Despite near universal exposure to gluten-containing wheat products,
only a small percentage of susceptible individuals develop celiac disease,
suggesting other factors are involved. Norris and colleaguesArticle collected dietary information for children at increased risk of celiac disease
to determine whether the timing of dietary gluten introduction is related
to development of celiac disease autoimmunity (CDA). They found that children
with gluten exposure in the first 3 months of life or after 6 months had a
significantly increased risk of CDA compared with children exposed to gluten
at 4 to 6 months of age. In an editorial, FarrellArticle discusses
the complexities of infant dietary practices and celiac disease risk.
The contribution of clinical factors, including thrombophilia, to the
risk of recurrent thrombotic events is unclear. From follow-up of patients
participating in the Leiden Thrombophilia Study, Christiansen and colleagues
estimated the venous thrombosis recurrence rate and investigated associated
factors. The incidence rate of recurrence was 25.9/1000 patient-years and
was highest in the first 2 years after initial thrombosis. Factors associated
with recurrence included male sex, idiopathic vs provoked first thrombosis,
and use of oral contraceptives. Prothrombotic abnormalities, such as factor
V Leiden or elevated levels of clotting factors, did not appear to play an
important role in recurrence risk.
Two measures of the importance of information in the health sciences
are the design of the study from which the information derives and the citation
index of the article, but little is known about the relative citation impact
of articles using different study designs. Patsopoulos and colleagues determined
the citation count for 2646 articles representing various study designs that
were published in 1991 and 2001. They found that meta-analyses received more
citations than other types of study design. In 2001, randomized controlled
trials were the second most cited study design and the citation impact of
epidemiological studies declined compared with 1991, consistent with proposed
hierarchies of evidence.
Brain and colleagues report serious adverse events leading to premature
termination of a multicenter randomized trial comparing the effectiveness
of doxorubicin plus docetaxel with doxorubicin plus cyclophosphamide as adjuvant
chemotherapy for breast cancer. Women in the doxorubicin-docetaxel group had
a significantly increased risk of febrile neutropenia (40.8% vs 7.1% in the
doxorubicin-cyclophosphamide group); 2 women died and 1 required surgery for
perforative peritonitis. Of 87 serious adverse events, 72 occurred in the
doxorubicin-docetaxel group, the majority of which were associated with febrile
Knowledge of neonatal risks from late in utero exposure to serotonin
reuptake inhibitors (SRIs) is important to guide maternal therapy during pregnancy
and neonate care after delivery. Moses-Kolko and colleagues reviewed published
evidence of neonatal symptoms associated with in utero exposure to SRIs. They
review the associated signs and suggest strategies to prevent or treat the
SRI-induced neonatal syndrome.
“The tears continue. What does she see? What does she know? Does
she understand?” From “Saying Good-bye.”
Despite the fact that 1 in 4 children and adolescents has a problem
with sleep that warrants a physician’s attention, such problems often
Leape and Berwick discuss progress and yet-to-be-realized improvements
in patient safety 5 years after release of the report To
Err Is Human.
The Rational Clinical Examination Accuracy
and reliability of symptoms and examination findings in patients with suspected
stroke or transient ischemic attack.
The case of Theresa Marie Schiavo.
For your patients: Information about celiac disease.
This Week in JAMA . JAMA. 2005;293(19):2315. doi:10.1001/jama.293.19.2315