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In This Issue of JAMA
March 27, 2018


JAMA. 2018;319(12):1177-1179. doi:10.1001/jama.2017.12295


Urinary sodium excretion may be a more accurate measure of sodium intake than dietary recall. Cogswell and colleagues analyzed 24-hour urine specimens from a nationally representative survey of 827 US adults and estimated mean sodium intake to be 3608 mg per day. In an Editorial, Ix and Anderson suggest that this estimate can serve as a benchmark for evaluating the success of public health strategies to reduce sodium intake from commercially processed foods and other sources.


In premature infants, closure of a hemodynamically significant patent ductus arteriosus may prevent organ damage from pulmonary hyperperfusion or systemic hypoperfusion. Mitra and colleagues reviewed 68 randomized trials enrolling 4802 infants and found that oral high-dose ibuprofen was associated with a higher likelihood of hemodynamically significant patent ductus arteriosus closure compared with standard doses of intravenous ibuprofen or indomethacin.


The lack of hospital-based obstetric services in rural areas may prolong travel distances and limit options for giving birth. Kozhimannil and colleagues conducted a retrospective cohort study of 4 941 387 births in 1086 rural US counties and found that loss of hospital-based obstetric services was associated with increases in out-of-hospital and preterm births. In an Editorial, Shah suggests that geographic distances could be bridged with modern modes of communication to access expert consultants and triage women at risk of adverse birth outcomes.

Viewpoint and Editorial

Although infectious disease mortality in the United States is declining nationally, outbreaks may occur at the local level. El Bcheraoui and colleagues used death records and population counts to estimate age-standardized mortality rates and found large differences by county for several infectious diseases. In an Editorial, Shuman and Malani discuss several reasons why infectious disease mortality is likely to vary from place to place and over time.


Clinical Review & Education

Approximately 1 in 8 of the 1.2 million people living with HIV in the United States are unaware of their HIV status, and only half of those known to be infected are receiving effective antiretroviral therapy. Riddell and colleagues review the efficacy and safety of preexposure prophylaxis to prevent the transmission of HIV.


This article in the JAMA Performance Improvement series explores the case of a patient with complete heart block who developed cardiogenic shock after receiving β-blocker therapy. Gupta and colleagues discuss contraindications to β-blocker therapy and the limitations of standardized admission orders. In an Editorial, Shah and Cifu emphasize that clinical decision support tools should be designed to supplement, not replace, clinical judgment.


Author Audio Interview and CME

This JAMA Diagnostic Test Interpretation article by Patel and Gyawali presents a 56-year-old woman with persistent heartburn who was evaluated with ambulatory reflux monitoring. How would you interpret these test results?