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Journal Cover JAMA The Journal of the American Medical Association
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     ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
     Published by American Medical Association Homepage  [11 journals]   [SJR: 4.843]   [H-I: 456]
  • From JAMA’s Daily News Site
    • PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Adult Male Circumcision Not Associated With Risky Sexual Behavior
    • Authors: Friedrich MJ.
      Abstract: Young African men who have been circumcised to reduce their risk of acquiring HIV are not more likely than uncircumcised men to engage in unprotected sex and other risky sexual behaviors, report researchers from the United States and Kenya (Westercamp N et al. AIDS Behav. doi:10.1007/s10461-014-0846-4 [published online July 22, 2014]).
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Combating the Return of Polio in Iraq
    • Authors: Friedrich MJ.
      Abstract: The United Nations Children’s Fund (UNICEF) and the World Health Organization began a mass polio vaccination campaign to reach the more than 4 million children younger than 5 years in Iraq, which has seen a return of the virus for the first time since 2000 (http://bit.ly/VuWlf0).
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Rural Uganda’s Heart Disease Risk Factors Go Up With Urbanization
    • Authors: Friedrich MJ.
      Abstract: Even modest increases in urban features in rural villages in Uganda are associated with a greater prevalence of lifestyle risk factors for cardiovascular disease, report researchers from the United Kingdom, Uganda, and Australia (Riha J et al. PLoS Med. 2014;11[7]:e1001683).
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • World Bank Pledges $200 Million to Stem Ebola Outbreak in West Africa
    • Authors: Friedrich MJ.
      Abstract: The World Bank announced last month that it will allocate up to US $200 million in emergency assistance to help contain the outbreak of Ebola virus disease in West Africa that emerged in Guinea in December 2013 and has spread to Liberia, Sierra Leone, and Nigeria (http://bit.ly/1APsgaU).
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Pediatric Ebola Survivors
    • Abstract: An analysis of specimens from patients with Ebola virus disease during the 2000-2001 outbreak in Uganda’s Gulu District has shown that pediatric patients who survived had higher levels of certain biomarkers than children and adolescents who died.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • US Cigar Smokers’ Preferences
    • Abstract: The dramatic increase in cigar smoking in recent years prompted public health researchers to determine which segments of the cigar-smoking public prefer the various products available on the US cigar market.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Highest Heart Disease and Stroke Rates in Service, Blue Collar Jobs
    • Abstract: A recent analysis showed that the prevalence of coronary heart disease and stroke among US adults younger than 55 years is highest in those with service and blue collar jobs. The study’s authors say their findings have implications for clinicians, who should consider patients’ occupational risks for cardiovascular disease.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • USPSTF: Lifestyle Counseling Advised for Overweight, Obese Adults With
           Other Cardiovascular Risk Factors
    • Authors: Stephenson J.
      Abstract: Adults who are overweight or obese and have additional risk factors for cardiovascular disease such as hypertension, dyslipidemia, or impaired fasting glucose should be offered intensive counseling to promote a healthful diet and physical activity, the US Preventive Service Task Force (USPSTF) has advised (http://bit.ly/1lu0CMp).
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Reports: HIV Drugs Targeted for Black Market
    • Authors: Kuehn BM.
      Abstract: Expensive HIV medications are likely being targeted for resale on the black market, according to a new report from a federal watchdog. The report explained that the patterns the agency detected could mean patients were diverting the drugs for sale on the black market or that pharmacies were fraudulently billing Medicare for drugs that were never dispensed.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Still Life
    • Authors: Nash W.
      Abstract: Weekend retreats, the cold breath of   your girlhood home would vanish inthe open of grandma’s farm. She   joined you in everything: carvingbutter on the antique sideboard,   playing hide-and-seek in the barn,
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Geriatrics—The Care of the Aged
    • Abstract: Geriatrics is a term, inclining toward general adoption, for that division of medicine which deals with the treatment of the diseases and special problems of old age and senescence. Between 1900 and 1930, Horn says, there was an increase of 52 per cent in the actual numbers of those 60 years of age and over, compared with an increase of only 38 per cent in the total population. According to present trends, therefore, by 1990 the senescent population will have become equal to, if not in excess of, the preadolescent population. Furthermore, disease in old age differs in many ways from disease in younger groups; the incidence is different and the symptoms often diverge widely from those seen in middle and early life.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Over-the-counter Laxatives
    • Authors: Jin J.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • JAMA
    • PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Certification of Mobile Apps for Health Care
    • Authors: Chan SR; Misra S.
