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JAMA Internal Medicine - más leídos

Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes
Young LA, Buse JB, Weaver MA, et al.
ver resumen
This randomized trial compares 3 approaches of self-monitoring of blood glucose levels for effects on hemoglobin A1c levels and health-related quality of life among patients with non–insulin-treated type 2 diabetes in primary care practice.

Mediterranean Diet and Cognitive Decline
Valls-Pedret C, Sala-Vila A, Serra-Mir M, et al.
ver resumen
This randomized clinical trial found that a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognitive function in older people.

Association Between Indulgent Descriptions and Vegetable Consumption
Turnwald BP, Boles DZ, Crum AJ.
ver resumen
This observational study examines the association of labeling vegetables with indulgent descriptions and overall vegetable consumption compared with labeling vegetables with basic or health-focused labels.

Educational Attainment and Lifetime Risk of Cardiovascular Disease
Kubota Y, Heiss G, MacLehose RF, et al.
ver resumen
This population-based observational study estimates lifetime risks of cardiovascular disease according to categories of educational attainment.

Adverse Events From Cosmetics and Personal Care Products
Kwa M, Welty LJ, Xu S.
ver resumen
This study examines adverse events for cosmetics in the FDA’s Center for Food Safety and Applied Nutrition’s Adverse Event Reporting System to inform future policymaking to protect consumers.

Association of Prescription Drug Price Rebates With Out-of-Pocket and Federal Spending
Dusetzina SB, Conti RM, Yu NL, et al.
ver resumen
This special communication examines the role of prescription drug rebates in driving up Medicare Part D expenditures and consumer out-of-pocket costs.

Why Asymptomatic Patients Receive Carotid Imaging
Keyhani S, Cheng EM, Naseri A, et al.
ver resumen
This study examines why asymptomatic patients who are 65 years and older and undergo revascularization receive initial carotid imaging.

Older Adults’ Views About Cancer Screening Cessation
Schoenborn NL, Lee K, Pollack CE, et al.
ver resumen
This qualitative interview study examines community-dwelling older adults’ perspectives on the decision to stop cancer screening when life expectancy is limited.

Risks of Statin Therapy in Older Adults
Curfman G.
ver resumen
Should adults older than 75 years receive statin therapy for the indication of primary prevention of cardiovascular disease? Last year, the US Preventive Services Task Force concluded that the evidence was insufficient to draw a conclusion about the balance of benefits and harms for the primary prevention of cardiovascular events and mortality in this age group. Even so, statins are commonly prescribed to patients over the age of 75 years, and the prevalence of use is increasing. The Medical Expenditure Panel Survey reported that statin use for primary prevention in adults older than 79 years increased more than 3-fold, from 8.8% in 1999-2000 to 34.1% in 2011-2012.

Strong Anticholinergics and Incident Dementia
Gray SL, Anderson ML, Dublin S, et al.
ver resumen
This prospective population-based cohort study reports an increased risk for dementia with increased total standard daily doses of anticholinergics. See the Invited Commentary by Campbell and Boustani.

Medical Cannabis Laws and Opioid Mortality
Bachhuber MA, Saloner B, Cunningham CO, et al.
ver resumen
Bachhuber et al determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality in a time series analysis. See also the Invited Commentary by Hayes and Brown.

USPSTF Recommendations on Obesity in Children and Adolescents
Block JP, Oken E.
ver resumen
This Editorial highlights the importance of a comprehensive and practical approach to implementing the USPSTF recommendations on childhood obesity screening and treatment.

Sodium Reduction in US Households’ Packaged Food and Beverage Purchases
Poti JM, Dunford EK, Popkin BM.
ver resumen
This longitudinal study of the Nielsen Homescan Consumer Panel assessed 15-year changes in the amount of sodium in goods purchased by US households and the proportion that have purchases with optimal sodium density.

The Need to Test Strategies Based on Common Sense
Khoong EC, Ross JS.
ver resumen
“You have diabetes.”

Health Status of Gender Minorities in the United States
Streed CG, Jr, McCarthy EP, Haas JS.
ver resumen
This study examines gender minority adults in the United States in terms of whether they experience health disparities compared with their cisgender peers.

Outcomes Among Older Adults Randomized to Statin Treatment or Usual Care
Han BH, Sutin D, Williamson JD, et al.
ver resumen
This post hoc secondary analysis of older adults in the randomized clinical trial ALLHAT-LLT compares statin treatment vs usual care for primary cardiovascular prevention.

A Brief Measure for Assessing Generalized Anxiety Disorder The GAD-7
Spitzer RL, Kroenke K, Williams JW, et al.
ver resumen
Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.
A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.
A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.
The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
Shanafelt TD, Boone S, Tan L, et al.
ver resumen
Shanafelt and colleagues evaluated rates of burnout among US physicians, differences by specialty, and comparisons of physicians with US workers in other fields. Burnout was measured using validated instruments, and satisfaction with work-life balance was explored. See the editorial by O’Malley.

Effects of Evening vs Morning Levothyroxine Intake A Randomized Double-blind Crossover Trial
Bolk N, Visser TJ, Nijman J, et al.
ver resumen
Levothyroxine sodium is widely prescribed to treat primary hypothyroidism. There is consensus that levothyroxine should be taken in the morning on an empty stomach. A pilot study showed that levothyroxine intake at bedtime significantly decreased thyrotropin levels and increased free thyroxine and total triiodothyronine levels. To date, no large randomized trial investigating the best time of levothyroxine intake, including quality-of-life evaluation, has been performed.
To ascertain if levothyroxine intake at bedtime instead of in the morning improves thyroid hormone levels, a randomized double-blind crossover trial was performed between April 1, 2007, and November 30, 2008, among 105 consecutive patients with primary hypothyroidism at Maasstad Hospital Rotterdam in the Netherlands. Patients were instructed during 6 months to take 1 capsule in the morning and 1 capsule at bedtime (one containing levothyroxine and the other a placebo), with a switch after 3 months. Primary outcome measures were thyroid hormone levels; secondary outcome measures were creatinine and lipid levels, body mass index, heart rate, and quality of life.
Ninety patients completed the trial and were available for analysis. Compared with morning intake, direct treatment effects when levothyroxine was taken at bedtime were a decrease in thyrotropin level of 1.25 mIU/L (95% confidence interval [CI], 0.60-1.89 mIU/L; P < .001), an increase in free thyroxine level of 0.07 ng/dL (0.02-0.13 ng/dL; P = .01), and an increase in total triiodothyronine level of 6.5 ng/dL (0.9-12.1 ng/dL; P = .02) (to convert thyrotropin level to micrograms per liter, multiply by 1.0; free thyroxine level to picomoles per liter, multiply by 12.871; and total triiodothyronine level to nanomoles per liter, multiply by 0.0154). Secondary outcomes, including quality-of-life questionnaires (36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, 20-Item Multidimensional Fatigue Inventory, and a symptoms questionnaire), showed no significant changes between morning vs bedtime intake of levothyroxine.
Levothyroxine taken at bedtime significantly improved thyroid hormone levels. Quality-of-life variables and plasma lipid levels showed no significant changes with bedtime vs morning intake. Clinicians should consider prescribing levothyroxine intake at bedtime.
Trial Registration Identifier: ISRCTN17436693 (NTR959).

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease
Lazarus B, Chen Y, Wilson FP, et al.
ver resumen
This population-based cohort study quantifies the association between proton pump inhibitor use and incident chronic kidney disease among participants in the Atherosclerosis Risk in Communities study.

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