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.
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.
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.
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%.
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.
Data from 9 recent randomized trials of high-dose chemotherapy for breast
cancer are informative but inconclusive.
The military medical professionals serving with peacekeeping forces
in the Balkans face a variety of threats in addition to violence.
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.
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.
For your patients: Prevention of hepatitis B infection.
Web-only articles expand the debate on competing ethical principles
involved in physician miscoding of diagnoses on insurance claims.
Global Theme Issue on New Technologies in Medicine
This Week in JAMA. JAMA. 1999;282(18):1697. doi:10.1001/jama.282.18.1697