0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2002;162(19):2160. doi:10.1001/archinte.162.19.2160.
Text Size: A A A
Published online

FREQUENCY OF ANALGESIC USE AND RISK OF HYPERTENSION IN YOUNGER WOMEN

Analgesic use is quite common, particularly among women. Curhan et al prospectively studied the association between the frequency of use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen and the risk of incident hypertension in a young female cohort (Nurses' Health Study II). After adjusting for potential confounders, the risk of hypertension increased with increasing frequency of use of NSAIDs and acetaminophen; women who took NSAIDs or acetaminophen for 22 or more days per month nearly doubled their risk of developing hypertension over a 2-year period. A substantial proportion of hypertension in the United States may be due to the use of these readily available medications.

OUTCOME AND ATTRIBUTABLE MORTALITY IN CRITICALLY ILL PATIENTS WITH BACTEREMIA INVOLVING METHICILLIN-SUSCEPTIBLE AND METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

Blot et al determined attributable mortality in critically ill patients with methicillin-susceptible (n = 38) and methicillin-resistant (n = 47) Staphylococcus aureus bacteremia. Therefore, 2 independent case-control studies were performed, after which attributable mortality rates were compared. Methicillin-susceptible S aureus bacteremia was associated with an attributable mortality rate of 1.3%, since mortality rates for cases and controls were, respectively, 23.7% vs 22.4%. Methicillin-resistant S aureus bacteremia had an attributable mortality rate of 23.4%, since mortality rates in cases and controls were, respectively, 63.8% vs 40.4%. The difference between both attributable mortality rates (22.1%) was significant (95% confidence interval, 8.8%-35.3%).

ANTIBIOTIC RESISTANCE: A SURVEY OF PHYSICIAN PERCEPTIONS

Among 424 internal medicine physicians surveyed at 4 hospitals in Chicago, Ill, 87% believed that inpatient antibiotic resistance was a very important national problem, but only 55% considered it a very important problem at their hospitals, despite rates that were similar to the national average. Similarly, 97% believed that widespread and inappropriate antibiotic use were very important causes, yet only 60% favored restricting broad-spectrum antibiotics, an intervention of proven benefit. Surprisingly, fewer than half the physicians at the 2 teaching hospitals considered poor hand washing a very important cause, despite strong supporting published evidence. These contradictory perspectives must be addressed to effectively combat antibiotic resistance.

RACIAL AND ETHNIC DIFFERENCES IN ALCOHOL-ASSOCIATED ASPARTATE AMINOTRANSFERASE AND Γ-GLUTAMYLTRANSFERASE ELEVATION

Age-adjusted mortality from liver cirrhosis has been shown to vary by race and ethnicity in the United States. Mortality is highest in Hispanics, intermediate in non-Hispanic blacks, and lowest in non-Hispanic whites. The contribution of alcohol drinking to these differences is unknown. In this epidemiologic analysis, Stewart evaluated aspartate aminotransferase and γ-glutamyltransferase level elevations among Mexican American, non-Hispanic black, and non-Hispanic whites within defined drinking categories. For both these enzymes, the relative risk for at least a 2-fold elevation was proportional to drinking frequency, and no increased risk was detected among current abstainers. These results suggest that racial and ethnic differences in susceptibility to alcohol-induced hepatotoxicity may contribute to corresponding disparities in cirrhosis mortality.

UNDERTREATMENT OF OSTEOPOROSIS IN MEN WITH HIP FRACTURE

The medical community has become increasingly aware that women are not aggressively treated for osteoporosis after hip fracture; however, the treatment status of men with hip fracture has not been extensively studied. Kiebzak et al evaluated the outcome and treatment status of men with hip fracture. Data from medical records were obtained for 110 men and 253 women 50 years or older with atraumatic (low-energy) hip fracture between 1996 and 2000. Surveys were mailed to surviving patients. The mean age for men was 80 years vs 81 years for women. Most fractures resulted from falls from a standing height. At discharge, only 4.5% of men had treatment of any kind for osteoporosis compared with 27% of women. The 12-month mortality rate was 32% in men compared with 17% for women. At 1- to 5-year follow-up, 12 (27%) of 44 men were taking treatment of any kind for osteoporosis compared with 88 (71%) of 124 women. Only 11% of men had a bone mineral density measurement compared with 27% of women. After discharge, the number of men and women who required wheelchairs, walkers, and canes, and who lived in institutions, increased significantly. The burden of hip fracture is illustrated by both the high incidence of postfracture disability and the high mortality rate in both men and women. Nevertheless, only a minority of men receive antiresorptive treatment.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.