The role of foods in the etiology of disease may relate more to patterns
of dietary intake than to the intake of any single nutrient, food, or food
group. Using data from food questionnaires completed by 42,254 women enrolled
in the Breast Cancer Detection and Demonstration Project, Kant and colleagues
calculated overall diet quality (Recommended Foods Scores [RFSs]) based on
current dietary recommendations for 23 foods. After a median follow-up of
5.6 years, all-cause mortality was inversely associated with the RFS.
In Australia, the decision to list new drugs or alter indications for
existing drugs in the federal Schedule of Pharmaceutical Benefits is based
on expert evaluation of cost-effectiveness analyses submitted by pharmaceutical
companies to the Department of Health and Aged Care. Hill and colleaguesArticle report
that 218 (67%) of 326 analyses submitted between 1994 and 1997 had serious
deficiencies, including uncertainty in the estimates of comparative clinical
efficacy, modeling issues, problems with the choice of comparator, and calculation
errors. In an editorial, Rennie and LuftArticle describe key requirements for reporting
a pharmacoeconomic analysis and propose that all trial data used in the analysis
be submitted electronically for prepublication peer review and then posted
on a journal's Web site if the study is published.
Assessment of cerebral hemodynamic function may identify patients with
asymptomatic carotid artery stenosis who are at increased risk of cerebral
ischemic events. In this prospective longitudinal study of 94 patients with
severe unilateral asymptomatic carotid artery stenosis, Silvestrini and colleagues
found that reduced cerebrovascular reactivity to hypercapnia in the middle
cerebral artery ipsilateral to the stenosis was associated with a significantly
increased risk of transient ischemic attack or stroke.
To investigate an outbreak in which 7 patients at a single hospital
developed decreased vision and hearing, headache, conjunctivitis, and other
severe neurologic symptoms within 7 to 24 hours after hemodialysis, Hutter
and colleagues conducted a retrospective cohort study of all 9 patients who
received hemodialysis at that hospital on the same day and a laboratory investigation
of dialyzer membranes. All case-patients, but neither of the 2 non–case-patients,
were exposed to 11.5-year-old dialyzers with cellulose acetate membranes.
Testing of cellulose acetate dialysis membranes of various ages retrieved
from other sources indicated physical and chemical membrane degradation with
age. Rabbits injected intravenously with water-soluble material recovered
from extraction of a 13.6-year-old dialyzer developed iritis, ciliary flush,
and ocular hemorrhages.
In 1994, the American Academy of Pediatrics and other sponsoring organizations
initiated the national public education "Back to Sleep" campaign to promote
nonprone sleep position for infants to reduce the risk of sudden infant death
syndrome. Using data from National Infant Sleep Position Study annual telephone
surveys, Willinger and colleagues found that prone placement declined from
43% in 1994 to 17% in 1998 and supine placement increased from 27% to 56%.
Among factors that influenced a caregiver's choice of infant sleep position
after the start of the campaign, sleep position recommendation of "supine
not prone" by physicians was significantly associated with decreased prone
and increased supine placement.
"The doctor with bag in hand is a nostalgic icon of trustworthiness,
commitment, and personal service." From "Holding the Bag."
Physicians in Antarctica provide clinical care and conduct research
on medical consequences of the Antarctic environment.
Recent research shows that mental health professionals should learn
to recognize and treat the first episode of psychosis in people with schizophrenia
because delay reduces the likelihood of a good therapeutic response.
Pathogenesis and management of chronic sinusitis and discussion of treatment
options for Mr S, a 48-year-old man with recurrent sinusitis.
A comparison of mortality rates among men using homeless shelters in
Toronto with mortality rates for men in the city's general population and
for homeless men in 3 US cities.
Exhaustion of drug benefits by Medicare beneficiaries enrolled in managed
care health plans is associated with plan disenrollment, threatening continuity
of care and strengthening the argument for a Medicare drug benefit.
See Article and Article
For your patients: Healthy eating.
This Week in JAMA. JAMA. 2000;283(16):2069. doi:10.1001/jama.283.16.2069