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
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.
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
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.
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.
"There is a brotherhood that transcends race, creed, sex, age, and economic
status." From "Who Cares About Tarawa?"
Advances in emergency contraception, new methods of cervical cytologic
screening, and an update on bacterial vaginosis.
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.
A meta-analysis comparing prehospital with in-hospital thrombolytic
therapy for acute myocardial infarction (AMI).
Seven requirements for systematic ethical evaluation of clinical research
involving human subjects.
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.
An analysis of the violence content in 74 G-rated animated feature films
released between 1937 and 1999.
For your patients: Guidance about violence in the media.
This Week in JAMA. JAMA. 2000;283(20):2621. doi:10.1001/jama.283.20.2621