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This Week in JAMA
October 9, 2002

This Week in JAMA

JAMA. 2002;288(14):1689. doi:10.1001/jama.288.14.1689
Overweight and Obesity in US Adults and Children

Two reports from the National Center for Health Statistics update data on the prevalence of obesity and overweight in the United States using measured weights and heights obtained during the National Health and Nutrition Examination Survey (NHANES) conducted in 1999 and 2000. Flegal and colleagues report that the age-adjusted prevalence of obesity (body mass index [BMI] ≥30) among US adults increased from 22.9% in 1988-1994 (NHANES III) to 30.5% in 1999-2000. Ogden and colleagues report that the prevalence of overweight among US children (≥95th percentile of sex-specific BMI for age) increased in 1999-2000 compared with 1988-1994. Prevalence of overweight in 1999-2000 was 15.5% among 12- through 19-year-olds, 15.3% among 6- through 11-year-olds, and 10.4% among 2- through 5-year-olds. In another article in this issue of THE JOURNAL, Freedman and colleagues, using self-reported weights and heights obtained in the Behavioral Risk Factor Surveillance System survey of US adults conducted between 1990 and 2000, found that the prevalence of class 3 obesity (BMI ≥40) increased from 0.8% in 1990 to 2.2% in 2000.

Drug Benefit Plans and Prescription Drug Spending

With rapid increases in prescription drug spending, many employers and health insurance providers are changing benefits packages to better control costs. In this analysis of claims data from working-age adults with employer-provided drug coverage with varying benefit designs, Joyce and colleagues found that adding an additional level of co-payment, increasing existing co-payments, and requiring mandatory generic substitution all significantly reduced health insurance plan payments and overall drug spending. Increasing co-payments in multitier plans increased the percentage of drug expenses paid out-of-pocket by beneficiaries. In an editorial, Steinwachs notes that as co-payments became larger, patients filled fewer prescriptions, an outcome that may have adverse health consequences.

Brain Volume Abnormalities and Brain Growth in ADHD

To assess brain volume abnormalities and longitudinal brain growth in attention-deficit/hyperactivity disorder (ADHD), Castellanos and colleagues conducted serial magnetic resonance imaging scans over 10 years in children and adolescents with ADHD and in healthy controls. On initial scan, children and adolescents with ADHD had significantly smaller brain volumes in all regions. Longitudinal growth curves for almost all brain structures among children and adolescents with ADHD were roughly parallel to those among controls, but on a lower track.

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HPV DNA Screening for Cervical Abnormalities

To determine the accuracy of human papillomavirus (HPV) DNA testing for detection of high-grade cervical lesions or cancer, Kulasingam and colleagues screened women aged 18 to 50 years during an annual examination using a thin-layer Papanicolaou (Pap) test and 2 different assays for HPV DNA testing: a polymerase chain reaction–based assay and a liquid-based DNA-RNA hybridization capture with signal amplification assay. Women with positive screening results (presence of high-risk HPV types or Pap result of atypical squamous cells of undetermined significance or higher) were referred for colposcopy and biopsy, and a random sample of women with negative screening results were also referred for colposcopy. Of 7 colposcopy triage strategies evaluated, those based on a single HPV DNA test were more sensitive but less specific for detection of cervical intraepithelial neoplasia grade 3 or higher than screening strategies based on thin-layer Pap testing.

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Direct-to-Consumer Advertising for Genetic Testing

Direct-to-consumer advertisements that promote genetic testing and services have begun to appear in a variety of print media. Gollust and coauthors examine the potential benefits of direct-to-consumer health promotions and discuss factors that limit the value and appropriateness of direct-to-consumer advertising for genetic testing.

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Medical News & Perspectives

The National Cancer Institute is recruiting 50 000 current and former smokers for a study of spiral computed tomographic scans for early lung cancer detection. The scans have grown in public popularity despite the absence of solid evidence that they prevent premature death from lung cancer.

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CLINICIAN'S CORNER

Effective treatment of tobacco dependence includes clinical, health system, and community-level interventions.

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Call for Papers: Obesity Research

Original clinical research reports, translational research studies, and systematic reviews on obesity are invited for a JAMA theme issue scheduled for spring 2003.

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Chronic Illness Care in Primary Care: Innovations in Primary Care

Part 1 of a 2-part article describes a model for effective primary care of patients with chronic illness and how components of the chronic care model have been implemented in 4 health care organizations.

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JAMA Patient Page

For your patients: Information about attention-deficit/hyperactivity disorder.

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