In this analysis of data from 46,355 postmenopausal women who participated
in the Breast Cancer Detection Demonstration Project, Schairer and colleaguesArticle report that increased risk of breast cancer was associated only with current or recent use (within the past 4 years) of estrogen-alone or combined estrogen-progestin
hormone replacement therapy (HRT). Among women with recent use of HRT, the
increase in the relative risk of breast cancer associated with each year of
combined estrogen-progestin use was significantly greater than that associated
with use of estrogen alone. In an editorial, Willett and coauthorsArticle emphasize
the value of good diet and lifestyle for maintaining health after menopause.
To determine the efficacy of protease inhibitors for the treatment of
children infected with HIV, Nachman and colleagues in the open-label Pediatric
AIDS Clinical Trials Group Protocol 338 trial changed the antiretroviral therapy
of 297 children who were clinically stable and who had not had prior treatment
with protease inhibitors to a 2- or 3-drug protease inhibitor–containing
regimen (ritonavir plus 1 or 2 nucleoside analogs) or to a dual nucleoside
analog regimen. The proportion of children with undetectable plasma HIV RNA
levels at study week 12 was greater among those receiving ritonavir-containing
regimens than among those in the dual nucleoside group. At week 48, more children
receiving the 3-drug ritonavir-containing regimen had undetectable plasma
HIV RNA levels than children receiving the 2-drug ritonavir-containing regimen.
Hospitalization rates for acute lower respiratory tract infections have
increased since 1980 despite a trend for decreasing hospitalization rates
overall. In this study of patients from 4 large clinics in Texas, Glezen and
colleagues found that during a 4-year period, 93% of all patients older than
5 years hospitalized with acute respiratory tract conditions had a chronic
underlying (high-risk) condition, most commonly a chronic pulmonary condition.
The hospitalization rate for low-income high-risk patients was almost an order
of magnitude greater than that for middle-income high-risk patients. Respiratory
tract viral infections were detected by culture, antigen detection, or a significant
serum antibody rise in 366 (35.6%) of 1029 patients and in 181 (44.9%) of
403 patients who submitted paired serum samples for antibody testing.
The presence of comorbid mental disorders with cardiovascular disease
may influence the likelihood of undergoing cardiovascular procedures. In this
analysis of data from 113,653 adults aged 65 years or older with a confirmed
acute myocardial infarction (MI) at hospital discharge, Druss and colleagues
found that patients with a comorbid mental disorder were significantly less
likely to undergo cardiac catheterization, percutaneous transluminal coronary
angioplasty, or coronary artery bypass graft surgery during the index hospitalization.
Among those patients who underwent cardiac catheterization, rates of coronary
revascularization procedures were similar for patients with and without mental
Using data from the National Mortality Followback Surveys of 1986 and
1993, Liao and colleagues compared quality of life during the year before
death from nationally representative samples of decedents aged 65 years or
older as reported by next of kin. Quality of life measures included use of
hospitalization and nursing home services, self-care activities, cognitive
function, and a summary sickness score. Compared with 1986, most quality of
life indices during the year before death in 1993 improved for individuals
aged 85 years or older and improved or did not change for those aged 65 through
"How do hands that hurt change to hands that help?" From "Casting Stones."
Treatment of ductal carcinoma in situ of the breast.
Efforts are being made to increase incentives and develop infrastructure
for collaboration and interaction between those who practice clinical medicine
and public health professionals.
Although the forthcoming fifth edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment offers
improvements over the previous edition, further revision may be warranted
to achieve a rating system for permanent impairment that is valid, reliable,
See pages Article and Article
Mrs J is a 55-year-old woman who has moderately severe rheumatoid arthritis.
She has been unable to tolerate most disease-modifying antirheumatic medications.
Goldring discusses the epidemiology and pathophysiology of rheumatoid arthritis
and optimal treatment of patients with this disease.
For your patients: Maintaining health for older adults.
This Week in JAMA. JAMA. 2000;283(4):433. doi:10.1001/jama.283.4.433