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In This Issue of Archives of Internal Medicine
February 23, 2009

In This Issue of Archives of Internal Medicine

Author Affiliations

Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Intern Med. 2009;169(4):332. doi:10.1001/archinternmed.2008.615
Dairy Food, Calcium, and Risk of Cancer in the NIH-AARP Diet and Health Study

Intakes of dairy food and calcium in relation to total cancer as well as cancer at individual sites were examined among 492 810 men and women in the National Institutes of Health–AARP Diet and Health Study. The study found that calcium intake was not related to total cancer in men but was nonlinearly associated with total cancer in women: the risk decreased up to approximately 1300 mg/d of total calcium intake, above which no further risk reduction was observed. In both men and women, dairy food and calcium intake were inversely associated with cancers of the digestive system, especially with colorectal cancer. Supplemental calcium was also related to lower risk of colorectal cancer.

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Risk Factors for End-Stage Renal Disease

In this study by Hsu et al, 177 570 individuals from a large integrated health care delivery system who volunteered for health checkups were followed up for a mean of 25 years for development of end-stage renal disease (ESRD). The importance of established risk factors such as older age, male sex, African American race, lower education attainment, diabetes mellitus, higher blood pressure, higher body mass index, higher serum creatinine concentration, and more proteinuria were all confirmed in this comprehensive evaluation. The 2 most potent risk factors were proteinuria and excess weight. Several novel independent risk factors for ESRD were identified, including lower hemoglobin level, higher serum uric acid level, self-reported history of nocturia, and family history of kidney disease. This result may allow better identification of patients with heightened risk for ESRD for early screening and implementation of timely preventive interventions.

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Increased Risk of Testicular Germ Cell Cancer Among Infertile Men

Using a large US cohort of men evaluated for infertility, Walsh et al found that men with male factor infertility have a 3-fold higher risk of developing testicular germ cell cancers subsequent to their infertility diagnosis. This finding suggests the existence of common etiologic factors for male infertility and testicular germ cell cancer.

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Understanding Physicians' Risk Stratification of Acute Coronary Syndromes

Among 1956 patients with non-ST elevation acute coronary syndrome (ACS) enrolled in Canadian ACS 2 Registry, those considered as high risk by their treating physicians were more likely to receive aggressive medical therapies and to undergo coronary angiography and revascularization. However, there were only weak correlations between physician risk assessment and validated risk scores. In a multivariable analysis, worse Killip class, electrocardiographic abnormalities, and positive cardiac biomarker status were independently associated with a high-risk categorization by the treating physician. However, advanced age was an independent negative predictor, and there was no significant association between the high-risk category and several well-established prognosticators. These findings suggest that physicians may fail to recognize and incorporate the most powerful adverse prognosticators into overall patient risk assessment. More widespread use of validated risk scores may improve ACS risk stratification and better inform medical decision making in clinical practice.

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Patient and Physician Reminders to Promote Colorectal Cancer Screening

Screening reduces colorectal cancer mortality, but effective screening tests remain underused. Sequist et al conducted a randomized controlled trial of patient and physician reminders for 21 860 patients of 110 primary physicians in 11 ambulatory health centers. Patients aged 50 to 80 years who were overdue for screening were randomly assigned to receive mailings with a fecal occult blood test kit and instructions for scheduling flexible sigmoidoscopy or colonoscopy. Physicians were randomly assigned to receive electronic reminders during office visits with patients overdue for screening. Over a 15-month period, colorectal cancer screening rates were significantly higher for patients who received mailings compared with those who did not (44.0% vs 38.1%), and the effect of the mailings was greater for older patients. Screening rates were similar among patients of physicians receiving electronic reminders and the control group (41.9% vs 40.2%), but screening tended to increase with physician reminders among patients who had 3 or more office visits (59.5% vs 52.7%).

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Active electronic reminders were delivered to physicians during office encounters and facilitated electronic ordering of recommended tests.

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