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In a systematic analysis of the epidemiology of 291 diseases and injuries, their sequelae, and
associated risk factors, the US Burden of Disease Collaborators assessed the health status of the US
population in 2010, determined changes in health status from 1990 to 2010, and compared US
population health with population health in 34 other wealthy nations. Among the investigators’
findings were that from 1990 to 2010, life expectancy at birth and healthy life expectancy
increased, rates of all-cause mortality at all ages decreased, and age-specific rates of years lived
with disability remained stable in the United States. However, improvements in population health in
the United States have not kept pace with those in other wealthy nations. In an Editorial, Fineberg
discusses strengths and limitations of the study and its potential to advance understanding of
population health status in the United States.
Optimal management of patients with severe mitral valve regurgitation without heart failure
symptoms or left ventricular dysfunction is not clear. In an analysis of registry data from 1021
consecutive patients with severe mitral regurgitation due to flail mitral valve leaflets, Suri and
colleagues found that compared with initial medical management, mitral valve surgery within 3 months
was associated with greater long-term survival and a lower risk of heart failure but no difference
in new-onset atrial fibrillation. In an Editorial, Otto discusses surgical intervention for patients
with a flail mitral valve leaflet.
The role of QRS duration and morphology in the selection of patients for cardiac
resynchronization therapy (CRT) is unclear. In a retrospective cohort study of 24 169 Medicare
beneficiaries who received a CRT defibrillator (CRT-D), Peterson and colleagues found that patients
with left bundle-branch block (LBBB) and QRS duration of 150 ms or greater had a lower risk of
all-cause mortality and of all-cause, cardiovascular, and heart failure readmissions compared with
patients with no LBBB or LBBB with shorter QRS duration.
Mr K is a 43-year-old man with a 20-year history of gastroesophageal reflux disease (GERD).
Endoscopic examination and biopsy confirmed the presence of Barrett esophagus—replacement of
the normal stratified squamous epithelium with metaplastic columnar epithelium. In this Clinical
Crossroads article, Spechler discusses the pathogenesis, epidemiology, diagnosis, and treatment of
Barrett esophagus, including evidence for endoscopic eradication therapy of dysplasia in Barrett
esophagus and current recommendations for screening and treatment of patients with Barrett esophagus
with and without dysplasia.
A 2012 Archives of Internal Medicine article reported that zonisamide—an
antiepileptic drug with a side effect of weight loss—added to diet and lifestyle counseling
moderately enhanced weight loss beyond that achieved with diet and lifestyle counseling alone. In
this From the JAMA Network article, Apovian and Aronne discuss challenges faced by patients and
physicians in efforts to achieve long-term weight loss and difficulties encountered in clinical
trials of obesity treatments.
A 73-year-old man with a several-week history of herpes zoster in the left T11-T12 dermatome
developed a painful, progressive bulge in the left flank, which was more prominent on standing,
coughing, and straining. Computed tomography showed convexity of the left abdominal wall but no
intraabdominal mass or fluid accumulation. What would you do next?
Highlights. JAMA. 2013;310(6):557-559. doi:10.1001/jama.2013.5247