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This Week in JAMA
JAMA. 2007;297:337.
Citalopram and Psychotherapy for Depression in CAD
Depression is common in many patients hospitalized with coronary artery disease (CAD) and is associated with increased risks of cardiovascular morbidity and mortality. However, few studies have assessed the effectiveness of interventions to treat depression in patients with CAD. In this issue of JAMA, Lespérance and colleagues (SEE ARTICLE) report results of a 12-week randomized trial, which assessed the efficacy of citalopram, a selective serotonin reuptake inhibitor (SSRI), vs placebo and interpersonal psychotherapy added to supportive, nonpsychotherapeutic clinical management vs clinical management alone to reduce symptoms of depression in patients with CAD and major depressive disorder. The investigators found that citalopram was superior to placebo when administered with weekly clinical management in reducing self-reported and clinically assessed symptoms of depression. There was no evidence that the addition of interpersonal therapy to clinical management was beneficial. In an editorial, Glassman and Bigger (SEE ARTICLE) discuss the efficacy and safety of 2 SSRIs—sertraline and citalopram—for the treatment of depression in patients with coronary heart disease.
Improving Adherence to Tuberculosis Treatment
Tuberculosis (TB) control in developing countries is often impeded by poor adherence to treatment. Thiam and colleagues report results of a cluster randomized controlled trial that tested the efficacy of a strategy based on improved communication between health personnel and patients, patient choice of directly observed therapy supporter, decentralized treatment, and community involvement compared with usual care to improve treatment adherence among newly diagnosed adult patients with TB in Senegal. The authors found that patients randomly assigned to receive the intervention had higher cure and treatment completion rates and lower treatment default rates compared with patients randomly assigned to the usual care group.
(SEE ARTICLE)
Refracture Risk After Low-Trauma Fracture
Few studies have examined the long-term risk of subsequent fracture (refracture) after an initial low-trauma fracture, particularly among men. Center and colleagues examined this question in a cohort of community-dwelling Australian men and women who were 60 years and older at baseline and were followed up for 16 years. The authors found that both men and women had a similar absolute risk of refracture following an incident low-trauma fracture. This increased risk persisted for up to 10 years after the initial fracture, by which time 40% to 60% of women and men had sustained a second fracture.
(SEE ARTICLE)
CLINICIAN'S CORNER
Inflammatory Aortic Aneurysm
Grand Rounds
Inflammatory abdominal aortic aneurysm (AAA) accounts for 5% to 10% of all cases of AAA. Hellmann and colleagues review the epidemiology, etiology, and pathogenesis; signs and symptoms; radiological, surgical, and pathological findings; and treatment of inflammatory AAA in their discussion of the case of Mr A, a 42-year-old man with a history of approximately 30 years of tobacco use and a 2-year history of worsening back pain.
(SEE ARTICLE)
A Piece of My Mind
"Can dual relationships be avoided in a small town? Should they even be avoided?" From "Boundaries."
(SEE ARTICLE)
Medical News & Perspectives
Novel therapies for bleeding disorders show promise in recent clinical trials.
(SEE ARTICLE)
Genetics of Age-Related Macular Degeneration
From the Archives Journals
An article in the Archives of Ophthalmology quantifies the risk of age-related macular degeneration (AMD) in persons with 1 or 2 AMD-associated genetic polymorphisms and modifiable lifestyle factors. Haines and Pericak-Vance discuss the genetics of AMD and the promise of genomic medicine.
(SEE ARTICLE)
Blue Highways on NIH Roadmap
Practice-based research networks could be "blue highways" on the National Institutes of Health Roadmap, connecting academic research centers with primary care practice.
(SEE ARTICLE)
Engaging Communities in Research
Principles and strategies of community-partnered participatory research, which promotes academic and community partnerships and power sharing in research endeavors.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about aortic aneurysms.
(SEE ARTICLE)
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