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Journal Cover   JAMA The Journal of the American Medical Association
  [SJR: 6.278]   [H-I: 491]   [998 followers]  Follow
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   ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
   Published by American Medical Association Homepage  [11 journals]
  • Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy
    • Authors: Elmore JG; Longton GM, Carney PA, et al.
      Abstract: ImportanceA breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood.ObjectivesTo quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics.Design, Setting, and ParticipantsStudy of pathologists who interpret breast biopsies in clinical practices in 8 US states.ExposuresParticipants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%.Main Outcomes and MeasuresThe proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed.ResultsSixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%-77.0%; 5194 of 6900 interpretations). Among invasive carcinoma cases (663 interpretations), 96% (95% CI, 94%-97%) were concordant, and 4% (95% CI, 3%-6%) were underinterpreted; among DCIS cases (2097 interpretations), 84% (95% CI, 82%-86%) were concordant, 3% (95% CI, 2%-4%) were overinterpreted, and 13% (95% CI, 12%-15%) were underinterpreted; among atypia cases (2070 interpretations), 48% (95% CI, 44%-52%) were concordant, 17% (95% CI, 15%-21%) were overinterpreted, and 35% (95% CI, 31%-39%) were underinterpreted; and among benign cases without atypia (2070 interpretations), 87% (95% CI, 85%-89%) were concordant and 13% (95% CI, 11%-15%) were overinterpreted. Disagreement with the reference diagnosis was statistically significantly higher among biopsies from women with higher (n = 122) vs lower (n = 118) breast density on prior mammograms (overall concordance rate, 73% [95% CI, 71%-75%] for higher vs 77% [95% CI, 75%-80%] for lower, P 
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Association of Aspirin and NSAID Use With Risk of Colorectal Cancer
           According to Genetic Variants
    • Authors: Nan H; Hutter CM, Lin Y, et al.
      Abstract: ImportanceUse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with lower risk of colorectal cancer.ObjectiveTo identify common genetic markers that may confer differential benefit from aspirin or NSAID chemoprevention, we tested gene × environment interactions between regular use of aspirin and/or NSAIDs and single-nucleotide polymorphisms (SNPs) in relation to risk of colorectal cancer.Design, Setting, and ParticipantsCase-control study using data from 5 case-control and 5 cohort studies initiated between 1976 and 2003 across the United States, Canada, Australia, and Germany and including colorectal cancer cases (n=8634) and matched controls (n=8553) ascertained between 1976 and 2011. Participants were all of European descent. ExposuresGenome-wide SNP data and information on regular use of aspirin and/or NSAIDs and other risk factors.Main Outcomes and MeasuresColorectal cancer.ResultsRegular use of aspirin and/or NSAIDs was associated with lower risk of colorectal cancer (prevalence, 28% vs 38%; odds ratio [OR], 0.69 [95% CI, 0.64-0.74]; P = 6.2 × 10−28) compared with nonregular use. In the conventional logistic regression analysis, the SNP rs2965667 at chromosome 12p12.3 near the MGST1 gene showed a genome-wide significant interaction with aspirin and/or NSAID use (P = 4.6 × 10−9 for interaction). Aspirin and/or NSAID use was associated with a lower risk of colorectal cancer among individuals with rs2965667-TT genotype (prevalence, 28% vs 38%; OR, 0.66 [95% CI, 0.61-0.70]; P = 7.7 × 10−33) but with a higher risk among those with rare (4%) TA or AA genotypes (prevalence, 35% vs 29%; OR, 1.89 [95% CI, 1.27-2.81]; P = .002). In case-only interaction analysis, the SNP rs16973225 at chromosome 15q25.2 near the IL16 gene showed a genome-wide significant interaction with use of aspirin and/or NSAIDs (P = 8.2 × 10−9 for interaction). Regular use was associated with a lower risk of colorectal cancer among individuals with rs16973225-AA genotype (prevalence, 28% vs 38%; OR, 0.66 [95% CI, 0.62-0.71]; P = 1.9 × 10−30) but was not associated with risk of colorectal cancer among those with less common (9%) AC or CC genotypes (prevalence, 36% vs 39%; OR, 0.97 [95% CI, 0.78-1.20]; P = .76).Conclusions and RelevanceIn this genome-wide investigation of gene × environment interactions, use of aspirin and/or NSAIDs was associated with lower risk of colorectal cancer, and this association differed according to genetic variation at 2 SNPs at chromosomes 12 and 15. Validation of these findings in additional populations may facilitate targeted colorectal cancer prevention strategies.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Law, Ethics, and Public Health in the Vaccination Debates Politics of the
           Measles Outbreak
    • Authors: Gostin LO.
