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JAMA Internal Medicine - más leídos

The Personal Care Products Safety Act
Feinstein D, Collins S.
ver resumen
This Viewpoint outlines goals of the proposed Personal Care Products Safety Act, a response to the problems associated with the current regulatory approach to cosmetics and personal care products in the United States.

April 20 and Fatal Traffic Crashes in the United States
Staples JA, Redelmeier DA.
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This data analysis examines the association between the April 20 cannabis celebrations in the United States and a population-level increase in the risk of fatal traffic crash involvement.

Putting the “She” in Doctor
DeFilippis EM.
ver resumen
This essay examines some of the ways that women clinicians face discrimination in the workplace.

Prevalence of Pulmonary Embolism in Patients With Syncope
Costantino G, Ruwald MH, Quinn J, et al.
ver resumen
This study of longitudinal administrative data estimates the prevalence of pulmonary embolism in patients presenting to the hospital for syncope in 4 countries.

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.

Out-of-pocket Spending and Premium Contributions After the ACA
Goldman AL, Woolhandler S, Himmelstein DU, et al.
ver resumen
This nationally representative survey estimates changes in household health spending nationwide after implementation of the Affordable Care Act among adults aged 18 to 64 years.

Lactation Duration and Incident Diabetes in Young Women
Gunderson EP, Lewis CE, Lin Y, et al.
ver resumen
This 30-year prospective cohort study examines the association between lactation and progression to diabetes using biochemical testing both before and after pregnancy, accounting for prepregnancy cardiometabolic measures, gestational diabetes, and lifestyle behaviors.

Association of Protein Intake With Mortality
Song M, Fung TT, Hu FB, et al.
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This cohort study assesses the associations of animal and plant protein intake with the risk for mortality in 2 populations of US adults.

Meditation for Psychological Stress and Well-being
Goyal M, Singh S, Sibinga ES, et al.
ver resumen
Goyal et al determine the efficacy of meditation programs in improving stress-related outcomes in diverse adult clinical populations. See the Invited Commentary by [IIC130096].

A Brief Measure for Assessing Generalized Anxiety Disorder The GAD-7
Spitzer RL, Kroenke K, Williams JW, et al.
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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.

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.

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).

Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population
Simonsen L, Reichert TA, Viboud C, et al.
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Observational studies report that influenza vaccination reduces winter mortality risk from any cause by 50% among the elderly. Influenza vaccination coverage among elderly persons (≥65 years) in the United States increased from between 15% and 20% before 1980 to 65% in 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period. We tried to reconcile these conflicting findings by adjusting excess mortality estimates for aging and increased circulation of influenza A(H3N2) viruses.
We used a cyclical regression model to generate seasonal estimates of national influenza-related mortality (excess mortality) among the elderly in both pneumonia and influenza and all-cause deaths for the 33 seasons from 1968 to 2001. We stratified the data by 5-year age group and separated seasons dominated by A(H3N2) viruses from other seasons.
For people aged 65 to 74 years, excess mortality rates in A(H3N2)-dominated seasons fell between 1968 and the early 1980s but remained approximately constant thereafter. For persons 85 years or older, the mortality rate remained flat throughout. Excess mortality in A(H1N1) and B seasons did not change. All-cause excess mortality for persons 65 years or older never exceeded 10% of all winter deaths.
We attribute the decline in influenza-related mortality among people aged 65 to 74 years in the decade after the 1968 pandemic to the acquisition of immunity to the emerging A(H3N2) virus. We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10% of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.

Is There a Future for Ovarian Cancer Screening?
Narod SA.
ver resumen
Currently, about 65% of the 22 000 women diagnosed with ovarian cancer annually in the United States will die of their cancer, and we all would like to reduce the mortality rate. Possible approaches to reducing mortality include prevention, screening, and better treatment. In the current issue of JAMA, the US Preventive Services Task Force issued a grade D recommendation, against population-based screening for ovarian cancer, based on a review of 4 randomized screening trials. The 2 largest studies in the review were the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and the Prostate, Lung, Colorectal and Ovarian screening trial (PLCO); UKCTOCS used a proprietary algorithm that incorporates changes in cancer antigen 125 (CA-125) over time, whereas the smaller PLCO trial assigned women to CA-125 and ultrasonography vs usual care. Both screening interventions failed to reduce ovarian cancer mortality.

Sugar Intake and Cardiovascular Diseases Mortality
Yang Q, Zhang Z, Gregg EW, et al.
ver resumen
Yang et al examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with cardiovascular disease mortality. See the Invited Commentary by [IIC130095].

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.

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.

Depression Is a Risk Factor for Noncompliance With Medical Treatment Meta-analysis of the Effects of Anxiety and Depression on Patient Adherence
DiMatteo M, Lepper HS, Croghan TW.
ver resumen
Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression.
Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with n>10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it).
Twelve articles about depression and 13 about anxiety met the inclusion criteria. The associations between anxiety and noncompliance were variable, and their averages were small and nonsignificant. The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89).
Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects. Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.

Duration of Menopausal Vasomotor Symptoms
Avis NE, Crawford SL, Greendale G, et al.
ver resumen
This multiracial/multiethnic observational study finds that frequent vasomotor symptoms lasted more than 7 years during the menopausal transition for more than half of the women and persisted for 4.5 years after the final menstrual period. See the Invited Commentary by Richard-Davis and Manson.

Firearm Legislation and Firearm-Related Fatalities in the United States
Fleegler EW, Lee LK, Monuteaux MC, et al.
ver resumen
Fleegler and colleagues review the association of US firearm laws with number of firearm-related fatalities. In the Invited Commentary, Wintemute further discusses US firearm violence.

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