Rapid reperfusion after acute myocardial infarction (MI) using thrombolytic
therapy has been associated with reduced mortality, but whether time to primary
angioplasty is also related to mortality is less certain. In this analysis
of data from 27,080 patients with acute MI associated with ST-segment elevation
or left bundle-branch block who were treated with primary angioplasty, Cannon
and colleaguesArticle found that the odds of in-hospital mortality increased 41%
to 62% when the time to first balloon inflation was more than 2 hours from
hospital arrival. Increasing delay from symptom onset to first balloon inflation,
however, was not associated with significant increase in in-hospital mortality.
In an editorial, LauerArticle observes that these findings suggest that hospitals
caring for patients with acute MI should offer primary angioplasty only if
they can consistently perform the procedure within 2 hours of patient arrival.
Recent trends in the average age and employment of registered nurses
(RNs) will influence the future age distribution and size of the RN workforce.
In this analysis of successive cohorts of RNs over their lifetimes, Buerhaus
and colleaguesArticle found that the average age of working RNs increased 4.5 years
between 1983 and 1998, and the number of full-time equivalent RNs in recent
cohorts has decreased compared with cohorts at similar ages that entered the
labor market 20 years earlier. The authors estimate that the RN workforce
in 2020 will be the same size as today, approximately 20% below projected
requirements. In a related commentary, BednashArticle proposes reforms in nursing
education and credentialing to reverse current trends in aging and supply
in the RN workforce.
In prior studies, an increase in the number of acquired nevi has been
associated with increasing risk of cutaneous malignant melanoma in white populations.
To determine whether use of broad-spectrum, high–sun-protection sunscreen
would reduce the development of acquired nevi in children, Gallagher and colleagues
randomly assigned white school-aged children to receive a supply of SPF 30
broad-spectrum sunscreen with instructions for use or to a control group with
no intervention. After 3 years, children in the sunscreen group, especially
those with more facial freckling, developed significantly fewer new nevi than
those in the control group.
Increased physical activity has been associated with reduced risk of
coronary heart disease, but data on the relationship between physical activity
and risk of stroke have been inconsistent. During 8 years of follow-up of
72,488 women in the Nurses' Health Study, Hu and colleagues documented a total
of 407 incident cases of stroke, of which 258 were ischemic strokes. Risk
of total stroke and ischemic stroke decreased significantly in a dose-response
manner as level of physical activity increased.
Transmission of tuberculosis (TB) continues to occur despite improvements
in TB control. In this epidemiological study of transmission of a specific
strain of Mycobacterium tuberculosis in an urban
community that has been using TB control measures, including directly observed
therapy, Chin and colleagues found that reasons for disease transmission included
failure to identify contacts of source case-patients, delayed diagnosis of
source case-patients, and problems associated with evaluation or treatment
Stroke risk factors and prevention of stroke in patients with chronic
Because problems can belie the promise of highly active antiretroviral
therapy for HIV, researchers are exploring ways to improve it without compromising
effectiveness. One approach—under study by Anthony Fauci, MD, and coworkers—is
structured therapy interruption.
Analysis of data from the Surveillance, Epidemiology, and End Results
(SEER) program indicates that the increase in 5-year cancer survival over
time observed for 20 common solid tumors does not correlate with change in
cancer mortality and may reflect changing patterns of diagnosis rather than
improvement in therapy.
Public health powers of federal and state government and constitutional
limitations on these powers to protect individual liberties.
For your patients: Information on benefits of physical activity.
This Week in JAMA. JAMA. 2000;283(22):2895. doi:10.1001/jama.283.22.2895