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In This Issue of JAMA Internal Medicine
January 2020


JAMA Intern Med. 2020;180(1):No Pagination Specified. doi:10.1001/jamainternmed.2019.4346

In this before-and-after study and additional randomized trial, Epel and colleagues evaluated whether a workplace ban on sugar-sweetened beverage sales was associated with sugar-sweetened beverage intake and cardiometabolic health among employees and whether a brief motivational intervention provided added benefits to the sales ban. The employer in the trial stopped selling sugar-sweetened beverages in all workplace venues, and half of the participants were randomized to receive a brief motivational intervention. Participants reported consuming fewer sugar-sweetened beverages after the ban as well as a reduction in waist circumference and sagittal diameter but no change in body mass index or insulin sensitivity. Those randomized to receive a brief motivational intervention reported greater improvements.

Wang and colleagues performed this randomized clinical trial to assess the effectiveness of a delirium-prevention intervention that incorporated family and caregiver participation for reducing postoperative delirium and functional decline in older patients in China. Eligible participants admitted to surgical floors of a hospital were randomized into a nursing unit providing the Tailored, Family-Involved Hospital Elder Life Program (intervention group), which addressed each patient’s risk-factor profile, or a nursing unit providing usual care (control group). Results showed that postoperative delirium occurred in fewer participants randomized to the intervention group compared with those in the control group. Tang and colleagues provide the Invited Commentary.

Invited Commentary

In this randomized clinical trial, Persaud and colleagues examined whether providing essential medicines at no charge to outpatients who reported not being able to afford medicines improved treatment adherence. Participating patients were randomly allocated to receive free medicines on a list of essential medicines in addition to otherwise usual care or usual medicine access and usual care. This study found that when compared with usual care, free distribution of essential medicines resulted in greater adherence to treatment. Control of type 1 and 2 diabetes was not significantly improved by free distribution of essential medicines, systolic blood pressure was reduced, and low-density lipoprotein cholesterol levels were not affected.

This longitudinal cohort study by Kagawa and colleagues investigated whether prior convictions for driving under the influence (DUI) were associated with the risk of subsequent arrests for a violent crime among handgun purchasers. The study cohort included all legally authorized handgun purchasers in California aged 21 to 49 years at the time of purchase in 2001. Results demonstrated that 9% of purchasers with prior convictions for DUI and 2% of purchasers with no prior criminal history were subsequently arrested for murder, rape, robbery, or aggravated assault during the 13 years of follow-up. Kaufman and colleagues provide the Invited Commentary.

Invited Commentary

In this cross-sectional study of Medicare beneficiaries aged 65 years and older, Burke and colleagues examined trends in 30-day mortality rates associated with care in the emergency department from 2009 to 2016. Results showed that there was a significant decline in mortality rates during or after an emergency department visit over the time period. This decline was greatest for patients with a high severity of illness compared with those with a medium severity or low severity of illness. Smith and colleagues provide the Invited Commentary.

Invited Commentary

This systematic review and meta-analysis by Garland and colleagues evaluated whether mind-body therapies were associated with pain reduction and opioid-related outcome improvement in adults using opioids for pain. Randomized clinical trials were included in the analysis if they assessed the use of mind-body therapies (ie, meditation, hypnosis, relaxation, guided imagery, therapeutic suggestion, cognitive behavioral therapy) for symptom management in adults who were also prescribed opioids for clinical pain. Overall, mind-body therapies were associated with pain reduction and reduced opioid dose. Moderate to large effect size improvements in pain outcomes were found for meditation, hypnosis, therapeutic suggestion, and cognitive behavioral therapy but not for other mind-body therapies.

Continuing Medical Education

Paulin and colleagues performed this cohort study to analyze the association of historical ozone exposure with risk of chronic obstructive pulmonary disease (COPD), computed tomography scan measures of respiratory disease, patient-reported outcomes, disease severity, and exacerbations in smokers with or at risk for COPD. Included participants had historical ozone exposure data, were either current or former smokers, were with or without COPD, and were aged 40 to 80 years at baseline. Higher concentration of 10-year historical ambient ozone exposure was associated with greater computed tomography scan–measured emphysema and gas trapping, worse patient-reported outcomes and functional status, and increased respiratory exacerbations. Limaye and Knowlton provide the Invited Commentary.

Invited Commentary

In this randomized clinical trial, MacGowan and colleagues evaluated the effect of providing HIV self-tests on frequency of testing, diagnoses of HIV infection, and sexual risk behaviors among men who have sex with men. Participants were recruited through online banner advertisements and were randomized to a control group or a self-testing group, which received 4 HIV self-tests with the option to replenish after completing quarterly surveys regarding their results. More participants in the arm that was mailed HIV self-tests reported testing for HIV 3 or more times during the trial compared with control participants, with more infections identified in the self-testing arm than in the control arm. Janssen and Katz provide the Editor’s Note.

Editor’s Note and Related Article