This Week in JAMA FREE

High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation is often used for the treatment of women with advanced breast cancer despite controversy regarding its indications and benefits. In a multivariate analysis of Autologous Blood and Marrow Transplant Registry data from 1188 women with advanced breast cancer who received this treatment, Rowlings and colleagues found Article that factors associated with disease progression or death included poor response to pretransplantation chemotherapy, central nervous system metastases, 3 or more metastatic sites, and prior adjuvant chemotherapy. In an editorialArticle, Gradishar points out that many of the factors associated with treatment failure identified in this study are similar to those associated with poor outcomes using standard-dose chemotherapy and recommends that autotransplantation be used only in the context of clinical trials until more definitive data are available.

In this randomized trial of the bisphosphonate risedronate for the treatment of postmenopausal osteoporosis, Harris and coworkers found that among 2458 women with osteoporosis and at least 1 preexisting vertebral fracture, those who received risedronate had a significantly lower incidence of new vertebral fractures within 1 year of initiating treatment (Figure 1) and a significantly lower incidence of nonvertebral fractures within 3 years of treatment compared with women who received placebo. The incidence of adverse events was similar in the treatment and placebo groups.

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Using data from the 1996 state-based Behavioral Risk Factor Surveillance System telephone survey, Serdula and colleagues found that 28.8% of 46,220 men and 43.6% of 61,584 women reported attempting to lose weight and 35.1% of the men and 34.4% of the women respondents reported attempting to maintain weight. Only about a fifth of individuals trying to lose weight reported both eating fewer calories and exercising at least 150 minutes per week, the weight loss strategy recommended by US dietary guidelines.

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In an analysis of data from the Adverse Childhood Experiences Study mail survey, Dietz and colleagues found that more than 45% of the 1193 adult women who responded reported that their first pregnancy was unintended and 65.8% reported exposure to at least 2 types of childhood abuse or household dysfunction. Compared with women who reported no childhood abuse, women who reported frequent exposure had a modest but statistically significant increased risk of unintended first pregnancy and the risk of unintended first pregnancy increased as the number of types of abuse experienced increased.

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Although patients with advanced dementia and eating difficulties are often fed using enteral feeding tubes, Finucane and colleaguesArticle, in a MEDLINE search from 1966 through 1999, found no clinical trials comparing tube feeding with oral feeding in this group of patients, no data supporting that tube feeding benefits patients with advanced dementia, and some evidence that tube feeding may be harmful. In an editorialArticle, McCann discusses alternatives to tube feeding for patients with severe dementia and eating difficulties.

Current concepts in the understanding and treatment of drug addiction.

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High hopes that HAART (highly active antiretroviral therapy) might totally eradicate HIV in infected people have proved illusory. A new report demonstrates that when therapy is discontinued, the virus rebounds.

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How to determine whether a drug is better than others in the same class.

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For your patients: Osteoporosis and prevention of hip fractures.

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Introductory free and unrestricted access to the complete contents of JAMA and 10 Archives journals is now available on the JAMA Web site.

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Additional Web-only reports on gay and lesbian issues in medicine, an interview with physician-poet Rafael Campo, and selections from his new collection of poems, Diva.

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