Data from National Health and Nutrition Examination Surveys (NHANES)
from 1960 through 1991 suggest that the prevalence of hypertension in the
US population is decreasing, but self-reported rates of hypertension in Behavioral
Risk Factor Surveillance System surveys were higher in 1999 than in 1991.
In this analysis of data from the 1999-2000 NHANES, Hajjar and Kotchen report
that 28.7% of NHANES participants had hypertension, an increase of 3.7% from
the 1988-1991 NHANES. Hypertension control rates increased slightly, but were
Dietary supplements containing isoflavones derived from soy or red clover
are increasingly being used as alternative treatments for menopausal symptoms.
Tice and colleagues conducted a randomized trial among menopausal women who
were experiencing 35 or more hot flashes per week to compare the efficacy
of 2 dietary supplements derived from red clover, Promensil and Rimostil,
with placebo. After 12 weeks of treatment, reductions in hot flashes and improvements
in quality of life were not significantly different in the 3 study groups.
Ruo and colleagues conducted a cross-sectional study of adults with
stable coronary artery disease (CAD) to examine the relative influence of
depressive symptoms and cardiac function on health status. Depressive symptoms
were significantly associated with patient-reported health status, including
symptom burden, physical limitation, disease-specific quality of life, and
overall health. In contrast, 2 traditional measures of cardiac function—left
ventricular ejection fraction and ischemia—were not associated with
health status outcomes.
Annual dollar limits ("caps") on drug benefits have been considered
as a way to provide a national Medicare drug benefit at reasonable costs.
Tseng and colleagues conducted a cross-sectional analysis of 2001 pharmacy
claims data from a Medicare + Choice managed care plan to determine how cap
levels affect the percentage of patients exceeding the cap and their out-of-pocket
drug costs. A total of 22%, 14%, and 4% of Medicare patients exceeded caps
of $750, $1000, and $2000, respectively. After exceeding caps, patients faced
a potential 2- to 3-fold increase in median out-of-pocket costs to continue
using the same prescriptions as before exceeding caps. For patients who exceeded
the lowest cap, yearly out-of-pocket drug costs ranged from $564 to $4201
(5th-95th percentiles). Most of the medications with the highest total prescription
expenditures for patients who exceeded the cap were for chronic conditions.
Systemic activation of the coagulation cascade has been postulated to
contribute to organ dysfunction and mortality in patients with sepsis. Abraham
and colleagues Article conducted a randomized trial
among patients with severe sepsis and elevated international normalized ratio
(≥1.2) to determine if a 96-hour infusion of tissue factor pathway inhibitor
(TFPI), which blocks coagulation at its earliest stages, would decrease mortality.
At 28 days after initiation of medication, all-cause mortality in the TFPI
group was not significantly different from that in the placebo group. In an
editorial, Angus and Crowther Articleexamine why this
trial failed and discuss implications for future studies of naturally occurring
anticoagulants for treatment of severe sepsis.
"Physicians don't want to take care of these people, and insurance companies
don't want to pay for their care." From "Patients Like Linda."
Transplantation experts say that the long-term health effects for living
organ donors are unknown and that some kind of registry or database is needed
to track outcomes.
A cost-effectiveness analysis using a Markov model indicates that newer
treatments for chronic hepatitis C virus (HCV) infection appear on average
to be reasonably cost-effective, but results varied widely across different
patient subgroups and depended on quality-of-life assumptions.
Advances in the treatment of age-related cataracts.
In this discussion of psychological mechanisms underlying financial
conflicts of interest, Dana and Lowenstein conclude that gifts from pharmaceutical
companies to physicians should be prohibited.
For your patients: Information about cataracts.
This Week in JAMA . JAMA. 2003;290(2):157. doi:10.1001/jama.290.2.157