      Abstract: To the Editor A Viewpoint by Dr Powell and colleagues highlighted just how difficult it is for patients and clinicians to identify safe, effective mobile apps for health care, with the thousands of apps in the marketplace having received little review or clinical evaluation. The authors called for more “rigorous certification criteria and unbiased accrediting bodies,” claiming the need for certification of apps.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Certification of Mobile Apps for Health Care—Reply
    • Authors: Powell AC; Landman AB, Bates DW.
      Abstract: In Reply We agree with Drs Chan and Misra that it is difficult to review and certify large numbers of mHealth apps and that conducting traditional randomized clinical trials of specific apps may not be reasonable given the current rate of innovation. However, we also believe it is problematic to ask clinicians and patients to fend for themselves when evaluating apps. The new challenges that the rapid innovation in apps present may require new types of solutions.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Incorrect Data in a Table
    • Abstract: In the Grand Rounds report entitled “Resistant Hypertension: A Review of Diagnosis and Management” published in the June 4, 2014, issue of JAMA (2014;311[21]:2216-2224. doi:10:1001/jama.2014.5180), an incorrect dose range was presented in Table 2. In the Lisinopril row, the dosing range should be “5-80 mg/d.” This article was corrected online.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Guideline: New HCV Drugs Should Go to Sickest Patients
    • Authors: Kuehn BM.
      Abstract: Patients who have advanced liver disease or other severe symptoms of hepatitis C virus (HCV) infection should be first in line for an expensive new medication for treating HCV, according to a new guideline. The guideline, from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, was created with support from the International Antiviral Society–USA (IAS-USA). It is the latest in a series of guidelines from the groups on treating HCV.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • US Breastfeeding Rates Fall Short of National Goals
    • Abstract: More than three-quarters of new mothers in the United States breastfeed their infants, but not for as long as is recommended, according to the latest status report.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Bingham Mine Jonas Lie
    • Authors: Cole TB.
      Abstract: The Bingham Canyon Mine, near Salt Lake City, Utah, is the largest excavation in the world. Since 1906 it has produced millions of tons of copper and a fortune in gold, silver, and molybdenum, but it has also contaminated local ecosystems with lead and arsenic; to keep the mine open its managers have agreed to clean up the mess. In the early years of mining in Bingham Canyon, the environmental hazards of open-pit extraction were unforeseen. The sole challenge was to scoop out the mine’s ore as efficiently as possible, an operation that supported thousands of workers and their families who lived in communities built into the canyon walls.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Trends in Mean Waist Circumference and Abdominal Obesity Among US Adults,
           1999-2012
    • Authors: Ford ES; Maynard LM, Li C.
      Abstract: Waist circumference is a simple and valuable anthropometric measure of total and intra-abdominal body fat. The clinical guidelines from the National Heart, Lung, and Blood Institute on the identification, evaluation, and treatment of overweight and obesity in adults recommend that clinicians assess waist circumference of their patients. Although the prevalence of abdominal obesity has increased in the United States through 2008, its trend in recent years is unknown. Therefore, our objective was to provide recent information about the trends in mean waist circumference and prevalence of abdominal obesity among adults in the United States from 1999 to 2012.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Diabetes Prevalence Among Youth
    • Authors: Demmer RT; Zuk AM, Rosenbaum M.
      Abstract: To the Editor The SEARCH investigators assessed the burden of diagnosed diabetes among youth. We wish to discuss 2 important limitations of the SEARCH study design.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Diabetes Prevalence Among Youth—Reply
    • Authors: Dabelea D; Mayer-Davis EJ.
      Abstract: In Reply Accurate estimation of the prevalence of childhood diabetes is challenging. Dr Demmer and colleagues raised 2 issues: undiagnosed diabetes and geographic representativeness.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Recurrence Rates in Autism Spectrum Disorders
    • Authors: Constantino JN.
      Abstract: To the Editor The recent report by Dr Sandin and colleagues contributes to a converging body of recent research specifying recurrence rates in autism spectrum disorders (ASD) by analyzing data from a large epidemiological birth cohort in Sweden.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Recurrence Rates in Autism Spectrum Disorders—Reply
    • Authors: Sandin S; Reichenberg A.
