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This Week in JAMA
March 26, 2008

This Week in JAMA

JAMA. 2008;299(12):1399. doi:10.1001/jama.299.12.1399

Preterm birth is a major cause of infant mortality, but few studies have assessed long-term health among survivors of preterm birth, particularly their health status in adulthood. In an analysis of data from 1.1 million singleton births that occurred from 1967 to 1988 in Norway, Swamy and colleagues Article examined the effects of preterm birth on survival, reproduction, and next-generation preterm birth. The authors report that compared with persons born at term, participants who were born preterm had diminished long-term survival and reproduction, and women born preterm were at increased risk of having preterm offspring. In an editorial, Adams and Barfield Article discuss the clinical utility of these findings for preterm birth survivors and their families.

Some evidence suggests that homozygosity may play a role in cancer predisposition. Assié and colleagues assessed this relationship in a case-control study in which germline and tumor DNA were obtained from patients with breast, prostate, or head and neck carcinoma and analyzed for whole-genome loss of heterozygosity/allelic instability (LOH/AI). The frequency of homozygosity at specific loci in the cancer cases was compared with ancestry-matched population-based controls, and the frequency of somatic LOH/AI in cancers at loci with the highest homozygosity was determined. The authors found increased germline homozygosity frequencies in the cancer patients compared with the controls. When the germline was heterozygous at these loci, the authors found a high frequency of LOH/AI in the corresponding carcinomas.


The Rational Clinical Examination

Treatment options for urinary incontinence can depend on whether the patient has stress or urge urinary incontinence. Holroyd-Leduc and colleagues systematically reviewed the evidence relating to elements of patient history, findings on physical examination, and results of office-based procedures to distinguish stress from urge urinary incontinence during an office assessment. Forty articles were reviewed and only minimal data were available for men. Among the authors' findings were that a history of urine loss associated with urgency was most helpful for diagnosing urge incontinence and that a positive—but not negative—urinary stress test may be useful in the diagnosis of stress urinary incontinence.


Perspectives on Care at the Close of Life

Mr X—a 33-year-old man with a 4-year history of metastatic mucinous adenocarcinoma of the appendix, malignant bowel obstruction, and chronic abdominal pain who has responded poorly to opioids—was admitted to the hospital in acute distress and with a self-reported pain score of “15 out of 10.” Moryl and colleagues discuss the diagnosis and management strategy for a patient with an advanced illness and an acute pain crisis superimposed on chronic pain. Care goals, risks and benefits of treatment, and psychosocial and existential needs of the patient and family are reviewed.


“Entering the Pure Land is in some respects similar to the Western concept of heaven, in that there is much joy and contentment upon reaching it.” From “A Practical Pact for the Pure Land.”


Why do health care disparities among racial and ethnic groups persist, even after decades of efforts to reduce such treatment gaps?


Bone integrity and fracture risk


Potential penalties for work refusals


Surrogate end points and FDA drug approval


Join Laura P. Svetkey, MD, MHS, April 16, 2008, from 2 to 3 PM eastern time to discuss strategies for sustaining weight loss. To register, go to http://www.ihi.org/AuthorintheRoom.

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

How would you manage a 21-year-old man with chronic idiopathic pancreatitis? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is March 26.

For your patients: Information about premature infants.