JAMA Current Issue

This Week in JAMA

Wed, 15 May 2013 00:00:00 GMT

May 15, 2013

Addressing the Social Determinants of Health Within the Patient-Centered Medical Home Lessons From Pediatrics Social Determinants of Health in the Medical Home

Garg A, Jack B, Zuckerman B. — Wed, 15 May 2013 00:00:00 GMT

Socioeconomic disparities in health continue to exist, despite advances in medicine. Since the classic Whitehall studies, it has been well known that the social context in which an individual lives and works influences health. Mitigating the harmful consequences of social factors that contribute to health disparities has largely been left to the public health and policy communities, whereas clinical medicine has traditionally focused on identifying and reducing biological risk factors for an individual patient. The patient-centered medical home (PCMH), however, offers an important opportunity to promote population health through systematically addressing the social determinants of health.

Contraception Is a Fundamental Primary Care Service Contraception Is Fundamental in Primary Care

Gossett DR, Kiley JW, Hammond C. — Wed, 15 May 2013 00:00:00 GMT

Contraceptives and the Law A View From a Catholic Medical Institution Contraceptives and the Law

Zimmer EA, Welie JM, Rendell MS. — Wed, 15 May 2013 00:00:00 GMT

Cost Consequences of the 340B Drug Discount Program Cost Consequences of the 340B Drug Discount Program

Conti RM, Bach PB. — Wed, 15 May 2013 00:00:00 GMT

Created in 1992, a little-known federal drug discount program called “340B” allowed a handful of hospitals that cared for the poor to obtain drugs for their patients at substantially reduced prices. Today, through a series of expansions, including some enumerated in the Affordable Care Act, numerous other types of entities such as community hospitals and cancer centers that serve both the poor and the well-insured can participate. Between 2009 and 2012 the number of enrolled hospitals doubled, and today the program includes 1679 hospitals, a third of all hospitals in the United States.

Patient’s Sister, Seeking Job

Zimmerman B. — Wed, 15 May 2013 00:00:00 GMT

My brother was diagnosed with hepatoblastoma when I was 4 years old and he was just shy of 2. It wasn't until years (and several cancers) later that we learned he had Gardner syndrome. Over the last 26 years, Hans had dozens of operations and underwent many lifetime doses of radiation and chemotherapy. The disease and its treatments took a toll on his body, and he had a multivisceral transplant in 2007 that gave him a new stomach, small intestine, pancreas, and liver. Five years later, his liver showed signs of chronic rejection and he was put back on the transplant list. We waited for organs for four months. Hans was primarily in the hospital during this time. Finally, internal bleeding, the result of debilitated organs and a large abdominal wound, took his life on December 26, 2012.

Association of Single- vs Dual-Chamber ICDs With Mortality, Readmissions, and Complications Among Patients Receiving an ICD for Primary Prevention Dual Chamber ICDs, Mortality, and Complications

Peterson PN, Varosy PD, Heidenreich PA, et al. — Wed, 15 May 2013 00:00:00 GMT

Importance

Randomized trials of implantable cardioverter-defibrillators (ICDs) for primary prevention predominantly used single-chamber devices. In clinical practice, patients often receive dual-chamber ICDs, even without clear indications for pacing. The outcomes of dual- vs single-chamber devices are uncertain.

Objective

To compare outcomes of single- and dual-chamber ICDs for primary prevention of sudden cardiac death.

Design, Setting, and Participants

Retrospective cohort study of admissions in the National Cardiovascular Data Registry's (NCDR) ICD registry from 2006-2009 that could be linked to Centers for Medicare & Medicaid Services fee-for-service Medicare claims data. Patients were included if they received an ICD for primary prevention and did not have a documented indication for pacing.

Main Outcomes and Measures

Adjusted risks of 1-year mortality, all-cause readmission, heart failure readmission, and device-related complications within 90 days were estimated with propensity-score matching based on patient, clinician, and hospital factors.

