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.
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
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.
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.
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.
"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."
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.
Cardiovascular effects of mental stress in patients with coronary artery
disease and efficacy of psychosocial interventions.
Public information about the performance of hospitals, health professionals,
and health plans: who uses it, who does not, and does it affect quality of
See Article and Article
How to choose and search electronic medical information resources to
find the best evidence for evidence-based practice.
For your patients: Information about common lung diseases.
This Week in JAMA. JAMA. 2000;283(14):1787. doi:10.1001/jama.283.14.1787