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    <recommendedItem id="20100101_19_463"
                     title="AAPM: Online Program Helps Manage Pain (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18393?impressionId=1265797798213"
                     
      &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_101"
                     title="Exercise May Aid Cognitive Function (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PrimaryCare/ExerciseFitness/tb/17907?impressionId=1265797798213"
                     
      &lt;p&gt;Almost any amount of moderate physical activity in mid- or late life reduced the odds of mild cognitive impairment by 30% to 40% in an ongoing cohort study, researchers reported.&lt;/p&gt;
&lt;p&gt;Men and women derived similar benefit, which was limited to moderate exercise  --  not light or vigorous physical activity, investigators wrote in the January &lt;em&gt;Archives of Neurology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Our findings contribute to the growing body of literature that indicates the potentially beneficial relationship between physical exercise and cognition,&quot; Yonas E. Geda, MD, of the Mayo Clinic in Rochester, Minn., and colleagues concluded. &quot;A future population-based cohort study is needed to confirm whether physical exercise is associated with decreased risk of incident mild cognitive impairment.&quot;&lt;/p&gt;
&lt;p&gt;Meanwhile, a small, separate interventional study described in the same journal showed that six months of high-intensity aerobic exercise was associated with significant improvement in executive function in older women at increased risk of cognitive decline, but not in older men.&lt;/p&gt;
&lt;p&gt;Mild cognitive impairment confers a five- to 10-fold increased risk of dementia compared with normal cognition. Observational studies have shown that physical activity may protect against dementia and Alzheimer&apos;s disease, and some evidence suggests that exercise for individuals with mild cognitive impairment offers some protection, too, the authors wrote.&lt;/p&gt;
&lt;p&gt;Geda and colleagues continued exploration of the association between physical activity and cognitive impairment with an evaluation of the effect of physical activity in midlife, approximately the age of onset for mild cognitive impairment. Data for the study came from the Mayo Clinic Study of Aging.&lt;/p&gt;
&lt;p&gt;The study included 1,324 participants who completed a standardized questionnaire about physical activity. Their median age was about 80, and none of the participants exhibited signs of dementia at baseline.&lt;/p&gt;
&lt;p&gt;Investigators assessed the frequency and intensity of physical activity as reported by each participant. &lt;ul&gt; &lt;li&gt;Light exercise: bowling, leisurely walking, stretching, slow dancing, and golfing using a cart.&lt;/li&gt; &lt;li&gt;Moderate exercise: brisk walking, hiking, aerobics, strength training, swimming, tennis doubles, yoga, martial arts, weight lifting, moderate use of exercise machines, and golfing without use of a cart.&lt;/li&gt; &lt;li&gt;Vigorous exercise: jogging, backpacking, bicycling uphill, tennis singles, racquetball, skiing, and intense or extended use of exercise machines.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The neuropsychologic evaluation consisted of nine tests that assessed memory, executive function, language, and visuospatial skills.&lt;/p&gt;
&lt;p&gt;A consensus panel classified each participant as having normal cognition (N=1,126) or mild cognitive impairment (N=198). The two groups differed significantly in several respects. Participants with mild cognitive impairment were more likely to be men, older, less educated, more likely to be depressed, and had more comorbidity (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 to &lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;Any frequency of moderately intense activity in midlife (ages 50 to 65) was associated with an odds ratio of 0.61 for mild cognitive impairment (95% CI 0.43 to 0.88, &lt;em&gt;P&lt;/em&gt;=0.008). Moderate activity in later life was associated with an odds ratio of 0.68 (95% CI 0.49 to 0.93, &lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;More or less intense activity of any frequency or duration did not significantly affect the odds ratio for mild cognitive impairment.&lt;/p&gt;
&lt;p&gt;The authors noted several limitations of the study, including a cross-sectional design than could not assess causality, self-reported physical exercise data and relatively few subjects engaged in vigorous exercise in late life, which limited statistical power for that analysis.&lt;/p&gt;
&lt;p&gt;A prospective evaluation of high-intensity aerobic exercise for patients with existing mild cognitive impairment showed that women had improved executive function, but men did not.&lt;/p&gt;
&lt;p&gt;The study involved 17 women and 16 men ages 55 to 85. All had mild cognitive impairment by standardized assessment criteria, and all reported sedentary lifestyles at enrollment, Laura D. Baker, PhD, of the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues reported.&lt;/p&gt;
&lt;p&gt;Participants were randomized 2:1 to aerobic exercise or stretching activity (control) and followed for six months. Both groups engaged in their assigned, supervised activities four times a week for 45 to 60 minutes at each session.&lt;/p&gt;
&lt;p&gt;After two weeks, activity was supervised once a week. Participants assigned to aerobic exercise increased the duration and intensity of exercise over the first six weeks until they reached 75% to 85% of heart rate reserve, a level maintained for the remainder of the study.&lt;/p&gt;
&lt;p&gt;Cognitive function was assessed at baseline and after three and six months of follow-up, as were physical status and laboratory values.&lt;/p&gt;
&lt;p&gt;The results showed overall improvement in executive function among aerobic exercisers (&lt;em&gt;P&lt;/em&gt;=0.04). Including gender as a predictive variable in the statistical model revealed significant interaction, reflecting a difference in response to the intervention for men and women (&lt;em&gt;P&lt;/em&gt;=0.04).&lt;/p&gt;
&lt;p&gt;Aerobic exercise increased glucose disposal, and reduced fasting plasma levels of insulin, cortisol, and brain-derived neurotrophic factor in women, the researchers reported. Among men, aerobic exercise increased plasma levels of insulin-like growth factor I.&lt;/p&gt;
&lt;p&gt;Women on aerobic exercise demonstrated improvement in all four assessments of executive function, while men showed improvement in only one test.&lt;/p&gt;
&lt;p&gt;&quot;Aerobic exercise is a cost-effective practice that is associated with numerous physical benefits,&quot; the authors concluded. &quot;The results of this study suggest that exercise also provides a cognitive benefit from some adults with mild cognitive impairment.&quot;&lt;/p&gt;
&lt;p&gt;They also noted several limitations, including small sample size, exclusion of a number of subjects for medical reasons, and the fact that &quot;the demands of the aerobic intervention are suited for a controlled trial, but may not be well-tolerated in less structured, less supervised population-based studies.&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;David S. Knopman, coauthor of the st&lt;em&gt;u&lt;/em&gt;dy by Geda et al, disclosed relationships with Eli Lilly, Baxter Pharmaceuticals, Elan Pharmaceuticals, Forext Pharmaceuticals, and GlaxoSmithKline.&lt;/p&gt;&lt;p&gt;Authors of the study by Bakere et al had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
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                     title="Drug Side Effects Can Befuddle Elderly Brains"
                     score="-0.005"
                     href="