Whether the dramatic increase in knee replacement surgery over recent years corresponds to an increase in knee osteoarthritis has been unknown. Using data from NHANES (National Health and Nutrition Examination Survey) and the Framingham Osteoarthritis Study, researchers identified increases in knee pain that changes in population age and body mass index do not explain. No increase in radiographically defined knee osteoarthritis was observed.

Pregnant women and infants who get influenza are at increased risk for severe illness. In this prospective, multicenter, single-group clinical trial from France, nearly all women who received a single dose of a nonadjuvant 2009 influenza A(H1N1) vaccine in their second and third trimesters had antibody titers that were considered protective. Antibody titers in cord blood samples from 95% of the infants were also at a level considered protective. A single dose of influenza vaccine administered to women during pregnancy should protect both mothers and their newborns.

To determine whether the inverse associations between high-density lipoprotein cholesterol (HDL-C) or apolipoprotein A-I levels and cardiovascular disease (CVD) exist across all levels of low-density lipoprotein cholesterol (LDL-C), this study examined data from 26 861 participants in the Women's Health Study. Levels of HDL-C and apolipoprotein A-I were inversely associated with coronary events, but not stroke, across a range of LDL-C levels. Neither was associated with coronary events among women with decreased total atherogenic particle burden.

The optimum timing and strategies for screening women for osteoporosis are topics of debate. This modeling analysis found that initiating screening at age 55 years and continuing to age 80 years was cost-effective. Several strategies, including prescreening with a risk estimation tool or calcaneal quantitative ultrasonography, were also cost-effective. The model suggests that the best strategy was screening with dual-energy x-ray absorptiometry, treating if the T-score was −2.5 or less, and repeating screening every 5 years.

This systematic review was conducted to inform an update of U.S. Preventive Services Task Force recommendations on prostate cancer screening. The authors searched MEDLINE and Cochrane databases from 2002 to July 2011 for randomized trials of prostate-specific antigen–based screening, trials and cohort studies of prostatectomy and radiation therapy, and observational studies of harms associated with these therapies. Identified evidence documents that prostate-specific antigen–based screening leads to detection of more prostate cancer cases but also to small or no reduction in prostate cancer mortality after about 10 years of follow-up. There were potential harms related to evaluation of positive screening test results and subsequent therapies.

This review compares the benefits and harms of second-generation antidepressants for treating major depressive disorder in adults. On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of major depression. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on demographic characteristics or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life.

In this issue, Nguyen and colleagues show that the prevalence of knee pain, but not of radiographically defined knee osteoarthritis, has increased over recent years, a period during which knee replacement surgery has also increased. The editorialist asserts that these findings call health services researchers and treating clinicians to action, to investigate possible secular trends in the radiographic severity or demographic profile of patients who are referred for and those who undergo knee replacement surgery.

The findings that Nayak and colleagues report in this issue extend those of prior studies by estimating that dual-energy x-ray absorptiometry is cost-effective for women aged 55 to 64 years with an average fracture risk and pretest probability of osteoporosis by bone mineral density criteria. However, the editorialists believe it is premature to conclude that bone densitometry for all white women in this age group is cost-effective, and they discuss other factors to consider when interpreting Nayak and colleagues' analysis.

For centuries, soldiers and physicians have pondered the apparent random nature of life and death in battle. Does fate alone dictate who lives and who dies? Step to the left, and you survive the mortar strike. Switch convoy vehicles, and the IED devours your friend instead of you. Are such events predetermined? Or do our choices decide these outcomes?

As the prayer service began, I looked up toward the altar. Until then, I had not noticed the three young men in wheelchairs along the center aisle.