Results

Among 32 034 patients, 12 246 (38%) received a single-chamber device and 19 788 (62%) received a dual-chamber device. In a propensity-matched cohort, rates of complications were lower for single-chamber devices (3.51% vs 4.72%; P < .001; risk difference, −1.20 [95% CI, −1.72 to −0.69]), but device type was not significantly associated with 1-year mortality (unadjusted rate, 9.85% vs 9.77%; hazard ratio [HR], 0.99 [95% CI, 0.91 to 1.07]; P = .79), 1-year all-cause hospitalization (unadjusted rate, 43.86% vs 44.83%; HR, 1.00 [95% CI, 0.97-1.04]; P = .82), or hospitalization for heart failure (unadjusted rate, 14.73% vs 15.38%; HR, 1.05 [95% CI, 0.99-1.12]; P = .19).

Conclusions and Relevance

Among patients receiving an ICD for primary prevention without indications for pacing, the use of a dual-chamber device compared with a single-chamber device was associated with a higher risk of device-related complications and similar 1-year mortality and hospitalization outcomes. Reasons for preferentially using dual-chamber ICDs in this setting remains unclear.

Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse Outcomes for Pelvic Organ Prolapse

Nygaard I, Brubaker L, Zyczynski HM, et al. — Wed, 15 May 2013 00:00:00 GMT

Importance

More than 225 000 surgeries are performed annually in the United States for pelvic organ prolapse (POP). Abdominal sacrocolpopexy is considered the most durable POP surgery, but little is known about safety and long-term effectiveness.

Objectives

To describe anatomic and symptomatic outcomes up to 7 years after abdominal sacrocolpopexy, and to determine whether these are affected by concomitant anti-incontinence surgery (Burch urethropexy).

Design, Setting, and Participants

Long-term follow-up of the randomized, masked 2-year Colpopexy and Urinary Reduction Efforts (CARE) trial of women with stress continence who underwent abdominal sacrocolpopexy between 2002 and 2005 for symptomatic POP and also received either concomitant Burch urethropexy or no urethropexy. Ninety-two percent (215/233) of eligible 2-year CARE trial completers were enrolled in the extended CARE study; and 181 (84%) and 126 (59%) completed 5 and 7 years of follow-up, respectively. The median follow-up was 7 years.

Main Outcomes and Measures

Symptomatic POP failure requiring retreatment or self-reported bulge; or anatomic POP failure requiring retreatment or Pelvic Organ Prolapse Quantification evaluation demonstrating descent of the vaginal apex below the upper third of the vagina, or anterior or posterior vaginal wall prolapse beyond the hymen. Stress urinary incontinence (SUI) with more than 1 symptom or interval treatment; or overall UI score of 3 or greater on the Incontinence Severity Index.

Results

By year 7, the estimated probabilities of treatment failure (POP, SUI, UI) from parametric survival modeling for the urethropexy group and the no urethropexy group, respectively, were 0.27 and 0.22 for anatomic POP (treatment difference of 0.050; 95% CI, 0.161 to 0.271), 0.29 and 0.24 for symptomatic POP (treatment difference of 0.049; 95% CI, 0.060 to 0.162), 0.48 and 0.34 for composite POP (treatment difference of 0.134; 95% CI, 0.096 to 0.322), 0.62 and 0.77 for SUI (treatment difference of 0.153; 95% CI, 0.268 to 0.030), and 0.75 and 0.81 for overall UI (treatment difference of 0.064; 95% CI, 0.161 to 0.032). Mesh erosion probability at 7 years (estimated by the Kaplan-Meier method) was 10.5% (95% CI, 6.8% to 16.1%).

Conclusions and Relevance

During 7 years of follow-up, abdominal sacrocolpopexy failure rates increased in both groups. Urethropexy prevented SUI longer than no urethropexy. Abdominal sacrocolpopexy effectiveness should be balanced with long-term risks of mesh or suture erosion.

