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This Week in JAMA
November 6, 2002

This Week in JAMA

JAMA. 2002;288(17):2079. doi:10.1001/jama.288.17.2079
Hormone Therapy and Alzheimer Disease

The association between hormone replacement therapy (HRT) and risk of Alzheimer disease (AD) in postmenopausal women is unclear. In this analysis of data from the Cache County Study, a prospective study of incident dementia in older adults, Zandi and colleaguesArticle found that women who used HRT had a lower incidence of AD over a 3-year follow-up than nonusers. Risk of AD was reduced among former users of HRT but not among current users, unless the duration of current use was longer than 10 years. In an editorial, Resnick and HendersonArticle suggest that these findings are consistent with the possibility that a critical period for neuroprotection by hormone therapy exists during the menopausal transition.

Mortality at 1 Year and Reperfusion Therapy After MI

In the Global Use of Strategies To Open Coronary Arteries (GUSTO) V trial, rates of nonfatal reinfarction and other nonfatal ischemic complications within 30 days after acute myocardial infarction (MI) were lower among patients who received reperfusion therapy with a platelet glycoprotein IIb/IIIa receptor inhibitor (abciximab) and a half dose of a plasminogen activator (reteplase) than among those who received a full dose of reteplase. Mortality rates, however, were not significantly different. In this follow-up study, Lincoff and colleagues found that despite early beneficial effects of combined therapy, all-cause mortality at 1 year was the same in the combined therapy group as in the group that received fibrinolytic therapy alone.

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Crosswalks and Collisions With Older Pedestrians

Rates of pedestrian deaths among older adults are higher than in any other age group. Koepsell and colleaguesArticle conducted a case-control study to determine whether marked crosswalks at urban intersections increased or decreased risk of pedestrian–motor vehicle collision involving pedestrians aged 65 years or older. Risk of pedestrian–motor vehicle collision was significantly greater at intersections with marked crosswalks, especially those without a traffic signal or stop sign. In an editorial, Runge and ColeArticle discuss strategies to improve the safety of crosswalks.

Characteristics of Isolated Diastolic Heart Failure

Many older patients with symptoms of congestive heart failure have preserved left ventricular systolic function, but whether this disorder, termed diastolic heart failure, represents true heart failure is disputed. In this comparison of older patients with presumed diastolic heart failure, patients with classic systolic heart failure, and healthy volunteers, Kitzman and colleagues found that despite marked differences in left ventricular systolic function, patients with isolated diastolic heart failure and those with typical systolic heart failure had similar key pathophysiologic abnormalities, including severely reduced exercise capacity, increased neuroendocrine activation, and reduced quality of life.

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ICU Physician Staffing and Patient Outcomes

Staffing of intensive care units (ICUs) with critical care physicians varies widely. Pronovost and colleagues conducted a systematic review of randomized and observational controlled studies of critically ill adults or children and ICU physician staffing strategies to evaluate the association between ICU staffing and patient outcomes. Hospital and ICU mortality and length of stay were lower in ICUs with mandatory intensivist consultation or staffing than in those with no intensivists or elective intensivist consultation.

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A Piece of My Mind

"I shudder, not sure whether it's from the cold or from the shock of seeing the transformation of a physician." From "The Changing Room."

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Medical News & Perspectives

Swedish scientists raised concerns earlier this year about whether acrylamide produced in the cooking of starchy foods such as French fries poses a cancer risk. In the absence of conclusive data, scientists and public health experts are trying to put the potential risk in perspective.

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Pregnancy Complications and Protein Defects

Maternal history of acute fatty liver of pregnancy appears to be associated with mutations in the mitochondrial trifunctional protein α subunit in the fetus that cause long-chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency.

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Clinician's corner

Hyperglycemia as a risk factor for adverse outcomes in acutely ill patients.

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Call for Papers: Pain Management

Original clinical research reports, basic science and translational research studies, and systematic reviews and commentaries on pain management are invited for JAMA and Archives theme issues scheduled for November 2003.

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Societal interventions to address the epidemic of obesity in the United States.

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JAMA Patient Page

For your patients: Information about pedestrian safety.

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