Little evidence is available to guide therapy for common depressive
disorders less severe than major depression. Williams and colleaguesArticle conducted
a randomized trial in 4 primary care practices comparing paroxetine, psychotherapy
adapted specifically for primary care, and placebo for the treatment of older
patients with minor depression or dysthymia. During the 11-week trial, depressive
symptom scores decreased in all treatment groups. Symptom reduction in the
2 active treatment groups was similar, but only the change in the paroxetine
group was significantly greater than that in the placebo group. In an editorial,
Gallo and CoyneArticle question whether current diagnostic categories and pathophysiologic
concepts of depression are applicable to depression in older adults and emphasize
the importance of conducting mental health research in primary care settings.
Alcoholism is a major risk factor for unintentional injury, but almost
one third of persons injured while under the influence of alcohol have never
met criteria for alcohol dependence. To determine whether early age of drinking
onset is associated with increased risk of alcohol-related injury, Hingson
and colleagues analyzed data from the 1992 National Longitudinal Alcohol Epidemiology
Survey, a cross-sectional survey of US adults aged 18 years or older. Respondents
who began drinking before age 21 years were significantly more likely to have
been injured while under the influence of alcohol than were respondents who
began drinking at age 21 years or older, even after controlling for alcohol
Higher dietary intake of whole grains has been associated with a decreased
risk of coronary heart disease morbidity and mortality in women. To determine
whether whole grain consumption reduces the risk of ischemic stroke, Liu and
colleagues analyzed data from 75,521 women enrolled in the Nurses' Health
Study. During 12 years of follow-up, 352 cases of ischemic stroke occurred.
Higher intake of whole grain foods was associated with a lower risk of ischemic
stroke, independent of known cardiovascular disease risk factors.
Current US safety regulations may be inadequate to prevent illness caused
by ingesting contaminated shellfish. In this investigation of an outbreak
of acute gastroenteritis in May and June 1998, Daniels and colleagues estimate
that approximately 200,000 people may have become ill after eating oysters
harvested from Galveston Bay. The oyster harvest met bacteriologic standards,
and fecal coliform counts in water samples were acceptable. All available
stool specimens from affected persons yielded Vibrio parahaemolyticus serotype O3:K6 isolates, the first reported isolation of this serotype
in the United States.
In this review of 10 trials of platelet glycoprotein IIb/IIIa inhibitor
therapy for acute coronary syndromes, Bhatt and Topol conclude that current
data support its intravenous use at the time of urgent angiography with percutaneous
coronary revascularization or for initial medical management in the emergency
Mrs B is a 26-year-old physical education teacher who has had bilateral
shoulder pain for about 4 years. Treatment with subacromial corticosteroid
injections, physical therapy, and ibuprofen has provided only partial, temporary
relief. Burkhart describes common conditions that cause shoulder pain and
dysfunction, and diagnostic assessment and treatment.
"Lesson 12: All physicians become patients." From "Twenty Lessons From
the Heart of Medicine."
Diagnosis and treatment of obstructive sleep apnea syndrome.
The head of the new Office of Human Research Protection says that clinical
researchers who fail to protect study participants will be put out of business.
Clinical manifestations, diagnosis, and treatment of peristomal pyoderma
Simpson and coauthors encourage support for the recent decision of the
International Olympic Committee to discontinue gender verification procedures
during the Olympic Games.
Strategies to overcome barriers to conversations at the end of life
between patients and health care professionals.
For your patients: Information on symptoms and types of depression.
This Week in JAMA. JAMA. 2000;284(12):1481. doi:10.1001/jama.284.12.1481