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This Week in JAMA |

This Week in JAMA FREE

JAMA. 1998;279(24):1929. doi:10.1001/jama.279.24.1929.
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PREDICTING ISCHEMIC HEART DISEASE: BEYOND CHOLESTEROL

Many patients develop ischemic heart disease despite normal lipid levels. Dr Lamarche and colleagues studied nontraditional metabolic risk factors—fasting insulin levels, apolipoprotein B, and small LDL particles—in patients who developed ischemic heart disease compared with those who did not. Even after controlling for LDL, triglycerides, and HDL, the nontraditional risk factors were associated with increased risk of ischemic heart disease.

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ZINC FOR KIDS WITH COLDS?

Evidence on the role for oral zinc in relieving cold symptoms has been mixed, but all studies reported to date have involved adults. In this randomized trial, Dr Macknin and colleagues found that zinc gluconate lozenges were not effective in reducing time to resolution of cold symptoms in children and adolescents but were associated with increased frequency of adverse effects. As Dr Gadomski emphasizes in an accompanying editorial, there's not yet evidence to support the use of zinc lozenges for treating cold symptoms in children and adolescents.

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CESAREAN DELIVERY RATES SHOULD REFLECT PATIENT MIX

Health plans are ranking hospitals' cesarean delivery rates, implying that lower rates represent more appropriate care. However, most rankings don't account for patient-specific factors that affect the likelihood of a cesarean delivery. Dr Aron and colleagues looked at the effect of such adjustments on the rankings for cesarean delivery rates among 21 Cleveland-area hospitals. Four hospitals were outliers using adjusted or unadjusted rankings, whereas for 5 hospitals, outlier status depended on whether unadjusted or adjusted rates were used.

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GASTROSTOMY PLACEMENT: INCIDENCE AND MORTALITY

Gastrostomy tube placement is often considered when elderly patients have difficulty getting adequate nutrition orally. Dr Grant and colleagues determined the number of Medicare beneficiaries in the United States aged 65 years and older who received gastrostomy tube placement. The procedure was performed in 1 in 131 white and 1 in 58 black Medicare beneficiaries aged 65 years and older; mortality increased from 15% in-hospital to 24% at 30 days and 81% at 3 years.

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TESTING FOR ANTIRETROVIRAL DRUG RESISTANCE

Resistance to antiretroviral agents used to treat patients with HIV infection is an important cause of treatment failure. In this Consensus Statement, Dr Hirsch and colleagues review the principles and clinical implications of HIV resistance, describe the assays for measuring drug resistance, and present strategies for antiretroviral drug resistance testing in clinical practice.

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A 24-YEAR-OLD WOMAN WITH ANOREXIA NERVOSA

Anorexia nervosa is a troubling disease that mainly affects young women. In this Clinical Crossroads, Ms K speaks about her ongoing struggles with the disease she believes will be part of her for life, and Dr Halmi discusses anorexia and approaches to treating this often devastating and sometimes fatal disease.

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THE COVER

"That amidst the flounces, the frou-frou, and the confections, amidst even the restlessness and anxiety, there is, after all, a tale worth hearing?" Richard Emil Miller, Reverie, c 1913, American.

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CONTEMPO 1998

The accomplishments of global public health programs and strategies to improve the health status of populations worldwide.

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MEDICAL NEWS & PERSPECTIVES

Spurred by a private venture to sequence the human genome, the nation's genome researchers say it's time to step up the pace of the public effort.

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LETTER FROM ISRAEL

Patients' preferences for direct access to specialty care vs initial contact with a primary care physician.

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JAMA PATIENT PAGE

For your patients: the basics on the common cold.

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NEXT WEEK IN JAMA

A theme issue on HIV/AIDS.

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