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This Week in JAMA
May 21, 2003

This Week in JAMA

JAMA. 2003;289(19):2459. doi:10.1001/jama.289.19.2459
Active Muscle Training for Treatment of Neck Pain

Therapies commonly used for chronic neck pain have not been evaluated in randomized studies. In this trial, Ylinen and colleagues randomly assigned female office workers with chronic, nonspecific neck pain to a neck muscle endurance training program, an intensive isometric neck strength training program, or to a control group. After 1 year, neck pain and disability had decreased significantly in both training groups compared with the control group.

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Outcomes for Black vs White Patients With Heart Failure

Previous studies suggest that black patients hospitalized with heart failure receive poorer quality of care and have worse outcomes than white patients, but the evidence is inconsistent. In this analysis of data from the National Heart Failure Project, an ongoing initiative to improve quality of care for Medicare beneficiaries hospitalized with heart failure, Rathore and colleagues found that black and white patients with Medicare had comparable quality of care during hospitalization for heart failure. Black patients had slightly higher readmission rates than white patients but lower mortality rates up to 1 year after hospitalization.

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Combination Therapy for Prevention of Bone Loss

Treatment with individual bone antiresorptive agents has been shown to increase bone mineral density (BMD) and reduce fracture risk in women with postmenopausal osteoporosis, but the effectiveness of combination antiresorptive therapy is not known. Greenspan and colleagues conducted a placebo-controlled randomized trial comparing hormone therapy combined with alendronate to each therapy alone among community-dwelling women aged 65 to 90 years. After 3 years, increases in spine and total hip BMD were significantly greater in the combination therapy group than in the monotherapy groups.

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Cardiovascular Outcomes of Antihypertensive Agents

To synthesize evidence from the many clinical trials of antihypertensive agents, Psaty and colleagues conducted a network meta-analysis that combined direct within-trial between-drug comparisons of first-line antihypertensive agents with indirect evidence that was derived from trials that had 1 treatment in common. Low-dose diuretics were more effective for preventing cardiovascular disease morbidity and mortality than the other first-line treatment strategies—β-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, α-blockers, and angiotensin receptor blockers.

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Contempo Updates

Evaluation and treatment of insomnia.

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Medical News & Perspectives

Researchers have discovered the cause of the premature aging that characterizes a rare disorder called progeria—a finding that is also expected to provide insight into the normal aging process.

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Issues in Trial Design and Reporting

The use of composite outcomes that combine multiple end points provides efficiencies in the conduct of clinical trials as does the use of factorial designs, but both require careful attention to appropriate analysis and reporting.

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CLINICIAN'S CORNER

A practical guide to the new guidelines for hypertension prevention and management from "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" (JNC 7).

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JAMA Patient Page

For your patients: Information about insomnia.

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