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This Week in JAMA
September 27, 2000

This Week in JAMA

JAMA. 2000;284(12):1481. doi:10.1001/jama.284.12.1481

Minor Depression and Dysthymia in Older Adults

Little evidence is available to guide therapy for common depressive disorders less severe than major depression. Williams and colleaguesArticle conducted a randomized trial in 4 primary care practices comparing paroxetine, psychotherapy adapted specifically for primary care, and placebo for the treatment of older patients with minor depression or dysthymia. During the 11-week trial, depressive symptom scores decreased in all treatment groups. Symptom reduction in the 2 active treatment groups was similar, but only the change in the paroxetine group was significantly greater than that in the placebo group. In an editorial, Gallo and CoyneArticle question whether current diagnostic categories and pathophysiologic concepts of depression are applicable to depression in older adults and emphasize the importance of conducting mental health research in primary care settings.

Alcohol-Related Injury and Age of Drinking Onset

Alcoholism is a major risk factor for unintentional injury, but almost one third of persons injured while under the influence of alcohol have never met criteria for alcohol dependence. To determine whether early age of drinking onset is associated with increased risk of alcohol-related injury, Hingson and colleagues analyzed data from the 1992 National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey of US adults aged 18 years or older. Respondents who began drinking before age 21 years were significantly more likely to have been injured while under the influence of alcohol than were respondents who began drinking at age 21 years or older, even after controlling for alcohol dependence.

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Dietary Whole Grains and Ischemic Stroke in Women

Higher dietary intake of whole grains has been associated with a decreased risk of coronary heart disease morbidity and mortality in women. To determine whether whole grain consumption reduces the risk of ischemic stroke, Liu and colleagues analyzed data from 75,521 women enrolled in the Nurses' Health Study. During 12 years of follow-up, 352 cases of ischemic stroke occurred. Higher intake of whole grain foods was associated with a lower risk of ischemic stroke, independent of known cardiovascular disease risk factors.

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Raw Oysters and an Outbreak of

Current US safety regulations may be inadequate to prevent illness caused by ingesting contaminated shellfish. In this investigation of an outbreak of acute gastroenteritis in May and June 1998, Daniels and colleagues estimate that approximately 200,000 people may have become ill after eating oysters harvested from Galveston Bay. The oyster harvest met bacteriologic standards, and fecal coliform counts in water samples were acceptable. All available stool specimens from affected persons yielded Vibrio parahaemolyticus serotype O3:K6 isolates, the first reported isolation of this serotype in the United States.

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Platelet Glycoprotein IIB/IIIA Inhibitor Therapy

In this review of 10 trials of platelet glycoprotein IIb/IIIa inhibitor therapy for acute coronary syndromes, Bhatt and Topol conclude that current data support its intravenous use at the time of urgent angiography with percutaneous coronary revascularization or for initial medical management in the emergency department.

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A 26-Year-Old Woman With Shoulder Pain

Mrs B is a 26-year-old physical education teacher who has had bilateral shoulder pain for about 4 years. Treatment with subacromial corticosteroid injections, physical therapy, and ibuprofen has provided only partial, temporary relief. Burkhart describes common conditions that cause shoulder pain and dysfunction, and diagnostic assessment and treatment.

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A Piece of My Mind

"Lesson 12: All physicians become patients." From "Twenty Lessons From the Heart of Medicine."

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Contempo Updates

Diagnosis and treatment of obstructive sleep apnea syndrome.

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Medical News & Perspectives

The head of the new Office of Human Research Protection says that clinical researchers who fail to protect study participants will be put out of business.

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Peristomal Pyoderma Gangrenosum

Clinical manifestations, diagnosis, and treatment of peristomal pyoderma gangrenosum.

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Gender Verification in the Olympics

Simpson and coauthors encourage support for the recent decision of the International Olympic Committee to discontinue gender verification procedures during the Olympic Games.

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End-of-Life Discussions

Strategies to overcome barriers to conversations at the end of life between patients and health care professionals.

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JAMA Patient Page

For your patients: Information on symptoms and types of depression.

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