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This Week in JAMA
JAMA. 2001;285:9.
Chlamydia Serotype G Associated With Cervical Cancer
Chlamydia trachomatis infection has been associated with an increased risk of cervical squamous cell carcinoma. In this case-control study, Anttila and colleagues (SEE ARTICLE) found that the C trachomatis serotype most strongly associated with invasive cervical squamous cell carcinoma was serotype G, followed by serotypes I and D. The presence of serum IgG antibodies to more than 1 serotype increased the risk of cervical squamous cell carcinoma. In an editorial, Zenilman (SEE ARTICLE) speculates about ways in which C trachomatis might enhance progression of human papillomavirus infection to invasive cervical cancer.
Fludrocortisone Therapy for Chronic Fatigue Syndrome
In preliminary studies of patients with chronic fatigue syndrome and neurally mediated hypotension, symptoms of chronic fatigue syndrome improved when the hypotension was treated. In this randomized trial, however, Rowe and colleagues found that for patients with both chronic fatigue syndrome and neurally mediated hypotension, treatment of hypotension with fludrocortisone acetate monotherapy was no more efficacious than placebo. The proportion of patients who experienced a 15-point or greater improvement in global wellness score was 14% in the fludrocortisone group and 10% in the placebo group.
(SEE ARTICLE)
ADHD and the Use and Costs of Medical Care
To compare the use of health care services and medical care costs among children and adolescents with and without attention-deficit/hyperactivity disorder (ADHD), Leibson and colleagues retrospectively followed up 4119 members of a birth cohort born between 1976 and 1982, 309 of whom met criteria for ADHD. During the 9-year study period, children and adolescents with ADHD were more likely to have comorbid clinical diagnoses in several categories, including major injuries and asthma, compared with children and adolescents without ADHD. Among children and adolescents with ADHD, the proportion with any hospital inpatient, hospital outpatient, or emergency department admission was significantly greater than among those without ADHD, and the 9-year median costs were more than 2 times higher.
(SEE ARTICLE)
Assessment of Reliability of Hair Mineral Analysis
Despite a 1985 study that found that the reliability of hair mineral analysis to assess health status or toxic exposures was poor, an average of 225 000 hair mineral tests costing $9.6 million are performed yearly by 9 laboratories in the United States. Seidel and colleagues (SEE ARTICLE) submitted hair samples cut adjacent to the scalp from a single healthy volunteer to 6 commercial US laboratories. Laboratory differences between highest and lowest reported mineral concentrations for the sample exceeded 10-fold for 12 minerals, and statistically significant extreme values were reported for 14 of the 31 minerals that were analyzed by 3 or more laboratories. Laboratory designations of normal reference values varied widely. In an editorial, Steindel and Howanitz (SEE ARTICLE) discuss possible explanations for the observed disparity in interlaboratory results, but caution physicians about using hair analysis to assess nutritional status until an appropriate normal reference range and reliability of this approach are established.
A 35-Year-Old Woman With Difficulty Breastfeeding
Mrs C, who began breastfeeding her newborn soon after delivery, developed sore, cracked, and painful nipples within 24 hours. She continued breastfeeding, but then developed a lump in 1 breast accompanied by redness, pain, and fever. Lawrence discusses the benefits of breastfeeding, proper technique, preparation of women during pregnancy, and management of breastfeeding problems.
(SEE ARTICLE)
Medical News & Perspectives
The American Academy of Pediatrics is encouraging pediatricians to take an active role in minimizing the impact on children of the entertainment industry's ever-increasing focus on sex and violence.
(SEE ARTICLE)
MSJAMA
Defining disease: Essays on the biomedical and social understanding of disease and implications of assigning diagnostic labels.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about sexually transmitted diseases.
(SEE ARTICLE)
New Online
Index to Collections of JAMA Articles
Collections of JAMA research articles and features—including the Users' Guides to the Medical Literature, The Rational Clinical Examination, Clinical Crossroads, and A Piece of My Mind—are now available in the Department Index on the JAMA Web site.
http://jama.ama-assn.org/info/list_indexes.html
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