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In patients with chronic hepatitis C virus genotype 2 or 3 participating in this randomized trial, the sustained virologic response rate was higher with 24 weeks of peginterferon and ribavirin than with 16 weeks of treatment (70% vs. 62%, P<0.001). In the subgroup of patients with a rapid virologic response, sustained response rates were 85% in the 24-week group and 79% in the 16-week group (P=0.02).
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In 1998, fortification of cereal products with folic acid became mandatory in Canada. The authors assessed the prevalence of neural-tube defects in seven Canadian provinces before and after the implementation of folic acid fortification; they found that the rate of defects was reduced almost by half and that the magnitude of reduction was proportional to the prefortification baseline rate in each province. These data are evidence of beneficial effects of food fortification with folic acid on rates of neural-tube defects in Canada.
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Using longitudinal self-reported data about health care use from 1992 to 2004, this study showed that adults who were uninsured before becoming eligible for Medicare had higher health care use after the age of 65 years than those who were previously insured. These findings suggest that the additional cost of providing Medicare coverage before age 65 may be offset by reductions in Medicare costs after age 65.
A healthy 33-year-old woman comes to establish care. She has no breast symptoms, her age at menarche was 14 years, and she has no children. She notes a family history of early-onset breast cancer in her sister, mother, and maternal aunt. Her maternal grandfather died of prostate cancer. What screening and risk-reduction strategies would you advise?
A 58-year-old woman was admitted to this hospital because of a recent history of progressive fatigue and right-sided weakness, with headache and word-finding difficulty. Similar episodes had occurred over the previous 3 years, with increasing frequency and with residual right-sided weakness. She had a 30-year history of type 1 diabetes, complicated by retinopathy, neuropathy with gastroparesis, nephropathy, and cardiovascular disease. Symptoms of gastroparesis progressed; the patient refused further care and died. An autopsy was performed.
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In 2004, the United Kingdom invested $3.2 billion in a new program to reward general practitioners for the delivery of high-quality care. The authors examine longitudinal data on quality and report that the incentive program may have prompted a modest improvement in the quality of care for two of the three chronic conditions they studied.
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