In this analysis using data on alcohol consumption from several national
data sets from 1999, Foster and colleaguesArticle estimated that underage (12- to
20-year-old) drinkers consumed 19.7% of the total number of alcoholic drinks
consumed per month. The amount of alcohol consumed by adult excessive (>2
drinks per day) drinkers that was in excess of 2 drinks per day was 30.4%.
Consumer expenditures on alcohol in the United States in 1999 was $116.2 billion,
of which $22.5 billion was attributed to underage drinking and $34.4 billion
to adult consumption in excess of 2 drinks per day. In an editorial, Hanson
and LiArticle emphasize the importance of strategies to prevent alcohol abuse and
reduce underage drinking, including interventions by primary care practitioners.
SehgalArticle analyzed data from a national Medicare-funded quality improvement
project among adult hemodialysis patients to determine whether successful
quality improvement efforts that do not specifically target race or sex have
a beneficial effect on race and sex disparities in health outcomes. The proportion
of patients that achieved an adequate hemodialysis dose increased from 43%
in 1993 to 86% in 2000. The gap between white and black patients and between
female and male patients decreased significantly over this period. Race and
sex disparities in anemia management and nutritional status did not change
significantly. In an editorial, Felix Aaron and ClancyArticle discuss initiatives
to improve quality and reduce race and sex disparities.
An important component of the response to medical errors is disclosure
of errors to patients, but little is known about how patients and physicians
think medical errors should be discussed. In this qualitative analysis of
transcripts from a series of 13 focus groups that included 6 groups of adult
patients, 4 groups of academic and community physicians, and 3 groups of patients
and physicians, Gallagher and colleagues found that patients and physicians
had notably different perspectives on what information should be disclosed
about medical errors. Both patients and physicians expressed unmet needs following
harmful medical errors.
Development of a vaccine has been proposed for prevention of congenital
cytomegalovirus (CMV) infection, but the ability of maternal immunity to prevent
transplacental transmission of CMV is uncertain. In this cohort study of multiparous
women whose prior immune status to CMV was determined from cord serum specimens
obtained from a previous delivery, Fowler and colleagues found that the rate
of congenital CMV infection among infants born to women who were CMV seropositive
at the time of the previous delivery was much lower than that among initially
CMV seronegative women. Preconception maternal immunity and maternal age of
25 years or older were significantly associated with decreased risk of congenital
Childhood exposure to BCG vaccine has been suggested to have a protective
effect against development of allergic diseases, but the evidence is inconsistent.
Krause and colleagues compared the prevalence of atopy, as determined by assays
for specific IgE against common inhalant allergens, among children aged 8
to 16 years in Greenland who received BCG vaccine with the prevalence of atopy
among children who did not receive the vaccine. The risk of atopy among children
who received BCG vaccine was not significantly different from that among children
who did not receive BCG vaccine. Among children who received BCG vaccine,
age at vaccination was not associated with risk of atopy.
"I feel sad for the parents of this baby. Watching them over the last
few weeks, I have grown fond of them, even without really knowing them." From
"The Cross-Cover Resident."
Transfusion-transmitted infections: current and emerging risks.
The use of testosterone replacement products is prompting concern among
researchers who say data on long-term safety are lacking. At a recent meeting,
experts proposed launching a large clinical trial to sort out potential benefits
and adverse effects.
Mr V, a 57-year-old man, has severe osteoarthritis of his left knee,
but continues to be an active long-distance cyclist. Lonner discusses the
epidemiology, natural history, causes, and diagnosis of knee osteoarthritis
and nonsurgical and surgical treatment options.
For your patients: Information about osteoarthritis of the knee.
This Week in JAMA. JAMA. 2003;289(8):947. doi:10.1001/jama.289.8.947