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.
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.
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.
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.
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.
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.
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
Advances in molecular genetic testing promise innovative diagnostic and
therapeutic strategiesArticle, but are molecular genetic testing laboratories
making the gradeArticle?
How to protect the rights of patients: several perspectives on this key
health policy issue.
For your patients: Coping with the stress of parenting.
This Week in JAMA. JAMA. 1999;281(9):777. doi:10.1001/jama.281.9.777