0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
This Week in JAMA |

This Week in JAMA FREE

JAMA. 2007;298(1):9. doi:10.1001/jama.298.1.9.
Text Size: A A A
Published online

MORBIDITY IN VON HIPPEL-LINDAU DISEASE

The common finding of endolymphatic sac tumors and sensorineural hearing loss and vestibulopathy in patients with von Hippel-Lindau disease has led to prospective screening of patients for these tumors. However, the pathophysiology of the audiovestibular morbidity is not clear. Butman and colleagues analyzed serial imaging and clinical findings in a consecutive series of 35 patients with von Hippel-Lindau disease to determine the mechanisms of sensorineural hearing loss and vestibular dysfunction. The authors found that sensorineural hearing loss and vestibulopathy occurred suddenly in patients with tumor-associated intralabyrinthine hemorrhage and more gradually in patients with endolymphatic hydrops. These outcomes were not related to tumor size.

EFFECTS OF COCOA INTAKE ON BLOOD PRESSURE

Preliminary evidence suggested that regular consumption of polyphenols in cocoa (equivalent to ≥100 g of chocolate per day) was associated with lower blood pressure (BP). Given concerns about the high sugar, fat, and calorie intake from cocoa consumption of this magnitude, the effects of low doses of cocoa would be of interest. Taubert and colleagues report results of a clinical trial in which 44 older adults who had untreated prehypertension or stage 1 hypertension were randomly assigned to either 6.3 g (28.9 kcal) per day of dark chocolate containing 30 mg of polyphenols or a matching amount of polyphenol-free white chocolate. At the 18th week of follow-up, the authors found that participants consuming dark chocolate had experienced reductions from baseline in mean (SD) systolic and diastolic BP of 2.9 (1.6) mm Hg and 1.9 (1.0) mm Hg, respectively, without changes in body weight or other adverse effects. Persons who were consuming white chocolate experienced no change in BP.

PRESCRIPTION DRUG COST SHARING

In a systematic review of the literature, Goldman and colleagues analyzed the association of cost-sharing features of prescription drug benefits, such as co-payments, tiering, or coinsurance, with patient access to prescription medications, medical spending, and health outcomes. Among the authors' findings were that increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of treatment. For some chronic conditions, higher levels of prescription cost-sharing were associated with increased use of medical services and worse clinical outcomes.

CLINICIAN'S CORNER

Inhibition of the epidermal growth factor receptor (EGFR), which regulates important cellular functions in epithelial malignancies and is overexpressed in some aerodigestive carcinomas, is the goal of several novel chemotherapies. Karamouzis and colleagues summarize the biology of EGFR inhibitors and their therapeutic efficacy in aerodigestive carcinomas, including patient and tumor characteristics that may be associated with or predict efficacy.

A PIECE OF MY MIND

“He is primed for autonomic overload, the anxiety that won't subside, the depression that is too heavy to bear, the nightmare that won't go away.” From “Stress, Redeployed.”

MEDICAL NEWS & PERSPECTIVES

Studies of the mechanisms underlying migraine and rare pain disorders are providing insights that may help efforts to develop treatments that selectively target sources of pain.

XDR-TB AND PUBLIC HEALTH

Public health powers and challenges relating to extensively drug-resistant tuberculosis (XDR-TB).

TOBACCO LITIGATION

Possible public health benefits of recent litigation against the tobacco industry.

GLOBAL HEALTH

Why everyone should care about global health.

CLINICAL TRIAL REGISTRATION

An update from the International Committee of Medical Journal Editors.

JAMA PATIENT PAGE

For your patients: Information about adult hearing loss.

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.