of ciprofloxacin twice daily for 6 weeks experienced an 11% decline in mean PSA values, compared with a 4% increase in PSA values among men in the observation group.

The difference was neither statistically nor clinically significant, Dr. Robin R. Bhavsar reported.

Thirty patients in the ciprofloxacin arm and 26 patients in the observation arm ended up having biopsies. The cancer detection rate was 53% in the ciprofloxacin arm and 42% in the observation arm, a difference with no statistical significance, said Dr. Bhavsar of the Medical University of South Carolina, Charleston.

The investigation included asymptomatic men with PSAs between 4.0 and 20.0 ng/mL. Patients were excluded if they had used 5-alpha-reductase inhibitors, if they had undergone prior prostate surgery, had a prior diagnosis of prostate cancer, had used androgen ablative therapies, had evidence of prostatitis, or if they were allergic to fluoroquinolones.

“There's a natural PSA variation in men, and the PSA may increase or decrease spontaneously with or without the use of antibiotics,” Dr. Bhavsar said.

Some physicians may argue that it still makes sense to use antibiotics in these men because of the small risk of adverse events, but Dr. Bhavsar noted that unnecessary antibiotics add cost and may lead to the development of resistant organisms. In addition, there are rare adverse events, such tendon rupture, associated with long-term antibiotic use.

Dr. Bhavsar said that none of the men in either of his groups experienced dramatic decreases in PSA levels.

Major Finding: Asymptomatic patients with elevated PSAs who were given 6 weeks of ciprofloxacin saw mean PSA levels decline 11%, compared with an increase of 4% in patients in a control group. The difference was not statistically significant.

Data Source: Randomized controlled trial of 120 men.

Disclosures: The investigators stated that they had no conflicts and that the study received no specific funding.

SAN FRANCISCO — Some physicians prescribe antibiotics to men with elevated prostate specific antigen to differentiate those who have infection or inflammation from those who have cancer, but a randomized controlled trial shows no significant change in mean PSA levels between 60 asymptomatic men given a 6-week regimen of a fluoroquinolone and another 60 men assigned to observation.

Those who took 500 mg of ciprofloxacin twice daily for 6 weeks experienced an 11% decline in mean PSA values, compared with a 4% increase in PSA values among men in the observation group.

The difference was neither statistically nor clinically significant, Dr. Robin R. Bhavsar reported.

Thirty patients in the ciprofloxacin arm and 26 patients in the observation arm ended up having biopsies. The cancer detection rate was 53% in the ciprofloxacin arm and 42% in the observation arm, a difference with no statistical significance, said Dr. Bhavsar of the Medical University of South Carolina, Charleston.

The investigation included asymptomatic men with PSAs between 4.0 and 20.0 ng/mL. Patients were excluded if they had used 5-alpha-reductase inhibitors, if they had undergone prior prostate surgery, had a prior diagnosis of prostate cancer, had used androgen ablative therapies, had evidence of prostatitis, or if they were allergic to fluoroquinolones.

“There's a natural PSA variation in men, and the PSA may increase or decrease spontaneously with or without the use of antibiotics,” Dr. Bhavsar said.

Some physicians may argue that it still makes sense to use antibiotics in these men because of the small risk of adverse events, but Dr. Bhavsar noted that unnecessary antibiotics add cost and may lead to the development of resistant organisms. In addition, there are rare adverse events, such tendon rupture, associated with long-term antibiotic use.

Dr. Bhavsar said that none of the men in either of his groups experienced dramatic decreases in PSA levels.

Major Finding: Asymptomatic patients with elevated PSAs who were given 6 weeks of ciprofloxacin saw mean PSA levels decline 11%, compared with an increase of 4% in patients in a control group. The difference was not statistically significant.

Data Source: Randomized controlled trial of 120 men.

Disclosures: The investigators stated that they had no conflicts and that the study received no specific funding.

