Study of hands.

JAMA. 2010 Aug 25;304(8):833

Authors: Cole TB

PMID: 20736457 [PubMed - in process]

Study of hands.

JAMA. 2010 Aug 25;304(8):833

Authors: Cole TB

PMID: 20736457 [PubMed - in process]

Hope.

JAMA. 2010 Aug 25;304(8):835

Authors: Wani L

PMID: 20736458 [PubMed - in process]

Hope.

JAMA. 2010 Aug 25;304(8):835

Authors: Wani L

PMID: 20736458 [PubMed - in process]

Memories of katrina continue to hinder mental health recovery in new orleans.

JAMA. 2010 Aug 25;304(8):841-3

Authors: Voelker R

PMID: 20736459 [PubMed - in process]

Memories of katrina continue to hinder mental health recovery in new orleans.

JAMA. 2010 Aug 25;304(8):841-3

Authors: Voelker R

PMID: 20736459 [PubMed - in process]

FDA approves generic enoxaparin.

JAMA. 2010 Aug 25;304(8):844

Authors: Voelker R

PMID: 20736461 [PubMed - in process]

FDA approves generic enoxaparin.

JAMA. 2010 Aug 25;304(8):844

Authors: Voelker R

PMID: 20736461 [PubMed - in process]

As use of foreign drug trials grows, FDA oversight may not be keeping up.

JAMA. 2010 Aug 25;304(8):843-4

Authors: Mitka M

PMID: 20736460 [PubMed - in process]

As use of foreign drug trials grows, FDA oversight may not be keeping up.

JAMA. 2010 Aug 25;304(8):843-4

Authors: Mitka M

PMID: 20736460 [PubMed - in process]

High-dose oral vitamin d supplementation and risk of falls in older women.

JAMA. 2010 Aug 25;304(8):854-5

Authors: Prieto-Alhambra D, Judge A, Pazianas M

PMID: 20736463 [PubMed - in process]

High-dose oral vitamin d supplementation and risk of falls in older women.

JAMA. 2010 Aug 25;304(8):854-5

Authors: Prieto-Alhambra D, Judge A, Pazianas M

PMID: 20736463 [PubMed - in process]

FDA opioid safety plan promotes patient, physician education to prevent abuse.

JAMA. 2010 Aug 25;304(8):845

Authors: Kuehn BM

PMID: 20736462 [PubMed - in process]

High-dose oral vitamin d supplementation and risk of falls in older women.

JAMA. 2010 Aug 25;304(8):854

Authors: Mak JC

PMID: 20736464 [PubMed - in process]

High-dose oral vitamin d supplementation and risk of falls in older women.

JAMA. 2010 Aug 25;304(8):854

Authors: Mak JC

PMID: 20736464 [PubMed - in process]

High-dose oral vitamin d supplementation and risk of falls in older women.

JAMA. 2010 Aug 25;304(8):855-6

Authors: Malgarini RB, Pimpinella G

PMID: 20736465 [PubMed - in process]

High-dose oral vitamin d supplementation and risk of falls in older women.

JAMA. 2010 Aug 25;304(8):855-6

Authors: Malgarini RB, Pimpinella G

PMID: 20736465 [PubMed - in process]

High-dose oral vitamin d supplementation and risk of falls in older women.

JAMA. 2010 Aug 25;304(8):855

Authors: Gallieni M

PMID: 20736466 [PubMed - in process]

High-dose oral vitamin d supplementation and risk of falls in older women.

JAMA. 2010 Aug 25;304(8):855

Authors: Gallieni M

PMID: 20736466 [PubMed - in process]

Genome-wide Association Study of Genetic Loci and Alzheimer Disease.

JAMA. 2010 Aug 25;304(8):858

Authors: Brown AM, Finch SJ, Gordon D

PMID: 20736468 [PubMed - in process]

Genome-wide Association Study of Genetic Loci and Alzheimer Disease.

JAMA. 2010 Aug 25;304(8):858

Authors: Brown AM, Finch SJ, Gordon D

PMID: 20736468 [PubMed - in process]

Traumatic brain injury and major depressive disorder.

JAMA. 2010 Aug 25;304(8):857

Authors: Thombs BD

PMID: 20736467 [PubMed - in process]

Traumatic brain injury and major depressive disorder.

JAMA. 2010 Aug 25;304(8):857

Authors: Thombs BD

PMID: 20736467 [PubMed - in process]

Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects.

JAMA. 2010 Aug 25;304(8):859-66

Authors: Pasternak B, Hviid A

CONTEXT: Herpes simplex and herpes zoster infections are common and often treated with antiviral drugs including acyclovir, valacyclovir, and famciclovir. Safety of these antivirals when used in the first trimester of pregnancy is insufficiently documented. OBJECTIVE: To investigate associations between exposure to acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and risk of major birth defects. DESIGN, SETTING, AND PARTICIPANTS: Population-based historical cohort study of 837 795 live-born infants in Denmark from January 1, 1996, to September 30, 2008. Participants had no diagnoses of chromosomal aberrations, genetic syndromes, birth defect syndromes with known causes, or congenital viral infections. Nationwide registries were used to ascertain individual-level information on dispensed antiviral drugs, birth defect diagnoses (categorized according to a standardized classification scheme), and potential confounders. MAIN OUTCOME MEASURE: Prevalence odds ratios (PORs) of any major birth defect diagnosed within the first year of life by exposure to antiviral drugs. RESULTS: Among 1804 pregnancies exposed to acyclovir, valacyclovir, or famciclovir in the first trimester, 40 infants (2.2%) were diagnosed with a major birth defect compared with 19 920 (2.4%) among the unexposed (adjusted POR, 0.89; 95% confidence interval [CI], 0.65-1.22). For individual antivirals, a major birth defect was diagnosed in 32 of 1561 infants (2.0%) with first-trimester exposure to acyclovir (adjusted POR, 0.82; 95% CI, 0.57-1.17) and in 7 of 229 infants (3.1%) with first-trimester exposure to valacyclovir (adjusted POR, 1.21; 95% CI, 0.56-2.62). Famciclovir exposure was uncommon (n = 26), with 1 infant (3.8%) diagnosed with a birth defect. Exploratory analyses revealed no associations between antiviral drug exposure and 13 different subgroups of birth defects, but the number of exposed cases in each subgroup was small. CONCLUSION: In this large nationwide cohort, exposure to acyclovir or valacyclovir in the first trimester of pregnancy was not associated with an increased risk of major birth defects.

PMID: 20736469 [PubMed - in process]

Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects.

JAMA. 2010 Aug 25;304(8):859-66

Authors: Pasternak B, Hviid A

CONTEXT: Herpes simplex and herpes zoster infections are common and often treated with antiviral drugs including acyclovir, valacyclovir, and famciclovir. Safety of these antivirals when used in the first trimester of pregnancy is insufficiently documented. OBJECTIVE: To investigate associations between exposure to acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and risk of major birth defects. DESIGN, SETTING, AND PARTICIPANTS: Population-based historical cohort study of 837 795 live-born infants in Denmark from January 1, 1996, to September 30, 2008. Participants had no diagnoses of chromosomal aberrations, genetic syndromes, birth defect syndromes with known causes, or congenital viral infections. Nationwide registries were used to ascertain individual-level information on dispensed antiviral drugs, birth defect diagnoses (categorized according to a standardized classification scheme), and potential confounders. MAIN OUTCOME MEASURE: Prevalence odds ratios (PORs) of any major birth defect diagnosed within the first year of life by exposure to antiviral drugs. RESULTS: Among 1804 pregnancies exposed to acyclovir, valacyclovir, or famciclovir in the first trimester, 40 infants (2.2%) were diagnosed with a major birth defect compared with 19 920 (2.4%) among the unexposed (adjusted POR, 0.89; 95% confidence interval [CI], 0.65-1.22). For individual antivirals, a major birth defect was diagnosed in 32 of 1561 infants (2.0%) with first-trimester exposure to acyclovir (adjusted POR, 0.82; 95% CI, 0.57-1.17) and in 7 of 229 infants (3.1%) with first-trimester exposure to valacyclovir (adjusted POR, 1.21; 95% CI, 0.56-2.62). Famciclovir exposure was uncommon (n = 26), with 1 infant (3.8%) diagnosed with a birth defect. Exploratory analyses revealed no associations between antiviral drug exposure and 13 different subgroups of birth defects, but the number of exposed cases in each subgroup was small. CONCLUSION: In this large nationwide cohort, exposure to acyclovir or valacyclovir in the first trimester of pregnancy was not associated with an increased risk of major birth defects.

