Depression screening and enhanced care programs are associated with clear clinical benefits, but concerns about the cost-effectiveness of such programs—in terms of work-related outcomes—may limit their inclusion in employer-sponsored health plans. Wang and colleagues Article report the results of a randomized controlled trial that examined the effects of depression screening and telephonic outreach and care management vs usual care for depressed employees at 16 large companies with managed behavioral care benefits. At the 6- and 12-month follow-up assessments, the authors found that participants in the intervention group had fewer depressive symptoms, had higher job retention, and worked more hours than participants receiving usual care. In an editorial, Wells and Miranda Article discuss reasons many persons with depression do not receive treatment and the benefits of improved access to care.
In a previous retrospective study, Chan and colleagues found an association between colorectal neoplasm (adenoma and cancer) and coronary artery disease (CAD). In this issue, they report results of a cross-sectional study from Hong Kong in which they assessed the prevalence of colorectal neoplasm in a consecutive sample of patients who were having their first coronary angiogram for suspected CAD and examined potential risk factors for having both diseases. The authors found the prevalence of colorectal neoplasm was 34% in persons with a new diagnosis of CAD compared with prevalences of 18.8% in persons without CAD and 20.8% in an age-matched and sex-matched general population control group. The metabolic syndrome and a history of smoking were independent risk factors for the diagnosis of both CAD and an advanced colonic lesion.
Dietary factors have been implicated in the etiology of type 1 diabetes and in the autoimmune process that leads to clinical disease. For example, results of a retrospective case control study of children in Norway suggested that the risk of type 1 diabetes mellitus was lower in children who were given marine omega-3 containing cod liver oil supplements during infancy, a dietary practice that may reduce the inflammatory response and the risk for autoimmune diseases later in life. In a longitudinal cohort of children at increased genetic risk for type 1 diabetes, the Diabetes Autoimmunity Study in the Young (DAISY), Norris and colleagues examined the association of dietary intake of omega-3 and omega-6 fatty acids starting at age 1 year with the development of islet autoantibodies. The authors report that among 1770 children enrolled in the study, 58 developed islet autoimmunity. In analyses that were adjusted for HLA genotype, family history of diabetes, caloric intake, and omega-6 fatty acid intake, dietary intake of omega-3 fatty acids was inversely associated with the risk of developing islet autoantibodies.
Recent reviews of hypothalamopituitary function after traumatic brain injury and subarachnoid hemorrhage have suggested that hypopituitarism may be more common than previously suspected. Schneider and colleagues conducted a systematic literature review and report their findings relative to the prevalence, pathogenesis, risk factors, outcomes, and clinical course of hypopituitarism after traumatic brain injury or subarachnoid hemorrhage.
“Trust was cultivated carefully and held gingerly at camp; children can sniff out lies with greater accuracy than a bloodhound.” From “Prescription for Community.”
Scientists are zeroing in on potential therapies for Duchenne muscular dystrophy that may boost patients' quality of life.
RD Cohn and HC Dietz/The Johns Hopkins University School of Medicine
Action is needed to achieve recommended reductions in dietary sodium intake.
Achieving rational and equitable access to bariatric surgery.
Competition, physician leadership, and other efforts to reform England's National Health Service.
The problem of self-neglect among elderly persons.
For your patients: Information about type 1 diabetes.
This Week in JAMA . JAMA. 2007;298(12):1367. doi:10.1001/jama.298.12.1367