Annual influenza immunization rates among the elderly approach 60% to
70%, but rates among nonelderly persons with chronic medical
conditions and among health care professionals who may transmit the
disease are much lower. Neuzil and colleaguesArticle found that excess
cardiopulmonary hospitalizations and deaths during influenza season in
women aged 15 to 64 years were highest among women aged 45 to 64 years
with chronic medical conditions (estimated number of annual excess
events, 58 per 10,000 women compared with 6 events per
10,000 middle-aged low-risk women). In a placebo-controlled
trial of influenza vaccine in healthy hospital-based health care
professionals, Wilde and coworkersArticle found that vaccine recipients were
significantly less likely to become infected with influenza than were
controls. In an editorial, GlezenArticle points out that strategies to
increase immunization rates and new methods of prevention and treatment
of influenza are needed.
Results of previous case-control and cohort studies investigating the
relationship between dietary fat intake and the risk of breast cancer
have been inconsistent. In this extension of the Nurses' Health Study,
Holmes and colleagues measured dietary intake 4 times during 14 years
of follow-up of more than 85,000 women. The researchers found no
significant association between intake of total fat, including very low
fat intake, or of specific types of fat and the risk of breast cancer.
In this autopsy study of cases of sudden death in men with
severe coronary artery disease, Burke and colleagues found that acute
coronary artery plaque rupture occurred in a significantly higher
proportion of men who died during exertion compared with men who died
at rest. The mean total cholesterol/high-density lipoprotein
cholesterol ratio was higher in the exertion group and was
significantly associated with acute plaque rupture among all cases.
Morphologic characteristics of plaque rupture in the exertion group
(Figure 1) included hemorrhage into the plaque
(arrowhead) and rupture (arrows) in the central region of the fibrous
cap (FC) with an overlying acute thrombus (Th) in the artery lumen.
Infection with Babesia microti, an intraerythrocytic protozoan
transmitted by the northern deer tick, is often asymptomatic but may
cause severe and potentially fatal hemolytic anemia, if untreated. In
this epidemiologic investigation, Dobroszycki and coworkers report the
clinical outcomes of 6 patients who received blood products derived
from a single unit of blood contaminated with B microti from
an asymptomatic donor: 1 recipient, an infant with hyopoplastic lung
(index case), became clinically ill, 2 developed parasitemia, and 3 had
no evidence of infection. The 3 infected recipients and 1 additional
recipient were treated successfully with antibiotics.
Henderson discusses advances in the understanding of the early stages
of human immunodeficiency virus (HIV) infection and recent experimental
and clinical experience with antiretroviral agents. Based on these
considerations, he outlines a systematic approach to the clinical
management of health care workers with occupational exposure to HIV.
"All human life is special and full of potential regardless of one's
state of emotional or physical disrepair." From "Sherry and
New procedures advance the treatment of osteoarthritis of the knee.
At the Sixth Conference on Retroviruses and Opportunistic Infections,
researchers reported new findings on the role of key immune cells in
controlling human immunodeficiency virus (HIV) infection, the
recovering immune system, and drug-resistant HIV.
From the AMA Council on Ethical and Judicial Affairs,
recommendations for an institutional policy on medical futility based
on a fair process approach for determining when care at the end of life
In his report on the 50th World Health Assembly, US Surgeon General
David Satcher, MD, PhD, discusses global health and US collaboration
with the World Health Organization.
An interview with Sam Ho, MD, "a practitioner of public
health—private-sector, market-driven, equal-opportunity, for-profit
For your patients: A primer on influenza and the flu vaccine.
This Week in JAMA. JAMA. 1999;281(10):871. doi:10.1001/jama.281.10.871