Archives of Internal Medicine
ISSN / EISSN : 0730-188X / 1538-3679
Published by: Rockefeller University Press (10.1001)
Total articles ≅ 51,495
Latest articles in this journal
Archives of Internal Medicine, Volume 172, pp 1762-1764; https://doi.org/10.1001/2013.jamainternmed.65
Handoffs in hospitals have been widely recognized by both regulators and researchers as a locus of potential communication failure, with substantial risks to patient safety and quality of care.1,2 By conservative estimate, there are over half a billion patient handoff discussions annually in US hospitals. Most empirical studies have been performed in shift-change settings, where most handoffs occur, and where it is typical that responsibility for multiple patients is transferred during a single handoff session. However, theoretical analysis in the literature is entirely focused on how best to hand off a single patient.3-5 As a result, research has overlooked what has been labeled the portfolio problem: how best to allocate across multiple patients the scarce time available for a handoff session.6
Archives of Internal Medicine, Volume 172, pp 1760-1762; https://doi.org/10.1001/2013.jamainternmed.77
Country of birth and length of stay in the United States have proven to be strong predictors of obesity among Mexican Americans,1 suggesting the US environment may be distinctively “obesogenic.”2 For example, a 12-oz bottle of American-made Coca-Cola has 240 calories with 65 g of sugar, whereas Mexican-made Coca-Cola has 150 calories per 12-oz bottle with 39 g of sugar (the former is made from high-fructose corn syrup).3,4 However, there is also evidence that immigrants are resistant to these influences: growth in body mass index (BMI), calculated as weight in kilograms divided by height in meters squared, is slower among immigrants than among US-born Mexican Americans.5 Studies have yet to examine the relationship between migration and obesity in a transnational perspective, including comparisons with the Mexican source population to help identify patterns distinctive to the United States.
Archives of Internal Medicine, Volume 172, pp 1751-3; https://doi.org/10.1001/jamainternmed.2013.1780
Published: 10 December 2012
Archives of Internal Medicine, Volume 172, pp 1710-2
Archives of Internal Medicine, Volume 172, pp 1758-1758; https://doi.org/10.1001/2013.jamainternmed.105
Archives of Internal Medicine, Volume 172, pp 1703-1704; https://doi.org/10.1001/2013.jamainternmed.117
The Supreme Court's ruling to uphold most elements of the Accountable Care Act (ACA) provoked a political and legal firestorm that likely will continue past the 2012 election cycle. Numerous commentaries have already been written about the political and legal ramifications of the ruling. Ultimately, however, the Court's decision is likely to have its biggest impact not on politicians or legal experts but rather on those who the current system fails: the uninsured. Perhaps the most influential part of the Court's ruling was its decision to uphold the individual mandate. The mandate, scheduled to phase in over 3 years, will require most US citizens and legal residents to purchase insurance or face an annual tax penalty of either $695 per person (maximum $2085 per family) or 2.5% of household income, whichever is greater. Assuming that most uninsured Americans opt to purchase insurance rather than face the penalty (which is what occurred in Massachusetts following implementation of the individual mandate1), many of the young and healthy who are currently uninsured—the so-called invincibles, who feel they do not need health insurance—will become part of the insurance market. Premiums from these relatively low-cost members will help subsidize sicker, more costly patients, allowing insurance providers to fulfill their obligations to insure everyone, including those with preexisting conditions. For the first time in recent US history, the insurance system could function as it was intended by covering a broad population, both healthy and sick, at more affordable rates.
Archives of Internal Medicine, Volume 172, pp 1710-1711; https://doi.org/10.1001/2013.jamainternmed.263
Lipid testing plays a major role in cardiovascular risk stratification and the assessment of lipid responses to clinical interventions. Current guidelines suggest that blood samples for lipid profiles should be obtained after a 9- to 12-hour fast.1 This requirement is not always practical for patients, who rarely present to health care providers in a fasting state. Patients often expend additional resources to return to a laboratory while fasting, and some may forgo coming back altogether. A report by Sidhu and Naugler in this issue challenges the necessity of fasting before blood collection.2
Archives of Internal Medicine, Volume 172, pp 1707-1710; https://doi.org/10.1001/archinternmed.2012.3708
Background Although current guidelines recommend measuring lipid levels in a fasting state, recent studies suggest that nonfasting lipid profiles change minimally in response to food intake and may be superior to fasting levels in predicting adverse cardiovascular outcomes. The objective of this study was to investigate the association between fasting times and lipid levels. Methods Cross-sectional examination of laboratory data, including fasting duration (in hours) and lipid results, was performed over a 6-month period in 2011 in a large community-based cohort. Data were obtained from Calgary Laboratory Services, Calgary, Alberta, Canada, the sole supplier of laboratory services for Calgary and surrounding areas (source population, 1.4 million persons). The main outcome measures were mean levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, and triglycerides for fasting intervals from 1 hour to more than 16 hours. After differences in individual ages were controlled for, linear regression models were used to estimate the mean levels of cholesterol subclasses at different fasting times. Results A total of 209 180 individuals (111 048 females and 98 132 males) were included in the study. The mean levels of total cholesterol and high-density lipoprotein cholesterol differed little among individuals with various fasting times. The mean calculated low-density lipoprotein cholesterol levels showed slightly greater variations of up to 10% among groups of patients with different fasting intervals, and the mean triglyceride levels showed variations of up to 20%. Conclusion Fasting times showed little association with lipid subclass levels in a community-based population, which suggests that fasting for routine lipid levels is largely unnecessary.
Archives of Internal Medicine, Volume 172, pp 1731-1737; https://doi.org/10.1001/2013.jamainternmed.447
Background Employment instability is a major source of strain affecting an increasing number of adults in the United States. Little is known about the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction (AMI). Methods We investigated the associations between different dimensions of unemployment and the risks for AMI in US adults in a prospective cohort study of adults (N = 13 451) aged 51 to 75 years in the Health and Retirement Study with biennial follow-up interviews from 1992 to 2010. Unadjusted rates of age-specific AMI were used to demonstrate observed differences by employment status, cumulative number of job losses, and cumulative time unemployed. Cox proportional hazards models were used to examine the multivariate effects of cumulative work histories on AMI while adjusting for sociodemographic background and confounding risk factors. Results The median age of the study cohort was 62 years, and 1061 AMI events (7.9%) occurred during the 165 169 person-years of observation. Among the sample, 14.0% of subjects were unemployed at baseline, 69.7% had 1 or more cumulative job losses, and 35.1% had spent time unemployed. Unadjusted plots showed that age-specific rates of AMI differed significantly for each dimension of work history. Multivariate models showed that AMI risks were significantly higher among the unemployed (hazard ratio, 1.35 [95% CI, 1.10-1.66]) and that risks increased incrementally from 1 job loss (1.22 [1.04-1.42]) to 4 or more cumulative job losses (1.63 [1.29-2.07]) compared with no job loss. Risks for AMI were particularly elevated within the first year of unemployment (hazard ratio, 1.27 [95% CI, 1.01-1.60]) but not thereafter. Results were robust after adjustments for multiple clinical, socioeconomic, and behavioral risk factors. Conclusions Unemployment status, multiple job losses, and short periods without work are all significant risk factors for acute cardiovascular events.
Archives of Internal Medicine, Volume 172, pp 1737-1738; https://doi.org/10.1001/jamainternmed.2013.1835
Opinion from JAMA Internal Medicine — Evolution of Research on the Effect of Unemployment on Acute Myocardial Infarction Risk — Comment on “The Cumulative Effect of Unemployment on Risks for Acute Myocardial Infarction”