Overall survival of children with acute lymphoblastic leukemia (ALL)
has improved during the past several decades, but evidence on the role of
race and ethnicity in survival of children with ALL has been inconsistent.
Pui and colleaguesArticle, in an analysis of data from
children with ALL enrolled in successive clinical trials at a single pediatric
cancer center during the 1990s, found no significant difference in survival
between black and white children. In contrast, in an analysis of data from
Surveillance, Epidemiology, and End Results (SEER) population-based registries
from children diagnosed with ALL in the period 1973-1999, Kaden-Lottick and
colleaguesArticle found that black, Hispanic, and American
Indian/Alaskan Native children with ALL had worse survival than did white
and Asian/Pacific Islander children. In an editorial, CarrollArticle discusses
factors that may explain the discrepancies in survival outcomes across racial
and ethnic groups in these 2 studies.
Alzheimer disease is associated with physical deterioration as well
as with declines in cognitive, emotional, and behavioral functioning. In this
randomized trial among community-dwelling patients with Alzheimer disease,
Teri and colleagues found that patients in the group that received a home-based
exercise program combined with caregiver training in behavioral management
techniques had improved physical role function and depression, whereas physical
function and affective status declined among patients in the routine medical
During a study of the development of mental illness in a sample of rural
children, one quarter of which was American Indian, a casino opened on the
Indian reservation that provided an income supplement to every tribal member.
Costello and colleaguesArticle compared the results
of annual psychiatric assessments of the children from the 4 years before
the casino opened with those from the 4 years after the casino opened. Children
of Indian families whose income increased from below to above the federal
poverty line after the casino opened had a significant decrease in symptoms
of conduct and oppositional defiant disorders, but symptoms of anxiety and
depression were not affected. In an editorial, RutterArticle discusses
the social causation theory of mental illness as an explanation for these
Barzilai and colleagues conducted a case-control study to identify specific
biological and genetic factors associated with exceptional longevity. Long-lived
probands from Ashkenazi Jewish families and their offspring had significantly
larger high-density lipoprotein and low-density lipoprotein particle sizes
than did age-matched control participants, independent of lipoprotein and
apolipoprotein levels. This phenotype was associated with lower prevalence
of hypertension, cardiovascular disease, and the metabolic syndrome and with
increased frequency of homozygosity for the I405V variant in the cholesteryl
ester transfer protein (CETP) gene.
In a recent study, intensive care unit (ICU) and hospital mortalities
were reduced in critically ill patients who received aggressive glycemic control,
but the mortality benefit may have been attributable to blood glucose level,
quantity of exogenous insulin administration, or both. In this prospective
study of adults admitted to an ICU, Finney and colleagues found that increased
administration of insulin was positively associated with ICU mortality regardless
of blood glucose level, suggesting that control of blood glucose levels rather
than absolute levels of exogenous insulin account for the mortality benefit
observed with intensive insulin therapy.
New insights into the genetic changes that drive the cancer process
are emerging from studies with three-dimensional cell cultures, which allow
cells to develop and form structures similar to those in living animals.
Excerpts of interviews from physicians who cared for Dr B during his
terminal illness and from his son, also a physician, illustrate issues unique
to end-of-life care of patients who are physicians.
Causes of visual impairment.
For your patients: Information about causes of visual impairment.
This Week in JAMA. JAMA. 2003;290(15):1953. doi:10.1001/jama.290.15.1953