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In This Issue of Archives of Internal Medicine
Feb 27, 2012

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2012;172(4):307. doi:10.1001/archinternmed.2011.1024

Lin and Ferrucci investigated current rates of hearing aid use among adults 50 years or older in the United States using data from the National Health and Nutritional Examination Survey. They report that only 1 in 7 individuals with hearing loss uses hearing aids, resulting in nearly 23 million older Americans with untreated hearing loss. Future intervention studies that could demonstrate even a small beneficial effect of hearing loss treatment on mitigating adverse outcomes in older adults would have significant public health implications, given the prevalence of hearing loss and the extent of hearing loss undertreatment.

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Because many smokers stop smoking only after an acute cardiovascular event, Rodondi et al hypothesized that smokers without known cardiovascular disease who are made aware of having atherosclerotic plaques through a carotid ultrasound examination are motivated to optimize their healthy behaviors and enhance smoking cessation rates. However, although the prevalence of plaques was high (58%), smoking cessation rates and control of cardiovascular risk factors did not differ between the screened group and the unscreened group at 1 year.

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Patients with asthma engage in less physical activity than peers because of concern about exacerbating respiratory symptoms. The randomized trial by Mancuso et al attempted to increase lifestyle physical activity, primarily walking, in 258 New York City primary care patients with asthma over 12 months by applying several tenets of health behavior theory. Patients randomized to the control group received a multicomponent protocol consisting of making a contract to participate in a specific physical activity, increasing knowledge of exercise and asthma, using a pedometer, and receiving telephone reinforcement. Patients randomized to the intervention group received these same components and were also taught techniques to increase positive affect and self-affirmation that were linked to the physical activity. After 12 months, energy expenditure measured by self-report increased by 415 kcal/wk (95% CI, 76-754; P = .02) in controls and 398 kcal/wk (95% CI, 145-652; P = .002) in intervention patients, with no difference between groups. For both groups, this increase exceeded a clinically important difference. No adverse events were attributed to the trial. At close-out, asthma-related quality of life stayed the same or improved in 81% of patients.

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This is 1 of 3 randomized controlled trials presented in this issue that are the first to translate induction of positive affect to a clinical population. This trial randomized 242 immediate post–percutaneous transluminal coronary angioplasty (PTCA) patients to induction of positive affect/self-affirmation (PA intervention) vs an educational control group (PE control). Significantly more PA intervention patients increased expenditure by 336 kcal/wk or greater at 12 months, our main outcome, compared with PE control patients (55% vs 37%; P = .007). The PA intervention patients were 1.7 times more likely to reach 336 kcal/wk or greater by 12 months, controlling for demographic and psychosocial measures. The PA intervention patients had nearly double the improvement in kilocalories per week at 12 months compared with the PE controls in multivariate analysis (602 vs 328; P = .03). This expenditure is equivalent to the PA patients walking 7.5 mile/wk vs the PE patients walking 4.1 mile/wk. These results demonstrate sustained and clinically significant improvements in physical activity at 1 year in post-PTCA patients randomized to PA intervention. Longer follow-up intervention studies are warranted to assess whether improvements in physical activity can be maintained longer term with PA intervention and translate into improved clinical outcomes in this high-risk group.

Weekly kilocalorie expenditure for the PA intervention and PE control groups during the 12 months of follow-up.

Weekly kilocalorie expenditure for the PA intervention and PE control groups during the 12 months of follow-up.

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