Observational studies have found an association between breastfeeding
and reduced risk of infection, associated infant mortality, and atopic disease
in infancy and childhood, but the relationship between breastfeeding and infant
health has not been studied in randomized trials. Kramer and colleaguesArticle randomly
assigned 32 maternity hospitals and their associated polyclinics in the Republic
of Belarus to receive an experimental breastfeeding promotion intervention
or a control intervention of usual infant feeding practices and policies.
The intervention group of 8865 mother-infant pairs had significantly higher
rates of continued breastfeeding throughout the 1-year follow-up compared
with the 8181 mother-infant pairs in the control group. Risk of gastrointestinal
infection and atopic eczema were reduced in the intervention group, but there
was no significant reduction in respiratory tract infection. In an editorial,
LawrenceArticle stresses the important research opportunities provided by continued
follow-up of these large randomized cohorts of children for the study of long-term
outcomes of breastfeeding.
In 1996, the province of Quebec legislated mandatory drug insurance
for all residents and instituted a deductible and 25% coinsurance charge for
prescription drugs for elderly persons and welfare recipients who had previously
received free medication. Tamblyn and colleagues report that the use of essential
medications decreased by 9.12% among elderly persons and by 14.42% among welfare
recipients after cost-sharing was introduced. Rates of serious adverse events
and of emergency department visits related to reductions in the use of essential
Previous trials have shown that statin treatment initiated 3 to 6 months
after acute myocardial infarction (MI) reduces mortality in patients with
elevated cholesterol levels. Stenestrand and Wallentin used data from the
Swedish Registry of Cardiac Intensive Care on patients with a first registry-recorded
acute MI hospitalized in 1995-1998 to evaluate the benefit of beginning statin
treatment before or at hospital discharge. Early initiation of statin treatment
among hospital survivors of acute MI was associated with a significant reduction
in mortality during the following year.
Ioannidis and LauArticle evaluated the quality and quantity of drug safety
reporting in 192 randomized drug trials in 7 different areas of drug therapy.
Severity of clinical adverse events was adequately defined in only 75 (39%)
of the trials, and laboratory-determined toxicity was adequately reported
in only 56 (29%) of the trials. Only 88 (46%) of trials presented the frequency
of specific reasons for discontinuation of study treatment due to toxicity.
In a related study of trials comparing the method of administration of thrombolytic
agents for acute myocardial infarction, Eikelboom and colleaguesArticle found that
meta-analysis of small phase 2 trials showed a lower risk of intracranial
hemorrhage with bolus injection compared with standard infusion therapy, but
meta-analysis of large phase 3 trials indicated the opposite, even though
efficacy outcomes were similar.
Over 3 years, Ms G was hospitalized twice for manic episodes and experienced
a major depression after her second hospitalization. She is currently being
treated with divalproex and bupropion hydrochloride. Sachs discusses diagnostic
criteria for bipolar disorder, prevalence and course, and treatment.
"This is the only time I intend to go through this with my husband,
and I want to be there for him." From "From the Foot of the Gurney."
Pharmacology and clinical applications of β-lactam antibiotic and β-lactamase
The discovery of the first human cases of bovine spongiform encephalopathy
in Spain and Germany, along with continued spread of the disease throughout
Europe, has led to new calls for surveillance and testing of beef cattle.
Evaluation of the New York City Department of Health risk assessment
questionnaire used to assess the need for tuberculin skin testing in children
indicates that it is a valid instrument with a high sensitivity (85.2%) and
negative predictive value (99.8%).
Original research and comprehensive reviews are invited for the annual JAMA
medical education issue scheduled for September 2001.
For your patients: Information about breastfeeding.
This Week in JAMA. JAMA. 2001;285(4):371. doi:10.1001/jama.285.4.371