Major depression is associated with a high risk of recurrence,
especially in the elderly. In this study of elderly patients who had
recovered from a recurrence of major depression, Reynolds and
colleaguesArticle found that patients who received maintenance therapy with
nortriptyline plus interpersonal psychotherapy had the lowest rate of
recurrence over 3 years compared with patients who received
nortriptyline or psychotherapy alone or placebo. In a related
editorial, GlassArticle emphasizes the importance of providing access to
long-term combined pharmacotherapy and psychotherapy for patients with
Leviton and coworkers compared changes in the use of antenatal
corticosteroids for fetal maturation in women at risk of preterm
delivery in 27 tertiary care hospitals randomly assigned to usual
dissemination of practice recommendations (guideline publication) or to
an active intervention that included educational activities and
monitoring and feedback by an influential physician and a nurse
coordinator at each hospital. The use of antenatal corticosteroids in
eligible patients increased 108% in hospitals with active
dissemination compared with a 75% increase in hospitals with usual
Results of studies of the effect of alcohol consumption on the risk of
ischemic stroke have been inconsistent and have varied among different
racial/ethnic groups. In this case-control study in a diverse
population of individuals aged 40 years or older, Sacco and colleagues
found that moderate alcohol consumption of up to 2 alcoholic drinks per
day was protective for first ischemic stroke across all age, sex, and
racial/ethnic groups. The risk of ischemic stroke increased with heavy
drinking and was significantly greater among individuals who consumed 7
or more alcoholic drinks per day.
Infectious disease mortality in the United States has generally
declined this century, but episodic increases interrupt this trend
(Figure 1). Contrary to what might have been predicted based on data
through 1980, infectious disease mortality increased 4.8% per year
between 1980 and 1995. This analysis by Armstrong and colleagues
illustrates the need to be watchful for changes in microbial threats.
Available pharmacologic treatments approximately double the success
rate of smoking cessation compared with placebo. In this Special
Communication, Hughes and coauthors assert that physicians are
obligated to make pharmacotherapy available for every patient who
smokes, combined with behavioral interventions when necessary.
In this article, part of The Rational Clinical Examination series,
Lederle and Simel assess the value of abdominal palpation for the
detection of abdominal aortic aneurysm and describe the technique to
measure aortic width.
"That shabby little unknown bundle of neglect and despair that was
dropped off by the police six weeks ago...is now a driving
force on the infants' ward." From "Vergil."
Stress as a factor in the pathogenesis of peptic ulcer disease.
Sex and drugs—and helping adolescents cope with them—are
a major concern to the US public health establishment.
Original research, reviews, and commentaries are invited for a
JAMA theme issue on atherosclerosis scheduled for December
Easier to read, improved graphics; still authoritative and uniquely
A look at the MD-PhD programs, established 33 years ago, to foster the
translation of basic science research to clinical applications.
For your patients: Health effects of alcohol.
This Week in JAMA. JAMA. 1999;281(1):5. doi:10.1001/jama.281.1.5