Wednesday, February 19
9 a.m. to 5 p.m.--Clinical Preventive Medicine--Women's Health
Heart Disease in Women--The following points will be among those presented: Approximately one-third of postmenopausal women will have a heart attack or die from coronary heart disease (CHD) during their remaining lifetime. The extent of sub-clinical atherosclerosis, as measured by coronary calcium, carotid artery wall thickness, and ankle-brachial blood pressure, are strong predictors of the risk of heart attack and stroke in postmenopausal women. Prevention of CHD in women is possible by both non-pharmacologic and pharmacologic measures. Physicians often prescribe statins, blood pressure lowering compounds, ACE inhibitors, and aspirin. The risk of stroke is almost as high in women as that of heart attack. Stroke prevention measures can include aggressive antihypertension drug therapy and aspirin prophylaxis. In addition, these approaches can play an important role in reducing disability in women. For example, using measures to prevent vascular disease can play a role in reducing dementia in women. Finally, the presentation will involve a discussion about the lack of emphasis by many physicians on preventing cardiovascular risk factors in women.
Presenter: Lewis Kuller, M.D., University of Pittsburgh
Sarcopenia and Frailty in Older Women--As women age, they begin to lose significant amounts of muscle mass, a deterioration that physicians call sarcopenia. Although women have a survival advantage over men, as they grow older they are at greater risk of being disabled. Throughout life, women have a very different distribution of lean and fat mass than do men, including a higher proportion of fat, lower lean mass and bone mass, and different proportion of visceral fat. Aging, with important changes in body composition, can contribute to a great degree of disability in women. Changes due to aging include the loss of muscle mass and bone mass, and a shift to a higher proportion of visceral fat. The role of changes in the development of preclinical disability and frailty will be discussed.
Presenter: Ann B. Newman, M.D., M.P.H., University of Pittsburgh
Other Presenters: Elizabeth Barrett-Connor, M.D., University of California, San Diego, School of Medicine, and Robert Wallace, M.D. University of Iowa.
9 a.m. to 5 p.m.--Public Health Practice--Emergency Preparedness
This session is designed to increase understanding of what to expect and how to respond to different types of terrorism: chemical, biological, radiological, and mass casualty forms. The roles of Federal, state, and local health and response workers will be examined. The first terror scenario to be investigated is the situation created by "Sarin Gas in a Japanese Subway." Another case-based scenario will be featured between 1:30 p.m. and 4:30 p.m.. Among the aspects to be explored are the Health Alert Network, the National Pharmaceutical Stockpile, and the Federal Response Plan. Presentations will be made by representatives from the Centers for Disease Control and Prevention (CDC), the Center for Occupational and Environmental Health, the New York City Health Department, and the California Emergency Medical Services Authority.
Thursday, February 20
1:30 p.m. – 3:30 p.m.--Concurrent Session 2, No. 3--STD's: New Research, New Guidelines
In the "Sexually-Transmitted Treatment Guidelines 2002," the following points are among the new recommendations to be discussed at this session:
- All women with chlamydial infections should be rescreened three to four months after treatment is completed.
- The guidelines warn doctors that fluoroqinolone-resistant strains of gonorrhea have become so common on the West Coast that use of this agent to treat this disease is inadvisable in California.
- Recent data have shown a higher frequency of unprotected sex, as well as increased rates of syphilis and gonorrhea, among men who have sex with men. Many of these individuals are also HIV-infected. The new guidelines urge health care providers to asses the risk of those diseases for all male patients, including discovering the gender of their partners. For men who are sexually active with other men, the guidelines recommend annual screening for STDs, including HIV, chlamydia (anal and urethral), syphilis, and gonorrhea (anal, pharyngeal, and urethral). Doctors are also advised to vaccinate these patients against hepatitis A and B.
- New tests are available to help health care providers diagnose and manage genital herpes types one and two. Since antiviral therapy may benefit individuals with herpes symptoms, health care providers should become aware of the patient's viral serotype in order to tailor treatment plans and counseling to that person's individual needs.
Presenters: Stuart Berman, M.D., Sc.M., Division of STD Prevention, CDC
Gail Bolan, M.D., STD Branch, California Department of Health Services
Moderator: Diane Simpson, CDC
Other Presenter: Jeanne Marrazzo, M.D., University of Washington
Friday, February 21
11:30 a.m. – 1 p.m.--Concurrent Session 5, No. 2--Postmenopausal Revelations: Findings from the WHI and "What's in Store," including RUTH and MORE
Findings from the "Women's Health Initiative –Estrogen Plus Progestin Trial
The treatment phase of the hormone therapy trial (estrogen plus progestin) was halted in July 2002, approximately three years early, on the recommendation of the Data Safety and Monitoring Board of the Women's Health Initiative (WHI). Despite overwhelming observational evidence suggesting that the therapy reduces the incidence of coronary heart disease (CHD), the combination therapy did not demonstrate that benefit after 5.2 years of average follow-up. The trial enrolled women between the ages of 50 to 79 years and achieved an ethnic distribution that closely mirrors the age-specific distribution in the U.S. population. The trial tested the most commonly prescribed hormone combination in the U.S., on women with a uterus, in contrast to a placebo. The trial was halted because the trend for invasive breast cancer exceeded the pre-set stopping point. However, the WHI continues. It is testing estrogen only, versus placebo, in women with a prior hysterectomy. This trial has not demonstrated similar harm and is continuing. From a public health perspective, the WHI results do not support the use of estrogen plus progestin for the prevention of major chronic diseases in postmenopausal women.
