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This Week in JAMA
October 6, 1999

This Week in JAMA

JAMA. 1999;282(13):1205. doi:10.1001/jama.282.13.1205
Eating Fruits and Vegetables May Reduce Stroke Risk

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.

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Oral Neuraminidase Inhibitor Effective Against Flu

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.

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Tobacco Use Increases in China

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.

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COX-2 in Colon Cancer and Disease Severity, Survival

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.

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IPAs Blend Fee-for-Service and Capitation

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.

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A Piece of My Mind

"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."

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JAMA NETSIGHT

A guide to Web sites on women's health.

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Medical News & Perspectives

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.

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Review

Infant outcomes associated with maternal antidepressant treatment during pregnancy.

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The Rational Clinical Examination

Evaluation of the screening clinical breast examination for detection of breast cancer.

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Call for Papers: Tobacco Theme Issue

Original research, reviews, and commentaries are invited for the eleventh JAMA theme issue on tobacco scheduled for August 2000.

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MSJAMA

Gay men and lesbians in medicine.

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JAMA Patient Page

For your patients: Dietary guidelines for fruits and vegetables.

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