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.
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.
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.
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.
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.
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.
Genetic studies are helping to reveal the etiology of Marfan syndrome
and providing hope of better therapies for individuals with the disorder.
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,
An examination of litigation history and the role of liability relief
in averting future influenza vaccine shortages.
For your patients: Information about palliative sedation.
This Week in JAMA . JAMA. 2005;294(14):1729. doi:10.1001/jama.294.14.1729