The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Background 
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
Objectives 
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data Extraction 
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Results 
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
Conclusions 
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.

Please see later in the article for the Editors' Summary

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Social Relationships and Mortality Risk: A Meta-analytic Review

Heavy metals are naturally occurring elements that have a high atomic weight and a density at least five times greater than that of water. Their multiple industrial, domestic, agricultural, medical, and technological applications have led to their wide distribution in the environment, raising concerns over their potential effects on human health and the environment. Their toxicity depends on several factors including the dose, route of exposure, and chemical species, as well as the age, gender, genetics, and nutritional status of exposed individuals. Because of their high degree of toxicity, arsenic, cadmium, chromium, lead, and mercury rank among the priority metals that are of public health significance. These metallic elements are considered systemic toxicants that are known to induce multiple organ damage, even at lower levels of exposure. They are also classified as human carcinogens (known or probable) according to the US Environmental Protection Agency and the International Agency for Research on Cancer. This review provides an analysis of their environmental occurrence, production and use, potential for human exposure, and molecular mechanisms of toxicity, genotoxicity, and carcinogenicity.

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Heavy metal toxicity and the environment.

The detection of psychiatric illness by questionnaire

Epidemiology of insomnia: what we know and what we still need to learn

The effect of traffic noise on sleep was evaluated in an experimental room using repeated recorded truck-passing sounds. The peak sound level was 55, 60 or 65 dB (A) with frequencies of three times per hour. The background noise of the exposure night was Leq 42 dB (A) and that of the control night was Leq 35 dB (A). The subjects were five students 23 to 24 years old. The sleep stage of each epoch with a 20-second duration was judged visually based on the criteria of Rechtschaffen & Kales and the data of the second night of noise-exposure and the control night were used. The sleep parameters used were total sleep time (TST), each sleep stage, % of sleep stage against TST, sleep efficiencies, sleep latency, REM latency, REM cycle, REM duration, waking from sleep, number of stage shifts, and subjective sleep judged by the OSA sleep inventory. A paired t test was used for the statistical analysis. TST, REM stage in minutes, and % of REM stage against TST of the exposure night were significantly decreased compared with those of the control night. Other objective and subjective parameters showed no changes during noise exposure. Dividing the all-night into halves, the amount and % of each sleep stage were compared between the exposure and control night. There was no change of sleep stage in the former half, but the % and amount of REM sleep in the latter half were significantly decreased as a result of the noise exposure. The decreases of REM sleep and % REM against TST, especially in the latter half of all-night sleep, were caused by the intermittent truck-passing sounds 20 to 30 times per night. Language: ja

[The effect of noise on sleep--changes in hypnograms of subjects exposed to repeated truck-passing sound].

