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This Week in JAMA
January 19, 2005

This Week in JAMA

JAMA. 2005;293(3):269. doi:10.1001/jama.293.3.269

Quality of CPR in the Field and Hospital

Cardiopulmonary resuscitation (CPR) guidelines provide clear specifications for CPR performance, but whether these standards are achieved in clinical settings is not clear. Two articles in this issue of JAMA report data on guideline adherence in out-of-hospital and in-hospital settings. Wik and colleaguesArticle assessed CPR performance by ambulance personnel in the field and Abella and colleaguesArticle assessed CPR performance during in-hospital cardiac arrests, using the same monitoring techniques. In both settings, chest compressions were not administered in a significant number of events. Compression rates and depth were often less than recommended and ventilation rates were higher than recommended by the guidelines. In an editorialArticle, Sanders and Ewy discuss clinical benefits that could derive from simplifying CPR technique and training and ways to improve the guideline development process.

Improving Care of Adolescents With Depression

An estimated 6% of adolescents have major depression, but few receive effective treatment in primary care settings. Asarnow and colleagues report results of a randomized trial that involved care managers to support primary care physicians in evaluating and managing adolescent depression and provided training and educational materials for the physicians to increase access to evidence-based treatments. Six months after randomization, patients in the intervention group reported fewer depressive symptoms and had greater access to mental health care, including psychotherapy, than usual care patients.

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Folate Intake and Hypertension

Folic acid supplementation reportedly reduces systolic and diastolic blood pressure, but whether folate intake modifies the risk of incident hypertension is not known. Using food frequency data from women enrolled in 2 prospective cohort studies, Forman and colleagues examined the risk of incident hypertension in relation to dietary folate and folic acid supplement intake. During 8 years of follow-up, the risk of incident hypertension was significantly decreased in women who consumed at least 1000 μg/d of total folate.

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Effect of Estrogen Therapy on Gallbladder Disease

Observational data suggest estrogen therapy may promote gallstone formation and cholecystitis, but there are limited prospective data assessing this relationship. Cirillo and colleagues analyzed data from the Women’s Health Initiative trial to determine the effects of estrogen or estrogen plus progestin therapy vs placebo on gallbladder disease in healthy postmenopausal women. They found an increased risk of cholecystitis, cholelithiasis, and cholecystectomy among women using estrogen alone or in combination with progestin, compared with women taking placebo.

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Parents’ Knowledge of Teen Sexual Health Service Use

Many states provide confidential sexual health services to adolescents. However, little is known about parents’ knowledge that their daughter has received this care or how adolescent girls would react if parental notification was required. Jones and colleagues surveyed adolescent females seeking reproductive health services at family planning clinics and asked whether a parent knew they were obtaining sexual health services and whether they would still seek prescription contraception if parental notification was required. Sixty percent of adolescents surveyed reported a parent or guardian knew they were accessing reproductive health services. If parental notification was required, 59% would still use the clinic, but 20% would use no contraception or use less reliable methods.

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Medical News & Perspectives

A new report on global trends in the HIV/AIDS pandemic warns that the disease is increasingly affecting women and girls and populations in Asia and Eastern Europe.

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Clinician’s corner

Clinical Review
A simplified approach to treating non–ST-segment elevation (NSTE) acute coronary syndromes.

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Drug Reimportation

Choudhry and Detsky discuss why drug reimportation from Canada is poor policy.

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Coxibs and Cardiovascular Events

Topol discusses cardiovascular risks associated with cyclooxygenase 2 inhibitors (coxibs) and the consequences of inadequate postmarketing surveillance.

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JAMA Patient Page

For your patients: Information about cardiopulmonary resuscitation.

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