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In This Issue of Archives of Internal Medicine
September 24, 2007

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2007;167(17):1821. doi:10.1001/archinte.167.17.1821
Persistent Staphylococcus aureus Bacteremia

This retrospective case-control study compares the clinical characteristics, management, and outcomes of 84 patients with persistent Staphylococcus aureus bacteremia (pSAB) (> 7 days of bacteremia) and 152 patients with nonpersistent S aureus bacteremia (< 3 days of bacteremia). Methicillin resistance, intravascular catheter or other foreign body use, chronic renal failure, more than 2 sites of infection, and infective endocarditis were all independently associated with pSAB. The mean time to device removal was also significantly longer among patients with pSAB. Although clinical outcomes were significantly worse among patients with pSAB, persistent status was not found to be an independent predictor of in-hospital crude mortality.

Prospective Study of Leukocyte Count as a Predictor of Incident Breast, Colorectal, Endometrial, and Lung Cancer and Mortality in Postmenopausal Women

The association of white blood cell (WBC) count with incident cancer was examined in a cohort of 143 748 postmenopausal women enrolled from 1993 to 1998 in the Women's Health Initiative. During a mean 8 years of follow-up, there was a graded association of WBC count with incident invasive breast cancer, colorectal cancer, endometrial cancer, and lung cancer. The WBC count was also significantly associated with breast cancer, lung cancer, and overall cancer mortality.

Effect of Race on Asthma Management and Outcomes in a Large, Integrated Managed Care Organization

Morbidity from asthma disproportionately affects black patients. Whether this excess morbidity can be fully explained by differences in asthma therapy, access to care, or socioeconomic status is unknown. In this prospective cohort study of 678 patients with asthma enrolled in a large, integrated managed care organization, Erickson et al examined whether racial disparities in asthma management and outcomes existed in a health care environment that provided uniform access to care. Black race was associated with a nearly 2-fold higher risk of emergency department visits and hospitalizations. This finding persisted after adjustment for socioeconomic status and asthma therapy and therefore suggests that unmeasured environmental factors or genetic differences may underlie these racial disparities.

German Acupuncture Trial (GERAC) for Chronic Low Back Pain

Low back pain (LBP) is a major reason for absenteeism and disability, with staggering costs to society, and efforts to find effective treatments for this often chronic condition have not been particularly effective. This study by Haake et al compares acupuncture with guideline-based conventional therapy consisting of physical therapy and medication for chronic LBP. The most surprising result of this large-scale randomized controlled trial was that 6 months after randomization and approximately 4 months after the end of treatment, nearly half of the subjects receiving acupuncture (either verum or sham) showed clinically relevant improvements in pain intensity or back-specific disability compared with an improvement rate of only about one-quarter in the conventional treatment group. In Germany, this evidence of a significant superiority of acupuncture over guideline-based conventional treatment led to acupuncture being adopted as a covered benefit for chronic LBP treatment under statutory health insurance plans.

Preventive Health Examinations and Preventive Gynecological Examinations in the United States

Preventive health examinations (PHEs) and preventive gynecological examinations (PGEs) are controversial, and limited data are available on their use and content. Mehrotra et al analyzed a national sample of office visits and estimate that 64 million adults receive such a visit each year at a cost of almost $8 billion. Receipt of a PHE or PGE varied significantly by demographic characteristics, and there was no consistency in the content of these visits. Most preventive services Mehrotra et al examined were provided in nonpreventive visits. Their findings provide a foundation for continuing national deliberations about the use and content of PHEs and PGEs.