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This Week in JAMA
JAMA. 2000;284:1481.
Minor Depression and Dysthymia in Older Adults
Little evidence is available to guide therapy for common depressive disorders less severe than major depression. Williams and colleagues (SEE ARTICLE) conducted a randomized trial in 4 primary care practices comparing paroxetine, psychotherapy adapted specifically for primary care, and placebo for the treatment of older patients with minor depression or dysthymia. During the 11-week trial, depressive symptom scores decreased in all treatment groups. Symptom reduction in the 2 active treatment groups was similar, but only the change in the paroxetine group was significantly greater than that in the placebo group. In an editorial, Gallo and Coyne (SEE ARTICLE) question whether current diagnostic categories and pathophysiologic concepts of depression are applicable to depression in older adults and emphasize the importance of conducting mental health research in primary care settings.
Alcohol-Related Injury and Age of Drinking Onset
Alcoholism is a major risk factor for unintentional injury, but almost one third of persons injured while under the influence of alcohol have never met criteria for alcohol dependence. To determine whether early age of drinking onset is associated with increased risk of alcohol-related injury, Hingson and colleagues analyzed data from the 1992 National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey of US adults aged 18 years or older. Respondents who began drinking before age 21 years were significantly more likely to have been injured while under the influence of alcohol than were respondents who began drinking at age 21 years or older, even after controlling for alcohol dependence.
(SEE ARTICLE)
Dietary Whole Grains and Ischemic Stroke in Women
Higher dietary intake of whole grains has been associated with a decreased risk of coronary heart disease morbidity and mortality in women. To determine whether whole grain consumption reduces the risk of ischemic stroke, Liu and colleagues analyzed data from 75,521 women enrolled in the Nurses' Health Study. During 12 years of follow-up, 352 cases of ischemic stroke occurred. Higher intake of whole grain foods was associated with a lower risk of ischemic stroke, independent of known cardiovascular disease risk factors.
(SEE ARTICLE)
Raw Oysters and an Outbreak of Vibrio Gastroenteritis
Current US safety regulations may be inadequate to prevent illness caused by ingesting contaminated shellfish. In this investigation of an outbreak of acute gastroenteritis in May and June 1998, Daniels and colleagues estimate that approximately 200,000 people may have become ill after eating oysters harvested from Galveston Bay. The oyster harvest met bacteriologic standards, and fecal coliform counts in water samples were acceptable. All available stool specimens from affected persons yielded Vibrio parahaemolyticus serotype O3:K6 isolates, the first reported isolation of this serotype in the United States.
(SEE ARTICLE)
Platelet Glycoprotein IIB/IIIA Inhibitor Therapy
In this review of 10 trials of platelet glycoprotein IIb/IIIa inhibitor therapy for acute coronary syndromes, Bhatt and Topol conclude that current data support its intravenous use at the time of urgent angiography with percutaneous coronary revascularization or for initial medical management in the emergency department.
(SEE ARTICLE)
A 26-Year-Old Woman With Shoulder Pain
Mrs B is a 26-year-old physical education teacher who has had bilateral shoulder pain for about 4 years. Treatment with subacromial corticosteroid injections, physical therapy, and ibuprofen has provided only partial, temporary relief. Burkhart describes common conditions that cause shoulder pain and dysfunction, and diagnostic assessment and treatment.
(SEE ARTICLE)
A Piece of My Mind
"Lesson 12: All physicians become patients." From "Twenty Lessons From the Heart of Medicine."
(SEE ARTICLE)
Contempo Updates
Diagnosis and treatment of obstructive sleep apnea syndrome.
(SEE ARTICLE)
Medical News & Perspectives
The head of the new Office of Human Research Protection says that clinical researchers who fail to protect study participants will be put out of business.
(SEE ARTICLE)
Peristomal Pyoderma Gangrenosum
Clinical manifestations, diagnosis, and treatment of peristomal pyoderma gangrenosum.
(SEE ARTICLE)
Gender Verification in the Olympics
Simpson and coauthors encourage support for the recent decision of the International Olympic Committee to discontinue gender verification procedures during the Olympic Games.
(SEE ARTICLE)
End-of-Life Discussions
Strategies to overcome barriers to conversations at the end of life between patients and health care professionals.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information on symptoms and types of depression.
(SEE ARTICLE)
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