Despite traditional rehabilitation, a high percentage of stroke survivors have persistent functional limitations of affected extremities. The multicenter randomized Extremity Constraint Induced Therapy Evaluation (EXCITE) trial compared the effects of 2 weeks of constraint-induced movement therapy (CIMT) vs usual care for patients who had upper extremity paresis and had experienced a stroke 3 to 9 months before trial entry. Wolf and colleaguesArticle, writing for the EXCITE investigators, report that compared with patients who had received usual care, patients randomly assigned to CIMT had significantly greater improvements in arm motor function. These improvements persisted for up to 1 year and were not influenced by age, sex, or arm function at trial enrollment. In an editorial, Luft and HanleyArticle discuss the EXCITE trial results and directions for future research in stroke rehabilitation.
Epidemiological studies have suggested that a link exists between low lipoprotein levels and an increased risk of adverse events in individuals with heart failure. Go and colleagues evaluated the association between initiation of statin therapy and risks of death and hospitalization in a cohort of adults with heart failure who were eligible for lipid-lowering therapy. The authors found that statin therapy was independently associated with lower risks of death and hospitalization among patients with heart failure whether or not they had coronary artery disease.
Interventions to reduce suicide among black Americans are limited by a lack of data on suicide prevalence and risks in this population. Joe and colleagues analyzed data from a nationally representative survey to assess the prevalence and correlates of suicide ideation, planning, and attempts among blacks of African American and Caribbean ethnicity. The authors found a lifetime prevalence of 11.7% for suicide ideation and 4.1% for suicide attempts, levels that are comparable with the general population. Caribbean black men had the highest prevalence of attempts. Other factors associated with suicide attempts included younger age, lower education, Midwest residence, and having 1 or more psychiatric disorders.
Serotonergic (5-HT) neurons in the medulla oblongata project to respiratory and autonomic nuclei in the brainstem and spinal cord, and previous studies identified abnormalities in medullary 5-HT receptor binding in a subset of cases of sudden infant death syndrome (SIDS). Paterson and colleaguesArticle investigated cellular defects associated with altered 5-HT receptor binding in autopsy samples obtained from 31 SIDS cases and 10 infant controls. The authors report that compared with control infants, SIDS cases had a higher number and density of 5-HT neurons and lower density of binding sites in regions of the medulla involved in homeostatic functions. In an editorial, Weese-MayerArticle discusses the neuropathology of SIDS and the importance of confirming these findings in autopsy studies reflecting the ethnic diversity of SIDS.
“The hospital bond feels deeper than 2 people sharing the patient's dramatic story of recovery from illness.” From “The Hospitalist's Story.”
An Institute of Medicine committee is calling for sweeping improvements in the Food and Drug Administration’s efforts to ensure drug safety, particularly measures that increase the agency’s postmarket safety monitoring activities and expand its regulatory authority.
Ms K is a 47-year-old woman who was recently diagnosed with sarcoidosis. Weinberger discusses the diagnosis, pathophysiology, treatment, and prognosis of sarcoidosis.
Join Dariush Mozaffarian, MD, DrPH, Wednesday, November 15, 2006, from 2 to 3 PM eastern time to discuss the risks and benefits of eating fish. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about sarcoidosis.
This Week in JAMA . JAMA. 2006;296(17):2059. doi:10.1001/jama.296.17.2059