Initiation of hormone replacement therapy (HRT) has been shown to increase
breast density, which may decrease the sensitivity of screening mammography,
but the effects of discontinuing and continuing use on breast density are
not known. Rutter and colleagues studied changes in breast density in a cohort
of 5212 postmenopausal women who had 2 screening mammograms between 1996 and
1998. Compared with women who did not use HRT, women who initiated HRT after
the first mammogram were more likely to have increases in breast density on
the second mammogram; women who discontinued HRT after the first mammogram
were more likely to have decreases in density; and women who were using HRT
prior to both mammograms were more likely to have increases in breast density
on the second mammogram and high density at both exams.
In response to an outbreak of meningococcal disease in Quebec province,
a mass immunization program using polysaccharide vaccine was conducted between
December 1992 and March 1993 for all people aged 6 months through 20 years.
De Wals and colleagues report that the average annual incidence of serogroup
C meningococcal disease decreased from 1.4 per 100 000 in 1990-1992 to
0.3 per 100 000 in 1993-1998, while the overall incidence of cases due
to other serogroups remained stable. Vaccine effectiveness was highest among
those immunized at age 15 through 20 years, and there was no evidence of protection
among children younger than 2 years when immunized.
Economic models have predicted that better glycemic control will reduce
the long-term health care costs of patients with diabetes mellitus, but recent
studies suggest that cost savings may be more immediate. In this historical
cohort study conducted between 1992 and 1997, Wagner and colleagues found
that patients with type 2 diabetes whose glycemic control improved between
1992 and 1993 and was maintained through 1994 had lower mean total health
care costs than patients whose glycemic control was unimproved. Health care
utilization for primary care visits was significantly lower in the improved
cohort compared with the unimproved cohort beginning in 1994 and for specialty
visits in 1997.
In the previously reported SHOCK (Should We Emergently Revascularize
Occluded Coronaries for Cardiogenic Shock) Trial, 30-day mortality among patients
with acute myocardial infarction and cardiogenic shock treated with early
revascularization was 47% compared with 56% among those who received initial
medical management, a nonsignificant reduction. In this analysis, Hochman
and colleagues found that 1 year after randomization, there was a significant
difference in survival between the 2 groups. One-year survival was 46.7% for
patients in the early revascularization group compared with 33.6% in the initial
medical stabilization group.
In recent trials, combination therapy with interferon and ribavirin
was more effective than interferon monotherapy for patients with chronic hepatitis
C who had no prior interferon therapy or who relapsed after interferon therapy.
Cummings and colleaguesArticle conducted a meta-analysis of 12 trials to compare
combination therapy with interferon plus ribavirin with interferon alone for
re-treatment of patients who failed to respond to interferon monotherapy.
The pooled virological response rate was 14% for combination therapy and 2%
for monotherapy, with a significant overall risk difference of 7%. In an editorial,
KoffArticle notes that because histological improvement of hepatic fibrosis may occur
without a complete virological response, long-term therapy may still be beneficial
for patients despite failure to clear serum HCV RNA levels at conventional
time points after treatment.
Hematologists report success using new gene-based therapeutic approaches
to chronic myelogenous leukemia, hemophilia A, and other difficult-to-treat
In this analysis of data from a nationally representative survey of
people who use homeless services, those who were homeless reported high rates
of acute hospital-based care and difficulty accessing needed care. Medical
insurance was associated with greater use of ambulatory care and lower reporting
of barriers to care and to compliance with prescribed medication.
Protection of the privacy of family members in survey and pedigree research:
analysis of ethical issues and regulatory standards.
For your patients: Information about mammography and breast cancer.
This Week in JAMA. JAMA. 2001;285(2):133. doi:10.1001/jama.285.2.133