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This Week in JAMA |

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JAMA. 2001;285(17):2165. doi:10.1001/jama.285.17.2165.
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CARDIORESPIRATORY EVENTS DETECTED BY HOME MONITORS

Home cardiorespiratory monitoring to identify prolonged apnea and bradycardia is commonly used to prevent sudden infant death syndrome (SIDS) in high-risk infants. Ramanathan and colleaguesArticle analyzed home monitoring data from 306 healthy term infants and 773 high-risk infants—preterm infants, siblings of infants who died of SIDS, and infants who experienced an apparent life-threatening event. The incidence of cardiorespiratory events that exceeded conventional thresholds was common even among healthy term infants. The risk of at least 1 event exceeding extreme thresholds was higher among preterm infants compared with healthy term infants, but only through 43 weeks postconceptual age, before the age when the incidence of SIDS peaks. In an editorial, JobeArticle notes that placing infants in the supine position for sleep and the use of proper bedding will prevent most cases of SIDS and, based on these findings, home monitoring is unlikely to prevent the remaining cases.

TREATMENT OF CHRONIC TENSION-TYPE HEADACHES

Chronic tension-type headaches are frequently treated with tricyclic antidepressants despite limited evidence that this treatment is beneficial. In this trial, Holroyd and colleagues found that patients with chronic tension-type headaches who received tricyclic antidepressants and stress management therapy, singly and in combination, had larger reductions in headache activity, analgesic medication use, and headache-related disability compared with patients who received placebo. Improvement in headache activity was most rapid among patients who received antidepressants. The proportion of patients who achieved clinically significant reductions in headache activity was greater in the combination group than in the groups that received either therapy alone.

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PREVALENCE OF MUTATIONS IN THE HEMOCHROMATOSIS GENE

Population-based estimates of the prevalence and penetrance of disease-associated genetic mutations are necessary to determine the usefulness of screening for genetic conditions. Hereditary hemochromatosis, an iron metabolism disorder, is one of the most common autosomal recessive disorders in whites in the United States. Steinberg and colleagues estimated the prevalence of 2 mutations in the hemochromatosis gene (HFE), C282Y and H63D, using samples from participants in the Third National Health and Nutrition Examination Survey. The C282Y mutation had an estimated prevalence of 5.4% in the US population, and the H63D mutation, 13.5%. Estimated prevalences of the mutations were highest among non-Hispanic whites compared with non-Hispanic blacks and Mexican Americans.

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SELF-REFERRAL IN POINT-OF-SERVICE HEALTH PLANS

Point-of-service health plans, developed in response to dissatisfaction with "gatekeeping," allow patient self-referrals to specialty care at increased out-of-pocket costs. Forrest and colleagues report that most patients enrolled in 3 point-of-service health plans did not exercise their option to obtain specialty care via self-referral during a 1-year period. The proportion of patients self-referring to generalists was 4.7% to 8.5%, and the proportion self-referring to specialists was 3.7% to 7.2%. Patients who self-referred to specialists were more satisfied with the specialty care they received than were patients referred by physicians.

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CLINICAL EVALUATION BEFORE HORMONAL CONTRACEPTION

Breast and pelvic examinations are commonly required before providing women with hormonal contraceptives. In this review of the medical literature and of policy statements from professional organizations, Stewart and colleagues conclude that hormonal contraception can safely be provided based on careful review of the medical history and blood pressure measurement. Breast and pelvic examinations are not necessary to identify women who should avoid hormonal contraception and may create obstacles to obtaining contraception.

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MEDICAL NEWS & PERSPECTIVES

Medical spin-offs from the space program are a long-time NASA promise. Recently the agency released research results showing that a weightless environment enhances the growth of human tissue for therapeutic purposes.

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GRAND ROUNDS

A discussion of the etiology, diagnosis, natural history, and management of Proteus syndrome, a disorder that causes overgrowth of multiple tissues, is illustrated by a case presentation of a 5-year-old patient with this condition.

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BASIC SCIENCE AND TRANSLATIONAL RESEARCH

Original research papers in basic biomedical science and translational research are invited for a JAMA theme issue scheduled for March 2002.

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MSJAMA

Alternative career options for physicians.

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JAMA PATIENT PAGE

For your patients: Information about tension headache.

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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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