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This Week in JAMA
March 1, 2006

This Week in JAMA

JAMA. 2006;295(9):967. doi:10.1001/jama.295.9.967
Stem Cell Mobilization by G-CSF in Acute MI

Results of several small studies suggested that enhanced mobilization of bone marrow–derived stem cells is associated with improved left ventricular function following acute myocardial infarction (AMI). In a randomized, placebo-controlled trial of patients with ST-segment elevation AMI and successful reperfusion by percutaneous coronary intervention, Zohlnhöfer and colleaguesArticle assessed the effect of stem cell mobilization by granulocyte colony-stimulating factor (G-CSF) therapy on infarct size, left ventricular function, and coronary restenosis. The authors found no differences in outcomes in the G-CSF vs placebo groups. In an editorial, KlonerArticle discusses late treatment of AMI and the importance of well-designed clinical trials to determine treatment efficacy.

Radiation, Thyroid Disease, and the Atomic Bomb

Little is known about the relationship of radiation exposure in the distant past to prevalent thyroid disease. Imaizumi and colleaguesArticle examined this relationship in Japanese atomic bomb survivors, for whom radiation dose was calculated. The authors found an overall prevalence of thyroid disease of 44.8%. There was a significant dose-response relationship for all solid nodules, malignant tumors, benign nodules, and cysts but not autoimmune thyroid disease, and disease risk declined with increasing age at exposure. In an editorial, BoiceArticle discusses late effects of radiation exposure, particularly exposures during childhood.

Mental Health Impact of Military Deployment

The relationship between combat deployment and mental health problems in US military personnel was explored by Hoge and colleagues in their analysis of 2003 to 2004 data from health screening questionnaires completed by combat soldiers returning from Iraq, Afghanistan, and other locations. Among the authors' findings was that 19.1% of soldiers returning from Iraq reported a mental health problem vs 11.3% returning from Afghanistan, and 8.5% returning from other locations. In the first year after deployment, 35% of Iraq war veterans accessed mental health services and 12% received a mental health diagnosis.

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Thyroid Status, CV Risk, and Mortality in Older Adults

Whether subclinical abnormalities in thyrotropin levels are associated with increased cardiovascular (CV) risk in middle-aged and older adults is controversial. Using data from a prospective cohort study of community-dwelling adults aged 65 years or older, who were not taking thyroid medication, Cappola and colleagues assessed the relationship of baseline thyroid status to CV disease and mortality. The authors found that subclinical hyperthyroidism was independently associated with incident atrial fibrillation, but subclinical hypothyroidism or hyperthyroidism were not associated with other CV diseases or mortality.

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Staffing Shortages in Community Health Centers

A 2002 federal initiative increased spending for community health centers (CHCs), with the goal of extending care to more patients. However, whether CHCs have the staffing capacity to support this expansion is not clear. In a 2004 survey of federally funded CHCs, Rosenblatt and colleaguesArticle found there are significant shortages of primary care clinicians, particularly in rural areas, and significant barriers to staff retention and future recruitment. In an editorial, ForrestArticle discusses current efforts to expand the primary care workforce.

A Piece of My Mind

“I’ve been a physician longer than I’ve been a father. The two roles are not like costumes, taken on and off but worn only one at a time.” From “You Can't Unring a Bell.”

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Medical News & Perspectives

Researchers have identified a genetic variant that may account for more than 20% of all cases of type 2 diabetes in society, making it the most significant genetic risk factor for the disease found to date.

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CLINICIAN'S CORNER

Management of thrombosis risk in patients with antiphospholipid antibodies or the antiphospholipid antibody syndrome.

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Author in the Room Teleconference

Join Anna Taddio, PhD, on Wednesday, March 15, 2006, from 2 to 3 PM eastern time to discuss her study of systemic analgesia and local anesthesia for procedural pain in neonates, published in the February 15, 2006, issue of JAMA . Author in the Room is a teleconference call between the author, JAMA readers, and experts in implementing practice change to help clinicians implement research into practice.

To register, go to http://www.ihi.org/AuthorintheRoom.

JAMA Patient Page

For your patients: Information about granulocyte colony-stimulating factor.

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