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Gema Rodríguez-Trigo, MD; Jan-Paul Zock, PhD; Francisco Pozo-Rodríguez, MD; Federico P. Gómez, MD; Gemma Monyarch, MSc; Laura Bouso, MSc; M. Dolors Coll, PhD; Héctor Verea, MD; Josep M. Antó, MD; Carme Fuster, PhD; Joan Albert Barberà, MD, for the SEPAR (Sociedad Española de Neumología y Cirugía Torácica)-Prestige Study Group

Oil spills are ecological disasters, but their health effects on humans are uncertain. This study followed 501 fishermen who participated in the clean-up of a 2002 oil spill off the coast of northwestern Spain. The fishermen had a higher prevalence of respiratory symptoms, higher levels of markers suggestive of airway injury in exhaled breath condensate, and chromosomal alterations in lymphocytes compared with 177 local fishermen who did not participate in clean-up activities. Participation in clean-up was associated with adverse health findings, but the long-term clinical significance of the observations is not known.

Topics: chromosomes, lymphocyte, signs and symptoms, respiratory, biological markers, isoprostanes, spain
  
Caroline Minassian, MSc; Francesco D'Aiuto, PhD; Aroon D. Hingorani, PhD; and Liam Smeeth, PhD

Chronic inflammatory states, such as periodontal disease, are increasingly believed to play a role in causing cardiovascular disease. Using a large administrative database, researchers found that adults who underwent invasive dental procedures had an increased risk for myocardial infarction or stroke in the 4 weeks after the procedures compared with during other times. Further study is needed to determine whether this transient increase is due to acute dental inflammation, periprocedure changes in antiplatelet medications, physiologic stress, or other mechanisms.

Topics: myocardial infarction, dental procedures
  
Michele Heisler, MD, MPA; Sandeep Vijan, MD, MS; Fatima Makki, MPH; and John D. Piette, PhD

This randomized trial compared usual care with a reciprocal peer-support program that paired diabetic patients who had similar self-management challenges to assist each other through weekly contact. Patients in the reciprocal peer-support program had greater improvement in hemoglobin A1c levels, were more likely to initiate insulin treatment, and had several other positive outcomes compared with patients who received usual care. Reciprocal peer support holds promise as a method for diabetes care management.

Topics: diabetes mellitus, type 2, nurses, patient care management, peer support, diabetes mellitus, ...
  
Max R. O'Donnell, MD, MPH; Julie Jarand, BSc, MD; Marian Loveday, BSc, MPhil; Nesri Padayatchi, BSc, MBChB, DCH, DTM+H, DHSM, DPH, MS(Epi); Jennifer Zelnick, MSW, ScD; Lise Werner, MSc; Kasavan Naidoo, MSc, BSc; Iqbal Master, MBChB; Garth Osburn, MBChB; Charlotte Kvasnovsky, MD, MPH; Karen Shean, MSc; Madhukar Pai, MD, PhD; Martie Van der Walt, PhD; Charles R. Horsburgh, MD, MUS; and Keertan Dheda, MBBCh, PhD

The rates of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are high in South Africa, but the risks for these diseases among health care workers have not been quantified. This retrospective study estimated the rate of hospitalizations for the initiation of treatment of MDR-TB and XDR-TB in a single South African province where all treatments occurred at a single referral hospital. Health care workers had more than 5 and 6 times the rates of hospitalization for MDR-TB and XDR-TB treatment, respectively, as those of non–health care workers. These observations suggest a need for tuberculosis-control programs that target health care workers.

Topics: health personnel, multidrug-resistant tuberculosis, tuberculosis, extensively drug-resistant, hospital admission, tuberculosis, south africa, ...
  
James Douketis, MD; Alberto Tosetto, MD; Maura Marcucci, MD; Trevor Baglin, MD, PhD; Mary Cushman, MD, MSc; Sabine Eichinger, MD; Gualtiero Palareti, MD, PhD; Daniela Poli, MD; R. Campbell Tait, MBChB; and Alfonso Iorio, MD

Guidelines recommend at least 3 months of anticoagulation for unprovoked venous thromboembolism (VTE) and indefinite treatment for some patients. Questions remain about the best implementation of d-dimer testing for identifying patients with low recurrence risk who might safely avoid prolonged anticoagulation. This patient-level meta-analysis of 7 studies involved 1818 patients with a first unprovoked VTE who had d-dimer testing after anticoagulation was stopped and were followed for recurrent VTE. Researchers confirmed that positive d-dimer results after cessation of anticoagulation is associated with recurrent VTE and that timing of testing, patient age, and d-dimer cut point do not affect this association.

