A Senior Primary Care Physician Trying to Take Good Care of His Patients.

JAMA. 2012 Jan 31;

Authors: Reynolds E

PMID: 22298564 [PubMed - as supplied by publisher]

Patient-centered care model demands better physician-patient communication.

JAMA. 2012 Feb 1;307(5):441-2

Authors: Kuehn BM

PMID: 22298662 [PubMed - in process]

The cover. Snowscape with cows at Montfoucault.

JAMA. 2012 Feb 1;307(5):435

Authors: Torpy JM

PMID: 22298661 [PubMed - in process]

Veterans health system cited by experts as a model for patient-centered care.

JAMA. 2012 Feb 1;307(5):442-3

Authors: Kuehn BM

PMID: 22298663 [PubMed - in process]

Programs to reduce childhood obesity seem to work, say Cochrane reviewers.

JAMA. 2012 Feb 1;307(5):444-5

Authors: Mitka M

PMID: 22298665 [PubMed - in process]

FDA: Limited ban on cephalosporin use in major food-producing animals.

JAMA. 2012 Feb 1;307(5):443

Authors: Voelker R

PMID: 22298664 [PubMed - in process]

Panel advises tougher limits on lead exposure.

JAMA. 2012 Feb 1;307(5):445

Authors: Kuehn BM

PMID: 22298666 [PubMed - in process]

Prostate cancer risk and vitamin E.

JAMA. 2012 Feb 1;307(5):453-4; author reply 454

Authors: Gaby AR

PMID: 22298667 [PubMed - in process]

Prostate cancer risk and vitamin E.

JAMA. 2012 Feb 1;307(5):454; author reply 454

Authors: Hoskote SS, Nadkarni GN, Fried ED

PMID: 22298668 [PubMed - in process]

ECMO centers and mortality from influenza A(H1N1).

JAMA. 2012 Feb 1;307(5):454; author reply 454-5

Authors: Haeck JD, Dongelmans DA, Schultz MJ

PMID: 22298669 [PubMed - in process]

Benefits of male circumcision.

JAMA. 2012 Feb 1;307(5):455; author reply 457

Authors: Masem M

PMID: 22298670 [PubMed - in process]

Benefits of male circumcision.

JAMA. 2012 Feb 1;307(5):455-6; author reply 457

Authors: Klausner JD, Morris BJ

PMID: 22298671 [PubMed - in process]

Benefits of male circumcision.

JAMA. 2012 Feb 1;307(5):456; author reply 457

Authors: Darby R

PMID: 22298672 [PubMed - in process]

Benefits of male circumcision.

JAMA. 2012 Feb 1;307(5):456-7; author reply 457

Authors: Croff JM

PMID: 22298673 [PubMed - in process]

Physician medical identity theft.

JAMA. 2012 Feb 1;307(5):459-60

Authors: Agrawal S, Budetti P

PMID: 22298674 [PubMed - in process]

The ethical hazards and programmatic challenges of genomic newborn screening.

JAMA. 2012 Feb 1;307(5):461-2

Authors: Goldenberg AJ, Sharp RR

PMID: 22298675 [PubMed - in process]

Specialization in medicine: how much is appropriate?

JAMA. 2012 Feb 1;307(5):463-4

Authors: Detsky AS, Gauthier SR, Fuchs VR

PMID: 22298676 [PubMed - in process]

A piece of my mind. A doctor’s kid.

JAMA. 2012 Feb 1;307(5):465-6

Authors: Brake M

PMID: 22298677 [PubMed - in process]

Variability in reexcision following breast conservation surgery.

JAMA. 2012 Feb 1;307(5):467-75

Authors: McCahill LE, Single RM, Aiello Bowles EJ, Feigelson HS, James TA, Barney T, Engel JM, Onitilo AA

Abstract

CONTEXT: Health care reform calls for increasing physician accountability and transparency of outcomes. Partial mastectomy is the most commonly performed procedure for invasive breast cancer and often requires reexcision. Variability in reexcision might be reflective of the quality of care.

OBJECTIVE: To assess hospital and surgeon-specific variation in reexcision rates following partial mastectomy.

DESIGN, SETTING, AND PATIENTS: An observational study of breast surgery performed between 2003 and 2008 intended to evaluate variability in breast cancer surgical care outcomes and evaluate potential quality measures of breast cancer surgery. Women with invasive breast cancer undergoing partial mastectomy from 4 institutions were studied (1 university hospital [University of Vermont] and 3 large health plans [Kaiser Permanente Colorado, Group Health, and Marshfield Clinic]). Data were obtained from electronic medical records and chart abstraction of surgical, pathology, radiology, and outpatient records, including detailed surgical margin status. Logistic regression including surgeon-level random effects was used to identify predictors of reexcision.

MAIN OUTCOME MEASURE: Incidence of reexcision.

RESULTS: A total of 2206 women with 2220 invasive breast cancers underwent partial mastectomy and 509 patients (22.9%; 95% CI, 21.2%-24.7%) underwent reexcision (454 patients [89.2%; 95% CI, 86.5%-91.9%] had 1 reexcision, 48 [9.4%; 95% CI, 6.9%-12.0%] had 2 reexcisions, and 7 [1.4%; 95% CI, 0.4%-2.4%] had 3 reexcisions). Among all patients undergoing initial partial mastectomy, total mastectomy was performed in 190 patients (8.5%; 95% CI, 7.2%-9.5%). Reexcision rates for margin status following initial surgery were 85.9% (95% CI, 82.0%-89.8%) for initial positive margins, 47.9% (95% CI, 42.0%-53.9%) for less than 1.0 mm margins, 20.2% (95% CI, 15.3%-25.0%) for 1.0 to 1.9 mm margins, and 6.3% (95% CI, 3.2%-9.3%) for 2.0 to 2.9 mm margins. For patients with negative margins, reexcision rates varied widely among surgeons (range, 0%-70%; P = .003) and institutions (range, 1.7%-20.9%; P < .001). Reexcision rates were not associated with surgeon procedure volume after adjusting for case mix (P = .92).

CONCLUSION: Substantial surgeon and institutional variation were observed in reexcision following partial mastectomy in women with invasive breast cancer.

PMID: 22298678 [PubMed - in process]

Association of emergency department length of stay with safety-net status.

JAMA. 2012 Feb 1;307(5):476-82

Authors: Fee C, Burstin H, Maselli JH, Hsia RY

Abstract

CONTEXT: Performance measures, particularly pay for performance, may have unintended consequences for safety-net institutions caring for disproportionate shares of Medicaid or uninsured patients.

OBJECTIVE: To describe emergency department (ED) compliance with proposed length-of-stay measures for admissions (8 hours or 480 minutes) and discharges, transfers, and observations (4 hours or 240 minutes) by safety-net status.

DESIGN, SETTING, AND PARTICIPANTS: The 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS) ED data were stratified by safety-net status (Centers for Disease Control and Prevention definition) and disposition (admission, discharge, observation, transfer). The 2008 NHAMCS is a national probability sample of 396 hospitals (90.2% unweighted response rate) and 34 134 patient records. Visits were excluded for patients younger than 18 years, missing length-of-stay data or dispositions of missing, other, left against medical advice, or dead on arrival. Median and 90th percentile ED lengths of stay were calculated for each disposition and admission/discharge subcategories (critical care, psychiatric, routine) stratified by safety-net status. Multivariable analyses determined associations with length-of-stay measure compliance.

MAIN OUTCOME MEASURES: Emergency Department length-of-stay measure compliance by disposition and safety-net status.

RESULTS: Of the 72.1% ED visits (N = 24 719) included in the analysis, 42.3% were to safety-net EDs and 57.7% were to non-safety-net EDs. The median length of stay for safety-net was 269 minutes (interquartile range [IQR], 178-397 minutes) for admission vs 281 minutes (IQR, 178-401 minutes) for non-safety-net EDs; 156 minutes (IQR, 95-239 minutes) for discharge vs 148 minutes (IQR, 88-238 minutes); 355 minutes (IQR, 221-675 minutes) for observations vs 298 minutes (IQR, 195-440 minutes); and 235 minutes (IQR, 155-378 minutes) for transfers vs 239 minutes (IQR, 142-368 minutes). Safety-net status was not independently associated with compliance with ED length-of-stay measures; the odds ratio was 0.83 for admissions (95% CI, 0.52-1.34); 1.03 for discharges (95% CI, 0.83-1.27); 1.05 for observations (95% CI, 0.57-1.95), 1.30 for transfers (95% CI, 0.70-2.45]); or subcategories except for psychiatric discharges (1.67, [95% CI, 1.02-2.74]).

