This Week in JAMA FREE

Increased competition in the medical marketplace, intended to address issues of cost and quality, may jeopardize other important functions of a health care system. In a survey of a national sample of US physicians in clinical practice, Cunningham and colleaguesArticle found that although 77.3% of respondents reported that they had provided charity care during the month prior to the survey, physicians were less likely to provide charity care as the proportion of their practice revenue derived from managed care plans increased. Weissman and colleagues, based on a national survey of medical school research faculty, found that the proportion of research funds from institutional sources was significantly higher in schools in less competitive local markets than in those in more competitive markets. In an editorial, FletcherArticle proposes that all health care payers contribute to a pool to fund medical teaching, research, and community service.

Valeur-Jensen and coworkers studied a population-based cohort of pregnant women to estimate the incidence of and risk factors for parvovirus B19 infection, an infection that has been associated with fetal loss in 1% to 9% of cases acquired during pregnancy. They report that 65% of the study population had parvovirus B19–specific IgG antibodies in the first trimester of pregnancy, evidence of past infection. The estimated annual rate of seroconversion during a parvovirus B19 epidemic period was 13% and during endemic periods, 1.5%. Risk of seroconversion during pregnancy increased significantly with increased exposure to children in the household, especially those aged 6 to 7 years. Occupational contact with young children also increased the risk of seroconversion, but not as much as exposure to one's own children.

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In a prospective study, Khattak and colleagues found that the risk of major congenital malformations among infants born to women with occupational exposure to organic solvents during the entire first trimester of pregnancy was significantly higher than that among matched controls. All of the major malformations occurred in infants of women who reported symptoms associated with their exposure. A higher rate of fetal distress and lower mean birth weight were associated with maternal exposure longer than 7 months compared with shorter exposures of 3 to 7 months.

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Abstracts are the most frequently read section of research articles and are widely disseminated in secondary publications and databases. Pitkin and colleaguesArticle evaluated the quality of abstracts in 44 articles from each of 6 major general medical journals. The proportion of abstracts that contained data inconsistent with that reported in the text or not found in the text of the article ranged from 18% to 68%. In an editorial, WinkerArticle outlines the criteria used by JAMA to improve the accuracy and quality of abstracts and the rationale on which they are based.

Ms B is grateful for the relief from feelings of anxiety and depression afforded by alprazolam therapy, but her physician is concerned about benzodiazepine dependence. Salzman discusses the appropriate use of benzodiazepines and the adverse effects of benzodiazepines in elderly patients.

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"We sit around a table, the Ethics Committee, a team of caregivers called together to decide about a different kind of care." From "A Mother's Voice."

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Advanced telecommunications systems support diverse telemedicine programs, but clinical effectiveness and policy questions remain.

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Clinicians giving potent combinations of antiretroviral drugs to patients with HIV to suppress the virus are finding how much the effectiveness of such regimens depends on strict adherence.

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Recommendations for prevention of a first stroke from the National Stroke Association emphasize the need to help patients adhere to strategies that reduce stroke risk.

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An analysis of the portrayal of tobacco and alcohol use in children's animated films.

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For your patients: Guide to prevention of a first stroke.

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