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In This Issue of Archives of Internal Medicine
November 22, 2010

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2010;170(21):1873. doi:10.1001/archinternmed.2010.437
Subclinical Thyroid Dysfunction and Incident Hip Fracture in Older Adults

Lee et al conducted a prospective analysis of biochemically defined subclinical hypothyroidism and hyperthyroidism and subsequent risk of hip fracture in 3567 US community-dwelling adults 65 years or older who were followed up for a median of 13 years. Men with endogenous subclinical hyperthyroidism had a nearly 5-fold (hazard ratio, 4.91) increased risk of hip fracture after adjustment for putative fracture risk factors and potential confounders. Men with endogenous subclinical hypothyroidism had a 2.5-fold (hazard ratio, 2.45) increased risk of hip fracture. This study introduces prospective evidence that, in older men, subclinical hyperthyroidism and hypothyroidism are independent risk factors of hip fracture, associated with a 2.5- to nearly 5-fold increased risk.

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Bidirectional Association Between Depression and Type 2 Diabetes Mellitus in Women

The comorbidity of depression in patients with type 2 diabetes mellitus has been observed for a long time; however, the temporal relationship between the 2 conditions remains controversial. Pan et al evaluated the bidirectional association between diabetes and depression in more than 60 000 women aged 50 to 75 years from the Nurses' Health Study with 10 years of follow-up. The authors found that depression was associated with a 17% increased risk of developing type 2 diabetes, while type 2 diabetes was associated with a 29% increased risk of incident depression after multivariable adjustment, and this relationship also depended on the severity or treatment of each condition. The results provide strong evidence that the association between diabetes and depression is reciprocal.

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Validation of an Atrial Fibrillation Risk Algorithm in Whites and African Americans

Schnabel et al validated the performance of a recently published Framingham Heart Study–derived risk algorithm for incident atrial fibrillation (AF) modified for 5-year incidence in 2 geographically and ethnically diverse cohorts: AGES (Age, Gene/Environment Susceptibility-Reykjavik Study [n = 4238]) and CHS (Cardiovascular Health Study [n = 5410, of whom 874 were African Americans]). The risk algorithm included age, sex, body mass index, systolic blood pressure, electrocardiographic PR-interval, hypertension treatment, and heart failure. The strongest risk factors were age and heart failure. The relative risks for incident AF associated with risk factors were comparable across cohorts and racial groups. After recalibration for baseline incidence and risk factor distribution, the Framingham algorithm performed reasonably well in all samples. Risk of incident AF in community-dwelling whites and African Americans can be assessed reliably by routinely available and potentially modifiable clinical variables.

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Health Care Use and Decision Making Among Lower-Income Families in High-Deductible Health Plans

The number of families in health insurance plans with large annual deductibles is growing. The patient cost-sharing in these plans may pose particular challenges for families with low incomes. In this study, families in a New England–based health insurer's high-deductible health plan were surveyed about their health care use and attitudes. Families with lower incomes were more likely than higher-income families to report cost-related delayed or foregone care. However, lower-income families did not report more difficulty understanding or using their plans and said they would be more likely to question their physicians about services requiring out-of-pocket expenditures. Physicians and policy makers should consider focused monitoring and benefit design modifications to support families in high-deductible health plans, particularly those families with low incomes.

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Renal Ultrasonography in the Evaluation of Acute Kidney Injury

Clinicians commonly order a renal ultrasonography (US) study for hospitalized patients with elevated creatinine levels to rule out an obstructive cause. However, for many patients, US results do not affect management, and thus routine testing may not be necessary. Licurse et al derive and validate a classification framework to stratify hospitalized patients with acute kidney injury according to their risk of renal obstruction on US. They find that, using common information available to clinicians, patients with elevated creatinine levels can be effectively risk stratified, with at least one-third of these patients classified as low risk. This system may lead to improved diagnostic approaches and reduce the cost of evaluation in patients with acute kidney injury.

HN indicates hydronephrosis; HNRI, hydronephrosis requiring intervention.

HN indicates hydronephrosis; HNRI, hydronephrosis requiring intervention.

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