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This Week in JAMA
March 3, 1999

This Week in JAMA

JAMA. 1999;281(9):777. doi:10.1001/jama.281.9.777
Stress in Mothers of Very Low-Birth-Weight Infants

In this study of mothers followed up from the time their children were born to age 3 years, Singer and colleagues found that mothers of high- and low-risk very low-birth-weight (VLBW) infants reported higher levels of overall psychological distress at infant age 1 month than mothers of normal weight term infants. By child age 3 years, levels of maternal psychological distress were similar in the 3 groups, but mothers of high-risk VLBW infants perceived their children as more demanding. The severity of depression reported by mothers of high- and low-risk VLBW infants was significantly correlated with lower child cognitive development scores.

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Risk of TTP With Ticlopidine

Steinhubl and colleagues for the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT) study group identified 9 cases of thrombotic thrombocytopenic purpura (TTP) following coronary artery stenting and treatment with the antiplatelet agent ticlopidine among the EPISTENT study cohort in 1 year—a TTP incidence of 0.02% compared with 0.0004% in the general population. Investigation of these and 10 additional cases of TTP related to ticlopidine therapy and vascular stenting indicated that the onset of TTP in relation to treatment was highly variable and duration of ticlopidine therapy less than 2 weeks did not prevent TTP. No TTP-related deaths occurred in patients who received plasmapheresis, but 4 deaths occurred among the 6 patients not treated with plasmapheresis.

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Traveler's Diarrhea Among Visitors to Jamaica

Based on a 1-year survey of short-term visitors returning home from a Jamaican airport, Steffen and coworkers found that the overall attack rate of diarrhea was 23.6% and of classic traveler's diarrhea, 11.7%. Few travelers reported avoiding the consumption of high-risk foods and beverages. In a volunteer sample of hotel guests with classic traveler's diarrhea, specific pathogens were detected in 31.7% of cases; the most common pathogens were enteropathogenic Escherichia coli, Rotavirus, and Salmonella species.

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Novel Therapy for Relief of Chronic Low Back Pain

Percutaneous electrical nerve stimulation (PENS) therapy applies electrical stimulation through bipolar leads connected to acupuncturelike needle probes that are positioned according to the dermatomal distribution of pain, such as for low back pain (Figure 1). In this crossover study of patients with chronic low back pain, Ghoname and colleagues report that pain relief and improvements in physical activity, sleep, and overall well-being were significantly greater with PENS therapy than with sham-PENS, transcutaneous electrical nerve stimulation, or exercise therapy.

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Improving Drug Development and Safety Surveillance

Three articles in this issue address shortcomings of standard methods to assess the efficacy and safety of drugs during development and postmarketing surveillance. Brewer and ColditzArticle review current strategies to detect and confirm adverse drug reactions. Berlin and ColditzArticle propose meta-analysis of randomized drug trials and case-control studies to increase the generalizability of individual trials and improve the efficiency of the drug approval process. TempleArticle considers these proposals and other methodological modifications in the context of existing Food and Drug Administration requirements.

Medical News & Perspectives

Adolescents with questions about their sexuality, mental health, or just their fitness for sports often find the answers at a growing number of school-based health clinics.

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On the international scene, Europe is making plans to deal with the health needs of its aging population, and Russian physicians are upgrading their skills in hopes of improving the health—and longevity—of theirs.

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Toward Optimal Laboratory Use

Advances in molecular genetic testing promise innovative diagnostic and therapeutic strategiesArticle, but are molecular genetic testing laboratories making the gradeArticle?

MSJAMA

How to protect the rights of patients: several perspectives on this key health policy issue.

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JAMA Patient Page

For your patients: Coping with the stress of parenting.

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