Exposure to high levels of air pollution has been shown to increase
the risk of respiratory symptoms in children with asthma. Gent and colleaguesArticle conducted a prospective study of children with asthma
in southern New England during spring and summer 2001 to assess the simultaneous
effects of exposure to ozone and fine particles on asthma severity. In copollutant
models, exposure to ozone, often at levels below Environmental Protection
Agency air quality standards, was significantly associated with increased
respiratory symptoms and rescue medication use among children using maintenance
asthma medication, but exposure to fine particles was not. In an editorial,
Thurston and BatesArticle urge greater recognition
that exposure to air pollution is an important factor in asthma exacerbations
and describe ways for patients with asthma to avoid the potentially adverse
effects of air pollution.
Patient Safety Indicators (PSIs), developed by the US Agency for Healthcare
Research and Quality, are tools designed to screen administrative data for
potential patient safety problems. Using PSIs to identify medical injuries
in hospital discharge abstracts from a sample of approximately 20% of US hospitals,
Zhan and MillerArticle found that for 18 types of medical
injuries, the excess length of stay attributable to medical injuries ranged
from 0 days to 10.89 days, excess charges ranged from $0 to $57 727,
and excess mortality ranged from 0% to 21.96%. In an editorial, Weingart and
IezzoniArticle discuss limitations of current measurement
tools, including administrative data–based algorithms, for capturing
patient safety information.
Methotrexate has been proposed for long-term therapy to maintain the
hearing improvement achieved by high-dose prednisone in patients with rapidly
progressive, bilateral sensorineural hearing loss (autoimmune inner ear disease
[AIED]). In this randomized controlled trial, however, Harris and colleagues
found that among patients with AIED whose hearing improved after 1 month of
high-dose prednisone, methotrexate was no more effective than placebo in maintaining
the initial hearing improvement after prednisone therapy was tapered.
Using data from the National Health Interview Surveys (1984-2000) and
the US Census Bureau, Narayan and colleagues estimated the lifetime risk of
developing diabetes from birth to 80 years for the US population born in 2000.
The estimated lifetime risk of developing diabetes was 32.8% for males and
38.5% for females. Life-years and quality-adjusted life-years lost due to
diabetes were substantial at all ages, including among individuals diagnosed
as having diabetes at older ages.
Thrombolytic therapy is the most widely used method of achieving coronary
artery reperfusion in patients with acute ST-segment elevation myocardial
infarction (STEMI), but management of patients with STEMI who have contraindications
to thrombolytic therapy is unclear. In this propensity analysis using data
from the National Registry of Myocardial Infarction 2, 3, and 4 databases,
Grzybowski and colleagues found that immediate mechanical reperfusion (percutaneous
coronary intervention or coronary artery bypass graft surgery) in patients
with STEMI who have contraindications to thrombolytic therapy was associated
with a significantly reduced risk of in-hospital mortality.
Cardiologists are exploring whether anemia causes or worsens congestive
Patients in isolation for infection control precautions were twice as
likely as control patients to experience adverse events during their hospitalization,
expressed greater dissatisfaction with their care, and had less documented
Acute hemodynamic consequences of obstructive sleep apnea and abnormalities
associated with obstructive sleep apnea that may contribute to the initiation
and progression of cardiovascular disease (CVD).
For your patients: Information about health effects of ozone.
This Week in JAMA. JAMA. 2003;290(14):1817. doi:10.1001/jama.290.14.1817