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
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.
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.
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.
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
"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.'"
NIH consensus conference recommendations for postsurgical adjuvant therapy
for breast cancer emphasize that physicians must explain all options to patients
and individualize treatment.
Projected workforce requirements for the care of critically ill patients.
Clinical characteristics and management of Fabry disease, an X-linked
recessive lysosomal storage disorder.
A US Supreme Court decision highlights the conflict between societal
demands for cost control and expectations that individuals receive all possibly
Better use of available therapies and new uses of emerging therapies.
For your patients: Coping with back pain.
This Week in JAMA. JAMA. 2000;284(21):2679. doi:10.1001/jama.284.21.2679