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This Week in JAMA
JAMA. 2001;286:3047.
EBV Antibodies and Risk of Multiple Sclerosis
The cause of multiple sclerosis is not known, but an infectious etiology or an autoimmune response to an infectious or other agent are leading possibilities. Ascherio and colleagues (SEE ARTICLE) analyzed data from 2 large prospective cohort studies of US women, the Nurses' Health Study and Nurses' Health Study II, to determine whether elevation in serum antibody titers to Epstein-Barr virus preceded the onset of multiple sclerosis. The 18 women who developed definite multiple sclerosis and who had blood samples collected prior to disease onset had significantly higher serum antibodies to Epstein-Barr virus compared with matched control study participants. In an editorial, Gilden (SEE ARTICLE) reviews research on the etiology of multiple sclerosis and suggests approaches for future investigation.
Adverse Childhood Experiences and Suicide Risk
Suicide is a leading cause of death in the United States, especially among young persons and older adults. In this analysis of data from the Adverse Childhood Experiences Study, a retrospective cohort study of 17 337 adults, Dube and colleagues (SEE ARTICLE) found that self-reported adverse childhood experiences in any of 8 categories increased the risk of attempted suicide 2- to 5-fold. Zametkin and coauthors (SEE ARTICLE) , in a Grand Rounds at the Clinical Center of the National Institutes of Health, present a case of a 16-year-old girl who committed suicide and discuss the assessment, management, and prevention of teenage suicide. In a commentary, Keith (SEE ARTICLE) discusses risk factors for adolescent suicide and interventions for suicidal patients.
Intranasal Corticosteroid Therapy for Acute Sinusitis
Previous studies evaluating whether intranasal corticosteroid therapy improves clinical outcomes in patients with acute rhinosinusitis have been inconclusive. Dolor and colleagues randomly assigned adults with a history of recurrent sinusitis or chronic rhinitis and evidence of acute infection to receive intranasal fluticasone in addition to cefuroxime or cefuroxime alone. Patients who received intranasal fluticasone in addition to antimicrobial therapy improved more rapidly and had higher rates of clinical success than did patients who received antimicrobial therapy alone.
(SEE ARTICLE)
Persistent HPV Infection and Cervical Neoplasia
To assess the risk of cervical cancer precursor lesions in relation to prior and cumulative human papillomavirus (HPV) infection, Schlecht and colleagues conducted a prospective study of women with no cervical cytological lesions at enrollment who were followed up for up to 6 years. Cervical specimens were obtained for Papanicolaou cytology and HPV testing every 4 months for 1 year and twice yearly thereafter. Women with persistent HPV infection, particularly with oncogenic types, had a significantly higher risk of incident squamous intraepithelial lesions compared with women who had negative HPV test results at the first 2 visits.
(SEE ARTICLE)
Quinolones and False-Positive Opiate Urine Screening
Immunoassays to screen urine samples for illicit opiate use are considered to be reliable, and results may be accepted without confirmatory testing with other techniques. Baden and colleagues report, however, that 9 of 13 tested quinolone antimicrobials caused immunoassay results above the threshold for a positive test result in at least 1 of 5 commercial opiate screening immunoassays.
(SEE ARTICLE)
A Piece of My Mind
"I think it's easy to forget about the power of compassion when we are focused so often on the power of science." From "The Subtle Power of Compassion."
(SEE ARTICLE)
Contempo Updates
Neurosurgical treatments for Parkinson disease.
(SEE ARTICLE)
Medical News & Perspectives
To bolster physicians' "special place in society" and reaffirm commitment to patients, internal medicine specialists are promulgating the Physician Charter of Professionalism. Another effort to improve patient care is Pennsylvania's new Regional Medication Safety Program for Hospitals, poised to become a national model.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about adolescent suicide.
(SEE ARTICLE)
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