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This Week in JAMA |

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JAMA. 2008;299(2):137. doi:10.1001/jama.2007.61.
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Infants experience high rates of invasive meningococcal disease; however, the currently licensed meningococcal vaccine is poorly immunogenic in infants. In a randomized open-label study, Snape and colleagues Article assessed the safety and immunogenicity of a novel tetravalent (serogroup A, C, W-135, and Y) meningococcal vaccine (MenACWY) in infants. The primary study outcome was the percentage of infants who had a human complement serum bactericidal activity titer greater than 1:4 against the vaccine meningococcal serogroups, which was assessed 1 month after receipt of the primary immunization series (at either 2, 3, and 4 months or 2, 4, and 6 months). The authors report that the novel MenACWY vaccine was well tolerated and immunogenic when given according to either vaccination schedule. In an editorial, Harrison Article discusses vaccine efficacy and progress toward global prevention of meningococcal disease.


Weight gain and adverse metabolic effects are common in patients taking antipsychotic medications. In a randomized trial of adults with schizophrenia who had a 10% or greater medication-associated weight gain, Wu and colleagues assessed the effects of a lifestyle intervention (education, diet, and exercise), metformin therapy, or the 2 treatments combined, on antipsychotic-induced weight gain and abnormalities in insulin sensitivity. The authors found that patients in all treatment groups experienced reductions in body mass index and increased insulin sensitivity during the 12-week trial. Patients who received the lifestyle intervention plus metformin lost the most weight, while metformin alone was superior to the lifestyle intervention alone in achieving weight loss and improved insulin sensitivity.


Carriers of mutations in BRCA1/2 have an increased risk of breast cancer, but whether the magnitude of risk varies between carriers is not known. Begg and colleagues assessed the incidence of breast cancer in 598 first-degree female relatives of 181 women who had BRCA1/2 mutations and either asynchronous contralateral breast cancer or unilateral breast cancer (probands). The authors report considerable variation in breast cancer risk among relatives of the probands, including a significantly increased risk associated with younger age at diagnosis in the proband.


To examine the association between rural residence and access to solid organ transplant services, Axelrod and colleagues evaluated population-based rates of organ wait-listing and transplantation among patients residing in rural vs urban regions. In their analysis of national data for 1999-2004, the authors found that rural patients were 8% to 15% less likely to be waitlisted, and 10% to 20% less likely to undergo liver, kidney, or heart transplantation compared with patients who resided in urban areas.


Dengue, one of the world's most aggressive reemerging infections, could threaten public health in the United States. Morens and Fauci discuss the dengue viruses, mosquito vectors, and control; the pathogenesis; and clinical manifestations of dengue fever and vaccine development.


“The responsibility to overcome attitudinal barriers has to lie with those who make clinical decisions and the institutions they work in.” From “Assuming the Worst.”


A new report has found that 2 decades of underinvestment have left the US Food and Drug Administration unable to effectively carry out its mission to protect the public from unsafe food and medical products.


Practice guidelines and legislative mandates

Defining translational research


Revisiting medical training in The House of God.


How would you manage a 32-year-old woman with a 1-year history of chronic abdominal pain? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is January 30.


Join Ian George Williamson, MD, from 2 to 3 PM eastern time on January 16, 2008, to discuss antibiotics and nasal steroids for acute sinusitis. To register, go to http://www.ihi.org/AuthorintheRoom.


For your patients: Information about organ donation.



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