The American Journal of Medicine (AM J MED)

Publications in this journal

• Article: Sleep Apnea and Risk of Deep Venous Thrombosis: Looking for Potential Confounders

  Aibek E. Mirrakhimov
  The American Journal of Medicine 11/2012;
• Article: Total antioxidant capacity from diet and risk of myocardial infarction: a prospective cohort of women.

  Rautiainen S, Levitan EB, Orsini N, Åkesson A, Morgenstern R, Mittleman MA, Wolk A
  The American Journal of Medicine 10/2012; 125(10):974-80.
• Article: Attributable risk estimate of severe psoriasis on major cardiovascular events.

  MD Nehal N. Mehta, MSCE, FAHA, BA YiDing Yu, BS Rebecca Pinnelas, MD Parasuram Krishnamoorthy, BA Daniel B. Shin, Andrea B. Troxel, ScD, MD Joel M. Gelfand, MSCE
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  ABSTRACT: BACKGROUND: Recent studies suggest that psoriasis, particularly if severe, may be a risk factor for major adverse cardiac events, such as myocardial infarction, stroke, and mortality from cardiovascular disease. We compared the risk of major adverse cardiac events between patients with psoriasis and the general population and estimated the attributable risk of severe psoriasis. METHODS: We performed a cohort study in the General Practice Research Database. Severe psoriasis was defined as receiving a psoriasis diagnosis and systemic therapy (N=3603). Up to 4 patients without psoriasis were selected from the same practices and start dates for each patient with psoriasis (N=14,330). RESULTS: Severe psoriasis was a risk factor for major adverse cardiac events (hazard ratio 1.53; 95% confidence interval, 1.26-1.85) after adjusting for age, gender, diabetes, hypertension, tobacco use, and hyperlipidemia. After fully adjusted analysis, severe psoriasis conferred an additional 6.2% absolute risk of 10-year major adverse cardiac events. CONCLUSION: Severe psoriasis confers an additional 6.2% absolute risk of a 10-year rate of major adverse cardiac events compared with the general population. This potentially has important therapeutic implications for cardiovascular risk stratification and prevention in patients with severe psoriasis. Future prospective studies are needed to validate these findings.
  The American Journal of Medicine 01/2011; 124:775.e1-775.e6.
• Article: Introduction.

  Eugene R Schiff
  The American Journal of Medicine 11/2005; 118 Suppl 10A:1S-6S.
• Article: The two cultures in Chekhov's "The Butterfly".

  Helle Mathiasen
  The American Journal of Medicine 11/2005; 118(10):1179.
• Article: Doctors and the drug industry: reader feedback.

  David A Nardone
  The American Journal of Medicine 11/2005; 118(10):1176-7; author reply 1177.
• Article: Folate, mitochondria, ROS, and the aging brain.

  Celia M Ross
  The American Journal of Medicine 11/2005; 118(10):1174; author reply 1174-5.
• Article: Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence.

  Louise C Walter, Carmen L Lewis, Mary B Barton
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  ABSTRACT: There is general consensus that screening can reduce mortality from colorectal, breast, and cervical cancer among persons in their 50s and 60s. However, few screening trials have included persons over age 70 years. Therefore, indirect evidence must be used to determine when results in younger persons should be extrapolated to older persons. In this review, we focus on cancer screening tests that are well accepted in younger persons (mammography, Papanicolaou smears, and colorectal cancer screening) and discuss the strength of inference concerning benefits and harms of screening older persons. Some aspects of aging favor screening (eg, increased absolute risk of dying of cancer) whereas other aspects do not (eg, decreased life expectancy). Age also affects the behavior of some cancers (eg, increases the proportion of slow-growing breast cancers) and affects the accuracy of some screening tests (eg, increases the accuracy of mammography; decreases the accuracy of sigmoidoscopy). These effects make the application of evidence in younger populations to older populations complex. However, given the heterogeneity of the elderly population, there is no evidence of one age at which potential benefits of screening suddenly cease or potential harms suddenly become substantial for everyone. Therefore, characteristics of individual patients that go beyond age should be the driving factors in screening decisions. For example, persons who have a life expectancy less than 5 years or persons who would decline treatment should generally not be screened. Decisions to either continue or discontinue screening in the elderly should be based on health status, the benefits and harms of the test, and preferences of the patient, rather than solely on the age of the patient.
  The American Journal of Medicine 11/2005; 118(10):1078-86.
• Article: Hepatitis A and B immunization in persons being evaluated for sexually transmitted diseases.