PMID: 20736469 [PubMed - in process]

Elective Intra-aortic Balloon Counterpulsation During High-Risk Percutaneous Coronary Intervention: A Randomized Controlled Trial.

JAMA. 2010 Aug 25;304(8):867-874

Authors: Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D, de Belder A, Redwood S,

CONTEXT: Observational studies have previously reported that elective intra-aortic balloon pump (IABP) insertion may improve outcomes following high-risk percutaneous coronary intervention (PCI). To date, this assertion has not been tested in a randomized trial. OBJECTIVE: To determine whether routine intra-aortic balloon counterpulsation before PCI reduces major adverse cardiac and cardiovascular events (MACCE) in patients with severe left ventricular dysfunction and extensive coronary disease. Design, Setting, and PATIENTS: The Balloon Pump-Assisted Coronary Intervention Study, a prospective, open, multicenter, randomized controlled trial conducted in 17 tertiary referral cardiac centers in the United Kingdom between December 2005 and January 2009. Patients (n = 301) had severe left ventricular dysfunction (ejection fraction </=30%) and extensive coronary disease (Jeopardy Score >/=8/12); those with contraindications to or class I indications for IABP therapy were excluded. INTERVENTION: Elective insertion of IABP before PCI. MAIN OUTCOME MEASURES: Primary end point was MACCE, defined as death, acute myocardial infarction, cerebrovascular event, or further revascularization at hospital discharge (capped at 28 days). Secondary end points included all-cause mortality at 6 months, major procedural complications, bleeding, and access-site complications. RESULTS: MACCE at hospital discharge occurred in 15.2% (23/151) of the elective IABP and 16.0% (24/150) of the no planned IABP groups (P = .85; odds ratio [OR], 0.94 [95% confidence interval {CI}, 0.51-1.76]). All-cause mortality at 6 months was 4.6% and 7.4% in the respective groups (P = .32; OR, 0.61 [95% CI, 0.24-1.62]). Fewer major procedural complications occurred with elective IABP insertion compared with no planned IABP use (1.3% vs 10.7%, P < .001; OR, 0.11 [95% CI, 0.01-0.49]). Major or minor bleeding occurred in 19.2% and 11.3% (P = .06; OR, 1.86 [95% CI, 0.93-3.79]) and access-site complications in 3.3% and 0% (P = .06) of the elective and no planned IABP groups, respectively. CONCLUSIONS: Elective IABP insertion did not reduce the incidence of MACCE following PCI. These results do not support a strategy of routine IABP placement before PCI in all patients with severe left ventricular dysfunction and extensive coronary disease. Trial Registration isrctn.org Identifier: ISRCTN40553718; clinicaltrials.gov Identifier: NCT00910481.

PMID: 20736470 [PubMed - as supplied by publisher]

Elective Intra-aortic Balloon Counterpulsation During High-Risk Percutaneous Coronary Intervention: A Randomized Controlled Trial.

JAMA. 2010 Aug 25;304(8):867-874

Authors: Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D, de Belder A, Redwood S,

CONTEXT: Observational studies have previously reported that elective intra-aortic balloon pump (IABP) insertion may improve outcomes following high-risk percutaneous coronary intervention (PCI). To date, this assertion has not been tested in a randomized trial. OBJECTIVE: To determine whether routine intra-aortic balloon counterpulsation before PCI reduces major adverse cardiac and cardiovascular events (MACCE) in patients with severe left ventricular dysfunction and extensive coronary disease. Design, Setting, and PATIENTS: The Balloon Pump-Assisted Coronary Intervention Study, a prospective, open, multicenter, randomized controlled trial conducted in 17 tertiary referral cardiac centers in the United Kingdom between December 2005 and January 2009. Patients (n = 301) had severe left ventricular dysfunction (ejection fraction </=30%) and extensive coronary disease (Jeopardy Score >/=8/12); those with contraindications to or class I indications for IABP therapy were excluded. INTERVENTION: Elective insertion of IABP before PCI. MAIN OUTCOME MEASURES: Primary end point was MACCE, defined as death, acute myocardial infarction, cerebrovascular event, or further revascularization at hospital discharge (capped at 28 days). Secondary end points included all-cause mortality at 6 months, major procedural complications, bleeding, and access-site complications. RESULTS: MACCE at hospital discharge occurred in 15.2% (23/151) of the elective IABP and 16.0% (24/150) of the no planned IABP groups (P = .85; odds ratio [OR], 0.94 [95% confidence interval {CI}, 0.51-1.76]). All-cause mortality at 6 months was 4.6% and 7.4% in the respective groups (P = .32; OR, 0.61 [95% CI, 0.24-1.62]). Fewer major procedural complications occurred with elective IABP insertion compared with no planned IABP use (1.3% vs 10.7%, P < .001; OR, 0.11 [95% CI, 0.01-0.49]). Major or minor bleeding occurred in 19.2% and 11.3% (P = .06; OR, 1.86 [95% CI, 0.93-3.79]) and access-site complications in 3.3% and 0% (P = .06) of the elective and no planned IABP groups, respectively. CONCLUSIONS: Elective IABP insertion did not reduce the incidence of MACCE following PCI. These results do not support a strategy of routine IABP placement before PCI in all patients with severe left ventricular dysfunction and extensive coronary disease. Trial Registration isrctn.org Identifier: ISRCTN40553718; clinicaltrials.gov Identifier: NCT00910481.

PMID: 20736470 [PubMed - as supplied by publisher]

Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms: A Randomized Controlled Trial.

JAMA. 2010 Aug 25;304(8):875-80

Authors: Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW

CONTEXT: Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments. OBJECTIVE: To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms. Design, Setting, and PATIENTS: Randomized controlled trial assessing the efficacy of cognitive behavioral therapy for 86 symptomatic adults with ADHD who were already being treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments. INTERVENTIONS: Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attention-matched comparison). MAIN OUTCOME MEASURES: The primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6- and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms. RESULTS: Cognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude -0.0531; 95% confidence interval [CI], -1.01 to -0.05; P = .03) and the ADHD rating scale (magnitude -4.631; 95% CI, -8.30 to -0.963; P = .02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (beta = -0.41; 95% CI, -0.64 to -0.17; P <001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P = .01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P = .002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months. CONCLUSION: Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months. Trial Registration clinicaltrials.gov Identifier: NCT00118911.

PMID: 20736471 [PubMed - in process]

Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms: A Randomized Controlled Trial.

JAMA. 2010 Aug 25;304(8):875-80

Authors: Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW

CONTEXT: Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments. OBJECTIVE: To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms. Design, Setting, and PATIENTS: Randomized controlled trial assessing the efficacy of cognitive behavioral therapy for 86 symptomatic adults with ADHD who were already being treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments. INTERVENTIONS: Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attention-matched comparison). MAIN OUTCOME MEASURES: The primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6- and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms. RESULTS: Cognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude -0.0531; 95% confidence interval [CI], -1.01 to -0.05; P = .03) and the ADHD rating scale (magnitude -4.631; 95% CI, -8.30 to -0.963; P = .02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (beta = -0.41; 95% CI, -0.64 to -0.17; P <001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P = .01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P = .002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months. CONCLUSION: Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months. Trial Registration clinicaltrials.gov Identifier: NCT00118911.

PMID: 20736471 [PubMed - in process]

Genetic Variants of the Protein Kinase C-{beta} 1 Gene and Development of End-Stage Renal Disease in Patients With Type 2 Diabetes.

