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
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.
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.
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.
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.
"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."
Advances in the treatment of rheumatoid arthritis emphasize early intervention
to prevent irreversible joint damage.
With worldwide extinction of wild poliovirus almost accomplished, public
health experts plan what to do next.
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.
Diagnosis and management of common psychiatric disorders that complicate
the treatment of patients infected with HIV: case presentation and discussion.
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.
For your patients: Information about kidney failure.
This Week in JAMA. JAMA. 2001;286(22):2775. doi:10.1001/jama.286.22.2775