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In This Issue of Archives of Internal Medicine
July 11, 2011

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2011;171(13):1145. doi:10.1001/archinternmed.2011.293

In a longitudinal study to investigate how diet may be influenced by food resources located within varying distances from homes, Boone-Heinonen et al estimated how neighborhood fast food, supermarket, and grocery store availability affect diet behaviors in a cohort of more than 5000 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study. In addition, the authors tested if lower-income individuals may be more sensitive to resources in close proximity to their homes. These findings provide some support for zoning restrictions on fast food restaurants within 3 km of low-income residents but suggest that increased access to food stores may require complementary or alternative strategies to promote dietary behavior change.

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While several epidemiologic studies suggested that higher sodium and lower potassium intakes were associated with increased risk of cardiovascular diseases (CVDs), few studies have examined joint effects of dietary sodium and potassium intake on risk of mortality. In a prospective cohort study of a nationally representative sample of US adults, Yang et al examined the association between the estimated usual intake of sodium and potassium and sodium-potassium ratio and risk of all-cause and CVD mortality. We found that higher sodium intake was associated with increased all-cause mortality, but higher potassium intake was associated with lower all-cause and CVD mortality risk. In addition, higher sodium-potassium ratio was significantly associated with increased all-cause and CVD mortality. These data provide further evidence to support current public health recommendations in reducing dietary sodium. A simultaneous increase in potassium intake may have additional health benefits.

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One reason chest radiographs are recommended after pneumonia is to rule out underlying lung cancer. Tang et al studied 3398 adults with pneumonia and followed them 5 years. They found that new lung cancer was uncommon, with an incidence of 1% within 90 days and 2% over 1 to 5 years. No lung cancers were detected in those younger than 40 years, and the only major predictor of cancer was age older than 50 years (adjusted hazard ratio, 19.0; P < .001). The authors suggest restricting routine radiographic follow-up of pneumonia to patients older than 50 years because 98% of cancers would still be detected, diagnostic yield would triple, and 40% fewer chest radiographs would be needed.

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Advanced access scheduling, a novel approach to appointment scheduling, has been increasing in popularity as a way to decrease patient wait times, improve continuity, and increase patient satisfaction. While it has been widely implemented in the United Kingdom and the Veterans Health Administration, few large-scale studies have investigated the outcomes of its use. This article systematically reviewed the literature to determine the outcomes of advanced access scheduling. The results were mixed: studies showed that advanced scheduling improves wait times and no-shows but patient satisfaction does not consistently improve. In general, there is a paucity of data on clinical outcomes.

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Approximately 600 US veterans, half of whom were African American, were randomized to either usual care or 1 of 3 telephone-based intervention groups: (1) nurse-administered behavioral management, (2) nurse- and physician-administered medication management, or (3) a combination of both. The intervention telephone calls were triggered based on home blood pressure (BP) values transmitted via telemonitoring devices. Behavioral management involved promotion of health behaviors. Medication management involved adjustment of medications by a study physician and nurse based on hypertension treatment guidelines. Each intervention demonstrated improvements in BP control or systolic BP at 12 months; none of these improvements were sustained at 18 months and did not result in lower medical care costs. However, among those individuals with poor baseline BP control, the combined intervention significantly decreased systolic and diastolic BP at 12 and 18 months. This study indicates the importance of identifying individuals most likely to benefit from potentially resource-intensive programs.

Estimated systolic BP from baseline to 18 months, by intervention group, for 241 patients with inadequate baseline BP control.

Estimated systolic BP from baseline to 18 months, by intervention group, for 241 patients with inadequate baseline BP control.

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