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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2003;289(18):2325. doi:10.1001/jama.289.18.2325.
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BP LEVELS, HYPERTENSION IN EUROPE AND NORTH AMERICA

Wolf-Maier and colleaguesArticle analyzed data from 8 national surveys in Europe and North America to assess geographic variation in blood pressure (BP) levels and in the prevalence of hypertension. Mean BP measurements and hypertension prevalence were higher in 6 European countries than in the United States and Canada. Hypertension prevalence was strongly correlated with stroke mortality. In an editorial, Staessen and coauthorsArticle note that BP is the most consistent and powerful predictor of stroke risk and suggest that a downward shift in the distribution of BP in large populations would likely lead to a marked reduction in the global burden of stroke.

CHRONIC PAIN IN PATIENTS WITH CHEMICAL DEPENDENCY

Limited data suggest that pain may be more prevalent in populations with chemical dependency than in the general population. In this study of 2 chemically dependent populations, Rosenblum and coauthors found that the prevalence of chronic severe pain was 37% among patients receiving methadone maintenance for opioid addiction and 24% among patients recently enrolled in a residential substance abuse treatment program primarily for treatment of alcohol or cocaine dependence.

PHYSICAL ACTIVITY AND MORTALITY RISK IN OLDER WOMEN

Physical activity has been consistently associated with reduced mortality in a variety of populations. Gregg and colleagues analyzed data from community-dwelling women aged 65 years and older participating in the Study of Osteoporotic Fractures, a prospective cohort study designed to assess the incidence of and risk factors for fractures among older women. Sedentary women who increased physical activity between baseline and a follow-up visit 6 years later and women who remained physically active had significantly lower all-cause mortality and cardiovascular mortality than continually sedentary women.

FUNCTIONAL DECLINE AT THE END OF LIFE

Lunney and coauthors analyzed physical function data from the last year of life of participants enrolled in the Established Populations for Epidemiologic Studies of the Elderly study, a community-based prospective study of persons aged 65 years and older. Consistent with a previously published theoretical model, patterns of observed decline in performance of activities of daily living at the end of life differed among 4 types of illnesses—sudden death, cancer death, death from organ failure, and frailty.

RISK FACTORS FOR CANCER IN CHILDREN INFECTED WITH HIV

Children infected with HIV have a marked increase in risk of malignancy. In this case-control study among children infected with HIV, Pollock and colleagues found that high Epstein-Barr virus viral load was strongly associated with cancer risk only among children with CD4 cell counts of at least 200/µL. Route of infection, demographic characteristics, and prior zidovudine use were not associated with development of malignancy.

USE OF THE INTERNET AND E-MAIL FOR HEALTH CARE

Estimates of the extent of Internet use for health care in the United States vary widely. Baker and colleagues conducted a survey of a nationally representative sample of individuals aged 21 years and older who were self-reported Internet users to determine the extent of Internet and e-mail use for health care. Approximately 40% of respondents reported using the Internet to look for advice or information about health or health care in 2001, and approximately 6% reported using e-mail to communicate with a physician or other health care professional.

A PIECE OF MY MIND

"Did Alice have an inkling of what she looked like? . . . How did her husband manage to care for her?" From "Alice's Husband."

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MEDICAL NEWS & PERSPECTIVES

Blood safety testing for West Nile virus is expected to be in place this summer, but not before the occurrence of early, localized outbreaks of the infection.

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IMPROVING TEST ORDERING: TOWARD OPTIMAL LABORATORY USE

A multifaceted strategy focusing on using evidence-based guidelines, feedback, and social interaction reduced the total number of tests and the number of inappropriate tests ordered by primary care physicians.

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CLINICIAN'S CORNER

Advances in the management of patients with chronic hepatitis C infection.

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INDUSTRY SUPPORT OF CME

Relman rebuts the Washington Legal Foundation critique of standards limiting commercial support of continuing medical education (CME) that were proposed by the Accreditation Council for Continuing Medical Education.

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ALCOHOL MAGAZINE ADS AND TEENAGED READERS

Medicine and the Media From 1997 through 2001, beer and liquor advertisements appeared more frequently in magazines with higher adolescent readership.

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JAMA PATIENT PAGE

For your patients: Information about hepatitis C.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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