  H Hunter Handsfield
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  ABSTRACT: Sexual transmission accounts for the majority of hepatitis B virus (HBV) infections in industrialized countries. Hepatitis A virus (HAV) can be transmitted by sexual practices that involve fecal-oral exposure. Both infections are disproportionately frequent in men who have sex with men (MSM). Routine immunization against HBV is recommended for MSM and for persons being evaluated or treated for sexually transmitted diseases (STDs), and HAV immunization is advised for MSM and for other persons at risk who are commonly seen in STD care settings, such as users of illegal drugs. However, numerous attitudinal and structural barriers interfere with routine immunization in persons at risk for sexual acquisition of HAV and HBV. Substantial success has been documented in vaccinating persons at risk in public STD clinics and other settings; however, at a national level, efforts to achieve desired immunization rates have largely failed. Until universal childhood immunization produces a largely immune adult population, the universal vaccination of adults-as a supplement to the current risk-based approaches-may be worthwhile to achieve immunization of persons at risk for sexual transmission of HBV.
  The American Journal of Medicine 11/2005; 118 Suppl 10A:69S-74S.
• Article: Overcoming obstacles to immunization in patients with chronic liver disease.

  Kathleen Bockhold, Caroline A Riely, Chantil Jeffreys
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  ABSTRACT: The importance of vaccination to protect against hepatitis A virus (HAV) and hepatitis B virus (HBV) infections in patients with chronic liver disease has been established. However, in this population, a number of obstacles can interfere with appropriate and timely hepatitis immunization. The costs of hepatitis A and B vaccine series are out of reach for many uninsured patients. Many private and government-sponsored insurance programs do not routinely cover these vaccinations for patients with chronic liver disease. Varying recommendations by government and national organizations, such as the Centers for Disease Control and Prevention (CDC) and the American Association for the Study of Liver Diseases (AASLD), may lead to uncertainty and inconsistent vaccination practices. Because of the need for multiple office visits for prescreening assessment and vaccine administration, patient adherence can be an issue as well. Improved coverage of vaccines by government and third-party health plans is needed, as are uniform guidelines regarding the vaccination of patients with chronic liver disease. Providers should counsel such patients about the serious health risks incurred by infection with HAV or HBV and encourage vaccination in these patients. A combination of interventions can be used to facilitate timely and appropriate vaccination against hepatitis and to improve the affordability of vaccination for patients with chronic liver disease.
  The American Journal of Medicine 11/2005; 118 Suppl 10A:40S-45S.
• Article: Screening for hepatitis A and B antibodies in patients with chronic liver disease.

  Daryl T-Y Lau, Alex T Hewlett
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  ABSTRACT: Chronic liver disease (CLD) is highly prevalent, and hepatitis C is one of the leading causes. Acute hepatitis A or B in patients with chronic hepatitis C can lead to more severe hepatic injury and a higher fatality rate than in patients without hepatitis C. Thus, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention and the World Health Organization recommend that persons with CLD be vaccinated against hepatitis A virus (HAV), and the ACIP and the National Institutes of Health recommend vaccination against both HAV and hepatitis B virus (HBV) in patients with chronic hepatitis C. Because coinfection with HAV or HBV in patients with chronic hepatitis C or CLD is common, antibody screening prior to hepatitis A or B vaccination can identify patients who are already immune to these viruses and thus do not need to be vaccinated. Selective hepatitis A vaccination (i.e., vaccination of patients who test negative for either HAV antibody immunoglobulin G or total antibodies to HAV) is most cost-effective in areas where the local prevalence of hepatitis A is higher than the national prevalence and in populations with higher background rates of HAV exposure compared with the general population, such as older adults, foreign-born patients, African Americans, and persons with CLD or hepatitis C. Although not usually recommended for healthy adults or those with compensated CLD because of virtually 100% postvaccination seroconversion, serologic testing after hepatitis A vaccination is recommended in patients with decompensated or advanced end-stage liver disease because of the much lower seroconversion rates in these patients. Selective vaccination against HBV in patients with CLD or hepatitis C is also recommended. Testing for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) is considered the most efficient and reasonably cost-effective method to screen for hepatitis B serologic markers because HBsAg identifies individuals with both acute and chronic HBV infection, and anti-HBs identify those who are immune secondary to vaccination or past infection. Testing for antibodies to hepatitis B core antigen is needed to further distinguish between immunity due to vaccination and immunity due to past infection, but it is not recommended as the only screening test for HBV immunity. Postvaccination testing for hepatitis B seroconversion is recommended in all patients with CLD, especially in those with more advanced disease, because the rate of seroconversion is generally lower than in healthy adults. If patients with CLD are not adequately protected after a standard course of hepatitis B vaccination, a repeat course of vaccination using the standard schedule or an accelerated schedule (days 0, 7, and 21) should be considered.
  The American Journal of Medicine 11/2005; 118 Suppl 10A:28S-33S.
• Article: Expanding the use of hepatitis vaccines in obstetrics and gynecology.

