This Week in JAMA FREE

Cross-sectional studies have linked sleep-disordered breathing with poor cognition; however, it is unclear whether sleep-disordered breathing precedes cognitive impairment in older adults. Yaffe and colleagues Article examined this question in a prospective study of 298 older women without dementia who underwent overnight in-home polysomnography. The authors found that, compared with women without sleep-disordered breathing, women with sleep-disordered breathing—reflected in measures of hypoxia but not sleep fragmentation—had an increased risk of developing cognitive impairment after a mean 4.7 years of follow-up. In an editorial, Canessa and Ferini-Strambi Article discuss the potential role of sleep-disordered breathing in cognitive decline among older adults.

Among persons with end-stage renal disease (ESRD), racial disparities in access to and quality of care are well documented. Yet black patients with ESRD survive longer while undergoing dialysis than white patients. Kucirka and colleagues hypothesized that differences in age and differential rates of kidney transplantation among black and white ESRD patients modify the risk of death while receiving dialysis. In an analysis of data from 909 841 patients with incident ESRD included in the United States Renal Data System between 1995 and 2009, the authors confirmed that in aggregate, black patients have a lower risk of death while receiving dialysis. However, in analyses stratified by age and treating kidney transplantation as a competing risk, black patients younger than 50 years had a significantly higher risk of death than their white counterparts.

Noninvasive prenatal diagnosis of fetal sex through detection of cell-free fetal DNA sequences in maternal blood or urine may offer an alternative to invasive techniques for diagnosing sex-linked inherited disorders. In a systematic review and meta-analysis including 57 studies, Devaney and colleagues assessed the reliability of tests for fetal sex determination using markers in cell-free fetal DNA. The authors report that tests using maternal blood performed well, particularly those that used reverse transcription–quantitative polymerase chain reaction methods. Urine-based tests and those performed before 7 weeks' gestation were unreliable.

Mr Y is a healthy 42-year-old man who presents to establish care with a new physician. His medical and behavioral histories suggest he is at relatively low risk of human immunodeficiency virus (HIV) infection and he declines HIV testing. Libman discusses the rationale for HIV screening, its potential benefits and risks, current testing options, and barriers to incorporating HIV screening into routine care.

An August Archives of Ophthalmology report describes the case of a patient with an ovarian retinoblastoma that had a genomic profile distinct from her childhood eye tumor. Levin and O’Brien discuss the molecular biology of retinoblastoma and factors that may predispose retinoblastoma survivors to second primary tumors.

“I worried about how my future would unfold. How on earth would I ever go out on a date with a boy?” From “A Great Case.”

A recent controversy involving the agency that evaluates drugs in Europe highlights long-standing concerns about the inaccessibility of data from unpublished clinical trials sponsored by pharmaceutical companies.

The individual mandate and patient-centered care

Physicians' role in medical cost control

Genomic technology and pharmacological traits

Join Ross Zafonte, DO, Wednesday, August 17, from 2 to 3 PM eastern time to discuss sports-related concussion in adolescents. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Winker summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Mr X is an elderly man with multiple medical problems and limited health literacy. How would you reduce complexity in his medical care and ensure he understands his self-care needs? Read the case at www.jama.com. Submit your response by September 14 for possible online posting.

For your patients: Information about systemic lupus erythematosus.