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This Week in JAMA
December 15, 1999

This Week in JAMA

JAMA. 1999;282(23):2191. doi:10.1001/jama.282.23.2191
Mortality Risk Among Elderly Spousal Caregivers

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.

Antiretroviral Therapy and Opportunistic Infection Risk

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 antiretroviral therapy.

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Adolescents at Risk Fail to Seek Care

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.

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Modifiable Risk Factors Affect Short-term Care Costs

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.

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Transmission Mode of

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.

A Piece of My Mind

"Being an HIV-dedicated physician in the Dominican Republic has introduced me to some wonderful people." From "AIDS in Paradise."

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Medical News & Perspectives

In efforts to effectively treat patients with Parkinson diseaseArticle , researchers are exploring new models of its pathogenesis and alternatives to transplanting fetal human brain tissue.

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Assessment of Medical Interventions

Ratings of an expert panel are compared with results of decision analytic techniques on the appropriateness of coronary angiography after myocardial infarction.

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William Osler at 150

A portrait of the life and legacy of Sir William Osler 150 years since his birth.

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Access to Health Care

Original research, reviews, and commentaries on access to health care are invited for a JAMA theme issue scheduled for October 2000.

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JAMA Patient Page

For your patients: Caregiving and stress reduction.

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