SAN FRANCISCO — Some physicians prescribe antibiotics to men with elevated prostate specific antigen to differentiate those who have infection or inflammation from those who have cancer, but a randomized controlled trial shows no significant change in mean PSA levels between 60 asymptomatic men given a 6-week regimen of a fluoroquinolone and another 60 men assigned to observation.

Those who took 500 mg of ciprofloxacin twice daily for 6 weeks experienced an 11% decline in mean PSA values, compared with a 4% increase in PSA values among men in the observation group.

The difference was neither statistically nor clinically significant, Dr. Robin R. Bhavsar reported.

Thirty patients in the ciprofloxacin arm and 26 patients in the observation arm ended up having biopsies. The cancer detection rate was 53% in the ciprofloxacin arm and 42% in the observation arm, a difference with no statistical significance, said Dr. Bhavsar of the Medical University of South Carolina, Charleston.

The investigation included asymptomatic men with PSAs between 4.0 and 20.0 ng/mL. Patients were excluded if they had used 5-alpha-reductase inhibitors, if they had undergone prior prostate surgery, had a prior diagnosis of prostate cancer, had used androgen ablative therapies, had evidence of prostatitis, or if they were allergic to fluoroquinolones.

“There's a natural PSA variation in men, and the PSA may increase or decrease spontaneously with or without the use of antibiotics,” Dr. Bhavsar said.

Some physicians may argue that it still makes sense to use antibiotics in these men because of the small risk of adverse events, but Dr. Bhavsar noted that unnecessary antibiotics add cost and may lead to the development of resistant organisms. In addition, there are rare adverse events, such tendon rupture, associated with long-term antibiotic use.

Dr. Bhavsar said that none of the men in either of his groups experienced dramatic decreases in PSA levels.

Major Finding: Exercise equivalent to 30 minutes of brisk walking per day, 4 days per week, is associated with a 65% decrease in the risk of sexual dysfunction.

Data Source: Study of 178 healthy men.

Disclosures: Dr. McNamara reported that she had no conflicts of interest. The study was supported by the Department of Defense and the Department of Veterans Affairs.

SAN FRANCISCO — Higher levels of exercise are associated with lower levels of sexual dysfunction, according to a study of 178 healthy men.

Men who reported exercise of at least 9 metabolic equivalents (METs) per week were 65% less likely to report sexual dysfunction. Brisk walking for 30 minutes a day for 4 days per week is equivalent to about 9 METs, according to Dr. Erin R. McNamara of Duke University Medical Center, Durham, N.C., who presented the results of her study at the meeting.

“If men won't exercise for the cardiovascular benefits, maybe they'll exercise to have better sex,” Dr. McNamara said at a news briefing.

The men in the study were all enrolled in a prospective case-control study at the Durham Veterans Affairs Medical Center. Their mean age was 62 years, and their mean body mass index was 30.7 kg/m

The sexual function survey consisted of six questions, asking men to evaluate their ability to have an erection, the quality and frequency of their erections, their ability to reach orgasm, their overall sexual ability, and the extent to which they were bothered by their sexual functioning. The investigators converted scores on the survey to a 0–100 scale. Overall, the participants' mean sexual function score was 53.

The men also were asked to assess their duration, intensity, and frequency of exercise. The investigators converted these estimates to MET hours per week. They classified men reporting fewer than 3 MET hours per week as sedentary (53% of the sample), 3–8 MET hours as active (14% of the sample), 9–17 MET hours as moderately active (9% of the sample), and 18 or more MET hours as highly active (24% of the sample).

Mean sexual function scores were 42 for sedentary men, 50 for active men, 72 for moderately active men, and 70 for highly active men. The trend was statistically significant.

In a multivariate analysis, the investigators controlled for age, race, BMI, heart disease, diabetes, medications, and depression. They defined a sexual function score of less than 40 as sexual dysfunction. Compared with sedentary men, those reporting moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

In an interview, Dr. McNamara emphasized that her study demonstrated only correlation, not causation. Asked to speculate on the reason for the association, she said, “Just as exercise provides cardiovascular benefit by increasing blood flow, we think the same thing probably happens [with sexual function] because the penis is engorged with blood vessels.” She also suggested that exercise may improve sexual function as a psychological byproduct of improved feelings of well-being.

