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Nancy L. Keating, MD, MPH; Paul D. Cleary, PhD; Alice S. Rossi, PhD; Alan M. Zaslavsky, PhD; and John Z. Ayanian, MD, MPP

Sociodemographic factors, such as region and education, may be more strongly associated with use of hormone replacement therapy than are clinical factors, such as risk for cardiovascular disease.

Topics: hormone replacement therapy, postmenopause, women, hysterectomy
  
Clemens von Schacky, MD; Peter Angerer, MD; Wolfgang Kothny, MD; Karl Theisen, MD; and Harald Mudra, MD

Dietary intake of ω-3 fatty acids modestly mitigates the course of coronary atherosclerosis in humans.

Topics: atherosclerosis, fatty acids, diet, double-blind method, coronary angiography, fish oil
  
Kenneth E. Covinsky, MD, MPH; Eva Kahana, PhD; Marshall H. Chin, MD, MPH; Robert M. Palmer, MD, MPH; Richard H. Fortinsky, PhD; and C. Seth Landefeld, MD

Depressive symptoms are associated with long-term mortality in older patients hospitalized with medical illnesses. This association is not fully explained by greater levels of comorbid illness, functional impairment, and cognitive impairment in patients with more symptoms of depression.

Topics: mortality, elderly, depressive disorders
  
Veronica Miller, PhD; Amanda Mocroft, PhD; Peter Reiss, MD; Christine Katlama, MD; Anthony I. Papadopoulos, MD; Terese Katzenstein, MD; Jan van Lunzen, MD; Francisco Antunes, MD; Andrew N. Phillips, PhD; Jens D. Lundgren, MD, for the EuroSIDA Study Group*

Increases in CD4 counts from very low levels to at least 200 cells/mm3 are associated with a reduced rate of disease progression. However, a previously low CD4 cell count nadir remains associated with a moderately high risk for disease progression among patients with CD4 cell counts of at least 200 cells/mm3.

Topics: cd4 count determination procedure, disease progression, hiv-1, anti-retroviral agents
  
Olli T. Raitakari, MD, PhD; Mark R. Adams, MB, BS, PhD, FRACP; Robyn J. McCredie, BSc; Kaye A. Griffiths, DMU; and David S. Celermajer, MB, BS, PhD, FRACP

In healthy young adults, arterial endothelial dysfunction related to passive smoking seems to be partially reversible.

Topics: endothelial dysfunction, passive smoking
  
Eduardo R. Locatelli, MD; Jacob P. Varghese, MD; Ashfaq Shuaib, MD; and Samuel J. Potolicchio, MD

This report describes three patients with asystole or bradycardia associated with complex partial seizures and reviews the relevant literature.

Topics: cardiac arrest, bradycardia, temporal lobe, seizure, complex partial
  
Karl A. Sporer, MD

This Update reviews the clinically relevant pharmacology of heroin and naloxone, the epidemiology of fatal and nonfatal heroin overdose, the clinical diagnosis of heroin overdose, appropriate treatment, complications, and prevention strategies.

Topics: heroin, naloxone, heroin overdose, overdose
  
Moderator: Stephen E. Straus, MD; Discussants: Michael Sneller, MD; Michael J. Lenardo, MD; Jennifer M. Puck, MD; and Warren Strober, MD

The autoimmune lymphoproliferative syndrome is a recently defined illness that arises in early childhood and is associated with prominent nonmalignant lymphadenopathy, hepatosplenomegaly, and autoimmune manifestations. This syndrome affords novel insights into the mechanisms that regulate lymphocyte homeostasis and underlie the development of autoimmunity.

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The results of Keating and colleagues' study, reported in this issue, suggest that we may have many more questions to ask and answer about our female patients and how we collaborate with them to find out whether they should use hormone replacement therapy.

Topics: hormone replacement therapy
  

As highlighted by Steiner's paper in this issue, evidence-based medicine must grapple with the fact that in the individual patient, one of its pillars—probability—is ambiguous and elusive, no matter how we choose to communicate it.

Topics: seizures, evidence-based medicine, urinary bladder calculi, calculi, conception, risk reduction, puerperal sepsis, ...
  

The shortage of transplantable organs hits the African-American community disproportionately hard. What is responsible for this shortage, and what can be done about it?

Topics: altruism, organ donation, african american
  
Bhuvana Chandra, MD

He greeted me as he always did, hands folded weakly together in the gesture of respect that is ubiquitous in India.

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J. Carlos Ayus, MD; and Allen I. Arieff, MD
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I. Maurice Ndukwu, MD, MPH; Jane E. Dematte, MD; and Karen O'Mara, DO
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William W. Merrill, MD
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William S. Beckett, MD, MPH
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Lawrence W. Raymond, MD
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David G. Kern, MD; Robert S. Crausman, MD; and Charles Kuhn III, MD
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David G. Kern, MD; Robin K. Kern, JD; and Kate T.H. Durand, MHS, CIH
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Anna B. Reisman, MD; and Cary P. Gross, MD
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Ross Andersen, PhD; Shawn Franckowiak, BS; and Susan Bartlett, PhD
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Daniel G. Federman, MD; and Robert S. Kirsner, MD
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As physicians, we need to become bilingual—we must speak the language of populations as well as the language of individual patients. If we are fluent in both languages, we remind ourselves that we offer our patients choices, not treatments, and we remind our patients that whatever their treatment choices, the outcomes of health care are uncertain.

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Kenneth R. Hande, MD
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Jennifer Best
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