Maternal cigarette smoking during pregnancy is an important risk factor
for low infant birth weight, but not all women who smoke during pregnancy
give birth to low-birth-weight infants. In this case-control study, Wang and
colleaguesArticle found that polymorphisms of 2 maternal genes involved in the metabolism
of toxic metabolites in tobacco smoke, CYP1A1 and GSTT1, modified the association between maternal cigarette
smoking and infant birth weight. Among women who smoked during pregnancy,
the greatest reduction in birth weight was found in the group with the CYP1A1 Aa/aa and GSTT1 absent
genotypes. In an editorial, Vogler and KozlowskiArticle discuss research methods
necessary for reliable identification of gene-environment interactions and
the potential to target interventions based on genetic risk assessment.
Olfson and colleagues compared the outpatient treatment of depression
in 1997 with that in 1987 using data from a nationally representative survey
conducted in each study year. The rate of outpatient treatment for depression,
treatment by physicians, the use of psychotropic medication, and coverage
by third-party payers increased significantly in 1997 compared with 1987,
whereas the proportion of patients who received psychotherapy and the number
of depression treatment visits per user decreased.
Evidence suggests that mortality risk after acute myocardial infarction
(MI) is higher among women than among men. Mehilli and colleagues found, however,
that in a cohort of patients with acute MI in which most patients, both women
and men, received reperfusion therapy primarily via percutaneous coronary
interventions, 1-year mortality was not significantly different among women
compared with men.
Raloxifene, a selective estrogen receptor modulator, blocks the effects
of endogenous estrogen in the breast and reduces the risk of breast cancer.
In this analysis of data from the Multiple Outcomes of Raloxifene Evaluation
(MORE) trial, a placebo-controlled trial that assessed the effect of raloxifene
on vertebral fracture risk in postmenopausal women with osteoporosis, Cummings
and colleagues found that among women with relatively high estradiol levels,
the rate of breast cancer was significantly lower in the raloxifene group
than in the placebo group. Women with undetectable estradiol levels, however,
had similar breast cancer risk regardless of treatment.
To assess associations between Kaposi sarcoma–associated herpesvirus
(KSHV) infection, HIV infection, and sexual behavior, Osmond and colleagues
studied homosexual male cohorts in San Francisco at points during 1978 through
1996. Prevalence of KSHV infection was high at the start of the study. Reduction
in unprotected anal intercourse coincided with decline in HIV, but not in
KSHV, prevalence. Although observed at an ecological level, behaviors remaining
highly prevalent, such as unprotected oral intercourse, may be more likely
to account for KSHV transmission.
"The truly competent physician is the one who sits down, senses the
‘mystery' of another human being, and offers with an open hand the simple
gifts of personal interest and understanding." From "The Morning After."
Follow-up of patients who received fetal dopamine cell transplantation
to treat Parkinson disease is suggesting ways to improve treatment for the
1.5 million people in the United States with this disorder.
A new, comprehensive definition of professional competenceArticle and current
and future methods for assessmentArticle.
Guidelines for glucocorticoid therapy for patients with adrenal insufficiency
and for those who are critically ill.
For your patients: Information about low birth weight.
This Week in JAMA. JAMA. 2002;287(2):155. doi:10.1001/jama.287.2.155