Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19
This randomized trial compares the effects of ivermectin vs placebo on time to symptom resolution within 21 days among patients with mild COVID-19. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

COVID-19 in 2021 —Continuing Uncertainty
This Viewpoint summarizes the current best evidence about COVID-19 vaccines, immunity, and whether SARS-CoV-2 will become an endemic or seasonal virus. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

COVID-19 Precautions Are Scarce in Non –Health Care Workplaces
Less than half of US workers in non –health care fields had COVID-19 prevention measures in place at work as of June 2020, based on an online survey of 4000 US, nonremote workers. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Disparities in Suicide Persist Despite Overall Dip in US Rate
After increasing by about one-third for nearly 2 decades, the overall US suicide rate dipped by about 2% between 2018 and 2019. However, CDC researchers reported that the improvements didn ’t extend to all racial and ethnic groups. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

How the Biden Administration Can Improve Health Equity for Racial and Ethnic Minorities
This Viewpoint outlines actions that the new federal administration could consider related to health care access and quality, and social determinants of health, to meaningfully improve health equity for racial/ethnic minority populations. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening for Vitamin D Deficiency in Adults
This 2021 US Preventive Services Task Force Recommendation Statement concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults (I statement). (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

USPSTF Review: Screening for Vitamin D Deficiency in Adults
This systematic review to support the 2021 US Preventive Services Task Force Recommendation Statement on screening for vitamin D deficiency summarizes published evidence on the benefits and harms of screening and interventions for vitamin D deficiency in asymptomatic, community-dwelling adults. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

On Mentoring —A Meditation of Gratitude
In this narrative medicine essay, JAMA ’s editor in chief remembers his career mentors and their selflessness as they guided him in his early and mid-career and later became friends and colleagues. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Winter of Fear
For Aviya (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Patient Information: Screening for Vitamin D Deficiency in Adults
This JAMA Patient Page summarizes the US Preventive Services Task Force ’s 2021 recommendation that current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults (I statement). (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Review of Gastroesophageal Reflux Disease —Reply
In Reply We agree with Dr Mehta and colleagues that lifestyle interventions may reduce heartburn symptoms among patients with GERD. As highlighted in our Review, there is solid evidence to advise patients with GERD to lose weight if they are obese and to abstain from smoking. However, currently available data regarding lifestyle changes are limited, and studies have often shown divergent results. Associations between dietary or beverage modifications and GERD symptoms are weak, and large population-based studies have often failed to provide reproducible results. Although the currently available medical literature is not su...
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Effect of Early Recombinant Human Erythropoietin on Neurodevelopmental Outcomes at Age 5 Years —Reply
In Reply Before exposing preterm infants to erythropoietin for neuroprotection, potential benefits and safety need to be assessed using the highest possible level of evidence by performing randomized clinical trials instead of extrapolating results from retrospective analyses in neonates exposed to diverse doses of erythropoietin for the prevention of anemia of prematurity. Our recent study demonstrated no significant difference in neurodevelopmental outcomes at age 5 years in children born at 26 to 32 weeks ’ gestation treated with early high-dose rhEpo compared with saline during the first 2 days of life. These fin...
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Review of Gastroesophageal Reflux Disease
To the Editor In their Review about gastroesophageal reflux disease (GERD), Dr Maret-Ouda and colleagues discussed risk factors and treatment options for GERD, including surgery and advanced endoscopic techniques. However, we believe they overlooked several recommendations that may benefit patients with heartburn. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Effect of Early Recombinant Human Erythropoietin on Neurodevelopmental Outcomes at Age 5 Years
To the Editor The Research Letter by Dr Natalucci and colleagues reported no benefits of early high-dose recombinant human erythropoietin (rhEpo) on neurodevelopmental outcomes at age 5 years in very preterm infants. We are concerned about the interpretation of this study because the enrolled neonates carried a very low risk of brain damage, given their average birth weight of 1200 g and average gestational age of more than 29 weeks. In 2016, the same authors and, recently, others reported no advantage of rhEpo in preterm infants when examining neurodevelopmental outcome at age 2 years. We previously voiced criticism about...
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Neurology in Art
In 1861, the medical historian K. F. X. Marx published an essay of seventy-four pages on medicine in the graphic arts, containing the first list of paintings and engravings relating to medicine. Unnoticed in its time, this pamphlet opened a new pathway of research which has since been retraced and extended by many investigators, more particularly in the subsequent lists made by Sudhoff, in the well known illustrated books of Charcot, Holl änder, Müllerheim and Parkes-Weber, and in various magazine articles of more recent date. The subject is one of immense interest to the physician who loves his profession, for p...
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Time to Rethink Nursing Homes
Hundreds of thousands of people who are older and disabled live in nursing homes not because they need specialized care or want to live in those facilities, but because Medicaid payment rules make that the only housing with daily living care they can afford. (Source: JAMA)
Source: JAMA - April 13, 2021 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 - April 13, 2021 Category: General Medicine Source Type: research

