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This Week in JAMA
October 18, 2000

This Week in JAMA

JAMA. 2000;284(15):1891. doi:10.1001/jama.284.15.1891
Early Therapy for Parkinson Disease

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.

Brain Volumes, Cognitive Outcomes of Preterm Infants

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 brain injury.

Timing of Misoprostol for Early Medical Abortion

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.

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Cost-effectiveness of Screening for Colorectal Cancer

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%.

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Patients' Use of the Web for Medical Information

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.

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A Piece of My Mind

"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 Tomorrow."

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Medical News & Perspectives

A look at this year's winners of the Lasker Medical Research Awards.

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Clinicians Infected With Blood-Borne Pathogens

Should current US policy that requires health care workers infected with a blood-borne pathogen to disclose their infection status to patients be reformed?

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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.

JAMA Patient Page

For your patients: A primer on Parkinson disease.

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