JAMA. 2010 Aug 25;304(8):881-9

Authors: Ma RC, Tam CH, Wang Y, Luk AO, Hu C, Yang X, Lam V, Chan AW, Ho JS, Chow CC, Tong PC, Jia W, Ng MC, So WY, Chan JC

CONTEXT: Protein kinase C-beta (PKC-beta) is a cell-signaling intermediate implicated in development of diabetic complications. OBJECTIVE: To examine the risk association of PKC-beta 1 gene (PRKCB1) polymorphisms and end-stage renal disease (ESRD) in an 8-year prospective cohort of Chinese patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: We genotyped 18 common tag single-nucleotide polymorphisms (SNPs) that span the PRKCB1 gene (r(2) = 0.80) in 1172 Chinese patients (recruited 1995-1998) without renal disease at baseline. A validation cohort included an additional 1049 patients with early-onset diabetes who were free of renal disease at baseline and were recruited after 1998. MAIN OUTCOME MEASURES: Associations of PRKCB1 polymorphisms under additive, dominant, and recessive genetic models with new onset of ESRD (defined as estimated glomerular filtration rate <15 mL/min/1.73 m(2) or dialysis or renal-related death) were assessed by Cox proportional hazard regression, adjusted for all conventional risk factors including use of medications. RESULTS: After a mean (SD) of 7.9 (1.9) years, 90 patients (7.7%) progressed to ESRD. Four common SNPs were associated with ESRD (P < .05). The closely linked T allele at rs3760106 and G allele rs2575390 (r(2) = 0.98) showed the strongest association with ESRD (hazard ratio [HR], 2.25; 95% confidence interval [CI], 1.31-3.87; P = .003, and HR, 2.26; 95% CI, 1.31-3.88; P = .003, respectively). Four common variants predicted ESRD in separate models. The HR for ESRD increased with increasing number of risk alleles (P < .001) in the joint effect analysis. The adjusted risk for ESRD was 6.04 (95% CI, 2.00-18.31) for patients with 4 risk alleles compared with patients with 0 or 1 risk allele. Incidence was 4.4 per 1000 person-years (95% CI, 0.5-8.2) among individuals with 0 or 1 risk allele compared with 20.0 per 1000 person-years (95% CI, 8.8-31.1) in those carrying 4 risk alleles (6.9% of the cohort). These results were validated in a separate prospective cohort of young-onset diabetic patients. Of 1049 patients in the validation cohort, 151 (14.3%) developed chronic kidney disease (CKD) during follow-up, and there were significant associations between both the T allele of rs3760106 and the G allele of rs2575390 and development of CKD (HR, 1.68; 95% CI, 1.10-2.57; P = .02, and HR, 1.62; 95% CI, 1.07-2.47; P = .02, respectively). CONCLUSION: Genetic variants in the PRKCB1 gene were independently associated with development of ESRD in Chinese patients with type 2 diabetes.

PMID: 20736472 [PubMed - in process]

Genetic Variants of the Protein Kinase C-{beta} 1 Gene and Development of End-Stage Renal Disease in Patients With Type 2 Diabetes.

JAMA. 2010 Aug 25;304(8):881-9

Authors: Ma RC, Tam CH, Wang Y, Luk AO, Hu C, Yang X, Lam V, Chan AW, Ho JS, Chow CC, Tong PC, Jia W, Ng MC, So WY, Chan JC

CONTEXT: Protein kinase C-beta (PKC-beta) is a cell-signaling intermediate implicated in development of diabetic complications. OBJECTIVE: To examine the risk association of PKC-beta 1 gene (PRKCB1) polymorphisms and end-stage renal disease (ESRD) in an 8-year prospective cohort of Chinese patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: We genotyped 18 common tag single-nucleotide polymorphisms (SNPs) that span the PRKCB1 gene (r(2) = 0.80) in 1172 Chinese patients (recruited 1995-1998) without renal disease at baseline. A validation cohort included an additional 1049 patients with early-onset diabetes who were free of renal disease at baseline and were recruited after 1998. MAIN OUTCOME MEASURES: Associations of PRKCB1 polymorphisms under additive, dominant, and recessive genetic models with new onset of ESRD (defined as estimated glomerular filtration rate <15 mL/min/1.73 m(2) or dialysis or renal-related death) were assessed by Cox proportional hazard regression, adjusted for all conventional risk factors including use of medications. RESULTS: After a mean (SD) of 7.9 (1.9) years, 90 patients (7.7%) progressed to ESRD. Four common SNPs were associated with ESRD (P < .05). The closely linked T allele at rs3760106 and G allele rs2575390 (r(2) = 0.98) showed the strongest association with ESRD (hazard ratio [HR], 2.25; 95% confidence interval [CI], 1.31-3.87; P = .003, and HR, 2.26; 95% CI, 1.31-3.88; P = .003, respectively). Four common variants predicted ESRD in separate models. The HR for ESRD increased with increasing number of risk alleles (P < .001) in the joint effect analysis. The adjusted risk for ESRD was 6.04 (95% CI, 2.00-18.31) for patients with 4 risk alleles compared with patients with 0 or 1 risk allele. Incidence was 4.4 per 1000 person-years (95% CI, 0.5-8.2) among individuals with 0 or 1 risk allele compared with 20.0 per 1000 person-years (95% CI, 8.8-31.1) in those carrying 4 risk alleles (6.9% of the cohort). These results were validated in a separate prospective cohort of young-onset diabetic patients. Of 1049 patients in the validation cohort, 151 (14.3%) developed chronic kidney disease (CKD) during follow-up, and there were significant associations between both the T allele of rs3760106 and the G allele of rs2575390 and development of CKD (HR, 1.68; 95% CI, 1.10-2.57; P = .02, and HR, 1.62; 95% CI, 1.07-2.47; P = .02, respectively). CONCLUSION: Genetic variants in the PRKCB1 gene were independently associated with development of ESRD in Chinese patients with type 2 diabetes.

PMID: 20736472 [PubMed - in process]

Does this coughing adolescent or adult patient have pertussis?

JAMA. 2010 Aug 25;304(8):890-6

Authors: Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R

CONTEXT: Pertussis is often overlooked as a cause of chronic cough, especially in adolescents and adults. Several symptoms are classically thought to be suggestive of pertussis, but the diagnostic value of each of them is uncertain. OBJECTIVE: To systematically review the evidence regarding the diagnostic value of 3 classically described symptoms of pertussis: paroxysmal cough, posttussive emesis, and inspiratory whoop. Data Sources, Study Selection, and DATA EXTRACTION: We searched MEDLINE (January 1966-April 2010), EMBASE (January 1969 to April 2010), and the bibliographies of pertinent articles to identify relevant English-language studies. Articles were selected that included children older than 5 years, adolescents, or adults and confirmed the diagnosis of pertussis among patients with cough illness (of any duration) with an a priori-defined accepted reference standard. Two authors independently extracted data from articles that met selection criteria and resolved any discrepancies by consensus. DATA SYNTHESIS: Five prospective studies met inclusion criteria; 3 were used in the analysis. Presence of posttussive emesis (summary likelihood ratio [LR], 1.8; 95% confidence interval [CI], 1.4-2.2) or inspiratory whoop (summary LR, 1.9; 95% CI, 1.4-2.6) increases the likelihood of pertussis. Absence of paroxysmal cough (summary LR, 0.52; 95% CI, 0.27-1.0) or posttussive emesis (summary LR, 0.58; 95% CI, 0.44-0.77) reduced the likelihood. Absence of inspiratory whoop was less useful (summary LR, 0.78; 95% CI, 0.66-0.93). No studies evaluated combinations of findings. CONCLUSIONS: In a nonoutbreak setting, data to determine the diagnostic usefulness of symptoms classically associated with pertussis are limited and of relatively weak quality. The presence or absence of posttussive emesis or inspiratory whoop modestly change the likelihood of pertussis; therefore, clinicians must use their overall clinical impression to decide about additional testing or empirical treatment.

PMID: 20736473 [PubMed - in process]

Does this coughing adolescent or adult patient have pertussis?

JAMA. 2010 Aug 25;304(8):890-6

Authors: Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R

CONTEXT: Pertussis is often overlooked as a cause of chronic cough, especially in adolescents and adults. Several symptoms are classically thought to be suggestive of pertussis, but the diagnostic value of each of them is uncertain. OBJECTIVE: To systematically review the evidence regarding the diagnostic value of 3 classically described symptoms of pertussis: paroxysmal cough, posttussive emesis, and inspiratory whoop. Data Sources, Study Selection, and DATA EXTRACTION: We searched MEDLINE (January 1966-April 2010), EMBASE (January 1969 to April 2010), and the bibliographies of pertinent articles to identify relevant English-language studies. Articles were selected that included children older than 5 years, adolescents, or adults and confirmed the diagnosis of pertussis among patients with cough illness (of any duration) with an a priori-defined accepted reference standard. Two authors independently extracted data from articles that met selection criteria and resolved any discrepancies by consensus. DATA SYNTHESIS: Five prospective studies met inclusion criteria; 3 were used in the analysis. Presence of posttussive emesis (summary likelihood ratio [LR], 1.8; 95% confidence interval [CI], 1.4-2.2) or inspiratory whoop (summary LR, 1.9; 95% CI, 1.4-2.6) increases the likelihood of pertussis. Absence of paroxysmal cough (summary LR, 0.52; 95% CI, 0.27-1.0) or posttussive emesis (summary LR, 0.58; 95% CI, 0.44-0.77) reduced the likelihood. Absence of inspiratory whoop was less useful (summary LR, 0.78; 95% CI, 0.66-0.93). No studies evaluated combinations of findings. CONCLUSIONS: In a nonoutbreak setting, data to determine the diagnostic usefulness of symptoms classically associated with pertussis are limited and of relatively weak quality. The presence or absence of posttussive emesis or inspiratory whoop modestly change the likelihood of pertussis; therefore, clinicians must use their overall clinical impression to decide about additional testing or empirical treatment.

