In this trial, Lipton and colleaguesArticle compared 3 strategies for the treatment
of up to 6 migraine attacks: step care within attacks using aspirin plus metoclopramide
for each attack and zolmitriptan if no response after 2 hours; step care across
attacks using aspirin plus metoclopramide for the first 3 attacks, then zolmitriptan
as initial therapy for attacks 4 through 6 if the response for 2 of the first
3 attacks was unsatisfactory; and stratified care based on MIDAS disability
levels (for MIDAS grade II disability, aspirin plus metoclopramide for all
attacks; for MIDAS grade III or IV, zolmitriptan for all attacks). Headache
response at 2 hours was significantly better among patients who received stratified
care compared with both step care strategies, and disability time over 4 hours
was significantly less. In an editorial, Matchar and coauthorsArticle note that this
trial provides evidence to support US Headache Consortium guidelines for the
selection and sequencing of treatments for acute migraine.
Based on data from the National Comorbidity Survey conducted during
1991 and 1992, Lasser and colleagues estimated that persons with mental illness
comprised 44.3% of the US tobacco market. The current smoking rate for respondents
with no mental illness was 22.5%, and for respondents with mental illness,
34.8% to 41.0%. Self-reported quit rates for persons with any history of mental
illness or past month history of mental illness were less than for smokers
without mental illness, but still substantial.
In this case-control study, Stephansson and colleagues found that a
high maternal hemoglobin concentration at the first antenatal visit was associated
with an increased risk of stillbirth, especially preterm and small-for-gestational-age
antepartum stillbirth. Weekly changes in hemoglobin concentration in early
or late pregnancy were not significantly associated with risk of stillbirth,
but a larger decrease tended to be protective.
Use of nandrolone, an anabolic steroid banned by sports organizations,
is detected in the urine by the presence of an inactive metabolite, 19-norandrosterone.
Catlin and colleagues measured levels of urinary 19-norandrosterone in study
participants randomized to receive either an over-the-counter (OTC) androstenedione
supplement or no supplement to determine whether individuals who use OTC androstenedione
supplements will test positive for urinary 19-norandrosterone. All urine samples
of participants in the androstenedione group tested positive for 19-norandrosterone,
whereas none tested positive in the other group. Trace amounts of 19-norandrostenedione
were detected in 7 of 8 tested capsules of the androstenedione preparation.
In the United States, the incidence of end-stage renal disease (ESRD)
has been higher in black persons than in white persons, but factors other
than race/ethnicity may also contribute to differences in ESRD incidence.
In this study of the incidence of ESRD between 1982 and 1998 in Japan, where
the population is ethnically homogeneous, Usami and colleagues found significant
regional differences in both the incidence and the rate of increase in incidence
Mrs D, a 44-year-old woman with amyotrophic lateral sclerosis, uses
Canadian crutches and a rolling walker. She is considering using a wheelchair
because of increasing difficulty walking. Iezzoni discusses assessment and
management of mobility problems.
"I wonder at the defense mechanisms of physicians who see patients full-time.
How do they bounce professionally from room to room, pedaling hope and optimism
amidst such palpable unhappiness?" From "No Time to Say Hello Good-bye."
Soft tissue paleopathology: methods and insights into
Genomic researchers are working to translate their findings into reductions
in disease incidence, improvements in diagnosis, and individualized therapies.
Recommendations to reduce disparities in the prevalence of dental caries
Original research reports, reviews, and commentaries on human genetics
research and its clinical applications are invited for JAMA and Archives theme issues scheduled for November 2001.
Vaccination programs and the elimination of mumps and rubella in Finland.
For your patients: A primer on migraine.
This Week in JAMA. JAMA. 2000;284(20):2559. doi:10.1001/jama.284.20.2559