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This Week in JAMA
November 10, 1999

This Week in JAMA

JAMA. 1999;282(18):1697. doi:10.1001/jama.282.18.1697
HBV Vaccination Rates in a Pediatric Outreach Program

In a cohort of 1143 children enrolled in a community outreach program to improve immunization rates in a Chicago public housing development, Lauderdale and colleagues foundArticle that within 4 years of the 1991 recommendation for universal hepatitis B virus (HBV) vaccination of infants, the percentage of children fully immunized on time against HBV increased to a plateau of about 50%, similar to the percentage of children fully immunized on time with other recommended childhood vaccines. Compared with children who received the first HBV vaccine dose at age 1 or 2 months, children who received the first HBV dose during their first month of life were more likely to receive subsequent doses of HBV and other childhood vaccines on time. In an editorialArticle, Halsey discusses the possible hazard for infants exposed to the mercury-containing preservative thimerosal that is used in vaccines, including HBV vaccine, measures being taken to reduce or eliminate thimerosal from vaccines, and revised vaccine recommendations during this transition.

Risk Factors for Exertion-Related Acute MI

In a cohort of 640 patients with acute myocardial infarction (MI) selected for treatment with primary angioplasty, 64 of whom experienced an exertion-related MI, Giri and colleagues found that exertion-related MI was associated with male sex, hyperlipidemia, obesity, smoking, and a history of very low or low physical activity. Patients with exertion-related MI were more likely to present with ventricular fibrillation and to have single-vessel coronary artery disease and a large thrombus in the infarct-related artery. For all patients, the relative risk of exertion-related MI was 10.1 times higher during vigorous physical activity than at other times, but among patients classified as moderately active or highly active, risk during exertion was not significantly increased.

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Short Survey Accurately Detects Mental Disorders

The Primary Care Evaluation of Mental Disorders (PRIME-MD), a screening instrument for mental disorders designed specifically for the primary care setting, has been shown to have diagnostic validity, but its administration time may limit its clinical use. In this study of a self-administered version of the PRIME-MD, the Patient Health Questionnaire (PHQ), based on data from 3000 patients in 8 primary care clinics, Spitzer and colleagues found that the diagnostic accuracy and validity of the PHQ were comparable to those of the PRIME-MD. Physician time required to review the PHQ was less than 3 minutes for 85% of patients.

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Costs and Benefits of an MRSA Control Strategy

Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in many regions and a major nosocomial pathogen. In this analysis based on 27 patients with MRSA infection acquired in a medical intensive care unit (ICU) and 27 matched controls without MRSA infection, Chaix and colleagues estimated that the mean total costs attributable to MRSA infection were $9275. Costs of an MRSA control program consisting of selective screening for MRSA at ICU admission and weekly thereafter and contact isolation precautions for all patients colonized or infected with MRSA ranged from $340 to $1480 per patient. Compared with a strategy of no screening and standard precautions, the MRSA control program was cost-beneficial if the ICU-acquired MRSA infection rate was reduced by 14%.

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Meta-analysts Find Study Flaws, Duplicate Publication

In this first-hand accountArticle, Johansen and Gøtzsche describe problems they encountered when trying to perform a meta-analysis of trials comparing fluconazole and amphotericin B in patients with cancer complicated by neutropenia. They report discovering biased study designs and analyses that favored fluconazole, covert duplicate publication, and having difficulty obtaining additional information. In an editorialArticle, Rennie advocates advanced registration of trials and publication of all results to ensure fair conduct and fair reporting of trials and to help prevent publication bias.

Contempo 1999

Data from 9 recent randomized trials of high-dose chemotherapy for breast cancer are informative but inconclusive.

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Medical News & Perspectives

The military medical professionals serving with peacekeeping forces in the Balkans face a variety of threats in addition to violence.

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Medicare Reform

An analysis of whether the Medicare "premium support" proposal, which may be introduced as legislation in Congress, could compromise the universal guaranteed coverage for basic medical care at a predictable and affordable price currently provided by the Medicare program.

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Managed Medicaid

Medicaid health plans are more likely to implement programs that target specific needs of the Medicaid population than commercial health plans participating in the Medicaid program.

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JAMA Patient Page

For your patients: Prevention of hepatitis B infection.

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MSJAMA ONLINE

Web-only articles expand the debate on competing ethical principles involved in physician miscoding of diagnoses on insurance claims.

http://www.msjama.org

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