This Week in JAMA

Although the adverse health effects of exposure to airborne particulate matter are well established, few studies have examined the health effects of exposure to fine-particulate matter, defined as less than 2.5 μm in aerodynamic diameter (PM_2.5). Dominici and colleagues used 1999-2002 data on PM_2.5 concentrations from 204 urban US counties and hospital admission data for Medicare enrollees to assess cardiovascular and respiratory health risks associated with short-term PM_2.5 exposure. The authors found that short-term exposure to increasing concentrations of PM_2.5 was associated with a higher risk of hospital admission for cardiovascular and respiratory diseases in this older cohort.

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Investigations of the association between coffee consumption and risk of myocardial infarction (MI) have yielded inconclusive results, and it is unknown whether caffeine alone is the responsible risk factor. Cornelis and colleagues assessed whether CYP1A2 genotype—which reflects rapid or slow metabolism of caffeine—modifies the association between coffee consumption and risk of nonfatal MI in a population-based case-control study. The authors found that coffee intake was associated with an increased risk of MI only among individuals with the slow caffeine metabolism allele, CYP1A2*1F.

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Mass antibiotic distribution is recommended to eliminate chlamydia strains responsible for blinding trachoma, but whether a single antibiotic distribution is sufficient is not clear. Chidambaram and colleagues conducted a longitudinal cohort study, in which a single dose of oral azithromycin was offered to all residents of 8 villages in a hyperendemic region of Ethiopia. The prevalence of ocular chlamydial infection prior to treatment and at intervals for 24 months was determined in children 1 to 5 years of age. The authors found that treatment was associated with an initial significant decline in chlamydial infection, but there was a slow rise in ocular chlamydial infection during the follow-up period.

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The quality of randomized clinical trials designed to assess the noninferiority or equivalence of an experimental treatment vs an active control is the subject of 2 articles in this issue of JAMA. First, Le Henanff and colleaguesArticle conducted a systematic review of 162 randomized trials of noninferiority and equivalence hypotheses and found a number of deficiencies in the reporting of the trials. These included the absence of noninferiority or equivalence margins, failures to perform both intent-to-treat and per-protocol analyses, inadequacies in the reporting of results, and misleading conclusions. In a second article, Piaggio and colleaguesArticle present an adapted CONSORT (Consolidated Standards of Reporting Trials) checklist for reporting noninferiority and equivalence trials, with illustrative examples and explanations for the items specified. In an editorial, GøtzscheArticle discusses important considerations in the application, design, analysis, reporting, and interpretation of noninferiority and equivalence randomized trials.

As human H5N1 avian influenza moved beyond Southeast Asia in early 2006, scientists reported advances in vaccine development and other areas.

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Ms G, a healthy 71-year-old woman with no family history of colon cancer, is uncertain whether to have a screening colonoscopy. Taylor discusses the epidemiology and pathophysiology of colon cancer, the effectiveness, accuracy, and adverse effects of colon cancer screening tests, and considerations when screening patients older than 65 years.

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Nolan and Berwick discuss the advantages of an all-or-none assessment strategy in achieving high-quality health care.

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Sincere thanks to the 2005 JAMA peer reviewers and authors.

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Join William C. Taylor, MD, on Wednesday, April 19, 2006, from 2 to 3 PM eastern time to discuss approaches to screening for colonoscopy, reviewed in his article “A 71-Year-Old Woman Contemplating a Screening Colonoscopy,” published in the March 8, 2006, issue of JAMA.

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

For your patients: Information about colon cancer screening.

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