Topics: venous thromboembolism, dimers, anticoagulation
  
Beatrice A. Golomb, MD, PhD; Laura C. Erickson, BS; Sabrina Koperski, BS; Deanna Sack, BS; Murray Enkin, MD; and Jeremy Howick, PhD

This study evaluated how frequently placebo composition was specified in the published reports of randomized, placebo-controlled trials in 4 journals (New England Journal of Medicine, JAMA, The Lancet, and Annals of Internal Medicine). Most published reports did not include a description of placebo composition. Descriptions of placebo composition were less common for studies of oral medications than for injections and other treatments.

Topics: internal medicine, languages, guidelines, evidence-based medicine, consensus, reasoning, excipients
  
David A. Savitz, PhD; and Lawrence S. Engel, PhD

In this issue, Rodríguez-Trigo and colleagues' study, on the health of fishermen who participated in clean-up of a 2002 oil spill off the coast of Spain, provides an opportunity to consider practices that will facilitate study of health effects among the 50 000 workers and others exposed during the 2010 Deepwater Horizon spill and future incidents. This editorial recommends collecting data from workers as early as possible; conducting detailed exposure assessment; considering a broad range of health issues; and planning research to guide immediate public health interventions and emphasizes the need to recognize and work within the political context.

Topics: disasters, environmental exposure, public health medicine, gulf oil spill
  

In this issue, Minassian and colleagues report an association between invasive dental treatment and vascular events. This editorial reviews the advances in our understanding of perioperative risk and notes the limited ability of the study to determine the mechanism that explains the transient increase in vascular risk after invasive dental procedures. The study is an important reminder to continue cardioprotective antiplatelet agents if at all possible before dental procedures in patients who are receiving these agents.

Topics: dental procedures, chewing, heart
  
Amelie G. Ramirez, DrPH; and Barbara J. Turner, MD, MSED, Executive Deputy Editor

In this issue, Heisler and colleagues' randomized trial provides evidence that a peer-support program can improve diabetes outcomes. This editorial sees promise in reciprocal peer support and other interventions that engage laypeople in helping others manage disease. The editorialists note unanswered questions about payment, standards for training, and long-term outcomes of such programs.

Topics: chronic disease
  
Michelle Daniel, MD
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Michal Shani, MD, MPH
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Siobhan Sutcliffe, PhD; Gerald L. Andriole, MD; Ichiro Kawachi, MD, PhD; Jonathan M. Zenilman, MD; and Elizabeth A. Platz, ScD
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Salomeh Keyhani, MD, MPH; Mark Woodward, PhD; and Alex D. Federman, MD, MPH
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Topics: benazepril, amlodipine, hypertension, diabetes mellitus, diabetes mellitus, type 2, hydrochlorothiazide (hctz)
  
Topics: peripheral neuropathy, diabetes mellitus, type 1, insulin
  
Topics: colorectal cancer, mortality, flexible fiberoptic sigmoidoscopy
  
Topics: fecal occult blood test, feces, guaiac, colorectal cancer screening
  
Topics: liver cirrhosis, transjugular intrahepatic portosystemic shunt, variceal hemorrhage
  
Topics: aspirin, abortion, habitual, nadroparin, women, live birth
  
Topics: tension headache
  
Topics: coronary angiography, exercise stress test
  
Topics: peripheral neuropathy, diabetes mellitus, type 2, vibration
  
Topics: confrontation visual field test, visual field defects
  
Topics: antibiotics, infection, recurrent infection
  
Topics: hemorrhage, outpatients, atherothrombosis
  
Topics: respiration, dyspnea, blood test, inspiration, laboratory techniques and procedures, injury of lung, ...
  
Topics: dental procedures
  
Topics: diabetes mellitus, type 2
  
Topics: health personnel, tuberculosis, extensively drug-resistant, hospital admission
  
Robert Kocher, MD; Ezekiel J. Emanuel, MD; and Nancy-Ann M. DeParle, JD

This commentary provides the view of individuals presently or previously affiliated with the White House Office of Health Care Reform about the opportunities and challenges that the Affordable Care Act is likely to present for the practice of medicine.

Topics: clinical medicine, patient protection and affordable care act, incentives
  
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