Universal bone densitometry for women older than 65 years has demonstrated cost-effectiveness, but whether osteoporosis screening and treatment are cost-effective in elderly men is not clear. Schousboe and colleagues report results of a computer simulation that evaluated the cost-effectiveness of bone densitometry and 5 years of oral bisphosphonate therapy for white men found to have osteoporosis compared with no intervention. In hypothetical cohorts of men stratified by age and the presence or absence of prior clinical fractures, the authors found that bone densitometry followed by bisphosphonate therapy may be cost-effective for men with a self-reported prior fracture beginning at age 65 years and for men 80 years and older with no prior fracture. The authors also present results for other screening and treatment strategies based on alternate assumptions for screening and bisphosphonate cost and for societal values.
As the number of recommended vaccines for children and adolescents has increased in recent years, the ability of existing government programs to ensure that all children are fully vaccinated has been questioned. In interviews with 48 state immunization program managers, Lee and colleaguesArticle investigated access to new vaccines among children who have private insurance that does not cover all recommended vaccines (“underinsured”). Among the results reported by the authors was that underinsured children were unable to receive publicly purchased meningococcal conjugate or pneumococcal conjugate vaccines in private physician offices in 70% and 50% of states, respectively, or in public health clinics in 40% and 17% of states, respectively. In an editorial, DavisArticle discusses economic barriers to vaccination and ways to improve access for children who are underinsured.
In anticipation of a potential influenza pandemic, the relationship between nonpharmaceutical interventions to achieve social distancing and reductions in morbidity and mortality merits investigation. To do so, Markel and colleagues searched archival records and performed statistical and epidemiological analyses to assess the weekly excess death rate in 43 US cities during the 1918-1919 influenza pandemic in relation to the existence, timing, and duration of school closures, cancellation of public gatherings, and isolation and quarantine. The authors found a strong association between early, sustained, and multicomponent application of these nonpharmaceutical interventions and reduced influenza mortality rates in the cities studied.
A systematic review of remission-induction or maintenance drug therapies and medical interventions for acute or chronic antineutrophil cytoplasmic antibody–associated vasculitis of varying severity.
“It seems that far too often, we physicians are vendors of suffering, infusing toxic chemicals when we know that it's not only futile but, in the realm of ethics, wrong.” From “Chemotherapy.”
Researchers have found that blood glucose levels during pregnancy that are elevated but still within normal range may put women and newborns at increased risk for adverse outcomes traditionally associated with overt gestational diabetes.
An alliance between society and medicine is needed for physicians to meet their professional responsibilities.
Integrating evidence-based medicine with evidence-based management may improve the quality of patient care.
A framework for systematic assessment of new health policies and the benefits and drawbacks of accountability for policy making.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about vasculitis.
This Week in JAMA . JAMA. 2007;298(6):597. doi:10.1001/jama.298.6.597