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This Week in JAMA
JAMA. 2002;288:1197.
Psychological Responses to the September 11 Attacks
Silver and colleagues conducted a longitudinal study of acute responses to the terrorist attacks against the United States on September 11, 2001, using Web-based surveys of a national probability sample of adults residing outside New York City 9 to 23 days (wave 1) and approximately 2 (wave 2) and 6 (wave 3) months after the attacks. Two months after the attacks, 17% of the US population outside New York City reported symptoms of September 11–related posttraumatic stress, and 5.8% reported posttraumatic stress symptoms 6 months after the attacks. Coping strategies assessed shortly after the attacks in wave 1 were the strongest predictors of posttraumatic stress symptoms over time.
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Splinting vs Surgery for Carpal Tunnel Syndrome
Evidence evaluating conservative and surgical treatments for carpal tunnel syndrome is limited. Gerritsen and colleagues conducted a randomized controlled trial among patients with clinically and electrophysiologically confirmed carpal tunnel syndrome to compare short-term and long-term efficacy of wrist splinting and open carpal tunnel release surgery for relieving symptoms of carpal tunnel syndrome. Outcomes after 1 month of treatment were generally better in the splinting group than in the surgery group, but longer-term outcomes at 3, 6, 12, and 18 months were better in the surgery group. In an editorial, Wilgis discusses when to consider surgery for patients with carpal tunnel syndrome.
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Plasma Natriuretic Peptide Levels as Screening Tests
Left ventricular systolic dysfunction (LVSD) and left ventricular (LV) hypertrophy have been associated with elevations of plasma natriuretic peptides. Prior research has suggested that measurement of plasma brain natriuretic peptide (BNP) and the N-terminal component of proatrial natriuretic peptide (NT-ANP) may be useful as a mass screening tool to detect asymptomatic LV hypertrophy and LVSD in the general population. In this analysis of data from the Framingham Heart Study, however, Vasan and colleagues found that performance of both BNP and NT-ANP for detection of elevated LV mass and LVSD was only fair in men, and poor in women. Overall, areas under the receiver operating characteristic curves for elevated LV mass or LVSD were at or below 0.75 for both peptides.
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Trends in Smoking Cessation, Use of Pharmaceutical Aids
Many smokers in the United States attempt smoking cessation each year, but the success rate per attempt is low. Pierce and Gilpin analyzed data from the large population-based California Tobacco Surveys of 1992, 1996, and 1999 to examine trends in smoking cessation, use of pharmaceutical cessation aids, and success in cessation in the general California population. Cessation attempts among California smokers increased from 38.1% in 1992 to 61.5% in 1999. Use of nicotine replacement therapy increased short-term cessation success in moderate to heavy smokers in each survey year, but a long-term cessation advantage was observed only before nicotine replacement therapy became widely available over the counter in August 1996.
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Obesity Among Adults With Disabling Conditions
In this analysis of data from the 1994-1995 National Health Interview Survey, Weil and colleagues found that obesity was more prevalent among adults with disabling sensory, physical, and mental health conditions than among adults without disabilities. Most adults with disabilities were as likely to attempt weight loss and report exercise counseling as those without disabilities.
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A Piece of My Mind
"I am humbled by the convincing demonstration that even in the unlikeliest of places, where faith fuels it, there will be life." From "Beyond Hope?"
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Medical News & Perspectives
Efforts are under way to assess the health consequences of exposure to airborne contaminants resulting from the destruction of the World Trade Center. Innovations in accessing and using DNA evidence are helping forensic scientists and genetics experts identify victims of the disaster.
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CLINICIAN'S CORNER
Illness, Death of a Parent and Adolescent Grief
Excerpts from an interview with Robert, a 14-year-old adolescent whose mother died of breast cancer, illustrate the adaptive challenges posed by the terminal phase of a parent's illness and death, and how health care professionals can help parents support an adolescent through this process.
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Maternal Mortality in Afghanistan
A cross-sectional survey indicates that women in the Herat Province of Afghanistan have a high risk of mortality during pregnancy and childbirth. Human rights factors identified during the survey may contribute to preventable maternal deaths in that region.
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JAMA Patient Page
For your patients: Information about carpal tunnel syndrome.
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