Trial Registration

clinicaltrials.gov Identifier: NCT00099372

Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial Supplements and Age-Related Macular Degeneration

Wed, 15 May 2013 00:00:00 GMT

Importance

Oral supplementation with the Age-Related Eye Disease Study (AREDS) formulation (antioxidant vitamins C and E, beta carotene, and zinc) has been shown to reduce the risk of progression to advanced age-related macular degeneration (AMD). Observational data suggest that increased dietary intake of lutein + zeaxanthin (carotenoids), omega-3 long-chain polyunsaturated fatty acids (docosahexaenoic acid [DHA] + eicosapentaenoic acid [EPA]), or both might further reduce this risk.

Objectives

To determine whether adding lutein + zeaxanthin, DHA + EPA, or both to the AREDS formulation decreases the risk of developing advanced AMD and to evaluate the effect of eliminating beta carotene, lowering zinc doses, or both in the AREDS formulation.

Design, Setting, and Participants

The Age-Related Eye Disease Study 2 (AREDS2), a multicenter, randomized, double-masked, placebo-controlled phase 3 study with a 2 × 2 factorial design, conducted in 2006-2012 and enrolling 4203 participants aged 50 to 85 years at risk for progression to advanced AMD with bilateral large drusen or large drusen in 1 eye and advanced AMD in the fellow eye.

Interventions

Participants were randomized to receive lutein (10 mg) + zeaxanthin (2 mg), DHA (350 mg) + EPA (650 mg), lutein + zeaxanthin and DHA + EPA, or placebo. All participants were also asked to take the original AREDS formulation or accept a secondary randomization to 4 variations of the AREDS formulation, including elimination of beta carotene, lowering of zinc dose, or both.

Main Outcomes and Measures

Development of advanced AMD. The unit of analyses used was by eye.

Results

Median follow-up was 5 years, with 1940 study eyes (1608 participants) progressing to advanced AMD. Kaplan-Meier probabilities of progression to advanced AMD by 5 years were 31% (493 eyes [406 participants]) for placebo, 29% (468 eyes [399 participants]) for lutein + zeaxanthin, 31% (507 eyes [416 participants]) for DHA + EPA, and 30% (472 eyes [387 participants]) for lutein + zeaxanthin and DHA + EPA. Comparison with placebo in the primary analyses demonstrated no statistically significant reduction in progression to advanced AMD (hazard ratio [HR], 0.90 [98.7% CI, 0.76-1.07]; P = .12 for lutein + zeaxanthin; 0.97 [98.7% CI, 0.82-1.16]; P = .70 for DHA + EPA; 0.89 [98.7% CI, 0.75-1.06]; P = .10 for lutein + zeaxanthin and DHA + EPA). There was no apparent effect of beta carotene elimination or lower-dose zinc on progression to advanced AMD. More lung cancers were noted in the beta carotene vs no beta carotene group (23 [2.0%] vs 11 [0.9%], nominal P = .04), mostly in former smokers.

Conclusions and Relevance

Addition of lutein + zeaxanthin, DHA + EPA, or both to the AREDS formulation in primary analyses did not further reduce risk of progression to advanced AMD. However, because of potential increased incidence of lung cancer in former smokers, lutein + zeaxanthin could be an appropriate carotenoid substitute in the AREDS formulation.

Trial Registration

clinicaltrials.gov Identifier: NCT00345176

Do Findings on Routine Examination Identify Patients at Risk for Primary Open-Angle Glaucoma? The Rational Clinical Examination Systematic Review Patients at Risk for Primary Open-Angle Glaucoma

Hollands H, Johnson D, Hollands S, et al. — Wed, 15 May 2013 00:00:00 GMT

Importance

Glaucoma is the second leading cause of blindness worldwide, and its insidious onset is often associated with diagnostic delay. Since glaucoma progression can often be effectively diminished when treated, identifying individuals at risk for glaucoma could potentially lead to earlier detection and prevent associated vision loss.

Objective

To quantify the diagnostic accuracy of examination findings and relevant risk factors in identifying individuals with primary open-angle glaucoma (POAG), the most common form of glaucoma in North America.

Data Sources

Structured Medline (January 1950-January 2013) search and a hand search of references and citations of retrieved articles yielding 57 articles from 41 studies.

