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This Week in JAMA
April 19, 2006

This Week in JAMA

JAMA. 2006;295(15):1741. doi:10.1001/jama.295.15.1741
Health Effects of Dental Amalgam in Children

Adverse health effects associated with inhalation of mercury vapor released by mercury-containing dental amalgam have not been systematically assessed in children. In this issue of JAMA, 2 groups of investigators report results of clinical trials in which children were randomly assigned to have dental restoration with either amalgam or mercury-free materials. Bellinger and colleaguesArticle assessed neuropsychological and renal function during a 5-year follow-up period and found no significant differences by type of dental restoration received. DeRouen and colleaguesArticle assessed memory, attention/concentration, and motor/visuomotor functions and nerve conduction velocities over 7 years of follow-up and found no differences between children in the amalgam group vs the resin group. In an editorial, NeedlemanArticle discusses the importance of investigating possible genetic vulnerability to mercury toxicity and molecular-level effects of mercury exposure before the safety of dental amalgam can be ensured.

Education and Subclinical Cardiovascular Disease

Prior studies document that education and established cardiovascular disease are inversely related, but whether education is similarly related to subclinical cardiovascular disease is not clear. Yan and colleagues examined the association of educational attainment with the presence of coronary artery calcium (CAC), a marker of subclinical atherosclerosis, in young black and white urban-dwelling adult participants in a prospective study of coronary artery disease risk. The authors found that education was inversely related to the prevalence of CAC in early middle age. This association was partially explained by baseline cardiovascular risk factors and by risk factor changes over time.

Second-Order Peer Review of Medical Literature

Journals commonly report findings that are not yet suitable for direct clinical application, and physicians may find it challenging to keep current with the literature that does not have immediate value for their patients. Haynes and colleagues describe a demonstration project that involved second-order (postpublication) peer review by practicing clinicians. These reviewers rated the articles for relevance to specific clinical disciplines and for the presence of useful new information. They also developed an e-mail alert system to notify registered physicians of articles of potential interest to them.

Birth Spacing and Adverse Perinatal Outcomes

Both long and short interpregnancy intervals have been associated with an increased risk of adverse perinatal outcomes, but few studies have controlled for possible confounding by maternal characteristics. In a meta-analysis of data from studies assessing birth spacing and perinatal outcomes, Conde-Agudelo and colleaguesArticle found that interpregnancy intervals shorter than 18 months and longer than 59 months are associated with increased risk of preterm, low-birth-weight, and small-for-gestational-age births. The authors found no diminution in risk when they controlled for a number of maternal and socioeconomic factors. In an editorial, RoyceArticle discusses the influences of country of birth, breastfeeding, maternal nutrition, and other factors on birth spacing.

Medical News & Perspectives

Although studies suggest that women fare worse than men in the prevention, treatment, and outcome of stroke, some researchers say that the older age of onset of stroke in women helps explain this disparity.


Epidemiologic, pathophysiologic, and clinical evidence link estrogen and migraine headaches in women.

Performance Measures and Malpractice

Information derived from existing and emerging models for assessing physician clinical performance is unlikely to be admissible evidence in malpractice litigation.

Author in the Room Teleconference

Join Donald M. Berwick, MD, MPP, on Wednesday May 17, 2006, from 2 to 3 PM eastern time to discuss the clinical implications of research results. To register, go to

Audio Commentary

Dr DeAngelis summarizes and comments on this week's issue. Go to

JAMA Patient Page

For your patients: Information about medical journals.