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21 December 2010 Annals of Internal Medicine Tip Sheet

Below is information about three articles being published in the December 7 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.

1. Echinacea No Better Than Placebo at Decreasing Cold Duration, Severity

The common cold is the most frequent human illness. There is no cure for the common cold, but symptoms such as congestion, sore throat, and fever usually spontaneously resolve themselves in about seven to 10 days. Some over-the-counter treatments may reduce symptoms, but none has been proven to shorten illness duration. Echinacea, an herbal treatment, has been widely used to treat the cold, but its efficacy is a source of debate. Researchers studied 719 persons with early cold symptoms between 12 and 80 years old to determine whether Echinacea decreased the severity or duration of cold symptoms. Participants were randomly assigned to receive either no pill, a pill that they knew contained Echinacea, or a pill that could be either Echinacea or a placebo. Patients recorded their symptoms twice a day for approximately one week. Participants who received Echinacea had a very slight (7-10 hour), statistically insignificant decrease in the duration of their cold symptoms. Similarly, there was no significant decrease in severity of symptoms. This study suggests that taking Echinacea does not make a difference in the length or severity of the common cold.

2. Whole-fat Dairy Consumption Linked to Decreased Diabetes Risk

The effects of fatty acids on metabolic outcomes such as cholesterol, insulin, and blood sugar levels are complex and often depend on whether the fats are produced in the body or come from dietary sources. Palmitoleate is a fatty acid that has been linked to both positive and negative metabolic outcomes. It is both produced by the body and comes from dietary sources. Conversely, the trans isomer of palmitoleate, trans-palmitoleate, comes only from whole-fat dairy products. Researchers observed 3,736 adults 65 and older from 1992-2006 to determine the relationship between dairy consumption and metabolic outcomes. Participants completed a questionnaire about diet and other factors related to health. After three years, researchers took blood samples and measured fatty acid levels, including trans-palmitoleate. The researchers found that participants that reported eating more whole-fat dairy products had higher blood levels of trans-palmitoleate. Higher trans-palmitoleate levels were associated with slightly lower body fat, higher good cholesterol levels, and lower triglyceride levels, among other metabolic benefits. Most significantly, those with higher blood levels of trans-palmitoleate had a three-fold lower risk of developing diabetes. Researchers suggest more research to see whether eating more dairy fat to raise trans-palmitoleate levels might be useful in preventing diabetes.

3. USPSTF to Update its Recommendations for Preventing Falls in the Elderly: Exercise and Vitamin D Shown to be the Most Effective Intervention

Falls are a leading cause of death and injury among persons 65 years and older. The U.S. Preventive Services Task Force (USPSTF) has drafted a revised recommendation statement on fall prevention in the elderly. With the unique needs of the geriatric population in mind, researchers reviewed more than 50 clinical trials to determine the benefits and harms of various primary care interventions to prevent falls in community-dwelling older adults. According to the authors, exercise and Vitamin D supplements are the best ways to reduce the risk of falling in people aged 65 and over. Multifactorial assessment and management interventions, medication assessment and withdrawal, home hazard modification, and behavioral counseling also helped to reduce falls. Data from this review will be used to draft an updated recommendation statement to be posted for public comment at http://www.uspreventiveservicestaskforce.org/tfcomment.htm (date of posting to be determined). Study analysis and conclusions are published in Annals of Internal Medicine and will be used to draft the final recommendation.

4. Expanding HIV Screening and Treatment Effective and Cost-Effective for Improving Health Outcomes, But Not Enough to Reduce Rates of New HIV Infections

The incidence of U.S. HIV infections has remained steady at approximately 56,000 new infections a year. Recent clinical guidelines recommend expanding HIV screening to all patients 13 and older regardless of risk factors. Researchers developed a mathematical model to evaluate the effect of expanded screening, use of antiretroviral therapy (ART), and behavioral counseling on the U.S. HIV epidemic. The researchers sought to determine whether expansion of screening, treatment, or both could substantially diminish the HIV epidemic in the U.S. and whether allocating resources to screening or to treatment was a better strategy to reduce new infections. Unlike previous studies, the researchers also evaluated the effects of reductions in risk behavior on the epidemic. They found that expanding HIV testing and treatment simultaneously was more beneficial and cost-effective in reducing new infections than using either method alone. However, this combination only decreased new infections by 17.3 24 percent, depending on screening intervals. Adding strategies to reduce behaviors that spread infection for those who test positive to the mix reduced new infections by 65 percent, suggesting that a multimodal approach of testing, treatment, and behavior change would be needed to significantly reduce the HIV epidemic.