Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Volume 103, Issue 4 (2004)

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Thomas C. Meyer, MD
For your consideration
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In recent months, the Wisconsin Medical Journal’s mailbox has been stuffed, and our Editorial Board has been working overtime!

Original Research

Norman M. Jensen, MD, MS, FACP; Anthony L. Suchman, MD, MA, FACP
Partnering with citizens to reform Wisconsin health care: A report of the first Citizen Congress
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Many Americans today seem unhappy with health care that is envied by many in the world.

Randy Brown, MD
Heroin Dependence
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Heroin use, particularly injection use, is a problem of great public health importance. The risks associated with heroin dependence, such as HIV and viral hepatitis, and the social costs due to associated crime and poverty exceed those of most other drugs of abuse. Increasing purity and decreasing cost of heroin likely contribute to trends of decreasing age at first use and an increasing rate of initiation into regular use in the United States. Effective treatment is available for heroin dependence, so primary care providers should screen patients for this disorder. This article reviews the epidemiology of heroin use and dependence in the United States and outlines what is known regarding risk factors for initiation of heroin use and for heroin dependence.

Clare E. Guse, MS; Anne M. Marbella, MS; Peter M. Layde, MD, MSc; Ann Christiansen, MPH; Patrick Remington, MD, MPH
Clean Indoor Air Policies in Wisconsin Workplaces
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Objective: To describe the nature and extent of workplace environmental tobacco smoke exposures in Wisconsin.

Methods: Descriptive data and confidence intervals from the Current Population Survey tobacco supplements of 1995-1996 and 1998-1999 are presented.

Results: The percent of indoor workers working under a smoke-free policy increased slightly, from 62% in 1995-1996 to 65% in 1998-1999. Respondents with a college degree were more likely to work under a smoke-free policy than those with a high school education or less. Among respondents with a work policy in 1998-1999, a complete ban on smoking reduced any workplace exposure in the past 2 weeks (4%) compared to a partial ban (26%) or an unrestricted policy (30%).

Conclusion: Wisconsin has seen a small increase in workplace policies that ban smoking in the workplace. These policies are more likely to protect workers of higher socioeconomic status and may increase health disparities in tobacco-related diseases in the future.

Review Articles

Charles E. Bailey, MD; Suhail Allaqaband, MD; Tanvir K. Bajwa, MD, FACC
Current Management of Patients with Patent Foramen Ovale and Cryptogenic Stroke: Our Experience and Review of the Literature
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Background: Patent Foramen Ovale (PFO) occurs in approximately 25% of the population and has been implicated in the etiology of cryptogenic stroke. Although the exact mechanism of PFO’s role in stroke has not been defined, there is a growing body of evidence that supports both the safety and therapeutic benefit of PFO closure in cryptogenic stroke. Current methods of therapy include anticoagulation, surgical closure, and percutaneous closure.

Methods: We completed a retrospective analysis of data from the first 20 PFO closures at our institution and evaluated the current literature on PFO treatment.

Results: Percutaneous closure had a 100% technical success rate. There were no procedural complications and only 1 episode of supraventricular arrhythmia requiring therapy.

Conclusion: Percutaneous closure is associated with a high technical success rate, decreased morbidity compared to surgery, and equal benefits after endothelialization of the device. As the mechanisms involved in PFO are better delineated, clear guidelines can be established for the percutaneous closure and follow-up of PFO.

Your Practice

Jay A. Gold, MD, JD, MPH
Managing diabetic dyslipidemia: Testing is step one
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Recently, the Centers for Disease Control and Prevention (CDC) estimated that 18.2 million Americans have diabetes, the sixth leading cause of death in the United States. Of that number, over 70% of all deaths are due to macrovascular complications —CVD, cerebrovascular disease, and peripheral vascular disease. CVD events are 4 times more likely, occur at a younger age, and have a much greater case fatality rate among adults with diabetes. Indeed, the National Cholesterol Education Program (NCEP) considers diabetes to be a CVD risk equivalent, requiring aggressive care to prevent future vascular events.

Maureen E. Hansen, CLU
Are you emotionally ready to retire?
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Do you catch yourself looking out the window, dreaming of a day when your life is less harried, you have time to pursue your hobbies and the freedom to travel whenever you want? If so, early retirement may sound like a dream come true. But early retirement isn’t as simple as it may seem. Not only do you have to consider the financial cost of early retirement, you also need to determine if you are emotionally ready to retire.

Your Profession

Edited by Kesavan Kutty, MD, FACP
Proceedings from the 2003 Annual Meeting of the American College of Physicians, Wisconsin Chapter
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The Wisconsin Chapter of the American College of Physicians held its annual meeting in Waukesha, Wis, September 5-7, 2003

Michael J. Dunn, MD
The growing medical and scientific challenges of obesity
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Obesity places nearly onethird of American adults at higher risk for developing myriad health problems, including type 2 diabetes, heart disease and some forms of cancer.

Your Society

Arthur J. Patek, AB, MD
Looking Back
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Advertisements excerpted from Wisconsin Medical Journal, 1904;2(11):XIII