CONCLUSION: Compliance with proposed ED length-of-stay measures for admissions, discharges, transfers, and observations did not differ significantly between safety-net and non-safety-net hospitals.

PMID: 22298679 [PubMed - in process]

The challenge of developing quality measures for breast cancer surgery.

JAMA. 2012 Feb 1;307(5):509-10

Authors: Morrow M, Katz SJ

PMID: 22298680 [PubMed - in process]

National reporting of emergency department length of stay: challenges, opportunities, and risks.

JAMA. 2012 Feb 1;307(5):511-2

Authors: Emerman CL

PMID: 22298681 [PubMed - in process]

JAMA patient page. Prostatitis.

JAMA. 2012 Feb 1;307(5):527

Authors: Pluta RM, Lynm C, Golub RM

PMID: 22298682 [PubMed - in process]

Oral Human Papillomavirus Infection: Hazard of Intimacy.

JAMA. 2012 Jan 26;

Authors: Schlecht HP

PMID: 22282320 [PubMed - as supplied by publisher]

Prevalence of Oral HPV Infection in the United States, 2009-2010.

JAMA. 2012 Jan 26;

Authors: Gillison ML, Broutian T, Pickard RK, Tong ZY, Xiao W, Kahle L, Graubard BI, Chaturvedi AK

Abstract

Context Human papillomavirus (HPV) infection is the principal cause of a distinct form of oropharyngeal squamous cell carcinoma that is increasing in incidence among men in the United States. However, little is known about the epidemiology of oral HPV infection.Objective To determine the prevalence of oral HPV infection in the United States.Design, Setting, and Participants A cross-sectional study was conducted as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010, a statistically representative sample of the civilian noninstitutionalized US population. Men and women aged 14 to 69 years examined at mobile examination centers were eligible. Participants (N = 5579) provided a 30-second oral rinse and gargle with mouthwash. For detection of HPV types, DNA purified from oral exfoliated cells was evaluated by polymerase chain reaction and type-specific hybridization. Demographic and behavioral data were obtained by standardized interview. Statistical analyses used NHANES sample weights to provide weighted prevalence estimates for the US population.Main Outcome Measures Prevalence of oral HPV infection.Results The prevalence of oral HPV infection among men and women aged 14 to 69 years was 6.9% (95% CI, 5.7%-8.3%) and of HPV type 16 was 1.0% (95% CI, 0.7%-1.3%). Oral HPV infection followed a bimodal pattern with respect to age, with peak prevalence among individuals aged 30 to 34 years (7.3%; 95% CI, 4.6%-11.4%) and 60 to 64 years (11.4%; 95% CI, 8.5%-15.1%). Men had a significantly higher prevalence than women for any oral HPV infection (10.1% [95% CI, 8.3%-12.3%] vs 3.6% [95% CI, 2.6%-5.0%], P < .001; unadjusted prevalence ratio [PR], 2.80 [95% CI, 2.02-3.88]). Infection was less common among those without vs those with a history of any type of sexual contact (0.9% [95% CI, 0.4%-1.8%] vs 7.5% [95% CI, 6.1%-9.1%], P < .001; PR, 8.69 [95% CI, 3.91-19.31]) and increased with number of sexual partners (P < .001 for trend) and cigarettes smoked per day (P < .001 for trend). Associations with age, sex, number of sexual partners, and current number of cigarettes smoked per day were independently associated with oral HPV infection in multivariable models.Conclusion Among men and women aged 14 to 69 years in the United States, the overall prevalence of oral HPV infection was 6.9%, and the prevalence was higher among men than among women.

PMID: 22282321 [PubMed - as supplied by publisher]

The cover. Lights of other days.

JAMA. 2012 Jan 25;307(4):339

Authors: Cole TB

PMID: 22274675 [PubMed - in process]

Breast cancer symposium highlights risk, recurrence, and research trials.

JAMA. 2012 Jan 25;307(4):348-50

Authors: Hampton T

PMID: 22274677 [PubMed - in process]

Treatment rather than avoidance may be within reach for children with food allergies.

JAMA. 2012 Jan 25;307(4):345-6, 348

Authors: Slomski A

PMID: 22274676 [PubMed - in process]

BRCA1 and BRCA2 mutations in ovarian cancer.

JAMA. 2012 Jan 25;307(4):359; author reply 360-1

Authors: Buerkle B, Tempfer C

PMID: 22274678 [PubMed - in process]

BRCA1 and BRCA2 mutations in ovarian cancer.

JAMA. 2012 Jan 25;307(4):359-60; author reply 360-1

Authors: Swisher E, Walsh T

PMID: 22274679 [PubMed - in process]

Hospital readmissions and measures of quality.

JAMA. 2012 Jan 25;307(4):361; author reply 361-2

Authors: Dardick KR, Stein JA

PMID: 22274680 [PubMed - in process]

Physician autonomy and health care reform.

JAMA. 2012 Jan 25;307(4):367-8

Authors: Emanuel EJ, Pearson SD

PMID: 22274681 [PubMed - in process]

Affordable Care Act litigation: the Supreme Court and the future of health care reform.

JAMA. 2012 Jan 25;307(4):369-70

Authors: Gostin LO, Garcia KK

PMID: 22274682 [PubMed - in process]

A piece of my mind. Of what am I afraid?

JAMA. 2012 Jan 25;307(4):371-2

Authors: Dohrenwend A

PMID: 22274683 [PubMed - in process]

Lansoprazole for children with poorly controlled asthma: a randomized controlled trial.

JAMA. 2012 Jan 25;307(4):373-81

Authors: , Holbrook JT, Wise RA, Gold BD, Blake K, Brown ED, Castro M, Dozor AJ, Lima JJ, Mastronarde JG, Sockrider MM, Teague WG

Abstract

CONTEXT: Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma. Untreated GER has been postulated to be a cause of inadequate asthma control in children despite inhaled corticosteroid treatment, but it is not known whether treatment with proton pump inhibitors improves asthma control.

OBJECTIVE: To determine whether lansoprazole is effective in reducing asthma symptoms in children without overt GER.

DESIGN, SETTING, AND PARTICIPANTS: The Study of Acid Reflux in Children With Asthma, a randomized, masked, placebo-controlled, parallel clinical trial that compared lansoprazole with placebo in children with poor asthma control who were receiving inhaled corticosteroid treatment. Three hundred six participants enrolled from April 2007 to September 2010 at 19 US academic clinical centers were followed up for 24 weeks. A subgroup had an esophageal pH study before randomization.

INTERVENTION: Participating children were randomly assigned to receive either lansoprazole, 15 mg/d if weighing less than 30 kg or 30 mg/d if weighing 30 kg or more (n = 149), or placebo (n = 157).

MAIN OUTCOME MEASURES: The primary outcome measure was change in Asthma Control Questionnaire (ACQ) score (range, 0-6; a 0.5-unit change is considered clinically meaningful). Secondary outcome measures included lung function measures, asthma-related quality of life, and episodes of poor asthma control.

RESULTS: The mean age was 11 years (SD, 3 years). The mean difference in change (lansoprazole minus placebo) in the ACQ score was 0.2 units (95% CI, 0.0-0.3 units). There were no statistically significant differences in the mean difference in change for the secondary outcomes of forced expiratory volume in the first second (0.0 L; 95% CI, -0.1 to 0.1 L), asthma-related quality of life (-0.1; 95% CI, -0.3 to 0.1), or rate of episodes of poor asthma control (relative risk, 1.2; 95% CI, 0.9-1.5). Among the 115 children with esophageal pH studies, the prevalence of GER was 43%. In the subgroup with a positive pH study, no treatment effect for lansoprazole vs placebo was observed for any asthma outcome. Children treated with lansoprazole reported more respiratory infections (relative risk, 1.3 [95% CI, 1.1-1.6]).

