Jama

Articoli pubblicati su jama

1. JAMA

2. Audio Highlights March 22-28, 2025

   Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.

3. HPV Vaccine Cuts Cervical Precancer Incidence, but Rural Access Gaps Remain

   A new report indicates that the human papillomavirus (HPV) vaccine is preventing cervical cancer in young women.

4. US Hospital Bed Shortage Looms as Occupancy Rates Climb

   Hospital occupancy in the US averaged about 75% during a 1-year period between 2023 and 2024, up from the average 64% capacity in the decade before the COVID-19 pandemic. If the hospitalization rate and bed supply don’t change, the US could face a critical hospital bed shortage by 2032, a recent study found.

5. Expert Panel Advises Against Common Spine Treatments for Chronic Back Pain

   Chronic back pain is the leading cause of disability worldwide, affecting 1 in 5 adults aged 20 to 59 years. But an analysis of randomized trials and observational studies led a panel of experts to strongly advise against the spine interventions commonly used for chronic axial and radicular back pain in a new clinical guideline. The panel found that the treatments offered little or no relief compared with placebos.

6. Should Race Continue to be Factored Into Birth Defect Screenings?

   This Medical News article is an interview with Daniel S. Herman, MD, PhD, about his recent research on including race and ethnicity as a factor in prenatal screening for open neural tube defects.

7. What to Know About the Updated Acute Coronary Syndromes Guideline

   This Medical News article discusses new recommendations from the American College of Cardiology and the American Heart Association for managing patients for a year and beyond after they’ve experienced a heart attack or unstable angina.

8. Data Errors

   The Original Investigation titled “Neurodevelopmental Outcomes After Late Preterm Antenatal Corticosteroids: the ALPS Follow-Up Study,” published in the May 21, 2024, issue of JAMA, included errors for the Social Responsiveness Scale t scores that were greater than 65, reported in Tables 2 and 3 and in eTable 4 of Supplement 3. This article was corrected online.

9. The Immoderate Publicity of Science

   In recent years, many of the sciences have found it increasingly easy to demonstrate how indispensable they are to modern life. This has been conspicuously true since the World War, during which science in the broadest sense made itself felt as a constructive factor in the solution of innumerable problems. This period of stress presented many serious difficulties that needed to be overcome promptly. The physicists and chemists, in particular, bent their energies to the task, with results that brought widespread acclaim. In the works of either construction or destruction, chemistry and physics contributed in many new and unanticipated ways. Necessity became the mother of invention in the scientific laboratories. The latter deserve much, and they have been justly lauded. One hears on many sides that “science has come into its own” in the last decade.

10. Zerlasiran for the Treatment of Atherosclerotic Cardiovascular Disease

    To the Editor A recent article reported that zerlasiran was well tolerated, with a time-averaged percent change in lipoprotein(a) concentration of more than 80% from baseline to 36 weeks in patients with atherosclerotic cardiovascular disease. However, we have some concerns about this study.

11. Gap Years

    To the Editor The rise in prevalence of gap years among applicants prior to medical school, as described in the Viewpoint by Dr Schwartzstein and Mr Marzouk, not only presents a trend but rather an evolution in how we, as future physicians, strive to meet the demands of an increasingly competitive application process to medical school. While we do not deny that the gap-year system may be flawed and possibly exacerbate inequities, for many students, especially collegiate athletes, it provides a unique opportunity. If taking 15 to 18 credit hours per semester was not enough, as athletes, we dedicated more than 40 hours per week to our respective sports, including meetings, practice, weight lifting, and treatment and recovery from injury. As former collegiate athletes, we utilized gap years as opportunities to strengthen our résumés, which, as a consequence of the time devoted to athletics, often lacked experiences in research and clinical work and were blemished by some grades or Medical College Admission Test scores. While many athletic programs attempt to mitigate the athletic and academic workload by providing tutors and academic advisers along with other resources, the difficulty of obtaining acceptance into medical school is at an all-time high. Competitive applications require more than just good grades and communication of the demands of a “full-time job” (our sport), which is sometimes perceived less favorably when compared with more traditional premedical activities.

12. Zerlasiran for the Treatment of Atherosclerotic Cardiovascular Disease—Reply

    In Reply Ms Wu and colleagues raise the concern that use of PCSK9 inhibitors may have resulted in underestimation of the lipid-lowering effect of zerlasiran in our trial. We think this is highly unlikely. Although PCSK9 inhibitors slightly reduce lipoprotein(a), the trial protocol (posted with the article), required trial participants receiving lipid-modifying therapy at trial entry (including statins, PCSK9 inhibitors, and ezetimibe) to be taking a stable, maximum-tolerated regimen for a minimum of 8 weeks with no changes to existing regimens, and introduction of new lipid-modifying regimens was not permitted after screening. For monoclonal antibody PCSK9 inhibitors, a stable dose was defined as at least 4 doses at a consistent dose level. Given the requirement for stable background lipid-lowering therapies, the effects of zerlasiran on lipoprotein(a) reduction was not likely influenced by use of PCSK9 inhibitors.

13. Gap Years—Reply

    In Reply We appreciate the perspective of the Letter focusing on gap years for college athletes and acknowledge the challenges of training as a member of a varsity team while maintaining one’s commitment to a rigorous premedical course load. The notion, however, that this group is an exception to the warnings we posted about pursuing gap years fails to acknowledge a robust literature on the favorable views of medical school admission committees for this applicant group.

