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This Week in JAMA
October 12, 2005

This Week in JAMA

JAMA. 2005;294(14):1729. doi:10.1001/jama.294.14.1729
Comorbidity and Survival Disparities in Breast Cancer

The shorter survival of black vs white women with breast cancer remains unexplained. Tammemagi and colleagues assessed the association of comorbid conditions with survival in a cohort of black and white breast cancer patients who were followed up for a median of 10 years. They found more recurrence/progression and worse all-cause, breast cancer–specific, and competing-cause survival in black women. Adverse comorbidities, more common in black than white women, were associated with worse all-cause and competing-cause survival, but that did not explain racial disparity in breast cancer–specific survival.

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Trends in Serum Lipids and Lipoproteins

Carroll and colleagues examined data from 5 national cross-sectional surveys, conducted between 1960 and 2002, to assess trends in serum lipids and lipoprotein levels. They report significant declines in mean total and low-density lipoprotein cholesterol levels in men aged 60 to 76 years and women aged 50 to 74 years, no change in high-density lipoprotein cholesterol levels, and a small nonsignificant increase in triglyceride levels. They report that a Healthy People 2010 goal of a maximum of 17% of adults with a total cholesterol level of 240 mg/dL (≥6.22 mmol/L) or higher has been achieved.

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End-stage Renal Disease in Type 1 Diabetes

Finne and colleagues estimated the risk of end-stage renal disease (ESRD) and risk modification in a cohort of patients younger than 30 years diagnosed with type 1 diabetes from 1965 to 1999. They report a cumulative incidence of ESRD of 2.2% at 20 years and 7.8% at 30 years after diagnosis. A diabetes diagnosis before age 5 years and in the later years of the study period were associated with less risk of developing ESRD.

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Quality and Pay-for-Performance

Interest in pay-for-performance mechanisms for quality improvement is growing, but little evidence of their effectiveness exists. Rosenthal and colleaguesArticle evaluated the impact of a health plan’s pay-for-performance program by comparing the performance of California physicians, hospitals, and health plans that were subject to pay-for-performance incentives with those in the Pacific Northwest who were not. The authors found that both groups improved on the 3 quality measures assessed, with the California network outperforming those in the Pacific Northwest on just 1 of the measures. In an editorial, DudleyArticle discusses the design, interpretation, and research funding for these strategies.

Candesartan, Nonfatal MI, and Cardiovascular Death

In a randomized, placebo-controlled trial of patients receiving optimal therapy for heart failure, Demers and colleagues investigated the effect of candesartan, an angiotensin receptor blocker, on risk of nonfatal myocardial infarction (MI) or cardiovascular death. During a median follow-up of 37.7 months, patients receiving candesartan were at significantly lower risk of this composite outcome compared with patients receiving placebo.

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Fibrinogen and Disease Outcomes

To examine the relationship of plasma fibrinogen concentration with risk of incident coronary heart disease (CHD) and other major vascular and nonvascular outcomes, members of the Fibrinogen Studies Collaboration conducted a meta-analysis of individual data from 154 211 adult participants in 31 prospective studies. They found moderately strong associations of usual plasma fibrinogen concentration with risks of CHD, stroke, and other vascular and nonvascular mortality in healthy middle-aged and older adults.

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Medical News & Perspectives

Genetic studies are helping to reveal the etiology of Marfan syndrome and providing hope of better therapies for individuals with the disorder.

(Photo credit: Rick Guidotti/NMF)

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CLINICIAN’S CORNER

Conceptual and practical aspects of palliative sedation are reviewed by Lo and Rubenfeld in their discussion of Mrs B, a 49-year-old woman with widely metastatic breast cancer and despite skilled palliative care, distressing, unrelieved symptoms.

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Liability Concerns and Flu Vaccine Supply

An examination of litigation history and the role of liability relief in averting future influenza vaccine shortages.

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JAMA Patient Page

For your patients: Information about palliative sedation.

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