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This Week in JAMA
July 22/29, 1998

This Week in JAMA

JAMA. 1998;280(4):309. doi:10.1001/jama.280.4.309

Are All Infants Getting "Back to Sleep"?

Infants placed on their back to sleep are at decreased risk of sudden infant death syndrome (SIDS). In a nationally representative survey, Dr Willinger and colleaguesArticle found that the prevalence of prone infant sleep position declined from 70% in 1992 to 24% in 1996. However, Dr Lesko and colleaguesArticle report that prone infant sleep position increased from 18% to 29% between 1 month and 3 months of age. In a study of low-income, inner-city mothers, Dr Brenner and colleaguesArticle found that 40% of infants aged 3 to 7 months were placed for sleep in the prone position. As Dr MalloyArticle discusses in an accompanying editorial, public health messages generally have been successful, but should now focus on low-income mothers of black or Hispanic racial/ethnic background.

Radioiodine Treatment and Cancer Mortality

Although radioiodine (131I) is an effective treatment for hyperthyroidism, whether the radiation involved increases the risk of cancer remains undefined. In this long-term cohort study, Dr Ron and colleaguesArticle found a slight elevation in risk of thyroid cancer; the absolute risk was very low and underlying thyroid disease appeared to contribute to the risk. As Dr CooperArticle explains in a related editorial, 131I remains a safe first-line treatment for hyperthyroidism.

Socioeconomic Status and Cardiovascular Risk Factors

Black and Mexican American women have higher rates of obesity, diabetes, and hypertension than do white women. Dr Winkleby and colleagues evaluated the independent relationships of ethnicity and socioeconomic status, as measured by education and poverty income ratio, along with the traditional risk factors of blood pressure, cigarette smoking, body mass index, physical inactivity, non–insulin-dependent diabetes, and cholesterol level. The rates of cardiovascular risk factors differed by socioeconomic status, but these factors did not explain all the differences among racial and ethnic groups.

See Article

Assessing Cure in

Serologic testing for anti–Helicobacter pylori antibodies is less invasive for patients than endoscopy, although its usefulness in assessing cure is unknown. Dr Feldman and colleagues find that all 15 patients they studied who were cured of H pylori infection (as assessed by gastric mucosal biopsy) had undetectable antibody titers at 18 months, whereas the 8 patients who were not cured had persistent antibodies.

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A 75-Year-Old Woman With an Abdominal Aortic Aneurysm

Determining when the risk of abdominal aortic aneurysm rupture exceeds the risk from the patient's other medical conditions is a vexing clinical issue. In this Clinical Crossroads, Dr Goldman discusses the approach to assessing Mrs H's risk of aneurysmal rupture, her potential risk from elective surgery, and her risk of death and major morbidity from her severe emphysema.

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The Cover

Vincent van Gogh, Vineyards at Auvers, 1890, Dutch.

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Medical News & Perspectives

Older people with chronic pain are best treated with a combination of pharmacologic therapy and nonpharmacologic strategies such as education, cognitive-behavioral therapy, and exercise, according to new clinical practice guidelines from the American Geriatrics Society.

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A Piece of My Mind

"If there is no greater joy than watching the birth of your first child, then there is no greater sadness than watching your child delivered, knowing she is already dead." From "A Visit From My Daughter."

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Contempo 1998

Early diagnosis and prompt treatment of giant cell arteritis may prevent the onset or alter the progression of visual loss. Immunologic research is clarifying the pathogenesis, but more clinical data on the effectiveness of treatment are needed.

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JAMA Patient Page

For your patients: Information about sudden infant death syndrome (SIDS).

See Article