In This Issue of Archives of Internal Medicine FREE

In a dose-finding study, the authors tested the administration of 4 fixed doses of oral ximelagtran twice daily starting after elective total knee replacement as prophylaxis against venous thromboembolism and compared the most effective ximelagatran dose with 30 mg of enoxaparin sodium subcutaneously twice daily starting 12 to 24 hours after surgery. The 6- to 12-day rates of overall venous thromboembolism (and proximal deep vein thrombosis or pulmonary embolism) for the 8-, 12-, 18-, and 24-mg doses of ximelagatran twice daily were 27% (6.6%), 19.8% (2.0%), 28.7% (5.8%), and 15.8% (3.2%), respectively. The rates of overall venous thromboembolism (22.7%) and proximal deep vein thrombosis or pulmonary embolism (3.1%) for enoxaparin did not differ significantly compared with the 24-mg dose of ximelagatran twice daily (overall difference, −6.9%; 95% confidence interval, −18.0% to 4.2%; P = .3). There was no major bleeding with 24 mg of ximelagatran twice daily. Fixed dose, unmonitored ximelagatran, 24 mg twice daily, starting after surgery seems to be safe and effective oral prophylaxis against venous thromboembolism after total knee replacement.

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Choose to Move is a 12-week self-help lifestyle intervention program designed by the American Heart Association for women across the United States. The purpose of this study was to evaluate the impact of the 1999 Choose to Move Program on women's physical activity, diet, and knowledge about heart disease and stroke. Of the 23 171 participants, 90% were white and 56% were aged 35 to 54 years. Women who completed the biweekly evaluations (n = 6389 at 2 weeks to 3775 at 12 weeks) reported significantly increased levels of physical activity, reduced consumption of high-fat foods, and increased knowledge of symptoms of heart attack or stroke. This program provides an important model for public health, voluntary, and other health organizations of population-based, low-cost self-help programs that support the Healthy People 2010 objectives for physical activity, nutrition, and cardiovascular health.

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The prevalence of gallstone disease was significantly higher in 330 consecutive patients with Crohn disease than it was in the general population (24.0% vs 13.8%). Age, site of disease at diagnosis, and the presence, number, and site of bowel resections were independently associated with gallstone disease at multivariate analysis.

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Hepatitis C has been called the "epidemic of the new millennium." Annual deaths from hepatitis C within the United States may surpass those from acquired immunodeficiency syndrome (AIDS) by 2010. Little is known about the annual costs of hepatitis C. In this study, standard techniques are used that split the costs into categories such as medical spending and lost wages. Total costs were estimated to be $5.5 billion in 1997, which significantly exceeds the only other hepatitis C estimate ($0.6 billion) for the 1990s; however, it is less than the annual costs of AIDS ($30 billion in 1992). Hepatitis C costs will rise considerably in the future as more people manifest symptoms and die.

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