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This Week in JAMA
JAMA. 1998;280:1891.
Breathing Easier in Smoke-Free Bars
Few studies have examined the short-term outcomes of reducing environmental tobacco smoke (ETS) in adults. Eisner and coworkers (SEE ARTICLE) observed that self-reported ETS exposure and respiratory symptoms decreased in a cohort of San Francisco bartenders after smoking in bars and taverns was prohibited in California, and spirometry performance improved. In a related editorial, Davis (SEE ARTICLE) calls for increasing efforts to ban smoking in indoor areas.
Lead Levels Decline but Cognitive Deficits Persist
To determine whether declines in blood lead levels in childhood would be associated with improvement in cognitive function, Tong and colleagues analyzed data from 375 children followed up from birth through 11 to 13 years of age in Port Pirie, South Australia, the site of a large lead smelting facility. The researchers found that mean blood lead levels declined with age, but overall the cognitive scores of children with the greatest decline in blood lead levels after age 2 years were not improved relative to those of children whose lead levels declined least.
(SEE ARTICLE)
White Matter Swelling in High-Altitude Cerebral Edema
Cerebral edema may result from cellular cytotoxic swelling, extracellular vasogenic swelling, or both. In a case-control study by Hackett and colleagues, magnetic resonance imaging (MRI) revealed edema of the white matter acutely in 7 of 9 patients with high-altitude cerebral edema, but no gray matter abnormalities—findings consistent with vasogenic cerebral edema. No MRI abnormalities were found in the 6 control patients with comparable altitude exposure.
(SEE ARTICLE)
Epidemiology of Thoracic Aortic Aneurysms
In an epidemiologic study of Olmsted County Minnesota residents between 1980 and 1994, Clouse and colleagues found that the overall incidence of degenerative thoracic aortic aneurysms was more than 3-fold higher than the rate from 1951 to 1980, but the 5-year survival was significantly better in the more recent period. Women were significantly older than men at the time of diagnosis and had a greater probability of aneurysm rupture and a lower rate of surgical intervention.
(SEE ARTICLE)
Risk of Hemorrhagic Stroke With Aspirin Therapy
In a meta-analysis of data from more than 55,000 subjects in 16 controlled trials of preventive aspirin therapy, He and colleagues (SEE ARTICLE) found that aspirin therapy increases the risk of hemorrhagic stroke. But the observed reduction in the risk of myocardial infarction and ischemic stroke with aspirin therapy may outweigh the risk of hemorrhagic stroke in many patients. In a related editorial, Boissel (SEE ARTICLE) discusses the application of these findings to decisions about aspirin therapy for individual patients.
Treatment of Opiate Addiction
A National Institutes of Health Consensus Conference reviewed the scientific evidence on the treatment of opiate addiction through a literature review, expert presentations, and discussion. The Conference panel concluded that persons dependent on opiates should have ready access to medical treatment with methadone or other opiate agonists.
(SEE ARTICLE)
The Cover
"Sinuous hills appear surreal. . . ." Georgia O'Keeffe, Black Place I, 1944, American.
(SEE ARTICLE)
Medical News & Perspectives
Advances in assisted human reproduction and insights into gynecologic disorders are the focus of two major meetings.
(SEE ARTICLE)
A Piece of My Mind
"The young technician wondered if this old man had ever done anything in his life that was worthwhile or important." From "Alton Small."
(SEE ARTICLE)
Commentary
When to accept gifts from patients—and when to refuse them.
(SEE ARTICLE)
Policy Perspectives
Recommendations for updating regulations that protect human research subjects.
(SEE ARTICLE)
From the JAMA Web Sites
Testosterone replacement therapy improves HIV-related wasting and may also be indicated for HIV-infected men with hypogonadism without weight loss.
(SEE ARTICLE)
JAMA Patient Page
For your patients: The hazards of secondhand smoke.
(SEE ARTICLE)
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