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This Week in JAMA
May 24/31, 2000

This Week in JAMA

JAMA. 2000;283(20):2621. doi:10.1001/jama.283.20.2621
Maternal Mortality in Japan

Compared with other developed countries, the maternal mortality rate in Japan is relatively high, in contrast to its perinatal and infant mortality rates, which are among the lowest in the world. In this cross-sectional study of maternal deaths in Japan, Nagaya and colleaguesArticle report that 230 maternal deaths occurred between January 1, 1991, and December 31, 1992 (overall maternal mortality rate, 9.5 per 100,000 live births). The most common causes of death were antepartum and postpartum hemorrhage, occurring in 86 of 219 women. Based on an expert medical panel's evaluation of 197 maternal deaths that occurred in medical facilities participating in the study, 72 (37%) were judged preventable by an expert medical panel and 32 (16%), possibly preventable. Forty-nine (68%) of the preventable deaths were attributed to a single physician acting as both obstetrician and anesthetist. In an editorial, Ikegami and YoshimuraArticle consider whether the decrease in maternal mortality likely to be achieved by regionalization of obstetric care in Japan warrants restructuring of the current system.


To determine the incidence of antimicrobial resistance among Salmonella serotype Typhi isolates in the United States and risk factors for infection with multidrug-resistant (MDRST) and nalidixic acid–resistant (NARST) Salmonella Typhi, Ackers and colleagues analyzed data from national laboratory-based surveillance for 1 year beginning June 1, 1996. Eighty-five of 350 Salmonella Typhi isolates from patients with acute typhoid fever were resistant to at least 1 antimicrobial agent; 56 were resistant to 5 or more agents; 23 were NARST isolates; and no resistance to ciprofloxacin or ceftriaxone was observed. Most patients had traveled abroad during the 6 weeks prior to illness onset, and patients with MDRST and NARST infections were significantly more likely to report travel outside the United States, particularly to the Indian subcontinent. Only 1 isolate among 53 domestically acquired cases was MDRST.

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Caffeine Intake and Risk of Parkinson Disease

Risk factors for typical late-onset Parkinson disease (PD) appear more likely to be environmental than genetic. Among 8004 Japanese-American men aged 45 to 68 years at enrollment and followed up for 30 years in the Honolulu Heart Program, Ross and colleagues report that 102 men were identified with PD. Age-adjusted incidence of PD decreased with increasing amounts of coffee intake measured at enrollment and 6 years later and with total dietary caffeine measured at enrollment, but not with intake of noncaffeine nutrients in coffee. The association between incident PD and coffee intake was independent of cigarette smoking.

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Enterovirus PCR Testing in Suspected Aseptic Meningitis

Enterovirus-specific reverse transcriptase polymerase chain reaction (EV-PCR) is a highly accurate diagnostic test for enterovirus infection, the cause of most cases of aseptic meningitis with an identifiable etiology. In this medical record review of 276 pediatric patients for whom a diagnostic EV-PCR test was performed in 1998, Ramers and colleagues report that 137 (49.6%) had a positive cerebrospinal fluid EV-PCR result. Compared with patients who had negative EV-PCR test results, patients with EV-PCR positive results available before hospital discharge had significantly fewer ancillary tests performed, shorter duration of intravenous antibiotic therapy, and shorter hospital stays.

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A 52-Year-Old Man With Suicidal Thoughts

Mr D, a 52-year-old man with a history of depression and gambling addiction, almost jumped in front of a moving train and reports having had suicidal thoughts on many occasions in the past. Jacobs discusses clinical assessment of suicide risk and medical intervention.

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A Piece of My Mind

"There is a brotherhood that transcends race, creed, sex, age, and economic status." From "Who Cares About Tarawa?"

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Contempo Updates

Advances in emergency contraception, new methods of cervical cytologic screening, and an update on bacterial vaginosis.

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Medical News & Perspectives

After 30 years of delivering medical care in inadequately served areas of the United States, the National Health Service Corps looks at some recommendations and hopes for congressional reauthorization.

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Thrombolysis and AMI

A meta-analysis comparing prehospital with in-hospital thrombolytic therapy for acute myocardial infarction (AMI).

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Ethical Research

Seven requirements for systematic ethical evaluation of clinical research involving human subjects.

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Women's Health

Original research, commentaries, systematic reviews, and policy perspectives pertaining to the health of women are invited for a JAMA theme issue scheduled for March 2001.

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Animated Film Violence

An analysis of the violence content in 74 G-rated animated feature films released between 1937 and 1999.

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JAMA Patient Page

For your patients: Guidance about violence in the media.

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