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JAMA. 2000;284:1345.

Home Visitation and Prevention of Child Maltreatment
Nurse home visitation prenatally and during the first 2 years after birth was associated with significant short-term and long-term reductions in child maltreatment in a previously reported trial conducted among high-risk families in Elmira, NY. Eckenrode and colleagues (SEE ARTICLE) further analyzed long-term data on child maltreatment in the Elmira trial and found that in families in which mothers reported having experienced more than 28 incidents of domestic violence, maltreatment involving the study child was not significantly reduced in home-visited families compared with families who did not receive home visitation services. In an editorial, Gomby (SEE ARTICLE) emphasizes that home visitation programs are unlikely to benefit all families and that recognition of the limitations of these services is important for targeted implementation and program improvement.

Heart Rate Recovery, Treadmill Score, and Mortality
In a cohort of 9454 patients who underwent symptom-limited exercise electrocardiographic testing and were followed up prospectively for a median of 5.2 years, Nishime and colleagues found that both abnormal heart rate recovery and intermediate- or high-risk Duke treadmill exercise scores were predictive of mortality. Abnormal heart rate recovery provided additional prognostic information to the treadmill exercise score.

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PSA Screening Strategies for Prostate Cancer
Prostate-specific antigen (PSA) screening for prostate cancer is often performed annually for men aged 50 through 75 years. Using a Monte-Carlo simulation, Ross and colleagues compared this standard screening strategy, no screening, and 6 strategies in which the PSA threshold for prostate biopsy, PSA testing intervals, and the start age for PSA testing were varied. The strategy of PSA testing at ages 40 and 45 years followed by biennial testing beginning at age 50 years, with a PSA threshold of 4.0 ng/mL for prostate biopsy, was estimated to simultaneously reduce prostate cancer mortality and number of PSA tests and biopsies performed per 1000 men compared with the standard strategy.

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Periodontal Disease and Coronary Heart Disease Risk
Prior research has suggested a relationship between periodontal disease and coronary heart disease, but these 2 conditions share common risk factors and their apparent association may be explained by confounding. In this analysis of data from 8032 adults aged 25 to 74 years followed up from baseline (1971-1975) through 1992 in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, Hujoel and colleagues found no evidence supporting an association between the presence of periodontitis or gingivitis at baseline and the risk of coronary heart disease events or mortality.

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Reminders and Compliance With Standards of Care
Limited evidence suggests that computerized reminder systems might improve physician compliance with specific standards of care. Demakis and colleagues studied a computerized reminder system in a randomized trial among resident physicians at 12 Veterans Affairs ambulatory care clinics. In the 17-month study during which 12,989 patients received care, compliance with applicable standards of care was significantly greater in the reminder group compared with the control group. Over time, however, the proportion of visits for which care was in compliance with the standards declined progressively in the reminder group, but remained stable in the control group.

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A Piece of My Mind
"In the sacredness of just being together, . . . none of the struggles between faith and doubt really mattered anymore." From "Three Lessons."

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Medical News & Perspectives
Pediatric gastroenterologists are pursuing research on probiotic therapy, in which adding certain microorganisms to the diet can improve microbial functioning and benefit health.

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Chorioamnionitis and Cerebral Palsy
In this meta-analysis of data from 26 studies, clinical chorioamnionitis was significantly associated with cerebral palsy in preterm and full-term infants and with cystic periventricular leukomalacia in preterm infants.

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Lead in Calcium Supplements
Eight of 22 widely available calcium supplements contain measurable lead content (SEE ARTICLE) , but do these products truly present a health risk? (SEE ARTICLE)

Controversies
Immediate defibrillation is the optimal treatment for sudden cardiac arrest due to ventricular fibrillation. Eisenberg (SEE ARTICLE) asserts that defibrillation should be a lay procedure and argues for widespread dissemination of automated external defibrillators (AEDS) in homes, whereas Brown and Kellermann (SEE ARTICLE) maintain that current evidence does not support access to AEDs in public locations or homes.

JAMA Patient Page
For your patients: Information about maintaining healthy gums.

(SEE ARTICLE)

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