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This Week in JAMA
March 22/29, 2000

This Week in JAMA

JAMA. 2000;283(12):1527. doi:10.1001/jama.283.12.1527

Amyloid β-Peptide Levels Correlate With Dementia

Two distinctive neuropathologic lesions are characteristic of Alzheimer disease (AD)—amyloid β-peptide (Aβ)–containing plaques (Figure 1 , arrow) and neurofibrillary tangles composed of the protein tau (arrowhead). Using enzyme-linked immunosorbent assays to determine brain tissue Aβ peptide levels in a postmortem study of 79 nursing home residents, Näslund and colleaguesArticle found that brain tissue levels of Aβ peptides were elevated in early dementia (Clinical Dementia Rating [CDR] score, 0.5) and increased as CDR scores increased. In the frontal cortex, elevation of Aβ peptides preceded the development of tau pathology. In an editorial, SelkoeArticle describes the evidence supporting the amyloid hypothesis of AD and discusses therapeutic approaches based on inhibiting Aβ peptide production or increasing Aβ peptide clearance.

Risk Factors for Crash Fatalities Among Teen Drivers

The National Highway Traffic Safety Administration, to reduce motor vehicle fatalities associated with teenaged drivers, has recommended graduated driver licensing systems with 3 levels of licensure—learner's license requiring supervision at all times; intermediate license with restricted unsupervised driving; and full-privilege license. In this analysis of data from 3 US federal sources, Chen and colleaguesArticle report that the risk of a motor vehicle crash fatal to a 16- or 17-year-old driver increased significantly as the number of passengers increased, irrespective of time of day or sex of the driver. In an editorial, FossArticle emphasizes the importance of prohibiting young drivers from driving with passengers and from driving after 10 PM.

Outpatient Treatment of Acute Pyelonephritis

To determine effective outpatient treatment of uncomplicated acute pyelonephritis in women, Talan and colleagues randomly assigned 378 premenopausal women aged 18 years or older to receive a 7-day course of ciprofloxacin or a 14-day course of trimethoprim-sulfamethoxazole. At 4 to 11 days after treatment, bacteriologic and clinical cure rates were significantly higher among women in the short-course ciprofloxacin group than in the trimethoprim-sulfamethoxazole group. Rates of bacteriologic and clinical failure in the trimethoprim-sulfamethoxazole group were significantly higher among patients infected with Escherichia coli with in vitro resistance to trimethoprim-sulfamethoxazole. Adverse drug events occurred in 46 (24%) of 191 patients treated with ciprofloxacin and in 62 (33%) of 187 patients treated with trimethoprim-sulfamethoxazole.

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Incidence and Risk of Recurrent Preterm Delivery

In this analysis of data from singleton birth and fetal death certificates from Georgia, 1980 through 1995, Adams and colleagues found that most women whose first delivery was preterm did not have a subsequent preterm delivery, but recurrence of preterm delivery was higher among black women (26.0%) than among white women (19.9%). For both white and black women, the rate of preterm delivery in the second pregnancy increased as the length of gestation of the first pregnancy decreased.

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An 82-Year-Old Woman With Poststroke Mood Changes

Mrs K, an 82-year-old woman whose recent stroke resulted in left-sided ataxia-hemiparesis syndrome, has experienced episodic changes in her mood and behavior beginning 2 months after the stroke. Robinson discusses pathogenesis of poststroke depression, differential diagnosis and clinical evaluation of mood change after stroke, and treatment.

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Contempo Updates

Clinical applications of polymerase chain reaction DNA amplification.

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Medical News & Perspectives

The World Health Organization has set 2005 as the target date for global eradication of polio. Now safe containment of remaining poliovirus must be ensured.

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Screening Athletes for Cardiovascular Disease

Survey results indicate that preparticipation cardiovascular screening of student-athletes at most US colleges and universities is unlikely to detect cardiovascular abnormalities that could cause sudden death.

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Medical Information on the Internet

AMA Web site guidelines outline standards in 4 specific areas: content, advertising, privacy and confidentiality, and e-commerce.

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JAMA Patient Page

For your patients: Information about urinary tract infections.

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