Table of Contents

According to this decision model, vaccinating older adults against herpes zoster can improve quality-adjusted life expectancy by small amounts. However, vaccination is unlikely to cost less than $100 000 per quality-adjusted life-year gained unless the vaccine price is less than $200. Targeting those at high risk for zoster and adults 60 to 69 years of age and avoiding people in their 80s will maximize cost-effectiveness.

Trained interviewers asked fast-food restaurant customers to estimate the calorie content of their meals. Interviewers counted the empty food containers on each participant's tray and calculated the meal's actual calorie content from the posted calorie content of each item. People, regardless of their weight, estimated normal-sized meals accurately. Likewise, everyone underestimated large meals. Overweight people were more likely to order larger meals and therefore to make larger errors in estimation.

The authors studied virgin olive oil (high in polyphenols), refined olive oil (low in polyphenols), and a mixture of the 2 oils in equal parts. Two hundred healthy young men consumed 25 mL of an olive oil daily for 3 weeks, followed by the other olive oils in a randomly assigned sequence. Olive oils with greater polyphenol content increased high-density lipoprotein cholesterol levels and decreased serum markers of oxidation.

The authors evaluated the effect of the Medicare Quality Improvement Organization (QIO) Program in 4 clinical settings (nursing homes, home health agencies, hospitals, and physician offices) by using performance data for 41 quality measures. Overall, improvement was seen in 34 of 41 measures from baseline to remeasurement. Nursing homes, home health agencies, and physician offices that received intensive QIO assistance showed greater improvement than those that did not.

An article published in Annals of Internal Medicine in 2001 reported that Academy Award–winning actors and actresses lived almost 4 years longer than their nonwinning peers. However, the analytic method used to derive this statistically significant difference gave winners an unfair advantage because it credited Oscar winners with years lived before winning rather than crediting them only with years lived after winning. Sylvestre and colleagues' article suggests ways to recognize this bias and avoid it.

This Update in Infectious Diseases focuses on emerging and reemerging infections, public health and preventive medicine, and therapeutics. Important papers in 2005 shed new light on disease caused by methicillin-resistant Staphylococcus aureus, respiratory syncytial virus, Clostridium difficile–associated diarrhea, and influenza. Useful advances occurred in the treatment of recurrent sexually transmitted infections, the radiographic appearance of tuberculosis, intrapleural streptokinase for pleural effusion, and antibiotic prophylaxis for neutropenic patients.

This State-of-the-Science Conference explored the following key questions related to use of multivitamin/multimineral (MVM) supplements: 1) What are the current patterns and prevalence of the public's use of MVM supplements? 2) What is known about the dietary nutrient intake of MVM users versus nonusers? 3) What is the efficacy of single vitamin/mineral supplement use in chronic disease prevention? 4) What is the efficacy of MVM in chronic disease prevention in the general population of adults? 5) What is known about the safety of MVM for the generally healthy population? and 6) What are the major knowledge gaps and research opportunities regarding MVM use?

This background review supports the National Institutes of Health State-of-the-Science Panel statement on the use of multivitamin and mineral supplements.

Is it worthwhile to use the new varicella-zoster virus vaccine to protect against shingles? In their cost-effectiveness analysis in this issue, Hornberger and Robertus demonstrate that assumptions about age distribution of the vaccinated population, cost of the vaccine, quality-adjusted life-year (QALY) weights assigned to zoster and to postherpetic neuralgia, and duration of vaccine efficacy each independently alter the cost per QALY. Some of these key variables are known and others are not, and the durability of protection is currently speculative. We must therefore interpret the cost–utility ratios proposed in their analysis with substantial caution.

The Centers for Medicare & Medicaid Services (CMS) is responsible for improving the quality of care for the nation's Medicare beneficiaries. A key component of this responsibility is the Quality Improvement Organizations (QIOs), which contract with CMS to provide technical assistance and case reviews and investigate beneficiary complaints. CMS has made some largely isolated efforts to systematically evaluate its quality improvement efforts. The article by Rollow and colleagues in this issue is one example.

“Mrs. M., the doctor is here to see you.” I looked up to see a nurse peering sympathetically at me. “Huh?” I thought. “But I'm the doctor. Where am I?”