In the Iowa Women's Health Study
of 37,105 women followed up for 11 years, Gapstur and coworkersArticle
found that exposure to hormone replacement therapy (HRT) was associated
with an increased risk of invasive breast cancer with a favorable
prognosis but not of ductal carcinoma in situ or invasive ductal and/or
lobular breast cancer . In an editorial, Bush and WhitemanArticle question the prognostic groupings and suggest that inconsistent
evidence on the association of HRT and breast cancer despite years of
research may be reassuring.
To assess the reliability of physician profiling, Hofer and colleaguesArticle
analyzed several measures of physician performance with and without
detailed case-mix adjustment for the care of patients with type 2
diabetes mellitus by physicians at 3 diverse practice sites. After full
case-mix and reliability adjustment, differences in physician practice
accounted for 4% or less of the observed variance in rates of
hospitalization, office visits, and laboratory utilization and in
levels of glycemic control. Gaming the system by excluding patients
with poor glycemic control would markedly improve a physician's
profile. In an editorial, BindmanArticle explains why physician profiling may
not improve quality of care.
Specific metabolic actions of coffee could prevent the formation
of gallstones, but results of epidemiologic studies on the association
of coffee consumption and gallstone disease have been conflicting. In
this study of 46,008 men aged 40 to 75 years followed up from
1986 through 1996 in the Health Professionals Follow-up Study,
Leitzmann and colleagues found that coffee consumption, as measured by
repeated food frequency questionnaires, was associated with a
significant decrease in the risk of symptomatic gallstone disease.
Homocysteine, an intermediate product of methionine metabolism, may
increase the risk of atherosclerotic cardiovascular disease by
impairing endothelial cell function through an oxidative mechanism. In
this crossover study of 20 healthy volunteers by Nappo and colleagues,
plasma homocysteine levels increased significantly after an oral
methionine load administered with and without pretreatment with
antioxidant vitamins (vitamin E and ascorbic acid). Levels of
coagulation factors and circulating cellular adhesion molecules
increased significantly and hemodynamic and rheologic responses to
infusion of the nitric oxide precursor L-arginine were
impaired after methionine ingestion alone, but not after ingestion of
methionine with vitamin pretreatment or after placebo.
Oral corticosteroid therapy has been shown to reduce the relapse
rate after treatment of acute exacerbations of asthma. Rowe and
colleagues report that compared with patients who received a 7-day
nontapering course of oral prednisone after an acute episode of asthma
treated in an emergency department, patients who also received 21 days
of high-dose inhaled budesonide had a significantly lower relapse rate
for the 3 weeks after the initial episode. Pulmonary function was
similar in the 2 groups at 21 days, but β2-agonist use
was less and quality-of-life and symptom scores were better in the
Protecting children in automobiles: engineering, legislative, and
educational solutions to improve the use of restraint systems.
Improved diagnostic imaging techniques and new pharmaceutical options
may offer a more positive outlook for victims of stroke.
Second in a series of consensus statements from the Working Group on
Civilian Biodefense on medical and public health management after the
use of biological agents as weapons.
Treatment of multidrug-resistant tuberculosis is costly, but Heymann
and coauthors argue that the international community must provide the
necessary resources now to check the rising worldwide prevalence of
For your patients: Asthma.
This Week in JAMA. JAMA. 1999;281(22):2065. doi:10.1001/jama.281.22.2065