Reports of adverse cardiac events associated with sildenafil use have
raised concerns about the safety of this drug in men with coronary artery
disease. To assess the hemodynamic effects of sildenafil during exercise,
Arruda-Olson and colleaguesArticle conducted a crossover trial in which men with
erectile dysfunction and known or probable coronary artery disease underwent
exercise electrocardiography and echocardiography 1 hour after a single dose
of sildenafil or placebo. Reduction in systolic blood pressure was significantly
greater after sildenafil than after placebo, but there were no differences
in symptoms, exercise duration, or presence or severity of exercise-induced
myocardial ischemia. In an editorial, MarwickArticle observes that the adverse cardiac
events reported with sildenafil are more likely related to sexual activity
than to the use of the drug, and discusses evaluation of functional capacity
to assess the risks of physical and sexual activity in patients with coronary
Estimates of the prevalence and distribution of gonococcal and chlamydial
infection in the general population have been inexact. In this cross-sectional
survey of a sample of adults aged 18 to 35 years in Baltimore, Turner and
colleaguesArticle used nucleic acid amplification tests of urine specimens to detect
the presence of untreated gonococcal and chlamydial infections. Based on the
results of this survey, an estimated 5.3% of the young adult population has
an untreated gonococcal infection and 3.0%, an untreated chlamydial infection.
The combined number of untreated gonococcal and chlamydial infections exceeded
the number of infections diagnosed and treated in a given year. In an editorial,
FortenberryArticle emphasizes the importance of improving sexual health risk assessment
and STD screening, treatment, and surveillance.
Long-term use of hormone replacement therapy (HRT) has been associated
with an increased risk of breast cancer. To determine whether this association
differs according to histologic type of cancer, Chen and colleagues conducted
a case-control study assessing the incidence and type of breast cancer by
duration of HRT in postmenopausal women with primary invasive breast cancer
and aged-matched controls. Consistent with previous studies, the incidence
of breast cancer of all histologic types was increased in recent long-term
users of HRT. This association was stronger for lobular breast cancer than
for nonlobular breast cancer. Longer duration of HRT use was associated with
an approximate 3-fold increased risk of lobular breast cancer, and current
use of combination estrogen plus progestin therapy was associated with a 4-fold
Frequent participation in cognitively stimulating activities has been
hypothesized to reduce the risk of Alzheimer disease. To test this hypothesis,
Wilson and colleagues rated the frequency of participation in common cognitive
activities in a cohort of Catholic nuns, priests, and brothers aged 65 years
or older. During a mean follow-up of 4.5 years, increased participation in
common cognitive activities at baseline was associated with a decreased risk
of incident Alzheimer disease.
Patients often raise spiritual and religious concerns as they near the
end of life, concerns that may be distressing and that also may influence
their decisions regarding medical interventions. Lo and colleagues analyze
3 cases to illustrate how physicians might respond when patients or families
raise religious and spiritual concerns near the end of life.
A laboratory-made peptide that has blocked the development of diabetes
in animals and, in preliminary studies, in patients may undergo larger human
Mechanisms and management of virus-induced asthma attacks: case presentation
A review of postpartum mood disturbances and treatment and prevention
of postpartum depression.
The influence of mass media on the understanding of scientific and medical
information by the general public.
For your patients: Information about postpartum depression.
This Week in JAMA. JAMA. 2002;287(6):685. doi:10.1001/jama.287.6.685