Table of Contents

In this study of 210 U.S. students visiting Guadalajara, Mexico, prophylactic rifaximin substantially reduced the risk for travelers' diarrhea. Fecal flora changed very little. The results raise the possibility of liberalizing the indications for prophylaxis against travelers' diarrhea.

The authors evaluated the association between cardiovascular outcomes and fasting glucose using 2 definitions for impaired fasting glucose: the 1997 definition (6.1 to 6.9 mmol/L [110 to 125 mg/dL]) and the 2003 definition of the American Diabetes Association (5.6 to 6.9 mmol/L [100 to 125 mg/dL]). Women identified with the 2003 definition but not the 1997 definition (those with blood glucose levels between 5.6 mmol/L and 6.0 mmol/L [100 mg/dL and 109 mg/dL]) had the cardiac risk of normal women. The 1997 definition is preferable.

Lamivudine is an effective treatment against chronic hepatitis B virus (HBV) infection, but drug resistance occurs frequently. The authors performed a cost–utility analysis of treatments for chronic HBV infection. Neither lamivudine nor adefovir monotherapy was cost-effective, but using adefovir only when patients developed resistance to lamivudine was cost-effective.

The authors measured the accuracy of rapid diagnostic tests for ruling out malaria, using the thick smear as a gold standard. The rapid malaria tests had excellent sensitivity and specificity and may be a useful diagnostic adjunct to microscopy in centers without expertise in tropical medicine.

The incidence of pertussis has been rising, especially in adolescents and adults, and pertussis belongs on the list of community-acquired pathogens in adults. All physicians, not just pediatricians, need to know about the diagnosis, treatment, and reporting requirements for pertussis.

For many years, U.S. health care expenditures have been growing faster than the overall rate of inflation. This article, the first in a 4-part series, discusses 3 perspectives on health care costs: 1) Are high and rising health care costs a serious problem? 2) Are rising costs explained by such factors as an aging population? 3) Is the absence of a free market in health care the explanation?

This statement summarizes the U.S. Preventive Services Task Force recommendations on hormone therapy for the prevention of chronic conditions in postmenopausal women and the supporting scientific evidence, and updates the Task Force's 2002 recommendations on hormone replacement therapy.

In this issue, DuPont and colleagues present good evidence that rifaximin can prevent travelers' diarrhea in persons traveling to Mexico. However, although rifaximin may be a useful alternative for those who travel frequently, universal prophylaxis leads to problems of its own. Treatment of diarrhea, not prevention, is the best recommendation for most travelers.

Clinicians and researchers are paying renewed attention to hepatitis B because of hepatitis B virus (HBV) DNA testing; improved understanding of HBV-related disease; and introduction of potent, orally administered antiviral agents. The authors discuss HBV treatments and comment on the role of cost-effectiveness in evaluating them.

The cost of health care is one of the most serious problems facing the United States. Many factors drive health care costs, and their interrelationships are so complex that most people, whether in the health care field or not, do not understand them. Since understanding a problem is an essential step toward solving it, Annals will publish a series of 4 articles on health care costs intended as a touchstone for physicians and the public. The first of these articles appears in this issue.

Recently, a case of HIV infection in New York City gained wide public attention because of the possibility that it represented a novel and “superaggressive” virus. Publicizing this case before careful epidemiologic investigations were completed has been criticized as an overreaction leading to unnecessary public fear. The physicians and public health authorities involved argue that the unusual nature of this case—a transmitted drug-resistant virus and an apparently rapid disease course—required wide disclosure to find or prevent additional cases. This editorial discusses the New York case and its implications.

“He made me out a liar” is a common saying in the southern states. I'm not sure where it originated, but I have heard it all my life. It roughly means, “He showed me that something I had said was in fact not the truth I originally thought it to be.” Well, Minnie made me out a liar.