      Abstract: This Viewpoint discusses whether parental objections to mandatory childhood vaccinations justify decisions that place the community at risk.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Highlights
    • PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome An IOM Report on
           Redefining an Illness
    • Authors: Clayton E.
      Abstract: This Viewpoint describes an Institute of Medicine report on chronic fatigue syndrome, the result of efforts to develop diagnostic criteria for clinical use and recommend new terminology for the disorder.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Antiplatelet Therapy Duration Following Bare Metal or Drug-Eluting
           Coronary Stents The Dual Antiplatelet Therapy Randomized Clinical Trial
    • Authors: Kereiakes DJ; Yeh RW, Massaro JM, et al.
      Abstract: ImportanceDespite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS, and the appropriate duration of DAPT after BMS is unknown.ObjectiveTo compare (1) rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE; composite of death, myocardial infarction, or stroke) after 30 vs 12 months of thienopyridine in patients treated with BMS taking aspirin and (2) treatment duration effect within the combined cohorts of randomized patients treated with DES or BMS as prespecified secondary analyses.Design, Setting, and ParticipantsInternational, multicenter, randomized, double-blinded, placebo-controlled trial comparing extended (30-months) thienopyridine vs placebo in patients taking aspirin who completed 12 months of DAPT without bleeding or ischemic events after receiving stents. The study was initiated in August 2009 with the last follow-up visit in May 2014.InterventionsContinued thienopyridine or placebo at months 12 through 30 after stent placement, in 11 648 randomized patients treated with aspirin, of whom 1687 received BMS and 9961 DES.Main Outcomes and MeasuresStent thrombosis, MACCE, and moderate or severe bleeding.ResultsAmong 1687 patients treated with BMS who were randomized to continued thienopyridine vs placebo, rates of stent thrombosis were 0.5% vs 1.11% (n = 4 vs 9; hazard ratio [HR], 0.49; 95% CI, 0.15-1.64; P = .24), rates of MACCE were 4.04% vs 4.69% (n = 33 vs 38; HR, 0.92; 95% CI, 0.57-1.47; P = .72), and rates of moderate/severe bleeding were 2.03% vs 0.90% (n = 16 vs 7; P = .07), respectively. Among all 11 648 randomized patients (both BMS and DES), stent thrombosis rates were 0.41% vs 1.32% (n = 23 vs 74; HR, 0.31; 95% CI, 0.19-0.50; P 
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Aspirin and NSAID Chemoprevention, Gene-Environment Interactions, and Risk
           of Colorectal Cancer
    • Authors: Wender RC.
      Abstract: In this issue of JAMA, Nan and colleagues report the results of a gene-environment interaction study examining an interaction between a genetic polymorphism and the regular use of aspirin or other nonsteroidal anti-inflammatory agents (NSAIDs) and the association with risk of colorectal cancer. This case-control study is scientifically noteworthy for 4 distinct reasons. First, the study advances understanding of how to conduct research designed to detect gene-environment interactions. Second, the study illustrates that interventions can be genetically targeted not just to direct treatment but also to direct preventive interventions. Third, the study provides insight into the mechanistic understanding of how aspirin alters colon cancer risk. Fourth, the study highlights the need to conduct implementation research to ensure clinicians are prepared to apply gene-environment research in daily practice.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Expertise vs Evidence in Assessment of Breast Biopsies An Atypical Science
    • Authors: Davidson NE; Rimm DL.
