Racial disparities in health care are well documented, but little is
known about racial differences in genetic susceptibility testing. Armstrong
and colleaguesArticle investigated the relationship between race and use of
BRCA1/2 counseling among women with a family history of
breast or ovarian cancer and assessed the contributions of socioeconomic factors,
probability of carrying a BRCA1/2 mutation, cancer
risk perceptions and worry, attitudes about genetic testing, and physician
recommendations to the counseling decision. They found that African American
women were significantly less likely than white women to undergo genetic counseling,
with much of the disparity unexplained by the potential confounders considered.
In an editorial, Hall and OlopadeArticle discuss factors contributing to race- and
ethnicity-related disparities in cancer prevention and general preventive
Elderly patients with chronic kidney disease are at increased risk of
cardiovascular mortality, but the relative importance of traditional vs novel
risk factors in predicting risk has not been evaluated. Shlipak and colleagues
assessed the predictive value of traditional and novel risk factors in a longitudinal
study of patients with and without chronic kidney disease. Among patients
with chronic kidney disease, traditional risk factors including left ventricular
hypertrophy, current smoking, physical inactivity, systolic hypertension,
diabetes, and nonuse of alcohol were better predictors of cardiovascular mortality
than novel risk factors.
Incorrect dosing of fibrinolytic therapy has been associated with adverse
clinical outcomes, but whether the adverse events are related to the dosing
errors or patient factors is not clear. Mehta and colleagues analyzed data
from a randomized trial in which patients with an ST-segment elevation myocardial
infarction were assigned to either a bolus of tenecteplase (with alteplase
placebo) or a bolus of alteplase (with tenecteplase placebo) to examine the
relationships between fibrinolytic therapy dose, patient factors, and adverse
outcomes. In their analyses, adverse outcomes were as likely in patients with
alteplase placebo dosing errors as in patients with alteplase dosing errors,
suggesting that patient-related factors, not fibrinolytic dosing errors, are
responsible for the adverse outcomes.
Buttery and colleagues report results of a randomized trial assessing
the safety and immunogenicity of a combination 9-valent pneumococcal–group
C meningococcal conjugate candidate vaccine (Pnc9-MnC) compared with a monovalent
group C meningococcal conjugate (MenC) in infants. Reports of increased irritability
and decreased activity were higher in the Pnc9-MnC group, and infants receiving
the Pnc9-MnC vaccine had reduced group C meningococcal immunogenicity compared
with those receiving the MenC vaccine.
To better establish the role of abciximab as adjunctive therapy to reperfusion
in ST-segment elevation myocardial infarction (STEMI), De Luca and colleagues
conducted a meta-analysis of data from 11 randomized trials of abciximab in
STEMI. They found that compared with patients in the control group, patients
undergoing primary angioplasty and receiving abciximab had significant reductions
in 30-day and 6- to 12-month mortality, and the 30-day reinfarction rate was
reduced in patients receiving abciximab and treated with either fibrinolysis
or primary angioplasty. Major bleeding complications were more common in patients
receiving fibrinolytics and abciximab compared with those among control patients.
Researchers are exploring the use of transcranial magnetic stimulation,
a technique that uses a magnetic field to induce small electrical currents
in the brain, as a potential treatment for depression and other brain conditions.
Guidance for understanding when incidental disclosures of patient information
are ethically permissible under US federal health privacy regulations.
Ms Q is a 64-year-old woman with a history of hypercalcemia. Strewler
discusses the evaluation of patients with hyperparathyroidism, end-organ effects,
and treatment options.
Accurate assessment of child health requires data on biological, behavioral,
environmental, and social factors.
For your patients: Information about hyperparathyroidism.
This Week in JAMA . JAMA. 2005;293(14):1701. doi:10.1001/jama.293.14.1701