The risk of nonmelanoma skin cancer among elderly persons is well documented,
but little is known about the incidence among younger persons. Christenson
and colleagues used population-based data (1976-2003) from Olmsted County,
Minnesota, to estimate the incident basal cell carcinomas (BCCs) and squamous
cell carcinomas (SCCs) and change in incidence over time in persons younger
than 40 years. The age-adjusted incidence of BCC was 25.9 per 100 000
persons for women and 20.9 for men, and the incidence of SCC was similar for
men and women, with an average age-adjusted incidence of 3.9 per 100 000
persons. The incidence of both cancers increased over the study period. Basal
cell carcinomas increased significantly more in women than men.
Some evidence suggests that individual response to exercise may be influenced
by the angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) genotype. Kritchevsky and colleagues
assessed the association of reports of mobility limitations with the ACE genotype
in community-dwelling adults aged 70 through 79 years. They found that physical
activity was associated with preserved physical function. However, among physically
active persons, those with the II genotype had higher
risk of mobility impairment than those with the ID/DD genotypes.
Risk by genotype did not differ among physically inactive persons.
To test the hypothesis that multiple-antigen vaccines and aggregated
vaccine exposure lead to immune dysfunction and an increase in nontargeted
infectious diseases among children, Hviid and colleagues reviewed national
registry data on vaccinations and infectious disease hospitalizations for
Danish children born from 1990 through 2001. They found no evidence to support
a link between routine childhood vaccinations and hospitalization for nontargeted
Patients treated for venous thromboembolism (VTE) are at risk of a recurrence,
but the optimal duration of anticoagulation is not clear. In a meta-analysis
of data from clinical trials of anticoagulation for VTE, Ost and colleagues
found that compared with short-term therapy, patients receiving extended anticoagulation
had a reduced risk of recurrent VTE while receiving therapy. The authors found
evidence of a smaller risk reduction when long-term therapy was discontinued.
Clinical practice guidelines (CPGs), developed to improve health care
quality, exist for many chronic conditions experienced by older patients.
Boyd and colleaguesArticle reviewed national data to
assess whether CPGs are applicable to older patients who have several common
comorbid conditions and the implications for patients when the CPGs are followed.
They found that many CPGs did not consider comorbidities, treatment burden
or patient preferences, or potential adverse interactions of CPG recommended
medications given concurrently for coexisting conditions. In an editorial,
O’ConnorArticle discusses the limitations of
guideline-based care for individual patients and the problems of tying CPGs
to physician compensation schemes.
Unanswered questions about addressing age-related declines of certain
hormones in older adults are gaining unprecedented attention from researchers
Assessing prognosis and informing decisions about life-sustaining therapies
in mechanically ventilated patients with stroke.
Consent requirements for human immunodeficiency virus tests interfere
with efficient diagnosis and treatment of critically ill patients who are
unable to give consent.
Respect for persons underlies the ethical obligation to share individual
results with research participants.
For your patients: Information about thrombophlebitis.
This Week in JAMA . JAMA. 2005;294(6):653. doi:10.1001/jama.294.6.653