The Internet is providing a new environment for initiation of sexual
contact and for public health measures to control sexually transmitted diseases
(STDs). McFarlane and colleaguesArticle found that 135 of 856 clients of a Denver
HIV counseling and testing site reported having sought sex partners on the
Internet, and 88 reported having sex with partners initially met on the Internet.
Compared with persons who did not seek sex partners on the Internet, those
who did were more likely to be men, to be homosexual, and to report risk factors
for STDs. Klausner and colleaguesArticle investigated 2 new cases of syphilis in
gay men who reported meeting sex partners in an Internet chat room and identified
5 related cases through an information campaign conducted in the chat room
and partner notification via e-mail messages. In an editorial, Toomey and
RothenbergArticle discuss use of the Internet for the prevention and control of STDs.
Factors that determine the outcome of hepatitis C virus (HCV) infection
are not well understood. In a cohort of persons with a history of injection
drug use and serologic evidence of HCV infection, Thomas and colleagues found
that most had persistent viremia without clinically detectable liver disease.
Viral clearance occurred in 90 of 919 study participants and was associated
with nonblack race and absence of HIV infection. Forty of 1667 participants
followed up prospectively for a median of 8.8 years developed end-stage liver
disease, which was associated with older age at study enrollment and heavy
Labarrere and colleagues investigated whether levels of cardiac troponin
I, a contractile protein, would be a useful prognostic indicator for long-term
cardiac allograft survival in 110 patients who received heart transplants.
All patients had elevated troponin I levels during the first month after transplantation.
Persistent elevation for 12 months, which occurred in 56 patients, was associated
with increased fibrin deposits in cardiac microvasculature (Figure 1, arrow)
and cardiomyocytes (Figure 1, arrowhead) and with increased risk for subsequent
development of coronary artery disease and graft failure.
In the Systolic Hypertension in the Elderly Program (SHEP), patients
with isolated systolic hypertension who received antihypertensive treatment
had a lower incidence of total stroke than patients who received placebo.
In this additional analysis of SHEP data, Perry and colleagues found that
the incidence of both hemorrhagic and ischemic stroke types and the incidence
of lacunar stroke subtype were reduced among patients who received antihypertensive
treatment compared with placebo. The benefit of treatment on stroke incidence
was observed within 1 year for hemorrhagic stroke but not until the second
year for ischemic stroke.
Many patients infected with HIV and treated with combination antiretroviral
therapy have developed a lipodystrophy syndrome characterized by redistribution
of body fat (increased truncal fat and loss of facial and extremity fat) and
insulin resistance. In this pilot study with 26 HIV-infected patients with
lipodystrophy and abnormal glucose homeostasis, Hadigan and colleagues found
that patients who received low-dosage metformin treatment for 3 months had
significantly greater reduction in insulin resistance and hyperinsulinemia,
weight loss, and decrease in diastolic blood pressure than patients who received
"Mrs Jones and many like her . . . see a cancer diagnosis as a death
sentence, one that implies not only the end of being but the inevitability
of unsupportable pain, unspeakable indignity, unbearable loneliness." From
Clinical characteristics and management of postpolio syndrome.
The number of older people is growing in rural areas worldwide just
as it is in cities—but they are less visible to helping agencies. Experts
gathered at an international conference to direct attention to the specific
issues surrounding rural aging.
Second part of a 2-part series on qualitative research: how to determine
what the study results are and how these results can help in patient care.
Starfield presents recent US rankings among industrialized countries
on indicators of health care performance and considers explanations for the
relatively poor performance of the United States.
For your patients: A primer on syphilis.
This Week in JAMA. JAMA. 2000;284(4):401. doi:10.1001/jama.284.4.401