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This Week in JAMA
JAMA. 2003;289:135.
Influenza-, Respiratory Syncytial Virus–Associated Deaths
Influenza and respiratory syncytial virus (RSV) epidemics often overlap, both viruses causing considerable morbidity and mortality. Using a new statistical model based on national mortality and viral surveillance data, Thompson and colleagues (SEE ARTICLE) found that influenza-associated deaths increased substantially from 1976-1977 through 1998-1999 seasons. For the 1990-1991 through 1998-1999 seasons, influenza A(H3N2) viruses were associated with the highest attributable mortality rates followed by RSV, influenza B, and influenza A(H1N1) viruses. Influenza- and RSV-associated mortality rates were highest among persons aged 65 years or older. In an editorial, Morens (SEE ARTICLE) encourages new strategies for influenza prevention, especially for the most elderly individuals.
Years of Life Lost Due to Obesity
Information regarding population-level adverse effects of obesity may not effectively communicate the health risks of obesity to individuals. To quantify individual health risks of obesity, Fontaine and colleagues (SEE ARTICLE) estimated the expected number of years of life lost (YLL) due to overweight or obesity compared with the reference BMI of 24 for adults aged 18 to 85 years. Among whites, a J- or U-shaped association was found between overweight or obesity and YLL. Among black men and black women older than 60 years, overweight and moderate obesity were generally not associated with increased YLL. For any degree of overweight, younger adults generally had greater YLL than older adults. In an editorial, Manson and Bassuk (SEE ARTICLE) consider why the patterns of YLL due to obesity differed between whites and blacks and discuss limitations of the use of YLL as a metric to quantify health risks associated with obesity.
Prevalence of Diastolic and Systolic Dysfunction
Early recognition and treatment of preclinical diastolic and systolic ventricular dysfunction could potentially reduce the incidence of congestive heart failure (CHF), but the prevalence of diastolic dysfunction and its relation to systolic dysfunction and congestive heart failure (CHF) in the community are unclear. In this population-based study of 2042 residents of Olmsted County, Minnesota, aged 45 years or older, Redfield and colleagues found that the prevalence of CHF based on medical record review was 2.2%. CHF was more common among individuals with systolic or diastolic dysfunction, as determined by Doppler echocardiographic assessment, than among those with normal ventricular function. Less than half of individuals with moderate or severe diastolic or systolic dysfunction had recognized CHF. Both mild and moderate to severe diastolic dysfunction were associated with increased all-cause mortality during a median follow-up of 3.5 years.
(SEE ARTICLE)
Risk Factors for Mother-to-Infant HSV Transmission
Risk factors for the transmission of herpes simplex virus (HSV) from mother to infant are not well defined, and no data exist on whether cesarean delivery, the standard of care for women with genital lesions at the time of delivery, reduces HSV transmission. In this prospective cohort study of pregnant women, Brown and colleagues found that risk of neonatal herpes was significantly associated with several factors, including isolation of HSV at the time of delivery, first-episode infection, and invasive fetal monitoring among women shedding HSV at the time of delivery. Cesarean delivery was associated with a significantly decreased risk of HSV transmission among women from whom HSV was isolated.
(SEE ARTICLE)
A Piece of My Mind
"Were the jokes my father had made in the face of his terrible losses the manifestation of courage and spirit, or of sclerotic plaques?" From "Family History."
(SEE ARTICLE)
Medical News & Perspectives
Tantalizing evidence suggests that genetic microarrays will someday tell clinicians whether a patient's early-stage cancer will metastasize or will respond to chemotherapy. An interview with John Quackenbush, PhD, details some of the promises gene chip studies hold for insights into basic biology.
(SEE ARTICLE)
Cholinesterase Inhibitors for Alzheimer Disease
Results of this meta-analysis of 29 randomized trials indicate that cholinesterase inhibitors have a modest benefit on neuropsychiatric and functional outcomes in patients with mild to moderate Alzheimer disease.
(SEE ARTICLE)
Artificial Support Systems for Liver Failure
This systematic review of 12 randomized trials suggests that compared with standard medical therapy, artificial support systems reduce mortality in patients with acute-on-chronic liver failure. Neither artificial nor bioartificial support systems appear to reduce mortality in patients with acute liver failure.
(SEE ARTICLE)
CLINICIAN'S CORNER
Contempo Updates
Prevention and management of pressure ulcers.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about pressure ulcers.
(SEE ARTICLE)
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