Previous studies have found that treatment with oral topiramate is associated with reductions in drinking behavior and alcohol craving among alcohol-dependent persons. In this issue, Johnson and colleagues Article report results from a randomized multisite clinical trial in which adults with alcohol dependence were assigned to receive topiramate or placebo and participated in weekly brief adherence counseling sessions. The authors found that persons who received topiramate reported significantly fewer heavy drinking days, fewer drinks per day, and more days abstinent and had lower laboratory-confirmed levels of alcohol consumption compared with persons who received a placebo. In an editorial, Willenbring Article discusses alcohol dependence and strategies for its effective treatment.
Some evidence suggests that jobs with high psychological demands and low decision latitude—components related to job strain—increase the risk of a first coronary heart disease (CHD) event. However, whether job strain is associated with recurrent CHD events is not clear. Aboa-Éboulé and colleagues Article assessed this relationship in a prospective cohort study of persons who returned to work after a first myocardial infarction. The authors found that persons who reported high job strain at 6 weeks and 2 years following their return to work had a significantly increased risk of a new CHD event compared with persons who did not report high job strain at 1 or both interviews. In an editorial, Orth-Gomér Article discusses the evidence linking job and personal stress to adverse health consequences.
Weight maintenance following weight loss is a significant challenge for patients. In a 4-month extension of a family-based behavioral weight-loss treatment program for children, Wilfley and colleagues Article assessed the short-term and long-term efficacy of 2 weight maintenance approaches—one emphasizing behavioral skills and the other social facilitation. The authors found that children who were randomly assigned to either weight maintenance intervention had greater success maintaining their weight loss at 4 months than children who were randomly assigned to a control group with no further intervention. Successful weight maintenance waned during the 20-month follow-up, particularly among children with social problems. In an editorial, Rhodes and Ludwig Article discuss unique features of childhood obesity and its management.
To examine the quality of care received by Medicaid beneficiaries vs commercial populations in managed care plans, Landon and colleagues analyzed national quality of care data for 11 quality indicators from the Healthcare Effectiveness Data and Information Set. The authors found that among Medicaid enrollees in managed care plans, performance measures were comparable for Medicaid-only plans and Medicaid/commercial plans that serve large numbers of both types of enrollees. Similarly, among commercial enrollees, there was no difference in quality of care in plans that served primarily commercial enrollees vs Medicaid/commercial plans. However, in comparisons of Medicaid beneficiaries with commercially insured persons, performance measures for commercial populations exceeded those for Medicaid populations.
“Was my failure to respond to a fellow human being who was balanced precariously on life's precipice a sign of my own arrogance?” From “The Book.”
Factors behind the severe shortage of nurses in the United States.
An appraisal of the likely contribution of genomics to personalized medicine.
The role of stress in depression, cardiovascular disease, HIV/AIDS, and cancer.
Implications of petroleum scarcity for medical care and public health.
Submit your views on the diagnostic or treatment options for a patient at a medical crossroads. Your response may be selected for online publication with the article. Go to www.jama.com on October 3 to read the first case. Submission deadline is October 31.
For your patients: Information about chronic stress and the heart.
This Week in JAMA . JAMA. 2007;298(14):1605. doi:10.1001/jama.298.14.1605