Elevated total homocysteine levels have been associated with an increased
risk of ischemic stroke, but a reduction in risk with homocysteine-lowering
therapy has not been demonstrated. Toole and colleaguesArticlereport results of a randomized trial of the effects of high- and low-dose
folic acid, pyridoxine (vitamin B6), and cobalamin (vitamin B12) for preventing recurrent ischemic stroke among patients with elevated
baseline homocysteine levels. Although the high-dose formulation achieved
a moderate reduction in total homocysteine levels, there were no dose-related
differences in risk of subsequent stroke over the 2-year follow-up period.
Similarly, there were no treatment group differences in coronary heart disease
events or death. In a second articleArticlein this issue of
THE JOURNAL, the Antiphospholipid Antibodies and Stroke Study Investigators
examined whether the presence of anticardiolipin or lupus anticoagulant antibodies
at baseline might predict future ischemic events, including recurrent stroke.
In this investigation, the presence of either antiphospholipid antibody did
not predict an increased risk of future vaso-occlusive events. In an accompanying
editorial,ArticleHanley discusses the challenges in reducing
stroke risk and directions for future research.
Chronic inflammation has been hypothesized to play a role in the pathogenesis
of colorectal cancer. Erlinger and colleaguesArticleinvestigated
the association of incident colon and rectal cancer with baseline C-reactive
protein (CRP) levels in a prospective case-control study examining risk factors
for cancer and heart disease. They found that CRP levels were significantly
higher in the participants who developed colon cancer during 11 years of follow-up
compared with those who did not. No association was found between baseline
CRP level and risk of rectal cancer. In an editorial,ArticlePasche and Serhan discuss potential pathogenic relationships between inflammation
and colon carcinogenesis and implications for prevention.
Little is known about the circumstances and characteristics of intentional,
resident-to-resident injuries sustained in nursing homes. Shinoda-Tagawa and
colleagues conducted a case-control study using data from 2 administrative
data sets in Massachusetts to examine the types of injuries sustained and
risk factors associated with resident-to-resident violent encounters. Bruises
and hematomas were the most frequent injuries and more than half occurred
around the head or face. Injured residents were more likely to wander; to
be more cognitively impaired and to reside in an Alzheimer disease unit; to
be verbally or physically abusive of others; and to have socially inappropriate
behavior compared with uninjured controls. In contrast, residents who were
severely dependent had a reduced risk of injury, suggesting that provocation
may play a role in experiencing resident-to-resident injury.
Investigations of the efficacy and safety of complementary and alternative
medicine (CAM) have increased dramatically in the past decade, but little
attention has been paid to the ethics of research involving CAM therapies.
Specifically, should CAM modalities be subjected to the same rigorous evidence-based
standards as are other medical therapies? Miller and colleagues review 7 requirements
for ethical clinical research and find little reason to exempt CAM studies
from these standards. They present scientific and societal arguments for requiring
randomized, placebo-controlled clinical trials to assess the efficacy of CAM
therapies even when proven effective conventional therapies are available.
The potential value of CAM therapies offering no more than a placebo effect
is also examined.
After the discovery of the first case of bovine spongiform encephalopathy
("mad cow" disease) in the United States, experts provide perspective on the
potential risk to beef-eating consumers.
Part 1Articleof this 2-part article provides an evidence-based
review of clinical trial data on the efficacy and adverse event profiles of
8 antiepileptic drugs approved for use since 1990. Four clinical cases discussed
in Part 2Articleoffer guidance for appropriate medication
Physicians' satisfaction with their careers; physical and mental health
of physicians; and pregnancy during residency.
For your patients: Information about epilepsy.
This Week in JAMA. JAMA. 2004;291(5):523. doi:10.1001/jama.291.5.523