Cultural Influences in Psychiatry —Reply
In Reply Both Dr Aggarwal and Ms Deshmukh and colleagues answer our question of whether transcultural psychiatry is possible with a resounding “yes.” (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Online Mindfulness Therapy Improves Residual Depression
Patients whose depression lingered after treatment had less severe residual symptoms, higher rates of remission, and lower rates of relapse following online mindfulness-based cognitive therapy, a trial in JAMA Psychiatry reported. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Hotspotting Doesn ’t Prevent Hospital Readmissions in Study
An intensive “hotspotting” program designed to reduce unnecessary medical care by so-called superutilizer patients while improving their health failed to prevent hospital readmissions, a trial in the New England Journal of Medicine reported. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

“Superdonor” Fecal Microbiota Transplant Effective for IBS
Fecal microbiota transplant (FMT) using a single “superdonor” produced high rates of clinical response in patients with irritable bowel syndrome (IBS) in a trial published in Gut. Two previous randomized clinical trials of FMT for IBS had conflicting results. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Leading HIV Vaccine Trial Stopped for Ineffectiveness
The National Institute of Allergy and Infectious Diseases last month halted a highly anticipated clinical trial testing an investigational HIV vaccine regimen. After an interim review, a data and safety monitoring board found that the 2 experimental vaccines in the regimen were ineffective against HIV, although there were no safety concerns. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Despite Law, Most Clinical Trial Results Still Not Posted
Less than half of US clinical trial results are reported on ClinicalTrials.gov in accordance with US law, according to a recent study in The Lancet. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Accuracy of Newborn Screening for Biliary Atresia Using Direct or Conjugated Bilirubin Measurements
This cross-sectional study characterizes the diagnostic accuracy of direct or conjugated bilirubin measurements for identifying newborns with biliary atresia and the associations between screening and age of therapeutic surgery. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Trends in Diet Quality Among Youth in the United States, 1999-2016
This national survey study uses NHANES data to characterize trends in diet quality among US youth aged 2 to 19 years between 1999 and 2016. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Association of Daily Step Count and Step Intensity With Mortality Among US Adults
This study uses National Health and Nutrition Examination Survey data to examine the dose-response relationships between step count (steps/d) and step intensity (steps/min) and mortality in a representative sample of US adults aged 40 years or older. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Penicillin Allergy in Pregnancy
This JAMA Patient Page describes testing for penicillin allergy among pregnant women. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Delirium
For days, the silver sprinkler high on the wall is a mouse poking its head out. The tangle of tubing draped over the circulation-boot pump is a Medusa-woman ’s hair. You watch a battle rage on the blank TV screen; outside the hospital room window, the white-washed high-rise makes you think you’re in Miami, though you’ve never been. Then again, you’ve never died before either, never come back like Lazarus to this same old unfamiliar world. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

The Other Side
In this narrative medical essay, a medicine resident describes her father ’s vegetative state following a cardiac arrest and finds herself identifying with families who don’t want limitations on medical care for their loved ones in conflict with her identity as an internist. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

JAMA Peer Reviewers in 2019
We sincerely thank the 2816 peer reviewers who completed manuscript reviews for JAMA in 2019. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Nonalcoholic Steatohepatitis —A Review
This narrative review summarizes the epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), proposes a diagnostic algorithm for distinguishing the 2, and reviews management options. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Enhancing Private Sector Health System Preparedness for 21st-Century Health Threats
This Viewpoint summarizes recommendations made by National Academies of Sciences, Engineering, and Medicine (NASEM) experts to address the US health system ’s preparedness for major threats, highlighting 5 principles to help regions prepare for specific threats as a prelude to partnerships that would facilitate more comprehensive national preparedness. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Preparation for Possible Sustained Transmission of 2019 Novel Coronavirus
This Viewpoint discusses the concepts of transmissibility and severity as the critical factors that determine the extent of an epidemic, drawing on the previous pandemic of influenza A(H1N1) and epidemics of SARS and MERS to consider what the scope, morbidity, and mortality of the 2019 novel coronavirus (2019-nCoV) epidemic might be. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

