Wolf-Maier and colleaguesArticle analyzed data
from 8 national surveys in Europe and North America to assess geographic variation
in blood pressure (BP) levels and in the prevalence of hypertension. Mean
BP measurements and hypertension prevalence were higher in 6 European countries
than in the United States and Canada. Hypertension prevalence was strongly
correlated with stroke mortality. In an editorial, Staessen and coauthorsArticle note that BP is the most consistent and powerful
predictor of stroke risk and suggest that a downward shift in the distribution
of BP in large populations would likely lead to a marked reduction in the
global burden of stroke.
Limited data suggest that pain may be more prevalent in populations
with chemical dependency than in the general population. In this study of
2 chemically dependent populations, Rosenblum and coauthors found
that the prevalence of chronic severe pain was 37% among patients receiving
methadone maintenance for opioid addiction and 24% among patients recently
enrolled in a residential substance abuse treatment program primarily for
treatment of alcohol or cocaine dependence.
Physical activity has been consistently associated with reduced mortality
in a variety of populations. Gregg and colleagues analyzed
data from community-dwelling women aged 65 years and older participating in
the Study of Osteoporotic Fractures, a prospective cohort study designed to
assess the incidence of and risk factors for fractures among older women.
Sedentary women who increased physical activity between baseline and a follow-up
visit 6 years later and women who remained physically active had significantly
lower all-cause mortality and cardiovascular mortality than continually sedentary
Lunney and coauthors analyzed physical
function data from the last year of life of participants enrolled in the Established
Populations for Epidemiologic Studies of the Elderly study, a community-based
prospective study of persons aged 65 years and older. Consistent with a previously
published theoretical model, patterns of observed decline in performance of
activities of daily living at the end of life differed among 4 types of illnesses—sudden
death, cancer death, death from organ failure, and frailty.
Children infected with HIV have a marked increase in risk of malignancy.
In this case-control study among children infected with HIV, Pollock and colleagues found that high Epstein-Barr virus viral load was
strongly associated with cancer risk only among children with CD4 cell counts
of at least 200/µL. Route of infection, demographic characteristics,
and prior zidovudine use were not associated with development of malignancy.
Estimates of the extent of Internet use for health care in the United
States vary widely. Baker and colleagues conducted
a survey of a nationally representative sample of individuals aged 21 years
and older who were self-reported Internet users to determine the extent of
Internet and e-mail use for health care. Approximately 40% of respondents
reported using the Internet to look for advice or information about health
or health care in 2001, and approximately 6% reported using e-mail to communicate
with a physician or other health care professional.
"Did Alice have an inkling of what she looked like? . . . How did her
husband manage to care for her?" From "Alice's Husband."
Blood safety testing for West Nile virus is expected to be in place
this summer, but not before the occurrence of early, localized outbreaks of
A multifaceted strategy focusing on using evidence-based guidelines,
feedback, and social interaction reduced the total number of tests and the
number of inappropriate tests ordered by primary care physicians.
Advances in the management of patients with chronic hepatitis C infection.
Relman rebuts the Washington Legal Foundation critique of standards
limiting commercial support of continuing medical education (CME) that were
proposed by the Accreditation Council for Continuing Medical Education.
Medicine and the Media From 1997 through 2001,
beer and liquor advertisements appeared more frequently in magazines with
higher adolescent readership.
For your patients: Information about hepatitis C.
This Week in JAMA . JAMA. 2003;289(18):2325. doi:10.1001/jama.289.18.2325