Chlamydia trachomatis infection has been associated
with an increased risk of cervical squamous cell carcinoma. In this case-control
study, Anttila and colleaguesArticle found that the C trachomatis serotype most strongly associated with invasive cervical squamous
cell carcinoma was serotype G, followed by serotypes I and D. The presence
of serum IgG antibodies to more than 1 serotype increased the risk of cervical
squamous cell carcinoma. In an editorial, ZenilmanArticle speculates about ways in
which C trachomatis might enhance progression of
human papillomavirus infection to invasive cervical cancer.
In preliminary studies of patients with chronic fatigue syndrome and
neurally mediated hypotension, symptoms of chronic fatigue syndrome improved
when the hypotension was treated. In this randomized trial, however, Rowe
and colleagues found that for patients with both chronic fatigue syndrome
and neurally mediated hypotension, treatment of hypotension with fludrocortisone
acetate monotherapy was no more efficacious than placebo. The proportion of
patients who experienced a 15-point or greater improvement in global wellness
score was 14% in the fludrocortisone group and 10% in the placebo group.
To compare the use of health care services and medical care costs among
children and adolescents with and without attention-deficit/hyperactivity
disorder (ADHD), Leibson and colleagues retrospectively followed up 4119 members
of a birth cohort born between 1976 and 1982, 309 of whom met criteria for
ADHD. During the 9-year study period, children and adolescents with ADHD were
more likely to have comorbid clinical diagnoses in several categories, including
major injuries and asthma, compared with children and adolescents without
ADHD. Among children and adolescents with ADHD, the proportion with any hospital
inpatient, hospital outpatient, or emergency department admission was significantly
greater than among those without ADHD, and the 9-year median costs were more
than 2 times higher.
Despite a 1985 study that found that the reliability of hair mineral
analysis to assess health status or toxic exposures was poor, an average of
225 000 hair mineral tests costing $9.6 million are performed yearly
by 9 laboratories in the United States. Seidel and colleaguesArticle submitted hair
samples cut adjacent to the scalp from a single healthy volunteer to 6 commercial
US laboratories. Laboratory differences between highest and lowest reported
mineral concentrations for the sample exceeded 10-fold for 12 minerals, and
statistically significant extreme values were reported for 14 of the 31 minerals
that were analyzed by 3 or more laboratories. Laboratory designations of normal
reference values varied widely. In an editorial, Steindel and HowanitzArticle discuss
possible explanations for the observed disparity in interlaboratory results,
but caution physicians about using hair analysis to assess nutritional status
until an appropriate normal reference range and reliability of this approach
Mrs C, who began breastfeeding her newborn soon after delivery, developed
sore, cracked, and painful nipples within 24 hours. She continued breastfeeding,
but then developed a lump in 1 breast accompanied by redness, pain, and fever.
Lawrence discusses the benefits of breastfeeding, proper technique, preparation
of women during pregnancy, and management of
The American Academy of Pediatrics is encouraging pediatricians to take
an active role in minimizing the impact on children of the entertainment industry's
ever-increasing focus on sex and violence.
Defining disease: Essays on the biomedical and social understanding
of disease and implications of assigning diagnostic labels.
For your patients: Information about sexually transmitted diseases.
Collections of JAMA research articles and features—including
the Users' Guides to the Medical Literature, The Rational Clinical Examination,
Clinical Crossroads, and A Piece of My Mind—are now available in the
Department Index on the JAMA Web site.
This Week in JAMA. JAMA. 2001;285(1):9. doi:10.1001/jama.285.1.9