Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
has been associated with a reduced risk of breast cancer, but the importance
of factors such as frequency of use and hormone receptor status is not clear.
Terry and colleaguesArticle examined data on aspirin and NSAID
use collected in a case-control study of women with breast cancer to determine
whether frequency and duration of use influence breast cancer risk and to
assess for a relationship with tumor hormone receptor characteristics. The
authors found that use of aspirin alone or aspirin with other NSAIDs was associated
with a reduced risk of breast cancer, particularly among frequent (≥7 tablets
per week) and current users, and among women with hormone receptor–positive
tumors. In an editorial, DuBoisArticle discusses the role of
cyclooxygenase and prostaglandins in breast cancer.
Coexisting illnesses may influence treatment planning or survival in
patients with cancer, but data on comorbid conditions are not systematically
collected or considered when estimating prognosis from cancer registry data.
To determine whether information on comorbidities provides important prognostic
information, Piccirillo and colleagues reviewed comorbidity data abstracted
from the medical records of patients with new diagnoses of cancer. The authors
classified the comorbidities by severity and found that severity of comorbidity
was associated with survival in a dose-dependent fashion, and decrements in
survival were independent of cancer stage.
Fetal cocaine exposure is believed to affect neurodevelopment and cognitive
outcomes, but prior studies of exposed children have yielded inconsistent
results. Singer and colleagues assessed the association between prenatal cocaine
exposure and the quality of the caregiving environment on cognitive outcomes
in a longitudinal, case-control study with follow-up through 4 years of age.
The authors found that exposed and nonexposed children had equivalent full-scale,
performance, and summary verbal IQ scores, but prenatal cocaine exposure was
related to lower scores on several IQ subscales and to a lower likelihood
of above average IQ. The quality of the home environment was an important
contributing factor. Cocaine-exposed children who lived in a more stimulating
environment had cognitive scores equivalent to nonexposed children.
The possibility of bias in the reporting of clinical trial outcomes
has been suspected but not demonstrated through systematic study. Chan and
colleagues reviewed the trial protocols and related publications for 102 randomized
trials to assess the extent and nature of outcome reporting bias. They found
substantial evidence of incomplete reporting of efficacy and harm outcomes
in publications, with statistically significant outcomes more likely to be
fully reported than nonsignificant outcomes. The authors also found evidence
of alteration, introduction, or omission of primary outcomes in published
articles compared with the outcomes prespecified in the trial protocols.
Naylor and colleagues participated in a review of the public health
system's response to the 2003 SARS epidemic, report on the challenges encountered,
and make recommendations to guide the response to future epidemics.
"A generation of patients grew up with him, and then he saw their children,
and they grew up with him too." From "Twilight on North Second."
Researchers are seeking ways to disseminate state-of-the-art findings
and promote public health initiatives to address untreated sleep disorders.
Pitfalls of defining quality as adherence to practice guidelines.
Outcomes improve with multidisciplinary care teams and protocol-based
Strategies for optimizing symptom management and addressing prognosis,
advance directives, and hospice care for patients with advanced heart failure.
For your patients: Information about preventing cancer.
JAMA Theme Issue on Global Health
This Week in JAMA. JAMA. 2004;291(20):2407. doi:10.1001/jama.291.20.2407