Table of Contents

The authors compared the effects of sibutramine and placebo in 498 obese adolescents who all received behavior therapy. The mean weight of participants was 215 lb. At the end of 1 year of treatment, participants receiving sibutramine had greater reductions in body mass index and body weight than did those who received placebo. The difference in change in weight was 18 lb.

In 102 400 women from the Nurses' Health Study II, those with higher body mass indices at age 18 years had a greater risk for obesity during adulthood and for premature death. Differences in the adult body mass index of those who had been obese as adolescents only partly explained their increased rate of premature death.

The authors studied 10 405 persons 49 to 73 years of age who had no history of stroke or coronary heart disease. People with early-stage age-related macular degeneration had a higher cumulative incidence of stroke. Those who had a stroke had higher systolic blood pressure and more diabetes, cigarette smoking, and use of antihypertensive medications. Statistical adjustment for differences in these stroke risk factors did not substantially alter the association with macular degeneration, suggesting that it is a risk factor for stroke.

The authors studied the effects of disease management by physician groups. Using disease management strategies was associated with better diabetes care, but better diabetes care was not associated with improved intermediate outcomes, such as lower hemoglobin A1c level, or more intense efforts to correct unfavorable intermediate outcomes. The authors believe that disease management programs should give more feedback about intermediate outcomes and what physicians are doing to improve them.

In 13 of 15 randomized studies involving 1384 patients, statins reduced albuminuria and proteinuria. Since these outcomes were not the primary goals of the 15 clinical trials, we need larger trials that focus on the effect of statins on these renal outcomes and on progression of chronic kidney disease.

The authors briefly review the pharmacologic characteristics of currently available insulin products and describe 3 common blood glucose profiles in patients with diabetes. They suggest an initial insulin regimen for each profile and show how to modify it according to the patient's response.

This article is a republication of an eyewitness account of the 1918 Spanish influenza pandemic. The author, Isaac Starr, cared for influenza victims as a medical student in Philadelphia. His article first appeared in Annals of Internal Medicine in 1976.

In this paper, the author describes several important aspects of planning for pandemic influenza and appraises our prospects for preparedness. Getting from our present state of readiness to full preparedness will require an unprecedented effort.

The threat of an H5N1 influenza virus (avian flu) pandemic is substantial. The success of the current U.S. influenza pandemic response plan depends on effective coordination among state and local public health authorities and individual health care providers. This article summarizes a public policy paper developed by the American College of Physicians to address physician-related issues in the U.S. Department of Health and Human Services Pandemic Influenza Plan.

Effective weight loss strategies for overweight children and adolescents may reduce the risks for obesity-associated diseases or the premature death reported by van Dam and colleagues in this issue. As Berkowitz and colleagues demonstrated, weight loss requires substantial therapist time and drug costs. Preventing children and adolescents from becoming overweight may be a more cost-effective approach to weight control.

In this issue, Douglas and colleagues report the results of a rigorous systematic review on the effect of statins on urinary protein excretion. The strength of their conclusions is limited by the relatively poor quality of the available studies. An ideal study would evaluate whether statins (as an add-on to conventional therapy) reduce time to doubling of serum creatinine level or end-stage renal disease, especially in a high-risk population with overt proteinuria. In the meantime, it is premature to recommend statin therapy solely to achieve renal benefit.

“There's a new man here to see you,” said Joyce, the nurse at the Toronto homeless shelter where I see patients once a week. “He just had his leg cut off. Says it hurts a lot.”