Men with moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

Source Courtesy Ken Trombatore

Major Finding: Exercise equivalent to 30 minutes of brisk walking per day, 4 days per week, is associated with a 65% decrease in the risk of sexual dysfunction.

Data Source: Study of 178 healthy men.

Disclosures: Dr. McNamara reported that she had no conflicts of interest. The study was supported by the Department of Defense and the Department of Veterans Affairs.

SAN FRANCISCO — Higher levels of exercise are associated with lower levels of sexual dysfunction, according to a study of 178 healthy men.

Men who reported exercise of at least 9 metabolic equivalents (METs) per week were 65% less likely to report sexual dysfunction. Brisk walking for 30 minutes a day for 4 days per week is equivalent to about 9 METs, according to Dr. Erin R. McNamara of Duke University Medical Center, Durham, N.C., who presented the results of her study at the meeting.

“If men won't exercise for the cardiovascular benefits, maybe they'll exercise to have better sex,” Dr. McNamara said at a news briefing.

The men in the study were all enrolled in a prospective case-control study at the Durham Veterans Affairs Medical Center. Their mean age was 62 years, and their mean body mass index was 30.7 kg/m

The sexual function survey consisted of six questions, asking men to evaluate their ability to have an erection, the quality and frequency of their erections, their ability to reach orgasm, their overall sexual ability, and the extent to which they were bothered by their sexual functioning. The investigators converted scores on the survey to a 0–100 scale. Overall, the participants' mean sexual function score was 53.

The men also were asked to assess their duration, intensity, and frequency of exercise. The investigators converted these estimates to MET hours per week. They classified men reporting fewer than 3 MET hours per week as sedentary (53% of the sample), 3–8 MET hours as active (14% of the sample), 9–17 MET hours as moderately active (9% of the sample), and 18 or more MET hours as highly active (24% of the sample).

Mean sexual function scores were 42 for sedentary men, 50 for active men, 72 for moderately active men, and 70 for highly active men. The trend was statistically significant.

In a multivariate analysis, the investigators controlled for age, race, BMI, heart disease, diabetes, medications, and depression. They defined a sexual function score of less than 40 as sexual dysfunction. Compared with sedentary men, those reporting moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

In an interview, Dr. McNamara emphasized that her study demonstrated only correlation, not causation. Asked to speculate on the reason for the association, she said, “Just as exercise provides cardiovascular benefit by increasing blood flow, we think the same thing probably happens [with sexual function] because the penis is engorged with blood vessels.” She also suggested that exercise may improve sexual function as a psychological byproduct of improved feelings of well-being.

Men with moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

Source Courtesy Ken Trombatore

Major Finding: Exercise equivalent to 30 minutes of brisk walking per day, 4 days per week, is associated with a 65% decrease in the risk of sexual dysfunction.

Data Source: Study of 178 healthy men.

Disclosures: Dr. McNamara reported that she had no conflicts of interest. The study was supported by the Department of Defense and the Department of Veterans Affairs.

SAN FRANCISCO — Higher levels of exercise are associated with lower levels of sexual dysfunction, according to a study of 178 healthy men.

Men who reported exercise of at least 9 metabolic equivalents (METs) per week were 65% less likely to report sexual dysfunction. Brisk walking for 30 minutes a day for 4 days per week is equivalent to about 9 METs, according to Dr. Erin R. McNamara of Duke University Medical Center, Durham, N.C., who presented the results of her study at the meeting.

“If men won't exercise for the cardiovascular benefits, maybe they'll exercise to have better sex,” Dr. McNamara said at a news briefing.

