Highlights

Selenium and preterm birth

Low selenium status in early pregnancy is associated with preterm birth. This is the finding of a cohort study of 1197 women that measured serum concentrations of selenium at 12 weeks’ gestation and followed the women through to the end of their pregnancies. Further research is needed to clarify the mechanism of this association, as there may be implications for the prevention and treatment of preterm birth, say Rayman and colleagues. See Research, page 549

Free journals may be biased

Articles in free medical journals paid for by advertising are more likely to recommend the use of a drug, whereas articles in subscription medical journals are more likely to be critical of those same drugs. Becker and colleagues examined the editorial content of a whole year of 11 German medical journals comparing recommendations made and pharmaceutical advertising placed in those journals. Physicians should be made aware of this potential bias in the material they are reading, say the authors. See Research, page 544

Biased reviews of drugs and the advertising published in free medical journals may lead to overuse of inappropriate off-label use of drugs, cautions Kesselheim. See Commentary, page 534

Patients with COPD at risk for zoster

Patients with chronic obstructive pulmonary disease (COPD) are more likely than those without to experience herpes zoster, and the likelihood is greater among those using oral steroids. Yang and colleagues used a national health insurance database to match more than 8000 people who had COPD to 34 000 control patients, examining up to 10 years of records for new diagnoses of herpes zoster as well as comorbid conditions. The authors suggest that people with COPD should be considered for preventive methods such as the new zoster vaccination. See Research, page E275

Medical evacuation for Iraq and Afghanistan

The most frequent reasons for medical evacuation of nonmilitary personnel from US operations in Iraq and Afghanistan related to general health conditions, with war-related injuries accounting for about one-quarter of the cases. The reasons for evacuation were similar for military personnel for the most part. Cohen and colleagues collected data on diagnoses and return-to-duty rates for nonmilitary personnel and compared them with published data for military personnel. Because nonmilitary personnel are expected to play an increasing role in future deployments, recognizing patterns of illness and injury may be useful for planning preventive and treatment strategies, say the authors. See Research, page E289

Insulin resistance

Insulin resistance plays a central role in the pathogenesis of type 2 diabetes and greatly increases a patient’s risk for numerous metabolic abnormalities and adverse clinical outcomes. Reaven explains why the roles of insulin resistance and hyperinsulinemia in disease can only continue to expand. See Commentary, page 536

Empathic responses in clinical practice

Many physicians find it difficult to respond to the emotions their patients express, report Buckman and colleagues. Yet an empathic response can improve patient satisfaction and adherence to treatment as well as result in fewer malpractice complaints. There is abundant evidence that empathic communication is a skill that can be taught, but there is insufficient emphasis and time devoted to it during medical school, postgraduate training and continuing medical education. See Analysis, page 569

NSAIDs-induced enteropathy

Up to 70% of people taking nonsteroidal anti-inflammatory drugs (NSAIDs) may have asymptomatic enteropathy of the small bowel, Are and colleagues warn. Mucosal ulcers, tears or diaphragm-like strictures will develop in some patients, resulting in anemia, abdominal pain or bowel obstruction. The mainstay of treatment is to stop NSAID use. See Practice, page 577