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This Week in JAMA |

This Week in JAMA FREE

JAMA. 1998;280(13):1121. doi:10.1001/jama.280.13.1121.
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IMPROVING INNER-CITY IMMUNIZATION RATES

Immunization rates increased from 56% to 89% over a 15-month period at Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites in inner-city Chicago, report Hoekstra and colleaguesArticle, where a food voucher incentive program restricted vouchers to a 1-month supply for participants with children 24 months or younger whose immunizations were incomplete. In an editorial, Wood and HalfonArticle discuss barriers that may impede immunization of inner-city children and consider approaches to improve the delivery of child health services in the inner city.

EQUITY AND SUCCESS OF ORGAN TRANSPLANT PROGRAMS

Alexander and SehgalArticle found that among more than 7000 individuals beginning hemodialysis, blacks, women, and low-income individuals were less likely to complete the steps necessary to acquire a kidney transplant. In a related article, Lin and colleaguesArticle analyzed survival rates after solid organ transplantation in the United States during a 6-year period beginning in 1988. The major risk of graft failure occurred during the first year after transplantation, after which the 3-year patient and graft survival rates exceeded 90% for all organ transplants except lung and heart-lung. Centers that performed fewer transplantations had lower-than-expected graft survival rates. In an editorial, MilfordArticle considers the policy implications of these findings for the equitable allocation of solid organs for transplantation.

PERSONALIZED COUNSELING REDUCES STD RISK

An enhanced, personalized risk reduction counseling program in 5 public STD clinics was associated with higher condom use and lower incidence of sexually transmitted diseases during the next year compared with the didactic intervention typical of current care. Kamb and colleagues report that the 2-session enhanced intervention in this randomized trial was as effective as the longer 4-session enhanced intervention and was suitable for busy public clinic settings.

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CHOOSING FIRST-LINE DRUGS TO TREAT HYPERTENSION

Renin profiling has been suggested as a useful way to predict response to antihypertensive agents, but renin level measurements can be expensive and are not routinely required for patient care. Preston and colleagues analyzed data from the Veterans Affairs Cooperative Study to determine if renin profiling or age-race subgroup was a better predictor of therapeutic response to a particular drug for the treatment of stage 1 and 2 hypertension. Therapeutic response rates were equivalent for patients treated with agents matched to their renin profile or age-race subgroup, but in a logistic regression analysis, age-race subgroup was the better predictor.

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WHAT THE TOBACCO INDUSTRY KNEW

The tobacco industry had full knowledge of the addictive properties of nicotine, which shaped product development and marketing strategies, and of the health risks associated with cigarette smoking, according to documents presented at the Minnesota tobacco trial. Hurt and Robertson urge a stringent national tobacco policy to curtail tobacco use in the United States and abroad.

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THE COVER

"When considered within the vastness and grandeur of nature, the human is tiny and nearly insignificant." Jasper Francis Cropsey, Janetta Falls, Passaic County, New Jersey, 1846, American.

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MEDICAL NEWS & PERSPECTIVES

New research on how to help blind people cope with sleeping problems, which are often caused by "free running" circadian rhythms.

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CONTEMPO 1998

Aggressive treatment of ocular inflammation in children with juvenile rheumatoid arthritis.

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A PIECE OF MY MIND

"A simple handshake, friendly greeting, or welcomed smile is what a patient will ultimately remember." From "On Being Human."

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MSJAMA

Medical students at the University of California at Davis develop and operate a harm-reduction clinic for injection drug users.

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PATIENT PAGE

For your patients: A guide to organ donation.

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