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In This Issue of Archives of Internal Medicine
November 14, 2005

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2005;165(20):2319. doi:10.1001/archinte.165.20.2319
Prescribing Exercise at Varied Levels of Intensity and Frequency

This randomized trial examined the effects of counseling free-living, sedentary adults to exercise at different levels of intensity and frequency. Significant improvements in cardiorespiratory fitness were achieved and maintained over 24 months via exercise counseling with a prescription for walking 30 minutes per day, either at a moderate intensity 5 to 7 days per week or at a hard intensity 3 to 4 days per week. Additional benefits, including larger changes in fitness level and short-term increases in high-density lipoprotein cholesterol level, were achieved by prescribing the combination of hard-intensity plus high-frequency exercise.

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Progression and Regression of Sleep-Disordered Breathing With Changes in Weight

Newman et al studied the relationship between weight loss or weight gain and the progression or incidence of sleep apnea over 5 years in a diverse group of 2790 men and women in the Sleep Heart Health Study. Both men and women had increases in the number of breathing pauses at night over the 5-year period. The greater the gain in weight over time, the greater the increase in breathing pauses. This was more pronounced in men than in women. Among those with weight loss, the number of breathing pauses decreased compared with those who maintained a stable weight, but to a lesser degree in women than in men. However, sleep apnea progressed over time even in those with stable weight. Results were similar in African American, Hispanic, Native American, and white participants. This illustrates the importance of the prevention of even moderate weight gain in the prevention of sleep apnea.

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The Risk of Lymphoma Development in Autoimmune Diseases

The aim of this meta-analysis was to determine the risk of lymphoma development for several types of autoimmune disorders, such as primary Sjogren syndrome (SS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). In total, the studies included 8700 patients with SLE, 95 104 with RA, and 1300 with SS. The meta-analysis showed that lymphoma is more common in patients with autoimmune diseases than in the general population. There is a high risk of lymphoma development in SS, a lower risk in SLE, and even a lower risk in patients with RA. In patients with RA, the use of cytotoxic or immunomodulatory agents may increase the risk of lymphoma. In this setting, the association of lymphoma with autoimmune diseases generates interest because it may enlighten the mechanisms of lymphomagenesis and provide new tools for therapy.

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Symptoms and Related Functioning in a Traumatized Community

Most studies after traumatic events focus on mental health problems such as posttraumatic stress disorder and depression. In this longitudinal study, van den Berg and colleagues examined physical symptoms such as headache, fatigue, and stomachache among survivors of a fireworks disaster. Up to 4 years after the disaster, symptoms were more common among survivors than among controls. Although a medical disorder could not be ruled out, the reported symptoms showed several similarities with medically unexplained symptoms in the general population.

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Relationship of Day-to-Day Reproductive Hormone Levels to Sleep in Midlife Women

Kravitz et al examined whether reproductive hormones are associated with trouble sleeping in women beginning the menopausal transition. Trouble sleeping was recorded nightly in a bedtime diary, and urinary reproductive hormones were measured each morning for 1 menstrual cycle in 630 mid-life women. Average adjusted odds of reporting trouble sleeping were 29% higher in perimenopausal than in premenopausal women, and trouble sleeping was more frequent at the beginning and end of their cycle in both groups. In adjusted analyses, pregnanediol glucuronide was associated with increased trouble sleeping in perimenopausal women, and follicle-stimulating hormone was associated with increased trouble sleeping in premenopausal women.

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