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In this randomized trial, Morin and colleaguesArticle found that older
adults with chronic insomnia treated with 8 weeks of either
pharmacotherapy (PCT) (temazepam), cognitive-behavior therapy (CBT), or
combined behavioral and pharmacological therapy had greater initial
posttreatment improvements in sleep continuity and efficiency than
those who received placebo. Patients treated with CBT alone best
maintained sleep improvement over time (lower scores on the Sleep
Impairment Index; Figure 1). In an editorial,
Reynolds and coauthorsArticle point out that insomnia is associated with
serious morbidity, including depression, both of which are undertreated
in elderly patients.
Moderate daily doses of methadone are generally recommended for
the treatment of opioid dependence, but higher doses may offer more
benefit. In this study of methadone treatment in patients with
intravenous opioid dependence, Strain and colleagues found that
although patients in the high-dose group (80-100 mg/d) had
significantly lower rates of opioid-positive urine samples than
patients in the moderate-dose group (40-50 mg/d), opioid use was
reduced in both groups and treatment program retention was similar.
Using data on a large sample of white, Mexican American, and black
children and young adults from the US Third National Health and
Nutrition Examination Survey, 1988-1994, Winkleby and colleagues found
that ethnic differences in cardiovascular disease (CVD) risk
factors—body mass index, percentage of energy from dietary fat,
glycosylated hemoglobin levels, and systolic blood pressure—were
already observable in the youngest age group, 6 to 9 years. Prevalence
of CVD risk factors was generally higher in Mexican American and black
youth than in white children; however, cigarette smoking was most
prevalent among white children beginning at age 10 to 13 years.
Prior estimates of the risk of isoniazid hepatotoxicity included
cases of isolated liver enzyme level elevations now known to occur
without consequence in up to 20% of patients who receive isoniazid. To
reassess the risk of hepatotoxicity associated with preventive
isoniazid therapy using current diagnostic criteria, Nolan and
coworkers followed up a cohort of 11,141 patients with latent
tuberculosis who began isoniazid treatment between 1989 and 1995.
Clinical symptoms of hepatotoxicity occurred in 11 patients, 0.10% of
those starting therapy and 0.15% of those who completed therapy, rates
lower than the 0.5% to 2.0% risk of hepatotoxicity previously
reported. The rate of hepatotoxicity increased with increasing age and
was more frequent in women than in men and in whites than in nonwhites.
Cigarette smokers may continue smoking despite knowing that smoking
increases their risk of cardiovascular disease and cancer, or they may
fail to perceive their increased risk of these conditions. In a
nationwide survey, Ayanian and Cleary found that only 29% of current
smokers reported that they thought they had a higher-than-average risk
of myocardial infarction than others of the same age and sex, and only
40% of current smokers thought they had a higher-than-average risk of
Online resources in otolaryngology for patients and health care
Researchers are attempting to translate laboratory insights on the
behavior of malignant cells into novel therapies that thwart ovarian
tumor growth in patients.
What physical findings best detect hypovolemia in adults?—a systematic
review of the literature.
Defining health as "a resource for everyday life" adds new
dimensions to the concept of health promotion.
Understanding medical risk and how to discuss it with patients.
For your patients: A primer on insomnia.
This Week in JAMA. JAMA. 1999;281(11):967. doi:10.1001/jama.281.11.967
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