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In This Issue of Archives of Internal Medicine
October 24, 2005

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2005;165(19):2186. doi:10.1001/archinte.165.19.2186
Justice at Work and Reduced Risk of Coronary Heart Disease Among Employees

Justice is of fundamental value to human societies, but its impact on health has been little studied. Kivimäki and colleagues examined whether justice at work is associated with coronary heart disease risk among employees participating in the British Whitehall II Study. The researchers found that employees who experienced a high level of justice at work had a 30% lower risk of coronary heart disease compared with employees who experienced a low or intermediate level of justice.

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Effects of Adding Ribavirin to Interferon to Treat Chronic Hepatitis C Infection

Globally, 170 million people are chronically infected with hepatitis C virus. This systematic Cochrane Hepato-Biliary Group review including 72 randomized trials with almost 10 000 patients with chronic hepatitis C found that ribavirin plus interferon compared with interferon is more effective in clearing hepatitis C virus and improving liver histologic diagnosis. This may lead to reduced morbidity and mortality. However, the number needed to treat to prevent 1 patient from developing morbidity or dying is very large, and combination therapy significantly increased the risk of several adverse events.

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Epidemiologic Study of the Autoimmune Health Effects of a Cargo Aircraft Disaster

In an epidemiological study (N = 2499), Slottje and colleagues assessed long-term autoimmune health effects of occupational exposure to the 1992 cargo air disaster in Amsterdam, the Netherlands. They demonstrated that exposed professional assistance workers reported autoimmune-like symptoms more often than reference groups of their nonexposed colleagues, but that there were no statistically significant differences in autoantibody prevalence rates between exposed and nonexposed workers.

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Prevention of Fall-Related Injuries in Long-term Care

Previous studies have shown that interventions that improve safety practices can reduce falls; however, in long-term care, successful programs have relied heavily on external funding and staff. Ray and colleagues hypothesized that this reliance on external resources could be reduced by appropriate training of nursing home staff. The authors conducted a randomized controlled trial to determine whether an intense 2-day safety-practice training program, with long-term follow-up, could reduce fall-related injuries. The program focused on improving the safety of the residents’ living space, wheelchairs, canes and walkers, psychotropic drugs, and transferring and ambulation. The cluster-randomized trial included 112 qualifying nursing homes and 10 558 residents aged 65 years or older. However, despite the intensive training program and regular follow-up, there was no difference in injury occurrence between the intervention and control facilities: adjusted rate ratio of 0.98 (95% confidence interval, 0.83-1.16). The authors thus conclude that staff training programs alone may not be sufficient to prevent fall-related injuries in long-term care.

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A Prospective Study of Anemia Status, Hemoglobin Concentration, and Mortality in an Elderly Cohort

Anemia is often thought of as a marker illness rather than a disease with significant morbidity and mortality. In this article, Zakai and colleagues report the association of anemia status (by the World Health Organization [WHO] criteria) and hemoglobin concentration with 12-year mortality risk in 5888 community-dwelling elderly individuals. Independent of other risk factors, low hemoglobin concentration (whether defined by the WHO criteria or by the lowest hemoglobin quintile) was associated with a 30% to 40% increased risk of mortality. This association was not mediated by cardiovascular disease status, inflammation, renal insufficiency, or an increase in cardiovascular death. Because hemoglobin concentration in the normal range by WHO criteria was related to risk of death, the WHO criteria may be insensitive among the elderly. Findings suggest a hypothesis that treatment and evaluation of anemia might improve long-term health outcomes.

Unadjusted mortality over 11.2 years by hemoglobin quintiles.

Unadjusted mortality over 11.2 years by hemoglobin quintiles.

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