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This Week in JAMA
May 12, 2004

This Week in JAMA

JAMA. 2004;291(18):2169. doi:10.1001/jama.291.18.2169
Reducing Racial Disparities in Pneumococcal Disease

The incidence of invasive pneumococcal disease has declined since 2000, when a new conjugate pneumococcal vaccine was recommended for infants and children, but whether long-standing racial disparities in disease incidence have narrowed is not known. Flannery and colleaguesArticle analyzed data from a continuous, population-based surveillance system in 7 states to assess the effect of the vaccine on disease rates in whites and blacks. Their analyses documented significant declines in pneumococcal disease in both whites and blacks and noted a significant narrowing of racial disparities in disease incidence in the postvaccine period. In an editorial, Davis Article discusses race-based vaccination strategies and the positive "spillover" effects of childhood pneumococcal vaccination on disease incidence in adults.

Parental Contribution to Cardiovascular Disease Risk

Prior studies have failed to conclusively determine whether having a parent with cardiovascular disease (CVD) influences an individual's risk of CVD. Lloyd-Jones and colleagues examined this question using prospective data from the Framingham Heart and Framingham Offspring studies. In analyses adjusted for the offspring's age, they found that having a parent with premature CVD (onset age <55 years in father and <65 years in mother) significantly increased a person's risk of CVD events compared with persons whose parents were free of CVD. Parental history of CVD was particularly useful in predicting risk in offspring with intermediate-range CVD risk factors.

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Fracture Risk and Hormone Therapy

Women who receive postmenopausal hormone therapy have a reduced risk of fractures, but whether this protection is influenced by the estrogen dose or type of hormones used or the duration of protection after cessation of therapy is not known. Banks and colleagues analyzed data from a prospective study of postmenopausal women and found that current users of hormone therapy had a reduced risk of fracture compared with nonusers. In analyses examining risk over time and comparing hormone users with nonusers, the investigators found that the reduction in fracture risk was evident within the year hormone use commenced and that prior use conferred no protection. Neither estrogen dose nor specific estrogen and progestin components modified the hormone therapy and fracture risk relationships.

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Prevalence of Chlamydial and Gonococcal Infections

Most current estimates of Chlamydia trachomatis and Neisseria gonorrhoeae infection prevalence in the United States are derived from clinic-based studies and may not reflect the true prevalence in young adults. Miller and colleagues report results from a nationally representative, prospective cohort study of young adults who provided a urine specimen to test for C trachomatis and N gonorrhoeae. The prevalence of chlamydial infection was 4.19% and the prevalence of gonococcal infection was 0.43%. Substantial variation was found in analyses by race/ethnicity. Of note, among young adult men and women, chlamydial infections were 6 times higher in blacks than in whites, and the prevalence of gonorrhea was 36 times greater in black men and 14 times greater in black women than in white men and women, respectively.

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Medical News & Perspectives

Brain imaging studies and other findings are revealing the close connections that stress, substance abuse, and lack of sleep have with increasing depression among college students.

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Genetic Marker of MI and Stroke Risk

A guanine to cytosine substitution at position −765 of the cyclooxygenase 2 gene is associated with a lower risk of myocardial infarction (MI) and ischemic stroke.

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AMA Proposes Health Insurance Reforms

Individually owned insurance, tax credits, and greater consumer choice are featured. The proposal's feasibility is discussed in an editorial by Pauly.

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CLINICIAN'S CORNER

Benefits of lipid-lowering therapy on coronary heart disease events and mortality in women.

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JAMA Patient Page

For your patients: Information about treatment of high cholesterol.

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