In This Issue of Archives of Internal Medicine FREE

Depression is a common disorder among older adults and has been associated with adverse health outcomes, including increased risk of morbidity, disability, and mortality. This study assessed the relationship between depression and adverse drug reactions (ADRs) among 3134 patients admitted to hospitals in Italy. An ADR was recorded in 101 (7.4%) of the 1363 depressed patients and in 82 (4.6%) of the 1771 nondepressed patients (P = .001). After adjusting for potential confounders, depression was associated with a significantly higher rate of ADRs (odds ratio, 1.58 [95% confidence interval, 1.14-2.20]). The risk of developing ADRs progressively and significantly increased as Geriatric Depression Scale score increments increased (signifying more severe depression). These findings suggest that among older hospitalized patients, depression is associated with a greater occurrence of ADRs.

In this study, Tu and Gong from the Institute for Clinical Evaluative Sciences, Toronto, Ontario, examined temporal trends in the treatment and outcomes of all 91 419 patients having a new stroke in Ontario between the years 1992 and 1998. They observed significant declines in risk-adjusted in-hospital and 1-year mortality rates but stable 30-day mortality rates over the 7-year study period. The authors believe that improvement in 1-year mortality rates may be attributable to increasing use of secondary prevention medications such as warfarin sodium (Coumadin) and statins observed in their study population.

Celiac disease, an immune-mediated enteropathy triggered by the ingestion of gluten-containing grains in genetically susceptible individuals, has been considered rare in the United States. To establish the prevalence of celiac disease in the United States, the largest multicenter epidemiologic study ever performed in the country was conducted by screening more than 13 000 subjects from 32 states. Celiac disease was found to be a more common but neglected disorder than has generally been recognized in the United States, occurring frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives of subjects with celiac disease and patients with numerous common disorders even in the absence of gastrointestinal symptoms.

To assess the impact of quality improvement activities for pneumonia in very small hospitals, Chu and colleagues evaluated the care of 2154 patients from 36 hospitals (20 intervention and 16 control) after measurement and intervention by a Medicare Quality Improvement Organization. Significant improvements in process measures were demonstrated in the intervention hospitals, including performance of sputum cultures, blood cultures, antibiotic administration within 4 hours of arrival, and administration of the first dose of antibiotic in the emergency department. These measures did not change significantly in the control hospitals over the same period.

Fung et al prospectively assessed the associations between major dietary patterns and the risks of colorectal cancer in women. Dietary information was collected in 1984, 1986, 1990, and 1994 from 76 402 women aged 38 to 63 years without history of cancer in 1984. The authors conducted factor analysis and identified 2 major dietary patterns: "prudent" and "Western." The prudent pattern was characterized by higher intakes of fruits, vegetables, legumes, fish, poultry, and whole grains, whereas the Western pattern was characterized by higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains. The authors then calculated pattern scores for each participant and examined prospectively the associations between dietary pattern scores and colon and rectal cancer risks. During 12 years of follow-up, 445 cases of colon cancer and 101 cases of rectal cancer were identified. After adjusting for potential confounders, a relative risk for colon cancer of 1.46 (95% confidence interval, 0.97-2.19) was observed when comparing the highest to lowest quintiles of the Western pattern (P value for trend across quintiles, .02). The prudent pattern had a nonsignificant inverse association with colon cancer. The authors did not observe any significant association between dietary patterns and rectal cancer.