CONCLUSION: In this trial of children with poorly controlled asthma without symptoms of GER who were using inhaled corticosteroids, the addition of lansoprazole, compared with placebo, improved neither symptoms nor lung function but was associated with increased adverse events.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00442013.

PMID: 22274684 [PubMed - in process]

Association between BRCA1 and BRCA2 mutations and survival in women with invasive epithelial ovarian cancer.

JAMA. 2012 Jan 25;307(4):382-90

Authors: Bolton KL, Chenevix-Trench G, Goh C, Sadetzki S, Ramus SJ, Karlan BY, Lambrechts D, Despierre E, Barrowdale D, McGuffog L, Healey S, Easton DF, Sinilnikova O, Benítez J, García MJ, Neuhausen S, Gail MH, Hartge P, Peock S, Frost D, Evans DG, Eeles R, Godwin AK, Daly MB, Kwong A, Ma ES, Lázaro C, Blanco I, Montagna M, D’Andrea E, Nicoletto MO, Johnatty SE, Kjær SK, Jensen A, Høgdall E, Goode EL, Fridley BL, Loud JT, Greene MH, Mai PL, Chetrit A, Lubin F, Hirsh-Yechezkel G, Glendon G, Andrulis IL, Toland AE, Senter L, Gore ME, Gourley C, Michie CO, Song H, Tyrer J, Whittemore AS, McGuire V, Sieh W, Kristoffersson U, Olsson H, Borg Å, Levine DA, Steele L, Beattie MS, Chan S, Nussbaum RL, Moysich KB, Gross J, Cass I, Walsh C, Li AJ, Leuchter R, Gordon O, Garcia-Closas M, Gayther SA, Chanock SJ, Antoniou AC, Pharoah PD, , ,

Abstract

CONTEXT: Approximately 10% of women with invasive epithelial ovarian cancer (EOC) carry deleterious germline mutations in BRCA1 or BRCA2. A recent article suggested that BRCA2-related EOC was associated with an improved prognosis, but the effect of BRCA1 remains unclear.

OBJECTIVE: To characterize the survival of BRCA carriers with EOC compared with noncarriers and to determine whether BRCA1 and BRCA2 carriers show similar survival patterns.

DESIGN, SETTING, AND PARTICIPANTS: A pooled analysis of 26 observational studies on the survival of women with ovarian cancer, which included data from 1213 EOC cases with pathogenic germline mutations in BRCA1 (n = 909) or BRCA2 (n = 304) and from 2666 noncarriers recruited and followed up at variable times between 1987 and 2010 (the median year of diagnosis was 1998).

MAIN OUTCOME MEASURE: Five-year overall mortality.

RESULTS: The 5-year overall survival was 36% (95% CI, 34%-38%) for noncarriers, 44% (95% CI, 40%-48%) for BRCA1 carriers, and 52% (95% CI, 46%-58%) for BRCA2 carriers. After adjusting for study and year of diagnosis, BRCA1 and BRCA2 mutation carriers showed a more favorable survival than noncarriers (for BRCA1: hazard ratio [HR], 0.78; 95% CI, 0.68-0.89; P < .001; and for BRCA2: HR, 0.61; 95% CI, 0.50-0.76; P < .001). These survival differences remained after additional adjustment for stage, grade, histology, and age at diagnosis (for BRCA1: HR, 0.73; 95% CI, 0.64-0.84; P < .001; and for BRCA2: HR, 0.49; 95% CI, 0.39-0.61; P < .001). The BRCA1 HR estimate was significantly different from the HR estimated in the adjusted model (P for heterogeneity = .003).

CONCLUSION: Among patients with invasive EOC, having a germline mutation in BRCA1 or BRCA2 was associated with improved 5-year overall survival. BRCA2 carriers had the best prognosis.

PMID: 22274685 [PubMed - in process]

Serum vaccine antibody concentrations in children exposed to perfluorinated compounds.

JAMA. 2012 Jan 25;307(4):391-7

Authors: Grandjean P, Andersen EW, Budtz-Jørgensen E, Nielsen F, Mølbak K, Weihe P, Heilmann C

Abstract

CONTEXT: Perfluorinated compounds (PFCs) have emerged as important food contaminants. They cause immune suppression in a rodent model at serum concentrations similar to those occurring in the US population, but adverse health effects of PFC exposure are poorly understood.

OBJECTIVE: To determine whether PFC exposure is associated with antibody response to childhood vaccinations.

DESIGN, SETTING, AND PARTICIPANTS: Prospective study of a birth cohort from the National Hospital in the Faroe Islands. A total of 656 consecutive singleton births were recruited during 1999-2001, and 587 participated in follow-up through 2008.

MAIN OUTCOME MEASURES: Serum antibody concentrations against tetanus and diphtheria toxoids at ages 5 and 7 years.

RESULTS: Similar to results of prior studies in the United States, the PFCs with the highest serum concentrations were perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA). Among PFCs in maternal pregnancy serum, PFOS showed the strongest negative correlations with antibody concentrations at age 5 years, for which a 2-fold greater concentration of exposure was associated with a difference of -39% (95% CI, -55% to -17%) in the diphtheria antibody concentration. PFCs in the child’s serum at age 5 years showed uniformly negative associations with antibody levels, especially at age 7 years, except that the tetanus antibody level following PFOS exposure was not statistically significant. In a structural equation model, a 2-fold greater concentration of major PFCs in child serum was associated with a difference of -49% (95% CI, -67% to -23%) in the overall antibody concentration. A 2-fold increase in PFOS and PFOA concentrations at age 5 years was associated with odds ratios between 2.38 (95% CI, 0.89 to 6.35) and 4.20 (95% CI, 1.54 to 11.44) for falling below a clinically protective level of 0.1 IU/mL for tetanus and diphtheria antibodies at age 7 years.

CONCLUSION: Elevated exposures to PFCs were associated with reduced humoral immune response to routine childhood immunizations in children aged 5 and 7 years.

PMID: 22274686 [PubMed - in process]

Caregiving burden, stress, and health effects among family caregivers of adult cancer patients.

JAMA. 2012 Jan 25;307(4):398-403

Authors: Bevans M, Sternberg EM

Abstract

Unlike professional caregivers such as physicians and nurses, informal caregivers, typically family members or friends, provide care to individuals with a variety of conditions including advanced age, dementia, and cancer. This experience is commonly perceived as a chronic stressor, and caregivers often experience negative psychological, behavioral, and physiological effects on their daily lives and health. In this report, we describe the experience of a 53-year-old woman who is the sole caregiver for her husband, who has acute myelogenous leukemia and was undergoing allogeneic hematopoietic stem cell transplantation. During his intense and unpredictable course, the caregiver’s burden is complex and complicated by multiple competing priorities. Because caregivers are often faced with multiple concurrent stressful events and extended, unrelenting stress, they may experience negative health effects, mediated in part by immune and autonomic dysregulation. Physicians and their interdisciplinary teams are presented daily with individuals providing such care and have opportunity to intervene. This report describes a case that exemplifies caregiving burden and discusses the importance of identifying caregivers at risk of negative health outcomes and intervening to attenuate the stress associated with the caregiving experience.

PMID: 22274687 [PubMed - in process]

Papules, plaques, and nodules in an immunocompromised patient.

JAMA. 2012 Jan 25;307(4):404-5

Authors: Man XY, Zheng M

PMID: 22274688 [PubMed - in process]

Children, asthma, and proton pump inhibitors: costs and perils of therapeutic creep.

JAMA. 2012 Jan 25;307(4):406-7

Authors: Martinez FD

PMID: 22274689 [PubMed - in process]

Unwrapping the implications of BRCA1 and BRCA2 mutations in ovarian cancer.

JAMA. 2012 Jan 25;307(4):408-10

Authors: Hyman DM, Spriggs DR

PMID: 22274690 [PubMed - in process]

JAMA patient page. Childhood asthma.

