CHICAGO—Aspirin appears to be the better treatment than the antiplatelet drug ticlopidine for preventing recurrent stroke in black patients, according to a study in the June 11 issue of The Journal of the American Medical Association (JAMA).

"Blacks are disproportionately affected by stroke, yet they have been underrepresented in clinical trials," the authors provide as background information in the study. "Recommendations for stroke prevention have been based largely on trials that have included few black participants." The authors add that blacks are about two times more likely than most other individuals in the United States to die of or experience stroke.

Philip B. Gorelick, M.D., M.P.H., from Rush Medical College, Chicago, and colleagues from the African American Antiplatelet Stroke Prevention Study (AAASPS) conducted a randomized, double-blind, multicenter clinical trial to evaluate the effectiveness and safety of aspirin and ticlopidine (a drug that blocks the action of platelets) to prevent recurrent stroke in black patients.

The study included 1,809 black men and women who recently had a noncardioembolic ischemic stroke (strokes that were not due to bleeding in the brain or to blockage of a blood vessel in the brain due to an embolism [i.e., small clot] that originated from the heart.) Study participants were recruited for the study between December 1995 and October 2001. The patients received either a 500 mg/daily dose of ticlopidine (n= 902) or 650 mg/daily of aspirin (n= 907). The study participants were examined in person at baseline; every two weeks during the first three months; and at six, 10, 12, 16, 20 and 24 months, and at any other time if the investigative team thought it necessary for patient safety.

"We hypothesized that ticlopidine, a more global platelet inhibitor, would be more effective in black ischemic stroke patients with a substantial stroke and cardiovascular disease risk profile and that aspirin might prove to be an inferior platelet inhibitor in these high-risk patients," the authors state.

"The blinded phase of the study was halted after about 6.5 years when futility analyses revealed a less than one-percent probability of ticlopidine being shown superior to aspirin in the prevention of the primary outcome end point (recurrent stroke, heart attack or vascular death)," the authors report. The primary outcome occurred in 133 (14.7 percent) patients assigned to ticlopidine and 112 (12/3 percent0 patients assigned to aspirin. The authors also suggest that, "These analyses also indicated a 40 percent to 50 percent likelihood of aspirin being significantly better than ticlopidine in reducing the risk of recurrent fatal or nonfatal stroke if the trial were to continue to completion."

CHICAGO—Contrary to previous perceptions, babies born at a hospital on the weekend are not at a greater risk for death than those born during the week, according to a study in the June 11 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, increases in death rates for infants born on the weekend were last noted several decades ago. Although the current health care environment has raised concern about the adequacy of weekend care, until now, according to the article, there have been no contemporary evaluations of weekly patterns of births, obstetric intervention, and rate of newborn deaths.

Jeffrey B. Gould, M.D., M.P.H., of the Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, Calif., and colleagues investigated whether California infants born during the weekend had a higher death rate than infants born on weekdays. The study included 1,615,041 live births (birth weight equal or greater than 500 grams [17.65 ounces]) in California between 1995-1997. Analyses were stratified by birth weight and delivery method.

There was a 17.5 percent decrease in births on weekends, accompanied by a decrease in the proportion of cesarean deliveries from 22 percent on weekdays to 16 percent on weekends. Weekend decreases in births were least pronounced in smaller infants, resulting in a weekend concentration of high-mortality, very low-birth-weight (less than 1,500 grams [52.95 ounces]) births. Observed newborn deaths increased from 2.80 per 1,000 weekday births to 3.12 per 1,000 weekend births for all births, and from 4.94 to 6.85 for cesarean deliveries. "After adjusting for birth weight, the increased odds of death for infants born on the weekend were no longer significant, " the authors write.

CHICAGO—Using a computer does not appear to create a severe occupational hazard for developing symptoms of carpal tunnel syndrome (CTS), according to a study in the June 11 issue of The Journal of the American Medical Association (JAMA).

Computer use is increasingly common among many working populations, and concern exists about possible adverse effects of computer use, such as CTS, according to background information in the article. Use of the keyboard and the mouse as key interface devices to the computer has led to much debate concerning their role in development of injuries to the nerves in the upper limbs. The proposed mechanism for this relation is regional compression or nerve stretching. There is evidence that repetitive work is a contributing factor in CTS, but the role of computer use, which mainly consists of repetitive, nonforceful movements, is less clear.

Johan Hviid Andersen, M.D., Ph.D., of the Department of Occupational Medicine, Herning Hospital, Herning, Denmark, and colleagues conducted a study to determine the contribution of weekly use of computer mouse devices and computer keyboards, work-related physical factors, work-related psychosocial factors, and individual characteristics in the occurrence and onset of possible CTS. This was a one-year follow-up study, with questionnaires conducted in 2000 and 2001 at 3,500 workplaces in Denmark, followed on each of the 2 occasions by a clinical interview on distribution and frequency of hand symptoms. The questionnaire was sent to 9,480 members of a trade union, with an initial response rate of 73 percent (n = 6,943), and 82 percent (n = 5,658) at follow-up.

At baseline, there were 3 outcome measures of interest: tingling/numbness in the right hand once a week or more as reported in the questionnaire; tingling, numbness, and pain in the median nerve (the nerve involved in CTS) in the right hand confirmed by clinical interview; and tingling, numbness, and pain in the median nerve in the right hand confirmed by clinical interview with the addition of symptoms at night. At one year of follow-up the main outcome of interest was onset of symptoms among participants who had no or minor symptoms at baseline.

The overall self-reported prevalence of tingling/numbness in the right hand at baseline was 10.9 percent. The interview confirmed that prevalence of tingling/numbness in the median nerve was 4.8 percent, of which about one-third, corresponding to a prevalence of 1.4 percent, experienced symptoms at night. Onset of new symptoms in the 1-year follow-up was 5.5 percent. "In the cross-sectional comparisons and in the follow-up analyses there was an association between use of a mouse device for more than 20 h/wk and [a slightly elevated] risk of possible CTS but no statistically significant association with keyboard use," the authors write.

ASPIRIN SLIGHTLY MORE EFFECTIVE THAN PRESCRIPTION DRUG TICLOPIDINE IN REDUCING RISK OF RECURRENT STROKE IN AFRICAN AMERICANS