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This Week in JAMA
January 26, 2000

This Week in JAMA

JAMA. 2000;283(4):433. doi:10.1001/jama.283.4.433

Hormone Replacement Therapy and Breast Cancer Risk

In this analysis of data from 46,355 postmenopausal women who participated in the Breast Cancer Detection Demonstration Project, Schairer and colleaguesArticle report that increased risk of breast cancer was associated only with current or recent use (within the past 4 years) of estrogen-alone or combined estrogen-progestin hormone replacement therapy (HRT). Among women with recent use of HRT, the increase in the relative risk of breast cancer associated with each year of combined estrogen-progestin use was significantly greater than that associated with use of estrogen alone. In an editorial, Willett and coauthorsArticle emphasize the value of good diet and lifestyle for maintaining health after menopause.

Anti-HIV Therapy With a Protease Inhibitor in Children

To determine the efficacy of protease inhibitors for the treatment of children infected with HIV, Nachman and colleagues in the open-label Pediatric AIDS Clinical Trials Group Protocol 338 trial changed the antiretroviral therapy of 297 children who were clinically stable and who had not had prior treatment with protease inhibitors to a 2- or 3-drug protease inhibitor–containing regimen (ritonavir plus 1 or 2 nucleoside analogs) or to a dual nucleoside analog regimen. The proportion of children with undetectable plasma HIV RNA levels at study week 12 was greater among those receiving ritonavir-containing regimens than among those in the dual nucleoside group. At week 48, more children receiving the 3-drug ritonavir-containing regimen had undetectable plasma HIV RNA levels than children receiving the 2-drug ritonavir-containing regimen.

See Article

Hospitalization for Lower Respiratory Tract Infections

Hospitalization rates for acute lower respiratory tract infections have increased since 1980 despite a trend for decreasing hospitalization rates overall. In this study of patients from 4 large clinics in Texas, Glezen and colleagues found that during a 4-year period, 93% of all patients older than 5 years hospitalized with acute respiratory tract conditions had a chronic underlying (high-risk) condition, most commonly a chronic pulmonary condition. The hospitalization rate for low-income high-risk patients was almost an order of magnitude greater than that for middle-income high-risk patients. Respiratory tract viral infections were detected by culture, antigen detection, or a significant serum antibody rise in 366 (35.6%) of 1029 patients and in 181 (44.9%) of 403 patients who submitted paired serum samples for antibody testing.

See Article

Post-MI Procedures in Patients With Mental Disorders

The presence of comorbid mental disorders with cardiovascular disease may influence the likelihood of undergoing cardiovascular procedures. In this analysis of data from 113,653 adults aged 65 years or older with a confirmed acute myocardial infarction (MI) at hospital discharge, Druss and colleagues found that patients with a comorbid mental disorder were significantly less likely to undergo cardiac catheterization, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery during the index hospitalization. Among those patients who underwent cardiac catheterization, rates of coronary revascularization procedures were similar for patients with and without mental disorders.

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Quality of the Last Year of Life

Using data from the National Mortality Followback Surveys of 1986 and 1993, Liao and colleagues compared quality of life during the year before death from nationally representative samples of decedents aged 65 years or older as reported by next of kin. Quality of life measures included use of hospitalization and nursing home services, self-care activities, cognitive function, and a summary sickness score. Compared with 1986, most quality of life indices during the year before death in 1993 improved for individuals aged 85 years or older and improved or did not change for those aged 65 through 84 years.

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A Piece of My Mind

"How do hands that hurt change to hands that help?" From "Casting Stones."

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Contempo Updates

Treatment of ductal carcinoma in situ of the breast.

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Medical News & Perspectives

Efforts are being made to increase incentives and develop infrastructure for collaboration and interaction between those who practice clinical medicine and public health professionals.

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Rating Impairment

Although the forthcoming fifth edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment offers improvements over the previous edition, further revision may be warranted to achieve a rating system for permanent impairment that is valid, reliable, and evidence-based.

See pages Article and Article

Clinical Crossroads

Mrs J is a 55-year-old woman who has moderately severe rheumatoid arthritis. She has been unable to tolerate most disease-modifying antirheumatic medications. Goldring discusses the epidemiology and pathophysiology of rheumatoid arthritis and optimal treatment of patients with this disease.

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JAMA Patient Page

For your patients: Maintaining health for older adults.

See Article