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This Week in JAMA |

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JAMA. 2002;287(2):155. doi:10.1001/jama.287.2.155.
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MATERNAL SMOKING, METABOLIC GENES, AND BIRTH WEIGHT

Maternal cigarette smoking during pregnancy is an important risk factor for low infant birth weight, but not all women who smoke during pregnancy give birth to low-birth-weight infants. In this case-control study, Wang and colleaguesArticle found that polymorphisms of 2 maternal genes involved in the metabolism of toxic metabolites in tobacco smoke, CYP1A1 and GSTT1, modified the association between maternal cigarette smoking and infant birth weight. Among women who smoked during pregnancy, the greatest reduction in birth weight was found in the group with the CYP1A1 Aa/aa and GSTT1 absent genotypes. In an editorial, Vogler and KozlowskiArticle discuss research methods necessary for reliable identification of gene-environment interactions and the potential to target interventions based on genetic risk assessment.

CHANGES IN THE OUTPATIENT TREATMENT OF DEPRESSION

Olfson and colleagues compared the outpatient treatment of depression in 1997 with that in 1987 using data from a nationally representative survey conducted in each study year. The rate of outpatient treatment for depression, treatment by physicians, the use of psychotropic medication, and coverage by third-party payers increased significantly in 1997 compared with 1987, whereas the proportion of patients who received psychotherapy and the number of depression treatment visits per user decreased.

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MORTALITY AFTER ACUTE MI FOR WOMEN VS MEN

Evidence suggests that mortality risk after acute myocardial infarction (MI) is higher among women than among men. Mehilli and colleagues found, however, that in a cohort of patients with acute MI in which most patients, both women and men, received reperfusion therapy primarily via percutaneous coronary interventions, 1-year mortality was not significantly different among women compared with men.

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BREAST CANCER RISK DURING RALOXIFENE THERAPY

Raloxifene, a selective estrogen receptor modulator, blocks the effects of endogenous estrogen in the breast and reduces the risk of breast cancer. In this analysis of data from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial, a placebo-controlled trial that assessed the effect of raloxifene on vertebral fracture risk in postmenopausal women with osteoporosis, Cummings and colleagues found that among women with relatively high estradiol levels, the rate of breast cancer was significantly lower in the raloxifene group than in the placebo group. Women with undetectable estradiol levels, however, had similar breast cancer risk regardless of treatment.

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KSHV INFECTION AND SEXUAL BEHAVIOR IN THE HIV EPIDEMIC

To assess associations between Kaposi sarcoma–associated herpesvirus (KSHV) infection, HIV infection, and sexual behavior, Osmond and colleagues studied homosexual male cohorts in San Francisco at points during 1978 through 1996. Prevalence of KSHV infection was high at the start of the study. Reduction in unprotected anal intercourse coincided with decline in HIV, but not in KSHV, prevalence. Although observed at an ecological level, behaviors remaining highly prevalent, such as unprotected oral intercourse, may be more likely to account for KSHV transmission.

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A PIECE OF MY MIND

"The truly competent physician is the one who sits down, senses the ‘mystery' of another human being, and offers with an open hand the simple gifts of personal interest and understanding." From "The Morning After."

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MEDICAL NEWS & PERSPECTIVES

Follow-up of patients who received fetal dopamine cell transplantation to treat Parkinson disease is suggesting ways to improve treatment for the 1.5 million people in the United States with this disorder.

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PROFESSIONAL COMPETENCE

A new, comprehensive definition of professional competenceArticle and current and future methods for assessmentArticle.

CLINICIAN'S CORNER

Guidelines for glucocorticoid therapy for patients with adrenal insufficiency and for those who are critically ill.

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JAMA PATIENT PAGE

For your patients: Information about low birth weight.

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