Many patients develop ischemic heart disease despite normal lipid levels.
Dr Lamarche and colleagues studied nontraditional metabolic risk factors—fasting
insulin levels, apolipoprotein B, and small LDL particles—in patients
who developed ischemic heart disease compared with those who did not. Even
after controlling for LDL, triglycerides, and HDL, the nontraditional risk
factors were associated with increased risk of ischemic heart disease.
Evidence on the role for oral zinc in relieving cold symptoms has been
mixed, but all studies reported to date have involved adults. In this randomized
trial, Dr Macknin and colleagues found that zinc gluconate lozenges were not
effective in reducing time to resolution of cold symptoms in children and
adolescents but were associated with increased frequency of adverse effects.
As Dr Gadomski emphasizes in an accompanying editorial, there's not yet evidence
to support the use of zinc lozenges for treating cold symptoms in children
See Article and related editorial Article
Health plans are ranking hospitals' cesarean delivery rates, implying
that lower rates represent more appropriate care. However, most rankings don't
account for patient-specific factors that affect the likelihood of a cesarean
delivery. Dr Aron and colleagues looked at the effect of such adjustments
on the rankings for cesarean delivery rates among 21 Cleveland-area hospitals.
Four hospitals were outliers using adjusted or unadjusted rankings, whereas
for 5 hospitals, outlier status depended on whether unadjusted or adjusted
rates were used.
Gastrostomy tube placement is often considered when elderly patients
have difficulty getting adequate nutrition orally. Dr Grant and colleagues
determined the number of Medicare beneficiaries in the United States aged
65 years and older who received gastrostomy tube placement. The procedure
was performed in 1 in 131 white and 1 in 58 black Medicare beneficiaries aged
65 years and older; mortality increased from 15% in-hospital to 24% at 30
days and 81% at 3 years.
Resistance to antiretroviral agents used to treat patients with HIV
infection is an important cause of treatment failure. In this Consensus Statement,
Dr Hirsch and colleagues review the principles and clinical implications of
HIV resistance, describe the assays for measuring drug resistance, and present
strategies for antiretroviral drug resistance testing in clinical practice.
Anorexia nervosa is a troubling disease that mainly affects young women.
In this Clinical Crossroads, Ms K speaks about her ongoing struggles with
the disease she believes will be part of her for life, and Dr Halmi discusses
anorexia and approaches to treating this often devastating and sometimes fatal
"That amidst the flounces, the frou-frou, and the confections, amidst
even the restlessness and anxiety, there is, after all, a tale worth hearing?"
Richard Emil Miller, Reverie, c 1913, American.
The accomplishments of global public health programs and strategies
to improve the health status of populations worldwide.
Spurred by a private venture to sequence the human genome, the nation's
genome researchers say it's time to step up the pace of the public effort.
Patients' preferences for direct access to specialty care vs initial
contact with a primary care physician.
For your patients: the basics on the common cold.
A theme issue on HIV/AIDS.
This Week in JAMA. JAMA. 1998;279(24):1929. doi:10.1001/jama.279.24.1929