Home cardiorespiratory monitoring to identify prolonged apnea and bradycardia
is commonly used to prevent sudden infant death syndrome (SIDS) in high-risk
infants. Ramanathan and colleaguesArticle analyzed home monitoring data from 306
healthy term infants and 773 high-risk infants—preterm infants, siblings
of infants who died of SIDS, and infants who experienced an apparent life-threatening
event. The incidence of cardiorespiratory events that exceeded conventional
thresholds was common even among healthy term infants. The risk of at least
1 event exceeding extreme thresholds was higher among preterm infants compared
with healthy term infants, but only through 43 weeks postconceptual age, before
the age when the incidence of SIDS peaks. In an editorial, JobeArticle notes that
placing infants in the supine position for sleep and the use of proper bedding
will prevent most cases of SIDS and, based on these findings, home monitoring
is unlikely to prevent the remaining cases.
Chronic tension-type headaches are frequently treated with tricyclic
antidepressants despite limited evidence that this treatment is beneficial.
In this trial, Holroyd and colleagues found that patients with chronic tension-type
headaches who received tricyclic antidepressants and stress management therapy,
singly and in combination, had larger reductions in headache activity, analgesic
medication use, and headache-related disability compared with patients who
received placebo. Improvement in headache activity was most rapid among patients
who received antidepressants. The proportion of patients who achieved clinically
significant reductions in headache activity was greater in the combination
group than in the groups that received either therapy alone.
Population-based estimates of the prevalence and penetrance of disease-associated
genetic mutations are necessary to determine the usefulness of screening for
genetic conditions. Hereditary hemochromatosis, an iron metabolism disorder,
is one of the most common autosomal recessive disorders in whites in the United
States. Steinberg and colleagues estimated the prevalence of 2 mutations in
the hemochromatosis gene (HFE), C282Y and H63D, using
samples from participants in the Third National Health and Nutrition Examination
Survey. The C282Y mutation had an estimated prevalence of 5.4% in the US population,
and the H63D mutation, 13.5%. Estimated prevalences of the mutations were
highest among non-Hispanic whites compared with non-Hispanic blacks and Mexican
Point-of-service health plans, developed in response to dissatisfaction
with "gatekeeping," allow patient self-referrals to specialty care at increased
out-of-pocket costs. Forrest and colleagues report that most patients enrolled
in 3 point-of-service health plans did not exercise their option to obtain
specialty care via self-referral during a 1-year period. The proportion of
patients self-referring to generalists was 4.7% to 8.5%, and the proportion
self-referring to specialists was 3.7% to 7.2%. Patients who self-referred
to specialists were more satisfied with the specialty care they received than
were patients referred by physicians.
Breast and pelvic examinations are commonly required before providing
women with hormonal contraceptives. In this review of the medical literature
and of policy statements from professional organizations, Stewart and colleagues
conclude that hormonal contraception can safely be provided based on careful
review of the medical history and blood pressure measurement. Breast and pelvic
examinations are not necessary to identify women who should avoid hormonal
contraception and may create obstacles to obtaining contraception.
Medical spin-offs from the space program are a long-time NASA promise.
Recently the agency released research results showing that a weightless environment
enhances the growth of human tissue for therapeutic purposes.
A discussion of the etiology,
diagnosis, natural history, and management of Proteus syndrome, a disorder
that causes overgrowth of multiple tissues, is illustrated by a case presentation
of a 5-year-old patient with this condition.
Original research papers in basic biomedical science and translational
research are invited for a JAMA theme issue scheduled for March 2002.
Alternative career options for physicians.
For your patients: Information about tension headache.
This Week in JAMA. JAMA. 2001;285(17):2165. doi:10.1001/jama.285.17.2165