Several lines of research suggest that estrogen may influence cognitive
function in postmenopausal women. To test whether estrogen replacement therapy
(ERT) affects progression of preexisting Alzheimer disease, Mulnard and colleaguesArticle
randomly assigned 120 postmenopausal women with mild to moderate Alzheimer
disease to receive low-dose or high-dose estrogen or placebo for 12 months.
At 12 months, the proportion of women with clinical decline in the combined
estrogen groups was similar to that in the placebo group. There was no significant
difference in change in score on most measures of functional and cognitive
outcomes between women who received estrogen therapy and those who received
placebo. In an editorial, Shaywitz and ShaywitzArticle discuss the many questions
regarding estrogen therapy and Alzheimer disease that are still unanswered.
Oseltamivir, an oral influenza neuraminidase inhibitor, has been shown
to improve symptoms in subjects experimentally infected with influenza virus.
In this trial of oseltamivir for the treatment of naturally acquired influenza
infection in 629 otherwise healthy adults aged 18 to 65 years with acute febrile
respiratory illness, Treanor and colleaguesArticle found that the duration and severity
of illness was significantly reduced among patients infected with influenza
who received oral oseltamivir compared with placebo. Among the 374 patients
infected with influenza, the incidence of any secondary complication, such
as sinusitis or bronchitis, was significantly lower in the oseltamivir groups
compared with placebo. In an editorial, WenzelArticle considers benefits of different
treatment options for influenza at both individual and population levels.
Despite the lack of data on the efficacy and safety of psychotropic
medications for the treatment of very young children, Zito and colleaguesArticle
found that prescriptions for psychotropic medications increased markedly between
1991 and 1995 among children aged 2 to 4 years enrolled in 3 different health
care plans. The 1995 utilization prevalence of prescribed stimulants, the
most frequently prescribed of the 3 psychotropic drug classes in this study
in all 3 settings, was 5.1 per 1000 children in a health maintenance organization
(a 3.1-fold increase from 1991), 8.9 in a mid-Atlantic state Medicaid program
(a 1.8-fold increase), and 12.3 in a midwestern state Medicaid plan (a 3.0-fold
increase). Clonidine use increased 6.8- to 28.2-fold between 1991 and 1995.
In an editorial, CoyleArticle cautions that use of psychotropic medications in young
children may have long-term adverse effects on the developing brain and discusses
why prescribing patterns may have changed.
In this prospective cohort study, Ellerbrock and colleagues found that
67 (20%) of 328 women infected with human immunodeficiency virus (HIV) who
had no evidence of cervical squamous intraepithelial lesions (SILs) at baseline
developed a SIL during 30 months of follow-up compared with 16 (5%) of 325
women not infected with HIV. The incidence of SILs was 8.3 cases per 100 person-years
in women infected with HIV and 1.8 in women not infected with HIV. Risk factors
for the development of SILs in women infected with HIV included transient
and persistent infections with human papillomavirus.
Mr J, an 80-year-old man, has noticed memory loss for the past 7 years.
Recently, Mr J became lost while driving along a familiar route, and family
members are concerned that his memory loss is progressing. Larson discusses
the epidemiology, diagnosis, and treatment of Alzheimer disease and other
"A team of health professionals had agonized over how to deal with the
ethical problems generated by Mr Dean's care, while failing to notice and
understand the most pressing ethical problem." From "Attention Must Be Paid."
Healthy People 2010, the third US national preventive health initiative,
aims to improve the quality of life and eliminate disparities in health among
In this prospective study of 189 patients with septic shock, plasma
cortisol levels and cortisol response to a short corticotropin stimulation
test at the onset of septic shock predicted mortality at 28 days.
Two perspectives on the ethics of withdrawing life-sustaining treatment
in patients with severe chronic illness.
See Article and Article
For your patients: A primer on cervical cancer.
This Week in JAMA. JAMA. 2000;283(8):965. doi:10.1001/jama.283.8.965