JAMA. 2012 Jan 25;307(4):421

Authors: Punnoose AR, Burke AE, Golub RM

PMID: 22274691 [PubMed - in process]

Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010.

JAMA. 2012 Jan 17;

Authors: Flegal KM, Carroll MD, Kit BK, Ogden CL

Abstract

Context Between 1980 and 1999, the prevalence of adult obesity (body mass index [BMI] ≥30) increased in the United States and the distribution of BMI changed. More recent data suggested a slowing or leveling off of these trends.Objective To estimate the prevalence of adult obesity from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) and compare adult obesity and the distribution of BMI with data from 1999-2008.Design, Setting, and Participants NHANES includes measured heights and weights for 5926 adult men and women from a nationally representative sample of the civilian noninstitutionalized US population in 2009-2010 and for 22 847 men and women in 1999-2008.Main Outcome Measures The prevalence of obesity and mean BMI.Results In 2009-2010 the age-adjusted mean BMI was 28.7 (95% CI, 28.3-29.1) for men and also 28.7 (95% CI, 28.4-29.0) for women. Median BMI was 27.8 (interquartile range [IQR], 24.7-31.7) for men and 27.3 (IQR, 23.3-32.7) for women. The age-adjusted prevalence of obesity was 35.7% (95% CI, 31.9%-39.2%) among adult men and 35.8% (95% CI, 34.0%-37.7%) among adult women. Over the 12-year period from 1999 through 2010, obesity showed no significant increase among women overall (age- and race-adjusted annual change in odds ratio [AOR], 1.01; 95% CI, 1.00-1.03; P = .07), but increases were statistically significant for non-Hispanic black women (P = .04) and Mexican American women (P = .046). For men, there was a significant linear trend (AOR, 1.04; 95% CI, 1.02-1.06; P < .001) over the 12-year period. For both men and women, the most recent 2 years (2009-2010) did not differ significantly (P = .08 for men and P = .24 for women) from the previous 6 years (2003-2008). Trends in BMI were similar to obesity trends.Conclusion In 2009-2010, the prevalence of obesity was 35.5% among adult men and 35.8% among adult women, with no significant change compared with 2003-2008.

PMID: 22253363 [PubMed - as supplied by publisher]

Prevalence of Obesity and Trends in Body Mass Index Among US Children and Adolescents, 1999-2010.

JAMA. 2012 Jan 17;

Authors: Ogden CL, Carroll MD, Kit BK, Flegal KM

Abstract

Context The prevalence of childhood obesity increased in the 1980s and 1990s but there were no significant changes in prevalence between 1999-2000 and 2007-2008 in the United States.Objectives To present the most recent estimates of obesity prevalence in US children and adolescents for 2009-2010 and to investigate trends in obesity prevalence and body mass index (BMI) among children and adolescents between 1999-2000 and 2009-2010.Design, Setting, and Participants Cross-sectional analyses of a representative sample (N = 4111) of the US child and adolescent population (birth through 19 years of age) with measured heights and weights from the National Health and Nutrition Examination Survey 2009-2010.Main Outcome Measures Prevalence of high weight-for-recumbent length (≥95th percentile on the growth charts) among infants and toddlers from birth to 2 years of age and obesity (BMI ≥95th percentile of the BMI-for-age growth charts) among children and adolescents aged 2 through 19 years. Analyses of trends in obesity by sex and race/ethnicity, and analyses of trends in BMI within sex-specific age groups for 6 survey periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, and 2009-2010) over 12 years.Results In 2009-2010, 9.7% (95% CI, 7.6%-12.3%) of infants and toddlers had a high weight-for-recumbent length and 16.9% (95% CI, 15.4%-18.4%) of children and adolescents from 2 through 19 years of age were obese. There was no difference in obesity prevalence among males (P = .62) or females (P = .65) between 2007-2008 and 2009-2010. However, trend analyses over a 12-year period indicated a significant increase in obesity prevalence between 1999-2000 and 2009-2010 in males aged 2 through 19 years (odds ratio, 1.05; 95% CI, 1.01-1.10) but not in females (odds ratio, 1.02; 95% CI, 0.98-1.07) per 2-year survey cycle. There was a significant increase in BMI among adolescent males aged 12 through 19 years (P = .04) but not among any other age group or among females.Conclusion In 2009-2010, the prevalence of obesity in children and adolescents was 16.9%; this was not changed compared with 2007-2008.

PMID: 22253364 [PubMed - as supplied by publisher]

The cover. The philosopher.

JAMA. 2012 Jan 18;307(3):233

Authors: Torpy JM

PMID: 22253376 [PubMed - in process]

Research yields new insights into mechanisms and treatment of pain.

JAMA. 2012 Jan 18;307(3):239-41

Authors: Friedrich MJ

PMID: 22253377 [PubMed - in process]

Studies probe self-referral for imaging.

JAMA. 2012 Jan 18;307(3):241-2

Authors: Mitka M

PMID: 22253378 [PubMed - in process]

Poisonings top crashes for injury-related deaths.

JAMA. 2012 Jan 18;307(3):242

Authors: Kuehn BM

PMID: 22253379 [PubMed - in process]

Same-day discharge after percutaneous coronary intervention.

JAMA. 2012 Jan 18;307(3):251; author reply 252

Authors: Janus TJ

PMID: 22253384 [PubMed - in process]

Same-day discharge after percutaneous coronary intervention.

JAMA. 2012 Jan 18;307(3):251-2; author reply 252

Authors: Hauville C, Barbash IM, Waksman R

PMID: 22253385 [PubMed - in process]

Mandatory HPV vaccination.

JAMA. 2012 Jan 18;307(3):252-3; author reply 254-5

Authors: Gilkey MB, Brewer NT

PMID: 22253386 [PubMed - in process]

Mandatory HPV vaccination.

JAMA. 2012 Jan 18;307(3):253-4; author reply 254-5

Authors: Berger LC, Blog D, Birkhead GS

PMID: 22253387 [PubMed - in process]

Mandatory HPV vaccination.

JAMA. 2012 Jan 18;307(3):254; author reply 254-5

Authors: Tomljenovic L, Shaw CA

PMID: 22253388 [PubMed - in process]

Screening for osteoporosis in men receiving androgen deprivation therapy.

JAMA. 2012 Jan 18;307(3):255-6

Authors: Alibhai SM, Yun L, Cheung AM, Paszat L

PMID: 22253389 [PubMed - in process]

Is universal pediatric lipid screening justified?

JAMA. 2012 Jan 18;307(3):259-60

Authors: Gillman MW, Daniels SR

PMID: 22253390 [PubMed - in process]

Plain packaging of tobacco products in Australia: a novel regulation faces legal challenge.

JAMA. 2012 Jan 18;307(3):261-2

Authors: Mitchell AD, Studdert DM

PMID: 22253391 [PubMed - in process]

A piece of my mind. Lessons in elder care.

JAMA. 2012 Jan 18;307(3):263-4

Authors: Cannuscio CC

PMID: 22253392 [PubMed - in process]

Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial.

JAMA. 2012 Jan 18;307(3):265-74

Authors: Angiolillo DJ, Firstenberg MS, Price MJ, Tummala PE, Hutyra M, Welsby IJ, Voeltz MD, Chandna H, Ramaiah C, Brtko M, Cannon L, Dyke C, Liu T, Montalescot G, Manoukian SV, Prats J, Topol EJ,

Abstract

CONTEXT: Thienopyridines are among the most widely prescribed medications, but their use can be complicated by the unanticipated need for surgery. Despite increased risk of thrombosis, guidelines recommend discontinuing thienopyridines 5 to 7 days prior to surgery to minimize bleeding.

OBJECTIVE: To evaluate the use of cangrelor, an intravenous, reversible P2Y(12) platelet inhibitor for bridging thienopyridine-treated patients to coronary artery bypass grafting (CABG) surgery.

