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.
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.
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
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.
"We gather around to watch the replay of the second hit on Manhattan,
the one that changed everything." From "In Memoriam."
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
For your patients: Information about fainting.
This Week in JAMA. JAMA. 2004;292(10):1143. doi:10.1001/jama.292.10.1143