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This Week in JAMA
December 17, 2003

This Week in JAMA

JAMA. 2003;290(23):3033. doi:10.1001/jama.290.23.3033
Efalizumab for Moderate to Severe Plaque Psoriasis

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.

Intervention to Enhance Quality of Early Childhood Care

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.

Fitness and Development of CVD Risk Factors

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.

Cost-effectiveness of Screening for Proteinuria

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.

A Piece of My Mind

"As fast as cream lightens coffee her eyes went from lucent to cloudy and she was gone." From "Passing Through."

See Article

Medical News & Perspectives

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.

See Article

Intra-articular Hyaluronic Acid for OA

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.

Strengthening the US Vaccine Supply

Summary of strategies recommended by the National Vaccine Advisory Committee to stabilize and strengthen the supply of routinely recommended vaccines in the United States.

CLINICIAN'S CORNER

Risk stratification for sexual activity in patients with cardiovascular disease and management of coital angina.

JAMA Patient Page

For your patients: Information about psoriasis.

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