Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma, and untreated GER has been postulated as a cause of poor asthma control. Investigators from 19 American Lung Association Asthma Clinical Research Center sites randomly assigned 306 children with poor asthma control despite inhaled corticosteroid treatment and without symptomatic GER to receive either the proton pump inhibitor lansoprazole or placebo for 24 weeks. The investigators report that compared with placebo, lansoprazole was not associated with improvement in asthma symptoms or lung function but was associated with an increase in adverse events. In an editorial, Martinez discusses the lack of evidence supporting the role of GER in asthma pathogenesis and consequences of therapeutic creep.
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Approximately 10% of women with invasive epithelial ovarian cancer carry germline mutations in the BRCA1 or BRCA2 genes . In an analysis of pooled data from 26 studies that assessed survival among 3879 women with invasive epithelial ovarian cancer, Bolton and colleagues found that compared with women without a BRCA1 or BRCA2 mutation, those with a mutation had improved 5-year overall survival in analyses adjusted for tumor stage, grade, histology, and age at diagnosis. In an editorial, Hyman and Spriggs discuss implications of these findings for ovarian cancer research and treatment.
Perfluorinated compounds (PFCs)—present in food packaging and widely used in manufacturing—have been associated with immune suppression in mice at serum concentrations similar to those found in humans. Grandjean and colleagues assessed the effect of PFC exposure on the response to childhood diphtheria and tetanus immunizations in a cohort of 656 Faroe Island children. Serum concentrations of PFCs were assessed at age 5 years. The authors report that PFC concentrations at commonly prevalent levels were associated with lower concentrations of tetanus and diphtheria antibodies at ages 5 and 7 years.
Family and friends who care for elderly individuals, those with dementia, or patients with cancer may experience negative psychological and physiological effects from caregiving. Bevans and Sternberg present the case of a 53-year-old woman, the sole caregiver for her husband who was undergoing hematopoietic stem cell transplantation for acute myelogenous leukemia. The authors discuss stresses associated with informal caregiving, stress assessment tools, and interventions and resources to reduce caregiver stress.
An 85-year-old man, receiving oral methylprednisolone therapy for Sjögren syndrome, had a 5-month history of papules, plaques, and subcutaneous nodules on his face, trunk, and extremities that had not responded to topical therapies. What would you do next?
Scientists are attempting to explain the increase in food allergies in developed countries and are investigating ways to induce tolerance to problematic foods.
Science, politics, and emergency contraception
Physician autonomy and health care reform
The Supreme Court and the future of health care reform
“Marriage, divorce, coming out—none of these things are as life altering as gender change.” From “Of What Am I Afraid?”
Join George A. Bray, MD, Wednesday, February 15, from 2 to 3 PM eastern time to discuss the effect of dietary protein content on weight. 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.
Ms K, a 14-year-old girl with a BMI of 40, experiences significant discord with her parents over food choices. How would you manage her clinical care? Go to www.jama.com to read the case. Submission deadline is January 29.
For your patients: Information about childhood asthma.
This Week in JAMA. JAMA. 2012;307(4):335. doi:10.1001/jama.2012.3