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This Week in JAMA
June 23/30, 1999

This Week in JAMA

JAMA. 1999;281(24):2265. doi:10.1001/jama.281.24.2265
Risk and Toxicity of Elevated Blood Lead Levels

Elevated blood lead levels and associated toxicity remain an important public health problem despite recent reductions in population lead exposure. Two studies reported in this issue of THE JOURNAL used data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) to explore a previously unexamined correlate of blood lead level, serum ascorbic acid, and toxic effect of lead exposure, dental caries. Simon and HudesArticle found that high serum ascorbic acid levels were associated with decreased prevalence of elevated blood lead levels among both youth and adults. Moss and coworkersArticle found that blood lead levels were significantly associated with the prevalence of dental caries. In an editorial, MatteArticle advocates increased efforts to reduce residential lead exposure and control the lead hazard in contaminated exterior dust and soil.

Therapy for Chronic Symptomatic Hyponatremia

The serious morbidity and mortality associated with chronic symptomatic hyponatremia have been attributed both to the hyponatremia and to its treatment. Ayus and ArieffArticle found that among 53 postmenopausal women with chronic symptomatic hyponatremia, neurological outcomes were better in patients treated with intravenous sodium chloride than in those treated with fluid restriction alone. Neurological outcomes did not correlate with initial plasma sodium level or rate of correction of hyponatremia. In an editorial, KnochelArticle emphasizes that clinicians must be alert to clinical and therapeutic situations associated with risk of chronic hyponatremia and underscores that fluid restriction is inadequate therapy for symptomatic hyponatremia.

Variations in Care of Adults Infected With HIV

In this study of variations in health care from 1996 to 1998 of a nationally representative sample of adults infected with the human immunodeficiency virus (HIV), Shapiro and colleagues measured patient-reported compliance with 6 indicators of optimal care—3 measures of service utilization and 3 measures of medication utilization. Overall, the proportion of patients reporting compliance with all 6 indicators increased from 29% to 47% after a median follow-up of 15 months. Patterns of care remained inferior for blacks and Latinos compared with whites, women compared with men, and uninsured and Medicaid-insured patients compared with patients with private insurance, although disparities in care among these subgroups decreased with time.

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Gene Mutations and Colorectal Cancer

DNA mismatch repair (MMR) gene alterations have been associated with colorectal cancer, particularly among individuals with hereditary nonpolyposis colorectal cancer (HNPCC), but genetic predisposition for MMR gene-related colorectal cancer has not been studied in African Americans, a population with an increased colorectal cancer mortality rate compared with whites. In this preliminary investigation, Weber and coworkers identified novel mutations in the hMLH1 and hMSH2 MMR genes in 3 of 11 African Americans with early-onset colorectal cancer, including 1 person who was a member of an HNPCC family.

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A 75-Year-Old Man With Congestive Heart Failure

Mr C has severe chronic congestive heart failure, intermittent atrial fibrillation and flutter, and chronic obstructive pulmonary disease and is being treated with multiple medications and oxygen. Recently, he has had frequent hospitalizations and his clinical condition and functional status have declined. Guyatt discusses how to identify and assess evidence on the treatment of congestive heart failure and how to evaluate the potential benefit of each treatment in Mr C's complex pharmacologic regimen.

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Contempo 1999

Psychological stress, the immune response, and infectious disease.

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Medical News & Perspectives

A recent symposium assessed the value of lithium, which, in its 50 years of therapeutic use, has been prescribed for diseases ranging from gout to bipolar disorder.

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Risk of BSE in Humans

The occurrence of new-variant Creutzfeldt-Jakob disease (Figure 1) in the United Kingdom has been linked to transmission of bovine spongiform encephalopathy (BSE) to humans. This report from the Council on Scientific Affairs of the AMA examines the risk of BSE transmission to humans in the United States.

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Journal Editors, Journal Owners

Davies and Rennie assert that trust between journal editors and owners is essential to the collective enterprise of journal governance.

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JAMA Patient Page

For your patients: Facts about lead poisoning.

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