      Abstract: Breast biopsies are performed in 1.6 million women in the United States each year and yield results ranging from benign to atypical hyperplasia to carcinoma in situ to invasive cancer, each with specific implications for subsequent management. The critical tissue diagnosis from the anatomic pathologist directly determines patient management. That diagnosis is based on morphology, the relationship between cellular and architectural features, devoid of any molecular evidence. The accuracy of the pathologist’s diagnoses is relatively understudied and represents an important knowledge gap at a time when medicine is becoming ever more evidence-based.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Time Will Tell
    • Authors: Sisk B.
      Abstract: The sac was empty on the ultrasound screen. There was no heartbeat, no recognizable shape, just an empty black space. After saving the image, the ultrasonographer continued with her measurements in silence. I put my hand on my wife’s shoulder, watching her hold back the tears. I was thankful that we had not told anyone we were expecting.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Reengineering Advance Care Planning to Create Scalable, Patient- and
           Family-Centered Interventions
    • Authors: Chiarchiaro J; Arnold RM, White DB.
      Abstract: This Viewpoint proposes applying web-based technologies combined with user-centered design to improve the advance care planning process for patients, families, and clinicians.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • The Birth of Public Health Education
    • Authors: Hunter DJ; Frenk J.
      Abstract: This Viewpoint reviews the inception of public health education and recalls then visionaries whose roles have slipped from common histories of the tale.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Infectious Mononucleosis
    • Authors: Thompson AE.
      Abstract: Infectious mononucleosis, also known as “mono,” is an illness that usually affects adolescents and young adults.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • JAMA
    • PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • HIV Prevention Trial in African Women Fails, Adherence a Problem
    • Authors: Friedrich MJ.
      Abstract: Three antiretroviral products evaluated among African women in the Vaginal and Oral Interventions to Control the Epidemic (VOICE) HIV prevention trial were found to be safe but, because of poor adherence, were not effective in preventing sexually acquired HIV (Marrazzo JM et al. N Engl J Med. 2015;372[6]:509-518).
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Report Outlines Steps to Address Antibiotic Resistance
    • Authors: Friedrich MJ.
      Abstract: The second report from the United Kingdom’s Review on Antimicrobial Resistance (AMR), “Tackling a global health crisis: initial steps,” which was issued in February, notes that chronic underinvestments in financial and human capital are major impediments to progress being made in this field and outlines 5 steps that should be taken to combat the rise in infections caused by drug-resistant pathogens (
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Risk of HIV Infection Increases With an Injectable Hormonal Contraceptive
    • Authors: Friedrich MJ.
      Abstract: The risk of HIV infection is moderately increased among African women who used the injectable hormonal contraceptive depot-medroxyprogesterone acetate, according to 2 recently published meta-analyses.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Higher Folic Acid Intake Needed
    • Abstract: In the 17 years since US enriched cereal grain products have been fortified with folic acid, approximately 1300 babies each year are spared neural tube defects (NTDs). Yet despite this effective measure to prevent spina bifida and anencephaly, nearly a quarter of US women of childbearing age do not have high enough folate concentrations to reduce the risk of NTDs.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Windblown Pesticide Hazard
    • Abstract: Errant pesticides that drift from one farm to another are the leading cause of acute pesticide-related illnesses among farmworkers. Case in point: in April 2014, 20 laborers in a Washington State cherry orchard fell ill within minutes of exposure to pesticides sprayed in an adjacent pear orchard.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Do-Si-Do Dan Christensen
    • Authors: Smith JM.
      Abstract: Painting in typical fashion with a brush only was seemingly too limited in its scope for the inventive mind of abstract painter Dan Christensen (1942-2007). With tools that included spray guns, rollers, and squeegees, he created pictures of festively tinted looping strips resembling ribbons, mysterious wedges of color, and spheres that were all a-shimmer. His painting processes were fascinating in their own right, and in making the bright pictures that epitomize his body of work he may have had more fun than just about anyone else.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Mariner
    • Authors: Margolis B.
