Treatment decisions for extremely low-birth-weight infants include
consideration of quality-of-life outcomes of intensive neonatal care.
Saigal and colleaguesArticle found that preference ratings by neonatologists
of 5 hypothetical child health states depicting possible outcomes of
neonatal care were similar to ratings by neonatal nurses, but generally
lower than those by adolescents who had been extremely low-birth-weight
infants, adolescent controls who had been normal-weight term infants,
and their parents. In an editorial, FostArticle discusses the complexities of
treatment decisions for seriously ill newborns.
To determine whether high dietary fiber intake is associated with a
decreased risk of coronary heart disease (CHD) in women, as has been
observed in men, Wolk and coworkers analyzed CHD events and data
collected by repeated food frequency questionnaires for 68,782
women followed up for 10 years in the Nurses' Health Study. After
controlling for age and other cardiovascular risk and dietary factors,
the risk of a CHD event was significantly less for women in the highest
quintile of cereal fiber intake compared with the lowest quintile, but
a similar association was not seen with vegetable or fruit fiber
Tight glycemic control, which is associated with a decreased risk of
microvascular complications in patients with type 2 diabetes mellitus,
may require treatment with more than 1 pharmacological agent in most
patients over time. In the UK Prospective Diabetes Study of more than
4000 patients with newly diagnosed type 2 diabetes mellitus, Turner and
colleagues found that overall more than twice as many patients randomly
allocated to monotherapy (insulin, a sulfonylurea, or metformin) as
patients randomized to conventional treatment (diet alone) achieved
target levels of fasting plasma glucose and glycosylated hemoglobin
(HbA1c). By 9 years after diagnosis, however, only about
25% of patients in the monotherapy group attained the target
HbA1c level of less than 7%.
Sullivan and colleagues report that only 42 (8.5%) of 497
patients aged 65 years or older admitted to a medical or surgical ward
of a Veterans Affairs hospital maintained the level of average daily
nutrient intake recommended for hospitalized patients. One hundred two
patients (21%) had an average daily nutrient intake of less than 50%
of their calculated maintenance energy requirements. Patients in this
low-nutrient group were more likely to be functionally dependent at
discharge and had higher rates of in-hospital mortality and mortality
within 90 days of admission compared with the other patients.
In this study of healthy young men,
King and coworkersArticle found that testosterone levels did not increase
immediately after androstenedione administration or during
8-week resistance training with androstenedione supplementation.
Increases in muscle strength during training were similar in
androstenedione and placebo groups, but estradiol and estrone levels
increased significantly over baseline in the androstenedione group. In
an editorial, YesalisArticle questions whether androstenedione should be
At their spring meeting in Chicago, pediatricians were updated on the
efficacy and cost of vaccines against varicella, Lyme disease,
influenza, and rotavirus, and on progress against group A streptococcal
How to assess recommendations for screening.
Long and Marquis estimate the increase in annual physician visits among
low-income uninsured children expected to follow implementation of the
State Children's Health Insurance Program (CHIP) and predict marked
variation between states.
Bodenheimer and coauthors propose that primary care physicians become
coordinators of care rather than gatekeepers.
For your patients: Facts on dietary fiber.
This Week in JAMA. JAMA. 1999;281(21):1967. doi:10.1001/jama.281.21.1967