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This Week in JAMA |

This Week in JAMA FREE

JAMA. 1998;280(24):2057. doi:10.1001/jama.280.24.2057.
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ALENDRONATE, BMD, AND FRACTURE RISK

In a 4-year study of postmenopausal women with low bone mineral density (BMD) and no vertebral fractures, Cummings and coworkersArticle found that women treated with alendronate had an increase in BMD and a lower rate of first vertebral fracture than women who received placebo. However, alendronate reduced the risk of clinical fractures only in women with lower BMD at baseline. In an editorial, HeaneyArticle emphasizes that bone fragility is only partly related to BMD and suggests an individualized approach to fracture prevention.

VIOLENT CRIMES AMONG HANDGUN PURCHASERS

A 15-year retrospective study of almost 6000 authorized purchasers of handguns by Wintemute and colleaguesArticle showed that purchasers with a prior misdemeanor conviction were almost 5 times more likely to be charged with a new crime involving firearms or violence than those without convictions. In an editorial, BradyArticle and coauthors note that prohibiting the purchase of handguns by individuals with prior misdemeanor convictions would require more complete and accessible criminal records than are currently available.

COST-EFFECTIVE TREATMENT OF CHRONIC HEPATITIS C

In a hypothetical cohort of patients with chronic hepatitis C infection, Wong and colleagues compared the cost-effectiveness of no interferon treatment, empirical treatment of all patients, and selective interferon treatment based on factors predictive of long-term response. They found that treating all patients with an initial trial of interferon would have a reasonable cost and would avoid missing any patients who would have a sustained treatment response.

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EPIDEMIOLOGY OF SEROGROUP Y MENINGOCOCCAL DISEASE

Racoosin and colleagues report that the proportion of cases of invasive meningococcal disease in Chicago due to serogroup Y increased from 4% in 1991, peaked at 61% in 1995, and declined to 18% in 1997. In this retrospective study, patients with serogroup Y disease were more likely to be older, to be African American, and to have an underlying chronic illness than patients infected with other serotypes, but disease outcomes were similar among all serotypes.

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EPIDURAL ANALGESIA AND LABOR OUTCOMES

In a meta-analysis of data from 10 randomized trials that compared epidural analgesia with parenteral opioids during labor, Halpern and colleagues found that epidural analgesia was not associated with an increased risk of cesarean delivery or instrumental vaginal delivery for dystocia. Compared with analgesia with parenteral opioids, epidural analgesia was associated with longer labors but better pain relief and better neonatal outcomes.

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A 69-YEAR-OLD MAN WITH CHRONIC DIZZINESS

For several years, Mr D has experienced unpredictable, recurrent episodes of dizziness of variable duration and severity. The episodes no longer respond to treatment and Mr D restricts his activity, fearing that an episode may impair his functioning. Drachman describes a clinical strategy for the diagnosis and treatment of dizziness.

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THE COVER

Paul Lauritz, Poinsettias, c 1925, American.

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MEDICAL NEWS & PERSPECTIVES

As HMOs reach age 25 years, experts take a new look at the medical results and the ethical basis of managed care.

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CONTEMPO 1998

Antileukotriene drugs in the management of chronic asthma.

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A PIECE OF MY MIND

"Are we not obligated to meet the needs of our patients, even if at times these needs are poorly articulated?" From "Four-Wheel-Drive Medicine."

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CALL FOR PAPERS: VIOLENCE THEME ISSUE

Original research, reviews, and commentaries are invited for the annual JAMA theme issue on violence scheduled for August 1999.

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PUBLIC OPINION AND HEALTH CARE

What Americans think about issues affecting children's health and the implications for health policy.

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JAMA PATIENT PAGE

For your patients: Detecting hepatitis C infection.

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