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This Week in JAMA
July 16, 2008

This Week in JAMA

JAMA. 2008;300(3):247. doi:10.1001/jama.300.3.247

Neurofibromatosis type 1 (NF1) is associated with cognitive disabilities that can impair learning. In an animal model of NF1, statin-mediated inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase was found to restore cognitive deficits in mice. To assess a possible benefit of statin therapy in humans with NF1, Krab and colleagues enrolled 62 children with NF1 in a randomized 12-week trial that examined the effects of simvastatin vs placebo on neuropsychological, neurophysiological, and neuroradiological measures of cognitive function. The authors found no significant improvements in cognitive function among children who received simvastatin compared with children who received placebo.

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Physical inactivity is associated with the increase in childhood obesity. Experts recommend that children engage in moderate to vigorous physical activity for a minimum of 60 minutes per day, but how many youth meet this standard is not known. To examine patterns and determinants of moderate to vigorous physical activity among youth, Nader and colleagues analyzed data from a large cohort study of children who had accelerometer-determined physical activity measurements at ages 9 through 15 years. The authors report that at age 9 years, children engaged in moderate to vigorous physical activity for approximately 3 hours per day on both weekdays and weekends. Physical activity steadily declined each year. By age 15 years, adolescents engaged in moderate to vigorous physical activity for 49 minutes per weekday and 35 minutes per weekend. Although boys were consistently more active than girls, rates of decline in physical activity were similar for both boys and girls.

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Although rarely acknowledged, a legacy of racial bias and segregation in US medicine has had far-reaching implications for the profession and patients. To improve understanding of this legacy, the American Medical Association (AMA) Institute for Ethics convened a panel of experts to explore the historical roots of the black-white divide in US medicine. The panel members reviewed documents in the archives of the AMA and the National Medical Association and newspaper reports from 1847—when the AMA was founded—through 1968 and reviewed articles identified in a MEDLINE search. Baker and colleagues, writing for the panel, summarize their findings and highlight key historical events that maintained segregation in organized medicine for more than 100 years.

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Ms W, a 50-year-old woman with a long history of opiate addiction, has been successfully treated with methadone for 9 years. However, she would like to consider new treatment options for relapse prevention. O’Brien discusses the epidemiology of heroin addiction and relapse, the pros and cons of methadone treatment, and 2 new alternatives for detoxification and relapse maintenance—buprenorphine and naltrexone.

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“Excessive pride can be a clinician's downfall in the world of P4P.” From “6 EZ Steps to Improving Your Performance (or How to Make P4P Pay 4U!).”

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Investigators say new data from recently reported clinical trials could change diagnostic and therapeutic standards for lung cancer.

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Racial harmony and the medical profession

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European practices of genetic information and insurance

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The Blalock-Taussig-Thomas Collaboration

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JAMA celebrates 125 years of publication

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Join Beverly Beth Green, MD, MPH, August 20, from 2 to 3 PM eastern time to discuss home blood pressure monitoring and Web and pharmacist care for hypertension control. 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 neurofibromatosis.

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