This Week in JAMA FREE

To estimate the genetic component of otitis media in children, Casselbrant and colleagues studied 135 sets of same-sex twins and 5 sets of same-sex triplets recruited within the first 2 months of life and followed up prospectively for up to 24 months. The correlation of the proportion of time with middle ear effusion between siblings was consistently higher in monozygotic twin or triplet sets than in dizygotic sets. The estimate of the heritability component of proportion of time with middle ear effusion by age 2 years was 0.73. Estimates of discordance for recurrent (3 or more) episodes of middle ear effusion and for at least 1 episode of acute otitis media at 2 years were significantly lower for monozygotic twin or triplet sets compared with dizygotic sets. In an editorial, Ehrlich and Post consider the evidence supporting a multifactorial basis for otitis media in children that includes genetic, environmental, and infectious components.

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Overweight and obesity may be associated with low-grade inflammation perhaps mediated by the release of the proinflammatory cytokine interleukin 6 by adipose tissue. Using data from 16,616 adults aged 17 years or older enrolled in the Third National Health and Nutrition Examination Survey (NHANES III), Visser and colleagues found that the level of serum C-reactive protein (CRP), a marker of systemic inflammation, was more likely to be elevated (CRP level ≥0.22 mg/dL) in obese men and women (body mass index ≥30 kg/m²) compared with normal-weight individuals, and more likely to be clinically raised (CRP level >1.00 mg/dL) among obese women. In an editorial, Danesh discusses the relationship between persistent low-grade inflammation, obesity, and risk of coronary heart disease.

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Based on data from 40,098 women aged 46 to 71 years enrolled in the 4-year prospective Nurses' Health Study, Fine and colleagues found that weight gain of 2.25 kg (5 lb) or more was associated with decreased physical function and vitality and increased bodily pain among women in all baseline body mass index (BMI) categories, including normal BMI. Weight loss of 2.25 kg (5 lb) or more in overweight women (BMI ≥30 kg/m²) was associated with improved physical function and vitality and decreased bodily pain. Weight change was more strongly associated with changes in physical than mental health.

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Gender appears to be a determinant of many disease outcomes, but evidence has been inconsistent. In a prospective study of 892 surgical patients with 1470 episodes of nosocomial infection, Crabtree and colleagues found no significant difference in overall mortality prior to hospital discharge between men and women. For lung and soft tissue infections, however, mortality was significantly higher among women than among men.

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Mortality from ischemic heart disease has increased sharply between 1981 and 1994 among both men and women in Korea. Jee and colleagues report that in a cohort of more than 100,000 Korean men aged 35 to 59 years followed up for 6 years, the risk of hospitalization and death from ischemic heart disease and cerebrovascular disease was significantly higher among current smokers compared with nonsmokers. Low serum cholesterol was not protective against cardiovascular disease (CVD) morbidity and mortality. At all levels of serum cholesterol, including the lowest quartile (<4.42 mmol/L [171 mg/dL]), current smoking significantly increased the risk of ischemic heart disease and cerebrovascular disease events and mortality, and there was no evidence of an interaction between current smoking and total cholesterol level.

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"In my 20 years as a practicing physician, I have been intimately involved in many tragedies, yet I have never cried in front of a patient or a patient's family." From "A Rainbow From Joanne."

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Update on the safety and efficacy of the anthrax vaccine.

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An increase in patients' use of mechanical ventilation at home is enabling children and adults worldwide to lead less stressful, more productive lives.

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Is screening mammography beneficial in older women? A decision and cost-effectiveness analysis compares 3 strategies for breast cancer screening in women aged 65 years or older.

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Factors to consider in the decision whether to use thrombolytic therapy for acute deep venous thrombosis.

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History of the debate in Japan on oral contraceptive (OC) use and how approval of low-dose OC use in June 1999 might affect women's health.

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For your patients: A primer on otitis media in children.

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