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This Week in JAMA
October 20, 2010

This Week in JAMA

JAMA. 2010;304(15):1639. doi:10.1001/jama.2010.1521

Some epidemiological studies have suggested that higher intake of n-3 long-chain polyunsaturated fatty acids—particularly docosahexaenoic acid (DHA)—is associated with a reduced risk of postpartum depressive symptoms and improved infant developmental outcomes. In a randomized trial that enrolled 2399 pregnant women (<21 weeks, singleton gestation) and assigned them to receive either high-DHA fish oil capsules (providing 800 mg DHA daily) or vegetable oil capsules (without DHA) from study entry to birth, Makrides and colleagues Article found similar percentages of women with high levels of postpartum depressive symptoms and similar cognitive and language development scores—assessed at 18 months—among the children in the DHA and control groups. In an editorial, Oken and Belfort Article discuss the evidence supporting DHA intake—from fish or through dietary supplements—during pregnancy.

In an analysis of data from the Women's Health Initiative estrogen and progestin randomized trial—including data from 83% of the original and surviving trial participants who enrolled in an extension phase—Chlebowski and colleagues Article assessed the effects of hormone therapy on cumulative breast cancer incidence and breast cancer mortality. After a mean (SD) follow-up of 11.0 (2.7) years, the investigators report that compared with placebo, postmenopausal estrogen plus progestin therapy was associated with an increased incidence of breast cancer, with cancers that were more commonly node-positive and with more deaths attributed to breast cancer. In an editorial, Bach Article discusses risks associated with and unanswered questions related to postmenopausal hormone therapy use.

The Veterans Health Administration (VHA) has implemented its Medical Team Training program for operating room personnel, which uses aviation crew resource management theory adapted for a health care setting. Neily and colleagues Article assessed the association between the training program and surgical mortality in a retrospective analysis of fiscal year 2006 to 2008 surgical mortality data from 108 VHA hospitals. The authors found that participation in the VHA training program was associated with significant reductions in surgical mortality. In an editorial, Pronovost and Freischlag Article discuss the patient-safety benefits of a medical culture that embraces teamwork.

Newborn hearing screening is the norm in many developed countries; however, there is a paucity of strong evidence to support universal newborn hearing screening. In an analysis of data from the Netherlands, Korver and colleagues examined the effect of newborn hearing screening compared with distraction (behavioral) hearing screening conducted at 9 months of age on child development, spoken communication, and quality of life. The authors found that among children with permanent hearing impairment, newborn hearing screening, compared with distraction hearing screening, was associated with better general and language developmental outcomes and quality of life at ages 3 to 5 years.

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“[W]hile it's nice to have that little window looking out onto my patients . . . what I see in that parking lot presents dilemmas.” From “A Room With a View.”

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New findings appear to bolster the link between chronic fatigue syndrome and a family of mouse retroviruses, but many questions remain.

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Meaningful use of electronic health records

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Public reporting of health care quality

AND AUTHOR INTERVIEW

Making research consent transparent

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Accountability of accountable care organizations

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Join Michael A. Steinman, MD, Wednesday, November 17, from 2 to 3 PM eastern time to discuss managing medications for elders with clinically complex medical conditions. 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.

For your patients: Information about postpartum depression.

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