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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.
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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.

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%).

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.

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.

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.




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