Influenza and respiratory syncytial virus (RSV) epidemics often overlap,
both viruses causing considerable morbidity and mortality. Using a new statistical
model based on national mortality and viral surveillance data, Thompson and
colleaguesArticle found that influenza-associated deaths increased substantially
from 1976-1977 through 1998-1999 seasons. For the 1990-1991 through 1998-1999
seasons, influenza A(H3N2) viruses were associated with the highest attributable
mortality rates followed by RSV, influenza B, and influenza A(H1N1) viruses.
Influenza- and RSV-associated mortality rates were highest among persons aged
65 years or older. In an editorial, MorensArticle encourages new strategies for influenza
prevention, especially for the most elderly individuals.
Information regarding population-level adverse effects of obesity may
not effectively communicate the health risks of obesity to individuals. To
quantify individual health risks of obesity, Fontaine and colleaguesArticle estimated
the expected number of years of life lost (YLL) due to overweight or obesity
compared with the reference BMI of 24 for adults aged 18 to 85 years. Among
whites, a J- or U-shaped association was found between overweight or obesity
and YLL. Among black men and black women older than 60 years, overweight and
moderate obesity were generally not associated with increased YLL. For any
degree of overweight, younger adults generally had greater YLL than older
adults. In an editorial, Manson and BassukArticle consider why the patterns of YLL
due to obesity differed between whites and blacks and discuss limitations
of the use of YLL as a metric to quantify health risks associated with obesity.
Early recognition and treatment of preclinical diastolic and systolic
ventricular dysfunction could potentially reduce the incidence of congestive
heart failure (CHF), but the prevalence of diastolic dysfunction and its relation
to systolic dysfunction and congestive heart failure (CHF) in the community
are unclear. In this population-based study of 2042 residents of Olmsted County,
Minnesota, aged 45 years or older, Redfield and colleagues found that the
prevalence of CHF based on medical record review was 2.2%. CHF was more common
among individuals with systolic or diastolic dysfunction, as determined by
Doppler echocardiographic assessment, than among those with normal ventricular
function. Less than half of individuals with moderate or severe diastolic
or systolic dysfunction had recognized CHF. Both mild and moderate to severe
diastolic dysfunction were associated with increased all-cause mortality during
a median follow-up of 3.5 years.
Risk factors for the transmission of herpes simplex virus (HSV) from
mother to infant are not well defined, and no data exist on whether cesarean
delivery, the standard of care for women with genital lesions at the time
of delivery, reduces HSV transmission. In this prospective cohort study of
pregnant women, Brown and colleagues found that risk of neonatal herpes was
significantly associated with several factors, including isolation of HSV
at the time of delivery, first-episode infection, and invasive fetal monitoring
among women shedding HSV at the time of delivery. Cesarean delivery was associated
with a significantly decreased risk of HSV transmission among women from whom
HSV was isolated.
"Were the jokes my father had made in the face of his terrible losses
the manifestation of courage and spirit, or of sclerotic plaques?" From "Family
Tantalizing evidence suggests that genetic microarrays will someday
tell clinicians whether a patient's early-stage cancer will metastasize or
will respond to chemotherapy. An interview with John Quackenbush, PhD, details
some of the promises gene chip studies hold for insights into basic biology.
Results of this meta-analysis of 29 randomized trials indicate that
cholinesterase inhibitors have a modest benefit on neuropsychiatric and functional
outcomes in patients with mild to moderate Alzheimer disease.
This systematic review of 12 randomized trials suggests that compared
with standard medical therapy, artificial support systems reduce mortality
in patients with acute-on-chronic liver failure. Neither artificial nor bioartificial
support systems appear to reduce mortality in patients with acute liver failure.
Prevention and management of pressure ulcers.
For your patients: Information about pressure ulcers.
This Week in JAMA. JAMA. 2003;289(2):135. doi:10.1001/jama.289.2.135