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This Week in JAMA
September 3, 2008

This Week in JAMA

JAMA. 2008;300(9):995. doi:10.1001/jama.300.9.995

Observational data suggest that physical activity lowers the risk of cognitive decline and dementia, but confirmatory evidence from randomized trials has been lacking. To provide an objective assessment of whether physical activity reduces the rate of cognitive decline among older persons, Lautenschlager and colleagues Article randomly assigned persons 50 years or older who reported memory problems but who did not meet criteria for dementia to usual care or a 24-week home-based program of physical activity. The investigators found that compared with the usual care control group, participants in the physical activity group had a modest reduction in the rate of cognitive decline during an 18-month follow-up period. In an editorial, Larson Article discusses the benefits of exercise to prevent cognitive decline and to improve well-being among older adults.

Nephropathy is a recognized complication of exposure to iodine contrast media. Some data have suggested that sodium bicarbonate infusion may prevent contrast medium–induced nephropathy. To assess this, Brar and colleagues conducted a clinical trial in which patients with chronic kidney disease who were undergoing coronary angiography were randomly assigned to receive an infusion of either sodium bicarbonate or sodium chloride for hydration during angiography. The authors report that hydration with sodium bicarbonate was not superior to hydration with sodium chloride for the prevention of contrast medium–induced nephropathy in this at-risk patient population.

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In 2004, California enacted the Paid Family Leave Insurance Program. To assess awareness and use of the program by parents of children with special health care needs, Schuster and colleagues Article interviewed successive cohorts of employed parents in California and in Illinois (a state without paid family leave insurance) before and after enactment of California's program. The authors report that only 18% of California parents of children with special health care needs were aware of the paid leave program and only 5% had used it. The Paid Family Leave Insurance Program did not increase the frequency or duration of leave taking, nor did it decrease the need for child health–related leave among California parents compared with parents in Illinois. In an editorial, Neff Article discusses the challenges faced by parents of children with chronic illnesses and the strengths and weaknesses of several state-based efforts to provide paid family leave.

Mr B is a 39-year-old man who has been living with HIV since 1994. He has been treated with several different antiretroviral regimens, and although he is pleased that his “numbers are good,” he reports significant distress related to fat loss in his cheeks and fat accumulation in his neck, chest, and abdomen. Fuller discusses the clinical features, pathophysiology, and management of HIV-associated lipodystrophy syndrome.

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“‘A witch doctor's secret of success has three parts. One: Take good care of your patients. Nothing should come before this.’” From “One Hundred Thousand Cows: A Fable.”

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Three years after hurricanes Katrina and Rita ravaged the Gulf Coast, survivors with persistent mental health problems face shortages of mental health professionals and facilities.

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Physician-industry relationships

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Bias in industry-sponsored research

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Industry support of medical education

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Preparing fresh tissue for microscopy

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Join H. George Nurnberg, MD, September 17 from 2 to 3 PM eastern time to discuss sildenafil for women with antidepressant-associated sexual dysfunction. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 60-year-old woman with mild memory impairment and white matter lesions on MRI? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is September 24.

JAMA Theme Issue on Medical Education

For your patients: Information about fitness for older adults.

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