Study Selection

Population-based studies of high-level methods relating relevant examination findings of cup-to-disc ratio (CDR), CDR asymmetry, intraocular pressure (IOP), and demographic risk factors to the presence of POAG.

Results

The summary prevalence of glaucoma in the highest-quality studies was 2.6% (95% CI, 2.1%-3.1%). Among risk factors evaluated, high myopia (≥6 diopters; odds ratio [OR], 5.7; 95% CI, 3.1-11) and family history (OR, 3.3; 95% CI, 2.0-5.6) had the strongest association with glaucoma. Black race (OR, 2.9; 95% CI, 1.4-5.9) and increasing age (especially age >80 years; OR, 2.9; 95% CI, 1.9-4.3) were also associated with an increased risk. As CDR increased, the likelihood for POAG increased with a likelihood ratio (LR) of 14 (95% CI, 5.3-39) for CDR of 0.7 or greater. Increasing CDR asymmetry was also associated with an increased likelihood for POAG (CDR asymmetry ≥0.3; LR, 7.3; 95% CI, 3.3-16). No single threshold for CDR or asymmetry ruled out glaucoma. The presence of a disc hemorrhage (LR, 12; 95% CI, 2.9-48) was highly suggestive of glaucoma, but the absence of a hemorrhage was nondiagnostic (LR, 0.94; 95% CI, 0.83-0.98). At the commonly used cutoff for high IOP (≥22), the LR was 13 (95% CI, 8.2-17), while lower IOP made glaucoma less likely (LR, 0.65; 95% CI, 0.55-0.76). We found no studies of screening examinations performed by generalist physicians in a routine setting.

Conclusions and Relevance

Individual findings of increased CDR, CDR asymmetry, disc hemorrhage, and elevated IOP, as well as demographic risk factors of family history, black race, and advanced age are associated with increased risk for POAG, but their absence does not effectively rule out POAG. The best available data support examination by an ophthalmologist as the most accurate way to detect glaucoma.

Pelvic Organ Prolapse Surgery Long-term Outcomes and Implications for Shared Decision Making Pelvic Organ Prolapse Surgery

Iglesia CB. — Wed, 15 May 2013 00:00:00 GMT

Pelvic floor disorders, including pelvic organ prolapse, urinary incontinence, fecal incontinence, and other sensory disorders of the gastrointestinal and genitourinary tract, are common with nearly 1 in 4 US women having at least 1 pelvic floor condition. In this issue of JAMA, Nygaard and colleagues present findings from the extended Colpopexy and Urinary Reduction Efforts (extended CARE) trial. The original CARE trial was a double-blind randomized trial of 322 women mostly with advanced (stage 3-4) prolapse and without stress incontinence symptoms undergoing an open abdominal synthetic mesh sacrocolpopexy procedure either with or without a urethropexy for prevention of stress urinary incontinence.

Cephalosporin Resistance in Neisseria gonorrhoeae Infections

Klausner JD, Kerndt P. — Wed, 15 May 2013 00:00:00 GMT

To the Editor: The emergence of extended-spectrum cephalosporin resistance in Neisseria gonorrhoeae infections in North America and worldwide is worrisome, as is the current US response to that problem. Authorities call for adherence to treatment recommendations, use of test of cure, risk-reduction counseling, increased condom use, clinician vigilance for treatment failure, and novel antimicrobial development. Even though these measures are reasonable, none has been shown to reduce the population-level ecological effects of drug-resistant organisms.

Cephalosporin Resistance in Neisseria gonorrhoeae Infections—Reply

Kirkcaldy RD, Bolan GA, Wasserheit JN. — Wed, 15 May 2013 00:00:00 GMT

In Reply: We agree with Drs Klausner and Kerndt that antibiotic stewardship is an important component of controlling antibiotic resistance, and we support such efforts as sound clinical and public health practice. For many bacterial pathogens, antibiotic consumption appears to promote the emergence of resistance, and judicious antibiotic use may reduce the prevalence of resistance.

