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This Week in JAMA
April 12, 2000

This Week in JAMA

JAMA. 2000;283(14):1787. doi:10.1001/jama.283.14.1787
Sleep-Disordered Breathing and Hypertension

Prior studies on the association between sleep-disordered breathing (SDB) and hypertension have been inconclusive, limited by small sample sizes, use of self-report for measurement of SDB, and confounding effects, especially obesity. In this cross-sectional study of 6132 healthy adults aged 40 years or older, Nieto and colleaguesArticle found that the prevalence of hypertension increased with increasing SDB and sleep apnea events as assessed by home polysomnography. In stratified analyses, an association between SDB and hypertension was observed in both men and women, all ethnic groups, and in older and younger and normal-weight and overweight individuals. In an editorial, ZwillichArticle discusses research that has explored the relationship between sleep apnea and hypertension, but on the basis of current clinical evidence, he concludes that sleep studies are not indicated for the evaluation of all patients with hypertension.

Sertraline Treatment for Posttraumatic Stress Disorder

Despite the serious and often chronic functional and psychosocial disability associated with posttraumatic stress disorder (PTSD), few studies have evaluated the efficacy of medication treatment. In this 12-week trial comparing the selective serotonin reuptake inhibitor sertraline to placebo in 187 patients with PTSD, Brady and colleagues found that improvements in investigator-rated measures of global and functional outcomes and symptom severity were significantly greater in the sertraline group. At study end point, significantly more patients in the sertraline group were improved or very much improved compared with placebo.

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Lipoprotein(a) Levels and Risk of CHD Events

In the previously published Heart and Estrogen/progestin Replacement Study (HERS), 2763 postmenopausal women with known coronary artery disease were randomly assigned to receive daily combined estrogen plus progestin or placebo and followed up for a mean of 4.1 years. Using data from this trial, Shlipak and colleagues found that the risk of nonfatal myocardial infarction and coronary heart disease (CHD) death increased as baseline levels of lipoprotein(a) increased among women in the placebo group. Mean levels of lipoprotein(a) were significantly reduced in the estrogen/progestin group after 1 year of treatment compared with placebo.

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Diagnosis of Obstructive Airway Disease

To determine the accuracy of the patient history and clinical examination for the diagnosis of obstructive airway disease (OAD), Straus and colleagues evaluated 309 consecutive patients aged 18 years or older—76 with known OAD, 114 with suspected OAD, and 119 with neither known nor suspected OAD. Using spirometry results as the gold standard, only smoking for more than 40 pack-years, self-reported history of chronic OAD, maximum laryngeal height of at least 4 cm, and age at least 45 years were significantly associated with the diagnosis of OAD in a multivariate analysis. Presence of wheezing and decreased laryngeal descent were not useful in diagnosing OAD.

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Bending Reimbursement Rules

Previous research using hypothetical scenarios has indicated that many physicians believe that manipulating reimbursement rules is justifiable to get coverage for services that they perceive as necessary. In a survey of a random national sample of 1124 practicing physicians conducted in 1998, Wynia and colleaguesArticle found that 275 (39%) of the 720 respondents reported using at least 1 tactic to manipulate reimbursement rules "sometimes" or more often in the last year. Fifty-four percent of these physicians reported using these tactics more often in 1998 than 5 years earlier. In an editorial, BlocheArticle emphasizes the importance of defining the scope and limits of patient advocacy by physicians when conflicts arise between the needs of the individual patient and cost control by health care payers.

A Piece of My Mind

"I knew Agnes could absorb any blow that life dealt her, but she would need my support and permission for the decision she now faced." From "The Old Man's Friend."

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Medical News & Perspectives

Research on vaginal microbicides to protect against HIV infection and other sexually transmitted diseases was spotlighted at the first large international conference on the topic.

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Contempo Updates

Cardiovascular effects of mental stress in patients with coronary artery disease and efficacy of psychosocial interventions.

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Public Disclosure of Performance Reports

Public information about the performance of hospitals, health professionals, and health plans: who uses it, who does not, and does it affect quality of care?

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Users' Guides to the Medical Literature

How to choose and search electronic medical information resources to find the best evidence for evidence-based practice.

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JAMA Patient Page

For your patients: Information about common lung diseases.

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