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This Week in JAMA
October 11, 2006

This Week in JAMA

JAMA. 2006;296(14):1693. doi:10.1001/jama.296.14.1693
Myocardial Infarction Risk in Patients With Psoriasis

Some data suggest that patients with psoriasis have a higher prevalence of cardiovascular disease, including myocardial infarction (MI). In a population-based cohort study, Gelfand and colleagues investigated whether psoriasis is an independent risk factor for incident MI. The authors found that compared with patients without psoriasis, patients with psoriasis had an increased risk of MI. This risk was attenuated with advancing age and remained high after controlling for traditional cardiovascular risk factors.

Respiratory Effects of a Smoking Ban in Public Places

Despite accumulating evidence of an association of secondhand smoke exposure with adverse health consequences, many public spaces are not smoke-free. Menzies and colleaguesArticle report results of a prospective study of nonasthmatic and asthmatic nonsmoking bar workers, in which the investigators measured respiratory and sensory symptoms, pulmonary function, and markers of inflammation 1 month before and 1 and 2 months after Scotland had implemented a smoking ban in confined public places. Compared with preban measures, the authors found that both nonasthmatic and asthmatic bar workers experienced significant improvements in respiratory and sensory symptoms and in pulmonary function, and reductions in systemic inflammation in the first 2 months following implementation of the smoking ban. In an editorial, EisnerArticle discusses the benefits of smoking bans in public places.

Outcomes After Reperfusion for ST-Elevation MI

Acute reperfusion with fibrinolytic drugs has been the primary treatment of ST-segment elevation myocardial infarction (STEMI) since the late 1980s. However, some clinical trial data suggest that primary percutaneous coronary intervention (PCI) is associated with better outcomes than fibrinolytic therapy. To assess whether superior outcomes with PCI can be achieved in unselected patients and outside the clinical trial setting, Stenestrand and colleagues analyzed 1999-2004 data from 26 205 consecutive STEMI patients in Sweden who were treated with primary PCI, prehospital thrombolysis, or in-hospital thrombolysis. In analyses that adjusted for age and comorbidities, the authors found that patients who received PCI had lower 30-day and 1-year mortality, less reinfarction, shorter hospital stays, and fewer readmissions than patients receiving prehospital or in-hospital thrombolysis.

Nonmedical Exemptions to Required Immunizations

State policies allowing nonmedical exemptions for school immunizations may influence the incidence of some vaccine-preventable diseases, such as pertussis. Omer and colleagues analyzed 1991 through 2004 state-level data on rates of nonmedical exemptions at school entry and 1986 through 2004 data on pertussis incidence to assess the relationship of exemption policy characteristics to pertussis incidence. The authors found that states permitting personal belief exemptions compared with religious exemptions and states with easily obtained vs medium or difficult to obtain exemptions had higher and increasing nonmedical exemption rates during the period of study. In addition, the authors report that states with personal belief and easily obtained exemptions had increased pertussis incidence compared with states with religious or harder to obtain exemptions.

A Piece of My Mind

“[Randy] had the classic dilemma of the working poor—an injury or condition that wasn't a life-threatening emergency but still clearly needed treatment.” From “The Imaginary Safety Net.”

Medical News & Perspectives

Researchers have identified a genetic variant that weakens amniotic membranes and increases the risk of premature delivery.

Clinician's corner

Opiate analgesia in patients with acute abdominal pain may alter physical examination findings but does not increase the likelihood of errors in management.

Plan B Contraceptive

Pregnancy prevention from the Plan B contraceptive occurs prior to fertilization.

Chronic Diseases in Childhood

Authors may submit manuscripts for an upcoming JAMA theme issue.

Audio Commentary

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

JAMA Patient Page

For your patients: Information about acute abdominal pain.