Cephalosporin Resistance in Neisseria gonorrhoeae Infections—Reply

Allen VG, Melano RG, Low DE. — Wed, 15 May 2013 00:00:00 GMT

In Reply: Drs Klausner and Kerndt highlight the urgent need for innovative approaches to address the continued emergence of multidrug-resistant N gonorrhoeae. Specifically, by analogy to efforts successful at reducing macrolide-resistant group A streptococci, they suggest real-time detection and antimicrobial testing use may turn the tide of cephalosporin resistance in N gonorrhoeae.

Use of Administrative Data for Public Reporting of Outcomes

Utter GH, Romano PS. — Wed, 15 May 2013 00:00:00 GMT

To the Editor: In their Viewpoint regarding the use of administrative data (ie, International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]) in public reporting of outcomes and pay for performance, Dr Farmer and colleagues argued for “a national, standardized system for outcome reporting” separate from administrative data that is “minimally affected by the incentives to alter coding created by public reporting.” Count us as skeptics.

Use of Administrative Data for Public Reporting of Outcomes—Reply

Farmer SA, Black BS, Bonow RO. — Wed, 15 May 2013 00:00:00 GMT

In Reply: Drs Utter and Romano have made important contributions to society's ability to measure patient safety using patient safety indicators based on administrative (billing) data. But their response to our article is puzzling. Our central claim was that billing data cannot be relied on to simultaneously measure quality, publicly report quality, and pay for performance. If they are, the ability to measure true changes in quality will be lost.

Temporal Trends in Smokeless Tobacco Use Among US Middle and High School Students, 2000-2011

Agaku IT, Vardavas CI, Ayo-Yusuf OA, et al. — Wed, 15 May 2013 00:00:00 GMT

To the Editor: Tobacco use remains the leading preventable cause of death and disease in the United States. Declines in smoking among youths were observed from the late 1990s, particularly after the Master Settlement Agreement in 1998. However, limited information exists on trends in smokeless tobacco use among US youths.

ACP, State Medical Boards Offer Advice on Online Professionalism for Physicians

Kuehn BM. — Wed, 15 May 2013 00:00:00 GMT

Physicians should pause before hitting Send on an e-mail, tweet, or other digital communication to ensure that the communication will uphold their professional obligations to patients and not mar the reputation of the profession, urges a new joint position paper (http: //annals.org/article.aspx?articleid =1675927) from the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).

Volunteer Corps Aims to Improve Training for Clinicians in Developing Countries

Kuehn BM. — Wed, 15 May 2013 00:00:00 GMT

Like many developing countries, Malawi faces a shortage of clinicians to meet the demand for care. According to the World Health Organization, there are just 3 nurses per 10 000 Malawians (compared with approximately 100 nurses to 10 000 citizens in the United States and the United Kingdom) and even fewer physicians, with fewer than 1 per 10 000.

Selections From News@JAMA and JAMA Forum

Wed, 15 May 2013 00:00:00 GMT

The Role of Medicaid and Medicare in Women's Health Care

Wed, 15 May 2013 00:00:00 GMT

This month's Visualizing Health Policy provides information about the role of Medicaid and Medicare in women's health care: the proportion of US women who are covered by Medicaid and Medicare; how women comprise the majority of those covered by the Medicaid and Medicare programs and the majority of those receiving long-term services and supports (such as home health care); how women on Medicaid are poorer and sicker than women with private coverage; how Medicaid is a primary payer for women's reproductive health services; and how women on Medicare spend more than their male counterparts on medical care and also have higher rates of health problems and social challenges. For a complete view, select the PDF available in the upper-right article toolbar.

Two or Three Things

Smith JM. — Wed, 15 May 2013 00:00:00 GMT

Just as fashions moved through the decades, from poodle skirts in the 1950s to go-go boots (1960s) and granny dresses (1970s), the abstract art of Elizabeth Murray (1940-2007) would also undergo changes in style, though always retaining a sense of her wink and a smile. Murray had moved from her birthplace of Chicago to Bloomington, Illinois, as a child, but her influence would someday extend far beyond the prairie horizon. The family had little, but movies brightened Murray's life, especially cartoons. To her family's delight, Murray could readily draw images from movies or the funny papers.

