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This Week in JAMA
April 26, 2000

This Week in JAMA

JAMA. 2000;283(16):2069. doi:10.1001/jama.283.16.2069

Diet Quality and Mortality in Women

The role of foods in the etiology of disease may relate more to patterns of dietary intake than to the intake of any single nutrient, food, or food group. Using data from food questionnaires completed by 42,254 women enrolled in the Breast Cancer Detection and Demonstration Project, Kant and colleagues calculated overall diet quality (Recommended Foods Scores [RFSs]) based on current dietary recommendations for 23 foods. After a median follow-up of 5.6 years, all-cause mortality was inversely associated with the RFS.

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High Rate of Flaws in Pharmacoeconomic Studies

In Australia, the decision to list new drugs or alter indications for existing drugs in the federal Schedule of Pharmaceutical Benefits is based on expert evaluation of cost-effectiveness analyses submitted by pharmaceutical companies to the Department of Health and Aged Care. Hill and colleaguesArticle report that 218 (67%) of 326 analyses submitted between 1994 and 1997 had serious deficiencies, including uncertainty in the estimates of comparative clinical efficacy, modeling issues, problems with the choice of comparator, and calculation errors. In an editorial, Rennie and LuftArticle describe key requirements for reporting a pharmacoeconomic analysis and propose that all trial data used in the analysis be submitted electronically for prepublication peer review and then posted on a journal's Web site if the study is published.

Carotid Artery Stenosis, Vascular Reactivity, and Stroke

Assessment of cerebral hemodynamic function may identify patients with asymptomatic carotid artery stenosis who are at increased risk of cerebral ischemic events. In this prospective longitudinal study of 94 patients with severe unilateral asymptomatic carotid artery stenosis, Silvestrini and colleagues found that reduced cerebrovascular reactivity to hypercapnia in the middle cerebral artery ipsilateral to the stenosis was associated with a significantly increased risk of transient ischemic attack or stroke.

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Acute Neurologic Deficits Traced to Use of Old Dialyzers

To investigate an outbreak in which 7 patients at a single hospital developed decreased vision and hearing, headache, conjunctivitis, and other severe neurologic symptoms within 7 to 24 hours after hemodialysis, Hutter and colleagues conducted a retrospective cohort study of all 9 patients who received hemodialysis at that hospital on the same day and a laboratory investigation of dialyzer membranes. All case-patients, but neither of the 2 non–case-patients, were exposed to 11.5-year-old dialyzers with cellulose acetate membranes. Testing of cellulose acetate dialysis membranes of various ages retrieved from other sources indicated physical and chemical membrane degradation with age. Rabbits injected intravenously with water-soluble material recovered from extraction of a 13.6-year-old dialyzer developed iritis, ciliary flush, and ocular hemorrhages.

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Factors Influencing "Back to Sleep" Campaign Success

In 1994, the American Academy of Pediatrics and other sponsoring organizations initiated the national public education "Back to Sleep" campaign to promote nonprone sleep position for infants to reduce the risk of sudden infant death syndrome. Using data from National Infant Sleep Position Study annual telephone surveys, Willinger and colleagues found that prone placement declined from 43% in 1994 to 17% in 1998 and supine placement increased from 27% to 56%. Among factors that influenced a caregiver's choice of infant sleep position after the start of the campaign, sleep position recommendation of "supine not prone" by physicians was significantly associated with decreased prone and increased supine placement.

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A Piece of My Mind

"The doctor with bag in hand is a nostalgic icon of trustworthiness, commitment, and personal service." From "Holding the Bag."

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Contempo Updates

Physicians in Antarctica provide clinical care and conduct research on medical consequences of the Antarctic environment.

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Medical News & Perspectives

Recent research shows that mental health professionals should learn to recognize and treat the first episode of psychosis in people with schizophrenia because delay reduces the likelihood of a good therapeutic response.

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Clinical Crossroads

Pathogenesis and management of chronic sinusitis and discussion of treatment options for Mr S, a 48-year-old man with recurrent sinusitis.

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Mortality and Homelessness

A comparison of mortality rates among men using homeless shelters in Toronto with mortality rates for men in the city's general population and for homeless men in 3 US cities.

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When Drug Benefits End

Exhaustion of drug benefits by Medicare beneficiaries enrolled in managed care health plans is associated with plan disenrollment, threatening continuity of care and strengthening the argument for a Medicare drug benefit.

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JAMA Patient Page

For your patients: Healthy eating.

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