      Abstract: In Reply We share Dr Constantino’s interest in determining if there are differences in the etiology of ASD between males and females. We did not compare the heritability of ASD between males and females in the study for 2 reasons.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Dual X-ray Absorptiometry for Diagnosis of Osteoporosis
    • Authors: Neuner J; Carnahan J.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Treating Prescription Opioid Dependence
    • Authors: Ruetsch C.
      Abstract: JAMA PsychiatryA Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid AbusersStacey C. Sigmon, PhD; Kelly E. Dunn, PhD; Kathryn Saulsgiver, PhD; Mollie E. Patrick, MA; Gary J. Badger, MS; Sarah H. Heil, PhD; John R. Brooklyn, MD; Stephen T. Higgins, PhDImportance Although abuse of prescription opioids (POs) is a significant public health problem, few experimental studies have investigated the treatment needs of this growing population.Objective To evaluate, following brief stabilization with a combination of buprenorphine hydrochloride and naloxone hydrochloride dihydrate, the relative efficacy of 1-, 2-, and 4-week buprenorphine tapering regimens and subsequent naltrexone hydrochloride therapy in PO-dependent outpatients.Design, Setting, and Participants A double-blind, 12-week randomized clinical trial was conducted in an outpatient research clinic. Following a brief period of buprenorphine stabilization, 70 PO-dependent adults were randomized to receive 1-, 2-, or 4-week tapers followed by naltrexone therapy.Intervention During phase 1 (weeks 1-5 after randomization), participants visited the clinic daily; during phase 2 (weeks 6-12), visits were reduced to thrice weekly. Participants received behavioral therapy and urine toxicology testing throughout the trial.Main Outcomes and Measures The percentage of participants negative for illicit opioid use, retention, naltrexone ingestion, and favorable treatment response (ie, retained in treatment, opioid abstinent, and receiving naltrexone at the end of the study).Results Opioid abstinence at the end of phase 1 was greater in the 4-week compared with the 2- and 1-week taper conditions (P = .02), with 63% (n = 14), 29% (n = 7), and 29% (n = 7) of participants abstinent in the 4-, 2-, and 1-week conditions, respectively. Abstinence at the end of phase 2 was also greater in the 4-week compared with the 2- and 1-week conditions (P = .03), with 50% (n = 11), 16% (n = 4), and 20% (n = 5) of participants abstinent in the 4-, 2-, and 1-week conditions, respectively. There were more treatment responders in the 4-week condition (P = .03), with 50% (n = 11), 17% (n = 4), and 21% (n = 5) of participants in the 4-, 2-, and 1-week groups considered responders at the end of treatment, respectively. Retention and naltrexone ingestion also were superior in the 4-week vs briefer tapers (both P = .04). Experimental condition (ie, taper duration) was the strongest predictor of treatment response, followed by buprenorphine stabilization dose.Conclusions and Relevance This study represents a rigorous experimental evaluation of outpatient buprenorphine stabilization, brief taper, and naltrexone maintenance for treatment of PO dependence. Results suggest that a meaningful subset of PO-dependent outpatients may respond positively to a 4-week taper plus naltrexone maintenance intervention.JAMA Psychiatry. 2013;70(12):1347-1354. doi:10.1001/jamapsychiatry.2013.2216.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Evaluation and Treatment of Older Patients With Hypercholesterolemia A
           Clinical Review
    • Authors: Strandberg TE; Kolehmainen L, Vuorio A.
      Abstract: ImportanceHypercholesterolemia is common among people older than 80 years. Substantial functional heterogeneity exists among older patients, and decision making for statin use differs in older patients relative to younger ones.ObjectiveTo discuss the presentation, modifying factors, and treatment of hypercholesterolemia (usually with statins) among persons older than 80 years.Evidence ReviewMEDLINE and other sources were searched from January 1990 to June 2014. Personal libraries and a hand search of reference lists from guidelines and reviews from January 2000 to June 2014 were also used.FindingsNo randomized clinical trials (RCTs) of statin or any other hypocholesterolemic medication included persons older than 80 years at baseline. Findings from 75- to 80-year-old patients enrolled in RCTs and information from observational studies support statin treatment for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and probably in patients with diabetes without ASCVD. Harms from statin drugs are not increased in older patients, so the use of these agents for primary prevention is possible. Because people older than 80 years are biologically heterogeneous with varying life expectancy, may have frailty or comorbid conditions, and may take multiple medications, the decision to treat with statins must be individualized.Conclusions and RelevanceIdeally, treatment of hypercholesterolemia for patients at risk of ASCVD should start before they turn 80 years old. No RCT evidence exists to guide statin initiation after age 80 years. Decisions to use statins in older individuals are made individually and are not supported by high-quality evidence.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Clinical and Safety Outcomes Associated With Treatment of Acute Venous
           Thromboembolism A Systematic Review and Meta-analysis
    • Authors: Castellucci LA; Cameron C, Le Gal G, et al.
