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In This Issue of Archives of Internal Medicine
Dec 12 2011

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2011;171(22):1984. doi:10.1001/archinternmed.2011.574

The Journey for Control of Diabetes Interactive Dialogue to Educate and Activate (IDEA) Study is a pragmatic randomized controlled trial of 623 subjects with established suboptimally controlled diabetes. The objective is to determine if group education using the US Diabetes Conversation Map Program improves patient outcomes compared with individual education and with usual care (no assigned education). In this population, the study concludes that individual education results in better short-term glucose control outcomes and better trends in psychosocial and behavioral outcomes than group education and usual care. The findings have implications for diabetes patient education guidelines, public policy, and Centers for Medicare and Medicaid Services reimbursement for diabetes education.

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This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain. A total of 228 adults with chronic mechanical low back pain were randomized to yoga, conventional stretching exercises, or self-care. By the end of 12 weeks of classes, yoga classes were more effective than a self-care book, but not stretching classes, in improving function and reducing symptoms due to chronic low back pain, with clinically important benefits lasting at least several months.

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The goal of this study was to use data from the National Health Interview Survey to establish prevalence estimates and correlates of cancer screening, including physician recommendation in older racially diverse adults (age ≥75 years). Screening behaviors were examined according to current US Preventive Services Task Force recommendations for breast, cervical, colorectal, and prostate cancer screening. Among adults aged 75 to 79 years, the percentage screened was colorectal (57%), breast (62%), cervical (53%), and prostate cancer (56%). Among the 80 years or older group, rates of screening ranged from a low of 38% for cervical cancer screening to a high of 50% for breast cancer screening. Physician recommendation for a specific test was the largest predictor of screening. More than 50% of men and women 75 years or older reported that their physicians continue to recommend screening. A high percentage of older adults continue to be screened despite ambiguity of recommendations for this group.

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Perhaps the most persuasive messages promoting screening mammography emanate from women who argue that the test “saved my life.” Other possibilities, however, exist. Welch and Frankel devised a simple method to estimate the answer to the question: How likely is a woman with screen-detected breast cancer to have had her life saved by screening? Using different age groups and a range of estimates on the ability of screening mammography to reduce breast cancer death, they found that the estimated probabilities that a woman with screen-detected breast cancer had her “life saved” were all below 25% and were as low as 3%. These findings suggest that most women with screen-detected breast cancer have not been helped by screening mammography. They are instead either simply diagnosed early (with no effect on their mortality) or overdiagnosed.

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To test the efficacy of a behavioral diabetes intervention for improving glycemia in long-duration, poorly controlled diabetes, Weinger et al randomized 222 adults with type 1 or type 2 diabetes to attend (1) an educator-led structured group intervention with cognitive behavioral strategies, (2) an educator-led attention-control group education program, or (3) unlimited individual nurse and dietitian education sessions for 6 months. Linear mixed modeling found that all groups showed improved hemoglobin A1c levels (P < .001). However, the structured behavioral arm showed greater improvements than the group and individual control arms. Furthermore, type 2 diabetic participants improved more than type 1 diabetic participants. A structured, cognitive behavioral program is more effective than 2 control interventions in improving glycemia in adults with long-duration diabetes.

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