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This Week in JAMA
April 27, 2011

This Week in JAMA

JAMA. 2011;305(16):1625. doi:10.1001/jama.2011.523

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in US children and adolescents. Based on preliminary data that suggested potential efficacy of metformin or vitamin E in pediatric NAFLD, Lavine and colleagues randomly assigned 173 children and adolescents with biopsy-confirmed NAFLD to receive vitamin E, metformin, or placebo for 96 weeks. The authors report that neither vitamin E nor metformin was superior to placebo in attaining the primary trial outcome—a sustained reduction in alanine aminotransferase level at each study visit from 48 to 96 weeks of treatment.

Medication nonadherence—not taking medications as prescribed—is common among children with epilepsy and may be influenced by a variety of family and medical factors. In a prospective study that involved 124 children with newly diagnosed epilepsy and assessed medication adherence with electronically monitored medication bottles, Modi and colleagues identified trajectories of medication adherence and examined potential predictors of adherence. The authors report that 58% of the children demonstrated persistent nonadherence during the first 6 months of therapy, and they describe 5 distinct trajectories of adherence, which were associated with the family's socioeconomic status.

Jernberg and colleagues Article analyzed 1996-2007 Swedish national coronary care registry data from patients who experienced ST-elevation myocardial infarction (STEMI) to examine the association between adoption of evidence-based treatment and patient survival. The authors found that the prevalence of evidence-based invasive procedures and pharmacological therapies increased and 30-day and 1-year mortality rates decreased between 1996 and 2007. In an editorial, Mukherjee Article discusses strategies to improve adoption of evidence-based therapies.

Activation of the WNT signaling pathway and its major mediator cadherin-associated protein β 1 (CTNNB1) have been implicated in colorectal carcinogenesis and metabolic diseases. In an analysis of data from 2 prospective cohort studies, Morikawa and colleagues assessed whether CTNNB1 activation in colorectal cancer might modify prognosis associated with body mass index and postdiagnosis physical activity. The authors report that activation of CTNNB1 was associated with improved overall and disease-specific survival among obese patients and that postdiagnosis physical activity was associated with better cancer-specific survival among patients negative for CTNNB1.

Health literacy, which includes obtaining, processing, and understanding basic health information, is an important component of disease self-management. Peterson and colleagues evaluated the association between low health literacy and all-cause hospitalization and mortality in a cohort of managed care patients with heart failure. The authors found that 17.5% of the patients had low health literacy, which was independently associated with higher all-cause mortality but not higher rates of hospitalization.

Gheorghiade and Braunwald describe a 6-point model to guide the initial assessment and management of patients presenting with acute heart failure syndromes.

“[T]he patient claimed it was too late at night, he was too tired and irritable, and the medical establishment could never give him what he wanted anyway, so he did not want to be bothered with any interventions.” From “Paracentesis by Moonlight.”

Updated guidelines take a “real world” approach to preventing cardiovascular disease in women, but critics say the guidelines go beyond the evidence and will result in more women undergoing tests and receiving unnecessary medication.

Interactive games to promote healthful behavior change

Health care disparities and accountable care organizations

Incarceration and research on health disparities

Join Lydia A. Bazzano, MD, PhD, Wednesday, May 18, from 2 to 3 PM eastern time to discuss antihypertensive treatment and prevention of cardiovascular disease among those without hypertension. To register, go to http://www.ihi.org/AuthorintheRoom.

A patient has a renal mass discovered with magnetic resonance imaging (MRI) that was not addressed clinically for several months. How would you improve communication? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is May 8.

For your patients: Information about epilepsy.