Medicine JournalFeeds

Health Changes in Fishermen 2 Years After Clean-up of the Prestige Oil Spill.

Ann Intern Med. 2010 Aug 23;

Authors: Rodríguez-Trigo G, Zock JP, Pozo-Rodríguez F, Gómez FP, Monyarch G, Bouso L, Coll MD, Verea H, Antó JM, Fuster C, Barberà JA,

Background: In 2002, the oil tanker Prestige spilled more than 67 000 tons of bunker oil, heavily contaminating the coast of northwestern Spain. Objective: To assess respiratory effects and chromosomal damage in clean-up workers of the oil spill 2 years after the exposure. Design: Cross-sectional study. Setting: Fishermen cooperatives in coastal villages. Participants: Local fishermen who were highly exposed (n = 501) or not exposed (n = 177) to oil 2 years after the spill. Measurements: Respiratory symptoms; forced spirometry; methacholine challenge; markers of oxidative stress (8-isoprostane), airway inflammation (interleukins, tumor necrosis factor-alpha, and interferon-gamma), and growth factor activity in exhaled breath condensate; and chromosomal lesions and structural alterations in circulating lymphocytes. Results: Compared with nonexposed participants, persons exposed to oil were at increased risk for lower respiratory tract symptoms (risk difference, 8.0 [95% CI, 1.1 to 14.8]). Lung function did not significantly differ between the groups. Among nonsmoking participants, exposed individuals had higher exhaled 8-isoprostane levels than nonexposed individuals (geometric mean ratio, 2.5 [CI, 1.7 to 3.7]), and exposed individuals with lower respiratory tract symptoms had higher 8-isoprostane levels than exposed individuals without symptoms. Exposed nonsmoking participants also had higher levels of exhaled vascular endothelial growth factor (risk difference, 44.8 [CI, 27.9 to 61.6]) and basic fibroblast growth factor (risk difference, 16.0 [CI, 3.5 to 28.6]). A higher proportion of exposed participants had structural chromosomal alterations (risk difference, 27.4 [CI, 10.0 to 44.8]), predominantly unbalanced alterations. The risk for elevated levels of exhaled 8-isoprostane, vascular endothelial growth factor, basic fibroblast growth factor and structural chromosomal alterations seemed to increase with intensity of exposure to clean-up work. Limitations: The clinical significance of exhaled biomarkers and chromosomal findings are uncertain. The association between oil exposure and the observed changes may not be causal. The findings may not apply to spills involving other types of oil or to different populations of oil spill workers. Conclusion: Participation in clean-up of a major oil spill was associated with persistent respiratory symptoms, elevated markers of airway injury in breath condensate, and chromosomal damage. Primary Funding Source: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation.

PMID: 20733177 [PubMed - as supplied by publisher]

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The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges.

Ann Intern Med. 2010 Aug 23;

Authors: Kocher R, Emanuel EJ, Deparle NA

Reader Survey: Which objectives will the Affordable Care Act succeed in achieving? The Affordable Care Act is a once-in-a-generation change to the U.S. health system. It guarantees access to health care for all Americans, creates new incentives to change clinical practice to foster better coordination and quality, gives physicians more information to make them better clinicians and patients more information to make them more value-conscious consumers, and changes the payment system to reward value. The Act and the health information technology provisions in the American Recovery and Reinvestment Act removes many barriers to delivering high-quality care, such as unnecessary administrative complexity, inaccessible clinical data, and insufficient access to primary care and allied health providers. To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put in motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups. The most successful physicians will be those who most effectively collaborate with other providers to improve outcomes, care productivity, and patient experience.

PMID: 20733178 [PubMed - as supplied by publisher]

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Health Effects in Fisherman 2 Years After Assisting With Oil Spill Clean-up.

Ann Intern Med. 2010 Aug 23;

Authors:

PMID: 20733180 [PubMed - as supplied by publisher]

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Lessons for Study of the Health Effects of Oil Spills.

Ann Intern Med. 2010 Aug 23;

Authors: Savitz DA, Engel LS

PMID: 20733179 [PubMed - as supplied by publisher]

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The Vulnerable Atherosclerotic Plaque: Scope of the Literature.

Ann Intern Med. 2010 Aug 16;

Authors: Alsheikh-Ali AA, Kitsios GD, Balk EM, Lau J, Ip S

The scope of recent literature on the concept of “vulnerable plaque” was reviewed by examining 463 abstracts of primary and review articles identified through MEDLINE (2003 to April 2010). Proposed definition criteria of vulnerable plaque included active inflammation, a thin cap with a large lipid core, endothelial denudation, fissured cap, severe stenosis, or combinations of these findings. In 242 primary studies, histopathology, biomarkers and imaging of carotid and coronary artery plaques were evaluated for features suggestive of vulnerability. Notably, 89% of these studies were cross-sectional in design and exclusively conducted in patients with known cardiovascular disease. None of the imaging studies documented whether the identified lesions were responsible for cardiovascular events. Cross-sectional design precludes evaluation of the predictive utility of biomarkers. Because vulnerable plaque is not an established medical diagnosis, no studies have been done that explicitly evaluate the treatment of vulnerable plaques per se. Few studies examined potential systemic treatments (for example, statins) to modify vulnerability features. Large prospective studies in patients with and without previous cardiovascular events during long follow-up are required to validate this concept.

PMID: 20713770 [PubMed - as supplied by publisher]

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Does admitting mistakes to patients lead to more lawsuits?

Ann Intern Med. 2010 Aug 17;153(4):I28

Authors:

PMID: 20713776 [PubMed - in process]

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Dexamethasone did not reduce mortality or neurologic sequelae in bacterial meningitis.

Ann Intern Med. 2010 Aug 17;153(4):JC210

Authors:

PMID: 20713777 [PubMed - in process]

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HbA1c levels <= 5.5% ruled out, and levels >= 7.0% ruled in, type 2 diabetes in clinical and community populations.

Ann Intern Med. 2010 Aug 17;153(4):JC211

Authors:

PMID: 20713778 [PubMed - in process]

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Review: Clinical pathways reduce in-hospital complications but not in-hospital mortality or readmissions.

Ann Intern Med. 2010 Aug 17;153(4):JC212

Authors:

PMID: 20713779 [PubMed - in process]

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Review: Some instruments predict development of persistent, disabling low back pain.

Ann Intern Med. 2010 Aug 17;153(4):JC213

Authors:

PMID: 20713780 [PubMed - in process]

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