To provide recent estimates of obesity prevalence in the United States, Ogden and colleagues analyzed 2011-2012 National Health and Nutrition Examination Survey (NHANES) data. The authors report that 8.1% of infants and toddlers, 16.9% of 2- to 19-year-olds, and 34.9% of adults were obese in 2011-2012. Examination of NHANES data from 5 consecutive surveys revealed no significant changes in obesity prevalence between 2003 and 2012.
The patient-centered medical home practice model is intended to improve health care quality and efficiency. Friedberg and colleagues assessed whether these goals are achieved in an analysis of claims data from 32 primary care practices participating in a pilot medical home intervention and 29 comparison practices of similar size, specialty, and location. The authors found that practices participating in the intervention adopted new structural capabilities such as chronic disease registries and received National Committee for Quality Assurance recognition; however, the intervention was associated with very limited improvements in quality and did not reduce hospital use or costs over 3 years. In an Editorial, Schwenk discusses focused implementation of the medical home practice model.
Author Video Interview
Some data suggest that receipt of live vaccines may affect morbidity and mortality from nontargeted diseases. In a population-based cohort of more than 475 000 Danish children, Sørup and colleagues found that compared with children whose most recent vaccination was the inactivated diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b vaccine, children receiving the live vaccine against measles, mumps, and rubella (MMR) had a lower rate of all-cause infectious disease hospital admissions during the second year of life. In an Editorial, Goldblatt and Miller discuss the evidence for nonspecific effects of vaccines.
In an analysis of registry data from more than 2.2 million patients who underwent percutaneous coronary intervention (PCI) at 1431 hospitals in the United States from 2009 to 2013, Sherwood and colleagues assessed current patterns of red blood cell transfusion and the association of transfusion with adverse cardiac outcomes. The authors found considerable variation in transfusion practices across hospitals, which persisted after adjustment for patient demographic and clinical factors. Receipt of transfusion was associated with increased risk of in-hospital adverse cardiac events.
Asymptomatic bacteriuria and symptomatic urinary tract infection (UTI) in older women are commonly encountered in outpatient practice. Mody and Juthani-Mehta reviewed the literature relating to the diagnosis, management, and prevention of asymptomatic bacteriuria and symptomatic UTI in older, community-dwelling women. The authors discuss the importance of differentiating asymptomatic bacteriuria, which is usually transient and resolves without treatment, from symptomatic UTI. They summarize clinical and diagnostic characteristics of UTI and review risk factors for recurrent symptomatic UTI and its treatment.
Continuing Medical Education
This Medical Letter article summarizes recent guidelines on the choice of antimicrobials for treatment of uncomplicated urinary tract infections (UTIs) in nonpregnant women. Specifically, fluoroquinolones should not be used for empiric treatment of uncomplicated UTIs; however, use of a fluoroquinolone is recommended for treatment of acute uncomplicated pyelonephritis and for outpatient treatment of complicated UTIs.
Related Articles 1 and 2
Highlights. JAMA. 2014;311(8):773-775. doi:10.1001/jama.2013.279346