The preclinical phase of type 1 diabetes mellitus (DM) is characterized
by development of autoantibodies to pancreatic islet cells. Two articles in
this issue of THE JOURNAL examine whether dietary exposures in infancy influence
the risk of developing islet autoantibodies. Norris and colleaguesArticle followed
up a birth cohort of children at increased risk of type 1 DM based on HLA
genotype or family history of type 1 DM and found that risk of developing
islet autoantibodies was significantly higher among children initially exposed
to cereals between ages 0 and 3 months or at 7 months or older than among
infants exposed to cereals between ages 4 and 6 months. In a second birth
cohort study of children with parents with type 1 DM, Ziegler and colleaguesArticle found that introduction of gluten-containing foods
before age 3 months was significantly associated with increased risk of developing
islet autoantibodies. In an editorial, Atkinson and GaleArticle suggest
that trials of dietary interventions to test whether early infant diets affect
risk of type 1 DM be deferred until more insight into underlying disease mechanisms
has been acquired.
In this updated final analysis of fracture end points in the Women's
Health Initiative (WHI) trial of estrogen plus progestin therapy, a randomized
placebo-controlled trial among postmenopausal women, Cauley and colleaguesArticle report that fracture risk was significantly decreased
in the estrogen plus progestin group, and bone mineral density was significantly
increased. In the global model of overall risk-benefit of estrogen plus progestin
therapy that includes other disease outcomes, however, there was no net benefit
of estrogen plus progestin therapy even among women considered to be at high
risk of fracture. Anderson and colleaguesArticle analyzed
data from the WHI estrogen plus progestin trial to determine whether continuous
combination hormone therapy is associated with gynecologic malignancies. Risk
of invasive ovarian cancer was increased and risk of endometrial cancer was
decreased in the estrogen plus placebo group, but these differences were not
statistically significant. Women in the estrogen plus progestin group underwent
more endometrial biopsies and vaginal ultrasounds and were more frequently
found to have minor abnormalities on routine Papanicolaou tests.
To determine whether macrolide antibiotics benefit patients with cystic
fibrosis, Saiman and colleagues conducted a 24-week randomized placebo-controlled
trial of azithromycin among patients with cystic fibrosis who were chronically
infected with Pseudomonas aeruginosa. At the end
of the trial, improvement in forced expiratory volume in 1 second (FEV1) was significantly greater in the azithromycin group than in the placebo
group, and risk of exacerbation was significantly lower in the azithromycin
In preclinical studies, CT-3, a synthetic cannabinoid, has been shown
to have anti-inflammatory, analgesic, and antiallodynic effects without psychoactive
effects. Karst and colleagues conducted a randomized, placebo-controlled crossover
study among patients who had chronic neuropathic pain for at least 6 months
and found that pain reduction during the CT-3 intervention was significantly
greater than during the placebo intervention.
"Growing up, I had seen my father sick enough to stay in bed only once
and thus was convinced he was invulnerable." From "Reflections While Listening
to the Glazunov Saxophone Concerto."
Driven by concerns that the severe acute respiratory syndrome (SARS)
will make a return appearance on the world's stage, researchers are testing
existing drugs and new agents as possible anti-SARS drugs.
In a cohort of children in Denmark, the risk of autism and other autistic-spectrum
disorders among children vaccinated with thimerosal-containing pertussis vaccine
was not significantly different from that of children vaccinated with the
same pertussis vaccine formulated without thimerosal—findings that do
not support a causal relationship between thimerosal-containing vaccine and
development of autistic-spectrum disorders.
Diagnosis and management of female infertility.
Political activism among medical students and recent legislation that
For your patients: Information about infant feeding.
This Week in JAMA. JAMA. 2003;290(13):1675. doi:10.1001/jama.290.13.1675