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In This Issue of Archives of Internal Medicine
April 13, 2009

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2009;169(7):648. doi:10.1001/archinternmed.2009.47

Incarceration, Incident Hypertension, and Access to Health Care

Incarceration is associated with increased cardiovascular disease mortality, but prospective studies exploring mechanisms of this association are lacking. In this article, Wang et al explore the association between prior incarceration and cardiovascular risk factors using data from 4350 black and white men and women of the Coronary Artery Risk Development in Young Adults study. Former inmates were more likely to develop hypertension in young adulthood (odds ratio, 1.7; 95% confidence interval, 1.2-2.6), even after adjustment for race, sex, smoking, alcohol and illicit drug use, and lower income observed in former inmates (adjusted odds ratio, 1.6; 95% confidence interval, 1.0-2.6). Identification and treatment of hypertension may be important in reducing cardiovascular disease risk among formerly incarcerated individuals.

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Suboptimal Nutritional Intake for Hypertension Control in 4 Ethnic Groups

Gao et al conducted an analysis of 5972 multiethnic middle-aged and older adults to compare intake of specific nutrients based on the Dietary Approaches to Stop Hypertension (DASH) guidelines for hypertension management. In this sample, less than 30% met any DASH nutrient target. Accordance with the DASH guidelines was lowest in saturated fat intake and highest in cholesterol intake. Multivariate analyses showed significant ethnic differences in DASH accordance in all nutrients but saturated fat. Accordance with the DASH guidelines also differed significantly with and without the inclusion of dietary supplements in the analysis. This study suggests that there is significant variation in DASH goal attainment among ethnicities. Assessments of nutrient intake that exclude dietary supplements may be underestimating DASH accordance.

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Effectiveness of Physical Activity Advice and Prescription by Physicians in Routine Primary Care

Grandes et al address the relevant question of whether physicians working in standard primary care conditions enabled inactive patients to increase physical activity. The results of this large randomized controlled trial of physical activity promotion within primary health care show that the PEPAF program (“Experimental Program for Physical Activity Promotion”), implemented by family physicians in routine primary care, significantly increased physical activity of inactive patients over 6 months. While the overall clinical effect was small, this is the first clinical trial run in primary health care to show a significant positive effect on the achievement of minimum recommended physical activity levels. These results may have an impact on what clinicians do in practice by emphasizing the prescription of physical activity rather than simply its advice.

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Yield of Diagnostic Tests for Celiac Disease in Individuals With Symptoms Suggestive of Irritable Bowel Syndrome

There may be some overlap in symptoms in individuals with irritable bowel syndrome (IBS) and celiac disease. However, testing routinely for celiac disease in individuals meeting diagnostic criteria for IBS is not recommended by the majority of current IBS guidelines. This systematic review and meta-analysis of case series and case-control studies reports the yield of screening for celiac disease in individuals with symptoms suggestive of IBS, with either celiac serologic testing or distal duodenal biopsy. The pooled prevalence of positive celiac serologic test results and biopsy-proven celiac disease in those meeting diagnostic criteria for IBS was as high as 4%. When only case-control studies were included in the analysis, the pooled odds of positive celiac serologic test results or biopsy-proven celiac disease were 3-fold to 4-fold higher in subjects with symptoms suggestive of IBS compared with controls. These data suggest that testing for celiac disease in patients that report symptoms compatible with IBS may be worthwhile.

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Epidemiology of Incident Heart Failure in a Contemporary Elderly Cohort

In the community-based Health, Aging, and Body Composition Study, 258 of the 2934 elderly participants (8.8%) developed new-onset heart failure after 7.1 years of follow-up (13.6 of 1000 person-years). Men and blacks were more likely to develop heart failure. No significant sex-based differences were observed in risk factors. Coronary heart disease and uncontrolled blood pressure had the highest population attributable risk in both races; however, a higher proportion of heart failure cases were attributable to modifiable risk factors in blacks compared with whites (67.8% vs 48.9%). Annual mortality after incident heart failure was 18.0% vs 2.7% in those without heart failure. Although no racial difference in mortality was noted, rehospitalization rates after heart failure were higher in blacks.

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