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This Week in JAMA
January 6,1999

This Week in JAMA

JAMA. 1999;281(1):5. doi:10.1001/jama.281.1.5
Long-term Treatment of Major Depression

Major depression is associated with a high risk of recurrence, especially in the elderly. In this study of elderly patients who had recovered from a recurrence of major depression, Reynolds and colleaguesArticle found that patients who received maintenance therapy with nortriptyline plus interpersonal psychotherapy had the lowest rate of recurrence over 3 years compared with patients who received nortriptyline or psychotherapy alone or placebo. In a related editorial, GlassArticle emphasizes the importance of providing access to long-term combined pharmacotherapy and psychotherapy for patients with major depression.

Changing the Use of Antenatal Corticosteroids

Leviton and coworkers compared changes in the use of antenatal corticosteroids for fetal maturation in women at risk of preterm delivery in 27 tertiary care hospitals randomly assigned to usual dissemination of practice recommendations (guideline publication) or to an active intervention that included educational activities and monitoring and feedback by an influential physician and a nurse coordinator at each hospital. The use of antenatal corticosteroids in eligible patients increased 108% in hospitals with active dissemination compared with a 75% increase in hospitals with usual dissemination.

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Alcohol Consumption and Risk of Ischemic Stroke

Results of studies of the effect of alcohol consumption on the risk of ischemic stroke have been inconsistent and have varied among different racial/ethnic groups. In this case-control study in a diverse population of individuals aged 40 years or older, Sacco and colleagues found that moderate alcohol consumption of up to 2 alcoholic drinks per day was protective for first ischemic stroke across all age, sex, and racial/ethnic groups. The risk of ischemic stroke increased with heavy drinking and was significantly greater among individuals who consumed 7 or more alcoholic drinks per day.

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Uneven Decline in Infectious Disease Mortality

Infectious disease mortality in the United States has generally declined this century, but episodic increases interrupt this trend (Figure 1). Contrary to what might have been predicted based on data through 1980, infectious disease mortality increased 4.8% per year between 1980 and 1995. This analysis by Armstrong and colleagues illustrates the need to be watchful for changes in microbial threats.

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Pharmacotherapy for Smoking Cessation

Available pharmacologic treatments approximately double the success rate of smoking cessation compared with placebo. In this Special Communication, Hughes and coauthors assert that physicians are obligated to make pharmacotherapy available for every patient who smokes, combined with behavioral interventions when necessary.

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Palpation for Detecting Abdominal Aortic Aneurysm

In this article, part of The Rational Clinical Examination series, Lederle and Simel assess the value of abdominal palpation for the detection of abdominal aortic aneurysm and describe the technique to measure aortic width.

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A Piece of My Mind

"That shabby little unknown bundle of neglect and despair that was dropped off by the police six weeks ago...is now a driving force on the infants' ward." From "Vergil."

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Contempo 1999

Stress as a factor in the pathogenesis of peptic ulcer disease.

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Medical News & Perspectives

Sex and drugs—and helping adolescents cope with them—are a major concern to the US public health establishment.

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Call for Papers: Atherosclerosis

Original research, reviews, and commentaries are invited for a JAMA theme issue on atherosclerosis scheduled for December 1999.

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JAMA's New Look

Easier to read, improved graphics; still authoritative and uniquely JAMA .

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A look at the MD-PhD programs, established 33 years ago, to foster the translation of basic science research to clinical applications.

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JAMA Patient Page

For your patients: Health effects of alcohol.

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