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.
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.
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.
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.
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.
"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."
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.
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
Hyperglycemia as a risk factor for adverse outcomes in acutely ill patients.
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.
Societal interventions to address the epidemic of obesity in the United
For your patients: Information about pedestrian safety.
This Week in JAMA. JAMA. 2002;288(17):2079. doi:10.1001/jama.288.17.2079