There have been few systematic evaluations comparing surgical vs medical
therapy for menorrhagia. Two articles in this issue of THE JOURNAL address
this deficiency. In the first, Kuppermann and colleaguesArticle
report health-related quality-of-life outcomes from a randomized trial comparing
medical treatment including estrogen, progesterone, and a prostaglandin synthetase
inhibitor with surgical treatment in women who did not achieve symptom relief
with medroxyprogesterone. At 6-month follow-up, women who had a hysterectomy
reported greater symptom improvement and higher ratings of overall health
than women who received medical therapy; however, at 24 months, many of the
differences between the groups were no longer statistically significant. In
the second article, Hurskainen and colleaguesArticle
report results of a randomized trial comparing treatment with a levonorgestrel-releasing
intrauterine system with hysterectomy in terms of cost and quality of life.
At 5-year follow-up, the groups did not differ substantially on quality-of-life
measures and women were similarly satisfied with their treatment. Although
almost half the women randomized to medical treatment eventually underwent
hysterectomy, costs for medical therapy were less. In an editorial, Pitkin
and ScottArticle discuss the challenges in studying therapies
for menorrhagia and treating women with this condition.
Hypochondriasis occurs in an estimated 5% of patients, and psychological
and pharmacological treatment trials have not demonstrated benefit. Barsky
and Ahern report results of a randomized trial involving 6 sessions of scripted,
individual cognitive behavior therapy (CBT) compared with usual medical care.
At 6- and 12-month follow-up, patients assigned to CBT had fewer hypochondriacal
symptoms, less health-related anxiety, and improved health beliefs and attitudes
than patients receiving usual care.
Violations of human rights by Saddam Hussein's regime have been widely
reported but not systematically studied. Two articles in this issue of THE
JOURNAL from authors affiliated with Physicians for Human Rights provide some
insight into these events. Amowitz and colleaguesArticle
a survey of adults in 3 major cities in southern Iraq to ascertain the nature
and scope of abuse and also assessed perspectives on women's rights. Nearly
half of the respondents reported human rights abuses perpetrated against household
members, including torture, killings, and disappearances/kidnappings. Women's
rights to education, access to health care, and equality in decisions about
marriage and childbearing were endorsed, but half of both male and female
respondents agreed that a man may beat his wife if she disobeys him. In the
second article, Reis and colleaguesArticle
report results of
a survey of physicians regarding physician participation in human rights abuses.
Respondents reported widespread human rights abuses, primarily initiated by
paramilitary forces and involving physician participation in amputation of
ears, falsification of reports of torture and death, and other abuses. Fear
of physical harm to oneself or family members was a common explanation for
complicity. In an editorial, PellegrinoArticle
necessity for the world's physicians to uphold medicine's moral center even
in the face of tyranny and war.
"Three streets away, a tattered man in a throwaway overcoat sits shivering
in the diner." From "Diner on Commercial Street."
Amid concerns about the potential emergence of a deadly strain of avian
influenza that spreads easily from person to person, researchers are scrambling
to develop a protective vaccine (avian influenza A[H5N1] viruses shown above
Part 1Article of this 2-part article discusses appropriate
screening, treatment, and referral for eye disorders seen in an older adult
primary care population. Four cases presented in part 2Article
highlight important strategies for maximizing visual health in patients with
comorbid conditions and age-related eye diseases.
For your patients: Information about hysterectomy.
This Week in JAMA. JAMA. 2004;291(12):1415. doi:10.1001/jama.291.12.1415