In This Issue of JAMA

In This Issue of JAMA

August 14, 2013

Volume 310, Number 6 Pages 551-660

Research

The State of Health in the United States, 1990-2010

591

Years Lived With Disability, in Millions

Years Lived With Disability 3.5

3.0

2.5

2.0

1.5

1.0

0.5

0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Age, y

Diseases and injuries Intentional injuries Unintentional injuries Road injuries

Other noncommunicable Musculoskeletal disorders Diabetes/urogenital/blood/endocrine Mental and behavioral disorders Neurological disorders Digestive diseases Cirrhosis Chronic respiratory diseases Cardiovascular and circulatory diseases Cancer

Other communicable Nutritional deficiencies Neonatal disorders Maternal disorders Neglected tropical diseases and malaria Diarrhea/lower respiratory tract infections/other infections

HIV/AIDS and tuberculosis

In a systematic analysis of the epidemiology of 291 diseases and injuries, their sequelae, and associated risk factors, the US Burden of Disease Collaborators assessed the health status of the US population in 2010, determined changes in health status from 1990 to 2010, and compared US population health with population health in 34 other wealthy nations. Among the investigators' findings were that from 1990 to 2010, life expectancy at birth and healthy life expectancy increased, rates of all-cause mortality at all ages decreased, and age-specific rates of years lived with disability remained stable in the United States. However, improvements in population health in the United States have not kept pace with those in other wealthy nations. In an Editorial, Fineberg discusses strengths and limitations of the study and its potential to advance understanding of population health status in the United States.

Related Editorial 585 Author Video Interview

Management of Severe Mitral Valve Regurgitation

609

Optimal management of patients with severe mitral valve regurgitation without heart

failure symptoms or left ventricular dysfunction is not clear. In an analysis of registry data

from 1021 consecutive patients with severe mitral regurgitation due to flail mitral valve

leaflets, Suri and colleagues found that compared with initial medical management, mitral

valve surgery within 3 months was associated with greater long-term survival and a lower

risk of heart failure but no difference in new-onset atrial fibrillation. In an Editorial, Otto

discusses surgical intervention for patients with a flail mitral valve leaflet.

Related Editorial 587

Opinion

Viewpoint 575 The Critical Role of Caregivers in Achieving Patient-Centered Care MR Gillick

577 First, Do No (Financial) Harm C Moriates and Coauthors

579 The Evolution of the Master Diagnostician G Dhaliwal and AS Detsky

581 Social Media and Physicians' Online Identity Crisis M DeCamp and Coauthors

A Piece of My Mind 583 Scared of Worms RE Hirschtick

Editorial 585 The State of Health in the United States HV Fineberg

587 Surgery for Mitral Regurgitation: Sooner or Later? CM Otto

589 Research Letters in JAMA: Small but Mighty JW Zylke

LETTERS Research Letter 642 Incidence of Sports-Related Sudden Death in France by Specific Sports and Sex E Marijon and Coauthors

Comment & Response 643 Efficacy of Sublingual Immunotherapy

645 Mortality After Perioperative -Blocker Use in Noncardiac Surgery

646 The Role of Persuasion

647 Corrections

Instructions for Authors public /instructionsforauthors.aspx

The Art of JAMA 564 Georgia O'Keeffe (1887-1986), Chicken in Sunrise, 1917, American.

Editor in Chief Howard Bauchner, MD

130 YEARS

OF CONTINUOUS

PUBLICATION

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In This Issue of JAMA

August 14, 2013

Volume 310, Number 6 Pages 551-660

Research (continued)

QRS Duration, Morphology, and Cardiac Resynchronization

617

The role of QRS duration and morphology in the selection of patients for cardiac resyn-

chronization therapy (CRT) is unclear. In a retrospective cohort study of 24 169 Medicare

beneficiaries who received a CRT defibrillator (CRT-D), Peterson and colleagues found that

patients with left bundle-branch block (LBBB) and QRS duration of 150 ms or greater had

a lower risk of all-cause mortality and of all-cause, cardiovascular, and heart failure read-

missions compared with patients with no LBBB or LBBB with shorter QRS duration.

Clinical Review & Education

Barrett Esophagus and Risk of Esophageal Cancer

627

Mr K is a 43-year-old man with a 20-year history of gastroesopha-

geal reflux disease (GERD). Endoscopic examination and biopsy

confirmed the presence of Barrett esophagus--replacement of

the normal stratified squamous epithelium with metaplastic

columnar epithelium. In this Clinical Crossroads article, Spechler

discusses the pathogenesis, epidemiology, diagnosis, and treat-

ment of Barrett esophagus, including evidence for endoscopic

eradication therapy of dysplasia in Barrett esophagus and current recommendations for screen-

ing and treatment of patients with Barrett esophagus with and without dysplasia.

CME

Zonisamide for Weight Reduction in Obese Adults

637

A 2012 Archives of Internal Medicine article reported that zonisamide--an antiepileptic

drug with a side effect of weight loss--added to diet and lifestyle counseling moderately

enhanced weight loss beyond that achieved with diet and lifestyle counseling alone. In this

From the JAMA Network article, Apovian and Aronne discuss challenges faced by patients

and physicians in efforts to achieve long-term weight loss and difficulties encountered in

clinical trials of obesity treatments.

A Painful Bulge in the Left Flank

639

A 73-year-old man with a several-week history of herpes zoster

in the left T11-T12 dermatome developed a painful, progressive

bulge in the left flank, which was more prominent on standing,

coughing, and straining. Computed tomography showed

convexity of the left abdominal wall but no intra-abdominal

mass or fluid accumulation. What would you do next?

Quiz

Online @

Editor's Audio Summary Howard Bauchner, MD, summarizes and comments on this week's issue.

Author Interview VIDEO Interview with Christopher J. L. Murray, MD, DPhil, author of The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors

Author Reading Muriel R. Gillick, MD, reads her Viewpoint, The Critical Role of Caregivers in Achieving PatientCentered Care.

The JAMA Forum Insightful commentary on the political aspects of health care from leading health economists, health policy experts, and legal scholars

JAMA Patient Page 658 Options for Colorectal Cancer Screening

NEWS & ANALYSIS 568 Medical News & Perspectives Blood Pressure, Cholesterol Guidelines Face More Delays Deadly MERS Coronavirus Not Yet a Global Concern Preventing Suicide's Ripple Effects Takes Coordinated Effort 572 Capitol Health Call High-Cost Drugs Account for Most of Medicare Part B Spending

VA Acts on Old Health Compensation Claims by Military Veterans

Senate Hearing Focuses on Advance Care Planning for the End of Life

Federal Mandate Requiring Backup Cameras in Vehicles Delayed Until 2015

573 News From the Centers for Disease Control and Prevention Revised HIV Testing Procedures Could Detect More Acute Infections

Homemade Bomb Explosions Increase

No Increase in Cesarean Deliveries

New Flu Vaccine Recommended for Adults Who Are Allergic to Eggs

HUMANITIES 648 Poetry and Medicine Incomplete Knowledge 649 JAMA 100 Years Ago Mushroom Fallacies

Departments 561 Staff Listing 641 CME Questions 650 JAMA Network Abstracts 653 Classified Advertising 656 Journal Advertiser Index 657 Contact Information

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