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This Week in JAMA
JAMA. 2005;294:2811.
Dietary Fiber and Risk of Colorectal Cancer
The contribution of dietary fiber intake to colorectal cancer risk, assessed in many studies since the late 1960s, is not clear. In an analysis by Park and colleagues, (SEE ARTICLE) which pooled data from 13 prospective cohort studies of dietary fiber and incident colorectal cancer, the authors found a significant inverse relationship between dietary fiber intake and colorectal cancer risk in analyses adjusted for age.However, this association was attenuated and no longer significant when other colorectal cancer risk factors were taken into account. In an editorial, Baron (SEE ARTICLE) discusses how the nature of dietary fiber, lifestyle factors related to fiber consumption, and measurement error complicate analyses of a fiber–colorectal cancer connection.
Status of Patient Safety Systems
Hospital systems—such as the policies, procedures, technologies, and their interactions that are necessary for patient care—are a focus of patient safety initiatives. Longo and colleagues (SEE ARTICLE) conducted surveys of hospitals in 2 states in 2002 and 2004 to examine components of the hospitals' patient safety systems and changes over time. The authors found there has been some improvement in patient safety systems, but overall progress has been slow. In an editorial, Pauker and colleagues (SEE ARTICLE) discuss factors that may constrain progress in patient safety.
B-Type Natriuretic Peptide After ACS
In the first 7 days after an acute coronary syndrome (ACS) elevated levels of B-type natriuretic peptide (BNP) are associated with an increased risk of long-term mortality. Whether BNP levels in the longer term are associated with clinical outcomes is not known. Morrow and colleagues determined BNP levels in patients with ACS prior to and at 4 and 12 months after hospital discharge. They found that persistently elevated or newly elevated levels of BNP predicted an increased risk of death or new-onset congestive heart failure during 2 years of follow-up.
(SEE ARTICLE)
Insulin, Insulin Resistance, and Pancreatic Cancer
Diabetes mellitus and glucose intolerance have been associated with increased risk of pancreatic cancer in several studies, but these could be a result of subclinical malignancy. Stolzenberg-Solomon and colleagues assessed the relationship of baseline fasting serum insulin and glucose concentrations to a diagnosis of exocrine pancreatic cancer 5 or more years later in a prospective case-cohort study of male smokers. After adjustment for age, years smoked, and body mass index, the authors found that higher prediagnostic fasting serum insulin and insulin resistance were related in a dose-response manner to an increased risk of exocrine pancreatic cancer.
(SEE ARTICLE)
Socioeconomic Status in Health Research
Socioeconomic status (SES) is a common variable in studies of health among populations. However, not all measures of SES are comparable and this could affect research findings and interpretations. Braveman and colleagues examined 5 national and state-level data sets and evaluated current approaches to SES measurement. Their analysis highlights common reliance on inadequate measures of education, income, occupation, or neighborhood of residence in assignment of SES. They recommend ways to improve measurement and interpretation of SES in health studies.
(SEE ARTICLE)
A Piece of My Mind
"It all began with a promising diagnosis . . . and just one year later, it is down to a matter-of-fact directive from her physician to ‘Get your affairs in order.’" From "Fourth Floor."
(SEE ARTICLE)
Medical News & Perspectives
Researchers are discovering that a variety of environmental, medical, and lifestyle factors can damage sperm and affect male fertility and offspring health.
(SEE ARTICLE)
CLINICIAN'S CORNER
Mechanical Ventilation in ALI and ARDS
Clinical Review
Volume- and pressure-limited mechanical ventilation strategies benefit adult patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).
(SEE ARTICLE)
Electron-Beam CT for CHD Screening
Evidence does not support electron-beam computed tomography (CT) to identify and quantify coronary artery calcium and detect subclinical coronary heart disease (CHD).
(SEE ARTICLE)
Patient Stories
The value of patients' stories to inform clinical research and health policy.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about pancreatic cancer.
(SEE ARTICLE)
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