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This Week in JAMA |

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JAMA. 2003;290(8):989. doi:10.1001/jama.290.8.989.
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SERTRALINE FOR PEDIATRIC MAJOR DEPRESSIVE DISORDER

Empirical evidence on the effectiveness of selective serotonin reuptake inhibitors for the treatment of children and adolescents with major depressive disorder (MDD) is limited. Wagner and colleaguesArticle conducted 2 identically designed, concurrent, international 10-week randomized trials to evaluate the efficacy and safety of sertraline compared with placebo in children and adolescents with MDD. In pooled analyses of data from the 2 trials, overall improvement in depression symptoms was significantly greater among children and adolescents who received sertraline than among those who received placebo. In an editorial, VarleyArticle discusses the pharmacological treatment of MDD in children and adolescents.

LOW-DOSE ESTROGEN AND BONE DENSITY AND TURNOVER

Estrogen therapy has been used for the prevention and treatment of osteoporosis, but recent studies indicate that conventional doses of estrogen therapy in postmenopausal women increase risk of adverse events. In this randomized trial of ultralow-dose micronized 17β-estradiol (one quarter of standard treatment) in healthy women older than 65 years, Prestwood and colleagues found that over 3 years of treatment, bone mineral density (BMD) of the hip, spine, and total body increased significantly in the low-dose estrogen group compared with the placebo group and markers of bone turnover decreased significantly. Adverse events were not significantly different in the 2 study groups.

RISK SCORE FOR STROKE OR DEATH IN ATRIAL FIBRILLATION

Using data from the Framingham Heart Study, a prospective, community-based observational cohort study, Wang and colleaguesArticle derived a clinical risk score for stroke alone and for stroke or death in adults with new-onset atrial fibrillation. Risk predictors included advancing age, female sex, increasing systolic blood pressure, prior stroke or transient ischemic attack, and diabetes. In an editorial, WaldoArticle advocates the use of warfarin for patients with atrial fibrillation at risk of stroke, noting that the potential benefits of stroke prevention outweigh the potential risks of bleeding secondary to warfarin.

PNEUMOCOCCAL PROPHYLAXIS FOR SICKLE CELL DISEASE

Published consensus statements recommend that children younger than 5 years with sickle cell disease take daily antibiotic prophylaxis to prevent pneumococcal infections. In this analysis of Medicaid administrative claim and encounter data from Tennessee and Washington, Sox and colleagues found that publicly insured children with sickle cell disease were dispensed prophylactic antibiotics for a mean of only 148 days during the 365-day study period. Outpatient visits for preventive care were associated with increased provision of prophylactic antibiotics.

QUALITY OF TRIALS OF NONPHARMACOLOGICAL TREATMENTS

Boutron and colleagues reviewed reports of randomized controlled trials assessing nonpharmacological and pharmacological treatments for hip and knee osteoarthritis published between January 1, 1992, and February 28, 2002, to identify specific methodological issues related to the assessment of nonpharmacological treatments. Overall methodological quality of reports of nonpharmacological treatments was lower than that of pharmacological treatments. Lack of reporting adequate random sequence generation, adequate allocation concealment, and intention-to-treat analysis was common in both pharmacological and nonpharmacological articles. Methodological difficulties specific to trials of nonpharmacological treatments included choice of a control intervention, blinding of patients, care providers, and outcome assessors, and standardization of the intervention.

A PIECE OF MY MIND

"With no one to oversee the appropriate treatment, no one to emphasize to the family the paramount importance of adherence to treatment, and no one to confirm that the bacterium was indeed sensitive to the prescribed formula, it was destined to be a recipe for disaster."

CONTEMPO UPDATES

Diagnosis and treatment of genital lesions.

MEDICAL NEWS & PERSPECTIVES

Counterfeit drugs, often distributed by shady or uncautious wholesalers, pose a potentially serious health risk to patients.

D-DIMER LEVELS AND THROMBOEMBOLISM

A prospective cohort study suggests that adults with a first spontaneous venous thromboembolism who have a D-dimer level less than 250 ng/mL after discontinuation of oral anticoagulation have a low risk of recurrence.

ETHICS OF PHASE 1 ONCOLOGY TRIALS

In a critical analysis of data on the risk-benefit ratio and quality of informed consent in phase 1 oncology trials, Agrawal and Emanuel refute claims that phase 1 cancer research is unethical.

CLINICIAN'S CORNER

Mrs P, a 41-year-old woman with chronic myelogenous leukemia (CML), is planning to undergo stem cell transplantation. Antin discusses the epidemiology, diagnosis, natural history, and treatment of CML.

JAMA PATIENT PAGE

For your patients: Information about atrial fibrillation.

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