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Screen Twice a Year for Chlamydia
Most guidelines recommend annual screening of sexually active adolescent
females for Chlamydia trachomatis genital infections.
Dr Burstein and colleaguesArticle used chlamydial polymerase chain reaction testing
at 5360 clinic visits made by 3202 sexually active adolescent females during
33 months. Twenty percent of test results were positive for C trachomatis. The median time from a negative to a positive test result
was 7.2 months and the median time from a positive test result to a repeat
positive test result was 6.3 months. In an accompanying editorial, Dr OrrArticle
suggests that sexually active adolescent females be screened for C trachomatis every 6 months.
Measles Vaccine in Younger Infants
Measles vaccine has not been recommended until 12 to 15 months of age
because younger infants may be unable to respond if they retain passive immunity
or if immunocompetence has not yet developed. However, measles can infect
younger children. Dr Ganz and colleagues administered measles vaccine to 6-,
9-, and 12-month-olds and measured measles neutralizing antibody titers, T-cell
proliferation, and cytokine profiles and found that even among infants without
passive antibodies, neutralizing antibody titers, seroconversion rates, and
seroprotective titers were all lower in 6-month-olds than in 9- or 12-month-olds.
Birth Control Pills and Gestational Diabetes
Gestational diabetes mellitus (GDM) is an important predictor of the
subsequent development of overt diabetes. Since additional pregnancies increase
the risk further, effective contraception is important, especially in high-risk
populations. Dr Kjos and colleagues examined the association between oral
contraceptive use and the risk of diabetes in a cohort of Latin women with
a prior history of GDM. Progesterone-only oral contraceptive use increased
the risk of subsequent diabetes almost 3-fold in breast-feeding women compared
with those who were breast-feeding but using nonpharmacologic contraception,
while combination estrogen-progesterone contraception did not increase diabetes
Antiretroviral Therapy Among Injection Drug Users
Antiretroviral regimens substantially affect the course of HIV disease,
yet certain HIV-infected individuals may not be receiving such treatment.
Dr Celentano and colleaguesArticle studied injection drug users during a 1-year period
and found that only 14% reported receiving a combination therapy regimen that
included a protease inhibitor. In a related report, Dr Strathdee and colleaguesArticle
found that even when treatment is free, as in British Columbia, where they
conducted their study, only 17% of injection drug users reported receiving
any antiretroviral therapy. Dr ShererArticle places these findings in context in
Laboratory Utilization Criteria Insufficient
Appropriate and cost-effective use of laboratory testing is an important
indicator of quality clinical practice. In this review of 44 studies of clinical
laboratory audits, Drs van Walraven and NaylorArticle found that many studies evaluating
inappropriate laboratory utilization are based on implicit or explicit criteria
that do not meet methodological standards suggested for audits of therapeutic
maneuvers. In an accompanying editorial, Dr LundbergArticle calls for development
of an outcomes research agenda for clinical laboratory testing.
"What name to give this new and highly distinctive style?" Paul Sérusier, Landscape at Le Pouldu, 1890, French.
A Piece of My Mind
"The interface between those in pinstripes and those in white laboratory
coats has . . . been less than perfect, as is evidenced not only by our different
ideals and conceptual constructs, but also in the very language used to communicate
them." From "In a Word."
New insights are modifying the surgical approach to the treatment of
severe, complex abdominal trauma. Data from outcomes research are becoming
available to inform the use of laparoscopic surgery.
Medical News & Perspectives
Celebrating its historic decision 25 years ago to declare homosexuality
not a disorder, the American Psychiatric Association examines the way gay
and lesbian patients—and physicians—are treated in the United
Based on in-depth interviews with 355 oncologists, Dr Emanuel and colleagues
present new empirical data on euthanasia and physician-assisted suicide.
JAMA Patient Page
For your patients: the facts on chlamydia.
This Week in JAMA. JAMA. 1998;280(6):491. doi:10.1001/jama.280.6.491
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