JAMA : the journal of the American Medical Association
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Biography Historical Article
Medicine in the USA: historical vignettes. XX. The Flexner report of 1910.
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Data on the risk of death associated with various contraceptive methods are incomplete. Therefore, we analyzed the mortality rates for young, black inner-city women who used one of four methods of contraception--oral contraceptives, depomedroxyprogesterone acetate, intrauterine (contraceptive) devices, and barrier methods. The subjects were 30,580 15- to 44-year-old women who enrolled at a family planning clinic between 1967 and 1972 and who were observed by monitoring death certificates through the end of 1977. ⋯ Use of this family planning clinic greatly reduced the risk of death from childbearing; only two deaths were associated with pregnancy and childbirth, compared with the 24 deaths expected. Overall, users of the four methods died at similar, low rates. Given that this study involves considerable loss to follow-up, possible acute effects of contraceptives (eg, infections or thrombosis) are more accurately estimated than possible long-term effects (eg, cancer).
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Randomized Controlled Trial Clinical Trial
Auriculotherapy fails to relieve chronic pain. A controlled crossover study.
Enthusiastic reports of the effectiveness of electrical stimulation of the outer ear for the relief of pain ("auriculotherapy") have led to increasing use of the procedure. In the present study, auriculotherapy was evaluated in 36 patients suffering from chronic pain, using a controlled crossover design. ⋯ Pain-relief scores obtained with the McGill Pain Questionnaire failed to show any differences in either experiment. It is concluded that auriculotherapy is not an effective therapeutic procedure for chronic pain.
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Comparative Study
Midtrimester abortion. Intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha v dilatation and evacuation.
Although dilatation and evacuation (D&E) is currently the most common method of midtrimester abortion in the United States, the intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha combined (U-P) has been proposed as a safer technique. To evaluate the comparative safety of U-P and D&E, we analyzed 2,805 U-P and 9,572 D&E abortions at 13 to 24 menstrual weeks' gestation. ⋯ This advantage for D&E stems from its applicability to the 13- to 16-week interval. Although D&E appears to be safer overall in the midtrimester, for women obtaining abortion after 16 weeks, the rates of serious complications were comparable, with a relative risk of 1.0 (95% confidence interval, 0.4 to 2.5).
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The distinction between venomous, potentially dangerous snakes and snakes considered to be harmless to humans is not always clear. A man was bitten by an assumed harmless pet snake, Rhabdophis subminatus (the red neck keelback), that had been obtained from a pet store. The patient experienced a severe coagulopathy with life-threatening hemorrhage unresponsive to transfusion. Since this snake frequently is sold legally in the United States, we wish to alert the medical community to its potential danger and to discuss the pathophysiological mechanism by which the coagulopathy was produced.