Popular diets promise weight loss and disease risk reduction, but data
to support their efficacy and health effects are limited. Dansinger and colleaguesArticle assessed adherence and 1-year changes in baseline
weight and cardiac risk factors in overweight and obese patients who were
randomly assigned to 1 of 4 diets (Atkins, Zone, Weight Watchers, and Ornish),
with varying nutrient composition. Adherence to the assigned diets was low.
Modest weight change from baseline was associated with diet adherence, not
diet type, and participants adhering to their assigned diet achieved comparable,
modest improvements in several cardiac risk factors. In an editorial,Article Eckel discusses the challenges of helping patients
achieve and sustain a lower weight.
Emergency contraception (EC) can reduce the number of unintended pregnancies,
but there are concerns that easy availability will reduce regular contraceptive
use or increase sexually transmitted infections (STIs). Raine and colleaguesArticle conducted a randomized trial to evaluate the effect
of direct access to EC through pharmacies and advance provision vs clinic
access on use of EC, pregnancy rate, and new STIs. They found that women in
the advance provision group were almost twice as likely to use EC as women
in the clinic access group. Pharmacy access did not increase use relative
to clinic access. Rates of unprotected intercourse, pregnancy, and new STIs
were similar across the groups. In an editorial,Article Litt
discusses the importance of these findings to stimulate new initiatives for
improving access to EC.
Microvascular disease has been suggested as a factor in the development
of congestive heart failure (CHF). To investigate this possible association,
Wong and colleagues examined the relationship of retinopathy to risk of incident
CHF in a population-based cohort of middle-aged men and women who were followed
up for 7 years. The authors found that retinopathy at baseline was an independent
predictor of CHF, with a significantly elevated risk even in persons without
preexisting coronary heart disease, diabetes, or hypertension.
Previous studies have documented lower health-related quality of life
(QOL) in selected samples of overweight and obese children, but population-based
data are lacking. Williams and colleagues assessed health-related QOL in a
representative sample of Australian children, 9 to 12 years of age. They found
that health-related QOL declined with increasing weight, particularly in measures
of physical and social functioning. Measures of emotional and school function
did not differ significantly across weight categories.
Prior research by Levine and colleagues suggested that low serum levels
of placental growth factor (PlGF) antedate the clinical signs of preeclampsia.
In an extension of this work, they hypothesized that urinary levels of PlGF
would be similarly reduced and would predict women who developed preeclampsia.
They determined urinary PlGF levels in women who developed preeclampsia vs
those who did not. The authors found that PlGF levels were significantly lower
beginning at 25 to 28 weeks of gestation in women who developed preeclampsia
compared with women who did not, particularly in women with early onset of
preeclampsia or small-for-gestational-age infants.
“Mrs Smyth . . . made it very clear to me
that if she ever stopped breathing, she wanted no ‘so-called resuscitation.’”
From “The Octogenarian’s Plan.”
The use of 3-dimensional ultrasound for the purpose of creating “keepsake”
fetal images for parents rather than for medical purposes is generating a
debate about the appropriateness of the practice.
In a prospective study of women, magnesium intake was inversely associated
with colorectal cancer risk.
Contempo UpdatesErythropoietin appears
to have neuronal and vascular cytoprotective effects.
For your patients: Information about retinopathy.
This Week in JAMA . JAMA. 2005;293(1):7. doi:10.1001/jama.293.1.7