Investigation of patient contacts is recommended for all patients with
suspected or confirmed active pulmonary tuberculosis (TB) reported in the
United States. In this review of US health department records, Reichler and
colleaguesArticle found, however, that contact investigations were often deficient.
Thirteen percent of patients with active pulmonary TB reported during 1996
had no contacts identified, and only 55% of identified contacts completed
screening. To improve methods of TB contact investigation, Bailey and colleaguesArticle
developed and validated a model of TB transmission identifying those variables
that best predict a positive tuberculin skin test result among contacts of
active TB cases. In an editorial, Mohle-Boetani and FloodArticle discuss the importance
of conducting timely TB contact investigations and of developing more effective
approaches for tracking TB transmission.
Using data from participants aged 55 and 65 years in the Framingham
Heart Study, a community-based prospective cohort study, Vasan and colleagues
estimated that the probability that an individual will develop hypertension
during his or her remaining lifetime (residual lifetime risk) was 90% for
the period 1976 through 1998. Compared with the period 1952 through 1975,
the lifetime risk of hypertension was approximately 60% higher for men but
was unchanged for women.
Environmental design measures and administrative interventions have
been recommended to prevent homicide in the workplace, the second leading
cause of death on the job for US workers. In this case-control study of homicides
in North Carolina workplaces, Loomis and colleagues found that several administrative
and environmental interventions appeared to be beneficial for preventing workplace
homicides, especially bright exterior lighting and eliminating solo work at
Preimplantation genetic diagnosis after in vitro fertilization identifies
embryos carrying genes that predispose to genetic disorders so that only embryos
free of predisposing genes are transferred to achieve a pregnancy. Verlinsky
and colleagues report the use of preimplantation genetic diagnosis for a 30-year-old
woman who carried the autosomal dominant V717L mutation in the amyloid precursor
protein (APP) gene associated with early-onset Alzheimer
disease. In a commentary, Towner and Loewy consider the ethics of assisted
reproduction when the parent, in this case because of early-onset Alzheimer
disease, is likely to become unable to care for the child while the child
is still very young.
Ms J is a 44-year-old woman with borderline personality disorder that
began in her 20s and multiple comorbid medical conditions. She has received
extensive treatment for her psychiatric and medical problems, and recently
her condition has improved. Oldham discusses the epidemiology, natural history,
diagnosis, and treatment of borderline personality disorder.
Effects of sleep deprivation on clinical performance.
A new study showing that prostate-specific antigen levels between 2
and 9 ng/mL are not useful for predicting the size and aggressiveness of prostate
tumors is reigniting the screening debate.
Meta-analysis of randomized trials of the effects of preventive home
visitation programs for elderly people suggests that these programs decrease
nursing home admissions and reduce functional decline if the interventions
are based on multidimensional geriatric assessment with extended follow-up,
include multiple follow-up home visits, and target persons at lower risk for
A survey of ill residents of Tbilisi, the capital of the Republic of
Georgia, indicates that under the recently reformed health care system, which
is largely financed through out-of-pocket payments, most respondents had serious
problems paying for health care.
For your patients: Information about hypertension.
This Week in JAMA . JAMA. 2002;287(8):947. doi:10.1001/jama.2012.187