  Stanley A Gall
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  ABSTRACT: Current pediatric vaccination schedules in the United States are based on age. In contrast, adults are vaccinated against most infectious diseases, including hepatitis A and B, only when they are identified as at high risk or after a known exposure. There are multiple risk factors for hepatitis A and B of which clinicians often are not aware. Consequently, many persons at high risk are never vaccinated. Universal vaccination against hepatitis A and B is recommended for adults to halt transmission of the virus and prevent long-term sequelae. Women and their offspring are an especially important population to consider in efforts to reduce the incidence of hepatitis. The following recommendations for expanding the use of hepatitis vaccines in obstetrics and gynecology are made in this article: all older adolescents and adults should be vaccinated regardless of risk factors, and greater efforts should be made to educate physicians about the need to vaccinate their patients against hepatitis.
  The American Journal of Medicine 11/2005; 118 Suppl 10A:96S-99S.
• Article: Experience with hepatitis A and B vaccines.

  Jeffrey P Davis
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  ABSTRACT: The lengthy history of efforts to understand the pathogenesis and means of preventing and controlling both hepatitis A and B is noteworthy for many exceptional scientific achievements. Among these are the development of vaccines to prevent the spread of infection through induction of active immunity to hepatitis A virus (HAV) and hepatitis B virus (HBV). The first plasma-derived hepatitis B vaccine was licensed in the United States in 1981 and was replaced by recombinant hepatitis B vaccines in 1986 and 1989. Vaccines to prevent HAV infection were licensed in the United States in 1995 and 1996. Subsequently, combination vaccines that included both hepatitis A and B vaccine components, or the hepatitis B component in combination with other commonly administered vaccines, were licensed in the United States. Despite significant reductions in hepatitis-related morbidity and mortality that have resulted from widespread use of these vaccines, vaccine-preventable morbidity and mortality still occur. The purposes of this article are to review clinical trial and other experience with hepatitis A and B vaccines in healthy individuals as well as in those with chronic liver disease, infected with the human immunodeficiency virus, or requiring hemodialysis; describe the impact that these vaccines and national recommendations for vaccination have had on reducing the incidence of HAV and HBV infection; and recommend expansion of these recommendations to include universal vaccination of adults as a means of further reducing the burden of viral hepatitis.
  The American Journal of Medicine 11/2005; 118 Suppl 10A:7S-15S.
• Article: Acute hepatitis A and B in patients with chronic liver disease: prevention through vaccination.

  Emmet B Keeffe
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  ABSTRACT: Retrospective and prospective studies have demonstrated that the occurrence of acute hepatitis A in patients with chronic liver disease is associated with higher rates of morbidity and mortality than in previously healthy individuals with acute hepatitis A. The mortality associated with acute hepatitis A may be particularly high in patients with preexisting chronic hepatitis C. Although acute hepatitis B in patients with preexisting chronic liver disease is less well studied, worse outcomes than in previously healthy individuals are apparent. However, numerous studies convincingly demonstrate that chronic hepatitis B virus coinfection with hepatitis C virus (or hepatitis D virus) is associated with an accelerated natural history of liver disease and worse outcomes. These observations led to studies that demonstrated the safety and efficacy of hepatitis A and hepatitis B vaccination in patients with mild-to-moderate chronic liver disease. Hepatitis A and B vaccination is less effective in patients with advanced liver disease, especially after decompensation, such as in patients awaiting liver transplantation, and in liver transplant recipients. The emerging lower rates of inherent immunity in younger individuals, higher morbidity and mortality of acute hepatitis A or B superimposed on chronic liver disease, and greater vaccine efficacy in milder forms of chronic liver disease suggest that it is a reasonable policy to recommend hepatitis A and B vaccination in patients early in the natural history of chronic liver disease.
  The American Journal of Medicine 11/2005; 118 Suppl 10A:21S-27S.
• Article: Changing travel-related global epidemiology of hepatitis A.

  Robert Steffen
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  ABSTRACT: Hepatitis A is highly endemic in many emerging cultures. Despite the availability of safe and effective vaccines and some improvements in sanitation in developing countries, hepatitis A remains a significant cause of morbidity for nonimmune travelers visiting such destinations. All are at risk, including short-term vacationers or business travelers who stay in deluxe accommodations. This may have considerable implications on public health. Hepatitis A vaccination programs for travelers have not proven to be effective, since many visitors to destinations at risk (e.g., Mexico) fail to consult health professionals prior to departure. Because 50% of the US population has an anticipated lifetime risk for exposure, universal immunization against hepatitis A should be considered.
  The American Journal of Medicine 11/2005; 118 Suppl 10A:46S-49S.
• Article: Hypophosphatemia: an update on its etiology and treatment.

