This Week in JAMA FREE

Paying individuals to donate organs has been proposed or justified as a way to increase the supply of organs for transplantation and to benefit donors by improving their economic status. In this survey of individuals who sold a kidney in Chennai, India, Goyal and colleaguesArticle found that almost all respondents had sold a kidney to pay off debt, but at an average of 6 years after nephrectomy, three fourths of respondents were still in debt, average annual family income had declined by one third, and the percentage of respondents living below the poverty line had increased. Most respondents reported a deterioration in their health status after nephrectomy. In a commentary, RothmanArticle discusses economic implications of selling organs for transplantation, noting how commerce in organs hinders organ donation.

In this randomized controlled trial, Weinberger and colleaguesArticle compared a pharmaceutical care program in community pharmacies with a peak expiratory flow rate (PEFR) monitoring control group and a usual care control group for patients with asthma or chronic obstructive pulmonary disease. The pharmaceutical care program provided pharmacists with patient-specific clinical data and included pharmacist training, patient education materials, and program support. Patients receiving pharmaceutical care had significantly higher peak flow rates than patients in the usual care group, but not compared with patients in the PEFR monitoring control group. Differences in medication compliance and health-related quality of life were not significant among the 3 groups. Patients with asthma in the pharmaceutical care group had significantly more breathing-related emergency department or hospital visits than those in the usual care group. In an editorial, Strom and HennessyArticle emphasize the importance of evaluating programmatic interventions in clinical care with rigorous, controlled studies.

Minority children have higher rates of substantiated maltreatment than do white children, but it is not clear whether minority children are abused more frequently or whether their cases are more likely to be reported. Lane and colleagues conducted a retrospective chart review at an urban US children's hospital among children younger than 3 years hospitalized for treatment of an acute primary skull or long bone fracture. Abusive fractures occurred more commonly among minority children than among white children, but minority children were also more likely to be evaluated and reported for suspected abuse even after controlling for the likelihood of abusive injury.

Hysteroscopy is used extensively for the evaluation of uterine bleeding disorders. Clark and colleagues conducted a quantitative systematic review to estimate the diagnostic accuracy of hysteroscopy for endometrial cancer and hyperplasia in women with abnormal uterine bleeding. Diagnostic accuracy of hysteroscopy was high for endometrial cancer, but only moderate for endometrial disease (cancer and/or hyperplasia).

In this literature review, Stewart identifies plausible mechanisms by which exercise training may improve the cardiovascular health of persons with type 2 diabetes and hypertension. Evidence for an exercise training benefit was strongest for improvements in endothelial vasodilator function and left ventricular diastolic function. Stewart proposes general guidelines for exercise prescriptions for patients with diabetes and hypertension.

A case linking West Nile virus and organ transplantation has spurred attempts to discover whether the infection can be transmitted through blood and ignited interest in developing a screening test.

Grand Rounds at the Johns Hopkins Hospital

Stone discusses the evaluation and treatment of a 30-year-old man with a 12-year illness diagnosed as Still disease who had persistent symptoms despite treatment with high doses of corticosteroids.

Approaches to challenges in international health.

For your patients: Information about endometrial cancer.