The use of national estimates to track progress toward achieving public
health goals may obscure important trends at the state or local level where
most preventive public health activities occur. Nelson and colleaguesArticle used
data from the Behavioral Risk Factor Surveillance System, 1991 through 2000,
to determine state-specific trends for 5 health risk factors and 6 clinical
preventive services. Most states experienced increases in safety belt use
and in receipt of mammography and of adult influenza and pneumococcal vaccinations.
Trends were mixed for binge alcohol use, physical inactivity, and cholesterol
screening. Obesity increased in all states, cervical and colorectal cancer
screening increased in some states, and smoking increased in some states and
declined in only 1 state. In an editorial, McGinnisArticle considers why some health goals might be easier to achieve than others.
The Women's Health, Osteoporosis, Progestin, Estrogen (HOPE) trial demonstrated
that low-dose combination hormone replacement therapy (HRT) had beneficial
effects on vasomotor symptoms, vaginal atrophy, lipid profiles, bleeding profiles,
and endometrial hyperplasia. In this substudy of the HOPE trial, Lindsay and
colleagues evaluated the efficacy of lower doses (less than 0.625 mg/d) of
conjugated equine estrogens (CEEs) alone and in combination with medroxyprogesterone
acetate (MPA) on bone mass and biochemical markers of bone turnover in healthy
postmenopausal women aged 40 to 65 years. At 24 months, spine and hip bone
mineral density increased significantly from baseline in the lower-dose CEEs
alone and CEEs and MPA groups but decreased in the placebo group. Bone turnover
was significantly reduced from baseline in the active treatment groups but
unchanged in the placebo group.
The Joint National Committee (JNC-IV) blood pressure classification
emphasizes the prognostic importance of both systolic and diastolic blood
pressure for cardiovascular disease mortality. Domanski and colleagues analyzed
data from the Multiple Risk Factor Intervention Trial, a 22-year prospective
study of men aged 35 to 57 years, to determine whether pulse pressure is also
a risk factor for cardiovascular disease mortality. Among men aged 35 to 44
years, cardiovascular disease mortality risk was greatest for those with elevation
of both systolic and diastolic blood pressure. Among men aged 45 to 57 years,
however, higher cardiovascular disease mortality risk was associated with
elevated systolic blood pressure and low diastolic blood pressure (higher
pulse pressure) as well as with elevation of both systolic and diastolic pressure.
A trial of labor after a previous cesarean delivery is associated with
increased risk of uterine rupture. To determine whether a trial of labor is
also associated with increased risk of perinatal death, Smith and colleagues
analyzed data on delivery-related perinatal deaths from national registers
in Scotland for births from 1992 through 1997. The overall rate of perinatal
death among women who had a trial of labor following previous cesarean delivery
was 12.9 per 10 000 women, approximately 11 times greater than the risk
associated with planned repeat cesarean delivery, twice the risk associated
with other multiparous women in labor, and similar to the risk among nulliparous
women in labor.
In this review of 79 studies on the quality of health information on
the Web, Eysenbach and colleaguesArticle found that study methodology and results
varied widely, but most studies concluded that the quality of health information
on the Web is a problem. In an editorial, Risk and PetersenArticle examine quality
criteria that are often used to evaluate health information on the Web and
describe efforts to address Web health information quality initiated by some
governmental agencies in Europe and by the World Health Organization.
"When you practice medicine individual by individual, when you are not
merely checking off forms and writing knee-jerk prescriptions, when you listen
to patients and respond naturally and honestly and caringly . . . you may
be at the top of your game." From "Value."
Vaginal birth after cesarean delivery: trends and current recommendations.
Federal officials who analyzed the effects of last fall's anthrax attacks
are calling for creation of a national plan to be invoked in emergencies that
would redefine the protection of research subjects.
A review of the accuracy and precision of history taking and physical
examination for the diagnosis of urinary tract infection in women.
For your patients: Information about cesarean delivery.
This Week in JAMA. JAMA. 2002;287(20):2615. doi:10.1001/jama.287.20.2615