CHICAGO—High levels of C-reactive protein are associated with an increased risk of developing high blood pressure, according to an article in the December 9 issue of The Journal of the American Medical Association (JAMA).

Increased levels of C-reactive protein are associated with chronic activation of the immune system, otherwise known as an inflammatory response, according to background information in the article. High C-reactive protein levels have also been linked to an increase risk of heart attack and stroke. Because of this association, some researchers believe that hypertension (high blood pressure) may be in part an inflammatory disorder.

Howard D. Sesso, Sc.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues examined whether C-reactive protein levels were associated with hypertension.

The researchers studied 20,525 women who participated in the Women's Health Study, which started in 1992. Women participating in this study were 45 years or older at the beginning of the study, and had normal blood pressures (systolic blood pressure less than 140 mm Hg; diastolic blood pressure less than 90 mm Hg). Blood samples collected at the beginning of the study were used to measure C-reactive protein levels. Women were followed up for a median of 7.8 years (half the women were followed up longer than 7.8 years, half were followed up less than 7.8 years) for the development of hypertension.

Over the follow-up period, 5,365 women developed high blood pressure. The researchers found that "Overall, there was a positive association between increasing levels of C-reactive protein and risk of developing hypertension," the authors write. Participants with the highest levels of C-reactive protein measured at the beginning of the study were about twice as likely to develop hypertension.

CHICAGO—Smoking, drinking alcohol at or above moderate levels, or having a first degree relative with colorectal cancer are associated with an increased risk for having serious colon polyps, according to an article in the December 9 issue of The Journal of the American Medical Association (JAMA).

Colorectal cancer is the second leading cause of cancer death in North America, according to background information in the article. Evidence exists that screening asymptomatic populations beginning at age 50 years can reduce death due to colorectal cancer and that removal of precursor tumors may reduce the incidence of colorectal cancer. Identification of important risk factors for advanced colonic tumors could inform both risk stratification and development of risk reduction strategies. Few studies have evaluated risk factors for advanced colorectal tumors in asymptomatic individuals, compared risk factors between persons with and without polyps, or included most purported risk factors in a multivariate analysis.

David A. Lieberman, M.D., of the Department of Veterans Affairs Medical Center, Portland, Ore., and colleagues conducted a study to determine the risk factors associated with advanced colorectal neoplasia (tumors) in a group of asymptomatic persons with complete colonoscopy. The study, conducted between February 1994 and January 1997, included 3,121 asymptomatic patients aged 50 to 75 years from 13 Veterans Affairs medical centers. All participants had complete colonoscopy to determine the prevalence of advanced neoplasia. Variables examined included history of first-degree relative with colorectal cancer, prior cholecystectomy (surgical removal of the gall bladder), serum cholesterol level, physical activity, smoking, alcohol use, and dietary factors.

A total of 329 participants had advanced neoplasia and 1,441 had no polyps. The researchers found positive associations for history of a first-degree relative with colorectal cancer (66 percent increased risk), current smoking (85 percent increased risk), and current moderate to heavy alcohol use and colon neoplasia.

Patients had a lower risk for advanced neoplasia with cereal fiber intake (greater than 4.2 grams/.15 ounces a day), vitamin D intake of greater than 645 IU/d, and daily use of nonsteroidal anti-inflammatory drugs (NSAIDs, 34 percent lower risk). Marginal factors included physical activity, daily multivitamin use, and intake of calcium and fat derived from red meat. No association was found for body mass index, prior cholecystectomy, or serum cholesterol level. Risk variables were similar to those for patients with no polyps, except that past and current smoking were associated with an increased risk of polyps.

CHICAGO—The number of reported cases of the respiratory illness pertussis among infants increased in the 1990s, according to an article in the December 9 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, pertussis is characterized by a cough that can last for several weeks. In the prevaccine era, pertussis was a major cause of illness and death among infants and children in the United States, with an average of more than 160,000 cases and more than 5,000 deaths reported annually in the 1920s and 1930s. After the introduction of a pertussis vaccine in the 1940s, reported cases decreased more than 99 percent, reaching approximately 1,000 in 1976. After 1976, the number of reported cases of pertussis progressively increased, despite increasingly high rates of vaccination among infants and children.

