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This Week in JAMA
May 28, 2008

This Week in JAMA

JAMA. 2008;299(20):2361. doi:10.1001/jama.299.20.2361

Patients who survive a stroke are at high risk of developing depression. In a multisite randomized trial involving nondepressed patients with a recent stroke, Robinson and colleagues investigated whether treatment with escitalopram or problem-solving therapy during the first year following acute stroke would be associated with a lower incidence of major or minor depression. The authors report that patients who received escitalopram or problem-solving therapy had a significantly lower risk of depression in the 12 months following stroke than patients who received placebo, although problem-solving therapy did not achieve significant results over placebo using a conservative intention-to-treat method of analysis.

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The prevalence of overweight among US children and adolescents increased between 1980 and 2004. In analyses of national data, Ogden and colleagues Article estimated the 2003-2006 prevalence of high body mass index (BMI) for age at or above the 97th, the 95th, or the 85th percentiles of standard BMI-for-age growth charts. The authors report that 11.3% (95% confidence interval [CI], 9.7%-12.9%) of children and adolescents aged 2 through 19 years were at or above the 97th percentile, 16.3% (95% CI, 14.5%-18.1%) were at or above the 95th percentile, and 31.9% (95% CI, 29.4%-34.4%) were at or above the 85th percentile of BMI for age. The authors found no statistically significant trends in BMI for age between 1999 and 2006. In an editorial, Ebbeling and Ludwig Article discuss pediatric obesity and the clinical use of BMI-for-age categories for risk assessment and patient counseling.

Per capita Medicare expenditures vary widely by region, but whether beneficiaries in low-expenditure regions perceive their care to be lower quality than beneficiaries in high-expenditure regions is not known. Fowler and colleagues Article surveyed Medicare beneficiaries to assess perceptions of unmet care needs and care quality and found no consistent association between the mean per capita expenditure and patients' perceptions of the quality of care received. In an editorial, Anderson and Chalkidou Article discuss spending on medical care, medical outcomes, and patient satisfaction.

Jugular venous access is often preferred to femoral access for patients requiring acute renal replacement therapy on the assumption that femoral catheterization poses a higher risk of infection. In a randomized trial of severely ill patients requiring a first-catheter insertion for hemodialysis, Parienti and colleagues assessed the rates of infectious complications associated with jugular vs femoral venous catheterization. The authors report that jugular venous access was not associated with lower rates of catheter colonization compared with femoral access, except among adults in the highest tercile of BMI (>28.4). Catheter-related bloodstream infections did not differ by venous access site.

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A systematic review of the association of candidate gene polymorphisms and genetic susceptibility to cancer.

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“I am not arguing against confidence, only against arrogance.” From “In Defense of Phobias.”

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Formaldehyde, anticholinergic drugs, and heavy drinking and smoking are factors that may compromise neurological function, according to findings presented at the American Academy of Neurology's annual meeting in April.

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The power of prevention

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Spirituality in medical care

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Join Wendie Berg, MD, PhD, June 18 from 2 to 3 PM eastern time to discuss screening women at high risk of breast cancer with mammography plus ultrasound vs mammography alone. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about depression.

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