14. Patient Information: Ovarian Aging and Fertility

    This JAMA Patient Page describes ovarian aging, its effect on fertility, and strategies to address infertility due to ovarian aging.

15. The Last Conversation

    In this narrative medicine essay, an emergency physician who knows well the look of coming death reflects on his communication regrets in the final days and hours of his father’s life.

16. Error in Table

    The Original Investigation titled “Tirzepatide vs Insulin Lispro Added to Basal Insulin in Type 2 Diabetes: The SURPASS-6 Randomized Clinical Trial,” published online October 3, 2023, was corrected to fix an error in Table 3 in which a row was erroneously labeled as adverse events leading to “study treatment discontinuation” rather than “study discontinuation.” This article was corrected online.

17. Artemisinin Partial Resistance in Ugandan Children

    To the Editor The article by Dr Henrici and colleagues notes an urgent problem of artemisinin combination therapies that induced artemisinin partial resistance in 110 Ugandan children. Resistance was promoted by Pfkelch13 gene variations in Plasmodium falciparum. Even before the 2015 Nobel Prize for artemisinin’s discovery and isolation from the plant Artemisia annua, reports of resistance arose in Cambodia and Thailand. It was inevitable that resistance to a single compound would develop in a highly mutable parasite. Centuries before artemisinin’s discovery, the A annua plant itself was used as a therapy and may constitute a natural combination therapy more robust than monotherapy or artemisinin combination therapies against the inexorable evolutionary pressure toward drug resistance.

18. Artemisinin Partial Resistance in Ugandan Children—Reply

    In Reply We read with interest the Letter from Dr Weathers and colleagues in response to our recent Research Letter in JAMA. The possibility of using whole-plant preparations of Artemisia species is worth pursuing if such use holds promise as a cost-effective and potent antimalarial chemotherapy strategy. It is plausible that additional Artemisia phytochemicals not present in purified artemisinin preparations can synergize with the endoperoxides to enhance antimalarial benefits. The evidence from these authors that such preparations slow the evolution of reduced susceptibility to artemisinin in the rodent malaria Plasmodium yoelii is also intriguing. However, drug selection of P yoelii with artemisinins often produces phenotypes that are not readily heritable and have no well-established genetic basis. Therefore, this model does not suffice as a source of insights into reduced artemisinin susceptibility of P falciparum in humans.

19. The Roses

    We walk past the old, slump block house, & I can’t help but glance at the blinds, drawn down like surrendering eyelids. The front yard has a small, white statue of Mary Magdalene with her palms turned up in what could either be a gesture of welcome or a sign of dismay. Once, as part of a home health care company, I was inside, speaking with a woman who thought I was her grandson. I corrected her the first time, but afterwards, I went along with the story. It was easier. My job was to get her up & walk with her around the home, where residents gazed with peach-pit eyes at the television & waited for a savior to come. We walked on a thin, cement path that lined the backyard, between geraniums arranging their lipstick toward the light. We came to know each other. I learned that she grew up in a small farming town not far from my real grandmother, which explained her familiar tenderness & prolonged drawl. After several days of this, she asked if I would go to her house & check on the roses, like her husband & son had done before they died, tragically, in the same 12 months. I don’t know why, but I did. It was summer, & roses are not a hardy plant. The raised bed held nothing but a crisp, brown carcass. Rather than lie, I bought a 3-gallon rose plant at the nursery & returned with a shovel. That way, I could say Don’t worry, as she breathed more heavily, as the day came she could not leave her bed, they are doing alright. It was true— I’d managed to fix her irrigation, & I shouldn’t have expected, I guess, more than one miracle. So when she died two weeks later, her room a blank slate, all I could think about— & all I can see for a block after passing that house— was that she’d never said goodbye to her grandson & the deep, deep red of those roses.

20. The Rose as a Symbol of Love and Healing in Poetry and Medicine

    Floriography, the study of the symbolic meaning of flowers historically and across cultures, reveals that flowers are a universal symbol of love and healing. Perhaps unsurprisingly, recent scientific studies confirm that hospitalized patients given flowers or plants experience measurable health benefits. In poetry, the rose especially is a recurring symbol of love, featuring prominently in the canonical work of the likes of Sappho, Shakespeare, and Stein. In “The Roses,” we both admire this floral symbol and witness its healing properties. The speaker, at first impersonally “part of a home health care company,” provides rehabilitative services to an older woman in a nursing facility who reminds him of his grandmother. Vivid details soon evoke a more caring relationship that extends beyond rehabilitation—the patient confuses him with her grandson, while he finds in her his own grandmother’s “familiar tenderness & prolonged drawl.” His growing compassion is then expressed in tending to her roses at home, which she anxiously asks him to check on. When he discovers them dead, the speaker replaces them with new plants and, just as he cares for her, ensures they are properly tended: “That way,/I could say…as the day came she could not leave her bed,/they are doing alright.” When she finally dies, his grief overflows, as “all I could think about—/& all I can see for a block after passing that house—/was…the deep, deep red of those roses.” Thus, the thriving roses symbolize not just enduring love, but healing.