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In This Issue of Archives of Internal Medicine
December 10/24, 2007

In This Issue of Archives of Internal Medicine

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Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Intern Med. 2007;167(22):2390. doi:10.1001/archinte.167.22.2390
Symptom Presentation of Women With Acute Coronary Syndromes

This review by Canto et al describes the presenting symptoms of acute coronary syndrome (ACS) in women compared with men and ascertains whether women should have a symptom message that is separate or different from that for men. Approximately one-third of patients in the large cohort studies and one-quarter of patients in the smaller reports and direct patient interviews presented without chest pain or discomfort. The absence of chest pain or discomfort with ACS was noted more commonly in women than in men in both the cumulative summary from large cohort studies (37% vs 27%) and the single-center/small reports or interviews (30% vs 17%). These differences are not, however, likely large enough to warrant sex-specific public health messages regarding the symptoms of ACS at present. Further research must systematically investigate sex differences in the clinical presentation of ACS symptoms and must include standardized data collection efforts.

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Physical Activity Recommendations and Decreased Risk of Mortality

Leitzmann et al report results from a large US cohort study of the association between federal recommendations for physical activity and mortality. Compared with being physically inactive, achievement of activity levels that approximate the recommendations for moderate activity (at least 30 minutes on most days of the week) or vigorous exercise (at least 20 minutes 3 times per week) was associated with 27% (relative risk, 0.73; 95% confidence interval, 0.68-0.78) and 32% (relative risk, 0.68; 95% confidence interval, 0.64-0.73) decreased risk of mortality, respectively. These data suggest that following current physical activity guidelines plays an important role for longevity.

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Inadequate Control of Hypertension in US Adults With Cardiovascular Disease Comorbidities in 2003-2004

Wong et al examined the prevalence and adequacy of treatment and control of hypertension (HTN) in persons with cardiovascular comorbidities in 4646 adults (projected to 192 million) in the US National Health and Nutrition Examination Survey (2003-2004). Among persons with cardiovascular comorbidities, prevalence of HTN ranged from 52% to 82%, compared with 23% in those without these conditions. Despite HTN treatment rates for patients with diabetes, stroke, heart failure, and coronary artery disease being higher (83%-89%) compared with those without these conditions (66.5%), control rates on treatment remained poor (35%-62%). Isolated systolic HTN was the most common hypertensive subtype in those with cardiovascular comorbidities. Nearly three-fourths of adults with cardiovascular comorbidities have HTN, which further compromises their already high cardiovascular disease risk.

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Multicenter Implementation of a Shared Graduate Medical Education Resource

The Accreditation Council of Graduate Medical Education (ACGME) Outcome Project mandates that education outcome assessment be included in residency training programs. In this study, Sisson et al describe how 74 internal medicine residency training programs have implemented an online medical knowledge curriculum composed of educational modules that also provides education outcome assessment. Most programs use the curriculum to comply with ACGME requirements; 82% make module completion mandatory. Nearly all programs track module completion by house staff, and nearly half have resorted to penalties to encourage module completion. Less than half of the programs track group results, and only 1 in 10 use these results for programmatic improvement. Shared educational resources and assessment tools may help residency programs to comply with ACGME program requirements.

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Trends in Tuberculosis/Human Immunodeficiency Virus Comorbidity, United States, 1993-2004

Albalak et al analyzed all incident tuberculosis (TB) cases reported to the Centers for Disease Control and Prevention (CDC) national TB surveillance system from all 50 states and the District of Columbia from 1993 through 2004. Cases of TB/human immunodeficiency virus (HIV) decreased from 3681 (15% of 25 108 TB cases) in 1993 to 1187 (8% of 14 515 TB cases) in 2004, accounting for 23% of the overall decrease in TB cases during this period. The TB/HIV case rate decreased from 1.4/100 000 in 1993 to 0.4/100 000 in 2004. The substantial decreases in TB/HIV comorbidity coincide with improvements in TB control and advances in HIV treatment and diagnosis. The overall decreases obscure the wide variation in comorbidity that exists among some demographic groups and the recent slowing in the decline over the past 3 years.

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Number of TB/HIV cases as a percentage of all TB cases by region.

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