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JAMA. 2008;300(11):1273.

Urinary Bisphenol A and Adult Health
Bisphenol A (BPA)—a plasticizer present in food and drink packaging—has estrogenic and possibly other adverse health effects. Lang and colleagues (SEE ARTICLE) analyzed data from the 2003-2004 National Health and Nutrition Examination Survey, which included measurement of urinary BPA concentration in a random sample of participants, to assess the associations of urinary BPA concentrations with chronic disease diagnoses, lipid levels, biomarkers of inflammation, liver function, and glucose homeostasis in adults. The authors report that higher BPA concentrations were associated with cardiovascular diagnoses, diabetes, and liver enzyme abnormalities. In an editorial, vom Saal and Myers (SEE ARTICLE) discuss the data that link BPA exposure to health risks.

Symptomatic Pelvic Floor Disorders in Women
Many women report symptoms of pelvic floor disorders. To determine the prevalence of pelvic floor disorders in US women, questions relating to urinary and fecal incontinence and pelvic organ prolapse were added to the 2005-2006 National Health and Nutrition Examination Survey. In an analysis of responses from women who were 20 years or older and not currently pregnant, Nygaard and colleagues found a weighted prevalence of at least 1 symptomatic pelvic floor disorder of 23.7% (95% confidence interval, 21.2%-26.2%). The prevalence of pelvic floor disorders increased with increasing age, parity, and body mass index.

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Bicuspid Aortic Valve in Adults
Previous studies have suggested that adult patients with a bicuspid aortic valve—the most common congenital cardiac anomaly in adults—are at increased risk of morbidity and mortality associated with aortic valve dysfunction, endocarditis, and aortic dissection. To assess whether these risks are present in a contemporary cohort of adults with bicuspid aortic valve, Tzemos and colleagues determined rates of mortality and primary cardiac events in a cohort study of 642 adults with bicuspid aortic valve who were a mean (SD) age of 25 (16) years. The authors report that during a mean (SD) follow up of 9 (5) years, 161 patients experienced 1 or more cardiac events, and survival rates were comparable with the general population.

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Behaviors of Highly Professional Resident Physicians
Physicians are expected to exhibit "professionalism," but the teaching and assessment of qualities that determine professionalism have received little attention. In a comparative study involving first-year internal medicine residents at a single academic medical center, Reed and colleagues sought to identify behaviors that distinguished highly professional residents from their peers. The authors developed a multi-item assessment of professionalism that was anonymously scored by peers, senior residents, faculty, medical students, and nonphysician professionals with whom the residents worked during the year. The authors found that specific behaviors, such as conscientiousness, and higher scores on tests of medical knowledge and clinical skill competencies distinguished highly professional residents from their peers.

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CLINICIAN'S CORNER
Neurologic Features of von Hippel-Lindau Disease
Butman and colleagues discuss the molecular pathogenesis of von Hippel-Lindau disease and review the diagnosis and treatment of disease-associated endolymphatic sac tumors and central nervous system hemangioblastomas.

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A Piece of My Mind
"I cared for those burned beyond recognition: soldiers whose facial topography had become flat and barren, devoid of features besides scar tissue and pained orifices." From "The War Goes On."

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Medical News & Perspectives
Although physicians often do not discuss sexual health issues with older adults, new data indicate that opening these lines of communication may improve the health and well-being of this group of patients.

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JAMA Classics
The Multiple Risk Factor Intervention Trial (MRFIT)

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Commentaries
Sequential therapy for Helicobacter pylori

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Health professionals' role in discussions of public figures

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Mindfulness in medicine

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Readers Respond
How would you manage a 60-year-old woman with mild memory impairment and white matter lesions on MRI? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is September 24.

JAMA Patient Page
For your patients: Information about Helicobacter pylori.

(SEE ARTICLE)

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