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This Week in JAMA
JAMA. 2000;283:2757.
Meningococcal C Conjugate Vaccine in Infants
Prevention of meningococcal disease is essential to advance control of bacterial meningitis, but the effectiveness of available meningococcal polysaccharide vaccines is limited, especially in young children. In this randomized trial of primary immunization with serogroup C meningococcal conjugate vaccine in infants beginning at age 2 months, MacLennan and colleagues (SEE ARTICLE) found that meningococcal C conjugate vaccine was well-tolerated, immunogenic, and resulted in immunologic memory. In an editorial, Perkins (SEE ARTICLE) discusses factors that must be considered to achieve successful control of meningococcal disease.
Outreach Program for Elderly With Psychiatric Illnesses
Elderly residents of public housing have higher rates of psychiatric disorders than those living in the community, and more than half of those needing mental health care may not receive it. The Psychogeriatric Assessment and Treatment in City Housing (PATCH) program is a nurse-based mobile outreach program to identify elderly residents with psychiatric illness in urban public housing sites and provide on-site case management. Rabins and colleagues (SEE ARTICLE) report that after 26 months of follow-up, psychiatric symptoms among residents with psychiatric illnesses in sites implementing the PATCH program decreased more than among residents with psychiatric illnesses in control homes, but rates of moves from public housing to a nursing home or board-and-care home were similar at all sites. In an editorial, Katz and Coyne (SEE ARTICLE) discuss the public health model of mental health care, the effectiveness of interventions derived from this model, and policy implications.
Aortic Arch Calcification and Risk of CVD
Arterial calcium deposits may be indicative of the extent of atherosclerosis and a marker of subclinical cardiovascular disease (CVD). To determine whether arterial calcification is associated with increased risk of hospitalization or mortality due to CVD, Iribarren and colleagues followed up 116,309 adults, aged 30 to 89 years at baseline, for a median of 28 years. Calcification of the aortic arch detected on chest x-ray at baseline was associated with increased risk of coronary heart disease events in both men and women and with ischemic stroke events in women independent of other cardiovascular risk factors.
(SEE ARTICLE)
Clinical Decision Support System and Physician Behavior
Computer-based clinical decision support systems (CDSSs) provide management recommendations derived from linking specific patient characteristics to a computerized knowledge base. By alternating control periods with intervention periods during which a CDSS notified physicians about the appropriateness of anticoagulation prescriptions for prevention of venous thromboembolism after orthopedic surgery, Durieux and colleagues evaluated whether the CDSS changed physician behavior and improved compliance with preestablished guidelines. Physician compliance with prescription guidelines increased significantly during intervention periods compared with control periods, but each time the CDSS was removed, compliance reverted to control levels.
(SEE ARTICLE)
Effectiveness of Automatic Shoulder Belt Systems
Evidence on the effectiveness of motor vehicle automatic shoulder belt systems in reducing injury and mortality among front-seat passengers has been contradictory. In this analysis of data from 25,811 tow-away motor vehicle crashes, Rivara and colleagues found that use of automatic shoulder belt systems without lap belts was associated with a decreased risk of death compared with no restraint use. But the risk of death and serious injury with use of automatic shoulder belt systems without lap belts was greater than that associated with use of manual lap and shoulder belts or automatic shoulder belts with manual lap belts.
(SEE ARTICLE)
A Piece of My Mind
"It is no surprise that patients notice the difference between a doctor who rushes through his or her own agenda, and one who endeavors to give every bit of his or her attention to the patient." From "Paying Attention"
(SEE ARTICLE)
Medical News & Perspectives
Experts in medicine and in law are "divided by a common language," says one of the experts, and to improve understanding between the professions, the gap must be bridged.
(SEE ARTICLE)
Calcium Carbonate and Levothyroxine
Serum thyroxine levels decreased and thyrotropin levels increased in patients with hypothyroidism when calcium carbonate and levothyroxine were administered at the same time.
(SEE ARTICLE)
Users' Guides to the Medical Literature
How to determine the benefit-risk ratio of a specific treatment for an individual patient and incorporate the patient's values about therapy and potential outcomes into clinical decision making.
(SEE ARTICLE)
Public Health Law Part I: Definition
Essential features of public health law: the first article in a 3-part series examining public health law as a tool to protect and promote the health and safety of a community.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about psychiatric disorders in older adults.
(SEE ARTICLE)
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