American Journal of Medicine最新文献

{"title":"When Public Health and Government Officials Violate their Own Precautions: Lessons for the Next Crisis.","authors":"Vinay Prasad","doi":"10.1016/j.amjmed.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.amjmed.2024.10.009","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SOCIODEMOGRAPHIC DISPARITIES IN CORONARY ARTERY CALCIUM SCREENING.","authors":"Andrew Faturos, Melinda Wong, Ahmadreza Ghasemiesfe, Ezra A Amsterdam, Surabhi Atreja","doi":"10.1016/j.amjmed.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.amjmed.2024.10.006","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the demographic features and socioeconomic status of patients who underwent coronary artery calcium screening to that of their local population.</p><p><strong>Background: </strong>Coronary artery calcium scores provide important evidence of subclinical atherosclerosis. However, insurance often does not cover coronary artery calcium testing, which could exclude people of lower socioeconomic status.</p><p><strong>Methods: </strong>Demographic and occupational data were obtained for all patients referred for coronary artery calcium in a metropolitan area between October 2010 and August 2023. Household income and population reference information were taken from US Census Data and matched to zip code and regional metropolitan area.</p><p><strong>Results: </strong>Coronary artery calcium tests were performed on 627 patients with a median age of 63 years and equal gender representation (52% female, 48% male). Patients were predominately White (77%) and English-speaking (98%), which is incongruent with local demographic data (p<0.001). Healthcare workers were the largest workforce (22%), followed by people involved in education (12%), which is higher than the local healthcare workforce of 10% (p<0.001). Those with graduate/professional degrees accounted for 32% of patients, significantly more than the local population (p<0.001). The average median annual income ($94,116) of patients who underwent CAC testing was greater than that of the metropolitan median income of $81,264 (p <0.001).</p><p><strong>Conclusion: </strong>The disproportionate distribution of coronary artery calcium screening favoring educated, affluent, White English speakers indicates that higher-income and healthcare personnel are more likely to receive testing. Disparities in coronary artery calcium testing, especially in minorities and non-English speaking individuals, should be further explored.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Persistent Abdominal Pain With High Blood Pressure.","authors":"Julien Graessel, Philippe Kauffmann, Pierrick Le Borgne","doi":"10.1016/j.amjmed.2024.10.005","DOIUrl":"10.1016/j.amjmed.2024.10.005","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-acute COVID-19 syndrome: prevalence of peripheral microvascular endothelial dysfunction and associations with NT-proBNP dynamics.","authors":"Marcus Ståhlberg, Katarina Fischer, Maged Tahhan, Allan Zhao, Artur Fedorowski, Michael Runold, Malin Nygren-Bonnier, Mikael Björnson, Lars H Lund, Judith Bruchfeld, Liyew Desta, Frieder Braunschweig, Ali Mahdi","doi":"10.1016/j.amjmed.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.amjmed.2024.10.012","url":null,"abstract":"<p><strong>Background: </strong>Post-acute COVID-19 syndrome (PACS) has been linked to microvascular endothelial dysfunction as a potential underlying pathomechanism and can manifest even following a mild course of the initial infection. Prevalence of microvascular endothelial dysfunction and circulating natriuretic peptides in such PACS patients remains unknown.</p><p><strong>Methods and results: </strong>This prospective, cross-sectional cohort study enrolled 92 patients (82% females, median age 48 years) with PACS. Reactive hyperemia index (RHI) was evaluated with peripheral arterial tonometry where <1.67 was defined as microvascular endothelial dysfunction, 1.67-2.0 impaired- and >2 normal endothelial function, on average 31 months after the acute infection. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were collected at two different time points within over 1-year span. In total, 41% of PACS subjects had microvascular endothelial dysfunction and 20% had impaired RHI. No major differences in clinical characteristics, routine chemistry laboratory testing or symptom burden were observed across the groups. Only subjects with microvascular endothelial dysfunction and impaired endothelial function had a significant increase in NT-proBNP levels over time and those with larger increase in NT-proBNP had significantly lower RHI. There was a significant correlation between relative or absolute increase in NT-proBNP and RHI, which remained significant in a multivariable adjusted linear regression.</p><p><strong>Conclusions: </strong>Peripheral microvascular endothelial dysfunction was prevalent in a symptomatic PACS population long after recovery from a mild acute infection. Increases in NT-proBNP levels were associated with microvascular endothelial dysfunction, suggesting a link between and providing a foundation for future studies on post viral microvascular endothelial dysfunction in PACS.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive Non-Traumatic Facial and Truncal Purpura.","authors":"Esther Choi, Simran Chadha, Lida Zheng","doi":"10.1016/j.amjmed.