      Abstract: Three minutes after pressing in with the scalpelA sea of yellow fat becomes my Faraway night and bow-crashing dip and swellA mist of chemicals washes over with each silver stroke
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Courses and Degrees in Public Health Work
    • Authors: ROSENAU MJ.
      Abstract: The educator interested in preparing students for service in public health work must take several factors into account. First of all, the education must be for service. Furthermore, the quality of that service is exacting and of great importance to the community. In order, then, to be satisfactory, the education must be special, yet comprehensive. The saying that the student should know something of everything and everything of something applies here with particular emphasis. The underlying sciences which form the basis of preventive medicine are various, and therefore a satisfactory knowledge of the medical as well as the related sciences is necessary for success in a public health career.…
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Perioperative Treatment With Aspirin or Clonidine and Risk of Acute Kidney
    • Authors: Sun J; Liu H.
      Abstract: To the Editor A large randomized clinical trial, which was a substudy of the Perioperative Ischemia Evaluation-2 (POISE-2) trial, reported that among patients undergoing major noncardiac surgery, perioperative use of aspirin or clonidine did not reduce the risk of acute kidney injury. Aspirin actually increased the risk of major bleeding and clonidine increased the risk of hypotension. We have several comments and concerns.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Perioperative Treatment With Aspirin or Clonidine and Risk of Acute Kidney
    • Authors: Devereaux PJ; Sessler DI, Garg AX, et al.
      Abstract: In Reply Drs Sun and Liu are concerned that the risk of major bleeding in POISE-2 (ie, 3.8% in the aspirin placebo group) does not reflect the real-world experience because a study that used the NSQIP database reported a 0.8% risk of major perioperative bleeding. There were, however, substantial differences in the populations and bleeding definitions between these studies.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Time-Limited vs Unlimited Physician Certification
    • Authors: Friedmann P.
      Abstract: To the Editor Dr Lee discussed the need for restructuring of the Maintenance of Certification (MOC) programs by the American Board of Medical Specialties, but did not provide a clear direction for change. The MOC programs began as Maintenance of Competence programs, but it was difficult to measure competence.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Time-Limited vs Unlimited Physician Certification—Reply
    • Authors: Lee TH.
      Abstract: In Reply Dr Friedmann argues that physicians who have passed board certification tests once should retain the highest possible professional status for the rest of their careers because that status is important to them—even if they are not actually involved in patient care, “but still want or need to have the imprimatur of the board certification available to them.”
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Precision Medicine: The Future or Simply Politics'
    • Authors: Rubin R.
      Abstract: Barrett Rollins, MD, PhD, chief scientific officer at the Dana-Farber Cancer Institute, tells an anecdote to illustrate the promise of “precision medicine.” A 35-year-old patient at Dana-Farber was dying of myeloid sarcoma, a rare tumor consisting of a solid collection of leukemic cells outside of the bone marrow. Although the man was about to enter hospice care, he consented to having his tumor’s genome sequenced.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • An Observational Study Goes Where Randomized Clinical Trials Have Not
    • Authors: Frakt AB.
      Abstract: Randomized clinical trials (RCTs) are considered the “gold standard” for providing actionable evidence to guide clinical decision making. However, they cannot always address important questions. For instance, statistically significant results for low-frequency outcomes like mortality sometimes require longer follow-up times or larger studies than can be practically undertaken.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Screening for Abdominal Aortic Aneurysm
    • Authors: Bird A; Davis AM.
      Abstract: This JAMA Clinical Guidelines Synopsis article evaluates the most recent US Preventive Services Task Force guideline on ultrasonographic screening for abdominal aortic aneurysms.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Diffuse Vesicular Rash With Intractable Pruritus
    • Authors: Olson MA; Wieland CN, Newman CC.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Reporting of Noninferiority Trials in and Corresponding
    • Authors: Gopal AD; Desai NR, Tse T, et al.
