Current recommendations for menopausal symptom management with hormone
therapy encourage prescription of the lowest effective dosage for the shortest
duration possible. However, few data exist regarding symptoms experienced
when hormone therapy is discontinued. Ockene and colleaguesArticle report
results of a survey completed by 8405 women (89.9% of those eligible) who
were still taking their study medication (combined conjugated equine estrogens
plus medroxyprogesterone acetate [CEE + MPA] or placebo) when the
Women’s Health Initiative trial was stopped. Among their findings were
that women formerly taking CEE + MPA reported more symptoms than
women formerly taking placebo and that the presence of symptoms at baseline
was associated with increased symptom reports after stopping either CEE + MPA
or placebo. In an editorial, Petitti Article discusses
symptoms of menopause, aging, and treatment options.
Incidence of hepatitis A following implementation of wide-scale vaccination
programs is reported in 2 articles in this issue of JAMA. First, Wasley and colleaguesArticle compared
the incidence of hepatitis A in the United States from 1990 to 1997—a
period preceding recommendations for targeted vaccination of children and
adults at risk—to that in 2003. They found a 76% decline of hepatitis
A from the 1990-1997 rates to the 2003 rates. In the second article, Dagan
and colleaguesArticle report hepatitis A incidence
in Israel before and after a national immunization program for children 18
to 24 months of age. They found a more than 95% decline in overall hepatitis
A incidence compared with rates before establishing the immunization program.
In an editorial, Van Damme and Van HerckArticle discuss
the contributions of national immunization programs and herd immunity to reductions
in hepatitis A incidence.
Hospice care may improve the quality of end-of-life care for nursing
home residents, but data suggest that hospice is underused. Casarett and colleagues
conducted a randomized trial to determine whether a simple communication to
the responsible physician could increase hospice use and improve care among
patients whose care goals and needs were appropriate for hospice care. Residents
in the intervention group, whose physician received a fax requesting authorization
of a hospice informational visit, were more likely to enroll in hospice and
had fewer acute care admissions and their family or surrogate rated their
care more favorably than residents in the control group whose physicians were
not informed of their suitability for hospice.
In uncontrolled studies of pediatric acute lung injury, prone positioning
appeared to improve oxygenation, but its effects on ventilator-free days or
clinical outcomes are not known. Curley and colleaguesArticle randomly
assigned infants and children with acute lung injury to supine or prone positioning
and assessed outcomes through 28 days. The trial was stopped when an interim
analysis confirmed improved oxygenation but revealed no difference in ventilator-free
days or clinical outcomes in children being placed in the prone position compared
with those placed in the supine position. In an editorial, KavanaghArticle discusses
implications of the trial outcomes for clinical practice and future investigations.
Scientists report that live vaccines targeting Ebola and Marburg viruses
have successfully protected monkeys from infection, findings seen as an advance
toward the development of effective human vaccines.
In subsequent well-designed investigations of clinical questions initially
explored in highly cited research studies, contradictory results or effect
sizes of smaller magnitude are not uncommon.
Risks and benefits of androgen deprivation therapy and treatment of
For your patients: Information about hepatitis A.
This Week in JAMA . JAMA. 2005;294(2):153. doi:10.1001/jama.294.2.153