The cause of multiple sclerosis is not known, but an infectious etiology
or an autoimmune response to an infectious or other agent are leading possibilities.
Ascherio and colleaguesArticle analyzed data from 2 large prospective cohort studies
of US women, the Nurses' Health Study and Nurses' Health Study II, to determine
whether elevation in serum antibody titers to Epstein-Barr virus preceded
the onset of multiple sclerosis. The 18 women who developed definite multiple
sclerosis and who had blood samples collected prior to disease onset had significantly
higher serum antibodies to Epstein-Barr virus compared with matched control
study participants. In an editorial, GildenArticle reviews research on the etiology
of multiple sclerosis and suggests approaches for future investigation.
Suicide is a leading cause of death in the United States, especially
among young persons and older adults. In this analysis of data from the Adverse
Childhood Experiences Study, a retrospective cohort study of 17 337 adults,
Dube and colleaguesArticle found that self-reported adverse childhood experiences
in any of 8 categories increased the risk of attempted suicide 2- to 5-fold.
Zametkin and coauthorsArticle, in a Grand Rounds at the Clinical Center of the National
Institutes of Health, present a case of a 16-year-old girl who committed suicide
and discuss the assessment, management, and prevention of teenage suicide.
In a commentary, KeithArticle discusses risk factors for adolescent suicide and interventions
for suicidal patients.
Previous studies evaluating whether intranasal corticosteroid therapy
improves clinical outcomes in patients with acute rhinosinusitis have been
inconclusive. Dolor and colleagues randomly assigned adults with a history
of recurrent sinusitis or chronic rhinitis and evidence of acute infection
to receive intranasal fluticasone in addition to cefuroxime or cefuroxime
alone. Patients who received intranasal fluticasone in addition to antimicrobial
therapy improved more rapidly and had higher rates of clinical success than
did patients who received antimicrobial therapy alone.
To assess the risk of cervical cancer precursor lesions in relation
to prior and cumulative human papillomavirus (HPV) infection, Schlecht and
colleagues conducted a prospective study of women with no cervical cytological
lesions at enrollment who were followed up for up to 6 years. Cervical specimens
were obtained for Papanicolaou cytology and HPV testing every 4 months for
1 year and twice yearly thereafter. Women with persistent HPV infection, particularly
with oncogenic types, had a significantly higher risk of incident squamous
intraepithelial lesions compared with women who had negative HPV test results
at the first 2 visits.
Immunoassays to screen urine samples for illicit opiate use are considered
to be reliable, and results may be accepted without confirmatory testing with
other techniques. Baden and colleagues report, however, that 9 of 13 tested
quinolone antimicrobials caused immunoassay results above the threshold for
a positive test result in at least 1 of 5 commercial opiate screening immunoassays.
"I think it's easy to forget about the power of compassion when we are
focused so often on the power of science." From "The Subtle Power of Compassion."
Neurosurgical treatments for Parkinson disease.
To bolster physicians' "special place in society" and reaffirm commitment
to patients, internal medicine specialists are promulgating the Physician Charter of Professionalism. Another effort to improve patient
care is Pennsylvania's new Regional Medication Safety Program for Hospitals,
poised to become a national model.
For your patients: Information about adolescent suicide.
This Week in JAMA. JAMA. 2001;286(24):3047. doi:10.1001/jama.286.24.3047