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This Week in JAMA
May 7, 2008

This Week in JAMA

JAMA. 2008;299(17):1989. doi:10.1001/jama.299.17.1989

Assessments of the relationship between dietary supplementation with folic acid, B vitamins, or both and cardiovascular disease (CVD) risk have been inconclusive. Albert and colleagues Article report results of the randomized, placebo-controlled Women's Antioxidant and Folic Acid Cardiovascular Study, which tested whether a combination of folic acid, vitamin B6 and vitamin B12 would reduce CVD events among women at high risk of CVD. The authors found that although vitamin treatment was associated with significant reductions in homocysteine levels, there was no difference in the risk of CVD events among women in either the vitamin or placebo groups during 7.3 years of follow-up. In an editorial, Lonn Article discusses possible reasons that clinical benefits have not been realized in randomized trials of B vitamin supplementation for CVD prevention.

In an analysis of prospective data from 104 519 women participating in the Nurses' Health Study, Kenfield and colleagues examined the association of current smoking or smoking cessation with total and cause-specific mortality. The authors found that compared with never smokers, current smokers had increased risks of both total and cause-specific mortality, and they estimated that 64% of deaths in current smokers and 28% of past smokers were attributable to smoking. Quitting smoking reduced the smoking-related excess risk of mortality for all major outcomes examined.

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Adjuvant corticosteroids reduce mortality in adults with bacterial meningitis, but whether children experience a similar benefit is not clear. Mongelluzzo and colleagues assessed time to death and time to hospital discharge in a retrospective cohort study of 2780 children who were discharged from 27 children's hospitals with a primary diagnosis of bacterial meningitis. The authors report that 248 children (8.9%) received adjuvant corticosteroids within 24 hours of hospital admission. Adjuvant corticosteroid therapy was not associated with time to death or hospital discharge.

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In an analysis of data from active, population-based surveillance in 10 US states, Phares and colleagues assessed the incidence of invasive group B streptococcal disease during 1999-2005. The authors report that the incidence of disease among infants aged 0 to 6 days was significantly lower in 2003-2005 than in 1999-2001, which may reflect the 2002 release of revised guidelines for prevention of perinatal disease through intrapartum chemoprophylaxis. Infection rates were stable among older infants and pregnant women, increased among persons aged 15 through 64 years, and were twice as high among blacks compared with whites during the study period.

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Mr S is a 50-year-old man with a 30-year history of low back pain. His treatment has included two L5-S1 diskectomies, facet blocks, epidural injections, physical therapy, and medication management at a pain clinic. Rathmell discusses the epidemiology and pathogenesis of chronic low back pain, and he discusses the conventional, alternative, and emerging approaches to its treatment.

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“You and I both know that our profession does not protect us, we are no more or less than other, mortal women.” From “The Question.”

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Reports of contamination of the US water supply with trace amounts of pharmaceuticals have raised concerns about potential health effects and drawn attention to safer drug disposal.

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The April Archives of Pediatrics & Adolescent Medicine focuses on sleep research. Giordani and Chervin discuss the association of childhood sleep disorders and adverse neurobehavior.

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A population health framework

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Treating tobacco use and dependence

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Join Barbara Howard, PhD, and William Howard, MD, on May 21, 2008, from 2 to 3 PM eastern time to discuss lower blood pressure and cholesterol targets in diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 40-year-old woman with type 2 diabetes, hypertension, and a history of gastric surgery who wants to conceive? Go to www.jama.com, read the case, and submit a response, which may be selected for online publication. Submission deadline is May 28.

For your patients: Information about smoking and the heart.

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