Extracardiac findings in cardiac computed tomographic angiography in patients at low to intermediate risk for coronary artery disease.

PURPOSE: To evaluate the prevalence, clinical significance, interobserver agreement, and follow-up of extracardiac findings on coronary computed tomographic angiography (CTA). METHODS: A prospectively recruited cohort of 80 patients at low to intermediate risk of having coronary artery disease underwent CTA with field of view imaging from lung apices to upper abdomen. Two staff radiologists read each scan independently. Scans read by reader no. 1 were read as part of routine clinical practice, and the findings were subsequently reclassified to potentially significant, as defined by requiring clinical or radiologic follow-up, and insignificant by a separate observer, whereas reader no. 2 retrospectively read and autonomously classified the findings as potentially significant or insignificant. RESULTS: Reader no. 1 found 7 potentially significant findings in 7 patients and 33 insignificant findings in 29 patients. Reader no. 2 found 10 potentially significant findings in 10 patients and 59 insignificant findings in 42 patients. Inter-rater agreement was moderate (kappa = 0.49; 95% confidence interval, 0.31-0.67) for the presence vs the absence of extracardiac findings and moderate (kappa = 0.52; 95% confidence interval, 0.15-0.89) for the presence of potentially significant extracardiac findings. The most common potentially significant finding was possibly malignant lung nodule (n = 6 [reader 1], 4 [reader 2]). Four patients with potentially significant findings received follow-up imaging, and 1 patient underwent biopsy, which was complicated by pneumothorax. No diagnoses of malignancy were made. CONCLUSIONS: Extracardiac findings are frequent and moderately reproducible, however, in this study, not associated with clinical benefit. Large prospective studies are required to establish whether reporting of extracardiac findings is associated with improved patient outcomes.

Public and private providers' involvement in improving their patients' contraceptive use.

BACKGROUND: This study measured differences in the provision of care between public and private providers of contraceptive services, what problems using contraception these providers perceived their patients to have and providers' views on how to improve their patients' method use. STUDY DESIGN: A nationally representative mixed-mode survey (mail, Internet and fax) of private family practice and obstetrician/gynecologist physicians who provided contraceptive care in 2005 was conducted. A parallel survey was administered to public contraceptive care providers in community health centers, hospitals, Planned Parenthood clinics and other sites during the same period. Descriptive and multivariate analyses were conducted across both surveys. RESULTS: A total of 1256 questionnaires were completed for a response rate of 62%. A majority of providers surveyed believed that over 10% of their contraceptive clients experienced ambivalence about avoiding pregnancy, underestimated the risk of pregnancy and failed to use contraception for one or more months when at risk for unintended pregnancy. Implementation of protocols to promote contraceptive use ranged widely among provider types: a full 78% of Panned Parenthood clinics offered quick-start pill initiation, as did 47% of public health departments. However, 38% of obstetrician-gynecologists, 27% of "other public" clinics and only 13% of family physicians did so. Both public and private providers reported that one of the most important things they could do to improve patients' contraceptive method use was to provide more and better counseling. At least 46% of private providers and at least 21% of public providers reported that changing insurance reimbursement to allow more time for counseling was very important. CONCLUSIONS: Strategies to improve contraceptive use for all persons in need in the United States have the potential to be more effective if the challenges contraceptive providers face and the differences between public and private providers are taken into account.

Factors associated with the content of sex education in U.S. public secondary schools.

CONTEXT: While sex education is almost universal in U.S. schools, its content varies considerably. Topics such as abstinence, and basic information on HIV and other sexually transmitted diseases (STDs), are commonly taught; birth control and how to access STD and contraceptive services are taught less often. Factors potentially associated with these variations need to be examined. METHODS: Data on 1,657 respondents to a 1999 national survey of teachers providing sex education in grades 7-12 were assessed for variation in topics covered. Logistic regression was used to ascertain factors associated with instruction on selected topics. RESULTS: The content of sex education varied by region and by instructors' approach to teaching about abstinence and contraception. For example, teaching abstinence as the only means of pregnancy and STD prevention was more common in the South than in the Northeast (30% vs. 17%). Emphasizing the ineffectiveness of contraceptives was less common in the Northeast (17%) than in other regions (27-32%). Instructors teaching that methods are ineffective and presenting abstinence as teenagers' only option had significantly reduced odds of teaching various skills and topics (odds ratios, 0.1-0.5). CONCLUSIONS: Instructors' approach to teaching about methods is a very powerful indicator of the content of sex education. Given the well-documented relationship between what teenagers learn about safer sexual behavior and their use of methods when they initiate sexual activity, sex education in all U.S. high schools should include accurate information about condoms and other contraceptives.