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This Week in JAMA
May 3, 2006

This Week in JAMA

JAMA. 2006;295(17):1973. doi:10.1001/jama.295.17.1973
Combination Therapy for Alcohol Dependence

The efficacies of medication and behavioral therapies, alone or in combination, for treating alcohol dependence were assessed in the multicenter randomized Combined Pharmacotherapies and Behavioral Interventions (COMBINE) study, in which study participants were randomly assigned to 1 of 9 treatment groups. Eight of the groups included medical management plus naltrexone or acamprosate, both medications, or placebos, for 16 weeks, and with or without a combined behavioral intervention (CBI). A ninth group received CBI alone. Anton and colleaguesArticle writing for the COMBINE study investigators report that patients in all groups had an increased number of days of abstinence. However, patients receiving naltrexone, CBI, or both along with medical management had more days of abstinence and fewer heavy drinking days than patients in other treatment groups. Acamprosate did not appear to be efficacious in this study. In an editorial, KranzlerArticle discusses the treatment of alcohol dependence.

Walk Performance, Mortality, and Morbidity

In a cohort of community-dwelling adults who were aged 70 to 79 years and had no apparent mobility limitations, Newman and colleagues examined the association of baseline performance on a 400-m corridor walk test with total mortality, incident cardiovascular disease, and incident mobility limitation and disability during 4.9 years of follow-up. The authors found that not completing the test or taking a longer time for completion than other patients predicted the occurrence of these adverse events during follow-up.

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Income and Health Care Among the Uninsured

To assess whether having a higher income attenuates the association between being uninsured and receiving fewer recommended health services than insured persons in the United States, Ross and colleagues examined data from a 2002 nationally representative survey. They found that persons without health insurance were less likely to use recommended cancer prevention, cardiovascular risk reduction, and diabetes management services compared with persons having insurance. Higher income did not attenuate the difference.

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Disease, Disadvantage in the United States and England

Whether higher per capita health care expenditures are associated with better health outcomes is not known. Using nationally representative data from the United States and England, Banks and colleagues compared biological disease markers and self-reported disease prevalence rates for non-Hispanic whites aged 55 to 64 years in the 2 countries. The authors found that despite higher expenditures on health, persons in the United States reported more disease and had more adverse biological disease markers than persons in England at all levels of education and income.

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Early Statin Therapy and Outcomes in ACS

Long-term statin therapy benefits patients with cardiovascular disease risks, but whether early statin therapy can improve outcomes in patients with recent acute coronary syndromes (ACS) is not clear. Briel and colleagues conducted a meta-analysis of data from 12 clinical trials that compared early outcomes of patients with ACS who were randomly assigned to receive statin therapy within 14 days of the event vs placebo or usual care. The authors found no evidence that early initiation of statins reduces death, nonfatal myocardial infarction, or stroke in the immediate 4 months after ACS.

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A Piece of My Mind

“His dramatic stories and gestures, the musicality of his speaking voice, his larger-than-life facial expressions . . . one could describe them all as ‘operatic.’” From “A Glimpse Backstage.”

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Medical News & Perspectives

To limit the exchange of infectious agents between animals and humans, a key precursor to many pandemics, infectious disease experts have launched efforts to monitor emerging diseases in domestic and wild animals.

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CLINICIAN'S CORNER

Several nonhormonal therapies demonstrate modest efficacy for reducing the frequency and severity of menopausal hot flashes. In an editorial, Tice and Grady discuss the pathophysiology of hot flashes, treatment efficacy, and safety.

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Drug Safety

Strom discusses limitations of the current system for monitoring drug safety and suggests an alternate approach.

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Audio Commentary

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

JAMA Patient Page

For your patients: Information about alcohol abuse and alcoholism.

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