The Internet Medical Journal This Week in Medicine 23-Jan-1998 Issue Monday, February 22, 1999 2:30 AMPeople are walking less and less. A report this week in the British Medical Journal(http://www.bmj.com/archive/7127/7127e2.htm) estimated that people are walking 22% less today thanthey did in 1972. The greatest decline in walking was among 5 to 15 year olds. Thought to be primarilyresponsible for this decline is the rising use of the automobile. The report estimated that one fourth ofall car trips are less than 2 miles. Also, since 1975 the percent of children travelling to school by car hasincreased from 12% to 23% in 1994. No amount of money devoted to medical care will make up forthe decline in activity by our youth.This week the Lancet reports on a patient with intractable hiccups that apparently was cured bysmoking marijuana.(http://www.thelancet.com/lancet/User/vol351no9098/letters/research.html#marijuanafor).Recommended reading this week is Dont Sweat the Small Stuff... and Its All Small Stuff: SimpleWays to Keep the Little Things from Taking over Your Life by Richard Carlson. $7.96.Now for the pearls of the week...About 1 in 20 Americans have asthma, with about 1 in 10 children suffering from it; the good news itthat a SINGLE daily dose of inhaled steroids can control symptoms (I.e. 4 puffs once a day is aseffective as 1 puff 4 times a day). J Allergy Clin Immunol 1997 100:0771.The combination of aspirin and coumadin (mean INR 1.47, mean dose 4 mg/d) was successful inpreventing a heart attack in 5,085 men. Treating 1,000 men with aspirin OR warfarin a year would save3 deaths; if both used for a year, 5 deaths avoided. Lancet 1998 351:0233.The International Study of Infarct Survival (isis 3) concluded that contrary to earlier reports, sex has aminimal effect upon outcome after a heart attack. Age and other confounding factors are much, muchmore important. NEJM 1998 338:0008.It is advocated the the use of bisphosphonates for the treatment of osteoporosis be restricted to 80 yearolds with at least one spinal compression fracture and also a low bone mineral density. Arch Intern Med1997 157:2617.Treating chronic anal fissures with botulinum toxin was found to be more effective than salineinjections in this study of 30 patients. Maria G … NEJM 1998 338:0217.Aspirin is as effective as cholesterol lowering medications in the primary prevention of a myocardialinfarction. Lancet 1998 351(9098).HMGcoA reductase inhibitors are useful in the primary prevention of stroke. Bucher HC … Ann InternMed 1998 128(2).In Kentucky, 60% of medicaid patients with an upper respiratory infection were given antibiotics
although only an estimated 6% actually needed them. The cost savings for unnecessary antibioticprescriptions in Kentucy is $1.62 million dollars a year. Mainous AG … Arch Fam Med 1998007:0045.