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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2002;162:2160.
Frequency of Analgesic Use and Risk of Hypertension in Younger Women
Analgesic use is quite common, particularly among women. Curhan et al
prospectively studied the association between the frequency of use of aspirin,
nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen and the risk
of incident hypertension in a young female cohort (Nurses' Health Study II).
After adjusting for potential confounders, the risk of hypertension increased
with increasing frequency of use of NSAIDs and acetaminophen; women who took
NSAIDs or acetaminophen for 22 or more days per month nearly doubled their
risk of developing hypertension over a 2-year period. A substantial proportion
of hypertension in the United States may be due to the use of these readily
available medications.
(SEE ARTICLE)
Outcome and Attributable Mortality in Critically Ill Patients With
Bacteremia Involving Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus
Blot et al determined attributable mortality in critically ill patients
with methicillin-susceptible (n = 38) and methicillin-resistant (n = 47) Staphylococcus aureus bacteremia. Therefore, 2 independent
case-control studies were performed, after which attributable mortality rates
were compared. Methicillin-susceptible S aureus bacteremia
was associated with an attributable mortality rate of 1.3%, since mortality
rates for cases and controls were, respectively, 23.7% vs 22.4%. Methicillin-resistant S aureus bacteremia had an attributable mortality rate
of 23.4%, since mortality rates in cases and controls were, respectively,
63.8% vs 40.4%. The difference between both attributable mortality rates (22.1%)
was significant (95% confidence interval, 8.8%-35.3%).
(SEE ARTICLE)
Antibiotic Resistance: A Survey of Physician Perceptions
Among 424 internal medicine physicians surveyed at 4 hospitals in Chicago,
Ill, 87% believed that inpatient antibiotic resistance was a very important
national problem, but only 55% considered it a very important problem at their
hospitals, despite rates that were similar to the national average. Similarly,
97% believed that widespread and inappropriate antibiotic use were very important
causes, yet only 60% favored restricting broad-spectrum antibiotics, an intervention
of proven benefit. Surprisingly, fewer than half the physicians at the 2 teaching
hospitals considered poor hand washing a very important cause, despite strong
supporting published evidence. These contradictory perspectives must be addressed
to effectively combat antibiotic resistance.
(SEE ARTICLE)
Racial and Ethnic Differences in Alcohol-Associated Aspartate Aminotransferase
and  -Glutamyltransferase Elevation
Age-adjusted mortality from liver cirrhosis has been shown to vary by
race and ethnicity in the United States. Mortality is highest in Hispanics,
intermediate in non-Hispanic blacks, and lowest in non-Hispanic whites. The
contribution of alcohol drinking to these differences is unknown. In this
epidemiologic analysis, Stewart evaluated aspartate aminotransferase and -glutamyltransferase
level elevations among Mexican American, non-Hispanic black, and non-Hispanic
whites within defined drinking categories. For both these enzymes, the relative
risk for at least a 2-fold elevation was proportional to drinking frequency,
and no increased risk was detected among current abstainers. These results
suggest that racial and ethnic differences in susceptibility to alcohol-induced
hepatotoxicity may contribute to corresponding disparities in cirrhosis mortality.
(SEE ARTICLE)
Undertreatment of Osteoporosis in Men With Hip Fracture
The medical community has become increasingly aware that women are not
aggressively treated for osteoporosis after hip fracture; however, the treatment
status of men with hip fracture has not been extensively studied. Kiebzak
et al evaluated the outcome and treatment status of men with hip fracture.
Data from medical records were obtained for 110 men and 253 women 50 years
or older with atraumatic (low-energy) hip fracture between 1996 and 2000.
Surveys were mailed to surviving patients. The mean age for men was 80 years
vs 81 years for women. Most fractures resulted from falls from a standing
height. At discharge, only 4.5% of men had treatment of any kind for osteoporosis
compared with 27% of women. The 12-month mortality rate was 32% in men compared
with 17% for women. At 1- to 5-year follow-up, 12 (27%) of 44 men were taking
treatment of any kind for osteoporosis compared with 88 (71%) of 124 women.
Only 11% of men had a bone mineral density measurement compared with 27% of
women. After discharge, the number of men and women who required wheelchairs,
walkers, and canes, and who lived in institutions, increased significantly.
The burden of hip fracture is illustrated by both the high incidence of postfracture
disability and the high mortality rate in both men and women. Nevertheless,
only a minority of men receive antiresorptive treatment.
(SEE ARTICLE)
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