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This Week in JAMA
June 26, 2013

This Week in JAMA

JAMA. 2013;309(24):2515. doi:10.1001/jama.2012.174898

Aspirin use is associated with a lower risk of colorectal carcinoma—potentially through inhibition of prostaglandin-endoperoxide synthase 2 (PTGS2). With experimental evidence of a role of RAF kinases in up-regulation of PTGS2, Nishihara and colleagues assessed whether the association of aspirin intake with colorectal carcinoma risk differs according to BRAF mutation status in an analysis of data from 2 prospective cohort studies involving 127 865 individuals. The authors found that regular aspirin use was associated with lower risk of BRAF –wild-type colorectal cancer but not BRAF -mutated cancer risk. In an editorial, Pasche discusses differential effects of aspirin before and after diagnosis of colorectal cancer.

See Article and Editorial

A small proportion of patients accounts for the majority of health care spending in the United States. Joynt and colleagues analyzed 2009 and 2010 data from approximately 1.1 million Medicare fee-for-service beneficiaries to determine the proportion of potentially preventable acute care hospital and emergency department costs among high-cost (eg, top decile of spending) beneficiaries. The authors report that only a small percentage of costs incurred by high-cost patients appeared related to acute care services—potentially preventable by better outpatient care.

See Article and Editorial

The Affordable Care Act (ACA) extends Medicaid eligibility to many previously uninsured low-income adults. To examine the health care needs of individuals who could gain Medicaid coverage under the ACA, Decker and colleagues analyzed data from a nationally representative sample of 1042 low-income, uninsured adults and 471 adults enrolled in Medicaid. Among the authors' findings were that compared with Medicaid enrollees, uninsured adults were less likely to be obese and sedentary and less likely to report a physical, mental, or emotional limitation. Individuals without insurance had a lower prevalence of hypertension, diabetes, and hypercholesterolemia; however, if they had these conditions, the uninsured were less likely to be aware of the diagnosis and to have good disease control.

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Jacobs and colleagues assessed the use of advanced treatment technologies—intensity-modulated radiotherapy and robotic prostatectomy—among men with a low risk of prostate cancer mortality in a retrospective cohort study involving nearly 56 000 men diagnosed with prostate cancer between 2004 and 2009. The authors report that use of advanced treatment technologies has increased among men with low-risk disease, a high-risk noncancer mortality, or both.

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JAMA Clinical Challenge

A 26-year-old woman has a 5-week history of vulvar swelling; she also reports occasional constipation and bloody, mucoid diarrhea. Examination reveals labial swelling and multiple perineal and perianal nodules. What would you do next?

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An Institute of Medicine report finds insufficient evidence to support general recommendations to drastically reduce dietary sodium to lower the risk of myocardial infarction, stroke, and death.

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Sorting through the arguments on breast cancer screening

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Breast cancer screening: conflicting guidelines and medicolegal risk

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Challenges to an effective and timely influenza A(H7N9) vaccine

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Personalized medicine vs guideline-based medicine

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"The metaphor was clear: I experienced someone thrusting a large chef's knife into my right flank." From "Cocktail Party Nephrology"

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New evidence supports, challenges, and informs health reform

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Dr Livingston summarizes and comments on this week's issue, including Viewpoints, Editorials, Original Contributions, and clinical content. Go to www.jama.com

For your patients: Information about ciguatera fish poisoning.

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