Guidelines for the treatment of children after a first urinary tract infection (UTI) include assessment for vesicoureteral reflux and antibiotic prophylaxis for children diagnosed with reflux. Conway and colleagues analyzed data from 27 primary care pediatric practices to identify risk factors for recurrent UTI and assessed the effectiveness of antimicrobial prophylaxis to prevent recurrences. The authors found that among 74 974 children who had at least 2 clinic visits between July 2001 and May 2006, 611 had a first UTI and 83 had a recurrent UTI. Risk factors for recurrent UTI included white race, age between 3 and 5 years, and grade 4 to 5 vesicoureteral reflux. Antimicrobial prophylaxis did not reduce the risk of UTI recurrence but was associated with an increased risk of antibiotic resistance among children with recurrent UTI.
The antimalarial hydroxychloroquine is a proven disease-modifying agent in patients with rheumatoid arthritis (RA). Results of several investigations indicate hydroxychloroquine improves insulin secretion and insulin sensitivity. Wasko and colleagues hypothesized that hydroxychloroquine use would be associated with a lower likelihood of incident diabetes among patients with RA, and they tested their hypothesis in a longitudinal observational cohort study. The authors found that compared with never use, hydroxychloroquine use was associated with a lower risk of self-reported diabetes among patients with RA. They also found that the diabetes risk reduction increased with longer duration of hydroxychloroquine use.
Incretins are gastrointestinal hormones secreted in response to glucose or nutrients in the gut after a meal, and the incretin pathway is a target for new hypoglycemic therapies in type 2 diabetes. In a systematic literature review and meta-analysis of data from 29 clinical trials of incretin-based therapy, Amori and colleagues found that incretin therapy lowered hemoglobin A1cmore than placebo and was noninferior to other hypoglycemic agents. In trials of the incretin mimetic glucagonlike peptide 1 (GLP-1) analogues, patients randomly assigned to a GLP-1 analogue lost weight, whereas patients taking placebo or insulin gained weight. Nausea and vomiting were risks associated with GLP-1 analogue therapy, and an increased risk of infection was identified among patients taking the incretin enhancer dipeptidyl peptidase 4 inhibitor.
Perspectives on Care at the Close of Life
Dr SP is a 56-year-old neurologist who was diagnosed with amyotrophic lateral sclerosis (ALS) in 2004. Mitsumoto and Rabkin discuss the treatment of patients with ALS, concerns of informal caregivers and professional staff who care for ALS patients, and palliative care decisions applicable to ALS and other progressive and ultimately fatal neurologic diseases.
“Any age, certainly 68, is too young to stop learning.” From “On Retirement.”
New research about genes and other factors that contribute to various forms of dementia is providing insights that scientists hope will lead to new therapies or preventive measures.
Limitations of recent advances in genomics and directions for future investigation.
Appropriate application of cost-effectiveness information.
Improving survival of the world's poor through a proposed model for global health governance.
Call for Papers
Authors are encouraged to submit manuscripts for a JAMA theme issue on genetics and genomics.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about amyotrophic lateral sclerosis.
This Week in JAMA . JAMA. 2007;298(2):139. doi:10.1001/jama.298.2.139