PMID: 20736473 [PubMed - in process]

Minimizing bias due to confounding by indication in comparative effectiveness research: the importance of restriction.

JAMA. 2010 Aug 25;304(8):897-8

Authors: Psaty BM, Siscovick DS

PMID: 20736474 [PubMed - in process]

Minimizing bias due to confounding by indication in comparative effectiveness research: the importance of restriction.

JAMA. 2010 Aug 25;304(8):897-8

Authors: Psaty BM, Siscovick DS

PMID: 20736474 [PubMed - in process]

Health care reform and chronic diseases: anticipating the health consequences.

JAMA. 2010 Aug 25;304(8):899-900

Authors: Laiteerapong N, Huang ES

PMID: 20736475 [PubMed - in process]

Health care reform and chronic diseases: anticipating the health consequences.

JAMA. 2010 Aug 25;304(8):899-900

Authors: Laiteerapong N, Huang ES

PMID: 20736475 [PubMed - in process]

The shared decision-making continuum.

JAMA. 2010 Aug 25;304(8):903-4

Authors: Kon AA

PMID: 20736477 [PubMed - in process]

The shared decision-making continuum.

JAMA. 2010 Aug 25;304(8):903-4

Authors: Kon AA

PMID: 20736477 [PubMed - in process]

Comparative Effectiveness--of What?: Evaluating Strategies to Improve Population Health.

JAMA. 2010 Aug 25;304(8):901-2

Authors: Kindig D, Mullahy J

PMID: 20736476 [PubMed - in process]

Comparative Effectiveness--of What?: Evaluating Strategies to Improve Population Health.

JAMA. 2010 Aug 25;304(8):901-2

Authors: Kindig D, Mullahy J

PMID: 20736476 [PubMed - in process]

Acyclovir exposure and birth defects: an important advance, but more are needed.

JAMA. 2010 Aug 25;304(8):905-6

Authors: Mills JL, Carter TC

PMID: 20736478 [PubMed - in process]

Acyclovir exposure and birth defects: an important advance, but more are needed.

JAMA. 2010 Aug 25;304(8):905-6

Authors: Mills JL, Carter TC

PMID: 20736478 [PubMed - in process]

Pertussis.

JAMA. 2010 Aug 25;304(8):922

Authors: Pluta RM, Lynm C, Glass RM

PMID: 20736479 [PubMed - in process]

Early-onset obesity and risk for psoriatic arthritis.

JAMA. 2010 Aug 18;304(7):787-8

Authors: Gladman DD, Callen JP

PMID: 20726050 [PubMed]

The cover. Eve of Saint John.

JAMA. 2010 Aug 18;304(7):720

Authors: Torpy JM

PMID: 20716728 [PubMed - in process]

A piece of my mind. Journalist feels palpitations, enrolls in medical school.

JAMA. 2010 Aug 18;304(7):723-4

Authors: Tompkins J

PMID: 20716729 [PubMed - in process]

Successes, challenges emerge from efforts to shift away from industry-funded CME.

JAMA. 2010 Aug 18;304(7):729-31

Authors: Kuehn BM

PMID: 20716730 [PubMed - in process]

Report clarifies scientists' understanding of association between diabetes and cancer.

JAMA. 2010 Aug 18;304(7):731-2

Authors: Mitka M

PMID: 20716731 [PubMed - in process]

Coronary artery calcium score and cardiovascular event prediction.

JAMA. 2010 Aug 18;304(7):741-2; author reply 742

Authors: McEvoy JW

PMID: 20716732 [PubMed - in process]

Coronary artery calcium score and cardiovascular event prediction.

JAMA. 2010 Aug 18;304(7):741; author reply 742

Authors: Diederichsen A, Mickley H

PMID: 20716733 [PubMed - in process]

Pneumococcal vaccination and cardiovascular events in men.

JAMA. 2010 Aug 18;304(7):742; author reply 743

Authors: Kaczorowski J

PMID: 20716734 [PubMed - in process]

Early physician follow-up and 30-day readmission among older patients with heart failure.

JAMA. 2010 Aug 18;304(7):743; author reply 743-4

Authors: Wexler R

PMID: 20716735 [PubMed - in process]

Cognitively impaired older drivers, risk assessment, and physician responsibility.

JAMA. 2010 Aug 18;304(7):744; author reply 744-5

Authors: Finucane TE

PMID: 20716736 [PubMed - in process]

Prediction of critical illness during out-of-hospital emergency care.

JAMA. 2010 Aug 18;304(7):747-54

Authors: Seymour CW, Kahn JM, Cooke CR, Watkins TR, Heckbert SR, Rea TD

CONTEXT: Early identification of nontrauma patients in need of critical care services in the emergency setting may improve triage decisions and facilitate regionalization of critical care. OBJECTIVES: To determine the out-of-hospital clinical predictors of critical illness and to characterize the performance of a simple score for out-of-hospital prediction of development of critical illness during hospitalization. DESIGN AND SETTING: Population-based cohort study of an emergency medical services (EMS) system in greater King County, Washington (excluding metropolitan Seattle), that transports to 16 receiving facilities. PATIENTS: Nontrauma, non-cardiac arrest adult patients transported to a hospital by King County EMS from 2002 through 2006. Eligible records with complete data (N = 144,913) were linked to hospital discharge data and randomly split into development (n = 87,266 [60%]) and validation (n = 57,647 [40%]) cohorts. MAIN OUTCOME MEASURE: Development of critical illness, defined as severe sepsis, delivery of mechanical ventilation, or death during hospitalization. RESULTS: Critical illness occurred during hospitalization in 5% of the development (n = 4835) and validation (n = 3121) cohorts. Multivariable predictors of critical illness included older age, lower systolic blood pressure, abnormal respiratory rate, lower Glasgow Coma Scale score, lower pulse oximetry, and nursing home residence during out-of-hospital care (P < .01 for all). When applying a summary critical illness prediction score to the validation cohort (range, 0-8), the area under the receiver operating characteristic curve was 0.77 (95% confidence interval [CI], 0.76-0.78), with satisfactory calibration slope (1.0). Using a score threshold of 4 or higher, sensitivity was 0.22 (95% CI, 0.20-0.23), specificity was 0.98 (95% CI, 0.98-0.98), positive likelihood ratio was 9.8 (95% CI, 8.9-10.6), and negative likelihood ratio was 0.80 (95% CI, 0.79- 0.82). A threshold of 1 or greater for critical illness improved sensitivity (0.98; 95% CI, 0.97-0.98) but reduced specificity (0.17; 95% CI, 0.17-0.17). CONCLUSIONS: In a population-based cohort, the score on a prediction rule using out-of-hospital factors was significantly associated with the development of critical illness during hospitalization. This score requires external validation in an independent population.

PMID: 20716737 [PubMed - in process]

Effect of an implantable gentamicin-collagen sponge on sternal wound infections following cardiac surgery: a randomized trial.

