Dopamine-receptor agonists have been proposed as an alternative to levodopa
for the treatment of Parkinson disease to reduce the risk of motor adverse
effects associated with levodopa therapy. In this 2-year trial comparing pramipexole,
a dopamine-receptor agonist, with levodopa for the initial treatment of patients
with early Parkinson disease, the Parkinson Study GroupArticle found that the proportion
of patients who developed dopaminergic motor complications was significantly
less in the pramipexole group than in the levodopa group. Parkinsonian features,
however, improved more in the levodopa group than in the pramipexole group,
and somnolence, hallucinations, and edema were more frequent in the pramipexole
group. In an editorial, TannerArticle weighs the benefits and risks of these drugs.
Preterm infants often experience long-term neurodevelopmental difficulties.
To examine whether regional brain volumes are associated with cognitive outcomes
in prematurely born children, Peterson and colleaguesArticle used structural magnetic
resonance imaging to measure regional brain volumes of 25 prematurely born
8-year-old children and 39 matched term controls. Volumes of specific cerebral
regions were significantly reduced in the preterm children compared with the
term children, and these abnormalities correlated with poorer scores on measures
of cognitive function. In an editorial,
Hack and TaylorArticle discuss possible mechanisms of perinatal
For medical abortions, the conventional timing for misoprostol administration
is 48 hours after mifepristone. Schaff and colleagues conducted a trial to
determine whether a more flexible schedule for misoprostol administration
would be as effective and safe as the 2-day protocol for women seeking early
abortion. Among women with gestations no more than 56 days, complete medical
abortion rates and adverse effects were comparable for self-administration
of vaginal misoprostol at 1, 2, or 3 days after mifepristone.
Screening for colorectal cancer has been shown to reduce colorectal
cancer mortality through early detection and treatment. Using a Markov model
with a hypothetical cohort of 50-year-old white men at average risk for colorectal
cancer, Frazier and colleagues compared the cost-effectiveness of 22 screening
strategies for colorectal cancer, including those recommended by expert panels.
With screening compliance assumed to be 60%, the most effective screening
strategy was annual rehydrated fecal occult blood testing plus sigmoidoscopy
every 5 years (with colonoscopy if either a low- or high-risk polyp was found)
from age 50 to 85 years, which reduced colorectal cancer incidence by 60%
and colorectal cancer mortality by 80% compared with no screening. The most
effective 1-time screening strategy was colonoscopy at age 55 years, which
reduced colorectal cancer mortality by 31%.
In 1998, an estimated 60 million persons in the United States searched
for health information on the Web. To determine the use of the Web for health
information specifically in a clinical population, O'Connor and Johanson surveyed
patients attending gastroenterology outpatient clinics in August 1999. Fifty
percent of patients reported having access to the Web and about one quarter
of all respondents reported having obtained medical information from the Web
within the previous year.
"When a man feels his ability to help the tribe has expired, he chants
a prayer and, dressed in his finest skins, bids farewell to his family and
walks over the frozen Arctic Ocean, never to return." From "Five Miles From
A look at this year's winners of the Lasker Medical Research
Should current US policy that requires health care workers infected
with a blood-borne pathogen to disclose their infection status to patients
See Article and Article
PettyArticle outlines why screening for detection of early-stage lung cancer
should be beneficial, but FrameArticle points out that there is no evidence that
screening reduces lung cancer mortality.
For your patients: A primer on Parkinson disease.
This Week in JAMA. JAMA. 2000;284(15):1891. doi:10.1001/jama.284.15.1891