Early-onset alcoholism, a subtype of alcohol dependence, is characterized
by early age of onset, antisocial behaviors, and serotonergic dysfunction.
Johnson and colleaguesArticle conducted a trial to determine whether patients with
early-onset (before age 25 years) alcoholism would have a different response
to treatment with ondansetron, a serotonin receptor antagonist, than patients
with late-onset alcoholism. Among patients with early-onset alcoholism, those
who received ondansetron had a significant increase in the proportion of days
abstinent and decrease in the intensity of alcohol intake compared with those
who received placebo, but the drinking behavior response among patients with
late-onset alcoholism was similar in the ondansetron and placebo groups. In
an editorial, KranzlerArticle discusses pharmacological treatment of alcoholism based
on clinical subtypes.
Several clinical conditions and characteristics of the physical environment
have been associated with increased fracture risk among nursing home residents.
In this 18-month prospective study of 1427 white female nursing home residents
aged 65 years or older, Chandler and colleaguesArticle found that low bone mineral
density (BMD), as measured by distal ulnar single-beam absorptiometry, and
transfer independence were significant independent risk factors for fracture.
In an editorial, WallaceArticle considers nutritional, pharmacological, and environmental
interventions to maintain bone health and prevent fractures in nursing home
In this evaluation of the quality of health care in a historical cohort
of 1355 patients with rheumatoid arthritis, MacLean and colleagues determined
quality scores in 3 health care domains—arthritis care, comorbid disease
care, and health care maintenance. Overall, quality of care was suboptimal
in all 3 domains. Patients generally received higher quality care for arthritis
than for prevention or for treatment of comorbid diseases. Patients who had
contact with a relevant specialist received substantially higher quality of
care in all 3 domains compared with patients who did not. These findings suggest
that current health care delivery models that use primary care physicians
to manage overall care and regulate access to specialty care may not be optimal
for patients with complex conditions.
Although modification of dietary fat intake in infancy and early childhood
might reduce risk of coronary heart disease, possible impairment of growth
and neurological development has been a concern. In a previous report of the
Special Turku Coronary Risk Factor Intervention Project, children whose parents
received counseling to maintain a low–saturated fat, low-cholesterol
diet after age 7 months had smaller increases in cholesterol levels at age
3 years than children in the control group, and growth rates were similar.
Rask-Nissilä and colleagues now report that at age 5 years, children
in the intervention group had reduced dietary fat and cholesterol intake compared
with the control group, and lower serum cholesterol levels, and performed
at least as well on neurodevelopmental tests.
Guidelines for the administration of rabies postexposure prophylaxis
have been published by the Advisory Committee on Immunization Practices and
by public health departments based on local rabies epidemiology. In this prospective
study of patients who presented with an animal exposure to 1 of 11 emergency
departments, Moran and colleagues found that management was appropriate according
to local health department guidelines in 1857 (91.5%) of 2030 exposures. Management
was considered inappropriate for 54 (40%) of the 136 patients who were given
postexposure rabies prophylaxis and for 119 (6.3%) of 1894 patients who were
not given it. These results suggest that increased compliance with guidelines
would increase the use of postexposure rabies prophylaxis.
Management of patients with primary hyperparathyroidism: suggestions
for new guidelines based on the availability of minimally invasive parathyroidectomy.
Online publishing initiatives offer immediate access to research data—but
they also raise questions about cost and peer review.
The option to begin the recommended childhood 3-dose hepatitis B vaccination
series at birth provides an opportunity to immunize newborns prior to hospital
discharge. In the 1998 National Immunization Survey, administration of the
first dose within 7 days of birth was associated with increased likelihood
of completing the series by age 19 to 35 months.
A meta-analysis of overall and cancer-specific mortality rates, local
recurrence rates, and rates of occurrence of distant metasases from 14 randomized
controlled trials comparing preoperative radiotherapy plus surgery with surgery
alone for patients with rectal adenocarcinoma.
In a sample of 116 primary care and surgery office visits, most physicians
missed opportunities to address psychosocial concerns of their patients signaled
by patient clues during the visits.
For your patients: A primer on rabies.
This Week in JAMA. JAMA. 2000;284(8):925. doi:10.1001/jama.284.8.925