DESIGN, SETTING, AND PATIENTS: Prospective, randomized, double-blind, placebo-controlled, multicenter trial, involving 210 patients with an acute coronary syndrome (ACS) or treated with a coronary stent and receiving a thienopyridine awaiting CABG surgery to receive either cangrelor or placebo after an initial open-label, dose-finding phase (n = 11) conducted between January 2009 and April 2011. Interventions Thienopyridines were stopped and patients were administered cangrelor or placebo for at least 48 hours, which was discontinued 1 to 6 hours before CABG surgery.

MAIN OUTCOME MEASURES: The primary efficacy end point was platelet reactivity (measured in P2Y(12) reaction units [PRUs]), assessed daily. The main safety end point was excessive CABG surgery-related bleeding.

RESULTS: The dose of cangrelor determined in 10 patients in the open-label stage was 0.75 μg/kg per minute. In the randomized phase, a greater proportion of patients treated with cangrelor had low levels of platelet reactivity throughout the entire treatment period compared with placebo (primary end point, PRU <240; 98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR], 5.2 [95% CI, 3.3-8.1] P < .001). Excessive CABG surgery-related bleeding occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and placebo groups, respectively (RR, 1.1 [95% CI, 0.5-2.5] P = .763). There were no significant differences in major bleeding prior to CABG surgery, although minor bleeding episodes were numerically higher with cangrelor.

CONCLUSIONS: Among patients who discontinue thienopyridine therapy prior to cardiac surgery, the use of cangrelor compared with placebo resulted in a higher rate of maintenance of platelet inhibition.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00767507.

PMID: 22253393 [PubMed - in process]

Survival without disability to age 5 years after neonatal caffeine therapy for apnea of prematurity.

JAMA. 2012 Jan 18;307(3):275-82

Authors: Schmidt B, Anderson PJ, Doyle LW, Dewey D, Grunau RE, Asztalos EV, Davis PG, Tin W, Moddemann D, Solimano A, Ohlsson A, Barrington KJ, Roberts RS,

Abstract

CONTEXT: Very preterm infants are prone to apnea and have an increased risk of death or disability. Caffeine therapy for apnea of prematurity reduces the rates of cerebral palsy and cognitive delay at 18 months of age.

OBJECTIVE: To determine whether neonatal caffeine therapy has lasting benefits or newly apparent risks at early school age.

DESIGN, SETTING, AND PARTICIPANTS: Five-year follow-up from 2005 to 2011 in 31 of 35 academic hospitals in Canada, Australia, Europe, and Israel, where 1932 of 2006 participants (96.3%) had been enrolled in the randomized, placebo-controlled Caffeine for Apnea of Prematurity trial between 1999 and 2004. A total of 1640 children (84.9%) with birth weights of 500 to 1250 g had adequate data for the main outcome at 5 years.

MAIN OUTCOME MEASURES: Combined outcome of death or survival to 5 years with 1 or more of motor impairment (defined as a Gross Motor Function Classification System level of 3 to 5), cognitive impairment (defined as a Full Scale IQ<70), behavior problems, poor general health, deafness, and blindness.

RESULTS: The combined outcome of death or disability was not significantly different for the 833 children assigned to caffeine from that for the 807 children assigned to placebo (21.1% vs 24.8%; odds ratio adjusted for center, 0.82; 95% CI, 0.65-1.03; P = .09). The rates of death, motor impairment, behavior problems, poor general health, deafness, and blindness did not differ significantly between the 2 groups. The incidence of cognitive impairment was lower at 5 years than at 18 months and similar in the 2 groups (4.9% vs 5.1%; odds ratio adjusted for center, 0.97; 95% CI, 0.61-1.55; P = .89).

CONCLUSION: Neonatal caffeine therapy was no longer associated with a significantly improved rate of survival without disability in children with very low birth weights who were assessed at 5 years.

PMID: 22253394 [PubMed - in process]

Complete immunosuppression withdrawal and subsequent allograft function among pediatric recipients of parental living donor liver transplants.

JAMA. 2012 Jan 18;307(3):283-93

Authors: Feng S, Ekong UD, Lobritto SJ, Demetris AJ, Roberts JP, Rosenthal P, Alonso EM, Philogene MC, Ikle D, Poole KM, Bridges ND, Turka LA, Tchao NK

Abstract

CONTEXT: Although life-saving, liver transplantation burdens children with lifelong immunosuppression and substantial potential for morbidity and mortality.

OBJECTIVE: To establish the feasibility of immunosuppression withdrawal in pediatric living donor liver transplant recipients.

DESIGN, SETTING, AND PATIENTS: Prospective, multicenter, open-label, single-group pilot trial conducted in 20 stable pediatric recipients (11 male; 55%) of parental living donor liver transplants for diseases other than viral hepatitis or an autoimmune disease who underwent immunosuppression withdrawal. Their median age was 6.9 months (interquartile range [IQR], 5.5-9.1 months) at transplant and 8 years 6 months (IQR, 6 years 5 months to 10 years 9 months) at study enrollment. Additional entry requirements included stable allograft function while taking a single immunosuppressive drug and no evidence of acute or chronic rejection or significant fibrosis on liver biopsy. Gradual immunosuppression withdrawal over a minimum of 36 weeks was instituted at 1 of 3 transplant centers between June 5, 2006, and November 18, 2009. Recipients were followed up for a median of 32.9 months (IQR, 1.0-49.9 months).

MAIN OUTCOME MEASURES: The primary end point was the proportion of operationally tolerant patients, defined as patients who remained off immunosuppression therapy for at least 1 year with normal graft function. Secondary clinical end points included the durability of operational tolerance, and the incidence, timing, severity, and reversibility of rejection.

RESULTS: Of 20 pediatric patients, 12 (60%; 95% CI, 36.1%-80.9%) met the primary end point, maintaining normal allograft function for a median of 35.7 months (IQR, 28.1-39.7 months) after discontinuing immunosuppression therapy. Follow-up biopsies obtained more than 2 years after completing withdrawal showed no significant change compared with baseline biopsies. Eight patients did not meet the primary end point secondary to an exclusion criteria violation (n = 1), acute rejection (n = 2), or indeterminate rejection (n = 5). Seven patients were treated with increased or reinitiation of immunosuppression therapy; all returned to baseline allograft function. Patients with operational tolerance compared with patients without operational tolerance initiated immunosuppression withdrawal later after transplantation (median of 100.6 months [IQR, 71.8-123.5] vs 73.0 months [IQR, 57.6-74.9], respectively; P = .03), had less portal inflammation (91.7% [95% CI, 61.5%-99.8%] vs 42.9% [95% CI, 9.9%-81.6%] with no inflammation; P = .04), and had lower total C4d scores on the screening liver biopsy (median of 6.1 [IQR, 5.1-9.3] vs 12.5 [IQR, 9.3-16.8]; P = .03).

CONCLUSION: In this pilot study, 60% of pediatric recipients of parental living donor liver transplants remained off immunosuppression therapy for at least 1 year with normal graft function and stable allograft histology.

PMID: 22253395 [PubMed - in process]

Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review.

JAMA. 2012 Jan 18;307(3):294-303

Authors: Januel JM, Chen G, Ruffieux C, Quan H, Douketis JD, Crowther MA, Colin C, Ghali WA, Burnand B,

Abstract

CONTEXT: Symptomatic venous thromboembolism (VTE) after total or partial knee arthroplasty (TPKA) and after total or partial hip arthroplasty (TPHA) are proposed patient safety indicators, but its incidence prior to discharge is not defined.

OBJECTIVE: To establish a literature-based estimate of symptomatic VTE event rates prior to hospital discharge in patients undergoing TPHA or TPKA.

DATA SOURCES: Search of MEDLINE, EMBASE, and the Cochrane Library (1996 to 2011), supplemented by relevant articles.

STUDY SELECTION: Reports of incidence of symptomatic postoperative pulmonary embolism or deep vein thrombosis (DVT) before hospital discharge in patients who received VTE prophylaxis with either a low-molecular-weight heparin or a subcutaneous factor Xa inhibitor or oral direct inhibitor of factors Xa or IIa.

