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Obesity Treatment for Socioeconomically Disadvantaged Patients in Primary Care Practice
Be Fit, Be Well was a 2-year effectiveness trial conducted in Boston community health centers. The study enrolled 365 obese patients with hypertension. Patients were randomized to usual care or a behavioral intervention that promoted weight loss and hypertension self-management. The intervention included 18 telephone counseling calls and optional group sessions and was delivered using a website or interactive voice response. As Bennett et al report, Be Fit, Be Well produced modest 24-month weight losses (−1.03 kg; 95% CI, −2.03 to −0.03 kg), but promoted clinically significant improvements in blood pressure control and slowed increases in systolic blood pressure.
Continuous Mortality Risk Among Peritoneal Dialysis Patients
Among conventional hemodialysis (CHD) patients, the period following the long interval has recently been associated with an increased risk of death compared with other days of the week. Using the Canadian Organ Replacement Register, Perl et al identified all incident patients receiving peritoneal dialysis (PD) in Canada between 2001 and 2010 and demonstrated that among this cohort there was no difference in the observed and expected number of deaths by day of the week (P = .16). This finding is in contrast to those recently found in CHD patients. The variation in mortality risk by day of the week among CHD but not PD patients highlights an opportunity to improve survival among individuals receiving CHD.
“Lost to Follow-up”: The Public Health Goals of Accountable Care
To better address public health goals, Calman et al propose a novel method for quality reporting within accountable care organizations: introducing an “expanded denominator” that attributes patients to a health system if they have ever been seen within the system. An “expanded denominator” would ensure that accountable care organizations are held accountable not only for patients already engaged in primary care but also for patients with fragmented care and high-risk community members not receiving adequate care. Ultimately, payment reform in Medicare, and potentially Medicaid, must support this new approach to quality measurement for it to have lasting ramifications.
B Vitamin and/or ω-3 Fatty Acid Supplementation and Cancer
The effects of B vitamins and/or ω-3 fatty acids on cancer outcomes were investigated in cardiovascular disease survivors participating in the French Supplementation With Folate, Vitamins B6 and B12, and/or Omega-3 Fatty Acids trial. This was a secondary analysis of data from 2501 individuals aged 45 to 80 years, randomized in a 2 × 2 factorial design to 1 of 4 daily supplementation groups. After 5 years of supplementation, incident cancer was validated in 7% of the sample (145 events in men and 29 in women), and cancer mortality occurred in 2.3% of the sample. Cox proportional hazards models showed no association between supplementation with B vitamins and/or ω-3 fatty acids and cancer incidence or mortality. There was a statistically significant interaction of treatment by sex, with no effect of treatment on cancer risk among men and increased cancer risk among women for ω-3 fatty acids supplementation (hazard ratio, 3.02; 95% CI, 1.33-6.89). Overall, no beneficial effects of supplementation with relatively low doses of B vitamins and/or ω-3 fatty acids were found regarding cancer outcomes in individuals with cardiovascular disease history.
Red Meat Consumption and Mortality
Pan et al evaluated the association between red meat intake and mortality risk in 37 698 men aged 40 to 75 years from the Health Professionals Follow-up Study (1986-2008) and 83 644 women aged 34 to 59 years from the Nurses' Health Study (1980-2008). The authors found that consuming 1 additional serving of unprocessed and processed red meat per day was associated with an increased mortality risk of 13% and 20%, respectively. Substitutions of 1 serving per day of other foods (including fish, poultry, nuts, legumes, low-fat dairy, and whole grains) for 1 serving per day of red meat were associated with a 7% to 19% lower mortality risk. The results provide strong evidence that red meat consumption is associated with an increased risk of mortality, and the risk could be reduced by replacement of other healthy protein sources for red meat.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2012;172(7):534. doi:10.1001/archinternmed.2011.932
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