The men in the study were all enrolled in a prospective case-control study at the Durham Veterans Affairs Medical Center. Their mean age was 62 years, and their mean body mass index was 30.7 kg/m

The sexual function survey consisted of six questions, asking men to evaluate their ability to have an erection, the quality and frequency of their erections, their ability to reach orgasm, their overall sexual ability, and the extent to which they were bothered by their sexual functioning. The investigators converted scores on the survey to a 0–100 scale. Overall, the participants' mean sexual function score was 53.

The men also were asked to assess their duration, intensity, and frequency of exercise. The investigators converted these estimates to MET hours per week. They classified men reporting fewer than 3 MET hours per week as sedentary (53% of the sample), 3–8 MET hours as active (14% of the sample), 9–17 MET hours as moderately active (9% of the sample), and 18 or more MET hours as highly active (24% of the sample).

Mean sexual function scores were 42 for sedentary men, 50 for active men, 72 for moderately active men, and 70 for highly active men. The trend was statistically significant.

In a multivariate analysis, the investigators controlled for age, race, BMI, heart disease, diabetes, medications, and depression. They defined a sexual function score of less than 40 as sexual dysfunction. Compared with sedentary men, those reporting moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

In an interview, Dr. McNamara emphasized that her study demonstrated only correlation, not causation. Asked to speculate on the reason for the association, she said, “Just as exercise provides cardiovascular benefit by increasing blood flow, we think the same thing probably happens [with sexual function] because the penis is engorged with blood vessels.” She also suggested that exercise may improve sexual function as a psychological byproduct of improved feelings of well-being.

Men with moderate or high levels of physical activity were 65% less likely to have sexual dysfunction.

Source Courtesy Ken Trombatore

SANTA MONICA, Calif. - Melasma is notoriously difficult to eliminate, but adding cosmeceuticals to the treatment can improve chemical peel results, according to Dr. Cherie M. Ditre.

"I use a combination of retinols, combinations of antioxidants such as green tea, along with hydroquinones," Dr. Ditre said in an interview at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

"Those three together are a powerhouse. And, occasionally, I'll add in alpha-hydroxy acids to actually help increase permeation through the skin."
The exact combinations depend on the procedure planned, said Dr. Ditre director of the University of Pennsylvania Health System's Skin Enhancement Center in Radnor.

If she is planning a chemical peel, for example, she has the patients "prepped first in the morning with an alpha-hydroxy acid cleanser starting at 10% and moving up. And then I also have them use hydroquinone at 4%. I can also titrate that in office to 6% or 8% depending on what they need. And then I go with an antioxidant such as green tea and a sunscreen."

She prefers sunscreens containing titanium dioxide and zinc oxide, and recommends Anthelios, which contains Mexoryl, and is a Food and Drug Administration-approved sun filter.

For the evening, Dr. Ditre instructs her chemical peel patients to use an alpha-hydroxy acid cleanser with a retinol that she titrates based on skin type and condition. She mixes that with an antioxidant such as green tea.

"I do that for a period of about 2 weeks prior to the chemical peel," she said. "The chemical peel that I'm presently using is a combination of a 1% retinol with 14% hydroquinone, and we leave it on as a masque for about 5-8 hours to wash off at home. And then, for the following 2 weeks, they use a regimen of a retinol and hydroquinone along with their sunscreen and a calming lotion," after which patients will return for follow-up.

Dr. Ditre said she has never seen an adverse reaction to green tea, which she described as "very gentle." Retinols are another story, however.

"Some of the retinols can approximate retinoic acid, so you have to be careful in very sensitive skin patients," she said. "I think that starting with the 2X [concentration] is better for sensitive skin patients. And that's why you do it as a prep prior to actually doing procedures, to make sure it's agreeable with them prior to doing a more invasive procedure."

Dr. Ditre reported having no disclosures. SDEF and this news organization are owned by Elsevier.

SANTA MONICA, Calif. - Melasma is notoriously difficult to eliminate, but adding cosmeceuticals to the treatment can improve chemical peel results, according to Dr. Cherie M. Ditre.

