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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2007;167(8):749. doi:10.1001/archinte.167.8.749.
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In this retrospective cohort study of 11 728 health care and university employees (34 858 full-time equivalents) with at least 1 health risk appraisal (1997-2004), Østbye et al determined the relationships between body mass index and number and types of workers' compensation claims, associated costs, and lost workdays. The authors found a clear linear relationship between body mass index and rate of claims: employees in obesity class III had 50% more claims than recommended-weight employees. The effect on lost days and costs was even stronger, approximately 10 times higher among the heaviest workers. Maintaining healthy weight is important to workers themselves and should also be a high priority for their employers. The authors conclude that work-based programs targeting healthy eating and physical activity should be developed and evaluated.

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The association between induced and spontaneous abortion and the incidence of breast cancer was examined in a prospective cohort of young women (the Nurses' Health Study II), including 105 716 women aged 29 to 46 years at start of follow-up in 1993. During 973 437 person-years of follow-up between 1993 and 2003, 1458 newly diagnosed cases of invasive breast cancer were ascertained. Among this predominantly premenopausal population, neither induced nor spontaneous abortion was associated with the incidence of breast cancer; number of abortions, age at abortion, parity status, or timing of abortion with respect to a full-term pregnancy did not affect the results.

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Continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS) might lower blood pressure, yet evidence from clinical studies is inconsistent, perhaps as a result of small sample size or heterogeneity in study design. This systematic review and meta-analysis of placebo-controlled clinical trials shows that among patients with OSAS, CPAP reduces 24-hour ambulatory mean blood pressure, with greater treatment-related reductions in ambulatory mean blood pressure among patients with a more severe degree of OSAS and a better effective nightly use of the CPAP device. These reductions in blood pressure are likely to contribute to a better prognosis in terms of adverse cardiovascular events.

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Recombinant human erythropoietin (EPO) is widely used to stimulate red blood cell production in patients with anemia due to cancer, renal disease, andother medical conditions, but concern has grown about its overuse and potential for harm. Fischer et al reviewed 3 years of drug use data from a large academic medical center for all noncancer patients who received at least 1 dose of EPO and evaluated the rates of laboratory testing in patients with and without chronic kidney disease (CKD). An analysis of more than 3000 admissions revealed important problems in EPO use. Almost 1 in 5 patients receiving EPO had a hematocrit level greater than 36%; this was more common in patients with CKD. Only 60% of patients had iron levels checked, and nearly a quarter of those patients had absolute iron deficiency at the time they were treated with EPO. These results identify important targets for quality improvement interventions in patients treated with EPO.

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Contemporary population-based data on the age- and sex-specific incidence of bloodstream infections (BSIs) are limited. In this issue, Uslan et al retrospectively reviewed all cases of bloodstream infection in Olmsted County, Minnesota, over a 3-year period. Of 650 patients with clinically significant cultures, the most common organisms were Escherichia coli and Staphylococcus aureus. The age-adjusted incidence rate of BSI was 156 per 100 000 person-years for female patients and 245 per 100 000 person-years for male patients (P<.001). There were significant differences in age- and sex-distribution of organisms among patients with BSI. The incidence of BSI climbed sharply with increasing age and was significantly higher in men, mainly because of nosocomial organisms including S aureus.

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