Wasting, defined as a weight-for-height z score less than −2 of the National Center for Health Statistics reference median, affects approximately 10% of children worldwide. In a cluster randomized controlled trial involving 12 villages in Maradi, Niger, Isanaka and colleagues Article assessed the effect of short-term preventive supplementation with ready-to-use therapeutic food (500 kcal/d) on nutritional status among children aged 6 to 60 months who were not malnourished at study enrollment. The authors found that compared with children who did not receive nutritional supplementation, children who received 3 months of therapeutic food supplementation experienced less decline in weight for height and a reduced incidence of wasting and severe wasting during an 8-month follow-up. In an editorial, Neufeld Article discusses the effectiveness and cost efficiencies of interventions to prevent severe malnutrition in children.
In a cross-sectional study of patients who were undergoing exercise echocardiography and who did not have evidence of exercise-induced ischemia, Grewal and colleagues examined the relationship of left ventricular function to exercise capacity. In analyses that adjusted for clinical and echocardiographic variables, the authors found that patients with diastolic dysfunction had substantially lower maximal exercise capacity than patients with normal left ventricular function.
Generalized anxiety disorder (GAD) is a common psychiatric disorder in older adults. To assess whether selective serotonin reuptake inhibitors (SSRIs) are effective among older patients with GAD, Lenze and colleagues randomly assigned 177 patients aged 60 years or older with a principal diagnosis of GAD to receive either the SSRI escitalopram (10-20 mg/d) or placebo for 12 weeks. The main outcome—cumulative response—was assessed by trained raters using the Clinical Global Impressions-Improvement scale, which synthesizes anxiety rating scale scores, participants' self-reports, and raters' impressions. The authors report that the cumulative incidence of response at 12 weeks was higher in the escitalopram group than the placebo group. However, in an intent-to-treat analysis, response rates did not differ significantly between the 2 groups.
In the third in a series of 3 Users' Guides to the Medical Literature on genetic association studies, Attia and colleagues use the APOE polymorphism and its association with dementia to review the clinical application of results from gene association studies. Previous articles in the series reviewed basic genetic concepts and assessment of study validity.
Symptoms of pleural effusion are nonspecific, and the value of bedside examination findings is unclear. In a systematic review and quantitative data synthesis, Wong and colleagues assessed the accuracy of physical examination to diagnose a pleural effusion. The authors found that dullness to percussion and tactile vocal fremitus were the most useful bedside examination findings for identifying patients who should have diagnostic imaging.
“Part-time medicine allows physicians to be a part-time something else, and perhaps this is something that should be recognized in its own right.” From “Part-time Medicine.”
Recommendations by the Institute of Medicine to shorten medical residents' work shifts to reduce fatigue and improve patient safety are proving controversial.
Sweetened beverage consumption and obesity
Consumer-driven health care—caveat emptor
Contracting schizophrenia: lessons from the 1918-1919 influenza epidemic
Join Mary M. McDermott, MD, February 18 from 2 to 3 PM eastern time to discuss treadmill exercise vs resistance training for patients with peripheral arterial disease. To register, go to http://www.ihi.org/AuthorintheRoom.
How would you manage smoking cessation treatment in a 51-year-old woman with a history of bipolar disorder and tobacco use for more than 35 years? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is January 28.
For your patients: Information about pleural effusion.
This Week in JAMA . JAMA. 2009;301(3):247. doi:10.1001/jama.2008.1026