This Week in JAMA FREE

Women who have inherited mutations in the BRCA1 or BRCA2 (BRCA1/ 2) genes have elevated risks of breast and ovarian cancer and may elect to reduce their risk by undergoing prophylactic mastectomy and salpingo-oophorectomy. In an analysis of data from a prospective multicenter cohort of 2482 BRCA1/2 mutation carriers, Domchek and colleagues Article assessed cancer risk and mortality reduction. In analyses stratified by mutation and prior cancer status, the authors found that mastectomy was associated with a lower risk of breast cancer, and salpingo-oophorectomy was associated with a lower risk of ovarian cancer, first breast cancer, overall mortality, and breast and ovarian cancer–specific mortality. In an editorial, Esserman and Kaklamani Article discuss the importance of identifying women with genetic predispositions for breast and ovarian cancer and advances in risk-reducing surgery.

Preterm delivery is an established risk factor for cerebral palsy; however, about three-fourths of all infants with cerebral palsy are born after 36 weeks' gestation. In an analysis of Norwegian national health and insurance registry data, Moster and colleagues assessed whether timing of birth in the term and postterm period is associated with risk of cerebral palsy. The authors report that compared with delivery at 40 weeks' gestation, delivery at 37 weeks or at 42 weeks was associated with an increased risk of cerebral palsy.

Gitlin and colleagues report results of the Care of Persons with Dementia in their Environments (COPE) trial in which community-dwelling patients with dementia and their caregiver were randomly assigned to either a home-based nonpharmacological biobehavioral intervention or a minimal contact control condition. The intervention involved up to 12 home or telephone contacts by health professionals who identified and targeted modifiable sensory, physical, and cognitive stressors in the patient's home environment and sought to enhance caregivers' skills. Patient-caregiver dyads assigned to the control group participated in up to 3 scripted telephone conversations with the research staff and received informational brochures. The authors report that compared with control, the biobehavioral intervention resulted in better outcomes for the patient-caregiver dyads at 4 months, but no difference in patient outcomes at 9 months' follow-up.

To maximize access to and the capacity of neonatal intensive care units, it is recommended that perinatal services in the United States be regionalized, and that very low-birth-weight (VLBW) infants receive care at highly specialized, level III hospitals. However, significant percentages of VLBW infants are born in lower-level hospitals, which may have implications for infant survival. In a systematic review of the published data on the relationship between hospital level at birth and neonatal and predischarge mortality, Lasswell and colleagues found that birth outside a level III hospital was associated with higher rates of neonatal and predischarge mortality among VLBW and very preterm infants.

“I was at a loss for words to respond to my patient's tearfulness. Instead, I took his hand and held it firmly. He gently squeezed my hand in reply.” From “Holding the Hand.”

Resting heart rates above 80/min—considered within the normal range and often discounted in physical examinations—increase the risk of cardiovascular complications and may be associated with poor renal outcomes.

From the Archives Journals

An April Archives of Surgery article reported on a trial comparing laparoscopic with open repair of ventral incisional hernia. Livingston discusses advising patients about repairing abdominal wall hernias.

Biomedical research: a new policy framework

A national strategy on sexual health

Improving access to health care data

Physicians: knights, knaves, or pawns?

Join Matthew K. Wynia, MD, MPH, Wednesday, September 15, from 2 to 3 PM eastern time to discuss the role of professionalism and self-regulation for detecting impaired or incompetent physicians. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about cerebral palsy.