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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2009;301(2):133. doi:10.1001/jama.2008.992.
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TREADMILL EXERCISE AND PERIPHERAL ARTERIAL DISEASE

Supervised treadmill exercise improves walking performance in patients with peripheral arterial disease (PAD) and symptoms of intermittent claudication. However it is not clear whether patients with PAD and no symptoms of intermittent claudication benefit from supervised treadmill exercise or whether strength training is beneficial for patients with PAD. To address these questions, McDermott and colleagues randomly assigned patients with PAD to supervised treadmill exercise, to supervised lower extremity resistance training, or to a control group. At a 6-month follow-up, the authors found that participants with PAD—with and without intermittent claudication symptoms—who were assigned to treadmill exercise had greater increases in their 6-minute walk distance than did participants assigned to strength training. Neither exercise group experienced improvements in their physical performance battery scores.

NEURODEVELOPMENT OF PRETERM INFANTS FED DHA

Accretion of the n-3 long-chain polyunsaturated fatty acid docosahexaenoic acid (DHA), a major lipid in the brain, is greatest during the last trimester of pregnancy and DHA deficiency is hypothesized to result in poor neurodevelopmental outcomes in preterm infants. In a randomized trial that enrolled infants born at less than 33 weeks' gestation, Makrides and colleagues assessed the effect of high-dose DHA vs standard-dose DHA enteral feeds—from day 2 to 4 of life until term-corrected age—on neurodevelopmental outcomes. The authors report that compared with standard-dose DHA, high-dose DHA enteral feedings were not associated with higher scores on the Bayley Mental Development Index at the 18-month follow-up. In a subgroup analysis, girls, but not boys, fed the high-DHA diet had improved mental development index scores.

TREATING INCARCERATED DRUG USERS

It is estimated that 50% of incarcerated individuals meet the diagnostic criteria for drug abuse or dependence. Chandler and colleagues discuss the neurological basis of addictive behavior; evidence-based principles of addiction treatment that could be used in the criminal justice system; and the implications of addressing addiction within the criminal justice system for persons with addiction and society.

USERS' GUIDES FOR GENETIC ASSOCIATION STUDIES

In the second in a series of 3 Users' Guides to the Medical Literature on genetic association studies, Attia and colleagues use the APOE polymorphism and its association with dementia to discuss how to assess the validity of these studies. The third article, which will discuss how to interpret study results and apply this information in clinical care, will be published in next week's issue of JAMA.

CLINICIAN'S CORNER
ANTIDEPRESSANT TREATMENT IN FIBROMYALGIA SYNDROME

Symptoms of fibromyalgia syndrome (FMS) include chronic pain, fatigue, nonrestorative sleep, and other somatic and psychological symptoms, and effective treatment options are needed. In a meta-analysis of randomized placebo-controlled trials of antidepressants in the treatment of FMS, Häuser and colleagues found that antidepressant therapy is associated with reductions in pain, fatigue, depressed mood, and sleep disturbances and improvements in quality of life.

A PIECE OF MY MIND

“Doc's diagnoses were rendered with such authority and confidence that his patients were certain that theirs was the best, most competent physician to be had at any price.” From “Provenance.”

MEDICAL NEWS & PERSPECTIVES

Experts are working to improve the diagnosis and treatment of Chiari malformation.

COMMENTARIES

Transparency in standards for diabetes performance measures

Sliding scale insulin therapy

Improving health care quality: who is responsible for what?

ADVANCES IN SURGERY

Call for Papers

Authors are encouraged to submit manuscripts for an upcoming JAMA theme issue.

AUTHOR IN THE ROOM TELECONFERENCE

Join David J. A. Jenkins, MD, PhD, January 21 from 2 to 3 PM eastern time to discuss low–glycemic index or high–cereal fiber diets and type 2 diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.

JAMA PATIENT PAGE

For your patients: Information about peripheral arterial disease.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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