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This Week in JAMA
July 7, 1999

This Week in JAMA

JAMA. 1999;282(1):5. doi:10.1001/jama.282.1.5
Prophylaxis With Zanamivir Reduces Influenza Illness

Zanamivir, a sialic acid analog, inhibits viral neuraminidase, an enzyme that is necessary for the replication of both type A and type B influenza viruses. Monto and colleagues reportArticle that daily inhalation of zanamivir during influenza outbreaks in the 1997-1998 season was 67% efficacious in preventing laboratory-confirmed clinical influenza among adults aged 18 to 69 years at 2 study sites. In an editorialArticle, Patriarca considers how antiviral prophylaxis complements vaccination in achieving influenza control.

Incidental Findings on Brain MRI Scans

To measure the frequency of abnormalities found incidentally on brain magnetic resonance imaging (MRI) scans in a healthy population, Katzman and coworkers reviewed the results of brain MRI scans from 1000 healthy, asymptomatic volunteers (mean age, 31 years) who had participated in research studies at the National Institutes of Health. One hundred eighty scans had abnormal findings, 11 of which were classified as requiring urgent referral, including 3 with lesions suspicious for primary brain neoplasms.

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∊4 and Other Risk Factors for Cognitive Decline

In a cohort of 5888 elderly individuals followed up for 7 years in the Cardiovascular Health Study, Haan and colleagues found that diabetes mellitus, several indicators of subclinical and existing cardiovascular disease, and the APOE ∊4 genotype were each associated with an increased risk of cognitive decline as measured by the Modified Mini-Mental State Examination (3MSE) and the Digit Symbol Substitution Test. The rate of decline in 3MSE scores associated with peripheral vascular disease, atherosclerosis, and diabetes mellitus was greater in the presence of the APOE ∊4 allele than with each risk factor alone.

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Disease Risk Associated With Vaccine Exemption

Based on US measles surveillance data from 1985 through 1992, Salmon and colleagues estimated that individuals aged 5 to 19 years who received religious and philosophical exemptions from measles immunization were 35 times more likely to contract measles than were vaccinated youth. In a mathematical model, changes in the number of exempt individuals would alter the incidence of measles infection in nonexempt individuals; doubling the number of exempt individuals would increase the incidence of measles in nonexempt individuals from 5% to 31% depending on the contact between the 2 groups.

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Mechanical Ventilation and Inflammatory Mediators

In this randomized controlled trial in patients with adult respiratory distress syndrome (ARDS), Ranieri and colleaguesArticle found that after 36 to 40 hours of mechanical ventilation, mean levels of several cytokines measured in bronchoalveolar lavage fluid and plasma had increased over baseline in patients who received conventional mechanical ventilation, but had decreased and were significantly lower in patients ventilated using a lung-protective strategy. In an editorialArticle, Hudson comments that the pulmonary and systemic release of inflammatory mediators in response to lung injury caused by mechanical ventilation may explain in part the multiple organ failure and high mortality rate associated with ARDS.

Correct Use of Serologic Testing in Lyme Disease

Brown and colleagues review the types and performance characteristics of available serologic assays for Borrelia burgdorferi and discuss their appropriate use for the diagnosis of Lyme disease in the clinical setting. In an editorial, Wormser and coauthors highlight opportunities to improve serologic testing for Lyme disease.

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A Piece of My Mind

"I was the best 11-year-old clarinetist I had ever known." From "Master Class."

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Medical News & Perspectives

Physicians′ personality traits that lead to professional success may also lead to psychological stress. Psychiatrists offer some hints on coping.

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Users' Guides to the Medical Literature

How to use articles on the impact of computer-based clinical decision support systems on clinician behavior and patient outcomes.

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JAMA Patient Page

For your patients: A primer on childhood immunization.

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