Restricted activity, defined as staying in bed for at least half a day and/or cutting down on one's usual activities because of an illness, injury, or other problem, is common among community-living older persons, but its prognostic significance is not known. In this prospective cohort study of 680 community-living older persons, Gill et al found a strong and independent association between the occurrence of restricted activity and functional decline over an 18-month period. This association was not observed, however, among the frailest subgroup of older persons, who had high rates of functional decline even in the absence of restricted activity. These results suggest that for most older persons restricted activity is an important predictor of functional decline and not just a benign feature of old age.
Eosinophilia requires a careful differential diagnosis, since several diseases in addition to allergy and parasitic infection can provoke this abnormality. Among 1862 patients with eosinophilia, Lombardi and Passalacqua found allergic diseases in 79.7% of cases, parasitic infestation in 8.2%, hematological malignancies in 2.4%, solid tumors in 1.9%, gastrointestinal disorders in 1.6%, and skin diseases in 2.1%. Autoimmune disorders and pulmonary granulomatosis accounted for less than 1.5%, whereas in 2.7% of patients no specific disease could be diagnosed. These findings highlight the importance of a careful evaluation of this hematological abnormality, which can be the primary manifestation of severe disorders.
Several prospective studies mainly conducted in men have suggested that light to moderate drinking may be inversely associated with the development of type 2 diabetes mellitus, whereas heavy consumption increases this risk. The findings from this prospective study of over 100 000 female nurses aged 25 to 42 years suggest that light to moderate alcoholic beverage consumption (<30 g/d) is associated with lower risk of type 2 mellitus diabetes among women, although this benefit may not persist at higher levels. The inverse association with light to moderate drinking was most apparent in women who reported wine or beer drinking. Heavier drinking (≥30 g/d) did not confer benefit, and women who reported high levels of liquor intake (≥30 g/d) showed increased risk.
Donnelly et al examined the long-term effects of a 16-month, supervised program of moderate-intensity exercise on body weight and composition of previously sedentary, overweight, and moderately obese men and women. Seventy-four subjects were randomized to exercise or control, and all subjects maintained normal, ad libitum diets. Exercise prevented weight gain in women and produced an average of 5.2-kg weight loss in men. Both men and women significantly reduced visceral fat. Thus, exercise was effective for weight loss in men and weight maintenance in women.
Patients with a first episode of venous thromboembolism are treated with vitamin K (phytonadione) antagonists for several months. There is much debate about the length of this period. Treatment with vitamin K antagonists reduces the risk for recurrent venous thrombosis but induces a risk for bleeding. There are indications that the risk for recurrent venous thrombosis after treatment is diminishing over time, which will affect treatment decisions. van Dongen et al performed a meta-analysis to gain insight into the risk for recurrent venous thrombosis after treatment with vitamin K antagonists and found that the monthly incidence immediately after cessation of treatment is high and declines rapidly thereafter. After 9 months, the monthly incidence stabilizes and seems independent of the duration of the initial treatment period.
Monthly incidence and 95% confidence intervals of recurrent venous thromboembolism after treatment with vitamin K (phytonadione) antagonists for different durations in relation to the time since index event.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2003;163(11):1257. doi:10.1001/archinte.163.11.1257