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JAMA. 2001;285(23):2945. doi:10.1001/jama.285.23.2945.
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Folic acid intake of 400 µg per day before conception and during pregnancy significantly reduces the occurrence of neural tube defects. In March 1996, the US Food and Drug Administration authorized the addition of folic acid to enriched grain products, and in January 1998, folic acid fortification of grain products became mandatory. Honein and colleaguesArticle report that the birth prevalence of neural tube defects reported on birth certificates decreased significantly after mandatory folic acid fortification of the US food supply. In an editorial, Mills and EnglandArticle discuss the limitations of birth certificate data for estimating the occurrence of neural tube defects and consider possible reasons to explain why the observed decrease in rates of neural tube defects was less than expected.


Physical decline among elderly patients after hospitalization for an acute medical illness may result in high mortality rates during the year after hospital discharge. Walter and colleaguesArticle developed and validated a prognostic index for 1-year mortality after hospital discharge among adults aged 70 years or older. The prognostic index included 6 independent risk factors for mortality: male sex, number of dependent activities of daily living at discharge, congestive heart failure, cancer, creatinine level higher than 3.0 mg/dL, and low albumin level. The area under the receiver operating characteristic curve for the index was 0.75 in the derivation cohort and 0.79 in the validation cohort. In an editorial, Redelmeier and LustigArticle discuss the use of prognostic indices in clinical practice.


Evidence suggests that risk factors associated with cervical human papillomavirus (HPV) infection may differ from those associated with the development of low-grade squamous intraepithelial lesions (LSILs). Moscicki and colleagues prospectively studied a cohort of young women aged 13 to 21 years to identify risk factors for incident cervical LSIL development among participants with HPV infection and risk factors associated with acquiring HPV infection among participants negative for HPV DNA at study entry. Risk factors for acquiring HPV infection included number of new sexual partners per month, history of herpes simplex virus, and history of vulvar warts. The use of oral contraceptives had a protective effect. Among the 496 women who were HPV-positive at baseline or during follow-up, 109 developed LSILs within a median follow-up of 60 months. HPV infection was the most significant risk factor for development of LSILs; the other significant risk factor specific to LSIL development was daily cigarette smoking.

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Holman and colleagues evaluated a statewide quality improvement project in Alabama to improve performance of coronary artery bypass grafting (CABG) surgery. The quality improvement intervention included confidential hospital-specific performance feedback on 8 process and outcome quality indicators, experience sharing, information on the performance of each hospital compared with the statewide mean and achievable benchmarks of care based on peer performance, anonymized performance data from all participating Alabama hospitals, and performance data from a comparison state and a national sample. Improvements in duration of post-CABG intubation, use of the internal mammary artery, and aspirin prescriptions at discharge were greater in the Alabama hospitals than in the comparison state that did not use performance feedback to providers and or in a national sample.

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The Caribbean region's HIV infection rate of 2% among adults is second only to sub-Saharan Africa, where it is 8%, and 9 of the 12 countries with the highest HIV prevalence in the Americas are in the Caribbean basin. Medical and other leaders are placing new emphasis on prevention and treatment.

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In this survey of youth aged 10 through 17 years who were regular Internet users, 19% reported receiving at least one unwanted online sexual solicitation. Risk for online sexual solicitation was higher for girls, older adolescents, troubled youth, frequent Internet users, chat room participants, and those who communicated online with strangers.

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The first rule providing nationwide privacy protection for health information, issued by the Department of Health and Human Services, became effective last April. Gostin describes the rights afforded by the rule and discusses achieving balance between individual privacy and public responsibility.

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For your patients: Information about folic acid and the prevention of neural tube defects.

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