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This Week in JAMA
JAMA. 1998;280:491.
Screen Twice a Year for Chlamydia
Most guidelines recommend annual screening of sexually active adolescent females for Chlamydia trachomatis genital infections. Dr Burstein and colleagues (SEE ARTICLE) 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 Orr (SEE ARTICLE) 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.
(SEE ARTICLE)
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 risk.
(SEE ARTICLE)
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 colleagues (SEE ARTICLE) 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 colleagues (SEE ARTICLE) 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 Sherer (SEE ARTICLE) places these findings in context in an editorial.
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 Naylor (SEE ARTICLE) 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 Lundberg (SEE ARTICLE) calls for development of an outcomes research agenda for clinical laboratory testing.
The Cover
"What name to give this new and highly distinctive style?" Paul Sérusier, Landscape at Le Pouldu, 1890, French.
(SEE ARTICLE)
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."
(SEE ARTICLE)
Contempo 1998
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.
(SEE ARTICLE)
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 States today.
(SEE ARTICLE)
Policy Perspectives
Based on in-depth interviews with 355 oncologists, Dr Emanuel and colleagues present new empirical data on euthanasia and physician-assisted suicide.
(SEE ARTICLE)
JAMA Patient Page
For your patients: the facts on chlamydia.
(SEE ARTICLE)
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