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    <recommendedItem id="20100101_19_463"
                     title="AAPM: Online Program Helps Manage Pain (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18393?impressionId=1265783971053"
                     
      &lt;p&gt;SAN ANTONIO  --  A personalized, online self-management program helped patients with pain syndromes improve coping skills and reduce stress and depression in two studies reported here.&lt;/p&gt;
&lt;p&gt;Patients randomized to the self-management program demonstrated significant improvement in multiple social, emotional, and behavioral outcomes after six months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01). Improvement in some parameters occurred within one month. A control group that was not exposed to the program showed no significant improvement.&lt;/p&gt;
&lt;p&gt;&quot;Our goal is to help people communicate better with providers, understand better how they can use social support, understand the comorbid conditions, like anxiety and depression, and develop cognitive skills to help get them through their pain episodes,&quot; said Emil Chiauzzi, PhD, of Inflexxion, the Newton, Mass. company that developed the program.&lt;/p&gt;
&lt;p&gt;Although the studies involved patients with migraine or low-back pain, programs are being developed for other types of pain condition, including several forms of neuropathic pain.&lt;/p&gt;
&lt;p&gt;The online program, demonstrated at &lt;a href=&quot;http://www.painACTION.com&quot; mce_href=&quot;http://www.painACTION.com&quot; target=&quot;_blank&quot;&gt;www.painACTION.com&lt;/a&gt;, employs patient-specific information to generate individualized self-management strategies.&lt;/p&gt;
&lt;p&gt;Patient responses to assessments are analyzed by a &quot;recommendation engine,&quot; which produces content recommendations designed to address each patient&apos;s informational and self-management needs.&lt;/p&gt;
&lt;p&gt;Elements on the Web site include multimedia education units, a pain inventory, interactive tools that provide information based on patient-provider communication, and medication risk management.&lt;/p&gt;
&lt;p&gt;&quot;The content on the Web site is focused on teaching people practical skills to manage the behavioral side of pain,&quot; Jonas Bromberg, PsyD, also of Inflexxion, said in an interview.&lt;/p&gt;
&lt;p&gt;Bromberg presented results of a randomized study involving 210 patients, all of whom met International Headache Society diagnostic criteria for migraine, with or without aura.&lt;/p&gt;
&lt;p&gt;Patients assigned to the online program completed at least eight 30-minute session during the first month of the study and at least five more 30-minute sessions during the five-month follow-up period. Patients in the control group continued to receive usual care without exposure to the Web site.&lt;/p&gt;
&lt;p&gt;Participants assigned to the online program had a minimum set of requirements for each session, which were provided at log-in. Follow-up assessments occurred at one, three, and six months.&lt;/p&gt;
&lt;p&gt;The two groups were balanced with respect to sex and headache frequency and severity, the researchers said.&lt;/p&gt;
&lt;p&gt;Bromberg reported that patients assigned to the self-management program demonstrated significant improvement in: &lt;ul&gt; &lt;li&gt;Headache self-efficacy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 compared with baseline)&lt;/li&gt; &lt;li&gt;Use of relaxation (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Use of social support (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Pain catastrophizing (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Depression (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Chiauzzi presented results from a randomized study of 209 patients with low-back pain. The design was similar to that of the migraine study, except results were analyzed for between-group differences.&lt;/p&gt;
&lt;p&gt;The results showed significant improvement in the study group versus control group with respect to: &lt;ul&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Coping (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Social supports (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The data showed significant effects of both treatment (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) and time (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) favoring the Web site versus control. Chiauzzi said patients assigned to the Web site had greater mean improvement at posttest, three months, and six months.&lt;/p&gt;
&lt;p&gt;Qualitative analysis suggested that Web site participants had clinically meaningful improvement in depression, anxiety, and stress.&lt;/p&gt;
&lt;p&gt;Additionally, patients in the self-management program reported a 12.3% decrease in pain from baseline, versus 7% in the control group.&lt;/p&gt;
&lt;p&gt;Access to the Web site did not improve physical functioning.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The studies were funded by the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Chiauzzi and Bromberg are employees of Inflexxion, developer of the online program.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_233"
