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This Week in JAMA
JAMA. 2000;283:965.
JAMA-EXPRESS
ERT Fails to Slow Progression of Alzheimer Disease
Several lines of research suggest that estrogen may influence cognitive function in postmenopausal women. To test whether estrogen replacement therapy (ERT) affects progression of preexisting Alzheimer disease, Mulnard and colleagues (SEE ARTICLE) randomly assigned 120 postmenopausal women with mild to moderate Alzheimer disease to receive low-dose or high-dose estrogen or placebo for 12 months. At 12 months, the proportion of women with clinical decline in the combined estrogen groups was similar to that in the placebo group. There was no significant difference in change in score on most measures of functional and cognitive outcomes between women who received estrogen therapy and those who received placebo. In an editorial, Shaywitz and Shaywitz (SEE ARTICLE) discuss the many questions regarding estrogen therapy and Alzheimer disease that are still unanswered.
Oseltamivir Attenuates Influenza Illness
Oseltamivir, an oral influenza neuraminidase inhibitor, has been shown to improve symptoms in subjects experimentally infected with influenza virus. In this trial of oseltamivir for the treatment of naturally acquired influenza infection in 629 otherwise healthy adults aged 18 to 65 years with acute febrile respiratory illness, Treanor and colleagues (SEE ARTICLE) found that the duration and severity of illness was significantly reduced among patients infected with influenza who received oral oseltamivir compared with placebo. Among the 374 patients infected with influenza, the incidence of any secondary complication, such as sinusitis or bronchitis, was significantly lower in the oseltamivir groups compared with placebo. In an editorial, Wenzel (SEE ARTICLE) considers benefits of different treatment options for influenza at both individual and population levels.
Use of Psychotropic Medications in Preschool Children
Despite the lack of data on the efficacy and safety of psychotropic medications for the treatment of very young children, Zito and colleagues (SEE ARTICLE) found that prescriptions for psychotropic medications increased markedly between 1991 and 1995 among children aged 2 to 4 years enrolled in 3 different health care plans. The 1995 utilization prevalence of prescribed stimulants, the most frequently prescribed of the 3 psychotropic drug classes in this study in all 3 settings, was 5.1 per 1000 children in a health maintenance organization (a 3.1-fold increase from 1991), 8.9 in a mid-Atlantic state Medicaid program (a 1.8-fold increase), and 12.3 in a midwestern state Medicaid plan (a 3.0-fold increase). Clonidine use increased 6.8- to 28.2-fold between 1991 and 1995. In an editorial, Coyle (SEE ARTICLE) cautions that use of psychotropic medications in young children may have long-term adverse effects on the developing brain and discusses why prescribing patterns may have changed.
Cervical Disease in Women Infected With HIV
In this prospective cohort study, Ellerbrock and colleagues found that 67 (20%) of 328 women infected with human immunodeficiency virus (HIV) who had no evidence of cervical squamous intraepithelial lesions (SILs) at baseline developed a SIL during 30 months of follow-up compared with 16 (5%) of 325 women not infected with HIV. The incidence of SILs was 8.3 cases per 100 person-years in women infected with HIV and 1.8 in women not infected with HIV. Risk factors for the development of SILs in women infected with HIV included transient and persistent infections with human papillomavirus.
(SEE ARTICLE)
An 80-Year-Old Man With Memory Loss
Mr J, an 80-year-old man, has noticed memory loss for the past 7 years. Recently, Mr J became lost while driving along a familiar route, and family members are concerned that his memory loss is progressing. Larson discusses the epidemiology, diagnosis, and treatment of Alzheimer disease and other dementing illnesses.
(SEE ARTICLE)
A Piece of My Mind
"A team of health professionals had agonized over how to deal with the ethical problems generated by Mr Dean's care, while failing to notice and understand the most pressing ethical problem." From "Attention Must Be Paid."
(SEE ARTICLE)
Medical News & Perspectives
Healthy People 2010, the third US national preventive health initiative, aims to improve the quality of life and eliminate disparities in health among all Americans.
(SEE ARTICLE)
Cortisol Response in Septic Shock
In this prospective study of 189 patients with septic shock, plasma cortisol levels and cortisol response to a short corticotropin stimulation test at the onset of septic shock predicted mortality at 28 days.
(SEE ARTICLE)
Controversies
Two perspectives on the ethics of withdrawing life-sustaining treatment in patients with severe chronic illness.
(SEE ARTICLE) and (SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on cervical cancer.
(SEE ARTICLE)
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