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This Week in JAMA
JAMA. 1998;279:1763.
Preventing Occupational Back Injuries
Low back pain is a highly prevalent—and costly—problem among workers. Dr van Poppel and colleagues (SEE ARTICLE) randomized work groups at a Dutch airline company to lumbar support and back education, each intervention alone, or no intervention. Neither intervention, whether separately or together, was effective in preventing low back injuries. In a related editorial, Dr Dillingham (SEE ARTICLE) says studying prevention of back pain in the workplace should be a top priority for occupational health research.
More Cocaine-Related Deaths During Hot Weather
The potentially lethal effects of cocaine intoxication and overdose largely reflect the drug's powerful sympathomimetic and thermogenic properties. But in this study of New York City medical examiner cases from 1990 to 1995, Dr Marzuk and colleagues (SEE ARTICLE) found that when the ambient temperature exceeded 31.1°C (88°F), the number of cocaine overdose deaths per day increased significantly.
related editorial (SEE ARTICLE)
Influence of Race on Breast Cancer Diagnosis
Disease risks often vary by race but seldom result from genetic differences among patients, and so race is viewed as a marker for other risk factors that are more difficult to measure. Dr Lannin and colleagues explain the influence of race on delayed diagnosis of breast cancer partly by socioeconomic factors and partly by cultural beliefs and attitudes. Unless care is provided in the context of cultural beliefs, the authors say, patients may be unwilling to accept medical services.
(SEE ARTICLE)
The Perils of Publishing Pedigrees
Pedigree diagrams represent a particularly challenging aspect of balancing the value of scientific communication with rights to privacy and confidentiality, because of the difficulty of obtaining informed consent to publish identifiable information about many relatives. Dr Botkin and colleagues suggest that the current practices of human genetics investigators and journals regarding publication of pedigrees vary widely and are sometimes problematic.
(SEE ARTICLE)
Can Diuretics Do the Job?
For years thiazide diuretics for hypertension have been known to reduce cardiovascular morbidity and mortality. Yet their use has been declining in favor of newer drugs, despite newer agents' greater cost and less evidence about their effects on major outcomes. Dr Moser considers several common beliefs regarding the effectiveness and desirability of diuretics and finds that the arguments against diuretics don't hold up under objective scrutiny of existing trials.
(SEE ARTICLE)
Screening Exams for High School Athletes
Sudden cardiac death among high school athletes is rare, but even one such death during competition is too many. Drs Glover and Maron (SEE ARTICLE) evaluated state high school athletic associations' preparticipation screening processes and found substantial variation across the United States in screening requirements, composition of approved history and physical examination questionnaires, and qualifications of examiners.
related editorial (SEE ARTICLE)
The Cover
". . . they sing alone, each in a distinctive voice, and in unison, ‘the still, sad music of humanity' for the vespers of the millennium." Gari Julius Melchers, Vespers, c 1910, American.
(SEE ARTICLE)
A Piece of My Mind
"Having lived long enough, we old ones can give equal respect to all the events in a life cycle, from beginning to end." From "On Being Eighty."
(SEE ARTICLE)
Medical News & Perspectives
Physicians who seize the "teachable moment" can help their patients greatly reduce alcohol consumption and associated health risks.
(SEE ARTICLE)
Contempo 1998
An update on aerospace medicine examines in-flight emergency medical care on commercial aircraft and innovations in telemedicine.
(SEE ARTICLE)
Profiles in Primary Care
Dr Fitzhugh Mullan interviews Connie Adler, MD, a generalist physician in rural Farmington, Maine, who "is never far from giving service to someone."
(SEE ARTICLE)
JAMA Patient Page
For your patients: the lowdown on low back pain.
(SEE ARTICLE)
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