                     title="Obese Blacks at Higher Risk of Stroke (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/Neurology/Strokes/tb/18083?impressionId=1265783971053"
                     
      &lt;p&gt;Obesity raises the risk of stroke regardless of race or sex, according to a new study that is one of the first to show a link between obesity and stroke risk in blacks.&lt;/p&gt;
&lt;p&gt;The most obese black women were at 43% higher risk of stroke than the thinnest black women (95% CI 0.81 to 2.53; trend &lt;em&gt;P&lt;/em&gt;=0.016), while the fattest black men had more than three times the stroke risk of their thin counterparts (95% CI 1.53 to 6.67; trend &lt;em&gt;P&lt;/em&gt;=0.0026), depending on the measure of obesity used, researchers reported online Jan. 21 in &lt;em&gt;Stroke&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Based on the fact that we consistently found positive associations between obesity measures and ischemic stroke incidence in blacks in the present study, we believe that obesity, however it is measured, significantly increases ischemic stroke risk in blacks as well as in whites,&quot; Hiroshi Yatsuya, MD, of the University of Minnesota, and colleagues concluded.&lt;/p&gt;
&lt;p&gt;Stroke is the third leading cause of death in the U.S., and incidence of stroke among blacks is about twice that of whites. But while research has established that being overweight raises risk of stroke in whites, it was not clear whether obesity put blacks at higher risk of stroke, too.&lt;/p&gt;
&lt;p&gt;&quot;We tested the hypothesis that there are differences in the association for black versus white men and women,&quot; Yatsuya and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The researchers analyzed records of 13,549 middle-age black and white men and women in four U.S. communities who participated in the Atherosclerosis Risk in Communities Study (ARIC).&lt;/p&gt;
&lt;p&gt;The data included measurements of the subjects&apos; body mass index (BMI), waist circumference, and waist-to-hip ratio taken between 1987 and 2005. The participants started the study free of cancer and cardiovascular disease, but during the two decades of the study, 598 suffered ischemic strokes, based on hospital records.&lt;/p&gt;
&lt;p&gt;Relatively speaking, blacks suffered two to three times the number of strokes of their white counterparts.&lt;/p&gt;
&lt;p&gt;The thinnest white women suffered about 1.2 strokes per 1,000 person-years on average, while their black counterparts suffered 4.3 per 1,000 person-years. The difference was more dramatic when comparing the heaviest white women (2.2 strokes per 1,000 person years) with the heavy black men (8.0 strokes&lt;strong&gt; &lt;/strong&gt;per 1,000 person years).&lt;/p&gt;
&lt;p&gt;While their findings agreed with previous research that linked obesity to stroke risk in whites, Yatsuya and colleagues found stronger evidence than most previous studies for such an association in blacks.&lt;/p&gt;
&lt;p&gt;They generally found a linear relationship between obesity and stroke risk for both whites and blacks, with a person&apos;s risk increasing as they grew heavier. &quot;Higher disease burden of stroke in blacks exists, and is at least partly due to their higher obesity level compared to whites,&quot; Yatsuya said.&lt;/p&gt;
&lt;p&gt;Hypertension and diabetes attenuated the effect of obesity on the risk of stroke.&lt;/p&gt;
&lt;p&gt;&quot;Given the strong association between obesity and hypertension and other risk factors, including diabetes mellitus, obesity would be an important target for the prevention of ischemic stroke,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;The authors noted that most of the black subjects were from one region and the whites mostly from three other areas, which limits the ability to generalize the results to other settings and socioeconomic groups.&lt;/p&gt;
&lt;p&gt;&quot;Strictly speaking, clinical trials are now needed to determine whether obesity prevention or control would actually decrease stroke incidence,&quot; Yatsuya said. &quot;However, it would be reasonable to say we can prevent stroke targeting at obesity control and prevention.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Heart, Lung, and Blood Institute.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1570"
                     title="APA: Depression Linked to Obesity Mainly in Women"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/APA/tb/14292?impressionId=1265783971053"
                     
      SAN FRANCISCO, May 20 -- Depression may be more closely associated with obesity in women than in men, researchers found.
              &lt;br&gt; 
              &lt;br&gt;Overall, obese women were 3.9 times more likely to be depressed than normal weight women (&lt;em&gt;P&lt;/em&gt;=0.04), Tuan-Anh Nguyen, M.D., M.P.H., of Maricopa Integrated Health System in Phoenix, Ariz., reported here at the American Psychiatric Association meeting.