"I use a combination of retinols, combinations of antioxidants such as green tea, along with hydroquinones," Dr. Ditre said in an interview at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

"Those three together are a powerhouse. And, occasionally, I'll add in alpha-hydroxy acids to actually help increase permeation through the skin."
The exact combinations depend on the procedure planned, said Dr. Ditre director of the University of Pennsylvania Health System's Skin Enhancement Center in Radnor.

If she is planning a chemical peel, for example, she has the patients "prepped first in the morning with an alpha-hydroxy acid cleanser starting at 10% and moving up. And then I also have them use hydroquinone at 4%. I can also titrate that in office to 6% or 8% depending on what they need. And then I go with an antioxidant such as green tea and a sunscreen."

She prefers sunscreens containing titanium dioxide and zinc oxide, and recommends Anthelios, which contains Mexoryl, and is a Food and Drug Administration-approved sun filter.

For the evening, Dr. Ditre instructs her chemical peel patients to use an alpha-hydroxy acid cleanser with a retinol that she titrates based on skin type and condition. She mixes that with an antioxidant such as green tea.

"I do that for a period of about 2 weeks prior to the chemical peel," she said. "The chemical peel that I'm presently using is a combination of a 1% retinol with 14% hydroquinone, and we leave it on as a masque for about 5-8 hours to wash off at home. And then, for the following 2 weeks, they use a regimen of a retinol and hydroquinone along with their sunscreen and a calming lotion," after which patients will return for follow-up.

Dr. Ditre said she has never seen an adverse reaction to green tea, which she described as "very gentle." Retinols are another story, however.

"Some of the retinols can approximate retinoic acid, so you have to be careful in very sensitive skin patients," she said. "I think that starting with the 2X [concentration] is better for sensitive skin patients. And that's why you do it as a prep prior to actually doing procedures, to make sure it's agreeable with them prior to doing a more invasive procedure."

Dr. Ditre reported having no disclosures. SDEF and this news organization are owned by Elsevier.

SANTA MONICA, Calif. - Melasma is notoriously difficult to eliminate, but adding cosmeceuticals to the treatment can improve chemical peel results, according to Dr. Cherie M. Ditre.

"I use a combination of retinols, combinations of antioxidants such as green tea, along with hydroquinones," Dr. Ditre said in an interview at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

"Those three together are a powerhouse. And, occasionally, I'll add in alpha-hydroxy acids to actually help increase permeation through the skin."
The exact combinations depend on the procedure planned, said Dr. Ditre director of the University of Pennsylvania Health System's Skin Enhancement Center in Radnor.

If she is planning a chemical peel, for example, she has the patients "prepped first in the morning with an alpha-hydroxy acid cleanser starting at 10% and moving up. And then I also have them use hydroquinone at 4%. I can also titrate that in office to 6% or 8% depending on what they need. And then I go with an antioxidant such as green tea and a sunscreen."

She prefers sunscreens containing titanium dioxide and zinc oxide, and recommends Anthelios, which contains Mexoryl, and is a Food and Drug Administration-approved sun filter.

For the evening, Dr. Ditre instructs her chemical peel patients to use an alpha-hydroxy acid cleanser with a retinol that she titrates based on skin type and condition. She mixes that with an antioxidant such as green tea.

"I do that for a period of about 2 weeks prior to the chemical peel," she said. "The chemical peel that I'm presently using is a combination of a 1% retinol with 14% hydroquinone, and we leave it on as a masque for about 5-8 hours to wash off at home. And then, for the following 2 weeks, they use a regimen of a retinol and hydroquinone along with their sunscreen and a calming lotion," after which patients will return for follow-up.

Dr. Ditre said she has never seen an adverse reaction to green tea, which she described as "very gentle." Retinols are another story, however.

"Some of the retinols can approximate retinoic acid, so you have to be careful in very sensitive skin patients," she said. "I think that starting with the 2X [concentration] is better for sensitive skin patients. And that's why you do it as a prep prior to actually doing procedures, to make sure it's agreeable with them prior to doing a more invasive procedure."

