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This Week in JAMA
JAMA. 2001;286:2907.
Comparison of SSRIs in Primary Care Patients
Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for the treatment of depression. Kroenke and colleagues (SEE ARTICLE) compared the effectiveness of initial treatment with 3 SSRIs—paroxetine, fluoxetine, and sertraline—in a randomized trial among patients beginning antidepressant therapy in primary care practices. During 9 months of follow-up, amelioration of depression and improvements in other psychological, functional, and health-related quality-of-life outcomes were not significantly different among the 3 treatment groups. In an editorial, Simon (SEE ARTICLE) discusses selection of first-line antidepressant medication and care after the initial prescription, noting that initial treatment with any SSRI drug will not be successful in a substantial minority of patients.
Omalizumab Therapy for Seasonal Allergic Rhinitis
Inflammatory mediators are released from basophils and mast cells when IgE bound to these cells is cross-linked by specific allergens. Omalizumab, a recombinant humanized monoclonal anti-IgE antibody, blocks binding of IgE to inflammatory cells. In this randomized trial, Casale and colleagues (SEE ARTICLE) found that patients with ragweed-induced seasonal allergic rhinitis who received omalizumab, 300 mg for 3 or 4 treatments beginning just prior to the ragweed season, experienced less severe nasal symptoms, used less rescue antihistamine, and had better rhinitis-specific quality of life during the ragweed season compared with patients who received placebo. In an editorial, Plaut (SEE ARTICLE) describes the effects of omalizumab on IgE pathways and discusses other potential immune-based therapies for allergic diseases.
Childhood Hepatitis A Vaccination and Disease Control
Young children are often asymptomatic when infected with hepatitis A virus (HAV) and may play an important role in HAV transmission. Averhoff and colleagues report that following the introduction of routine childhood hepatitis A vaccination in Butte County, California, a large community that had experienced recurrent outbreaks of HAV infection, the community-wide incidence of hepatitis A declined markedly.
(SEE ARTICLE)
Risk of Boating Fatalities Associated With Alcohol Use
Evidence suggests that alcohol use is a risk factor for boating fatalities. In this case-control study of alcohol use and recreational boating fatalities in Maryland and North Carolina, Smith and colleagues found that the risk of death associated with alcohol use increased with increasing blood alcohol concentrations and was significantly increased even at a blood alcohol level of 10 mg/dL.
(SEE ARTICLE)
Structured Treatment Interruptions for HIV Infection
Some patients with HIV infection appear to benefit from structured treatment interruptions—repetitive on-and-off cycles of highly active antiretroviral therapy (HAART)—as an alternative to continuous HAART. In this review of recently published studies on STI, Lori and Lisziewicz evaluate the advantages and potential risks of STI as a treatment option for patients infected with HIV.
(SEE ARTICLE)
Cost-effectiveness of Influencing Physician Behavior
Economic analyses that determine treatment cost-effectiveness generally do not include estimates of costs and benefits of implementation methods to influence treatment use in clinical practice. Mason and colleagues describe a model for estimating the cost-effectiveness of methods to influence physician behavior and apply the model to a recent trial of educational outreach by community pharmacists to influence physician prescribing of angiotensin-converting enzyme inhibitors and antidepressants.
(SEE ARTICLE)
A Piece of My Mind
"A process designed to evaluate my potential as a future colleague had instead shown me a profession that appeared indifferent, demeaning, and horribly out of touch. Did I really want to be a physician?" From "Welcome to the Process."
(SEE ARTICLE)
Medical News & Perspectives
Thirty years after passage of the National Cancer Act, Samuel Broder, MD, former National Cancer Institute director, reflects on successes and failures of the war against cancer.
(SEE ARTICLE)
Cultural Differences and Care at the End of Life
Two case studies—one of an African American couple and the other, a Chinese American family—illustrate issues involved in cross-cultural care at the end of life.
(SEE ARTICLE)
Physicians' Emotions and Patient Care
A medical model for increasing physician awareness of personal emotions during the care of seriously ill patients.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about seasonal allergic rhinitis.
(SEE ARTICLE)
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