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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2003;289(12):1469. doi:10.1001/jama.289.12.1469.
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NATIONAL INVENTORY OF US TRAUMA CENTERS, 2002

The last full accounting of trauma centers in the United States identified 471 trauma centers in 1991 and 21 states with formal trauma systems. In this national inventory of US trauma centers as of April 2002, MacKenzie and colleaguesArticle identified 1154 trauma centers and 35 states with formal trauma systems. The number of level I and II centers increased from 374 to 453, but the geographic distribution and configuration of centers by level varied widely. In an editorial, TrunkeyArticle discusses implications of these findings for health care policy.

LEAD LEVELS AND BLOOD PRESSURE IN OLDER WOMEN

Higher lead levels in bone and blood have been associated with increased risk of hypertension in older men. Nash and colleagues analyzed data from women aged 40 to 59 years who participated in the Third National Health and Nutrition Examination Survey to examine the relationship between blood lead levels and blood pressure and hypertension during perimenopause and postmenopause when increased bone demineralization may mobilize skeletal lead stores. Blood lead levels were positively associated with both systolic and diastolic blood pressure. Risk of systolic and diastolic hypertension was greatest in the highest blood lead level quartile, especially among postmenopausal women.

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EPSTEIN-BARR VIRUS INFECTION AND MULTIPLE SCLEROSIS

Anti–Epstein-Barr virus (EBV) antibodies are elevated in individuals with multiple sclerosis. To determine whether antibodies to EBV are elevated before the onset of multiple sclerosis, Levin and colleagues conducted a case-control study among US military personnel with blood samples collected between 1988 and 2000. Baseline geometric mean serum antibody titers to EBV were consistently higher among individuals who later developed multiple sclerosis than among matched controls. All cases were seropositive at the time of collection of the first blood sample, a mean of 4 years before onset of multiple sclerosis.

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EFFICACY AND SAFETY OF EPHEDRA AND EPHEDRINE

Serious adverse effects have been associated with products containing ephedrine and ephedra. Shekelle and colleaguesArticle conducted a meta-analysis of data from controlled trials and reviewed case reports of adverse events to assess the efficacy and safety of ephedra and ephedrine use for weight loss and enhanced athletic performance. Ephedrine and ephedra use was associated with modest short-term weight loss, but no data were available regarding long-term weight loss. Data regarding enhancement of athletic performance were insufficient for analysis. Use of ephedrine or ephedra was associated with a 2- to 3-fold increase in psychiatric symptoms, autonomic symptoms, upper gastrointestinal symptoms, and heart palpitations. In an editorial, Fontanarosa and coauthorsArticle propose major revisions to the current system used for regulation of dietary supplements.

A PIECE OF MY MIND

"The pain has disappeared from his face now, and as a father I can only pray, Keep him in remission. Let him live his dream." From "Fragile Corners."

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GORHAM-STOUT DISEASE

Cutaneous lesions in a 34-year-old man with Gorham-Stout disease.

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MEDICAL NEWS & PERSPECTIVES

In a large phase 3 trial, an experimental HIV vaccine appears to be largely ineffective, and the interpretation of some of the findings has ignited a controversy.

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EVOLUTION OF US LAW AND MEDICAL PRACTICE

How changes in the legal framework for medicine have influenced medical practice.

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CLINICIAN'S CORNER

Mr H, a 73-year-old man, continues to experience limitations related to hearing loss despite use of digital hearing aids. Jackler discusses the epidemiology, pathophysiology, evaluation, and treatment of hearing loss.

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JAMA PATIENT PAGE

For your patients: Information about ephedra and ephedrine in dietary supplements.

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