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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2007;167(4):321.
Risk of Tuberculosis From Exposure to Tobacco Smoke
Bates et al carried out a systematic review and meta-analysis to quantify the relationship of active smoking with tuberculosis (TB) infection, pulmonary disease, and mortality. Twenty-four studies were eligible for inclusion. Data were pooled across studies, and separate meta-analyses were done for TB infection, disease, and mortality. For infection, the summary relative risk (RR) estimate was 1.73; for TB disease, summary estimates ranged from 2.3 to 2.7. This suggests an RR for development of disease in a population of infected individuals of approximately 1.4 to 1.6. Mortality RRs were mostly below the disease RRs, suggesting no additional mortality risk from smoking in those with active TB. These results indicate that TB control policies should incorporate tobacco control as one of the preventive interventions.
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Screening for Occult REnal Disease (SCORED)
Using demographic information and simple noninvasive medical characteristics from a national representative data set, Bang et al developed a numerical scoring system to predict prevalent chronic kidney disease. The scoring system was developed using the National Health and Nutrition Examination Survey and was validated independently in the Atherosclerosis Risk in Communities Study. Advanced age, female sex, history of hypertension, diabetes mellitus, proteinuria, or cardiovascular disease (including peripheral vascular disease and heart failure) were associated with a glomerular filtration rate less than 60 mL/min per 1.73 m2. After assigning points to each risk factor, a score of 4 or higher was chosen as a numeric cutpoint for screening based on the optimal balance of diagnostic characteristics (sensitivity of 92%, specificity of 68%, positive predictive value of 18%, and negative predictive value of 99%). This scoring system may be a useful tool for identifying individuals with a high likelihood of underlying kidney disease.
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Web-Based Education in Systems-Based Practice
All accredited US residency programs are expected to offer curricula and evaluate their residents in 6 general competencies. Medical schools are now adopting similar competency frameworks. In this multi-institutional randomized controlled trial, 693 residents and medical students were enrolled in a Web-based educational program on systems-based practice competencies (patient safety and the US health care system). Over its 9-week duration, the educational program generated significant and durable learning.
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Frequency of Analgesic Use and Risk of Hypertension Among Men
Forman et al studied the association between intake of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin and risk of incident hypertension in a prospective cohort analysis of 16 031 male health professionals without baseline hypertension. After adjusting for multiple potential confounders, the relative risk of incident hypertension during 4 years of follow-up among men who used acetaminophen 6 to 7 days per week compared with nonusers was 1.34 (95% confidence interval [CI], 1.00-1.79; P value for trend, .01). Similar comparisons resulted in relative risks of 1.38 (95% CI, 1.09-1.75; P value for trend, .002) for nonsteroidal anti-inflammatory drugs and 1.26 (95% CI, 1.14-1.40; P value for trend, <.001) for aspirin. The authors conclude that nonnarcotic analgesic use is independently associated with an increased risk of incident hypertension.
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Effect of Raw Garlic vs Commercial Garlic Supplements on Plasma Lipid Concentrations in Adults With Moderate Hypercholesterolemia
This study compared the effects of raw garlic with 2 types of garlic supplements (dried powdered vs aged garlic extract) for their effects on low-density lipoprotein cholesterol (LDL-C) among 192 adults, aged 30 to 65 years, with LDL-C concentrations of 130 to 190 mg/dL (3.36-4.91 mmol/L) at the time of screening for eligibility, who were otherwise generally healthy. Participants were randomized to 1 of the 3 types of garlic or placebo groups for 6 months, with blood sampling every month. The doses used were roughly equivalent to an average-sized clove of garlic per day, and for both of the supplements, this amount was between 50% and 100% higher than the label recommendations for these products. The raw garlic was provided to participants as a component of the condiment for daily sandwiches that were given to participants 6 days a week for 6 months. None of the forms of garlic used in this study, including raw garlic, had statistically or clinically significant effects on LDL-C or other plasma lipid concentrations among moderately hypercholesterolemic adults. The authors conclude that physicians can advise patients with moderately elevated LDL-C that garlic supplements or dietary garlic in reasonable doses is unlikely to produce lipid benefits.
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Six-month percent change (mean and SE) relative to the end of the run-in phase in participants with available data.
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(SEE ARTICLE)
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