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This Week in JAMA
JAMA. 2008;300(24):2829.
Short Sleep Duration and Coronary Artery Calcification
There is some evidence that sleep duration is related to several risk factors for coronary artery calcification. In an analysis of data from the Coronary Artery Risk Development in Young Adults study, King and colleagues assessed whether objective and subjective measures of sleep duration and quality were associated with the incidence of calcification at a 5-year follow-up examination. The authors found that objectively measured longer sleep duration was associated with a decreased incidence of calcification, which was independent of other potential mediators and confounders.
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Medication and Dietary Supplement Use
Qato and colleagues analyzed data from a nationally representative sample of community-residing adults aged 57 through 85 years to estimate the prevalence and patterns of medication use, including concurrent use and potential major drug-drug interactions. The authors report that 81% (95% confidence interval [CI], 79.4%-83.5%) of surveyed individuals used at least 1 prescription medication, 42% (95% CI, 39.7%-44.8%) used at least 1 over-the-counter medication, and 49% (95% CI, 46.2%-52.7%) used a dietary supplement. Concurrent use of medications and supplements was common, and 4% of the survey respondents were potentially at risk of a major drug-drug interaction.
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Insurance Parity and Psychiatric Care
Recently enacted legislation requires that group health and Medicare Part B insurance plans provide equal cost sharing ("parity") for mental health and other medical services. In a review of Medicare data from 2001 to 2006, Trivedi and colleagues assessed the relationship between mental health insurance parity and receipt of outpatient mental health visits within 7 and 30 days following hospital discharge for a mental illness. The authors found that Medicare enrollees in health plans with insurance parity for mental health and primary care had higher use of clinically appropriate mental health services following a psychiatric hospitalization compared with enrollees in plans that required greater cost sharing for mental health than primary care services.
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Birth Weight and Risk of Type 2 Diabetes
An inverse association between low birth weight and risk of type 2 diabetes has been reported, but the strength, consistency, independence, and shape of the association are not entirely clear. Whincup and colleagues examined these factors in a quantitative systematic review of the published evidence. The authors report that in most of the middle-aged and older populations that have been studied there is an inverse, graded, and independent association between birth weight and risk of type 2 diabetes.
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CLINICIAN'S CORNER
Agitation and Delirium at the End of Life
Perspectives on Care at the Close of Life
Mr L, a 59-year-old man with non–small cell lung cancer and brain metastases that had been treated with gamma-knife radiation, had recently opted for home hospice care. He was brought to the hospital with progressive lower extremity weakness and agitation that was difficult to manage at home. Breitbart and Alici discuss the diagnosis and treatment of delirium in terminally ill patients.
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A Piece of My Mind
"If you ask, the answer is sometimes no; but if you never ask, the answer is always no." From "Trying Not to Miss the Point."
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Medical News & Perspectives
The NIH's Fogarty International Center has embraced a new strategic plan that recognizes a changing disease burden worldwide that includes chronic diseases and aging of populations.
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Commentaries
Carbapenem-resistant Enterobacteriaceae
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Physician autonomy and informed decision making
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The physician as public health professional
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Editorials
The power of hope
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Update on JAMA-EXPRESS
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Author in the Room
Teleconference
Join David J. A. Jenkins, MD, PhD, January 21 from 2 to 3 PM eastern time to discuss low–glycemic index or high–cereal fiber diets and type 2 diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.
Readers Respond
How would you manage a 41-year-old woman with recurrent uterine fibroids? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is December 31.
JAMA Patient Page
For your patients: Information about delirium.
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