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This Week in JAMA
April 28, 1999

This Week in JAMA

JAMA. 1999;281(16):1465. doi:10.1001/jama.281.16.1465

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.

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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.

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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.

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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 elderly women.

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Contempo 1999

Recommendations for screening mammography for women aged 40 to 49 years: controversy and reason.

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Medical News & Perspectives

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.

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Brief Report

Use of hormone replacement therapy and breast cancer prognostic indicators in postmenopausal women presenting with invasive breast cancer.

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JAMA Patient Page Reaches 1-Year Mark

A communication tool for patients and physicians: feedback and tips for use.

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JAMA Patient Page

For your patients: A concise guide to meningitis in children.

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Next Week in JAMA

A theme issue on cancer.