This Week in JAMA FREE

In this 36-month interim analysis of follow-up radiographs from 6828 postmenopausal women at high risk for osteoporotic fractures enrolled in the Multiple Outcomes of Raloxifene Evaluation study, Ettinger and colleagues reportArticle that the risk of new vertebral fractures was significantly lower in raloxifene treatment groups than in the placebo group, but risk of nonvertebral fractures was similar in all study groups. Bone mineral density of the spine and femoral neck increased 2.1% to 2.7% more in the raloxifene groups than in the placebo group. In an editorialArticle, McClung points out that prior fracture is a strong risk factor for subsequent fracture in postmenopausal women and that drug therapies for fracture prevention affect determinants of fracture risk differently.

Pneumococcal immunization rates among elderly and high-risk patients are well below target levels. Jacobson and colleagues report that in an elderly clinic population with low health literacy, patients who received an educational brochure on pneumococcal vaccination written at below fifth-grade reading level were significantly more likely to receive a pneumococcal vaccine or discuss it with their physicians than patients who received a similar educational brochure on nutrition.

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To determine whether patients use unconventional therapies in conjunction with mainstream medical care or as an alternative, Druss and Rosenheck analyzed data from a national probability sample of individuals who responded to the 1996 Medical Expenditure Panel Survey. Based on responses of 16,068 adults aged 18 years or older, an estimated 6.5% of the US population had visits for both unconventional therapies and conventional medical care; 1.8% had visits only for unconventional services; 59.5% had visits only for conventional care; and 32.2% used neither type of medical service.

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In this observational behavioral study and preliminary neuroendocrine study, Birketvedt and colleagues found that patients with night-eating syndrome ate more frequently than control subjects, consumed most of their daily energy intake at night, often in association with night awakenings, and had abnormal circadian patterns of plasma melatonin, leptin, and cortisol levels. In an editorial, Yager reviews clinical characteristics of sleep-related eating disorders and considers explanations for the neuroendocrine findings observed in this study.

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A large randomized trial, the Calcium for Preeclampsia Prevention (CPEP) study, showed no reduction in preeclampsia risk among healthy nulliparous women who received calcium supplementation, contradicting the results of a meta-analysis of earlier clinical trials published the preceding year. In this second meta-analysis of 14 trials on calcium supplementation and preeclampsia published prior to the CPEP study, DerSimonian and Levine used subgroup analyses to explain the marked heterogeneity of effects among the trials. Results of the meta-analysis of placebo-controlled trials that enrolled healthy low-risk women were consistent with the CPEP results of no reduction in preeclampsia risk with calcium supplementation, but the analysis of trials that enrolled healthy high-risk women supported a beneficial calcium effect.

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"How meaningful to be told by my physicians that they are learning from me!" From "Partnership for Good Dying."

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Scientists respond to the continuing need to increase the public's understanding of why animals are used in research and how those animals are treated.

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At The Johns Hopkins Hospital

Symptoms of adrenal insufficiency complicate withdrawal of oral glucocorticoid therapy in a 36-year-old woman with severe chronic asthma.

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From the WHO Global Surveillance and Monitoring Project

Updated worldwide estimates of the prevalence of Mycobacterium tuberculosis infection and tuberculosis incidence, prevalence, and mortality.

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Brand and Kliger demonstrate the value of decision analysis as a tool for shared medical decision making by applying it to Brand's decision to have an early kidney transplantation.

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For your patients: Primer on tuberculosis.

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