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This Week in JAMA
JAMA. 2000;284:1749.
Breast Cancer Risk and OC Use in High-Risk Women
Oral contraceptive (OC) use has been associated with a slight increase in breast cancer risk in the general population, but among women with a family history of breast cancer, evidence on the association of OC use and breast cancer risk has been inconsistent. Between 1991 and 1996, Grabrick and colleagues (SEE ARTICLE) interviewed the relatives of women who had been diagnosed with breast cancer between 1944 and 1952. Among sisters and daughters of the probands, ever use of OCs was associated with a significantly increased risk of breast cancer, but not among granddaughters or nieces or women who had married into the families. In an editorial, Burke (SEE ARTICLE) points out that factors that may influence the apparent association between OC use and breast cancer risk are still uncertain, complicating the decision to use OCs, especially for high-risk women considering OCs to reduce ovarian cancer risk.
Outcomes of Coronary Stenting in Women and Men
Women have been thought to have poorer outcomes than men after conventional coronary interventions. In this study of patients with symptomatic coronary artery disease treated with coronary stenting between May 1992 and December 1998, Mehilli and colleagues (SEE ARTICLE) found that the risk of death or myocardial infarction 1 year after coronary artery stenting was similar in women and men, but baseline characteristics, outcomes at 30 days, and baseline prognostic factors were substantially different. Suwaidi and coauthors (SEE ARTICLE) , in a review of studies comparing coronary artery stenting with balloon angioplasty, note that the use of coronary stents has improved the outcomes of interventional procedures for many types of lesions in patients with coronary artery disease. In an editorial, Lincoff (SEE ARTICLE) qualifies these reports with a discussion of problems associated with coronary stenting, including restenosis within a stent and failure to use adjunctive antiplatelet therapy, economic issues, and lack of comparative data on outcomes of death or myocardial infarction after stenting.
Hearing Aid Circuits for Sensorineural Hearing Loss
Hearing aids are the principal treatment for persons with sensorineural hearing loss. In this crossover trial of 3 common hearing aid circuits—the linear peak clipper, the compression limiter, and the wide dynamic range compressor—Larson and colleagues found that all 3 circuits improved speech recognition compared with the unaided condition in patients with bilateral sensorineural hearing loss, and reduced the frequency of problems in verbal communication. Differences in speech recognition and sound quality observed in pairwise comparisons of the 3 circuits were small, but generally favored the compression limiter and wide dynamic range compressor circuits over the linear peak clipper.
(SEE ARTICLE)
Genes for Cystic Fibrosis and Chronic Rhinosinusitis
Chronic rhinosinusitis is a common condition in the general population and also a consistent feature of cystic fibrosis. To investigate the molecular basis of chronic rhinosinusitis, Wang and colleagues screened patients with this condition and matched controls for mutations in the cystic fibrosis transmembrane regulator (CFTR) gene. The proportion of patients who had the CFTR mutations was significantly higher in the chronic rhinosinusitis group than in the control group, suggesting that the CFTR gene may be associated with the development of chronic rhinosinusitis in the general population.
(SEE ARTICLE)
Immunizations Increase With Patient Reminder Systems
Rates of immunization of children and adults in the United States have been increasing, but are still below national goals. Szilagyi and colleagues systematically reviewed studies on the effectiveness of patient reminder systems (postcards, letters, and telephone or autodialer calls) to improve immunization rates. In 33 of the 41 reviewed studies, patient reminder systems improved immunization rates independent of baseline immunization rates, patient age, clinical setting, or vaccination type. All types of reminders were effective; telephone reminders were the most effective, but the most costly.
(SEE ARTICLE)
A Piece of My Mind
"To see you was to glimpse the limits of the medical craft, but worse, it was to realize even the strongest love couldn't stop a disease's course." From "Hands That Held Other Hands."
(SEE ARTICLE)
Contempo Updates
Surgical reconstruction of defects of the head and neck using microvascular free-tissue transfer restores function and appearance after tumor excision or trauma.
(SEE ARTICLE)
Medical News & Perspectives
The release of the National Institutes of Health guidelines for research using pluripotent stem cells holds promise for the discovery of potentially lifesaving therapies.
(SEE ARTICLE)
JAMA NetSight
Establishing a secure Internet Web site for collecting and managing data for collaborative multisite research studies.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on cystic fibrosis.
(SEE ARTICLE)
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