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Group B Meningococcal Disease: Trends and Control
In an investigation of the rising incidence of serogroup B
meningococcal disease in Oregon, Diermayer and coworkersArticle conclude that
the epidemiologic features of cases in Oregon since 1993 are
characteristic of the transition from endemic to epidemic disease, the
first large serogroup B meningococcal epidemic in the United States.
Morbidity and mortality patterns, however, remain consistent with
endemic disease. Results of a trial by Tappero and colleaguesArticle of 2
serogroup B meningococcal vaccines using outer-membrane protein
antigens indicate that these vaccines were sufficiently immunogenic to
provide protection against vaccine-type meningococcal strains
homologous for the class 1 outer-membrane protein, but not against
heterologous strains. In an editorial, WengerArticle points out the
complexities of epidemic serogroup B meningococcal control strategies
based on the development of strain-specific vaccines.
Obesity, Age, and Excess Mortality
To investigate whether the excess mortality associated with obesity
varies with age, Bender and colleagues followed up more than 6000 obese
individuals aged 18 to 74 years for a median time of almost 15 years.
They found that mortality risk increased with increased body mass
index, but obesity-related excess mortality declined with age for all
degrees of obesity in both men and women.
Occult Vitamin D Deficiency and Fracture Risk
LeBoff and colleagues report that postmenopausal women with acute hip
fractures hospitalized for joint replacement, all of whom had
osteoporosis, had lower levels of vitamin D and higher levels of
parathyroid hormone than women admitted for elective hip replacement,
both with and without osteoporosis. The investigators note that
prevention of vitamin D deficiency may reduce fracture risk among
postmenopausal women and correction of vitamin D deficiency at the time
of fracture may promote fracture repair.
Reducing Antibiotic Prescriptions for Outpatients
Antibiotics are often prescribed in ambulatory settings for the
treatment of respiratory illnesses, most of which are viral in origin.
Gonzales and colleagues found that a multidimensional intervention that
included office-based and household patient education and clinician
education and practice profiling was associated with a significant
decline in antibiotic prescription rates for the treatment of acute
bronchitis. Antibiotic prescription rates at a limited intervention
study site and 2 control sites did not change significantly during the
study and changes in prescription rates for other medications and in
the rate of return office visits for acute bronchitis or pneumonia were
similar at all study sites.
A 73-Year-Old Woman With Osteoporosis
Mrs Z has a history of multiple clinical fractures and a
family history of osteoporosis. Bone mineral density measurements of
her hip (Figure 1 black circle indicates the patient's bone mineral
density level) and spine were more than 2.5 SDs below young adult peak
bone mass, which, with the history of atraumatic fractures, meet World
Health Organization criteria for severe osteoporosis. Greenspan
discusses the prevention, evaluation, and treatment of osteoporosis in
Recommendations for screening mammography for women aged 40 to 49
years: controversy and reason.
Proponents of the medical use of marijuana cheered a recent Institute
of Medicine report supporting clinical trials, but opponents are not
eager to see the substance legalized.
Use of hormone replacement therapy and breast cancer prognostic
indicators in postmenopausal women presenting with invasive breast
JAMA Patient Page Reaches 1-Year Mark
A communication tool for patients and physicians: feedback and tips for
JAMA Patient Page
For your patients: A concise guide to meningitis in children.
Next Week in JAMA
A theme issue on cancer.
This Week in JAMA. JAMA. 1999;281(16):1465. doi:10.1001/jama.281.16.1465
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