JAMA. 2010 Aug 18;304(7):755-62

Authors: Bennett-Guerrero E, Ferguson TB, Lin M, Garg J, Mark DB, Scavo VA, Kouchoukos N, Richardson JB, Pridgen RL, Corey GR,

CONTEXT: Despite the routine use of prophylactic systemic antibiotics, sternal wound infection still occurs in 5% or more of cardiac surgical patients and is associated with significant excess morbidity, mortality, and cost. The gentamicin-collagen sponge, a surgically implantable topical antibiotic, is currently approved in 54 countries. A large, 2-center, randomized trial in Sweden reported in 2005 that the sponge reduced surgical site infection by 50% in cardiac patients. OBJECTIVE: To test the hypothesis that the sponge prevents infection in cardiac surgical patients at increased risk for sternal wound infection. DESIGN, SETTING, AND PARTICIPANTS: Phase 3 single-blind, prospective randomized controlled trial, 1502 cardiac surgical patients at high risk for sternal wound infection (diabetes, body mass index >30, or both) were enrolled at 48 US sites between December 21, 2007, and March 11, 2009. INTERVENTION: Single-blind randomization to insertion of 2 gentamicin-collagen sponges (total gentamicin of 260 mg) between the sternal halves at surgical closure (n = 753) vs no intervention (control group: n = 749). All patients received standardized care including prophylactic systemic antibiotics and rigid sternal fixation. MAIN OUTCOME MEASURES: The primary end point was sternal wound infection occurring through 90 days postoperatively as adjudicated by a clinical events classification committee blinded to study treatment group. The primary study comparison was done in the intent-to-treat population. Secondary outcomes included (1) superficial wound infection (involving subcutaneous tissue but not extending down to sternal fixation wires), (2) deep wound infection (involving the sternal wires, sternal bone, and/or mediastinum), and (3) score for additional treatment, presence of serous discharge, erythema, purulent exudate, separation of the deep tissues, isolation of bacteria, and duration of inpatient stay (ASEPSIS; minimum score of 0 with no theoretical maximum). RESULTS: Of 1502 patients, 1006 had diabetes (67%) and 1137 were obese (body mass index >30) (76%). In the primary analysis, there was no significant difference in sternal wound infection in 63 of 753 patients randomized to the gentamicin-collagen sponge group (8.4%) compared with 65 of 749 patients randomized to the control group (8.7%) (P = .83). No significant differences were observed between the gentamicin-collagen sponge group and the control group, respectively, in superficial sternal wound infection (49/753 [6.5%] vs 46/749 [6.1%]; P = .77), deep sternal wound infection (14/753 [1.9%] vs 19/749 [2.5%]; P = .37), ASEPSIS score (mean [SD], 1.9 [6.4] vs 2.0 [7.2]; P = .67), or rehospitalization for sternal wound infection (23/753 [3.1%] vs 24/749 [3.2%]; P = .87). CONCLUSION: Among US patients with diabetes, high body mass index, or both undergoing cardiac surgery, the use of 2 gentamicin-collagen sponges compared with no intervention did not reduce the 90-day sternal wound infection rate. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00600483.

PMID: 20716738 [PubMed - in process]

System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention.

JAMA. 2010 Aug 18;304(7):763-71

Authors: Terkelsen CJ, Sørensen JT, Maeng M, Jensen LO, Tilsted HH, Trautner S, Vach W, Johnsen SP, Thuesen L, Lassen JF

CONTEXT: Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and door-to-balloon delay has been proposed as a performance measure in triaging patients for primary percutaneous coronary intervention (PCI). However, focusing on the time from first contact with the health care system to the initiation of reperfusion therapy (system delay) may be more relevant, because it constitutes the total time to reperfusion modifiable by the health care system. No previous studies have focused on the association between system delay and outcome in patients with STEMI treated with primary PCI. OBJECTIVE: To evaluate the associations between system, treatment, patient, and door-to-balloon delays and mortality in patients with STEMI. DESIGN, SETTING, AND PATIENTS: Historical follow-up study based on population-based Danish medical registries of patients with STEMI transported by the emergency medical service and treated with primary PCI from January 1, 2002, to December 31, 2008, at 3 high-volume PCI centers in Western Denmark. Patients (N = 6209) underwent primary PCI within 12 hours of symptom onset. The median follow-up time was 3.4 (interquartile range, 1.8-5.2) years. MAIN OUTCOME MEASURES: Crude and adjusted hazard ratios of mortality obtained by Cox proportional regression analysis. RESULTS: A system delay of 0 through 60 minutes (n = 347) corresponded to a long-term mortality rate of 15.4% (n = 43); a delay of 61 through 120 minutes (n = 2643) to a rate of 23.3% (n = 380); a delay of 121 through 180 minutes (n = 2092) to a rate of 28.1% (n = 378); and a delay of 181 through 360 minutes (n = 1127) to a rate of 30.8% (n = 275) (P < .001). In multivariable analysis adjusted for other predictors of mortality, system delay was independently associated with mortality (adjusted hazard ratio, 1.10 [95% confidence interval, 1.04-1.16] per 1-hour delay), as was its components, prehospital system delay and door-to-balloon delay. CONCLUSION: System delay was associated with mortality in patients with STEMI treated with primary PCI.

PMID: 20716739 [PubMed - in process]

Change in prevalence of hearing loss in US adolescents.

JAMA. 2010 Aug 18;304(7):772-8

Authors: Shargorodsky J, Curhan SG, Curhan GC, Eavey R

CONTEXT: Hearing loss is common and, in young persons, can compromise social development, communication skills, and educational achievement. OBJECTIVE: To examine the current prevalence of hearing loss in US adolescents and determine whether it has changed over time. DESIGN: Cross-sectional analyses of US representative demographic and audiometric data from the 1988 through 1994 and 2005 through 2006 time periods. SETTING: The Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994, and NHANES 2005-2006. PARTICIPANTS: NHANES III examined 2928 participants and NHANES 2005-2006 examined 1771 participants, aged 12 to 19 years. MAIN OUTCOME MEASURES: We calculated the prevalence of hearing loss in participants aged 12 to 19 years after accounting for the complex survey design. Audiometrically determined hearing loss was categorized as either unilateral or bilateral for low frequency (0.5, 1, and 2 kHz) or high frequency (3, 4, 6, and 8 kHz), and as slight loss (> 15 to < 25 dB) or mild or greater loss (> or = 25 dB) according to hearing sensitivity in the worse ear. The prevalence of hearing loss from NHANES 2005-2006 was compared with the prevalence from NHANES III (1988-1994). We also examined the cross-sectional relations between several potential risk factors and hearing loss. Logistic regression was used to calculate multivariate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The prevalence of any hearing loss increased significantly from 14.9% (95% CI, 13.0%-16.9%) in 1988-1994 to 19.5% (95% CI, 15.2%-23.8%) in 2005-2006 (P = .02). In 2005-2006, hearing loss was more commonly unilateral (prevalence, 14.0%; 95% CI, 10.4%-17.6%, vs 11.1%; 95% CI, 9.5%-12.8% in 1988-1994; P = .005) and involved the high frequencies (prevalence, 16.4%; 95% CI, 13.2%-19.7%, vs 12.8%; 95% CI, 11.1%-14.5% in 1988-1994; P = .02). Individuals from families below the federal poverty threshold (prevalence, 23.6%; 95% CI, 18.5%-28.7%) had significantly higher odds of hearing loss (multivariate adjusted OR, 1.60; 95% CI, 1.10-2.32) than those above the threshold (prevalence, 18.4%; 95% CI, 13.6%-23.2%). CONCLUSION: The prevalence of hearing loss among a sample of US adolescents aged 12 to 19 years was greater in 2005-2006 compared with 1988-1994.

PMID: 20716740 [PubMed - in process]

Does this patient have delirium?: value of bedside instruments.

JAMA. 2010 Aug 18;304(7):779-86

Authors: Wong CL, Holroyd-Leduc J, Simel DL, Straus SE

CONTEXT: Delirium occurs in many hospitalized older patients and has serious consequences including increased risk for death and admission to long-term care. Despite its importance, health care clinicians often fail to recognize delirium. Simple bedside instruments may lead to improved identification. OBJECTIVE: To systematically review the evidence on the accuracy of bedside instruments in diagnosing the presence of delirium in adults. DATA SOURCES: Search of MEDLINE (from 1950 to May 2010), EMBASE (from 1980 to May 2010), and references of retrieved articles to identify studies of delirium among inpatients. STUDY SELECTION: Prospective studies of diagnostic accuracy that compared at least 1 delirium bedside instrument to the Diagnostic and Statistical Manual of Mental Disorders-based diagnosis made by a geriatrician, psychiatrist, or neurologist. DATA SYNTHESIS: There were 6570 unique citations identified with 25 prospectively conducted studies (N = 3027 patients) meeting inclusion criteria and describing use of 11 instruments. Positive results that suggested delirium with likelihood ratios (LRs) greater than 5.0 were present for the Global Attentiveness Rating (GAR), Memorial Delirium Assessment Scale (MDAS), Confusion Assessment Method (CAM), Delirium Rating Scale Revised-98 (DRS-R-98), Clinical Assessment of Confusion (CAC), and Delirium Observation Screening Scale (DOSS). Normal results that decreased the likelihood of delirium with LRs less than 0.2 were calculated for the GAR, MDAS, CAM, DRS-R-98, Delirium Rating Scale (DRS), DOSS, Nursing Delirium Screening Scale (Nu-DESC), and Mini-Mental State Examination (MMSE). The Digit Span test and Vigilance "A" test in isolation have limited utility in diagnosing delirium. Considering the instrument's ease of use, test performance, and clinical importance of the heterogeneity in the confidence intervals (CIs) of the LRs, the CAM has the best available supportive data as a bedside delirium instrument (summary-positive LR, 9.6; 95% CI, 5.8-16.0; summary-negative LR, 0.16; 95% CI, 0.09-0.29). Of all scales, the MMSE (score <24) was the least useful for identifying a patient with delirium (LR, 1.6; 95% CI, 1.2-2.0). CONCLUSION: The choice of instrument may be dictated by the amount of time available and the discipline of the examiner; however, the best evidence supports use of the CAM, which takes 5 minutes to administer.

