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Am Fam Physician. 2004;69(6):1346-1348

Coming to a hospital near you: virtual colonoscopy. A study published in the New England Journal of Medicine found that computed tomographic (CT) virtual colonoscopy is comparable to optical colonoscopy in detecting colorectal neoplasia in asymptomatic average-risk adults. The minimally invasive technique generates both two-and three-dimensional displays of the rectum and colon. In the study, 1,233 asymptomatic adult patients had same-day virtual and optical colonoscopy. More than one half of the 1,005 patients who returned a post-study questionnaire recalled greater discomfort with virtual colonoscopy than with optical colonoscopy. However, most patients found CT virtual colonoscopy to be acceptable in terms of convenience and would prefer it to optical colonoscopy for future screenings.

Arm position matters when measuring blood pressure, according to the results of a prospective study reported in the Annals of Internal Medicine. As described in a letter to the editor, 100 patients had their blood pressure measured in three body positions (standing, sitting, and lying down) and two arm positions (perpendicular or parallel to the torso). In all body positions, blood pressure values were higher when the arm was parallel to the torso and decreased by 8.8 to 14.4 mm Hg when the arm was in a perpendicular position (arm in front of the patient and bent at 90-degree angle). The letter points out that a standard technique for blood pressure measurement has not been used or consistently documented. The American Heart Association recommends measuring blood pressure with the patient’s arm flexed at the level of the heart.

More than 80 percent of Americans expect another terrorist attack on the United States in the near future. A survey conducted for the National Mental Health Association and the National Association of State Mental Health Program Directors found that 70 percent of Americans believe the government needs to develop programs to help people deal with the emotional impact of another terrorist attack. The nationally representative and census-balanced telephone survey (December 2003) of 750 Americans older than 18 years showed that only 25 percent of Americans think that the nation’s public health system currently is meeting terrorism-related mental health needs.

More women than men are applying to medical school. According to data published in Internal Medicine News, 17,672 women and 17,113 men applied to U.S medical schools in 2003. Of those applicants, 8,209 women enrolled, compared with 8,315 men.

A possible solution for “sick” office buildings? Previous studies have shown that bacterial, fungal, and protozoan contamination of ventilation systems can cause rhinitis, asthma, and other respiratory symptoms in workers. According to the findings of a double-blind, multiple crossover trial published in The Lancet, ultraviolet germicidal irradiation (UVGI) of the drip pans and cooling coils of ventilation systems in office buildings could reduce microbial contamination and, thus, work-related symptoms. The operation of UVGI lights in three office buildings in Montreal, Canada, resulted in a 99 percent reduction in microbial and endotoxin concentrations on irradiated surfaces. Their use also resulted in significantly fewer work-related symptoms.

The National Institute of Mental Health is sponsoring a trial to test a treatment that can cure childhood phobias in as little as three hours. According to an article published in The New York Times, the patients receive intensive exposure to whatever they fear and, with the help of a therapist, learn that what they fear will happen does not actually happen. To date, co-investigators at Virginia Polytechnic Institute and State University and at Stockholm University in Sweden claim a 75 percent cure rate at approximately one year of follow-up. At Virginia Tech, one 10-year-old boy overcame his fear of insects in just one three-hour session. As noted by a researcher at the Child Study Center at Yale University, the current approach is to be less concerned about what triggers a phobia and more concerned about how the phobia can be counteracted so that excessive fear does not impair function.

A high “good” cholesterol level is not always good. Instead, it may be a sign of increased liver enzyme activity. A prospective cohort study conducted in Finland and published in BMJ found that, in men with heavy alcohol intake and increased liver enzyme activity, the risk of coronary events increased with every 1 mmol per L rise of the high-density lipoprotein (HDL) cholesterol level. The authors of this study of 2,464 men (ages: 42, 48, 54, and 60 years) speculate that the protective effect of HDL cholesterol is lost when liver enzyme activity rises. Increases in liver enzyme activity, as well as liver damage, may be caused by heavy alcohol intake, hepatotoxic nutrients, drugs, or contaminants in food.

About one third of Americans did not seek medical treatment in 2003 because of the cost, according to a poll of 1,000 adults conducted by the Gallup Organization for the Reader’s Digest Family Index. More than one half of those who did not seek treatment indicated that they had a very serious or somewhat serious medical problem. The findings suggest that 18 percent of families in the United States could not afford treatment for a serious medical problem during the past year.

British researchers found corticosteroids in “herbal creams” used to treat atopic eczema in children. In a study published in the Archives of Disease in Childhood, parents of 19 patients at a pediatric dermatology office in the United Kingdom submitted samples of herbal creams they reported using with good results. Most of the creams were of Indian or Pakistani origin. Of the 24 creams collected, seven of the labeled herbal creams (Wau Wa and Muijiza) illegally contained a potent synthetic corticosteroid. Corticosteroids also were found in 13 of the 17 unlabeled creams. All of the parents said they thought the creams were herbal, steroid-free, and safe for use in children.

Jumping exercises can result in significant bone mass gains in prepubertal girls. According to a study published in Pediatrics, extra jumping increased bone mass in the lumbar spine and femoral neck by approximately 5 percent. Gym classes in British Columbia were selected to add a 10- or 12-minute set of jumping exercises three times a week (32 girls) or to offer it in their regular gym routine (43 girls). There is evidence that links physical inactivity with the increasing prevalence of osteoporosis in the United States.

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Copyright © 2004 by the American Academy of Family Physicians.

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