Chlamydia pneumoniae has been implicated in
the pathogenesis of atherosclerosis, but clinical trials of antibiotic therapy
in patients with coronary artery disease have had conflicting results. In
this randomized trial among stable patients with previous myocardial infarction
and evidence of C pneumoniae exposure, O'Connor and
colleaguesArticle found that 12 weeks of azithromycin
therapy was not associated with a significant reduction in the composite end
point of death, nonfatal reinfarction, coronary revascularization, or hospitalization
for angina. In an editorial,Article Pislaru and Van
de Werf question whether clinical trials of antibiotics fail to improve outcomes
of patients with coronary artery disease because C pneumoniae does not play a role in atherogenesis or because the antibiotic regimens
in negative trials have not been optimal or focused on patients most likely
In the United States, anticonvulsants, especially divalproex and other
newer agents, have increasingly been used for treatment of bipolar disorder,
and lithium use has declined. In an analysis of data from administrative databases
of 2 large integrated health plans, Goodwin and colleaguesArticle found,
however, that risks of suicide attempt and suicide death were significantly
higher during treatment with divalproex than during treatment with lithium.
In an editorial,Article Baldessarini and Tondo underscore
the serious risk of suicide associated with bipolar disorder and discuss the
effectiveness of treatments for the various phases of this illness.
To evaluate the effectiveness of magnetic insoles for the treatment
of plantar heel pain, Winemiller and colleagues conducted a randomized trial
comparing cushioned insoles with embedded active bipolar magnets with identical
insoles containing sham magnets among adults who had plantar heel pain for
at least 30 days. After 8 weeks of treatment, intensity of morning foot pain
decreased in both the active magnet and sham magnet treatment groups, but
there were no significant differences in symptom improvement between the groups.
Khosla and colleagues used data from the Rochester Epidemiology Project
to estimate the incidence of distal forearm fractures that occurred in residents
of Rochester, Minn, younger than 35 years during 4 time periods—1969-1971,
1979-1981, 1989-1991, and 1999-2001. The incidence of distal forearm fractures
in children and adolescents increased significantly between 1969-1971 and
1999-2001. The peak incidence and greatest increase occurred between ages
11 and 14 years in boys and 8 and 11 years in girls.
Many states have turned to commercial managed care organizations to
provide care to children enrolled in Medicaid programs. In this analysis of
1999 data collected through the Health Plan Employer Data and Information
Set (HEDIS), Thompson and colleagues report that in health plans that served
both Medicaid and commercially enrolled children and adolescents, performance
scores on most quality indicators for children enrolled through Medicaid were
significantly lower than performance scores for commercially enrolled children.
Scientists studying the mechanisms that malignant cells use to resist
the effects of cancer drugs are gaining insights that may help in the development
of new therapies.
Analysis of data from 6 Medicaid programs shows no reduction in the
rate of exceptions (potential prescribing errors) after implementation of
retrospective drug utilization review.
Misleading promotional claims by vendors of herbal products and risk
of serious drug interactions emphasize the need for more effective regulation
of dietary supplements.
Natural history, diagnosis, and treatment of syphilis.
For your patients: Information about plantar fasciitis.
This Week in JAMA. JAMA. 2003;290(11):1417. doi:10.1001/jama.290.11.1417