PMID: 20716741 [PubMed - in process]

The President's Global Health Initiative.

JAMA. 2010 Aug 18;304(7):789-90

Authors: Gostin LO, Mok EA

PMID: 20716742 [PubMed - in process]

The US Global Health Initiative: informing policy with evidence.

JAMA. 2010 Aug 18;304(7):791-2

Authors: Bendavid E, Miller G

PMID: 20716743 [PubMed - in process]

Minimizing bias in randomized trials: the importance of blinding.

JAMA. 2010 Aug 18;304(7):793-4

Authors: Psaty BM, Prentice RL

PMID: 20716744 [PubMed - in process]

Physician compensation, cost, and quality.

JAMA. 2010 Aug 18;304(7):795-6

Authors: Brook RH

PMID: 20716745 [PubMed - in process]

Assessing critical illness during emergency medical services care.

JAMA. 2010 Aug 18;304(7):797-8

Authors: Wang HE, Yealy DM

PMID: 20716746 [PubMed - in process]

JAMA patient page. Delirium.

JAMA. 2010 Aug 18;304(7):814

Authors: Torpy JM, Burke AE, Glass RM

PMID: 20716747 [PubMed - in process]

Health Effects of the Gulf Oil Spill.

JAMA. 2010 Aug 16;

Authors: Solomon GM, Janssen S

PMID: 20713544 [PubMed - as supplied by publisher]

The cover. Nude in a wood.

JAMA. 2010 Aug 11;304(6):612

Authors: Torpy JM

PMID: 20699445 [PubMed - in process]

A piece of my mind. Maintenance.

JAMA. 2010 Aug 11;304(6):615-6

Authors: Ephgrave KS

PMID: 20699446 [PubMed - in process]

Experts focus on identifying, mitigating potential health effects of Gulf oil leak.

JAMA. 2010 Aug 11;304(6):621-2, 624

Authors: Slomski A

PMID: 20699447 [PubMed - in process]

Targeted therapies take aim against lung cancer and melanoma.

JAMA. 2010 Aug 11;304(6):624-6

Authors: Mitka M

PMID: 20699448 [PubMed - in process]

H1N1 influenza virus reassorting in pigs, poses unknown risk to human health.

JAMA. 2010 Aug 11;304(6):626-7

Authors: Mitka M

PMID: 20699449 [PubMed - in process]

IOM advises FDA on ethics in postmarket safety trials.

JAMA. 2010 Aug 11;304(6):627

Authors: Kuehn BM

PMID: 20699450 [PubMed - in process]

B-vitamin therapy for diabetic nephropathy.

JAMA. 2010 Aug 11;304(6):636; author reply 636-7

Authors: Kadam S, Kulshrestha S, Swaminathan S

PMID: 20699451 [PubMed - in process]

B-vitamin therapy for diabetic nephropathy.

JAMA. 2010 Aug 11;304(6):636; author reply 636-7

Authors: Drion I

PMID: 20699452 [PubMed - in process]

Association between maternal height and childhood outcomes.

JAMA. 2010 Aug 11;304(6):638; author reply 638-9

Authors: Handel AE, Handunnetthi L, Ramagopalan SV

PMID: 20699453 [PubMed - in process]

Diagnostic testing for celiac disease.

JAMA. 2010 Aug 11;304(6):639; author reply 639-40

Authors: Plebani M, Basso D

PMID: 20699454 [PubMed - in process]

Health care-associated invasive MRSA infections, 2005-2008.

JAMA. 2010 Aug 11;304(6):641-8

Authors: Kallen AJ, Mu Y, Bulens S, Reingold A, Petit S, Gershman K, Ray SM, Harrison LH, Lynfield R, Dumyati G, Townes JM, Schaffner W, Patel PR, Fridkin SK,

CONTEXT: Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of public health importance; MRSA prevention programs that may affect MRSA transmission and infection are increasingly common in health care settings. Whether there have been changes in MRSA infection incidence as these programs become established is unknown; however, recent data have shown that rates of MRSA bloodstream infections (BSIs) in intensive care units are decreasing. OBJECTIVE: To describe changes in rates of invasive health care-associated MRSA infections from 2005 through 2008 among residents of 9 US metropolitan areas. DESIGN, SETTING, AND PARTICIPANTS: Active, population-based surveillance for invasive MRSA in 9 metropolitan areas covering a population of approximately 15 million persons. All reports of laboratory-identified episodes of invasive (from a normally sterile body site) MRSA infections from 2005 through 2008 were evaluated and classified based on the setting of the positive culture and the presence or absence of health care exposures. Health care-associated infections (ie, hospital-onset and health care-associated community-onset), which made up 82% of the total infections, were included in this analysis. MAIN OUTCOME MEASURES: Change in incidence of invasive health care-associated MRSA infections and health care-associated MRSA BSIs using population of the catchment area as the denominator. RESULTS: From 2005 through 2008, there were 21,503 episodes of invasive MRSA infection; 17,508 were health care associated. Of these, 15,458 were MRSA BSIs. The incidence rate of hospital-onset invasive MRSA infections was 1.02 per 10,000 population in 2005 and decreased 9.4% per year (95% confidence interval [CI], 14.7% to 3.8%; P = .005), and the incidence of health care-associated community-onset infections was 2.20 per 10,000 population in 2005 and decreased 5.7% per year (95% CI, 9.7% to 1.6%; P = .01). The decrease was most prominent for the subset of infections with BSIs (hospital-onset: -11.2%; 95% CI -15.9% to -6.3%; health care-associated community-onset: -6.6%; 95% CI -9.5% to -3.7%). CONCLUSION: Over the 4-year period from 2005 through 2008 in 9 diverse metropolitan areas, rates of invasive health care-associated MRSA infections decreased among patients with health care-associated infections that began in the community and also decreased among those with hospital-onset invasive disease.

PMID: 20699455 [PubMed - in process]

Prevalence of diabetic retinopathy in the United States, 2005-2008.

JAMA. 2010 Aug 11;304(6):649-56

Authors: Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, Gregg EW, Albright AL, Klein BE, Klein R

CONTEXT: The prevalence of diabetes in the United States has increased. People with diabetes are at risk for diabetic retinopathy. No recent national population-based estimate of the prevalence and severity of diabetic retinopathy exists. OBJECTIVES: To describe the prevalence and risk factors of diabetic retinopathy among US adults with diabetes aged 40 years and older. DESIGN, SETTING, AND PARTICIPANTS: Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N = 1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A(1c) of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older. MAIN OUTCOME MEASUREMENTS: Diabetic retinopathy and vision-threatening diabetic retinopathy. RESULTS: The estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 21.7%-30.1%; P = .04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of diabetic retinopathy (38.8%; 95% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening diabetic retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of diabetic retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A(1c) level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 1.02-1.03). CONCLUSION: In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was high, especially among Non-Hispanic black individuals.

PMID: 20699456 [PubMed - in process]

Exposure to oral bisphosphonates and risk of esophageal cancer.

