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Dietary factors have been linked to development of the insulin resistance
syndrome, a syndrome that includes obesity, glucose intolerance, hypertension,
and dyslipidemia. Using data from the Coronary Artery Risk Development in
Young Adults study, a prospective study of cardiovascular disease risk factors
in a cohort of adults aged 18 to 30 years, Pereira and colleagues found that
the 10-year incidence of the insulin resistance syndrome was inversely associated
with dairy consumption among individuals who were overweight at baseline but
not among those who were normal weight.
The Medicare Alzheimer's Disease Demonstration and Evaluation study,
a randomized trial that enrolled community-living patients with advanced dementia
and their caregivers, compared expanded in-home and community-based services
and case management with usual care. For this analysis, Yaffe and colleagues
combined all patients from the intervention and control groups and randomly
divided them into development and validation cohorts to develop and assess
a prognostic model to determine comprehensive predictors of nursing home placement
for patients with dementia. Patient and caregiver characteristics were independently
predictive of nursing home placement during a 3-year period, and patient and
caregiver characteristics together predicted placement better than either
patient or caregiver characteristics alone.
Restorative models of home care integrate principles from geriatric
medicine, rehabilitation, nursing, and goal attainment. Tinetti and colleagues
compared the outcomes of restorative care vs usual home care among older adults
after acute illness or hospitalization. Patients who received restorative
care were more likely than those who received usual care to remain at home
following completion of the home care episode. Functional outcomes were better
in the restorative care group, and the duration of the home care episode was
significantly shorter than in the usual care group.
Survival after a cancer diagnosis is worse among blacks than among whites,
which may be explained by disparities in treatment or rates of death due to
other causes or by differences in cancer biology. Bach and colleaguesArticle conducted
a systematic review of studies in which survival was reported for blacks and
whites who had received comparable cancer treatment for similar stages of
disease. After correction for deaths due to other causes, the estimated cancer-specific
mortality was only modestly increased among blacks compared with whites. Of
14 different cancers, blacks were at a significantly higher risk of cancer-specific
death only for cancer of the breast, uterus, and bladder. In an editorial,
KiefeArticle discusses possible explanations for the observed differences in cancer-specific
mortality and advocates addressing these differences by focusing on disparities
at the level of delivery of care.
Mrs W has been taking hormone replacement therapy (HRT) since undergoing
hysterectomy and bilateral salpingo-oophorectomy 20 years ago. She has a family
history of breast cancer and has attempted to discontinue estrogen therapy
several times, but experiences severe hot flushes and discomfort. Grady discusses
indications for postmenopausal hormone therapy, associated risks, and ways
to discontinue therapy.
Preoperative evaluation and management of patients with hypertension.
HIV/AIDS in Russia, a new approach to Chagas disease, and a welcome
payoff from banning antibiotics in animal feed are some current issues that
were addressed at the recent conference on emerging infections at the Centers
for Disease Control and Prevention.
Statements from recent consensus processes present new Bethesda System
terminology for reporting the results of cervical cytologyArticleArticle and evidence-based
guidelinesArticle for the management of women with cervical cytological abnormalities.
Kushner discusses a randomized trial recently reported in the Archives of Ophthalmology that compared the effectiveness
of atropine and patching for the treatment of mild to moderate amblyopia in
For your patients: Information about home health care.
This Week in JAMA . JAMA. 2002;287(16):2031. doi:10.1001/jama.287.16.2031