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
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.
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.
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.
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.
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
Individually owned insurance, tax credits, and greater consumer choice
are featured. The proposal's feasibility is discussed in an editorial by Pauly.
Benefits of lipid-lowering therapy on coronary heart disease events and mortality in women.
For your patients: Information about treatment of high cholesterol.
This Week in JAMA. JAMA. 2004;291(18):2169. doi:10.1001/jama.291.18.2169