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This Week in JAMA
JAMA. 2005;294:653.
Skin Cancer in Persons Younger Than 40 Years
The risk of nonmelanoma skin cancer among elderly persons is well documented, but little is known about the incidence among younger persons. Christenson and colleagues used population-based data (1976-2003) from Olmsted County, Minnesota, to estimate the incident basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) and change in incidence over time in persons younger than 40 years. The age-adjusted incidence of BCC was 25.9 per 100 000 persons for women and 20.9 for men, and the incidence of SCC was similar for men and women, with an average age-adjusted incidence of 3.9 per 100 000 persons. The incidence of both cancers increased over the study period. Basal cell carcinomas increased significantly more in women than men.
(SEE ARTICLE)
ACE Insertion/Deletion Genotype and Exercise
Some evidence suggests that individual response to exercise may be influenced by the angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) genotype. Kritchevsky and colleagues assessed the association of reports of mobility limitations with the ACE genotype in community-dwelling adults aged 70 through 79 years. They found that physical activity was associated with preserved physical function. However, among physically active persons, those with the II genotype had higher risk of mobility impairment than those with the ID/DD genotypes. Risk by genotype did not differ among physically inactive persons.
(SEE ARTICLE)
Vaccination and Infectious Disease Hospitalization
To test the hypothesis that multiple-antigen vaccines and aggregated vaccine exposure lead to immune dysfunction and an increase in nontargeted infectious diseases among children, Hviid and colleagues reviewed national registry data on vaccinations and infectious disease hospitalizations for Danish children born from 1990 through 2001. They found no evidence to support a link between routine childhood vaccinations and hospitalization for nontargeted infectious diseases.
(SEE ARTICLE)
Duration of Anticoagulation Following VTE
Patients treated for venous thromboembolism (VTE) are at risk of a recurrence, but the optimal duration of anticoagulation is not clear. In a meta-analysis of data from clinical trials of anticoagulation for VTE, Ost and colleagues found that compared with short-term therapy, patients receiving extended anticoagulation had a reduced risk of recurrent VTE while receiving therapy. The authors found evidence of a smaller risk reduction when long-term therapy was discontinued.
(SEE ARTICLE)
Guidelines and Quality of Care for Older Patients
Clinical practice guidelines (CPGs), developed to improve health care quality, exist for many chronic conditions experienced by older patients. Boyd and colleagues (SEE ARTICLE) reviewed national data to assess whether CPGs are applicable to older patients who have several common comorbid conditions and the implications for patients when the CPGs are followed. They found that many CPGs did not consider comorbidities, treatment burden or patient preferences, or potential adverse interactions of CPG recommended medications given concurrently for coexisting conditions. In an editorial, O’Connor (SEE ARTICLE) discusses the limitations of guideline-based care for individual patients and the problems of tying CPGs to physician compensation schemes.
Medical News & Perspectives
Unanswered questions about addressing age-related declines of certain hormones in older adults are gaining unprecedented attention from researchers and clinicians.
(SEE ARTICLE)
CLINICIAN’S CORNER
Severe Stroke
Clinical Review
Assessing prognosis and informing decisions about life-sustaining therapies in mechanically ventilated patients with stroke.
(SEE ARTICLE)
HIV Testing in Critically Ill Patients
Consent requirements for human immunodeficiency virus tests interfere with efficient diagnosis and treatment of critically ill patients who are unable to give consent.
(SEE ARTICLE)
Disclosing Individual Research Results
Respect for persons underlies the ethical obligation to share individual results with research participants.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about thrombophlebitis.
(SEE ARTICLE)
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