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The relationship between environmental exposures early in life and subsequent
development of allergic disease is not well understood. In this prospective
birth cohort study, Ownby and colleaguesArticle found that risk of allergic sensitization
to common aeroallergens at age 6 to 7 years was lower among children exposed
to 2 or more dogs or cats in the first year of life than among children exposed
to 1 dog or cat or those without any early dog or cat exposure. In an editorial,
Platts-MillsArticle discusses immunologic mechanisms that may explain the different
associations that have been observed between allergen exposure and risk of
allergic sensitization and disease.
Previously published results of the Swiss Heart Study, a randomized,
placebo-controlled trial, showed that the rate of restenosis after coronary
angioplasty was reduced among patients who received homocysteine-lowering
therapy (folic acid, vitamin B12, and vitamin B6) during
the 6 months of follow-up. In this report of clinical outcomes after additional
follow-up through 1 year, Schnyder and colleagues found that the risk of major
adverse clinical outcomes (death, nonfatal myocardial infarction, and need
for repeat revascularization) was significantly lower among patients who had
received 6 months of homocysteine-lowering therapy after coronary angioplasty
than among patients who had received placebo.
Postmenopausal hormone replacement therapy (HRT) has been shown to elevate
levels of C-reactive protein (CRP), one of several inflammatory biomarkers
associated with increased cardiovascular risk. In this case-control study,
Ridker and colleagues analyzed data from the Women's Health Initiative Observational
Study, a prospective study of healthy, postmenopausal women, to assess whether
the effect of HRT on CRP increases risk of incident coronary heart disease
(CHD). Increased baseline levels of CRP and interleukin 6 (IL-6) were independently
associated with increased risk of developing a first myocardial infarction
or death from CHD after a median of 2.9 years of follow-up. Long-term use
of HRT was associated with increased levels of CRP, but not of IL-6. In analyses
stratified by baseline CRP and IL-6 levels, risk of incident CHD was similar
among HRT users and nonusers.
Carbon monoxide (CO) poisoning contributes to more than 2000 poisoning
deaths annually in the United States. Mott and colleagues examined national
non–fire-related CO poisoning mortality data from 1968 through 1998
and CO vehicle emissions data from 1968 through 1996 to describe trends in
CO-related deaths and to evaluate the influence of national vehicle emissions
standards on CO-related mortality. The annual rate of CO poisoning declined
from 20.2 deaths to 8.8 deaths per 1 million persons, and CO emissions from
automobiles decreased by an estimated 72.8 g/mile from 1975, when the catalytic
converter was introduced in automobiles, through 1996. During 1975 through
1996, an annual decrease of 10 g/mile of estimated CO emissions from automobiles
was associated with a 21.3% decrease in the annual unintentional motor vehicle–related
CO death rate and a 5.9% decrease in the annual rate of motor vehicle–related
"All [of my stories] involve the idealistic thoughts of a clinician
just formally entering the medical profession." From "More Stories."
Noninvasive ventilation for acute respiratory failure: indications,
benefits, and risks.
Multidisciplinary treatment tactics help patients with chronic pain
return to normal functioningArticle, whereas palliative careArticle goes beyond pain relief
to embrace emotional, social, and spiritual needs of seriously ill patients.
Meta-analysisArticle of 9 studies indicates that antibiotic treatment of Escherichia coli O157:H7 enteritis is not associated with
an increased risk of hemolytic uremic syndrome (HUS). In an editorial, Mølbak
and coauthorsArticle discuss empirical antimicrobial treatment of diarrhea and clinical
management of patients known to be infected with E coli O157:H7.
Mr C has been treated with repeated courses of antibiotics over a period
of 5 years for recurrent musculoskeletal and neuropsychiatric symptoms diagnosed
as chronic Lyme disease. Steere discusses the epidemiology, diagnosis, and
treatment of Lyme disease and the evaluation and treatment of patients with
persistent symptoms after Lyme disease.
For your patients: Information about carbon monoxide poisoning.
This Week in JAMA. JAMA. 2002;288(8):923. doi:10.1001/jama.288.8.923