USPSTF 2021 Recommendations on Screening for Asymptomatic Vitamin D Deficiency in Adults
Interest in the relationship between vitamin D and health has increased over the past decade, with concurrent increases in the number of 25-hydroxyvitamin D (25[OH]D) assays performed and in the use of vitamin D supplements. In 2011, the National Academy of Medicine determined that a 25(OH)D level less than 20 ng/mL (49.9 nmol/L) was consistent with deficiency and that there was no evidence for different 25(OH)D thresholds for different health conditions. This recommendation resulted in vigorous debate within the medical and scientific community regarding the merits of screening for vitamin D deficiency and the goal 25(OH)...
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

The Near-Term Future of Health Care Reform
Over the past decade, the US has made progress on the core problems of access, cost, and quality involving health care. Although it is valuable, this progress seems inadequate compared with the magnitude of the challenges. Approximately 20 million individuals in the US have received insurance coverage because of the Affordable Care Act (ACA), yet an estimated 29 million (approximately 9% of the US population) remain uninsured. In addition, over the past decade, health care costs have stabilized at approximately 18% of gross domestic product, yet per capita costs are far higher than all other high-income countries, includin...
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Confronting Challenges in the US Health Care System
The sheer number of challenges facing the Biden Administration and the 117th Congress in the health policy sphere is staggering, as is the range of potential solutions offered by the authors of the Viewpoints in the JAMA Health Policy series. The most pressing challenges involve addressing the global COVID-19 pandemic. Yet policy makers would be remiss if they did not leverage this opportunity to also address the fundamental problems with the US health system laid bare by the nation ’s response to the pandemic. These include major challenges related to health insurance coverage, the solvency of publicly funded progra...
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Crucial Questions for US Health Policy in the Next Decade
With the inauguration of President Biden and a shift in control of the US Senate from Republicans to Democrats, the landscape for health policy has changed substantially in 2021. Just as the signing of the Affordable Care Act (ACA) by President Obama in 2010, along with sustained Republican opposition to this landmark law, set the health policy agenda for the past decade, the actions of the new president and Congress this year will determine how the US health care system functions and changes over the next decade. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Incorrect Values in Table
This article was corrected online. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Wearable Bilirubin Measurement Device for Neonatal Jaundice
Jaundice, caused by high levels of the reddish-yellow pigment bilirubin in blood, affects more that 80% of newborns. Although neonatal jaundice usually resolves with treatment, severe hyperbilirubinemia can cause a form of brain damage called kernicterus or bilirubin-induced neurologic dysfunction (BIND). In low- and middle-income countries, jaundice is a major cause of neonatal death and brain damage. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Data Leak Exposes Early COVID-19 Vaccine Manufacturing Hiccups
After a cyberattack late last year against the European Medicines Agency (EMA), anonymous emails dispatched a trove of classified documents to academics and journalists. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Teplizumab Improves Beta Cell Function, Delays Type 1 Diabetes
The investigational monoclonal antibody teplizumab improved beta cell function among high-risk relatives of individuals with type 1 diabetes in a phase 2 randomized clinical trial, according to extended follow-up data published in Science Translational Medicine. A previously reported delay in diabetes development among treated participants also increased. (Source: JAMA)
Source: JAMA - April 13, 2021 Category: General Medicine Source Type: research

