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This Week in JAMA
JAMA. 2000;283:1251.
JAMA-EXPRESS
 -Blocker Therapy Improves Outcomes of Chronic CHF
In previously published results of the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF), which enrolled 3991 patients with congestive heart failure (CHF) and systolic dysfunction, total mortality was 34% lower among patients assigned to receive controlled-release/extended-release metoprolol (metoprolol CR/XL) in addition to standard therapy than in the placebo group. In this report on outcomes of the MERIT-HF trial during a mean follow-up of 12 months, Hjalmarson and colleagues (SEE ARTICLE) found that patients in the metoprolol CR/XL group had a lower risk of total mortality or all-cause hospitalization and of mortality or hospitalization due to worsening heart failure, improved symptoms of heart failure, and better quality of life compared with patients in the placebo group. In an editorial, Califf and O'Connor (SEE ARTICLE) discuss why most patients with heart failure due to systolic dysfunction do not receive  -blocker therapy despite evidence of its effectiveness and present ways to increase its use in eligible patients.
Rethinking Treatment of Opioid Dependence
Methadone maintenance therapy for opioid dependence has been shown to be effective but requires indefinite treatment with a dependence-producing medication and, in the United States, specialty care in methadone maintenance clinics. In this trial comparing traditional methadone maintenance treatment with a 180-day program of opioid detoxification supplemented with intense psychosocial services, Sees and colleagues (SEE ARTICLE) found that treatment retention was higher in the methadone maintenance treatment group than in the detoxification program, and rates of heroin use and drug-related HIV risk behaviors were lower. Weinrich and Stuart (SEE ARTICLE) describe 2 large opioid treatment programs in Scotland that integrate primary care, specialty care, and methadone maintenance. The proportion of injection drug users enrolled in these programs (60% to 80% in Edinburgh; 41% to 73% in Glasgow) greatly exceeds that in the United States (14% of heroin addicts). In an editorial, Rounsaville and Kosten (SEE ARTICLE) discuss issues of access and quality of care for treatment of opioid dependence.
Extraimmunization Among Young Children
Using data from the US 1997 National Immunization Survey, Feikema and colleagues (SEE ARTICLE) found that 21% of 22,806 children received an extra immunization with at least 1 vaccine. In an editorial, Davis (SEE ARTICLE) observes that these findings do not warrant a change in current immunization practices, but suggests that more effort be directed toward creating a complete and accurate immunization history for each child.
Early and Later Response to Osteoporosis Treatment
To determine whether women who lose bone mineral density (BMD) during the first year of treatment for osteoporosis will continue to lose BMD if the same treatment is continued, Cummings and colleagues analyzed data from women enrolled in 2 clinical trials who completed 2 years of BMD monitoring and adhered to study medication—5 mg/d of alendronate sodium in the Fracture Intervention Trial; 60 or 120 mg/d of raloxifene hydrochloride in the Multiple Outcomes of Raloxifene Evaluation trial. In both trials, most women who lost BMD during the first year of treatment gained BMD in the second year. Women who lost the most BMD in the first year gained the most in year 2, consistent with regression to the mean.
(SEE ARTICLE)
Magnet Therapy Not Helpful for Low Back Pain
Therapy with permanent magnets is used for the treatment of musculoskeletal conditions, but few studies have evaluated its effectiveness. In this crossover trial that enrolled 20 patients with chronic low back pain, Collacott and colleagues found no differences between treatment with bipolar permanent magnets and sham magnet devices on measures of pain intensity, pain quality, or lumbosacral range of motion.
(SEE ARTICLE)
Contempo Updates
Helicobacter pylori cytotoxin-associated gene A (cagA) gene and risk of clinical gastrointestinal disease in persons infected with H pylori.
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Medical News & Perspectives
With the advent of at least partial peace in the Balkans, psychiatrists from the war-torn region are attempting to help survivors cope with their residual mental trauma.
(SEE ARTICLE)
Injuries Among Jockeys
Incidence and pattern of injuries among professional jockeys during official horse races at US tracks.
(SEE ARTICLE)
Judicious Use of Antiretroviral Therapy
Grand Rounds at The Johns Hopkins Hospital
How selection and timing of antiretroviral therapy for human immunodeficiency virus infection determine risk of drug resistance and may constrain treatment options and alter response to future therapy.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about opioid dependence and treatment.
(SEE ARTICLE)
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