September 5, 2002
Decline in Physical Activity in Girls during Adolescence
In this longitudinal study of black girls and white girls, the authors measured habitual levels of recreational activity from the age of 8 or 9 through the age of 18 or 19 years. The level of physical activity declined precipitously over time, so that by the age of 18 or 19, 56 percent of black girls and 31 percent of white girls reported no habitual recreational activity. Predictors of declines in physical activity among black girls, white girls, or both included lower levels of parental education, higher body-mass index, pregnancy, and cigarette smoking. This study demonstrates substantial declines in girls' physical activity during adolescence, which are greater for black girls than for white girls. These data suggest the need for interventions to maintain or increase activity levels in adolescence.
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Walking Compared with Vigorous Exercise for Prevention of Coronary Events in Women
It is generally accepted that physical activity reduces the risk of coronary events. This study focused on whether walking, an activity of only moderate intensity, protects against coronary events in postmenopausal women. Walking was associated with risk reductions similar to those associated with vigorous exercise. The findings applied equally to both white women and black women. The findings are important for women's health, because walking is an activity preferred by many women. The study shows that among postmenopausal women, brisk walking for at least 2.5 hours per week is associated with a 30 percent reduction in the risk of coronary events — a finding of considerable public health importance.
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Prevention of Deep-Vein Thrombosis with Reviparin
This randomized, placebo-controlled trial assessed the efficacy and safety of reviparin, a low-molecular-weight heparin, in reducing the risk of deep-vein thrombosis in patients requiring prolonged immobilization after a leg fracture or rupture of the Achilles tendon. Deep-vein thrombosis (in a distal segment, in most cases) was documented by venography in 19 percent of the patients in the placebo group and 9 percent of those in the reviparin group, indicating that active therapy halved the risk. The incidence of bleeding and other adverse events did not differ significantly between the groups. Deep-vein thrombosis is common after leg injury requiring prolonged immobilization, and its occurrence is reduced by reviparin therapy. Whether such therapy is warranted routinely requires further study.
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Brief Report: A Patient with HIV-1 Superinfection
An HIV-1–infected patient had a rebound in viremia when antiviral therapy was discontinued as part of a vaccine research protocol. Careful studies showed that this patient was infected initially with subtype AE of the virus but then became infected with subtype B. There was no evidence of dual infection, so the data indicate that this is a case of superinfection with a different strain of HIV-1. Natural infection does not necessarily produce cross-clade protection, a finding that may have implications for the development of a vaccine against HIV-1.
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Medical Progress: IgA Nephropathy
IgA nephropathy is the most common form of primary glomerulonephritis in the world and is also the most common cause of end-stage renal disease in patients with primary glomerulopathy. This article discusses current views on the pathogenesis, pathophysiology, clinical course, and treatment of this important glomerular disease. Although clinical trials have suggested that therapies such as glucocorticoids, n–3 fatty acids, and angiotensin-converting–enzyme inhibitors are efficacious, more definitive treatment is being sought.
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Clinical Problem-Solving: Out of Africa
A 42-year-old man who had been a human-rights leader in the Democratic Republic of Congo presented with emotional distress and difficulty coping. He had been tortured while imprisoned during the recent civil war and was having personal and financial difficulties. A mental-status examination revealed delusional thinking. Physical examination was normal, and routine laboratory testing was remarkable only for a normochromic, normocytic anemia.
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Sounding Board: Nonfinancial Conflicts of Interest
The dramatic growth in associations between investigators and industry has raised appropriate concern about financial conflicts of interest. Investigators are also faced with potent nonfinancial conflicts of interest. Because career advancement in academic medicine depends on grant awards and research publications, investigators have strong personal interests in the successful completion of their research studies, which often involve human subjects. In this essay, the author explores how nonfinancial interests of investigators can be at odds with the interests of research subjects and outlines an approach to better management of nonfinancial conflicts of interest.
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