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Articles 
Seth A. Eisen, Han K. Kang, Frances M. Murphy, Melvin S. Blanchard, Domenic J. Reda, William G. Henderson, Rosemary Toomey, Leila W. Jackson, Renee Alpern, Becky J. Parks, Nancy Klimas, Coleen Hall, Hon S. Pak, Joyce Hunter, Joel Karlinsky, Michael J. Battistone, Michael J. Lyons and the Gulf War Study Participating Investigators* The authors compared the prevalence of medical conditions in 2 groups of veterans of U.S. military service: One served in the Gulf War, and the other did not. Physical health was similar in the 2 groups, except Gulf War veterans had a higher prevalence of fibromyalgia, the chronic fatigue syndrome, certain skin conditions, and dyspepsia.
Jennifer S. Haas, Kathryn A. Phillips, Eric P. Gerstenberger, and Andrew C. Seger From 1997 to 2000, 56% of all drugs were available under a brand name and as generics. Sixty-one percent of the drugs were dispensed in generic form. If physicians prescribed a generic drug whenever it was available, savings would have been $5.9 billion for adults age 65 years or younger.
Alexandre Macedo de Oliveira, Kathryn L. White, Dennis P. Leschinsky, Brady D. Beecham, Tara M. Vogt, Ronald L. Moolenaar, Joseph F. Perz, and Thomas J. Safranek Failure to use careful aseptic technique can cause transmission of hepatitis C virus (HCV). The authors investigated an outbreak of HCV infection involving 99 patients of a hematology/oncology clinic. A nurse routinely used the same syringe to flush several patients' infusion catheters with saline drawn from a single container.
Alessia Ciancio, Paola Manzini, Franco Castagno, Sergio D'Antico, Paolo Reynaudo, Laura Coucourde, Giovannino Ciccone, Mario Del Piano, Marco Ballarè, Sergio Peyre, Roberto Rizzi, Claudio Barletti, Mauro Bruno, Stefania Caronna, Patrizia Carucci, Wilma De Bernardi Venon, Claudio De Angelis, Anna Morgando, Alessandro Musso, Alessandro Repici, Mario Rizzetto, and Giorgio Saracco The authors evaluated the role of digestive endoscopy in transmitting hepatitis C virus (HCV) by measuring the incidence of HCV infection in a cohort of patients undergoing endoscopy and in a cohort of blood donors. All 8260 persons remained negative for anti-HCV for 6 months after the procedure, including all of the 912 patients who underwent endoscopy with the same instrument previously used on an HCV carrier.
Reviews
Robert L. Cook, Shari L. Hutchison, Lars Østergaard, R. Scott Braithwaite, and Roberta B. Ness The authors reviewed studies of the sensitivity and specificity of 3 nucleic acid amplification tests for Chlamydia trachomatis and Neisseria gonorrhoeae. The accuracy of these tests for Chlamydia trachomatis is nearly identical in urine samples and in samples from the cervix or urethra. All 3 assays can also be used to test for Neisseria gonorrhoeae.
M. Regina Castro and Hossein Gharib Although thyroid nodules are common, few are malignant and require surgery. The approach to the thyroid nodule should focus on avoiding unnecessary surgery. When fine-needle aspiration obtains an adequate tissue sample, biopsy is accurate, is low in cost, and yields a high rate of malignancy at surgery. When the sample is inadequate, the experts do not agree on the best approach.
Perspectives
Niteesh K. Choudhry and Jerry Avorn The British government recently decided to permit over-the-counter sale of a statin. The U.S. Food and Drug Administration decided not to allow it. Many questions remain about statin effectiveness at the lower doses in over-the-counter use, the ability of patients to appropriately self-select to take statins, and the social and economic implications of this approach to disease prevention.
Medicine and Public Issues
Thomas Bodenheimer Article 1 in this series addressed 3 questions about the high and rising cost of health care: Is it a serious problem, do demographic factors account for it, and would competition contain costs? This article examines the roles of technologic innovation, administrative costs, and cost-containment measures.
Editorials
Anthony L. Komaroff Eisen and his colleagues provide robust evidence that armed forces personnel deployed to the Gulf War in the early 1990s are more likely to report a constellation of debilitating symptoms than armed forces personnel deployed elsewhere at the same time. However, no one has shown that these symptoms have a specific cause or even constitute a syndrome unique to Gulf War service.
Richard P. Wenzel and Michael B. Edmond In this issue, reports by Macedo de Oliveira and Ciancio and their coworkers emphasize the importance of good infection-control procedures in avoiding patient-to-patient transmission of disease during outpatient care. Given the shift of care from hospital to clinic, we must develop effective systems to monitor outcomes of infection-control practices in the outpatient setting.
Cynthia Mulrow and Michael Pignone In 2002, Annals published a systematic review of aspirin for the primary prevention of cardiovascular disease for the U.S. Preventive Services Task Force. Because few women participated in previous trials, the evidence that women benefit was inconclusive until the March 2005 publication of the Women's Health Study. We explain how this study clarifies the use of aspirin to prevent cardiovascular disease in women.
On Being a Doctor
John McClenahan At Ain Z'halta, a remote village in Lebanon, a mosquito bit me on the wrist. I slapped it, brushed away a smear of blood, and returned to my guidebook. That evening, the bite itched. I scratched it and awoke the next morning with a welt the size of an almond at the base of my right thumb, a tender elbow, and disquieting red streaks running up to my armpit. I walked to the village square wondering what to do.
Letters Balancing the Risks and Benefits of Fish Consumption
Other Disorders That Mimic Infectious Cellulitis
Rhabdomyolysis with Cardiac Involvement and Acute Renal Failure in a Patient Taking Rosuvastatin and Fenofibrate
Correction: Meta-Analysis: Acupuncture for Low Back Pain
Amit K. Ghosh
Laura L. Sessums
Jerald Winakur
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