Environmental as well as genetic factors are likely to influence
the risk of Alzheimer disease. Hendrie and colleaguesArticle compared the
incidence rates of dementia and Alzheimer disease among Yoruba
residents of Ibadan, Nigeria, with rates among African American
residents of Indianapolis, Ind, after 2 and 5 years of follow-up. The
age-standardized annual incidence rates for both dementia and Alzheimer
disease were significantly lower among Yoruba in Ibadan than among
African Americans living in Indianapolis. In an editorial, FarrerArticle
suggests that identification of distinct genetic and environmental risk
factor profiles for Alzheimer disease might eventually lead to
therapies tailored for specific risk groups.
In prior studies, oseltamivir, a selective oral inhibitor of influenza
neuraminidase, has been shown to be efficacious for treatment of
influenza and for prevention during an outbreak. To study the efficacy
of oseltamivir in preventing the spread of influenza to household
contacts of influenza-infected individuals, Welliver and colleagues
randomly assigned household contacts by household cluster to receive
oseltamivir or placebo once daily for 7 days within 48 hours of symptom
onset in the infected household member. The overall protective efficacy
of oseltamivir against clinical influenza was 89% for household
contacts and 84% for households of influenza-infected individuals.
Few data are available on the risk of birth defects among offspring of
fathers with birth defects. Lie and colleagues followed up a cohort of
males born between 1967 and 1982 for survival rates through 1992 and
for reproductive outcomes through 1998. Compared with males without
birth defects, males with birth defects had higher mortality through
infancy and childhood and were 28% less likely to father a child. The
total risk of birth defects was 5.1% among offspring of males with
birth defects and 2.1% among offspring of males without birth defects.
In acute care settings, evaluation of patients with suspected pulmonary
embolism using pulmonary vascular imaging is often time-consuming and
costly. Kline and colleagues studied whether the use of 2 minimally
invasive bedside tests—whole-blood agglutination D-dimer assay and
volumetric capnometry with PaCO2 to measure
alveolar dead-space fraction—could exclude the diagnosis of pulmonary
embolism. Among 380 emergency department patients with suspected acute
pulmonary embolism, pulmonary embolism was diagnosed in 64 patients
based on standard criteria using radiographic examinations. Sixty-three
of the 64 had either an abnormal D-dimer concentration or alveolar
dead-space fraction or both (sensitivity, 98.4%), and 163 of the 316
patients without pulmonary embolism had normal results for both tests
Most of the studies supporting an association between fruit and
vegetable consumption and a reduced risk of breast cancer have been
case-control studies, which are subject to recall and selection bias.
In this analysis, Smith-Warner and colleaguesArticle pooled data from 8
prospective cohort studies on breast cancer risk and dietary intake.
Fruit, fruit juice, total fruit, total vegetable, and total fruit and
vegetable intakes were not associated with reduced breast cancer risk
when modeled as continuous variables, and breast cancer risk was only
3% to 9% lower in women in the highest decile of fruit or vegetable
consumption compared with the lowest decile. In an editorial, SlatteryArticle
discusses limitations of studies of diet and cancer risk and comments
on current National Cancer Institute recommendations for fruit and
"Mrs DeFranco was a veteran of many grand rounds and knew what to
expect." From "Tactile."
Analysis of data from recent studies on mother-to-infant transmission
of HIV suggests that about half of transmissions occur during the days
just before delivery and another third occur during labor and delivery.
The Ethical, Legal, and Social Implications program of the National
Human Genome Research Institute marked its 10th birthday with a
conference aimed at fitting the new knowledge of genetics into the
reality of 21st-century life.
In AIDS clinical trials, a regimen termination end point—the
time to the first occurrence of any protocol-specified event that leads
to cessation of the assigned treatment regimen—measures important
effects of treatment not captured by plasma HIV RNA levels.
Report from the National Institutes of Health Consensus Development
Panel on the prevention, diagnosis, and treatment of osteoporosis.
The impact of the Internet on patient advocacy and support, medical
education, health law and ethics, and clinical practice.
For your patients: Information about pulmonary embolism.
This Week in JAMA. JAMA. 2001;285(6):695. doi:10.1001/jama.285.6.695