      Abstract: ImportanceMany anticoagulant strategies are available for the treatment of acute venous thromboembolism, yet little guidance exists regarding which drug is most effective and safe.ObjectiveTo summarize and compare the efficacy and safety outcomes associated with 8 anticoagulation options (unfractionated heparin [UFH], low-molecular-weight heparin [LMWH], or fondaparinux in combination with vitamin K antagonists); LMWH with dabigatran or edoxaban; rivaroxaban; apixaban; and LMWH alone) for treatment of venous thromboembolism.Data SourcesA systematic literature search was conducted using MEDLINE, EMBASE, and the evidence-based medicine reviews from inception through February 28, 2014.Study SelectionEligible studies were randomized trials reporting rates of recurrent venous thromboembolism and major bleeding in patients with acute venous thromboembolism. Of the 1197 studies identified, 45 trials including 44 989 patients were included in the analyses.Data Extraction and SynthesisTwo reviewers independently extracted trial-level data including number of patients, duration of follow-up, and outcomes. The data were pooled using network meta-analysis.Main Outcomes and MeasuresThe primary clinical and safety outcomes were recurrent venous thromboembolism and major bleeding, respectively. ResultsCompared with the LMWH–vitamin K antagonist combination, a treatment strategy using the UFH–vitamin K antagonist combination was associated with an increased risk of recurrent venous thromboembolism (hazard ratio [HR], 1.42; 95% credible interval [CrI], 1.15-1.79). The proportion of patients experiencing recurrent venous thromboembolism during 3 months of treatment were 1.84% (95% CrI, 1.33%-2.51%) for the UFH–vitamin K antagonist combination and 1.30% (95% CrI, 1.02%-1.62%) for the LMWH–vitamin K antagonist combination. Rivaroxaban (HR, 0.55; 95% CrI, 0.35-0.89) and apixaban (HR, 0.31; 95% CrI, 0.15-0.62) were associated with a lower risk of bleeding than was the LMWH–vitamin K antagonist combination, with a lower proportion of patients experiencing a major bleeding event during 3 months of anticoagulation: 0.49% (95% CrI, 0.29%-0.85%) for rivaroxaban, 0.28% (95% CrI, 0.14%-0.50%) for apixaban, and 0.89% (95% CrI, 0.66%-1.16%) for the LMWH–vitamin K antagonist combination.Conclusions and RelevanceUsing meta-analytic pooling, there were no statistically significant differences for efficacy and safety associated with most treatment strategies used to treat acute venous thromboembolism compared with the LMWH–vitamin K antagonist combination. However, findings suggest that the UFH–vitamin K antagonist combination is associated with the least effective strategy and that rivaroxaban and apixaban may be associated with the lowest risk for bleeding.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Combination Long-Acting β-Agonists and Inhaled Corticosteroids
           Compared With Long-Acting β-Agonists Alone in Older Adults With
           Chronic Obstructive Pulmonary Disease
    • Authors: Gershon AS; Campitelli MA, Croxford R, et al.
