This Week in JAMA

Environmental as well as genetic factors are likely to influence the risk of Alzheimer disease. Hendrie and colleaguesArticle compared the incidence rates of dementia and Alzheimer disease among Yoruba residents of Ibadan, Nigeria, with rates among African American residents of Indianapolis, Ind, after 2 and 5 years of follow-up. The age-standardized annual incidence rates for both dementia and Alzheimer disease were significantly lower among Yoruba in Ibadan than among African Americans living in Indianapolis. In an editorial, FarrerArticle suggests that identification of distinct genetic and environmental risk factor profiles for Alzheimer disease might eventually lead to therapies tailored for specific risk groups.

In prior studies, oseltamivir, a selective oral inhibitor of influenza neuraminidase, has been shown to be efficacious for treatment of influenza and for prevention during an outbreak. To study the efficacy of oseltamivir in preventing the spread of influenza to household contacts of influenza-infected individuals, Welliver and colleagues randomly assigned household contacts by household cluster to receive oseltamivir or placebo once daily for 7 days within 48 hours of symptom onset in the infected household member. The overall protective efficacy of oseltamivir against clinical influenza was 89% for household contacts and 84% for households of influenza-infected individuals.

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Few data are available on the risk of birth defects among offspring of fathers with birth defects. Lie and colleagues followed up a cohort of males born between 1967 and 1982 for survival rates through 1992 and for reproductive outcomes through 1998. Compared with males without birth defects, males with birth defects had higher mortality through infancy and childhood and were 28% less likely to father a child. The total risk of birth defects was 5.1% among offspring of males with birth defects and 2.1% among offspring of males without birth defects.

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In acute care settings, evaluation of patients with suspected pulmonary embolism using pulmonary vascular imaging is often time-consuming and costly. Kline and colleagues studied whether the use of 2 minimally invasive bedside tests—whole-blood agglutination D-dimer assay and volumetric capnometry with PaCO₂ to measure alveolar dead-space fraction—could exclude the diagnosis of pulmonary embolism. Among 380 emergency department patients with suspected acute pulmonary embolism, pulmonary embolism was diagnosed in 64 patients based on standard criteria using radiographic examinations. Sixty-three of the 64 had either an abnormal D-dimer concentration or alveolar dead-space fraction or both (sensitivity, 98.4%), and 163 of the 316 patients without pulmonary embolism had normal results for both tests (specificity, 51.6%).

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Most of the studies supporting an association between fruit and vegetable consumption and a reduced risk of breast cancer have been case-control studies, which are subject to recall and selection bias. In this analysis, Smith-Warner and colleaguesArticle pooled data from 8 prospective cohort studies on breast cancer risk and dietary intake. Fruit, fruit juice, total fruit, total vegetable, and total fruit and vegetable intakes were not associated with reduced breast cancer risk when modeled as continuous variables, and breast cancer risk was only 3% to 9% lower in women in the highest decile of fruit or vegetable consumption compared with the lowest decile. In an editorial, SlatteryArticle discusses limitations of studies of diet and cancer risk and comments on current National Cancer Institute recommendations for fruit and vegetable consumption.

"Mrs DeFranco was a veteran of many grand rounds and knew what to expect." From "Tactile."

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Analysis of data from recent studies on mother-to-infant transmission of HIV suggests that about half of transmissions occur during the days just before delivery and another third occur during labor and delivery.

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The Ethical, Legal, and Social Implications program of the National Human Genome Research Institute marked its 10th birthday with a conference aimed at fitting the new knowledge of genetics into the reality of 21st-century life.

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In AIDS clinical trials, a regimen termination end point—the time to the first occurrence of any protocol-specified event that leads to cessation of the assigned treatment regimen—measures important effects of treatment not captured by plasma HIV RNA levels.

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Report from the National Institutes of Health Consensus Development Panel on the prevention, diagnosis, and treatment of osteoporosis.

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The impact of the Internet on patient advocacy and support, medical education, health law and ethics, and clinical practice.

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For your patients: Information about pulmonary embolism.

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