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In This Issue of Archives of Internal Medicine
July 8, 2002

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2002;162(13):1437. doi:10.1001/archinte.162.13.1437
Obesity Is a Risk Factor for Dyspnea but Not for Airflow Obstruction

Previous research suggests that obesity is an important risk factor for asthma. However, since obesity can cause dyspnea through mechanisms other than airflow obstruction, diagnostic misclassification of asthma could partially account for this association. This study used data from the Third National Health and Nutrition Examination Survey to evaluate the effect of body mass index on self-reports of asthma and objective airflow obstruction. The investigators found that while obesity increased the risk of asthma diagnosis by 50%, it decreased the risk for airflow obstruction by 33%. These data suggest that many obese individuals are being diagnosed as having asthma in the absence of airflow obstruction, causing concerns about asthma overdiagnosis in the obese and overweight populations.

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The Hospital Water Supply as a Source of Nosocomial Infections: A Plea for Action

This comprehensive literature review describes 43 outbreaks of waterborne nosocomial infections and suggests that a large number of potentially preventable deaths occur as a result of some of these infections. A recommendation to avoid patient exposure to tap water in the hospital setting is made.

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Short-Duration Prophylaxis Against Venous Thromboembolism After Total Hip or Knee Replacement

Although anticoagulant prophylaxis reduces the risk of venous thromboembolism (VTE) by 50% to 70% after hip or knee replacement surgery, there is concern about the high prevalence of venographically detected residual deep vein thrombosis in patients who receive short-duration (7-10 days) anticoagulant prophylaxis. Because the risk of symptomatic outcomes in such patients is unclear, the authors performed a meta-analysis to provide reliable estimates of the risk of symptomatic VTE in patients who received short-duration prophylaxis with low-molecular-weight heparin or warfarin after hip or knee replacement. Based on a pooled analysis of 6089 patients, the 3-month incidence of nonfatal VTE and fatal pulmonary embolism was 3.2% (95% confidence interval, 2.0%-4.4%) and 0.10% (95% confidence interval, 0.02%-0.20%), respectively. Although asymptomatic deep vein thrombosis was more common after knee replacement than hip replacement within 10 days after surgery (39.1% vs 16.4%; P<.001), symptomatic VTE was more likely to occur after hip replacement in the subsequent 3 months (2.5% vs 1.4%; P = .02).

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Vitamin Supplement Use in a Low-Risk Population of US Male Physicians and Subsequent Cardiovascular Mortality

Although basic research suggests that vitamins may have an important role in the prevention of cardiovascular disease (CVD), the data from cohort studies and clinical trials are inconclusive. We explored the association of vitamin E, ascorbic acid (vitamin C), and multivitamins with CVD and total mortality in a large prospective cohort study of 83 639 male physicians without history of CVD or cancer residing in the United States. At baseline, use of vitamin E, vitamin C, and multivitamin supplements was provided by a self-administered questionnaire. Mortality from CVD and coronary heart disease (CHD) was assessed by death certificate review. Use of supplements was reported by 29% of the participants. During a mean follow-up of 5.5 years, there were 1037 CVD deaths including 608 CHD deaths. In this large cohort of apparently healthy US male physicians, self-selected supplementation with vitamin E, vitamin C, or multivitamins was not associated with a significant decrease in total CVD or CHD mortality. Data from ongoing large-scale randomized trials will be necessary to definitely establish small potential benefits of vitamin supplements on subsequent cardiovascular risk.

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Effect of Fracture on the Health Care Use of Nursing Home Residents

Nursing home residents fracture at a rate as much as 11 times higher than age-matched community dwellers, but nothing is known about their health care use following fracture. Knowing the amount of care following fracture may help inform practice and determine the effects of fracture prevention on use and costs in this population. This study followed up 1427 randomly selected white female residents 65 years and older who resided in 47 randomly selected homes in Maryland for 18 months to compare health care utilization for those who fractured and those who did not. Residents who fractured were hospitalized 15 to 31 times as often as those who did not fracture in the month following fracture and at a higher rate again 3 to 12 months following fracture. Rates of emergency department use and contacts with physicians and therapists were also increased, the latter 2 for 12 months following fracture; rates for hip fracture patients decreased after 6 months, similar to community cohorts. Comparisons with community patients suggest that care may be less than what would be provided in other settings.

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