To evaluate diabetes mellitus as a risk factor for pancreatic cancer with the consideration that diabetes may also be a consequence of pancreatic cancer.

To evaluate the effect of angiotensin-converting enzyme (ACE) inhibitors on mortality and morbidity in patients with symptomatic congestive heart failure.

To determine if short-term exercise reduces falls and fall-related injuries in the elderly.

A coalition conference of acute resuscitation researchers was held to discuss the feasibility of applying current federal research regulations regarding informed consent to the emergency setting. This article presents consensus recommendations for regulatory changes for consent in emergency research.

OBJECTIVE--Recent clinical, laboratory, and epidemiological evidence that passive smoking causes heart disease was reviewed, with particular emphasis on understanding the underlying physiological and biochemical mechanisms. DATA SOURCES--Publications in the peer-reviewed literature were located via MEDLINE, citation in other relevant articles, and appropriate reports by scientific agencies. Greatest emphasis was given to work published since 1990. CONCLUSIONS--Passive smoking reduces the blood's ability to deliver oxygen to the heart and compromises the myocardium's ability to use oxygen to create adenosine triphosphate. These effects are manifest as reduced exercise capability in people breathing secondhand smoke. Secondhand smoke increases platelet activity, accelerates atherosclerotic lesions, and increases tissue damage following ischemia or myocardial infarction. The effects of secondhand tobacco smoke on the cardiovascular system are not caused by a single component of the smoke, but rather are caused by the effects of many elements, including carbon monoxide, nicotine, polycyclic aromatic hydrocarbons, and other, not fully specified elements in the smoke. Nonsmokers exposed to secondhand smoke in everyday life exhibit an increased risk of both fatal and nonfatal cardiac events.

Evidence that dying occurs as a natural, final event in the wholeness of human life is culturally, artistically, and scientifically persuasive. Very elderly patients eventually undergo a process of functional declines, progressive apathy, and loss of willingness to eat and drink that culminates in death, even in the absence of acute illness or severe chronic disease. Despite clinical resemblances to depression and dementia, aging itself and a loss of will to live are the most probable explanations for natural dying. Acceptance of the naturalness of dying, however, directly conflicts with the medicalization and legalization of death that characterizes modern society's treatment of dying elderly patients. We prefer instead to believe that dying results from disease and injury, which may yield to advances in medical technology. The progressive move of the dying out of the home and into acute and long-term care facilities suggests that medicalization may be an irreversible process. Viewing dying as an independent diagnosis in patients who are obviously undergoing terminal declines from aging and chronic diseases can facilitate communication about spiritual and palliative care needs, which tend to be neglected in the medicalized view of dying. Physicians and nurses may need to assume the role of medical stewardship to help prevent the overtreatment and overtesting of modern medicine's approach to the dying. The emotional burdens of caring for the dying elderly, however, must be addressed openly through collaborative work, institutional policies on limitation of treatment, and support building among physicians and other caregivers.

A meta-analysis of randomized trials was performed to estimate the effectiveness of antibiotics in treating exacerbations of chronic obstructive pulmonary disease (COPD).

In many parts of the developing world, drinking water is collected from unsafe surface sources outside the home and is then held in household storage vessels. Drinking water may be contaminated at the source or during storage; strategies to reduce waterborne disease transmission must safeguard against both events. We describe a two-component prevention strategy, which allows an individual to disinfect drinking water immediately after collection (point-of-use disinfection) and then to store the water in narrow-mouthed, closed vessels designed to prevent recontamination (safe storage). New disinfectant generators and better storage vessel designs make this strategy practical and inexpensive. This approach empowers households and communities that lack potable water to protect themselves against a variety of waterborne pathogens and has the potential to decrease the incidence of waterborne diarrheal disease.

To develop a set of minimum clinical guidelines for use by primary care physicians in the evaluation and management of patients with hyperthyroidism and hypothyroidism.

To assess the evidence for a cause-and-effect relationship between Helicobacter pylori infection and antral gastritis, peptic ulcer disease, and recurrent abdominal pain in children.

To provide physicians with a current consensus on screening, prevention, diagnosis, and treatment of ovarian cancer.

To develop a consensus on the use of antenatal corticosteroids for fetal maturation in preterm infants.

To determine if inadequate approaches to randomized controlled trial design and execution are associated with evidence of bias in estimating treatment effects.

To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.