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This Week in JAMA
December 6, 2000

This Week in JAMA

JAMA. 2000;284(21):2679. doi:10.1001/jama.284.21.2679
Workplace Back Belt Use and Reduction of Back Pain

Back belts are widely used in the workplace to prevent low back injury. Wassell and colleaguesArticle conducted baseline and follow-up interviews of more than 6000 employees who handled materials in jobs such as receivers/unloaders, stockers, and department managers, at 160 new retail merchandise stores. The 6-month incidence of low back pain and rate of back injury claims were not associated with the frequency of back belt use or store policy requiring belt use. In an editorial, Hadler and CareyArticle point out that psychosocial factors may be more important determinants of whether an episode of regional back pain is recollected or described as incapacitating than severity or magnitude of injury.

Investigation of Rubella Outbreak in Nebraska

Between March and August 1999, an outbreak of 125 cases of rubella occurred in Nebraska. In this investigation of the 83 rubella cases that occurred in Douglas County, Nebraska, Danovaro-Holliday and colleagues found that all 83 cases occurred in individuals who were unvaccinated or whose vaccination status was unknown. Fifty-two cases were meatpacking plant workers, most of whom were young adult men born in Latin American countries where routine rubella vaccination has only recently been implemented, and their household contacts. Fifteen cases were community-related cases, most of whom were non–US-born Hispanic young adults who resided in the same densely populated, predominantly Hispanic census tracts as the meatpacking plant cases. Sixteen cases were day care center–related, and 6 of 24 susceptible pregnant women had serologic evidence of infection during the outbreak despite preoutbreak immunity levels thought to provide herd immunity.

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Familial Differences in Cholesterol Response to Diet

Variation in individual serum cholesterol response to changes in diet is greater than expected based on population mean responses. Some individuals achieve a substantial reduction in low-density lipoprotein cholesterol (LDL-C) in response to diet and others have little or no change despite major dietary modification. To evaluate whether familial differences explain individual variation in response to cholesterol-lowering diets, Denke and colleagues studied 46 families in a crossover trial of 2 isocaloric dietary regimens using either butter or margarine as the major dietary fat. Reduction in total LDL-C was greater on the margarine-based diet compared with the butter-based diet. Family membership accounted for 19% of the variability in response of percent change in LDL-C levels for adults and children combined, and 40% of the variability in children.

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Benefits of Increased β-Blocker Use After MI

Using a Markov model of coronary heart disease in the US population, Phillips and colleagues estimated the epidemiological impact and cost-effectiveness of increased use of β-blockers among survivors of acute myocardial infarction (MI) aged 35 to 84 years. The simulation indicated that initiating use of β-blockers for all patients surviving a first MI annually for the next 20 years, except those with absolute contraindications, would save $18 million and result in 72,000 fewer deaths due to coronary heart disease, 62,000 prevented MIs, and 447,000 life-years gained compared with current use.

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Control of Chemotherapy-

Many patients undergoing high-dose chemotherapy experience emesis that is difficult to control with antiemetic medications. In this randomized trial among patients with breast cancer undergoing intensive myeloablative chemotherapy administered over 4 days, Shen and colleagues assessed the effectiveness of electroacupuncture as an adjunct to antiemetic pharmacotherapy. During the 5-day study period, which began on day 1 of chemotherapy, patients who received low-frequency electroacupuncture at classic antiemetic acupuncture points in addition to antiemetic medications had fewer episodes of emesis compared with those receiving minimal needling and pharmacotherapy or pharmacotherapy alone.

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A Piece of My Mind

"Rather than ‘embracing error' so as to learn from it and reduce it, we operate under a form of self-delusion that errors don't or shouldn't exist." From "The Harm of ‘First, Do No Harm.'"

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Medical News & Perspectives

NIH consensus conference recommendations for postsurgical adjuvant therapy for breast cancer emphasize that physicians must explain all options to patients and individualize treatment.

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Care for the Critically Ill

Projected workforce requirements for the care of critically ill patients.

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Fabry Disease

Clinical characteristics and management of Fabry disease, an X-linked recessive lysosomal storage disorder.

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Health Care Rationing as National Policy

A US Supreme Court decision highlights the conflict between societal demands for cost control and expectations that individuals receive all possibly beneficial care.

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MSJAMA

Better use of available therapies and new uses of emerging therapies.

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JAMA Patient Page

For your patients: Coping with back pain.

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