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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2000;284(20):2559. doi:10.1001/jama.284.20.2559.
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TREATMENT STRATEGIES FOR ACUTE MIGRAINE

In this trial, Lipton and colleaguesArticle compared 3 strategies for the treatment of up to 6 migraine attacks: step care within attacks using aspirin plus metoclopramide for each attack and zolmitriptan if no response after 2 hours; step care across attacks using aspirin plus metoclopramide for the first 3 attacks, then zolmitriptan as initial therapy for attacks 4 through 6 if the response for 2 of the first 3 attacks was unsatisfactory; and stratified care based on MIDAS disability levels (for MIDAS grade II disability, aspirin plus metoclopramide for all attacks; for MIDAS grade III or IV, zolmitriptan for all attacks). Headache response at 2 hours was significantly better among patients who received stratified care compared with both step care strategies, and disability time over 4 hours was significantly less. In an editorial, Matchar and coauthorsArticle note that this trial provides evidence to support US Headache Consortium guidelines for the selection and sequencing of treatments for acute migraine.

SMOKING PREVALENCE AND MENTAL ILLNESS

Based on data from the National Comorbidity Survey conducted during 1991 and 1992, Lasser and colleagues estimated that persons with mental illness comprised 44.3% of the US tobacco market. The current smoking rate for respondents with no mental illness was 22.5%, and for respondents with mental illness, 34.8% to 41.0%. Self-reported quit rates for persons with any history of mental illness or past month history of mental illness were less than for smokers without mental illness, but still substantial.

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MATERNAL HEMOGLOBIN LEVEL AND RISK OF STILLBIRTH

In this case-control study, Stephansson and colleagues found that a high maternal hemoglobin concentration at the first antenatal visit was associated with an increased risk of stillbirth, especially preterm and small-for-gestational-age antepartum stillbirth. Weekly changes in hemoglobin concentration in early or late pregnancy were not significantly associated with risk of stillbirth, but a larger decrease tended to be protective.

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ANDROSTENEDIONE USERS TEST POSITIVE FOR BANNED STEROID

Use of nandrolone, an anabolic steroid banned by sports organizations, is detected in the urine by the presence of an inactive metabolite, 19-norandrosterone. Catlin and colleagues measured levels of urinary 19-norandrosterone in study participants randomized to receive either an over-the-counter (OTC) androstenedione supplement or no supplement to determine whether individuals who use OTC androstenedione supplements will test positive for urinary 19-norandrosterone. All urine samples of participants in the androstenedione group tested positive for 19-norandrosterone, whereas none tested positive in the other group. Trace amounts of 19-norandrostenedione were detected in 7 of 8 tested capsules of the androstenedione preparation.

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REGIONAL VARIATIONS IN INCIDENCE OF ESRD IN JAPAN

In the United States, the incidence of end-stage renal disease (ESRD) has been higher in black persons than in white persons, but factors other than race/ethnicity may also contribute to differences in ESRD incidence. In this study of the incidence of ESRD between 1982 and 1998 in Japan, where the population is ethnically homogeneous, Usami and colleagues found significant regional differences in both the incidence and the rate of increase in incidence of ESRD.

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A 44-YEAR-OLD WOMAN WITH DIFFICULTY WALKING

Mrs D, a 44-year-old woman with amyotrophic lateral sclerosis, uses Canadian crutches and a rolling walker. She is considering using a wheelchair because of increasing difficulty walking. Iezzoni discusses assessment and management of mobility problems.

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A PIECE OF MY MIND

"I wonder at the defense mechanisms of physicians who see patients full-time. How do they bounce professionally from room to room, pedaling hope and optimism amidst such palpable unhappiness?" From "No Time to Say Hello Good-bye."

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CONTEMPO UPDATES

Soft tissue paleopathology: methods and insights into human disease.

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MEDICAL NEWS & PERSPECTIVES

Genomic researchers are working to translate their findings into reductions in disease incidence, improvements in diagnosis, and individualized therapies.

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CHILDREN'S ORAL HEALTH

Recommendations to reduce disparities in the prevalence of dental caries in childhood.

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GENOMIC MEDICINE

Original research reports, reviews, and commentaries on human genetics research and its clinical applications are invited for JAMA and Archives theme issues scheduled for November 2001.

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ELIMINATION OF MUMPS, RUBELLA IN FINLAND

Vaccination programs and the elimination of mumps and rubella in Finland.

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JAMA PATIENT PAGE

For your patients: A primer on migraine.

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