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Racial Disparity in Managed Care vs Fee-for-Service Plans
Racial disparities in the use of health care resources have been well
documented. In this analysis of data from the 1996 Medicare Current Beneficiary
Survey, Schneider and colleaguesArticle report that rates of influenza vaccination
were higher among both blacks and whites enrolled in Medicare managed care
than in fee-for-service insurance, but the racial disparity in vaccination
rates was similar in the 2 health plan groups. In a commentary, KatzArticle considers
how factors that influence patient preferences may contribute to racial disparity.
Lifespan of Clinical Practice Guidelines
Practice guidelines must be both valid and up-to-date to be clinically
useful. Shekelle and colleaguesArticle assessed the current validity of 17 guidelines
developed between 1990 and 1996 and found that 13 required updating. About
half of the guidelines were outdated in 5.8 years. In an editorial, BrowmanArticle
suggests frequent updating as a method to maintain guidelines that is both
pragmatic and likely to preserve the validity of the original document.
LDL Particle Size and Coronary Events
Evidence suggesting an association between low-density lipoprotein (LDL)
particle size and coronary heart disease has been inconsistent and contradictory.
Campos and colleagues investigated whether LDL particle size was an independent
predictor of recurrent coronary events in patients with known coronary heart
disease who participated in a randomized placebo-controlled trial of pravastatin.
The mean LDL particle size was identical in case patients—those who
experienced a coronary death or myocardial infarction during the trial follow-up
period—and controls. Large LDL particle size was an independent predictor
of coronary events only among patients in the placebo group.
Blood Donors With Hereditary Hemochromatosis
The use of blood from donors with hereditary hemochromatosis has been
restricted by regulatory policies, in part because of the perceived risk associated
with possible financial incentives related to therapeutic phlebotomy. In this
survey of blood donors from 8 US blood centers, Sanchez and colleagues found
that almost half of donors with hemochromatosis reported donating for therapeutic
reasons, but the prevalence of unreported deferrable risks for transfusion-transmissible
viral infections and positive screening test results was similar in donors
with hemochromatosis and non–health-related donors.
Cost-effectiveness of AEDs on Commercial Aircraft
The Federal Aviation Administration has issued a ruling requiring all
commercial aircraft with at least 1 flight attendant to carry automated external
defibrillators (AEDs) by 2004. In this cost-effectiveness analysis of different
options for AED deployment in commercial aircraft, Groeneveld and colleagues
found that the incremental cost per quality-adjusted life-year gained of placing
AEDs on mid-sized and large-capacity commercial aircraft compared favorably
with other accepted health care and transportation safety interventions.
A Woman With an Extremely Premature Newborn
After an uneventful pregnancy until the 24th week of gestation, Mrs
C delivered an 830-g infant at 25 weeks' gestation by emergency cesarean delivery.
Richardson discusses the survival, early complications, and long-term outcomes
of very low-birth-weight infants.
A Piece of My Mind
"It has been six months since he died, master of the garden, master
of everything. His garden personifies him—vivid, unpredictable, maverick,
cynical, nuanced in every aspect. Beautiful." From "Futility."
Type 2 diabetes mellitus in children.
Medical News & Perspectives
A scientific meeting meant to clarify issues surrounding cloning generated
more heat than light, but studies by experts in epigenetics are resulting
in answers to some basic questions about this novel method of reproduction.
Subcutaneous Ovarian Transplantation
Transplantation of ovarian cortical strips to the forearm preserved
endocrine function in women undergoing sterilizing cancer therapy or surgery.
Calculating Adjusted Survival Curves
The mean of covariates method to calculate adjusted survival curves,
commonly used despite questionable validity, is compared with the corrected
group prognosis method.
JAMA Patient Page
For your patients: Information about type 2 diabetes mellitus in children.
This Week in JAMA. JAMA. 2001;286(12):1415. doi:10.1001/jama.286.12.1415
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