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This Week in JAMA
JAMA. 1999;281:2165.
Raloxifene Therapy and Risk of Breast Cancer
In the Multiple Outcomes of Raloxifene Evaluation trial, Cummings and colleagues (SEE ARTICLE) found that after a median of 40 months, postmenopausal women with osteoporosis who received raloxifene had a significantly lower cumulative incidence of breast cancer than women who received placebo (Figure 1). In an editorial, Franks and Steinberg (SEE ARTICLE) discuss the treatment implications of these findings and the continued uncertainty about the cardioprotective and cognitive benefits of estrogen therapy in postmenopausal women.
Why Are Drowning Rates Declining?
Mortality from unintentional drowning has decreased in the United States during the past several decades. In this analysis of cases of submersion injuries in King County, Washington, Cummings and Quan (SEE ARTICLE) found that drowning mortality rates declined 59% between 1975 and 1995, explained in part by decreases in the severity of submersion episodes and in the use of alcohol around water, but not by improvements in prehospital and hospital care. In an editorial, Smith and Howland (SEE ARTICLE) explore various explanations for the declining rate of deaths from unintentional drowning.
Potassium Level and Perioperative Arrhythmia Risk
Correction of abnormal serum potassium levels prior to cardiac surgery may reduce the risk of adverse perioperative events. Wahr and coworkers report that perioperative arrhythmias occurred in 1290 (54%) of 2402 patients undergoing elective coronary artery bypass graft surgery. A preoperative serum potassium level of less than 3.5 mmol/L was associated with a significantly increased risk of serious perioperative arrhythmias (those requiring intraoperative treatment or combined postoperative ventricular and atrial arrhythmias), intraoperative arrhythmias, and postoperative atrial fibrillation/flutter.
(SEE ARTICLE)
Carrier Rates of Mutations Causing Inherited Deafness
Mutations in the GJB2 gene are the most common known cause of inherited congenital severe-to-profound deafness. Based on genetic screening of 52 children with moderate-to-profound congenital sensorineural hearing loss and 560 control neonates, Green and colleagues estimate that the carrier rate for the 35delG mutation of the GJB2 gene is 2.5% and for all recessive deafness-causing GJB2 mutations, 3.01%.
(SEE ARTICLE)
Laboratory Detection of Iron Deficiency in Children
Iron deficiency anemia in young children has been associated with cognitive and motor developmental deficits that persist even after the anemia is corrected. To determine the optimal approach for the laboratory diagnosis of iron deficiency and iron deficincy anemia, Brugnara and colleagues (SEE ARTICLE) tested the blood samples drawn for lead screening of 210 children, mean age 2.9 years, using several conventional and newer biochemical and hematological indices. They found that the reticulocyte hemoglobin content was the best predictor of both iron deficiency and iron deficiency anemia in children. In an editorial, Cohen (SEE ARTICLE) points out that better clinical and public health interventions may offer more to prevent and detect iron deficiency in young children than an improved screening test.
A Piece of My Mind
"A single rise, a single missed opportunity, is all the stream chooses to yield this evening." From "Cold Blue."
(SEE ARTICLE)
From the
JAMA Web Sites
Base pair inserts in the reverse transcriptase gene of the human immunodeficiency virus develop during antiretroviral therapy and result in resistance to many nucleoside reverse transcriptase inhibitors.
(SEE ARTICLE)
Medical News & Perspectives
As the prevalence of asthma increases, the medical community continues to seek causes and treatment and prevention strategies.
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Clinical Investigation
Mak and colleagues find that routine testing for common mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene may miss about 40% to 80% of detectable mutations in the CFTR gene in men with obstructive azoospermia.
(SEE ARTICLE)
The Rational Clinical Examination
How to detect aortic regurgitation.
(SEE ARTICLE)
JAMA Editorial Governance Plan
TheJAMA Editor Search Committee and AMA Board of Trustees and senior staff agree on a governance plan for JAMA and the Archives Journals.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Water safety tips.
(SEE ARTICLE)
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