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This Week in JAMA
JAMA. 1999;281:489.
Reservoir of Resistant Bacteria in Nursing Homes
In an investigation of an outbreak of infections caused by ceftazidime sodium–resistant Escherichia coli and Klebsiella pneumoniae, Wiener and coworkers (SEE ARTICLE) found that 35 of 55 hospitalized patients who were colonized or infected with these isolates had been admitted from nursing homes. Risk factors for colonization with these resistant bacteria among nursing home patients included presence of a gastrostomy tube and prior use of ciprofloxacin or trimethoprim-sulfamethoxazole. All resistant isolates were found to have plasmids encoding a common ceftazidime-hydrolyzing  -lactamase. In an editorial, Fierer and Guiney (SEE ARTICLE) explain how transfer of resistance plasmids among bacterial species spreads antibiotic resistance even in the absence of antibiotic-mediated selection.
Prognostic Value of Cardiac Function Test Results
Lauer and colleagues (SEE ARTICLE) report that chronotropic incompetence (attenuated heart rate response to exercise) on symptom-limited exercise thallium scintigraphy was an independent predictor of all-cause mortality during 2 years of follow-up of patients with known or suspected coronary disease. Daviglus and coworkers (SEE ARTICLE) found a linear association between the number of annual electrocardiograms in a 5-year period with minor ST-T abnormalities and the risk of cardiovascular and all-cause mortality in men during 29 years of follow-up. In an editorial, Goldstein and Holmboe (SEE ARTICLE) discuss criteria that determine the clinical usefulness of prognostic indicators of coronary events.
Prevalence of Sexual Dysfunction in United States
Based on an analysis of data from the 1992 US National Health and Social Life Survey, Laumann and colleagues estimated that the prevalence of sexual dysfunction is 43% in women and 31% in men. Patterns of sexual dysfunction varied with age, sex, race, marital status, and education. In both men and women, sexual dysfunction was associated with emotional and stress-related problems, including prior traumatic sexual experiences, poor physical health, and poor quality of life.
(SEE ARTICLE)
Health Literacy Among Elderly Patients
Specific health-related reading and numerical skills are essential for patients to accomplish health care activities, such as understanding appointment slips, consent forms, and medication instructions, and performing self-monitoring tasks. Gazmararian and colleagues (SEE ARTICLE) measured the functional health literacy of 3260 individuals aged 65 years or older who were newly enrolled in a Medicare managed care plan. More than one third of study participants had inadequate or marginal health literacy, and literacy skills appeared to decline with increasing age. The report from the American Medical Association Ad Hoc Committee on Health Literacy (SEE ARTICLE) discusses the impact of low health literacy on patient outcomes and on costs, and implications for physicians, researchers, and policymakers.
Hand Grip Strength Predicts Later Disability
In this prospective cohort study, Rantanen and colleagues found that hand grip strength of healthy men aged 45 to 68 years was highly predictive of functional limitations and disability 25 years later. For example, the proportion of men in the lowest baseline grip strength tertile who had functional limitations at follow-up was more than twice that of men in the highest baseline grip strength tertile.
(SEE ARTICLE)
A Piece of My Mind
"Dan was determined not to allow this patient to sit through a mute weekend." From "Star Material."
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Contempo 1999
Advances in the management of common urologic problems.
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From the JAMA Web Sites
Maintenance regimens with 2 antiretroviral drugs fail to preserve viral suppression after 4-drug induction therapy in patients infected with human immunodeficiency virus.
(SEE ARTICLE)
Medical News & Perspectives
At the Society of Neuroscience's annual meeting, researchers probed the roots of narcolepsy, the potential of nicotine-like drugs, and a possible link between an infectious agent and Alzheimer disease.
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Commentary
Eradication of rubella and congenital rubella syndrome seems possible: vaccination and surveillance strategies that are likely to be successful.
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JAMA Patient Page
For your patients: A guide to understanding sexual dysfunction.
(SEE ARTICLE)
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