Antibiotic-mediated alterations in immune function and estrogen metabolism
have been hypothesized to contribute to breast cancer risk. Velicer and colleaguesArticleexamined the association between antibiotic use and risk
of breast cancer in a case-control study of women enrolled in large health
plan. More days of antibiotic use and a greater cumulative number of antibiotic
prescriptions were associated with an increased risk of incident and fatal
breast cancer for all antibiotic classes after controlling for age and length
of health plan enrollment. These relationships persisted in analyses adjusting
for known and suspected breast cancer risk factors and in analyses excluding
antibiotic use 2 and 4 years prior to breast cancer diagnosis. In an editorial,ArticleNess and Cauley discuss potential mechanisms whereby antibiotics
might influence breast cancer risk and suggest questions to pursue in further
investigations in light of this newly discovered association.
An important goal of the National Institutes of Health (NIH) is to translate
basic science discoveries into clinical applications; however, some observers
have suggested an element of bias in the peer review process against clinically
trained researchers and research involving human subjects. Kotchen and colleaguesArticlefrom the NIH Center for Scientific Review assessed grant
applications submitted during 2 funding cycles in 2002 and compared the median
priority scores and funding rates for physician vs nonphysician investigators
and for clinical vs nonclinical research proposals. They found that priority
scores and funding rates were more favorable for MD than for non-MD investigators
but that priority scores and funding rates were less favorable for clinical
than for nonclinical research applications, particularly for clinical research
categorized as "mechanisms of disease" or "clinical trials and interventions"
and for applications with human subject concerns. In an editorial,ArticleSnyderman discusses the challenges of attracting and supporting the clinical
researchers necessary for a strong clinical research enterprise.
Early identification of patients at risk of kidney disease could slow
or prevent disease sequelae. Fox and colleagues examined the predictors of
incident kidney disease in participants enrolled in the Framingham Offspring
Study, a community-based, longitudinal cohort study. They found that established
cardiovascular risk factors including older age, diabetes, hypertension, obesity,
cigarette use, low levels of high-density lipoprotein cholesterol, and mild
reductions in glomerular filtration at baseline were associated with new-onset
kidney disease during a mean follow-up of 18.5 years.
Varicella vaccine is recommended for healthy children aged 12 to 18
months and for older children who have not had chickenpox. However, outbreaks
of chickenpox in groups with high rates of immunization and breakthrough infections
have raised questions about administration guidelines and the efficacy of
the vaccine. Vazquez and colleagues assessed the relationship of age at immunization
and time since vaccination in a case-control study of varicella in previously
immunized children and found that the effectiveness of the vaccine diminished
significantly after 1 year and offered less protection in the first year after
vaccination if the child was younger than 15 months at the time the vaccine
was administered. Breakthrough cases of chickenpox in vaccinated children
were more likely to be mild compared with cases in unvaccinated children.
Experts warn that lifestyle and dietary factors during childhood, including
a lack of exercise and inadequate intake of calcium and vitamin D, may set
the stage for osteoporosis. (Photo credit: American Society for Bone and Mineral
Content analysis of teen-rated video games reveals more blood, sex,
profanity, and illicit substance use than would be expected from the content
descriptors assigned by the Entertainment Software Rating Board.
Interview and medical record data reveal factors predicting failure
to diagnose subarachnoid (SA) hemorrhage and the ensuing consequences.
The Rational Clinical Examination Neurologic
impairment is common in survivors of cardiac arrest. Several simple physical
assessments performed 24 hours after the arrest predict death or poor prognosis
in comatose survivors.
For your patients: Information about chickenpox.
This Week in JAMA. JAMA. 2004;291(7):787. doi:10.1001/jama.291.7.787