US Emergency Legal Responses to Novel Coronavirus —Balancing Public Health and Civil Liberties
This Viewpoint discusses the policy and legal ramifications of the national public health emergency declared by the US government in response the coronavirus disease 2019 (COVID-19) outbreak, and examines the lawfulness of quarantine and other compulsory measures. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Adults Are Making It Easier for Children to Ingest Dangerous Drugs
When children accidentally swallow prescription drugs, more than half the time it ’s because an adult has removed the medication from child-safe packaging, according to a CDC study in the Journal of Pediatrics. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Hundreds of Health Care Workers Exposed to Rabies
A Utah man who became infected with rabies after handling several bats potentially exposed 279 other people, most of them health workers. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Errors in Table 1, Figure 3, and Results Section
This article was corrected online. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Errors in Text
This article was corrected online. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Healthcare Is a Right and Not a Privilege
The US will elect a new president in 8 months. Voters in the election will need to consider many issues in selecting their preferred candidate. Among the most important issues is the future of the US health care system. Several options have been proposed as part of the current political landscape, including expand the current system, adopt a single-payer model, or retreat from recent reforms, once again leaving more individuals without health coverage. Embedded in these discussions is the cost of care, which increased to an estimated $3.6 trillion in the US in 2018, about $11  000 per person, with increasing amounts of a...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Controversies in Hip Arthroplasty —Using Registries to Answer Difficult Questions
The advent of hip arthroplasty to treat hip fractures and hip degeneration has been an extraordinary achievement that has significantly changed the lives of millions of people. Hip hemiarthroplasty involves replacement of the femoral head and neck. Modern total hip arthroplasty (replacement of both the femoral head and acetabulum) was developed by Charnley in the 1960s and has allowed generations of surgeons to treat previously disabling hip disease, keeping patients active, productive, and independent. Since the development of these procedures, there has been debate about the techniques used for both fixation and surgical...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

FDA Takes on Agricultural Biotech
A new pilot program from the FDA ’s Center for Veterinary Medicine is intended to facilitate the development of genetically altered animal products and clarify the regulatory process involved in bringing those products to market. The Veterinary Innovation Program covers “intentional genomic alterations in animals and animal cel ls, tissues, and cell- or tissue-based products seeking FDA approval.” (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Cardiac Ultrasound Uses Artificial Intelligence to Produce Images
The FDA has authorized the first cardiac ultrasound software using artificial intelligence to guide clinicians in capturing diagnostic-quality images of a patient ’s heart. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Prescription Drugs Switched to OTC
Three prescription drugs —1 used to treat osteoarthritis pain and 2 for ocular conjunctivitis—have been approved for over-the-counter (OTC) sales. The drugs will no longer be available by prescription. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

How Not to Spend an Opioid Settlement
With fatal overdose numbers remaining unacceptably high in 2019, an important story in 2020 will be the outcome of litigation against opioid manufacturers and distributors. Signs point to settlements in lawsuits brought by cities, counties, and states as well as to distributions from the bankruptcy case of Purdue Pharma. Billions of dollars are at stake. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Physiologic Significance of Record Aeroplane Flight
A few days ago an aeroplane carrying Major R. W. Schroeder of the American army aviation service reached an altitude of 36,020 feet, about 5,000 feet higher than the previous world ’s record for such a mode of flight. Only a few years ago this marvelous performance would have been rated as virtually impossible because of the limitations of the human organism at great heights. In the oft quoted balloon ascension of the meteorologist Glaisher, in 1862, an altitude of about 30, 000 feet was reached. When the balloonist attained a height of 26,000 feet, he first noticed that he could not read his instruments properly. Sh...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Return on Investment From Co-Locating Tax Assistance for Low-Income Persons at Clinical Sites
This study characterizes net dollars low-income persons received from participation in tax preparation services co-located at clinical sites in New York City intended to maximize credits and reduce poverty. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Measuring vs Estimating LDL-C Levels in a Clinical Trial of Bempedoic Acid
To the Editor Dr Goldberg and colleagues reported that bempedoic acid compared with placebo provided additional lowering of low-density lipoprotein cholesterol (LDL-C) levels in patients who did not achieve an adequate response to standard lipid-lowering therapy. We are concerned that the patients ’ LDL-C levels used in this study were not directly measured but were estimated by the Friedewald equation. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Bisphosphonates for Osteopenia in Postmenopausal Women
To the Editor The JAMA Insights article on bisphosphonates for postmenopausal osteoporosis commented that no clinical trials have assessed benefit of treatment with bisphosphonates in women with osteopenia. I disagree. A double-blind, randomized, placebo-controlled trial of nearly 2000 older women with osteopenia with average bone mineral density (BMD) T scores between −0.91 at the lumbar spine and −1.67 at the femoral neck showed a fracture reduction rate at 6 years of at least 33% from intravenous zoledronate given at 18-month intervals. The reduction in hip fracture rates did not achieve statistical signific...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Treatment of Older Adults With Subclinical Hypothyroidism
To the Editor In the study by Dr Mooijaart and colleagues of adults aged 80 years and older with subclinical hypothyroidism, treatment with levothyroxine vs placebo was not associated with improvement in symptoms. The lack of subjective benefit of therapy was not surprising because at least half of the participants did not qualify for the diagnosis of subclinical hypothyroidism. The study did not use the age-adjusted criteria for the upper limit of normal serum thyrotropin in individuals older than 80 years of 7.5 mIU/L based on an analysis of 924 disease-free participants older than 80 years in the National Health and Nut...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Measuring vs Estimating LDL-C Levels in a Clinical Trial of Bempedoic Acid —Reply
In Reply Drs Xu and Pan comment that the Friedewald formula used for calculating LDL-C levels is not as accurate as direct LDL-C measurement and that our study should have used the latter methodology. Although it is true that methodology improves over time and that there are new methods under exploration that may be more sensitive, those methods have not yet been widely adopted in clinical practice or investigational research. The methods used in our study were consistent with the current gold standard and with the way clinical trial data are typically reported. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Bisphosphonates for Osteopenia in Postmenopausal Women —Reply
In Reply The topic addressed by our article was the efficacy and safety of bisphosphonate treatment for women with postmenopausal osteoporosis, not osteopenia. Dr Snyder comments that we stated that no clinical trials have assessed the benefit of treatment with bisphosphonates in women with osteopenia. However, our article instead stated that while some organizations recommend treatment initiation in postmenopausal women with osteopenia who have a 10-year fracture probability (calculated using the FRAX tool) at or above intervention thresholds proposed by the National Osteoporosis Foundation, the benefit of treatment in pa...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Treatment of Older Adults With Subclinical Hypothyroidism —Reply
In Reply The population distribution of thyrotropin across the human life span has been reported in multiple studies with ambiguous results: both increase and decrease with increasing age have been reported. These inconsistencies may reflect differences in iodine intake across cohorts or age categories and underscore that population distributions alone are unfit to determine reference ranges. Other observational studies of subclinical hypothyroidism, including the NHANES study mentioned by Dr Hershman as well as an individual patient data meta-analysis by Rodondi et al, showed no association of subclinical hypothyroidism w...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty
This cohort study uses Ontario administrative data to estimate the risk of complications associated with posterior or lateral vs anterior surgical approaches to total hip replacement arthroplasty. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Association Between Uncemented vs Cemented Hemiarthroplasty and Revision Surgery in Hip Fracture
This cohort study compares the rate of aseptic revision among patients with hip fracture undergoing cemented vs uncemented hemiarthroplasty in a large US integrated health care system. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

