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This Week in JAMA
JAMA. 2001;285:2415.
Infant Breastfeeding and Risk of Overweight in Childhood
Some evidence suggests that breastfeeding in infancy protects against overweight later in life. In this analysis of data from the Third National Health and Nutrition Examination Survey, Hediger and colleagues (SEE ARTICLE) found that among children aged 3 to 5 years, the risk of having a body mass index (BMI) between the 85th and 94th percentiles (at risk of overweight) was reduced among children ever breastfed compared with those who were never breastfed. However, no difference in the risk of overweight (BMI in the 95th percentile or higher) was observed, and there was no clear dose-dependent effect of the duration of exclusive breastfeeding on either weight outcome. To assess whether breastfeeding in infancy is associated with a reduced risk of overweight in adolescence, Gillman and colleagues (SEE ARTICLE) analyzed survey data from children in the Growing Up Today Study, a study of the sons and daughters aged 9 to 14 years of women participating in the Nurses' Health Study II. Children who had been mostly or only breastfed, or breastfed for longer periods, had a reduced risk of being overweight at age 9 to 14 years. In an editorial, Dietz (SEE ARTICLE) considers possible explanations for the disparity in the findings of these 2 studies and mechanisms by which breastfeeding may protect against overweight.
Benefit of Eptifibatide Persists 6 Months After Stenting
In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, patients scheduled to undergo nonurgent coronary stent implantation who received eptifibatide, a competitive inhibitor of platelet glycoprotein IIb/IIIa, had significantly better outcomes 30 days after the percutaneous coronary intervention than patients who received placebo. In this 6-month follow-up study, O'Shea and colleagues report that the primary composite end point, rates of death or myocardial infarction (MI), continued to be significantly lower in the eptifibatide group. Composite rates of death, MI, or target vessel revascularization were also lower in the eptifibatide group, but there was no significant difference in 6-month mortality alone.
(SEE ARTICLE)
Effectiveness of Treatments for Hallux Valgus
Treatments for hallux valgus include conservative management with orthoses and surgical correction. Torkki and colleagues compared these treatments with no treatment (control group) among patients with a painful bunion and a hallux valgus angle of 35° or less. At 6 months, pain intensity during walking was less in the 2 active treatment groups than in the control group. At 12 months, however, there was no significant difference in pain intensity in the orthoses and control groups, whereas pain intensity continued to decrease in the surgery group. Number of painful days, cosmetic disturbance, and footwear problems were lowest in the surgical group, and satisfaction with treatment and patient global assessment were better than in the other 2 groups.
(SEE ARTICLE)
Biomarkers Predictive of Peripheral Arterial Disease
Using data from the Physicians' Health Study, a prospective cohort of healthy male US physicians aged 40 to 84 years at baseline, Ridker and colleagues conducted a nested case-control study to evaluate biomarkers as risk factors for the development of symptomatic peripheral arterial disease (PAD). Lipid biomarkers included total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, total cholesterol to HDL-C ratio, triglycerides, lipoprotein(a), and apolipoproteins A-1 and B-100. Nonlipid biomarkers included homocysteine and 2 inflammatory markers, fibrinogen and C-reactive protein. In multivariable analyses, total cholesterol to HDL-C ratio was the strongest lipid predictor of PAD; and C-reactive protein, the strongest nonlipid predictor.
(SEE ARTICLE)
A Piece of My Mind
"There was a time when I could not imagine life without practicing medicine; now I consider other choices." From "Visiting the Sadness."
(SEE ARTICLE)
Medical News & Perspectives
Successful treatment of many children with cancer has led to a need to find and address factors contributing to the negative consequences that can occur later in their lives.
(SEE ARTICLE)
Adult Treatment Panel III Report
The third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (SEE ARTICLE) emphasizes primary prevention of coronary heart disease in persons with multiple risk factors and early and aggressive lipid-lowering therapy for those at highest risk. (SEE ARTICLE)
The Rational Clinical Examination
How to assess whether a patient with a stated penicillin allergy is truly allergic to penicillin.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about cholesterol and atherosclerosis.
(SEE ARTICLE)
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