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This Week in JAMA
October 1, 2003

This Week in JAMA

JAMA. 2003;290(13):1675. doi:10.1001/jama.290.13.1675
Infant Diet and Diabetes-Associated Autoantibodies

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.

Estrogen Plus Progestin and Fracture, Cancer Risk

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.

Azithromycin in Patients With Cystic Fibrosis

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 group.

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Cannabinoid CT-3 and Chronic Neuropathic Pain

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.

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A Piece of My Mind

"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."

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Medical News & Perspectives

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.

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Thimerosal-Containing Vaccine and Autism

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.

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CLINICIAN'S CORNER

Diagnosis and management of female infertility.

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JAMA

Political activism among medical students and recent legislation that affects them.

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JAMA Patient Page

For your patients: Information about infant feeding.

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