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JAMA. 2004;291:523.

Prevention and Identification of Stroke Risk
Elevated total homocysteine levels have been associated with an increased risk of ischemic stroke, but a reduction in risk with homocysteine-lowering therapy has not been demonstrated. Toole and colleagues (SEE ARTICLE) report results of a randomized trial of the effects of high- and low-dose folic acid, pyridoxine (vitamin B₆), and cobalamin (vitamin B₁₂) for preventing recurrent ischemic stroke among patients with elevated baseline homocysteine levels. Although the high-dose formulation achieved a moderate reduction in total homocysteine levels, there were no dose-related differences in risk of subsequent stroke over the 2-year follow-up period. Similarly, there were no treatment group differences in coronary heart disease events or death. In a second article (SEE ARTICLE) in this issue of THE JOURNAL, the Antiphospholipid Antibodies and Stroke Study Investigators examined whether the presence of anticardiolipin or lupus anticoagulant antibodies at baseline might predict future ischemic events, including recurrent stroke. In this investigation, the presence of either antiphospholipid antibody did not predict an increased risk of future vaso-occlusive events. In an accompanying editorial, (SEE ARTICLE) Hanley discusses the challenges in reducing stroke risk and directions for future research.

C-Reactive Protein and Colon Cancer Risk
Chronic inflammation has been hypothesized to play a role in the pathogenesis of colorectal cancer. Erlinger and colleagues (SEE ARTICLE) investigated the association of incident colon and rectal cancer with baseline C-reactive protein (CRP) levels in a prospective case-control study examining risk factors for cancer and heart disease. They found that CRP levels were significantly higher in the participants who developed colon cancer during 11 years of follow-up compared with those who did not. No association was found between baseline CRP level and risk of rectal cancer. In an editorial, (SEE ARTICLE) Pasche and Serhan discuss potential pathogenic relationships between inflammation and colon carcinogenesis and implications for prevention.

Violent Incidents in Nursing Homes
Little is known about the circumstances and characteristics of intentional, resident-to-resident injuries sustained in nursing homes. Shinoda-Tagawa and colleagues conducted a case-control study using data from 2 administrative data sets in Massachusetts to examine the types of injuries sustained and risk factors associated with resident-to-resident violent encounters. Bruises and hematomas were the most frequent injuries and more than half occurred around the head or face. Injured residents were more likely to wander; to be more cognitively impaired and to reside in an Alzheimer disease unit; to be verbally or physically abusive of others; and to have socially inappropriate behavior compared with uninjured controls. In contrast, residents who were severely dependent had a reduced risk of injury, suggesting that provocation may play a role in experiencing resident-to-resident injury.

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Ethics of CAM Research
Investigations of the efficacy and safety of complementary and alternative medicine (CAM) have increased dramatically in the past decade, but little attention has been paid to the ethics of research involving CAM therapies. Specifically, should CAM modalities be subjected to the same rigorous evidence-based standards as are other medical therapies? Miller and colleagues review 7 requirements for ethical clinical research and find little reason to exempt CAM studies from these standards. They present scientific and societal arguments for requiring randomized, placebo-controlled clinical trials to assess the efficacy of CAM therapies even when proven effective conventional therapies are available. The potential value of CAM therapies offering no more than a placebo effect is also examined.

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Medical News & Perspectives
After the discovery of the first case of bovine spongiform encephalopathy ("mad cow" disease) in the United States, experts provide perspective on the potential risk to beef-eating consumers.

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CLINICIAN'S CORNER
Antiepileptic Drugs
Scientific Review/Clinical Applications
Part 1 (SEE ARTICLE) of this 2-part article provides an evidence-based review of clinical trial data on the efficacy and adverse event profiles of 8 antiepileptic drugs approved for use since 1990. Four clinical cases discussed in Part 2 (SEE ARTICLE) offer guidance for appropriate medication selection.

STUDENTJAMA
Physicians' satisfaction with their careers; physical and mental health of physicians; and pregnancy during residency.

(SEE ARTICLE)

JAMA Patient Page
For your patients: Information about epilepsy.

(SEE ARTICLE)

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