In this 36-month interim analysis of follow-up radiographs from 6828
postmenopausal women at high risk for osteoporotic fractures enrolled in the
Multiple Outcomes of Raloxifene Evaluation study, Ettinger and colleagues
reportArticle that the risk of new vertebral fractures was significantly lower in
raloxifene treatment groups than in the placebo group, but risk of nonvertebral
fractures was similar in all study groups. Bone mineral density of the spine
and femoral neck increased 2.1% to 2.7% more in the raloxifene groups than
in the placebo group. In an editorialArticle, McClung points out that prior fracture
is a strong risk factor for subsequent fracture in postmenopausal women and
that drug therapies for fracture prevention affect determinants of fracture
Pneumococcal immunization rates among elderly and high-risk patients
are well below target levels. Jacobson and colleagues report that in an elderly
clinic population with low health literacy, patients who received an educational
brochure on pneumococcal vaccination written at below fifth-grade reading
level were significantly more likely to receive a pneumococcal vaccine or
discuss it with their physicians than patients who received a similar educational
brochure on nutrition.
To determine whether patients use unconventional therapies in conjunction
with mainstream medical care or as an alternative, Druss and Rosenheck analyzed
data from a national probability sample of individuals who responded to the
1996 Medical Expenditure Panel Survey. Based on responses of 16,068 adults
aged 18 years or older, an estimated 6.5% of the US population had visits
for both unconventional therapies and conventional medical care; 1.8% had
visits only for unconventional services; 59.5% had visits only for conventional
care; and 32.2% used neither type of medical service.
In this observational behavioral study and preliminary neuroendocrine
study, Birketvedt and colleagues found that patients with night-eating syndrome
ate more frequently than control subjects, consumed most of their daily energy
intake at night, often in association with night awakenings, and had abnormal
circadian patterns of plasma melatonin, leptin, and cortisol levels. In an
editorial, Yager reviews clinical characteristics of sleep-related eating
disorders and considers explanations for the neuroendocrine findings observed
in this study.
See Article and editorial Article
A large randomized trial, the Calcium for Preeclampsia Prevention (CPEP)
study, showed no reduction in preeclampsia risk among healthy nulliparous
women who received calcium supplementation, contradicting the results of a
meta-analysis of earlier clinical trials published the preceding year. In
this second meta-analysis of 14 trials on calcium supplementation and preeclampsia
published prior to the CPEP study, DerSimonian and Levine used subgroup analyses
to explain the marked heterogeneity of effects among the trials. Results of
the meta-analysis of placebo-controlled trials that enrolled healthy low-risk
women were consistent with the CPEP results of no reduction in preeclampsia
risk with calcium supplementation, but the analysis of trials that enrolled
healthy high-risk women supported a beneficial calcium effect.
"How meaningful to be told by my physicians that they are learning from
me!" From "Partnership for Good Dying."
Scientists respond to the continuing need to increase the public's understanding
of why animals are used in research and how those animals are treated.
At The Johns Hopkins Hospital
Symptoms of adrenal insufficiency complicate withdrawal of oral glucocorticoid therapy in a 36-year-old
woman with severe chronic asthma.
From the WHO Global Surveillance and
Updated worldwide estimates of the prevalence of Mycobacterium tuberculosis infection and tuberculosis incidence, prevalence,
Brand and Kliger demonstrate the value of decision analysis as a tool
for shared medical decision making by applying it to Brand's decision
to have an early kidney transplantation.
For your patients: Primer on tuberculosis.
This Week in JAMA. JAMA. 1999;282(7):611. doi:10.1001/jama.282.7.611