              &lt;br&gt; 
              &lt;br&gt;But obese men were only 2.54 times as likely to be depressed as their normal weight counterparts, a difference that was not significant (&lt;em&gt;P&lt;/em&gt;=0.84), according to an analysis of data from the National Health and Nutrition Examination Survey (NHANES).
              &lt;br&gt; 
              &lt;br&gt;The researchers defined obesity as a Body Mass Index (BMI) of 30 to 39 and morbid obesity as a BMI of 40 or higher.
              &lt;p&gt; 
              &lt;p&gt;While the cross-sectional data could provide no explanation for the gender difference, Dr. Nguyen speculated that women might suffer more from the social pressure to be beautiful.
              &lt;p&gt; 
              &lt;p&gt;However, a biological explanation may be just as likely, commented Julio Licinio, M.D., of the University of Miami and a program committee member at the conference.
              &lt;p&gt; 
              &lt;p&gt;&quot;Depression tends to be a disease predominantly of women -- the ratio of women to men is 2:1,&quot; he said. Studies like this are fueling discussion over whether depression has very different features in men than in women, he said.    
              &lt;p&gt; 
              &lt;p&gt;The results also give primary care physicians an extra impetus to screen for depression in obese women, &quot;so we can provide treatment appropriately and as soon as possible,&quot; Dr. Nguyen said. 
              &lt;p&gt; 
              &lt;p&gt;However, because the risk of depression rose with obesity severity (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), Dr. Nguyen suggested that screening is still warranted for morbidly obese men.
              &lt;p&gt; 
              &lt;p&gt;She and co-author Stephanie Riolo, M.D., of Wright State University in Dayton, Ohio, analyzed data from the 2004 to 2005 iteration of NHANES, which included a single measurement of body mass index and mental health in a nationally representative sample.
              &lt;p&gt; 
              &lt;p&gt;To minimize confounding from medical disability, the researchers limited their analysis to the 4,627 participants age 15 to 40.
              &lt;p&gt; 
              &lt;p&gt;As BMI category rose, the relative prevalence of major depressive disorder increased as well, an effect that was significant among women (&lt;em&gt;P&lt;/em&gt;=0.002) but not among men (&lt;em&gt;P&lt;/em&gt;=NS).
              &lt;p&gt; 
              &lt;p&gt;The association in women remained significant after controlling for race, education, poverty, and marital status (&lt;em&gt;P&lt;/em&gt;=0.04).
              &lt;p&gt; 
              &lt;p&gt;But the association with major depressive disorder was seen only with BMI categories, and not when BMI was treated as a continuous variable.
              &lt;p&gt; 
              &lt;p&gt;&quot;This is because the association between BMI and depression is not linear,&quot; the researchers said. &quot;The risk of depression in overweight individuals depends on the type of obesity.&quot;
              &lt;p&gt; 
              &lt;p&gt;Other factors in the risk of major depressive disorder included:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;Education in men (OR 2.14, &lt;em&gt;P&lt;/em&gt;=0.02) but not in women
                &lt;li&gt;Poverty in both men (OR 11.44, &lt;em&gt;P&lt;/em&gt;=0.01) and women (OR 45.62, &lt;em&gt;P&lt;/em&gt;=0.01)
                &lt;li&gt;Being divorced or separated for both men (OR 1.42, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) and women (OR 1.44, &lt;em&gt;P&lt;/em&gt;=0.02)
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;Dr. Nguyen noted that earlier, smaller studies found conflicting evidence on the connection between depression and obesity.
              &lt;p&gt; 
              &lt;p&gt;She cautioned that the survey provided only a single snapshot of participants, without any indication of causality.
              &lt;p&gt; 
              &lt;p&gt;&quot;Further investigation is needed to determine whether gender is a mediator in the association between obesity and major depressive disorder or simply a confounding variable,&quot; Drs. Nguyen and Riolo concluded.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Nguyen reported no conflicts of interest. Dr. Licinio reported no conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
    <recommendedItem id="20090101_1_499"
                     title="ACR: Moderate Weight Loss Eases Knee Pain"
                     score="-0.006"
                     href="