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This Week in JAMA
JAMA. 2003;290:1277.
Exercise and Weight Loss, Breast Cancer Risk in Women
The optimal amount and intensity of physical activity necessary to maintain health and control body weight have not been established. Jakicic and colleagues (SEE ARTICLE) conducted a randomized trial among overweight, sedentary women comparing the effect of 4 exercise prescriptions—vigorous intensity/high duration, moderate intensity/high duration, moderate intensity/moderate duration, and vigorous intensity/moderate duration. After 12 months, no significant differences in weight loss or improvement in cardiorespiratory fitness were found between the 4 groups. In an analysis of data from postmenopausal women enrolled in the prospective Women's Health Initiative Observational Study, McTiernan and colleagues (SEE ARTICLE) found that risk of breast cancer was significantly reduced among women who had participated in regular strenuous activity at age 35 years and among those who currently engaged in the equivalent of 1.25 to 2.5 hours per week of brisk walking. In an editorial, (SEE ARTICLE) Lee notes that the findings from these studies suggest that women are able to achieve health benefits from modest levels of physical activity.
Diarrhea-Associated Hemolytic Uremic Syndrome
Management of diarrhea-associated hemolytic uremic syndrome (HUS), which is primarily caused by intestinal infection with Shiga toxin–producing strains of Escherichia coli, relies mostly on intensive supportive care. Trachtman and colleagues (SEE ARTICLE) conducted a multicenter placebo-controlled randomized trial among children with diarrhea-associated HUS to determine whether an oral agent that binds Shiga toxin would reduce disease severity. The combined frequency of death or serious extrarenal events or need for dialysis was not significantly different in the 2 treatment groups. In a meta-analysis of 49 published studies on diarrhea-associated HUS, Garg and colleagues (SEE ARTICLE) estimated that end-stage renal disease or death occurred in 12% of patients and 25% of survivors experienced long-term renal sequelae. In an editorial, (SEE ARTICLE) Siegler proposes preventive measures to reduce the incidence of diarrhea-associated HUS as the main approach available to decrease the morbidity and mortality related to this condition and urges more research on the pathogenic cascade initiated by Shiga toxin–producing strains of E coli.
Type 2 Diabetes Mellitus in Taiwanese Children
In recent years, the prevalence of type 2 diabetes mellitus among children and adolescents has been increasing. Wei and colleagues studied the rate of type 2 diabetes and associated risk factors in children aged 6 to 18 years in Taiwan based on a national screening program. The rate of newly diagnosed diabetes was 9.0 per 100 000 for boys and 15.3 per 100 000 for girls. Among those with newly diagnosed diabetes, the ratio of type 2 to type 1 diabetes was approximately 6:1. Factors significantly associated with type 2 diabetes included obesity, hypercholesterolemia, blood pressure greater than the 85th percentile, and family history of diabetes.
(SEE ARTICLE)
Experimental Therapy in Nontrial Patients During RCTs
Clark and colleagues evaluated national data on apheresis use before and during 3 Canadian randomized controlled trials (RCTs) of apheresis to determine whether use of an experimental therapy during an RCT increases outside the trial. The number of patients receiving apheresis increased during all 3 trials, and most of the increased use was among patients who were not participating in the trials.
(SEE ARTICLE)
A Piece of My Mind
"Far from raising us up, brute suffering can drag us down to the elemental, the animal, heralding that feared leveler, death." From "For What?"
(SEE ARTICLE)
Medical News & Perspectives
Experts say that clinicians' lack of knowledge about addiction as a medical disease hampers treatment efforts.
(SEE ARTICLE)
Internet Cigarette Sales to Minors
In this cross-sectional study, 4 adolescents were able to purchase and receive cigarettes from approximately 90% of 55 Internet vendors.
(SEE ARTICLE)
CLINICIAN'S CORNER
Diabetic Peripheral Neuropathy
Grand Rounds
Two case presentations illustrate that peripheral neuropathy may be the first symptom of impaired glucose metabolism. Polydefkis and coauthors discuss visualization of small-caliber sensory nerve fibers in skin biopsies to study diabetic peripheral neuropathy.
(SEE ARTICLE)
Global Health
Call for Papers
Research reports that address major health problems and diseases in developing countries are invited for a JAMA theme issue on global health scheduled to be published in June 2004.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about food-borne illnesses.
(SEE ARTICLE)
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