Dr. Ditre reported having no disclosures. SDEF and this news organization are owned by Elsevier.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said she had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study among adolescents, Dr. Rebekah L. Williams said at the meeting.

The randomized crossover study involved 55 young women aged 14-20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy. Among the young women, 85% were African American and 20% said they had never had sex.

At baseline, the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations. At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation. At the end of another 3 months, they were again surveyed, and were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects. The experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

With two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects. “Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said. “The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

“I'm not 100% sure why we [saw] such a striking preference,” Dr. Williams said, noting that there were no reported differences in injection pain during the injection, immediately after the injection, or 7 days later.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said she had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study among adolescents, Dr. Rebekah L. Williams said at the meeting.

The randomized crossover study involved 55 young women aged 14-20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy. Among the young women, 85% were African American and 20% said they had never had sex.

At baseline, the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations. At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation. At the end of another 3 months, they were again surveyed, and were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects. The experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

With two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects. “Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said. “The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

“I'm not 100% sure why we [saw] such a striking preference,” Dr. Williams said, noting that there were no reported differences in injection pain during the injection, immediately after the injection, or 7 days later.

Major Finding: No significant differences were found in physical or sexual side effects in adolescents taking DMPA-IM and DMPA-SC.

Data Source: Randomized crossover trial of 55 adolescents.

Disclosures: The study was supported by the National Institutes of Health, the Health Resources and Services Administration, and the Indiana Clinical and Translational Sciences Institute. Dr. Williams said she had no conflicts of interest.

LAS VEGAS — The intramuscular and subcutaneous formulations of depot medroxyprogesterone acetate seem to have similar side effect profiles in adolescents, according to a randomized crossover study.

Although the side effects of the two formulations (DMPA-IM and DMPA-SC) have been studied in adult women, this is the first study among adolescents, Dr. Rebekah L. Williams said at the meeting.

The randomized crossover study involved 55 young women aged 14-20 years, with a mean of 16.5 years. All participants were either initiating or restarting DMPA therapy. Among the young women, 85% were African American and 20% said they had never had sex.

At baseline, the participants completed surveys about their expectations regarding the side effects, and they were randomized to receive one of the two formulations. At the end of 3 months, participants answered questions about side effects, and then they were given the other formulation. At the end of another 3 months, they were again surveyed, and were permitted to choose which formulation they preferred for a third injection. Thirty-eight of the women completed surveys at all three visits.

The investigators found no significant differences between the two formulations in participants' expectations or experience of physical or sexual side effects. The experience of side effects was not significantly related to expectations of side effects, participants' level of general worry, or their level of general concern about birth control side effects.

With two exceptions, there was no difference in the expectation or experience of side effects between the participants' first and second injections, no matter in which order they received them.

The two exceptions were amenorrhea and irregular bleeding. During the first dose, 10.5% of the participants had amenorrhea, and this increased significantly to 31.6% at the second dose. In contrast, the proportion of women reporting irregular bleeding declined significantly from 26.3% at dose one to 7.9% at dose two.

Dr. Williams of Indiana University, Indianapolis, noticed a mismatch between expectations and experience for sexual side effects. “Over one-third of our sample experienced some change in sexual interest, and one-quarter experienced changes in lubrication during sex,” she said. “The striking difference between expectations between physical and sexual side effects may reflect our clinical practice, in that physical side effects are emphasized during contraceptive counseling but sexual side effects may be relatively neglected.

“Clinical counseling should include both physical and sexual side effects, both of which have the potential to significantly impact young women's contraceptive use in the long run.”

One difference between the intramuscular and subcutaneous formulations emerged when the women were allowed to choose which one they would receive at the third visit. Of the 38 women who made it to that visit, 26 chose a subcutaneous injection, 9 chose an intramuscular injection, and 3 chose to discontinue DMPA.

“I'm not 100% sure why we [saw] such a striking preference,” Dr. Williams said, noting that there were no reported differences in injection pain during the injection, immediately after the injection, or 7 days later.