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This Week in JAMA
JAMA. 2008;300(9):995.
Physical Activity and Cognitive Function
Observational data suggest that physical activity lowers the risk of cognitive decline and dementia, but confirmatory evidence from randomized trials has been lacking. To provide an objective assessment of whether physical activity reduces the rate of cognitive decline among older persons, Lautenschlager and colleagues (SEE ARTICLE) randomly assigned persons 50 years or older who reported memory problems but who did not meet criteria for dementia to usual care or a 24-week home-based program of physical activity. The investigators found that compared with the usual care control group, participants in the physical activity group had a modest reduction in the rate of cognitive decline during an 18-month follow-up period. In an editorial, Larson (SEE ARTICLE) discusses the benefits of exercise to prevent cognitive decline and to improve well-being among older adults.
Prevention of Contrast Medium–Induced Nephropathy
Nephropathy is a recognized complication of exposure to iodine contrast media. Some data have suggested that sodium bicarbonate infusion may prevent contrast medium–induced nephropathy. To assess this, Brar and colleagues conducted a clinical trial in which patients with chronic kidney disease who were undergoing coronary angiography were randomly assigned to receive an infusion of either sodium bicarbonate or sodium chloride for hydration during angiography. The authors report that hydration with sodium bicarbonate was not superior to hydration with sodium chloride for the prevention of contrast medium–induced nephropathy in this at-risk patient population.
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Awareness and Use of Paid Family Leave Insurance
In 2004, California enacted the Paid Family Leave Insurance Program. To assess awareness and use of the program by parents of children with special health care needs, Schuster and colleagues (SEE ARTICLE) interviewed successive cohorts of employed parents in California and in Illinois (a state without paid family leave insurance) before and after enactment of California's program. The authors report that only 18% of California parents of children with special health care needs were aware of the paid leave program and only 5% had used it. The Paid Family Leave Insurance Program did not increase the frequency or duration of leave taking, nor did it decrease the need for child health–related leave among California parents compared with parents in Illinois. In an editorial, Neff (SEE ARTICLE) discusses the challenges faced by parents of children with chronic illnesses and the strengths and weaknesses of several state-based efforts to provide paid family leave.
CLINICIAN'S CORNER
HIV-Associated Lipodystrophy
Clinical Crossroads
Mr B is a 39-year-old man who has been living with HIV since 1994. He has been treated with several different antiretroviral regimens, and although he is pleased that his "numbers are good," he reports significant distress related to fat loss in his cheeks and fat accumulation in his neck, chest, and abdomen. Fuller discusses the clinical features, pathophysiology, and management of HIV-associated lipodystrophy syndrome.
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A Piece of My Mind
"‘A witch doctor's secret of success has three parts. One: Take good care of your patients. Nothing should come before this.’" From "One Hundred Thousand Cows: A Fable."
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Medical News & Perspectives
Three years after hurricanes Katrina and Rita ravaged the Gulf Coast, survivors with persistent mental health problems face shortages of mental health professionals and facilities.
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Commentaries
Physician-industry relationships
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Bias in industry-sponsored research
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Industry support of medical education
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JAMA Classics
Preparing fresh tissue for microscopy
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Author in the Room Teleconference
Join H. George Nurnberg, MD, September 17 from 2 to 3 PM eastern time to discuss sildenafil for women with antidepressant-associated sexual dysfunction. To register, go to http://www.ihi.org/AuthorintheRoom.
Readers Respond
How would you manage a 60-year-old woman with mild memory impairment and white matter lesions on MRI? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is September 24.
NEXT WEEK
JAMA Theme Issue on Medical Education
JAMA Patient Page
For your patients: Information about fitness for older adults.
(SEE ARTICLE)
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