JAMA. 2010 Aug 11;304(6):657-63

Authors: Cardwell CR, Abnet CC, Cantwell MM, Murray LJ

CONTEXT: Use of oral bisphosphonates has increased dramatically in the United States and elsewhere. Esophagitis is a known adverse effect of bisphosphonate use, and recent reports suggest a link between bisphosphonate use and esophageal cancer, but this has not been robustly investigated. OBJECTIVE: To investigate the association between bisphosphonate use and esophageal cancer. DESIGN, SETTING, AND PARTICIPANTS: Data were extracted from the UK General Practice Research Database to compare the incidence of esophageal and gastric cancer in a cohort of patients treated with oral bisphosphonates between January 1996 and December 2006 with incidence in a control cohort. Cancers were identified from relevant Read/Oxford Medical Information System codes in the patient's clinical files. Cox proportional hazards modeling was used to calculate hazard ratios and 95% confidence intervals for risk of esophageal and gastric cancer in bisphosphonate users compared with nonusers, with adjustment for potential confounders. MAIN OUTCOME MEASURE: Hazard ratio for the risk of esophageal and gastric cancer in the bisphosphonate users compared with the bisphosphonate nonusers. RESULTS: Mean follow-up time was 4.5 and 4.4 years in the bisphosphonate and control cohorts, respectively. Excluding patients with less than 6 months' follow-up, there were 41 826 members in each cohort (81% women; mean age, 70.0 (SD, 11.4) years). One hundred sixteen esophageal or gastric cancers (79 esophageal) occurred in the bisphosphonate cohort and 115 (72 esophageal) in the control cohort. The incidence of esophageal and gastric cancer combined was 0.7 per 1000 person-years of risk in both the bisphosphonate and control cohorts; the incidence of esophageal cancer alone in the bisphosphonate and control cohorts was 0.48 and 0.44 per 1000 person-years of risk, respectively. There was no difference in risk of esophageal and gastric cancer combined between the cohorts for any bisphosphonate use (adjusted hazard ratio, 0.96 [95% confidence interval, 0.74-1.25]) or risk of esophageal cancer only (adjusted hazard ratio, 1.07 [95% confidence interval, 0.77-1.49]). There also was no difference in risk of esophageal or gastric cancer by duration of bisphosphonate intake. CONCLUSION: Among patients in the UK General Practice Research Database, the use of oral bisphosphonates was not significantly associated with incident esophageal or gastric cancer.

PMID: 20699457 [PubMed - in process]

Trends and characteristics of US emergency department visits, 1997-2007.

JAMA. 2010 Aug 11;304(6):664-70

Authors: Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R

CONTEXT: The potential effects of increasing numbers of uninsured and underinsured persons on US emergency departments (EDs) is a concern for the health care safety net. OBJECTIVE: To describe the changes in ED visits that occurred from 1997 through 2007 in the adult and pediatric US populations by sociodemographic group, designation of safety-net ED, and trends in ambulatory care-sensitive conditions. DESIGN, SETTING, AND PARTICIPANTS: Publicly available ED visit data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1997 through 2007 were stratified by age, sex, race, ethnicity, insurance status, safety-net hospital classification, triage category, and disposition. Codes from the International Classification of Diseases, Ninth Revision (ICD-9), were used to extract visits related to ambulatory care-sensitive conditions. Visit rates were calculated using annual US Census estimates. MAIN OUTCOME MEASURES: Total annual visits to US EDs and ED visit rates for population subgroups. RESULTS: Between 1997 and 2007, ED visit rates increased from 352.8 to 390.5 per 1000 persons (rate difference, 37.7; 95% confidence interval [CI], -51.1 to 126.5; P = .001 for trend); the increase in total annual ED visits was almost double of what would be expected from population growth. Adults with Medicaid accounted for most of the increase in ED visits; the visit rate increased from 693.9 to 947.2 visits per 1000 enrollees between 1999 and 2007 (rate difference, 253.3; 95% CI, 41.1 to 465.5; P = .001 for trend). Although ED visit rates for adults with ambulatory care-sensitive conditions remained stable, ED visit rates among adults with Medicaid increased from 66.4 in 1999 to 83.9 in 2007 (rate difference, 17.5; 95% CI, -5.8 to 40.8; P = .007 for trend). The number of facilities qualifying as safety-net EDs increased from 1770 in 2000 to 2489 in 2007. CONCLUSION: These findings indicate that ED visit rates have increased from 1997 to 2007 and that EDs are increasingly serving as the safety net for medically underserved patients, particularly adults with Medicaid.

PMID: 20699458 [PubMed - in process]

A 29-year-old woman with flu-like symptoms: review of influenza diagnosis and treatment.

JAMA. 2010 Aug 11;304(6):671-8

Authors: Barry MA

Peaks of seasonal influenza activity occur annually in many countries, resulting in significant morbidity and mortality. Using the case of Ms R, a 29-year-old woman who presented with acute onset of respiratory symptoms and was evaluated for influenza, considerations regarding symptoms and signs, evaluation, treatment, and prevention of influenza are discussed. Symptoms of influenza can be similar to those of other respiratory viruses, making diagnosis challenging. Laboratory testing should be reserved for patients who are seriously ill or for whom test results may affect management or have public health implications. For most cases of influenza, treatment is supportive and specific antiviral medication is not needed. Annual vaccination is the most effective way to prevent infection. Educating patients on practical steps to reduce the spread of influenza in the community is critical.

PMID: 20699459 [PubMed - in process]

Future of the safety net under health reform.

JAMA. 2010 Aug 11;304(6):679-80

Authors: Katz MH

PMID: 20699460 [PubMed - in process]

Dietary guidelines in the 21st century--a time for food.

JAMA. 2010 Aug 11;304(6):681-2

Authors: Mozaffarian D, Ludwig DS

PMID: 20699461 [PubMed - in process]

Evaluation of comparative treatment trials: assessing clinical benefits and risks for patients, rather than statistical effects on measures.

JAMA. 2010 Aug 11;304(6):683-4

Authors: Kraemer HC, Frank E

PMID: 20699462 [PubMed - in process]

Should sensitive information from clinical trials be included in electronic medical records?

JAMA. 2010 Aug 11;304(6):685-6

Authors: Dunlop BW

PMID: 20699463 [PubMed - in process]

Decline in invasive MRSA infection: where to go from here?

JAMA. 2010 Aug 11;304(6):687-9

Authors: Perencevich EN, Diekema DJ

PMID: 20699464 [PubMed - in process]

JAMA patient page. Esophageal cancer.

JAMA. 2010 Aug 11;304(6):704

Authors: Torpy JM, Burke AE, Glass RM

PMID: 20699465 [PubMed - in process]

The legend of john brown.

JAMA. 2010 Aug 4;304(5):502

Authors: Cole TB

PMID: 20682923 [PubMed - in process]

The haircut.

JAMA. 2010 Aug 4;304(5):504-5

Authors: Taylor DR

PMID: 20682924 [PubMed - in process]

Child marriage threatens girls' health.

JAMA. 2010 Aug 4;304(5):509-10

Authors: Hampton T

PMID: 20682925 [PubMed - in process]

Violence in health care settings on rise.

JAMA. 2010 Aug 4;304(5):511-2

Authors: Kuehn BM

PMID: 20682926 [PubMed - in process]

Antiepileptic medications and the risk of suicide.

JAMA. 2010 Aug 4;304(5):521-2

Authors: Gibbons RD, Lambert BL, Mann JJ

PMID: 20682927 [PubMed - in process]

Antiepileptic medications and the risk of suicide.

JAMA. 2010 Aug 4;304(5):521

Authors: Neligan A, Bell GS, Mula M

PMID: 20682928 [PubMed - in process]

Insurance and financial concerns among patients seeking care for acute myocardial infarction.

JAMA. 2010 Aug 4;304(5):523

Authors: van Riezen J, de Jonge P

PMID: 20682929 [PubMed - in process]

Donor policies for stem cell transplantation.

JAMA. 2010 Aug 4;304(5):524

Authors: Tischler DH

PMID: 20682930 [PubMed - in process]

Donor policies for stem cell transplantation.

JAMA. 2010 Aug 4;304(5):525

Authors: Navarro WH

PMID: 20682931 [PubMed - in process]

Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial.

JAMA. 2010 Aug 4;304(5):527-35

Authors: Walton MA, Chermack ST, Shope JT, Bingham CR, Zimmerman MA, Blow FC, Cunningham RM

CONTEXT: Emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury. OBJECTIVE: To determine the efficacy of brief interventions addressing violence and alcohol use among adolescents presenting to an urban ED. DESIGN, SETTING, AND PARTICIPANTS: Between September 2006 and September 2009, 3338 patients aged 14 to 18 years presenting to a level I ED in Flint, Michigan, between 12 pm and 11 pm 7 days a week completed a computerized survey (43.5% male; 55.9% African American). Adolescents reporting past-year alcohol use and aggression were enrolled in a randomized controlled trial (SafERteens). INTERVENTION: All patients underwent a computerized baseline assessment and were randomized to a control group that received a brochure (n = 235) or a 35-minute brief intervention delivered by either a computer (n = 237) or therapist (n = 254) in the ED, with follow-up assessments at 3 and 6 months. Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included review of goals, tailored feedback, decisional balance exercise, role plays, and referrals. MAIN OUTCOME MEASURES: Self-report measures included peer aggression and violence, violence consequences, alcohol use, binge drinking, and alcohol consequences. RESULTS: About 25% (n = 829) of screened patients had positive results for both alcohol and violence; 726 were randomized. Compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, -34.3%; control, -16.4%; relative risk [RR], 0.74; 95% confidence interval [CI], 0.61-0.90), experience of peer violence (therapist, -10.4%; control, +4.7%; RR, 0.70; 95% CI, 0.52-0.95), and violence consequences (therapist, -30.4%; control, -13.0%; RR, 0.76; 95% CI, 0.64-0.90) at 3 months. At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, -32.2%; control, -17.7%; odds ratio, 0.56; 95% CI, 0.34-0.91) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, -29.1%; control, -17.7%; odds ratio, 0.57; 95% CI, 0.34-0.95). CONCLUSION: Among adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in the prevalence of self-reported aggression and alcohol consequences. Trial Registration clinicaltrials.gov Identifier: NCT00251212.

