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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2002;287(6):685. doi:10.1001/jama.287.6.685.
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Reports of adverse cardiac events associated with sildenafil use have raised concerns about the safety of this drug in men with coronary artery disease. To assess the hemodynamic effects of sildenafil during exercise, Arruda-Olson and colleaguesArticle conducted a crossover trial in which men with erectile dysfunction and known or probable coronary artery disease underwent exercise electrocardiography and echocardiography 1 hour after a single dose of sildenafil or placebo. Reduction in systolic blood pressure was significantly greater after sildenafil than after placebo, but there were no differences in symptoms, exercise duration, or presence or severity of exercise-induced myocardial ischemia. In an editorial, MarwickArticle observes that the adverse cardiac events reported with sildenafil are more likely related to sexual activity than to the use of the drug, and discusses evaluation of functional capacity to assess the risks of physical and sexual activity in patients with coronary artery disease.


Estimates of the prevalence and distribution of gonococcal and chlamydial infection in the general population have been inexact. In this cross-sectional survey of a sample of adults aged 18 to 35 years in Baltimore, Turner and colleaguesArticle used nucleic acid amplification tests of urine specimens to detect the presence of untreated gonococcal and chlamydial infections. Based on the results of this survey, an estimated 5.3% of the young adult population has an untreated gonococcal infection and 3.0%, an untreated chlamydial infection. The combined number of untreated gonococcal and chlamydial infections exceeded the number of infections diagnosed and treated in a given year. In an editorial, FortenberryArticle emphasizes the importance of improving sexual health risk assessment and STD screening, treatment, and surveillance.


Long-term use of hormone replacement therapy (HRT) has been associated with an increased risk of breast cancer. To determine whether this association differs according to histologic type of cancer, Chen and colleagues conducted a case-control study assessing the incidence and type of breast cancer by duration of HRT in postmenopausal women with primary invasive breast cancer and aged-matched controls. Consistent with previous studies, the incidence of breast cancer of all histologic types was increased in recent long-term users of HRT. This association was stronger for lobular breast cancer than for nonlobular breast cancer. Longer duration of HRT use was associated with an approximate 3-fold increased risk of lobular breast cancer, and current use of combination estrogen plus progestin therapy was associated with a 4-fold increased risk.

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Frequent participation in cognitively stimulating activities has been hypothesized to reduce the risk of Alzheimer disease. To test this hypothesis, Wilson and colleagues rated the frequency of participation in common cognitive activities in a cohort of Catholic nuns, priests, and brothers aged 65 years or older. During a mean follow-up of 4.5 years, increased participation in common cognitive activities at baseline was associated with a decreased risk of incident Alzheimer disease.

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Patients often raise spiritual and religious concerns as they near the end of life, concerns that may be distressing and that also may influence their decisions regarding medical interventions. Lo and colleagues analyze 3 cases to illustrate how physicians might respond when patients or families raise religious and spiritual concerns near the end of life.

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A laboratory-made peptide that has blocked the development of diabetes in animals and, in preliminary studies, in patients may undergo larger human trials soon.

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Mechanisms and management of virus-induced asthma attacks: case presentation and discussion.

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A review of postpartum mood disturbances and treatment and prevention of postpartum depression.

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The influence of mass media on the understanding of scientific and medical information by the general public.

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For your patients: Information about postpartum depression.

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