The Spider

Dorsett T. — Wed, 15 May 2013 00:00:00 GMT

The harvestman's diminutive braincontained in a quarter-inch bodyeasily moves eight Irishmaneyelashes rapidly upleaf or down,or as now, perfectly still,spread like the spokes of a leprechaun's fan—The neurons inside a squirreldo not add up to 100 billionand probably equal the few million starsin a dwarf galaxy, yet are,shall we say, spectacularly adequate—While waiting for ants in a shoethe six eyes of a recluse spiderdo not cause synapses behindto constitute a jealous mind;he bites a two-eyed creature's footin defense and not from spitebecause the black widow has eight.Our brains feel so precariousthey somehow envy flies'—Have you ever met a ladybug who careswhether her extended wingsare caught by a draft or a web?If so, you have a child's mind.No tarantula fears being buriedalive with a pepsis wasp's larva–Yet, like him, I have goneperfectly beyond despair;my cancerous, his paralyzed bodyat peace, despite being eaten alive.

NEW ANALYSES OF HOT SPRING WATERS

Wed, 15 May 2013 00:00:00 GMT

May 17, 1913

Climate Change Linked With Increase in Diarrheal Disease

Friedrich MJ. — Wed, 15 May 2013 00:00:00 GMT

Changes in climate that lead to an increase in temperature and a decrease in precipitation are associated with an increase in diarrheal disease in children in Botswana, a sub-Saharan country with distinct wet and dry seasons (Alexander KA et al. Int J Environ Res Public Health. 2013;10[4]:1202-1230).

Cognitive Effects of Konzo

Friedrich MJ. — Wed, 15 May 2013 00:00:00 GMT

Konzo, an irreversible neuromotor disorder in children that has been linked to ingestion of bitter cassava root, a staple food in sub-Saharan Africa, also undermines cognitive function, even in those with no physical symptoms of the disease, report researchers from Michigan State University, East Lansing (Boivin MJ et al. Pediatrics. 2013;131[4]:e1231-e1239).

Do TNF Inhibitors Reduce the Risk of Myocardial Infarction in Psoriasis Patients? TNF Inhibitors and MI Risk in Psoriasis Patients

Armstrong AW. — Wed, 15 May 2013 00:00:00 GMT

Jashin J. Wu, MD; Kwun-Yee T. Poon, MS; Jennifer C. Channual, MD; Albert Yuh-Jer Shen, MS, MDObjective: To assess whether patients with psoriasis treated with tumor necrosis factor (TNF) inhibitors have a decreased risk of myocardial infarction (MI) compared with those not treated with TNF inhibitors.Design: Retrospective cohort study.Setting: Kaiser Permanente Southern California health plan.Patients: Patients with at least 3 International Classification of Diseases, Ninth Revision, Clinical Modification, codes for psoriasis (696.1) or psoriatic arthritis (696.0) (without antecedent MI) between January 1, 2004, and November 30, 2010.Main Outcome Measure: Incident MI.Results: Of 8845 patients included, 1673 received a TNF inhibitor for at least 2 months (TNF inhibitor cohort), 2097 were TNF inhibitor naive and received other systemic agents or phototherapy (oral/phototherapy cohort), and 5075 were not treated with TNF inhibitors, other systemic therapies, or phototherapy (topical cohort). The median duration of follow-up was 4.3 years (interquartile range, 2.9, 5.5 years), and the median duration of TNF inhibitor therapy was 685 days (interquartile range, 215, 1312 days). After adjusting for MI risk factors, the TNF inhibitor cohort had a significantly lower hazard of MI compared with the topical cohort (adjusted hazard ratio, 0.50; 95% CI, 0.32-0.79). The incidence of MI in the TNF inhibitor, oral/phototherapy, and topical cohorts were 3.05, 3.85, and 6.73 per 1000 patient-years, respectively.Conclusions: Use of TNF inhibitors for psoriasis was associated with a significant reduction in MI risk and incident rate compared with treatment with topical agents. Use of TNF inhibitors for psoriasis was associated with a non–statistically significant lower MI incident rate compared with treatment with oral agents/phototherapy.doi:10.1001/archdermatol.2012.2502

Finding Ways to Cut Drug Costs

Wed, 15 May 2013 00:00:00 GMT

Adults in the United States have found a number of ways to reduce their prescription drug costs, and some could be hazardous to their health.