DATA EXTRACTION AND SYNTHESIS: Meta-analysis of randomized clinical trials and observational studies that reported rates of postoperative symptomatic VTE in patients who received recommended VTE prophylaxis after undergoing TPHA or TPKA. Data were independently extracted by 2 analysts, and pooled incidence rates of VTE, DVT, and pulmonary embolism were estimated using random-effects models.

RESULTS: The analysis included 44,844 cases provided by 47 studies. The pooled rates of symptomatic postoperative VTE before hospital discharge were 1.09% (95% CI, 0.85%-1.33%) for patients undergoing TPKA and 0.53% (95% CI, 0.35%-0.70%) for those undergoing TPHA. The pooled rates of symptomatic DVT were 0.63% (95% CI, 0.47%-0.78%) for knee arthroplasty and 0.26% (95% CI, 0.14%-0.37%) for hip arthroplasty. The pooled rates for pulmonary embolism were 0.27% (95% CI, 0.16%-0.38%) for knee arthroplasty and 0.14% (95% CI, 0.07%-0.21%) for hip arthroplasty. There was significant heterogeneity for the pooled incidence rates of symptomatic postoperative VTE in TPKA studies but less heterogeneity for DVT and pulmonary embolism in TPKA studies and for VTE, DVT, and pulmonary embolism in TPHA studies.

CONCLUSION: Using current VTE prophylaxis, approximately 1 in 100 patients undergoing TPKA and approximately 1 in 200 patients undergoing TPHA develops symptomatic VTE prior to hospital discharge.

PMID: 22253396 [PubMed - in process]

Neuroprotection for premature infants?: another perspective on caffeine.

JAMA. 2012 Jan 18;307(3):304-5

Authors: Maitre NL, Stark AR

PMID: 22253397 [PubMed - in process]

Estimating the incidence of symptomatic postoperative venous thromboembolism: the importance of perspective.

JAMA. 2012 Jan 18;307(3):306-7

Authors: Heit JA

PMID: 22253398 [PubMed - in process]

JAMA patient page. Liver transplantation.

JAMA. 2012 Jan 18;307(3):320

Authors: Torpy JM, Lynm C, Golub RM

PMID: 22253399 [PubMed - in process]

New reports examine psychiatric risks of varenicline for smoking cessation.

JAMA. 2012 Jan 11;307(2):129-30

Authors: Kuehn BM

PMID: 22235073 [PubMed - indexed for MEDLINE]

The cover. Thomas Cromwell.

JAMA. 2012 Jan 11;307(2):123

Authors: Cole TB

PMID: 22235072 [PubMed - indexed for MEDLINE]

NIH shifts focus from sequencing genes to fostering clinical applications.

JAMA. 2012 Jan 11;307(2):132

Authors: Kuehn BM

PMID: 22235074 [PubMed - indexed for MEDLINE]

Expert panel advocates surveillance for men with low-risk prostate cancer.

JAMA. 2012 Jan 11;307(2):133

Authors: Slomski A

PMID: 22235075 [PubMed - indexed for MEDLINE]

Sex-specific prevalence of adenomas and colorectal cancer.

JAMA. 2012 Jan 11;307(2):142; author reply 143-4

Authors: Roy HK, Bianchi LK

PMID: 22235076 [PubMed - indexed for MEDLINE]

Sex-specific prevalence of adenomas and colorectal cancer.

JAMA. 2012 Jan 11;307(2):142-3; author reply 143-4

Authors: Hoffmeister M, Brenner H

PMID: 22235077 [PubMed - indexed for MEDLINE]

Supplementation in acute lung injury.

JAMA. 2012 Jan 11;307(2):144; author reply 145-6

Authors: Felbinger TW, Weigand MA, Mayer K

PMID: 22235078 [PubMed - indexed for MEDLINE]

Supplementation in acute lung injury.

JAMA. 2012 Jan 11;307(2):144-5; author reply 145-6

Authors: Bistrian BR

PMID: 22235079 [PubMed - indexed for MEDLINE]

Supplementation in acute lung injury.

JAMA. 2012 Jan 11;307(2):145; author reply 145-6

Authors: König K, Rosenberger P, Mirakaj V

PMID: 22235080 [PubMed - indexed for MEDLINE]

Thromboaspiration before intra-aortic balloon counterpulsation.

JAMA. 2012 Jan 11;307(2):146; author reply 147

Authors: Potter BJ

PMID: 22235081 [PubMed - indexed for MEDLINE]

Addressing requests by patients for nonbeneficial interventions.

JAMA. 2012 Jan 11;307(2):149-50

Authors: Brett AS, McCullough LB

PMID: 22235082 [PubMed - indexed for MEDLINE]

The courts, futility, and the ends of medicine.

JAMA. 2012 Jan 11;307(2):151-2

Authors: White DB, Pope TM

PMID: 22235083 [PubMed - indexed for MEDLINE]

A piece of my mind. On grace.

JAMA. 2012 Jan 11;307(2):155-6

Authors: Stillman MD

PMID: 22235085 [PubMed - indexed for MEDLINE]

A prescription for drug shortages.

JAMA. 2012 Jan 11;307(2):153-4

Authors: Gehrett BK

PMID: 22235084 [PubMed - indexed for MEDLINE]

Serum potassium levels and mortality in acute myocardial infarction.

JAMA. 2012 Jan 11;307(2):157-64

Authors: Goyal A, Spertus JA, Gosch K, Venkitachalam L, Jones PG, Van den Berghe G, Kosiborod M

Abstract

CONTEXT: Clinical practice guidelines recommend maintaining serum potassium levels between 4.0 and 5.0 mEq/L in patients with acute myocardial infarction (AMI). These guidelines are based on small studies that associated low potassium levels with ventricular arrhythmias in the pre-β-blocker and prereperfusion era. Current studies examining the relationship between potassium levels and mortality in AMI patients are lacking.

OBJECTIVE: To determine the relationship between serum potassium levels and in-hospital mortality in AMI patients in the era of β-blocker and reperfusion therapy.

DESIGN, SETTING, AND PATIENTS: Retrospective cohort study using the Cerner Health Facts database, which included 38,689 patients with biomarker-confirmed AMI, admitted to 67 US hospitals between January 1, 2000, and December 31, 2008. All patients had in-hospital serum potassium measurements and were categorized by mean postadmission serum potassium level (<3.0, 3.0-<3.5, 3.5-<4.0, 4.0-<4.5, 4.5-<5.0, 5.0-<5.5, and ≥5.5 mEq/L). Hierarchical logistic regression was used to determine the association between potassium levels and outcomes after adjusting for patient- and hospital-level factors.

MAIN OUTCOME MEASURES: All-cause in-hospital mortality and the composite of ventricular fibrillation or cardiac arrest.

RESULTS: There was a U-shaped relationship between mean postadmission serum potassium level and in-hospital mortality that persisted after multivariable adjustment. Compared with the reference group of 3.5 to less than 4.0 mEq/L (mortality rate, 4.8%; 95% CI, 4.4%-5.2%), mortality was comparable for mean postadmission potassium of 4.0 to less than 4.5 mEq/L (5.0%; 95% CI, 4.7%-5.3%), multivariable-adjusted odds ratio (OR), 1.19 (95% CI, 1.04-1.36). Mortality was twice as great for potassium of 4.5 to less than 5.0 mEq/L (10.0%; 95% CI, 9.1%-10.9%; multivariable-adjusted OR, 1.99; 95% CI, 1.68-2.36), and even greater for higher potassium strata. Similarly, mortality rates were higher for potassium levels of less than 3.5 mEq/L. In contrast, rates of ventricular fibrillation or cardiac arrest were higher only among patients with potassium levels of less than 3.0 mEq/L and at levels of 5.0 mEq/L or greater.

CONCLUSION: Among inpatients with AMI, the lowest mortality was observed in those with postadmission serum potassium levels between 3.5 and <4.5 mEq/L compared with those who had higher or lower potassium levels.

PMID: 22235086 [PubMed - indexed for MEDLINE]

Association of incident dementia with hospitalizations.

JAMA. 2012 Jan 11;307(2):165-72

Authors: Phelan EA, Borson S, Grothaus L, Balch S, Larson EB

Abstract

CONTEXT: Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether some admissions of persons with dementia might be potentially preventable.

