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This Week in JAMA |

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JAMA. 2004;291(10):1167. doi:10.1001/jama.291.10.1167.
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CARE OF FEBRILE INFANTS

Distinguishing a serious illness from a minor illness can be difficult among febrile infants. Pantell and colleaguesArticle report data on the management strategies and clinical outcomes for more than 3000 febrile infants 3 months or younger who were seen by physicians participating in a practice-based research network. The authors compared the clinicians' diagnostic and treatment decisions with existing guidelines. They found that the majority of infants were treated as outpatients and specific diagnostic and treatment strategies depended on the infant's age and the physician's subjective assessment of illness severity. Clinicians did not strictly follow existing guidelines, but relying on current guidelines would have resulted in more hospitalizations and laboratory testing without improving care. In an editorial, RobertsArticle reviews the historical development of guidelines for treating febrile infants and discusses the applicability of guidelines developed in academic centers and emergency departments to community-based pediatric practice.

COFFEE AND RISK OF DIABETES

Previous studies have suggested an association between coffee consumption and a reduced risk of diabetes. Tuomilehto and colleagues conducted a prospective study of Finnish adults to further investigate this purported link. After adjusting for potential confounders including age, body mass index, physical activity, alcohol use, and smoking status, they found a significant inverse and graded association between daily coffee consumption and risk of type 2 diabetes during a mean follow-up of 12 years.

SEX DIFFERENCES IN CARDIAC OUTCOMES

Prior studies of sex differences in cardiac outcomes have yielded inconsistent results. King and colleagues assessed survival after cardiac catheterization in more than 37 000 patients to examine whether the extent of coronary disease, treatment strategy, and follow-up time influence the risk of death in women vs men. Women were found to have higher 1-year mortality than were men, specifically in the first 40 days after catheterization. There were no sex-related differences among patients who did not undergo revascularization procedures, but among patients who did, women had a higher mortality rate within the first year after the procedure. These outcomes remained unchanged in analyses controlling for age and comorbidities.

CALORIC INTAKE AND RISK OF BREAST CANCER

Restricted caloric intake protects rodents from spontaneous breast tumors, but whether a similar protective effect might exist in women is not known. Michels and Ekbom conducted a retrospective cohort study of women who had been hospitalized for anorexia nervosa before age 40 years to examine whether they had a lower risk of incident breast cancer than women in the general population. They found that women with a history of anorexia had a significantly lower risk of breast cancer, with the greatest risk reduction among women with anorexia who subsequently had children.

CAUSES OF DEATH IN THE UNITED STATES, 2000

Lifestyle factors are likely responsible for a substantial number of deaths in the United States, and modifications in these choices could improve public health. Mokdad and colleaguesArticle used cause-of-death reports from the Centers for Disease Control and Prevention and data abstracted from a systematic review of studies linking risk behaviors and mortality to calculate risk-attributable mortality rates. They found that tobacco use is the major cause for deaths, accounting for an estimated 435 000 deaths annually. Overweight and physical inactivity contributed to approximately 400 000 lives lost in 2000. In an editorial, McGinnis and FoegeArticle discuss the progress made over the past decade and the challenges to improving US public health.

MEDICAL NEWS & PERSPECTIVES

Scientists reported they had succeeded in deriving human stem cells from a cloned human embryo—work seen as an advance toward stem cell–based transplantation medicine, not reproductive cloning.

HEALTH INSURANCE FOR ADOLESCENTS

Recent expansion of public health insurance programs has improved coverage for poor and near-poor adolescents, but reductions in private insurance availability left more middle- and high-income teens without health insurance in 2002.

CLINICIAN'S CORNER

Mrs C, a 43-year-old woman with chronic renal insufficiency, is anticipating dialysis and a possible renal transplant. Chertow discusses the epidemiology and clinical course of end-stage renal disease and the risks and benefits of dialysis and transplantation.

JAMA PATIENT PAGE

For your patients: Information about fever in infancy.

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