Presenter: Robert Langer, M.D., UCSD School of Medicine
Moderator: Dorothy S. Lane, M.D., State University of New York, Stony Brook
Other Presenter: Elizabeth Barrett-Connor, UCSD School of Medicine
Sunday, February 23, 2003
8 a.m. – 9:30 a.m.--Plenary Session IV--Fixing What's Broke: How Can We Improve Preventive Coverage Care in Medicare?
When Congress created Medicare in 1965, it did not provide for coverage of clinical preventive services: screening tests for early detection (mammography); immunization (flu shot); and counseling to reduce unhealthy behaviors (smoking cessation). This oversight meant that Congress had to pass a separate law each time that a preventive service was to be covered by Medicare. Since 1965, Congress has decreed that preventive care be covered for 10 conditions; however, several important, well-proven preventive services remain uncovered for America's seniors and for its disabled population.
This session, based on three papers commissioned by Partnership for Prevention, will discuss the problem in depth:
- Background on historical and current policy issues in establishing Medicare coverage.
Presenter: Gil Omenn, M.D., University of Michigan - The options for changing current Medicare preventive care coverage policy.
Presenter: Douglas Kamerow, M.D., RTI International - Discussion of the current use of preventive care in Medicare and how it can be increased
Presenter: Jonathan Fielding, M.D., LA County Department of Health Services - Issues from the perspective of Congress, and likely future Medicare reforms
Presenter: Dean Rosen, Senate Subcommittee on Public Health
10 a.m. – 11:30 a.m.--Concurrent Session 9, No. 1--Physical Activity: What Is the Appropriate Dose?
Lack of regular physical activity is now well-established as one of the important causes of coronary heart disease, type 2 diabetes, colon cancer, loss of functional capacity, and other health problems. Also, there is a substantial body of data directed at the effects of physical activity on other health risk factors such as overweight, lipid profile, blood pressure, and carbohydrate metabolism. Clinicians, as well as the general public, often consider the primary value of physical activity to be the control of such risk factors. However, it is important for physicians to give attention to the physical activity levels of their patients as a way of maintaining health and preventing disease. They should ask their patients about exercise and give them a strong message about the importance of becoming active. Other health care professionals can provide more specific advice and counseling about individual activities. Among other points, the presenters will note that fit individuals with another risk factor often have lower mortality rates than do unfit individuals without such a risk predictor.
Presenters: Alan Oberman, M.D., University of Alabama at Birmingham
Steven Blair, M.D., The Cooper Institute
SUMMARY OF PREVENTIVE MEDICINE 2003 KEYNOTE ADDRESS
To Be Presented on Wednesday, February 19, 2003 at 5:30 p.m.
Presenter: John Seffrin, Ph.D.
CEO, American Cancer Society (ACS)
Title: Seizing Collaborative Opportunities With the Primary Care Community To Advance the Fight Against Cancer
Approximately 70 percent of cancers in the United States can be avoided if Americans adopt healthier lifestyles. This percentage is based on the following estimates:
- 30 percent of cancers are related to tobacco use.
- 30 percent of cancers are related to nutrition and a lack of physical activity.
- 10 percent of cancers are related to sun exposure and unsafe sexual practices.
In addition, regular screening examinations by a healthcare professional can result in detection of cancers of the breast, colon, rectum, cervix, prostate, testis, oral cavity, and skin at early stages when treatment is more likely to be successful. Currently, the five-year relative survival rate for these cancers is approximately 82 percent. If all cases of these cancers were diagnosed when they were localized, the five-year survival rate would increase to approximately 95 percent.
Through the adoption of healthier lifestyles and a greater utilization of regular screening examinations, the American Cancer Society hopes to play a major role in the achievement of three established ACS challenge goals for the United States by 2015:
- Reduce the overall age-adjusted cancer mortality rate by 50 percent.
- Reduce the overall age-adjusted cancer incidence rate by 25 percent.
- Improve the quality of life for all cancer survivors.
The active support of primary care physicians will be necessary to achieve these goals.
This will involve primary care physicians delivering high-quality care in a managed care environment in order to implement effective cancer control and prevention interventions. To accomplish this objective, untapped collaborative opportunities must be pursued.
Therefore, strengthening relationships with the primary care community and promoting greater access to evidence-based medicine are top priorities in the American Cancer Society's efforts to advance the fight against cancer and significantly reduce the burden of this disease on the American society.
Preventive Medicine 2003
American College of Preventive Medicine Annual Meeting
February 19 – 23, 2003
Paradise Point Resort
San Diego, California
Contact: Bill Glitz (703) 532-3797/Jim Augustine (703) 644-6824
From February 19 to 23, please contact us at the meeting press room by calling
The Paradise Point Resort at (858) 274-4630 and asking for The Boardroom