Efalizumab is a humanized monoclonal IgG1 antibody that targets T-cell
interactions involved in the pathophysiology of psoriasis. Gordon and colleaguesArticleconducted a randomized trial to assess the efficacy and safety
of efalizumab among adults with stable, moderate to severe plaque psoriasis.
The proportion of patients who achieved at least 75% improvement on the Psoriasis
Area and Severity Index after 12 weeks of treatment was significantly greater
in the group that received efalizumab than in the placebo group. Improvements
in other clinical end points were also greater in the efalizumab group, and
serious adverse effects were infrequent. In an editorial,ArticleStern advises reserving use of efalizumab and other new biologic therapies
for patients with severe psoriasis who are unresponsive to or unable to tolerate
established systemic therapies until long-term data comparing the efficacy
and safety of efalizumab with other currently available therapies are available.
Deficiencies have been documented in the quality of care related to
developmental and behavioral services for US children in the first 3 years
of life. Minkovitz and colleaguesArticleconducted a controlled
trial to evaluate the Healthy Steps for Young Children Program, a clinical
intervention that incorporated developmental specialists and enhanced developmental
services into pediatric practice. Children were enrolled in the trial at birth
or at the first office visit at up to 4 weeks of age and followed up through
age 3 years. Quality of care in the Healthy Steps group, including effectiveness,
patient-centeredness, timeliness, and efficiency of care, was significantly
greater than in the control group. Some parenting outcomes, including use
of favorable discipline techniques, were also better in the Healthy Steps
group. In an editorial,ArticleHalfon and Inkelas urge funding
of higher-quality early childhood developmental health services.
Carnethon and colleagues analyzed data from participants enrolled in
the Coronary Artery Risk Development in Young Adults Study, a population-based
longitudinal cohort study of adults aged 18 to 30 years, to assess whether
low cardiorespiratory fitness is associated with development of cardiovascular
disease (CVD) risk factors. Participants with low cardiorespiratory fitness
at baseline, estimated by shorter duration on an exercise treadmill test,
were significantly more likely to develop diabetes, hypertension, the metabolic
syndrome, and hypercholesterolemia than participants with high fitness during
up to 15 years of follow-up. The strength of these associations was diminished
after adjusting for baseline body mass index. Improved fitness over 7 years
was associated with reduced risk for developing diabetes and the metabolic
syndrome, but these associations were no longer significant after adjusting
for baseline body mass index and change in weight.
Using a Markov decision analytic model, Boulware and colleagues assessed
the cost-effectiveness of periodic, population-based urine dipstick screening
for early detection of urine protein followed by angiotensin-converting enzyme
inhibitor or angiotensin II-receptor blocker therapy, which have been shown
to decrease mortality and disease progression in adults with proteinuria and
chronic renal disease. For US adults with neither hypertension nor diabetes,
annual urine dipstick screening beginning at age 50 years to detect proteinuria
was not cost-effective compared with no screening (usual care). Annual screening
was cost-effective when initiated at age 60 years and for those with hypertension
beginning at age 30 years. Screening at 10-year intervals was also cost-effective.
"As fast as cream lightens coffee her eyes went from lucent to cloudy
and she was gone." From "Passing Through."
Many people with risk factors for kidney disease are unaware that they
are already in the early stages of the disease, according to a new study of
more than 11 000 individuals.
Meta-analysis of data from randomized trials indicates that intra-articular
hyaluronic acid has only modest efficacy in the treatment of knee osteoarthritis
(OA) when compared with intra-articular placebo injection.
Summary of strategies recommended by the National Vaccine
Advisory Committee to stabilize and strengthen the supply of routinely recommended
vaccines in the United States.
Risk stratification for sexual activity in patients with cardiovascular
disease and management of coital angina.
For your patients: Information about psoriasis.
This Week in JAMA. JAMA. 2003;290(23):3033. doi:10.1001/jama.290.23.3033