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This Week in JAMA
September 8, 2004

This Week in JAMA

JAMA. 2004;292(10):1143. doi:10.1001/jama.292.10.1143
Inactivity and Obesity as Health Risks in Women

Physical inactivity and obesity are closely linked established risk factors for cardiovascular disease (CVD) and type 2 diabetes; however, the relative contribution of each alone is not clear. Wessel and colleaguesArticle examined the relationship of obesity and physical fitness to CVD in women being evaluated for suspected myocardial ischemia. They found that women with higher self-reported physical fitness scores had a less adverse CVD profile than women with lower scores, whereas measures of obesity were not independently associated with CVD risk. In a second article, Weinstein and colleaguesArticle examined the association of physical activity and body mass index (BMI) with incident type 2 diabetes in women. They found both BMI and physical inactivity to be independent predictors of incident diabetes, but the magnitude of risk from BMI was much greater. In an editorial, Blair and ChurchArticle emphasize the benefits of increased physical activity to diminish disease risks and improve health.

Galantamine for Chronic Fatigue Syndrome

Some evidence suggests that chronic fatigue syndrome (CFS) results from a deficiency in cholinergic neurotransmission; however, a small study found that patients who received the acetyl cholinesterase inhibitor galantamine hydrobromide improved. Blacker and colleaguesArticle report results of a randomized dose-ranging clinical trial to assess efficacy and tolerability of galantamine vs placebo in the patients with a clinical diagnosis of CFS who completed the study. Galantamine was well tolerated but was no more effective than placebo in relieving the symptoms of CFS. In an editorial, StrausArticle discusses the challenges of treating CFS and the importance these results have in elucidating its pathogenesis.

Vaccination Success With Diluted Smallpox Vaccine

In the event that large-scale smallpox vaccination becomes necessary, the efficacy of diluted doses of stockpiled vaccine is important to determine. In a randomized trial, Talbot and colleagues assessed the vaccination success rate and reaction profile of undiluted and 1:5 and 1:10 dilutions of an Aventis Pasteur smallpox vaccine maintained at −20°C since manufacture in the late 1950s. Participants in all 3 dilution groups demonstrated a successful clinical response to vaccination, which supports efficacy of the diluted vaccine. Similar local and systemic reactions were seen in the undiluted and diluted vaccine groups.

Consumer-Driven Health Care in Switzerland

Consumer-driven health care (CDHC) allows enrollees to tailor their insurance plan to meet personal needs through individual choice of benefits. Switzerland is the only developed country with a long-standing CDHC system, and its experience may inform the development of CDHC programs in the United States. Herzlinger and Parsa-ParsiArticle describe characteristics of the Swiss CDHC system, note its strengths and weaknesses, and suggest lessons for the United States. In a commentary, ReinhardtArticle provides additional details about Swiss health care economics and policy and suggests that the Swiss system is more akin to other government-regulated social insurance systems than to a truly consumer-driven system.

A Piece of My Mind

"We gather around to watch the replay of the second hit on Manhattan, the one that changed everything." From "In Memoriam."

Medical News & Perspectives

The rates of new HIV infections in Asia are among the fastest growing in the world. That trend, a shortage of physicians with HIV clinical expertise, and other problems threaten efforts to make HIV treatment accessible to those who need it.


The importance of the clinical history in evaluating the cause of near-syncope after exercise.

JAMA Patient Page

For your patients: Information about fainting.