      Abstract: Noninferiority clinical trials are designed to determine whether an intervention is not inferior to a comparator by more than a prespecified difference, known as the noninferiority margin. Selection of an appropriate margin is fundamental to noninferiority trial validity, yet a point of frequent ambiguity. Given the increasing use of noninferiority trial designs, maintaining high standards for conduct and reporting is a priority. Publicly accessible trial registries and results databases promote transparency and accountability by requiring specification of research designs and end points and disclosure of summary results.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • BK Virus Prophylaxis With Levofloxacin
    • Authors: Landman GD.
      Abstract: To the Editor Dr Knoll and colleagues performed a randomized clinical trial of BK virus prophylaxis with levofloxacin after kidney transplantation. The authors did not find a reduction in BK viruria, the primary outcome, with approximately 30% of patients developing low-level viruria and 10% viremia.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • BK Virus Prophylaxis With Levofloxacin—Reply
    • Authors: Gill JS; Knoll GA, Humar A.
      Abstract: In Reply Our trial to test a strategy to prevent BK infection was motivated by limitations of the current reactionary approach to management that involves reduction in immunosuppression after development of infection. However, because the alternative surrogate outcome of immunosuppression reduction suggested by Dr Landman was not evaluated in our trial, we cannot offer a formal opinion regarding its potential use. In our opinion, because the decision to reduce immunosuppression may be influenced by many other factors, including risk of rejection, this outcome may be difficult to implement in a clinical trial.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Association of Early Imaging for Back Pain With Clinical Outcomes in Older
    • Authors: Jarvik JG; Gold LS, Comstock BA, et al.
      Abstract: ImportanceIn contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes.ObjectiveTo compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy.Design, Setting, and ParticipantsProspective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use.ExposuresDiagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit.Main Outcome and MeasuresPrimary outcome: back or leg pain–related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment.ResultsAmong the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, −0.10 [95% CI, −0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,−0.51 [−1.62 to 0.60]; mixed model, P = .18).Conclusions and RelevanceAmong older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
  • Risk Factors for Suicides Among Army Personnel
    • Authors: Friedman MJ.
      Abstract: JAMA PsychiatryPredictors of Suicide and Accident Death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)Michael Schoenbaum, PhD; Ronald C. Kessler, PhD; Stephen E. Gilman, ScD; Lisa J. Colpe, PhD, MPH; Steven G. Heeringa, PhD; Murray B. Stein, MD, MPH; Robert J. Ursano, MD; Kenneth L. Cox, MD, MPH; for the Army STARRS CollaboratorsImportance The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multicomponent study designed to generate actionable recommendations to reduce Army suicides and increase knowledge of risk and resilience factors for suicidality.Objectives To present data on prevalence, trends, and basic sociodemographic and Army experience correlates of suicides and accident deaths among active duty Regular Army soldiers between January 1, 2004, and December 31, 2009, and thereby establish a foundation for future Army STARRS investigations.Design, Setting, and Participants Analysis of trends and predictors of suicide and accident deaths using Army and Department of Defense administrative data systems. Participants were all members of the US Regular Army serving at any time between 2004 and 2009.Main Outcomes and Measures Death by suicide or accident during active Army service.Results The suicide rate rose between 2004 and 2009 among never deployed and currently and previously deployed Regular Army soldiers. Increased suicide risk was associated with being a man (or a woman during deployment), white race/ethnicity, junior enlisted rank, recent demotion, and current or previous deployment. Sociodemographic and Army experience predictors were generally similar for suicides and accident deaths.Conclusions and Relevance Predictors of Army suicides were largely similar to those reported elsewhere for civilians, although some predictors distinct to Army service emerged that deserve more in-depth analysis. The existence of a time trend in suicide risk among never-deployed soldiers argues indirectly against the view that exposure to combat-related trauma is the exclusive cause of the increase in Army suicides.JAMA Psychiatry. 2014;71(5):493-503. doi:10.1001/jamapsychiatry.2013.4417.
      PubDate: Tue, 17 Mar 2015 00:00:00 GMT
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