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February 28, 2011, Vol 171, No. 4, Pages 279-369

Editorial

Usefulness of Novel Screening Tests for Cardiovascular Disease

Abstract Full Text
Arch Intern Med. 2011;171(4):284-285. doi:10.1001/archinternmed.2010.543
Original Investigation

The Relationship Between Hospital Spending and Mortality in Patients With Sepsis

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Arch Intern Med. 2011;171(4):292-299. doi:10.1001/archinternmed.2011.12

Helping Patients Simplify and Safely Use Complex Prescription Regimens

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Arch Intern Med. 2011;171(4):300-305. doi:10.1001/archinternmed.2011.39

Preventing Weight Gain by Lifestyle Intervention in a General Practice SettingThree-Year Results of a Randomized Controlled Trial

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Arch Intern Med. 2011;171(4):306-313. doi:10.1001/archinternmed.2011.22

The Influence of Physician Acknowledgment of Patients' Weight Status on Patient Perceptions of Overweight and Obesity in the United States

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Arch Intern Med. 2011;171(4):316-321. doi:10.1001/archinternmed.2010.549

Delivery and Outcomes of a Yearlong Home Exercise Program After Hip FractureA Randomized Controlled Trial

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Arch Intern Med. 2011;171(4):323-331. doi:10.1001/archinternmed.2011.15

Heavy Smoking in Midlife and Long-term Risk of Alzheimer Disease and Vascular Dementia

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Arch Intern Med. 2011;171(4):333-339. doi:10.1001/archinternmed.2010.393
BackgroundSmoking is a risk factor for several life-threatening diseases, but its long-term association with dementia is controversial and somewhat understudied. Our objective was to investigate the long-term association of amount of smoking in middle age on the risk of dementia, Alzheimer disease (AD), and vascular dementia (VaD) several decades later in a large, diverse population.MethodsWe analyzed prospective data from a multiethnic population-based cohort of 21 123 members of a health care system who participated in a survey between 1978 and 1985. Diagnoses of dementia, AD, and VaD made in internal medicine, neurology, and neuropsychology were collected from January 1, 1994, to July 31, 2008. Multivariate Cox proportional hazards models were used to investigate the association between midlife smoking and risk of dementia, AD, and VaD.ResultsA total of 5367 people (25.4%) were diagnosed as having dementia (including 1136 cases of AD and 416 cases of VaD) during a mean follow-up period of 23 years. Results were adjusted for age, sex, education, race, marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease, stroke, and alcohol use. Compared with nonsmokers, those smoking more than 2 packs a day had an elevated risk of dementia (adjusted hazard ratio [HR], 2.14; 95% CI, 1.65-2.78), AD (adjusted HR, 2.57; 95% CI, 1.63-4.03), and VaD (adjusted HR, 2.72; 95% CI, 1.20-6.18).ConclusionsIn this large cohort, heavy smoking in midlife was associated with a greater than 100% increase in risk of dementia, AD, and VaD more than 2 decades later. These results suggest that the brain is not immune to long-term consequences of heavy smoking.

Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black MenThe BARBER-1 Study: A Cluster Randomized Trial

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Arch Intern Med. 2011;171(4):342-350. doi:10.1001/archinternmed.2010.390
BackgroundBarbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain.MethodsTo evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers motivates male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control, a cluster randomized trial (BARBER-1) of HTN control was conducted among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006–December 2008). Participants underwent 10-week baseline BP screening, and then study sites were randomized to a comparison group that received standard BP pamphlets (8 shops, 77 hypertensive patrons per shop) or an intervention group in which barbers continually offered BP checks with haircuts and promoted physician follow-up with sex-specific peer-based health messaging (9 shops, 75 hypertensive patrons per shop). After 10 months, follow-up data were obtained. The primary outcome measure was change in HTN control rate for each barbershop.ResultsThe HTN control rate increased more in intervention barbershops than in comparison barbershops (absolute group difference, 8.8% [95% confidence interval (CI), 0.8%-16.9%]) (P = .04); the intervention effect persisted after adjustment for covariates (P = .03). A marginal intervention effect was found for systolic BP change (absolute group difference, −2.5 mm Hg [95% CI, −5.3 to 0.3 mm Hg]) (P = .08).ConclusionsThe effect of BP screening on HTN control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician follow-up. Further research is warranted.Trial Registrationclinicaltrials.gov Identifier: NCT00325533

Translation of a Dementia Caregiver Support Program in a Health Care System—REACH VA

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Arch Intern Med. 2011;171(4):353-359. doi:10.1001/archinternmed.2010.548
Invited Commentary

Is Primary Care Practice Equipped to Deal With Obesity?Comment on “Preventing Weight Gain by Lifestyle Intervention in a General Practice Setting”

Abstract Full Text
Arch Intern Med. 2011;171(4):313-315. doi:10.1001/archinternmed.2011.3

