Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

15 June 2010 Annals of Internal Medicine Tip Sheet

Below is information about two early online releases and three articles being published in the June 15 issue of Annals of Internal Medicine. The information is not intended to substitute for articles as sources of information. Annals of Internal Medicine attribution is required for all coverage. For an embargoed copy of a study, contact Angela Collom at acollom@acponline.org or 215-351-2653.

Early Online Releases:

1. Insufficient Evidence to Suggest Lifestyle or Medical Interventions Can Delay or Prevent Alzheimer’s or Cognitive Decline in Later Life

Experts Say ‘Promising’ Research on Medication, Diet, Exercise, and Cognitive Engagement May Offer New Insights

Alzheimer’s disease accounts for 60 to 80 percent of all dementia cases and may affect as many as 5.1 million Americans. The prevalence of mild cognitive impairment is even higher. Multiple biological, behavioral, social, and environmental factors may contribute to the delay or prevention of cognitive decline. Researchers reviewed evidence from 127 observational studies, 22 randomized control trials, and 16 systematic reviews in areas such as diet; medical factors/medications; socioeconomic and behavioral factors; environmental factors; and genetics. Based on the evidence, the researchers sought to determine if any of these factors could delay or prevent Alzheimer’s disease or cognitive decline later in life. While some lifestyle factors such as a Mediterranean-type diet, consumption of omega 3 fatty acid, and engagement in physical and leisure activities were associated with a lower risk of cognitive decline, available evidence is too weak to justify strongly recommending them to patients. Likewise, some factors, such as the gene marker APOEe4 allele, depressive symptoms, and metabolic syndrome were associated with a higher risk of cognitive decline, yet evidence was also limited. Stronger evidence showed that people who smoke or have diabetes are at an increased risk for cognitive decline. The researchers could not draw firm conclusions about the association of any modifiable risk factor with cognitive decline or Alzheimer’s disease. They recognize that a large amount of promising research on medication, diet, exercise, and cognitive engagement is underway.

2. Ribavirin Shows Promise for Treating Chronic Hepatitis E

Hepatitis E (HEV) is inflammation of the liver spread through food or water contaminated by feces from an infected person. While uncommon in the United States, people who travel internationally and those who live with or have sex with an infected person are at risk. Acute HEV infection has a high mortality rate in older persons, pregnant women, and patients with underlying chronic liver disease. Currently, there is no accepted treatment for HEV. However, researchers have reported two cases in which patients with HEV seemed to improve after being treated with ribavirin. The patients were given oral doses of ribavirin for 12 weeks. Liver function returned to normal for both patients after two weeks, and both were cleared of HEV after four weeks. HEV RNA remained undetectable in the serum and stool tests throughout the two- to three-month follow up period. Researchers conclude that ribavirin shows potential promise in the treatment for HEV.

In This Issue:

3. Adding Nucleic Acid Testing to HIV Screening May Help Identify More People with HIV

Patients Willing to Use Automated Systems to Retrieve Results

Community-based HIV testing programs generally use only HIV antibody testing, but nucleic acid testing (NAT) can detect the presence of HIV earlier. Researchers studied more than 3,000 patients who sought HIV testing in community-based clinics in or near San Diego to examine the yield of testing with a rapid test plus NAT and to see whether patients would be willing to access their resulst by phone or computer. The patients were first tested for HIV with a rapid saliva test. If the result was positive, a counselor informed the patient and blood was obtained for a standard HIV test. If the result was negative, blood was obtained for a NAT. Nearly one quarter of persons with identified cases of HIV had positive results only by NAT testing. More than two thirds of patients with negative NAT results retrieved them via computer or voicemail. The researchers conclude that addition of NAT to HIV antibody testing in community-based programs may significantly improve case yield and diagnosis. In addition, automated reporting of negative results may prove an acceptable and less resource intense alternative to face-to-face reporting.

4. Hemoglobin A1c Levels Differ in Black and White Patients, Regardless of Blood Sugar Level

Findings Could Affect the Way Physicians Use Hemoglobin A1c to Test for Diabetes in Blacks

Studies have shown that blacks have higher hemoglobin A1c levels than whites. Experts have attributed this disparity to differences in diabetes control related to socioeconomic status, access to and use of medical care, and health care provider behavior. However, some prior studies suggest that hemoglobin A1c levels may be affected by factors other than glucose concentration. Researchers studied two populations of patients without known diabetes: 1,581 non-Hispanic black and white patients between the ages of 18 and 87 and 1,967 non-Hispanic black and white patients over the age of 40 who did not have diabetes to determine whether black-white differences in hemoglobin A1c levels differed between blacks and whites with no differences in glucose concentration. They found that hemoglobin A1c levels are consistently higher in black than in white populations, regardless of glucose levels. Researchers suggest that these findings could limit the use of hemoglobin A1c screening for glucose intolerance, predicting the risk for complications of diabetes, and measuring quality of care.

5. Researchers Rank Medical Schools Based on Their Contribution to the Nation’s Health Care

One of the basic purposes of medical schools is to educate physicians to care for the national population. This requires adequate number of primary care physicians, adequate distribution of physicians to underserved areas, and a sufficient number of minority physicians in the workforce. Researchers sought to rank medical schools based on their contributions to society. They studied more than 60,000 physicians in active practice who graduated from medical school between 1999 and 2001 to determine the percentage of graduates who practice primary care, work in underserved areas, and are underrepresented minorities. They used this data to develop “social mission score” for U.S. medical schools. Schools that ranked high on social mission scores were not necessarily those that ranked high on more traditional measures of medical school performance such as research funding*. The study authors say the rankings are important because, regardless of any future health care reform, “a diverse, equitably distributed physician workforce with a strong primary care base is essential to achieve quality healthcare that is accessible and affordable.”

*For a complete list of rankings, contact Angela Collom at acollom@acponline.org or 215-351-2653.