OBJECTIVE: To determine whether dementia onset is associated with higher rates of or different reasons for hospitalization, particularly for ambulatory care-sensitive conditions (ACSCs), for which proactive outpatient care might prevent the need for a hospital stay.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of adults aged 65 years or older enrolled in an integrated health care system. All participants had no dementia at baseline and those who had a dementia diagnosis during biennial screening contributed nondementia hospitalizations until diagnosis. Automated data were used to identify all hospitalizations of all participants from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned February 1, 1994, to December 31, 2007.

MAIN OUTCOME MEASURES: Hospital admission rates for patients with and without dementia, for all causes, by type of admission, and for ACSCs.

RESULTS: Four hundred ninety-four individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained free of dementia and 1478 (59%) of those were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admissions per 1000 person-years vs 200 admissions per 1000 person-years in the dementia-free group. After adjustment for age, sex, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23-1.61; P < .001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38-2.31; P < .001). Adjusted admission rates classified by body system were significantly higher in the dementia group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia.

CONCLUSION: Among our cohort aged 65 years or older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs.

PMID: 22235087 [PubMed - indexed for MEDLINE]

Association between marijuana exposure and pulmonary function over 20 years.

JAMA. 2012 Jan 11;307(2):173-81

Authors: Pletcher MJ, Vittinghoff E, Kalhan R, Richman J, Safford M, Sidney S, Lin F, Kertesz S

Abstract

CONTEXT: Marijuana smoke contains many of the same constituents as tobacco smoke, but whether it has similar adverse effects on pulmonary function is unclear.

OBJECTIVE: To analyze associations between marijuana (both current and lifetime exposure) and pulmonary function.

DESIGN, SETTING, AND PARTICIPANTS: The Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal study collecting repeated measurements of pulmonary function and smoking over 20 years (March 26, 1985-August 19, 2006) in a cohort of 5115 men and women in 4 US cities. Mixed linear modeling was used to account for individual age-based trajectories of pulmonary function and other covariates including tobacco use, which was analyzed in parallel as a positive control. Lifetime exposure to marijuana joints was expressed in joint-years, with 1 joint-year of exposure equivalent to smoking 365 joints or filled pipe bowls.

MAIN OUTCOME MEASURES: Forced expiratory volume in the first second of expiration (FEV(1)) and forced vital capacity (FVC).

RESULTS: Marijuana exposure was nearly as common as tobacco exposure but was mostly light (median, 2-3 episodes per month). Tobacco exposure, both current and lifetime, was linearly associated with lower FEV(1) and FVC. In contrast, the association between marijuana exposure and pulmonary function was nonlinear (P < .001): at low levels of exposure, FEV(1) increased by 13 mL/joint-year (95% CI, 6.4 to 20; P < .001) and FVC by 20 mL/joint-year (95% CI, 12 to 27; P < .001), but at higher levels of exposure, these associations leveled or even reversed. The slope for FEV(1) was -2.2 mL/joint-year (95% CI, -4.6 to 0.3; P = .08) at more than 10 joint-years and -3.2 mL per marijuana smoking episode/mo (95% CI, -5.8 to -0.6; P = .02) at more than 20 episodes/mo. With very heavy marijuana use, the net association with FEV(1) was not significantly different from baseline, and the net association with FVC remained significantly greater than baseline (eg, at 20 joint-years, 76 mL [95% CI, 34 to 117]; P < .001).

CONCLUSION: Occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function.

PMID: 22235088 [PubMed - indexed for MEDLINE]

Prognostic indices for older adults: a systematic review.

JAMA. 2012 Jan 11;307(2):182-92

Authors: Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK

Abstract

CONTEXT: To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions.

OBJECTIVE: To assess the quality and limitations of prognostic indices for mortality in older adults through systematic review.

DATA SOURCES: We searched MEDLINE, EMBASE, Cochrane, and Google Scholar from their inception through November 2011.

STUDY SELECTION: We included indices if they were validated and predicted absolute risk of mortality in patients whose average age was 60 years or older. We excluded indices that estimated intensive care unit, disease-specific, or in-hospital mortality.

DATA EXTRACTION: For each prognostic index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy.

RESULTS: We reviewed 21,593 titles to identify 16 indices that predict risk of mortality from 6 months to 5 years for older adults in a variety of clinical settings: the community (6 indices), nursing home (2 indices), and hospital (8 indices). At least 1 measure of transportability (the index is accurate in more than 1 population) was tested for all but 3 indices. By our measures, no study was free from potential bias. Although 13 indices had C statistics of 0.70 or greater, none of the indices had C statistics of 0.90 or greater. Only 2 indices were independently validated by investigators who were not involved in the index’s development.

CONCLUSION: We identified several indices for predicting overall mortality in different patient groups; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended.

PMID: 22235089 [PubMed - indexed for MEDLINE]

Purple urine.

JAMA. 2012 Jan 11;307(2):193-4

Authors: Ben-Chetrit E, Munter G

PMID: 22235090 [PubMed - indexed for MEDLINE]

Potassium concentration and repletion in patients with acute myocardial infarction.

JAMA. 2012 Jan 11;307(2):195-6

Authors: Scirica BM, Morrow DA

PMID: 22235091 [PubMed - indexed for MEDLINE]

Prevention of unnecessary hospitalization for patients with dementia: the role of ambulatory care.

JAMA. 2012 Jan 11;307(2):197-8

Authors: Lyketsos CG

PMID: 22235092 [PubMed - indexed for MEDLINE]

The central role of prognosis in clinical decision making.

JAMA. 2012 Jan 11;307(2):199-200

Authors: Gill TM

PMID: 22235093 [PubMed - indexed for MEDLINE]

JAMA patient page. Respiratory syncytial virus bronchiolitis.

JAMA. 2012 Jan 11;307(2):213

Authors: Punnoose AR, Golub RM

PMID: 22235094 [PubMed - indexed for MEDLINE]

Access to Emergency Contraception for Adolescents.

JAMA. 2011 Dec 19;

Authors: Wilkinson TA, Fahey N, Suther E, Cabral HJ, Silverstein M

PMID: 22182591 [PubMed - as supplied by publisher]

Science, Politics, and Over-the-Counter Emergency Contraception.

JAMA. 2011 Dec 19;

Authors: Steinbrook R

PMID: 22182592 [PubMed - as supplied by publisher]

The cover. Madonna and child in a landscape.

JAMA. 2011 Dec 21;306(23):2542

Authors: Cole TB

PMID: 22187264 [PubMed - indexed for MEDLINE]

A piece of my mind. Fix it!

JAMA. 2011 Dec 21;306(23):2544-5

Authors: Webster JR

PMID: 22187265 [PubMed - indexed for MEDLINE]

Policy paper highlights concerns about the future of HIV care and its funding.

JAMA. 2011 Dec 21;306(23):2551-2

Authors: Hampton T

PMID: 22187267 [PubMed - indexed for MEDLINE]

USPSTF finds little evidence to support advising PSA screening in any man.

JAMA. 2011 Dec 21;306(23):2549-51

Authors: Slomski A

PMID: 22187266 [PubMed - indexed for MEDLINE]

High residual platelet reactivity and thrombotic events.

JAMA. 2011 Dec 21;306(23):2561; author reply 2561-2

Authors: Cuisset T, Morange PE, Alessi MC

PMID: 22187272 [PubMed - indexed for MEDLINE]

Depression and risk of stroke.

JAMA. 2011 Dec 21;306(23):2562; author reply 2563

Authors: Dong JY

PMID: 22187273 [PubMed - indexed for MEDLINE]

Depression and risk of stroke.

JAMA. 2011 Dec 21;306(23):2562-3; author reply 2563

Authors: Yang ZY, Mao C, Tang JL

PMID: 22187274 [PubMed - indexed for MEDLINE]

Assisted reproductive technology program reporting.

JAMA. 2011 Dec 21;306(23):2564; author reply 2564-5

Authors: Kissin DM, Jamieson DJ, Barfield WD

PMID: 22187275 [PubMed - indexed for MEDLINE]

Sleep disorders, health, and safety in police officers.

