This Week in JAMA FREE

Glucosamine is widely used by patients with chronic low back pain, despite minimal evidence to support its use. To investigate whether glucosamine reduces pain-related disability in patients with degenerative lumbar osteoarthritis and low back pain lasting longer than 6 months' duration, Wilkens and colleagues Article randomly assigned patients to receive 6 months of treatment with oral glucosamine sulfate (1500 mg/d) or pill placebo. They found no difference in pain-related disability during the 6-month intervention or at a 1-year follow-up among patients taking glucosamine compared with those taking placebo. In an editorial, Avins Article discusses the public health burden of chronic low back pain and the need for clinical research to identify effective treatments.

Caseloads vary substantially among lung transplant centers in the United States. To assess center effects on long-term survival following lung transplantation, Thabut and colleagues Article analyzed United Network for Organ Sharing registry data from 15 642 patients who underwent the procedure at 61 hospitals between 1987 and 2009. The authors report that 5-year survival rates ranged from 30% to 61% and that this marked variation in survival was only partly associated with center procedural volume. In an editorial, Livingston and Cao Article discuss methodological considerations in analyses of the procedural volume and outcome relationship.

To assess whether tight control of systolic blood pressure—defined as less than 130 mm Hg—is associated with fewer adverse cardiovascular events among patients with diabetes and coronary artery disease (CAD), Cooper-DeHoff and colleagues performed a post hoc and observational subgroup analysis of data from participants with diabetes in the International Verapamil SR-Trandolapril study. The investigators found that compared with “usual control” (systolic blood pressure between 130 mm Hg and 140 mm Hg), tight control of systolic blood was not associated with improved cardiovascular outcomes among patients with diabetes and CAD.

Telomeres—nucleoprotein complexes at the ends of chromosomes that shorten with each cell cycle—are important in the maintenance of chromosomal integrity. Some evidence suggests that short telomeres may lead to malignant transformation. In an analysis of data from a prospective population-based study of individuals aged 40 to 70 years and free of cancer at baseline, Willeit and colleagues found that baseline leukocyte telomere length was inversely associated with incident cancer and cancer mortality.

Patients with limited ability to understand and process written health information are at risk for poor health outcomes. In a systematic review, Powers and colleagues assessed the accuracy of brief instruments that identify patients with limited literacy in the clinical setting. They found that several single-item questions including confidence filling out medical forms and use of a surrogate reader were moderately effective for identifying patients with limited literacy.

“We physicians are like the sea at city's edge—a point of orientation. We are a beacon for patients in crisis. We are the locker for their sunken histories. We gather flotsam from their foundered dreams.” From “Old Men and the Sea.”

Recent studies have found that exposure early in life to certain pesticides and industrial chemicals is associated with development of attention-deficit/hyperactivity disorder.

Restoring health to health reform

Cardiopulmonary resuscitation: celebration and challenges

Meaningful use of health information technology

Aging adults with intellectual disabilities

Join Kenneth J. Mukamal, MD, MPH, MA, Wednesday, July 21, from 2 to 3 PM eastern time to discuss advising a 42-year-old patient about whether he should drink alcohol for his health. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 29-year-old woman with flulike symptoms? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is August 8.

For your patients: Information about osteoarthritis of the lumbar spine.