Given current high levels of sexual activity among youth and the increasing
risks of sexually transmitted diseases, the question has become not whether
to provide sex education but how. In a randomized trial, Dr Jemmott and colleaguesArticle
compare 2 sexual risk-reduction intervention strategies and an active control
intervention. The results, based on self-reported behavior, appear to favor
safer sex interventions over abstinence, although both had some short-term
See related editorial Article
Clinicians often can't cure infection associated with orthopedic fixation
devices and prosthetic joints without removing the foreign body. Dr Zimmerli
and colleaguesArticle conducted a randomized controlled trial of antimicrobial therapy
for staphylococcal infections involving orthopedic devices and found that
rifampin plus a companion drug was superior to placebo plus companion in eradicating
Prostate specific antigen (PSA) elevations predict the presence of prostate
cancer, but test specificity is poor when the PSA is 4 to10 ng/mL. The proportion
of PSA that is free in the serum is lower in prostate cancer than in benign
disease, leading some to suggest that measuring free PSA would enhance diagnostic
utility. In this study of men with PSA 4 to 10 ng/mL, Dr Catalona and colleagues
use a 25% cutoff value for free PSA, which still detected 92% of the cancers
(98% in younger men), and improved the test's overall specificity to 20%.
Many reasons have been offered to explain why patients seek alternatives
to the traditional medical care most physicians provide. In this nationally
representative survey, Dr Astin finds that alternative medicine is used by
up to 40% of individuals in a given year for a wide range of health problems
and across a wide range of modalities; few individuals rely primarily on alternative
therapies, and dissatisfaction with traditional medicine did not predict use
of alternative care.
Genetic variation known as microsatellite alteration (in which the size
of a single allele is altered) occurs in a variety of sporadic cancers, including
lung cancer. Dr Wistuba and colleagues find the frequency of microsatellite
alteration was substantially greater in HIV-associated tumors, suggesting
that genomic instability may be the responsible molecular mechanism.
In this innovative experiment, Dr Wachter and colleagues find a reorganized
inpatient medical service, led by faculty members who became involved early
and more intensively in clinical decisions and served as attending physicians
more often, resulted in similar clinical outcomes but significant resource
savings and decreased length of stay compared with the traditional medical
"The artist who attends to an object so closely that he can put its
spirit on canvas is no less a creator." Pieter Claesz, Still Life, 1643, Dutch.
Some experts bet advances in materials and design will give artificial
hearts the edge over xenotransplants in the race for an acceptable alternative
to human donor hearts.
"[T]o hold the living heart of another human being is among the rarest
of privileges. Those so favored should never lose sight of the inherent mystery
and wonder of the experience." From "Holding the Heart."
Changing societal attitudes and legal and medical opinion are defining
the approach to palliative care for patients who are terminally or incurably
ill. Dr Pellegrino examines the ethical context of this fundamental medical
Web sites that can provide useful information for parents of pediatric
patients. In our guide to interactive medicine.
For your patients—information about preventing HIV infection.
This Week in JAMA. JAMA. 1998;279(19):1507. doi:10.1001/jama.279.19.1507