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This Week in JAMA |

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JAMA. 2006;295(24):2819. doi:10.1001/jama.295.24.2819.
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Prior studies support both pharmacotherapy and behavioral therapy for the treatment of insomnia. Few studies, however, have assessed their relative efficacies, particularly in older individuals with chronic insomnia. Sivertsen and colleagues report results of a randomized trial that examined both short-term and long-term efficacies of 6 weeks of cognitive behavioral therapy (CBT) vs 6 weeks of pharmacological treatment (zopiclone) or placebo in older adults with chronic primary insomnia. The authors found that CBT—which included information about sleep hygiene, sleep restriction, control of the bedroom environment, cognitive therapy, and progressive relaxation techniques—was superior to pharmacotherapy with zopiclone (or placebo) in both the short-term and long-term treatment of insomnia in older adults.


Hypertension is a recognized risk factor for congestive heart failure (CHF), but whether diurnal variations in blood pressure are related to incident CHF is not known. Ingelsson and colleagues report results of a population-based cohort study in which they measured 24-hour ambulatory blood pressure in elderly Swedish men who were free of CHF, valvular disease, and left ventricular hypertrophy at baseline to assess blood pressure variables as predictors of first hospitalization for CHF. During a median follow-up of 9.1 years, the authors found that an increased nighttime ambulatory diastolic blood pressure and a nondipping night-day blood pressure pattern (night/day ambulatory blood pressure ratio ≥1) were associated with incident CHF in analyses adjusted for baseline CHF risk factors and antihypertensive treatment. They also found that a nondipping night-day blood pressure pattern was associated with an increased risk of CHF in analyses adjusted for conventional office blood pressure measurements.


Since March 1, 2005, an increasing number of cases of contact lens–associated Fusarium keratitis have been reported in Singapore. Khor and colleagues reviewed all cases of Fusarium keratitis diagnosed in Singapore during the period from March 1, 2005, to May 26, 2006, involving individuals who wore contact lenses to correct a refractive error. Sixty-six patients were identified with Fusarium keratitis. Among the 66 patients, 65 patients wore soft, disposable contact lenses and 62 patients reported using one brand of contact lens cleaning solution. Poor lens hygiene practices and wearing lenses past the replacement date were additional factors reported by patients with Fusarium infection.


Major depression is associated with new cardiovascular events in healthy patients and adverse cardiovascular outcomes among patients with established heart disease. Whooley discusses a patient with a 5-year history of coronary heart disease, a recent myocardial infarction, and a new diagnosis of major depression. Mechanisms through which depression may lead to cardiac events and the identification and treatment of depression in patients with cardiovascular disease are reviewed.


“‘The autopsy is done respectfully. The internist or surgeon may err in diagnoses, yet the pathologist approaches the postmortem with humility.’” From “The Autopsy Room.”


Reports of jaw osteonecrosis in patients taking bisphosphonates have clinicians weighing how to minimize the risk of this rare adverse event while allowing patients to benefit from the drugs’ bone-protecting effects.


Compelled authorized disclosures of personal health information may compromise health privacy.


Osler's advice to pay close attention to fever is as important today as it was in his time.


Academic institutions are invited to submit manuscripts for JAMA's Clinical Crossroads section.


For your patients: Information about insomnia.



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