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This Week in JAMA
September 28, 2005

This Week in JAMA

JAMA. 2005;294(12):1463. doi:10.1001/jama.294.12.1463
Lifestyle Choices and Lung Cancer Risk

Personal choices that might reduce lung cancer risk are explored in 2 articles in this issue of JAMA. First, Schabath and colleaguesArticle examined the relationship between dietary intake of phytoestrogens and lung cancer risk in a case-control study. Their results suggest that higher phytoestrogen intake is associated with a lower risk of lung cancer, particularly among never and current smokers. In a second article, Godtfredsen and colleaguesArticle assessed the effects of smoking reduction on lung cancer incidence in a population-based cohort. They found that compared with continued heavy smokers (≥15 cigarettes/d), persons who reported a 50% reduction in tobacco consumption between baseline and a follow-up examination had a significantly reduced risk of lung cancer over a mean follow-up of 18 years. In an editorial, Dacey and JohnstoneArticle summarize the study findings and emphasize the importance of smoking cessation to reduce lung cancer risk.

Decision Instruments to Assess Minor Head Injury

Minor head trauma rarely results in intracranial injury, but identifying the few patients who are injured is critically important. Two articles in this issue of JAMA compare and validate the clinical performance of 2 decision instruments that guide the use of cranial computed tomography (CT) for minor head injury—the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC). The investigators in both studiesArticleArticle found that the CCHR and NOC had similar sensitivities (100%) for patients needing neurosurgical intervention. A greater number of patients with any intracranial injury were identified using the NOC. However, the CCHR had higher specificity for important clinical outcomes, and its application could lower CT use and health care costs. In an editorial, HaydelArticle discusses the use of clinical decision instruments in the assessment of patients with traumatic head injuries.

Genotype, β-Blocker Therapy, and Survival After ACS

Previous data support an association between polymorphisms of the β1- and β2-adrenergic receptors (ADRB1 and ADRB2) and response to β-adrenergic blocker therapy. Lanfear and colleagues investigated the effect of 4 common ADRB1 and ADRB2 gene variants on survival of patients receiving β-blocker therapy after an acute coronary syndrome (ACS). They found a significant association of the ADRB2 genotype with an increased risk of 3-year mortality among patients prescribed β-blockers after ACS. No increased mortality risk was observed in patients with the same ADRB2 gene variants who were not prescribed β-blockers.

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Coercive Interrogation Policies and Medical Ethics

Rubenstein and colleagues summarize the new Department of Defense Medical Program Principles and Procedures for the Protection and Treatment of Detainees in the Custody of the Armed Forces of the United States (DoD guidelines) and contrast these with principles of ethics for physicians and other health professionals developed by the United Nations. They found that the DoD guidelines allow participation of physicians in coercive interrogation practices prohibited by international human rights law, the Geneva Convention, domestic law, and professional codes of ethics.

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Medical News & Perspectives

Scientists predict that a new technique for producing human embryonic stem cells by reprogramming adult cells will yield clues to the processes that underlie stem cell development and provide a new tool for studying diseases.

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CLINICIAN’S CORNER

Assessment and management of laryngopharyngeal reflux.

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Sun Exposure and Protection

Factors associated with sunscreen use are examined in 2 articles published in the Archives of Dermatology. Robinson discusses the studies’ results and reinforces the importance of counseling patients to limit UV light exposure.

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JAMA Patient Page

For your patients: Information about head injury.

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