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The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality
After adjusting for sociodemographics, access, illness burden, health status, and prior health expenditures, patients with the highest satisfaction with their physicians (relative to those with the least satisfaction) had lower emergency department use but greater inpatient use, higher total and prescription expenditures, and higher mortality (an adverse effect more pronounced among those with better health status and lower illness burden). These associations point to the need for better understanding of the factors driving patient satisfaction and raise concern that overemphasis on patient satisfaction could have unintended consequences for health care utilization, costs, and outcomes.
Obesity and Increased Risk for Oligozoospermia and Azoospermia
A systematic review of available literature was conducted to investigate the impact of body mass index on sperm count in men. A total of 14 studies were included in the meta-analysis based on individual patient data, corresponding to a total study sample of 9779 individuals. Overweight and obese men were at significantly increased risk of presenting with oligozoospermia or azoospermia compared with men of normal weight. These data strongly suggest that excess body weight affects sperm production.
Total Daily Physical Activity and Longevity in Old Age
Total daily exercise and nonexercise physical activity was measured 24 h/d for up to 10 days with actigraphs worn on the wrists of 893 community-dwelling older adults. A higher level of total daily physical activity was associated with a reduced risk of death. This association persisted even after adjusting for a wide range of late-life activities and possible confounders. Total daily physical activity captures aspects of activity not assessed by traditional activity measures. These data support a link between a more active lifestyle and survival in old age.
Dabigatran Association With Higher Risk of Acute Coronary Events
Uchino and Hernandez performed a systematic review and meta-analysis of noninferiority randomized trials of dabigatran that reported acute coronary outcomes (myocardial infarction [MI] or acute coronary syndromes [ACS]) until May 2011. Seven trials were selected (n=30 514) including 2 studies of stroke prophylaxis in atrial fibrillation, 1 of acute venous thromboembolism, 1 of ACS, and 3 of short-term prophylaxis of deep venous thrombosis. Control arms included warfarin, enoxaparin, or placebo. Dabigatran was associated with a higher risk for MI or ACS than the control group (dabigatran, 237/20 000 [1.19%], vs control, 83/10 514 [0.79%], odds ratio (Mantel-Haenszel), 1.33; 95% CI 1.03-1.71; P = .03). Clinicians should consider the potential of serious harmful cardiovascular effects with the use of dabigatran.
Trial of Prevention and Reduction of Obesity Through Active Living in Clinical Settings
Ross et al assessed the effectiveness of a 2-year behaviorally based physical activity and diet program implemented entirely within clinical practices to reduce obesity. A total of 490 sedentary, obese adults were randomized to usual care (n = 241) or behavioral intervention (n = 249). A significant main effect was observed for waist circumference change within behavioral intervention compared with usual care (P < .001) that was sustained at 2 years (mean [SE], −0.9 [0.4] cm vs +0.2 [0.4] cm; P < .05). The authors conclude that a pragmatic, behavioral intervention program implemented within clinical settings was associated with sustained reductions in waist circumference in abdominally obese adults.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2012;172(5):387. doi:10.1001/archinternmed.2011.922
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