The optimal amount and intensity of physical activity necessary to maintain
health and control body weight have not been established. Jakicic and colleaguesArticle conducted a randomized trial among overweight, sedentary
women comparing the effect of 4 exercise prescriptions—vigorous intensity/high
duration, moderate intensity/high duration, moderate intensity/moderate duration,
and vigorous intensity/moderate duration. After 12 months, no significant
differences in weight loss or improvement in cardiorespiratory fitness were
found between the 4 groups. In an analysis of data from postmenopausal women
enrolled in the prospective Women's Health Initiative Observational Study,
McTiernan and colleaguesArticle found that risk of
breast cancer was significantly reduced among women who had participated in
regular strenuous activity at age 35 years and among those who currently engaged
in the equivalent of 1.25 to 2.5 hours per week of brisk walking. In an editorial,Article Lee notes that the findings from these studies suggest
that women are able to achieve health benefits from modest levels of physical
Management of diarrhea-associated hemolytic uremic syndrome (HUS), which
is primarily caused by intestinal infection with Shiga toxin–producing
strains of Escherichia coli, relies mostly on intensive
supportive care. Trachtman and colleaguesArticle conducted
a multicenter placebo-controlled randomized trial among children with diarrhea-associated
HUS to determine whether an oral agent that binds Shiga toxin would reduce
disease severity. The combined frequency of death or serious extrarenal events
or need for dialysis was not significantly different in the 2 treatment groups.
In a meta-analysis of 49 published studies on diarrhea-associated HUS, Garg
and colleaguesArticle estimated that end-stage renal
disease or death occurred in 12% of patients and 25% of survivors experienced
long-term renal sequelae. In an editorial,Article Siegler
proposes preventive measures to reduce the incidence of diarrhea-associated
HUS as the main approach available to decrease the morbidity and mortality
related to this condition and urges more research on the pathogenic cascade
initiated by Shiga toxin–producing strains of E coli.
In recent years, the prevalence of type 2 diabetes mellitus among children
and adolescents has been increasing. Wei and colleagues studied the rate of
type 2 diabetes and associated risk factors in children aged 6 to 18 years
in Taiwan based on a national screening program. The rate of newly diagnosed
diabetes was 9.0 per 100 000 for boys and 15.3 per 100 000 for girls.
Among those with newly diagnosed diabetes, the ratio of type 2 to type 1 diabetes
was approximately 6:1. Factors significantly associated with type 2 diabetes
included obesity, hypercholesterolemia, blood pressure greater than the 85th
percentile, and family history of diabetes.
Clark and colleagues evaluated national data on apheresis use before
and during 3 Canadian randomized controlled trials (RCTs) of apheresis to
determine whether use of an experimental therapy during an RCT increases outside
the trial. The number of patients receiving apheresis increased during all
3 trials, and most of the increased use was among patients who were not participating
in the trials.
"Far from raising us up, brute suffering can drag us down to the elemental,
the animal, heralding that feared leveler, death." From "For What?"
Experts say that clinicians' lack of knowledge about addiction as a
medical disease hampers treatment efforts.
In this cross-sectional study, 4 adolescents were able to purchase and
receive cigarettes from approximately 90% of 55 Internet vendors.
Two case presentations illustrate that peripheral neuropathy may be
the first symptom of impaired glucose metabolism. Polydefkis and coauthors
discuss visualization of small-caliber sensory nerve fibers in skin biopsies
to study diabetic peripheral neuropathy.
Research reports that address major health problems and diseases in
developing countries are invited for a JAMA theme issue on global health
scheduled to be published in June 2004.
For your patients: Information about food-borne illnesses.
This Week in JAMA. JAMA. 2003;290(10):1277. doi:10.1001/jama.290.10.1277