Editorials

For your consideration

Thomas C. Meyer, MD

In recent months, the Wisconsin Medical Journal's mailbox has been stuffed, and our Editorial Board has been working overtime!



Author Affiliations: Medical Editor, Wisconsin Medical Journal


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53719

Original Research

Partnering with citizens to reform Wisconsin health care: A report of the first Citizen Congress

Norman M. Jensen, MD, MS, FACP; Anthony L. Suchman, MD, MA, FACP

Many Americans today seem unhappy with health care that is envied by many in the world.



Author Affiliations: Doctors Jensen and Suchman were facilitators for the Citizen Congress on Health Care. Doctor Jensen is a Professor, General Internal Medicine, University of Wisconsin Medical School, and a Fellow, University of Wisconsin Teaching Academy. Doctor Suchman i

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Heroin Dependence

Randy Brown, MD

Heroin use, particularly injection use, is a problem of great public health importance. The risks associated with heroin dependence, such as HIV and viral hepatitis, and the social costs due to associated crime and poverty exceed those of most other drugs of abuse. Increasing purity and decreasing cost of heroin likely contribute to trends of decreasing age at first use and an increasing rate of initiation into regular use in the United States. Effective treatment is available for heroin dependence, so primary care providers should screen patients for this disorder. This article reviews the epidemiology of heroin use and dependence in the United States and outlines what is known regarding risk factors for initiation of heroin use and for heroin dependence.



Author Affiliations: Doctor Brown is a clinical instructor at the University of Wisconsin Department of Family Medicine and a PhD student at the University of Wisconsin Department of Population Health Sciences. He is also a consulting physician in addiction at Madison Health

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Clean Indoor Air Policies in Wisconsin Workplaces

Clare E. Guse, MS; Anne M. Marbella, MS; Peter M. Layde, MD, MSc; Ann Christiansen, MPH; Patrick Remington, MD, MPH

Objective: To describe the nature and extent of workplace environmental tobacco smoke exposures in Wisconsin.

Methods: Descriptive data and confidence intervals from the Current Population Survey tobacco supplements of 1995-1996 and 1998-1999 are presented.

Results: The percent of indoor workers working under a smoke-free policy increased slightly, from 62% in 1995-1996 to 65% in 1998-1999. Respondents with a college degree were more likely to work under a smoke-free policy than those with a high school education or less. Among respondents with a work policy in 1998-1999, a complete ban on smoking reduced any workplace exposure in the past 2 weeks (4%) compared to a partial ban (26%) or an unrestricted policy (30%).

Conclusion: Wisconsin has seen a small increase in workplace policies that ban smoking in the workplace. These policies are more likely to protect workers of higher socioeconomic status and may increase health disparities in tobacco-related diseases in the future.



Author Affiliations: Ms Guse, Ms Marbella, and Doctor Layde are with the Department of Family and Community Medicine at the Medical College of Wisconsin. Ms Guse is senior biostatistician and Ms Marbella is an epidemiologist with the Department and the Injury Research Center.

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Review Articles

Current Management of Patients with Patent Foramen Ovale and Cryptogenic Stroke: Our Experience and Review of the Literature

Charles E. Bailey, MD; Suhail Allaqaband, MD; Tanvir K. Bajwa, MD, FACC

Background: Patent Foramen Ovale (PFO) occurs in approximately 25% of the population and has been implicated in the etiology of cryptogenic stroke. Although the exact mechanism of PFO’s role in stroke has not been defined, there is a growing body of evidence that supports both the safety and therapeutic benefit of PFO closure in cryptogenic stroke. Current methods of therapy include anticoagulation, surgical closure, and percutaneous closure.

Methods: We completed a retrospective analysis of data from the first 20 PFO closures at our institution and evaluated the current literature on PFO treatment.

Results: Percutaneous closure had a 100% technical success rate. There were no procedural complications and only 1 episode of supraventricular arrhythmia requiring therapy.

Conclusion: Percutaneous closure is associated with a high technical success rate, decreased morbidity compared to surgery, and equal benefits after endothelialization of the device. As the mechanisms involved in PFO are better delineated, clear guidelines can be established for the percutaneous closure and follow-up of PFO.



Author Affiliations: Doctor Bailey is in his third year of Cardiovascular Fellowship training at Aurora Sinai Medical Center in Milwaukee, Wis. Doctors Allaqaband and Bajwa are with the Department of Medicine, University of Wisconsin Medical School Milwaukee clinical campus.

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, Wi 53715

Case Reports

A Glimpse into our Past

Kendi Neff-Parvin

Glimpse into the past of the journal.

Author Affiliations: Managing Editor, Wisconsin Medical Journal

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Your Practice

Managing diabetic dyslipidemia: Testing is step one

Jay A. Gold, MD, JD, MPH

Recently, the Centers for Disease Control and Prevention (CDC) estimated that 18.2 million Americans have diabetes, the sixth leading cause of death in the United States. Of that number, over 70% of all deaths are due to macrovascular complications —CVD, cerebrovascular disease, and peripheral vascular disease. CVD events are 4 times more likely, occur at a younger age, and have a much greater case fatality rate among adults with diabetes. Indeed, the National Cholesterol Education Program (NCEP) considers diabetes to be a CVD risk equivalent, requiring aggressive care to prevent future vascular events.



Author Affiliations: Doctor Gold is senior vice president and principal clinical coordinator at MetaStar, Inc. This material was prepared by MetaStar, the Quality Improvement Organization for Wisconsin, under a contract with the Centers for Medicare & Medicaid Services (CMS),

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Are you emotionally ready to retire?

Maureen E. Hansen, CLU

Do you catch yourself looking out the window, dreaming of a day when your life is less harried, you have time to pursue your hobbies and the freedom to travel whenever you want? If so, early retirement may sound like a dream come true. But early retirement isn’t as simple as it may seem. Not only do you have to consider the financial cost of early retirement, you also need to determine if you are emotionally ready to retire.



Author Affiliations: Maureen Hansen, CLU is a fee-only financial consultant with SVA Planners Inc., Registered Investment Advisor working out of the Brookfield, Wis office.

Corresponding Author: For more information, call Wisconsin Medical Society Insurance and Financial Services, Inc. toll free at 866.442.3810.

Your Profession

Proceedings from the 2003 Annual Meeting of the American College of Physicians, Wisconsin Chapter

Edited by Kesavan Kutty, MD, FACP

The Wisconsin Chapter of the American College of Physicians held its annual meeting in Waukesha, Wis, September 5-7, 2003

Author Affiliations: Chapter Governor


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, Wi 53715

The growing medical and scientific challenges of obesity

Michael J. Dunn, MD

Obesity places nearly onethird of American adults at higher risk for developing myriad health problems, including type 2 diabetes, heart disease and some forms of cancer.



Author Affiliations: Dean and Executive Vice President, Medical College of Wisconsin


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, Wi 53715

Your Society

Looking Back

Arthur J. Patek, AB, MD

Advertisements excerpted from Wisconsin Medical Journal, 1904;2(11):XIII

Author Affiliations: Editor


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715