Masahiro Tanaka, M.D., M.Sc., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study to determine the trends and characteristics of reported cases of pertussis among infants younger than 12 months of age in the United States from 1980 to 1999. The researchers used data reported to the National Notifiable Disease Surveillance System of the Centers for Disease Control and Prevention between 1980 and 1999, and detailed case data from the Supplementary Pertussis Surveillance System.

The authors found that the incidence of reported cases of pertussis among infants increased 49 percent in the 1990s compared with the incidence in the 1980s (19,798 vs. 12,550 cases reported; 51.1 cases vs. 34.2 cases per 100,000 infant population, respectively). "Increases in the incidence of cases and the number of deaths among infants during the 1990s primarily were among those aged four months or younger, contrasting with a stable incidence of cases among infants aged five months or older. The proportion of cases confirmed by bacterial culture was higher in the 1990s than in the 1980s (50 percent and 33 percent, respectively); the proportion of hospitalized cases was unchanged (67 percent vs. 68 percent, respectively). Receipt of fewer doses of vaccine was associated with hospitalization, when cases were stratified by age in months."

"The increase in reported cases of pertussis among young infants may have resulted from several factors, including a real increase in disease, increased awareness of pertussis among clinicians, or improved surveillance activities," the authors write. "We believe that the increase of reported cases among infants reflects a real increase in B pertussis disease and is not an artifact from the surveillance system ..."

CHICAGO—A perception exists among medical school deans and state medical society executives that shortages of physicians exist, particularly in the non-primary care specialties, according to an article published in the December 9 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, "analyses of trends in health care indicate that, at current rates of production, there will be too few physicians to meet future needs. This conclusion is supported by warnings of physician shortages by some medical specialty organizations and state medical societies as well as by signals from the marketplace, which indicate that young physicians are in greater demand and that patients are having greater difficulty in accessing physicians."

Richard A. Cooper, M.D., from the Medical College of Wisconsin, Milwaukee, and colleagues conducted telephone and Internet surveys with medical school deans and state medical society officials to determine their perceptions about the status of physician supply in their regions and whether, if more physicians were needed, that medical schools could expand. A total of 73 (58 percent) of 126 medical school deans and 44 (86 percent) of medical society executives responded to the survey.

"Of the 70 responding deans from mainland schools, 62 (89 percent) cited shortages of physicians in at least one specialty," the authors report. "Six deans (9 percent) also reported surpluses and 8 others (11 percent) were either uncertain or believed that there were no shortages or surpluses." The authors note that most frequently cited shortages were in anesthesiology (50 percent) and radiology (44 percent). Other medical subspecialties noted for apparent shortages were cardiology, gastroenterology, and geriatrics. Among surgical specialties, shortages were noted in both general surgery (17 percent) and the surgical subspecialties (21 percent). "Shortages within the adult primary care disciplines were cited by 30 percent of responding deans," the authors add.

"The 44 responses from state medical society executives were similar to those of the deans, with 82 percent reporting shortages of physicians in at least one specialty," the authors continue. "Physician shortages in medical subspecialties were cited most often (43 percent); surgical subspecialists were cited by 30 percent and shortages in general and/or trauma surgery by 14 percent. Six other specialties that frequently were cited were anesthesiology, psychiatry, emergency medicine, dermatology, radiology, and neurology, with the shortages in anesthesiology and radiology being characterized as most severe."

"... More than 80 percent of the deans surveyed who commented on the impact of shortages on their schools noted negative effects on faculty recruitment and retention, clinical education, clinical revenues, and related matters." The authors found that there is limited potential for medical schools to expand. "Recent or planned increases in class size were reported by 27 percent of deans and expansion capacity by another 34 percent, but 7 percent noted recent decreases in class size." They add that these changes in class size might be able to produce another 7.6 percent medical school graduates each year.

CDC TRACKS LARGE INCREASE IN SERIOUS INFANT WHOOPING COUGH CASES IN U.S.