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This Week in JAMA
April 14, 2010

This Week in JAMA

JAMA. 2010;303(14):1339. doi:10.1001/jama.2010.422

Congenital cytomegalovirus (CMV) infection is an important cause of hearing loss in children. However, the majority of infants with congenital CMV infection have no detectable abnormalities at birth, and a reliable method to screen newborns for congenital CMV infection is needed. To assess one possible approach to newborn CMV screening, Boppana and colleagues Article examined the diagnostic accuracy of real-time polymerase chain reaction (PCR) assays of dried blood spots (routinely collected for newborn metabolic screening). The authors found that the PCR assays had low sensitivity and missed approximately two-thirds of the congenital CMV infections. In an editorial, Bale Article discusses challenges confronting universal screening for congenital CMV infection.

Chen and colleagues analyzed serological samples collected before, during, and after a single epidemic wave of 2009 influenza A(H1N1) in Singapore from several distinct cohorts of adults and found that 13% of adults in the general population (community) cohort seroconverted compared with 29% of a military personnel cohort and 7% of staff from 1 acute care hospital. The authors report factors associated with seroconversion in the different populations examined.

Smolderen and colleagues analyzed data from a multicenter, prospective registry of patients with acute myocardial infarction (MI) to examine the association between patients' lack of health insurance or the presence of financial concerns about accessing care among insured patients and the time from symptom onset to hospital presentation during acute MI. In analyses that controlled for sociodemographic and clinical factors, both lack of health insurance and concerns about costs among patients with insurance were associated with delays in seeking emergency care for acute MI.

A published meta-analysis of data from placebo-controlled trials of 11 anticonvulsant drugs identified an increased risk of suicidal behavior or suicidal ideation among patients taking anticonvulsant medications; however, the risk associated with individual anticonvulsants could not be determined. In this issue, Patorno and colleagues report results of an exploratory analysis of prescription and clinical claims data from health plans in 14 states that assessed the risk of suicide, attempted suicide, or violent death associated with individual anticonvulsants. The authors found that compared with topiramate, use of gabapentin, lamotrigine, oxcarbazepine, and tiagabine may be associated with an increased risk of suicidal acts and combined suicidal acts or violent death.

In a meta-analysis of data from 27 randomized trials that evaluated the effects of noninsulin antidiabetic drugs added to metformin therapy in patients with type 2 diabetes not controlled by metformin alone, Phung and colleagues found that the different classes of noninsulin antidiabetic drugs were associated with similar hemoglobin A1c reductions but varied in their effects on weight gain and risk of hypoglycemia.

“If he had been blessed with the privileges that I have, or if I had been born to his social circumstances, would our seats in the courtroom have been reversed?” From “Letter to a Father in Jail.”

The US Food and Drug Administration is calling for more limited use of long-acting β-agonists to reduce rare but serious adverse events associated with the drugs.

Regulation and education to reduce distracted driving

Stem cell transplantation: increasing the donor pool

Management of HIV among substance users

Join Mary E. Tinetti, MD, Wednesday, April 21, from 2 to 3 PM eastern time to discuss the evaluation of and treatment for patients who fall. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about cytomegalovirus.

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