Telling Patients They Are Overweight or Obese: An Insult or an Effective Intervention?Comment on “The Influence of Physician Acknowledgment of Patients' Weight Status on Patient Perceptions of Overweight and Obesity in the United States”

Abstract Full Text
Arch Intern Med. 2011;171(4):321-322. doi:10.1001/archinternmed.2011.5

Preclinical Alzheimer Disease: Prevention Holy Grail or Pandora's Box?Comment on “Heavy Smoking in Midlife and Long-term Risk of Alzheimer Disease and Vascular Dementia”

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Arch Intern Med. 2011;171(4):339-340. doi:10.1001/archinternmed.2010.547

A Bald Fade and a BP CheckComment on “Effectiveness of a Barbershop-Based Intervention for Improving Hypertension Control in Black Men”

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Arch Intern Med. 2011;171(4):350-352. doi:10.1001/archinternmed.2010.404

Fulfilling Our Obligation to the Caregiver: It's Time for ActionComment on “Translation of a Dementia Caregiver Support Program in a Health Care System—REACH VA”

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Arch Intern Med. 2011;171(4):359-360. doi:10.1001/archinternmed.2011.17

A Model Program for a Devastating Disease: Important Content and Methods Issues in Translating Research Into PracticeComment on “Translation of a Dementia Caregiver Support Program in a Health Care System—REACH VA”

Abstract Full Text
Arch Intern Med. 2011;171(4):360-361. doi:10.1001/archinternmed.2011.11
Research Letter

When Metformin Fails in Type 2 Diabetes Mellitus

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Arch Intern Med. 2011;171(4):365-366. doi:10.1001/archinternmed.2011.4
Images From Our Readers

Virgin Island at noon

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Arch Intern Med. 2011;171(4):315. doi:10.1001/archinternmed.2011.37

Kruger National Park, South Africa

Abstract Full Text
Arch Intern Med. 2011;171(4):352. doi:10.1001/archinternmed.2011.38
In This Issue of Archives of Internal Medicine

In This Issue of Archives of Internal Medicine

Abstract Full Text
Arch Intern Med. 2011;171(4):279-279. doi:10.1001/archinternmed.2011.24
Commentary

Texas Atherosclerosis Imaging BillQuiet Origins, Broad Implications

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Arch Intern Med. 2011;171(4):281-283. doi:10.1001/archinternmed.2011.25
Special Article

Assessing Risk Factors as Potential Screening TestsA Simple Assessment Tool

Abstract Full Text
Arch Intern Med. 2011;171(4):286-291. doi:10.1001/archinternmed.2010.378
Many risk factors for disease are suggested as screening tests when there is little prospect that they could be useful in predicting disease. To avoid this, it is useful to know the relationship between the relative risk of a disease or disorder in people with high and low values of a risk factor, and the equivalent screening performance in terms of the detection rate (sensitivity) for a specified false-positive rate. We describe an interactive Risk-Screening Converter, accessible from the Internet (http://www.wolfson.qmul.ac.uk/rsc/http://www.wolfson.qmul.ac.uk/rsc/), that transforms an odds ratio into the equivalent estimates of detection and false-positive rates. The converter is intended for general clinicians, for people engaged in research into risk factors and disease, and for those who give advice on applying such research findings into medical practice. It should help to distinguish effective screening methods from ineffective ones, and so improve clinical guidelines relating to screening and the prediction and prevention of disease.
Article

Error in Wording in: Persistence of Cardiovascular Risk After Rofecoxib Discontinuation

Abstract Full Text
Arch Intern Med. 2011;171(4):305-305. doi:10.1001/archinternmed.2010.546
Clinical Observation

Frequent Hypoglycemia Among Elderly Patients With Poor Glycemic Control

Abstract Full Text
Arch Intern Med. 2011;171(4):362-364. doi:10.1001/archinternmed.2010.539
Editor's Correspondence

Caution in Generalizing Part D Results to Medicare Population—Reply

Abstract Full Text
Arch Intern Med. 2011;171(4):365-369. doi:10.1001/archinternmed.2011.10

Outcomes of Preoperative Medical Consultation

Abstract Full Text
Arch Intern Med. 2011;171(4):365-369. doi:10.1001/archinternmed.2011.6

Is There Value in a Preoperative Medical Consultation?

Abstract Full Text
Arch Intern Med. 2011;171(4):365-369. doi:10.1001/archinternmed.2011.7

Is There Value in a Preoperative Medical Consultation?—Reply

Abstract Full Text
Arch Intern Med. 2011;171(4):365-369. doi:10.1001/archinternmed.2011.8

Caution in Generalizing Part D Results to Medicare Population

Abstract Full Text
Arch Intern Med. 2011;171(4):366-367. doi:10.1001/archinternmed.2011.9
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