JAMA. 2011 Dec 21;306(23):2567-78

Authors: Rajaratnam SM, Barger LK, Lockley SW, Shea SA, Wang W, Landrigan CP, O’Brien CS, Qadri S, Sullivan JP, Cade BE, Epstein LJ, White DP, Czeisler CA,

Abstract

CONTEXT: Sleep disorders often remain undiagnosed. Untreated sleep disorders among police officers may adversely affect their health and safety and pose a risk to the public.

OBJECTIVE: To quantify associations between sleep disorder risk and self-reported health, safety, and performance outcomes in police officers.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional and prospective cohort study of North American police officers participating in either an online or an on-site screening (n=4957) and monthly follow-up surveys (n=3545 officers representing 15,735 person-months) between July 2005 and December 2007. A total of 3693 officers in the United States and Canada participated in the online screening survey, and 1264 officers from a municipal police department and a state police department participated in the on-site survey.

MAIN OUTCOME MEASURES: Comorbid health conditions (cross-sectional); performance and safety outcomes (prospective).

RESULTS: Of the 4957 participants, 40.4% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously. Of the total cohort, 1666 (33.6%) screened positive for obstructive sleep apnea, 281 (6.5%) for moderate to severe insomnia, 269 (5.4%) for shift work disorder (14.5% of those who worked the night shift). Of the 4608 participants who completed the sleepiness scale, 1312 (28.5%) reported excessive sleepiness. Of the total cohort, 1294 (26.1%) reported falling asleep while driving at least 1 time a month. Respondents who screened positive for obstructive sleep apnea or any sleep disorder had an increased prevalence of reported physical and mental health conditions, including diabetes, depression, and cardiovascular disease. An analysis of up to 2 years of monthly follow-up surveys showed that those respondents who screened positive for a sleep disorder vs those who did not had a higher rate of reporting that they had made a serious administrative error (17.9% vs 12.7%; adjusted odds ratio [OR], 1.43 [95% CI, 1.23-1.67]); of falling asleep while driving (14.4% vs 9.2%; adjusted OR, 1.51 [95% CI, 1.20-1.90]); of making an error or safety violation attributed to fatigue (23.7% vs 15.5%; adjusted OR, 1.63 [95% CI, 1.43-1.85]); and of exhibiting other adverse work-related outcomes including uncontrolled anger toward suspects (34.1% vs 28.5%; adjusted OR, 1.25 [95% CI, 1.09-1.43]), absenteeism (26.0% vs 20.9%; adjusted OR, 1.23 [95% CI, 1.08-1.40]), and falling asleep during meetings (14.1% vs 7.0%; adjusted OR, 1.95 [95% CI, 1.52-2.52]).

CONCLUSION: Among a group of North American police officers, sleep disorders were common and were significantly associated with increased risk of self-reported adverse health, performance, and safety outcomes.

PMID: 22187276 [PubMed - indexed for MEDLINE]

Temporal changes in resting heart rate and deaths from ischemic heart disease.

JAMA. 2011 Dec 21;306(23):2579-87

Authors: Nauman J, Janszky I, Vatten LJ, Wisløff U

Abstract

CONTEXT: Resting heart rate (RHR) has long been recognized as an independent predictor of cardiovascular risk. However, whether temporal changes in RHR influence the risk of death from ischemic heart disease (IHD) in the general population is not known.

OBJECTIVE: To assess the association of long-term longitudinal changes in RHR with the risk of dying from IHD. DESIGN, SETTINGS, AND PARTICIPANTS: A prospective cohort study of 13,499 men and 15,826 women without known cardiovascular disease in Norway. Resting heart rate was measured on 2 occasions around 10 years apart in the Nord-Trøndelag County Health Study. The second RHR measurement was obtained between August 1995 and June 1997, with subsequent mortality follow-up until December 31, 2008. A total of 60 participants were lost to follow-up, all due to emigration from Norway. Using Cox regression analyses, adjusted hazard ratios (AHRs) were estimated of death from IHD related to changes in RHR over time. In a corresponding analysis, death from all causes also was assessed.

RESULTS: During a mean (SD) of 12 (2) years of follow-up, 3038 people died, and 388 deaths were caused by IHD. An increase in RHR was associated with increased risk of death from IHD. Compared with participants with a RHR of less than 70 beats/min at both measurements (8.2 deaths/10,000 person-years), the AHR was 1.9 (95% CI, 1.0-3.6) for participants with a RHR of less than 70 beats/min at the first measurement but greater than 85 beats/min at the second measurement (17.2 deaths/10,000 person-years). For participants with RHRs between 70 and 85 beats/min at the first measurement and greater than 85 beats/min at the second measurement (17.4 deaths/10,000 person-years), the AHR was 1.8 (95% CI, 1.2-2.8). The association of change in RHR with IHD mortality was not linear (P = .003 for quadratic trend), suggesting that a decrease in RHR showed no general mortality benefit. Excluding the first 3 years of follow-up did not substantially alter the findings. The associations for total mortality were similar but generally weaker than those observed for IHD mortality.

CONCLUSION: Among men and women without known cardiovascular disease, an increase in RHR over a 10-year period was associated with increased risk of death from IHD and also for all-cause mortality.

PMID: 22187277 [PubMed - indexed for MEDLINE]

Association between chlorthalidone treatment of systolic hypertension and long-term survival.

JAMA. 2011 Dec 21;306(23):2588-93

Authors: Kostis JB, Cabrera J, Cheng JQ, Cosgrove NM, Deng Y, Pressel SL, Davis BR

Abstract

CONTEXT: In the Systolic Hypertension in the Elderly Program (SHEP) trial, conducted between 1985 and 1990, antihypertensive therapy with chlorthalidone-based stepped-care therapy resulted in a lower rate of cardiovascular events than placebo but effects on mortality were not significant.

OBJECTIVE: To study the gain in life expectancy of participants randomized to active therapy at the 22-year follow-up.

DESIGN, SETTING, AND PARTICIPANTS: A National Death Index ascertainment of death in the long-term follow-up of a randomized, placebo-controlled, clinical trial (SHEP) of patients aged 60 years or older with isolated systolic hypertension. Recruitment was between March 1, 1985, and January 15, 1988. After the end of a 4.5-year randomized phase of the SHEP trial, all participants were advised to receive active therapy. The time interval between the beginning of recruitment and the ascertainment of death by National Death Index (December 31, 2006) was approximately 22 years (21 years 10 months).

MAIN OUTCOME MEASURES: Cardiovascular death and all-cause mortality.

RESULTS: At the 22-year follow-up, life expectancy gain, expressed as the area between active (n = 2365) and placebo (n = 2371) survival curves, was 105 days (95% CI, -39 to 242; P = .07) for all-cause mortality and 158 days (95% CI, 36-287; P = .009) for cardiovascular death. Each month of active treatment was therefore associated with approximately 1 day extension in life expectancy. The active treatment group had higher survival free from cardiovascular death vs the placebo group (hazard ratio [HR], 0.89; 95% CI, 0.80-0.99; P = .03) but similar survival for all-cause mortality (HR, 0.97; 95% CI, 0.90-1.04; P = .42). There were 1416 deaths (59.9%) in the active treatment group and 1435 deaths (60.5%) in the placebo group (log-rank P = .38, Wilcoxon P = .24). Cardiovascular death was lower in the active treatment group (669 deaths [28.3%]) vs the placebo group (735 deaths [31.0%]; log-rank P = .03, Wilcoxon P = .02). Time to 70th percentile survival was 0.56 years (95% CI, -0.14 to 1.23) longer in the active treatment group vs the placebo group (11.53 vs 10.98 years; P = .03) for all-cause mortality and 1.41 years (95% CI, 0.34-2.61; 17.81 vs 16.39 years; P = .01) for survival free from cardiovascular death.

CONCLUSION: In the SHEP trial, treatment of isolated systolic hypertension with chlorthalidone stepped-care therapy for 4.5 years was associated with longer life expectancy at 22 years of follow-up.

PMID: 22187278 [PubMed - indexed for MEDLINE]