PMID: 20682932 [PubMed - in process]

Effect of an advocacy intervention on mental health in chinese women survivors of intimate partner violence: a randomized controlled trial.

JAMA. 2010 Aug 4;304(5):536-43

Authors: Tiwari A, Fong DY, Yuen KH, Yuk H, Pang P, Humphreys J, Bullock L

CONTEXT: Intimate partner violence (IPV) against women can have negative mental health consequences for survivors; however, the effect of interventions designed to improve survivors' depressive symptoms is unclear. OBJECTIVE: To determine whether an advocacy intervention would improve the depressive symptoms of Chinese women survivors of IPV. DESIGN, SETTING, AND PARTICIPANTS: Assessor-blinded randomized controlled trial of 200 Chinese women 18 years or older with a history of IPV, conducted from February 2007 to June 2009 in a community center in Hong Kong, China. INTERVENTION: The intervention group (n = 100) received a 12-week advocacy intervention comprising empowerment and telephone social support. The control group (n = 100) received usual community services including child care, health care and promotion, and recreational programs. MAIN OUTCOME MEASURES: Primary outcome was change in depressive symptoms (Chinese version of the Beck Depression Inventory II) between baseline and 9 months. Secondary outcomes were changes in IPV (Chinese Revised Conflict Tactics Scales), health-related quality of life (12-Item Short Form Health Survey), and perceived social support (Interpersonal Support Evaluation List) between baseline and 9 months. Usefulness of the intervention and usual community services was evaluated at 9 months. RESULTS: At 3 months, the mean change in depressive symptom score was 11.6 (95% CI, 9.5 to 13.7) in the control group and 14.9 (95% CI, 12.4 to 17.5) in the intervention group; respective changes at 9 months were 19.6 (95% CI, 16.6 to 22.7) and 23.2 (95% CI, 20.4 to 26.0). Intervention effects at 3 and 9 months were not significantly different (P = .86). The intervention significantly reduced depressive symptoms by 2.66 (95% CI, 0.26 to 5.06; P = .03) vs the control, less than the 5-unit minimal clinically important difference. Statistically significant improvement was found in partner psychological aggression (-1.87 [95% CI, -3.34 to -0.40]; mean change at 3 months, 1.5 [95% CI, -1.0 to 3.9] in the control group and 0.3 [95% CI, -0.7 to 1.4] in the intervention group; mean change at 9 months, -6.4 [95% CI, -7.8 to -5.0] and -8.9 [95% CI, -10.6 to -7.2]) and perceived social support (2.18 [95% CI, 0.48 to 3.89]; mean change at 3 months, 6.4 [95% CI, 4.9 to 7.8] and 9.2 [95% CI, 7.7 to 10.8]; mean change at 9 months, 12.4 [95% CI, 10.5 to 14.3] and 14.4 [95% CI, 12.7 to 16.1]) but not in physical assault, sexual coercion, or health-related quality of life. By end of study, more women in the intervention group found the advocacy intervention useful or extremely useful in improving intimate relationships vs those in the control group receiving usual community services (93.8% vs 81.7%; difference, 12.1% [95% CI, 2.1% to 22.0%]; P = .02) and in helping them to resolve conflicts with their intimate partners (97.5% vs 84.1%; difference, 13.4% [95% CI, 4.7% to 22.0%]; P = .001). CONCLUSION: Among community-dwelling abused Chinese women, an advocacy intervention did not result in a clinically meaningful improvement in depressive symptoms. Trial Registration clinicaltrials.gov Identifier: NCT01054898.

PMID: 20682933 [PubMed - in process]

Association of Exposure to Violence and Potential Traumatic Events With Self-reported Physical and Mental Health Status in the Central African Republic.

JAMA. 2010 Aug 4;304(5):544-52

Authors: Vinck P, Pham PN

CONTEXT: For decades, the Central African Republic (CAR) has experienced violence, economic stagnation, and institutional failure. The latest wave of violence erupted in 2001 and continues to this day in some areas. Yet there has been little attention to the conflict and even less research to document and quantify the conflict's human cost. OBJECTIVE: To study levels of violence in CAR, including mortality levels, and the association between exposure to violence and traumatic events with self-reported physical and mental health status. DESIGN, SETTING, AND PARTICIPANTS: Multistage stratified cluster random survey of 1879 adults 18 years or older in selected households conducted in 5 administrative units of CAR (3 in the south, which has been free from recent violence, and 2 in the north, in which violence continues) between October and December 2009. MAIN OUTCOME MEASURES: Mortality, morbidity, exposure to potential traumatic events, sense of insecurity, and meeting of symptom criteria for depression and anxiety using the Hopkins Symptom Checklist-25 with a cut-off score of 1.75. RESULTS: The crude mortality rate (CMR) was 4.9 deaths (95% confidence interval [CI], 4.6-5.1) per 1000 population per month and self-reported CMR due to violence was 0.8 deaths (95% CI, 0.6-1.0) per 1000 population per month. Thirty-five percent reported their physical health status as being good or very good while 29% described it as bad or very bad. Respondents in northern prefectures reported higher rates of mortality, exposure to trauma, and insecurity and lower levels of physical health and access to health services compared with those in the south. The estimated prevalences of symptoms of depression and anxiety were 55.3% (95% CI, 51.6%-59.0%) and 52.5% (95% CI, 48.1%-56.8%), respectively. Exposure to violence and self-reported physical health were statistically associated with mental health outcomes (P < .001). Anxiety symptom scores were higher for respondents in the northern prefectures than those in the south (t = 2.54, P = .01). CONCLUSION: A high proportion of adult respondents in CAR reported witnessing or having personally experienced traumatic events over the course of the conflicts, and more than half met symptom criteria for depression and anxiety.

PMID: 20682934 [PubMed - in process]

Association of sexual violence and human rights violations with physical and mental health in territories of the eastern democratic republic of the congo.

JAMA. 2010 Aug 4;304(5):553-62

Authors: Johnson K, Scott J, Rughita B, Kisielewski M, Asher J, Ong R, Lawry L

CONTEXT: Studies from the Eastern Region of the Democratic Republic of the Congo (DRC) have provided anecdotal reports of sexual violence. This study offers a population-based assessment of the prevalence of sexual violence and human rights abuses in specific territories within Eastern DRC. OBJECTIVE: To assess the prevalence of and correlations with sexual violence and human rights violations on residents of specific territories of Eastern DRC including information on basic needs, health care access, and physical and mental health. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, population-based, cluster survey of 998 adults aged 18 years or older using structured interviews and questionnaires, conducted over a 4-week period in March 2010. MAIN OUTCOME MEASURES: Sexual violence prevalence and characteristics, symptoms of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), human rights abuses, and physical and mental health needs among Congolese adults in specific territories of Eastern DRC. RESULTS: Of the 1005 households surveyed 998 households participated, yielding a response rate of 98.9%. Rates of reported sexual violence were 39.7% (95% confidence interval [CI], 32.2%-47.2%; n = 224/586) among women and 23.6% (95% CI, 17.3%-29.9%; n = 107/399) among men. Women reported to have perpetrated conflict-related sexual violence in 41.1% (95% CI, 25.6%-56.6%; n = 54/148) of female cases and 10.0% (95% CI, 1.5%-18.4%; n = 8/66) of male cases. Sixty-seven percent (95% CI, 59.0%-74.5%; n = 615/998) of households reported incidents of conflict-related human rights abuses. Forty-one percent (95% CI, 35.3%-45.8%; n = 374/991) of the represented adult population met symptom criteria for MDD and 50.1% (95% CI, 43.8%-56.3%; n = 470/989) for PTSD. CONCLUSION: Self-reported sexual violence and other human rights violations were prevalent in specific territories of Eastern DRC and were associated with physical and mental health outcomes.

PMID: 20682935 [PubMed - in process]