Distinguishing a serious illness from a minor illness can be difficult
among febrile infants. Pantell and colleaguesArticle report
data on the management strategies and clinical outcomes for more than 3000
febrile infants 3 months or younger who were seen by physicians participating
in a practice-based research network. The authors compared the clinicians'
diagnostic and treatment decisions with existing guidelines. They found that
the majority of infants were treated as outpatients and specific diagnostic
and treatment strategies depended on the infant's age and the physician's
subjective assessment of illness severity. Clinicians did not strictly follow
existing guidelines, but relying on current guidelines would have resulted
in more hospitalizations and laboratory testing without improving care. In
an editorial, RobertsArticle reviews the historical development
of guidelines for treating febrile infants and discusses the applicability
of guidelines developed in academic centers and emergency departments to community-based
Previous studies have suggested an association between coffee consumption
and a reduced risk of diabetes. Tuomilehto and colleagues conducted a prospective
study of Finnish adults to further investigate this purported link. After
adjusting for potential confounders including age, body mass index, physical
activity, alcohol use, and smoking status, they found a significant inverse
and graded association between daily coffee consumption and risk of type 2
diabetes during a mean follow-up of 12 years.
Prior studies of sex differences in cardiac outcomes have yielded inconsistent
results. King and colleagues assessed survival after cardiac catheterization
in more than 37 000 patients to examine whether the extent of coronary
disease, treatment strategy, and follow-up time influence the risk of death
in women vs men. Women were found to have higher 1-year mortality than were
men, specifically in the first 40 days after catheterization. There were no
sex-related differences among patients who did not undergo revascularization
procedures, but among patients who did, women had a higher mortality rate
within the first year after the procedure. These outcomes remained unchanged
in analyses controlling for age and comorbidities.
Restricted caloric intake protects rodents from spontaneous breast tumors,
but whether a similar protective effect might exist in women is not known.
Michels and Ekbom conducted a retrospective cohort study of women who had
been hospitalized for anorexia nervosa before age 40 years to examine whether
they had a lower risk of incident breast cancer than women in the general
population. They found that women with a history of anorexia had a significantly
lower risk of breast cancer, with the greatest risk reduction among women
with anorexia who subsequently had children.
Lifestyle factors are likely responsible for a substantial number of
deaths in the United States, and modifications in these choices could improve
public health. Mokdad and colleaguesArticle used cause-of-death
reports from the Centers for Disease Control and Prevention and data abstracted
from a systematic review of studies linking risk behaviors and mortality to
calculate risk-attributable mortality rates. They found that tobacco use is
the major cause for deaths, accounting for an estimated 435 000 deaths
annually. Overweight and physical inactivity contributed to approximately
400 000 lives lost in 2000. In an editorial, McGinnis and FoegeArticle
discuss the progress made over the past decade and the challenges
to improving US public health.
Scientists reported they had succeeded in deriving human stem cells
from a cloned human embryo—work seen as an advance toward stem cell–based
transplantation medicine, not reproductive cloning.
Recent expansion of public health insurance programs has improved coverage
for poor and near-poor adolescents, but reductions in private insurance availability
left more middle- and high-income teens without health insurance in 2002.
Mrs C, a 43-year-old woman with chronic renal insufficiency, is anticipating
dialysis and a possible renal transplant. Chertow discusses the epidemiology
and clinical course of end-stage renal disease and the risks and benefits
of dialysis and transplantation.
For your patients: Information about fever in infancy.
This Week in JAMA. JAMA. 2004;291(10):1167. doi:10.1001/jama.291.10.1167