Immunization rates increased from 56% to 89% over a 15-month period
at Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites
in inner-city Chicago, report Hoekstra and colleaguesArticle, where a food voucher
incentive program restricted vouchers to a 1-month supply for participants
with children 24 months or younger whose immunizations were incomplete. In
an editorial, Wood and HalfonArticle discuss barriers that may impede immunization
of inner-city children and consider approaches to improve the delivery of
child health services in the inner city.
Alexander and SehgalArticle found that among more than 7000 individuals beginning
hemodialysis, blacks, women, and low-income individuals were less likely to
complete the steps necessary to acquire a kidney transplant. In a related
article, Lin and colleaguesArticle analyzed survival rates after solid organ transplantation
in the United States during a 6-year period beginning in 1988. The major risk
of graft failure occurred during the first year after transplantation, after
which the 3-year patient and graft survival rates exceeded 90% for all organ
transplants except lung and heart-lung. Centers that performed fewer transplantations
had lower-than-expected graft survival rates. In an editorial, MilfordArticle considers
the policy implications of these findings for the equitable allocation of
solid organs for transplantation.
An enhanced, personalized risk reduction counseling program in 5 public
STD clinics was associated with higher condom use and lower incidence of sexually
transmitted diseases during the next year compared with the didactic intervention
typical of current care. Kamb and colleagues report that the 2-session enhanced
intervention in this randomized trial was as effective as the longer 4-session
enhanced intervention and was suitable for busy public clinic settings.
Renin profiling has been suggested as a useful way to predict response
to antihypertensive agents, but renin level measurements can be expensive
and are not routinely required for patient care. Preston and colleagues analyzed
data from the Veterans Affairs Cooperative Study to determine if renin profiling
or age-race subgroup was a better predictor of therapeutic response to a particular
drug for the treatment of stage 1 and 2 hypertension. Therapeutic response
rates were equivalent for patients treated with agents matched to their renin
profile or age-race subgroup, but in a logistic regression analysis, age-race
subgroup was the better predictor.
The tobacco industry had full knowledge of the addictive properties
of nicotine, which shaped product development and marketing strategies, and
of the health risks associated with cigarette smoking, according to documents
presented at the Minnesota tobacco trial. Hurt and Robertson urge a stringent
national tobacco policy to curtail tobacco use in the United States and abroad.
"When considered within the vastness and grandeur of nature, the human
is tiny and nearly insignificant." Jasper Francis Cropsey, Janetta Falls, Passaic County, New Jersey, 1846, American.
New research on how to help blind people cope with sleeping problems,
which are often caused by "free running" circadian rhythms.
Aggressive treatment of ocular inflammation in children with juvenile
"A simple handshake, friendly greeting, or welcomed smile is what a
patient will ultimately remember." From "On Being Human."
Medical students at the University of California at Davis develop and
operate a harm-reduction clinic for injection drug users.
For your patients: A guide to organ donation.
This Week in JAMA. JAMA. 1998;280(13):1121. doi:10.1001/jama.280.13.1121