Evidence suggests that increased expression of transforming growth factor β1
(TGF-β1) may decrease susceptibility to cancer. As part of the Study
of Osteoporotic Fractures, a prospective study of white, community-dwelling
women aged 65 years or older, Ziv and colleaguesArticle studied the association between
breast cancer risk and the T→C transition at nucleotide 29 of the TGF-β1
gene, which is associated with increased serum levels of TGF-β1. The C/C genotype at nucleotide 29 was associated with a markedly
reduced risk of breast cancer compared with the T/C
and T/T genotypes. In an editorial, ArmstrongArticle discusses
ways to improve the conduct and interpretation of genetic epidemiological
studies of cancer risk.
Recommendations for antithrombotic therapy for patients with atrial
fibrillation vary depending on the estimated risk of stroke. Gage and colleagues
combined 2 existing stroke-risk classification schemes (the Atrial Fibrillation
Investigators scheme and the Stroke Prevention and Atrial Fibrillation scheme)
to form a new stroke risk index, CHADS2, and assessed the predictive
accuracy of all 3 schemes using data from a registry of Medicare beneficiaries
hospitalized with atrial fibrillation. The CHADS2 index assigned
1 point each for the presence of congestive heart failure, hypertension, age
75 years or older, and diabetes mellitus, and 2 points for history of stroke
or transient ischemic attack. All 3 classification schemes predicted ischemic
stroke better than chance, but the CHADS2 index was the most accurate
An achievable benchmark is a performance standard for a specific indicator
of care, such as the proportion of eligible patients receiving influenza vaccine,
based on the average performance for the top 10% of physicians being assessed.
Kiefe and colleagues randomly assigned physicians to receive a multimodal
quality improvement intervention (control group) or the quality improvement
intervention plus achievable benchmark feedback for 5 process of care quality
indicators. Improvement in physician performance was significantly greater
in the achievable benchmark feedback group compared with the control group
for 3 of the 5 quality measures.
The prognosis for persons infected with the human immunodeficiency virus
(HIV) has improved substantially, but many persons infected with HIV will
die from the infection, and advance care planning is still needed. Wenger
and colleagues interviewed a nationally representative sample of persons infected
with HIV about end-of-life discussions with physicians, advance directive
use, and willingness to tolerate future adverse health states. Of the 2864
study participants, 50% had discussed some aspect of end-of-life care with
their health care practitioner, and only 38% had completed an advance directive.
Blacks and Latinos reported discussing end-of-life care issues less frequently
than whites, and patients infected with HIV via injection drug use and patients
with less education reported less frequent communication with physicians about
end-of-life issues. The most important predictor of advance directive completion
was whether the practitioner had discussed the topic.
Apolipoprotein E, a protein involved in lipid metabolism, has 3 major
allelic variants. The ∊4 allele has been associated
with an increased risk of Alzheimer disease and cardiovascular disease. Among
middle-aged adults participating in a longitudinal study of sleep disorders,
Kadotani and colleagues found that the prevalence of moderate-to-severe sleep-disordered
breathing was significantly higher among adults with ApoE ∊4, and the severity of sleep-disordered breathing increased as the number
of ∊4 alleles that an individual carried increased.
Advances in schizophrenia genetics research.
Successful trials of a drug designed to counter genetic mutations responsible
for 2 forms of cancer portend a wave of novel therapies that will transform
the way cancer is treated, said researchers at the recent American Society
of Clinical Oncology meeting.
In this meta-analysis of randomized trials of hormone replacement therapy
(HRT)Article, estrogen therapy significantly reduced the risk of nonvertebral fractures,
particularly among women younger than 60 years. In an editorial, Grady and
CummingsArticle examine the validity of the evidence.
The story of Mr N, a 77-year-old man with metastatic pancreatic cancer,
illustrates common psychological concerns and coping responses of patients
with life-threatening illnesses and how physicians can assess and address
the psychological concerns and emotional distress of patients at the end of
For your patients: Information about sleep apnea.
This Week in JAMA. JAMA. 2001;285(22):2823. doi:10.1001/jama.285.22.2823