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This Week in JAMA |

This Week in JAMA FREE

JAMA. 1998;280(7):585. doi:10.1001/jama.280.7.585.
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HEART DISEASE UNAFFECTED BY HORMONE THERAPY

Findings of a multicenter, prospective, controlled trial of estrogen plus progestin in postmenopausal women with established coronary disease failed to support the use of hormone replacement therapy for the secondary prevention of heart disease, a practice that has been based on observational data. Dr Hulley and colleaguesArticle found no differences in occurrence of myocardial infarction or death from coronary heart disease between treatment and placebo groups over an average follow-up of 4 years. In an editorial, Dr Petitti Article discusses these new findings in relation to the observational data, along with clinical considerations for the initiation and continued use of hormone replacement therapy.

GENETIC RISK FOR ALZHEIMER DISEASE

Four genes are known to account for approximately 50% of the genetic risk for all forms of Alzheimer disease, and a recent linkage analysis suggested a new susceptibility gene on chromosome 12 for the common late-onset form of the disease. Dr Rogaeva and colleaguesArticle examined chromosome 12 markers in 53 families with multiple members affected with Alzheimer disease and confirmed the previously observed linkage. In contrast, Mr Wu and colleaguesArticle found no evidence of linkage in this same region of chromosome 12 in their study of 230 families. In an editorial, Mr DalyArticle offers insights to reconcile these apparently discrepant findings.

Β-BLOCKERS UNDERUSED IN ELDERLY PATIENTS AFTER MI

In a nationwide study, only 50% of eligible elderly patients were prescribed β-blockers at hospital discharge after acute myocardial infarction. Dr Krumholz and colleagues report that variation in prescription patterns was explained by regional differences and physician specialty rather than by patient characteristics. They also report that elderly patients who were prescribed β-blockers at discharge had a 14% lower risk of mortality 1 year later.

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DIETHYLSTILBESTROL-

Several million women used diethylstilbestrol to prevent spontaneous abortion and premature delivery before the association of the drug with vaginal and cervical clear cell adenocarcinoma in their daughters was recognized. Dr Hatch and colleagues studied whether women exposed in utero to high estrogen levels are also at increased risk of breast cancer and other cancers. They confirmed the uncommon yet increased occurrence of clear cell adenocarcinoma associated with in utero diethylstilbestrol exposure after an average of 15 years of follow-up. But they did not find an increased risk of all cancers combined or of other individual cancers, including breast cancer.

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RESPONDING TO REQUESTS FOR PHYSICIAN-ASSISTED SUICIDE

Many physicians are likely to receive requests from patients for physician-assisted suicide. Dr Emanuel presents an 8-step strategy for physicians to respond to these challenging requests. This approach involves identification and treatment of causes motivating the request and includes a plan for consistent application of practical and principled clinical skills.

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THE COVER

"The result was a near lyrical abstraction of forms, a new consideration of reality itself." Claude-Oscar Monet, Water Lilies, 1907, French.

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MEDICAL NEWS & PERSPECTIVES

The 12th World AIDS Conference—a "new realism" of advances and obstacles.

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CONTEMPO 1998

The serious problem of adolescent substance abuse.

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COMMENTARY

Dr Joycelyn Elders and Ms Albert issue a grim reminder of the need to rule out sexual abuse in pregnant teenagers.

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A PIECE OF MY MIND

"The contrast between the attitudes toward the dead that I have observed in my religious communal life and in my professional life is striking." From "The Holy Society."

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PROFILES IN PRIMARY CARE

An interview with Linda Headrick, MD, an academician in primary care, who "is a quiet but constant warrior against complacency in the work of physicians."

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JAMA PATIENT PAGE

For your patients: A primer on Alzheimer disease.

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