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This Week in JAMA
JAMA. 2000;283:2895.
Time to Angioplasty After Acute MI and Mortality
Rapid reperfusion after acute myocardial infarction (MI) using thrombolytic therapy has been associated with reduced mortality, but whether time to primary angioplasty is also related to mortality is less certain. In this analysis of data from 27,080 patients with acute MI associated with ST-segment elevation or left bundle-branch block who were treated with primary angioplasty, Cannon and colleagues (SEE ARTICLE) found that the odds of in-hospital mortality increased 41% to 62% when the time to first balloon inflation was more than 2 hours from hospital arrival. Increasing delay from symptom onset to first balloon inflation, however, was not associated with significant increase in in-hospital mortality. In an editorial, Lauer (SEE ARTICLE) observes that these findings suggest that hospitals caring for patients with acute MI should offer primary angioplasty only if they can consistently perform the procedure within 2 hours of patient arrival.
Aging Registered Nurse Workforce
Recent trends in the average age and employment of registered nurses (RNs) will influence the future age distribution and size of the RN workforce. In this analysis of successive cohorts of RNs over their lifetimes, Buerhaus and colleagues (SEE ARTICLE) found that the average age of working RNs increased 4.5 years between 1983 and 1998, and the number of full-time equivalent RNs in recent cohorts has decreased compared with cohorts at similar ages that entered the labor market 20 years earlier. The authors estimate that the RN workforce in 2020 will be the same size as today, approximately 20% below projected requirements. In a related commentary, Bednash (SEE ARTICLE) proposes reforms in nursing education and credentialing to reverse current trends in aging and supply in the RN workforce.
Sunscreen Use and New Nevi in Children
In prior studies, an increase in the number of acquired nevi has been associated with increasing risk of cutaneous malignant melanoma in white populations. To determine whether use of broad-spectrum, high–sun-protection sunscreen would reduce the development of acquired nevi in children, Gallagher and colleagues randomly assigned white school-aged children to receive a supply of SPF 30 broad-spectrum sunscreen with instructions for use or to a control group with no intervention. After 3 years, children in the sunscreen group, especially those with more facial freckling, developed significantly fewer new nevi than those in the control group.
(SEE ARTICLE)
Physical Activity and Stroke Risk in Women
Increased physical activity has been associated with reduced risk of coronary heart disease, but data on the relationship between physical activity and risk of stroke have been inconsistent. During 8 years of follow-up of 72,488 women in the Nurses' Health Study, Hu and colleagues documented a total of 407 incident cases of stroke, of which 258 were ischemic strokes. Risk of total stroke and ischemic stroke decreased significantly in a dose-response manner as level of physical activity increased.
(SEE ARTICLE)
TB Transmission Persists Despite Control Measures
Transmission of tuberculosis (TB) continues to occur despite improvements in TB control. In this epidemiological study of transmission of a specific strain of Mycobacterium tuberculosis in an urban community that has been using TB control measures, including directly observed therapy, Chin and colleagues found that reasons for disease transmission included failure to identify contacts of source case-patients, delayed diagnosis of source case-patients, and problems associated with evaluation or treatment of contacts.
(SEE ARTICLE)
Contempo Updates
Stroke risk factors and prevention of stroke in patients with chronic atrial fibrillation.
(SEE ARTICLE)
Medical News & Perspectives
Because problems can belie the promise of highly active antiretroviral therapy for HIV, researchers are exploring ways to improve it without compromising effectiveness. One approach—under study by Anthony Fauci, MD, and coworkers—is structured therapy interruption.
(SEE ARTICLE)
Cancer Survival and Therapeutic Progress
Analysis of data from the Surveillance, Epidemiology, and End Results (SEER) program indicates that the increase in 5-year cancer survival over time observed for 20 common solid tumors does not correlate with change in cancer mortality and may reflect changing patterns of diagnosis rather than improvement in therapy.
(SEE ARTICLE)
Public Health Law
Part II: Government Powers and Limits
Public health powers of federal and state government and constitutional limitations on these powers to protect individual liberties.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information on benefits of physical activity.
(SEE ARTICLE)
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