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This Week in JAMA
JAMA. 1999;281:871.
Influenza Morbidity and Mortality and Control
Annual influenza immunization rates among the elderly approach 60% to 70%, but rates among nonelderly persons with chronic medical conditions and among health care professionals who may transmit the disease are much lower. Neuzil and colleagues found that excess cardiopulmonary hospitalizations and deaths during influenza season in women aged 15 to 64 years were highest among women aged 45 to 64 years with chronic medical conditions (estimated number of annual excess events, 58 per 10,000 women compared with 6 events per 10,000 middle-aged low-risk women). In a placebo-controlled trial of influenza vaccine in healthy hospital-based health care professionals, Wilde and coworkers found that vaccine recipients were significantly less likely to become infected with influenza than were controls. In an editorial, Glezen points out that strategies to increase immunization rates and new methods of prevention and treatment of influenza are needed.
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Fat Intake Not Associated With Breast Cancer Risk
Results of previous case-control and cohort studies investigating the relationship between dietary fat intake and the risk of breast cancer have been inconsistent. In this extension of the Nurses' Health Study, Holmes and colleagues measured dietary intake 4 times during 14 years of follow-up of more than 85,000 women. The researchers found no significant association between intake of total fat, including very low fat intake, or of specific types of fat and the risk of breast cancer.
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Plaque Rupture in Sudden Coronary Death
In this autopsy study of cases of sudden death in men with severe coronary artery disease, Burke and colleagues found that acute coronary artery plaque rupture occurred in a significantly higher proportion of men who died during exertion compared with men who died at rest. The mean total cholesterol/high-density lipoprotein cholesterol ratio was higher in the exertion group and was significantly associated with acute plaque rupture among all cases. Morphologic characteristics of plaque rupture in the exertion group (Figure 1) included hemorrhage into the plaque (arrowhead) and rupture (arrows) in the central region of the fibrous cap (FC) with an overlying acute thrombus (Th) in the artery lumen.
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Transmission of Babesiosis by Blood Transfusion
Infection with Babesia microti, an intraerythrocytic protozoan transmitted by the northern deer tick, is often asymptomatic but may cause severe and potentially fatal hemolytic anemia, if untreated. In this epidemiologic investigation, Dobroszycki and coworkers report the clinical outcomes of 6 patients who received blood products derived from a single unit of blood contaminated with B microti from an asymptomatic donor: 1 recipient, an infant with hyopoplastic lung (index case), became clinically ill, 2 developed parasitemia, and 3 had no evidence of infection. The 3 infected recipients and 1 additional recipient were treated successfully with antibiotics.
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Chemoprophylaxis After Occupational Exposure to HIV
Henderson discusses advances in the understanding of the early stages of human immunodeficiency virus (HIV) infection and recent experimental and clinical experience with antiretroviral agents. Based on these considerations, he outlines a systematic approach to the clinical management of health care workers with occupational exposure to HIV.
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A Piece of My Mind
"All human life is special and full of potential regardless of one's state of emotional or physical disrepair." From "Sherry and Richard."
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Contempo 1999
New procedures advance the treatment of osteoarthritis of the knee.
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Medical News & Perspectives
At the Sixth Conference on Retroviruses and Opportunistic Infections, researchers reported new findings on the role of key immune cells in controlling human immunodeficiency virus (HIV) infection, the recovering immune system, and drug-resistant HIV.
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Council Report
From the AMA Council on Ethical and Judicial Affairs, recommendations for an institutional policy on medical futility based on a fair process approach for determining when care at the end of life is futile.
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Commentary
In his report on the 50th World Health Assembly, US Surgeon General David Satcher, MD, PhD, discusses global health and US collaboration with the World Health Organization.
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Profiles in Primary Care
An interview with Sam Ho, MD, "a practitioner of public health—private-sector, market-driven, equal-opportunity, for-profit public health."
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JAMA Patient Page
For your patients: A primer on influenza and the flu vaccine.
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