Hypertension Increasing Among US Adults

Wed, 15 May 2013 00:00:00 GMT

The prevalence of US adults with hypertension as well as those who take antihypertensive medication has increased in recent years, according to telephone surveys carried out by state health departments and the Centers for Disease Control and Prevention (CDC).

Many Children Still Have High Blood Lead Levels

Wed, 15 May 2013 00:00:00 GMT

Eliminating lead in paint, gasoline, and children's toys has drastically reduced the number of children with dangerous blood lead levels since the late 1970s. But a new study shows that 2.6% of US children aged 1 to 5 years still have excess lead in their blood.

One in 5 Teens Giving Birth Already Has a Child

Wed, 15 May 2013 00:00:00 GMT

Teen births have decreased in the last 20 years, but a new statistic demonstrates the need for more counseling about preventing pregnancy: nearly 20% of teens giving birth already have at least 1 child.

Tapeworm Infection of the Brain

Friedrich MJ. — Wed, 15 May 2013 00:00:00 GMT

An evidence-based guideline developed by the American Academy of Neurology to address controversy over the optimal therapy for parenchymal neurocysticercosis, a tapeworm infection of the central nervous system that causes seizures, advises treating patients with a combination of the antiepileptic albendazole plus a corticosteroid (Baird RA et al. Neurology. 2013;80[15]:1424-1429).

Waning Efficacy of Experimental Malaria Vaccine

Friedrich MJ. — Wed, 15 May 2013 00:00:00 GMT

The efficacy of the malaria vaccine candidate RTS,S/AS01E against episodes of malaria diminishes over time and also varies with exposure to the Plasmodium falciparum parasite, according to data from a long-term follow-up of a phase 2 trial of the vaccine in Africa (Olotu A et al. N Engl J Med. 2013;368[12]:1111-1120).

Incorrect Sentence in: Effect of Shock Wave–Facilitated Intracoronary Cell Therapy on LVEF in Patients With Chronic Heart Failure: The CELLWAVE Randomized Clinical Trial

Wed, 15 May 2013 00:00:00 GMT

Incorrect Sentence: In the Preliminary Communication titled “Effect of Shock Wave–Facilitated Intracoronary Cell Therapy on LVEF in Patients With Chronic Heart Failure: The CELLWAVE Randomized Clinical Trial,” published in the April 17, 2013, issue of JAMA (2013;309[15]:1622-1631), a sentence was incorrect. In the last paragraph of the Results section, the first sentence beneath the “Clinical Outcome” heading should have read “As shown in the analysis of multiple and recurrent clinical events (eFigure 3), the overall frequency of MACEs was significantly reduced in patients receiving shock wave + BMCs (32 events) compared with patients receiving shock wave + placebo infusion (61 events) or placebo shock wave + BMCs (18 events) (hazard ratio, 0.58 [95% CI, 0.40-0.85]; P = .02).” This article has been corrected online.

Misuse of Opioid Medication

Alford DP, Livingston EH. — Wed, 15 May 2013 00:00:00 GMT

About 100 million Americans have chronic pain and some may be treated with opioid medications. Opioid medications include codeine, morphine, oxycodone, and fentanyl, among others. These medications can help some people and harm others. In the United States, opioid medications are the second most common drug abused after marijuana. Opioid medication misuse is defined as use of an opioid medication different than the way in which it was prescribed (for example, in higher doses) or for reasons other than why it was prescribed (for example, to get high). An article published in the March 6, 2013, issue of JAMA discussed opioid misuse.

About This Journal

Wed, 15 May 2013 00:00:00 GMT