To estimate the genetic component of otitis media in children, Casselbrant
and colleagues studied 135 sets of same-sex twins and 5 sets of same-sex triplets
recruited within the first 2 months of life and followed up prospectively
for up to 24 months. The correlation of the proportion of time with middle
ear effusion between siblings was consistently higher in monozygotic twin
or triplet sets than in dizygotic sets. The estimate of the heritability component
of proportion of time with middle ear effusion by age 2 years was 0.73. Estimates
of discordance for recurrent (3 or more) episodes of middle ear effusion and
for at least 1 episode of acute otitis media at 2 years were significantly
lower for monozygotic twin or triplet sets compared with dizygotic sets. In
an editorial, Ehrlich and Post consider the evidence supporting a multifactorial
basis for otitis media in children that includes genetic, environmental, and
See Article and editorial Article
Overweight and obesity may be associated with low-grade inflammation
perhaps mediated by the release of the proinflammatory cytokine interleukin
6 by adipose tissue. Using data from 16,616 adults aged 17 years or older
enrolled in the Third National Health and Nutrition Examination Survey (NHANES
III), Visser and colleagues found that the level of serum C-reactive protein
(CRP), a marker of systemic inflammation, was more likely to be elevated (CRP
level ≥0.22 mg/dL) in obese men and women (body mass index ≥30 kg/m2) compared with normal-weight individuals, and more likely to be clinically
raised (CRP level >1.00 mg/dL) among obese women. In an editorial, Danesh
discusses the relationship between persistent low-grade inflammation, obesity,
and risk of coronary heart disease.
Based on data from 40,098 women aged 46 to 71 years enrolled in the
4-year prospective Nurses' Health Study, Fine and colleagues found that weight
gain of 2.25 kg (5 lb) or more was associated with decreased physical function
and vitality and increased bodily pain among women in all baseline body mass
index (BMI) categories, including normal BMI. Weight loss of 2.25 kg (5 lb)
or more in overweight women (BMI ≥30 kg/m2) was associated with
improved physical function and vitality and decreased bodily pain. Weight
change was more strongly associated with changes in physical than mental health.
Gender appears to be a determinant of many disease outcomes, but evidence
has been inconsistent. In a prospective study of 892 surgical patients with
1470 episodes of nosocomial infection, Crabtree and colleagues found no significant
difference in overall mortality prior to hospital discharge between men and
women. For lung and soft tissue infections, however, mortality was significantly
higher among women than among men.
Mortality from ischemic heart disease has increased sharply between
1981 and 1994 among both men and women in Korea. Jee and colleagues report
that in a cohort of more than 100,000 Korean men aged 35 to 59 years followed
up for 6 years, the risk of hospitalization and death from ischemic heart
disease and cerebrovascular disease was significantly higher among current
smokers compared with nonsmokers. Low serum cholesterol was not protective
against cardiovascular disease (CVD) morbidity and mortality. At all levels
of serum cholesterol, including the lowest quartile (<4.42 mmol/L [171
mg/dL]), current smoking significantly increased the risk of ischemic heart
disease and cerebrovascular disease events and mortality, and there was no
evidence of an interaction between current smoking and total cholesterol level.
"In my 20 years as a practicing physician, I have been intimately involved
in many tragedies, yet I have never cried in front of a patient or a patient's
family." From "A Rainbow From Joanne."
Update on the safety and efficacy of the anthrax vaccine.
An increase in patients' use of mechanical ventilation at home is enabling
children and adults worldwide to lead less stressful, more productive lives.
Is screening mammography beneficial in older women? A decision and cost-effectiveness
analysis compares 3 strategies for breast cancer screening in women aged 65
years or older.
Factors to consider in the decision whether to use thrombolytic therapy
for acute deep venous thrombosis.
History of the debate in Japan on oral contraceptive (OC) use and how
approval of low-dose OC use in June 1999 might affect women's health.
For your patients: A primer on otitis media in children.
This Week in JAMA. JAMA. 1999;282(22):2097. doi:10.1001/jama.282.22.2097