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This Week in JAMA
JAMA. 2002;288:923.
Early Exposure to Dogs and Cats and Allergic Sensitization
The relationship between environmental exposures early in life and subsequent development of allergic disease is not well understood. In this prospective birth cohort study, Ownby and colleagues (SEE ARTICLE) found that risk of allergic sensitization to common aeroallergens at age 6 to 7 years was lower among children exposed to 2 or more dogs or cats in the first year of life than among children exposed to 1 dog or cat or those without any early dog or cat exposure. In an editorial, Platts-Mills (SEE ARTICLE) discusses immunologic mechanisms that may explain the different associations that have been observed between allergen exposure and risk of allergic sensitization and disease.
Homocysteine-Lowering Therapy After Angioplasty
Previously published results of the Swiss Heart Study, a randomized, placebo-controlled trial, showed that the rate of restenosis after coronary angioplasty was reduced among patients who received homocysteine-lowering therapy (folic acid, vitamin B12, and vitamin B6) during the 6 months of follow-up. In this report of clinical outcomes after additional follow-up through 1 year, Schnyder and colleagues found that the risk of major adverse clinical outcomes (death, nonfatal myocardial infarction, and need for repeat revascularization) was significantly lower among patients who had received 6 months of homocysteine-lowering therapy after coronary angioplasty than among patients who had received placebo.
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HRT, Inflammatory Biomarkers, and CHD Risk
Postmenopausal hormone replacement therapy (HRT) has been shown to elevate levels of C-reactive protein (CRP), one of several inflammatory biomarkers associated with increased cardiovascular risk. In this case-control study, Ridker and colleagues analyzed data from the Women's Health Initiative Observational Study, a prospective study of healthy, postmenopausal women, to assess whether the effect of HRT on CRP increases risk of incident coronary heart disease (CHD). Increased baseline levels of CRP and interleukin 6 (IL-6) were independently associated with increased risk of developing a first myocardial infarction or death from CHD after a median of 2.9 years of follow-up. Long-term use of HRT was associated with increased levels of CRP, but not of IL-6. In analyses stratified by baseline CRP and IL-6 levels, risk of incident CHD was similar among HRT users and nonusers.
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Carbon Monoxide Deaths and Vehicle Emissions
Carbon monoxide (CO) poisoning contributes to more than 2000 poisoning deaths annually in the United States. Mott and colleagues examined national non–fire-related CO poisoning mortality data from 1968 through 1998 and CO vehicle emissions data from 1968 through 1996 to describe trends in CO-related deaths and to evaluate the influence of national vehicle emissions standards on CO-related mortality. The annual rate of CO poisoning declined from 20.2 deaths to 8.8 deaths per 1 million persons, and CO emissions from automobiles decreased by an estimated 72.8 g/mile from 1975, when the catalytic converter was introduced in automobiles, through 1996. During 1975 through 1996, an annual decrease of 10 g/mile of estimated CO emissions from automobiles was associated with a 21.3% decrease in the annual unintentional motor vehicle–related CO death rate and a 5.9% decrease in the annual rate of motor vehicle–related CO suicides.
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A Piece of My Mind
"All [of my stories] involve the idealistic thoughts of a clinician just formally entering the medical profession." From "More Stories."
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Contempo Updates
Noninvasive ventilation for acute respiratory failure: indications, benefits, and risks.
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Medical News & Perspectives
Multidisciplinary treatment tactics help patients with chronic pain return to normal functioning (SEE ARTICLE) , whereas palliative care (SEE ARTICLE) goes beyond pain relief to embrace emotional, social, and spiritual needs of seriously ill patients.
HUS After Antibiotic Therapy for E Coli
Meta-analysis (SEE ARTICLE) of 9 studies indicates that antibiotic treatment of Escherichia coli O157:H7 enteritis is not associated with an increased risk of hemolytic uremic syndrome (HUS). In an editorial, Mølbak and coauthors (SEE ARTICLE) discuss empirical antimicrobial treatment of diarrhea and clinical management of patients known to be infected with E coli O157:H7.
CLINICIAN'S CORNER
A Man With a Diagnosis of Chronic Lyme Disease: Clinical Crossroads
Mr C has been treated with repeated courses of antibiotics over a period of 5 years for recurrent musculoskeletal and neuropsychiatric symptoms diagnosed as chronic Lyme disease. Steere discusses the epidemiology, diagnosis, and treatment of Lyme disease and the evaluation and treatment of patients with persistent symptoms after Lyme disease.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about carbon monoxide poisoning.
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