Results of studies of the effectiveness of St John's wort (Hypericum perforatum) for the treatment of major depression and depressive
symptoms have been inconsistent. In this randomized trial, the Hypericum Depression
Trial Study GroupArticle used a placebo control and sertraline as an active comparator
to evaluate the efficacy of St John's wort in adult outpatients with moderately
severe major depression. After 8 weeks of treatment, change from baseline
in the Hamilton Depression (HAM-D) scale and rates of full response were not
significantly different from placebo in either the St John's wort or sertraline
group. Walsh and colleaguesArticle reviewed placebo-controlled trials of medications
for major depressive disorder published between 1981 and 2000 and observed
that the response to placebo was variable, but often substantial, and was
significantly correlated with the year of publication, increasing in recent
years. In an editorial, Kupfer and FrankArticle describe the current debate about
the use of placebo controls in randomized clinical trials and discuss their
contention that placebo-controlled trials of antidepressant therapy will be
necessary for the forseeable future.
Current dietary guidelines recommend fish consumption twice weekly for
the prevention of coronary heart disease (CHD). The association between consumption
of fish and long-chain omega-3 fatty acids and reduced risk of CHD has been
documented primarily in men. In this analysis of data from the Nurses' Health
Study, a prospective cohort study of women aged 34 to 59 years at baseline,
Hu and colleagues found that higher consumption of fish and omega-3 fatty
acids was associated with a significantly lower risk of incident CHD events
(CHD deaths and nonfatal myocardial infarction) during 16 years of follow-up.
The Term Breech Trial, a randomized trial that compared planned cesarean
delivery with planned vaginal delivery for pregnancies with breech presentation
at term, found a significant reduction in adverse perinatal outcomes with
planned cesarean delivery and a low but slightly increased risk of maternal
mortality or serious maternal morbidity during the first 6 weeks after delivery.
In this follow-up study, Hannah and colleagues compared a variety of maternal
outcomes in the 2 study groups at 3 months post partum, including breastfeeding,
urinary, flatal, or fecal incontinence, and sexual relations. Women in the
planned cesarean delivery group were less likely to report urinary incontinence
than those in the planned vaginal delivery group, but other maternal outcomes
were not significantly different.
Adults who have survived childhood cancer are at risk for adverse effects
related to the malignancy and to the cancer therapy. Kadan-Lottick and colleagues
conducted a cross-sectional survey of individuals 18 years or older participating
in the Childhood Cancer Survivor Study, a cohort study of individuals who
have survived at least 5 years after a cancer diagnosis at age 21 years or
younger, to assess their knowledge of their primary cancer diagnosis and associated
therapies. Only 74% of respondents provided an accurate general summary of
all elements of their cancer history, and none provided an accurate detailed
"I know I can't scream here. There is enough screaming in this place;
why add to it?" From "Cord."
New findings about physical changes that occur in the brain's emotional
centers during episodes of major depression give new meaning to the old idea
that the disorder is "all in the head."
A review of the function of and current indications for cardiac pacemakers
and implantable cardioverter defibrillators.
Mental illness: perceptions and misperceptions.
For your patients: Information about childhood cancer.
This Week in JAMA. JAMA. 2002;287(14):1763. doi:10.1001/jama.287.14.1763