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This Week in JAMA
March 17, 1999

This Week in JAMA

JAMA. 1999;281(11):967. doi:10.1001/jama.281.11.967
Treatment of Chronic Insomnia in Older Adults

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- vs High-Dose Methadone Treatment

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.

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Ethnic Differences in CVD Risk Factors in Youth

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.

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A New Look at the Risk of Isoniazid Hepatotoxicity

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.

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Perception of Disease Risk Among Smokers

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 cancer.

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Jama netsight

Online resources in otolaryngology for patients and health care professionals.

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Medical News & Perspectives

Researchers are attempting to translate laboratory insights on the behavior of malignant cells into novel therapies that thwart ovarian tumor growth in patients.

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The Rational Clinical Examination

What physical findings best detect hypovolemia in adults?—a systematic review of the literature.

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Defining health as "a resource for everyday life" adds new dimensions to the concept of health promotion.

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The Patient-Physician Relationship

Understanding medical risk and how to discuss it with patients.

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JAMA Patient Page

For your patients: A primer on insomnia.

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