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This Week in JAMA
JAMA. 2006;296:1561.
Screening and Sudden Death in Athletes
Preparticipation cardiac evaluation of young competitive athletes is intended to identify and disqualify those with serious cardiac abnormalities. However, the effect of such screening on sudden cardiovascular death in young athletes has not been determined. Using population-based data from Italy, where preparticipation screening of athletes was introduced in 1982, Corrado and colleagues (SEE ARTICLE) assessed 1979-2004 trends in sudden death among athletes and nonathletes. The authors found that the incidence of sudden cardiac death in young competitive athletes declined significantly after introduction of preparticipation athlete screening, whereas rates were steady among unscreened nonathletes. In an editorial, Thompson and Levine (SEE ARTICLE) discuss the contribution of these findings to the ongoing debate about the role and components of preparticipation screening programs.
Clinical and MRI Correlates of Cerebral Palsy
To identify potential strategies to prevent cerebral palsy, Bax and colleagues (SEE ARTICLE) reviewed clinical data and magnetic resonance imaging (MRI) brain scans obtained at 18 months of age from a cohort of children with cerebral palsy. Among the authors' findings were that maternal infection during pregnancy and multiple gestation were associated with having a child with cerebral palsy. On MRI, white matter damage of immaturity was the most common finding. In an editorial, Msall (SEE ARTICLE) discusses the findings' implications for understanding cerebral palsy syndromes, prevention, and improved patient care.
Gene Polymorphisms and Antidepressant Response
Genetic polymorphisms are thought to be one explanation for individual variability in response to antidepressants. In 241 Korean patients with major depression, Kim and colleagues investigated the association of genetic polymorphisms of the monoamine transporters for serotonin and norepinephrine with patient response to therapy with a selective serotonin or norepinephrine reuptake inhibitor. The authors found that the presence of certain polymorphisms, alone or in combination, was associated with response and nonresponse to therapy with serotonin or norepinephrine reuptake inhibitors.
(SEE ARTICLE)
CLINICIAN'S CORNER
Risks of COX-2 Inhibitors and Other NSAIDs
Clinical Reviews
Recent studies have challenged the safety of selective cyclooxygenase 2 (COX-2) inhibitors and nonselective nonsteroidal antiinflammatory drugs (NSAIDs). Two articles in this issue summarize new data on risks associated with these drugs. First, Zhang and colleagues (SEE ARTICLE) conducted a meta-analysis of 114 controlled clinical trials of COX-2 inhibitors to evaluate the risk of adverse renal events and arrhythmias. Among their findings was that rofecoxib was associated with an increased risk of adverse renal events and arrhythmias compared with controls. McGettigan and Henry (SEE ARTICLE) conducted a meta-analysis of controlled observational studies of NSAIDs and COX-2 inhibitors to assess cardiovascular risks. Among their findings was that rofecoxib was associated with an increased risk of cardiovascular events that was evident early in treatment and was dose-related and that diclofenac is associated with increased cardiovascular risk. In an editorial, Graham (SEE ARTICLE) discusses industry and regulatory agency contributions to the delays in identifying these risks.
A Piece of My Mind
"Should I tell this man—in this impoverished and virtually inaccessible place—that he has what I believe is a tumor in the base of his brain?" From "Patagonia Pastorale."
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Medical News & Perspectives
The rising incidence of obesity worldwide threatens to end the steady gains in human life expectancy seen over the past 2 centuries. This week’s Medical News & Perspectives section highlights research tackling the obesity problem on several fronts.
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Rapid Response Teams
Insufficient evidence exists to make rapid response team programs a standard of care for hospitals.
(SEE ARTICLE)
Author in the Room Teleconference
Join David Spiro, MD, MPH, Wednesday, October 18, from 2 to 3 PM eastern time to discuss wait-and-see prescription for otitis media. To register, go to http://www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
JAMA Patient Page
For your patients: Information about cerebral palsy.
(SEE ARTICLE)
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