This Week in JAMA FREE

In the Iowa Women's Health Study of 37,105 women followed up for 11 years, Gapstur and coworkersArticle found that exposure to hormone replacement therapy (HRT) was associated with an increased risk of invasive breast cancer with a favorable prognosis but not of ductal carcinoma in situ or invasive ductal and/or lobular breast cancer . In an editorial, Bush and WhitemanArticle question the prognostic groupings and suggest that inconsistent evidence on the association of HRT and breast cancer despite years of research may be reassuring.

To assess the reliability of physician profiling, Hofer and colleaguesArticle analyzed several measures of physician performance with and without detailed case-mix adjustment for the care of patients with type 2 diabetes mellitus by physicians at 3 diverse practice sites. After full case-mix and reliability adjustment, differences in physician practice accounted for 4% or less of the observed variance in rates of hospitalization, office visits, and laboratory utilization and in levels of glycemic control. Gaming the system by excluding patients with poor glycemic control would markedly improve a physician's profile. In an editorial, BindmanArticle explains why physician profiling may not improve quality of care.

Specific metabolic actions of coffee could prevent the formation of gallstones, but results of epidemiologic studies on the association of coffee consumption and gallstone disease have been conflicting. In this study of 46,008 men aged 40 to 75 years followed up from 1986 through 1996 in the Health Professionals Follow-up Study, Leitzmann and colleagues found that coffee consumption, as measured by repeated food frequency questionnaires, was associated with a significant decrease in the risk of symptomatic gallstone disease.

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Homocysteine, an intermediate product of methionine metabolism, may increase the risk of atherosclerotic cardiovascular disease by impairing endothelial cell function through an oxidative mechanism. In this crossover study of 20 healthy volunteers by Nappo and colleagues, plasma homocysteine levels increased significantly after an oral methionine load administered with and without pretreatment with antioxidant vitamins (vitamin E and ascorbic acid). Levels of coagulation factors and circulating cellular adhesion molecules increased significantly and hemodynamic and rheologic responses to infusion of the nitric oxide precursor L-arginine were impaired after methionine ingestion alone, but not after ingestion of methionine with vitamin pretreatment or after placebo.

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Oral corticosteroid therapy has been shown to reduce the relapse rate after treatment of acute exacerbations of asthma. Rowe and colleagues report that compared with patients who received a 7-day nontapering course of oral prednisone after an acute episode of asthma treated in an emergency department, patients who also received 21 days of high-dose inhaled budesonide had a significantly lower relapse rate for the 3 weeks after the initial episode. Pulmonary function was similar in the 2 groups at 21 days, but β₂-agonist use was less and quality-of-life and symptom scores were better in the budesonide group.

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Protecting children in automobiles: engineering, legislative, and educational solutions to improve the use of restraint systems.

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Improved diagnostic imaging techniques and new pharmaceutical options may offer a more positive outlook for victims of stroke.

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Second in a series of consensus statements from the Working Group on Civilian Biodefense on medical and public health management after the use of biological agents as weapons.

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Treatment of multidrug-resistant tuberculosis is costly, but Heymann and coauthors argue that the international community must provide the necessary resources now to check the rising worldwide prevalence of this disease.

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For your patients: Asthma.

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