This Week in JAMA FREE

Treatment decisions for extremely low-birth-weight infants include consideration of quality-of-life outcomes of intensive neonatal care. Saigal and colleaguesArticle found that preference ratings by neonatologists of 5 hypothetical child health states depicting possible outcomes of neonatal care were similar to ratings by neonatal nurses, but generally lower than those by adolescents who had been extremely low-birth-weight infants, adolescent controls who had been normal-weight term infants, and their parents. In an editorial, FostArticle discusses the complexities of treatment decisions for seriously ill newborns.

To determine whether high dietary fiber intake is associated with a decreased risk of coronary heart disease (CHD) in women, as has been observed in men, Wolk and coworkers analyzed CHD events and data collected by repeated food frequency questionnaires for 68,782 women followed up for 10 years in the Nurses' Health Study. After controlling for age and other cardiovascular risk and dietary factors, the risk of a CHD event was significantly less for women in the highest quintile of cereal fiber intake compared with the lowest quintile, but a similar association was not seen with vegetable or fruit fiber intake.

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Tight glycemic control, which is associated with a decreased risk of microvascular complications in patients with type 2 diabetes mellitus, may require treatment with more than 1 pharmacological agent in most patients over time. In the UK Prospective Diabetes Study of more than 4000 patients with newly diagnosed type 2 diabetes mellitus, Turner and colleagues found that overall more than twice as many patients randomly allocated to monotherapy (insulin, a sulfonylurea, or metformin) as patients randomized to conventional treatment (diet alone) achieved target levels of fasting plasma glucose and glycosylated hemoglobin (HbA_1c). By 9 years after diagnosis, however, only about 25% of patients in the monotherapy group attained the target HbA_1c level of less than 7%.

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Sullivan and colleagues report that only 42 (8.5%) of 497 patients aged 65 years or older admitted to a medical or surgical ward of a Veterans Affairs hospital maintained the level of average daily nutrient intake recommended for hospitalized patients. One hundred two patients (21%) had an average daily nutrient intake of less than 50% of their calculated maintenance energy requirements. Patients in this low-nutrient group were more likely to be functionally dependent at discharge and had higher rates of in-hospital mortality and mortality within 90 days of admission compared with the other patients.

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In this study of healthy young men, King and coworkersArticle found that testosterone levels did not increase immediately after androstenedione administration or during 8-week resistance training with androstenedione supplementation. Increases in muscle strength during training were similar in androstenedione and placebo groups, but estradiol and estrone levels increased significantly over baseline in the androstenedione group. In an editorial, YesalisArticle questions whether androstenedione should be available over-the-counter.

At their spring meeting in Chicago, pediatricians were updated on the efficacy and cost of vaccines against varicella, Lyme disease, influenza, and rotavirus, and on progress against group A streptococcal disease.

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How to assess recommendations for screening.

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Long and Marquis estimate the increase in annual physician visits among low-income uninsured children expected to follow implementation of the State Children's Health Insurance Program (CHIP) and predict marked variation between states.

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Bodenheimer and coauthors propose that primary care physicians become coordinators of care rather than gatekeepers.

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For your patients: Facts on dietary fiber.

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