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This Week in JAMA
October 12, 2011

This Week in JAMA

JAMA. 2011;306(14):1513. doi:10.1001/jama.2011.1458

A previous analysis of data from the Selenium and Vitamin E Cancer Prevention Trial, in which 35 533 healthy men were randomly assigned to receive either selenium, vitamin E, both agents, or dual placebo, found no significant reduction in prostate cancer risk associated with either selenium or vitamin E after a median 5.5 years of follow-up. However, a nonstatistically significant increase in prostate cancer risk among men receiving vitamin E (with selenium placebo) was of concern. In this issue, Klein and colleagues report that after a median 7 years of follow-up, men randomly assigned to receive vitamin E plus placebo had a significantly increased risk of prostate cancer.

Article (AUTHOR VIDEO INTERVIEW)

The clinical significance of BRCA1/2 mutations in ovarian cancer is not clear. In an analysis of clinical and multidimensional genomic data from 316 patients with high-grade serous ovarian cancer, Yang and colleagues assessed the relationships between BRCA1/2 mutations and patient survival, chemotherapy response, and gene mutation rates. The authors found that BRCA2 mutations, but not BRCA1 mutations, were associated with improved overall survival and progression-free survival, improved chemotherapy response, and higher mutation rates compared with BRCA wild-type cases. In an editorial, Grann and Parsons discuss implications of the study findings for patient care and future research.

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Roth and colleagues examined the association between mothers' use of prenatal folic acid supplements and risk of severe language delay in their children at age 3 years in an analysis of data from the Norwegian Mother and Child Cohort Study. The authors report that among 38 954 children with 3-year follow-up data, 204 (0.5%) had severe language delay, which was associated with maternal nonuse of folic acid supplements from 4 weeks before conception to 8 weeks after conception.

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Some data suggest that enteral supplementation with omega-3 fatty acids, γ-linolenic acid, and antioxidants benefits patients with acute lung injury. In a multicenter trial, Rice and colleagues randomly assigned 143 adults to receive twice-daily enteral supplementation of these substances (n-3 supplement) and 129 to receive an isocaloric control infusion. The authors report the study was stopped early when it was found that the n-3 supplement did not improve ventilator-free days or other clinical outcomes and may in fact be harmful. In an editorial, Cook and Heyland discuss pharmaconutrition in critically ill patients.

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Ms J is a 46-year-old woman with a history of iron deficiency anemia and 3 miscarriages who was recently diagnosed with celiac disease. Leffler discusses the epidemiology and pathophysiology of celiac disease, diagnostic testing (including population screening and testing of patients' family members), treatment, and patient follow-up.

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“How, I ask myself, do you combine the heartsickness of humanism with the mental acrobatics of medicine, when both are required to be a good doctor, but only one is reinforced?” From “The Good Doctor.”

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States are hoping to boost access to mental health care for children by linking pediatricians to mental health specialists for training and consultation.

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A model for independent analysis of industry data

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Improving postmarketing drug safety

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Join Michael Paasche-Orlow, MD, MA, MPH, Wednesday, October 19, from 2 to 3 PM eastern time to discuss caring for patients with limited health literacy. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl

For your patients: Information about celiac disease.

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