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The risk of falling and the severity of
associated complications increase with advancing age. To determine
trends in the epidemiology of injuries and deaths secondary to falls
among older adults, Kannus and colleagues analyzed data on individuals
aged 50 years and older from the National Hospital Discharge Register
and the Official Cause-of-Death Statistics of Finland. They found a
marked increase in the age-adjusted incidence of fall-induced injuries
for both men and women between 1970 and 1995,
age-adjusted incidence of fall-induced deaths between 1971 and 1995 did
not show an increasing trend.
Shaneyfelt and colleaguesArticle evaluated clinical practice guidelines to
assess how well they adhere to methodological standards. On average,
clinical practice guidelines met fewer than half of the standards and
were particularly deficient in reporting how evidence was identified,
evaluated, and synthesized. In an editorial, Cook and GiacominiArticle point
out that the criteria used in this study may not be suitable for all
guidelines and emphasize the importance of measuring the effect of
guidelines on clinical and economic outcomes.
The number of outbreaks of meningococcal infection on college
campuses has increased recently, but in this study of cases of
meningococcal infection among Maryland residents between 1992 and 1997,
Harrison and coworkers found that the incidence of meningococcal
infection in college students was similar to that in the general
population of the same age. The incidence of meningococcal infection
was significantly higher, however, among students at 4-year colleges
living on campus compared with those living off campus.
The tobacco industry has argued that ordinances that prohibit smoking
in restaurants adversely affect tourism. Glantz and Charlesworth,
however, report that the rate of growth in hotel revenues as a marker
of tourism increased or remained steady in 8 of 9 US study localities
after passage of 100% smoke-free restaurant ordinances.
In this meta-analysis of trials that compared the efficacy and
safety of drugs for the treatment of stable angina, Heidenreich and
colleagues found that the number of episodes of angina per week and
discontinuation of treatment because of adverse events were less
frequent with β-blockers than with calcium antagonists. Rates of
cardiac death and myocardial infarction among patients treated with
β-blockers or calcium antagonists were similar, but most of the
studies were short-term. There were no significant differences in
outcomes in the few studies comparing long-acting nitrates with calcium
antagonists or β-blockers.
During the 2-week hospitalization that ended with her death from
metastatic lung cancer, Mrs L experienced severe back pain and headache
despite different therapies for pain. Foley discusses effective pain
management strategies for patients with end-stage cancer.
Genetic factors associated with alcohol abuse and dependence.
Schizophrenia researchers hope that early detection and intervention
will lead to a better prognosis for people with this mental disorder.
Bogardus and colleagues examine the epidemiologic quality of molecular
genetic research studies published in 4 major general medical journals.
Stringer and colleagues argue that evidence is insufficient to support
the use of cesarean delivery to prevent perinatal transmission of human
immunodeficiency virus (HIV) in most circumstances.
For your patients: Preventing falls among the elderly.
This Week in JAMA. JAMA. 1999;281(20):1871. doi:10.1001/jama.281.20.1871