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This Week in JAMA
December 12, 2001

This Week in JAMA

JAMA. 2001;286(22):2775. doi:10.1001/jama.286.22.2775
Low Bone Mineral Density Often Undetected

Osteoporotic fractures are associated with serious morbidity and excess mortality. In this analysis of the initial results of the National Osteoporosis Risk Assessment, a longitudinal observational study of more than 200 000 postmenopausal women in US primary care practices, Siris and colleaguesArticle report that almost half of the population had previously undetected low bone mineral density (BMD) and 7% had osteoporosis. Low BMD at peripheral skeletal sites was significantly associated with increased fracture risk within 12 months. In an editorial, ChesnutArticle emphasizes the importance of early identification and treatment of women at risk for osteoporosis and fracture in primary care settings.

Inappropriate Medication Use Among Elderly

Prior studies based on data from nationally representative surveys estimated that 23.5% of community-dwelling elderly used at least 1 of 20 potentially inappropriate medications in 1987, and 17.5% in 1992. In this analysis using data from the 1996 Medical Expenditure Panel Survey, Zhan and colleaguesArticle found that 21.3% of community-dwelling elderly patients received at least 1 of 33 potentially inappropriate medications, and about 2.6% used at least 1 of 11 medications that should always be avoided by elderly patients. In an editorial, AvornArticle discusses ways to improve medication use in elderly patients.

Early Ischemic Changes in Acute Stroke

The presence of early ischemic changes (EICs) on computed tomography (CT) scan of the head after acute stroke has been an exclusion criterion in recent stroke trials of thrombolytic therapy because of a perceived association between EICs and adverse outcomes of thrombolytic therapy. Patel and colleagues reevaluated the baseline head CT scans of all participants in the National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator (rt-PA) Stroke Trial, which used CT scan evidence of intracranial hemorrhage as an exclusion criterion, but not EICs. The prevalence of EICs on baseline CT scan among all trial participants was 31%. Baseline EICs correlated with stroke severity but were not associated with increased risk of adverse outcomes after rt-PA treatment.

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Guided Medication Dosing for Renal Insufficiency

In patients with renal insufficiency, in addition to avoiding use of nephrotoxic drugs, the dose and dosing interval of drugs that are renally cleared must be adjusted according to renal function. Chertow and colleagues report that a computer-based decision support system for prescribing drugs for patients with renal insufficiency when combined with a computerized order entry system improved the appropriateness of drug dose and frequency decisions for hospitalized patients with renal insufficiency.

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Increase in Prevalence of Childhood Overweight

Data from several national surveys suggest that the prevalence of overweight among children in the United States continues to increase rapidly. In this analysis of data from children aged 4 to 12 years who participated in the 1986-1998 National Longitudinal Survey of Youth, Strauss and Pollack report that the prevalence of overweight increased by over 120% among African American and Hispanic children, and by over 50% among white children. In addition, overweight children were significantly heavier in 1998 compared with 1986.

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A Piece of My Mind

"One of the rewards in medicine is the frequent challenge of connecting to, understanding, and helping people who are unlike ourselves, often in profound ways." From "The Consultation."

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Contempo Updates

Advances in the treatment of rheumatoid arthritis emphasize early intervention to prevent irreversible joint damage.

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Medical News & Perspectives

With worldwide extinction of wild poliovirus almost accomplished, public health experts plan what to do next.

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Sex Differences in Cardiac Catheterization

Women are less likely than men to undergo cardiac catheterization after acute myocardial infarction. Factors other than sexual bias appear to account for this difference.

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Psychiatric Disorders and HIV Infection

Diagnosis and management of common psychiatric disorders that complicate the treatment of patients infected with HIV: case presentation and discussion.

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From the Archives Journals

Rosenberg highlights the comparative genomic analysis of human neurogenetic diseases that result from specific disease-predisposing alleles by Cravchik and colleagues reported in the Archives of Neurology and discusses the transformation of neurology by neurogenomics.

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JAMA Patient Page

For your patients: Information about kidney failure.

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