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This Week in JAMA
JAMA. 2000;284:1615.
JAMA-EXPRESS
Influenza Vaccination of Working Adults: Benefits, Costs
Annual influenza vaccination of persons aged 65 years or older has been shown to have both health and economic benefits. To study the clinical efficacy and cost-effectiveness of annual influenza vaccination of younger, working adults, Bridges and coauthors (SEE ARTICLE) conducted a trial of influenza vaccine among healthy employees of a US manufacturing company, aged 18 to 64 years, during 2 consecutive influenza seasons. In the 1997-1998 influenza season, when the vaccine virus differed from the predominant circulating viruses, rates of influenzalike illnesses and associated physician visits and work absenteeism were higher in the vaccination group than in the placebo group. In the 1998-1999 season, when the vaccine and predominant circulating viruses were well-matched, rates of influenzalike illnesses, lost work days, and physician visits were significantly reduced in the vaccination group compared with placebo. However, vaccination did not provide overall economic benefit in either season—the net cost per person was $65.59 in 1997-1998; $11.17 in 1998-1999. In an editorial, Monto (SEE ARTICLE) points out that because vaccine availability is expected to be limited this coming influenza season, these findings support current recommendations to give first priority to immunizing elderly and high-risk patients, and their contacts.
Gene Locus for Combined Neurodegenerative Diseases
In some cases, amyotrophic lateral sclerosis may be familial. It may also occur concurrently with other neurodegenerative syndromes. In a set of families in which persons develop both amyotrophic lateral sclerosis and frontotemporal dementia or either alone, Hosler and colleagues identified a new genetic locus linked to familial amyotrophic lateral sclerosis with frontotemporal dementia located on chromosome 9.
(SEE ARTICLE)
Quality of Care Provided to Medicare Beneficiaries
About 4 years ago, the Health Care Financing Administration began a program to measure and track the quality of medical care provided to fee-for-service Medicare beneficiaries. Jencks and colleagues describe the initial 24 process-of-care quality indicators used in the program and report the performance of each state on these measures and their relative rank between 1997 and 1999. Performance rates for each measure varied widely by state; and for all measures, the percentage of patients receiving appropriate care in the median state ranged from 11% to 95%.
(SEE ARTICLE)
Vaccination of Day Care Children and Flu Transmission
Young children in day care are at high risk for influenza infection and appear to be more likely than school-aged children to transmit respiratory illnesses to their household contacts. In this randomized trial during the 1996-1997 influenza season, Hurwitz and colleagues administered inactivated influenza vaccine or hepatitis A vaccine as a control to children aged 24 to 60 months in day care centers. Febrile respiratory illnesses were significantly reduced among unvaccinated household contacts of day care children in the vaccination group, as was respiratory illness–related morbidity among unvaccinated household contacts aged 15 to 17 years, compared with the control group.
(SEE ARTICLE)
TB From Occupational Exposure to Medical Waste
Mycobacterium tuberculosis is usually transmitted directly from person to person when aerosolized by coughing or sneezing. Johnson and colleagues (SEE ARTICLE) report an investigation of tuberculosis (TB) transmission to 3 workers at a medical waste treatment facility exposed during processing of infectious medical waste from a laboratory. In an editorial, Sepkowitz (SEE ARTICLE) stresses the importance of conducting research on occupationally acquired infections in non–health care workers.
A Piece of My Mind
"Intimidated and confused, never before had I sat so close to one who was dying. Never had I listened to thoughts of how the path to death might unfold, or heard the desire to seek not more life but less suffering." From "Dare We Go Gently."
(SEE ARTICLE)
Medical News & Perspectives
Experts debate the need for new federal regulatory measures to control the spread of tuberculosis in health care facilities.
(SEE ARTICLE)
Drug Dependence as a Chronic Illness
Reasons to consider drug dependence as a chronic medical illness, rather than a social problem or an acute, curable condition, and implications for treatment, insurance coverage, and outcomes evaluation.
(SEE ARTICLE)
Public Health Challenges for the 21st Century
Koplan and Fleming from the Centers for Disease Control and Prevention outline 10 public health challenges for the next century.
(SEE ARTICLE)
MSJAMA
Patient-centered medical care: Benefits and opportunities.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on influenza vaccination.
(SEE ARTICLE)
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