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This Week in JAMA
JAMA. 2001;285:133.
Breast Density Changes With Changes in Use of HRT
Initiation of hormone replacement therapy (HRT) has been shown to increase breast density, which may decrease the sensitivity of screening mammography, but the effects of discontinuing and continuing use on breast density are not known. Rutter and colleagues studied changes in breast density in a cohort of 5212 postmenopausal women who had 2 screening mammograms between 1996 and 1998. Compared with women who did not use HRT, women who initiated HRT after the first mammogram were more likely to have increases in breast density on the second mammogram; women who discontinued HRT after the first mammogram were more likely to have decreases in density; and women who were using HRT prior to both mammograms were more likely to have increases in breast density on the second mammogram and high density at both exams.
(SEE ARTICLE)
Mass Immunization Against Meningococcal Disease
In response to an outbreak of meningococcal disease in Quebec province, a mass immunization program using polysaccharide vaccine was conducted between December 1992 and March 1993 for all people aged 6 months through 20 years. De Wals and colleagues report that the average annual incidence of serogroup C meningococcal disease decreased from 1.4 per 100 000 in 1990-1992 to 0.3 per 100 000 in 1993-1998, while the overall incidence of cases due to other serogroups remained stable. Vaccine effectiveness was highest among those immunized at age 15 through 20 years, and there was no evidence of protection among children younger than 2 years when immunized.
(SEE ARTICLE)
Glycemic Control and Short-term Health Care Costs
Economic models have predicted that better glycemic control will reduce the long-term health care costs of patients with diabetes mellitus, but recent studies suggest that cost savings may be more immediate. In this historical cohort study conducted between 1992 and 1997, Wagner and colleagues found that patients with type 2 diabetes whose glycemic control improved between 1992 and 1993 and was maintained through 1994 had lower mean total health care costs than patients whose glycemic control was unimproved. Health care utilization for primary care visits was significantly lower in the improved cohort compared with the unimproved cohort beginning in 1994 and for specialty visits in 1997.
(SEE ARTICLE)
Early Revascularization for Cardiogenic Shock
In the previously reported SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) Trial, 30-day mortality among patients with acute myocardial infarction and cardiogenic shock treated with early revascularization was 47% compared with 56% among those who received initial medical management, a nonsignificant reduction. In this analysis, Hochman and colleagues found that 1 year after randomization, there was a significant difference in survival between the 2 groups. One-year survival was 46.7% for patients in the early revascularization group compared with 33.6% in the initial medical stabilization group.
(SEE ARTICLE)
Re-treatment of Hepatitis C Nonresponsive to Interferon
In recent trials, combination therapy with interferon and ribavirin was more effective than interferon monotherapy for patients with chronic hepatitis C who had no prior interferon therapy or who relapsed after interferon therapy. Cummings and colleagues (SEE ARTICLE) conducted a meta-analysis of 12 trials to compare combination therapy with interferon plus ribavirin with interferon alone for re-treatment of patients who failed to respond to interferon monotherapy. The pooled virological response rate was 14% for combination therapy and 2% for monotherapy, with a significant overall risk difference of 7%. In an editorial, Koff (SEE ARTICLE) notes that because histological improvement of hepatic fibrosis may occur without a complete virological response, long-term therapy may still be beneficial for patients despite failure to clear serum HCV RNA levels at conventional time points after treatment.
Medical News & Perspectives
Hematologists report success using new gene-based therapeutic approaches to chronic myelogenous leukemia, hemophilia A, and other difficult-to-treat disorders.
(SEE ARTICLE)
Health Care Utilization by Homeless Persons
In this analysis of data from a nationally representative survey of people who use homeless services, those who were homeless reported high rates of acute hospital-based care and difficulty accessing needed care. Medical insurance was associated with greater use of ambulatory care and lower reporting of barriers to care and to compliance with prescribed medication.
(SEE ARTICLE)
Family Members as Research Subjects
Protection of the privacy of family members in survey and pedigree research: analysis of ethical issues and regulatory standards.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about mammography and breast cancer.
(SEE ARTICLE)
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