Table of Contents

November 18, 2003; 139 (10)

Articles

  • A plurality of U.S. physicians supports government legislation to establish national health insurance. Fewer agree that the government should be the single payer under national health insurance.

  • Three metabolic markers help to identify overweight persons who are sufficiently insulin resistant to be at increased risk for adverse outcomes. One is serum insulin, which is impractical until a standardized insulin assay becomes available. Until then, the most practical approach is the serum triglyceride level or the ratio of triglyceride to high-density lipoprotein cholesterol.

  • Delaying highly active antiretroviral therapy (HAART) until the CD4+ cell count falls to 0.200 × 109 cells/L does not increase the mortality rate in HIV-infected patients with good medication adherence. Above a CD4+ cell count of 0.200 × 109 cells/L, medication adherence is the critical determinant of survival, not the cell count at which HAART is begun.

  • The incidence of hepatocellular carcinoma continues to increase rapidly in the United States. Rates are increasing fastest in white men 45 to 54 years of age. Acquisition of hepatitis C virus during the 1960s and 1970s may explain the continued rise in incidence rates.

Reviews

  • This review defines the mechanisms for the propensity for accelerated atherosclerosis in diabetic patients, emphasizes the benefits of prevention, and reviews the optimal management of coronary atherosclerosis in patients with type 2 diabetes.

  • With advancing age, women with breast cancer are increasingly likely to die of other diseases. How this trend affects the effectiveness of screening women for breast cancer after age 65 years is not known. Estimates from decision models suggest that biennial breast cancer screening after age 65 years reduces mortality at reasonable costs for women who do not have major comorbid conditions.

Clinical Guidelines

  • These guidelines provide evidence-based recommendations for the management of patients with acute nonvariceal upper gastrointestinal bleeding. The recommendations emphasize early action to improve patients' general condition and clinical risk stratification to help decide who will benefit from early endoscopy.

Editorials

  • In this issue, Ackermann and Carroll report that a plurality of a nationwide sample of physicians supports national health insurance in one form or another. Whether this support is sufficient to mount a successful effort to cover the uninsured will depend, in large part, on whether the status quo remains everyone's “second choice.”

  • The mission of Annals of Internal Medicine remains as fresh today as at our founding 75 years ago, even as we are embracing tomorrow's technology to achieve our aims. In this editorial, we describe our progress in using electronic journalism and computer-aided journal management.

Letters

Medical Writings: Book Notes

Current Clinical Issues

Book Listings

Medical Notices

Summaries for Patients