Dear Editor Considerate and careful interventions for eating, which may be time-consuming and costly, are not only related to weight per se, but also to psychological distress There are several reports that depression is associated with dietary patterns and food consumption The present cross-sectional study was performed to validate this association, with special emphasis on sweet preference, snacking, body mass index, depressive state, and aging A sample of 11 134 adults (5433 men and 5701 women) from the local Japanese population comprised the original subjects Subjects who were using antidepressant medications could not be excluded prior to registration Responses were received from 11 007 people in total (5359 men and 5648 women), resulting in a response rate of 989% Informed consent was obtained from each respondent The Todai Health Questionnaire (THI) is used for the self-management of health and is composed of 130 questions, with responses being either affirmative, negative, or neutral The first question on the THI is ‘Do you eat sweets?’ and the 15th question is ‘Do you eat between meals?’ A reply was deemed ‘positive’ when respondents answered in the affirmative Furthermore, the depressive mood in each subject was assessed quantitatively by 10 items on the THI questionnaire, termed the THI depression scale (THI-D) The higher the score on the THI-D, the greater the depressive state The THI-D has been validated previously against the Center of Epidemiological Studies Depression Scale (CES-D) and Zung’s depression scale, and we have used it previously in elderly people aged in their 60s According to distribution of scores, subjects were classified into quintiles after stratification by sex and age class (10-year intervals from 40 to 69 years of age) The age of the subjects in the present study ranged from 40 to 69 years The mean (1SD) age was 539 1 85 years in men and 544 1 84 years in women As indicated in Table 1, the percentage of frequent snacking was higher when levels of depressive state increased in all age classes for both sexes In contrast, there was no significant difference in the percentage sweet preference and body mass index stratified according to depressive state Using logistic regression analysis, the ageand body mass indexadjusted odds ratios (95% confidence intervals) in men from the lowest through to highest quintiles of THI-D scores for snacking habits were 100 (reference), 135 (093–196), 182 (124–266), 237 (164– 342), and 336 (234–481), respectively In women, the adjusted odds ratios (95% confidence intervals) from the lowest through to highest quintiles of THI-D scores for snacking habits were 100 (reference), 164 (125–215), 205 (155–270), 240 (183–315), and 328 (249–431), respectively In contrast, there was no significant association between THI-D and sweet preference in either men or women The age of the subjects was originally limited to 40–69 years in this survey because the main purpose of the study was health risk appraisal for middle-aged doi:101111/j1479-8301201100365x PSYCHOGERIATRICS 2011; 11: 247–248

Depressive state, aging, and prevalence of snacking: a preliminary study.

Risk Factors for Liver Dysfunction in Middle Aged Men based on Four Year Health Examination Data: Kumiko TAJIMA, et al. Department of Public Health, Gunma University School of Medicine-In order to develop a better lifestyle improvement program, the relationship between lifestyle and changes in liver function were compared through data-linkage of a self-administered questionnaire to the results of annual health examinations over 4 years. In this study, 2, 511 male subjects aged 40-69 yr were asked to fill in the questionnaire. Of these, 824 subjects had a health examination in 1993. Two hundred and twenty-eight of these remained within the normal range in liver function tests (LFT) in each of annual health examinations between 1994 and 1996, whereas 63 had worsened LFT results after the initial examination and were therefore called the decreased liver function (DLF) group. Controls age-matched to the DLF group were chosen from the normal liver function group. Discriminant function analysis was carried out to identify the differences between the DLF group and the control group. The independent variables were selected from the variables which showed significant differences in the univariate analysis, considering multicollinearity. The independent variables used for the discriminant analysis were therefore alcohol consumption, diastolic blood pressure (DBP), BMI and “aggression” by THI. The Wilks'' Lambda value was 0.787 (p value=0.0001). The overall correct identification rate in the discriminant analysis was 75.0%. The results of the present study suggest that men who are heavy drinkers, hypertensive, obese and aggressive had a high risk of developing liver dysfunction within a few years, even if their LFT values were within normal limits in any single year.

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Risk Factors for Liver Dysfunction in Middle Aged Men based on Four Year Health Examination Data.

The purpose of this study was first to determine copper content in soil, foodstuff and feces of villagers, and estimate the daily copper intake of the villagers and a guest. The data obtained may help clarify the relationships of copper content in the soil-plant (food)-daily intake-feces in Indonesia. Secondly, the percentage of copper contribution of food groups was calculated to determine the influence of the food patterns of villagers and a guest on daily copper intake. Finally, evaluation was made of daily copper intake of villagers in terms of estimated daily copper requirement by WHO.

Shosuke Suzuki

Papers

[The effect of noise on sleep--changes in hypnograms of subjects exposed to repeated truck-passing sound].

Depressive state, aging, and prevalence of snacking: a preliminary study.

Risk Factors for Liver Dysfunction in Middle Aged Men based on Four Year Health Examination Data.

Copper content in foods of Java Island and estimation of daily copper intake.

Copper in Rice and in Soils According to Soil Type in Japan, Indonesia, and China: A Baseline Study