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This Week in JAMA
July 26, 2000

This Week in JAMA

JAMA. 2000;284(4):401. doi:10.1001/jama.284.4.401

Sexual Behavior, Public Health, and the Internet

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.

Natural History of Hepatitis C Virus Infection

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 alcohol use.

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Cardiac Troponin I Levels After Heart Transplantation

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.

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Antihypertensive Treatment and Stroke Risk

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.

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Metformin Therapy for HIV-Associated Lipodystrophy

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 placebo.

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A Piece of My Mind

"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 "Missed Connections."

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Contempo Updates

Clinical characteristics and management of postpolio syndrome.

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Medical News & Perspectives

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.

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Users' Guides to the Medical Literature

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.

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US Health Care Not Best in World

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.

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JAMA Patient Page

For your patients: A primer on syphilis.

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