Changes in Shooting Incidence in Philadelphia, Pennsylvania, Between March and November 2020
This study uses police department registry data to describe trends in incidence of firearm shootings and deaths in January-November 2020, before and after the closure of nonessential businesses in March, the killing of George Floyd in May, and the partial lifting of containment policies in June. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Expanding COVID-19 Vaccination —Optimizing Use and Maximizing Efficacy
This Viewpoint proposes ways to maximize vaccine efficacy and allocation given the rise of coronavirus variants and authorization of a Johnson& Johnson vaccine, including reserving the latter for younger healthier populations, boosting it with a single-dose messenger RNA (mRNA) vaccination, and single mRNA immunization of people with prior documented SARS-CoV-2 infection. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

What the 2020 Election Means for the Future of Health Policy in a Partisan United States
This Viewpoint summarizes views measured in national opinion polls about COVID-19 response, national health insurance reform, reforming the US health care system in general, and race and race disparities in health, with a focus on differences between Democrat and Republican respondents and implications of those differences for enacting meaningful legislation. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Reinventing the Center for Medicare and Medicaid Innovation
This Viewpoint makes 6 recommendations for how the Center for Medicare and Medicaid Innovation, as it enters its second decade, can better fulfill its mission of testing health care payment and service delivery models and scale them up to a national level to reduce health care expenditures and improve quality and safety. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

