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16 May 2006 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Three Simple Questions Reliably Distinguish Between Types of Incontinence

Instead of the battery of complicated tests currently recommended for diagnosis of urinary incontinence in women, a new study shows that answers to three simple questions can determine whether a woman has stress incontinence or urge incontinence (Article, p. 715). This issue is important because many older women have urinary incontinence, and the treatment of urge incontinence is different from that of stress incontinence. Asking patients if they leaked urine during the last three months, when they leaked urine, and when they leaked urine most often may help primary care physicians more easily distinguish between the two types of incontinence.

Hepatitis C Profile Suggests Consequences of Disease Are Yet to Come

An update to a large national health survey finds that the total number of people infected with hepatitis C virus has not changed substantially between 1994 and 2002. However, the most frequent age bracket of those infected has shifted from 30 to 39 in the earlier study to 40 to 49 in the current study (Article, p. 715). Most infected people engaged in IV drug use in their youth and are now entering the age when the consequences of HCV infections, such as cirrhosis, liver cancer and kidney disease, begin. An editorial writer says that the “curious distribution” of HCV infection probably reflects “the aging of the same cohort with HCV infection that was identified during the 1988-1994 survey” (Editorial, p. 770). These people, now in their 40s and 50s, “acquired their infections primarily through injection drug use that began in the 1960s and peaked in the 1980s … a time of widespread experimentation with substances of abuse.” The writer says, “This cohort has lived with unrecognized HCV infection for several decades; however, as they age, they are more likely to seek regular medical care and apply for life insurance, unearthing their HCV infection.”

Study Says Drug Is Effective in Treating Long-Term Chagas Disease

A new controlled, long-term study finds that benznidazole, a drug used to treat early phases of Chagas disease, also appears to slow worsening of the consequences of chronic Chagas disease, such as heart failure (Article, p. 724; Editorial. p. 772). Chagas disease, a parasitic infection, is on the World Health Organization’s list of neglected infectious diseases that disproportionately affect poor and marginalized people.

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