To ascertain whether providing care to a family member with a chronic
illness or disability is associated with increased mortality risk, Schulz
and Beach Article followed up 819 individuals aged 66 to 96 years, 392 of whom had
a spouse who had difficulty with at least 1 activity of daily living or instrumental
activity of daily living and 427 control participants whose spouse was not
disabled. Compared with control participants, individuals who provided spousal
care and were experiencing mental or emotional strain had a relative 4-year
mortality risk of 1.63; caregivers not experiencing strain, 1.08; and participants
with a spouse with a disability but not providing care, 1.37. In an editorialArticle,
Kiecolt-Glaser and Glaser discuss the effect of chronic stress on physical
and mental health in older adults.
Using Swiss HIV Cohort Study data from 2410 individuals infected with
human immunodeficiency virus treated with at least 3 antiretroviral drugs,
including a protease inhibitor, Ledergerber and colleagues found that the
incidence of acquired immunodeficiency syndrome (AIDS)–related opportunistic
infections (OIs) decreased from 15.1 per 100 person-years in the 6 months
before potent antiretroviral therapy to 7.7 in the first 3 months after starting
treatment, 2.6 in the following 6 months, and 2.2 between 9 and 15 months.
The rate of reduction in incidence varied according to OI, ranging from 38%
per month for Kaposi sarcoma to 5% per month for non-Hodgkin lymphoma. In
multivariate regression analyses, baseline CD4 cell count, viral load, and
clinical stage were significantly associated with OI risk after starting potent
In this analysis of data from 20,746 adolescents in grades 7 through
12 enrolled in the National Longitudinal Study of Adolescent Health, Ford
and colleagues found that 18.7% of adolescents reported not seeking medical
care at least once when they thought they needed it during the year preceding
the study interview. Factors associated with decreased risk of foregone medical
care included continuous private or public insurance and having had a physical
examination within the past year. Factors associated with increased risk of
foregone care included older age, minority race/ethnicity, single-parent home,
and disability. Adolescents who reported participating in behaviors associated
with adverse health outcomes and frequent symptoms suggestive of physical
or mental health problems were more likely to forego health care than those
not reporting these behaviors and symptoms.
Modifiable health risk factors that adversely affect long-term health
outcomes may also increase health care costs in the short-term. In this study
of 5689 adults aged 40 years or older enrolled in a Minnesota health plan,
Pronk and colleagues estimated that median health care charges over 18 months
were 4.7% lower for each day of physical activity per week, 1.9% higher for
each unit increase in body mass index, 18% higher for current smokers, and
25.8% higher for ever smokers.
To determine how Helicobacter pylori is transmitted,
Parsonnet and colleagues Article studied stools before and after catharsis, saliva
and air before and after induced emesis, and vomitus in 16 asymptomatic adults
infected with H pylori and stool and saliva samples
from 10 uninfected adults. H pylori was cultured
from all vomitus samples from infected subjects and occasionally from saliva,
air during emesis, and cathartic stools. All of the samples from uninfected
subjects were negative for H pylori. In an editorialArticle,
Blaser discusses how gastric-oral transmission of H pylori suggested by this study may explain the progressive decrease in prevalence
of colonization by H pylori in developed countries.
"Being an HIV-dedicated physician in the Dominican Republic has introduced
me to some wonderful people." From "AIDS in Paradise."
In efforts to effectively treat patients with Parkinson diseaseArticle
are exploring new models of its pathogenesis and alternatives to transplanting
fetal human brain tissue.
Ratings of an expert panel are compared with results of decision analytic
techniques on the appropriateness of coronary angiography after myocardial
A portrait of the life and legacy of Sir William Osler 150 years since
Original research, reviews, and commentaries on access to health care
are invited for a JAMA theme issue scheduled for October 2000.
For your patients: Caregiving and stress reduction.
This Week in JAMA. JAMA. 1999;282(23):2191. doi:10.1001/jama.282.23.2191