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In This Issue of JAMA Internal Medicine
March 2017

Highlights

JAMA Intern Med. 2017;177(3):297-299. doi:10.1001/jamainternmed.2016.6134
Research

Hohl and colleagues conducted a citywide population-based case-control study to determine alcohol-related and drug-related risk factors for becoming a firearm homicide victim at the individual, family, and neighborhood levels. Overall, 161 cases of adolescent homicide, including 157 firearm homicide cases, and 172 randomly selected matched controls, including 166 for firearm homicides, were included, and individual, family, and neighborhood exposures to drugs and alcohol were measured for each case. No significant relationship between adolescent drug or alcohol use at the time of the incident and firearm homicide was found; however, adolescents with a history of drug or alcohol use had increased odds of firearm homicide. McGinty and Webster provide an Invited Commentary.

Invited Commentary

Editorial

While recent research has begun to uncover how gunshot victimization concentrates in small social networks, this study by Green and colleagues is one of the first to use epidemiological models of disease transmission to uncover how gun violence spreads from person to person via social interactions. An epidemiological analysis of a social network of 138 246 individuals in Chicago, Illinois, over a 6-year period found that social contagion between individuals explains 63% of the 11 123 gunshot victimizations that occurred. A network-based approach can provide a proactive and precise maps of the individuals in harm. Following similar efforts in other areas of public health and epidemiology, contagion modeling can provide critical insights for abating gun violence within cities in the United States. Branas and colleagues provide the Invited Commentary.

Invited Commentary

Editorial

O’Donovan and colleagues investigated relationships between leisure time physical activity patterns and mortality in this pooled analysis of 8 population-based surveys that included 63 591 men and women and found that all-cause mortality risk was approximately 30% lower, cardiovascular disease mortality risk was approximately 40% lower, and cancer mortality risk was approximately 20% lower in inactive individuals than active individuals, including “weekend warriors,” who participated in the recommended 150 minutes of moderate activity or 75 minutes of vigorous activity once or twice per week; the “insufficiently active,” who participated in less than the recommended amount of physical activity once or twice per week; and the “regularly active,” who participated in the recommended amount of physical activity 3 or more times per week. Arem and DiPietro provide the Invited Commentary.

Invited Commentary

Patient advocacy organizations (PAOs) are influential health care stakeholders that provide direct patient counseling and education, engage in policy advocacy, and shape research agendas, and many report having financial relationships with for-profit industries. Among a sample of 289 PAOs, Rose and colleagues found that 68% of nonprofit advocacy organizations reported receiving for-profit industry funding; with 12% receiving over half of their funding from industry; and 50% coming from pharmaceutical, device, and/or biotechnology companies. The median amount received from for-profit companies was $15 000. Among PAOs that received industry funding, 44% received less than $9999, whereas 9% received over $1 million. Moynihan and Bero provide the Invited Commentary.

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Invited Commentary

The effect of high-deductible insurance enrollment on diabetes outpatient care and acute complications is unknown. In a controlled interrupted-time-series study of 24 168 patients with diabetes, Wharam and colleagues found that high-deductible insurance enrollment was associated with minimal changes in outpatient visits and disease monitoring. Low-income individuals and health savings account–eligible high-deductible health plan members experienced 22% and 16% increases, respectively, in emergency department visits for preventable acute diabetes complications. Fendrick and Chernew provide the Invited Commentary.

Related Article

Invited Commentary

In this 2-year longitudinal study conducted in an integrated healthcare system, Fernandez and colleagues compared adherence rates with new diabetes medication prescriptions among 30 838 Latino and white insured patients, stratifying Latinos patients by their English language ability and found high rates of nonadherence to medication among Latinos compared with whites, with somewhat higher rates among Latinos with limited English proficiency. Contrary to an initial hypothesis, adherence among limited–English proficiency Latino patients did not vary by the Spanish fluency of the primary physician. Early nonadherence was particularly common among Latinos and suggests a target time for future interventions.

Related Articles 1 and 2

Editorial

Achieving adequate glycemic control among the growing number of limited–English proficiency (LEP) Latino patients with diabetes in the United States has proved to be challenging. Using data from a large, integrated, health care delivery system, Parker and colleagues studied changes in risk factor control among 1605 LEP Latinos with diabetes who switched from a language-discordant (English-only) primary care physician (PCP) to language-concordant (Spanish-speaking) PCPs or vice versa. Among those who switched from language-discordant PCPs to language-concordant PCPs, glycemic control improved approximately 10% more than those who switched from one language-discordant PCP to another language-discordant PCP.

Related Articles 1 and 2

Editorial

The Veterans Health Administration (VHA) conducted a demonstration project in 8 of its academic medical centers to test the implementation of a proactive, comprehensive lung cancer screening (LCS) program, as recommended by the US Preventive Services Task Force. Over 93 000 patients were assessed on screening criteria, and 2106 patients were screened between July 2013 and June 2015. Kinsinger and colleagues found that wide variation in clinical processes and patient experience occurred. More than 56.0% of patients screened had nodules to be tracked, 2.0% had findings requiring further evaluation, and 1.5% had lung cancer. A variety of incidental findings was noted on the scans of 40.7% of patients.

Continuing Medical Education

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Editorial

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