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In This Issue of Archives of Internal Medicine
November 26, 2007

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2007;167(21):2282. doi:10.1001/archinte.167.21.2282
Glycemic Index, Glycemic Load, and Cereal Fiber Intake and Risk of Type 2 Diabetes in US Black Women

Data from the Black Women's Health Study were used to evaluate the relationship of glycemic index, glycemic load, and cereal fiber with risk of type 2 diabetes. During 8 years of follow-up, there were 1938 incident cases of diabetes. Glycemic index was positively associated with risk of type 2 diabetes, and cereal fiber intake was inversely associated with risk of type 2 diabetes. Stronger associations were seen among those women who were not overweight. The authors conclude that increasing dietary cereal fiber may be an effective method of reducing risk of type 2 diabetes in black women.

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Nonconsented Human Immunodeficiency Virus Testing Among Critically Ill Patients

Although human immunodeficiency virus (HIV) testing can improve care for many critically ill patients, state laws and institutional policies generally bar testing when patients cannot consent. In this survey of US academic intensivists, Halpern et al found that 77% had encountered decisionally incapacitated patients for whom HIV testing was desired; 22% of these pursued nonconsented HIV tests, while 62% first obtained surrogate consent. Intensivists who believed that nonconsented HIV testing was ethical and those who believed that their states allowed nonconsented testing when medically necessary were more likely to pursue nonconsented HIV tests, but actual state laws were unrelated to testing practices. Halpern et al also found that when intensivists are unable to obtain HIV tests, they frequently rely on surrogate markers of infection, despite the fact that these markers are poor indicators of HIV status in the critically ill.

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Patient Knowledge of Coronary Risk Profile Improves the Effectiveness of Dyslipidemia Therapy

In this randomized controlled trial by Grover et al, 230 primary care physicians from across Canada enrolled 3053 patients with treatable dyslipidemia to receive ongoing feedback regarding their calculated coronary risk or usual care. After 12 months of follow-up, greater mean reductions in low-density lipoprotein cholesterol levels and the total cholesterol to high-density lipoprotein cholesterol ratio were observed among subjects receiving risk profiles (51.2 and 1.5 mg/dL) vs usual care (48.0 and 1.3 mg/dL). The differences were small but significant (−3.3 mg/dL and −0.1 mg/dL, respectively). Risk profile patients were also more likely to reach lipid targets (odds ratio, 1.26), and a significant (P = .04) “dose-response effect” was noted when the impact of the risk profile was strongest (odds ratio, 1.69) among those with the worst profiles. Informing a patient of his or her coronary risk is associated with a measurable improvement in the efficacy of lipid therapy.

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Health Care Access, Use of Services, and Experiences Among Undocumented Mexicans and Other Latinos

Ortega et al used the California Health Interview Survey to study health care access, utilization, and experiences for 1317 undocumented Mexicans and 271 undocumented other Latinos vs 2851 US-born Mexicans and 852 US-born other Latinos, as well as 1218 naturalized Mexicans, 546 naturalized other Latinos, 1352 Mexicans, and 327 other Latinos with green cards. Undocumented Mexicans and other Latinos had fewer physician and emergency department visits compared with their US-born counterparts. Both undocumented groups were less likely to report difficulty obtaining necessary health care than their US-born counterparts. Undocumented Mexicans were less likely to have a usual source of care and were more likely to report negative experiences with care compared with US-born Mexicans.

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Sex, Depression, and Risk of Hospitalization and Mortality in Chronic Obstructive Pulmonary Disease

To investigate whether depressive or anxiety symptoms are associated with hospitalizations and mortality in patients with chronic obstructive pulmonary disease (COPD), Fan et al examined data from patients with severe COPD who participated in the National Emphysema Treatment Trial. In a prospective cohort study of 610 patients randomized to medical therapy, the authors found that depressive symptoms, measured with the Beck Depression Inventory, were common and that the majority of patients were not being treated with antidepressants. Depressive symptoms were associated with a significantly increased adjusted risk for 3-year mortality (odds ratio, 2.26) but were not associated with risk of hospitalizations after adjustment for disease severity. Anxiety symptoms did not increase the risk of either hospitalizations or mortality. This suggests that a further understanding of depression in COPD may help to target therapies to reduce mortality.

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