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In This Issue of JAMA Internal Medicine |

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JAMA Intern Med. 2016;176(6):725-727. doi:10.1001/jamainternmed.2015.4882.
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In the CALERIE 2 randomized clinical trial, Martin and colleagues tested the effect of 2 years of calorie restriction (CR) on mood, quality of life (QOL), sleep, and sexual function in healthy nonobese adults. Healthy adult men and women with a body mass index (calculated as weight in kilograms divided by height in meters squared) between 22 and 28 were enrolled and assigned to 2 years of 25% CR or an ad libitum control group. Self-report questionnaires were used to measure mood, QOL, sleep, and sexual function at baseline, 12 months, and 24 months. The CR group and ad libitum control group both lost weight at month 24, but the CR participants reported reduced tension and improved mood, general health, sexual drive, and sleep. Also, greater weight loss among the CR participants was associated with improvements in health-related QOL.

In this randomized clinical trial of 599 normal-weight and overweight young adults, Wing and colleagues found that 2 self-regulation interventions were effective in reducing both mean weight gain and the incidence of obesity over an average of 3 years of follow-up. Participants were randomized to control, self-regulation plus small changes, or self-regulation plus large changes. Both interventions focused on frequent self-weighing to cue behavior changes. “Small changes” taught participants to reduce intake and increase activity, both by approximately 100 calories per day. “Large changes” focused on losing 2.3 to 4.5 kg initially to buffer against expected weight gain.

In the Nurses’ Health Study prospective cohort study, Li and colleagues evaluated associations between religious service attendance and mortality and found that attending religious services more than once a week was associated with 33% lower all-cause mortality, compared with women who had never attended religious services. Social support, depressive symptoms, smoking, and optimism mediated the relationship between attendance and mortality. Frequent religious service attendance was associated with significantly lower risk of all-cause cardiovascular and cancer mortality.

Rivera-Hernandez and colleagues compared the quality of care provided to Medicare Advantage (MA) enrollees in Puerto Rico and the United States among the following 3 groups: whites in the United States, Hispanics in the United States, and Hispanics in Puerto Rico. Modest differences in the quality of care between white and Hispanic MA enrollees in the United States were found, but quality of care for enrollees in Puerto Rico compared with their US counterparts was markedly worse. Hispanic MA enrollees in Puerto Rico received care of lower quality than Hispanics in the US for 15 of 17 measures. Major efforts are needed to improve quality of care within MA plans in Puerto Rico to a level equivalent to that in the United States.

Longtin and colleagues performed a single-center quasi-experimental study to investigate the effect of detecting and isolating Clostridium difficile carriers upon hospital admission on the incidence of healthcare-associated C difficile infection. Over a 15-month period, 7599 patients were screened, and 368 patients were identified as carriers. Using multiple statistical analyses, the intervention was shown to be associated with a significant decrease in the incidence of healthcare-associated C difficile infection compared with the preintervention period. Longtin and colleagues estimated that the intervention had prevented 62% of the expected cases and concluded that the intervention may help decrease the incidence of C difficile infection.

Knox and colleagues performed a cohort study in Northern Manhattan to address the question of environmental contamination within households as a risk factor for recurrent community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections. Eighty-two index patients with community-associated MRSA infection and 214 household members were enrolled and followed for 6 months. Most infections were due to the epidemic MRSA strain USA300. A significant minority of index patients reported a recurrent infection during follow-up. Participants with household environmental contamination had a higher rate of recurrent infection. Environmental decontamination should be considered as a strategy to prevent future MRSA infections, particularly among households where an infection has occurred.

In an analysis of 1.4 million participants in prospective studies from the United States and Europe, Moore and colleagues found that high levels of leisure-time physical activity were associated with a lower risk of 13 different types of cancer, with substantially lower risk for 7 types. The lower risk of cancer associated with physical activity was generally similar among the participants who were normal weight and overweight, smokers and nonsmokers, and in all other subgroups examined, supporting the broad generalizability of results. These findings extend our current evidence base beyond colon cancer, breast cancer, and endometrial cancers and support promoting physical activity as a key component of population-wide cancer prevention and control efforts.

Wong and colleagues found a short-term increased risk of neuropsychiatric events associated with current use of Helicobacter pylori therapy containing clarithromycin. The temporal increased risk is in full concordance with the treatment duration. Given the low absolute neuropsychiatric risk, an immediate change to prescribing practice based on the observed increase in neuropsychiatric events is not suggested, particularly in the absence of better treatment alternatives. Clinicians should be well informed of transient neuropsychiatric events associated with this treatment. Such events will usually resolve spontaneously after treatment cessation and psychiatric interventions can be avoided.





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