      Abstract: ImportanceChronic obstructive pulmonary disease (COPD), a manageable respiratory condition, is the third leading cause of death worldwide. Knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes.ObjectiveTo estimate the long-term benefits of combination long-acting β-agonists (LABAs) and inhaled corticosteroids compared with LABAs alone in a real-world setting.Design, Setting, and PatientsPopulation-based, longitudinal cohort study conducted in Ontario, Canada, from 2003 to 2011. All individuals aged 66 years or older who met a validated case definition of COPD on the basis of health administrative data were included. After propensity score matching, there were 8712 new users of LABA–inhaled corticosteroid combination therapy and 3160 new users of LABAs alone who were followed up for median times of 2.7 years and 2.5 years, respectively.ExposuresNewly prescribed combination LABAs and inhaled corticosteroids or LABAs alone.Main Outcomes and MeasuresComposite outcome of death and COPD hospitalization.ResultsThe main outcome was observed among 5594 new users of LABAs and inhaled corticosteroids (3174 deaths [36.4%]; 2420 COPD hospitalizations [27.8%]) and 2129 new users of LABAs alone (1179 deaths [37.3%]; 950 COPD hospitalizations [30.1%]). New use of LABAs and inhaled corticosteroids was associated with a modestly reduced risk of death or COPD hospitalization compared with new use of LABAs alone (difference in composite outcome at 5 years, −3.7%; 95% CI, −5.7% to −1.7%; hazard ratio [HR], 0.92; 95% CI, 0.88-0.96). The greatest difference was among COPD patients with a codiagnosis of asthma (difference in composite at 5 years, −6.5%; 95% CI, −10.3% to −2.7%; HR, 0.84; 95% CI, 0.77-0.91) and those who were not receiving inhaled long-acting anticholinergic medication (difference in composite at 5 years, −8.4%; 95% CI, −11.9% to −4.9%; HR, 0.79; 95% CI, 0.73-0.86).Conclusions and RelevanceAmong older adults with COPD, particularly those with asthma and those not receiving a long-acting anticholinergic medication, newly prescribed LABA and inhaled corticosteroid combination therapy, compared with newly prescribed LABAs alone, was associated with a significantly lower risk of the composite outcome of death or COPD hospitalization.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • School-age Outcomes of Very Preterm Infants After Antenatal Treatment With
           Magnesium Sulfate vs Placebo
    • Authors: Doyle LW; Anderson PJ, Haslam R, et al.
      Abstract: ImportanceAntenatal magnesium sulfate given to pregnant women at imminent risk of very preterm delivery reduces the risk of cerebral palsy in early childhood, although its effects into school age have not been reported from randomized trials.ObjectiveTo determine the association between exposure to antenatal magnesium sulfate and neurological, cognitive, academic, and behavioral outcomes at school age.Design, Setting, and ParticipantsThe ACTOMgSO4 was a randomized clinical trial conducted in 16 centers in Australia and New Zealand, comparing magnesium sulfate with placebo given to pregnant women (n = 535 magnesium; n = 527 placebo) for whom imminent birth was planned or expected before 30 weeks’ gestation. Children who survived from the 14 centers who participated in the school-age follow-up (n = 443 magnesium; n = 424 placebo) were invited for an assessment at 6 to 11 years of age between 2005 and 2011.Main Outcomes and MeasuresMortality, cerebral palsy, motor function, IQ, basic academic skills, attention and executive function, behavior, growth, and functional outcomes. Main analyses were imputed for missing data.ResultsOf the 1255 fetuses known to be alive at randomization, the mortality rate to school age was 14% (88/629) in the magnesium sulfate group and 18% (110/626) in the placebo group (risk ratio [RR], 0.80; 95% CI, 0.62-1.03, P = .08). Of 867 survivors available for follow-up, outcomes at school age (corrected age 6-11 years) were determined for 669 (77%). Comparing the magnesium sulfate and placebo groups revealed no statistically significant difference in proportions with cerebral palsy (23/295 [8%] and 21/314 [7%], respectively; odds ratio [OR], 1.26; 95% CI, 0.84-1.91; P = .27) or abnormal motor function (80/297 [27%] and 80/300 [27%], respectively; OR, 1.16; 95% CI, 0.88-1.52; P = .28). There was also little difference between groups on any of the cognitive, behavioral, growth, or functional outcomes.Conclusions and RelevanceMagnesium sulfate given to pregnant women at imminent risk of birth before 30 weeks’ gestation was not associated with neurological, cognitive, behavioral, growth, or functional outcomes in their children at school age, although a mortality advantage cannot be excluded. The lack of long-term benefit requires confirmation in additional studies.Trial Registrationanzctr.org.au Identifier: ACTRN12606000252516
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Whose Autonomy'
    • Authors: Stonington SD.
      Abstract: During my medical residency, I took care of a 64-year-old man, Ian (a pseudonym, as are all names in this essay). He had come to the emergency department for an exacerbation of his chronic obstructive pulmonary disease. He also had rheumatoid arthritis, and before I could take a history, his wife Sarah pulled me aside to say that he was in increasing pain from his arthritis. He never missed a dose of methotrexate, but refused to take nonsteroidal anti-inflammatory drugs. I asked if there was some ill effect from them, but she said, “No, it is just part of his self-image to be tough and not treat his pain. But he needs treatment, whether he will say so or not.” When I saw Ian, it was clear that he was in pain, and I inquired about his opposition to NSAIDs, expecting some adverse effect or fear of harm. But he simply said, “I don’t need them. My wife is just putting you up to this.” Sarah responded, “Ian, you’re being ridiculous. You’re in pain!” He rolled his eyes and said, “Fine, just this once, for her,” and acquiesced to a one-time dose. To me this seemed like progress, but in subsequent encounters when I met with Ian alone, he resisted any suggestion of a more stable regimen.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Treating COPD in the Real World
    • Authors: Calverley PA.
