In This Issue of Archives of Internal Medicine FREE

The quality of communication between African American patients and white health care providers has been shown to be poorer than race-concordant patient-provider communication. In a randomized study, Havranek et al assessed the effect of a values-affirmation intervention shown to reduce the impact of stereotype threat. Analyzing audio recordings of visits, the authors found that patients performing a values-affirmation exercise before the visit requested and provided more information about their medical condition. Patient-provider communication in the intervention group was characterized as being more interested, friendly, responsive, interactive, and respectful and less depressed and distressed.

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Debate exists regarding the relative potency of medications beyond their labeled expiration dates. Cantrell et al analyzed 14 active ingredients found in 8 different prescription medications, which had been stored for a minimum of 25 years (range, 25-40 years) in their original, sealed containers. The authors found that 12 of the 14 drugs tested (86%) were present in concentrations of at least 90% of the labeled amounts. Given that recent studies have demonstrated significant cost savings from lengthening drug expiration dates, we suggest that the current practices of drug expiration dating be reconsidered.

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In 2002, a smoke-free restaurant ordinance was implemented in Olmsted County, Minnesota, and in 2007, all workplaces including bars became smoke free. Hurt et al measured, through the Rochester Epidemiology Project, the incidence of myocardial infarction (MI) and sudden cardiac death in Olmsted County during the 18-month calendar period before and after implementation of each smoke-free ordinance. During this period, the incidence of MI declined by 33% (P < .001), and the incidence of sudden cardiac death declined by 17% (P = .13). During the same period, the prevalence of smoking declined and that of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased. Secondhand smoke exposure should be considered a modifiable risk factor for MI.

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Legumes including beans, chickpeas, and lentils are among the lowest glycemic index (GI) foods known. As a central feature of a low GI diet, Jenkins et al have studied the effect of introducing 2 servings per day of legumes into the diets of participants with type 2 diabetes mellitus to determine the effect, over a 3-month period, on diabetes control and cardiovascular risk factors. Compared with a high wheat fiber diet, the low GI-legume diet improved glycemic control, largely through a significant reduction in blood pressure. Furthermore, there was also a significant reduction in heart rate, suggesting a further reduction in risk for heart disease.

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Vivante et al have recently conducted a nationwide population-based retrospective cohort study evaluating the association between body mass index (BMI) at age 17 years among almost 1.2 million adolescents and the future risk for all-cause treated end-stage renal disease (ESRD), with over 25 years of follow-up. Compared with normal weight (5th-84th percentiles of BMI), overweight (85th-94th percentiles) and obese (≥95th percentile) adolescents showed an increased future risk for treated ESRD, with adjusted hazard ratios (HRs) of 3.00 (95% CI, 2.50-3.60) and 6.89 (95% CI, 5.52-8.59), respectively. As expected, overweight and obesity were associated with diabetes-related ESRD, with HRs of 5.96 (95% CI, 4.41-8.06) and 19.37 (95% CI, 14.13-26.55), respectively. However, overweight and obesity were also associated with diabetes-unrelated ESRD, with HRs of 2.17 (95% CI, 1.7-2.74) and 3.41 (95% CI, 2.42-4.79), respectively.

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