Using data from 75,596 women followed up for 14 years in the Nurses'
Health Study and 38,683 men followed up for 8 years in the Health Professionals'
Follow-up Study, Joshipura and colleagues found that overall, fruit and vegetable
intake was inversely related to risk of ischemic stroke. Compared with individuals
in the lowest quintile of fruit and vegetable intake, those in the top quintile
had a relative risk of ischemic stroke of 0.69. Risk of ischemic stroke decreased
as the number of daily servings of fruits and vegetables increased from fewer
than 3 servings per day to 6 servings per day, with no further reduction in
risk associated with more than 6 servings per day.
In parallel randomized controlled trials, Hayden and colleagues found
that prophylaxis and early treatment with oseltamivir, an oral influenza virus
neuraminidase inhibitor, reduced the infection rate and viral shedding in
healthy adults inoculated with influenza A virus. Eight (38%) of 21 individuals
who received oseltamivir beginning 26 hours before inoculation with influenza
A virus became infected and none shed virus or developed infection-related
respiratory illness. In the placebo group, 8 (67%) of 12 individuals became
infected, 6 shed virus, and 4 became ill. In the treatment study, the total
amount of viral shedding during the week after treatment initiation was significantly
lower in infected individuals who received oseltamivir compared with those
in the placebo group.
Results of the Third National Prevalence Survey on Smoking in China,
1996, document the increasing severity of the tobacco epidemic in this populous
nation. Yang and coworkers report that in a nationally representative sample
of 120,298 individuals aged 15 to 69 years, the prevalence of daily smoking
was 34.1%, 3.4% higher than that found in a 1984 national survey of tobacco
use, and the age of initiation of tobacco use was about 3 years younger than
in the 1984 survey. Current smoking was more prevalent among men (63%) than
among women (3.8%), and 53.5% of nonsmokers reported exposure to environmental
tobacco smoke at least 15 minutes per day on more than 1 day per week.
Using immunohistochemistry, Sheehan and colleagues found that cyclooxygenase-2
(COX-2) was expressed in tumor specimens from all 76 subjects with colorectal
adenocarcinoma and in none of 14 normal control colon biopsies. COX-2 staining
was localized primarily in tumor epithelial cells
(Figure 1 , brown staining) and was greater in more advanced Dukes stage tumors, in larger
tumors, and in tumors from patients with lymph node metastases. Survival of
patients with less than 1% COX-2 staining was significantly better than the
combined survival of patients with greater COX-2 expression.
In this study of physician payment methods under managed care, Robinson
reviews economic theory of payment incentives to understand the impact of
reimbursement methods on practice patterns. An analysis of data from 7 independent
practice associations (IPAs) showed that IPAs are blending fee-for-service
payment with capitation for both primary care and specialty physicians to
balance multiple economic and clinical practice objectives.
"We receive thank-you cards from patients; how often do we send a note
of appreciation to a fellow physician?" From "Islands I Hardly Knew."
A guide to Web sites on women's health.
Advances in treating depression in elderly persons, and new knowledge
about providing medical care for those who are terminally ill, offer assistance
to physicians treating an increasing aged population.
Infant outcomes associated with maternal antidepressant treatment during
Evaluation of the screening clinical breast examination for detection
of breast cancer.
Original research, reviews, and commentaries are invited for the eleventh JAMA
theme issue on tobacco scheduled for August 2000.
Gay men and lesbians in medicine.
For your patients: Dietary guidelines for fruits and vegetables.
This Week in JAMA. JAMA. 1999;282(13):1205. doi:10.1001/jama.282.13.1205