The Pritikin Diet
This JAMA Patient Page describes the Pritikin diet and its potential benefits and risks. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Rupture
They let me cut the umbilical cord that late night when you convulsed (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

How Becoming a Doctor Made Me a Worse Listener
In this narrative medicine essay, a former National Public Radio reporter turned neurologist regrets time and attention she once had to show interest in and learn about people and tells how she ’s adapted to retain a small measure of that reporter’s curiosity in her interactions with patients. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Hong Kong Unrest Contributes to Increased Mental Health Care Burden
An observational study has linked the social unrest roiling Hong Kong since June 2019 with a 5-fold increase in probable depression and a 6-fold increase in posttraumatic stress disorder (PTSD) symptoms. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

International Measles Vaccination Campaign to Reach Millions
Up to 45 million children in 7 low-income countries will be vaccinated against measles through a campaign launched in February by Gavi, the Vaccine Alliance. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Guided Self-help Program May Help Refugees in Distress
A guided self-help program that uses audio courses and an illustrated book helped reduce psychological distress and improve functioning among female South Sudanese refugees in Uganda, according to the results of a cluster randomized trial. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Oral Injections Tested in Proof-of-Concept Trial
A microneedle-containing pill safely injected an oral version of a biologic drug directly into the intestinal wall in a first-in-human phase 1 trial, Rani Therapeutics recently announced. The drug, octreotide, is a subcutaneous injection used to treat acromegaly and neuroendocrine disorders. The San Jose –based startup is also developing orally administered injections for diabetes, rheumatoid arthritis, and cardiovascular disease biologics, among others. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

CAR Natural Killer-Cell Therapy Safe and Effective in First Trial
A variation on chimeric antigen receptor (CAR) T-cell therapy that instead modifies natural killer (NK) immune cells appeared to be safe and effective in an ongoing phase 1 and 2 trial of patients with CD19-positive blood cancers. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

23andMe Develops First Drug Compound Using Consumer Data
Direct-to-consumer genetic testing company 23andMe has developed an antibody aimed at treating inflammatory skin conditions. The DNA testing and research outfit licensed the compound to Barcelona-based pharmaceutical firm Almirall in January, its first such deal for a drug compound developed in-house using consumer data. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Data Errors in Table 3 and Figure 1
This article was corrected online. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research