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In This Issue of Archives of Internal Medicine
April 24, 2006

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2006;166(8):827. doi:10.1001/archinte.166.8.827
Racial Differences in Trust in Health Care Providers

This study evaluated the association between trust in health care providers and prior health care experiences, structural characteristics of health care, and sociodemographic factors in a national survey of 954 African Americans and whites. African Americans were significantly more likely than whites to report low levels of trust in health care providers. While fewer quality interactions with health care providers were associated with low levels of trust among both African Americans and whites, African Americans whose usual source of care was not a physician's office were most likely to report low trust, whereas whites who were female and those with fewer annual health care visits were most likely to report low trust. Different factors may influence trust in health care providers among African Americans and whites.

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Association of Impaired Diurnal Blood Pressure Variation With a Subsequent Decline in Glomerular Filtration Rate

A physiologic drop in systolic blood pressure of at least 10% overnight is observed in most healthy people. Absence of this decline, or “nondipping,” is associated with chronic kidney disease, insulin resistance, and cardiovascular events. In this retrospective cohort study, Davidson et al examined whether nondipping predicted a decline in glomerular filtration rate over a median follow-up of 3.2 years. The study population comprised 322 consecutive patients referred for ambulatory blood pressure monitoring. Glomerular filtration rate remained stable among dippers but declined by an average of 16% among nondippers. A greater than 50% increase in creatinine level was demonstrated in 32 nondippers vs 2 dippers (P<.001). Nondipping may represent a risk factor for deterioration of renal function, independent of 24-hour mean systolic blood pressure.

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Depressive Symptoms After Acute Myocardial Infarction

Mallik et al examined the prevalence of depression at the time of hospitalization in 2498 patients with acute myocardial infarction (AMI) prospectively enrolled from 19 US centers. Depression was defined as a Patient Health Questionnaire (PHQ) score of 10 or higher. They found that younger (≤60 years) patients had higher mean PHQ scores compared with older patients and women had higher mean PHQ scores compared with men. However, younger women had the highest PHQ scores and the highest prevalence of depression. After adjusting for study center and clinical factors, the odds of depression for younger women were significantly higher than for the other sex-age groups and were 3.1 times higher than the reference group of men older than 60 years. Depression after AMI has been associated with adverse outcomes, and although screening for depression is warranted in all patients with AMI, screening should be particularly aggressive in younger women with AMI.

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Prospective Study of Health Status PREFERENCES and Changes in PREFERENCES Over Time in Older Adults

In this longitudinal study of older persons with advanced illness, Fried et al examined whether willingness to undergo treatment is based on the health state that would result from treatment changes over time and with changes in the person's own state of health. Over a 2-year period, the likelihood of rating treatment resulting in mild and severe functional disability as acceptable increased, whereas the likelihood of rating treatment resulting in severe cognitive disability decreased. Participants who experienced a decline in their ability to perform instrumental activities of daily living were more likely to rate as acceptable treatment resulting in functional disability, and participants who experienced moderate to severe pain were more likely to rate as acceptable treatment resulting in severe pain. These changes pose a challenge to advance care planning, which asks persons to predict their future treatment pREFERENCES.

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Effects of Etanercept in Patients With the Metabolic Syndrome

Adipose-derived cytokines, including tumor necrosis factor α, may contribute to the inflammation in metabolic syndrome. Bernstein et al conducted a randomized, double-blind, placebo-controlled trial to investigate the effects of inhibition of tumor necrosis factor α with etanercept treatment in patients with the metabolic syndrome. C-reactive protein level decreased significantly in the etanercept group compared with the placebo group. Fibrinogen level decreased, interleukin 6 level tended to decrease, and adiponectin level increased in the etanercept-treated subjects compared with the placebo group. There were no changes in body composition parameters or insulin sensitivity, but high-density lipoprotein level tended to decrease in the etanercept group compared with the placebo group. The data demonstrate that etanercept reduces the C-reactive protein level and tends to improve other inflammatory cardiovascular risk indexes in patients with the metabolic syndrome, suggesting that etanercept may interrupt the inflammatory cascade that occurs in this context.

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