Empirical evidence on the effectiveness of selective serotonin reuptake
inhibitors for the treatment of children and adolescents with major depressive
disorder (MDD) is limited. Wagner and colleaguesArticle conducted
2 identically designed, concurrent, international 10-week randomized trials
to evaluate the efficacy and safety of sertraline compared with placebo in
children and adolescents with MDD. In pooled analyses of data from the 2 trials,
overall improvement in depression symptoms was significantly greater among
children and adolescents who received sertraline than among those who received
placebo. In an editorial, VarleyArticle discusses the pharmacological
treatment of MDD in children and adolescents.
Estrogen therapy has been used for the prevention and treatment of osteoporosis,
but recent studies indicate that conventional doses of estrogen therapy in
postmenopausal women increase risk of adverse events. In this randomized trial
of ultralow-dose micronized 17β-estradiol (one quarter of standard treatment)
in healthy women older than 65 years, Prestwood and colleagues found that
over 3 years of treatment, bone mineral density (BMD) of the hip, spine, and
total body increased significantly in the low-dose estrogen group compared
with the placebo group and markers of bone turnover decreased significantly.
Adverse events were not significantly different in the 2 study groups.
Using data from the Framingham Heart Study, a prospective, community-based
observational cohort study, Wang and colleaguesArticle derived
a clinical risk score for stroke alone and for stroke or death in adults with
new-onset atrial fibrillation. Risk predictors included advancing age, female
sex, increasing systolic blood pressure, prior stroke or transient ischemic
attack, and diabetes. In an editorial, WaldoArticle advocates
the use of warfarin for patients with atrial fibrillation at risk of stroke,
noting that the potential benefits of stroke prevention outweigh the potential
risks of bleeding secondary to warfarin.
Published consensus statements recommend that children younger than
5 years with sickle cell disease take daily antibiotic prophylaxis to prevent
pneumococcal infections. In this analysis of Medicaid administrative claim
and encounter data from Tennessee and Washington, Sox and colleagues found
that publicly insured children with sickle cell disease were dispensed prophylactic
antibiotics for a mean of only 148 days during the 365-day study period. Outpatient
visits for preventive care were associated with increased provision of prophylactic
Boutron and colleagues reviewed reports of randomized controlled trials
assessing nonpharmacological and pharmacological treatments for hip and knee
osteoarthritis published between January 1, 1992, and February 28, 2002, to
identify specific methodological issues related to the assessment of nonpharmacological
treatments. Overall methodological quality of reports of nonpharmacological
treatments was lower than that of pharmacological treatments. Lack of reporting
adequate random sequence generation, adequate allocation concealment, and
intention-to-treat analysis was common in both pharmacological and nonpharmacological
articles. Methodological difficulties specific to trials of nonpharmacological
treatments included choice of a control intervention, blinding of patients,
care providers, and outcome assessors, and standardization of the intervention.
"With no one to oversee the appropriate treatment, no one to emphasize
to the family the paramount importance of adherence to treatment, and no one
to confirm that the bacterium was indeed sensitive to the prescribed formula,
it was destined to be a recipe for disaster."
Diagnosis and treatment of genital lesions.
Counterfeit drugs, often distributed by shady or uncautious wholesalers,
pose a potentially serious health risk to patients.
A prospective cohort study suggests that adults with a first spontaneous
venous thromboembolism who have a D-dimer level less than 250 ng/mL after
discontinuation of oral anticoagulation have a low risk of recurrence.
In a critical analysis of data on the risk-benefit ratio and quality
of informed consent in phase 1 oncology trials, Agrawal and Emanuel refute
claims that phase 1 cancer research is unethical.
Mrs P, a 41-year-old woman with chronic myelogenous leukemia (CML),
is planning to undergo stem cell transplantation. Antin discusses the epidemiology,
diagnosis, natural history, and treatment of CML.
For your patients: Information about atrial fibrillation.
This Week in JAMA. JAMA. 2003;290(8):989. doi:10.1001/jama.290.8.989