      Abstract: Evidence-based medicine is central to modern medical practice and relies on the availability of data from appropriately conducted randomized clinical trials (RCTs). These studies establish whether treatment is effective and, when an active comparator group is included in the trial, whether the new therapy is better than currently used treatment. In some conditions such as chronic obstructive pulmonary disease (COPD) for which no single surrogate end point predicts response to treatment, multiple trials of varying duration are needed to convince physicians and regulators that drug therapy is beneficial. The mainstays of COPD management, including inhaled long-acting antimuscarinic agents or long-acting β-agonists (LABAs) alone or combined with inhaled corticosteroids (ICSs), have been shown in RCTs to improve lung function and quality of life and reduce exacerbation frequency. Patients included in these trials are selected on the basis of having stable COPD without serious diseases that would lead to premature death, and these studies are then incorporated into treatment guidelines that direct clinical practice.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Child Health Theme Issue 2015 Call for Papers
    • Authors: Zylke JW.
      Abstract: In hospital corridors, it is easy to spot a pediatrician a mile away. It’s the adornments—the miniature bear on the stethoscope, the Mickey Mouse earrings, the comical tie. But caring for children differs from caring for adults in more ways than the clinician’s appearance. Caring for children involves a different set of diseases, such as congenital anomalies, different concerns, such as developmental issues, and different treatments. Yet, despite the differences, the health of children should be of great interest to all physicians, even those wearing scrubs or suits in hospital corridors. The health of children reflects many of the social problems facing the nation and foreshadows the health of adult patients tomorrow. In addition, key approaches to child health have implications for changes in the health care system.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Quantifying a Nonnotifiable Disease in the United States The National
           Amyotrophic Lateral Sclerosis Registry Model
    • Authors: Horton D; Mehta P, Antao VC.
      Abstract: Public health surveillance is an essential tool for assessing, controlling, and preventing disease. In the United States, public health surveillance has evolved from a focus on monitoring infectious diseases to also tracking injuries, chronic diseases, birth defects, environmental and occupational exposures, and risk factors. Despite this evolution of surveillance topics, many conditions still are not notifiable to federal public health officials nor are there surveillance systems in place to capture such conditions. The lack of morbidity data for nonnotifiable conditions makes it difficult to access accurately the populations at greatest risk and the true economic and societal burden of such diseases. New approaches are needed to more accurately quantify nonnotifiable conditions of interest in the United States, such as amyotrophic lateral sclerosis (ALS).
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Highlights
    • PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Population-Based Screening for BRCA1 and BRCA2 2014 Lasker Award
    • Authors: King M; Levy-Lahad E, Lahad A.
      Abstract: This Viewpoint describes the application of the discovery of BRCA1 and discusses screening for BRCA1/2 in clinical practice.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • Discovery of High-Frequency Deep Brain Stimulation for Treatment of
           Parkinson Disease 2014 Lasker Award
    • Authors: DeLong MR; Benabid A.
      Abstract: This Viewpoint provides a summary of their discoveries in understanding the role of the basal ganglia in movement, in determining the neurophysiology of Parkinson disease, and in the development of deep brain stimulation.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
  • The Ebola Epidemic A Global Health Emergency
    • Authors: Gostin LO; Lucey D, Phelan A.
      Abstract: On August 8, the World Health Organization (WHO) Director-General Margaret Chan declared the West Africa Ebola crisis a “public health emergency of international concern,” triggering powers under the 2005 International Health Regulations (IHR). The IHR requires countries to develop national preparedness capacities, including the duty to report internationally significant events, conduct surveillance, and exercise public health powers, while balancing human rights and international trade. Until last year, the director-general had declared only one such emergency—influenza AH1N1 (in 2009). Earlier this year, she declared poliomyelitis a public health emergency of international concern and now again for Ebola, signaling perhaps a new era of potential WHO leadership in global health security.
      PubDate: Wed, 17 Sep 2014 00:00:00 GMT
       
 
 
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