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This Week in JAMA
JAMA. 2007;298(24):2829.
Pathogenic BRCA1 Carrier Prevalence
Mutations in the tumor suppressor gene BRCA1 confer a high risk of breast and ovarian cancer. The mutations are more frequent in persons of Ashkenazi Jewish ancestry or those with multiple affected relatives or early onset disease, but relatively little is known about the prevalence of BRCA1 mutations in racial/ethnic minorities. John and colleagues (SEE ARTICLE) examined the prevalence of BRCA1 mutations in a population-based cohort of female breast cancer patients in San Francisco and estimated carrier prevalence in Hispanic, African American, and Asian American patients vs non-Hispanic white patients with and without Ashkenazi Jewish ancestry. The authors report estimated prevalences of BRCA1 mutations of 3.5% in Hispanic, 1.3% in African American, and 0.5% in Asian American patients compared with prevalences of 8.3% in Ashkenazi Jews and 2.2% in other non-Hispanic white patients. In an editorial, Olopade and Huo (SEE ARTICLE) discuss genetic testing and cancer-risk assessment in minority populations.
Transient Neurological Attacks
In the assessment of patients with transient attacks of neurological dysfunction, a distinction is often made between attacks characterized by focal symptoms (transient ischemic attacks [TIAs]) and attacks characterized by diffuse, nonlocalizing symptoms—often considered more benign than TIAs. In an analysis of data from 6062 participants in a prospective population-based cohort study of chronic disease in Rotterdam, the Netherlands, Bos and colleagues (SEE ARTICLE) assessed the incidence and prognosis of transient neurological attacks (TNAs), a category that included focal transient neurological dysfunction (focal TNAs or TIAs), nonfocal TNAs, and mixed focal and nonfocal TNAs. The authors report that during 60 535 person-years of follow-up, a TNA occurred in 548 participants (282 focal, 228 nonfocal, and 38 mixed). Among the authors' findings were that persons with focal TNAs had a higher risk of stroke, and persons with nonfocal TNAs a higher risk of stroke and dementia compared with persons without TNAs. In an editorial, Johnston (SEE ARTICLE) discusses the utility of TNA as a broad diagnostic category and considers the implications of the reported findings for the evaluation of patients with nonfocal neurological symptoms.
Benefits of Insurance for the Previously Uninsured
To assess the effects of acquiring Medicare coverage on the health of previously uninsured adults, McWilliams and colleagues analyzed nationally representative survey data (1992-2004) from adults who were continuously insured or were persistently or intermittently uninsured between the ages of 55 to 64 years and compared changes in self-reported health among the previously insured vs the previously uninsured study participants. The authors found that summary health scores were significantly worse for the uninsured vs the insured participants before age 65 years. However, compared with previously insured adults, previously uninsured adults reported significant improvements in health after acquiring Medicare coverage.
(SEE ARTICLE)
Repair of Combat-Related Facial Fractures
From the Archives Journals
An article in the Archives of Facial Plastic Surgery reports patient outcomes following definitive in-theater (Iraq) facial fracture repair. Holt discusses the capabilities of combat zone military hospitals.
(SEE ARTICLE)
A Piece of My Mind
"I recoil at the horror of even contemplating euthanasia, mainly because it goes against the grain of everything I was taught as a physician." From "In Search of Redemption."
(SEE ARTICLE)
Medical News & Perspectives
Researchers are seeking ways to hasten delivery of lifesaving therapies that restore circulation in blocked coronary arteries of patients experiencing acute myocardial infarction.
(SEE ARTICLE)
CLINICIAN'S CORNER
Pediatric UTI
The Rational Clinical Examination
Individual signs and symptoms of urinary tract infection (UTI) in children lack sufficient accuracy for a definitive diagnosis.
(SEE ARTICLE)
Commentary
Regulating expert witness testimony
(SEE ARTICLE)
Readers Respond
How would you manage a 39-year-old man with erythema and swelling of a finger? Go to www.jama.com to read the case. Submission deadline is December 26. Your response may be selected for online publication.
Author in the Room Teleconference
Join Ian George Williamson, MD, from 2 to 3 PM eastern time on January 16, 2008, to discuss antibiotics and nasal steroids for acute sinusitis. To register, go to http://www.ihi.org/AuthorintheRoom.
JAMA Patient Page
For your patients: Information about transient neurological attacks.
(SEE ARTICLE)
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