Prevention of meningococcal disease is essential to advance control
of bacterial meningitis, but the effectiveness of available meningococcal
polysaccharide vaccines is limited, especially in young children. In this
randomized trial of primary immunization with serogroup C meningococcal
conjugate vaccine in infants beginning at age 2 months, MacLennan and colleaguesArticle
found that meningococcal C conjugate vaccine was well-tolerated, immunogenic,
and resulted in immunologic memory. In an editorial, PerkinsArticle discusses factors
that must be considered to achieve successful control of meningococcal disease.
Elderly residents of public housing have higher rates of psychiatric
disorders than those living in the community, and more than half of those
needing mental health care may not receive it. The Psychogeriatric Assessment
and Treatment in City Housing (PATCH) program is a nurse-based mobile outreach
program to identify elderly residents with psychiatric illness in urban public
housing sites and provide on-site case management. Rabins and colleaguesArticle report
that after 26 months of follow-up, psychiatric symptoms among residents with
psychiatric illnesses in sites implementing the PATCH program decreased more
than among residents with psychiatric illnesses in control homes, but rates
of moves from public housing to a nursing home or board-and-care home were
similar at all sites. In an editorial, Katz and CoyneArticle discuss the public health
model of mental health care, the effectiveness of interventions derived from
this model, and policy implications.
Arterial calcium deposits may be indicative of the extent of atherosclerosis
and a marker of subclinical cardiovascular disease (CVD). To determine whether
arterial calcification is associated with increased risk of hospitalization
or mortality due to CVD, Iribarren and colleagues followed up 116,309 adults,
aged 30 to 89 years at baseline, for a median of 28 years. Calcification of
the aortic arch detected on chest x-ray at baseline was associated with increased
risk of coronary heart disease events in both men and women and with ischemic
stroke events in women independent of other cardiovascular risk factors.
Computer-based clinical decision support systems (CDSSs) provide management
recommendations derived from linking specific patient characteristics to a
computerized knowledge base. By alternating control periods with intervention
periods during which a CDSS notified physicians about the appropriateness
of anticoagulation prescriptions for prevention of venous thromboembolism
after orthopedic surgery, Durieux and colleagues evaluated whether the CDSS
changed physician behavior and improved compliance with preestablished guidelines.
Physician compliance with prescription guidelines increased significantly
during intervention periods compared with control periods, but each time the
CDSS was removed, compliance reverted to control levels.
Evidence on the effectiveness of motor vehicle automatic shoulder belt
systems in reducing injury and mortality among front-seat passengers has been
contradictory. In this analysis of data from 25,811 tow-away motor vehicle
crashes, Rivara and colleagues found that use of automatic shoulder belt systems
without lap belts was associated with a decreased risk of death compared with
no restraint use. But the risk of death and serious injury with use of automatic
shoulder belt systems without lap belts was greater than that associated with
use of manual lap and shoulder belts or automatic shoulder belts with manual
"It is no surprise that patients notice the difference between a doctor
who rushes through his or her own agenda, and one who endeavors to give every
bit of his or her attention to the patient." From "Paying Attention"
Experts in medicine and in law are "divided by a common language," says
one of the experts, and to improve understanding between the professions,
the gap must be bridged.
Serum thyroxine levels decreased and thyrotropin levels increased in
patients with hypothyroidism when calcium carbonate and levothyroxine were
administered at the same time.
How to determine the benefit-risk ratio of a specific treatment for
an individual patient and incorporate the patient's values about therapy and
potential outcomes into clinical decision making.
Essential features of public health law: the first article in a 3-part
series examining public health law as a tool to protect and promote the health
and safety of a community.
For your patients: Information about psychiatric disorders in older
This Week in JAMA. JAMA. 2000;283(21):2757. doi:10.1001/jama.283.21.2757