In an investigation of an outbreak of infections caused by ceftazidime
sodium–resistant Escherichia coli and Klebsiella
pneumoniae, Wiener and coworkersArticle found that 35 of 55 hospitalized
patients who were colonized or infected with these isolates had been
admitted from nursing homes. Risk factors for colonization with these
resistant bacteria among nursing home patients included presence of a
gastrostomy tube and prior use of ciprofloxacin or
trimethoprim-sulfamethoxazole. All resistant isolates were found to
have plasmids encoding a common ceftazidime-hydrolyzing β-lactamase.
In an editorial, Fierer and GuineyArticle explain how transfer of resistance
plasmids among bacterial species spreads antibiotic resistance even in
the absence of antibiotic-mediated selection.
Lauer and colleaguesArticle report that chronotropic incompetence (attenuated
heart rate response to exercise) on symptom-limited exercise thallium
scintigraphy was an independent predictor of all-cause mortality during
2 years of follow-up of patients with known or suspected coronary
disease. Daviglus and coworkersArticle found a linear association between the
number of annual electrocardiograms in a 5-year period with minor ST-T
abnormalities and the risk of cardiovascular and all-cause mortality in
men during 29 years of follow-up. In an editorial, Goldstein and
HolmboeArticle discuss criteria that determine the clinical usefulness of
prognostic indicators of coronary events.
Based on an analysis of data from the 1992 US National Health and
Social Life Survey, Laumann and colleagues estimated that the
prevalence of sexual dysfunction is 43% in women and 31% in men.
Patterns of sexual dysfunction varied with age, sex, race, marital
status, and education. In both men and women, sexual dysfunction was
associated with emotional and stress-related problems, including prior
traumatic sexual experiences, poor physical health, and poor quality of
Specific health-related reading and numerical skills are
essential for patients to accomplish health care activities, such as
understanding appointment slips, consent forms, and medication
instructions, and performing self-monitoring tasks. Gazmararian and
colleaguesArticle measured the functional health literacy of 3260 individuals
aged 65 years or older who were newly enrolled in a Medicare managed
care plan. More than one third of study participants had inadequate or
marginal health literacy, and literacy skills appeared to decline with
increasing age. The report from the American Medical Association Ad Hoc
Committee on Health LiteracyArticle discusses the impact of low health
literacy on patient outcomes and on costs, and implications for
physicians, researchers, and policymakers.
In this prospective cohort study, Rantanen and colleagues found that
hand grip strength of healthy men aged 45 to 68 years was highly
predictive of functional limitations and disability 25 years later. For
example, the proportion of men in the lowest baseline grip strength
tertile who had functional limitations at follow-up was more than
twice that of men in the highest baseline grip strength
"Dan was determined not to allow this patient to sit through a mute
weekend." From "Star Material."
Advances in the management of common urologic problems.
Maintenance regimens with 2 antiretroviral drugs fail to preserve viral
suppression after 4-drug induction therapy in patients infected with
human immunodeficiency virus.
At the Society of Neuroscience′s annual meeting, researchers probed
the roots of narcolepsy, the potential of nicotine-like drugs, and a
possible link between an infectious agent and Alzheimer disease.
Eradication of rubella and congenital rubella syndrome seems possible:
vaccination and surveillance strategies that are likely to be
For your patients: A guide to understanding sexual dysfunction.
This Week in JAMA. JAMA. 1999;281(6):489. doi:10.1001/jama.281.6.489