JAMA : the journal of the American Medical Association
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Because of an explosive increase in the use of emergency rooms in hospitals across the country, many hospitals have found it expedient to employ full-time emergency physicians. The demand for emergency physicians has prompted the development of training programs in emergency medicine in academic medical centers. ⋯ With the increasing identification and distribution of emergency physicians, there has been an attempt to develop emergency medicine as a distinct discipline and to establish its legitimacy in the structure of academic medical centers. A variety of problems must be addressed to clarify the role of emergency medicine in the academic setting.
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Analysis of the association between oral contraceptive use and the development of myocardial infarction in women less than 50 years of age shows that cigarette smoking is the most important factor in increasing the likelihood of myocardial infarction. This effect is independent of oral contraceptive use but oral contraceptive use also appears to be a risk factor; however, their use in the absence of other predisposing factors appears to have only a small effect on increasing the risk of dying from myocardial infarction. This small increase is of the same order of magnitude as the increased risk of death from thromboembolic disease. Oral contraceptive users more than 30 years of age who have other factors that increase the likelihood of myocardial infarction appear to have a substantially higher death rate.