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In This Issue of JAMA |

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JAMA. 2014;311(9):877-879. doi:10.1001/jama.2013.279360.
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In analysis of registry data from 24 317 patients admitted to hospital with myocardial infarction and preexisting or new atrial fibrillation (AF), Carrero and colleagues investigated outcomes associated with warfarin treatment in relation to kidney function. The authors report that warfarin treatment was associated with a lower 1-year risk of a composite outcome of death, myocardial infarction, and ischemic stroke without a higher risk of bleeding—unrelated to the severity of concurrent chronic kidney disease (CKD). In an Editorial, Winkelmayer and Turakhia discuss implications of the findings for patient care.

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Childhood overweight and obesity have been inversely associated with economic resources. In an analysis of anthropometric data from American Indian children in California who attended schools in 117 districts that encompassed tribal lands and of socioeconomic data for American Indians living on the tribal lands, Jones-Smith and colleagues found that opening or expansion of American Indian–owned casinos was associated with decreased risk of childhood overweight and obesity, increased family income, and decreased poverty rates.

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In the Moving to Opportunity study, 4604 families living in public housing in 1994-1998 were randomly assigned to receive a housing voucher and counseling to facilitate relocation from high-poverty to low-poverty neighborhoods, a geographically unrestricted housing voucher, or no intervention. In an exploratory analysis, Kessler and colleagues evaluated the association of housing mobility randomization with psychiatric disorders in adolescence among 2872 participants who were aged 0 to 8 years at randomization. The authors report that compared with no intervention, interventions to encourage moving out of high-poverty neighborhoods were associated with increased rates of depression, posttraumatic stress disorder, and conduct disorder among boys and reduced rates of depression and conduct disorder among girls. In an Editorial, Halfon discusses socioeconomic influences on child health.

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Tremor—a rhythmic and involuntary movement of any body part—is an extremely common but potentially disabling condition. Elias and Shah review the clinical evaluation of patients presenting with tremor, highlighting features of the history and physical examination that help to distinguish essential tremor from Parkinson disease. Based on a systematic review of clinical trials of pharmacologic treatment of essential tremor (n=131) and Parkinson disease (n=27), the authors provide recommendations for medical management of these common types of tremors.

In this JAMA Clinical Evidence Synopsis, Vickers and Linde summarize results of a meta-analysis of data from 29 high-quality trials that compared trials that compared acupuncture with a no-acupuncture control (14 587 participants) or sham acupuncture (5320 participants) for relief of chronic pain. The authors found that acupuncture was associated with greater reductions in chronic pain than the comparator interventions.

A 53-year-old homosexual man with multiple sclerosis and recent rituximab treatment was admitted to hospital for worsening lower extremity weakness. One week prior to admission he noticed tender perianal and lower leg skin eruptions. On examination, the lesions were erythematous with irregular borders and the leg lesion was observed to have a central black hemorrhagic crust. What would you do next?



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