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This Week in JAMA
January 17, 2001

This Week in JAMA

JAMA. 2001;285(3):255. doi:10.1001/jama.285.3.255
Racial Differences in Mortality in the VA System

Differences in access to care may contribute to observed racial disparities in health care delivery and outcomes. To study racial differences in health outcomes in an equal-access health care system, Jha and colleaguesArticle analyzed data in a Veterans Affairs (VA) administrative database from a cohort of 28 934 white men and 7575 black men admitted to VA hospitals. Thirty-day mortality among black patients hospitalized for 1 of 6 common medical diagnoses was 4.5% compared with 5.8% among white patients, and mortality was lower among blacks for each of the 6 diagnoses. In an editorial, MarkArticle discusses limitations of research based on data from administrative databases that do not incorporate sufficient clinical information to allow adequate adjustment for potential confounding factors.

Fish Intake and Risk of Stroke in Women

Prior studies have reported an inverse association between fish intake and risk of stroke, but risk of specific stroke subtypes has not been evaluated. In this analysis of data from 14 years of follow-up of women aged 34 to 59 years at baseline in the Nurses' Health Study, Iso and colleagues found that higher consumption of fish and omega-3 polyunsaturated fatty acids was associated with a reduced risk of thrombotic stroke. Risk of hemorrhagic stroke was not associated with fish intake or with omega-3 polyunsaturated fatty acid intake.

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Guideline for Stool Cultures in Hospitalized Patients

Microbiology laboratories commonly reject stool specimens obtained from hospitalized patients more than 3 days after hospital admission because of low yield. This policy, however, might miss cases of nosocomial illness caused by enteropathogenic bacteria detected by stool culture. Bauer and colleagues developed a modified 3-day rule that would reduce the laboratory burden of stool cultures, but still provide rapid diagnosis for patients at increased risk of nosocomial bacterial gastroenteritis. Criteria for selecting patients with onset of diarrhea more than 3 days after admission for whom stool cultures would be indicated included age 65 years or older with preexisting comorbidity; HIV infection; neutropenia; and suspected nosocomial outbreak. In validation samples, only 2 of 65 patients with nosocomial diarrhea related to enteropathogenic bacteria would not have been identified with the modified 3-day rule, whereas the original 3-day rule would have missed 52 cases.

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Vertebral Fracture Risk After a Recent Vertebral Fracture

Using data from women enrolled in the placebo groups of 4 large 3-year clinical trials evaluating the efficacy of a bisphosphonate for treatment of postmenopausal osteoporosis, Lindsay and colleagues determined the incidence of new vertebral fractures after the occurrence of a vertebral fracture during the trial. The cumulative incidence of new vertebral fractures in the first year was 6.6%, and among women who developed an incident vertebral fracture, the incidence of another vertebral fracture in the subsequent year was 19.2%. Presence of a vertebral fracture at study baseline was associated with an increased risk of incident fracture.

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Urine Survivin as a Marker for Bladder Cancer

Survivin, an inhibitor of apoptosis, is undetectable in most human tissues but is often overexpressed in common cancers and correlates with aggressive disease and decreased overall survival. To determine whether survivin would be a useful molecular marker for bladder cancer, Smith and colleagues tested urine specimens from 5 patient groups for the presence of survivin. Survivin was detected in the urine samples of all patients with new or recurrent bladder cancer and in none of the samples from healthy volunteers or from patients with other genitourinary cancers. Thirty-two of 35 patients treated for bladder cancer who had achieved cystoscopic remission had negative test results for urine survivin and only 4 of 30 patients with nonneoplastic genitourinary disease had positive test results.

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A Piece of My Mind

"In seeking treatment for my son's psychological problems, I was frequently considered as the source of these problems." From "Stigma."

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Contempo Updates

Liposuction: Patient selection, technical advances, outcomes, and complications.

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Medical News & Perspectives

Research into infectious triggers for multiple sclerosis is generating controversy over 2 pathogenic suspects—one a virus, the other a bacterium.

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Who Can Authorize Organ Donation?

Survey resultsArticle indicate that consent practices for cadaveric organ procurement vary widely among the 61 US organ procurement organizations. Marked inconsistency among organ procurement organizations about whether the wishes of the deceased or those of next of kin determine if organs are procured, despite legal priority of the decedent's wishes, adds to the need to reevaluate the current system for organ donation in the United StatesArticle.

JAMA Patient Page

For your patients: Information about preventing dehydration from diarrhea.

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MSJAMA ONLINE

This month's Web-only features include a personal essay describing the experience of a medical student facing a diagnosis of hypertension, and book reviews by MSJAMA editors: The Elusive Magic Bullet: The Search for the Perfect Drug by John Mann and The Third Patient by George B. Mannis.

http://www.msjama.org

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