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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2000;284(8):925. doi:10.1001/jama.284.8.925.
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RESPONSE TO ONDANSETRON AND ALCOHOLISM SUBTYPES

Early-onset alcoholism, a subtype of alcohol dependence, is characterized by early age of onset, antisocial behaviors, and serotonergic dysfunction. Johnson and colleaguesArticle conducted a trial to determine whether patients with early-onset (before age 25 years) alcoholism would have a different response to treatment with ondansetron, a serotonin receptor antagonist, than patients with late-onset alcoholism. Among patients with early-onset alcoholism, those who received ondansetron had a significant increase in the proportion of days abstinent and decrease in the intensity of alcohol intake compared with those who received placebo, but the drinking behavior response among patients with late-onset alcoholism was similar in the ondansetron and placebo groups. In an editorial, KranzlerArticle discusses pharmacological treatment of alcoholism based on clinical subtypes.

BMD AND FRACTURE RISK IN NURSING HOME RESIDENTS

Several clinical conditions and characteristics of the physical environment have been associated with increased fracture risk among nursing home residents. In this 18-month prospective study of 1427 white female nursing home residents aged 65 years or older, Chandler and colleaguesArticle found that low bone mineral density (BMD), as measured by distal ulnar single-beam absorptiometry, and transfer independence were significant independent risk factors for fracture. In an editorial, WallaceArticle considers nutritional, pharmacological, and environmental interventions to maintain bone health and prevent fractures in nursing home residents.

PHYSICIAN SPECIALTY AND QUALITY OF CARE FOR ARTHRITIS

In this evaluation of the quality of health care in a historical cohort of 1355 patients with rheumatoid arthritis, MacLean and colleagues determined quality scores in 3 health care domains—arthritis care, comorbid disease care, and health care maintenance. Overall, quality of care was suboptimal in all 3 domains. Patients generally received higher quality care for arthritis than for prevention or for treatment of comorbid diseases. Patients who had contact with a relevant specialist received substantially higher quality of care in all 3 domains compared with patients who did not. These findings suggest that current health care delivery models that use primary care physicians to manage overall care and regulate access to specialty care may not be optimal for patients with complex conditions.

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LOW DIETARY FAT IN CHILDHOOD AND NEURODEVELOPMENT

Although modification of dietary fat intake in infancy and early childhood might reduce risk of coronary heart disease, possible impairment of growth and neurological development has been a concern. In a previous report of the Special Turku Coronary Risk Factor Intervention Project, children whose parents received counseling to maintain a low–saturated fat, low-cholesterol diet after age 7 months had smaller increases in cholesterol levels at age 3 years than children in the control group, and growth rates were similar. Rask-Nissilä and colleagues now report that at age 5 years, children in the intervention group had reduced dietary fat and cholesterol intake compared with the control group, and lower serum cholesterol levels, and performed at least as well on neurodevelopmental tests.

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USE OF RABIES POSTEXPOSURE PROPHYLAXIS

Guidelines for the administration of rabies postexposure prophylaxis have been published by the Advisory Committee on Immunization Practices and by public health departments based on local rabies epidemiology. In this prospective study of patients who presented with an animal exposure to 1 of 11 emergency departments, Moran and colleagues found that management was appropriate according to local health department guidelines in 1857 (91.5%) of 2030 exposures. Management was considered inappropriate for 54 (40%) of the 136 patients who were given postexposure rabies prophylaxis and for 119 (6.3%) of 1894 patients who were not given it. These results suggest that increased compliance with guidelines would increase the use of postexposure rabies prophylaxis.

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CONTEMPO UPDATES

Management of patients with primary hyperparathyroidism: suggestions for new guidelines based on the availability of minimally invasive parathyroidectomy.

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MEDICAL NEWS & PERSPECTIVES

Online publishing initiatives offer immediate access to research data—but they also raise questions about cost and peer review.

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HEPATITIS B VACCINE AT BIRTH

The option to begin the recommended childhood 3-dose hepatitis B vaccination series at birth provides an opportunity to immunize newborns prior to hospital discharge. In the 1998 National Immunization Survey, administration of the first dose within 7 days of birth was associated with increased likelihood of completing the series by age 19 to 35 months.

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RADIOTHERAPY, SURGERY FOR RECTAL CANCER

A meta-analysis of overall and cancer-specific mortality rates, local recurrence rates, and rates of occurrence of distant metasases from 14 randomized controlled trials comparing preoperative radiotherapy plus surgery with surgery alone for patients with rectal adenocarcinoma.

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CLUES TO PATIENT CONCERNS AT OFFICE VISITS

In a sample of 116 primary care and surgery office visits, most physicians missed opportunities to address psychosocial concerns of their patients signaled by patient clues during the visits.

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JAMA PATIENT PAGE

For your patients: A primer on rabies.

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