This Week in JAMA FREE

Bile-acid sequestrants have been used to treat children with heterozygous familial hypercholesterolemia (HeFH), but these agents are only somewhat effective and poorly tolerated. Stein and colleaguesArticle report that lovastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, significantly decreased low-density cholesterol levels in adolescent boys with HeFH treated for 1 year compared with placebo and did not appear to adversely affect growth or sexual maturation. In an editorial, Rifkind and coauthorsArticle stress that further study is needed to identify the optimal time to begin treatment of HeFH.

In this 6-month study of an oral anticoagulation therapy self-management program, Sawicki and coworkersArticle found that patients in the program had better anticoagulation control and improved treatment-related quality of life than patients managed with conventional care. In an editorial, AnsellArticle suggests that physicians may be more likely to prescribe oral anticoagulants if therapy is simplified by patient self-management, but research is needed on long-term outcomes and costs of self-management.

Antiretroviral treatment is recommended for all HIV-infected individuals, including pregnant women, but the long-term effects of in utero and neonatal exposure to antiretroviral agents on children are not known. In this study of more than 200 uninfected children who had participated in a trial of perinatal zidovudine for HIV prevention, Culnane and colleagues found no significant differences in growth, cognitive development, or immunologic function at 3 to 5 years of age in children exposed to zidovudine in utero and during the first 6 weeks of life compared with those who had received placebo.

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In this epidemiologic investigation, Van Beneden and coworkers identified alfalfa sprouts grown from contaminated seed distributed by a European wholesaler as the common source of 2 North American outbreaks of Salmonella enterica serotype Newport infections in late 1995 to early 1996 as well as of an outbreak in Denmark in June 1995. The authors point out that there are no effective methods to decontaminate alfalfa seed and caution consumers about the risk of foodborne illness from eating sprouts.

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To identify what patients consider to be elements of quality end-of-life care, Singer and colleagues conducted a content analysis of in-depth, open-ended interviews with patients undergoing hemodialysis, patients infected with HIV, and elderly patients with chronic illnesses. Differences between patient-identified elements of quality end-of-life care and those in expert-derived models suggest that end-of-life care based solely on expert models is likely to miss important areas of concern to patients and their families.

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Cannom and Prystowsky review advances in the detection and treatment of ventricular arrhythmias. Figure 1 shows ventricular fibrillation detected by an implantable cardioverter defibrillator that delivers a 24-J shock and the return to sinus rhythm.

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"I had never seen my patients smile before." From "Too Sad."

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Advances in the treatment of hypertension.

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A report from Sweden showing a decrease in the rate of ectopic pregnancy as the rate of genital chlamydia infections declined highlights the promise of chlamydia prevention programs for improving reproductive health.

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A new technique for rewriting tiny errors in mutant genes may someday offer a strategy for treating some human diseases.

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Delays in cultivation of redistributed land and in access to water in postwar El Salvador associated with stunted linear growth in Salvadoran children.

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For your patients: Understanding cholesterol.

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