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.amjmed.2024.10.013","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fitz-Hugh-Curtis Syndrome.","authors":"Kosuke Ishizuka, Yoshiyuki Ohira, Mitsuyasu Ohta","doi":"10.1016/j.amjmed.2024.10.008","DOIUrl":"10.1016/j.amjmed.2024.10.008","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminated Herpes Zoster in an Immunocompromised Patient: Challenges for Preventing Transmission Before Diagnosis.","authors":"Shiori Kitaya, Reina Iyobe, Hajime Kanamori","doi":"10.1016/j.amjmed.2024.10.010","DOIUrl":"10.1016/j.amjmed.2024.10.010","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Left Ventricular Dilation in an Active Duty Athlete with Bicuspid Aortic Valve and Aortic Regurgitation.","authors":"Robert L Fenequito, Travis E Harrell, Gilbert E Boswell, Matthew C Russell","doi":"10.1016/j.amjmed.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.amjmed.2024.10.003","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Vaccine Safety Observational Studies and Authors' Attitudes: A Systematic Review.","authors":"Mariana Barosa, Vinay Prasad","doi":"10.1016/j.amjmed.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.amjmed.2024.10.007","url":null,"abstract":"<p><strong>Background: </strong>Post-licensure observational studies are the mainstay of vaccine safety evaluation. However, these studies have well-known methodological limitations, rendering them particularly vulnerable to unmeasured confounding. We sought to describe high-impact observational studies of vaccine safety, investigate the authors' attitudes towards their study's findings and limitations, and report on spin practices.</p><p><strong>Methods: </strong>We conducted a Pubmed systematic review of comparative observational studies of vaccine safety published in the six top medical journals from inception to March 2024.</p><p><strong>Results: </strong>Thirty-seven studies were included, spanning publications from 1995 to 2024. Most studies focused on COVID19 and influenza vaccines (n=11, 30%, and n=10, 27%, respectively). Study designs and methodologies varied. Electronic health records (54%), passive surveillance databases (32%) and national registries (27%) were the most common data sources. Negative control outcomes were used in a single study. Residual confounding was conceded in 54% of studies, and an additional 24% did so implicitly. Spin was noted in 48.6% of the studies. This systematic review found that authors of observational vaccine safety studies in high-impact medical journals often acknowledge residual confounding, but rarely use methods like negative control outcomes to better detect unmeasured confounding. Furthermore, spin is common, occurring in approximately 50% of the studies.</p><p><strong>Conclusions: </strong>Although our findings are somewhat limited by subjectivity in study assessments, they suggest that editors and reviewers of high-impact journals should ensure the language used in reporting observational studies accurately reflects the findings and their limitations.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Audit and Feedback and Academic Detailing Interventions to Support Safer Opioid Prescribing in Primary Care.","authors":"Meagan Lacroix, Fred Abdelmalek, Karl Everett, Monica Taljaard, Lena Salach, Lindsay Bevan, Victoria Burton, Hui Jia, Jennifer Shuldiner, Celia Laur, Emily Nicholas Angl, Noah M Ivers, Mina Tadrous","doi":"10.1016/j.amjmed.2024.09.017","DOIUrl":"10.1016/j.amjmed.2024.09.017","url":null,"abstract":"<p><strong>Background: </strong>Opioids, prescribed to manage pain, are associated with safety risks. Quality improvement strategies such as audit and feedback and academic detailing may improve prescribing in primary care.</p><p><strong>Methods: </strong>We used a matched-cohort design with claims databases. Participants were family physicians practicing in Ontario, Canada. The interventions were a voluntary audit and feedback report with or without academic detailing sessions. Physicians in the control group received neither intervention. The primary outcome was mean rate of high-risk opioid prescriptions per 100 patients per month. Data were analyzed comparing monthly percentage change in slope over 12 months before and 18 months after the intervention. Additional analyses considered only the subgroup of higher-prescribing physicians.</p><p><strong>Results: </strong>There were 1469 (25%) physicians in the audit and feedback group, 245 (4%) in the audit and feedback + academic detailing group, and 4211 (71%) matched controls. All groups showed a significant preintervention decline in opioid prescribing. There were no significant between-group differences in opioid prescribing postintervention. Among high-prescribing physicians, there was a significant reduction in the audit and feedback group (% change in slope = -0.37, 95% CI = -0.65 to -0.09, P < .01), but not in the academic detailing group (% change in slope = 0.19, 95% CI = -0.52 to 0.91, P = .59).</p><p><strong>Conclusions: </strong>This study demonstrated declining secular trends in prescribing and suggests that two large-scale initiatives had limited additional benefits. We found some additional reductions after audit and feedback among the highest-volume opioid prescribers. Future interventions should focus on these physicians for the greatest benefit.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}