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This Week in JAMA
JAMA. 2002;287:2031.
Dairy Intake and the Insulin Resistance Syndrome
Dietary factors have been linked to development of the insulin resistance syndrome, a syndrome that includes obesity, glucose intolerance, hypertension, and dyslipidemia. Using data from the Coronary Artery Risk Development in Young Adults study, a prospective study of cardiovascular disease risk factors in a cohort of adults aged 18 to 30 years, Pereira and colleagues found that the 10-year incidence of the insulin resistance syndrome was inversely associated with dairy consumption among individuals who were overweight at baseline but not among those who were normal weight.
(SEE ARTICLE)
Predictive Model for Nursing Home Placement
The Medicare Alzheimer's Disease Demonstration and Evaluation study, a randomized trial that enrolled community-living patients with advanced dementia and their caregivers, compared expanded in-home and community-based services and case management with usual care. For this analysis, Yaffe and colleagues combined all patients from the intervention and control groups and randomly divided them into development and validation cohorts to develop and assess a prognostic model to determine comprehensive predictors of nursing home placement for patients with dementia. Patient and caregiver characteristics were independently predictive of nursing home placement during a 3-year period, and patient and caregiver characteristics together predicted placement better than either patient or caregiver characteristics alone.
(SEE ARTICLE)
Restorative Model of Home Care for Older Adults
Restorative models of home care integrate principles from geriatric medicine, rehabilitation, nursing, and goal attainment. Tinetti and colleagues compared the outcomes of restorative care vs usual home care among older adults after acute illness or hospitalization. Patients who received restorative care were more likely than those who received usual care to remain at home following completion of the home care episode. Functional outcomes were better in the restorative care group, and the duration of the home care episode was significantly shorter than in the usual care group.
(SEE ARTICLE)
Survival of Blacks vs Whites After a Cancer Diagnosis
Survival after a cancer diagnosis is worse among blacks than among whites, which may be explained by disparities in treatment or rates of death due to other causes or by differences in cancer biology. Bach and colleagues (SEE ARTICLE) conducted a systematic review of studies in which survival was reported for blacks and whites who had received comparable cancer treatment for similar stages of disease. After correction for deaths due to other causes, the estimated cancer-specific mortality was only modestly increased among blacks compared with whites. Of 14 different cancers, blacks were at a significantly higher risk of cancer-specific death only for cancer of the breast, uterus, and bladder. In an editorial, Kiefe (SEE ARTICLE) discusses possible explanations for the observed differences in cancer-specific mortality and advocates addressing these differences by focusing on disparities at the level of delivery of care.
CLINICIAN'S CORNER
A 60-Year-Old Woman Trying to Discontinue HRT
Mrs W has been taking hormone replacement therapy (HRT) since undergoing hysterectomy and bilateral salpingo-oophorectomy 20 years ago. She has a family history of breast cancer and has attempted to discontinue estrogen therapy several times, but experiences severe hot flushes and discomfort. Grady discusses indications for postmenopausal hormone therapy, associated risks, and ways to discontinue therapy.
(SEE ARTICLE)
Contempo Updates
Preoperative evaluation and management of patients with hypertension.
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Medical News & Perspectives
HIV/AIDS in Russia, a new approach to Chagas disease, and a welcome payoff from banning antibiotics in animal feed are some current issues that were addressed at the recent conference on emerging infections at the Centers for Disease Control and Prevention.
(SEE ARTICLE)
CONSENSUS STATEMENTS
Cervical Cytology Abnormalities
Statements from recent consensus processes present new Bethesda System terminology for reporting the results of cervical cytology (SEE ARTICLE) (SEE ARTICLE) and evidence-based guidelines (SEE ARTICLE) for the management of women with cervical cytological abnormalities.
From the Archives Journals
Kushner discusses a randomized trial recently reported in the Archives of Ophthalmology that compared the effectiveness of atropine and patching for the treatment of mild to moderate amblyopia in children.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about home health care.
(SEE ARTICLE)
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