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
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.
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.
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.
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.
"In seeking treatment for my son's psychological problems, I was frequently
considered as the source of these problems." From "Stigma."
Liposuction: Patient selection, technical advances, outcomes, and complications.
Research into infectious triggers for multiple sclerosis is generating
controversy over 2 pathogenic suspects—one a virus, the other a bacterium.
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.
For your patients: Information about preventing dehydration from diarrhea.
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.
This Week in JAMA. JAMA. 2001;285(3):255. doi:10.1001/jama.285.3.255