Reviews

From BMJ USA 2002;Nov:639

This section calls attention to new studies and systematic reviews selected by the Editor from journals published just as this issue went into production (approximately 2 months before publication). Studies are noted that might directly influence clinical practice decisions in primary care. Journals hand-searched for the Journal rack are: American Journal of Medicine, American Journal of Preventive Medicine, Annals of Internal Medicine, Circulation, JAMA, Journal of Family Practice, Journal of General Internal Medicine, Journal of the American Board of Family Practice, JNCI, Lancet, New England Journal of Medicine, and Pediatrics.

CardiovascularA prospective study involving 73 743 women age 50-79 found that vigorous exercise and walking achieved similar reductions in the risk of future cardiovascular events. (Manson et al. N Engl J Med Sept 5, 2002;347:716-725.)

CardiovascularA Dutch randomized trial involving 143 patients at increased cardiovascular risk found that nutrition counseling based on stage of readiness for change resulted in lower intake of total and saturated fat at 6 and 12 months than did usual care. (van der Veen et al. J Fam Pract Sept 2002;51:751-758.)

CardiovascularA prospective study of 7814 participants in the Framingham Heart Study found that unlike cardiac or neurologic syncope, vasovagal syncope was not associated with increased cardiovascular morbidity or mortality. (Soteriades et al. N Engl J Med Sept 19, 2002;347:878-885.)

CardiovascularA French randomized trial involving 840 patients presenting with ST-segment elevation within 6 hours of acute myocardial infarction reported that angioplasty and fibrinolysis achieved a similar incidence of the primary outcome. (Bonnefoy et al. Lancet Sept 14, 2002;360:825-829.)

CardiovascularA Norwegian randomized trial in 5477 high-risk patients with acute myocardial infarction found no significant difference between captopril and losartan in terms of all-cause mortality or cardiovascular outcomes, but losartan was better tolerated. (Dickstein et al. Lancet Sept 7, 2002;360:752-760.)

CardiovascularA Norwegian randomized trial involving 3630 patients with myocardial infarction found that either warfarin or the combination of warfarin and aspirin was more effective than aspirin alone in reducing death, nonfatal reinfarction, and thromboembolic stroke, but warfarin increased the incidence of major nonfatal bleeding (0.62% versus 0.17% of patients/treatment-year). (Hurlen et al. N Engl J Med Sept 26, 2002;347:969-974.)

CardiovascularA cohort study involving 2619 patients who were discharged from the hospital after a first myocardial infarction found that those who were smokers and stopped smoking for 3 years lowered their risk of recurrent events to that of non-smokers. (Rea et al. Ann Intern Med Sept 17, 2002;137:494-500.)

CardiovascularA British randomized trial involving 1810 patients with non-ST-segment elevation acute coronary syndromes found that early angiography followed by revascularization resulted in a 34% greater reduction in the composite end point (death, nonfatal myocardial infarction, and refractory angina) than did conservative treatment consisting of symptom-driven angiography. (Fox et al. Lancet Sept 7, 2002;360:743-751.)

Infectious DiseasesA Pakistani randomized trial involving 2000 children with uncomplicated pneumonia found that 3 versus 5 days of amoxicillin did not influence the incidence of treatment failure. (Pakistan MASCOT pneumonia study group. Lancet Sept 14, 2002;360:835-841.)

Infectious DiseasesIn a national survey of 1606 internists and family physicians, 80% reported administering influenza vaccination, but only 27% continued doing so after the peak of influenza activity. Half the respondents said that their practice could generate lists of patients with chronic illness at high risk of influenza complications. (Davis et al. J Gen Intern Med Sept 2002;17:670-676.)

Infectious DiseasesA randomized trial involving 892 female sex workers in four countries found that use of COL-1402, a nonoxynol-9 vaginal gel, was associated with a higher incidence of HIV-1 infection compared with placebo. (Van Damme et al. Lancet Sept 28, 2002;360:971-977.)

Infectious DiseasesA survey of 220 patients with HIV found that those with optimistic beliefs about their prognosis were more likely to report nonadherence to medication and to safe sex. (Holmes and Pace. J Gen Intern Med Sept 2002;17:677-683.)

OncologicA British randomized trial involving 7152 women age 35-70 at increased risk of breast cancer found after 50 months that tamoxifen reduced the risk of breast cancer by 32% compared with placebo, but it increased the incidence of thromboembolic events and deaths from all causes. (IBIS investigators. Lancet Sept 14, 2002;360:817-824.)

OncologicA Swedish cohort study of 30 552 women with breast cancer found that the incidence of ovarian cancer was double that observed among women without breast cancer, and the risk was much higher among those diagnosed with breast cancer before age 40 and those with a family history of breast or ovarian cancer. (Bergfeldt et al. Lancet Sept 21, 2002;360:891-894.)

OncologicFollow-up data from a Canadian trial of mammography screening for women age 40-49 continue to show no evidence of a reduction in breast cancer mortality after 11-16 years. (Miller et al. Ann Intern Med Sept 3, 2002;137(5 part 1):305-312.)

OncologicA meta-analysis of eight randomized trials of mammography screening concluded that it reduces breast cancer mortality by 16%. The numbers needed to undergo screening to prevent one death from breast cancer within 14 years were 838 and 1792, respectively, for women age 50 and older and for women age 40-49. (Humphrey et al. Ann Intern Med Sept 3, 2002;137(5 part 1):347-360.)

OncologicThe rate with which 24 radiologists identified abnormalities in 8734 screening mammograms varied considerably for masses (0-8%), calcifications (0-21%), and fibrocystic changes (2-28%); false-positive rates ranged from 2.6% to 15.9%. (Elmore et al. J Natl Cancer Inst Sept 18, 2002;94:1373-1380.)

PediatricA prospective study of 2379 girls age 9-19 found that physical activity levels declined between ages 9 and 19 in 100% of African American girls and 64% of white girls. By age 16-17, 56% of African American females reported no habitual leisure-time activity. (Kimm et al. N Engl J Med Sept 5, 2002;347:709-715.)

PediatricA cohort study of 9374 adolescents in grades 7 through 12 revealed that those who were depressed at baseline were twice as likely to be obese at follow-up. (Goodman and Whitaker. Pediatrics Sept 2002;110:497-504.)

PediatricA cohort study of adolescents age 10-15 revealed that those who watched 5 or more hours of television per day were 6 times more likely to start smoking than were those who watched for less than 2 hours. (Gidwani et al. Pediatrics Sept 2002;110:505-508.)

PediatricA national survey of 2000 pediatricians and family physicians found that 5-8% routinely screened parents for intimate partner violence during well-child and teen visits. Between 60% and 75% of respondents said that a woman should always be urged to leave her abusive partner immediately. (Borowsky and Ireland. Pediatrics Sept 2002;110:509-516.)

UrologicA Swedish randomized trial involving 695 men with newly diagnosed prostate cancer found that radical prostatectomy, when compared with "watchful waiting," reduced prostate cancer mortality by 50%, had no significant effect on all-cause mortality, but increased the incidence of erectile dysfunction (80% versus 45%) and urinary leakage (49% versus 21%). (Holmberg et al. N Engl J Med Sept 12, 2002;347:781-789; Steineck et al. N Engl J Med Sept 12, 2002;347:790-796.)