Increased competition in the medical marketplace, intended to address
issues of cost and quality, may jeopardize other important functions of
a health care system. In a survey of a national sample of US physicians
in clinical practice, Cunningham and colleaguesArticle found that although
77.3% of respondents reported that they had provided charity care
during the month prior to the survey, physicians were less likely to
provide charity care as the proportion of their practice revenue
derived from managed care plans increased. Weissman and colleagues,
based on a national survey of medical school research faculty, found
that the proportion of research funds from institutional sources was
significantly higher in schools in less competitive local markets than
in those in more competitive markets. In an editorial, FletcherArticle
proposes that all health care payers contribute to a pool to fund
medical teaching, research, and community service.
Valeur-Jensen and coworkers studied a population-based cohort of
pregnant women to estimate the incidence of and risk factors for
parvovirus B19 infection, an infection that has been associated with
fetal loss in 1% to 9% of cases acquired during pregnancy. They
report that 65% of the study population had parvovirus B19–specific
IgG antibodies in the first trimester of pregnancy, evidence of past
infection. The estimated annual rate of seroconversion during a
parvovirus B19 epidemic period was 13% and during endemic periods,
1.5%. Risk of seroconversion during pregnancy increased significantly
with increased exposure to children in the household, especially those
aged 6 to 7 years. Occupational contact with young children also
increased the risk of seroconversion, but not as much as exposure to
one's own children.
In a prospective study, Khattak and colleagues found that the risk of
major congenital malformations among infants born to women with
occupational exposure to organic solvents during the entire first
trimester of pregnancy was significantly higher than that among matched
controls. All of the major malformations occurred in infants of women
who reported symptoms associated with their exposure. A higher rate of
fetal distress and lower mean birth weight were associated with
maternal exposure longer than 7 months compared with shorter exposures
of 3 to 7 months.
Abstracts are the most frequently read section of research articles and
are widely disseminated in secondary publications and databases. Pitkin
and colleaguesArticle evaluated the quality of abstracts in 44 articles from
each of 6 major general medical journals. The proportion of abstracts
that contained data inconsistent with that reported in the text or not
found in the text of the article ranged from 18% to 68%. In an
editorial, WinkerArticle outlines the criteria used by JAMA to
improve the accuracy and quality of abstracts and the rationale on
which they are based.
Ms B is grateful for the relief from feelings of anxiety and depression
afforded by alprazolam therapy, but her physician is concerned about
benzodiazepine dependence. Salzman discusses the appropriate use of
benzodiazepines and the adverse effects of benzodiazepines in elderly
"We sit around a table, the Ethics Committee, a team of caregivers
called together to decide about a different kind of care." From "A
Advanced telecommunications systems support diverse telemedicine
programs, but clinical effectiveness and policy questions remain.
Clinicians giving potent combinations of antiretroviral drugs to
patients with HIV to suppress the virus are finding how much the
effectiveness of such regimens depends on strict adherence.
Recommendations for prevention of a first stroke from the National
Stroke Association emphasize the need to help patients adhere to
strategies that reduce stroke risk.
An analysis of the portrayal of tobacco and alcohol use in children's
For your patients: Guide to prevention of a first stroke.
This Week in JAMA. JAMA. 1999;281(12):1061. doi:10.1001/jama.281.12.1061