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This Week in JAMA
May 22/29, 2002

This Week in JAMA

JAMA. 2002;287(20):2615. doi:10.1001/jama.287.20.2615
State Trends in Health Risk Factors, Preventive Services

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.

Lower Doses of HRT and Bone Mass and Bone Turnover

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.

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Pulse Pressure and Cardiovascular Disease Mortality Risk

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.

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Perinatal Death and Labor After a Previous Cesarean

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.

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Studies on Quality of Health Information on the Web

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.

A Piece of My Mind

"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."

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Contempo Updates

Vaginal birth after cesarean delivery: trends and current recommendations.

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Medical News & Perspectives

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.

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Clinician's corner

A review of the accuracy and precision of history taking and physical examination for the diagnosis of urinary tract infection in women.

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JAMA Patient Page

For your patients: Information about cesarean delivery.

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