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This Week in JAMA
February 18, 2004

This Week in JAMA

JAMA. 2004;291(7):787. doi:10.1001/jama.291.7.787
Antibiotics and Breast Cancer Risk

Antibiotic-mediated alterations in immune function and estrogen metabolism have been hypothesized to contribute to breast cancer risk. Velicer and colleaguesArticleexamined the association between antibiotic use and risk of breast cancer in a case-control study of women enrolled in large health plan. More days of antibiotic use and a greater cumulative number of antibiotic prescriptions were associated with an increased risk of incident and fatal breast cancer for all antibiotic classes after controlling for age and length of health plan enrollment. These relationships persisted in analyses adjusting for known and suspected breast cancer risk factors and in analyses excluding antibiotic use 2 and 4 years prior to breast cancer diagnosis. In an editorial,ArticleNess and Cauley discuss potential mechanisms whereby antibiotics might influence breast cancer risk and suggest questions to pursue in further investigations in light of this newly discovered association.

Clinical Research Funding by the NIH

An important goal of the National Institutes of Health (NIH) is to translate basic science discoveries into clinical applications; however, some observers have suggested an element of bias in the peer review process against clinically trained researchers and research involving human subjects. Kotchen and colleaguesArticlefrom the NIH Center for Scientific Review assessed grant applications submitted during 2 funding cycles in 2002 and compared the median priority scores and funding rates for physician vs nonphysician investigators and for clinical vs nonclinical research proposals. They found that priority scores and funding rates were more favorable for MD than for non-MD investigators but that priority scores and funding rates were less favorable for clinical than for nonclinical research applications, particularly for clinical research categorized as "mechanisms of disease" or "clinical trials and interventions" and for applications with human subject concerns. In an editorial,ArticleSnyderman discusses the challenges of attracting and supporting the clinical researchers necessary for a strong clinical research enterprise.

Risks of New-Onset Kidney Disease

Early identification of patients at risk of kidney disease could slow or prevent disease sequelae. Fox and colleagues examined the predictors of incident kidney disease in participants enrolled in the Framingham Offspring Study, a community-based, longitudinal cohort study. They found that established cardiovascular risk factors including older age, diabetes, hypertension, obesity, cigarette use, low levels of high-density lipoprotein cholesterol, and mild reductions in glomerular filtration at baseline were associated with new-onset kidney disease during a mean follow-up of 18.5 years.

Effectiveness of Varicella Vaccine

Varicella vaccine is recommended for healthy children aged 12 to 18 months and for older children who have not had chickenpox. However, outbreaks of chickenpox in groups with high rates of immunization and breakthrough infections have raised questions about administration guidelines and the efficacy of the vaccine. Vazquez and colleagues assessed the relationship of age at immunization and time since vaccination in a case-control study of varicella in previously immunized children and found that the effectiveness of the vaccine diminished significantly after 1 year and offered less protection in the first year after vaccination if the child was younger than 15 months at the time the vaccine was administered. Breakthrough cases of chickenpox in vaccinated children were more likely to be mild compared with cases in unvaccinated children.

Medical News & Perspectives

Experts warn that lifestyle and dietary factors during childhood, including a lack of exercise and inadequate intake of calcium and vitamin D, may set the stage for osteoporosis. (Photo credit: American Society for Bone and Mineral Research)

Teen Video Games

Content analysis of teen-rated video games reveals more blood, sex, profanity, and illicit substance use than would be expected from the content descriptors assigned by the Entertainment Software Rating Board.

Misdiagnosis of SA Hemorrhage

Interview and medical record data reveal factors predicting failure to diagnose subarachnoid (SA) hemorrhage and the ensuing consequences.

Clinician's corner

The Rational Clinical Examination
Neurologic impairment is common in survivors of cardiac arrest. Several simple physical assessments performed 24 hours after the arrest predict death or poor prognosis in comatose survivors.

JAMA Patient Page

For your patients: Information about chickenpox.