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This Week in JAMA
JAMA. 2006;296:2767.
Cognitive Training and Function in Older Adults
Previously, investigators from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, which enrolled independently living older adults with a mean age of 73.6 years, reported that 10-session training for memory, reasoning, or speed of processing was associated with improved cognitive ability in the respective ability through 2 years of follow-up. In this issue of JAMA, Willis and colleagues (SEE ARTICLE) report 5-year follow-up data for cognitive ability and self-reported and performance-based measures of daily function. The investigators found that compared with the control group, participants who received cognitive training had improved cognitive function in the specific domain up to 5 years after beginning the intervention, and they reported less decline in performance of instrumental activities of daily living. In an editorial, Shumaker and colleagues (SEE ARTICLE) discuss the potential of behavior-based interventions to improve cognition and possibly functional performance in elderly adults.
Diagnosis and Cancer Screening Reimbursement
Gross and colleagues (SEE ARTICLE) analyzed trends in colonoscopy use and stage at diagnosis of colon diagnosis among Medicare fee-for-service beneficiaries during 1992-2002, a period that encompassed several changes in Medicare reimbursement for screening colonoscopy. The authors found greater use of screening colonoscopy as reimbursement policy shifted from no coverage to coverage for persons at high risk, and to universal coverage. Among persons with a colon cancer diagnosis, expansion of coverage was associated with an increased likelihood of having early stage disease. In an editorial, Morris (SEE ARTICLE) discusses the benefits and costs of universal colon cancer screening.
Cancer Risk Before and After Kidney Transplantation
That immune suppression after organ transplantation is associated with increased risk of several cancers is widely accepted, but whether other types of cancer occur at increased rates and whether the risk is a direct consequence of immune suppression is not clear. To assess these questions, Vajdic and colleagues compared cancer incidence after kidney transplantation to incidence before transplantation (during dialysis and during end-stage kidney disease) in a population-based cohort of patients who received renal replacement therapy (RRT). The authors found marked increase in the incidence of cancers at 25 sites—most with known or suspected viral etiologies—after RRT but only slight increases during the 2 periods preceding transplantation.
(SEE ARTICLE)
Vitamin D Levels and Risk of Multiple Sclerosis
Epidemiological and experimental evidence suggest that high levels of vitamin D may decrease the risk of multiple sclerosis. Munger and colleagues analyzed the medical records and stored serum samples from US military personnel to assess the association of levels of 25-hydroxyvitamin D with risk of multiple sclerosis. In their prospective, nested, case-control study, the authors found an inverse relationship between presence of multiple sclerosis and serum 25-hydroxyvitamin D levels in whites, but not blacks or Hispanics, who had lower serum 25-hydroxyvitamin D levels than whites.
(SEE ARTICLE)
A Piece of My Mind
"I comb her hair, straighten the sheets, let her suck on the damp oral hygiene sponge. Her body, which was my home for nine months, is shutting down." From "A Long Time Ago."
(SEE ARTICLE)
Medical News & Perspectives
Researchers are testing various cell replacement strategies to generate insulin-producing beta cells for patients with type 1 diabetes.
(SEE ARTICLE)
CLINICIAN'S CORNER
ICD Therapy
Clinical Review
Evaluation and management of patients with an implantable cardioverter-defibrillator (ICD) that has delivered a shock.
(SEE ARTICLE)
Patient-Centered Care
Redesigning systems of care to meet patients' needs and expectations.
(SEE ARTICLE)
Medical Education
Call for Papers
Authors are invited to submit manuscripts for an upcoming JAMA theme issue.
(SEE ARTICLE)
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
JAMA Patient Page
For your patients: Information about multiple sclerosis.
(SEE ARTICLE)
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