  André Gaasbeek, A Edo Meinders
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  ABSTRACT: Phosphate plays a key role in several biological processes. In recent years, new insights have been obtained into the regulation of the phosphate metabolism, including a growing amount of evidence suggesting that factors other than parathyroid hormone (PTH) and vitamin D are involved in maintaining the phosphate balance. A new class of phosphate-regulating factors, the so-called "phosphatonins," have been shown to be important in phosphate-wasting diseases. However, the role of the phosphatonins in the normal human homeostasis remains to be established. The incidence of hypophosphatemia in selected patient series can be more than 20%, with clinical sequelae ranging from mild to life threatening. Only when combined with phosphate depletion does hypophosphatemia become clinically significant. The factors that are involved in the phosphate homeostasis, the pathophysiology, the relevance in patient care, the clinical manifestations, and an appropriate management of phosphate depletion are discussed in this review.
  The American Journal of Medicine 11/2005; 118(10):1094-101.
• Article: Physician specialty and mortality among elderly patients hospitalized with heart failure.

  JoAnne Micale Foody, Saif S Rathore, Yongfei Wang, Jeph Herrin, Frederick A Masoudi, Edward P Havranek, Harlan M Krumholz
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  ABSTRACT: Whether specialty care improves survival among patients with heart failure remains controversial. We evaluated specialty care and outcomes in 25869 Medicare beneficiaries hospitalized with heart failure in the United States from 1998 through 1999. Patients were classified based on the specialty of their attending physician: cardiologist, internist, general physician, or family physician. The primary outcome of interest was all-cause mortality within 30 days of admission. Cardiologists were attending physicians for 26%, internists for 50%, and general and family physicians cared for the remainder. Mortality at 30 days was lowest for patients cared for by cardiologists (8.8%), higher for patients cared for by internists (10.0%, relative risk [RR] = 1.07; 95% confidence interval [CI]: 0.97 to 1.19; P = 0.059) and general physicians (11.1%, RR = 1.26; 95% CI: 0.99 to 1.58; P = 0.086), and highest for patients cared for by family physicians (12.0%, RR = 1.31; 95% CI: 1.15 to 1.49; P <0.001). Patients cared for by family physicians remained at higher 30-day mortality rates whether with (RR = 1.30; 95% CI: 1.11 to 1.52) or without consultation with cardiologists (RR = 1.31; 95% CI: 1.13 to 1.52). Hospitalized patients with heart failure had lower 30-day mortality when treated by cardiologists than when they were treated by other physicians. Although these differences were modest (RR = 1.07) for internists, they were substantial for general physicians (RR = 1.26) and family physicians (RR = 1.31); of note was that inpatient cardiology consultation did not appear to change this relation.
  The American Journal of Medicine 11/2005; 118(10):1120-5.
• Article: Doctors and the drug industry: reader feedback.

  Rugmini Warrier, Bruce Houghton
  The American Journal of Medicine 11/2005; 118(10):1175-6; author reply 1176.
• Source

  Available from: travelhealth.net

  Article: Hepatitis A vaccine in the last-minute traveler.

  Bradley A Connor
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  ABSTRACT: Current recommendations state that travelers should receive hepatitis A vaccine 2 to 4 weeks before departure. Such recommendations, however, may dissuade last-minute travelers from receiving the vaccine. A preponderance of evidence exists to support hepatitis A vaccination of the imminent-departure traveler and therefore suggests that these guidelines merit reconsideration. In examining this issue, one of the most important elements to determine is the amount of time required for seroconversion following vaccination. Clinical trials of hepatitis A vaccines measured antibody response at 2 and 4 weeks after vaccination. However, studies investigating early seroconversion found that the vast majority of vaccinees develop antibodies within 2 weeks of vaccination, some as early as 12 days after vaccination. This is relevant information, given that the hepatitis A virus has an average incubation period of 28 days. Seroconversion is predicated on achieving a "protective" antibody level. However, levels of antibody considered protective remain debatable. Evidence suggests that clinical disease does not occur at antibody levels lower than those currently accepted as protective. Furthermore, hepatitis A vaccine has been proved effective in controlling outbreaks worldwide. Research data show that a single dose of vaccine can halt outbreaks if an adequate number of susceptible individuals are vaccinated. Information from rapid-outbreak control studies and those assessing postexposure administration of hepatitis A vaccine suggest that late vaccination provides a significant degree of protection. For these reasons, hepatitis A vaccine may be administered at any time before departure because it will still provide travelers with protection.
  The American Journal of Medicine 11/2005; 118 Suppl 10A:58S-62S.