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This Week in JAMA
August 8, 2001

This Week in JAMA

JAMA. 2001;286(6):639. doi:10.1001/jama.286.6.639
Physical Activity Counseling in Primary Care

Despite the known health benefits of physical activity, how to best counsel patients to increase physical activity is uncertain. In this randomized trial that enrolled sedentary patients from 11 primary care facilities, the Activity Counseling Trial Research GroupArticle compared the effectiveness of 3 physical activity counseling interventions of varying intensity—a high-intensity counseling intervention, an intermediate-intensity assistance intervention, and an advice comparison intervention. After 24 months, there were no significant overall differences in self-reported physical activity among the 3 groups. Improvements in cardiorespiratory fitness among women in the counseling and assistance groups were significantly greater than in the advice comparison group, but there were no significant differences in cardiorespiratory fitness among men. In an editorial, WeeArticle stresses the magnitude of the health risk associated with sedentary lifestyle and low physical fitness and discusses strategies that may improve adherence to physical activity recommendations.

Meningococcal Disease Among College Students

Invasive meningococcal disease has increased among young adults during the past decade. Bruce and colleaguesArticle conducted a prospective surveillance study among US college students from September 1, 1998, to August 31, 1999, to determine rates of and risk factors for meningococcal disease in this population. The overall incidence rate for undergraduates was 0.7 per 100 000 persons, lower than the rate of 1.4 per 100 000 in the general population of 18- to 23-year-old nonstudents. However, the incidence rate was highest among freshmen living in dormitories (5.1 per 100 000), and the risk of meningococcal disease was significantly higher among freshmen living in dormitories compared with other college students. In a population-based surveillance study from January 1, 1990, through December 31, 1999, in Maryland, Harrison and colleaguesArticle found that the incidence and proportion of cases of meningococcal infection among persons aged 15 through 24 years initially increased and then markedly decreased in 1998-1999. In an editorial, WengerArticle discusses immunization strategies as a way to control meningococcal disease.

Femoral vs Subclavian Central Venous Catheterization

The choice of insertion site for central venous catheterization can influence the frequency and type of associated complications. In this randomized controlled trial among intensive care unit patients, Merrer and colleagues found that catheterization of the femoral vein was associated with a significantly higher risk of overall complications compared with catheterization of the subclavian vein. The rates of mechanical complications did not differ between the 2 sites, but the rates of infectious and thrombotic complications were significantly higher for femoral venous catheterization.

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Women and Elderly Persons in Cardiovascular Trials

More than one third of patients with myocardial infarction in the United States are elderly persons, and more than 40% are women, but historically these patient groups have been underenrolled in published cardiovascular clinical trials relative to younger persons and men. In this review of randomized controlled trials among patients with acute coronary syndromes published from January 1996 to March 2000, Lee and colleagues found that although enrollment of persons aged 75 years or older and of women has increased, the proportion of elderly persons and women enrolled in these trials remains well below their proportion in the affected population.

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A Piece of My Mind

"How can we be gentle on our patients if we are not gentle on ourselves? How can we care for our patients if we do not care for ourselves, if we do not care for one another?" From "A Golden Rule: Remember the Gift."

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Contempo Updates

A review of the epidemiology and clinical features of infections caused by West Nile virus and strategies for prevention.

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Medical News & Perspectives

At the first conference to which both Chinese and US health care leaders brought their unique perspectives on national health care, they shared experiences to learn from each other and help find solutions to surprisingly similar problems.

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Runner's Anemia

Case presentation and discussion of a woman with mild macrocytic anemia, leukopenia, and chronic fatigue.

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JAMA Patient Page

For your patients: Information about beginning a physical activity program.

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