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Subsidies and Prohibitions in a Food Benefit Program
In this randomized clinical trial, Harnack and colleagues randomized lower-income adults to 1 of 4 experimental financial-food-benefit conditions: (1) incentive (30% financial incentive for fruits and vegetables purchased using food benefits); (2) restriction (not allowed to buy sugar-sweetened beverages, sweet baked goods, or candies with food benefits); (3) incentive plus restriction (30% financial incentive on fruits and vegetables and restriction on the purchase of sugar-sweetened beverages, sweet baked goods, or candies with food benefits); or (4) control (no incentive or restrictions on foods purchased with food benefits). A number of favorable dietary changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition. Fewer improvements were observed in the incentive-only and restriction-only arms. Schwartz provides an Invited Commentary.
Nausea and Vomiting During Pregnancy and Pregnancy Loss
Hinkle and colleagues analyzed data from a cohort of women followed from preconception through pregnancy to investigate the association between nausea and vomiting in pregnancy and the risk for pregnancy loss. Of the 797 pregnancies followed, 188 ended in a loss. Nausea and vomiting symptoms were common very early in pregnancy. Nausea and nausea with vomiting during pregnancy were associated with a 50% to 75% reduction in pregnancy loss risk. These findings overcome prior analytic and design limitations and represent the most definitive data available indicating the protective association of maternal nausea and vomiting in early pregnancy on the risk for pregnancy loss. Nippita and Dodge provide an Invited Commentary.
Azithromycin for Acute Asthma Exacerbations
In this randomized clinical trial—the AZithromycin Against pLacebo in Exacerbations of Asthma (AZALEA) study—Johnston and colleagues aimed to determine whether azithromycin added to standard care for asthma attacks in adults resulted in clinical benefit. Adults recruited were randomized to either 500 mg azithromycin daily or matched placebo for 3 days. Of 4582 patients screened at 31 centers, 199 of 380 were randomized. There was no significant difference in symptom score between azithromycin and placebo at day 10, nor on any day between exacerbation and day 10. No significant between-group differences were observed in quality-of-life questionnaires or lung function between exacerbation and day 10 or in time to 50% reduction in symptom score. In this randomized population, azithromycin resulted in no statistically or clinically significant benefit. Brusselle and Braeckel and Mehrotra and Linder provide Invited Commentaries.
Invited Commentaries 1 and 2
Continuing Medical Education
National Trends of Antibiotic Use in US Hospitals
In this descriptive study, Baggs and collegaues examine patterns and trends in the use of all antibiotics, as well as specific types of antibiotics, among a representative sample of United States acute care hospitals from 2006 to 2012 and found that overall days of therapy of all antibiotics among hospitalized patients has not changed significantly in recent years. Use of some antibiotics, especially broad spectrum agents, however, has increased significantly. Mehrotra and Linder provide an Invited Commentary.
Overnight Extubations and ICU Outcomes
In this study, Gershengorn and colleagues conducted a propensity-matched analysis using the Project IMPACT database to evaluate the association of overnight extubations and patient outcomes. For patients receiving mechanical ventilation for less than 12 hours, reintubation rates were similar for patients extubated overnight vs daytime, but intensive care unit (ICU) and hospital mortality were slightly increased for patients extubated overnight. For patients with a duration of mechanical ventilation greater than or equal to 12 hours, overnight extubations were associated with a higher reintubation rate, as well as higher ICU and hospital mortality. Moore and Matthay provide an Invited Commentary.
Dabigatran vs Rivaroxaban for Atrial Fibrillation
In this observational cohort study of 118 891 patients with atrial fibrillation treated with once-daily rivaroxaban or twice-daily dabigatran for stroke prevention, Graham and colleagues found that rivaroxaban was associated with an increase in intracranial hemorrhage and an increase in major extracranial hemorrhage, compared with dabigatran. Thromboembolic stroke risk was reduced and mortality was increased with rivaroxaban, but these were not significant. The absolute increase in intracranial hemorrhage with rivaroxaban (2.3 excess cases per 1000 person-years) exceeded its reduced rate of thromboembolic stroke (1.8 fewer cases per 1000 person-years). Once-daily rivaroxaban resulted in a greater anticoagulant effect and greater bleeding risks than twice-daily dabigatran.
Lifelong Gender Gap in Risk of Myocardial Infarction
In a large population-based, prospective study from Tromsø, Norway, Albrektsen and colleagues found that men had about twice the risk of incident myocardial infarction compared with women after adjustment for serum lipids, blood pressure, and smoking. Additional adjustment for diabetes, body mass index, and physical activity had minor effect. The gender gap persisted throughout life but declined with age. The age-incidence curves for men and women revealed that the diminishing gender contrast was due to a flattening of the incidence curve in men (on logarithmic scale), rather than being related to a postmenopausal risk increase. In women, the incidence rate increased steadily with age; no sudden change in risk was seen when moving from premenopausal to postmenopausal ages.
Clinical Review & Education
Sugar Industry and Coronary Heart Disease Research
After evidence linking sucrose to coronary heart disease (CHD) emerged in the 1950s, the Sugar Research Foundation sponsored a 1967 review in the New England Journal of Medicine that identified fat and cholesterol as the dietary causes of CHD and downplayed the CHD risk of sucrose. Industry-sponsored research in the 1960s and 1970s cast doubt about the hazards of sucrose while promoting fat as the dietary culprit in CHD. Future policymaking committees should evaluate the CHD risk of added sugars, deemphasize food industry-funded studies, and include mechanistic and animal studies, as well as studies appraising the effect of added sugars on multiple CHD biomarkers. Nestle provides an Invited Commentary.
Author Audio Interview
Highlights. JAMA Intern Med. 2016;176(11):1591–1593. doi:10.1001/jamainternmed.2015.4912
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