The first, targeting family behaviors to preventchildhood obesity.
Obesity often begins in childhood.
Bargaining and colleagues randomized 610 parent-childpairs from underserved communities and found that a 36 month intervention topromote healthy family behaviors have no effect on body mass index amongpreschool age children.
In the second related paper, responsive parenting andchildhood weight outcomes. Developmentally appropriate parenting can promotehealthy childhood outcomes.
In a trial that randomize 291 mother-infant pairs in asingle site, Pawling colleagues found that a responsive parenting interventioninitiated early in infancy resulted in a modest reduction in body mass index Zscores at age 3 years, but there was no significant difference in body massindex percentiles.
However, the results from some of the secondaryoutcomes were encouraging.
Of the 116 children in the responsive parenting group,13 or 11.2% were overweight versus 23 or 19.8% of the 116 children in thecontrol group.
The absolute difference was -8.6% and approachedstatistical significance.
In addition, 3 children or 2.6% in the responsiveparenting group of obese versus 9 children or 7.8% in the control group, andabsolute difference of -5.2% and again this approached statistical significance.
Accompanying these two papers is an editorial by JodySelke and myself, it's entitled preventing obesity in children: a glimmer ofhope.
In this editorial, we contrasted two different studiesand highlighted that if the results from the second trial which generally wassuccessful could be duplicated in a multisite clinical trial then it would beimportant given the overwhelming concern about obesity in infants, children,adolescents and adults to roll it out at the national level.
Onto the third original research report， genomic sequencing andnon-small cell lung cancer.
Testing non-small cell lung cancers for specificgenetic mutations can identify patients who are likely to benefit from targetedtreatments, but broad-based genomic sequencing has not been shown to improvepatient outcomes.
Presley and colleagues conducted a retrospectivecohort study of over 5600 patients with advanced non-small cell lung cancer andfound that broad-based genomic sequencing which was done on 875 patients wasnot associated was not associated with better survival.
Among the patient who received broad-based genomicsequencing, 4.5% receive routine EGFR ALK targeted treatment and 85.1% receiveno targeted treatment.
Using an instrumental variable analysis there was nosignificant association between broad-based genomic sequencing and 12 monthsmortality 41.1% for broad-based genomic sequencing versus 44.4% for routinetesting.
In a wide-ranging editorial, Fin Eissner suggestedthat a broad-based genomic sequencing is likely to be beneficial but only whenit leads to evidence-based targeted therapy.
Onto the clinical review and education section andthere are three papers, two from theUSpreventive services task force.
The first is the recommendation statement itself andit's entitled screening for atrial fibrillation with electrocardiography.
atrial fibrillation is a major risk factor forischemic stroke.
ThisUSpreventive services task force statement concludes that current evidence isinsufficient to assess the balance of benefits and harms of screening withelectrocardiography to identify patients with atrial fibrillation.
the related evidence report outcomes of screening foratrial fibrillation and a review of 17 studies with over 135,000 participants,Jonas and colleagues found that screening with electrocardiography has not beenshown to detect more cases of atrial fibrillation than screening with pulsepalpation nor has treatment of screen detected asymptomatic older adults thathas been shown to result in better health outcomes than treatment afterdetection by usual care.
In an editorial, Goldberger and Mitrani suggestedatrial myopathy may lead to cardioembolic stroke even in the absence of atrial fibrillation.
In addition they discussed the task forcerecommendation agreeing with the current high statement.
And the third article in the section, probiotics toprevent Clostridium difficile infection.
Antibiotic therapy can alter the colonic microbiotaand increase the risk of Clostridium difficile infections.
Probiotics live in microbio preparations that maydecrease this risk.
In this JAMA clinical evidence synopsis summarizing aCochrane review of 39 randomized clinical trial Goldenberg and colleaguesdiscuss the benefits of administering probiotics along with antibiotics andpatients at high risk of infection with Clostridium difficile.
And let's wrap it up with the viewpoints.
And there are four.
The first, type 2 myocardial infarction diagnosis ,prognosisand treatment;
The second, return of research results to studyparticipants, uncharted and untested;
The third, progress in prevention and treatment ofacute kidney injury, moving beyond kidney attack;
And the last, protecting NIH's integrity andtrustworthiness in public-private partnerships.