CHICAGO—About half of all deaths in the U.S. can be attributed to largely preventable behaviors and exposures, with tobacco use and poor diet/physical inactivity accounting for the majority of preventable deaths, according to a study in the March 10 issue of the Journal of the American Medical Association (JAMA).

According to background information in the article, quantifying modifiable behavioral risk factors, which are the leading causes of death in the United States, will provide insight into the effects of recent trends and indicate missed prevention opportunities.

Ali H. Mokdad, Ph.D., and colleagues from the Centers for Disease Control and Prevention, Atlanta, conducted a study to identify and quantify the leading causes of death in the United States. The study included a comprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality (death). Prevalence and relative risk were identified during the literature search. The researchers used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of actual cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data.

The researchers found that the leading causes of death in 2000 were tobacco (435,000 deaths; 18.1 percent of total U.S. deaths), poor diet and physical inactivity (400,000 deaths; 16.6 percent), and alcohol consumption (85,000 deaths; 3.5 percent).

Other actual causes of death were microbial agents (i.e., influenza and pneumonia, 75,000), toxic agents (exposure to pollutants, asbestos, etc., 55,000), motor vehicle crashes (43,000), incidents involving firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000).

CHICAGO—Researchers have found an association between drinking coffee and a reduced risk for type 2 diabetes in Finnish adults, according to a study in the March 10 issue of the Journal of the American Medical Association (JAMA).

Only a few studies of coffee consumption and diabetes mellitus (DM) have been reported, even though coffee is the most consumed beverage in the world, according to background information in the article.

Jaakko Tuomilehto, M.D., Ph.D., of the National Public Health Institute, Helsinki, Finland and colleagues conducted a large study aimed at determining whether the suggested inverse relationship between coffee and type 2 DM exists. The study was conducted among the Finnish population, who have the highest per capita coffee consumption in the world.

The study combined surveys conducted in 1982, 1987, and 1992 of 6,974 Finnish men and 7,655 women aged 35 to 64 years without a history of stroke, coronary heart disease, or DM at baseline. Coffee consumption and other study parameters were determined at baseline using standardized measurements.

The researchers found that the risk of developing diabetes decreased as the amount of daily coffee consumed increased. For women, drinking 3-4 cups of coffee a day was associated with a 29 percent reduced risk of diabetes; 10 or more cups a day, a 79 percent reduced risk.

For men, drinking 3-4 cups of coffee a day was associated with a 27 percent lower risk for diabetes; 10 or more cups a day, a 55 percent lower risk.

CHICAGO—Pediatricians and other pediatric clinicians who use individualized clinical judgment in treating infants with fevers can effectively diagnose serious illnesses and provide appropriate follow-up care, even when not following all the current clinical guidelines on how to manage such cases, according to a study in the March 10 issue of the Journal of the American Medical Association (JAMA).

According to background information in the article, infants with fevers (febrile infants) often lack the symptoms necessary for physicians to distinguish between a minor illness and one that is life-threatening. "To avoid the consequences of failing to detect serious bacterial illness (SBI), such as bacteremia (bacteria in the blood) and bacterial meningitis, a variety of clinical strategies have been developed to identify infants at high and low risk, including policies that require extensive laboratory testing, hospitalization, and treatment with intravenous antibiotics." The authors add that previous studies indicate that a large proportion of office-based physicians do not routinely follow these guidelines.

In this study, Robert H. Pantell, M.D., from the University of California, San Francisco and colleagues evaluated data from 3,066 infants aged 3 months or younger with temperatures of at least 38 degrees Celsius (100.4 degrees Fahrenheit) who were seen by physicians from February 28, 1995 through April 25, 1998. The 573 practitioners in the study were part of the Pediatric Research in Office Settings (PROS) network of the American Academy of Pediatrics in 44 states, the District of Columbia, and Puerto Rico.

"The PROS clinicians hospitalized 36 percent of the infants, performed laboratory testing in 75 percent, and initially treated 57 percent with antibiotics," the authors report. "The majority (64 percent) were treated exclusively outside of the hospital. Bacteremia was detected in 1.8 percent of infants (2.4 percent of those tested) and bacterial meningitis in 0.5 percent." The authors found that the physicians followed current guidelines in 42 percent of episodes.

OBESITY, TOBACCO LEADING CAUSES OF PREVENTABLE DEATHS