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This Week in JAMA
JAMA. 2002;287:947.
Tuberculosis Contact Investigation
Investigation of patient contacts is recommended for all patients with suspected or confirmed active pulmonary tuberculosis (TB) reported in the United States. In this review of US health department records, Reichler and colleagues (SEE ARTICLE) found, however, that contact investigations were often deficient. Thirteen percent of patients with active pulmonary TB reported during 1996 had no contacts identified, and only 55% of identified contacts completed screening. To improve methods of TB contact investigation, Bailey and colleagues (SEE ARTICLE) developed and validated a model of TB transmission identifying those variables that best predict a positive tuberculin skin test result among contacts of active TB cases. In an editorial, Mohle-Boetani and Flood (SEE ARTICLE) discuss the importance of conducting timely TB contact investigations and of developing more effective approaches for tracking TB transmission.
Lifetime Risk of Developing Hypertension
Using data from participants aged 55 and 65 years in the Framingham Heart Study, a community-based prospective cohort study, Vasan and colleagues estimated that the probability that an individual will develop hypertension during his or her remaining lifetime (residual lifetime risk) was 90% for the period 1976 through 1998. Compared with the period 1952 through 1975, the lifetime risk of hypertension was approximately 60% higher for men but was unchanged for women.
(SEE ARTICLE)
Interventions to Prevent Workplace Homicide
Environmental design measures and administrative interventions have been recommended to prevent homicide in the workplace, the second leading cause of death on the job for US workers. In this case-control study of homicides in North Carolina workplaces, Loomis and colleagues found that several administrative and environmental interventions appeared to be beneficial for preventing workplace homicides, especially bright exterior lighting and eliminating solo work at night.
(SEE ARTICLE)
Preimplantation Genetic Diagnosis
Preimplantation genetic diagnosis after in vitro fertilization identifies embryos carrying genes that predispose to genetic disorders so that only embryos free of predisposing genes are transferred to achieve a pregnancy. Verlinsky and colleagues report the use of preimplantation genetic diagnosis for a 30-year-old woman who carried the autosomal dominant V717L mutation in the amyloid precursor protein (APP) gene associated with early-onset Alzheimer disease. In a commentary, Towner and Loewy consider the ethics of assisted reproduction when the parent, in this case because of early-onset Alzheimer disease, is likely to become unable to care for the child while the child is still very young.
(SEE ARTICLE)
CLINICIAN'S CORNER
A Woman With Borderline Personality Disorder
Ms J is a 44-year-old woman with borderline personality disorder that began in her 20s and multiple comorbid medical conditions. She has received extensive treatment for her psychiatric and medical problems, and recently her condition has improved. Oldham discusses the epidemiology, natural history, diagnosis, and treatment of borderline personality disorder.
(SEE ARTICLE)
Contempo Updates
Effects of sleep deprivation on clinical performance.
(SEE ARTICLE)
Medical News & Perspectives
A new study showing that prostate-specific antigen levels between 2 and 9 ng/mL are not useful for predicting the size and aggressiveness of prostate tumors is reigniting the screening debate.
(SEE ARTICLE)
Preventive Home Visits for Elderly People
Meta-analysis of randomized trials of the effects of preventive home visitation programs for elderly people suggests that these programs decrease nursing home admissions and reduce functional decline if the interventions are based on multidimensional geriatric assessment with extended follow-up, include multiple follow-up home visits, and target persons at lower risk for death.
(SEE ARTICLE)
Health Care Reform in Republic of Georgia
A survey of ill residents of Tbilisi, the capital of the Republic of Georgia, indicates that under the recently reformed health care system, which is largely financed through out-of-pocket payments, most respondents had serious problems paying for health care.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about hypertension.
(SEE ARTICLE)
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