This Week in JAMA FREE

Pain and depression occur simultaneously in many primary care patients. In a randomized trial that enrolled primary care patients with chronic musculoskeletal pain and depression of moderate or greater severity, Kroenke and colleagues assessed the effects of an intervention that included individually tailored optimized antidepressant therapy and a pain self-management program compared with usual care, which consists of informing patients that they had symptoms of depression and recommending that they seek advice about treatment. At a 12-month follow-up, the authors found that patients who received the intervention had significantly greater reductions in depression and pain severity than had patients who received usual care.

There is concern that large body size attained by some professional athletes may have adverse health consequences. To explore this question, Tucker and colleagues assessed cardiovascular disease (CVD) risk factors in a cross-sectional survey of 504 active National Football League players and compared these with the risks of men of similar age who were enrolled in the population-based Coronary Artery Risk Development in Young Adults (CARDIA) study. The authors found that compared with men in the CARDIA study, the professional football players had a lower prevalence of impaired fasting glucose, less cigarette smoking, a similar prevalence of dyslipidemia, and a higher prevalence of hypertension.

An increased risk of community-acquired pneumonia has been found in current users of acid-suppressive medications. In an analysis of data from a large, hospital-based pharmacoepidemiological cohort study, Herzig and colleagues assessed the incidence of hospital-acquired pneumonia among patients who were hospitalized for 3 or more days. The authors found that patients who were prescribed an acid-suppressive medication—specifically a proton pump inhibitor—had a 30% increased odds of developing hospital-acquired pneumonia.

Chan and colleagues reviewed recent data on the epidemiology, pathophysiology, risk factors, and complications of type 2 diabetes in Asia. Among the authors' findings was that the prevalence of type 2 diabetes is increasing rapidly, particularly among young and middle-aged adults and among persons of relatively low body mass index, and that diabetes risk varied by ethnicity, degree of urbanization, and socioeconomic conditions. Cancer was found to be an important cause of morbidity and mortality among Asian patients with diabetes.

While undergoing an evaluation for erectile dysfunction, Mr D was found to have a serum prostate-specific antigen level of 5.3 ng/mL. Prostate biopsy revealed adenocarcinoma involving 10% of a single biopsy core with a Gleason score of 6. Mr D consulted a urologist and a radiologist and decided on an approach characterized as watchful waiting. Sanda and Kaplan discuss the prevalence and natural history of early stage prostate cancer, indications for treatment vs active surveillance, and treatment efficacies.

“How would I respond if asked to care for individuals involved in the destruction of the lives of my loved ones?” From “The Intervention of Saint George.”

Citing concerns about serious cardiac and metabolic adverse events, a US FDA advisory panel said a new formulation of quetiapine should not be used as monotherapy for depression and generalized anxiety.

The future prevalence of age-related macular degeneration, risk reduction, and the impact of new treatments.

Noninvasive prenatal diagnosis: practical and ethical considerations

Advancing 21st-century medical professionalism

Parent-investigators: an ethical dilemma

Join Peter Hwang, MD, June 17, 2009, from 2 to 3 PM eastern time to discuss the diagnosis and treatment of rhinosinusitis. To register, go to http://www.ihi.org/AuthorintheRoom.

Theme Issue on Child and Adolescent Health

For your patients: Information about risk factors for heart disease