Induced preterm delivery is common in pregnancies complicated by preeclampsia, but little is known about the effects of early delivery on fetal and infant survival. Basso and colleagues analyzed data from 1967 to 2003 for singleton first-born infants of Norwegian-born mothers to assess fetal and infant survival following early delivery of preeclamptic pregnancies. Comparing data from 1967-1978 with that from 1991-2003, the authors found a significant increase in the rate of preterm inductions for preeclampsia, a reduction in the risk of stillbirth in preeclamptic vs nonpreeclamptic pregnancies, and relatively stable risks of neonatal and later infant deaths.
Whether lipoprotein(a) is a meaningful marker of cardiovascular risk in women is controversial, and part of the controversy could be a consequence of interassay differences. To explore these questions, Suk Danik and colleagues used a state-of-the-art lipoprotein(a) assay to assess the association between baseline lipoprotein(a) levels and incidence of future cardiovascular events in a prospective cohort study of 27 791 women who were healthy at study enrollment. The authors found a significantly increased risk of future cardiovascular events among women with extremely high (≥90th percentile) levels of lipoprotein(a), particularly among women with high levels of low-density lipoprotein cholesterol.
Studies examining the association of fatty fish consumption with risk of several cancers have yielded inconsistent results, and no studies have explored fatty fish consumption and risk of renal cell carcinoma (RCC). To address this deficiency, Wolk and colleagues assessed the association of fatty and lean fish consumption with the risk of RCC in a prospective cohort study of Swedish women. Compared with women reporting no fish consumption, the authors found an inverse association between fatty fish consumption of 1 or more servings per week and risk of RCC during a mean 15.3 years of follow-up. No association was found between lean fish consumption and risk of RCC.
Patients with renal disease are at high risk of cardiovascular disease (CVD) morbidity and mortality. However, if patients with renal disease are not represented in CVD treatment trials, optimal treatment strategies for these patients will not be identified. Coca and colleagues reviewed 153 CVD treatment trials, published in 1985 through 2005, to assess the representation of patients with renal disease in the trials. The authors found that patients with renal disease were excluded in 56% of the trials, and few trials assessed baseline renal function of trial enrollees or the effect of the intervention in patients with renal disease.
Sulmasy discusses the physician's role in ascertaining and responding to terminally ill patients' spiritual beliefs, including the possibility of a miraculous cure.
“Is it ever appropriate to sacrifice one student's comfort or privacy for the benefit of the group? When should a teacher impose her own ideology—her own solution to a problem—rather than allowing students to stick with their own conclusion?” From “Mistakes.”
One year after Hurricane Katrina pummeled New Orleans and the surrounding Gulf Coast, efforts are under way to rebuild a health system that has lost much of its original work force and infrastructure.
Accomplishments and failures in the US federal health policy response to Katrina.
Concerns about terminal withdrawal of life-sustaining supplemental oxygen.
The role of apology in clinical practice.
For your patients: Information about palliative care.
This Week in JAMA . JAMA. 2006;296(11):1323. doi:10.1001/jama.296.11.1323