CHICAGO—A survey of U.S. medical schools shows that the number of full time faculty members has increased, the number of enrolled students has remained steady, and approximately half of applicants and entering students are women, according to an article in the September 1 issue of JAMA.

Barbara Barzansky, Ph.D., and Sylvia I. Etzel, of the American Medical Association, Chicago, examined data from the 2003 - 2004 Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire and the Association of American Medical Colleges (AAMC) Directory of American Medical Education. The LCME questionnaire was sent to the deans of the 126 LCME-accredited medical schools, with a 100 percent response rate.

The LCME questionnaire recorded a 4.6 percent increase in the number of full-time medical school faculty members, from 109,526 in 2002 - 2003, to 114,549 in 2003 - 2004. Forty-eight percent of medical school deans stated they held an additional academic title, such as vice president or president. Deans also showed a high turnover rate, with only 41 of 125 in the same position in the fall of 2004 as five years prior.

For the 2003 entering class, the number of U.S. medical school applicants increased by 3.5 percent from the previous year, to 34,786, the first increase since 1996. Of all the applicants to U.S. medical schools in 2003, 51 percent were women, marking the first time that they were the majority of applicants. For the 2003 - 2004 academic year, the enrollment in U.S. medical schools was 67,166 students, 47.9 percent (n = 32,146) of which were women. Of the 15,996 individuals projected to graduate in 2004, 45.9 percent were women.

CHICAGO—The number of physicians in graduate medical education is at its highest, at about 100,000, according to an article in the September 1 issue of JAMA.

Sarah E. Brotherton, Ph.D., and colleagues from the American Medical Association, Chicago, analyzed data from the National GME (Graduate Medical Education) Census, a survey jointly administered by the American Medical Association and Association of American Medical Colleges on 8,192 residency programs. These specialty and subspecialty programs were surveyed about active, transferred, and graduated residents.

In the 2003 - 2004 academic year, there were 99,964 active medical residents, the highest number ever recorded by the National GME Census. The survey also noted the greatest number of residents entering U.S. medical education programs for the first time (n = 22,444). In 2003, there were 29,745 medical school graduates, compared to 28,773 in 1999. Of the 2003 graduates, 11,681 (39.3 percent) were women, a 10.8 percent increase from 1999.

From 1998-1999 to 2003-2004, several specialties experienced a decrease in male graduates, while the number of female graduates increased. Male graduates of obstetrics/gynecology decreased by 31.3 percent, while female graduates increased by 18.2 percent. Dermatology, family medicine, internal medicine, ophthalmology, pathology, psychiatry, and general surgery showed a similar shift. The authors also noted that the number of subspecialty programs had increased by 13 percent over the past six years, from 3,561 to 4,023.

In 2003, 50.7 percent of programs provided opportunities to develop cultural competence, in order for physicians to improve their ability to communicate better with patients with various cultural backgrounds; 35.7 percent of programs provided such options in 2000. Despite this expansion, the proportion of programs offering instruction in non-English languages has decreased by 12 percent.

CHICAGO—Women who have breast cancer detected by mammography screening have a reduced risk of distant tumor recurrence than women with breast cancer detected outside of screening, according to a study in the September 1 issue of JAMA.

The incidence of cancerous tumors detected by mammography screening is increasing due to its expanding use, according to background information in the article. Selection of therapies for women diagnosed as having breast cancer is based on risk estimations for cancer recurrence.

Heikki Joensuu, M.D., of Helsinki University Central Hospital, Helsinki, Finland, and colleagues compared the survival outcomes of women with cancerous tumors detected by mammography screening with women whose tumors were detected outside of screening. The study included 2,842 women identified from the Finnish Cancer Registry as having breast cancer in 1991 or 1992. The average follow-up time was 9.5 years. The clinical, histopathological and biological features of the tumors were compared.

The researchers found that women with cancerous tumors detected by mammography screening had better estimated 10-year distant (other location in the body) disease-free survival than women with tumors found outside of screening. In analysis that included factors related to the biological aspects of the cancers, women with tumors detected outside of screening had a 90 percent increased risk for distant recurrence than women with tumors detected by mammography screening.

CHICAGO—A review of the medical literature suggests that older persons with systolic hypertension (and systolic blood pressure of at least 160 mm Hg) should receive treatment, according to a study in the September 1 issue of JAMA.

Systolic hypertension (SH), defined as systolic blood pressure (SBP) of at least 140 mm Hg and diastolic blood pressure (DBP) of less than 90 mm Hg, is a major public health issue that predominantly affects older individuals, according to background information in the article. A major message of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) is that in older persons (those aged 60 years and older), SH is a much more important cardiovascular disease risk factor than diastolic hypertension, and consequently, the control of SBP should be the focus of treatment in this population. Despite this recommendation, poor control of SH is increasing. A recent study examining trends in hypertension control found that isolated elevation of SBP was the most common finding among patients being treated for hypertension (high blood pressure), occurring in 76 percent of patients in 1999 compared with 57 percent in 1990-1995.

Sarwat I. Chaudhry, M.D., of the West Haven Veterans Affairs Medical Center, West Haven, Conn., and colleagues examined the evidence on the clinical management of SH in older persons by reviewing previous studies. The researchers performed a MEDLINE search for relevant reports from 1966-2004 and identified 1,064 studies, of which 36 articles met criteria they established for inclusion in their review.

In analyzing the studies, the researchers found: "There is strong evidence from clinical trials to support the treatment of SH in older persons with SBP of at least 160 mm Hg. Large-scale trials to assess the value of antihypertensive therapy for older patients with SBP of 140 to 159 mm Hg have not been performed, and recommendations to treat these patients are based on observational studies that show a graded relationship of cardiovascular risk with increasing SBP. The studies most strongly support the use of thiazide diuretics and long-acting calcium channel blockers as first-line therapy to treat SH."

" ...recent work demonstrates the long-term (11-14 years) effectiveness of treating SH in reducing cardiovascular events. Despite this effectiveness, poor control of SH among patients seeking treatment for hypertension is increasing," the authors write.

SYSTOLIC HYPERTENSION SHOULD NOT GO UNTREATED IN THE ELDERLY