In a 4-year study of postmenopausal women with low bone mineral density
(BMD) and no vertebral fractures, Cummings and coworkersArticle found that
women treated with alendronate had an increase in BMD and a lower rate
of first vertebral fracture than women who received placebo. However,
alendronate reduced the risk of clinical fractures only in women with
lower BMD at baseline. In an editorial, HeaneyArticle emphasizes that bone
fragility is only partly related to BMD and suggests an individualized
approach to fracture prevention.
A 15-year retrospective study of almost 6000 authorized purchasers of
handguns by Wintemute and colleaguesArticle showed that purchasers with a
prior misdemeanor conviction were almost 5 times more likely to be
charged with a new crime involving firearms or violence than those
without convictions. In an editorial, BradyArticle and coauthors note that
prohibiting the purchase of handguns by individuals with prior
misdemeanor convictions would require more complete and accessible
criminal records than are currently available.
In a hypothetical cohort of patients with chronic hepatitis C
infection, Wong and colleagues compared the cost-effectiveness of no
interferon treatment, empirical treatment of all patients, and
selective interferon treatment based on factors predictive of
long-term response. They found that treating all patients with
an initial trial of interferon would have a reasonable cost and
would avoid missing any patients who would have a sustained
Racoosin and colleagues report that the proportion of cases of invasive
meningococcal disease in Chicago due to serogroup Y increased from 4%
in 1991, peaked at 61% in 1995, and declined to 18% in 1997. In this
retrospective study, patients with serogroup Y disease were more likely
to be older, to be African American, and to have an underlying chronic
illness than patients infected with other serotypes, but disease
outcomes were similar among all serotypes.
In a meta-analysis of data from 10 randomized trials that compared
epidural analgesia with parenteral opioids during labor, Halpern and
colleagues found that epidural analgesia was not associated with an
increased risk of cesarean delivery or instrumental vaginal delivery
for dystocia. Compared with analgesia with parenteral opioids, epidural
analgesia was associated with longer labors but better pain relief and
better neonatal outcomes.
For several years, Mr D has experienced unpredictable, recurrent
episodes of dizziness of variable duration and severity. The episodes
no longer respond to treatment and Mr D restricts his activity, fearing
that an episode may impair his functioning. Drachman describes a
clinical strategy for the diagnosis and treatment of dizziness.
Paul Lauritz, Poinsettias, c 1925, American.
As HMOs reach age 25 years, experts take a new look at the medical
results and the ethical basis of managed care.
Antileukotriene drugs in the management of chronic asthma.
"Are we not obligated to meet the needs of our patients, even if at
times these needs are poorly articulated?" From "Four-Wheel-Drive
Original research, reviews, and commentaries are invited for the annual
JAMA theme issue on violence scheduled for August 1999.
What Americans think about issues affecting children's health and the
implications for health policy.
For your patients: Detecting hepatitis C infection.
This Week in JAMA. JAMA. 1998;280(24):2057. doi:10.1001/jama.280.24.2057