JAMA Peer Reviewers in 2020
We sincerely thank the 2880 peer reviewers who completed manuscript reviews for JAMA in 2020. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Sitting in the River —Being With Patients May Be All We Can Manage
In this narrative medicine essay, a palliative care physician finds the space between professional and patient distance thinning as the COVID pandemic drags on and wonders whether abiding with them is the lesson. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Passing Out at the Hospital
It was foolish of me to swoon outside the room where your wife was going to die soon and end your natural life. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Patient Information: Giardiasis
This JAMA Patient Page summarizes risk factors, symptoms, diagnosis, and treatment of giardiasis, an intestinal parasite infection that can cause gastrointestinal symptoms including nausea, stomach cramps, and prolonged diarrhea. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Antimicrobial Use in a Cohort of US Nursing Homes, 2017
This cross-sectional survey assessed the risks of antimicrobial use among 15  276 nursing home residents across 161 facilities. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Low- vs High-Intensity Walking Exercise and Walk Distance in Patients With Peripheral Artery Disease
This randomized trial compares the effects of comfortable low-intensity home-based walking exercise vs high-intensity exercise sufficient to elicit ischemic symptoms vs nonexercise control on 6-minute walk distance among patients with peripheral arterial disease (PAD). (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Effect of Celecoxib vs Placebo With Adjuvant Therapy on Stage III Colon Cancer
This randomized trial compares the effect of adding celecoxib to standard adjuvant chemotherapy in improving disease-free survival among patients treated for stage III colon cancer. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Drugs for Atopic Dermatitis
This Medical Letter provides a Table summarizing key information about topical corticosteroids available for atopic dermatitis published as part of a comprehensive review on the topic. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk —Reply
In Reply The letter from Dr Olshansky and colleagues proposes several hypotheses to explain the different outcomes in the REDUCE-IT and STRENGTH trials. They suggest that the greater content of EPA (4 g/d) administered in REDUCE-IT produced superior results but also suggest that the results were replicated in JELIS, an open-label study that used only 1.8 g/d. If EPA dosage is the critical issue, then the 4 g/d administered in STRENGTH should have produced some benefit. These authors suggest a threshold effect, but for the top tertile of change in EPA in STRENGTH (>435% increase), there was no benefit. With respect to mi...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Whistleblowing and Misconduct at Large Pharmaceutical Firms —Reply
In Reply Data indicate that whistleblower incentives are an important way to reduce the incidence of illegal activities by large pharmaceutical firms. Incentivized whistleblowing in the US includes the False Claims Act ’s qui tam provision as well as a variety of other forms of whistleblowing. In response to our recent article, Dr Hashimoto and colleagues asked about the extent of whistleblowing activity in relation to financial penalties against large pharmaceutical firms in the US. We have now conducted dual-r ater content analysis of all press releases for state and federal settlements between January 2003 and Dec...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk
To the Editor The STRENGTH trial reported no benefit on cardiovascular events with omega-3 CA in contrast to a 25% reduction in REDUCE-IT and a 19% reduction in JELIS, an open-label study without placebo that used the same formulation of omega-3 ethyl ester as REDUCE-IT. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk
To the Editor Cardiovascular disease is a leading cause of mortality in Asia and hypertriglyceridemia is prevalent in Asian populations. We are particularly interested in the results of the prespecified subgroup analysis in the STRENGTH trial shown in Figure 3 of the article. This analysis revealed a significant reduction in the risk of the primary composite cardiovascular end point of 0.72 (95% CI, 0.54-0.96) among Asians and 0.78 (95% CI, 0.62-0.98) in the Asia region, which raises the possibility that administration of high-dose omega-3 fatty acids has cardiovascular benefits in Asian subgroups. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk
To the Editor The results of the STRENGTH trial showed conclusively that omega-3 CA, a carboxylic acid formulation of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), did not improve cardiovascular outcomes compared with corn oil placebo. In contrast, REDUCE-IT demonstrated improved cardiovascular outcomes with 4 g/d of icosapent ethyl, a highly purified ethyl ester of eicosapentaenoic acid, compared with a pharmaceutical-grade mineral oil placebo. Similarly, the randomized JELIS trial demonstrated a statistically significant decrease in major adverse coronary events with an even lower dose of icosapent ethyl, 1...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids Effect on Major Cardiovascular Events in Patients at High Cardiovascular Risk
To the Editor I am concerned that the STRENGTH trial did not have adequate treatment adherence, as evidenced by plasma EPA and DHA levels that increased by 269% and 40%, respectively, after treatment with omega-3 fatty acids for 12 months. This increase was lower than expected because the authors had previously shown that treatment with the same omega-3 formulation at the same dose for 3 months increased plasma EPA and DHA by 406% and 72%, respectively. Another report demonstrated that treatment with a similar omega-3 formulation at the same dose for 2 months increased EPA and DHA by 402% and 86%, respectively. In addition...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Whistleblowing and Misconduct at Large Pharmaceutical Firms
To the Editor In their recent Research Letter, Dr Arnold and colleagues presented profiles of illegal activities and penalties paid by pharmaceutical firms in the US from 2003 to 2016. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Trends in Age at Natural Menopause and Reproductive Life Span Among US Women, 1959-2018
This national survey study uses the National Health and Nutrition Examination Survey (NHANES) to describe trends in age at natural menopause, age at menarche, and reproductive life span, and variables associated with shorter and longer spans, among US women between 1959-1962 and 2015-2018. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

The Medical Profession and the Public
William J. Mayo, M.D., Rochester, Minn. (Source: JAMA)
Source: JAMA - April 6, 2021 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 - April 6, 2021 Category: General Medicine Source Type: research

Thermal Imaging Systems May Pose Public Health Risks
Thermal imaging systems used to measure human body temperature in airports, workplaces, and other venues where COVID-19 may spread aren ’t accurate if used improperly and shouldn’t be considered a tool to diagnose the disease, according to an FDA safety communication. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research